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(*! .rjl ::i- i'gji^if *^ ■"'i' '.■' tM ■ t ' i > i" 'I :J - ». -L dk^iiSOi^'.'' £ A IT !K' A 5» © d! £ A y 'V ^ ^ ROBB'S Family Physician: ?.RIXO A CONCISE AND COMPREHENSIVE TREATISE ON DISEASES. AS THEY OCCUR IN EVERYDAY LIFE. SHOWING EXri.AIMNd THE SYMPTOMS AND TREATMENl, AND DEMONSTRATING THE CURE OF '11 IK VARIOUS ILLS HUMANITY IS SUBJECT TO. BY J. V. BEAN, M. D., R. L. ROBB. M. D.. Allopathic. Homoeopathic. SARAH L. ROBB. U. D., Diseases of Women and Children. SOLD BY SUBSCRIPTION ONLY. JOHN S. BROWN, PAEIS, ONTARIO, CANADA. -1-7 -f Entered accoiding to Act of Coiigrss, In tho jeiir ISS . By R. J,. mulS. L. KOUB, In the ofllce of the Librarian oi CoiiKruss at Washington. AI,I, liKillTS RKSIillVED. I ll f^c 2-1 h* % 11—7 T. DEDICATED TO THE THINKING MASSES ■r. OF ALL ENGLISH-SFEAKING COUNTRIESt .:i u .■ '• :',' ': ('!' - I ' • "U,. ■ ■ 'I'/m:) i; , : ■;• >.!-S ,S-- A -I.; :ut-i^'' ii ^/^.<>:u,i:-.=/: ^:' •; .Mi •i ./ M AUTHORS' PREFACE TO 'M SEVENTH EDITION. When, a ferw months ago, we saw this fruit of our labors issue from the press, we thought " Now all the long years of labor, study, care, and anxiety bestowed upon its preparation are ended ; " but already our publishers ask of us a pi'eface to the SkvKiNTii Edition. We take this opportunity to express our thanks for the very kind and unusually grateful manner in which the work has been received by the people, press, and medical profession. In token of our thanks we have subjected every page to a careful revision, adding to every part matter likely to enhance its value. The arrangement of the typi is more condensed and the book enlargeid, so that there ai)- p*ars'i4 this ^edition miny pages of new matter in addition to what the first contained. E^ery article has been carefully compared and made to contain the very best of the thoughts, researches and treat- ment appearing in the medical literature of the old and new schools. Thus we have aimed, up to the hour of going to press, to make this the most complete Hand-Book on Domf:stic Medicine ever issued from -any press. While we thus prepared a work for the people, we have b4en both surprised and pleased to learn that it has been adopted by hundreds of physicians as a daily companion in their professional labors, placing upon us a responsibility we had never intended to assume. Realizing the extent of this added field, we have endeavored* to make this edition more worthy of the liberal patronage and generous praise the first editions received. . While it has been our aim to produce a book giving in plain lan- guage the "seed thoughts" of our best American and English physi- cians, we are not unaware that such is the wid*! range of our subjects, and such the abundance of the material, that a collection of this kind, large as it is, must be like a bouquet picked from the fields in June, when hundreds of flowers will be left in unvisited spots, as beautiful as those which have been taken. THE AUTHORS Chicago, III , (4) I Ij" 1 ■ s' ■-■ •>..•.-' ;■> ^■' ffih':-' ■ ■: .. A ; •. , ..!•.!, r ,11. 1,1-1 it • J.] i PUBLISHER'S PREFACE TO THE FIRST EDITION. I '■ ! >■..• '»-'.'•• r / '. ..If • ' 5. ....ti,..H'.i In presenting this work, the publishers talte a special pride,, believing it is a book which will be the means of saving many valuable lives, and a vast amount of needless suffering from disease. There has never been published any work on domestic medicine which aimed to put in the hands of the people the vast amount of information as to disease, its causes, the circumstances modifying it, its course, its careftd and systematic treatment, and all the signs of the pulse, toni)ue, breath* inif, digestive organs, evacuations, appetite, thirst, position, tntntal state, eyes, ears, nose, etc., and the indications of those signs, as used by physi" cians, in determining the nature of tlie disease and its probable termina- tion ; all this has been kept back from the masses, by physicians, as their individual jtock in trade; here it is all shown in phiin language. While the authors do not claim this as a purely original work with them,, we claim that they have brought together in this compact form, the^em* of us^ul infoi'mation gleaned from the whole field of medical art ard literar ture, and adapted in language to the comprehension of th. common reader who is entirely unversed in the technical language of medical science. ' While it has been necessary to use a vet'ijfew of those medical wprdsi whenever they do appear, there and then appear their meaning, enclosed in parenthesis. Efforts have been heretofore made to produce a, book giving the treatment of a few diseases, with their Allopathic and Homoj- opathic treatment, but 6o</i treatments written up 6y the Aa/nc author; and, in the nature of the human mind, there would be some bias in favor of one or the other of the leading schools of medicine; and the treatment of the school of their choice would be fair, while that of the opposite would be more or less incomplete or unfair. ; Here we offer a work complete— covering the whole field of theoai of medicine, ,,i , i„. . . ., .^f, , The treatment includes only those remedies which have been proven by personal observations to be truly reliable, and are accompanied by practically verified curative ipdications in every case. The Allopathic Treatment, by Du. J. V. Bean, must satisfy the friends of that school of medicine. As a staunch, rock-rooted, educated and experienced physician of that school, he stands in the front rank of his profession. While his education gives him command of the whole field of his art, his experience enables him to select his reniedies fropi. the v«ry best, and present them to his readers in the manner they can most 6 PREFACE. I safely use, and receive the most benefit from them. His language is plain, forcible, to the point, and very easily understood. The HoMCEOPATmu Treatment, following each separate disease, is clear, concise, careful, full, and entirely reliable. The •* Repertory " is one of the many valuable features of this work. By its help the remedy may be surely selected that will most certainly remove any disease, or symptom of disea % that can be cured at all. The HvDROPATHic treatment is recommended by all the authors whenever it may accomplish, or aid in accomplishing, the desired end. ' Dr. S. Lucretia Robb has added much valuable information on the treatment of the diseases of women and children, suggested by, and proven to be good, during years of experience. Being a thoroughly edu- cated physician, and herself a mother, she has been able to write upon the subjects connected with diseases peculiar ioher sex fully, knowing, from personal experience and a large practice, just what would be most useful to mothers and daughters, in trying to understand and treat themselves, in all those cases in which a lady's natural and proper deli- cacy prevents her from going to a physician and telling him just what is the matter. Many and many a young lady, or young mother, has lost her life, for the reason that she could not bring herself to the determination to tell all to her physician. Mrs. Robb here removes that necessity, and we must say, she has done it successfully. Her work is a model of clear- ness in expression, and completeness in covering all this most delicate subject. This, alone, is worth many times the price of the complete work to any family. The Home Remedies.— A great many times, in cases of extreme emergency, there is some simple remedy in the house, which, if known, could be used, and thereby ctire, or at leaHt relieve, until something more could be done in the way of selecting a l)etter remedy, or procuring the aid of a physician. These home remedies are pointed out and are always »afe and at hand. The IKDXX is very complete. If you have any name for your disease, you will find that in the index, and from the index will be guided fo the description and treatment you are in search of. While we do not expect or desire this work to entirely do away with the good, faithful physician, we do expect to make a very great reduction in the number of his professional visits and office prescriptions to every one of our subscribers. And we do hope and desire to assist in educating the massesof the people in the art c f medicine, until it will be altogether impossible for any of those designing or ignorant pretenders, now living off the ignorance of the people on this subject, to so live at all. We aim to encourage every competent and educated physician, and by helping our subscribers to know the true and good from the false, we know we are surely gaining that end ; and while greatly reducing the amount of his bill to any one family where our work enters, we increase greatly the number of families he will be called upon to treat. With the strong conviction that we are offering a work of no ordinary merit, we present this to a discerning and appreciative public, believing th«y will, on examination, fully confirm our convletions. THE PUBLISHERS. ,• - m: •yt (7) ittM 'r .••Hi '-■*'• AUTHORS' PREFACE. "V. In undertaking a work of this character, it is but natural to feel the great weight of the i esj onsibility assumed. Taking the holding of the health and life of tl ousands upon thousands of fellow human beings, with all that life and 'lealth contains of usefulness, happiness, love and power, to individuals, milies, communities, states and nations, upon ourselves, we cannot avoid a feeling of solemn responsibility. A desire and deliberate determination takes possession of our minds to write nothing without careftU consideration— to liold nothing back from the people, that can give them a better understanding of themselves and their diseases. In this work, we have endeavored to bring together in a compact form, all the information necessary to give the reader (without any ref- erence to other books,) all the information needed to fully understand the cause, nature, course and treatment of any disease they may feel called upon to treat, or may in any way come in contact with. Following the description of the peculiarities of each disease, we have arranged a care- fully prepared treatment. Those who prefer to employ the Hydro- pathic, or water treatment, will find a chapter giving full directions for the preparing and using the different baths ; and, in the treatment of separate diseases, you will And full and frequent directions for their use. We have omitted all treatment and reference to diseases of the sexual organs of a venereal nature. It is felt that their introduction into any work, save one intended strictly for physicians, is highly improper. They are of so grave a character, and so long-lasting and often terrible in their effects upon the organism, as to demand the highest professional skill in their treatment. t We have included articles on the treatment of numerous complaints not heretofore included in any work on domestic medicine— especially of those wliich are peculiarly prevalent in certain climates— such as Tropical Diseases, etc.; directions for the discrimination between what is really a symptom of disease, and what is not, etc. The public is entitled to an explanation of the more cogent reasons we have for such a course, and for so enlarging the work over others heretofore offered to the public. f ; « authors' preface. 9 First of all, the common sense of every reader will admit, that we should write for the man>/, and not for individual cases— that we should attempt to embrace all contingencies os much as possible, and not con- fine ourselves to merely local circumstances ; and that it does not, there- fore, follow that persons whose situation and the like render any of these details unnecessary to tJietn., should be compelled to adojjt our suggestions, simply because we have published them ; whereas, it does necessarily follow, that those who are beyond the reach of any other resource— eitJiet by reason of distance or want of means— m\xs,t t^^oZZ^ depend, either upon their own unaided judgment, or upon the directions afforded in works of this kind. Suppose, for instance, a family resident in the center of a higlily cultivated country; that family is not, therefore, within easy and imme- diate reach of the best professional advice, in which case, it is best that a work like this sivould be in the house to represent the physician, in so far as that is possible. And suppose another, and a very common case, as of the emigrant to distant states and territories ; to sparsely inhabited or desolate regions ; from whence, we would ask, are these to obtain the professional advice which would be so essential to them, unless it be from such directions as we are able to afford them in a work of this kind? In this case, it must be admitted on all hands, that the work does good in comparison to its extent, amplitude, enlargement and comprehensiveness. Wherefore, then, should these essential conditions be withheld? Again, these are not all the questions involved ; there are yet more vital points relating to the m;7"a^io?is which may become necessary in the actual treatment of disease when once undertaken. In these cases, it is sufficiently obvious that those who prefer to exclude professional advice, should be so far removed from the chattce of error as possible, which cannot be done without ample detail, because disease has scarcely ever, in two distinct cases, the same positive and exact characteristics. It is for this reason, also, that we have entered so largely into the consideration of the " Investigation of the Patient," and of "Disease." We are convinced that the (/reaf fault of domestic works in general is, that they do not give enough information, and, consequently, that they often mislead, instead of enlightening, the reader. ,''*■ It is, also, for these reasons, as well as for those already given, that we object to the extreme condensation of a domestic work, or to the lim- itation of its sphere to a particular class of diseases, and that we consider works founded upon this affected idea practically useless. AVe nowhere enjoin a person who has means and immediate access to edwated and reliable professional advice, to undertake the treatment of da: 3us diseases without it. We endeavor to provide for those who do noi possess these advantages. Upon such grounds as these, we trust this work to the verdict of a liberal and discriminating people. We anticipate a hearty welcome to our evident endeavor, even if tl product of our labor should fall short of Ita earnest purpose. ,,,,,, ^j,.;^.., ;,., ,,,^,, ^ , ,:,„.. ., , , I I ''} LETTER TO MOTHERS. ^W^S^N^^^>M Dear Mothers: ; ,.. , I really wish it could be my privilege to meet each one of you face to face, who may read that part of this work intended more particularly for you. In a brief manner I have endeavored to treat, with as much simplic- ity as possible, the more common disorders of women and children. You know how much and how often we, as females, suffer from dis- eases peculiar to our sex. First, On account of the dread we have of going to a man and telling him plainly just what is the matter with us, (if we kiiow)— which is unfortunately not always the case. Second, From the inability of the average physician to understand our mental and physical diseases, on account of not knowing " how it is" himself. Third, From the harsh and often outrageous treatment we are subjected to by his harsh injections, burning with caustics, and deluging our systems with powerful drugs, which you and I know to be not only needless, but decidedly liarui- ful. In this work, I believe you will find the needed information to ena- ble you to understand and treat all our ailments in a manner that is not only rational but really curative. And in the treatment of your daughters you will find what you long have needed— reliable help. I have long felt a deep interest in my own sex and have often felt the desire to warn mothers, more particularly in regard to daughters, as they attain the age of puberty ; tell them what they may expect in the way of " msiithly changes." Who can guide girls at such an age as well as a mother? Experience has shown how many women there are, whose happy girlhood days were blighted, with health, beauty, merriment, yes, and virtue too, gone forever, all through ignorance of themselves. It is false delicacy that would hide from girls that whicli, by all means it belongs to them to know. Mothers, teachers, it is with you this respon- sibility rests. The thousands of wretched wives who are thus sulTering from a neglect of proper instruction at tliis turning point of their Uvea, warn you bow serious this responsibility is. :« < : « .- Every mother should carefully study all that is said in regard to in- fants in this work. There is a frightful waste of life caused from ignor- ance and neglect. Hence the need that mothers should understand and practice the means best adapted to preserve the health of their frail charges; and the importance of timely corrective measures in infantile affections. One of the fertile causes of disease and death in early life, is to be found in the ignorance displayed in regard to the dress of children. And it ii> not the poorly attired, but in many cases, the fashionably robed child which suffers the most. To parental vanity can be traced many of the causes which have resulted in death. SARAH L. ROBB. 10 ■*s« INTRODUCTION. It Is my purpose, In writing a description of the treatment of disease for popular use, to represent as fairly and plainly as I can, the principles and practice of the reoulau allopathic profession or school ok MEDICINE, in a manner which can be comprehended by all. It Is not my intention to present an exhaustive treatise upon the practice of med^ icine In all its departments. It is a matter of great Importance how far it is proper to interfere in the management of diseases. Obvious is the fact, that in the great ma< jority of cases, diseases will, without special treatment, end in recovery. It is not to be supposed, therefore, that every Instance of recovery is a cure. The prevalence of quackery depetids largely upon the popular error, that the favorable termination of disease is always owing to the means employed. The greater the enlightenment of the public upon this subject, the less frequent will be imposition in medicine. The fact is, that disease, as a rule, tends to recovery and not to death, by the powers of nature alone. In all such diseases, the true course of treatment is indicated by a study of the way in which nature effects her cure, and in following that course. Much harm is often done by the unnecessary em- ployment of medicines. It is, therefore, a rule which should never be violated, that active treatment should not be employed, except in cases where it is certain to do good. It should not be Inferred that proper treatment is uselesij. On the contrary, even in cases which would end favorably, if trusted to nature alone, much good may be done by shortening the duration of the disease, relieving the sufferings of the sick, and in preventing unpleasant and even dangerous consequence. In other instances, proper treatment is the means of saving life. The successful application of remedies, and the power of choosing between those of less or greater enerj" depend upon experience and observation (or knowledge) not only, but u logical mind, Judgment, common sense, and tact. The General Rules for Treatment of the sick may be sum- marized as follows : 1. The removal of the cause upon which the disease depends, ia among the most important. In many instances this suffices. For exam- ple, nervous headaches may depend upon the continual use of coffee; dys- pepsia upon improper food and insufficient exercise in the open air ; colic upon irritating matters in the bowels, etc., etc. Causes are also sure to Interfere with a cure, as cholera infantum and the summer diarrhoea 11 f ,1 12 INTRODUCTION. often resist treatment until the patient Is removed from the air of a large city to the country. In other cases, the cause once operating ends Its influence and adds nothing thereafter to the violence of the disease; as In most of the contagious diseases. In other Instances, the cause generally ceases when it has produced Its effect, us Is often the case In inflammation resulting from cold. Attention to the cause is important in the treat- ment, as far as it leads to a correct estimate of tlie nature of the disease. In endeavoring to remove the cause of disease, the attention must be directed to those within the system, as well as to the external agents One disease action is frequently the result of another, so that by removing the cause of the flrst, the latter trouble is cured 2. y/te exact seat of the disease should be ascertained, and, as "the life is In the blood," it should be determined whether or not this is in the blood, and if so, its condition should be corrected and improved. Many cases are known to have continued for weeks and months, obstinately resisting treatment, or whlchonly temporarily improve, quickly relapsing again, which have Immediately and permanenlly yielded to treatment calculated to restore the blood to health. Even when the depraved con- dition of the blood is only secondary, measures to correct its condition are almost equally Important, for the health cannot be regained while the blood remains impaired. Most diseases affect the solid tissues, and it is obviously necessary to restore the proper grade to the vital actions. ' 3. It may be stated, as a general law, that diseases are rarely station- ary. They tend to get better or to get worse. This fact affords valuable indications for treatment. It should be determined whether the disease inteiinits or not — i. e., whether the pain, fever, or other disordered sensation or action returns at regular intervals of time, and going off again after a longer or shorter period of duration ; or whether the disease remits— i. e., becomes less vio- lent at regular intervals. Such diseases will yield to the treatment known as anti-periodic, which will be given in the article on the treatment of Intermittent fever. " '•■ '^.' Some diseases run a definite course and cannot be safely Interrupted, such as the irruptive fevers. In such cases, when fully formed, proper management consists in preventing or removing injurious Influences, mitigating their violence, correcting, as far as possible, any tendency to a fatal issue, and conducting them to a favorable termination. There are diseases which are indefinite in their course, and have a tendency, when not unusually severe, to get well sometime, and are often arrested or shortened by treatment. The apparent danger should be then kept in view, and energetic measures never used, if moderate means will accomplish the end. r.. . i Again, there are diseases which have a tendency to a fatal result, unless Interrupted. These must be checked with mild means, if you can, but with the most energetic, if necessary. Then again, we find there are diseases which are necessarily fatal in their character, or at least are so in the present state of our knowledge. Here our endeavors should be to support thepowers of life, and so prolong It, and to relieve the suffering of the patient and render him more com- fortable. INTRODUCTION. 13 ' III the diseases Involving great danger to life, the way in which the affection will cause death, aftbrds an Important guide In treatment, by melius of which a fiitul termiuati^.ii may be averted. In many cases, the whole aim of treatment will be to obviate the tendency to death. For our purpose here, wo can reduce all modes of death to two, viz : by inter- ruption of respiration (called apnaa), and by failure of the circulation or exhaustion (called asthenia). These two modes of dying may be com- bined. The best illustration of the first mode named, (apTum), i? furn- ished by cases of strangling. Other instances, are In diseases 'nvolving obstruction to the passage of air to the lungs, or which make tL. .ji incom- petent to receive air, as croup and other inflammations of the air passages, catarrhal fever in children, extensive inflammation affecting both lungs, dropsy of the lung or pleural sac, and acute consumption. In all these cases, the obvious indication is, to supply oxygen to the blood. Obstruc- tion to the circulation may be caused by paralysis of the heart, by over- distension, by pressure upon the great vessels, by tumor, by dropsy of the sack covering the heart (pericardium), or coagulation. In these cases, the indication is to prevent or overcome, if possible, these obstructions. But in all diseases which prove fatal by exhaustion, the mode of dying is by asthenia, as in the continued fevers fatal of themselves. The Indication is then to obviate this tendency by tonics, nourishment, and, perhaps, also by stimulants. 4. The use of remedies is also governed by the stage of the disease. In the commencement of a disease, experience shows that a iiieaoure may be effectual in arresting its progress, which would be harmful or useless at any later period in its course. A beginning cold is frequently cut short by a full dose of Opium or Dover's powder, but so favorable a result would not follow later in the case. Depletion Is frequently useful in the commencemeni of diseases, but is harmful when advanced; on the other hand, stimulation is frequently of gi*eat importance in the latter stages of acute prostrating diseases, where, if employed at the commencement, it would have worked an injury. "When one disease follows or appears in the course of another, or an accompanying symptom develops an undue importance, great watchfulness, and frequently new measures of treat- ment, are demanded. 5. The condition of the system, at the time of the attack, has the most important bearing upon the treatment. Measures which would be proper in a robust, hearty person, with an abundance of healthy blood, would be wholly unsuited in a feeble constitution, and those in whom the blood is impoverished or vitiated. The latter would necessarily require ionic and supporting treatment from the very first, while depletion might be beneficial in the former. The circumstances under which the patient is constantly placed, or those to which he was exposed previous to the occurrence of the disease, must be taken into account. .-..-. The age of the patient has an important bearing upon treatment. Infancy is well known to be more than proportionately susceptible to many medicines, and while the restorative processes are rapid, the sys- tem is also easily depressed below the point of recovery. Supporting treatment is early called for in prolonged diseases of infants. In ad- H I t i 1^ INTRODUCTION. vanced Hfe, though less susceptible than middle life to the action of med- icines, excesses, of any kind whatever, are not well borne, caution is demanded and large doses should never be given. Supporting measures are demanded earlier in the course of disease in the old than in middle life, though excessive stimulation is not safe. Women are more susceptible than men, and should be treated more delicately. Particular care is required during menstruation, and unless treatment is demanded, it should be suspended during menstruation. In pregnancy, all purturbating treatment, such as emetics and cathartics, should be avoided. Individual peculiarities should be considered; any special suscepti- bility, or peculiar action of a remedy, dictates its avoidance in those per- sons. Hereditary influences must be considered ; the known constitutional habits of the parents should be weighed and govern the treatment of the child. For example, the child of scrofulous parents should, under some cir- cumstances, be treated differently from one in whom there is no heredi- tary morbid predisposition. The habits of the patient have an important bearing upon the treat- ment, and should be thoroughly investigated and known. Exhaustion from immoral excesses ; deuility and impoverishment of the blood from insufficient food in quality, or variety, if not absolute starvation and bad air; gluttonous indulgence of the appetite ; intemperance in the use of alcoholic drinks, and the effects of one's occupation or business, all have an impurlant bearing upon the treatment. All these conditions call for supporting treatment at once, and often for stimulants. Previous disease often leaves a debility which calls promptly for sup- porting treatment. Peculiar tendencies to different diseases (diatheses) such as rheumatism, gout, consumption, etc., modify greatly different diseases, and may impress upon them more or less of their own character. The patient cannot be properly treated without giving these facts their proper bearing. 6. Co-existing influences often modify greatly the disease results of particular causes. The most prominent of tiiese, are the epidemic (a widely prevailing disease,) or endemic (a locally prevalent disease) influ- ences and the miasmatic, especially marsh miasma, which causes ague and other periodical diseases. Without attending to these influences which modify disease, the treatment will be liable to bo attended with fatal blunders. In all miasmatic districts, it is well known, that all diseases assume a character resembling more or less closely the periodical fevers with which these districts are infested. In all these localities, especially in autumn and winter, when other fevers, from whatever cause, and also inflammatory diseases, exhibit the remittent character of the proper miasmatic (or marsh) fever, we also see the best results follow the admin- istration of Quinine. Epidemics, (wide-spread prevalent diseases) it is well known, impart more or less of their own character to all coincident diseases. Sometimes, notwithstanding the epidemic influence, there is maintained a vigorous state of the system ; when this is the case, the type of disease is said to be ethenic. At other times, the tendency is to ff > INTRODUCTION. Id a feeble and weak, or typhoid, condition ; this is said to be asthenic. Tne latter condition calls at once for supporting and nutritious measures, nnd in tlie former, these measures are not as early called for, and even deitlot- ing remedies may be useful. 7. The pointing of nature, as shown by the expression of wants by the patient, should not be uisregarded, but should be watched for, and cautiously gratified, even though tkey are opposed by the dictates of our own reason, or even to the wliole course of our experience. It is some- times noticed that the patient, during the progress of a severe disease, expresses a wish for some drink, or article of food, or some change in other respects, which would seem to be highly improper. As such wants are expressed, often as the mere result of restlessness, or whim of the patient, it should, of course, be properly denied. But, if the same wish is repeated from time to time, against the authority of physician, attend- ant, and the judgment of the patient himself, it may be looked upon as a real want of the system, and indication by nature, which ought to be com- plied with. At first, it should be gratified cautiously, and in a manner that little harm could result, if it should happen to be a mistake. If good should result from careful trial, a greater indulgence may be per- mitted. On this point, Prof. Geo. B. Wood forcibly says: "The prac- titioner will often be gratified at witnessing a rapid recovery, dating from the moment of his jfldicious surrender of his own judgment to the impe- riouB call of the system.'' If error is committed on this point, let it bo ou the side of caution. 8. In the treatment of any disease, it is a good general rule to attend to the state of the functions, (secretions and excretions,) and to correct any disorder there, even though they are not directly connected with the disease. Especially should the bowels be kept regular, and constipation (fecal accumulations) carefully guarded against. The secretions of the skin and kidneys should be maintained, as nearly as possible, in a healthy state, and to this end, frequent examination of the urine is to be made. An irregular circulation, the temperature and nervous action should also receive attention. By these means alone, we occasionally cut off one of the chief sources of disease, and give great aid to recovery, for it is not always easy to determine how far diseases are mutually dependent. ? ' J. V. B. ■':j>:t;x,- ; t I . ■'■ ■■:• T ^•WTBI^"" I J »■■ ■ . . . ' .' ,.,-.,■ ■ . . , • '•:;■■ ' ■ • • ■ ' ...... • , .,:.,■,. •...". i| :.. «|.ii • ■ ' ' '■ • • ' • ' • ' ' ' .j. , I . . . I ',1 I M <i, . , I .. •. I ■ 'I. ::;;;:''•■;;.;'' contents. ';;■■■;; I.; •.•!,, " 1 • ■' i' • _ . Preface to Seventh Edition rage 4 Publisher's Prefiu-c to First Edition ^iiRo 5-3 Autliors' Prefiico ^age 8-9 Mn. Dr. Robb's Letter to Mothers TiiK^ 10 Introduction to Alh)i)atliic Treutmont Pi»BH 11-15 Table of Contents r^ge lft-23 List of Illustrations Page 21 - ,. I,, '. ,r| '• .. ^,... y. ""■ * •! !■, , - .m|( ,.' ( I. .J" . .,, ,., „,, „. .., ., ,^;.,; Part thirst. .,ft, .., ,,, ,,-, , „., , . ,u DIAGNOSIS AND PROGNOSIS; OR, WHAT IS THE ':;:" DISEASE, AND HOW WILL IT END? ',. ' HOW TO INVESTIGATE THE CONDITION OF THE '' PATIENT AND DISTINGUISH BETWEEN A '" ' . STATE OF HEALTH AND DISEASE, *; , ' • "'* *■ ' AND DETERMINE THE PECU- " ' ' ' " " "■" ■'•"•" LIAR NATURE OF THE ' ' ' , ' "■' ''"■'■ ' '••• DISEASE. • ■ * '■•' ■ '^ ....,';. r. .. , CHAPTER I...:;.. ...Page 25 •^ ' THE GENERAL INVESTIGATION OF THE PATIENT. The Constitution and its Vauikties: Plethoric or Sanguine, Feeble, Bilious, Apoplectic, N;rvous, Dry, "Wiry, Lax, Lymphatic or Mucous, Catarrhal or Rheumatic, Scrofulous, and Consumptive. Thk Temperaments and tiieik Vauxkties: Tiie SKOguine, The Bil- ious, The Melancholic, and The Plilegraatic.. The Antecedents of the Patient's Family. The Sexes and tiieib Distinctions. The Age and the Conditions "Which Qualify It: The earliest period ot childhood. The second period of chililiiood. The third period of childhood. The first period of maturity. Full maturity. The first period of decline. The second period of decline, or old age. Individual CHAnACTERisTics: Diseases to which (if any) the patient is liable. . , Manner of Living, General Habits, Occupation. 16 iige 4 ape 5-3 ■ige 8-9 ige 10 ig« 11 -lo ^go 16-23 ige 21 :••,} ; , , f 1 . •••• 8 THE IE ■''' .■/■ Page 25 , Feeble, Mucous, The Bil- earliost d period 'he first itient is FANWDE'S FETS. Hi CONTENTS. 17 CHAPTER II Page83 THE INVESTIGATION OF DISEASE. By Consideration of the Cause, General Character and Particular Symptoms. The Causes of Diseases: Fr ^t. Individual exposure, excesses, etc.. Second, Endemic, or those be aliar to a certain locality. Third, Ki)i- demic causes, or those for the time being prevailing over a large extent of country. The Pulse, its Variations and Indications: The art of feeling the pulse, in order to determine its character accurately. What to do before you feel the pulse. How to place the lingers to get the most informa- tion, and what you learn from the fingers correctly placed. TJie average standard of health. General infei-ences dedumble from the pulse. Var- ious names for alterations of tlie pulse, as frequent, slow, quick, slug- gish, or tardy, soft, strong, feeble, large, small, full, empty, unequal and intermittent pulse, Indications attributable to these varieties, respec- tively and jointly. The Condition ok the Blood, its charactervitics. Spontaneous dis- charges of blood generally. The Urine, its Varieties and Indications: The v»^rialions apparent in the urine, and their indications. 27/e urine as a guide in fevers. Breathing, its Varieties and their Indications: The breath in health. The variations to which breathing is subject, and their indi- cations. The Digestive Functions, and the indications which they afford. The evacuations and their indications. Nausea and vomiting, and their meaning. Information derived from the appetite, and its variations. Absence of app'^tite. Natural appetite. Excess of appetite. Thirst, and the ladicr-Hons it affords. The Tongue, and its indications and differences of appearance. The Nerves, Brain, Sensations and senses, and the information de- rived from their study. Loss of consciousness. Delirium. Fainting, etc. Motion, or muscular action, and rest orsleep, including spasms, convul- sions and paralysis. The Sensations and their Indications: Pain Discomfort, Anxiety. Heat, Chill. The Organs of Sense, eyes, ears, nose, taste, etc., and the knowledge derived from them. CHAPTER III Page 72 INVESTIGATION QP THE DISEASE CONTINUED. Coughs, and their indications. The condition of the skin, hot, natural or sweaty, and the lesson it teaches. The com2)lexion, its change.;, and varieties. Sounds given out bv the chest, and the method of ex- amining and interpreting them. I'he voice and speech. Tearfulness and laughter, as signs of health or disease. Loss of, or unhealthy in- crease of flesh. Sneezing, yawning, groaning, etc. The saliva, defi- ciency and increase. The expectoration, and its /aluable indica- tions. Hi u 111 f! ■ g CONTKNTS. CHAPTER IV Page 8 DIET AND MAXXER OF LIVING. CLOTHING AND HABITS, CHAPTER V Pageso ADMINISTRATION AND REPETITION OF THE HOMCEOPAXHIC ME- DICINES. External applications. Internal remedies and doses. Forms of medi- cines. Table of analogous remedies. THE BATH. Cold Salt Water Bath. Cold Fresh Water Bath. Hot Fresh Water Bath. Tepid, Shower. Vai)or and Medicated Baths. Instructions, when and how to use the different baths. Acclimation. -<-♦-»- F*ai»t Second.. DISEASES OF THE BKAIN, THE SPINAL COBD, AND THE NERVOUS SYSTEM GENERALLY. CHAPTER VI Page 113 Spotted Fever— Cerebro-Spinal Meningitis. Hyperemia of the Brain, or Excess of Blood to tlie Brain. Anaimia.orLack of Blood to the Brain. Apoplexy. Ptiralysis. Brain Fever. Acute Inflammation of the Brain. Hydroceplialus.— Dropsy of the Brain.'or Water on the Brain. Lock Jaw — Tetanus — Trismus. Delirium Tremens. Epilepsy- Spasms. Si)asnis o Ini-Awia— Eclampsia Ivfantuvi. Chorea.— St. Vitus' Dance. Catalepsy— Trance. Hysteria— Hysterics. I»art Third. DISEASES OF THE HEAD. CHAPTER VH Page ler THE BRAIN AND NERVES. Headache— Cephalaljia—Hemicrania. Nerve Pain. Face Ache. Face Ague Neuralgia of the Face. CHAPTER Vlir Page 180 DISEASES OF THE EYE. Inflammation of the Eye—OphtJialmia~Acuie and Chronic. Cataract- Specks on the Eye. Stiabitsmus—Cross-Eye. Weeping, or Watery Eye. Bloodshot Lye. Stye. Blindness Conjunctivitis. CHAPTER IX Pagem DISEASES OF THE EAR. Inflammation of the Ear and Earache— Ostitis-Otalgia. Discharge from ; the Ears— Otorr^i<»a. Deafness. Humming or buzzing in the Ear. - ^mntinfiiMtllliMm CONTENtS. CHAPTER X DISEASES OF THE NOSE. 1* .Page 204 Catarrh— Cold iu the Head— Coriy^a— Acute and Chronic. Inflammation of the Nose. Bleeding at the Nose— -&pi»taajw. « <!»» «- I*a,rt F'oii.rtli. THE GATE. CHAPTER XI Page 215 DISEASES OF THE MOUTH AND THROAT. Inflammation of the Mouth. Canker of the Mouth— Stomatitis. Angina. Aphthous Sore Throat. Catarrhal Sore Throat. Quinsy. Diphtheria. Mumps— Parotitis. Scurvy of the Quma— Scorbutus. Toothache— Odontalgia. ^1 <i<»>>--»^ I»art Fifth. DISEASES OF THE STOMACH AND INTESTINES. CHAPTER XH Page 240 DISEASES OF THE STOMACH. Dyspepsia— Acute and Chronic. Nausea. Eructations. Sick Headache. Bleeding from the Stomach — Haematamesis. Spasm or Cramp of the Qiom&ch—Cardialyia. Heartburn. — Wsxterhrash—Pyrosis. .Page 277 CHAPTER XHI DISEASES OF THE INTESTINES. Diarrhoea— Intestinal Catarrh. Simple Diarrhoea. Chronic Diarrhoea. Cholera Morbus. Fevers. Bilious Fever. Gastric Fever. Inflamma- tion of the Bowels— Enteritis. Catarrhal Dysentery. Epidemic Dys- entery—Flux. Colic— Enteralgia. Flatulent, Bilious, Hysteric, Rheu- matic, Neuralgic, Printers' and Copper Colic. Constipation— SteTiom. Files— Hemorrhoids. Worms— Helminthiasis. Prolapsus Ani. In« flammation of the Peritoneum— Peritonitis. I*art Sixth. DISEASES OF THE LIVER AND SPLEEN. ' t ■ :■{: CHAPTER XIV Pagesas r. V DISEASES OF THE LITER. inflammation of the Liver— Acute— Chronic and Suppurative. Conges* tion of the Liver. Jaundice. Gravel in the Gall-bladder— Gall Stones. Cancer of the Liver. 20 CONTENTS. CHAPTER XV Page 349 DISEASES OF THE SPLEEN. Inflammation of the Spleen. Part Seventh. DISEASES OF THE KIDNEYS AND BLADDER. CHAPTER XVI Page 362 DISEASES OF THE KIDNEYS. Inflammation of tlie Kidneys— lienhritis. Briglit's Disease of tlie Kia- neya—Morbits Brightii. Gravel— /tenaZ Calculi. '^ ■ ■■ CHAPTER XVH Page 364 DISEASES OF THE BLADDER. . Inflammation of the Bladder— Ct/A^tiw. Bloody Urine— ^ema^wn'o!. Wet- ting the Bed— JSntiresis Nocturna Spasm of the B\Si.ddet— Cystospas- mvs. Paralysis of the Bladder. JPart Eigrhtli. THE MALE SEXUAL ORGANS. CHAPTER XVIII Page 373 0;c^i^ts— Inflammation of the Testicles. Nightly Emissions— /Spermo- torrhcea. ^ I*art IVinth. DISEASES OF THE RESPIRATORY ORGANS. CHAPTER XIX Pagesso DISEASES OF THE LARYNX AND TRACHEA. Catarrh or Common Cold . Catarrhal Fever. Inflammation of the Lar- ynx or upper part of the windpipe. Cough. Croup— Laryngitis. Mem- branous Croup. Hoarseness. CHAPTER XX Page 400 DISEASES OF THE LUNGS. Congestion of the Lungs. Hemorrhage of the Lungs. Bronchitis- Acute and Chronic. Influenza. Whooping Cough— Pertussis. Pneu- monia—Inflammation of the Lungs. Asthma. Hiccup— Singultus. CHAPTER XXI Page 448 DISEASES OF THE PLEURA. Pleurisy— Inflammation of the Pleura. ' "■ Part TentJi. DISEASES OF THE ORGANS OF CIRCULATION. CHAPTER XXII Page455 DISEASES OF THE HEART. Inflammation of the Heart- Carci^M*. Palpitation of the Heart. Fatty CONTENTS. ei Degeneration of the Heart. Hypertrophy of the Heart— Enlarge- ment of the Heart. Angina Pectoris. • CHAPTER XXIII Page 470 DISEASES OF THE ARTERIES AND VEINS. Diseases of the Arteries. Inflammations of the Yeina— Phlebitis. Vari- cose Veina or Dilation of the Veins. ^^1 I Fatty E^n-rt Eleventli. DERANGEMENTS OF SINGLE SYSTEMS. CHAPTER XXIV Page 476 DISEASES OF THE BONES, MUSCLES, AND JOINTS. Ostitis — Inflammation of the liones and the Membranes covering them. Rickets — Rachitis. Lumbago. Inflammation of the Joints. Hip Joint — Coxalgia. Knee Joint — White Swelling— G'oruYw. Joints of the Foot. CHAPTER XXV Page 494 DISEASES OF THE LYMPHATIC VESSELS AND GLANDS. Acute Inflammation. Chronic Inflammation. CHAPTER XXVI Page 497 DISEASES OF THE SKIN. ffry<7iewia— Simple redness of the Skin — Erysipelas. Hives— CTrffcarto. HawAvvifT— Pityriasis. Scaly Tetter. Barbers' Itch. Bottle Nose. Ring Worm. Tetter Salt Rheum— ^C2e?na. Shingles. Boils and Carbuncles. Scald llGnA—Famis. Itch— *S'ca6ies. Ulcers. Abscess. Whitlow— -P'eZow. Chilblains. Corns. Part Twelfth. CONSTITUTIONAL DISEASES. CHAPTER XXVII Page62i ACUTE CONTAGIOUS DISEASES. Measles. Scarlet Fever. Smallpox— Variola— Varioloid. Chicken Pox. . CHAPTER XXVIII Page 544 EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. Fever and Ague— Intermittent Fever. Inflammatory Fever— Synocfiia Typhoid Fever— Enteric Fever. Yellow Fever. Cholera. CHAPTER XXIX Page 595 CONSTITUTIONAL DISEASES WITHOUT DEFINITE INFECTION. Rheumatism of Joints and Muf oles. Rheumatism of Sciatic Nerve. Con- sumption— 2'M6erc*it/o»ii'. Hcrofulfi—Scrofulosis. Ii i JIK CONTENTS. Part Thirteenth. DISEASES PECULIAR TO WOMEN. CHAPTER XXX Page 6:^1 DISEASES OF THE FEMALE SEXUAL ORGANS. Menstruation ; what it means. Its course in healtli. Derangements at- tendant on its appearance. Chlorosis—Green Sickness. Amenoirhoea —Suppression or Delay of tlie Menses. Menorrhagia — Profuse Men- struation. Leucorrhvea — Wliites— C'utarrli of t'lie Sexual Mucous Lining. Prolapsus C/^ten— Falling of the Womb. Menopause— Tha change of life. ITasMWs— Inflammation of the Breasts. Carcinoma Uteri—Cancer of the AVomb. Carcinoma Mammce—C&ncer of the Breast. CHAPTER XXXI ..Page 652 CONDENSED SIGNS OF PREGNANCY. General Obsei'vations, Air and Exercise, Clothing, Diet Employment of the Mind, and habits during. Morning Sickness. Heartburn— Acidity— Waterbrash. Constipation. Diarrhoea. Toothache. Urinary Difficulties. Swelling of the lower limbs. General Symptoms. MISCARRIAGE, Exciting Causes. TREATMENT BEFORE CONFINEMENT, Preparation of the Breasts. Preparations for Labor. The Bowels. Diet. False Pains. Parturition or Lalior. Treatment after Delivery. Gen- eral Management. After Pains. Flooding. Spasm of the Bladder— Retention of the Urine. Duration of Oontinement. CHAPTER XXXH Page 674 DISEASES FOLLOWING CONFINEMENT. Secretion of Milk. Excessive Secretion of Milk. Perspiration after De- livery. Milk Fever. Childbed Fever. Puerperal Fever. The Lochial Discharge. Diarrhoea of Lying-in Women. Abdominal Deformities. Weakness after Labor. Sore Nipples. Inflammation of the Breasts. JPart Fourteenth. TREATMENT OF INFANTS. CHAPTER XXXHI Page ess TREATMENT AFTER BIRTH. Stillborn children— Suspended Animation, treatment, mechanical mea- sures, etc. Swelling of the Head. Navel rupture in Infants ; mecha- nical treatment. Rupture in the Groin. Expulsion of the Meconium. Suckliugof the Infant. The choice of the Nurse. Diet during Nur- sing. Additional Diet of Infants. Sleep— Sleeplessness. Exercise. Weaning. 1 CONTENTS. CHAPTER XXXIV. DISEASES OF INFANCY. 28 .Page 695 Inflammation of the Eyes. Hiccup. Cold in the Head. Crying and Wakefulness of Infants— Colic. Regurgitation of Milk. Acidity. Flatulence, etc. Milk Crust— Milk 8cab— Milk Blotches. Tlirush— Aphthce. Constipation. Diarrhoea of Infants. Cholera Infantum— Summer Complaint. Chaflnn — Excoriations. Asthma of Infants. Swelling of the Breasts. Atrophy— Emaciation Dentition. Spasms —Convulsions of Infants and Children. Vaccination. P»art Fifteentli. SURGERY. CHAPTER XXXV... Page 724 Accidents of various kinds. Apparent Death, from Hunger; from a Fall; from Suffocation; from Lightning; from Drowning; frombeingFrozen. Verification of Death. Concussion of the Brain. Concussion of theCliest. Sprains— Partial Dislocation. Ilemorrluige — with. Moans of Suppres- sing. Wounds, with their Divisions; Incised, Lacerated, Bruised, Punctured, and Gunshot Wounds. Bandages and how to apply them. Fractures— Broken Bones. Burns and Scalds. Sunstroke — Sun Fe* ver. Stings of Insects. Dropsy. .Page 744 Broth. Baby Brown Mush CHAPTER XXXVI FOOD FOR INFANTS AND INVALIDS. FOOD FOR INFANTS. Starchy Food. English "Pap." Cow's Milk. Infants Pudding. Food for Young Children. Children's Pie. for Supper. Bread and Milk. Cranberries. FOOD FOR INVALIDS. Gruel. Panada. Soft Toast. Egg Toast. Soft Boiled Eggs. Dry Toast. Milk Toast. Thickened Milk. Milk and Eggs. Beef Tea. Oyster Soup. Broiled Tenderloin. Arrowroot Gruel. Mutton Tea. Chicken Broth. Water Gruel. Rice Gruel. Sago Gruel. Tapioca Cup Pud- ding. Invalid Apple Pie. Roast Apples. Stewed Prunes. Lemon- ade. Apple Water. Toast Water. Flaxseed Tea. Barley Coffee. Oatmeal Coffee. Rice Water. Mu ullage of Elm Bark. Alum Wliey. Mustard Whey. Vinegar Whey. Rennet Whey. Orange Whey. Tableof Remedies with abbreviation of Latin name. Full Latin (or technical) name. Common English name. Name of antidote to be used when the medicine has, from any reason, been taken in too large doses, and the names of a few diseases which are often cured by the rem- edy they follow. I*ai:*t gSixteentli. THE REPERTORY. CHAPTER XXXVII Page 760 A list of all the symptoms develoj)ed by different diseases. Arranged with relation to the part of the body affected, and the symptoms of each part follow each other in alphabetical order. After each symptom is given the abbreviated name of a few remedies known to Ije excellent as a means of curing that particular condition. i TME (FAOK OKEAMER.. fi ^ i ■'• KOBE'S FAMILY PHYSICIAN. FJLTEt^ FIHST. DIAGNOSIS AND PROGNOSIS; OR, WHAT IS THE DISEASE, AND HOW WILL IT END? CHAPTER I. HOW TO INVESTIGATE THE €ONDITION OP THE PATIENT AND DIS- TINGUISH BETWEEN A STATE OF HEALTH AND DISEASE, AND DE'^ ERMINE THE PECULIAR NATURE OF THE DISEASE. The investigation of the condition of tho Patient, and the deter- mining the particuiar nature of the Disease, are evidently essential to appropriate treatment. It is, tlierefore, imperative that a work of this kind should contain such simple instructions on this head ns may lead unprofessional persons easily and simply to a clear and positive conclu- sion. Such an investigation may properly be divided into two distinct ■ections, namely: first, the general investigation of the patient, aud secondly, the particular investigation of the disease THE GENERAL INVESTIGATION OF THE PATIENT. The general investigation of the patient should comprise a scrutiniz- ing inquiry into the particular constitution of the individual — the tem- perament—the antecedents of the patient's family, as of general health, habits, etc., of the parents, and of each of their families respectively— the sex, and the relative state of the secretions especially consistent with the state of health in such sex— the age of the patient, and the circumstances which qualify this condition— conditions, impressions, or habits, etc., which are individually peculiar to the patient— the toeak or particularly susceptible part, and what, if any, be the particular affections to which the patient has been subject— the general habits, occupation, method ot living, diet, etc.,— the relations between the climate and the individual, or any transitions of climate to which the patient may have been exposed. THE CONSTITUTION AND ITS VAKIETIES. A plethoric {sanguine) constitution, or full habit of body, characterized by redundancy of animation and vital energy in he-alth, and a prevailing and predominant activity in tL a circulative system; tb ecompi ax 'ou being 25 t i' i8 INVESTIGATION OP TUB PATIENT. florid and glowing, the frame full and stalwart, the limbs generally active, the spirits and muscular apparatus buoyant arid elastic, the generation of natural warmth abundant, and tlie \m\»ef till and strong ; butcouHequently with suHceptibiiity to inflammatory influences, and a predisposition to local, organic, or general congestions, suffusions, or emissions of blood. A feeble coiutittUion, us opposed to the foregoing— in which fatigue is naturally a ready consequence of exertion; when the breath will easily be exhausted by sudden or rapid motion ; when the generation of heat will be naturally deflcient, and the operation of the functions generally slow and easily impeded, or vexed, by being the least overtaxed, the mus- cles being readily wearied and incapacitated— the secretions varying from excess to deficiency or suspension— and the organs being either too readily provoked and stimulated, or very dull and Insusceptible of external cir- cum«ta:iot-8— and the pulse beir.j naturally feeble, soft, and yielding. The patient is consequently subject^^o diseases characterized by torpidity and utter inaction of the functions, or by excessive relaxation. A bilious constitution, characterized by dark and somewhat turgid skin, or even by superabundant yellowness of the skin, (an imperceptible proportion of yellow in the skin, observed on close examination, being indispensibie to a really healthy complexion,) and by the readiness with which the liver sympathizes in, and becomes affected by, every external or Internal contingency, with predisposition to derangements affecting the digestive functions and the stomach generally, and to irregularity of such functions ; as also to dark colored urine, costiveness (with dark motions,) and piles; the pulse is apt to be v>iry. All apoplectic constitution, (a sub-division which Is Important liere,) characterized by the short, thick-set, or close, full frame, with large head, apparently buried between the shoulders, the neck being very short and thick, and the pulse being more or less of the character of the plethoric habit, and the patient being predisposed to sudden rushes of blood to the brain. A nervous constitution, (a variety which is often found In combination with the bilums,) especially characterized by predominant excitability of body and of mind ; absence of fixity (or changeableness) of ideas, habits, inclinations, etc. ; irritability, and extreme sensitiveness and inequalities of temper— the pulse being accordingly also variable, easily subject to exceeding acceleration, but often subsiding, in sedate moments, to a move- ment slower than is customary. The patient is subject to the various affections so difficult of distinction and classification, which come under the head of nervous diseases ; such as spasmodic affections, fits, apparently traceable to no distinct cause; fugitiveand inexplicable pains, particularly such as are aggravated by very slight touch, or by approximation, but which are relieved by pressure. A dry, wiry constitution, (not uncommonly combined with the bilious or nervous,) characterized by swarthy complexion, sharp, deep-set fea- tures, searching glance, persistently dry condition of the the skin, firm, hard, wiry condition of the muscular and tendinous fibre; deficiency of flesh and angular frame; generally, also, a rapid motion und quick per- ception; the urine is dark, the motions are habitually hard and scanty, the secretions and sweat are usually deflcient, and the pulse is generally MM INVESTIGATION OF THE PATIENT. distinct and wiry, but commonly, alwo, qnhker than tliat of the ner- vous habit (when uuexcited). The patient is Hubjec>t to inflammatory atfeetions— to which the intestines are especially predlspoHcd— as also to diseases generally, which occur (as it were) with superabundant animal power. A lax, lymphatic, or mtmous constitution. —The^Q cnree varieties, which are, indeed, susceptible of very nice distinctions, are, however, sufllcient'v analogous to be united In a work of this kind ; they are opposed to the fo^ going. The complexion Is generally fair, the flesh apparently full, but soft, flaccid, and puffy ; the skin pallid, the frame rounded, the muscular and tendinous flbre unstrung, yielding, and relaxed ; sensations of chilli- ness prevail, and the individual is usually more sensitive of cold than of heat, but is also alive to Immoderate elevation of the latter; the natural generation of heat Is deflclent, the circulation sluggish, the pulse l)eing slow, (sometimes rather full, but always soft, easily compressed, yialdiny). The patient is subject to the transmutation of every disease into a sluggish, persistent, or chronic form, (the crisis and resolution being in general imperfect,) to Piiperabundant secretions or accumulations of phlegm, to catarrhal affections, to abcesses, to excessive discharges of phlegm, etc., etc. ; to the accumulation of iter (by decomposition, or Imperfect compo- sition of the blood,) about particular organs, oi throughout the l)ody, (generally as ^'.d immeillate consequence of inflammation,) and sometimes to the sudden suppression of discharges. Tha catarrhal or rheumatic constitution, (nearly analogous to the last, but having one very distinctive feature in the susceptibility of the exter- nal surface,) characterized especially by want of sulliclent activity and nervous tension and vitality in the skin, which, therefore, remains easily affected by every external circumstance, effects transpiration (throwing oft moisture and unhealthy matter, through the pores of the skin,) very defec- tively and inadequately, and is apt, by being susceptible to the sudden suppression or repercussion of such transpiration, to re-convey the morbid humors which have been expelled by internal organs, upon those organ? themselves, and thereby to generate diseases of the character indicated by the name here selected. A very decided feature of this habit of body consists of extreme susceptibility to derangement of digestion, which, if inlierited, may be considered as the predisposing cause to such tendencies. A constitution in which the skin is especially liable to become diseased, (jpsortc) (more distinctly capable of individual classification than the scro/u- lous habit, but yet a mere modiflcation of the l;itter)— distinguishable bv the predominance, recurrence, or continuance of irregular and unhealthy secretions ttom the skin, and irregular action of the ghinds associated with it ; eruptions of various characters—ulcerative sores, general foul, ness— which seem to appear as the result of every afTection, of wliatever kind, and either to accompany or to follow every derangement. The consumptice constitution, (in the majority of instances, again, a modiflcation of the scrofulous habit, but more subject to appropriate class- iflcation in a work of this nature,)— identified in general by a very clear, transparent skin, bright flush-spot on the cheeks, especially on the left cheek ; flatness 'if the chest, and hollowness on the breast-bone ; slender, attenuated, lengthened, fragile frame; elongation and spareness of the neck; prominent protrusion of the shoul Jer-blades ; sudden and rapid 9S » INVKSTIGATION OF THE PATIENT. !li! growth ; prevalence of heat of the hands after eating ; irritability of the circulativesystem.and consequently Apulse characterized by umallne.'is and quickness. The patient ia particularly susceptible to complicatipui. affect- ing the lungs, resulting f^om every inflammatory or irritative process (which is also very frequent, and readily provoked;) to want of breath, and complete exhaustion after every unusual degree of exertion, especially after rapid motion, and often in consequence of mere mental excitement, or momentary irritability; to intlammatory affections of the lungs and adjacent membranes, (and expectoration of blood,) which will always be liable to result in decay of those organs. THE TEMPERAMENTS AND THEIR VARIETIES. The temperaments are subject to an infinity of individual peculiari- ties which might constitute separate divisions, ^ut which, in our estima- tion, will be no more readily comprehended by the reader in his investi- gation into individtial characteristics. We shall, therefore, confine the division of temperamonts to the following distinctions, which, even then, are often compounded, and which should be held to modify the relations of morbid manifestations. A sanguine temperatnent, (usually asNociated with a plethoric nonstitu- Mow,)— which is characterized by habitual animation and buoyancy of spirits, gaiety, good humor, etc.; the mind and body are alike quickly stimulated into excessive action, but every affection, or disturbance, ia usually of as rapid a course, and brief duration, as it ia severe while it iasts. The bodily health is, usually, good and strong,— and slow or last- ing diseases are of rare occurrence ; but the majority of affections, (which have a predisposition to assumf^ a violent and inflammatory type,) are exceedingly severe, when they do occur, and run a very rapid course. A choleric temperament, (usually associated with the bilious constitu- tion,) characterized by the violence of the reaction occasioned by any irri- tation, or stimulus, or impulse, and, particularly, by its severe implica- tion of the biliary apparatus, which, with increased and altered secretion of bile, reacts upon the moral and mental faculties, and has a tendency to engender a liability to the provocation of ill-humor, and even venge- fulness, and malignity, or to rancor, and acrimony of temper, upon the revival of causes of excitement. The complexion is usually swarthy, with a yellowish tinge; the muscular and tendinous fibre hard, wiry, and tightly strung; the hair dark, and the features acute or deep-set. The patient is subject to bilious derangements, and to bilious complica- tions with every derangement, not uncommonly provoked by the violent fits of excitement to which he is constitutionally subject. Tfie melancholic temperament is identified by the slow, meditative dis- position ; the gloomy, retiring, solitary, and hypochondriacal temper ; the tacit, latent, and unobservable progress of affections produced by external impressions, but silently harbored. Every impression is deep and lasting, and broods upon the mind and body; but the patient is not subject to violent impulses, nor very susceptible to sudden impressions, the organs being none the less alive to such impressions ; the sensibility Is apparently blunted or subjected to the reflective powers. The body is fclike slowly, but progressively, affected by external circumstances. The INVESTIGATION OF THE PATIENT. 29 patient is r.ubject vo diseases affecting the intestinal apparatus, especially those which assume a chronic and continuous character. A Phlegmatic temperament (which is usually associated with the/eeble and Ifux, or lymphatic constitution,) is distinguishable by the tardy ope- ration of all functions, mental as well as bodily; by the slowness with which irritation, or stimulation, is produced, and by the no less remark- able slowness, as well as by the inadequacy of the reactionary power. The predispositions are to be gathered from the remarks on the " feeble," and on the " lax," or " lymphatic constitutions." THE ANTECEDENTS OF THE PATIENT'S FAMILY. We should pay especial attention to the general health, habits, or particular diseases (if they be known) of the parents of the patient, and of the paternal and maternal relations, which may serve t<5 elucidate the origin of a bad habit of body, especially if such diseases as scrofula (in any of its multiplied forms,) cutaneous (skin) disorders, consumption, gout, piles, etc , be habitual with any member of the family, whose consti- tution could have been inherited by the patient. This is a most essential consideration, for it will, very frequ,ently, be found that when a remedy is distinctly indicated in the case, it/ails to operate without previous prepar- atory treatment, an ' we are puzzled by the failure; whereas, after the previous administration of an opposite preparatory remedy, the medi- cine already Belected as appropriate, but administered without effect, fre- quently becomes signally succestful. This is generally owing to hereditary defects of constitution. THE SEXES AND THEIR DISTINCTIONS. 3n the male, we anticipate redundancy of animal strength, vigor, energy, and circulative power, and we must consider disease in a modified or aggravated aspect, according to the ascendency or deficiency of these characteristics. In the female, we may anticipate more acute sensibility, greater ten- derness and excitability, and a less vigorous and persistent reactionary power. We must not, moreover, omit to consider the conditions depend- ent peculiarly upon the organs of parturition, etc., and upon the func- tions associated with them ; the progress of pregnancy, and the genera- tion of milk ; or, on the other hand, the presence of periodical changes should be duly considered, in relation to every simultaneous derange- ment. Relaxation of fibre, and lymphatic accumulations, are, also, (to a greater or less degree,) inseparably associated with the peculiarities of the aex; and the greater intensity and additional sphere of nervous sensibil- ity should lead us to consider, with great caution, such nervous, spas- modic, or hysterical indispositions, as occur, associated with natural pre- disposing causes. THE AGE AND THE CONDITIONS WHICH QUALIFY IT. Age is not to be considered, without regard to conditions of previous health or disease — of habits, manner of living, climate, avocations, etc., especially iii relation to persons who have attained maturity. It may, however, (subject to such modifications,) be considered under seven dis- tinct sections, viz:— childhood constituting three, maturity two, and decline two. Si iiH 80 INVESTIGATION OF THE PATIENT. , ; ^i|! ill I 1. In the earliest period of childhood (the first of infancy,) extend- ing to the period of the earliest teeth, tlie human being is extraordinarily susceptible to external influences ; sensitive, to a higlier degree, and, con- sequently, alive to any sudden Irritation from, apparently, slight causes; the brain, in particular, is liable to pi*eclpitatlon of blond, and the acute sensitiveness of the whole nervous structure renders spasmodic affections predominant. 2. In the second period of childhood—extending to the seventh year in our climate— v/e have to consider the natural irritability of the system, the want of firmness of fibre, the susceptibility to fatigue, readily obvi- ated by the provision of nature— a preponderance of tendency to rest ; and we have to anticipate the occurrence of organic Inflammations, par- ticularly as connected with the respiratory or cerebral apparatus, and irregularities in the accumulation of flesh. 3. In the third period of childhood— extending to the beginning of manhood, or womanhood— the equilibrium between the functions, facul- ties, etc., being better established, and the tissues having become inured to external influences, we should consider the occurrence of such aflTec- tlons, as already described more minutely, with reference to particular habit of body, circumstances, Individual habits, avocations, etc. ; situation, and other local and general external causes. 4. In the period of approaching and progressive maturity — extend- ing to the twenty-fifth year, in our climate — the vigor of the clrculative system should be developed ; it is then, also, that wo may anticipate the serious development of latent, or declared bad habits of body, traaeable to parentage, and particular care should then be taken — especially, if in infancy, or childhood, a course of constitutional treatment has been neg- lected—to neutralize, or modify such constitutional de/ects—affecting the Lungs, and the Brain especially— as In Epileptic or Consumptive affec- tions ; both being considered in due relation with the progress of sexual powers. 5. The period of maturity — extending, generally, from the twenty- fifth to forty-fifth year. In our climate, must, especially, be considered in relation with habits, mode of life, avocations, locality inhabited, trans- itions of climate, (if any,) etc., because any of these circumstances may tend, very materially, to lengthen or abbreviate the stage of vigorous maturity. In some cases, we may extend It to the fifty-fifth year ; in others, it may a<3 reasonably be limited to the thirty-fifth year. In gen- eral, the period of maturity, properly so called (whether of long or short duration,) is characterized by continual, even, regular, and vigorous ope- ration of all the functions and faculties. 6. The first period of decline— which may, at present, be said to extend, in our climate, generally, from the forty-fifth to the fifty-fifth year— may be distinguished by diminished activity of mind and body, supervening irregularity of the functions, decreased powers of endurance and strength, returning susceptibility to external Influences, and debili- tation of the attributive powers of either sex. This period, whether deferred or premature, is almost infallibly distinguishable by such chai- acteristics. INVESTIGATION OF THE PATIENT. 31 4 7. The second period of decline, or old age, which may set In from llie fiftieth to the sixtieth year, in our climate— or sooner, or later, accord- ing to antecedent circumstances, is indelibly characterized by the decrease of acuteness in the perceptive faculties, and in the organs which convey sensations— as of light, sound, smell, taste, and sensitiveness of touch- by growing obtuseness of moral and mental sensibilities; bj' decreasing retentive mental power; by general attenuation of frame, diminution of physical power, stiffhesa of joints, muscles, etc., aridity and puckering of the skin, the development of latent defects of circulation, and the like. INDIVIDUAL CHABACTEEISTICS. The peculiarities of individual patients, and the particular effect of particular external influences, etc., upon them, both as to mind and body, should be very carefully considered ; and it is absolutely necessary, for the thorough appreciation of the distinctive points relating to the case of a patient, with whose habits, constitution, and susceptibilities, etc., we are not perfectly conversant, that we should most carefully gather the history of the particular and characteristic mannerism (if it may so be termed) which identifies him. Evsry person w hatsoever, must, in some point or other, be considered to constitute an exceptional case, and be so studied, for successful treatment. DISEASES TO WHICH (IF AXY) THE PATIENT IS ESPECIALLY LIABLE. It can hardly occur that a patient is not more subject to one class of disorders than to any other ; and although this, to a certain extent, falls within the pale of the considerations suggested above, (see 0.,) yet there is one essential point to be considered here, namely, the issue, or flnai cruis, in which such disorders terminate, Vhich is ever characteristic METHOD OP LIVING, AND GENERAL HABITS. It is a most important comparison to institute, in the study of any case, to consider the relav. jn between the habit of body in health or diseaset and the method of living, occupation, etc. The habits may be especially considered in respect to the following distinctions: — (1) whether seden- tary or active ; (2) whether the chief exertion be of mind or body ; (3) whether the locality generally inhabited be of a close, artificial, (town) or of a free, natural atmosphere ; (4) whether the clothing, food, and other comforts, or even necessaries of life, have been sufficient, but moderate, or excessive, (both as to quantity, in proportion to actual requirement, or richness,) or deficient in quantity simply; or, not only insufficient, but also unwholesome; (5) whether the domicile and person, or either, have been habitually cleanly, carefully attended to, or foul and neglected, (as to domicile, particularly as to cleanliness, drainage, and ventilation ; order and regularity are, however, also essential) ; (6) whether the habite as regards eating and fasting, labor and rest, etc., occupation or want of occupation, have been regular or irregular. With excessive confinement, close atmosphere, deficiency of exercise, etc., we may associate affections of the stomach and liver (especially,) of the digestive functions generally, and depression of spirits, as also (if the place of occupation be of a foul atmosphere,) affections of the lungs. With excess of mental labor we may associate nervous complaints, and habitual irritative fevers. With insufficiency or unhealthy kind of food, Tgr 32 INVESTIGATION OF DISEASE. I'' i ii!ii 'Im ik> deficient ventilation, drainage, and cleanliness, we associate low fevers, eruptive fevers, typhoid and putrid, or even intermittent complaints, and skin diseases. With excess of nutrition and indulgence (in comparison to physical exercise,) we may associate inflammatory complaints, and rushes of blood to particular organs. And in all cases, analogical!' we may ally the nature of the complaint with the nature of the habits, occupation, food, etc. THE PART OR ORGAN USUALLY DISEASED. By investigation into the most frequent result of casual, accidental, external or internal causes, we may readily ascertain what part of the system is particularly liable to irregular or unhealthy action. And this research is always requisite, because every individual will be found to have one organ especially susceptible, and liable to become deranged by given causes, in some cases even, such as would seem to involve any other complication, rather than that which actually occurs. ATMOSPHERIC AND OTHER LOCAL INFLUENCES. The atmosphere, soil, etc., of particular localities, is known to be prone to engender particular derangements. It is also known that the water of particular springs and rivers, whether owing to the presence of mineral substances, to excessive hardness, or to other causes, has a ten- dency to generate particular diseases. It is, therefore, very important that these, and the like particulars, should be submitted to close iuvestiga- tion. CHAPT.ER II. THE INYESTI6ATI0X OF DISEASE. BY CONSIDERATION OF THE CAUSE, GENERAL CHARACTER, EXAMPLES, AND PARTICULAR SYMPTOMS. The investigation of disease may properly be confined to the consid- eration (1) of the various general, particular and local causes ; (2) of the general character of the disease; (3) of the general characteristics of the disease, as compared with existing or recorded examples; (4) of the symptoms— which last must again be divided into the consider- ation of the PULSE, its varieties and indications ; the discharges generally ; the nature of the blood, if any be discharged ; the state of the digestive functions ; the mouth and tongue ; the eyes; the breathing, and its pecu- liarities; the peculiarities of complexion, motion, action, or inactivity; appearance, etc. ; the symptoms exhibited by the nervous system gener- ally, and especially by the brain. THE CA USES OF DISEASE. These are either what may be termed constitutional causes, which consist in any unhealthy condition of the system, and for the distinction of which the reader should consult the part on " Constitution," or they are more immediate, as those hereafter described : m CATMEl^ONG. WOLO FLOWERS. I I "Madam, you cannot have health without exercise in the pure air." (M) ^m 34 CAUSES OF DISEASE. This latter class of causes consists •—First. Of such as may be traced to indioidiuil exposures, excesses, etc , or to particular conditions, eitlier of locality, dwellings, atmosphere, circumstances, habits, particular suscep- tibility, constitutional predisposition, /y/'e^otwfl' disecms, and consequent deterioration of constitutional strongtli, etc., all of which belong, more esix'cially, to the " Investigation of the Patient," and liave, already, been recited. Second. Causes, which are peculuir to a district, country, climate, or particular spot, and which are, then designated as endemic: Almost every district, especlUly such as are remarkable, for rapid evaporation, excessive and sultry heat, stagnant waters, and rapid decomposition of vegetable matter, or marshes with little or no drainage, or bleak, exposed situations, wliere dry, cold, and searching winds prevail, and the waters are hard, and, generally, impregnated with mineral substances; for sud- den and frequent changes of temperature ; for general flatness of country, or for elevated and irregular surface; for winds of a particular character, and from a particular quarter; whether inland, insular, or coasting; whether the prevalent occupation be that oi factories or fields; and whether the habitations of the people are isolated, well ventilated, well drained, generally clean, or closely packed, squallid, small, dark, loath- some, i'1-drained, and ill-ventilated. These, and many local distinctions of a similar character, will tend to render the generation and prevalence of particular diseases, properly speaking, indigiuous, or endemic, and should, therefore, be duly considered. Third. Causes, which are of a general, indeterminate character, such as heat, cold, damp, draught, and particular electric relations, but which are prone to become associated with sudden transitions of atmospheric condition, and which will be the more surely developed by the presence, or pr^odence, of certain other diseases arising from similarly itideterm- Incite causes, by the superabundance of particular natural products, (veg- etable or fruit,) or by the deficiency of food, as in cases of famine, or by calamities of various kinds. These are generally cUissed as Epidemic caus'^ and are properly divided into three sections, viz : those which occui regularly at certain seasons ; tiiose which are of continuous dura- tion, and are, apparently, of incessant development, such as small-pox, measles, scarlet fever, etc.; and those more properly and exactly epi- demic, that is, which appear under particular electric, and other condi- tions, from time to time, scouring whole regions, and whole continents, wherever the like circumstances tend to engender them, but which, then, unaccountably subside. It is worthy of especial notice, that all three general classes of these causes engendering, disease, are to be removed, modified, extenuated, or even eradicated, by judicious management, by the removal of tlie direct causes, (if any be apparent,) or by the preparation of the system, by means of specific remedies. THE GENERAL CHARACTER OF THE DISEASE. This is determinable by considering the various manifestations in conjunction with the state of the circulation, or action of the heart, as dis- tinguishable in the condition and peci'.liarities of the pulse, which, alone, can serve distinctly to characterize disease. Pain is, very generally, no 1 INVESTIGATION OF DISEASE. 35 criterion, except as quallflod by the pulse; the muscular and nervous action is usually no criterion, except as qualillcd l)y tiie I'Ulsk; the diges- tive functions, secretions, discharges, etc., will ol'te;i leave the degree of progress, danger, or curability in disease undetermined, without rel'er- ence to (he i'ulse; to the consideration of which wo will, therefore, proceed . THE PULSE: ITS VARIATIOXS AXD IXnTCATTOXS. THE AIIT OK Fi:iiLI>fO TIIE PULSE IN ORDER TO DETEUMINE ITS ClIAli- ACTEU ACCURATELY. First. Avoid feeling the puliio abruptly, and until the patient has been beguiled (if possible) by irrelevant conversation. ISecojul. M Uce such an investigation of the iiistory of the case as to assure yourself that there may not be some immediate casual circumstance calculated to have fluttered, or otherwise affected the patient, and thereby to have disturbed tlie pulse more immediately. Third. Place tiiree of the fingers upon the artery on the inner side of the left wrist of the patient, having the thumb so applied to the back of the wrist that tlie pressure which you apply to the artery can be niodilied, increased, etc., in any and every degree; and that thereby, and by so vary- ing the degrees of i)ressure,) having a considerable length of the artery under the three (ingin-s.) you may be able, not only to distinguish the num- ber of beats which occur in the minute, but, also, the particular nature of such beats; as, for instance, whether by pressure, you can, api)arently, suppress the gush of bloo I tln-ough the vessels; or whether, wlien strongly pressed, the current seems to worm through, beneath the lingers, like a wire; or whether the bound is so strong as apparently to force the fingers away in its impetuous passage; or whether the pulsations are very sud- den, distinct, abrupt, and, as it were, convulsive; or whether, on the '^ther hand, the pulsation appears to linger, and to pass languidly ; or whether, again, there is no distinct pulsation, but a rapid thrill, rather to be called a vibration than pulsation. In order to thoroughly distinguish these vari- ations, it is imperative that the attention should be absolutely centered in this one object, and not distracted by any other circumstance. THE AVERAGE STANDARD OF HEALTH. The healthy pulse of an adult (in the stage of maturity) male person of large and expansive fram;), should (with the modifications before men- tioned, under the head of "Constitutions,") be firm, not compressible, but sensibly urged through the artery, notwithstanding pressure, yet neither hard, (conveying a shock to the touch,) sudden and twitching, nor like a thread, worming its way beneath the fingers; but moderately full, even, regular, and numbering from 70 to 75* beats in the minute. The healthy pulse of an adult (in the stage of maturity) male person, of smaller frame and proportions, should, in general, number from 72 to 78 beats, subject to the same general characteristics in other respects. <■ If, however,. the puUo bo habitually slower or quicker, we shoul 1 assume this as an individual Btandard, because instiinces are upou record of the pulse of healthy adult males varying from 30 to U\ beats. Young infants are known to have a pulse numbering from 140 to 150 beats. If tho skin ''r> moist at a natural A?a<, and not flushed, this would be no sign of disease, Tho pulse also vi;,,^ befiwe aud after uju''^" I ■'V\ v:\ m INDICATIONS OF THE PULSE. The healthy pulse of an adult female should, with tho same general reservationH, number from 80 to 85 beats In the minute; but we should not anticipate as strong or full a pulse in a woman as in a man ; n()r, indeed, siiould we always attach much imiiortance to the carnal precipi- tation of tiie pulse, especially of highly nervous fcMuales. Tho healthy pulse of a young person in tiie second stageof childhood, viz.: Irom seven to fourteen years of age, should number from 80 to 3i beats in the minute. The healthy pulse of a child, under seven years old, from tho period of teething, may be stated at from 86 to 06 beats in the minute. The healthy pulse of an infant, before teething, nuiy be stated at from 100 to 120 beats in the minute, according as the child is robust or weakly ; the robust infant generally exhibitingaloss frequent but stronger pulsation. The healthy pulse of the first stage of declining life may bo generally stated, for the male, at 70 beats; and for the female at 7o beats in the minute. The healthy pulse of the second stage of declining life (that is, old age,) may be stated for the male, at from 55 to 65 beats ; and for the female, at from 65 to 70 beats in the minute. GENBPvAL INFERENCES DEDUCir.LE FROM TIIE PULSE. 1. Palpitation of the heart— The palpitation or pulsation of the heart, when felt di-stinctly, and predominantly, or when even heard,ov so .severe as to reverberate, as it were, through the frame, and to shake the &ide, may be considered as characteristic, either of— Nervous irritation, tho result of sympathetic disturbance, originating in the stomach, especially if worms be present; of hysterical and other spasmodic affections ; or severe bodily suffering, or of violent emotion, etc., and when the result of hysterical disposition, should occasion no apprehension ; or of— Excessive debilitation, resulting from loss of blood, or other .severe, excessive and protracted discharges, in which case it generally termin- ates in a swoon, which, if only occasional, does not indicate organic disease of the heart ; or of— Sudden determination of blood to the heart, or other organs, which, in females, should apprize us of an approaching menstrual crisis, (if in due season ;) or of— Organic disease of the heart, when it will be characterized by con- tinuance, or very frequent recurrence, constantly terminating in loss of consciousness. 2. The pulse— VfiW serve to determine the most essential questions respecting disease, such as (1) the degree of vital power possessed by the patient; (2) the nature of the disease, that is, whether or not inllamma- tory action be present; (3) specific characteristics of the disease, that is, whether it be the result of superabundant strength of the blood and sys- tem, or whether it be occasioned by, or attended with, a depressed condi- tion of vital energy; (4) the degree of progress made by disease upon the vital power, and consequently the greater or less degree of urgency ; (5) especially in highly critical cases, when no other distinct index is afforded the selection of the appropriate reactionary remedy ; (6) according to tho ! INVESTlQATtON OI' DISEASE. HI Renter or less degree of impres. .on lUiule upon the pulse hy such iidinin- istration, whetlier or not we have properly selected, and horn far we ahoulJ be justilied in chaiKjlng Hie niedicine. ■■3. ■■>'; ■t- VARIOUS NAMES OK ALTERATIONS OF TUB PULSE. 1. Frequent pulse— X term appli(!d to tlie succession of tlie beats. I3y this we understand sinii)ly an increased rapidity of repetition. 2. ISlow pulse — The designation of a pulse less rapid than in health. ?j. QiUL'k pulse— A. term wliich designates tiie rapidity witii wliich the current passes through the artery at (sacli beat, (pialifying the character of the beat; whereus./?'e9ite/ic.y (as above) is a term denoting tlie rapidity with which one beat follows another. 4. Sluyc/ish or Tardy pw/se— Expressive of the languid, extended nature of the beats. 6. Hard pwZi'e— Expressive of the sensation of flrmnoss and positive- ness wliicii it conveys to the touch. fi. iSoft palse—Exi)ressive of the smooth How (so to speak) of the blood beneath the pressure of the fingers. 7. StroiKj pulse— Is the name of a pulse, which leems to bound beneath the touch and repel compression. 8. Feeble pidse— That which yields to compression, apparently defi- cient of vigor to force its way in spite of pressure. 9. Lar(/e;«iZse— Expressive of the dilation and expansion of the artery as evinced to the touch. 10. iHmall prtZse— Expressive of the apparent retraction of the artery, and the minute channel through which the blood passes, as evinced to the touch. 11. Full pulse— A denomination applied to a pulsation which seems thoroughly to Jill the artery at each beat; wliereas, the laroe pidse is only understood of a dilaUnu current, without conveying the idea of solidity, as of a well-filled vessel. 12. Empty pwZ.se— When the beats do not seem to convey a very dis- tinct elevation to the artery, and which appears as a combination of the characteristics of the soft and small pulse. 13. Unequal pulse— T\vAt which, without being suspended, does not beat at regular intervals of time, or in which the quality of the current (as hard, soft, feeble, full, etc.,) differs with different beats. 14. Intermittent pulse— Ov that which is characterized by the occa- sional suspension of beats. 1 INDICATIONS ATTRIBUTABLE TO THESE VARIETIES, SEPARATELY AND JOINTLY 1. A very important distinction to be deter-iained, namely: whether the disease is characterized or engendered by excess or deficiency of vitul power; that is, by over-luxuriance, or poorness of blood, is to be evinced by the strong, hard (incompressible,) pulse, on the one hand, and by the soft feeble (compressible,) pulse, on theotherhand; the ^/'ii being indicative of excess, and the second of deficiency of strength. 2. Another distinction, in determining the nature of the disease, con- sists in the explicit indications afforded by an unequal or changeable pulse, 'I i, •r i »8 LESSONS FROM TUB PULSE. which, in acute cases, identines the inalmly as nerm'K, not inflamnuitory ; aiul, in dironio cusos, as Irrespcclive of tli«!circuhiii'.iii, ami associated witli llie nervous system only. Thus, we sliould be mow iiiitious not to mistake (Mitting, stitcllin,!,'. pricldns, or siiootiiij,' pains, in tl; • i iiesl, or violent lixcd liains, (even willi violent throhbinL--,) or pains i.i llie chest, (as just d(!8cribed,) with sulfocative opi)ressi()i! oi' breath, a> r.impanied with such a state ol' pulse, for injldtninalion ; for the jailse would dl.-iliuctly identify a. purely spasmodic or nairalnia sufferin|f. 3. A healthy pulse, or a pulse of a purely nervous chanicter, as just described, attending affections of the chest, and especially of i\\ti a b-pas- sai/es, is precisely, in some cases, tlie nnmistakable index of AhtiTma, in contra-distinct ion to Consumptive affections, which are always character- izedhy iifeocrish, feeble, irritative, accelerated pulse. 4. The accelerated jmlse if unqualified by any other feature, exhibit? irritation, or fever, (pmperly so called,) or increased susceptibility to irrita- tion, which may result from mechanical causes, tending to lessen the action of the heart; (as tight lacing, etc.;) or from cold in particular, which has caused an irregular retrocession, or congestion of blood ; or, again, from an increase in the richness, or quantity of the blood, wlwch destroys the equilibrium between the motive action and tlie current of l)lood. Increas- ing acceleration Is Indicative of increasiufj inllammatory action; subsiding rapidity Is indicative of the removal of the irritation, and analogously of its cause. If the frequency of the pulse continues or returns after a crisis, (resulting In peraplration, slcej), etc.,) we may judge tliat tlie effort of nature was Incomplete, and that, therefore, a continued effort remains. Frequency of pulse may be associated with tlio owr-stromj or mrij feeble state of the circulation, and will bo more continuous and dltlicult to subdu ""n qualified by feebleness, than by strength; It will, also, in mar le more excessive. Thus, In cases In which tlie pulse Is very ■> IS, for Instance, 120 to 180, or even 200 beats to the minute,) It Is Aill, and then points out the lowest state of debility, or what Is called .trld condition. Tliis is. Indeed, an Imperfect pulse, and sometimes proceeds to a mere thrill or vibration, when It Is totally indistinct. An analogous sensation may, however, be conveyed In very severe cases of "Inflammation of the substance of the lungs,'' as an inflammatory pulse; but then the artery will be dilated a.m\fidl. If a long breath be drawn and held; whereas, the pulse of debility Is quallfled by n small, retracted artery. Again, if the pulse be accelerated, and also strong, or full, and Jiard, we may distinguish a decidedly Inflammatory condition— Inflammatory fever. 5. The s'n, nlse, unqualified by any other condition. Is Indicative, either of weakH<i.K or of spasmodic condition, which may be easily deter- mined by the accompanying or antecedent circumstances, and by the following distinctions :— If associated with hardness (small and hard,) It Is especially Indicative of a convulsive state. If associated with softness (small and soft,) It Is especially characteris- tic of debility. Further, we may study the following distinctions, either singly or in association :— ThQ slow pulse (If not habitual— some adult subjects, especially males, having habitually a pulse varying from thirty to fifty beats in the minute, INVESTIGATION OF DISEASR. 39 I ^1 without disease,) is indicutive of iiuMilUciont (luiintity of l)lo()il— as uftor severe depletion— of adviiiicing age, of tlio aubsideiico of fover, (wliieli frequently leaves a reactionary i)ul30 bdofo llio standard of liealtli,) or of pressure on the brain, as in cases of congestion, water in the lioad, etc. Associated with the following variety, especially after concussioa of tlio brain, etc., it is of a serious character. The sluggish or tardy pulse particularly distinfeulshes a torpid condition and a low typhoid character assumed by the disease, and pressure on the brain, when it is of more serious import tiian ilie slum palM',imd of still more serious consequence when associated with the last. The hard pulse (simply) indicates especially in/Uimmalimi, (as in fever, etc.,) or a convulsive condition, when qualified by evidences rcsidtiiig from the investigation of the nervous symptoms distinguishing this condition. In old age, again, the hard pulse (especially if lan/e,) is of very frequent occurrence", or caused by the dryi.ig, contraction, or even ossilication of Iho arteries, which convey this sensation to the touch, owing to a decrease of suppleness or elasticity. The soft pulse (Him\)ly) i^ioves the absence, both of inflammation and convulsive condition. The strong pulse, which indicates superfluity of blood, a full habit. The fteble pulse, indicating deficiency of blood, an attouualed habit. The large pulse, (simply) indicates an unimpeded elasticity of action, and is the truest index of the absence of cramp, irritation, or excessive irritability; it is^JUe distinctive feature, especially after 4icutc inflanirna- tions, of a vigorous operation of the heart, and proves that there is an ample sulficiency of blood in active circulniion,{coi\s>(H{\.w.\\\.\y no local or organic determination ;) the large pulse iwhen unqualified by otlier features.) is, therefore, to be considered as a proof of the effectual resolution of an irritative effort, (such as fever,) when it sets in at the crisis. The large pulse may, however, be associated wiih fvUness (only) when itpointsout the insulficicnt liquefaction of blood (or thickness) in which case it is easily compressed, as often occurs in typhoid fevers, (•^ith debil- ity,) and when it is a spurious fullness; or, again, the large pulse may by iissoc'uiteCi wilh fullness andJiardness, when it clearly indic.ites irritation of a peculiar kind. Thefullpulse distinguishes a plethoric or full condition of habit of body. TheewpiypjiZse offers indications analogous to the".sma/Z and soft,'' (as above stated.) The unequal or changeable pulse generally characterizes a universal nervous condition, and is one of the distinctive featc.ves of nervous fevers, or of fevers resulting from or accompanying deficient vital energy. It also indicates spasm at the heart, or even deeper and organic derange- ment of the heart, or deficiency of elasticity or energy in the action of the heart; and it may, also, in cases of inflammation of the substance of the lungs, be held to indicate such a state of congestive, or other obstruction, as impedes the progress of the current through those organs, when, conse- quently, it is a most serious symptom. The intermittent pulse. In this, we may, especially, distinguish a spas- modic condition of the heart, (sometimes organic disease,) particularly sympathetic as resulting from intestinal affections, such as congestive JL^4-J. ■-{ruT^ (- 40 CONDITION OF TIIK BLOOD. determination of blood, or sucli as excessive relaxation of the bowels, or predisposition to relaxation. .!■-,» ! i.1 f' i't n THE CONDITION OF THE BLOOD. Bv *his division of investigation, it must not be suspected that the inspr iici of blood abstracted by venesection is indicated, for the use ol the lancet is the (jreat and tjrievuus eiror which has been effectually super- seded. The artificial abstraction of blood is, th'^refore, as an all but inva- riable n ■ out of the question. But it will often occur, when the condi- tion of the blood affords vary distinctive indications of the nature of the disease, or of the system generally, that spuntancotis or casual dischanjes take place, which we may have an opportunity of investigating. We should, principally, notice a tendency to coagulate very quickly, or too firmly, or in too great a relative proportion to the fiuid residue; or, on the other hand, an excessive predominance of the fluid proportion or absence of coagulation. 1. Coagulation, which is too r?pid, firm, or too great in proportion to the fluid residue, especially if further qualified by the superficial floating of very little of the watery humor, (which is one of its constituents,) that, again, being coated over the surface with a very firm, white skim, is posi- tively iuv^icative of inflammation, tendency of the disease to develop inflammation, or predisposition of the patient (if in health) to attacks of inflammatory disease. Coagulation, in general aspect,^ just stated, but which throws up a superficial skim, of detached, unconnected, woolly, or yellowish, or, sometimes, greenish app,earance, distinguishes an irritation of nervous rather than of a specifically inflammaLory character. 2. Insufliciency of the watery constituent, that is, when all, or almost all, of the blood is dark and thick, indicates a liigDy bilious habit of the body. 3. Superabundance of the watery humor, as a constituent of the blood, that is, when the tendency to coagulate is slow, and affects only a small portion, (and that, often, of a paler color than is usual,) and when the greater part resolves itself into a watery superfluid, indicates a deficiency of power to appropriate and distribute the nourishing portion of the food for the sustenance and uses of the system; and (if of menstrual blood) a constitutional disposition to debilitating disorders, such as "green sickness." 4. Absence of healthy coagulation, the blood being dark, but remain- ing entirely commingled in all its component parts, not separating the Watery humor, and remaining in a thick, inadhesive condition, (not jelly- like,) indicates what is termed a putrid condition, or that stage of dissolu- tion in which the vital energy sinks fro.n deficiency of power to expel what is mischievous (as in putrid typhus); and, in general, a scorbutic habit of body, which involves a predisposition in every disease to assume a putrescent character. 5. A dark, yet clear, red blood, indicates strength, and a sufliciency of reactionary power. 6. Black, or very dark purple blood— which is associated with such diseases as result in predominance of venous over arterial blood, and which may indicate organic defect of the structyre of the heart, jiarticu- larly if the complexion have a bluish or purplish hue ; and which may. I 4t INVESTIGATION Of disease!. 41 also, indicate a highly bilious complication of intestinal derAAgement in scorbutic subjects (particularly,) more especially if the blood be muddy, thick, and black. 7. Pale blood, from superabundance of watery fluid, also, character- ized by excessive liquidity, indicates constitutional weakness in the pre- dominance of the watery humor, as a constituent. Pale blood (from light redness of the coagulating portion) indicates a pernicious constitutional habit, such as the constitution heretofore des- cribed as " Rheumatic." 8. The watery Immor (as a constituent of the blood) thoroughly and distinctly separated from the coagulating portion, which is deposited in a firm jelly (and without any of the unhealthy manifestations described under 1) above, may be assumed, as an index of a healthy process of circu- lation. 9. The watery humor (as a constituent of the blood) appearing whit- ish, and thick, indicates deficiency of constitutional vigor, especially in the distribution of nutriment. 30. The watery humor (as a constituent of the blood) appearing of a distinctly yellowish hue, indicates an admixture of bile with the blood. SPONTANEOUS DISCHARGES OF BLOOD GENERALLY. If the discharge be from the nose, in cases of inflammation of the brain, severe determination of the blood to the brain, or of inflammatory fever of any kind, the symptom is to be considered as a wholesome crisis. In general, discharges of blood may appear as the crisis of a disease, particularly of severe fever ; but they may occur as the result of local deter- minations of blood, or inflammations, of over-due fullness and distension of the vessels, of precipitation of blood upon a weak part, (or, generally, of comparative deficiency of firmness and strength in such part, as when a blood-vessel is broken ;) or again (as a most critical symptom) of a putrid condition. vJ! THE UBINE, ITS VABIETIES AND THEIR INDICATIONS. From the considi .ation of the blood and its appearances, we cannot transfer our attention more appropriately than to the like variations in the urine, as the discharge, the pr messes attending the secretion of which are most intimately connected with the blood. THE HEALTHY APPEAnANCE OP THE URINE. Unaffected by any of the subjoined or other particular circumstances of age, sex, method of living, active, or sedentary, particular articles of food or drtnk, the season of the year, and as a most important exceptional condition, the constitution of the patient— the urine should be of a pale, bright yellow, or straw-color, remaining clear after standing, precipitat- ing no sediment, and of the peculiar ammoniacal smell, but devoid of all loathsome odor. Exception 1. However, in old ?.ge, it is consistent with healtli that the urine should be offensive, lessened in quantity, and deepened in color. I' ; « ' 1 ) r II' 9 Im i |i t iV ::.- -- r ,- ' ' v ■■«-»Uta:a-M 42 APPEARANCE, ETC., OF THE URINE. . Exception 2. Amongst femalos a degree of sediment is not always an unhealtliy sign, and tiie urine is liabitually of a paler hue. Exception 3. Witli respect to the habits of life, it may be expected that a person leading a very active life, with especial predominance of I)liysical exertion, should emit darker and more scanty urine than the stated standard— and. tliat in an individual of very sedentary habits, it should be ciiaracterized by more copious, but paler discharge. Exception 4. As to eating and drinking, it may be stated as an excep- tion to the general rule above, tliat certain vegetables, (especially those of a diuretic nature.) such as asparagus, will usually cause the discharge to be offensive; other substances will give it a bright, gold yellow; excess of stimulating liquor will render the discharge pale and copious, etc. ; whereas, also, within about six hours after eating, it will commonly be cloudy. Exception 5. The increase of constitutional vigor, or perhaps more directly, the greater enjoyment of open-air exercise, which the summer affords, tends to render the urine darker and more scanty, whereas, in win- ter, (that is, under contrary circumstances,) it is usually less highly colored and more abundant. THE PROfER TIME AND METHOD OF INVESTIGATION. Tlic urine should not be examined, or, at least, no reliance should be placed upon its manifestations, within less than six hours after a meal; and such of tlie urine as is reserved for investigation, should then be set aside in a place wliere the temperature is even and moderate, for at least two hours, not being at all exposed to sudden transitions of temperature in the interval, after which we may examine wliether any of tlie subjoined evidences be present. THE VARIATIONS APPARENT IN TIIE URINE, AND THEIR INDICATIONS. 1. AVith respect to the progress of fevers, the urine affords the most valuable characteristics, varying with each stage, as the result of the febrile course is developed ; as, for instance : Before the fever has taken ai ,, turn towards issue, that is, so long as it continues to rage without any tendency to a crisis, the urine, of wliat- ever color, is emitted (and remains after standing) perfectly transparent and clear; or, in other cases, (especially nervous fevers, and fevers in which the digestive functions are predominantly implicated,) tlie urine will be emitted (and will continue the same, and without deposit after standing,) thick and cloudy. 2. As the crisis of any fever having critical days, approaches, the urine, which was previously clear, will become thick, and will form a small half-floating cloud, or sometimes a similar cloud completely buoyant, or Avhich, should it sink for a time_, will rise again to the surface. In other cases the cloud will sink to the bottom. If the cloud should float, the patient will die, even though they may not appear very sick, ^f the cloud sinks for a time and then comes again to the surface, or, if it remains half- lloating, there will be about an even chance between recovery and death. If, on the other hand, the cloud sinks to the bottom of the vessel, the patient will recover, no matter how sick they may apparently be. 8. The actual determination or crisis of the fever is distinguishable by the precipitation of a sediment (simply,)— in cases in which the urine luul previously been clear— and by the like precipitation of a sediment. INVESTIOATION OF DISEASE, 43 and the complete clearness and transparency (as if filtered) of the over- (loiiting fluid, in cases in which the urine had previously been muddy and thick. But for this precipitation of a sediment to constitute a wholesome indi- cation, it should, also, be smooth, undisturbed, light— assuming an appar- rent, slight, rounded, elevation towards the center— white, or of a slightl.v f^ray color. It should not constitute more than one-fifth or one-fourth (at the most) of the whole volume discharged, and it should be deposited liiickly after the emission. For, otherwise, it is a bad signj as for in- stance: If black, or very dark, it indicates a putrid condition. If of the color of bile, or red, it characterizes an intermittent type of disease, or sometimes a rheumatic tendency. If white "and gritty, or deposited from dark, turbid urine, there is depraved habit of body, or perhaps some concreting substance in the urin- ary canal. Or, generally, if disturbed, irregular, of a purple hue, muddy, heavy, and constituting from one-half to two-thirds of the whole volume dis- cliarged, it is a bad sign. In General: If the URINE BE RED wlien the pulse is accelerated, there is a decisive, and positive indication whereby to distinguish constitutional fevei", inflam- matory action, and increased development of internal heat— from a similar condition of pulse, which might otherwise characterize a purely spasmodic affection. If of a deep saffron color, it represents the admixture of bile in tho blood, and if this hue be conveyed to white, absorbent surfaces, mois- tened with it, it decisively indicates jaundice. If it be thick and black, here is an indication of such a degree of inflammatory or putrid condition, as resolves itself into gangrene. If bloody, turbid, thick, and depositing an excessive proportion of sedi- ment, we have an evidence of approaching decomposition of the blood. If, other things being equal, it be characterized by the floating of an apparently oily substance on its surface, we have an evidence of what may be termed advanced constitution.il decay. If matter be mingled with it, there must be internal suppuration. If the urine (of children) appear, as it were, milky, we liave reason to suspect the presence of worms in the intestines. If it be thick, but pale, or still more, if it be very changeable in appear- ance, during the course of a fever, we have reason to look upon the tlisease as of a nervous kind. If it be clear, transparent, and watery, and there be continual urging to discharge it, the nature of the affection is distinctly spasmodic. If it be bloody, there is probably a degree of inflammation about the bladder or kidneys. If slimy, we look for a discharge of the character of phlegm from the bladder, or obstruction of the neck of the bladder by some concreting substance. Or, again, as regards the manner or sensations which characterize the discharge : ■HliiSiiiii 44 VAE1ET16S OF BREATHING. ;!i D f| '\:i i u I i If the discharge be invohmtary, the affection is of a paralytic char- acter; but it should, also, be noticed that in such cases of fever as evince this symptom, it is sometimes very diflicult to ascertain \vhether it is realltj inwluiA%ry (in the true sense of the term). If really so, it is a serious manifestation. If, on the other hand, the discharge be either difficult, painful, or impeded, it variously represents disease of a locally inflammatory, or spas- modic nature. It should be noticed that sudden checic of perspiration will often occasion an exceedingly copious and watery discharge of urine. Excessive relaxation of the bowels, the previous use of drastic purga- tives, or profuse sweating, will fre(iuently cause a darker and more scanty discharge. Chemical and Microscopic Distinctions, and the distinctive fea- tures of other varieties of the urine, have been intentionally omitted, as calculated to lead unprofessional persons into erroneous experiments. BREATHING; ITS VABIETIES AND THEIB INDICATIONS. In many diseases, especially those whose seat is in the respiratory apparatus, the manner of breathing, the pains, etc. , developed by the act of breathing, the sound emitted by the inward and outward i)assage of the breath, etc., are the only signs upon which we can rely for a thorough and distinctive apjireciation of the nature of the affection, with the reservation, iiowevcr, that the relations between iXxa pulse and respiration are never to be overlooked. In all diseases, especially in those of an inflammatory or putrid character, there is much important insight into the direction, etc., of the malady, acquired by a careful consideration of the operation of this vital function. THE BREATH IN HEALTH. The frequency, and even the manjier of breathing, in individual cases, is best determined by the habitual conditions of both. But, as there should be about four pulsations to every act of respiration, it may be expected that, in healtii, supposing the medium standard of the adult pulse to be SO beats in the minute, there would be 20 inspirations and 20 respirations in the same time ; and in the lilce proportion. The breathing would also be easy, slow in repetition, and in inhaling and exhaling eqnal i\n(\.ftill. It is not, however, to be inferred that the relative equality of 2^i'oportion between the beating of tiie pulse and the expansion of tlie lungs, is, in itself, a sign of Jiealth although it may be assumed there- from that the blood is not deteriorated in quality, on the one liand, and tliat the operation of the lungs is not organically affected, on the other hand. THE VARIATIONS TO WHICH BREATHING IS SUBJECT, AND THEIR INDICATIONS. Frequentbreathing— hy which is nnderstood a rapid and continuous suc- cession of inspirations and respirations— is an evidence cither of acceler- ated circulation, or fever, .and consequently of organic inflammatory affections of any kind, involving constitutional disturbance ; and also of INVESTIGATION OF UlSEASE. 45 Insufficient ('lasticity) strength of the lungs. Frequency of breathing, when associated with inadequate expansion, is an evidence of some obstruction whicli oppresses the operation of the kings; as, for instance, created by congested blood (as in inflammation of the lungs,) by tlie pres- ence of water in the cavity of llie chest, (or even, in severe cases, in the cavity of the belly,) by inflation with wind, (the oppression being communi- cated by the contiguity of the lungs to the inflated parts of the stomach,) or by the alteration of tlie substance of the lungs. This variety is opposed to the hahitiud degree of slowness, in the breathing of health. Slou) (unfrequent) hreathiim, when less frequent than in healtl), and further qualified, by deep breathing, at remote intervals, as if in a convul- sive effort, is frequently associated with spasmodic affections, swooning, etc., and is an evidence of want of strength. Qxikli breathing—a term by which is understood that the i/i-spiration is incomplete, and is quickly succeeded by the re-spi ration— is occasioned by the presence of some oppression or obstruction, which renders tlie expansion of the chest so painful as to hurry the oi)eration of decreasing the pressure, by expelling the air; it is almost invariably the result of any severe inflammatory affection of the intestines, or apparatus of respira- tion, ai\d commonly occasions a more sudden and spasmodic effort to expel the air, as manifested in cough. It is opposed to the healthy tar- (Hness of respiration ; tliat is, to the deep, {^\o\\\ 2)rotracted inspiration and respiration, with power to JioM tbe breath (full) for a length of time. Tardiness— may, however, be excessive, as resulting from weakness. The deefp or long breath — when even, protracted— as to the inlialiiig, and exhaling— noiseless nd evidently without effort, is one of the charac- teristic features of healtiiy respiration; but, when deep, long breath, is evi- dently the result of a severe effort, somewhat difficult, irregular, sonorous and, sometimes, abrupt, it becomes an evidence of spasmodic affection— especially involving the anterior (front) portion of the cavity of tlie chest and abdomen, or, sometimes, of great fullness of tlie vessels about those regions ; or, again, (as if there be a long pause between the explosion of one draught, and the re-inspiration of another,) of a condition of stupor and delirium. The small or short breatli (simply)— may be considered an evidence either of weakness, or of spasm. We have already noticed this variety, as associated with frequency. Difficult breathing— iva^MQ.?, several distinct varieties, either of whicli may, appropriately, bear this name. In any degree, difficulty of breathinfr may be associated with coldness of the extremities, (especially the feet,) confusion and heat of the head, an empty, small and remittent pulse, owing to the obstructed and dilatory progress of the blood through the lungs. If rare, difficult breathing may be attributed to some accidental, or even mechanical, cause of oppression. As a symptom of disease, it would arise from the presence of any obstructing matt'er, (blood or water, etc..) impeding the action of the lungs and air passages; or, as a symptom, unat- tended with any evidence of inflammation, it would be occasioned by spas- modic affection of the respiratory apparatus. ^9" id VARIETIES OF BREATHING. 1 5 1; Monnin-ff or sigliinff breath is a variety of difficult brealliing, and seems ratiier to identify the enveloping membranes of the Inngs as the seat of the affection. Oppressed breath (simply) may arise either from impeded digestion, from particular conditions of atmospher-s or from affections of the air- l)assages. Panting breath rather identifies obstructions (such as thickening of the lining membrane,) in the windpipe and air-tubes. Siiffocative breath— i\\'Ai is, when the breath is totally arrested by re- cumbency—may result from extravasation (pouring out) of blood on the lungs, etc., from the accumulation of water, from alteration of the sub- stance of tlie lungs, or from what is termed paralysis of those organs ; in any case it is a most urgent symptom. In all respects, it is opposed to the easy breathing, or to the habitual degree of ease in breathing, which char- acterizes the healthy state of the patient. Warm breath (simply)— indicates a degree of fever; if very hot, particu- larly if the extremities be cold, it is a positive index of general, internal inttanmiatory action, or more particularly of inflammation of the substance of the lungs, or of some of the adjacent intestinal parts. Cold 6reai7t— indicates a deficiency of vigor (superfluity of watery humor,) in the blood, and, consequently, sluggish, languid circulation. Jt may result, however, from obstruction which prevents the effectual pas- sage of the blood through the lungs. As a symptom appearing with the sudden suspension wf pain, and with general dullness of sensation in severe organic inflammation, it indicates internal mortification; in any case, as attendant upon the last stage of a very critical disease, it is a fat ' sign. Unequal breath— im expression which conveys its meaning— may, in very severe cases, result from obstructions impeding the inhalation or exhalation of the air, (chiefly in the windpipe and aii-tubes.) or it may be occasioned by purely casual circumstances; as, for instance, spasmodic affection of the nerves connected with the respiratory apparatus. It is opposed to the eipial breathing of health. Noisy respiration— ov that which is attended with unnatural sounds,— is subject to several modifications; as, for instance, whistling breath, which, in the majority of cases, indicates the result of spasm, or of accu- mulation of phlegm, etc., in the windpipe. Rattling breath, wlwch may result from the presence of matter, blood, or phlegm, partly obstructing the air-tubes ; or, as a fatal sign, it is the result of paralysis of the lungs. Flapping breath, or that which is accompanied with an occasional sound as of the sharp flapping to and fro of a dry valve, indicates the presence of very adhesive matter, or phlegm, in delicate cells connected with the air- passages. Crackling or a-epitating breath, which, as associated with inflamma- tion of the lungs, would be qualified by the other distinctive symptoms of that disease, may (particularly in aged persons) indicate deficiency of moisture in the lining membrane of the air-passages. Oppressed breathing, or oppression of the chest, will be treated of under the head of anxiety, (see "Pain,'' etc). Offensive or fetid breath— a symptom which requires no further des- cription, but which must be considered in due relation to other circum- 8tauces~as, for instance, going too long without food, will engender it INVESTIGATION OF DISEASE. 47 The menstrual periods are sometimes attended witli it. Excessive use of mercury, under any treatment, is anotlier ascertainable cause. A .scorhutk hdhit of' body (or that in wliich every affection has a disposition to resolve itself into a greater or less degree of putresence,) is unmistakably discernible from this symptom, when continual and liabitudl. Excess of animal food may occasion it. Decay of the teeth, and inattention to the proper cleans- ing of the mouth and teeth, will almost inevitably induce it. In typhus it characterizes the putrid degeneracy of the disease. In all'ections of the chest it usually characterizes suppurative proce.sses in the lungs, etc. As a general rule, especially in the absence of any particular conditions, such as have been stated— foulness of the stomach, or the presence of worms, or other impure substances in the intestines, may be distinguishable by offenaive breath. u\ THE DIGESTIVE FUNCTIONS, AND THE INDICATIONS WHICH THEY AFFORD. The digestive functions, as is well known, afford some of the most palpable indications of derangement; and as the nutritive or tributary pro- cess is ent\i'ely centered in this portion of the system, one very important deduction is dependent upon its condition; namely, the sufficient or insufficient degree in which the subsistence of the whole constitution is provided for by the processes acting upon the food, and, in the habitual state of the digestive process. Persons of habitually strong digestive powers are more likely to resist the injurious effects of external circumstances; such as heat, cold, infection, sorrow, etc., etc.; but once attacked with disease (especially inflam- mation,) they are prone to be very seriously affected. At the same timii disease will be more likely to run a rapid course with such subjects, and to terminate promptly, than to degenerate into chronic disease. If the digestive process be habitually weak, we have a general indica- tion of precisely contrary conditions. THE EVACUATIONS AND THEIR INDICATIONS. CosTivENEss. — Suspended or deficient evacuations maybe the effect of inflammatory tendency ; or of muscular debility; or of inaction of the lower intestines; or, again, of deficient or altered discharge of bile from the liver into the intestines; or of general debility of the system, and poverty of blood. Suspended evacuations may, however, be occasioned by mechan- ical obstruction of the bowels, as the lodgment of improper substances, etc.; whereas, deficiency of discharge may result from excessive dis- charges or transpirations of another kind. Very dark evacuations may be either associated with costiveness or relaxation, and in both instances they usually, when not induced by tlip nature of the food, evince an excess of bile. Hard, evacuations are of various kinds :— as hard and large ; hard and small (detached) ; hard and knotty, etc.; in general they exhibit a deficient degree of natural irritability in the lining membranes, more or less excess of internal heat, and deficiency of moisture. Relaxation, as understood, not only of less consistent, but of more oapious evacuations, is also subject to variations in the frequency, Hi 1 , ,1 t -- i ( ■ m I 1 1 1 , I! i 48 DIGESTIVE FUNCTIONS. ']^ ' color, od(a, etc., of the motion. In general, it may result from inflamma- tory or nervous irritability of tlie intestinal canal; or from llio presence of obnoxious, irritating substances, impurities, etc.,— such as undigested food, worms,— lliereiu; or from suppression of otiior discharges; or emo- tions; or, again, from a debilitated condition of the bowels, or of tlio entire system. If the discharge be green (of an infant), acidity is commonly exhilj- ited; if dark, predominance of bile; if pale, deficiency of bile. Spontantiius dischaiye should be distinguished from inwlautary (lis cJiaiyc, the former being of little importance, and being a common result of unconsciousness (when relaxation is present) and occurring, also; owing to the excremental matter being completely liquehed. Involuntary evacuations, properly so called, and attendant upon the last stage of severe fevers, especially fevers of a typhoid cliaracter, are indicative of paralysis, and are to be looked upon with great apprehension. Diminished evactcations are not necessarily opposed to the lessened consistency, and may occur either with highly consistent or very liquid motions; in the latter case, however, they generally exhibit an mpe//a'i expulsion of the matter to be evacuated, and, in such instances, of the presence of some irritative substances in the canal. If unqualified by any other manifestation (such as hardness, or those already stated) and espe- cially, if there be a constriction of the passage, the decreased quantity of the evacuation may be attributed to spasm. Straining to evacuate, is sometimes of spasmodic character, especially if the motion be only partial, very scanty, or totally sui)pressed. But without spasm, or especially nervous character, such straining may result from a greater or less degree of inflammation and its sequels, or from the peculiar susceptibility of the canal to irritations. Of painful evacuation we shall have occasion to speak under the head of " Pains." FLATULENCY— WIND IN THE STOMACH AND INTESTINES— AND ITS INDICATIONS. The generation of wind, either in the stomach or in the bowels, arises from the production of the elements, in the form of gases of the normal phlegm which is secreted from the blood. If habitual and excessive, it is clearly indicative of weakness or derangement (of nervous action or tone) in the stomach, if the wind be expelled upwards,— ov in the bowels, if the intestines become inflated, or the wind be expelled downwards. Flatulent distention of the belly, occurring in children, often identifies an additional morbid state, characterized by the presence of worms in the intestinal canal. Flatulent, drum-like distention of the belly dini g the course of FEVER, betrays want of vigor which may occasion serious results. If, at, the same time, theljelly thus distended be very tender, and severe pain he caused by pressure, a tendency to local inflammation in clearly exhibited. NAUSEA AND VOMITING, AND TIIEIII INDICATIONS. 1. These symptoms especially point out either original, local, or sym- pathetic affections of the stomach, or upper portion of the digestive apparatus, as opposed to the bowels or intestinal canal, which constituf (? the second division of this portion of the system. If, therefore, these symp- ^ "V INVKSTIOATION OF DISEASE. 40 toras be simultaneous witli unhealthy evacuations, it is to be deduced tliat botli the stomach and bowels are affected, either simultaneously or sytnpa- tlietically, or by communication oi the irritability from tlie one to the other. But tiiey may be occasioned by mere sympathy, without finy actual local affection, as: 1, by sympathy with the woj^b in females, and indica- tive of the earliest stage of pregnancy ; or, 2, by sympathy with the livek, as evinced by the pain or otiier symptoms emanating from tliat organ; or, 3, by sympathy with the buain, as tlie result of in'itation, or of oppres- sion occasioned by determination of blood, concussion, or water; or, 4, by sympathy with the intestines, as particularly evinced by perverse and continued constipation. All these relations should be duly considered, and, in the absence of any such remote causes, we may trace the origin of Uiese symptoms to the stomach itself, as: It habitual, i, to an organic derangement of that and the neighboring portions of tlie system. 2. If both food and drink are thrown up as soon as swallowed, to inllammation. 3. If accompanied ^itli foulness or enlargement of the tongue, as evinced in the state of the matter thrown up, especially if the suffering be immediately relieved after vomiting, to the presence of obnoxious and indigestible substances in the stomach. 4. If attended with sudden paroxysms of cramp-like pain, and abrupt suspension of breath, to increased irritability of a purely spasmodic char- acter. 5. If both symptoms occur habitvally in the morning, and there be no further indication of irritation of the stomacii itself, and if further exam- ination of the urine, and other symptoms lead to the same conclusion, they may be attributable to yravel or pregnancy. THE APPETITE, AND ITS INDICATIONS. The appetite maybe equally great, . greater, in disease than in health, but there are very distinct indications which distinguish these opposite conditions. The appetite of health should be even, regular, (not capricious or fitful) varying in the frequency of its return only according to the habitual periods of meals; but, if not governed by any habit calculated to modify the intervals between the returns of hunger, it should recur, in the adult, about every four to five hours, and in infants and children at intervals of from one to three, hours ; ami the meal should rvit be accompanied with flushing of heat, but rather with a sensation of chilliness. As an indica- tion of disease we find tlie appetite deficient, or absent, excessive and irregular— fitful— capricious— craving after particular substances, with absolute repugnance to others— characterized by a desire for unnatural things, as chalk— or by a particular longing for stimulants, etc., in the majority of which cases the stomach is the seat of derangement, but occa- sionally, also, the bowels, (as wlien worms are present in the intestinal canal;) except as regards suspension of appetite, which, in most cases, (particularly if supplanted by thirst,) indicates constitutional irritation, (FEVER), whatever be the original seat of the affection . In other instances we may remark an habitually excessive or craving hunger (not necessarily either capricious or fitful,; but particularly qualilied M flushing ofJieat, or i -"0 APPETITE AND THIRST. l)eculiar Jieat of the hands follow a meal when we may have reason to appreliend a hectic or consumptive disposition. In some cases, Iiowever, in wliich excess of appetite occurs (unaccompanied with tliese qualifying conditions) especiuily in young persons, it may l)e attributed to worms alone— to over-rapid growth— to violent exercise and excessive perspira- tion (sweat,) or to any other cause whi .. would tend to absorb or to con- sume the substance and nutriment of the body. Absence of appetite may more particularly be attributed : 1. To organic derangement of the stomach, or simply to weakness of the first process of tligestion. 2. And more frequently, to overloading the stomach, or the pressure of injurious and indigestible substanoos, even in moderate or small quan- tities. 3. To FKVEK of any kind, otherwise determinable hy the pulse, etc., except, indeed, to hectic or rheumatic fever, neither of which necessarily subdue the appetite. 4. To nervous, hysterical, and hypochondriacal conditions— or to nervous derangement resulting from emotions, as from excessive grief, alarm, etc.; or to the like, resulting (without fever) from undue pliysical exertion (a rare case) when the nerves of the stomach are implicated ; or frequently from undue mental labok or anxiety. Natural appetite, that is, appetite neither increased nor decreased, may occur, associated with hectic or rheumatic fever; when, however, it is generally qualified by other circumstances— in both cases, it is more likely to be irregular or excessive. Excess of appetite, as a symptom of disea.se, is nn evidence of poorness of blood, frequently attended with the secretion of an acrid, irritating phlegm ; but, without such conditions, it may result from purely nervous and sympathetic irritability— as during pregnancy, or in diseases of a purely hysterical charactei'- or, again, from some habitual cause of irri- tation, such as worms. In hectic or consumptive complaints, it indicates the insufficient distribution of nutriment by the tributary apparatus, that is, a \^nt of proper action in the digestive function to appropriate the nutritive constituents of the food. Excess of appetite will, also, often appear associated with habitual vomiting, or continued relaxation of the bowels, owing to the deficient distribution of nourishment. THIRST AND ITS INDICATION.S. 11:! In the majority of cases, continued thirst indicates fever or inflam- mation ; but, inasmuch as it will result from any dryness of the mouth and throat, and from lack of moisture in the stomach (without disease,) we must be careful to distinguish the thirst of health. The thirst of health may be the consequence of any condition calcu- lated to absorb the moisture of the mouth, throat, gullet, and stomach- such as:— severe physical exertion, greatly elevated temperature, particu- larly in a dry state of the atmosphere, or even when the temperature is much depressed by the deficiency of moisture in the air, particulaily if strong exercise be taken during the prevalence of such atmospheric con- ditions,— or, again, eating salt food, or eating solid food, especially heating Xood (chiefly animal) in excess, or continuing too long without food (with- INVESTIGATION OF UISKASK. 51 out necessary abatement of appetite) after the return of hunger, whereby III'' saliva has been exhausted. When, however, tliere in no apparent canst! for the thirst, eapecii'lly if accompanied witli increased heat, or dryness of tlio skin, vAv.., and if, upon investigation of other symptoms, further indications sliould warrant the conclusioM. we may infer that tlio thirst arises from internal lieat, iind is, consequently a symptom of fkvfk. If, in sucli a case, the tliirst be inteiiMe and insatiable (the pulse being full, hard and frequent,) the character of the FKVKR is distinctly ind'icaled— it in inflammatory ; that is, there is a deficiency of tlie watery constituent in the blood. Tliirst may, however, arise purely from acidity; when it will be char- acterized by risings, and acrid sensations in the gullet, etc. It may, also, be associated with spasm ; when, however, it will be characterized by dejkiency, not by excess of heat. THE TONGUE AND ITS INDICATIONS. The tongue affords many of the most important indications associated with derangement of the digestive functions. Tongiie thickly furred, dirty white, or brownish white, witiiout either unusual dryness, enlargement, or redness, indicates that the derangement involves ratiier tlie lining membranes than the nerves of the stomach, and that not to a serious extent. The derangement is then identified as com- paratively recent, and easily cured. Tongue furred with slimy matter, and with vioid red. tip and mar- gins, indicates also an affection of the lining membrane of the stomach, but one of a more serious and continuous character. Yellow tongue, also qualified by one or more of the last-stated condi- tions, indicates the liver as implicated. Clean tongue, of bright redness, naturally moist, but with the papilla} unnaturally prominent, indicates that the derangement affects the nerves of the stomach, and is of recent date. Dry, red, glazed tongue represents a similar affection to the last, but more severe, and of longer standing. Swollen, red tongue, hwi slightly charged with white fur, represents such a degree of nervous derangement of the digestive organs as to react congestively upon the brain, and implicate that organ. Cracked, furrowed fissured, swollen tongue, conveys to our apprehen- sion the most severe degree of derangement of the nerves of the stomach. Swollen tongue, thinly coated white, but bright red at the tip and mar- gins, indicates a complication of both varieties of indigestion— viz., that of the lining membranes, and that of the nerves of the stomach, which is of old standing, and of an obstinate character. We may look for irregular operation of the brain, as associated with this symptom, as well as xtreme despondency, nervous irritability, and depression of spirits and activity. Tongue indented on either side is a modification of the swollen tongue, already nif^ntioned as associated with derangement of the nerves of the stomach, and consists of a very severe degree of tumefaction (transient swelling). • . 58 SENSATIONS OF THE NERVES, ETC. Tremtilous tonffm, or tonRuo tremblinK' when protruded. Is often noticed umongHt hahitual drunkards, and distinctly indicates u complex variety of the nervous form of indigestion, implicttting tlio Hpinal niai rov,'. BJai!ltlfih,dry,fnrred and tremulous tonr/ti^, Ifi a symptom in abdomi- nal or putrid typhua. THE NERVES, BRAIN, SENSATIONS AND SENSES. This section inc'.ades tlie consideration of suspension, or ncuteness of sensation, perception, consciousness, volition, motion, rust, etc. LOSS OF OONSCIOUSNESS, DELIRIUM, FAINTING, ETC., AND TIIEIK INDI- CATIONS. Loss of consciousness nuiy be of three kinds, (as we sliall luive occa- sion to consider it.) two of which are primarily referaljle to tlu> brain, and one to tiio heart, namely : Apoplexy, (considered as a riymi)tom,) whicli consists in total snsjmision of tlie activity of the brain, and conse- quently, also, of nervous irritability and vitality; delirium, wliich con- sists in disturbance or irregularity in tlie activity of tlie brain ; and fainting, wliicla consists of temporary suspension of tlie activity of the heart, Init which, also, involves the like prostration of general nervous activity. Apoplexy, which is distinguishable by unaltered strength, or l)y increased strength of pulsation, accompanying total suspension or motion, or motive power, (wiiich does not always return witli consciousness.) indicates an organic aftection of the substance of the brain more or less critical. Delirium, which is distinguishable by loss of consciousness, or more properly, perhaps, of connected ideas, (generally of the nature of sleep, without rest,) with or without frantic movements, but always .. ith inciTased or diminislied activity of tlie brain of an irregular nature, affords various indications, according to the particular conditions and circumstances wliich precede, accompany, or follow it; or to tlie particu- lar disposition of the patient, which may serve to qual'fy it. 1. When it becomes continuous, and is divested of any other symp- tom of derangement, and tlie functions of the system continue in regular operation, it ceases to be a sijmptom, assumes the individual character of an independent disease, and would seem to indicate a greater or less alter- ation of the substance of the brain. 2. "When there is a continual predisposition to the return of attacks of delirium, without a permanent and continual duration, qualified, moreover, l^y other symptoms of hysterical or hypochondriacal suscepti- bility, it is of comparatively little importance as a symptom of diseases which exliibit tliat character (hysterical, etc.) 3. Persons of a habit of body and temperament, characterized by a peculiar activity, susceptibility, and excitement (easily provolied or aggravated) of the brain, so invariably exhibit this symptom with the least acceleration of circulation, and are so prone to become wholly alwtracted by the continued activity of the brain, that we should weigh (53) .M 54 INVESTIGATION OF DISEASE. well the accompanying iiKlications, which further characterizQ disease, before attaching!; much importance to delirium alone, in patients of such a descripton. 4. If, however, there be active delirium— that is, raving, occasioned by suddenly increased How of blood to the brain, with or without frantic action, with considerable derangement of the system, as shown by other symptoms, especially if this symptom occur in persons who are not sub- ject to u manifestation of the kind, we should first consider— whether tliere be continuous and active fevkh, in which case we have an indica- tion of the most inllammatory disposition of disease, and it remains to be considered whetlier the brain itself, or its membranes, be the primary seat of intiammat'on— or whether there has, previously, been some skin disease which has suddenly disappeared, or whether there are such symp- toms as forebode an eruption; or whether, again, there have been evi- dences of influnnnation, developed in some other orgiin, which suddenly subsided or disappeared. Or, if no such manifestations be present, we may consider the delirium as resulting from a sympathetic affec-tion of the brain, of which the primary cause is seated in some other part,— such as tlie stomach or the bowels, or both, arising from the presence of irrita- tive ni;itters, (as, for instance, worms, bile, etc.;) or, again,— if any such cause can be identified— the influence of narcotic and poisonous drugs. 5. There is, also, another kind of delirium which appears as a very important symptom, especially associated with any cause of pressure on the brain, generally the immediate or remote result of accident, or of— Inflammation : — Immediate, when it appears as an attendant symp- tom of tlie actual disease,— in which case, it distinctly indicates the pres- ent'., of blood disengaged, and accunmlating in the substance of the brain, or suffusion of extravasated blood in the enveloping membrane; remote, when acute organic inflammation is not present, in which case, it identi- fies the presence of water. This is what is termed c/roms(?/ fZe/m?t?». It is identified by a defl- Meji(^7/ of activity of tlie nerves and brain, the absence, even, (in many cases,) of any motion of the body, a species of dull, inanimate sleep, total helplessness, and complete silence, or, at most, a low, internal murmur ; and it is characterized by prostration of nervous action. Drotost/ delirium, may, also, appear in nervous and typhoid fevers, as an indication of general debility. In any case, it may be considered as a more critical symptom than active delirium. Fainting — swoonintj — should, also, be considered with due regard to the disposition of the patient, and to the circumstances which qualify it. • 1. If it be /ia6«Y?taZ, especially as the termination of violent attacks of palpitation of the heart, which, generally, if not invariably, lead to this issue, there is reason to apprehend organic derangement of the heart. 2. If, on the other hand, it should occur casually, after violent emo- tion— as joy, fear, grief, etc., or after severe loss of blood, etc., or as the result of casual, but very excruciating pain, or as the consequence of an accidental injury of no great moment, it is not to be looked upon as a very important symptom. The location r ' iescription of the organs as lixed by phreuologists, (» fij ! 66 MOTION OR MUSCULAR ACTION, REST. 3. If, again, it be tlie habitual result ot mere nervous excitement, in persons of a highly susceptible hysterical, or hypochondriacal dispo- sition,— in which case, it is merely spasmodic,— it is not of great moment. 4. If, however, one or more fainting fits should usher in an attack of FEVER, we have a positive indication of the subsequent nervous type of the disease. 3IOTION, OB MUSCULAR ACTIOX, BEST- AND THEIR INDICATIONS. Although not in accordance with technical classification, we shall include under this head of "motion and rest," every circumstance, inter- nal as well as external, in which the motary power is called into play, or subdued. Wherefore, it must be premised, that motion and rest are either healthy and natural, or symptomatic of derangement, and, conse- quetly, unnatural. AnA, first, with respect to motion :— it is clear that to be healthy and natural, it must be stibject to the WILL, and the consciousness; that is, that until the resolution to effect a certain movement (as of the arm or leg) instinctively calls the proper muscle into play, that muscle should remain i7iaci/«e(butwoit incapable of action.) It is, also, clear that it should not eaxeed the limit prescribed by the will, (except in so far as the phys- ical impulse prevents an abrupt arrest— as, for instance running at great speed, the runner should be unable to stop himself suddenly, when at the top of his speed upon the sudden intervention of circumstances re- quiring it. It is, further, evidently clear that even if the will, excited by sensations, (which are painful,) does prompt mot: mi— such as change of position — such motion is not to be considered as a heulthy n/ovement properly so called. An example of this occurs in anj restlessness caused by suffering. With respect to motion, which occurs when nature, in health, would have prescribed ••est- as in the case of restlessness at night, — this is, evidently, a case in which the motion is 7U)t subject to the will, and, therefore, unhealthy and unnatural; because sleep is totally independent of volition. The activo a'.<l n'ottuy condition of health, as the general rule for an adult male, shoiu i no* continue («/i spife of the WILL) more than from sixteen to eighteen hours out of the twenty-four. In the earliest days of infancy, it should occur during little more than the time required for feeding. Young persons, under twelve or fourteen years of age, should have a natural tendency to activity during about fourteen to sixteen hours out of the twenty-four. Secondly, with respect to rest:— If understood purely in tlie sense of muscular inactivity, during the active aiid conscious operation of the WILL, it is also clear, that in order to be truly denominated as healthy and natural, it must, likewise, be subject to the will, which has the power of determining its duration, and of prescribing its recommencement at any moment. Even if prompted or disturbed by tiie sensations, the will is yet, to a certain extent, tlie mediating power. As sleep is not purely a degree of mur^alar inactivity (which it does not even necessarily induce,) it la total y exceptional. But, even here, if the avill be retained in proper INVESTIGATION OP DISEASE. 57 ascendency, by being habitually exerted, it is well known that it h:is the power of determining the duration of sleep; for many persons can wake precisely at a given moment, after many hours' sleep, merely by having previously resolved to wake at such a moment. It is even admissible, that the WILL has an initiating power in inducing sleep, because sleep would net, in many cases, occur without a resolution to permit it ; and, if it occurs in s-pite of the will, it is exceptional, because it must either be an unhealthy symptom in itself, or the absence of it must have been an excess of exertion, forced upon lature by the will. That sleep can be induced even with a disposition to rest— by a mere resolution of the will— has been asserted, but is far more problematical. If, however, it does not occur when the will composes the body for it, it is again exceptional, and the absence of it is a symptom of derangement (not healthy). It can not, nevertheless, be denied tliat the will cannot coerce it; and if the will, wliich is refinement of nervous power, combat the irritation and irritability which repels sleep, it becomes a mere combat between one portion of the nervous system and another, (resulting, perhaps, in fever,) both become more and more irritated, and each repels the other more violently. Thus, the very thought that one cannot sleep, and the wish to do so, makes one more restless. The sleep of persons, of all ages, should be calm, neither interrupted, nor of too long duration, undisturbed, evincing a placid countenance and no evidence of pain, uneasiness, or fantastic dreams and visions. The only motion which does not identify irregularity during sleep, is the occasional turn from side to side. The more noiseless tlie breathing, the more per- fectly healthy the sleep. The skin during sleep should be warm, but neither very hot, dry, nor excessively moist. Restlessness, therefore— that is doubly, the inability to rest, in spite of the will, and the muscular motion prompted by the will (under such conditions,) may be considered as an unhealthy and unnatural condition of activity or motion (either internal or external). As a symptom of fever, it identifies an excessive susceptibility or irregularity, and irritative activity of sensation. It is a symptom rather of an inflammatory than of a debilitated state. Contraction of the extremities towards the belly, identifies pain in those parts (chiefly colicky pains). Contimial starting up in bed, indicates great oppression and anxiety, or simply delirium. Continual sinking down towards the foot of the bed, denotes great prostration of vital energy. Throwing off the clothes— y/hen the patient lays himself bare, denotes excessive oppression and anxiety, or simply active delirium, which nuiy, likewise, be identified by evident inability on the part of the patient, to bear the bed clothes upon tlie body, or when they seem to oppress him like heavy weights. Grasping at imaginary objects, may be considered as one of tlie most severe indications of utter failure of vital energy, if not of approaching dissolution. .: J 1\ Ml,: 68 POSITION, SLEEP, SPASMS Position op the PatiTent— a question which is distinctly dependent upon the questions of motion and rest, and which evinces some very important manifestations— as, for instjince : 1. Severe suffering, provok-jd by lying on one side, which constitutes inability to lie on tliat side, generally denotes internal derangement of organs, whose seat is in the opposite side. 2. Immovable retention of one position, identifies either excessive weakness or stupor, according to the associated symptoms, and the previ- ous duration or nature of the disease. 3. Repeated oliangeof position— u\ some measure distin. t from what has been more generally described as restlessness— if occurring on what are termed the "critical days" (as tho seventh or fourteenth,) or anticipated periods of determinative issue in fevkrs, wiiich run a regular course, (especially eruptive fevers,) may be assumed to indicate the approach of the crisis; or, if occurring early, in, or during the course of a fever, which has not been accompanied by an eruption, we may infer the necessity for such a development ; or, again, if unattended with the general indications of a forthcoming eruption, or unconnected with any period of crisis, and characterized either by determination of blood to important organs, or by deficiency or suspension of natural discaurges or evacuations, this symp- tom may variously indicate the lodgment of oppressive matters in the stomach, or simply internal pain, or anxiety. 4. The favorable indications connected with the position, consist of such a position as is least inconsistent with that usually assumed by the patient when in health, and ability of tlie patient equally to lie on one side or the other, or upon the back, which is decisive in determining the absence of disease of the organs of the cliest (if tiie breatli is not impeded or oppressed, when tlie head is bent backwards,) or of the intestines. Sleep, when unhealthy, is distinguishable by any circumstance con- trary to tliose above stated, or opposed to the habitual condition of the patient (in health). 1. Or, again, when it is characterized by delirium, under the head of which the particular indications afforded by this symptom will be found. 2. When it is impossible to rouse the patient, in which case fever being present, it is identifled as of a typhoid character, or we may other- wise infer that tliere is an inflammation of the brain. This is especially an ill omen when it is manifested at the commencement of the fever. 3. When the sleep is disturbed by the least noise, but relapses imme- diately. 4. When it is interrupted by muscular twitches, convulsive move- ments, and rei)eated starting, or when there is grinding of the teeth dur- ing sleep, all of wliich occur associated witli a high degree cf hysterical excitement in females, when they are not serious evidences of disease, but which may occur in consequence of sympathetic irritation, resulting from oppression or irritation of the stomach. Spasms and Convulsions should, according to our purpose, be classi- fied under the liead of motion. Indeed they constitute muscular motion, both internal and external; but in order justly to discriminate their INVESTIGATION OF DISEASE. 69 symptomatic importance, we must have duo regard to the general cir- cumstances, age, sex, disposition, etc., wliich may qualify them, for: 1. As occurring in females of a highly susceptible or hysterical dis- position, or in children, they are usually ])rovoked by such trivial causes (often unattended with such constitutional disturbance,) that they are commonly not to be considered as of great moment, and may generally be traced to some source of irritation of the bowels. 2. If, however, they occur in consequence of wounds, by which important tendons have been seriously injured, spasms may be considered as highly momentous, and may result in lock-jaw, or, at all events, in permanent rigidity of the parts injured, or of other parts. 3. If again, they should occur (in jiersons of mature years, and of robust habit,) as resulting from severe loss of blood, etc., they are of por- tentous import. In this case they are the result of exhaustion of vital energy. 4. If, again, they appear as the effect produced by determination of blood to the brain, or to the spinal marrow, or are derived from the pres- ence of obnoxious matters or foreign bodies, they are not to be negU ;ted. In the first of these cases, they are caused by super-abu"dance of blood, etc., in the second by nervous irritation. o. If they occur at the point of issue in typhus fever, t-luy may either be critical, (terminating in convalescence,) or fatal (when the vital energy sinks in this last effort). 6. If they appear associated with contagion, or the irregular develoi)- ment of eruptions or efflorescences, (as with purple rash, smallpox, etc.,) they are attributable to nervous irritation. 7. They may be attributed to the presence of worms in the intestines, or to any other obnoxious or irritating matter, either in the stomach or intestines, in which case, also, they are directly occasioned by nervous irritation. 8. Co7ivnlsions resulting from the pressure of extraneous matter (such as water) on the brain, or otherwise traceable to irritation of tiie brain primarily, may result in the highest degree of which they are sus- ceptible, namely epilepsy. Spasms, particularly if caused by tendinous injuries, may terminate in the highest degree of which they are susceptible, namely, peiinanent rigidity, (such as lock-jaw or the contraction of any limb, or part of a limb). 10. /Spasms which affect tlie muscles of any limb, are commonly called ^^Cminp." The distinctive feature of a spasm is gathered therefrom, namely, an uninterrupted muscular contraction . 11. CoumUsions consist in the alternate contraction and ilslaxation of one or more muscles. 12. Spasms and Conmilsinns, internally, include such affections as Vjmitinf/, already separately considered, (wlien they affect the stomach;) Colic, exemplified under the head of "Pain,"' (when they affect tlie bowels,) Palpitation, considered under the head of " Pulse," when they affect the heart;) Couffh, separately considered hereafter, and also imder the head of " Breath,'' (when they affect the chest;) Retention of urine, , t", 11^ !l! iiwm \' 60 PARALYSIS, HICCUP, THKMBLINO. con.ildered under the head of "Urine," (when they affect the bhidder;) Ilicciip or Hiccough, separately considered, (when they affect the dia- phragm or midriff). Paiialysis, which may be confined to muscular power, or which may extend to the superior faculties of the brain, and to all power of sensation and perception, must be considered with due regard to every circumstance connected with it, in order to form a just idea of its indications. In any case, tiio brain must be considered as the seat whence this symptom, either directly or Indirectly, springs. But it nuiy either appear as the result of some external oppression, or from internal and organic affection of the brain and spinal marrow. 1. If it be i)urel3' occasioned by external causes, or by causes which are external as regards the oi'ijanic sabaUince, as, for instance, if the oppression arisu from congestion of an enveloping membrane, it will be easily distinguisliable by being transitory, and consequently the more simjily remediable. In the majority of such cases tlie paralysis will be local, leaving the superior faculties, and all other physical parts of the organism, uiuifl'octed. Very severe cases hold as an exception. 2. If it be the result of internal affection of the organic substance, as of disengaged accumulation of blood in the substance of the brain, it will be continuous, and will almost invariably impair, if not destroy, the memory, and permanently detract from the powers of perception and sensation. Hiccup or Hiccouair, an internal development of muscular action, must, also, be considered with due regard to the conditions and circum- stances of age, and of the symptoms witii which it is associated. Simply described it is a convulsion affecting the midriff or diaphragm. 1. If it occurs in children, and can be associated with cold, or with distension of the stomach, (that is, flatulency,) it is casual and of little moment. 2. If, however, it should be associated with nervous fkveb, it indi- cates a malignant tj'pe. 3. If associated with inflammatory fever, it identifies, to a certain degree, the tendency to inflamnuition of the bowels. TuembIjING is a symptom which is of various import, according to the circumstances and conditions under which it apijears, and according to the disposition of the patient. 1. For, if the patient be of a highly nervous susceptibility, and it cannot be traced to any of the other causes metiojied, it may be attribu- ted to a degree of nervous excitement or irritation, which may result from emotions of any kind— abuse of stimulants, whether medicinally administered (under foolish treatment) or not, or to excess of physical exertion, but more frequently of mental labor. 2. If the antecedent circumstances be characterized by loss of blood, or any animal lluid, it may, unquestionably, be attributed to debility, as, also, if it attend every attempt at exertion after severe acute disease. 3. If it be distinctly manifested, as unconnected with other direct causes, at the outset of a feveu, here is an unquestionable premonition of the subsequent nervous character of the disease. INVESTIGATION OF DISEASE. 61 4. If it sliould appear in a person of a full habit of body, or other- wise, with evident distention of the bowels, and unconnected witli any other apparent cause, it may, with propriety, be attributed to superabun- dance of blood in the vessels. it indl- THE SENSATIONS, AND THEIR INDICATIONS. The sensations need not necessarily be painful to afford a distinctive symptomatic indication, although it be true that, as an index of disease, every particular or characteristic sensation is generally painful, or, at all events, disagreeable. The most distinct sensation, as a symptom of dis- ease, however, is pain, or the painful operation of a function — or absennn of pain, when there is disease which should cause pain ; but we may also divide these sensations into two further distinotivo subdivisions, namely, sensations of discomfort or uneivsiness, and sensations of anxiety. PAIN, DISCOMFORT, AND ANXIETY, AND THEIR INDICATIONS. Pain, as a distinguishing symptom, in whatever part or organ it may have its seat, is to be divided into (1) that which continues uninterrupt- edly, which, if persistently in the sayne part or parts, and continues to become aggravated, (until resolution takes place,) and which is furtlier qualified by being aggravated by the touch, and Htill jnore by severe pres- sure, and temporarily by the application of heat, is the general distinctive indication of inflammation of the part, or parts, whence the pain orig- inates: (2) Pam which is chiefly developed in a particular course, or direction, (the course or direction of a nerve.) or which is changc.ihle, as to the part in which it occurs, but which, in either case, is geiierally characterized by aggravation from apparent contact, or slight toucli, and relieved, or not aggravated, by severe pressure, identifies pain of a nerv- ous character : and, (3), Pain which comes and goes in the same i)art, or parts, partakes of a contractive, or cramp-like character, is relieved hi/ pressure, or warmth, ot friction, is often intermittent, and always irregu- lar, and which is rarely continuous, and never persistently continuing to become aggravated, identifies pain of a spasmodic character, that is, SPASM of the part, or parts, affected. 1. Pain in the chest, or painful breathing, may be the result of an overloaded stomach and impeded digestion, or may be occasioned either by a rheumatic, (2) a spasmodic, or an inflammatory affection ; or by occa- sional determination of blood to the part of the enveloping membrane of the lungs. If it communicate a sensation of being bruised, or of a stiffness, as if the nmscles could not bear the expansion of the chest, (3), if the pain is of a shifting character, or if touching and pressing the chest causes pain, it may be identified as of a rheumatic character. If it be casual stitching, as, for instance, suddenly interrupting tlic respiration, without returning regularly, or being regularly provoked by a similar effort in breathing, it may be considered as of a neuralgic character. If there he persistent stitching pain whenever a certain degree of expan- Bion takes place, with a dull, heavy pain, (without progressive agarava- ■ 1 t lii! 9' 3li J i 1 i <l I ( MS 111 mn ! I 1)1; li «? SENSATIONS AND THEIR INDICATIONS. tio7i) In the intervals between such cxi)ansion, we may identify determin- ation of blood to the enveloping of membranes of the lungs. If, a!,'!iin, there be a continual acute pain, growing progressively worse and worse, and furtiier (lualKied by a general and severe degree of fever, which has been preceded by chills, and is associated with more or less prostration of strength, inflammation of the membranes in question is clearly established, 2. Pain in the bowels, or painful evacuation, is either of (1) a neuv- ors character, when it will be fugitive, returning when the attention of the patient is directed to it, fugitive and aggravated liy apparent contact or by slight touch, and relieved by severe pressure ; or, (2), spasmodic, (a modification of the nervous,) but relieved by contact and pressure of every kind, by lying on the belly, and by drawing the legs up, and oth- erwise contracting the body, may, by continuance, become inflam- matory; ov, {Z) inflammatory, whan li will be readily distinguished by persistency, accurate localitj', progressive aggravation, and by excessive tenderness of touch, and still more of pressure. Colic, properly so called, is, strictly .speaking, a spastrvKlic pain, but by long continuance may become inflammatory. 3. Faliif III discharge of ttrine nvAy ii\)\'>Gi\.vvtsi the symptom, either of inflammation or irritability of the passage, or of the bladder, or neck of the bladder, distinguishable by the locality of the pain and nature of tiie discharge; for (I) if tlio pain arise from inflammation of the bladder, or neck of the bladder, it, will be associated with fever and hard pulse, and tiie pain most severely felt at the bottom of the belly, and the discharge will, usually, be either mingled with blood, or blood will predominate over the urine, or the discharge of urine will be followed by that of pure blood, with excruciating, twinging pain ; (2) if the pain be occasioned by inflammation, irritation, or irritability of the passage, it will be qualified by a scalding sensation, (when urinating,) towards the terminal part of the passage, with or without discharge of matter ; (3) if the pain be dependent upon inllammation, irritation, or irritability of the kidneys, the water evacuated will be hot, and the seat of pain will be chiefly in the loins and small of the back ; or, (4), if the pain be occasioned by spasm of the bladder, or neck of the bladder, there will be continual urging to pass water, but total inability to efTect it ; that is suspension of urine, with cutting, cramp-like, agonizing pain in the part, relieved, however, by pressure; th, is, by doubling the body forward, and pressing the liands firmly upon the lower part of the belly. 4. Absence or sudden suspension of pain, in severe caseS of organic inflamm.ation, is, in all instances, a most ominous manifestation, but it may indicate two distinct conditions, namely: (1) the sudden transition of tlie inflammation to another organ, (in most eases to the brain,) when it requires the utmost care, but is, nevertheless, not so alarming as when such reappearance of the disease in another quarter does not quickly follow; for, in this case, the change, in tlie majority of cases, has been one from inflammation to mortification, (and consequent loss of sensa- tion). 5. Intermittent pain, which is also either periodical or irrej^ilar, or that which is very severe for a certain period, often accompanied INVESTIGATION OF DISEASE- 63 I'ganic but it isition when wiion uickly boeii sensa- ar, or )anied by local heat or general fluHhcs of heat, sometimes by the palpitation of the heart, and frequently by a degree of irritative fever during its contin- uance, and terminating with local or general sweat, (and that only,) and by an acute degree of nervous susceptibility and irritability, often aggra- vated by heat, or by slight contact, (the patient having, however, an inclination to press severely upon the part,) but which tutally subsides during regular or irregular intervals, and which is of a nervous char- acter. 6. Keniittent pain, or that wliich becomes modified from time to time for certain intervals, especially at certain periods of the day, or undc( particular conditions of heat, cold, access or exclusion of air, or owing tti palliative measures, but which never totally subsides during the intervals, but continues dull, heavy, and persistent, instead of being highly acute, pulsating, or shooting, and wliich is furtl er qualified by severe /ere/v's/t symptoms during the acute stages, which, Iiowever, also become modified, though never wholly subdued, during the intervals of comparative relief. This description of pain is generally associated with organic inflamma- tions, or with obstructive causes of irritation, with a strong tendency to organic inflammation, and identifies a tendency to chronic or continued inflammatory action in such parts or organs. 7. Inflammatory pain, in its genuine distinctive character, is very plainly distinguishable from pain of any other nature, as for instance: It is always accompanied with increased heat of the particular part affected, (if purely local,) and then even in some cases, especially, if it be ot long continuance, by general increased heat of the body, or alternate heat and chills, frequent and hard pulse, and other sign» of fever. And if it be internal, and airecting one or more of Ine important organs, the adjacent jvirts, as also the whole body, (ex .'ept the lower extremities,) will manifest greatly increased heat, and the general symp- toms of fever will run high, the thirst being generally considerable, and often intense and insatiable, (in highly inflammatory subjects). It will be continuous, proceeding from bad to worse, until the crisis or other issue. It will be relieved by moisture of the skin, and general or even local perspiration. It will be greatly aggravated by pressure, or even by the least touch, as of the clothes or bedclothes, but still more so by severe pressure, which is usually insupportable. If local, there will be redness and often swelling of the parts ; if affect- ing the outer membranes, iiarticularly of the intestines, again, redness will often be discernible externally. There will be sometimes more or less strong development of the adja- cent vessels, which will be observed to be swollen and dark, their course l)eing palpable, where, in general, they are externally imperceptible. There will be often more or less throbbing or pulsation in the part with the pain, especially in the after or suppurative stage, (although this symptom may also accompany nervous pain). If local, it will usually be much aggravated immediately by ivarm applications, such as fomentations, but will afterwards decrease, and will be generally relieved at first by cold applications, but in such cases the -■ V— jj. 7 . r v .jm B4 SENSATIONS AND THEIR liNDlCATIONS. 1,1 ni I iJ li pain will often return more severely, as soon as the cold application is removed. Whether local or affecting internal nnd iini)ortant organs, it will he aggravated hy stimulants, motion, exertion, mental or nervous excite- ment, fatigue, etc., and will have a tendency to grow worse towards night. If natural discharges have occasion to pass over the inflamed surfaces, as, for Instance, of the bladder or bowels, the pain will usually become excruciating. If internal, the natural discharges will be qualified hy the evacuation of blood, and either by being very liquid (of tlie excrements,) or very dry; in any case (of all discliargos) thoy will bo deficient in quantity, occur frequently, and there will be continued urging to discharge. The external surface, whether attending local or internal inflamma- tory pain, will invariably be dry until the ciasis, when the pain will subside, with the development of moisture. The pain will, inseperably, prevent or disturb projier rest, (sleep; a condition whicli onli/ applies to iirflammatorij ^>aiu, because pains, either of a nervous or spasmodic character, may bo overcome by sleep, which frequently occurs in spite of them, especialVy the latter). Consequently extreme and insepcrable restlessness, with such indications as above stated, identifies pain as infiammatory. The most perfect ciiisis, or resolution of inflammatory pains of any kind, consists in gentle, undisturbed, and placid sleep, with proper mois- ture of the skin. 8. Nervov^ pains ara of a fugitive, irregular or periodical, pulsating, dragging, darting character, with or .vithout local heat during the entire continuance of local sufTering, but then often attended witli local sweat, (simultaneously— which never occurs of inhammatory pain,) flushes of heat without fevet?: or with temporary irritative fever, (in modified degree,) restlessness, depression of spirits, hysterical disposition, or fantastic ideas; aggravated by thinking of them, and relieved when the attention is dis- tracted by objects of interest, or aggravated by apparent contact, or slight touch, and relieved by pressure, unattended with any variations of appe- tite or thirst; characterized by the occurrence of involuntary motions, as by jerking, or the sensation of twittering (vibrating) in particular parts, in the latter case, frequently without external perceptibility of such action— by extreme restlessness and uneasiness, with or witiiout a degree of irritative fever, (and often with an extremely low pulse,) by intermittency or periodicity, by being usually dispelled during motion, or absorbing occu- pation, and by a peculiarly intractable persistency, continuing to recur, in spite of every resource, (when they cannot be traced to a precise point or cause,) without, however, affecting the general health, or detracting from the vigor of the functions. 9. Spasmodic pains are of a cramp-like, contractive, and very severe cutting character, but they are usually of brief duration, though they may be of frequent recurrence. In their distinctive and peculiar qualifications they are totally unassociated with heat, or any other inflammatory symp- tom, and are, rather, except in highly excitable subjects, habitually attended with depressed than over-active circulation ; but by long continvr INVESTIGATION OF DTSKASE. t ancc thoy will frequently engonder a reactionary indanimation, and assume all tliv- characteristic featunis of iiillauiiiuitory pain, sometimes becoming, in sucn cases, very severe and intractable. As allocting important organs, they may Jlrst accelerate, tlwn temporarily suspend the circulation and breath. In their distinctive character they are relieved by stimulants, heat, contraction of the i)art3, or of the whole body (doubling up,) pressure and especially friction. In their excess they ren.ler expansion of th« parts impossible. They are either local, affecting particular motary mus- cles, or they are internal, affecting the muscles which are connected with or constitute important organs. A constant and severe degree of iya-s- vindic pain, affecting important organs (as, for instance, the heart or stomach,) is indicative of organic derangement. A casual spasmodic pain, however severe, is attributable chiefly to tlie accidental presence of irrita- tive matters, especially in the stomach or bowels. 10. Pain in the back of the head usually denotes determination of blood to the head. 11. Pressing pain in the forehead, accompanied with giddiness, com- monly implies the presence of irritative or impure substances in the stomach; or, in some cases, excessive weakness:— that is, if it occur after a severe attack of illness, confinement to the bed, or more especially loss of blood, or other animal fluids. 12. Pains particularly and persistently, occurring in the back or loins, may (in females,) be associated with pregnancy, or, if at due time, with tiie montlily retiu'n; but, in such cases, as in the more yenerul definition, it may be held to intimate the presence of, or a tendency to i)iles. 1.3. Pai7i in the front part of the stomach or bowels, occasioned by pressure, (although there be no actiuil or positive pain without pressure,) wlien occurring as associated with fevkii, or at the onset of fever, and further qualified by heat of the parts, and retching, (if of thestomacli,) or straining (if of the bowels,)— denotes respectively inflammation of such part or organ as thereby typifies the fever. 14. Stitching, or prickling pain, may denote a spasm, but more fre- quently determination of blond to a part, or inflammation, especially of the enveloping membrane of an organic part. If it be occasioned by spasm— as of the stomach— it will be casual, generally severe, sometimes even to the dogree of suspending the breath, but passing off without return, or with a similarly casual return, in the majority of cases, upon the dislodgment of wind, especially belching; pressure and friction will relieve it. If it be the result of determination of blood, such as when it occurs on the right or left side, (about the liver or spleen,) provoked by rapid mo- tion, immediately after eating, or the like conditions— or when it occurs without such immediate causes, and continues to be perceptible upon drawing a deep breath for some time without striking constitu- tional derangement*— pressure does not always aggravate it, unless severe motion does: relaxation of the parts, as by bending the body forward, relieves. Tf it be the decisive symptom of inflammation, as in pleurisj% we may thereby distinguish inflammation of the pleura, (the membrane which covers the lungs, etc, and lines the cavity of the chest,) from inflammation 5 pTi ZTTXZ ^3^^ B6 SENSATIONS AND THEIR INDICATIONS. ^^^ ] J! 'I : ,';,'L of the substance of the lunRs, especially, if there belittle, if any i)ain, until the parts are expanded, as by drawing breath deeply; and Its intlam. matory character will be di.stinguishable in the i?eneral derauBeinent and lii^li degree of fever, which accompanies it, with local and general inc'icase of heat, (except soraotiraes of the extremities,) dryness of the skin, thirst, etc. Sensations of discomfort, such as the following: 1. Restlessness has been already mentioned under the head of Motion. 2. Giildiness, (simply) except in the cases mentioned as important, is a symptom of no great moment, but it often serves to determine the indi- viduality of disease. It may identify a nervous condition, generally speaking, occasioned by an ii ritation of the stomach, when we may identify the cause as an over- loaded stomach, with a tendency to expel the irritating substances, iipunrd. In many cases, particularly as occurring in persons of a full hab'.t of body, it denotes congestion of blood to tlie head. .3. In persons of advanced age, or of apoplectic tendency, it may be looked upon as one of the unpropitious indications of imminent apoplexy. Sensations of heat and cold are of two kinds— those (1) with which there is actual heat or coldness, and those (2) which merely convey these sensations, i\\Q part affected with such feeling being neither hotter nor colder (necessarily,) in a degree which should occasion such feeling. These are subject to many modifying conditions— of which we shall briefly notice the most Important— and are generally to be held as of very great importance in the Investigation of disease. Actual increase of heat, if unqualifled by any particular local deter' mination, or by particular and local pains, denotes (1) increased actn'ity of circulation, that Is, feveu (simply,) more or less inflammatory, as the degree of heat is greater or less ; (2) local inflammation, whether of par- ticular parts, if purely local, or atttiided with general inflammatory action throughout the system, If the heat be general, and simply charac- terized by local determination and other particular Identifying symptoms. Tliis heat, as regards a particular spot, may or may not be externally apparent to another person, it Is sutliclent that It is iiiteniallij felt by the patient; (3) a determination of blood to particular parts or organs, with- out active Inflammation, when the heat, wliethcr internal or external, Is confined to the spot, part, or organ aflfected, and to those which are con- tiguous; (4) when inflammatory and general heat is present, it Is Identi- fied by the simultaneous frequency, hardness and strength of the pulse, which increases with the increase of heat, and by its conveying no unpleas- ant sensation on contact to a healthy person ; and further, by the part of the healthy body thus brought into contact with it becoming so accus- tomed to It, after a short duration of contact, as to lose the distinct sensa- tion of greater heat in the sick body; or (5) In the ftist stage of putrid fever, or as an indication that fever has assumed a portentous putrid character, It may signify inci^nent decomposition, in which case, however, it will increase as theptdse becomes more and vv)re feeble. It will convey a most disagreeable sensation of a burning, stinging character to the part of a healthy body on contact, becoming more and more disagreeable the INVESTIOATION OF DISEASE. er longer the contact continues, and leaving tlio sanio ui;pleasant Hcnsalions for Honic time after tlie contact liiw ceased; tiiis in a n/uimi'ud, uot an uniinal lieat. Heat in tlio front portions of tlio stomach, bowels and chest, and especially, if conveyin;^ a Imrnin;^ sensation intoni'dli/, to the |)atient, accompanying a higli degree of fever, shows a general inllanimatory con- dition of the tributary organs of life. Heat 0/ the haii'fs, after eating, denotes a disposition lu the disease to become habitual, or if there be no distinct disease, u predisposition to hectic complaints. Fugitive heat Is particularly associated with a nervous condition ; it is, therefore, more common among females, (at certain periods especially,) but 1( lay occur In either sex, associated with nervous debility, lrrltai)ll- ity, or susccr-tibility. Coldness of the extremities, associated with a severe degree of fever, denotes a high degree of Inflammation in one or more of the Important organs of life, such as may impede tlio thorough distribution of the blood throughout the system. Therefore, It Is one of the distinctive features of Inllammatlon of the lungs. But It may, also, denote deflnient circulation or deficient strength of the blood, as associated with other symptoms of an enfeel)led condition, and, assiich. It Identlfiesdepresslon of vital energy. Or, again. It may be the result of spasm, either of particular parts or of a superior organ, (as of the heart in particular,) if associated with other spasmodic symptoms. Numbness or deadness of particular parts may (I) be indicative of latent and Insidious gout, and If from other symptoms there be such further analogy as to i<lentlfy this condition, it may be of much conse- quence; or (2) it may be purely nervous, and then quite superficial, In which case It will generally l>e palliated by cold applications; or (8) it may be occasioned by temporary arrest of circulation in the parts, in which case tlicre will be no contraction or rigidity, and hot applications, friction, or rapid motion will palliate or remove it; or (4) it may be tha result of spasm, in wlilch case there will generally be contraction and rigidity, and heat or friction will likewise relieve, but motion will be, commonly, arrested. Ttchivrj, (without the presence of any eruption,) especially If preceded by chill, and accompanied by heat (as associated wltli fever,) usually announces the approach of a critical sweat; or, if unattended with fevei', commonly denotes an acrid condition of the humors. CiiiiiL (or the sensation of coldness without actual coldness,) is a purely nervous indication of Irregularity. It may consist of a spasm of the skin. The conditions whicli precede, accompany, and follow It, must indispensably be considered, in order to form a correct judgment of the various important indications which it affords, and which qualify every fevek; as for instance: 1. Acute FEVERS are characterized by tlie single and unrepealed occurrence of the chill. Intermittent fevers by the more or less fre- quent repetition of this symptom, according as the repetition of the fever flts return. 2. If the FEVER be of an intermittent character, and the chill be slight, with great predoaiinanceof heat, there is reason to anticipate tluit x:: II .; 1 i lii i!*i!i| «fi SENSATIONS AND TIIEIK INDICATIONS. tlie disease will run into a distinctly acute character; but if the ciiill be Bcvcrc, of long duration, and very predominant, the occurrence of lieat boing imperfectly developed, the disease exhibits a tendency to become sluggifili and of long duration, and to assume a chronic form. 3. Cliill, which is very severe, and precedes the heat, may first be generally designated as identifying either violent, acute, or even inflam- matory fever, or, on the other hand, intermittent fever, 4. Chill, which is imperfect, or comparatively feebly developed, and wliich alternates with heat, (that is, is successively preceding and suc- ceeding it,) usually identifies fever of a nervous character, or of a rheu- matic, or catarrhal description 6. Chill (rigor, coldness attended with shivering,; which occurs durinn the course of an acute feveb, possesses many important significa- tions; as, for Instance: If there be inflammation of any particular and important organ, especially of the lungs, we may anticipate suppuration or the still more urgent result of mortification, which will be further identified by subsidence of pain; or, in cases, particularly, in which no decided and local inflammation has existed, or in which the general symjitoms are favorable, the approach of the crisis is identified, namely, tlie thorough development of an eruption, or, more frequently, the occur- rence of copious perspiration, followed by general abatement of the dis- ease; or, when inflammation of one particular organ has existed, and any abrupt arrest has taken place, such as the irregular suppression of a discharge, we may anticipate a transition to other organs; if no inflam- mation of any particular organ has existed, and there be evident suscep- tibility of any particular part, or evident tendency to determination of blood to such part, or obstruction to the operation of its functions, we may anticipate inflammation of such part; or, if none of these circum- stances be so combined as to warrant deductions, such as have been sug- gested, the chill may forebode the succession of intermittent feveu. Sensations of anxiety : a name which is applied to a certain feel- ing of weight or jjressure, with oppression of the breath, of which the seat appears to be the front part of the stomach and chest. No pains (or vei '^ few) are so distressing as these sensations, in which there .almost appears to be a struggle for life, although, except in cases of organic dis- ease of the heart or lungs, or of inflammation of some important organ, or of general dropsy, thoy ar not so immediately urgent as they aijpear. They may be the result of an accumulation of blood in the lungs, (con- gestion,) in which case, if the patient were of a consumiitlve habit, the symptom would be urgent. They may occur as a spasmodic affection of the lungs; or, again, from local derangement of the 3ame organs, such as irregular reception and expulsion of the blood, owing, perhaps, to the obstruction occasioned by enl^.geimnts, (jis of any important gland,) deposits of matter etc., in which last case, as distinguishable by the PULSE, much importance should bo attached to them. Such sensations may be the result of merely sympathetic nervous irri- tation of tue lungs, moat frequently when the stomach is aflfected, as by deleterious drugs, tobacco, coflTee, excess of fermented liquor, or obstruc- INVESTIGATION OP DISEASE. 69 tive and indigestible substances, in wliich case the affection must not be attributed to the lungs. They may be occasioned, as last indirectly stated, by overcharging or overtaxing the powers of digestion, especially, if the stomach be weak, a condition easily identilied in those who have been treated with copious use of purgatives, emetics, or even tonics, or who have been addicted to excesses in eating or drinking, or in young persons allected wilh worms; in s" eh cases, if the patient has partaken of flatulent substances, or of very rich, heavy, or irritating food, or of mixed liquors, or has been aflfoc;- ted with bilious symptoms, the occasion of the anxiety is sufficiently apparent. They may be associated with intlammation of the heart, stonia'".Ii, liver, lungs, or bowels; or wilh dropsy of the belly, general dropsy of the system, or water on the chest; or, again, with permanent or organic dis- ease of the heart or lungs, or with determination of blood to any of these organs, in the majority of which cases they are of great consecjuence. They may be purely spasmodic, in which case the apparent sult'ering of the patient will be greater than in any oiuer, and it is not uncommon, even without serious disturbance of pulse, to see the patient, as if in the last struggle of existence, either speechless and prostrate, or occasionally grasping at the bystanders, and feebly expressing an apprehension of immedia' death. Such cases, especially, occur from comparatively slight causes of derangement (of the stomach, in particular,) in subjects of a highly nervous disposition, if males, or amongst females of excessive hj'sterical susceptibility, i)articularly if there be actually some affection of the womb. Women subject to frequent miscarriages are, particularly, subject to be affected in tliis manner. Under such circumstances, these symptoms are of comparatively slight importance. rom and by in [)uld irri- by ruc- THE ORGANS OF SENSE * AND THEIR INDICATIONS. This section involves, to a certain extent, not only the investigation of the condition o" th ^ sense, which may bt deranged without appar * derangement of i^,. organ, but, also, of the external appearance of organ itself (esi)ecially) — namely, of the eye, as well as of the sbjht. T.. other organs of sense — namely, the ears, nose, and palate, convey no such very distinct or important external manifestations, or none which are not included under various heads in the coi -se of this article; and we shall, therefore, rest contented, in alluding to these, to treat of the senses which they coni'cy— namely, hearing, smell and taste. The EYi. ..Tords a multitude of external evidences of deran.^ement— A«^, for instance : \ A dilated pttpil maybe engendered by sympathetic irritaMon of tl 'ain, as associated with irritation of the stomach and bowels, partic- ularly from the presence of worms ; or it may indicate a local affection of the brain itself— as inflammation of the membranes— or water— and is then the result of direct pressure upon the Liain ; or, again, it may result " -m total inaction, or suspended action of the bowels, in which case the * The icnso of feeliug is derived from tlie uorves, and is, eliewbcre, separately considered. K) THIS ORGANS OF SENSE. I : tymptoiii would identify a sympathetic atrection of the brain ; or, it may be associated with insensibility of the nerve, which communicates the representations of the eye to the brain, in which case it need not be oth- erwise tluin a i)urely local symptom 2. A contracted pupil may l)e caused by great teiulernens to lt(/ht, when it consists of a convulsive effort to exclude the light from acting too powerfully upon the eye. If attended with sensibility to light, it exhibits over-due irritability of the nerves connected with the siglit, and, consequently, an irritative Inflammatory tendency, ^f attended with insensibility to light, and associated with fever, it is an indication of the utter prostration of the vital energy. Languid eoqjression of the eye, occurring as a distinct and appreciable iymptom, may indicate (1) if associated witli anaJtV^?/— overloaded stom- ach ; or, sometimes, the action of fermented liquor on the stomach; or of deleterious substances, or of heavy and indigestible food; in such cases it forebodes vomiting, especially if cold sweat bedews the forehead; (2) if associated with general debility, as the result of sudden and severe loss of animal fluids, or of very :.evere acute disease, it denotes the sinking of the vital energy, and often forebodes fainting. Squinting, or distorted sight, is always symptomatic, when it is not iiabituai, .nd constitutes a very important indication, in children especi- ally, affording a decisive index to the case, wlien other symptoms con- spire to evince the probability of acute water on the brain. Otherwise, it exhibits a sympathetic affection of the brain, originating in irritation of the stomach and bowels, especially if worms be the direct cause of euch irritation. Staring expression of the eye, or fixed stare at one object, with or without raving, or muttering, if consciousness be absent, identifies delir- ium ; or even if consciousness be not absent, (in the usual acceptation of the phrase,) there is a degree of abstraction, amounting to momentary and accidental suspension of consciousness, absorbed by a fixed tliought, or with vacancy of thought, in which case, also, it may be termed the indi- cation of a degree or species of delirium (in its strict sense). Sunken or retracted eyes denote debility. Protruding or prominent eyes, particularly if they be glittering, and characterized by suffusion of redness, combine to identify considerable congestion of blood in the head. The sight is attended with some variations of distinctive import- ance—as, for instance : 1. Double sight, or half-! ight, either of which may exhibit a degree of spasm, and which may be simply associated with a hypochondriacal or hysterical disposition, but which may also arise from irritation of the stomach, especially, as the result of very stimulating food or drink; in which case, however, it is usually characterized by giddiness, drowsiness, dread of motion, talkativeness, extreme taciturnity, or excessive rest- lessness and excitement • i •, again, as one of the premonitory symptoms of imminent apoplexy. 2. Tlie appearance of a profusion of dark spots bx. ^re the eyes, g,»n- erally conveying the idea of a slow des rudiiig movement aggregately, but sometimes, also, of irregular oscillation, which, even when theputien! INVESTIGATION OF DISEASE. 71 wanders, is often to be distinguished in some fantastical expression ; ot dread of insects, a.^, in liealth, he or she abhors, may (according to otlier symptoms present) identify or /oretode;— depression of vital energy and fainting, if tlie pat'ent has suffered from very debilitating aflections, such as excessive loss of blood or other animal fluids, or from very rapid or severe acute disease, determination of blood to the head, or a deranged or over-loaded stomach ; and. perhaps, in the latter case, vomiting. 3. Obscuration of sight alTords indications similar to those of dark spots before the eyes, as just stated. The taste affords very important indications in respect of its alter- ations — as, for instance: 1. Foul taste may originate either in local affections of the mouth, teeth, throat, etc., or in irregularities of the nervous system, as occurs particularly amongst women of a highly susceptible, hysterical disposi- tion ; or, sometimes, also, without such causes, during pregnancy ; or, again, as associated with fever, in a tendency to putridity in the blood, whicli it, therefore, denotes to a certain extent ; or, again, if saltish and putrid, as occurring in persons of a consumptive constitution, or under circumstances likely to provoke consumption, it may originate in a sup- purative condition of the last-named" disease. Furthermore, a sweetish, saline, bitter, slimy, or harsh and acrid taste, especially, if considerable phlegm be constantly in the throat, may bo traced to the jiresence of an irritative condition of the stomach, occasioned by the j)reseueo of impure matters. 2. Loss, or absence of taste, may arise from some organic, nervous affection; or, again, from cold, or derangements dependent upon cold. The hearing may constitute a characteristic symptom, either in its excessive or deflcient sensibility. 1. If deficient, as associated with fevers, and, particularly, with typhus, tills very irregularity constitutes a wholesome indication. 2. If excessive, associated with fever, we may identify eitlier a degree of inllammatory action involving the brain, or, in general, too acute a susceptibility of the nervous system. 3. Buzzing or ringing in the ears, as associated witn inflammatory action, or occurring without any apparent cause, or without either of the other conditions here mentioned, in persons of a full habit of body, may be attributed to congestion of the blood in the part; or, if associated with cold, to that, with or without increased secretion ; or, again, to determin- ation of humors to the ears, when more or less deafness usually qualifies the ca.«!e. The sense of smell, is also qualified by two chief conditions, namely; (1) deficiency or loss of smell, which is attributed to nervous dis- turbance, or to the effect of cold (when associated with cold,) or to indi- gestion ; and (2) unnatural conditions of smell; as, for instance: — tlie prevalence of putrid smell in the nose, which is att.ib'? table either to local ciseasf! of an ulcerative and putrid character in the nose or palate, or to tendency to putridity in the blood or developed as a'.» early mani- festation of disposition to apoplexy— or peculiar smell (which is not putrid, but may be very disagreeable,) and which consists of an affection of the olfactory apparatus of a si)asmodie character. n COUGHS AND TIIEIK INDICATIONS. CHAPTER III. INYESTIGATION OF THE DISEASE-Continued. I'pi COUGHS, AND TIIEIH IXDICATIOXS. Coughs are of various significance, and point to various derange-^ men ts, or i'eaii' of derangeiueut, according to tlie conditions which pre- cede, accompany, or follow tlieni, or by wliich they are immediately pro- voked. They constitute a scries of manifestations, whicli should never be overlooked in the investigation of disease, because it is clear that whether associated with direct or local inflammation of the respiratory apparatus, and of the lungs in particular, or witli sympathetic affections of these organs, originating in other organic causes of irritation, whether in the stomach and digestive process generally, or particularly in the spleen, liver, etc.; the presence of cough indicates, for the time being, one of two conditions, respecting the respiratory apparatus, namely:— either (1) that there is in the system some cause of irritation oppressing these organs, directly, or reacting upon them from other parts. If the affection be merely sympathetic, caused, as is very frequently the case, by irregularity in the process of digestion, chronic derange- ment of the lining membrane of the stomach, etc., or by tlie presence of any impure substance in the stomach or bowels, either received from without, or spontaneously engendered from within, it does not indicate circumstances of nmch consequence as regards the organs of respiration, and should be dealt with purely as an affection of the stomach or bowels, etc. ; with this reservation, however, that if the increased irritation of the lungs, etc., be allowed to continue too long, for want of the removal of such provoking cause in the digestive process, it may lead to congestion of blood to the hmgs themselves. If the respiratory organs themselves be clearly the seat of the affec- tion, it may be the product of the congestion of blood, suj)puration. tubercles, etc., or of a purely nervous affection; or, again, of inflamma- tory action in the lungs, or the ramifications of the wind-pipe, or pri- marily of common catarrh, etc. The condition of perfect health, as respects the respiratory organs, is, therefore, in any case, inconsistent with tlie presence of cough ; for when no cau.se of irritation, either local or sympathetic, is present, there will be no cough, nor anything to impede tli# breath, and a deep inhalation may take place, the air being retained for many seconds in tho lungs, without the slightest disposition to cough. If the habit of body be such as to lead to the suspicion that there is some latent taint in the system; or if, again, the taint be testified by morbid affections of the glands, skin, or bones, or by tendency, in every affection, to assume a sluggish, chronic character, or by continual inflam- matory or ulcerative affections of the eyelids or gums, every cough may be of momentous importance, and should lead us to investigate its cauee, INVESTIGATION OK DISEASE. n and to treat the aflection, of whatever cliaraeter, without dehvy, lest, while we pause, it should run on to organic affection of the lungs, and degenerate into consuiuption. 8hort, dry cough, accompanied by watering of the eyes and frecjuent fits of sneezing, in the early stage of acute fever, usually prognosticales measles. It may, likewise, (wltliout such particular accompaniments) announce an eruption of another character. Co'-gh, (generally,) pauiful, hac/dng cough, associated with acute FEVERS (other than those originating in, or associated with, cold,) may often be the foreboding symptom of incipient inflammation of the lungs, when the manifestation of crepitating (crackling) breath will frequently be decisive. Predisposition to cough, as the result of every exertion of the lungs — such as the accelerated breathing caused by rapid motion, or speaking, or laughing; or, even as occasioned by mental or moral excitement— such as emotions, etc. ; or, again, as the result of every derangement of the sys- tem, usually identifies a tendency to organic affections of the lungs. Chronic, dry cough, especially if associated with more or less difficulty in breathing, and readily provoked by the slightest causes, and accom- panied from time to time with stitching sensations, or pains in the chest, would lead to the belief that tuberculous disease had set in. TRANSPIRATION FROM THE SKIN, AND SWEAT, AND THEIR INDICATIONS. The more distinctive method of dividing the consideration of this cutaneous process, would be to consider "transpiration," properly so called, as a heaUhy, natural operation — indicative of derangement only, when qualified by excess or deficiency. Excess of transpiration, under the name of sweat, and deficiency of transpiration, under the name of dryness of the skin. 1. The transpiration of health is evinced by softness, with slight moisture of the whole surface of the skin, in an equal degree, and without any roughness, crackling, extreme tension, shriveling or withering, or flaccid, fiabby looseness of the skin, but with natural fullness and elastic- ity; and it consists of a continual, imperceptible, gaseous exudation. 2. Sweat is a disturbed degree of transpiration, characterized by excessive discharge of humor of the skin ; it may be perfectly consistent with health, as the result of severe corporeal exertion; but, in relation to disea.se, sweat must be considered as of two distinct kinds: (1) that which accompanies the healthy determination or crisis of disease, or by which such healtliy determination is effected, which is called critical, and (2) that which occurs bff'ore the critical period, which is followed by no relief, but rather by aggravation, or which is excessively profuse, which fore- bodes, or ushers in, or originates from, the peculiar operation of disease it'-elff ^specially characterized by the eruption of pimples (and not of a healthy reaction,) which is called symptomatic. Of the latter variety— symptomatic sweats— we may ^particularly notice (1) sweat occurring in the morning (without previous habit of the kind) and which, if associutsd with fever, identifies its hectic character; r ! t ! '< 74 SWEATS, TIIH ( OMl'I.KXtON. II Mil (2) offensive sweats, which, as associated with fever, identify putrid typJius; (3) sweat emitting a sour smell, wliich commonly characterizes the fever as miliary; (4) local sweats, as, for instance, on the chest, or aljout the head, which are characteristic of determination of hlood to those parts ; (5) cold sweats, which deiiote a depression of vital energy, and which, in the last stage of pro.:itration, forebode dissolution; (G) tran- sitory sweats, as opposed to the continuous sweat of a wholesome crisis; (7) symptomatic sweats may, liowever, be caused by a mere accessory mismanagement— such as want of ventilation, and excessive heat of the apartment— the use of feather-beds, which is much to be deprecated, especially in cases in which fever becomes developed— or the superfluous (and very mistaken) excess of covering; (8) otherwise we may generally attribute them either to great debility of the whole system, as associated with depressed pulse, etc., especially if occurring after long and debilitat- ing diseases, severe loss of blood or other animal fluids or other exhaust- ing causes, or to accumulation of noxious matters or substances in tlie stomach, when they will appear more particularly about the forehead and face, and will usually be cold and clammy; or, again, to overdue activity of the circulation, accompanied witli comparative deficiency of energy in tlie functional process of the skin. Critical Sweat, on the other hand, is to be distinguished (1) by affording general relief, and by the simultaneous modification of every source of suffering and the subsidence of the irregularities of tlie pulse; (2) l)y being warm and clammy ; (3) by being developed over the whole sur- face of the body simultaneously; (4) by the subsidence of all restlessness, nervo\is irritation, or mental uneasiness, and the occurrence of calm, even, undisturbed sleep; (5) by continuity; (G) by tlie period of its development, .n relation to the duration and course of a fever— viz., on what is termed liie critical day of those fevers whicli run a regular course and usually resolve themselves into an issue about a given period, as on the seventli or fourteenth day, etc. THE COMPLEXION AND ITS INDICATIONS. Red, florid complexion, commonly identifies determination of blood to the head, or a full habit of body in general. White (cold, dead white,) complexion of young females at the critical age, denotes a difficulty in the sexual transition— green sicknePH. Faint-yellow complexion, usually denotes intestinal disease— disease of the bowels. Deep-yellow complexion, on the other hand, identifies jaundice or even organic disease of the liver. Pallid complexion, with (more usually) meagreness, want oi fullness of the skin, commonly identifies the stomach and intestinal canal as the seat of disorder, and may be caused by any obnoxious or impure matters therein— such as worms, (in particular) or associated with acidity of ihe stomach, with a drawn, sunken appearance, (especially,) it denotes spasm; with (more usually) puffiness of tlie tlesh, it is associated with constitu- tional weakness, qualified bv sluggish circulation or congestion, or excess of watery liumor (as a constituent) in the Idood, or by deficiency of blood. INVESTIGATION OF JJlSKASE. 75 6 Patuhy redness of the complexion— that is, redness as of a flush- spot on tlie clieek, denotes a hectic disposition. 7. Su'ldeii ami total change in the appearance of the complexion is often to be considered as a very serious manifestation. 8. JAml spots, may, in advanced age, lead to an apprehension of apoplexy, as indicating inactive accumulations of blood upon important organs (witli stagnant circulation); the general indication, however, afforded by this nianife:5tation, is that of a putrescent condition of the blood (as associated with scorbutic habit of body). 9. Bhte, or livid complexion (habitual)— organic alfectioij of the heart. SOUNDS EVINCED BY THE CHEST, AND THEIR INDICATIONS. The only varieties which have been considered susceptible of general investigation, or which appear appropriate for the consideration of unpro- fessional persona, are such as are plainly manifested by what is termed permission— that is, by tapping upon the chest, etc., with the tips of tlie first two lingers of the right hand, or upon the index linger of the left hand, being laid flat upon the surface— and which we shall confine to the dear and dull sounds. Auscultation, or the act of listening by tiie application of the ear to the chest {immediate or by the unassisted enr— mediate, or by the stethoscope,) requires anatomical knowledge, and considerable experi- ence, to insure a correct interpretation. 1. The clear sound— ov that which conveys the idea of an unoccupied cavity— is a sufllcient evidence that the cavity of the chest and the lungs are free from any abnormal formations or accumulations of obnoxious matters, such as blood, matter, water, etc., and, therefore, indicates sound- ness. 2. The dull or muffled sound, or that which conveys the idea of a cavity, the resonanoo of which is impeded by repletion, indicates the presence of accumulations, whether of lilood, matter, or water, etc., and consequently unsoundness. The sounds elicited anteriorly, posteriorly, and laterally, in one-half of the chest, ought to be carefully compared with those of the other; but, as the sound is natnially dull over the region of the liver, we must not expect to find it clear below the sixth rib anter- iorly, tlie eighth rib laterally, and immediately beneath the shoulder-blade posteriorly. THE VOICE AND SPEECH, AND THEIR INDICATIONS. 1. Loss of twice— which may be occasioned by paralysis, or by simple spasm in the organ of voice— generally, however, indicates inflammation of the upper part of the wind-pipe, and if this symptom becomes perma- nent, or chronic, it denotes organic disease of the part. •2. Hoarseness is likewise a symptom which originates in the upper part of the wind-pipe, and may consist of a temporary congestion or inflammation resulting from cold, or may denote organic disease of the part. •S. St(im7neii7)g—as associated with fever— is a symptom of great moment, and which may sometimes be distinguished and foreshadowed in ^m fQ CRYINd, LAtlOHlNO, SNEEZINO, ETC. the early stage of diseuso, by the imperfect pronunciation of particuliir vo-a-els or syllables-in wliicli case it sliouUl be held to forebode severe jiffection of tiio brain. It is a frequent premonitory symptom of apoplexy. 4. Loss of spenr.h is a very grave .svmptom wlien it occurs a3.40ciated witli concussion of tiie brain, apoplexy or typiius; or it may be associated with worms or other noxious matters in the intestines, or simply witli hysterical disiwsition; or, again, it may be the result of spasm, in which case it may assume a periodicity. TEARFULNESS AND LAUGHTER, AND THEIR INDICATIONS. 1. Copiom watering of the oi/fs in tlie early stage of i<m-:ver, com- monly forbodes measles; or, if occurring in the course of acute fever, it usually denotes determination of blood to the head. 2. Tear/ulniiss, or weepin!/—\n-ovoked Ijy the most trivial causes, is one of the chief manifestations of hysterical disposition, the same being the. cause of laughing; therefore, the two symptoms are generally combined, and the one succeeds, or runs on into, the otlier. In such cases, howevt-r, lauyhter is genevaWy the first symptom, which, becoming prolonged and convulsive, is converted into weeping. An excessive susceptibility and tearfulness, or weeping upon the slightest vexation, or upon fantastical grounds of vexation, is similarly indicative of a hysterical disposition, and is one of its chief indications. 3. Lauyhter, in every case, denotes a great degree of nervous irrita- tion, both as regards the superior faculties and the animal functions; if there be a predisposition to laughter, whicli is provoked by very trifling causes, a hysterical disposition is clearly identified, as already stated under the head of tearfulness; if associated with fevkb, this symptom often forbodes convulsions or delirium. LOSS AND UNHEALTHY INCREASE OF FLESH, AND THEIR INDICATIONS. 1. Aceumulation of flesh, (fat,)* which is sudden, excessive, or other- wise irregular, is usually associated with organic disease of the liver, but may, at any rate, be very closely watched to detect the lirst manifestations of distinctive indications of disease. 2. Emacialion, or loss of flesh, when it does not occur as the result of fever, or of distressing affection of the mind— such as deep and gnawing grief, or continued mental excitement, etc.,— may be attributed (i) to unduc^ and irregular discharges of blood, etc., evacuation of water, and the like; (2) to disease of the lungs, or of other organs connected with the respira- tory apparatus; (3) and most frequently, to derangements involving the digestive functions, and seated either in the stomach or bowels. SNEEZING, YAWNING, GROANING, ETC., AND THEIR INDICATIONS. 1. Sneezing is directly caused by irritation of the nerves connect< d with the lining membranes of the nose, and consists of a convulsive respl- * It is not unworthy of notice, tlmt the samn Hymptom Jms boen ideiitificMl amongst tbu iriforiut animali, as ^ 'ompanying the earliest etasc of Uiaoases rosulting from obstruction of thu biliury ilii,.tn. \\ , INVESTIGATION OF DISUASB. 77 ration; it may bo the result of irritation in tlio b iwels, and as such, when it occurs very frequently, in cliiidren, without Ijoins associiited with any more direct cause, (as hero stated,) we may infer tiie presence of worms, sw the pi'ovoking cause; or it may occur as an incipient symptom of measles, if associated with fever which cannot be traced to cold ; or, again, it may be the more manifestation of cold in tlio head. 2. Yawning is the result of asluoffrish passage of blood through the lungs, and, if associated with lever, wliether acute or intermittent, in its incipient stage, it identifies one of two conditioiis; either a spasmodic, or a debilitated state. 3. Groaning may be attributable to purely mental causes, with which, indeed, this symptom is gener illy associated , otlierwise it affords tlie same clue to the distinctive nature of the affection as tlie preceding symptom '.yawning). THE SALIVA AND ITS INDICATIONS. The distinctive features respecting the saliva, as indicative of more or less derangemtMit, are either an increased, or a deficient and diseased flow of this iliiid, as compared with the habitual coiulition of health respect- ing it. 2. Dejlclencij of Salion, or dryness of the mouth and throat, denotes eithei' (1) a deficiency of the watery humor, as a constituent of the blood and consequently an inflammatory or feverish condition— in which case it will occur as a continuous symptom, associated with extreme thrist; or (2) may originate purely in spasm, in wliicli case it will occur but casually, and, if attended with unnatural tliirst, the latter symptom will disappear with the direct cause, and with the resumed action of the salivary glands. A diseased state of the saliva, which is so frequently associated with indi- gestion, may be manifested in the form of a thick and tenacious, or— though less often— a thin and acrid fluid. 2. Increased flow of Salioa may either be critical, as, for instance, in small-pox, or in sluggish nervous fevers, or in fevers generally, as occa- sioned l)y sunpression of transpiration (through the skin); or it may be symptomatic, (in which case it may either identify a jjurely local affection of the salivary glands, or be associated witli p.yrapathetic disorders origina- ting in tlie stomach or intestines; such, for instance, as that deranged state which gives rise tg the existence of worms) ; or, again, it may be associated with sore throat. THE EXPECTORATION AND ITS INDICATIONS. 1. Expectoration, which indicates a wholesome determination or crisis of disease, especially inflammatory diseases affecting the lungs, is technically termed "critical,'' and is identifled by tlie facility with which it is detached and expelled, by the absence of pain associated witli it, and, on the coa- trary, by the relief which it affords, and by exiiibiting a thick agglomera- tive consistency and yellowish color, occasionally modified by a few slight streaks of blood. 2. Expectoration, which is expelled by an effort, such as repeated hawk- ing or coughing, or which causes more or less acuie pain or soreness in the rs DIET AND MANN Ell OF LIVINn. effort to detach it, may either denote the presence of acoumulatlona of obstructive and obstructed matters, in any of tiie air-cells or tubes, or in the windpipe, or wliencetlie discharge of expectprated matler proceeds, a^ the result of a continued irritation If jelly-like, or sticlty and rusty-colored, it will usually indicate Inflam mation of the lungs. If transparent, stringy, or sticky, sometimes streaked with blood, and expectorated with much dilllculty and without relief to the patient, itco;ij monly identifies acute inllauimation of the tubes of the lungs, (bronchitis); in which affection a change in tlie expectoration to that of an opaque* yellow, or greenish-white colored substance, which is easily coughed uj), and is followed by considerable relief, gives evidence of subsiding infliun- mation. If it bo of the character of matter, or it whitish streaks are seen, or small whitish-yellow, sometimes globular masses, connected together by, or floating amongst, sticky phlegm (continuously,) it is usually a symptom of suppurative (the second stage of) consumption ; again, if it consists of masses of substance of a brown orgreonish-white color, and which flattens at the bottom of the vessel, into a shape- resembling a piece of coin, it ia an indication of an advanced stage of consumption. If it be of pure blood, it may be the result of inflammatory action, or of consumption ; but it is, very frequently, the oflTspring of congestion, or an overcharged state of the vessels of the lungs. If a permanent symp- tom, (and not a critical expectoration,) it is, gencrully, of mucli import. If yellow, and particularly if also bitteriah, affection of the liver is ideoti^ed. CHAPTER IV. DIET AND MANNER OF LIVING. DIET. These excellent rules on diet have receiveil the approbation of all classes; the self-denial imposed seems more stringent tluiii it will prove on being carried into effect. Many individuals, in the authors' own experience, have pursued the same system of diet after they had no fur- ther occasion, for medical assistance, thus continuing, from choice, what they had begun from necessity. These dietetic rules consist merely in the avoidance of medicinal and indigestible substances during treatment, both as calculated to interfere with the action of the medicines, and the proper functions of the alimen- tary system. Consequently, among liquids, the articles generally i)ro- Bcribed are green tea or strong black tea, coffee, malt liquors, wine, Ki)ir its, and stimulants of every description ; lemonade, or other acid or alka- line drinks, and natural or artificial mineral waters. On the other hand cocoa, unspiced chocolate, toast, rice or barley-water, oatmeal gruel,. sweet- ened with a little sugar, or raspberry or straM'beri'y syrup, if desirfd; INVKSTUJATION OF DISEASK. 7» P.I- whey, milk nnd water, or pure milk not too recent from tiie row, l)0iled milk, nnd, in Honie instances, butter-milk, or, in fact, any non-medicinal beverage is allowable. Tlie diet should, however, bo accommodated to Uie peculiarities of the constitution in individuals; for instance, some persons cannot take the snuiUest quantity of milk without serious Inconvenience; others tlirow out a rash after partaking offish; and, again, others loatlie the very sight of animal food. These peculiarities should, also, bo taken into account in the selection of tlie remedies. Of the varieties of animal food, pork, young or salted meats, and, amongst poultry ducks and geese, were better avoided, particularly wlion derangement of the digestive functions exist. Beef, mutton, venison, and most descriptions of game, if not too lrii,'| kept, (high,) piget \s, larks, 'abbits, etc., are allowable at discretion. (Refer to the Synopsis, Fish is a wholesome article of diet, and may, in most cases, be par- taken of occasionally, with the exception of the oleaginous species— such as eels, salmon, etc.; or shell-fish— as lobsters, etc.; and all kinds of salted, pickled, potted, or smoked fish. Eggs, when known to agree; butter, if free from rancid, or unusual taste; cream, plain, unseasoned cuskirds, and curds, are also admissible in moderation. (S<«m/f/ffii;iflf soups, and high-seasoned, or rich-made dishes, are directly opposed to this regimen. Beef tea, veal, and chicken broth, etc., thick- ened with rice, macaroni, or sago, and seasoned merely with a little salt, are, of course, allowable. Amongst vegetables, all of a pungent, aromatic, medicinal, or indi- gestible description, or greened with copper, are prohibited; such as onions, garlic, eschalots, asparagus, radishes, horse-radish, celery, parsley, mint, sage, mushrooms, etc.; but others, free from such qualities, such as potatoes, French beans, green peas or beans, cauliflower, sijinach, seakale, mild turniiis, carrots, etc., may l)e used with the needful precaution of avoiding any particular article of diet, vhetlier of [the animal or vegetable kingdom, that may seem to disagree in the particular case in question. Lemon or orange-peel, laurel leaves, bitter almonds, peach leaves or kernels, fennel, anise seed, marjoram, etc., are objectionable ;acid.'<, and the ordinary condiments, such as pepper, mustard, picliles, etc., and salads, ought either to be sparingly partaken of, or entirely alistained from, par- ticularly, by persons predisposed to indigestion. Salt and sugar, in mod- eration, are admissible. All kinds of light bread and biscuit, free from soda or jjotash, and not newly baked ; also, simple cakes, composed of flour or meal, eggs, sugar, and a little good butter; or light puddings, such as bread, rice, sago, sem- olino, with9ut wines, spices, or rich sauces, are admissible; but colored confectionery, pastry, and, in some cases, also, honey, must be rejected. Regularity, in the hours of meals, should be observed, and too long fast ing, as well as too great quantity of food, at one time, should be avoided. It is not sufficiently considered that excess in eating, even wholesome and digestible food, is a most grievous error. The lightest diet will impede the operation of the digestive functions, if tlie stomach be over- loaded. It were always better to leave the table unsatisfied, than to ^%^ ^ n% V>, IMAGE EVALUATION TEST TARGET (MT-3) 1.0 I.I 1^ tii li. JIM 12.5 IIIIIM 12.2 2.0 1.8 1.25 1.4 1.6 M 6" - ► Photographic Sciences Corporation S ,v fv^ \\ % V « a ►^ >^ # 6^ <^ 'b'' .^ ^' 23 WEST MAIN STREET WEBSTER, N.Y. 14580 (716) 872-4503 L<P cp. >mm If r^ 80 CLOTHING AND HABITS. indulge in nny oxcdss in this particular. Nor should it bo forgotten, that a craving appetite, wliich induces an inclination to eat excessively, is, in Itself, an unhealthy condition, which requires to be counteracted, rather than to be encouraged. During fevers and infiammatory aflections, the patient must, of course, be kept upon a low regimen— gruel, barley-water, etc., and, at the commencement of convalescence, a light juKlding, with a little weak beef tea, or mutton or chicken broth, should form the whole of the nour- isinnent given. Nature, however, is our best guide; and whenever she takes away appetite, the necessity of not taxing the digestive functions must, with rare exceptions, be deemed imperative. (See Fever, and also Synopsis of the Rules of Diet). CLOTHIiVG AND HABITS. Upon the first point, it were scarcely worth while entering into any observations, were it not simply to remark upon the impropriety of wearing garments impervious to air, and fitting closely to the shape, and the custom of exposing the extremities and chests of young children to the chilling atmosphere of our jieculiarly variable climate, under the absurd idea of making them hardy. The evil consequences arising from tliecheck given to perspiration, by the first-mentioned practice, are too well known to require any particular comment; but as the other is an error widely prevalent, I consider it my duty to mention it; and I feel assured, that, ifmothei's would only reform this custom, and clothe their chil- dren in a more rational manner, they would make no slight advance towards the prevention of serious aflfections, not only during childiiood, but in after life. Cotton, linen, and even leather, worn next to the skin, are generally preferable to coarse woolens. As regards habits, it may be briefly observed, that a regular metliod of living, avoiding ill-ventilated apartments, late hours, dissipation, over-study, anxiety, and other mental emotions, and taking sufficient air and exercise, are the best preservatives of health. The frequent use of hot-baths is injurious and liable to retard th*! cure under treatment. The idea that sea-bathing is almost universally beneficial is exceedingly erroneous; there are many constitutions on which it acts prejudicially. Medical baths, either natural or artificial, are .strictly forbidden. Bathing the whole frame daily witli a sponge or wet towel, with cold or scarcely tepid water, and the use of the flesh-brush are by no meavis objectionable, and, indeed, frequently strongly to be recommended. (See Notes on the Use of the Bath.) C H A P T E R V. ADMINISTRATION AND REPETITION OF HOM(EOPATHIC MEDI- CINES. The method, quantity, potency, and frequency of repetition, to be selected and observed in the administration of the remedies, will be stated m->re explicitly as regards particular eases, in the subsequent directions for the treatment of each separate disease. t I ADMINISTHATiON OK IIOMCEOPATIIIC MEDICINES. 81 18 Tlicre will also be additional particulars in the remarks on internal and external remedies; and material assistance may be derived from the Repertory. Yet much will still be left to the discrimination and judgment of the administrator; because it is obvious, that a multiplicity of exoei^tional cases and conditions will arise, to which no general rule and few special regulations will apply. In instances of this description the particular character of each symptom distinguishable by the condi- tions under which it is manifested— or still more properly the assemblai/c of symptoms similarly qualified by conditions, will be the safest guide for tiie judicious selection of the remedy; and the continuance, return, sus- pension, aggravation, palliation, modification, or change of such particu- lar features of ailment, will serve to regulate the repetition, suspension, or change of the remedy. The same circumstances will also frequently guide the administrator to change the potency (strength,) when the remedy selected is evidently indicated, but has not been followed by adequate restilts; or, in other instances, to adopt a similar remedy, when both of the previous methods have equally failed. In pursuing such changes, great care should be taken in turning to the Table of Analogous Remedies, and from thence to the Repertory, and thereby selecting the remedy or potency whose operation assimilates most nearly to the aggregate features of symptoms and conditions in the case. The form of the medicine.— With respect to the/orwin which the medicines should be used, see under the head of " Remarks and Regu- lations respecting Internal Remedies and Doses." Repetition and selection.— The following are a few of the gen- eral rules to be observed in the domestic employment of tlie homoeoi)athic medicines: In diseases which are severe, and run their course rapidly, we must carefully watch tho symptoms, and when we feel assured we have chosen the proper remedy, if no perceptible medicinal aggravation or improve- TTient declare itself, but the disease seems to gain ground, repeat the medi- cine. In cases of high inflammatory action, Aconite or Belladonna, etc., should sometimes be repeated at intervals, varying from fifteen minutes to two, four, or six hours. If a medicinal aggravation take place, followed by improvement, we must let the medicine continue its action, until the improvement appears to cease, and the disease again makes head; if new symptoms set in, we must then have recourse to the medicine thereby indicated. Should, iiowever, no perceitible medicinal aggravation take place, but improve- ment follow, we n. ay safely await its approach to a termination, ere we again administer. If any symptoms remain, from the remedy first selected having affb.'ded only partial relief, we must have recourse to some other medicine, \vhich seems best fitted to meet them; but refrain from changing the remedy as long as benefit results from its employ- ment. In diseases whose symptoms are obstinate and long-continued, and in those which are virulent, but of sliort duration, as well as in those which partake somewhat of these features of violence, when a very striking improvement takes place, it will generally be found advantage- 82 ADMINISTRATION OF IIOMCEOPATHIC 3IEDICINES. y>i' I] 0U3 to cease to administer the medicine as long as the improvement continues^ and only to repeat as soon as the slightest symptoms of activity in the progress of the disease reappear. But when a sudden or marked improve- ment, of comparatively short duration, follows the first dose of a remedy, and on repeating the dose, the symptoms of the complaint increase instead of subsiding, as they did in the first instance, it may be concluded that the medicine does not answer, and that another must accordingly be resorted f-^, in the selection of which it will be necessary to choose one related oraiialogous to the remedy first prescribed. The distinguishing of the medicinal aggravation from that of the dis- ease, being a point of material consequence, we shall hero give the leading and most usual characteristics of each. The medicinal aggravation comes on suddenly and without previous improvement; the aggravation of the disease more gradually, and frequently /oZZoz^jm^ an amelioration. Lastly, thd pulse is also a good guide, particularly in fevers and infiammations. Thus, when it becomes less frequent, or when, at all events, it does not increase in frequency, on an accession of aggravation, the aggravation is to be attributed to the medicinal influence; but when it does increase in frequency, the aggravation of symptoms must be considered as depending on the advance of the disease. Wo cannot attach too much importance to the necessity of carefully watching the effects of each dose, as, in addition to the temporary aggra- vation of the symptoms which sometimes set in, a development of collat- eral or medicinal signs occasionally takes j^lace, particularly after fre- quent repetition of different remedies, in susceptible patients. By a want of attention, therefore, to this important point, we may incur confusion, and may be, unconsciously, treating a temporary medicinal disease of our own creation. We must, also, guard against falling into the opposite extreme— that of allowing the disease to gain head unchecked. Slight diseases arc often removed by a single dose of a well-chosen medicine ; the more severe and deeply-seated disorders are, also, frequently removed by a single dose of a well-selected, or specific remedy; but, in general cases, and, particularly those which have been long and rudely treated by other means, a frequent repetition is usually required. As a general rule, however, a given number of repetitions, more or less, according to the severity of the case, will serve to place the patient thoroughly under the influence of the medicine, after which tlie pause may be protracted, so long as the indications of progressive improvnment are present. If, then, it becomes necessary to resume the administration, it will, generally, avail at remoter intervals than during the previous course. In complaints which are of a mild, though sluggish type, and which are unattended with any critical characteristics, the intervals, in tlie first period, may vary according to circumstances, from six to twelve hours. But in most complaints, in which constitutional or local inflammation is present, the intervals, in the first period, should not exceed /owr hours, and when "mportant organs are involved, and constitutional fever runs high, these intervals should not, at first, exceed ttm hours. In severe acute affections, such as infllaramations, fevers, etc., we may often repea; the same medicine in the same dose, at regular intervals, as long as it does good; but this rule has many exceptions, and the directions, ADMINISTIIATION OF HOM(KOi'ATIIIC JMKDICINK.S. m already given at the commencement of this article, should be borne in mind. In obstinate and lasting cases, by a long-continued administration of the same medicine, the patient often becomes l(!ss susceptible to its action ; in such instances, if the improvement remains stationary, or progresses slowly, we may gradually increase the dose, or still better, give, at suit- able intervals, some other remedy jr remedies, of as nearly analogous medicinal properties, to that first administered, as i)ossible, and then return to the original remedy, if needful: if, on the other hand, decided amelior- ation follow each administration, we should allow a longer interval to olai)SO before repeating, by which means the system gradually recovers itself, and tlie susceptibility to medicinal influence remains unimpaired until the cure is completed. In rare cases, this susceptibility increases; in such instances a higher potency should be selected— provided the remedy still appears to be appro- priate — and the intervals between the doses should be lengthened. This occasionally occurs when the medicine has been frequently repeated and given in solution. When the beneficial effect of a medicine is interrupted by any intermediary irregularity, such as attack of cold, looseness of tiie bowels, etc., some other medicine must be given for ths new affection, on the removal of which, the medicine, which was previously acting favorably must be .again used. In the Selection op the Remedy, it is not necessary that all the symptoms noted should be present; at the same time care must be taken that there are no important symptoms uncovered by the medicine, or which more strongly indicate another remedy. m ily rst irs. is ^ay ilS ns, REMARKS RESPECTING INTERNAL REMEDIES AND DOSES. PRELIMINARY OIJSERVATIONS AS TO THE FORM OF THE MEDICINES. The Form in which Ilomoepathic Medicines are employed for internal administration, requires some particular notice, in order that the reader may have an additional opportunity of administering the medicine, with the medium or veliicle which may be most likely to promote its active operation in the case under con.sideration. It is well known, that the medicines are prepared in three distinct forms, namely: GLOBULES, (pills,) TINCTURES, AND TRITURATIONS OR POWDERS. 1. Globules, (or pellets of sugar of milk saturated with the tinc- ture), are, in a great majority of cases, the only form ret^uired for tlomcstic treatment, and so greatly facilitate the explicitness of the directions for doses, that in the first instance, all the medicines comprised in the list of the remedies which are quoted in this work, must be understood to be recommended in globules, (at the potencies, (strength) also, stated in that list). Dose.— For adults eight globules, (pills), either dry or dissolved in a little water (a teaspoonful). For infants two globules in the same manner. 2. Tinctures might, as far as practical purposes are concerned, be coupled with Triturations, (powder) the latter being the form in which those remedies, which are insoluble, save first made, and consequently which i 84 INTERNAL REMEDIES AND DOSES. rl; represents those lesser degrees of attenuation which are administered in a fill id form— at such remedies as do not require such pulverization to ren- der them soluble (or approximately so). It is this fluid form of soluble substance which is called the Tincture. Tinctures have, upon the whole, (like powders Triturations), been found better adapted to the treatment of ueute diseases, and some forms of scrofula, ague, etc. Dose usually employed— For an adult, two drops to a spoonful of water ; ov, in case's in which the substance medicating the tincture is precipitated (becomes thickened) l)v water— as, for instance, cam- plior,— then give two drops on a small piece of pure loaf sugar. For a child above two years and under twelve years old, one drop — constituting from two to three doses, according to the strength of the child. For an infant under two years old, one drop, similarly divided into six to eight doses, rf. Triturations, as ha:^ already been explahied in speaking of Tinc- tures, represent the lower potencies (as administered in the latter) in rowDER, of substances which are not susceptible of immediate (approx- imate) solution, and which require previous and repeated jt>Mtoen2«iion, and extreme and minute distribution. Tlie administration of Triturations is adapted to circumstances, such as those just mentioned in relation to the Tinctures of completely soluble sut^stances. The objection to Triturations for unprofessional persons, is, that being in ^o^^>(Z«•, we have ho other means of naming a precise quantity for the dose, than by indicating the weight. Persons, therefore, who are in the habit of using them, should furnish themselves with appropriate and well- approved scales. Dose usually employed. For an adult, from half a grain to a grain (about jvhat would lay on the point of a penknife blade of medium size). For a child between two and twelve years old, half a grain distributed as equally as possible into three portions— one of these third portions constituting a dose. For an infant under two years old, one-sixth part similarly. 1. Previous to undertaking the treatment of any affection, it is advis- able that the article on the administration and repetition of the medicine should be carefully studied. 2. Should the progress of the malady, notwithstanding treatment, witliout a distinct change in the nature of the symptoms, indicate a cliange v)f the remedies, it is advisable that the table of analogous remedij* (see page 81) should be consulted in the selection of the new remedy. 3. In cases in which the distinctions between the indications for dif- ferent medicines prescribed are so slight as to leive the least doubt on tlie mind of the administrator, as to which he shouVi select, the decision will be determined by making out the list of symptoms, and referring to the " Repertory." This difficulty may frequently arise where two or more medicines are of closely analogous operation. 4. Of doses for infants and children.— Whore no particular direction is given for the treatment of young children, or children under the age of twelve years, it is to be understood, that the dose, in general cases, should be in proportion of one-third of that directed to be taken I AbMlNISTBATlON OF iAeDICINES. 8A |(lif- the 'ill lllie tire lar Ider iral Len tjeaendlji, or especially for an adult, as nearly a.s that proportion can be ascertained. The general dose for an infant, under six months of age, may be stated at the proportion of two globules (pills) to three teasjjoonfuls of water, which solution should be administered by the teasjioonful at each dose. The general dose for an infant, between six and twenty-four months old, may be stated at two globules (pills) to the teaspoonful of water for each dose. Of Potencies.*— With respect to the potencies or dilutions to be employed, although it is by no means an essential point, still, as all the directions for treatment herein given, have been drawn in confuriiiity with that scale, it is well that they should be in accordance with those quoted in the table of medicines and dilutions prescribed in this work. 6. Of the division of doses and solution.— The doses prescribed m this work, are all directed to be taken in solution, as that is doubtless the most efHcacious method of administration. But when that is not con- venient, or is rendered impossible by the state of the patient, the globules (pills) may be administered dry, by being placed on the tongue. When the solution of any medicine in water has to be kept more than three days before the whole is consumed, it is necessary to preserve tlio water from decomposition, by adding six drops of proof spirit to the two tal)lespoonful3 of solution. In very hot weather, one day should be the limit beyond which no solution should be kept without such infusion of spirit. When it is not convenient to &,dd the proof-spirit to the solution, the only way of obviating deterioration is to make a fresh solution at the expiration of every such stated period of time. The best medium of solution is distilled water ; the next, filtered or ptre rain water; the next, water which has previously been boiled, or pure spring water. 7. Of the kecurbence, suspension, etc., of doses.— It were impossible, as lias been already stated, in laying down a general rule for treatment, always to assign a given recurrence of the dose of any remedy, without being as egregiously wrong in one case, as one might be positively right in another. The discretion of the person who uses the medicine, guided by a careful study of the article on the repetition of medicines, must indicate the frequency of the dose?, the pause, the renewal, and the change, according to the conditions of each particular case. As far as the frequency, suspension, and resumption in the exhibition of medicine can be reduced to a systematic scale, this has been done in the subjoined table, from which the p Jent may occasionally derive assistance, but to which he must not trust in vhe least exceptional instances. Great care must be taken in distinguishing between the scale set forth for a(mte,teA\i\ that designed to direct the treatment in chronic disease. The cons/'ITUtion, tempekament, and habit op body must also modify all set regulations in respect to the recurrence, etc., of doses. Highly susceptible subjects require more sparing treatment, and must be closely watched, to observe the earliest indications in the cessation of effect, medicinal aggravation, or other exceptional conditions. * Pi)t -'oy ia the t^rxa used to describe the strength of the medicine used. ^Wl K6 TABLE OF ANALOGOUS REMEDIES. 8. Of coNSKruTiVE TREATMENT,— It is a manifest error, in treating of any malady, to direct a patient positively to begin by the administra- tion of this or that remedy. Every rimlady may develop itself in a variety of ways. The incipient stage of the same disease, even, is scarcely ever Identical in two cases. In all instances, the development of complaint must depend upon constitutional tendencies, atmospheric inlluenccs, external circumstances especially relating to each case, condition of the system of previous treatment, etc. All the remedies which are applicable to the treatment of any com- plaint within the proper province of domestic management, together with the symptoTiis which indicate the exhibition being detailed, the only imy whicJi an unprofessional 2}enon mill avoid eiror, is by invariably selecting TIIK IJKMKDY INDICATED BY THE SYMl'TOMS THAT AKE PRESKNT, and the circumstances which attend them, irrespective of any order of succession, except where (as next stated,) a particular course of medicine is directed to be taken in rotation. TABLE OF ANALOGOUS REMEDIES. As a general rule, however, when consecutive treatment is required, with medicines of analogous jiroperties to those below stated, it will be found that such as are named, iva operating beneficial after others, will be j))eferal)le for selection in such relation, to former treatment, viz: After Acidium-MtHcum—Cd\c'dvea, Petroleum, Pulsatilla, Sulphur. " Acidtim-Phos2>horicuni— China, Lachesis, Rhus, Veratrum. " Aciduin-Snl2}hurician—Pnls'dti\hi. " Aconite— Arnica, Arsenicum, Belladonna, Bryonia, Cannabis, Ipecacuanha, Spongia, Sulphur. " Alumina— Bryonia. " AnUmoniuni Ci'MtZwm— Pulsatilla, Mercurius. " AnUmoniuni Tartaricutn—See Tartarus-emeticus. " ^i'/i/ca— Aconite, Ipecacuanha, Rhus, Sulphuric-acid. " Arsenicuni— China, Ipecacuanha, Nux Vomica, Sulphur, Veratrum. " Belladonna— China, Conium, Dulcamara, Hepar, Lachesis, Rhua, Stramonium. " JB»7/on«a— Alumina, Rhus. " C«/crti'ea-C«»'6on*crt— Acidum-nitr., Lycopodium, Phosphorus, Silicea. " Carho- Vcf/etabilis-Arsenicvim, Kali, Mercurius. " CVmtrt— Ars(!nicum, Belladonna, Pulsatilla, Veratrum. " Cu2trum-Aeet—Ca\carea, Veratrum. " Ifepar-Sulphti'i'is—Acidum, Nitr., Belladonna, Mercurius,Spongia, Silicea. " Ijtecacuan ha- Arnica, Arsenicum, China, Coculus,Ignatia, Nux Vomica. " Xrtc/*,e.s«s— Acidum-phosph., Alumina, Arsenicum, Belladonna, Carbo-veg., Causticum, Conium, Dulcamara, Mercurius, Nux Vomica. •* JJijcopodiuiji— Graphites, Ledum, Phosphorus, Pulsatilla, Silicea. • JJfe»'f?ti'/«.s— Acidum-nitr.. Belladonna, China, Dulcamara, Hepar, Lachesis, Sepia, Sulphur. ADMINISTKATION OP MEDlC'lNKS. Wi After JVicr Vomica— J\ryoniii, Pulsatilla, Sulphur. •' 0^i/*/wt-— Calcarea, Petroleum, Pulsatilla. " i*/to.«</>/to*'«.»i— Petroleum, Rlius. " PtilHatitla—Aci(i[im-mtr., Bryonia, Sepia. " lthun-Toxico<leHdt'on—AcU\um-i>hos., Ammonium-c, Arsenicum, Bryonia, Calcarea, Conium, Pliosphorus, Pulsatilla, Sulphur. " Sej) id— Ciivho-w, Causticum, Pulsatilla. " Silicea — Hepar, Lachesis, Lycopodium, Sepia. " /S/>ow(/i«— Hepar-sulphuris, Kali-Bi., (for instance, in croup;. " (S«i^>/t»er— Acidum-nitr., Aconitum, Belladonna, Calcarea, Cuprum, Mercurius, Pulsatilla, Rhus, Sepia, Silicea. " Tartarns-Eineticus—Tiaxyi?k-c., Ipecacuanha, Pulsatilla, Sepia. " Fera^i'/fm— Arsenicum, Arnica, China, Cuprum, Ipecacuanha. 9. Ok Accessory or Palliative Treatment.— In cases of obsti- nate constipation, the use of the injection, or lavement, is allowable. The injection should consist of cold water, or, if that disagree, of tepid water; in some cases it may, also, oe requisite to add a tablespoonful of sweet or castor oil. The quantity of water necessary for the different ages may, under ordinary circumstances, be stated to be a pint for an adult; J of a pint for a youth of ten or fifteen ; t a pint for a child between one and five years of age ; and about one ounce for an infant at birth, or soon after. In Cases of Acute, External and Local Inflammation, or, more particularly,with wounds in which there is a lodgment of foreign sub- stances, which cannot be extracted, or where ^uppuration is not sufficiently progressive, we may have recourse to an application ot the nature of a poultice, such as that which is described in the ensuing page 87- All appliances and methods, such as bleeding, cupping, leeching, blis- tering, etc., are strictly prohibited. 10. Precaution to Insure a Proper DoaE.— When the adminis- trator is not certain that the patient will adhere rigidly to the dose pre- scribed, or when given doses of medicines have to be sent to a distance, th«5 simplest and safest expedient is to drop the globules into as much suoAn OF MILK, as will envelop them securely, fold the contents together in a slip of cZeaw, wwi/Za2e(i paper, and crush them from the outside, with the bla^e of a knife, or some other hard and even substance. 11. When Medicines Should be Taken, etc.— The medicines should invariably be taken fasting, (save the understated exceptions,) and abstinence from food or drink for about an hour after the administration, is equally important. It is, also, of great consequence, to abstain from excessive bodily or mental exertion during treatment, and to keep perfectly quiet, if possible, for about an hour after the admijiistration of medicine. There are exceptional cases, such as modify this rule, which may arise out of accidents or sudden emergencies, but the rule should be followed as closely as possible, even in cases of this kind. INDISPENSABLE RULES FOB THE PBESEBVATION AND MANAGEMENT OF HOMCEOPATHIC MEDICINES, ANTIDOtES, ETC. 1. Keep your chest closed, or your vials in a dark, dry, clean, and cool place, free from odor or scent of any kind, or, if in a hot climate, in as regular a temperature as possible. hi 1 l» 1 k ' ,' f i (. : \ ; ) ! 1 \ 1 i: !i 1) ^1 i*! n PRESEKVATION OF IIOMaCOPATUIO MEDICINES, ETC. 2. Do not cliiingc the corks, or use the same vials to contain a difftT- ent remedy, without huviug previously been assured that it has been thor- ouglily cleansed, first 'vith boiling and then with cold water. It is better, at all times, to rinse a vial, which has already contained medicine, with spirits of wine, and to expose it, uncorked, to tiie action of great heat, before it is filled with a different medicine. The cork, or stopper, should be submitted to the same process. The safest way of all is, to destroy empty bottles. 3. Let all the medicines be carefully marked and labeled, and abstain from handling two at one time. 4. In preparing your solution for administration, be assured that the glass, or spoon, or other vessel in which you are about to mix it, is per- fectly clean. 6. If it is necessary to prepare solutions of two or more medicines at one time, take care to keep them apart, and to mark them so that na mistake can occur. 6. Do not use the same spoon or other vessel to administer two dif- ferent remedies, witliout having previously ascertained that it has been Kcrupulousiy cleaned. Porcelain spoons are preferable to any metal, on tills account, because you are more certain of the thorough removal of any former medicinal substances. 7. If you dissolve your medicines in open vessels, such as tumblers, take the precaution to have them well covered down during the intervals between the administration, and keej) them in a dark, dry, clean, and cool place, totally free from odor or scent of any kind. 8. Do not resort to any other medi>.'inal agency during homoeopathic treatment, and abstain from any external applications, except such as are described hommopathically. 9. Avoid the use of all articles of perfumery, restoratives, cosmetics, and the like. Camphor, and other popular appliances for cleansing the mouth, etc., are strictly prohibited. The same may be said of smelling salts, etc: 10. The saturated tincture of camphor, as it is used homoeopathically, must be kept entirely apart from any other medicines, or from any vessels or vehicles, such as powders, in which it is proposed to convey or administer other medicines. 11. Do not change your course of treatment cr your remedies, (when change becomes necessary,) too suddenly, or without allowing a sufficient pause to elapse, viz.: at least two hours, if possible, six hours, in general cases of a severe inflammatory nature, and in malignant fevers — and at least from two to three days (48 to 72 hours,) in diseases of a chronic kind. 12. If the symptoms be so violent as to compel you to resort to imme- diate change after any previous treatment, administer one drop of spirits of camphor on a lump of sugar, or a teaspoonful of strong cofTee, and then wait one hour, half an hour, or only a. quarter of an hour, in urgent cases, before you proceed with further treatment. "When, as occasionally happens with persons who are extremely suscep- tible to the effects of the homoeopathic remedies, an undue medicinal action is developed, giving rise to considerable local pain, or general con- stitutional disturbance, camphor is, generally speaking, the most effective ADMINISTRATION OF JIKDICINKS. 8» antidute, particularly to tho vegetable mediciiieH. (See Table of Medicines, etc.) It may simply be inhaled by tlio iio.stril.s, or a droi) of Thuittire of Camphor may be taken on a piece of lump auyar. Cofl'ee, without milk or sugar, is also a useful antidote, provided the i)atient lias not been long accustomed to its use. The same may, in a measure, be said of wine. ^ SYSTEMATIC TABLE, rOEMINQ A SUMMARY OF THE RULES FOR THE ADMINISTRATION AND REPETITION OF THE MEDICINES. In summing up the general regulations for the administration and repetition of medicines, the following particulars may be mentioned: 0"" ACUTE DISEASE, NOT CRITICAL..— GENERAL INITIA1 ORY REMARKS. In acute diseases, not critical, when, after tho lapse of four, or at the most, six hours, no amendment -results, another remedy should gener- ally be selected, or the general state of the patient and the nature of tlio disease should be re-investigated. When, on the other hand, in the course of an hour or two, symptoms of improvement ensue— such as inuiiit skin, a clear state of the intellectual faculties, a happier frame of mind, or a gentle and undisturbed slumber, no repetition or change of medicine must be thought of until a cessation of the imjiroved condition of the patient becomes manifest. In acute diseases of a severe and critical kind, however— such as severe inflammatory complaints, cholera, croup, nervous fevers, asthmatic affections, etc., the repetition of tho dose sometimes becomes necessary every flye, ten, or fifteen minutes— or, at all events, at intervals of from one to three hours, subject to the like conditions, 1. That there are two distinct periods ;n the course of treatment:— the first period, or that in which the medicino is more rapidly repeated to establish a medicinal ascendency over the disease; and the second j^eriod, or that in which the treatment is resumed and continued to complete the cure, or, until change of treatment. That these two periods are advantageously divided by a pause, during which the medicine may be suffered to exhaust its action, and the varia- tion of symptoms, etc., be observed. That during the first period, in the treatment of ac^de disease, which is not of immediately critical character, the intervals between doses should extend over from two to four, or even six hours, according to the severity of the symptoms. That, as a general rule, a course of two, three, or four doses, according to the length of the intervals, will constitute the first period ; the grealest number of doses agreeing with the shortest intervals. That the pause, at the conclusion of the first i)eriod in the treatment of such diseases, should extend over from four to twelve hours, according as the progress of the disease has been checked by the previous treatment or not. 2. That the disease continuing to make head after the pause, whether modified or not, (if no suspension or change should appear desirable in conformity with the exceptions below stated), the same treatment shoulO be resumed during the second period. 90 CIIRONIO DISEASfi. I ' >^ :_, That (Uuing the second period In the treatment qf actite disease, which iH not orininiediutely (rntical character, the interval between doseaahouid extend over from four to eight, or even twelve hours, according to the severity of the syniptoms. That, aa a general rule, one, two, or three doses, accordl.ig to the length of the Intervals, will constitute the second period; the greatest number of doses agreeing with the shortest intervals. 3. That, in the event of no alteration, or, 1 1 most, a merely tempo- rary mitigation of the smyptoms, by the remedy or remedies administered during the Jlrst period, another remedy must be selected as closely anal- ogous as possible to the symi)toms present. 4. That, after the completion of the second period, in the event of the rc-appearanco of symptoms, which have yielded to the use of the remedy or remedies previously administered, the same remedy or remedies shall be administered at still more extended intervals. That, in this after-treatment, the intervals between doses shall exteml over from 12 to 48 hours. CRITICAL CASES OP ACUTK DISEASE. . 1. That critical cases of acute disease— auch, for instance, as of cholera, croup, or severe inflammatory disorders, which are excessively rapid in their issue, are not susceptible of the general rules applied to acute diseases. That the majority of these are indimdually exceptional. That, in their crLical acceptation, they are only susceptible of 07ie period of treatment. That, in cases of this nature, such remedies as Arsenicum, Capruni, Digitalis, Lachesls, Sambucus, Hepar, Spongia, and Vcratruiu, may be administered at intervals, varying from Ave to thirty minutes, according to the urgency of the symptoms, until beneficial reaction takes place. That the evident (and progi'essive) decline of the vital principle, not- toitlistanding treatment, may, in such instances, warrant the change of the remedy, if there be any hope that the change may produce the desired reaction. That, otherwise, cases of this nature are susceptible of the same excep- tional conditions, as have been reserved for the previous class of com- plaints. OF CHRONIC DISEASE. — GENERAL INITIATORY REMARKS. In chronic diseases of a severe and obstinate kind, it is often very advisable to administer a dose of the remedy selected daily, the first thing in the morning (fasting) for a period of from four to eight days ; or, in short, until such time as one or more symptoms become developed, which the patient had not experienced l>efore commejjcing to take the remedy. When the remedy has been properly selected, the change in the patient's state will commonly occur within or shortly after the periods just named. Should no medicinal manifestations of any kind become apparent, another remedy may be selected, from two to four days after the last dose of the previous remedy has been taken. In chronic diseases, sulphur * is very often the most appropriate remedy to begin with, if no other is better indicated, and particularly if i %i\ * 8«e, also, the article oa "Ebadioativs Tbbatmkm*>'* l> if AUMINISTUATION OF MEDICINES. 91 the patient lias proviouHly Iwon afTcotccl with any 8kln disease. As Hoon us tiio Hyiiii)l<)iiis (k-vi'lopcd hy tinlphar luive cntirt'ly subsided, a new medicine must be lulinlui.stered In accordance >vitii the remaining symptoms (if any); but not for a ioiif^er period than from four to eight days. If improvement then sets in, the new remedy need not he repeated until tlie favorable change ceases to become progressively manifest. But, if no improvement ensues, although the remedy seems to 1)0 correctly chosen, Sulphur may again be resorted to, for from two to four days, and so on. It is fr'^juently necessary to fall back upon ^Sul- phnr several times in this manner during a protracted course of treat- ment. It sliould 1)0 rememl)ered. 1. That there are two distinct periods in the course of treatment ; the first period in which the medicine is more rapidly repeated to establish a medicinal ascendency over tlie disease: and the secoml period, or that in which the treatment is resumed and continued to complete the cure, or till change of treatment. These two periods are advantageously divided by a jxinse, during which tlie medicine may be suffered to exhaust its action and the varia- tion of symptoms, etc., l^e observed. During the lirst period in tlie treatment of chronic disease, tlie inter- vals l)etween doses should extend to about twelve hours, and, as a gen- eral rule, a course of twelve doses will constitute the Jlrst period. The 2^0 «se at the conclusion of the ftmt period in the treatment of chronic diseases; should extend, for the vegetable remedies, generally, over from three to six days, according to the severity of the case, and the effect produced ; and for sucli remedies as Staphysagria, Conium, etc., over from four to eight days; for the mineral remedies, generally, over from six to ten days; and for such remedies as Calcarea, Hepar-stdphuris, Graphites, Silicea, Stannum, Stdphur, Zim:, etc., from eight to twelve days. 2. That the disease continuing to make head after the pause, whether modified or not, (if no suspension or change should appear desirable, in conformity with the exceptions below .«*'^ed,) the same treatment should be pursued during the second period. During the second period in the trea*^ment of chronic disease, the inter- vals between doses should extend over from twenty-four to seventy-two hours, according to the severity of the case. As a general rule, two, four, or six doses should constitute the second pei'iod, according to the length of intervals— the greatest number of doses agreeing witli the shortest intervals be^/Ween doses. 3. That in tlie event, or mere temporary mitigation of tlie symptoms, by the remedy or remedies administered during tlie ^rii period, another remedy must be selected, as closely analogous in its properties as possible to the symptoms present, for further treatment. That, after the completion of the second period, in the event of the reappearance of symptoms, whi h have yielded to the v.se of the remedy or remedies previously employed, the same remedy or remedies shall be administered at still more extended intervals. I l,t i^' 92 EXTERNAL RKMEDIES. That, in this ufter-treatinent, the interviils between doses shall extend over from two to six days. CONDITIONS CREATIXa EXCEPTION TO THE FOREGOING RULES, RESPECTING CHRONIC DISEASE. 1. That the repetition of any medicine be suspended. Upon the intermediate appearance of symptoms involving a complica- tion not covered by the previous treatment. Or, again, as soon as a positive degree of improvement becomes appa- rent. To be renewed and recontinued upon the first indication that th( natural and original disease is regaining its ascendency, from which we may judge that the medicine has exhausted its active agency. 2. That anotlier remedy must be selected as closely analogous in its action as possible to the symptoms present. Upon the intermediate appearance of another symptom or symptoms, involving a complication not covered by the previous treatment. If- no change takes place, and the disease continues to (jain (/round pro- gressively, notwithstanding the administration of ten or twelve doses. ItEMABKS AND REGULATIONS llESPECTING EXTER- NAL REMEDIES AND APPLICATIONS. Any remedy, whicli is prescribed for internal administratioTi as IIo- MCEOPATiiic to a ZocaZ affection, may be api)lled to the parts as a lotion, either by dissolving the globules in water, or by using the tincture to mingle with the water. External Application of the Nature of a Poultice.— The simplest and best application which can be used in cases requiring external treatment of this nature, to forward and encourage suppuration, or for any other reason, consists solely of a piece of lint saturated with cold water, applied to the parts, and kept constantly wet, the whole being care- fully covered with oiled silk, so as to exclude the air. All medicated poultices should be avoided. External Application of the Nature op Fomentation.— As a palliative ajjplication, pending the salutary action of internal treatment, in cases in which local irritation and tension are excessive, it is allowable to bathe the parts with wa^e?* moderately hot, by means of a piece of flannel ; oi" to expose the parts to the action of the steam rising from boiling water poured into an open vessel. In cases of sore throat, in which the obstruc- tion and burning sensation in the nostrils is excessively distressing, the patient may similarly inhale the steam of boiling water. Hop poultices, and bread and milk poultices are good. Tincture of Artiii-a.—'T\\\s useful medicine, when employed as a lotion to wounds, should always be discontinued upon the appearance of any eruption, etc. Individuals, of what is ordinarily designated as an inflammatory habit, or who have very irritable skins, and are liable to be affected with erysipelas, must be very cautious how they use it, and must modify their treatment accordingly, and abstain from the application upon the earliest appearance of medicinal irritation or erysipelatous swelling or redness. Such patients should invariably dilute the tincture with two- thirds more of water (in proportion) than is indicated in the directions, i ADMINISTRATfON OF MEDICINES. 03 which occur in v.irious parts of this worlc, when they have occasion to employ it; and, should this precaution not suffice to exempt thoin from excessive medicinal aggravation, they should have recourse to CAiiENuuLA- oFFiciNALis as a substitute. Gfiicriil proportion of the lotion Tincture Of Arnica 1 part, to water d p.irta. Or for very suscoptiblo siibjocts Tincture of Arnica 1 part, to water 12 p.irts. For tlio eye, or as a garglo for the gums, after dental treatment Tincture of Arnica 1 part, to water 20 ))arta. For an Infant under six '"onth? old Tincture of Ar/iica 1 part, to water :)2 parts. For an infant over six months and under two years. . ..Tincture of Arnica 1 part, to water If) jiarts. Tincture of Calendula-Ojjicinalls may be employed in the trraL- ment of wounds of every description, by those who, from constitutional causes, are unable to employ Arnica externally, without subjecting tlioin- selves to the inconveniences generated by the character of that remedy. Ca/ti/icZMZa lias, moreover, an inii)ortant advantage over Arnica in very severe incised or lacerated wounds, where there are indications of a serious scar being otherwi.se left by the cut. It is also preferable in all severe wounds which cannot heal wiUiout previous suppuration. General proportions of tlie lotion — Tincbwe of Calendula one part, to ivater six i);irts. {Vov infants and children the same as Arnica.) Tincture of Ilhtis-Toxicodendrou is more especially adapted to the treatment of Sprains, for the milder forms of which it is a specific remedy General proportions of the lotion — Tincture of lifms-fox., one \y,\rt, to water six i)arts. (For infants and children the same as .\rnica.) Tincture of Aconite. — Aconite has beei used externally with great success for local inflammation arising from check of perspiratJoi'.. (or from other causes,) hi conformity with its well-known characteristic properties. Care must be taken to distinguish such cases of inflammation, usually extending to the membrane wliich invests tlie bone, and affecting joints in parth'ular, from erysipelatous inflammation, to wliich it frequently bears a striking resemblance. The sudden appearance of sj'mptoma of this nature in young persons, who are jiarticularly liable to accidents arising out of carelessness, etc., and who, at the same time, have no pre- dispo.>ition to erysipelas, may be a stron^g ground of assurance in rcspe(!t to the cliaracter of such inflammatory action, which may farther be explained by a brief inquiry into the previous circumstance.s. In such cases, the external application of a lotion, composed of diluted Tincture of Aconite (siniuUaneously with the internal administration of tlie same remedy,) by means of a linen rag saturated therewith, and applied to tlie parts, will speedily subdue the symptoms, and preclude more serious con sequences. General proportions of the lotion — for a person of adult age, Tincture of Aconite, ten drops to a wineglassful of water. For a child under twelve years of age. Tincture of Aconite, six drops to a wineglassful of water. Tincture of CantJiaris or Cantha rides. — The peculiar property which Cantharis, or vSpanish Blistering Fly, possesses of creating a severe burning pain, followed by the etFusion of watery fluid beneath the scarf skin, bears so close an analogy to tlie efFects of a burn or scald, with tlie formation cf vesication or blisters, that we can readily conceive it well adapted, according to the homreopathic law, to be an admirable remedy for injuries of tiie like description, or attended with similar symp- 94 EXTERNAL AITLICATIONS. toma. Cantharis is, in fact, specific as an external remedy, in tlie treat- ment of burns or scalds, and is by far the most efficacious, i f apj)lied imme- diately after the injury has been inflicted (otherwise see Causticum,) and before the application of cold water, Acetate of Lead, or similar expedients have been adopted. Cantharis is, however, objectionable for persons whose constitutional peculiarity renders them susceptible of erysipelatous tumefaction of the skin, in the place of blisters, from the effect of a burn or scald. In these cases, Urtica-dioica is specific. In some instances, although very rarely, the external application of Cantharis may produce deranged action in the urinary organs, (exemplified by suppression of water); in such cases the mischief is readily counteracted by the internal administration of one drop of Tincture of Camphor on a lump of sugar. The lotion should gen- erally consist of the tincture at the second dilution and water, wherewith a linen rag is to be saturated, the linen being so wound around the parta as to exclude the air, and the moistening repeated as often as it becomes dry. General proportions— three drops of the Tincture ofCanthaiides, 2d, to every teaspoonful of water. Tincture of Urtica-Dioica, or Urtica-Urens, should be used in preference to tincture of Cantharides by tliose in whom a burn or scald is apt to produce erysipelatous swelling in the place of blistering. But this is the only case iu which Cantharides is superseded by Urtica. General proportion of the lotion Tincture of Urtica-dioical part, to water \Opart». For an infant under six months old Tincture of Urtica-dioica 1 part, to water 20 parts. For an infant over six months and under two years I\ncture of Urtica-dioica 1 part, to water 15 parte Proof Spirits of Wine.— In mild cases of burns or scalds, if Spirits of Wive can be procured immediately, (otherwise, see Causticum,) speedy relief may often be obtained therefrom, and after-suffering avoided. Apply it warm to the parts (as hot as the patient can bear it,) the injured part having meanwhile been exposed to the heat of the fire. Caiisficuin or Lime JFater, as already intimated under the head of Cantharis and Spirits of Wine, is a preferable remedy to either of the foregoing, when an hour or two may chance to have elapsed before the use of any remedial application. The Causticum wash is, also, of much service in more serious burns, and in those of long standing. General i)roportions of the lotion— to every teaspoonful of water, add six drops of tiie Tincture of Causticum, and apply frequently to the parts by means of a piece of linen rag saturated therewith. Raw Cotton, (excepting when the suppuration is excessive, ana the ,/eather liot, for whicli case see Soap,) is highly useful as an external application to burns or scalds of a serious nature, and more especially when an injury extends over a large surface. The method of use is as follows : Puncture any blister which may have arisen, bathe the sore v\rell with tepid water, and then cover the parts with carded cotton or wadding in three layers— removing the outer laytr only, and substituting a fresh one— when suppuration sets in. The Soap Planter (Pure, whits, hard Soap). This application is more particularly serviceable iu cases of burns, where not only the outer AD'IINISTRATION OF MEDICINES Qu or scarf skin, but also the inner, or true sltin, lias been destroyed. In serious cases, which have previously been treated with the lotion of Can- thaiides,ov Urtica-dioica, and in which the inflammation and pain have yielded to these remedies, hv vhich are too severe (owing to the injuries inflicted on the tnie skin and adjcu'^ent miisdes) to heal without suppuration, the soap plaster is a very useful accessory. It should be made and applied as follows: Moisten the soap with tepid water, and make a thick lather or paste, and spread it upon linen ; then puncture any blisters which may appear on the exponed surface, and remove all loose skin. After these precautions, apply the plaster to the parts, and secure it by means of a bandage, being careful that the whole of the injured surface is covered with the plaster. As a general rule, the plaster may remain undisturbed for twenty-four hours, when it should be gently removed and changed ; but there are many exceptional cases, and the feelings of the patient should guide us in the removal and change of the plaster, whenever a return of pain is complained of. This course of application should bo con- tinued until the injured parts are completely healed. The application of the plaster will always be attended with increased pain at first; but this must not deter us from the employment of it, as it Avill soon be followed by marked improvement. Flour — May be used as a substitute for cotton or the soap-plaster, when neither of the latter can be obtained at the moment. The motiiod of application is simply to sprinkle flour copiously over the injured parts, after having taken the precautions directed to be observed under the heads of cotton and soap plaster. When it becomes necessary to remove the dry paste formed by the incrustation of the flour, this should be gently effected by first moistening and loosening it, by means of poultices (as directed under the head of external applications of the nature of a poutlice.) Tincture of Arsenicuui (considerably weakened with wnter) is a good application to bedsores, and Jis a local resource, in many cases, of malignant ulceration. General proportions of the lotion— to one wineglassful of water, ten drops of the Tincture. Tincture of Carbo-vegcfabilis, in similar cases, as directed for the afToction in question. General proportions of the lotion— to two tablespoonfuls of water, twenty drops of the Tincture. Tincture of Cinchona (concentrated). See "Bed-soues," after typhus, etc. General proportions of the lotion— to a wineglassful of water, fifty drops of the Tincture. REMARKS AND REGULATIONS RESPECTING THE BATH The bath may be divided, according to modern ajjpliances, into eight varieties, viz: — the hot and cold salt-water bath, the hot and cold fresh- water bath, the tepid, the shower, the vapor, and the medicated baths. Of these we shall here consider the two first-named only, viz • THE HOT FKESU WATER BATH. Except as respects new-born infants, for whom a third variety is necessary, namely; fjft REMARKS RESPECTING THE BATH. i y it^ THE COLD SALT WATER, AND THE COLD FRESH WATER BATH. All tlie Other varieties, especially medicated hatha, are commonly prohibited, except for infants. The consideration of the bath is a matter of essential importance to health, r..d hui been acknowledged as such, from the remotest antiquity, and in every climate. It is almost as much a necessity of existence as food and clothing. It involves what is a primary essential, cleanliness; but like all generalities, it is subject to exceptional modifications arising out of the condition of the system, or the temporary state of the body : such, for instance, as the presence of an eruption, or rash, or the exuda- tion of perspiration after violent and prolonged exercise, both of which would render the bath obnoxious for the time. But for persons who are free from any morbid manifestation, which may render the free use of cold water objectionable, nothing, perhaps, will tend so much to. brace the nervous and muscular construction of the frame, and to i)reserve the sturdy physical power of youth in advanced age, as the regular observ- ances of the bath. GENERAL EXCEPTIONAL CONDITIONS UNDEi WHICH COLD BATHING SHOULD BE AVOIDED. "When (as is sometimes the case) it is found to induce constitutional disturbance, or is invariably followed by headache, etc., of the same character. When it is followed by lasting chilliness, instead of the glow, which Indicates its healthy action . There are comparatively few instances in which the cold fresh vxiter bajh disagrees with persons in good health ; in such instances, however, when they occur, the use of a sponge or wet towel must be substituted for the bath, and should be followed with brisk friction. When any inflammatory action is present, or when from exertion or from any other cause, the skin is moist and the pores are open, the Cold Bath should be avoided. During the presence of headache, other than headache arising from irregularities of digestion or nervous causes. Immediately, or within one hour after a meal. Before any meal has been partaken of, or, in other words, upon first getting up in the morning. Generally— with a declining temperature, as, for instance, late in the evening, when the temperature of the water will not have declined equally with that of the atmosphere. When the atmospheric temperature is not sufficiently high, as com- pared with that of the water ; or, in other words, when the water feels warm and the air cold. Generally— during the prevalence of cold east winds. GENERAL CONDITIONS UNDER WHICH COLD BATHING IS BENEFICIAL. When the temperature of the water, rclalivoly to that of the atmos- phere, is aa nearly as possible that which it would reach and maintain, by being constantly exposed to the action of the same atmospheric tem- perature. When it is always followed by a glow. £^^•7^: lirst the ined om- ''eels AL. lOS- lin. m- 8EA BATHING, K In affections of a purely nervous character. In the majority of affections resulting from debility of the digestive functions. During an aseewUng temperature, that is to say, in the earlier part of the day, generally, about <m;9 or </iree hours aftsr the first meal, and at an tMlual distance from the second. When the water is cold compared with tJie air, but not so cold as to p7-oduce a shock or numbness. In this climate, from the end of June to the middle of September, may be stated as the best season for out-door hathing. In-door bathing may be continued throughout the year with great advantage, with the precaution that the thermometer in the apartment stand at from 50° to CO" of Fahrenheit, and that the water be exposed to this atmospheric temrarature at least six hours (when that is possible,) or be raised to from 45° ,o 55°, if below it. The sioimminy baih, or bath in which (if not in open water) there is room to exercise the limbs, is preferable. GENERAL PKECAUTI0N8 TO BE OBSERVED IN BATHING. Do not bathe the lower extremities first. The immersion should be complete at once. This need not be effected by plunging, when, as is not unfrequently the case, such a method is found to induce headache or temporary deaf- ness. Diving, which is a v^ery common amusement, is very often prejudicial without sufPcicnt attention being paid to the fact. In general, you should abstain from diving. Never leap into deep vrd^Qv, feet foremost and in an erect position. The best method is to drop into it, the body and limbs being bent together. Do not stand still or remain motionless in the water. Do not remain too long in the water. Five minutes is quite long enough to derive all the advantages of the bath. Never remain so long as to become thoroughly chilled. Leave the bath upon the first appeai'ance of cramp. Apply a coarse towel briskly, all over the body, as soon as you leave the water, and take pains to dry yourself as thoroughly and as expeditiously as possible. Dress as soon as you are thoroughly dry. The bath should be followed by a brisk walk, but, not sufficient to heat you. Tj3B SALT Ve/»TER BATH, OR SEA BATHING. There has been a popui. . notion that sea-bathing is always preferable to fresh water bathing. Nothing can be a greater mistake, and there are a far greater number of exceptions to the proper use of the former than to that of the latter. It is indeed true, that the quest; i of temperature is far liss important in respect to sea-bathing, except, indeed, towards the fall of the year, when the temperature of the atmosphere, in our climate, becomes considerably depressed, and when, in conformity witli one of the " general exceptional conditions'' above stated, it were advisable for those, even with whom sea-bathing generally agrees, to discontlBue it 08 FRESn TTATEK BATniNO. But it is a matter of experience, that there are a great number of con- stitutional exceptions. And it is quite as important tliat all those with whom sea-bathing is found habitually to disagree, should abstain from what, at certain seasons and in certain places, may be a great indulgence. There are instances in Avhich sea-bathing produces a species of nau- sea similar to that of sea-sickness, in persons who are totally exempt from this inconvenience on ship-board. This, then, is clearly a constitutional exception. In brief, however, it maybe laid down as a rule, that when sea-bathing habitually induces any kind of constitutional disturbance, it should be avoided. THE FRESH WATER BATH. The instances in which/mTi water bathing disagrees, may almost be summed up under the head of the " General Exceptional Conditions '' above stated. The cases of constitutional exception are far less numerous than th»se which occur with respect to sea-bathing, and there are fewer cases still in which persons who cannot bear fresh water can tolerate the sea-bath. When, however, they occur, they should indicate the course of the patient. TEMPERATURE OP THE BATH FOR INFANTS. The warm bath, which is requisite for the treatment of newly-born or very young infants, should never exceed 98 degrees of Fahrenheit in heat. It should, in general, range from 92 to 98 degrees, according to the effect produced on the child. When the bath is used as a remedial agent, it is important to maintain the temperature at which the immersion had taken place; and it will, therefore, be desirable on all occasions to have a thermometer within, so as to detect and regulate any variations. The cold bath should be, as nearly as possible, of the temperature at which the atmosphere would place or keep it. It is, therefore, desirable that cold spring water, which has not been exposed to the action of the air, for four hours at least, should be avoided in hot weather, when the atmospheric temperature would have materially increased the heat of it. Exceptions to tJie use of the cold bath.— In almost all cases the use of the cold bath, with new-born or very young infants, is reprehensible. /* PREVENTIVE AND ERJDICATIVE TREATMENT. It is too true that the every-day practitioner suffers himself to be too completely engrossed by the actual condition of disease to investigate or to provide against its accessibility. The duty, however, of every man who deals with his profession, as a noble and humane science, is rather to point / out the method of preventing the occurrence of active disease, and eradicating (if possible) the latent and slumbering defects of constitution, which may be described as dormant disease, than to confine his attention solely to the treatment of its active manifestation. This great and humane purpose should characterize the philosophy of every medical creed or denomination, and should ennoble, if it may not consecrate any system. tmm PREVENTIVE TREATMENT OF DISEASE. 98 le le 10 It 'I n By the terra "enidiciition," I wish to be understood to allude to the method of modifying or removing sucli unheiiltliy conditions of the system, as necessarily predispose the subject upon whom they operate to particular developments of active organic disease. I would first, however, be understood to confine myself, here, to such general hints as may, with due consideration of the regulations hereafter laid down for the treatment of each disease as it occurs, enable the non- professional reader to form some idea of the mode in which the rule is capable of being applied in the majority of individual cases, because it is obvious 1 li!it tliis subject alone might require the whole space of moie than one of Bucli volumes as this, ere it was considered in detail. I would also hint that the rule is so distinct and positive, that the appropriate preventive treatment of any disease may be readily in- ferred from the distinction of the medicines which are specific (that is of i)ositively analogous properties) in its treatment. PREVENTIVE TREATMENT GENERALLY. In respect to the prevention of disease, men, of all medical creeds, wiio have devoted their time and toil to the consideration of the subject, hold opinions which are necessarily in accordance to a certain point; that is, as regards the modification or removal of the extei'nal and excdtiny causes of disease, such as local or general climate, and the substitution of clean- liness, pure air, drainage, etc. There is, however, a limit to the concur- rence of opinion, even on some of these points. We are further agreed as regards some of those causes which proceed from irregularities of living, from excesses, and, also, from improper or insufficient food. Amongst these accessory measures, which are essential to the pre- vention of disease, I would, therefore, particularly, draw the reader's atten- tion to the following:— involving, first, those which concern the person immediately ; and, secondly, those which concern the locality immediately, and the person indirectly. Those which concern the person, immediately, amongst others, are : 1. £a;em.se, in proper relation to the habits of the individual, to his strength and capabilities of physical exertion, the state of tlie weather, the method of taking exercise, whether active or passive (the latter being rather a modification of the accession of pui'e air than an application of exercise, properly so called,) and the circumstances of climate— involving the degree of altitude, or depression of temperat ire, the time of the day, (the evening being very adverse to health, especially, in districts in whicli thick vapor, lying close to the ground, is observable at and after sunset, marshes, etc.,) and the nature of the atmosphere at the time— whether unduly charged with, or deficient of, moisture ; or, again, whether any par- ticular wind prevail, which is known to be charged with noxious exhala- tions, as the Sirocco of Southern Europe, etc. 2. Cleanliness of person and habitation, which is subject to no excep- tional condition, but those of rare occurrence, which render it impossible. This action may, also, involve the free use of (cold) water in ablution, except in particular cases. 3. Ventilation, partly applicable to the person, and partly to the local- ity, by which I understand the admission, and free circulation of pure air, without the action of a direct current, or draught, and the avoidance of I! f| Ml \ PUEVKNTIVE TIlEATMIiNT. 101 H I fcfj ns X o P3 i! 'Ii' closely confined aparlments, sedulously closed agaii.st the external atmos- phere. In ninety-nine cases out of a hundred, such exclusion would repulse, more probably, a restorative of health, than an aggravant of dis- ease. For nature is more surely in accordance with tlio requirements of human life, than any artificial means; and science sliould be lendered not a repellant, but an assistant of natukh. 4. Apparel, by which should be understood all coverings— which Bhould be as light as possible, consistently with weather, climate, and par- ticular susceptibilities, or h.tbits. The action of the skin is one of tlie most important functions of life, inasmuch as, if irregularly performed, it reacts iipon all, or any of the organs most intimately connected with exist- ence. Over-clothing, or covering, on the one hand, therefore, may pro- mote an irregular excess of action, which will result in continued relaxation of tne function, and consequent exhaustion ; whereas, expos- ure, on the other hand, may occasion a repression and suspension of action which will, inevitably, recoil upon the superior organs. The strict consid- eration of this question is, more especially, imperative in climates in which the transitions of temperature are svdden or very considerable. 5. Aliments— by which is here understood l)oth food and drink- should, in every case, be modified, in relative proportion, according to the climate, and to exceptional conditions arising out of the particular degree of strength or weakness of digestion, which characterizes particular persons, or to any casual circumstances which may modify, alter, or deteriorate the digestive functions, and, consequently, operate upon the appetite. Tlie Amerif'an native, or the habitual inhabitant of a temperate climate, removing into a tropical zone, should decrease (if not totally eschew) the admixture of animal food; or, if removing into an arctic, or very cold cli- mjite, might, with due regard to condition (especially whether salt or fresh) of such animal food, advantageously increase its proportion ; the habitual use of very salt, or otherwise highly seasoned food, is always uni- formly prejudicial ; he should, also, diminish the proportion of stimulating ingredients, as the heat of the climate is increased; under the same condi- tions he should strictly abstain from the use of stimulating liquor, or, if that has previously been 7ta6it?«i^, he should decrease it gradually, until very moderate indulgence (if any) remains; and he should be very careful not to overload the stomach with either food or drink of any kind. It is very important that the American, removing into a tropical climate, Bhould neither eat nor drink more than what is absolutely necessary— inas- much as every disease to which the inhabitants of temperate zones are subject, between the tropics, not only assumes complications, particularly, implicating the organs of digestion, but very frequently springs, either remotely (by predisposition thus occasioned,) or immediately, from impe- ded, or overtaxed digestion. The person of weak digestion should care- fully abstain from all indigestible or stimulating articles of food— should select the plainest diet— feed to supply the necessities alone, and not to gratify the palate— should eat but little at a time, and not at all, as the time of rest approaches— should avoid all stimulating food or drink, and should never attempt to force an appetite. Regularity is indispensable to health. 6. The Habits of Living.— Regularity is a great preservative in this respect, including the just appropriation of the period of rest, as indi- II 102 ADMINISTRATION OF MEDICINES, ETC. rated by tlio secession of light and the dormancy of nature, generally, and, consequently, early hours, both in resting and rising, and a sullicient, but not excessive proportion of rest. Tlie relations of niglit and day constitute the best directions for the equable adjustment of tiio due proportion of rest. The summer of temperate zones indicates a less proportion than the winter, as, also, the tropical night and day indicate a greater e<(uality in the disposition of time. (See also "Rest," under "Investigation of Disease.") Excessive disposition to rest, (indolence,) is as injurious, on tlie one hand, as excessive duration of mental or bodily activity is on the other, and the regular return of both conditions, at corresponding and stated hours, isiniportant. Regularity of habits, also includes regularity in the period of mating, or the hours of meals, which is no less important than the former. The art of dividing time in every way is a powerful preservative. The preventive measures, which involve locality, amongst others, are: h PuAiXACJE.— If tiie locality be subject to periodical, irregular, or casual saturation, or Hooding of water; that is, if it be nearly on a level with some adjacent surface of water, such as hikes, rivers with sluggish current, or the sea ; the generally applicable metliods of preventing the exhalation of noxious vapors, and the consequent impregnation of the atmosphere with miasma, injurious to life are (1) to create, artificially, where practicable, such channels as shall lower the general level of the water, or comparatively elevate the general surface of the soil, and which shall prevent the stagnation of waters; and (2) so to disturb the surface of the soil, as by furrowing, plowini^, etc., that tiie exhalations shall be rapidly emitted, and thereby be subject to dilution and dispersion, as soon as they transpire. Or. again, and especially to towns and crowded districts, in which the accumulivtion of decomposing or decomposed animal and vegetable matter must necessarily be great, to create so free a vent, by means of proper sub- terraneous canals, and by the removal of all filth, etc., (exposed to the action of the atmosphere,) that any such matters shall be rapidly dis- charged, into such currents as shall remove impurities rapidly, or into such remote receptacles as shall secure the absorption, dilution, or dispersion of all noxious vapors, before they can impregnate the habitual atmosphere of the inhabitants. Tlierefore, every dwelling, to be wholesome, should be accessible to the free passage of natural currents of air, and should be provided with an ample and wholesome supply cf water, and an easy dis- charge for all refuse deposits.* 2. Ifodl/ications of climate, by clearing, tillage, and every other result and accompaniment of industry, which thereby produces a doubly benefi- cial result, (1) by removing the susceptibility of the inhabitant to disea.se, and (2) by removing the cause which too frequently generates disease, viz: the unhealthy exhalation of the soil. 3. The choice of habitation, as to site, which should be removed as much as possible from particular geological influences; from localities in * Vested interests, stolid indifference, and an indolent disinclination to listen to the voice of reason, too often oppose a formidable barrier to the removal of crying nuisances. If there were any one act of despotic government interference, more capable of defance than another, it would be one which was directed towards effectual sanitary improvement. PREVENTIVE RESOT'noES. 1()3 which the water is impregnated with mijicnil substanres, hucIi as lc';ul, iron, etc., from particular (local) and injurious currents of air, as in certiiiu valleys; from the midst of woodland (and ,••. sulllcient clearage shouM ho effected) ; from the adjacency of stagnant wate*^, and, lastly, above the level of the mist or vapor, which consist doubly of the precipitated and continued exhalation from the soil, and which is readily distinguishable, in marshy districts, especially, by the dense white fog, which lies like a separate atmosphere, at an elevation of a few feet above the flat soil, after %unset. This subject has lately attracted much attention in the more populous countries, and is, therefore, of particular import to the colonist who may fiave to select the site of his own habitation. HOMOJOPATHIC MEDICINAL PREVENTIVE RESOURCES. No medicine, unless its action upon the human organs be analogous to disease, can be really, truly, and invariably preventive. The preventive measures, as regards the employment of medicinal agents, consist, in the repeated administration, usually in somewhat large doses, at intervals approximately of twelve hours, of one or more of such remedies, (for alter- nation is occasionally requisite,) as most closely assimilate in their specific action, and according to the indications stated for their selection in the case of each particular disease, or which, in combination, by alternate administration, most completely embrace the distinctive characteristic features of disease, when it assumes an epidemic, or even a local preva- lence. The first point is, therefore, to refer to the iirticle hereinafter devoted to the treatment of such particular disease, whereby, to ascertain the principal remedies quoted, whether any, either singly or in combina- tion, (by alternate administration,) are described as direct specifics, and then compare that remedy with all the symptoms, by aid of the "Reper- tory." If, under the head of the particular disease, one or more remedies, under certain circumstances, and qualified by the presence of certain symptoms, are announced direct spedjics, they will, doubtless, when eaily employed, be the unerring preventives or modifiers of the disease. Sucli, for instance, as vaccination against smallpox, which should be repeated, if many years had elapsed since the former operation, or which should not fail to be resorted to by those who have not been previously vaccinated : Belladonna against Scarlet Fever, China and Lobelia (chiefiy) against Marsh Intermittent Fevers; Mercurius-Courgsivus against Dysentery, especially red Dysentery ; Bryonia and Rhiis-Toxicodendrou a' id Arsenicum. against some varieties of typhus; Cuprum- Aceticum, Campaor and Verat- rum, against Cholera and Diarrhoea, respectively, or against excessive and sudden relaxation, with spasmodic pains and cramps, when the diseases just named are prevalent ; Aconitum and Pulsatilla, against measles; Aeonitnm, Belladonna and Hyoscjjamus, in cases and particular localities, in which inflammatory fever, with prominent affection of the brain, 1 ocomes prevalent, and similarly occurs amongst numbers of persons at once. Bryonia, in cases and particular localities, in which inflammatory fever, with prominent derangement of the stomach, appears. Carbo- veg., etc., against scurvy, (see also "Eradicative Treatment.") Sahina and Secale, etc., against imminent miscarriage, (see also "Eradicative 104 ADMINISTRATION OP MEDICINKS, liTO. l!i| Trejitmeiit," for ciisea in which tills caaiiulty bocoraos habltuul). Camphor against severe colds, (inllueiiza,) when they are what is termed going through the house. In fact, every remedy, as applied to the treatment of a particular disease, after it has set in under a particular aspect, is equally applicable to the preservation, when the current com- plaint bears a similar stamp. The DosESof preventive remedies shoiild usually be repeated at inter- vals of about twelve hours, until a degree of medicinal action has set in, when the course may be considered complete; but the action thus excited^ must be watched, lest it should occur that the prevailing disease (in a modified degree) has supervened. KRADICATIVE TREATMENT. No cure can be conipl'ite, where there is a latent constitutional taint, without proper ekadicative tkeatment. Sckopitla, in one shape or another, or complicated with oUior diseases, may be considered as the pre- disposing cause of susceptibility to the recurrence of every disease, that is, as the great parent of disease, and the most common source of the malig- nity and fatality of other diseases, when not itself the fell destroyer. Eradicative treatment is applicable to the removal or subjugation of defects in constitution, habit of body, or temperament, which operate con- tinually, not only as the predisposing causes of every prevalent disorder, but also as the complicating accompaniment of every disease; or, on tlie other hand, which resolve or threaten to resolve, themselves into organic decay, by attacking one or more of the important organs of life, especially. Eradicative treatment is also applicable to the extirpation of those slow, latent, or occasionally more active chronic diseases which are gradually sapping the constitution, and which would otherwise finally result in general disorganization, but which have not hitherto permanently destroyed the functions of any important organ of life. The space, which is necessarily confined in a work of this kind, will not admit of great detail, nor, indeed, could a whole volume, such as this, exhaust the subject, if compressed within the narrowest compass. We have the intention, therefore, of confining our remarks to such general relations, as may afltbrd some idea of the mode in which the treatment is conducted, subject to the regulations severally laid down under the head of each disease (in the subsequent parts of this work,) or, as it would then appear, in the character of a symptom, development, or manifestation of a more deeply-seated diseased condition— in conformity with the nature of the pareni disease. The reasons for susp3cting. nnd the grounds for ascertaining the exis- tence of such parent disease, will be gathered from the article on " The ] ivestigation of the Patient," particularly if due regard be paid to pak- entage (including near relations— uncles or aunts) ; to the part or organ most susceptible to the action of morbid influences, transitions of climate, the nature of the locality generally inhabited, the diseases which most frequently affect the patient, and the inveterate or peculiar or dangerous form, which all maladies affecting the patient, assume. Of these, the question of parentage and near (blood) relations involve the most impor- tant and weighty considerations, as thence we may derive the origin of SCROFULOUS habits of body, in all their varieties of combination, compli- cation, and development. EBADICATIVE TREATMENT. 10& Indeed, we may not Iniprnperly attribute every family defectof con- Btitution, or every nmnlfoHtatloii of a latent eonstltutlonul taint, which appears with gr ter or less Intensity In several, or pre-eminently in one* i)f the meml)er8 "a family, to an unwholesome or scrofulous inheritance. Thus to Scrofula wc may attribute, amongst other derangements, Rickets, or enlargement.} and curvatures of the l)ones, and decay or exfoliation of the bones, resulting from comparatively trivial circumstances; chronic disease of the skin, or extreme susceptibility to the development of nmr- bld appearances of the skin, of an endless variety, or especially to erup- tions of the nature of tetters, to ringworm, etc ; imperfect construction of the brain; and imbecility, or prevalence of susceptibility to derange- ments of the mind, esprcially if complicated with glandular swellings or their jicatrices; tori>I(l, or usually painless ulcerations, frequently char- acterized by a degree of putrescence and commonly discharging a thin, watery, corrosive fluid; or which, if somewhat qu!ckly dried up in one part, are usually (l«.>veloped in some other; affections of the lining mem- brunes, in general (as of the stomach and bowels, air passage, etc.); habitual or long continued discharges of thin, watery fluid from any parts, as the result even of very slight causes of irritation, manifesting a deficiency of vigor in 'le membranes, to which may also .be appended obstinate or continuous whites, and chronic disclmrges from the ears; chronic intiammatory affections of tlie eyes and eyelids, qualified by dis- charge of very adhesive gum, and continual adhesion of the lids in the morning, by excessive susceptibility to the action of currents of air, or to irritation by reading, by excessive or even continual flow of tears, or susceptibility to watery eyes, by excessive sensibility of light; or, again, habitual susceptibility to styes; chronic inflammatory and sup- purative affections, or chronic enlargements or indurations, of gland- ular parts in general: as, for instance, of the neck and under the jaw, the groin, the armpits, etc.; or abscesses; chronic enlargement and habitual hardness of the belly; the prevalence of water on the brain, water on the chest, dropsy of the belly, or general dropsy in more than one member of any family ; the like of wliat is called tubercular consumption, or of organic affection of the mesentery, or of unaccount- able emaciation and gradual decline; worms, when they are evidently generated in consequence, not of casual circumstances, but of an inherited defect of constitution. The Accessory Means adapted to the eradication or modiflcation of scrofula, are, amongst others: 1. Diet— the most important consideration of all— which should be always as nourishing, in relation to its bulk, as mucli compressed or reduced in bulk, as light and easy of digestion and as regularly administered as possible — sometimes frequently, but in small quantities at a time. An \f * Paronts (or a parent) possessing the semblance of sound health, may yet carry the germs of dcro- fula In the system, and consequently be capable of transmitting the disease to the offspring; henco the neccBHity for Inquiry into the health of blood relations. Again, although there may not be aby hered- itarr taint in the family of either parent, the capability of giving a scrofulous constitution to tho off- spring may bo acquired by too early or too late a contraction of marriage, by disproportloned marriages, (u to relative ages,) by parental excespes, ere, and by any cause which may tend to injure the constitu- tion of one or both parents— as improper or insufficient food, impure air, etc. Lastly, the germ ol Bcrofala may be tr»D8mitted to an infant by the milk of a scrofulouv, or otherwise diseased nurse. ■in m If;: ' M dm 106 ADMINISTRATION OF MEDICINES, ETC. iri equal proportion of animal and vegetable food, or vegetable food pre- pared with u fair proportion of tlie pure gravy of sound and wholesome iieat. Roasted meat in preference to any other— especially mutton and beef. Eaos, when found to agree, lightly boiled (soft), and eaten with a fair proportion of good, home-made, stale, wheaten bread, but not in com- bination with other ingredients. Sometimes milk (when it does not dis- agree, as is sometimes the case in particular instances.) Of beverages, water is the only fluid which is universally safe. Stimulants, of all kinds, should usually be strictly avoided. 2. A.IR is second only to diet, in the treatment of scrofulous habits; puie country air, in a healthy, dry, rather elevated situation, not exposed to the prevalence o] bleak winds ; free access and circulation of air within doors, in all apartments inhabited, and, particularly in the sleeping room ; as great a proportion of th ; day time as possible, without severe fatigue, particularly in fine or favorable weather, should be spent in the open air. 3. Exercise should be as free and unrestrained as is consistent|with the avoidance of excessive fatigue, or any of its consequences, and with due precaution that check of perspiration does not occur; no person should remain uncovered, or even sitV/, for some time after strong exer- cise; proper protection of the skin from the arrest of transpiration and gentle motion are indispensable; nor should strong exercise in. the open air be resorted to in extreme conditions of temperature, and especially when there is greut moisture in the ground, and, consequently, much exhalation. But when exercise cannot, owing to extremely unfavorable weather, be consistently obtained out of doors, it should be sought in doors. With these, and other like precautions, active sports, appropriate gymnastic or oalisthenic exercises, and every such occupation as calls the muscles and sinews into play, will go far to promote a vigorous operation of all the organic functions. 4. Water, used not only 'ii the sonse of ablution, or cleansing, but for the purpose of promoting a healthy action of the skin. The cold fresh water bath should be used daily, (in the absence of particular reasons for abstaining) either m doors or oMi of doors, according to circumstances, with due regard to the precautions mentioned under the head of the " bath,'' and to the habitual temperature of the body, (which at the time of bathing should, if possible, neither be above nor below the natural standard,) and with careful observance of the process of brisk friction afterwards, and of avoiding permanent chill. Washing and rubbing the body, esiiecially, the chest, stomach, and neck, daily, first with a coarse, wet towel, and then with a coarse, dry one, will frequently form a good substitute for the bath. 5. CiiEANLiNESS of person, dwelling, clothing, bed clothes, etc., is imperative. If it be possible, the clothes, both of the person and bedding, should be frequently changed ; the bed itself, even, sliould be frequently emptied, purified, and replaced, feather beds being wholly objectionable; and the greatest precaution should be observed against the use of damp apparel or bedding. 6. Habits of Regularity, mental, moral, and physical, should be strictly observed ; excesses of all kinds are prejudicial; mental or moral EBADICATIVE llESOURCES. im I be ral excitement should be as much iis possible avoided; the habitual observ- ance of duties, as tending to obviate irre<iular habits, on the one hand, and evil consequences, on the other, is not to be overlooked ; a proper degree of mental and physical occupation, without either undue pliysical exhaustion or ' -cessive mental application, and, above all, in a method- ical and regulu .nanner, is indispensable; a proper pro}K)rtion, without excess, of rest, or without indnhjiiiij a:i indolent disposition, is to be enforced. (See ''Investigation of the Disease,'' part "Rest.") Regular hours, and hours consistent with the natural division of night and day, should be observed, and the contrary strictly avoided; gloomy thoughts should, as much as possible, be dispelled by averting the attention to interesting occupations, but not by recourse to excite- ment ; frequent change of scene is often very advantageous to those who have means to procure it, but this should be understood of changes which do not occasion great excitement. HOMCKOPATIIIC MEDICINAL EKADICATIVE RESOUHCES. In cases in which an inherent defect of constitution either provokes the development of particular diseases, or appears in complication witli them, we not uncommonly find that remedies which, in every respect, correspond with the symptoms, and which would, under other circum- stances, operate as specifics, are repeatedly andministered without the least apparent effect. The reconsideration of the symptoms having more than once confirmed our selection, we should turn our attention to more deeply-seated causes which are present to thwart us. It is obvious, that the presence of inherent constitutional defects may occasion external appearances in disease, which are esf jially susceptible of erroneous infer- ences, and, therefore, without this very important due, the special direc- tions for the treatment of any particular disease may frequently tend to discourage the unprofessional reader. In every case of disease, therefore, in which a remedy, after repeated reconsideration and i»,ft^ec'i«aZ administration, is still apparently homre- opathio, or analogous to the manifestations present, I would beg of tlie reader to investigate very closely all details of parentage, antecedent cir- cumstances, etc., (as .'ibove stated,) in order to ascertain the indication of inherent taint, whether strikingly apparent, or extremely remote and obscure, and, as far as in him lies, to make a judicious selection from ERADicATrvK REMEDIES, such as Sui-PHUR, which is, especially appro- priate when there arechrouic affections of the skin; Calcarea-carb, when, the GLANDS, in general, are particularly affected; iWercwnws', when the BONES are prominently involved, unless this be traced, immediately, to abuse of mercury, in whieh case, Nitrie-acid will be particularly useful, or, perhaps, Hepar-sulphiiris may be required; or, again, McrrAirius, wiicn the salivary gcands are, especially, involved, saving under the excej)- tional condition just named ;Ca?'6o-W(/., against what are termed scorbutic complications; Hahina and Secale occasionally, generally, however, with an occasional cour.se of Suljjhur against predisposition to miscarriage. These are only to be considered as a few general suggestions ; but I would further add, with respect to Sulphur, that repeated occasions in which I, in common with many other homoeopathic practitioners, have employed this medicament ii; 108 ADMINISTRATION OF MEDICINES, ETC. under the circumstances above detailed, and when the remedies seemingly appropriate to tlie external evidences of disease had signally failed, have confirmed its pre-eminent utility. Very often, after the patient had been submitted to a few doses of Sulphur, the dormant susceptibility of the system becomes awakened, and a subsequ( nt return to the particular and appropriate remedy which had hitherto failed, has been attended with the most decided benefit. In eases in which the constitutional taint is deeply seated, or very virulent, a long course of such alternations becomes necessary, continually returning to one or more doses of Sulphur, when the effect of other remedies becomes less apparent, and again employing the intermediary remedies, or those appropriate to special indications as before, if still required. In many cases, it is either highly beneficial or absolutely necessary, in treating chronic diseases of all kinds, to commencewitli a consecutive courseof Sulphurin singledaily doses, con- tinuing for a week or ten days, or until a more or less distinct degree of medical action has set in ; then pausing for about four days to watch the subsidence of such medicinal action, or to detect any particular symiJtoms requiring an intermediary remedy, or, sometimes suspending treatment for several days, or even weeks. These variations of treatment must be subject to the discretion and judgment of the administrator, because no two ca>>es are strictly analogous, and, therefore, a rule would be merely one of many exceptions. So long, however, as greater activity of the skin, etc., is manifest after a course of Sulphur, it will be advisable to pause in the administration. If there be intermediary and distinct symptoms, not appertaining to Sulplmr, hni identifying a special remedy, it should be given till such particular symp- toms are subdued. Or, so long as general improvement makes steady progress, however slow, it will be advisable to absi n from repeating the doses of Sulphur, resuming the administration, however, immediately the malady becomes stationary or retrogressive. If acute or active disease has supervened, and yielded under the influence of intermediary or special treatment, we are not to consider the cnre complete, but should return to extended courses of Sulphur at remote intervals. By persever- ing in such treatment, the most obstinate chronic diseases, short of actual organic decay, are overcome; and even if actual organic decay has set in, we have frequently found means to arrest its progi'ess, and to prolong existence, and even comparative health, for a surprising length of time. The Doses. — As a general rule, the recurrence of the administration should take place once in twenty-four hours, namely: the first thing in the movning, fasting. The quantity should be sufficient to develop slight medicinal action, which is usually essential to the eradication of deeply- seated disease, but avoid the error of plunging into extremes. Eight pills daily. General conditions and injunctions respecting eradicative treatment. It is natural that the vigor of animal, as of vegetable life, is in the ascend- ant in the spring, and in the decline at the fall ; it, therefore, follows that the spring will be the season, in which eradicative resources, backed by the greater buoyancy of the vital energy, will be most successful. I would also strongly enjoin every person who has occasion to undertake the treatment of disease, characterized by conditions of the nature above ■w— i KUIiES FOR DIET. 109 detailed, above all things not to be discouraged, but, so long as all circum- stances corresoond to identify the accuracy of his treatment, to persevere steadfastly, assured that, especially if the patient does not lose ground, he is pursuing a course towards ultimate success. When a mother has given birt one or more sickly children, she ought to undergo a course of coi. jtional treatment forthwith, even though she may again have fallen into the pregnant state. In tlie latter case, however, somewhat more than ordinary caution is required in watching the progress of treatment. pent. 3end- that Id by |l. I take 3ove SYNOPSIS OF THE liULES FOB DIET, UNDER TREAT- MENT. ALIMENTS ALLOWED. Soup or broth (in special cases of illness or indisposition) made from the lean of beef, veal, or mutton ; to which may be added well-boiled sago, tapioca, vermicelli, rice, semolina or macaroni, pearl-barley, and sometimes carrots, young peas, or cauliflower, seasoned merely with a little salt. Meats aiid animal products. Mutton, beef, lean pork of good quality; in a few exceptional cases,, in which it is known not to disagree, (poultry rarely, except in particular cases,) pigeons, larks, rabbi is, (venison, and game in general, may, if tender, in most cases, be jxirtaken of in moder- ation, but never when high,) plainly cooked and roasted, stewed or steamed, in preference to boiled; further, soft-boiled eggs, good fresh but- ter and curds. Fish {occasionally). Soles, whiting, smelts, trout, cod, haddock, mul- let, perch, turbot, oysters and flounders, boiled, in preference to fried ; when cooked in the latter manner, the white must alone be partaken of, and the outer, or fried portions rejected. Vegetables. Potatoes, brocoli, green peas, cauliflower, spinach, mild turnips, carrots, parsnips, French beans, beans, seakale, vegetable marrow stewed lettuce, well cooked, and prepared with the gravy of meat, where required, instead of butter. Condiments. Salt and sugar in moderation. Bread. All kinds of light bread, not newly-baked; and biscuit, free from soda, potash, and the like ingredients. Light puddings, such as those made from vermicelli, semolina, corn starch, sago, arrow-root, rice; macaroni (without cheese,) simple cakes, composed of flour or meal, eggs, sugar, and a little good butter. Frttit. Baked, stewed, or preserved apples and pears ; also gooseber- ries, raspberries, grapes, or any other fruit not of an acid quality, fully ripe, preserved, or in the form of jelly, may occasionally be partaken of. Beverage. Water, toast-water, sometimes milk, milk and water, cocoa, chocolate (unspiced), arrow-root or gruel, made thin, barley-water, sugar and water, rice-water, and weak black tea, in cases where it has long been taken habitually, and has not been productive of injurious effects. Salt should be used in great moderation. 110 ADMINISTRATION OF MEDICINES, ETC. n^P' II'- m 'M^: ALIMENTS PKOHIBITED. Soups. Turtle, mock-turtle, ox-tail, giblet, mulligatawny, and all rich and seasoned soups. Meats. Pork, (except in instances named as allcwable,) bacon, calf's head, veal, turkey, duck, goose, sausages, kidney, liver, tripe, and every kind of fat meat. Fish. Crab, lobster, and shellfish in general ; and almost all other fish not specified amongst the alinwnts allowed, as likewise all kinds of salted, smoked, potted or pickled fish. Vegetables. Cucumbers, celery, onions, radishes, parsley, horse-radish, leeks, thyme, garlic, asparagus, and every description of pickles, salads, and raw vegetables, or vegetables greened with copper. Rich or high seasoned made dishes. Pastry of all kinds, whether boiled, baked or fried. Spices, aromatics, and artificial sauces of all kinds, as also the ordinary condiments, mustard and vinegar, must be used in moderation. Cheese. Chestnuts, filberts, walnuts, almonds, raisins, and indeed the entire complement of a dessert, except what has been mentioned amengst the aliments allowed, under Fruit. The above regulations are subject to considerable modifications in par- ticular cases, both as regards the aliments allowed, and those which are prohibited. When it is necessary to make a very material alteration in the diet and habits of a p.itient, it ought, in general, to be done gradually and cautiously. Regularity in the hours of meals should be observed ; and too long fasting, as well as too great a quantity of food at one time, should be avoided. ^ ACCLIMATION, OB ACCLIMATIZATION. The process by which an individual or a species, on being removed to a different climate, becomes modified in constitution, and adapted to the changed conditions. The two words, however, are not strictly synonymous. Acclimation is generally used in speaking of particular individuals, and more especially of those belonging to the human species, and refers to the alterations which the system undergoes spontaneously in a foreign climate, by which it at last becomes no longer subject to the maladies peculiar to new comers. Acclimatization, on i\\f contrary, expresses the artificial care by which man succeeds in naturalizing, under his own supervision, a species of animals or vegetables of exotic origin. Man inhabits all the zones, and nearly every region of the earth, and has been enabled, in repeated migrations, to change the place of his habitations, and to occupy new countries. The human species is, therefore, regarded as cosmopolitan ; and yet, two facts are important to notice, in this respect. First, most of the great migrations, historic or traditional, have been made in the direction of longitude, and not in that of latitude; the migrating tribes instinctively, or intentionally, keeping nearly within the same par- allels of latitude, and consequently not suffering very great alterations of temperature, nor meeting in their new homes with a flora and fauna very (lissiniilar to those of their native country. Secondly, at the present day, although an individual may migrate, either westward or eastward, as a mm ACCLIMATION, OR ACCLIMATIZATION. Ill general rule, withoui; suffering from tlie change, a removal into a different latitude is almost always accompanied with lu'culiar dangers during the first few years of residence in the new locality. T\\v. most marked instance ot this kind is, when a person from the temperate zone visits, for the first time, to a tropical or subtropical region. The dangers tliat first beset him are fevers, which are so marked in type, and so ready to attack new'y arrived innuigrants, that they are sometinn's called the "strangers' " fever. The yellow fever of the West Indies and southern United (States, auu the coast fever of Western Africa, are well known examples of these atfeotions. They are not absolutely restricted to new coinrrs, tiie natives beings alst) subjected to them, but the recent immigrant is so much more likely to be affected, and is attacked by the disease in su much larger proportion, it Is evident that his system has in it something wliich offers a peculiar attrac- tion for the febrile poison, and which does not fxist, at least to the same extent, in that of the native or old resident. After passing through a period of general ill health and debility, extending over some years, and perhaps one or more severe attacks of illness, the immigrant approximates in his appearance and habit of body, to tlie older denizens of the place, and is no longer peculiarily liilble to disorders, which affected him on his arrival. He is then said to be acclimated. No doubt, part of the immunity enjoyed by old settlers, in a tropical or subtropical climate, is due to the fact that they have learned prudence, in regard to exposure, and have come to regu- late, habitually, the inode of life to correspond witli the climate of the country. Eecent immigrants often neglect these essential precautions because they have not found them necessary in a temperate climate ; and it is only after repeated experience of their value, that they come to adopt thero habitually, and as a constant protection. PosTEBioR View of thk Heart, LvNOg, Trachea, and Larynx. 1. KpiRlottis cartilage. 2,3. Arytenoid muscleo. 4. Tracliou, witti its mu- cous fiillicloM. 5, 6. Right und left bronchi. 1, S. 9. Rinlit loboB oi' the lungs. 10, 11. Loft do. 12, 12. Their baae. 13. Heart. 14. Aorta. 15. Left subclavian art«ry. 18. Right do. 16. Left i)riniitive carotid do. Right do. do. 17. 19. Vena cava doscfiiidonH. 20. Right vena innominata. 21. Right subclavian vein. 24. Left do. 22, 23. Right and left jugular veins. 25, 26. Puliiiouary do. 27. Pulnioiiiiry artery bi- furcating as it enters Ithe left lung. 112 mAIN AND SPINAL CORD. sectujN of the head and neck. The opposite cut shows the head and part of tlie spinal cord cut throngti the centre, showing the relative position of all the; parts as they are placed in a healthy person of normal development, the left eye being cut around showing it in its natural position. The skull, composed of a number of bones and covered by the scalp above, contains the brain, traversing which may be seen the arteries (ribbed lines), which carry blood to the various portions of the brain. Above is the Cere- brum, occupying the entire upper portion of the skull. In this part of the brain is the seat of all knowledge, and the size of this part as compared with the lower orders of animate life, constitutes one of the most important jthysi. cal differences between man and the lower animals. In the lower back portion of the skull is the Cerebellum, in the centre of which in the illustration is the letter D. This is the seat of our animal life, instincts and passions, and is in man smaller in comparison than in many of the lower animals. Extending down from the brain inside of th(> back-bone (spinal column) is the spinal cord, which has its origin in the Medulla oblongata, inside the skull and in front of the Cerebellum, and extends the entire length of the back-bone ; the spinal cord is really in some sense an extended portion of a part of the brain, and from it branches out at different points through little holes (foramens) in the bone a large number of the nerves that supply various parts of the body. , Inflammation of the brain and spinal cord in an intense acute degree is wiiat we know as Spotted Fever, or Cerebro Spinal Meningitis. The large fan-shaped muscle bearing the numbers 10, 11, 26, is that which enables us to use the tongue so freely and for such varied uses— would they were always good. Downward and rather below the base of the tongue is seen the Trachea, commonly called the "windpipe;" letters Y, Z, Z, distin- guish it; and bacic of this next the spinal column or back-bone is the (Esophagus, "Gullet " or food-passage to the stomach. In the lower part of the cut may be seen a portion of the aortic arch or large artery, that carries the blood /ro?n the heart ; also, some of the arteries which carry the blood to the head. The Eye is beautifully shown with its surrounding blood-vessels and larger nerves and muscles. And at K is the location of disease of the bone present in many cases of severe Nasal Catarrh. \ SECTION OF THE HEAD AND NECK. ; 1.. i! wtmmm £>AR,T ®EC01VI>. DISEASES OF THE BRAIN, THE SPINAL COED, AND THE NERVOUS SYSTEM, GENERALLY. CHAPTER VI. MENINeiTIS CEREBBO-SPINALIS. i SPOTTED FEVER— CEREBROSPINAL MENINGITIS. This disease has appeared in various parts of the United States and Europe, as an epidemic. It is of a most serious, and often, malignant character. The symptoms are not constant, but vary in each epidemic; indeed, the variation is so great, that of the reports of some thirty physi- cians, which we have consulted, we find no two alike. Our own experience in this disease, is confined to three cases of undoubted spotted fever, two of which recovered, the third coming into our hands after the disease had continued five days, and the patient was then dying. "We will, therefore, in view of our own inexperience, transcribe the symptoms, as given by Professor Felix Niemeyer, of Berlin, in his exhaustive report of the epi- demic in the Grand Duchy of Baden, 1865, and, after that, the symptoms as given by Dr. Bushrod W. James, of Philadelphia, as he observed them with his very extensive opportunities in the United States. Symptoms, by Niemeyer: "Without any other precursory symp- toms, the patient is at once attacked with a chill, attended with violent headache and vomiting. The headache speedily increases in intensity, the patient becomes exceedingly restless, tosses about, the pupils remain contracted, the sensual consciousness remains unembarrassed. The pul8« rises to eighty or one hundred beats per minute. At the end of the first, or on the second day, much less frequently at a later period, we notice that the head is somewhat drawn backwards; the patient continues to complain of violent headache, and the pain spreads from the head to the back of the neck, and to the back. The restlessness becomes excessive, the thoughts of the patient become confused, the pupils remain con- tracted, the abdomcH caves in, the bowels are constipated. The frequency of the pulsations and respirations now increase to about one hundred and twenty, of the former, and upwards of seventy of the latter, per minute; 8 "3 114 SPOTTED FEVER. HA ;i| il^v,^- the bodily temperature continuoa moderately low. In the course of the third and fourth day, the tetanic HpuHniH of the posterior cervical and dor- sal muaclea become more and more prominent, and. patients are, somc- times, attacked witli lock-jaw. Oitisthotonus (l)endlnt? backward) super- venes with an extraordinary degree of intensity ; tlie consciousness is gone, l)Ut the i)ati('nt .still continuoH to to.ss about in bed; the pupils still continue contracted, the bowel.s constipated, the abdomen sunken; tho urine is discharged involuntarily, or else the bladder remains distended, and the urine has to be drawn ofl' with a catheter. The patient now lapses into a prolound stupor, (unnatural sleep,) the moaning breathing is accotupuni( •! by a ralil (rattle,) and death takes place with tlie phenom- ena of an acute oidema of the lungs (collection of a liquid serum in the lungs, so as to till them up)." (I dislike Niemeyer's use of the word oede- ma, here.) " This picture of the di.sease is, sometimes modified by the occurrence of a short preliminary stage, which is marked by slight pains in the head and back, or by the breaking out of herpatic vesicles (erup- tion of bllster.-i,) or of scattered, dark-colored, roseola (red) spots on the first, second, or third day of the disease, or else the above described symp- toms develop themselves in a mucli siiorter period, which circumstance constitutes one of the most important modilications of the disease; so that the consciousness vanishes, even on the first day of the attack, and a vio- lent tetanic spasm (si)asm with unyielding stiffness) of the back of the neck, and back, begins; or, finally, may set In with such violence that a fatal termination of the disease is reached, even on the first or second day. This cursory picture of cerebro-spinal meningitis, and of the gen- eral course of the disease, applies, indeed, to most, but not by any means, to all cases of the epidemic. This picture does not comprehend phenom- ena that occui in a variety of cases, such as : deafness in one or both ears, diplopia (double vision) from a diseased condition of the optic nerves, ptosis (palsy of the upper eyelid), softening and destruction of the cornea (front coating of the eye), and, finally, paralysis of the facial nerves ^nd of the extremif 3, either on both or only one side of the body.'' Symptoms as quoted by B. \V. James, M. D., from experience and a careful study of the disease, as it has appeared in the' American epidem- ics. In many of the epidemics, prostration appears to have been a very prominent symptom : " It sometimes sets in, witli such a sudden violence, that persons who were afflicted with heart disease, dropped down dead in the street, incon- sequence of the sudden shock. This happened in a number of cases, ^lany persons died twenty-four or forty-eight hours after being seized witli the chill. Persons overtasked with labor would very often die in four- teen to sixteen hours from the chill. The general features of the ^Lisease were: vertigo, with headache; diarrhoea, sometimes of a very prostrating character; in other cases, diarrhoea alternating with constipation; mod- crate fever; flashes of heat, mingled with creeping chills, piercing pain through the head, soreness and stifTness of the upper portion of the spine, with aciiing pains in the spine, or tingling soreness and tenderness of the hlcin, severe muscular jiains, numbness of the limbs, with partial paral- ysis; spasmodic twitcliings of the muscular system, sometimes amounting to tetanic convulsions, with lock-jaw; the consciousness not much aflTec- i^' 1 THE BRAIN AND NERVOUS SYSTEM. 11 : 13 who lin coa- cases. Id with In four- Liisease [rating mod- pain Ispinc, lof the |paral- ^nting aflfec- I te<l, except when the disease is at its liight, when a more or less actlv« deliriiiin, and, dually, coma and death set in. la most cases the eye looked injected and red, and the hearing was impaired; the pulse had a moderate fre(|Uoncy, generally, about one hunch-ed per minute, the tongue remained moist, and in the course of the disease, became covered with a dark, Ijrownlsii fur; the breathing was somewhat accelerated and inter- rupted l)y moaning inspirations; during the tetanic spasms, the expira- tions had a hissing sound, the air seeming to bo forced out with an cflort, thcskin has a peculiar bluish pallor in this disease, owing to the gcncM'al turgescenco of the venous aystein; the spots which have given to tills dis- ease its name, .spottkd trvkr, broke out on ditrerent parts of the l)ody, generally liowever, on the chest, abdomen, ami thiglis ; sometimes the skin had a mottled appearance, or the spots looked like measle spots, or had a rose colored-tint. One hour the patient will seem quite well, and the next the most alarming symptoms may be present." TuKATMKNT.— Give, as soon as the nature of the attack is known, a good, full sweat; the hemlock sweats, of easy application, where hemlock branches are obtainable, are always efficacious. Two teaspoonfuls of best alcohol to four of water; one teaspoonful of this solution every half hour, until there is a decided abatement of tlie symptoms. In cases threaten- ing immediate dissolution, the dose may be doubled for a short time. ALLOPATHIC TREATMENT.— This disease is an ess.^ntial fever, attended with inflammation of the mem' ranes of tlie brain and spinal cord; hence its name. It is popularly c:.lled spotted fever. The disease is very fatal, in some epidemics reaching as liigh as four-fifths of all the cases, . in other epidemics, not over one-fourth of the cases die. The bowels should at once be unloaded, but beyond that, purgation should not be practiced. Ice, in bladders, may be applied to the head and spine, if agreeable to the patient, otherwise they should not be used. The cold or warm wet pack, according to the degree of fever, should be used once a day. If the temperature is one hundred and four degrees, or over, the pack should be cold If not so high as this, cool sponging of the skin will sulHce. When tlie pack is used, the patient is to be wrapped in a slieet wrung out of water, and then enveloped in blankets. In about an hour, free sweating occurs. Tlie pack is then removed, the patient wiped dry and placed in bed. Opium should always be given to the extent of relieving pain. This is the most useful known remedy in this disease. The physician will obtain the best results by the hypodermic use of morphia. When effusion has taken place, and there is stupor and insensibility, the usefulness of Opium is at an end. Ergot is the remedy calculated to diminish the congestion of the cord, and should be given in large doses; a teaspoonful of tlie fluid extract, every six hours, is a good rule, ^n the beginning of the disease, Quinine is useful in controlling the fever and inflammation. If, however, a single large dose— twenty grains— is not followed by benefit, it should not be repeated, unless malarial diseases exist. In the cases having high fever, the Fluid Extract of Oelseminum, given in five-drop doses, two or three hours apart, will be found useful in moderating the action of the heart, and producing a general calm. Ice, acid drinks, cold tea, and lemonade, should be freely allowed to 116 SPOTTED FEVER. ■H HI 1 H = P \ i i i \ \ h. V relieve thirst. Mill<, eggs, and noiuisliing brotli.s sliould bo given in siiffl- cient variety and quantity to maintain, as I'ar as i)03.iil)le, tiie strength of the pationt. In case food is nottakon, from voniitingorother cause, nourishmciit siiouhl bo given by injooting into tho rccitum; half a pint of strong beef tea witli two or tlireo tablespoonftils of ri(!h cream, or a liaif teacnp eacii of l)oef essence and mill<, can l)e given two or three times in tlio twenty- four hours. The injected nourishment sliouid l)o caused to be retained l)y pressure ui)on tlieanus witli a napltin or towel. Stimulants should be avoided until the symptoms denote tiiat the vital forces are l)eginning to fail, and just in proportion to this failure, are they demanded. Their bene- ficial effect is shown by a fuller, stronger, and more regular pulse and reduced febrile and nervou^; excitement. A taldesjmonful of whisky or brandy, from one to three hours apart, is a good rule, varied according to the judgment of your physician. In SriNAL Mkninoitis (inflamm.ation of the membrane of the spinal cord,) the jjrinciples of treatment are the same as is given for acute Men- ingitis-Cerebral. Tlie disease generally proves fatal within a week. HOMEOPATHIC TliEXrVlEXr.—aclseinimnn, if indicated and used nt the very beginning of the disease, will never disappoint us. It is indicated by the following symptoms: Severe chill, followed V)y conges- tion of the brain and spinal cord, dark red cheeks, dilated pupils, very little, if any thirst, perfect loss of strength, especially of the legs, with staggering gait, imi)eded si)eech, icy-cold lUvUds and feet, pulse very weak, if perceptible, difficult and weak breathing, nausea and vomiting, eyelids close in spite of all the patient can do to prevent it; stoeatimj relieves inability to direct the movements of the limbs with accuracy, the men- tal powers remain active. Dose: Six pills dissolved in a tablespoon ful of water, of which give two teaspoonfuls every fifteen to thirty minutes, until there is improvement and sweat, or the symi)toms indicate some other of the remedies here mentioned, in preference to this. liellatlonua is indicated by stupefying, stunning headache, from the neck into the head, with bent and pulsations in it ; inclined to bend the head backward, even before spasmodic notion is shown in any other part of the body; it relieves the pain; spasmodic bending the head back- ward ; convulsive shaking, distortion by spasm of the face and lips, grind- ing of the teeth, inclination to bite, the urine retained, or involuntary discharge, heat of the upper part of the body and coldness of the extrem- ities, hightened sensibility of all the senses, renewal of the spasm by touch or light. Dose: Six pills, as just directed for Getsemiimm. Cicuta Vir. Vertigo, with reeling, moaning, and howling ; grind- ing of the teeth, double vision, pupils dilated or contracted ; dumb, deaf, great difficulty in breathing or swallowing, ashy jmleness or bluish puffed face, cramp in the muscles of the back of the neck, with inability to move the head after it has been turned in any direction, trembling of the limbs, convulsions with cries, pressing together of the jaws, numbness and distortion of the limbs, forcible and involuntary bending of the body backward; violent, sudden jerks through the head, arms, and legs; after fits, insensibility and immobility ; pain in the stomach, with vom- iting, abdomen painfully puflTed. THE BRAIN AND NERVOUS SYSTEM. Ill Dose : VMhi pills or two drops of the inedk'i • in a little wutor, every twenty •iilnutes to one hour. nyoHCUttmuH. Ileud heavy and violent puins, alternating w..U pains In the nape of the neck; eonstrietlng, stupefyint,' headache, Henna- tion as if the hruln were shaken and loowe; dimness of eyes, fearful grinding of teeth, ^oc/c-Ju?/), palsy of tongue, vomiting, involuntary stool, and urine; spasm of hreast vvitli arrest of breathing; sensation on bend- ing the neck as if the nui.scles were too sliort ; twisting of the neck to one side; stiffness of arms and legs, jerking of Imnds and feet, spasms resembling epilepsy; great sensitiveness of the skin ; sores on the body, that have a tendency to gangrenous destruction ; pulse small, quick, intermitting. Dose: As directed for C/mte Vir. Veratfum nHdc, Opium, Nnx Vom., Arsenicum and Digita- lis f are v/ell approved remedies. h give lere is lier of from to bend other d back- grind- untary xtrem- ■ism by grind- 3, deaf, puffed 5 move of the ibness 1 of the legs; vom- JiyPERJEMlA OF THE BRAIN. EXCESS OP BI.OOD IN THE TUAIN — CONGESTION OF THE BRAIN. By Hypera)niia of tlie Brain is generally understood an excess of blood in the arteries and veins (Ijlood vessels) of tlie brain; or. in other words, more blood in the brain than is uiiUiral in a condition of perfect health. This unhealthy increase of the volume of blood may be occasioned by tliree distinct causes. In the first place, the flow of the blood from the brain, being natural, a larger quantity of blood returns to the brain. In the next place, the flow of blood from tlie brain may be diminished by some disease of the blood vessels, or their surroundings, while the amount carried to the brain by other vessels, not so diseased, may be natural in amount. Finally, the cause may be located in tlie brain itself, the brain substance (cerebral parenchyma^ may become hardened or wasted away {atrophied) or softened ; or the capillaries (very small ends of the vessels) may become enlarged. This diseased condition of the brain is confined either to a limited locality, or extends throughout the whole brain. It is scarcely ever pos- sible to establish, during the life of the patient, a sure diagnosis regarding the exact seat ar.J the extent of the hyperaimia, for the reason that conges- tions of very limited extent frequently excite mucli more striking symp- toms, than more extensive congestions. So far as treatment is concerned, such a diagnosis is scarcely ever of much importance. The most important terminations of this engorged condition of the brain, which impart to it a higher significance, in practice, are: sudden death from paralysis of the brain, in consequence of excessive pressure of the blood; dilation (widening') of the vessels, especially the capillaries, by which the tendency to congestion is increased, exudation and extravasation (or throwing out, and collection of blood in some of the cavities, or coUeo tion beneath some of the covering membranes.) The Causes of cerebral hyper£emia are various and important, in a practical point of view, ^nce, in most cases, they determine the choice in the selection of the proper remedy. These causes are of two kinds : 118 CONGESTION OF THE BllAIN. ». Causes.— First, those wliicli affect the brain directly, and second, indi- rect causes, by whicii.tiirougli the operation of influences that are partially unlcnown to us, the brain becomes involved in ;:n affection more or less remote from itself. Among the direct causes alfei ; ing the brain, the most prominent are: concussions of the h(^ad by a fall, hlow, or like accident; continued, persevering, and excessive mental exertions; emotional excite- ment, such as joy, grief, anger, disappointment,-chagrin, etc.; exposure to excessive heat of the sun (A'?</J.s'i/v)A*e,) or to artificial he;it; likewise to excessive cold; more particularly, if the influence of cold is siiddenly fol- lowed by the action of intense heat. In the second class of causes, we may range, according to circum- stances, almost all kinds of febrile (fever) affections, since almost all of them may be iissociated with this condition of the brain ; in this place we must content ourselves with mentioning diseases where almost always congestions of the brain are present; tbe^ are: erysipelas of the face; diphtheria; mumps; inflammatory diseases of the eyes and ears ; diflicul- ties during teething. Among the more or less chronic afTections that maj be mentioned in this connection, as casual circumstances, the most prominent in the list of those that impede the How of blood from the brain, are : defects of the heart, right side, and tumors (morbid growths) on the neck. In the list of those that occasion a general increase in the impulse of the circulation, are: diseases of the heart, left side, suppres- sion of habitual losses of blood (such as menses or piles) . In this last list, we likewise include those cases caused by the abuse of alcohol, in all its varied forms, or of other narcotic substances — s ich as oi)ium. Without doubt tliere, also, exists a tendency to congestion of the brain; in which case, they may be excited by any perceptible change from a condition of health. This tendency is identical with the so-called apopZeciic /trtW^, but cannot be recognized, with any certainty, before its occurrence, by definite diagnostic signs, but has to be determined, in most cases, by the occurrence of the actual fact; it is a certain fact, that it is not alone indicated, as is poi)ularly believed, by a thickset frame, and a short, thick neck. On the other hand, the idea of a probable occurrence of hyper- jemia of the brain, suggests itself before it happens, in the case of indi- viduals, who, while consuming quantities of nourishing food, do not take bodily exercise in a corresponding ratio, and in whom this mode of living develops a condition that may justly be termed plethora, or excessive flesh. We have already stated, that the frequent repetition of attacks of this nature leads to a dilation (widening) of the blood vessels, which increases the disposition to renewed attacks. Generally speaking, you can safely predict a favorable termination in this disease, since a fatal result need not be apprehended, unless some other complicating disease should supervene. In one respect, it depends upon the age of the patient; while, in i ersons of middle age, the danger is not very serious; it is, on the contrary, much greater in the case of children and old people. In the case of children, death takes place very fre- quently in consequence of the paralysis of the brain, occasioned by the excess of blood in that organ; in old people, the vessels are generally so fragile that they easily tear, and their contents are discharged upon the brain. The apparent violence of the disease is no adequate guide by which n THE BRAIN AND NERVOUS SYSTEJI. 119 orid, indi- I partially )re or less , tlu". most accident; lal cxcitfi- posurc to Icewisft to denly fol- circum- ost all of 1 place we st always the face; ; difllcul- ions that the most from the growths) se in the , suppres- this last lol, in all n of the e change so-called efore its , in most it is not a short, f hyper- of indi- iiot take f living xcessive acks of , which lation in 33 some [depends |anger is ?]iildren :>ry fre- by the bally so |)on the which I ■I I to judge of tlie danger likely to resuli^ from it, but the more frequently the trouble occurs, the more dangerous it becomes. When it depends upDU pre-existing derangements, the prognosis depends almost exclusively upon the character of these derangements. The symptoms by which hyperajmia manifests itself, vary according as one or another locality of the brain is the seat of the affection, and according as the pressure upon the brain is more or less violent. The head feels heavy, confused, or as if encircled by a tight band; tlie head- ache, which is scarcely ever wanting, is almost always throbbing, and is made worse by stooping, unusual exercise, and every mental effort ; buz- zing in the ears, sensitiveness of the eyes, even seeing sparks and obstruc- tion or obscuration of sight, aie generally present. Vertigo (giddiness, dizziness,) is seldom wanting. If arising from hypersemia, a characteristic sign is to become aggi'avated by stooping, but more especially bj'^ looking up. Generally, the patient feels drowsy without being able to sleep, or else the sleep is anxious, disturbed, full of dreams. Feels very languid, and his gait is rendered insoeuro by want of firmness in the lower limbs. The p Ise may continue natural, and there may be no fever present. This mildest form may be combined with constant restlessness and gloomy ideas; sleep is disturbed by anxious dreams, which, in the more violent cases, do not altogether disappear while the patient is awake; they even assume the character of hallucinations, and if the trouble continues without being checked, a permanent mental derangement will not unfrequently result. Palpitation of the heart, ill humor, distrust, total indisposition to work, and fitful mood are almost always present. This form of hyperajmia mostly befalls individuals, who, while enjoying good cheer, take but little bodily exercise, but per- form a large amount of mental labor. The foregoing symptoms are almost characteristic, also, of hyper- semia, consequent upon suppression of certain forms of loss of blood. The trouble is much more dangerous, if it sets in as an acute disease, and, although violent at first, continues to increase in intensity, until it terminates in death. In such ca^es, the face looks dark-red, tlie eyes are streaked with red, the blood vessels of the head and neck juilsate vio- lently; the pupils of the eyes look smaller, all the senses are very sensi- tive, the headache is maddening, sometimes driving the patient to sui- cide. Delirium is apt to follow. Tliifj type of the disease is mostcomnion after sunstroke, and not unfrequently is an accompaniment of mental derangem?nt, of which, indeed, it may frequently be said to l)e the cause. Not unfrequently the above described symptoms are suddenly followed by all the signs of apoplexy, regarding wliich the diagnosis cannot be established wi!h any certainty, until the rapid course and sudden disap- pearance of the symptoms of paralysis have satisfied one that no pouring out of blood (extravasation) can have taken place, since the fluid could not have been reabsorbed oo solu. In this category belong, most likely, all the cases that are said to have been cured so rapidly. This disease never exists during an epileptic attack, in which the course of the attack alone gives perfect certainty concerning its true nature. Among children, hyperfemia is an almost habitual accompaniment of all fevers, ad not unfrequently conceal the symptoms of the true dia ^ -«&*•. '' > 11" flS ' ! 120 CONGESTION OF THE BRAIN. ease, for the reason that the course of the hypersemia is marked by thc more violent symptoms. In every considerable congestion of the brain convulsions of some kind almost always occur ; they are accompanied by drowsiness, even to the extent of sopor (sound but unnatural sleep), delir- ium, excessive restlessness, and anxiety and vomiting, in nearly all cases. However threatening such a condition may seem at first sight, in must cases it passes ofT speedily, and without leaving a trace behind, so that the congestion seldom lasts longer than thirty-six hours, and generally abates after the lapse of twelve hours. Treatment.— In the acute form of the disease, applications of cold or ice water to the hciul, and keeping the extremities warm, is excellent. In the chronic form, resort to frequent bathing and rubbing, aud plenty of healthy outdoor exercise. ALLOPATHIC TREATMENT.— Active congestion of the brain, not sufficient to produce apoplexy or sudden coma (insensibility), is denoted by the following symptoms: Pain in the liead, sometimes intense, not limited to any special part, with a sense of fullness, bursting, or weight and throl)l)ing. The head is hot, and the carotid, and other arteries of the neck and head, pulsating violently. The face is flushed, the eyes injected; there is intolerance of light. The mind is confused, and con- sciousness may be suspended; there is dizziness, ringing in the ears, and difficulty in speech. If paralysis and insensibility exists, the trouble is greater than simple congestion— there is apoplexy from extravasation of blood. These symptoms (signs) are, also, those of the beginning of inflamma- tion of the membranes of the brain, and a discrimination cannot, at once, be made. The treatment is the same. The intensity of the congestion determines the prominence of the symptoms. Intense congestion calls for blood-letting, promptly, at the hands of a surgeon, as necessary in preventing apoplexy and sudden death, hemorrh- age upon the brain, watery effusion, or inflammation. Blood-letting gives relief, by weakening the action of the heart, and diminishing the quantity of blood sent to the head. If the congestion is not suflicient to call for bleeding, eitlier general or by wet cups, applied to the back of the neck, relief may be obtained by ice to the head, hot foot-baths, made stimulating by the addition of mustard or red pepper, and an active purgative ; one or two tables poonfuls of Epsom Salts dissolved in water, is as good a physic aa any for the piu'pose, in domestic practice. The after-treatment will have reference to the removal of the causes, if possible; they are, aside from enlargement of the heart and sunstroke, principally some form of using alcoholic stimulants, and over-stimulating food, excessive mental or emotional activity, and anger. If the patient is strong, or robust, the diet should be less hearty, and a cathartic of a smaller dose of salts, or a Seidlitz powder, taken occasionally. Let all the habits of life be governed by the word moderation. Passive Conqestign of the Brain is caused by some obstruction to the return of the blood from the head, through the veins, except it may be caused by weakened arterial circulation. The trouble is distinguished by drowsiness, dullness of mind and perceptions, and sometimes by convQl- sions, in children. Active delirium, throbbing arteries, and increased heat, THE BRAIN AND NERVOUS SYSTEM. 121 t;d by the he brain lanied by ip), delir- all cases. in most so that generally i of cold xcellent. id plenty irain, not denoted ense, not r weight rteries of the eyes and con- ears, and rouble is satiou of iflamma- , at once, gestion inds of a leniorrh- ng gives quantity call for le neck, ulating ; one or a physic ent will aside form of ental or the diet Seidlitz i by the ction to may be shed by convol- id heat, e, are wanting. Passive congestion may lead to watery effusion or extrava- sation of blood upon the brain. When caused by disease of the heart, or by tumors pressing upon the veins, and so producing the congestion, treat- ment has reference to a removal of the obstruction. See treatnaent of diseases of the heart. For the treatment, or removal of tumors, the skill of a surgeon is necessary. To overcome enfeebled circulation, everything which produces exhaustion is to be avoided, and its force increased, and the blood enriched by nutritious food and tonics. Citrate of Iron and Quinine, one dram, dissolved in four ounces of simple syrup. Dose, a teaspoonful. Or the Soluble Citrate of Iron, dissolved in Sherry Wine, one dram to eight ounces. Dose, a teaspoonful, are good tonics taken before each meal. HOMCEOPATHIC TREATMENT.— J3eMat?omia. In plethoric persons, disposed to rush of blood to the head, red, almost purple face, dilated pupils, nervous agitation, sensitiveness to all unusual sounds and motions, especially any sudden jar, as of the bed or floor, delirium, constant or inter- mittent mutterings, and, if present a disposition to perspire, will be found reliable indications for Bell. Dose: Six or eight pills, or two drops of the remedy, in a little water, once in one to twenty-four hours, as the urgency of the case may demand. Study article on dose and repetition, in the previous pages. Aconite. If the trouble is the result of violent emotions, such as fright or mortified feelings. This remedy is also very useful in alternation with Bell., in cases of acute hypersemia among women and children, at times where the latter remedy is indicated, but the symptoms show, also, A high fover and excited condition of the heart. Dose: As for Bell., and also subject to the same considerations. Opium is a more useful remedy in tl i disease than either of the others already mentioned, provided tlie trouble has not been produced by this remedy in some of its forms. Its use is indicated by continued sopor, (sleep) with insensibility of all the senses, dark redness of the face, with paleness and coldness of the rest of the body, slow pulse, slow breathing. Dose : As for Bell. Tobacco is one of two drugs which frequently cause this disease. Do not take or give it in any form. If this so-called innocent habit is one of your failings, be firm, shake off the demon you see so surely destroying your life, and quit, forever, the habit which is costing you so dearly. Kux Vomica. When the disease is caused by a sedentary mode of life, or excessive mental labor, and more especially in the commencement, when caused by frequent use of spirituous liquors, attended with constipa- tion or irritation of the kidneys, Ntix is a good remedy. Dose : Six pills every evening. Arnica. When the derangement is the result of a concussion, fall, or blow on the head, etc., use Arnica freely. Veratrum Viride. When Bell, is indicated apparently, but after being given for twenty-four hours, a dose every half hour, or hour, has produced no change for the better, you will iind a change to Veratrum Viride a. gooA one; it has been used extensively in this affection, both in general and hospital practice, with the best results. It is best given in a low potency. '.m I 1!:^ 1' HI H^^ m LACK OF BLOOD TO THE BRAIN. Dose: Ei it pills in three tablespooiifuls of water, to be given a teiispoonful evei'y two to four hours. Sunstroke in hyperaimiji from the heat of the sun, applications of ice or cold water to the Iieail, along the back, and to the extremities, is iudis- ■i)ensabie to re-awaken the paralyzed reaction of the organism, but this should not be an entirely constant application, but should have short inter- ruptions at intervals. ANEMIA OF THE BRAIX.—LACK OF BLOOD TO THE BBAIN. Antemia of the Brain is not, as generally considered, a separate affec- tion, but rather a symptom of, or an atfection caused by, some other disease. Anaemia of tlin brain either consists in a diminished volume of blood in the brain, or i r supply of blood to the brain, destitute of red globules. In the formor case, it is caused by constriction or compression of the arter- ies through which the blood courses towards the brain, or by any other circumstances, in consequence of which the space within the skull is nar- rowed. In the second case, all the causes of ansemia must be considered; whereas, the deliciency of blood, consequent upon sanguinous losses, will have to be counted, since it is not only the decrease in the quantity of the blood, but, also, in the quality, that determines the anajmia. Then, again, there is no doubt but that changes of a spasmodic nature may induce a sudden decrease of the volume of blood to the brain; a greater or less degree, we have observed, in consequence of powerful men- tal enotion or excitement. The symjitoms of anaemia of the brain differ a good deal, according as it develops itself more or less rapidly. If it develops (^uite rapidly, we have a most jiefect image of syncope (fainting or Kwooning,) luif ascious ness, voluntary muscular movements are suspended, most generally, amid slight convulsions, and both the breathing and the pulse, are slower. This condition is most prominently seen, during metrorrhagia (hemor- rhage from the womb) in confinement; or from some other morbid dis- charge of blood. Evidently such accidents are attended with great danger to life. If the anrcmia sets in more slowly, symptoms of stimula- tion always precede the sinking of the activity of the brain. Here, as well as in excess of blood in the brain, wo have violent headache, great irritability of the organs of sense, buzzing in the ears, dimness of sight, vertigo (dizziness) ; and it is only from the course, and a careful study of the causes of disease, that we are able to obtain light regarding their cause. It is characteristic of most cases of ansemia of the brain, that the symptoms either abate or disappear in the horizontal position, and that the partaking of food or stimulating substances, cause an improvement. The course and duration of this disorder depends, of course, upon the aggravating causes. What is certain, is, that the appearance of aneeniia of the brain is always a very bad symptom, especially in the case of chil- dren. ALLOPATHIC TJIT^ATMENT. When this condition exists in the whole of the brain, it is associated with, or depends upon, general anaemia or impoverishment of the blood of the whole system. There are also THE BRAIN AND NERVOUS SYSTEM. 128 e given a ions of ice 3, is iudis- Q, but this lioit inter- TO rate affec- er disease, blood in , globules, the arter- any other uU is nar- insidered; )sses, will ;ity of the lie nature ! brain ; a rful men- jrding as )idly, we iscious enerally, slower, (homor- bid dis- til great stimula- Here, as le, great f sight, study their il mt the nd that ment. pon the inscntia of chil- in the mseinia re also present, as a rule, the headache, dizziness, and other symptoms of exhaustion and weakness. This anaemia of the brain, is tliat of a lack ot the quality of blood, and not a lack of quantity. The essential element in which the blood is deficient, in these cases, and all cases of general anaimia, is iron, which enters so largely into the composition of the red globules. The proper treatment, therefore, is to introduce into the blood, through the stomach, blood making materials. Nutritious food is most important, and should consist largely of fresh, rarely cooked, lean meat, as, beef and mutton, milk and eggs. The medicinal treatment should consist of Iron and vegetable tonics. The Citrate of Iron and Qiiinine. fulfdls the indication and may be given in doses of two to five grains, three times a day, before meals. It should be dissolved in water or syrup. This, with Cod Liver Oil and good food, will restore the health and the proper amount of blood to the brain. The CodLiver Oil should be given, at first, in doses of a teaspoonful, increased to a tablespoonful. If cream can be obtained it is equally as beneficial. If the nervous debility should be great, Stryfhnlne and PJiosphorus, in atldition to the above, will be mosf useful. The pills of Phosphorus or Phosphide Zinc and Nux Vomica will answer very well, and, as they are sugar-coated will be preferred by many. Dose; One or two pills, three times a day. The^itrate of Iron and Strychnine is a pleasant preparation and can be given in three grain doses, dissolved in syrup, three times a day and will generally sulflce alone. Quinine should also be given in one or two grain doses, in pill or powder, or some other bitter tonic, as Tincttire of Bark, or Gentian. The Elixir of Quinine, Iron and Strychnine, also meets the needs of these cases, and can be used in doses of a teaspoonful at each meal. The electric current, known as Galvanism, is immediately useful. The l)oles of the battery should be applied to the mastoid processes (behind each ear) or upon the forehead and nape of the neck. In partial anaemia of the brain, caused by embolism, as occurs in that form of apoplexy, time is the necessary element in its removal, by the establishment of the collateral circulation. There can be no doubt, how- ever, in many cases, of the benefit of Strychnine in doses of about one- thirtieth of a grain, and the judicious emijloynient of Galvanism, though much harm may also be done by their improper use. HOM(EOPATHIC TREATMENT. We must content ourselves with mentioning only a few remedies, known to be most jirominent for anfe- mia of the brain, when manifesting itself as an independent, and more particularly in the form of an acute disease. Ipecac, as a remedy, is particularly suitable for children, after rapid losses of animal fluids, if the symptoms of convulsions are present, together with more or less stupor. Dose : Eight pills, or four drops of solution, in three tablespoonfuls of water. Give a teaspoonful every two or three hours. Secale Cornutum is particularly useful in the hemorrhage from the womb of parturient females; here it acts in a two-fold direction, against the hemorrhage itself, and against the symptoms arising from the brain n i \m 124 APOPLEXY. and spinal marrow; upon both of these organs it acts in a very marked manner. Dose : As for Ipec. CupruDi is only suitable where the whole process is developed slow- ly, and is more especially characterized where there is some spasmodic phenomena, such as some mental excitement. Dose: A small powder, or eight pills, in water, as directed for Ipec. HOME REMEDIKS. Ammonia or Camphor applied to the nose, or even a little cold water applied to the face, will often arouse from syncope arising from anajmia of the brain. APOPLEXY. Apoplexy is a sudden loss of consciousness, beginning at the brain, depending upon hemorrhage upon the brain, congestion or embolism (a small clot from the heart lodged in an artery of the brain). CiiAKACTEKiSTics. — Suddcn or gradual loss of consciousness, sensa- tion, and motion, with greater or less disturbance of the pulse and res- piration. It is extremely difficult to distinguish clearly between the different varieties, the external symptoms not always bearing a uniforni relation to tlie internal injury ; thus all the indications of serous apoplexy may declare themselves from sanguinous extravasation ; and it is not always possible to decide, in apoplexy, whether effusion, or simple congestion of the vessels of the brain, has taken place. Premonitory Symptoms.— Contiimed inclination to somnolence; heavy, profound sleep, with snoring respiration; nightmare, grinding of the teeth, shocks or cramps, extreme drowsiness, or a general feeling of heaviness, or disinclination to the least exertion ; frequent yawning and fatigue after the slightest exercise. A sense of weight and fullness, and pains in di.orent parts of the head, sometimes very deep-seated. Head- ache and megrim, or giddiness and fainting; pulsation of the arteries of the temples and neck, with swelling of the veins of the head and fore- head ; disturbance of the functions of the brain, evinced by the loss of memory, irritability of temper, or mildness and indiflference, despondency and weeping; irritation of the membranes covering the eye, diuniess of vision, specks or motes before the eyes, or flashes of fire, or sparks, during darkness; acuteness of vision, or double vision ; sometimes, also, the words in a line appear to run into one another ; difficulty of opening or closing the eyes ; noises, humming, singing, etc., in the ears; dullness of hearing; dryness of the nostrils, pinched appearance of the nose, with false perception of an unpleasant odor; sneezing, and slight bleeding of the nose; stammering, and indistinct pronunciation; difficulty of swal- lowing ; numbness or torpor, or pricking sensation in the extremities, with inarticulate speech, and occasional partial attacks of paralysis in the face, (distorting tlie features,) or in some of the nmscles of the limbs ; pains in the joints ; weak or unsteady mode of progression ; difficulty of passing water, etc. THE BHAIN AND NERVOUS SYSTEM. 125 ry marked loped slow- spasmodic I for Ipec. le nose, or m syncope the brain, iboli.sm (a ess, sensa- , e and res- ' different ni relation ilexy may j^M lot always ■■ ?estion of H inolence; B inding of ^B feeling of ^m ning and ' ^ff uoss, and " -.'* Head- •teries of ind fore- (.■',' e loss of .'■■y ondenoy .. ■■' *,'■• uness of i, during Iso, the ning or llness of se, with ''S-'- ding of >f swal- es, with 10 face, ains in lassing .'^d •■■■.;!( ■J Confirmed Attack. Syjiptoms— The attack itself is commonly ushered in by either of the following groups of symptoms: The patient suddenly falls to the ground, and is instantaneously deprived of sense and motion. The limbs are relaxed and perfectly motionless, or the whole of one side is rigidly contracted, whilst the other is relaxed and powerless; in f ome Instances one limb (such us an arnij is alone implicated. The speech is either entirely suppressed, or a few inarticulate sounds are all that can be uttered ; the countenance is flushed or livid and puffed, and there is foaming at the mouth, with contortion towards the affected side. The respiration is slow, impeded, and usually accompanied by a rough, harsli snoring. The pulse varies, but is usually weak at the commencement, and fuller and stronger, but slower, as reaction sets in. In other cases, again, the patient is suddenly seizerl with partial 2Jaralysiii, comprising either an arm or leg, or the wliole of one side of the body, attended with loss of the power of utterance, and pale, sallow, or livid and bloated countenance. In the course of a few hours, all, or the greater part of the symptoms mentioned under the first variety of apo- plexy, are prone to follow. Issue and Results.— When, in either form of the disease, recovery is about to take place, consciousness gradually dawns upon the patient; he begins to recognize persons {md objects around him, answers when spoken to, or makes signs for writing materials, in order to express his wants on paper, when the power of speech is still denied him. But when a fatal termination is to be apprehended, the breathing becomes more and more oppressed, the face becomes pallid, and a cold, clammy sweat bedews the brow; the act of swallowing is rendered difli- cult or impracticable, the teeth become clenched, the eyes dim and glazed, and the evacuations are passed involuntarily. Predisposing Causes.— Chronic derangement of the primary organs of digestion, and, in some cases, disease of the heart, are the principal predisposing causes of apoplexy. The conformation of the frame is rise considered to predispose persons to attacks of apoplexy. Old age is more subject to this disease than the robust or mature periods of life. Particu- lar seasons, such as the equinoxes, (the transition from winter to summer, and from autumn to winter,) increase the predisposition to attacks of apoplexy. Pudden changes of the barometric conditions of the atmosphere are, also, knowr* to operate as predisponents. Exciting Causes.— The exciting causes of apoplexy are intemperance in eating and drinking ; mental emotions; obstructed circulation, arising from tight articles of dress around the neck or waist, or from prolonged stooping, or keeping the head in a dependent position; intense study ; blows on the head ; the use of opiates ; baths at too high a temperature ; violent vomiting, or strong muscular efforts; the suppression of habitual dis- charges; exposure to the rays of the sun; extremes of temperature; accidental loss of blood, or excessive bleeding. ALLOPATHIC TREATMENT of apoplexy will have reference to the period of the attack, and to its prevention. If an attack lias occurred, the patient is to be placed in a cool, well aired room, with tlie head raised and cold applications made. If the head is hot, and the arteries throbbing, and I 111 i It las APOPLEXY. the face (liisiiecl, ice slioukl be applied to the head, and hot foot-baths, with miishud phisters, to Uie fcot and h^jjfs. Tlie dress about tlie chest and neck loosened to permit the free return of blood from the head. If tlie stomach is full, a vomit (omotic) slu)uld be given; but not other- wise. A tablespoonful of mustard, in water, is as good as any. An emetic which produces straining should not bo given. There is, generally, an advantage in an active cathartic. For this purposQ three drops of Croton OUiH the best cathartic, on account of the briskness and quickness of its action. It can be given in a little syrup or glycerine. If free purgation does not occur in four hours, tlie dose siiould be repeated. The action of the physic can be liastened by injection of soap sitds havimj a little salt added ; one pint is the usual size for an injection. If the pulse is small or feeble, or the patient weak, a cathartic should not l)e given; but if it is known that the bowels have been constipated, they should be moved by an injection. If the patient is belovy middle life, the condition is probably active congestion, particularly if the symptoms characteristic of this condition obtain, such as fluslied face, congested eyes, throbbing of tlie carotids and other arteries of the head and neck, and a hard, resisting pulse, the life of the patient may depend on the immediate abstraction of blood. When paralysis exists, the apoplexy depends npon extravasation of blood from the rupture of an artery within the skull, or upon embolism (plugging of an artery in the brain, by a small clot from the heart,) bleed- ing should not be resorted to. In the latter case it can do no good, and in the former may do positive harm, by so weakening the patient that he cannot survive long enough for the clot of blood to be absorbed. If the patient regains consciousness, and paralysis of one side of the body (hemiplegia) remains, there is a clot. Cooling washes should be applied to the herd, the bowels kept open, and the food nutritious, but unstimulating. Recovery will depend upon the absorption of the clot by the eiforts of nature. Paralysis will be treated under that disease. HOM(EOPATHIC T' VTMENT.— Homoeopathy possesses many reme- dies, by means of which it is frequently possible to ward off an impending attack of apoplexy. In order to better facilitate the selection of the appropriate medicines, inasmuch as the immediately exciting cause frequently serves to modify the course to be adopted, the subjoined table of medicines, especially appropriate for the treatment of cases distinctly traced to particular causes, has been pre-attached to the distinctive indications afforded for each medi- cine, separately, further on in this article. But it is, at the same time, necessary to caution the reader against holding the cause as paramount to the particular indications present, for the cause is ever the subordinate reason for selection. But when any one of the remedies named as appropriate for the treatment of cases traceable to particular causes, is, also, found upon reference to particular and dis- tiiwtios indications, to correspond with the requirements of the case, we have thus ascertained a double reason for being assured that the selection Is correct. THE BRAIN AND NERVOUS ST3TEM. w laths, with cliest and ; not other- An emetic For this ant of the 9 syrup or ose slioultl ton of soap injection, iliould not lated, they bly active condition rotids and the life of iisation of embolism rt,) bleed- od, and in it that he ide of the hould bo ious, but le clot by ase. reme- ipending idicines, modify specially causes, bh medi- I against jent, for my one iceable id dis- se, we llection 11 INDICATIONS AFFORDED BY PARTICULAR CAUSES, DURING THE PRES- ENCE OF PUE.MON1TOUV SYMPTOMS. When the attack iH directly traced to a (;iiiL,L, select from:* AcoNi- TUM, Opium, Niix-vomiat, and Micucuitius. When the attack is traceable to a sudden fiuoht, select either: *Acu- nitiim, or Opium, or both, alternately. When CONCENTRATED oiiiEF is ascertained to be the exciting cause, select from : * Ignatia and Lachesis. When sedentary habits, or over-application to study, is distin- guished as the exciting cause, select: * Nux-winiva or Bdladonna. When the attack is directly traced to a fit of passion, select from : * Aoonitum, Bryonia and Nux-vomka. When excessive joy is distinguished as the exciting cause, select from : * Coffea and Opium. When the attack is directly traced to over-indulgenck in vinous and spirituous liquors, select from : * Nux- vomica, Opium, Lachesis and Pulsatilla. When DERANGEMENT, from overloading the stomach, is recognized a» the exciting cause, select from : * Pulsatilla, Ipecacuanha and Nux-vomiea. When exposure to the sun, or a hot bath (too hot), is distin- guished as the exciting cause, select from:* Belladonna and Aconite, or both, alternately. When the attack is directly traced to suppression of an habitual evacuation of blood, select from : * Nax-vomica and Pulsatilla. Aconitiun is required in all cases where there are evident symptoms of fullness of the vessels, determination of blood to the head, character- ized by redness and fullness of the face, distention of the veins of the forehead, quick, full pulse, restlessness, and anxiety. Dose: Of a solution of six pills to two tablespoon fuls of water, give a teaspoonful every hour, until amelioration or change; but if, after three doses have been given, the improvement does not become speedily progressive, proceed with the next medicine. Selladonnn is of essential service when the symptoms of congestion do not speedily or thoroughly yield to A nunite, or should only a partial degree of amelioration have taken place, in which case, this remedy should be administered four hours after the last dose of the foregoing— or, further, should the following symptoms present themselves : redness and bloatedness of the face, injection of the conjunctiva (the mucous membrane which lines the eyelids, and covers tlie front of the eyeball), violent beating of the arteries of the neck and temples, noises in the ears, darting pains in the head, with violent pressure at the forehead, increased by movement, the least noise or bright light, double vision, and almost all the symptoms relative to the eyes already mentioned ; dryness of the nose, with unpleasant smell and bleeding of the nose; fiery redness of the * The Belection from one or more of tho medicines thns enumerated, must, however, as already observed, depend upon tha correspondence between the symptoms uf the case, and those horeinaftef enumerated in connection with such of these medicines, separately. But if the indiccUiont for two ot more medicines bo so closely identical as not to be decisive between them— whereas b»th are not api'li- cabletothe treatment of cases arising from tho same cause— thon this discrepancy will he decisive between them, if the cause be dearly ascertained. 128 APOPLEXY. :l, ! 'I' ! throat; difflculty of swallowing; Blight attacks of paralytic weakness or heaviness in the limbs. Dose : Of a solution of six pills to two tablespoon fills of water, give a teaspoonful (or two pills dry on the tongue) every three hours, until improvement or change. Nux-vomica is particularly suited to cases in which the apoplexy threatens individuals of sedentary habits; or addicted to the use of ardent spirits, or too great an indulgence in the pleasures of the table, or in those who have long been affected with indigestion, either bilious or nervous ; and have, consequently, more or less of the rheumatic or gouty constitutional tendency ; and, also, when the following symptoms present themselves: headache, deep-seated or frontal, but more especially at the right side, and (jiddiness, confusion, and humming in the ears ; nausea, and inclination to vomit; turgescenco of tlie superficial vessels of the face or redness only of one cheek ; drowsiness; feeling of languor, with great disinclination to exertion, either mental or bodily ; cramps of the limlis, especially at night, and weakness in the joints; constipation and diffl- culty in passing water ; irritability of temper, aggravation of tlie symp- toms in the morning, or after a meal, and also in the open air ; bilious, sanguine, or nervous temperament. Dose: A solution of six pills, as directed for Belladonna. Opium is a most important remedy in almost all severe attacks, but particularly in old people, when we find the following symptoms : marked congestion to the head, indicated liy stupor, giddiness, heaviness in tiie head, and violent pressure in the forehead ; singing in the ears and hardness of hearing; sleeplessness, or agitating dreams, or frequent and almost overpowering drowsiness during the day ; redness of the face, and constipation ; pulse slow but full. Dose : Of a solution of six pills to two tablespoonfuls of water, give a teaspoonful (or two pills dry on the tongue) every two hours, until improvement or change. Ignatia is, also, indicated by many of the symptoms mentioned under the head of Nux-vomica, but it is chiefly called for when depress- ing emotions (particularly severe, and protracted gi'ief) have been the exciting cause, and when the person affected is of a nervous tempera- ment. Dose: Six pills in two tablespoonfuls of water, a teaspoonful every two hours, until improvement or change. HOME TREATMENT..— As there is liability of apoplexy recurring, after recovery from an attack, all possible precautions should be observed. The individual should avoid violent bodily exertion, or strong mental labor, venereal excitement, the use of alcohol in any form, the stooping posture, and tight neck cloths. The head shov.ld be well elevated at sleep, and every morning the head bathed in cold water. When dizziness, head- ache, with throbbing of the arteries occur, a brisk cathartic should be taken. The rule of life, as stated in the treatment of acute congestion, is moderation. Head symptoms are sufficiently common, without being followed by apoplexy, so that those who experience them need not become unhappy from fear of apoplexy, especially if they have never had the disease. eakncss or lUlAIN. 120 iter, give ft lOurs, until ! apoplexy of ardent able, or in bilious or c or gouty ims present pecially at rs ; nausea, 1 of the face with groat ' fhe limbs, and diffl- f the symp- ir ; bilious, attacks, but symptoms : j, heaviness the ears and pcjuent and face, and 'ater, give a lours, until mentioned n depross- been tlie IS tempera- nful every recurring, e observed, mg mental e stooping ed at sleep, ness, head- should be gestion, is allowed by unhappy tease. UNI>EIt HUliFAfJE OF TITE BRA IN. TIio undersurfaco of tlie Jhaiii as it rosts on basooi under surface of skull. a, n. Tlie halves of the Ceifbrum, the upper suvfac(!s of wliioli are scon in the cut. 6, b. The Cerebellum ; tlio principal scat and origin of nearly all tlie nerves of sensation and motion, and by many anatomists believed to be tlie seat of tlie sexual instinct. ih The Medulla oblongata is the enlarged upper end of tlie spinal cord ; it is about an iiicii and a (piarter in lengtii by thrce-fouvths of an inch in breadth at its widest i)art, and one-half inch in thicicni'ss. c. Tlie lower end wliero it joins the cord is called Medulla spinalis. 1, 1. Tlie origins of tlie olfactory nerves are indiciited by tins number on the right and left sides of the cut ; these extend out- ward, and are distributed on the inner .'surface of the nose and give lis the sense of smell. 2, 2. lleiire- sent the oj;//c no'i'cs, which, extended to the eyes, give us the sense I of sight. 3, 3. Nerves tiiat move the ball of the eye. The Trifacial nerve i n d i - c.ated by 5, 5, flud known to anatomists as the trigemi- nus or fifth pair, is the largest of the nerves issuing from the cra- nium ; it is also peculiar in tliat it is unlike other cranial nerves, performing more than one duty. It is a nerve ot special sense, that of taste ; of common sensation for tlic head and face, and of motion, as it controls the motions of the nniscles of mastication, and is widely distributed over the head and face and to the various muscles thereof; indeed, if it was not for this nerve's help, our smiles and I'rowns would be very much alike. The Facial nerve indicated by 7 is the motor nerve of all the muscles of ex- pression in the face ; just try to make all the faces you can, and you will learn a little of the great variety of work over which it has supreme command. The Auditory nerve, by means of which we examine sound, is indicated by 8, 8. This is a most important member of the nerve system, and is sometimes the seat of disease, causing deafness more or less marked. 9, 9. The Glosso Phaiyngeal. 10, 10. Pneumogastric nerve is both a nerve of motion and sensation. It governs the voice and breathing, the heart and stomach, and is very often overworked in the careless pushing American. 9 THE HKAIN AND NERVOUS SYSTEM. PJRALYSTS. By parnlyfllfl, wo underHtiind n suspension of nervous action. Tt dif- fers in character according as one or anotiior, or aii tlie nerve tninkn are attacked. And its Hyniptoins must vary, just as tlie functions of tiie nerves vary. The name paralysis, implies tlie complete cessation of the action, both of the nerves of sense of feeling, and of the nerves of motion. If only one set of nerves are affected, it is called incomplete paralysis, or paresis; one side of the hody affected is called hemi])]agia. If the upper extremities of one side, and the lower extremities of the other, are tht seat of disease, we call it transverse ]xmil>/sis. The causes of paralysis are various. Diseases of the brain and spinal cord, are the principal causes. Of these apoplexy, inflammation, and •oftening of the brain, are most prominent. Ther<! are many other influ- ences to which paralysis may be traced, as their result. The main causes of tills class are : excessive exertions of the parts to which the paralyzed nerve is distributed, in which list must appear cases resulting from con- vulsions, continued and excessive pains, swellings, neuralgia, ligatures, a stroke of lightning, rheumatism, hysteria, gout, pregnancy, violent acute diseases, among which contagious and miasmatic diseases occupy a front rank, such as scarlatina, measles, variola, typhus, dysentery, and Anally, poisoning by animal, vegetable, and more particularly, by mineral poi- sons. The Symptoms of paralysis may readily be understood. There can only be doubt, when the paralyzed part is not accessible to our vision. The prognosis depends on the nature of the exciting causes, and upon the possibility of removing them. If from disease of the brain, or spinal cord, a cure is not imposr '-'o, but doubtful. If from some acute disease, then; is very little douF ultimate cure. That the prognosis is ren- dered much more d^' an advanced age, an enfeebled constitution, and an extension .*ralytic phenomena over a large surface, is but natural to expect ALLOPATHIC i«EATMENT.— Pahalysis. There are no diseases, the, treatment of which ought more certainly to be directed by a judicious person, than the treatinent of the several forms of paralysis. The treatment, as a matter of necessity, will have reference to the diseased conditions causing the paralysis, the state of the system, and any independent affections which may be co-existing. Treatment is not to be addressed to the inability to make muscular movements directly, but to the cause and associate affecti The nature of the causes must, therefore, when possible, be deteKiuned with positiveness. Among the questions to be settled before intelligent treatment can be begun, are: Is the cau.se of paralysis inflammatory, or is there a structural change of tissue (lesion,) and where is this lesion or inflammation situated? Is it in the course of a nerve within the skull or spinal canal? If it is a lesion, what is its nature and extent? Is it the result of poison, as lead or arsenic, copper or mercury? Or, are all these causes absent, and is the paralysis functional? "What influence do co-existing diseases have on the paralysis? Is the system well nourished, or h there debility or anaemia? The treat- ment will vary according to the conclusions arrived at in answer to tho above questions, and the result will, therefore, depend upon the correct- PAItALYSIS. 181 I. Tt dlf- m trunkn 1118 of the on of the )f motion, ralysis, or the upper Dr, are the ind spinal ition, and thor inllu- iiin causes paralyzed Tom con- gaturea, a lent acute )y a front d finally, aeral poi- rhere can »ur vision, upon the or sjiinal te disease, sis is ren- stitution, ce, is hut leases, the Ijudicioua Ice to the [teni, and jnt is not >ctly, but |es must, nong the |, are : Is ]hange of ? Is it a lesion, arsenic, aralysis iralysis? le treat- ;r to the correct- ness of the conclusions, and the jiidj^mont with wiiich tiio indications are carried out. Tliore are cases in wliirli tlio structural changes (lesions) are such as arc beyond hope of repair ; in such cases the comi)leto success of treatment cannot l)o hoped for. That jmrtof tiie treiitment having reference directly to (lie paralysis or to the paralyzed parts, and calculated to restore their function, promote the circulation in them and their healthy nutrition are chiefly Electricity, passive motion, (moving or exercising the paralyzed part by the hands of the patient or others,) active exercise undrr the direction of the will, rub- bing, shampooing, and stimulating applications. Stri/chuia Is also given internally for this purpose. It must be borne in mind, that these measures cannotbeefTectual and may be injuries, so long as the paralysis Is maintained by the conditions which caused it. The general treatment having reference to the causes of the paralysis Is considered uiuler their respective heads as apoplexy, as a cause of hemi- plegia (paralysis of one side of tlie body) and myeletis (inllammatiou of the spinal cord) as the cause of paraplegia, (paralysis of the lower half of the body.) The chief remedies are Strychnine and Electricity, but their use should bo delayed until the acute stage of the causing disease has passed, though later on, both these agents are useful in restoring tlie circulation to the brain in cases of thrombusis (obstruction of tlie circulation in the brain by inflammation of an artery) or to embolism (obstruction of the circulation in the brain, caused by a plug lodging in an artery) and to proinote the al)Sorption of a clot in case of hemorrhage in tlie brain. For this end, very mild Galvanism (the direct electric current,) should be used. One pole should be placed upon the najjeof the neck and the other upon the forehead, or ui)()n each mastoid process. Strong currents may do serious mischief. But sutflcient time having elapsed for the immedi- ate efTects of the brain disease to subside, its judicious use will be beneflcial. If there is headache or dizziness, the greatest care will be necessary, and in all probability, ^/ednciY?/ should be discontinued. It is also important to remember, that part of the paralyzing effects of th^.se causing conditions is tcnporary, and may be the result of shock, contusion, or congestion, which are temporary. Even paralysis depend- ing upon no appreciable lesion (functional) is, for a time, stationary, before improvement begins. Beside^, paralyzed parts do not, of themselves, resume their healthy action, even after the conditions causing the paraly- sis are removed, so that it will not do to trust to nature alone, but appro- priate efforts must be made to restore healthy action. It is a serious error to begin treatment addressed directly to the paralysis, while that condition is maintained by the primary causes, fur- ther than to maintain the nutrition of the paralyzed muscles, by main- taining the circulation in them. It is a serious error to overlook the fact that after the paralysis has existe<l some time, that recovery will not take place spontaneously. After paralysi's has existed so long that degenera, tive changes have taken place in the muscles or nerves, recovery cannot take place. So long as contractions take place upon passing the electric current 132 THK BUAIN AND NEllVOUS SYSTEM. through the paralyzed muscles, they have not yet reached a condition that renders them hopeless. If pain is produced upon passing the elec- tric current through the paralyzed part, but no contractions are produced, the case is less hopeful than as if both contraction and pain were pro- duced. The former is o. 'ieti electro-muscular contractility, and the latter elec- tro-muscular sensilU if >f. When both are lacking, the case may bo said to be hopeless Electricity.— As I 'e stated, the constant current may be applied tc 4ie brain for the purpose of improving the circulation and its nutrition (u the case is hemiplegia.) To the muscles, usually, the induced (or farauic) is used. This will prevent wasting and loss of function from disease; but, as a rule, that current should be used which produces the the rreatcst number of contractions and the least amount of pain. If the teirperatureof the paralyzed part is lowered and the muscles weak and flabby, great benefit, in all these particulars, will follow the use of the faradic current. Large, well-moistened electrodes should be used, one being placed over the motor nerve affected, and the other over the belly of the muscle. Every affected muscle should be faradized at each sit- ting. The same principle will govern the use of electricity in all forms of paralysis. ln/acjraZpar«i?ysw', one pole should be placed on the mastoid process, and with the other stroke the face. Pain is an evil, and the current should not be stronger than neces- sary to produce contractions. Nor should its application be made to one muscle long enough to tire it. From ten to twenty minutes is long enough for an electric sitting, nor should any muscle be subjected to the electric current for more than Ave minutes, nor oftener than every day or every other day. In in fantile paralysis the most decidedly beneficial results are obtained from electricity. The electrical treatment should be begun early, but after all inflammation has subsided. So long as the electro-muscular contrac- tility continues, especially, if the joints have not become changed, the spinal cord and the nerve plexuses, as well as the paralyzed muscl&s, should be subject to faradization or galvanization. <S^rj/r/iHi/ie.— Continuous with the use of electricity. Strychnine should be given. It is most useful in hemiplegia, when the muscles are completely relaxed; when they are rigid, it is not to be given. After the acute symptoms disappear, Strychnine is useful in promoting the nutri- tion of the affected nerves or nerve centers, as well as 'kjY kindling the contractile oower of the muscles, whether the ])aralysis be hemiplegic, paraplegic, or of a local character. The most effectual method of administering Strychnine in paralysis, is by hypodermic injection. One tliirty-second of a grain a day, by hypo- dermic injection, has a better effect than the same or a greater quantity three times a day by the mouth. A good formula is : Take of Sulphate of Strychnine one and a half grains. Distilled Water one ounce. Mix. Apply heat to effect a solution ; ten drops contain one thirty-second of a grain, and can be given once a day, by hypodermic injection, to an adult. In Infantile paralysis one drop of this solution, diluted by five drops of Din- ^J^^H I PARALYSIS. 133 a condition ng tlie elec- le produced, n were pro- e latter elec- ly bo said to y be applied its nutrition induced (or notion from produces the pain. If the s weak and e use of the oe used, one /er the belly . at each sit- all forms of the mastoid ' than necco- made to one lutes is long jected to the every day are obtained y, but after ar contrac- anged, the ed muscles, Strychnlm nuscles are After the the nutri- ndling the lemiplegic, 1 paralysis, , by hypo- ■r quantity Sulphate of ix. Apply f a grain, adult. In [ops of JHh- tilled Water, and given once a day, is very beneficial, if tlie muscles have not lost their electro-contractility. It promotes the capillary circulation and the growth and power of the muscles. In making the injection, it is best to throw the solution into the muscle itself, taking the paralyzed muscles each in turn. To do this dex- trously requires the skill of a physician. Cases of paraplegia, in the early stages, should doubtless be treated with Ergot and Belladonna. A teaspoonful of the Fluid Extract of Err/ot and ten drops of the Fluid Extract of Belladonna should be given thi ee times a day, but after three or four weeks have passed, they should give place to electricity and Strychnine. In paralysis of the insane, there is scarcely any hope of permanent improvement from treatment, much less for a cure. These patients should be removed to insane hospitals. The treatment consists, for the most part, of palliative measures, and a regulation of the diet, with a view of retarding the progress of the disease, and contributing, as far as possible, to the comfort of the patient, during the continuance of tlie malady. HOMCEOPATHIC TREATMENT.— Paralytic attacks, being almost with- out any exception, secondary affections, are results following some other disease, or injury. It is evident that in treating them it is of the utmost importance to learn the first, or primary cause of the present affection. It is not always possible to do this, but when the cause is once known, the treatment should be directed to its removal. If it is the result of dis- ease, look for the treatment under the name of that disorder. If from some external cause, study and remove that. The treatment by Homoeopathic means always includes the searching out of the cause of the paralysis— which is always a symptom, or the result of a previous condition of disease or injury— and treating the malady from that point of observation, as far as it is practicable. Electricity is the sheet-anchor, in all schools of medicine, for the treatment of this disease, and it is for this reason that all Homoeopaths point to it with pride. As it is beyond successful contradiction thai the cures it does so very frequently produce are in full accord with what they liave demonstrated to be nature's law ot ure. The use of this remedial agent is so fully and plainly given by my co-author, Dr. Bean, in the Allo- pathic Treatment of this disease, that I shall be con snt to refer my read- ers to that part of his work ; indeed, the whole of his treatment is so fully in accord with our experience and practice— except in the matter of dose, —that we will only add that the annexed are a few paralytic conditions and remedies, proven to be the best for that condition ; a further study may b'e made by means of the Repertouy. CaustiGum, while not sup- posed to be able to produce a cure alone, is still one of the most substantial helps in almost all forms of paralysis. When caused by suppressed ERUPTIONS and ulcers, Canst., Ars., Sul. After excessive bodily EXERTIONS, Rhus-tox., Ai's., Causf. After rheumatism. Canst., Fer., Biy., China, Am., Bhus-t. After apoplexy. Bell., Nux., Caust., Am. HOME REMEDIES.— Passive motion, in cases of complete paralysis is important, i. e., movements of the paralyzed limbs by the hands of the 184 THE BUAIN AND NERVOUS SYSTEM. attendants or the r»;itlent. It aids the circulation and nutrition, and maintains them in a state of preparation to respond to the force of the will. Friction of the surface of the paralyzed limbs, kneading the rausclee, with a deep pressure, and shampooing, are useful in maintaining nutri- tion, and should be employed with perseverance. Persistent voluntary motion, in all cases of incomplete paralysis, is very important. There is reason to believe that, in some cases, paralysis continues at a certain point, until it becomes incurable, when persever- ing exercise, with other treatment, would have resulted in improvement or recovery. With this view, gymnastic exercises are to be enforced. The simplicity of this method does not prevent its being of great benefit. INFLAMMATION OF THE BRAIN. BRAIN FEVBR, PHRENITIS, MENINGITIS, MENINGITIS CEEEBRALE. The Causes are sometimes veiled in obscurity; at others thej' are known to be the effect of excessive mental exertions, or the use of alco- holic drinks, or the effect of heat, or sometimes of cold, and other like causes, as mentioned under " Hypersemia of the Brain." Symptoms.— An attack of this disease may take place either gradu- ally, or very suddenly ; generally the former. The premonitory symp- toms are, at first, depression of spirits, impaired appetite, mental uneasi- ness, and confusion of ideas, especially when in the recumbent posture, debility, and sometimes ringing in tlie ears, and blindness. These are succeeded, in most instances, by a more or less severe chill, and constant headache, which are soon followed by severe fever, hot and dry skin, flushed face, red eyes, or a haggard, anxious, fearful expression of them; the pulse is quick, rapid, and forcible. The intensity of the headache increases, as also the ringing in the ears, sometimes changing to a humming or rumbling sound; the senses become morbidly acute, as known by the sensitiveness or restlessness as shown on exposure to either light or sound. The pupils of the eyes are constantly con- tracted, the patient is extremely restless or wakeful, with more or less delirium. They frequently imagine that some one designs to injure them and cannot bear restraint or contradiction, and the delirium is sometimes of a furious, raving nature. * The head is remarkably hot, while the extremities are cold. The ton.'^ue is furred white, red at its edges, dry, pointed, and the papUljE ele- vated; the bowels are obstinately constipated, and nausea and vomiting are common. Breathing is accelerated and laborious, seldom hurried, ;is in fevers, but irregular and with frequent sighs. Generally there will be spasmodic movements of the muscles and of the tendons. The urine is scanty and of deep color. As the disease advances, a change occurs in the symptoms, the pre- vious delirium changes for a stupor which gradually passes into coma. The formerly contracted pupils are now dilated, and there is less sensi- bility to t!' > light, the eye loses its b-ightness; sometimes there is J. »r'<^^ INFLAMMATION OP *Hfi BRAIN. I3f) rition, and )rce of the le muscles, ling nutri- laralysis, is s, paralysis [1 persever- iprovement rorcod. Tlie •eneflt. EBRALE. rs they are use of alco- i other like ther gradu- itory symj)- ptal uneasi- nt posture, These are d constant d dry skin, of them ; e lieadaciie nging to a dly acute, II exposure antly con- )re or kss ijure them sometimes cold. The mpUlse ele- vomiting lurried, ;is [there will JThe urine Is, the pre- Into coma, less sensi- there is squinting, and the countenance is vacant or idiotic; picking at the betlclothes or grasping in the air are almost always present at this stage. The hearing is much diminished, and, indeed, all the senses are very much blunted; the limbs become perfectly relaxed, the pulse is slow, sluggish, and irregular or intermittent, the respiration is deep, slow, and often stertorous (noisy, loud); the urine is very scanty, if passed at all, and the fseces are involuntarily discharged. Convulsions or paralytic attacks often ensue. Finally, the pulse becomes hurried, small, and unequal, the counte- nance pale and sunken, the skin has a cold and clammy perspiration upon it, the urine flows without any knowledge, the coma becomes more profound and death terminates the scene. It must be remembered, that these symptoms vary, being very mild with some, and extremely violent with others, depending upon the degree of strength of the system, the severity of the cause, and other attending circumstances. Some care is necessary in discriminating inflammation of the brain from fever of some other form; the headache of brain fever is more con- stant than that of fever, and appears to be confined to no particular spot. The sleep in this disease is disturbed with bad dreams and sudden starting or waking in fear, and with children a scream on awakening. The Prognosis is generally doubtful . Much depends upon the cause of the attack; if it be produced accidentally by blows, etc., it is more favorable than when owing to some constitutional disease or difficulty. The milder the symptoms the more certain is a favorable termination, but we should not be discouraged and despair, even in the worst cases. ALLOPATHIC TREATMENT of acute meningitis, cerebral, (inflamma- tion of the membranes of the brain). In the first stage of the disease, the object of treatment will be, to diminish the active congestion, and to limit the inflammation and its products. The hair is to be cut close to the head, and cold applied by means of a sack or bladder of pounded ice, or constant washing with cold water; the head should also be raised. An active cathartic is to be given : One drop of Croton Oil in Syrup or Glycerine, is appropriate, or twenty grains of Calomel, in a tablespoonf ul of Castor Oil, may be given. Owing to the urgency of the case, and the extreme danger to life, if the patient is robust, and the arteries of the head and neck beat- ing violently, in short, if the congestion is intense, blood-letting should be resorted to, preferably by wet cups to the nape of the neck, than general bleeding. The treatment, in this stage, is the same as in the condition called active congestion. These measures are only proper in the beginning of the disease, as exhaustion is one cause of death in cases of meningitis, which do not die quickly. Food should be of the blandest kind, and taken cold. The restlessness and excitement should be relieved by Chloral Hy- drate &nd Bromide of Potassium. Take of Chloral Hydrate eight scruples, Elixir of Bromide of Potassium four ounces, water four ounces. Mix. Dose ; One to two dessertspoonfuls, in syrup or sweetened water, from two to four hours apart, until relief is obtained. Opium is beneficial in relieving pain, and accomplishes as much as any other remedy, in controlling the inflammation. Dose : A grain to a grain and a half, in powder or pill, two or more hours apart, until pain is relieved. 136 THE 13KA1N AJS1> M:jlVOLS SYSTEM. I f ;! .'i' After the s'liso of active congestion is over, tlie indications for treat- ment are to support tlie powei's of life, and to promote tlie absorption of the products of inflammation (lympli and serum). The former indication is to be met, as far as possible, with nutritious, easily-digested food, of which meat essences and extracts, the preparations of milk, and milk beaten with eggs, form the principal part. Should the drowsiness and insensibility become so profound as to pre- vent sufficient food being given by the mouth to support life, as is fre- quently the case, half a pint of these strong liquid forms of food should be given, by injections into the rectum, two or tliree times a day, in addition to the amount taken by the mouth, and tlieir retention effected by firm pressure upon the anus with a napkin. The absorption of the lymph will be aided by giving Iodide of Potassium. Take of the Saturated kolution of /odirifeo/Potoi'swrn one ounce, and give five drops in sweetened water, flavored with Essence of Peppermint, two or three times a day. Strict attention should be given to. the bowels, that they do not become consti- pated. If the bladder is not emptied by nature's efforts, the water should be regularly drawn, twice a day, with a catheter. For this the help of a physician is necessary. Vomiting, during any period of the disease, should be met by a fly blister to the nape of the neck, and a mustard plaster to the stomach . The following mixture is as commonly successful as any internal remedy: Take of Carbolic Acid ten grains, Simple Syrup one once. Mix, and give a teaspoouful each hour until relieved. Chronic Meningitis, Cerebral: In all probability, this affection is the result of a poison in the system, known as sypliilis, either acquired or hereditary, and a history of the constitutional aflection should always be sought for. Even when it is not cleanly found, if the inflanwiiation can- not be traced possitively to another cause, the existence of syphilis is to be suspected and govern the treatment. Iodide of Potassium sliould be given. Take oi th.e Sat^trate Solution of Iodide of Potassium one ounce, and give at first five drops, in sweetened water flavored with Essence of Peppermint, three times a day. Increase tlie dose by one drop each day, until relief is obtained. Tliirty or forty drops may be given at a dose, if relief is not sooner obtained. Give after meals. Quiet of mind and body is necessary. Nutritious food and warm clothing should be provided, and a warm bath be given two or three times a week. If the patient is pale and weak. Iron and bitter tonics sliould be given. The Citrate of Iron and Quinine in an eligihle form in two-grain doses; one dram of the drug dissolved in four ounces of syrup or water, is a convenient mixture. Dose : A teaspoouful, given before meals. Let us repeat, Iodide of Potassitim appears to be the remedy for chronic meningitis not dependent upon tubercle or an injury. The writer is of the opinion that cauterization, blistering, etc., in this disease, are not, in the slightest degree, beneficial in arresting the disease, but add to the discomfort of the patient. They are not to be used, except in obstinate vomiting, when a fly blister should be applied to the nape of the neck. Treatment of Tuherclous Mcninnitis : This disease, depending upon the presence of tubercular deposit, offers very little encouragement for INFLAMMATION OK THE BKAIN. .187 for treat- rptioii of ndication d food, of ind milk 13 to pre- U3 is ive- should be addition 1 by firm rrapli will oUition of ed water, y. Strict lie consti- er should help of a by a fly stomach . 1 remedy: and give ion is the [Hired or ilways be tion can- lis is to lould be |e ounce, ■ssence of fach day, dose, if Id warm [ee times liould be ^o-grain kvater, is ledy for I, in this 1 disease, I, except ]nape of upon ent for treatment, if the diagnosis if clear. "\Vo are bound, however, to do what we can to give relief. The general princijjles of the treatment of anute and then oi chronic meningitis obtain. Depletion should not be practiced. Cathartics should be limited to the reliel'of the constipation, which, as a rule, exists. For this purpose, Ca/ome/, in one or two-grain doses to a child, and ten grains to an adult, followed, in six hours, by Castor Oil— a teaspoonful to a child ; a tablespoonful to an adult, if the bowels have not opened. In the main, measures to relieve pain and prolong life, are alone indicated. For the relief of pain, restlessness, etc., the use of Opium, CTuoral and Bromide of Potassium, are indicated. The dose of Opium will vary from one-tenth of a grain to a child a year old, and a grain to an adult, repeated at intervals of two hours, until pain is relieved. Or Chloral Hydrate can be given in combination with Bromide of Potassium, as fol- lows: Take of C/itomZ Hydrate two scruples, /ocZMe o/ Potassium two scruples, Syrup of Tolu and water each one ounce. Mix. Dose: Give a teaspoonful, three or four hours apart, to a child one year old. The dose for an adult would be twenty grains of each drug. To prolong life, stimulants, in doses of a teaspoonful of whisky or brandy, may be given to a child, and one or two tablespoon fuls to an adult, in addition to nourishing, easily-digested food — as milk and eggs, either alone or beaten together; cream, meat essences and extracts, and raw lean meat, minced fine. Preventive treatment is by far the most important and hopeful, especially for the consumptive predisposition, which is generally hereditary. If a baby, he (or she) should be brought up by a hearty wet nurse, and should not be weaned until he has cut all his teeth. Flannel should be worn next the skin, and the lothes should be warm. Over- exertion of mind and body should be avoided, but free exercise taken in the open air. The diet should be plain and nutritious. Milk should be freely taken. If the patient is reduced or decreasing in strength, Cod Liver Oil should be given. The Syrup of the Phosphates with Iron is, also, an appropriate remedy. Exposure to measles, and whooping cough, should be avoided, being especially liable to be followed by some form of tuberculous disease. HOM(EPATHIC TREATMENT.- With regard to the treatment of this disease, we may begin by stating that medical aid should always be pro- cured, if within reach; but when it is impossible or difficult to secure such assistance, the following remedies may be resorted to: Aconite is invariably required at the commencement of the attack, when the skin is Imt and dry, and the pulse rapid, with the ordinary \\\d\- caWon^ of pnxQ Inflammatory Fever, -which is especially liable to be the case in young plethoric subjects. Dose : Dissolve six globules in three tablespoonfuls of water and give a teaspoonful of the solution every hour, until the pulse diminishes in force and frequency, and the skin becomes moist or covered with profuse perspiration; after which, the intervals may be extended to two hours and the administration be proceeded with, if no other medicine appears to be indicated, until general and progressive im- proveinent becomes apparent. But if any of the subjoined symp- toms remain or supervene, consider the following medicines, and select that which is indicated by the symptoms present. J83 THE BRAIN ANI> NEllVOUS SYSTEM. Belladonna seems to possess a certain specific influence over inflam- mation of tlie brain and its membranes, and is generally tlie remedy we Bhould select, when the following, amongst other symptoms, present themselves: .yrea^/tea^o/i/te /tert(i/ redness and bloatedness of the face, with violent pulsations of the arteries of the neck; buryimj the head in the pillow, and increase of suflTering from the slightest no e, with extreme sensibility to light; violent shooting and burning pains in tlie head; eyes red and sparkling, with protrusion or wild expression; contraction or dila- tion of the pupils ; violent and furious delirium ; loss of conciousness ; some- times low nuittering; convulsions; occasionally symptomatic hydropho- bia; vomiting ; involuntary evacuations of the faicesand urine. Dose: Of a solution of six globules to three tablespoonfuls of water, give a teaspoonful every two liours, until a change. But if distinct improvement supervene, (without intervening apparent Hggravution,) tlie intervals should be extended to four hours, and, again, after two more doses— if the amelioration be regularly progressive — to eigiit hours; and so on, until permanent improveiiiont or change. But, in very urgent cases, and when repeated doses of Belladonna have pro- duced inadequate results, consider the next medicine, and proceqd accordingly. If in alternation with Zincam, a similar solution of each (separately) administered by teaspoon fuls, at intervals of half an hour (or even fifteen minutes,) in rotation, until the urgent symp- toms abate. Zincuni may be had recourse to, after, or in alternation with Bella- donna, when that remedy effects only partial amendment. In those extreme cases, where symptoms of threatening paralysis of the brain are manifested by the following indications: Loss of consciousness; half- closed eyes; dilated, insensible pupils; icy coldness of the extremities, or of the entire surface of the body; blueness of tlie hands and feet; impeded respiration; small, weak, scarcely perceptible pulse; Zincuin has been found effectual in averting a fatal issue. Dose: If singly, dissolve six globules in three teaspoonfuls of water; and give a teaspoonful of the solution, (or, otherwise, three globules dry on the tongue,) every hour, (or, in very urgent cases, even every quarter of an hour,) until the lividity and coldness, and the indica- tions of the pulse assume a more natural aspect— and then every three hours, until general improvement or change. If in alternation with Belladonna, as directed for that medicine. Bryonia. This remedy will frequently be found of great eflicacy in children, when Aconite weal Belladonna have produced but trivial improve- ment, and the symptoms manifested resemble those enumerated in the article on "water on the brain." Dose: Dissolve six globules in four teaspoonful.^ of water, and give a teasp; onful of the solution every two hours, until amelioration or changj;but if partial improvement only should become apparent, within two hours after the third dose of Bryonia, pause two hours longer, and proceed with the next medicine. Helleborus-N'if/er is required after Bryonia, in cases exhibiting the characteristic features of water on the brain, when the last named medi- cine has been inadequate to overcome the disease. In such cases, and when partial improvement only has resulted froni the previous adminis- tration of Bryonia, Helleborus should be given four hours after the third dose of the last named medicine. Dose: Asdiveeted for Bryonia. verlnflam*' remedy we IS, present the face, lead in the h extreme head ; eyas ion or dila- Qess;some- hydropho- Is of water, if distinct gniviition,) I, after two e— to eiglit je. But, in a have pro- ud proceqd sohition of t'als of half ■gent symp- tvith Bella- In those e brain are iiess; half- remities, or it; impeded iuis been of water; |ee globules iven every lie indica- n every Iternation WATER ON THE UK A IN. 139 eflicacy in 11 improve- led in the land give a loration or apparent, ;wo hours Ibiting the ned medi- |ases, and adminis- the third Hyoscyamns is appropriate when there is drowsiness, loss of con- sciousness; deliiuim about one's own affairs; inarticulate speech ; lont^^ue coated white, with frothy mucus about the lips; dilation of the pupils; lixedness of vision ; skin dry and parched; redness of the face, and picking of the bed clothes with the fingers. Dose: Of a solution of six globules to two tablespoonfuls of water, give a teaspoonful every one to three hours, until amelioration or change. Opliiin. When there is lethargic sleep, AVith snoring respiration ; Iia(/ open ti/ev, and coni'iisiou or giddiness after waking; congestion of blood to the head; complete apathy and absence of complaint. Dose: Of a solution of six globules to two tablespoonfuls of water, give a teaspoonful (or otherwise three globules dry on the tongue,) every hour, until amelioration or change. Stramonium* When there is starting or jerking in the limbs; sleep almost natural, followed by absence of mind after waking, but sometimes attended with moaning and tossing about; vision fixed, and the patient frequently ai)pears in a state of dread, and utters cries; redness of the face; feverish heat, with moisture of the skin. In many of the symptoms this remedy bears a close resemblance to Belladonna, with the exception of being indicated by signs of a more spasmodic character, and by less acute pain in the head. Dose : As directed for Hyoscyamus. HYDBOCErilAL US. DROPSV OF THE BRAIN. WATER ON THE BRAIN. In general, we understand by Hydrocephalus, every unhealthy accu- mulation of fluid in the cavity of the skull. It may be either acquired or exist from earliest life. Acquired Hydrocephalus is seldom an independent disease, but rather is generally symptomatic of some other constitutional disease. It becomes an important symptom when the disease sets in as a chief complication in meningitis; or when it develops itself so rapidly that it acts like apoplexy, and speedily terminates fatally, (then it would be called .se;'on,vrf;>op/ea;?/.) It is very hard, indeed always uncertain, to diagnose this disease. It scarcely ever calls for a special treatment, and had better be treated with- out medicines, by means of care and diet. Congenital hydrocephalus (that which exists from earliest life,) com- mences before the child is born, but may increase after birth. The quantity of accumulated fluid may be very large, and hence the skull may acquire an extraordinary size. Its effects upon the child are sometimes impercei'Lible, but at other times very decided: the mental actions of the braia are mostly involved. It is only in very fully developed cases, that the motions of the muscles are interfered with, in which case a more or less complete paralysis sets in. The life of the patient is not absolutely threatened; it may be admitted that hydrocephalic children, who have got over the period of infancy, have pretty nearly escaped the most imminent danger of death, from this immediate cause. But they always remain weakly, irritable, and unusually disposed to frequent and malignant diseases. Hydrocephalus, oi' dropsy of tiie brain, is a curable ^i^Simmutiimmm 140 THE BUAIN AND KERVOUS SYSTEM. disease, but such a cure is mostly spontaneous, taking place in proportion as the bodily development progresses, and if the body does not develop, the limbs remaining small, or paralyzed, the chances of cure are propor- tionately less. A cure may, indeed, be facilitated by artilicial means, but not by medicines. A main point is to bring up such children with great care, to accustom them to light and nourishing food, and to active bodily exercise, and to excite their mental faculties until the body is well devel- oped. Such children should not be allowed to attend school until they are fourteen or fifteen years of age, and there need be no uneasiness about them falling behind their companions of the same age. If so held back they will, almost without exception, excel in study when permitted to apply themselves. HOMCEOPATHIC TKEATMENT.— Among medicines, if we do use them at all, there are none wliicli »)lfer more hope than iJdt'bouatc of Ijinn- (CalcariaCarb.,) and Afaenietini, hwi they must be givi'u in small ami very rarely repeated doses. Do not Itandage the head of infants tiijhtlyiov this disease. A very moder.ate bandage, in very early life, will likely be beneficial, while the tight bandage will be likely to cause inflammation and death. ALLOPATHIC TREATMENT.— This disease unfortunately gives very little hope of benefit from treatment. Physicing, bleeding, blisters, and salivation are to be avoided. Gentle laxatives or injections should be depended on to keep the bowels open. Plain nourishing food and Cod Liver Oil or Cream should be given. A child can take a teaspoonf ul of Cod Liver Oil two or three times a day, while a tablespoonful is enough for an adult. The active remedies which appear the most useful are Iodide of Potassium and Iron. A convenient prescription for a child is : Take of Iodide of Potassium thirty-two grains, Phosphate of Iron sixteen grains. Dissolve each salt in a little water separately, then mix and add simple syrup suffl- oient to make a two ounce mixture. Dose: A teaspoon half full four times a day, to a child one year old. One drop each of the Vinegar of Squills and Tinctiire of Digitalis can be given to a child three or lour times a day to keep the kidneys active. As a last resort, the physician would be barely justified in resorting to puncturing, to draw the water, and compressing the head by strapping. Preventive measures should be closely followed. The strength of the child having a tendency to hydrocephalus, should be increased as far as possible. Nourishing food with as much milk as can be digested, meats, and, if the child is reduced in strength, Cod Liver Oil should be given. Warm clothing, a daily bath, good sleep every night, in a well ventilated room, and exercise in the fresh air, are all helpful. Stimulants should be avoided. When the child has become of an age to commence its education (seven or eight years) only short and varied lessons should be given, and mental fatigue avoided. Congenital Hydrocephalus, or dropsy of the brain.— If the disease is congenital (from birth,) it may be questioned whether anything should be done to relieve the infant, except attending to its general health. There are medicines which, in many instances, diminish watery accumulations in internal cavities; the parents are very anxious for the recovery of the little one; some recoveries are reported. These facts, and the hopelessness of the disease, if left to nature alone, lead the physician to resort to medi- cina^treatmeut. roportion develop, re propor- leans, but vith great ive bodily veM devel- il they urn es9 about held back mitted to lusetlieiu of IJllK- 1 and V(!rv bjiov this boneflcia), death. gives very sters, and should be Cod Liver Cod Liver • an adult. Potasmun Iodide of Dissolve y^rup suffl- ear old. italis can active. orting to pping. th of the as far as :d, meats, )e given, entiliited hould be ducation e given, lisease is Ihould be There itions in of the tlessness lo medi- LOCK-JAW. 14} Medicines which act on the kidneys (diuretics) are generally supposed to be called for, and with reason. Tlio best of these u Iodide of Potassium, as an efllciont diuretic, and, possibly having a direct influence over the dis- ease. The dose for a child, six montiis or a year old, is one or two grains three to six hours apart, dissolved in half a teaspoonful of Syrup of Pep- pe?'mitt<, or sweetened water (lavored with Essence of Peppermint. Pressure of the head by a closely fitting cap, or very narrow strips of adhesive plaster, (one-third of an inch wide) and applied evenly over the skull, from side to side, and then from back of the neck to the orbit, may be of great use. Care in the use of pressure should be exercised, not to produce compression of the brain. If pressure is tolerated, and health good, tlie prospect is better. Generally the fluid accumulates so the straps must be loosened in two or three days. This process should be managed by a physician. Tapping is sometimes resorted to, and, also, sometimes after the re- moval of the fluid, a solution of Iodine, one-third of a grain, and Iodide of Potassium one grain, to an ounce of distilled water, is injected into the cavity of the arachnoid membrane. This requires a physician. I can see no indication for irritating applications. Attention to the general health is necessary. Constipation of the bowels should be relieved by an occasional purgative, as a half teaspoonful of Rochelle Salts; three to five grains of Calomel, or a teaspoonful of Castor Oil. (The disagreeable taste of Castor Oil is removed by mixing it with an equal quantity of pure Glycerine and flavoring with a couple of drops of Oil of Cinnamon or Wintergreen, The diet should be of the breast milk, with Cream or Cod Liver Oil, and raw meat minced fine. The treatment of acquired dropsy of the brain will be noticed in the diseases leading to tliis affection. Generally there is but little encourage- ment for treatment. Diuretics are called for. Iodide of Potassium and Acetate of Potash, are the best ; tlie dose of the former one or two grains, and the latter three to six grains, four to six times a day. Blistering should be produced beiiind the ears with the Blistering Col- lodion. Active congestion will call for cold to the head, cathartics and Bromide of Potassium h\ doses of five to ten grains, three or four hours apart, for a child a year old. Constipation should be relieved. TETANUS. TRISMUS. LOCK-JAW. A painful disease, the leading symptom of which is persistent spasm of the voluntary muscles. When the muscles of the lower jaw are affected it is called trismus, or lock-jaw. The disorder is chiefly occasioned, eitlier by exposure to cold or by some irritation of the nerves resulting from local injury, particularly of tendinous parts, (example in the hand or foot,) it is then called trumatio tetanus or trumatic trismus. The amputation of a limb, or the pulling on a nerve by some ligature used in tying some of the blood vessels, cut into either accidentally, or during some surgical operation. When it takes place in consequence of such a cause, or from any other external injury, the symptoms generally set in about the eighth day, sometimes later, 142 THE BRAIN AND NPJRVOUS SYSTKJI. lU but when thoy follow exposure to cold, tlioy usually sot in much earlier In some cases ti'.e attack comes on suddouly, uiul wilU extreme violence, but it more generally approaches gradually, a slij^lil HtilTupsa being first experienced in the back of tlio neck, with an uneasy sensation ut the rootof the tongue, and a dininilty in performing the act of swallowing, an oppressive tightness is complained of across the bicnst or in the chest, with a pain at the lower end of the breast lione, or in the pit of stomacht extending into the back, the breathing i.s hindered, the face pale, pulse small, bowels constipated and urine higii-colored; a stiffness takes place in the lower jaw, which soon increases (o such an extent, and presses the jaws so closely together thi.t the smallest oi)ening is unattainable, and now the patient has the lock-jaw. Tn some cases the spasmodic contractions proceed no further ; in others (hey return with great frequency and intense severity, and, also, extend to the arms, the abdominal nmscles, the back and lower extremities, so as to bend the body forcibly backward (Opisthotonos), even to such a degree that the back of the head touches the heels, or forward (Ejipuosthotonos) until His nose touches his toes, or sideways (Pleuuostiiotonos). Finally.tho arms, lower extremities, head and trunk become rigidly extended, caused by an equal contraction of all the muscles. Tlie tongue is, also, seized with spasm, and is, not unfrequently, injured by the teeth becoming clenched together just as it is convulsively darted out. As the afTection advances, the eyes become fixed and immovable, the whole countenance is IViglil- fully distorted and expressive of extreme anguisli, the pulse irregular, the strength completely exhausted, and a termination is put to *he sufler- ings, generally, about the fourth day, in acute cases, by one conce^sfrated spasm. In some cases, the fatal termination is protracted considerably beyond the stated period. The si)asmodic action does not continue unremittingly, the muscular contractions occasionally adiuittiiig of some abatement, but is generally renewed as soon as the patient makes an cfTort to speak, drink or move. PuOGXOSis. — This disease is so intractable, that under any known treatment, the most stolid |)ractitioner can but consider the attack as unfortunate in the extreme, and his prognosis mutit be unfavorable, although not always /«te?. ALLOPATHIC TREATMENT.— "Lock-jaw" Is so dangerous an afTec tion, that none would scarcely venture to assume the responsibility of the treatment, and, unless he be a physician, such a person would be fool- hardy. Most, if not all plans of treatment, prove unsuccessful in a large pro- portion of cases. The remedies, which appear to be most successful, are: Bromide of Potassium a.n<\. Hydrate of Chloral. Forty grains of Bromide of Potassium, dissolved in water with syrup or sugar, should be given every two or three hours, or a dram (sixty grains) every three or four hours apart, during the day, until half an ounce (two hundred and forty grains) has been given ; double this amount maybe necessary. At bed time, a full dose of Chloral Hydrate, forty grains, dissolved in water with syrup or sugar, should be given for the purpose of securing sleep. In the morning, thirty grains of Chloral may be given, if the temperature reaches one hundred and one degrees Farenheit. LOCK-JAW. 14S ^h oarlior B violence^ being first on lit the vallowinj?, tlie chest, ■ stomacht face pale, I stiffness such an Ht Opening e cases the turn witli arms, tlie bend tlie }e tliat the )SOs) until inally.tho ed, caused L'ized with ; clenched advances, is frigiit- irrcgular, l*he sufTer- CL'it rated iisiderably muscular generally )r move. y known attack a.s 'avorable, « an affeC' ityof the be fool' lirge pro- |sful, arc; BromirU 3e given or four |nd forty At bed Iter with In the Iperature Nitrite of Anifjl has been used with success In a very limited num- ber of cases. It appears to control the spjisms, and may be adndniatered by inhalation, three to six drops on a handkerchief. A fullness of the head dictates the removal of the handkerchief. It should be repeated sufficiently often to relievo the spasms. I would recommend giving Chloral Hydrate at bed time, as directed above, even if the Nitrite is depended on. Crtia6rti'jBertn.— Of late years this remedy has come largely into vogue in the treatment of tetanus. Out of fifty-nine cases treated with this drug thirty-two recovered. Dr. Fraser recommends beginning with one-third of a grain of the extract by subcutaneous injection, and increase the dose continuously until the reflex excitability is sensibly diminished, then continue the injections at that dose. In milder cases, the medicine may be continued by the mouth in doses three times as large as the largest given by hypodermic injection. It is possible that if a good qual- ity of extract could be used every time, the result would be better. . In all cases attention should be strictly paid to nourishing the patient and so support the powers of life. Four ounces (one-fourth of a pint) of good rich milk, with brandy, should be given every four hours, and a raw egg. beaten with milk and brandy, four times in the twenty-four hours. In cases of trumatic tetanus (caused by injury), all remaining sources of irritation, such as fragments of bone, bullets, pieces of cloth, or any- thing else, should be removed. Oftentimes the surgeon is justified in amputating the injured part, as, a means of cure of the lock-jaw. This procedure is the more hopeful, if the spasm is confined to the jaw. Tetamis of infants is best prevented by cleanliness, warmth, fresh air and dry apartments. On southern plantations, where the disease appears endemic, it is arrested by having the cabins whitewashed with lime, both inside and out ; raising the floors up from the ground, that air nu.y cir- culate freely under them; removing all filth from and about the he use < ; particular attention to cleanliness of the bedding and clothing of the mother and child, and preventing any matter from the navel coming and remaining in contact with the skin. A dressing of one part Turpentine and two parts Sweet Oil or Lard, is highly recommended. A warm liath should be given the child daily. After the disease has become developed, the foregoing hygenic meas- ures should be carried out rigidly. The medicinal agents, which, in my judgment, are preferable to all others, are the Bromide of Potassitim and Hydrate of Chloral, given after the same manner as directed for adults. The dose for an infant would be three grains given every two or three hours, which may be increased to five, or even ten grains, if the spasms are not relieved. When desirable to produce sleep, I would give two grains of Hydrate of CJiloral with the Bromide of Potassium, every hour, until sleep takes place. After a couple of doses of the ^2/cZraie o/6Wo?-aZ, if sleep has not taken place, the dose should be gradually increased until five or six grains are given, or until the desired eh'ect is reached, namely, sleep. Eight scruples of the bromide o/Potassww, dissolved in two ounces of simple syrup, contains ten grains tc •> teaspoonf ul. Of this mixture, o^e-fourtli 144 Tllli UUAIN AND NEaVOUS SYSTEM. of a toaspoonful will be a doso to begin with. Blx scruples of Hydrate of Chloral, dissolved in two ounces of syrup, gives eight grains to the tea- spoonful, and one-fourth of a teaspoonf ul the dose to begin with. If the spasms are so severe that the child cannot swallow, I would not hesitate to give at once, by injection into the bowel, a teaspoonf ul of the Bromide qf Potassium mixture and a half teaspoonful of I/i/drnte of Chloral mix- ture. The disease is very dangerous, too dangerous to be treated without a physician. A blister, the size of a dollar, over the navel, is said to be useful when the disease does not yield to rc.nedies by the mouth. The spine may also bo thoroughly rubbed with some stimulating appli- cations, as turpentine, or Iiartsliorn liniment. Brandy should be given in doses of ten drops to half a teaspoonful, with milk or beef essence, at short intervals, to prevent the rapid exhaus- tion of the patient. HOM(EOPATHIC TREATMENT.— ^coh«c is useful in lock-jaw, where there is frequent alternatitm of red and pale iace, with distorted eyes, thumb turned into the palm of the hand, and the hand clenched, pulse full and bounding. Aniica.— In cases arising from an injury, such as bruise or cut of the flesh, or the punctureof a needle, pin, hay-fork, or like sharp pointed instru- ment, it should be given internally, ten drops in a quarter glass of water, two teaspoonfuls every hour, or half houj-, if the case is urgent, at the same time it should bo applied externally to the wound ; take one part Tincture Arnica to five parts water, moisten a soft cloth, and keep it on the parts injured. Opium is a useful remedy in some of the severest forms of tetanus, as well as lock-jaw, either from an injury or cold. The muscles of the whole body tremble, there is foam at the mouth, and finally the whole body is bent backward, in the form of an arch, when Opium is useful. Nux-vomica, or Str}/chnia.— When there are extremely severe spasms, followed by a short period of relaxation, then another spasm at periods of three to six minutes. Belladonna.—ln attacks of trismus among children, when a jar of the bed will bring on a spasm. DELIRIUM TREMENS, This is a disease frequently occurring in persons who are in the habit of using intoxicating liquors, even when they do not drink enough, at any one time, to become intoxicated. It is a dangerous disease, which frequently destroys life, or causes a state of insanity. Symptoms: It usually commences with some degree of nausea, vom- ting, and loss of appetite, especially for breakfast, which is, ;^ooner or later, followed by constant wakefulness, incessant talking, walking about restlessly, arid, sometimes, raving from tlie first. There is a constant trembling and unsteadiness of the limbs ; the hand is unsteady ; the tongue is tremulous when protruded ; the walk is staggering, the skin is cold, and the pulse is weak and rapid. As the disease progresses the symptoms become worse ; the patient is not silent for a moment ; he is constantly talking, scolding or laughing ; I PF^Linn'M ti:rmi:.v3. M5 if Hydrate of 3 to tho teii- with. If the not hesitate the liromide Chloral mix- ated without 3 useful when ulating appli- R teiispoonful, rapid exliaus- •ck-jaw, wliere listorted eyes, lied, pulse full e or cut of tho )ointed instru- fluss of water, irgent, at the take one part keep it on the 3 of tetanus, nuscles of the ly the whole is useful, jeniely severe er spasm at Iwhen a jar of |e in the habit lOUgh, at any sease, which I nausea, vom- [s, i^ooner or l^alki ig about IS a constant ; the tongue is cold, and J ; the patient lor laughing ; changing fi-otn one thing to another, rapidly; arranging his clothes, room, bed, etc., with more or loss agitation and moulal sulTuriiig. lie imsigines the presence of things which ho knows are more illusions, or they may appear so real us, for a time, to make him actually believe that they truly exist; but, most generally, this deranged perception may be explained away, for tho moment, by some kind friend. Among these imaginary objects, are: rats, mice, serpents, licnds, witches, guns, dragons, bugs, insects, etc., to free himself fiom which, ho will have tho most fearful slriiggles, with expressions of disgust, distress, and even fear anil horror. IL is iini)03slblo to name tiie various fancies wliich lie creates ; at one time laughing, at another bogging, witli tears in his eyes, for life; then humbly asking pardon for some imaginary wrong. Again, pointing, with raving expressions, to thool)jects conjured up in his disordered mind; and, Unally, raving almost like a maniac. Ilis eyes are bloodshot and in constant motion, with a peculiar glare, glancing fearfully and suspiciouisly at every ol)ject around him; the coun- tenance is usually pale, haggard and distressed, tho tongue coated with a thick, yellowish mucus, tho head hot, and the bowels costive, with occa- sionally nausea and vomiting. If thepatient is not relieved, he becomes worn out, and is compelled to lie down from sheer weakness, and may die suddenly, in an apoplectic or epileptic fit, or, ho may gnidually sink, the surface becoming cold, with clammy sweats, low, muttering delirium stupor, picking at the bedclothes, twitching of tho tendons, and death. Sometimes the first symptom is an epileptic fit, or apoplexy, on recovery from which, well marked delirium tremens occur. - ' The development of the disease most frequently follows a sudden abstinence from the nse of liquors, among tliose who have become addicted to their exces, live use, by wliioh means tlie brain becomes excessively weakened and impaired. It likewise frequently happens, while the person is in the full tide of his "spree," and also, occasionally, after a continued but moderate use of alcoholic drinks. It usually comes on, in from one to five days, after the discontinuance of the inordinate alcoholic excitement. In the treatment of a patient with delirium tremens, opposition and the use of force should be avoided as much as possible, because they give rise to irritation, and increase the difficulty. Gentle and persuasive measures are the best, with a degree of firmness ; and at no time must you yield to the fancies of the patient, but rather reason or laugh him out of them. This course will accomplish much more than an opposite one. T!'3ikQ ot fhQ Sulphate of Quinine eight grains, Sidphate of Morphia one grain, mix and divide into four powders; one of these powders should be given every hour, for ^wo or three doses; afterward, lengthening the time, so that too much Morphine be not given. Give the patient, shortly after the first powder, a tablespooiif ul of good brandy, in water and sugar, as a reward for a promise from him that be will lie still and try to go to sleep; repeat, if need be, until he does sleep ; then let him rest three hours ; after he awakes, give light food. ALLOPATHIC TREATMENT.— The success of treatment in this disease, attendedwith prostration, depends on nourishment.relieving the restlessness and inducing sleep. Milk, raw eggs, beef essence, or strong beef tea, should 10 li' 140 THE BRAIN AND NERVOUS SYSTEM. be freely given. Both these ends are aided by the administration of Quin- ine, in two or three grain doses every three or four hours. The nervous- ness and restlessness, preceding the active delirium, is best relieved by the Bromide of Potassium, during tlie course of the disease ; it is, also, equally useful to relieve the same symptom ; but, to be effectual, it must be given in doses of forty tc sixty grains, every four hours, dissolved in water or syrup. For the production of sleep, there is no remedy so uniformly suc- cessful as Hydrate of Chloral, given with the Bro7nide of Potassium, in doses of twenty to thirty grains. In old drunkards, it should be used with great caution. After a second dose of thirty grains of Chloral, if sleep is not induced. Morphine, in doses of one-third of a grain, may be given, and repeated, if necessary, in two or three hours. It is best given by hypoder- mic injection. However necessary sleep and quiet is, it is still more necessary to establish digestion, and support the powers of life, by suitable nutrition. In most cases, this, of itself, will quiet the delirium, induce sleep and carry the patient to recovery. Difjitalis is found useful in this disease, in doses of a teaspoonful of the tincture, or a tablespoonful of the infusion, made to two drams of the leaves to a pint of hot water. After four hours, the dose may be repeated. Pouring cold water on the head, and the free use of hop tea, are frequently of advantage in quieting the delirium. The patient should be treated kindly, and left in charge of an attend- ant in whom he has confidence. Visitors should be excluded from his room. Treatment op Alcoholism.— The chief point in the treatment of the mania for drink is to enforce at once total abstinence; this is more easy than to practice moderation. The sleeplessness may be guarded against by forty to sixty grain doses of Bromide of Potassium at bed time. If necessary, with this can be com- bined fifteen to twenty grains of ^?/r7ra^e o/CWora^, or two teaspoonfuls to a tablespoonful of Tincttire of Hyoscyamus, gradually diminishing the dose as the symptoms disappear. Tonics should also be given. Of these the Citrate of Iron and Quinine, in doses of five grains, dissolved in water or syrup, two drams and a half to eight ounces. Dose: A dessertspoonful three times a day. The Phosphate of Zinc, with extract of Nux Vomica in pill form, a quarter of a grain of the former, and a quarter to half of a grain of the latter, and one grain of Quinine, three or f(Hir time.« a day, will aid greatly in restoring the nervous system to a healthy state. The diet should l)e strong and nourishing, consisting largely ol' milk and eggs, beans, oatmeal, wheat and vegetables, with an absence of lean meat. This rule of diet should be observed after health is established. There is no more deplorable practice, both among physicians or in domestic practice, than the frequent giving or taking of alcoholic stimu- lants. It is not to be doubted that a habit of using liquors as a beverage not infrequently begins by " taking a little brandy and water occasionally," or " a glass or two of wine," for low spirits or a temporary indisposition. The practice is both harmful and useless. HOMOJOPATIilC TREklWrni.- Arsenicum. Pale, yellow com- plexion; bloated face, and cold, blue skin; fainting fits, particularly during vomiting. The patient imagines that vermin are crawling about the bed. tion of Quin- 'he nervous- lieved by the also, equally lust be given I in water or niformly buc- Fotassium, in be used with al, if sleep if; )e given, and n by hypoder- is still more fe, by suitable iirium, induce ;easpoonful of drams of the ly be repeated. are frequently of an attend- luded from his ) treatment of ^3 is more easy ty grain doses is can be coni' teaspoonfuls Iminishing the len. Of these )lved in water |n pill form, a J grain of the lill aid greatly let sliould be ^ans, oatmeal, rule of diet [sicians or in lobolic stimu- a beverage Lccasionally," Indisposition. i^ellow com- larly during bout the bed, EPILEPSY. W and ugly animals are staring him in the face. Great restlessness and fear of death. Extreme thirst; drinks little and often. Dose: Six pills to a tablespoonful of water, one teaspoonful every thirty minutes. Belladonna. Persons of a full, plethoric habit r ^ody. Flushed face and red eyes, with dilated pupils. Boisterous delirium, with desire to escape. He tears the clothes, strikes, bit»s and shrieks, in his rage. Sud- den starting and jumping, while sleeping. Dose: As for Arsenicum. Cumphot: Features distorted; eyes sunken ; face, hands, and feet, icy cold. Confusion of ideas; maniacal delirium; convulsions, frothing at the mouth, and insensibility. Retention of urine, with constant desire to puss water. Dose : A drop or two, on a little lump of sugar, every hour. Hf/oiicyauufs. Twitching and jerking of the muscles, especially of those about the face and eyes. Furiom deUrium, with wild, staring look ; dilated pupils, and throbbing of the carotid arteries. Grasping at imagin- ary objects; muttering. Dose: As directed for Arsenicum. Nux Vomica. Trembling of tiie limbs, and spasmodic twitching .of different parts of the bixly. Incapable of thinking correctly. Makes fre- quent mistakes in talking. Delirium, with frightful visions, and ei'Corts to escape. Very irritable, and wants to be alone. Constipation with lar<jc and difficult stools. Apprehensive of death. Dose : Double that recommended for Arsenicum. Tlio best remedies for the inclination to drink, and the evil effects of drunkenness, are Ars., Niix.-v., Sulph. EPILEPSY. MORBUS DIVINAS, MORBUS IlERCULEUS. This is a disease marked by sudden and temporary seizures of un- consciousness, accompanied by convulsions, and is one of the most terriblo diseases that afflict mankind. There are so many varieties of epilepsy that it is impossible to give a delinition of the disease that will apply to them all. In most cases it is characterized by convulsions and loss of con- sciousness, occurring at longer, or shorter intervals, during which th(> patient is almost in good health. The absence of fever in epileptics serves to distinguish their affection i'v-"- meningitis, and other inflammations accompanied by convulsiontJ The v;omplete loss of conciousness, also, dis- tinguishes ei)ilepsy from hysteria, as in jnost nervous diseases, a heredi- tary tendency is among the most frequent i)redisposing causes of epilepsy. Epilepsy often appears in the offspring of persons who have had various nervous complaints, such as epilepsy, insanity, paralysis, apoplexy, and hysteria. There is no doubt that women aie much more frequently attacked with this disease than men. The most frequent periods at which epilepsy begins are: early infancy, and puberty, although no period of life is exempt from its first attacks. Various mallbrmations of the body, and especially of the cranium, are certainly among the most frequent predis- posing causes. Weak constitutions are favorable to the production of 148 THE BRAIN AND NERVOUS SYSTEM. epilepsy. Among other predisposing causes, are dentition, the first appearance, and the cessation of menstruation, onanism, and the abuse of alcoholic drinks. Almost all kimls of diseases may produce epilepsy, but among the principal we must phue those aflections in which the blood becomes altered, or diminished, and organic affection of thecerebro-spinal axis, and of certain other parts of the nerve centers. Another powerful cause is excessive loss of bloocf. Pregnancy, parturition (confinement), menstruation, frequently cause epilepsy. A tumor, or a nerve, or any cause of irritation on the trimU, or the terminal part of any sensitive nerve, and especially, in the skin, or mucous membrane very often pro- duces it. A wound, a burn, worms ill the bowels, or elsewhere, stone in the bladder, or in other places, foreii^'n matter in the ear, etc., are known to have caused epilepsy. It is quite certain that great mental excitement has originated jt in many cases, but it seems probable that the disease was not introduced by those causes, but was only brought oa by them to man- ifest itself. When a fit is about to take place, it is usually preceded by some sensa- tion, or some change in the mind of the patient. If a sensation precedes the fit, it comes most frequently from some part of the skin, and especially from that of the fingers and toes. This sensation is well known under the nanieofow/a epilcptica. There is as much variation in the variety, and intensity of the sensation, as in its point of starting. Most frequently the auni is a sensation of cold, or burning, or tliat kind of sensation producec by a draft of cold air on limited parts of tlie body. Sometimes the aura starts from the eye or the ear, and then a flash of liglit, or some othersen- sation comes froui some part of the eye, or peculiar sounds are heard. The stomach and bowels are also often the starting point of the aura. t.ome epileptics become gay, others mournful when they are about to have a fit; in others, the attack is announced by some change in the digestive func- tion. A complete attack usually begins with an extreme paleness of the face, and at the same time, or nearly so, there are contractions of several muscles of the face, the eye, and the neck. Observers do not agree as regards the first manifestation of a fit, probably, becatiso tho seizure does not always begin with the same phenomena. >loton".y h-ivc .vo known the first symptom, not to be the same in different epilept'?^. but in the same one we have seen differences, in three different attacks. Many phy- sicians think the scream, the first symptom. Itoften is, but the pale- ncHH of the face usually precedes it. Some epileptics do not scream; as soon as these symptoms have appeared a rigid spasm lakes place in the limbs, and the patient falls. Respiration is suspended, and the face becomes quite injected witli black blood, and a.ssumes a hideous aspect, both from the spasm of its muscles and its blackish or bluish hue. Some- times a momentary relaxation is then observed in the limbs, but all at once clonic (jerking), convulsions occur everywhere in the trunk, the limbs, the face, and often in the various internal organs, as the bladder, the bowels and the uterus. The mouth then ejects a frothy saliva, often reddened with blood from the bitten tongue. The respiratory muscles, after the first spasm.s which produce the .scream, and suffocation, causing a gurgling or hissing sound, become relaxed,and then those employed in inspiration contract. EPILEPSY. 149 he first abuse of psy, but le blood •o-spinal )Owerful lement), or any jensitive ten pro- jtone in 3 known 3itenient ease was I to man- nesensa- precedes specially inder the ety, and ently the producer I the aura thersen- rd. The onie !ive a fit; ve tunc- of the several !^ree aa re does known in the ny phy- he pale- am ; as in the he face a-speet, Sonie- t all at nk, the ladder, |h blood spasms 1 hissing jntract, and almost as soon as air has reached the lungs, the convulsions cease or notably diminish. Ordinarily the fit is over in a few minuttvs, hut it is not un frequently the ease, that after a general relaxation, another seizure comes on, and sometimes many occur with very short intermissions. During the whole time the fit lasts, the patient is deprived of conscious- ness, and when he recovers he remembers nothing that lias taken place in the meantime. In some cases, the seizAire is followed by prolonged coma, (insensibility) ending sometimes in death. When a patient recovers from a fit, even if it has not been very se- vere, he usually feels fatigue and suffers trom headache. Fortunately he soon falls asleep, and ordinarily is almost as well as usual, when he wakes up, except that the headache and fatigue still continue, though much diminished. When many fits have taken place, even at some- what long intervals, such as several weeks mental derangement often supervenes, and in this way epilepsy often leads to insanity. In some cases the fits recur at regular periods, in others they return with every return of the circumstances which seem to have caused the first, such as menstruation, pregnancy, the influence of certain seasons, etc. There is sometimes, although seldom, perfect regularity in the length of the inter- vals between the fits, and tliey come every day, every week, every month, etc., at irregular hours. Many patients have very difierent intervals between their successive tits. Some have many fits a day, others every six months or every year. The greater the number of fits, the less violent they generally are. In the complete fit of epilepsy, there are two distinct features. 1. " The loss of consciousness. 2. The muscular convulsions. Each of these may exist alone. In the case of a seizure, consisting only in tile loss of consciousness, without convulsions, we have the so-called epih'ptic vertigo, which is a form of epilepsy which frequently exists alone, and also co-exists often with the form of the disease in which the attack is complete. In this last case, the patient sometimes has a complete seiz- ure, sometimes only an attack of vertigo. Whether vertigo exist aloneor co-exists with complete attacks, it isivery dangerous, not for the lifeol the patient, but because fits of simple vertigo lead more frequently to insan- ity than complete fits of epilepsy. The cases of epileptiform convulsions, withoutlossof consciousness, are not so frequent as the eases of simple vertigo. They are particularly produced by injuries to the nerves or spinal cord . The first thing to be done for an epileptic fit, is to find out, if possible, the cause which produced the attack, and, if it still exists, try to get rid of it. Very often epilepsy depends on some external cause of irritation, which may easily be removed. It is of the greatest importance to discover if there is anywhere such an irritation, and as the patient may not be aware of its existence, it is necessary to look for it everywhere. This is a proper place to point out the fact, not generally known among the masses of the people, that onanism or self-abuse, among eliildren and young people of both sexes, is one of the most prolific causes of this truly terrible disease, and if the patient can be induced by any means to breakaway from the practice in any reasonable time, the epilepsy is virtually cured. Parents should not rest easy under the impression that their children would not be guilty of such a thing, but know to a certainty that such is not the case. My 150 THE BllAlN AND NERVOUS SYSTEM. litil I' l\m i young frienil, troubled with epilepsy, you know whether this is one of your habits, contracted by the induence of companions in school or elsewhere, and if such is the case, you may rest assured, that if you continue in the habit, absolute and certain ruin of your body and mind are the inevitable consequences. Patients and their families should remember tiuit the rules of hygiene must be followed much more closely by epileptics than by those afflicted by almost any other disease. ALLOPATHIC TREiTJUENT. The treatment of Epilepsy will have reference to tlie management of the paroxysms (fits,) and, also, to measures for effecting a cure, which are to be employed during the intervals between tiie fits. During the fit, the patient siiould be laid on a large bed, or even the floor, where the fresh air can freely circulate around him. No effort should be made to restrain the convulsive movements. The necktie and all tight clothing should be loosened. A cork, roll of linen, or piece of soft wool should be held between the teeth to prevent the patient biting the tongue. Cooling washes may be applied to the head. In those cases which have a brief warning of an approaching fit (which J3 called iheaura epileptka) the paroxysm may be warded off by inhaling Nitrite of Amyl at the beginning of the warning. Tlie patient should carry a small vial of Nitrate of Ainyl and inhale irom three to five drops upon a liandkerchief, when this warning or aura is experienced. Tne handker- chief should be removed when fullness of the head is experienced. Also those cases characterized by frequent repetition of the fits the same remedy is very useful in stopping their recurrence. It is also recommended as a means of mitigating severe attacks, but in advanced stages of the parox- ysms, it should be used very cautiously. Of all the remedies which enjoy a reputation for preventing or mitigating a fit, this occupies the first rank. Among other remedies which are recommended for the purpose of preventing a fit. Chloric Ether, Hoffman's Anodyne and Fluid Extract of Valerian, are to be mentioned ; the dose of Ether is a teaspoonful. These same remedies arc, also, used to present tlie frequent recurrence of parox- ysms before alluded to ; Tincture of Belladonna or Opium are said to be useful for this end, given in doses of from fifteen to- thirty drops. The physician is often led to try the inhalation of Ciiloroform. Jiut all these remedies are, in my opinion, inferior to Nitrite of Amyl. If other mea- sures fail, or are not at hand, compression of the carotid arteries may be tried, first upon one side of the neck, for ten or fifteen minutes, and then ipon the other side. If the convulsions are very severe, both arteries may be compressed at once. The compression is produced by pressing the artery with the finger or thumb, firmly against the spinal column. The treatment of epilepsy, as far as a permanent cure is concerned, has not been very successful. Endeavor must be made to improve the patient')^ general health, and to this end all the vital functions must be carefully inquired into, with all the penetration of the most skillful physician. All advanced physicians are agreed that every thing which depresses the vital powers does harm. The habits of life must be regular and moderate; daily exercise, early hours, and plenty of sleep, quiet occupation ; atten- tion must be given to regularity of the bowels, and urinary secretion. Mental excitement should be avoided, and if the patient is a child, be EtlLEfSY. 161 1, has jent's fully jcian. Is the Irate; It ten- It ion. l.be kept from school. The diet should be simple, but generous and nutritious, including animal food, milk and eggs. Frequent bathing, two or thre« times a week, should be practiced. The liabits of life which are pernicious, and may stand in a causative relation to epilepsy, and are to be prohibited, are: over-tasking of mind or body, either undue exjiosure or sedentary liabits, the free use of alcoholic liquors, or tobacco, and sexual excesses, or self-pollution. There is no better established fact in the healing art, than the benefit of the Bromides (usually the Bromide of Potassium) in the treatment of epilepsy. It is not to be understood that the remedy is infallible, but it is true that it has been m-^re useful than all other remedies combined. It I3 well determined that Bromide of Potassium is most valuable in those cases of epilepsy Which are characterized by violent and frequent convul- sions. It is also noticed, that the beneficial effect of the remedy is more marked in attacks occurring in the day time than those occurring at night. The nice discrimination, in the use of remedies in epilepsy, requires the skill of an accomplished physician. But, roughly, it maybe said, that Bromide of Potassium should be given in all eases which have a con- gested, (flushed,) or full appearance of the face, rush of blood to the head, <,or more accurately, to the brain, this is most accurately determined by the physician, by examination with the ophthalmoscope). The dose of Bromide of Potassium at the beginning, should be about fifteen or twenty grains, three times a day, increasing the dose by ten grains each week, until from forty to sixty grains are taken at a dose, three or four times a day. The medicine should be continued in these doses until the peculiar effects of the drug (called Bromism,) are produced, or the fits have ceased. Bromisni is shown by mental weakness, heaviness of the intellect, failure of memory, partial loss of voice, drowsiness, depression of spirits, pallor, and an eruption of the skin, and sometimes by abscesses. The remedy, if it prevents the fits, should be continued for several weeks, or even months, at the dose which has proved efFectual, and gradually decreasing the dose until twenty or thirty grains are reached three times a day. The drug should not be discontinued, until fifteen ,or eighteen months have passed without a paroxysm. It is better for the patient to take the bro- mides all his life, than to have fits. The addition of the Bromide of Iron from one-half a grain to a grain, to a dose of the bromides, will do much to prevent the impoverishment of the blood due to bromism. The follow- ing is a good formula: Take of Bromide of Potassium, six drams: Bromide of Ammonirun, two drams: Bromide of Iron, six yraiiis: water, six ounces. Mix and give a table' spoonful three times a day. It is a good rule, even after the case has been free from fits for fifteen or eighteen months, to give a dose of from two scruples (forty grains) to a dram (sixty grains) every night for a couple of years. Many of those cases of epilepsy which are not benefited by the bro- mides, are greatly benefited by Strychnine, especially in subjects which have the lighter seizures {petit mat) as well us the severe paroxysms {grand mal), and, also, in those cases having the attack at night, though in the latter cases, if severe, the bromide will be required, also. The dose of Strychnine is one-thirtieth of a grain. It had better be given in solu- 152 THE BUAIN AND NKRVOUS SYSTEM. im. tion, though it is disagreoablc to take, on account of its bitterness. The fol- lowing is asuitable formula: Take of Strychnme one grain, dissoloe in tim ounvci of Dilute PhoKphorin Acid, and two ounces of water. The Strychnine dissolves slowly, and i)lenty of time should l)e given for solution to be effected before taking it. If tlie appetite is i)oor, thirty grains of Quinine should be added to this mixture. The dose is a teasijoonful tliree times a day. Should it be found impossible to take this mixture, the pills ot Strychnine, of one-tliirtieth of a grain each, may be given instead. I pre- . fer the pills of Phosphorus, one-hundredth of a grain, with Strychnine, one-sixtieth of a grain. Dose: Two pills three times a day, for a grown person. The Phos- phorus is valuable in improving the nerve nutrition. The direct Galvanic (electric) current is, sometimes, of great service, and may be used in connection with either Strychnine or tlie Bromides, or both. It can only be of service in essential or idiopathic epilepsy (i. e., cases not dependent on structural changes, or other obvious cause). Tlio current should include tlie whole brain, having tlie poles of tlie battery behind each ear; or on the forehead and nape of the neck; or one pole on the nape of the neck, and with the other follow the course of tiie sympathetic,and, also, the nerves along which the aura, or warning, is transmitted. Each method of application may be used for one-third of the time at each sitting. If beneficial, the use of the Galvanic current should be continued for several montlis or a year. In some cases, it is necessary to pass a seton quite deeply through the back of^the neck, in addition to the internal remedies. This is par- ticularly serviceable in connection with the Bromide. Both it and tlie Bromide seem to relieve the so-called reflex irritation. Cases of epilepsy caused by injuries to the skull, whicli is not relieved by the Bromide of Potassium, may call for surgical operation. If the patient has liud syphilis or has syphilitic parentage, the Iodide of Potassium should i)e given either alone or in conjunction with other treatment, until ail syphilitic symptoms disappear, when, if tlie fits cease, the further treat- ment will be that appropriate to that diseased condition, syphilis. For this complaint, medical advice should be sought. Belladonna and Hyoscyamus, are recommended by high authority. They are applicable to these cases, in wliich Strychnine is most useful, viz.: in epilepsy occurring at night, in the lighter fits (petit mat), and in pale, delicate subjects, with cold hands and feet, a blue skin and feeble cir- culation. Belladonna, if used, should be given as follows: One fifth of a gi-ain of the Solid Extract of Belladonna, or a hundred and twentieth (1-120) grain of Atrophine, its active prhudple, each night for a month, when the dose should lie doubled for the second month, trippled fortho third month, and so on until as large a dose as can be borne should be reached. Trouseau speaks very liighly of this remedy, and recommends its continuance for from one to four years. Hyoscyamus may be used In the same way, beginning with one-half grain of the Solid Extract. These remedies can be had in pill ; for the first niontli, the dose is one pill; for the second, two pills; for the third, three pills, and so on, until the largest possible dose is reached. The existence of ana3inia (impoverished condition of the blood) EPILEPSY. 153 less. The fi>l- Ussolve in tim le Strychnine olution to be ns of Quinine tliree times a ?, the pills of istead. I pre- I Strychnine, I. The PhoS' great service, the Bromides, epilepsy («. e., s cause). The of the battery ;k; or one pole course of the ar warning, is )r one-third of Ivanic current leeply through 3. This is par- oth it and the uses of epilepsy the Bromide tient has had um should be ent, until all further treat- isyphilis. For tgh authority. lis most useful, m trial), and in land feeble cir- Onejifthofa \and tiventieth for a month, rippled for the :ne should be recommends may be used tolid Extract, le dose is one [d so on, until )f the blood) demands the use of tonics of Iron and Quinine. The Cltrato of Iron and Quinine, two to five grains in syrup, before each meal. The Pyroplios- phate of Iron will be found useful in one or two-grain doses, instead of the Citrate of Iron and Quinine, if the appetite is not deficient. Cod Liver Oil is always useful in improving nutrition of tlie body. It should he given in doses of a teaspoonful, gradually increased to a tablespoonf ul. HOMCEOPATHIC THEXTJlEyiT.— Belladonna has, amoiig its patho- gnetic symptoms, the whole series of the phenomena which characterize an epileptic fit. It is most useful wln're the disease has not continued long, and has the fits rather close together, and especially if an attack of vertigo is apt to supervene; rush of blood to the liead, red and bloated face, rene'val of the attacks by contact, distention of the eyes with dilation of the pupils, full, hard, and hurried pulse, sudden starting from sleep with a cry and fear, obstinate, malicious temper, desire to tear everything, to bite, spectra which cause anxiety, fear; deep sleep with smiles and distortion of the features. Done: Six pills every morning and evening, for a week, then ex,ery morning, for two weeks; then every tliird morning, for six weeks; then every week, as long as its beneficial effects are apparent. Fre- quently a dose of Sulphur occasionally helps materially. Cw/>r/e/n is one of the few remedies which we know positively lias cured many cases. In cases where epilepsy is a primary or original dis- ease, and not merely a symptom of some oilier disease, Cuprum is one of the first remedies to be thought of and used. It may not be any the less suitable in complicated cases. In this latter class of cases, the accessory symptoms will be found the best guide in the selection of the remedy; probably, in cases where the disease bre-iks out in the night, this medicine will be found the most beneficial, tlie aitra commencing in tiie extremities and moving upward, until the speech is gone. In the treatment of epi- lepsy, use the higher potencies in less frecpientiy repeated doses. "We intend this last remark to apply to all the remedies in tlie Homoeopathic treatment. And we may further say, that a careful arrangement of the symptoms, and careful selection of the remedy, by the use of the Reper- tory, will be decidedly the most satisfactory mode of selecting the remedy. Dose : As for JRelL Plumbum is very nearly related to Copper. Plumbum is particularly adapted to epileptic attacks with a well defined aura, or to attacks where paralytic conditions are present ; entire or ])artial loss of consciousness remain for some time after tlie attack. Plumbum acts very slowly, but, on the other hand, its action lasts long; it is very penetrating, so it, for this, if no other reason, is suited to cases of long duration. Dose: A small powder, or eight pills, at times as directed for Bell. Conium, in epilepsy, arising from self-abuse. Opium, in epilepsy, arising from a fright, or where it supervenes during insanity. Rana Bufo is undoubtedly a capital agent in the treatment of epilepsy, especially if the patient is the victim of onanism, and will dis- continue the practice. Bromide of Potassium.— Three grain doses, three times dally, and gradually increased, until the dose is ten grains for an adult ; dissolve in a little water. i64 THK MUSCM.KS OF THE FACE, AND BONES OP THE VERTKBRiB. I i'ig. 1. A. Tlie Occipito frontalis, a broad muscle extemlinij over the head from the eyebrows to the lower back part of the head; by means of the frontal portion (B, H,) oi which the eyebrows and skin over the root of tiie nose are raised and the skin of the forehead thrown into wrinkles. C. At- toleus Aurera — This muscle in man is rndinu'iitary on ac- count of the ears being almost immovable ; but in some of the lower animals is (juite large and gives motion to the ears. U & E. Obicularis Palpebarum surrounds the eye and fris'es motion to the orbit and eyelids. F like C is a ru- dimentary muscle, Attrahcus Atirem. II is the little fellow that helps show disdain by raising the co; u-sof the nose. T. Obicularis Oris is the muscle surroun.mg the mouth, P. The Masseter muscle is one of the great powers of the lower jaw. IT, V, W, X, Y, are muscles of the head and ueck, and their actiou is in moving the head and jaws. Fig. 2. The spine is composed of thirty-three bones called ver- tehrcF,, and is divided into four sections, namely : 7 cervical, 12 dorsal, 5 lumbar, 5 sacral and 4 coccygeal. These bones are united by strong ligaments and through a central open- ing in each bone i)asses the spinal cord. In Fig. 8 tlie two upper cervical vertebrte are shown enlarged, on the upper one of these two, the atlas, rests the skull at (', C; throngii an 0})eniiig in which projects A — the odontoid (tooth-like) point of the lower of the two bones called the axis, from the fact that on it rotates the head. In Fig. 4 the same bones are shown separated. THK BIIAIN AM) MOHVOUS SYSTEM. lU \ija. >0 ECLAMPSIA. KCLAMPSIA INFANTUM. FITS OV LITTLE CIIILDRKN. Eclampsia occurs most freqiuMitly at an age when opilei)sy is least fre- qBent;tiiaL is, diiriiig the (irst inontiis of infancy, until the fourth year. Symptoms and Couusk of tiik Diseask.— Eclampsia sets in without any premonitory symptoms, only when it is the first symptom of the bef(inning of someotiier acute disease. As an independent disease, it is almost always preceded by preliminary symptoms. These are: ill humor, a whining mood, obstinacy, indisposition to play, sudden starting when touclied ever so liglitly, witliout expecting it, sleejjlessness or restless sleep, during which tiie lids are not entirely closed ; a peculiar twist of the moutii, gritting the teeth, change of color from the least cause, crying out without any apparent cause, sudden relinquishing of tiio nipple, uneasy, unecpial breathing, sometimes a peculiar livid color around the iiouth and eyes, and pointed appearance of the nose and cliin. After ther^e premoni- tory symptoms have lasted for a longer or shorter time, the actual paroxysm break« out with the same suddenness as an ei)ileptic attack, only witli this difference: tiie patient utters no cry. Otlierwise the attack has all the characteristic features of an epileptic fit. At the beginning the convul- sions are for some time tonic, (stiff and still,) after which they become clonic, (jerking,) and in less frecinent cases they aflVct only one side. The features become distorted, the eyes stare, generally squinting upwards, the body is tossed to and fro, but the extremities are not as stiff or rigid as they are during an epileptic fit. The breathing is hindered, the abdomen distended. The face is either l)lue-red and bloated, with considerable full- ness of the blood vessels, jr else it is pale and sunken, the bodily temper«,- ture is rather decreased than raised. During the iuught of tlie convulsion the consciousness and sensibility are completely extinct. Usually the paroxysm ends with a deep, moaning inspiration, after having lasted a few minutes, or even a number of hours, and tlie patients sink into a deep sleep, from which they awake in apparent health. The paroxysm does not always have such a fearful degree of intensity. Eclampsia, as well as epilepsy, has a series of gradations, the attack being sometimes marked only by partial convulsions, movements of the muscles, a staring look, with some squinting and drawing up of the mouth. The consciousness remains either entirely undisturbed, or is only partially interfered with, sometimes the attack consists in a comatose soper, (death like sleep,) which lasts for hours, with the characteristic half closing of the eyelids, and a few convulsive twitchings, taking the place of the convul- sions, even the face may retain its natural expression and color. A single fit is scarcely ever the end of the trouble. In the first place, tliere generally remains a disposition to relapse, and, in the second place, several fits usually follow, one after the other, the intervals between the fits being of uncertain duration, and the intensity varying in degree, sometimes increas- ing, at others decreasing in violence. Eclampsia may terminate in recovery, partial recovery, or death. Eecovery may take place after any fit, sometimes quite unexpectedly, so that a child may be playing about one morning, which the day before was the victim of terrible fits. In partial recovery, some of the symptoms either remain permanently, or disappear only gradually. In such cases it is a question whether such remaining symptoms are not the result of Wi FITS OF LITTLE CIIILDUEN. disease of me brain, wliich may, also, liavo been the cau.s(; of tht; fits Among sucli reniaininjtfsyiiiploiiis, wc mention paralysis of the eyeti, los.s frequently the mascles of the l)ack, idiocy, or only a certain degree of backwardness in the development of the mental faculties, and an unusuul degree of nervous irritability. Death results, either during the attack, or else the death like sleep (coma,) terminates in death. The prognosis depends on many accessory circumstance ,and is always doubtful. Age is an imiwrtant consideration; the younger tlie child, tlio more likelythey are to die, esi)ccially infants at the breast, hut even they frequently recover, if the treatment is in careful hands. Wiiere the ilis(!a->!i is inherited, tliere is little probability of recovery. Tlio more rapidly tlio fits follow each otlier, the more danger there is, especially if they contin- ually increase in violence. Convulsions, setting in at the coMimeiicpinciit of some acute disease, are scarcely ever dangerous. If tliey set in (hirin^; the course of the disease, they are more dangerous; tiiey gen(!nUIy mean death. M !i H0M(E0PATH1C TREXTyiEl^T.-Belladoniui is, witliorj douliMhc main remedy in eclampsia. It is particularly indicated in the casi; df robust, fleshy children, who show unmistakable signs of congestion of Ihc brain, with very red face, the pupils expanded, the eyes stare, or constantly vibrate, the lower jaw firmly pressed agiiiiist the upper, tlie head drawn backward, possibly the urine may be discliarged involuntarily. JlyoHcyanms acts very similarly to Bell. The sigiit of the eyes con- tracted, face dark red and bloated, the walls of the abdomen drawn firmly in, and the attack being caused by a fright, are indications for the use of Hyosc. ' Cujyrum. See indications under Epilepsy. Iffnatia. If the attack is sudden and violent, the fit being more free from jerking than common, if the spinal cord appears to bo the seat of tlie disease, that is an additional indication for Ignatia. ChnmomUla is seldom useful for the fit, but may be needed to remove trouble with the bowels, before or between the fits. The child moans imd worries, and wants to be carried. Cina, or Santonine, if the attack arises from worms. (See worins.) Vr.: i CA TA LEPS Y.— TRANCE. We mention this disease, only because you expect us to, and can only say that it is one in which the consciousness and the voluntary motion oi the muscles is suspended ; though they retain the faculty of passive motion, There are very few well established cases on record. It is very generally conceded, among physicians, that no treatment yet known amounts to anything. It may be necessary, in order to inuin- tain life, to inject food into the rectum, or, by means of the stomach puni]), into the stomach. JO of tilt! fits tlio eyes, Icsn liii degree of ul an unusuiil the iittiick, or iuul in cvlways the eliild, the but even tlicy LTc thoilisea;i(^ re rapidly tin; (' tliey coiitiii- jiiiineiu'prnciit y sot in diirin;' eniinijly mean lorj doubt, tlio n the case (if n^cstion of the e,ore()iistaiit!y lie head drawn iiy. if the eyes con- in drawn (innly 3 for the use of being more free ) the seat of the eeded to remove :;hild moans and s. (See worms.) THE BRAIN AND NEUVOUS SYSTEM. 151 ;o, and can only ntary motion of f passive motion. \t no treatmeut I order to main- e stomach punii), HYSTERIA, OR HYSTERICS.* It is not only difTiciilt, but almost impossible, to furnish a satisfactory and sutliciently comprehensive delinition of hysterics. It is a nervous spasmodic affection common to females, but known by some other name, when it appears (as it rarely does) among males, usually as hypochondria. It attacks pregnant as well as non-pregnant females, and however alarming any single attack may appear, it is, in fact, seldom attended with any danger, unless it should pass into epilepsy. Symptoms: Usually the lady, from a calm or excited condition, but in which no symptoms of disease are shown, by an unwise word, and often from no apparent reason, commences crying and laughing at intervals, perhaps, also, venting reproaches; peal upon peal of immoderate crying afid laughter, sobs, 11u(k13 of tears, stolid silence, wringing of hands, tearing of hair, stiff (tonic) convulsions, clonic (jerking) si)asms, and smiles, are all irregularly combined and followed by a profound caim of the constitution, and a feeling of coinpliicency. During these symptoms the female, at the commencement, is attacked with a sense of tightness about the throat, with throbbing, or repeated attempts at swallowing. Sometimes a sensa- tion as if a ball passed upward to the throat and lodged there, is experi- enced, and whicli is called tlie " globus hystericus.'' She may roll about from side to side, or she may lie perfectly still and motionless. She fre- quently presses her hands to her breasts or carries them to her throat, as if to remove some pressure or obstruction, the face is, usually, pale, tliou;,'h not always, and is not distorted; no froth issues from the mouth, nor are there convulsive motions of the lower jaw, but the large muscles of the back are violently contracted, so as in many instances to cause the body to describe an arch backward. The trunk of the body is twisted forward and backward, the limbs are variously agitated, and the fists are firmly closed. SoinetiuK's there i.s obstinate constipation and retention of urine; gener- ally, however, the urine is pale and copious. The paroxysm continues for a longer or shorter time, the sobbing becomes more violent, or the patient screams and sheds tears, and thus the fit ends. Sometimes they will lie apparently insensible and immovable for a .j^er or shorter time. The attack is often preceded by dejection of spirits, anxiety, yawning, shedding of tears, difficult breathing, nausea, palpitation of the heart, numbness of the extremities, etc. It is not uncommon for ladies affected by this terribly annoying dis- ease, to complain of dreadful and excruciating pains in the hips, knees, spine, etc., with great tenderness to the touch, and which is owing to the severe muscular contraction caused by the spasms, rather than by any dis- ease of these parts. Sometimes a species of paralysis accompanies hyste- ria, and, occasionally, ladies will imagine many strange things, and even practice more or less deception, speaking in a whisper, pretending to vomit blood, meat, etc. In some women, and especially during pregnancy, with a very slight warning, they may be attacked with a severe fit of hysterical convulsions * I brlicvo tbttt tho common opinion, that hysterics amounts to nothing, has done a vast amount of mischief in tho world, aside from uU the actual suffering it has cauied. I wish to say, once for all, that hysteria is as much a diseaHo, and as real in every Bcn-^e aa suiall-pux, but a little more under the control of tho will, if the disease had not already oTerpowereu that, too, which it does in many casei. '$ ■ii! iii (IIS) HYSTEUICS. i.jy H J < 3 1 a 5 Si < 'A O H 4 J 72 which may occur diiily. ovcry other day, or at longer intervals, and whicli, if not removed, will induce miscarriage, which usually occurs at the time of a tit. Causes. Hysteria is a disease that attacks only women, after the beginninf/ of menstruation, iuul may bo produced by various causes, as: want of sleep, excessive fatigue, disordered digestion, sudden mental shock;;, as, joy, fear, grief, etc., excitement of tlie reproductive organs, onanism, excessive sexual intercourse, or, more freciueiilly, abstemiousness among unmarried or widow ladies. Females of a ncrvoi's, irritable tera- IHTaiiieut, arc most.likely to bo attacked. The paroxysms occur more fre- quently about the monthly period than at any otiier timn. Excessive dis- cliarges, or dc!l)ilitating diseases, frequently give rise to attacks of hysteria wiiicii occur during convalescence, and are renewed frequently, and from the slightest causes. ITysteria may be distinguished from epilepsy by observing that, in the former, tliero is no frothing at tlie mouth, no protrusion of the tongue, and alter the paroxysm is over, the patient recovers her usual state, and does not fall into a sleep as in epil('i>sy. It may be distinguislied from apoplexy by observing that In this the l)atient loses consciousness and voluntary motion first, and finally all motion ceases, and the breathing is stertorous. From puerperal convulsions, by observing that in these, the action of the muscles are violent and irregular, the head is strongly rotated to tlie liylit and left, and backward, witii violent jerking convulsions of the mus- cles of the back, abdomen, and upper and lower extremities, spasmodic actiim of the muscles of the face is rapidly repeated, the lips and teeth are fiMuly closed, the breathing is loud and hissing, the tongue is very livid, iirolruded forward, and often bitten so that the blood and saliva is thrown to 301110 distance through the compressed lips, the face becomes livid and the attack usually occurs in first labors, among females with short, tliick necks. HOM(EOPATHIC TREAT3IENT.-The medicines which offer the closi'st similarity to tiie symptoms of the fits, when they occur, and whicii are most successful in restoring the patient during the paroxysms, may, in many cases, be adminislerod in repeated doses, for the pur- pose of overcoming, or, at all events, of moderating the predis- position. It sliould, also, be Iwrne in mind, that if this condition be associated with other derangements, the treatment which is particularly api)ropriate for such derangements is also the best i)reventivo and eradicative resource. There are, however, a few medicines which are especially and particularly applicable to the removal or modification of this constitutional tendency; these, however, we shall simply enumerate, with their chief and characteristic indications. Sepia is, in the great majority of eases, the medicine upon which the chief reliance can be placed, more particularly if the patient has been affected with green-sickness, whites, or with other chronic derangements, Dr diseases of the womb and its appendages ; or, again, when she is liable to be seized with sudden attacks of debility, approaching to general but temporary palsy, and attended with outbreak of profuse and of tea clammy persj)iration. 160 THE BRAIN AND NERVOUS SYSTEM. J ,!ii L'ose: Four globules in a teaspoonful of water, every nipht at bed time, for ten days (unless change should sooner occur); then pause a fortnight, after which the course may, if necessary, be repeated aa before, and so on, from time to time. Calcarea Cnrbonica, on the other hand, is more especially appro- priate for the treatment of persons of an attenuated, sickly-looking frame, and pale, wan, sunken countenance, with whom the gereral convulsion attending the attacks is very violent, and who are subject to fainting- fits, or to an habitually impaired and capricious appetite, the menstrual discharge occurring too frc(juently, and in excess. Dose: Four globules, as directed for ISepia. Natrani Mnriaficiim is to be pref"rred, also, in cases in which the countenance is sickly, pallid and sunken, but more particularly Vr hen there is an habitual dislike to society, and when constant gloom, sadness, or despondency is apt to afTect the patient; whilst feeble powers of diges- tion, and prevailing chilliness, with occasional flushing of the face, and retarded menstrual discharge, further characterize the cas% Dose: Four globules, as directed for Sepia. FeiYtfjvfwt is of much service in overconiii!;; the constitutional ten- dency to hysterical attacks, as well as in modifying their immediate vio- lence, in cases in which they are attended with clenching of the jaws, or general spasm, coldness of the extremities, and clammy sweat, especially on the face and forehead. Dose: Three globules, as directed for >Se/«'a. Treatment of the Attack. Belladonna is appropriate when the paroxysms are characterized by, and commence with, a sensation of chok- ing, with spasmodic closing or obstruction in the throat, and every sensa- tion as if suflbcation would ensue; the face being hot, bloated, and of a dark-ica hue, and therj being other indications of determination of blood to the head; or, when, as the paroxysm proceeds, the eyes become prom- inent, wild, and staring, and the pupils much dilated; or, when, again, during the intervals between attacks, the patient habitually sleeps in a disturbed and restless manner, suddenly tossing in, or even starting from, sleep. Dose: ^\'llen the sensations of an approaching attack are apparent, give two globules in a teaspoonfui of water, repeating the dose after the lapse of a (juartor of an hour, and again half an hour later, if the symptoms do not socmic subside ; v,r, again, after the subsidence of the attack, or during the i.onientary intervals of calmness, give similar doses from time to time. After the attack, the doses shoul<l be repeated every six hours, for twenty-four hours. Jf/Hf/A/a is of great value for the treatment of hysterical paroxysms affectii ^ patients of a mild and very sensitive disposition, or those who are subject to extreme variatioi.s of sj)irits, and when the attacks are apt to be somewhat suddenly announced by convulsive laughter, provoked by some sliguo or imperceptible cause; the face, previously pale, becom- ing ilushed, deep-red, or even livid, and the laughter termi;iating iii screams; or, more especially, when the attack is preceded by the sensation of a ball In the gullet, which gives rise to a feeling of suffocation, attended with spasmodic eructation; further, when convulsive movements of the extremities, with clenching of the thumbs, occur during the paroxysm ; or when, njnsin. (luie is alteni;ition of flushing and pallor; or when the ^^r HYSTERICS, 161 ;ht at bed lien pause epeated aa lly appro- ing frame, onvulsion ) fivinting- nienstrual whicb the arly v.ben n, sadness, ■4 of diges- e face, and itional ten- lediate vio- le jaws, or , especially e when the )n of I'hok- vcry sensa- l1, and of a on of blood ome prom- H'n, again, sloops in a rling from, ! apparent, dose aftor our later, if subsidence Illness, give osos should paroxysms those who cks are «.pt r, provoked >ale, becom- litiatlng i;i le sensation »n, attended lents of the paroxysm ; •r when Mie m patient is afTected with frequent fits of yawning, or with drawing of a deep breath upofi recovery. Dose; Two globules, as directed for Belladonna. P/f/.srt^/V/rMs appropriate for the treatment of patients of mild aud sensitive or exceedingly timid disposition, or of phlegmatic or lymphatic constitution, and when there is an habitual or very frequent derangement of menstruation, or. more particularly, with predominant derangement of the orgf'ns and functions of digestion at the period of the menstrual dis- charges, and wlicn Uie attacks are characterized by tearfulness or fits of crying without any ostensible cause. Dosp: In all respects as directed for Belladonna. Gchscminian should be given when the hysterical paroxysms assume tho proportions of convulsions ; there are: excessive irritability of body and mind ; a semi-stupid condition, with languor and prostration; nerv- ous headache, commencing in the back of the neck, and thence spread- ing over the head; vertigo and dimness of vision; diflflcult menstru- ation. '' Dose: As direetod for Belladonna . ^. Sfrninonitun may be named as especially appropriate when the attacks are characterized by the predominance of limcough and are at- tended with convulsive movements of the arms, and with an expression of extreme exhaustion or of vacancy, and difficult articulation : or some- times with violent ravi .<g, sudden desire to remove, as if from the reach of some fancied danger, and with alternations of crying, or even discordant attempts to sing, and violent convulsive laughter ; or when, again, the violence of the attack is liable to be re-induced or aggravated by the sight of shining or glistening objects. Dose: As directed for Belladonna. Xux Vomica is preferred when the patient ia habitually of an irritable disposition, or of nervous or bilious temperament, and of costive habit— or generally, of a meagre frame and pointed features ; the attacks being i)receded or accompanied witli twitchings of the limlis or of partic- ular muscles, and when a \ jxation or disappointment has been the excit- ing cause of the attack. Also when stimulants of various kinds have been too freely employed from tinu • tiiue. D:\se : In every particular as for Belladonna. Verati'uin is generally to be recommended when the attacks are characterized by clenching of the jaws, or general spasmodic affection of the entire frame, coldness of the extremities, and clammy nerspiration, especially on the face and forehead, and when a considerable quantity of pale urine is generally voided before or after the attack. Dose: As directed for ^eiUdonna. Coniuni should be administered when there is much vertigo, partic- ularly on lyii 'own; she cannot turn in bed, without exciting great dizziness. The asts swell, and be(!oine painful and hard, as the men- strual period approaches, at which time tiie hysterical symptoms are usually developed. Choking sensation in throat, as though a ball were ascending from the stomach. Dose: In -"ery particular as directed for Belladonna. Moschus. Violent, long-continued scolding, until she falls down in 11 ||lr I li r ' f 1 1' ' 1 ff 1 i I* ,„,.y ;02 THE BBATN AND NEKVOUS SYSTEM. Great nnguisli ; she feels as if she rv ist die, and Feeling of constriction or tightness on the chest an hysterical paroxysm . insists that she will die. during the paroxysm. Dose: As directed for Belladonna. Cnnlophyliiui will jirove of value in some cases, when the hysteria can be traced to disordered condition of the menstrual flow, or to some diisease of the womb. Dose: As directed for Belladonna. HUME 2ICASURES. Above all things, it is necessary that any portion of the clothing which may fit tightly should be loosened as an attack ensues, or threatens to ensue ; ail strings and fastenings should be undone. Whatever may tend to impede the circulation should be removed, and the patieni should be stretched out in a recumbent position, (the floor being the safest and best place,) beyond the reach of any article which she might strike against in the convulsive movements. A free current of air should then be admitled, and the face of the patient should be sprinkled with cold water. Friction of the wrists, ankles, and palms of the'hands, is often also of service. Gkneual Remarks. In order to overcome the constitutional ten- dency to hysteria, a long and judicious course of treatment is always recjuired in inveterate eases. Persons who aresubject to hysterical attacks should avoid tight lacing, or any articles of clothing \vhich fit too closely and firmly round the body. Elastic jackets are much to be preferred to corsets. They should also take regular exercise in the open air, without fatiguing tliemselves, avoid all depressing and exciting emotions, live regularly, keep early hours, abstain from rich, seasoned, or stimulating food or drinks, and partake only of plain but nourishing food. To these regulations may be added such others as have been enumerated under the head of " Green-Sickness," "Suppressed Menstruation,'' "Excessive Men- struation," "Difficult or Painful Menstruation,'' "Whites," and also the general rules prescribed in the article on " Eradicative Treatment." ALLOPATHIC TREATMENT. Iluste: in. The name given to this dis- ease was because of asupposed connection between it and a diseased uterus (womb). In acertain proportion ofcafos there can be nodoubtthatthisrela- tion exists. When the uterus Is afTected, with a decided alteration in shape, general treatment, while not without benefit, will quite frequently fail in removing tlie disease. If the patient is young and unnuirried, without any irregularity in the catamenial flow, without pain in the back, or with- out pains or undue frequen^^y in micturition, such cause may be excluded, and the patient placed at once on general treatment alone. If the patient is married, but barren, there is a probal)^' causative relation between the womb and the hysteria, or, in any case, if there is marked irregularity of thecatanienia (monthly sickness ) backache, and freq\ient passage of urine, in only small quantities, there is doubt'ess a displacement of the uterus which should be restored to its proper position and maintained in a .state of rest. The services of a competent physician will be required for this purpose. Regarding general treatment, one of the princi.ydl objects is . ivig' orate the body by good nutritious food, exercise in th'' open air just short HYSTERICS. 1G3 lis dis- uterus jisrela- sbape, fail in without 3r with- cluded. latient een the arity of f urine, uterus state or thia ivis- it short of weariness, and regular habits regarding sleep. The mind should be strengthened by healthful occupation. Everything which excites the feelings, emotions, passions, or imagination, should be avoided. The patient should be urged to arouse the will against giving way to the paroxysms. The discreditable opinion commonly held of the disease may be urged as a motive for the patient to resist, to use the power of her own will, in warding off the afTection. This part of treatment is moral and its success rests on the tact of the attendant, but requires discretion and delicacy. Many times is the physician's patience sorely tried by patients prolonging the malady by their own desire to excite sympathy. If the patient is in reduced health, the Elixir of Quinine, Iron and Strychnine, in doses of a teaspoonf ul before each meal, will prove beii^fi- cial. Or the Elixir of Bark, Iron and Strychnine, may be given in the same doses, or doses of a dessertspoonful (two teaspoonfuls). If the patient is young, and in vigorous health, the Bromide of Potas- sium, in doses of twenty or thirty grains, three or four times a day, will often prove most beneficial, by allaying all forms of nervous excitement. Mono-Bromated Camphor is, also, benelicial, under the same conditions. It is best given in pills. The dose is four to ten grains, three or four hours apart. The distressing symptoms in hysteria demand attention andjelief. In a hysterical convulsion, if it were not that the patient may inflict injury upon herself, as they would soon end of themselves, it would be well, gen- erally, to make no attempt to interfere, but let the paroxysm exhaust itself. Care should, however, be used to prevent the patient injuring her- self. Pourhig cold wai.er upon the head, from a littleheigh, Mill, generally, bring the "hysterical fit" to an end. The insensibility (coma) of hysteria will generally yield to the same means. Some of the remedies which many times have a favorable effect upon the hysterical condition, are : Assafoetida and Valerian Mixture or nnlk of Assafoetida, (two drams of Assafoetida, dissolved in a pint of water,) may be given in doses of one or two tablespoonfuls, just before an expected attack. It may be repeated two or three times in the twenty-four hours. The Assafoetida may be given in pill. Valerian, in fluid extract, dose, a teaspoonful; tjncture , dose, two tea- spoonfuls; an infusion, (tea) made with a half ounce of the Valerian root to a pint of water. Dose : A wineglassf ul may be given to answer the same purpose as Assafoetida. The headache of hysteria is best relieved by Ilyoscyamus and Camphor or the Bromides. The Tincture of Hyoscyamus and Spirits of Camplior may be given in doses of a teaspoonful. A pill containing a grain of the Extract of Valerian, a grain of Camphor, and half a grain of Extract of Ilyoscyaiaus, may be given in doses of one or two pills, three iiours apavt The Bromides may be given according to the directions in a previous para- graph. In the absence, of other means, the free use of hop tea will afford a good degree of tranquility to the nervousness of the patient. m THE BRAIN AND NERVOUS SYSTEM. I:'l ! I V CtlOREA, ST. VITUS* DANCE. EPILEPSIA 8ALTAT0R1A. Chorea is a disease of the later years of childhood. It is seldom seei) before the sixth year of age, and only occasionally after the fifteenth. Causes: Onanism, worms, fright, anger, second period of dentition, (teething,) and a continued effoit to imitate some one afflicted with the disease. Symptoms: At first the patients show a certain uneasiness in their movements, and an unusual hurrisdness, low spirits, ill temper. (The last two symptoms are often made much worse by the unkind rebukes the child receives, for what appears like hurried carelessness in handling things.) Gradually, or, in some cases, very soon, the involuntary movements begin, either confined to single parts, or affecting the whole muscular system ; the upper extremities are usually more affected than the lower ones. The face shows every possible contortion ; even the eye balls are rolled about in every direction ; the arms and hands are, at times, flexed, (drawn up,) at others extended. The grip is no longer firm; the patients cannot eat alone, or if they do, have to bring their food to the mouth by a very circuitous route; the walk becomes unsteady, because the legs can no longer be put down with sufficient steadiness, and even the ability to keep them stiff enough to support the body firmly, is .wanting. A striking feature of the disease is, that the more the patient tries to keep the part still, the more violent the involuntary motions become. It is peculiar to this disease, that even those excessive muscular movements do not fatigue the patient. After a gradual increase of the symptoms, the disease reachesits height, where it remains stationary for a time, lasting a few weeks, or even several months, and sometimes terminating in recovery, either quite suddenly, or only gradually. The cases where the convulsive movements become habitual, are very rare. Death is a very rare termination of the disease. So that the prognosis is favorable. ALLOPATHIC TREATMENT. C/*ore«-St. Vitus' or St. Gay's Dance. This disease occurs, in a huge proportion of cases, in persons whose vital forces are, more or less, reduced, and in a state of anaemia (impoverished blood). The diet should be plain, and unirritating, but nourishing. Fresh air, and out of door exercise, are to be insisted on. In proportion to the weakness, and ansemia, tonic treatment should be resorted to. Iron should be given, to restore the blood to its healthy state. I would use the Pyro- phosphate of Iron, in doses of a grain, three times a day. Take a dram of Pyrophosphate of Iron, dissolve in four ounces of simple Syrup, and give a teaspoon half full to a young child, and a teaspoonf ul to a nearly grown child, three times a day. Sweet cream, or Cod Liver Oil, will be useful in restoring health and strength ; of course, they are not to be given if the patient is full blooded, or over fat; but this is not likely. The bowels should be kept regular, and a daily bath should be given. If agreeable to the patient, and the reaction is good, a cool bath is prefera- ble, but if not, the bath should be warm. In some cases, the involuntary movements are so violent, that the patiei>t should remain in bed. '*itt^&^'TrS;- CHOREA. 105 tlom seen nth. ilentition, with the s in their (The hist , the child ,hinss.) overaents muscular the lower balls are les, flexed, ,6 patients louth by a egs can no ty to keep L striking sp the part peculiar to lot fatigue L, its height, en several denly, or become le disease. ly's Dance. lose vital )overished Fresh ion to the on should the Pyro- a dram of md give a rly grown ig. lealth and blooded, be given, s prefera- The two remedies which certainly exert a curative influence over tlie disease, are Arsenic and Strychnine. Arsenic is of undoubted value. It is conveniently given in the form of Fowler's Solution, in doses of live drops, three times a day, after eating. It can be given in water, or added to each dose of the Syrup of Iniii, recommended above. It should be continued until swelling of the eyelids is produced. In obstinate ca?ds, of general or local Chorea, this remedy has been found exceedingly useful, administered by hypodermic injection, in doses gradually increased to fourteen drops, diluted by an equal (juantity of water. This treatment should be given and managed by a physician. The chief reliance of many physicians is upon Strychnine, but the most effectual manner of administering is such that it is unsuited to domestic practice. If the case is obstinate, and a physician cannot be obtained, I would recommend the following: Take one grain of Sulphate of Strychnine, water four ounces; after solution is effected, give a tea- spoonful three times a day, to a child ten years old. After a few days, it may be given four times a day. If rigidity of muscles is produced, the dose should then be diminished. In those severe cases in which the excessive choried movements pre- vent the proper amount of sleep, moderate doses of Hydrate of Chloral should be given to secure rest. Take of Hydrate of Chloral aiid Bromide of Potassium each two drams, simple syrup tioo ounces. Mix. Dose : A dessertspoonful once or twice a day, to procure rest. HOMEOPATHIC TREATMENT.— In view of the well recognized fact, that most cases of chorea get well themselves, although slowly, we would recommend the very limited use of medicine. The Homoeopathic remedies we will only mention the names of; they can be compared by the use of the Repertory : Cuprum, Stramonium, Belladonna, Hyoscyatnus, I gnatia, Zincum, Cina, Oeheminum. If caused by onanism, Phosphoric Acid. THE BBAIN AS SEEN FROM ABOVE. This cut shows the brain— cerebrum— as seen from above, o is at the front or forehead —called anterior portion, and h is at the back— posterior portion. The left Iialf, c, is covered by the dura mater (the tliiii outtn-most mem- bram' of the brain) through which may be seen the convolutions and undu- lations of the biaiii. The small round bodies upon the surface of the dura mater are called <>lan(lula paccliioiii, and are not present in infancy, but usually are after the seventh year, iUtt'r which time they increase in number and size. d. On the right side the dura mater lias been removed and shows the cerebrum stripped, e. The /((/.*; cerebri, so called from its sickle-like form, is an extension v)f tlie dura mater down between the two lobes of the brain to separate them. It contains the large blood reservoir that is laid-open dtj- U| that the 166 BRAIN. On the right side, the dura mater being removed on the front half of the side lettered j, may be seen tlie reri/ tliiii menibrane or middle coiit of the covering of tlie bniin culled urachnoiil nievdirane; through it cun bo seen Ihepia muttr or inner nienibnine covering tlie hrain witii its blood-vessels ; iit h the jmt muUr is cut througli to show plainly 1io\n il with its blood-ves- sels sink into the lissures - gyri of the cerebrum; o;i the back posterior part of tlie right .sii'c. all time of the covering membranes have been re- moved to expose li:c cert'hnini, ( Vnain pvoix-r. I In these various membranes, their extensions and blood-vessels, are located some of the very painful and sometimes dangerous inflammatory dis- eases of the brain. A rupture of one very small blood-vessel is quite enougli to cause blood to flow into the space around it, and give rise to a stroke of apoplexy. The brain-coverings are also the seat of a variety of consumption ofteu developed In our school-rooms, and called Tubercular Meningitis alf of the Hit of the n bo seen 1-vessels ; 3lood-ves- posterior i been re- I»AR,T TH[IK.r> DISEASES OF THE HEAD. CHAPTER VII THE BRAIN AND NERVES. -essels, are latory dis- laviae blood p'xy. Itiou ofteu HEADACHE. Headache is one of the most common symptoms of mtvuy forms of disease. Hence we might ?i«TOe a great many forms of lieadache arisiiic: from a variety of causes, witliout, however, helping the treatment in the least by so doing. Tlie headache will disappear as soon as tlie affection upon whicli it depends is cured. It is not always easy to find out tlie causes of headache —it is sometimes very violent, when tlie general disease soonis very slight and on that account, to be more or less an independent condition of distress— but all attempts to point out remedic; here, for all such casei, would be more than our space will allow. If the headache is simply an accompaniment of some other complaint, we must refer the reader to that complaint, and the Repertoiy, for treatment, and here only devote our attention to some particular forms of headache, which appear to be almost disconnected with other affections. 1. Hemtcmania or Meguim.— a lieadache which usually afTeots one side of the head, and occurs paroxysmally at more or less regular inter- vals. This headache is a pure iicuralgia, and while it does sometimes occur in company with other diseases, it occurs more freijuently without such associations. Thh Causes: Where it occurs as a complication of other diseases, it may depend upon liver-complaint, derangement of the stomach or heart, but more frequently upon an unhealthy condition of the sexual organs. As an independent iisease, it is only met with in the constitution and temperament which we term " nervous." Hence, it is more frequent among females, and occasionally among children. The Symptoms : In general, tho symptoms of this form of headache »re very constant and uniform, varying only in less important points. In most cases, without any precursory symptoms, much less frequently after 107 ICS HEADACHE. :% ft previous feeling of fatigue, the patient awakes in the morning witli a I'iolent and constantly increasing headache. The imin is Ihrohbing or /earing, or burning, or simply an a(jhe, and is generally confined to a sharply circumscribed locality on o/ie side of the head, usiially the left. External pressure afTords relief. Every mental and physical effort is pain- ful, while mental pleasure and attractive occupation afTord some relief. As the pain increases, the eyes become sensitive to the light, and there is a copious flow of tears. When the pain is at its hight, the patient vomits a watery phlegm, after having experienced nausea for some time previous After the vomiting the patients feel better, and want to sleep, and after a sound sleep thoy generally wake quite well, only a little weary. Such j)aroxysmH sometimes recur again in a few days, sometimes not till months iiave elapsed; in the case of femules, they are apt to come on about the monthly period. The general condition of the system is not always affected by the attacks; in the intervals l)etween the attacks the l)ati('nts may have the api)earance of enjoying good health. Very rarely the pum lasts beyond twelve hours; if it lasts longer, it may continue thirty six iiours. (See treatment at the end of this article). Nkui;aloic Headache. What this formof headache has in common with megrim is, tiiat it likewise oc<*urs i)eriodically, most couimonly ufl'ecting only one side of tlie head, and likewise tending in some cases to excite vomiting. But unlike megrim, this lieadache never ends with one paroxysm alone, but after the headache has once begun, the paroxysm generally returns at the same hour for several days in succession, some- times with as much regularity as intermittent fever. The remaining varieties of headache— Catarrhal, Congestive, Gastric, Rheumatic, Sick and Nervous — will be kejjt in mind in the treatment of tills subject, without further reference here to each of their peculiarities, and patients will find the treatment very satisfactory. ALLOPATHIC TKEATMENT. nocuning headache is one of the most difficult troubles to treat successfully, as far sxs permanent cure is con- cerned, yet many cases are much benefited by treatment. Hereditary predisposition, which is found in many cases, is beyond the reach of art, as far as removal is concerned, l)ut their operation may be greatly less- ened by prudence and proper treatment. The disease, when not a symptom of the numerous atfections which it accompanies, as active congestion of tlie brain, inflammation of the membranes of the brain, inflammation of the brain, tlie essential fevers, etc., is, especially, neuralgic, and similar measures are called for in its treatment. When the pain is located in the face, or forehead, in the scalp, or back of the head and neck, and two or three tender points are found by pressing on the skin with the flnger, the disease is a neuralgia of those parts, and should be treated as directed in the article on neu- ralgia. - The treatment will embrace measures to be employed at the time of the attack, when immediate relief is urgently demanded and during the intervals, when the design will be to guard against a recurrence of the attacks, and moderate their severity. If the patient is ii hearty, robust person, with an abundance of blood, and the headache dependent upon fullness v}f blood, and such symptoms of congestion occur, as a flushed DISEASES OF THE HEAD. ids iig with a olibiug or fined to a ,' the left. ort is pain- iine relief, d there is u ent vomits e previous and after a iry. Such es not till ) come on stem is not jttaeks the /ery rarely ly continue in common commonly me cases to Is with one i paroxysm siou, some- ve, Gastric, ■eatment of eculiaritie-s, of the most cure is con- Hereditary ach of art, reatly less- ions which tion of the tial fevers, for in its ead, in the points are V neuralgia cle on neu- he time of during the uce of the rty, robust dent upon a flushed face, throbbing of the head and ears, the congestion should he relieved. Probably a saline purgative, as a tables])oonfuI of Epsom Salts (Sulphate of Magnesia,) in water slightly acidulated with lemon juice, or in coftee, will prove eflective against both the congestion and the headache. Such means as the application of cold to the head, by means of cold, wot cloths, or pounded ice in a sack or bladder, and hot foot-baths of simple warm water, or with the addition of mustard or red pepper, may be employed. In such persons the diet should be somewhat reduced, more exercise taken, and if constipation exists, it should be overcome by a daily dose of a teaspoon ful of Epsom or Rochelle Salts. Many cases occur where congestion is not so violent, following some error of diet, in which mild purgatives are useful ; two or three Compound Cathartic Pills, U. S. P., or the Improved Cathartic Pills, will answer a good purpose, though many others may be given. The salines act more quickly. If patients are not unpleasantly aflected by Opium, an attack may frequently be warded ofT, shortened or lessened, by a full dose of Opium in some of its forms, as, one grain of powdered Opium, or one-sixth to one-third of a grain of Sulphate or Acetate Morphine, or a grain of Codia. Carbonate of Ammonia, in doses of from five to ten grains, is some- times successful in affording relief; also the Muriate of Anmionia (Sal. Ammoniac,) in doses of ten grains. The congestive form of nick headache, is generally dispelled by one or more full doses, twenty to forty grains, of the Bromide of Potassium. The variety in which it acts, almost as a specific, is characterized by a flushed face, throbbing temples and intolerance to light. Ergot is also a valuable remedy in this variety of headache, and should be given in doses of a dram (teaspoonful) of the Fluid Extract. Some physicians extend its use to all forms of headache. The opposite form of sick-headache, manifested by paleness of the face, dizziness, and ringing of the ears, is quite certainly relieved by Bel- ladonna. The distress may be increased at first, but great relief follows jifterward. The following is a useful formula : Take of Atropium (the active principle of Belladonna) one-fourth of a grain; Chinoidine, twenty grains. Mix and make into twenty pills. Take one pill two or three times a day. Five grains of Extract cf Belladonna may be used instead of the Atropium. Relief is often obti.ined in this form of headache by the use of Elixir of Guaraua, In doses of a table- spoonful frequently repeated— from thirty minutes to an hour apart. If the face is pale and bloodless during the headache, three to six drops of Nitrite of Amyl inhaled from a handkerchief, will give relief. Some cases of nervous headache are quickly relieved by a teaspoon half full of Hoffman's Anodyne (Compound Spirits of Ether.) I have found cases in which the following relieved the pain with greater certainty than anything else used in their treatment: Take of i Moral Hydrate eight scruples; Bromide of Potassium one dram ; Simple i^yrup ttvo ounces. Mix. Dose : A dessertspoonful, and repeat in two or three hours, if the pain is not relieved. The physician often finds it necessary to let the patient inhale a little 170 HEADACHE. I] a Chloroform. Evaporating lotiotiH (wimlies,) as Alcohol, Spirits, Cologne, Vinegar, or Ether, often attbrd relief. Sonietiniea a towel, or other large oloth, wrung out of hot water and applied to the head, t^^ivea greater relief liian cold applications. Strong cotlee or tea niuy give ijreat relief in some caseB, though their constant use is often a cause of aggravating the malady. During the interval between the paroxysms, attention should be given to the general health, and to correct, as far as possible, any disorder which may be discovered. Indigestion and constipation are to be guarded against. The laws of bealth sliould be closely observed. Everything^ which is noticed to excite or inercasc the severity of the attacks, must be avoided. Sleep should be sufficiently long, and to this end the patient should habitually retire early. If the appetite is poor, and the patient weak and pale, or if he feels weary upon rising in the morning, lie should have an Iron tonic, and plain but nourishing food. The Pyrophosphate of Iron one drxim, dissolved in four ounces of water, or syrup, can be given in doses of a teaspoon ful after each meal. Or the Citrate of Iron and Quinine can be given in the .same way. In addition to Iron, I would recommend the pills of one-tenth grain of Phosphide of Zinc, and one-fourtli grain of Extract ol Xux-vomica, known as Hammonds' formula, of which one or two pills may be given three times a day; or the i)ills of Phosphorus, one-fiftieth of a grain, and Extract of Nux- vomica one-fourth of a grain, may be given in the same manner. Arsenic has been found useful, giver, between the attacks, and should be tried if the other means, after a faithful trial, do not benefit. It can be given in the form of Fowler's Solution, in doses of five drops in water, after eating. If swelling or watering of the eyes oecurs, its use should be Buspended until this symptom disappears, and then resumed again. Small doses of Quinine, two or tliree grains three times a day, may prove effective in guarding against a recurrence ot tiie attack. It can be taken in powder or i)ill. Stimulants of all kinds are generally harmful, including beer and wine, and can be generally given up with advantage. Excesses of all kinds should be avoided. HOMCEOPATHIC TREATMENT. Arsenieum for intense frontal head- ache with vertigo, tearing in the head, with vomiting, when raising tlio head. Headache after meals, relieved l)y a])plying cold water, or Ity walking in the fresh air; sensation in the l)rain as if torn to pieces, with unquenchable thirst; a\\ perMic fieadanJies ; sometimes, when the head- i'che is intense, a dose or two of Ars. gives as much ease as a dose of Opi- um ever does. Belladonna for hmdache from the heat of the sun. Nervous headacho frequently on one side of the head, esjjecially the right side, coming on from four p. m., to eight A. im., aggravated by the heat of the bed, and l)y lying down; better when sitting up, feeling in the brain like the swash- ing of water; cold sensation in tlie brain, in the middle of the forehead: pressive frontal headache, .so severe when walking that the eyes are some- times drawn shut, frequently obliged to stand still, when walking, froi.i the violence of the pain in the forehead ; at every step it seems as if the I'.ain rose and fell in the forehead, relieved by strong pressure on th- •1: DISEASES OP THE HEAD. 171 rits, Cologne, )r other large greater relief relief in .some gtheuiulady. u should be , any disorder to be guarded Everything acks, must be 1 the patient d the patient ng, lie should yrophosj)hate yrup, ean be trate of Iron e-tenth grain Nux-vomica, may be given ■ a grain, and in the same ?s, and should nefit. It can rops in water, use should be I again, I day, may k. It can be ing beer and xcesses of all 3 frontal head- II raising the water, or by pieces, with vn the head- dose of Opi- •(uis headaclio ;, coming on } bed, and by e the swasli- the forehead : ■yes are some- ralking, fror.i !m9 as if tlie ssure on th- forehead; violent throbbing in the brain, from behind forward, and towards both sides; finally, painful shootings, stabbing as if with a knife from temple to temple; boring, tearing, cutting, shooting pains in vari- ous parts of the head, worse on the riglit side and in the foreliead, less in llie back of the head; headache is accompanied by dizziness, stupefaction, red and bloated face, red eyes; excessive sensitiveness to noi.se, light shock, jar, or slight contact ; ill humor -fpaiiUi come uu audcknl'j, last Indefi- nitely, but cease suddenly; headache from catching cold in the head, as from having the hair cut. Dose: Of a .solution of eight pills in four tablespoon fu Is of water, give a teaspoonful every fifteen minutes to two hours, according as the severity of the case demands. Nux-vomica. Congestive headache, and lieadache from derangement of the stomach (gastric), with nausea and vomiting, worse \ j coughing and stooping; pain as-, from a nail driven into the brain, or stitching pain with nausea and sour vomiting, stitches and pressure in one side of the head, worse in the morning, driving the patient out of his senses; exces- sive sensitiveness of the brain to motion and walking; heaviness of the liead, especially when moving the eyes or thinking ; inith scnsntlon as if the skull wotdd split ; whizzing in the head, with vertigo, or with shocks when walking; lieadache every morning on waking, after eating, and in the fresh air, when stooping or during motion, even when merely moving the eyes; the pains come again after drinking cofTee ; aversion to coffee, pale, worn-out look ; comtipatlon, with tendency of blood to the head, irritable, vehement disposition, or lively, sanguine tempers ; persons who lead a sedentary life, or who drink. Dose : As for Belladonna. Calcarca Carb, for icy coldness in and on the head, also one-sided headache, with pale, puffed face, with empty belchings (eructations) and nausea, vertigo ; worse from mental exertion, stooping, or walking in the open air; better by closing the eyes or lying down; headache begins in the back part and spreads to the top of the head, so severe one thinks their head will burst and they will go crazy ; throbbing headache in the middleof the brain, every morning, lasts all day; headache from owr- Z^/<i7J.9; menstrual headache ; worse going upstairs, talking, or walking, or riding in the hot sun, or from taking cold ; better from tight bandag- ing, vomiting of mucus and bile, and pressure with cold hands, or some- thing cold. Dose : As for Belladonna. Ignatia is especially appropriate for one-sided headache.s proceeding from irritation of the spinal nerves, or may be required in cases where Pulsatilla appeared to be indicated, but failed to relieve. It is, also, an excellent remedy, and should be preferably selected in cases in which tlio pain is confined to a small space, and causes a sensation as if a nail were being driven from within outward ; also, wiien the pain is of a pressive aching, or of a shooting description proceeding from within outward and chiefly confined to the forehead and root of the nose; and when there are nausea and dimness of sight, and sensibility of the eyes to light ; palewss of the face (Nux is red), and temporary alleviation from change of posi- tion ; aggravation from Tv iso, strong odors, and drinking coffee. Ignatia is especially applicable to nervous females of a mild and sensitive dispo- IMAGE EVALUATION TEST TARGET (MT-3) nil 1.0 I.I iilllllM llll|^ 2.2 2.0 1.8 1.25 1.4 III 1.6 ^ 111^ ^ 6" ► V] <^ /a 7 <rS 'W Ji '/ -^^ m Photographic Sciences Corporation ?3 WEST MAIN STREET WEBSTER, N.Y. 14580 (716) 872-4503 ^n 172 HEADACHE. I* B 1 III' liii^' I* sition, or to those in whom the attacks are prone to be excited by depress- ing emotions, or return at the menstrual period. Dose: As for Belladonna. Sepia is one oi'the most valuable remedies in the treatment of severe and inveterate sick headache or meynm. It is more particularly required in periodical headaclie, aggravated by mental emotions, in nervous females; the pain is either of a lancinating description, or it is a pressive aching, shooting, or a tearing, piercing or jerking pain, and affects the whole of tlie head, or it is only seated under the eye, or occupies one half of the head or forehead ; in the latter case, the pain is experienced chiefly in tlie morning, and is frequently attended with extreme sensibility of the eyes to the light. Sepia is, also, very efficacious in cases of obstinate megrim, with violent, piercing, or rending pain, intermingled with lan- cinations so excruciating that the patient is afraid to move, and can obtain only a very little relief by keeping perfectly still with the eyes closed; at other times, the pain is so severe as to cause the patient to scream out.and is accompanied witli heat in the head, or faintness and giddiness, fol- lowed by nausea and vomiting. The source of the nei'vous headaches which call for the employment of Sepia, is to be found in derangement of the digestive organs, or in some derangement of the womb, in the case of females. The headache is, consequently, a secondary, and not a primary affection . We, accordingly. And that it is of the greatest efficacy in cases attended with green sickness, or with whites, in the intervals between periods, when a sensation" of heat and fullness in the lower part of the belly, and, also, a peculiar offensive-smelling sweat, particularly in the armpits, and on the feet, prevail ; lastly, pale, dirty, or yellowish com- plexion, with a number of yellowish brown spots across the nose, a little resembling a saddle; shrunken features, or a countenance expressive of suffering; spare habit of body; constipation. Done : As for Belladonna. Suuff Ulnar in. This is one of the choice remedies for the sick head- ache to which Americans are subject; the attacks occur paroxysmally ; the pains begin in the morning, increase during the day, and last till eve- ning; the head seems to feel as if it would burst, or as if the eyes would be pressed out, or the pains are digging, attended with sudden, piercing, throbbing lancinations through the whole brain, involving the forehead and top of the head more particularly, and being most severe on the right side, followed by chills, nausea, and vomiting of food and bile, forcing the patient to lie down and preserve the most perfect quiet, as every motion aggrav;..tes the suffering, which is only relieved by sleep ; the head is congested, and the veins on the forehead are distended like whip cords. Dose : As for Belladonna. P?tfsa<«//rt is a I'emedy of great value in the treatment of megrim, characterized Ijy rending or shooting pains, with heaviness of the head, giddiness, dimness of the sight, sensibility to light, or buzzing or singing in the ears, and earache; nausea, paleness of the face, lowness of spirits, headache with pain in the back of the neck ; aggravation of the head- ache, with chilliness towards evening, during repose, or particularly when sitting; amelioration in the open air; disposition mild; tempera- ment phlegmatic. In females with retarded periodical returns. Dose ; As for Belladonna. Diseases of the Jiead. 173 iSi'yonia for rlieuniatic headache, or headache with aching, i>iorcing, or digging, tearing pain at a small fixed spot, or piercing, aching pain in the forehead, daily, after a meal, or coming on in the morning, disappear- ing in tlie afternoon and returning again in the evening witli great vio- lence, when it is attended with a sensation as if the liead were pressed together, particularly at the temple; barning, tearing pains over the entire head, or shootings in one side of the head. The pains are increased by motion, and are attended with ill humor and disposition to chilliness or shivering; they are, sometimes, relieved or terminated by n, fit of vom- iting. Dose : As for Belladonna, >S«/y>/t»<r is indicated in chronic lieadache, following the suppression or driving in of some eruption or disease of the skin ; headaches occurring every day or every eight days, worse in the morning, or during the night, and attended with heaviness of the head, aching, or pressive pains in the forehead above the eyes, cansing the patient to knit tiie brows or keep the eyes closed, or over the entire head ; incapability of mental exeition from the pains in the head; pains as if the head would split, or rending, shoot- ing, dragging, jerking pains on one side of the head; aggravation of the headaclie from meditation, the open air, or movement; extreme tfnuler- ness of the scalp, cannot bear to touch or comb the hair; falling off of the hair. If none of these remedies appear to be appropriate, study, with the aid of the Repertory, the following additional remedies: China, Veratnim, Gelseminum, Colocynth, CLmicifuga. In general cases, headaches which do not simply occur as the result of casual or accidental derangements involv- ing irregularities of digestion, the diet should be plain, but (in the absence of fever) nutritious, and the meals should be regular. Regula-rity of the general habits, and early resting and rising, with exercise in tlie open air (short of fatigue), are valuable aids in promoting and assisting a perma- nent cure. Everything which is known to provoke or aggravate an attack should be carefully avoided. Nineteen out of twenty cases can be cured, if this treatment is perseveringly adhered to. HOME REMEDIES.— Soda one-fourth teaspoonful, pulverized charcoal one-fourth teaspoonful, paregoric ten drops. Mix, to be taken as one dose, and repeated in one-half hour, if need be. This is splendid for sick head- ache, and should bo given as soon as the indistinctness of vision comes on, Blood Root, or Sanguinaiia (Red Percoon), which is so common in oui country, is a most sovereign remedy for American sick headaches. Constant headaches may, frequently, be cured by snuffing certain arti' cles, such a^Caraphor, the juice of Blood Beets, or Ground Ivy, or freshly- grated Horse Radish Roots. A towel or night cap, wrung out of cold water and applied to the head, on retiring at night, is good for a headache which returns every morning. Applications of water, sometimes hot, at other times cold, will give relief in many cases. If iii .11 L 111 ^i i s. «■ NEURALGIA. NERVK-PAIN, FACE-ACHE, FACE-AGUE, AND NEURALGIA IN GENERAL. Symptoms,— Neuralgia is one of the most painful diseases, or rather symptoms of disease, to which the human family is subject. It commonly f7t NEURALGIA. a ;■ ! !^ occur.s ill the nerves of the face, although it is met with in different parts of tho head, in the brrast, side, hip-joints, and other parts of the body anil limbs. Its attacks arc usually sudden, and the paroxysm of pain varies in its duration. The pain is agonizing, lancinating, and shooting along the nerves like a shock of electricity, frequent feeling as if red-hot wires were thrust into the parts, and after the pain passes away, a numbness remains for som time. Sometimes, instead of attacking suddenly, it commences with a slight lieat o'- Si'nse of itching or numbness, which augments in severity more or less rapidly. The pain occurs, from time to time, at longer or .shorter intervals, and is often produced by the most trifling causes, as a draught of air, a slight jar or noise, or even talking. The prognosis is favorable, as far as life is concerned, but the fearful, and frequently returning pain exhausts the body and wears on the mind to such an extent, that the patient is often driven to Insanity, melancholy apoplexy, and even suicide C A us KS.— Exposure to miasmatic influences, injuries to the nerves by accident, heat or cold, derangements of the digestion, the growing of the bone through which the nerve passes, so as to close the very small open- ing through it; tumors growing in such a j^osition as to make pressure on the nerve, and other causes, which are to this day not well understood by physicians. Neuralgia may be distinguished from rheumatism by the intensity of the pain, its short continuance and rapid return, and its liability to return on the slightest touch ; in acute rheumatism there is fever, redness, heat in the affected part, and some swelling, all of which are absent in neural- gia; in chronic rheumatism the pain is continuous, less severe and often worse at night. From toothache, by the short continuance of the parox- ysms, the rapidity with which it comes and goes, and the frequent con- vulsive twitchings of neuralgia. ALLOPATHIC TREATMENT.— The treatment of neuralgia has refer- ence, in the first place, to the removal of the cause, or morbid condition, upon which the neuralgia is ascei'tained to depend. These may be mala- ria (or miasmatic poisoning), poisoning by lead, an impoverished condi- tion of the blood (anismia), syphilis, pressure by morbid growths upon a nerve, etc. In all these instances, while it is common to consider the neuralgia a disease, it is, really, but a symptom, and the cause behind is the disease. A rheumatic or gouty condition of the system frequently contributes to the production of the neuralgia, and treatment appropriate to these conditions is called for, if they exist, ^ We nearly always find the health poor ; the bowels should be kept reg- ular by means of laxatives, but physicing should be avoided. Aloes and Pepsin answer very well. Take of Aloes eight grains; Pepsin thirty-two grains, Syrup of Gum Arabic a sufficient quantity. Make a mass and divide into sixteen pills. Dos6 : One or two pills each day at dinner. \ generous, nourishing diet should be given with plenty of milk and cream, raw eggs beaten with sugar and water, or milk and animal food, twice a day. Cod Liver Oil will be found beneficial in building up the «fi I DISEASES OF THE HEAD. 1 10 Iiealth. The clothing should be warm, and flannel worn next to the skin. Often, in intercostal neuralgia (in the nerves between the ribs), a ( haniois skin shirt will bo exceedingly useful, and chamois skin drawers will be equally useful in sciatica (neuralgia of the great nerve of the thigh.) Iron is the great restorer of the nealth in these cases, by enriching the blood. The Citrate of Iron and Quinine, dissolved in Orange Flower Water, or syrup, can be given in Ave grain doses three or four times a day, or the Tincture of the Chloride of Iron can be given in thirty-dro}) doses, largely diluted in sweetened water, after each meal. Other preiia- rations of Iron may be given with equally good results. When the bene- fit expected does not follow the use of iron, it should be given with Man- ganese. An eligible formula is: Take of Sulphate of Quinine, Dried fivl- plmteof Iron, Dried Sulphate of Manganese, each, thirty (/rains. Mix, and let them be made into thirty pills. Dose : One or two pills, to be taken three times a day. When the neuralgia is periodical, i. e., the pain recurs at regular inter- vals, QUININE is a sovereign remedy, but its suceeos'is often remarkable I when given in cases which are not periodical. It should be given in large doses— fifteen to thirty grains a day — for a week or more. This remedy is elevated to the first rank as an internal remedy for neuralgia. Arse- nous Acid (Arsenic) will rank next in value to Quinine, and will be ordered by the physician in cases in which Quinine is not tolerated, though it will not be likely to succeed, if Quinine has failed. Fowler's Solution is the most convoiient form, and should be given in doses of five drops in water after each meal. But if the hygienic and tonic plan of treatment fails, a physician had better be consulted before resorting any farther to internal remedies. In rebellious cases, the other remedies usually given are Strych- nine, the preparations of Zinc, Carbonate of Iron in large doses, Phos- phorus, Oil of Turpentine and Iodide of Potassium. The latter is indica- ted when the neuralgia depends upon a rheumatic condition, and, also, with Mercury, when the neuralgia depends upon syphilis. Tlie relief of pain occupies a hirge place in the treatment. During the severe parQX'vsm, large doses of Opium are generally required. Morpliiue in doses of one-fourtii to one-half a grain can be given every hour, imtil relief is obtained, then stop giving it. Tlie most effective method of giving Opium is by injection beneath the skin (hypodermic), over the seat of pain, at the hands of a physician. Tlie relief given is complete, and cures are effected in numerous instances, especially, in sciatica, lliis ele- ment in the treatment should be guarded most carefully to avoid the mor- phia habit. If the pain is not severe, relief may be had from Belladonnti, Hyoscyamus, Conium, Stramonium or Aconite, etc. Probably as good an internal anodyne as any, is Brown-Sequard's Neuralgia Pills, in which several of the pain-relieving Bubstanv.es are combined ; the dose is one pill, from two to four hours apart. When the patient cannot take a pill, a watery solution may be made, or a pill may be crushed and taken as a pow- der In the absence of these pills, the Tincture of Belladonna may be given in doses of ten to twenty drops; or the Tincture of Hyoscyamus. in doses of a teaspoonful to a tablespoonful, 'di the same intervals. The object to attain is relief from pain. 11 II »Ml 4\ m i I ..^ HI I 171} NEURALGIA. if t !ii' If Much relief may be obtained by local applications. The best of those are liniments of Aconite, Chloroform, or Opium. A piece of llannel should be saturated with tho liniment, laid on tlio painful part and cov- ered with oiled silk. A good liniment, applied in this way, is this: Take of Tincture of Aconite and Chloroform, each half an ounce, Soap Liniment one ounce. Mix. Of the forms of counter-irritation resorted to in neuralgia, the one most generally useful is the "Hying blister.'' Small fly plasters, about half an inch in diameter, are placed over the painful points, fortwo hours The blistered points are to bo dressed with simple ointment or tallow anl allowed to heal as soon as i^ossible. The blisters are to be repeated ia y few days, if the neuralgia continues. Mustard plasters and dry cupping can also be resorted to. Severer counter-irritatiou will be resorted to by the physician in obstinate cases. In essential neuralgia, i. e., not dependent on an ascertained cause, there is no more useful agent than electricity in procuring relief from pain, and sometimes a cure results. Neuralgia of the face, neck and shoulder, and of the hip and thigh (sciatica,) are the forms of neuralgia, most likely to be benefited by electricity. The positive pole of the cal- vanic battery should be placed at the point of emergence of tiie affected nerve, and the negative over the princii^al divisions of the expansion. From five to ten minutes should be occuijied at each sitting. In old cases of a sciatica, a needle, isolated nearly to its i)oint, should be passed down into the flesh, near the nerve, and attached to the positive pole, while the negative sponge, e' ■tetrode, is passed over the course of the nerve. Gal- vanism frequently gives the best results in neuralgia of the uterus and ovaries. A permanent cure will generally depend upon a correct appreciation and management of the (diseased) constitutional condition upon which the neuralgia is dependent, or with which it is associated, with hygienic and tonic measures to strengthen the tone of the system and general health. These were alluded to in the beginning of our description of the treatment of this malady. HOMEOPATHIC TREATMENT. Belladonna is indicated by darting pains in the cheek-bones, nose, jaws, or in the bones adjoining the ears; or cutting and tensive pains, with stiffness at the nape of the neck, uml clenching of the jaws, twitching of the eyelid, or violent, shooting, tear- ing, and dragging pains in the ball of the eye; jerking pains in the facial muscles and mouth ; heat and redness of the face. The pain is, generally, preceded by itching and creeping in th^ afTected side of the face, and at times becomes so severe as to be almost insupportable. The paroxy s are prone to be excited by rubbing the usual seat of the sufferings. Dose: Three globules in a teaspoonful of water, or dry on the tongue, repeated at intervals of four hours, for the first fc'\vo'days (sliould the pains continue, or recur without change of charact<jr during this period,) and, subsequently, at interviils of twelve hours, for two days (if yet required); after which (if necessary and still indicated) the course may be repeated as before, and so on, until decided and permanent amelioration or change. Platina is appropriate when the subjoined symptoms are predomi- nant. Feeling of coldness and torpor in the affected side of the face, with ill i< Ik DISKASES OF THE HEAD. 17» severe spasmodic pain ; or tensive pressure in the bones adjoining the ears, with u sensation of creeping or cniwling, tmd aggravation or renewal of the sufFerings in the evening, and when in a stateof rest; flow of tears; redness of the face, etc. Dose: Three globules, as directed for Belladonna. Gelseminnin should be given when the pain comes on in distinct paroxysms, and is very severe, accompanied witli twitching and drawing in tlie muscles around the part affected ; the parts in and around the orbit of the eye are most commonly affected. Doi;e: Three globules, as directed for Belladonna. Coloeyuth. Violent rending and darting pains, which chiefly occupy the left side of the face, are aggravated by the slightest touch, and extend to all parts of the head, temples, nose, ears, teeth, etc.; mitigated by perfect rest, and by external v/armth. Dose : Three globules, as directed for Belladonna. Avsenicaiu should be given when there is a tendency to periodicity in the attacks or paroxysms, and the pains partake more especially of a burning, pricking, and rending character, and are experienced chiefly around the eye, and occasionally in the temples ; the suflferings l)eing occasionally of so severe a description as almost to drive the jjatient dis- tracted ; great anguish ; excessive prostration, with desire for the recum- bent posture ; sensation of coldness in the affected parts; exacerbation during repose, from fatigue, in the evening, when in bed, or after a meal; temporary amelioration from external heat. Dose: Three globules, as directed for Belladonna. China should be selected when, as in the instance of the foregoing remedy, there is a tendency to periodicity in the attacks, and when the pains are excessive, attended with extreme sensibility of the skin, and consequent aggravation from the slightest touch; the pains are located below the eye and in the cheek; great prostration after the paroxysms. Dose : Three globules, as directed for Belladonna. Veratrnm is more especially indicated by insupportable pains, which almost drive the patient to distraction ; excessive weakness, even to faint- ing; general chilliness; exacerbation of sufTering on getting warm in bed, or towards morning; temporary relief on moving about. Dose: Three globules, as directed for Belladonna. Spigelia is frequently a useful palliative remedy in all cases when the pain is excessive ; but it is more especially required when the pains are of a jerking, tearing character, ». .acerbated by the slightest touch, or by movement of the affected parts, or when they appear to shoot from the center of the brain to the sides of the head, or to the ears; flow of water from the eyes and nose; further, when the pains partake of a burning and pressive aching character, and liave their seat in the zygomatic process ; glossy ti:mefaction of the affected side of the face ; excessive agitation and anguish ; rheumatic pains elsewhere. Dose : Three globules, as directed for Belladonna. Mezeretun is more especially indicated for burning, pressive pains, coming very suddenly, and which leave the parts numb, attended with cWlliness and shuddering; they are worse from eating warm food, or from entering a warm room; there is frequently redness and burning of the 12 •i I III! S 'V ii I ■ I !'« NEUBALOTA. throat, and a slifiE feeling of the jaws. It is, especially, suitable after the abuse of Mercury, or in syphilitic persons. Dose : Three globules, as directed for Belladonna. Iris Versicolor is adapted to such cases as are associated with ytVA"- Jieadache, where there is a good deal of vomiting of a sweetish mucus, and sometimes of bile. Dose: Three globules, as directed for Belladonna. Nux-vomica should be administered when the pain is mostly below the eye, n,nd the eye is inflamed and watery ; profuse watery disciuirge from the nostrils ; the affected side feels numb. The patient is morose, irritable, belches a great deal, and is constipated. It is, especially, suitable after abuse of coffee, liquors or drugs. Dose : Three globules, as directed for Belladonna. Rhus Tox. will be found useful for drawing, burning, tearing pains ill the face, and a feeling as though the teeth wero too long ; very great restlessness, and tossing about; particularly adapted, if brought on by getting wei. or after wet weather. Dose : Three globules, as directed for Belladonna. Bryonia may be administered, particularly in cases of rheumatic face-ache, when the pains are of an aching, pulling, or tearing description, exacerbated by movement; irritability of temper, and general tendency to rheumatic attacks. Dose: Three globules, as directed for Belladonna. Hepar Sulphuris is also of much service against face-ache, resulting from excessive mercurial treatment, and is more particularly indicated when the pains are so much aggravated by th'^ pressure of the teeth or by eating, that the patient is afraid to allow the crowns of the teeth to meet; pains of a drawing or jerking character, often aggravated by entering a warm room, or by the warmth of the bed at night; also when there is great sensibility of tne cheek and base of the temple, with extension of the pains into the ears, and up the side of the face. Dose : Three globules, as directed for Belladonna. Sulphur is rrequently a medicine of considerable value, whether for the treatment ot ihe immediate acute symptoms, or for the after-treatment, in cases in whicli abuse of mercury has developed a predisposition to face- ache. This remedy is especially indicated by throbbing, drawing and jerk- ing, or burning, aching pains in the bones of the face, and in the jaws, and all the teeth, whecher sound or decayed; or when the pains involve the whole lace, and even head, and are accompanied with determination of the blood to the head, redness and swelling of the cheeks and nose, with suf- fused redness and inflamed appearance of the eyes; or when there are also aching, weary sensations in tlie limbs, or in the small of the back, or catch- ing, stitching, d-dvting paitis in the ears; general chilliness and susceptibility to the least current of air, with sleeplessness during the whole or greater part of the night, and drowsiness towards morning or in the day; cold water or cold applications, and mastication, greatly aggravate or provoke a return of the pains, which are also renewed or aggravated, generally towards evening, at night, or by currents of air. Dose: If against the immediate acute symptoms, three globules, as directed tov Belladonna. If for after treatment, four globules in a- teaspoonful of water, the first thing in the morning, (fasting,) for ten ' he ■k- nd )W >m le. na at by ;ic n, to ed by >t; :a at DS ill ^1] "« ill ''J V or It, k- id lie lie if- 30 b- ty er Id ke ly as a. 3n THE EYE.— PLATE !l. Flff. 1. i!i»' " i Fig. 2. ■ l! DISEASES OF THE EYE. no days, (or until the earlier develonraent of cliange,) tlien pause ten days, after which the course may be repeated, as before, ir any ten- dency to a return of tlie attack should yet bo perceptible, or dreaded. PhosphoruH is indicated by tearing pains, which occur more especi- ally about the left side of the face, and which are further characterized by determination of blood to the iiead, and by a sensation of tiglitness in the skin of tlio face, by aggravation upon the slightest touch or movement of the parts, or by pains extending deep into the ear, and to the root of the ■ ose, and often attended with a confused, shell-like roar in tlie ears. Dove; Tlu'ee globules, as directed for 5eZtado?ma. Pulsatilla, on the other hand, is to be preferred when the pains are usually a-Tgravated towards evening, and at night, or in the morning, when .seated, and when they are somewliat moderated in the open air; or further, wlien t Jiere is general cliilliness with depression of spirits ; or, again, when ! lie patient is of phlegmatic temperament. Dose : Th'ree globules, as directed for Belladonna. THE EYE.— PLATE 1, The eye, while being the great medium for the study of nearly every* thing else, is in itself a study that will excite the wonder of every one who has a taste for the mysteries of nature's workshop. In the beautiful illustration on the opposite page, we see in Fig. 1, the facial surface of eyelids of left eye, with tlie blood-vessels and nerves, which ramify every part in the most wonderfully confused exactness. Fig. 2 is a vertical section of the Orbit and Globe of the eye, through its centre from before backwards, o. The frontal bone. 6. Tlie upper jaw. c. Fat. d. Frontal muscle same as seen at c. in Fig. 1. m. Tlie optic nerve, n. The conjunctiva which covers the front of the ball and inside of the eyelids, the reflection of which is shown at o. r. The cornea, t. The front, u. The rear cornea on wliich every object presented to the vision is photographed for our examination, x. The crystaline lens. z. Corpus vi- trum, a collection of liquid contained in a capsule, to the lining of wliich the optic nerve is distributed, so, like liearing, we must have water to help us to see ; both sound and light are carried in water. 11 ! Ili'l ;d 111 - H! 1'' i^i il % til;.:'' CHAPTER VIII. DISEASES OF THE EYE. OPHTHALMIA.— INFLAMMATION OF THE EYES, ACUTE AND CHRONIC. Ophthalmia is a term applied to inflammation of tlie eyes, whether of the acute or chronic form. All parts of the eye are subject to inflamma- tion, more especially its outer covering (conjunctiva) and the inner sur- face of the lids. At this place catarrhal ophthalmia, purulent ophthal- mia, and inflammation of the iris will be considered. CATAERHAL OPHTHALMIA. Symptoms. The conjunctiva, or white of the eye, becomes swelled, and of a scarlet color, being more or less covered with blood vessels, pre- senting the appearance of what is usually termed bloodshot, with this there is a sensation of heat, smarting, and pain, as if particles of sand were in the eye, and which pain is aggravated by rubbing the eye. There is much pain and uneasiness on exposing the'eye to the light, and sometimes even on the least motion of the Qyeball, so that the ])atient usually keeps the lids closed. A copious flow of hot or excoriating tears is also present. When the disease is very violent, or, in irritable habits, febrile symptoms are manifested. Causes. Catarrhal ophthalmia may be produced by exposure to cold, sudden changes of temperature, blows and other injuries to the eyeball, irritating vapors, foreign particles in the eye, improper exjiosure of the eye to strong light, overtasking tlie eyes by reading or writing late at night, intemperance, and other causes similar to those producing inflam- mation of other mucous surfaces. This disease may be distinguished from rheumatic ophthalmia, by the presence of headache, the greater intoler- liURe of light, and the severe, throbbing pain common to the latter, beside* 180 INFLAMMATION OF THE EYES. 181 In cutarrhul ophthalmia the blood vessels arcapparoiitiy tortuous ami of a scarlet red color, and in the rheumatic form, they are straight, hair-like radiated, and of a pink or violet hue; in rheumatic ophtluilniia the sensa- tion of roughness or foreign bodies in the eye is never present. There is seldom any danger to bo apprehended in catarrlial ophthalmia, when properly treated. PUUULENT OPHTHALMIA. Symptoms. Usually a great itching is felt in the eye, or a sensation, as if a particle of dust were between the lids and the eyeball, and this usu- ally happens at niglvt ; this is succeeded by a sticking together of the lids, generally in the morning, owing to a secretion of mucus. The lids aio somewhat stiff, there is great and uniform redness of the eye, but without pain, tension, or intolerance of light, and a watery fluid is discharged. Tlie disease soon extends to the globe of the eye, with high, vascular action and bright redness, great tumefaction of the membrane, and increased dis- charge. The conjunctiva suddenly swells, and becomes considerably elevated around the cornea. The cornea, appearing, as it were, at tlu) bottom of a pit. This swelling is called chemosis, and is often so great as to overlap and nearly cover the cornea. The yelids swell, ai)d are almost immovable. The discharge is profuse and of a yellow color, and .nay con- tinue for ten or fifteen days without much change. Finally, the chemosis begins to shrink, the discharge diminishes and becomes thin and gleety, and the parts, which were the f .'st attacked, are the last in which the dis- ease disappears. The inflammatory symptoms vary from a mild character to one of great violence, being accompanied with sharp, lancinating pain situated deep in the eye-ball, and which is usually worse at night. Some- times a deep-seated, throbbing pain in the eye comes on in paroxysms, or it may be violent and continuous, without any mitigation until the cornea bursts. The disease may terminate ir bursting of the cornea, abscess ol cornea, ulceration of the cornea, opacity of the cornea, thickening or granu- lation of the lids. Purulent ophthalmia ma> be discriminated from catarrhal by the che- mosis, the bright red meiubrane, x the profuse purulent discharge. The right eye more frequently suffei , and more severely than the left, though the discharge may attack either or both. Causes: The disease is propa'^ated by contagion. It frequently occurs epidemically, and seems to depend upon some peculiar condition of the atmosphere And, under some circumstances, there is no doubt but it may be produced by exposure, injuries and other circumstances, that will occa- gion the catarrhal form. INFLAMMATION OF THE IRIS. Inflammation of the Iris, or Iritis, may be accompanied with rheuma- tism; sometimes with gout, and not unfrequently with syphilis; hence the names, rheumatic iritis, syphilitic iritis, etc., have been applied to these various forms. The disf ase is, however, in all instances, only a modiflca- tion of one, and of the a 'lection. Symptoms. Uneasy sensations are experienced in the neighborhood of the eye, with pains about the forehead, brow, and orbit, extending to the side of the head, There is, also, a redness of the sclerotica or white o* •^1 s ji r I IM DISEASES OF THE EYEJ. the eye, with intolerance of light, and watery discha.ge, as these symptomg increase in severity. The iris, or that part of the eye wliicli surrounds the pupil, and which we judge of the color ut the eye— whether blue, black, etc., —becomes involved. Its color laidergoes a change; first in the lesser circle, which becomes of a darker hue, and afterwards in tiie greater, which becomes greenish, if it were originally blue or greyish ; and reddish, if it were brown or black. The pupil is contracted, its opening being deprived of the briglit, black color it naturally possesses, and the motions of the iris are impeded. Headache and feverish disturbance of the system are gent rally present. After a violent attack, with great diminution of sight, the symptoms subside, the eye recove.-s, and sight is restored. The iris is found to be connected to the capsule by adhesions of white coloi-. The inflammation returns again, and again new adhesions take place; the pupil becomes more and more conti'acted, and finally vision is lost. Occa- sionally the first attack may be so violent as to occasion loss of sight. Causes: It may be produced by cold, and frequently attended with rheumatism, syphilis, etc. Some rheumatic persons have one attack, or more, every year, in which the sight becomes gradually destroyed. ALLOPATHIC TREATJIENT.-Slmple Ophthalmia (Inflammation of the Conjunctiva). In a person who is robust, over-stimulated, or over-fed, a brisk cathartic of a tablespoonf ul of Epsom or Rochelle Salts, or a Sied- iitz Powder, should be given, and repeated in four hours, if a free cathar- sis has not taken place. Such a patient should, also, have a low diet. A weakly patient, or one with impoverished blood, or one that habitu- ally feels tired and sleepy on rising in the morning, after a full night's sleep, should have hearty, blood-making, but plain, nutritious food; also, tonics of Bark and Iron. One or two tablespoonfuls of tlie Infusion (tea) of Cinciionia Bark (one ounce of Bark to a pint of water) may be ^iven iu doses of one or two tablespoonfuls, before eating Tincture Muriate of Iron may be given in doses of from ten to twenty drops, well diluted in sweetened water, after meals. The mouth should be rinsed with water, after taking the Iron. The Citrate of Iron and Quinine, in from two to five-grain doses, will fulfill all the indications. Rest, and temporary protection from liglit, will be required. Frequent application of water, either cold or warm, guided by the feel- ings of the patient, should be made. Quite warm applications are gener- ally preferred, and are more useful. One of the best stimulating washes is a solution of six grains of Alum or one grain of White Vitriol (Sulphate of Zinc,) and two to four grains of the Sulphate of Morphine, in two ounces of warm water. A few drops may be dropped in the eye, two to four times a day, with a quill or camel's hair brush. After using these stimulating applications for a ;few days, their use should be suspended for a day or two, and observe the result; for it does happen, sometimes, that the irritability of the congestion is kept up by their prolonged use. The extreme pain should be relieved, if necessary, by an occasional dose of Opium and Hyoscyamus. For an adult, a quarter of a grain of Morphine, or twenty drops of Laudanum, with one or two teaspoonfuls of Tincture of Hyoscyamus. are suitable doses. The Morphia, or Opium, may INFLAMMATION OF THE IRIS. 183 be given, with one grain of solid extract of ITyoscyaraus, in pill. Font cliild, Paregoric (Camphorated Tincture of Opium) and Tincture of Ilyos- cyaraus, should be used in eciual quantities. Dose: From fifteen drops to a teaspoonful, according to age. "When the ophthalmia continues, and becomes catarrhal (mucus form- ing), the treatment above recommended for simple application will be appropriate. The tonics recommended will, generally, be more urgently needed. Frequent bathing of the eyes, Avith warm water, will be useful. The edgesof the lids should be smeared with Brown Citrine Ointment, or, in its absence, with Castor Oil, or some simple ointment. Tiie stimulating wash, which is followed most rapidly by benefit, is Nitrate of Silver— its use requires the direction of a physician. Two or three drops of a solution of Sulphate of Atropine (two grains to the ounce of water) should be dropped in the eye two or three times a day ; or a solution of half a dram of Extract of Belladonna to the ounce of water. Purulent Ophthalmia usually occurs in persons feeble in general health, and where such is the case, tonics and nourishment are urgently called for. Citrate of Iron and Quinine should be given in doses of from two to five grains, dissolved in water or syrup, three times a dfiy ; or the following: Take of Citrate of Iron and Strychnine a dram and a half, Quinine half a dram, Citric Acid a dram, Simple Syrup four ounces. Mix. Dose: A teaspoonful, three times a day. Or the bitter infusions and Tincture of Iron, as recommended in sim- ple ophthalmia, may be given instead. The diet should be of nutritious, blood-making varieties, but plain. Fresh meat, milk, and eggs, may be allowed. A furred tongue and constipation will call for one or two Compound Cathartic Pills, once or twice a day, until the bowels move. Should the patient be robust and hearty, the tonic treatment snould not l)e pursued, but an active cathartic should be given. Four Compound Cathartic Pills maybe given; or, doubtless, a full dose (one or two tablespoonfuls) of Salts will answer the purpose. In such cases, also, the diet should be reduced. Pure air is a necessity, and the patient must not be confined in bed, if it can be avoided. The greatest care should be exercised to avoid communicating the dis- ease to others. No other person should wipe on the towel or napkin used by the patient. If only one eye is affected, the well eye ought to be her- metically closed until all danger of contagion has passed. The great danger is, that the cornea may become ulcerated and slough, causing complete or partial blindness. I should strongly advise that no case should be treated without a phy- sician. The local treatment will consist of repeated cleansing of the eye by carefully injecting warm water with a syringe; a solution of Nitrate of Silver, three grains to the ounce of distilled water, should be dropped in the eye twice a day, or oftener ; after a few days, a strong solution of Alum (ten grains to the ounce of water), should be substituted for the Nitrate of Silver, and vice versa. fi! Hi 'Ml m :i|:^ ill* 4 'ill i mil J 184 DISEASES OF THE EYE. M t, r: i)uring the course of this disease, a solution of Sulphate of Atropine (twograinstotheounceof distilled water), should be dropped in the eye two or three, or more times a day, according to the urgency of the symp- toms. If the Atropine cannot be obtained, a solution of a half a dram of Extract of Belladonna, to the ounce of water, may be used instead. The pain may require relief by the administration of anodynes once a day, or of tener. Opium and Ilyoscyamus, one grain each of the extract ; or a quarter of a grain of Morphine, a grain of the Extract of Opium, or twenty or thirty drops of Laudanum, with two teaspoonfuls of Tincture of /ITyoscyamus. Wet cups or blisters to the temple may be useful. Attendants often assisting the patient should immediately wash their hands to avoid carrying the disease to their own eyes. Granular Ophthalmia calls for the same general treatment as is recom- mended for the other forms of ophthalmia, and is appropriate under the same st?-t<? of health. The form of iron I generally give is the Pyro-Phos- phate in solution with Iodide of Potassium, the latter having a favorable effect on the disease. Take of Iodide of Potassium Jive drams, Pyrophos- phate of Iron half a dram; dissolve each in two ounces of simple syrup with trituration in a mortar and mix. Dose: Give a teaspoonful after each meal. The bitter infusives recommended in simple ophthalmia may be given, if the appetite is poor. The diet should be good and abundance of exercise should be taken in the fresh air. The edges of the eyes should be anointed each night with Brown Citrine ointment. The nice local treatment demands a skilled physician ; it con- sists principally in inverting the lid and applying the solid stick or crystal of Sulphate of Copper (blue stone) across the granulations. Before the lid is restored to its natural position, it should bo bathed with a camel, hair brush, dipped in sweet oil. Another useful agent, applied in the same way is Nitrate of Silver; it should he fused with Nitrate of Potash, as the pure stick is too caustic. The lid should be washed witli a camel, hair pencil dipped in water, after each application. Liquor Potasse, applied with a camel, hair pencil to the granulations is useful. These agents can be used in succession as the case continues. Once a day is frequent enough for their application. As a wash, a solution of Alum, three grains to the ounce of distilled (or rain) water is useful. If tne edges of the lids are irritable or stick together at night, they should be anointed each night with Brown Citrine Ointment, Spermaceti Ointment, Castor Oil, or lard. Treatment of Chronic Ophthalmia.— The use of artificial light should be avoided, also ill-ventilated rooms and working upon small objects. If it is impossible to do this, care should be taken to obviate the ill effects. Great relief may be had by having a pale, blue chimney, or shade to the lamp or gas jet. Free exercise in the open air should be taken and plenty of regular sleep. The diet should be wholesome, consisting largely of fresh beef, mutton, or chicken, milk, and eggs. Some of the tonics recommended in other forms of ophthalmia will be useful, if the patient is in feeble health. The bowels should be kept regular. The eyes should be frequently bathed with warm water, and a solution of alum or sugar of lead three grains to the ounce of pure rain water, or a solution of Tan- The eye.— plate Fig. I. The an- terior (front) and internal muscles of the right eye. Fig. 2. The upper surface of the orbi- tal (eye) cavity, (the bony structures i<e- ing removed) with muscles and nerves. Tiie means by which the eye is adapted to carefully view objects at dif- ferent distances are very hard to ex- plain ; but it can be understood that in the defect known as short or near-sight- FIr. 1 wmwfW edness, the image, instead of foiling direct and perfect on the retina, is formed by the con- vergence of the rays of light, before the retina is reached ; and can easily, and should be by means ofglasses,adaptedto that particular case by an expert oculist. The far-sighted eye has the focus of the rays of light completed behind the retina, and can well be remedied by good glasses. Fig. 2. i-^?--f , >,' ■,.♦•: ■ V.V/V i*i? ■:^?' -■ % INFLAMMATION OF THE IRIS. 186 nln, ten grains to the ounce of water dropped in the eyes night and morning. It is sometimes well to bathe tlie closed lids after use of the eye water, with cold water. The edges of the lids should be anointed each night with Brown Citrine Ointment. Continual watering of the eyes in the wind should lead to the exam- ination of the lachrymal duct. In all tedious cases, which cannot be traced to a previous attack of catarrhal ophthalmia, or obstruction of the lachrymal duct, the edges of the lids should be examined to see whether an irregularly growing eyelash may not be the cause of the irritation. The irritability of the eyes of students is frequently relieved by bath- ing the eyes in very warm water, and the redness of the edges of the lids can be prevented by the use of Brown Citrine Ointment. The Opthalmia of Newly Born Children.— If the attack is a severe one, recovery.may depend on the health and vigor of the child. The health of the mother, and her ability to nurse the child properly, will govern, in a measure, the chances of the child's recovery with a useful eye. The child may need feeding, but ought not to be weaned, for almost as surely as the cornea becomes ulcerated, the eye will be lost, if the attempt is made to raise the child " by hand.'' The preventive treatment will consist chiefly in the avoidance of the causes which may originate the disease, which are, besides contact with the unliealthy discharges of the mother during birth, etc., rude washing with soap and cloths by the nurse, cold, exposure to strong light, and contagion. The eyes should be thoroughly and frequently cleansed with warm water. Probably this can be best done by a small glass syringe, introdu- cing itat the outer corner of the eye and gently injecting. No harshness should be used, but firmness, for the eye must be thoroughly cleansed. After each cleansing, which should be as often as every hour, a solution of Sulphate of Zinc one grain to the ounce of distilled water or jjure rain water, should be dropped in the eye. In severer cases, (which should be in the hands of a skillful physician,) a stronger solution should be used. Sulphate of Zinc three or four grains, and Alum six or eight grains to the ounce of water. In cases which are not too severe to be treated without a physician, a solution of one grain of Sulphate of Zinc in from two to four ounces of water, will be perfectly effectual. A soft piece of muslin, wet with water, folded several times, should be laid over the eyes and tied loosely, but firmly enciigh to be kept in place. A skillful physician should have charge of the case, if possible. Scrohtlous OPHTiiALMrA is characterized by small serous vesicles which arise on the .ijunctiva. It is especially liable to invade tlie cornea. The afTection is especially liable to occur in feeble persons whose nutrition is not good. Good diet of a plain but nutritious kind is espe- cially called for. Fresh meats, cream, milk, and raw eggs are suitable. Tae Syrup of Iodide of Iron in doses of twenty ops after meals, seems especially serviceable; or the Tincture Muriate of Iron may be given in similar doses, well diluted, with sweetened water. If the appetite is poor, an infusion of Peruvian Bark, Gentian or Quassia, made by maceratinn an ounce of the drwj in a pint of hot water, may he given. Dose : Half a wineglass to a wineglassful. I'Hii 11 ! 'S III I 1 !l ^\\ II fll ■|:li I !■)■, mi 1 w iM 18G raSjEASES OF THE EYE. Or the bitter tonic and iron can be given together by using the Citrate of Iron and Quinine, in doses of two to five grains tlireo times a day. A solution often grains of Tannin to an ounce of water, is a good ap- plication in this and all forms of conjunctivitis, or finely levigated Calomel uuiy be dusted over the vesicles, by means of a camel, hair brush, once a day. The invasion of the cornea should be met with the solution of Sul- phate of Atropliiue, four grains to the ounce of distilled water, dropped in tlie eye with a quill or clean camel's hair brush, two to six times a day, according to the intensity of the pain and inflammation. The edges of the lids should be kept annointed with Brown Citrine Ointment. If a skillful ])hysician can be obtained, he ought to have charge of the case. ALLOPATHIC TREATMENT. In the treatment of Iritis, tlie Hrst thing is to secure and maintain a full dilatation of the pupil, to prevent com- I)': te or partial obliteration of the pupils, by adhesion of the free edges of ilieiris. or by adhesion of the iris to tlie capsule of the crystalline lens, i;r possibly by adhesion of the muscular fibres of the iris. The required dilatation of the pupil is obtained by dro])ping into the eye, from two to four hours apart, a solution of two to four grains of Atropine in an ounce of distilled water. Pain should be relieved by Opium, in doses oi one {jrain, or Morphine, in doses of one eighth grain, or Laudanum, in doses of twenty-five drops, repeated at sucli intervals as may be necessary tu relieve the pain— two to six hours apart. If the strength of the patient is reduced, the Citrate of Iron and Quinine, in three grain doses, dissolved in Syrup of Orange, may be given three times a day. In case the patient is rheumatic, or the disease is obsti- nate, the Iodide of Potassium should be given in Peppermint Water and Syrup, in doses of five to ten grains after meals. Besides the above treatment in syphilitic iritis. Iodide of Potassium should be given in large doses. Mercury will also be required in this form of disease. Iritis should be treated by a physician. HOMOEOPATH 10 TREATMENT. To save space* and needless repeti- tion, we will huiG mention all the remedies needed in the treatment of this affection, viz: Acute, Chronic, Simple, Scrofulous, Purulent, Granular, etc., and that sirising from external injuries. The remedy which will be best suited to the treatment of any particular case, can be readily selected by comparing the symptoms of the case with those mentioned under each remedy. Of course, you will not find all the symptoms that may arise in .my case, under the proper remedy, but the leading symptoms for which that remedy can be fully recommended as curative, will be found, and, on account of the great difference in different cases, there will be more symp- toms mentioned than are likely to be found in any one case. ^con«7e, in inflammation of the eyes, where there is a pus-like dis- charge. The inflammation runs high ; dry hot skin, and full quick pulse; intense redness and swelling of the affected parts, attended with acute pain. Great intolerance to liglit. Fear, anxiety, and great restlessness ; flushed face and throbbing in the arteries of the neck. Done: Six pills in tliree tablespoonfuls of water, of which give one teaspoonf ul every one to three or four hours, owing to the intensity of the symptoms, also as an external remedy. I 'I INFLAMMATION OF THE EYES. 187 SeUadonna in acute Ophthalmia, with very Rroat intoleronoo to light or noise. Vivid redness of tlie sclerotica (white of tho eye) with the discharge of hot salt tears, or great dryness of the eyes, with sonsation as if there was dust or sand in the eye. Sharp pains in tho eyeballs, extending to the brain. Pains which appear suddenly, and disappear just as suddenly. Dimness of vision. Throbbing headache, increased liy motion. , Dose: As for Aco7iite. Cnlcnrea CrtJ'&., for scrofulous sore eyes, with inflammation, redness, and pus or pus-like secretion from the eyeballs, swelling and redness of the eyelids, which are aglutinated (stuck together). Stinging pains, worse (it lamplight. Specks and ulcers on the eyeball, constant desire to keep the eyes in tho darkness, swelling of the glands about the neck, and erup- tion on the hairy scalp, are additional symptoms calling for the use of Cal. Carb. Also chronic inflammation of the eyes. Dose: A powder of four pills every morning and evening. If the improvement is not satisfactory, give a single dose of Sulphur, and after three days, or in acute cases. sooner.return to Cal. Carb. Arsf'tifctim. Inflammation of the lining membrane of the eyelids, and the outer covering of the eyeball, (conjunctiva) and even of the deeper coats of tiie eyeball, with dark redness and congestion of the blood vessek. Burning i)ains; the parts burn like fire. Inflammatory swelling of the lids. Specks or ulcers on tlie eye. Nightly aglutinatious of tlie lids. Great anguish and restlessness. Intense thirst for small quantities of water very often. Dose: As directed for Aconite. Mercurius. — For scrofulous ophthalmia. Violent inflammation and redness of the eyes. Cutting, burning pains, or pressure in the eyes, as if from sand. Excessive sensitiveness of the eyes to the glare of fire, or the light. Little blisters and pimples on the eyeball. Little boils or styes, scurfs around the eyes and on the margins of the lids. In inflam- mation of the iris (colored parts of the eye), this medicine is of great ser- vice. It should nevei- be given in large doses. Dose: As for Calcarea. Pulsatilla. — Aching, or burning and smarting irritation in the eyes, as if from copious secretion of mucus. Disordered stomach, foul tongue, with chilliness towards evening, followed by feverish heat. Piercing, shooting, pricking pains in the eyes with bright redness and flow of tears —especially on looking at the light or going into 'he open air ; or, on tlie other hand, excessive dryness of the eyelids, especially in the evening; sensitiveness, with disposition to weep. Dose : As for Aconite. Arnica is a very superior remedy when the inflammation is the result of an external injury. Use it simultaneously with its external use. (See external applications.) Dose: Internal, four pills every two to six hours. Application (exter- nal) five drops to two tablespoon fuls of water. Apply four times, daily. HOME REMEDIES.— Alum curd, made by stirring or rubbing a lump of Alum in the white of an egg, is frequently applied in domestic prac- tice, and with benefit. Some simple ointment, or oil, applied to the edges of the lids, will »dd to the comfort, particularly at night. ■|!|'!l 111 s !i! I n ! M * I % f ''^1 188 DISEASES OF THE EYE. SnORT-SIGHT, NEAB-SlGirTEDNESS. PnlfiatUla and Sulphur according to indicatioiiH, may be men- tioned as of the chief importance in the treatment of short-sightedness, when this aflection remains as an after ellect of acute inllammation of the eyes. Dose: Of either medicine, as selected, give three globules in a tea- spoonful of water, morning and evening, for a week (or until the earlier development of improvement or change), then pause four days, after whicli the course may, if necessary, be repeated as before, and so on from time to time, until amelioration or change. Ariilnin Phosphoric am is to be preferred in cases in which short- sightedness occui^jras the consequence of a severe attack of typhus, or has been occasioned by debilitating loss of -blood or other animal fluids. Bone: Three globules, as directed for Pulsatilla and ISuIpJmr. Carborrf/,, A('i(lumnit.,ov Sulphur, -wiU be appropriate for the treatment of short-sightedness, when this condition can be traced to exces- sive use of Mercury. Dose: Of Carboveff. or Acid-um nit. give three globules in a teaspoon - ful of water, every morning, — or, of ISti.lpJiicr, six globules in a table- spoonful of water, every morning, the flrst thing (fasting), for ten days (or until tlie earlier development of new symptoms, improve- ment, or change); then pause a week, after which the course may, if necessary, be repeated as before, and so on, from time to time, until manifest amelioration or change. Mi 1 ')(i«f3 BLINDNESS. In common use, this name implies persons who are totally blind, or persons who possess some powers of vision, but not enough to enable them to distinguish the forms of objects. The causes of blindness are both ante-natal (before birth), and post-natal (after birth). It is contended by some, and likely with truth, that influences acting on the mother's niind(psyeologically)may induce blindness in her ofTspring —as wlien the mother has received a powerful nervous impression from witnessing some horrible spectacle, or an extremely disgusting case of sore eyes, or malformation of the eyes. Many cases have been adduced which establish this as a truth in some cases, but not by any nuans with enough to establish the theory as a rule or law of psychological eifeet. The ante-natal causes which are now acknowledged to produce blindness, are the intermarriage of near relations, especially first cousins; scrofula and syphilis. In intermarriage, deafness follows more frequently than blinds ness; in very many, indeed, in almost all of those cases where near rela- tives have married, the ofTspring shows a marked tendency to deficiency of the nerves of special sense; but in most cases, ante-natal, as well as post-natal, blindness is caused by imperfection or disease of the optical apparatus, which is accessory to the nerves of special sense, or, in other words, the defect generally exists in some part of the globe of the eye. Hereditary blindness is not frequent. Of seven hundred blind persons in the institutions of Pliiladelphia, whose parentage is known, only twelve had either parent blind. In Paris, of several hundred children born there, of whom one or both parents were blind, not one was blind at birth. lil BLINDNESS. 189 After birtli, the principal causes of blindness are : 1. Special diseases of the eye, such as purulent ophthalmia, inflammation of the cornea i*nd ot the iris, cataract, or opacity ot the crystalline lens, and amaurosis, or pnral- ysis of the optic nerve. 2. Generid diseases, whose sequela) attack differ- ent parts of the eye, as small-pox, scarlet fever, measles, typlius fever.and other inflammatory fevers, and scrofula. 3. Injuries from blows or wounds, and from malpractice; the latter being the most fnutfnl <f all causes. Hence, we say, in any disease of the eye, avoid all ignorant i)ersons and experiments of every kind and nature, and employ only the highly skilled; if you cannot do that, better let nature alone, using only water to allay the inflammation. HOMCEOPATHIC TREATMENT.-For blindness caused by paralysis of the nerve of vision, from overtaxing the eyes, tliere is nothing tliat will excel the skilled and intelligent use of elkcthicity. We are very far from meaning by skilled, those ignorant criminals, Avho go about the coun- try with their machines shocJcing every one tiiey can persuade to take hold of the electrodes. Atropine, an alkaloid of Belladonna, is a prime remedy where blind- ness is the result of paralysis ; it should be used in small doses, not fre- quently repeated. Aconitunt is th»^ medicine of chief importance in cases of this land, when characterized >»y a general fullness of the vessels, or by a full, hard pulse, and should b* given, first, against the congestion, which is identified by the development of this symptom, as affecting the vessels of the head. It is the more appropriate when this symptom occurs associated with derangement of the stomach, and the c jngestion of the vessels of the head is recognized as of sympathetic origin, Dose: Three pills, in a teaspoonful of water, repeated at intervals of twelve hours, until general improvement or change. Causticun% for sudden and frequent loss of sight, as from a pellicle drawn over the eyes, or as if looking through a mist. Dose : Three pills, as directed for Aconitum. Gelseminuni is indicated by sudden and total blindness, with giddi ness ; the eyes look heavy and dim. Dose: Six pills, as directed for Aconitum. Mercurius will prove of service when there are momentary parox- ysms of blindness, the eyes being very sensitive to light or the glare of a fivv. Dose : Three pills, as directed for Aconitum. acuta Virosa should be given when there is frequent vanishing of sight, as if from absence of mind, with groat giddiness, particularly when walking; when reading, the letters appear to move to and fro irregularly. Dose : Three pills, as directed for Aconitum. Phosphorus is most valuable when the obscuration of vision occurs at twilight, or at night; objects appear as if seen through a thick gray vail; blackness, or black points, or sparks before the eyes. Dose: Three pills, as directed for ^com^M»». Pulsatilla should be selected in cases where there is a sensation, as if the dimness of sight could be removed by Aviping the eyes; great dread of light; frequent and copious lachrymation ; the pupils are con- tracted. Dose : Six pills, as directed for Aconitum. II l« I If' Ml if i \\ M! I' ' i i 11^ s 190 DISEASES OF THE EYE. m w * ,|i,'i " ' 1 Hf 1 m\ 19 WBiljii 1 ill 'li WEEPIXG'EYE.-FISTULA LACHR YMALIS^ WATERY EYE. These names are applied to an ulcerated opening in the little sac, or bag, wliich is situated In tlie inner corner or angle of the eye, and which is technically named the lachrymal sac. Its ollice is to receive the tears and mucus of tlie eye, in order tliat tl-.y may be transmitted from thence to the nose. In tlie early stages, thu aflection consists of a thickened con- dition of the lining membrane of til sac, and the adjacent lachrymal juirts, the result of inflammatory action, and, in consequence of which, the tears and mucus are obstructed in their passage to the nose, and hence escape by passing down over the cheek, giving rise to an habitually weep- ing eye, and an adhesion of the lids after £;leeping. Children of a scrofu- lous habit, and adults who have suffered from rickets, or from swelling of the glands al)out the neck, groin, or other parts, in youth, and who are, more or less, troubled with derangement of digestion, are the most fre- quent subjects of the disease. When the disease is not checked, or in con- sequence of frequent returns of acute inflammation, sloughing ensues, the contentsof the tumor escape through the break thus made in the skin. AVhen the complaint has reached this stage, it presents a much more unsightly appearance, and if neglected or mismanaged, as it so frequently is by means of severe and irritating remedies, extensive inflammation and excoriation, are jM-odiH-ed in all the surrounding jiarts ; in some rare eases a diseased state oi" tlie bones of the nose accompanies or precedes this malady. See treatment of Chronic Ophthalmia. HOM(EOPATHIC TREATMENT. In recent cases the cure is easily and •speedily accomplished by homoeopathic treatment, without the aid of the painful, irritating, and disfiguring local means resorted to in some cases. In those of longstanding, or of complicated character, occurring in scro- fulous, cancerous, or otherwise debilitated constitutions, the successful issue is necessarily of more difficult and tedious attainment. Aconitum is to be selected in all recent cases, but particularly when the inflammation and pain are considerable, when this remedy is of much efficacy. Done: Of a solution of six globules to two tablespoonfuls of water give a teaspoonful every two hours, until the pain and redness iire removed or diminished, or until other symptoms occur to indicate other treatment. Pulsatilla is more especially appropriate for the treatment of per- sons of phlc'^iiiatic temperament and of mild disposition, and when the symptoms have a tendency to become aggravated in the evening or at r ight. In such cases Pulsatilla should be administered twelve hours after the last dose of Aconitum. Dose: Three globules in a teaspoonful of water, night and morning. Nax-voinica is more especially appropriate for the treatment of i)er- sons of sanguine or bilious temperament and of irascible disposition, the symptoms, generally speaking, tending to become exacerbated in the morning. Done: Three globules, as directed f^r Pulsatilla. Gra2ihit€S, Calcarea c, Silicea, or Sulphur, are frequently required to complete the cure, or to overcome the tendency to recurrence BLOODSHOT EYE. IPl of the disenae, after previous treatment, according to the inatructlons dbove aflbrdcd. In the severer forms of the conii)Iuint occurriuy in per- sons of bad constitutions, with or without iniplication of tlie nasal liones, II n uncomplicated cases of lonj? standing?, occu. ing either in children, jrlth or without glandular enlargements, or in adults, tliey are atill luoro frequently needed. Dose : Of either as for Pidsatilla. BLOODSHOT EYE. This derangement may arise from a blow or fall, the act of retching vomiting, or violent coughing, crying, etc. It presents a bright, scarh.t appearance in most instances at the commencement, but usually assumes a livid hue at a subsequent period. The afTection generally disappears of itself; but as it is occasionally liable to prove exceedingly obstinate, the subjoined method of treatment may be rc(iuircd, or such other manage- ment as may be more particularly enjoined in the article on " Exteunal (njukies," or also in that on " Inflammation of the Buain.*' ALLOPATHIC TREATMENT. The immediate application of cold Is generally most serviceable. If the trouble is not ra2)idly removed its cure is hastened by hot appli- cations. In case the congestion is greatly prolonged it is to be treated the same as is directed for conjunctivitis or simple ophthalmia, i)age 182. HOMEOPATHIC TllEATMENT. Arnica nhouia be employed inter- HJilly and externally when this derangement has been caused by external injury, such as a blow or fall, and does not disappear spontaneously, in which case this remedy will quickly promote absorption, and remove the unsightly appearance. Dose {Internal) : Three globules in a teaspoonful of water, repeated after twelve hours, and subsequently, if necessary, at intervals of twenty-four hours, until the discoloration is removed. Application (External) : To two tablespoonl'uls of water, add six drops of the conceiitrated Tincture of Arnica, and bathe the eye or eyes freely with this lotion, tlirce times a day, until the discoloration disappears— only, however, during the internal administration of the same medicine as above directed. Belladonna is preferably indicated when the bloodshot eye is asso- ciated with symptoms of fullness and throbbing of the vessels of the neck. Hushing of the face, oppressive pain in the head and the like, even in cases in which the direct cause of these symptoms is distinguished in a blow, fall, or other external injury ; or again, in cases in whijh the blood- shot eye appears as a symptom of cerebral derangement, as evinced by the associated symptoms, conditions, and circumstances. Dose: Two globules in a teaspoonful of water, repeated at intervals of four hours, until manifest improvement occurs, or such change should ensue as to render other treatment necessary. CATARACT. By this name is understood a partial or general turning white (opac- ity) of the more vital parts of the eye. The formation of a cataract is generally slow, requiring weeks, months, or years for its complete devel- ill* I A\\ ll {|. ' !! < if I II I : I' ^ \ 192 DISEASES OF THE EYE. '■] t opnient. It may appear In one eye or both ; but when tlie former Is the caae, the other eye is generally aftbctod, either nooner or later. In cata- ract all objects, especially those that are white, appear to be encomptussed with a cloud or mist. This disease is beyond the means that can l)e used at home, and must be treated by a good physician, wlio makes this his business. In liis hands a small operation on the eye will, usually, entirely remove the dlfll- culty. CROSfi'EYES.-STllABISMUS, NEARSIGHTED. Tills trouble is usually prt sent from birth, (congenital,) and can then only be cured by a surgical operation, by which the small muscle which turns tlie eye towards the nose is entirely, or partially severed, when the eye will very soon, if not at once, return to its proper position. Tliis operation need.'only require two or three minutes, and give but little pain, and is a i;reat help to any one so afflicted . There is anotlier variety, which is tlie result of too constant and close application of the eyes, espe- cially by lamp light, as in children overtasked at school, sewing girls, etc. This can be cured by at once quitting the work that is tlie cause of the overstraining. As a rule, a little Bell, will help very materially in bet- tering this condition. Blindfolding the stronger eye— the one which is constantly used— for a long time will gnuiually strengthen the weaker eye by the use which Che patient will be forced to make of it. In many cases, the axis of vision in botb eyes will, by this means, become the samewheu the strabismus is spontane- ously cured. As a rule, if the patient can bring the eye which turns in (or out) to the front, or a direct line, an operation should not be resorted to until the means above recommended have been faithfully tried. Other cases are relieved by glasses which will make the focus of vision of both eyes the same. The operation for strabismus should only be practiced as a last resort. STYE. Symptoms.— This is a little hard tumor, a])p'^aring like a small, dark red boil, generally in the corner of the eyelid, atteni'ed with severe inflam- mation, and frequently causing fever; considerable pain and suffering. It suppurates slowly and imperfectly ; usually being from four to six days, and has no tendency to burst spontaneously. Presents a small yellow, or greenish yellow speck, in or near the center; when ready to be opened., touch lightly with a needle, or other sharp point, and apply a little pres- sure, ALLOPATHIC TREATMENT.— Styes may, sometimes, be aborted by the continuous application of hot fomentations. A large flannel cloti), wrung out of hot water, may be applied over the eye, and replaced by another as soon as it cools. I have known tl.ls procedure to cure a begin- ning stye in a day. Sometim ^s extracting the eye-lash, situated upon tlie stye, will be followed by a cure. Carefully brushing the surface of the lid with Tincture of Iodine will, sometimes, prove curative. If pus is formed aud is spontaneously evacuated, the stye should be opened carefully. :' 1 m ♦ 1 III'' III I' ii ' It II liili I* 11 N ml ^^1>i" m > i" ^ii 1 IS ', i ill* THE EAR.— PLATE I Fit:. 1. FiL'. 2. STYE. 193 The general health of a person subject to styes will require attention. HOMCEOPATHIC TllEXTSlEST.—ruIsamia alone, will, in most cases, suflice to remove the stye, it' given upon its earliest appearance. It is a sure cure. Dose: Giv three globules in a tablespoonful of water, morning and evening, .til the stye is removed, or such change takes place as to require other treatment. llepar Snljthiiris should be given when matter threatens to form, (indicated by increased swelling and heat, usually attended with throbbing) in order to expedite the ripening of the tumor. Z>ose: Two globules in a teaspoonful of water, repeated six times, at intervals of three liours. Staphi/sagria should be given two days after the last dose of any medicine previously administered, to complete the cure, particularly when the swelling degenerates into a liard white tumor. Dose: Three globules in a teaspoonful of water, night and morning, for a week, (or until the earlier manifestation of decided improve- ment or cliangej; then piiUHe four days, alter which tlie course may, if necessary, be repeated as before, and so on, until the dispersion of the tumor, or the accidental occurrence of new symptoms. But if no effect be produced within four days after the second course, pro- / ceed with tlie next medicine. Silicca should be employed after the foregoing medicine in some cases, in which, after a second course, the treatment just recomended lias failed to produce any effect whatever, a condition which sometimes pre- vails in bad constitutions. Dose: In every respect, as directed for Staphysagria. Arsenicum, Lycoiiodinui, St phur and Aurani, may be required in addition to tiiose above iircscribed, .u ^ases of stye, which occur as asso- ciated with marked scrofulous taint of ccnstitution. Aurum, it may be liere observed, is particularly indicated when there is obstinate obstruc- tion and formation of scabs in the nose, with redness, and swelling in Ihe eyelids. Dose: Of Arsenicum, or Lycopodiura, give three globules in a tea- spoonful of water, niglit and morning, or of Sulpiiur and Aurnm, six globules in a tablesi>oonfwl of water, every morning, the first thing (fasting), for a week, (or until the earlier manifestation of new symi)toms, or of general imi)i'ovement or cliange,) Mien ])ause eiglit days, at'ter which tlie ronrse may, if necessary, be repeated as before, and so on, from time to time, until manifest improvement or cliange. DiKT. —During the inflammatory stage the diet should be sparing, and the restrictions should be more or less rigid. i « (, £ H ! THE EAR.— PLATE 1. Of all the many wonderful organs, composed of many parts, performing their varying functions in this most wonderful piece of mechanism we call our bodies, there are none more wortliy of careful study than the ear. Sounds low and high, soft and harsli, from far and near, are collected, car- ried into the labyrinths of tlie ear, analyzed, located and recorded upon mernory's tablets by its means. And how unconscious of effort on our part ! How amazingly ignorant are we of how this delicate work is done 1 To say 13 i '^1 104 THE KAK— PLATE 1. Jf !»x-'i !i that the ear is composed of bones held in water, surrounded by bone lined with a tliin membrane, would surprise many; yet it is the truth. Tlie outer ear, called Piima or Auricle— shown in Fig. 1 and 2 with the muscles of tlie left side— is only a means oi assisting in the collection of sound, and possibly by means of nerve communication helping to locate the direction from which the sound comes. The eye only takes cognizance of things in the direct line of view ; the ear stops not at any intervening substance or any number of curves. Fig. 3, a vertical section of the left temporal bone, just back of the joint of the lower jaw, shows the internal ear Tympanum d, Cochlea y, semi-circular canal w, and enables the observer to see how very smiill and fragile these parts must be when comi)ared to the bones of thu skull. Fig. 4 shows the internal organs of hearing exposed conjointly with- out the bony structures. Did you ever realize its complexity V and inside of tills are placed the bones of Fig. 5. Tlie Ossicula or bones of the tym- panum are placed within a cavity in the inner ear called the tympanic cavity, just back of the tympanum, and these bones being supported in fluid, like water, are among the main means of communicating the sound to the auditory nerve. The same bones shown joined together in Fig. 5 appear separate in Figs. 6, 7 and 8, and are called respectively Incas, Malleus and Stapes. Fig. 9 represents the cavity of the tympanum as it appears in the left side, showing the ossicular or small bones as they appear in position, a. Inner wall of the tympanum ; b, finestra rotunda ; d, caput mallei (head of the mallet) ; /, manubrira mallei ; /;, corpus incudis ; ?, stapes (styrup) ; t, the eustachian tube, bony portion leading into the moutli uear the fauce*. DISEASKS OF THE EAR. CHAPTER IX VJo DISEASES •^HE EAR. OTITIS INTERNA.— INTERNAL INFLAMMATION OF THE EAR. EARACHE. [nflammation of the inner ear is chiefly recognized by the extraordi- nary pain (earache) it causes. Tlie pain is cliiefly a tearing, throbbing or burning pain, is very much increased by motion, lilcewise by chewing, loud noise, contact of the outer parts. Inflammatory earache is one of the most distressing tortures that man can suffer. Tlie excruciating character ot this pain accounts for the cerebral irritation wliich is almost always present in this disease. The fever is very violent, and the pulse is hurried and small. The head glows, whereas the extremities are cold as ice; delir- ium and fainting fits set in, before the brain can be said to sympathize with the distress. The outer ear usually shows signs of inflammation ; the passage into the ear is sometimes entirely closed, red and very sensitive, and the swelling spreads to the outer ear and the surrounding soft parts. Otitis is very apt to result in suppuration, and is still more inclined to 8i)read to the brain. It is not certain whether the invasion of the brain takes place more easily when the inflammatory process has reached its higlit, or after the pus has begun to form. Suppuration supervenes bui too frequently during the course of a chronic affection of the bones ; hence suppuration of a bone near the ear, may involve the brain, and lead to a fatal termination, even after all danger consequent upon inflammation, seems to be entirely removed. Otitis may be complicated with a meuin- pitis, which runs a very rapid course, and is one of the most dangerous diseases. Its treatment has already been indicated in a former chapter. Otitis may ti'rniinate, in favorable cases, in complete recovery; this result, howevei , is rare ; generally a disturbance of the functions of the ear remain behind, sometimes assuming the form of perfect deafness. If pus forms, it is fortunate if it is discharged externally, even if the tympanum (ear drum,) should be greatly injured, and chronic otorrhcea (discharge from the ear,) should be the result. Tlie causes of otitis cannot be mentioned with positive certainty. A cold ; and suppressed or receding skin diseases, are among the prominent ones ; syphilis and scrofula are other causes. OTITIS EXTERNA. As we remarked above, an inflammation of the external meatus usually accompanies an inflammation of the internal ear, and, by its pres- ence, always reveals the existence of a higher grade of otitis interna. As an idiopathic affection, disposed, however, to extend to the inner parts of the ear, it is either an inflammation of the cellular tissue, in the external passage, spreading uniformly all around, very painful, but not very dan- gerous, and of short duration, or else it consists in suppuration of one or more glaii(fs of the outer passage. In such a case, a small abscess is seen on one or the other side, more or less deeply in the inner ear. lu this mi !i « .»: 'I X » m 1. ,, i !-■ li i !. i lil I ] i'^ ■{ 190 DEAFNESS. form of the inflammation the pain is, Iil<ewise, comparatively very acute, l)ut usually ceases all at once, when at its hight, by the bursting of the abscess. This inflammation very frequently accompanies, as a compli- cating disorder, an inflammation of the parotid gland, or of other adjoin- ing parts. Erysipelas, likewise, does not un frequently attack the outer ear, and, if it begins at the ear itself, may lead to errovs in diagnosis. OTOBBH(EA. DiscHABaE FROM THE EAR.— As a coiisequence of otitis, but some- times from other causes, we frequently meet with a discharge from the ears, which is, at times, slimy, at others purulent or ichorous, at others, again, watery or bloody. The slimy discharge is of a catarrhal nature, makes its appearance in the cases of many children, whenever they are attacked with a severe cold, and has no special significance. As a gen- eral rule, it very soon yields to a few doses of Pulsatilla. The other forms of otorrhoea are symptomatic manifestations of otitis, and require the same treatment as that disease. Injections of lukewarm water have always a good efTect, and should never be omitted. DEAFNESS. Hardness of hearing may depend upon a variety of causes, by the peculiar nature of which, its curability is determined. If it proceeds directly from the auditory nerve, and is the commencement of complete deafness, it is not likely that much can be done for it by internal treat- ment. If the deafness is caused by a stoppage of the meatus externus, various obstacles may prevent the free entrance of sound, the most com- mon obstacle is the accumulation of indurated cerumen (ear wax) in front of the tympanum. ■ This is most effectually removed by continued injec- tions of lukewarm water, until the plug is loosened, after which it can be readily grasped with a pair of pincers and drawn out. If an unopened abscess is the cause, which is not often the case, its reabsorption is easily accomplished by frequently dropping lukewarm water into the ear, which has to be retained in it for some tmie. A polypus in the passage may, if possible, be twisted or cut off; where this is not possible, the polypus can graduallj' be caused to shrink, by touching it frequently with the half- diluted tincture of of Thuya. If the tympanum (drum of the ear) is injured, a cure is, of course, impossible; in such cai?e, the patients hear often much better by inser< < ig a loose plug of cotton in the ear. This custom is so common, with many people, that they are never seen with- out cotton in their ears. It Is a bad habit, which favors, more than any other proceeding, the formation of little plugs of earwax ; for the nuclei of most plugs, which we have removed in large numbers, were found to consist of cotton fibres. Still more hurtful is the habit of introducing medicinal substances into the ear. We are acquainted with a lady who has been using Camphor in this manner until her tympanum has become perforated in consequence. If little children are hard of hearing, we must ascertain, in every case, whether they have not insertecf something like a bean, pea, millet seed, radish seed, or like articles into their ears. DISEASES OF THE EAR. 101 ALLOPATHIC TREATMENT.— The external canal (meatus) of tlie ear sometimes becomes obstructed by the natural secretion of the canal, owing to some accidental cause. Sometimes foreign paiticles add to the accu- mulation. These are best removed by thorough syringing with an ear- syringe with a warm solution of Bicarbonate of Soda (baking). Before attempting to syringe the ear, the plug somtimes will reciuire previous moistening with a few drops of glycerine. A preternatural dry- ness of the canal of the ear sometimes exists, which is easily relieved Ijy a small quantity of glycerine carried into the canal, occasionally, by a camel's hair brush . It is not unfrequently necessary for the surgeon to have to resort to the use of the ear scoop and forceps for the removal of these obstructions. If, after their removal, there is intense and painful sensibility to sounds, a pledget of cotton, moistened witli glycerine, ui.iy be laid in the exter- nal ear, and retained in place with a bandage or handkerchief. Chronic eczema (salt rheunj) of the ear, generally depends upon some vice of the system, which may be removed by the use of the following tonic, viz. .' Takeof Citrate of Iron and Quinine a dram and a half; Fowler's Solution a dram and a half ; Simple Syrup four ounnes. Mix. Dose: Give a teaspoon ful three times a day. The ear should be syringed out, twice a day, with a warm solution of Bicarbonate of (baking) Soda, and, after eacli cleansing, the following application made by carrying it within the caiiiil of the ear with a cam- el's hair brush: Take of Tannin a dram ; of Oxide of Zinc two drams ; of (jHyceritvi one ounce. Mix. Shake tJie vial, and apply with a camel's hair brush or feather. Inflammation of the external canal {external otitis) occurs most fre- quently in childhood, from exposure to cold, or other causes. The inflammation extends from the outer covering of tho drum to the bony lining of the auditory canal. The danger, aside from the imme- diate pain, is, that the disease may lead to perforation of the drum, and the possibility of necrosis (death of bone and exfoliation). In a few cases, the inflanmiation has been conveyed through the bony wall to the membranes of the brain, causing deatli. As a means of relieving pain, the canal may bo filled with u solution of Morphine four grains, and Atropine two ;j,rains, in half an ounce of Glycerine, applying at the same time, over the ear, several thicknesses of flannel saturated with hot water. Laudanum may be used instead of Morphine, but it is not so efFectnal. If this does not pro- cure relief, the inflammation is deeply seated, and may eventuate in necrosis, if not relieved. Such cases should be in tlie hands of a surgeon. It is probable that the most, or only effectual treatment is, to cut down to tlie bone through the whole length of the auditory canal. Usually the inflammation subsides in two or three days, superseded by a more or less profuse discliarge. This is called otorrhoea. Otorrhoea (discharge from the ear) is a symptom, or consequent of many affections of the ear ; but from whatever cause, it requires in itself about the same treatment— tlie frequent use of the syringe. Warm water should be used, and should, generally, be rendered slightly alkaline with a little soda. If tlie dis- charge does not soon disappear, astringent washes should be used. A 1 1 ill' ^iii J 'Hi; 13! Ml 1 •f 1 ii % ,» I "lit '■, f^a :: , if. !•: ii ^.;i m .'II 'ii : ^V m ■l|;'i 11 Pi'* 198 INTKUNAL OTITIS. dram of Tannin, in an ounce of Glycerine, will frequently prove effectual. The Tannin may be added in nmch larger quantity. It can be applied with a camel's hair brush, or a feather. A solution of Sulphate of Zinc, or Alum in water, may be used instead. After using one of these, time should be given for it to take effect, and then moisten the ear with a very little Glycerine. In all cases of discharge from the ear, not dependent on evident inllam- raation of the canal, or previous intkimmation of the internal ear, examin- ation should bo made for disease of the mastoid cells (in the eminence behind the ears called the mastoid process,) which may require incision, and; perhaps, trephining (boring into them). Intkrxal Otitis. Inflammation of the middle and intei'nal ear is very serious, the pain is deep-seated and intolerable, attended with throbbing, con- fusion of the head, and fever. The inflammation is probably advancing to suppuration, possible disease of the internal eai', and permanent deafness- The drum of the oar should be closely watclied by frequent examination with the speculum, and as soon as matter has formed, shown by the altered color and form of the drum, the drum should be punctured by the surgeon, and the pus let out. In this way the patient is not only spared much pain, but more serious damage, from the drum breaking down beyond repair; and the chances are also better for recovery witliout disruption of the internal ear. The tliroat is almost always inflamed. Tiiis should be met by appropriate treatment. Mustard plaster to the neck, or rubbing the neck with turpentine or harts- horn liniment, or the constant application of flannels wrung out of liot water, and astringent gargles of Sulphate of Zinc, a scruple to a teacup of water, or the application of Tannin in Glycerine (one dram to the ounce) with a linen mop, or such other suitable treatment as a physician would direct. The Eustachian tube should be inflated. This can be done, if a physician is not in attendance, by closing the mouth and nose, and making forciblej.expulsion of the breath simultaneous with the act of svvallov/ing. External applications will be the same as directed for external otitis. Otalgia {or Neuralgia of the ear) uncomplicated with inflainmaticjn, is, I believe, very rare. It may be connected with some irritation of the mouth, as a decayed molar (double) tooth, or it may be due to some irrita- tion of the stomach, or some other organ supplied by the pneumo-gastric nerve. In these cases the trouble is reflex and its treatment consists in the removal of the offending cause. If no such cause is discoverable, and espe- cially if the pain is intermittent or periodical, such general treatment should be resorted to as is recommended in the article on neuralgia. Scune relief may be given by applying over the ear, warm poultices of hops or poppy heads, or by pouring into the ear a few drops of Laudanum, Tincture of Aconite, or Belladonna, or the three may be mixed and diluted with a little glycerine. The local means for the relief of pain directed for exter- nal otitis are effectual here. Not unfrequently is the administration of an anodyne necessary. So often is earache caused by inflammation and the production of pus or mucus, that 1 believe the drum ought always to be thoroughly examined with the ear speculum, and, if indications of either are present, the drum ouglit to be punctured by the surgeon, and relief will follow the escape of the pus or mucus. DISEASES OF THE EAU. 199 Deafness. Some of the causes of tleiif ness which may be removed by domestic hajid, are the following: A dried accumulation of the natural secretions of the canal of the ear, (meatus) may prevent the vibrations of sound reaching the tympanum (drum). This obstruction may be rendered still more complete, by wool or cotton with which the person negligently stops his ears, neglecting to prac- tice proper cleanliness. This obstruction is easily discovered. Its removal is best efTected by thorough washing with warm water, or a weak solution of Bicarbonate of (baking) Soda, witli a hard rubber ear syringe. A com- mon four ounce, hard rubber syringe, may be used, taking the precau- tions to wind the nozzle with muslin, until it is too large to penetrate the canal, except just at the point. A tin cup, with one side flattened, should be held under the ear, to catch the outflow of water. The injections should be continued at one or repeated sittings, until the canal is clean, and the passage to the drum is unobstructed. When the accumulation is unusually hard, it may be softened by moistening with Glycerine or bland oil, as Almond or Olive Oil. A deficiency of seci-eUon in the canal may be partly overcome by mois- tening it with Glycerine, or Sweet, or Almond Oil, until the natural secre- tion returns. This may be hastened by very warm water injections and the application of essential oils, as Turpentine. They may require dilut- ing with Glycerine, or Sweet Oil to prevent too much irritation. ThicJiening of the lining membrane of tlie meatus may cause deafness, the lesult of chronic inflammation. It may be overcome by applying a mixture of Tincture of Iodine with Glycerine and Tannin. Take of Tannin one dram, dissolve in hat f an ounce ofQlycerine, then add half an ounce of Tincture of Iodine, apply twice a day with a cameVs hair brush, or a feather. Attention to the general health is required, by the use of tonics aa recommended in Eczema of the ear. Other causes of deafness require the attention of experts. HOMCEOPATHIC TREATMENT. Inflammation o^ the Eaus. Aconitiun is required in commencing treatment wlien the alTection is attended with considerable febrile disturbance, dry heat of the skin, with fullness and quickness of pulse. Dose: Of a solution of six globules to two tablespoonfuls of water, give a teaspoonful every two hours, until the indicative symptoms subside. Belladonna is indicated when there is determination of blood to the head, with redness of the face, by digging, boring, tearing or shooting pains extending to the throat ; fever and extreme sensibility to the slight- est noise; wlien the pains are more severe internally ; also, when the brain partakes of the inflammation, and delirium is present. Also, in external inflammation of the ears, when the inflammation runs high, and threatens to extend to the face and scalp. Dose: Six globules, as directed for ^com'^wm. Ilepar siilphuris should be administered twelve hours after the last dose of Belladonna, if, after the second day from the commencement in* ! P Ml ■ / ■'*. Ml '■' \\k - ;!i r v. 'I * t 1 I 1 : ■I soo miEUaiATlU KAUACIIE. ,;»>■ f Ik,,' ''' '■' ^i»:i«, i: of treatraeut, the pain and Inllammation be not completely reduced ; or, again, and more especially in cases in whicli suppuration ani discharge have taken place. Dose: Three globules in a tnaspoonful of water, repeated at intervals of twelve hours, until decided and permanent improvement or change. Sulpfnir. Tills medicine should be administered twelve hours after the hist dose of Hepar sidphuris, if the discliarge of matter, in particular, .sliould continue unarrested; or twelve hours after the fourth dose of Mervuriun, if, in addition to the discharge of uiatter there should be huin- miny in the ears and pricking pains. buse: Three globules as directed for Hepar sulphuris. Mefcurlus should be selected when the following symptoms and conditions characterize the case :— Shooting or tensive pajns in the ear, extending to the cheeks and teeth ; sensation of coldness in tlie ear ; increase of suffering in the warmth of the bed ; inflammation and indura- tion of the ear, with soreness of the orifice, and discharge ; swelling of the glands. Also, in external inflammation, particularly when the adja- cent glands are involved. Dose : Six globules, as'directed for Aconitum. Pulsatilla is a most valuable i-emedy in this affection. It is partic- ularly indicated when the external ear is simultaneously much affected, and appears inflamed an<i swollen; attended with heat, shooting and tensive excruciating pain .uternally ; moisture in the ear, or somewhat copious discharge. This medicine is particularly useful for females and individuals of chilly habit. Applicable, also, to most cases of external inflammation of the ears. Dose : Six globules, as directed for Aconitum. NERVOUS OR RHEUMATIC EARACHE. Pulsatilla is not unfrequently indicated for the treatment of cases 'of nervous or rheumatic earache, which ensue, from time to time, as the consequence of antecedent inflammation; or more particularly, if there be a tendency to discharges from the ear, or if the ear be habitually moist. This is the best remedy for earache in most cases. Dose: Of a solution of six globules, to two tablespoonfuls of water, give a teiispoonful every half hour, (when the pain is very distress- ing,) or every three hours, (in less severe cases,) until a degree of improvement takes place; after which the intervals should l)e gradu- ally extended to twelve hours, and the administration thus continued, until the cessation of the pain, or the occurrence of other symptoms, requiring different treatment. Phytolacca should be administered when there is shooting pain in both ears, the right being worse, aggravated by swallowing ; feeling as if the ears were stopped up, with crackling sounds in them ; the sense o£ hearing seems dull, while it is really more acute. Dose : A solution of six globules, as directed for Aconitum. Nux-vomica is preferably indicated when the pains are of a tearing, shooting nature, extending to the forehead, temples, and bones of the face, worse towards morning ; dryness of the ear, particularly when the affection occurs in persons of a lively, choleric disposition. Dose : Of a solution of six globules, to two tablespoonfuls of waiter, give a teaspoouful every hour, (when the pain is unbearably severe,) DISEASKS UK HUJ LAU. 201 or every three liours, (in less distressing cise.s,) iinl:il ;i degree of amelioriition becomes iipi)areiit; after wliicli tlie intervals should he gradfially extended to twelve liours, and the administration thus continued until permanent and decided iinprovement or clian'^o. DnlcaiHara Hhould be selected when the affeiition has arisen from a chill or wettint,', and will, in many cases, prove suflicient for its removal; it is also indicated when the paius increase at night, and are attended with uuusea. Dose: A solution of six globules, as directed for Nux-vomku. Mercurius should be employed when the pain is attended with a sen- sation of coldness in the ears, and is characterized by exacerbatiuii in tlie warmth of the bed; or, again, when there are shooting or tensive pains in the internal ear, extending to the cheeks and teeth. Done: A solution of six globules, as directed for Nux-vomica. Chamoniilla should be administered when there are stabbing pains in the ear, as if knives were driven into the head; great sensitiveness of noise, and even of music; extreme sensitiveness, susceptibility, and irrita- bility. Dose: A solution of six globules, as directed for Nux-vomlca. Snnfjuinaria should be exhibited when there is burning of the ears, with bright redness of tlie cheeks, and headache accompanying the ear- ache; the neck feels stiff; painful sensitiveness to sudden sounds. Dose: A solution of six globules, as directed for Nux-vomlca, Arnica is often of much service for the treatment of individuals of a nervous, excitable temperament, subject to attacks of earache, provoked by trivial causes, and is, moreover, characteristically indicated when tliere is an excessive sensibility to noise. Dose: A solution of six globules, as directed for Nuos-mndca. China is frequently suitable after Arnica, in cases in which the last named medicine has been productive of partial relief only, and when, moreover, the pains are aggravated by lying on the ear, or by contact. Dose: A solution of six globules, as directed for Nux-v<mma. Sulphur should be administered, if the excessive sensibility to noise should constitute a predominant indication; it is, especially, suitable to persons subject to catarrh, or tendency of the blood to the head. Dose: Three globules, in a teaspoonful of water, night and morning, until permanent improvement or change. HOME TREATMENT.— Patients who are subject to attacks of nervous or rheumatic earache, should be very careful and moderate in the indnV gence of their appetite; and the food should be simple but nourishing. Fermented and spirituous liquors, coffee and strong tea, etc., are capable of themselves of provoking an attack; and, inasmuch iis a tendency to derangements of the digestive functions is very frequently to be distin- guished as characterizing the predisposition to earache, it is very essen- tial that those things should be avoided which are likely to engender irreg- ularities of digestion, however apparently trivial. Everything which is known to operate as an exciting cause, should, as much as possible, be avoided. Moist heat may relieve. Humming or Buzzing in tub BAns.—Kux-vomica will be found of service in the treatment of recent cases of humming or buzzing in the ears, when this annoying affection is most predominant, or the symptoms are aggravated at night. I. <» !■. S J, ^ ■ ;f SMd DISCHABOli: FROM THE KAtt, 11 '' m 1 :1ft i| ■ m Dose: Six glohulea, in a teaspoonfiil of wiitor, moniiiiR aiul ovening. for a week; tlien ^)au3e a week, lesuminR the udininistration alter the hipse of that time, if yet required. rulsafil/a is to l)e preferred when tlie evening is more ospocially tlie period of exacerbation, and for persons of a mild character, particularly females. J)ose: Six globules, as directed for Nitx-vomica. C'auHticHtn.—LouA vibration of all sounds, and even of the patient's own voice,. Dose: Six globules, as directed for Nux-vomica. Mercurlus is more distinctly indicated when the attacks are attended with sioeatiufj. Dose: Six globules, as directed for Nux-oomiaa. DisciiAROK FiioM Tiiii Eak. — Avsenictiin should be given when the discharge is profuse, smells very badly, and makes the adjacent parts sore ; also when there is prostration and weakness. Dose: Give four globules, in a teaspoonful of water, night and morn- ing, for four davs, (or until tlie earlier development of manifest; im- provement or change,) then pai'^e four days, after wliicli the course may be repeated, as before, if necessary, and so on, until manifest improvement or change. Aurum will be found to be useful in chronic cases, particularly after the abuse of mercury, under old school treatment, where the discharge is tetid, and the bones of the ear are diseased. Dose: Four globules, as directed for Arsenicum. CV/?6'a/'t(* CVtrft., should be administered in chronic cases, when the discharge looks like matter, the glands of the neck are swollen, the abdo- men is large, aud there are other evidences of a scrofulous constitution Dose : J''our globules, as directed for Arsenicum. Carbo Vcg. is suitable after the suppression of itch, or itcli-like erup- tions ; the discliarge is offensive, the ear is inflamed, and sensitive to touch. Dose: Four 'obules. as directed for Arsenicxim. Ileiiar Snlphuvis may be administered when the discharge is very profuse and mild, particularly in scrofulous persons, or when it results from acute inflammation of the internal ear. Dose : Four globules, as directed for Arseiiicum,. Sulphur is indicated when the discharge consists of offensive matter, particularly if the left ear be affected ; eruptions behin<l the ears, which itcli, and bleed after scratching. Dose : Four globules, as directed for Arsenicum. Mercurius is indicated, if the affection be of syphilitic origin ; the ears itch, the face is covered with little pimples which secrete pus. Dose: Four globules, as directed for Arsenicum., Pulsatilla will be found to be a very valuable remedy in the treat- ment of this troublesome affection. It is indicated when tlie discharge is the result of a cold, (catarrhal) or follows acute inflammation of the ear. The discharge is usually thick and yellow; the ear is red and swollen, and there are stitch-like i>ains in it. The left ear is commonly affected. Dose: Of a solution of six globules, in two tablespoonfuls or watei give every three hours, if required, a teaspoonful. ti ll 't Ml l?f it i •¥■ I PI II 11 i •1 1 1 p. •I ' I'J. f > • ■ i .' ; ^ I i •! THE EAR. -PLATE II. I! f'"! ■ i" ¥■ I Mm ■« Fipr. 10 FiK. 12. Fig. 14. Fi-. 15. THE EYE AND NOME. ^03 CROSS SECT I OX OF UK An. Cross sfiction of the IIciul in w lioi i/untul direction, the eyes niul n'^'^al cavities Ix'iiif^ cut tliroiij^li :ih joii look down \ipon tlu\ cut piirt. />'. li. Arteries snp])lvintj tlic l>r;iiii with hlood. ('. C (Jonimcnceni- ..t of tliO()i)li<!niTveH. I), \V^iier(( the inner thrc^iidsof tlufoptio nerves cross e;u:li oilier. It Nv'ill be seen how tli(M)i)ti(r nerve of the ri},dit eye hiis its ori}^in in tin.' left Hide of the brain, and tli(! left in the right side. E. E. Tlio optic nervein the cavity of tiie eye. i*'. i''. Muscles of the eye-ball <t. V i t r e o u 8 (.'rystaline Ions, l)eliind the J)Ui)il, its capsule is the ease called ca- Iris (meaning a called from the colors ill dividnals; circular tain thro' circular tiie inser- p u p i 1 I G. Thocye ball. (glassy) body. 6. lies immediately and either it or seat of the diii- tar act. c. Tiio rainbow) so- fact of its various different in- it is a thin shaped cur- which is a aperture for tion of the of which light is the eye. The ties near tlie cut are the nose extending opening to that admitted to two long cavi- centre of the passages of the from the front in the back of the mouth, ar^d on the mucous membrane lining these cavities becoming in. llamed depend those terrible Nasal Catarrhs. THE EAR.— PLATE II. Continuing the subject of the ear and a study of its parts from Plate II., we see in Fig. 10 the long labyrinth of the left ear external surfaee. The sound enters the parts before (IS at a, called "finestra ovalis," and runs its course around and through these various curves. Fig. 11 shows the same parts as Fig 10, cut through the centre to show the inte- rior of the labyrinth. Fig. 12 ilhistrates the manner in which the acoustic nerve is dis- tributed to these same parts coming in one nerve, as shown enlarged above e and/; it is divided into hundreds of fine fibres, and distributed to ev6ry minute portion of the inner part of tiiis bony labyrinth. Then in Fig. 1.3 appears the very fine linings of the laby- rinth. Fig. 14. The ))ouy cochlea with one side removed to show the internal arrange- ment of the same ; these "curves are curious, being two and one-half circles c, d, c, respec- tively. Fig. l.j. The cochlea cut through from apex to base to show the bony structure of th2 vvmc Ilk ' 1 li tJ I ; n r 7M niSEASES OF THE NOSE, m h m *« C'H A P T E R X. DISEASES OF THE NOSE. CORYZA, CATABRII.—COLD IN THE HEAD. Catarrh of Ihe nasal m neons membrane is one of the most common and most fnuiuently occnrrinj,' affitctions. A simple catarrh arises from a cold. Jriilividnals who watch them- selves somewhat, know very well, that if they feel ciiilly from exposing themselves to a cnrrent of air, after Ixdn;^ heit.;d, they will liiive a catarrh witliin twelve hours. Sovei-e attacks always coiiuncnoe wiiii a febrii'; sensation, lassitude, dull headaclie, es{)ecially ubovtH.he root of the nose. At first one nose is drier than usual, sensitive to cool air, the smell i3 sornetimes remarkably affected; there is a tingling in the nose and a desire to siueze. If a discharge takes place at the commencement, it is generally very tenacious, yellowish, or almost entirely watery. In most cases the adjoining parts are involved, especially the tonsils, which are slightly reddened, and where a stinging pain is experienced. The larynx is likewise affected, the speech being somewhat hoarse. A i)ecnliar symi> torn is the remarkable frequency of the pulse^ with which some persons be(!onie affected at the commencement of a catarrh, and the striking eleva- tion of the temperature. Among children, particularly, the constitutional symptoms are much more striking than among adults; whereas the latter continue in tlie enjoyment of a sound sleep, children, on the contrary, spend restless nights. Usually, after tho lapse of twenty-four liours, a copious secretion of mucus takes place, after which the patient feels better, and the constitutional symptoms disappear. Within nine days at most, the patient is completely restored to health, unless a relapse should have taken place. This very common form of catarrh scarcely requires to be treated medicinally. Cases may, however, occur, where the secretion remains copious and watery for three or four days, the pati(;nt feeling very much indisposed and very anxious to be freed from his com- plaint. Moreover, in the course of tiie catarrh, relapses may take place, in consequence of which, the feljrile exacerbations may increase to such an extent, that a catarrh, whlcii was, at Qrst, quite unimportant, becomes a real torture. Under favorable circumstances, especially if the patient exposes him- self to frequent relapses, or, is otherv/iso constitutionally predisposed tu the complaint, the acute form passes into the chronic. Generally, the chronic form consists in a profuse secretion of mucus, without any othei trouble. Freiiuently, however, the profuse mucus secretion is accompa- nied by swelling of tho mucous membrane and impeded respiration. After a number of relapses, the swelling increases to such a degree, that breath- ing through tho nose becomes impossible, v/hich gives rise to a number of ailments; tho speech has a nasal twang, the tiiroat hurts in consc(iuence of the dryness induced by breathing exclusively with the mouth open, and sleM."'- is variously disturbed. These difficulties remain even after tlie COLD IN TjIE head. 205 mucus secretion has entirely ceased ; in that case, they are even more unbearable than before. If there is a peculiar predisposition, such as scrofulous, the internal parts of the nose becomes inflamed, side by side, with the catarrhal irritation, and an ulcerative process sets in, which secretes a foul-smelling purulent matter, (ozjena). A bad smell from the nose may, however, take place, without any ulceration. The structural clianges in the mucous membrane frequently gives rise to fungoid growths, polypus, etc. ALLOPATHIC TRVATKEm,— Acute Coryza.— Many times a cold in tiio head may be promptly relieved by inhaling the vapor of Iodine every three or four minutes, for an hour or so. Each inhalation should occupy a minute. The Iodine may be vaporized by merely holding a bottle of the Tincture, or Compound Tincture, in the warm hands under the nose. Greater heat increases the strength of the vapor. Pure Bromine may be inhaled in the same way, with btneflt. Should a prolonged sitting of an hour at the inhalation of the Iodine vapor fail, I recommend inhaling into tlie nose the fumes of cigarettes made of white blotting ])aper, soaked in Fowler's Solution; and, in case a cu 3 was not affected by a night's treatment with the opiate, etc , followed by a cathartic in tlie morning, I would give two drop-doses of Fowler's Solution, three times a day, for a few days. Hot baths (air, vapor, or water,) may often do good. Hot applications, as the use of very warm water, applied with a sponge, or nasal douche, are also useful. Protection of the body from wet or cold is necessary to prevent recur- rence of the attacks, which may result in chronic catarrh. Treatment of Chronic Oataruii.— Tliis is both local and constitu- tional. The nose should be thoroughly cleansed by a warm nasal douche. This must be completely done, and to effect it, the douche must be contin- ued as long as any of the secretion appears in the water as it flows from the nose. In the absence of a regular nasal douche, an ordinary flexible syringe, made to act as a siphon, can be used. The tube sliould be wound with muslin until it closes the opening of the nostril. Then^ is, sometimes, an advantage in adding a little Salt, Alum, Sulphate of Zinc, a half to a quarter teaspoonful of Permanganate of Potash, to the pint of water, (especially if the breath is bad). After a thorough cleansing, the frequent inhalation of Compound Tincture of Iodine, with Carbolic Acid, is beneficial. Take of the Compound Tincture of Iodine half an ounce. Carbolic Acid half a dram, and inhale from the bottle. The vapor is generated by the heat of the hand clasping the bottle. The same mixture, diluted with an equal part of Glycerine, maybe applied to the liiiing membrane of the nose, with a camel's hair brush, twice a day. It should, also, be well arpliei' to the posterior nares, through the throat, by thrusting the brush well up behind the palate. Other substances, which are useful for inhalation, are Ihomine, which may be vaporized from the bottle, by the heat of the hand, and Iodoform. The latter is vaporized by sprinkling a little of the powder on a saucer, and applying heat. The vapor is con''ucted to the nostril by a paper or pasteboard cone. Drepared for the purpose. ii ¥\ 's lli ) IM^ I 1 i! 206 DISEASES OF THE NOSE. m \m mm 1 ' The following ointments, applied through the nostril, are useful: Take of Gitrim Ointment two drams, Extract of Belladanna half a dram, Simple Ointment half an ounce. Mix. Apply with a cameVs hair brush, twice a day. The ointment may need softening, by warming, before using it, or Take of Tanin one dram, dissolve in seven drains of Qlycenne, and add a dram of tlie Fhtid Extract of Belladonna. Apply to the nostril, two or three times a day, with a camel's Mir brush. Supposing the catarrh to liave been of very long standing, in addition to douches, vapors, and astringent applications, attention will need to be directed to constitutional treatment. Two remedies, which do especial good in cases of habitual discharge from the mucous membrane, are Iodide of Potassium, and Arsenious Acid, and if the patient is feeble, Iron should be given, also, as in the following formula: Take of Iodide of Potassium five drams, dissolve in two ounces of simple sijrup, and mix with a solution of half a dram of Pyrophosphate of Iron, with tioo ounces of simple syrup; then add two and a Jmlf drams of Fowler's Solution. Dose : A teaspoonful after eating. Other tonics may be needed to meet any existing state of the system, as if tlie patient should be feeble, the Citrate of Quinine and Iron, in two to five grain doses, three times a day, will be retiuired to build up tlie apijetite and strength. If this is given, the iron should bo oiuitted from the former formula. Nourishing diet is always to be given. If the patient craves sour drinks, or digestion is poor, Muriatic Acid, in filtoeu drop doses, before <!.iting, will be useful. It should be largely diluted in sweetened water, and the mouth rinsed after taking. Not unfrequently a change of air to a locality which agrees best with the general health of the patient, is of the greatest advantage. This treatment is, also, adapted for the extreme cases of catarrh with ulceration and offensive discharges, called Ozseiia. HOMCEOPATHIC TREATMENT.— f;rtJMi>/«o/' (Concentrated Tincture). This medicine, if employed upon the earliest development of symptoms of cold in the head, will sometimes suffice to arrest the progress of the affec- "tion at once. It is particularly indicated when the premonitory stage of the complaint is characterized by fits of shivering and headache. Dose: One drop of the concentrated tincture, on a small lump of sugar, three times, at intervals of ten minutes, then twice at intervals of an hour, and, lastly, twice at intervals of four hours. Aconitum may precede, or be given alternately, with either of the next two remedies, when, in consequence of the swollen and congested state of the lining membrane of the nostrils, a painful sensation of full- ness, heat, and smarting is experienced; and, also, when active fever symptoms supervene. Bose: Of a solution of six globules, to a teaspoonful of water, give every three hours, until the indicative symptoms subside. If in alternation with muK-vomica, or with any other medicine, give six pills separately of each, so that four hours elapse between doses. Niix-vomica is, generally, preferable to all other remedies in the first stage, and, especially, when there is dry obstruction tiuring the niglit only, with pressive heaviness in the forehead, and confusion in the head; heat in the head and face, increasing towards evening. If these sensations occur COLD IN THE HEAD. 20T in combination with othsr catarrhal symptoms, refer to the indications afforded for the exhibition of this remedy, under the heads of Horseness anil Cough. This direction equally applies to the other medicines here quoted. Dose : Six pills every two to six hours. Mercurius is indicated by profuse discharge, producing excoriation, swelling or redness of the nose, pains in the head and face. This is a valu- able remedy in the generality of ordinary eases of cold in the head, partic- ularly when the complaint is epidemic. Dose: Two globules in a teaspoonful of water, night and morning, for four days, out, if within twelve hours after the second dose the symptoms continue to become aggravated, notwithstanding treat- ment, proceed with the next remedy ; or, if the nasal discharge and watering of the eyes predominate, consider Euphrasia. Jlepar-sulphuris is chiefly of service when only one nostril is affected, or, when there is headache, which is aggravated by tlie slightest movement; or, when the complaint is renewed on each exposure to cold air; further, in most cases in which Mercurius, though apparently indi- cated, has produced little or no improvement, when it should be admin- istered six hours after the second dose of that medicine. Dose: Four pills in a teaspoonful of water, night, morning and noon. If, however, the headache continues unabated, within six hours after the second dose of Hepar, consider Belladonna. Euphrasia should be employed six hours after the second dose of Mercurius in preference to Ilepar-s., when the discharge from the nose is excessive, and there is, at the same time, confusion of tlie head, with red- ness of the eyes and eyelids, and copious, acrid or scalding flow of tears. Dose : Three pills in a teaspoonful of water, every three hours, until improvement or change. Belladonna should be administered, ii. the headache continues una- bated, or when it becomes associated with a sensation of heat and fullness about the head and eyes. When the sense of smelling is variously affected, being at one time too acute, at another time too dull, there will be addi- tional reason for resorting to this remedy. Dose : Six pills in a tablespoonf ul of water, repeated at the expiration of four hours, and .again after an interval of eight hours, if the indi- cative symptoms be still predominant. Natrutn-tn. is indicated by cold in the head, renewed by the slightest chill or exposure to a current of air ; obstruction of the nose every second day. Dose : Four pills in a teaspoonful of water, night and morning, foi a week. Kali-hichront is indicated by swelling of the noso and nostrils, with copious watery secretion, and diminished sense of smell. Dose : Four pills in a teaspoonful of water, night and morning, until amelioration or change. Arsenicum is indicated by obstruction of the nose, with, at the same time, discharge of a thin, acrid, excoriating phlegm, and burning heat in the nostrils, etc. Suffering relieved by heat; pain in the back; feeling of general debility, or prostration of strength. Dose: Two pills in a teaspoonful of water, every three hours, until amelioration or change ; but if only partial relief ensue within three hours after the fourth dose, pause three hours more, and proceed with next remedy. III lit % ;>' III if: '* I 20S DISEASES OF THE NOSE. '■if 'JP :,!! Septa, in clironic catarrh, with pressive pains in root of nose; sore feeling ill nose on drawing tlie air tlirongli; nose swollen and inflamed: nostrils ulcerated; scurfy nostrils; discharge of yellow water from the nose, with cutting pains in the forehead; dryness of the uose and throat. This is an excellent remedy. Dose : As for Mcreiiriiis. Dnlcamava should bo given, if, after the previous administration of the two preceding remedies, fresh obstruction is provoked by the sliglitest exposure to aii*. Dune: Three pills in a teaspoonful of water, night and morning, until permanent amelioration or change. Pulsatilla is indicated when the nasal discharge is thick, fetid, greeuisii-yellow, < r rr>ixed with clots of blood; loss of taste and smell, head- ache, sneezing, chill, especially towards evening; disposition to weep, low- ness of spirits, heaviness or confusion of the head in a warm room Dose: Three pills in a teaspoonful of water, night and morning, for four successive days. ChanioniUla should be selected when the affection has arisen from checked perspiration, and there is an acrid discharge from the nose, causing redness of the nostrils, and excoriation or soreness under the nose ; chapped lips; shivering loith thirat. Dose: Of a solution of six pills to four tablespooiifuls of water, give a tablespoonful every three hours, until amelioration or change. Ami:: on i it m-carb. is often of service in cases of cold in the head, with copious discharge, particularly of an acrimonious, burning, watery fluid ; hoarseness, tickling, suffocating cough, with alternate heats and cliills; or stuffed nose, especially at night; swelling and painful sensi- bility of the nostrils ; dryness of the nose. Dose: Three pills in a teaspoonful of water, every four hours, until amelioration or change. Difficulty in Breathing.— Jpecrtcw-cfH/ta should usually be se- lected instead of Aoonitum and the successive remedies, when tlie sudden suppression of cold in the head is followed by difficulty of breathing. Dose: Six pills in a teaspoonful of water, every three hours. If, how- ever, witliiii two hours after the third dose, there be no decided relief, pause four hours longer, and proceed with the next nunlicine. Bryonia should be administered six hours after the third dose of Ipecacuanha, if the employment of the latter medicine has been followed by inadequate relief, and the difficulty of breathing still continues pain- fully predominant. Dose: Four pills as directed for /j9eca/3?*an/ia. Tf, however, there be no positive relief within two hours after the second dose of Bryonia, pause four hours longer, and proceed with the next medicine. Sulphur should be administered six hours after the second dose of Bryonia, in cases in which the second dose of the last named medicine has been productive of inadequate benefit. Dose: Four pills in a teiispoonful of water, morning and evening, for three days. CONSTITUTIONAL SUSCEPTIBILITY TO COLD IN THE HEAD. Calcarca is very generally of service in overcoming the extreme susceptibility to cold, which distinguishes some constitutions. This remedy COLD IX THE IIKAD. 209 Is, espcciall.y indicated when the attacks of cold in tlie head of infants, at the period of teetMng, occur, accompanied by oppressive breatliing. In general, also, Calcarea is of service when the attacks are liable to be pro- voked by every change of the weather. Dose: Four pills in a teaspoonful of water, at bed time, two days in succession. Repeat in one week. Silicca should be employed upon the subsidence of a repeated attack, in cases (as just stated) in which Calcarea has, apparently, failed to modify tiio predisposition, Dof-e: Four pills, as directed for Calcarea. Pulsatilla is generally of great service in the treatment of predispo- Hition to cold, when the attacks are complicated . with marked derange- ment of the digestive functions, especially for persons of a mild and sensitive dirsposition and lymphatic constitution. D'ric; As for Cdlcnrea- HOME REMEDIES.— In view of the obstinacy of chronic catarrh and of (lie bad consequence it may intail, among which loss of smell is one of (lie most important, it is certainly advisable to devise a course of ti'eat- iiicnt that shall prevent relapses. Oneof the most useful means to accom- plish this result, is a gradual hardening of the whole body by means of cold water. Cold water is altogether an important remedy in the treat- ment of catarrh. When drank at the outset of an acute attack, in con- siderable quantity, it very soon moderates the most disagreeable sensa- tions; and, in the chronic form, it renders good service when drawn up into the nose several times during the day. This last-mentioned use of water, likewise, acts as an excellent prophylactic. For catarrh, properly speaking, it is better to draw up tepid instead of cold water ; tepid water loosens the tough mucus better than cold. In the chronic form, likewise, cold water is often much less suitable than warm water, which feels nmch more pleasant. That it has a favorable effect upon existing ulcers, is evi- dent were it only by cleansing the suppurating surface and preventing the formation of crusts. It is well known, ttuit coi)ious draughts of some lukewarm beverage are likewise recommended for catarrh ; it is undeni- able that it has an excellent effect in catarrhal conditions of the respira- tory organs. This management, however, seems so annoying to many persons, that only a few are willing to take this trouble. Of much more importance is the use of water in the epidemic catarrh of the respiratory organs ; we shall revert to its use when treating of this disease. An ordinary proceeding in domestic practice is to excite a profuse perspira- tion. It is undeniable, that this proceeding moderates the course of a catarrh, almost without an exception. Nevertheless, serious doubts may be entertained against such a course. In the first place, sweat is sought to be excited by medicinal herbs. This conduct is decidedly reprehensi- ble, for the reason that the organism should never be drenched witt: medicinal decoctions without the most urgent necessity. And, in th second place, the skin is rendered more susceptible to cold, which is muci: worse than that the first cold should remain uncured. If the skin is to be excited to increased action, the best and least hurtful means to accom- plish this, is a moderate vapor-bath ; or, if we desire to excite perspiration in the bed, we may drink a glass of warm water with a little syrup. n U J i , h'-\\ fUO DISKASKS OK THK NOSE. iU,J m 'H i^iii i-i I •■ Permnngnnate of Potash, dissolved in water (just enough to give a beautiful color), is an excellent remedy for the offensive odor from a bad catarrh. PoLYi'r IN Tilt: Xosii:,— If we except the cancerous growth, there are two distinct kinds of jjolypi. One is a simple fungoid growth of the nasal mucous membrane, and owes its origin to chronic catarrh; the other ia rather an idiopathic growth, with vessels and cellular tissue. These excrescences sometimes impede respiration to such an extent, that they have to be removed, either by an operation, or by medicinal treatment. That the latter is sometimes adequate to their removal, has been placed beyond all question by numerous successful results. In treating a nasnl polypus, we use the following remedies : Calcarea carboniai, i n the higher attenuations, is recommended by many authorities, likewise for polypus excrescences of the Schneiderian membrane. We have never been able to obtain any good from its use in this disease. Against cancerous i)olypi, we frequently find useful: Kall-hkhromiciim, Phoxphonis or i<u?phnr. The result of the treatment, however, in such cases, is much less favorable than that of mucus polypi. INFLAMMATION OF THE NOSE, NASITIS.' Inflammation of the Schneiderian membrane generally occurs ui der the form of a more or less intense catarrh, of which it is very frequently a symptomatic manifestation. The ulcerative process, to which attention has been called when treating of catarrh, dei)ends upon v-his inflamma- tion. The treatment is conducted with the same remedies that havo already been indicated in the former chapter. There is another form of nasitis where single follicles are attacked, in consequence of which abscesses form. This disorder is very painful, and it is desirable that its course should be shortened as much as possible. The best remedy for this purpose is Mercurias; Hepa?- Sulp?Mris niay, likewise, prov iseful. In some cases, if the afTection is just beginning, it may be well to commence the treatment with Belladonna, The appli, cation of a warm fluid does uie same good here as in any other abscess. Inflammations of the no.se, which constitute partial manifostations jf other constitutional afTections, will be spoken of in connection witli tlie latter, where the proper treatment will likewise be explained. A peculiar inflammation of the na.sal mucous membrane, which bears the greatest resemblance to eczema of the external skin, and frequently spreads in the form of an eczematous proce.ss to the external nose and 1(» the lips, results in a continual formation of crusts and runs a very slow course, requires for its cure Mei'ourins, Kali biaJiromicnm, or in more chronic cases, Qraphites. Inasmuch as the cure does not take place very rapidly, it is well not to change the remedy too .soon, EPISTAXIS.— BLEEDING AT THE NOSE. Bleeding at the nose is one of the most frequent occurrences; no organ is as e:isily inclined to bleed as the nose, the ca<ite of which has to be sought in the peculiarly delicate structure of its nmcous membrane, in its great vascularity, and in the circumstance that the nose is remarkably exposed to external influences and injuries. BLIiKDINO AT TlIK NOSF. 211 Bleeding at the nose generally sets in une\pectcdlj' without any pro- cursory symptoms, which, when existing, consist of congestion about tiio head, such as hcudaclie, vertigo, buzzing in tlie ear, etc., or fever. Gen- erally, the bleeding takes place oniy from one nostril, and, as regards quantity, varies from a fe\/ drops, mixed with nasal mucus, to whole pounds. Sometimes it is a s )arcely perceptible flow of blood, sometimes a mere dribbling of a few drops, and sometimes, but very seMoin, the blood rushes out in torrents. Accordingas the bleeding vessels are located, the blood is poured forth from the external nostrils, or else from the ])os- terior nares into the pharynx. The latter result is apt to occur at night during sleep. On waking, the patient vomits up the blood, or, if it had run into the larynx, it is coughed up, leading both the physician and the l)atient to suppose that he had an attack of hicmoptysis, so much the more when tlie co-existing symptoms render this supposition more or less founded in fact. The bleeding may continue from a few seconds to whole days. If the single turns follow each other in rapid succession, it may often seem as if the bleeding continued for days. The causes are various ; but if a good deal of blood is lost, it is always desirable to investigate them with accuracy. There is, undoubtedly, such a thing as a constitutional predisposition to nose-bleed, in consequence of which the vessels are abnormally inclined to All up and burst. This pre- disposition may even l)'e hereditary, although it does not show itself in the looks of the individual. Besides this, a marked flowofbiood to the nose, or even to the whole head, is one of the most frequent causes ; like- wise, mechanical impressions, ulcers of the mucous membrane, ami, finally, a peculiar comi)osition of the blood, which favors the exudation of the l)lood, as in typhus, scurvy, etc. The frequent appearance of nose- bleed at a time wiien the barometer is very low, causes us to adopt the theory that tlie atmosphere exerts a peculiar pressure, resulting more par- ticularly in the production of congestions about the head. Although nose-bleed, as we stated above, is, generally speaking, an occurrence of trilling importance, yet, under certain circumstances, it accjuires a peculiar significance. In the first place, the quantity of the blood that is lost by one or by asei-ies of successive l)leedings, may b(; .so great that t»;e most dangerous symi)toms of anajmia (bloodlessness) may result^rom such a loss. In the next place, the hemorrhage is dangerous in such conditions as auicmia and typhus, which do not bear any loss oi' blood. It is, undoubtedly, wrong to view the nosebleed in such condi- tions, as a critical endeavor of the organism, although such a view ,seeiii.s justified by momentary amelioration of single symptoms, especially, the congestive head symptoms. Such an improvement is very soon followed l)y a so much more disagreeable aggravation. Nature thus points out the value we are to attach to artificial bleedings, and that they, at most, only palliate the distress at the expense of the general organism. In little children and old people, nose-bleed is always a dangerous occurrence. ALLOPATHIC TREATMENT. Hemouriiagk from the Nosr. The neck ties, collar or binding should be unloo.sened, and the neck left per- fectly free. The application of cold water to the nose or back of the neck ilii I *v\ ' a !' ! I, i 'X . i ■ l!«f iiri,, j!. ^ 21? DISEASES OF TIIR NOSK. may stop the flow. ^ Strong solutions of Alum, Sulpliate of Zino (whifp vitriol,) or Tannin may 1)0 iippliod to the nostril by snuffing it from tlio hand, or inserting plugs in the uoho, soalied with the solution. In urgent cases, if you have solution of the Persulphate of Iron, or the powder, it may be carried well up into the nostril with a swab, and may stop the flow by forming a clot. Powdered Alum with Tannin may be snuflTed into the nostril dry. If a clot of blood is formed in the nose, it should be left undisturbed until it conies away of itself, for meddliii".' with it may rekindle the bleeding. If these means fail, and a surgeon is not available, it may be necessary to plug the nostrils by domestic hands. To do this, a twine well waxed, is passed through a gum-elastic catheter, and both are then passed through the nose into the mouth. By means of a hook, crotchet needle, or forceps, the twine is drawn forward and made fast to a piece of sponge or plug of cloth. ]Jy removing the catheter and drawing on the twine projecting from the nose, the plug is drawn firmly into the nares. It should not be removed for forty-eight hours. Should bleeding continue from the nose, the anterior nares may also be plugged. Gallic Acid, in doses of a scruple, with twenty drops of Aromatic Sul- phuric Acid in water, may be ^iven internally every three or four hours. Tincture of Iron, in doses of thirty drop.s, well diluted, may be given at the same intervals, or Ergot, in doses of a teaspoon ful of the powder, or fluid extract. Turpentine in doses of ten to twenty drops in mucilage or syrup, from two to four hours apart. The bowels should be kept regular, with mild laxatives. The diet should be nourishing meat, potatoes, celery, and fruits. » HOM(EOPATHIC TREATMENT, vlcon^wm is indicated by prolonged or violent bleeding at t.ie nose, in plethoric subjects, with a considerable degree of fever, flushing of the face, pulsation of the arteries of the tem- ples and neck, or general fullness of the vessels of the head. Dose: Of a solution of f . globules to two tablespoonfuls of water, give a teaspoonful ev( half hour, until amelioration or change. Belladonna is frequently of the greatest service when there is bleed- ing from the nose at night, wliich awakens the patient from sleep, and sometimes returns in the morning; bleeding from the nose from bein:^ overheated. I)nse : Four globules, as directed for Aconitum. lirf/onia is preferably indicated by bleeding from the nose, chiefly in tlie morning, or at night during sleep, causing the patient to awake; or wlion it arises from suppressed menstruation, or from overlieating during warm weather ; obstinate or irritable disposition. Dose: Four globules, as directed for Aeonitxim. Mei'enrius is of great service against bleeding of the no.se during sleep, or while coughing, with speedy coagulation, so that the blood hangs in clots at the nostrils ; or when the aft'ection is preceded by a sensation of tightness round the head, as if it were bound. Dose: Four globules, as directed for Aconitum. Carho-v. is of essential service against bleeding at the nose during the night, with ebullition of blood ; violent nasal hemorrhage in the morning while in bed, followed by pain in the che,st; discharge of a few drops of blood from the nose every forenoon ; excessive bleeding from ulrkd'No at the nose. 211 the noae Heveral times a day, particularly after stotyping, or after every exertion, preceded and followed hy great paleness of the face. Dose: Two globuhs in a teaspocnful of water, morning and evening, for three days (or until the earlier development of improvemenl or change); then pause four days, after which the course may, if neces- sary, be repeated as before. Graphites may sometimes prove useful against bleeding of the nose towards night, with heat in the face, preceded l)y determination of blood to the head, in the after i)art of the day, particularly in females who have svanty menstruatUni. Dose: Two globules, as directed for Carbo-v. Pulsatilla, is indicated by discharge of blood from the nose every afternoon, evening, or before midnight, especially in females with sui>- pressed or scanty menstruation, or in those of a mild and placid disposi- tion. « Dose: Four globules, as directed for Aconitum. //«/«rtm<^//.s should be administered in cases in which the blood is dark colored and Hows sluggishly but profusely. It is also useful if the nosebleed be complicated with bleeding of the lungs, or if resulting from suppressed menstrual flow. One of the best remedies. Dose: Four globules, as directed for AconUum. Veratfum Alb. will be found ellicacious, when there is present, death- like paleness of the face, coldness of the surluce of the body, and slow, intermitting pulse. Dose: Four globules, as directed for Aconitum. Arnica, in addition to being the principal medicine in violent nasal hemorrhage from external injury, or from great jihysical exertion, is, moreover, an important remedy in all cases in which the hemorrhage ia preceded by itching in the nose and forehead; and when the nose feels hot, and the blood discharged is red and liquid. Dose: Four globules, as directed for Aconitum. Jlhus, id appropriate for the treatment of bleeding of the nose, occa- sioned by physical exertion, such as lifting a heavy weight, or when blowing the nose, spitting, etc.; or for discharge of blood from the nose, which becomes aggravated or renewed on stooping, or during the night. Dose: Four globules, as directed for Aconitum. China is generally to be selected when the loss of blood has been very considerable, aud when the patient is much weakened before assistance is rendered. Dose: Four globules, as dir».cted for Aconitum. Ferrttni should be employed after the previous administration of China, in cases in which the last named medicine has been productive of partial amelioration only. Ferrum is, moreover, of much service in the treatment of bleeding of the nose occurring in debilitated subjects, with excessive paleness of the face. Dose: Two globules, as directed for Carbo-v. Sepia. Frequent attacks of hettiorrhage from the nose, with pale or sallow comi)lexion, especially in females with obstructed menstruation. Dose: T J globules, as directed for Carbo-v. .yiw-v. is inore particularly indicated by bleeding of the nose, espe- cially in the morninj, from being overheated, or from the suppression of I !V •it A I ^ r\ ': !' J 214 DISEASES OP THE NOSE. Hil !Ui accustomed (li.sclmrge, such as that of piles ; also, after drhiking wine, etc., or in iiiil)itunl drunkardH. Dose: Four globules as directed for Aconitum. Crocus is useful for dlscliarge of darlt-colored, thick, or viscous blood from the nose; tiie blood iiaiigs in long black strings; i)articulariy in females who menstruate too copiously, sometimes followed by fainting. Dose: Four globules, as directed for Anonitum. Moschus ia tmiuently serviceable vvlien tl»e bleeding of the nose occurs in nervous, hysterical femali s, or wlien the bleeding has continued to depletion, and iXwvo is spasmodic jei king of the nmscles. Dose: Four globules, as directed for Aconitum. Silicca is an excellent remedy for the treatment of those obstinate and sometimes habitual di.schar.tjes of l)lo()d from tlie nose, wliich occur in persons of a marked scrolulous liul)it of body. Dose. Two globules, ns directed for Cnrbo-v. HOME REMEDIES. Wlieii Ihe liemorrhage is of an active kind, tha patient sliould be placed in tlie erect jjosture, and kept ttool and »iuict for bome tinie afterwards. When there is reason to fear sulTocation from the bleeding conlinuing inwardly, and getting into (Ije tliroat, as is lial)lo to liappen in extremely debilitated subjects, in wliom Utile or no reaction appears to Ibllow tlie administration of the remedies, t bo anterior and posterior outlets from" tiie nose may be plugged; the latter i)y passing tlireads up the nostrils, and bringing tlieni out at the mouth, then securing pieces of sponge, or smalls rolls of lint, to the ends ; after tliis the threads should be drawn back, and tied sufficiently tight so as to bring the plugs somewhat lirmly against the orifices. Cold water, ice, snow, or cold or cooling articles applied to the liead and neck are beneficial, when the bleeding is eoideiUly caused by excessive flow of blood to the head. Diet and Regimen.— In all cases in wliicli bleeding of the nose occurs, otherwise than as the result of a mere casual accident, (and even then, until the discharge is tliorougly subdued), tlie diet siiould be j)lain and unstimulating; it sliould, nevertheless, be nourishing, for— altliough, in many cases, as this discharge occurs in the place of some oilier natural evacuation, the system is not so much exhausted tliereby as migiit be aiiti(!ipated— it may still be looked upon aa an indication of some local or general debility. The state of tlie organs of digestion sliould, therefore, be subjected to close attention, that any irregularities may be obviated, and tliat proper nutrition may be promoted. Regular habits, early hours, avoidance of over-intense application, extremes of temperature, or of excesses of any kind, a fair proportion of exercise in the open air, in favor- aljle weather (but witliout enduring fatigue), and tlie like, are essential. In cases of very debilitathiy and long-continued discharges of blood from tlie nose, change of air and scene will often materially assist in tlni restoration of the patient. JPAR-T FOUR,TH. THE GATE. CHAPTER XI. DISEASES OP THE MOUTH AND THROAT. 8TOMATIT1S.-INFLAMMATION OF THE MOUTL\ CANKER OF THE MOUTH. We comprehend under tliis name all the catarrhal affections of tb«» mouth and fauces, from simple hyperajmia to the formation of erosions, aphtha). Generally speaking, it is a mere symptom of some more general die* ease. In a few cases it is an independent disease, with a tendency to run a chronic course, and torment the patient to sucli a degree, that it becomes necessary to proceed against it. In such cases, we find certain places of the mucous membrane, most frequently the arch of the palate and the under side of the tongue, covered with spots of various sizes, of a uniform bright, and very seldom of a dark, redness, causing a feeling of intense burning, impeding mastication, and frequently disappearing very suddenly in order to break out again in some other part, and running altogether a very obstinate course. A catarrhal affection of the mouth and fauces accompanies the most diversified diseases of the digestive apparatus, as well as of the organs adjoining the mouth, and acquires importance, not so much from its inher- ent dignity, as from the fact that by it, we determine thecondition of other organs. The coating of the tongue, for instance, which depends upon the degree and form of stomatitis, is, undoubtedly, an important diagnostic sign. The main symptoms of catarrh of the mouth are painfulness, which is particularly prominent in the case of little children; altered taste, secretion of a greater or less quantity of tenacious mucus, attended with diminished secretion of saliva, fetid smell from the mouth, some- times frontal headache. The chronic form of catarrhal stomatitis is, likewise, characCerized by an unusual secretion of mucus, altered taste and bad smell from the mouth, which is even perceptible to the patient. Of more importance is the chronic form of catarrh of the fauces, which is 215 ill- II U' I n 1 1 V ,: *t;-'-I '^ftr 2lG DI8I:ASE5 op TIII2 MOUTH AND THROAT. % a 8()iur(» of great annoyance. It is generally met with amonj? sinjter^. smokers, drinkers, and is, likewise, one of tlie remote consequences ul syphilis. If the alFcctioii springs from the last mentioned cause, it lill.-* tiie i)atients with great anxiety, liecause tluiy are in eonslant dread oi' a sypliilitic affection in the mouth. It is generally conlined to the posterior wall of the pharynx; the tonsils, however, are fre(iuently involved in the morhid process. Tlie affected part shows a sonunvhat dee|)er redness, i.-> traversed with distinctly inj(!cted, varicose vessels, is more or less swollen, sometimes exhibiting granulations, and at times streaks of swelling, so lliat tht! nnicous membrane seems'divided in regular parallel \niiiy eleva- tions, l»etw(!eii and on top of which streaks of a very tenacious, yellow mucus are seen. This secretion of tenacious mucus is the greatest torture to the iiatii.'nts, for the affection is not painful of itself, but only becomes s(» wheii, by the constant etTorts nuidc; to hawk u]> tlie mucus, the mucous nu'tnbrane of the fauces becomes irritated. This trouble is always very ol'stinate. "Hy aphtlue, we understand a peculiar disorganization of the mucous lining of the moutii. Aphtlue, generally, sets in with the synii)toms of ;icute catarrh of the mouth, seldom without premonitory symptoms, hav- iii;^' the appearance of small watery or whitish blisters on the lijts, tongue or cheeks, surrounded l)y a narrow, red areola. They soon break, leaving small ulcerations of the skin, with a yellow or yellow-gray baseband a vividly red, sharply circumscribed border. With the outbreak of the blis- ters, the fever often disappears, and only continues, if the eruption, instead of breaking out all at once, makes its appearance in a successive series of crops. The single little ulcer usually heals very rapidly, and it is only under very unfavorable circimnstances that more deeply-penetrating ulcer- ations and diphtheritic menibr -'s formations take the place of the sim- ple aphthaj. Stomatitis proper, tb .ammation of the mucus lining of the mouth, commences wi ymptoms of a violent, more or less exten- 8ive hyperjemia, from .v.li, however, it soon differs by the greater swelling of the more especially affected parts, particularly the gums. Every part of the mouth is very painful, not even the softest nourishment can be taken without intense pain; if infants are the victims of this disor- der, they refuse the breast very obstinately. In the further course of the disease, the gums look dark-red, with whitish streaks, but, at any rate, at the beginning, without any loss of substance. There is no increased secre- tion of mucus, but profuse ptyalism, with metallic taste, and disagreeable odor of the breath. Fever is always yr t, sometimes to a high degree, and attended with the most threatening ceiebral symptoms. After a while the digestion becomes impaired, the deficient nutrition leads to a loss of strength, which is still increased, by the fact that the sleep is usually very much disturbed. In the higher grad'S of the inflammation, the salivary glands are always very much inflamed, swollen and painful. This disorder scarcely ever runs a rapid course; it lasts at least seven days, and may become very much protracted by secondary- ulcerations and inflammation of the salivary glands. In this way the lives of little chil- dren may be placed in jeopardy, or by an extraordinary increase of the cerebral irritation and appearance of convulsions. CANKKU 0>' tin: MOl'TII. 217 IH The inoibitl pioci'saes of Iho iiiiicoiis uit'inbiaiu! of the iiioutli, wliic'i \v(> liiivi! ciimucriitt'd si/ fur, occiii- uiiicli inoie frnjiR'ntly, aiul broak oui, imicli more readily in tlie orgaiiiHiiis of ciiildn'ii, tliiin in tlioso of adults. Wlictiicr tiih is owing to tlie ^'leater delicacy of the infantile mucous incnihiane, or to delicient nutrition, is not very clear. Moat diseases of this class, uinoiiK infants, at any rate, undeniably arise from the circum- stance that tlie mouth is not kept .siilliciciilly clean; whereas, on the otiur hand, stomatitis often attacks children where the utmost eleaidiness is observed. One great cause of the (lis(>ase, is the pernicious habit of giving children the breast much too trecpiently ; not only is the proper digestion interfered with by this pernicious hul)it, but the mouth cannot be kept clean when It is continually lined with milk. A mother cannot be too careful in this respect; a slight derangement in the functions of the mouth is sometimes sulllcient to interfere with the assimilative process, and to bring on a condition of tilings that must inevitably lead to the deteriora- tion of the infantile organism. Ti!i:ATMKNT--We have placed these apparently different, and yet in many respects, homogeneous diseases together, Ix.'cause the remedies which tiiey require are generally the same, and unnecessary repetitions are thus avoided. ALLOPATHIC TREATMENT.-TiiE tki:atmi:nt of Stomatitis is not, as a rule, very complicated. In follicular .sore mouth and the aphthous sore mouth of children (thrush) a mouth wash of two drains of Chlorate of Polaah, half a dram of Caibolic Add, to eh/hi ounces of tvater, is gener- ally ellicacious. The Borax and Honey ot domestic practice, or preferably Borax and Glycerine, (two drams to the ounce) applied with a camel's hair brush or pencil, is also generally effectual. Or a weak solution of Sulphate of Zinc (White Vitriol) or Alum will generally effect a cure. In ulcerative sore mouth, (canker,) Chlorate of Potash is almost a spe- cific. It should be finely pulverized, and mixed with an equal part of pulverized sugar The powder should be sprinkled on the ulcerated surface. Alum makes a serviceable application, by touching each ulcer with the crystal. Oiher astringent applications are useful, as Sulphate of Zinc, (White Vitriol,) Sulphate of Copper, (Blue Vitriol.) Xitrate of Silver (Lunar Caustic,) touching each ulcer with the dry salt, or Tannin sprinkled dry upon tlie surface of the ulcer. In infants there is probably no better treatment than the Chlorate of rotasli. The powdered salt may, also, be given internally to children, in doses of five grains, in sugar and water. When these painful ulcers occur periodically, the ulcers may be touched with Muriatic Acid, applied by means of a pine stick. In case there is any derangemei'it of the stomach in these latter cases, the internal use of the Dilute Muriatic, or Nitro-Muriatic Acid, in doses of fifteen drops for adults, well diluted in sweetened water, three times a day, is often extremely ben eficial. The general health will need attention, poor digestion is assisted by Pepsin alone, or with Bismuth. The ordinary do%e of each is five grains. Impoverished blood calls i'or bitter infusions of Peruvian Bark and Iron. The bitter infusions are made by niacerating a dram of the crude drug in a pint of water— the dose a wineglassful. The Citrate of Iron and Quinine, in doses of two to five grains, generally, fills all the indications. •«, M II'! i 1>18 DISEASES OF THE MOUTH AND THROAT. The Elixir of Bark and Iron, or the Compound Syrup of Hypoplios- phites, witii a fourtli part Dilute Phosphoric Acid, in doses of a teaspoon- ful to an adult, tiiree times a day, will be useful. The diet should be nourishing and digestible, as is recommended below. In nursing sore mouth, th*^ above treatment is applicable, but the chief object is to support the y u m so that the waste will be supplied. The diet should consist of niejit, i gg; , milk, cream, oat meal, graham, etc. The Citrate of Iron and Quiniuf , and Syrup of the Hypophosphites, will be materially boneficial. HOMEOPATHIC TREATMENT. Belladonna. We can safely say, that in all cases where the lining membrane of the mouth becomes red and inflamed, without the appearance of little blisters, or sores, Bell, is the best remedy. It acts most powerfully on the organism of children, while they are most liable to these inflammations. It is most appropriate in the con mencement of the attack; the higher the constitutional symp- toms run, the more appropriate this remedy becomes. In chronic catarrh or inflanmiation of the mouth, it is of very little use. Dose: Six pills in three tablespoon fuls of water, of which solution, • take a teaspoonful everyone to four hours, as the ease is more or less urgent. Mercnriiis is a specific ii. cases where there are little blisters or sores (aphthfe,) as Bell, is where there are none. It is suited to every grade of the disorder, even to ulcerations of the mucous lining. Dose: Ah for Belloflonna, Other remedies are Nux-v., Dulcamara and Nitric Acid. The latter, for that form of the disease which is the result of the use of Calomel, or Mercury, in too large doses. HOME REi^IEDIES. Precautions in diet, are particularly important in cases of children and infants. A frequent cleansing of the mouth, has a palliative and curative effect, not only in the case of children, but in that of adults. Warm water is the best means to cleanse the mouth. Tae use of fat food must be strictly forbidden; after eating fat food, every symptom of the disease becomes aggravated . Cooling washes are usually to be recommended. Honey and Borax, a weak solution of Aium, or Sul- phate of Zinc used as a gargle or wash. ^f ANGINA.— SOBE THRO AT.- APHTHOUS SORE THROAT. By this name we understand an inflammatory affection of the poster- ior (back) parts of the mouth and pharynx. According as it consists only in a catarrhal irritation of the mucous lining, or in actual inflammation of the parts, it is divided into catarrhal and tonsillary angina, which are two distinct forms of the disease. Catarrhal Angina is synonymous with acute catarrh of the pharynx and the posterior buccal cavity. The disease usually arises as independent of other affections, less frequently in the course of other catarrhal pro- cesses. Its most common cause is a cold; it likewise breaks out as a symptom of scarletina, less frequently as a symptom of typhus, and some- times it seems to spread even epidemically. Many individuals have from their youth a peculiar disposition to catarrhal angina, without showing in #!'•; SORK TIIUOAT. 219 iiiil their external appearance any signs of a peculiar irritability or weakness; on the contrary, they are persons of healthy-looking and vigorous consti- tutions. Symptoms. These vary according as children or adults are affected. In either case the disease usually breaks out suddenly without any pre- monitory symptoms. The children were f{uite cheerful the moment previous, and are suddenly attacked with uU the symptoms of a very vio- lent fever and marked cerebral congestion. The temperature of the skin is very high, the pulse disproportionately accelerated, that is, in compar- ison with the trifling importance of the pathological process; the children want to lie down, and they sink into a soporous condition from which they are frequently roused by sudden exclamations or anxious fancies, wliich sometimes continue even after the patients are wide awake, so that they seem really delirious. All these symptoms are worse towards even- ing and attain their climax about midnight, after which they decrease in intensity. The cerebral symptoms are so intense, and, by their form and violence, cause so much anxiety, that it would seem at first sight as thougii the little patients were attacked with inflammation of the bruin ; tlicre is but one certain diagnostic sign, which is the copious swkat, that is scarcely ever wanting in this disease, and which always breaks out, if the patients are covered ever so little, sometimes even if they are not cov- ered at all. and which is never wanting, if the patients are sleeping. The appearance of the tongue may be perfectly natural ; generally, however, it shows a thin, whitish coating at an early stage of the disease. The pupils are at times dilated at times contracted. If the children are old enough to describe their morbid feeling, they complain much less fre- quently of pain in the throat than of pain in the pit of the stomach and in the ears. The pain in the latter may increase to a high degree of intensity, and may cause the patients to moan all the time. The appar- ently threatening intensity of these symptoms in the evening or at niglit bears no proportion to their striking decrease in the morning, when the children are seen playing about very cheerfully, only, perhaps, feeling a little more tired than usual. If left to '<^Melf, the disease does not termin- ate here, but soon after dinner a fever ^ets in, which, however, does not attain the same degree of intensity that the fever had at the first outbreak, and ceases on the third, sometimes not till the sevei .;h day. The appetite is very bad, the bowels constipated, thirst moderate. There is very fre- quently a peculiar odor from the mouth, which is not so much a foul smell, as rather like that of Phosphorus; and is always more marked in the more violent cases, perhaps, because in such cases the stomach is gen- erally very seriously involved. Catarrhal Angina is undoubtedly one of the most common causes of the cerebral congestions with which children are so often attacked, and is but too seldom recognized as their exciting cause. The above-mentioned diagnostic sign has never left us in tiie lurch, and we deem it so much more important as it is difficult, especially in the case of little children, to undertake an inspection of the throat. In children wi six or seven years, marked cerebral congestionsdo not usually accompany this form of angina, which runs the same course, in their case, a!> in the case of adults. Among older individuals, catarrhal angina generally sets in without 5t «*i, I I I! ! \ A \ 220 DISEASiiS OK THE MOUTH AND THROAT. Uflli iir' ii; % iir uiiy decided fever syinptoni.s; if they are present, they correspond to the febrile stiige of every catarrhal fever; that is to say, they consist of alter- nate attacks of chills and heat, great lassitude, and rheumatic drawinj; and tearing in the extremities. At the same time they complain of disa- greeable dryness in the throat, and painful deglutition (swallowing), especially of the saliva, wiiich is generally very tenacious, and secreted in small quantities. Drinking, or swallowing solid food, is generally much loss painful. The f-vuces (back of the mouth), esiTCcially at the arch of the palate, appear uniformly red, less frequently dark than bright red, the uvula (palate) is involved in the attack, looks swollen and elongated, so that its tip touches the root of the tongue, by which many patients ai e obliged to swallow all the time, and even causes an inclination to vomit. The tonsils are, likewise, somewhat swollen. If the disease is neglected at lUis first stage, or if the patient takes, perhaps, a second cold, the difficulty of swallowing increases a good deal, even to such an extent that the liquid returns by the nosf, and tiic attempt to swallow solids causes actual paroxysms of sutlotation. In siu'ii higher grades of the disease, even adults are affected v.itl) a very foul breath, the fever assumes a more continuous type, and violent head- ache, nausea and vomiting, are seldom wanting. On inspct^ting the mouth, we find the whole of the back part of this organ dark red, some- times we notice a few superficial ulcers; ihe nnicous liiiiii^^ is very much swollen, and the tongue thickly coated. In children, we have seldom an opportunity of watching these different degrees of tlie disease; on the contrary, they always feel sickest at tlie commencement of the attick. Amid a gradual decrease of all tlie symptoms, the patient generally recov- ers in seven to nine days, provided no untoward accident interferes with the cure. Only in the lighter forms of the disease recovery may take place in three, and even in two days. Catarrhal angina is a prevailing aflTection of young people; where there is a c(?nstitutioiial disposition to this disease, its attacks continue to a late age; decreasing, however, in intensity. Before the first year, it occurs less frequently; between tlie second and seventh, it is one of the most common diseases. Whereas, among young people, it is very com- monly an independent disease; among individuals between the ages of forty and fifty, on the contrary, it is, most generally, a mere symptom of some general disorder. The prognosis is always favorable, especially, if the catarrhal angina is the only morbid symptom. Some profess to have seen death result from the convulsions caused by the congestion of the brain ; in such cases, however, the cause of death has, most likely, been ascertained only super- ficially. ALLOPATHIC TIIEATMEXT. Simple inflammation of the throat (angina) is most properly treated by a mild purgative. Gargles of a solu- tion of Chlorate or Nitrate of Potash (Saltpetre) may be used to relieve the dryness and irritation of the throat. A small quantity of Mucilage or Glycerine applied to the throat with a brush or mop will meet the same end. If the cas^ ' hould not end at once in recovery, Chlorate of Potash maybe gi /en inttfnally in doses of ten grains, three or four hours apart, and Quinine in doses of three grains tlue^i limes a day. Should restlessness be •Tr ll , SORE THROAT. 221 great, an anodyne of Opium and Hyoscyamus will be needed. One grain of each may be given at bed time to an adult. Should there be mucli secretion from the throat, Ave drops of the Tincture of Belladonna sliould be given every hour, until a slight dryness of the throat is felt, and every three or four hours thereafter. If there is much fever. Aconite should be given as directed for Quinsy. It can be given with the Belladonna. In sub-acute cases, the throat is frequently dry, and may be relieved by the frequent application of Glycerine, and by allowing lumps of sugar to dissolve in the mouth. If other measures are needed, they are the same . as those just described for the acute form of the disease. For tlie clironic form of the disease, which is quite common among professional men and others who lead a sedantary life, the treatment is, I believe, mostly hygienic. More time should be spent in the open air. Indeed, it would be better if some calling " out of doors" could be followed until tlie throat wliolly recovers. Then, such time should be spent out of doors, i;s will maintain the body at its greatest vigor. This and recreation for both body and mind are necessary, and treatment is useless without it, generally unnecessary with it. Regular sleep of eiglit hours every night is,also,an essential. Every working man (pliysical or mental) requires one day's rest in seven. The clergyman should rest every Monday, and all others on the Sabbalii. The throat requires protection. For this there is notliiiig better than a full beard, wiiicli nature provides. Tonics m;iy be necessary, if the body does not regain its vigor. The form of the tonics should be changed from time to time, and their use continued for a long lime. Astringent applications are useful, especially, in the follicular variety. A gargle of Alum a dram to the pint of water, or Sulphate of Zinc a half a (iram to tlie pint, or Tannin in Glycerine adram to the ounce, applied will) a cainers hair brush or mop are useful. If the secretion is great;, ten droi)sof the Tincture of Belladonna maybe given two or three times a day. nt>M[(EOPATHIC TREATMENT.— In its ordinary form, there is no betti r rtMtiedy for this affection than Belladonna. When given every two or three iiour.s, it hushes, in twelve to twenty-four hours, the most violent pains in tlie throat, removes the febrile and congestive symptoms, and ieavL's mostly only a little lassitude and an impaired appetite . This effect of Bi'Uwlonaa is almost constant among children who ai»e sometimes seen in tlie morning, after taking Belladonna, jumping about bright and cheerful, even if they seemed deathly sick the evening previous. Dim'.: Four pellets every two or three hours. 3f err /tr««s, when there is loss of strength, profuse sweats, bad breath, delirium, etc. Dose: Six pills, every two hours, in a little water. Aconite, if the fever is very high, with hot skin. Dose: As for Belladonna. . , QUINSY. Inflammation of tiik Tonsils, Ulcerated Sore Thro at.— This affection is usually met with only to the age of forty or fifty years, very fieldom at a later period ; most frecjuently between the years of seven and iliU 11 I «22 DISEASES OF THE MOUTH AND THROAT. flftt'oii. It is certain that persons who have to use their voice a good deal are more liable to an attack of angina, and are more generally ufTected v.'ith the chronic form. One attack of quinsy predisposes, in a striking manner, to relapses. Such diseases are more frequent in spring and fall, than in summer and winter; their frequent appearance in the same locality, at certain periods, justifies the inference that this disorder is sometimes epidemic. Damp, gloomy, and badly ventilated dwellings, are, undoubtedly, very frequent causes of amygdalitis ; we attend families in whom the children are, very frequently, attacked with tliis disease, and where, in the absence of any other unfavorable circumstances, the frequency of these attacks can only be accounted for by the unwholesome- ness of their habitations. The peculiar relation of syphilis and Mercury to the tonsils, although, as yet, beyond the bounds of comprehension, is well known. In scarlatina, we meet with amygdalitis as a characteristic symptom of the disease ; in less frequent cases, amygdalitis, likewise, accompanies other exanthema, least frequently measles. Symptoms: Acute amygdalitis (quinsy) generally commences, like all other acute affections, with a violent chill, which is speedily followiMJ bj' an unusual rise of temperature, and increased frequency of the pulse, with violent headache, and sometimes violent symptoms of cerebral hype- raimia; so that in the absence of local symptoms, which have not yet made their appearance, we are easily led, especially, in the case of children, to suspect the invasion of some acute disease. Generally, all the morbid symptoms, which occur in catarrhal angina, make their appear- ance in this disease, only they are more continuous, the fever, especially, is less remittent, on which account, acute tonsillitis is more readily tiian catarrhal angina con founded with some violent acute disease, such as men- ingitis, even in the caseof adults. This is, particularly, owing to the fact that the local throat symptoms do not make their appearance at once, but not till the fever has lasted already a whole day; in consequence of which, we neglect to examine the throat at the onset of the disease. The tiiroat, generally, looks redder, more so on one side than on the other. The red- ness is very soon followed by a swelling of the tonsils; at first, only one tonsil being affected, the other tonsil remaining either unaflected or being attacked after the other. The more rapidly the infiammatory swelling increases in intensity, and the higher the grade to which tlie inllammu- tion is carried, the greater the danger of the intlanmiation terminating in sujjpuration. The swelling sometimes enlarges to such an enormous si ",(.-, that it is no longer possible to see the back of the tonsils. As the local symptoms increase, the general condition of the patient becomes more and more unfavorable; the fever remains at its hight; swallowing is almost impossible, and yet there is a constant urging to swallow. Speech beconu\s guttural, sometimes quite impossible; the breathing is, more or less, impeded. During perfect rest, the pain is not so great, but is excited or aggravated by every motion. The lassitude is continually on the increase —partly owing to the violence of the fever, and partly to the deficient sup- ply of solid, and, more particularly, of liquid nourishment. The tongue is lined with a thick, tenacious phlegm, which is exceedingly trouble- some to the patient, and seems to cause the urging to swallow, which fre- quently results in an inclination to vomit. The bowels are constipated, QUINSY. 223 the urinary secretions dimini. herl, and urine is very thick. In this man- ner, the disease continues about nine days, and sometimes increased to such degree in intensity that the patient, tlie day previous to the opening of the abscess, seems to be lilte one near death. Very seldom the general condition improves during the formation of the pus. As soon as the abscess breaks, the threatening symptoms disappear almost immediately. That perfect recovery cannot take place at once, must be self-evident to any one who considers how much strength the body has lost by sleepless- ness and deficient nourishment. Not in every case, and, as we shall show more particular whea speak- ing of the treatment of this disease, is the course of tonsilitis as acute as we have described. From tiie most violentfever, with sopor and delir- ium, to a scarcely perceptible disturbance of the general health, all sorts of degrees of constitutional malaise can be noticed, even though the local afTection should be the same. I f the inflammation is dispersed, this result does not take place very rapidly ; on the contrary, in such a case, the inflammation is very apt to pass into the chronic form, which is much more rarely met with when the inflammatory process terminates in sup- puration. But even if the inflammation is dispersed, a febrile condition of the system, lassitude and loss of appetite, continue for some days; whereas, the decrease in the inflammatory symptoms ought to lead one to infer that the general well-being was much improved. Tlie prognosis is almost always favorable. Only in children the disorder may terminate fatally, either in consequence of brain difficulties, or by suffocation, or even, under certain unfavorable circumstances, by mortitication of the parts. Among adults, this danger need not be apprehended. Anginas, initiating or accompanying exanthemn''C affections (scarlet fever, etc.,) have to be viewed from a difTerent standpoint to that of independent angina. Tlie chronic form of amygdalitis arises, in most cases, out of the acute forn>, in consequence of the reabsorption of the inflammatory exudation only taking place partially, and the swelling of the tonsil remaining. It seems as though, independently of all constitutional predisposition, such reiiuiining infiltrations superinduced a tendency to relapses. Every new attack increases the swelling, so that an hypertrophy may ensue, by which access to the pharynx may be almost entirely prevented. After an abscess, hypertrophies of any size occur much less frequently. With- out any previous acute attack, chronic amygdalitis may develop itself almost imperceptibly, in persons wlio have to exert their vocal organs a good deal, such as ministers, singer.-;, actors; but acute cases, arising from such causes are not near as violent or important as cases arising from the previously mentioned causes. It is only exceptionally that the enlargement of the tonsils causes trouble to the patients. It is seldom that they experience any pain ; nor is the pain ever very acute, unless an acute attack has just taken place. The most common derangement is an alteied tone of tlie voice, as in an acute attack, and a weakness of the vocal organs, in consequence of which the suflTerer is easily attacked with hoarseness. In spite of the swelling, which is sometimes very large, the difficulty of swallowing is either tri- lling, or else there is no difliculty at all. O" ly in rare cases, the patienta « I '4 i : ;;, vj 224 DISEASES OF THE JIOUTH AND THROAT. iV 'i*; -li ^ r :j»^ \im' complain of the swelling, as of a foreign body in the throat. It is a pecu- liar feature in such cases, that every cold brings on an acute attack of ivmygdalitis, which is generally, however, confined to some fever with pain in the throat, and some difficulty of swallowing, with -Moderate red- ness of the tonsils. By neglecting such attacks, they may recur so often, and in such rapid succession, that the patient's health may remain dis- turbed for weeks. The. enlargement of the tonsils is always a very obstinate difficulty, which it is so much more troublesome to remove, as the patients who feel tolerable well otherwise, do not feel disposed to take medicine. In an advanced age the swelling J^ierally disappears spontaneously. ALLOPATHIC TREATMENT.— Quinsy, (tonsilitis) is often relieved in robust persons promptly, especially if previous attacks have resulted in suppuration, by abrisk saline purge (Epsom Salts) given in doses of a table- spoonful and a half in water. Cold applications should be api)lied to the neck and lumps of ice taken into the mouth. As soon as the bowels have moved, a full dose of Quinine, ten or fifteen grains, and a third of a grain of Morphine, or its equivalent of Opium (a grain and a half,) or Laudanum, (forty drops) should be given. The attack is frequently cut short by this treatment. If the Opium cannot be well borne, Tincture of Aconite should be given in doses of a drop every hour until the fever is reduced, and then continuetl every two or three hours. In case the disease is not cut short, Belladonna or Stramonium (James- town weed) should be freely applied to the neck and covered with a warm poultice. Cooling or warm drinks may be given as is most grateful to the patient. Should the inflammation result in suppuration, as denoted by heavy throbbing pain, the abscess should be opened by a surgeon. Chronic enlargement of the tonsils generally comes on slowly in scrof- ulous cliildren, weakly youths and young women. The enlargement is somel jnes so great that the fauces (throat) seems filled up, so that res- piration (breathing,) speech and hearing are interfered with. In these cases the enlarged organ ought to be excised by a surgeon. As much time as possible should be spent in the open air. The habits should be regular, and the diet good. Frequent bathing should be practiced. EvcMy morning the throat should be bathed freely with cold water. Tonics may be indi- cated by the general health, and will require changing from time to time. Iodine seems, p'pecially, useful. The syrup uf the Iodide of Iron may be given in doses of five to ten drops to a child, and twenty drops to an adult. Iodide of Potassium and Pyrophosphate of Iron, have a good effect. Ten grains of the former, and 1 wo grains of the latter, in syrup, is a dose for an adult. A suitable formula is the following: Take of Iodide of Potassium Jive drams, Pyrophosphate of Iron one dram. Simple Syrup four ounnes, Essence of Peppermint half a dram. Mix. Take a teaspoonful in water after each meal. An additional tonic effect is sometimes obtained, by giving the Iodide of Potassium in Elixir of Bark ami Pyrophosphate of Iron. Five drams of Iodide of Potassium may be dissolved in eight ounces of the Elixir, and from a teaspoonful lo a (Ics.serlspoonful, taken three times a 0;iy. •^■".' QUINSY. 235 This treatment will need to be continued for a longtime, to be of much benelit- Irritating the neck over the enlargement, with Tincture of Iodine, applied daily, or every other day, may aid in reducing the enlargement. The Compound Ointment of Iodine is often preferred to the Tincture, and it is doubtless best, when its use must be long continued. The best result from Iodine is obtained by injecting the tincture into ths substance of the enlargement. HOM(EOPATHIC TREXTmmT.-Belladouna should be given as soon as the patient complains of dryness with difliculty of swallowing, and n sense of constriction, or choking in tlie thr^iit, wiiich, on examination, is observed to be swollen, and to present a (loritl, red appearance. Bellculonna is additionally indicated when the fever continues to run high, when the face is bloated, and the eyes are much inflamed, when there is considerable delirium and a disi)Osition shown to leave tlie bed, or commit some act of violence, or when the nish, which sometimes attends this disorder, shows a scarlet liue. Dose • Of a solution of eight globules in each two tablespoonfuls of water, give one teaspoonful every two hours, until improvement or change. Pulsatilla may be given with good effect, in cases in which the symptoms are mild, and an increased secretion of phlegm has taken the place of the dryness usually present in the early stages, while the patient is at the same time afflicted with nausea and bilious vomiting. Dose : As for Belladonna. Nux-v. is preferable to Pulsatilla when the phlegm is very viscid, and is secreted in such a quantity as to create a feeling of threatening suffoea- tion. Dose: As directed for SeZ^odlonTia. The progress of matters iu the throat must, however, be carefully watched, and Mercnrius should be prescribed as soon as the presence of small ulcers, or, still better, their incipient formation can be detected. Dose: Three globules, in a teaspoonful of water, repeated in two J, hours, and again in two hours more, unless the pain and extent of ' the ulceration should continue to increase, when proceed at once with the next remedy. Acid uni-nitricu ill should be administered two hours after the last flose of Mercnrius, when, from the increasing size and painfulness of the ulcers, the latter remedy does not promise to arrest their progress or caus© them to assume a healthy aspect. Dose : Three globules, as directed for Merciiritis. In the milder forms of this disease, the two last named remedies will, frequently, be found sufficient to conduct it to a speedy and successful ter- mination. But in those much more dangerous forms, which the complaint so readily assumes, when it rages as an epidemic, and when the patient at the commencement is seized with vomiting and purging, attended with such prostration of strength as to render it impossible for him to leave the recumbent posture, without feeling faint and being compelled to fall back exhausted by his efforts ; where, moreover, the ulceration spreads with 16 i » ' »i, ii! 9. II 11^ r S 2:J(5 DISEASES OF THE MOUTH AND THROAT. ii'i,i*T '!• li alarmiii}? rapidity, {uul early take on a sloughing character— in such cjises the conuucting of tlio disease to a happy issue becomes, obviously, a much more serious and difiicult task, Arsenicum will, in tlie majority of such cases, Ix; promptly required, although sometimes advantageously preceded by a single dose of Pulsatilla, (as before directed,) if called for by the predominance of bilious vomiting. Arsenicum is distinctly indicated by that marked prostration of strength, so characieristic of this disease, accompanied by nausea or vomiting; or when the ulcers present a livid hue. This important remedy is, also, indi- cated in a more advanced stage of the disease, when the ulcerations are covced with dark sloughs, surrounded by a livid margin; the teeth and lip£, incrusted with a brownish, fetid.discharge; the pulse small and irreg- ular, and there is delirium or constant muttering, with frequent hanging of the lower jaw ; laborious respiration ; acrid discharge from the nostrils, causing excoriations; the eyes dull and glassy; the skin liot and dry, the thirst excessive, yet the patient drinks but little at a time, and appears to perform the act of deglutition with great pain and difficulty; finally, when the prostration of strength is so extreme, that the patient seems rapidly sinking, and a rash of a livid color breaks out in blotches, here and there intermingled with purple spots. Dose: Of a solution of six globules, to two tablespoonfuls of water, give a teaspoonful every hour, until amelioration or change, contin- uing the administration at intervals of four hours, when the more urgent aspect of the disease has been overcome. In very serious cases the doses may be required similarly every ten, fifteen or twenty minutes. If in alternation with any otlier remedy, two doses of Arsenicum should be followed by a pause of two hours, and then by two doses of the other remedy in like manner. China will often be found of service when the tendency to gangrene continues, and the patient is still affected with considerable prostration of strength; accompanied with debilitating sweats. Dose : Pause at least two hours after the last dose of any other rem- edy, and then of a solution of six globules, to two tablespoonfuls of water, give a teaspoonful every two hours, until amelioration or change. NuX'Votnica is frequently serviceable after Arsenicum, when the diarrhoea has been checked, but numerous small, foul, offensive ulcers, are seen in the mouth and throat. Do.se; Three globules in a teaspoonful of water every hour, until ame- lioration or change, proceeding with the next remedy, if the sub- joined symptoms ensue. Carbo-veff. should be administered after a pause of six hours after the last dose of the foregoing remedy, should a copious, fetid, watery secretion be discharged from the ulcers, attended with extreme exhaustion and small, indistinct, or scarcely perceptible pulse. Dose: Six pills every hour, until amelioration or change. Acidum-nitriciun may be employed with great advantage when, from the beneficial effects of Arsenicum, or any of the other remedies above mentioned, the strength of the patient becomes invigorated, the countenance more animated, and the sloughs are thrown off in a satisfac- tory manner, yet the ulcers threaten to become indolent; under the influ- ence of this remedy, these will, in most cases, very speedily acquire a clean and florid bottom, and begin to heal. Dose : As for Belladonna. !,' DIPIITHEKIA. 227 DIPHTHERIA. This disease gencnilly coiunienccs with unimportant symptoms of fever, and most commonly witliout any local appearances. Only in a few cases may be observed symptoms of a not very intense inllammation of the tonsils. Hence, the case is usually neglected at this important point, because neither the patient nor the family are disturbed or uneasy about the matter. At Ih'st, there is a slight redness of the back of the mouth, {fauces,) the vessels in one or more places being full or injected. Itishere that in a few hours you may first see traces of the patches of mucus [exu- dation). Atthesame time the redness increases considerably, without, how- ever, spreading to the front part of the mouth. One or more snow-white membranous patches seem to be laid loosely upon a deep-red or bluish-red of violet base ; they have exactly the appearance of a layer of cream spread upon the mucous membrane (skin of the mouth). But yet the general health is not very much disturbed; the fever is slight, the pulse not very much increased in rapidity, the skin is not very dry, even a slight per- spiration breaks out from time to time, swallowing is not much hindered, the pains at tlie affected part of the throat are not very acute. Only a general feeling of lassitude shows that the local ajipearances have a deeper significance than one would suppose. The affection may, (if not prevented by remedies,) thus remain unchanged for the first seven days, only the exudation at most, inva^'es a few other parts, in addition to the former. In tiie most fortunate cases the membranee become detached at the end of this period, leaving sores on the surface, (where they were at- tached,) with shaggy borders, which heal rapidly and leave the patient restored to perfect health. If the disease does not take this favorable turn, it assumes a much more serious form in the second week. The formation of the membranes keep spreading; they assume rather a dingy, blackish hue; the constitutional disturbance is more marked ; the pulse remaining about the same. The prostration increases, yet tl)' patients, even in violent cases, are not always compelled to lie down. SleeiJ is generally very much disturbed. The pains in the throat are intense, swallowing and speech are very much impeded ; the patients often complain of violent earache, whicli Is not constant, but comes on by spells. This stage, also, lasts a week (if not prevented by remedies) and may be followed by re- covery ; the ulcerative process, however, is much sharper than at the end of the first week. The further progress of the disease in the third week, consists in an increase of the constitutional symptoms, but principally in gangrenous destruction of the affected parts in the fauces. There arise deep ulcers of various sizes, with a gray or blackish bottom, with shaggy borders and having a horrid smell. The loss of substance may be very considerable. The salivation is copious and very fetid ; the patients look very ill, although they may yet be callable of walking about. The termin- ation in recovery is a very slow process, in so far, at least, as recovery depends upon the healing of the ulcerated surface; for the constitutional symptoms show a nuirked improvement, at a period when the ulcers still retain their malignant appearance. The return of the appetite is the most favorable symptom, likewise the decrease of the salivation and the fetor from the mouth. It takes several weeks before the ulcerated surfaces are completely healed. It is peculiar to this disease, that as the local ) fe' 228 DISEASES OK THK MOUTH AND THKOAT. ■•■Hi symptoms disappear, a more or Ies8 universal paralyHia sets in ; thiH iu not always llio case, but very frequently. In tlio preceding description wu give the picture of an attack of moder- ate violence, and running a favorable, but very protracted course. This case maybe regarded as a fair illustration of most cases of diphtheria. Under certain circumstances, the disease offers a very different group of symptoms, which the importance of the subject demands should be faith- fully portrayed by us. In the more violent cases, the preliminary stage is often very sliort. The disease sometimes enters the system so rapidly and with such extraordinary intensity, that the patient \i\ at once attacked with excessive prostration, a small pulse, death-like pallor, and death takes place as soon as the membranes begin to form. In other cases, the disease beijins quite suddenly with vomiting and an intensely sore throat, violent fever, heavy sleep, stiffness and external swelling of the neck and extraordinary frequency of the pulse. The speech is peculiarly altered, on account of the difficulty of moving the tongue. The vomiting consists of a thin, yellowish liquid, and is very often accompanied by a similar diarrhoea. The formation of tlie membranes takes place very rapidly, spreading almost simultaneously over tlie entire mouth and throat, even extending to the nose. The swel- ling of the adjoining parts and of the external neck becomes quite con- siderable, so that it extends like a tliick pad around the lower jaw. At this time the fever symptoms are not very high, even if they had run ever so high at the commencement of the attack ; but the strength decreases very rapidly. When the attacks are so violent, the formation of the membrane extends towards the lungs, where it occasions all the symp- toms of true croup, induces, at an early period, suffocative paroxysms and stupor, and usually terminates fatally, death being preceded by very vio- lent vomiting. Very seldom consciousness remains undisturbed until the moment of death. After such violent attacks, deatli generally follows in two to four days. In certain conditions of the system, the affection runs a chronic course, the membranes being frequently detaclied and renewed again, and at the same time being confined within definite local- ities. In this way the strength of the patient vanishes by degrees, and death is almost always the end of this chronic form of tlie disease. If the constitution of the patient is, at the outset, tlioroughly tainted with scrofula, consumption or other diseases, the membranes evince, from the commencement, an extraordinary tendency to decomposition, and death results at an early period, although the extent and intensity of the disease may not yet seem very far advanced. Unfavorble external circumstances, such as damp dwellings, a crowd of persons living together in small rooms, insufficiency of fresh air, likewise extrt a deleterious infiuence, on which account the worst forms of the disease are more frequently met with among the lower than among the higher classes. The prognosis of diphtheria is always doubtful, for the disease may terminate fatally, no matter what course it may take. If the disease sets in accompanied by symptoms of violent constitutional disturbance, the danger of a fatal termination is very great, since we may be almost sure the more unfavorable the constitutional and domestic conditions of the patient, the more general the spread of the poison, the more rapid the DIPHTHEUIA. 229 prostfaticn, the lesc: the chances of recovery. The extension of the diph- theritic process to the larynx and lungs, is almost always fatal. Nor should the protracted and mild course of the disease superinduce a feeling of security, for even tlien a malignant aspect may supervene. One of the most threatening symptoms is a deposit in the urine, that, when heated, changes like the white of an egg (albumen,) especially if there Is a large amount of it. Wlien the disease has subsided. It Is found that paralysis, either gen- eral, or of special parts, or derangement of the special senses, such ai hearing, smell, taste, etc., remain as sequela! of this formidable malady. ALLOl'ATIIIC TIIEATMKNT. We have to contend with a constitu- tional disease belonging to the same category as small-pox, scarlet fever, and other Infectious diseases, and. like them, due to a special virus, or blood poison. This, of late years, has l)ecome more generally recognized. The troul)le in the throat, and the development of a false mombrane are regarded as special lesions (local disorders) characterizing the disease. The treatment will then l)e i)oth general, or addressed to the condition of the system, and local or addressed to the local lesions, the former being regarded as supreme. In the great majority of cases which prove fatal, the mode of dying is by astlienia, (failure of tlie powers of life). This fact calls for remedies of a supporting kind. These, as almost every one wlio has witnessed much of diphtheria must feel, almost alone give any promise of being useful. There Is no specific for the disease, and all we can reasonably hope from treatment is, to guide the patient safely to tlie end. It is true some practitioners report almost uniform success in treating this disease, but as the same plans of treatment have not proved more than usually successful in other hands, it is to be inferred that the cases reported were largely or wholly a disease less dangerous, probably follicular sore throat which have, by mistake, been called diphtlieria. ^ In local treatment, the great objects to be kept in view are, to favor the separation of the false membrane and prevent its extension, an J give relief, as far as possible, from the suffering experienced from the affection In the throat. Of the external applications to the throat, they are all either injurious or useless. Blisters, leeches, and remedies of thah class, are powerful for harm, while poultices and other mild applications fail to give relief, thougli it cannot be said that they are productive of harm. In selecting local remedies, it should be borne in mind that the pro- gressive extension of tlie false membrane and local inflammation is not a spreading of the same, properly considered, but the successive invasion of the different parts is due to the agency of an internal determining influ- ence, and that influence is the special morbid condition which consti- tutes tne disease. If that is true, topical treatment will be likely to exert but little influence in controlling the extent of the local disease. In conformity with this view, many, if not the great majority of practition- ers, have abandoned the use of cauterizing and irritating local applica- tions to the throat (both inside and outside), and are content with the use of soothing and antiseptic (anti-putrid) local measures. Hence, the strong solution or solid stick of Nitrate of Silver, Sulphate of Copper, Alum, Hydrochloric Acid, an'' the astringent preparations of Iron are not to be ii I' i: w. %■ H DISEASES OF THE MOUTH AND THROAT. used. Ro far as my own opportunltioH for ob.servation enable me to decide, the milder meiisiires are to he preferred. The remedies which enjoy a reputation for meeting the end.s deaired in local applications, are: Carbolic Acid, SulphurouH Acid, Lactic Acid, Chlorate of Potasli, and Permanganate of Potash. I usually combine Curbolic Acid witli a solution of Chlorate of Potash, as follows: 2'ake of Chlorate of Potash four drams, dmoloe in eUjht ounces of hot water,aHd when cold, add one dram of CarhoUn Acid. This Is a useful gar- gle, or it may be applied with a soft lir.eu mop, or by a spray-producer, in cases not old enough to gargle. Sulphurous Acid, one or two drams to an ounceof water, is, also, use- ful, and may be applied by a mop, or in atomized spray; the usefulness of this remedy Is attested by high authority, and is so grateful to the natlent, that its use is frequently asked for every few hours. Lactic Acid enjoys a reputation of being an excellent solvent of the false membrane, used in the same way as before mentioned, in the Btrength of three and a half drams of the Acid to two ounces of distilled water; if the spray is used, the eyes should be protected by a l)andage or napkin; if used as a gargle, it should bo diluted until the water is dis- tinctly sour. One or two grains of Permanganate of Potash to the ou>ice of water, is the proper strength for the use of that drug, uiid the methods of using it are the same as above mentioned. Bromine five grains, Bromide of Potassium two grains, water one ounce, is a mixture highly extolled by some practitioners. It should be applied by mop, camel's hair brush, or in spray. Probably, as useful an application as can be found at hand, in domes- tic practice, is common Lime Water. It may be used in any of the ways before named. Small pieces of ice, held in the mouth ; or, in young children, a teaspoonful of ice water, swallowed occasionally, give relief. When the false membrane is removed, and the local inllammation begins to decline, all local applications should cease. The greatest danger from the local afTection, is from its invasion of the larynx (the organ at the top of the wind-pipe); it is accompanied by a croupy cough. As soon as respiration is interfered with, an emetic should be given, which produces but little prostration. The end is to expel the false membrane from the wind-pipe. For this purpose, the Yellow Sulphate of Mercury, in three to five-grain doses rubbed up with sugar, may be given ; Sulphate of Zinc in doses of five to ten grains, repeated every fifteen minutes, until vomiting is produced; or Powdered Alum in doses of a teaspoonful, mixed with syrup or honey, repeated every half hour, until the patient vomits, meets the end required. The patient should, also, breathe steam constantly, either from Rou- cheti's Croup Kettle, or by keeping the room filled with steam from boil- ing water. Quinine, given internally to the extent of reducing the pulse, is thoucht useful by most physicians. A grain may be given to a child from three to five years old, every two hours, or five grains to an adult. If the respirations become greatly embarrassed, and lividity ot ihe face occurs, the case will, probably, prove fatal in spite of all eflbrta; but the DIPHTHERIA. lai physician ouglit, at once, to perform tracljcotoniy (openinjj tiie wind- pipe, tliat tlie air may enter tlie lungs tlirougli tlie opening). Sometimes life is saved, and, at ail events, the last hours are rendered more com- fortable. Regarding </en«mZ treaiinent, there should be no prostrating remedlos used. Emetics or cathartics are not to be given ; but if the bowels r^re constipated, they are to bo moved by an injection of a dessertspoonful of Castor Oil, or a couple of (VM..pound Cathartic Pills. The line of treat- ment should embrace tonics, nourishment and sthnulants. Of '•emedies, the Sulphate of Quinine, the Tincture of the Chloride of Iron, Chlorate of Potash, and Brandy, are, especially, to be named as having been found useful. In my opinion. Quinine should be given from tlio beginning of the disease to the extent of tolerance, L e., until the pulse is slowed and a slight ringing of the ears is i)roduced — in doses of one grain, to a child, and Ave grains to an adult, from two to four hours apart, and then con- tinued in a dose just less than Is necessary to produce this eflect. In debilitated patients, there is no doubt of the benefit of Iron ; it should be given from tlie first, and is well combined with Chlorate of Potash. I con- sider this a useful mixture: Take of Tindure of Iron two drams, Chlorate of Potash two drains, Simple Syrup two ounces. Mix. Dose: A teaspoonful to an adult, or fifteen or twenty drops to a child, in water, every four hours. Nourishment forms an important point in the treatment. It should be concentrated, highly nutritious and varied. Millc, cream, eggs, and animal essences best meet these requirements. They may be used in the forms described in tlie article on the treatment of scarlet fever. A seri- ous difficulty in tlie treatment often arises from the refusal to take food, possibly from repugnance, and from vomiting. Owing to this difficulty, in some cases, and sometimes from a failure to appreciate the importance of feeding, deatli takes place from starvation. Food Should be given from four to six liours apart, niglit as well as day. Should the fever run high, or prostration be noticeable, brandy should be given at once, without reference to other medicines, as a means of sup- porting the ijowers of life. There is, also, reason to believe that both brandy and Quinine protect the system against the action of the disease poison. A teaspoonful of the former, for a child, and a tablespoonful for an adult, properly diluted in sweetened water or milk, from two to four hours apart, is the usual method of administration, though double these quan- tities have been given hourly with good effect, and witliout producing excitement. Permanganate of Potash, two grains to the ounce of water, given in teaspoonful doses every three hours, is tliought by many to be useful. Bisulphite of Soda is thought by some to have special powers over the disease, but probably its usefulness is overrated. It may be given as follows: Tahe of Bisulphite of Soda four dratns. Tincture of Orange Floioers one ounce, Water four ounces. Mix. Give a child three years old one teaspoonful, and an adult one tablespoonful every two or three hours. The Sulpho Carbolate of Soda, in doses of two to five grains, according to the age of the child, four to six times a day, is highly recommended by some physicians, on account of its antiseptic action. Db. Holiday, of I* 1 I ^ 'ii«*fT' 282 DISKASKS OK THE MOUTH AND THROAT. ::»-:■ : i Hi ,■ 1 1 HH 1 Burlington, Iowa, speaks quite warmly in its favor. It is to be given instead of tlie Bisulpliite of Soda. The fetid odor in tlie breatli disappears rapidly under its use. Incidental symptoms demand attention. Vomiting is to be relieved by Bismuth, in five' grain doses, Creosote in doses of a drop in water, or Hydrocyanic Add in doses of three drops, repeated hourly. Diarrhoea calls for astringents, and, if severe, for opiates (see article on the treac- raent of Diarrhoea). Anodynes may be required to relieve restlessness; for this purpose equal parts of Paregoric and Tincture of Hyoscyamus is useful for children, and may be g' ven in doses of from ten drops to a tea- spoonful, according to age. For adults ten to fifteen drops of Deod0rized Tincture of Opium may be given with a teaspoonf ul of Tincture of Hyos- cyamus. Hemorrhage may be relieved by Persulphate of Iron, used in doses of ten to fifteen grains, locally, and Gallic Acid, or Fluid Extract of Ergot internally, in doses of a teaspoonful every two or three hours. Under all circumstances, the patient should be kept in bed, and in the recumbent posture. The disease is so weakening, that slight exertion has been known to cause fatal syncope (fainting). The room should be kept warm, and the air moist with steam. The room should, occasionally, be disinfected by burning Powdered Sulphur upon a shovel of coals, or by evaporating a few drops of Carbolic Acid on the surface of hot water. Ozone (active oxygen,) may be generated in the room, by pouring three parts strong Sulphuric Acid upon two parts of Permanganate of Potash, in a deep glass dish, with benefit. Cleanliness is absolutely necessary, and the management e'lould be similar to that for contagious diseases. See article on Scarlet Fever. Children not affected, being specially liable to the disease, should, if possible, be removed to a neighborhood free from the disease. In a disease so serious as diphtheria, where physicians are not content to trust their own judgment alone, in case of its occurring in a member of their family, without calling in the aid of a physician, I hardly presume that any intelligent person will take the responsibility of managing the disease in his family, without tlie guidance of a skilled physician, even if the directions in this article are never so plain. HOMCEOFATIIIC TREATMENT. Belladonna is frequently of great value in the early stage of mild cases, more particularly when the disease sets in with marked febrile symptoms, and there is marked redness and inflammation of the tonsils; the patient is uneasy and restless, and com- plains of the throat ; is drowsy, and cannot sleep, or starts up suddenly out of every sleep. Dose: Of a solution of twelve globules to five teaspoonf uls of water, give a teaspoonful every two hours, until amelioration or change. Many mild cases, with the above characteristics, will be properly relieved and cured, by this remedy alone; and should amelioration l)0 noticed, the interval between the doses should be lengthened to three or f(|ur liours, according to circumstances. Should the symptoms recur with violence, however, after having been once mitigated under the action of Belladonna, do not resort to that remedy again, but select one of the subjoined. Acidutn Muriaticum. This remedy has proved of great efficacy in a number of cases of simple diphtheria, and may very generally be admin- DIPIITHKRIA. 283 bo istered as soon as the membranous deposit begins to appoar, and particu- larly when there is not much glandular swelling, but considerable prostra- tion of strength and fetid breath, with little fever, but marked lassitude and weariness. Dose: Three drops of the second decimal dilution in a teaspoonful of water, every hour, until relief or change. In tlie event of improve- ment, lengthen the intervals to two liours, then to ' se hours, and so on, until the cure is complete; but if the exudai,ion spreads to fresh surfaces, in spite of the employment of Acid Muriatimm for twenty-four to forty-eight hours, another remedy must be selected. Mercurias Protiodatus. One of the best remedies. Should the throat present a deep-red appearance, and the tonsils and surrounding parts be considerably swollen and studded with specks of exudation; and if, moreover, there be cold in the head, accumulation of mucus in tlie throat, and excessive secretion and flow of saliva of a fetid odor, Mercurius is a useful, if not an indispensable remedy. It is an important remedy in all forms of the disease. Dose: One grain of the third trituration in six teaspoonfuls of water, a teaspoonful every two hours; or as n.ucli of the trituration as can be carried on the point of apenknife, administered dry (undissolved), at tlie same intervals, untilamelioration or change; but if, after the lapse of forty-eiglit hours, or even a shorter period, the exudation, fetor, and swelling increase, proceed to select another remedy. Kali Bichroniicuni. In the event of no improvement, from thirty- six to forty-eight hours after the employment of Mercurius Protiodatus, and particularly when the disease extends into the posterior parts of the throat, and thence into the nostrils. Kali Bichromicum should be selected. Ifc is, moreover, indicated by a tough and stringy discharge from the nose or mouth; pain in the left ear; swelling of the glands under the ears; croupy cough; measle-like eruption, and red and shining tongue. Dose: As directed under Mercjirius Protiodatus. Acidnni Nitricmn. When, notwithstanding the employment of Acidum Mur., or Mercurius, superficial patches of exudation continue to present themselves; and when the throat, in place of healing, becomes painful and of a vivid-red color ; also, when '^liere is a tendency to ulcera- tive complication, and the gums are dispopeu to bleed, this remedy may be employed with advantage. It is further indicated by the presence of ulcers on the mucous membrane of the mouth, and by an acrid, corrosive dis- charge from the nose. Dose: Two drops of the third decimal dilution in a teaspoonful of water, every two hours, until relief or change. Kali Chloricuni. When, after a period of not longer than forty- eight hours, the above descr' symptoms either remain stationary, or become aggravated; or when the gums are more or less red and swollen, and the exudation is extensive, but confined to the mouth and palate. Kali Chlor., may be substituted with the best results. Dose : Same as directed for Acidum Nitrioum. Phytolacca is a remedy which has been promptly curative in many cases of diphtheria, particularly in the mild, or non-malignant variety. It is indicated, more particularly, when there is considerable febrile mani- festations; headache; violent, aching pains in the back and limbs; grwit weakness, so that the patient cannot stand, and gets faint and dizzy, even, when rising up in bed. Dose: As directed for Acidum Muriaticum. IW y I \i.. ,*-^* / .4 . «ft4 DISEASES OF THE MOUTH AND THROAT. Lachesis will prove useful when the inflammation and the diphthe- ritic deposit commence on the left side of tlie throat, and either remain there.or spread to the right side. It is further indicated, when the patient is always worse after sleeping, and cannot bear the slightest pressure on the throat. It is frequently useful after the previous employment of Belladonna, and in malignant forms of the disease, when mortification or sloughing of the parts threatens. Done: As directed for 5e7/ofZo7ina. Ly'co2)odiuin'6\\o\\\*\. be given in mild cases, when the right side of the throat is first invaded, and the soreness is aggravated by warm drinks; the nostrils are stopped up. and the patient cannot breathe with his mouth closed; starting and jerking of the lower limbs; dread of being left alone. Dose: As directed for Belladonna. Apis MelUfica should be given when there is great debility from the commencement of tiie disease; the false membrane presents a dirty- grayish hue; there is puHiness around the eyes, pain in the ears when swallowing; an itchy, stinging eruption on the skin ; numbness of the feet and hands. Dose : As directed for Belladonna. Cantharides will prove very efficacious in many cases when the diphtheritic exudation appears in patches; the adjoining surfaces of the mucous membrane being of a bright-scarlet redness, with intense 6Mrwin^ and dryness of the throat, and great thirst, the burning resembling that produced by the application of a blister. It is further indicated by derangement of the urinary organs, manifested by burning and scalding on urinating; or by a suppression or increased discharge of urine; as well as by extreme prostration, and an irritable looking rash upon the skin. Dose : As directed for Acidum Nitncum. HOME REMEDIES.— Frequently gargle or wash the mouth and throat with a solution of Salt, Pepper, and Vinegar; or a solution of Saleratus in watei ; or Borax and Ahun in a solution of water vith a little Brandy added, if at hand. The patient should be removed ♦lo a clean bed, in a dry, well ventilated room, kept sweet and clean, and no one should be allowed to sleep in the room except the attendant. All visitors or v^allers should be positively kept out of the sick room. IH S MUMPS-PAROTITIS. We comprehend under this designation two tolerably distinct condi- tions, which have, however, this in common: that the salivary glands are the seat, or rather the starting point of the disease. Consequently we shall first describe parotitis proper, or an intlainmation of the parotid gland, together with the non-maligiumt inflammation of the other salivary glands, and afterwards the malignant form of the disease, attended with gangrene of the cellular tissue. Mumi)3 is generally preceded for a few days by febrile symptoms. The patients feel languid, sleep is uneasy, the appetite is gone; headache, with a feeling of stiffness ir the muscles of the back of the nccl** is, scarcely ever absent; a slight catarriial irritation of the digestivo tract is, likewise, generally present. After these preliminary symptoms have i;ll MUMPS. 2sa lasted for a short period, sometimes even for several days, the region below the ear on one side begins to swell, the swelling spreading very rapidly over the cheek and under the jaw ; in a short time the face looks very much disfigured by the swelling. The swelling is not very painful even to rather hard pressure ; the color of the swellinf^ does not differ from that of the surrounding skin, except sometimes a slight redness ; the swelling is at times of a stony hardness, at times it is soft, and at other times has an uneven feel. The movements of the head, more especially of the jaws, are very much impeded. With the appearance of the swelling, the general symptoms usually improve, the fever abates rapidly, and the patients, in spite of their great disfigurement, feel tolerably well. In most cases the swelling spreads to the other side in one or tvvo days, but here never attains the same size as on the former side. If the swelling runs a normal course, it generally reaches the climax on the fifth day, after which it gradually begins to disperse, so that between the tenth and four- teenth day no trace of the swelling remains visible. With a higher grade of inflammation, or under otherwise unfavorable circumstances, the red- ness assumes an inflammatory erythematous character, and suppuration may take place, which, in comparison to the size of the swelling, remains inconsiderable, but protracts Lub course of the disease very greatly. The swelling takes this course more frequently in the case of adults than in that of children; in the case of tlie former, an inflammatory hardness of greater or less extent frequently remains for some time. Only in rare cases, or if the affection assumes a* certain degree of malignancy, as it sometimes does in certain epidemics, the brain may become involved in the process. Wliat is more frequently the case is, that the testicles, or the labia majora, swell suddenly, while the swelling about the neck disap- pears; both swellings may, however, co-exist. Secondary parotitis occurs in the course of many acute diseases, par- ticularly typhus; in some typhus epidemics it is a constant sequelaj of the disease, whereas, in other epidemics, it is entirely absent. The appear- ance of the swelling is not bound to any definite period of the disease; at times we see it break out at the commencement, at other times during the period of convalescence. It is generally preceded by local pains, in- creased congestions of the head, even delirium and chilly creepings ; its rapid development is seldom attended with abatement of the fever. The further course of the local process issimilarto thatof the genuineiuunips; the swelling either scatters or else it terminates in violent iiilhinnnation with suppuration, which, during a state of great constitutional prostra- tion, may assume a malignant form, with the discharge of pus. Whereas, in the former case, parotitis always indicates a favorable course of the general disease ; the formation of pus, on the contrary, always portends danger, and is, at least, a disturbing complication. It is dillicult to deter- mine beforehand of what character the swelling will be ; but when paro- titis sets in at the acme of the disease, it is always more dangerous than when it occurs at the commencement or during convalescence. Here, too, as in the case of mumjis, an induration may be left behind for a long time. In isolated cases, of either variety, the ear seems to be affected, iiardness of hearing, and discharge of pus from the ear, remaining after the disappearance of the swelling. ' i'l 1 ftJ7 tii jaii'i!.'. 'i '* Jfi ■1^ :§...'« 236 DISEASES OF THE MOUTH AND THROAT. The cause of parotitis is involve^ in obscurity, in so far as we are unable to determine by what atmosplieric or other influences the disease Is caused. Its epidemic character leads us to adopt the existence of some peculiar miasm, similar to the miasm of typhus, cholera, etc. We know that the common epidemic mumps prevail most frequently in the fall and «pring. But it is a mystery why the parotid gland should be invaded in acute diseases of the general organism, in one epidemic quite frequently, in another scarcely ever ; or why, at one time, it should be harmless, and at another time a phenomenon portending great danger. This difference accounts for the circumstance why some consider this form of parotitis a dangerous, and others a trifling, disease. An intlammation of the other salivary glands often accompanies par- otitis as an accessory disorder. Numerous facts lead us to believe that eacli separate salivary gland may become the seat of an affection like mumps. After very acute diseases, we have often noticed stony swellings of the lesser salivary glands of a very obstinate character, and running their course amid a general prostration of strength. ALLOPATHIC TREATMENT. The treatment of parotitis (or mumps,) only requires soothing applications, as warm fomentations and wool, flanN nel, or cotton batten to the neck. Severe pain will call for an anodyne for its relief. Opium combined with Hyoscyamus is generally the best for this. A pill of a grain each of Extract of Oj^ium and Hyoscyamus at night, and repeated once or twice in^he twenty-four hours, will generally beefrcctual. Generally, when warm applications are used, the addition of a little Laudanum to the fomentation will suflice. The bowels should be kept regular. The diet should be light. Milk is the one article which seems best suited. HOMCEOPATHIC TREATMENT. In ordinary mumps, which run a very rapid and painless course, it makes very little difference what medi- cine is given ; indeed, the afTection might safely be left to take its own course. However, inasmuch as we cannot well know what the final ter- mination of the affection may be, it is best to always give the suitable remedy, since we can rest assured that under its usesuppui'ation will only take place exceptionally. The best reniedy is Mercurius. The specific action of Mercury upon the salivary glands is well known. It not only increases the secretions of these glands, but likewise causes a real inflam- mation in the body of the glands, which may readily terminate in suppu- ration, as is often seen in the violent treatment of diseases with large doses of Mercury. Xo remedy prevents suppuration as certainly as Mercurius. Belladonna deserves a preference, if the constitutional symp- toms are very severe, and the swelling assumes an erysipelatous char- iwster. TOOTHACHE.— ODONTALGIA— PAIN IN THE TEETH. When we find a constant disposition to this painful condition of the teeth on the slightest exposure to cold, or indiscretion in diet, without any other presumable cause, or what is generally called rhenmaUn tooth- ache, weare warranted in concluding that some taint lurks in the consti- tution which must be sought for, and, if it can be, eradicated. Otherwise, the best selected remedies will frequently fail in affording relief where TOOTH ACHK. 237 most expected, or, if relief is obtained, it is only temporary. By common consent, tliis, and all other diseases of the teeth, are turned over to the dentist, and as they are now generally educated and fully prepared for their professional duties, this custom is becoming more and more general, and now it is safe to depend on them to do the best that can be done for you. ALLOPATHIC TREATMENT. Toothache may be neuralgic, and if so, will be treated as described for that disease. When resulting from a decayed tooth, a drop of Carbolic Acid, or Tincture of Opium (Laudanum,) Aconite or Belladonna usually gives relief. Rinsing the teeth with a solution of baking soda sometimes accomplishes the result. Often in instances of oM, decayed teeth, inflammation of the fang has occurred. Heat may then relieve, or the discharge of a little blood may accomplish the result. Generally, however, the advice of a dentist should be fol- lowed. IIOMffiOPATHIC TREATMENT. MercuHus holds a front rank among medicines, being indicated by pains in decayed teeth, or in the roots of the teeth, frequently occupying one whole side of the head and face, extending even to the ears, loosening of the teeth, and a feeling as if they were too long. The pain becomes worse towards evening, and espe- cially at ni(jht in the warmth of the bed, is worse after eating or drinking anything cold. Swelling and inflammation of the gums. This medicine is, especially, useful to persons who are subject to swelling of any of the glands of the body. Dose . Four pills or a small powder of the 3d x potency, every two or three hours until improvement or change. Belladonna. When the pains are very severe, of a drawing, tear- ing or shooting nature* in the teeth, face, and ears, with swelling of the cheek, dryness of the mouth or excessive secretion, like salivation ; great thirst. Pains come on suddenly, and leave just as suddenly ; face flushed and eyes red. Dose: Six pills every two or three hours. Bryonia. 'Pams in souiid teeth. Sensation of being too long, with drawing, jerking pains. Worse at night, and from taking anything warm in the mouth. Constipation, stools dry and hard as if burnt. Improved by being still, and cold applied in the mouth. Dose : As for Belladonna. Chaniomilla. After taking cold when in a perspiration. The pains are drawing, jerking, beating or stitching. Intolerable pains at night, driving one to despair. One cheek red and the other pale. Becomes almost furious about the pains. Worse in the open air. Very impatient. Dose : As for Belladonna. Pulsatilla. Suited to persons of a mild disposition, easily moved to tears. Toothache, with earache or headache. Pains as if the nerve was put on the stretch and suddenly let go again, like a piece of rubber. Bet- ter from cold things, and worse from warm. Chilliness, even in a warm room. Scanty or suppressed 7nenses. Dose: Five pills every three or four hours. Sepia. Toothache during pregnancy, where there is sallow complex- Ion, with spots on the face. Dose: As directed for ilfercMnw*. 28tt DISEASES OF THE MOUTH AND THKOAT. I Nux-vomica. Sore pains or jerking, driiwiiif? Htitclu's in the tcetii and jaw. Worse early in the morning. Where tiie result of mental labor, sedentary liabits, or constipation, or the use of intoxicating drinks. Dose: As for Belladonna. Sulphur. Where Nux. appeared indicated, but failed. Pains in hol- low teeth. Made worse by cold drinks. Burning heat on top of the head. Dose: As (or Pulsatilla. The thirtieth potency is best. SC Ult VY-SCORB UTIS. Scorbutis (scurvy) will scarcely be met with in the history of the fara- ily that is even moderately well supplied with a variety of food; though lack of food in proper quantity and quality is the chief cause of the disease, exposure to wet and cold, bad ventilation and depression vof spirits causing indifTerence to food, may be added as causes of the disease. For its prevention, and also its cure, these causes may be removed, The diet should be composed of articles which will supply the system with its needed elements. Of these, I believe, milk stands first. Fresh meat and fresh vegetables, in great variety, with fresh fruits and starchy food, are to be freely given. The apartments should be warm and well ventilated. When the skin is dry, warm baths are called for. Constipation is to be relieved by injections or mild laxatives. Diarrhoea will call for the astringents directed in the treatment of that disease. ALLOPATHIC TREATMENT. Pains in the limbs or joints can gen- erally be relieved by rubbing them with a mixture of Laudanum and Turpentine in equal parts. If it is too irritating, a little Sweet Oil may be added. Or a liniment of equal parts of Tincture of Aconite and Chloroform, and two parts Soap Liniment, maybe used. Tonics are generally called for. The Citrate of Iron and Quinine in doses of two or three grains, meet the end re(iuired. Bitter infusions made with an ounce of the crude drugs (Peruvian Bark, Gentina, Quassia, etc.), to a pint of hot water, in doses of half a wineglassful, before meals, will answer the purpose. If this be used, the Tincture Muriate of Iron should be given in doses of ten to twenty drops, in sweetened water, after each meal. The juice of lemons, oranges, or limes should be given to the extent of the patient's wish. Cream of Tartar (Bitartrate of Potasli) may be given quite largely, as having a direct effect on the disease, in doses of a teaspoonful several times a day. A coui)le of teaspoonfuls four times a day, is thought, with reason, capable of preventing the disease, when the supply of fresh vegetables, etc., is deficient. A solution of Alum will generally suffice as a mouth wash, called for by the condition of the gums. Other astringents may be used. Hemorrhage will be met by scruple doses of Gallic Acid, or teaspoon- ful doses of Ergot, or Turpentine in doses of fifteen drops, given on sugar. A similar condition of the system to that existing in this disease, which results from continued prostrating disease, is to be met with the same remedies. Mucli of the so called scurvy of the gums results mostly from neg- lect of cleaning the teeth, "tartar'' accumulates on them, and the gums become unhealthy. The proper course is, to have the tartar removed by a dentist, and then kept off by frequent and thorough brushing. m\ m vmil ■ »^'^ ' •• Uj-!*,;.' VHE DIGESTIVE TRACT. i-.l n THE HUMAN TEETIl. VIE If 07' i7//i' lit MIX TEETH, 23U NAMES OK THE HUMAN TI.KTll. 1, 1. Middle inciuoiH. 2, 2. Lateral iiiciauiii. 9, 3. Canine. 4, 4. FiiHt lijiiispiduti). f>, fi. Second bicuspidate. 6, 6, 7, 7. Molaiu. 8, 8. Wisdom. THE DTGESTIVE TRACT. The Alimentary Canal, the principal portion of wliich is shown opposite, is a most important factor in tlie pliysical economy, and in proportion to its performance of the function belonging to it is the general health of each individual. The liver is shown lilted up from its normal position on the stomach V in order to bring to view the latter organ, and expose the gall bladder Hi. The gall is discharged from the bladder into tlie alimentary canal, and there performs its important functions. That pait of the human organism liere represented is subject to many diseases. The abused stomach V often punishes its possessor by Dyspepsia in its many forms. The liver is frequently inflamed or ilcerated and in other ways affected, but is not the part really affected in one-half the cases where it gets the credit of being. "Liver Complaint" is most frequently a falb: name for dyspepsia. The ulcers which give rise to the excessive pain and tenderness in Typhoid fever are found in the glands in that portion of the small intestines indicated by IX, the illium. The bladder XI also has to bear its share of the ills flesh is beurto. i PART FIF'TH. THE DIGESTIVE FUNCTIONS. CHAPTER XII. DISEASES OF THE STOMACH AND INTESTINES. BILIOUS COMPLAINTS, OR DYSPEPSIA. Bilious complaints have, of late years, become the popular term for almost all derangements of the digestive functions. The truth is, ho'»V- ever, that in affections of this nature, although in very severe cases, the liver or biliary system is more or less powerfully affected, yet it is gener- ally so only by sympathy; and the real seat of the disorder is in the stomach and bowels, except, indeed, amongst natives of the temperate zone, resident in tropical climates, or, who have recently left the tropics. In considering the various forms of the derangement of the stomach under the general, more appropriate, and more comprehensive designation of indigestion, therefore, we shall have occasion to include the majority of those symptoms, which are ascribed to the two opposite causes of derange- ment, inactivity of the liver, and too great a secretion of bile. Indigestion, or Dyspepsia. Natcsea, Eructations, Depression of Spirits, and other Sympatfietic Affections. What is termed Indigestion, may be identified as the prolific parent of Chronic Disease. This disease, however, appears in so many forms, that we shall simply content ourselves here with sketching out a general outline of its chief distinguishing features, and enumerating some of the principal predis- posing and exciting causes to which it may usually be traced, directly or indirectly. Predisposing Causes. Close, unhealthy, ill-drained, ill-ventilated dwellings ; the atmosphere of some factories ; hereditary or other constitu- tional defects ; the influence of the atmosphere of particular climates and localities ; exposure to unhealthy exhalations ; the water of particular local- ities, which is impregnated with mineral substances, (such as lead) and in which the diseases of this nature assume an endemic character, etc. Exciting Causes. Irregularities in diet— such as an over-indulgence in the pleasures of the table, partaking of rich and indigestible food and stimulatiag soups ; excess in the quantity of food ; excessive use of wine, m DISEASES OK TIIK STOMACH AND INTESTINES. 241 maltand spirituous liquors, tea, coffee, and other stimulants; imperfect mastication of food, inepularity of, or too long fasting between raeals; indolent or sedenl.iry habits; exhaustion from intense study; keeping late hours ; mental emi^tions ; reaction from the external surface, etc. The foundation of this disorder is frequently laid in early life, by the frequent and copious admhiistration of aperients, calomel (in large doses) and other deleterious drugs ; and the evil is perpetuated in more mature age, by a continuance of the same absurd and injurious system. An abuse of coffee and tea is a frequent cause of many descriptions of sick and nervous headache, attended with excitement and symptoms of deranged digestion, which will frequently disappear of themselves, on the disuse of these beverages. If, however, the troublesome symptoms sliould continue, a course of treatment should be adopted, in conformity with the following regulations. Indigestion, or that which we understand by the term, is not, how- ever, necessarily associated with physical suffering of any kind, much less with sensation of pain, or any distinguishable sensation in the stomach or intestinal region itself. It very frequently occurs in its worst organic forms, without, so; far as o6A'e7'«ed, exhibiting any symptoms whatever, developed in the digestive organs themselves. But in such cases, it has reacted upon some other portion or portions of the organic structure, and may be distinguished in the affections occurring in other organs, and which, therefore, very frequently becomes susceptible of mistaken inter- pretation. Therefore, in such complicated cases, the most careful review of the antecedent course of life, constitution, circumstances, and the like, as well as very minute inapectton analysis of every symptom, becomes necessary to come to a correct conclusion, and thereby to pursue a correct course of treatment. In the great majority of cases of chronic disease, in fact, which daily occur in civilized life, the original seat of disturbance may be identified in the digestive and nutritive functions, whence the pro- gress of disease may be traced through the organic apparatus in which such functions are lodged to the centers of vital action, and throughout the system. Abstractedly, the primary disease consists— first of local increase of the -''^ural irritability, that is, of irritation, and afterwards, (when this in i^ation has expended itself in exhausting the natural irritability) of com- parative deficiency of irritability, that is, of weakness or debility, with susceptibility to irritation. But it is worthy of notice, that whilst this irritative process, at first purely local and superficial, has exhausted the vital energy of the particular organs in which it was first developed. It may (even without having possessed sufficient violence to alter the organic structure of such parts) have been conveyed through the medium of the communicative nerves to the center of sensation— the brain— and conse- quently, also, to the mental and moral faculties:— to the center of motive impulse— the spinal coi J; by regurgitation, or other interference with the biliary discharge, or by nervous affinity, etc., to the liver, by insufficient or altered supply of material to the blood, through the channels of that fluid to the heart; and, owing to similar irregularities, as well as from the deteriorated condition of the center of the nervous system to the lungs the skin, and to the motory muscles of the frame. 16 m DYSPEPSIA. Il •* !lf ,»•.,. I I It if, ot course, understood, tluit the derangement of the stomach, of whatever deacriptiou, may readily be oomimmicated to tlie intestines, and that, morn or less, tlie wliole of tlie aijparatus of nutrition, and its appurtenances, are directly aflectcd. and, in general, necessarily involved. The just appreciation of these facts, pursued by the progressive dis- ease, is of paramount importance, because, should affections bo developed in oue or more of these organs which occur sympathetically, and as the result of primary derangement of the stomach, it is needless to argue that a perfect cure (if yet possible) (.(in onlij be attained by uttackiny the original scat of disease. The important observance of accessory measures, such as the appropriate diet, exercise, habits, and the like, may be nuterially qual- ified by the accurate discrimination of the orlgimil derangement. And, inasmuch as the original character of functional derangement, or organic disease of the stomacii, consists of an increase of the; natural irritability, or of irritation, and the subsequent cliaracter consists of a morbid sensi- bility (whether tl'.ere be increase or decrease of sensation), and of conse- quent susceptibility to irritation, and as the recurivnce of active irritation will, in each successive instance, subtract more from the vital energy, or sooner or later unhinge the organic structure, and do irreparable mischief, —it is sulliciently obvious, that in every disease which owes its origin to the stomach, any internal, external, or inducted cause of irritation will have a tendency to confirm the disease. Whence, it may be deduced that the accessory treatment resolves itself in the most perfect avoidance of every- thing stimidativy or irritatiny, whether in the department of diet, in that which involves mental or corporeal exercise, or in that which affects the mind in its moral capacity, including all emotions, whether productive of immediate pleasure or pain. Everything which may tend to engender or sustain excitement of any kind, especially, if it operate siuldenly, should be strictly prohibited. Sympathetic Affections of other Functions or Organs. As the primary organs of digestion are readily and materially influenced by disturbances of the brain and its tissues, so in like manner do we as fre- quently find that the brain and the nervous systems in general, sym- pathize immediately with the stomach, and are subject to the induction of derangement from that source, whether the primary cause affect merely the lining membrane, or the tributary nerves:— or, again, whether the disturbance in either case be merely functional (affecting the operation of such organ's) or organic (affecting their substance). There is, however, some difference in these derivative Tsympathies, both as regards variation, intensity, and locality. 1. Mental deranyeinent upon a given point, or general aberration of mind, extreme and restless anxiety, with visionary fears, or apprehension without foundation, alternation between extreme excitement and utter- prostration or inactl ni, both of will and of impulse, uncontrolable irasci- bility and excitab' :i,y, morbid impatience, wretchedness with agitation, thoughts confined to self, and generally clouded, unaccountable dread of undefined ills, conveying an intense inclination to engage actively in the investigation of such ■ supposed misfortunes, fitful and capricious temper and disposition, and a highly suspicious disposition, etc., may be distin- guished as an affection of the tributary nerves of the apparatus of nutrition. I TilSEASKS OF THE STOMACH AND INTKSTINES. 24:' 9.. Pains in various parts of the liead, expansive, daiting, or spas- modic pains of various descriptions and often indescribable, giddiness, tlie multitude of f.3nsation3 of weakness, of lieat or cold, of expansion or con- traction, of trembling or uneasiness, convulsive and involuntary move- ments of particular linibs or muscles, local or general cramp or spasm, are also amongst those symptoms which may be traced to an affection of the tributary nerves.^ 8. Gradual deterioration of nervous vitality amounting to palsy, and temporary or permanent loss of control by volition over the muscies of voluntary motion, owing to the nervous implication of the spinal cord, are attributable to a similar originating cause. 4. Sudden arrest of the functional operation of the brain, and tor- pidity, numbness, or suspended sensibility of the nervous structure- locally or generally— as well as dullness of thought, aversion to exercise of the mind or body, ge.ieral torpor or indolence, listlessness, drowsiness, depression of spirits, characterized by constant stupor, sluggishness of the perceptive or reflective faculties, vacancy, listlessuess, incapability of fixing tlie tattention, imbecility without mania, confusion of ideas, irresolute, yielding and dependent (submissive) disposition— which arise from deter- mination or accumulation of the blood— are associated with derangement of the (raucous) lining membranes. 5. Pains in the head, of a dull, obtuse description, pain in the forepart of the head, sick-headache, numbness or dullness of the head, heaviness of the head, sensations of .smeZZ- whether pleasant or unpleasant— which are merely morbid, deficiency, dullness, or suspension in the sense of smell, sensations of unnatural tastes in the mouth, an J the like are, also associa- ted with morbid condition of the lining membrane. 6. Palsy, occurring suddenly and without premonition, which is attrib- utable to an oppressive accumulation of blood, is also amongst the affec- tions of the nervous system, which are attributable to the same conditions as the last. [When both portions of the nutritive organs are simultaneously affected, these results may appear in combination]. TiiK Lungs and Hespiratoky Apparatus are liable to be organi- cally affected by sympathy with the stomach, when the tributary nerves of the organs of nutrition are affected. The Liver may be fitfully or occasionally implicated in the general derangement, resulting from such affection of the nerves of the stomach; but important functional or organic deran,<Tement of this organ is gener- ally associated with disturbance of the stomach, consisting of morbid con- dition of the lining membrane. The Heart is, necessarily, more or less affected by both conditions of disturbance in the digestive apparatus, because in both there is either defi- cient, irregular, or moibid assimilation and distribution of the constituents of the blood. 1. Accelerated ofdion, with, however, imperfect, incomplete, and irregu- lar operation of the circulative process, with too abrupt, sudden contraction, and, analogically, a spasmodic condition, characterized by quick, pointed pulse; or, generally, identified by sudden flushes of heat, or chills, is asso- ciated in the generality of cases with disturbance of the nerves of the stomach. i% )\ ■t ■■ 244 DYSPEPSIA. 2. Retarded action, with, at the same time, the distribution of vitiated blood, or with deficient supply of the constituents of the blood, and, con- sequently, insufficiency of the* volume of that fluid, generally character- ized by a slow and tardy, but hard pulse, and attended with coldness of the extremities, and general deficiency of the animal heat, may usually be attributed to derangement existing in the lining membrane. [When both portions of the nutritive organs are simultaneously affected these results may appear in combination]. The skin almost immediately sympathizes with the stomach when the slightest derangement occurs, being doubly susceptible of the effects of impaired circulation of the blood, and of irregular nervous action or sen- sibility. Whether one or the other, or both portions of the organs c'' nutrition beafTected, and, whether functionally, or organically, the skin manifests its immediate sympathy, either in sensation, appearance, feel ing to the touch, or all three. 1. Extreme susceptibility to sensation of cold (or chills,) is more or less associated with every variety of derangement of the stomach. 2. Sensations of pricking, fugling, crawling, shuddering, itching or irritation, burning (flushes of heat,) with redness, further characterized by the appearance of marked spots, pimples, and other eruptions, etc., are generally associated with derangement of the nerves of the stomach. 3. Turgid, sallow, dirty hue of the skin, without loss of softness, moisture, or elasticity, though usually associated with derangement whose seat is in the lining membrane, may be observed in both varieties. 4. Flaccid or withered, or deadened skin, having the appearance of parchment, with general deficiency of sensation, though usually attribut- able to the continuance of derangement of the membrane, may also be identified in r-ises in which every other indication identifies the nerves of the stomach as the seat of the affection. 5. Dryness of the skin may be associated with derangement, whether functional or organic, of either portion of the apparatus of nutrition. The eyes and sight reildily sympathize with the stomach, owing to the uninterrupted continuity of the mucous membrane of the various pas- sages to that which comes inio contact with the external poriions of the eye. Whence watery eyes, dark appearance around the eyes, redness of the edges and inner surfaces, or swelling of tht eyelids, bloodshot eycL', glutinous discharge from the ey^s (adh sive gum,) which occur as mani- festations of irritation or accumulation of blood about the membranous surfaces— extending along such membranous surfaces from those of the , stomaci. may generally be associated with disturbance of the lining mucous men brane. ^ i 1. Even blindness, from palsy of tus nerve of sight, is generally dependent upon pressure occasioned by similar local accumulation of blood, and is, therefore, associated v/ith a similar cause; although In some cases, it may result from affections of the nerves of the stomach. The association of other symptom.^ will be distinctive in such cases. The ears and hearing are, alsOj most frequently affected by irritation, accu'Tiulation of blood, or dryness (deficiency of wax) extending to these organs from the lining membrane of the stomach. It is, however, obvioua ^.i DISEASES OF THE STOMACH AND INTESTINES. ZJ.'i that excessively acute hearing, or total deafness, etc., might result fiom affection of the nerves acting sympathetically on the brain. 2. Excessive dryness of the ears, sometimes characterized by increased sensibility of the organ of hearing, and sometimes by sensation of heat, or by burning pain, is usually attributable to derangement of the lining membrane of the stomach ; and the same mnv be said of a sensation as if khe ears were muffled, a dead iiess of sound, the internal passages being swo'en, and the orifice being, consequently, lessened. DisTiNCTiViO Classification of Varieties. It is apparent from the foregoing remarks, that we should distinguish five modifications of that form of disease which is popularly termed indigestion or dyspepsia: namely— 1. That which is merely functional, or which consists in irregularity In the operation of the organ involved. 2. That which is organic, or which consists in some change in the structure of the organ affected. 3. That which afTects the lining membrane of the organ— which is at first evidently superficial, and is generally conveyed to contiguous or- gans by the irritation extending along the uninterrupted surface of the membrane — but which, inasmuch as it embraces the extremities of the nerves, may sooner or later become complicated with— 4. That which is seated in the tributary nerves of the organs of nutri- tion—which may therefore be conveyed directly to the substances of the brain and spinal cord, through the medium of the nerves which are in direct communication with these concentrating points, and from which we may anticipate a more immediate development of symiiathetic mani- festations in the nervous system generally. 5. That in which the nerves and membranes are both implicated. The third and fourth distinctive varieties are those which require the most particular investigation; not only because they may or may not involve the first two, but, more particularly, because, whether the disease be organic or merely functional, the distinction between the nervous and membranous varieties will afibrd the real clue to, or at all events materi- ally facilitate, the treatmer*. The initiatory condition, both of nervousandofmembranousderange- mentof the stomach, is the same; it consists in determination and accu- mulation of inactive blood in the vessels associated with the tributary nerves on the one hand, or in those connected with the lining membrane on the other. In both cases, the first unnatural condition is increase of the natural irritability— that is, irritation— respectively of the portion afTected; and in bothcpse? ^he exciting cause is something which impedes or unduly hurries the ..iitural operation, and "onsequently excites an irri- tative effort in the organ, either to repel the matter which oppresses or disturbs h to fulfill its functions with that degree of acceleration to which it is J ^ ailed. Disturbance or oppression of tlie functions of the tributary nerves may, therefore, be occwioned (chiefiy) either: 1. By tlie reception of irri- tating, stimulating, or indigestible substances into the stoniach. 2. By superabuTiMinnf; of food, luiwever plain and digestible, too suddenly cram- med into the stomach. 3. By the imperfect preparation of the food (by % y ,afi:| y*i» "' i . 1 i 1 ; ^6 DYSPEPSIA. mastication, etc. ,) before it is conveyed to the stomacli. 4. By over-exer- tion of tlie wewtoZ faculties of tlie brain, wbicli operates directly to the medium of the communicating nerves. 5. J>y sudden depression or excitement of tlie moral faculties of the brain (as l)y passions or emotions conveying pleasure or i)ain). 0. By dcjiciencij of physieul muscular action (as in sedentary habits), whereby the evacuation of matters rejected (se- creted) from the nutritive apparatus is impeded, and wliereby, therefore, tlie organs whose function consists in the ai)propriation of the aliment and the expulsion of the residue are opposed with the latter, which gives rise to an irritative effort to expel the obnoxious matters. 7. By eax;eA.S' of physical muscular action, which compels the organs of nutrition to make an undue effort for the 8ui)pl7 of the necessary sustenance over and above what is ordinarily required. 8. By tbe abstraction or undue discharge of animal fluids (such as blood, sweat, etc.,) which equally renders an undue effort necessary for the supply of the deficiency. 9. Generally— by irreg- ularity of habits, or by deviation from habitual method, whereby the t)rgftns of nutrition are either chocked or accelerated, or otherwise com- l)elled to provide for the disturbed l)alance between the tributary functions and the vital energy to which they are subservient. 10. By external influences (such as cold, heat, etc.,) whereby the circulating and secreted fluids are either too quickly absorbed or dispersed, etc., or, on the other band, arearrested or suspended in their progress, and consequently driven back upon the secreting organs, or left to impede the channels through which the successive course of secretions, etc., should be circulated or dispersed. 11. Which may be superadded to the foregoing general causes —by abuse of bitter tonics, sal-volatile, sedatives generally, opium, iodine, and mercury, as also by depletive measures in nervous fevers— all of com- mon occurrence. Respecting disturbance or oppression of the functions of the lining membrane ; it may be said In general that the conditions 1, 2, 3, 6, 7, 8, 9, and 10, just mentioned, operate as exciting causes; but that con- ditions 4 and 5 more rarely (li' ever) operate ..i ritVeei exciting causes. A twelfth class of causes may, however, be added with regard to this variety ; namely — 12. By abuse ot" arsenic and other mineral tonics, and still more frequently of saline purgative medicines. Respecting disturbance, implicating both the nerves and the mem- branes, it will readily be distinguished that any or all of the conditions above mentioned may operate as exciting causes. General Symptoms Exhibited by Ikbitation, etc., of the Lin- ing OR Mucous Membrane. This variety of the disorder is more apt to be developed at the stage of maturity, or within the period of life which is termed middle age; and in general, individuals who are little susceptible to excitement, whose sensations are not acute, and whoso temper is even, or whose disposition is indolent or listless, are more likely to become thus affected. Distinctively it consists of tardy, insufli- cient, or oppressed functional operation, a -d of inactive accumulation of blood in various parts. The first characteristic manifestation 'ch springs from it is aciVZii^— usually, however, attendeu with little ^ .in; regurgitation of food, insipid or acrid risings in the gul!ot, and heartburn; occasionally nausea, but more rarely vomiting; habitual dejlciency of i'^ DISEASES OF THE STOMACH AND INTESTINES. 241 appetite ; iiiibitiml or continued predominance of thirst, especially in obstinate aiul continuous casts ; dryness of tiie inoutli and throat from deficiency of saliva, or thick, adhesive saliva or i>hlcL^ni in the ii;outli; bitter, sweet, or salt taste in the mouth ;— or, again, insipid, claniiiiy, or metallic taste; extreme susceptibility to change of tciiii)cralure and weather, affecting the throat and nostrils, and conseciu^'iitly (o relaxed or inflammatory Ao/e-i7iroa^, or to cold in the head, excessive discharge from the nostrils, or continual dryness or itching in the nose, with or without altered or f(f»«.«/it67<«Z sensation of 67/irV^' ," <)ffin>ili's hrattfi, inter- nal dryness with heat of the cars and acuteness of hearing, or internal swelling witli impeded hearing; hummiwj or bu-ziug in the cars; red sufTusion of the eyes and bleared appearance, esi)ecially on waking in ihe morning ; dark rim around the eyes, with redness and swelling of the inner side and margin of the eyelids ; waterimj of the eyes; oscillation as of fluctuating vapors before the sight ; flashes of light or appearance of sparks before the eyes; dark shade as of clouds or flickering of black spots before the eyes; adhesion of the eyelids — especially on waking in the morning ; yellowish or waxy appearance of tlie eyelids — with glutin- ous matter; in recent or casual cases, and when the aflection is neither severe nor inveterate, the tonyue may be flabby or coated with a brown- ish-white fiir, but neither very dry nor enlarged; in cases in which the liver and first portion of the intestinal tube are an'ected, the tongue will generally be coated in the center with a yellowish fur, somewhat dry, the tip and margins being of a bright-red color and free from fur; in cases in which the afrection is confined to the stomach, but is of a severe character and of K.'ig standing, the tongue will usually be covered ia the center with a slimy fur, the margins and extremity being in this state, also, free from fur, and exhibiting bright redness; in cases in which the nerves of the stomach are a/vo implicated, and in which the irritation of both portions is of a most severe and inveterate character, the tongue will usually be enlarged, and will exhibit a glistening, white, and thin coating in the center, the margins and extremity being free from fur and of a bright-red hue; or, again, it may be so much ^swol- len as to become indented along the lateral margins by the impression of the teeth ; progressive decay of the teeth ; constant or casual toothache, or predisposition to toothache; accumulation of brownish and oflensive matter on the teeth; yellowness, or blackness, or other discoloration of the teeth; ofFensive exhalation from the gums ; soreness or tenderness of the gums; unhealthy and spongy i)ufliness, or redness and swelling of the gums; the gums bleed spontan(>ously, ov ar^i easily provoked to bleed; unhealthy, spongy pufTiness, or excessive redness and swelling of the lips, indicative of recentaflection, when associated with such symptoms as iden- tify the lining membrane as the seat of disease, but occurring irrej;j)ective of degree and length of continuance, when associated with such symptoms as identify the nerves "is the seat of the disease; scaliness of the lips; in cas^^s in which the liver and first portion of the intestines are inii)licated in t'le derangement, we may notice the mottled appearance of the lips; in similar cases of longer standing, and of the most inveterate and incorrigible Ciiar- Rcter, especially if continual excess in the use of fermented liquors, and particularly of ardent spirits, has been the exciting cause of disease ; sallow liAi IM w ':•;.'* J i m.:^ 248 DYSPKP.SIA. in ¥>ii wJiiteness and hardness of tlie lips may be exhibited, or wliat lias been oppositely described as a 7/WX7/ ap/)m/•a7^w,• pressive headache, seated in the anterior part of the head, or what is called sick headache ; dull or intense, fixed, aching ])ains in t!ie head, with sensation of con fusion, heavi- ness, and sometimes, also, wiUi giddiness or numbness; geucval uneasy sensations about the head, or as if the contents were expanded ; determina- tion of blood to the brain, and sudden attacks of apoplexy, without premonitory symptoms; dullness and confusion of thougiit; general dullness of sensation; tardiness of conception ; reflection and motion ; vacancy and incapability of fixing tlio attention for any length of time; drewsiness.or even lutliargy, general indolence and inaction, or even torpor of mind and body ; excessive reluctance to move or exert one's self in any way; deep depression of spirits, witii listlessness; deficient vigor of will, and consequent irresolution and indecision -Jiard but tardy pulse, generally, also, decreased in frequency; unhealthy pudiness of tlie body, morbid accu- mulation of fat; flabby skin; muddy, sallow complexion; and, in severe and obstinate cases, chippy.deadened, i)archment-like skin; inaction, or even torpor of the bowels; and, therefore, suspension of evacuation; slow, tardy evacuations, or evacuated matters pafe/- than in health; liabitual constipation. Genekal Symptoms ExiiiniTicD nv Irritation ok ttik Nkrvks.' This variety of the disonhjr is more apt to hv. developed amongst females and young persons; and, in general, individuiils of acute Hensil)ility, of active, restless habits, of (juick imi)ulses, excitable and irritable disposition, choleric temperament, and of si)are. wiry frames, are not liable to be thus affected. Distinctively, it consists of inordinate, irregular functional oper- ation, resulting in defect in the distribution of blood, or even of the (luality of the blood distributed. The first characteristic manirestation which springs from it ia flatulency ; this variety of the disorder Ixung, also, char- acterized by the multiplied development of pain, and painful or otherwise acute sensations— or, in the worst and incurable cases oi organic disorder, total suspension of pain, which has previously been acnu', and of which the cause is not removed ; intense and pressive pain at the lower part of the chest, sometimes extcMiding through the body; wrenching, gnawing pain at the pit of the stomach; sinking at the stomach; heart-burn very predominant; nausea, and generally vomiting; irregular, fitful, capricious appetite, either inordinately voracious and insatiable, or very delicient, or more generally greater than in health, but sometimes, also, in very severe cases, totally suspended: eating provokes or aggravates the suftering: stimulants, and even hot plain drinks, have tlie same effect; eructations and hiccough, and, in fact, all manifestations of spasmodic contraction of the muscles, connected with and operating upon the stomach; conse- quently, general siiasin of the stomach; thirst usually absent, occurs fitfully or irregularly, but sometimes of excessive temporary intensity; morbid taste in the mouth, chiefly the metallic; thin, acrid saliva ; fitful or period- ical pains in the teeth, of the most intense and distressing description; lips habitually of an over-vivid redness, or spongy; ni"rbid acuteness of the senses of smell and hearing; occasional darting, fugitive or distracting pains in the cavity of the ear, and deep in the head ; the tongue generally free from coating, but of a bright red, fiery hue; in cases which ara of DISEASES OF THE STOMACil AND INTESTINES. ;jft on; of ing illy of recent occurrence, there will not, usually, be either swelling or dryness of the tongue, but the extremity will exhibit a species of roughness from papillary elevations; in more severe and old established cases, the redness of the tonjjue will bo further qualilied by dryness and glistening appear- ance (glossy surface); in cases in which tlie intensity of the irritation may have become complicated with sympathetic affection of the brain, the red- ness of the tongue will bo further qualified by general swelling, and, sometimes, also, by aslight degree of white coating, not sudicient, however, to conceal the characteristic redness of the surface beneath ; the tongue much swollen, and deeply intersected with lissures. iu'licates a very serious fidvancement of the disorder ; the swollen tongue, with a bright, glistening, white surface, whereby is conveyed a distinct indication of severe sympa- thetic affection of the brain, as in highly hypocondriacal subjects, especially those who have been treated with large doses of mercury; the co-existence of both varieties of the disorder of considerable duration, is evinced in the swollen tongue, of which the margins and extremity are red, but tlie center is slightly covered with a glistening white coating; the tongue quivers on protrusion (whereby is identified a symj)atlieticafle(;tionof thesinnal cord). The change from vivid redness, with or without swelling, but without coating, to brownish hue, and more or less thick coating, implies a modifi- cation of tlie disonler, or progress towards cure. In general, moreover, we may notice every variety of hysterical or hvpochondriucal excitement; unaccountable uneasiness and restlessness; su-lden lits of laughter, or the contrary, the one terminating in, or alternating with tlie other, apparently without a cause, or provoked by very slight causes; sudden starting or shuddering; incessant tossing about,or movingfrom place to placf%' general or local convulsive movcMuents of every description, such as trembling, jerking of the limbs, eougbing; convulsive cough, dillicult respiration, and sensation as of a ball rising in the throat; cramps in the muscular parts; chattering of the teeth, or clenching of the hands and teeth, or grinding of the teeth during sl(!(q); an interminable variety of erroneous impressions, upon which the mind harps with persistency, and which appear to haunt the patient more painfully at stated periods; intense and restless anxiety about one's self, one's affairs, one's health, with impulses even to self- destruction; extraordinary exaggeration of every feeling; intense sensi- tiveness of temper and disposition; intense impatience, not only of contra- diction, disapp .'intment, vexation or pain, but even of one's own moral feelings; excessive irrascibility and excitability; temporary suspension of control over the muscles of voluntary motion ; sudden local and temporary paralysis; apoplexy ; pains in the head, of various descriptions, giddiness, sensation of weakness in the head ; Tic-Douloureux. or nerv(^pain in the face, etc.; pains on one side of the iutad; darting pains, starting from one point, and piercimr the head in every direction; pains in the back of the head; darting pains in tluj eye balls; pains wiiit;h seem to run from one extremity of tlie body to the other, leavingan indescribable sensation after thani; jmlpit (I tio7i of the heart; quick, and soinetiipes small and frequent pulse; anxiety and oppression of tiio chest; flushes of heat, with patchy, circumscribed, or suffused redness; crawling, pricking sensations in the skin; redness and swelling of tlu^ gums and lips; spare, meager, or even withered frame; great delicieiiey of flesh ; scanty and wiry Iltish ; irregular operation of the bowels, both as to the fretiuency and the nature of the motions, which vary in color and consistency. t : If •I ,'"=ifci DYSPEPSIA. ALLOPATHIC TREATMENT. Exemption from inconvenience, with the mind pleasimtly occupiod during eiiting and digestion, as is tJie case when in agreeable company, frequently enables the patient to indulge the appetite freely, without inconvenience, but when they dine alone they experience trouble during or after the meal. In the latter case, tliey watch carefully the sensations of digestion, while in the former case, the diver- sion of the mind causes tlie unpleasant experiences to disappear. Good cheer and a good moral are valuable both in the way of prevention and cure of dyspepsia. As to diet, there is no doubt that when the dyspepsia succeeds over-in- dulgence of the appetite, one of the lirst tilings to be done is to give the stomach rest for a time, by abstaining from food or by taking less than the patient requires. The period to which this is appropriate is of short dura- tion, and must not be continued long enough for the system to become reduced. This abstinence may, of itself, become a cause of dyspepsia, as is the case when persons attempt to live on as little and as coarse food as possible. The food should be simple, but nutritious, and taken in ample quanti- ty and variety. Often it is an object of treatment to overcome the errone- ous idea, that various healthy articles of food do not agree witli him. Food which is wholesome for most people cannot be iiarmf ul for any. It is often said that " what is one man's meat is anotlier's poison," but tluue is scarcely a maxim which is more generally untrue. Almost all cases of dyspepsia can, and should conform to the ordinary rules of diet, and not to any parti- cular rules. He shoidd take, from time to time, any and all articles of wholesome food, and aim to eat like a well person williout the need of selecting food to suit his particular case. In most cases of dyspepsia lean meat is digested the best, especially, from mature fat animals. It should be plainly but well cooked, never fried. Sometime? milk with starchy articles of food, such as bread, rice and tlie like agree best. Doubt- less milk is not healthy when taken on a full stomach, in large quantities, but if taken with the understanding that it is hearty .'ood, it will almost never disagree. Bread, to be in its best condition, sliould be in that state between fresh and stale. Corn meal, oat meal, and cracked wheat or Gra- ham mush, and boiled rice, are easily digested. Ripe fruits partaken of moderately are beneficial. Pastries, rich puddings and sweetmeats are inappropriate. The kind of food most appropriate will vary, as it is found that the digestive derangement is in the stomach or intestines. If in the former, starchy articles and fat will agree l)est, butif in the latter, meats, eggs, and milk will be found most appropriate. The habits regarding eating should be regular, but at the same time, the dyspeptic ought never to go hungry. If no l>reakfast or an insufficient one has been taken, alunch in the early part of the day is desirable. His most hearty meal should be at an hour tliat can be followed by leisure and recreation. Often a little food had better be taken before retiring at night. No one ought to go to bed hungry. Hearty indulgence of tlie appetite is not to be permitted, but moderation is to be practiced until the digestive powers increase, when food may be taken in larger quantities. 4i DISEASES OK THE STOMACH AND INTESTINES. aoi Only a moderate amount of liquid should be taken at the meals, but liquids may be freely taken between meals. Regular habits of life, early liours, plenty of sleep and such changes in the occupation as will secure sufiicient bodily exercise and relieve from harrassing care and troubles of business, a rest of one day in seven, horse- back riding, a daily cool or tepid sponge bath, and abandoning the use of tobacco and alcoliol, will cure most cuses of dyspepsia. It is a common, and truthful saying in the main, that exercise will euro dyspepsia, but if taken simply for exercise It becomes neglected and tends to keep the mind of tiic patient on his disorder, wiiich is harniful. It is, tlierefore, desirable that the mind of the patient may be turned from his dyspeptic trouble, that he adopt such a mode of life as will, of itself, require a requisite amount of exercise in the open air. Most, if not all these rcfiuisites are secured l)y an overland tour in our own country and mountains, or l)y foreign travel. I l)elieve exercise never should be carried to the point of exhaustion, but should be sufficient to have earned a good sleep of eight hours at night. The benefit which can be derived from medicines is secondary, but important. The uneasiness of the stomach may som'etimes be relieved by a counter-irritant over the stomach, as a small blister, or rubbing the skin with a liniment made of equal parts of Ammonia water, (liartshorn,) Turpeatine and Olive Oil, or a couple of drams each of Croton Oil, Tur- pentine, and Olive Oil. If the blood is impoverished, and the appetite is poor, bitter infusions (teas), made of Colombo, Gentian, Cinchonia Bark, or Quassia.ctc, in the strength of one ounce of tlie crude (dry) drug to the i)int of liot water. Dose: Two or three tablespoonfuls before eating. The Tincture Muriate of Iron may be given in doses of fifteen drops in sweetened water, after eating. The Citrate of lr.);i luid Quinine, in doses of two to five grains, in solution, in water or syiup, almost always answers the same purpose as both the foregoing. Digestion is often greatly lielped by the use of Lactic or Hydrochloric Acids and Pepsin; the liquid Pepsin made by Sheffer's formula, combines botli tlie Hydrochloric Acid and the Pepsin: Take of Sheffer's Sacehurated Pepsin a hundred and twenty f/ rains, 7oater ft oe ounces, Hydrochloric Acid a dram, after solution is made, a/^ I of Qlycenne three oumses. Dose: A dessertspoonful before eating. When Lactic Acid is given, it may be combined with Elixir of Pepsin. fake of Lactic Acid one ounce, Elixir Pepsin, seven ounces. Mix. Dose: A dessertspoonful. Or, a good formula, is this: Take of Qlycerole of Pe')ysin three ounces. Lactic Acid an ounce. Mix, and give a teaspoonfal after each meal. If Iron is required, half a dram Lactate of Iron can be added to this mixture. In case the Hydrochloric Acid is used, if Iron is also given, it should be the Muriate Tincture of Iron. In case of acidity and heartburn* the acid mixture should be given before meals, instead of after. Should this not relieve. Bismuth, in doses of fifteen or twenty grains, with a little baking Soda or Saleratus, may be given after meals, upon the development of this symptom. Soda is to be preferred in doses of five or k 'I- 1 I I '*i>l If 252 DYSPEPSIA. w m m >■ ten grains repeated as often as the acidity (heartburn) occurs. Tlie Soda may be given alone. Flatulence and wind in the intestines is best relieved by the continued use of Nux-vomica. Ten drops of the Tincture of Nux-voniica, In water, or a quarter of a grain of the Extract in pill, or, a thirtieth to a twentieth of a grain of Strychnine, may be given three times a day. If Strychnine is used, sugar coated pills containing a thirty-second part of a grain may be given. Care should be used, that the pills arc soluble; they should bo soft under the sugar-coating. In solution, it is intensely bitter. For its administration, tales of Sulphate of Strychnine a grain, or, a urain amJ a half, water thirty-two drams. Mix. Dose; A teaspoonful three times a day. In extreme instances, when everything is vomited, the so-ealled milk cure is often appropriate. In its use all other food is omitted. A couple of tableapoonfuls with lime-water, is given every tliree hours durin;; the day, and the quantity gradually iiicrtased until the invalid can take one or two glassl'uls four times a day. One or two quarts is yonerally the amount that can be taken in the day. It is best given a little warm. The quantity of lime-water should be one-fourth that of the milk. If neces- sary, the milk can be flavored with a little coffee. Other useful proceed- ures are counter-irritation, as above suggested, a drop of Cresote in water, after each act of vomiting. Bismuth and Nux-vomica, also, as above directed, etc. HOMCEOPATHIC TREATMENT. Nux-vomica is particularly appli- cable to the treatment of indigestion in hypochondriacal subjects. It covers the following symptoms, either when they have arisen in conse- quence of sedentary habits, excessive mental exertion, or long watching, or of overloading the stomach, of excessive draughts of milk, or even water, or of eating or drinking acid things, or of using spices and seasoning to excess; or, again, in cases in which all food or drink, however plain, light and digestible, provokes indigestion; or from the abuse of coffee, tobacco, wineor ardent spirits; or, again, when the irregularity of digestion has been induced or confirmed by loss of animal fluids (profuse sweating, bleeding, and the like,) or by liabitual recourse to aperients ; the head con- fused, with, occasionally, a feeling as if resulting from intoxication, and giddiness, with sensation of turning and wavering of the brain ; headache, unfitting for, and increased by mental exertion; tearing, drawing, or jerk- ing pains in the head or cheeks, and pulsative pains, and a sensation as if & nail wem driven into the brain ; congestion of blood to the head, with humming in the ears. The headaches are often deeply seated in the brain or in the back part of the bead, frequently confined to one side, or over the eyes, and at the root of the nose, coming on chiefly in the morning, after a meal, or in the open air. Yellowness of the lower part of the white of the eyes, with a mist before them ; a sensation as if one were about to fall; sparks, or small gray or black spots before the eyes; short-sightedness; pale or yellowish color, or redness oi the face, especially, about the mouth and nose; frequent headache, and impaired powers of digestion, with insipid- ity of food ; foul, dry white or yellowish tongue: vivid redness of the mar- gins of the tongue ; thirst, with water-brash, particularly after acids or rich food ; accumulation of slimy phlegm or water in the mouth ; metallic, DISEASES OF THE STOMACH AND INTESTINES. flalt,sulphurou8, herbaceous, bitter, sour, suKetish or putrid taste, chiefly in the morning, or after meals ; bitter eruntationn, or continuetl nausea, espe- cially after meals, or even after drinking cold water or milk— or on going into the open air after a meal, or after partaking of acids ; heartburn, hic- cough, acidity, (latulence, frequent and violent vomiting of food, phlegm, or bile, ineffectuaUefforts to vomit; distention and fullness in region of the stomach, with excessive tenderness to the touch ; a feeling of tightness of clothes round the upper part of the waist; cramps of the stoirmeh ; constipa- tion; reddishurine, with hrickdust-cohned sediment; sleep unrefreshing and restless, either from suffering or otherwise, with disagreeable dreams, and drowsiness in the morning; tendency to exacerbation of symptoms during the prevalence of a northerly or easterly wind, or when the atmos- phere is loaded with vapor; better after warm food. One of the most distinctive indications for the employment of this remedy, in preference to the next mentioned, is the temi)erament, which is restless, irritable, lively and choleric. A disposition to piles is, also, a good indication. Dose: Three globules, in a teaspoonful of water, night and morning, for a week; then pause four days, resuming the same remedy in a similar course, or suspending treatment, or |)roceeding with another medicine, according to the circumstances which are present. CovruJus is appropriate to the treatment of highly bilious subjects, or when the derangement can be traced, however remotely, to long watch- ing or intense application to study; or when coffee, to6«a:o, or brandy, can be trac(al as the exciting cause. It may, generally, be employed in cases in which moroseness and hypochondriacal disposition are marked characteristics, either before, after, or in alternation with Nux-vomica, according as the characteristic efTects of the one or both most clearly cor- respond with the case. Dose: Throe globules, in a teaspoonful of water, every twelve hours, until amelioration or change. Or if, again, Cocculu's be apparently inadequate to complete the cure, consider the next remedy. Carho-vefj. is, especially, appropriate to the treatment of derange- ments of this nature, occurring amongst persons of advanced years; or when the derangements can be distinctly traced to Jongwatching, to abuse of wine, of ardent spirits, of coffee, to milk-diet or casual use of milk, to excessive use of butter, or to rancid butter, to fat and greasy things,su(ih as pork, to fish, especially, if tainted, or to shell-fish in partic- ular, to ^,r/^7fZt'/v^ vegetables, etc., to pastry or acid things, to excessive use of salt, or unguarded use of ices, or very cold drinks. Tliis remedy is particularly indicated by excessive and constant Jlatiilence, with heavy respiration, repugnance to animal food, or, especially, to fat or greasy things, or to milk, and when acidity is constantly provoked l)y such food; bitter taste in the mouth; accumulation of phlegm in the guile*" and stomach ; frequent empty, sour, or bitter eructations, etc. Hose: Tliroe globules, in a tablespoonful of water, every twelve hours. Puls(ifi/fa is indicated by a series of symptoms very analogous to those which have been enumerated under the head of Nux-v., but with this distinction, that it is particularly adapted for females generally, (e.v- peciallyfor hysterical sul\jects,) children, individuals with light liair, and a marked predisposition to purulent exudations at the edge of the eyelids, % ■ji% m *■ 264 DYSPEPSIA. i*i. ?Hif f^ 1 or to styes, and for mild or phlegmatic dispositions. Under such condi- tions it is appropriate to the treatment of deniugeinenta of tlio stomach, occasioned by excessive application to study, overloading tlio stomach, abuse of wine, spirits, beer, colTee.or rich cliocolate, l)y excessive draughts of milk, or even of water, by new,slack-l)al<ed, or otherwise unwholesome l)read, or butter, fat or greasy things, tainted or unwiioiesome meat (pork especially.) by eating oysters or tainted tish of any kind, by pastry, tlatu- lent vegetai)]es, fruits, or by ice cream ; or even wlien an external injury (as a strain) has been the exciting cause of the ailment. Amongst its characteristic indications, we more fre<iuently find a want of tldrst, than thirst; a repugnance to fat and rich meat, and sutrering after taking jmrk or pastry; general chilliness, or grelxt difficulty in keeping the hands and 1'eet sufficiently warm; deficient sense of smell, sometimes accompanied by increased secretion from the nostrils; frequent and loose, or diflicult and loose, or sluggish evacuations ; hypochondriasis, and convulsive fits of laughing and crying. Dose : Three globules as directed for Nux-v. Ignatia may, in some cases, be employed twelve hours after the fourth dose of Pulsatilla, if the latter has failed in affording permanent relief, and does not promise to complete the cure. It may, also, in some cases, be employed before or instead of Pulsatilla, when tliere is a tendency to alternations of exuberant and depressed spirits, or particularly, if grief be associated witli the derangement. Ignatia is, also, appropriate for the treatment of derangements of digestion occurring amongst highly hys- terical females; or of cases which result from abuse of cofTee, beer, bran- dy (or even ardent spirits, in general,) milk, sweet things, or tobacco. Dose: Three globules in a teuspoonful of water, three times a day. Bryonia is often appropriate to the treatment of derangements of the stonuich, associated either with a hypochondriacal or hysterical dis- position, or with habitually sedentary habits; or when occasioned by depressing emotions, by chocolate, milk, new or slack-baked bread, tainted sausage meat, flatulent fruit or vegetables, or pastry; the indicative symptoms are as follows: Headache, burning or expansive, particularly after drinking, attended with bewilderment of the head and giddiness; tongue glazed, dry, and red, or covered with a whity- yellow fur; sometimes the aversion to food is so strong, that the patient cannot bear the smell of it; loss of appetite, alternately with Uiinatural hunger; craving for acid drinks; great thirst; insipid, clammy, putrid, sweetish, or bitter taste in the mouth ; acidity and flatulence, or bitter risings after every meal, or after partaking of milk. Hiccough, nausea, water-brash, vomiting of food or bile, par- ticularly at night ; tenderness in the region of tlio stomach to tlie touch, sensation of swelling in the pit of the stomach, especially after a meal, or on wallting; sensation of burning in the pit of the stomach, especially when moving. Constipation, temper, restlessness, irascible and obsti- nate ; also, when want of exercise or anger are frequently the exciting causes of the derangement, or the means of aggravating the indigestion. The indigestion is more apt to manifest itself in summer, or in damp weather, with a northerly or easterly wind, and is frequently accona- panied with chilliness. ^W' DISEASES OF TIIU STOMACH AND INTESTINI 256 Dose: Three globules in ii toaHpnonl'ul of water, every twelve hours, until ninelioration or cliaiige. In caseH in which tlui Huflerings are very great, the lilte dose should he repeated every three houra during the attack, until the syniptonis subside or change. lihus-tojc., which is particularly aiipropriate for the treatment of indigestion resulting from nieclumiual injuries (such as a strain), or when beer, spirits, eofFee, milk. copiou3 draughts of cold water when heated, new or slack-baked bread, tainted sausajje-nieat or fish (especially shell- fish, as muscles,) may directly have provoked the attack. The speciflc symptoms are as follows: Flat, sticky, sweetish, bitter, or foul taste in the mouth ; drowsiness, eructations, and sensation of fullness, languor or gid- diness, after eatliifi ; a, Henaation of repugnance to food, especially, to meat, bread, etc., or sensation of satiety ; or want of appetite, with hankering after dainties; continued, emptij, painful and iioisy enictat io n s ; oSenaivo and very abundant llatulency; the derangements of the digestive func- tions more apparent and troublesome at night; distention and pressure in the region of the stomach. Extreme depression of spirits, despondency, insuperable anxiety, and uneasiness respecting affairs. Dose: Three globules, in a teaspoonful of water, every four hours, until the symptoms are moditied, and then every twelve hours, until positive change. Natvam-m. is particularly appropriate to the treatment of chronic <?cwcs occurring amongst hypochondriacal subjects, or, sometimes, of preg- nant females; or when habitual excess in the use of fermented liquors has been the chief cause of derangeinent; or when milk diet, mineral waters of particular localities (unless brackish,) or the water of hard springs and mountain streams — or unwholesome bread, or fat and greasy food (especi- ally pork,) — or excess in the use of fruit or tobacco, may be distinguished as associated with the origin of the affection. Natrum-m. is generally useful in such obstinate chronic cases as have resisted the operation of Bryonia, Nux-vomica, etc., and which are characterized by frequent attacks of morning sickness, or by heartburn after every meal, water- brash, constant nausea, occasional sensations of faintncss, pressure in the stomach, or intractal)le humor after eating, and obstinate costiveness, or whtu milk, and liquids in general, invariably disagree. Dose: Six globules in a tablespoonful of water, every morning, the first thing (fasting,) ten days (unless earlier improvement ensues,) then pause four days, resuniing the same course, if necessary, and so on . Knli-hich. is particularly applicable to the treatment of chronic cases in which milk, bread, fish, or pastry, constantly disagree with the patient. The distinctive synjptonis are as follows : Indigestion, with aggravation of symptoms in the morning and dur- ing movement, relieved after eating (sometimes, however, a distressing feeling of weight is experienced after a meal ;) mouth and tongue dry ; thick yellow fur on the tongue; conilux of water in the mouth ; metallic, acid taste; want of appetite, nausea, flatulence, frequently accompanied by colic. Constipation or hard stools, attended with straining and burn- ing in the outlet; alterations of hard and relaxed motions, great sensibil- ity to cold air, complications with affections of the liver and spleen; extreme depression of spirits, hysterics. Dose : As directed for Natrum-m. Ill „ , ';l'^' I •:;!>:' sir ■ f'' .n if IMAGE EVALUATION TEST TARGET (MT-3) 1.0 I.I 1.25 IIIM 112.5 ■|llllltt 1 22 I4£ 12.0 1^ I. ^ 1.4 1.8 1.6 Photographic Sciences Corporation 23 WEST MAIN STREET WEBSTER, N.Y. 14580 (716) 872-4503 m V :\ .^v \ ^'^^ % V <«*>. ,*, Ltf W/s^. "i vV - wEmm mam 256 DYSPEPSIA. ChaniomiUa is of great service in some derangements resulting from, or assoaiated with, excess in tlie use of coffee or sweet tilings; or more especially depressing emotions, such as vexation, disappointment, a fit of passion, and the like ; or again, if the derangement has been provoked by cheek of perspiration. The characterizing symptoms are as follows : Headache, with, sometimes, semi-lateral pulling, shooting, fullness, and beating in the head; giddiness and staggering in the morning, when getting up; oppressive heaviness, swimming in the head, and sensation of a bruise; headache, felt sometimes during sleep^ with- obscuration of the eyes, and yellow color of the whites ; tongue dry and cracked, with a thick and yellowish coating; mouth dry, with occasional presence of frothy phlegm ; excessive thirst and desire for cold drink ; bitter taste of the mouth and of food; want of appetite and dislike to food. Acidity or sour risings, regurgitation of food, nausea, vomiting of food, phlegm and bile; oppressive pain in the region of the heart, distention at the pit of the stomach and upper part of the waist, chiefly after eating and at night, attended with disquietude and terror; burning pain in the pit of the stomach; uneasiness, and feeling of sinkiag in the stomach ; cramps in the stomach, especially when traceable to coffee ; sometimes constipation, but generally relaxation of the bowels. Dose: In casual cases, of a solution of six globules to three table- spoonfuls of water, give a teaspoonful every three hours, until ame- lioration or change. In chronic eases, three globules in a teaspoon- ful of water night and morning, until similar variation occurs. Ipecacuanha is available for the treatment of indigestion, occurring amongst children and pregnant females, or when occasioned by overload- ing the stomach, imperfect mastication of food, hurried and voracious feeding, or by irregularity of meals, or by abuse of tobacco, or even of coffee; or in cases in which veal or other young meat particularly disa- grees ; or when cold, nervous excitement, late hours, or over-application to study in particular, are to be traced as the exciting causes of derange- ment. The distinctive symptoms are: face pale and yellowish ; tongue sometimes clean, at others coated white or yellow ; aversion to food, and particularly to fat or rich indigestible food, such as pork, pastry, etc., or suffering from indigestion on partaking of such ; vomiting of drink, food, phlegm, or bile, sometimes after a meal ; retching, easy vomiting, gener- ally attended with coldness of the face and extremities, and sometimes alternation with watery looseness of the bowels, feeling of emptiness aui flaccldity, and sensation of sinking at the stomach. Headaches attended with nausea and vomiting ; shooting pains, with heaviness and painful pressure on the forehead. Dose: Against tlie acute symptoms, when present, of a solution of eight globules to a wineglassful of water, give a tea-spoonful every hour, until amelioratJon or change; against the chronic aspect of the affection, that is, the recurrence of the acute symptoms, give three globules in a teaspoonful of water, night and morning until distinct change. China is appropriate to the treatment of derangements of this kind, according to the subjoined indications, when occurring in aged persons, or in patients of a hypochondriacal disposition, particularly if the loss of animal fluids, or mental affliction be distinguishable as the predisposing cause, or when the suffering can be attributed to overloading the stomach, DISEASES OF THE STOMACH AND INTESTINES. 2.5: to exce*«ive indulgence in strong tea, or, in some cases, to abuse of spirit- uous liquors or coffee, to milk diet, or to unguarded or too copious draughts of water; or again, wlaen bread, butter, fat and greasy things generally disagree, or when tainted fish has been the immediate cause of derangement; or, again, if the symptoms can be traced to flatulent food, over-indulgence in fruit or spices and other seasoning, or, in some cases, to tobacco; or, again, when every kind of food provokes an attack. This remedy is a valuable auxiliary in the treatment of this derangement, when there is impaired appetite with great weakness of digestion, whi(!h is more liabJe to be experienced on partaking of supper; flatulence, bitter taste, languor, hypochondriacal disposition, and particularly when we can trace the affection to debilitating losses of fluids, such as the abstrac- tion or loss of blood, too great a drain upon the resources when nursing, prolonged use of aperient medicines, etc., also in disorders arising from the abuse of tea, or from a residence in impure atmospheres, especially such as are overloaded with the exhalations of decayed vegetable matter, where tlio drainage is insuflicient, the cultivation imperfect, where stag- nant pools or ditches, charged with rank matters, abound, more particu- larly in the midst or vicinity of half-dried marshes, or on a level with them, or in such position in relation to them as exposes the habitation to the current of prevalent winds from them, or near the beds of periodical streams, when the water ceases tc flow, and the bed appears to be dried up (especially in warm climates,) or when the rays of the sun have great power; or, again, in districts which are habitually dry and well drained, but which have been extraordinarily saturated by a wet season, and are beginning to dry up again. Dose: Six globules, night and morning, one week; wait four days, and if still indicated by the symptoms present, resume the admin- istration of the same remedy night and morning, every fourth day. , DERANGEMENT OF THE STOMACH ABI8ING I BOM . CASUAL CAUSES-NOT HABITUAL. This should be understood to apply to those who are only casually afTected, but whose digestion is habitually unimpaired. Causes.— The ordinary causes of this derangement are, hurried, im- perfect mastication; overloading the stomach; fat, greasy, indigestible or tainted food, flatulent vegetables, ices, stimulants, and others equally well known. HO^(EOPATH(C TREATMENT. When the symptoms of approach- ing derangement of the stomach declare themselves immediately, or a few hours after a repast, which has been too freely partaken of, a cupful of strong coflTee, without milk or sugar, is frequently a sufficient restorative. Should, however, this fail to relieve, and sick headache and inclina- tion to vomit be present, we should assist nature by various artiflcial means— the milder, if sufficient, the better--cuch as tickling the throat «vith a feather, and by giving tej -id water to drink until the stomach has completely evacuated its contents. 17 •m 4-: ''I tt? * ,. >.^l a mum 258 DERANGEMENT OF THE STOMACH. Bryonia is very serviceable, wlien the following symptoms are pres- ent: bitter eructations ;/ewr, alternately witli coldness and shivering, a redness of the face, lieat in the head, and thirst with coldness and shiver- ing; also, when looseness of the bowels or constipation, and peevishness or excessive irritabiMty are present. In derangement of the stomach, arising from succulent vegetables, and attended with excessive flatulence, this remedy is frequently productive of speedy relief. Dose: Of a solution of six globules, to two tablespoon fu Is of water, give a teaspoonful every two hours. Arsenicum, When there are acrid and bitter eructations with nau- sea and vomiting; also dry tongue, excessive thirst, salt taste in the mouth, » i burning or violent pressure in the stomach, vrith diarrhoea or colic, r u griping in the lower part of the belly, particularly when arising from the effects of an ice which had been partaken of, the patient being warm, or from fruit, stale vegetables, or acids. Dose: Three globules, in a teaspoonful of water, every three hours, until amelioration or change. Carbo-vegetahilis is a very valuable remedy in this affection, either for the initiatory treatment, or after the previous administration of one or more of the other remedies, according to indications, for the purpose • of removing any symptoms that may remain; it is, moreover, particu- larly useful where great susceptibility to the influence of the atmosphere, particularly to cold, exists at the same time; or in suffering arising from abuse of wine, ices, or salt; further, in derangement of the stomach, aris- ing from having partaken of game or flsh which has been too long kept, or meat that has been re-cooked whilst in a state of fermentation, which is liable to occur in warm weather; in the latter instances, Carbo-v. is to be preferred to any other medicine, and will rarely fail to afford relief. Dose : Of a solution of twelve globules, to three tablespoonfuls of water, give a teaspoonful every four hours, until amelioration or change.* Nux-votnica is indicated bj' offensive or acrid eructations, constipa- tion, and confused headache, particularly, when arising from previous intoxication, or even slight over-indulgence in wine or other stimulants ; when possible, it should be taken the same night, as when taken in the morning, although eventually relieving, it frequently causes an aggrava- tion for a few hours. In derangement of the stomach, with heartburn, flatulence, more or less nausea and headache, etc., in consequence of a chill or of indulging in mental or corporeal exertion immediately after a meal, this remedy commonly affords speedy amelioration. Dose: Four globules, in a teaspoonful of water. Amicai^ indicated in cases of derangement of the stomach, charac- terized by eructations resembling rotten eggs. Dose : Of a solution of eight globules, to two tablespoonfuls of water, give a teaspoonful every three hours, until amelioration or change. Pulsatilla, in recent cases of deranged digestion, with rising of food, tongue foul, and covered with phlegm; chilliness, and lowness of spirits; and, also, when a rash has been thrown out, in consequence of the *A small quantity of flaely powdered charcoal, In a little good French brandy, or water, will b« found an equally effloacious mode of administering this remedy, as a co^rrectiTa against derangement of the stomach, arising from baying partaken of tainted meat or flsh. •r-'. DISEASES OF THE STOMACH AXO JVTESTINES. 259 derangement. This remedy is almost spcciC; • >vheii the disturbance has arisen from the effects of rich food, such as p'}, c, or pastry, or even tainted meat, or from the effects of ices, cold fruits, or crude vegetables, acid or impure wine, etc. Dose : Four globules, in a teaspoonful of water. Obstinate Chronic Cases of Functional Derangement.— In cases of derangement of the /M»cfio;i.s of digestion, which, though modi- fied, are extremely difficult of removal, the remedies hereinbefore noticed will be required for initiatory treatment; but, in the majorty of instances, the patient will have to be subjected to an appropriate course of such remedies as those iiereto subjoined, in order to complete the cure. Sulphur is one of the most important remedies for administration after the previous exhibition of Nux-vomica or Pulsatilla, and in cases which would otherwise correspond with the indications for either of those medicines, but when either of them has been inadequate to effect a perfect cure. Dose : Six globules in a wineglassf ul of water, every morning the first thing (fasting) for ten days, (unless there be earlier improvement or change,) then pause four days, resuming the course similarly, if necessary, and so on, from time to time, until positive amelioration or change. Hejjar SulphuHs is also of great value in cases in which the diges- tion is naturally weak, and sour vomiting, with burning sensation in the throat, colic and looseness of the bowels, are liable to be provoked by the slightest error in diet, and particularly when anything of an acid nature has been partaken of; or especially in cases in which the patient has previ- ously taken blue pills, or any other mercurial preparation, fd a considera- ble time. Dose: If singly, three globules in a teaspoonful of water, night and morning, for a week, (unless earlier and decided improvement or change ensue,) pause tour days, and resume the course, if necessary, and so on, from time to time, until amelioration or change ensues. Sepia is also indicated by a sensation of coldness, and is to be preferred to either of the preceding remedies, when this symptom is associated with a multiplicity of other equally characteristic indications, particularly if there be no appetite, or voracious appetite, and aversion to meat or milk, water-brash, especially after drinking; constant acidity of the stomach, aggravated by eating, and, if fat things, milk, etc., continually disagree. Dose : Four globules night and morning. Silicea is, especially, indicated when the patient ei^tertains a repug- nance to cooked food, and is particularly averse to meat; .if hen the patient is subject to severe pains in the stomach, attended with excessive thirst and water brash, bitter taste in the mouth in the morning, vomiting after drinking, and habitual nausea predominating after a meal, or upon rising in the morning. Doy • Six globules in a wineglassf ul of water, every morning the first ti;iitg (fasting,) until amelioration or change. Carbo-veg. Here, again, this remedy is peculiarly valuable when annoyance or inconvenience is felt after every meal, amounting to nausea and vomiting, attended with excessive flatulency, and when the pit of the stomach is tender on pressure. Do^: Three globules in a teaspoonful of water, until amelioration or change. s;« y 260 DERANGEMENT OF THE STOMACH. mi ' -I * :« Obstinatk OiiKONio Cases of Ouoanio Dkuangement. In cases in which organic disease has been establislu'd, that is, in such cases as assume the critical aspect described in the general description of symptoms at t!ie commencement of tliis article, it were desirable, if possible, that tlie interference of an experienced Ilomoeopatliic practitioner should be invoked. Geiieual Dekangejient of the Stomach in Children. The fore- going particulars, applying to general cases, are equally to be kept in view in considering this aifection, more particularly amongst children; but as the causes and features of such derangements are necessarily far less coni' plicated amongst children^han amongst adults, it may save the adminis- trator much trouble to extract and render in a summary form, such details respecting tlie treatment of this affection amongst children, as will other- wise be gatliered only in scattered portions of this article. TpccacHUuha, Pulsatilla or Carbo-veg. These medicines are of chief importance, either for independent, alternate, or successive adminis- tration, in cases in which hurried feeding (bolting the food,) imperfect mastication, and overloading the stomach, or rich, indigestible food, can be distinctly traced as the exciting causes of derangement. The particular indications for each may be gathered from those details v/hich have already !>een afforded. Dose: If singly or successively of cither remedy, two globules in a teaspoonful of water, every three hours, until amelioration or change. If in alternation, dissolve'eight globules of each remedy, separately, in a wineglass of water, and give a teaspoonful, first of one solution, then of the other, so that an interval of four hours shall elapse between the doses, and so on, until amelioration or cliange. l*nlsatUla, Arsenicani or Carbo-veg. These are in like manner appropriate in ciises in which ices or cold fruits have been the exciting causes of derangement. In this instance, also, the particular indications foi each may be gathered from the foregoing part of this article. J5o.se; In every respect as directed in the forgoing prescription. Pulsatilla, China or Carho-veg. These medicines selected accord- ing to tlie indications afforded in respect of each, in the former part of this article, are particuhirly appropriate to the treatment of derangf^menls of digestion, occurring amongst children, in consequence of having eateu tainted meat or fish. JDose : In every respect as directed in the foregoing prescription. Carbo-veg., or Arsenicum. These medicines, respectively, accord- ing to the indications hereinbefore afforded, respecting each, ai*e most appropriate, in the generality of cases, to the treatment of derangements of digestion occurring amonj'fc," cliildren, as the result of excessive use of salted articles of diet, especially salt meat. Dose: Of either medicine, give two globules in a teaspooi-iul of vater, every four hours, until amelioration or change. Aconitum, Arsenicum or Carbo-veg. These again occur as the most important remedies whence a selection should be made according to the special indications for each, which have already transpired in previous portions of this article, when acids (such as vinegar, etc.,) are identified as the exciting causes of derangement. Done; Of the remedy selected as directed iu the last prescri^ ion. Wl DISEASES OP THE STOMACH AND INTESTINES. 261 8TMPATHBTIC AFFECTION OF THE BRAIN AND NERVOUS SYSTEM. Depression of Spirits. — Hysterical and Ht/pnchondriacal AJfedions. These most distressing results of long-continued or very severe derange- ment of the digestive functions, are almost invariably associated with what is termed "chronic indigestion," and not un frequently afford an important clue to the treatment of the primary seat of disease. But nothing can be a greater source of error in most cases, than to deal witii them as primary diseases of the brain and nervous system. Depression of spirits may occur as the consequence of derangement, either of the nerves or lining membrane.T of the stomach, but with very different char- acteristic features ; for when the nerves are the seat of the disease, restless and uneasy anxiety, sudden fits of violent excitement, extreme irritabil- ity, impatience and despondency with violent impulses, are the result; when, however, the lining membrane is the seat of disease, extreme depres- sion of spirits occurs associated with languor, utter prostration, indolence, and listlessness. Sulphut' is appropriate to the treatment of both varieties, but is more especially indicated by the indolence of mind find body, or by the vacancy of thought, or absence of mind and irresolution, which character- ize the latter ; it is, however, also appropriate when tlie depression of spirits is associated with painful anxiety of mind, extreme solicitude con- cerning the future and respecting one's health and affairs, erroneous or exaggerated notions on given subjects, general wretchedness without any ascertainable reason, sudden fits of violent excitement and periodical return of exti'eme impatience, restlessness, irritability and impatience, when the following symptoms are also present : — sensation of fullness and weight at the pit of the stomach; habitual constipation, headache, and particularly pain at the top of the head; dullness and heaviness of the head, the patient being unable to exert his mental faculties, or becoming exceedingly weary and exhausted after any application of this kind; disposition to piles; or when chronic eruptions and affections of the skin are associated with the complaint. Dose; Repeated doses are generally required, administered thus : For adults six globules, or for young persons four globules in a wine- glassful of water, every morning the first thing (fasting,) for ten days (unless new symptoms or a change in the nature of the symp- '• toms be sooner developed) then pausing for a week, and resuming the like course, if necessary ; and so on until distinct amelioration , .. , or change; if in alternation with Calcarea, commence with three , ' ; doses of Sulphury as just described; pause four days and then "'' administer three doses' A Calcarea likewise, and so on until amelior- ation or change. Calcarea is indicated by depression of spirits, with disposition to tears ; flushing of blood to particular parts associated with attacks of inde- scribable anguish, and generally palpition of the heart, or painful sensa- tions in the region of the heart; general uneasiness wuth aversion to mental or physical exertion ; despondency respecting one's health, and •aiiprehension of death ; dread of mental aberration— or of contagion, or other causes of disease, or of imaginary misfortune ; and when there is intense acuteness of all the senses. Dose: In every respect as directed for Sulphur, whether singly or in -•/ alternation. .• .,-: . .. . .. >.. - ■ ^^ . - t' v ILA ^-^ 262 DURANOGMENT OF THE STOMACH. ii, * Natrunt-m, is indicated by deproitsion of spirits accompanied with apprehensive foreboaing, and witli fretful, tearful disposition with des- ponding expression; love of solitude, which, however, nourishes the disease, and dread of society, whereby, however, it is alleviated ; occasional bursts of violence; disgust of life; habitual moroseness and incapacity of mental labor; weakness of digestion characterized by aggravation of the suffer- ings, mental as well as bodily, and by general and indescribable uneasi- ness after a meal, and until the proper maceration of the food is completed ill the stomach and has been conveyed to the bowels, or by susceptibility to the recurrence of such symptoms provoked by the least excess or irre- gularity ; headache and want of appetite ; nausea occurring every morn- ing, etc. Dose: Six globules, or for young persons four globules, in a winegla^- ful of water every morning, the ttrst thing (fasting,) until amelior- ation or change. Auruin-tnett is indicated by incapability to concentrate the reflective faculties, and want of power of combination in the mind, characterized by ci-ushing headache after the least exertion of the mind, or attention, and a sensation as if the brain were dashed to pieces; painfnl anxiety of mind and excruciating restlessness; whining, fretful disposition and dread of death. This remedy is often of great service against the hysterical attacks of females. Dose: As directed for Natrum-m. Lnchesis is particularly indicated when the patient is haunted by the idea that he is the object of dislike, suspicion, or even hatred amongst his friends. Dose : Three globules in a teaspoonf ul of water, morning and evening, until amelioration or change. NuX'Voniica is indicated by almost every variety of nervous.hysteri- cal or hypochondriacal derangement, eitlier characterized by indolence, or excitability, but especially the latter; deep despondency with disgust of life, moroseness, and aversion to labor or exertion of any kind, character- ized by the following symptoms : excessive sensitiveness, and aversion. to ti.e open •dir ; /aintinrj Jits, after the least exertion, especially after motion in the open air, or giddiness, sensation of being stunned, and sparks or black spots before the eyes under the like circumstances; sensation of heaviness in the body, with weariness, languor, and great desire to assume or retain a recumbent position, by which the symptoms are alleviated; emaciation, and wiry condition of the flesh ; intense sensation of lassitude and fatiijue, even in the morning after rest, and often excitability which renders the patient reluctant to retire to rest at night: drowsiness in the morning, after meals, or in the evening, followed by sleeplessness at night; sallow, pallor or yeltoumess of the skin ; heaviness, with pressive, tensive and expansive pain in the head ; intense headache seated in the fore part of the head alo7ig the brows; or pain— often acute and piercing, as if some sharp instrument were lodged there— deep in the brain; swelling and redness of the eyelids, and red sufTusion of the eyes, particularly in the morning; cramp-like, contractive gnawing or pressive pains in the region of the stomach and below the ribs, and at the pit of the stomach; extreme sensitiveness of the pit of the stomach to pressure; constipation, character- ized by slow and sluggish action of tlie bowels, with dark, hard, dry, and DISEASES OF THE STOMACH AND INTESTINES. 263 large but unfrequent evjwuationa— or by intermingled, loose, and lumpy evacuations; particularly appropriate, if there be disposition to piles; frequent discharge of pale, watery urine— dragging and rheumatic aching pains in the back towards night; contused pains in the loins and back ; numbness of the arms at night. Dose: Tiiree globules in a teaspoonful of water, ni^^Tit and morning, until a degree of good effect results, and then four globules in a tea- spoonful of water every night, until positive amelioration or change. After which a course of Sulphur, as above directed, will usually be beneficial. Phosphorus is particularly appropriate for the treatment of delicate and highly hysterical females, and fair subjects of a spare and slender frame, and is indicated by sadness, alternated with apparently good spirits (with mirth); attacks of indescribable anguish, affright— and even distres- sing hallucination, when left by one's self, or during stormy weather; timid disposition, startled at every sound and apprehensive of thieves and acts of violence, etc., painful anxiety, or uneasiness respecting one's health. Dose: Four globules in a teaspoonful of water every night, until amelioration or change. Suspending treatment for four days after a a weeks course. China is indicated by distress, languor, or dullness of mind, the patient being easily disheartened and laboring under the impression that Insuperable combinations are devised against him by adversaries to frus- trate every undertaking ; the patient gives way to despondency, and is overcome by a prevailing idea, that he is doomed to he unfortunate— ^ym^ toms which are characterized by the following: weakness of digestion, with recurrence or aggravation of symptoms generally, and with indolent dis- position, ill-humor and distention of the belly, after eating; chronic relaxation of the bowels ; loose, yellowish, or slimy evacuations, or char- acterized by discharge of undigested food ; or pale evacuations with dark urine ; smcdl, detached evacuations with slow and sluggish discharge, and with deficiency of muscular vigor in the intestines ; sometimes the organs of sense are acutely sensitive ; sleeplessness occasioned by the crowding of idtas upon the mind, and by visionary projects, or sleep much disturbed by anxious, painful dreams, which continue to haunt the patient when auxike, and attended with frequent change of position and tossing. Dose: Three globules in a teaspoonful of water, night and morning, until amelioration or change. Sepia is of pre-eminent service in many confirmed and inveterate cases, particularly in females, and when complicated with severe hyster- ical affections; the patient being wholly abandoned to despondency and weary of existence, anxious respecting her own health, but averse to the consideration of household or other affairs, and often indifferent to every one but herself. Dose : As directed for China. Silicea is of great service, generally, in obstinate cases of hypochon- driacal affection, resulting from stomach derangement, particularly, if noise easily frightens or startles the patient, or if there be constant anxiety and agitation, weakness of the memory, incapability of reflection, morosetiess and taciturnity, intense irritability and tendency to be pro- voked to violence by contradiction, or excessive weariness of existence, further characterized by confusion of the head, or of ideas ; pain ascend- ^< \i. ^% m ff'' '"'' 1 i>64 NAUSEA. inyfrom the nape of the neck to the top of the head; headache recurring every morning ; heat in the head, particularly in the forehead ; lacerating or darting pains in the head, or pulsating headache, with flushing of blood to the brain; temporary defect or fmspemion of vision; confusion and mistiness of sight when reading; redness of the eyes and adhesion of the eyelids at night; the strong light of day is painful to the eye; bleeding at tlie 7iose; continued and watery discharge from the nose ; con- stant sneezing; hardness of hearing; scabby eruption on the lips, or swelling of the glands of the lf)wer jaw; toothache at night. afifRruvated or provoked by hot or cold things ; soreness of the tongue, or dryness of the mouth; deficiency of taste, or bitter taste; acid risings and wuter- brasb, or pains in the stomach or bowels, or even vomiting after cutiiifr ; nausea every morning; colicky pains associated with constipation ; pierc- ing or nipping pains In the bowels; puffing of the belly, and diffU'uit expulsion of very fetid flatulency ; hard stools with constant urging, or constipation characterized by hard, knotty, detached motions, evacuated slowly and with difficulty; wetting the bed; looseness; suffocating cough at night; aching pain in ih.Q cheat, and impeded breath; numbness of the arms induced by lying upon them; trembling of the knee; offensive smell from the feet; cold feet, sweating of the feet, or lastly, cramps of the legs, particularly during rest and after exertion. Dose: As directed for China. AccESSOiiY Tkeatment and Diet.— In no class of disorders is it more requisite to adhere strictly to dietetic regulations, than in those which consist of derangement in the digestive system, whether so-called functional or organic; the patient sliould, therefore, in such cases, regu- late ills regimen as closely as possible, by the rules laid down at the com- mencement of this treatise (pp. 78, 79,) carefully avoiding, moreover, all such articles as he may find disagree with him, even if they be allowable as a general rule. NAUSEA. ■■■.'■■'■ * With respect to ;:hi8 affection, wliich must be considered purely as a symptom, the reader is referred to the foregoing portions of this article, wherein directions have been given for the treatment. In the majority of simple and casual cases, however, it might suflice to consider the indications afforded for Ipecacuanha, Cocculus, Nux-voraica, Bryonia, Chamomilla, Pulsatilla, and Aconitum, following the same regulations respecting the dose. In inveterate cases, however, in which this symptom occurs continu- ously, the accurate investigation of all symptoms associated with it, and of the whole of the foregoing details, becomes necessary, and one or more of the following remedies, according to the directions hereinbefore offered, may become necessary. Natrum-m., Arsenicum, Lycopodium, Lachesia, Carbo-veg., Rhus-tox., or Silicea. Five grain doses each of Oleate of Cerium and Sub-Nitrate of Bismuth every hour. One drop of Carbolic Acid or Creosote in water, every hour, or Five drops Prussic Acid in water, every hour, until the nausea ceases, are quite effectual remedies. UI8EASKS OK THE STOMACH AND INTESTINES. 20.1 C'oltl iipplicatioiis, or mustard plasteis, may be applied over the stomach, and are uhcI'uI. If irritating substances are l<no\vn to be in tlie stomach, an emetic should be given at once; twenty grains of Ipecacuanha, witli water, is most suitable. After free emesis lias been produced, some of tlie above reu,edies should be given to quiet the stoma.)li. A sixth or a fourth of a grain of Vlorphine should be given, if there is pain or cramp in tlie stomach. M m EltUCTATIOXS. HOM(EOI*ATHIC TREATMENT. With reference to eructations, as well as to nausea, as they must be considered purely as syiiiptoms, tlie reader is referred to the foregoing portions of this article, wherein more distinct indications have been afforded, to faciliiato tiie selection of the appropriate remedy. In most cases of a sinjple and uncomplicated char- acter, the consideration of such indications as are aiforded for the admin- istration of tlie following remedies (chiefly) both as to selection and dose, willije sufllcient to meet the requirements of the case: Arnica, Nux- vomica, Pulsatilla, Sulphur, Bryonia. Carbo-veg., Chamomilla, Cocculus, China, Antimonium-crudum, and Antimonium-tartaricum. In cases of an inveterate nature, and which are evidently associated with complica- tions involving the whole of the digestive and nutritive system in more or less continual derangement, it may be advantageous to consider the indi- cations afforded for Sepia, Acidum-sulph., etc. ALLOPATHIC TREATMENT. Pyrosis. vSour eructations after meals may generally be prevented by taking fifteen drops of Dilute Hydro- chloric or Lactic Acid, i'^ sweetened water, before meals. Sulphurous Acid, in doses of twenty drops, in sweetened water, before meals, will sometimes have a better effect. Either of these Acids often has a better effect when given in a teaspoonful of Glycerole of Pepsin. Alkalies, to bo useful, should be taken when the sour eructation begins to appear in an amount sufficient to correct the symptom. Bicarbonate of Soda (xjaking Soda) is best suited to this end. Tt is best given in milk or water. Alkalies are beneficial when the amount taken can be gradually diminished with relief of the symptoms. Bismuth is a very useful agent in most of these cases. Tt is best given with a little Carbolic Acid, as in this formula : Take of Sub-nitrate of Bis- muth three drama, Carbolic Afdd four grains, Mucilage or Qum Arabic one ounce, Peppermint Water three ounces. Mix. Bose: Shake the vial and give a tablespooi.\ful three or four times a day. When Bismuth is given alone it is- best given in milk. The dose is from five to fifteen grains. BILIOUS OR SICK HE AD ACHE. In ordinary cases, in which sick headache is evidently the result of a casual cause, it will sullice to consider the indications afibrded for Anti- monium-crudum, Ipecacuanha, Nux-vomica, Pulsatilla and Sulphur; or Bryonia, if this symptom be associated with costiveness. it *i ^:^'. f! 266 VOMITINO OF BLOOD. ALLOPATHIC TREATMENT. Biliou.s or Hick headache is, generally, relieved by correcting the acidity of the Htoinach by the use of vlkallne remedies. The use of the Aromatic Spirits of Ammonia, in doscs of a teaspoon half full, well diluted in water, Is the most generally effectual. In caaes in which no stimulant is required, the ordinary' domestic alkalie«,as Soda or Saleratus, or a half teaspoon ful of Magnesia, may be used in doses of from five to len grains. In some cases relief is only obtained after a free vomiting. In such cases the quickest relief is procured by giving an emetic of twenty grains of Ipecacuanha, or a tablespoon ful of pulverized Mustard in a glass of water. Ergot has proved, in some hands, to be useful. The Fluid Extract may be given in doses of half a teaspoouful to two teaspoonfuls, three or four hours apart. HMMATEMESIS, HEMORRHAGE FROM THE STOMACH. VOMITING OF BLOOD. This is scarcely ever an original affieetion, but almost always symp tomatic of some other disease. "Vomiting of blood may depend on a variety of causes, and if it inclines to become profuse and threatening, it is of the utmost import- ance, in ^/actice, to investigate, with accuracy and care, tlie precise cause in each attack. As a complicating symptom, bleeding occurs, more par- ticularly, in diseases characterized by a peculiar alteration of the whole mass of blood, such as typhus, scurvy, yellow fever, etc. The L^emor- rhage may be very copious, although none of the larger vessels are rup- tured. A second cause of the bleedmg is, a rupture of the walls of ves- sels. It may be caused by excessive accumulation of blood in the stomach, depending upon disturbances, engorgements, etc., of the vena port -.liver, spleen— hence, it is not of unfrequent occurrence in the case of individ- uals afflicted with piles; or the hemorrhage may be caused by menstrual suppressions and stoppages, on which accountit occurs more frequently at the climateric age ; it sometimes seems as if the hemorrhage took place as a substitute for the menstrual discliarge. The vomiting during preg- nancy is very frequently stained with blood. The worst kind of bleeding arises from injuries of the stomach walls, consequent upon ulcerations of the mucous membrane. It is met with in chronic dyspepsia and cancer of the stomach. If there is a disposition to bleeding, it may be provoked by a blow upon the stomach, a fall, or violent emotion. The symptoms of hsematemesis differ, according as the bleeding is more or less copious, and arises from different causes. If the bleeding is but slight, and tlie blood is not vomited up, the accident remains some- times entirely unnoticed. If the vomited substance only contains a few streaks of blood, it has no particular significance, at the time, but the patient has to be watched with more care, because we can never be sure whether a more dangerous hemorrhage is not threatening. The blood should likewise be examined, with a view to discovering disease changes that had remained latent heretofore. The bleeding likewise acquires importance from the circumstance, whether the blood is discharged DISEASES or THE STOMACH AND INTESTINES. 267 with violent slrnining, or Is vomited up eiisily; in the latter case, the bleeding is much more signiticunt, on account of its indicating ulceration of the mucous membrane, or some Important chaage, dilatation, etc., of vessels, whereas a little blood may be discharged in consequence of vio- lent straining, even If the vessels are perfectly Intact. As soon ns a somewhat considerable quantity of blood is vomited, a series of characteristic symptoms appear. The morbid symptoms that already happen to be present, become associated with a constantly increas- ing dull pressu.e in the pit of the stomach, and a distressing feeling of distention of the stomaclj, generally attended with nausea. If the bleed- ing takes place slowly, the preliminary symptoms may be confined to these few; on the contrary, If the blood is expelled with rapidity and force, the patient experiences the usual symptoms of a considerable loss of blood, such as anxiety, paleness, cold sweat, cold skin, vertigo, and even fainting. A large quantity of blood Is vomited up at once, ai d with great force. The action of the gastric juice Imparts to It a blackish hue, and has the consistence of coagulated sour milk. The quantity dis- charged at one vomitlngoften exceeds one quart, so that it seems scarcely possible that the stomach could h ''e contained such a large quantity at once. Immediately after the vomiting the patients feel faint and exhausted, and are tormented by an almost unquenchable thirst; at the same time a visible throbbing occurs in the pit of the stomach, of which the patient himself is conscious. After this paroxysm, a period of rest and comparative ease sets in, until another attack of bleeding occurs. The interval to the next bleeding, lasts from a few hours to several days; in violent cases, four or five attacks may occur on the same day ; of course, in such a case, severe symptoms of ansemia may set in, even unto convulsions, and death may be the immediate consequence. If so much blood is expelled from the stomach, the stools are likewise black as coal, and very th.n; it may even happen that the blood is not vomited up fir^t, but that the black stools may be the first sign of the bleeding. Regardins: : ••eturn he bleeding, we cannot speak with certainty; it depends entirely upi the primary <!xciting cause. If there is a fre- quent return of the bleeding, ansema and dropsy are unavoidable results. Recovery from a single attack usually takes place slowly, the patients being at the same time tormented by a variety of gastric dis- orders, such as a burning distress in the region of the stomach, foul taste, sweetish or foul eructations, horrid thirst, and by a long-conti;iued abdominal pulsation. Under all circumstances, there is great danger lest the bleeding should return, hence the patient cannot be too careful in not overtaxing the stomach. Bleeding, resulting from ulceration, may not afford much relief, but in cases of lisematemesis, of which we are unable to discover the exact cause, or which depend upon tL<) sup- pression of other hemorrhages, the relief afforded by such bleedings may be quite considerable. As regards diagnosis, two circumstances may deceive us. In the first place a violent paroxysm of haemoptysis may be mistaken for vomiting of blood, and the deception may be kept up, if a physician does not himself examine the vomit, since patients often are so overwhelmed with anxiety w ees VOMITING OF BLOOD. that they lose all calmness and presence of mind. In other respects the black color of the vomit, and the al-dence of the bloody expectoration, which always follo\^ r a paroxysm of bloody cough, furnish the surest indi- cations regarding the true character of the attack. It likewise happens, that a person may h>tve a violent attack of nose-bleed over night, and that the blood may be swallowed; if the quantity of the swallowed blood becomes excessive, it awakens the person, and the blood is then vomited up, and may look precisely as it does when true hajniateraesis takes place. It is difficult to distinguish one from the other; our diagnosis has to be more particularly determined by the absence of all precursory symptoms, and subsequent gastric derangements. The use of whortleberries, and similarly colored fruit, may likewise occasion a momentary deception, more particularly, if the patients are very anxious. As a general rule, the prognosis, in all ordinary cases, is favorable, except where the hemorrhage is at once so excessive that death results from mere loss of blood. The prognosis, however, is always doubtful, in so far as a first bleeding leaves an inclination to a renewed attack, and the bleeding always indicates the presence of dangerous alterations in the stomach. Hence, a permanent cure is never absolutely certain. ALLOPATHIC TREATMENT. H^ematemesis (vomiting of blood,) is u symptom of some other affection, the most serious of which are an ulcer or cancer of the stomach. It may be well to enumerate the symptoms of hemorrhage of the stomach and hemorrhage of the lungs, inasmuch, as by so doing, needless fears may be allayed by fully understanding the contrast between the symptoms accompanying each. The distinction may be more clear, if given in this table: Id bleeding from the lungs Difficulty in breathing. Pain or beat in the chest. Blood coughed up by mouthfult. Blood frothy. Blood of a bright red color. Blood mixed with spittle. Symptoms refor to lungs and bronchi; I tuV)C8. The first efforts in treatment will be to arrest hemorrhage. Tlie patient should be confined to the bed; cold may be applied over the stomach; small pieces of ice should be swallowed. If the bleeding is excessive, there should be entire rest of the stomach, and nourishment should be given by injection. Among the most suitable for this purpose is strong beef tea and milk. From four to six ounces may be used at each injection, four times a day. The addition of half a teaspoonful of Pepsin will aid its digestion. If the rectum should be especially sensitive, and does not retain the injection, twenty or thirty drops of laudanum should be added, and after the injec- tion firm pressure should be made upon the anus, with a napkin under the hand, until all efforts to expel it cease. It sometimes happens that vomit- ing of blood takes the place of the menst'"ial flow. If this is the case it should not be immediately arrested, but kept' within proper limits. The swallowing of ice, cold over the stomach, and hot foot batlis, are permissi- ble. Pain will require an anodyne; twenty dropsof Laudanum, or a third of a grain of Morphine, every hour or two, until relief is obtained. In bleeding from the stomach. Sickness of the stomach. Fullness in vicinity of stomach. Blood vomited freely. Blood not frothy. Blood dark colored. Blood mixed with food. Symptoms refer to stomach. DISEASES OF THE STOMACH AND INTESTINES. 2,m Remedies addressed directly to the flow of blood, may be called for. Those most likely to be in the house, roady for an emergency, are: Acetate (sugar) of Lead, Turpentine and Alum. Acetate of Lead may be given in powder, in doses of a sixth or eighth of a teaspoonf ul, and repeated in an hour, if necessary. The dose of Turpentine is ten to twenty, or thirty drops, given on sugar, or in mucilage or syrup. Alum may be given in powder, in doses of a quarter of a teaspoonful. Cathartics or emetics must not bo given. J'^onsel's Solution of Subsulphate of Iron is the best remedy known to staunch hemorrhages. In these cases ten drops of the solution should be given in ice water, and, after the first two or three doses, can be given fre- quently, from ten to thirty minutes apart, if the bleeding does not cease. Tannin is a useful remedy; the dose in this disease is from ten to twenty grains. It should be given in powder. Excluding the existence of ulcer, cancer or other lesion of the stomach, treatment will have reference to the debilitated condition of the system, and the prevention of a recurrence of the hemorrhage. To this end, easily digested food, which is nutritious, as beef essence, milk, raw eggs, and broths. Ten drop doses of Aromatic Sulphuric Acid may be given Ijefore meals, in an ounce or two of some of the simple bitter infusions (teas,) as Colombo, Gentian, Quassia,Peruvian Bark, etc., made with an ounce of the rlrug to the pint of hot water. The Tincture Muriate of Iron may be given in doses of from ten to twenty drops, in sweetened water, after meals. The Citrate of Iron and Quinine frequently answers the purpose better than anything else. It sliould be given in solution, in water, or syrup of orange flowers, in doses of two to five grains. HOIKEOPATHIC TREATMENT. Aconitum should be given /hen the premonitory symptoms detailed declare themselves, and, particularly, when a considerable degree of fever preecdf»s the attack. Dose: Dissolve six globules in two tablespoonfpls of water, and give a teaspoonful of the solution, repeating the dose in half an hour, and then every hour, till positive amelioration or change. In this mode, if taken in time, we may often, by calming the circulation, prevent an attack. Ipecacuanha, For a first attack we know of no better remedy than this ; unless some very peculiar symptoms should render some other medi- cine necessary, we would use this. Against following attacks it is not so good. The less tfie vomiting of blood, depends on some previously existing disease, the more this remedy is indicated. Dose: This must be large; five or ten drops of the tincture, and fre- quently repeated every thirty to sixty minutes, if the case is urgent. Nux-voniica. In a full habit of body, with a marked tendency to congestion of the stomach and bowels, particularly, when arising from suppression of haemorrhoids, or of the menstrual discharge, or, from indul- gence in vinous, sprituous, or fermented liquors; this remedy is still further indicated by irritability of temper, and liability to constipation. Dose: Four globules in a teaspoonful of water, every four hours, until ^., , amelioration or change. Pulsatilla, The value of this remedy is noticed in tUe diseases of iLMuales above mentiOHed; it is, also, in many cases, found more suitable m t ''I !l ' i I 270 VOMITING OF BLOOD. than Nux-vomica for males, when of lymphatic temperament and mild dis- position. Distinctive derangement of the digestive or menstrual functions constitutes the general indication for this medicine. Dose: As directed for Nux-vomica. China. When a quantity of blood has been already vomited, this remedy, from its power of restoring the energy of the system after debili- tating losses, is clearly indicated; it should, also, be chosen when the patient has had a severe attack of vomiting of blood, which has ceased of itself, but still left great weakness. Dose: Six globules in a teaspoonf ul of water, every two hours, until improvement or change ; if, however, there be very palpable ameli> oration after the Jirst dose, the repetition may be suspended until the symptoms recur, or for twenty-four hours. Arnica. One of our most important remedies in severe cases, and especially when occurring in individuals of a robust constitution, of a san- guine temperament and choleric disposition. It is further indicated when the patient complains of pains, resembling the results of a contusion in all the extremities. Dose: Dissolve six globules in two tablespoonfuls of water, and give a teaspoonful of the solution every hour until distinct improvement or change. Sulphur is useful in scrofulous habits, or when the affection has arisen from suppressed haemorrhoids; its value, also, in cases of unhealthy menstruation will be pointed out in the proper place. Dose : Three globules in a leaspoonf ul of water, every four hours, for the first day, or until the violent symptoms subside. Then six glo- bules in a wineglassf ul of water, every morning the first thing, (fast- ing) for ten days ; pause four days, and resume the course, and so on, from time to time, when no acute symptoms are present. ACCESSORY MEASURES. The application of dry cupping-glasses to the stomach and under the ribs— or of a cloth, which has been dipped in moderately cold water, to the lower region of the belly— sometimes forms a useful auxiliary in arresting the discharge of blood. See also the article on " Discharge of blood from the Lungs." Diet and Kegisien. The rules hereafter given under Spasm of tub Stomach should be enforced, with the utmost rigor; solid food cannot be permitted, and all drinks should be cold ; animal jellies, preparations of milk, light puddings and broths, merely tepid, may be allowed in cases where the patient may require such nourishment, but nothing more must be taken than is absolutely necessary for that purpose; immediately after the attack, no food should be given for some hours, and then very cau- tiously, and ir. small quantity. It is evident that, in such cases, absolute rest, both mental and bodily, is essentially requisite. CARDALGIA-SPA8M OF THE STOMACH. Symptoms. Contractive and spasmodic, or gnawing pains about the region of the stomach, extending to the chest and back, attended with anxiety, nausea, eructation or vomiting, with faintness and coldness of the extremities: the patient is sometimes relieved by emission of ascend- ing wind, and when complicated with heartburn, by a discharge of a quan- I .-^.Mxe^'iij. DISEASES OF THE STOMACH AND INTESTINES. 271 in* tity of limpid flui'^ , occasionally headache and constipation are present In some cases tliQ pain isvery alight, (but there is always more or less,) and a degree of anxiety, with nausea, often increased by taking food. CoMPLic ^toNS. The disease is frequently accompanied by a disease of the liver, Sj/.een, or of the pancreatic gland, or even by cancerous degen- eration of the stomach, or first portion of the small intestines, in its fidvanced stages. It is a frequent attendant on gout. Age, Sex, etc. It is a more frequent affection in the female than tlie male sex, often occurring after the cessation of the usual monthly dis- charge, or from any interruption of its usual course; in such instances it is frequently accompanied with hysterics and fainting, and may pass on to vomiting of blood. It very rarely occurs before the age of puberty. The paroxysms last for a longer or shorter time, according to the vio- lence of the aifection, and return in many instances periodically ; and may be brought on by partaking of improper articles of diet, or, in severe cases, by any solid food whatever. Origin. This disease originates in an unhealthy state of the nerves of the stomach. The Exciting Causes are: Long fasting between meals, very hot or cold drinks, an habitual use of ardent spirits, or of indigestible food, worms, and, in some instances, exposure to cold or damp weather. But coffee is the article to which most persons owe this pain. Precautions to be observed by those who are sulyect to spasm of the stomach. The chief articles to be avoided by an individual suffering from this malady, are : Crude, uncooked vegetable substances (such as salads^l cheese, new bread, sweet meats, cherries, nuts, olives, and roasted chest- nuts, and stimulants of all kinds, whether tea, coffee, alcoholic or fermented drinks. ALLOPATHIC TREATMENT. Spasm or Cramp in the Stomach. If the trouble occurs suddenly upon the ingestion of some article of food, which is plainly irritating the stomach, the organ should be relieved by an emetic of twenty grains of powdered Ipecacuanha in a glass of warm water. If the treuble is not plainly referable to such a cause, neither eme- tics nor cathartics should be given, but the pain must be relieved. This is done most quickly by giving thirty drops of Laudanum, and repeating the dose at intervals of half an hour to an hour, until the pain is relieved ; or a third of a grain of Morphine may be given at the same intervals. A lax&tive of a couple of Compound Cathartic Pills may be needed after the pain is relieved, to prevent constipation from the opiate. In cases subject to frequent returns of the pain, it is not advisable f give opiates, on account both of the liability of producing the "opiui.. habit" and of the disturbance its frequent administration produces in digestion. Sometimes cold and sometimes hot applications, over the stomach, relieves the spasm and pain. Rubbing the skin over the stomach with a liniment made of an ounce each of Chlorofornv, Tincture of Aconite, and Soap Liniment, or laying a flannel, wet with equal parts of Turpentine and Laudanum, and covering it with oiled silk. Tinctur< of Belladonna in doses of ten drops, or Tincture of Hyoscyamus in doses of one or two teaspoonfuls, taken internally, is useful in relieving pain. '■ \ I': i:i^"'. If K ' nr < ffn 272 SPASM OF THE STOMACH. When pain occurs in the stomach, with spasms, the same procedures are useful, but some remedies seem to have especial benefit. If there la indigeHtion and irritation of the nmcous membrane, Bismuth, in doses of a scrui)le three or four tijues a day, may be uiven. In these cases the fol- lowing is a good formulo : Take of Sub-nitrate of Bismuth two drams, Pepsin one dram, Dilute Mydrocyonic Arxid half a dram, Mucilage of Qum Arabic, and Peppermint- loater each two ounces. ^lix. Doser A tablespoonful three times a day. The Purified Black Oxide of Manganese, in doses of ten to twenty grains, is also a beneficial remedy, and can be used in case of failure witli the Bismuth. Oases accompanied with the formation of gas, should be treated with Nux-vomica, in doses of ten drops of the Tincture, or one-fourth of a grain of the Extract in pill, three times a day; or Strychnine, in doses of one- thirtieth of a grain, may be given instead. The Elixir of Bark, Iron and Stry^^hnine, or Elixir of Quinine, Iron and Strychnine, in doses of one or two teaspoonfuls three times a day, are appropriate to these cases. In cases resisting other remedit T'owler's Solution (Solution of the Arseniteof Potash,) in doses of one (<. two drops, in water, after eating, is almost always beneficial. Some change in the mode of life may be particularly important, as from inactive pursuits indoors to an active life in the open air; as, also, in some instances, changeof scene and climate may be of the greatest value. In the use of stimulants, the advice of a conscientious physician should be rigidly followed. Harm will result from their use if taken at other times than with the meals, and in small qua.ntities. The symptoms of dyspepsia should be met as is directed in that article. The tonics recommended to be of use should be taken for a long time. Each recurrence should be met as directed in the first part of this article. HOMCEOPATHIC TREATMENT. Notwithstanding the usually intrac- table nature of this affection, it has been treated with marked success by the method about to be pointed out. Nux-vomica is one of the principal, and, in a large number of cases, the most appropriate of remedies against spasms of the stomach, and particularly in cases where this affection can be attributed to the long- continued use of strong coffee, or an excessive indulgence in spirituous* liquors; it is of essential service in many cases of the same disorder, which have arisen after the suppression of chronic or hemorrhoidal dis- charges, or when the party affected is liable; to fits of hysterics or nervous despondency. The following are the immediate symptoms which call for the administration of this medicine: Constriction, pressure, sqiteezing or spasm in the stomach, accompa- nied with a sensation as if the clothes were too tight at the waist, or as if wind were pent up in the sides, beneath the lower ribs, This sensation, as well as the pains before mentioned, become generally increased after a meal, or after partaking of coffee; in addition to whicli, a feeling of de- pression or constriction is experienced at the chest, which, in many cases, extends to between the shoulders and the lower part of the back. Pre- DISEASES OF THE STOMACH AND INTESTINES. 273 qucntly. also, we find niiuaea, accumulation of clear water in the mouth, or risings of sour bitter tluids, attended witli -x sensation of burning in the throat and gullet (heartburn); the tongue tremulous, cracked or fissured; clean, of a vivid red; coated yellow, or covered with a white mucus; lips and gums white, red and swollen ; blanched, yellowish, and somewhat indurated lips; eyelids inflamed at the margins; sour or putrid taste in the mouth; vomiting of crude materials; flatulent distention of the bow- els ; constipation ; aching in the forehead ; palpitation of the heart, and anxiety. When these symptoms are liable to be excited hy a fit of pas- sion, or become aggravated in the morning, or when the patient is occa- sionally awakened out of his sleep by the spasmodic attack, th's remedy is still more certainly indicated. Dose: In severe cases, of recent origin, three globules in a teaspoonful of water, every three hours, until amelioration or change. In chro- nic cases, with more or less acute pain after every meal, six globules every evening until positive amelioration or change. When the spasm of the stomach returns periodically, tliree globules should be taken in a teaspoonful of water, three hours before the expected recurrence of the symptoms. This rule applies in respect of any of the remedies herein prescribed, which have been administered with success against former attacks. If temporary relief only, followed by more intense sufTering, has ensued, and ' continues thi'ee houra after a second dose of Nux-mmica, proceed with the next medicine. Varho-vegUabilis should be given three hours after the second dose of Nux-vomica, if that remedy has produced only partial good efTect, and will generally complete the cure, provided the affection be not one of long standing, and, consequently, too deeply seated. Dose : Three globules in a teaspoonful of water, morning and even- ing, for four days. Chaniotnilla. For the employment of this remedy, the principal indications are: Pressure, as if from a stone in tlie pit of the stomach, or painful pressure and flatulent distention at the same part, as, also, of the region beneath the lower ribs and the belly itself, with shortness of breath, anxiety and throbbing headache ; mitigation of the above symptoms on partaking of coffee — a distinguishing mark between the indications of this remedy and tliose of Nux-vomica; on the other hand (as in the case of the latter,) it is also indicated when the symptoms as described are liable to be brought on by a fit of passion. Dose : Three gJobules in a teaspoonful of water, every four hours, until amelioration or change. Belladonna ought to be substituted for Chamomilla, or should be administered four hours after the third dose of the latter, when it has not been followed by relief, notwithstanding the apparent similarity of tliesesym . us; farther indications for Belladonna consist of gnawinia:, pressure, oi spasmodic tension in the pit of the stomach, relieved on bending back7vard and holding in the breath; or, further, spasm of the stomach, which recurs daily during dinner, or else pain of so violent a nature as to deprive the patient of coi ciousness; tremulous, vivid-red and sh'ning tongue, or redness of the tongue and elevation of the papillse; red and spongy lips. Dose : Three globules in a teaspoonful of water, every four hours, until the indicative symptoms are removed. If followed by more suffering after the third dose of Belladonna, prodeed with Qelsemi- num, as directed for Belladonna. 18 4 I v mi 'h ' 1 ! •74 srASSf OF THE STOMACn, a CocruluM, In many casfw of this complaint, Is particularly Indicated, when, in addition to the uHual Hymplom.H, there are constipation and con- strictive paliiH over the entire stomach, witli (lutulency, and accumulation of water in the mouth, and alleviation of the sufreringson the recuirenco of the latter symptoms. Pose: Of a solution of six globules to two tablespoon fu Is of water, give a teaspoonful every tliree hours, until amelioration or change. I* ulsaHlla \h UHtifnl in ca.ses with shooting pains in the stomach, wliich are afiyravdlnd by movement, ami partio.ulniiy by imtking afahe stej). Pulsatilla Is, also, one of the most approprlato remedies wlien the attacks are followed by vomiting, or accompanied by violent tension and squeez- ing, or throbbing and sensation of anxiety about the pit of tlie stomach, increase of pain after eating, or more particularly a feeling of pressure and pinching after dinner, with a relaxed state of the bowels, or a disposi- tion thereto. Disposition to hysterics or nervous despondency. This remedy is very serviceal)le in cases of this afTection, arising from suppres- sed monstruation. Dose: Of a solution of twelve globules to four (ablespoonfuls of water, give a tal)lesj)oonrul every six hours, until amelioration or change. Sepia Is an elTlcaolous medicine In spasm of the stomach, arising fi'om suppressed or diiUcult menstruation, and may, in general cases, advantageously follow Pulsatilla; it is indicated when most of the suffer- ings arise after a meal, by pressure in the stonxacli as from a stone, and by a burning pain in the pit of the stomach ; and by restoring singly, or in conjuTiction with Pulsatilla and Sulphur, the menstrual flux, it frequently removes the spasm at the stomach and hysterics consequent upon this derangement, or, at lejiat, places the affection in such a position that it is easily cured by some other medicine, closely corresponding to the remain- ing symptoms. Dose: In recent (not chronic) cases, of a solution of eight globules to two tablespoonfuls of water, give a teaspoonful every four hours until amelioration or (;hange. In chronic cases, give tliree globules ?n a teaspoonful of water night and morning for a weelc, then pause foi'r days, and resume the course, suspend treatment, or change tlie reriiedy according to circumstances, the thirtieth potency is best. China Is of great service in most cases of spasms of the stomach with general weakness, arising from loss of humors, the result of blood-letting, or repeated loss of blood, abuse of emeti js or aperients,*too long continued suckling, etc.; and it is further indicated by great weakness of digestion, distention, and uncomfortable weight, pressure or pains in the stomach after eating, so that the patient feels much easier when fasting; these latter symptoms are the more immediate indications for the employment of this medicine. Dose: Of a solution of six globules to two tablespoonfuls of water, night and morning for three days; and afterwards three globules in a teaspoonful of water every third night, until positive improve^ ment or change. Brj/onia. This medicine is more particularly adapted to the milder cases of spasm In the stomach, with painful pressure, or a feeling of disa? greeable fullness in the stomach after a meal, which occasionally becomes converted into a feeling of constriction, cutting or pinching, and is relieved by eructation and external pressure. This remedy is, moreover, still more DISEASES OF THE SVOMACH AND INTESTINES. rioarly indicated when the symptoms are generally accompanied by severe headache or painful compression in viirious parts of the head, and particularly at the temples, which is liable to he excited whenever any article of diet disagrees in the slightest degree; increase of the sufler- iiigH by movement; habitual costiveness. Duse: Three globules in a teaspoonful of water every two hours, until amelioration or change. Arnica-montana, in spasms or pains in the stomach, which have originated in the effects of a strain, or from a blow, etc., will be found specific. It is, however, also an excellent remedy when there is a sense of fullness and constrictive pain in the stomach and in the fore par; of the chest, shooting pain in the pit of the stomach, with painful pressure as from a stone, or aching, extending to the back, and tightness of the chest, increased by eat'ng, drinking, and external pressure. Done: Of a solution of four globules to two tablespoonfuls of water, or in the like proportion, give a teaspoonful night and morning, until amelioration or change. Arsenicum is required for periodic pains in the stomach, chiefly consisting of a burning character, and attended with acrid, sour eructa- tions, vomiting of crude materials, or of mucus, sometimes even of blood; tremulous, swollen, or glazed, red and fissured tongue; blanched, waxy, and somewhat indurated lips; want of appetite; extreme debility; ema- ciation. Dose: Two globules in a teaspoonful of water, every three hours, until amelioration or change; or in very acute cases characterized by excessive prostration and livid aspect, give one globule in a tea- spoonful of water immediately, repeating the dose after half an hour, and again every two hours, until positive amelioration or change. But if little or no permanent relief ensue within two hours after the sixth dose, consider the various other remedies herein named. In chronic cases, give three globules in a teaspoonful of water, night and morning, until distinct amelioration or change. Calcarea. In obstinate cases, occurring in individuals who are, habitually addicted to the abuse of wine or ardent spirits, Calcarea will generally, be found of great service, especially, after the previous employ- ment oi Nux-v. It is further a valuable remedy in the cases of females of full habit of body, subject to discharge of blood from the nose, or to exces- sively coi)ious menstruation; and is, generally, indicated when the parox- ysm of pain comes on usually at night, or after a meal, in which latter instance vomiting sometimes resuLd, or nausea and acidity, with painful sensibility on pressure at the region of the stomach. Constipation, hsenv orrholds, or chronic looseness of the bowels are additional oneral indications for the employment of this remedy. Dose: Six globules in a wineglassful of water, every morning the first thing, for a week (unless earlier relief or change ensue); pause four days, and then, if necessary, resume the course as before, and so on, until positive amelioration or change. Diet and Regimen. These are subject to the same general rules as have already been afforded in the article on Indigestion. HEARTBURN. BLACKWATER. WATER-BRASH. Thir Is not an affection of tlie organ whose name it bears, but a painful or uneasy sensation of heat, or aaimony, about the pit of the stomach, aometimes extending upwards. It is frequently accompanied with anxi- ) m w^ f 'J76 DlAKllIKKA. ety, nausea, and vomilini:; or a violfuit, gnawing, Hpaamodic pain in th« region of tlio stonuioh, from which tho patient experiences no relief, until ho succeeds in ejecting a (iiiantity of limpid fluid. Trkatmknt. As heartburn is, strictly speaking, a mere symptom, emanating from derangement of tho stomach, the general articles oi^ "Indigestion," and its subordinate affections, should be considered. THE LARGE TNTESTIXES, The cut on tho opjiosite page, showing the location, direction and shapw of the large intest iuoa, with their curves and convolutions, is important fiom the fact tliat in this part many diseases are liable to occur which to a greater or less degree endanger life. Dysenteria— flux— is an inflammation and at times ulceration of tlie lining mucous membrane of the bowel at X V, and desperate cases can ot^en bo cured by thoroughly washing out the bowel by large injections of water as hot as can possibly be borne. C!hronic diarrhoea is a chronic inllammaticm of this membrane, but often ex- tending furtlier nj) the bowel than is usual in dysenteria. Constipation is also a natural result of inflammation of tliis mucous membrane, drying up and preventing the secretion and discharge of the mucus that in health assists in the evacuation of tlie feces. A large injection forced up the bowel until it reaches X— the patient lying long on the right side so as to have the assistance of gravitation in holding in the fluid until it has had plenty of time to soften the feces which have been dried by the fever in the parte— will overcome the most obstinate case, and is much better than dosing n'itli a long list of medicines. This large intestine is known as the Colony and is divided into the ascending, up the right side ; transverse, across the abdomen about 2 or 3 inciies above the umbilicus— navel ; descending, down tiie left side to the i)lace of discharge, anus. Parts of the liver and stomach are seen in the upper part of the cut. The part where the small intestines, illium, empty into the colon is shown at VI. Gastric or Bilious Fever is another of tlie diseases of which these organs furnish the seat. . /. I I THE LAROB INTESTINES. M''. 4» I n I ''rr^' OIARUUUCA. 277 CHAPTER XIII DISEASES OF THE INTESTINES. I niABRnajA. Di.anhcea, or looseness of the bowels, is a disease of frequent occur- rence, manifesting itself, more especially, during the warm months of the year, though it may take place at any season. All persons are, alike, sub- ject to it when exposed to the causes. Symptoms. Diarrhoea consists in frequent evacuations from the bow, els, of a more fluid nature than usual, each discharge being, usually, accom- panied with, or preceded by a rumbling in the bowels, together with u sense of weight, or pressing down, and, commonly, relieved as soon as th<' evacuation takes place, but are renewed before the one, which is to suc- ceed, ensues. More or less griping is present, and not unfrequently nau- sea and vomiting. Fever is not, usually, present in diarrhoea. When the discharges are very frequent, or in large quantities, they rapidly Reduce the strength of the system ; emaciation takes place ; the functions of the system become impaired ; the skin becomes pale, dry, rigid, and eventu- ally, sallow ; and if the disease continues, the feet and legs become drop- sical. The discharges become more and more offensive, a slow fever ensues from the exhaustion, and the patient dies. According to the character of the evacuations and the exciting causes, diarrhoea has been divided into several varieties, thus: 1. Lienteric Diaii'hcea, in which the food is rapidly passed into the bowels, and appears in an undigested condition in the evacuations ; and is due to an impairment or suspension of the'functions of the stomach, with great irritation in the intestinal canal. 2. Chylous or Ccellao IHarrhcea, in which the discharges are of a milky white, or dirty white color, and is due nther to a congested con dition of the mucous membrane of the small intestines, or to tuberculai (consumptive) disease of the mesenteric glands (small glands in the mem- brane uniting the bowels). 3. Miurtis Diarrhoea, in which considerable mucus is found in the discharges, being, occasionally, streaked with blood; due to colds and exposures. 4. BilioxLs Diarrhoea, in which the evacuations are mixed with nmcb yellowish or greenish looking bile, and most generally accompanied b.y nausea and vomiting, duo to cold, anger, chagrin, etc. <;<=':>.':• I < il III 278 DISKASKS OK THK INTKSTINKS. ^ « ill Causes. Dlurrlxi-u may l)o rausod by improper exposure toexcesalve heat or cold; by the use; of acid, unrlpo fruit; indigestible or other irrita- ting food; from the i)rest'noe of worms; from overloading the stomueh with food ; 8ud<len frights; fits of ungor, grief, and other depressing emo- tions; certain urtlcles of diet occasion dlarrhani, In some persons, which arc quite agreeable and salutary to others. A very frequent cause of diar- rhoea, among Infants, is the use of spoon meats, and otiier gross articles of diot; itnuiy, also, arise from the liad (juality of the mother's or nurse's milk; from the irritation caused by teetiilng, etc., the going-ln of cutane- ous erui)tions , fermented liquors, etc., are also among the exciting causes; changes in the atmosphere, rendering the disease epidemic in certfiin localities; the unwise use of cathartics, Is not an unfrequent cause. ALLOPATHIC TREATMENT. Tills disease is, frequently, transient, due to temporary indigestion, or following some dietetic error. In these instances, little or no treatment Is necessary, except guarding indulgence of the appetite more carefully. If the contents of the large inteatlne (l)owel) is not spontaneously expelled, a cathartic siiouhT be given. For this purpose, a tal)ieHpoonful of Epsom Halts, witli ten drops of Deodor- ized or common Laudanum (Tincture of Opium,) to allay irritation, or a Stidlitz Powder, answers a good purpose. A tablespoon ful of Oastoi Oil, or five or ten grains of Powdered Rhubarb will, also, meet the indications. If the evacuations have been copious, and of a feculant character, a cathartic is not required. After the bowels have been thoroughly emptied, if diarrhiea and pain, or uneasiness, still continue, it should be relieved by an anodyne, one or two tej)8poonf uls of Paregoric, or ten or twenty drops of Laudanum, in a tablespoonful of Clialk Mixture, or Cinnamon SVater, with the addition of a little Prepared Chalk, or 8oda, or five grains of Dover's Powder. Whatever tlie remedy chosen, it should be rei>eated every six or eiglit hours, if needed. Tiie diet, for a few days, should be simple and restricted. A diet, largely composed of milk, is suitable. Care should be used that the bowels do not become over confined. If they do not move spontaneously, they should be started again by one or two Compound or Improved Cathar- tic Pills, twice a day, until an action is produced. It should, also, be stated that a free injection of warm water, followed by a small injection of warm water, or thin Starch, with half or two-'hirds of a teaspoonf ul of Lauda- nuiii, will, frequently, cure diarrlioea. Should the diarrhoea tend to continue, or frequently return, the prin- cipal treatment will refer to diet, and measures to render digestion ooiiX- plete. Tender meats, cooked rare; eggs, chicken, and milk, are, most gen- erally, found to meet the end required; but, in some cases, starchy articles, such as Rice, Corn Starch, Tapioca, Sago, Arrowroot, Wheat or Oatmeal, with milk, are found best suited. If the patient has been deprived of fresh vegetables, and ripe fruits, they should be supplied, in moderate quantities. A moderate quantity of food, frequently taken, is generall;, better than a full meal once or twice a day. In some instances, a change of climate is demanded. A removal from the city to the country, is, frequently, curative in the hot weather, partly from the tonic effect of the country air, and partly from the use of fresh DIARIUICEA. S79 milk, and ripe fruits, which the systerri required. In tlieae cases, the use of 'urn is only of limited and temporary value. It may be used as direr". d before, to relieve piiin and irritation, but its continued use impairs digeatioii. It sliould be remembered, that diarrhcjoas are, sometimes, prolonged l)y tlie presence of lianlened feces; in tliese cases, Epsom Baits, or Castor Oil, aiiould be given, in tablespoonlul doses, every six hours, until a free motion Is obtained; or injections of a quart of v/arm water, freqi. mtly repeated until hardened feces cease to be discharged. Large doses of Bisniutli, from twenty to thirty grains, repeated two or three times a day, is a most valuable remedy in continued diarrhoea, and is not accompanied by any disagreerble effects. It can best be given in some millc. Chronic diarrhoea is frequently of malarial origin. In these cases, Quinine, in five-grain doses, two to four times a day, is curative without any other remedy. Quinine is frequently required, as a tonic, in doses of two or three grains, three times a day. For the same purpose, the bitter infusion of Quassiu.Gentian, or Colombo, alone, or combined, two ounces to the pint of boiling water, dose: a tablespoonful, three times a day, are useful. C •? or two grains of Pyrophosphate of Iron may be combined with each dose of the bitters, or Quinine, if the patient is much reduced. The addition of Pepsin, in doses of five or ten grains, is, frequently, a great help to digestion. In clironic diarrhoea. Bismuth, given as before mentioned, occupies the first rank; anodynes, before described, maybe given with it, but only as required to relieve pain or irritation. Sugar of Lead may, in rebellious cases, be combined with the Bismuth, with or without the anodyne, in doses of one to three grains. The vegetable astringents— Blackberry-root, Logwood, Catechu, Kino —have been, in their turn, found useful. As their efficacy depends on the presence of Tannin, I prefer to use it. It can be given in doses of ten to twenty grains, in syrup, and repeated every few hours, and may be com- bined with Bismuth, or an anodyne, or both. One of the most effective prescriptions in chronic diarrhoea is the fol- lowing: Take of Sulphate of Copper one grain, Sulphate of Morphine one gi'ain. Sulphate of Quinine twenty-four grains. Make a maun and divide into tvoelve pills. Take one pill three times a day. In some rebellious cases the following is a highly useful combination: Take ofErgotine ( Watery Extract,) tiventy grains. Extract ofNux-vomica five grains. Extract of Opium ten yrains. Mix well, and divide into twenty pills. Take ore pill every four or six hours. If tue druggist is not known to be skillful and careful, probably the following had better be used instead: Take of Fluid Extract of Ergot two ounces, Tincture of Nux-vomica three drams, Deodorized Tincture of Opium three drams. TaJce a teaspoonful four or six hours apart In the treatment of chronic diarrhoea, it becomes necessary to change tlie remedy occasionally, as in some instances the system becomes habitu- ated, in a measure, to its use. It is not, however, best to change a remedy as long as it is proving efficacious. 1 I! 280 DISEASES OF THE INTESTINES. The Diarrhceas of Children Demand Separate Consideration. Those having the appearance of blood in the stools, will be treated under the head of dysentery. If the roundness of the figure, and the firmness of the flesh is maintained, it shows that nutrition is sufficient, and the diar- rhoea is not seriously harmful. On the other hand, if the cliild is beginning to waste, or the flesh becomes flabby, immediate treatment is required. Many of these cases are caused from poor food. If the child is at the breast, it may be the mother works too hard, and so impairs the quiility of milk, or it is insufficient, and creamy cow's milk should be given in addi- tion. A little penetration, guided by common sense, will discover the cause and correct it by better hygiene. A green or irritating stool shows tlie need of an alkali, lime water by preference, or a little prepared Chalk or Soda, one to three gra aIs, is a dose. When lumps or mucus pass in the stools a laxative is needed. For this purpose half a teaspoonful of Castor Oil, or Syrup of Rhubarb a tea- spoonful is suitable. Previous constipation also demands these laxatives, or the following may be given : Take of Epsom Salts one dram, Tincture of Rhubarb onejlram, Syrup qf Ginger one dram, Cinnamon Water, or. Water nine drams. Mix. Dose: A teaspoonful three times a day for a child a year old. If there is no improvement from this treatment, we must rely on astringents and alkalies. If the evacuations are frequent, and tlie child weak, no laxatives should be given, but astringents should be used from the first. Often much precious time is lost by not following this rule. The physician finds, generally, when he is called, that opiates and astring- ents are needed exclusively, attention being also given to hygiene. The Compound Powder of Chalk and Opium answers the indications, and may be given in doses of three grains every other hour, to a child a year old. I often use the following: Take of Compound Pnioder of Chalk half a dram, Bismuth one dram. Mix and divide into ten powders. Dose : One powder three hours apart until the diarrhoea is checked. Or the following may be used : Take of Paregoric two drams, Tincture of CatecJm tioo drams, Chalk Mixture one ounce. Mix. Dose : One teaspoonful every three or four hours, to a child one year old. Often the diarrhoea is due to, or aggravated by imperfect digestion ; it is well to give Pepsin and Sub-Nitrate of Bismuth. Take of Pepsin one dram, Sub-Nitrate of Bismuth one dram. Mix, "-id divide into twelve powders. Give one immediittely after the cliild has taken milk or food. They can be given in milk or syrup. Pepsin and Bismuth may be given in solution. In children over two or three years of age the treatment is similar to that for adults, making allowance for age. Take of Liquid Pepsin (Sheffer's formula) and Solution of Bismuth, (U. S. P.) of each two ounces. Mix. Dose: Half a teaspoonful, to a teaspoonful, three or four times a day. Quinine, in doses of half a grain, to a grain, three times a day, is also beneficial. fSSnWT.'( LIWJJJWI" a-s-^reir.ir;-^*?^^ tf-!i^«-»-».«^r™ DIAKRHCKA. 281 HOMCEOPATHIC TREATMENT. Dulcamara should be piven in diarrhoea, occurring in summer, from cold. Particular indications for its use are, the relaxation of the bowels, being attended with colic, or, cutting pain in the region of the navel; the evacuations being liquid, s y, and yellowish or greenish, generally coming on at night, and some- times being attended with nausea or vomiting; want of appetite, and great thirst; paleness of the countenance, and lassitude. This medicine may, also, be judiciously administered in many cases in which the relaxation of the bowels affords no ostensible specifle or characteristic indications for any particular remedy. Dose: For adults, eight globules, to each two tablespooufuls of water, give a teaspoonful after each evacuation, until distinct relief or change. But if only partial relief should ensue, in acute cases, in six hours after the second dose, or in clironic cases in twelve hours after the sixth dose, proceed with the next, or, study other medi- cines. Bryonia should be given in cases of diarrhoea arising from tlie before- mentioned causes, and attended with many of the symptoms noted under Dulcavmra, when that medicine has failed to afford the required relief, particularly if the looseness is liable to be aggravated after a meal, or after drinking, and tlie stools are passed almost involuntarily, and portions of undigested food are perceptible in the motions; also, wlion looseness is experienced after partaking of milk. In looseness of the bowels, occurring during hot weather, when we cannot trace the cause in any errors of diet, requiring other remedies, this medicine is further indicated, and especially so in the following instances ; diarrhoea, from checked perspiration, or being overheated— cold drink -a chill from remaining in any cold, exposed situ- ation, or in draughts— or from exposure to an eastlerly wind. When this alfection has been produced by passion, particularly in individuals of what is called a bilious temperament, Bryonia is, again, a most useful remedy. It may, also, be remarked that the relaxation of the bowels, arising from drinking impure water, or water strongly impregnated \\\i\\ vegetable substances, w n heated, has frequently found relief in tiiis medicine. Dose: In casual or chronic cases, and in all other respects, as more particularly directed for Dulcamara, China. Looseness in consequence of indigestion, particularly, if occasioned by partaking of fruit, or, flatulent food, such :! i vegetables; evacuations very profuse and sometimes attended with but little pain; and when the discharge comes on immediately after partaking of food, or espe- dally dtiring the night; evacuations liquid and brownish, and sometimes containing portions of undigested food ; it is, in some instances, further indi- cated when considerable spasmodic, or, colic-like pain is present with flatulence, want of appetite, thirst and great weakness; and is also valu- able after improper treatment of this affection, when considerable debil- ity remains. Dose: If singly, of a solution of eight globules to two tablespooufuls of water, give a teaspoonful after every motion, until amelioration or change. In like cases, for children, a solution of three globules to two tablespooufuls of water, similarly administered by teaspoon- fuls. H in alternation \\ith FeiTum, a similar solution (separalely) of each medicine (as distinctly stated for adults and for children,) of each of which the like dose should be given, the one four hours after ;«S lltl f I I iiiliU I ■I mvk '■ 1 ' !i DISEASES OF THE INTESTINES. the other, in rotivtioii, until amelioration or change. In cJi ronic casen, if singly, six globules, in a teaspooufnl of water (for adults,) or two globules, in a teaspoonful of water (for children,) morning and eve- ning, every other day, until amelioration or change. FeiTuni-m. may be advantageously given, in alternation with China, when the evacuations are partly composed of uiidiijeiited food, and pass without pain. This remedy may, however, be administered alone, wheii the discharge from the bowels is unattended with pain, or there are pains in the back and posterior passage, paleness of the face, watery evacuations —or looseness, particularly, observable at night, or after eating or drinking —loss of flesh, alternate absence of appetite and voracious hunger, disten- tion of the belly without flatulency, spasm of the stomach, continued thirst, and weakness of the eyes, with great weakness of digestion. Dose: In all respects, whether for casual or chronic cases, and whether singly, or in alternation with China, as directed for thQlatter medicine. Chaniomilla is a remedy, as already stated elsewhere, particularly useful in children, either at the time of teething, or at a more advanced period, when the affection has been excited by checked perspiration ; and it Is further, particularly indicated when the evacuations are watery, bilious, green, yellow, or slimy, or of a fetor resembling rotten eggs ; when there are fullness at the pit of the stomach, severe colic or spasm, pain, disten- tion and hardness of tlie belly, bitter taste in the mouth, foul tongue, thirst, want of appetite, bilious vomiting and flatulency (in infants,) attended with restlessness and screaming, and drawing up of the limbs towards the stomach. Dose: Of a solution of eight globules to four tablespoonfuls of water, give a teaspoonful, after every -notion, until positive amelioration or change ; or, in patients of a weun.iy habit of body, if this appears inad- equate to effect a cure (although the symptoms be analogous) and if, after repeated administration and temporary effect, the symptoms recur in all their former violence, consider Sulphur. Ipecacuanha is indicated by looseness, arising from indigestion, par- ticularly, if caused by imperfect mastication, and attended with nausea and vomiting, paleness of the face, weakness, and desire to retain the recumbent posture (in the case of children). Dose : As for Chamomilla. Pulsatilla should be administered six hours after the third dose of Ipecacuanha, if the latter affords only partial relief. It is, also, one of the best remedies for simple looseness of the bowels, arising from errors of diet, such as indulgence in acids, fruits, or rich, indigestible food, attended with foul tongue, and other symptoms of deranged digestion, aa stated in the article on " Indigestion." Another remarkable indication for this rem- edy is, one evactuition differing from another in color. Dose: Six globules, in a teaspoonful of water, after every motion, until amelioration or change. Rheum is to be preferred to Pulsatilla, and should be employed after Ipecacuanha, or even before that medicine, when the sour smell of the evacuations is a predominant symptom. In general, however, it may be advantageously employed, especially, amongst children, when the symp- toms, in a great measure, resemble those of Chamomilla, but the pain is not so violent, and the evacuations have a sour smell ; paleness of the face is, also, an indication for this inediciue. §\ DIARRHCEA. 2% Dose: Six globules, in a tetospoonf ul of water ; or, for children, three globules in a teaspoonf ul of water, after every motion. Mercui'iufi. When the diarrhcea arises from a cJiiU, and the motions are copious, watery, 6 ' .' frothy, bilious, or greenish, or streaked with blood, and cause a sn; ig or burning sensation on being evacuated ; also, when there is painful su'aining before, during, and after evacuation, In?- quently followed by protrusion of the lower intestine; severe, cutting pains; moreover, nausea and eructation, cold perspiration, tremhUng or shivering, great lassitude, and disposition to fainting; evacuations con- taining undigested substances. Dose: Of a solution of six globules to three tablespoonfuls of water; give a teaspoonful after every motion, until distinct amelioration or ciiange. Nnx-vomica. Scanty evacuations or motions, consisting of slime and blood, attended with straining a,ndi great toeakness; flatulency, and violent, cutting pains in the region of the navel ; diarrhoea, alternating.' with constipation. For some of the accompanying symptoms, the reader is referred to the indications mentioned respecting this remedy, in the arti- cle on " Indigestion." Dose: Six globules, in a teaspoonful of water, every two hours, until amelioration or change. Arsenicum. Autumnal diarrhoea, or looseness, arising from errors in diet, acids, fruits, cold drinks, ices, or from a chill, etc., the characteristic symptoms for its employment are: watery, slimy, greenish, or brownish, corrosive, burning evacuations, with violent colic, excessive thirst, ema- ciation and great weakness, and when the affection is more liable to come on at night, or after eating or drinking. This is. also, a most important medicine for the treatment of the bowel complaint of children, as hereaf- ter, separately, considered- Dose: Of a solution of six globules, to two tablespoonfuls of water, give a teaspoonful every half hour (in very acute cases); or every hour (when the symptoms are modified by intervals of respite, until amelioration or change. If in alternation with Veratrum, of a sim- ilar solution (separately,) of each medicine, give first two doses (as just stated,) of the one, then pause an hour, and continue with two doses of the other, similarly. If singly, however, and only partial relief ensue within half an hour, or an hour after the third dose, pro- ceed with the next medicine. Veratrum should be employed half an hour or an hour after the third dose of Arsenicum, when similar symptoms occur which have not yielded to the previous use of the latter. Veratrum is, moreover, especi- ally appropriate in cases in which the complaint is attributable to atmos- pheric causes. Veratrum and Arsenicum are important when excessive exhaustion accompanies the complaint. Dose : In all respects as directed for Arsenicum. DIARBHCBA ASSOCIATED WITH CONSTITUTIONAL DEBILITY. Sulphur is a most valuable remedy in diarrhea, particularly occur- ring during the night, in persons of a scrofulous habit, or in very obstinate cases. In adults predisposed to piles, or in children, when the looseness of the bowels is attended with excoriation and with papular eruptions, it is particularly efficacious ; also, in cases where the slightest cold brings on * relapse or an attack ; or when milk disagrees and causes a looseness. '■.'.■f. W' ^^•»=' 284 DISEASES OF THE INTESTINES. A- Dose. Against the prevailing acute symptoms, of a solution of six globules to two tablespoonfuls of water, give a teaspoonful every six hours, until the frequency of the motions are diminished. Sub- sequently give six globules, in a wineglussl'iil of water, every morn- ing (fasting) the first thing, for ten days, unless collateral symptoms meanwhile occur, requiring other treatment; after which, pause four days, resuming the course, if necessary, as before. Sepia is to be preferred in obstinate cases of diarrhoea, occurring amongst females ; especially, when associated with predisposition to hys- terical attacks, headache, whites, sudden sweats, or flushes of heat and frequent attacks of shivering or shuddering, chiefly during stools. Dose: In every respect as directed for Sulphur, continuing the course in like manner, until permanent amelioration or change. HOME TALK. Acids, or acidulous wines, beer, coffee, strong tea and fruits, whether raw or cooked, should be carefully avoided. Solid food is likewise forbidden, during the prevalence of an acute attack, as tending to keep up the intestinal irritation ; and gruel, fresh milk, (unless it should be known to disagree with the patient,) broths, and light mucilag- inous food should be substituted. The majority of vegetables are objectionable, potatoes in particular. In every severe case, indeed, (during the prevalence of the attack) little more than thin arrowroot or gruel should be taken. In milder forms of the complaint, well-boiled rice, moistened with good gravy, may be rather serviceable than otherwise. Beef tea (with or without addition of a teaspoonful of isinglass to the half-pint) may, in some cases, serve materially to assist the operation of the medicines. When the attack is subsiding, and for some time after- wards, young meat (such as veal or lamb) should be avoided; and sound, tender mutton, plainly roasted, will be found, generally speaking, most easy of digestion. Fish should be avoided. Above all, the patientshould guard against indulging a craving appe- tite, and eating too freely, or overloading the stomach. In protracted cases, attended with debility, but no symptoms of inflam- mation or ulceration, generous, easily digestible food, and sometimes a little wine, or wine and water, must not be withheld. In such cases, a basin (half a pint) of beef-tea, with the addition of a teaspoonful of isin- glass, and a few slips of toast taken daily, about three hours after break- fast, will usually prove a useful accessory. The use of a flannel bandage round the stomach, is often of service, especially for delicate children. In every case, the clothing should be warm ; exposure to moisture, and espe- cially to having the feet wet, should be avoided; fine woolen stockings or socks, and stout shoes, should be worn. Change of air will generally be of service to the convalescent. When diarrhcea prevails as an epidemic, as is not unfrequently the case towards the fall, all these precautions, which may or may not be essential under other circumstances, become indispensable. HOME REMEDIES. Take of Mayapple Root, pounded, one teaspoon- ful, White Oak Bark, pounded, or, if dry, powdered coarsely one tea- spoonful, boiling water a pint; steep near fire for an hour or two, and sweeten with white sugar. Dose: A spoonful after each motion of the bowels. A little burned brandy, added, helps this. This is very valuable. m CIIOLEUA MORBUS. 280 Take five or six clean corncobs, burn them on a clean fire, to a coal ; drop tlie cob-coals in two pints of boiling water; as soon as cool take a tablespoonful every three or four hours. This is specially valuable where there is much bloating, or the evacui'tions are very offensive, the eructa- tions tasting like what has been eaten. I ' ! M CHOLERA 3IOBBUS. Cholera Morbus is a disease common in warm seasons, and especi- ally in warm climates. The principal features of the disease are vomiting, purging, and severe griping pains in the abdomen. Symptoms. The attack is occasionally preceded by chills, headache, giddiness, and a numb sensation in the limbs, but more generally the attack is sudden, commencing with nausea and distress at the stomach, succeeded by violent gripings in the bowels; these are followed by fre- quent vomitings of a thin, dirty-yellowish, whitish, greenish, or even colorless fluid, with discharges from the bowels of a similar character to that vomited up, and which occur as frequently as the voiriting. During the intervals between the vomiting and purging there is nmch nausea and uneasiness at the stomach ; but in some cases a sensation of relief is afforded by the discharges and the patient lies in bed, much fatigued, but apparently free from pain and distress. These attacks of vomiting and purging usually take place every ten or twenty minutes, being either simultaneous, or the vomiting immedi- ately followed by the discharge from the bowels, or else the reverse. Sometimes the pain Is so severe as to cause the legs to be drawn up, or even to cry out. Generally, there is great thirst, but as soon as any liquid is swallowed it is ejected; the tongue is dry, the urine high-colored, deficient or sup- pressed, the pulse rapid, soon becoming small and feeble. If the disease is allowed to progress unchecked the pulse sinks, the extremities become cold, the countenance pale and indicative of nmch suffering, the breathing hurried, cramps in the limbs, hiccough, a cold, clammy sweat breaks out, great prostration, and death. The disease frequently proves fatal in twen- ty-tour hours, and, when malignant, even in a few hours ; sometimes it subsides spontaneously. Sometimes patients witli cholera morbus complain of a great burn- ing sensation internally, and in the more malignant forms of the disease, it is not uncommon for the last discharges to resemble the "rice water" evacuations of Asiatic Cholera. Cholera Morbus may be known from Diarrhoea and Dysentery by the character of the discharges from the bowels, which, in this, are of a purely bilious nature, not mixed with blood or mucus, and with scarcely any fecal matter. Causes.— Cholera Morbus is owing to an irritation of the stomach and bowels and a greater or less derangement of the liver, and is ordinarily caused by improper substances taken into the stomach, as unripe fruit, acids, much fat food, certain kinds of fish, lobsters, unfermented cider, improper use of alcoholic drinks, or any article that will irritate the mucous !y n ( ,iHl!' Ml i J I ■* i:^: I «86 DISEASES OF THE INTESTINES. I membrane of the stomach and bowels, by undergoing an acid fermenta- tion. It is, also, produced by exposure to sudden changes, by sitting in a draught of cool air while in a state "of perspiration ; by excessive heat ren- dering the bile more acid, or secreted in unnatural quantities, or by malarial influences. Persons of gross habits, or intemperate in eating and drinking, and those of sedentary habits, are the most subject to it. Pkognosis.— When the symptoms gradually improve, vomiting ceas- ing, or becoming less frequent and distressing, with a gentle moisture ui>on the surface, succeeded by sleep, they are favorable. But frequent and severe vomiting, with great prostration of strength, swelling of the bowels, intermittent pulse, cold, clammy sweats, short, hurried breathing, constant hiccough, spasms of the extremities or convulsions are unfavor- able symptoms. ALLOPATHIC TREATMENT. Sporadic Cholera occurs independently of epidemic Influences, and is commonly called Cholera Morbus. If the vomited matters have not contained undigested food, (the presence of which is probably causing the trouble,) a mild emetic should be given, if there is reason to suppose such irritating material still remains in the stomach. For this purpose, a teaspoonful of ground mustard in a glass of water is as appropriate as any other remedy, and has the advantage of being almost always on hand. Other mild emetics may be given. Almost always the contents of the stomach are expelled during the first acts of vomiting, and an emetic is almost always uncalled for, and, in that case will always do harm. The next indication is, to overcome the vomiting and purging. This is best effected by the hypodermic injection of one-eighth to one-fourth of a grain of Morphine, at the hands of your physician. This quickly effects the object. Other forms of Opium may be used by the mouth, if the phy- sician can not be procured. A third of a grain of Morphine, placed dry on the tongue, will generally prove efficient. Thirty drops of Laudanum is also an appropriate dose for the relief of the immediate symptoms. The dose ought to be repeated in an hour, if the vomiting and purging have not ceased. If the remedy is vomited as soon as taken, it should be immedi- ately repeated, in the absence of a physician, if administration of this by the mouth is not tolerated, a teaspoonful of Laudanum in a tablespoonful of thin starch or milk, should be given by injection into the bowels. It should be remembered, that this is a powerful remedy to handle, and if carried too far, there is danger of Opium poisoning. Another important point in the treatment of Cholera Morbus is, to tvith- hold liquids as far as posaible. The excessive thirst leads to an intense craving for drink. The presence of liquids in the stomach prolong the vomiting. The thirst may be relieved by letting small lumps of ice melt in the mouth, or ice water may be swallowed, but only a tablespoonful at a time. The immediate success of treatment depends largely on the strict compliance with this rule. The common practice is, to meet the prostration which follows the attack with small quantities of brandy or other spirits and water. They do not appear to be usually necessary. The appetite should be both carefully and moderately indulged after an attack. FEVERS.— GENERAL REMARKS. Tfi, Many other methods of treatment are in vogue, but are not given here, because this one is habitually successful, and the best suited of any for employment by those deprived of the attendance of a physician. In epidemic cholera (Asiatic,) the use of Opium is well suited i'jr use during the preliminary diarrhoea, but is decidedly inappropriate when col- lapse has occurred. After this stage has passed, the best results have been produced by the use of Chloroform and Camphor, internally. During the cold stage, the hypodermic injection of Hydrate of Chloral is the best treatment discovered so far. IIOMCEOPATHIC TREATMENT. Ipecacuanha corresponds to the less viole;it attacks, as long as the discharges have a bilious tinge, and the vomiting and retching are very severe. Dose: Six pills of the second or third decimal dilution, every fifteen to thirty minutes. Verntrum- Album is particularly adapted to a case where the evac- uations are colorless; these cases are always the most difficult to manage. This characteristic of the evacuations may be expected with tolerable cer- tainty, if the disease sets in at once, with violent, copious and frequent vomiting, and the accompanying diarrhoea is equally violent. Dose : As for Ipecacuanha. M idle, the pey Iter FEVEBS.— GENERAL REMARKS. In all forms of acute disease, fever is present; in fever, properly so- called, there is generally functional disturbance, accelerated action of the blood circulation with the participation of the nervous system, ^nd a marked tendency to an increased development of heat. The symptoms common to most fevers are, at first, a feeling of coldness or shivering, then heat, accelerated pulse, thirst, restlessness, and languor. Fever, also, possesses the property of passing from one species (variety) into another. Thus inflammatory fever may pass into a low typhus, or, on the other hand, a simple fever, by injudicious treatment, may be changed into an inflammatory one; and that, again, assume the intermittent form; also, one attack may, if miserably mistreated, present all these different phases. Fevers terminating fortunately, and running a regular course, may be divided into five stages; the accession, (or first appearance,) increase, crisis, decrease, and convalescence. AVhen the res-idt is fatal, it may arise from a metastasis, (changing from one part to another more vital part,) the exhaustion of the vital energy of the patient, or the disorganization of some important part of the body. The belief in critical days is of very ancient origin, though there is some difference in the calculation of physicians upon this point. Some counting from the day the shiverings declare the onset, others n;)m the first hot fit; except in cases where a marked periodicity exists, as in ague, such distinctions are of little value, because the treatment is directed to forwarding the crisis, and thereby materially shortens the duration of the disease, and changing its virulence, so the value of the counting for the critical day, is very materially lessened. The best course is to watch the 7.SS DISEASES OF THE INTESTINES. k' 1 iiiii m case closely, take careful note of tbe symptoms, and select, with great care, the reuiecly pointed us the best to meet successfully that condition. By so doing, you will be most certain to have the pleasure of seeing your l)atient coino safely through the attack, and arrive speedily at a state of perfect health. A Crisis may make itself known by diarrho-a, profuse perspiration homorrhago, or increase or alteration of other secretions, or by the appear- ance of an eruption, after which, if the turn is favorable, the skiH becomes moist and resumes its functions, and the pulse returns to its usual stan- dard. Fevers have been differently classified by difTerent medical writers. The arrangement we shall adopt is as follows: 8imi)le irritative fever, inllammatory fever, typhus, putrid, gastric or bilious, intermittent, and eruptive fevers, such as scarlet fever, meiisles, etc. Although I have, for convenience in describing fevers and their remedies, so named thcm,I do hope no one will commit the error of treating the disease only by its name. Study carefully every case, and treat it according to its own indi- vidual peculiarities, as shown by its symptoms. Causes of Fever. It cannot be denied that there exists, in certain individuals, a peculiar predisposition t© acute disejises. The sanguine, nervous, and bilious temperaments (see "Temperaments,") possess this susceptibility in a more marked degree than the phlegmatic. The exciting causes are numerous; miasms, epidemic influences, contagion, poAvcrful nu ital emotion, derangement of some important organ, exter- nal lesions, excess or errors in diet, heat or cold, eruptions which have gone in— in fact, anything that causes derangement of the equilibrium of the system, may produce fever. FEVEB.—GEXEBAL TREATMENT AND DIET. The great essentials in the treatment of fever, are : rerfeci rest— mental and bodily. Pure air and a cool apartment; the temperature of the sick room should be kept as near sixty degrees as possible. Feather beds should be avoided, and matresses substituted when prac- ticable ; let the bedclothes be light but suflicient. Nature herself, generally, prescribes the diet, taking away the appetite, while the thirst present is undoubtedly her loud and well considered call for water or fluid of some kind. Water is the best diluent ; no solid food, broth or even gruel is permissible, where the inflammation runs very high, and very great caution is to be observed in allowing gruel and weak broths during the decrease of the fever. An error here, often causes mis- chief which cannot be repaired ; it is always better to err a little on the side of abstinence, than on that of indulgence. Toast water, or barley water, or rice water, sweetened with a little sugar, and flavored with raspberry, strawberry, orange, or, above all, lemon, may be allo-wed frequently, and only a little at a time. Avoid, until recovery Is complete, any article of diet which might, in the least degree, over-tax the weakened digestive organs. Fruits fully ripe in almost any foim art not at all likely to do any injury. mm BILIOUS PEVEtt. 2«» ->Y&C- ittle all, |ght, fully GASTRIC OR BILIOUS FEVER. Thifl ia H form of fever in whicli, as its name implies, flie (li|j:e.stive organs are cliiefly affected. It Homewhut resembles typhus, but it is dis- tinguished from the latter by tlie absence of nervous symptoms— altliougli when it assumes a torpid character, these arc occasionally developed— by the absence of the ])ressive acliing pains in the back of th^iead ; and by the absence of disturbance or derangement in tlie 8ens(¥ of sif^ht and hearing ; further, that the pain in the right side of tlie belly, which ia so constant a symptom in typhus, is not a feature of this disease. Fevers of this description have no definite course or duration. They not unfrequently fall short of the particular course to which the defini- tion is especially a])propriate, as in sudi cases as result merely from indi- gestible substances, without actual increase in the disclnirge ot (acrid) bile. In suf^h cases, the successful effort of nature to expel the obnoxious Birbstance (as by vomiting or purging, or both) is often sulficient to consti- tute a perfect resolution, and convalescence succeeds. In otlier cases nature is thus but partly relieved, the whole circulative system having become essentially involved, and the fever continues until some other crisis (as of sweat or urine) succeeds. Thus, gastric fever, if associated with mere foulness of the stomach, may run its course to perfect resolu- tion in a few days; or, if the lining membranes of the stomach or bowels be seriously allected, or the action of the liver be much deranged, and there be bilious fever, properly so-called, the fever may continue for weeks (if not properly or successfully treated,) or may assume a highly Inflammatory character, or degenerate into nervous or even putrid or Into chronic or hectic fever. On the other hand, again, it may result in transitions of various characters — the superficial membranes, either of the throat or external surface (the skin) may become affected, and eruptions of various kinds, abscesses, boils, etc., may ensue. CompUeations, andtheir treatment. In the case of any such compli- cations occurring, the treatment must be conducted according to the spe- cial directions afforded in the separate article, respectively, devoted to the complicating disease. Predisposing causes. The predisposing causes may be identified in continued exposure to great heat— whereby, the rapid sympathy existing between the skin and the liver and stomach, lias conveyed, to those organs, an undue degree of irritability ; exposure to excessive moisture of tlie atmosphere, particularly, extreme accumulation of condensed vapors (heavy dews) over a reeking, heated soil, which continues to emit exhalations; exposure to great (especially sudden) transitions of temper- ature, particularly from great heat to comparative coldness, or to the alternation of heat and cold; whence, it follows, that, under such circum- stances, this disease may assume an endemic or epidemic character. The more particular and predisposing causes are: weakness of the stomach, that is, a morbid sensibility of the lining membrane, and overdue irrita- bility of the liver ; habitual debauchery or excesses, sedentary habits, or anything, in fact, which may occasion derangement of the stomach, as considered in the article on " Indigestion.'' Exciting causes. The presence of obnoxious, indigestible, or irrita- ting matters in the stomach or bowels— which cannot be dislodged by th« 1» W: f' ftno niHEASES OP THE INTESTINES. ordinary a(;tioii of thoHe organs— either In the Hliapeof exccHHive reception of food, whetlitT or not in itHclfof tin Indigehtiblt' cliunit'ttT, or simply tlie reception of indige.stible siil)stunceH in liowever Hniall a(|uantity, or in tlie Hluipe of altered or excessive internal Hecretions, sucli as bile. Otlier exciting causes are, tuliing cold, emotions, sudi as anger, grief, care, anxi- ety, etc , acute diseases; or, in fact, any cause of general irritation when acting upon j^rsons already predisposed to this complaint, by such con- ditions as luive been mentioned above. SvMi'TOMS— of which the following are the principal: sensation of fullness and weight in the region of the stomach, or tlatuient distention, with Inclination to vomit; offensive, tlatuient eructations, and, some- times, vomiting of food and tenacious plilegm mixed with bile; thickly furred, dirty-yellow tongue; belly soft; l)owels costive; but in tlie advanced stage of tlie disease, the evacuations are often very offensive, and contain portions of undigested food; frontal lieudache; languor; bickly and distressed expression of countenance, with yellow discolora- tion of the white of the eyes ; more or less chilliness, succeeded by heat and dryness of skin; pulsequick but soft, sometimes intermitting or irreg- ular, particularly the latter; urine thick, cloudy, and dark colored. Wlien bilious symptoms are markedly predominant, all the bymp- toms commonly appear in an aggravated form ; the heat of the skin is very considerable, and the restlessness and thirst are excessive (the patient expressing a constant desire for acid drinks.) The region of the stomach is much distended with flatulency, hut in addition to this symp- tom, the following are more or less marked; the tongue is covered, at first, with a pale yellow fur, which gradually as-sumes a deeper or brownish color; the taate and eructations are bitter, and the substance vomited con- ^iists of a greenish, bilious matter; the bowels are either confined or relaxed, the motions presenting, in the latter case, a yellow, green, or brown color; the face exhibits an earthly, somewhat jaundiced aspect; Boir times there is, also, a greater or less degree of sensibility, hardness, tension and burning in the region of the liver; the urine is dark-brown, bilious; the pulse full, accelerated, intermitting or double. ALLOPATHIC TREATMENT. Remittent fever (commonly called "bilious fever".) It is to be borne in mind that the exacerbations of fever, in this disease, are much longer tlian in intiermittent fever orague, and that the period of remission (diminishing) of the fever is of much shorter duration. It is not as convenient to get the physiological effect of anti-periodic remedies during the remission (while the fever is down,) as is the case in intermittent fevers. The one remedy whicli, par excellens, is a specific in this fever, is the Sulphateof Quinine, though tlie other preparations of Peruvian Bark hold a valuable place. As soon as it is discovered that the disease is remittent fever, by the occurrence of a distinct diminution of the heat (the degree of fever,) the p&tient should at once be given Quinine until its specific effect is pro- duced, viz.: a slight deafness, a slight ringing in the ears, or roaring in the head. This is best produced by giving large doses, not very fre- quently repeated. Ten grains of the Sulphate of Quinine, in solution, repeated every six hours, until the characteristic effects of the Quinine ;H BILIOUS FEVER. 201 the )the pro- igin fre- tion, aine are produced, Ih a good practice in tliis diHeoHe or in ague. Ff this dose is not sufHcient to produce tlie effect or prevent llie jmroxysnis of fpver, the dose may beincreuHcd to fifteen or even twenty grmns. An eminent authority adviseu the adminiHtration of twenty or tliirty grainn, at u Hingle dose, once or twice a day, until tlie efTects are produced. Other pliyHicianH give tlie remedy in doses of from tliree to six grains every two or tliree liours, which is by far the l)est practice. It')requires about five hours after its administration for the maximum efTect of Quinine to be reached, bo that it seems to me unnecessary to repeat the dose any oftener th^ tliat. For the solution of Quinine, the following is a suitable formula: Takb of StUphate of Quinine four scruples (eiyhty grains), water five ounces, Aromatic Sulphuric Acid a dram and a half. Mix. A fair-sized table' spoonful will contain ten grains. The excessive bitter taste of the solution is very much obscured by chewing some Chocolate or Extract of Licorice, and taking the medicine while tlie mouth is still coated with the Chocolate or Licorice. The remedy may be taken in powder, easily, by enveloping it in a moistened medicine wafer, or enclosing it in jujuba-paste capsules. Quinine can be made into pills, for immediate use, by moistening the powder with Glycerole of Starch, or Aromatic Acid, rolling out the mass and dividing into pills. If taeacidis used, the operator must bo expedi- tious, as the mass soon har lens. Sugar, or Gelatine-coated pills of Quinine, may be used, and are an elegant form for the administration of Quinine, but slower in its action. They are liable to become hard with age, and so unfit for use. Before buy- ing these ready-made pills, one of them should be cut open ; if the pill under the coating is hard, they are unfit for use; if soft, they are gt)od. This treatment is both curative and abortive. There is no complica- tion that can occur in this disease which will prevent the giving of Quinine. If the stomach can not be made to retain the remedy, it should be given by injection in the bowel. Once in twenty-four hours, is often enough to repeat the injection. The dose for this purpose is generally thirty to sixty grains. It may be mixed with Glycerine, Milk, or thin Starch. Thirty drops of Laudanum should be added to the mixture for the injection. If there is a disposition to expel the injection, firm pressure should be made on the anus (opening of the bowel) with a towel or napkin under the hand. A four or eight ounce hard-rubber syringe is preferable for the purpose of making the injection. Time need not be lost before the administration of Quinine for the action of cathartics, or any othar preparatory treatment. Constipation should be relieved by the laxative effect of an Aloetic Pill, or one or two Compound Cathartic Pills, or by an injection of tepid water. This plan of treatment will, in a large proportion of cases, succeed in arresting the disease, but if the disease should continue, the treatment thereafter is essentially the same as in other continued fevers, which is more especially given in connection with typhoid fever. Tlie anti-periodic remedies should be continued, but in n^ore moderate doses. Five grains of Quinine two or three times a day, will, probably suffice, but if the fever should run high, the dose should be increased sufficiently to moderate the fever. \ ^:M ;, I . 20i DISEASES OK THE INTRHTINKS. % .. When the IVver continues high, after the full effects of Quinine are produced, Fowler's Solution (Solution of the Arsenite of Potash,) may be given in doses of one drop, thno or four times a day. It may be given in water, and is useful if the delirium lessens, the Kkin becomes moist, and the tongue (!leaii. When this disease Is associated with Typhoid Fever (known us Typho-Malarial Fever,) Fowler's Solution seems particularly serviceable. Headache and delirium are due to the intensity of the fever, and much good may be done by applying cold to the head, by frequent bathing with cold water, or if the heat of the bead is very intense, with a sack *br bladder of pounded ice. Immediate relief from the intensity of the fever may be derived by sponging the surface of the whole body, with tepid or cold water, according as the fever is moderate or high. The degree of cold should be governed by its agreeableness to the patient. The spongings may be repeated as often as the patient desires. If the fever rises as high as one hundred and four degrees F , or higher, as shown by a fever taermometer in the armpit, the application of the cold wet sheet (cold wet pack,) will prove servicea- ble. For its application a sheet or linen is wrung out of cold water, and laid smoothly on a hard mattress; the patient then lies, or is placed upon it, with his head upon a pillow. The sheet is then drawn over the body, one side at a time, and tucked under the opposite side. Some blankets or comforters are then closely applied over the body. The patient may be placed in the wet pack several times a day, and allowed to remain in it from five or ten minutes to an hour, according to the state of the tempera- ture. The effect of cold water is only temporary, and the treatment with Quininej or other preparations of bark, must not be delayed or neglected. Water should not be applied to the body, if the patient is sweating. If any remedies, besides Quinine and cold, are needed to reduce the fever, the Tincture of Aconite is bast suited. Half a drop to a drop may be given from half an hour to an hour apart, until an impression is made on the fever movement, after which it may be given one or two hours apart, until the fever is reduced. Then its regular administration is to be discontinued, to be resumed again as before, when the fever rises. Nausea, (sickness at the stomach) and vomiting may sometimes be relieved by laying a cloth, previously dipped in ice water, and folded over the stomach or by a mustard plaster. Doses of one drop of Creosote, or Carbolic Acid in water, frequently give relief. Bismuth and Oxalate of Cerium are generally successful. Take of Stibnitrate of Bismuth a dram. Oxalate of Cerium half a dram. Mix, and divide into six papers. Dose : One every hour or two. The powder can be taken dry on the tongue, and swallowed with a little water. Milk, with one-third part of lime water, can generally be taken by the stomach with benefit. Should the patient need nourishment and the stomach not tolerate food, nutritious injections should be given. Strong beef tea made with OHe pound of finely chopped lean Beef, to a pint of cold water, by heat (the temperature, should be raised to 160°.) The tenaperature should be maintained at that fo'-^'our hours, water being added from time to time to keep the quantity lone pint. One-fourth of this can be given by injection, or one-eighth by the mouth. Milk may also be .Jk Ki BILIOUS rBVBR. :2M be be ver or of cm, an. int me lis Ibe give by Injfiction. To' the beef tea rtfteen drops of dilutd Hydrochloric Acid, and cwo teaspoonfuls of Glycerolo of Pepsin, oi 'o-tliirds of a tea- spoonful of powder of Pepsin ahould l)e iidded. If ni.irf ia used the acid should be omitted. Twenty or tliirty dropa of Lmidiiniun sliould be added to t)ic i'ljection, if the rectum is irritable, and tlie injection retained by Urni pressure with the hand over a towel. ViKilanfH and rcstles-snefls will call for anodynes. For this purpose Tincture of Hyoscyamus In doses of one or two teaspoonfuls may sufflco. If not, ten to twenty drops of Lau- diuuim may be added. A pill of one grain of Extract of Hyoscyamua and half a grain of Opium may be used. Protracted cases require the siime treatment, with more attention piven to feeding the patient. Fifteen drops of Diliito Hydrochloric Acid, in sweetened water, three or four times a day. It assists the digestion and relieves tl)e dryness of tlie mouth and throat. During convalescence, tonic do.ses of Quinine, or iJark and Iron,. should be taken. A dessertspoonful of tlie Elixir of Bark and Iron, is useful. Proljably the Citrate of Iron and Quinine, or the Citrate of Iron ..id Cinchonidia in doses of t^o to Ave grains dissolved in Orange Flower Water, taken three times a day, answers the purpose the best. A tea (infusion) of Dogwood, Colombo, Gentian, Quassia, Boneset, and Wild Cherry, and Poplar, ia useful, taken before meals. Two ounces of the dried drugs will make a pint of Infusion (tea;) the dose is one or two tablespoon fuls. The Tincture of Iron, in doses of fifteen drops in sweetened water, may then be taken after meals. Should intermittent fever (ague) follow bilious fever, it should be treated aa is directed for that disease. In Typho-Malarial fever the dlseasoshould be treated in the first place, as is directed in this article for remittent fever, aside from this the treat- ment will be as is directed for Typhoid fever. HOMCFOPATHIC TREATMENT. In simple cases, associated with uncomplicated derangement of the stomach, or simple foulness, especially, if the afTection be casual, and can be traced directly to excess in eating or drinking, or to some particular indigestible substance, if all strikingly bilious symptoms be absent, such as those above enumerated, and if there be no bitterness of taste, or bitter eructations, the treatment should be regulated by the directions affbrded in the article on " Indigestion." In the severer cases, characterized by predominant bilious symptoms, or if the disease assumes an inflammatory character, the ensuing indica- tions may advantageously be consulted. Aconituni is indicated, more especially, when everything received In the mouth, in the shape of food or drink, except water, has a bitter taste, or when there is continually a bitter taste in the mouth, the pulse being quick and frequent; when the tongue is covered with a yellow coating; when bitter eructations or violent urging to vomit, and retching occur, without discharge, or when there is vomiting of greenish, hitter, or slimy matters; also, by excessive nausea; suspended evacuations, or frequent, scanty, small motions, attended with much urging; swelling and tight- ness across the stomach, sensation of heaviness .ind fullness in the fore- head and temples ; and if fresh air appears to afTord some relief. Dose: Of a solution of ten globules to two tablespoon fuls of water, give a teaspoonful every two hours until amelioration or change. it M: )0 Tl } ,, $ 294 DISEASES OF THE INTESTINES. Belladonna is indicated when there is violent throbbing of thearter- ies of the temples, reeling giddiness, and intense and unbearable headache, chiefly seated in the forehead, as if the contents of the head v/ould fall out at the forehead; dryness of the mouth, and thirst; sometimes inces- sant nausea; tongue covered with a thick, whitish or yellowish coating; sour taste; repugnance to all kinds of food, and even to drink ; vomiting of food, or vomiting of sour, slimy or bitter matters ; suspension of evac- uations, or looseness of the bowels, with slimy evacuations; quick and full pulse; especially if the head symptoms be aggravated by moving the eyes, or by movement generally, or by shaking, or even by touch, and by the access of fresh air, or a draught, and if they be somewhat relieved when the head is supported or held backwards. Dose: In every respect as directed for Aconitum. Nux-vontica is indicated in bilious fever by the following symptoms amongst others: absence of thirst, or ardent thirst attended with heart- burn; constant nausea; bitter eructations; foul, or bitter taste in the mouth, ihe tongue dry and white, or covered with yellow coating towards the root; painful sensation of weight and tightness across the stomach, constipation, with repeated urging to evacuate, without discharge, or looseness of the bowels, with scanty, insufficient, watery or slimy evacua- tion ; spasm of the stomach ; great inclination to vomit, sometimes even with empty retching, or vomiting of food ; full and frequent, or quick and intermittent pulse ; great prostration of strength in the first stage, and characterized by shivering, occurring with partial heat, or by heat following; headache with heat of the head; dullness or confusion of th-s head, with reeling giddiness; buzzing, singing, or tingling in the ears; sallow appearance of the complexion, sensation of exhaustion and weari- ness; sometimes yellowish hue of the white of the eye, particularly of the lower part of the eyeball ; great sensibility of light, especially in the morning. Dose: Six pills dry, on the tongue, or in a teawpoonful of water, every two hours, until four doses have been given, and afterwards, if necessary, every six hours. Chamomilla is of eminent service after Nux-vomica, in very severe, cases, in which the last named remedy has failed to arrest the symptoms when the tongue is red and fissured, or when the tongue exibits yellow coating; or when further indicated by intense heat and redness of the face, (particularly at night,) restless and interrupted sleep, bruised pain in the head, with prersyure, fullness, and heaviness; inflammatory redness and burning sensation in the eyes, bitter taste in the mouth ; every kind of food conveys a bitter taste ; loss of appetite, nausea, or eructations ; vomiting of greenish, sour, or bitter matters; intense anxiety, and oppression of the chest; looseness of the bowels, with sour-smelling evacuations, having the appearence of stirred eggs; or greenish evacuations, or, on the other hand, constipation, with suspended evacuations. Dose : As directed for Nux-vomica. . ^ Bryonia is particularly appropriate to the treatment of this disease in the hot season. The indications which identify it are as follows:— in- sipid, foul, or bitter taste, particularly on waking; continued thirst, tongue exhibiting a number of blisters, and covered with a white or yellow coat- BILIOUS FEVER, 205 d, Ing; desire for acids and stimulants, such as colTee, wine, etc., but repug- nance to solid or wholesome food; vomiting of bilious matters, particu- larly after drinking, or sometimes frequent, but ineffectual retching; oppressive headache; constipation of hard difficult stools, as if burnt. Dose : As for Nxix-vomica. Pulsatilla is, also, a most important remedy in this, as in every other disease in which the digestive organs are particularly implicated —the tongue being covered with whitish coating; after swallowing food or drink, there is bit4er, foul taste in the mouth ; all food conveys a bitter taste, especially bread; regurgitation of food; extreme nausea, or inclination to vomit, in the evening; excessive accumulation of phlegm in the stomach and gullet; vomiting of food or of phlegm, or of bitter or sour matters, more severe riwiy/ii; acidity of the stomach ; flatulent dis- tention of the belly, wUh rumbling of wind in the bowels ; looseness of the bowels, with discharge of bilious or slimy matters in the evacuations, — or sluggish evacuations, and insufficient activity of the bowels; split- ting headache, with tightness and compression of the forehead ; slowness and fullness of the pulse (ir. general ;) fits of shuddering and coldness in the evening, or towards evening. Dose : In every respect as stated for Nux-vomica. Mercnritts may frequently be employed with great advantage after Belladonna, when indicated by the following symptoms and conditions: Dryness, and burning heat of the lips; drowsiness in the day time, but sleeplessness at night ; severe and painful sensitiveness of the helly and of the region of the stomach, to touch or to pressure, these symptoms being aggravated, or developed at night, the tongue covered with white or yellowish coating — or moist ; foul, or even offensive and loathsorm', or bitter taste in the mouth; nausea or inclination to vomit, or, at other times, actual vomiting of mingled phlegm and bilious matters; the fever- symptoms are characterized by general coldness, shivering and shudder- ing all over the body, irregrdar, or quick and intermittent pulse ; heat of the head and face, with flushing, when all other parts of the body are affected with coldness, shivering, etc.; giddiness when the head is raised; intense headache, with desire to press the head between the hands; intense dejection, and listlessness. Dose: Of a solution of six globules, to two tablespoon fuls of water, give a teaspoonful every four hours until improvement or change. Ipecacuanha is indicated by inclination to vomit, witli utter repug- nance to food; dryness of the mouth ; the tongue either clean, or covered with a <7iicZc, yellowish coating; violent retching, 'withowt discharge, and attended with great straining, or, easy, copious vomiting of slimy matters or v)f food, with a violent gush; looseness of the bowels, with discharge of yellowish and very offensive, or even putrid evacuations; and accompa- nied with severs colicky pains; weight, and sensation of fullness, with very severe pcii'<).sm the region of the stomach ; pale, yellowish hue of the skin; severe headache. Dose : Of a solution of ten pills to two tablespoonf uls of water, give (if violent vomiting occur,) one teaspoonful every hour, until the symptoms yield. China is applicable to such cases as evince the following symptoms: Frequent eructions; vomiting or regurgitation of food; loss of appetite^ rL. 1^' 'r^ti irjo DISEASES OF THE INTESTINES. and a sensation of thorough repugnajice to all food, or as if one had eaten enough, or more than enough ; frequent emission of very offensive wind from the bowels; evacuations containing indigested food ; painful sensa- tion of tightness in the belly, and of weight «in the region of the navel; sensations of chilliness and shuddering after drm/cin.(/ ; looseness of the bowels, with watery, slimy or yelhmrish evacuation ; heat, with full and quick pulse; headache (sometimes delirium,) 6M?'nin^ sensation in t\xQlips, red face, and dry mouth. Dose: Of a solution of ten pills, to two lalilespoonfuls of water, give a teaspoonful every two hours, until amelioration or change. Arsenicum is an invaluable remedy in the majority of very severe and urgent cases, either when one or more of the preceding have failed to arrest the symptoms, or when the disease has run on to an advanced stage before treatment has been resorted to. The chisf indications for it are dryness of the tongue, accompanied with severe thirst, and with continual inclination to drink, with, however, inability to drink more than a small quantity at a time ; bitter, or very acrid, pungent eructa- Mons ; saltish or bitter taste in the mouth ; nausea, vomiting of food or of greenish, brownish, or bilious matters; exi/'e/we tenderness of the region of the stomach to contact; bui'iiinrf tind cutting, cramp-like, or spas- modic pains in the stomach and bowels, accompanied with chil- liness and anguish— or very painful sensation of weight and burn- ing at 07ie spot in the stomacli ; suspension of evacuations, excessive and continued relaxation of the bowels, attended with severe urging, and with brownish, yellowish, or greenish evacuations; scalding sensation in passing water; the evacuations (or vomiting,) are provoked by, or occur after every movement, or after drinking ; general heat of the body, usu- ally occurring at night, and accompanied with restlessness, anxiety, etc.; irregular, frequent, and quick pulse; extreme prostration of strength, and desire to assume, or to retain a recumbent posture. Dose : As for Niuc-nomica, i> ENTERITIS-INFLAMMATION OF THE BOWELS, The causes of enteritis are mostly the same as those of indigestion, dietetic transgressions ; the use of irritating, readily decomposed, sour substances; overloading the stomach; abuse of spirits; a cold. In addi- tion, we have poisonous substances; mechanical irritation by fecal matter, the progression of which, in the bowels, is arrested, in consequence of which, the vessels become compressed, or, finally, though rarely, the in- flammation may be caused by worms. B('sides these causes, enteritis occurs as a continuation of other inflummatory processes, gastritis, peri- tonitis, and as a form of reaction against ulcerations of the intestinal mucous membrane. Symptoms.— If at first the inflammation is not spread over a largo surface, and confined to the lining membrane, the symptoms are not very grave. There are few local pains, little fever, loss of appetite, constipa- tion, feeling of fullness in the umbilical region; nausea occurs very sel- dom; tliere is never any vomiting. In this manner, the affection may exist a short time and disappear again almost imperceptibly, or it may f* INFLAMMATION OF THE BOWELS. J'J7 increase and continue to spread ; very rarely the disorder breaks out at once in all its violence. The pains now become intense, burning or tearinpr, or cutting like colic, until they sometimes grow intolerable; they spread over the whole abdomen ; are generally most violent in the nmbilical region, where the least pressure causes an intense aggravation of the pain, which is increased, even by tiie act of breathing; cou'j;hing causes extreme pain, which is likewise intensely aggravated every time the patient attempts to turn the upper part of his body, on which account he remains lying motionless on his buck. At all times the pain has more or less prolonged aggravations like colic, evidently caused by the pro- gressive descension of the contents of the bowels. At the same time the abdomen is distended, but not to excess. Where the small intestine is alone affected, there is obstinate constipation ; where the large intestine is involved in the inflammation, we have sometimes, not always, diarrhoea, colored, frequently bloody stools, or alternate constipation and diarrhoea, or, finally obstinate constipation. In such cases, the colicky pains are more frequent and extensive, the distention of the abdomen more consid- erable. In violent attacks of this disease the constitutional symptoms are always very marked. A general chill only precedes a very sudden invasion of the disease. The patient feels the heat more preceptibly than others ; he is constantly complaining of an intolerable thirst ; the pulse is accelerated, even to one hundred and twenty beats, small and contracted, not often unequal and intermittent; the skin of the body is hot and dry; the extremities are frequently cool; the forehead is covered with a perspiration, as if from anguish; the appetite is entirely gone; the tongue has at times a light coating, at times it is clean and very soon becomes dry. If the affection increases in violence, the first symptom generally is nausea, which soon beco. \es associated with retching and vomiting. At first, bile and mucus are vomited up with the food ; but if the inflam- mation is extensive, even fecal matter may be thrown up; the vomited matter very soon acquires a smell like, that of feces. The signs of col- lapsg now become more apparent; the face has a cadaverous appearance, expressive of deep suffering, with elongated features and sunken eyes. Under such circumstances, the patient often wanders, the skin becomes cool, and is covered with a cool perspiration. Convulsions and .'ainting fits occasionally complicate these symptoms, and death may ensue "mder such circumstances. A rapid and complete recovery only takes piace exceptionally. The prognosis is always uncertain, because the disease is apt to pass into insiduous chronic complaints, even after the recovery seemed to be fairly under way; at all events, enteritis always constitutes one of the more important diseases. Tiie diagnosis of enteritis, although somewhat diflicult, yet, with proper care, can be made, in the majority of cases, with positive certainty. The disorder is most easily confounded with incarcerations, simple choler- ine, colic. The last two can become dangerous, if the trouble is <'steenied too highly. Since it is not always possible to make a sure disignosis until the disease has run along foratime, tlie employment of irritating remedies cannot be sufficiently guarded against in cases of colic and cholerine. ALLOPATHIC TRT-ATMENT. Enteritis. The discrimination of acute enteritis (inflammation of the small intestines,) will be very unsat- I i yJ ■SI' 4 Pi™ I: W wm ■ii'.'|,i m DISEASES OF THE INTESTINES. ■i *. (i Br: isfacLory, if made by unprofessional hands. If tlie diagnosis is made out, the treatment will be, essentially, as follows: The patient should remain in bed. Hot fomentations should ' ^ per- sistently applied to the abdomen, and some form of Opium given to the extent of relieving the pain and checking the diarrhaja. Opium, in doses of a grain, should be given two to four liours, or longer, apart; but suffi- ciently often to procure relief from pain. Ilyoscyamus or Belladonna may be advantageously given with the Opium, rendering the action of the Opium more pleasant. The dose of the Extract of Hyoscyamus is one grain ; of the Tincture, one or two teaspoonf uls. The dose of Extract of Bella- donna is a quarter of a grain, and a dose of the Tincture is ten drops. Laudanum, in doses of twenty drops; or Morphine, in doses of a quar- ter of a grain, may be used instead of Opium. It i" as well to administer the Opium by injection into the rectum. For this purpose, a teaspoonful of Laudanum should be used, mixed with one or two tablespoonfuls of thin starch or milk. An eight-ounce hard- rubber syringe is a suitable instrument for this purpose. After drawing the mixture into the syringe, the nozzle should be elevated, and the air can be expelled by slowly pressing the piston. After the injection, firm pressure on the anus (opening of the bowel) with a towel under the hand, for a time, will enable the patient to retain the injection. Both these methods of giving the medicine may be alternated. It is not best to give cathartics, unless there is good reason to believe irritating substances are contained within the intestinal canal, and then it is better to resort to injections of warm water, if the bowels require moving. The diet should be of a character which will not reduire intestinal digestion, nor cause irritation by their presence in the intestine. Beef- tea, beef-juice, raw eggs, and milk, answer tliis purpose as well as any- thing of which we have command. Rice and barley-water, or arrow-root, boiled in water, may be drank. It is common to recommend Cod Liver Oil and Iron. They are well suited to these cases. I believe tablespoonful doaes of pure Glycerine, having dissolved in it three to Ave grains of the Citrate of Iron, or the Citrate of Iron and Quinine, answer the purpose better. The patient will require systematic feeding, if the disease be pro- longed, to support the powers of life, as in fevers. Full directions for this will be given on the subject of typhoid fever. During convalescence, the usual diet should be returned to very cau- tiously. When the disease affects children, it is necessary to be very cautious in the use of Opium. The Camphorated Tincture of Opium should be used, witli an equal quantity of Tincture of Hyoscyamus. The u.sual dose of each being fifteen or twenty drops for a child one year old. For a child of five years, three grains of Dover's Powder, equal to one-third of a grain of Opium, may be used. If the stools become charged with mucus, a teaspoonful or two of Castor Oil, with an equal quantity of Glycerine, flavored with one or two drops of Oil of Cinnamon, may be given. Rochelle Salts is, also, un INFLAMMATION OF THE BOWELS. 299 pe Id ■1 appropriate laxative, in doses of half a teaspoonful (in lemon syrup). Laxatives should, however, be given with caution. The diarrhoea, which follows often upon the subsidence of the inflam- mation, may be checked by appropriate doses of Paregoric, Dover's Pow- der, or Opium, witii ten grain doses of Sub-Nitrate of Bismuth, or Tinct- ure of Catechu, or Kino, in equal quantity with the Paregoric, in Chalk Mixture. Local, and other general treatment, will be the same as for adults. HOM(EOPATHIC TREATMENT. Aconite in the early stages, when the inflammation is just beginning, will cut the disease short. Dry, hot skin ; full, frequent pulse ; mouth and tongue dry, witli intense thirst. Abdomen swollen and tender to the touch ; cutting, burning and tearing pains in the region of the navel. Great fear and anxiety of mind with nervous excitability ; bright-red and hot urine, are the leading symptoms calling for this remedy. Dose: Eight pills every one to three hours, dissolved in a little water, or dry on the tongue. Mercurius. Abdomen swollen hard, and painful to contact. Cut- ting, stabbing pains in the bowels, accompanied with chilliness and shud- dering; green or bloody mucous stools, with violent griping; profuse perspiration affording no relief; pale, wretched complexion ; foul smell from the mouth ; vomiting of bitter mucus; restless sleep. Dose: A one-grain powder or six pills every two to four hours. Belladonna. Great heat and tenderness of the abdomen. "\'ioIent contraction or clutching pains in the bowels. Pains which appear sud- denly and disappear just as suddenly after continuing for a longer or shorter period. Congestion of blood to the head, with throbbing of the arteries of the neck (carotids.) Face flushed, eyes red and sparkling. Great intolerance to noise and light. Starting and jumping during sleep. Sleepiness, but cannot sleep. Partial or general spasms. Almost constant groaning or moaning. Dose : As for Amnite. Arsenicum. Even if the previous treatment fails, there is still hope that this remedy will succeed, if the following symptoms are present : — Very rapid and weak pulse. Sudden failure or sinking of strength. Cold, clammy sweat, and great restlessness. Intense thirst, drinking often but little at a time. Burning in the abdomen, worse after eating or drinking, usually followed by vomiting. Symptoms all worse after midniglit. Dose: As for Mercurius. Arsenicum always gives the best satisfac- tion in potencies as high as thirty or upward. Bryonia and Cantharis are, also, good sometimes. See " Repertory.'' Make hot applications to the abdomen. Bathe with tepid or cold water. Drink Elm Bark Water, etc. CATARRHAL DYSENTEBI A.— FLUX. ' Symptoms. The disease sets in without any definite precursory symp' toms, or suddenly with violent pinching, cutting pains, radiating from the umbilical region downwards, and which are speedily succeeded by a violent urging to stool, with discharge of fecal, soft or watery masses. ^. ;' ■ ^ ."{K» DISEABKS OP THE INTESTINES %i II LI'N. P' i 1 After the evacuation, the pains abate for a shorter or longer period, after which they return with renewed violence, and more particularly With increased urging, attended with tenesnuis, (pain and difficulty with fre<i^uent desire) and severe pressing pain, during which a small quantity of white, andsubsccpiently blood-stained, mucus isdischarged. withoutany admixture of fecal matter in most cases. At the same time, the patients experience an acute burning pain in the anus, and with every new dis- charge the tenesmus increases. In slighter ciises the disease sometimes runs its course without any fever; the more acute cases may be attended with violent fever; the stomach is at times involved in the afTection, at times not at all ; there is loss of appetite, retching, nausea, vomiting; the tongue is usually quite clean. The duration of the disease usually depends upon its extent, wliich is pretty accurately measured by tlie extent of the pain. The slighter cases sometimes do not last more than a day, the severe cases last weeks, and then are disposed to pass into the chronic form. In the case of children the non-admixture of fecal matter in the stools is an excei)tion to the rule; blood, pus, and scrapings of intestinal membrane, shreds of mucous membrane, and false membrane, are met with the more frequently, of mixed green color. The dysentery of chil- dren assumes more easilj' a chronic form than in the ciuse of adults, and almost always leaves a peculiar disposition to relapses. The so-called teething dysentery is just such a catarrhal affection, and arises less fre- quently in consequence of the process of dentition, tlian of other influ- ences acting upon the little patient, especially, an erroneous system of preparing and administering nourishment. In the case of children, even If there is no sign of fever, convulsive symptoms are apt to follow, imparting a higher degree of importance to the otherwise not very impor- tant disease. A fatal termination of catarrhal dysentery, in a person of an other- wise good constitution, is a rare occurrence. Even where the di^ea-se sets Id as a complication of other diseases, the danger Incident to its course is only of moderate importance. The treatment will be shown when we come to speak of dysentery proi er. DYSENTEBIA EPIDEMIC A, DYSENTERY PROPER, FLUX, However trifling catarrhal dysentery may seem, dysentery proper is an important and dangerous disease. HisTOiiY. Dysentery usually breaks out in an epidemic form; the fi?w cases of sporadic dysentery that call for treatment, are either not dysentery, properly speaking, or else they are very rare occurrences. Dysentery is, more particularly, a disease of young persons and those of middle age, and very seldom attacks either the very young or very old. Epidemic dysentery almost always breaks out late in the summer, or in the beginning of fall. In very hot and dry seasons; it rarely lasts until winter is somewhat advanced ; It seems to occur more frequently among the lower than the higher classes; its spread Is promoted by living in crowded rooms; nothing shows this clearer than the devastations which ?*: FLUX. 801 itery the not lose lold. in In til )ng in lich dysentery causes in tlie ranks of armies. Neither city nor country peo- ple are spared ; it even seems as though thH latter were more fearfully visited by this pl.'tgue. If a disposition to dysentery prevails, errors in diet and catarrhal exposures excite th ^ attack ; the statement, however, that the use of fruit favors the breaking out of dysentery, is not yet proven. This assertion, at most, only applies to unripe fruit, or to such kinds as are apt to cause cholera morbus, diarrhoea, etc., such as the early cherries, plums, etc. There are, undoubtedly, individuals whose bowels are irritated by the use of any kind of fruit, and in whom it may cause an attack of dys- entery. These detached and well established historical data, cannot well be harmonized in one series, except by the supposition that there exists a peculiar virus, which has a special relation to the large intestine; for it is only in these parts that the phenomena of dysentery become localized. In this respect, dysentery is very near to Asiatic cholera, and, likewise, to other infectious epidemics. What the quality of the dysenteric virus is, has not yet been decided with any degree of certainty. That the virus is of a vegetable nature, might be accepted as true, where dysentery spreads over extensive districts ; but this theory does not apply where dysentery attacks whole armies, A discussion of this point is not as use- less as it might seen., since its proper solution is intimately connected with the preventive treatment of dysentery. This question may, per- haps be better elucidated by subsequent epidemics. It is certain that the virus is engendered in the patient, and is transmitted by him, like the poison of cholera. Contagion does not take place by contact, but the Infection is propagated by water-closets, close stools, etc. This theory, which is now received as explanatory of the spread of cholera, explains the fact, why the disease decreases and disappears with the appearance of frost; the cold destroys the poison. This may be the reason, also, why dysentery sometimes continues as long as midwinter, provided the warm weather lasts, and there is no frost. The circumstance that during an epidemic all the inhabitants of one house, but not all the houses in the neighborhood, are attacked, and that epidemics spread more extensively, and more frequently in the country where the exhalations from excre- meuMtious matter are more freely diffused through the air, speaks, like- wise, in favor of the theory, that infection is communicated in the man- ner above described. Among armies in the field, the epidemic is propa- gated in a like manner, whereas, the soldiers, lying in the barracks, are protected much more efficaciously, and the cases of dysentery occurring among them, are less numerous. Even if the views which we have here expressed, are not absolutely accepted as true, yet no reasonable physi- cian will neglect to arrest the spread of the disease, by effecting the remo- val of the various circumstances, which we have pointed out as exciting causes of the epidemic. Another important question regarding the his- tory of dysentery is, whether an alteration in the functions of the liver does not constitute the chief exciting cause of the disease. The origin of the epidemic, at a time when the action of the liver is known to be altered, and the affections of the liver which so often prevail, during and after epidemic dysentery, seem to confirm this opinion. Hence, Individ' 1 1 \ « .'OJ DISEASES OK THE INTESTINES. ualH ill wlioiii unheulthy clmtiges in ttie funutionM of tlie livur, Imvu developed a diaitoHition to l)e uttuciied witli dysentery, are riioht liltely to be assailed L)y tliis plague; tlii.s eireumstunco again hIiows wliy middle- aged perHoiiH should be most liable. AVliere the ulcers are not too extensive, they lieal without much cica- trlseation. If tiie loss of mucous lining is ('onsideral)le contracting cicatrices are the result, ho that the bowels look as if twisted around by cords, or presenting valve-8liaj)cd contractions. It is upon the duration of this process that tiie length of the period of convalescence depends. SyMi'TOMs. The breaking out of the disease is almost always pre- ceded by precursory symptoms. The i)ati('nt feels languid, prostrate, and out of humor; the appetite is, more or less, wanting; there is oppression of the stomacli, deranged digestion, and an increased accumulation of flatulence. These symptoms soon increase to nausea and desire to vomit, with coated tongue and foul taste ; sleep is disturbed; there is drawing in the extremities, sensitiveness to external cold, shiverings, and an accel- erated pulse. These symptoms show that the disease lias invaded the organism. Abo"e all, it is the diarrhoea whicli denotes the local sphere of the disease. Even if all the other precursory symptoms are wanting, diarrhcDa generally precedes the attack, in company witli sliglit, colicky pains, and without any further cliaracteristic peculiarities. As these pains increase, the diarrhoeic discharges occur more frequently, but are, at the same time more scanty, in the same pi'oj)ortion the tenesmus, wlilch precedes every discharge, begins to distress the patient. At times, after a few fecal evacuations, and at otliers after a somewhat longer duration of the simple diarrhtt'a, fecal matter ceases to be dis- charged; this is the commencement of the real disease. The colicky pains, which are seldom wanting, increase in intensity, become more continuous, and are attended with a painful urging to stool; a sensa- tion as if th* jwels would press out of the abdomen, or as though a heavy weight »vere suspended from the anus, or as if the sphincter ani (muscle that closes the anus, "puckering string") would tear. When these pains reach their hight, there occurs a scanty discharge, attended witli an intense burning at the anus. At flrst a remission of the distress takes place after this discharge, but the more frequently it occurs, the more the tenesmus increases in violence, and the less it intermits after the evacuation has ttiken place. The evacuated substance, which, for some time, continues to show a little tinge, soon becomes a mere mucus, with a grayish admixture, or a more or less copious admixture of blood (red and wliite dysentery,) and of a peculiar insipid odor. In more violent cases, pure blood is evacuated. According as the disease is more or less intense the discharges occur every hour, sometimes every few minutes, so that the patient scarcely dares leave the chamber, however difficult it may be for him, owing to tlie con- tinued violent and colicky pains, to sit up The pains now become more tearing, cutting, radiating from the umbilicus (navel) downwards. The constitutional equilibrium is not much disturbed at the outset. In mild cases, the fever is scarcely perceptible, but there are frequent chilly creep- ings. The pulse is but a little accelerated, .and temperature of the skin is not much increased. In proportion as the discharges increase in fre- ,•■•(1 FLUX. «f« the ow a or a ■id of ited. very- ares con- Qore The nild eep- kin I fre- quency, the pulse becomes correspondingly accelerated, hard and small, the skin hot and dry, the thirst distressing; the desire to vomit increaseg to real vomitinjf, althougli not regularly ; the appetite is entirely gone The i)atient soon loses his strength, and leels unable to sit up. The affeo tion may continue, at this stage, for a week, after which it may gradually terminate in recovery. If the local changes are more considerable, the disease increases in intensity. Tiie pulse grows frequent, small, and feeble, the thirst becomes agonizing, tiie temperature uneciuul, the extrem- ities feel cool to the toucli, the tongue can hardly Ije kept moist, the face has a cadaverous expression, and the prostration is complete. Usually the abdomen ia much distended and sensitive. The discharges follow each other more rapidly, and the tenesmus continues uninteri-uptedly. The dis- charges, together with the blood, contain shreds of mucous membrane, and a number of membranous fragments. When the disease reaches this hight, delirium is not an unusual occurrence. If the disease approaches a fatal termination, the discharges either become fetid, or else they cease entirely, or take place involuntarily, as a sign that the bowel is paralyzed. It is always a bad symptom, if the discharges diminish in frequency without any corresponding improvement. Death supervenes amid symptoms of general prostration, meteorism (distention with ga8),delirium, coma. The termination in recovery may be considered certain, if a general improve- ment is accompanied by a decreasing frequency of the stools, and the colic abates, although the tenesmus still continues. As soon as the discharges contain feces, and the fecal odor is restored, recovery may be considered under full headway. The pulse generally continues somewhat more rapid, yet becomes fuller and stronger, and the symptoms of fever disappear. After a severe attack of dysentery, recov- ery scarcely ever takes place very rapidly; which, as we said before, ia owing to tlie slowness, with which the ulcerated surfaces heal ; it may, also, be owing to the fact, that the condition of the digestive organs does not admit of a rapid reparation of the waste, by a copious supply of food. In armies, especially, the transition of acute into chronic dysentery is not a rare occurrence. The symptoms of chronic dysentery correspond with those of ulceration of the bowels, which, indeed, constitutes the basis of the chronic form. In such a case the fever disappears entirely, but the diarrhoea continues, consisting at one time of fecal masses, lined with pus and blood, and at other times of a sanguineo-purulent mucus, or changing about with obstinate constipation. At the same time, the appetite do«B not return, and the patients continue to lose flesh. Death is apt to termi- nate such sufferings, though, frequently, not until they have lasted a long time. The severest forms of dysentery, the septic, putrid or typhoid form, are of very rare occurrence in our latitude ; they are more frequently met with in hot climates. Such forms arise either because the milder form assumes a malignant type, with all the signs of gangrenous destruction of the bowel, or else they break out at once, with an extraordinary degree of intensity, characterized by the signs of a most acute typhus, and rapidly terminating in death. Strictly speaking, there is no transition into other affections; the abscesses of the liver, which do not occur unfrequently, eveu among us, A. f ' i' 'I II' i M i: !f m I)Iskasi::h ok thk intkstinmh. after ii violent attack of (IvHentery, are moHt probably due to the absor])- lioii of pus Jiilo tlio vesselH; or possibly to a disease of the liver, running Its coiirsi! HiiniiltatieoiiHly with dysenUMv. Till': I'uooNosis, in the dysenteries of our ciimute, is empliatlcally favoralth". ALLOPATHIC TREATMENT. Treatment of Acute Sporadic Dysen- tery or Flux (oceurriiiB inrh^pendently of epidemic influences.) In tliii disease nature points unerrinjfly toward a thorou(;h emptying? of the intea- liiial canal of its contents. This is siiown ljy tiie copious diarrhoea which priicedes the dysentery. The first object of treatment, therefore, Is to efTect this end jis quickly and thoroughly us possible, assisting nature's elTorts by an efllcient cathar- tic. I{y fur the most effective cathartic for this purpose is Sulphate of Magnesia (Epsom Salts). Take a nujjlcient (jwmtity of Suiptiale of Mag- nesia to saturate 8evf'7i, ounces qf vxder; add oiie dram of Arutnatie Hulphurio Acid. The dose of this mixture is a tablespoonful every hour or two, until it operates freely; or the Epsom Salts may be given in dosea of a heaping talilespoonful steeped witii one-third of its i)iilk of roasted coffee and repeated in four hours, if a frtio watery stool has not befsn before produced. Ilochelle Salts, in doses of a tablespoonful in solution with water and lemon juice, or. Citrate of Magnesia, may be employed, but the acid solution of Epsom Salts is to be preferred. Castor Oil is only of less value as a purge in this diseii^e than the cathartics before mentioned. If used, it should bo given in doses of a tablespoonful or more, mixed with an equal quantity of Glycerine, and flavored with a couple of drops of Oil of Cinnamon. This should, also, bo repeated in four hours, if it has not oper- ated. After thorough purgation has been produced, the cathartic is to be discontinued. This effect is followed by a period of rest, and sometimes recovery im- mediately takes place. This rest of nature should be aided, and prolonged by a full dose of Opium. The Opium benefits, also, by its direct effect on the inflammation (called antiphlogistic) as well as aiding recovery by prolonging the quiet of the intestine. It is preferable to give the Opium by injection into the rectum. For this purpose a teaspoonful to a tea- spoonful and a half of Laudanum should bo mixed with one or two table- spoonfuls of thin starch or milk, and injected into the rectum with a hard rubber syringe. If it is thrown off it should be immediately repeated and caused to be retained, by flrrn pressure upon the anus (opening of the bowel,) with a towel under the hand, until the efforts to expel it cease. Generally speaking, once in twelve hours is often enough to repeat the injection of Laudanum, but it should be often enough to afford complete relief, and the dose increased until this effect is produced. Suppositories of Opium or Morphine can be purchased, which will answer the purpose. In some instances, neither the injections nor suppositories can be retained in the rectum. In such cases, it must be given by the mouth. Then the powder or pills of Laudanum or Morphine may be used. The usual dose is one grain of the powder, or one pill, or twenty-five drops of Laudanum, or a quarter of a grain of Morphine, but the dose must be increased until relief follows its administration, and repeated often enough to continue the relief. Til FI.UX. w> Tho patient sliould bo quiet in bod, a lar^c; Hax-seed poultice, contaiuin;; two or three tal)leai)oonl'ulM of niustani, placed over tho stomach. About half an hour after the Opium or Laudanum injection la fjiven, thirty grains of Ipecacuanha, wrapped in a medicine wafer, should be «iven, or it may be given in milk. The Ipecacuanha causes the stools to become natural, the fl:rii)ing and strainini,' cease, the hot, dry skin becomes moist, and the patient becomes refreshingly calm. In a simple acute case, this may com- plete the cure. Tiie Ipecacuanha may be rei)eated in from six to eight hours if required, and will be taken, if a disgustingsickness at the stomach is not caused. With every dose the hot poultice or u mustard plaster Bhould bo placed over the stomach. If a dose is vomited, it should be immediately repeated. Some i)atient3 find it impossible to continue the use of the remedy. In such instances, its use must be dispensed witii. The treatment, then, will rest upon free cathartics and Opium. Whenever stools, with mucus or slime and blood, begin to piiss, the cathartic should bo at once resorted to, as in the lirst place, to be followed as before, with the Opium an.l Ipecacuanha, if it is tolerated. It is well to .state here, that the treatment of dysentery, with Ipecacuanhii , has reduced the fatality in acutrf dysentery to one-third of the mortality, previous to its introduction, as shown by reports from the East Indies. Persons who cannot take Opium or Morphine, can usually take the Watery Solution, or the Alkaloid of Opium, called Codla, in doses of one grain. The benefit from Opium is so great, that it is best for ])atienta to suffer some inconvenience from the Opium. Its unpleasant effects may, sometimes, be obviated by giving with it a full dose of Hyoscyamus or Belladonna ; one or two grains of tho Extract of Hyoscyamus, or one-fourth of a grain of Extract of Belladonna. Remedies which may, sometimes, be associated with the internal use of Opium, in this disease, are Bismuth, in doses of twenty to thirty grains (half a teaspoorful); Acetate of Lead, (Sugar of Lead,) in doses of three to five grains ; Sulphate of Copper in doses of a twelfth to a fourth of a grain ; Tannin in doses of ten to twenty grains, and the various vegetable astrin- gents, among which are Rhatany, Kino, Catechu, Logwood, White Oak Bark, Witch Hazel, White Pond Lilly Root, etc. "Very seldom will it be necessary to resort to any of them, if the foregoing directions, regarding the use of Cathartics, Opium and Ipecacuanha, are strictly followed. When the disease is prolonged, and the stools become of a bloody, watery character, these astringents occupy quite an important place in the treatment. Ipecacuanha should be given, if tolerated, together with Opium, in some of its forms, to the extent of relieving pain, some of the foregoing astringents, which may be tried in succession, and tonics. Cathartics, as a rule, should not be given in such cases. Particular attention should be given to the diet, and nothing of a coarse character, which will make stools, should be allowed, but the food should be rich in nourishment. Milk, meat essences and broths, raw eggs beaten up with a little sugar and milk, or water, answers this purpose the best. Moderate quantities of arrow-root, sago, tapioca, and rice, may be given. Tho patient may drink, at will, of thin mucilage of Slippery Elm, or Qum Arabic, or Flaxseed Tea, Barley or Rice Water. 20 ^ , 'til ill u Hi r.oD DIHKAHKH OK TIIK INTKSTINRH. (J Ono of tlio lu'st fitriiiH of tonic ff)r inoHtratcd casos, un«l whon rftrovfiry J3 slow, is Klixir or Hyriii) of (iuiiiiiic, or (Mnclionidia. Strycliniiu! and Iron. Tho doHo is, usually, a tcaspdonfiil three* times a day, tliouj{li a dcssert- sjtoonfiil njay l»(! ^'ivcn. Whiitevcr tint fdiin of tonic Kiv«'n, tlio doso of Qninino is ono or two grains, Iron ono j,'rain, and of 8tiyohnino not to exceed a thirl iclli of a>,'rain. In acvt'iT ('iiidcrnicH of dysentery, the treatment docs not, materially, differ fronj the above, except, p(!rliaps, in the (juantities of medicines required to control (lie disease. The principles of IrfsatriKuit are ihe same. Cathartics are to he ^i'jfu more c;uilio:isly,;iiid ar(* toheoriiitt(!d altogetlicr, if the discliiUKes herouK! watery instead ot mucus, or if tlio patient bf- notably prostrated. The rules for Kivin(^0|iiMm and i|)eea('nanha are to he ol)served. Much 'arger doses of Opium may l)e required to procuK! relief from the pain and griping, and to arrest tlu; frecjuency of the discharges fnun the bowels. It should 1)0 given freepieutly enough, and in increasing (piautities, until that result is reached. After a doseof Ip(!cacuanha has been retained, as a rule, less Opium will be re<iuire(l. While th(! Ipecacuaidia should be repeated as before directed, no intermission must be permitted in giving the Opium, and should always be carried to the extent of che(;l<ing the watery, bloody discharges, in increased doses, till this effect is i)rodueed. In increasing the doses in this way, the patient must bo carefully watched tliat Opium i)oisoning (narcotism.) is not i)roducod. Contraction of the pupils ("sight of tlio eye,") decreasing freriuency of breathing, and profound sleei), indicate this conditi(ui. If, however, the patient breathes twelve times in -i minute, the danger from narcotism is not great. In cases of langer from exhaustion and prostration, stimulants are to l)e giv- ^he nourishment. For this purpos(% I l)elieve Brandy to be the ' , should be given to a i)oint short of excitement of the circulat .ervou.s system. Its l)onelicial effect will l)e shown by a general ^. i, and the pulse will l)ecomo softer, fuller, more regular, and Blower, and the tongue moistens. The (lose should be begun at a table- spoonful for an adult, repeated at intervals of four bours, preferably with food, and may, if necessary, l)o increased in fre(|ueney and quantity to meet the refjuirements of the case. It does harm, if the frequency of the pul.se is increa.sed and the tongue becomes dry. Symptoms of nuilarial trouble will call for Quinine, the same as is directed in (bilious) ren)'^*^ont fever. In all cases of dy.ie. .ory, patients should refrain as much as possible from eflTorts to stool, for the sensation is delusory, depending on the inllamed state of tlie liowel. Cold to the anus, as ice wrapped In a clotli, is useful. The Opium injections relieve this painful sensation tlie l)e8t of anytliing. Five grains of Sugar of Lead may be added to the injection witli benefit, tliougii for this combination a lialf a grain of the Acetate ci Morphine, dissolved in a teaspoonful of Glycerine is better than the Lau- danum. Tannin, in quantities of a scruple, may be used in this way, instead of Sugar of Lead. In cases which, after thorough trial, cannot tal<e Opium ifi any form, I would recommend an injection of one of the astringents named, dis- FMJX. 8(17 s;' sible the 4 of jtion Iter/ tead |rm, dis- •iolvc'd In ii tnblcHpoonful of Olycorliic, with ftfletii drops if the I'liild Kxtnu.tof lU'lladonnii or II tciisjioonfiil «>r tlic Tiiicluro. A^tcjixpoonful nr two of till' Fluid Kxtnu-t of Ify'iMcyniiius, (ir twn or thrco jrniliiH of the Holi<l ICxtract, nmy hu rulilu'il up with (liyccriiic, and used instnid of the Itelladoniiu. In caHo none of Ihcsc are proruraltlc, a slrotiK tea inude with Stramo- nium, (Jiiiisoii W('»(l) may l)o uHcd witli Ix-nellt. Duriiii,' convalt'scciicc', tli(>amouiiL of (loses and frequency ofj^iving thoiii, Hiiould lief^nidually diininislicd. Tonics, as recommended in simple acute dysentery, are aj)]ilicalile liere. Ho dangerous a disease as <.'pidende dysentery, recjuiring such positive treatment, on^ijlit 1<> i)e under tlie «lireetion of a competent pliysieian. II05ia:(>l»ATlIIC TIlEATMKNr. According to our remarks on tiie causes of dyseiilt-ry, it i.s evident tliat llien! must Ikj a preventive tr<.'at- ment of dysentery, an<l tliut it must result in great good. From wlmt we liavesaid on tlie sulyect, th« single i)oint« of tills proi)hylactic treatment can easily l)e inferred. In this place, we desire to call attention to tlie absolute necessity of keeping the evacuations of dysenteric })atients nejia- rate. It is, moreover, of tlie utmost importance to treat every diarrlneu that may occur during epidemic <lysentery, witli great care, and to arrest it as soon as p<issil)lt, since it is an established fact, that a diarrha'u pro- duces an Increased sensitiveness to the dysenteric virus. Mf'i'ritrinH occupies tlio first rank among the remedies for dysentery, and among the m«'r(;urial preparations it is theCorrosive Sublimate (Merc. Corr.) This remedy corresponds to the symptoois of ordinary dysentery ao perfectly, that it m;iy safely be regarded as a specific remedy for the whole process. The leading symptoms of dysentery, tlie bloody mucous evacuations without any fecal matter, attended with the most violent tenesnniH and cutting colic, is a characteristic and constant symptom of M«rc. Corr. All ])hysician3 agree that yie lower attenuations of this rem- edy are preferable, and that it should not be given higher tlian the sixth ; they likewise agree that the dose should be frequently repeated. The best >^Ian is to give a dose of the remedy after every discharge; as the dis- cljarges diminish in frequency, the medicine will likewise have to be repeated less frequently. The efTect of the remedy is perceived very soon, in most cases within thirty-six hours. Of course, we cannot expect to perceive a striking improvement in twenty-four hours; nor would it be advisable to select another medicine, if no improvement takes place in that space of time. For this and all other remedies in this disease, the Dose, is six jtills after every second motion of the bowels, as long as is required by the symptoms. The Merc. Corr. almost always deserves a preference in epidemic dys- entery; Morcurius sol. is preferable in the so-called white dysentery. In epidemic dysentery, the so-called white dysentery is of rare occurrence, and then only a very transitory condition. On the contrary, catarrhal dysentery, is, in every respect, adapted to Mercurius sol., and it is only in exceptional cases that this remedy will i)rove unavailing. As long as the evacuations contain feces, although in small quantity, it is well to give the solubilis the preference, no matter whether blood is discharged with the stools or not. On this account this remedy is especially appropriate 1^ Hi If ,;()8 DISEASES OF THE INTESTINES. tij?i I 'm in the dysentery of children, especially during tlie period of dentition. The triturations of Holubilis are preCerable, whereas, the Sublimate acta better in solution. The Mercurius vivus is preferred in tliis disease by many physicians Next to Mer. >ii...s Belladonna is, without doubt, the most important remedy in (lyseitipy botli the catarrlial and epidemic. As far as local symptoms are conceri">d, Belladonna is indicated l)y the v jlent urging to stool, with or withe scanty discharge; violent pains in the distended abdomen ; tliey are aggravated by pressure, or else evidently of an intlam^ matory character; liability of the rectum to protrude. Other prominent indications fur Belladonna are: considerable urinary difficulties, even retention of urine; violent fever, also, witli delirium, severe gastrid d' rangement, nausea, vomiting. Belladonna is most frequently suitable f )T children ; less so for adults. The catarrhal form of dysentery being exceedingly varied, a numbei of other remedies might be recommended for fliis disease. Chamomilla, for instance, is a main remedy in the dysentery of teething children, il the local symptoms are accompanied by acute fever, restlessness, sleepless- ness, constant cries, vomiting of bile, nightly aggravation of the symp- toms, or the symptoms only show tliemselves during night-time. Ano- ther remedy is Ipecacuanha, when the tenesmus only sets in after the discharge, and there is frequent and distressing vomiting of bile, while the fever is not very considerable; Dulcamara and Pulsatilla, when the dischargesconsistof meremucus; they mostly take place at night. Baryta, for tlie dysentery of children, when it threatens to become chronic, provid^jd there are no striking symptoms of ulceration of the intestines. Calcareu Carbon ica is adapted to the same form of dysentery as Baryta, likewise applicable to ulceration of the bowel. Here it is even a chief remedy for cliildren. A Ztose of any of the preceding remedies should be given after each evacuation, provided they do not occur more frequently than every liour. We have already stated, that the above-mentioned remedies are suffi- cient in epidemic dysentery, unless it should pursue an entirely excei)- tional, abnormal course, or be complicated with various accessory symp- toms. This statement, likewise, only applies to cases that have been treated homoeopathically, from the commencement. But we are also called upon to treat dysentery in its more advanced stages, or after the system has been saturated with powerful medicines. For such abnormal forms of dysentery, the above-mentioned remedies -^re not sufficient, and one or more of the following list will have to be selected. Arsenic Htn-albuni is never indicated at the commencement of dys- entery, only when evident signs of putrid decomposition become apparent,| together with paralysis of the bowels and anus, in a slight degree. The evacuations have no longer a peculiarly insipid smell, but are fetid, of a blackish-brown color, mixed with numerous shreds of mucous membrane. The pains are unifoi'mly severe, the fever is intense, attended with signs of rapid prostration and great tlurst. JHhus-toxicodendron, Hartmann says : " It is particularly applica- ble in protracted cases, where the violence of the symptoms has been diminished by the previous treatment, but where all the symptoms that characterized the attack from the commencement, are still preaent: itii HiiM COLIC. 301 prominently indicated by excessive prostration, tlie blood is greatly defi- cient in plasticity, the organic activity threatens to become extinct; typhoid symptoms supervene." In other words, Rhus is suitable in typhoid dysentery. A noteworthy symptom is the circumstance that the evacuations appear at night; there are, also, involuntary discharges. HOME REMEDIES. Of all treatments within the easy reach of all, there is nothing equals the complete and thorough washing out of the bowels, by large and frequent injections, of tepid or cool water. Many a case which appeared entirely hopeless, has been permanently <ni.red by this simple means ; but be sure the washinjj out is thorough and frequent. ■: '? COLIC— ENTEltALGlA. A disease which appears under a great variety of aspects, and which is associated with various derangements, either casual, or permanent and organic. It should, therefore, especially be considered, with due regard to the general review of disorders affecting the stomach and intestines, as afforded in the .article on " Indigestion." Colic may be spasmodic, particularly, as associated with hysterical complaints ; or may be associated with local determination (congestion) of blood, as occurring in conjunction with menstruation or piles; or, again, it may be developed as a transition of disease from other organs: as, for instance, when some previous disease has been suddenly suppressed ; or, again, it may be associated with worms, or, may appear as a manifestation of flatulency; or, again, purely from foulness or surfeit of the stomach, or result from indigestible food ; in other instances, again, colic is associated with gravel, or other organic derangements of the kidneys, etc.; or it may become developed in consequence of the suppression of chronic eruption on the skin, or again, from excessive or acrid discharge of bile from the liver into the stomach and intestines. Symptoms. Griping, tearing, gnawing, or shooting pain in the bowels, chiefly confined to the region of the navel, generally attended with a painful distcr.tion of tl ' belly, with spasmodic contraction, and some- times accompanied with vomiting and costiveness, or looseness of the bowels. One of the characteristic dif tinctions between thia disorder and inflammation of the bowels, consists \.\ the degree of alleviation to which the pain is subject upon pressure. The long continuance and intense severity of colic may, however, result in inflammation, for which reason it is ever advisable to arrest its progress in any severe case. Causes. The general exciting causes of this complaint are acid fruits^ and indigestible substances, cold from wet feet, drinking cold beverage.^ when heated, constipation, worms, etc. It is frequently, also, a concomit ant symptom of some other derangement, but occurs equally often as u primary disease. This disease is so well understood, that we are justified in proceeding at once to the treatment, giving in its course various symptoms, as devel- oped by different causes. ALLOPATHIC TREATMENT. Colic. In the treatment of colic, the first indication is to relieve pain, wliatever may be the cause. This is done best by an injection of a teaspoouf ul of Laudanum with fifteen dtovs I IL fi .. '< ^^ UK) niHKAHKH OK Tfli; INTKHTINKH. tf H I of TiiK'l.un; >)f JJclliidoniiJi. If tlitwo is nutuhincf, u couph) of ounces of MixtiiH! ol AHiil'daiflii rii.iy Lr; used jis ii voliicli; for tin; Laudanum. The injection HJiould Ih! made witii a lianl-rulibcr Hyringc. If no jlatnlenco exists, tlio injection of Laudanum, witli or witliout thn Ti/ictiiK! of IJelladoinia, may li(! Kiv(Mi witli a coupli- of tal)lespoonful.s of Htareli WaUir. Tlie Asaftetida Mixture (or Mill<) is made i»y rubbing two drams of tlie K'nri in a pint of watctr. A couple of teaHpoonfuls or a talilcspoonfui, of tlu! Mixture (Miilc) of AMafcetida Kiven l)y iiij(!(!tioti, is an efUeifMil remedy for tim (latiilent (olici (»f infants. TIir(;e to five drops of Ijaudaniim may l)e added, if the first injection does not r(di(!Ve. A catliartie oujj;lit not to ))e (.jivciii in colic, imtil after the ])ain is reliev(^(l, and tlKiU, if no inconvcMiiimce is experienced, twenty-four hour.H or a couple of days may pass before one is jjiven. In tlie moan time, the bowels will (generally move i<pontan(!ously. If tlnsy do not move, a largo iuj(!ction of warm water mny be glv(!n. If this proves ineflectual, throe Compound Cathartic Tills should bi; taken. If cathartics are given before* reli(!f from pain, the si>asm of tlie intes- tine interfen;s with its action, anil it aj^^ravates the; malady. Much relifif is obtained by hot applications over the abdomen. In mild cases, Honu! hot aromatic tea, as (Jinger, Anise, (!loves, or Mint, may give relief. In severe cases, recourse shoiiM be bad at once to the injefition of Laudanum, or to a dose of twenty-Iiv(* drojfs, and a teaspoonful of Spirits (»f ('ami)lior, by the mouth. Morphii\e, in dosiis of a quarter- of a grain, or an Opium and (Jamphor rill may be givcm. If complete! iclief is not obtained in an hour, the dose Hli(»uld be n^peated, either by inj(!(!tion or by the mouth. Hysterical coli<! is ulmiist always redicived by an injection of a pint of the Mixture of AsafVntida; but if this does not succeed, the same remedy may bo given by the mouth, in doses of a tablespoonful— Opium or Lauda- num may be adth'd, in extreme cases, as directed above. The carrniruitive teas, before mentioned, iin<l liot aj)pllcations, are useful. The treatnuint is given, in considering the disease (hysteria,) to which the reader is referred, if anything additiomil is needed. In rheunuitie colic;, immediate relief from pain is to bo procuro<l a.«j before directed for "colic." The rheunniti(! trouble nmy, generally, be overcome Ijy the continued use of Ralycilit! Acid, in doses of ten to twenty grains, four times a day, given in capsules or medicine wafers. For further consideration of the rheumatic condition, the reader is referred to the treatment of Rlieumatism. The treatment of neuralgic colic is identical with that of neuralgia, to whl(di, and to the treatment of neuralgia, the reader is referred. In J'rinteis' :x\u\ Painters' Colic (Saturnine or Ijcad Colic) the treat- ment <'onsisl.s, in the llr.st place, in the relief of the extreme i)ain. This is accomplished })reciHely as la directed for simple colic. Tlie use of opiates must be persisted in until relief Is obtained. The obstinacy of the colic will recpilre their continued administration at varying Inter- vals of from one to six hours, for a mucli longer period than is required in sinif colic. Together with the use of Opium, a liniment of one part each ofChloro- t I, _ ?r COLIC. 311 form, Tinc.tnrf of A<:onite awl Laudanum, a n/l three parts of .Soap Lin'- meut, may be freely applied over the abdomen. Hot bathing is, also yseful. As a means of relieving the pain of lead colic, used continuously with the use of Opium and hot bathing, Alum may be given by tlie mouth, in doses of fifteen grains every two liours. A go(jd formula is this: Take of Alum two drams. Aromatic fiulphurvc Acid o7te dram, fiynipof Lemmi arie (nmce, Water three ouitces. Mix. Dose: A tablespoon ful every two hours. A teaspoonful an(i a half of Alum may be added to a pint of boiling milk, separate the acrid acid from the whey (Alum whey.) The patient may take a wineglassful every hour or two. After the pain is relicv'-f], the elimination of the lead from the system may be greatly hastened \tw free purgation with the saline cathartics. The best one for this purpose is the Sulphate of Magnesia (Epsom Salts.) TaJa an ounce of Epsom (ialts, Aromatic Sulphuric Acid a dram, Water four ounces. Mix. Dose: One-fourth part every three hours, until free purgation takes place. After first giving relief with Opium, the bowels should be briskly movnd every day during the treatment, by the use of Epsom Salts. The Iodide of Pota.ssium is one of the best remedies to facilitate the elimination of lead from the system. Take of a satttrated solution of Iodide of Potassium fifteen drops three times a day, and gradually increase the dose until the cliaracteristic effects of Iodine are produced, viz : until the symptoms of an accute catarrh, with the presence of Iodine in the secretion from the nose. A drink of one dram (teaspoonful) of Aromatic Acid to the pint of water, sweetened as desired, is protective against lead poisoning. Thor- ough cleanliness, washing out tlie mouth and nose (with a douch) warm bathing each evening, and the occasional use of Epsom Salts as a purga- tive, should be practiced. In Colic from Copper, the relief of pain as directed for lead colic, with the use of Sulphate of Magnesia (Epsom Salts) for a purgation, are the principal points in treatment. Iodide of Potassium, given as directed for lead colic, assists in throwing the poison off from the system. The same precautions as to cleanliness ore required as against lead. Milk is said to be a preventive. HOMCEOPATHIC TREATMENT. Nux Vomica is a valuable rem- edy in colic, either associated with flatulency or piles, or in colic arising from a chill, and is, particularly, indicated when there is a sensation of fullness and tCyhtness at the upper part of the waist; deep-seated or cut- ting pains in the belly, with acute and hard, pressim, and forcing-down sensations, compelling the sufTerer to bend double; confused headache, with occasional loss of conciousness; flatulence, aggravation of the pains on the slightest motion, generally disappearing when at rest; constipa- tion, coldness and numbness in the hands and feet during the parox- ysm ; at tho monthly period in females, when we find weight, or vio- leot, deep-seated, aching pain in the belly, dragging pains extending to I! W \, 'I 312 DISEASES OF THE I N t EST INKS. the thigh ; acliing and creeping sensation in the same part when sitting; painful pressure towards tlie terminal l)owel. Done : Of a solution of six globules to six tablespoon fuls of water, give a teaspoon ful every half hour (in very acute cases,) or every hour, wlien the pain is not continuous or insupportable, until distinct amelioration or ciiange. PulHatfMa is more useful in the affection occurring in females, either during the menstrual discharge or at otiier times, when coming on periodically in the evening during cold, damj) weather ; also, when there are present a disagreeable tiijhtiiess ami distrjitlon of the belly and the upper part of the waist, pulsation in "the pit of tlie stomach, aggravation of tlie suffcrmg when at rust, or in tlie emning, ati.ii'led ivith shivering, whiclt increases with the pains, and is mitigated by motion, when it has arisen from overloading the stomach, or from ricii, greasy food, with \Uii\'n\vXion to \omit, flatulence, looseness of the bowels, paleness of the face, livid circle round tiio eyes, and headache ; also, Inemorrhoidal forehead, restlessness, in all respects, as colic, with fullness of the veins of the hands and anxiety, and sleeplessness. Dose: A solution of six globules, or, otherwise, directed for Nux-vomica. Chamomilla is chiefly useful for bilious colic (with looseness of the bowels and bilious vomiting ;) or for colic in females during the menstrual discharge. The following are the principal iiidii^ations; sensation as if the intestines were gathered into a ball, and as if the belly were empty, with tearing and drawing pains, attended with excessive anxiety and restlessness; distention under the lower ribs, and in the pit of the stomach; incarcerated flatulency, sometimes nausea, bitter vomiting, fol- lowed by desire to rtlieve the bowels, and bilious diarrhoea; livid circle round the eyes, alternate paleness and redness of the face; the pains come on imrticularly at night, at times early in the morning, or after a meal . This remedy is particularly adapted for children of irritable tempera- ments, and is extremely serviceable in all cases in which a fit of passion has been the exciting cause of the sufferings. It is, also, useful when colic lias arisen from cold in the feet, or checked perspiration. Dose : As for Nux, Colocynth. In the majority of violent and obstinate cases, we find this a most valuable remedy ; it is indicated when the pains are exces- sively violent, and of a constrictive or spasmodic character, or resemble stabbing and cutting, as if from knives; sometimes there is a sensation of clawing and pinching, and tenderness of the belly, with a pain, as from a blow, or distention ; at other times, a sense of emptiness is experienced, with cramps and shivering, or tearing pains in the legs; during the con- tinuance of the attack, we find excessive restlessness, agitation, and toss- ing about, from the violence of the pain ; when the pains come on, they continue without any apparent intermission; after their disappearance, a sensation of bruising remains, and the sufferer feels as if the intestines were held together by thin threads, likely to break from the slightest motion. This remedy, like Chamomilla, is, particularly, efficacious in the so-called bilious colic, being indicated by the loose discharge from the bowels, and bilious vomiting attending it; and, also, in cases where pa.i- sion has "leen the exciting cause. Colocynth is, more particularly, useful in the • si^ of adults. Dosi As for Nux. N« ^ COLIC. «13 Belladonna is useful against flatulent colic, when there is protru- sion of the transverse setdion of the r/reat intestine, wliich becomes dis- tended, like a pad, above the navel, attended with colic-like pain, doubling up of the body, which is relieved by pressure on the part; also, severe bearing down of the whole intestines; also, in menstrual colic, with spas- modic constriction in the belly, and a burning pain lower down, or in the small of the back; pain in the lower part of tlie bowels, as if a number of nails were holding the intestines. The symptoms are, also, attended with a liquid or matter-like discharge from the bowels, and swelling of the veins of the head ; and the pains are sometimes so violent as almost to deprive the patient of reason. Dose: Of a solution of six globules to two tablespoonfuls of water, give a teaspoonful every half hour (in very acute cases,) or every hour (when the sufferings are not continuous or intolerable,) until distinct amelioration or change. Cocculus is indicated {especially, in menstrual or flatulent colic) when there are severe constrictive or spasmodic pains, and distention of the entire stomach, with nausea and fullness of the lower part of the belly, great flatulence, and difficulty of breathing; also, when there is a sensa- tion of emptiness, and tearing and burning pains in the intestines, some- times with squeezing, tearing and pulling pains, excessive anguish and nervous excitement ; constipation. Dose : As for Hell. Arscnieuin is often appropriate in cases of colic (bilious,) arising from disordered stomach, with nausea, vomiting, great relaxation of the bowels, with green or yellow evacuations, violent gripings, headache, pale- ness of the face, and blue ui rks around the eyes. Again, in cases of bil- ious colic, which is prone to be preceded, followed or alternated with sick headache, Arsenicum is of great service. Dose : As for Nux-vomica. Coffea is valuable wlien we have to prescribe for colic with excessive pains, attended with great agitation, anxiety, and tossing about, grinding of the teeth, convulsions, suffocative attacks, oppressive despair, acidity of the stomach and coldness of the body and extremities. It is, also, useful in some kinds of menstrual colic, denoted by a sensation, as if the belly were being rent asunder ; or by fullness and pressure in the stomach, and violent spasms which extend to the chest. It is, also, indicated by cutting pains in the intestines, as if divided by a knife, and, also, by the pains present being so violent as almost to drive the patient to distraction, causing him to bend double, and draw up his limbs. Dose : As for Bell. Ignatia is a most valuable remedy for colic, particularly as affecting female patients of delicate constitution, and is indicated by the following symptoms, amongst others; Fullness, tightness, and pressive sensation, across tlie region which extencfs arOng the lower ribs; accumulation of wind in the bowels, which is expelled with much difficulty, a relief, how- ever, being obtained upon the expulsion of wind; stitching pains in the region of the spleeu, etc.; more especially, however, if the colic occurs, or is worse at night. Dose : Of a solution of eigh"^ globules to three tablespoonfuls of water, give a teaspoonful every Lour, (or in very mild cases, every three hours,) until distinct amelioration or change. f • I.. flit DISK ASKS OK TIIK INTK^S'IMNKH. P pii IHH-v(:rnlr,olor (lilac, Fluff.) IrivolunUiry f-scupo of fluid of an ofTciiHlvc, (>ul.ri(i iirifj f;oi)[)<!ry odor. In chohiru irior(>"s, it iirn.'stH tho vio- lent [mill. McmirhiH is u rnorlicitK! of (^rout valii<;, in cuhos of colic, cliunicter- lz«!<l hy tlif! followiiiK UH.s(!rnl»liij<«! of Hynijitorns: NiiiiHca, wilii profijHO llow of HHliva; vonufloiiH uppotit*.', witii ri;i)ii^,'nun(!e to Hwcct tiling's; fre- quent uti(i troui)leHoni(; lii(;(!ougli ; consluiit and i)aiiiful urKin^ lo evucu- lite ; H«!V<'n!, piucliinj^, drawing, nijipiiij^ pains, witii ti^litncss and hard- ness of tho iM'iiy, particularly, ai)ont fli<; navel; or tensive, sllnj^ing, cut- ting, or hurnin^ j)ains; aj^^ravation of these Hufrerin>(H at night, and, more i)artl(:ularly, in the latter part of tin; niglit; extreme ten<lernesH of the helly upon (tontaet or |)ressure (tlie (;lotiies or l)<!<l-elotlieH apjtear to cause pain ;) sometimes looseness of the i)Owels witii slimy evaeuatiouH; eonslderaljle prostration of stnitigtli, and (rhill (or eviMi shu<ldering,) aceomi>anied with flushing of tlie ehe-eks. Mercuriiis is, also, a most important m(>di(;inc in <;aseM of (;oli(;, asso(;iateiI with worms. Pose: Of a solution of six gloliules to tlirei! tal)ieHpoonfuls of water, give a (.(wispoonful every luilf iiour, until amelioration or (change. Seralfi-corimtiini Is indi(!ated for nidla pati(;nts afFeeled witii colic, attended with pain In the small of the back, eructations and vomiting, or •Iragging, tearing pain In tlu! tliigiis; or, amongst /ci/rw/V^' jiatic-nts, for eolle, o(;currlng at tlie menstrual [leriods, wlien tearing pains in the how els, pal(!n(,'.ss of the face, small, weak pulse, coldness of tlie extremities, and cold sweats, an; pr(>dominant symptoms; or wlien eonstijiation, with eranifi-llke jiains in the bowels, and burning pains on the right side of the belly jirevall. Dose: Of asolution of eight globules to tliree tablespoon fuls of water, give a teaspoonf'ul every hour until the suflering alialcs, and tlien every thrcio liours until distiiMit ameiictration or change. Cnrfto-iu-ff. o(!curs, in many (;ases of somewhat serious asjieet, as a medicine of great Importance, amkis |)articularly indicated l)y tlie follow- ing Hymi)toms : Violent pains in the liowels, provoked even by the light- est and most wholesome meal; sensation of lieat in tlie head and in the bowels; determination of blood to the head, attended with heavy, aching pains; fullness and tightness of the belly, so severe as to convey the seu- Hatlitn that it would burst, and accompanied with flatulent risings, or aeeu.uulatlon of wind with diflUiulty and opjinwsion of brealhing, nipping pains and rumbling, and sluggish action of the bowels. (!ari)o-veg. may often bo administered with striking success in cases of colic associated with pih:n or with fl/itulelicy. Dose: As (or Bell. PREDISPOSITION TO COLIC. Sulphur is amongst tlio most valuable remedies in the generality of oases, in which a constitutional predisposition to affections of this nature is evinced l)y the failure of other medicines to aflbrd permanent relief. Therefore, in particular, if Nux-vomlca, or Carbo-veg., or if botli have been employed as above directed, in ciuses of colic associated with piles, but have failed in obviating the repeated recurrence of the attacks, the persevering administration of Suljihur lieconies necessary. The same may, also, be said of bilious colic, in which {!hamoniilla or Colocynth, or both have been employed with similar results. The same remark is COLIC. 315 equally applk;able to cases of flatulent colic, in which Nux-vomica, Carbo- veg., Cbarnomllla or Cocculus, or two or more of these medicines, have been previou-ily employed in like manner. Dose: iJurinj^ the contirjuance (;f an acute attack, of a solution of six j^lobuUrs to two tablcHpooonfuls of water, K've a teaspoonful every hour until relief is obtained. Subseciuently, however, give six glo- bules in a wineghissful of water every ruorniiig, the first thing (fast- ing,; for ten days, (unless collateral nvmptoins should appear in the meanwhile)— after which pause four days, and resume the course as before Cif nc«'cssary,; and so on until the symptoms are permanently Bubdued or undergo a distinct change. WOUM COLIC. As this is, in point of fact, a mere symptom dependent upon the pres- ence of worms in the intestinal canal, or upon the cases which promote the generation of these parasites, the subject will be more accurately con- sidered In the article devoted especially to that subject, to which, there- fore, the reader is referred. lIoMii Mkasukks i.v Casual Attacks. In cases of colic, arising from indigeslilile food, a cup of black coflTee, without milk or sugar, will frequently aflbrd relief, by causing the stomach to free itself from tlie cause of annoyance ; that is, in patients who have not used that article as an ordinary b(!verage. DiKT ANO RKfjiMKV. In this, as in all otlier complaints arising out of derangements affecting the functions or organs of digestion, the diet and general habits, or the particular precautions in individual cases, should be regulated in confornuty with the directions afforded under the head of " Indigestion." If particular food or drink, such as raw fruit, milk, or cold things, be apt to provoke an attack of colic, the particular food or drink in question, in every particular case, should be carefully avoided. Aconitutn, licUadonnn. One or both of these medicines may be advantageously adniirnstered, singly, in alternation, or in succession, and, in addition to such as have been mentioned with detailed indications (such as Opium, Nux-v., etc.,) when the constipation is associated with predom- inant fullness of the vessels of the head. Dose: Of either medicine, as selected, give three globules in a tea- spoonful of water, every six hours, until the predominant head symptoms are modified, and then every twelve hours, until positive amelioration or change. HOME MEASUKES. In all cases of an inveterate or chronic nature, recourse may, occasionally, be had to an enema, or lavement of tepid or cold water, as a tenii)orary mode of relief, until the medicine has effected the desired result. The drinking of a tumblerful, or more, of cold water," thrice a day, when fasting— dashing cold water against the belly, and then apply- ing brisk friction, by means of a coarse towel— combined with early rising, and daily exercise, (not violent or beyond the strength of the patient, so as to cause suffering,) will be found useful auxiliaries in promoting a regular action of the bowels. Electro-magnetism is anothex*, and most useful, auxiliary, either in cases arising from culpable n'-^lect, or indolence, or from inability, or impracticability, to relieve nav^ a whilst traveling. In chronic cases, aris- L !T! ^ kKi If ft y m¥ i ■ Av M. TA^. DISEASES OF THE INTESTINES iii{? from inertness of the bowels, or a sort of intestinal paralytic debility, tiic application of electro-magnetism is often superior to any other aux- iliary. Dirt. The diet ought to be regulated according to the state of the primary digestive organs, and highly seasoned food, or that which con- tains much fibrous or ligneous matter, such as radishes, cabbages, tur- nips, green fruits, etc., should be avoided. HEMORRHOIDS— PILES. Symi'TOMS. Enlargement of the veins, or eftusion of blood in the cellular tissue of the terminal bowel, either within or without the fun- dament (internal or external piles;) or protrusion and distention of one or more of the inner foldings of the same intestine, with or without bleeding (open or blind piles,) preceded or accompanied by pains in the back, the base of the spinal column, and belly; sensation of itching, prick- ling, tickling, burning, or pressing at the terminal bowel, sometimes extending to the adjacent parts, with, in general, constipation, and not unfrequently derangements of the urinary organs. Predisposing Causes. The predisposing causes of the disease are: 1. A constitutional taint. 2. Local debilitation of the vessels by con- tinued excesses, by abuse of warm drinks, purgings, or injections, etc. Exciting Causes. Among the exciting causes are, habitual costive- ness, severe exertion on horse-back, use of drastic medicines; of warm stimulating diet, or of vinous, alcoholic, and fermented drinks, tea or cofTee, the excessive use of seasoned food and spices, the suppression of long-continued discharges, sedentary habits, sitting on a cold seat or on damp ground, the pressure of the gravid womb, tight-lacing, or any other causeof local pressure, morbid accumulation of blood in tbe liver, men- tal emotions, etc. The painful practice among surgeons of removing the hajmorrhoidal excrescences by means of the knife or ligature, is inuch to be deprecated ; for, independently of the danger not unfrequently attending the opera- tion, it may occasion serious consequences by a sudden transfer of the congestion to some of the noble organs ; in a great number of cases, more- over, it wholly fails, and the disease returns, sometimes even in an aggra- vated form. ALLOPATHIC TREATMENT. Treatment of Hsemorrii-ids (Piles) will consist, in the first place, in the avoidance of those causes, which pre- dispose to congestion of the veins of the rectum (lower bowels). Active out door life must take the place of sedentary occupation. Constipation must be completely remedied by the means directed for that disease. Attention to diet and the regular habit of emptying the Iwwels being all- important. Cathartics nor injections will not answer this purpose, though, as directed for constipation, a free cathartic will be necessary, when the bowels have been for a long time inactive, and the bowels filled with fecal accumulations. When this conditon of the bowels is attended with recurring attacks of bleeding the cathartic is especially useful. Straining at stool must be avoided, neither must the patient remain long sitting at stool. The inflammatiou which causes futile eflTorts at „ »i! PILES. 317 ty. ux- struiiiing, must be restrained by anodyne remedies. These efforts increase tiie congestion and contribute towards tiie formation of tumors. Diarriioeu must be treated as directed in timt disease. Tlie lax condition of the tissues in diarrhcea, aids in tlie development of piles. Immediately after the evacuation of the bowels has occurred, the anus (opening of the bowels) and the protruding piles should be bathed with cold water. The parts should be carefully dried and annointed with an ointment uuule by tlie following formula : I'alie of Tannin a dram, {sixty (jrains,) Pulverized Opium a scruple, {twenty grains,) and Stramonium Ointr ment an ounce. Mix. Five graiiis of Morpliine may be used instead of the Opium. In the absence of this ointment, before the piles are returned, they should be washed and dried as before, and lubricated with Cold Cream, Sweet (Olive) Oil, or Glycerine, before they are returned. When the piles are protruding, they can be more readily pressed back when tlio patient is in a stooping position, with the hips raised, or sup- ported on liis knees, wliile the chest and head rest on the bed. If the piles become swollen and intlamed and cannot be returned, the patient should remain in bed and cold applications, as cold water, or a cloth wet in a solution of Sugar of Lead thirty grains, Acetate of Morphine ten grains, in a pint of soft water, or poultices, may be used. Tlie above ointment m.ty be made more curative by thoroughly mixing with it half a dram of Iodine. At night, the ointment should be applied again, and if tlie piles have not protruded, it should be introduced into the rectum witli a suppository tube. Much suffering may be avoided, by establishing the habit of having the regular movement of the bovvels occur just before bedtime, after which, if the piles are returned, as before directed, tlie sphincter muscle recovers its tone during the night, and the tumor of piles does not escape during the next day. By removing this much irritatic jo much has been done toward a cure. The stools may be rendered soft and unirritating by taking one or two teaspoonfuls a day of the following mixture in water : Take of Magnesia, Hulphate of Magnesia, Precipitated Sulphur, and Sugar of Lead each an ounce, and Pulverized Anise Seed half an ounce. Mix well. The use of Ergot and Nux-vomica will often overcome the laxity of the tissues about the rectum, wliich predispose to piles, as: Take of Ergotine {Squibh\s Extract) a dram. Extract of Nux-vomica fifteen grains; make into thirty 2}ills and give one night and morning; or, take of Fluid Extract of Ergot one and a half ounces, Tincture of Nux-vomica half an tunce. Mix. Dose: Take a teaspoonful morning and evening. It is claimed a cure can be effected by the faithful application of a .otion of Iodine, Tannin and Stramonium, every night, to the part. Take of Iodine thirty grains. Iodide of Potassium six grains, water, eight drops is sufficient, Glycerine an ounce. Mix, and add to the mixture, two drams of Tannin, and afterward mix with it, in a mortar, two drams of Extract of Stramonium, moistened with sufficient water. Label Pile Lotion. This solution, to be beneficial, should be applied every night. A suppository of tallow may be formed.Cwith the fingers)dipped in this mixture, and inserted into the rectum at night, and allowed to remain !■> 4 m V J~ w \sm »8 DISKA8E8 OK THE INTESTINES. ^ I! l Hi i r until morning. If agresiter anodyne effect is desired, five grains of Mor- pbine may be added to the solution. The further treatment, if required, belongs to the practical surgeon. The most api)roved and most eflicient treatment for the cure of piles, istho old, and well-tested operation of tying them off. The cure, by this means, is the most invariably complete of any method known. Tlie plan is to tiioroughly empty the bowel with Epsom Salts or Castor Oil, tlie evening before the operation. In the morning, the patient should, a couple of hours before the operation, take a large injection of a quart or more of warm water, and then take a half a grain of Opium. Then the ana;stlietlc can be given, the tumors exposed with a Thebault's anal speculum, and the tumors brought within reach with a Vulsellum. A large needle witli a stout silk thread is passed through the base of the tumor, the needle re- moved and tiie thread tied tight on each side of the tumor, but not tight enough to tiever the tumor. Two tumors, operated on in this way on each side of the gut, is sufficient to cause the cure of the others, if any exist. The patient will remain in bed, the pain relieved by Opium, in doses of a grain. The bowels should not be moved until the fourth day, when Castor Oil may be given, followed by an injection of warm water. After the op- eration, the urine (water) will generally require removing with a catheter. If the operation is to be done without an anaesthetic the cathartic should be given only about five hours before the expected op-^ratlon, and, after they move, the warm water injection is given, and the patient brings down the tumors by straining over a vessel of warm water. When the tumors are down, tliey are tied as before directed. Small folds of membrane may protrude from the anus; when inflamed, they are troublesome and frequently bleed. They should be removed with the scissors, if not infianied, and if l^leeding follow. Sub-sulphate of Iron ought to be immediately applied to stop it. Other plans of treatment are by excision, the hot iron, Nitric Acid, the galvanic cautery or the ccraseur; but the plan of tying them off is to be preferred. The object is to obliterate the tumors. The plan of causing the obliteration of the tumors by injecting Carbolic Acid into each tumor, with a hypodermic syringe has come quite generally into vogue. The writer furnished the following description of this treat- ment for the Burlington Haivk-eye: Carl)olic Acid, either concentrated or diluted with one to three parts of Glycerine or Olive Oil, is Uf.ed. Four to six drops may be injected into each tumor. Only one tumor should be treated at a time, and from five to ten days should elapse between each operation. A coagulation is immediately formed in the tumor, which results in its ob- literation. Carbolic Acid, applied to the tissues, is an anesthetic, so this operation is not painful, but the inflammation which sometim- s results causes so much suffering, as to call for anodynes. For this purpose. Opium and Belladonna may be given by injection into the rectum— a tea- spoonful of Laudanum and ten to fifteen drops of the Fluid Extract of Belladonna, in a little Glycerine, will be quite effectual in controlling the inflammation and pain. The injection may be repeated in twelve hours, if necessary. Further means for relieving pain should be by Opiuru! given by the mouth. For this plan of treatment, the same preparation is required as for the operation by the ligature (tieingoff), and the after-tresr ment will be the same. f>tLBd. 310 on. he ns, to iig of of tic tho To prevent the return of piles, after a cure, attention to tlie Roneifil habit is necessiiry. The regular evacuation of tiie bowels, and keepinR the fecal discharges in a soft state, by diet and laxatives, aa is directed for constipation. HOMffiOPATHIC TREATMENT. Nur-vomlca is a moat valuable remedy, in tliiH affection, and is very efficacious against both descriptions of piles, but especially against bleeding piles, particularly for individuals who lead a sedentnry life, or who indulge in the use of cofTee or stimulat- ing liquids, and also for females during pregnancy— when the hromorrhoids are attended with shooting, burning, or itching pains, colic, shooting and jerkingpain, or pain as if from abruise in the loins, rendering it difficult to rise or walk in an erect position; and when they are accompanied by constipation, and sometimes painful and difficult passing of water, and the other symptoms described, as indicating this medicine, under the head of "Indigestion." Dose: Eight pills in a teaspoonful of water, night and morning, until amelioration or change. Suljihnr may follow the administration of Nxix-vomica; and an al- ternation of these remedies, at intervals of a week or ten days, frequently effects a cure in cases of long-staitiding. Dose: If to/oUow Nux-vomija, to complete the cure, give six globules in a wine-glassful of water, every morning, the first thing (fasting) for ten days. Pulsatilla,— Discharge of blood and mucus during stool, and at other times, with painful smarting and sensation of excoriation in the piles, pains in the back, pallid countenance and disposition to fainting; difficulty in passing water. Dose: Of a solution of eight globules to six teaspoonfuls of water (to which add ten drops of alcohol), give a teaspoonful, morning and evening, until the whole is consumed. If f unher treatment then be requisite, pause four days, and recontinue the course in like manner. Jgtiatia is indicated by itching and creeping, and also, sensation of constriction and excoriation in the posterior passage, and prickings ex- tending deep into the lower intestine; discharge of blood or of bloody mucus, rumbling noise in the belly, and protrusion of the lower intestine, accompanied with acute pain. Dose : Three globules in i teaspoonful of water, every twelve hours, until amelioration or cliange. Antimonium-crudttni.— Discharge of mucus and of blood at every stool, followed by severe colic and pains in the piles, with throbbing, itching and hxu-ning at the fundament, and discharge of glutinous, acrid moisture, particularly at night; frequent determination of blood to the head, with bleeding at the nose; stiffness in the back, shooting pains in the loins, burning and rheumatic pains in the limbs, flatulency and constipation. Dose: Of a solution of six globules to two tablespoonfuls of water, give a teaspoonful every six hours, until four doses have been given, and then every twelve hours, until positive change. HOME REMEDIES. BucJceyes. Take four or five ripe ones just after they come from the tree, remove the outer brownish shell from them; slice ""^em up fine; put them in a tin cup with enough melted lard to cover tL ; let them simmer or steep near a Are for an hour or two. Then strain and press out the lard, and when cold, it (the lard) is fit for Vi I ^ 1 ' i' ■fW^* S:>0 DISEASES OK THE INTESTINES. 11 use. A little of this ointment must be upplk'd to tUe tumors and within the bowel twice a day. Mullen. Takeof the leaves a large handful, put In a quart of cold soft water, tind plucu over the (ire; let it Hiininor until reduced to a pint; then take out all the leaves, pressing them as dry as possible. Now put all the remaining litjuor back over the tire and let it remain until reduced to one-fourth pint or less; put in three tablespoonfuls of good, clean lard, and a lump of beeswax as large as a hulled black walnut; let it simmer until all the water has passed off In stcant, then take oft' the fire and stir until almost cold, when you will have a nice smooth salve. To use. Api)ly a little of tlie salve to all the aflected parts two or three times a day, rubbing it in well with the finger, reaching well up the bowel. This is reliable and gives pernument relief. The SuKQicAii Oi'euation fok tiii: IIauical Cure ok I'iles,* which has, of very late years, been introduced among physicians, and also used to a great extent by specialists who have uniformly charged from fifty to five hundred dollars, and even more for the operation, is only this simple thing : Take of Carbolic Acid fiftd'U i/rains; of pure Glycerine sev- enty-Jive grains. Mix. ])o,se: Of this inject with a hypodermic syringe one to three drops (owing to the size of the tunlor) into each tumor. This causes the formation of pus or matter, and the absolute destruc- tion of the piles, but the pain after the operation is very great and, also, needless. One hour before the operation an injection of one dram of the Tincture of Nuxvomica, one dram Tincture of Stranionium and one dram Laudanum to a quart of water should be used. After the operation, a salve made by adding one dram Arnica Flowers, one dram Stramonium (Jimson Weed) leaves dry, one dram Tincture of Aconite, to a (juart of water-, let it simmer slowly until it is reduced to one half pint, then add half a pound of good lard and an ounce of beeswax. Let this evaporate on the back of the stove, or near the fire, until all the water is gone, which will be when there is no moresteam from it. It will burn very easy. Then pour off and press out all you can from the leaves, etc., and use to rub well on all the affected parts, two or three times a day, being careful to reach as far up the bowel as you can. With these precautions you will make a sure, safe, and almost painless cure. It will be best to go to some good, careful doctor, who knows his busi- ness, to get the hypodermic injections made. Tlie rest you can do just as well. WORMS.- HELMINTHIASIS. INVEMMINATIOK. The number of worms that are found, more or less frequently in the human bowels, is very large. Here we will name and speak of tliree *It ia a Diiittcr of surprise how many people suffer with piles. Naturally enough the number seeking relief is quite large, and it affords a tempting fieid for "specialists." Wo do not know of any plausible objection to a physician making the treatmeut of any disease a specialty, but, of course, there are reasons, not only plausible, but just, why he should not play upon the credulity of patients to extort unreason, nhle fees for his services. In a communication from a well-known physician of Burlington, in regular standing, the attention of the public is called to the practice that sometimes obtains of charg- ing an extortionate price for the cure of a disease any family physician, of ordinary skill and experience, can treat by the method indicated, and for which he would make no more than the customary prof«<)' ■ioual charget. * II. ■I ' K WOUM.S. «:i varieties as being tho ones likely to produce any of tlie syinptotus of dis- fuse. First: Pin ivorms or thread niorniH. Second : Long round worms or Lumhricoid. Third : Tape tvorm or Tivniu. First: Tb^ pin worm is the smallest of the three ; it is one-lhirrl to one-half an incli long, and as thick as common size t' read. It has a very email swelling, which it uses for, and out of courtesy, we call it its lieiul. Usually it is found only in the very last part of tlie intestine and some- times in tlie vagina, into wliicli it crawls from the anus. At times, only a few are seen togetlier; sometimes, liowever, they occur crowded togetlur In large masses, most generally among children. The symptoms occasioned by this worm, vary a great deal. One of the most common, is a violent, distressing itcliing of tlie amis, especially, in the evening and at niglit, and disturl)ing sleep a great <leal. Some children are driven almost frantic by this itching, and are tormented by an almost unaccountable nervousness in consequence of it. Among adults, this itching is scarcely ever so i)ainful and severe. The irritation caused by the worms, sometimes occasions a catarrlial atTection of the mucous membrane of the rectum, or a spasmodic contraction of the sphincter, witli a constant urging to stool, which is not less distressing than the Itcliing. If a large number of them penetrate into the vagina, they cause severe itching, whites, and tlie constant rui)bing is apt to give rise t« self-abuse. Beside these less important results, we sometimes meet, without any otherwise assignable cause, with more important disturb- ances, principally of tho central nervous system, sometimes resulting in indefinite spasmodic movements, and at other times in eclampsia, epi- lepsy, chorea, etc. We cannot prove that these afTections are caused l>y worms, but this seems the more probable, as a removal of the worms Is sometimes succeeded by an entire disappearance of the nervous disease. ALLOPATHIC TREATMENT. Pin Wokms. For practical purposes, it Is sufficient to divide the treatment for worms into that for seat uxjrms Hscarides,) also called " pin worms " and tliread worms. Hound worms lumbrici,) and tape jvonfis (tenia3). Seat worms inhabit the lower bowel (rectum) and large intestine. In females, they sometimes invade the vagina. They deposit their eggs in the folds of the anus and vagina. Remedies, to lie eflf'ective, must be ;ipplied to these parts. One of the best and simplest is a large injection of a solution of common salt, repeated every third or fourth day, until three or four injections are given. Some of thesiinie solution should be applied to the folds of the anus, and, with female children, to the folds of the external genitals. In cases of females, an injection may be required into the vagina. One Injection will kill all the worms that it touches, but the eggs hatch in three or four days, so that the injection needs repeating. Tea (infusion) of Quassia is, also, effective as an injection. The strength of tills tea is two ounces of Quassia chips to a quart of water. A weak decoction (tea) of Aloes may, also, he used for the same pur- pose. 21 A I I'- t la f'' ill < 1 i 1 II 1 iJi^ 1 h 1 m: i I 1 ••il t ^ li J' . '•i m DISEASES or THE INTESTINES. In case the last two remedies are used, a solution of Carbolic Acid should be applied with a sponge to the folds of the anus and external genitals of female children. Should the worms continue to appear, it indicates that they lodge high up in the intestine, and a few doses of Santonine, of two to five grains to an adult, and half a grain to a grain to a child, should be given two or three times a day, for two or tliree days, followed by a purge of twenty grains of Calomel, fov an adult, or five to ten grains for a child, or of Castor Oil. TheSantonine may be given, powdered with a little sugar. After the purge, the injections will complete the cure. HOMEOPATHIC TREATMENT. Of all three kinds of worms, the expulsion of the pin worm is by ail odds, the most difficult. Internal rem- edies can do very little good, as these little pests have their home in the very lowest part of the bowels, where medicine, taken by the mouth, can- not reach them to do any good. But a solution of salt in water, about two teaspoonfuls to the pint, will reach them, if used as an injection, and repeated a few times. Or a decoction (tea) of common Garlic (Allium Sativum) used in full injections for a month; at intervals of three or four days, will make them seek a more pleasant place. A few doses of Cina, or Sulph. will remove any unpleasant constitu- tional symptoms remaining after the removal of the worms. Dose: f^f either, six pills dissolved in a teaspoonful of water, every morning before eating. Long worm (lumbricoides). Tlie intestinal long worm is the most com- mon of all. It is, from six to twelve inches long, has a cylindrical body of the size of a goose-quill, tapering at both ends. Its common abode is the small intestine ; exceptionally, the worm wanders into the stomach. Very seldom, only one worm is present in the intestine, generally, there are several together, sometimes as many as twenty or thirty, and even many more. The symptoms caused by the presence of these worms, vary greatly. In the majority of cases, there are no very prominent symptoms present; it is only by accident, that the presence of worms is generally discovered ; the only symptom, is perhaps, an increased longing for bread and pota- toes ; and perhaps, a less fresh and healthy complexion, More deep-seated and more general derangements, may be caused by a number of worms together, or by the agglomeration of the worms into large balls, or by their entrance into some other organ; or else, the bowels may be exceed- ingly irritable, in consequence of which a small number of worms may cause intestinal catarrh or enteritis, together with their consequences. Among these latter, we number the nervous phenomena, caused by worms, which have already been mentioned in the paragraph on pin- worms. The ailments caused by lumbrici, often resemble greatly other more or less important processes, such as gastric fevers, typhus, dysentery, and likewise, the above mentioned nervous derangements ; it is of no small importance to ascertain their origin, at an early period. These nervous derangements, manifest themselves by various phenomena, of more or less constant occurrence. The appetite becomes fitful, or the patient has i / »r . IS WORiMS. 32k a more or less exclusive, or, at any rate, decided hanltering for farinaceous food,- the nose and anus, itch violently; the pupils are considerably dilated; the eyes are surrounded with dark margins; the patients are of a changeable and irritable mood; bowels act irregularly, at times consti- pated, at other times, alternately constipated and .ose, with frequent changes of this character. It sometimes happens, that their irritation occasions a real gastric fever, which does not always disappear immedi- ately after the removal of the worms; large balls of these worms may even cause the same functional or structural changes, as hard masses of fecal matter. Properly speaking, it is only in children, that lumbrici cause nervous derangements, and it is well, when these derangements manifest themselves, that you should direct your attention to the presence of worms. ALLOPATHIC TREATMENT. Round Worms. In giving medicines for worms, the bowels should be as empty as they conveniently can, so that the remedy may act on the worms as energetically as possible. For this reason, it is best to give remedies for worms in the morning, before break- fast, and if cases are rebellious, the patient should abstain from eafing till noon, or through the day. Medicines ought not to be given to children, for worms, merely on sus- picion, but only when there is positive evidence of their presence. For round worms, one of the most edicient remedies is the Fluid Extiact of Pink Root and Senna. The dose for an adult, is a tablespoon- ful, and half a teaspoonful to a teaspoonful for children, every four hours until it purges. This will probably end the round worm. Wormseed Oil, in doses of five to fifteen drops on sugar, three times a day for two or three days, followed by a purge of Citslor Oil, is successful treatment. It may, also, be given with the Fluid Extract of Pink Root and Senna. Santonine is an efficient remedy against the round worm. It is tasteless, and may be given with sugar, or sprinkled on bread and but- ter. The dose is from half a grain to five grains, according to the age of the patient. It should be given three times a day, for a couple of days followed by a purge v," Calomel or Castor Oil. After the purge, it should be given for a couple of days, to destroy any worm which may recently hatch. Another effectual plan is, to take a purge in the morning, fasting during the day, and take at night five grains of Santonine with twenty grains of Calomel, for an adult, o' e or two grains of Santonine and five grains of Colomel for a chilu. The next morning a purge of Senna should be taken. An infusion (tea) of Senna for this purpose may bo made by steeping an ounce of Senna leaves in a pint of water. One-fourth of this is a dose for an adult, and one or two tablespoonfuls for a child. It can be flavored and sweetened to suit the taste. The common remedy, Turpentine, ought not to be given, unless neces- sity compels it. It is not reliable against worms, unless given in doses of a tablespocnful, and then unpleasant effects may follow. If used, it should be given with *,wice the amount of Castor Oil. HOMCEOPATHIC TREATMENT. The long worm is most surely removed by Cina (worm seed,) and the form in which it is best, istheSan- tonine {an alkal^^id of worm seed, as Quinine is of Peruvian Bark.) This |)f N'-' It! 'I i I it ■p 324 DISEASKS OK THE llMXESTINES. can bo {riven in doses of one or two grains, twice each evening for two days; liion omit for one week, and rei)eut until tw^elve doses are taken. Tliis rv medy can usually be obtained in the shape of candy, called San- touine Lozenges, containing one grain each, and are to be given as directed above. After tlie child has taken this remedy, the clothing or bedding which comes in tontact Mith the urine, is almost alwaj's stained yellow or straw color, which is no cause for any alarm. It is best to keep the child from eating farinaceous food the day previous to taking tho mcdi(!ine. ^or conditions or symptoms remaining after the worms are removed, see Cina, Nux-vomica, Spigelia, Mercurius, Pulsatilla, at the close of this chapter. The Icrnia or tape worm is from three feet to twenty or more yards long, is smooth the best part of its length, and about a quarter to a half of an incli wide; towards the extremity representing the head, its shape is more rounded and thin, and the head itself is thin as a thread. The color is of a faintish white, with a yellowish tint. Tlie worm consists of the very small head, which is sucked fast in the intestinal nmcous mem- brane, and to which a neck of the thinness of a thread, and half an inch in length, is attached, from which neck, the single links of the worm afterwards proceed. At first, these links are narrow, but yf" '^r short than broad, so that the worm exhil)its a series of closely-crowded trans- verse lines; the further removed from the head, the more the length of these links increase in proportion to their breadth, until the last links acquire a length of half an inch to one inch and more. The worm grows in lengtli from head outward, until the last 'ull- growu links become, sooner or later, detached, and are ex,)elled witii tlie stool. Thetfcnia has its principal abode in tlie small i.itestines, and is only exceptionally met with in the la.'ge. Generally, there is only one tajnia found in the same individual, although we are acquainted witli one case wliere twenty-one worms were cMscharged by the same person. Such cases are, of course, very rare. As in the case of other worms, so are the '^'-.^^urbanccs caused by the tainia exceedingly various, both in kind and degree of intensity. It may be safely asserted, that in the majority of cases, the taenia causes very lit- tle trouble, and that the patients do not become aware of its existence, until a few links have been expelled with the stools, when a variety of ailments and distresses are forthwith traced to tlie taenia, which, in real- ity, are the work of the imagination, rather than of the taenia. The mildest disturbances whicli the taenia occasions, are winding, twisting, colicky pains around the navel, not very intense, setting in paroxysm- ally, more particularly after eating certain k'nds of food, and in the morning, wlieu the stomach is yet empty. Generally, these pain are associated with a little nausea, or even with a sensation of canine hunger, but these symptoms are so trifling, tliat they are only complained of wlieii the patient 1 as become i)erfectly certain that n ta;nia is growing in liis bowels. Under circumstances which it is difficult to analyze, more intense disturbances may sliow themselves, a disconneded enumeration of which we here subjoin : violent colicky pains in the bowels, or a creep- ing or crawling sensation, as from a worm around the umbilicus, with 'fll IP W0UM8. 32S Increased secretion of saliva, nausea, even vomiting, especially after eat- ing fermented food, herring, Kluirp condiments, sour fruit. Increased appetite, canine hunger, in spite of wliich tlie patient emaciates ; itching of the nose and anus ; sickly complexion ; low spirits and irritable mood; irregular stool, alternately normal and diarrh(ea; lieadache, disturbed sleep, vivid dreams; jialpitation of tlie heart; changes in the sound of the voice. Finally, tlie abovenienfloned more striking alieclions of the general nervous system, which can be traced with more certainty to the presence of taenia. The presence of tuenia can only be diagnosed, with i)erfect certainty, if the patient has actually passed links of tiie worm. Many lay-persons are too anxious to attribute their ailments, gastric derangements, such as heartburn, water-brash, etc., to the presence of taenia ; especially, if they experience a sensation aa if a worm were crawling about in the stomach, or up the oesophagus ; if, in such a case, no links are passed within a few weeks, it is pretty certain that there is no taenia. Most links are passed spontaneously at the time of the new moon. ALLOPATHIC TREATMENT. Tape Worms. In the treatment of tape worm the patient should fast for a day, taking a little milk or beef tea only. In the evening a purge should be taken of a tablespoonful of Castor Oil, a tablespoonful of Epsom Salts, or three drops of Croton Oil. After this purge operates, the worm is exposed to the full effect of the medicine which should then be taken. One of the most efficient remedies we have against tape worm, is Pumpkin Seed. Two ounces of fresh seeds are to be pounded in a mortar with half a pint of water, until the husks are separated, and the meats thorouglily incori)orated with the water. The mixture is strained and taken, the fastings in the meantime continuing. The dose may bo repeated in three hours, and in three hours more a purge of two teaspoou- fuls of Castor Oil should be taken. If the worm is not removed, hend and all, the treatment is to be repeated the next day. Tlie pressed Oil of Pumpkin Seed may be given instead of the above emulsion in doses of a tablespoonful two or three times, and followed by tlie Castor Oil purge, as before directed. After the preparatory treatment of fasting and a purge, a dram tea- spoonful of the Oleo-Resin of Male Fern (Felix Mas,) give a fourth part thirty minutes apart, on two successive days, followed by a purge of Castor Oil (two teaspoonfuls); or three drops of Croton Oil is an efTectual remedy against tape or round worms in persons of any age. It can be given in syrup or mucilage. Should necessity compel the use of' turpentine, one or two table- spoonfuls, with an equal quantity of Castor Oil, should be given after the preparatory treatment. As a preventive of intestinal worms of all kinds, only filtered waiter should be drunk. Meat should be thoroughly cooked, bu , it is not neces- sary to cook it until dry. Fruit and vegetables should be made clean before eating. Tonics following the treatment are useful. HOME TREATMENT. Tapk worm is easily expelled by the use of either of the following: Take Kousso tlu-ee to four drams, place in a common goblet or tum- bler, and pour cold water upon it until the glasa is well flUed, being care- * 11 ■i ,i -!fi J;K ' I Mi jrl h \M ^■JSi^naiati 3L'6 DISEASES OF THE INTESTINES. til ful that none of the powder is left floating on the surface; let it stand over night, and in the morning, after taking nothing more than a small cup of black coffee, drink the medicine in two portions, half an houx apart. If there is a disposition to vomit, a little lemon juice may be swal- lowed. In from two to five hours after taking the medicine, the worm is expelled. No need of a cathartic. Pumpkin seeds two ounces, peel off the outer covering, bruise well, mix in a little water, and use as directed above for Kousso, except if the worm does not come away in six hours, use a cathartic or an injection of Oil. ■Mm COSTIVEyrESS-CONSTIPATIOX—OBSTIPATIOy. This complaint is generally sympathetic with some other derangement of the organism, and consequently, in our treatment of different diseases, we have had frequent occasion to allude to it. One of the leading causes ©f aggravation and excessive obstinacy in the cotistipation, is the practice of flying to laxative medicines on the slight appearance of costiveness, under the absurd idea, that keeping the bowels open is a species of panacea against disease of every description. Many mothers are so possessed with this idea, that they continually administer physic to their children, witli- out the slightest apparent call for it, and thus lay the foundation of dyspepsia and other visceral derangements in after life. Many a slij?ht case of costiveness, which, if left to nature, would have disappeared of itself, leaving no ill consequences, has, by an ill-judged administration of aperients, been converted into obstinate and habitual constipation, embit- tering existence, and predisposing the constitution to a variety of diseases in after life. To prevent misconception upon this point, it should be ;learly understood, that we by no means undervalue a regular state of the bowels, but, that when costiveness shows itself, yve happily possess reme- dies calculated to restore the general balance of the system ; and in obstinate cases, do not content ourselves with simply alleviating the sym{)tom3, but mainly direct our attention to the permanent removal of the affection. Many of the principal causes of this disorder, besides that mentioned, are the same as those particularized under Indigestion or Dyspepsia. ALLOPATHIC TREATMENT. Constipation is to be treated, always, with reference to the producing cause. In temporary constipation, us that of pregnancy, and in recovery from acute disease, is to be met, chiefly by attention to tlie diet; but, if this fail, recourse should be had to laxa- tives, or, possibly, in the first place, to an active purge. If there is com- plete obstruction, the disease is too serious to be tampered with by any but the most skillful man. In habitual constipation, there should be a regular effort at stool, at a regular time, whether the desire exists or not. The preferable time for this is soon after breakfast. As a preventive of constipation, the natural desire to go to stool should never be voluntarily restrained. The constipation should be remedied, as far as possible, without medi- cines, but by laxative food. Vegetable diet tends toward a looseness of the bowels, and animal food, by being almost wholly absorbed, to constl- COSTIVENESS. 82? pation. The articles of diet to be preferred for tliis end are, cracked wheat, graham flour, indian meal or hominy, and oat meal, prepared according to the art of the kiti-ihen, eaten with cream and sugar, or with butter and molasses. Almost all kinds of fruit, taken quite freely, are advantageous in overcoming constipation. Molasses and brown sugar aid to make the bowels more lax. Milk is constipating, but only, I believe, because it hi almost wholly absorbed. None of these articles of diet are to be used, if they disorder digestion or occasion other disturbance. Sometimes more harm is done by burden- ing the stomach and bowels with articles difficulty of digestion, or loading the intestines with unbolted flour, than could be done by the constipa- tion. In the use of medicines, the patient should not, as a rule, be physiced, but the least active medicines which will accomplish the result, are tc oe used. If, however, constipation has for a long time been present, and the bowels filled with fecal accumulations, a cathartic, which will thor- oughly empty them, is a necessity. For this purpose, a tablespoonful of Epsom Salts is a most efficient remedy. If boiled with a teaspoonful and a half of roasted cofffee, for a couple of minutes in an earthen vessel, and after it is allowed to draw for a few minutes and strained, the taste will be covered. A tablespoonful of Castor Oil, mixed with an equal quantity of Gly- cerine, flavored with a couple of drops of Oil of Cinnamon or Wintergreen is appropriate under the same conditions. From three to Ave Compound Cathartic Pills, are also suitable for an immediate cathartic. Cathartics must not be frequently repeated, as this secondary effect is to render the bowels torpid ; therefore, the smallest dose and the mildest means which will accomplish the result, should be resorted to, and prefer- ably those which have the peculiarity of not causing constipation after their action. One of the best of this class is Aloes. As a cathartic, the dose is from two to ten grains, but a fraction of a grain, with tonics, suffi- ces, generally. The remedy is well suited to all causes of debility in this disease, and to cases of hypochondria as with constipation. With sedentary persons, who cannot change their occupation to an active life, and women who suffer from a torpor of the intestines, and con- sequent constipation, the following pill will be found, in most cases, to overcome the trouble : Take of Extract of Ntix-vomica, Extract of Belladonna, each ten grains; Powdered Aloes fifteen grains, Extract of Dandelion thirty grains. Mix well, and divide into thirty pills. Take one pill at night. , If the bowels do not move next morning, another pill should be taken, but, usually, one a day will be sufficient. If this proves too active, the Aloes should be omitted from the formula. The directions for taking will be the same. After the bowels have been moving regular for a long time, the pill should be omitted, and only taken again if the regular opening of the bowel does not continue. Fw those who cannot take a pill, the same remedy may be given ia fluid. « 'S- l^ :ii f, !t,i '• ! 628 UlSKAHIOS OF THE IxNTKSTINKS. n I' I rill Take uf Tincture of Nux-ouinica, and Tincture of Belladonna, each two and a half drams, ami of Tincture of Aloes and Fluid Extract of Dandelion each Jive and a half drama. Mix. Ihse: A teaspoonful, imder the same conditions. The Dandelion is not necessary to the elflciency of the prescription. The Belladonna and Nux-vomica restore the tone and healthy action of the intestines, and seem, in my judgment, essential, particularly the latter, i'orthecureof many cases of constipation. There are many pills in the market for the relief of constipation, which have merit, as the Eccoprotic Pill of Wm. Warner & Co., and the Aperient Pills of other leading phar- maceutists. Before purchasing any of them, it should be ascertained that they contain Extracts of Nux-vomica and Selladonna, or Hyoscyamus. Palmer's Anti-constipation are a good remedy. Dose: One pill once or twice a day. From ten to twenty drops of the Tincture of Colchicum after each xeal will often overcome constipation. Podophyllum is an appropriate laxative for constipation ; a quarter of a grain is an appropriate dose. It is often used with benefit with Belladonna and Nux-vomica, as may, also, be the Compound Extract of Colocynth, the dose of which for this purpose being two grains. One or two Compound Cathartic Pills, at night, relieve constipation, but do not produce a cure, as a rule, without the use of Nux- vomica or Strychnine. Senna is not inappropriate as a laxative. The Confection of Senna may be eaten, one or two teaspoonf uls at a time, or a tea of ten ounces of Senna leaves to a pint of water may be made, and one to four ounces taken at a time. Co-existing dyspepsia will require treatment as directed in that disease. A general debility will require tonics of Quinine and Iron. TheCitrate of Iron and Quinine two drams ajul a half, dissolved in four ounces of Syrup of Oramje Flowers, is one of tlie best tonics. Dose: A teaspoonful three times a day. The Syrup of Elixir of Iron, Quinine and Strychnine, in doses of a tea- spoonful, three times a day, are appropriate. Many other tonics might be given, and are particularly suitable to cases afflicted with constipation. If a person is of a full habit, a teaspoonful of Epsom Salts daily, is an effectual remedy for his habitual constipation. The regular use of an injection of cold water, is a simple and often effectual temporary measure for relieving constipation. A piece of hard soap, about the size and shape of a pigeon's egg, will sometimes excite a movement of the bow3ls. These are only temporarily useful. An effectual cure almost always depends upon the will, establishing the habit of a regu- lar motion,*with the tone restored to the intestine, by the use of Nux- vomica and Belladonna. If these are given for a time with Aloes or Podophyllum, *the cathartic should then be omitted, and the Belladonna and Nux-vomica given alone. If the plan before suggested, of having a regular time for stool, and allowing nothing to interfere with it, were rigidly carried out, and taught by parents to their children, constipation would be a disease as seldom met with, as it is frequent now. HOMCEOPATHIC TREATMENT. In trivial cases it will be found suf- ficient to pay proper attention to diet, to avoid too dry or indigestible food, COSTIVENKSS. 320 to masticate properly, to partake of meat only ouco a clay, and to take sufficient exercise in the open air. Should this course not have the desired effect, we must choose one or more of tlie following remedies: Opium is chierty to he selected in recent cases, when constipation is not habitual ; but la, also, like Nax-v., and other remedies, serviceable in cases of a more chronic character, occurring in vigorous, plethoric, well- nourished subjects, and arising from inactiyly in the intestinal canal, or from sedentary habits: In old people, it is generally more useful than Bi'ijonla and Lacheslis, when diarrhoea alternates with the constipation, although tiiese, and other remedies, such as Antlm., Phosph., i\\\(\ Ruta, must be borne in mind, and, administered wlien called for by the nature of the symptoms. The more immediate indications for C>j)i«/» are: want of power to relieve the bowels, witli a feeling of constriction in ano; pulsa- tion and sense of weight in the abdomen, dull, heavy pain in the stomach, parched mouth, and want of appetite, determination of blood to the head, with redness of the face, and headache. Dos%: Six pills every twelve hours, Nu.v-vomlca. This remedy is particularly useful when constipa- tion results from too lieavy a meal, indigestible food, and stimulating liquids; or when the confined state of the bowels has resulted from pro- longed diarrhaa, or frequent i)urgings. In the latter instances, Opium may often be advantageously alternated with Nux-v. In obstinate cases, arising from long-continued indulgence in vinous, firniented, or spirit uous drinks, or cofl'ee, or from sedentary habits or excessive study. Nux-v is one of the most ellectual medicaments. It is peculiar);;' adai)ted to per- sons of irascible and lively teni])er, with determination of blood to the head, and headache, unfitness for exercise, disturbed sleep, and a feeling of gen- eral oppression, or heaviness; frequent and InefTectual efforts to relieve the bowels, attended with sensation of stricture, and sometimes frequent, painful and difficult emission of urine. It is, further, as remarked under the head of Indigkstion (which see, for other indications for this rem- edy) particularly indicated for individuals subject to piles. Dose: Six pills, taken in a teaspoonl'ul of water every night, until amelioration or change. Pulsatilla. Has nearly the same indications ;is Nux-vomica, with the characteristic distinction of temperament before noted under the head of Indigestion, (which see). In recent cases, it is particularly indi- cated when the obstruction has arisen from indigestion brought about by rich or greasy food, and when it is accompanied with moroseness and shivering. Dose: Six pills, as directed for Nux-minlca. Alumina is useful against constipation, from inactivity of the bowels; motions liard, dry, broken, evacuated with considerable exer- tion and forcing, and sometimes streaked with blood ; constipation from traveling. Dose: Six pills in a teaspoon ful of water every evening, or every night at bedtime, until amelioration or change. Brtjouia is especially useful in constipation occurring in warm xreather, and in persons of dark complexion, and of irritable or obstinate disposition, with a tendency to be easily chilled, and subject to rheumatism ; it is further indicated, when constipation arises from dis- ff>^ " m kff! u U j T^ 330 DISKASKS OF TllK INTKSTINKS h li^rl' ordered stomach, and is attended with determination of blood to the liead, and lieadaclie. Dose: Six pills in a teaspoonful of water, repeated in twenty-four- hours, even if partial relief ensue. In chronic cases, six pills niaj^ in like manner, be taken daily for ten days, or until positive ameli oration or change. Platiud is a useful remedy, when constipation has been brought about by traveling, when CTpium lias failed; or especially when the act of expulsion is attended witii straining, and when a feeling of weakness is experienced in the bowels after a stool, sometimes accompanied by shuddering. » Dose: Eight pills in a teaspoonful of water, night and morning, until amelioration or change. Sulphur is one of the best remedies in the relief of habitual consti- pation, particularly, when haimorrhoids are present, or a disposition to them exists; costiveness; with hard, bullet-shai)ed stools; or frequent inclination to go to stool, but without the desired result. , Dose: For adults, six pills, for young persons, four pills every morn- ing the first thing (fasting,) until amelioration or change; or for ten days, then pausing four days;— after wliicli, if requisite, the same course may be resumed, and so on . Sepia may frequently be taken with advantage, in chronic consti- pation, after Nux-v. and Sulphur ; and is, moreover, particularly well adapted for females, in whom there is an irregularity, or obstruction of the menstrual discharge; it is also indicated by constipation in individuals subject to rheumatism, as well as by hard, conglomerate, bullet-shaped motions, and stoppage of the bowels. Dose: When the disorder is not of very old standing, give six pills in a teaspoonful of water, every twelve hours, until amelioration or change. In very inveterate cases, six globules, as directed for Sul- phur, r Lycopodiuni. CJironic constipation with ebullition and determina- tion of blood to the head; colic, flatidence, sense of weight in ih^ lower part of the bowels. Dose : For adults, four globules, or, for young persons, three globules in a teaspoonful of water, every twelve hours, until amelioration or change. CONSTIPATION ALTERNATING WITII LOOSENESS. RhuS'tox., Antitnon-crud,, Ruta, Phosphorus. One or more of these four medicines may be advantageously administered singly, in alternation, or in succession, in addition to such of those already men- tioned, as correspond with the features of the case, when the costiveness or constipation occurs in alternation with looseness. Dose: Of the remedy selected, give four globules in a teaspoonful of water, every twelve hours, until amelioration or change, or for ten days, if requisite; then pausing four days, and resuming the course, if yet required. ^scnlus-hippocastanum {Horse-Chestnut). Dull headache. Dis- tress in the stomach. Desire for stool and pains in the abdomen. Con- gestion of the liver, which pains by walking; it acts when Nux-v. and Sul- phur fail to cure. Dose : As directed for Baryta-c. (See next page.) ! b- COSTIVKXKSS. 3:51 If Kr^ Colllntionia-canadensis (Stone Root). Headache. Constipation with flatulence. Sluggish stool with distention of the abdomen, Intonse heat and itching of the anus. Dose: As directed tor Haryta-c. HydraHtis-eanudensis {Golden Seal). In chronic and obstinate con- stipation. Jhse: As directed for Baryta-c. Vhytolacca-deeandi'a {Poke- Weed). Long-standing constipation. Pains in the abdomen, when moving. Dose : As directed for Baryta-c. Podophyllam-iteltatam {Mandrake). Pain in the forehead. Acute and chronic constipation of long standing. Dose: A small powder of the first trituration when rising and when going to bed, will make a permanent cure in ten days. CONSTIPATION OF AGED PKUSONS. liaryta-c, will often be found of great service in cases of this kind, in addition to, before, or after, such of those medicines, named in the foregoing part of this article, as correspond most closely with the case in question. The particular indications may be gathered from the article upon the characteristic action of the medicines. Dose: Four pills in a teaspoonful of water the first thing in the morn- ing, (/'aiim.'/) until amelioration or change, pausing, iiowever, for four days, after a cour.so of ten days, if the administration should require to be continued so long. CONSTIPATION OCCASIONED BY PURGING. China is particularly appropriate to the treatment of constipation, which occurs as the result of previous and violent purging, continued looseness, and the like. Dose: Four pills in a teaspoonful of water every twelve hours, until distinct amelioration or change. is ► i 'in J I PROLAPSUS ANI-FALLING DOWN OF THE LOWEB PART OF THE INTESTINES. A protusion of a portion of the rectum, or of its internal coat from the anus, is denominated a prolapsus or procidentia ani. In some cases, a con- siderable portion of the rectum comes out to the extent of three or four inches, in others only a little, it presents a circular dark red, pad-like lump, from the size of a small hulled black walnut to that of a goose-egg. Causes. Anything which tends to weaken the muscles which sup- port the intestine. Among these are the frequent use of cathartics (phy- sic,) especially, those containing Aloes, Epsom Salts, etc. The presence of ()in worms, (ascarides) in the lower portion of the intestinal canal, habitual costiveness, piles, straining at stool during diarrhoea, or dysentery (flux,) or when straining to pass water. This is much more frequent among child- ren than grown people. In some cases, the intestine remains out a considerable time without any ill consequences, but more commonly it swells and inflames very speedily. TREATMENT. "When this accident occurs, some person of strong and steady nerve, should at once attempt to replace the protruding parts, by 4, iVi2 DISEASES OK TUK INTKSTINES. !'•■ ^1 lit? jlrnt oiling tlio parts well with fresh liird, Svvoot Oil, Tallow, fresh butter not salted, or sweet cream ; then secoiul, make steady, iiot very hard, pres- sure in tlie center of the protruding parts, with the well oiled thumb or thumb and foreflnger; occasionally, if necessary, making life''t pressure on the outside of the tumor with tlie thumb and linger of the other hand, near the anus ; when it will slowly, or in some cases, (luickly return to its proper place. If, after cargfuUy and persemringly trying for a reasonable time, ten or fifteen minutes, (which will appear to bo a long time,) the parts do not return, send at once for a good and canf ul physician. Tills trouble having once occurred, is liable to occur again. The best neans of preventing this, is a (luiet position and careful attention to the diet, which should consist of tlu! plainest aliment; ryo mush and sugar is very good food in such cases. The IIouuBpatliic remedies, whicli will usually permanently relieve the tendency to return, aiiil, also, help in the moment of tho accident, are in tlio order of their names, Nnx-vonma, Igmitia, Mercurius, Snlpluir, Fodo. Hydropathic in connection with careful diet, take a cold sitz bath every evening. This bath is, also, generally used by tho homccopath. ECLECTIC. Gently push the piotruding part back into the body and inject into the bowels the following: Take of Crowfoot or Alum Root, While Oak bark, each in coarse powder, a tablespoouful ; make half a pint of strong decoction (tea,) to which add half a tablespoonful of powdered Alum. Tills should be injected cold two or three times a day; when very severe, a bandage will have to be worn to keep the bowel from falling. Internally let the child drink freely of tea, or equal parts of Golden Seal and Solomon's Seal. The child should be taught not to strain during stool, and its diet must be similar to that recommended for costiveness. If while the bowel be firmly held in place by a tight bandage, the child be made Lo lift several times every day, a weight proportioned to its strength, it will aid materi- ally in overcoming the difficulty. PEBITOJS'ITIS-INFLAMMATION OF THE PEltlTONEUM. Causes. In the main, the origin of the disease is traceable to the following causes: After all injuries which bring the peritoneal cavity in contact with atmospheric air, peritonitis may be expected in the majority of cases. Although the inflammation very often remains confined to the injured locality, yet it will almost certainly spread over a larger portion of tho peritoneum, if blood, pus, or a quantity of atmotpheric air enters the peri- toneal cavity. This point deserves the utmost consideration in operations upon the abdominal cavity. The danger of inflammation is likewise greater, if the abdomen is very much distended before the operation, and collapses after it; hence, peritonitis is very apt to occur after tapping for dropsy, and after operations during confinement. An intense cold will sometimes cause peritonitis among persons, who are otherwise perfectly healthy. Among women, a cold may bo a mat- ter of great importance. There is no question, that confinement and tho menses aro very apt to cause peritonitis: especially, if a cold super- m riiUITOMTlS. 838 vcnc-' at .<ii(li tiinus. This observation is so common, even among lay- peoplo, tliut women linve become accustomed to be very caict'ul at such tinies. The disaijpearance of the menses, or of lochia, at the commence- ment of the inlhimmation, has given rise to the theory, tliat it is tliis supiirc'saion which causes tlie inflammation ; It seems to us more iujple, iind more natural, to reverse tliis relation of cause and effect. During conflneiuent, the collajtse of the distended abdomen exerts a powerful influence; hence, peritonitis is more apt to occur in the case of women, who have borne several children, than among primiparie. By far tlio most violent forms of peritonitis, and which run the most ra])i(l course, occur, if an organ becomes perforated, and its contents, or even tlio smallest portion thereof, escape into the peritoneal cavity. Tliis occurs most frequently in the case of perforating ulcer, ulcerations of the intestines, and gangrenous destruction, consequent upon stricture of the intestine. Symptoms and Couuse. Tliesc, of course, not only differ in degree, according as tiie inflammation is confined to small portions of the perito- neum, or, as diffuse peritonitis invades tlie whole of the peritoneal expanse; even the diffuse form differs, according as it develops itself sud- denly, or l^y degrees. Acute, diffuse peritonitis, either if caused by perforation, or when setting in as an idiopatliic affection, almost always commences with a severe cliill, attended with pain in the abdomen. This pain, whichls the most characteristic symptom of the disease, is most intense from the vciy moment it is first felt. The pain is, as though a pointed knife were plunged through the abdomen, from above downwards, without the patient being always able to indicate the precise starting jwint of it. Immediately after, a feeling of illness overtakes the patient, he feels unable to remain up, and he is satisfied that a severe sickness is upon him. If peritonitis sets in, in coiisequence of tlie gradual spread of some other affection of the bowels, its own development is gradual ; the existing local pains increase in intensity, and gradually spread over the whole abdomen, at times rapitlly and at others moie slowly. In violent cases, the invasion of tlie pain is not at once followed by violent fever; on the contrary, the patients die in u slate bordering on syncope, with cold extremities, and it is only the extremely hurried pulse that indicates the approach of a violent fever, which is scarcely ever more than twenty-four hours in coming. From its first beginning, the pain never abates one moment, except, that it some- times seems more like a colicky pain 5 as the pain spreads the abdominal walls become so sensitive, that the patients cannot bear the least pressure, so that it is even a relief to them, if the blankets or sheets do not touch the abdomen. The least motion increases the intensity of the pains to such an extent, that the patients have to lie on their backs motionless, and dare not draw a deep breath, because tlie pain is aggravated by the pres- sure of the descending diaphragm; they even have to speak in a low whisper. The pains are at times tearing, at others stinging, lancinating, but most of tlie time fiercely burning, and with a soreness as from an open wound. Sometimes the disease sets in with violent vomiting, and diar- rhoea, almost like cholerine; in such a case, the act of vomiting causes intense suffering. The general symptoms betray, at first sight, the exist- ence of an intense disorder. At the first onset of ^ue disease the face I I if. I ' H' r '■■»*■ 334 DISEASES OK THK INTESTINKH. 1^ K looks i)alc, with a peculiar expression of dlatrHss ainl anxiety, and with pendulous features; afterwards the face loolis lluslied, or else tiie paleness remains throughout the whole disease, in Hi)iti5 of thu fever. Tiie eyes are dull and unsteady. The breatiiing is hurried, is carried on with tlie riba only, the speech is short, a mere whisper. Tiie tongue is usually <iuito clean; there is a craving lor cold water, yet only a small quantity can be dranlc at one time. Retching and vomiting, unless present at the lirst, are very apt to supervene ; otherwise tliese phenomena and the diarrhfoa dis- appear as the disease increases in inteudity; as a general rule, the peritonitis is attended with complete retention of stool the llrst eiglit days of its existence. The urine is always less; voiding it is often painful, or there is constant urging, yet no urint! is voided. The pulse is hurried, from one hundred and twenty to one hundred and sixty beats, and soon becomes small, hard and tense. Tiie skin is dry and constricted, altliough profuse and exhausting sweats sometimes break out ; tlie temperature varies from a burning heat to a disagreeable coolness. An examination of the abdomen is difllcult, on account of the pain, wliicli is aggravated by the least attempt at percussion. Soon after tlie pains are felt, the abdomen becomes more and more distended, so that the distended bowels can be felt through the abdominal walls. The sleep is very much disturbed ; it Mie patients sink momentarily into a sort of slumber, they at once become delirious. All such patients habitually lie on their backs, with the lower extremities slightly drawn up toward the abdomen. In the further course of the disease, the symptoms generally undergo the following changes: The distention of the abdomen increases more and more, although its painfulness to contact generally decreases in proportion as tlie exudation becomes more copious ; it even happens, that the sensi- tivoness disappears entirely. Tliis, however, is a bad symptom, if, at the same time, the wliole condition of the patient seems to change for the worse. Tlie difficulty of breathing corresponds to the degree of meteoristic distention. The anguish increases, tlio lips become bluish. The pulse is a little slower than at the commencement of the fever, but its quality remains the same; it does not indicate any remission of the fever, whoso intensity continues unabated. If tlie disease terminates fatally, the general sensorium is overwhelmingly brought under its influence, the patients grow apathetic, do not feel any pain; the pulse becomes imper- ceptible, the face has a sunken, cadaverous appearance. Death may take place in thirty-six hours, and seems to be principally caused by paralysis )f the bowels; the disease, however, seldom terminates in such a short period of time; it generally continues until the seventh day. ALLOPATHIC TREATMENT. The one remedy, without which acute peritonitis cannot be treated satisfactorily, is Opium, and it is invaluable. It should ) given in doses of one grain, from two to four hours apart, until the pain is completely relieved, after which the dose should be repeated sufficiently often to maintain freedom from pain. Tliis treat- ment, alone, will often save the patient's life. Right hot poultices, applied over the abdomen, will benefit, if their weight does not cause distress; or the ointment of Extract of Belladonna and Extract of Opium may be smeared upon the skin of the abdomen and hot fomentations. The appli- cations should be kept hot. '* l*k naiiTONiTis. 835 Cathartics should, in no wise, bo pflvon, but if tlioro are fooes in the large intestine, an injection may l)e cautiously given. Nourishment should consist of milk, cream, raw eggs and beef essence. Upon the first indication of exhaustion, sUinulauts should be given in doses of a tablespoonful of brandy at intervals, varying from two to four hours apart. IIOMCEOrATHIO TRKATMENT. Aconltmn. For many forms of peritonitis, Aconite is undoubtedly the most suitable and surest remedy. It is thespeclllc remedy, If the inflammation eltiier spreads further from a circumscribed spot, or increases where it sets in with more local symp- toms, without the accompaniment of the general disturbances, which are sometimes truly fearful, except, perhaps, the presence of an intense fever. It is in this manner, that inllammations, with an excess of plastic, exudation, generally announce tliemselves. OI)servation has shown, that In inllammatlon Aconite is only useful until the exudation Is completed At this stage the pulse, in inllammations, for which Aconite is indicated, becomes somewhat slower and stronger, and the pain abates in a marked manner, which is seldom the case before the fifth day of the disease. All physicians agree, that one of the lower attenuations should be given in rei)eated 'loses. Dose: Six i)ills in a little water every hour or two, until the fever is somewhat under control. It is frequently well to alternate witli JieU<ul<mna. Belladonna is suitable only at the commencement of peritonitis. It competes with Aconite, if the local symptoms are accompanied by severe congestions of the head and chest, with anguish, dyspnoea, restlessness, dark-red and bloated face; and continual and distressing vomiting of bile, which changes about with retching. The exudation is profuse, and the Intestines are distended at an early stage of the disease, so that the single convolutions can be distinctly felt through the abdominal integuments. Intestinal catarrh, which nuiy be present during the first days of the disease, isan additional recommendation forthis drug.soisthe development of this inflammation from enteritis. Belladonna is likewise an excellent remedy for the vomiting, which is apt to set in, in the subsequent stages of the disease; in this respect it is only surpassed by Arsenic in a few cases. The abatement of meteorism designates exactly the period when Belladonna is indicated. Dose : Six pills as directed for Aconitum, If in alternation with Acon- ite, give a dose of one, and in one or two hours a dose of the other, and so' on. Veratrutn album is related to Belladonna in some respects. If the disease sets in in the form of chlorine; more particularly, if tiic vomiting is copious and frequent, at the same time the patients look pale and sunken, and feel cool to the hand ; the pulse is small at the onset, and the anguish, restlessness and thirst are exceedingly distressing, Veratrum is the appropriate remedy. As a general rule, the disease assumes this form in the first three days; afterwards other remedies have to be employed. Dose: As for Aconite. Mercurias is less adapted to peritonitis than to enteritis. The ten« dency to suppuration is the best indication for this remedy. Hence, it is in the second and third week, that Mercurius must be given ; and the ir I—' V * .1 \W M e, i 'i ;« rk 886 DISEASES OF THE JiNXESTlNES. more special indications are tlie aljovc-iucti tinned phenomena, cliaractor- izing tlio process of purulent inetainorpliosis. It is the frequently exacer- bating fever, with creeping chills, and copious perspiration after the heat, wliich points to Mercury. In i)artial peritonitis, on the contrary, as soon as the inflammation is localized, Mercurius may be given at the onset. It is lilvcwise appropriate, if tlie purulent exudation seeks to penetrate to the outside and form an abscess. These four remedies are the only ones that need be given in the first stage of the disease. In the furtlier course of the disease we may have to administer : Jiryonia alba. It comes into i)lay at the most decisive period in the development of the disease, namely : wlien we desire to remove the effused fluid as soon as possible It is almost certain, that under the influence of Bryonia the exuded fluid will be reabsorbed without causing any furtlier derangements ; hence, tliat no suppuration will take place. But the medi- cine should be used consistently; we cannot expect to obtain results in a day, that can only be obtained in from ten days to a fortnight. Asa gen- eral rule, Bryonia is not indicated, if a copious diarrhoea is present; this, liowever, is a rare occurrence in the second stage, and, if it does occur, it is a bad omen. Dose: Six pills in a little water every two to three hours. Sulphur is a second remedy we make use of in order to promote, or JTleed, to excite the absorption of the ex-'^led fluid. In ca.ses where Bry- onia leaves us in tl^e lurch, or eflects tlie absorption of the exudation only to a certain point, S'lphur is entirely appropriate. It acts even when tlie remaining portion of tue exuded fluid had been left for months without any alteration. Ai'senicuni album is very closely related to Veratrum album symp- tomatically; in a present case, it is difficult to decide between the two remedies, especially at the commencement of the attack. In the further course of the disease, it is particularly the continued, violent, colicky l)ains, that point to Arsenicum ; which is, likewise, sometimes indicated by tiie gradual development o; the inflammation out of gastritis, the per- forating ulcer, or ulceration of tlie bowels. We must not allow ourselves, by the peculiarities of the picture of the disease, more particularly by the extraordiLary restlessness and anxit y, to be too readily induced to use Arsenic, as is so easily tlie (, ise at the comrnenceiuent of the disease. If Arsenic acts as a homoeopathic specific, the reaction must not i)e pros- trated, on th'* contrary it must be veliement; hence the fever must be violent and continued. Dofie: Three pills every three to four ,10 irs. It romains for us to mention several drugs, to which atteniion must be directed under certain circimistances. Opium, m »m9,\\ doses is sonie- timea useful against tlie paralytic weakness of the intestinal canal, which often remains after tlie disappearance of the exudation; the intestine is unusually distended, and the constipation is complete. Nux-mmira is still more jireferahle, under such circumstances, only the meteoricm must not be too gioat. In general, it is an excellent remedy in equalizing the remaining trifling irregularities in tlie digestive functions, especially, the torpor of the bowels. Tlie medicines we have indicated are most probably sufficient in every case of peritonitis witliout any unusual complications. PEIUTONITIS. 837 proH- iist bo muBt some- which stine is •nica is fi must ng the Uy, the •ob:ibly ations. HOME REMEDIES. Altliongh we have every reason to depend upon the eJlicacy of our means of treatment, yet the disease is so dangerous, its first invasion fills the patient with so much anxiety, and it is so exces- sively painful, that we are anxious to find out and apply such remedial agents, as will afford a momentary relief from the pains; and will, per- haps, exert a curative influence upon the morbid process generally. The chief palliatives are injections and fomentations. It is impossible to decide before hand, whether cold, or warm, moist, or dry applications deserve a preference. At first, when the pains are very violent, the patient usually prefers cold applications, ice-clotlis, or even a bladder filled with ice. There are, however, exceptions to this rule, more particularly the cir- cumstance that patients cannot bear the least weight on their bowels, on account of the extraordinary sensitiveness of these parts. "Warm and moist fomentations are generally best applied on the fifth day, in some cases, the patients prefer them at the very beginning of the disease; they are more especially useful, if the patients perspire very copiously. They should never be applied too hot, for too high a temperature is pr(;judicial. What had best be applied in a given case, M'ill have to be decided by an actual trial, but such an experinu>iit should be instituted with great care, lest obstinacy in waiting for a result, aliould prove injurious. As a gen- eral rule, the fomentations tliat do not afford relief to the patient within a few hours, or ...e otherwise than pleasant to his feelings, are not adapted to his condition. As regards the wet sheet, it is one of the best means of reducing the inflammation. At first, these wet clothes should be applied to the abdomen alone. In view of the great sensitiveness of the abdom- inal walls, it is doubtful whether such an application can bo frequently repeated. Simple injections of water, whether colder tei)id, are exceed- ingly beneficial. If used at the commencement of the disease, they will prove sufiicient to remove the paralysis of the intestinal canal. During convalescence, injections of water often render excellent service. In scarcely any other disease, the diet deserves more careful attention than in peritonitis. There is no necessity of enjoying special rest, since the pain, which the patient suffers, renders movcient almost impossible. The room should be k..^ " at u uniform temperature of about fifty degrees, F., the air should be kept fresh, and the patient should only be lightly cov- ered. Feather beds should never be used as a covering. Very frequently, all kinds of covering should be kept from Uie abdomen by some suitable contrivance, such as barrel-hoops. At the commencement of the disease, the patients are tormented by an agonizing thirst, which can only be quenched by fresh water. Small lumps of ice in the mouth, likewise, :'"en- der good service, 3' ? are partieularly suitable, if there is much retching and vomiting. Afterwards, if the appetite commences to return, such f )od shouir > used as will leave the smallest amount of fecal matter to be ca' - ried ok the bowels. Give beef broth early, and often enough to pre- vent exiirtustion. 22 k « «.* yi K?' I* ART SIXrTM. DISEASES OF THE LIVER AND SPLEEN. » 1 5 CHAPTER XIV. DISEASES OF THE LIVER. . INFLAMMATION OF THE LIVEB. Thlf? disease is divided into the acute and chronic ; the latter geii erally goes by the name of Liver complaint, although, a careful con sideration of the symptoms, will frequently discover that the real dis- ease is in tlie stomach and intestines ; however, in many cases, the liver itself becomes much affected from this cause, and, in itself, deserves considerable attention. When the disease lias been for a long time unchecked, and the inflam- mation becomes deeply seated in the substance of the liver, an uocess frequently forms, bursting either externally or internally ; in the latter case often proving critical, inducing hectic fever. ACUTE INFLAMMATION OF THE LIVEB. This disease is much more common in tropical climates than with us. There, a high mode of living, exposure to heavy dews, or damps in the evening, and the powerful rays of the sun by day, are amongst its princi- pal exciting causes; but it may, also, arise from violent mental emotions, the use of stimulating, or alcoholic drinks, suddenly suppressed evacu- ations, strong emetics, or purgat ves, the abuse of mercury, gall-stones, external injuries, or injury of the brain. Symptoms. These differ according to the seat of the inflammation . When it occurs on the outer surface, or convex side, the symptoms closely resemble those of pleurisy ; there is, generally, a violent pain under the false ribs on the right side, sometimes resembling stitches, at others burning — shooting to tl.e breast-bone, the right shoulder-blade, nd point of the shoulder, and even affecting the right *,— sensation jf numbness, or tingling in the arm of the same side, the ^ ain increaset) by inspiratioii ; a short, dry cough, and the oymptoms of inflammatorji fever; bowels irregular, generally constipated, and stools, in tbemajoritj of cases, of an unnatural color 888 ■^'■?rFj INFLAMMATION OF THE LIVEU. S.'JT In tills form, the patient can only lie on the left side. When tlie seat of inflauunation is on the inner, or concave side of tlie liver, the pain is nuich less, and tlie patient conii)lains rather of a sensa- tion of pressure, than actual pain, "but the whole biliary system is much affected. The eyes and countenance become yellow, and sometimes com- plete jaundice declares itself; the urine is orange-colored, the evacuations mostly hard, and generally, of a whitish or gray color. We also find bitter taste in the mouth, vomiting, and considerable distress. The patient can only lie on the right side. Inflammatory fever is present in this form, likewise. In both forms, on examination, the region of the lower ribs, on the right side, will usually be found hot, tumefied and painful on pressure. Inflammation of the liver, unless properly treated, is apt to assume the chronic form ; it may, also, end in suppuration externally, or inter- nally by a communication, either with the lungs or intestinal canal, or by an abscess in the substance of the organ itself, or may terminate in indurations, or other alterations of structure, in gangrene, or in the form- ation of adhesions. The disease may terminate by resolution, critical transitions to other organs, piles, diarrhoea, bleeding at the nose, or eruptions in the skin generally, erysipelas. ALLOPATHIC TREATMENT. The treatment of congestion of the liver, will consist, as far as possible, in the removal of the causes of the disease. In some instances, there are sedentary life, and too generous living. (Irou benefit will be derived in some of these cases, from horse- back riding, hunting, walking, etc., while saline laxatives, as Seidlitz Pov- ders, directly diminish the congestion. The use of beer, and spirits should be discontinued, and the diet made more simple and plain. It' the congestion is of long continuance, benefit will result from the use of Dilute Nitro-Muriatic Acid. It may Ije given in doses of ten or fifteen drops. It should be given before meals, largely diluted in sweetened water, or preferably in a couple of ounces of some bitter infusion, as infusion of Columbo (one ounce simmered in a pint of water). Bathing the right side with a solution of Nitro-Muriatic Acid — three ounces to a gallon of water, is of advantage. Drinking the water from some of the sulphur springs, is sometimes useful. If the patient is debilitated, the use of Nitro-Muriatic Acid should be associated with the use of Citrate of Iron and Quinine, a dram and a half dissolved in four ounces of Lemon Syrup, or of Syrup of Orange Flowers, of which, a teaspooniul may be taken after each meal. If the congestion of the liver depend on disease of the lungs or heart, treatment, will of course, have reference to those affections, and remedies addressed directly to the congestion of the liver, w ill lo only palliative. In inflammation of the liver, there is great danger to life. The intense pain should he relieved by the use of Opium, in doses of a grain, j.t such ■'T.tervals as may be necessa "y to relieve the pain— one or two hours, <ir . ^ger, apart. The pain must be relieved. Laudnuni may be given by injection, in doses of a teaspoonful in a tablespoonful of thin Starch, and rei)(;vted once a day. The anodyne effects of this may be increased, if H: \ \M ''■■ '' m . I. 340 DISEASES OF THE LIVER. necessary, by giving Opium in doses of a grain, or Morphine in dose.iof a quarter ol" ii grain, by tlie uioulli . AlinunQut of eqimt 2)cirts of LauIanuniyTiiictureof Aconite, Chloroform, aiul Soap Liniment, may be continuously applied to the right side, over the liver, by means of a flannel, saturated in the liniment, and covered with oiled silk. The bowels may need acting on mildly, preferably by an injection of warm water. In this disease there is especial danger from suppuration. Tonics and nutritious food are early called for. The best tonic remedy is Quinine and Nitro Muriatic Acid. Two or three grains of Quinine, every four hours, will be appropriate. The Nitro-Muriatic Acid should be given in doses often to twenty drops, largely diluted in sweetened water, at about such intervals as food is given, as an aid to digestion. Such food as milk, eggs beaten up with sugar and water, or milk, given raw, strong beef tea, and animal essences, are appropriate. Should the inflammation, whether embracing the whole organ or limited to a portion, result in abscess, which can be distinguished througli the abdominal wall by feeling with the hand (palpation,) it is proper to open it. If the surface of the liver is adherent to the inner surface of the Avail of the abdomen, the opening may be made directly into the abscess. But if the adhesion has not plainly taken place, an incision should be made down to the peritoneum (lining membrane of the cavity of the abdomen) and tlie wound filled with Lint or Oakum. In three days tlie membrane will be adhered so the opening can be made with safety, which may be done either witli the knife or trocar. Generous diet, with the Quinine, will probably enable the patient to survive. Should the abscess open into the intestine or bronchial tubes, it may be necessary to give anodynes (as Opium) in small doses to relieve the irri- tation of tliosc iiarts, HOMOEOPATHIC TREATMENT. Aconitiim, Belladonna, Mereur- ius, Lachesis, Aconite is especially indicated in the commencement of the attack, and may always precede the other remedies, when there is vio- lent inflammatory fever, attended with insupportable shooting pains in the region of the liver, with tossing, restlessness, and great anxiety and anguish. Dose: Of a solution of eight globules to two tablcspoonfuls of water, give a teaspoonful every three hours, until improvement or change. Belladonna may be advantageously administered, after Aconite has subdued the preceding symptoms, or from tlie commencement, when the following indications present themselves; oiDpressive pains in tlie region of the liver, which exten<l to the chest and shoulders, distention of the pit of the stomach, sometimes extending across the region of the stomach, producing a sensation of tension, with diflicult and anxious res- piration ; determination of blood to the head, with cloudiness and giddiness, sometimes causing faintness ; great thirst, tossing about at night, and sleeplessness. Belladonna maybe advantageously alternated with Nux-vomica in such cases as coincide with the joint indications afforded for both of those medicines, especially, if the patient has been ^1 M ACUTK INFLAMMATION OF THE LIVER ail 'iir- it of vio- iis in iind onito ,vhen the on of tlje s res- and at at lated tionn been addicted lo excesaive use of fermented liquors. Belludoniuv is, moreover, especially appropriate when tlie temperament of the patient exhibits u combination of the sanguine and lymphatic. Dose; If singly, dissolve eight globules in two tablespoonfuls of water, and give a teaspoonful of the solution every two liours, until amelioration or change. If no positive and i)erniaiient improve- ment should ensue within four hours alter the third dose, pause two hours more, and lU'oceed with tlie next iiieuieine. If in alternation with Nux-v., the like solution of each administered in rotation, by teaspoonfuls, at intervals of two liours. Mercui'iiifi will, in the majority of cases, prove cU'ectual when Bella- donna has failed to produce a favorable impression on the disease, and should accordingly be administered six hours after tlie third dose of the foregoing remedy in such instances. The particular indications for Mer- eiirius are as follow: Considerable fullness or tumefaction in tlie region of the liver, with prir.king, burning, or oppressice pains, not allowing the patient to lie long on tiie riglit side, and sometimes augmented by movement of the body or part afFected; pain in the shoulders; bitter taste in the mouth, want of appetite, thirst, and continual shivering, sometimes followed by sweat- ing, but without relief, with pale yellow color of the skin and eyes; also, in niort' advanced stages of the complaint, when tliere is induration of the liver. This medicine may, moreover, like 7Mto ?'>«»«, be adminis- tered in alternation with i\r«a;-?5o/rtjV;a., under similar conditions. If the patient is of a lymphatic temperament, or is distinguished by softness of the muscular system, there will be additional reason for selecting Mer- curius. Dose: A solution of eight pills, in all respectfi, sintjly, or in alterna- tion, as directed for Belladonna. Ilri/oiiia, ChainoinUfa. Bryonia, when the pains in the region of the liver are mostly shooting, or consist of an obtuse i)ie.ssure. witli tension and burning, increased l)y touch, coughing or resi)irati<)ii, and, especially, during insi)irati()n, or much exacerbated by movement; also, when tiie symntoins are attended with violent spasmodic o])pressioii of the chest ; rapid and anxious respiration; bitter taste in the mouth, tongue coated yellow, and constipation. Jiryonla, like Chamomilla, is particularly useful in cases which have been excited by mental emotions, such as a violent paroxysm of anger, and is well adapted to persons of nervous or bilious temperament, and of choleric disposition. Dose: Of a solution of eight pills to two tablespoonsful of water, give a teaspoonful every three hours, until distinct amelioration or change. In case^ in which the pain is very severe, tlie doses should be rt'peated every (wo, liree and lour hours, progressively, accord- ing as an improvement ensues, and, subsequeiiHy, every six hours. ChatuotnUla is more particularly required in the milder forms of the complaint, or, more correctly speaking, in simple irritation of the liver, w'leii there are pressive pains, pressure in the stomach, oppression of the chest, and a sensation of tightness under the ribs; yellow color of the skin, pains not aggravated by motion, etc.; tongue foul and yellow, bitter taste in the mouth; paroxysms of great anxiety. Chamomilla is, also, almost a specific, when the above symptoms have been brought on ^y a fit of passion. Dose: In all resi)ects iis directed for Bryonia. m -.■■ 1 im I I 11 I (^ 1 m 51 ' 342, DISKASES OK THE MVEK. r \s I * •'i T^i ■ NiKii'-vontica is imrticiilsuiy indicated when the pains are shooting and pulsalive, and attended witli excessive tenderness in the region of the liver, to tlie toucli, ]iressure in tlie region of the stomacli and under tlie ribs, witli shortness of breatl) and constipation ; also, when enlarge- ment and induration occur; and, in the chronic form, when there are marked symptoms of derangement of the stomach. This medicine is, especially, appropriate for the treatment of patients of a sanguine or bil- ious temperament or choleric disposition. Dose : In acute attacks, four globules in a teaspoonful of water every two hours, until a degree of effect is apparent, and then every six hours, until positive improvement results. In chronic cases, six globules in a tablespoonful of water, every night at bed-time, for a week, after which, a pause of four days should ensue, the adminis- tration Ijeing similarly resumed, if necessary, and so on. Pulsntilla. Sensation of tension in the region of the liver, and pres- sure or dull pain in the region of tlie stomach; oppression at the chest, bitter taste, yellow tongue, nausea; loose, greenisli, and slimy stools; excessive anxiety, especially, towards evening or during the night. (Tem- perament lymphatic; disposition mild). Dose: Of a solution of six globules to two tablespoonfuls of water, give a teaspoonful every six hours, until amelioration or change. Sulphur is valuable to follow any one of the preceding medicines, which, although apparently indicated, does not speedily produce a decided action; or when the disease continues, although in a diminished degree; it is particularly efficacious, after Nax-vomica, to combat the bad conse- quences of the disease. In many instances, in which the distinct analogy between the symptoms of the disease, and those which characterize one or more of the other medicines enumerated herein, has led to the administra- tion of such other medicine or medicines, and when such treatment has failed to be followed by adequate benefit, the intermediate administration of a single dose of Sulphur, from time to time, has served to awaken the susceptibility of the system to the action of such other medicine (when evidently appropriate,) and the repetition of its administration after such dose of Sulphur has been followed by admirable results. Dose : To assist the action of the other medicines, give four globules in a teaspoonful of water, following up the treatment with the rem- edy judged most appropriate to the case, after an interval of twelve hours. suppuhative inflammation ob abscess of the LIVER. * Sulphur, Silicea, Kali-c, Lycopodium. These four medicines may be numbered amongst those which have proved most useful in cases of suppuration of the liver. The selection from amongst them, must, of course, depend upon the particular features of each individual case, and must be regulated by instituting a comparison between the symptoms of the disease, and those which are recorded as characteristic of each of these medicines in the article on that subject. Dose : As for Nux. * See Treatment of Xailammutioa of the Liver. CHRONIC INFLAMMATION OF THE LIVKK,— JAUNDICE. 843 JJiet. The regulations for diet wliicli are prescrilied for the treat- ment of Fevers in general, and sucli other regulations as are detailed in llic article on "Indigestion," are equally applicable to cases of Inflani- niiition of the Liver. CHRONIC INFLAMMATION OF THE LIVER, OR CIRRHOSIS. In this form of the disease, we find many of the foregoing symptoms, but in a moditied degree ; and in addition, a continued pain or uneasiness in the right side seldom leaves the patient, who gradually falls off in flesh and loses strength; and there is, not unfrequently, present an occasional cough with expectoration; sometimes, considerable perceptible enlarge- ment of the liver, either continual or returning periodically, with a num- ber of dyspeptic symptoms; high-colored or red urine, yoUow tinge of the skin and eyes, occasional febrile symptoms; the pulse, except during these .attacks, generally quick but regular. ALLOPATHIC TREATMENT. Chronic Inflammation (Cirrhosis) ot the Liver is, generally, caused by the use of alcoholic drinks. The patient> generally, pays no attention to this trouble, until it causes dropsy of the abdomen. It is then safely regarded as incurable. In the early stages of the disease, by the abandoning of the use of spirituous liquors, and by the use of Arsenious Acid, and the Iodides, as in the following formula, a recovery can doubtless be made. Take of the Iodide of Ammonium a dram, Fowler's Solution, half a dram. Tincture of Columbo, an ounce, Water, four ounces. Mix. Dose: A teaspoonful three times a day, before meals. The use of Dilute Nitro-Muriatic Acid in doses of ten or fifteen drops in sweetened water, three or four times a day is beneficial. In the later stages, the treatment is the same as for Dropsy of the Peritoneum (Ascites) HOM(EOPATUIC TREATMENT. With proper modifications, as to the frequency of doses, the regulations prescribed in the foregoing article (pp. 340 to 342) are equally applicable to this variety of the disease. The med- icines enumerated should, accordingly, be selected in conformity with the indication therein set forth. The following, however, are especially appro- priate, in the majority of cases of Chronic Inflammation of the Liver, and the undermentioned rule 'or the dose is generally, reliable, as regards other medicines. Nux'voniica, Bryonia, Sulphur, Sepia, There are compara- tively few cases (if any) of Chronic Inflammation of the Liver, in which one or more of these medicines, either singly, successively, or alternately, will not be required ; for indications see pages 340 to 342. Bose: Of the medicine selected, give four globules in a teaspooiuul of water, morning and evening, for a week (or until an earlier subsi- dence or change in the symptoms); after which, pause four days, resumi: g the course, as before, if necessary, and so on. «i|: I. (ft.- III ■ 'ii JAUNDICE. Symptoms. Yellow color, varying in shade from a pale saffron to a dark-brown yellow, appearing first in the eyes, then extending over the l|4 ^iii if II 811 DISEASKS OF TIIK LIVER. surface of the whole body; hard, whitish evacuations; orange-culorcd urine; symptoms of deranged digestion, and sometimes, tensive pain tn pressure in the region of the liver. In severe cases, even, the perspiration will impart a yellow hue to the patient's linen. ExciTiNo Causes. The disease frequently declares itself without being plainly referable to any exciting cause ; the principal causes, how- ever, are affections of the liver, indigestion, poisonous substances, taking cold, powerful mental emotions, emetics^ drastic purgatives,, or internal obstructions, such as gall-stones, or even worms obstructing the biliary duct. PiiiiDisPOSiNG Causes. Amongst the predisposing causes may be enumerated, a too sedentary or irregular mode of life, indulgence in spirit- uous liquors, and the frequent use of aperients. It may be, also, remarked, that this disease frequently assumes the intermittent type. Jaundice is not, of itself, to be considered as a dangerous disorder, but rather as an indication of some internal derangement, which, if neglected, may entail serious consequences; for example, dropsyt hectic fever, or gen- eral wasting away. ALLOPATHIC TREATMENT. Jaundice is a symptom which accom- panies (other) diseases of the liver, and, in such instances, its treatment is that of those affections. Generally, there is a catarrhal inflammation of the upper part of tlie intestine (duodenum) requiring that the food should be light and nnirri- tating to this part of the digestive tube. Milk, eggs, animal broths, broiled beef steak, oysters, fresh fish, are suitable. Bread, arrow-root, rice, pota- toes, beans, pies, etc, may, by calling upon the functions of that part of the intestine, continue the disease, and should not be used. Laxatives may be called for, but must be mild. Injections are to be preferred, if there is constipation. A Seidlitz Powder may bo taken. In this, as in other affections of the liver, the Nitro-Muriatic Acid is useful, in doses of ten drops in sweetened water, three times a day. Manganese has appeared useful, in catarrhal jaundice. Take of dried Sulphate of Manganese forty grains, Ptirified Ox Oall sixty grains, Rcs>n of Podophyllum ttoo and a half grains. Mix well, make a mass and dii'ile into twenty pills. Dose : One three times a day. In Malarial Jaundice, after from ten to twenty grains of Quinine has been given, Manganese is, also, useful. Take of Dried Sulphate of Man- ganese forty grains, Chenoidine sixty grains. Mix and make into twenty pills. Dose : One three times a day. A small blister over the stomach has appeared useful. Pain should be relieved with half grain doses of Opium, or ten drops of Laudanum, or a grain of the Extract, or one or two teaspooufuls of the Tincture of Ilyoscyamus. Wiien jaundice has continued for weeks or months, there probably is an ineraediable obstruction to the flow of bile. If it cannot be removed, remedies are Jrected to aid in the elimination of bile by the kidneys, and akin and to support the powers of life. Ill> JAUNUICK. 3!j To increase the flow from the kidneys, the diuretic pill composed of one gram each of Extracts of Sqaill and Dif/italis and Calomel, may be given, one pill every three hours, until it acts freely on the kidneys. Or tlie Fluid Extract of Broom may be given in doses of half a teaspoonful. Watermelon or Pumpkin Seed tea may be useful. The skin may be sufficiently acted on by hot bathing. If not, by the hot wet i)ack. Bile may be supplied to the aid of digestion by giving one or two cap- sules filled with ox-gall after each meal. It should be remembered, that the yellowness will exist in the skin for some time after the bile duct is open, so that the bile Hows naturally into the intestine. HOMCEOPATHIC TREATMENT. Mcrcuriiis, China. These are two of tlie best remedies in the treatment of the disorder. MercH riiiti may be denominated a specific remedy for jaundice in a great number of cases, when, indeed, the patient has not been subjected to drenching courses of Mercury or Calomel, Dave* Six globules in a teaspoonful of water, every six hours, until four doses have been given, and then every twelve hours, until per- manent and positive amelioration or change. C'hhta is, however, to be preferred to Mercurius, in cases in which Mercury has been too copiously administered. C.'iina is, also, particularly appropriate when the attack has come on after violent corporeal exertion, or when it can be distinctly traced to indigestible substances; also, when tl)« diseiise assumes tin intermittent character. In a great number of cases, indeed, in wiiich jaundice recurs periodically, or in which patients, already predisposed to its attacks, have been unavoidably or inadvertently exposed to some directly exciting cause, (such as over-exertion, cold, etc.,) China will operate as a preventive resource, and will commonly ward ott the develop- ment of an incipient attack. Dose: For the treatment of jaundice, in an advanced stage, give four globules in a tablespoonful of water, three times at intervals of four hours, and at intervals of eight hours, until amelioration or change. As a preventive resource, give six globules in a wineglasst'ul of water, night and morning, for three days, the.i pause two days, sus- pending treatment, or resuming the course, similarly, according to the state of the patient. Nux-voniica is preferable in the generality of cases, even in such as have been directly occasioned by violent emotion, when the bowels are confined, or alternately confined and relaxed. Niix-vomica is, also, espe- cially, appropriate when sedentary habits, or study, or indulgence in spirituous liquors, appear to have been the predisposing, or, partly, tlie exciting causes of the attack. Dose : Three globules in a teaspoonful of water, every four to eight hours. Digitalis. A most important remedy in many cases of this disease ; the following are the principal indications for its employment: nausea, retching, or vomiting and purging of greenish fluid; or sluggish state of the bowels, with white, gray, or clay-colored evacuations; tongue clean, or coated white; pressure at the pit of the stomach, and region of the liver; alternate heats and chills. 840 DISEASKS OF THE HVKU. Dose: Of ii Hohition of six Klobiilcs to tliroe tul)loHpooufulH of water, giveu tt'aspoonful every two Iioimh, until the violence of theHynip- touis become niodifled ; aud then every four houra, until poaitivo amelioratiun or change. INPLAMMATOUY JAUNDICE. Cases in which jaundice is associated with symptoms of inflammation and pain on pressure in the region of the liver, are ho closely analogous to iniliimmation of the liver, that the reader is referred, on this subject, to the foregoing articles, treating especially of that disease. ,'t'!jl:,; GALL STOyE.-CIIOLELITiriASIS. lilLIARI CALCULI, The tendency inherent in the bile to form firm concretions, is quite considerable; lience biliari calculi are a common occurrence. The causes of sucli concretions are very obscure; they occur in indi- viduals of the most varied constitutions, and pursuing the most diversified occupations, diet, and habits of life. Tlieir formation seems to be most promoted by a copious supply of animal food, and by the use of lime-water. As a rule, sucii calculi are not met with until after the tliirtietli year, but occasionally before; they occur more fre(iuently among females, anct their formation is promoted by every circumstance tliat causes an arrest of the How of bile. Biliari calculi are chiefly found in tlie gall-bladder; here they are met with in large numbers, seldom iis solitary concretions. In tlie latter case their form is oval or rounded ; where .several concretions are preset, they assume an angular form with more or less curved surfaces, in conse- quence ae sides being rubbed off, and of the pressure and couuter- l)ressure tliey exert upon each other. They mostly consist of a nucleus, round which a lighter-colored layer of lime has been deposited, which is again surrounded by an envelope composed principally of cholestrine and bile-pigment. Their color is at times liglit, at others white, yellow, dark-brown, dark-grp.y or black. They are not very firm ; in their recent state they are friable and can easily be crushed. Bilious concretions may be present withoutany danger to the individual affected with tliem; they may be expelled without any pain ; on theotlier hand they may acquire importance from the pains which they cause and from the lesions to which they give rise. In this respect, tlie size of the concretions is of much less importance than their shape and the internal condition of the gall-bladder ; biliari calculi (gall stones) of the largest size sometimes cause the least distress. Symhtoms. Plence the symptoms caused by these cohcretions vary a great deal according to their shape and intensity of pain. In sliglit cases, a short-lasting spasmodic pain, corresponding to the region of the gall- bladder, accompanies the expulsion of the calculi into the bowels. In other ciises the pain is continuous but not violent, sometimes it is parox- y.smal. It is only in the smallest number of cases that tlie calculi cause regular attacks of colic. This colic commonly sets in all at once, the patient feeling otherwise perfectly well ; it is attended with a more or less violent pain in the region of the gall-bladder. Generally, this pain OAI.I. SToNK. 84> increases very rapidly in intensity; it is an intoleral)ly burning, boring piiin, and, while increasing in intensity, nuiiates over the chest and abdo- incn to varying distances. At the same time the region of the liver becomes exceedingly painful to jjressurc, it is apt to bloat, and, in consequence of the contraction of the abdominal muscles, the abdo- men becomes hard as a board. The pain is generally so distres- sing and acute, and the patients find it so dithcult to breathe, that tliey toss about in the greatest agony. The general constitutional condi- tion is, likewise, affected by the pain according to the sensitiveness of the patient and the duration of the pain. Although there is no fever, yet the pulse soon becomes small, filiform, almost unaccountable, disappears even entirely, although the heart is in tumultuous motion; the skin becomes correspondingly cool, and is covered with a cold perspiration, the com- plexion is cadaverous. The pain is most commonly associated with distressing vomiting and retching which terminates in a ^;ainful hiccup- ing. The nervous system participates in the violent r icking of the frame; the patient is attacked by violent chills or local cramps, or else by violent convulsions at times tonic, at others clonic, whic.i are apt to ter- miiuite in syncope. Such paroxysms sometimes last a few aours, at others a d:iy and longer. The pains usually all cease as soon as the calculus entt;rs the intestine; sometimes they disappear gradually or have complete remissions, according to the condition of the excretory ducts of the gall- bladder, or to the peculiar shape of the calculus, which at times adheres and at others moves on again. After the pain ceases, all the incidental ailments generally disappear very rapidly, and nothing remains but languor and weariness. About this time, icterus (jaundice) makes its appearance in different degrees of intensity. The appearance of icterus depends upon the length of time that the excretory ducts of the bile remain obstructed. If the obstruction only continues a short time, the icterus may not break out at all ; on the contrary, if the obstruction lasts ]ong, the jaundice may already set in during the pains. As regards fre- quency, the attacks vary, but the same individual is scarcely ever attacked once only; because, as we stated before, solitary concretions cause pain only exceptionally, whereas a multitude of smaller concretions that have become sharply angular by rubbing against each other, penetrate more easily into the excretory duct, and cause a more acute irritation. PuoGNOSis. The terminations of colic from the presence of biliari calculi, or rather the consequences of gall stone, vary a great deal. Death scarcely ever takes place in consequence of an attack of such colic. If the cahiulus remains incarcerated for a long time, and fills, at the same time, the whole space of the excretory duct, we obtain a picture of a fully developed jaundice, with the various symptoms previously described. If the incarceration is not removed, suppurative hepatitis, inflammation of the gall-bladder; and its excretory ducts, may be the consequence. In the laiit mentioned case, the patients succumb to peritonitis arising from perforation of the gall-bladder, or, if the gall-bladder should have become adherent to the surrounding parts, the patients fall away, gradually, until death ends their sufferings. The diagnosis of biliari calculi is, generally, very easy and sure. Tha seat of the pain, the sudden beginning and the equally sudden cessation of the pain, and, above all, the discharge of bilious concretions with the 11^ 'V' m m %, ♦• i M k l?f: ?y n'i IMAGE EVALUATION TEST TARGET (MT-3) // W- 1.0 If I.I 1.25 2.5 US 22 1^ ^ i^ ill 2.0 1.4 1.8 1.6 h V] / V M Photographic Sciences Corporation 23 WEST MAI^ STREET WEBSTER, N.Y. 14580 (716) 872-4503 [L<? W^ 848 DISEASES OF THE LIVER. feces, establish the diaf.nosis. If the concretions are soft, they may not appear in tlie feces, for the former may break up and scatter during tl)eir passage through the intestines. Ifthe colic is not violent, it is difficult to recognize its true character, especially, ifthe symptoms of the stomach are not very prominent, and the attack runs a slow course. The swell- ing and painfulness of the region of the liver may remind one of hepa- titis, or else the symptoms may be those of acute hypersemia of the liver. The spasmodic symptoms do not, generally, follow immediately after the commencement of an attack, so that it is scarcely possible to confound it with eclampsia, epilepsy, etc. The treatment involves an abbreviation and mitigation of the attacks of colic, and prevention of all further mischief from it; at the same time we must try to prevent the return or reproduction of new concretions by proper treatment. ALLOPATHIC TREATMENT. In the treatment of the pa.^sage of gall stones, is in the first place, to relieve the pain, and for this purpose, the best remedies are Opium and Belladonna. If a physician is at hand, he will give a hypodermic injection of a quarter of a grain of Morphine witli a sixtieth of a grain of Atropine. The effects of the anodyne should be maintained, until the pain, caused by the passage of the stone, ceases. An injection into the bowel of a teaspoonful of Laudanum, with half a tea- spoonful of Tincture of Belladonna, in a couple of tablespoon fuls of thin starch, maybe made, or the same remedies given by the mouth in lialf the quantities. The pain may be intense enough to induce the physician to resort to the inhalation of Chloroform or Etlier. Belladonna Ointment may be applied over the seat of pain, and cov- ered with a hot flaxseed meal poultice. A hot bath is sometimes successful in mitigating pain . No rule can be given for giving Opium in this disease, but when larger doses have been given for a few days, Opium poisoning may occur unexpectedly. Expulsion of the calculus (stone) may be aided by cathartics. For this purpose salines are to be preferred, as Epsom Salts and Seidlitz Powders. No remedies are known which can be given in sufficient quantity to dissolve the stones. As a preventive measure, the Phosphate of Soda should be given in doses of from twenty to thirty grains, two or three times a day. The rem- edy should be persevered in for months. It has the property of rendering the bile more liquid, and so prevents the formation of new gall stones. A change from a sedentary life is desirable. A simple, wholesome diet, and attention to the general health are called for. i 11 CARCINOMA HEPATIS, CANCER OF THE LIVER. The disposition to cancerous growths in the liver is one of the most common accompaniments of what is generally designated as the carcino- matous diathesis. Cancer of the liver constitutes one of the most fre- quent forms of the carcinomatous disease. The symptoms caused by carcinoma of the liver, differ in intensity according to the size and locality of the degeneration, so that the disease INFLAMMATION OF THK SPLEEN. 84U sometimes remfiins without any symptoms. Usually the disease com- mences with the vague symptoms of hypeioDmia or of fatty liver, witli pressure and a feeling of fullness in the right side; tlie pain, as a rule, exceeds that of any otiier affection of the liver, and, on that account, is an important diagnostic sign. If the carcinoma is deep-seated, the pain may be entirely absent. An important item in tlie diagnosis of the carcinoma of tlie liver is the rapid enlargement of this organ, even to an enormous size, and the consequent bulging of the margin of the ribs. The constitutional symptoms vary a great deal. Sometimes the stom- ach and irjtestinal canal are much disturbed by the affection of the liver, and sometimes they remiiin perfectly free from all traces of trouble. As a rule, Carcinoma of the liver is an incurable affection, which must prove fatal sooner or later. The duration varies from a few months to a number of years, and depends upon the rapidity with which tlie cancer grows. Carcinomata that, break out after operations, are generally more speedily fatal, tlian sucii as are restricted to tlie liver. A treatment pursued v.ith a view of curing the disease, has very small chances of success, lieported cures should be received with a great deal of distrust. ;»t,(t » 1 I wM) ■i 1#, M CHAPTER XV. INFLAMMATION OF THE SPLEEN. Symptoms. Sharp, pressing, or shooting pains in the region of the spleen, l»oneath the lower ribs on the left side, v/ith, in most cases, a high degree of fever, with general derangement; and sometimes enlargement and tumefaction; when very severe, vomiting of blood. From our very imperfect knowledge, however, of the physioJcgy of this (>igan and its relation to the others, this disease, except when it pre sents itself in the tangible form above mentioned, is extremely ditlicult to discover. Its best characteristics are tenderness or sensibility on pres- sure in the region about the sj^leen, with general debility ; paleness of tlie complexion, bloodless appearance of the conjunctiva (the superficial membrane lining the eyelids, and extending over the fore part of the eyeballs,) languid circulation, and tendency of the extremities to become cold. It is a rare disease in this country, but sometimes declares itself in hot seasons, when it is not unfrequeiitly mistaken for other affections. It may, however, arise in individuals of delicate constitutions, or in children, when exposed to the influence of marsliy miasms, particularly when, to that cause, has been added insulReient clothing, want of exercise or proper nutriment, and long-continued mental disquietude. ALLOPATHIC TREATMENT. Acute inflammation of the spleen is to be treated on the same general principles as inflammation of the liver. The same anodynes will be required, and tliey are to be administered in the same way. The constant application of cold by means of a bladder of k 550 DISEASES OF THE LIVER. pounded ice over the region of the spleen, is particularly appropriate. Benefit will, also, result from the use of Ergot in large doses. A teaspoon- ful of the Fluid Extract of Ergot may be given three or four times a day. By far the most common affection of tho spleen, is a chronic inlhiinma- tion, known as enlargement of the spleen, which occurs in malarial dis- tricts, or where intermittent fever prevails. It is also known as aj:tc cake. Tliis affection, occurring periodically, requires the use of Quinine in full doses— five or engrains, given six hours apart, until a slight ringing of the ears is produced. For continued use for enlarged spleen, it should ho continued with Sulpliate of Iron. Take of Sulphate of Qxiinine swty grains, Dried Sulphate of T^-on, ninety grains. Make into thirty pills, acco7'ding to the art of the aj . icary. Dose : One pill, tliree, four or five times a day. Bromide of Potassium, given in doses of from ten to fifteen grains three times a day, sometimes reduces the enlargement of the spleen witli wonderful rapiditj^. The Iodide of Ammonium and Arsenious Acid, in small doses, fre- quently repeated, are particularly efficacious in chronic enlargement of the spleen (ague cake) with ciironic malarial poisoning. Take of Iodide, of Ammonium ttoo and a half drams, Iodide of Arsenic one and a half grains. Peppermint Watei-four otinces. Mix. Dose: Take a teaspoonful from three to five times a day. A dram of Fowler's Solution may be substituted for the Iodide of Arsenic. Brushing the skin over the spleen with Tincture of Iodine, or rub- bing it with the Red Iodide of Mercury Ointment, will be of benefit. Sometimes wearing a Belladonna Plaster, on tlfe left side, will relieve the pain of enlarged spleen. HOMEOPATHIC TREATMENT. China should be administered at the onset of the treatment, if no fever of any moment existed from tho commencement, particularly, if the disease owes its origin to marsh miasm, or if the accompanying fever present an intermittent type, in which case, it should be administered during the intervals, if impaired appetite and general derangement be present. Also, if the patients liave been weakened by vomiting of blood, or diarriicea. When the abuse of this medicine, or Quinine, has given rise to dis- ease of the spleen, benefit will often be derived from the employment of such of the subjoined remedies as may correspond most closely with the symptoms of the case. The alternation of China and Arsenicum is appro- priate, when the symptoms involve a combination of the indications aflTorded for each, respectively. Dose: li singly, when the disease presents no positive periodical character, and the symptoms are not violent, of a solution of eigiit globules, to two tablespoonfuls of water, give a teaspoonful every two hours, until positive amelioration or change. If the symptoms be ^ery severe, tlie like dose should be repeated at intervals of one hour. " If the disease assume a distinctly p'^riodical character, the like dose should be administei^ed, during the respite, an hour before the anticipated return of the attack. If in alternation witli Arseni- cum, dissolve the like quantities of each, separately, and adminis- ter, first two doses of the one, at intervals of three hours, then pause nine hours, and proceed with two similar doses of the other, and !0 on. INFLAMMATION OF THE SPLEEN. 351 Arsenicum is useful where tlio disease assumes tlie intermittent type, or is complicated witii ague; and, further, when the patient complains or a violent, burning pain in the region of the spleen, and a constant pulsation at the pit of the stomach, attended with great anxiety ; also, vomiting of a dark, gruraous Uuid, watery, or bloody discharge from the bowels, and burn- ing at the posterior passage; excessive weakncsn, und dropsical swelling at the feet. The alternate administration of this medicine, with China, is sometimes advantageously adopted as above stated. (See China.) Dose: In all respects, whether singly, or in alternation with China, as directed for the last named medicine. Arnica is indicated by pressing pain in the left side, under the short ribs, causing difficulty of breathing, and when the vomiting of blood is very severe. When external violence has given rise to the disorder, Arnica is, especially, called for. Dose : In ordinary cases, of a solution of six globules to three table- spoonfuls of water, give a teaspoonful every three hours, until ame- lioration or change. But, if vomiting of blood occur, the like dose should be repeated every hour. Niix-voinica is chiefly indicated by the symptoms of deranged diges- tion, constipation, etc., which remain after the more threatening symptoms are removed, or aiter the use of Quinine. Dose : Six globules, in a teaspoonful of water, at bed-time, until ame. lioration or change. 1!!^' 1lll I " .'■■If, 'i ii, "t - Lii A— Sternum (Breast- bone). B— Clavicula (Collar- bone). C— Scapula (Shoul- der-blade). D — Humerus (Upper Arm-bone). E— True Ribs. F— False or Floating Ribs. G — Vertebrae (Spinal Column). H — Maxilla Inferior (Lower Jawbone). J'- I»AR-T SiEVElVTH. DISEASES OF THE KIDNEYS AND BLADDER. CHAPTER XVI. DISEASES OF THE KIDNEYS. XEPHBITIS—INFLAMMATION OF THE KIDNEYS. The history of the disease, in individual eases, is in many respecta very obscure. It occurs chiefly among middle-aged persons, and among men more frequently than women. Some of the causes are: Bruises in the region of the kidneys ; sharp, or adhering gravel in the kidney; violent colds, employment of various drugs, such as Turpenune, Spanish Fly, Nitre and Savin, whether used internally or externally. Sometimes, violent, extensive burns. Exces- sive use of stimulants. Suppression of the "courses." Long lying on the back. Secondarily, the disease is caused by suppurative inflamma- tions in other organs ; also, by diseases of the brain and spinal marrow, lieart disease, etc. Nephritis usually sets in, like other acute inflammatory diseases,witli a violent chill, which is almost immediately succeeded by the local pains. After they have reached the acme of their intensity, they estend over the whole region of the kidneys, on both sides ; they are continuous, of different degrees of acuteness, c«"nnot easily be described according to their nature, they are considerably aggravated by pressure upon the renal region by taking a full breath, or by motion generally; also, by lying on the aflfected side, and by the warmth of the bed. They are scarcely ever restricted to the kidneys; on the contrary, following the course of the ureters (little tubes that carry the urine from the kidneys to the blad- der) they radiate into the bladder, testicles, and, in the ease of females, into the round ligaments and thighs. Sometimes <"he testicles are found drawn up spasmodically. With theappearanceof these pains, the urinary secretion diminishes jn proportion as the inflammation involves a larger portion of the kid- neys, so that the secretion of urine may be entirely suspended. At first, the urine is only saturated, sometimes tinged like blood ; but it may, like- wise, preserve its normal color, if one kidney is sound and the other does not secrete any urine at all. The general constitutional balance is very much disturbed. The fever is very violent, the pulse hurried and soon becomes small and. contracted, the skin is hot and dry, the thirst 352 ^•i INFLAMMATION Ol TIIK KIDNEYS. 358 rst agonizing. The patients feel sick to tliecore. Vomiting is a frequent occurrence witliout the stomach appearing much deranged, for tl\e tongue may l)e quite clean. At first, tlie bowels are quite constipated, the appe- tite is gone. The further course of nephritis corresponds with the changes that have been indicated. Recovery may talce place after the first onset of the disease, witliout any suppuration having taken place, or by arresting it, the completeness of the recovery being shown most conclusively by the urine resuming its normal quality. On the contrary, if suppuration sets in, the local pain decreases, becomes duller, and more like a painful pres- sure; the fever, however, increases, frequent chills or sliiverings are experienced by the patient, the tongue becomes coated, tiie stomach is still more disturbed, pus is found in the urine at an early stage of the disease, and there is frequently an admixture of blood. Tiie patient becomes anxious, restless, the pulse is more frequent and smaller. The subsequent phenomena depend upon how far the urinary secretion is suspended. If only one kidney is diseased, or only a small portion of both, there is no material diminution of the quantity of urine secreted ; an abscess forms, with the usual phenomena characterizing the suppurative process, the abscess either discharging, and recovery taking place, or else renal phthisis (consumption) setting in, with all the symptoms of marasmus (wasting away) gradually following. This last mentioned result may drag along for months, the urine containing pus all the time. Characteristic features of renal phthisis are, a great tendency to malignant affections of the skin, and a disposition to lie down. In some cases, serious symptoms set in most suddenly when the discharge of urine had been completely sus- pended from the beginning, and the patients die in a few days. Tliey may, likewise, set in gradually, so that the disease, by slow degrees, assumes a typhoid character. The patients sink into a sound sleep, are attacked with a more or less violent delirium, convulsions, and finally die. The diagnosis of nephritis cannot always be made with perfect certainty, because the symptoms are sometimes very trifling, and, moreover, very little characteristic. In nephritis the bowels are almost always obsti- nately constipated ; if the disease terminates in phthisis, the constipation changes to diarrhoea. The termination is unfavorable, only, if the symptoms of poisoning with urajmia become more and more manifest, until they reach the liighest degree of intensity. In other respects, the disease becomes the more threatening, the more protracted a course it run , until it finally terminates in phthisis. ALLOPATHIC TREATMENT. Treatment of inflammation of the kid- neys will consist in the use of hot applications to the loins, hot poultices, dry cupping, and other remedies to relieve pain. Mild purgatives, and medicines to act on tlie skin, and by these means relieve the kidneys, are indicated. If tnere is much pain, the medicines to act on the skin, should contain Opium, as the powder of Ipecacuanha and Opium with Chlorate of Potash, or Dover's Powders, the dose of which is ten grains. The popular objection to Opium in this disease, in sufficient doses to re- lieve tho pain, on account of drying up the secretions, is groundless, because it acts freely on the skin, and so is protective uy.iiii^t any ill which may vein dt from a diminution of exertion from the kidneys; besides this su§- 23 ii rr Mi' >«t(; ' '*>! i^ 554 DISEASES OF THE KIDNEYS. pension of the action of the kidneys will enable them to recover from the inflammation the more quickly, from simply the rest. The antiphlogestic effects of Opium, are, also, most important. Notwithstanding the consti- pating effects of the Opium, there is no difficulty in obtaining copious dis- charges from the bowels. Further efTects on the skin may be secured by hot bathing, the hot wet pack, and the hot air batli. The hot air bath may be given by burning alcohol in a saucer, under tlie patient, sitting in a cano seated chair, well wrapped, (chair tand patient), from the floor up to the neck with blankets. Jaborandi has especial power of causing the elimination of urea (a poisonous ingredient of tlie urine,) by the skin, and is, especially indicateil in this disease. The dose of the tincture, or fluid extract is half a tea- spoonful to a teaspoonf ul. It may be repeated at such intervals as is required to excite a suflicient degree of sweating. Tlie bowels may be freely moved with two or three grains of Jalap, and a half a grain of Podophyllum, or a saline cathartic may be given. The amount of purging and sweating required, will be proportioned to the decrease in the natural flow of urine. Nothing more than water should be given to increase its flow. Ice may be given in small lumps, and swal- lowed, or allowed to melt in the mouth, if there is sickness at tlie stomach. In the early stages, the diet should be light, but solid food is to be allowed as early and as freely as there is power to digest and assimihate it. If suppuration should occur, great attention must be given to sustaining the strength of tlie patient, and nourishment of milk, cream, raw eggs, beaten up with sugar and water, or milk, strong beef tea, juice of meats and aniseed essence, freely and regularly given. The difficulty of discriminating this disease and its various conditions, together with its serious nature, dictate that its control should be placed wholly in the hands of a skillful physician. HOMCEPATIIIC TREATMENT. Cantha rides will be found most efiica- cious in the treatment, and'may be taken, at the very commencement of the attack, even when the accompanying fever is considerable, particularly, when the urine passes off in drops, or is tinged with blood; or when it is exceedingly painful to pass water, with burning pain in the urinary canal ; and when there are the general symptoms of shooting, cutting, and teari; g pains in tiie loins and regions of the kidneys; or even in cases of complete suppression of urine. JJose: Of a solution of eight globules, to two tablespoonfuls of water, give a teaspoonf ul every three hours, until positive change. Xux-voinica is appropriate when the Jiffection can be traced to excess of wine or stimulants, and sedentary habits; and where we find constipa- tion, feeling of faintness, nausea, vomiting, distention of the stomach, and drawing up of the testis, and of the spermatic cord. Dose : As for Cantharis. Belladonna. When shooting pains in the kidneys are present, extend- ing to the bladder— and further, when inflammation in the kidneys is accompanied with colic and spasms of the stomach, heat in the region of the kidneys, scanty flow of water of an orange-yellow, or sometimes of a bright-red color, depositing red or whitish thick sediment ; anxiety, restlessness, and periodical aggravation. jDose: As for Cantharides. ■ ., INFLAMMATION OF THK KIDNKVS— BUIGHT'S DISEASE. 8.^ JTepar-aulpJmrift is useful when we have reason to apprehend the formation of an abscess, or the conunenceuicnt of suppuration. The non- professional prescriber must be careful not to niistako the ajiparent alle- viation of suffering hero for the subjugation of the disease, as tlie distinc- tion is difTicuit. The following symptoms may serve as a guide in these serious cases ; cessation of the acute pain, a sensation of throbbing and a feeling of weight in the region of the kidneys, alternate chills and slight lluslies of heat, and copious perspiration are sure signs of pus forming. Dose : A powder of eight pills diasolved, to be taken like Canth. INFLAMMATION OF THE KIDNEYS OCCASIONED BY MECHANICAL INJURIES. Arnica is appropriate for the treatment of Inflammation of the Kid- neys resulting from mechanical injuries (such as contusions or severe con(^ussions,) and should be employed at the onset of treatment, whatever lu> the course afterwards indicated by the subsequent development of symptoms. ILL-EFFECTS FROM ABUSE OF CANTHARIDES. Tlie mischievous use of Caiitharides, in the applicatio. , of blisters, whereby the kidneys often become considerably, and even seriously, afroctcd, is promptly and effectively counteracted by the Homoeopathic antidote employed internally and externally. Camphor (Concentrated Tincture) should be administered without delay, when an affection of this kind is distinctly traced to the cause in (question. Dose {internal) : One drop of the concentrated Tincture of Camphor, on a small lump of sugar, every hour, until tliree doses have been given; and afterwards, every two hours, until the symptoms sub- side. Application {external) ; Moisten the palm of the hand with a few drops of the concentrated tincture, and apply with friction oa the inner side of each thigh. INFLAMMATION OF THE KIDNEYS ASSOCIATED -WITH GRAVEL. This disease sometimes arises from the presence of stone in the kid- neys ; in which case the symptoms of fever do not occur, until a consid- erable time after acute pain has been experienced. Further, a numbness of the tliigh, and a retraction of the testicle of tlie affected side, are con- sidered afi distinguisliing marks of the existence of a concretion in the kidney or urinary duct. BRIGHT' S DISEASE OF THE KIDNEYS-MOBBUS I BBIGHTII. Bright's disease mostly attacks persons of middle age, less frequently, children, and still less old people. Males appear more disposed to contrac- this disease, probably, because they use such noxious substances as predis- pose to it, more frequently than women. Feeble individuals are more frequently attacked than vigorous parsons. Damp and cold weather it considered one of the most frequent causes of this disease. If we admit that colds, which are so common, may give rise to renal diseases iij cqtj ■!%;iji3> ''* . 1 4'- * M B y ;| 35« DISEASES OF THE KIDNEYS. '.,1^ %: %. sequence of a siippresaion of the cutaneous exhuhitions, on tlie other Iiand, we must not forget that the abuse of ulcoliolic beverages, which is uuch a prevalent vice, likewise, is a main cause of the nephritis, which is so fre(iuenlly mrt with. But it is not only alcoliol, but likewise, the above- mentioned drugs and poisons, that cause both nephrilis and liright's disease. Among general febrile diseases, it is, particularly, after cholera and scarlatina that nephritis occurs, although, it may, likewise, develop itself after other acute affections, but rather exceptionally. Among chronic diseases, it is, such as rachitis, rheumatism and scrofulosis, which are often accompanied by this disease. We are no more able to account for the connection between these dyscrasias and Bright's disease, than we are for the frequent occurrence of Bright's disease during extensive suppu- rations of bones, although we may know, that the quality of the urine, during such conditions of the system, undergoes considerable changes. A division of Bright's disease into acute and chronic, is a very dilficult task. What can at most be asserted, is that the disease only passes through the first stage, or, goes on its course further into the other stages. It is only the characteristic nephritis during scarlatina, very seldom dur- ing the course of other exanthematic fevers, to which the name of Briglit's disease can properly be applied, for the reason, that in most eases, it passes only through the first stage. The cause of it, in our opinion at least, is not so much a difference in the causing influences, .is the age of the patients. Nephritis after scarlatina is scarcely ever met with, except in children or young persons, in whom the reactive efforts of the organism differ greatly, especially, in regard to the kidnejs, from those of middle-aifcd persons. This difference is, likewise, clearly manifested by the symptoms, as the following description sufficiently sliows: The acute form of Bright's disease, after scarlatina, generally seta in with distinct febrile phenomena, sometimes with pain in the renal region, and almost always associated with vomiting at an early period, a circum- stance that deserves to be considered with great care in convalescents from scarlet fever. Only in rare cases, the disease develops itself without the above-mentioned symptoms, in a more insidious manner, or is cov- ered up by the other morbid phenomena accompanying the exanthcm. From the onset, the quantity of the urine is considerably lessened, but a day seldom passes that some urine is not voided. The urine has a very dark color, red, or brown, like beer, makes a very consistent foam, and, after settling, deposits a dark sediment. The excretion of the urine is interrupted ; there is a good deal of urging, with scanty discharge. These symptoms of disturbance of the renal functions are very soon succeeded by a dropsical swelling over the whole body, which is first strikingly seen in the face, and attains a high degree of intensity. During this stage, the fever, is, generally, not very violent, the patients may, even feel tolerably well, and have some appetite. The thirst is always crreat, they desire cold drinks; the skin is entirely inactive, cool, feels dry, and has a pale, sickly color. The bowels are, generally, confined ; the pres- ence of diarrhrea is not a favorable symptom. If the disease has a favor- able termination, which may take several weeks, the urine is again secre- ted in larger quantity, the morbid products in the urine decrease, the skin resumes its functional activity, and, without any special signs of disor- dered functions, the disease soon yields to perfect recovery. Not unflre- Srioht's disease. 851 llttit'l quently, however, such patients succumb to Inlluinmationa of other organs, or, whicli is less frequently the case, tlie second and third stat'o of the disease may appear. If the disease runs a rapid and favorable course, there is no great loss of strength, and the patients, generally, recover very rapidly. Where IJrlght's disease is not a sequela of acute diseases, it has an entirely different beginning. Under such circumstances, the first stage may, indeed, pass away very rapidly, with the more or less marked symp- toms of typhus, which, however, is, generally, associated with convul- sions, and where the accompanying oedema (pufTy swelling) of the face, generally, shows the true character of the disease. If both Icidneys are affected, an acute dropsy may, suddenly, cause death. But, almost always, the disease commences without any preliminary symptoms, without chilliness or heat, and without local pains; at any rate, these pains are not very prominent. Thus, it happens that the patients are unable to indicate the beginning of their trouble. Insensibly they begin to complain, their strength diminishes, they feel that some illness is about to overtake them, tlie appetite is less, symp- toms of stomach-catarrli become manifest, the intestines may, likewise, be similarly affected. The urine is voided as usual, seldom less, rather more, and, should the disease set in with much severity, the urine shows the above-mentioned darker color, and diminishes in quantity. Usually, it is feebly turbid, even while being voided, of a pale color, of a bluish- green tint, foams very strongly, and the foam lasts a great while. Only at the commencement of the disease, blood is found mixed up with it. The test for albumen shows decisive results. Much less rapidly than with the acute fr '•m, sometimes even at a remarkably late period, but rarely before the termination of a few weeks, a symptom makes its appearance, together with the dropsical phenom- ena, which renders any error, in diagnosis, almost impossible. Here, too, one of the first symptoms is oedema of the skin, which has the peculiarity to be more prominent in ono place or the other, and, at times, to disap- pear entirely. It is alwayii most marked in the face and on the lower extremities. While the oedema of the skin is constantly increasing, water, finally, accumulates in the cavities, and the patient succumbs to the injury which the increasing pressure of the water inflicts upon the most important organs. In the more acute cases the disease hastens, with uniform rapidity, onward towards a fatal termination. If the disease runs a more chronic course, its intensity varies ; remissions that almost seem intermissions, and of various duration, are observed, during which, the strength of the patient not only increases, but the albumen disappears from the urine down to a scarcely perceptible trace. Accordingly, the disease at times lasts months, and at others, years; there are no positive landmarks by which the duration of the disease can be determined beforehand, even approximately. The prognosis is always very doubtful ; in cases of long standing, it is absolutely unfavorable. A complete cure is most easily affec- ted in recent cases that do not run too rapid a course. The danger is essen- tially increased, if there is a tendency to inflammation of other organs, or by the presence of heart-disease. If the disease had been caused by exter- 11 I ;i: ". I. Jr.: '* L 86^ DISE/JE8 OP THE KIDNEYS. \ |4L.al. nal circurastiinccs, a dump climiito or dwelling, or frequent calds, the removiil of those causes niiiy bo of great Iniportuncc. ALLOPATHIC TREATJIENT. Treatment of acute r.right's diseftse (acute innaniniatory dropsy) will have reference, in the first place, to ooni- hating the inllaniiuation of the kidneys. Upon the early recognition of this dinejise may depend largely the success of treatment. The patient siiould bo kept warm in bed. Hot fomentations should be a])plied over tlie loins, by means of wet cloths covered with oiled mus- lin and several tbickyesses of Hannel. Dry cupping should be applied over the loins, as the best method of revulsion. If tlie patient is strong and robust, wet cupping (blood-letting by cupping) will be of the highest possible service. General bleeding is sometimes necessary in the very robust, but should never be employed, if the patient is in any way en- feebled, as when the disease occurs after scarlet fever, and in persons given to intemperance. Saline laxatives are valuable, both by way of revulsion and eliminating poisonous material from the blood, and so relieving the kidneys, as Epsom Salts, Seidlitz Powders, or ten grains of Jalap, or two or three grains of the extract, with a tablespoonful of Rocbello Salts, or Cream of Tartar. Opium, as a rule, ought not to be given in this disease ; while it is ai)proi)riate in acute intlaamation, it is not suitable in Bright's disease. It diminishes the secretion from the kidneys, while they ought to flow naturally. Belladonna, in doses often or fifteen drops of the Tincture, twice a day, or sufficiently often to produce a slight dryness of the throat, is said to be serviceable in this disease. The diet should be light. The drinks should be confined to water» barley-water, flaxseed tea, and other nourishing drinks, which may be given as freely as the patient desires. Nothing acts so satisfactorily on the kidneys in this disease as the free use of pure water. Medicines, to act on the kidneys, (diuretics) ought not to be given in the early stage of the disease, because their action may increa^ie inflam- mation. . The dropsy is not dangerous, unless it invades the pleural cavity (cavity of the sac lining the chest and covering the lung,) or the lung cells. This will be shown by the marked dyspnoea (difficulty of breath- ing, or short breath;. As the danger is from urajmia (blood poisoning from urea, an ingredient of the urine remaining in the blood,) it is fortu- nate that remedies which will cause the elimination of urea from the blood, also, diminish the dropsy. This is done through the skin and bowels, the former by measures which produce sweating, (diaphoretics) and the latter by remedies which produce free, watery discharges from the bowels (hydrogogue cathartics). Hydrogogue cathartics are by far the most efficient. They are called for in proportion to the amount and Jocation of the dropsy, and the dan- ger from blood-poisoning. When the dropsy invades the pleura or lungs, and the shortness of breath is marked, relief may be had in a few hours by giving Elaterium in doses of an eighth to a quarter of a grain, two or three hours apart, until free catharsis is produced. It may be given with a grain of Extract of Hyoscyamus, or a teaspoon ful or two of the Tinct- BRIOUT'8 UISEASI::. ^69 uro and a grain of rulveiized Capsicum. Elaterium must bo u.^mI with caution, on account of its pioatratiny oai'ctd. It is scarcely safe for vvculc subjects, but may bo a necessity. Croton Oil maybe givon in doses of a drop, repeated at the same iniervals. The hot air bath may bo used alternately with these active cathartics. Tho decreaae of the amount of urine passed, and its low specific grav- ity shows that urea is not eliminated by the kidneyj in sufficient quanti- ties, and measures should bo at oi)'") resorted to, to compensate for tiuit deficiency. The most reliable means at our hands for tliis puri)ose, are the watery stool-producing (hydrogogue) cathartics and copious sweating, by means of the liot air bath. In case of insensibility, or convulsions from blood-poisoning by urea, Elaterium should be given in doses of a quarter or half a uralii mixed witii butter, and placed well back on the tongue. The hot air bath should be used simultaneously. The hot air bath may be easily given by conveying hot air from an alcohol lamp, through a sheet iron pipe under the bedclothes. The part of the pipe which rests under the clothes may be closed in •• tin box for con- venience. Ronchette, of New York, devised a very simple apparatus for this purpose, called Ronchette's hot air bath. The elimination of urea by the skin, will be greatly facilitated by the use of Jaborandi. Half a teaspoonful to a teaspoonful of the tincture, or Fluid Extract may be given three or four times in tlie twenty-four hours. A very eligible remedy as a diaphoretic, is a solution of the Acetate of Ammonia, in doses of a tablespoonf ul three times a day. If the symptoms are not very urgent, the ,ise of the saline cathartics, recommended in the first part of this article, are to be used instead of these most powerful ones just spoken of. The daily use of tho hot air bath may be continued, during the disease as the most eflicient means of producing elimination of urea by tlie skin. If the effect of the bath is agreeable, its aiij>lication may be continued from half an hour to an hour each time, or if too de» sing, it may be used for a shorter time, at more frequent intervals. When the flow of urine begins naturally t'^ increase, the use of diure- tics (medicines which cause a flow of urine,) may be cautiously begun, and the other evacuates omitted, beginning with the cathartics. Among the eligible diuretics for this purpose, are Cream of Tartar (Bitartrate of Potash,) which may be drank at will in lemonade, made of a clear solution of an ounce of Cream of Tartar, dissolved in hot water, using a suflicient quantity of lemon and sugar. (See formula on next page.) Digitalis in doses of ten drops of the tincture three times :i day, gradually increased until the desired effect is produced, or Broom (Scorporius,) in a tea, or half teaspoonful doses of the fluid extract three times a day. During convalescence, attention should be given to the diet, that the food is nourishing, and well digested co itaining temier meat, milk, and eggs. As the patient leaves the room, he should be clothed in flannel, and prop- erly protected against cold. Generally, the Tincture Muriate of Iron shoidd be given in doses of from ten to twenty drops, largely diluted in swept- ened water, after eating. Tonics of one or two grains Quinine, or a couple \\h i iv h M, m m m m ■ S60 DISEASES OF THE KIDNEYS. n t : TP of ounces of some of the simple bitter teas as Col umbo, Quassia, Gentian, etc., may be taken with benefit before meals. Chronic Buight's Disease.— It is to be understood, in the first place, that this disease is incurable, but \\?a is greatly prolonged by judicious management. The indications are related to the dropsy and the uroemia (poisoning by that ingredient of the urine known as urea, remaining in the blood.) General dropsy calls for the same treatment as is directed in the acute disease. It is better, however, to use the saline catliartics as Sulphate of Magnesia (Epsom Salts.) Citrate of Magnesia, Ilochelle Salts or Seidlitz powder, if the dropsy be moderate, but if the dropsy be great, the more powerful hydrogogue (water-producing) cathartics may be used, as, Elaterium, Croton Oil, or Bitartrate of Potash (Cream of Tartar) and Jalap, as directed in the acute disease. One free watery stool may be produced daily. Care should be exercised not to weaken tlie patient by pusliing cathartics too far. Remedies to act on the kidneys (diuretics) may be used in the chronic form of the disease, without risk of harm. Pure water may be drunk in large quantities. Of the diuretic medicines, the Cream of Tartar, Citrate or Acetate of Potash, are to be preferred. They may be used in connec- tion with the vegetable diuretics Digitalis, Squills, or Broom. The potash may be readily taken, prepared as follows: Take of Creaiu of Tartar an ounce, dissolve in hot water; when cold pour off the clear super- natant liquid, cut up some lemons into it, and sweeten to the taste. The whole of this Cream of Tarter lemonade is to be taken during the day, or: Take of the Citrate of Potash and liicarbonate of Potash each four ounces, dissolve in a pint of soft water. Of this solution two tablespoonfuls may be put in a large tumbler hali' full of water, sweetened to the taste, add a large tahlespoonful of lemon juice, and drink while effervescing, six times a day. In the absence of lemons, a tahlespoonful of a «o^Miio?i q/' three draTns of Citric Acid, in half a pint of ?vater, may be used instead. Of the vegetable diuretics Digitalis is to be preferred, given in infu- sion, (tea) two drams of leaves to the pint of water, in doses of one or two tablespoonfuls. Broom in decoction (tea boiled,) one ounce of broomtop to a pint, in the same doses. The tincture of Digitalis, Vinegar of Squil) and the Fluid Extract of Broom may be used in doses of half a teaspoonf ul to a teaspoon ful. When the stomach or bowels will not permit giving diuretics, cloths may be soaked in an infusion of Digitalis made, with an ounce of the leaves in a pint and a quarter of water, and laid over the abdomen. Or the body mi\y be rubbed for a time with a liniment made with equal parts of the Tinctures of Digitalis, Squill, and Iodine. Medicines which produce sweating (diaphoretics) must be depended 0*1, if hydrogogue cathartics are not well borne, and the kidneys do not act freely with the use of diuretics. Indeed, it seems preferable to use dia- phoretic measures alternately with the action of cathartics. Or rather use diaphoretic measures regul-./ly, and resort to cathartics to cau. i a greater elimination of water nvA urea. The first and best means at our disposal for this purpose, is the hot air balh, as described in the treatment for Inflammation of the kidneys, and in the treatment^of acute Bright's dis- ease. In short, the benefit from the hot air bath is so great, and it acts so BRiailT'S DISEASE. 3G1 nicely, that I am disposed ':o recommend its use to the exclusion of every other means. Jaborandi and Solution of the Acetate cf Ammonia are appropriate, used as recommended in the treatment of acute Bright's dis- ease. The measures for the elimination of urea, are the same as given for that purpose in the acute form of tho disease, namely: reliance, when the symptoms are urgent, on the use of the hot air bath, and the hydrogogue action of Elaterium, especially, when the urea has produced coma, insen- sibility, or convulsions. V'hen this urgency does not exist, it is best to avoid the use of Elaterium, but recourse may be had to the milder cathar- tics, directed for the mitigation of the dropsy, in this and the acute disease. The tonic effect of Quinine and Iron, are markedly useful in this dis- ease. The former may be given in doses of two or three grains, three times a day. The form of Iron to be preferred is the Muriate Tincture of Iron. It should be given in doses of twenty or thirty drops, largely dilu- ted in sweetened water, three times a day. A change in the form of these tonics from time to time, is advantageous. Pills of a twentieth to a thir- tieth of a grain, given one three times a day, appears to be of great advan- tage in chronic Bright's disease. Food should be nutritious, and as abundant as the digestion will admit of. The clothing should be warn and the patient should lead an out door life to such a degree as his strength will warrant. For the relief of pain, Opium should be avoided, if possible, and Bel- ladonna, Hyoscyamus, Indian Hemp, Aconite, Conium, etc., used instead. When these fail to give relief, recourse may be had cautiously to Opium. It has acted admirably in some cases. Vomiting and purging are to be regarded as conservative, they only are nature's means for eliminating urea. They should be rastrained only sufficiently to keep them within the bounds of safety. They may be relieved by aiding in throwing ofT the urea, by resorting to the hot air bath. Medicines calculated to relieve vomiting are Oxolate of Cerium in doses of five grains. Dilute Hydrocyanic Acid in doses of three to five drops, Creosote, in doses of one drop in water. Bismuth, in doses of ten to twenty grains, and lumps of ice swallowed whole, or allowed to dissolve in the mouth. • If any remedies are necessary for diarrhoea, the remedies directed foi the treatment of that trouble are appropriate. Upon the early recognition of the disease, and the promptness with which its effects are met, will depend the benefit of treatment. The disease may be stayed, and in some cases, life may continue with comfort- able health for years. Gallic Acid appears to have the power of preventing the waste oi albumen. It should be given in doses of five to fifteen grains in solution with five or six drops of Aromatic Sulphuric Acid. The following is the formula of Dr. Aitken: Take of Gallic Acid, from one to two drams, Dilute Sulphuric Acid, one dram. Tincture of Lupuline {the yellow powder shaken from hops) a dram. Infusion of Hops ,v'x ounces. Mix. Dose : A tablespoon ful three times a day. Ill m\ m^i A*l ;i r M M 868 DISEASKS OF THE KIDNEYS. GBArET^KEXAL CALCULI. The formation of gravel in tlie l<idney.s is a common occurrence, hut frequently remains unnoticed, because no uni)leasantsymptoms are caused by them. In most cases, the causes of tiiis alfection are obscure or very ■ uncertain. While the 'gravel (calculi) are generally met with in rather tleshy per- sons wlio live mostly on animal food, yet tiiey do, also, occur in wealily persons, who use a very spare diet. Witliout doubt, the mode of living is the cause of the concretions (gravel,) although a peculiar disposition of body must exist, which is as yet unknown to us. Tlu; urinary concre- tions in the kidneysvary ; at times they form a tine sandy deposit, gravel; at other timeslarger bodies, whose shapes vary aitcording to tlieir locality and their place of origin ; tliey may even be large enougli to fill the cavity of the kidney. Their surface is at times smootli, at otliers rough ; the number of calculi contained in one kidney is very indefinite ; some- times their sides, whore they had been in contact with other calculi, form regular facets. The symptoms, caused by renal calculi, are very iiriportant, because they frequently attain a great hight, and have the appearance of great danger, as though life itself were imperilled by tliem. Gravel may exist without any morbid symptoms; in other cases, the passage, and, perhaps, the formation of gravel are attended with marked derangements of the functions of the stomach, the main feature of which, generally, is an excess of acidity. We have pointed out tliis connection, when si)eaking of chronic catarrh of the stomach. Even larger calculi may exist, and be passed without any i)ain. This depends upon tlie size of the calculus, its smoothness, roughness, or tlie angularity of its form, upon the width of the ureters, upon the sensitiveness of tlie urinary pa.s- sages to the foreign body, whether and what .severe disturiiances the passage of the calculus occasions. Tliese .symptoms, together, are gener- ally designated by the name of renal colic. It should be observed, how- ever, that other oljstacles to the excretion of urine, sucli as tiie presence of bloody coagula in renal liemorrhage, may cause renal colic, except that such colic is usually less persistent, violent, and distressing; for the reason that the obstruction is not fixed, and does not irritate or wound the mucous membrane. Renal colic generally breaks out suddenly, after a severe eflbrt or con- cussion; its gradual development form indefinite pains in tiie renal region, whence they spread to adjoining parts, is of less frequent occur- rence; the former generally takes place, if the pains announce the entrance of a renal calculus into tlie ureter; the latter, if the pain is occa- sioned by a gradual irritation of tlie renal pelvis, or by a change in the position of the concretion. The pains, generally, are very violent, are felt in the region of tiie affected kidney, whence they spread to the blad- der and tlie tliigli, and, wlien excessive, generally, affect the whole side. The patients suffer a great deal, are tortured by an agonizing anxiety, and have no rest in any position or place. Their face is, at times, pale as death, at others bright-red ; the body is cool, the pulse small and fre- quent. If the parts are very sensitive, convulsive symptoms are apt to set in. The passage of urine is impeded and painful, sometimes the GRAVEL. 803 HI le re licl- to ha stranguary is complete. The pains, sometimes, continue gnidiially to increase, until tlie abdomen slirinlcs from tlie least toucli, ur else they remain unchanged, or they remit at intervals, until they finally cease en- tirely, and the patient again enjoy- erfcf^t healtli. In such (.ascs, tlie concretions usually pass off, soon arier, with the urine. If the calculus has not passed the pain may continue, and nephritis result in conseriuence. The passage through the ureter, which, after the intense pain has some- what abated, the patient is able to watcli and point out u.s tiie calculus progresses, lasts from a few hours to several days. The diagnosis of renal colic is not always very easy. Tiie most com- mon characteristic indications of tlie disease are: the fixed sliirtiny-poirit of the pain, togetlier with tlie urinary dilliciilties. Tlie prognusis is unfa- vorable only, if the concretions remain in tiie Icidney, and cause a danger- ous irritation in this organ. An arrest of the calculus in the ureter is a rare exception. ALLOPATHIC TREATMENT. Ghavel or IIhnal Calculus. Tlie relief of pain in a "fit of gravel" (nepliritic colic) is tlie first tiling called for. The most reliable means of relief, is the liypodennlc injection of a quarter of a grain of the Sulphate of .\trophine every fifteen or twenty minutes until relief is oljtained, (by the liands of a physician.) In case relief is not soon given, recourse in severe cases, may be had to the inhala- tion of chloroform. The pa.ssage of the gravel may be hastened by freely drinking water, which increases the secretion of urine; this will carry the gravel before it into the bladder. The most common variety of gravel is uric acid. This ingredient of the urine is very insoluble, and precipitates from the urine in the pelvis of the kidneys. The passage of this gravel causes pain. Wlien gravel of this kind is passed in tlie urine into a vessel, it is known by its red color. The urine is, almost always, acid when voided. The ))reventive treat- ment of this condition consists in rendering tlie uric acid soluble, by tlie use of ihe vegetable salts of potash, as the citrate and Bitartrute of Potash. The Bicarbonate of Potash is, also, appropriate. The uric acid unit( s with the Potash and forms the .Soluble Urate of Potash. Cream of Tartar lemonade may be made by the directions given in the treatment of chronic Bright's disease, and drank as freely as is agreeable to the patient. Or Citrate and Bicarbonate of Potash may be used, also, as there directed, as freely as is desired. Carbonate of Litliium should be given, two or three times a day, in doses of five grains. It may be taken in either of the Potash solutions, or, if disagreeable to the taste, in wafer or capsule Soda is inappropriate in this condition as with Uric Acid; it forms a hard insoluble salt. Alcoholic drinks, wine and i>eer, ought to be omitted. The diet should be plain and simple, but nutritious. An active life in the open air is beneficial. Sometimes the gravel is composed of phosphate salts; then the gravel, If voided in the urine, is of a grayish or white color. The urine is, generally, alkaline. The use of Dilute Nitro-Muriatic Acid, in doses often to twenty drops ;t^ m 1!.il iM DISEASKS OF THE BLADDER. diluted with sweetened water until pleasant, should be taken three timea a day. Benzoate of Ammonia has the power of dissolving the phosphate cal- culi. It may be given in doses of ten to twenty or thirty grains, two or three times a day. The diet should be generous, both in quality and quantity. There should be nervous and mental rest. Tonics of bark and iron are useful. The gravel may be composed of oxalate of lime. In that case, thi' color of the gravel, if voided, is dark brown or y How. Its prevention will consist mainly in the use of Dilute Nitro-Muriatic Acid twenty or thirl v drops in a glass of water, three times a day. TIio use of sweets, and espt-- cially, the rhubarb or pie-plant ought to be disallowed in tlie diet. A calculus may be more easily discharged from tlie bladder, if the urine is retained for a long t'v.up, or the bladder may be washed out through an open mouthed catheter. Stone in the bladder nearly always begins with the presence of a cal- culus (gravel). CHAPTER XVII. DISEASES OF THE BLADDER. m CYSTITIS— INFLAMMATION OF THE BLADDER. Inflammation of the bladder, in most cases, involves the mucous lin- ing of the bladder, and such is called Catari'hal Cystitis. Tlie most frequent causes of cystitis are irritations affecting the mu- cous lining of the bladder, directly; they areeitlioruiechanical, catheter- ism, injections into the bladder^ stone, or medicinal; acrid diuretics, Can- tharides, Copaiba, Cubebs, or even the decomposing urine itself. In other cases, the disease may occur as a complication ; inflammatory dis- turbances of adjoining organs may spread to the bladder, or the cystitis may simply be symptomatic of some acute general affection. In rare cases, only, a cold alone will be sufficient to cause an inflammation of tlie bladder. Thesymptomsofacute cystitis vary. The local symptoms nuiy amount to no more than a slight feeling of pressure in the region of the bladder, andarescarcely ever as intense as Ilartmann describes them. Amid more or less febrile motions, the patient always experiences at first a pain when urinating. When the attack first sets in, a large quantity of urine is voided with painful urging; soon, however, the urine is voided only in drops, and amid the most agonizing pains, as though burning embers were passing through the urethra. This symptom is most strikingly witnessed in the most acute form of cystitis after the use of new beer; it is charac- teristic of this iullammation. Very soon the difficulty of urinating be- comes associated with a constant pain in the region of the bladder: it is INFLAMMATION OF THE BLADDER. 365 a cutting or stitching pain, and is aggravated by motion, urging to stool, cougliing, sneezing, pressure from without; itspreadsupwards tuid down- wards to the penis, perinteum and thigh. At the outset of tlio disease, tlie urine is clear; after a while, it becomes slightly tinged witli blood, and, in the furtlier course of the disease, mixed with flocks of nuu^us and pus-corpuscles, turbid, inclined to decomposition. The general health is not always disturbed correspondingly to tlie abnonuul sensations pro- ceeding from the bladder; at the coirmencement of the disease, tiie gen- eral health is not much impaired, and it is oidy at a later period that restlessness, chills, loss of appetite, and even vomiting, set in. Tlie disease, very frequently, runs such a rapid course that an im- provement, and even complete recovery, may take place in a few days. If the disease increases in intensity, the tenesnms of the bladder may increase to complete retention, the bladder lieeomes extremely distended, and threatening symptoms of prostration set in, whicli may end in death. Usually, however, the disease, unless recovery takes place, assumes alen- tescent character, and becomes chronic. In the chronic form, the pains decrease considerably, only the con- stant urging remains. The mucus is secreted in considerable quantity, and along with it pus, so that the urine has a marked white-yellow appearance, sometimes like milk, and <lcp()sits a very tenacious mucous sediment. The tendency to decomi)osition is very great, the reaction decidedly alkaline, less frequently neutral. However, the urine is decom- posed, only, if it remains for a long time in the bladder. Unless pecu- liar circumstances hasten the loss of strength, it generally takes place very slowly, and the disease may continue for years before death takes place from exhaustion. Complete recovery is a rare event. Among the sequelae, we distinguish ulceration of the mucous membrane, hypertro- phy of the walls of the bladder, paralysis of the detrusor muscle; it is, particularly, the two first named secjuelce that hasten the fatal termina- tion of the disorder, by causing hectic fever, and real phthisis of tlie bladder. What we have said, shows that the prognosis is (juite uncertain. Even if we usually succeed in overcoming an acute catarrh of the blad- der, yet ailments sometimes remain for a long time after the slightest attacks, to which the careless or improper conduct of tlie patient may impart a high degree of gravity. Chronic catarrh of the bladder is always a dangerous disorder, whenever a great deal of the mucus and pus is secreted. HOM<EOPATHIC TREATM ~'. This malady, like the previous one, ought only to be treatetl by non-professional persons wlien medical aid i:! not at hand. Aconifuin is ever requisite in the initiatory treatment o*" this disease, if there be a 'considerable degree of fever, with hot, dry skin and quick, hard pulse. Dose: Dissolve ten pills in two tablespoon fuls of water, and give a taaspoonful of the solution every two hours, until the pulse becomon more healthy, and the skin moist, etc. After which, consult the indications for the following medicines, respectively, wherewith to continue treatment. ir_ ^.:i,v .■H M :¥ i 866 DISEASES OF THE BLADDER. m ! MS - CanfharidcH* \s iiH vahmhlo a remedy in the treatment of Inflam- mation of the BUidder, us in that of the Kidneys, and will, in the greater number of civses, be required to follow the initiatory administration of Aconitum (or even to precede the latter, when the fever has not run so high). Dose: Dissolve eight pills In two tablespoonfuls of water, and give a tcasi)oonful of tiio solution every three hours, until change. Niix-vomica. When the afTection is attributable to an indulgence in wine and spirituous liquors, this remedy, timely administered, will, in many instances, chock its further progress; and, also, when it results from suppressed piles, or other habitual discharges, or from dyspeptic derangements. Done: An for Canth. Pulsatilla is valuable in checking the development of the affection when arising from suppressed menstruation. It is, also, serviceable in all cases, from whatever cause arising, when occurring in individuals of phlegmatic temperament, with the following symptoms: frequent desire to urinate, painful and scanty emission of water, either slimy or tinged with blood, which deposits a purulent-looking sediment; burning and cutting pains in the lower part of the belly, with external heat and tume- faction ; suppression of urine. Dose: Six pills in a tcaspoonful of water, every six hours, until ame- lioration or change. Helleboras-niff., Veratrutn, These medicines are of considerable service in cases of in llammation of the bladder, which come on gradu- ally, but, subsequently, become very severe, attended with frequent urg- ing to pass water, and spasmodic pains, during which only a small quan- tity of wator is passed ; to these symptoms are added continual inclination to vomit, aversion to all kinds of food, excessive distention of the belly. Dose: Of either of these remedies as selected, give six pills in a tea- spoonful of water, every two hours, until three doses have been given, and then every six hours, until positive amelioration or change. HEMATURIA— BLOODY URINE. Bloody urine, proceeding from the bladder, originates most com- monly in injuries of the mucous membrane of the bladder by foreign bodies, or by concretions. Moreover, hematuria, and malignant growths in the bladder, may arise from inflammation of the bladder and its conse- quences, ulcerations and dilation of the vessels. It is seldom the case that hemorrhage from the bladder occurs without any, evidently, mate- rial cause. As in the kidneys, so in the bladder, certain poisons may cause hemorrhage, though, in the latter, less frequently than in the former. Excepting the symptoms of the casual afTection, the symptoms of hematuria are generally trifling, determined, for the most part, by the coagula that form very readily, and interfere with the easy flow of urine. *AVhpti mi nffpctlon of the bladder haa been Induced by the local application of CantharidoB, tii the fiirm of II wlaster, the Tincture of Camphor should bo employed as an antidote, In the manner desrribed iit ]jR5e 8y. BLOODY URINE 367 Hence, we have urging, tenesmus, spasm of the bladder, burning or cut- ting pains, and, very frequently, a perfect 'absence of pain. Tlio symp- toms are always restricted to the bladder, and do not involvo tiie kidneys in any way. As a rule, the blood is not intimately mixed with the urine, is not decomposed, and, if the liomorrlKige is at all considerable, the blood coagulates in such quantity, that the catheter is often required in order to efTccta passage for the urine. Tlie flow of blood from the bladder very easily exceeds the quantity flowing from the kidneys, and hence super- induces, more readily, the phenomena entailed by loss of blood. On tlie other hand, an hemorrliage from the bladder usually lias a shorter dura- tion than hemorrhage from the kidneys, and scarcely ever lasts uninter- ruptedly for weeks. Of itself, it is scarcely ever an accident of any great Importance. ALLOPATHIC TREATMENT. In the treatment of bloody urine, we ought to discriminate between hemorrhage from the bladder and from the kidneys. In hemorrhage from the kidney the blood is more evenly mixed through the urine, and flbrin ■ i^ apt to be discharged in long strings, which have been moulded in the ureter (the tubes leading from the kidneys to tlie bladder). In hemorrhage from the bladder, the blood is apt to be passed with the very last of the urine voided. Internally, the remedies to be resorted to are the following: The Tincture Muriate of Iron, which should be given in doses of twenty or thirty drops largely diluted in sweetened water ; Gallic Acid may be given with Ergot, the former in doses of ten to fifteen grains, with five or six drops of Aromatic Sulphuric Acid, in water, and the latter in doses of a teaspoonful of tlie Fluid Extract, four times a day, or oftener. In this, as in other forms of hemorrhagic disease, a useful formula is : Take of Qallio Acid a dram, Ergotiw and Di;/italis,ea.ch, a Neni,ple. Make into twenty pills. Dose: One every four hours. Turpentine is also a useful and available remedy. It may be given in the following mixture: Take of Oil of J'urpentine three drams. Fluid Extract of Digitalis a dram, Mucilage of Ouin Arabic half an ounce. Gly- cerine two ounces, Water an ounce, Oil of Gaultheria half a dram. Mix. Dose : A dessertspoonful every three hours. Should the disease be periodical, ten grains of Quinine once or twice a day, wUl prove the l)est remedy. The Tincture Muriate t^iu.uld be given alternately with any of the other plans of treatment given. In case the hemorrhage is from the bladder, it is best to wash out that organ by injecting into it a solution of Tannin, or Alum, or both, strong enough to have a styptic taste. When the hemorrhage is from the kidneys, hot air baths and purga- tives are called for, as directed in the cha])ter on Diseases of the Kidneys. Drink should be simple, as plain water, barley-water, etc., which may be taken freely. HOMCEOPATHIC TREATMENT. The best remedies for hemorrhage from the urinary organs are : Arnica. When caused by gravel in the bladder, injury from exter- nal causes, like a fall or blow. Especially, if caused by the awkward or iguorant use of the catheter. »h-" ■iV'] '» I H . Ff y iM 868 DISEASES OF THE BLADDER. . Dose: Six pills every two to four hours. Cannabis. The flow of blood is accompanied by retention of nrino, or at least, by painful urination, burning, lancinating, sliarp pains during the emission of urine, j/Z/ie where the blood comes from the urethra also. Dose : As for Arnica. Cantliaris is only good where there is much pain of a violent cut- ting, pressing, and crampy character, extending into the urethr*. and, also, into the kidneys. Pain increased by drinking water. Dose : As for Arnica . Nux Vomica. If the difficulty is caused by the abuse of spirits, by suppressed menses, etc. Dose: Afi for Arnica. Sassafras tea, or a few drops of Oil of Sassafras on a lump of sugar, taken three times a day, is a sovereign remedy. Tlie Oil is best. Take it for two days only. Witch Hazel. In any form, as a tea (home-made,) Pond's Extract, Humphrey's Extract, or any of the standard extracts of this remedy may be relied on as very good indeed, in all cases of this kind, as well as in many other forms of excessive bleeding. Ipecacuanha. Is reliable where there is profuse loss of blood, with cutting in the abdomen and urethra, faintness, deadly paleness, sickness at the stomach, oppression of the chest, and a feeling of warmth in the lower abdomen. Dose : As for Arnica. ENUBESI8 NOCTUJtNA— WETTING THE BED. This inconvenience would be of little consequence, except for the cry- ing abuses to which the endeavor to remove it has led. Physicians, as well as parents, have supposed that this weakness could be done away with by purely educational means, whicii were, moreover, suggested by the most insane views regarding its causes. Latterly, physicians have im- proved their methods of meeting this accident ; lay-persons, however, are still true to their absurd prejudices in this respect. AVetting the bed is an accident to which children are liable; it seldom lasts beyond the age of pubescence, still less beyond the age of twenty years. Healthy individuals scarcely ever wet their beds more than once. This trouble, generally, dates from the earliest infancy, and rarely makes its appearance at a later period. Various causes have been assigned for it, and corresponding methods of treatment devised for its cure, however, with varied results. Laziness may give rise to it in many cases, but more frequently it is the fearof getting up in the dark. A common causeof the trouble is, that children sleep too soundly to be roused from their sleep by the irritating action of the urine upon the bladder. Yet the bladder need not be weak or paralyzed ; if so, the accident may take place even during a light sleep. The children, generally, say that they dreamed of wetting the bed, showing that the irritation was not sufficiently powerful to wake them. The quality of the urine may cause a passing attack of enuresis; we see this in children who are liable to catarrhal attacks, and, under such circumstances, immediately void a saturated urine. The irritation caused by pin-worms may, likewise, induce enuresis, "Bi l||! WETTINO THE BED. 869 e Corporeal punishment shouM never be resorted to as a meima ^f curing this weakness, wl>ich is rather made worse by it than otherwise ; older children are made so nervous by this treatment, that they sometimes remain wide awake half the night On the contrary, their sense of honor and will should be appealed to. It is of no use to keep the ordinary bever- age from them in the evening; this may cover up tlie weakness for a time, which returns again as soon as a little more liquid is again partaken of. Nor is» it of any more use to frequently rouse children from tlieir sleep at night. If no abnormal conditions forbid, the best ])lan is. to gradually accustom the bladder to hold larger quantities of liquid. Children should be accustomed during the day to retain the urine as long as may seem proper, and not to yield to the least desire to urinate, as is their usual cus- tom. This system, if carried out consistently and vigorously, is often alone sulRcient, u\ otherwise normal cases, to effect a cure, of course not in a few days. By measuring the quantity of urine at every discharge, we can determine a priori the time when tlie enuresis will cease. The more the quantity increases the nearer we are to a cur(5. This method has the advantage of being readily adopted by the children, provided they are promised a speedy delivery from their trouble. ALLOPATHIC TREATiM:ENT. The involuntary now of urine during sleep, so frequently met with in young children, may result from any of the causes of incontinence. The character of the urine is to be examined in all cases. If it is alkaline when first voided Dilute Nitro-Muriatic Acid should be given in doses of from five to twenty drops, in from a (luarter to half a glass of sweetened water, three or more times a day, to cause an acid reaction of the urine. If the patient is weakly, ten drops of the Tinc- ture Muriate of Iron should be given in the same way as the acid, after each meal. Should the urine be exceedingly acid when first voided, alkalies ought to be given. A drink of Cream of Tartar Lemonade may be used: Take from two to four teaspoonfuls of Cream of Tartar, dissolve in hut water; when cold pour of the clear liquid, cut soTue lemons into it and sweeten. Brink as desired. The patient ought to be made to drink spar- ingly of water, or other fluids, during the latter part of the day. During the night he should sleep on the side. He ought to be wakened if he turn on his back. The next indication, is to overcome the irritability of the bladder. There is no remedy, which so positively accomplishes this as Belladonna. Take of Sulphate of Atropine one grain, dissolve in one ounce of distilled water. Give five drops at bed-time, and increase the dose by two drops each night, until the incontinence ceases, or marked dryness of the throat, or dila- tion of the pupil is produced. The Tincture of Belladonna may be used for the same purpose, in doses of five drops. The ratio of increase of the Tincture may be five drops, until the same results are produced. If the trouble does not cease under the use of the Belladonna alone, the Tincture of Nux-vomica may be given, in doses of three drops three times a day, to a child of three to five years old. If the child is five years old or over, five drops may b6 given. Ergot is often efficacious in this disease, twenty to thirty drops of the fluid Extract may be given in water, two or three times a day. 24 . • w I M it y": u ifTO DISEASES OP TIIR BfiADnKR. l\ Iodide of Iron is often, especiiilly servicoiiblo in this troublo. It SRCins adapted to cases of woalc, pilo, HcrofnloiiH diildren. Thn Sy,-npofthe Iodide of Iron may bo given in doses of twenty drops, largely diluted in water, three times a day. If it is used, it is not necessary to use tho Muri- atic Tincture. If these means fail, it is best to awaken tlie patient once or twice in the night to empty the bladder. A large ball, roll of cloth, or something of the kind may be tied to the back of the patient, which will awaken him if he turns upon his l)ack, when he may arise and empty his bladder. It is claimed, tliat the trouldo is caused in some boys by a long prepuce having a very small opening, giving rise to irritability of tlie bladder: That, in that case, drugs are useless, but circumcision removes tlie diffi- culty. HOMCEOPATHIC TREATMENT. Wliere, in spite of every precaution on the part of tlie nurse, cliildren wet tlie bed every niglit, and no otlier symptom of derangement can be detected, the following remedies are often elTectnal in surmounting the weakness. Sepia is to be preferred, when the mishap generally occurs during the first sleep. Dose: Six pills in a teaspoonf uT of water at bed time, for four nights in succession; tlien pause four days, and resuuie the administration, if necessary, on alternate days, four times ,uu\ so on. AHdum-ithosphoricani will prove useful in some cases when large quantities of urine are emitted, so that the child's bed is "Hooded" nightly. Dose : As for Sepia. Belladonna is appropriate in cases in wliich the weakness is evi- dently incidental to a relaxed condition of the bladder, or, to cerebral irri- tation. Dose: Four pills in a teaspoonf ul of water, repeated, if necessary, every day. Sulphnv sliould be perseveringly employed in almost all chronic cases occurring in delicate children, but particularly in those who are, or have been subject to eruptions on the skin. Dose: As directed for Sepia. Cina is a useful remedy when the existence of worms appears to b» the irritating cause. Dose: Eight pills, as directed lor Sepia. CrSTOSPJSMUS-SPAS3r OF THE BLADDEB. This spasm is a symptom in many affectiwiis of the urinary organs and, as such, is not referred to in this place. There is no doubt, that if may, likewise, present a. pure nervous condition of the bladder, although its occurrence, as such, is comparatively rare. The disease may break out at any age, but is most frequent in middle- aged individuals of the male sex. All persons with weak and irritabl'? nerves are predisposed to this affection, hence it is most frequently met with amcmg hypochondriac and hysteric individuals. Hence, a sudden emotion, an outburst of passion, great depression of strength, violent exertions during sexual intercourse, onanism, may be proximate causes of » SPASM UF TllK ULADDKK. 871 the disease. Whether a simple spasm of the bladder may be caused by a cold, is questionable. A spasm of the bladder commonly sots iu quito suddenly, (the patient beinj; otherwise in tlie onjoymenl ofyood liealtli,) as a 'olent, constrictive pain, proceeding from the neck of the bladder, and extondinj? alonf,' the under side of the penis towards tlie glans, and attended with i)artial or complete erection ; sometimes radiating to tlie groin, testes, tliiglis, and very often, at the same time, along tlie perinooum towards the anus, accom- panied by a pain resembling tenesmus. If tlie spasm affects tlie detrusor muscle (the muscle tliat forces the urine from tlie bladder) alone, tlie least accumulation of urine excites a violent desire to void it, so that the patients are sometimes unable to prevent the tlovvof urine; if the sphincter (the muscle that retains the urine in the bladder) is affected, the urine; is either voided drop by drop, or cannot be voided at all; if the detrusor and sphincter are affected at the same time, we have the most violent urging to urinate, attended with a more or less complete inability to void the urine; tliis last-mentioned case is most apt to cause nervous phenom- ena of a different kind, such as anguish, restlessness, trembling, convul- sions, violent tenesmus. An attack of spasm may l.ist from one or more minutes to half an hour. After the pains begin to abate, the urine some- times passes off in a full stream, clearer and paler than usual. The return of the paroxysm is not governed by any rule, since the spasm sometimes only takes place once, sometimes a number of times, even on tlie same day. ALLOPATHIC TREATMENT. Spasm of the bladder is best and most quickly relieved by an injection into the bowel, of a teaspoonf u! of Laud- anum, and thirty drops of tlie Tincture of Belladonna, in one or two table- spoonfuls of thin starch. The injection should be made with a hard- rubber syringe. Hot applications may be made over the bladder and between the legs. This may be well done with a hop poultice. The removal of the cause is more difficult. A gouty condition and a highly acid urine, is to be met by the use of alkalies, as the Cream of Tar- tar Lemonade, made by dissolving an ounce of Cream of Tartar in hot, loater ; after cooling, the dear, supernatant liquid is to be poured off and drank during tlie day, uiith the addition of lemons and sugar. Or Citrate of Potash may be taken as follows: Dissolve four ounces, each, of Citrate and Bicarbonate of Potash in a pint of water. Tioo tablespoonfuls of this may be drank in Imlf a glass of sweetened water, after mixing with it a tablespoonful of Lemon Juice, or a solution of Citric Acid two ounces io the pint of water. The dose may be repeated four to six times a da„ This makes the urine bland and unirritating. Wine of Colchium may be given in doses of ten to thirty drops, tliree or four times a day, omitting its use wlien the bowels move too freely. Should the trouble be caused by an inflamed (or abscess of) kidney, anodynes should be given as needed, and the person treated as directed in that disease. If caused by a stone in the bladder, as denoted by severe pain afte;- voiding urine, the removal of the stone by a surgeon, is ine only certain treatment. Opium and Belladonna can only temporarily relieve pain. . Excessive venery is one cause whicli is removed only by continence. The diet should be plain and nutritious. All stimulants should be m IH^ iI'M. m 872 OIBKAHIiS OF THK BLADDKK. avoided. Milk may be allowed freely. Barley-water and Flaxseed tea are apprupriatu as driiikn. In Paralysis ok thk Bladdeu, if there is an overflow of urine (con- stant passinjf water.) the catheter ought iuiniediatoly to bn nsed, the bladder emptied, and tlitn washed out with warm water. Tlie use of the catlictei twice a day, or oftener, is necessary, as Ion)? as the paralysis continues. The catheter used should be large, and the bladder completely emptied each time. The bladder ouglit frequently to be washed out with warm water. Remedies calculated to restore the muscular power, are: Strychnine, Electricity and Ergot. The dose of Strychnine is one-thirtieth of a grain three times a day. It may be given in solution with Dilute Phosphoric Acid. Take of the Sulphate of Strychnine one grain. Dilate PhospfiDria Acid half an ounce. After solution is effected, add Syrup of Ginger three and a half ounces. Mix. Dose: A teaspoonful three times a day. *" If the patient is feeble, half a dram of the Pyro-phosphate of Iron may be added to the mixture, and also half a dram of Sulphate of Quinine, if its tonic effect is needed. Ergot is also valuable in this trouble. The dose of the Fluid Extract ia half a teaspoonful to a teaspoonful, in water, three or four times a day. The form of Electricity most appropriate, is the direct current. Hot hip batiis, the cold douche, blisters over the lower part of the spine, are said to be serviceable. Aloes is the most suitable purge. HOME REMEDIES. Acid, or alkaline drinks, in any of the various forms usually present in the house. Hot poultices, hot bricks, or other hot applications to the region of the bladder. Camphor, freely inhaled, sometimes relieves ; a wry t^;eaA; tea made from a few sprigs of Deadly Nightshade, will be good, but must be used very carefully. I»AJE1T EIGmTH. DISEASES OF THE MALE SEXUAL ORGANS. CHAPTER :i^VIII. OnCniTIS-INFLAMMATlOX OF THE TESTES. Now niul tlu'ii, tliia affection is met with, as tlie result of mechanical injuries, but most froquently originates in gonorrhoea. It not only super- venes during tlie eourse of acui uretliritis, but it may, likewise, set in suddenly during gleet, generally, witliout any apparent exciting cause. Severe exertion, or the discontinuance of the use of suspensories, are said sometimes to cause the disease, but this is not an established fact. The excessive use of beer or wine is a mucli more active cause of the disease, probably because tlie inflammation is very much increased by such stim- ulants, lioth Cubebs and Coj)aiba hold tlie same relation to gonorrhoea. They have a speciflc effect upon the ur(!thra, and it is easily conceivable that, instead of effecting a cure when given in large quantities, they aggravate the inflammatory symptoms, and, owing to the speciflc action wliich tliey likewise exert upon the testicles, communicate the inflam- mation to tliese organs. Symptoms. Orchitis seldom sets in suddenly. Ordinarily, it com- mences with slight drawing painsin the spermatic cord, which is sensi- tive to contact. At the same time, the patient experiences violent tearing pains in the thigh of the affected side. The weight of the testicles at first is troublesome, then becomes painful, and, finally, intolerable. In one or two days tlio epididymis becomes painful to pressure, swells with more or less rapidity, and shortly after is succeeded by an inflammatory effusion into tlie tunica propria, in consequence of which the testicle very soon enlarges to tiie size of aflst. The pains now become agonizing; the patient has to confine himself to a horizontal posture, with the testicle properly supported. The pain is a burning, tearing pain, most frequently, with remissions after the fashion of rheumatic pains. The general con- dition of the patient does not suffer much, only in violent cases, there is fever or even vomiting. The discharge usually disappears after the orchitis is fully developed, and does not re-appear until the inflamma- tion has run its course; only in a few cases, it does not re-appear aftet the subsidence of orchitis. The inflammation, in its acute form, does not often last beyond the tenth day, sometimes the improvement commences on the fourth day. 373 ^ !l ft74 DISEASES OF THE MALE SEXUAL OT'.nANS. i ^'ffl 'i II »•.,«' m. Z" This, liowever, is not very rapid, since it soniotiiiu's lakes weel^s before ilie testicle resumes its former size; very fequently an obstinate swelling of the testiciefi remains. ALLOPATHIC TREATMENT. Inflammation <,r tlie testicle is to l)e treated, flrst, by absolute rest. Tlie patient slioukl lic confined to liis bed, and should not be permitted to rise for anj'thing. The bowels should move into a bed pan, and the urine be voided while lying down ; above? all, he must not walk about, nor even sit in a chair. Tlio testicles must be sujiported by a roll of soft cloth between the thighs, while the patient lies upon his back. Tlie support nmst be sufflcient to relieve the pain as much as jjossible. Such applications should be made as will give ihe greatest relief to the pain. This is, generally, best done jy hot applications, as flannels wrung out in hot water, covered with oiled 3ilk to retain their moisture, and heat or warm poultices. Sometimes cold applications are more grate- ful ; tliey should then be resorted to, and cYen ice applied, if it relieves the pain more than otlier means. I have often found cloths, di])ped in a solution of ten grains of the Acetate of Morphine, and two scruples of Sugar of Lead, in a quart of soft water, a grateful application. * A brisk purge may be given at the beginning of the trouble. For tills purpose, nothing is better than a couple of tablespoon fuls of Epsom Salts. (If this amount is boiled a couple of miimtes with two and a half teaspoonfuls of roasted cofFce in an earthen vessel, and allowed to draw for a few minutes, tlien strained, it can l)e taken without trouble) or the sameamountof Citrate of Magnesia, or Roclielle Salts taken in lemonade or a couple of Seidlitz Powders may bo used. During tlie liight of tlie inflammation, a quarter of a grain of Mor- phine, or twenty-five drops of Laudanum, with ten or fifteen drops of Tincture of Belladonna maybe given sufficiently often to relieve the pain. Or a teaspoonful of Laudanum, anr thirty drops of Tincture of Belladonna, with a couple of tablespoonfuls of thin starcli may be given by injection into the Iwwel, once or twice a day, and any additional ano- dyne, if needed, given by the mouth. If the inflammation leaves the testicle in a hardened condition, which does not disappear, it may be removed by applying Tincture of Iodine once a day, or every otlitr day. HOMffiOPATHlC TREATMENT. Orchitis, or inflammation of the testicles, when depending on an injury can be relieved by Arnica. A dose every four to eight hours ; also, apply exterally. If the result of gonorrhoea, by Clematis or Aurum if a dose is t^iCeu every evening. Pulsatilla is, also, a reliable remedy, if the swelling is considerable, without fever or tliirst. ^Icomfe, if there is much fever and tliirst, and, especially, if this should occur at the beginning of the attack, which it should, usually, be expected will be the case. SPEBMATORRIICEA. By this heading, we, strictly speaking, compreiiend a flow of semen without any sexual excitement. However, iii order to avoid the necessity SPKRMATOllUIICEA. 375 of resorting to a number of sub-divisions, we have classed together in this chapter abnormal nocturnal emissions, as well as various other nioibid derangements of the male sexual organs; an additional motive for tliis arrangement, is the circumstance that the treatment of most of tliese con- ditions is the same. The functions of the male sexual orgiins, vary in accordance Avith tem- perament, mode of . constitution, etc., to such an extent, that it is often difficult to decide, wlietlier, these differences are of a morbid nature, or belong to the normal standard. This can only lie detenniucd by tlio man- ner in whicli the male sexual sphere is, generally, affected by tlie local phenomena; whether the organs are not abnormally disturbed, or whet'.K.r the procreative powers are impared or even suspended. The history of these various abnormal condition;^ (jf the sexual si>here is pretty much tlie same, ©ebilitating constitutional diseases, or acute diseases during the period of convalescence, are apt to causo a so-called irritable weakness in the sexual sphere, which, in the former case, is per- manent, and in the latter case only temporary. This fact is most strikingly witnessed in iliabetes and tuberculosis. In the last-named condition, tho excessive irritability of the sexual organs contribute to hasten tho gen- eral decay. A second cause are cardiac aiid nervous diseases, wliicli may, however, likewise, result from the sexual weiikuess. Hypoelioniria is a frequent cause, and still a more frequent consequence of sexual weakness. The most common cause of sexual weakness is tlie vice of onanism, which is too much overlooked by physicians. Yet it is certain, tint tlu)usand3 miglit, by a timely warning, l)e saved from unspeakable mental and pliysi- cal disease. Excessive nocturnal emissions, generrlly, take place between the years* of twenty and twenty-five, and, excepti. aally. at an earlier age, even six- teen. They are of a morbid nature, if they occur aluiOLst regularly without rousing one from sleep, and if tliey do not occur often, yet leave for days a sensation of languor and debility, and of mental depression. They are, likewise, abnornuil if they occur several times in one niglitor week. More- over, every emission that takes place in the waking slate, with or without any special cause, at stool for instance, is to be regarded as abnormal. The consequences of such abnormal losses very soon show tlieniselves: Paleness of the face, with dark margins arouiul the eyes; insullieient sleep; drowsiness, with inability to sleep; dullness of the head ; aching, pressing pain in the head ; vertigo; irritable, sensitive teiujicr; aversion to society, to work, and, after a while, a deranged ai)i)etite and digestion ; deficient assimilation. Spermatorrluea, properly speaking, consists of a loss of semen at every emission of urine, at stool, without any cause, or after the most tri- fling erections. The pernicious consequences of this sort of spermator- rhoea, manifest themselves much more speedily than after nocturnal emissions, most probably because spermatorrha3a never occurs in organ- isms, whose physiological functions had been carried on in a normal manner. Irritable weakness of the sexual organs is sometimes the cause, but more frequently the consequence of both tlie previously-mentioned anomalies. The sexual excitement occurs too easily and too vehemently without possessing sufficient energy and consistence, for the act of coition. »i "■•<■. ^. ''.'iAv: t W\ ■j -■■« I ■>% !»'< U 176 DISEASES OP THE MALE SaXUAL, ORGANS. J ** -^ The ejaculation of the semen takes place too soon, or even not iit uh, or the introduction of the penis into the the vagina is prevented, 1»)' a prcuia- ture cessation of the erection. The sexual weakness may be characterized by all sorts of abnormal manifestations in the sexual sphere. The mental disposition exerts a powerful hilluenco in this direction. Hypochondriacs are particularly disposed to irritable weakness, which, under abnormal mental influences, sometimes attains to such a degree of intensity, that it seems to amount to complete impotence. Complete impotence, by which Is meant an entire suspension of tlie ability to perform the sexual net, is, upon the whole, a very rare and, fre- quently, only temporary disorder, except wlien depending upon debilitat- ing incurable consatutional diseases, such as diabetes or tuberculosis, or when depending upon the loss of one testicle. An excess of sexniil excitement (satyriasis) besides taking place at the comraenoement of gouorrluea, as we have already stated, may, likewise, occur ill consequence of debilitating conditions, first as a passing increase, and subsequently, to bo succeeded by a decrease of excitability. It is fre- quently met with, in tlie case of persons who have been addicted to the vice of onanism, or among worn-out roues; very rarely without such a cause, and then, mostly as a symptom of some deep-seated disease of the brain. In treating most of these forms of sexual weakness, the diet, modo of life and psychical (mental) agencies exert an important influence ; bonce we place them in the front rank. We cannot lay it down, a^ a rule, that these morbid conditions require either a lean or strengthening diet. Some are afflicted with weakness of the sexual organs, more especially wit' excessive pollu- tions, because they live too well; it is a mistake to suppose that this waste is repaired by a nourishing diet, since it is well known that some })ers(ms are living in circuniKtanci s whicli preclude the possibility i»f indulging in good living. Hence, it becomes a matter of interest to inquire whether a lean or rich diet is the more suitable. All such patients must be cautioned against going to sleep v/itli a full bladder or a full stomach, either in the daytime or at night, (certain beverages, such as spirits and hop beer, nmst be strictly avoided. Beer-drinkers are very apt to deny the debilitating influence of hop beer on the genital organs ; that this influence exists, must be evident to all who are aequainted with the effects of Lupulin. It is well known that drunkenness, either partial or total, causes an irritable weakness of tiie sexual organs. Coffee, and, in some, even tobacco, liaveto bo interdicted ; among the secondary efTeets of cofTee, \/e notice a depressing excitability and irritability of the nervous system. In general, all strongly spiced and stinuilatlng food is hurtful. Af« regards bodily exercise, it is certain that bodily fatigue di ■^'nishes sexual excitement, and brings it bach again t a normal stauoard; muscular exercise has also the advantage of preventing the mind from dwelling upon erotic subjects. Viewed from this point, walking is not the best kind of exercise, for the reason that it leaves the mind free to revel in all kinds of fancies; onanists are verv apt to be fond of walking. Severe mental labor is sometimes preferable to bodily exercise, especially in the ';!ft SPERMATOURIICEA. m case of hypocondriacs and onanists. This leads us to a consideration o' psychical inlluences, as a means of cure. Every physician knows, that the evil consequences of nocturnal emis- sions, and even, to some extent, of self-abuse, are more imiiginsvry tluin real. Numbers are made hypocondriuc reading books that fill tbem with fear and trembling at the exces '>y may have been guilty of in former days. Encouraging advice does inoie good than medicine. Self- abuse is prevented much more certainly by comforting encouragement than by picturing the consequences of sucli a crime in the most frightfu/ colors. In dealing with sexual weakness, it is, in the first place, necessary to depress the fancy, and in the second place, to strengtlien the will. On this account, reading novels is so hurtful, and cold-water treatment has such an excellent effect. Prof. O. S. Fowler, the world-renowned Phrenologist, and keen observer, makes these truthful remarks about the prevention of this fear- ful vice, self-abuse, bv knowledge: "What .Sala'^ation remains for those yet guiltless? To forestall is infinitely better than to cure. Must all our noble boys, all our pure, lovely girls, be defiled by this moral leprosy, and lost if not redeemed?" "Is there no pukvention? Can they not, somehow, be kept from this fell destroyer? Must all fall over this moral precipice, only to lie marred and defiled for life? What a pity, this offering up of human life on this vile alter! We cannot spare our sons, we must not lose our daughters thus! They are too infinitely precious. Tiiink what a darling child is worth ! Its entire future, and all its decendants are at stake. The risk is too awful. No parents should sleei) until they have first so liedged tlieir children around that they cannot sin. How can this plague be stayed;' Not by Ignorance. TJiat has been tried, only to fail, quite too long already. All who fail, sin for want of knowledge. Nothing can he clearer. Say, ye M'ho have sinned, did you not err through ignorance? Would not one seasonable word have prevented all tiie suffering it has caused you? Let universal experience decide. Parkntal WAitxiNG and counsi:ling are its great forestallers and preventers. Parents aie bound to feed, clothe and educate their children, and guard them asiainst lying, stealing, etc., then why not against this secret sin, as well, as much the 7nost, iis it is ruinous to soul and body. God in nature puts on parents the sacred duty of guarding their children against all sinful and self- ruining practices; and their first duty is to guard them against tliis vice. And the guilt of those who do tall, rests not on tl\e poor, life-long suffering victims, but on their parents." "An eighteen-year old liliputian, in Portland, Me., when told that this had made him small and weak, clinched his fist, gritted his teeth, and muttered curses upon his father and elder brother who lately deceased, who died by this sin, because they allowed him to fall by not warning him, and he was uiaiiT. So has any otlier child, whose parents let hira or her contract tliis vice. Parents are their children's keepers, i^t the children their own. Choose your own means, but use some eff'ei't ual endl Give them no occasion to curse your neglect. Tiie mother is more especially adapted and required to teacli tliis class of trutlis. In ordaining that she nurse them, nature; commands that slic supi)ly their other physical wants, and also mould their morale! Those who defile themselves, may justly fci !< k' 4 "IK I ^ 878 DISEASES OF THE MALE SEXUAL ORGANS. i *'6>* ■' blame her most; yet blame is too weak a term. She should teach them the sacreduess ot this structure, and to guard it as the apple of their eye.'' "All communities contain sufferers from sexual abuses; let her make such her walking examples of breaking this law of chastity. Parents should teach sexual trutlis, aided by good books, as early as they can bo understood. You must plant knowledge before the sin has taken root; muo?i best— before the seeds of sin have been sown." " To THE Sexual Education of Gikls, these i)rinciple3 apply with redoubled force. Young America Icauis s'l'.'h things earli/ and easily." Stop the act, and that and cold water will complete the cure. ALLOPATHIC THE ATMENT. In Spermatorrhcca, if the discharges are only occasional, and tlie general health is not affected, no special treat- ment is required if tlie patient is un!narri(v,l ; as soon after marriage the annoyance will cease witliout treatment. It is best, however, that he should not eat a hearty meal for four or five hours before retiring ; he should empty the bladder before retiring ; the bod sliould be hard avid the coverings rather light; he must lie on his side, never on his back, and rise about the middle of his night's rest, and stepping on the cold floor, empty his bladder again. In instances in which the health has become debilitated, and the functions of the mind impaired.it will be necessary to institute medical treatment. In these cases, the wliole nervous system has lost tone. The diet should be nutritious but plain; cold batliiug and tonics shomd be i-esorted to. If the patient is unmarried, I wouhl put him upon the use of Strychnine and Quinine dissolved in Dilute Pliosphoric Acid, as: Take, of Sulphate of Strychnine a (jrain. Dilute Phospliorin Af.id oneoaiv;e; after the Strynhnine is dismlved, add half a dram of the Sulphate of Quinine, and three ounces of Syrup of Oranoe Flowers, or Simple Syrup. Dose : A teaspoonf ul three times a day. If the patient is married, I would give two or three grains of Pyro- phosphate of Iron in syrup, after eating, giving tlie former mixture before eating; or, instead of the first mixture, Piiosphid'' of Zinc and Niix-vomica, a quarter of a grain each, may be taken in pill three times a day; or the pills of Phosphorous, N'ux-vomica. and Quinine may be used. In addition, toaspoonful doses of Fluid Extract of Er'jotmay be taken one, two or three times a day; from two to twenty droi)3 of Tincture of Belladonna may be given with the Ergot, at night, witli benefit. The dose should be increased until benefit or dryness of the throat is produced. In cases more extreme, with greatly reduced health, it may he neces- sary to resort to Cod Liver Oil, in addition to other tonic treatment. In rebellious cases, Mr. Erichsen's method of ai)plying a solution of Nitrate of Silver to the neck of the bladder, through a silver catheter hav- ing several fenestrations (openings) should be resorted to. The strength of theSolutloi«ihould be five grains to the ounce, at first ; but, after two or three weeks, if no improvement result, the strength may be Increased. The solution is driven out of the openings by a sponge fastened to the end of a wire stylet, being pushed through the catheter to the end next the bladder. Occasionally, the daily introduction of cold steel sounds, will answer the same purpose. ! i lem i-e.'' iike mts 1 bo Jot; nth •ges 3;it- the he he the 3or, the ical Hie be use ake fUr Ine, i 'J • m ' iHi '* rv 'M 11, ! IP if UH k M w^U ro- Dre iCil, tlie oil. ree be iod es- of IV- ;lh wo ed. nd he ill ll ifl ill i 'I't ■ i:-' i *« « mim l«i.' S9 ■■ Vi h f S'-lT^ ^i M: '■< li '' 'lib 1 i.t ' \h: m THE HEART AND LUNGS. It' ,■• li'i SPEKMATOltRHCEA. 879 T)ie measure, which succeeds in the end, without fail, is life in wed- lock. In some extreme cases, the cure is not attained for ii year, or, per- haps, more. Only a temjiorary lack of capacity exists, and, eventually, u complete cure results, if the patient lives a married life, and the general liealth is good, or restored with tlie use of appropriate tonics. If the person is unmarried, and in robust health, it is best to use the following prescription : Take of Bromide of Potassium an ounce, Infu- •ilon of Digitalis eight ounces. Mix. Dose: A tablespoonful twice a day, and, after the emissions cease; give at night only. In this class of persons, from two to five two grain pills of Monobro- mated Camphor, taken twice a day, is api)ropriate treatment. As with the Bromide of Potassium, after the involuntary emissions cease, the medicine need only be taken at nlsht. When the Bromides of Camphor or Potassium are used, and the discliarge is not stopped, a pill of a third of a grain of Extract of Bolladoniia, and one or two grains of Extract of Hyoscyamus should be taken, at bed time, in addition. THE ITEABT AND LUNOS. The Heart and Lungs in their natural position, showing how the air is passed to, througli and from the lungs, and liow the blood is distributed through the lungs. The left side of the illustration shows the small air-cells all removed, exposing all the bronchial tubes of the rigiit lung. The right side of the illustration shows iiow the blood i)asses from the heart through the pulmonary artery/, y, and by means of the very numerous branches of that artery is distributed to every part of the loft lung, where it comes in close contact witli the air in the lung, and is changed and purified, throwing off the impure gases gathered up in its circuit tlnougii the body, and is further changed by chemical action of the air on the blood, a process too complicated to permit of an explanation here. Tliere is a very thin parti- tion through which the blood will not pass, separating the blood from the air in the lungs. Tlie lungs must be filled with air every few seconds from 15 to 25 times every minute, and the blood is forced into them by the heart's pidsations from 60 to 100 times per minute, viirying in either case with the age of the individual; and ;dl these numbers are further varied by the effects of various diseases, as indicated in the body of this work. Usually the heart beats four times for every time the lungs are filled with air. This illustration is very fine, and to any person desiring to make a minute study of anatomy the reference letters will render much assistance. ;* 1 Hi* "■ill ifli" I 1»>J 4., S^ ^ t \ n IW-, f m I>AIl.T IVIIVTH. DISEASES OF THE RESPIRATORY ORGANS. CHAPTER X IX. DISEASES OF THE LARINX AND TRACHEA— WINDPIPE. CATABRH OR COMMON COLD-CATARBIIAL FEVER. This term is given to an affection, whicli consists of a mild degree of inttanimation of tlie lining membrane of the nostrils and windpipe, and occasionally, also, of the ramifioations of the latter, induced by exposure to sudden changes of temperati (>, or to a damp or chilly atmosphere with insufflcient clothing, particularly as regards children. Symvtoms. This complaint is characterized by slight fever, impaired appetite, obstruction of the nose, sneezing, unusual languor, pains in the head, or in the back and extremities, and subsequently hoarseness or cough, generally preceded by transitory chills or shiverings ; there is, also, a slight degree of wheezing and ditHculty of breathing. When the disease is confined to the nose pad sinuses, it is termed a cold in the head. ALLOPATHIC TREATMENT. The treatment of catarrh, or common cold, is given in Chapter X, under the head of catarrh, and under the head of acute bronchitis. Sub-acute laryngitis often occurs in colds, either alone, or with coryza (acute catarrh of the nose,) or with acute bronchitis, but may occur alone. The inflammation is of a low grade. There is either hoarseness, or loss of voice (aphonia,) and a hoarse cough. In children, spasm of the larynx is apt to be excited, known as false croup, but this is rarely the case in the adult. Besides the treatment, as recommended for acute bronchitis, strong irritations over the larynx (Adam's apple) is use^ ful. This is best made by the frequent application of Tincture of Iodine. "When the coloring of the skin is an objection, the Decolorized Tincture of Iodine may be used, or a blister can be applied over the larynx. The inhalations of warm vapor is, especially, useful in all inflamma' tions of the larynx. The steam from a solution of Chloride of Ammo, nium from a croup kettle, or a spray producer may be inhaled with ben- efit. Glycerine may be applied freely to the epiglotis, and orifice of the larynx, with benefit, in some cases. It should run into the larynx. A large camel's hair brush should be used. 880 Pi COMMON COLD. 881 Should the fever run high, mid the pulse rapid, great hencflt will ho rterlved in this, as in other cattirrlml inflanmuitiona, hy giving Tincture of Aconite, in doses of half a droj) to a drop, every half hour, until an inipression is made on the fever, and then given one or two hours apart It may he used without interfering with other treatment. A couple of drops of Tincture of Belladonna may be advantageously given with ea(!h dose of Tincture of Aconite, espeeially, when the secre- tion of phlegm is profuse. Tincture of Iodine, dropped in hot water, will yield a vapor which may be inhaled frequently, during the day. The vajwr may be made to ascend through a funnel made of stiff paper, and so conveyed to the mouth. Chronic hoarseness of the throat occurs, most frequently, in persons of sedentary habits, in a somewhat debilitated state of health. The indi- cations are, in the first place, for life in the open air, and less at the desk. These persons, also, need tonics, and, possibly, an alterative. Such a med- icine we have in the Syrup of the Iodide of Iron, whicli may be given in doses of thirty drops, in water, three times a day. An equally serviceable, and more elegant preparation, is the follow- ing: Take of the Iodide of I'otassium Jive drams, Pynyphosphite of Iron one dram, Water one ounce, Simple Syrup three ouikxh, Spirits Pep})ermint half a dram. Dissolve the Iron in half the Water, and add the Syrup; dis- solve the Iodide of Fota,ssiuni in tlie remainder of tJie Water, mix and add the Spirits of Peppermint. Dose : A teaspoonful three times a day. In robust persons, the Iron may be omitted. Other tonics, which may be useful, are Citrate of Iron and Quinine, in doses of from three to live grains, three times a day, dissolved in water or syrup of Orange. Two or three grain doses of Citrate of Iron and Strychnine, given in the same way, may be found useful, in restoring the general health. Three to five drops of Fowler's Solution may be given, often with advantage, with the above remedies. A dram and a half, to two and a. half, is proper for a four-ounce mixture. Pills of the Phosphide of Zinc, and Extract of Nux-vomica, will ofter prove serviceable. The following mixture of Iron may be given in connection, if Iron seems required : I'afce of Pyrophosphate of Iron a dram. Water sufficient to dissolve. Syrup of Ginger sufficient to make four ounces. Mix. Dose: A teaspoonful three times a day. Nervous hoarseness is often relieved by from five to ten grains each of the Bromide of Ammonia and Bromide of Potassium, in water, three times a day. Atrophine, in doses of a hundred and twentieth to an eighti cth of a grain, twice a day, will often prove effectual in relieving this form of hoarseness. Counter-irritation, by means of Tincture of Iodine, or Decolorized Tincture of Iodine, applied by a camel's hairbrush; or a liniment of equal parts of Croton Oil, Turpentine and Sweet Oil ; or by the use of Ointment of Tartar Emetic (made by mixing two drams of Tartar Emetic with an ounce of Lard,) rubbing it well into the skin twice a day. Applications to the diseased surface, the vocal cords, and interior of the larnyx, can best be made by inhalation. Iodine may be inhaled by »lH..i II iHM SR2 DISEASES OP THE UKHr'IHATORV OHGANS. 1!4 ¥>'. I ii dropping tlio Tincture into liot wator. Carbolic Acid may be ronibincd with 'I'iiicture of Iodine in tlie proportion of lialf a drain to a dram, to liaUan ounce; a suOicicnfc (juantity of Iodide of Potassium sliould be added, to prevent tlie Iodine from jtrecipitatiiig. Iodoform vapor may l)e inlialed witii bcm'tH often. Tlie vapor may lie generated l)y lieating a plate «)r saucer witli Home of tlie jxjvvder upon it, and may be conducted to the mouth by astifTpaper funnel. Ilroinine vapor may l)e inhaled by warming a vial having a few drops of the liquid, and holding to the mouth. A solution of Ni' rate of Silver, containing ten to twenty grains to the ounce, is, perhaps, tlie most useful of all the local ai)plicatioiis. It should be applied with a brush or probang, with the aid of a laryngo- Hcopic mirror. Various substances, besides the above, may be used by means of the steam atomizer, or the air spray producer, but they have no special advantage over the methods given. Persistent cases of excessive hoarseness (chronic laryngitis) depend, generally, upon tuberculosis or syphilis. If ulceration has gone on to any extent, the hoarseness, or loss of voice is incurable. The former dis- ease is treated in the article on consumption. The latter disease does not come within the scope of this work. This trouble must not be confounded with the hoarseness which exists in chronic pharyngitis (inflammation of throat) frecjuently called clergy- man's sore throat, which is treated of in chapter XI. The treatment of this form of catarrh (sub-acute laryngitis) in chil- dren does notdifFer materially from its treatment in adults. The child, in the majority of cases, should be kept within doors until the inflammation —cough and hoarseness— disappear. Then lie may be gradually accus- tomed to his out door play, by beginning first at mid-day. In fact, some children may be permitted to go out for a littlt; while in the middle of the day, during the course the attack. The clothing should be warm enough to keep the skin warm and moist. Flannel^should be next to the skin. A stimulating application should be made to the neck, as rubbing the skin thoroughly and often with Turpentine, or Turpentine and Spirits o^ Cam- phor and a flannel saturated with Camphorated Oil, (Camphor one scruple, Olive Oil one ounce,) may he worn around the neck. Cough should be relieved by the use of Paregoric, in doses suited to the age of the child, with an equal quantity of Tincture of Hyoscyamus, from ten to thirty drops each, can be given to children two to six years old in Syrup, or Syrup of Squills or Ipecacuanha. A hot foot bath at night will be useful. The cough mixture, or ten to thirty drops of Paregoric, or three grains of Dover's Powders (to a child three to five years old,) should be given upon going to bed. If the disease becomes chronic, as in the adult, it probably depends upon tuberculosis or syphilis, and is amenable to treatment proper for these diseases. Should the chronic affection be of scrofulous origin, benefit will result from the internal use of the following mixture: Take of Iodide of Potasdum a dram ami a half, Pyrophospldte of Iron half a dram, Simple Syrup four ounces, Spirits Peppermint half a dram. COMMON rOLD. ■38a •^) I ;o / Dosr: A teaspoojiful may bo pivpii tliroo tlmos a day. Cod Liver Oil will \w U3(!l'iil. Tlio diet should lie good, tlio clothini,' flannel, and warm. The 'IMiiclun^ of Iodine should Ik' aitpliwd upon the neck, over the larynx, every day, or if the neck beoonie.s very sore, every other (hiv. HOMCKOPATHIC TREATMENT. Puicmonitohv 8TA(iK. CftiHphor {(X>m:Pi it rated tincture) is freiiuently edeclivc' in arrest iii;^ the develop- ment of incipient cold or inlluen/a, j)artieularly if the ex<-iling cause, to which It is iniincdialely traced, has been wet feet. The syn)i)t()nis which, usually, identify the i>roi)riety of resortiii;; to Camphor under t^ese circumstances are as follow: unusual weariness, heaviness, and general uneasiness, attended with shiverinj,' and dryness or coldness of the skin, and symptoms of aijproaching fever. Dose: One drop of the eoncenlraled tincture on a snnill lump of pure loaf sugar every three hours, until three doses have been given. Nux-i'omifa is the most generally useful, i)articularly when tlie 8ymi)toms have accrued after exposure to a draught, or i)rolonged expo- sure, in winter, to a cold, dry, frosty almosplu rt'. Dose: 8ix pills in a teaspoonful of waR'r at night, repeated, if neces- sary, after an interval of six hours. ChdimmiUld is pnjferable wlien a cojjious otitbrealv of i)erspiration has been suddenly checked by a current of dry.coM air, or by asudden tran- sition from heat to culd. In the case of clii! iren. and highly sensitive females, this remedy is more especially useful. Dose: Six globules in a teaspoonful of water, as is directed for Nux- vomica. Iti'i/ouia should beemployed when tliesymptonisof incipient catarrh have been excited by i)rolonged exposure to a cold ea.sterly wind ; or wlien in adults, who are subject to liver complaints or to rheumatism, tlie natural sweat has been suddenly suppressed, wliilst they were somewhat heated. Dose: Six pills in a teaspoonful of water, repeated, if requisite, after the lapse of twelve hours. DifffaiiKira is the most appropriate remedy to be taken by those who are subject to severe coughs, or to sore throat, whenever they are exposed to a close, damp atmosphere (either during the day or late in the evening,) or after getting the feet wet. Its alternate administration witii Mercurius is sometimes of great advantage. In other cases, when Dulca- mara fails to arrest the symptoms, it should be promptly followed by Mer- curius. Dose: As for Nnx- If in alternation with Mermriui; six pills, first of the one then of the other, in a teaspoonful of water, at intervals of four hour^ii betweeii tliem. Arsrniruin is, tspecialiy, appropriate for the treatment of ill- effects resulting irom a chill whilst bathing, or from long-continued immersion in the wiiler, either voluntary or otherwise. Chills in the stomach, produced li.v fiaitakiiig of raw, cold fruits, or by eating ices, or drinking very cold water when' heated, are also moat readily counteracted by this medicine. Dose: Four piils in a teaspoonful of water, repeated, if necessary, every three boura. w W( r m 884 DISEASES OF THE RESPIRATORY OROANS. ' '•'?• J< PulantUla nliould, liowcver, be preferred under similar anteoodcnt clrcumHtunceH, if drinking whilst lieiited, or eatinj? cold fruit, iceH, etc., has caused the indlHpoHition. Done: Hlx pills, as directed for Ntix. Fevkr Stage. Arouitam Is one of the principal remodloH In fever- ish attacks, provoked by cold, and i)articularly fronj exposure to a dry, cold wind, or to a draught, when hot, dry skin is present, or general shiv- ering chills, alternating with burning heat of the surface ; great thirst, especially towards evening, with ii sensation of dryness, and roughness or scraping, slight burning, and s' usation of e\coriation in (ho upper part of the windpipe, or even throughout the whcie of the cheat, which gives rise to an incessant short, dry, hollow cough (more of a hoarse or rough des- cription at night ;) restless sleep. Dose: Six pills every two hours in a teasi)oonfuI of water. Bryonia when there is an excessively dry, hollow cough, accompanied by tenderness of the upper part of the windpipe, on pressure ; inclination to vomit, and pain in the chest, as if it would be torn asunder; severe headache, aching painsin the limbs, increased by the slightest uio»fement, violent cold in the head. Dose: Four pills h\ a teaspoon ful of water, every two hours. Nux-voniica. Pry cough, particularly iu the morning, and some- times during the day, rarely during the night; occasionally a small quantity ot adhesive phlegm is with difficulty expectorated after a fit of cough- ing; and the paroxysms are frequently attended with a painful seuHation in the region about the navel, as if arising from the effects of a bruise or blow. This remedy is, further, of great utility in catarrhal fever, with dis- position to chilliness or wandering fever-chills, worse during movement, coming on and gradually increasing in the after part of the day, and alter- nating with flushes of heat. Warmth and absolute rest mitigate these symptoms. Dose : As for Bryonia. Chatnotnilla, In tha treatment of children, this medicine is gene- rally preferable to Nux-vomica, in arresting the attack. It is extremely valuable in restoring the suppressed perspiration, and removing the fol- lowing symptoms: colic, with pains in the head, ears, and teeth, thirst, and ill humor, and impatience; dry heat of the skin, or chilliness in any part of the body which may happen to be uncovered for a short time, or on lifting up tiio bed-clothes; burning heat in one part (as for instance one cheek) and chilliness m 'another; severe, dry couRh, especially, at night, excited by tickling in the upper part of the windpipe. Do.se : As for Aconite. Belladonna is indicated when there is a throbbing, bursting head ache, attended with tendency of blood to the head, and increase of the pain from movement, or exposure to cold air, pain and heat in the head, eyes, and nose; cough at night. Dose : As for Bryonia. Mereurius, when the lining membrane of the eyelids, nostrils and air-tubes is highly irritated, and gives rise to copious shedding of tears, cold in the head, and cough with profuse expectoration ; lie',' iche, or feel- ing of tightness and fullness in the head, with pulsation Ca Lending to the «l l1 i INFLAMMATION OK THK LAIIYNX. l\K'i nose; itaiiiH in the Iiinl).s and joinlH, iicconi|),init!(l with pi'i'f"*''^ f*^v»;iiting, whicli afTord.H no rcliof. Dose : As for Bryonia. Sepia is indicated in casos of catarrhal fever, witli sluverinp diills on etery movement in u warm room, rarely alternatinj; with heat; nocturnal Hpasinodio cough, with shortness of breath and inclination to vomit; cold in the head, pain at the back of the head. PUKOISPOSITION TO COLD. PllECAlTTIONAUY MANAGEMENT. Rome individuals, particularly among those of the fair sex, arc tormented witli an extreme degree of susceptibility to cold, the host corrective of whicl: i«. to rub the throat, chest, and indeed, the whole body, every morning with a wet towel, until a glow of heat Is produced, drying one part before another is commenced; also, to acquire a habit of going out every day, pro- vided there is no inherent predisposition to pulmonary consumption; extremes, either of heat or cold, should a!, the same time be avoided, and care taken, when the body is heated, to let it cool gradually. The shower- bath is another useful means of overcruung an unusr ^ susceptibility to cold. It should, generally speaking, be begun in summer and used tepid at first. iCCESSORY MEASURES. In many instances catarrh is carried off, or runs to a salutary termination, in a day or two; and this desirable result is frequently obtained by having timely recourse to the simple expedient of remaining a little longer in bed, and encouraging a gentle sweat by drinking a warm demulcent fluid, such as gruel; bathing the feet and legs in warm water, at the temperature of about 98 to 100 degrees Fahrenheit, is, also, a useful auxiliary mode of restoring perspiration, but the patient should go to bed immediately afterwards. Very robust persons wlio are accustomed to be in the open air in all weathers, but who have caught cold after having overheated themselves, will frequently prevent any bad effects by drinking one or two glasses of cold water on going to bed. Others again, recover quickly, especially, when the cold is confined to the liead, by totally abstaining from all fluids for forty-eight hours, or by tak- ing a tablespoonf ul of fluid, thrice a day only (at breakfast, dinner, and tea,) for seventy-two hours. 1^1!' %-K. i*»i It. id rs, lel- luo INFLAMMATION OF THE LARYNX, OR UPPEB PART OF THE WINDPIPE. The disease consists in a suppurative inflammation, having its seat in the lining membrane of the upper part of the windpipe, or the connecting cellular tissue between it and the subjacent parts. The disease bears a considerable resemblance to croup, of wliich it very generally, forms a part; but occasionally the inflammation is exclusively restricted to the upper part of the windpipe ; and it is a frequent cause of a fatt^l termina- tion in scarlet fever and smallpox. It is distinguished from croup by a constant hawking (which the patient voluntarily exercises in order to clear the air-passage) rather than a violent and involuntary cough, and by the character of the expectoration, which consists of a thick, tenacious phlegm, rather than of a coaguable and membranaceous looking ejcuda- tion. 25 % ''A' % <JVM dSR DISKA'-lOS OK Tin: RESPIUATOKY ORGANS. ' •■;; ,1 V!S I ,. Symptoms, Th(3 invasion of the disorder is announced by the usual signs of inflammatory fever; the voice soon becomes lioarse and inarticu- late, wiiilst a painful sense of constriction is experienced in the throat; the breathing is laborious and siirill during inspiration ; the upper part of the windpipe is extremely sensitive to the toucii, so tiiat the slightest pressure against it, either externally, by the hand, or internally, from the perform- ance of tlje act of deglutition is productive of the most distressing spasms, which threaten death from suffocation. The heat of the skin is great, the pulse rapid and Jiard, the tliirst considerable, but incapable of being satis- fied from the suffering that is occasioned by the attempt. On examining the throat, it is often found to present a red, inflamed, and turgid appear- ance; in some cases the epiglottis (the small, oblong body, attached to the root of the tongue, which protects tlie opening of tlie windpipe) is involved, and tlie motions of the tongue are thereby rendered painful and diflScult. As the disease gains ground, the face becomes swollen, and sometimes livid, the eyes i)rotruded as in threatened strangulation, and life is speedily cut short by suffocation. Results. The disease, if not arrested, occasionally terminates fatally within a few hours, or in a day or two, at the farthest. It ought not to be treated by the non-professional reader. HOMEOPATHIC TREATMENT. Aconitum must immediately be exhibited when tiie signs of inflammatory fever declare themselves, and continued until it gives evidence of having effected an abatement of tiie fever. Dose: Of a solution of six globules to two tablespoonfub of water, give a teaspoonful every half hour. Spongia should, in the generality ot cases, be administered with Aconite every two hours; after tlie last dr ^e of Aconite, or, Jis soon as the breathing becomes shrill, and tlie pain and sensibility in the upper part of the windpipe are more decided, witli increase of Iioarseness and difficulty of articulation. He2)ar-8ulphuri(t should be given six hours, or sooner, if needful, after the last dose of Spongia, when the latter remedy appears to have done all that it is capable of effecting; in which case, this medicine will either be adequate to complete the cure, or, at all events, to bear the patient out of danger, and thus to leave more leisure for appropriate selection in treating the remaining symptoms. Ilepar-s. may, however, be selected, to follow Aconitum in preference to Spongia, if the fever and burning heat of the skin continue, notwithstanding uhe previous administration of Aconitum. Belladonna has, likewise, rendered very appreciable service, espe- cially, when there were considerable heat of the skin, much thirst, but complete inability to swallow liquids, owing to the spasms which the attempt occasioned : further, when, on looking into the throat, it was found to present an inflamed and swollen appearance. Belladonna is, however^ not to be administered in cases in which it has previously been employed; as, for instance, if the affection of the windpipe occurred immediately after an attack of pure scarlet fever. Hoarseness, or roughness of the voice, arises from some morbid con- dition of the upper part of the windpipe. In the majority of cases, the seat of the affection is in the mucous membrane, which lines that part, 1 l:^'^'?5. ^ INFLAMMATION OF TH/3 LARYNX. 387 s which is extremely liable to be ivJtected by the common causes of catarrh; hence, it is a frequent accompaniment of the latter disorder. Pulsatilla is indicated by almost complete loss or voice, particularly, when accompanied with loose cough, or thick, yellow discharge from the nostrils. Dose: Six pills in a teaspoonful of water, night and morning, but if, after the course of a week's treatment, although much improved, the case be not cured, but appears to have become stationary, proceed with one or the other of the following medicines, according to symp- toms. Mercurlus. This remedy will be found useful in removing any symptoms remaining after the above, but it is to be preferred, should the hoarseness, from the commencement, be attended with thin discharge from the nose; and, also, when a sensation of burning or tickling is complained of in the upper part of the windpipe, with the characteristic indication of Mercurius, namely, a disposition to profuse sweating, especially at night. Dose: Six pills in a teaspoonful of water, repeated at intervals of twelve hours, until amelioration or change. Nux-votnica. Hoarseness, accompanied with a dry, fatiguing cough, worse in the early hours of the morning, with dry obstruction of the nose. Dose : As for Pulsatilla. Mhus-toxicodnndron. Hoarseness, accompanied with sensation of excoriation in the chest; oppressed breathing, with frequent and violent sneezing, unaccompanied by cold in the head, but occasionally by a great discharge of phlegm from the nose. Dose: As tor Mercurius. Stannum is mor/ particularly required when symptoms, such as the following, are present: cough, with copious expectoration of a greenish- yellow color, and of a. siveetlsh or saltish taste, attended with great weak- ness, and disposition to sweats ; soreness at the chest, as from internal excoriation ; feeling of weakness or sinking in the chest, as if it were empty, particulary after expectorating, or even after speaking; or dry, shaking cough, worse at night or towards morning, excited or aggravated by speaking or laughing, and occasionally followed by vomiting of food. Dose: Four pills, as directed for Pulsatilla, I/j/copodiuni is very efficacious in obstinate coughs, which are worse atniglit, and are attended with expectoration of tenacious phlegm, and sometimes vomiting; paleness of the face, emaciation, pains and oppres- sion in the fore part of the chest, flatulence, ill-humor, etc. Dose. Six pills in a teaspoonful of water, morning and evening, until change. Phosphorus is appropriate to the following symptoms : dry cough excited by tickling irr J;atiou in the throat or phest, or by laughing, talking or drinking, or by cola air, and accompanied with pricking in the wind- pipe; hoarseness, or pains in the chest as if from excoriation; cough, with hoarseness, fever and depression of spiiits, sometimes with apprehensions of death; dry-sounding cough, followed by expectoration of viscid or bloody phlegm, and attended with oppressed breathing and livid hue of lips and face; cough occurring in consumptive habits. Dose : Six pills in a teaspoonful of water, night and morning, until change. Arnica is of great value in coughs, attended with bleeding from the ! hi .■ Ilvl :.^i **! 'i; Irr 988 DISEASES OF THE RESPIRATORY ORGANS. mj nose and iiioiitli; headache, pricking in the chest, rheumatic pains in th(? loins and extremities, and soreness or pain, as from a bruise, in tlie chest and belly. Dose : As for Phosphorus. Spoitgla. In acute inflammation of the lining membrane of the air- tubes, tills remedy is often of essential service; but it is of equal utility in the ciironic variety, when the chronic symptoms prevail ; cough, with muco-pnrulent expectoration, emaciation, redness and deformity of tho points of the fingers, lividity and incurvation of the nails, hectic fever. JDose: Four pills, as directed for Lycopodium. COUGH. Symptoms. Forced and audible expiration, with or without fever; either dry or accompanied with expectoration. Cough, although not dangerous of itself, may become so, or form an important feature of other diseases. As a precursor of consumption, it is too often neglected. Causes. It may arise from an irritation of the air-passages or lungs, from disease of these organs, or from cold or other causes, or be merely sympathetic— or the consequence of derangements of other important organs. We purpose here to treat more particularly of simple rmwotis or moist and dry cough. nervous coughs. Obstinate nervous coughs, occurring in highly-irritable, nervous, and hysterical subjects, and which are generally dry, or attended with scanty and difficult expectoration, consisting of a little dear phlegm, are often relieved by change of air and scene, or even by exhileratiiig or active occu- pation, when medicinal resources fail to insure a permanent cure. HOMCEOPATHIC TREATMENT. Aconitum is indicated by violent, short cough, with quick, hard pulse and feverish heat; pricking in the chest when coughing, or during inspiration. Dose: Six pills in a teaspoonful of water. Dulcamara. The following are indications for the selection of this remedy: moist or loose cough, with copious expectoration after exposure to a cold damp atmosphere: or cough with hoarseness and copious secre- tion of phlegm in the ramifications of the windpipe, sometimes acconn»a- nied by expectoration of bright-colored blood during the night; barking, shaking cough, increased or excited by taking a deep breath. Dose: Of a solution of six pills to two tablespoonfuls of water, give a teaspoonful every three hours. Belladonna. Short, dry, harking, (spasmodic catarrhal, or nervous) cough at night, in bed, and, also, during sleep, renewed by the slightest movement; dry cough day and night, with irritation or tickling in the pit of the throat, or sensation as if a foreign body were in the windpipe, or as if dust has been inhaled; spasmodic cough, which scarcely allows time for respiration. This medicine is also sometimes useful in cough, with rattling of phlegm in the chest, pricking in the front or sides of the COUGH. chest, and expectoration of thick, white phlegm, coining on, especially, after meals; lancinating pain in the belly ; hoarseness, redness of the face, headache, sneezing after coughing, and pain in the nape of the nock. Dose: Dissolve six pills in four tablespoonluls of water, and give a teaspoonful of the* solution every three hours; hwt U owXy partial relief has resulted, within three hours after the fourth dose, pause three hours longer, and proceed with the next medicine. HyoHcyanius frequently answers when Belladonna has only afforded partial relief, and may be preferred to that remedy when the dry, tickling, nocturnal cough is mitigated for the time by sitting up in bed; also, when there is mucus rattling in the throat. Dose: A solution of four globules, as directed for Belladonna. Ignatia-atnara is i)referable to Belladonna and Hyoscyamus in very tickling coughs, which continue day and night with equal severity, and ;ire accompanied by a running cold in the head. Ignatia is, moreover, es})ecially, indicated by the subjoined symptoms, — shaking, spasmodic CI uigii, or short, hacking cough, as if arising from the presence of dust or feather-down in the tliroat, which becomes? aggravated the longer the l>uioxysm of coughing continues; dry, tickling cough, with cold in the head, occurring both day and night. This remedy is, further, particularly efficacious, when the attacks of coughing become aggravated after eating, or on lying down at night, or on rising in the morning, and when the patient is of a mild and placid temper, or subject to alternations of high and low spirits. Do«e .- As for Belladonna. Nux-voniica, This is a valuable remedy in many cases, either of catarrhal, or nervous character, and is particularly efficacious where thffre is a dry, hoarse, fatiguing, and sometimes spasmodic cough, which occurs in an aggravated form in the morning, a. l occasionally, also, towards evening; or which recurs more or less during the day, but relaxes again at night, and is then occasionally supplanted by oppression at the ehest, on lying down, or on awaking during the night, accompanied with a feelingof heat, and dryness in the mouth; if there be any expectoration, it consists merely of a little phlegm, which is detached with great diffi- culty. The cough is, generally, excited by a disagreeable tickling or scrai)- ing, with a feeling of roughness, or rawness in the throat, sometimes attended with hoakseness, and feeling of roughness in the chest, but more frequently with severe headache, or pain, as if from a blow or bruise in the pit of the stomach, under the false ribs ; it is frequently aggravated after meals, or by movement, not unfrequently, also, by reading or medita- tion, and is, occasionally, followed by vomiting. Dose: Six pills in a teaspoonful of water, every three hours. Pulsatilla. vSevere shaking, catarrhal or nervous spasmodic cough, worse towards evening, and at night, frequently followed by vomiting; sensation of suffocation, as if from the vapor of sulphur; increase of cough, when in a recumbent posture; cough which is, at first, dry; then followed by copious expectoration of yellowish or whitish phlegm, some- times of a salt or bitter taste; or expectoration of mucus, streaked with blood; wheezing, or rattling of mucus in the chest; the paroxysms of coughing are, frequently, accompanied with soreness in the belly, as if from a bruise, or blow, or painful shocks in the arms, shoulders, or back. is l»w" 300 DISEASES THE RESPIRATOUY ORGANS. and sometimes, followed by a sensation, as if the stomach became inver- ted from the violence of the cough; involuntary emission of urine when coughing; loose cough, with aching in the cliest, hoarseness, cold in the head; excited by a sensation of scraping, or of erosion in the throat; shiv- ering. * Dose : Six pills in a teaspoonful of water, every four hours. Chamomilln is indicated by dry cough, excited by continual tick- ling, or irritation in tiie upper part of the windpipe and chest, and increased by talking; the cough is most troublesome during the wiV/*^; but also occurs during the day, particularly, in the morning, and toward the evening; accumulation of tenacious phlegm in the throat; wheezing in the chest, cough during sleep, sometimes accompanied with paroxysms, as of threatening suffo .it' ^n; cough, with scanty expectoration of tena- cious, bitter phlegm. This medicine is well adapted to the treatment of coughs in children, accompanied with more or less of the symptoms above described, or with hoarseness, cold in the head, dryness in the throat and thirst; great fretfulness; fever towards evening; paroxysms of coughing after crying, or after a fit of passion. Dose : Of a solution of eight pills to three tablespoonf uls of water, give a teaspoonful every four hours. Brj/onia is indicated by catarrhal cough, occurring in winter, during the prevalence of frost, and cold easterly winds, with aggravation of the fits of coughing on coming from the open air, into a warm room. The following are th > general indications for its employment: dry cough, with or without hoarseness, ^ad excited by constant irritation in the throat — or as if caused by vapor in the windpipe, with greatly accelerated respira- tion, as if it were impossible to obtain sufficient air ; spasmodic, suj^oca- ting cough, after partaking of food or drinks, and, also, after midnight; cough with prickings or shootings in the chest, and violent, bursting headache, especially at the temples— also, with prickings in tlie pit of the stomach, or in the side; further in loose cough, day and night, with scanty expectoration of whitish, or yellowish, viscid plilegm, or slight spitting of blood, the paroxysms being sometimes followed by vomitings, and accompanied by pain, as from a bruise under the collar-bones, and pain and fullness in the forehead, as if the contents of the head were forced out, this remedy will, frequently, be found of great service ; and, likewise, in dry, nervous cough. Dosei Of a solution of twelve pills to three tablespoonfuls of water, give a teaspoonful every three hours. Rhus-toxicodendron is indicated by short, dry cough, worse towards evening, and before midnight, excited by tickling in the chest, attended by hoarseness, or a feeling of roughness, or rawness in the throat, congestion in the chest, a sensation of suffocating constriction, anxiety, aid shortness of breath; cough on wjiking in the morning, or short cough, with bitter taste in the mouth, on lying down at night, and on waking in the morning, with expectoration of viscid phlegm, some- times followed by vomiting, pains in the stomach, and dartinps, or prick- ing in the thigh. Cough with expectoration of bright blood with sensa- tion of sinking, or exhaustion of the chest, or shooti/ig pains in the chest and sides. Dose: Eight pills in a teaspoonful of water, night and morning. COUGH. 801 Ipecacuanha is, more particularly, required when the following symptoms occur; catarrhal, nervous, or spasmodic cough, particularly at Right, attended with painful shocks in the head and stomach, and fol- lowed by nausea, retching, and vomiting; or dry cough, arising from tickling in the throat; or severe, shaking, spasmodic cough, with oppressed breathing, almost amounting to suffocation, iii the case of children, this remedy is frequently valuable, when they appear to be threatened with sufTocation from the accumulation of phlegm, or where the paroxysm is so severe as scarcely to afford time for respiration, causing the face to assume a livid hue, and the frame to become quite rigid. Done: Of a solution of twelve pills to three tablespoonfuls of water, give a teaspoonful every hour, until positive change. Mercurius is indicated by catarrhal cough, with hoarseness, or watery discharge from the nose, or accompanied with diarrhoea; or dry cough, excited by irritation in the throat, or the upper part of the chest, which becomes particularly troublesome towards evening, and at night; sometimes with slight pricking in the chest when coughing or sneez- ing; excited, or increased by talking; cough in children, with discharge of blood from the nose, vomiting, and headache ; dry, spasmodic cough, with pain in the head and chest, as if they would burst, retching after the paroxysms, and occasional expectoration of blood. Dose: Four pills in a teaspoonful of water, night and morning, until distinct change; or, if retching be present, the like dose, every two hours, after fits of coughing. Carbo-vegetahilis is, particularly, indicated by hollow cough, exci- ted by irritation, or a troublesome sensation of crawling in the throat, and attended with burning pain and sensation, as if from excoriation in the chest ; catarrhal or nervous spamiodio cough, frequently followed by incli- nation to vomit, or vomiting, occurring in paroxysms throughout the day; cough with Jioarseness, especially towards evening, or morning and even- ing, increased by speaking. Obstinate cough with expectoration of greenish phlegm, or even of yellowish matter, or with expectoration of blood and burning sensation in the chest (a characteristic indication for this remedy as well as for Arsenicum). Dose: Four pills in a teaspoonful of water, night and morning, for four days. Arsenicum is required for cough with oppression at the chest, and tenacious phlegm in the upper part of the windpipe and chest; cough excited by a sensation of dryness and hwning in the windpipe. Dry cough, chiefly in the evening after lying down, often with difficult respiration and fear of sufjfocation [suffocative catarrh, catarrhal asthma,) as if arising from inhaling the vapor of Sulphur ; dry cough, excited by eating or drink- ing, or by ascending stairs, or cough which arises as soon as tfis open air is encountered; thin acrid discharge from the nose; sneezing: periodic dry cough, nocturnal cough with general burning heat, cough, with expectora- tion of bloody phlegm, catarrh in the lungs of old people, attended with tenacious mucus expectoration, which is extremely diffloilt to eject, and causes rattling in the chest, oppressed respiration, and frequently, sym}>- toms of impending suffocation, or paralysis of the lungs. Dose : Three pills in a teaspoonful of water, every two hours. Atntnoniuin-carhonicum, is indicated by dry, tickling, suffocative cough, especially, in the morning, sometimes with fever, occurring during ; % M IK S92 SKASKH OK THE RESPIRTOBY ORQANS. \l \h the prevalence of ii cold, stormy, bleiilt .state of tlie atmosphere, and attended with a sensation of heat or buriu'.).\/ behind the breast-bone, resem- bling that which is occasioned by drinlcing spirits; hoarseness; cold in the head, with copious discliarge of acrid, watery fluid. Dose: A^ for Arsenicum. Caiisticnm, which ftuiy sometimes be of service in cases analogous to that which has been named as suggesting Ammoniuni-c, either before, after, or in place of that medicine, is, especially, indicated by rfr?/, ttolluw cough, which even wakes the patient from sleep ; short cough, excited by tickling, crawling, or a feeling as if the throat were excoriated, or by talking; and cold, attended at times with burning, or a sensation of sore- ness in the chest, and rattling of phlegm ; pain in the hip, and, occasion- ally, involuntary emission of urine when coughing; pain in the chest, as if it were raw and sore, (the patient comparing his feelings to those which he could conceive to arise from the application of a blister to the exterior of his chest). Dose: Three pills, as directed for Arsenicum. Silicea is indicated by cough, with oppressed breathnng on lying on the back, or cough attended with tightness and oppression at the chest, as if something stopped the respiration wliile speaking or coughing. Fatiguing, or deep hollotocough, day and night, aggravated by movement or by speaking, and sometimes attended with aching and pain, as if from a bruise in the chest; cough with copious expectoration of transparent phlegmor purulent matter, sometimes streaked with blood ; cough with asth- matic breathing and emaciation, and with dread of suffocation at night; cough irritated or excited by a sensation as if a hair were on the tongue. Dose: Six pills in a teaspoonful of water, night and morning, for four days. Sulphur is of paramount importance in some cases of obstinate coughs, and particularly in dry cough, which disturbs the patient at night as well as during thf day; the cough is frequently excited after partaking of food, or during a Lcp inspiration, and is, generally, attended with a sensation of spasmodic constriction in the chest, sometimes followed by inclination to vomit, or the involuntary escape of urine, or pain as if from excoriation, or pricking pains in the chest ; headache, pains in the chest, belly, loins, and hips ; also, cough, with expectoration of thick, whitish or yellowish phlegm, or of a greenish-yellow, fetid mucus, or i)ur- ulent matter, of a saltish or sweetish taste ; feverish cough with si)itting of blood. Dose: Three pills in a teaspoonful of water, morning and evening, for four days. Calearea-carboniea is particularly indicated, when the following, symptoms occur: dry cough, aggravated towards evening, or at night excited by tickling in the throat, or by a sensation as if there wera feather donm in the throat; also, loose cough, with rattling of mucus in the chest, and expectoration of offensive, thick, yellow phlegm; anxiety. Dose: Six pills, in every respect as for Sulphur. Sanguinhria-canadensiH. Dry cough ; pain and stitch in the right side of the chest ; diseases of the lungs ; it has a certain reputation in the cure of coughs. Dose: The same as Cafc. car6. - , . > ■ . \\,' CROUP. SDJI Sepia. The symptoms which iiuliciito this in«tli<!i no areas follows; cough, with copious expectoration of phlegm of a saltish taste, and of a yel- low or greenish color; also, dry, spasmodic cough, particularly, at night, or on first lying down, attended, in children, with crying, (its of choking, nau- sea, retching, and bilious vomitiug. This remedy is, especially, adapted to individuals having a constitutioi al taint, such as scrofulous, scorbutic, etc., and, in chronic coughs, with thick, yellowish, greenish, or even puii- form expectoration, with a putrid taste, it is, also, a valuable remedy. Dose: Four pills in a tablespoonful of water, night and morning, until change. CRO UP— LAB YXGITIS. In an attack of Croup, it is of the utmost importance to afford help before the dangerous stage sets in. Tlie mother, who has the best oppor- tunity of watching her child, may, avert the danger by the care and treat- ment recommended here. If the family physician is in reach he should be sent for at once. If no physician is near, this treatment may be used in perfect confidence of its ultimate favorable effects. Persons who have once li card the croup cough will never forget it; those who have not heard it may know it by the following signs; It is very much like the hoarse barking of the com- mon cur dog; sometimes shrill (crowing,) sometimes deep and hollow, but rough; it is an anxious sound. The cough occurs in paroxysms. Tlie inspirations are long and labored; the exjjirations interupted and jerking. The little patients frequently toss about the bed in great agony, stretch the neck, and bend the head backwards, boring ic fnto the pillow, which last should not be prevented, as, if forced to raise the liead too high suffocation may take place in consequence. The pulse Is feverish and the urine is deep rod True membraneous croup is not near so fre- quent as most persons imagine; most cases of croup would remain without any danger, if the proper treatment was at once pursued. ALLOPATHIC TREATMENT. Laryngitis with spasms of the larynx (spasmodic, catarrhal or false croup,) is the form of croup, which is most common with children who are said to be "suVjject to croup." As the attack generally occurs suddenly, and is quite alarming in its symptoms, It is very important that the parent should know what is to be done. If the little patieni is put into a warm bath at the temperature of one liun- dred degrees, the great probability is, that the spasm of the larynx, and the difficulty of breathing will soon cease. The bath should continue from ten to twenty minutes, or until the full relaxing effect is produced. The patient, if four or five years old, should then have a dose of twenty drops to three-fourths of a teaspoonful of Paregoric with half a teaspoon ful of Syrup of Ipecacuanha, and placed in a warm bed. The tliroat should then be well rubbed with Turpentine, or a Liniment composed of Aqur Ammonia one part, Olive Oil two parts, mix and add one part of Turpen- tine. The severe smarting (counter irritation,) of the application wii prove most serviceable. If the spasm is not relieved by the warm bath, an emetic should bi gjven. The Syrup of Ipecacuanha is very suitable in doses of a teaspoon ful from ten to twenty minutes apart, until vomiting occurs, or the pav oxysm ceases. In very robust children the Hive Syrup is admissiole i-or <l»t ■! M 1* I- tin I DISEASKS OF THE RESPIRATORY GROANS. this purpose In doses of fifteen to thirty drops every fifteen minute*, but on account of tiie extreme and continual depressing etrect of tlie Tartar Emetic it contains, it sliould l)e given only to the strongest chil- dren. Twenty grains of Powder of Ipecacuanha nuiy Ue put in two or three tablespoonfuls of warm water and a teuspoonful given at a dose. Bloodroot given with Ipecacuanha has j)roved serviceable with both catarrhal and true croup, in tlie hands of Dr. Ransom, of Burlington, Iowa. The following is a suitable formula: Talie of Powdered Ipecacuanha a dram, Powdered Bloodroot a sample, mix and divide into three potoders. Put one powdei' in a wineglass of warm water and give one or two teaspoonfuls . Or, one dram each of the Fluid Extract of Ipecacuanha and Tincture of Bloodroot may be given, in doses of five or six drops every ten or twen- ty minutes in syrup or sweetened water. The do.se of the emetii; should be repeated until vomiting occurs or the paroxysm ceases. If neither result can be produced by these means, a tcaspoonful of Powdered Alum may be given, mixed with syrup or honey, to produce vomiting, which will relievo the difficult breathing. The use of Ether by the mouth and inhalations would be prudent at the hands of a physician, and is useful; the same may be said of Chloroform. As soon as the sickness of the stomach has subsided, unless the bowels are weU open, a saline catharic should be given, as, a teaspoonful or two of Rochelle Salts in lemonade or from five to ten grains of Calomel. If the emetic has been given at night the cathartic can generally be given the next morning. A poultice or a flannel wet with a saturated solution of Gum Camphor in Olive Oil or Belladonna Ointment, may be applied to the neck after thorough rubbing with the Turpentine Irritating Liniment, During the day the patient should have an anodyne sulliciently often to relieve the cough, as two parts '^f Paregoric and one part Tincture of Hyoscyamus may be given in d ; of twenty to forty drops to children old enough to run out of doors. The Tincture of Belladonna may be given instead of Hyoscyamus in doses of two to ten drops. The anodyne and a hot foot bath should be given at night. The following is a suitable mixture for an anodyne to be administered through the day : Take of Paregoric half an ounce, fiyrtip of Ipecacuanha half an ounce, Tincture of Ilyoscyatnus two drams, water and simple syrup each three drams; to this may be added a dram of Citrate of Potash previ- ously dissolved in the water. Dose: Haifa teaspoonful may be given from two to four hours apart, to a child two or three years old, a teaspoonful to older children, If the fever and pulse shouhl run high, a quarter or half of a drop of Tincture of Aconite may bo given, without reference to other remedies, every half hour until an impression is made on the fever; then at inter- vals of two or three hours, as : Ta/ce of Tincture of A'^onite a dram, Syrup three drams. Mix. Dose : One or two drops. If the child is weakly, a grain of Quinine (in pill or powder) should be given three or four times a day, and a teaspoonful of a solution of Imlf a dram of Pyrophosphate of Iron in four ounces of simple syrup. CROUP. 305 The child should be confined to tlie bed during the acute stage, and after this passes, should be kept in the room for a few days, and then gradually accustomed to the ojjeu air by going out for a short time only, In the middle of the day. As a preventive of this annoying trouble, children of all ages should be clothed in flannel during the later autumn, winter and spring. The dress should be high in the neck, the sleeves long and warm. The legs and feet should, also, be warmly dressed with woolen stockings and drawers. Then, if warmly clad and the feet kept dry and warm, out of door life will be beneficial In weakly children tonics of Quinine and Iron, will prove serviceable. The sugar-coated pill and Pyrophosphate of Iron recommended above, will be found appropriate given three times a day. It is needless to say that a recurrence of the paroxysms of difficult breathing occurring at any time in the course of the disease, demands the repetition of the hot bath or emetics, or both. Tkue Croup. Infliimmation of the larnyx, with exudation (false membrane,)— the most dangerous of all the forms of Laryngitis— is not, as a rule, marked in tiie beginning of the disease with such alarming symp- toms, as accompanies the various forms of false croup, yet, ui)on its early recognition, and prompt measures of treatment, depend the degree of success which will follow our efforts. In order, if possible, to render the distinction between false and true croup, the following table is inserted, which is compiled from various authorities. Simple lAii^jngitiH with Spasm or False Croup. Begins with nasal catarrh, or cold and hoarse cough, or, witli a sudden attack at night with suffocation. The throat is natural or slightly reddened. After the paroxysm, the child fieems well, or nearly so, the fever disappears or diminishes greatly* Voice is nearly natural, never whis- pering. If a paroxysm returns, it is during the following night, but not as se- vere ; the hoarseness disappears and the cough becomes loose. Seldom lasts more than three days. Seldom destroys life. Laryngitis with Exudations or True Croup. When epidemic, begins as an in- flammation, with exudation of false membrane. When not occurring epidemic, the invasion is more grad- ual, with a slight hoarseness one or two days. There is fever, hoarseness increases, the cough is hoarse, muf- fled, crammed. Generally, there is exudation in the throat, and later, paroxysms of suffocation. Fever continues ; breathing is dif- ficult, labored, and each act greatly prolonged ; cough hoarse and smoth- ered; voice hoarse ami whispering. The difficulty of breathing and' suffocation increases; the cough and voice are smothered, or gone alto- gether; the stridulous (harsh sound) breathing continues. Seldom lasts less than five or six days. The hoarseness lasts several weeks. The majority of cases prove fatal r, 'I m h », i iS m. hm 1 m 396 DISEASES OF THE RE8P1RAT0UY OUQANS. ■:%¥i So that if a case recovers, and no false membrane has been discovered in the expectorated matter, the case was almost positively not one of true croup. Tlie child should be confined in bed. The food should be digestible and nutritious, such as milk, strong beef tea (made l)y putting a pound of finely minced, lean bi'cf into a pint of cold water, and slowly raising the temper- ature to one hundred and si\tydegree3Farenl»eit, and maintaining it tliere for four hours— a little water may be supplied from time to time, to supply loss by evaporation) or beef essence, raw eggs beaten with sugar and waier or milk. Starchy food may be allowed in limited amount. In this disease, the writer believes that local applications hold the first rank, and the best of all local means is the constant inlialation of steam. This end is accomplished the best by maintaining tiie room at a temperature of eighty-five or ninety degrees, and fill the air with steam from kettles of boiling water. The breathing of this warm, moist air has the best effect upon the local inflammation, relieves the spasm of the larynx, and facili- tates the ease of breathing and, also, contributes to the separation of the false membrane by allaying inflammation and liastening separation. A kettle may be made of tin, with a spout so fixed, tliat sitting on a stand at the side of the bed, a jet of steam can be thrown across tiie patient's face. By this means the moisture inhaled can be greatly iucreased. This kettle can be heated by a spirit lamp. A simply constructed kettle for tliis pur- pose was invented and sold in New York at .$3.00. It is called Ronchette's Croup Kettle, but any tinner can make one which will answer the same purpose. The inhalation of steam should be continued through the whole course of the disease. The freedom from spasm and other difficulty of breathing while this warm, moist air is inhaled, greatly decreases the need of emetics, whicli will be spoken of hereafter. Counter irritation to the neck over the larynx, should be thoroughly made with Turpentine, or the Liniment of Ammonia and Turpentine directed for false croup, or Tincture of Iodine applied twice a diiy, after which Belladonna Ointment, containing a scruple or half a dram of Cam- phor to the ounce, should be freely applied to the neck, and then cover with a flax-seed poultice. The Camphor can be mora easily incorporated in the Ointment by dissolving it with a little Ether. In the case of some strong children, cold applied to the neck over the larynx and windpipe, is more effective in the earliest part of the disease. A piece of pork should be applied to the sides of the neck to keep it from getting cold, and a nap- kin wrung out of ice water, or containing a lump of ice, should be laid over the larynx, and then covered with a dry towel to prevent wetting the patient's clothes and bed. The best known solvent for the false membrane is Lime Water It is best applied, from time to time, by means of an atomizer or spray appa- ratus, and should be used warm. The air of the room may be purified every hour or two, slaking a lump of quick lime in the room. The other most useful applications, which may be applied to the in- flamed surface, are: Lactic Acid, Nitrate of Silver, Tincture Muriate of Iron, Tannin and Alum. Three and a half drams of Lactic Acid to ten drams of distilled water may be used with a spray apparatus. The eyes should be protected from the spray. Bromine may be used as directed in diphtheria. Half a dram of / CUOUP. 897 Carbolic Acid to four ounces of water, may be applied ivith an atomi/er. It is, ilo ibtless, especially useful after suppuration, and separation of the false merabrano lias begun. Nitrate of Silver, if used, should be applied to the patches of false mem- brane only, but in strong solution by a physician. Tannin in Glycerine (one or two drams to the ounce,) may be applied, Willi a large camel's hair brush, to the oriflce of the larynx, with the aid of a laryngeal mirror. Tincture of Iron, one or two drams to the ounce of distilled water and Alum in saturated solution, may be applied by a spray apparatus. * Of these, the writer considers them all inferior to Lime Water. In the treatment of croup, emetics hold an important place. They aid in expelling the false membrane when it becomes detached. They should be given at once, when the labored, smothered breathing indicate the presence of false membrane in the larynx. Many physicians prescribe an emetic in the beginning of the disease, believing its tendency is to pre- vent the developement of false membrane, and hasten its separation. If the i)atient is strong, an emetic of Ipecacuanah may be given at once. Mix a teaspoonfal of Ipicac in half a glass of unter, and give from a desert- spoonful to a tahlespoonfal every fifteen minutes, until vomiting take.' place. Bloodroot, to one-third the amount of Ipecacuanha, may be given in the same mixture. The efficiency of the Ipecac emetic is increased by giving, at the same time, a teaspoonful of powdered Alum. In cases of feeble children, the Sub-Sulphrte (Yellow Sulphate) of Mer- cury is the best emetic, and after the disease has progressed for a time, as it causes the least exhaustion of any of the emetics, it is to be preferred. Three to five grains, rubbed up with sugar, may be placed on the base of the tongue, and swallowed with a little water. If vomiting does not occur, the dose should be repeated at the end of fifteen minutes. Professor Barker, of New York, prescribes this remedy immediately, when called to a case of croup, and claims not to Uave lost a case since he began this treatment. Alum, powdered, given in doses of a teaspoonful, in syrup or honey, with or without a teaspoonful of Syrup of Ipecacuanha, repeated every fifteen minutes, until vomiting occurs, is a serviceable emetic. One or two grains of Sulphate of Copper, given in powder, with two or three grains of Ipecacuanha, given every ten minutes, until vomiting occurs, is, after the Yellow Sulphate of Me.rcury, probably the best emetic in true croup. After vomiting has been produced by Sulphate of Copper, many German physicians claim it has a specific effect on the croup, which may be obtained by giving it in doses of a quarter of a grain every two hours. While it is true, that in the majority of cases, which have recovered, emetics have formed a prominent part of the treatment, the writer believes they have been beneficial only by removing during the act of vomiting, the false membrane that was already detached or separable, andnot by any specific effect. Hence, in his opinion, the indication for their use is the difficult breathing. They should be given from time to time, to accomplish that purpose, three or four times in the twenty-four hours. In extreme cases, every three or four hours. I S" ■J' 't*i,) If 803 DISKASlCa OP THE KE8PIIIATOUY OlfOANS. In order to Miistuin the streiiKtli of the ptitient, some nourishing uiul quickly-digestible food should he given immediately ufter tlie action of un emetic. Mercury is tliought, by many physicians, to diminish the intlammation and exudation of false membrane. This opinion is held by I'lof. H. C. Wood, in his recent work on tlie therapeutics, second edition. He says when the patient is robust and the general symptoms active, no time should be lost in bringing the patient under its influence. From half a grain to a grain, may be given every two or three hours, or three grains, with three grains of Dover's Powder may be given two or three times a day, until the patient is mercurialized (salivated.) The writer is skeptical as to the beneiit from this practice, but in so dangerous a disease, if the good which may come from it is ever so small, the voice of any one ought not to be raised against it. It is not used in the writer's practice. Alka- lies are more serviceable. In the use of alkalies, the following formula may be used: Take of Chlorate of Potash two drams, Citrate of Potash ttoo drams, Tincture Muriate of Iron a dram, Simple Syrup ttoo ounces, unter sufficient to make four ounces. Mix. Dose : One or two teaspoonf uls every four hours. A dram and a half of the Muriate of Ammonia may be used instead of tlie Citrate of Potash, or two or tliree grains may be given separately, in water. This treatment should be continued night and day, until the cough becomes loose, or treatment is abandoned on account of the hope- lessness of the case. Anodynes are, generally, required in this disease. The most useful Is Opium, but on account of the t' ' ""y of the disease to destroy life by suffocation, much caution shou' ed in its employment. It is best to give it alone, or add it to o ' cines as they are given, that it may be discontinued at any tim( should be done on the appearance of asphyxia (symptoms of sufl ^n.) The Deodorized Laudanum in doses of four or five drops, or three grains of Dover's Powder, sufficient to maintain such an impression as will relieve excitement and spasm. Paregoric may be used for this pur- pose. In some cases, the Bromide of Potassium, with a little Hydrate of Chloral acts better : Take of Bromide of Potassium two drams, Hydrate of Chloral half a dram. Syrup ofTolu half an ounce. Water, an ou7ice and a half. Mix. Dose: A teaspoonful three.or four hou .)art, until spasmodic symp- toms cease. If spasmodic action is marked, it can be given every half hour until relieved. To those who have never resorted to it, the little call for ano- dynes when the patient is kept in a warm room, filled with vapor, will be surprising. When all remedies are proving unavailing, and the difficult breathing increases and marches on to suffocation, the operation of tracheotomy opening into the windpipe,) should be resorted to by the medical attend- ant, as offering the only hope for recovery. The friends ought not to object. After this operation, the treatment is simply to keep the patient in the warm moist atmosphere. Keep the tracheotomy tube clean, and support the powers of life by nourishing food. The other danger is from >.c CROUP. •6V<i btie disease traveling down the windpipe, and causing death from siififoca- tlon, or from tlie development of bronchitis, or pneumonia. The ateady continuancM! of tlie moist air at 00" of temperature is tiie best preventive, should they occur (broiicliial-pneumonia) the cliest sliould be wrapped in an oiled silk jacket, and tlie skin of tlie chest frequently rubbed with Turpentine.or the Ammonia and Turpentine Liniment before recommen- ded for the throat. .Should the patient recover, the tracheotomy tube nuiy iuive to be worn for months, or until the larynx is clear of obstruction. At any time during the disease, if llu! patient becomes enfeebled, stimulants may have to be given in addition to nourishment, as, a tea or dessertspoonful of brandy in milk, beef tea or essence, or egg. Wine whey may be given, if preferred. In the paragraph on emetics Tartar Emetic (and Hive Syrup), were not mentioned because deemed unnecessary, as having no special benefit on the disease, and frequently doing harm, and sometimes even causing death by its prostrating effect, when given at a time when danger was apparently not immediate. HOMCEOPATHIC TKEATMENT. Aconite is the remedy in the first stage, when tliere is high fever, dry hot skin, and yreat reNtlessness. On attempting to swallow, the child cries as if from soreness aud pain in the throat. Loud breathing during expiration, but not during inspiration. Hepar-sul. Croup with loose, rattling, choking cotigh; the air pas- sages appear clogged with mucus. The child cannot bear to be uncovered and coughs whenever any part of the body is uncovered enough to get cold. Great drowsiness and profuse sweat. Iodine. Soreness and pain in the throat and chest, which the child manifests i)y grasping the parts with its hand. Dry, short, hacking cough, with difficulty of breathing. Memhranemts croup with wheezing, satoing respiration. Face pale and cold, voice deep, rough, and hoarse. Kali-hichronticum, in tfue membraneous croup. The disease approaches gradually ; at first there is slight dyspnoea (short breattiing) with hoarse, croupy cough; as it progresses, the difficulty of breathing increases, and the air, as it passes in, sounds as if it toei-e passing through a metallic tube. Hoarse, dry, barking cough ; tonsils and throat red, swollen, aud covered with a membrane; head inclined backwards; violent wheez. ing and rattling in the windpipe, heard at a distance. This is one of the vei-y best remedies known, in true o'oup; wse crude, finely powdered. Spongia in non-membraneous croup, where there is a rough, crowing sound to the cough. Slow, loud, wheezing and sawing respiration, or suffocative fits with inability to breathe, except with the head thrown backwards. Discharge from the nose or sneezing, or dribbling of saliva from the mouth. Dose: Any of these remedies need to be repeated rapidly during the most critical part of the attack, say a dose every thirty minutes to two hours. HOME REMEDIES. Take three or four thicknesses of linen or domestic, wrung out of cold water, leaving it so that it will just drip, apply it closely around the neck, allowing it to extend over the che.«»t; cover the parts well with dry flannel. If not relieved in from five to ten minutes, repeat. h Wti, U' IW DISEASES OF THE liUNOS. K not relieved by application of cold cloths, as just directed 'witli in twenty minutes, give broken doses of Tincture of Ijobelia. If tlie breatli- iii!» is very difficult at the end of the twenty miuutes, give a full dose of one-fourth to one-half teaspoonful of Tincture of Lobelia, that vomiting may be produced as quick as po'='-!ble. Take a lump of UuMnke L. me, put it in a bowl of water, inclose the head of thechild and boA'l logfther by throwing a light cloth of some kind over the head, allowing the child to breathe the steam made by 'he dissolving lime. This has been ' wn to save life after all other means had failed. CHAPTER XX DISEASES OP THE LUNGS. CONGESTION OF THE LUNQ8. Symptoms. The symptoms »,£ congestion of the lungs vary greatly, ..'ccording to the condition of the lungs and the degree of congestion The lower grades of acute congestion only cause a sensation of oppression with shorter and more hurried breathing, at times passing away rapidly, at other times more slowly, or having remissions, but being otherwise painless. In the higher grades, the breathing suddenly becomes oppressed to an extraordinary degree, so that the patient seems on the point of suf- focation. The respiration is hurried, superficial, noisy ; the pulse increases in frequency and fullness, the face looks flushed. Most commonly these symptoms are associated with a desire to cough, and the frothy sputa are tinged with blood. There is no pain, if the lungs are otherwise sound, wheic.;3, consumptive persons experience a great deal of pain. In the highest grades of congestion, the dyspnoea (difficult breathing) increases so rapidly, and the congestion becomes so great, that the patients die of asphyxia, sometimes so suddenly that an accident of this kind has been termed apoplexy of the lungs. The lesser grades of the affection, generally, terminate sooner or later in complelk- /-ecovery. Passive congestion has almost the same symptoms as the active form, great oppression of breathing, red face, accelerated action of the heart. The prognosi s in the acute congestion is almost always favorable ; con- gestions caused by violent emotions are the least promising. A frequent repetition of the attacks is always a very bad sign ; they show that either the heart is intensely diseased, or else that consumption is their exciting cause. ALLOPATHIC VIEWS. The treatment of acute congestion of the lungs does not differ in the first place, if it be general, from that given fur- ther on in this chapter for the invasion of acute bronchitis (see page 390;) or if the congestion be limited to one (or more) lobes of the lung, the treatment will be the same as that of pneumonia during the stage of invasion, (which see). Should the disease not eud at once, the subse- I I t i'm% 'THE HEART AND LUNGS, SHOWING THE BLOOD VESSELS IN THE LUNGS: THE RUPTURE OF ANY ONE MAY CAUSE SPITTING OF BLOOD. CONGESTION OF THE LUNGS. 401 quent treatment will be that for bronchitis or pneumonia, whichever the affection proves to be. If the congestion produces hemorrhage, the treat- ment given for hemorrhage from the lungs should be used, (see page 386). Cold may be applied for the relief of acute congestion in the same way as hereafter directed in hemorrhage from the lungs. A passive congestion in tlie lungs may arise from any cause which obstructs the return of blood through the pulmonary veins to the heart. In asthma or emphysema of the Itiug (dilation of the air-cells of the lung) imperfect oxygination of the lung causes passive congestion in the pulmonary circulation. A diseased condition of the mitral orifice of the heart, which obstructs the flow of blood, or allows the blood to regurgitate from the left auricle into the right ventricle, is another cause. Tumors pressing on the pulmonary veins may be another cause. In other instan- ces the whole veinous system will become congested and the skin livid. Dropsy will occur in the case of heart disease, or an obstructive tumor. The treatment will have reference to the relief of the disease causing the obstruction. It should be borne in mind, that the congestion is in an entirely differ- ent part of the circulation in acute congestion of the lungs, which is in the nutrient circulation from the bronchial arteries, and, in passive con- gestion which is from obstruction to the return flow of blood, which passes through the lungs for the purpose of being purified. HOSKEOPATHIC TREATMENT. The main remedy for all active con- gestions of the lungs is undoubtedly Aconite. Aconite is particularly appropriate in congestion depending upon heart afTections, or indicating and accompanying Consumption ; such individuals have a delicate skin, bright complexion and sanguine temperaments. If the disease was caused by a fit of anger, or vehement chagrin, or mortification. Aconite is indicated so much more fully. Dose : Six pills in a teaspouutul of water, every hour to three hours. Belladonna has, lilcewise, many symptoms pointing to pulmonary congestion, but it is not so easy to determine the conditions for which Belladonna is indicated; they, likewise, occur less frequently. Belladonna is preferable, if not only the lungs, but, likewise, the brain is involved in the congestion, and it is less depending upon disease of the heart than upon some other afffection. Leading symptoms distinguished from those of Aconite are : dark redness of the face, bluish redness of the lips, glist- ening eye; anguish and restlessness; a constant, dry, hacking cough, or else a spasmodic and dry cough. Dose : As for Aconite, Nux-votnica is an excellent remedy for certain kinds of pulmonary congestion, if the following conditions prevail : The attack is occasioned by sedentary habits, excessive mental eflforts, the use of coflfee, ardent spirits, in the case of sanguine, robust individuals who are free from dis- ease of the heart ; after a copious meal in the night. The symptoms resemble those of Belladonna more than they do those of Accnite. Dose ; As for Aconite. IHgitalis-purpurea is inappropriate, in an isolated attack, but Is, on the other hand, indicated, if the congestions occur very frequently, or evidently point to tuberculosis. In such affections, however, there is 26 I m , <4i ■={ ■ ". DISEASES OF THE LUKUS. every reason why the medicine should be given very cautiously. It &i not absolutely necessary for the heart to be the starting point of the dis- ease, for uncomplicated, tubercular congestions of tlie lungs are, likewise, most easily relieved by Digitalis. Dose: As for Aconite, Bn/ouia is the next best remedy to this latter drug. In very acute cases, which may become dangerous to life by the premature superven- tion of an acute (edema of the lungs, no time should be lost, unnecessarily, by awaiting the effect of the first named three remedies ; if they act at all, they will show their curative iullucnce after the very first dose. If they do not afford speedy relief, Phosphorus should at once be used ; or, in case of heart affections, Arsenicum. Dose : Six pills every two hours. SPITTING OF BLOOD-DISCHARGE OF BLOOD FROM THE LUNGS-BUPTLllE OF A BLOOD-VESSEL. Symptoms: Expectoration of blood, in greater or less quantity, Induced by coughing, attended by symptoms more or less severe. Various Forms. This disease discovei-s itself in three varieties: First, by an effusion of blood from the mucous lining of the air-tubes; secondly, by congestion of the lungs; and, thirdly, by the rupture of a blood-vessel in the tubular cavity of the lungs, during the course of con- sumption. It is, however, proposed to deal, Kenerally, with the subject, and to point out the different remedies found useful in tiie treatment, according to the symptoms present. Distinctive Ciiaracteuistics. We must be careful not to con- found this disease with affections of the mouth or gums, or the occur- rence of discharge of blood from the nose, escaping through the posterior opening of the nostrils, and being returned by the mouth. Wlien the blood proceeds from the chest, it is, almost invariably, attended with a sensation, as if it came from a deep-seated source, is warm, generally tastes sweet, and there is, frequently, a simultaneous burning, and pain- ful sensation in the chest. Precautions to be Observed. When the attack is imminent, and is preceded by well-known premonitory symptoms, the patient should refrain from loud or prolonged speaking, calling, singing, blowing wind instruments, violent exercise of the arm, running, ascending stairs, or, in short, from anything calculated to increase the respiratory action, or otherwise, to fatigue the chest. Issue and Results. When spitting of blood occurs, in a robust and healthy person, of sound constitution, it is not very dangerous; but when it attacks slender and delicate persons, it is more serious and difficult of removal. It is, however, chiefly when the patient has had a succession of severe attacks, and the blood is discharged in a large quantity, that the case may be considered dangerous. Symptoms. The disease may present itself without any marked pain or difficulty of breathing, and pass off with no return of the attack ; or be preceded by dry cough, oppression, or tightness at the chest, shiverfhg coldness ofthe extremities, great lassitude, and high pulse— and beaccono* .'-. f 1 SPITTING OF BLOOD. 409 panied by hacking or husky and distressing cough, anxiety, quick pulse, pale and livid countenance— cease, and then return in a few hours, and be followed by difficulty of respiration, and cough; in still more severe cases, when a marked tendency to consumption exists, the anxiety, oppression at the chest, and febrile symptoms are more severe, pure blood, is coughed up, and the paroxysms frequently return. Rupture of a Blood-vessel. [Tlie rupture of a blood-vessel is a rare occurrence, although it sometimes occurs in consumption. When, however, a blood-vessel of any consequence, included in a t' berculoua excavation, does give way, the result is generally fatal.] Causes. Indulgence in spirituous beverages, overheating the body by immoderate exertion, or too great external heat ; blowing wind-instru- ments; contusion of the chest or back ; falls; injury of the lungs; breath- ing a vitiated atmosphere, or vapors charged with acrid substances ; colds or coughs ; violent mental emotions ; diseased state of the lungs ; whether as the immediate result of inflammation or during the progress of actual consumption ; a general scrofulous habit ; Suppressed menstrual, hemor- rhoidal, or other discharges; or repelled cutaneous eruptions. ALLOPATHIC TREATMENT. In hemorrhage from the lungs, quiet in bed is to be insisted on, the head and shoulders should be raised, the food cool, drinks should be cold, and small pieces of ice may be frequently taken into the mouth, the voice is not to be used. Food should be simple and nutritious. Liquids are preferable to solids, as milk, raw eggs beaten up with sugar and water, and beef tea. Regarding treatment by medicines, the remedies which are constantly on hand, and are appropriate, are Tu entine, Alum, Sugar of Lead and Ice. Ten to tv.enty drops of Turpentine may be given every hour. One or two teaspoonfuls of Glycerine, flavored with three or four drops* of Oil of Gaultheria, will almost completely cover the taste of Turpentine— it may be given on sugar. Sugar of Lead may be given in doses of two to five grains two to lour hours apart. Two to five grains of Alum may be given with an equal quantity of sugar every two hours. In case there is pain small doses of Opium should be given at the same intervals, as long as required ; as, half a grain of Opium, five grains of Dover's Powder, or ten or fifteen drops of Laudanum. In applying cold to the chest, large linen cloths may be wrung out of ice water, and wrapped around the chest, or, what is better, cold may be applied to the chest and back by means of ice-bags. It is unnecessary to resort to this, unless the bleeding is severe, especially, if the patient is in good strength. Tight bandaging of a limb at its junction with the body, will be serviceable by preventing the return circulation. Other remedies which are most important are Ergot, Ipecacuanha, Digitalis, Gallic Acid, Subsulphate of Iron. Ergot may be given in connection with other remedies in doses of one or two teaspoonfuls of the powder or fluid extract as often as every half hour, if required. The following is a good mixture: Take of Fluid Extract of Ergot three ounneft, Fluid Extract of Ipecactianha and Deodar* ized Tincture of Opium each half an ounce. Mix. Dose: A teaspoonful every half hour o hour. 404 DISEASES OK THE LUNQ8. Or, Take of Fluid Extract of Ergot an ounce, Fluid Extract of Ipeccu*. uanha, Fluid Extract of Digitalis each half an ounce. Mix. Dose: From thirty drops to a teaspoonful, as is required. It will 1)0 observed in tlie use of Ipecacuanlia, in frequently . >peated doses, for hemorrhage, that when vomiting occurs the bleeding ceases. Digitalis is especially serviceable when a little bleeding occurs constantly with the expectoration, with an occasional mouthful of blood. Cjlallio Acid, in doses of ten grains with ten drops of Aromatic Sulphuric Acid in a wineglass of water, is a valuable internal astringent in cases of heni' orrhage. This dose may be repeated every two hours. The solutions of- Sub-Sulphate of Iron, in doses of twenty drops in Glycerine, have proved eirectual. Astringent inhalations are a very useful form of medication, given from an atomizer or spray apparatus. The following solutions may be used for atomizing : Tannin twenty grains to the ounce of Distilled Water; Alum in saturated solution ; and the solution of the Sub-Sulphate of Iron from ten drops to half a dram, in an oume of distilled water. Persons who have hemorrhage from the lungs may be saved a great deal of unnecessary alarm by a knowledge of the fact, that the trouble, of itself, very seldom leads to serious results. Aside from the fact that it is a symptom of tuberculous or some serious disease, no uneasiness need be felt. HOMCEOPATHIC TREATMENT. In by far the greater number of cases the discharge or spitting of blood soon ceases of its own accord ; the most important object, therefore, is to seek tocnire the complaint when the hemorrhage has ceased, and thereby to prevent its return, or to check the development of organic disease of the lungs (that is, disease attended with alteration of structure.) Pulsatilla, Cocculus, Sepia, Stilphiir, One or more of the last three of these remedies will sometimes be required, successively, after the previous employment of Pulsatilla, when this remedy is insufficient, to restore tne regularity of the periodical discharges, and the spitting of blood is associated with suppression of tlie menses. Pulsatilla is, however, the medicine which is most appropriate wherewith to commence treatment, in the majority of cases arising from suppression of the monthly discharge in females, or of a hemorrhoidal flux in either sex, (particularly when the individual is ofleuco-phlegmatic temperament,) a./ J also in other instances characterized by the following symptoms: expev. to ration of dark, clotted blood, attended with shivering, especially towards evening, or at night, and great anxiety ; pain in the lower part of the chest ; feeling of fiaccidity in the region of the stomach, ^ and weakness. Dose: Six pills in a teaspoonful of water night, morning and noon,l for a week ; then pause four days, after which the course may be resumed as before, if necessary, and so on, until change. Befer also to the articles on " Green Sickness " and " Suppression of the Menses." Bryonia is a good remedy in cases where the expectoration of blood, which is often in a coagulated state, is excited by a tickling cough ; and where there is oppression at the chest, with frequent necessity to take a deep inspiration ; anxiety and irascibility. Dose: lu every respect as directed for Pulsatilla. SPITTING OF BLOOD. 40fi Nux-vomica is adapted to individuals of an irritable temper, in whom this affection owes its origin to a hemorrhoidal suppression, a fit of passion, or exposure to cold. It is furtlier indicated i)y dry cougli, which causes headache, with excessive tickling in the chest, and exacerbation of the symptoms towards morning. Dose: Four pills in a teaspoonful of water, night and morning, for a weelc, tlien pause four days, after which repeat the same course, if yet requisite, and so on until permanent reliefer change ensues. Ithnii. Wlien the blood expectorated is of a briglit-red, the mind much agitated, and the patient irritable and rendered worse after the slightest vexation or contradiction. Dose : In all respects as directed for Nux-vomica, Arnica-motitana is principally useful in cases arising from exter- nal injury, sucli as a severe blow on tlie chest, or from lifting a heavy weight, or any other exertion, even blowing wind instruments; but, also, in almost all cases, where the stethoscope detects effusion of blood into the air-cells, attended with a sensation of constriction, and burning in the chest, pain as from contusion in tiie back and slioulder-blades, and diffi- culty of breatliing. Moreover, profuse expectoration of dark-colored blood or clots, brought up without much exertion, or bright, frothy blood, mixed with mucus and clots ; sensation of tickling behind the breast-bone, general heat, great weakness and fainting. Dose: Of a solution of eight pills to three tablespoonfuls of water; give a teaspoonful every hour, until six doses have been given, and then every six hours, until manifest improvement or change. Treatment op Very Severe Cases. Aconltuni is often found most serviceable in warding off an attack, by the great power which it posesses in controlling the circulation, and is indicated, previous to the paroxysm, by the premonitory symptoms of shivering, with accelerated pulse, palpitation of the heart, a sensation of ebullition of blood in the chest, with burning and fullness in the same region; paleness, and expression of anxiety in the face ; great anguish and anxiety, aggravated by lying down; or dwing the aitac/c, when the expectoration is profuse, coming on in gushes, and excited by a slight, dry cough. Dose: Four pills in a teaspoonful of water, repeated at intervals of two hours, until manifest change. Ipecacuanha is required when a taste of blood remains in the mouth a few hours after the employment of Aconite has been commenced, and there is frequent cough, with nausea, weakness, and expectoration streaked with blood. In some instances, in which neither this remedy nor Arsenicum avails singly to subdue the symptoms, the alternate adminis- tration of both has been resorted to with admirable results Dose: If singly, six pills in a teaspoonful of water, repeated at inter- • vals of an hour, until change. If in alternation with Arsenicum, a solution of eight pills of each, separately, to four teaspoonfuls of water, administered by teaspoonfuls every half hour in rotation, until manifest improvement or change. Arsenicum becomes necessary when the anxiety, anguish, and pal- pitation of the heart increase, notwithstanding the previous administration of Aconite or Ipecacuanha (or both ;) and when, in addition, we find extreme restlessness, and general, dry, burning heat. Dose: If singly, four pills in a teaspoonful of water every hour. If in alternation with Ipecacuanha, i directed for that medicine, above. M r, i HI m "f»! 40(i DISEASES OK THE LUNGS. Sulphnr, followed by the Bubsequent administration of Arnica, is of essential seivicw in cases iu wliicli the spitting of blood recurs, after having previously yielded (with the associated symptoms) to the action of the foregoing medicines. Dose; Tliiee pills of sulphur in a teasi)Oonful of water, repeated in three liours, and followed by a pause of six hours, and then by tlie consecutive administration of similar doses of Arnica every three hours, until manifest improvement or change results. China is one of our best remedies in restoring the vital energies of the patient, after considerable loss of lluids, whether blood or otlier secre- tions; if .3, tlierefore, particularly ellicacioiis o/ter a severe attack of this affection ; but it is, also, indicated diirimj its course, wlien tlio spitting of blood takes place after a violent cough, or wlieii there is a continual taste of blood in the mouth, or when we iind sliivering alternately with access of heat, frequent, and short-lived perspirations, tremor, and confusion of vision, with a sensation of vacuity, or lightness in the head, weakness, and desire to remain constantly recumbent. Dose : If against actual discharge of blood, give six pills in a teaspoon- ful of water, every hour, until change. If as a restorative uganta/ter an acute attack, give four pills in a tablespoonful of water, night and morning, until manifest improvement or change. Ferruin-tnetallicam may be exhibited with advantage after China, in severe ciises, and when the fourth dose of the last named medicine has been productive only of partial effect ; or may be preferred if the expec- toration follow a slight cough, and is scanty, but consists of pure bright- red blood, attended with pain between the shoulder-blades, witli inability 10 remain long in a sitting posture; the patient feels the concomitant symp- toms relieved by movement, but is speedily fatigued, especially, by con- versation. Dose : If against actual discharge of blood, six pills ; if as a restorative remedy, four globules, as directed for Chiim. HOME REMEDIES. Salt, freely used by taking in the mouth, will frequently stop the bleeding. The following has permanently cured many cases where the bleeding was so profuse as to apparently leave no hope : Take Spikenard-root one pound, Liquorice root one pound, Comphrey root one pound, Horehound four ounces, Hops four ounces, Bloodroot (Sanguinaria) one-half ounce. Water five gallons. Boil in an ii'on kettle, until reduced io one gallon, strain through a woolen cloth, and boil the liquor down to one-half a gallon. Then add one and one-half pints strained honey, and three pounds loaf sugar, boil three minutes. Dose : One tablespoonful three times each day. ACUTE BRONCHITIS— INFLAMMATION OF THE MUCOUS MEMBRANE OF THE BRONCHIAL TUBES. History. Acute bronchitis is one of the most frequent diseases of the human kind generally. It is not, generally, a dangerous disease when attacking middle-aged persons; it is, on the contrary, very dangerous to children and old people, and therefore, constitutes one of the most im- ACUTE BRONCHITIS. 407 portant discuses of these two periods of human existence. It is unde- niable thai tlu! first years of cliihlhood, are peculiarly prc(lisi)i)S(.'il to thid disease. A predisposition of this kind, likewise, exists ainont,' persons of a more advanced age, and may almost always be attributed to ilie follow- ing circumstances : An effeminate mode of living, witliout adequate exer- cise in the open air, and not admitting of a free, and easy respiration ; con- stitutional diseases, even such as do not emaeiatci and debilitate the system, more especially scrofula and consumptive irritability of the mucous membrane in consequence of frequent attacks of bronchitis; acute and chronic disejises of the lungs. The exciting causes cannot well be traced with positive certainty. A cold and consequent suppression of the perspiration is, undoubtedly, one of the most ordinary causes, but not quite as common as is generally sup- posed. The atmosphere doubtless exerts a powerful influence, not only in consequence of rapid changes in the temperature, but principally through the changes in atmospheric electricity, and, as modern investigations seem to have confirmed, througli consequent changes in the amount of ozone in the atmosphere. This becomes so much more probable, if we observe that a large nunjber of cases of bronchitis are not so much caused by a damp and cold, as by a dry and cold wind, such as prevails in our region of country when the wind blows from the northwest and north. If the tem- perature of the wind were the main cause of the trouble, an east wind would cause bronchitis most easily, which is certainly not the case. An epi- demic bronchitis spreading over a large tract of country, and being even considered contagious, the so-called influenza or grippe, depends upon conditions which we designate as miasmatic, but of the true nature of which we .are as yet ignorant. Secondary bronchitis develops itself secon- darily in persons afflicted with heart disease, congestion of the lungs or during the presence of acute exanthems (measles, scarlet fever, etc.,) or various intensely acute constitutional diseases. The lighter form of bronchitis, generally designated as bronchial catarrh, frequently sets in without any fever; at any rate, generally, it is scarcely perceptible ; sometimes no fever at all is present, or the fever is at most indicated by a succession of creeping chills. Tills form of bronchitis scarcely ever exists isolated, but is almost always attended with catarrh of the nose and larynx. After experiencing a feeling of malaise for several hours, and a marked sensation of languor, the patients are attacked with a dry and spasmodic cough, attended with a raw or sore feeling in the chest; at the same time the breathing is somewhat oppressed, and there is no expectoration at the outset of the disease. Tlie appetite is less, but not gone, the tongue is not always coated; the patients are able to remain up, but feel drowsy, and often complain of violent headache. Very often the cough remains dry for a long time, but more frequently a tenacious, greenish-yellow scanty expectoration commences on the second day, which it is very difficult to hawk up. At the end of three to nine days, very rarely at a later period, and then only if the patients neglect themselves, the expec- toration becomes more copious, whiter, lumpy, and is raised more easily, the normal feeling of health is restored, and, while the cough is gradually decreasing, the disease passes off. The attack seems so sliglit, that many patients go about as usual, but, by pursuing this course, expose themselves to relapses, which are very apt to take place and beget a tendency towards 11 408 DISEASES OF THE LUNGS. the inflammatory form of oronchitia, or else orifjiniite the consequences that will be more fully described in <i subse(iuent paragraph. INFLAMMATOUY OE ACUTE BKONCIIITIfl. This form of bronchitis, which is marked by much more vMoint phe- nomena, is not, by any means, a purely simple form of bronchitis of a higher degree of intensity. It does not, ordinarily, result from an existing catarrh of the upper respiratory organs, unless the catarrh is suddenly and violently increased by severe neglect; but, most generally, it occurs as a primary disease. It generally cotnmouces with a violent chill, which is distinguished from the chill that initiates acute intlammatioub, by the cir- cumstances that it is nut followed by as higli an increase of temperature, and that there is a frequent recurrence of the chill, especially, on motion. The patient feels very weary and languid, complains, most generally, of a violent headache, exhibits frequent changes of complexion, experiences a rheumatic drawing in the limbs, and great restlessness, and is scarcely ever capable of remaining out of bed. Very soon these general symptoms, which do not point out more particularly the locality of the disease, are followed by a burning, sore pain in the chest under the sternum at every deep inspiration, which is felt more severely when coughing. The cough sets in at the same time as the pain is felt; it is more or less violent, some- times spasmodic, at first dry, but not hoarse, but very soon accompanied by the abov^-described expectoration. There is no dyspncea, properly speak- ing, but the breathing is more labored, less full, and hence somewhat nvre hurried. The pulse is accelerated, but it is only in the severe grades of the disease that it exceeds one hundred pulsations. In this form of bron- chitis, the digestive organs are always involved, the appetite is entirely gone, the bowels are constipated, there is seldom any vomiting. Even in simple bronchitis, when not complicated with tubercles, the expectoration is easily tinged with blood, whereas, raising a quantity of pure blood is a rare occurrence, and always points to a more dangerous and more deep-seated constitutional disease. All the phenomena, espe- cially the cough, exacerbated in the evening, and about midnight. The further course of the disease is governed by a variety of circumstances. The importance of bronchitis of any degree in the case of tuberculous consumptive patients; will be more fully inquired into when we come to treat of consumption. In favorable cases, uncomplicated forms of bronchitis terminate in four or five days, or, exceptionally, at an earlier period, in simple bronchial catarrh. The general symptoms moderate in intensity, the fever abates almost entirely, the expectoration becomes more profuse, more fluid, of a whitish-gray color, and is more easily raised by the cough, which is now much less painful. The patients do not often feel well again before the tenth day. If the course of the disease is less favorable, its diflferent phases are either more protracted, or else other morbid conditions become associated with it. In the former case, the dry, spasmodic, distressing cough may last beyond the seventh, or even to the fourteenth day, after which the period of a more profuse secretion of mucus lasts equally long Although this longer duration of the disease shows, as a rule, that it is of a secondary nature, yet a purely primary form of bronchitis may run an equally long course, au occurrence peculiar to old age. ACTJTE BRONCHITIS. 400 The patient's agb ?xert.s a greatly modifying influence over tlio course of tlie diseaso, as well as over its danger to life. AnM)ng old people, or only somewhat advanced in ago, tlie danger is ([uite consideral)le. and seems to depend more particularly upon the increased liability of tlie broncliial mucous lining to swell; upon the profuse quantity of the secre- tion at tlie same time as the respiratory process becomes feebler, and upon the consequently increased danger of ccdema of the lungs. Honco the bronchitis of old people differs greatly from that which we have described in the preceding paragraphs. The disease originates in the same manner, only the fever symptoms seeia to be less violent. The pulse soon becomes smaller and weaker, the skin becomes moist and cool, the tongue dry and brown, and the senses are powerfully affected by the diseivse; sopor, delirium and grasping at flocks, setting in. In this man- ner the patient may succumb to the disease in a few days, the increase of the mucus rales (rattle) and the decrease, and final and total cessation of the expectoration, constituting the most ominous signs of approaching dis- solution. One of the most common terminations of broncliitis is chronic bron- chial catarrh, which succeeds the acute form the more rarely, the younger and healthier the individual. Having described the other forms of bronchitis, we here devote a few lines to a description of infantile bronchitis, which, as regards its course and importance, differs most essentially from the corresponding bronchitis of adults. In inflammation of the larger bronchial tubes, be it slight or severe, has almost the same phenomena in the case of children, as in that of adults, except that the fever is much more violent and the breathing, is in almost every case, interfered with very considerably, at an early period. The importance of this process, in the case of children, is much greater than in that of adults, for the reason that in the former it is apt to spread to the, smaller broncliial tubes, after which the children, who at (irst gave no cause for alarm, suddenly appear attacked by t dangerous dises.se. The symptomatic development, generally, takes place as follows: After the children have had for some days a simple catarrh, attended with severe fever, the breathing becomes more hurried and, progressively, more oppressed, and the children become more and more restless and anxious. The respiration, during inspirations as well as expirations, now becomes wheezing, more especially during an insp' ration. The cough continues to increase in vehemence, without anything being expectorated ; or, if any- thing is raised, it is only with great difficulty a small quantity of mucus, which is swallowed again as soon as raised. The general organism, in such a severe disease, is, of course, correspondingly affected. The diffi- culty of breathing now increases from hour to hour, and soon reaches a degree of intensity that is in no respect inferior to the worst attack of (uuui>, and becomes still more distressing in consequence of the unceasing rlforts on the part of the children to obtain relief by coughing. The pulse becomes frequent and small, the skin on the extremities and head is covered with perspiration, the face is pallid or livid, becomes bluish dur- ing an attack of cough, the anxiety and restlessness reach the highest degree of intensity. If, at this stage of the disease, there is no improve- ment, by an increase of ' expectoration and a relief from the difficulty of m < IJ;, w 'Mi ml*- ' if 410 DISEASED OF THE LUNOS. breathing, the disease presents tlie sanje picture as in the last stage of croup, only tiio hissing sound caused by the stricture of the glottis is want- ing. The children become calmer, pallid and cool; they are lying in a state of unconsciousness or sopor, the respiration becomes vfry 8U|)erflcial, the paroxysms of cough abate more and more, and the children di(U'onia- tose. This fatal termination sometimes takes place in the llrst week of the disease, loss fequently, after the fourteenth day. Recovery always takes place slowly, the liability to relapses is very great: the strength does not easily return, and the cough sometimes con- tinues for many weeks. The diagnosis is only difiicidt in the case of very umall children; here the characteristic cough is almost always entirely absent; in general, the reaction against the disease is either slight or non- apparent. The prognosis is the more doubtful the younger the patient; That dentition complicates the prognosis cannot be taken for granted, the greater liability to the disease, at this period, is probably owing to the increased susceptibilities of the infantile organism. ALLOPATHIC TREATMENT. A common catarrh or cold affecting the bronchial tubes, is known to physicians as acute bronchitis. It fre- quently begins as a coryza (catarrh or cold in the head) and nuiy often be cut short by a full opiate and a diaphoretic (medicines wiiich produce sweating). A remedy which fulfills these indications the best is the Dover's Powder (Compound Powder of Ipecacuanlui.) It may be given in doses of ten to fifteen grains at bed-time. Twenty or thirty drops of Laud- anum, a quarter of a grain of morpiiine, or half a grain of Codia may be given instead. The proper time to take this remedy is before going to bed. It should be accompanied with a hot foot bath, and a copious drink of gin- ger tea. The next morning a free cathartic should bo given, as a Seidlitz Powder, or a tablespoonful of Roehelle Salts in lemonade, or a tablespoon- ful of Citrate of Magnesia, or a tablespoonful of Epsom Salts. (The dis- agreeable taste of Epsom Salts is removed by boiling with one-third of its bulk of roasted coffee in an earthen vessel for a couple of minutes, then let it draw a few minutes and strain.) This plan of treatment is effectual in stopping or lessening the effects of a cold. If the disease becomes established, it will yield more readily, if the patient remains in bed, to secure uniform warmth and moisture of the skin. In severe cases, the room should be charged with steam in the man- ner described for croup. If there is much pain or soreness of the chest, a mustard plaster, or a liniment of one part of Aqua Ammonia, two parts Olive Oil, and one part Spirits Turpentine, will be found useful. Spirits Turpentine, alone, or with an equal part Spirits Camphor, may be used for this purpose, with equal benefit. Three to ten drops of the Fluid Extract, or teaspoon ful doses of the Syrup of Ipecacuanha, or ten drops to half a teaapoonful of Hive Syrup, can be given at such intervals, through the day, as will keep the skin slightly moist. Morphine, in doses of a twelfth to an eighth of a grain, or Paregoric, in doses of a teaspoonful, may be given three or four times, or ofteuer, during the day, to relieve cough. k7 ACUTE BIIONCIIITIS. 411 I And H mixture of equal parts of Paregoric, Tincturo of Hyoscyanius «nd Fluid Extract of WiW (Jliorry Hark, in dosen of ono or two toaspoon- fuls, an exceedingly etllcacious remedy for the relief of cough in all forma of bronchitis; if the Fluid Extract of Wild Clierry IJarlc haa been deprived of aatringency as is done by Chapman, Green & Co., of ChicarjO, the remedy Is an agreeable one to take. In case there is fever wU!: the attack, or much secretion of mucus. Aconite may be used witli the best efTect, and is not Incompatible with other treatment, which may be needed. The Tincture of Aconite may be given in doses of half a drop, or a drop, every half hour, until an imiiression is made on the lever movement, and then continue in doses of a drop every liour, or two or three hours. In the continued use of the Aconite, if the bronchial secretion is very profuse, tlie Tincture of Bella- donna may be given witli it, as follows: Take of Tiiuitare of Aconite a dram, Tincture of lielladonna two drams. Mix. Dose: Tliree or four drops from one to three hours apart. If the inilammation linger, and appear disposed to become chronic. Quinine should be given in doses of two or three grains three times a day. If the patient is pale and feeble, fifteen or twenty drops of the Tincture Muriate of Iron should be given, with a dessertspoonful of a Saturated Solution of Chlorate of Potash, in Syrup enough to make a pleasant mix- ture, after each meal. The diet should be nutritious. Warm clothing, hearty food, and life in the open air, are the best pre- ventives against " taking cold." Acute Buonciiitis. Some points in the treatment of acute bron- chitis, in young children, reciuire special consideration. Youuf children do not expectorate (throw the phlegm oft" from the bronchial tubes,) and suffocation nxay be caused from its accumulation. This may be supplied in the act of vomiting. An occasional emetic should, therefore, be given. Teaspoonful doses of the Syrup of Ipecacu- anha are appropriate. Or one or two grains of Powdered Ipecac may be given in water, and repeated every fifteen minutes, until vomiting occurs. Alum may be given, with Ipecac, in doses of a teaspoonful, If vomiting does not soon produce an emesis. The emetic should be repeated every day, or oftener, or when the breathing becomes impeded by the accumulation of phlegm. After vom- iting is produced, no nauseant medicines should be given until vomiting is again required. A warm bath should be given at the commencement of the disease. This, with an emetic in the first twelve hours, may cut the attack short. The chest should be wrapped with a flannel saturated with Cam- phorated Oil (Olive Oil containing twenty or thirty grains of Gum Cam- phor to the ounce,) and this covered with oiled muslin. If this oil does not redden the skin, a little Turpentine may be added, until it does; or a thin poultice made of flaxseed meal, containing one-sixteenth part of pulverized Mustard, may be applied to the chest, and covered with oiled muslin. The bowels should be moved, regularly, and if thi^ does not occur, naturally, a laxative should be given. Castor Oil, with an equal quantity of Glycerine, flavored with a couple of drops of Oil of Gaultheria, or Cin- I I, m m DISEASES OF THE LUNOa H EmmM \ "jsii i:m.\' namon, to each dose, may be used for this purpose, in doses of one or two teaspoonfuls. For constitutional treatment, the following formula may be used: Take of Syrup of Squills ttoo drams, Acetate of Potajih half a di'am, Syrupof Tolu, and Anise Water, each seven drams: Mix. Dose: For a child of six months cr a year, a teaspoonful every three or four hours. Twenty or thirty drops of Tincture of Bloodroot may be added to this formula. If the kidneys, or skin, are not acting freely, twenty or thirty drops of Spirits Mendirerus may be given at the same time, or separately. Opiates ought not to be given with any freedom, but if there is much cough or restlessness, it should be relieved with from fifteen to thirty drops of the mixture of Paregoric, Ilyoscyamus and Wild Cherry Bark, as spoken of in the treatment of adults, at such intervals as is required; it may be given in the syrup above mentioned. If there is much fever, and the child is two years old, or over, eight to twelve drops of Tincture of Aconite Root may be, also, added to the above syrup mixture. The patient should be allowed the breast, freely, and have, in addi- tion, if that is insufficient, creamy milk, juice of lean meat, or strong beef tea. The object of treatment, is to supply the lack of expectoration by the proper use of emetics, to support the powers of life by nutritious food, and diminish the congestion of the bronchial mucous membrane by warm and mildly irritating applications, and by diaphoretics, laxatives, and, last and least, anodynes. Capillaiiy Bronchitis. The treatment of capillary bronchitis, (i.e., in the small bronchial tubes,) does not differ, essentially, from the treatment of ordinary bronchitis, except that as the disease is infinitely more grave, much more attention must be given to .supporting the strength of the patient, and, in children, relieving the lungs of mucus, by the use of emetics. When the fever runs high. Aconite should be given as before directed. In capillary bronchitis, Snakeroot, Carbonate of Ammonia and Iodide of Potassium, seem, especially, useful. Take of Fluid Extract of Snakeroot an ounce, Carbonate of Ammonia, a dram, Iodide of Potassium a dram and a half, Syrup of Tolu and Water, each an ounce and a half Jlix. Dose: A teaspoonful for a child, and a tablespoonful for n adult, three or four hours apart. HOMffiOPATHIC TREAT:.2ENT. Aconitum. Marked indications are, hot, dry skin, with otrong, hard, and accelerated pulse ; roughness of the voice; short, dry, and frequent cough, excited by tickling in the throat and chest; obstructed respiration, wheezing or sonorous noise in the chest ; anxiety, restlessness, headache, and thirst, with occasional Bcanty expectoration of a sticky phlegm. Dose: Of a solution of six pills to two tablespoon fuls of water, give a teaspoonful, repeated at intervals of an hour, until the indicative a^mptoms are allayed. Bryonia is of great service, in a large number of cases of bronchitis, at the commeucem.ent of the attack, and should be administered two hours 1 ii ACUTE BRONCHITIS. 413 after the third dose of Aconitum, in the event of the unmodified con- linuuuce of the fever symptoms— the following indications being present: laborious, rapid, and anxious breathing, with constant inclinations to make a deep inspiration ; hoarseness ; headache ; dry cough, attended witli a burning, pricking pain, extending from the throat to the middle of the breast-bone; orcough.day and night, with scanty and diffi Itexpec- toration of viscid white or yellow-colored phlegm, in some instances tinged with blood; wheezing; dryness of tlie mouth and lips; hot, dry skin, or dryness of the skin during the day, and copious perspiration at night; excessive thirst. When a pain, as if arising from the efTects of a bruise, is experienced under the breast-bone, with aching and sensation, as if tlie contents of the cranium would be forced through the forehead, after each fit of coughing, or when the breathing is 'nipeded by shootings in th6 chest, and the affection threatens to become complicated with pleurisy, tills remedy is still more particularly called for. Dose : A solution of six pills, as directed for Aconitum. Spongla is often of great service after the previous administration of Aconite, when there still remains a considerable degree of inflammation in the air-tubes, especially the larger, with wheezing or sonorous noise in the chest; and, also, at a more advanced stage of the disease, when rat- tling of mucus is distinctly audible; hollow, dry cough day and night, but worse towards evening; or cough with scanty, viscid, ropy expector- ation ; heat in the chest; burning, tickling irritation In the top of the windpipe; quick, anxious, laborious respiration; inability to breathe unless the head is thrown backwards; hoarseness. Dose: Of a solution of six pills to two tablespoonfuls of water, give a teaspoon ful every two hours. Belladonna. This remedy is useful when there is severe headache, materially aggravated by coughing; flushed face ; oppression of the chest, and constriction, as if bound, with loud wheezing and rattling of mucus intheair tubes; short, anxious, and rapid breathing, dry, fatiguing cough, especially at night, which is endeavored to be suppressed on account of the pains which it creates ; heat of the skin, and thirst ; soreness of the throat. Belladonna is often exceedingly efHcacious in children, particularly in those insidious cases which commence with a slight wheezing, and then suddenly become aggravated to such a degree as to threaten suffocation ; the heat of the skin being at the same time considerable, and the pulse excessively rapid, and sometimes even intermittent. Dose: Of a solution of six pills to two tablespoonfuls of water, give a teaspoon ful every three hourp MereaHus. This remedy may, occasionally, be found useful in the second or secretive stage, v/hen the symptoms of bronchitis are accom- panied by excessive perspiration; when the cough is fatiguing, worse in the (ivening and at night, and excited by a tickling irritation, or sensation of dryness in the chest, with quick, short, oppressed breathing, and louder breathing than ordinary ; hoarseness ; cold in the head, with watery, acrid discharge ; swelling of the nose. Dose: As for BelU'donna. Phosi}horus, This important remedy is frequently of great utility In bronchitis, when the more inflammatory symptoms have been subdued by Aconite, but the breathing continues much oppressed, accompanied if i m \i\ « '4 114 DISEASES OP THE LUNGS. with great anxiety, and heat in the chest; dry cough, excited by tick J g in the throat or chest, aggravated by talking or laugliing, and folluw^d by expectoration of stringy plilegin of a saltish taste. Further, wheu the disease has been neglected, or when, from the symptoms which present themselves at the commencement, we have rea.son to dread complication, or an extension of the inflammation to the substance of the lungs, there will be additional reason for administering Phosphorus. Dose: Four pills in a teaspoonful of water every four hours, until distinct change. Pulsatilla. This remedy is often required in the second or secre- tive stage to complete the cure, after the previous exhibition of Aconitum, when the acute inflammatory symptoms have been subdued, and the expectoration has become thicker and more copious. It may, however, be prescribed before or after any of the medicines we have named, especially when the disease occurs in persons of mild disposition, or lymphatic con- stitution, and the symptoms are as follow : breathing short, accelerated, and impeded, attended with rattling of phlegm, heat in the chest and anxiety; hoarseness; shaking cough, worse towards evening, at night, or in the morning, accompanied with considerable expectoration of tenacious, or thick, yellowish phlegm, sometimes mixed with blood ; cold in the head, with copious discharge of thick, discolored phlegm. Dose: Of a solution of six pills to two tablespoon fuls of water, give a teaspoonful every two hours, until improvement or change. If improvement occur, the intervals should be extended to six hours, and the administration thus continued, until the subsidence of the symptoms. BRONCHITIS IN CHILDREN. Chatnomilla is often a most useful remedy after the previous exhi- bition of Aconitum in cases occurring amongst children, when a slight degree of whistling or sonorous noise in the chest still remains ; dry cough, worse at night, occurring even during sleep. (See also Belladonna) . Dose: Four pills in a teaspoonful of water, given e /ery three hours. Tpecacuanha is, also, a very serviceable remedy for children, when there is wheezing or rattling in the chest, and when on couoihing they are almost suffocated by the excessive secretion of phlegm, and ■ ''jcome iivid in the face; shortness of breath and perspiration on the fortbead after each fit of coughing. Dose : Same as Chamomilla. Arsenicum should be given two hours after the third dose of Tpecac- uanha, if the latter remedy has only been productive of partial benefit, and is indeed to be selected in preference to Ipecac, if the following indi- cations occur; the pulse very quick, feeble, and irregular, and the patient reduced to a state of extreme deL)ility and collapse, the breathing obstructed almost to suffocation, and attended with a wheezing and whist- ling noise in the chest, cough and hoarseness. Dose: Of a solution of eight globules, to four teaspoonfuls of water, give a teaspoonful (or two globules dry on the tongue.) at intervals of five, ten, fifteen, and twenty minutes, and .so on, adding five min- utes to the length of each succeeding interval. HOME TREATMENT. In the commencement of this disease, the patient should take a profuse sweat. After this has continued for three or four hours, and then been allowed to cool off, the whole surface of the CHRONIC BRONCHITIS. m I i body should be bathed with a warm, weak ley-water,* and then be thor- oughly dried. Immediately after this, place mustard poultices to the soles of the feet, and along the whole course of the backbone, but be very careful not to allow them to blister; and cover the whole chest, or upper part of the body, with a fomentation of Hops, Lobelia leaves and Tansy, equal parts of each, steeped for a short time in hot water, ana applied as hot as the patient can bear ; this should be changed as often as it become?, tepid. If the inflammation continues, this should be repeated every day, for three or four days, if the patient's strength will bear it. To relieve the cough the following may be used : Take of Flaxseed or Slippery Elm Bark, two ounces ; Lobelia leaves, one ounce; Bloodroot or Red Puccoon, in powder, two teaspoonfuls ; add to these one quart of boiling water, cover the vessel and let it steep near the fire for an hour; then, when cold, strain and sweeten with honey or molasses. Dose : A teaspoonful of this may be given every hour or two. Should this vomit or nauseate too much, the dose must be lessened. il CHRONIC BBON^CHITIfi.—CHROXIC PULMONARY OR BRONCHIAL CATARRH. In the majority of cases, chronic bronchitis owes its existence to one or more attacks of acute bronchitis, out of which it arises by gradual development. Even as thus arising as a secondary disease, the affection is exceedingly frequent, but this frequency is still more increased by the cir- cumstance that it accompanies most of the material changes of structure in the lungs, particularly, consumption, and that it likewise, occurs as a complication of diseases of other organs. The latter occurs more particu- larly in diseases of organs, that obstruct the return of the blood from the lungs, such as heart disease and affection of the liver. As a primary dis- ease, chronic bronchitis is more particularly met with among persons who are upwards of forty-five years old ; every chronic pulmonary catarrh of young people excites a well-founded suspicion that it emanates from some other pulmonary disease as its source. Men are mucli more frequently afflicted with chronic bronchitis than women; children are seldom attacked. In northern climates, clironic pulmonary catarrli becomes much more frequent; in the countries with a damp and cold climate it is almost endemic; it likewise, prevails among individuals whose business confines them to damp and cold places. Persons who have to inhale a good deal of dust during their work, such as stone-cutters, millers, and sculptors, are likewise, exposed to frequent attacks of chronic bronchitis. Smoking is, likewise, a frequent cause of this disease. The use of tobacco causes chronic catarrh of the bronchial lining membrane much more frequently than one imagines, without any acute attack having preceded the chronic form. Considering our mode of living, and when affecting persons beyond the age of fifty, the milder cases of chronic bronchial catarrh do not pre- sent any marked symptoms. The parties cough a little, most generally, in the morning, and after that they expectorate some, but assimulation is not affected by the disease, nor is the respiratory process interfered with, and the condition sometimes remains unchanged for years. The more violent 1;:^ Tfe 'I., ^■fF'' 5jf«; 416 DISEASES OF THE LUNGS. cases, on ^\e contrary, cause constant and most commonly increasing trouble. After the termination of an acute bronchial catarrh, for chronic catarrh seldom sets in gradually, without any preliminary acute stage, cough and expectoration remain and continue with slight variations until made worse again by another acute attack. The cough is marked by two essentially distinct features. If the bronchial secretion is scanty, tena- cious and firmly adhering, the paroxysms of cough occur less frequently, but in sucli a case the cough is most severely spasmodic, and not unfre- quently leads to gagging and vomiting. The paroxysms occur most fre- quently at night, less commonly in the day-time. After violent exertions, some of the above-described mucus is expelled; sometimes a little mucus is not hawked up till some time after the cough. If the secretion is more copious, the cough sets in chiefly in the morning-hours, or after the use of warm food; it may continue for a long time, but is not spasmodic, for after a few energetic spells of cough, the mucus is detached and expector- ated. Sooner or later the cough becomes associated with more or less violent oppression of breathing, which may even creep along without being per- ceived, and corresponds with the increasing thickening of the broncliial raucous membrane, a diminution of its elasticity and the copious quantity of the secretion. At first this oppression is only perceived by the patients when making an effort, during a rapid walk, going up hill; soon, however, it is felt even during an ordinary walk, even during rest, and causes a great deal of annoyance. In the higher grades of the disease, the patients are threatened during the paroxysm of cough with danger of suffocation ; even between the paroxyms the nature of the existing affection is revealed at first sight by the elevated thorax and consequent shortening of the neck. The most intense pain, however, is endured by the patients, if an acute aggravation of the disease takes place. Under such circumstances, they exhibit such a picture of distress, that it seems as though they could not possibly live longer than twenty-four hours. These acute exacerba- tions occur almost certainly once, at least, every spring and fall, even if the patients have not knowingly been exposed, or have not even left their ; oom. In the beginning, the general organism is not effected by the complaint; even tolerably severe forms of this disease are borne for a long time with- out any perceptible detriment. Very seldom, and only if the secretion is very profuse, emaciation gradually supervenes, in spite of which the patients may live, however, for many years. The greatest danger is occa- sioned by the influence exerted by the impeded respiration over the cir- culation. The functions of the heart become* abnormal; the deficiency of blood in the lungs and its imperfect aeration, either cause passive conges- tion of the lungs, and a corresponding chronic intestinal catarrh, or diturb- ances in the functions of the spleen or kidneys, or passive congestion of the brain, with its inherent dangers, so thsvt it is not, without reason, that a raised thorax and short neck are designated as an apoi)lectic habit. If the catarrh has become an inveterate disease, it is apt to last to the end of life; but that such a noble organ as the lungs should be capable of bearing for so long a time, even a severe degree of an apparently dangerous •lisease, is indeed remarkable. It is not marasmus, wasting of flesh, the i OHRONIO BRONCHITIS. 41T I patient need dread, but the constant succession of acute attacks, which indeed, are rarely immediately fatal; most patients die of this disease amid symptoms of general dropsy. If an acute attack assumes the form of capilliary bronchitis or pneumonia, the lives of such patients are indeed in extreme peril. In recent cases, the prognosis is not altogether unfavorable, so far as a cure is concerned ; life is very seldom endangered by such a disease. The chances, of course, depend upon what structural changes have taken place, and to what extent. The worst omen is heart disease, which almost alwayi terminates in dropsy in a very short time. ALLOPATHIC TREATMENT. In chronic bronchitis, the general health demands attention in the first place. To this end the diet should be good and nutritious, but plain ; meat, milk, eggs, fowl, fish, and fari- nacious food will be required. As a rule, alcoholic stimulants are not to be used. In case of feeble persons, Quinine and Iron should be 'fHiven. The Quinine may be given in pills, and the Muriate Tincture of Iron (tlio prc^paration which I prefer) in doses of fifteen or twenty drops, largely diluted in sweetened water, three times a day. Cod Liver Oil may 1)0 called for, and when there is much secretion, the Ilypophosphites or Phospliates are serviceable in supporting the patient. If the Compound Syrups are used, which contain Iron, the Muriate Tincture of Iron need not bo given : Take of the Compound Syrup of Hypophosphites (containing Iron) tJiree and a ha7f ounces, Dilute PTwspJioric Acid half an ounce. Mix. Dose . A teaspoonf ul three times a day. Out of door life is often to be insisted on, and sometimes a change of cli- mate is not only beneficial, but necessary, to effect a cure. The surface of the body is to be kept warm, and the skin active. Frequent warm baths should be taken, though cool baths are not to be prohibited, if the reaction after them is good, and they prove beneficial. Special attention should be given to the clothing. In cold climates, woolen or silk underclothiiig should be worn, and the other clothing sufficiently heavy to avoid chilli- ness. A vest and drawers of chamois or buckskin, worn immediately over the underclothing, affords the required protection, and avoids the necessity of an inconvenient weight of clothes in cold weather. This simple device secures a uniform temperature and activity of the skin, which will, to a degree, relieve the bronchial mucous membrane. Counter irritation is many times a successful means of securing the same result. For this pur- pose, the use of Croton Oil, or a liniment of equal parts of Croton Oil, Tuipentine, and Olive Oil, to maintain a slight eruption over the chest, is often very appropriate. Tartar Emetic Ointment (one part of Tartar Emetic to five of Lard) is a suitable preparation. A " warming plaster " is often worn with benefit. Some medicines often exert a curative influence. The Iodide of Potas. slum, or Ammonia with Fowler's Solution of the Arsenite of Potash are among these ; as in the following: Take Iodide of Ammonia or Potassium five drams, Fowler's Solution a dram and a half, Simple Syrup four ounces, Svirits of Peppermint half a dram. Mix. Dose : One or two teaspoonfuls in water three times a day aftei If the patient needs Iron, a dram of the Pyrophosphate may eating be ad( ed to the mixture. W it Muriate of Ammonia is conBidered by many physicians a valuable 27 I'ij { 1 1 1 1 1 RIH f 414 DISEASES OF THE LUNGS. remedy in this' disease. Liquorice disguises the taste. It may be piven as follows: Take of Muriate of Ammonia two drams, Extract of Liquorice two drams, Syrup of Tolu/our ounces. Mix. Dose: A teaspoonful in water four to six times a day. Copaiba of ten exerts a wonderfully curative effect. It may be given In doses of fifteen or twenty drops three or four times a day. It may be given on sugar, or in Aromatic Mucilage, as: TaJ<e of Copaiba, Balsam Tolu ami Potodered Acacia, each one ounce, Aromatic Sulphuric Acid half a dram, Peppermint Water six ounces. Mix. Dose : A tablespoonf ul three or four times a day. The remedy is so unpleasant that few take it willingly. Gelatine Cap- sules of Copabia. as sold in the drug stores, is the most convenient form for many to take the remedy. Chlorate of Potash in saturated solution, given in doses of a tea» spoonful to a tablespoonful three or four times a day is often curative. The taste is pleasant, if mixed with syrup. When Iron is required, the Mur- iate Tincture can be given in this solution. A form of medication which is often useful in cases with profuse secretion, and is adopted largely by quacks, is inhalation. Steam is the simplest, and one of the best. A solution of Morphine, one-half to one grain to the ounce of water, Extract of Belladonna in the same propor- tions. Extract of Hyoscyamus four to five grains to the ounce, and inhalfid from an atomizer, or spray producer, wonderfully relieves the cougk and irritation of the bronchial tubes. Astringent solutions may be used in this way. Tannin from one to twenty grains to the ounce. Alum from five grains to the ounce, to a satu- rated solution. Morphine can be added to the solution in the strength of one-quarter to one grain to the ounce, if local anodyne effect is desired. Sugar of Lead in solution three to ten grains to the ounce, are among the indications appropriate to inhale from the atomizer, or spray apparatus. Should the expectoration be fetid. Carbolic Acid— the spray of a soli»- tion of Carbolic Acid, one to four grains to the ounce, Sulphurous Acid one to four drams to the ounce— may be used. The vapor of Carbolate of Iodine (half an ounce of Tincture of Iodine, Iodide of Potassium fifteen grains, Carbolic Acid one dram,) produced by warming the bottle with the hand, may be inhaled with advantage. The solution should be weak to begin with, and its strength gradually increased as is required. For anodyne remedies to relieve the cough, if anything is necessary, the preference should be given to Hyoscyamus and Belladonna, to the exclusion of Opium, because of the latter deranging the digestion, and the danger from the indefinitely continued use of the drug, establishing the opium habit. Tincture of Hyoscyamus in doses of a teaspoonful, or Tinc- ture of Belladonna in doses of ten or fifteen drops, may be given as often as is required to relieve cough. The mixture of Paregoric, Hyoscyamus and Wild Cherry, recommended for acute bronchitis, may be appropri- ately used. The use of Bromide of Potassium, or Ammonia and Chloral Hydrate, is frequently very serviceable in relieving the cough, either alone, or given in connection with other anodyne medicines, but most benefit will follow its use when the cough is of a spasmodic character. Take qf Bromide qf CHRONIC BRONCHITI'^ 41 » 'S^ 4' I? ,qf Potassium half an ottnce, Chloral Hydrate f.'»n drains, Syrup of Tolu two ounces, water to make t?ie mixture six ounces. Mix. Done : A tableapoonf ul three or four hours apart. HOMOEOPATHIC TREATMENT. Sulphur is, in the majority of cases, one of the principal remedies for the treatment of chronic bron- chitis. The particular symptoms wliich serve to indicate its employ- ment, are as follows: Dry, racking cough, with spasmodic tightness of the chest, sometimes aggravated by the recumbent position, not unfrequently attended with nausea, or even vomiting ; accumulation of phlegm in the air tubes, and scraping sensation in the throat; sensation of soreness at the chest; chronic hoarseness, and even loss of voice; aggravation of the generality of the symptoms in raw, damj), cold weather ; dry cough at night ; or cough witli considerable expectoration of tliick, wliitish or yellowish phlegm, chiefly in the day time ; attacks of suffocative sensation, and oppression of breath ; rattling of phlegm on the chest, and occasional, or, even frequent palpitation of the heart; pains in the head and chest, during fits of coughing; mistiness of sight, and sensation of darting ; fullness in the head. Dose: Six pills in a tablespoonful of water, every morning, the first thing (fasting,) for a week, then pause four days, after which the course may, if necessary, be resumed as before, and so on. Calcarea-carb. is more distinctly indicated, when the patient is subject, from time to time, to depression of spirits, characterized by exceeding anxiety respecting his or hev health, and attend* I with great languor (often to a distressing degree;) stitches, and occasional pains in the chest, and in the sides ; tickling sensation in the throat, accompanied or followed by dry, violent cough ; the last-named symptoms occur, espe- cially, at night, when in a recumbent position, or even during sleep, or iu the evening; prolonged and obstinate hoarseness, to which the patient is much subject, and which is constantly induced by changes of water; accumulation of adhesive phlegm in the air tubes, and rattling of phlegm in the chest; sometimes moist cough, with expectoration of oflensive phlegm (thick and yellowish). Dose: Six pills, as directed for Sulphur. Carho'Vegetahilis is, more particularly, indicated by repeated fits of spasmodic cough during the day, and in the evening; pains, as of sore- ness in the upper part of the windpipe, or sensation of tickling and rough- ness in the same part; prolonged and intractable hoarseness and rougli- ness of voice, aggravated by talking, or by raw, cold, damp weather, and occurring, more particularly, in the morning or towards night; rheumatic pains in the chest and limbs; cough, with considerable expectoration of greenish phlegm. Dose: Six pills in a teaspoonful of water, morning and evening. Pulsatilla. This medicine is, more particularly, appropriate wlicu the following symptoms and conditions occur : Dry cough, which subse- quently becomes moist, and is then characterized by very considerable expectoration of saltish, or bitterisii phlegm, or of phlegm tinged with blood, or of a yellowish or whitish appearance, soreness of the palate and throat; frequent attacks of chilliness without thirst ; yellowish, greenisli or ofFensivo discharge from the nose ; hoarseness, or even loss of voice ; ^ough, with much expectoration, and with pain in the chest; racking M'^ 420 DISEASES OF THE liUNQS. cough, pxaeerhated at night and in a recumbent position, and ncconipa- nied with rattling of plilegm, nausea (or even vomitiiig,)and sensation of being stilled, feeling of soreness or contusion about the belly in the act of coughing. Dose: Six pills in a teaspoonful of water, night and morning. Sepia is, usually, of eminent service in such inveterate cases of chronic bronchitis us are characterized by— cough, attended with or fol- lowed by abundant expectoration of greenish-yellow, matter-lil<e, or even bloody phlegm of putrid or saltish taste, occurring chiefly in the morning and towards night, and accompanied with a sensation of weakness and soreness about the chest ; or sometimes dry, spasmodic cough, attended with nausea, and resulting in the vomiting of bilious matters — the cough occurring, particularly, at night, and being further characterized by dif- Ilcu'ty of breathing, or shortness of breath. Dose: Four pill in a teaspoonful of water, night and morning, for a week, then pause four days, resuming the course after this interval, if necessary, as before, and so on. CansHcuni is, also, a medicine of much importance in the treatment of this disease, and is, more particularly, indicated by aching pains in the limbs, 1 mcs of the face and jaws, and in the throat and head, associ- ated with a violent, racking cough, of which the fits occur, particularly, at night ; feebleness of voice; hoarseness, or even loss of voice; lacerated and painful sensations in the chest and throat; faltering or feebleness of the lower extremities ; rattling of phlegm ; watery discharge from the nostrils, accompanied with headache; flushing of heat at night, attended with palpitation of the heart; chill during every motion; sometimes nausea, and even vomiting of food, with dainty or deficient appetite. The oi)cn air jirovokes or aggravates the symptoms. Dose: Three pills in a teaspoonful of water, morning and evening. Arsenicnin is a valuable remedy, in severe cases, characterized by great debility and languor, particularly, if the subjoined symptoms occur — violent, dry couf/h, accom])anied with shortness of breath, or even with attacks of apparent suffocation in the evening., or at night, and provoked by cold drinks, or by the least exposure to cold air; or moist cougli, with accumulation of very adhesive phlegm in the ramifications or the wind- pipe, wiiich is hawked or coughed up with great difficulty; and general aggravation of the symptoms at night, or after eating. Oo.se; Four pills in a teaspoonful of water, three times a day, until the symptoms become less violent ; and then at night and morn- ing. ■■■*!■' INFL UENZA— EPIDEMIC CATARRH. We apply the name, influenza, to every bronchitis invading a large surface of country, and involving, with marked symptoms of illness, the whole organism, more especially, the nervous system, attacking a num- ber of individuals, in the same epidemic, with very similar symptoms, iilthough these may differ ever so much in. different epidemics. Influenza is, generally, preceded by a preliminary stage where the local symptoms of catarrh of the respiratory organs are still wanting, or axt? but .imperfectly developed, whereas, the patient complains very much INFLUENZA. 42] 1- 1 of an extreme languor, with nervous excitement, sleepleHsness and lo,s.s of appetite, without or with only slight fi'ver. As the fovcr increases, the local symptoms become, generally, more markwd and more intense. At times, a coryza is the only prominent symptom, at other times the mucous lining, from the nose to the finest bronchial divisions, is inflamed. At the same time, a violent and constant headache is complained of, wlilch is commonly located in the forehead, and is marked by all the i)eculiari- ties that so commonly characterize the headache in an incipient typhus. This headache is accompanied by rheumatic ])aln9 in many parts of the muscular sy.stem, accompanied by adegreeof debility thatulmost amounts to i)aralysis. After a gradual, very seldom sudden increase, the disease reaches it.4 full hight. The catarrh is, at times, violent ; at other times very slight. The fever is intense, but .so plainly remittent that the remissions some- times appear like intermissions. The debility is excessive. The head- ache is agonizing, and is either complicated with sopor, or with violent delirium. The digestion is entirely prostrated; the tongue is thickly coated white or yellow, at times it exhibits a sickly redness, witli disjx)- sition to dryness ; nausea, and even diarrhoea are often present ; the bow- els are confined, diarrhoea is less frequent. The symptoms exacerbate in the evening, and at night, the patient being very much disturbed by the cough, which aggravates the headache a great deal. Thus, the more vio- lent attacks of influenza simulate an acute typhus, milder cases a so-called nervous gastric fever. Death may take place in the second week, amid symptoms of general exhaustion; sometimes it takes place at a later period, in consequence of the peculiar secondary diseases which frequently brealc out as sequelte of influenza. In tlie case of sound, robust individuals, the disease mostly termi nates its course in a fortnight, but always leaving an extreme weakness, which may last for weeks. In the case of old people, the danger is always great, and recovei-y takes place very slowly. An abatement of the fever is always the surest sign of an improvement. The disease very often leaves very threatening results, such as disease of the lungs, stomach and liver. Thus we see that the prognosis in influenza is uncertain, even if the disease sets in favorably at first, and the patient had been in the habitual enjoyment of good health. If the individual had pulmonary disease, or, in the case of old persons, a fatal termination is not tuncommon. The peculiar nature of the actually existing epidemic may, likewise, exert it. great influence ; whereas, one epidemic scarcely destroys a single life, another epidemic, on the contrary, claims a great many victims. ALLOPATHIC TREATMENT. In epidemic bronchitis or influenzu In addition to the treatment given for ordinary bronchitis, tonic doses oi Quinine, two or three grains three times a day, should be given. If the patient is feeble, Tincture Muriate of Iron is needed, in doses of ten to twenty drops in sweetened water, after each meal. The writer is of the opinion that Fowler's Solution, in doses of five to ten drops, and the Iodide of Potassium, in doses of fifteen or twenty grains, three times a day, is beneficial ; they can be given in syrup and water, with Sarsaparilla and Peppermint. .:^ m ^ II 422 DISEASES OF THE LUNGS. HOMffiOPATHlC TREATMENT. Incipient Stage. Caniphor (saturated tincture). This medicine, when employed upon the earliest manifestation of symptoms of influenza (or of common cold during the prevalence of Influenza,) characterized l)y chillinesa, shivering, and gen- eral sensation of uneasiness, will, frequently, prove effectual in arr 3ting the further development of the disease. In a more advanced stage, more- over, Camplior is equally indicated, and is often of great service, wlieu laborious, asthmatic breathing, accumulation of phlegm in the air tubes, and cold, dry skin, occur a-j predominant symptoms. Dose: One drop of the .Saturated Tincture on a small lump of fine loaf-sugar, repeated at intervals of one liour. Na:c-voniica. This remedy has, also, roi)eatedly proven of great efficacy in the flrst stage of influenza; and, frequently, when timely admin- istered, in the cases in which it is indicated, prevents the development of the disease. The symptoms which point out the fitness of Nux-v. are chiefly as follow ; obstruction of tlie nose; lioarse, hollow cough, excited by ticliling in the tliroat, and attended witli sevei'e headaclie ; confusion in the head, giddiness ; want of appetite, disgust at food, acid taste, or vomiting of bit- ter or acid matter; tliirst; pain, as from a bruise under the short ribs; aching pain in tiie lower part of the baclc; constipation ; pain in the cliest, as if from excoriation; alternate heats and chills; general aching and prostration ; sleeplessness, nocturnal exciteraen* and restlessness; pains in the face and teeth. Dose: Six pills in a teaspoonful of water, three times a day. Inflammatory Stage. AconUuni is indicated for children, when the disorder assumes an intiammatory ciiaraeter, with qu iclcness, hard- ness, and fullness of pulse, dry, hot sliin, and short, harsh, shaking cough. Dose: Of a solution of six pills to two tablespoonfuls of water, give a teaspoonful every three hours, vntil fever symptoms abate. Arsenicum. Tlie following are the characteristic indications for the employment of this important remedy : Heaviness and rheumatic pain in the head; profuse, watery and corrosive discharge from the nose, caus- ing a disagreeable, burning sensation in the nostrils; violent sneezing; shivering and shudderings, with severe pains in the limbs ; oppression of the chest; difficulty of breatliing ; thirst; anxiety; restlessness; great prostration of strength, with aggravation of suflerings at night, or after a meal; inflammation of the eyes, with sensibility to light. These symi>- toms may be attended with a deep, dry, fatiguing cough, worse in the evening, at night, or after drinking; or with sensations of dryness and burning, with mucus in the throat, which is dilflcult to detach. Dose: Two pills in a teaspoonful of water, every two hours, until the symptoms are moderated, and then every six hours. Mercurius. This remedy is indicated by the following symptoms: Chilliness, followed by profuse perspiration, unattended by mitigation of suffering; severe cold in the head, with copious, acrid, watery discharge; fever, witii general heat; great weakness, relaxed bowels, headache; pains in the head, face, teeth and chest; sore throat; swelling of the glands beneath the ear ; violent, shaking cough, at flrst dry, but, subse- quently, moist, with copious secretion of uhlegm— the paroxysms of i WHOOPING COUOH. 4M fine ooughiug being commonly excited by irritation in the throat and chest; aching in the bones, and slimy, bilious, diarrhoea, attended with straining. Dose: As for Aconite. Phosphorus has been found exceedingly useful when there was excessive irritation in the windpipe and its ramifications, bordering on inflammation, with alteration of the voice, and pain during speech. Dose: Six pills in u teaapoonful of water, every three hours. Bryonia has proved of great service in relieving the violent, pressive aching, bursting, frontal headache, dry, hot skin, with or without fever, and cough, both day and night, with scanty or copious, easily loosened, white or yellow colored phlegm ; or wlien the cough produced pain la the upper part of the belly, and caused a piiin, as if arising from the efTects of a blow, beneath the breast-bone or under the short ribs. It has, further, been found of great efBcacy when the liver was tumefied, painful to the touch, or on coughing, or taking a full inspiration ; also when vomiting was liable to take place after coughing. Dose: Of a solution of eight pills to four teaspoonfuls of water, give a teaapoonful every four hours. Opiutn has, in some cases, been successfully employed, when otlier remedies had failed, against distressing, dry cough, or cough with diffi- culty in expectorating the phlegm which haa been detached, the parox- ysms of which were always followed by yawning. Dose : Six pills in a teaspoonful of water, every four hours. i\' WHOOPING-COUGH— TU8SIS CONVULSIVA. PERTUSSIS, Whooping-cough is an epidemic disease which sometimes occurs in tlie form of very extensive, and sometimes circumscribed epidemics, in which latter case the few cases of whooping-cough might be called local. So far the real cause of the epidemic has not yet been determined. A connection with other epidemic affections, especially measles, and, likewise, with smallpox and scarlatina cannot well be denied. Whooping-cough frequently precedes or succeeds epidemics of the last-named diseases, and in ro"' -jases accompanies them. in the majority of cases, whooping-cough commences as an ordinary catarrh of the nose or of the larynx, trachea and bronchial tubes. This introductory catarrh, which does not, properly speaking, form a component part of whooping-cough, may break out in all degrees of severity and extent, without this circumstance justifying a conclusion regarding the approaching attack. Hence the most proper course would be to regard this preliminary catarrh, as connected with the epidemic only in so far as it furnishes a soil or a susceptible spot upon which the whooping-cough miasm can be grafted, and in which it can germinate. This is shown by the cases where the wh>^oping-cough breaks out without being ushered in by a simply catarrhal stage, or, where a simple catarrh exists for weeks before it is converted into whooping-cough. At any one period of this first stage, in a few days, or even after the lapse of weeks, either a harmlessly-sounding cough sets in, or else an actually existing cough becomes more severe, and sooner or later assumes a paroxysmal character, which constitutes it whooping-cough. After this form of cough ! n !l 421 DISEASES OF THE I.UNOB. has reuched its full development, the simple cough ceuses entirely ; only in a few instances violent paroxysms and Himplo turns of cougii occur mingled togetiier. A single paroxysm has the following characteristic symptoms : The children, who bad hitherto been bright and cheerful, shortly before the setting in of the paroxysm, become restless and anx- ious, or, if old enough, they complain of titillation in the larynx or under the i»reast-bone, or of oppression of breathing ; it is very seldom tli(' case that a violent cough sets in without any preliminary symptoms, which, aftei- a short lapse of time, is succeeded by a wheezing and labored inspiration, taking turns with the single paroxysms without admitting of a full respiration, for the reason that all the respiratory muscles, and par- ticularly the glottis, are affected l)y the spasm. While the exertion ti> cough is constantly increasing, and the spasm of the glottis is gradually abating, the children Anally succeed in raising or vomiting up a more or less considerable quantity of a tenacious, wliite mucus, whicli terminates the attack. During the attack the children express great anguish and restlessness; in consequence of the impeded l)reathing, the face an^l tongue become blue-red, the eyes weep, a watery nmcus Is disciiargei! from the nose, even blood is spit up sometimes and flows from the nose to the terror of the parents. Tlie vomiting either brings up mere mucus or the contents of tlie stomach. Involuntary discliarge of stool and urine is a rare occurrence, if the children are otlierwise robust. After the ter- mination of the paroxysm, the children continue for some time In a state of confusion and languor, after whicli they play again as if notliing had happened. Only in the case of feeble or very small cliildren tlie parox- ysms are succeeded by real attacks of eclampsia, or else by a state of sopor, or even complete catalepsy. Under such circumstances the intermissions are not free from morbid symptoms, whereas vigorous children seem per- fectly sound between the paroxysms. These paroxysms sometimes set in quite frequently, and at other times at more protracted intervals. Generally, their frequency increases up to a certain point where the affection remains stationary for some time, after which it gradually decreases in violence. In the space of twenty-four hours the children may have upwards of thirty paroxysms of cough ; they occur more frequently in the night, and at this time likewise last longer and are more intense. A paroxysm seldom lasts longer than three min- utes; if tlie parents assert that the paroxysms last longer, they are deceived by the anxiety which the mother, particularly, experiences, to whom a minute may possibly seem a quarter of an hour. The i)aroxysm is excited by talking, eating, screaming, or by violent exercise, likewise, by a violent fit of passion; the cough may likewise occur without any apparent cause, for instance, during sleep. The constitution 1 state of the little patients is variously affected by the cough, even if th ^re are no complications. Strong children bear this cough for months, without losing flesh, or without their general well- being being interfered with. It may, however, be accepted as a rule, that if whooping-cough lasts longer than four weeks, children begin to lose their strength and flesh, and that this loss goes on increasingly, in propor- tioji as the cough lasts longer. Sickly, and very small children, are speed- _ ily and threateningly affected by the cough, even if none of the foregoing W1IOOI'IN«-(;OUOH. nan (joiupllcations are present. Tho chikheii grow pale and laiiifuid, they Iohu their appetite, but are not otten attacked with diarrhoea. The course of the disease is, generally, for several months; but wlu-n we come to speak of the treatment, we shall show that this period la con- siderably abbreviated in skillful haiuls. Of particular importance, are the complications and sequela) of whoop- ing-cough, which alone constitute the dangerous features of this diaeat, . The most frequent of these complications, are inllammatory alfections of the lungs. The catarrh of the respiratory passages, which was incon- siderable at first, invades tho more delicate ramilications of tho air-pass- ages, more and more, until a more or less intense bronchitis sets in, wiiicli easily assumes the capillary form, and becomes readily associated wiili pneumonia. The presence of such pneumonia is suspected, if the bron- chitis steadily increases in intensity, and tlie intervals l)etween the parox- ysms are no longer free from hacking cough, and a constantly increasin;^ shortness of breath,— but the signs of tiiis untoward ciiange do not set in until the congii has lasted for days, and even weeks. In such a case, tlie little patient does not entirely recover from the attacks, he grows Iauj>uid and feverish, has a short and dry cough, he does not wish to rise from bed, the pulse is hurried, the respiration becomes more and more incomplete, more hurried ; he feels drowsy and tosses about. If these symptoms mani- fest themselves in the latter course of the disease, they always augur dan- ger, and very commonly lead to a fatal termination. Brain diseases are scarcely ever caused by the direct action of whoop- ing-cough ; existing diseases of this kind may become fatally aggravated by the cough. The convulsions, which of ten attack little children during the course of whooping-cough, are more correctly attributed te the iutlu- ence of whooping-cough, over the whole nervous system, and, on this accomit, may become lasting. The apparently violent congestions of the head during the paroxysms, are of very little importance to the brain of a perfectly healthy child, but they prognosticate trouble, if the brain w;is diseased befoie the cough set in. Acute heart disease is seldom one of the complications of whooping- cough. On the other hand, the development of consumptive pulmonary affections is a very common thing. Usually, however, the affections exis- ted before the cough set in, although many cases occur, where the cough occasions the deposition of the tubercular matter in individuals predis- Vosed to this disease. Beside the complications, the frequently occurring sequelae may prove very dangerous to the patients. Among them, we distinguish chronic bronchial catarrh, deterioration of single parts of the lungs, with conse- quent malformation of the thorax, pulmonary consumption, heart-disease, although the last-named rarely, and then involving mostly the right side of the heart; spasms, occasionally mental derangement, and lastly hernia, which is of comparatively frequent occurrence. If the disease lasts a long time, complete marasmus is not an unfrequent occurrence; it is not atteu' ded with other morbid conditions, and seems to result from the exhausted condition of the nervous system, caused by the excessive paroxysms of cough. The prognosis is always uncertain. Although the cough does not endanger the lives of healthy children, nevertheless, the supervention of . \: M I ' «26 DISEASES OP THE LUNGS. one of the above mentioned complications at anv period during the course of the disease, may occasion death, or a life-long infirmity ; thus it happens that we often see vigorous and healthy children come out of an attack of epidemic whooping-cough, like wretched invalids. ALLOPATHIC TREATMENT. In the treatment of whooping-cough, it is to be borne in mind, that the most careful attention to the hygienic management of the case, will save from the complications which constitute the chief danger from the disease, but with this attention, many cases require no further treatment. The clothing should be warm, and flannel should be worn next to the skin all seasons except summer. The child must be kept indoors during wet weather. The food should be plain a:j i digestible, but nutritious. In the beginning of the disease, the treatment should be the same as 3iat given for an essential catarrh in the same situation. The same direc- tions are appropriate for the continuing catarrh. Of the remedies especially appropriate in this disease, is Belladonna. It is markedly serviceable in the spasmodic stjvge, and if there is much bronchial secretion, but can be given at any time. The rule I have fol- lowed, is the one given by Trusseau, viz: to begin with a single dose at night, much smaller than will probably be required, the next night, two /loses were given, the third night three, and so on, regularly increasing in arithmetical progression until the cough and spasm is markedly relieved, (or excessive ''.ryness of the throat, and dilation of the pupils from Bella- donna, become so severe as to be impossible to continue.) The dose which is found to relieve the cough, should be given each night for a week. Then the dose may be lessened in the same manner as it was increased, back to the first dose, but if the cough increases, the size of th<j dose is to be increased a^.ain. The medicine should be given about a week after the spasmodic cough has ceased. Trosseau began by giving the young children a pill of one-tenth of a grain of Extract of Belladonna, or one-flfth of a grain for a child four years old, increased as above directed. As Atrophine is the only form which is of uniform strength, it is doubtless the best form for this use. Take of Sulp..ate of Atrophine one-flfth of a grain dissolved in an ounce of distilled water. The dose is two to four drops, taken at bedtime, and gradually increase the dose as directed above. T'le Tincture is a suitable preparation, beginning with three dropr for a child of two years. The Mono- Broraated Camphor, and the Bromide of Ammonia, probably rank next in value. The Mono-Bromated Camphor may be given in doses of three to five g. '13 in Syrup of Tolu, and Mucilage four times a day. Three ' "> ten grains of the Bromide of Ammonia, or Potassium may be given in Syrup of Tolu and Mucilage three or four times a day. When the Bromides are given, a dose of Chloral five to ten grains in Syrup and water «,t night will, generally, give a prolonged, and quiet sleep. The two may be prescribed in one mixture. Take of Bromide of Ammonium two drams. Chloral Hydrate half a dram, Syrup of Tolu half an ounce, water an ounce and a half. Mix. Dose: A teaspoonfui four times a day. In case spasm of the glottis (upper opening of the windpipe) occurs, the mixture may be given every half hour. It is claimed, that the local effect upon the throat, of a solution of p. WHOOPING-COUGH. 427 Quinine in wate*- acidulated (with Hydrochloric Acid) sufficient to effect a complete solution, proves curative. It is used by inhalations of the solu- tion in spray, and taken internally in the usual full doses, one to five grains every three or four hours. The writer has seen the disease yield with wonderful rapidity to this treatment in conjunction with the Bella- donna treatment. The inhalation of steam will often be beneficial. Tlie vapor of Carbolate of Iodine (Tinct. Iodine, four drams, Iodide of Potas- sium fifteen drams, Carbolic Acid a dram), or Bromine inhaled by dropping upon hot water is often beneficial in severe cases. The medicated steam may be conducted to the mouth by an inverted glass funnel or one made out ot stiff paper. The inhalation of Oliphiant Gas (burning gas) has proved beneficial. In case of excessive long-continued bronchial secretion, the above inhala- tions will prove of value. The inhalation recommended for chronic bron- chitis may, also, be used. Some of the other internal remedies deserve mention, as proving ser- viceable in domestic practice, and, in the hands of physicians. Carbonate of Potash (Saleratus) one or two grains three times a day to a child a year old. It may be given with Cochineal as follows: Take of Carbonate of Potash half a dram, Cochineal ten grains, W?nte Sugar tvoo drams, soft water four ounces. Mix. Dose: One or two t ,aspoonful8 three times a day. Alum is often serviceable in doses of one to six grains according to age. Take of Alum a dram, Syrup of Ginger, Syrup of Acada, and soft water each an ounce. Mix. Dose< One or two teaspoonfuls three times a day or oftener. Sulphur is often useful in doses of from two to five grains in milk or molasses, two or three times a day. Lung Fever (Pneumonia) is the most dangerous complication. Its management requirr , especial care. Stimulant applications to the chest, a thin poultice of sixteen pi:< i;3 flaxseed and one part fine mustard, covered with an oiled muslin jacket, should be used, or the chest wrapped in flan- nel, thoroughly wet with a s^ ral^l solution of Camphor Gum in Olive Oil. Anodyne and tonic remedies will be required, as in pneumonia occur- ring under other circumstances. Especial attention should be given to the latter, and to supporting the system with nourishment. Spasms will be best met by warm baths and the Bromide and Chloral mixture before given. HOM(EOPATHIC TREATMENT. First or Febrile Stage. In the Incipient, fevery, irritatlw o,. catarrhal stage of the cough, the most appropriate remedies are to be found amongsi those which we have already pointf' out in the treatment of common cough, and must be selected accords. o the indications there given, and administered in the same manner, ....»oss otherwise specified. By a careful selection of these remedies, it is frequently possible to check the disorder in the first stage. The following, however, according to the special Indications mentioned, are particularly appropriate. Aconitui.i is appropriate in many instances for initiatory treatment, inasmuch as there is, generally, a considerable degree of fever present. As soon, however, aa the febrile symptoms have somewhat subsided under .:!^\ M 428 DISEASES OF THE LUNGS. the employment of Aconite, wliicli, in the generality of cases, will occur within a few hours after tlie iir^t dose or two, and appropriate seloction should be made from amongst the following medicines. It should not be omitted, that Aconite will frequently be required from time to time, as an intermediary remedy, whenever marked febrile or inflammatory symp- toms are present, always returning to such other medicines as are most prominently indicated, as S'jon as the symptoms which especially indicate Aconite have been moderated. Dose: Six pills in a teaspoonful of water, repeated, when requisite, at Intervals of three hours. Pulsatilla is appropriate when the symptoms are as follow: cough loose, and accompanied with a How of tears, weakness of the eyes, sneez- ing, thick, discolored discharge from the nostrils, sliglit hoarseness, and inclination to vomit after coughing; occasional diarrlioei, especially, at night. Dose : Six pills as for Aconite. Mercurius is indicated by hoarseness, watery discharge from the nose, with soreness of the nostrils ; dry fatiguing cough, generally occur- ring in two successive fits. Dose: Four pills in a teaspoonful of water, immediately after the fits of coughing, (but not more frequently than every hour.) Belladonna is one of the most important remedies in the catarrhal stage of whooping-cough, when there is dry, hollow, or harsh and barking nocturnal cough, which becomes materially aggravated at night. This medicine is, also, particularly well adapted to the sore throat, which is not an unfrequent concomitant, at the commencement of the afioetion. Dose: Three pills as for Merimrlm. Nux-vomica is of great service when the cough approaches t!ii' second stage. It is indicated by the following symptoms: dry, fatiguing cough, attended with vomiting, and occurring, particularly, from about midnight until morning; the paroxysms so pi'otracted and violent as to produce apparent danger of suffocation, with blueness of the face, and, occasionally, bleeding from the mouth and nose. Dose : As for Me^'curius, Lpecacnanha is, like Xux-vomica, of great value when the cough is attended with danger of suflbcation, and each inspiration appears to excitu a fresh fit of coughing. It is, further, indicated when tlie fits are attendeii with spasmodic stiffness of the body and blueness of the face, great anxiety and accumulation of phlegm in the chest. Dose : Of a solution of ten pills to three tablespoonf uls of water, give a teaspoonful every three hours. Second or Convulsive Stage. Di'osera is one of the principal remedies in the treatment of the disease, when it has reached this stage ; and in cases where the constitution has not been enfeebled by the trans- mission of hereditary weakness, or other causes, it will speedily declare its beneficial effects, and materially shorten this trying and painful period of the diijorder. The particular indlcatio:iR for the use of this nied'^ine, are: Violent paroxysms of cough, occurring in such rnpid success' as to threaten suflTocation, and attended witli the characteristic shrill si>un<l during inspiration, and sometimes fever; after each flt of coughing, vom itJng of food, or of stringy mucus ; relief on moving about ; no fever ; or, 'M WnOOPING-COUGH. 420 give If there be fever, it consists of regular paroxysms of cliilliness and iieat; thirst after the cold fit ; warm perspiration, sometimes only at niji^ht. Dose: Of a solution of eight pi! Is to two tablespoonfuls of water, give a teaspoonful every seccre fit of coughing. Vera f rum-alb utit is indicated wlien the child has become reduced In strengtli and emaciated ; or when it suflers from cold swyats, jiarticu- larly, on the foreliead, with excessive thirst, involuntary eniission of urine, vomiting, and other symptoms common to this stage ; also, pain in tlie chest and towards the groin ; low fever, with small, weak, and accel- erated pulse; much thirst; aversion to conversation. Dose : As for Drosera. Carho-vegetabilis (Charcoal) is frequently useful in bringing this stage of tlie afTection to an early and successful termination, after the previous use of Veratrum or Drosera, or both of these important reme- dies, particularly, when, notwithstanding the decrease of cough, the ten- dency to vomit still remains. Ctiprtiiii-eiceticntn. This remedy is found most useful in the nerv- ous stage, particularly, when convulsions, with loss of consciousness ensue, after each paroxysm. Also, when we find vomiting after the attacks, rattling of mucus in the chest, and wheezing at all times. In almost all cases, a marked benefit has followed the employment of tills remedy ; sometimes it has been found sufficient of itself to cut sliort rlie disease, and, in others, has so far modified it, that other remedies, which had before seemed to fail, have, after its exhibition, acted with the most marked eiTect, and completed the cure. Dose: Of a solution of twelve pills to three tablespoonfuls of water, give a teaspoonful every half hour. HOME TREATMENT. A Burgundy plaster, or any other stimulating plaster, may be worn between the shoulders and across the breast, with advantage. After the first stage has passed, the patient should, if convenient, be removed to some other place, as a change of air is alway? beneficial in this disease. Among the many remedies that have been used with benefit in this disease, the following will be found to be some of the best: Take of Black Cohosh or Rattleroot, Bloodroot, Skunk Cabbage, each in coarse powder, a tablespoonful, add a pint of boiling water ; mix. Steep, in a covered vessel, near a fire, for six hours; when cold, strain ; add thirty drops of Nitric Acid or Afjua Fortis, and sweeten with sugar. Dose: From a teaspoonful to a tablespoonful, several times a day, whenever the cough is bad. Take five to ten drops, each, of Balsam of Sulphur and Oil of Amber, rubbed up with sugar, for a dose, repeating it three or four times day. |W' i*H !#i|fv . ii'liJ |l, PyEUMONIA— INFLAMMATION OF THE LUNGS, On account of its frequency and the importance of the affected organ pneumoiiia is one of the most imports ;it diseases. Pneumonia may occur at a'iy age, but attacks, more especially, individuals between the ages of t\\ enty and forty years, very rarely children in the first years of infancy. !,l ViitiA m^ I ! uo DISEASES OF THE LUNGS. No constitution is exempt from the liability of an attaclc ; if a robust and plethoric constitution is generally regarded as more susceptible, it is, most probably, because robust men are more frequently exposed to the exciting causes of pneumonia. This circumstance is, most likely, the reason why men are so much more frequently attacked than women ; the occupations pursued by men expose them more fully and more frequently than women to the deleterious influences productive of pneumonia. Infants at the breast, and children who have not yet passed through the first period of dentition, are seldom attacked with croupous pneumo- nia. The nature of the country does not seem to exert any palpable influence; for pneumonias occur in level country as well as on moun- tains, in sunny districts as well as in exposed places. The seasons, on the contrary, exert a decided influence. Our statistical tables show, to a demonstration, that the transition from cold to warm seasons is the most fruitful source of pneumonia ; the transition from warm to cold seasons is less productive of this disease, winter still less, and summer least of any. Mechanical injuries, more especially a violent blow, or kick, may, likewise, give rise to pneumonia; noxious agents, acting directly upon the lungs, such as irritating gases, excessive cold or heat, may, likewise, excite the disease. Symptoms. As yet we are not acquainted with any disease which, in the absence of any particular complications, runs its course in such fixed and stable forms as pneumonia, and adheres as fixedly as this disease to definite critical days. Pneumonia begins, almost without an exception, with a chill which is usually very severe, and is, in many respects, of great importance. It is from this chill that we date the commencement of the disease, and by it we determine the critical days. The chill, which is sometimes of very long duration, and is immediately succeeded by, but never alternates with fever, is in no other disease of such a peculiar nature. As soon as the chill sets in, the muscular strength vanishes, so that the patient finds it almost impossible to stand erect. As soon iis the chill, which almost always lasts several hours, and scarcely ever only a few minutes, is over, a violent, dry fever-heat sets in and the pulse becomes more or less accelerated, fuller and more tense, but very seldom exceeds the number of one hundred beats. The temperature is always raised a few degrees. The face, which, during the chill, has an almost cadaverous appearance, now becomes flushed, sometimes only on one side ; the cheeks are bright red, the eyes injected, and very conmionly some headache is felt, and the patient, generally, feels thirsty, but is very seldom disposed to vomit. The appetite is at once gone, and, owing to the intense fever, all the secretions are suspended. The patient feels more exhausted than he really is. This condition, which is, as yet, free from all local symptoms, may last longer than twenty-four hours, but, in such a case, the local symp- toms appear at an earlier period ; in rare cases, they precede the chill. The patient complains of unceasing stitching pains, which he gener- ally points out with tolerable accuracy as existinpj at the affected spot very seldom far removed from it ; they are aggravated by every uniuh 4 INFLAMMATION OP THE LUNGS. 431 unl exertion of the respiratory organs, especially, by cougliing, and tliey tjiometimes increase to a higli degree of intensity. The pain, usually, sets in, associated with a short, and, at first, dry cough, the respiratory movements are niueh less full, and more frequent in number. The breathing is not only painful and accelerated on this account, but the violent fever, likewise, occasions an increased desire for breath, which cannot be gratified, and causes great restlessness and anxiety, and a marked activity of all the other respiratory movements. These exertions are generally so striking, that pneumonia can be recognized from this very fact, more especially, from the fiapping of the alai nasi during an inspir- ation. Vocalization is of course altered, feebler and shorter, and fre- quently interrupted. Soon after the cough has begun to set in, the patient begins to expec- torate; this expectoration is important as a diagnostic sign. It is scanty, very tenacious, and usually intimately mixed with blood from the com- mencement, which imparts to it the color of rust, or brick-dust; this color is scarcely ever absent in the case of young, robust individuals. At this stage, the physical symptoms have so far advanced, that they render the diagnosis ; perfectly certain. During the first days the fever gradually increases, showing but slight morning remissions. Considering the high degree of temperature, the pulse is not so very frequenL, scarcely ever ejjceeding one hundred and twenty beats ; gradually the fullness of the pulse decreases considerably. The end of the inflammatory stage, generally, designates the period when a change takes place in the symptoms. The infiltration is seldom completed on the third day, sometimes not till the seventh, even still later. After this, the pains almost cease, the breathing becomes more tranquil, ..he fever is apparently less, the pulse remains unchanged, the constitu- tional symptoms do not mend very perceptibly. The local, as well as the general symptoms, may remain unchanged in intensity, until a change takes place in the disease. Such change seldom takes place before the fifth day. This critical change is very often preceded by the breaking out of herpes labialis (cold blisters) which almost always authorizes the expec- tation of a favorable turn. Previous to tlie critical change, the intensity of the symptoms either rises to a great bight by a gradual increase, or else it is often the case, that after two to four quiet days, a violent fever again rages for twelve to eighteen hours, after which the disease decreases very suddenly. Convalescence takes place so rapidly, that on the fourteenth day every trace of the disease has generally disappeared. As we shall aee presently, the mode of treatment exerts a great influen'-e in this respect. Pneumonia does not alter the shape of the thorax, or so little that no stress need be laid upon this symptom ; nor are the intercostal spaces altered any more than the general capacity of the throax. Very com- monly, however, a more distinct vibration of the thoracic wall, corres- ponding to the diseased portion of the lungs, as perceived when the patient is talking. The most important positive signs are yielded by percussion, which informs us with tolerable certainty, whether a larger portion of the lungs is infiltrated or not. We speak, of course, of croupous pneumonia, for it is this alone, that causes the infiltration of a considerable portion of the lungs, most commonly of a whole lobe. In the incipient stage of pneuDionia, the sound either remains unchanged, or is only changed very !!ll! hi t '; I' I 432 DISEASES OF THE LUNOS. sliglitly; lience, immediately after the occurrence of the chill, no changes can bo discovered. But in proportion as the hypericniia increases, the per- cussion-sound becomes more tympanitic, sometimes to such an extent that one might be led to believe, a piece of intestine liad been struck. Hence, the tympanitic sound is really characteristic in pneumonia, and is only less marked, if the thoracic walls are very thick, or if tlie diseased ))()rtion of tlie lungs is separated from the thoracic wall by a normal layer of pulmonary parenchyma. In croupous pneumonia, this is very seldom the case. The more complete the infiltration, the more completely the air escapes from the lungs, and the more empty the sound becomes, unless a layer, from which the air has not yet escaped, lies over the diseased portion of the lungs. On the sides of this normal layer, the dullness often first changes to the tympanitic and further on to the normal sound, the tympanitic sound is sometimes heard, even in tlie non-affected portion of the lungs, most likely owing to the accompanying hyperemia. A change in the infil- tration is revealed by percussion, if resolution takes place, in which case, the tympanitic sound most commonly returns for a short time, and soon after gives way to the full sound. The results of asculation are equally valuable as diagnostic signs. At the commencement of pneumonia, tlie normal respiratory murmur is very often quite feeble, much less frequently increased. As soon as the infiltration begins to set in, and the air is still able to circulate in the inflamed portion of the lungs, we perceive, espe- cially, during an expiration, tlie crepitation that is so rarely absent, that it can almost be regarded as characteristic in pneumonia. In the case of children, the invasion of the disease is of ten marked by Bonvulsions, such as may occur in other acute affections ; in the case of idults, spasmodic symptoms are seldom witnessed. A very severe intes- tinal catarrh sometimes constitutes the stage of invasion. In such a case, the vomiting only lasts until the infiltration is completed, whereas, the diarrhoea often continues throughout the whole course of the disease. In the case of children, as well as of old people, very seldom in the case of adults, pneumonia throughout its whole course, is sometimes accom- panied by such prominent cerebral symptoms, that a physical exploration alone is capable of establishing the diagnosis upon a perfectly reliable basis, or even the cough in such cases is often wanting. The patients sometimes remain unconscious during the whole course of the disease, which need not ri. !i a prolonged course on this account. Cerebral derangements of a sligliter grade, a light delirium, mostly of a merry nature, sleeplessness or sopor, are very common occurrences. These happen most frequently in the case of drunkards. The tongue does not exhibit any regularly-occurring changes ;— at times it is quite clean- sometimes very much coated, at times hinTiid, at other times quite dry. Tlie last-mentioned appearance is not very promising; it is, especially, ominous, if the balance of the symptoms impart to the affection a dubious character. The appearance of a slight icterus (jaundice) after the comple. iion of the infiltration is very common, nor is it of any particular impor- tance; but if icterus sets in, together with symptoms of catarrh of the stomach and bowels, it always indicates an unwelcome complication, which threatens to delay the course of the disease. As a rule, the skir remains pretty dry during the whole course of the disease ; prof use of exhausting sweats occur much less frequently. i INFLAMMATION OF THE LUNGS. 438 The symptoms specially appertaining to the lungs, vary considerably. The cough, which is usually not very violent and occurs in single short turns, may assume a spasmodic character, when, on account of the increase of pain, it becomes a source of great distress to the patient. It rarely is entirely wanting, or is quite dry. It is particularly old people who some- times do not cough at all. The frequency of the respirations is sometimes but inconsiderably increased, and it is the insufficient depth of the inspir- ations that reveals the character of the disease. The pain varies more than any other symptom; in the case of old people, it is generally very slight ; in their case the admixture of blood in the sputa is generally mis- sing. In the case of young and vigorous individuals, the resolution of the infiltration generally takes place very rapidly, sometimes in a single day. ThuH wo find that the fever decreases on the ninth day, and that the patient, generally, feels a little better; but there is no sudden decrease of all the abnorinal phenomena, no immediate, but a scarcely perceptible, dragging commencement of convalescence. We seldom notice this condi- tion of things in the case of robust men; it occurs quite easily among weakly persons, and after an exhausting method of treatment. Sometimes after convalescence has begun, an exacerbation with progressing infiltra- tion sets in, in which case the fever is very apt to assume an asthenic character and the appearance of typhus, yet the course of the disease need not necessarily be very much protracted or unfavorable. But almost with- out an exception, important complications exist in such cases ; such a form of pneumonia is very seldom the result of epidemic influences, but most generally of an exhausting treatment. Experience has shown that the seat of pneumonia is of great impor- tance, as regards the probability of a normal termination. As a rule pneu- monia of the right'side is much more favorable than that of the left, pneu- monia of a lower lobe lighter than that of an upper one, which is apt not to terminate in resolution, and to assume a tubercular form. Inflam- mations of the left upper lobe are especially obstinate and deviating from the normal course; they occur the least frequently. ALLOPATHIC TREATMENT. In the beginning of a case of Pneumo- nia, a saline purge, as one or two tablespoonfuls of Epsom Salts, (boiled for a couple of minutes with one-tliird its bulk of roasted coffee in an earthen dish, and allowed to draw i few minutes to disguise the taste,) the same quantity of Citrate of Magnesia, or Rochelle Raits, or a couple of Seidlitz Powders, and its operation followed by a full dose of Opium in some form, as the quarter grain sugar-coated pills of Morphine, the grain pills of Opium or Codia, ten grains of Dover's Powder, or twenty-five or thirty drops of Laudanum ; the opiate continued at such intervals as will relieve the pain, restlessness or vigilance of the patient, with hot fomen- tations, hot poultices, or hot Turpentine stupes applied to the chest, will meet the requirements of the cas?. The patient should be kept in a warm room of sixty-five to seventy degrees F. The air should be moistened with steam. There is no better treatment for the control of deep seated inflamma- tions, than the use of Opium in the doses above indicated. The writer 28 ' M m -m m %^ Mi. Ifi'l -^A- :iii;l ^T H||j llilill m Nil' m DISEASES OF THE LUNGS. has frequently seen a marked decline in the frequency of the pulse and breathings, (respirations) with comfort and refreshing sleep follow the use of full doses of Opium, not only in the early stage of the disease, but to accompany its continued use to the extent of relieving pain or restlessness throughout the course of the disease. The writer very seldom sees the need of any further sedative treatment. This treatment has the advan- tage of not being hsirmful. It in no way delays resolution. If the patient does not expectorate thoroughly, and mucus accumulates in the bronchial tubes, Opium ought not to be given in full doses. Doses about half the size of those named above, are appropriate, under such circumstances. From the beginning to the end of the disease, great benefit will be derived from hot fomentations. The hot wet pack is one of the most ser- viceable. A large towel, wrung out of hot water, is folded and laid on the affected side; the whole chest is then wrapped in a large towel or bandage. The covering should be thick, to retain the heat. Previous to applying the hot pack, it is doubtless advantageous to apply a hot Turpentine stupe. A flannel is wrung out of hot water, dipped in hot turpentine, applied to the chest, and thickly covered to retain the heat. When con- siderable smarting has been produced, the stupe may be replaced by a hot wet pack, or a hot poultice. Lay hot poultices, covering the aiTected side and front part of the chest, or the whole chest. They should be frequent- ly repeated- Linseed meal is the best substance from which to make a poultice. The stupe may be used twice a day. In case a poultice is used, suflficient mustard may be mixed with the flaxseed meal, (one or two ounces to the pound,) to make the poultice sufficiently irritating, without the use of the stupes. The amount of blood drawn to the surface from the internal organs, by these hot dressings, is simply immense. One of the best, and most easily managed dressings for the chest is a flannel jacket, covered with an oiled muslin one. This is the dressing used in IJellevue Hospital, N. Y. This protects against cold, and secures all the benefits of a poultice. The repeated application of the Tincture of Iodine, is an efTectual application. Blisters are harmful in the first stage, and after the fever subsides, when absorption has begun, they have no advantage over the application of the Tincture of Iodine. If the fever and pulse continue to run high, either the Tincture of Aconite or Veratrum Viride may be given, according to the following directions: Many physicians place great esteem upon the use of Veratrum Viride in the treatment of pneumonia. This opinion was extravagantly expressed by the gentleman with whom the writer first read medicine. Dr. A. K. Fifield, of Canneaut, Ohio : " Veratrum Viride is the sheet anchor with me in the treatment of pneumonia." Tliere is no doubt of its power to so reduce tlie force of the current of blood that in the early (beginning) stage of the disease, in strong subjects in full health, and so lessening the amount of blood circulating in the lung, that important service may be rendered. But as soon as the lobe of the lung aflTected becomes solidified its usefulness must cease. It is too powerful a remedy to be given with- out the guidance of a physician. The dose of the Fluid Extract Is one to three drops, and of the Tincture, (U. S. P.) is from two to six drops. If I « I i.H|||;| 5 I INFLAMMATION OF THE LINGS. 4^S6 used, the (lose sliould be snmll, at first, and frequently repeated, one to two hours apart. The dose can be increased until the rapidity of the pulse and hight of fever are materially lessened. The Tincture of Aconite is serviceable in tlie same way, and is pro- fered by many practitioners. It is, more especially, useful in the iiicij)- iency of the disease, but can be continued, with greater advantage, until the fever ceases to rise, when the remedy is omitted. It may je given itk doses of u half drop to a drop, every half hour, until an impression i» made on the fever movement, and then continued in doses of a drop every hour or two. This, in itself, is very efTectual treatment. Some physicians are so confident in its efficacy as to assert that no otlier treat- ment is required up to the period of crisis, but other measures of treat- ment are not incompatible with it. There is no doubt, in some cases of very strong, vigorous patients, when the constitutional symptoms are very violent, of the benefit of bleeding, if practiced during the stage of congestion ; this is within tlie first twenty-four hours, generally. Many circumstances prevent its prac- tice then, as a rule. Only the most robust can be benefited even then. Aft<?r the disease is fairly established, in any case, bleeding can only weaken. All the sedative and revulsive efteet required, can be secured by the cathartic. Opium and hot applications, with, perhaps, the use of Aconite, or Veratrum Viride. The use of Mercury or Tartar Emetic, according to the plan of some, is not called for, as they have no special influence over the disease. One of the principal objects in treatment, after exudation has taken place, is to support the strength of the patient, by means of nourishment, tonic remedies, and stimulants. The majority of cases which prove fatal, do so from failure of the powers of life before resolution can take place. It is, therefore, important that the supporting measures should not be delayed beyond the time when it is evident that the patient has pneu- monia. In patients who are feeble to begin with, this supporting treatment is all the more necessary early in the disease. It is just as important to support the strength of the patient in this disease, as it is with contin- ued fever, or any other disease. In warm climates, this part of the treat- ment is even more important than in cold or temperate climates, as, in them, patients are less able to sustain the disease. Animal essences (consisting of the juice of finely-chopped lean meat, extracted by heating in a loosely-corked bottle set in a kettle of water,) strong l)eef tea, made by taking a pound of finely-minced lean beef in a pint of cold water, gradually raised to a temperature of one hundred and sixty degrees, and maintained at that point for four hours, when it is to be strained and seasoned for use. During the steeping, a little water can be added, from time to time, to supply the loss by evaporation. Milk, eggs beaten with a teaspoonful of sugar, and mixed with a little water, or milk, and starchy articles of food, as bread, rice, gruel, etc., will form a suitable variety. The taste of the patient can be, generally, fol- lowed with safety. Tender beefsteak, broiled rare, is not inadmissible in many instances; tender fowl and game may, often, be allowed. %.,, V ,1 f ti*t L 1 '' iil , 1 1 1' 1 ii 1 "I ll > IM I I'll' ! II &' : i|!i.! 'i!i: if t86 DIRBASICS OK THK LUNOS. Nourish. /i^ ', should be given four tiine.s In the twenty-four hourn, In all cases. The patient ought to have nourishment in the night, and. if very ill, it shouhl be given from two lo four iiours ai)art, niglit and day. Of tonie remedies, Quinine is to be preferred. It is not needed in inild c.'ises, but should be given in doses of one to tiuee grains tlirco or four time.s in tlie twenty-four liours, when prostration of the vital powers Is likely to occur. It may be given tlirougliout the course of the disease. In cases occurring with intermittent fever. Quinine should be given in large doses, as directed for intermittent or remittent fever, until the periodical i)aroxysms are arrested. The high fever is not an objection to Its immediate use. In malarious localities, it is possible to prevent the development of these malarial complications by the use of tonic doses of Quinine. Alcoliolic stimulants are often a necessary part of rhe supporting treat- ment of this disease, as an aid to digestion. Two or three tablespoonfuls of Brandy or Whisky, may be given with the milk, beef tea or essence, or gruel, every time it is given. Tiieir use should be resorted to whenever any degree of prostration occurs, or insufficient nourishment is taken. The late Prof. Hughes Bennett, of Edinburg, directed the use of stim- ulants, as soon as the pulse became soft, to the amount of from four to eight ounces of wine a day. Out of one hundred and twenty-nine cases treated in the Royal Inlirniary, of Edinburg, treated by Prof. Bennett, one hundred and twenty-five recovered, and of these, eighty-five took wine, or spirits, in quantities varying from three ounces upward to, in one case, twelve ounces. Sometimes very large quantities of spirits are required. After convalescence is well established, their use should bo discontinued. In chronic pneumonia, tonics of Quinine and Iron, as three grains of the Citrate of Iron and Quinine, in Syrup, three times a day. Cream or Cod Liver Oil may be required. Anodynes should be given to palliate the cough and distress. Tim cough mixture of Paregoric, Ilyoscyamusand Wild Cherry Bark, directed in the treatment of acute bronchitis, is often suflicient, but stronger pre^ parations may be used if necessary. Cou'iter-irritation, by applying Tincture of Iodine over the afTected side, is useful. Supporting measures comprise all that can be done to j)rolong life. In thk Treatment of Pneumonia in Young Children, the same principles prevail as are given for adults. A teaspoonful of Rochelle Salts or Citrate of Magnesia, should be given, to move the bowels. They should be kept open by the occasional use of the same remedy. For the relief of pain, cough and restlessness, Opium should be given in just suflicient amount to relieve these symptoms. The most eligible are: Paregoric, Laudanum, particularly the Deodorized Laudanum, and Dover's Powders in doses suitable to the age. Under six months, five to ten drops of Paregoric ; half a drop, to a drop of Laudanum ; one-fourth to half a grain of Dover's Powder, given from two to four times in the twenty-four hours. Over the age of six months, up to two years, these doses may be doubled. A somewhat larger dose may be given to a child INFLAMMATION OF THE LUN09. 4;{7 y of three or four, and for one live or aix years old the dose iniiy be three tiinos iiH largo as for hIx months. The opiate is often more borviceable if Tincture of Ilyoscyamus, in (loses tlie same as of Paregoric; or Tincture of Beiladonna, in tlie same doses as of Laudanum, is given with it. In older oliildren, with excessive fever, and a l)oundin)L': luilse, tlie Tincture of Aconite may be given in doses of lialf a drop two or tiiree lioura apart. Its continued use will depend on the amount of impression on the fever and pulse. It should not be continued after the fever is down, or the pulse down to one hundred per minute, or if given in only half the former doses. Then, if tlie fever rises again, it can be given more fre- quently. The following is a suitable mixture : Take of Tincture of Aconite Root sixteen drops, Syrup of Ipecac two drams, Hyrup of Tolu to maliefour onnues. Mix. Dose: Half a teaspoonful can be given every two or three hours to a child five years old. From one to tliree grains of Citrate of Potash may 1)0 given about four hours apart, in syrup or in otlier mixtures, to stimulate tlie kidneys and skin. Spirits Mendireus in doses of half a teasi)oonfiil to a teaspoon- ful and a half, given in tlie same way, is suitable for the same purpose. Tlie supporting treatment should be the sameas for adults, and should be begun early. Strict attention to nourishment should be given from the beginning, from two to four hours apart. The dose of Quinine for a tonic is from half a grain to a grain. The dose of IJrandy or Whisliy, given in the food, is from half a teaspoonful to a teaspoonful every two or three hours. Infants at the breast will be sufficiently nourished by breast milk. Witli th<jm the stimulant slvould be given in sweetened water. The same plan of counter-irritation as with adults should be followed — giving preference to a thin poultice made of Flaxseed meal, witli one- sixteentii part of mustard, kept constantly on the chest, covered with a jacket of oiled muslin. Flannel wet with Olive Oil, containing as much Camphor as it will dissolve, wrapped about the cliest and covered with oiled muslin, is a convenient and suitable application. The Oil can lie made more irritating, if it does not redden the skin, by the addition of a little Turpentine. Turpentine, Tincture of Iodine, or Mustard poultices, may bo used, if preferred, but the ciiest should be covered by oiled muslin, whatever plan of counter-irritation is followed. H0M(E0PATH1C TREATMENT. Complicated Cases. Symptoms. In severe cases, inflammation of the lungs is often found combined with pleurisy, in which cases the pains of the chest are intense, and mostly of an acute, shooting character. Another and still more frequent complica- tion is formed with bronchitis. Issue and Results. When the disease comes rapidly to a favorable termination, some striking evacuation generally attends it, sueii as a very free and abundant expectoration of thick, wliite or yellow matter, often slightly t;trealied witli blood; or a profuse and general sweat; diarrh(£a; a profuse discharge of urine, with a copious sediment ; or a How of blood from the nose. If inflammation of the lungs be not checked in the earlier stages, the lung is altered in structure ; and the fac*» becomes patched with red, and K"' IMAGE EVALUATION TEST TARGET (MT-3) 1.0 I.I 1.25 [fflllM ■2-5 •^ lillM Ir 1^ III 2.0 UUl- 111= U IIIIII.6 V] <^ /2 A- W •c*J '# sV '/ /A Photographic Sciences Corporation 33 WEST MAIN STREET WEBSTER, N.Y. 14580 (716) 872-4503 v ^ \\ v";^ <\%^ cv >.. a^ &< . I i I r n $ lilll' ■~\ <3$ DISEASES OP THE LUNGS. sometimes livid, the vessels of the neck swollen and turgid, and the pulse weak and irregular. In the advanced or suppurative stage of the disorder, the expectora- tion becomes purulent or converted into a brown, serous fluid, and slight shiverings generally supervene ; the pain or sense of fullness and tight- ness becomes abated, and the patient is commonly enabled to lie on the affected side without much inconvenience; but the pulse becomes weak and thready, and the strength commonly sinks rapidly ; a fatal result is, however, sometimes even then, avoided by proper homoeopathic treat- ment. The great danger attendant upon this disease renders the assistance of professional experience, when that can be obtained, absolutely indispen- sable. Bat to provide, in some measure, for the contingencies in which such aid cannot be secured, the following directions are subjoined, to ena- ble even unprofessional persons to entertain some hope of insuring a suc- cessful issue. Aconituni, In the stage of simple inflammatory congestion, with severe inflammatory fever, whether or not accompanied or followed by violent shooting pains in the chest, this remedy is unquestionably of great service. Dose: If singly, of a solution of six globules to two tablespoon fu Is of water, give a teaspoonful every hour, until thepulse becomes reduced in volume and frequency, or the skin moist, or covered with profuse Eerspiration — upon which the intervals may be extended to two ours, and the administration thus continued. Bryonia, is frequently the best remedy to follow Aconite, when the more severe febrile symptoms have been lowered by the medicine, or, more especially, when such symptoms as the following predominate: cough with expectoration of stringy or tenacious phlegm of a brick-du.st color, oppression and acute shooting pains in the chest; or rheumatic pains in the chest and extremities, with aggravation on movement ; foul, dry tongue, constipation, and other indications of derangement of the stomach. When the pain in the chest is excessive, and of a shooting, cut- ting or pricking character, the membrane which invests the lungs is generally involved, and the case thereby complicated with pleurisy. In such cases the alternate use of Bryonia, with such other medicine as may further embrace some of the symptoms, is sometimes necessary, or, at all events, conducive to more speedy recovery. Dose: In every respect as directed for Aconitum. Belladonna is, generally, required before (or even after) Bryonia, when the fever returns, after having been apparently subdued by Acon- itum, and the difficulty of breathing, and pain, or feeling of uneasiness in the chest, continue; the expectoration tinged with blood, and difficult to bring up; the cheeks flushed, lips and tongue dry and parched, the skin hot, and the thirst incessant; the pulse hard, quick, and full; the sloep dis- turbed by frightful dreams and delirium. In young, robust subjects, Acon- itum and Belladonna may be exhibited in rapid alternation, with the most satisfactory results during the first stage. In such cases, indeed, the further progress of the disease is not unfre- quently arrested, or at all events, such a degree of improvement is effected that any remaining symptoms, such as some degree of oppression, and INFLAMMATION OF THE liUNQS. 4t» expectoration of viscid phlegm, readily yield to the administration of Bryonia. Dose : As for Aconite. Phosphorus. This remedy has been employed with striking suc- cess in almost every stage of the disease in question, under whatever form it presented itself, and even when the disease had already attained a some- what advanced stage. Much fever, with hard, full pulse, cough, and blood- stained expectoration, are the salient general indications for Phosphorus. It is, also, more or less necessary in all cases occurring in consumptive habits. Dose: If singly, of a solution of six pills to two teaspoonfuls of water, give a teaspoonf ul every three hours. Additional Pabticulars.— Serious Cases. Antimonium-tar- taricutn is frequently of service when the oppression at the chest, and anxiety continue to increase, and the pulse becomes small, weak, and irregular; or, moreover, either when there is no expectoration, or when the expectoration is not tinged with blood, and occurs chiefly at night; or, again, when difficulty of breathing, anxiety, and other dependent symptoms are always temporarily relieved after expectorating. Dose: Of a solution of six pills to two tablespoonf uls of water, give a teaspoonful, first at intervals of a quarter of an hour, and tlien of half an hour, and so on, extending the intervals to three liours. aa improvement gradually ensues. When the urgent symptoms have subsided, consider the general aspect of the symptoms, and suspend or continue treatment accordingly. Sulphur is a medicine of great service when a relapse threatens to succeed the improvement previously elfected by other treatment; and in repeated courses, upon the accession of convalescence, to restore the vigor and equilibrium of the system, aud to neutralize the remaining suscepti- bility to affections of the same organs. Dose: If against an impending relapse, three pills in a teaspoonful of water every three hours, until the progressive improvement, previ- ously manifested, becomes apparent. If as an after-remedy, against the remaining susceptibility of the lungs, give six pills in a table- spoonful of water, every morning, the first thing (fasting) for a week. HOME TREATMENT, From the beginning to the end of the disease, great benefit will be derived from hot fomentation. The hot, wet pack is one of the most serviceable. A large towel, wrung out of hot water, is folded and laid on the affected side ; the whole chest is then wrapped in a large towel or bandage (dry). The covering should be thick, to retain the heat. Hot poultices are of great benefit. Linseed meal is one of the best substances from which to make a poultice. Sacks of hot ashes applied to the affected side is, also, of great benefit. If poultices are used, suflicienk mustard may be mixed with the meal to excite a little irritation. liii ASTHMA, A disease characterized by an extreme difficulty of respiration (breath- ing) which is worse at certain seasons of the year, and particular periods of the day, being generally worse at night. The difficulty of breathing is 440 DISEASES OF THE LUNQS. ii'lil ilillW illl nil III ^l|:!i' '!Hl!|l' Ill II '-I I I'i increased by violent emotions, damp atmosphere, excess of any kinrt, strong exercise, running, wallsing briskly, or ascending a flight of stairvS. It is, also, more laborious in a horizontal position, and hence more distress is felt at night when in bed. The warmth of the bed, also, has a strong influence on the disease, b^' assisting In the causes that fill up the air-pass- ages, and hence causing paroxysms to be more frequent during the night than the day. The patient seeks relief by sitting upright in bed, or bending the body forward, and endeavoring to expand the chest mechanically by every pos- sible means. Old persons are more liable to the disease than young. It is now believed that spasmodic asthma is caused by a spasm of the muscular fibres encircling the bronchial tubes, especially, the small branches. The existence of these fibres is placed, beyond a doubt, by microscopic examinations. In common asthma, the lining membrane of the air passages is more or less affected, as in chronic bronchitis, but the affection of the mucous membrane extends further down into the lungs, the air cells are more obstructed, and the conformation of the chest itself, is often somewhat contracted and defective. The action of the diaphragm is imperfect, as well as that of the walls of the chest, and hence it is, that from want or inervation, and free action of these parts, the disease is com- monly deemed nervous, as distinguished from chronic bronchitis which affects the bronchial mucous membrane chiefly. In spasmodic asthma, tlie nerves are still more deeply implicated; their action seems defective in the respiratory organs, as stammering shows imperfect nervous action in thu organs of speech; and in both cases, the difficulty is increased by physical or moral excitement. Chronic asthma seldom shortens life where patients carefully avoid all violent emotions, exercise, and excess, although spas- modic paroxysms may endanger life at any time, if these precautions are neglected. Attacks of spasmodic asthma generally occur during the first sleep, soon after midnight when sleep is most sound, or early m the morning. The patient suddenly awakes with a sense of suffocation, tightness of the chest and difficulty of breathing; the respiration is wheezing and laborious, the shoulders r,re raised and every effort made to enlarge the chest. The pulse is usually quick, weak, and irregular, the lower extrem- ities cold. When cough and expectoration come on, or can be brought on the patient is relieved. The spasm may continue half an hour or more, and even three or four hours. Asthma is often complicated with diseases of the heart, or with chronic bronchitis, acting as a sotirce of permanent congestion, predisposing the parts to be more easily thrown into a state of spasm. The moot common consequences or concomitants of the disease are, chronic inflammation and dilation of the bronchia. Emphysema (a swel- ling produced by air or gas) oedema (tumefaction) of the lungs, spitting of blood, tubercular deposits, larger girth and widening of tlio cavities of the heart, collection of liquid into the sack containing the heart, into the pleura, and sometimes congestions and effusions in the head causing apoplexy. ALLOPATHIC TREATMENT. For the relief from a paroxysm of Asthma, a great variety of remedies have been tried by the patient and s ASTHMA. 441 frequently lie knows what will succeed most promptly, so that often his experience is the best guide. The narcotics which are best adapted for immediate relief are Mor- phine and Belladonna. A hypodermic injection of a quarter to a third of a grain of Morphine (always by a physic'an) is one of the surest known means for cutting short a paroxysm. Atrojihine may be injected in doses of a sixtieth of a grain, and is, ])robably, the next best method for procui'ing relief. These two remedies may be combined with advantage. A slower, and unsatisfactory way, is to give these remedies by the mouth. A third to half a grain of Morphine, and twenty to thirty drops of the Tincture of Belladonna, are the doses. Inhalations resorted to, are Stramonium, Belladonna, Tobacco, Opium, Nitrate of Potash (Saltpetre,) Arsenic and amesthetics. Stramonium or Belladonna leaves are smoked, from a common pipe, with benefit, or dipped in a strong solution of Saltpetre and dried, they may be burned in a close room, and the fumes breathed until relief is obtained. Cigarettes, made by the following formula (of Trousseau) are excel- lent, the patient smoking them when the paroxysm occurs, and breath- ing the fumes until relief follows : Take of Belladonna fii'e (jraiiis, i^tra- monium and Hyoscryatnus each three grains. Extract of Opium one-third of a grain, Cherry-Laurel Water sufficient quantity to moisten the leaves. Moisten the leaves of Belladonna, Stramonium and Ili/oscyamus in the Cher- ry-Laurel Water, having dissolved in it the Extract of Opium, dry and make into cigarettes. Two to four of these cigarettes may be smoked during the day. To persons who do not smoke, the smoking of one or two cigars will fre- quently bring relief. The following formula is a tried and useful one, and has been long and successfully employed in the Pennsylvania Hospital. Paper, pre- pared fs follows and rolled into cigarettes, can be smoked two or three times a day, until relief is afforded or giddiness follows. (It is called compound Arsenical Paper): Take of Belladonna leaves ninety-six grains, Hyoscyamus and Stramo- nium leaves each forty-eight grains, Extra".t of Opium four grains, Tobacco eighty grains, Water one pint. Mix; and ma/ce a solution; then add Nitrate of Potash (Saltpetre) one hundred and forty grains, Arsenite of Potash three hundred and twenty grains. Saturate white, thin, blotting paper with this solution, and when tlry, it is ready for use. It can then be rolled into cigarettes and smokea. Ether, Chloroform and Nitrite of Amyl, given by inhalation, by a physician, will frequently arrest a paroxysm. Burning Nitre paper in the room, and allowing the patient to inhale the fumes, is frequently successful in arresting the paroxysms or pro- ducing relief. The paper is made by dipping white blotting paper in a satuiated solution of Saltpetre, and drying Certain remedies which produce nausea will arrest a paroxysm. One of the best of these is Lobelia, one or two teaspoonfuls of the Tincture may be given every half hour, until nausea is produced. Other Emetics may be used; in this way the sickness of the stomach relaxes the spasm, and the patient breathes freely. W' m^ Itlll f I I 5!: 142 DISEASES OF THE LUNUS. 111 i i ':■; I { ! I Anti-spasmodics, such as Asafcetida, Skunk Cabbage, and Skull Cap, will sometimes relieve the spasm causing the difHcult breatliing. Brom- ide of Potassium in doses of fifteen or twenty grains, witli hilf as much lodideof Potassium, given every half hour or hour, will sometimes cut the attack short. In the interval between the attacks, attention should be given to the general health: by the use of tonics, as may be required, regular habits of life, the regular use of sponge or shower bath, regulating the diet to over- come dyspepsia, relieving constipation. When digestion is poor, one or two teaspoon ful doses of Liquid Pepsin, prepared by ShefTer's formula, taken at meal times, will be ben- eficial. Sometimes five or ten drops of Dilute Hydrochloric Acid, may be added to each dose, with benefit. Nearly all cases of asthma depend upon co-existing bronchitis, and upon the cure of that depends the cure of the asthma. The most efTect- ual measure to produce this, is a change of climate, (even changing tlie sleeping apartment, from one room to another, has been known to accom- plish it.) The most popular climate now, for asthmatic patients to resort to, is that of the Rocky Mountains— especially Colorado, This climate proves beneficial in a large number of instances. Commencing to change the residence, a locality chosen should, in the first place, be one which possessed just the cliaracters opposite to the former one, as from the city to country, or from country to the city. If the patient lived in a moist air, a locality with a dry one should be first tried— and vice versa; from a low region to a high one, or the oppo- site, etc. Sufficient has been said to guide in the selection of a change of residence. If the patient does not improve under the treatment resorted to, a change of climate should be insisted on. A remedy which proves successful, in a large number of instances, is Iodide of Potassium. It should be continued for a long time, in doses of five, ten, fifteen or twenty grains, three times a day. The smallest dose should be commenced with. It can be given with tonic remedies, should they be needed. This is one of the remedies which is sometimes given to relieve an attack ot asthma. For this purpose, it should be given in doses of fifteen, twenty or thirty grains, every two, three or four hours, according to the severity of the seizure. It is one of the most reliable remedies. In the so-called "hay asthma," or summer catarrh, the Iodide of Potassium, combined with Arsenic, gives good results : Take of Iodide of PotasHi. c an ounce, Fowlei''s Solution a dram. Water four ounces. Mix. Dose: A teaspoonful every four b s. When Arsenical Cigarettes are nc ...loker'. Arsenic may be given in doses of one to three drops, after eating. The two remedies, lodideof Potassium and Arsenic, have accomplished the greatest number of cures. For the relief of asthma, the various means recommended for bronchitis may be resorted to. HOM(EOPATHIC TREATMENT. The treatment has to aim at the relief of the present paroxysm, and at the curing of the disease. When the attack is accompanied by congestion o the head, in fieshy individu- HICCUPS. VA w als, and in women and children of a peevish, ill-nutured tendency, where the attacl^ usually occurs in the evening, sensiitiuu of du»t in the lungs, better when bending the head back and wlieu holding tlie brealh. Face and eyes red, head hot, sleepiness — but cannot sleep, Belladonna will prove itself a good remedy. If the attack was brought on by mental excitement: Aconite. If children are troubled with asthmatic breathiug while teething, and at the same time are very peevish, nothing pleasing them, want to be carried all the time: Chatnotnilla. If the breathing its anxious, short and oppressed, with much labor and greatly increased difficulty on assending a flight of stairs, attacks of suffo- cation, especially in the evening, at night, or in bed, attended with great restlessness and fear of death, extreme thirst, drinking often, but little at a time; cannot lie for fear of suffocation, and wants to be in a warm room, you will find Arsenicum the- best remedy. Ipecac for spasmodic asthma, with violent contractions in the throat and chest. Rattling noise in the bronchial tubes during an inspiration. Suffocation threatens from contraction in the throat and chest, worse from the least motion. Nausea with feeling of emptiness about the stomach. HOME TREATMENT. In most cases, persons can almost immediately relieve them^jelves of an asthmatic attack, by smoking in a pipe, Stra- monium or Jimson Weed leaves soaked in a solution of Saltpetre; at the same time, heating their feet thoroughly near a fire. If it should be dis- agreeable to use the pipe, the leaves may be pulverized and placed in a saucer, then drop some bright coals of fire in the saucer, and hold the face over it so as to inhale the smoke or vapor as it arises from it. This will frequently relieve a very severe attack. Deadly Nightshade (Belladonna) leaves may be prepared the same way, and will often prove of great benefit. Every person who is subject to this disease, should keep these articles prepared, on hand in readiness to use; it is easily made by carefully drying the Stramonium or Belladonna leaves, and then placing them in a solution of Saltpetre, made as strong as the water will take up of Saltpetre ; then dry the leaves and keen them in a tin or other vessel well closed. t SI .'Ml^'-iij SINOULTUS-HICCUP. ' This is owing to a spasmodic contraction of the diaphragm, during which, the air is drawn in through the contracted glottis with a shrill and short sound. The hiccup either originates in the nervous centers, as during a gen- erally increased irritability or neuralgia, especially, in the case of hysteric and hyphchondriao patients; or when accompanying cerebral (brain) dis- eases, such as cerebral anaemia, consequent upon long-lasting, exhausting diseases, or upon considerable losses of blood and other animal fluids, 'i\ li,'! 444 DISEASES OP THE LUNGS. >M III as well as upon violent psychical (mental) impressions, such as fright, anger, etc. Or else, it is simply a reflex-phenomenon, as durin,? diseases of the pleura and pericardium. Consensual singuUus may occur during diseases of the stomach, liver, pharynx, intestinal ciinal, etc. In the case of children, it often occurs in consequence of a cold, or acid stomach . Singultus, occurring during cerebral antemia (bloodlessness of the brain) consequent upon chronic diseases, sucli as cancer, IJriglit's disease, tuberculosis (consumption,) etc., or upon exhausting diseases, such as typhus, cholera, or upon pleuritis with profuse exudation; likewise, upon exhausting diarrhoea, is aiways a very dangerous 8ynii)tom, that may con- tinue for days, and finally increase to convulsions. ALLOPATHIC TREATMENT. The best remedy is Musk, in doses of five to fifteen grains suspended in Mucilage. It can be repeated at inter- vals of two to four hours. Oil of Amber is, probably, next to Musk, the most effectual remedy; the dose is ten tp twenty droits in emulsion with Syrup or Mucilage of Gum Arabic, repeated two to four hours apart. Tincture of Uelladonna, in doses of ten drops, repeated every hour until relieved, or dryness of the throat is produced, is generally effectual. Ether or Hoffman's Anodyne may be given in doses of a teaspoonful every half hour. A quarter of a grain of Morphine, or twenty grains of Chloral in water, will generally cut short a severe attack. The use of any anti-spasmodic remedy is appropriate. A glass of cold water, or a sharp word from a superior, will often succeed in relieving this cough. HOMEOPATHIC TREATMENT. A passing hiccup is scarcely noticed ; only if it lasts too long and becomes too severe, medical treatment may have to be resorted to. In case of simple hiccup, it may be arrested by stopping the breathing for some time, or by drinking a little cold water, by fixing one's attention upon a certain object, such as: holding a key in one's hand, by a system- atic crossing of the fingers of both hands ; by a sudden surprise, or such domestic remedies as eating a little sugar, magnesia, ice, etc. Infants vvlio have taken cold, have t'> be warmed, after which they should be put to the breast; if their stomachs are acid, we give them Cal- carb fl, or Nax-vom. 6 ; if they are affected with intestinal catarrh, we give them Chamomilla 3, or Rheum 3. A domestic remedy tliat is frequently made use of, is calcined Magnesia, as much as will cover the point of a knife, morning and evening. In one case, where not one of these remedies would help, a teaspoonful of recently prepared lime-water, removed the spasm. As external remedies, practitioners recommend, laying grated horse- radish upon the epigastrium, dropping Ether upon the pit of the stomach, painting this region with the Oil of Chloroform, one dram to two drams of Almond-oil; and in desperate cases the inhalation of Ether or Chloroform. "^ . .r . •, , .. : ......... .. . . ,. "kKi ;;■ H,ifi';i; T III rli «■ i l,ij ,1, I'll Si THE THORAX. THK THORAX. 44fi An aged and closo-ol)S(>rviii<x iiliysician recently said to an old and deal friend of his : " Yes, my friend, your lungs are not sound. And my advice to you and all who are of tiie nervous temperament like you is, live in Cen- tral Florida, and you will fully recover. Lymphatic people will do well in high altitudes and should not go soutli." THE Til on AX. The opposite illustration shows tlie Thorax with ribs and sternum— breast- bone— removed, and also part of the pleura from the left side, exposing to view the lobes of the lungs, of which there are two in the left and three in the right side ; on the right side the pleura and the blood-vessels just under the ribs are left. It is an inllammation of this lining membrane of the hmg cavity V V that is known as Pleuritis— Pleurisy ; and inflammation and swelling of the small air-cells that look in the illustration like sealed-up cells in a honey-comb (II, II,) tiiat is known as Pneumonia ; this swelling l»e(;ome3 so great at times as to exclude tlie air, and thus, by preventing the oxidation of the blood by contact with the air, causing death from tlie af- If'cted portion of the lung. A deposit of little white particles in the lungs, usually at first eitlier at the top or bottom of the lung, and an inflammation iiud suppuration of the lung tissue about tliem, is what is known as Phthisis ))uhnonalis or Consumption. E and F are portions of the breast-hone, and the ])oint where tlie clavicle— collar-bone G— joins the breast-bone is at Q. The diseases affecting the parts here shown are the cause of death of three- sevenths of the human family. 4M INFLiAMMATION OF THE PLEURA. CHAPTER XXI. DISEASES OF THE PLEULA. 'Tri I,: -!1:i: nil' PLEUBITIS, PLEURISY— INFLAMMATION OF THE PLEURA. ' Inflammatory affections of the pleura are not by any means rare occurrences; yea. the frequent adhesions of the lungs to the tliorax, revealed by post-mortem examinations, show that pleuritic affections aie not only very frequent, but that they run their course unobserved. The more trifling inflammatory phenomena are without any practical value, nor do they ever constitute an object of treatment ; for this reason, we hero treat only of the more acute forms of pleurisy with copious exudation. Pleurisies of this character are scarcely ever really primary diseases; in the majority of cases, they are of a secondary nature. The history of primary pleuritis is somewhat obscure, unless the disease Is caused by some direct and mechanically acting agency. A most frequent cause is said to be a violent cold ; but the case is here, as in pneumonia, the con- nection is taken for granted, rather than proven. The more frecjuent occurrence of pleuritis, during peculiar states of the weather, justilles the conclusion, that sitmosplieric conditions exert a decided influence upon tlie oiigin of this disease. To designate such inflammations as rheumatic, is in so far justifiable to some extent, at least, as acute rheumatisms occur epidemically at the same time. On the other hand, pleuritis as a complication or secondary affection, is exceedingly frequent. All inflammatory pulmonary affections, even hyperisraia of more than ordinary ext'^nt, if occurring near the surf sice of the lungs, develop pleuritis, which is, generally, confined to a very limited space, but may, likewise, be very extensive and violent. Inflammatory affections of the heart may lead to pleuritis. Acute rheumatism and peri- tonitis, and likewise, acute exanthemata, easily result in the development of pleuritis. Among chronic affections, the following may occasion the disease : Pulmonary consumption, pulmonary abscess, suppuration of the vertebra and ribs, Bright's disease. The occurrence of pleuritis during the stage of convalescence in severe acute affections, pyaemia and gen- erally, in diseases characteiized by mar'ked signs of a septic condition of the blood, is a remarkable fact which does not admit of any further exphi- nation. Like peritonitis, so pleuritis is superinduced in its worst and most extensive form by the intrusion of foreign substances into the pleu- ral cavity, most commonly by the effusion of pus from a superficial cavern, or from a suppurating bone. Symptoms. It is absolutely impossible to draw a permanently and universally true picture of pleuritis; the synijjtoms characterizing an attack of pleuritis vary greatly, in intensity as wcil as extent; many symp- toms are sometimes entirely wanting, whereas, in other cases they are most prominently present. However, inasmuch as the symptomatic dif- ferences of pleuritis are mostly depending upon the quality of the exuda- DISEASES OF THE LUNOS. <»« tion, we subjoin a superficial sketch of these differences, and shall discnss essential details in subsequent para^raplis. The plastic exudation exists seldom as an idiopathic affection; it gen- erally accompanies other diseases, more particularly i)neumonia. Iims- niucli, however, as it is scarcely ever, even when existing as an idiopathic disease, acoorapanied by violent fever, we may suppose, that even whore it exists as a complication, it does not contribute much to an increase of the fever. On the other liand, it is precisely this form that causes the most violent pain, which is very much increased by every somewliat more expansive movement of the thorax and of the body K^nf^rally, more partic- ularly by couching, and which very frequently renders even percussioti painful. After the lapse of at most a week, the pain disappears agaiii entirely; but the physical signs, of which we shall treat by and by, some- times remain for some time after. Like all other more extensive inflammatory processes, it almost always sets in with a severe chill, followed by conside; able increase of the pulse and temperature, attended with headache, intense thirst, loss of appetite, and almost immediately an intense pain in the inflamed region of the pleura. The pain, generally, decreases in proportion as the effusion increjvses ii. quantity. As the exudation increases the breathing of course becomes shorter, and a disti'essing cough sometimes sets in, with a thin expectoration, which is tinged with blood, but is not to be regarded as a sign that pneumonia or bronchitis has supervened, but most commonly depends upon no other cause than the congestion of the non-affected part, which congestion is a necessary consequence of the pressure caused by tlie exudation, and for this reason, does not show itself at the outset of the disease, but only in its subsequent course. In favorable cases, the termi- nation in recovery may commence with the second week, and may load to a complete restoration of health ; or else, the process of reabsorption takes place very slowly, imperfectly, and the patients remain for a long time in a sickly, lentescent condition, where they are threatened with renewed attacks and exacerbations. The third form, empyema, often develops itself, as was stated above, ^m the second form. That pus is forming, may be inferred from the cir- cumstance that the fever does not abate; on the contrary, that in the sub- sequent course of the disease, and without any increase of the exudation, tl.<e fever increases in violence, mingled with chills, or assuming the char- acter of a hectic fever, with a constantly increasing prostrntion of strength. If the purulent exudation is a consequence of pyaemia, of a ^ep- tic state, or a general dissolution of the blood tlie exudation may originate and run its course without pain ; it only aggravates the previously excit- ing morbid phenomena. The course of the disease depends essentially upon the fact, whether the exudation is re-absorbed or enclosed within a sack, or finally, whether it escapes from the cavity, and in what direction. The fourth form, where the exudation is chiefly serous, usually imparts to pleuritis a sub-acute or even chronic character. This form is very insidious, because it so often develops itself very gradually and with- out pain, and even commences without fever, which does not generally supervene until at a later period. At first, the patients only comi)lain of lassitude, they lose their appetite, have a sickly appearance. Gradually the S 448 INFLAMMATION OP THK PIjEURA. JIIIHII 1 ; : I I respiration becomes inore oppressed and labored, but not by any means to a degree tli; t ini},'bt lead the patients to suspect tlio presence of a pulmon- ary disease. Tiio quantity of the exudation occasions a displacement of tlio thoracic and abdominal organs. " Recovery from such attacks always takes place slowly; it is only exceptionally that absorption takes place very rapidly amid a i)rofuse flow of urine. Among the symptoms of pleuritis, there is not one that could be pointed out as characteristic of the disease. It is true, that in most cases of acute pleuiitis we have the peculiar pain, but it varies exceedingly in character and intensity. At times the pain is simply a sensation of tense- ness and constriction; at other times the pain is a seated, localized stilching pain; at other times again, the pain is spread over the whole side of the thorax, and is of a t(^;iriug or burning kind. Not unfrequently there is no pain at all; this happens more particularly in most insidious cases. In genuine pleurisy there is very seldom any cough, especially, at the commencement of the disease; if cough sets in at a later period, it may be occasioned by simple hyperaimia or by pneumonic infiltration. At all events, it causes the patient a good deal of distress, increjvses ids pain to an extraordinary degree, and complicates the course of the disease, since every additional obstacle must necessarily, in view of the existing shortness of breath, imply an additional amount of danger. The symp- toms presented by other organs cannot be determined beforehand. Moat j^enerally, it is the action of the heart, especially that of the right heart, which is altered; if any considerable amount of exudation is present, the beats of the heart become irregular, stronger and more rapid, the more so the more the heart is pushed out of its place by the effused fluid. A dis- placement of the liver is attended with pressure in the right side, and slight symptoms of jaundice. Neither the intestinal canal nor the kid- neys are involved in all cases. The brain becomes slightly engorged, if the elTusion is copious, and the circulation is interfered with. The posi- tion of the patients deserves particular notice, more especially, as con- trasted with their jmsition in pneumonia. Pleuritic patients, almost always, lie on the painless and unalFected side, whereas, if tlie effu- sion is not attended with pain, they prefer lying on the diseased side. Very seldom, the patient wants to lie on his back ; ii he does, the trunk has to be elevated a good deal. All these objective, as well as subjective symptoms, which we have described, are not sufficient to establish a reliable diagnosis. If a reliable diagnosis is at all possible, it will have to be based ui)on the results of a physical exploration, which is even more important in this diseiuso than in pneumonia, for the reiison that pleurisy often remains such a latent disease, that the objective phenomena alone can shed light upon its existence and true character. This examination can only be made by a physician. ALLOPATHIC TREATMENT. The indications for treatment. In the first place, are ^"^ subdue the inflammation and to relieve the pain. For this purpose, full doses of Opium is the most useful and effective treat- ment, which not only relieves the pain completely, but lessens the con- gestion very materially. Tl;e hypodermic injection of Morphine in doses sufficient to pro- D'SEASES OF THE LUNGS. 44(« duco its sedative influence, a third to lialf a grain, by the physician, is llie best method for its administration. If givon Ijy the mouth, from a grain and a half to two grains of Opium, thirty to forty drops of Lauda- num, fifteen or twenty grains of Dover's Powder, may be given every two hours, until tlie pain is relieved, ana repeated at intervals sntlicienlly often to relieve the pain. After the pain is relieved, doses half the size above named, will probably be sufficient, but the pain must be relieved. Morphine may be given, by the mouth, in doses of a third to half a grain, and repeated every hour, until the pain is relieved, after which tiie dose should not exceed a fourth of a grain, repeated often eough to relieve the pail). For continued use, if the preparations of Opium jiroduce unpleasant symptoms, probably Atropine in doses of one-sixtieth of a grain, given with the Opium, will obviate the difficulty ; or Codia may be used instead of Opium or Morphine, in the same doses as that of Opium. A full dose of Quinine (fifteen or twenty grains) at the very begin- ning, ia said to suppress the inflammation. It is more effectual if Opium be given with it as above directed. The cold, wet pack, applied to the side, diminishes inflammation and relieves the pain. A large towel is wrung out of cold water, folded and placed over the affected side. Then wrap the chest tightly with a long, broad bandage, or towel, which was previously had in readiness, and fastened. Oftentimes the hot, wet pack is more serviceable, and is to be pre- ferred, the feelings of iihe patient being a safe and reliable guide. It is applied in the same way, the towel being wrung out of water as hot as can be borne. Hot Linseed meal poultices applied to tLe affected side, will answer the same purpose. Some phyHicians prefer a large mustard plaster over the affected side, or Turpentine stupes, in the method described in the treatment of pneu« monia. The application of Tincture of Iodine may be made to the affected side, and is a serviceable form of counter-irritation. A large blister, over the affected side, is always applied by some good practitioners, but they do not seem to possess any advantage over the use of heat either by the pack or poultices, and appear to be harmful, by adding to the irritation from which the nervous and circulatory systems aie sulTering. When the disease has begun to decline, a blister is useful, by assisting in the removal of the products of inflammation, but then haa no advantage over the repeated applications of Tincture of Iodine. Like pneumonia, in cases of robust persons with high fever and a strong, incompressible pulse, and the pain is very severe, a blood-letting, in the very beginning of the disease, will prove serviceable, and often be followed by quick relief. The amount of blood taken should be from twelve to sixteen ounces. A feeble, or only moderately strong person, ought not to be bled. After the pain has been relieved for several hours, by the use of Opi- um, the revulsive effect of a free saline cathartic is required, purpose, one or two tablespoonfuls of ICpsom Salts is the most efficient. 29 W i<,^ )% m 3 M fli! ifii T ll 'HI f| i I! Ill 111 Hi ' I if ill i i!'j 'M J m INFLAMMATION OF THE PLEURA. If boilofl with onr-third its bulk of roasted coffee for a couple of min utes, in an earthen vessel, and then allowed to draw for a few minutes, tho taste will bo covered. Other salines may be given, but with less effect, iis the Solution of the Citrate of Magnesia, RochePe Salts or Seid- litz Powders. The bowels should be kept open by the use of moderate doses of tlio saline cathartics. For this purpose, the latter ones are as appropriate. If the fever and pulse continue to run high, after the influence of tho Opium is produced, a drop of the Tincture of Aconite should be given every half hour, until an impression is made on the fever movement, and then continued in one-drop doses of one hour to two hours apart, accord- ing to the degree of fever and the force of the pulse. The Opium should be continued, in doses of sufficient size, and with such frequency as would relieve the pain. The use of Veratrum Viride is preferred, by some practitioners, as a sedative for the pulse and fever. While it is very powerful, it seems to the writer that the Aconite is to be preferred. Neither of them should be prescribed, except by a physician, and then they are only called for, as a rule, in persons of robust constitution. In givingVeratrumViride, the Fluid Extract should be used, in doses of one to three drops, or the Tincture in doses of two to six drops, repeated every hour, until the pulse is slowed, and then repeated two hours ajiart, to continue the required impression upon the pulse. This treatment should continue as long as there is pain and fever, and should be maintained just in proportion to the prominence of those symptoms, but should be discontinued when they disappear. Counter- irritation will be appropriate, as will be shown. Great reliance is placed upon the use of Mercury by some practition- ers, as having a si>ecific efffict upon this and other inflammations of serous membrane, and by these is generally given with the Opium in doses of from one-half to one grain. The writer believes it is powerless in the way claimed. The use of the remedy as a cathartic, in doses of ten grains is admissible, if the pafent is not especially suscept.ble to the influence of the drug. If the bowels do not move, it should be followed by a Seidlitz Powder, or one of the other saline cathartics mentioned above. The nutrition of the patient should be maintained by allowing such food, from the very beginning of the disease, in patients not strong, as will be retained and is digestible; as a rule milk, eggs, animal essences or strong beef tea, and bread, rice, and other farinaceous articles are to be chiefly used, but in the latter part of the disease, the food should be more solid and meat maj' be allowed. In a very robust patient, feeding is not required to be followed as persistently until a few days have elapsed, but with feeble patients, the best results depend upon immediate and system- atic feeding from the beginning of the disease. The principles for nour- ishment given in the treatment of Pneumonia will apply here with only little less force. Measures to promote the absorption of the liquid thrown out into the pleural cavity (dropsy of the chest,) are hydrogogue cathartics (producing watery stools,) diuretics (medicines increasing the flow of urine,) counter- irritatioB, and such remedies as may, especially, promote absorption. DISEASES OF THE LUNGS. 461 It is generally not well to resort to these cathartics until late in the dis- ease, on account of their extreme depressing influence. Themost powerful should be given, only when tlie greatest urgency exists, as extreme diffi- culty of breathing, from the great amount of liquid in the pleural cavity, or where other means have proved unavailing. They are Elaterium, Croton Oil, and Gamboge. They ought, if used, to be prescribed by a physician. The dose of Elaterium is one-eighth to one-fourth of a grain ; it should be combined with half a grain or a grain of Extract of Hyoscya- mus. The dose of Croton Oil is one drop in mucilage or syrup. Tlie dose of Gamboge is three to five grains in pill form, or rubbed up with sugar. Cathartics which are less severe, and very effective and can be relied on, are the Saline Cathartics mentioned on the preceding page. Diuretics may be given without reducing the system, and they often act with effi- ciency. Mustard Whey is resorted to as a domestic remedy, and is often sufficient. It may be taken almost at will. Water Melon or Pumpkin Seed tea can be given, with the addition of fifteen or twenty grain doses ofthe Citrate, Bitartrate, or Acetate of Potash, Squill, Digitalis and Broom are the most efficient remedies for tliis purpose. They may be combined in an Infusion of Digitalis (made from one dram of Digitalis to a lialf pint of water,) four ounces.Vinegar of Squill lialf an ounce, Fluid Extract of Broom half an ounce. Mix, and giveatablespoonful three times a day or oftencr. The Potasli Salts just mentioned may also be given with this mixture, or the Iodide of Potassium in doses of twenty grains. When giving cathartics or diuretics for removing tlie dropsy, the amount of drink should be limited as much as possible. Blisters no doubt hasten the absorption of the fluid, but it is probable that as much ^ood will be done by the repeated applications of Tincture of Iodine to the side. If the strength of the patient should begin to fail, cathartics and diu- retics are out of place, especially the former, and Tonics and stimulants should be given as directed for Pneumonia. If the liquid accumulates in the cliest to such a degree as to endanger life, the surgeon should remove it by tapping, as will be described for Chronic Pleurisy, and Drojisy of the Chest, further on in this article. The treatment of chronic pleurisy calls for the same treatment as the latter stage of acute pleurisy, consisting of tlie same cathartics and diu- retics, and for the same purpose. Small blisters may be repeatedly applied over the side, or preferably the Tincture of Iodine may be applied from time to time. The strength of the system requires 8U'~^ort by the use of tonics, nourishment, and in extreme cases, alcoholic l ^mulants and out of door exercise. In many cases supporting measures are the chief means of cure. The Citrate of Iron and Quinine is as good a tonic as any, given in doses of two to five grains three times a day. It sliould be given in solution. The diet should be the most nutritious possible, but simple and digestible. If alcoholic stimulants are used at all, it should be a glass of wine or table- spoonful of whisky or brandy at meal times, and is doing good if it causes the patient to eat and digest m(ir(- food. If the fluid persists in the chest, it can be effectually removed by tap- ping by means of a small trocar and canula attached to a Davidson's ,4>i'', J tf% t 452 INFLAMMATION OF TIIK PLEURA. syriiigt'. The liquid ia removed in the same way aa it is drawn from a vet-sel, during theprocess of an injection. When the fluid returns after its rcmo.iil u half ounce of the Compound Solution of Iodine (Iodine a dram, Iodide of Potassium two drams, water twenty-one drams,) should be injected into the pleural sac. This ia especially serviceable if the sac con- tains pus. Then the sac may be washed out with an ounce of this solution to a pint of water. The use of Iodide of Potassium, in doses of ten to twenty grains three times a day for a long time, is useful in promoting absorption. The treat- ment of dropsy of the chest is tlie same as that for chronic pleurisy. The PiiiNciPLEs of Treatment for Pleurisy in Young Chil- dren are essentially the same as for the disease in the adult. The doses of Opium admissible are proportionately much smaller than are directed for an adult. It cannot, with safety, be used so heroically. For a child six months old, or less, five to ten drops of Paregoric, and half a drop to a drop of Lauiianum. Above this age, and under two years, ten to twenty drops of Pa "goric, two or three drops of Laudanum, or a grain of Dover's Powdt at the age of three or four, twenty to thirty drops of Paregoric, three to e drops of Laudanum or two grains of Dover's Powder may be given. The effect should be watched with a great deal of care. The doses should be repeated only sufficiently often "to relieve pain, which will vary in frequency from two hours apart to two or three times a day. "When the opiate is given every two hours until positive drowsiness is produced, it should be given at longer intervals, or its administration discontinued altogether for a time. Hot applications, poultices or the hot wet pack, are the preferable means for local treatment. Hot Turpentine stupes, or the application of the Tincture of Iodine, or Mustard plaster, may be resorted to. These are fully described in the treatment of pneumonia. After the pain is relieved, the bowels ought to be moved by the use of a saline purgative, as directed for adults, in doses of half a teaspoonful to a teaspoonful of Rochelle Salts; or Castor Oil may be given in doses of a teaspoonful mixed with an equal quantity of Glycerine, and a drop or two of Oil of Gauletina or Cinnamon, to disguise the taste. The bowels should be kept soluble by full or half doses of the same cathartics. If the pulse and fever continue high, after the pain is relieved, and the warm applications to the side have been made, if the patient is over three years old . the Tincture of Aconite in smajl doses frequently repeated, until an impression is made on the fever, and the pulse reduced to ninety or a hundred. It can be given with syrup, as follows: Take of Tincture of Aconite luilf a dram, of Syrup Tolu three and a Imlf drams. Mix. Dose: From one to six drops every one or two hours. If the disease is secondary, or the patient feeble, Aconite or other depressing measures ought not to be used. Opiates to relieve pain, stimulant and warm applications as above directed, tonics and nourishment, will constitute the treatment. Except the child lakes freely from the breast, nourishment consisting largely of milk, eggs, animal essences, and strong'beef tea should be given through the length of the disease. DISEASES OK THE LUNGS. 4" To promote absorption, the use of Tincture of Iodine for a counter- irritant is preferable. Small blisters, made with the Blistering Collodion, are admissible. The diuretic effect of Iodide of Potassium is very useful. It should be giveu in doses of two to five grains three or four hours apart : Takf ff Iodide of Potassium tnx) sc7-uples, Syrup of Peppermint aiul Water each an ounce. Mix. Dose: Twenty drops to a teaspoonful. If the child's blood Is much impoverished, a scruple of the Pyrophos- phate of Iron may be added to the above formula. This prescription is very useful in iireventing the disease passing into the chronic state. Other diuretics may be given in connection with the Iodide of Potas- sium. The following is a suitable formula: Take of Vinegar of SguiUs two drams, Tincture of Digita/ is thirty drops, Water four ounces. Mix. Dose: A teaspoonful for a child two years old, or a dessertspoonful for a child four or five years old, three or four times a day. Purgatives should be limited as above stated, to keeping the bowels open. In case the treatment failed to produce theabsorption of the fluid, the surgical procedures recommended for chronic pleurisy of the adult should be resorted to by the physician. HOMCEOPATHIC TREATMENT. Aconitum is an indispensable remedy in allaying the intense fever (with quick and full pulse) which is often attendant upon pleurisy ; and is in many cases, indeed, when timely administered, alone sufficient to cure the disease. It completely supplies the place of the lancet in such cases, and rarely fails to effect improve- ment in from six to eight hours; should it not do so in that space of time, another remedy must be selected. Bose : Of a solution of ten pills to two tablespoon fuls of water, give a teaspoonful every hour, until the pulse becomes more healthy, the skin moist, and the breathing less painful and impeded. Hr^/onia-alba should, in general cases, follow Aconitum, when the fever has been somewhat allayed by that remedy. It is, more particularly, indicated, either in simple or complicated pleurisy, when the following symptoms are encountered, at an eai-ly stage of the disease : Aching, burn- ing, but, more especially, acute shooting or cutting pains in the chest, much increased during inspiration or on movement ; oppression and anxious respiration ; palpitation of the heart; dry, cracked, brown, or yellow- coated tongue; bitter taste, nausea, and occasionally vomiting of mucus, or of a bitter, bilious-looking fluid; aching or painful pressu»'e at the pit of the stomach and under the false ribs ; intense thirst, especially at night ; constipation ; head confused and giddy ; giddiness on sitting up in bed; aching and shooting pains in the head, or pain as if the head would burst, particularly, at the temples, with exacerbation on coughing, or moving; fiery, or bluish redness, and puffliness of the face; restless, dis- turbed sle >, frequent startings ; nocturnal delirium, with alternations of lethargic s.eep; burning heat of skin; occasionally partial, clammy per- spiration ; pulse generally frequent, hard and small, but sometimes full, unequal, intermittent and weak; aching in the limbs. Lastly, when, in connection with many of the above, the following symptoms are mot with : Cough on lying on the side, or impossibility of lying otherwise iW lit tt^' h\ l:Y i(i ■ I ' I'l 454 INFLAMMATION OF THK PliEUKA. than on the hack; dry coiif^h, or cough with expectoration of dirty, yellow colored phlegm, stri'iikod or tinted witii Mood, and attended with great exacerbation of ]<aiii, Hryonia will rarely fail to render much service, and can, indeed, willi difTlculty, l>e dispensed with. Dose: Of a solution of six pills fo two tablespoonfuls of water, give a teaspoonful every four hours (or, in very Hevere caaea, every two hours). Sulphur may, with advantage, follow Bryonia, when the pain men- tioned liaa l)een removed by that medicine, and ol'ten completes the cure, when Aconite or Bryonia, or botli of tliese, have been InsufTicient. This remedy is, however, not unconnuonly of essential service as an Interme- diary resource, administered from time to time, to awaken the suscepti- bility in the system to the action v)f o( hers— in such cases (associated with constitutional taint) as are not adequately influenced by either of the fore- going. Dose: If as an intermediary medicine, two globules in a teaspoonful of water,/b?/r hours after the last dose of any other medicine, fol- lowed, in six hours, by such treatment as may be particularly indi- cated. If as a conclusive resource to perfect the cure (already advanced) three globules in a teaspoonful of water every six hours, until four doses have been given, and then six globules the first thing in the morning (fasting) for four tlays; then pause two days, resuming the course as before, ifnecessary.andso on, until all tracpH of the disease have been removed. THE HEABT AND rtUT OF THE ARTERr,CL 8. The right auricle receives the blood from all the veins in the body by the superior and inferior vena cava and corinary sinus, and passes it to the right ventricle. 1. The right ventricle receives the venous blood from the right auricle, and forces it through the pulmonary arteries to tlie lungs to be changed by contact with the air. 6. Pulmonary artery. 4. Left auricle receives the blood from the lungs by the pulmonary veins, and passes it on to the left ventricle. 2. The left ventricle receives the arterialized blood from the right yen- tricle, and forces it through the aorta (6) and its branches to every part of the body. 6. Aorta. 7, 8. Right and left coronary arteries respectively. 9. Inominate artery. 10. Left common carotid. 11. Left sub-clavicle. 12. Superior vena cava. 15. Inferior vena cava. I *i C'Ji \ -H .1 f I ii- I!: THE IIKAUT AND THE COMMKNCKMKNT OK TIIK AKTEUIES. I*AIfcrr TET^TH DISEASES OF THE ORGANS OF ClBCULATTOl/c CHAPTER XXII DISEASES OF THE HEART. INFLAMMATION OF THE HEART. Under this head, we will have reference to inflammation of the mus- cular structure of the heart, carditis, inflamhiation of the lining mem- brane of the heart, endocarditis, and inflammation of the membranous sac which envelopes the he&Ti, pericarditis . Tiiese are generally, treated upon as separate and distinct diseases, but as their symptoms are very similar, as well as the treatment recommended for them, we havejudged it best to embrace them under one head. Symptoms. Inflammation of the heart, or its membranes, usually commences with the symptoms common to most inflammatory attaclts, as chills, heat and dryness of the skin, thirst, flushed face, full pulse, etc. These are succeeded by rapid, imperfect and often unequal breathing and an acute lancinating pain about the region of the heart, which may extend to the shoulder. This pain, especi..lly in pericarditis, is aggravated by pressure over the heart, as well as by a full inspiration. There will, also, be a dry, harrassJng cough, which augments the patient's sufferings, and generally a sense of suffocation will be experienced. Motion or exercise will increase tlio pain and difficulty of breathing to a greater or less extent. The features are haggard and expressive of much suffering, with a degree of anxiety, the heart beats violently and irregularly ; a sensation of faint- ing is present, more or less constantly; at first the pulse is full, hard, and bounding, but speedily becomes small, frequent, and unequal, and fre- quently cannot be observed at the wrist; the appetite is deficient; the tongue coated white ; the bowels constipated ; the urine insufficient and high-colored; the skin is often bathed in sweat, as in acute rheumatisnj ; and when the diaphragm or midriff is involved, there will be a distressing and painful hiccup. Causes. These afffections are, most commonly, owing to the presence of acute rheumatism, the disease either attacking the heart primarily, or being translated to it from some otlier part of the system. They may, likewise, occur from other causes, and are sometimes met with in combi- nation with pleurisy, Bright's disease of the kidneys, etc. 45o will 4fi6 INFLAMMATION OI' TlIK UliAIlT. PuooNosiH. TlioHo uttiu'ks iiro of u very HcriouH chixracter, nnd may terminate fatally in IV very .short tiino; though it is .saiii tliat evcMi when left entirely (o MienuolvoH witlioiit any care or treatment, not more than one in six eases is wont to prove fatal. Tlie prineijiai evils to fear are the Becondary or olTronie ail'eetions resulting from tlie acute attack. ALLOPATHIC TREATMENT. Inllammation of tlie substance of the heart is so rare and so completely impossilde to determine during life, that u discii.ssioii of means of treatment is not called for. The most fro(iuent form of inllainnuition is that of the lining mem- brane of tlio heart (endocardium) and is called endocarditis. It procUuics the great majority of diseases of tlie heart by causing permanent clianges* in its valves. This form of iiiDammation of the heart (endocarditis) most frequently occurs with inllainmatory rheumatism (of the joints) ami appears to depend on tlie same morbid cause. When rheumatism exists, therefore, tlie treatment reciuired for it will have the most favorable inllu" enceon the endocarditis and siiould l)e employed. If promptly resorted to, it will prove protective against this disease. Remedies addressed directly to this inflammation may be briefly sum- marized as follows : It is ap])r()priate to use saline laxatives, provided tlio patient is not weak or reduced. Tlie articles most appropriate are a table- spoonful doses of Ilochelle Salts, and Seidlitz Powders. Pain over the region of the heart should be met by hot i)oultices, tlie hot wet pack, aa described for pleurisy, or Turpentine stupes. Opium in doses of lialf a grain to a grain, fifteen to twenty-five droj)s of Deodorized Laudanum, or appropriate doses of other preparations of Opium, may be given to relieve the pain, and sufficiently often to procure this effect. The subsequent ill-efTects of the disease are due to the products of the inflammation, cither the deposit of lyuipli beneath or upon that portion of the membrane covering the valves. Remedies wliich will reduce the fibrin in the blood or retain it in a fiuid state, are called for. Thealkalies called for by the rheumatism are approiiriate. Ammonia lias a direct influence to this end; the Aronuitic Spirits of Ammonia (Hartshorn) may be given through the course of tl.>e disease. The dose is a teaspoon half full to a teaspoonful in wateror syrup, and may be repeated from two to six hours apart, according to the se\ erity of the disease. To promote the absorption of the lymph Iodide of Potassium may be given in doses often to fifteen grains, tliree times a day, and tlie Tincture of Iodine may be applied, daily or less often, over the region of the heart. The discrimination of this afTection requires the skill of a physi<!ian. The more immediately and exceedingly dangerous inilammation to which the appendages of the lieart is subject is pericarditis (infiammation of the serous membrane covering tlie heart). When the disease occurs ia the course of acute articular rheumatism the remedies appropriate to that aflTection are urgently called for. The use of the saline cathartics, Rochelle Salts in doses of one to two tablespoonfuis or one or two Seidlitz Powders, are useful by way of revulsion. They should be repeated in four hours, if the bowels have not moved. Opium in some of its forms is invaluable given to the extent of reliev- ing pain. The best manner of using it is the hypodermic Injection of DISEASES OK THK OIUJANS OK CIIUJULATION. -iht They Morphine in cIohch of a quarter to atliird of iigruln, l>y a physician, may bo repeated every luilf liour, until i)ain i.s ovcrooine. A tlilrd of a grain of Morpliiiie, thirty drojjs of Laudanum, or a grain and a lu''^' of Opium may l)e given every liour, until pain is relieved. Afterwards, repeated at Hueh longer intervals as will maintain the efFeet. If, after tlic pain la relieved, the pulse continues Htrong and very rapid, Tincture of Aconite may be given in doses of a drop every hour, until an impression is made on the fever and pulse, and tlien every two hours, to maintain its eflect. Tincture of Veratrum Viride is used instead, by some i)ractitioners, for this purpose. The dose is two to five drops of the Tincture, or one to three drops of the Fluid Extract every two hours. Mercury is thought, by some practitioners, to exercise a controlling power over this and otlior indammations of serous membranes. If used, it may be given in doses of a sixth to a third of a grain of Calomel every two hours to Impress the system quickly. Its beneficial action is, to say the least, doubtful. Counter-irritation, such as Mustard plasters, Turpentine stupes as directed for pneumonia, the applications of Tincture of Iodine, the hot wet pack may be useful. A warm poultice may bo kept over the region of the heart. After the acute symptoms have subsided, to promote the absorption of fluid from the pericardial (upon tlie heart) sac, the region over the heart may be painted every day with Tincture of Iodine, and small blis- ters may be applied by using tli^-Blistering Collodion with u camel's hair brush. When a blister is made, it should be allowed to immediately dry up. The use of cathartics is admissible, as far'as the strength of the patient permits, to promote al)sorption. Epsom Salts, or Citrate of Magnesia, or Bitartrate of Potash may be made to produce one or more water stools a day. Diuretics, as Squills and Digitalis, may be given, in equal parts, three or four times a day, in doses of a teaspoon ful. It Is during this stage that the strength of the system needs support- ing with nutritious food, as strong beef tea, or essence, milk, raw eggs beat up with sugar and water or milk, or poached, and such farinacious articles as the patient desires; steak, broiled rare, may be eaten, If rel- ished. Quinine, In do'-r's of one to three grains, three times a day, may be given for a tonic If the circulation Is weak, stimulants are called for. A tablespoonful of Brandy or Whisky may then be given In milk or with the raw egg, as often a^; two hours apart. If required. Its beneficial effect will be shown by producing a fuller, softer, and more regular pulse. During convalescence, the diet should be good and nutritious, but simple. MhcIi exercise should be avoided, though part of the time spent in the open air Is beneficial. Treatment appropriate to other diseases when pericarditis occurs as a complication, must be continued. Pericarditis from wounds can have little else done for it, except to relieve the pain with Opium. :i\ 468 INFLAMMATION OK THE IIKART. ill ill ! Hi ■n Hi m^^^Hi ^^^H Should the diHenso becomo chronic, the treutiuent given for the acute disease, after tlu) early Hyniptoms, is appropriiite. Iodide of PotoaBluin nuiy be ^'ven, in doae.s often to twenty grainH, tliree limes a day. If tlie blood is nuicii inipoverislied, one or two grains of tlie Pyrophosphate of Iron may l)e given witlj tiie Iodide of Potassium. In ciises in which tlio useoftlu'se means witli cathartics, diuretics, etc., fail to remove the liquid, it has been successfully done by tapping, and in some instances the Compound Solution of Iodide of Potassium has been injected into tlie sac. So serious a disease, and one Involving such difliculty in its manage- ment, requires, Invariably, the services of a physician. H0M(E0PATH1C TREATMENT. The diseases of the heart are all so difficult to understand, and a i)roper understanding of the case Is so Important that, allliough I very much desire to bring their treatment within the comprehension of the masses, T am unable, thus far, to do so, fully. Appended are many of our most approved remedies, with their particular indications, by Liilientluvl. The dose should be varied and repeated in proportion to the urgency of the case. From four to eight pills in a little water, repeated at intervals of from one to twelve hours, may bo given. Aconite. Oppression about the heart, burning flushes along the back ; palpitation, with feeling as If boiling water was poured in the chest; anxiety, difflculty of breathing, flying heat in the face, sensation of something rushing into the head ; fainting with tingling. Arnon. cnrh. Audible palpitation, \vith attacks of great anxiety, as if dying; cold sweat. Involuntary flow of tears; unable to speak ; loud, difficult breathing and trembling of hand ; debility and soreness of (he whole body ; pulse hard, tense, frequent. Apismel, Sudden attack of acute pain just below the heart, soon extending diagonally toward the right chest; blowing sound with the diastole; sensation as if be would not be able to breathe again; great prostration ; pulse accelerated, full and strong, or feeble and imper- ceptible. Argentuni met. Full feeling in region of heart; frequent spas- modic, though painless, twitchings of tlie whole cardiac muscle, espe- cially on lyii.'T on back; fears apoplexy ; lame, weakness with all pains. Arnica. Sensation as if heart were grasped by an iron band; stitches in cardiac region ; region of base of the heurt feels as if bruised ; sudden pain, as if the heart got a shock ; intermittent, feeble, hurried, irregular pulse; hypertrophy of heart, induced l)y over-exertion, especially, in young men, as from rowing ; the fatty heart. Arsenicum. Palpitation, after suppressed herpes or footsweat, with feeble, irregular pulse; the heart beats strong, visible, and audible at night, more rapidly when lying on back; pericarditis in consequence of suppressed measles, or scarlet fever, with inexpressible anguish and rest- lessness, worse at right, flushed face, paralytic feeling in the upper extrem- ities; tingling in fingers, cold perspiration. Assafoetida. Nervous palpitations ; with small pulse, breathing not oppressed, in \yomen after suppressed discharges, or bodily exertions ; DISEASES OK TIIIC ORGANS OK ('IKCIII.ATION. m prefiHuro In cardiac repfioii, as If heart were too full ami expanded; pulse aiiiall. Auvtnn Met, Frequent attacks of anguish about the ht. \ with trenmlous foart'ulness ; violent beating of the heart after exertions, with great agony ; strong beating of heart, with anxiety and congestion to head, after inotorrhagia; when riding or walking, palpitation compels one to atop; pali)itation, with irregular intermittent pulHo, and short breathing. JiHlailonna. Nervous palpitations, with congestion to head; pres- sure in cardiac x'giou, which arrests the breathing, and causes a sense of anxiety ; gurgling at the heart, a kiiid of palpitation when going upstairs; throbbing of carotid and temporal arteries. licnzoic Arid, lienzoate of Ammonia, llheuraatism of heart; pains change place incessantly, but are not constant around the heart; awakens after midnight, with violent palpitations of thr; heart and tem- l)oral arteries ; internal, but not external heat; at times, tearing pains in tlie extremities, relieving the heart; urine high-colored, offensive, hot, scalding, amraoniacal, high specific gravity. Bryonia. Pericarditis, with stitching pain in cardiac region, pre- venting motion, and even breathing, wants to He perfectly quiet" heart beats violently, and rapidly, strong orgasm of blood ; from re-percussion of measles. Cactus Grand. Pericarditis and endocarditis ; sensation of con- striction of the heart, as if an iron band prevented its normal movement; acute pains and stitches in the heart; difliculty of breathing; attacks of suffocation, with fainting; cold perspiration on face, and loss of pulse; palpitation when walking, and at night when lying on left side. Nervous palpitations; easily frightened, often awakes in a fright; numbness of left arm, annoying, creeping sensation from before backwards, in cardiac region, cedema of the hands, especially, of left one; endocardial murmurs, excessive impulse, increased prajcordial dullness ; enlarged right ventri- cle; irregularity of the heart's action, at times frequent, at others slow ; great irritation of the cardiac nerves; enlarged left ventricle; pains in the apex of the heart, shooting down the left arm to the ends of the Angers; feeble pulse, dyspnoea; general weakness, prostration, great depression, sleeplessness, fainting. Cimicifuga, Excessive impulse of the heart over an extensive por- tion of the left side, with dullness on percussion ; heart's action ceases suddenly, impending suffocation ; pains from the region of heart, all over the chest and down left arm, palpitation, unconsciousness, cerebral con- gestion, dyspnoea, face livid, cold sweat on the hands, numbness of the body, the left arm numb, and as if bound to the side; pulse weak, irregu- lar, trembling; chorea of heart, tumultuous, irregular, unexpected, and strange motions of the heart ; cardiac debility ; rheumatic endo, and I)ericarditis. Colchicutn. Heart disease, following acute rheumatism, dropsy of heart (hydro-pericardium ;) pressure and anxiety in priecordial region ; fullness and oppression, as from stagnation of blood in the heart at night, while lying on left side, he is obliged to turn to the right side ; dull, irreg- ular, seemingly suppressed beats of the heart, with a peculiar sensation in chest ; pulse small, slow, and weak. fli % ' ^i'W i. I .*.t| h.k\ iw if: i i ;' ip 'if ii I Si !,i.:l: ill' III 1 T :•'■': •i j .ii I <ftO INFLAMMATION OF THE HEAUT. Digitalis. Pericarditis, witli copious serous exudation ; violent, but not very rai)id beating of the lieart, irregular, intermittent pulse, brick- dust sediment in urine, during or after rheumatism. Very feeble irregu- lar action of the heart, with feeble, small, intermittent pulse; great prostration, fainting on the least movement, even lifting the arms with palpitations, coldness of limbs and bodj', and dreadful weak feelinj^ pit of stomach, witli or without convulsions, of syncope; promse expector- ation of bloody mucus, and vomiting of food; sensation as if the heart would stop beating if she moved, with fear of impending death ; hydro- pericardium (drojjsy of the heart). Ferrum. Consecutive heart disease, especially from chlorosis and onanism; congestion to head, spitting of blood; palpitations, better from moving slowly about ; pseudo-plethora, witli hard, strong, beat- ing of the heart and throbbing in ail bloodvessels; pulse full, hard, increased by exertion; soft bellows sound at apex ; nervous restlessness, must walk slowly about. Gelseniinum. Cardiac neurosis. Feeling as if the heart would stop beating, if she did not move about; a sensible motion of the heart, as though it had attempted to beat, which it failed fully to accomplish, and the pulse then each time intermitted, worse when lying down in bed, especially when lying, on left side; excessive action of heart; stitching sensation in cardiac region, heart's action slow and feeble, the beats of heart cannot be felt, chills and pains in head ; nervous chills, yet skin is warm, wants to be held that she may not shake so. lodiun. Pericarditis in complication with croupous pneumonia purr- ing feeling in the region of the heart, violent palpitation, increased from the slightest motion, better while lying perfectly cxuiet on the back ; faint- ing spells; sensation as if the heart were squeezed together; fluttering sensation in heart ; constant, heavy, oppressive pain in cardiac region. Liliani Tigt'in. Cardiac irritability, nervous palpitation ; i)ains dull, pressing and heavy, as if tlie heart were grasped and released alternately ; sensation as if the heart contained too much blood, which might be re- lieved by throwing up blood ; pain, pressure, and fullness about the heart with a feeling of coldness about tlie heart, but no indicationof any organic lesion ; trembling feeling about the apex of the heart, worse on talk- ing; frequent sensation as if the heart stopped, followed by a rush of the blood to the heart and violent palpitations ; amelioration by lying on left side. I/f/copodium. Hydro-pericardium; trembling palpitation, pulsating tearing in the region of heart; sensation as if the circulation would stand still, or ebullition of blood ; palpitation of heart nearly every evening in bed; marked palpitation, with flatulence; acceleration of pulse, with coldness of the face and feet ; neck drawn towards right side, stitches in left side of chest ; typhoid symptoms. Nux moschata. Hysteria cardis ; violent action of heart ; feels as if her head would burst, and her heart be 8(|ueezed off; trembling flutter- ing of heart, as from fright; palpitation and fainting, followed by sleep; irregularity in heart's beat, pulse intermits sometimes so long that it ex- cites fear of death ; murmur in carotids ; frecjuent trembling pulse, accel- erated after wine; disposition to faint even from slight pains. m m Ii I 1 t, but »rick- regu- jreat with pit ictor- leart yd ro- an (J setter beat- lard, 11 ess, DISEASES OF THE ORGANd OF CIRCULATION. 461 Nnx-vomica. Hypertrophy of heart from portal obstruction; palpi- tation in frequent short paroxysms, with pulsating throbs in the direction of the heart, especially, from mental emotions, protracted study, after eating highly-seasoned food; tired sensation of the heart, with palpitation when lying down, frequent belching; dilation of heart (weakened heart) with nervous palpitation, with nausea, inclination to vomit, and heaviness of the chest. Phosphorus. Disease of right heart, with consequent stagnation; dilation of the heart following endocarditis; fatty degeneration of heart; dyspnoea, tightness across the chest; great weakness, with inability to exert himself; palpitation from every emotion, with rush of blood to the chest, especially, in rapidly-growing youths; over-sensitiveness to external impressions; congestion to lungs, tightness across chest, and tight cough; painless diarrhoea. Phytolacca. Chronic rheumatic endocarditis ; shocks of pain in car- diac region, pain goes into right arm; awakens with lameness near heart, worse during expiration, cannot get to sleep again; heart's action weak (fatty heart), with constipation; great exhaustion. Podophyllum. Nervous palpitation, in consequence of excessive hepatic action ; sensation in chest, as If heart were ascending to throat; palpitation, with a clucking sensation rising up the throat, obstructing res- piration ; palpitation from mental emotion or exertion, with rumbling in ascending colon ; heavy sleep, fatigue on waking in morning. Pulsatilla. Nervous palpitation in young girls during the time of puberty, or from amenorrhoea ; catching pain in cardiac region ; better for a time from pressure of hand , rheumatic irritation of heart, the pains shifting rapidly from one part of body to another; constant chilliness ; worse nights, especially after getting feet wet ; burning in cardiac region; violent fits of palpitation, often with anguish and obscuration of sight. JRhus-tox. Uncomplicated hypertrophy, from violent exercise ; organic heart disease, with sticking pain and soreness ; numbness and lameness of the left arm ; chest and heart feel weak after a walk ; violent palpitations when sitting still; pulse sometimes quicker than the heart's beat, irrogular; restlessness, must change position; always worse when keeping quiet. ScutellaHa. Irregular action of the heart, from derangprnent of the cardiac nerves; tremulousness and twitciiing of cardiac muscles; oppres- sion of the cliest, with a sticking pain in cardiac region; sensation of throbbing about the heart, witli Hushed face; nervous disorders of heart, as palpitation, tremor, and strange sensations, from emotional excite- ment; hysteria; reflex nervous irritation, from ovarian or uterine dis- orders. Sepia. Suppressed menses ; concestion of blood to the chest, with violent palpitations; an occasional hard tlium^' of the heart; palpitations, with anxiety about things which liappenod years ago; palpitation after mental emotion ; interruption of the beating of the heart, most after din- ner; alarming, quivering motion; restless, fidgety; sensation of ball in inner parts. Spigelia. Rheumatic pericarditis. Undulating motion ot the heart; indistinct beats of the heart, running one into another tumultuous beat- .1 i is ■Mi m m 462 INFLAMMATION OF THE HEART. ing of the heart, in recumb^nt as well as sitting positions, not synchronous witlithe radiiil pulse; spasms of the cliest; suffocative complaints ; trem- ulous sensation in chest and temples, increased by motion ; tearing sensation in chest when raising the arms overhead, and when touching pit of stomach ; purring murmur during the beats of the heart; stitches in cardiac region; pulsations of carotids, with tremulous motion ; great dysjjnaja at every change of position ; bright redness of lii)3 and ciieeks, changing to pallor during every motion ; audible beating of the heart.causing a pain that is felt through the back ; cutting pains from the heart to shoulders, as far as the head and arms; arthritic pain and stiffness in joints; dull stitches where the beats of heart are felt, and recurring with the measured regu- larity of the pulse ; scraping in throat , affection of the tracheal and bronchial mucous membranes ; systolic blowing at the apex ; pulse irregu- lar, strong, but slow. Spongia. Aneurisma aortas; dry paroxysmal cough; worse lying down; rheumatic endocarditis; loud blowing with each heart-beat; attack of oppression and cardiac pain; worse when lying with the head low; stinging-pressing pain in precordial region ; violent palpitation ; awakens at night with a sense of suffocation; violent gasping respiration; loud cough; great alarm; agitation and anxiety; valvular insufficiency; feel- ing of numbness of lower part of the body ; trembling in all the limbs. Veratrum-albinn. Tumultuous, irregular contractions of heart, forerunners of paralysis; intermittent action of heart in feeble persons, with some obstruction to heptic circulation ; violent, visible, anxious pal- l>itation, with fainting; pulse sometimes slower than heart-beat. Veratruin-viride. Idiopathic and rheumatic peri- and endocarditis; violciit fc-'er; full, hard, bounding pulse; congestion to the head, without delirium; tnrobbing carotids; constant burning pain, with oppression of the chest; sensation as of a lieavy load on the chest; heart's action violent and tumultuous ; respiration ra])id, labored, and sighing ; faintness and blind- ness when rising from lying, from sudden motions; patient feels best when lying quietly. PALPITATION OF THE HEART, Palpitation of the heart is symptomatic of some other disease, but is often so severe as to require a distinct consideration. There is a rapid beating or fluttering motion of the heart, which may be felt very plainly when the hand is placed upon the chest over this organ. Various other symptoms nuiy accompany it, as a shortness of respiration, a sense of pain in the neigliborhood Of the heart, a feeling of constriction across the chesti inability to lie down, pale countenance, sv/ollen feet, a real debility, irreg- ular or intermittent pulse, much distress on sligh" exertion, etc. The palpitation may vary from a simple, full, uniform, powerful beating of the lieart to a rapid, violent, confused and irregular action, shaking the whole system, and producing very disagreeable sensations. Causes. Palpitation of the heart is, generally, owing to dyspepsia, or some derangement of the digestive functions; occasionally, it occuns as a symptom ofsome ii-^rvous disorders, and it frequently accompanies m 10 us em- tion icli; ion; ery illor is as lies pgii- iiid gu- DISEASES OF TUK ORGANS OF CIRCULATION. 4rti enlargement of the heart, dropsy of the heart, and other diseases of this organ and its arteries. It may, also, be brought on by great mental excite- ment, intemperance, masturbation, excess in venery, etc. ALLOPATHIC TREATMENT. Many cases of palpitation of the heart . -ipend on an impoverished condition of the blood (anjemia,) in which •ase the remedy is to restore the blood to its natural richness by the use of Iron and Quinine, good food and hygiene. The Citrate of Iron and Quinine is one of the suitable remedies, given in doses of two to five grains in solution three times a day ; other tasteless forms of Iron may be used, as the Pyrophosphate, or the Soluble Citrate, and the Quinine may be taken in pills of one or two grains. Many cases of feeble heart, rapid in its action, are greatly relieved by five to twenty drops of Tincture of Digitalis, three or four times a day. If the patient is strong and robust, and the action of the heart vigor- ous, and the arterial action high, the physician would be justified in resorting to the use of such arterial sedatives, as Tincture of Aconite in doses of two or three drops, or Tincture of Veratrum-viride in doses of two to five drops, sufficiently often to produce a sedative effect on the action of the heart, one, two, or three hours apart. The Bromides are suited to cases of irregular action of the heart, and in cases having an irregular circulation in one extremity, while it is reg- ular in tiie other, and various other irregular symptoms referable to the circulation. The Bromide of Potassium may be given in doses of ten to thirty grains, three or four times a day. For feeble patients, the Bro- mide of Iron, in one or two-grain doses, may be given at the same time, or other tonics may be taken. A Belladonna plaster over the region of the heart, will sometimes give relief, especially, if there is pain. Prolonged attacks of palpitation are often speedily relieved by half teaspoonful doses of Chloric Ether, or HofTman's Anodyne every fifteen or twenty minutes, until relief is obtained. If valvular disease, or dilatation of the heart exist, exercise should be of the most moderate kind, and all excitement, of every kind, avoided. This trouble may be caused by tobacco, cofTee, tea, stimulants, narcot- ics, mental depression, or excessive venery. Such causes are to be sought for, and, if discovered, they are to be removed. HOMOEOPATHIC TREATMENT. When the palpitation is owing to disease of the heart, relief is all that can be expected, unless the disease be cured, and the same may be said when it is owing to the dyspepsia or other affections; but diseases of the heart are not so readily cured as many other maladies. Whatever may be the disease occasioning the palpitation, it should be treated and removed, if possible. Acotiitum may be recommended for palpitation of the heart, attended with a sensation of anguish and intense oppression at the chest, and, generally, with weight and weariness of the extremities, flushing of heat, especially in the face, short, painful and anxious respiration, or short- ness of breath, particularly during sleep; sometimes pricking sensations in the chest, or sensation of compression, or as if bruised in the left side, or, again, shooting pains in the left side, particularly during mo- tion, and on going up stairs ; palpitation caused by fright. 1 1 'ii '' ti \\\i '4 I 464 PALPITATION OF THE HEART. Dose; Six i)ills in a teaspoonful of water, repeated at intervals of an hour, until the particularly indicative symptoms are moderated; or afterwards again, from time to time, should those indications occur. Belladonna, when there are violent pulsations of the heart, reverb- erated, as it were, through the whole chest, and sometimes to the extrem- ities and head; sensation as of a heavy weight on, or firm band about the chest, with pains in the shoulder-blades; irregular, and sometimes interrupted breathing, with an occasional effort to expand the chest for breath, or short, anxious, and very accelerated respiration ; palpitation, sometimes attended with intense anxiety, particularly in the evening in bed; tremulous palpitation of the heart, with anguish; or palpitation generally on going up stairs. Dose : Six pills in a teaspoonful of water, as directed for Aconitnm. Nux-voniica is more particularly of service for palpitation of the heart, occurring in persons of dry, meager habit ; but, also, in persons of robust constitution and sanguine or bilious temperament, and, particu- larly, when the paroxysms are liable to come on either in the morning — sometimes attended with nausea, and even inclination to vomit, or with pressure at the chest — or, more especially, upon first lying down or after eating (sometimes after every meal.) heat, or even burning sensation in the chest, occasionally occurring at night, and attended with great anx- iety, sleeplessness, and agitation ; or if coming ou after the use of coftee or liquors. Dose: Six pills, as directed for Aconitum. Sulphur is. generally, of service after one or more of the foregoing medicines, in completing the cure, but, particularly, when the attacks arc- provoked by ascending stairs, etc., and are accompanied by a feeling of anxiety or d^ead. This remedy is, also, very serviceable when the afTec- tion has ensued after the suppression of an eruption, or the sudden healiny of an old sore. Dose: Six pills, as directed for Aconitum. Arsenictnn may sometimes be required after the previous adminis- tration of Sulphur, in cases in which the symptoms have not yielded to a SfcwtfZ course of the last named medicine, and when the affection has ensued as the consequence of a suppressed eruption, or of the sudden heal- ing of an old sore. Dose: Six pills, as directed for Aconitum. Lachesis is indicated when tiiereis frequent desire to draw a long or deep breath, or shortness of breath, chiefly prevalent after eating or after any exertion of the limbs (particularly of the arms,) generally attended with deep despondency ; also, by suffocative attacks at night; or spasmodic affections of the heart, attended with a jjcculiar pulsative sensation, deep (as if on the drum) in the ear, which make it appear as if the membrane would burst— or, again, in very severe cases, and when fainting-fits and cold sweats attend upon spasmodic attacks of the heart, and there is extreme shortness of breath. Dose: Six pills, as directed for Aconitum. Pulsatilla is a remedy of great value in the generality of cases, in which palpitation of the heart occurs as a nervous or hysterical symptom, or in young girls during the time of puberty, or from suppressed men- struation. ■Mtai DISEASES or THE OHOANS OF CIllCULATION. 465 Dose: Six pills, as directed for Aconitum. Cocculns is more particularly required when there is a suffocative palpitation of the heart associated with- weakness, trembling of the limbs and extreme languor, dizziness and faintishness, and when the attacks are aggravated or excited by talking, eating, or drinking. Dose: 8ix pills, as directed for Amnittivi. Cactaa is indicated in palpitation occurring in persons who are usu- ally low-spirited o'r hypochondriacal; palpitation worse when walking, and at night, when lying on the leftside; general prostration of strength, and sleeplessness. Dose: Six j)ills, as directed for Aconitum. Coffea is more especially required, in recent cases, particularly when the palpitation is attended with excessive nervous excitement, with suffo- cative attacks and excessive anxiety, attended with groundless apprehen- sions, tort 1 re of conscience, great despondency, restlessness, and some- times complaints; or again, when sudden emotions of joy have induced the attack. Dose: Six pills, as directed for Aconitum. ^tm '^ FATTY DEGENERATION OF THE IIEABT, Fatty degeneration either consists in an abnormal increase of the normal quantity of fat about the heart, or in the adventitious formation of fat within the muscular tissue of the heart. In the former case, the fatty heart proper, the disease can be traced to all those causes that deterniine a general iiiorcaseof fat; hence fatty heart is generally met with among persons inclined to grow fat; fatty heart is likewise the result of an exces.sivi' use of ardent spirits. On the contrary, and in defiance of all physiological explanations, a fatty heart is some- times, although rarely, met with in spare individuals or in persons tainted with a constitutional dyscrasia. The second kind, fatty degeneration of the muscular tissue, not unfre- quently results from the former. In fatty heart, the normal quantity of fat covering the heart, etc., is sometimes increased to such a degree, that the whole heart seems surrounded by a thick cushion of fat. The layer of fat deposited on the right side of the heart is uhvays more considerable, and is formed sooner than on the other side. Not unfrequently the fat dips into the interstices of the muscular fibres, imjjairs their nutrition, and either results in atro- phy or a fatty degeneration of the muscular tissue. Symptoms and Coukse. The lesser grades of fatty heart and fatty degeneration of the heart may run their course without any morbid phe- nomena; there, may even exi.st a considerable deposit of fat, and yet the general health of the patient may be perfectly sound. Morbid symptoms may not take place until the pressure of the fat causes atrophy or fatty degeneration of the nmscular tissue. The first .symptoms of this disease consist in functional deficiency of the action of the heart; peculiar feel- ings of weakness and siiort breath from the least exertion. In addition to this, we have disposition to vertigo, fainting-fits or paroxysms resembling syncope, and sometimes even apoplexy. Except a distressing sensation of 30 F*» ■■ VS'i si! P i^wp 466 PATrV DKOEXERATION OF THE HEART. pressure, the patient does not experience any pain. In the higher grades of this disease tlie slvin becomes cool, disposed to perspire profusely; it assumes a pale and slclily appearance, oedema seta in, and the excessive weakness of tlie circulation may result in dropsy. The physical signs are the following: Increasing weakness of the impulse of the heart; feeblenessof the soundsof the heart; easily com|)ressible, soft, unresisting pulse, which may show every possible irregularity and is often extremely slow. This afTection only runs an acute course if the fatty degeneration seta in rapidly and very extensively in consequence of inflammatory processes; otherwise the disease runs a very chronic course and depending upon the following conditions: If the fatty degeneration affects an hypertrophied heart with valvular disease, dilatation and finally paralysis of the heart result, or else rupture of the heart takes place. This may likewise result from a less extensive fatty degeneration, after partial dilatation has occurred. The disease is very commonly characterized by marked remis- sions or even complete intermissions. Death takes place, although not in a majority of cases, either by general wasting away with dropsy, or by dropsy of the lungs, or paralysis of the brain, or, which is most commonly the case, very suddenly by acute anjemia of the brain, rupture or paralysis of the heart. HOME TREATMENT. In treating this disease, we have to aim in the first place, at arresting its progress by the avoidance of every hurtful influ- ence generally, and every dietetio indiscretion in particular; next, at stopping the paroxysms of distress as soon as possible ; and finally, at effecting a retrograde change of the disorganization. We should be led too far, if we were to go into full particulars regard- ing tlie diet; all we shall do is to present the following general proposi- tions to the reader's attentive regard : The production of fat is owing to an excessive supply of food, the supply considerably exceeding the waste. The quantity of fat produced will be so much greater the more the supply consists of substances that are known to make fat, principally animal and vegeti)l)le fats and starch-containing food. Beer generally promotes the formation of fat, either directly or indirectly. Meat, if constituting the chief article of diet, scarcely ever makes fat. These few points suffice as general dietetic directions. Let the supply and waste be properly bal- anced by bodily and mental occupation, and let whatever excess remains be done away with. The patients should principally use lean meat, no starch-containing vegetables or fruit, and but little bread and wine ; and they should never o\'«rload their stomachs, as so many people do from mere habit, not from necessity. By pursuing such a system of diet and hygiene, the patient will be able, as a rule, to do without a resort to any remedial agents. Starvation-cures are the more condemnable in the case of such patients, the more the heart has already become diseased. At the same time, it must be admitted, that there are many persons who, most generally, in consequence of abnormal changes in the functions of the liver, deposit such quantities of fat, even under the simplest and most cau- tious diet, that it seems impossible to suggest any further changes in this respect. .^ Fatty degeneration may sometimes, but assuredly, only in rare Instances, have its primary origin in a constitutional tendency to fatnessr DISKASKS OK THE OUGANS OF' CIRCULATION. 4«7 otherwise, wo are unacquainted with any other cause of this disease, that might suggest special dietetic preventive rules. If the presence of cardiac disease is substantiated beyond any doubt, the patient's mode of living has'to be regulated with a view of^p^eserving his strength as much as possible. Substantial nourishment, so far from being forbidden, should be recommended; the modl^ate use of wine is generally attended with the happiest results. In the case of drunkards, spirits should be withdrawn gradually, not all at once. A sudden and complete abstemiousness might lead to dropsy; indeed the frequent occurrence of such an event should be a warning to us. The prostration which follows every considerable exertion, admonishes the patient never to use his strength to the point of exhaustion. This precaution, likewise, applies to mental efforts. The frequent paroxysms resembling syncope or simulat- ing apoplexy, are very apt to lead to the adoption of measures which, by depressing the strength, are at the same time calculated to aggravate the patient's condition, for the reason, that these cerebral phenomena do not depend upon anaemia, but hypersemia. 1 1 I if^ il HYPERTROPHY OF THE HEART— ENLARGEMENT OF THE HEART. By this name we mean a condition of the heart, where its volume is conalderably enlarged by the increased thickness of its muscular tissue, and by a more or less considerable distention of its cavities. Primary hypertrophy arises in consequence of hereditary disposition without any apjiarent cause ; or it may develop itself in cases where a pe- culiar mode of living stimulates the heart to a constant and severe action, as may take place in consequence of severe manual labor, continued run- ning, excessive gymnastic exercises, fencing, abuse of strong coffee, wine, lioer, spirits ; or, finally, hypertrophy may arise if the heart is kept in a constant state of tumultuous action by strong mental impressions, hence in the case of individuals witli intensely sanguine temperaments. Hypertrophy of tlie heart may occur at any age between the years of fifteen and forty. Males are decidedly more liable to it than females; this, however, is probably owing to the circumstance that men are more frequently exposed to the causes giving rise to such structural changes. Symptoms. While in a state of rest, the patients generally feel well; they complain at most of a slight feeling of pressure in the precordial region. Every rather violent and continued motion, every mental excite- ment not only causes a troublesome and even distressing palpitation of the heart, but along with it, a'n oppression and feeling of anxiety in the chest, a sensation as if the clothes were too tight, dyspnoea. The increased evcitement in the arterial circulation gives rise to congestion of the head, the face looks flushed, the eyes glisten and are injected, the margin of the lids often looks as if inflamed, there is buzzing in the ears, vertigo, etc. The Home * and dietetic management has to aim at two objects, in the first place, the avoidance of everything in the patient's mode of liv- 'i I ri^ m * This (ligcBfle ought, by aU ineain. to bo treated only by a physiciaD of largo experience, and for tli:tt ri'anon we omit other treatments. 468 ANGINA PECTORIS. ing thut might aggravate the disorder; and, secondly, to surround the patient witli influences that will have a direct tendency to ameliorate his condition. As regards the first point, spirits, cotlee, strong spices, the excessive use of salt, very substantial and more particularly fat food will have to be avoided. The patient should be governed by the nature of his business in the quantityf|f food he consumes. Overloading thestomacli is very -hurtful; frequent and small meals are preferable. A person alllicted with cardiac disease should never go to sleep immediately after dinner, or go to bed with a full stomach. Every bodily motion occasion- ing a sensation of increased action of the heart, is too great a tax on this organ ; all mental excitement is, likewise, strictly to be avoided. As regards the second point, we would call attention to the fact, that we very often succeed by changing the patient's mode of living, in avoiding or diminishing the violent congestions of the head. A business that coni- ])els tlio patient to lead a sedentary mode of life, or exposes him to muck excitonient, should be abandoned. If icy coldness of the lower extremi- ties is accompanied by heat of the head and a flushed face, this trouble might, perhaps, be remedied by rapid walking, which, by exciting the action of the heart, would, on the other hand, prove a source of mischief; whereas, gymnastic exercises, with the feet alone, might often render the best service, without causing palpitation of the heart. An exhaustive development of these rules would occupy too inch space in a work of this size. What we have said will suffice to show in how many ways a patient with heart disease claims our attention. Hi ANGINA PECTORIS-STENOCABDIA. The history and causes of this disease are obscure and vague; we only know from statistical data that males are infinitely more subject to this disease than females, and that fat individuals, or such as incline to make fat, are princii)ally attacked. Persons beyond the age of forty are mostly liable to the disease, and they generally belong to the higher classes. All exciting causes are very often entirely absent; buttheattacks are usually provoked by a bodily effort giving rise to an augmentation of the heart's activity. Tt is only exceptionally that a paroxysm does not set in suddenly; generally it takes place after very short and altogether vague preliminary symptoms. The patients suddenly experience a peculiar pain in th" region of the heart, which is sometimes extremely severe and at othe^ times (lull, yet of such a peculiar kind that the suflferer is scarcely ever abletotk'scribe it, either according to its quality or extent. With the paih a sensation of prostration and fainting sets in; all patients agree iw descril)ing this sensation, as if death were at hand. What is remarkalT»e is, that not a sound of pain escapes the lips of the sufferers, probably, however, owing to their dread of increasing the distress by the least exer- tion. They carry this precaution so far as to arrest the breathing, which gives them the appearance of great difficulty of breathing, although they are perfectly able to take a long breath, if tliey choose. Generally the patients remain immovably erect or in a sitting posture, a recumbent poB- OM DISrOASICS OK TllK OUGANS OF CIUCULATIO>f. 460 tiire suits (hern very solddin. The action of the heart Is at times normal, at other times slower tlian usual, luul aj,'iiin hurried and irregular, espe- cially if the patient is afllictted with heart disease. Very seldom the pain remains confined to the region of the heart; most commonly the i)ain radiates to the left shoulder and arm. less frt^yuently to the neck and nai)e of the neck, or to the lower extremities, pr even the right side. The pain very seldom increases gradually; it mostly sets in immediately in its greatest intensity. A single paroxysm generally lasts only a minute or two; it scarcely ever exceeds one hour. As the paroxysm generally sets in in all its inten- sity, so it generally ends all at once. It is onlj' if the paroxy.snis are slight, that the i)atient's health is at once completely restored, or at least very soon after t-he cessation of the paroxysm ; whereas, in this as in most other paroxysmal nervous affections, great lassitude and slee])lessness remain for some time. The CounsR of this whole disorder varies greatly. Very seldom a paroxysm is succeeded by a complete feeling of health. It more commonly happens that tlu; paroxysms commence slightly and increase in intensity 'with every succeeding attack. Except in cases of heart disease, the inter- vals are quite free from all morbid symptoms, the patients do not show a single trace of the insidious disease; they often have even a very llorid appearance. The single paroxysms, as well as the whole disease, are of an indefinite duration ; a paroxysm seldom occurs more than once on the same day; ordinarily they are separated by days, months and oven years. Many doubt the jjossibility of curing this disease; we, however, believe in tlie absolute possibility of the contrary, although a violent paroxysm may suddenly terminate in death . It is questionable wlietlier tlie disease ever changes to some other form of heart disease, for the reason tliat the heart-disease, most likely, was already in existence when the angina first broke out. Tlie i)rognosis is decidedly bad, if the angina is associated with or- ganic heart disease, and likewise in the case of older individuals, whereas the purely nervous form in the case of young persons very possibly admifs of a cure. We must always keep in mind, that tliis insidious disease sometimes remains quiescent for a long tiuic before it suddenly breaks out again in all its former, or with increased, violence. ALLOPATHIC TREATMENT. Attacks of Angina Pectoris are most speedily relieved by the inhalation of five or six drops of Xitrite of Amyl. If the circulation is feeble a teaspoonful of Brandy, or one or two tea- spoonfuls of Ether or Ilolfman's Anodyne may be given. The hypodermic injection of Morphine in doses of a third to half a grain is another effect- ual method. Mustard may be applied over the chest, and Mustard drafts to the extremities. During the interval between the attacks, excitement of all kinds, active exercise, immoderate eating, and the use of alcoholic liquors are to be avoided. The general health requires attention. Arsenic appears to have the power of preventing the attacks, or less- ening their severity. It may be given in the form of Fowler's Solution in doses of three to five drops, three times a day in water, after meals. Its use should be directed by a physician. During its administration, if pnffy- r<^- I ^,^u i ' I' r 470 INFLAMMATION OP THE VEINS. ness of tlio oyt'lids, or pain in the bowels occur, it should not be taken until thi'.<(' synijitonis (lisapiK'ar. HOMK TREATMENT. A treatment for a single paroxysm cannot well be arranged ; we might even inlllct injury if we would violently interfere with the position the patient may have selected instinctively for his relief. Even the use of local applications, especially severe cutaneous irritants, to which we might feel tempted, may prove dangerous; in no ease is the people's rule, not to touch an individual seixed with a nervous spasm, more appropriate than in angina pectoris. Such precepts as may be found in every therapeutic treatise, are unpractical, for the rea.son that the attack does not last long enough to test their clinical value. This remarls likewise applies to the use of remedial agents, wliich we might not even be afforded sufficient time to procure before the attack is ended. CHAPTER XXIII. DISEASES OF THE ARTERIES AND VEINS. DISEASES OF THE ARTERIES, The various diseases of the arteries are of very little importance In a hook like this, for the simple reason that they cannot be treated medicin- ally. Arterial inflanmiation, mostly only a symptom of other diseases, is scarcely recognizable with positive certainty, even in the case of larger arterial trunks. Of course, an inflammation of the larger arteries ia highly interesting, because the closure of an arterial trunk near the heart may give rise to cardiac hypertrophy. Aneurisms (dilatation of an artery with rupture of one or more of its coats,) are not exactly diseases, but conseciuences of other influences. We do not see how medicines are to accomplish anything in such cases. It is only the disturbances which such arterial lesions cause in the heart, that suggest the propriety of medicinal interference, and we regard it as down- right absurdity to recommend medicines for the cure of aneurisms, as has indeed been done. DISEASES OF THE VEINS. PHLEBITIS-INFLAMMATION OF THE VEINS. Phlebitis, the correct diagnosis of which is a recent triumph, is, so far as its conse(iuences are concerned, one of the most important of all known morbid processes. The veins of the lower extremities and of the cavity of the skull are particularly liable to inflammation, besides all the veins whose sides do not collapse, such as, above all other veins, those of the gravid uterus. The causes of Phlebitis are: Direct injuries of theve&sel; coagula arising from impediments to tlie circulation occasione«l by dilatation of the vessel; introduction of foreign substances resulting itt • f^ec<>mi)osi- DISEASES OP THE OHOANS OP t'lUCOLATlON. 471 Ml tlon of the blood. This last-nanied explanution is applicable to phlebitis wliifh Hcts In in an epidemic form in limited localities; or else thediseuso may urise secondarily from inllamnuitory aUcctions of neighboring parts, or of remote parts, but lying in the tract of the vein ; or from puerperal conditions, suppurations of bones, especially curies of the bones of ( lie ear. The symptoms of phlebitis vary according to its extent and intensity. The most intense forms of phlebitis originate in HUppuration, to which we therefore refer; in this category belongs, especially epidemic piilebitis, where the local process is rapidly extended tluough the whole organism. The less intense cases very usually set in with a chill, recurring either Irregularly with more or leas fre<iuency or otherwise, or else setting in typically, like an Intermittent paroxysm. The diseased vein is often indicated by a seated, circumscribed, burning pain, but is quite often altogether painless. The chill is succeeded by a feeling of illness, usually, 80 severe that it is entirely out of all proportion to the objective symptoms. The pulae is accelerated, and very mucii reduced in volume, the digestion is interfered with, a tendency to perspire sets in, tlie tract of the vein becomes oedematous. If the circulation in the vein is re tored, all these symptoms may disappear as rapidly as they came. If the vein remains closed, oedema develops itself beyond the closure, and, if a collat- eral circulation can be established, may last only a short 'while, or else remain permanent. In such a case, lassitude, chills at irregular intervals, ir.egular flashes of heat, sometimes continue for weeks. The terminations of phlebitis depend upon the changes going on in the inflammatory exudation. If no purulent decomposition takes place, life is not exactly in danger; if pus forms, jt may be carried along with the current of blood, and a most malignant phlebitis may suddenly arise, not- withstanding tiie trifling character of tlie symptoms sit the outset of the inflammation. It is, in this manner, that lying-in women and persons that had been operated upon, often perish quite suddenly, although not a single symptom existed at first that could have given rise to the least apprehen- sions of danger. The prognosis is uncertain. If the chills recur but seldom, and with increasing weakness, the danger is less; whereas, frequent chills, prostra- tion and sopor are decidedly ominous signs. Tlie treatment should only be in the hands of the best physician you can possibly obtain. The subsequently remaining and very prominent oedema of the parts which lose their normal circulation, in consequence of the obstruction of the vein, cannot be removed by treatment. It does not disappear until the collateral circulation is restored, which itsometlmcs takes years to accom- plish ; the uniform pressure of a bandage, if it can be applied, may, if it doeb not affect a cure, afford at least a good deal of relief. w VARICOSE VEINS— PHLEBECTASIA— VARICES— DILA- TION OF VEINS. In most cases, the causes of these very frequent dilations can be deter- mined with perfect certainty; in other cases, however, they are involved in obscurity. These are the cases where the disejise cannot well be traced hi 472 VAKICOSE VEINS. to some mochivniciil obstruction in tlie circulation of the blood. At all evontH, these cases are tin* least freciuent. Tluf existence of a peculiar predisposition in tlio wails of the veins, ot else the subsequent supervention of a morbid change in tlioso walls, will have to be talien for f,'rante(l. Tlie most f retjuent causes are : obliteration of tlie vein, owintr to wliicli tlie portion beyond the oltliterated vein dilates m its whole extent; dilation or contraction of tlio venous trunk, whicli bsis the same effect as obliterations, only in a less degree; every change tliat interferes witli the (low of blood to tlie heart, such as dilation of the riffht heart, atTections of tlie liver, tumors conipresHJiig tlie vein, tight clothing. In all such cases, varicose veins are of a secondary character; it may, likewise, occur as a primary dis-ase in tho case of men who have to be cimtinually in a position that interferes with tlie rellux of the blood, l»erson8 for instance who have to be continually in a sitting or standing posture. In a sitting posture, tiie dilation of the vessels can often bo accounted for by the pressure exerted upon tlie abdominal organs in tlie stooping posture; in the standing i)osture, on the contrary, the dilation is entirely owing to tne circumstance that the vertical position of the body embarrasses the course of tlie l)lood onward through the veins. Every vein in tlie body may become dilated; dilations occur most fre- quently in the veins of the rectum, (then called piles,) lower extremities and spermatic cord. We will briefly dwell here upon varices of the lowi-r <!xtremities. They occur more frequently among women in wliom the cause of the dilation is trac(!al)le to the impregnated uterus, whereas, pri- mary dilations are decidedly of more frequent occurrence anioi:j men. What we have said just now concerning the originating causes of (Illation is particularly ajjplicable to this fotni. At hist one of the larger cutaneous veins of the leg is most commonly affected, whence it does not usually extend to the thigh, but involves very regularly tlie larger as well as tho more minute veins of tlie foot, especially, of the veins situated around tl e anklei where they give rise to a considerable swelling, covered with a blu- ish 1 et of both delicate and coarser vessels. In most cases these varicose veins are painless. In other cases the leg pains for a short time, after which the pain again disappears. Very often the pain is felt while a pur tion of the skin assumes a bluish redness, swells and becomes quite hard ; the pain increases continually, finally the skin suddenly breaks at the place of inflltration, without being caused by mechanical injury as most of these patients fancy, and an ulcer of the size of a pea forms, which is at first round and provided with thin, somewhat undermined edges. Without proper management and hygienic precautions, the pains increase all the time; the ulcer spreads, its edges gradually swell, the surroiuiding skin becomes hypertrophied, (thickened) the ulcer secretes a watery and some- times exceedingly fetid fluid, and its base has a sickly color. If the same mode of living is continued, during which walking hurts only a little, but standing hurts a great deal, the ulcer may spread over tho whole surface of the leg from the ankle to the calf, and may even penetrate to the bone. Ulcers below the ankle and on the front portion of the foot are of rare occurrence. The fetor of the ulcer increases in proportion iis the ulcer spreads over a larger surface. l*(>isons go about with such ulcers for years, and 1* ij inconceivable that the constant drain of their vital fluids does not result in speedy emaciation. If a fever or some other constltu- DiaiiAHKH OK TUK OK0AN8 OK CI KlULATION. 473 tional (lis'^aHii breaks out (Uiriuf? tlio oyiHtoneo of llic ulcer, it HeomH to lieiil 8i)ontaiu'ou8ly, iA wliieli euno tlio ili.scase is very coiDinonly, but imnrop- erly, regarded as the eonsequenco of the healing. If the patienta are so situ mI as to be, abl«> to reinain at once in a recumbent posture, the little s en lieal very speedily, but break open again very easily, If the person has to stand a great d' '1, so that the exist- ence of such ulcers at any previous jx-riod leaves u nstant liability to their returning again at a subsequent time. In the higher walks of life, where every measure is taken from the start to prevent the formation of ulcers, a peculiar cutaneous uflectlon is witnessed in their stead. The skin usMunies a very dark and liluisb color, and scattered and violently Itching pustules form, very frequently, or else the skin peels oflMn scales, leaving the surface moist. This form of the varicose afTecMon Is, l)y far, the most nuilignant and distressing. With an entire change in the mode of living, tlie varicose ulcers nuiy heal of themselves, but this is, undoubtedly, a very rare occurrence. ALLOPATHIC TREATMENT. The radical cure of varicose veins is j)urely su'^'ical, and consists lu obliterating the veins. The means for this purpose will be enumerak'd, l)ut not descrilted. The large trunk above the dilated veins Ih occluded to prevcn* the return flow of blood through it, and, consefjuently, through the dilated veins leading to it, by pressure from metallic clanij)s, l)y cauterizing, l)y incision, by ligature by electrolysis, by Injection of tlu; .Sulphate of Iron. These operations areefTectual, but owing to oecasionul accidents, resulting f ,m the attempt to thus obliterate the veins, it is not attempted, except there is urgent necessity. Palliative treatment requires an artificial support to the column of blood in the veins. In the lower extremities, this is done by an elastic stocking, a band stocking, or a well a'dapted bandage. They may be removed at night, but re-applied before the patient rises in the morning. In other situations than this most common one, the same principle will govern the treatment, and the ingenuity of tlie physician will meet the required Indication, as in varicocele (varicose veins of the spermatic cord) a well adjusted suspensory bandage of silk or muslin, will be constantly worn. Varicose veins are subject to intlammation (phlebitis). If this condi- tion occurs, whether the veins are varicose or not, the patient should remain in bed. If there are wounds or ulcers, they should be poulticed ; If there is suppuration, tiie surface of the wound or poultice should be lightly covered with Carbolic Acid In Glycerine, one or two drams to the ounce. Generally, without the temperature is too low, cool evaporating lotions over the inflamed veins will be most useful. A piece of nmslln wet In a solution of forty grains of Silgar of licad, and a .scruple of Ace- tate of Morphine, in a quart of water, may be laid over the inflamed region, (two to four ounces of Laudanum may bo used instead of Mor- phine,) the cloth should be kept constantly wet. In other cases, hot fomentations are moresuitable, towels or fhmnels may be wrung out of hot water, spread over the inflamed snrface, and covered to retain the heat, or hot poultices ma.; i)e applied, Hops, or Laudanum, Stramonium, (Jamestown Weed,) Tobacco, or Belladonna, A brisk cathartic should be li: . ! .^J \ jLtZi k i m '"Iw- m d KS '.11 '(, u £ 474 VARICOSE VEINS. i|i ' ni n m M '.,:% m riif' given. One or two tablespoon fuls of Epsom Salts, (Sulphate of Magne- sia,) is a suitable one. Steeping the SaltLi with a third its bulk of colfee, covers the taste. Pain should be relieved with Opium, in doses of a grain, a quarter of a grain of Morphine, or twenty-five drops of Laudanum. If the l)Iood should become poisoned^ from tlie products of inflammation, Quinine in large do.ses, ten or fifteen grains four times a day, for two or three days. Stimulants will be required. ' Tonics, as twograins of Quinine four times a day, are needed, if the disease continues long. The patient should, also, be well nourished. HOMEOPATHIC TREATMENT. Painless varices, without ulcerixtion cannot be regarded as an object of treatment, nor do we believe that any- body can imagine the feasibility of removing them by means of medi- cines. If i)ains are felt, and the subcutaneous cellular tissue become infiltrated, it would seem as though medicines might be useful ; at any rate, we have seen a rapid improvement take place after the use of Sta- l^liysagria, Lycopodium and Graphites. These are the only remedies which we can recommend, as long as the ulcers are painful. If the ulcer has become old, even the three first-named remedies are no longer of any use, and a mechanical treatment is the only treatment that can prove of any use. These three remedies are, likewise, the only ones that we can recommend for the peculiar cutaneous affection, but we must confess that they, too, will often leave us in the lurch. Our nuvin resource in treating tliese varicose disorders, are external or mechanical means. The dilation of the veins being chiefly a passively mechanical change, it is evident that moderate compression, by means of a good bandage, will moderate, and, finally, remove the varicose dilation tltogethrr. If individuals with marked varicose dilations constantly wear a bandage, or silk elastio stocking, they will never be troubled with ulcers, nor with any other cuta^ neous aff'ection. Existing ulcers heal very rapidly under a carefully^ applied bandage, so much more rapidly if we first cover them with strips of adhesive plaster and a layer of cotton wadding over these, so as to pro- tect them from all contact with atmospheric air. By pursuing this course, we have never known ulcers of any size, or of upwards of twenty years standing, to remain uncured ; but we have never shunned the trouble ol applying the bandage ourselves. The longest time it has taken us to heal these ulcers, is six months. If the excessive sensitiveness does not admit of the immediate application of a bandage, the patient must be kept, for a short time, in a recumbent position, witli liis leg raised; in such a case, warm poultices afford a good deal of relief. THE HUMAN SKELETON. Tlie letters of reference appear the same in hoth views as Tar a4^ Uio name bones can be seen from both points of vision, a. Bones of the cranium. b. Bones of the face. c. The 7 cervical vertebrae. d. 12 dorsal vertebrae. e. 6 lumbar vertebse. aMk« THE HUMAN SKKLETON. 476 /. Bones of Sacrum. k. Bones of the pelvis —basin. jb. Ribs. m. Scapula— shoulder-blade. 0. Badius. g. Coccyx. 1. Sternum— Breast-bone I. Clavicle— collar-bone. n. Humerus. p. Ulna. UU3IAN SKKJ.KTON— FRONT AND BACK. q. Carpus and Metacarpus. r. Phalange^ Angel's. t. Femur t. Patella— knee-cap. u. Tibia. v. Fibula. w. Tarsi and metatarsi. x. Os calcis~th^ ttw«^<)one. z. Phalanges— toes. fli ilttS n \ i'- i' Mil Ml *'\ n m 'f I»ATl,T ^LEVElVmi DISEASES OF SINGLE SYSTEMS. CHAPTER XXIV. DISEASES OF THE BONES, MUSCLES, AND JOINTS. OSTITIS, PERIOSTITIS-rOTT'S niSEASE. INFAMMA- TION OF THE BONES A\I> rElilOSTEUM. Inflammations of the bones occur in every aj?o, less frequently, bow- ever, before the second, and after t lie fiftieth or sixtieMi year. In most cases, they originate in mechanical injuries, or mechanioally-acting inllu- ences ; they are less frequently owing to the extension of infianimation from the soft parts. In the great majority of cases, the mechanical is associated with a constitutional cause, very frequently the latter existing alone. Among the constitutional diseases, it is, more particularly, scrof- ula, consumption, syphilis, and calo)nel, that give rise toostiti^j. Very often, it is very difficult to trace the cause with anything like certainty, especially, so far as the inflammation of tlie substance of the bones is con- cerned, because it generally developes itself with scarcely perceptible symptoms, and in a very insidious manner, hence too long a period of time may have elapsed since the cause first began to uct, to permit of the disease being traced to a definite origin. Bones that are but thinly covered by soft parts, are particularly exposed to inflammation from mechanical causes; inflammation arising from more dynamic or constitutional causes, may attack any bone ; nev- ertheless, inflammations of the lower jaw, of the vertebrse (backbone,) the bones of the hands and feet, and of the ribs, occur most frequently, and ar^of particular importance. Periostitis (inflammation of the membrane covering the bones) occurs more particularly on liio fingers, on the bones of the lower extremities, and on theskull-bonos. The symptoms and course of ostitis differ very remarkably in extent as well as intensity. It is very often found that at the outset the <lisease is entirely without any symptoms, until the disease is fiiuilly revealed by the process of suppuration. It very seldom runs an acute and raj)id course; this is, generally, the case, if the inflammation attacks the outei surface of the bone. In such a case, the intensity of the pain depends upon the extent of the inflammation ; the fever is high, delirium some- 476 INFLAMMATION OF THE BONES. 477 times sets in, slight cliills tire common, and the patient very soon begins to lose liis strength. Cases of tliis Icind, which run a rapid course, always terminate in suppuration, and the artificial removal of pus is, in most cases, a matter of absolute necessity. After the pus is evacuated, a cure does not always take place immediately; the bone, divested of its perios- teum, becomes more or less careous before a cicatrix has time to form. If the periostitis runs a slow and somewhat chronic course, the inflam- mation, of itself, is not very i)ainful ; but very violent pains can be excited by contact; here, too, the exudation may be transformed into pus, but is, likewise, apt to result in bony growths, and to form extensive flat, or \^ tuberous, bony indurations. If the inllammation is located in the interior of the bone, the latter is generally distended in its whole length, is not very sensitive to pressure, but the patient is tormcjited by paroxysms of peculiar, dull, boring pains, which, even in the absence of any specific cause, are, particularly, apt to set in, and to become aggravated at night. These pains are usually felt for some time before the bone commences to swell ; they interfere with the mobility of Mie limb more or less, generally the less, the more remotely they are felt from the joint. Ostitis of this central character always runs a chronic course. Its terminations are suppuration or ossification of the exudation. If one of the largo hones in invaded by the suppurative process, death almost always results, althouirh in some cases, not till the patient has lived through years of suffering. An Important diagnostic symptom is the presence of albumen in the urine ; it almost always occurs, if the sujipur- ation is extensive, and augurs very badly for the final result. The importance of inflammation)) of bones varies a good deal. Age exe -ts a characteristic influence; children and young people generally r(*c"(»,'('r from such inflammations, even if these should last a long while, unless they originate in inveterate, constitutional maladies ; older per- sons, especially, when on the other side of forty, generally fall victims to such inflammations. Children very often recover when the second period of dentition sets in, or when they enter upon the period of pubescence. The seat of ostitis is of no small importance; inflammation of the bones in the upper part of the body is less dangerous than inflammation of the pelvic bones, or the bones of the lower extremities. It is, likewise, impor- tant to determine whether the inflammation is so located that vital organs may become involved; on this account, inflammations of the skull bones and ribs are more threatening on account of the danger to important organs resulting from them. Sometimes the inflammatory symptoms disappear entirely for a time, and then suddenly reappear again from some cause or other, or without any cause; or else, in one portion of the bone, the Inflammation runs a favorable course, and then all at once takes a new start, either continu- ously in the tissue of the bone, or in peparate portions. Every inflamma- tion involving more than one bone, renders the prognosis so much more unfavorable. ALLOPATHIC TREATMENT. Inflammation of bone can scarcely, in any case, be treated intelligently, except by a skillful surgeon. Re.st .and cold or cooling applications are the most important means of local >' ^tl 47« DISEASES or THE BONES, MUSCLES AND JOINTS. iK! ;*■''! fiH III-* troatnient. If cold is not aggreeable, it should be replaced by hot fomen- tations—a flannel, wrung out of hot water, and applied to the part, then covered well to retain the heat. In Chronic Ostitis (inflammation of bone,) counter-irritation by means of blisters, or the frequent (daily) application of Tincture of Iodine sliould bfi resorted to. Rometimps dcop incisions into the periosteum (the niom- brane covering the bone) allord relief in both the acute and chronic forms of the disease. Pus should be evacuated by the trephine (an instrument for taking out a disc of bone.) If the inflammation has continued long, especially, at tlio end of a bone, it is, probable, pus has formed and the trephine should bo used. When the Medullary Tissue (Marrow) of the bone is inflamed (myelitis) the bone us well as its medulla is, generally, involved, in which rase the condition is called osteo-myelitis. When the disease is the result of wounds, the dressings must often be changed, and the wound disinfected with a solution ol Carbolic Acid in water, one dram to the pint, or Chhn-- ino water, or the solution of Chlorinated Soda (Labarrague's Solution) diluted until they are unirritating. Absolute cleanliness and fresh air must bo secured. The diet should be good. Tonics may be necessary, two or three grains of Quinine three times a day seems the most suitable. Both tonics and stimulants may be employed. Cold is often the most useful, and may be applied by means of bags of ice. If cold causes pain or chills, hot applications should be used instead, as directed for ostitis. Free incisions through the periosteum (membrane covering the bone) and superficial tissues give some relief. If there is no opening into the cavity of V^q bone, and from the amount of inflammation and the length ol timewnich has elapsed, there is reason to suspect pus has formed, the trephine should be used, and the pus let out. As a rule, amputation is inadmissible, but if resorted to, it must be at the nearest joint towards the direction of the body or above it. In chronic osteo-myelitis counter-irritation with Tincture of Iodine or blisters and the internal use of lodideTof Potassium in doses of ten grains or more, three times a day, sliould be resorted to. Where matter forms, it should be let out with the trephine. Excision (taking out a piece) may be resorted to in the chronic affection, but not in the acute. When amputa- tion is called for, it may often be performed through the shaft of the affected bone, if the point of amputation is well above the diseased por- tion. Pekiostitts (Inflammation of the Periosteum-Membrane Cov- ering THE Bone.) in acute cases, requires perfect rest. Cold should be applied, either of cold water or bags of ice. If these cause pain, hot fomentations should bo ai)plied, or hot poultices used. Pain must be re- lieved by Opium in do.sis of a grain, a quarter of a grain of Morphine, or thirty drops of L;uid:r.rr:in given one, two, or more hours apart, as may be required. If these means do not succeed, free incisions must be made through the periosteum. If the disease is primary, and necrosis (death of bone) follow, it is generally confined to the outer lamina (layer). If the dis- ease is secondary, reauUing from ostitis or osteo-myelitis, and necrosis "ccurs, it is much more extensive, which will be considered under necrosis. i ■ m '•■ m\i INFLAMMATION Oi" THE BONES. 47& Specific forms of this disease (periostitis) from syphilis, scrofula, etc., gen- erally yield to appropriate constitutional treatment. One of the results of inflammed bone is caries— a kind of surface soft- ening and disintegration of the bone tissue. The constitutional treatment relates to the cause of the inflammation, whether speciflc or scrofulous, and the appropriate constitutional remedies should be taken. In the for- mer case Iodide of Potassium, or Mercury, or both and Iron. In the latter, Iodide of Potassium, Iron and other Tonics. The local treatment consists in the complete removal of all the dis- eased portion. First, by excision with instruments; second, by the appli- cation of Acids. When a joint is carious, amputation is, generally required, though sometimes excision may be practiced. Another of the results of inflammation of bone, and its membranes is necrosis (death of bone). The treatment required is its removal. While it remains, it is only a source of irritation ; but its removjU must not be attempted before complete separation has taken place. The suppuration wliich has gone on during the process of separation, generally requires supporting treatment— Tonics of Iron, Quinine, nutritious food, and in some instances. Cod Liver Oil. HOM(EOPATHIC TREATMENT. Tlio frequent occurrence of ostitis in individuals whose constitutions are tainted with some constitutional disease, invites a careful inquiry in+o the presence of such a constitutional tuint, even though not manifested by any outward signs; and, in the second place, to employ such remedies as not only correspond with the constitutional affection, but likewise, aim at remedying the local disease. A mere comparison of symptoms will scarcely ever answer the purpose, lor the reason that the localities may differ too much; it is only for a few definite localizations of ostitis, tliat we possess real remedies. In general, we advise, therefore, that the general, not the local symptoms, be taken as our guide; on this account we mention the following remedies, with a few short comments: Mercnrius is a medicine of whose specific and almost constantly defi- nite relation to the osseous tissue we may always rest satisfied. It is indeed suitable in most cases of ostitis and periostitis, provided they do not originate in calomel poisoning. It is particularly indicated by: Vio- lent bone-pains, distention, swelling, redness of the skin, and, in general, by the more acute symptoms of the disease. The infantile organism is more rapidly and certainly affected by Mercurius. The dose had better be as small as possible ; the slow course of the disease would seem to point to small doses, and given at comparatively long intervals, as preferable to large doses of this agent. Bose: Four pills daily. Merzereum antidotes Calomel in the bone-range. Merzereum is par- ticularly adapted to periostitis ; less to ostitis, and is particularly appro- priate at a period of the disease when no complete suppuration has yet set in. Dose : Four pills daily. I'hosphoric Acid is generally preferred to Nitric Acid in non- mercurial ostitis; it is indicated in the inflammatory bone-affections of children, especially, in inflammations of Ihe vertebra), (back-bone) if there IS an evident disposition to caries. I" ''"n.Uy developed canei? *v'tb ?j'inp 4: lit i.,f ;vf f I I m§, 180 DISEASKS OF THE BONES, MUSCLES AND JOINTS. !"m|*!'''||''' ' I l toras of alow hectic fever, Phosphoric Acid is one of the most iMiportanl remoflics. Dose: Four pills daily. Phosphorus is inferior to Phosphoric Acid, for the reason that the latter acts more specifically and more penetratingly in chr()n..c affections. In other respects, the curative acticm of both remedies is very Bimilar; we would accord tlie preference to Phosphorus, if consumption, with unceas- ing diarrhoea, has set in. Dose : As for Meretiriits. Staphysagria is indicated, if the ostitis runs its course with severe pains, and the bone and its coverings are affected at the same time; in the case of scrofulous individuals ; if the facial bones, or those of the legs and feet are involved. Dose : Same as for Mercimus. J5rtry*a7C«rfto»/cre is eminently adapted to a slow and almost pain- less scrofulous inrtammation of the bones of the extremities, after suppu- ration has begun to set in. Dose: As for Aferotimis. Aiiruni is, like Nitric Acid, an exquisitely anti-Calomel medicine, and hence, deserves special attention in cases of mercurial ostitis. It has, like- wise, an excellent effect in non-mercurial ostitis with caries, and violent pains, especially at night. Aurum is a speciJic remedy for inflammatory ulceiation of the nasal bones, and facial bones generally. In affection of this kind, we prefer Aurum muriaticum to the common gold. Dose : As for Mercuriiis. SUicca is one of the most important remedies in caries from .any cause, and at my age, as soon as tlie iiitlammatory stage has run its course: it is adapted to every constitution, but may not have a very favorable effect in acute ichorous suppuration. We must not forget that Silicea acts very slowly ; we recommend small doses at long intervals. Dose : Same as above. Calcarea. This agent is not so much indicated in uncomplicated ostitis, as in ostitis depending upon scrofula ; it dues not act directly as a curative, but by virtue of the favorable change it effects in the scrofulous disease. On this account, its use should be deferred until the suppurative irocess is fully established. Ifose : Same as for Mercurins. RICKETS. * Eauly Signs. This distressing disease commonly begins to show itself about the tender age of from one to two years. It is, generally, pre- ceded, for a longer or a shorter period, by derangement of the general health, before any of its well-known characteristic features become developed. Pale and sickly countenance : dry, harsh skin; soft and flabby flesh; irregular appetite, sometimes with desire for indigestible or unnatural food ; constipation or diarrh(Toa; general febrile excitement, f retf ulness, and languor. GENERAii Symptoms. After which, the head is observed to become RICKETS. 48i preternaturally enlarged, and the foreliead unusually prominent. The breast-bono projects; the ribs uiipear flattened; the belly is much dis- tended ; while the rest of the body, and the limbs in particular, are greatly emaciated, and the debility is extreme. As the disease advances, the muscles become more llacoid, the wrists and ankles become swollen, the legs, thighs, and arms distorted, and the spine partakes in the general dei'ormity, by becoming shorter, and curved in various directions. Wnen the disease is early attended to, and the more gent^ral exciting causes,— such as dofeolivo nursing, damp or wet, ill-veuLilated dwellings, insnincient exercise out of doors, improper food, and uncleanliness— are capabloof being removed— the chances of recovery are much increased, and tiie deformity is frequently materially, if not wholly diminished as the patient grows up. Otherwise, if life bo spared, it is liable to be r n dered miserable by a state of almost continuous suffering. HOME AND MECHANICAL MEASURES. At the head of the arti- ficial contrivances for counteracting dei'ormity, may be placed the gentle and cautious use of gymnastic exercises, as soon as the child is old enough to uud(!rgo them ; and it is surprising how early they may be advanta- geously resorted to. AVitiiout these, all instruments are often futile, not to say hurtful. But in cumbinailou with tftem, the objection to the tempo- rary emi)loymentof an appropriate apparatus for the purpose of exercising compression, is, I believe, in certain eases, removed. I allude, more espe- cially, to the instance in which the legs have become very much bent, eitluir in consequence of luiglect, or from its having been found imprac- ticable to prevent a high-spirited child from constantly getting on his feet before his delicate frame had become sufficiently invigorated by suitable treatment. I am free to admit, however, that instruments should always be rejected whenever uud wherever they can possibly be dispensed with. ALLOPATHIC TREATMENT. This is a disease which almost, witli- out exception, depends on poor feeding and hygiene, during the first year of the child's life. Children of unhealthy parents are more liable to the disease, but if the child is well fed, has plenty of fresh air, is kept clean, and is warmly clad it will not have rickets. If the child is not thriv- ing on its mother's milk, it ought to be fed artificially, or, what is bet- ter, a vigorous wet nurse procured. In the absence of a wet-nurse, rich, fresh cow's or goat's milk may bo given. For the first month the milk should be half water, enriched a little with cream, and sweetened with su- gar of milk or loaf sugar. At two months old only a quarter part of water need be added ; after three or four months genuine milk may be given pure. Eggs beaten up raw, with a little sugar, and diluted with water, may be given if the child likes it. The juice of lean meat may, also, be given. Strong beef tea, made from finely chopped lean meat and cold water, grad- ually raised to the temperature of one hundred and sixty degrees, and main- taining it at that temperature for four hours, may be employed for nour- ishment. Underdone lean beef, finely ground in a mortar, a teaspoonful at a time may be given. A pound of finely chopped lean meat, with eight ounces of distilled water and eight to ten drops of Hydrochloric Acid, and a third to half a teaspoonful of common salt, allowed to macerate for three liours, and then strained through a hair sieve, then pour on the meat a couple of ounces more of distilled water, and squeeze it through. The res- 4 i .*■'. ,1 m Hi' «2 DISEASES OF TIIK HONES, MUSCLES AND JOINTS. 111 .;i: I I. Hi t 'J;i iii iduo makes a nourishiiit? and valuable fdod in cases of debility. Mill<, lio'v over, is the food for babien, and the olliur articlt^s of food may bo reaorteei to only wlien tlio baby doos not tlirivc siifliciently on tiie milk. From the a[,'e of six montlis to a year, farinaceous food may be Riven, in restricted quantities. One of tlie best forms is liiebij^'s food. Take 8 heaping tablespooiifiil of wlicat Hour (middliui^'s is bi'tter,) a lieaping des- sertspoonful of malt Hour, seven and a quarter grains of Carl)onate oi Potash, and an ounce of water. Mix well. Add live ounces of cow's milk and heat Rnntly. \VIu!u tlio mixture liegins to thicken, remove from tlie fire and stir for five minutes, heat, and stir again until it becomes (luite fluid, tiien boil and strain tlu'ougli a sieve, wlieu it is ready for use. In tlie absence of malt llaiir, barh-y may bo ground in a coffee mill and sifted to remove the husk. Tliis food is a little laxative, so it cannot bo given more than tlireo times a day. If tliere is diarrhoea, twenty or tiiirty grains of preparcfl clialk may be used instead of tlie Bicarbonate of Potash. For older children the diet must bo good, containing such articles as meat, eggs, and milk. Notliing must be done to weaken, but everything to strengthen the patient. The child sliould have sucii exercise as is consistent with the weakened condition of the bones, such as rolling and tumbling on a hard matress. Older children may walk about some, if provided with proper artificial support, such as a wheel crutcii. Tiiey should be taken out into Uw open air every day, or two or three times a day for a ride, «)r carried out. Bending of the limbs may be overcome by applying a ligiit splint of paste- board or leather, but the liml)s must not bo so encumbered as to prevent tlieir pretty free use. A light al)paratns may be worn when the child walks, to prevent tiio curvature of tiio spine. The child shoul(\ lie upon a Hat matress without a jiillow. The principal treatment is dietary and hygienic, as given above. For medicinal treatment the Compound Syrujiof tlie Lacto-Phosphates gives the most promise of all medicinesof being useful, excepting Cod Liver Oil. It may be given in doses of from ten or lift.ien drops to a teaspounful according to the age of the cliild, three or four times a day. The dose of Cod Liver Oil may be begun at fifteen to twenty drops and increased to a teaspoonful or a dessertspoonful, according to the ago of the child and given four times a day. If the oil deranges the digestion, it should not be given, otherwise it alionld bo given continuously. Other tonics may be given instead of tlie Lacto-Phosphates, as the Syrups of the Phosphates or ir7popliosi)lutes, in the same doses as the Lacto-Phosphates. Th.^ Citrate of Quinine and Iron, in doses of half a grain to two grains, three times a day. Complications (other diseases) which may occur will require the appro- priate treatment, keeping this in view, that all treatment must bp sus- taining. HOMCEOPATHIC TREATMENT. Calcarea is a medicine of the most essential importance in all cases of rickety disease, and is more }>articu- larly required when the fontanels remain open too long, and when tiro process of teething is unduly protracted, or the teeth that are protruding have a tendency to premature decay; or, again, wlien there is curvature of the spine and of the limbs, with enlargement of the joints, and very undue dimensions of the skull. Calcarea, again, is yet more especially indicated. 'u RICKETS. 483 If, in addition to these manifestations-, tliore ])e incrustiitioiis un (ho f.-nc, or if tht) bciliy bo enlarged and lianl, and wliils! lapid or {gradual loss of flt'sli laiios i»hu;t', tiio apiwtitc is inorliidly voiadoiis; Uic, skin is coininoidy dry and flaccid, and tii(! child wcais Uic appearance, of Ix-ing much oldeir than il really is, alLlion^h it be, ^lomnionly diminutive and fraf^'ile; tlie bowels are habitually CDslive, or are frequently alTected witii excessive iinU protracted relaxation. Done: Four pills in a teaspoonful of water, tlu; lirst thiuf; (fvery morn- intf, for a week (unless decided (^llan^Je sliould sooner occur;) IhcMi pause ten days; after winch the course should be rej)eated us before, and so on, until some distinct sij^ns of t^eneral improvenxint follow. Jtarj/fa (Uirbouini will be found adapted to some cases, i)arti(^ii- larly of dwarJlsh children, vvhero there appears to be a general arrest and suspension of development, i)articularly if there be a tendency to i^laud- ular enlargements in the neck and elsewhere. Dnsi'.; As directed for C'aZca/w. MerrttriitH should bo employed if the following symptoms should en- sue: — Pains intlie b mes, as if from soreness, or as if ))ruised, witli extreme tenderness of the shin bono and knee-joinls to pnssiiie, with or without pressure of the limbs; dandruff, and other obslinali! aifeetioi:s of tii(! Hcalp and face; incrustations on the faces; extreme suscepliljilily io take cold, with constant or very frequent prevaleiuse of cold in the head or on tlie chest, and tendem^y to excessive perspiration, whether offensive or not; and often a ciironic, slimy, or clay-colored diarrhoea. Dost!.' As directed for 6'cffcrt?'ea. SiUvva is api)roi)riate to the treatment of almost all cases of disease of the bones; and is more particularly and decisively indicated by a pecu- liar tendency to ulceration manifested by the skin upon the least abrasion, — that is. wluMi it "Urals hadhj" as it is popularly termed; or when tliert! are scabby eruptions on the scalp, the fjlands being disposed to 3ui»puraLe, the complexion pallid but puffy, and the ears being constantly or fre- quently afl'ected with discharges of matter. Silicea may be required after Calcarea, to complete the cure. Dose : As directed for Cahnrea. Sulphur should be employed after Calcarea or Silicea, if these medi- cines, having previously been productive of decided good effect, should cease to operate so beneficially, or if the following symptoms should pre- vail (which, if predominant, however, might more distinctly indicate tlie employment of Sulphur at the onset:) — Extreme susceptibility to Lake cold, and to protracted discharges from the nose or from the wind-pii)e, or to excessive or continued relaxation of tiie bowels ; but still more espe- cially by obstinate and intractable consUpatvm, with flabbiness of tiie llesli or skin, pallor or pufliness of the face; protracted inability to use the legs or to maintain the erect position; tendency to be easily thrown into a vio- lent perspiration by any exertion; the skin being otherwise dry, and even harsh, and the eyes and eyelids appearing to be habitually more or less inflamed, and both mind and body languid, and unfit for exertion of any kind. Dose: The same, and at same intervals, as directed for Calcarea. ' When there is an hereditary predisposition to this disease, too groat attention cannot be paid to the first manifestations of ill-health. Great lllli: l! \- k !»%■' if \ i % '-■ i 4&1 DISEASKS OK THK BONES, MUSCLES AND JOINTS. ciuo sliouUl, at the sauio time, be taken to avoid unduo pressure upon the chest and other parts. The bones of a rickety chihl are wanting in the natural and rccjuisite strengtli, or (Irrnness, to 8ui»port the weiglit of tht; frame. Consequently, when every precaution is not adopted, and the child is allowed, or rather compelled, by its heedless or culpable parents, or oth- ers, to use muscular exertion, deformity invariably r^'sults. It will, there- fore, be necessary to deal gently and cautiously with the child, from thi' lirst day of its early existence. And while every care is observed, to escape the mischief alluded to, other means, having for their object the improve- ment of health, must be strictly followed. The child should be regularly in the open air, when the weather permits ; its apartments ought to hr well ventilated ; its personal cleanliness should be constantly ensured ; and wholesome and appropriate nourishment provided. When the health an<l strengLh are improving, but the limbs aiul other parts have become deformed, to a greater or less extent, in defiance of every solicitude— or, as more frequently happens, from oft-repeated infractions of the rules laid down— considerable benetit may yet be accomplished by judiciously applied mechanical aid. ^WA m l.'r • LUMBAGO-CRICK IN THE BACK, Diagnosis. Violent pain, of a rheumatic character, in the lumbar region, either periodical or permanent, frequently accompanied with ii considerable degree of fever. ALLOPATHIC TREATMENT. In acute lumbago, the employment of strong mustard plasters or repeated hot wet packs, with a hypodernii<r injection of a quarter of a grain of Morphine over the seat of pain, repeated sufficiently often to subdue the pains, is genernlly efTectual treat ■ ment. A cathartic should be given to move the bowels. If the disease does not subside after the pain is relieved and the bow- els moved, the treatment by mustard phistersorbot wet packs and Opium should be tried to relieve pain (a quarter of a grain of Morphine, a grain of Opium, or twenty-five drops of Laudanum, may be given by the mouth ) and should be continued. The effect of Salicylic A«id, given in doses of ten grains every fonr hours, should be tried. It can be given in capsules, or mixed with Starcli. Chronic lumbago is most frequently cured by Iodide of Potassium, given in doses of from ten to twenty grains, three times a day. It may be given in Peppermint Water, after meals. Much relief may be obtained by wearing a Belladonna plaster across the loin. Other remedies are the same as those recommended for chronic mus- cular rheumatism. HOMCEOPATHIC TREATMENT. Aconite may be given at the com- mencement, if much fever declare itself. Bryonia when the pains in the back are of asevere aching or lancin- ating description, constraining the individual to walk in a stooping pos- ture; aggravated by the slightest motion, or draught of cold air, and attended with a general seusaticu of chilliness. INFLAMMATION OF TIIK .lOlNTS. 485 Mii.r-t'o tied is imrticuhirly iiKlitiiiU.'d wlien tliei)aiiiH ro«eMil)I(; Ukwc jjnKluced by u hruiHo, or by uxft'ssivc fiitigiie; iilso wliuii thi'y uro niiKtIi iiicrLUSfd by motion imtl l)y tiirnlti^ in bud at niglit, und arc uttondod witli con.sidoruble weaknoHH; und nioruover, wlien Irritability of temper and constipation are present. Niix-vomica is often of j^reat Hervice alter iiryonia in acute lumbago. In chronic cauuH it is a remedy of no mean importance. IthuH-toxleodendi'on is almost Hpeciflc. U should be preferred to any remedy when the symptoms are as follows : Dragging or shooting pains in the bacli an<l small of back; severe aching or i)ain, as if from tlie eirects of a bruise or a sprain in the loins; a feeling of stiU'iiesH (»r ten- sion in the afl'ected parts on attempting to move, l)ut aggravation of the pains when in a state of rest, or when pressure is made on the seat of the sufferings. \t is also a useful remedy in chronic cases. BeMadunna, wiiere tlie pains are deeply seated, causing a sensation of heaviness, gnawing, or stitTness; It may follow Aconite with consider- able benefit, when slight inflammatory symptoms are present. Pulsatillrt, when the pains, resembling those mentioned under Nux- vomica, are njoreover attended with a sensation of tension or constriction at the allected part ; it is parti jularly indicated for females, or individuals of mild, sensitive, or phlegmalic temperaments. Mercurius, when the pains are much of tlie same description as those given under Nux-vomica, but considerably aggravated at night, incapaci- tating the sufferer from taking rest. (See Rheumatism). *■ Si' '^. I I IR- K INFLAMMATION OF THE JOINTS. ALLOPATHIC TREATMENT. Acute inflammation of a joint (syno- vitis,) demands, in the first place, absolute rest. Tins is imperative and invariable. Tins object may be aided by properly adjusted splints. The limb should be in a position wliich will relieve the articular surfaces from pressure. If the affected joint is in the lower extremity, the limb should he in the straight position. If the affection is in the knee, or hip joint, a degree of extension may be secured by the weight and pulley, as used for fractured thigh (described in the treatment forliip joint disease,) and relief from pain secured in this way. Rest and extension, whicli will >:';i,uMte the joint surfaces, and keep them apart, is, in most cases, all the l;- • ; uient needed to ensure recovery. Counter-irritation, by applying Tincture of Iodine, or blisters, the use cr cold by ice bags, compression with bandages, and a wet sponge, etc., hiive all, in some cases, been useful, and are sometimes hurtful, and do iiot r.)rapare with the me«ns»just described in elHcacy. When the inflamma- tion and heat in the joint is great, a solution of Sugar of Lead and Opium will benefit : Take of Sugar of Lead thirtj (/rains, Acetate of Morphine Jive t ) ten grains, (or two ounces of Laudanum,) and rain water a quart. Mix, and it is ready for use. The internal use of Opium may be called for by I lie severe pain. In chronic synovitis, rest and extension, as in the acute, are appropri- ate means of treatment. The use of blisters and other forms of counter- irritatiou are more useful and less often hurtful. The constitutional state 'Mi. m vk Hi r '• 4b6 DlSliASICS OK THE UONliS, MUSCLES AND fOINTfl. is gencnilly fiiulty. Tliis is to be corrected by good, imtritious food, fresli iiir, exercise and, soineliiiies, tonics. TIh; Citrate oi Iron and (Quinine is as i requently usi'l'id as any, and may be given in dosi-s of tiiree grains, three times a day, if Uie patient is feel)le. If absolute rest is enforced in tliis trouble, the j :int lacks its natural stimulus — that of motion. At the proper time (whicli is (lifflenlt to deler- iiiine often.) passive motion (moving liit; joint i)y thf hands of others;) must be resorted to, and after a time (which individual judgment only can determine.) active motion (by the patient) may bo tried. After several weeks have passed it is best to try passive and then active motion. Passive, then active motion, good food, air, and good hygiene, gener- ally, have oftoti restcrred swollen, painful, and stid'joints, in a few weeks, co their natural activity. It is often desirable to keep the surfaces of the joint apart liy traction oven when motion, botii active and passive, is practiced. The weight of the limb may l>e sulflcient. in ease of the upper extremity. In the lower extremities, wliieh must sustain tlie weight of the body, the end is met l)y very ingenious splints, invented l)y Dr. Sayre, of New York. Varieties are made for use of tlie difTerent joints, hip, knee, and ankle. When these 8i)lints are properly adapted, the patient can go about without pain. In this way the functions of the joint are maintained, while all irrit^ition is obviated, and the most favorable condition Is maintained for recovery. COXALGIA-IXFLAMM.tTfOy OF THE HIP JOINT. This inllammation, the chronic form of which is called "voluntary limping," cannot be traced to any detinite cause. It affects, principally, children and young people, during tiie first years of pubescence. Its extremely frequent occurrence during the years fourteen to seventeen, and in persons of rapid growth, leads us to Infer that a rapid growth of the bones constitutes a disposition to this inllammation, and that an exertion, a cold, or other scarcely apparent circumstances, simply act as exciting causes. Acute inflammation of the hip joint sets in suddenly, even with a violent chill, like all other acute inflammations, with which severe pains are associated. The patient locates these pains, at times, in the small of the l)ack,at other times, more in front, very seldom in tlie hip joint; they are extremely acute, tearing, burning, stitching, shooting, aggravated l)y every motion of the lower extremities, not altogether, and sometimes not at all, relieved by horizontal posture. At the same time, a high fever accompanies the pains, the pulse being not unfrecjuently upwards of one hundred and twenty ; this circumstance distinguishes the disease from lumbago, with which it is easily confounded. Amid symptoms of this kind, which may become suinciently Intense to simulate typhus, the following objective changes become manifest in one, two or more weeks: The affected hip, and the buttock of the same side swell, so that the fold between the buttocks Is much deeper ; the thigh is somewhat turned out- wariis, and slightly drawn up towards tlu- nlidomen ; the knee is half bent; extension and rotation of the thigh are very painful; nor can these w i| ! INFLAMMATION OF TIIK IIIT JOINT. movenicntH ho oxeru(<'(l r()niiilet«.'ly. Walking 1h not entirely liiiposHN ble, but can only be pc'iloiincd with the gretiteHt pain. It Ih very Hekloni that an inii»r(,venient begins at this point; ns a rule, an extuiiHlvu Miipi)uration sets in, amid Trequent chills and burning heat of the skin. After this, a short InteriiiisHion seems to take place in the further development of the disease, until the abscess reaches the skin and bursts. This may take place backwards, to one side, or In front. After the pus is discharged, the patient feels much better, and then worse again, provided the suppuration becomes very profus^e and continuous. As a rule, the prospect of a speedy closure of the cavlly is very slim. The terminations of the disease are: Very rarely a comi)letc and rapid restoration; long-lasting Kiijjpuration, with final recovery, and iv total or partial destruction of the joint. The chronic or subacute disease presents a very difTerciit group of symptoms. The disease commences witn vague Hym])!onis in the hip- joint, resembling riieumatic pains and alternately exuceri)ating, remit- ting, or even intermitting for some time. These pains may be absent and in their stead the patient may only complain of astitrjoiiit which is, more esi)ecially, felt during motion. Sensible pressure on tlie hip-joint generally causes more or less pain, and the thigh Is usually rotat.'d out- wards to some extent as soon as the disease commence^;. With s 'cli tri- lling symptoms it may go on for some time, before more serious changes become manifest. The pains increase in intensity, ami cau: o the patieut to limp, the thigli is slightly Hexed and turned inwards. Almost with- out an exception, a more or less violent pain is at the same time felt in the knee, very generally surpassing the pi*,in in the hip joint in intensity. Tlie affected limb becomes lengtliened, its muscles bocome relaxed and flabby. In the further course of the disease, suppuration sets in, tlie i)U3 escaping on the outside, and destroying life by caries and liectie fever. A cure at tliis stage is a rare occurrence, or else the parts grow together, and the joint is permanently stiff. ALLOPATHIC TIIEATMENT. Hip joint disease is simply an inflam- mation of tluvt joint, and is to be treated as already described for inflam- mation of the joints. In incipient hip joint disease, rest in bed and the straight position, witli extension with the weight and pulley, is to benuiinrain-d, the weight being sutTicient to relieve iwin. This will vary from tliree (.r four to ten pounds. The mode of its application is by long adhesive plasters applied to the sides of the leg. and well secured by a bandage above the ankle. The foot and ankle should be bandaged, but the plasters must not be included withlnthis part of the liandage. The lower end of the plasters are then fastened to a narrow board with a liole in the center, which is long enough to separate tiie piasters from the ankle, and so prevent irritation, a rope is knotted and passed through the hole in the board whicli is attached to the plasters. The rope is then passed over a pulley fastened to the foot of the bed, and tlio weight then fastened to the rope. The rope must draw in the line of the limb. In addition to this treatment, good hygiene, whicli consists in plenty of fresh air, comfortable temperature of the room, sponging of tlse body every otlier day, with water at an agreeable temperature ; good nil » f li: • ' k Hif>'',U il m If, w t W 1 if ■ \,ta J. m DISUASKS OK THE IJONKS, MUSCLKS AND JOINTH. nutritious food nxul choorful surroundings, will he sulflcient to carry the patient through tlie acute intlaniinatiou to recovery. It in best to bring tlie limb at once to a straight line, and tlie weight applied. It ouglit not to cause pain, or at least after a few hours. This treatment sliould continue six weelcs or longer. The time comes when exercise must bo secured, and at the same tiine extension contin- ued. This Is beat secured by a suitable splint for hip Joint disease. Tliere are several varieties of app: atus adapted to tliis end; one of the best is Dr. Sayre's, Tlie splints of Davis or Bauer meet the retjuired end. Many cases have been successfully treated by the use of the wire- trauze splint of Hamilton or Barwell . If these are used, tlio body is to be supported by crutches. A sole-leather, felt, or giittaj)ercha splint, similarly constructed, will meet the end. It sliould exlend from the top of the illium (hip bone) to nliove the knee, an(i hrojid .nou^li to cover the thigh one-half in. A pro- jection from the top of (lie splint behind, three or four inches wide, .-should extend nearly around the l»ody, and fastened in front with a strong piece of elastic bund. Leather sliould l)e softened witli cold water, and guttapercha with !.(>t water, and moulded to the limb and pelvis, and retaitied with a ban- «i:ij.^e, until it hardens. The inside of tlie thigh should l)e covered with a siiltuhle short splint. After the splint hardens, permanent fastenings can lie attached. This method of treatment, faithfu'ly and intelligently carried out, as a rule, will obviate tlie necessity of an operation, and .secure a satisfactory result. When tiie disease progresses until tlie bone becomes extensively tiiseased, an operation for its removal is demanded. HOMa:orATHlC TKEATMENT. Although the number of homteo- jialliic remedies for hip joint disease is but small, yet the success with which tliey are used in this di.sease, is a source of pride to our i)raetice. I M view of tlie almost positive certainty of a correct diagnosis, in most . cases of hi)) disease, the clinical results tiiat have; been obtained in the treatment of tills disorder, may be regarded as ab.solut( ly reliable testi- mony. Rhus Tax. At the outset of the disea.se, when violent fever, hur- ried pul.se, rleumatic pain from the hip to the foot, and constant desire to gain reliefby a change of jiosition, Ijut before pus has actually formed, will be found an excellent remedy. DoNo: Six jiills in u teaspoon ful of water, every five to twenty-four hours. Bellnflotnui. Under almo.st the same indications aa Rhus Tox., excejit the restlessness is not so mariu'd, and there is more of a tendency to a dark-red ai)i)e«rance of the skin over the aflected parts; showing a deep inflammation. Dose : As for I{7ius Tox. MereuriuH. If the formation of jius has really commenced, no rem- edy will compare with this, being free^uently able to arrest the disease and restore the patient to health, as fa." as the nature of the attack will permit any remedy to do so. P'we; Six pills, or a small powder, three or four times a day. INFLAMMATION OP THK KNEK JOINT. 4S6 Calrarcn-carh., after the disease lias turned, or shows marked signs of turnhig for the hetter, helps very much by aiding in the nutri- tion of the parts afTected, as well as the 8>.:lem in general. Dose: Kix pills (wiee each day. The rest of the treatment may be condensed in the following points : The patients should not remain in a state of aljsolute rest, on the con- trary, they had bettc.M' move about by means of crutches. If pus forms, warm i)oultices may bo applied; tliey not only promote the formation of pus. but very often favor its absorption. Only if carious destruction of the joint has taken place, the i)aticnts will have to remain ([uiet, lest spon- taneous luxation should result; in such circumstances, a .suitable exten- sion r.p,;ar:;tiis may bo resorted to, which will have to be applied, how- ever, with a great deal of caution. The diet should be, at all times, plain and strengthening; the use of fat is to be rigidly prohibited. 'IK { i. ' i U GOJ^ITTS-INFLAMMATIOX OF THE KNEE JOINT— WHITE SWELLING. This la one of the most frecjuently occurring inflammations of joints ; owing to the exposed situation of the knees, this might, indeed, be ex- pected. A simple inflammation of the knee, is generally tlie result of some mechanical injury or of excessive use, and is an unimportant afTection, as long as the inllammation is confined to the integuments. It is scarcely ever attended with fever, is never ushered in by a chill, and runs its cour.se within a few weeks. However, as we can never be sure whether such an unimjjortant diHea.se may not result in the more dangerous white swelling, it ought to be managed with all due precaution. Rymi'Toms. While using the joint, the patient complains of pain and impaired molality; in more rapidly progressing cases the temperature of the joiJit is higher tliaii usual. If the inflammation emanates from the soft parts, the pains are generally less than when the bones constitute the .starting-point. Sometimes the knee swells rapidly, at other times more slowly, and most slowly if the bones receive the first shock of the disease, n the latter case, the knee preserves its form for a long time, in the other cases the swell ingsoon modifies any former sliape of the knee. As the swel- ling increas' i, which generally has a very white appearance, it grows pro- gressively softer, elastic, and finally shows symptoms of fluctuation. The cutaneous veinsbecoinevery much enlarged. The pains generally increase •with an in(!rease of the swelling. Sometimes not till after the lapse of years, and, in a few cases, after that of weeks, distinct fluctuation is per- ceived in one or more places; here the skin reddens, breaks, and a pus, which is mostly tljin and mixed, is discharged. In spite of the evacuation of pus, the swelling remains almost unchanged. The suppuration in a case of white swelling is generally very tardy. The openings may close for a short time, after which they generally open again, so that, in a fortunate case, suppuration may cease after many months, and the swelling may grow smaller, but the joint remains stifl* and thick, and the leg somewhat bent. A cure of this disease is witnessed only in the ca.^c of young people. If the case terminates less favorably, t ,*l|l*: \ I ^*4 A' t ! 4 ■'" DISEASES OF THE BONES, Mt'SCI.ES AND JOINTS. the suppuration gradually superinduces hectic fever, and finally ends in death. Tlie prognosis is always bad, for no one escapes from such an attack without some permanent injury ; the difTereuce in favor of young and robust individuals is, that death needs not be apprehended in their case, which is generally sure to occur in individuals of upwards of thirty years of age. ALLOPATHIC TREATMENT. The treatment of inflammatory dis- ease of the knee does not differ materially from that given for inflamma- tion of tlie hip joint, and joints in general . Rest is the first esi^ential ; this may be secured, first, by applying a splint to tlie posterior of the limb, including both the thigh and leg, to l\eep the joint perfectly still. Cold applications, or warm, as give the most relief, may Ije employed. The hot wot pack applied to the knee will be useful, if cold causes pain. The evaporating solution of Lead and Opium, given in the treatment of synovitis may be used. If the joint continues painful, pull moderately on the ankle to separate the ends of the bones in tlie joint, and if this gives relief, the weight and pulley should be employed to produce exten- sion, as directed for disease of the hip. A large amount of water in the joint, producing enlargement, should be met by pressure, either an elastic band or bandage and wet sponge. Pressure would be painful and harmful without extension. After six weeks or more have passed, exercise of the joint becomes necessary, but extension must be continued. This can be (lone by the proper application of a Sayre's splint for the knee joint. If tlie limb isdistorted, the tendons necessary must be divided to bring it into shape. When the fluid in the joint is not removed by absorption from pressure and friction, (rubbing with a simple liniment,) aiding nature, it is neces- sary to remove the liquid with an aspirator, or possibly by incision, but the wou.id must be hermetically sealed immediately, and the joint kept motior.less by a well-secured splint until the wound heals. Ntiarly, if not all cases, can be cured by absolute and permanent rest, arid extension, as has been indicated, and, in some cases, compression. When the inflammatory disease in a joint has advanced tosujipuration and decay of tissues- it is commonly sjjolien of as a " white swelling." If it is the knee joint that is affected, it is then known as " white swelling of tlie knee joint." Tlie treatment described for inflammation of the knee or joints, if properly carried out, will jirevent tliis undesirable state of aflkirs. If it occurs there is puin, irritation, fever, loss of appetite and debility. Extension by means of Sayre's si)lint for the knee (or for such otlier joint as is affected) must be made. Tliis will relieve tlie jiain. Tlie services of a surgeon are necessary in the management of these cases. If it is impossible to procure a splint, extension should be made with a weight and pulley. There is the disadvantage of confinement with this manner of extension at a time when it is very important for the patient to bo much in the open air. The patient should have the benefit of fresli air, hunlight, and good food. Tonics may be required. There is no better one than the Citrate of Iron and Quinine, given in doses of one to four grains, three times a day. The Compound Syrup of Hypophosi)hites is another useful one, especially EnHESDDPAeCESMnW \\ m W»i ^492) i I 492 INFLAMMATION OF THE KNEE JOINf. ■i/i'i . j i '"id 1 if there is much discharge, as also is the Compound Syrup of the Lacto- Phospliates, Tlie dose of eadi is a teaspoonful. The former syrup may be combined with a fourth Dilute Phosphoric Acid. The dose then will be the same. When an inflamed joint, acute or chronic, will permit the two surfaces of the joint to como together by ajar, without iniin, and when there is no pain on pressure, the instruments may be removed. A condition of irri- tability remains and the joint cannot be used without pain. The case requires passive motion and rubbing. Gentle but thorough friction to restore the functions of tlie joint, remove the congestion and irritability. The i}retense that the hands of some persons have especial power in this direction is simply pretense. In the successful cases under their hands, they have only by accident stumbled upon the case at a stage when the nibbing was the element necessary to restore the use of tlio joint. One so-c;illed cure of this kind, at the hands of a pretender, is the source of a wonderful amount of fame to the injury of society, and an unfavor- able reflection is made on the medical profession, which is unjust. H03I(E0PATIC TREATMENT. Silicea is the medicine of chief im- portance in the treatment of the inflammation of the lining or covering membrane of the knee.joints, or for tlie treatment of the enlargements, and otlier mischiefs resulting from such inflammation. Dose : Six pills in a teaspoonful of water, three times a day. Sulphur and Calcarea are indicated at the onset, or after the pre vions administration of some other medicine, to complete the cure. They are of chief importance in scrofulous enlargements of the knee, and may also be required as intermediary remedies, when other medicines, apparently indicated, cease to produce any decided effect. Bose : Give six pills in a tablespoonf ul of water, every morning and evening. Brf/onia may be given, if the trouble results after rheumatism, with rod and very painful swelling of the knee, particularly, if the slightest motion aggravates the pain. Dose: S:\meiisSilicea. Pulsatilla is an excellent remedy for the treatment of glazed or shining, white, soft, or doughy swellings of the knee, and is, indeed, more or less especially appropriate for the treatment of soft, colorless swellings of the knee, in general, whether painful or otherwise. Dose: In every i)articular as directed for Bryonia and. Silicea. External applications are not always appropriate in this disease. Poul- tices are injurious if they increase the pains; in most cases, they not only relieve the pain, but likewise exert a favorable effect upon the reabsorp- tion of the pus in the diseased joint. An uninterrupted recumbent post- ure is to be avoided, as long as the patients remain capable of moving about; only the diseased limb must not be used for a walk. A moderate and constant pressure by a starched bandage is only borne, if the bones are not too much diseased; it has tlie double advantage of antagonizing the swelling, and protecting the limb during motion. It has the best effect, if the aliscess has already broke, for, in such a case, the bandage most decid- edly promotes the course of the suppurative process. Amputation is only advisable if the joint is utterly disorganized, and the constitution begins to show signs of failing under the constant pain and loss of fluids. wm DISEASES OK Til!': HOMOS, :J'J:(M:S AND JOINTS. 403 IJfFLAMHtATION OF TITI<: JOIXTS OF TUB FOOT— TARSUS. The inflammation is oitlior s(Mt('(l iu the bonos, or where they articu- late with those of tho metatarsus (between the ankle and toes;) or else in tlie articulation of tlie tarsus (iinkif") and tibia (large bone of the leg,) or in l)oth localities at tlie same time. Here, too, mechanical injuries ar(> rarely the ciiuse of the inflammation. An inflammation of tho metatarsus is particularly met with r<.mong children, and during tlie age of pubes- cence; an inflammation of the tibia-tarsal articulation occurs more fre- quently among adults. The Symptoms are most commonly the following: At first a pain is felt in walking, particularly during certain positions of the foot ; in a state of rest the pain subsides almost entirely. Gradually tlie joint begins to swell. the swelling increasing more and more, and gradually extending over the whole foot ; at the same time the pains increase, become continuous, and walking is entirely out of the question. At last, the pus finds an outlet ii" pne or more places. In favorable cases, the suppuration now decreases, the strength keeps up, the fistulous openings close, although sometimes not till years have elapsed. Or else the swelling continues to increase, even after the abscess, the foot becomes completely distorted, and hectic fever is the unavoidable consequence. The course of the disease always exceeds one, and even more years, until the pus escapes outwardly. At all times life is in danger, even in the case of children; adults succumb almost always with scarce an exception. A peculiar form of tarsal inflammation is a flat foot. Sometimes it .ffects small children, although it is only slightly developed at that age; it mostly shows itself after pubescence, most generally am'mg males if they suddenly grow up in hight. Every time after the foot . jerseveringly used, violent pains are experienced in the joint, which becoxnes stiff after walking, with inability to stand upon the affected limb. Little by littlo the foot loses its arched shape, and the patients generally walk on tlie inner edge of the foot. The malformation of the foot may become very considerable, and may, materially, interfere with its use. Sometimes tlu! trouble does not cease spontaneously, until after the patient is thirty years old. This form of inflammation, which, under similar circumstances, may likewise occur at the knee, never results in suppuration. Treat only by a physician. ALLOPATHIC TREATMENT. The principles of treatment of inflam- matory disease of the ankle joint, are essentially the same as is laid down for tlie treatment of synovitis in general, and of the hip and knee joints. Absolute rest is the first essential. Of all the plans of local applications, r believe heat to be the best. It can be applied by the hot wet pack, or by iramersingtlie ankle in water as hot as can be borne, when the pain is relieved by repeated hot packs, or by tho hot foot bath; the limb should bn elevated, and kept in that position until there is no tenderness on pressure, and until the limb can hang down without causing pain. If there is effu- sion in the tissues about the joint, compression should be made by firmly bandaging a large sponge around the joint, which has been previoufly satu- rat d with warm water and squeezed as dry as possible. (The foot, ankle and leg should be bandaged). The sponge and bandage about the joint % !> Ha .!«•».. ft it 194 ULCEnS. should be kept wet with warm water. By the swelling of ihe sponge, and the shrinking of the l.andage, considerable compression is produced. Com- pression can be made niorci onnvoniontly by tlie double India-rubber baj.^ whicli is inflated wit air. After a few days, rubbing the joints with tlie hand, will be useful. In more advanced cases, extension should be nuule by the use of Sayre's splint for the ankle joint, and tiie patient permitted togoabout'on crutches, while the surfaces of tlie joint are kept apart by the extension. The excessive secretion of fluid in the joint may bo caused to be absorboii by pressure and rubbing. If pus is formed in the joint, or a thickentd iluid which cannot be absorbed, as determined l)y the exploring-needli', or trocar — it should be withdrawn by the aspirator, or incision as dr scribed in the treatment of the knee joint. Extension by means of Sayre's splint, should i)e continued. "When the disease has advanced to destruction of the tissues of the joint (cartilage or bone,) the treatment is too complex to be described here. The reader is referred to some recent complete work on surgery, or diseases of the joints. Tf, however, the treatment described here is thor- oughly carried out in tlie beginning of the disease, recovery will l>c reached without serious consequences. CHAPTER XXV. ULCERS. LYMPHATIC TUMORS. DISEASE OF TIIE CINGLOBATE GLANDS. Abscess— by this term is meant a collection of purulent matter, result- ing from morbid action, contained in a sac or cyst of organized coagula- ting lymph furnished witli absorbent and secreting vessels. Abscesses are divided into acute and cli ionic. The acute variety is preceded by sensible inflammation in tlio atTected part, which is soon fol- lowed by suppuration. The commenccnKiit ol the suppurative p^oce^s is known by a change in tlie description of pain, which becomes more obtuse and throbbing, by an increase of the swelling, and when matter is formed, by the perceptible liuctuation of the ])art, when the abscess is no, toodeeply seated; lastly, particularly in idiojiathic (i)rimary) cases, when the formation of jius is considerable, tlie fever, which had attended tlie earlier stages, is materially lessened, and irregular chills, or rigors, super- vene, succeeded again by heat and increase of fever. When the abscess is mature, the tumor becomes pointed, or presents a conical shape, generally near the center of the inflamed cutaneous sur- face ; over this s])ot the skin assumes a reddish hue, becomes thin, and, ere long, gives way and allows the contents of the cavity to escape. The signs of the formation, or existence of a chronic abscess, on the other hand, are, in the generality of cases, devoid of any apparent disor- der, either local or constitutional, until it begins to approach the surface and form an external swelling. The secivted matter is unhealthy, thin, and contains substances resembling curds or flakes. DISEASES OK THE BONES, MUSCLES AND JOINTS. 465 When the pus is let out (evacuated,) anil tlio air admitted into the cav- ity, inflammation of the cyst arises, and is bcii iicial, if tlie cavity of the ab;-cess is small, but if it be large, great constitutional disturbance ensues, the cavity, instead of contracting and filling up by healthy granulation, goes on discharging copiously until, in the end, hectic fever is produced. ALLOPATHIC TREATMENT. Acute inflammation of the lymphatic vessels (angeiolencitis) requires the application of heat promptly and con- stantly. Flannels wrung out of hot water, and the limb, or other part affected, covered with them, and the wliole well covered in, to retain the lieat, is a form of hot wet pack which is most serviceable. They should be renewed as often as they become cool. The hardened inflamed lines may be covered with Belladonna Ointment. Any wound or ulcer causing the inflammation is to receive its appropriate treatment. Pain is to be relieved, if necessary, witli Opium in grain doses, Mor- phine in doses of a quarter of a grain, or Laudanum in doses of twenty- five drops, repeated just often enough to give relief. Free incisions through the inflamed part relieve the tissues strangu- lated by the inflammation, and evacuates the pus. Early incisions are very innortant. Pus has often formed in the subcutaneous tissue, which is not detected by fluctuation. Too great delay in making these incisions may be attended by serious consequnces. Tlie patient must be nourished with milk, strong beef tea, and eggs. It' much depression occurs. Quinine and Brandy, or Whisky, should bo freely administered. The former in doses of five to ten grains, from four to six hotus apart, according to the urgency of the symptoms. The latter may l)y given, according to the degree of urgency of the symptoms, in doses of a tablespoonful (half an ounce) to one or two ounces, from half an hour to. four hours apart, but always short of producing symptoms of intoxication The bowels should be moved by Citrate of Magnesia, or an injection of warm water. Should the disease become chronic, the strength of the patient should be supported by good food and tonics. Poor digestion may be improved bv tcaspoonful or dessertspoonful doses of Sheffer's Liquid Pepsin, * and the blood enriched by the Tincture Muriate of Iron in doses of ten to twenty drops, largely diluted in sweetened water, three times a day. The best local application is the application of tlie Biniodide of Mer- cury Ointment in one-half to a full strength, api)lied sufliciently^ften to produce slight irritation. Inflammation of the lymphatic glands (adenitis,) in the acute variety, is to be treated precisely as directed for inflammation of the lymphatic vesssls. As the inflammation is more localized, hot linseed poultices, hav- ing the surface strongly impregnated with Laudanum, may be used witli great advantage. Tue surface over the inflamed gland may be covered with Belladonna Ointment. Other hot applications are equally appropri- ate, as in inflammation of the lymphatics. When the general health is poor or the patient scrofulous, such reme- dies as the Citrate of Iron and Quinine, in doses of two to five grains should be given. Iodide of Potassium with Iron is often an appropriate remedy. ri.r, |l| 11 ♦ The formula for making Liquid Pepsin is, take of Saccharatod Pepsin (Sheffer'a) two drams. Hy- drocblorio Acid a dram, Water Ave ounces. When solution is effectod, add Glycerine throe oiincei. 4M ULCERS. I Tafce of Iodide of Potassium flve drams, PyrophospJiate of Iron a dram. Peppermint water eight ounces. Mix. Dose : A dessertspoonful three times a day. It can be sweetened or not, according to tlio taste of tlie patient. The Compound Syrup of the Phosphates or Hypophospliates in doses of a teaspoonful to a dessertspoonful tliree times a day is suitable. Cod Liver Oil is often required. After the disappearance of the acute inflammation, if the glands remain, hard rubbing with Iodide of Mercury Ointment will generally produce absorption. This ointment may often be reduced one half witli lard. HOMCEOPATHIC TREATMENT. In acute abscesses, apply poultices and warm, unmedicated fomentations, and forward the sujjpurative pro- cess. The lancet is never necessary, except when the pus, by its exten- sive diffusion or pressure, especially when deep-seated, is liable to injure important parts ; or when, from its situation, there is reason to apprehend its discharge into any of the cavities of the body. When it is necessary to make an opening with the lancet, the incis- ion ought to be made at the lowest or most dependent point, where this can be safely and readily accomplished ; but when tliis is impracticable, in consequence of the great thickness of the parts between the pus and the skin, the most prominent or pointed i^art should be selected. When, on the other hand, this latter point happens to bo at the upper jtart of the abscess, the lancet had better not be used at all, but trust rather to the use of remedies. Hepar Sul., Silicea, Arsenicum, and Lachesis. In chronic abscesses, it has usually been found most beneficial 1 to make an outlet for the matter (pus) as early as possible, so as to prevent its large accumulation, and thereby avoid tlie consequent frightful consti- tutional disturbance so liable to occur in such cases from the extent of the inflammation. After the bursting of the abscess, make the opening merely large enough to admit of the exit of the matter. When the col- lection of pus is very extensive, it frequently accumulates again after having been evacuated, hence it has been recommended to heal up the opening immediately, and to make a new one when necessary, but before the pus has accumulated in anything near like the first quantity evacu- ated. HOME TREATMENT. An excellent remedy for all open sores upon an inflamed base, milk leg, and iflamed breasts, is tobacco salve. To be made as follows: Take one-half pound of Navy plug tobacco, two pints of good Vinegar, three-fourths of a pound of Tallow, one-fourth of a ])ound of Lard or Sweet Oil, half a pound of l?osin, half a pound of Bees- wax, one ounce of Balsam Fir, one-fourth pound of Burgundy Pitch. Cut up the tobacco fine and soak in half an ounce of water till soft. Add one-half of vinegar, boil and strain, then add balance of vinegar, steep, rinse the dregs and strain ; then boil down one-half and add wax. rosin, lard, and Burgundy pitch ; then boil down till water is all evaporated, add balance of fir and stir till cold. If too stiff, add lard or oil to the con- sistency required. SIMPLE KKDNLbJ Ol' TliE SKIN. CHAPTER XXVI. DISEASES OF THE SKIN. 40r m m\ I: I!' 4 r V ERYTHEMA-SIMPLE REDNESS OF THE SKIN. Erythema occupies a middle rank between congestion and inflam- ,mation of thesl^in ; it is easily confounded with a benign form of ery- sipelas. Its causes are : Mechanical injuries of the skin ; the influence of a high temperature, of various medicinal agents; continual moistening of one part of the skin by urine, liquid stool, perspiration, tears, and even the constant use of moist compresses; constant irritation of the skin by rough clothes. In the case of children, erythema seems to be, likewise, caused by hearty and fat food. Erythema seldom occurs as a wide-spread affec- tion, to which the designation of "epidemic " might be applied. Chronic erythema breaks out chiefly in the face, and, more especially, on the nose; its causes sometimes seem to be purely local, and, at other times, constitutional. Erythema is characterized by a more or less diffuse redness of the skin, not separated from the normal redness by sharply-drawn outlines, assuming a yellowish, not a white tint under the pressure of the finger, and continuing for some time, and, finally, terminating in desquamation (peeling olf). These characteristics belong to aP forms of erythema. Ery- thema caused by external irritants, most generally breaks out on the scrotum, at the anus, between the tbiglis, in the axillse (arm pits,) face, and in the deep integumentous lolds of fleshy persons, or at the place where the irritating cause exerts its influence. After the ca. .' ceases to act, tlie erythema generally disappears of itself in a few days. If the irritation continues, the skin mny become detached (intertrigo,) and ulcers may form, or the skin may even become gangrenous. Erythema arising from intcTMul causes is almost exclusively located on tlie dorsal surface of the hands and feet, where it is never absent, even if other parts are, likewise, aflTected. At first the place exhib- its a redness, and in a few days darker-colored papules of various sizes spring up, which remain even for some time after the diffuse redness hits disappeared ; the affected spot, likewise, retains a yellowish tint for some time after. In particular circumstances, subsequent crops of this eruption break out on its borders, by which means the affection runs a very pro-' tracted course. This form of erythema is generally attended with a little fever, and at the diseased spot a darting-burning pain is generally expe- rienced. The former variety, on the contrary, has no fever as long as the erythema is of the simple kind ; whereas, the intertrigo of sensitive children may be attended with fever. The second variety, without aftiy subsequent crops, lasts from one to two weeks. In treating the first variety, all that it may be necessary for us to do, is to remove the exciting cause. In some individuals, the disposition to erythema is so great, and it leads so easily to more serious consequences, tliat we are led to suspect behind the local irritation the existence of some 32 J f ^\ (.SA' n m in HI n m 198 ERYSIPELAS. constitiitional <ii.sposition. Thh is particularly the rn'^c with the inter- trigo, or soreiu-'aa of fliildicii. Siiico this »oreness is oliou caused by impro- per diet, the first t>injj to be doiio la to regulate it with care; if the sore- ness continues in spite of this change, a f(>w doses of MercurluH vivus or Bolubilis will cure the trouble very speedily. 4 ERYSIPELAS. Erysipelas proper is altogether a primary afTection, the cause of which it is dilHcult to trace in every case, Tlie disease occurs almost exclusively between the age of pubescence and that of sixty, and is of less frequent occurrence among old people tiian among children. Atmospheric influ- tjuces are generally regarded as thcM-ause of erysipelas, but this theory is not Justified by the eviden(!e of fact. All we know positively is, that ery- sipelas often sets in as a sporadic disease, and that sometimes it breaks out in the tbrm of a limited epidemic, which never assumes a very exten- sive range, and has given rise to the erroneous view that erysipelas is a contagious disease. It is a characteristic feature of this disease that every new attack of erysipelas increases the patient's liability to other attacks, which only becomes extinct at an advanced age. The cause of successive attacks of erysipelas is very often to be found in violent emotions, gross errors in diet, and in coldit, more especially in the action of severe cold upon a heated skin. Thw origin of wandering erysipelas is involved in complete mystery; it is to be observed that it inclines to set in previous to the age of pubes- cence. Traumatic erysipehis arises in consequence of injuries, if suppuration ensues, or even at tlie start, soon after the infliction of the injury ; or it accompanies suppurating inflammatory processes, such as gumboils. It may be looked upon as an excess of reaction against the inflanmiation from which it proceeds. This circumstance likewise accounts for those cases of erysipelas that supervene during typhus and other constitutional diseases as a luulitinant complication or as a terminal disease. SYMPT05IS AND CouRSK. True, or the so-called exanthematic erysip- elas really only breaks out in the face, whereas erysipelas on other parts of the body is, properly speaking, erj'thema. The ai)pearance of the exanthem upon the akin is generally jireceded for a few hours or even days by a preliminary stage, consisting of a severe fever with marked gas- tric symptoms, with which symptoms of cerebral hypcrtemia, and more especially a violent headache, sometimes become associated at an early period. During a first attack these precursory symptoms are scarcely ever absent; but they do not occur with a return of the disease. While the fever is on the increase, the face feels hot and tense, and sometimes rheu- matic pains in the nape of the neck are complained of, a vivid redness breaks out at a certain circumscribed spot in the face, which spreads rapidlyand causes a burning pain. In proportion as the redness becomes more intense, the swelling likewise increases and the skin assumes a glis- tening appearance. Erysipelas generally breaks out oh oile cheek, whence it spreads to the nose, the eyelids, forehead, ears, less frequently to the iips and scarcely ever to the chin. Within two or three days, and som^ DISEASES OF THE SKIN. 49* times in thlrty-slx hours, the erysipchis roaches its nouio at the spot wljorc it llrst appeared, amid ft'hrilu.syniptoni.s, whicl', me Koinetiiuen exceedingly severe, attended witli a foul-snielling catarrh ol'tlie nioiUli, vomiting, and most generally delirium; these symptomH, however, are not constant, whereas the headache and soporous stupefaction arc exceedingly annoy- ing. The face is now very much swollen, 'lie features are (li.sfif,'ured to such an extent that they are no longer vi.cojrni/aljle, the redness has a l)luish and even brown-red tint, and vchIcIis of various sizes sometimes spring up upon the inflamed surface, wliicli always iudlcato an intense degree of illness. The inflammation decreases very rapidly ; the redness disappears after the existing vesicles liad dried up previously, and had become trans- formed itito thin and flat crusts, an<l very soon des<juamatioM conimences, iirst in large patches, and afterwards in very small scales. J5ut inasmuch as the disease never terminates M'itli lis first appearance, and usually .si)rcadaover the whole liead, we find erysipelas in full bloom close to the original spot in process of healing, and llnd the redness gradually dilFus- ing itself into this spot, whereas it forms a sharp contrast with the sur- rounding normal parts of the face. In this nuuuier erysipelas gradually v.anders over ttio whole face, even beyond the ears, invading a portion of the naj)e of the neck, and spreading over the forehead and the hairy scalp. In this latter case, the patients sufTer severe local p ins, even after tlie fever al)ates. The inliMisity of the fever, as it first breaks out at the ;;ommencement of the disease, does not keep pace witli its gradual pro- i;;ression. Whereas, at one spot, the inflammation runs its full course in fi ve to six days, yet, on account of its progressive appearance in difTerent localities, the whole course of the disease lasts from ten days to a fortnight. "I'he process of desquamation may last much longer, and the most severely a fleeted parts often exhibit, for a long time, a yellowish tint with signs ot serous infiltration. Deviations from this c urse are not unfrequent. The whole face may be covered so rapi'Ily, that it would seem as though the exantheni had broke out all over at once. The.se are cases of intense virulence, where one ear, however, commonly remains uninvaded. Moreover, the inflam- mation may communicate itself to thecerebril meningai; generally, how- ever, this does not take place until the local jirocess lias reached its bight. In such a case, the redness very soon assumes a dingy and livid look; the skin beconu'S lax and wrinkled, a most violent delirium seta in, and coma and death speedily supervene. This course has been mistaken for a metastasis of erysipelas : whereas, in such a case, the same changes take l)laceasin other similar cases, namely : that, with the appearance of a violent disorder, the ])reviously-existing le.-j.-;er disease abates and disap- pears. Erysipelas seldom becomes associated with diseases of other impor" tant organs. Attacks of erys'pelas succeeding the first attack are very apt to show deviations from the :?ormal course. These attacks are very seldom preceded l)y precursory symptoms, the less so the more frequently the attacks have occurred. Nor is the fever as severe, the swelling is less, and the spread of the disease over the face takes place more slowly. It not un frequently happens that in subsequent attacks the patients are not obliged to lie down, and that their appetite remains thv I'll M ir ! :\;'*- 500 ERYSIPELAS. #1 ;!i < '''-r same aH in their normal condition. Bubuequent uttticI^H ure more like erytheniu than oryaii)eIa.s. The frequency oCtlie attucks dillcrs ^I'^'atly hi (lld'crent iiidividuiilH; sonietinies tlioro are sovcrui attacks in a (V\v weeks, and, alter a wliort time, cease entirely ; or months, and even yeiUM, intervene between the attacks; in such cases a spontaneous cessation i.s mucli less frcijuent. Among tlie consequences of true erysipelas, the following deserve particular mention : Swelling of the skin, especially, that of the eyelids, nose and lijjs; the swelling is mostly pully, the skin having a pale look, and being disposed to the formation of comedones; if the attacks are very frequent, the swelling juay reach a consideral)le decree of (hickness., and is very obstinate. Loss cf the hair, which almost always falls out if the scalp had been Intensely afTected by the disease; in most cases, the luiir grows again, but there are exceptions to this rule. Severe catarrh of the ear, with obstinate hardness of hearing. Disposition to neuralgia. Wandering erysipelas, or erysipelas ambulans or erraticum, attacks the face less frequently than the extremities. On one of tlie extremities, an erysipelatous 8i)ot appears which heals exactly like the above desc'ril)ed spots, only there is very little tension and pain, and the general organ- ism is not so much involved. From this spot, the erysipelas spreads toward tlie trunk ; the spot which is attacked next, being either in dose contact with the first, or else all subsequent spots being more or less remote from each other. Symptomatic erysipelas, as an accompaniment of inflammatory pro- cesses, is of no great importance, except when it covers a large extent of surface and depends upon septic causes. Generally, it disappears of itself as soon as the cause that occasions it, is removed. If it is very intense, it may result in suppuration or gangrenous destruction of the skin. If the erysipelas sets in, in the course of serious, co' stitutional diseases, with fever, it Is always a bad omen. In such cascH. the redness is never very vivid— rather dingy, having a bluish tint ; the swelling is not excessive, and yet the disposition to form blisters is very great; these blisters do not always dry up, but often become transformed into Inidly-looking ulcers, which are apt to become gangrenous. The fever accompanying this form of erysipelas, always increases to a high degree, liut speedily assumes the character of an adynamic fever, the pulse becomes very small and frequent, the temperature increases considerably, the cerebral phe- nomena become very marked, and sopor and coma set in at an early period, and death sometimes takes place so rapidly that life becomes extinct already on the third day after the appearance of the inflam- mation. Erysipelas of babes generally sets in in the first week after the birth of the infant, very seldom after the first month. It almost always pro- ceeds from the umbilicus, on which account it has been traci-d with great l)robability to the consequences of an improper management of this organ, more especially to a purulent inflammation of this organ, which can eas- ily be accounted for by bad management. As a rule, the erysijielas .spreads from the umbilicus over the abdomen, the sexual organs, thighs, less frequently over the thorax and back. The redness is not very vivid, the ^welling, on the contrary, is very considerable. The children art? 0''' t'>: Mi l>I8E!A8Ka OP THK SKIN. 80\ exceedingly restless, feverish, and Incline Rroatly to apasniodlc nffectlnns and sopor. ALLOPATHIC TREATMENT. A patient with ervHipolas (erysipela- tous fever) should he confined to bed In a well-vcntiluti'd room. The diet should ho light, but condstlng largely of milk. Cold drinks may hc> uiven as( desired. If the hawels are constipated, they should ho niovocl by a saline cathartic, as the Citrate of Magnesia, aided, if necessary, by an Injection of warm water. If the case be a mild one, and the fever not liigh, It Is not generally necessary to resort to the use of drugs. In severe ', .isus, the remedies most useful are Quinine and the Muriate Tincture of Iron. Quinine, in these cases, should boglven in doses of five to ten or more grains every four hours. If a slight ringing in the ears is produced, the doses are sufliciently large. It is best given in powder enveloped in medicine wafers. The Tincture Muriate (Chloride) of Iron is very gen- erally given by physicians in doses of ten to thirty drops every four hours. It should bo largely diluted with sweetened water, and may bo given immediately after the Quinine. Beyond the support it gives to the system laboring under so debilitating a disease, the (direct) benefits from the Iron are questionable, but as it is beneficial in this way, it ought not to bo omitted in any severe (•■ e. Belladonna is especially an u ^onlstic to this disease. The Extract may be given in doses of a quarter of a grain in pill, three or four hours 11 part, or the Tincture may be given in doses of from Ave to ten drops at the same intervals. The Belladonna may be given with the Quinine. In cases with high fever, the pulse strong, and there is no depression of the system, the Tincture of Aconite should be given in doses of half a drop to a drop every hour until an impression is made on the fever move- ment, and then continued two or three hours apart, or just sufficiently often to continue the efToct of moderating the fever. This remedy does not require the suspension of any of the others mentioned, but it should not be given when there is prostration. There is no treatment which will limit the inflammation. The sooth- ing effect of the Lead and Opium wash, is often extremely grateful to the patient. A half a dram of Sugar of Lead and ten grains of the Acetate of Morphine are dissolved in a quart of rain water. A soft mus- lin cloth is dipped in this solution and spread over the inflamed sur- face. The cloth should be kept wet. If this does not relieve the pain markedly, it is well to try anointing the surface well with Olive Oil. Two dramsof the Fluid Extract of Belladonna to six drams of oil will give the oil a decided anodyne property. Glycerine, with ten to twenty drops of Carbolic Acid to the ounce, is another good application. Prostration or debility, occurring in the course of the disease, should be treated in the same manner as when it occurs with continued, or other fevers, with nutritious food, milk, beef essence, raw eggs beaten up with sugar and water or milk. Nourishment should be given in these cases four hours apart. If the pulse should be very rapid and feeble, brandy, or whisky in doses of one or two tablespoon fuls may be given with the nourishment. The stimulant is beneficial, if the pulse becomes fuller, slower, and more regular. Sago, Rice, and other farinaceous articles , lire not to be excluded, if agreeable to the patient. 'Mm I, M' h 1 502 ERYSIPELAS. I I !i H03I(E0PATHIC TIIE\TME\T. Aconite may be required at the onset, only in ciii^e there be iimchfeoer, or liot, dry skin at tiie commence- ment; or even during the course of tlie disease, if required. Dose: Dissolve six i)ills in tliree tablespoonfuls of wuter, and give a teaspoonful of tiie solution every three hours, until the pulse becomes diminisbed in force and frequency, and the skin moist. BeWidoitiia, when the redness expands in rays, and an acute shoot- ing i)ain with heat and tingling is experienced in the affected part, which is aggravated by movement. Erysipelas of the face, with burning heat, excessive swelling, so that the eyes are almost closed, violent head- ache, thirst, dry, hot, skin, restlessness, disturbed sleep, delirium. In such instances, lielladonna, is, generally, alone sulTicient to effect a cure. There are eases, however, in which it will be found necessary to have recourse to Rluis-toxicodendron, in alternation with Belladonna, according to the particular symptoms, or group of symptoms present. Dose: If singly, of a solution of eight pills to two tablespoonfuls of water, give a' teaspoonful every two hours, until change, when the " intervals should be extended to six hours, until tiie symptoms are wholly overcome, or assume distinctive features indicative ofanother remedy. But in those cases, of occasional occu'""ence, in which the symptoms, being severe,are but little moderated, within three hours after the fourth dose of I'elladonna, Rhus., a similar solution of each medh'ine, admiwistered by teaspoonfuls, at intervals of two hours, until change. Hhus-toxicodendron is to be preferred, particularly when the dis- ease manifests a tendency to extend itself to the brain and its membranes and the symptoms closely resemble those which characterize brain fever. Rhus is especially suitable for the treatment of erysipelas arising from ])articular kinds of food, ojjerating upon certain individual peculiarities of constitution which predispose the patient to such attacks. Dose: As directed for, and under Bell. Avf.enicum ic recpiired, either after the previous administration of one or more of the foregoing medicines olone, or in alternation with Rhus when vesicles of a blackish hue, with n lendency to degenerate into gan- grene, present themselves; or, still more essentially, if great (and rapid) prostration of strength occurs. Dose: In all respects, whether singly or in aZtovia^ion, as directed under the head of Belladonna. Pnlsatilfn is more especially indicated when the hue of the skin is less intense, or of a bluish-red, and the morbid spots frequently disappear from one place to reappear in another (fugitive erysipelas). It is further- more appropriate when the disease affects the internal and external car, especially in the vescular variety of erysipelas, and after the employment of Rhus toxicodendron. Dose: .Six pills, in a teaspoonful of water, every three hours. Nux-voviica is often of service in cases of erysipelas developed in the knee or foot, and characterized by extremely painful, bright-red swel- ling. It is more especially advantageous in cases of spurious erysipelas occurring in irritable subjects, particularly females, and when mortifica- tion of the subcutaneous cellular tissue has ensued. Dose: Ah for Pulsatilla. ERYSIPELAS TERMINATING IN ULCERATION. Sulphur, Arsenicum, See article on " Ulcers." DISEASES OF THE SKIN. rm SUSCKPriBILITY TO ERYSIPELAS IN THE I'ACE. Belladonna, Ithus. Wlioii this disease Is repeatedly developed in the face, atul there is, in fact, uu h;'J)itiial tendency to attacks of this na- ture, Belladonna and Rhus (in particular,) either singly, alternately, or successively, according to circumstances, are frequently capable of per- manently removing the complaint, and of obviating the return of the attacks. Dose: If shii/ly, of either remedy, give six pills, night and morning for a week, (as soon as the acute symptoms of an attack have been subdued;) then pause four days, after which the course may bo repeated, as before, and so on from time to time. If in aUcruatioii, — give first the one (as just directed,) a:id then after an interval of twenty-four hours or longer, proceed with the other, in like manner, and soon, occasionally, until the predispoKitiou seems conquered. HOME REiVIEDIES. To relieve tlie burning and pricking sensation, the I'ace or parts attacked may be bathed frequently with Ammonia Water. Or, clean, fine wood-soot from the chimney may be made into an ointment with lard spread on cotton batting, and applied upon the affected parts. Rye flour boiled i:\ water, and mixed with soft soap is a good applica- tion to lay on the affected parts, changing it twice a day. Sometimes tiie burning sensation will be allayed by washing with a solution of copperas, half an ounce to a pint of water. ./x •'f^'^'*^ ,;l NETTLE-RASH. HIVES— UBTICABIA. Diagnosis, Spots or wheals, fiat or prominent, and of a dull white color, like the sting of a nettle, or redder than the surrounding skin, generally encircled with a rosy areola, disappearing in warmth, and reappearing when exposed to cold, evolved suddenly, and continually changing their situation. This eruption is brought to the surface by various causes, not unfre- quently arising from indigestion, caused by the use of improper articles of food. Before the eruption discloses itself, the patient is affected with rest- lessness, languor, oppression and want of appetite, derangement of the digestive functions, and fever. When the eruption breaks out, the above symptoms become relieved, but considerable suffering arises from heat and itching, sometimes accompanied with swelling of the parts affected, Tliis disease, in almost all cases arising from a constitutional cause, requires foi! its total eradication a regular course of treatment, ALLOPATHIC TREATMENT. Acute Urticaria, depending on irrita- tion of the stomach, especially if caused by some food which has been eaten, an emetic of twenty grains of Ipecacuanha in half a glass of water should bo given After the vomit a simple laxative should be given. A Seidlitz Powder or Citrate of Magnesia in a dose of a tablespoonf ul in half a glass of water and drunk during effervescence. The diet should be simple for several days, consisting of rare lo:in beef or mutton, milk, eggs, bread, and farinaceous food. Bismuth in doses of ten or fifteen grains should be given (in milk) before each meal. Alkaline drinks should be taken to overcome acidity or irritation of the bowel. Ten to twenty grains of the Citrate of Potash in lemonade every four hours will be sufficient. ui i' ' Xi i-L'd m .j: *i * I .'.:)■ •'I: !i!ll Jf Ui !|i 004 NETTLE BABH. In the chronic disease the cause must be carefully sought out and removed. Articles of food which are found to disagree must be avoided. Sometimes itid necessary to omit one article after another until theoffend- ingone is found. A pure millc diet is sometimes necessary. Bismuth and Citrate of Potash recommended above are often useful. In many instances the Solution of Pepsin and Bismuth (Sheffer's formula,) in'dosos of a dessertspoonful before eating, should be tried. If the patient is rheu- matic or gouty Wine of Colchium should be tried in doses of a teaspoon- ful one or more times a day, to produce tf slight action on the bowels. "When causes iu the stomacli or bowels are excluded, Fowler's solution in doses of three to five drops after meals should be tried ; the remedy should be omitted for a time if it causes puffy lids, watery eyes, or abdominal pains. If the disease occurs periodically Quinine should be given in doses of five grains three to six times a day. The presence of fleas and insects as causes should be sought for. A solution of Corrosive Sublimate in half a pint of water, is a useful appli- cation where the disease depends on the bite of insects. Bathing with vinegar and water is often beneficial, or sponging with a tablespoonful of Dilute Nitric Acid in a quart of water. HOMEOPATHIC TREATMENT. In acute cases, the remedies found most useful are Dulcamara. Aeon'*' Nux-vomica, Pulsatilla, Antimonium- crudum, Belladonna, Hepar-sulpiiuns, Rhus-toxlcodendron and Bryonia. Dulcamara, when the exciting cause has been cold or damp; when the affection occurs in wet weather, or when we find considerable fever, with bitter taste in the mo"th, foul tongue, diarrhoea, pains in the limbs, and extreme itching, with a burning senr,ation after scratching. Aconite when the febrile symptoniM are more intense, the pulse high, the skin hot and dry, and great restlessness and anxiety are present. Xux -vomica when thore is considerable gastric derangement, with constipation, more especially when arising from wino, stimulants, or indi- gestible substances; it mr.y, if necessary, follow Aconite in eight or twelve hours afti-i Ihh tJr.Ati symptoms are somewhat modified. Pulsatilla leserves a preference, under similar circumstances, when the bowels are relaxed, and the patient is ot a quiet disposition, and lym- phatic temperament, and the attack has apparently been excited by indi- gestible food. Antimoniimi-crudutn may follow Pulsatilla should the latter have failed to relieve the aflTection. Belladonnais indicated when the affection is attended with a severe throbbing headache, with redness of the face. Hepar-stilphuria has frequently been found useful in urticaria accompanied by cold in the head, and particularly when the coryza (dis- charge from the nose,) was confined to one nostril. Jlhiis-toxicoflendron is one of the most useful remedies in a great majority of cases of this eruption, and especially when the affection ]u\h apparently arisen from some idiosyncrasy of constitution, in which the eruption has been thrown out by the use of some particular article of food. Prescription. In ordinary cases, we may prescribe 6-12 globules, of / f DISEASES OP THE SKIN. 501 the sixth dilution in six dessertspoonfuls of water, and order one to be talcen morning and evening, except in the case of Aconite, wliich may be more frequently repeated, wiien tlie febrile symptoms seem to demand it. In this, as in every other cutaneous eruption, great care ought to be taken against driving it inward, by external application or lotions; a sudden retrocession, as noted under Scarlatina and Small-pox, being fre- quently attended with fatal consequences. When, however, from inii)roper treatment, we have reason to dread tliis having tali'jn place, we may generally succeed in re-establishing the eruption, and thereby avert- ing any dangerous consequences, by the employment of Bryonia in repeated doses. Should, however, marked cerebral symptoms declare tlicniselves, the complaint should be treated as described under Scarla- tina. Urtica Urens has been found useful in some cases; and in those of a clironic or extremely obstinate character, Calcarea, Lycopodium, Sul- pjiur, Catb.ve;/., Causticum, Acid, nitric, Conium, Natr. mur.,etc., the last two, particularly, wlien the eruption is liable to reappear after violent exercise or exorliou of any kind ; Calcarea, when exposure to cold fresh air produces it; and Acid, nitricum when it arises from the patient going into the open air, after having kept within doors for a day or two. HOME REMEDIES. Whenever the eruption appears, rub the body with wheat flour, and let the patient drink freely of hot teas (Sage, Sassa- fras, or something similar). Warm saleratus water is a good application for the skin. !,! ^k\ m * { INftj.'l DANDB UFF— PITYRIASIS. Pityriasis is a throwing off of the skin, either in thin scales, or in larger patches; it may or may not be accompanied by some other affection of the skin, and tiie skin thrown off may, to all appearance, be perfectly sound ; or else the process may be accompanied by trifling local or more extensive symptoms of thickening of the skin. According as tlie skin is un- changed, or looks red under the scales, the affection is designated as pity- riasis simplex or rubra (red). The causes of this affection are very obscure: in some cases the disease can be traced, with some certainty, to a derangement of the functions of the liver, and of the female sexual organs. Pityriasis rubra, when spread over more extensive portions of the skin, not unfrequently sets in with slight febrile motions, which may break out at every renewed appearance of the exanthem. On portions of the skin, which itch and burn very fiercely, large red spots of indefinite and irregular shapes make tiieir appearance. Accompanied by a pecu- liar feeling of tension, the skin on tliese spots very soon begins to exfo- liate. Tlie eruption first manifests itself on the trunk, and only invades; the face, if exceedingly severe. Thealmost inevitable itching may cause a moisture to ooze from the otherwise dry spots on the skin. This itch- ing, which is absolutely agonizing, very commonly interferes with tlie sleep. The affection is very obstinate, but at the same time one of the rarer forms of cutaneous diseases. Pityriasis, confined to isolated spots, is much less frequently of the §\M ■b ' S M •f ' 606 DANDRUFF, 1lli>« m> -ill Lis character rubra than a general pityriasis ; it is most commonly met with on (he hairy scalp, in the palms of the hands, on the soles of the feet and In the face. The itching is much less distressing, hut is still very violent on the hairy scalp. By scratching the skin till it tears, a moisture is secreted from the irritated spot, resulting in the formation of superficial scurfs and crusts, and agglutination of the hair. In treating a case of general pityriasis, we must not forget that we are dealing with a very chronic aflfection which never promises rapid sucress, and where it would he, c .isequently, improper to make a fre- quent change of medicines, or to repeat the dose too often. The most inijjortant remedies are Graphites and Arsenicum, with which it is most likely that a cure can hest he affected. The attack may be modified in any and every degree, fiom that just described to that resulting only in the throwing oft' of small, dry scales from the hairy scalp. The treatment is one of the most difficult known to the profession of medicine only on account of its tediousness and the abC'Olute carelessness of patients who moi'e than half the time neglect to use the means which tvould cure, if used as directed. Sepia is, particularly, indicated in the case of females, if the spots breakout in consequence of menstrual irregularities.or at definite periods- of the year. ALLOPATHIC TREATMENT. For dandruff, there is no more efTect- ual application tlian keeping the scalp clean with a strong solution of Borax. Frequent daily (or often enough to keep off the scales) shampoo- ing witli a mixture of ecjual parts of Soft Soap (Sapo Veridis, made of Olive Oil and Caustic Potasli) and Alcohol, is most useful. Washing the head .with weak alkaline solutions is, also, useful. After each washing of the head, the hair should be well oiled to pre- vent the skin becoming too dry. Olive or Almond Oil, scented to suit, are appropriate for this. If the scales are thick, the use of a five per cent solution of Oleate of Mercury is very beneficial. An ointment of fifteen grains of Red Oxide of Mercury, or thirty grains of the White Precipitate, with an ounce of Lard and half an ounce of Sweet Oil, is beneficial. In old cases, with no derangement of the stomach or bowels, three drops of Fowler's Solution should be given after each meal. Derangement of digestion, or other indisposition, demands suitable treatment. HOME REMEDIES. Dissolve Salts of Tartar two drams, in one pint of clean rain water. Hub some of tliis upon the head until a lather is formed, and thoroughly cleanse the scalp from sill particles of dandruff by continued ruljbing. Then wash in clean water, and dry the head and hair as thoroughly as i)ossible. Continue this for a few times, as often as an accumulation of dandruff is noticed PSORIASIS— SCALE Y TETTER. This is pre-eminently an affection of the male sex; in the case of fe- males, it is never attended with sexual disorders. It attacks individuals between the seventh and fiftieth year, and occurs most frequently in the DISEASES OP THE SKIN. 601 cold season. It cannot be traced to constitutional derangements, since persons who are afflicted witli tliis diseaso, otlierwise, enjoy me must per- fect healtli. With the appearance of some constitutional disease, the pso- riasis disappears at once, but returns again as soon as the disease is removed. Psoriasis begins thus: At various, more or less numerous scattered spots, tlie detaclied epidermis (slvin) forms a small, white rising (psoriasis punctata). These spots gnKlually spread until they reach the size of drops (psoriasis guttata;) on removing the scales, we :ind the skin underneath slightly red and bleeding. In proportion as tlie circumference continues to expand, the original spot becomes cleansed of its scales, and a ring forms surrounding a healthy-looking skin (psoriasis annularis;) in the fur- ther progress of the exanthem, this ring opens, loosing its roundness (pso- riasis gyrata) and fiu'illy disappearing altogether. All these stages, or most of tliein, co-exist side by side in almost every case of this disease. Psoriasis is not attended with itching, or, at most, only at the com- mencement, but in no case if it has become an inveterate disease. It may remain stationary, though breaking out in n.;W places, or it may intermit on its manifestations for months and even years. Among external remedies which are never hurtful, and usually effi- cient, is the vapor bath, accompanied by frictions with castiUi soap, or brown soap; cold bathing is of decided benefit, but its effects are not at nee perceptible. ALLOPATHIC TREATMENT. The treatment!of psoriasis ought to be under the direction of a physician. The principal remedies which are use- ful, and sometimes curative, given internally, are Arsenic and Cod Liver Oil. The dose of Arsenic should be small— generally three drops of Fow- ler's Solution is sufficient — given three times a day, after meals. If tlie eyes become watery, or the lids puffy, or a silvery coat upon the tongue occurs, the dose of the Solution should be diminished to two drops or even one drop, if necessary. Tlie other remedies which are often useful are Quinine, Iron, Phosphorus, Iodide of Potassium, and Colchicum. The two remedies first named are, generally, applicable. The Quinine, in doses of one or two grains, and the Iron, in doses of a grain, three times a day. When other remedies are needed, will be determined by the physiciau, who should see the case once or twice a week. Bathing with Juniper Tar Soap, and, also, the use of Ointment of Liquid Pitch, are useful external applications. SYCOSIS MENTAGBA-BABBEB'S ITCH. This is, exclusively, a disease of the male sex. If persons who do not shave are attacked by it, which is a very rare occurrence, its causes are very obscure. In cases where the beard is shaved, the eruption may be caused by bad or irritating soap, or by a dull razor, but is almost always the result of shaving by a careless and uncleanly barber, who does not properly clean and scald his razor, and, although generally so frightfully obstinate, yet may heal spontaneously, even witiiout much loss of time; all that need be done is to omit shaving the affected parts. Dirt and snui? likewise seem to occasion sycosis (barber's itch). il' 'I* w M' ' ^iaC '' h ¥ I *» .- ' !l ^r ■H.:: » fjjfit •08 COPPEK-NOSE, BOTTLE-NOSE. 'I'M. :!' III! i'iiii The disease gener.ally sets in, like herpes hvbialis (cold blisters,) with :i Bensation of burninfj, heat and tension ; most commonly, we first notice on the chin a small cluster of isolated, red knobs or pimples (tubercles) of a pretty larpe size, each of which is perforated by a hair. Some of these tubercles, in a few days, change to pustules, break and form dark crusts, without the infiltration,"which forms the little tubercle, disappearing on that account. In spite of all care, and, generally, in consequence of con- tinued irritation, the number of tubercles increases slowly, but uninterrup- tedly, the former ones growing larger; the skin upon which they are seated, becomes more and more infiltrated; after breaking, the pustules change to ulcers. The patients do not complain of much pain, but their ugly appearance fdls them with anxiety. The disease is extremely obstinate, and may last for years. It is true that it not unfrequently abates in sever- ity, and, at times, even disappears altogether ; but it breaks out again witli renewed fierceness, and in such a case, in more than one spot simultane- ously. Its first apiiearance is almost always on the chin ; it is here that the disorder exists most commonly in its fiercest intensity, but if likewise invades every other bearded portion of the face, and, in severe cases, even the eyebrows. Fifteen grains of Carbolic Acid to one ounce of Glycerine, applied in small quantity after pulling the hair out of the centre of each tubercle, every day twice, after thorough washing with good soap, is a very certain cure. ALLOPATHIC TREATMENT. Removal of the diseased hair, by ex- traction with a pair of forceps, a few at a time, is the first requisite after subduing the inflammation with warm poultices. Then the application of an ointment of Carbonate of Copper two drams to an ounce of Lard, will complete the cure. The Oleate of Mercury: or a solution of Corrosive Sublimate fifteen grains with Muriate of Ammonia thirty grains In eight ounces of Distilled Water; or a dram of Sulphate of Copper and four drams of Sulphate of Zinc dissolved in a pint of water, are effectual applications. The general health and state of the bowels require attention. AC y A ROSACEA, OUTTA ROSACEA— COPPER-NOSE, BOT- TLE-NOSE. Acna Rosacea is an exanthem consisting of tubercles with some dis- position to suppurate; suppurating, tubercles; and, moreover, of contin- ual venous congestion. It almost always commences at the tip of the nose, whence it spreads over the nose and over both cheeks, finally, over the forehead and rest of the face. First, we notice a spot of small extent, painless, and distinctly traversed by dilated cutaneous veins. Upon this base single tubercles start up, which sometimes suppurate at an early period, but likewise .si)read in size after the i)us is discharged. New tubercles keep constantly lorming, new spots keep constantly breaking out, the skin becomes more and more thickened, the veins become more and more varicose, the iso- liiti'd little blotches change to large tubercles, cracks and deep rhagades, and even ulcers make their appearance, and the face looks very much DISEASES OF THE SKIN. 50^ disflgured in consequence of this extreme development of nasal exan- tlieni. At first, the affection has remissions, hut the dark reiiness never disappears entirely ; at a later period the disorder keeps growing all the time. Abuse of wine and spirits is the cause of the disease in l)y far the larger number of cases; but it likewise breaks out on individuals of very moderate habits, as drinkers. Among women the disease in of rare occurrence, and only among drinkers of spirits, as a rule, and associated with menstrual anomalies. The disease is not often seen previous to the twenty-fifth year; its most frequent occurrence is after the fortieth. Overheating the system and immodeidte drinking are very apt to cause a renewed outl)reak of the disease. It is exceedingly obstinate, and, in its higher grades, is considered incurable. HERPES-TETTER. All forms of herpes (and they are many), are characterized by the for- mation of little blisters, clusters of which are seated upon the inflamed, red epidermis; the vesicles of one cluster breaking out simultaneously and running an acute course. HERPES FACIALIS, FACIAL HERPES. This form of herpes accompanies a large number of fevers and chronic diseases, without exerting any specially modifying influences over their course; except in pneumonia, where this form of herpes is said to con- stitute a decidedly favorable omen. As an independent exanthem, it .seems to manifest itself when indicating the commencement of a catarrhal afle*^tion, provided the catarrhal irritation is not very intense. A first app^earance predisposes, most decidedly, to relapses. Herpes facialis (cold blisters) most generally breaks out on the lips, less frequently on the cheeks, forehead, ears, eyelids. A tension, burn- ingi and a marked sensation of swelling, are experienced at a certain inli' '.rated spot, where the blisters start up amid slight febrile motions and <vn unusual feeling of lassitude. In the face, they are always of :; tolerably large size, but there are not many of them clustered together, they incline to run into one another; the skin of the spot whei'e they in-" located does not show a very vivid redness; sometimes they are pitted or cleft. They contain a clear liquid which soon becomes dim and chango.* to a rather dark scurf thatsoon falls off, leaving for some time, a red, some- what infiltrated spot; burning pains, likewise, remain for some time. A few doses of Rhus-tox. will cure this form. ALLOPATHIC TREATMENT. The bowels should be kept open by the use of Roehelle Salts, Citrate of Magnesia, or Seidlitz Powders. If the health of the patient is not vigorous, two grain doses of Q,uinine (or some other preparation of Peruvian Bark,) should be given three times a day. The Ointment of Subacetate of Lead is a useful local application, or the Oxide of Zinc Ointment may be used. If the disease becomes chronic, Fowler's Solution, in doses of three to five drops, may be given after each meal. If the eyes become watery, or the lids swell, or the tongue has a silvered coating, the dose of Fow- Jer's Solution should be diminished- I 81& RINGWORM. i ,■ I' 8HINGLES-TTERPES ZOSTER, ZONA. I'hifl form is charactorizcd by the development of clusters of blistera (vtrsiiiles; ot which there jire, generally, several, along the tract of one'or niorespinai »ierves, aasuniing, on the trunk, the shape of a zone or belt, but, on tlie extremities, brealiing out in a more irregular form. Sluiigles commence almost without an excei)tion witii rheumatic pains in the parts wnere it is to break out, and is often attended with great las- situde and sever. The preliminary pains are not unfrequently like inflam- matory pains. iVilh violent and painful burning, an efllorescence breaks out, after which pimples without pus arise, next clusters of vesicles (blia- rers) with a tendency to run into one another. These vesicles remain out \t)r four to SIX days, after which tbeychinge to flat scurfs. Butasanewclus- ,,er may arise after the first, and these successive crops may continue, even utter the first vesicles are entirely healed, the whole process may last even vriree weeks. Tt Is vbry seldom the case thatscratching|or the friction of the Ctothes will < iiise a ^uper{icial ulceration. There m;iy he no i)ain during tne contiiuiiUice, except the slight burning attending the successive break- ing out of new crops of vesicles; but the greatest distress to the patient is the burnim,' itching which is especially severe in bed. After the falling off of the crusts all pain isgone.or the peculiar itching may perhaps continue for some time, or (inally — and this is not by any means a rare occurrence — intercostal neuralgia of a very obstinate typo may set in, apparently the more readily the less scantily the herpes was out on the skin. HO.>I(E()!'ATHI(^ TREATMENT. Merzereum is to be relied on, giving four dos<'s d :iiy, six i»ills at a dose. HO.HE 'I'REAT.VENT. Take green rye when about six or eight inches high and stew it into a salve with fresh cream. Apply this to the part every morning and evening till cured. Always wash the part with castile soap suds and dry it each tiniB before using the salve. ■!<»» RING WORM. HERPES IRIS AND CIRCINNATUS, Herpes iris consists of a larger blister, which is not unfrequently filled witb a blood-tinged liquid, and i.s surrounded by a wreath of smaller vesi- cles, around whose external border another and larger wreath may form. Tlie course is the same as that of other herpetic vesicles. The 'iffection first appears on the dorsa of the feet or hands, spreading on the extensor- surfaces from below upwards, and the new clusters of vesicles appearing either in the same relative position as the vesicles of herpes generally, or else again assuming the form of herpes iris. This form of herpes most fre- quently occurs among women and children. Herpes circinnatus, which comes out in the same manner as herpes iris, is distinguished from tlie latter by the circumstance that the central blister is missing, and that only the wreath of vesicles is present. ALLOPATHIC TREATMENT. In the treatment of " ringworm " (her- pes circinnatus) simple measures generally succeed at once, as the applica- tion of a strong solution of Nitrate of Silver, from ten grains to a dram to the ounce; an ointment of ten grains Acetate of Copper to the ounce of Lard ; a live-percent Solution of Oleate of Mercury in Oleic Acid, containing fi !iam of Kther to the ounce; asolution of Corrosive Sublimate two grains HH DISEASES OF THE SKIN. 511 and upward to the ounce of water, or the Corrosive Sublimate Ointment with from ten to twenty giiiin^ of Corrosive Sublimate to tlio ounce; or Tincture of Iodine, will aullice. Tlie,^ applications destroy the parasitic plant which causes the disease. In ringworm of the scalp (tinea tonsurans) the first indication, as in ringworm or scald liead, is th(! same. To destroy the parasitic plant is best done by applying a blistering fluid (Blistering Collodion,) remove the loos- ened epidermis, and then apply an ointment made by mixing twenty grains of Corrosive Sublimate, or forty grains of White Precipitate witii an ounce pf Sulphur Ointment, or some of the mixture given for ringworm. The scalp should be carefully cleansed everyday to remove any loosened scarf- skin which may inte'-fere with the ointment (or other application) reaching the parasite and the application made twice a day. Scroruldus or poorly nourished children will need tonic treatment, as a teaspoonful or more of Cod Liver Oil and a teaspoonf ul of the Coraoound Syrup of Hypo-phosphites daily. It is claimed that the continuous use of Soft Soap (Sapo Veridis) made with Olive Oil and Potash, will cure the disease in two week3. i?\ A ECZEMA-SALT BHEUMo The causes of eczema are either external irritants acting directly upon the skin, or else substances that affect this organ through the general circu- lation, into which they had been absorbed, or finally constitutional influ- ences. Heat, for instance, causes the so-called baker's itch ; and heat, intense cold, salt-baths, mercurial frictions, (Jroton Oil, etc., a number of nu'dicinal agents taken internally, fat food or food giving rise to an unu- sual deposition of fat, scrofulosis, affections of the female organs of gener- ation, varicose veins, and in gfcneral, all kinds of stoppage in the venous system, and a number of ouier similar circumstances and influences uni- formly occasion eczema. Among the direct cutaneous irritants we distinguish: Neglect in attending to the skin, vermin, friction by clothes, continued rubbing of a part, for instance, between the thighs when riding on horseback, and by continued walking. A good example of eczema is obtained by rubbing Croton Oil upon the skin. Upon a red surface a number of vesicles (blisters) or pimples shoot up, which, if carefully guarded, heal in a few days, leaving tlie affected l)ortion of the skin injected. If the vesicles are not protected, if they are scratched or rubbed against by the clothes, they break and crusts form, l)eneath which, if tlie irritation continues, the exudation continues like- wise, or else may be so copious that no crusts can form, in which case the affected part always looks red and moist. Iftheirri ..tion continues, the eczema spreads to the adjoining parts; scratching even conimunicates it to remote parts; tJesides the vesicles, i)ustules form likevvise. Eczema of the legs (salt rheum) really depends almost exclusively upon varicose veins, more especially upon dilation of the small cutaneous veins, whereas the larger vessels may continue in a perf(ictly normal con- dition. This eczema is extremely obstinate, itches most horribly, gener- ally exacerbates in the spring and fall, and is a species of eczema rubruni % i hm Al2 SALT UIIEUi;. ft 1^ '^^' "^ i with occasional formation of pustules and au inflltration of the skin thai makes it look very badly. Eczema seldom runs an acute course ; the extremely acute form of "eczema universale" is very rare; on the other hand, it not unfrequeiitly commences as an acute exmthem, slight fever, but very soon assumes a chronic character. All the different forms of eczema itch moro or less; scratching, which it is impossible to avoid, is a main cause of the onward spread, and the protracted course of the disease. Every kind of eczema may heal and does heal spontaneously, provided the chief requi- site towards a cure, namely, rest in a lying position, and absolute cleanli- ness is attended to. Eczema of the leg and of a cure. -> "* *>* Kx'/^ i Kg^'^' V'i Kl; ■ \ ^B^u ^ 1 ;i. .-•1 scrotum give the least hop6' -.^ ' ALLOPATHIC TREATMENT. In an acute attack of Eczema in a person of robust constitution, the bowels ought to be briskly moved. Tei\ "• grains of Calomel, followed after six hours, by a dessert to u tablespoonfui of Epsom Salts, or Citrate of Magnesia, or a double Seidlitz Powder. This should be followed by ten to flfieen grain doses of Citrate of Potash <■ or Cream of Tartar in Lemonade, a sixth of a grain of Tartar Emetic tj •• should be added to each dose, and given from two to four hours apart. ] •'* If the patient is not strong, Calomel should not be given, but a saline laxative of a dessert to a tablespoonfui of Epsom Salts or Ciliate of May;- \ nesia, or a Seidlitz Powder. This should be followed by Cream of Tartar t,^' in doses of «ten to twenty grains, in Lemonade, from two to four hour^f .• apart. - y The eruption should be poulticed with Flaxseed Meal or Slippery ilnvi* spread thin between very thin layers of muslin or soft linen dipped fjl warm water, spread over the eruption, and covered with oiled muslin. When there is much burning, the following powder, sprinkled on tli'' eruption, before the poultice 's put on, is useful: Take Camphor half ■/ dram, Ether a sufficient qiuintity to powder the Camphor, four drams eadi of Oxide of Zinc and Starch. Mix. Old chronic cases of this disease are known as Salt Rheum. The crusts should be softened by poulticing with Flaxseed meal or Powdered Slii)pery Elm. until they can be easily removed. After the crusts are removed and the surface carefully ..led, the Bsn zoated Oxide of Zinc Ointment should be applied constantly, and all irri- tating applications cease, though an occasional cleansing may be necces- sary. If the secretion does not disappear, or greatly diminisli, one of the best applications which can be made is a dram of Tannin dissolved in an ounce of Glycerine. The ointment may be used again in a short time after the Tannin and Glycerine are used. Tonics will be needed, and the principal ones are Quinine, Iron, * Arsenic and Cod Liver Oil. The Cod Liver Oil may be given in doses of a teaspoonful three or four times a day. The Citrate of Iron and Quinine in two to five grain do-ses, three times a day; it sliould be dissolved in Syrup of Gingei- or Orange Flower Water. These are particularly indica- ted, if the patient is in poor health with impoverished blood. All chronic cases are benefited by Arsenic. It should be given as Fowler's Solution, in doses of three to six drops, after meals. It can be combined with the Citrate of Iron and Quinine, as in the following formula; Take of CitratQ m pp DISEASES OK TllK SKlN. AlA >r- f i tt. 1 . of Iron arid Quinine a dram and a half, Slyrup of Oinger or Oramje Flowar Water four ounces, add Fowler's ISoluliou a dram and a half. Dose: A teuspoonful, three times a day. \ In the use of Fowlei'a Solution, if tlie eyes become watery or the lids swelled, or the tongue has a silvered coating the dose should be diminished. HOME TREATMENT. Take Beef Marrow, Sulphur, Black Pepper, White Turpentine, of ouch eciual parts, mix together and make an oint- ment to apply to the tetter. Another benetieial ointment can be made as follows : Take of fresh .Sheep's-Sorrel leaves, fresh Calendine leaves, and Red Clover leaves and TJowers, each a handftil; beat them up well in good cream or fresh butter ,.. , tlmt has not been salted. Then squeeze oil" the cream or butter, and use •' '*''%?'* *** ointment, applying it over the tetter two or three times a day. \" , - ^.Bathing the affected parts in strong Saieratus water has been known - *^fp'cUre eiftotuaily a number of cases. 'K i I. V! lU \ 1¥ , ■■ ' ■.♦ 4BQTI^FEBnNCULUS-ABSCESSUS NUCLEATUS. >■>*" i f Diagnosis. Round or rather cone-shaped hard elevations of different ■*■'»- ''KJ^jdaes slowly inlkiming and suppurating, discharging matter generally at ,^c^'Jirst, tinged, with blood, but still retaining a portion of morbidly-altered '* W^^-eUular tissue, which may form the nucleus of other elevations after those Svhich appeared first have healed. ALLOPATHIC TREATMENT. The maturity of a boil may be has^ ened iiy poulticing with Flaxseed meal, or powdered Slippery Elm, when it may be allowed to break, and run out into a poultice. Water dressings covered with oiled muslin maybe used instead. Boils which contain pus, and do not come to a head, should be opened. Boils occurring singly, or in crops wliich do not soon suppurate, but remain hard, may be made to disappear by brushing them over with Tincture of Iodine; sometimes crops of them may be suppressed by early resorting to this application. When boils occur in successive crops, it is probable poultices will induce their farther development, and should not be used if tliis appears to be the case. But if they are painful, a poultice, having incorporated In it Stramonium (Jamestown Weed,) or Tobacco, or that lias Lauda- num, or Fluid Extract of Belladonna should be poured upon its surface. A plegget of cotton, saturated with equal parts of Carbolic Acid and Gly- cerine, with, or without one-half part of Fluid Extract of Belladonna, placed over a group of boils, is often efTectual in relieving the pain. Soap plaster is a good application for these groups of boils, but after they open, Resin plaster should be used. The diet should be plain and nutritious. Occasionally a boil can be aborted by touching the inflamed pimple with the Acid Nitrate of Mercury, or the solid stick of Nitrate of Silver. The system of persons having boils requires supporting. For this purpose. Quinine and Iron should be given. The former may be given in sugar coated pills (Warner's,) in doses of from two to six grains three k; '^!>J U it" * }^' . i '■ 'M I fill CARBUNCLB& II « I '•'H iiijlil ^inics a day. When ringinj; of tiie ears Ih produced, the dose shuuld be docrenHcd. Tlio hitter nuiy IxiK'veu with ClUorate of Potush. Dissolve four dnims of Chhrdte of Potash in /our ounces of boiling vxitcr, add three <tnd a half ounces qf simple syrup, ami half an ounoe of Tincture of Chloride of Iron. Dose : A tableMpooiiful three times a day. If the ciiHe does not improve, Iron and ArHenic may \ given hiatead of Iron and Clilorate of Potasli. Take of Citrate of Iro , and Ammonia two drains, Fmnler's isolation eljhty minims, simple syrup one ounce, Anise unter sufficient to make eif/ht ounces. Dose:' A dessertspoonful three times a day. A terth of a grain of tlie Sulphide of Calclcum given hourly, Is claimed to prevent tlie recurring crops of boils. Sometimes a trip into the country is necessary for tlieir cure. HOM(EOI'ATIIIC TREATMENT. These sores yield readily to internal treatment and without pain wliii(5 tlio treatment witli drawing salves is often distressingly painful. No external application need be used, but as soon as the parts Ibegin to look red and cause pain, we give Arnica every two to four hours. If tlie swelling still increases and a small spot of pus has already made its appearance, give Anucaand Hepar Std. in alternation every two to four hours. If the tumor has been allowed to go on so long that pus lias formed deep in, tlu^ sore has become very painful and still does not discharge, but lluctuateson sudden pressure, an incision may be made witli a lancet, after which the pain will cease and the pus run out. Poultices of bread and milk or kindred substances should not be applied too soon, lest the natural development of the tumor should be interfered with. This is the reason why many persons are afflicted witli fresh boils, every six to eight weeks; the acrid matter is not permitted to be fully expelled from the organism. Pork and fat food must be avoided by those who are the subjects of such sores. A single small dose of Sulphur, allowed to act for mouths, will entirely eradicate the tendency to boils. CARBUNCLE. ANTHBAX-FERUNCULUS MALIGNANS- PUSTULA NIGRA. Diagnosis. A livid, bluish, or black spot upon an extended surface, extremely painful, readily running to gangrene, and proving fatal, occa- sionally from the extension of mortification. The disease is attended by headache, thirst, foul tongue, sickness, loathing of food, languor, jactita* tion, (trembling) and sleeplessness. ALLOPATHIC TREATMENT. Carbuncles should be early cut through to their base by a crucical (+) incision and dressed with a Flaxseed Meal poultice or the mixture of Carbolic Acid one part, and Glycerine two parts. After the slough comes away, the ulcer may be washed with a solution of Carbolic Acid lone dram in five ounces of water, or oiled with Olive Oil or Glycerine, containing twelve drops of Carbolic Acid to the ounce. The internal treatment is the same as recommended for boils. The diet should Ix' plain and nutritious, as lean meat, milk, eggs, and simpU starchy articles of food. i 1 DISEASEH OK THK SKIN. filA HOMCEOI'ATHIO TREATMENT. Tho best roinedlea in this af ruction are In the order of their ntiineH: Arw., Sillcea, MercuriuH. Arsenicum i.s, l)y all means, tlie most utiicaclouu remedy, and the more espeeially ho if gangrene is approaching or Ims appeared. Stlicea. VVlien administered in the beginning, In simple carbuncle Ib frequently found sufllcient to efFect a perfect cure. Mercui'ius. Pain, worse at niglit, attended with copious sweats wlilch give no relief. If the strength is greatly reduced by the loss of blood, etc., China, three doses a day for a week, will greatly assist nature. i« ?i ^^'i )\M ••I ' u: h FAVUS. nONEY-COMB TETTER, SCALD-HEAD. This cutaneous affection is characterized by the accumulation of mul- titudes of fungi around the roots of the hairs, hence their excluslveappear- ance on the hairy portions of the skin. Favus is a diseiuse of the lower classes. It only attacks individuals who pay no sort of attention to cleanliness. In other respects such Indi- viduals may enjoy either the most perfect health, or else be of sickly and cachectic constitutions; favus may attack either sex. This exanthem can be transferred to other persons by hats, caps And other head gear, likewise by sleeping in the same bed; it has likewise been transmitted purposely from one Individual to another. A single favus-efflorescence has its origin in the orifice of a soalJ gland in the form of a small, imbedded, not painful papule, which is per forated by the hair, and keeps constantly Increasing in breadth and bight until the characteristic crust finally arises from It. This crust has the shape of a dish, with a rounded central depression and round elevated borders; it has a yellowish or gray tint, without any exudation under- neath, and has a peculiar odor. Theconseqiiencesof favus are partial atrophy of theskln Inconsequence of the crusts being imbedded in it ; eczema occasioned by the scratching ; destruction of the halr^on Ihe aflTected parts; on the otlier hand, this dis- order has no influence flpon the general state of the constitution. Thft disease runs a very chronic course, yet spontaneous cures occur, although very tardily and not without corresponding modifications in the hygienic circumstances of the patients. According to what we have stated concerning the history of the dis- ease, we deem an Internal treatment of It useless and Ineffectual. This can only be cured by removing the crusts in which the fungi are imbed- ded, and by preventing their return. Thesurests means of accomplish- ing this result, Is care and cleanliness. The removal of the crusts is secured by softening them with oil, and afterwards removing them, together with the perforating hair. This is a very tedious but sure under- taking. Every slckly-looklng hair has to be pulled out singly, for the reaaon that the disease has already Invaded the soil In which it grows. Dr. H>le, of Chicago, says this eruption is treated with success in some cases by means of [Tis-versicolor; a cerate is applied to the scalp, and a few drops of tiie Tincture, even as many as twenty, in half a tum- blerful of water, given internally, in teaspoonful doses, three or four times a day n, Pi, J«Ki!i!. m % 4 ■ m ii;}' kill mi^ 610 HONEY -TETTER— SCALD HEAD. ALLOPATHIC TREiiTMENT. In this disease (scald-head— favus) iw in riugworni and tinea-tonsiiriins and barber's itch, the object of treat- ment is to destroy' the parasitic plant occasioning tlie disease. The crusts may be got rid of by poultices or preferably, by constantly applying a mixture of equal parts of Sulphurous Acid and Glycerine. A piece of lint may be saturated with the mixture, laid over the i^art and then covered with oiled muslin. This same mixture may complete the cure, or a solu- tion of Corrosive Sublimate, five to ten grains to the ounce may be used. The hair must be pulled out in the affected part rtnii for a little space around it. The cure is now easy, h''', without which is almost impossible. Tlie food should be good. Two lo five jjrains of the Soiubh^ Citrate of Iron or the Citrate of Iron and Quinine may be given thrift times a day. After the cure is complete the occasional application of the Ohjate of Mer- cury should be made or a hair pomade used, with which has been mixed five grains of Corrosive Sublimate to the ounce: Take of C<>rrosive SuhH- mate,/tve grains, Simple Ointment an ounce, Otto of Rosen threv or four drops. Mix, and use as a hair pomade. HOME TREATMENT. Take of good wood Soot, Saltpetre, and Sul- phur, each one teaspoonful. Lard two tablerpoonfuls ; mix together and form an ointment. Apply to the head every night and morning, first washing with Castile Soapsuds. Another ointment to be made in the following manner is, also, bene- ficial; Take a handful each of Jimson Weed leaves. Yellow Dockroot, and Mullen leaves, Lard half a pound, boil together until the leaves are crisp; squeeze, strain out the Lard, and then add six ounces of Tar. To be applied as an ointment to the head . ITCH—SCA BIES. This contagious, inflammatory affection of the skin is characterized by aa eruption of pointed vesicles, transparent at the summit, and filled witli a viscid and serous fluid, in which lives & very small Insect. These are subsequently mixed with, or terminate in, piwtules. Witii tlie excjep- tion of the face, they appear in every part of the body, but much more freqently and abundantly about the wrists, between the lingers, and at the bend of the joints, etc., and are accompanied by incessant and almost Insuperable itching, without fever. There are several varieties of the "disorder, but it is often very diflicult to distinguish their characteristic differences. ExTEKNAii Treatment. The local application of Sulphur, either in the form of lotion or ointment, should be used. The above method of treatment, combined with the free and freqf nt use of soap and water, undoubtedly suffices, in mild imd recent case remove this troublesome affection; but as in those of longer standing, .„ may be found inadequate to destroy the mites which have now been clearly demonstrated to be the cause (not the result) of the disease, the following course of treatment should be adopted, and will usually succeed in accomplishing a speedy and permanent cure: Let the patie.iu be placed in a hot bath, and the hands, wrists, and other affected parts be well rubbed with fine sand (or a sand ball,) for the purpose of tearing open the p, : wm DISEASES OF THE SKIN, 517 passages and cells where the vermin have burrowed and located them- selves. In persona of tender or delicate skins, brisk rubbing with a coarse towel, after the bath, may be sufficient to effect the required object; but the use of flue sand, or pounded chalk, is to be preferred. When the piitien^ has been dried, all affected parts should then be well rubbed witli a lotion made of Olive or Almond Oil and a few drops of some essential oil, thus: To two tablespoonfuls of Almond Oil add twenty drops of the Oil of Sassafras. The rubbing in, and, if needful, in inveterate cases, the hot bath and frictions, should be repeated every three days for a fortnight or so, or until the cure is complete. When, as is sometimes the case in certain habits, boils are associated with itch, and continue to break out for some time after the removal of the latter, the remedies prescrilied in the article on Boils should be had recourse to. Tlie sudden suppression, by external means, of some of the eruptions which have been mistaken for, or occasionally follow, or have been devel- oped during the existence of inveterate itch, has, undoubtedly, as not nnfre- quently happens in other chronic eruptions, been repeatedly attended with serious consequences. ALLOPATHIC TREATMENT. The remedy for scabies, itch, is Sul- phur, upon goin;^ to bed. The body should be rubbed well with Soft Soap and a little warm water, for flfteen or twenty minutes, then a warm bath for thirty minutes or more, then an Ointment Compound of two parts Sul- phur, one part Carbonate of Potash, and twelve parts Lard, should be tlior oughly vubbed over the whole body, especially to the affected parts. The patient may bathe the next morning. Tliis treatmeii' should be repeated for three separate nights. A solution of Sulphate of Copper— one ounc^to the pint— may be used after the i)athing, instead of the Sulphur Ointment. Clothes should be exposed to the fugaes of burning Sulphur (Sulphurous Acid Giis). ir;i*^!J I l*.rff » M' ABSCESS-PSOUS-PSOTTIS, (Lat. 4/wcectere, to separate,) a collec «f pus in a circumscribed cavity. The causes of abscess are often involves in obscurity, excessive exer- tions, a cold, rheumatism; mechanical injuries, caries of the bones, may be mentioned as p'^obable causes. The name is given to collections of pus in some of the natu "ally existing cavities of the body. Of these we do not propose to treat in this article. An abscess may bo acute or chrDnic, according to the character of the inflammation which produces it. The formation of an acute abscess is ushered in by a sudden, or else rapii^Iy-increasing violent pain, which it is difficult to define. It often radiates upwards or downwsvrds, ind soon produces a stiffness which materially interferes with the natural motions of the adjacent parts, the pain is generally, not always, of a throbbing character, and coon shows redness of the surface, if not t ) deeply seated ; swelling and violent fever is mostly present, attended witu increase in the pulse very marked. Pus forms rapidly, and is often so profuse in quantity '•ji* i\ t m ABSCESS. as to indicate its first appearance by a succession of chills, distinct or sud- denly following each other, called creeping chills, known by the sensation of "little chills playing tag up the patient's back." The fully-formed abscess can be reabsorbed, which is, however, rarely the case. When the pus has formed in considerable quantity near the surface, its presence may be readily discovered by the feeling of "fluctuation" produced by placiiig the fingers of one hand on one side of the swelling, and with those of the other, giving a smart tap on the opposite side. If the cavity formed, and contaning the pus is very deeply seated, it often baffles the skill; of the most experienced surgeon to determine its presence and exact location. The pus usually te.ids towards the surface, which it reaches by a gradual thinning of the intervening tissues: but if these be very resisting, it may travel in other directions, possibly to break into some of the natural cav- ities, lungs, or abdominal cavity, when it will be likely to result in death. It is in these cases that an early incision by the surgeon is especially called for before "pointirg" has taken place. In chronic abscess the pain, redness, fever, and increased temperatures of the parts may be abst" Jt, and for this reason, it is also commonly known as cold abscess. In most cases, its progress is slow, and it may remain for a long time without any increase in size, or any tendency to open through the skin. Usually it is necessary to open it ; this may be done by simply cutting directly into the cavity. Treatment is not surgical, except so far as the necessary slight amount of cutting into the cavity. In the first place, we liave to try to scatter the inflammation before the suppuration sets in, even if this can- not be accomplislied in all cases, it is at all events certain that the spread of^he inflammation maybe prevented by ajipropriate treatment. Th« following is the best : ALLOPATHIC TREATMENT. Ulcers will be benefited by some of the following applications : Ten or twenty drops of Carbolic Acid in an ounce f Glycerine, sometimes half a dram to a dram of Tannin should be added; a strong solution of Nitrate of Silver— forty grc*ins to the ounce— or the solid Stick; a solution of Sulpliate of Copper, three to ten grains to the ounce; Powdered Iodoform dusted over tlie ulcer, is an excellent appli- cation, as is pure Salicylic Acid. An Alum Curd (Alum dissolved in white of an egg) may be used, or if it prove ineffectual, the surface may be dusted with powdered burnt Alum. HOMEOPATHIC TREATMENT. Bell., especially if the fever it. accom'ianied by copious perspiration, and every motion aggravates the pain extr*':aiely. Rhus,, should be given if the fever consists of a burning, dry heat with intense thirst, if the trouble seems to have originated iii a cold, and the pains are worse at night, and when the patient is lying down, or at rest. •■f these two remedies do not effect an improvement, and tlie fever is mingled with chilly creeping" the pulse becomes very much accelerated- and the skin is ''.'. times very ' and at other times drenclied with perspir, ation, we should at once give Mercurius, which is the only .caiedy thai can at this stage arrest suppuration, if such a result can bj accomplished at all. DISEASES OF THE SKIN. 510 If an abscess forms, we give Hepar Sulph., in order to promote the suppuration, for the main point now is to evacuate tlie pus as rapidly as pos- sible and by this means to heal the sore as soon as the pus in discharged. If the opening becomes fistulous, we must be prepared for a very tardy recovery. Sulphur is espcially suited for chronic abscess, and for a tendency to suppuration, depending on a scrofulous constitution, when the pains are stinging in their character, and the pus of a healthy color. •■!v!n if}:H-i WHITLOW OR FELON. Is so well known that no description is needed. As soon as it is sus- pected that one is beginning to appear on the finger, remove the kind of skin lining from the inside of an egg shell in as long a strip as you can and wrap tightly around the affected finger. Tliis will, if used in time, stop the further progress of the disease, but is painful. If it has gone on until pus is already formed, the lance must be applied clear to, and a little way along the bone at tlie seat of pain, being careful that the knife does not cut across any muscle. After it is lanced apply poultices. Among the best of which is a linen pad, saturated with cold water, frequently removed and covered closely with a piece of oiled silk, bladder or similar substance. ALLOPATHIC TREATMENT. The earlier the periosteum (membrane covering the aflfected bone) is divided with the knife, the sooner will the patient have relief. Saving the bone depends on the promptness of this measure, and serious difllculty is prevented by early resorting to it. Subse- quently dressings are the same as for Carbuncles or Bolls. CHILBLAINS. External Treatment Tincture of Arnica may, in many cases, be advantageously applied externally to the parts affected simultaneously with the internal exliibition of the same medicine, in repeated doses. Application: To five parts of water add one of the concentrated Tinc- ture of Arnica, ardbathethe parts freely with this lotion, three times a day. Tincture of Canttiarides. In recent chilblains, induced by expo- ture to intense cold, this remedy may be applied externally with great success. It operates against the formation of vesicles or blisters, and aids in subduing the congestive action. AppHcntlon: Add four drops of the tincture, to two tablesi)oonfuls of water, and bathe the parts witli the lotion three times a day. Tincture of Causticuni is to be preferred to either of the foregoing for broken chilblains of old standing, and for those cases in which the ulceration has eaten deeply into the flesh. Application: Add four drop>' of the Tincture to two tablespoonfuls of water, and apply the lotion as directed for Cantharides. ALLOPATHIC TREATMENT, Useful applications for chilblains are: Take of Carbolic Acid a dram, Si;nple Ointment (or Lard) two ounces. Mix for an ointment ; the surface may be painted with Tincture of Iodine. Equal parts of Turpentine and Chloroform will give relief. ,, Ij;", ;Mj Iis-Jiivj I iil 'n^i if ill v., ^w m'r: 'M m S20 FROZEN MMBS. CORNS. FROZEN LIMBS. Application OF Snow. In slight cases m "frozen Angers," or other limbs, or portions of the body, the well-known practice of applying snow to the affected parts, is beneficial. Camphor (Saturated Tincture). Wlien Snow cannot be procured, this is a valuable substitute. For young cliildren this is more particularly applicable, especially when the face is the seat of the injury. Application : To five parts of Spirits of Wine add one of the Tincture of Camphor, and bathe the parts with this lotion freely twice a day. Acidunt-nitricum is a most efficient remedy in severer cases, both for internal and external exhibition. Dose: Of a solution of six pills to the wine-glassful of water, give a teaspoonful every three hours. Acidum-nitricum {externally — second diluthn). This remedy may simultaneously with its internal administration be applied externally. Application: Add four drops of the Tincture, at the second dilution, to two tablespoonfuls of water, and bathe the parts with this lotion three times a day. If convenient, it were preferable to saturate a piece of linen rag with the lotion, and to apply it to the frost-bitten part, covering the whole over with oiled silk. Diet and Regimen. Plain, wholesome, nutritious, but unstimulat- Ing diet; a sufficiency of active exercise in the open air; free ventilation; frequent change of linen; the free use of cold water CORNS. That these troublesome excresences not unfrequently arise from an inherent vice of constitution, is evident, from the fact of many individu- als who wear tight boots and shoes (unquestionably the principal exciting cause) escaping them, while others, with every precaution, suffer severely; sucli being the case, the main object must be, by a course of properly-se- lected internal remedies, to eradicate the predisposing cause or conditi(m. After removing the corn, which has boon destroyed by the application of Acetic Acid, the place where it was situated, must be relieved from pressure. For this purpose corn plasters of variows sizes, having holes in the center, may be obtained or made fnnn the soft felt of an old hat. Palliative Treatment. Great alleviation of suffering hsis been found to result from bathing the feet in warm water, and from subse- quently resorting to the following application- Tincture of Arnica, A lotion composed of a weak solution should be applied to the corn, after it has been previously soaked in warm water, after being pared down with great care. The skillful reduction of the corn by an experienced operator, may likewise be mentioned as a ready and prompt palliative treatment. E(iual parts of Spirits of Ammonia and lemon juice applied twice daily, after thoroughly soaking the feet in warm water, is excellent. mm, ( ■ I»i*LJEl.T TTVELFTH. %i CONSTITUTIONAL DISEASES CHAPTER XXVII. ACUTE CONTAGIOUS i)lSEASES. MEASLES— MORB ILL Measles attack individuals of every age and sex, but least frequentlj very old people and infants. Inasmuch as almost everybody has an attack of measles in his early youth, tiiey are on this account seldom met with among old people. One attack of measles generally protects persons against a second one; exceptions, however, are not very rare, although it behooves us to guard against mistaking roseola for measles. The ordinary season for measles are tlie months when catarrhs are common, from October till April. Symptoms and CounsK. The incubation-period of the measle-con- tngium, until the efflorescences break out upon the skin, is eleven or at most twelve days. The general health does not seem in the least dis- turbed in the first eight to nine days of this period ; definite preliminary symptoms show themselves in the last two or three days- These prelimi- nary signs are falsely said to have been noticed at an earlier period; but as catarrhal affections are very prevalent during epidemic measles, it is very likely that purely catarrhal symptoms have been mistaken for the prodromi (premonitory symptoms) of measles. Tiie prodromi proper begin with a slight catarrh of the nose, lassitude and some fever. This fever increases considerably on the second day, front il headache super- venes, the eyes look red, are sensitive to the liglil, l)ia the conjunctiva is seldom puffeil up. On the third day there is another increase of fever, the patients feel unable to sit up, the tongue is thickly coated, the appe-. tite gone, and in the night from the tliird to fourth day, immediately previous to the appearance of the exantliem, a hoarse, barking couijli sets in resembling croup, which, however, is scarcely ever attendi'd with the danger that generally ciiaracterizes croup and never changes to true croup. These symptoms may increase to a considerable degree of \ntensity, may be associated with vomiting, delirium, sopor; at tim^s however, they are entirely wanting, or so slight that it is not deemed 621 I: %i \ ■ Ife ,.|- \f.: ii' ^ M \ w til ':■% ««!'!; .•w MEASLES. ^^'l:'- necessary to confine children to the room. This is the reason why the measles spread so rapidly through the schools, for it is on the day previ- ous to the breaking out of the measles that the infectious principle is most active, and tliat the measles are most easily communicated. We account for this circumstance by the fact that in the hist twenty- four to twelve hours previous to the appearance of the exanthem upon the skin, distinct, lentil-sized measle-spots are perceived, in almost every case, on i,he sides of the fauces. Without doubt, it is the extension of these spots to the larynx and trachea that causes the peculiar croupy cough, and we have always considered it an excellent diagnostic sign to find this cough associated with red spots on the palate, in which case we were able to positively predict the ajipearance of the eruption within twenty-four hours. In other respects, the prodronii have no distinctive peculiarity from which the character of the oxantheni might be inferred ; it can, at most, only be suspected after several cases had already occurred in the place, or in its immediate vicinity. The measle-exanthem breaks out gradually, in one case more rapidly than another. The first spots fvlways show themselves in the face, niosl commonly on the cheeks and temples. They are of the same size, of a bright redness and with rather sharp outlines; after being out for a short time, they become somewhat raised above the skin and harder. With more or less speed, generally within twenty-four to thirty-six hours, the exan- them comes out over the wliole body from above downwards, and is fully out in forty-eight to sixty hours, so that no new spots appear; up to that time, new spots had continued to break out in addition to tlie first spots that were more or less scattered and isolated. The spots keep growing in size to such an extent that some of them run together, and the nor- mal skin, in the place of spots, exhibits here and there irregular red patches. In proportion as the exanthem comes out more profusely, its color gen- erally grows darker, sometimes with a bluish tint. With th(! fuller devel- opment of the eruption the constitutional symptoms most commonly increase in intensity. The catarrh of the conjunctiva and the cough, es] e cially, grow much worse. The pulse sometimes increases to one hund/ei and forty beats. Sometimes the skin is dry, but at other times covered with perspiration. In very rare cases tlie constitutional equilibrium remains undisturbed, even during the eruptive sta<re; however, in every considerable epidemic a child with measles is occiisionally seen running about the streets. If the exanthem runs a mild course, its decrease commences at the eml of the third day, seldom before this time, and continues willi great rapidity until the eruption has entirely disappeared. Tlie spots grow smaller, assume a distinctly yellowish tint, which is especially marked on pressnre with the finger, and within twelve to twenty-four hours the spots have completed their disappearance without leaviiig a vestige of their existence Very frequently, however, the yellowish tint remains for several days. Tlie fever declines very speedily, but the bronchial catanli most generally ct-n- tinues for a few days longer, and resolution somel;imes does not take place until a considerable quantity of mucus has formed. Not unfreqnently tli's patient is at this period attacked with diarrhoea for one or two days. Pro- ACUTE CONTAQIOUS DISEASES. fuse perspiration is not the rule, but is not by any means an unuanal occurence. Desquamation (peeling off) commonly commences on the seventh day, but may delay until the fourteenth. The skin comes off in bran-shaped scales, very seldom in larger patches; in the face and on the extremities the desquamation is most distinct. During this period, the general health is generally good ; except that the bronchial catarrh and still less frequently the diarrhoea may continue to some extent. Among the malignant deviations we name th« following: The spots when first coining out, are of a pale-red color, which do not increase in intensity, nor do they acquire the yellowish tint. Within / the spots liemorrhagic appearances are manifested, and between the spots ecchymoses are noticed. The spots fade away soon after their appearance, or else they fade very suddenly at the regular period or before. In the case of children the pulse exceeds one hundred and forty beats, and in the case of adults one hundred and twenty treats; moreover it is a small pulse. The tongue is dry. Angina tonsillaris. Diaphoretic mem- branes form in the buccal cavity. The respiration liecomes hurried and superficial . Sopor and delirium after the second day of the eruption. Of great importance are certain complications of measles, that are very apt to occur and which were formerly regarded as metastases, because the exanthem disappears with the appearance of these complications. Laryngitis with croupous exudation is of rare occurrence while the exan- them is still out; it is more commonly met with after the exanthem has left the skin. A slight bronchitis is an accompaniment of every case of measles ; it only assumes a dangerous character, if it continues beyond the stage of decline, or reappears again during the stage of desquamation, or otherwise assumes a very acute form. It is very apt to run into an exceedingly obstinate chronic catarrh. Enteritis (inflammation of the bowels) is a rather frequent complica- tion in some epidemics; it excites legitimate apprehensions, for the reason that other consecutive diseases, more pafrticularly scrofulosis, are apt to follow in its train. Affections of the brain are rare; their intensity is rarely such as to excite apprehensions; the supervention of sopor is a bad sign, because it may usher in a fatal general paralysis. Of the liighest importance are likewise the numerous and always obstinate sequelse (results of the disease) of the measles, which make this exanthem one of the most malignant, whereas, its ordinary normal course and character entitle it to be regarded as one of the most harmless. Among these sequelae we distinguish : Chronic conjunctivitis (inflammation of the eyes,) with impaired vis- ion; chronic ostitis, with deafness; chronic ozaina; oiironic inflammation of the lymphatic glands, mostly without suppuration; chronic inflam- mation of the parotid and submaxillary glands. Chronic bronchial catarrh, which gives rise to a peculiar spasmodic cough; or real whooping-cough, which is nnu-h more sevoreas a sequel.'e of measles than when setting in at other periods, and which very often developes a most dangerou . pneumonia- After measles, children are very frequently attacked with scrofulous symptoms. It is very likely that, in the case of little children, the mea' fe I 'lit m " ? ,mi' I m. ' " M ll 1 m % llt.'Bi! 'I 'hiMf ,■.),!■) 624 MEASL.K8. sles simply act as an exciting cause of scrofulosis ; but it is lilcewise among larger ctiildren ttiat, after an attaclc of measles, all sorts of ])hcnoniena maiie their appearance, wliich we are in tlie habit of designating us Hcrof- ulous, and wliich go to show that a morbid change has been impressed upon the whole activity of the organism. Tuberculosis (consumption,) likewise, frequently breaks out after measles. ALLOPATHIC TREATMENT. In mild cases of uncomplicated measles the treatment will contest of good hygiene, and the relief of such symp- toms as annoy or give trouble. Tlie patient should be in a large, well-ventilated, but somewhat dark- ened room, with a temperature wliich will be comfortable for attendants to sit in— sixty-eight or seventy degrees— and should be uniform day and night. Such a temperature is comfortable, and in it there is no danger of taking cold from temporary or accidental uncovering of the j>atient. The diet should be light and simple, consisting of milk, or milk and water, raw eggs lieaten up with sugar and water, gruel, toast, and such other farinaceous articles as the patient desires. Any simple drinks, cold water, lemon, or orangeade, gum, barley, or ricewater, llaxseed tea, etc., may Imj allowed as freely as desired. Emetics and cathartics are not to be given, but If the bowels have not moved for a couple of days, an iniection of warm water or a laxative dose of Castor Oil (a dessertspoonful,) or Citrate of Magnesia (a teaspoonful to a dessertspoonful for older children,) sliould be given. The injection is to be preferred, on account of the irritable state of the bowels. Remedies are indicated for tlie relief of the bronchitis and cough, or restlessness. Opium and Hyoscyamus are best suited for this. From Ave to ten grains of Dover's Powder, witli lialf agrain of the solid Extract of Hyoscyamus, or fifteen to twenty drops of Laudanum, witli an equal quantity of Fluid Extract of Hyoscyamus, may be given from two to six times in the twenty-four hours. For children, opiates may be given as directed for Bronciiitis or Pneumonia. Owing to the danger from severe bronchitis or pneumonia, it is l)est, in severe cases, to iiave an oiled mus- lin jacket worn over a flannel shirt. A malignant form of the disease will require tonics and stimulants. Of these, Quinine may be given in doses of half a grain to three grains, three to six times a day. If the imlse is weak. Carbonate of Ammonia in doses of one to ten grains, in half a teaspoonful to a tablespoonful of Spir- its Menderus, two to six hours apart. Brandy is Hiinilarly indicated, and should be given in liquid food, in doses of liulf a teaspoonful to a table- spoonful, or more, according to tlie age of the i)atient and severity of the symptoms of prostration, and may be given from three or four times u day to hourly. For liigb fever, with a strong, bounding pulse, no remedy acts better than Aconite. A drop of the Tincture can be given, to an adult, every hour until an impression is made on the fever, and then at longer inter- vals, to maintain tlie effect. When the erui)tion is especially irritating, much relief will be afforded by oiling the skin as in scarlet fever. Complications of any kind should be treated as directed for the special diseases, bearing in mind that supporting treatment only is appropriate ACUTE CONTAQIOUS DISEASES. 82b for serious coin plications. Tlie precautions directed by the New Yorlv Board of Health, against the spread of scarlet fever and measles, should be observed. An unusually high fever, when there is no sweating, will be benefited by a cool sponge bath or wet pack, Sleeplessneas, which is not relieved by the Opium or Opium and Hyoscyanius given for cough, may be relieved by giving to an adult twenty grains each of Cliloral Hydrate and Bromide of Potassium in syrup and water in one dose at bed time. A prostrated condition of the system follows some cases of measles, particularly in adults, which favors the development of any diathesis (tendency to disease) which may exist in the patient. Consumption is the most fro(iucnt exposure, and exertion should be avoided for some time after re(!ovory from measles. The debilitated system should be built u]) by tonics of Quinine and Iron, with such hearty food as the patient will take. The Citrate of Iron and Quinine, given in doses of half a grain to a grain to a child, or three grains to an adult, dissolved in Syrup of Orange or Orange Flower Water, three times a day, is as suit- able as any tonic. Other tonics, embracing the same principles, may be given. The Health Board of New York enforce the following Sanitary Regu- jations against Scarlet Fever and Measles: "Caue op Patients. The patient should be placed in a separate room, and no person except the physician, nurse, or mother, allowed to enter the room, or to touch the bedding or clothing used in the sick room, until they have been thoroughly disinfected. •'Infected Articles. All clothing, bedding, or other articles not absolutely necessary for the use of the patient, should be removed from the sick rooin. Articles used about the patient, such as sheets, pillow cases, blankets, or clothes, must not be removed froni the sick room until they have been disinfected, by placing them in a tub with the following disinfecting fluid: eight ounces of Sulphate of Zinc, one ounce of Carbolic Acid, three gallons of water. "They should be soaked in this fluid for at least one hour, and then placed in boiling water for washing. "A piece of muslin one foot square, should be dipped in the same solution and .suspended in the sick room constantly, and the same should be done in the hall way adjoining the sick room. "Feather beds and pillows, hair pillows and mattresses, and flanneli or woolen goods, requiring fumigation, should not be removed from the .sick room until this has been done. Whenever the patient is removed from the sick room, inform the Bureau of Sanitary Inspection, when the disinfecting corps will, as soon as possible thereafter, perform the work of fumigation. "All vessels used for receiving the discharges of patients, should have some of the same disinfecting fluid constantly therein, and Immediately after use by the patient, be emptied and cleansed with boiling water. Water closets and pfivies should, also, be disinfected, daily, with the same fluid, or a solution of Chloride of Iron, one pound to the gallon of water, adding one or two ounces of Carbolic Acid. »^«i I %% H f 62{i MKASLES. "All Htraw beds should bo burned, but must not be removed from the «ick room without a ]>ermit from this Uepurtmunt. They will be removed by the disinfecting corps. *' It is advised not to use handkerchiefs about the patient, but rather soft rags for cleansing the nostrils and mouth, which should be immedi- ately thereafter burned. "The ceilings and sidewalls of the sick room, after removal of the patient, should be tlioroughly cleansed, and lime-washed, and the wood- work and lloor thoroughly scrubbed with soap and water. "As a fumigating, antiseptic, and disinfectant. Chlorine Gas stands, unrivaled. The ingredients used in its production should be in glass or earthen deep di.slies or saucers placed in tlie hiylicr parts of the room. The Gas will descend, being heavier than the air, and become mixed with surrounding air. Tlie following articles are used for its production: One part of common Salt mixed with one part Black Oxide of Manganese, and placed in shallow earthen vcssles; two parts Suipiiuric Acid previ- ousiy diluted with two parts by measure of water, is tlien to be poured over it and the whole stirred with a stick. Tlie room with the infected articles should be thon sliut up tightly, and remain closed for several days. The cleaning, scrubbing, and white washing can then follow.'' HOMCEOPATHIC TREATMENT. ^con/«c, which is particularly indi- cated when tlie fever assumes an intlaminatory form, attended with dry heat of the skin, heat in the head, with confusion and giddiness, redness of the eyes, intolerance of light, general weakness or prostration; when- ever marked febrile or inflammatory action becomes prominent. Dose: Six pills every two to four hours, in water. Pulsatilla is also very efficacious in this affection, and is frequently indicated in the commencement, by the striking predominance of the characteristic mtor;7iaZ symptoms attendant upon measles, further quali- fied by aggravation towards evening. Tliis remedy is of great utility in bringing out the eruption, when it is longer than the average period in making its appearance. Pulsatilla is also valuable when any derangment of the stomach is present, or when tiie cougji, which so generally accom- panies the disease, is worse towards evening or in the night, and is atten- ded with considerable rattling of phlegm in the cliest, or copious, thick, yel- lowish or whitish expectoration, sometimes followed by vomiting or symptomsof approaching suffocation; further, when there is cold in the head with a thick, yellowish or greenish nasal discharge. Dose: Six pills every four hours, in water. Bryonia is an excellent remedy, when the eruption is faint, retarded or imperfectly developed, and the respiration much repressed and laborious attended with achings in the limbs; also, when there is a dry cough and the patient complains of shooting pains in the chest, increased by a full Inspiration. Dose : As for Pulsatilla. Sulphur is, in general, highly beneficial after the active symptoms of the disease have yielded to the action of immediate treatment, and espe- cially after the previous administration of Pulsatilla, particularly when we have reason to suspect a scrofulous or other constitutional taint. Sul- ACUTE CONTAUIOUS DISEASES. 027 phur will, frequently, in such cases, he most elYectlve in eradicating the predisposition to chronica alTections engendered by measles. Dose- Six pills in a tiiblespoonf'ul of water, every morning (fasting) for ten days. CiiKOK OK THH KiiiU'rioN. Tlie disease has frequently terminalcil fatally, from tlie eruption Ixflng driven in by sudden exposure to cold <>r change of temperature. lii'l/onia is generally found elllcacioua in re-evolving the eruption, and preventing disastrous consequences. Do.se: As directed above. Palftatilla is indicated, if looseness of the bowels, with mucous dis- charge, follow the supression. Dose: As directed for Itnjonia. APTEBEPFKCTS OP MEASLES— ^OUQHS. In general, the treatment of such affections will be most effectually conducted by following tiie instructions furnished separately in the arti- cle on "Coughs." LoosKNKss OK TiiK BowELS. Explicit directions on this subject will be found in the article on "Diarrluea." INKLAMMATION OK OU DiSCIIAKOE FROM THE EAKS. (SeO page 195.) Tendeuness of tiie Skin. Mercarius. This remedy, administered for a brief time, is gener^dly sulticient to remove the tenderness which is so peculiarly apt to result from measles . EiiuPTioNS ON THE 8kin. Niijc-voniica is indicated, in cases of this kinu resulting from measles, by the presence of an eruption of minute white grain-like elevations. Done: Six pills every evening for a week. HOME TREATMENT. Measles in their uncomplicated form gener- ally require but little, if any, medical treatment. The patient should be placed in a large well ventilated room, and it is better that he should remain iJi bed, and should have all the cold water which lie desires. The diet should be light, such iis wheat or rice flour gruel, toast water, milk and water, tapioca, sago, or other light food. He may be allowed a more liberal diet, as the fever subsides. The eyes should be excluded from the light. If the eruption be long in coming out, or recedes after it has appeared, apply mustard poultices over the abdo- men, to the feet, ankles and wrists; and if there are symptoms of inflam- mation of the lungs, apply a mustard poultice over the whole chest, which may be removed as soon as decided redness bas been produced. ' •^ ; ii! »< :$£' J SCARLET FEVER— SCARLATINA. This is distinguished from other eruptive fevers by the fact of the eruption being an exanthema, an efflorescence, or a rash; these terms not being strictly applicable to vesicles and pustules. Scarlet fever is higldy contagious, and it may be communicated by means of fomites (producers of contagious disease). The infectious material remains for a long time in garments, bedding, carpets, wall-paper, etc , preserving its power of producing the disease. It is, doubtless, occasionally transmitted '1%?? *ms ,1 IMAGE EVALUATION TEST TARGET (MT-3) 1.0 LI 1.25 turn |50 ^^ i^ IIIIIM I^ 116 i^ M 2.2 2.0 1.8 U IIIIIL6 6" V] <^ /2 7 ^^ v^' ^ '/ /A Photographic Sciences Corporation 23 WEST MAIN STREET WEBSTER, N.Y. 14580 (716) 872-4503 ^ ^J SCARLET t'KVKR. ■ in m Y through tho air at great distances; and, hence, sometimes breaks out spontaneously without any agency of affected individuals, or clothes of any kind. It is difficult to determine the duration of the period from the time of exposure to the contagious principle to the full development of the first well-marked symptoms. Austin Flint, and other recognized authorities, argue that twenty-four hours, often, is the extent; but eight days is generally allowed to be the period in a vast majority of cases. As a rule, the disease is experienced but once; but exceptions are not very rare; the author has known of a case where the same individual has been attacked four times. The contagion is most freely active soon after the appearance of the exanthem. As soon as the fever has subsided, the con- tagious nature of the disease has, most probably, become extinct. Chil- dren are much more susceptible to the special cause than adults. After forty years, very few persons are attacked ; also children, under two years, rarely contract the disease, and many persons appear to be entirely free through life, notwithstanding numerous exposures. The largest number, and most malignant cases occur between the second and seventh year; a much smaller number between the eighth and twenty-fifth year; from twenty-five to forty it is very rare. Scarlatina very often occurs in a neighborhood, either in company with or immediately after, epidemic measles. It also, not unfrequently occurs in company with small-pox. Symptoms and Course. The disease is variable, both in its symp- toms and course, and we will now endeavor to point out the fixed types of scarlet fever: The patients exhibit the symptoms of a severe cold (catarrhal fever,) which unlike measles, is not often attended with a cough, but with inflammation of the throat, and loss of appetite and generally, occasional vomiting ; the pulse is very rapid ; the skin seldom moist. After the preliminary stage has lasted two days, the exanthem makes its appearance, generally with a marked increase of the fever, and other preliminary symptoms. Children are attacked with convulsions at this stage more frequently than at any other. The eruption is first visi- ble in the throat, on the tonsils, etc.; externally, on the neck, whence it spreads downwards over the rest cf the body. First, we notice closely- crowdod red spots (stigmata,) these very speedily run into each other, causing a homogenous, faintly-dotted redness, or else they grow in size, and running together form single spots of a darker color, seated upon a faintly-red skin ; or, finally, small vesicles spring up upon the red surface most generally in consequence of the intense character of the skin afTec- tion. The exanthem is, in cases running a natural course, generally fully out in twenty-four hours after the first external appearance; during all this time the fever has continued as high, or even more intense, than before; the thirst great, the tongue coated, or, cleared of its coat, showing a dark strawberry appearance. One of the most constant of the symptoms of this fever is this strawberry tongue. The urinary secretion is much less; sometimes a little cough makes its appearance how, but rarely assumes a violent form. The throat is very sore, dark red, ahd swollen ; the surface of the body is also swollen. On the fifth or sixth day after the appearance of the eruption, it begins to pale off, with lesseuing of the fever and much more so the sore throat {angina). d r« ti I) "PB?: ACUTi: (X)NrAaious diseases. 5a» Soon after this, the process of desquaniiitioii (])eelingoff,) begins. It alvraj-s begins on tiie necli with small scales; on the body, and more par- ticularly on the hands, the skin peels off in lar^e patches; the itching is now severe, and may be allayed by rubbing the itching parts with some pure clean oil ; the appetite now speedily returns and the patient feela (luite well ; in fourteen days at the latest the desquamation is completed. Such is a plain case, and unless some important variation takes place frequent sponging of the whole body, cooling drinks and pure air, are all the remedies needed. But variations are so frequent that too much watch- fulness is impossible. As soon as a change takes place in any symptom, study, at once, its meaning, and if not fully satisfied as to the result being favorable, call aid without delay. ALLOPATHIC TREATMENT. Rigid isolation should be provided in all cases of scarlet fever, as a precaution against its spreading. They must be watched most carefully in every instance, for some of the most danger- ous complications (co-existing diseases) and sequelm (resulting diseases) occur in those cases, which, from their very mild character, have been left almost, if not entirely to themselves. Competent medical aid should in all cases be called upon the first appearance of a serious symptom, or one that is not well understood or certain to result favorably. Mild cases of scarlet fever do not call for active measures of treatment, but whether the disease is mild or severe, the strictest attention should be paid to hygiene (health rules). To this alone mild cases can be safely trusted. The room ought to be large and freely ventilated. The temper- ature of the room should be carefully kept at seventy degrees, except when the fever is extremely high, it may be as low as sixty-five degrees. The clothing on the bed should not be heavy enough to increase the heat of the body or to be disagreeable to the patient, nor light enough to cause chil- liness. The body linen and the bed linen must be changed every day. After the fever has begun to decline and the heat of the skin greatly diminished during the latter part of the diseas'*, the heat of the room should not fall below seventy degreesday or night. If the child is pale, weak, and chilly the temperature of the room should be kept as high as seventy-two degrees. Chilliness and taking cold must, in all cases, be avoided after the fever has begun to decline and the scarf-skin shed off (desquamation) on account of the liability of causing inflammation of the kidneys and dropsy, the most dangerous complication^ and sequelae we have to contend with. The patient should be kept in bed until the desquamation entirely ceases, nor should he be allowed to leave the house within four weeks. At first light food only should be given, such as milk and its prepar- ations, meat broths, egg beaten up with sugar and water, given raw, arrowroot prepared with milk and water, and gruels, but nothing more substantial should be given during the earlier stages of the disease. Cold water, lemonade, and juice of fruits may be freely allowed. As the fever declines and the patient recovers, the regular diet should be gradually resumed, If, however, there is great weakness or the case has run some time beef essence, juice of meats, egg beat up with sugar and milk should be given frequently and in such quantities as the child can be induced to take. Small (juuntities of wine, wine whey, milk punch or egg-nog .34 «»» 'I, 'I, imk-. M w f\ I l^^" m SCARLET FEVEU. '4 ':' 111? vikttll should also be given. A tejvspoonful of whisky or brandy and two or three tablespoon fu Is of sliorry wine, is a dose for a child one to three years old. One or two tablespoonfuls of whisky or brandy and a wineglassful of wine is a dose for an adult (grown pc ison). In general a tepid bath should be given twice a day, the temperature of which should be ninety degrees, if the fever is moderate, or eighty degrees if very high. The patient is undressed and immersed in the water for fifteen minutes or half an hour, until the heat of the body is reduced and the patient ([uieted. If the batli is not practicable, frequent sponging of the whole body, with tepid or cool water, as the fever is mod- erate or high, every two, three or four hours, or the application of the wet sheet— wet pack — once a day, should be practiced. In the applications of the wet sheet, the sheet should l)e wrung out of cool water of sixty or seventy degrees, according to tlie degree of fever, and the patient, stripped of all clothing, is enveloped in thd sheet and then surrounded with several blankets. Usually after remaining in the pack for about an hour, free sweating takes place. The pack is then removed, the patient wiped dry and placed in bed. When the heat of the body is one hundred and four degrees, or higher, the cold wit pack should always be used, and will render most signal service. If not as high, frequent sponging is pre- ferable in domestic practice. In no case should the bath with water, in any form, be given when the patient is sweating, or the skin moist. When the body is wiped dry, after each bath, sponging, or pack, it should be well rubbed with oil, from head to foot, except the face and scalp. One of the best ointments for this purpose is the following: Take of Glycerine one dram, Rosewate?- Ointment one ounce. Mix. Only that part of the body which is being rubbed should be uncovered at a time, or the whole can be done under the bedclothes. Glycerine one part and Sweet Oil four parts is a good application, or pure Lard may be used alone for the purpose. This oiling of the body relieves the itching and burning of the skin, keeps it moist and soft, and is in a general way, ben- eficial, as is shown by the lowered tv^mperat.re and pulse. It should be applied at least twice a day, even if a bath is not given as often, and con- tinued during tlio stage of disquamation. As a rule, cathartics should not be given, but constipation should be relieved by injections of warm water. For the sore tiiroat, a solution of Chlorate of Potash one dram to the pint of water, of which the patient can drink at will, is probably all that is needed to be done in mild cases. This remedy is beneficial in a general way, as well as giving relief to the throat. If the glands are enlarged (hard lumps about the neck,) Tincture of Iodine may be applied with a camel's hair brush or feather. Wlien the throat is severely inflamed, compresses wet with cold water should be applied to the sides of the neck. They should be changed often, to maintain a uniform degree of cold. Pounded ice may be applied to the sides of the neck, in little bags, if the inflammation of the throat is so violent and the fever high. The solution of Chlorate of Potash, kept cold, should be given often as a drink and a gargle, if the patient is old enough. Small lumps of ice may be held in the mouth, or icewater frequently swallowed. When the violence ACUTE CONTAGIOUS DISEASES. 531 of the Inflammation has begun to decline, or the cold becomes disagree- alile to the patient, or if suppuration (forming ofpu3 or matter) begins, the cold should be displaced by warm appUoations; warm poultices kept on the nock by a light kerchief, or a flannel cloth wrung out of hot water and applied to the neck, well covered with cloths, to retain the heat. If the discharge accumulates in the throat and nose, it should be removed by a soft cloth swab or feather wetted in a solution of Alum, in green tea or sage tea, or Borax mixed with honey and water. When the discharge is of a fetid or suppurative (pus-like) character, the following application should be made to the throat, with a soft swab, three or four times aday : Take ofCarbolio Acid tzoelve drops, Glycerine one ounce. Mix. If the nose is invaded with the inflammation, it should be carefully cleansed, and the same mixture carefully and thoroughly applied with a feather or camel's hair brush. When the secretion from the throat is profuse, BelladonnL is indica- ted until the throat becomes dryer, the pupils dilated or the secretion diminishes. The Tincture of Belladonna is an appropriate form, and may be given in doses of one to five drops to a child, or fifteen to twenty drops to an adult, four to six hours apart. The medicine may be continued just sufficiently often to maintain a slight dryness of the throat. Quinine should be given through the whole course of the disease, from the beginning of high fever until recovery is well established, and the appetite good. The dose is from one to two grains for a child, three or four times in the twenty-four hours; and three to five grains for a grown person, at the same intervals. As soon as the desquamation (shedding off of scarf skin) begins, the I'incture of the Chloride of Iron should !">e given in five-drop doses to a child, and froin fifteen to twenty drops to an adult, three times a day. It should be given well diluted in water. In malignant oases, in which the system is overspread by the disease, denoted by excessive frequoicy of the pulse, the chief reliance is on alco- holic stimulants, in the forms before mentioned, and they should be freely given. Uremia (urea, constituent of urine remaining in the blood) is the most serious result of diseased kidneys, and is indicated by prolonged convulsions, headache, disturbance of the sight, or insensibility, and should be promptly met by a cathartic dose of Epsom Salts— two table- spoonfuls for a grown person, and on'^ to two tablespoonfuls for a child. Free sweating should be produced quickly, by the use of the warm wet pack, or better, by the hot-air bath, once or twice a day. The hot air-bath can be given by putting the patient, 8trij)ped of clothing, in a cane-seated chair, then wrap a large blanket around both the patient and the chair, from his neck to the floor, covering the whole hi tightly, except the pa- tient's head; then burn alcohol in a saucer under the chair until free sweating is produced. Hot flannels should be applied constantly to the loins. The physician should be promptly sent for upon the first appear- ance of any of these symptoms. He will probably give Elaterium for a cathartic. Dropsy will be treated by hot-air baths, or the hot wet pack, once or twice a day. The bowels should be kept open by Bochelle Salts or Castor Hi ■fl!t»3 :w f'" •ii i^ii ,'• " n" ■ « j^i 632 SCARLET FEVER. Oil, in dosesof a teaspoonful fora child, or a tablespoonful for an adult, repeated every six hours until the bowels open. The Quinine and Iron, before mentioned, should be given through this complication. The fol- lowing mixture, to act on the kidneys, is useful : I'ake of Acetate of Potash one dram (or half an ounce;) Tincture of Digi- talis one dram {or half an ounce;) Syrup of Squills three drams {or an ounce and a half;) Water two ounces {or eight ounces). Mix. Dose : A teaspoonful every four hours to a child, or a tablespoonful to an adult. Use the smaller quantities in filling the formula for a child, and the larger for a grown person. In the absence of this mixture, the patient may drink quite freely of a decoction (tea) of Juniper Berries, or Water- melon Seeds. If discharge from the ear occurs, it should be frequently syringed with warm castile soapsuds, and the Carbolic Acid and Glycerine, before mentioned, applied. As a preventive of scarlet fever. Belladonna has some reputation. Take of Extract qf Belladonna three grains, Alcohol one dram, Water half ounce. Mix. Dose : A drop morning and evening, for each year of the child's age. Clotliing, and other articles, which have been exposed to the poison of scarlet fever can be cleansed by immersing them in boiling hot water, or exiiosing them to a heat of over two hundred degrees. All unnecessary articles of furniture or clothing should be removed from the room, before the scarlet fever patient occupies it. See also the sanitary rules of the New York, Board of Health, printed on pages 625 and 626. HOMffiOPATHIC TREATMENT. In those cases in which the disease appears in its simple form, the skin presenting the characteristic hue, with a smooth and glossy surface. Belladonna is a specific remedy. Even in the severer forms of scarlet fever, when the throat is con- siderably affected, and high fever or congestive symptoms set in and which if not properly treated: or if they occur in a bad habit of body, may assume the malignant type, attended with ulcerated sore throat, extension of the inflammation to the air-passages, delirium, spasm, etc., Bell, is a very valuable remedy. It should be given as soon as the throat and tongue become affected with dryness and burning, and there is a desire, but con;- plete inability to swallow even drinks or saliva; wi^h sense of suffocation; further, when the throat is of a bright-red color, havmg its surface excor- iated, or coverec- with white specks, or stringy mucus, or presenting the appearance of tl i \sh ; the tonsils swollen, and the tongue of a bright fiery- red hue, sometimes interspersed with dark-red bches at a later period of the disease; also when delirium exists. If tlit uiseas^ has taken a favor- able turn, we may allow Bell, to continue its action ; but if, after twenty- four to thirty-six hours, the swelling and inflammation increase rather than diminish, as in the case sometimes in strumous constitutions, or if we already perceive an appearance of ulceration commencing, with increase of mucus, give at once Mercurius. If, on the other hand, the ulcers pre- sent a livid appearance about the edges, and emit an offensive odor, or, when there is an excessive thirst for small qua) ities of water, and an extreme prostration of strength, Arsenicum is to be preferred to Mercutus, ACUTE CONTAGIOUS DISEASES. li.,.) and if this medicine prove inadequate to a complete cure, it siiould be fol- lowed by Nux-v., (seeUlcerated Sore Throat). Nux-v., is moreover of consid- erable efficacy, when a large quantity of viscid mucus is secreted from the inflamed and tumefied lining of the fauces, which adheres so tena- ciously, that it is with difficulty expelled, and sometimes even threatens sufTocation. Pulsatilla is, aLso, useful in such cases. When the fever assumes a clearly inflammatory type, and the pulse runs high, we may administer Aconite in the same manner as given under Inflammatory Fever, which sec. When the (juickness of the pulse, and other febrile inflammatory symptoms are subdued, and the affection of the throat again appears most prominent, we may return to Bell., especially if the skin retain the pecu- liar scarlet hue. Opitnn may follow the Bell, when there is burning heat of the skin, drowsiness, stupor, heavy breathing, open mouth, eyes half closed, rest- lessness with vomiting, or convulsions. Pulsatilla is indicated when derangement of the stomach and diges- tive organs is a prominent symptom, the face pale, red, or bloated; dispo- sition fretful and sensitive, or melancholy, with crying or tears, without sufficient cause. COMPLICATBI) FORMS OF SCARLET FEVER. Varieties of scarlatina not unfrequently occur in which the charac- teristic peculiarities of the efflorescence are wanting, namely, the color, which is not a bright scarlet, but of darker hue, and the effect of pressure which does not leave the white impression after it. There are, also, cases in which small granular elevations appear upon the surface of the red patches. These variations from the foregoing description of the manifes- tations afforded by scarlet fever, are not to be mistaken for indications of a different disease, but should be accepted as signs of a different type of the same disease. There are, also, instances in which the eruption is con- fined to internal parts, when, with the characteristic acceleration of pulse, there is sore throat, and the mouth and throat are bright red, hot, swol- len, and often very dry. This variety will be subject to treatment, such as that already detailed, according to the special indications present. Other instances, again, occur of a yet more insidious character, which are not distinguished until the dropsical swellings supervene, and which either evince no eruption at all, or so slightly as to escape notice. This variety must, in all instances, be treated as directed for the like symptoms supervening as the after-effects of the disease when the erup- tion lias l)een struck in or imperfectly developed. Another very danger- ous complication, which is frequently associated with scarlet fever, con-. sists of inflammation of the upper part of the windjiipe. This variety should be subjected to the treatment prescribed in the article devoted to the consideration of that particular disease, so long as symptoms of this nature continue -returning, however, to the specific treatment of the primary disease (scarlet fever) as already directed in this chapter, as soon as the complication is subdued. Another variety is characterized by degenerating into a low typhoid type, in which case, the following treatment becomes requisite. Ammoniutn-carb,, Arsenicum, Acidum-phosph,, Secale-com, ;i'i '» 'f'^ f\ 6S4 SCAKLET FEVER. 4 From uiiiongst these remedies, a selection should be made by accur ately studying the symptoms of tlie case, and by comparing them with the indications allbrded under the head of each symptom respectively. Cases in which tlie tliroiit becomes the chief seat of danger, require the following treatment : Arsenicum is indicated in the majority of cases in which severe and dangerous sore throat accompanies scarlatina, the tonsils being swollen into hard tumors, often as large as apples, attended with snorting and dif- ficult breathing, enlargement of the adjacent glands, and remittent puhe. Dose: Six pills every two to four hours. Acidiim-nitric., Aconitum, Lyco2>odium, Belladonna. If little or no improvement should have followed the administration of Arsenicum within the time just stated, proceed with these remedies in succession in the order in which they are placed. Dose as for Arsenicum. AFTER-EFFECTS OF SCARLET FEVER. Scrofulous subjects in particular are subject to a multitude of consecu- tive ailments of scarlet fever, which are often of an obstinate character, and require careful treatment and great precaution. Excessive Susceptibility to Take Cold. In general, also, we may number amongst these after-effects, when the skin has been cast, an exceeding susceptibility to take cold, which, if not obviated, may entail serious consequences. Treatment. As accessory precaution we may mention great care as to diet, sufficient exercise out of doors, if possible, but only in very dry weather, warm clothing, and avoidance of drafts, without, however, resorting to the extreme of coddling or the exclusion of free ventilatUm, which is as essential to thorough recovery as medicine. ■* Caicrtrea should, in the majority of cases, be administered, unless there be symptoms which distinctly jjoint to other remedies, in repeated doses. Rawness of the Face. Chamomilla, Belladonna, Aurum~ trip. Chamomilla may, in most cases, be employed singly with perfect success ajrainst this troublesonje consequence. When, however, an inflam- matory tendency continues, and the afTected parts are much swollen and painful, etc., it will be desirable to resort to alternate administration of Chamomilla and Belladonna as follows; and if no relief follows take Aurum-trip. Four doses daily. Offensive Discharge from the Nose. Auruni is indicated by offensive discharge of matter, from the nose, with soreness and swel- ling of the interior, following scarlet fever. Soreness of the Nose, etc., with Swelling of the Glands. Mer- curius and Hepar-s. Silicea, Sulphur, Calcarea. Mercurius is required when there is soreness of the nose and face, with swelling of th« glands on the inner side of the lower jaw, followed, if necessary, by one oi more of the other remedies named. Puffiness and Swelling of the Face and Extremities, etc. Belladonna is .in most cases sufficient to overcome the following symptoms, occurring as the after-effects of scarlet fever, namely:— Puffi- ness of the face, swelling of the hands and feet, lingering fever in the evening,glandular enlargements, chaps about the mouth, severe headaches, stammering, etc. r ACUTK CONTAGIOUS DI8EASFS. fna Dropsical Swellings, ktc. Arnicn, Bvllndonnn, HelUhorus, Acidum-I'/iospft., GelHeminntn, One or more of these remedies respectivi'ly iiccording to the detailed indications aflbrded reajieeting them in the Repertory should be administered, when symi)t()ms of water on the brain supervene, such as dullness of the mental faculties, with evident painful effort to think clearly ; excessive drowsiness; weakness of the feet and repeated falling down ; squinting dilation of the pupils, etc. Arsenicum., Hellehorus, Diyitalis. Selection should be made from these remedies, particularly when symptoms of water on the chest super- vene, such as; painful oppression of respiration, aijijravated by motion or by lying on the back; the patient is suddenly disturbed in sleej) by a suf- focative sensation, which compels him to sit up, or even to get ''p, and seek for air; or even inability to lie down, necessitating a sitting or even a perfectly erect posture; short, dry, and even spasmodic cough, and stitching, crampy pains between the shoulders ; excessive anxiety, etc. Mumps. Mercurius, Carbo-veg. Mercurius is specific in the ma- jority of cases of mumps under these circumstances. Ifose: Four globules in a teaspoonful of water every six hours, until amelioration or change; but if no improvement whatever should ensue within four hours after the second dose, or especially if there be reason to believe that the patient has been treated with Mercury, proceed with the next remedy. Carbo-veg. This remedy is required in cases in which a few doses of Mercurius produce no effect whatever, and more particularly when the patient has been subjected to doses of Mercury, or if induration begins to be developed. Dose : In every respect as stated above for Mercurius. Calcarea, Kali-carb. These remedies are invaluable in very obsti- nate and continuous cases, and should be selected, if the symptoms be conformable to those recorded of these medicines in referring to the "Re- pertory." Dose: Of either remedy, as selected, give six globules in a tablespoon- ful of water, morning and evening for ten days, if the malady does not sooner yield. HOME REMEDIES. The milder forms of the disease require but little treatment. Keep the patient in a well ventilated room, place him upon spare diet, and sponge the surface of the body occasionally with tepid water, if the heat of the skin is great. Instead of sponging with tepid water, take a lump of suet and rub the body with it, except tlie face and scalp, morning and evening. It has tlie effect to remove that pungent heat much more effectually than water. The greasing should be com- menced as soon as the disease is recognized, and continued during the whole course of it. During the stage of convalescence or when the skin is peeling off apply it in the morning and give the child a warm bath in the evening, rubbing it well with a soft towel. „,<«i ll '■4h 'I ilF" *1 'I I, m SMALLPOX. This disease is by medical practitioners of the present day, divided into two varieties : — the distinct, when the pustules on the face are clearly defined, and do not run into each other— and the confluent, when they coalesce and form one continuous whole. if. M 6S6 SMALLPOX. m. i^i'h When tlie syraptoras are loss sovero than those properly characteristic of the disease, and erii[)tioa on the fi'ce slight, it is called the modified smallpox. We generally find this description in such persons as have been properly vaccinated,— u precaution, whicli, although not always a preserva- tive against the attacks of smallpox, greatly lessens its virulence, and gives a milder character to the complaint, when taken. Symptoms. The disease is frequently very sudden in its attacks, com- mencing with chilliness and shivering, followed by symptoms of fever, headache, severe pains in the small of tlie back and loins, languor, weari ness and faintness; the patient, also, complains of oppression of the chest, and acute pains in the pit of the stomach, increased by pressure. The eruption makes its appearance at the close of the third day, first on tlie face and hairy scalp, tlieu on the neck, and afterwards spreads over the whole body. Symptoms of cold— as sneezing, coughing, wlieezing, and fre- quently difficulty of breathing, often accompany this disease. The eruption first displays itself in the sbvpe of small, hard-pointed, red elevations, whicli can be felt under the skin of the forehead, before it is possible to discover any eruption with the eye which, in about»three days, present a bladder-like appearance, surrounded by rn inflamed cir- cular margin, and become depressed in the center as they enlarge. About the sixth or eiglit day, the watery secretion in the pustule becomes con- verted into matter, and the depression in the center disappears. When the pustules are very numerous on the face, it generally becomes much swolen, and the eyelids are frequently closed up. On the first day, a smull lump, like a millet-seed, may be felt on each of the eleva- tions above noticed, distinguishing this eruption from all others. The pocks continue coming on during the first three eruptive days, and each pock runs its regular course; thus, those which first appeared are forming into scabs or drying off, whilst tlie others are suppurating. The drying off commonly t.ikes place on or about the eighth or fourteenth day, accord- ing as the pustules may happen to be distinct or confluent. When the pustules have obtained their full development, they gener- ally burrit, in mild cases emitting an opaque, watery discharge, which dries into a crust and falls off; wiiilst, in severe ones, we find a discharge of thick, yellowish matter, forming scabs and sores, which leave, on their healing, permanent marks or pits. Red stains, caused by increased vascu- lar action, always remain for a while after the eruption; but if no ulcera- tion hiis taken place, they disappear in process of time. In confluent smallpox, all the precursory symptoms are more severe, the fever runs high, and frequently continues so throughout the course of the disease; the pain in the pit of the stomach and difficulty of breath- ing are more complained of, and in children, the 'eruption is frequently preceeded by convulsions and delirium; the latter symptom, indeed is fre- quently present with adults, during the suppurative or secondary fever, which not uncommonly assumes a character akin to typhus, and sometimes carries off the patient on the eleventh day. All cases in which we have generally a deeply-rooted morbid constitutional taint to contend against, require tlie utmost skill of the experienced practitioner to ward off a fatal result. An extensive inflammatory blush of the face or trunk almost invariably precedes the eruption in the confluent variety of smallpox. Salivation, with soreness of the throat and small white ulcers or pus- ACUTE CONTAUTOUS DISEASES. 887 tiiles on tho tongne and in tho upper part of the gullet, frequently declares itself in botli forms of tliis diseaso, i)ut particularly in the confluent. Before we come to tlie medicines to he administered in tlie different stages of the disease, we may say a few words upon tlie general treatment of the patient. Cool and fresh air are our best auxiliaries, the emanations from tlie patient in thiscomplaint being of a nature to react upon the organism, and warmth being calculated to increase its activity. So beneficial is cool air found in this malady, that taking a child to iin open window wiien attacked with tho convulsions, frequently present, will generally be found to afford immediate relief. Great cleanliness must also be observed, and the linen frequently changed. When the vesicles declare themselves, and begin to form into pustules, the room ought to be kept as dark as possible, to aid in preventing the risk of disfigurement, a precaution deducible from common experience, since we find that the parts of tlie frame exposed to the action of light are always those most strongly marked by the ravages of tlie disease. To avoid the pits, and consequent disfigiirement left by tliis disease, many physicians have adopted a mask or plaster for the face, of different substances, such as gum, mucilage, calamine, etc. Tlie application of collodion to the face, or of oil when the collodion can not be tolerated — has been found of service in preventing disfiguration from pock-marks, but the most successful of all means, so far employed, is that followed by physicians of the Regular Homoeopathic school. ALLOPATHIC TREATMENT. As there are no specific remedies for small])ox, its treatment will be palliative and supporting. If tho person has not been vaccinated, tliis is the first thing to be done after exposure. Fiveor six points slionkl bo inserted in each arm. It is a good practice to resort to this in any one whether vaccinated or not, at any time before the appearance of the eruption. It will mitigate, if not prevent the dis- ease. Aside from tliis, the treatment is the same as in other continued fevers. The room should be large and well ventilated, and all unneces- sary articles removed from it, carpets, curtains, etc., that they may not be infected and act Jis conductors of the disease (fomites). The best dis- infectant in this disease is Iodine. A couple of drams of tlie Tincture should be placed in the vessels which receive the sputa or other excre- tions, and three drams of the scales may be put in a chip basket and hungover the patient's bed. If the room is not ke^t free from smell, the number of vessels containing Iodine may be increased, or a few scales may be vaporized by sprinkling them on a hot shovel. Carbolic Acid may be used with the Iodine by moistening one or two cloths, a little over a foot square, with a solution of Carbolic Acid in water, and hanging them up in the room, and adding a quarter part of Carbolic Acid to the Tincture of Iodine in the vessels receiving the excre- tions. ^ Chlorinated Lime and Labarraque's Solution, Quick Lime and Per- manganate of Potash in solution, are also useful disinfectants, and may 1)0 employed on account of cheapness. The nurse should, after waiting on the patient, wash his hands in clear water with soap, and then wash them in a disinfectant fluid. ft: ..-I -I I ill I III h. •I 7 ■ I 0"^ ■li 1^', M %. sua SMALLPOX. liS? m *i f'omploto isolation iH tlio only renl .Hiif<'j»nnl agaiiiHt a hj/iiuuI of the (liHi'iise. Dcstnuition of clothing used i.bout tlio piitient, ami in tiu» sick room, Ih neooHsary. During the invasion of the diHeiuse, the fobrilo movement may he Iphs- ened by fre<iuent teplu Hponging, cool drinks, sucli jus colil water, lem- onado or orangeade, or eold barley or rice water. The writer favors full doses of Quinine, live to ten grains every four hours, until tlio fever is lessened, and if the pulse 1)0 bounding, strong, und frequent. Tincture of Aconite nuiy be given in doses of one drop every hour, to an adult, until the fever and pulse are eomfortalily reduced. lOmeticaand cathartics are not to l)e given, but constipation in to bo relieved by injections of warm water, or the mildest laxatives, as directed in measles. During the eruption, and before suppuration, tlui measures before mentioned are to bo continued or not, according to tlie severity of tlie symptoms. Nausea and vomiting will lie relieved by tlve to ten-grain doses of Bismuth, with five grains of Oxalate of Cerium, or tive-drop doses of Dilute Hydrocyanic Acid, or one-drop doses of Carbolic Acid or Creosote in water every hour, until relief follows. Cold, or possibly heat, ai)plied over the stomach will aid. Diarrhoea is to be relieved by Bismutli in ten to flfteen-grain doses in milk, with, if neccessary, an opiate, as a dessertspoonful of Paregoric or ten to fifteen drojjs of Laudanum. Restlessness and watchfulness will be relieved hy a grain of Opium, and one or two grains of Extract of Hyoscyanma Acid, or twenty grains each of Hydrate of Chloral and Bromide of Potassium, given in solu- tion with sugar, given at bed time. Tliis will Insure a nights sleep. It is to be expected that Dilute Hydrochloric Acid in doses of ten to twenty drops, or Dilute Phosphoric Acid in doses of half a teaspoonful largely diluted in sweetened water, and taken three or four times in course of the day, as a drink, will prove beneficial, as it has done in other continued fevers. Systematic feeding should be begun in this stage, and should consist largely of milk, eggs beat up with sugar and milk, or water, (as directed in scarlet fever) strong beef tea or essence, poached eggs or cooked in the shell in hot (not boiling) water, toast, rice and water; simple farinaceous food may be given. The patient should be fed during this stage four times a day, and oftener if there is any appearance of the strength fail- ing, when food, such as milk or eggs should be given at not longer inter- vals than four hours. Feeding is most important during the suppurative stage. Upon any appearance of exhaustion alcoholic stimulants should be given ; from one to three teaspoonfuls of brandy or whisky may bo given with three to four ounces of milk or egg and water, a couple of hours apart. If the symptoms of prostration increase the stimulant may need to be increased. It is beneficial when it renders the pulse fuller, slower, softer and regular. Complications require treatment appropriate to those particular dis- eases. Local treatment consists of measures to prevent the pitting and to relieve itching, which becomes intolerable. ai dJ ACUTK CONTAGIOUS DISICASUS. Attt Forthoformerpurpo.se tho following have been found, in a degree uaeful : Cureful ovacuiitloM of tlio ve.siclos wltli a Hiu! needle; It is a tedi- ouH tiling to do. Second, afLor rui)turo inserting into <jaeli ''eniclo c. fine point of Nitrate of Kilver. It is claimed to Ije niowt Huccessful if done on the second day <»f the erujition. Tliird, tin; api)Iicati<in of the Tincture of Iodine twice a day during the papular Btage of the erujttion. Fourth, exclun'MU of the light and air hy means of a plaster. A mixture of Tan- nin and Iron is employed in cases in the N. Y. Hospitals It produces u l)Iaek mask. Co.iMng the face with Olive Oil and dusting upon.the oiled surface twice a day with equal parts of the Suh-Nitrale of IJismuth and prepared chalk. Pulverized {.'harcoul made into a paste with Ollvo Oil or Cjllycerinc is a Himph; application and as eirectual as any. Calamine is used in the same way as the pulverized charcoal. The application of Collodion once or twice daily with a et mel's hair brush while the eruption is pajjular, is said tfthe suctiessful. It should be hcgun when the eruption first appears, and acts l)y excluding the air and comi)ressing tlie i)apule. The application of guttuperclia, dissolved In Chloroform, acts in thi, ^arao way. These applications are made usu- ally to the face only. Tlio terrible itching is thought to be greatly relieved by smearing the pustules with cold cream, :i mixture of equal parts, by bulk, of Lime-water and Linseeu or Olive Oil, or a mixture of one part of the solution of the Subacetate of Lead to seven parts of Almond Oil. When the pustules burst, they should be dusted and ktpt coated with Oxide of Zinc 'n powder, or mixed with pulverized Starch. If fissun s (cracks in the skin) and excoriations occur, a mixture of Oxide of Zinc, in (ilycerine or Olive Oil, two drams to the ounce, should be made. Thorough vacc: nation, at four or five points, is an almost sure protec- tion against small-pox, and a certain protection against the disease proving fatal. Children should be vaccinated in infancy, and re-vaccinated not later than six or eight years, and still again before childhood passes. When epideuiics of lil-pox occur, all persons who have not been vaccinated within three v-i tour years, should be re-vaccinated. HOMCEOl'ATHIC TREATMENT. Aconitum may be required in the first, and early "n the second stage; if the fever runs high, the thirst is excessive, the skin very hot and dry, the pulse quick, hard and full, and the l)reathing laborious and rapid. Aconite should, also, be resorted to as an intermediary remedy, at any stage of the disease, when distinctly indicated by symptoms of this description. Dose : Six pills every two to four hours. Antitnoniuni-tart., (Tartar Emetic) is well indicated in this disease, from the close analogy which the eruption it is capable of producing bears to that of small-pox, and may, therefore, be, also, administered with advan- tage during all stages of the disease, unless some other remedies should be more urgently called for by the nature of the symptoms; this should be a constant remedy, tightness across the chest, perhaps attended with nausea and vomiting, or diarrhoea, before the eruption is fully out, and the exist- ence of a hollow, sounding cough, with loud, vwmis rattling, is an addi- tional index for the employment of Antimonium-tartaricum. ^ j %*c I.' i J- 4' 'i' t ^^mm MO SMALLPOX. Dose: Dissolve ten pills in two tablespoonfuls of water, and give a teaspoonful of the solution every three hours, until amelioration or change. Chamontilla is sometimes of great service during the course of the disease in children, when the following distinctive symptoms appear: — difficulty of breathing?, with predominant looseness of the bowels, deep green stools, severe colic, tenderness of the belly, and vomiting; it is like- wise calculated to be useful during the maturative stage, when much restlessness and whining prevail, and the rest is much disturbed by a troublesome cough at night. Dose: Four pills in a teaspoonful of water, every two hours. Belladonna. This remedy may follow Aconite or Chamomilla, -when either of the latter have been indicated, should symptoms of disturbance of the brain have set in, characterized by flushed countenance, intoler- ance of the eyes for light, headache and delirium, great thirst, nausea and vomiting, or, when there is redness of the tongue at the tip and margins; belly tumid and painful, particularly about the region of the stomach, with sensilility on pressure; prostration of strength and stupor. Dose: Of a solution of four pills to two tablespoonfuls of water, give a teaspoonful every two hours. Opium is useful, when there are symptoms of stupor or strong incli- nation to sleep; it may be employed after Belladonna, or even prefeixed to the latter remedy, in cases in which there is continuoiis lethargy, witli open mouth, half-closed eyes, and snoring breath ; or, again, when there is violent delirium, with incessant tossing about of the hands. Dose: Rix pills carefully placed upon the back part of the tongue, every three hours until change. CONFLUENT SMALLPOX. Aconite is indispensable when the fever runs high, and threatens to continue, as it usually does in this more malignant form of the disease; and it will be necessary to diverge even from other important considera- tions, from time to time, (having commenced with the administration of this remedy.) to return to it for the purpose of eflfectually acquiring an ascendency over the fever. The alternate administration of Sulphur is often necessary when the fever does not appear to be the least modified, within two hours after the second dose of Aconite. Dose: Six pills in a little water to be given every two hours. Mercurius is highly serviceable in confluent smallpox, after the pre- vious administration of two doses of Aconite, as above directed, when the following symptoms predominate:— Inflammation of the eyes, soreness of the throat and nose, offensive breath (salivation,) cough, hoarseness, tenderness of the stomach, excessive looseness of the bowels, particularly characterized by incessant straining, and, sometimes, bloody evacuations. Dose: Six pills in water every two hours. Pulsatilla is hig, ly useful in confluent smallpox, characterized by the presence of an efflorescence analogous to that of measles, before or du- ring the development of the eruption, especially when nausea or vomit- ing and marked aggravation towards night, additionally qualify the general symptoms. Dose: Six pills every two hours. Arsenicum shoulci be administered after tte second dose of Pulsa- ! l\ik\id ACUTE CONTAGIOUS DISEASES. Ml tilla, (or even of An timoni'::n-tart, or Ipecacuanha, in the event of nei- ther of the others having proved efficacious.) when the nausea and vom- iting continue unalluyed, especially if the patient complains of excessive thirst and dryness of the mouth, the tongue being foul and dark, and the prostration of strength severe. Arsenicum is also of great value in cases of a hard type, and when livid spots are observed on the skin before the eruption is out, or when— other symptoms corresponding— the scabs are tif a dark brown color and very offensive, more particularly if this man- ifestation be further characterized by intense weakness and languor, (hirst, nausea, or vomiting, with more or less severe pain in the region of the stomach,— or, again, when the fever assumes a putrid typhoid character. Bose : Six pills every two hours, in water. Carho-veg. should be admistered when the eruption assumes a gangrenous appearance; or when the pustules are thin and unhealthy, and the scabs and incrustations are of a dark brown color, and emit a very offensive smell. Dose: As directed for Arsenicum, Acidinn-muriatictini may be employed with great advantage in cases of a bad type, in whicli the fever assumes a typhoid character, and when the patient exhibits a continual tendency to sink downwards (towards the foot) of the bed. Dose: An fov Arsenicum. China may be advantageously administered against the debility resulting from profuse diarrhoea or discharge from the pustules. Dose: Six i)ills every four hours. Suljthur is a useful remedy at the maturity of the ei iption, and as the drying process is about to set in ; it will often tend materially to forward the total disappearance of lingering traces of the disease, as well as to overcome any latent mischief which has been left to rankle in the system by this virulent disorder. Tlie alternate administration of Rhus at this period will be required, if there be aching pains in the back and extremities, aggravated towards night, but somewhat relieved by motion. Dose: Of Sulphur, singly, six pil.^s (for adults,) or for young per- sons four pills in a wineglassful of water every morning the first thing (fasting,) continuing this course for a week; if in alter- nation with 7i?»/s., give three globules of either medicine in rota- tion, the one six hours after the other, until amelioration or change. Check of the Eruption. Bryonia, Antitnonium-tarU The administrjition of either of these remedies^ according to sjiecial indica- tions, will become requisite when the eruption is checked, and the chest is more prominently affected. Dose : Of either remedy, six pills every two hours. 1 1 ■ ■ .1 :l 1 X. ■ !«»;;:■ m i^ ^ ' \ M 5 i ^; i 1!.... ■]i m'^ 1)1 MODIFIED SMALLPOX-VARIOLOID. This is merely a mild description of smallpox, and, as we have before said, is the form which the disease generally assumes when it attacks those who have been properly vaccinated. We must regulate our treat- m VARIOLOID. i!-; tj ment according to the symptoms, being guided in the selection of the remedies by the indications before given. Complications and After-effects of Smallpox. We should \\ atch closely, during the progress of the disease, or symptoms of '• Inflam- mation of the Lungs," or of their enveloping membranes (pleurisy,) and the treatment, in cases in which sucli complications occur, should be regulated according to the directions especially afforded under the head of those particular maladies respectively. Boils, Glandular Swellings, etc. Amongst the many severe after-effects of smallpox, we may number glandular swellings and other scrofulous affections, developed by the malignancy of tlie disease, inflam- mation of the eyes, boils, etc.. which will be most effectually treated by reference to the separate articles devoted to these subjects respectively. Cough. In this respect, the reader is rec >m mended to refer to the separate article on this subject. Asthmatic Affections. Antiinoninm (Tartar Emetic) is, in the generality of cases, the most available remedy in cases of this kind, result- ing from the smallpox. Dose: Four pills night and morning, until amelioration or change. Looseness of the Bowels. China, Phosphorous. China is, in the majority of cases, more available when there has previously been excessive loss of animal fluids, especially, if the symptoms assume an intermittent character. Done: Six pills in a wmeglassful of water daily, the first thing in the morning, until change. Phosphorus is, especially, adapted for the treatment of blond sub- jects, or of a spare, slender habit of body, and fragile frame, when this relaxation continues any length of time. Dose : As directed for China. Diet and Mode of Life. In these particulars, we should be guided by the virulence of the attack ; but, in all instances, the beverages should be cold, as a warm diet, and neglect of the precautions before mentioned, may convert the mild into the malignant form. Whilst the fever runs liigh, water, or toast and water sliould alone be allowed; but when the uQection is going oflf, mildly nutritious food, such as lean meat, farinace- ous food, cocoa, and plain broths, or beef tea, are allowable. In mild cases, thin gruel, or farinaceous food, in small quantities, may be allowed tliroughout. Even after recovery, in some cases, \t is necessary that the patient abstain, for a considerable time, from animal food in a large quantity. It should not be omitted, that a plain, nutritious, and even generous diet, taken in small quantities at a time, and at regular periods (wlien there are no lingering after-effects,) combined with regular habits in other respects, and with the bracing effects of the open air, tend greatly to per- fect the cure. The general regulations in respect of diet and regimen, which apply to other eruptive fevers, or to fevers in general, hold good with regard to smallpox. It may be remarked that, after recovery from an attack of malignant smallpox, the patient's constitution often requires a thorough renovation, and that he should, therefore, be put under a course of medicine be'it cal- culated to attain that result. wm ACUTE CONTAGIOUS »ISEASE8. 54.t HOME MEASURES. In severe cases, when the pustules are very troublesome, they may be anointed with Oil of Almonds, or gently sponged with tepid water, when they become hard, — or dusted with pure starch, hen a thin, acrid, or otherwise unhealthy discharge runs from them. The hair of the head should be clipped, for the sake of the cleanliness and comfort of the patient; and the hands should be muffled, to prevent injury to the pustules from scratching. " I am willing to risk my reputation as a public man," wrote Edward Hine to the Liverpool Mercury, "if the worst case of smallpox cannot be cured in three days, simply by the use of Cream of Tartar. One ounce of Cream of Tartar dissolved in a pint of water, drank at in tervals,when cold, is a certain, never-failing remedy. It has cured thousands, never leaves a mark, never causes blindness, and avoids tedious lingering.'' CHICKEN-POX. Symptoms. A disease, bearing considerable resemblance, in its exter- nal character, to smallpox, but differing in its duration, and symptom- atically, being considerably milder, generally requiring no medical assis- tance, but merely attention to diet, and but rarely becoming dangerous, except when it extends itself to the lungs or brain. The fever, however, occasionally runs high. Wiien this affection attacks an individual, and smallpox is epidemic, which is not unf requently the case, it is often mistaken for that disorder, but it soon discovers its real character, by the rapidity with which the eruption declared itself, the vesicles (in many instances, closely resembling the pustules of the smallpox) being generally, fully matured by the third day, and the whole eruption disappearing at the end of the fourth or fifth without leaving any mark. HOMCEOI'ATHKJ TREATMENT. Aconite is required when much fever is present. Dose: Of a solution of four pills to two tablespoonfuls of water, give a teaspoonful every six hours, until amelioration or change. Cojfea is to be preferred when extreme restlessness and anxiety are present without a great degree or fever. Dose: A solution of four pills, as directed for Aconite. Belladonnu should be given if the brain become evidently affected. Dose : A solution of four pills, us directed for Aconite. Antimouiuni-tartaricum may be given to accelerate the develop- ment of the eruption, when it is slow in making its appearance. Dose: Dissolve six pills in two tablespoonfuls of water, and give a teaspoonful of the solution every four hours, until ^he eruption is thoroughly evolved, and the fever subsides. Mereurius may be given when the watery secretion of the vesicles becomes converted into thick, yellowish matter, as in the small-pox, and is, silso, beneficial if strangury be present. Dose: Two pills in a teaspoonful of water, every four hours, until amelioration or change. Check of the Eruption. This should be treated as directed for Small-Pox under similar circumstances, (seo page 57.) Cases, in which this disorder appears with manifestations closely resembling many of those which characterize small-pox, may be similarly treiitod, according to the partini1;ir indications present. 'W:fl 16 :■ t'l; '*!«: "i . ^^. m FKVER AND AGUE. CHAPTER XXVIII. EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. S! ' iviiik -4 :1I FEVEB IJV^D AGUE— INTERMITTENT FEVEB. We have now to enter upon a olass of fevers differing essentially from those already considered, in possessing a marked character of their own, in the simplicity of their form, the periodicity of the different stages, (al- though the periods of fever-flts are not necessarily regular,) and the uncer- tainty of their duration ; at the same time it may be noticed that one of the distinctive features of intermittent fever consists in the fact that the febrile action does not individually constitute the disease, but appears rather as an occasio al development of other morbid processes. Intermittent fev> s cannot be better described than as a compound of acute and chronic dise. ; acute during the continuance of each attack, and chronic in the continuance of liability to the attacks. Symptoms. These must be classified In three distinctive stages; (1) a chill or cold tit, (2) followed by heat, and terminating (3) in perspiration more or less profuse; these three stages constitute a paroxysm ; after which for a certain period, called the intei-val or respite, the patient is, generally, free from suffering. The fever-flts are characterized by the red deposit in the urine. These periods are, generally, of definite duration ; but occasionally Indefinite and irregular. If the paroxysms return at regular intervals of twenty-four hours, the fever is termed a Quotidian,— ot forty-eight, a Ter- tian,— of seventy-two, a Quartan; even longer intervals have been observed between the attacks, as that of seven days, which is somewhat inappropri- ately termed an eight-day intermittent fever. If two fever-fits take place within each period, the ague is said to be doubled ; as a double Quotidian, or Tertian, etc. These fevers are sometimes found existing in the simple form above noted ; that is, that each fever-fit (as it occurs) assumes the character of simple fever; in other instances, however, the fever-fits (as they occur) ils^•tlme the characteristic features of inflammatory or typhoid fever, or of complications involving the respiratory or digestive functions respectively, etc. The absence of continuity, or reguhir process to a crisis will then iden- tify the febrile symptoms as appertaining to this class in general, whereas, the peculiar implication of particular organs will qualify the specific char- acter of any particular variety. They are exceedingly indefinite in duration, and frequently assume a tediously chTonic. form. An individual once attacked with ague, is fre- quently liable to a return of it in after life, if the disease has not been rad- ically extirpated in the first instance; nay, more, any attacks of disease to which he may afterwards be subjected, are peculiarly apt to assume the intermittent form. Ague is rarely dangerous in this country, except when of long contin- uance, and then, owing to the weakness which it occasions, and the injury t ot h el •*W!»fe EPIDEMIC AM) ENDEMIC INFECTIOUS DISEASES. 64S which it inflicts upon the constitution ; it may, however, lead to obstruc- tions and indurations of the more important organs, particularly of the liver and spleen, or may induce dropsical affections. It should not be oiuitted, however, that the sudden development of ecwZta?- symptoms in connection with the fever-flts, may be more or less ominous, and should be watched and treated with especial care. Some- times, liowever, intermittent fevers appear (as a wholesome crisis) in the last effort of the constitution to expel morbid humors, which have long preyed upon the system ; and in such case, if treated with dtie care (which will assist in their development,) they will serve to carry off the catises of tediotis chronic disorders. But in hot climates, or in low, marshy countries, this disease is exceed- ingly fatal, in consequence of the brain and its tissues, the lining mem- brane of the stomach and bowels, the lungs, and the investing membrane of the stomach and bowels becoming affected; in such instances, when the disease gains ground, the patient loses strength and becomes emaciated; every fresh paroxysm entails an Increase of suffering, and the perspiration fails to relieve ; he complains of a sensation of weight in the region under the false ribs, particularly the right, with griping pain in the bowels, flatu- lent distention of the belly, looseness of the bowels or constipation, and constant thirst; or of headache, cough, and shortness of breath ; the tongue is furred, and dry at the tip ; the skin hot, harsh, and dry ; the urine scanty, the belly tumid, the extremities become dropsical, and sleep is restless or broken. Death may ensue from collapse in the cold stage, from the absence of perspiration, and from the disease passing into continued or remittent fever, or from disorganization of some important part, such as the brain, lungs, spleen, or liver. We shall now proceed to a general consideration of the three stages of the disease, premising that the various modifications of the symptoms will be found more in detail, under the medicines when we enter upon the consideration of the remedial treatment. The symptoms which precede the chill are a sense of languor, or general uneasiness; yawning, headache, stupor, pains in the limbs or back ; the toes and fingers becoming numb, and the nails blue. These are followed by the following, which belong to the fever stage. Coldness of the extremities, with a feeling as of a stream of cold water running down the back, and extending itself to the chest and belly ; general prostration of strength, insupportable coldness, exter- nal and internal tremors, chattering of the teeth, respiration labored and hurded, with inability to draw a full inspiration, and oppression at the chest. The head is variously afTected.sometimes with headache, at others with drowsiness, stupor, or delirium; the pains noticed in the premoni- tory symptoms are generally present, and, in some instances, the patient complains of pain all over ; the tongue is moist, the eyes are heavy and sunken, the features pf ohed, and the lips and cheeks livid; the rigors tiometimes run on to con pulsions. The pulse is weak and oppressed, sometimes slow, at others quick and frequently intermitting, and often, from the severity of the rigors, scarcely perceptible. The heat of the body, except at the extremities, is generally above the natural standard, while the patient complains of cold. 35 'iHi i iHlNl!*. I I :\>*l ; ^'^! >■ ■'If - ' If IM^£*s:mCSMBBIH Ifiif 546 FEVEU AND AGUK. Sometimes the patient feels only a slight degree of cold, without tre- mors, but accoinpanied witli symptoms of functional derangement, and in a few hours the hot fit declares itself. The duration of the cold stage is from an hour to four hours; and it runs without any marked interval, into the hot stage, which presents all the characteristics of a modified Inflammatory attack, with hot dry skin, and thirst, oppression at the chest, hurried and anxious breathing, and acute pains in the head, regions of the spleen, liver, etc.; there is also occasionally a degree of disturbance about the brain, or even delirium. The general duration of the hot fit is from four to twelve hours, when it terminates in the sweating stage; when this does not take place, it is apt to run on to continuous fever, or take the form of a remittent, a not uncommon issue of this disease in warm climates. After the hot fit has continued a longer or shorter period, profuse per- spiration sets in, commencing in the forehead and extremities, and quickly diffusing itself over the whole body ; as soon as it makes its appearance, the uneasiness and other symptoms begin to disappear, and the patient, in simple ague, continues free from suffering until the next paroxysm. Causes. Marshy districts are noted as being the hotbeds of this mal- ady ; the presence of stagnant water in the immediate vicinity of dwel- lings will provoke it; as occasionally, also, conditions which will engen- der low typhus ; the continued prevalence of epidemic disorders may also be cited amongst the causes of intermittent fever; a continuance of fish or farinaceous diet is also apt to produce it ; it may, moreover, arise from taking cold, indigestion, internal obstructions, the presence of inactive humors which oppress particular organs, from peculiar constitutional ten- dency or the like, occasioned by acute diseases, or by difi9cult chronic affections, or even from purely local irritation. Nervous or inflammatory fever may change into an intermittent, or the latter take upon itself, if it continue, the character of either of the two former, or become remittent ; this frequently happens in hot cli- mates- The medicines should generally be administered in the interval between the paroxysms but when these are extremely short, or when they are attended with after-pains of the preceding paroxysms, they should be administered when the sweats, or other concluding features of the attacks, begin to subside. ALLOPATHIC TREATMENT. The principles of treatment of inter- mittent fever maybe briefly given as follows: When there is violent derangement of the functions of the bowels, or in cases of long standing intermittents, it is well to begin treatment with a cathartic. In the for- mer condition a healthy action of the bowels is to restore, and, in the latter case, a cathartic unloads from the intestines and intestinal glanda the accumulated diseased secretions, and leave the intestinal tract free and active to absorb the anti-malarial remedies. If, however, there is not time to move the bowels, and get the system under the effect of the antimalarial remedies, time ought not to be lost by waiting for the action of a cathartic, but the specific treatment should be begun at once. Two to four Compound Cathartic Pills, or such other lax- atives as will move the bowels thoroughly without being severe, may b« i^-Jrx EPIDEMIC AND ENDEMIC INFECTI HIS DISEASES. ■547 used e(iually as well. The Calomel has no s] "! ial application heyond its action upon the upper part of the intestine a.s u cathartic. An efflcient cathartic for this purpose is live ^^ralns of Calomel with half a grain of liesin of Podophyllum, followed in six hours by a Seidlitz Powder or a tablcspoonfiil of Citrate of Magnesia or Castor Oil (the oil mixed with an equal part of Glycerine and flavored with Oil of Cinnamon or Winter- green). The remedies which act with complete certainty against this disease are the preparations of Peruvian ]5ark, i^referably the Sulphate of Quin- ine. The system comes fully under the effect of Quinine in five or six hours after it is taken. It is a point in the proper treatment that a suffl- cient quantity of the remedy be given before six hours of the time of the next expected paroxysm, to thoroughly affect the system. To do this, a safe and effectual plan is to give ten (10) grains of the Sulphate of Quin- ine as soon as the fever of a paroxysm has passed, and another dose of ten (10) grains six hours before the time oftlienext expected paroxysm. A better effect is obtai ted by giving with the Quinine on tliis plan an eighth to .1, quarter of a grain of Morphine. The Quinine may be given in black coffee, with chocolate and sugar, or licorice and sugar. One of the nicest ways of giving Quinine is to envelop the powder in a moist- ened medicine wafer when it is easily swallowed. It may be, also, given in capsule or in Gelatine or Sugar Coated Pills. These pills should always be examined before purchasing, by cutting one of them open with a knife to see that the interior is fresh and soft. Quinine is most active when given in solution. This is effected by adding to a mixture of Quinine and water a minim (drop) of Aromatic Sulphuric Acid for each grain of Quinine. Generally, have the acid in excess as in the following prescription: Take of Sulphate of Quinine forty grains^ Aromatic Bulphuric Acid one dram, Water a sufficient quan- tity to make four ounces. Mix. Each tablespoonful contains five grains of Quinine. If this mixture is used chewing a little licorice or choco- late until the mouth is well coated just before taking the mixture, will mask the taste of the Quinine. If taken in some of the previous ways the efficacy of the Quinine will be increased by a dose of Aromatic Sul- phuric Acid (two or three times as many drops as there were grains of Quinine) taken diluted in sufficient sweetened water to make a pleasant drink. If sufficient Quinine is taken to produce a rii ing of the ears before an expected pai'oxysm, that paroxysm will, m all probability, be pre- vented. Other plans of administering this drug are : in doses of three to five grains, from two to four hours apart, until the ringing of the ears, deaf- ness or roaring in the head (called cinchonism) is produced. It is, also, an effectual plan. The tendency of the disease is to recur at its regular periodical periods —the third, fifth, and seventh days. After a week has passed, the tendency of the disease, generally, is to return every seventh day until three or four septenary (seventh day) periods hfive passed. It is advisable, therefore, to continue the use of the Quinine in daily quantities of three to five grains, until ten days have passed ; but on the seventh day, or late in the sixth day a full dose of ten or fifteen grains should be taken, and every seventh day """"111 • II :i,!'' m i '%: \im 'if' ■L ¥. h W. t|i ■n C48 FEVER AND AGUE. thereaftor, until four septenary periods luive passed. Even then it is not safe to al)antlon tlie use of the remedy unless tlie patient has become strong and lioarty. It should be remembered, that the remedy is just as effective against tlie next seizure, if given during a paroxysm, as if given during the inter- val, so that if paroxysms occur with great frequency, no delay ought to bo allowed before giving the remedy, but it should be given at once. If only six to twelve hours can elapse before an expected seizure, twenty grains of Quinine ought to be given in two doses in the latter case, and fifteen or twenty grains in one dose in the former. Ten grains of Quinine possess a greater anti-periodic effect, if given at one dose than twenty grains given in small doses at short intervals dur- ing the intervals between paroxysms. Other preparations of Peruvian Bark are effective, given in the same way, but less so than Quinine. Quinidia, Cinchonidia, Cinchonia, the two latter have the advantage of being cheaper than Quinine. The Precipi- tatiid Extract of Bark (Chenoidine) given in double the quantities of Qui- nine is, also, efficient, and very cheap. The Cincho-Quinine is, also, an effectual remedy, is less bitter than Quinine, and costs about one-third less. The impure alkaloid of Quinine is comparatively tasteless, especially when mixed in three-fifths its quantity of Tannin— sugar may be added— and taken in powder, dry on the tongue, and swallowed with a drink of water: or the Taunate of Quinine may be given in a similar way, and is compara- tively tasteless. The dose is one-third-more than the Sulphate of Quinine. All these preparations, not taken in solution, should be followed by a dose of Aromatic Sulphuric Acid, as directed above under the directions for Quinine, as soon as the mouth is fully freed of the medicine. When a tonic effect of Bark is needed, the otiier preparations are generally to be preferred to Quinine. The dose for this purpose is gen- erally two or three grains three times a day. In case they are used in this way, it is generally advisable to give an anti-periodic dose of Quinine at the weekly periods, as before mentioned. In all cases where ague has existed for some time, the blood has be- come impoverished,— of poor quality — the patient is anseraic, and requires the use of Iron. It is advisable to give il in' connection witn tonic doses of some of the preparations of Bark. The Citrate of Iron and Quinine or Cinchonidia in doses of from three to five grains, generally meets the required indication. The Sulphate of Cinchonia may be given in pills with Iron as follows: Take of Sulphate of Chinchonia a dram, Reduced Iron half a dram. Make into thirty pills. Done: Take one three times a day. The other Alkaloids of Bark, and the Precipitated Extract of Bark may be used instead of the Sulphate of Cinchonia. Otiier Salts of Iron, as the Dried Sulphate of Iron, may be used instead of the Reduced Iron. The Muriate Tincture of Iron, is one of tlie best preparations of Iron in these cases in doses of fifteen or twenty <lrop3 given in sweetened water three times a day, or other preparations of Iron may be used alone, in which case the tonio doses of the preparations of Bark should be given separately. In some cases I have found the Citrate of Iron and Strychnine in doses of two or three grains three times n dnjj ^ Kiost useful tonic. EPIDEMIC AN1> ENDEMIO INFECTIOUS DISEASiSS. 640 Other medicines aometimes liave to be resorted to in tlie cure of ague, from force of circumstances, or oilier causes. The one most useful alter the preparations of bark is Arsenic. The most eligible form for giving this remedy, is in Fowler's Solution, (taste- less Ague Drops). It is not very suitable as a sole remedy against ague, but if given for this purpose, the dose is ten or fifteen drops in water, three times ada}' after meals, whmi given as the sole cure for ague. Pufli- ness of the eyelids and watering of the eyes may be sregarded, if the stomach or bowels do not become disordered, after a few days— three to live, according to the susceptibility of the patient— the dose should be decreased by two drops each day, until a dose of two drops is reached. The most important part which Arsenic plays in the cure of intermit- tents, is in the cure of chronic malarial infections, and to prevent relapses, when the paroxysms are broken up by the preparations of bark. For this purpose it is often combined with tonic doses of bark and Iron, as in the following: Take of Quinine a dram, Vallet's Mass of the Carbonate of Iron a dram, Arseniotis Acid one grain. Make into thirty pills according to art. It is advised, however, that the Arsenic be always given sepa- rately in the form of Fowler's Solution, (because it may be necessary to suspend its use for a time, when the other tonics ought to be continued; anotlier reason, the Arsenious Acid may not be propeny mixed in tlie mass on account of unskillful druggists, and, serious consequences might fol- low,) and Iron and tonic doses of Bark given, also, separately. The dose of Fowler's Solution for this purpose, is three to six drops after meals, upon puffiness, or watering of the eyes, or derangement of the stomach or iHJwels occurring, its use ought to be suspended for two or three days, until these symptoms disappear,) and then begun again. Full doses of Qui- nine should be given at the septenary periods, as before directed. The Sulphate, or Muriate of Berberina and Hyflrastia, probably rank next to the preparations of Bark, in the cure of interniittents. The dose of Berberina is fifteen to twenty grains given in capsules, medicine wafers or pills, on the same plan as directed for Qu' .line, or in five-grain doses every three hours, until twenty grains are taken. Hydrastia, which is really a Muriate of Berberia, may be given in the same way. It may be combined with Iron in pill. Salacin (Alkaloid of Willow Bark,) is some- times successful in arresting the paroxysms. Thirty to forty grains should be given in the intervals. Eight or ten teaspoonfuls (even,) of common salt, taken with intermission, will often arrest the disease. Ten drops of Nitric Acid in a glass of sugar and water taken every six hours will sometimes succeed. The Ilydrochlorate of Ammonia a dram between paroxysms, will often arrest the disease. The Carbazolate (Picrate) of Ammonia in doses of a quarter to half a grain in pill three times a day, is an old remedy which often succeeds. It can be given in pill. Just previous to an expected paroxysm, a hypodermic injection of a quarter of a grain of Morphine will often arrest or mitigate it. A full dose of Opium by the mouth is in a less degree eflflcacious. During the hot stage cold drinks and cold bathing maybe freely in- dulged in. If any medicines are needed in this stage a half a drop to a drop of Tincture of Aconite may be given every half hour until the pulse and fever is reduced, when its administration should be stopped. Taking M ' -Kit' !iit'' » ««l m !y It 1 k 1 1 ,- :; iji ,.>r,.,i| I ^t ■ '^■""■" <■ 560 FEVER AND AGUE. Ill m (2 i1 the bed before the exjiected chill, covering the body and keeping it wtinii with hot bottles has warded ofl' " the chill." A teaspoouful of Chloroform Bwallowed with mucilage or syrup has prevented the paroxysm. The difficulty of eflfecting a cure, especially in chronio cases, is experi- enced by the patient remaining in the malarious district where he is con- stantly receiving additional doses of the poison. So that sometimes it is necessary for the patient to removo to a locality where malaria is un- known. The best preventive of ague, aside from removal from the malarious district, is frequent doses of Quinine from daily to twice a week of two to five grains each, and the use of Iron to overcome the iiiix^inia. The pre- judice against taking Quinine for a long time, for fear of injury, is wholly without foundation. Poisoning by malaria is most apt to occur in the evening, night, and early morning. It is obvious, then, that remaining in the house during these parts of the day is advisable, preferably in an upper room (it is pro- bable that the poison does not rise as high as the second story of a house which is high— 10 or 12 feet between joists). It is also claimed t'.at if the oi)en doors and windows are closed with line muslin screens from sunset until the dew is off in tlie morning, the occupants of the house are in no danger— the poison caunot pass through these screens. The enlarged spleen from ague, will generally yield to the remedies which cure the ague. This dilliculty is treated of in diseases of the spleen (Chap. XV). The ointment of the Red Iodide of Mercury seems particu- larly applicable in cases of chronic enlargement. A Belladonna plaster worn over the side generally relieve.^ tlie pain materially. The ancemia and dropsy occasioned by chronic ague will be relieved by the tonic treatment recommended to prevent relapses. In pernicious (congestive or sinking chills) intermittents, no time should be lost in giving an anti-periodic, and nothing but Quinine is to be relied on. Twenty grains should bo given at once, by the mouth, or forty grains by injection into tlie rectum. The dose should be re])eated every five hours during the intervals, unless marked (Mnchonisni (ringing of the ears) is produced. The patient has, in some instances been kept under this elTfcct of the remedy for a long time after the paroxysm has passed ; subsequent doses after the patient merges from the paroxysm, will vary from ten to twenty grains. The hypodermic injection of Quinine is sometimes necessary here, and is, in the opinion of the writer, to l)e always preferred. From five to ten grains may be given at a dose: Take ofSul- pluite of Quinine a dram, Sulphate of Morphine a grain, Dilute Sulphuric Acid forty miniyns,. Water one ounce. Mix and filter. A dram contains seven and a half grains. The dose may be repeated, given in this way, in half the time given by the mouth or bowel. Excessive Cinchonism is not necessary, but promptness and intelli- gent boldness are necessary for success. Large doses must be given for a longer period than for the milder disease, but the treatment is governed by the same principles. HOMCEOrrtTHIC TREATMENT. In the treatment of ague, the type, although by no means to be held as unimportant, is yet of very secondary consideration to the other features of the malady. EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. 561 China or Quinine. Tlila well-known, but too frequently abused remedy, is of great efficacy in those fevers which owe their origin to the influence of mjirsh miasm, and are peculiarly prevalent at particular seasons of the year. Ii may be given when the fever commences with a sense of languor, or general uneasiness of the he.^rt, anxiety, headache sneezing, great thirst, craving hunger or nausea, and pain in the bowels. It is, also, indicated when the fever has set in with absense of natural thirst— during the cold stage— but thirst is experienced after the heat and during the sweating, or thirst between the hot and the cold stage, and when the chill and fever are followed by a copious sweat. It is contra- indicated when thirst exists during the hot stage. Turgidity of the veins, with heat in tho head, and natural warmth, or increased heat of the body, with or without increased heat of the surface. Or, again, determination of blood to tMe head, commonly with redness and heat in the face, with chilliness of iA\ the other parts of the body, and even external coldness or only a fe*»lingof internal heat in the face, with coldness of the cheeks to the touch, and cold sweat on the forehead, are further indications for the employment of this remedy. In many cases, China, although not capa- ble of effecting a radical cure, is yet of great utility as a palliative; it should, under such circumstances, be exhibited immediately before the cold stage. In such instances, the consecutive treatment should be adapted to the remaining or supervening symptoms. Dose: Of China, four drops in a teaspoonful of water every hour in the interval between the fever-fits— the same dose being repeated as the symptoms occur in like manner. When directly specific, how- ever, a single dose of this medicine will generally remove the fever. Of Quinine, one grain in the same intervals. Lobelia. This remedy promises to be of equal efficiency with China in the treatment of ague, and may be particularly selected, in many instances, even in preference to China; but in the majority of cases which appear to indicate the latter remedy, when that, however, has been pro- ductive of only temporary relief, and particularly when derangement or foulness of the stomach is present. Dose : Of a solution of ten pills to four tablespoonf uls of water, give a teaspoonful every three liours, until amelioration or change; or a dose in the like proportions, two hours before the anticipated return the attack. Arsenicutn is one of the most important remedies in intermittent fevers. It is indicated when the different stages are not definitely marked, but the fever and heat and shivering appear simultaneously — or when we find cold shuddering alternately v ith heat, or a sensation of cold internally, with heat, or an imperfect development of the paroxysms; or burning heat as If molten lead were coursing through the veins, communicating an unpleasant sensation of heat to the hand, when placed upon the body of the patient ; great restlessness ; excessive, almost insatiable thirst, oblig- ing the sulFerer to drink constantly, although but little at a time ; depres- sion, marked prostration of strength, and anxiety; nausea, desire to vomit, retohing, and even vomiting; severe and burning pains in the stomach, and insupportable pains all over the body, especially, in the limbs. One marked characteristic of Arsenicum is, that all the sufferings of the patient, pains in the limbs, etc., increase in intensity during the parox- ysm, and others develop themselves ; another is, its marked periodicity, fl I'M iw %. I ,, u ^1 "If 4.1 ;i : td FEVER AND AGUE. generally, either Tertian or Quartan, and the rigors generally setting in towards evening. It, is, therefore oallud for in these cases, where wo meet with a toell-markcd periodicity of imperfectly developed paroocysms, with some, or any of the symptoms above mentioned. It \i the remedy when large doses of Quinine have been used with no good result. Dose : Bix pills in a tablespoonf ul of water; administer during the inter- val between the fever- fits, three doses, as often as they continue to recur. Or in cases of the continuance of tlie cold fit, or exhaustion BO severe that tlie patient ia unable to rally, even during the inten vals,— of a solution of twelve globules to three tablespoonfuls of WBter, give a teaspoonful at intervals varying from a quarter of an hour to two hours, according to tlie seventy of the case, doubling the intervals, or suspending treatment as soon as reaction sets in. The thirtieth potency is best. Ipecacuanha is usefully employed in the majority of cases of marsh fever, at some stages of the disorder, espe^iially, in the earlier periods. Borne instances occur in which it issutHcient of itself to eftect a cure; in other instances, it is most successfully followed by other and appropriate remedies, or coupled with Nux-v. in particular. It is indicated by the following symptoms: much shivering, with but little heat, or vice versa ; increase of the shiveiing by external warmth; oppres-jion at the fore part of the chest; want of natural thirst, or at least, little thirst; dryness ofthu mouth, nausea, vomiting, and other symptoms of deranged digestion. Dose : As directed for Lobelia. Xux-vomica is, especially, indicated by excessive weakness at the commencement of the fever; the shuddering mixed with or immediately followed by heat ; warmth of the cheeks, with internal chilliness ; feel- ing of heat in the face, with shuddering in the remaining parts of the body ; heat in the head, with coldness of the body ; burning pain in tiiu eyes; or giddiness, with feeling in the head as if from intoxication, desire to lie down, with trembling of the limbs; fainting, or a sensation of paralytic weakness and prostration, with cramps in the different extremities, particularly the calves of the legs and feet; difficulty of breathing, palpitation of the heart, anxiety, irascibility, fear of death and even violent delirium ; derangements of the alimentary organs, sueh as want of appetite; dislike to bread ; bitter and sour eructations, tension of the belly, or spasms of the muscles in that region, and constipation ; burn- ing, itching miliary eruption, and burning itching sensation over the whole body. During the fever: coldness and blutness of the skin, desire to be constantly covered, even during the access jf beat and perspiration; occasionally stitches in the side, shooting pains in the belly, aching in the back and limbs, and dragging pain in the belly during the rigors. During the hot fit particularly: headache, buzzing in the ears, heat in the head or face, with redness of the cheeks, and thirst. Dose: Aa for Lobelia. Pulsatilla, like the two medicines last mentioned, is an excellent remedy in agues complicated with the stomach or bilious symptoms, whenever the slightest attack of indigestion brings on a relapse. Its more peculiar indications are vomiting of phlegm at the commence- ment of the cold stage; want of natural thirst, all through the fever, or thirst, only during the hot fit; simultaneous heat and shivering, aggra- vated in the aftemocm or towards evening; shivering when uncovered; in jet Ith on EPIDKMIO AND ENDBMK! INFECTIOUS DI8EA8KS. 5&i Hiixlcly und oj)pro9sioii of tlu," chest ilurinj? the wlilvoring. Riiiuiij thehof vtni/c, rt'dnusM and swoUlu}? of tlio face, or rtMliiess of the checks only, anti perHpiratlon on the fuce. The prcHenci'ordlurrhdni.und the patient beiny of a mild diHpoHition, lire corroborative indicutlona for its eniployiuent. Dose: h>ix pills every four hours. Cedron. ChillH reijular und very Hevore, with cramps, and tearing pains in upper and lower extreinlticH. Dry heat, followed by profuse per- spiration. Numb, dead feeling in legs ; tlwy IVcl eulaiged. The entire body feels numb. Tliis remedy is especially serviceabht in the intermittents of serai.tropical countries. Do»c : Ten drops in one-half glass of water. Teaspoonf ul every two hours. JBelladouHfi. Severe headache, with giddiness, or heat and redness of the face, pulsation of the large blood-vessels of the neck, and excessive aggravation of pain from luedlhition; partial shivering and shuddering, with heat in other parts; great heat with sliglit shivering; or violent shivering with moderate heat; absence of natural thirst or, on tlie con- trary, intense thirst ; extreme susceptibility, tearfulness, or depression of spirits, and desire for death, particularly wlien the sufferings are at their hight. Dose: Four pills in a teaspoonf ul of water every three lionrs, duriDcr the first interval whicli occurs after treatment has been undertaken and afterwards at lengthening intervals. Ignatla is indicated, when, with heat of some parts of the body, there is coldness, cliill, and shuddering of others; also where the heat is only external. Its best characteristic is, when the cliills are easily relieved by external warmth, and attended with thirst. Dose: As for Bryonia. AjHs. Violent headache, amounting almost to unconsciousness ; pain in the limbs and all over the body, thirst more during the heat; sensitive- ness at the pit of the stomach ; scanty uriue and swollen feet. Chill about four p. M, Dose : As directed for Ignatia. Natrum-tn. is especially advantageous, for cases wliich have been mismanaged with excessive doses of Bark or Quinine, pai "ularly as fol- lows: Ague-fits, commencing with headache, general achii.5 pains, predo- minant or prolonged shivering, great thirst during the hot fit, and nearly to the same extent during the cold stage; also, dryness of the mouth and tongue ; tenderness of the pit of the stomach to the touch ; bitter taste and loss of appetite; debility; sallow complexion; soreness of the corners of the mouth. Dose: Six pills in a teaspoonf ul of water every four hours, the first interval after treatment is undertaken, and three hours before the return of everv attack, until amelioration or change ; and afterward at longer and longer intervals. Carbo-vegetabilis is particularly indicated, when throbbing at the temples, aching in the teeth, and in the bones of the extremities, and the coldness of the feet precede the paroxysm ; v/hen thirst is present only dur- ing the shiverings, and there are rheumatic pains in the teeth or limbs before or during the attack ; or nausea, giddiness, and redness of the face during the hot fit ; further, when an intense, burning pain, occupying the till' 4'* I'tlii *'!J'\ V ■m ii M«!' AM INFLAMMTOBY FEVER. prominent part of the forehead and the eye on the right side accompanies the fever. Where Quinine has failed, this is anothei' excellent remedy Dose : As for Natrum. INFLAMMATORY FEVEB-8YNOCHIA. Diagnosis. Rigors (chills) — generally considerable— followed by burning heat; pulse strong, hard, and greatly accelerated ; dryness of the skin, n^outh, lips .md tongue; the latter generally of a bright red, in some Ct-aes slightly coated with white ; thirst; urine red and scanty ; con- stipation ; respiration hurried in accordance with the pulse; amelioration of symptoms as the pulse assumes a more normal state. It runs its course with rapidity, rarely exceeding fourteen days, and progressing with regu- larity to a crisis, which shows itself in profuse perspirations, diarrhoea or hemorrhage, principally epistaxis (nose bleeding). The period mentioned is its ordinary period of duration, but under careful treatment tlie perfect crisis is considerably hastened and without the long convalescence entailed by the usual heroic antiphlogistic treatment. It is peculiarly apt, if not carefully treated, to change to typhus, or, by mestastasis, to fix upon some important organ. Causes. Sudden chill, or check of perspiration, exposure to wet or damp winds, or dry, easterly winds, violent emotions, such as grief, joy, anger, etc., high living, external injury, local inllammations, and from slight attacks of fever mismanaged. Individuals of what is termed a plethoric habit are particularly sub- ject to this disease ; it mostly attacks between the ages of fifteen and thirty vears. Under diagnosis we have just now given the symptoms usually present in synechia; we, however, find it complicated, in many cases, with cere- bral (brain) disturbance which you will find more fully considered under Inflammation of the Buain. HOMEOPATHIC TREATMENT. When the symptoms above described are present, give at once a dose of Aconite.every two tosix hours, according to the intensity of the fever. The pulse should be carefully watched and also the appearance, first, of simple moisture of the skin, and afterward, of copious sweating, which generally takes place after a few doses of Aco- nite. The intervals between the d les must be lengthened as soon as this favorable change takes place. A slight degree of delirium is frequently present in this affection, chiefly at night, which— unless it threatens to run on to inflammation of the brain, in which case Belladonna must be given— Aconite of itself is sufficient to subdue. When, however, during the course of the disease, other important symptoms besides those mentioned develop themselves, different remedies, such as Bel)., Bry., etc., must be given. Belladonna is, especially, useful after the previous employment of Aconite ; but it may, also, be employed at the commencement of the attack in all cases where the cerebral (brain) system seems most prominently affected, and there is great heat in the head, with violent headache, par- ticularly in the forehead, and redness of the face; distention of the arteries EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. 565 0/ <^e fempZei',* nocturnal sleeplessness, with furious delirium; eyes red, shining and fiery ; general Internal and external heat ; burning thirst and agonizing restlessness. Bryonia. When the state of excitement is chiefly confined to the organs of the chest (thoracic viscera) or when there is gastric complica- tion, and the fever inclines to degenerate into typhus. This medicine is accordingly indicated when, in addition to the usual symptoms of inflammatory fever already given, we find a heavy stupefy- ing headache, with a sensation as if the head would burst at the temples, much aggravated by movement, vertigo and giddiness on rising up or moving, burning heat of the head and face, with redness and swelling of the latter; delirium; oppression at the pit of the stomach; excessive thirst, sometimes followed by vomiting ; constipation ; aching or shooting pains in the limbs, short cough, oppression of the chest, and laborious breathing. A do3e every three to six hours, according to the urgency of the symp- toms. Cantharis is good in irritative fever, especially when the following symptoms are developed: the fever is very intense during the night, and is accompanied by burning of the skin, strong accelerated pulse, general redness of the surface, dryness of the month, and violent thirst. Fur- ther, when pains are complained of in the right side of the body, attended with great anxiety and raving. Chamomilla is best when the attack is brought on by a fit of anger or vexation; present burning heat and briglit redness of the cheeks, treraulcMS, anxious, palpitation of the heart, extreme irritability of tem- per, ai»-* ove'- sensibility of the senses, alternate chill and heat and some- times spasmodic attacks. A dose or two of Aconite is generally needed in the beginning. When inflammatory fever seems to arise from a primary inflamma- tion of some important organ, such aahead, lungs, liver, stomach or bow- els, the appropriate treatment will be found under the title "Inflamma- tion of Head, Lungs, Liver," etc. liryonia is indicated by headache and giddiness, with dry heat pre- ceding the attacks of shivering; by the predominance of cold or shiver- ing, with redness of the cheeks, heat in the head, and headache; or marked heat, followed by shivering; by stitches in the side, excessive thirst, thickly coated tongue, bitter taste in the mouth, disgust at the sight of food, nausea or vomiting, and constipation, especially in the cases occurring in the spring. Dose : Six pills in a tablespoonful of water every morning, or as nearly at that period as possible, during the interval between the attacks. I I'""' 9)' St.! 1.1 ^'M i : ;i;: II. W i f " !' ■' yA I TYPHOID FEVEB-TYPIIVS-FErER— ENTERIC FEVER. Typhus occurs in two forms that do not differ much from each other, namely: abdominal typhus and exanthematic typhus. More recently, this lust-named form has become much less frequent than the former. In spite of these differences, the description of both forms is pretty mucii the 650 TYPHOID FEVER. same; up to this period, we have not succeeded in discovering the reason for the appearance of either one or the other form. Typlius originates in some infectious agent ; all that is known of this agent is: that it is caused by tlie decomposition of animal substances. Hence, typhus occurs most frequently where the decomposition of ani- mal matter is most favored by circumstances, namely : in large cities and hospitals; likewise, in localities which are least favorably situated for carrying away the products of decomposition, such as cities built in a flat country and with imperfect drainage. The infectious i>rinciple at times seems to act with great intensity; at other times very mildly, so that typhus in crowded localities sometimes breaks out with an extraordinary' virulence; and other times with comparative mildness. According to all probability, a graduated difference of this kind is chiefly owing to the quantity of the infectious agent that acts upon the organism, not to its quality. The contagion is reproduced by the patient. We cannot share the views which prevail concerning the formation of a contagion. We do not consider any form of typhus contagious. An apparently conta- gious transmission of typhus only takes place among those who have been for some time exposed to the emanations from the infected individ- ual, not among those who have only been in contact with the patient for a short period of time These remarks apply to exanthematic typhus, which is considered as decidedly contagious, but which only appears so for the reason that it produces a larger quantity and a more infectious quality of contagious matter. Physicians in private practice are seldom attacked, notwithstanding they are brought in closest contact with the patients wlien exp.oJng their chests; hospital-physicians and nurses, on the contrary are taken down very often. More recently the level of the surface-water has been more particularly examined with reference to typhus and cholera; a high level is supposed to favor the breaking out of these plagues. We are still without any reliable data in this respect. In large cities the construction of wells and water-closets deserves great at- tention; where both are so close together that the well-water can be con^ taminated by the contents of the closets, typhus is very likely to occur. This subject is, without doubt, worthy the most serious attention of the board of health, for typhus is not only one of the most dangerous, but likewise, one of the most frequent diseases. A few points can easily be inferred from what we have said, such as: epidemic and endemic, slightly endemic and sporadic type of typhus; breaking out of typhus in very damp and hot years, during the hot months of the summer and in the fall; likewise, in crowded hospitals, more par- ticularly, if they are full of wounded soldiers ; or in densely populated streets, tenement-houses, on ship-board, etc. Typhus occasioned by an insufficient supply of food, or by unwholesome and deteriorated food, is less easily accounted for. One attack of typhus does not always, but very generally, protect against a second attack. There are certain other circumstances that almost positively preclude the possibility of typhus, especially, abdominal typhus ; t'o.ese are : Intermittent fever, consumption, cancer, heart-disease of the higher grade. Age doei not establish any positive lines of demar- cation ; except infants, persons of any age may be aj^tacked, but more par- EProEMIC AND ENDEMIC INFECTIOUS DISEASES. 55t ticularly young people and individuals up to the age of lifiy. Vigorous constitutions are more easily attacked, and likewise more severely, Exoitinn- causes are: Fear and anxiety; a sudden change of diet when pel 'i, settle in a locality where typhus is endemic; catarrh of the intestine; ental depression, both by excessive mental labor as well as by care and grief. Symptoms and Course, In abdominal typhus, the ulcers in the intes- tines act the most important part; they have even given rise to the name of this form of the disease. However, it behooves us to premise tlie statement that in their various phases, these ulcers do not correspond with definite phases in the total course of the disease. Except these two almost constant phenomena, typhus does not offer any permanent, characteristic signs. The brain, especially, remains unal- tered; the lungs, on the contrary, show at first, symptoms of irritation; afterwards pneumonia. During the first weeks of the disease, the mus- cles h; . e a somewhat characteristically dark color, and thp internal sur- face of the arteries has, likewise, a dark-red appearance. In exanthem- atic typhus, the intestinal ulceration does not exist, whereas, in this form, likewise, the spleen is considerably hypertrophied and softened, and the vessels, also, have a bright appearance as if injected. Abdominal typhus very rarely breaks out suddenly ; it is, generally, preceded, for a few days, or even a week by indefinite symptoms, such as lassitude, indisposition to work, loss of spirits, impaired appetite, very seldom hunger, almost bordering upon a voracious desire for food; wander- ing rheumatoid pains in the limbs, especially in the back, headache of the indeterminate type, sleep full of dreams. The disease is generally ushered in by a chill of moderate violence, or by a marked fainting sensation, which is soon followed by the character- istic feeling of illness, namely : an inability to stand erect or move about, and a desire to lie down. Very seldom one of these conditions is entirely wanting, so that it is difficult to point out the real beginning of the disease ; instead of one severe chill, we often meet with a succession of very feeble chills. The disease now developes itself in the following manner: The patients feel weak, have neither the strength nor the desire to rise from their beds; headache, at times more frontal; and at other times, in the more violent cases, in the occiput, throbbing and very distressing ; com- plete loss of appetite ; altered, generally pasty taste ; vomiting not very frequent; bowels quite torpid in the first week; restless sleep; when waking early in the morning, the patients commence very soon to com- plain of phantasms whith they cannot avoid; yet they talk very ration- ally and are perfectly conscious of seeing phantasms. The pulse is gener- ally full, very seldom exceeding one hundred beats, very often dicrotic (double or rebounding,) the temperature is high, the skin feels burning hot. The breathing is almost constantly hurried, anxious, the patient talks hurriedly, yet is able to take a long breath. The spleen is generally swollen, the swelling increasing rapidly in size, and is not unfrequently painful. The abdomen does not show any constant alterations, but when pressed upon, the patients complain of pain in this region, and a gurgling sensation is communicated to the finger, with which the pressure is made- The tongue is at times coated very thickly, at other times it only has a wi* I i|!'.. ■■^n II m I >;'i fl nm • lE'. ' '9 i: )r:f| .*''! 558 TYrHOll) FEVER. whitish coating, and again it loolta quite clean, but tlie coating changes aa the disease progresses. Sometimes the patients complain of a little hack« ing cough, and exhibit symptoms of a slight bronchial catarrh. The urino is less in quantity, saturated, notwithstanding that the patients often experience a very violent thirst. All these symptoms remain in force only in very violent cases ; most generally a sensible remission of these symptoms takes place towards the e.nd of the first week. Second Week. In the second week the symptoms of the disease undergo a marked change, unless the morbid process takes a turn towards recovery, which is very seldom the case. For the present, we only speak of typhus of a moderately severe type. In this stage, the patients lose their consciousness more and more ; they are either lying in a state of lethargic apathy, or else it is only with great difficulty that they are able to reply to questions, or to give utterance to their own ideas. In the even- ing and during the night, this soporous prostration is generally interrupted by a state of nervous exaltation, during which the patients manifest their internal nervousness by animated talking, or by constant endeavor to escape from their beds. Sensations of pain now cease entirely; when asked how they feel, they answer: " Quite well." TJiey express no desire for drink, but they swallow the ofTered beverage hurriedly and greedily ; when rep'eatedly asked to do so. they put out their tongues slowly and tremulously, and forget to draw them in again. Another evidence that the influence of the brain is almost entirely suspended, is, that the patients persevere for a long time in an uncom- fortable position, and that they allow the urine and feces to escape into their beds. At the beginning of the second, and very frequently already at the end of the first week, the patients complain of a violent buzzing in the ears, afterwards they are evidently hard of hearing. Corresponding with these changes, the countenances of the patients become altered. Although the complexion seems to shine, yet it has a livid hue; the eyes stare, or they have a vague and unsteady expression ; when raised in their beds the patients at once turn pale and look as if they would faint. The vari- ous functions show the following deviations from their normal condition : The pulse is seldom below one hundred, nor is it often above one hundred and twenty, it is weaker than usual and sometimes dicrotic. The tongue, which already showed a good deal of dryness in the first week, now is constantly dry; the streaked coating, which had marked it hitherto, now vanishes ; it shows a peculiarly red color, and the papillae seem to have become effaced ; towards the end of the second week the tongue appears covered with a brownish incrustation. The appetite is entirely wanting, yet the patients will taste of what they are ofTered to eat. They do not seem thirsty, yet they drink greedily the proflFered beverage. At this stage the abdomen begins to bloat quite considerably ; when the iliocoecal region is pressed upon very hard, the patients distort the corners of their mouths. Diarrhoea now usually sets in, from four to eight passages tak- ing place involuntarily every day. They have a yellowish color, deposit a sediment of thick consistence over which floats a watery, opalescent sub- stance. The urine is secreted in smaller quantities, it is dark and is fre- quently voided involuntarily; sometimes it is retained altogether, so that EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES, 559 llie b.adder becomes very iiiiich distended. The respiration is still accel- erated, yet the peculiar hurried breathing of the first weeli is scarcely yet perceived; catarrhal symptoms are likewise discovered, altliough the patients scarcely ever cough and only rarely bring up a tenacious, yel- lowish mucus. The spleen continues to enlarge, although owing to dis- tention of the bowels, and the consequent displacement of the spleen upwards, the enlargement cannot well be discovered by examination. Upon the abdomen, thorax and back, roseola-spots break out in greater or less number, some of which are usually present at the end of the first week. About the middle of the second week all these symptoms generally show an increase, less frequently a remission ; both the increase and the remission are, however, of short duration. Third Week. In the third week, especially at the commencement, the symptoms continue to increase in intensity. Tlie patients are now lying in a state of complete apathy ; in the day-lime they are only slight- ly delirious, but during the night the nervous exaltation is nmch worse, attended with grasping at IlocLt<. The prostration is so great that the patients are no longer able to sit erect; they are constantly lying on their backs, and the body, yielding to the law of gravitation, settles from the pillow downwards towards the middle of the bed. The tongue is only slowly protruded after loud and repeated requests ; it is quite dry, with a brownish coating, which is likewise exhibited on the teeth and at the nostrils. Deglutition is very difficult, and it is only with a great effort that the patient is able to swallow very small (juantities of liquid at one lime. The diarrhoea continues, but the passages are generally less copi- ous, and not unfrequently tinged with blood. The urinary secretions continue to decrease and paralysis of the bladder is not an unfrequent occurrence. The abdomen is greatly distended and is no longer sensitive to pressure. The other symptoms continue unchanged, except that the roseola-spots pale off and become complicated with miliaria (measle-like) and sometimes with ecchymoses (black-like bruised place). Bedsores are now very apt to torment the patient. Emaciation proceeds very rapidly, and the whole appearance is that of a general collapse. Up to the middle of the third week, the fever maintains its intensity. In cases where the disease continues during the fourth week no remission of the fever is per- ceptible. In most cases, however, the seventeenth day is characterized by a sudden abatement of the fever and of most of the other derangement of the functions. This improvement at times is only apparent, as in a few hours the symptoms again exacerbate; but at other times it is a real improvement marking the beginning of recovery- If the patients die, it is most generally at this period ; the remission just alluded to, when followed by exacerbation of the symptoms, is generally looked upon as a fatal change. Death takes place with symptoms of paralysis of the heart and lungs. In favorable cases the fever remits every morning on the last days of the third week, whereas the evening exacerbations decrease in violence, the consciousness returns gradually and with it a desire for food and drink. At this stage the fever scarcely shows a sudden and considerable decrease, with a correspondingly sudden beginning of convalescence. With the third week typhus of a medium grade has reached its inten- ,LV« h-i i..i:. ¥i ir'ii '»|ili wS ■l fl ! \ J Hi Mi" ii I'ilfl'l WJO TVPHOID FEVER. sity in Ro far as signs of oonvaloscence now begin to show tlicniselvcs, althoiigli very slowly. Every cjise of tyhus out-lasting the third week, may he safely regarded us very severe. Except complications take place, no new symptom;; develop themselves during the fourth and fifth weeks. The remissions of the fever are very distinct and grow more decided in character; the pulse.ou the contrary.increasesin weakness and frequency. The patient looks as if he were in a state of terrible collapse; occa- sionally threatening paroxysms of collapse really take place, more partic- ulary in the night; in the latter course of the disease, such paroxysms are, however, not as dangerous as they seem. In the case of adults tiic consciousness usually returns towards tlie end of the fourth week ; but, if the fever continues, delirium is still very frequent towards evening. The diarrhoea is at times less than it was, and at other times more profuse ; in some cases it now ceases altogether. The skin looks clean, with the exception of miliaria here and there. The bed-sores which are never wanting during such a protracted course of the disease, grow rapidly in extent and malignancy. If the fever runs a course of four weeks, recovery takes place very slowly. In very fortunate cases recovery goes on uninterruptedly, but most frequently its course is disturbed by all sorts of accidental inconve- niences, such as vomiting after certain kinds of food, or even after any kind; sudden disappearance of the appetite that had just begun to return; return or protracted continuance of the diarrhoea; exacerbations of the fever. The decubitus, the nature and conduct of which afford an excel- lent criterion by which the amount of progress in the recovery of tlie patient can be measured, sometimes causes a great deal of serious trouble, provided the final cure of the fever is very much delayed. Death eitlnM- takes place in consequence of the utter prostration of the patient, from exhaustion, or from sudden and complete overpowering of the whole of the vital powers of the system. ALLOPATHIC TREATMENT. The first requisite for the proper treatment of typhoid fever is, that the patient shall be in a large room, ventilated by means of several windows, that the air may be constantly changed by the free entrance of pure fresh air. Disinfection should also be constantly practiced. The generation of Ozone (active oxygen) constantly in the sick roomj is very beneficial. This is best done by a mixture of two parts of I'li- inangauate of Potash and three parts strong Sulphuric Acid in a broad, open vessel. An invigorating quality is imparted to the atmosphere of the room, and is especially beneficial, when, for any reason, the room cannot be freely open. Dry scales of Iodine, in a chip-basket, hung over the bed, and placed in saucers in different parts of the room, are valuable in removing any unpleasant odor in the atmosphere. A few of the scales may be vaporized, occasionly, by sprinkling on a hot shovel. Another available disinfectant is Carbolic Acid; a few drops may be put on wetted cloths which are hung up in the room. The fioor miy he occasiofially sprinkled with Labarraque's Solution (Chlorinated Soda). The vessels which are to receive the excretions should always contain a little of the Solution of Chlorinated Soda, Permanganate of Potash, or Carbolic Acid, five or ten drops in water. I'."' EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. r«l It is needless to remark that carpets, curtains, and all unnecessary articles, ought to be removed from the room. The proper temperature of the room is sixty degrees. The bed linen should be changed daily. As soon as it is determined that the patient has typhoid fever, the hair should be shingled. The most effectual plan for controlling the temperature is, by the use of water. Where there are proper facilities for it, the bath is the surest and most efficient method for reducing a high fever. The patient should be placed in the bath at a temperature of ninety-eight degrees F., and the temperature of the water lowered to eighty degrees, or to sixty degrees, by the addition ice or of ice water. After a time varying from five minutes to half an hour, a marked reduction of the temperature is produced, ais shown by a thermometer placed in the rectum (bowel,) when the patient is removed from the bath, wiped dry and placed in bed. For this, a bath-tub is necessary, large enough to receive the body, provided with a discharge pipe to convey off the extra water, a strong sheet to lift the patient, a thermometer to test the temperature of the bath, and a fever thermometer to ascertain the amount of reduction in the heat of the patient. The most suitable method of applying water in private practice, and in families, is, by the use of the cold wet pack. A sheet is wrung out of cold water and placed on the bed. The patient is then laid on the sheet, with a proper support for his head. Each side of the sheet is then brought over tiio patient and tucked under the opposite side. The legs are well wrapped in, and the patient is well covered with blankets. He may remain in the pack from ten minutes to an hour. The pack may be repeated several times a day, the frequency being determined by the rise of temperature. When taken from the pack, the patient is to be wiped dry. An agreeable, but less effectual plan, is, cool sponging and having the cloths dipped in cold water and laid upon portions of the body. When there is any tendency to collapse, wet baths should not be ,L;i ven. There can be no doubt of a greatly diminished mortality by the use of cold baths, the disease pursuing a milder course under their use. If, in the use of water, the circulation becomes feeble, the skin blue or the extremities cold, stimulants should be given, and bottles of hot water placed at the feet. The use of the mineral acids is of marked benefit in this disease by aiding the gastric secretion and improving digestion and in increasing the mucus gecretions, and relieves somewhat the dryness of the tongue. The Dilute Hydrochloric (Muriatic) Acid is as applicable as any, given in doses of ten drops diluted in water, sweetened with simple Syrup or Byrup of Orange Peel. It seems better suited to aid digestion, than any other acid. If the teeth become set on edge, it is well to wipe them off after each dose of the Acid with a cloth wet with a solution of Bicarbonate of Soda. This will do much towards preserving the teeth from the injurious effects of the Acid. In case of ajiparent exhaustion of the nervous system the Dilute Phosphoric Acid may be given in doses of ten or fifteen drops every hour or two, properly diluted and sweetened. It is given habitually 36 Ill i M I i^ ''p ^ vm |> ! 869 TYPHOID FEVER. by some physicians in this disease. It is conclusive that the use of the Acids diminish the mortality of the disease very greatly, besides b(;ing very grateful to the patient. The patient may also drink freely of cold water or iced water, barley or rice water acidulated with lemon or orange juice; the only limit neces- sary to be observed is, that the amount taken does not derange the stomach. In view of the fact that typhoid fever is a self-limited disease, the essential element in the treatment is to support the powers of life and keep the patient alive until the di.sease shall disappear. The means for this purpose are food, (nourishment) alcoholic stimulants and tonic doses of Quinine. Regarding the nourishment of the patient, it is important that system- atic feeding be begun early in the course of the disease and continued throughout. In the beginning of the disease, but very little food will pro- bably be taken, owing to a repugnance to it, but if liquid food is given cold the patient will often take it to relieve his thirst, and in this way enough nourishment will be taken to maintain the strength. It should not be given to the extent of producing vomiting or a feeling of discomfort from over-fullness or indigestion. The forms of food best suited for fever patients are milk, strong beef tea or essence, and fresh luw eggs beaten with a teaspoonful of sugar and half a cup (four ounces) of water or milk. Further on in the disease, there is an indifTerence to food, but if it is given it is digested ; it should be regularly given. If only about four ounces of milk, beef tea, or egg and water or milk are taken at a time, it should be given every two hours. If an ordinary drinking glass full (eight ounces) is taken at a time, four hours should be the intervals of taking food. If the patient expresses a desire for any particular kinds of food, the wish should be complied with, as far as possible. It is a good rule, however, not to give solid food when there is diar- rhoea. With the three articles mentioned, sufficient nourishment may be given. In making beef tea, apound of finely chopped lean beef will make a pint of strong tea. A pint of cold water is poured upon the beef and brought to a temperature not above one hundred and sixty degrees Fah- renheit, and kept at that point for four hours, a little water being added from time to time to supply the loss from evaporation. (The Hydro- chloric Acid, previously directed, can be given in the beef tea.) Mutton or chicken can be used instead of beef. Finely divided lean beef pounded in a mortar, until the nutritious elements are separated from the fibre, may be given. Nothing excels a milk diet. Everything else should, as a rule, be supplementary. By early and continuous feeding, the severer 8ymi)toms of the disease are generally obviated, as they generally depend on the exhaustion and prostration, which is prevented by nourishment. In the course of the disease, if severe, alcoholic stimulants are almost always required. They should be given from an early period in the attack, as aid to digestion, a teaspoonful to a dessertspoonful of Whisky or Brandy with each half glass (four ounces) of milk or other liquid food, but not oftener than two hours, greatly aids in the feeding of the patient, and so prevents, in many cases, the innutrition and its results, which is shown by delirium, a rapid feeble nulse, twitching of the muscles, pick- rl HI r KPIDKMIC AND ENDKMIC INFECTIOUS DI3EA.SES. am ing at the hedclothos, coma, with watch fiUncss, rcHtlessnesa, etc. In a stage of this fever where there is marked cxiiaustion, Brandy or Wiiisl<y Hhould be given freely and to the extent of relieving the symptoms above enumerated. I believe life is saved by the free but judicious administra- tion of Alcohol in the advanced stage of prostrating diseases in obedience to the scriptural injunction, " Give strong drink unto him that is ready to perish." The appropriate dose will be from one to two tablespoonfuls of Brandy or Whisky, given from one to four hours apart. ThesiimuJant is doing good when the weak, rapid pulse becomes stronger, slower, fuller (a pulse of one hundred and twenty is generally a weak pulse; one of one hundred and thirty, or more, always so,) when the dry tongue becomes more moist, the delirium, vigil, restlessness, etc, lessened, and the sleep becomes more refreshing, It does harm, if the pulse is quickened, the tongue dryer, the delirium greater, the restlessness increased and is being jjiven too freely. The tonic cfTect of Quinine is best produced by doses of two or three grains four times in the twenty-four hours. In the early part, headache may be relieved by cold water, either by keeping a thin cloth on the head, which will keep cool by evaporation, or by the use of ice-water, vinegar and water, pouring water upon tlie iiead (douche) or by bladders of ice. Vi*gll (or wakefulness,) sfeeplessness, or delirium, should be relieved. For this purpose, there is nothing better than ten grains of Dover's Pow- der, or a grain of Opium with a grain of the Extract of Ilyoscyamus, at night, which will produce a refreshing sleep. A condition of semi-coma (insensibility) with watchfulness, does not prevent the use of Opium to produce sleep. It is, sometimes, better to give at night, especially when there is delirium, twenty grains of Hydrate of Chloral with an equal (luantity of Bromide of Potassium, dissolved in water with syrup. Nausea and vomiting are generally relieved by greater care in giving food and drink, especially, a more limited amount of the latter. Cold or Mustard may be applied over the stomach. Ten grains of Bismuth, Sub- Nitrate, witli five grains of Oxalate of Cerium, or a drop of Carbolic Acid in water, or three to five drops of Dilute Prussia Acid, may be given hourly, if needed. Diarrhoea is generally present, and may require to be restrained bv n|>iate8 and astringents, directed in the treatment of that disease. Some- times a large injection of thin Starch will suffice. Merely a looseness of the bowels does not need treatment. Cathartics are not to be given ; but if constipation exists, it is to bo relieved by injections or mild laxatives,- as a dessertspoonful of Castor Oil in emulsion with Glycerine, flavored with Oil of Wintergreen (Gaulthe- ria) or Cinnamon. Should ulceration of the intestines occur, a peritonitis or a hemor- rhage is almost sure to result. The former result is to be treated by full (loses of Opium, to relieve the pain, and every means should be used to support life. Large, warm poultices should be kept on the abdomen. Peritonitis not caused by ulceration, is not so fatal, but is to be met by the same means. Hemorrhage into the intestines will call for Opium in doses of a grain i ♦I! 5 m ■ffi I m;:MV)l J v/m fea 'if ^!l'**. 564 TYPHOID KICVKR. M fh ■.'i: with ten grains of GiilUe Acid, in solution, witli ton drops of Aromatic Sulpluiric A(!id. NoHe-l)leeding, if excessive, will cull for tlie treatment directed in tlie article or. tliat trouble. The distention of the abdomen from gas in the intestines (called tym- panites) occasions great dis(!omfort. It may be relieved ity a largo injec- tion of warm water, containing a tablespoonful of Turpentine previously mixed witii Glycerine. A flannel clotli wrung out of liot water and tliei; wet with Turpentine, laid over tlie abdomen, will afford relief. The urine should bepxiimined frequently, t<> ascertain whether a defi- ciency in tlie amount of urea may not warn of Urremia (poisoning by this ingredient of the urine remaining in the blood). Tbe smell of Ammonia in tlie expired breath, also, indicates Urajraia. Diuretics (medicines to act on the kidneys) are required, as, a lialf a teaspoonful of Vinegar of Squill in a tablespoonful of infusion of Digitalis every four hours until urine is passed freely, and if the symptoms are urgent, hot-air batiis should be given. Profound sleep (coma) will call for these measures for relieving tlie blood of urea, and blisters to ilie bach: of the necli, by means of Blistering Collodion, During convalescence, care is to be exercised againsi overloading tlie stomach, but, at the same time, the diet should consist largely of well- cooked meats, eggs, milk and simple farinacfeous articles. Iron sHouid be given as a means of enriching tlie blood. The Tincture of the Chloride of Iron, in doses often drops, largely diluted in sweetened water, and given after meals, is as approjiriate as any. The Pyropliosphate or Soluble Cit- rate of Iron, are efficient and pleasant to the taste. A dram may bedis- solved in Syrup of Orange and given, in doses of a teaspoonful, after meals. The Citrate of Iron and Quinine, given in the same way, and in the same doses, is a useful tonic during this stage of the disc-ase. Derangements of the stomacli will call for the Liquid Pepsin and Bismuth, or such other treatment as is directed in the treatment of Dys- pepsia. HOMCEOFATHIC DIVISION AND TREATMENT. It were of no service, as it would, also, be a difficult task, to define, exactlj', the varieties of complication whicli may attend disorders of this icind. Tiie broad distinction consists in the organs which are, espe- cially, atfceted. But, in order to facilitate the discrimination of unprofessional per- sons in tiie treatment of this most difficult species of disorders, we will divide their indication, progress, and issue, into three distinct stages, tlie premonitory and incipient, the acute, and the debilitated and convales- cent stages. It is not, however, to be assumed that these gradations are idways clearly defined. Tiiey may merge imperceptibly, may be arrested l)y treatment, or may be suspended l)y fatal results. The incipient stages iire, liowever, naturally distinguishable until the positive development of the fever becomes evident, and thestageof debility, which isaconsequence of tlie ravages of the fever, differs from the two former in the substance of active symptoms, and the accompanying prostration of animal power. In the treatment of all alike we must be guided by the symptoms, and select EPIDEMIC AND ENDKMIC INFECTIOUS DISEASES. tto.. the moat appropriate remedy according to tlie characterintlc indications iiirorded. IIOSKEOPATIIIC TKEATMENT-DuKiNO the Puemonitouy and iNCJi'iENT Stages, Bvyonia-alba, Khus-toxtcodcndron. Tliese reni- cdic'H, eltluT singly (according to tlie siibjoinod synii)toMiatic indications of each,) or in alternation (where the symptoms oi' the diaeaae eml>race llie characteristics of both,) have, when seasonably adminislerod in the incipient stages of many varieties of these fevers, been found sulliclent to arrest the progress and development of the malady, altogetlier, or at all t'venta so far as to modify its future course, as to deprive it of much mallg- jiancy. liryoniaand Rhus are, in fact, the medicines whoso ascertained operation is most closely akin to that of this class of disorders. Bi'i/onia. This remedy is especially applicable to cases which mani- fest an inflammatory tendency. It should he selected in the incipient stage, when the following symptoms are present: — After a slight cold tlie patient complains of aching pains over the whole body, which admit of no relief from a change of posture; severe, throbbing, bursting, frontal headache (aggravated by opening or turning the eyes) prevails ; the scalp is tender to the touch, and the head burning hot, yet the forehead is, nevertheless, frequently bathed with cold sweat; the sitting or even tlie recumbent posture is rendered compulsory by the prevalence of debility, languor and hcvlness of the limbs, and Wiero Is an aversion to cold air ; the nights ar^ disturbed, more especially the /ore jjar^ of theni(jM,hy (l)ullitlon or congestion of blood, heat, and anxiety; the patient sighs and groans during sleep, and Is often aroused by agonizing or frightful dreams, which continue to haunt him even whilst awake. The digestive functions are considerably deranged, as exemplified by the presence of l)itter taste, loathlng'of food, nausea, and Inclination to vomit, a yellow, furred and dry tongue, pressure or weight and pricking In the pit of the stomach, with sensation of distention about the lower ribs on both sides, and costiveness. Dose: If singly, dissolve eight pills In two tablespornfuls of water, and give a teaspoonful of the solution every two hour's; if in alter- nation with Illnis., dissolve six pills of each remedy separately In two tablespoonfuls of water, and give a teaspoonful of the one solution four hours after the other. In rotation, until amelioration or change. Rhus-toxicodendron Is especially applicable to the low, i^ervous variety in the premonitory stageof typhus. It should be employed when, ''ither after exposure to a thorough wetting, or without any as;signiil)le reiison, the patient is seized with violent relaxation of the bowels, accom- panied by colic, ana complains of chilliness, even when seated close to the lire; further, when aching pains (or pains as if arising from the efl'ects of contusions) are experienced In particular parts of the body, or when a l)ainful sensation Is experienced, as if the flesh had been torn fro:'^^ the l)ones; the tongue is furred white, and giddiness, Inclination to vomit, or actual vomiting of phlegm, is present; the patient is tormented by numb- ness, creeping and tingling in the parts of the body on which he lie?, together with lancinatic is, drawing pains, and stlfit'ness In the nape of the neck and In the back, rigidity and feeling of paralysis in the extrem- itic'i, with trembling on holdhiL; out the arms; the chief qualifying con- Hi, SjI'' n 'y ;i - . I I , I'i ^WP cm TYI'HOID FEVKR. (lition in, that nil the HyniptoiiiH aro, gcntM'ally speaking, exacerbuted dur- ing roHt and ut niglit. Dose: Ifwlngly: Of a Holiition of ton pillH to two taldespoonfulrt of water, give a teaspoon fill every two liourH, until amelioration or change. If in alternation with liryouui, diHsoIve ten pillH of each remedy separately in two tal)leHpoonfulH of water, and give a tea- upoonful of the.one solution four hours alter tlie other, in rotation, until amelioration or change. Ipecacuanha may be selected in the early stage of typhus, when it is Uohcred in l)y prominen* symptoms of derangement in the digestive organs, suci) as headache, giddiness, nausea, voni'.ting, watery, yellow oi- greenish, slimy evacuations; particularly wlien these are associated witli slight chills alternating with heat, or considerable shivering with slight heat or marked heat witli but little shiveritig. Dose: Eight pills in a teaspoonful of water every three hours until amelioration or change. Pulttatillii may also be selected in this stage of the disorder, when frequent shivering, bitter taste, whitish tongue, loss of appetite, nausea, vomiting of phlegm, slimy evacuations, and fel)rile heat, intermingled with chills, prevail; and more particularly when these symptoms become exacerbated towards evening, and occur In mild, temperate, or phlegma- tic subjects, or in females, with extreme depression of spirits and tearful- ness. Dose: Eight pills in a teaspoonful of water every three hours, until amelioration or change. DiyltaltH is indicated when nervous fever, or rather typhus, accom- panied l)y bilious derangement, is ushered in by yellow jaundiced hue of the skin ; violent, bilious, spasmodic pains in the stomach ; sensibility of the upper part of the stomach on the left side, on pressure; frequent urging to make water, particularly at night, witli scanty urine; burning heat of the head and face; anxiety of mind and dread of some imaginary impending misfortune ; urination painful and dilflcult, or entirely sup- pressed. Dose: Six pills in atablespoonful of water every three hours, until amelioration or change. JVM2c-vowiica.— Symptoms of stomacha derangement, constipation, with frequent inclination and ineffectual efforts to evacuate. Nux-vomica is further indicated when the spasms, which not unfrequently accompany this disease, are conflned to the stomach and intestines, particularly the inferior bowel— a frequent cause of the above-mentioned constipation; painful and difBcult emission of urine; painful pressure and tension in the regions about the stomach and the lower ribs; sensation as if the limbs were bruised; general nervous excitability, with great nocturnal restlessness and slight delirium; weakness and aggravation of the symp- toms in the morning. Temperament, sanguine or billions; disposition, irritable and impatient, ose: Six pills in a tablespoonful of '.vater every four hours until amelioration or change. C/i«na.— This rri.edy is frequently of service in the first stage, or when paleness of thu lace, lancinating, rending, aching, or pressive head- ache, cloudiness of vision, buzzing or roaring in the ears, dullness of hear- ing are present ; yellow or white coating on the tongue, dryness of the EPIDIOMK! AND RNDEMIC INFECTIOUS DlHKASra. wrr tnoutli, in»ipid, clammy, or bitter toate ; incliimtiou to vomit; auitHiltility und distention of tlie belly; thin, yellow, wutery motions, occusioiiully intermixed with undigested Hubslunce; urin 'canty, pule or dark colored and cloudy; oppres.sion ut the chest; dragt, •>(?• shooting pains in the liiabs; anxiety, sleeplessness, and general coldness and shivering. Dose: Six pills in a tablespoonful of water every six hou. until amelioration or change. AconUum. Belladonna. These are the best remedies in the Incipient stage of the disorder, when Inflammatory symptoms decUir« tliemsolves from the commencement. The selection between Aconite and Belladonna will be gathered from the subjoined symptomutic indi- cations, and from the article on the "characteristic symptoms" under tlie head of these remedies r«3spectively. It should be added here, that when the disease becomes further developed, and still retains the Inflammrtory character— Bryonia and Rhus respectively, according to the symptoms, are generally preferable. Aconitum is indicated in the incipient stage by the presence of the following symptoms:— Clnll fol- lowed by the burning neat, strong, hard, and quick pulse; dry skin, mouth, lips, and tongue; the latter being generally, of a bright red, but some- times also coated with white; excessive thirst; red and scanty urine; hurried breathing; the symptoms being aggravated or modified, according to the greater or less irregularity of the pulse. The condition whicli distinctly points to Aconite, as the remedy (wlien other complicat'o'.is are not present,) consists in the aggravation of the above symptoma at night, often attended with slight delirium. Should the delirium become violent, and considerable cerebral disturbance be otlierwise manifested, or should this particular symptom not yield rapidly to the action of Acon- ite;— when, moreover, the skin continues hot and dry, and the bowels relaxed, or the motions are oven passed involuntarily, or when theie is in- flammation of the glands of the throat (tonsils), or red, parched tongue, great thirst with disinclination or dread to satisfy it, it will be preferable to administer Belladonna until tlie indicative symptoms yield. Dose: Of a solution of six pills to two tablespoonfuls of water, give a teaspoonful every three hours, until amelioration or change. In mild cases in which the symptoms yield readily to the action of tlie medicine, the repetition may be deferred to intervals extending to twelve hours. Belladonna is particularly indicated by the following symptoms, in addition to those above enumerated: alternate heat and chills, or gen- eral beat externally and internally, with redness, burning heat, ai>d bloated appearance of the face, or alternations of coldness and paleness, and heat and redness of the face, violent throbbing of the large arteries of the neck; redness, sparkling, and protrusion of the eyes, with dilation of the pupils, extreme sensibility to light, and distortion of the eyes; singing or noise in the ears to a greater or less degree; wild expression of the countenance, with uneasy glancing around, as if from fear, sometimes attended with a marked inclination to run away; violent shooting pains in tlie forehead ; or dull heavy pain, causing the patient to put his hand frequently to his head ; sopor; furious delirium or loss of consciousness; delirium and snatehinfe at the bedclothes, or spasmodic or convulsive at- tacks; parched lips, soreness of the corners of the mouth, redness and V'i '5 (i: Sir .^t 'i k r, # 068 TYPHOID FEVER. 1 i i^^^P"! 1 :>-i M ll dl H 1 dryness of the tongue, which is also sometimes foul, and covered with a yellow coating; skin hot and dry; bitter taste in the mouth, intense thiist, difflculty of deglutition, especially of liquids; nausea; pressure at the pit of the stomach; excessive distention of the V)owel3, and constipation or watery motions ; scanty and red or amber-colored urine; rapid respiration ; pulse full and accelerated, or quick, hard and wiry; inflammation and swelling of the glands before and beneath the ears. Dose: Dissolve eight pills in three tablespoonfuls of water, and give a teaspoonful of the solution every four hours, until amelioration oi change. In mild cases, or when the symptoms yield readily to the action of the medicine, the repetition may be deferred to a period of twelve hours, and repeated at such intervals, until amelioration or change. Stramonium i. indicated by symptoms of the same nature as those which indicate Belladonna, with the addition of the following:— twitching of the muscles of the face, starting of the tendons, squinting, trembling of the extremities, tremulous motion of tongue on protrusion, burning heat of the body, suppression of the urine, fantastic gesticulations, and in- voluntary spasmodic smiling. Dose: Eight pills in a teaspoonful of water every three hours, until amelioration or change. Hyoacf/atnns is indicated by the same symptoms as have been stated at length under the head of Belladonna, with addition of the following: twitching of the tendons, strong, full pulse, fullness of the veins, burning heat of the skin, sensation of pricking all over the body, and constant delirium; frequent but ineffectual urging to urinate. Dose: Three globules in a teaspoonful of water every three hours, until the symptoms are distinctly modified or changed. Baptisia (Wild Indigo) is especially required when the weak and tremulous feeling; the quick (90,) full, and soft pulse; the internal and external heat, with thirst; the headache and tendency to delirium; the tongue yellowish-brown in the center," and red at t!ie edges ; the consti- pation alternating with diarrhoea; all contribute to make up tlie morbid picture ;— hot, dry skin, and a quick, full pulse: the tongue is thickly coated with a wMtey-brown fur; the head aches, and t here is at least, nocturnal delirium ; no appetite and great thirst ; tlie urine is high colored, and generally with constipation. Dose: The same as directed fox Stramonium. Treatment of Abdominal Typhus; that is, Typhus with tenderness and distention of the belly, giiping, or sometimes dull, continuotis pain, diarrhoea, etc. MercuHus will be found a most efficient medicine, if immediately employed when the disorder assumes the low form of abdominal typhus, or occurs in persons of sluggish constitution and slow circulation, and is attended with pale, yellowish appearance of the face, sevpre lieadaclie, or sensation as if a tight band were across the forehead: thickly coated tongue; bitter or foul taste; little thirst; sensitiveness of the region about the navel and the pit of the stomach, to the touch, and distention of the belly; evacuations, copious, watery, floculent, or slimy and even bloody, sometimes qualified by straining without ovaonation ; at first, drv burning skin followed by profuse, debilitating sweats ; depressed pulse, and great 'NHiIti EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. iiid prostratiim ; extreme restlessness and anxiety, with constant tossing about in bed; and disturbed and uuref resiling sleep with anxious dreams. Dose: Six pills in 'i teaspoonful of water, every two hours, until the evacuations become diminished in number, and improved iu appear- ance, and tb.e tenderness and pain in the lower part of tlie stomach, etc., are relieved. After which, some other remedy,j must be selected, in accordance with the remaining symptoms; consider Act- dam Nitricum, amongst others. Khus-toxicodendron is especially indicated in abdominal typhus characterized by continued heat and dryness of the skin ; violent delirium • oppression of the heart, with sighing and moaning; pains in the limbs , extreme debility ; tongue and lips dry and red, or covered with a brown or blackish, tenacious fur; red, burning cheeks; convulsive twitcliing of the tendons, snatching at the bedclothes, drowsiness or stupor, with mut- tering, and loud nasal breathing; weak, accelerated pulse; anxious expression of countenance ; sleep disturbed, or prevented by the frequent recurrence of sudden starts ; eyes inflamed, watery and insensible ; features collapsed; breath exceedingly offensive; involuntary evacuation of the excrement a id urine; coldness of the extremities; sinking energies; livid spots and miliary eruption. Dose: Dissolve twelve pills in three tablespoon fuls of water, and give a teaspoonful of the solution every two hours, until three doses have been given; then extend the intervals (or sooner, it rfiv^iuci improvement takes place) to four hours, and continue the adminis- tration until the symptoms particularly indicative subside or become altered. If no alteration follow the fourth dose, or tlio aspect of the symptoms be as follows, proceed with the next remedy. Camjjhor frequently proves useful after Rhus., particularly when the following symptoms prevail; heat of the head, with confusion of ideas, or violent delirium; giddiness; throbbing headache; burningheat in the forehead; cold and clammy skin ; continuous coldness of the hands and feet; debilitating and clammy sweat; tendenej' to v'olent relaxation of the bowels ; scanty, cloudy urine, which deposits a thick sediment; great weakness, and feel^le, scarcely perceptible pulse. Done : One drop of the saturated tincture on a small lump of loaf sugar every (luarter of an hour, until distinct amelioration or change ; or, if themore urgent sj'mptoms have yielded, and the following remain, proceed with the next remedy. Coeculus may often follow eitlier Rhus, or Camphor (after the previ- ous employment of Rhus.,) especially when the great debility continues, and the patient complains of giddiness and headache ; or when there is a tendency to swooning or paralysis of the limbs, and when there "''e prominent symptoms of derangement of the digestive functions. Dose: Of a solution of six pills to three tablespoon fuls of water, give a teaspoonful every two hours, until amelioration or change. These I'emedies, either singly or in alternation, are amongst the most important, in cases of a desperate character, and when the most alarming symptoms occur. Arsenicum, This is decidedly one of the most important remedies in abdominal typhus, especially in the second and third stages, sometimes restoring the patient when almost beyond tlie reach of hope, and renova-- ting the vital spark. The chief indications for its employment are:— extreme prostration of strength— falliDg of the lower jaw, open mouth, dull 1.1'!"! r ,mr< la, ' ' ' ■' v,f) im I i 570 TYPHOID PEVER. > l! and glassy eyes, bitter taste, inclination to vomit, pressure and aching at the pit of the stomach, pain in the right side of the inferior region of the belly, bursting headache, giddiness, violent or low delirium, drowsiness, flatulent distention of the bowels, burning thirst, dry. hot skin, parched, cracked, sometimes blackish-looking clammy tongue, and violent and continuous relaxation of the bowels; pulse scarcely perceptible, and inter- mittent. Dose: If singly, of a solution of six pills to three tablespoonfuls of water, give a teaspoonful every quarter of an hour (in very critical cases,) or every hour (in less urgent instances) until amelioration or change, doubling the length of the intervals as soon as distinct improvement occurs. If in alternation with Veratrum, dissolve separately six globules of each remedy in three tablespoonfuls of water, and give one teaspoonful of the one, half an hour after a similar dose of the other (in very critical cases.) in rotation— or at intervals of one hour (in less urgent instances,) until amelioration or change. Veratrum is occasionally useful after or in alternation with Arseni- cum, when the inferior extremities become cold and covered with cold sweat. Dose: In every respect, singly or in alternation with Arsenicum, as directed for the latter remedy. Carbo-vegetahilis may also prove serviceable in very critical cases. It ii indicated where we find drowsiness with rattling respiration, face pinched, sunken, and deathlike ; pupils insensible to light, pulse scarcely perceptible, and the vital power rapidly sinking; cold perspirations on the face and extremities; involuntary and offensive evacuations; deep-red urine, with a cloud floating in it, or rising towards the surface. In abdom- inal typhus, however, the more particular indication consists in symptoms of incipient ulceration, or in signs of so-called putrescency. The following symptoms are, also distinctly indicative of this remedy: burning, lancinating pains about the region of the stomacli, and deep in the bowels, which become renewed after partaking of food of any kind, and are accompanied by great anxiety, excessive flatulency, and the evac- uation of burning, light-colored, fetid, v.'atery, bloody stools, attended with painful urging ; desire for salt food, and for coflfee, with aversion to meat, generally, and dread of indulging the craving, lest the sufferings be aggra- vated. Dose: In every respect, singly or in alternation with Arsenicum, as directed for that remedy, above. Treatment OF THE Second or Active Stage in Typhus.— T^Mfter of the inflammatory or low variety. Bryonia is more particularly indi- cated when the disorder assumes the character of inflammatory nervous fever, or typhus especially affecting the brain, with violent, stupefying headache, as from a blow, and pain across the forehead and at the temples, as if the head would burst; frequent raising of the hands to the head. Aggravation of these sensations by movement; continued, violent delir- ium, with excessive febrile heats; foul, thickly-coated, yellow tongue, or dry, cracked tongue, with pinched mouth and great thirst, and vesicles in the mouth or on the tongue ; furred lips; nausea, inclination to vomit, or vomiting of mucous and bilious matter; tenderness of the pit of the stomach, when touched ; general heat of the whole body, dryness of the EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. m skin, redness of the face, and profuse perspiration during tlie fever; sensi- bility about the region of the stomach ; distention of the belly, oppression at the chest, and frequent sighing and moaning, indicative of threatening miliary eruption ; constipation, or relaxed stools ; urine of a deep orange color or bright yellow, with yellow sediment; sensation as of a plug in the throat, with difiiculty of hearing ; stitches in the side ; drowsiness or dispo- sition to sleep during the day ; sleeplessness, fugitive heat, f*nd excessive restlessness, or continued drowsiness or stupor, with starlings and unpleasant dreams; painful shootings and soreness of the limbs, aggra- vated by movement; trembling of the hands; pulse quick, aoit,freqv£nt, or irregular, small and intermitting; miliary irruption, livid spots ; irrita- bility, irascibility, despair of recovery. Dose : If singly. Under very favorable circumstances, of a solution of six globules to three tablespoonfula of water, give a teaspoonful every twelve hours. In cases which assume the more serious features, a similar dose should be repeated every three hours, until amelioration or change. If in alternation with lihtis, dissolve separately, six globules of each remedy in three tablespoonfuls of water, and give a teaspoonful of one solution four hours after the like dose of the other, in rotation, until amelioration or change. Eupatoriutn-perfoliatum. Pain in the bones, attended with hot, dry skin. This remedy has been highly recommended by the most success- ful practitioners, as Drs. Williamson, Neidhard, and others. Dose : The same as directed for Bryonia. Rhus-toxicodendron. This medicine is more peculiarly suitable to the low form or stage, Bryonia being more applicable to the inflammatory, but will frequently be found servicable in all the stages of the disease, particmlarly when there is undue relaxation of the bowels, congestion t.> the head, Oi-.^ression at the chest, and great weakness. The headache ia generally of a stupefying nature, with a feeling as if from a bruise, but not so severe as that indicating Bryonia; the tongue presents nearly tlie same character, less nausea and inclination to vomit exist; violent pain is present about the region of the stomach, especially when touched. Consti- pation as named of Bryonia, but more frequently copious, yolloioish, or loose, bloody evacuations, with severe cutting pains in the belly; the symptoms are general heat, and those of the face resemble those mentioned under Bryonia, but without the perspiration, or at most, a clammy feeling of the skin. The urine is hot, dark colored, or at first clear, and afterwards turbid ; the symptoms of the ears the same ; sleep also the same ; difficult deglutition of solids, as it from contraction of the throat and the gullet; general trembling, debility, and prostration, almost amounting to paralytic weakness of the different limbs ; shooting pains in various parts of the body, aggravated when at rest or at night, and momentarily relieved by moving the part affected ; pulse quick and small or weak and slow ; as mental or moral symptoms, we may notice, excessive anguish, anxiety, extreme lowness of spirits, and disposition to weep. Dose: Whether singly or in alternation with Bryonia, in all respects as directed for the latter remedy above. Arnica is also of some importance in low. or sluggish nervous fever, with lethargy, or delirium, and snatching at the bedclothes ; or when the patient lies in a state of unconciousness, as if he had been stunned by » concussion of the brain. ■ 1 H„,|:i 4 *if'l' i f|: f" d^ :• • illl r U;- 4 it it!! *i m M} "m Kh% \ ■ IEfi>;9 W , A M i #1 1^ ill tfr2 TYPHOID FEVER. fi i KS /^o.se; Tliree globules in a teaspoonful of water ery four houiv, until amelioration or change. Ptilsatilla is often of considerable service in the second stage of typhus, when slight delirium, tears and lamentations, alternating with drowsiness, prevail. Dose: Three globules in a teaspoonful of water, repeated, if necessary at the expiration of four hours, and so on until atnelioratinn or change. But if any of the undernientioued symptoms declaie them- selves, proceed with the next remedy. Aciduni-j)hosphoricum is frequently required, either when, at the commencement of the disease we find great exhaustion and prostration, with wandering even while awake ; or in almost hopeless cases (alone or still better in alternation with Rhus.) when the patient is always found lying on thv'^ back in a drowsy state, and either makes no reply when spoken to, or-answers /nco7terenW?/; or in other instances, and especially after the pj'epioMA- employment of Pulsatilla, when tlie following symplouis prevail: Constant loquacious delirium or low muttering ; snatching at the bedclothes ; fixed looks; seeming efforts to escape from some alarming object; black incrustations on the lips ; dry, hotskin ; continual, copious, watery discharges from the bowels, the motions, being in general invol- untary ; bloody evacuations ; frequent, weak, and occasionally an inter- mitting pulse. Dose: Three globules in a teaspoonful of water, at fust every hour, extending the intervals to three hours as soon as tlie .symptoms arc modified, and continuing the administration until positive a;, elior- ation or change. Or if Uie under-mentioned symptoms sliouUl, in particular, continue unmodified, proceed with the next remedy after a lapse of three hours from tlie las' jose. Acidum-nitricuni should be administered after or during the cours ■ of Acidum-phosphoricuiTi, but not within less than three hours of a previ- ous dose of the latter, if the bloody evacuations fail to yield readily to the previous treatment. Acidum-nitricum is, moreover, particularly useful when there are white specks in the mouth and throat ; sensibility of the belly on pressure ; relaxation of the bowels, and slimy, acrid, greenish- colored stools; straining; intestinal ulcerations; shooting pains in the lower bowel ; scalding when passing water ; and tendency to collapse In some cases it is necessary to administer this remedy by injec.ion or enema, as below stated. JDose : Th"ee globules in a teaspoonful of water, repeated, if necessary, after four hours (or every four hours till the symptoms yield,) return- ing to Acidum-phospJioricum; if requisite or proceeding with the next remedy, after a pause of three hours, if tiie un<ler mentioned symptoms, in particular, supervene. The enenui siiould consist of six drops of the tincture at the third dilution to every two table- spoonfuls of water. Cantharides should be administered after or during the course of either of the three foregoing remedies, but not witliin less than three hours of a dose of any other medicine, if painful evacuation of water be distinctly manifested. Dose: Three globules ir a teaspoonful of water, repealed, if neces- sary, after an interval of three hours (or continuing at such intervals until the indicative symptom is positively subdued,) returning to either of the foregoing, or proceeding with other treatment, or sus- pending treatment, according to the prevalence of particular symp- toms or general improvement be manifested. .* .-. KPIDKMIC AND ENDEMIC INFECTIOUS DISEASES. fi7S China is sometimes of considerable value in the second stage of this diseiiso, especially when the attack has become protracted and tedious:— nortunutl stveats, obstinate relaxation oi the Ijovvels, but unattended with pain in the liowels, the tongue at the same time being clean. Dnsr: Three globules in a teaspoonful of water, every fojir hours, until amelioration or change, unless, after the third dose, the sweats remain unmodified, when proceed with the next remedy, after a pause of four hours. Sulphur should follow the third dose of China, in the event of the continuance of the sweating, notwithstanding the previous administra- tion of the latter remedy. Sulpliur has always been found of considerable service— Bryonia, Rhus., or Acidum-phosphoricum having been fruitlessly administered, but particularly when the following symptoms were encoun- tered : Pale and collapsed countenance, burning, itching eruptions on tlie lips, dryness of the mouth, foul, dry tongue; bitter taste; slimy or l)ilious vomiting ; tenderness of the region about the stomach, and pain as from excoriation of the parts above the navel, increased on pressure; flat- ulent rumbling in the bowels; frequent, watery, floeculent, or yellow evacuations ; cloudy_ urine, depositing a reddish sediment ; miliary erup- tion ; erui)tion with a discharge of matter; bleeding at the nose ; stitches in the chest, oppressed breathing; dry cough, worse towards evening and at night ; sleeplessness, or whining during sleep ; dry heat during the day with moderately quick pulse, and profuse sweating at night. Dose: Dissolve six globules in three tablespoon fuls of water, and give a teaspoonful of the solution everysix hours, unless, after the second . dose, the following fe^Muptoms be present, when proceed with the next remedy. AciduiH-siUphuricuni should follow the second doseof Sulphurafter an interval of six hours, if the sweating be yet very profuse, particularly if so when li/inff still and modified by movement ; or it should even pre- cede either or both of the preceding remedies, if the sweating be very pro- fuse when lying still and diminished by movement. Dose: Three globules in a teaspoonful of water, every four hours until amelioration or change. Calcarey^, 1 Calctu'ea-c, may sometimes be adminls- Ilepar-sulphuris, > tered advantageously, alternately with Bella- Lifcopodium,. ) doiina, Arsenicum, or Rhus., according to the symptoms ; it is further, occasionally, a most efficient remedy in cases in which debilitating relaxations of the bowels, or bleeding of the nose, win not yield to such remedies as Acidum-phosph., Rhus., China, etc.; lastly. Calcarea-c, may be exhibited with advantage where there are symptoms of impending miliary eruption, jerking or twitchings in the i-mbs, particularly in children, tendency to inflammation of the mem- ! ranes of the brain, delirium, etc. Dose: Of a solution of six globules to three tablespoon fuls of water, give a teaspoonful every three hours until amelioration or change. ■ Or if the undermentioned symptom should declare itself, or having been previously present, should continue unmodified after the third dose of Calcarea, proceed with the next remedy, after a pause of four hours. Tlepar-ftulphuriH should follow the third dose of Calcarea after an interval of four hours, if discharge of blood from the nose should supervene m "II m m III ?»!*«*, 374 TYPHOID FEVER. •Jm.: I»^'1 or, having been previously present, sliould continue without material improvement ; except, indeed, the presence of other symptoms of u more urgent character, should require Hie administration of other remedies, such as Pulsatilla, Belladonna, Rhus , or Sulphur. Dose: Three globules in a teaspoonful of water, repeated, if noce8sar.v, after an interval of four iiours— or continuea, at such intervals, if requisite, until the distinct modiflcation of the indicative symptom. I/l/copo(liutn is often a valuable remedy after Calcarea, with or (with- out the intermediate administration of Ilepar-s. according to the circum- stances,) in the second stage of typhus, when miliary eruption is slowly and scantily developed, and the following symptoms occur; drowsiness with muttering delirium; confounding of words; stammering; twitching of the tendons, snatching at the bedclothes, flatulent distention of the bowels, with constipation; affections of the bladder; or when there are shiven'ngs alternating with heat; circumscribed redness of the cheeks ; debilitating sweats; excessive debility; complete hanging of the lower jaw; half-closed eyes ; slow respiration ; or, state of excitement, without heat or congestion in the head or lace; redness of the tongue; constipation ; burning urine ; tranquil and resigned state of mind, or surliness and malevolence, especially on waking. Dose: Three globules, in a teaspoonful of water, every three hours, until amelioration or cliange. In cfise of amelioration, pause until the symptoms evidently retrograde, when resume, at intervals of six hours, as long as necessary. In the case of change, suspend treat- ment for four hours, and continue with the remedy newly indicated. Laches is mny prove serviceable in fever analogous to typhus, attended with giddiness on rising or sitting up ; muttering ; bitter taste ; delirium, hanging of the lower jaw; vacant expression of countenance ; sunken features ; yellowish tongue, with bright-red margins ; cracked tongue ; smooth, dry tongue, with difficidty of proti'uding it, and inarticulate speech ; seeming paralysis of the eyelids; lethargic sleep, and tendency to lie in the prone position; thirst, with disinclinatiou to drink; brownish-red copious urine. Dose: Three globules, in a teaspoonful of water, as directed for Lyco- podiu7n—3r if the symptoms be very urgent, begin by adrainisteriuR at intervals of two hours— extending the intervals to four hours after two doses have been given. Phosphorus is of great service where we find great dryness of the tonfiuo, heat of the skin, small, hard, quick pulse, painless relaxation of the bowels, with excessive flatulent rumblings ; or when the disetise becomos, as it were, concentrated in the lungs, and there is consequently congestion, with extremely laborious breathing, and excessive anxiety, dullness on percussion, mucus rattling, stitching during respiration, cough, with copious expectoration of phlegm, mixed with blood or even offensive matter, more benefit may be looked for from this than from any other remedy. Phosphorus, is also, serviceable when, notwithstanding the pneu- monic concentration, there is, moreover, sensibility and rumbling on the right side of the lower part of the belly, or when there is continued heat of skin, with small, hard, accelerated pulse, throbbing of the great arteries of the neck, and nocturnal sweats; sleep disturbed by crowding of ideas, weeping, whimpering, sudden cries, and restlessness. Tho patient awakes from sleep complaining of great thirst and dryness of the mouth, excessive EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. 576 heat, and aching of the whole hody. In addition to these symptoms, there ir^ a burning sensation in the belly and fundament, with frequent senii-Jluid stools, streaked with blood; giddiness, confusion, and throbbing piiinsiii the head ; deafness ; frequent discharge of blood on blowing the nose, and h' at in the face; tongue and lips dry and cracked; bitter taste; copious evacuations of urine, which deposits a whitish or reddish sediment,- delirium ; stupefaction. Dose : Dissolve six globules in three tablespoonf ula of water, and give a teaspoonf ul of the solution every four hours, until amelioration or change. Aciilutn-tnuriatiruni. Weakness, with a constant tendency to sink down in the bed, with groaning during sleep, almost paralytic state of the tongue, rendering it nearly impossible for the patient to speak, even when in a collected state, and great dryness' of the mouth. Dose : Of a solution of six globules to three tablespoonfuls of water, give a teaspoonful every three hours, until amelioration or cliange. Natram-niiiHaticuin is recommended in nervous fevers with great debility, insatiable thirst, dryness of the tongue, and loss of conciousness, and particularly, when they follow in the course of antecedent debilitating diseases. Dose: Of a solution of six globules to three tablespoonf uls of water, give a teaspoonful every three hours, until amelioration or change. Ilelleborus has, also, been found of great utility in nervous fever, occurring after otlier febrile affections, such as scarlatina, mejisles, stom- achal fever, worm fever, and cholera, with pain as from contusion, com- bined with tumefaction in the integuments of the head; disposition to somnolency, with confusion of ideas, and extreme restlessness ; dark, cloudy urine; heaviness, or feeling of stiffness and powerlessness in the limbs; depression of spirits, and obtuseness of the faculties. Dose : A solution of six globules, as directed for Natrum-muriaticum. Secale-coT^iutunt is, in like manner, witlv Natrum-m. and Ilelle- borus, recommended by many homoeopathists who have had frequent opportunities of treating nervous fevers, particularly, in cases occurring in the wake of other diseases; but is more especially, appropriate where the symptoms developed clearly proceed from irritation of spinal nerves with wandering, fugitive, spasmodic pains, extending from the base and column of the spine into different parts of the body; the spasms which affect the face become subsequently of an intermittent nature; whilst those that have their seat in the hands and feet partake of a continued character. This remedy is, further indicated by dry heat of the skin, insatiable thirst, accelerated pulse, great restlessness and sleeplessness; excessive languor, and aveision to food. Should the spasmodic affections readily yield to the employment of this remedy, but if the febrile symp- toms continue, some other remedy appropriate thereto must be pre- scribed. Dose : Dissolve six globules in three tablespoonfuls of water, and give a teaspoonful of the solution every three hours, until amelioration or change. Arsenicum. \ These remedies are of signal importance, either Veratrutn, > singly, in succession, or in alternation according to the Carho-^eg, ) individuality, succession, or combination, of the symp- toms present, in the second stage of typhus, in all desperate cases in which 'K> *"?; If i I I.' 6 m\ . I rm '";fij| i ' ^ ii;:- „.;!«:• ii t> ^i^ ;.7a TYPHOID B'EVKK. m 4 ^M it vitiility becomes nearly extinct. For distinctive indications, tlie reader is referred totlie foregoing prescription of these remedies, iinder the head of Abdominal Typhus. Dose: If aliiiily, of either remedy; Dissolve six globules in three tablespoonfuls of water, and give one teaspoonful of the solution every quarter of an liour (in ver\ critical cases,) or every hour (in less urgent instances,) until amelioration or cliange, doubling the length of the intervals as soon as distinct improvement ensues If iu alternation, dissolve, scjiarately, six globules of the remedies to be used alternately in three tablespoonfuls of water, and give a tea- spoonful of one, half an hour after a similar dose of the other (in very critical vases), m rotation, or at intervals of an hour (in r&w urs/eut instaivies), until positive amelioration or change, doubling the length of the intervals as soon as a degree of improvement is evident. Carbo-veg. In addition to the indications given for this remedy, under the head of Abdominal Tviipus, the following synii)toms are characteristic of its employment in the .swo??// stage: excessive anxiety, und burning heat ot the skin, arising from congestions to the head and chest; the eyelids agglutinated during the night; deafness and rin'jiai} in the ears; hleedinij from the nose, and obstruction of the nose from incrusta- tions, eruption around the nose, and brown or blackish, cracked lips; the legs drawn up during sleep, and the sleep restless, and disturbed by frequent waking. Dose: Three globules in a teaspoonful of water, every three hours, until amelioration or change, when thus specially indicated; when, as above, singly, or in alternation, the dose should be as directed under the last head. Treatment of Typhus Characterized by Stupor. In treating of this variety of the malady, it will be unnecessary to recapitulate the remedies already enumerated, in relation to the various stages and vari- eties hereinbefore described. Suffice it to say, that the ?,&ruQ features and eorulitions would indicate their employment in this variety, and that the metliod of administration should be, in every respect, similar. But the symptoms which more particularly distinguish this species of typhus, especially indicate, by assimilating most closely to the specific opera- tion of. Opium, This remedy should accordingly be given when the follow- ing group of symptoms prevail : great drowsiness or lethargy, with stertorous breathing, open mouth, half-closed eyes or fixed look; slight delirium or muttering, snatching at the bedclothes; the patient being in a continual stpte of stupor, from which it is extremely difficult to rouse him, and from which he is scarcely aroused before he relapses into his former state; furious delirium, and incessant restlessness; dry, offensive stools, with involuntary evacuations of excrement and urine. Dose: Of a solution of six globules to three teaspoonfuls of water, give a teaspoonful every three hours, until amelioration or change. Treatment or the Stages of Debitity and CoNVALESCENcr, After Typhus. Hhus-toxicodendron. This remedy retains its importance in the treatment of typhus throughout ali the stages of the malady, and is amongst the best appliances during the period of debility, which generally supervenes after the issue of this fever. Rhus, is more EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. 877 ospeciaHy indicated in this stage, when the progress towards recovery is hluggish, the pulse retaining a febrile character, the appetite, although ijiil)rovud, being capricious, the bowels predisposed to relaxation, and the chest not yet exempt from feelings of oppression. Dose: Three globules, in a teaspoonful of water, night and morning, until distinct amelioration or change. Upon evident improvement taking place under this treatment, it will be sufficient to repeat the dose evt-ry night. China is frequently of great use in this stage, against the debility resulting from the etrects of the malady, more especially when the patient has suffered much from violent relaxation of the bowels during the previous course of the disease ; or if there be a tendency to continuance in this symptom. China is, also, particularly useful when debilitating sweats supervene. In this case it should be followed by Sulphur, if tlmt Bymptoni has not yielded distinctly, after the second dose. Dose: In the case lirst described, three globules, in a teaspoonful of water, repeated, at intervals of twelve hour.i, until three doses have been taken. Untlorliie l;ist-stated circumstances, a similar dose, night and morning, and if the symptcmi does not distinctly yield within twelve hours after the second dose, proceed with the next remedy. Sulplmv should follow, twelve hours after the second dose of China, In case of the obstinate continuiincc of the sweats, or of the presence of dry cough at niglit. Dose: Three globules, in a teaspoonful of water, every twelve hours, until amelioration or change. Ferruin-nic.tallicu-m is a preferable remedy Avhen the pulse contin- ues weak or frecjuent, after a i)rofuse discharge of blood, particularly in the case of females afl'ected with green sickness, or who have previously suffered from it. Dose: Three globules, in a teaspoonful of water morning and evening, for u week. ACCESSORY MEASURES DURING THE PERIOD OF DEBILITY. The fever having subsided, and the patient being able to sit up, should first be removed to another apartment, free ventilation and a moderate degree of warmness being simultaneously secured. By degrees, and as soon as i)ossible, passive motion, and from thence, if possible, walking exercise (not sufficient to exhaust the patient), should be daily sought in the open air, in fine Aveather, with, however, particular jjrecautions against damp or chill. Nothing will conduce to restore the patient to health and strength more rapidly and thoroughly than such accessory treatment, with proper precautions in respect of diet, as stated below. • AFTER EFFECTS OF TYPHUS. Bed-sores, Abscesses, Boils, Swelling of the Feet, Weakness of Digestion, and General Derangements, These are more or less frequently the results of very severe or protracted cases, esi)ecially when the reactionary process is sluggish, and require simultaneous local and constitutional treatment, with this reservation : that when the local application is unmedieated, (such as pure spirits), we may select the constitutional remedy, irrespec- tive of such application, according to the particular features of the case, 37 •lilt 111 ,|^i'l )S ■Jii \f '-«^ jAi I W it •hill l!h,fi;,!|, it ' ■'•'M m P" m m YELLOW FEVKll. by consulting the symptoms present, and the article on "Bolls" and " Abacesses,'' as regards those particular affections. ExTEUNAL Tkkatment OF Bed-sobes. Spirits of Wine, Col- lodion or QlyceHne will, in general, suffice to remove this trouble- some affection. Application: To one mrt of the Spirit, add two parts of pure water, and saturate with this solution a linen pad, which must be applied to the parts and kept moist. Arnica (tincture) should be employed, if the diluted Spirit has proved insufficient and inflammation has not supervened. ApjHication: To one part of the Tincture, add twenty parts of water, and proceed as directed for Spirits of Wine. Tincture of Carbo-veg., 1 When mortification Tincture of Arsenicum, V supervenes we may suc- Tincture of Cinchona (concentrated.; ) cessfully employ either of these remedies (according to symptomatic indications,) simultaneously with the internal administration of the same medicine, as stated below. Application: To a wine-glassful of water, add five drops (of the Tinct- ure of Arsenicum,) or ten drops (of either of the others,) and saturate with this solution a linen pad, which apply to the parts and keep moist. a^^^^^^^^^ YELLOW FEVER, In this article we have quoted freely from the report of that commis- jion of eminent physicians, appointed in 1878 by the oldest National Medical Association in America. This commission was composed of eleven of the most thoroughly educated physicians in the United States, seven of whom were experts in this disease in all its phases. Causes and Prevention. Yellow fever is a specific disease, entirely independent of malaria, occurring rarely a second time in the same person. It is infectious and capable of transmission to any distance by means of fomites or infected material. The yellow fever germs, for we accept provisionally the germ theory of the disease, are indigenous to the West Indies, and, perhaps, to the west coast of Africa, and have been thoroughly naturalized in many localities in the southern portion of the United States. They were imported into New Orleans during the last quarter of the eighteenth century, and have existed in the soil or atmosphere of that place ever since, either in a latent or an active condition. They may lie dormant for many years consecu- tively, and they require a concurreuce of causes to develop them into a state of disease-producing activity. Some of the factors which seem to be favorable to the excitation of the yellow fever germ, are the following; Low, swampy ground, near the level of a tropical sea. Long continuance of very high temperature, following heavy rains. Long continuance of south and east winds. Aggregations of human beings, with the excreta of their bodies in a small space. A crowded and dirty ship may be a nidus for yellow fever, as well as a crowded and dirty citv. Long concinuance of calm weather, unbroken by thunder-storms. BPIDBJ XC AND KNOKMIO INKKCTIOUS DISKASKS. /nro Exposure of deciiyins V{'g((tivblo and aniinul matter to a burning sun. Inetlicitint drainage and tlie general accumulation of filtli.especially the city garbage. Deficiency of ozone in the atmosphere. Pestilential exhalations from an upturned soil. When the yellow fever germ has been waked Into activity by these causes, it may be transported to places whero none of them exist. It eeeras that a certain concurrence of several of tlie above factors is neces- sary to the generation of yellow fever. There is probably one combina- tion in one epidemic, and a somewhat diflerent combination in the next ei)idemie. An epidemic may be mild or severe according to the number and force of the concurring causes. There may, also, be other unknown but discoverable factors, which may be necessary at oiic time to produce an epidemic, and not necessary another. No one of tlie above suggested causes could excite an epidemic by itself, and it is not probable that they all ever concurred equally to the formation of the disease. The most extensive collections and comparison of facts are necessary to illumine (he very great darkness which lies upon these complex question.s. The naturalized yellow fever germ; may receive [so slight a stimulus as to produce only a few sporadic cases. Or they may be vitalized in certain localities to sucli a degree as to occasion quite au outbreak in those localities, not easily communicated to other quarters. Or tiiirdly, the disseminated germs may be vivified in all directions, and a general epidemic excited. Or lastly, the naturalized germs may lie entirely quiescent, until fresh and active germs are brought in from foreign ports, which then act as sparks to ignite the inflammable material already existing. We thus have four shades or degrees of yellow fevor visitation : sporadic cases; local and limited outbursts; epidemics from naturalized germs; and epidemics from importation. In sporadic cases and limited outbreaks the specific nature of the fever is not clearly brought to light, and it is sometimes difHcult to diag- nose it from the dominant malarial or bilious diseases. The imported epidemic, whether from Havana to New Orleans or from New Orleans to Memphis, etc., etc., is always a more quick-spreading and malignant J isease than that arising from our naturalized germs The comparative mildness of the late epidemic in New Orleans, is one out of several reasons for believing that the disease was of local orii^in. The yellow fever of domestic origin can only be prevented by local sanitary measures. So long as the public authorities ignore the cry.'ng evils at home, and watch only for the enemy at the seaside, weshiU continue to be scourged with nipiutod epidemics of yellow fever. Quar- antine may or may not keep out the tropical foe, but our utmost energies should be concentrated against the enemy which has been domiciliated in our households for nearly a century. Is there any personal prophylatic against yellow fever? None which has the least scientific value. Quinine is probably serviceable when malarial fevers are simultaneously prevailing, not because it has any power against yellow fever, but because an attack of malarial fever, pre- ventable by Quinine, might, if allowed to occur, precipitate an attack of yellow fever. . M ,-»',;« W' iflO YELLOW FEVER. Quinine for intorinittontH, nelladonniv for Hcarlet fover, and vaccina- tion for Hinallpox, arc tlio only propliyiiuftlcs wliicii have conininndcd oven tl>e partial belief of Uie prol'i'i^sioii. Tlicy are all confessedly honui-- opatliic in their actions, and we conlldeiitly believe, if prophylactics for yellow fever or any other disease exist, tiiat they will bo found only by study and experiment in that direction. " To prevent the development of yellow fever we recommend: Ist. The thorough drainafo of the city. This mighty work can only be efficiently achieved by the general government. Whether that would bo constitutional or not we need not pause to hKjulre. An Intelligent people will some time or other so modify tlieir government, that 't shall recognize the superior claimsof the health and livosof its population over those of railroad companies and harbor improvements. As is well known the topography of New Orleans iirescnta very considerable difllculties in the way of a perfect system of drainage, but not such as to be insuperable to engineering skill. 2d. The constant irrigation or flushing of the street gutters and canals by fresh water pumped in daily by steam apparatus. Allied to this meas- ure is a perfect system of water works, which shall give an abundant supply of river water for drinking, bathing and cleansing purposes, so as to supersede the use of cistern water almost altogether. In this connec- tion we may mention a curious fact communicated to the Commission by Mr. Harry Hanimersly, who keeps a floating batliing establishment in Mississippi river. One hundred and fifty boys under twelve years ge took one, and some of them two baths a day during the whole sea- -n, and not one of them liad the yellow fever, although it prevailed ex- tensively among their families, and children of tliat age were peculiarly liable to it. 3d. The consumption of all the city garbage by cremation. This new process has been extensively experimented upon during the last six months in the city of New York, and with extraordinary success. The plan has been described to us by Dr. George F. Foote, of Stamford, Con- necticut, a brother of the inventor. A single large furnace has been so constructed as to consume 1,000 loads in twenty-four iiours. Thegarbage is not bandied, but dumped immediately from the carts into the furnace. The I justible material mingled with it— old rags, paper, straw, vege- table debris, unburnt coal in ashes, the sweepings of stores, factories, streets, etc., is about a sufficient supply of fuel for the whole work, when tJie tire is once started under a full blast. The gases from the combustion —carbonic oxide and carburetted hydrogen— are brought under the boiler and again burned to generate steam to drive the blowing engine. The expense for fuel is light ; there is no escaping odor, and the residue or slag, about eight per cent, by weight, can be made available for useful purposes. One such furnace in each district of New Orleans would cpnsume daily every atom of its garbage, deliver it from every pestilential emana- tion and odor, and give its atmosphere something like the sweetness and purity of mountain air. Nor will it be many years, in our opinion, before the people of New Orleans, wlio are compelled by the nature of the .soil to bury their dead above ground, will discover that in their case, at least, KPIDKMIf! AND KNDEMIO INFEOTIOUH DISKA8ES, A,sj t!reiimti<»ii in Uio vi-ry Ik'hI dispoHitlon to inaltt' of tliu luimun body, wlitu tht) principle of life Iium jittaiidoiiod itH tissia-H. 4tli. The gfiiL'uitioii of ozone to supjjly its deftclency In the atnio^f pliore when detected by the proper InHtruinentH. Tliia Hhould bo nmde one of the niowt Hpeciul and important duties of the .Sanitary Couunission. Ozone la u peculiar k^^i ii inodillcd form of oxygen, generated by electri- cal Htorm.s and violent concuHMions of the atnioHphere. It is ho powerful jiH a disinfectant, tliat one part of it will purify three million i)art8 of at- moapherluair. Ozone in thus nature's greatdisinfector and |)uritier, more subtle, powerful and ubiquitous than all others, an<l we must learn to utilize this splendid gift of the Creator for our own sanitary blessing. Wlien it is dert(uent, deleterious gases accumulate and produce diseases of various kinds, and when tlie other factors of yellow fever productions are present, the deficiency of ozone may be fho determining element for the manifestation of the J.seaae. The scientists of the Sanitary Commission will be provided witii the instruments ajid chemical means for detecting its slightest variation, and for restoring it in suitable (juantity to the air, where, by tlie law of the equitable difTusion of gases, it will be almost in- stantly distrilnited many miles around. There are many measures of great sanitary importance over which the Commission would exercise a strict supervision. It would enforce the frequent emptying and disinfection of water-closets, sewers and all places containing i)utrescent matters, vegetable or animal. It would see that no sacks of decaying cofree, or chaff in rice pits, or dead animals, or any ofTensive matter was left exposed so as to poison the atmosphere. It would prevent, so far as possil)le, the destruction of trees, and in every way encourage their planting and growth. Above all, it would forbid the upturning of the soil during the spring and summer months, as epi- demics of yellow fever have followed such upturning at New Orleans, Natchez and Vicksburg, in such a manner as very strongly to suggest that the relation of cause and efTect existed between this exposure of the earth and the development of the disease. YELLOW FEVER — ITS SYMPTOMS. This fever is a disease of warm climates, and has obtained the name of yellow fever from the hue which the skin of those affected by it very frequently acquires. The more constant symptoms of the disease are : violent vomiting, first of bilious and subsequently of brownisli-l)hick matter, which is also passed by stool; great anxiety and prostration, intense fever. Remarkable remissions take place in tlie course of tlie fever, succeeded in a few liours by exacerbations. Tlie outbreak of the malady is generally preceded by sudden debility and restlessness, which are soon followed by lieadache, giddiness, faintness, and sliglit chilliness, to whicli are added praecordial oppression, want of appetite and deranged digestion. In other cases, the seizure is sudden and unattended with premoni- tory symptoms; and the course of the disease exceedingly rapid, and a fatal termination not unfrequent within thirty-six liours from the acces- slon of the attack. The more usual form which the disease takes is, liowever, as follows : Immediately after the fit of chilliness and horror, violent reaction sets in, announced by a high degree of fever, with i1" li. k ■' . :i 582 YELLOW FEVER. U\ % p i^reat heat of skin, strong throbbing of all the arterie8 of the body, and 1^1 I'U'minutioii of blood to tlie head. The respiration is hurried and often .ibo'ious, attended with deep sighing and gasping for air. The face is '' isLed, the eyes heavy, sensitive to light, and affected with burning pain the tongue white, furred, and sometimes red, but soon beconrxea j)ai id and dark-colored, and tinged A^ith yellow after the vomitings (ome on; the thirst is excessive. A burning pain is sometimes experi- enced in the pit of the stomach ; an excessive sensibility to the touch in the right side; and the stomach, irritable from the first, is rendered so much so as the disease advances, that everything which is taken into it is almost immediately rejected, along with a quantity of bilious matter. Severe darting pains traverse the head, the small of the back, and even extend down tlie thighs. Tlie pulse is subject to variations, being in some cases quick and stronjr, in others quick, low and irregular; in pleth- oric individuals, who have not been long exposed to the relaxing effects of the warm climate, it is accelerated, full and bounding, for some hours a^^'^er the development of the reaction; the urine is suppressed, or scanty and offensive; tlie stools, likewise, have a most disagreeable fetor; the patient is excessively restless, tormented with spasms in the abdomen and legs, and tosses about with anguish. These symptoms constitute the first or inflammatory stage of the fever, and may continue from twenty- four to sixty hours, and upwards, according to th^ severity or mildness of the attack. The second stage commencus with the abatement of several of the preceding symptoms, and the increase or substitution of others. The skin and eyes present a yellow tinge; the head is confused, or delirium super- venes, and the eyes look glassy. The fits of vomiting are more violent, and the matter ejected l)ecomes thicker and darker; the patient occasion- ally drops asleep, but instantly awakes in a fright, and sometimes he springs out of bed in a state of furious delirium, but instantly sinks to the ground in a state of tremor and exhaustion ; the pulse flags, but is some- times soft, at others high ; the tongue is generally parched, harsh, and discolored, but sometimes moist, and covered with a dark fur; there is frequent hiccup, and t)ie sk'n is soft and clammy. The duration of this stage is also variable; rarely, if ever, longer than forty-eight hours, some- times only twelve. The first and second stages terminate by a remission of the more alarming symptoms, and a hope of recovery is entertained, but it is too often doomed to disappointment by insidious degeneration of the disease into the third stage, in wliich the pulse sinks, becomes irregular and intermittent, yet sometimes increases in frequency; the vomiting becomes incessant, and is attended with great straining and noise, from the violent belching of flatus; the matter vomited is grumous, resembling coffee grounds, and is nafned the black vomit. The breathing becomes more labored; the tongue black, or shrunk, dry, and red; the eyes hollow and sunk, and the features shortened. A gradual aggravation of the symp- toms then ensues, attended with startings or twitchiiigs of the tendons, the limbs become deadly cold, and the hiccup distressingly constant. Hemorrhage, or oozing of the blood takes place from different parts of the body; the urine is deep-colorod, the stools black or sanguineous; theabdo- EPllJEMin AND ENDEMIC INPECTtOtS DtSEASflS. 683 men often tense and tympanitic; varices make their appearance, and deatli slowly or suddenly terminates the scene. ALLOPATHIC TREATMENT. This disease is one in which the treatment must be directed to guiding the patient through it, as in typhoid fever. The fever is self-limited, and will run its course. The room should be managed as directed for typhoid fever. Disin- fectants should be used as directed for that disease. A very essential point in all cases, whether mild or not, is to keep the patient in bed. This cannot be too strongly insisted on, from the first slightest inrlicpceiticri. Duimg the first stage, the use of water should be resorted to, t< moderate the intensity of the fever. Preference should be given to tht wet sheet or cold sponging. They should be managed in the same way as directed for typhoid fever. If there is perspiration, (sweating,) bathing is not to be followed at all. Tt is recommended by good authority to give three grains of Quinine, three grains of Dover's Powder, and three grains of Calomel, every two or three hours, while this stage of the fever lasts. (The writer would omit the Calomel.) It is also recommended, if the skin continues hot and the fever high, to produce its reduction with Aconite. Sixteen drops of the Tincture in four ounces of water in doses of a teaspoonful, every half-hour, may be given until a reduction in the fever is produced. It may then be given every hour or two to maintain its effect. It certainly is appropriate, if the treatment with water is not satisfactory. Purgatives are generally given in the beginning of the disease, but they seem uncalled for, except for the relief of constipation, for which Castor Oil is to be preferred, in doses of a desertspoonful to a tablespoonful, mixed well with an equal quantity of Glycerine and flavored with Oil of Cinnamon (or Gaultheria,) or recourse should be had to injections. Regarding the use of Calomel or other mercurials, it is difficult to see what benefit can accrue from them, further than their action as cathar- tics, the b J of which has just been discussed. Emetics are not to be given, but all stomach troubles should be met by proper palliatives. Tl-e nausea and vomiting, by the use of Opium to the extent of relieving the pain, when, if the vomiting continue, tlie iuidition of Carbolic Acid, or Creosote, in doses of one drop, or ten to twenty grains of Sub-Nitrate of Bismuth, or flve-drop doses of Dilute Hydrocyanic Acid may be given every hour or two, until the vomiting is relieved. Small lumps of ice may be swallowed. Mustard plasters, dry cups, or small blisters, two inches square, may be applied over the stomach. Warm poultices over the stomach often relieve the nausea and i)ain. Probably as appropriate a way to administer Opium as any, is by the hypodermic injection of a sixth of a grain doses of Morphine, or injec- tion of a teaspoonful (dram) of Laudanum in an ounce of thin starch, in- to the bowel. The drug should be given at any time when necessary to relieve suffering. The ordinary dose may be given by the mouth, as one- fourth of a grain of Morphine. Anj' coldness of the extremities should be met by the application of heat by the hot foot-bath, made stimulating by adding Mustard or Cay- Mil,; ^\ M !t : 'm m ivV **►'! Ij! t'M 'M h 0' t t -•' 1 f f i .J ■IMILi^i^^PiaW* 684 YELLOW FEVER. \. >i igpw .''3 enne pepper, and Mustard plasters. The bath should be given under tlie bedclothes. In thi.s way the tendency to internal congestion, upon which may depend the tendency to heniorrliage, is relieved. Cold to the head, by means of cold water, the ice cap, or bladders of pounded ice, may be used to relieve headache. As soon as the amelioration of the symptoms (usually temporary) occur at the close of the second or third day, i)articular attention must be given to nourishing the patient and keeping liim quiet in bed— perfectly quiet, and carefully covered with blankets. Bathing and all other means of reducing the fever should cease. Food and alcoholic stimulants must be given, as directed in the treat ment of typhoid fever throughout the course of the disease. By this means alone life may be saved. Beginning at the period of amelioration in the symptoms, tonic diises of Quinine, from two to three grains four times a day, should be given. The mineral acids are indicated the same as in typhoid fever, prefer- ence being for the Aromatic Sulphuric Acid, on account of the tendency to black (hemorrhagic) vomit. The dose is ten drops largely diluted with water. It can be given at intervals of two hours or more. The teeth sliould be vviptd with a cloth dip})ed in a solution of Bicarl>onate of Soda after giving tlie acid to prevent injury to them from the Acid. To i^revent hemorrhage into the stomach, and consequent black vomit ten or fifteen-drop doses of the tincture of the Cliloride of Iron should be given four to six times a day, largely diluted in sweetened water. If hemorrhage occurs ten-grain doses of Gallic Acid shouldie given in the Acid mixture, until that symptom disappears. Difficulty in the secretion of urine should be met by diuretics, as the infusion of Digitalis in doses of a tablespoon ful, or the Tincture in doses of half a teaspoonful wita half a teaspoonful of the Vinegar of Squill, given four to eight times a day. If diuretics are inoperative, and especially if there are symptoms of uremia, (poisoning by retention of urea, an ingredient of the urine, in the blood,) the smell of Ammonia in the breath, or insensibility, the hot air bath should be used to produce copious sweating. If this does not relieve, a cathartic of one or two dro))s of Croton Oil or a quarter of a grain of Elaterium in Glycerine may be given. When the symptoms of remittent or intermittent fever are associated with yellow fever the first remission or intermission should be seized upon for giving thirty grains of Quinine at a dose. Subsequent treatment of these complications should be as directed for tliese diseases. Salycilic Acid lias been used by Dr. Buenz, of Savannah, in the epi- demic of 1876, in a single dose of a dram and a half in capsules, or rubbed up with sugar; if the stomach rejected it, twice the quantity (three drams) was given by the rectum (injections into tlie bowel.) Out of one hundred and seventy-nine patients only four died. The disease during that epi- demic was of intermittent and remittent type. Whether this treatment is generally applicable is a question as yet undecided. During the severe epidemic of 1S7S, in the Southern states, Dr. Mar- shall of Burlington, Iowa, who was then at J.ickson, Miss., states while the disease was almost universally fatal, wonderful results were obtained EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. 580 1»y treutiiij^ patients on the general principles api)i()iuiute to fevers wiiicli must run tlieir course, wliicli we have just slielclied. Tlie bowels were kept open and the kidneys active by the use, from the beginning to the end, of the Hyposulphate of Soda. An ounce of this salt was dissolved .n eight ounces of water and a tablespoonful given every four hours. The patient was kept well covered with blankets and a gentle sweating encour- aged by the use of Orange Leaf or Horse-iuint tea. Besides this, keeping the patient in bed during the stage of calm, and giving liquid nourishment and stimulants and tonic do&es of Quinine, constitute the treatment. An almost universal fatality was reduced to a fatality of one in ten in whites, two in fifteen in mulattoes, and one in thirty-six in negroes.r Getting up, or eating solid food of any kind during the disease, which patients desire to do during the stage of calm, is almost always fatal. II0M(E0PATH1C TREATMENT. All through this work numerical comparisons have been steadily avoided, but on account of the thorough reliability and the broad extent of country covered, we think we may be excused for thus presenting these statistics, when it issoevident that it will be the means of saving very many ya\uEih\e lives. The treatment here fol- lowing has been thus proven, and if these remedies are given in time (as they will be where this work is owned) and the full directions followed the deaths from this terrible destroyer and foul jilague of all hot climates will, we confidently believe, be reduced below three percent of all persons attacked with the disease. We (juote again from the before-mentioned report : On analyzing the reports handed to us, we ascertained the following facts : We have here 1.945 cases of yellow fever treated homoeopathically in the city of New Orleans, with a loss of 110 patients, a mortality of 5 6-10 per cent. We have 1,969 cases of yellow fever treated in cities and towns outside CI New Orleans, with a loss of 151 patients, a mortality of 7 7-10 per cent. This makes a total of 3,914 cases of yellow fever, treated homoeopath- ically, during the epidemic of 1878, with a loss of 2G1 patients, a mortality of 6 6-10 per cent. We have, moreover, reports of 555 cases treated homoeopathically in the great epidemic of 1853, with a loss of 33 patients, a mortality of 6 per cent. Also, reports of 2,100 cases treated during the several' minor and much milder epidemics which occurred between 1853 and 1878, with a loss of CO patients, a mortality of 3 7-10 per cent. Making a grand total of 0,.569 treated by homoeopathic physicians, with a loss of 360 patients, a mortality of 5 4-10 per cent. The number of cases reported as occurring in 1878, among negroes, including' mulattoes, was exactly 900— with a loss of 27 patients, a mor- tality of 3 per cent. Some physicians did not distinguish between their patients as to race or color. The number distinctly reported as white, was 2,299, of whom 194 died, a mortality of 8 4-10 per cent. Tliis includes the returns from points like Memphis or Chattanooga, where the fever was very malignant, 1 "I (III I "' III; I f'l h> )|if| f ¥ i)i , ' I H ¥ ft Hi.. ii' ' ■ ' '"ii lis ' '■ I '^ mm |ii' ■ ' •■ " m 6S6 YELLOW FEVER. and the mortality very great. In four of the New Orleans reports, l,07(> patients are described as being white, of whom 06 died, a mortality of 6 1-10 per cent. The number of cases distinctly reported as colored in the city of New Orleans, was 107, of whom 3 died, a mortality of a little less than 3 per cent. The total number of cases reported as being under 15 years of age, is 1,089, of whom 48 died, a mortality of 4 4-10 per cent. The total number of recoveries after black vomit, was 125. This dreaded symptom, formerly considered so fatal, has been growing less and less so since the epidemic of 1853, and a great many recoveries have been recorded during the great visitation by gentlemen of both Schools. Chil- dren seemed to have it more frequently in proportion to numbers, and to recover from it more readily than adults. We must not forget that there are various shades and degrees of black vomit. Blood more or less black- ened by the acids in the stomach, may have been quite liealthy when exuded from the mucous membrane of that organ, and be far less prog- nostic of danger than that sooty, coffee-ground substance, the genuine bhick vomit, which shows under the microscope a chemical destruction and disintegration of the blood-globules. Among these returns are nine papers to which we attach especial value. These comply fully with the request of the circular letter, to give not only cases and deaths, but the name, age and address of every patient attended, so that with these documents in our hands, we can verify every statement, and challenge comparison with any member of the Allopathic School who can furnish us with similar acurate data. These returns exhibit an attendance upon 2,010 cases of yellow fever, with a loss of 129 patients, a mortality of « 4-10 per cent. There were 64 recoveries after black vomit. The number of children under 15 years of age amounted to 828, of whom, only 40 died, a mortality of 4 6-19 per cent. HOM(EOPATHIC TREATMENT. Aconitum has been named as the most direct and positive remedial agent in the early stage of yellow fever; and, indeed, its specific effect upon the human economy in a healthy state, especially under conditions of temperature provocative of the generation of fevers of this kind, tends greatly to confirm this opinion. In case of an attack of fever of an inflammatory character, whether it be apprehended that it may resolve itself into this form or not, the prompt administration of Aconitum can only have been productive of benefit. Dose : Six pills in a teaspoonf ul of water, or drv on the tongue, repeated, after the lapse of one or two hours, and subsequently, at intervals of one, two, three and four hours, until the fever symp- toms abiite, the breathing becomes less laborious, and the pulse more regular, or less quick and frequent. But if symptoms of severe exacerbation should threaten to succeed, notwithstanding the admin- istration of Aconitum, proceed promptly with such of the following medicines as may offer the closest analogy to the case. Belladonna may prove of much service after the previous adminis- tration of one or two doses of Aconitum, for the treatment of those cases (during the first stage) which attack young, full-habited subjects, with very marked and predominant brain-symptoms. It is aseful'in the first or second stages. Dose: As directed for Aconitum. ■Pi ^iliil I! EPIdjcmk; and kndkmic infectious diseases. SSI Brt/onia umy be called for in the first, or even in the second stages, where Aconite or Belladonna have not sufliced to allay the symptoms. It is more particularly indicated when the pains assume a rheumatic charac- ter, and all the symptoms are aggravated by motion. Dose : As directed for Aconitum. Arsenicum. Faintness, depression, nausea with intense burning in the region of the stomach, increased by pressure ; violent vomiting of brown turbid matter, mixed with mucus, and sometimes stained with blood. Pulse small, frequent and irrej^ular ; skin cold and clammy in the stage of collapse, at other times it isvery hot; breathing feeble and accom- panied with sighing; great nervous irritability ; intolerable pain in the bowels, with dark, or bloody stools; great emaciation; want of sleep, mine scanty, high-colored, and passed with an effort; delirium; jerking; coma; convulsions; tJiirst frequent, hut usually for the moment satisfied with a small quantity of water. Dose: Six pills in a little water, or dry, every one to three hours, or in severe cases, every ten or fifteen minutes. Crotalun has been employed in some cases with very marked success, all danger having been subdued after a few hours, even in cases which had reached tlie fully developed third stage. It is more especially indicated ])y the hemorrhages occurring from the oyes, nose, mouth, ears, stomach and bowels. l)o8e : As directed for Arsenicum. Agentuin Nitricuni has been employed in some cases, with good effect, where the patient is sinking, the vomiting becomes worse, with brownish stilus in the matter ejected, or other evidence is given of effu- sion of bloiKi upon the mucous lining of the stomach. Dose: As directed for Arserdcum. Pulsatilla, Mercurius, Nux-vomica, Acid-nitricum, and C. ■ .a may prove of service in the first or second stages, more particularly, and Cantharis, Digitalis, Carbo-veg.,Croton-tiglum, Rhus-tox., and Veratrum- album, in the second and third stages, more particularly. The selection should t)e guided, in each case, by the analogy existing between the symptoms of the disease, and those which are specific to each of these medicines, as found by the appended " Repertory." ASIATIC CHOLEBA— MALIGNANT CHOLERA— EPI- DEMIC CHOLERA. This virulent disease generally commences with giddiness, headache, singing in the ears, and uneasiness, a sensation of flatulence in the stomach, (rumbling of wind), or griping pains, rapid loss of strength, and a feeling of weight and oppression in the. region of the heart. In the severest forms of the malady, the patient suddenly falls senseless to the ground, as if struck by electric fluid. But in many instances, diarrhoea is the first symptom, which, if neglected, soon becomes associated with vomiting, severe colic, cramps, or convulsions, anxiety, and dread of disso- lution, which appears to be inevitable. In some, t'^ough not all, cases of Asiatic Cholera, we find the lips, nails, and sometimes the whole skin, of a blue color, but, in almost every '•'111 111 "«iM^'Ju,:'' ill. II |!!li«;t||i 111' \m.jL iJiir W" ' i" t ■ ■ jS.J •:i1k 688 EPIDEMIC CHOLERA, instance, the frame loses its power of gencnitiiig heat, the pulse and j)ulsa- tion of the heart are almost unfelt, and the circulation of tlio blood becomes stagnant. Patients who have outlived the second stage sometimes fall victims to a secondary typhoid fever in the third. Predisposing Causes.— The predisposing influences are: intemper- ance in eating and drinking, insuflieient of or cold, indigestible fruit and crude vegetables, cold drinks, when tlic body is overheated; exposure to exhalations from decayed vegetable or animal matter, residence in low, damp, dark, ill-ventilated dwellings; excessive fatigue, suddenly suppressed perspiration, sudden mental shocks, or moral emotions, as fright, fear, grief, and especially passion; neglect of cleanliness, both l)orsonal and domestic, constitutional debility, serious deniiiLjenient oi' the digestive organs, weakness of the bowels, etc. As any, or, at all events, several of these in conjunction, tend to favor the invjision of tlic disease, they ought, when practicable, to be carefully guar.icd against or removed. Exciting Causes.— These are generally said to dej)eii(i upon some peculiar atmospheric conditions. But it is to bo remiukcd, that such atmospheric conditions, (properly so called, in contra-dislinciion to the many otiier immediate causes of disease, witli wiiicii the atmosphere may he impregnated), do not appear, necessarily, to involve whole regions, or even extensive tracts of country. Cases are not wanting, especially in tropical climates, in which this diseaso, in all its distinctive features, has occurred, almost in isolated instances, or has been confined to particular spots. ALLOPATHIC TREATMENT. In the treatment of epidemic, or Asiatic cholera, this much appears to be settled, that upon the appearance of the diarrhoea, (cholerine,) which is preliminary to the disease, the patient should take to his bed, and remain there; this is essential to success. The remedy which is best suited to control the preliminary diarrhoea, is Opium. Strychnine, Sulpluiric Acid. Chloroforln, and Camphor, have been found useful. The following formula is found useful during tliis stage: Take a foxtrtU of a grain of the Sulphate of Strychnine, Aromatic Sulphuric Add half an oiuKe, Sulphate of Morphine two grains, CampTwr Water three and a luilf ouiu:es. Mix; a teaspoouful, toell diluted, may be given every one, two or three hours, according to the severity of the diarrhaia. The plan of checking the diarrlioea by a full dose of Opium, varying from a quarter of a grain, to one grain of Morphine, according to the severity of the diarrhoea, is a good one. The continued use of the above mixture would then be appropriate. But a return or increase of this symptom, (diarrhoea.) should be met with another full dose of Opi.im after an interval of not less than an hour. The bowels should move in a bed-pan, the patient not being allowed to rise to stool. The stools should be buried, and the vessels thoroughly washed and disinfected by keeping a solution of Permanganate of Potash, or Carbolic Acid, in them. The floor may be sprinkled with Labarraque's Solution, or a solution of Carbolic Acid, one part to forty of water. » EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. 589 The food, when there is diarrhcea, should be composed of farinaceous Hrticles, mill;, and beef tea. Tlie drink may be Sulpliuric Acid Lemonade, using for a change, and \o gratify tlie taste, plain water, cold tea, or milk and water. Hot poultices, or mustard plasters, may be applied to the abdomen to relieve pain. When vomiting and purging occur, there appears to be no remedy more generally useful than Chloroform, given in doses of five to ten drops every half hour, or hour. It relieves the vomiting, pain, and spasms. Lint, saturated with Chloroform, laid over tlu stomach, and covered with oiled muslin, will aid in controlling the vomiting. The use of Chloroform may be continued in Ave to ten drop doses, or teaspoonful doses, of Spirits of Chloroform, (Chloroform one part to AIco- liol twelve parts,) every half hour, or hour, may be continued, either of which may be given in teaspoonful doses of Camphor Water, which will give the beneficial efTecji of the Camphor. The benefit of that variable mixture called Chlorodyne depends largely upon the Chloroform it contains. Brandy, or Whisky and water, should be given as freely as the stoniacli will retain them, in small quantities at a time. The thirst may l)o relieved by water, rendered slightly sour by the addition often to thirty drops of Aromatic Sulphuric Acid to a glass of water. Ice water may bo taken in small quantities, or simple water m.-ty be used. Water is not harmful, if it does not provoke vomiting. Small lumi)s of ice may be given. Concentrated nourishment as milk and meat essences should be fre- quently given in small amounts (with whisky or brandy, or without) if the stomach does not reject it. When collapse occurs the Opium and Strychnine before appropriate are not to be given, because they may not be absorbed, and when the pa- tient rallies from the collapse (if he does,) there is danger from an over dose by accumulation in the stomach. The remedy which has yielded the best results in the stage of collapse, or when it was approaching, is the Hydrate of Chloral given l)y hypoder- mic injection, from five to ten grains in solution in water being the dose given at intervals of half an hour to an hour or two. It is often advan- tageously given with Morphine in doses of from an eighth to a quarter of a grain. The surface of the body should be kept warm, if possible, by dry heat, such as hot flannels, bottles of hot water, etc. It is not desired to occasion sweating, but perspiration should be wiped off with warm dry cloths. Injections of warm water or injections of whisky with warm beef tea are permissible. The latter has been known to avert an approaching col- lapse. and arrest the diarrhoea. If the patient rally from the collapse the cautious use of nourishment and stimulants as directed for typhoid fever are indicated. If the kidneys do not act freelj' they should be ^stimulated by the use of half teaspoonful doses of the Vinegar of Squills in a dessert or tablespoonful of Infusion of Digitalis four times a day, and bland drinks such as flaxseed tea or barley water. " coma (insensibility) occurs, the hot air bath should be resorted tl' '"ii? l^\ mW"\ m^n iiiil" III h!" it i:v 'l^h Bii fill m EPIDEMIC CHOLERA. to, to throw off the urea by sweating. The danger of urcemlc poiHoning is averted by getting the kidneys to acting freely. Tonics sliould l)egiven For tills purpose there is none better than two or three grains of Quinine given four times a day. Thorough cleansing and disinfection of buildings and surroundings, having privy vaults, drains, and vessels which receive excretions, house waste, etc., contain disinfectants, no filth of any kind being allowed to accurauliite, the severe ravages of the disease may be prevented. HOM(EOPATHIC TREATMENT. The success of treatment much depends upon the promptness witli which remedial resources are exhib- ited, upon tlie earliest recognition of the attack. Tincture of Catnphor, if administered upon the earliest premoni- tory indications of tlie attaclt, will often avail to prevent the further development of the disease, and will, at all events, in the great majority of cases, avert fatal consequences. Tlie following are tlie particular indi- cations in tlio early stage— cliilliness, sliivering, giddiness, lieadaehe, singing in the ears, pain, weiglit, pressure, or a distressing sensation in tlio pit of tlie stomach, cramps with protracted rigidity in the calves of tlie legs, sensation of general uneasiness, sudden lossof strengtii ; sunken, blue-encircled eyes ; diminution of the senses; slow, or scarcely pereej)- tible pulse ; blueness and icy coldness of the face and hands, and greatly diminished temperature of the wliole body ; burning heat in the throat and region of the stomach; distended bowels ; much llatulent rumbling; nausea and even vomiting, and diarrhoea; diminished or suppressed urine (an almost constant symptom in cholera;) hoarse voice; countenance expressive of excessive anguish; suffocating oppression. After taking Camphor, sweat soon breaks out as a sure sign that an improvement has commenced. Then tlie remedy must be given less frequently and in smaller doses, or it may give rise to congestion of tlie brain. Dose : Take of the purest loar sugar, orof Smjar of Mill i finely ponxlered just a sufficiency, upon which dejjosit a drop of tlie tincture, tlius administering tlie dose, and repeating sucli dose, at first every live minutes, extending the intervals according to the duration of the intermissions between the spasmodic attacks, only repeating tlie administration as the attack returns, and continuing tliis course until positive amelioration or diange. Decided improvement is readily distinguisliable: first, by increased warmth, and, sliortly, by diminution of anxiety, by comparatively healthy perspiration, and by an inclination to sleep. After sleeping an hour or two the patient awakes with a sensation of • ise, which he can scarcely believe. Fera^rMJH (especially under the particular circumstances just enu- marated) sliould be employed witliout a moment's delay, when cholera sets in, in its worst and characteristic form, with sudden and violent fits of vomiting and purging, the evacuations resembling starch or rice-water, after several paroxysms; flatulent rumblings, excruciating gripes, severe cramps (either with pi'!?! ractcd rigidity, or with rapid alternations of eon- traction— particularly the Ic^tter) in the calves of the legs, etc., (second stage,) ice-like coldness of the entire body, even of the tongue, cold, clam- my sweat, suppressed respiration, feeble pulse, great thirst— the patient, if permitted, drinking large quantities of water — excessive weakness, terrified look, weak, h«llow voice, groaning and yawning. lllll. EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. m Dose: Six plohulos In a teaspoonful of water, every quarter of jm hour, (in extreme casos) or every lialf hour (in less urgent cinann- 8tances,)or even in some very (leHj)erate cases, and wlien a fatal issue seems imminent, every live minutes, until the extreme severity of the symptoms l)ecomes somewiiat abated ; and, subsequently, every time tlio paroxysms return, and so on until the symptoms yield or change. Arsenicum-albuni displays its curative action in those terribly rapid cases where cholera algida at once sets in without any premonitory symptoms. The most essential indications for Arsenicum are : Sudden and complete exhaustion, vanishing of the pulse, together with violent l)alpitations of the heart, great dyspnoea, inexpressible anguish, constant tossing about, horrid thirst, yet the least quantity of liquid is vomited up again immediately; burning distress in the region of the stomach and upper portion of the bowels; complete suppression of urine. In suoli cases Arsenicum should be given at once, without any other medicine being resorted to in the first place. After the exhibition of Arsenic the urine is often secreted in largo quantity, a very favorable change. Dose: Six pills in a teaspoonful of water, every quarter of an hour (in urgent cases,) or even every five minutes (when a fatal issue appears imminent.) or onlyevery half hour (in cases of a less desper- ate cliaractor,) until the symptoms are modified, and the sufferings are not so incessant; then extending the intervals according to tlio duration of the periods ofremission between the paroxysms and so on, until positive change. vlcoH/fe is a splendid remedy if, in the beginning, or after the blue cold stage, there is heat of tlie skin, quickness of the lulse, headache, noise in the ears, dryness of the tongue with craving thirst, this remedy sliould bo given in small doses— six pills every ten to thirty minutes. On the other hand, when the skin is cold, clammy and livid, the pulse not perceptible at the w'st, the action of the heart quite feeble and irregular, the head cold, ti. . pupils of tiie eyes dilated very much, and not sensitive to the effects of light, involuntary discharge from the bowels of a thin stool resembling rice-water, vomiting of a similar substance, the dose should be large— twenty drops of the Tincture of Aconite, in a glass- ful of water, to be given one teaspoonful every fifteen to sixty minutes. Carbo-vcff may often be advantageously employed after the previous administration of one or more of the preceding medicines, or even in alternation with Arsenicum (in some cases) when the patient is reduced to the last extremity, animation being all but completely suspended, and the pulse scarcely perceptible; or when, on the cessation of vomiting, purging, and cramps or convulsions, determination of blood to the head and chest ensues, attended with oppressed breathing, coldness of the breath, redness or livid hue of the face (which is covered with clammy sweat) and lethargy — the patient seeming as if seized with an appoplectic fit. Also, when every sign of reaction has been extinct from the beginning. Dose: Six pills in a teaspoonful of water (or,— if there be difficulty in ensuring its being swallowed thus— dry/ on the tongue,) at intervals of five, ten, and fifteen minutes successively, and then (if the pulse become stronger) every half hour until positive change. But if. upon the development of stronger pulse, and the subsidence of tlie lethargic symptoms, the pain, vomiting, cramps, etc., should return, at once, resume the administration of Veratrum, as before. Additional Partictlars. Ipecacuanha, Nux-vomica, These ^'ii 1 1 PS I \\' hi> 592 EPIDEMIC CUOLEUA. i;,,'^'^ remodics (the first either sincrly or followed by Nux-v.) have been found efflciiciouH pitlior before or iif* >• the previous adniiniatration of the other medicinea, (;,'enerally when more urgent symptoms had been overcome,) or at the onsot of tl»e attacic (in milder cases,) when sucli IndicaLions as the following could positively be identified. Ipecacuanha may be administered luider circumstances such as those just stated, either after previous treatment, when the vomiting becomes a prominent symntom, and tlio discharge attending it is more copious, or at the onset of the attack, when the vomiting (being copious, and attended with much nausea) predominates, so as to charsActerize the case distinctly. Further indications for this remedy, are such as the fol- lowing:— sensation of weakiies? (or of internal sinking,) coldness of the face and limbs, sensation of sliivering in the belly, slight cramps in the calves of the legs, and in the fingers and toes; or sometimes, again, vomiting, alter- nated with watery diarrhoea, accompanied with, or preceded by griping, colicky pains; or even yellowish diarrhoea in some cases in which the vomiting does not occur; or loose evacuations of excremental matter, mingled with slime (at the commencement of the attack,) or evacuations of a greenish or brownish character. Dose: Of a solution of twelve pills to four tablespoonfuls of water, give a teaspoonful every houi, until change. But if, after tiio mon; violent symptoms (the vomitii.g especially) have yielded in a d('i,'r('e to the action of IpefnciianJia, pMise three hours, and proceed with the next medicine, if the subjoined i-ymptoms remain. Nux-voinica may be employed with great advantage three hours after the last dose of Ipecacuanha, when the vomiting has subsided under the influence of the last-named medicine, but symptoms of spasm of tlie stomach remain, such as weight and constriction in the region of the stomach ; or again, when anxiety, great debility, griping, frequent, small evacuations with much straining, frontal headache, or aching i)ain at the back of the head, and shuddering, with predominant internal chill, con- tinue to prevail. Dose: Of a solution of six pills to two tablespoonfuls of water, give a teaspoonful every hour, until the symptoms abate ; and then every three hours, until positive cliange. Cicnta-inrosa has proved an appropriate remedy, when there are spasms in the muscles of the chest, continuous vomiting, and a little diar- rhoea, when the eyes are turned upwards, and the patient is in a drowsy state. Dose: Six pills in a teaspoonful of water, (or, if there be difiiculty in this method, dry on the tongue.) every ten minutes, until the symp- toms abate, and then every half hour, until positive amelioration or change. Treatment of the Afteu-evfiscts of Cholera. Carho-veg. is of much service in the stage of convalescence, when flatulent rumblings, and colic with diarrhoea and excessive flatulence during stool remain. Dose: Four pills in a teaspoonful of water every hour, or after every intestinal evacuation, until a degree of improvement becomes appar- ent, and then every tvvelve hours. Phosphoi'us is very useful when debilitating diarrhoea remains after the removal of the more urgent symptoms, and particularly when the stoo.s are watery, and sometimes productive of an acrid, pungent sensa- tion in the last intestiae, and attended with belching, weight or oppression EPIDEMIC AND KNDKMIC INFKCTIOU8 DISKASKS. 5DM nl tlio pit of tlio Htomacli, and lulenil regions (without tlio heat or burning wnich accompanicH tliis symptom in tlie cases tiiat call for tho employ- nienl of Arsenicum,) and pain in tiie region of tho navel, rumbling noise in the bowels, either at other times or on i)roHsing the liand iigainst the belly, pricking or shooting pains in the left side of the chest, etc. Phos- phorus is also useful when a tendency to vomit remains, but with the distinctive indication that it only occurs about a quarter of an hour or so after drinking, or when the cold fluid drank has become warm in the stomach. Again, it is u remedy of mucli importance in the event of con- gestion in the chest, with oppressed and laborious breathing, in addition to the before-mentioned symptoms during tlie course of the disease. Dose: Four pills in a teaspoonful or water, every three hours (or every hour in more urgent cases) until the symptoms abate, and then every six hours. Acidnin-phosphoi'icHtn should be administered, either after the previous use of Phosphorus, or even before it, in the event of the tongue becoming exceedingly clammy, or slirny; or, again, if eolliciuative diar- rhea should ensue, with or without the typhoid or congestive symi)tom8, hereafter described; or when the dullness of the head, and pallor of the face, occur; or tho evacuations are watery or slimy, or exhibit a green Ish- whitehue, and there is Inadeciuate discharge of urine. Dose: Of a solution of six i)llls to two tablespoon fu Is of water, givo a teaspoonful every two hours. AccRSSoKY Treatmrnt. The patient should be kept In a room of a w^arm temperature, the bed should be heated by artificial means, iioliles of hot water applied to the feet, if necessary, and hot Hannels to other parts of the body. Tiid observance of this rule greatly facilitates the action of the medicine employed. Enveloping the patient in a damp sheet, (one which has previously been soaked in warm water.) and then wrapping him in blankets, is another useful auxiliary mode of treatment. Frictions with woolen cloths, and the \ct of rubbing and pinching.'under the bedclothes, the parts affected \\ Ith spasms, have also been reconmiend- ed; but if these auxiliary measuras prove distressing to the patient, he shoul(i be left quietly under the action of the medicine. Anything which might disturb the equanimity of the sufferer, such as noise or contra- diction, should be carefully avoided, and his spirits should be sustained as much iis possible. Foou AND DiuNK. Cold water is the best drink, but the patient should not be allowed to take too much at a time ; the occasional adminis- tration of a small piece of ice, if possible, or of iced water in teaspoonfuls is often attended with benefit; and injections of iced water are sometimes serviceable in relieving the colic and cramps in the intestines, or of starch- water in the case of straining. When cold water, in lieu of diminishing, increases the vomiting or other sufferings, and the patient expresses a wlsli for a little nourishment, tepid emulsion of sweet almonds, thin gruel, barley water, toast water, milk and water, (all warm and given a teaspoonful at a time,) may be administered. During the convalescence following this disease, we must be careful not to indulge the patient to the full extent of his desires. It Is, there- fore, advisable, when the appetite returns, to commence with Semolina, Sago, Arrowroot, and such like, as also Cocoa, chicken broth, or beef tea; 38 iHr !l I Ml \'' V y 1, ]li C ^®(Mi / ftOl RHEUMATISM OF THE JOINTS. but pront cnution must be observed, in order to avoid the risk of a relapse from an uudiio amount of nutriment. Tliis is Ijest aceomplislunl hy tlie Hdministration of a tablespoonful every liour, or oniy every two or three iiours, diniinisliing, or gradually augmenting, and varying the quantity and (|uality of the food, according to the effects produced. OENKit\T. Accessohy Precautions.— Care ought to be taken to avoid excesses of all kinds, late hours, exposure to night air, melancholy thoughts, or fear, which are all predisposing causes to the attacks of this malady. Pure air, and thorough ventilation, are Indispensable, and the precaution of providing a free current of water through all drains, etc., is not to be neglected. If it be known that stagnant, or obstructed drains, cesspools, and the like, are distributing noxious exhalations al)out a dwelling, the safest course Is, (if possil)le,) to remove to another locality ; the next, to endeavor to neutralize the poison which Is given out by these decomposed deposits, by means of chloride of lime, or peat, charcoal, etc. It is, however, very hazardous to set about removing such nuisances d?mn.7 the prevalence of the epidemic; this should have been done before, or should jj^enerally be left until afterwards, when there is no longer reason to ;i])prehend the distribution of additional causes of diseuse; a keen frost may render the cleansing of foul places comparatively safe . Regular exercise should be taken during th» best part of the day (in fine weather) In the open air, but excessive fatigue should be avoided. PUESERVATIVE MEASURES DURING THE PREVALENCE OF CHOLERA. Accurate observance of the Homa3opathic Preventive Regulations will, in a very great number of cases, avert the attack altogether. But, even if this should not be the case, the disease »\ill, in general, be developed in a very modified form, and such as will usually be readily subdued by the employment of Camphor, (as heretofore directed at page 590.) In some few cases, further treatment may become neces- sary, according to the directions stated in the foregoing portions of this article, but there will rarely be reason to apprehend a serious issue. See, also, Veratrum. t| RHEUM ATI.SM OK TIIK JOINTS. MUHCLICH OF THE FOOT. Mb A. Os Calcis. B and F. Flexor brevis digitoriurn. C. Abductoi puUicis. D. Abductor minimi digiti. E. Flexor longus digitorium. CHAPTER XXIX. CONSTITUTIONAl DISEASES WITHOUT DEFINITE IXFECTION. ACUTE ARTICULAR RHEUMATISM — RHEUMATISM OF THE JOINTS. This form of rheumatism often arises from a cold, and from exposure to the atmospheric influences; it not unfrequently assumes an epidemic typ« uv.d, in sucli a case, breaks out most commonly :n the fall and winter. "i-::^' ■.i>,i' 096 CONSTITUTIONAL DISEASES WITHOUT INFECTION. t ^]^] The disease commences very gradually, with a vague feeling of fatigue, accompanied with slight catarrhal symptoms; it may break out after severe attacks of angina, very seldom suddenly, and scarcely ever with a chill, but with alternate chills and heat. Simultaneously with the fever, very seldom after, and still less seldom before, one or more joints become painful; the imin rapidly increases, and the joint swells, sometimes wit!i, and at other times without, redness ; at this period, the least motion, and the leadt pressure, cause pain, so that the patients remain perfectly quiet, for fear of hurting themselves. Generally, several joints are attacked at once, very seldom only one at a time, never all the joints at once from the start. The disease progresses in a very characteristic manner. While the joint that was first attacked, is getting better in three to five days, sometimes? with a complete cessation of the pain, as well as the swelling, other joints are attacked in the same manner; in this manner most of the other joints are invaded, after which the rheumatism frequently breaks out again in the joint whence it had originally proceeded. At times the swelling is quite considerable, at other times scarcely percept" le ; some- times it is confined to the joint alone, at other times the surrounding parts are very extensively involved ; not unfrequently the articular extremities feel enlarged. The constitutional symptoms are at times very violent, at other times very slight; this depends a good deal upon the number of joints involved. The fever runs pretty high, remitting very irregularly ; the temperature is not much raised above the normal level; pulse about one hundred, in very acute cases increasing very sel- dom to one hundred and twenty and upwards, small and changeable ; a copious perspiration, having a musty, sour smell, continues during, the whole course of the disease, corresponding with which the patients are tormented by a distresiing thirst. The urine is very scanty, saturated, and, on cooling, deposits a copious sediment. The digestion is slow, the appetite impaired, but very seldom entirely suspended. The course of uncomplicated rlicumatism is never very rapid, gener- ally more or less wavering; recovery takes place gradually; single joints may remain painful and swollen for a long time, the pulse remains obsti- nately accelerated, the perspiration continues, the weakness abates very slowly. A favorable change takes place very seldom after the first week, a little more frequently after the second, but most commonly only after the third and fourth week. Fery often we have noticed that, before the disease terminates, every joint is attacked twice, and that the second attack only lasts half as long as the first. In violent cases all the joints are affected together at the termination of the attack, some, however, are more acutely inflamed than others. With proper management and care this form of rheumatism ends in recovery in one week at the latest. However, by neglecting to guard against relapses, an acute attack may very easily terminate in a chronic form, and contractions and paralytic conditions may arise which can only be removed with great difficulty. CHUONIC ARTICULAR RHEUMATISM. It most frequently develops itself out of the acute form, of which it constitutes a rest, as it were; it likewise arises from the continued action of damp and cold places. WTfc »»», ■"«W,j ^>'r. "ic "■"^v, **r. CARPUS METADARP'bS 1*1 1 lull! Il Ktl '■fimi :li' !'lli iM I ,«'! 1 1- i tit h •* t n\ r ■ ■h J«|, -Mn e»r 5d8 RHEUMATISM OP THE JOINTS. i "l ''i Chronic rheumatism is less frequently located in the external integu- ments of the joints where acute articular rheumatism is generally seated than in the synovial (inner) membrane lining, tlie ligaments and articular cartilages. Little by little these grow thicker and rough. The disease sel- dom involves a number of joints ; generally it is limited to one or a few only. Neither the swelling nor the juiin is very considerable ; to some ex- tent the power of motion remains, yet tije j)atients may be entirely de- prived of the use of the atrected limb, wliile the rest of the body is i)er- fectly sound. The rheumatism has remissions followed by exacerbations, each of which leaves the joints somewhat worse. Those exacerbations often look like an attack of acute rheumatism, with fever and slight in- flammation of the affected part; sometimes, however, they are without fever and distinguished only by pain and loss of mobility. Chronic rheumatism sometimes remains after repeated attactks of acute rheu- matism, of which it seems to constitute the ultimate stage. The joint is not greatly distorted by the disease. A complete cure is very much impeded by the extreme obstinacy of the trouble, and likewise by the impossibility of preventing the joint from being acted upon by influences that never cease, by their jiresence, to perpetuate the dis- ease. DEFORMING RHEUMATISM. AETH .--0 RHEUMATISM. This form of articular rheumatism always runs an exceedingly chro- nic course; it does not develop itself out of the acute form, occurs very rarely previous to the thirty-fifth year of age, and i most frequent after the fortieth year. It breaks out among all classes, especially, however, the lower; on this account it is very diffiv^.ult to determine tlie degree of influence exerted by bad food or damp dwellings over this disease. Ar- thritic rheumatism ulfects more particularly the female sex ; the critical age undoubtedly favors an outbreak of this disease, for we meet with it most frequently about this time. This may attack any j'>'nt in the body, but it is mostly limited to the joints of the hand and feet, ufeetUig both sides of the body at the same time. It generally commences in the hand, whose joints become more or less painful, esiiecially when they are moved or pressed upon laterally. Sometimes the pain is principally felt in bed. The joint swells very slowly ; at times long intervals occur in the further continuance of the swelling, afterwhich the arthritic process resumes its course amid renewed paroxysms of pain. Towards the end the shape of the joints is very much altered, especially the shape of the finger joints. They look bulbous and arc especially enlarged in breadth ; they feel hard ; their integumen- tous covering has a natural color. The power of motion is not entirely suspended, but motion is very painful ; in the very highest grades of the disease the joints are entirely immovable. Life is not endangered by this condition, but its curability is very doubtful. The swelling never disap- pears entirely ; all that can be properly aimed at by treatment, is to arrest the further progress of the disease. ALLOPATHIC TREATMENT. In the treatment of inflammatory rheu- matism or rheumatic fever, no active single remedy has afforded such good results as Salicylic Acid. Its effectiveness in this disease, above all others has caused the repute of the drug. The fever is not unfrequently CONSTITUTIONAL DISEASES WITHOUT INFECTION. 599 corrected in forty eight hours. While not every ease is so fuvorably influenced, yet it exerts a remarkable power in greatly modifying the dis- ease, lessening the fever, pain, and swelling. Fifteen to thirty grains may be given in medicine wafers or capsules every hour until the fev6i and pain abate, when the medicine may be continued in doses of ten to fifteen grains every three or four liours for several days. It is claimed, that in some instances, these large doses cause sickness of the stomach, and prostration like collapse, which may be avoided by combining the acid with one-fourth its quantity, each of Bicarbonate of Soda and Carbonate of Ammonia. Tlie formula of Brideaux is; Take of Bicarbonate of 8oda, Carbonate of Ammonia, each Jioe grains^ Salicylic Acid twenty grains, Wate7' one ounce. Mix. For one dose. Much the pleasanter way to take the Acid, is in capsule, or wrapped in medicine wafers. Fifteen grains of Salicine (active principle of Willow Bark) every three hours, will often give relief within forty-eight hours. It can be given in capsule or wafer, or mixed in wat^r. It should be used, provided Salicylic Acid is not given. A well tested, and beneficial plan of treatment, is known as the alka- line treatment. A solution of a teaspoonful of Bicarbonate of Potash sliould be made in a quarter of a glass of water ; to this is added a table- spoonful of a solution of half an ounce of Citric Acid, in four ounces of water, and drank during effervescence. More water may be used if desired. Tliis should be repeated every three hours, until the urine has become alkaline, (as ascertained by testing freshly voided urine with lit- mus paper) or the fever has abated, then once in six hours, and after tli) ?e or four days, twice a day will be sufficiently often to keep the urine alka- line. After the violence of the symptoms has subsided, if anaemia (impov- erished blood and feebleness) exist, the Bicarbonate of Potash sliould be discontinued, and twenty to thirty drops of Muriatic Tincture of Iron, largely diluted in water, and ten grains of Iodide of Potash, at different times, should be given six hours apart. It is only fair to add, that the benefit of the alkaline treatment, which has such earnest advocates, is, also, seriously questioned by some who claim better results by some of the other methods of treatment, such as blisters, cold baths, and Quinine. The Chloride of Trimethylamine in doses of two grains every three hours, is claimed to moderate the fever and pain immediately, and moder- ate and shorten the disease. Take of Chloride of Trimethylamine sixty- four grains, Peppermint Water thirty two drams. Mix. Dose: A teaspoonful. This drug, if used, should be given alone. Prof. Da Costa recommends ten grains of the Bromide of Ammonium every three hours. It can be given in water flavored with Tincture of Orange peel. Quinine is useful in maintaining the reduction of heat produced by a cold bath, if given in a dose of twenty grains upon taking the patient from the bath, but it seems to the writer, that a more effectual plan, is the repeated application of tlie wet sheet and the use of Aconite. There is no doubt of the benefit of Quinine, or some other preparation of bark as a tonic in doses of two or three grains four times a day, after a few days (Mill ■I! . .m nm RHEUMATISM OF 'Villi JOINTS. have passed. Large doses of Quinine have been thought to iiu curative. It has not proved so in the common experience of the profession. In patients having a high fever and a strong pulse, the Tincture of Aconite may be given in doses of lialf a drop every hour or two to main- tain an impression on tlie fever, and to moderate tiie pulse, until such a time as the fever spontaneously subsides, or is urevented raising by the effect of one of the curative remedies before aientioned, viz: Salicylic Acid, Sulicine, or Alkalies, etc. In those cases having a stidden rise of temperature, to one hundred and five degrees or one liundred and seven degrees or more, (above which u fatal result is to be expected,) the most effectual and speedy method of reducing the fever, is by the cold bath, as directed in typlioid fever. By promptly reducing the fever in these extreme cases life may be saved. While this danger seldom occurs in this disease, it should promptly be resorted to, if required. Blisters are often applied around the affected joints, followed by poul- tices to keep up the discharge, or a small blister one or two inches square, which is allowed to heal, and another one immediately applied. This is called the flying blister. The preferable local application seems to the writer, and used in his practice, is hot packing of the affected joints, wraj)- ping them with flannels wrung out of hot water, and tliickly covered in. Clotiis saturated with an Alkaline and Opium Solution, similar to that recommended by Fuller, may be wrapped about the joint witli benefit. Take of Carbonate of Potash six drams, Laudanum one ounce, Glycerine twu ounces, Water nine ounces. Rubbing the affected joints carefully with A liniment of one part each, of Chloroform and Tincture of Aconite, and two parts Soap Liniment, will afford relief. Through the whole course of the disease. Opium given to the extent of relieving pain, is most happy in its effects. Two grains of the solid Extract, with a third of a grain of the Extract of Belladonna in pills may be given at night, if tlie pain is very severe, and repeated during the day in doses of half this amount, at such intervals (three to six hours) as will nuike the pain tolerable, until it disappears in tiie course of the disease, or under the effect of one of the three curative remedies mentioned above. Constipation should be relieved by half teaspoonful doses of Wine of Colcliicum six hours apart, until the bowels are moved ; Cathartics are not neeiUd. The appetite should be gratified, and encouraged by nutritious diet. The patient ought to lie between blankets, and wear flannel garments, if any, next to the skin, during the whole course of the disease. During the latter part of the diseatre, tonic doses of Quinine, three grains four times a day, or equivalent doses of some otlier preparation of Cinchona bark are advantageous. The Salicylic Acid, Saline, and Alkaline treatments, are said to pre- vent heart complications, hence, in part, is the prompt and bold manner with which they are recommended to be given. Should violent and irregular action of the heart, friction sounds, pain in the region of the heart, enlargement of the area of dullness on percus- sion, difficulty of breathing, and increase of fever occur in the course of the disease, the dangerous complication, pericarditis, has occurred. Full 'loses of Opium *re to be given. CONSTITUTIONAL DISEASES WITHOUT INFECTION. liOl Tlie treatment before recorameucled for the rheumatism should be continued. Large, hot poultices of flaxseed meal and mustard, should be kept over the region of the heart. If the action of the skin and kidneys is not sufficient, the hot air bath should be given. Particular attention should be given to nourishing the patient. Milk, raw eggs, beaten with milk or water, and strong b'.ef tea, or essence, should be freely given. When symptoms of weakness occur, stimulants should be given as are directed in the treatment of typhoid fever. The treatment of pericarditis has been more fully considered else- where. CHRONIC RHEUMATISM OF THE JOINTS. In chronic rheumatism of the joints, attention should be given to the general health, and measures employed to restore it to its fullest vigor. To this end, good food should be taken, avoiding sugar and starchy food, while milk, cream, eggs, and fruits, may be freely taken. The Citrate of Iron and Quinine, in solution, in doses of three to five grains, will be serviceable. It is claimed by good authority that the Tincture of Chloride of Iron is curative in acute rheumatism, and other equally high autiiority claims it to be a preventive of rheumatism. It is equally worthy of a trial in the sub-acute, or chronic form. The dose is twenty to thirty drops, largely diluted in water, every six hours, (four times a day.) It will be especially serviceable if tlie system is debilitated. Iodide of Potassium, in doses of ten grains, dissolved in water, (Peppermint or Sarsaparilla, covers the taste,) three times a day, frequently is very beneficial. A better efTect is sometimes produced by giving five droi>s of Fowler's Solution, with the Iodide of Potassium. The remedies so useful in acute rheumatism, are not so appropriate in this, though they may be tried. Alkalies are required, if the urine is acid, but they should be given more moderately. While Salicylic Acid has succeeded in my hands, it has often failed. The Hydrochlorate of Ammonia often succeeds admirably in doses of fifteen to twenty grains. It is best given in Elixir of Cinchonia,and given four times a day. Tincture of Guaiac, or the Ammoniated Tincture, in doses of one or two teaspoonfuls, three times a day, is one of the most successful remedies. It may be given in milk, or the gum prescribed in other mixtures. Prickly Ash, (Xanthoxylum,) has a deserved reputation in this disease ; the dose of the Tincture is one or two teaspoonfuls. In domestic use, a tea is generally made, (an ounce of bark to a jiint of tea,) and two to four tablespoonfuls taken at a time. Poke root, (Phytolacca Decandra,) cures some cases of chronic rheu- matism. The dose is ten or twenty drops of the Tincture. A tea made, in domestic practice, from half an ounce of the root to a pint of tea,) could be given in doses of a tablespoon fill. The waters from Sulphur springs are helpful in very old cases. "*Varm bathing, alkaline bathings, vapor baths, Turkish baths, and ■ i': A ■} ai: (If. 60j RHEUMATISM OF TUK JOINTS. the wet pack, are each in their turn useful means of treatment, and should be given a thorough trial in obstinate cases. The relief of pain is called for in some instances, and should be met, when not afforded by local applications, with Opium, given in half the doses recommended in the acute variety. Local applications are highly useful. Flying blisters, from one to two inches square, and allowed to heal at once, following each other over different parts of the joint, so that a fresh blister always exists on some part of the surface, is one of the best plans of local treatment. Stimulating liniments are frequently beneficial, as the following: Take of Ammonia Liniment an ounce and a half. Chloroform half an ounce, iioap Liniment two ounces; rubbiug the joint well with it. If the pain is very great: Take of Chloroform, and Tincture of Aconite, each an otmce, Soa]) Liniment two ounces; mix. Wet a flannel with the Liniment, apply it round the joint, and cover with oiled muslin. Turpentine, or Petroleum, well rubbed into the part, or a flannel, saturated with them, and wrapped round the part, are sometimes useful. Other useful Liniments: Take of Oil of Cajuput and Laudanum each two drams. Turpentine four drams, Ammonia lAniment an ounce ; mix. Or Aqua Ammonia a dram, Laudanum four drams, Tincture of Cantliurides three drams. Soap Liniment ten drams; mix. Iodine is one of the best local agents in overcoming inflammation, and removing its products. The Tincture may be used, but the following ointment is believed to be preferable, because, after a few applications of tlie Tincture, a dead scarf skin prevents the penetration of the remedy: Take of Iodine thirty grains, Iodide of Potassium a dram, Water a dram. Lard an ounce ; 7nix. If this irritates too much, it can be made weaker with Lard. A certain amount of stiffness, tenderness, and inability to use the joints, or limbs, is met with, in njany cases, after the influnimation has subsided. This is removed by regular passive motion, i. e., 'notion by the hands of others, systematic shampooing, kneading and slapping with the hands, (called massage,) So-called cures of rheumatism are effected at this stage by "rubbing," "slapping," and "mesmeric " quacks. Liniments are largely useful in this stage, partly becau.ie they neces- sitate a certain amount of rubbing. Flannel ought always to be worn by those who suffer from chionic rheumatism. The general treatment of muscular rheumatism is lot essentially different from that of chronic rheumatism affecting the joi\its, and it is unnecessary to describe it here. Absolute rest of the au. ^ted muscles is necessary. Pain should be relieved by the hypodermicin'' ction, overtlie affected muscle, of a quarter of a grain of Sulphate of Mo phine, with a fiftieth of a grain of Sulphate of Atrophine, in the acute "'ige, or of Atro- pine alone, in the chronic disease. Strong mustard plasters should be applied over the painful muscles, and immediately upo' their removal, a hot poultice of Flaxseed meal, with Lfiidanum poured ov«-r the surface, or hot fomentations of flannel wrung out of hot water ana well covered, to retain the heat. Rubbitfg the part and the use of liniments as in chronic rheumatism 1 CONSTITUTIONAL DISEASES WITHOUT INFECTION. ms of the joints, is useful. Sometiincs the dally use of the wet pack lias proved curative. Aside from tonic remedies probably Iodide of Potassium and Guiacum, as recommended for chronic rheumatism of the joints, and five grain doses of Quinine three or four times a day, are the most fre- quently curative, especially if the pain is periodical. Persons subject to this afTection should wear llannel the year round. The daily use of the cold sponge bath will Invigorate the system against liability to cold, while an over quantity of clothing, night or day, is to be avoided. Invigoration of the .system, especiaMy by an out of door life,i s to be sought for. HOMffiOPATHIC TREATMENT. Aconitum is the main remedy in acute articular rheumatism, if the pulse is not only frequent, but likewise l"ull and hard, the temperature is considerably higher, the joint is red and exceedingly sensitive to contact ; it is suitable for nervous, irritable, plv- thoric individuals; or when heart troubles have set in. Further indica- tions may be gathered from the Repertory. Aconite has been less fre- quently used in chronic caocs, where it sometimes acts with greatefflcacy. Aconite is less adapted to chronic articular, than to muscular rheumatism, especially when the disease is located in the upper extremities. Bryonia alba is a leading remedy for acute and chronic rheuma- tism, except the arthritic form. It is most suitable for rheumatism caused by exposure to cold and dampness after a severe muscular effort ; the vio- lent fever soon weakens the paf nt ; the swelling of the joint is dark-red and exceedingly painful ; the respiratory organsshow symptoms of inflam- mation; the perspiration has a sour smell. In muscular rheumatism, ]?ryonia is indicated by the following symptoms : The muscles of the trunk are the seat of tiie disease, especially the muscles belonging to the chest; the patient feels much better during rest; the pains are severe tear- ing pains, and incline to shift from one place to another. Mercuriiis. Mercurius is not so much adapted to chronic as to most forms of acute and sub-acute rheumatism, with the following general indi- cations: The fever runs high ; the pulse is remarkably quick and hard, the perspiration very copious and having a musty smell, the thirst is exceedingly tormenting. The local swelling is not very great, but painful, intensely red, giving rise to the apprehension of pus forming in the joints it is not apt to shift about; even if other joints are affected, yet the origi- nal joint remains swollen and painful; the breath is foul, the tongue has a thick, yellow coating, the appetite is gone, every kind of food causes nausea. The pains are worse every night, towards midnight, aggravated by severe cold and ameliorated by external w irmth. The more frequently relapses set in, the more specially Mercurius is indicated. In muscular rheumatism, Mercurius is indicated by the following circumstances; the pains exacerbate at night, they are deep-seated as if the bone were attacked with great sensitiveness to gentle as well as firm pressure. Rhus-toxicodendron is adapted to every kind of rheumatism, except arthritic. In acute articular rheumatism, it is indicated by the following symptoms: Violent fever, with tendency to the adynamic type, delirium and excessive restlessness; the swelling is inconsiderable, admits of some motion, is instantly red and somewhat sensitive to contact. The perspiration is not considerable. The patients are constantly changing It, '111, (iOl RHEUMATISM OF THE JOINTS. ')M r-) their position, for evea after lying for a short time in the same position, the pains arc very uiuoIj increased. Feather beds are intolerable, so is external artidcial warmth. For muscular rheumatism, Rhus-tox. is the best remedy, if the attack is caused by exposure to wot; if the above men- tioned circumstances either improve or a{j:gravate tlie symptoms; if the pains at once become associated with paralysis and contraction; if the muscles of the lower extremities are the seat of the disease. Rheumatic paralysis particularly points to Rhus. In chronic articular rheumatism, Rims, is of little, if any use. l*ttlsatilla is mdiciiiiid in mild, sub-acute rheumatism of the joints and muscles; the affection shifls about frequently ana speedily ; the pain exacerbates in tli« evening and at uifiht; they are violent, tearing, draw- ing and jerking pains, increased by warmth, improved by cold, at least for a short time. Pulsatilla is seldom appropriate in clironic rheumatism, but more so in the rheumatism of muscles and of joints. Tartar-entet, deserves to be used more than it has so far been —it is one of those remedies that have a good cilect in exceedingly painful local muscular rheumatism, for instance, rheumatism of the muscles of the back, contracted after a cold, during the performance of a fatiguing muscular effort. In such a case. Tartar emetic very soon brings relief. In acute articular rheumatism, Tartar emetic is indicated by the follow- ing symptoms: marked swelling of a immber of joints, the pains are not very great din'ing rest, but this rest is frequently interrupted by sponta- neous spasmodic, very painful contractions of single bundles of muscles There is not much fever; the symptoms of digestive derangement, on the contrary, are very prominent. A condition marked by such symptoms, sometimes occurs during the subsequent course of articular rheumatism, scarcely ever at the commencement. DigitaliH-jttirpurea is, in our opinion, a most important remedy in acute articular rheumatism; in the last few years we have often seen this remedy produce a striking eiTect, and shorten tlie course of the disease. Ilurrie ' small pulse, easily affected by motion ; increased strength of the beating of tlie heart, but the sounds are muffled and indistinct, mingled with arterial murmurs; hurried respiration, with ability to draw along breath; hurried, abrupt speecli; almost complete suspension of the urin- ary secretion ; shining-white swelling of the joints, not very sensitive to pressure; a numberof joints are attacked at once; the whole, body is very pale. During the whole course of the disease we have given tliis medicine without any other drug, and in spite of the violence of the symptoms, we have never been able to discover any but the best results. In conclusion, we desire to state that Digitalis holds a high ranlr as a remedy for rheumatism among the rational physicians ; there is, undoubt- edly, a reason for this. Sulphur bears almost a specific relation to the rheumatic process. In an acute attack, we would not think of giving Sulphur; on the other hand, Sulphur is indispensable to remove the remaining traces of acute rheu- matism, upon which the extraordinary disposition to relapse generally depends. What this remedy is capable of accomplishing in chronic rheu- matism, is shown by the numerous cures wliieli are every year wrought by the use of Sulphur-springs, and which it is impossible to doubt. CONSTITUTIONAL. DISEASES WITHOUT INFECTION. «W8 Rtilplmr exerts ii cuiativepower over Hitlirilic rlieuniiitism ; it arrests the progress of the disease, and materially reduces the swelling of the joints, hut must be given in large doses. Altiiough Sulphur-springs are the most elToctivo remedy for constitu- tional rheumatism, yet there are other means calculated either to heal or prevent new attacks; some of these means are often sufficient to perform a cure. In tills class we rank the cold-water treatment, sea-bathing, the Turkish and Russian baths. The two last-mentioned have to bo employed with great care ; if they help at all, the favorable effect is seen after a few baths. It is a matter of course ^hat the cause should be removed as much aa may be. The diet in acute rheumatism is easily managed ; the patients either do not crave any nourishment, or their appetite is very much impaired. Fat and greasy articles of diet are decidedly injurious; acid substances, espe- cially stewed fruit, have a very good effect; raw fruit may be partaken of, but moderately. HOME TREATMENT. In the treatment of acute rheumatism, the first thing to be affected, is tins production of a copious perspiration ; for this purpose, a warm vapor bath may be used, or the patient may be placed in a well warmed lied, with bottles of hot water, or ears of boiled (^orn placed around him. AVann drinks, such as Pennyroyal, Catnip, Sage, and Flaxseed tea should be freely administered over the painful and swol- len joints ; apply warm or cold lomentation of Hops, or Hops and Stra- monium (Jirason) leaves, or poultices of Flaxseed meal, or bran or rye meal may be used. Equal parts of vinegar and whisky made warm and rubbed on the principal joints, will sometimes relieve the pain. One of the best applica- tions, however, is fresh leaves of Stramonium, (Jimson Weed) which should be bruised, and moistened with a little watei', and applied over the parts, and renewed three or four times a day. After the hot applications have been used, the parts should be covered with cotton batting, about » quarter of an inch thick, and a piece of flannel spread over it so as to retain the heat and moisture. Lemon juice, a tablespoonful every two or three hours, or warm lem- onade will be found beneficial. A free use of lemonsjn any form, is bene- ficial. Celery is a cure for rheumatism ; indeed, the disease seems almost Impossible, if the vegetable be cooked and freely eaten. The celery should be cut into bits, and boiled in water until soft, and the water drank by the patient. Put new milk, with a little flour and nutmeg into a saucepan with the boiled celery, serve it warm with pieces of toast, and the painful ailment will soon yield. JIHEUMATIS3I OF THE SCIATIC NERVE. This constitutes one of the most frequent, and, at the same time, one of the most painful forms of rheumatism. Its causes are generally involved in uncertainty ; a cold.excessive exertions, abdominal affections, stagnation of habitual hemorrhages, etc., are mentioned as such causes, I ' I ill'ili, H I -1 , i'ji !(i. ■fl 1^ ■ .1 .1 1 1 m: RHEUMATISM OF TIIK SCIATIC NKIIVE. *lt '#' but it is dimcult to trace a distinct conuection between tliese two orders of phenomena as cause and effect. At times the affection commences very suddenly, at other times the pain arises gradually from sensations that r' semblo a sliglit attacic of ordi- nary rheumatism. The pain is generally located between the hip and knee, so that the course of the nerve can be determined very exactly by tlie pain. It is very seldom that the pain runs upwards, but more generally down- wards below the knee, and as far as the foot, on tlie internal or external surface of the leg. We distinguish two kinds of pain; eitlier the pain is constant, somewhat remittent, but never entirely intermittent, and usually following very exactly the tract of the nerve without the patient being able to define the quality of the pain ; or else peculiar tearing-darting pains may supervene, resembling electric shocks, setting in paroxysnially and being excited by motion or making a wrong step, sneezing or cougliing. At the same time one or more places in the course of the nerve are gener- ally sensitive to pressure. Although the pain does not seem to be worse at definite periods, yet all patients complain that it is worse in bed, and that this exacerbation is sometimes so great, that they dare not go to bed. Inas- mucli as the pains are very much increased by an extension of tlie log, by pressure or by the nerve being put on the stretch, the patients generally keep the limb slightly flexed, using it as little as possible during a w.ilk or for the performance of any other motion , This is generally the cause why the diseased limb, after. tlie rheumatism has lasted for some time, f-row.? thin, although the emaciation may likewise be caused by a gradually devel- oping paralysis. The diagnosis being sometimes extremely difficult, it is important to know that it always attacks only one limb. This disorder runs a chronic course. A spontaneous cure only takes plaee with a gradual abatement of the nains, but not till months have elapsed. The general health is very much disturbed by the constancy of the severe pains and by the sleeplessness; the appetite becomes impaired and the bowels are inactive. ALLOPATHIC TREATMENT. This aflTection is a form of neuralgia, but not unfrequently of a rheumatic origin. The remedy whicii gives the most speedy relief is Morphine, by hypodermic injection. A pronu and complete relief of the pain by this means is not unfrequently curative. The injection should be made in the neighborhood of the nerve. The dose to be preferred is a quarter of a grain, which can bo repeated in twenty or thirty minutes, if the pain is not relieved. If the Morphine should not succeed, the liypodermic injection of a fiftieth of a grain of Atropine should be made. Relief from it is more apt to be permanent than the same degree of relief from Morphine, but this injection cannot generally soon be repeated, but if the pain is not relieved nor excessive dryness of the throat, nor other inconvenience experienced; a second injection will be made, but generally, if the pain is not relieved by the first injection of Atropine, it is best, as a rule, to resort to Morphine. The injection, under the skin, of fifteen or twenty drops of Ether behind the great trochanter is often followed by quick relief. Electricity is often beneficial. The diix3ct current should be passed down the nerve. In old cases, a needle, such as is used in acupuncture, insulated to near its point, should be introduced to near the nerve, and CONSTIUTIONAL DISEASES WITHOUT INFECTION. COT Rttni'ljcd to the positive polo. The noRatlvc pole Is then passed down tli'i coiii-He of the nerve. A daily sitting of Ave to ten minutes is appropriate. Tlio neuralgic form of the disease Is more often benefited by Electricity than the rlieumatic. Acupuncture. In old cases, especially in the form originated by i3auden8cheld, is sometimes particularly beneficial. The general treatment is that given for chronic rheumatism or neuralgia, as the afTection is of a neuralgic or rheumatic origin. It is not necessary to repeat these directions here. Iodide of Potassium, in doses often to thirty grains, three times a day; Alkalies; Salicine, in doses of fifteen grains, four times n day; Quinine five grains, and tincture of Nux Vomica five drops, three or four times a day ; or ten to twenty drops of Turpentine, witli Honey, three or four times a day, are particularly recommended in rheumatic sciatica. The same local measures given for neuralgic and chronic rheumatism are appropriate. In addition may be mentioned as especially applicable: A strip of flannel wet with Chloroform, laid over the course of the nerve, and covered with oiled silk, (or nuislin,) or the whole limb covered with new flannel, which has been thickly sprinkled with sulphur and covered with oiled muslin, are recommended by Fuller. Enveloping the limb is claimed by Trosseau to have cured after blister and Morphine failed. Grea<%olief is sometimes given by blistering the head. Flying blisters, us directed in neuralgia, are generally beneficial. The actual cautery is recommended. CONSUMPTION-TUBERCULOSIS-PIITHISIS. Tuberculosis is not only the most frequent of all constitutional diseases, but likewise the most common of all diseases. It is character- ized by deposits into all sorts of tissues and organs, of a small lump or granule, the size of a millet seed ; of a pale yellowish, or gray color ; of a soft, cheesy consistency. The formation of these deposits or tubercles, depends, in most cases, upon the peculiar conditions of the organism. In almost every case, tuberculosis can be demonstrated as developing itself under the following circumstances : It may result from a deficient supply, or the bad quality of the food, in the same manner as scrofula; in this manner consumption, tuberculosis,) often succeeds the latter, so that when, at the age of pubescence, twelve to sixteen years, scrofula disappears, tubercles take the place. It may likewise be occasioned by a deficient activity of the respiratory (breathing) organs, as may occur during certain trades, which will be named by and by, or as may result from tight dressing, or from a sedentary mode of life. Whether a pre-existing germ is excited or ci'feated by such causes, is uncertain ; the former, however, seems to us more probable It may, likewise, be inherited like scrofula. The consumptive constitution does not manifest itself by any positive symptoms, and the so-called consumptive habitconsists of nothing else than the symptoms of general debility and imperfect digestion or nutrition. There die as many persons without as with this habit. The only point that 1 f" ill' I ' : 'J« If '' I An admirably arranged house for the seaside or country. W C0N8UJIP TION, enablos us to be tolerably sure of its existence, is the fact that the person was affected with scrofula wiien young. Consumption is found equally di.stribntod in botii sexes, perhaps a little more amoufj wonion. It breaks out ciiielly between the ages of eighteen and thirty years. The deposit of tubercles, and hence the tubercular disease generally; l)orhaps, liltewiso. in many cases, the origin of the peculiar consumptive habit, are founded in the following circumsta-.sesi A scanty supply and a bad quality of food, damp dwellings, deficient exercise in the open air— on this account the disease is chiefly met with in the lower walks of life, and likewise occurs more frequently in cities than in the country ; among individuals whose business confines them to a room ; and among prisoners. Too rapid growth, more particularly if the growing persons are fed on improper nourishment, for this will occasion a condition of great debility Continued depressing emotions, especially sorrow ancl grief, home- sickness. The connection of cause and effect between these influences and the disease is not clearly made out; but that this connection exists, can be shown by a number of cases ; tubercles are often very properly desig- nated as tears shed inwardly. Circumstances incident to pregnancy, confinement, nursing, tlie more certainly, the more rapidly one confinement follows another, and the longer the infant is nursed at the breast. Women with consumptive dispositions generally pass very well through their first confinement ; they keep up nurs- ing for a year, without losing much strength, but after that, they complain of feeling 'exhausted. During the next pregnancy they apparently feel better in every respect, but immediately after confinement the symptoms of an approaching consumption mulciply; while nursing her child, tiie mother experiences all sorts of inconveniences ; the next pregnancy again brings an improvement, until plithisis suddenly breaks out in all its might, usually during the first weeks after a new confinement, and very often runs a very rapid course to a fatal termination. A sudden change in the mode of living; if an occupation requiring constant exercise in the open air, is exchanged for a sedentary business; a luxurious mode of living is suddenly replaced by a mode of living full of I)rivations ; if the climate is suddenly changed, if persons move all at once from a warm into a cold climate. Circumstances and conditions that permanently Interfere with the breathing; tight dresses preventing a free expansion of the chest; occupa- tions that render constant stooping necessary, as in tlie carpenters' and tailors' trade, etc. ; or trades in consequence of which the lungs become filled with fine dust. Diseases of the respiratory organs. Frequent attacks of acute bronchial catarrh, pneumonia, pleuritis; above all, measles, whooping cough and influenza are very common exciting causes of tubercular deposits. Most diseases that cause a rapid decline in the assimilative functions such as: Typhus, dysentery, cholera, chlorosis, diabetes, inveterate syph- ilis, chronic eruptions. Influences which greatly debilitate the nervous system, such as long- continued mental labor, venereal excess, self-abuse. What causes are chiefly instrumental in exciting the first outbreak gt 39 I .i>: !*)5 ,! •' .!».. ^^m. 610 CONSTITUTIONAL DISEASES WITHOUT INFECTIONo # = \\ the disease, is liard to decide. If tlie germ is present, tlie most trivial ev ut may kindle tlie spark into a flame. Certain conditions of system afford a certain immunity from tubei a- losis. It is certain that mid-mountain air diminishes tlie chances of tul >r- culosis hecoming a fully developed disease. 8VMPTOMS AND COURSE. In describing this disease, we shall adhere to the most common form, namely : chronic miliary tubercul" "s, (consumption.) It is very difficult to say, with anything like certainty, when the disease really commences. The deposit of th;> irst tubercles, especially if not very numerous, is accompanied by symptoms that seem too insignifi- cant to a patient to complain of to a physician. When a physician ia consulted, the disease is already sufficiently advanced to be discoverable by the usual means of exploration ; at its first beginning, no such result can be obtained. That the disease is beginning to set in, can almost positively be inferred if individuals who were afflicted with scrofula when young or persons with a tubercular, (consumptive,) habit, show the following .symptoms : disposition to pulmonary by persemia, with palpi- tation of the heart ; disposition to catarrh of the air passages, the attacks being very obstinate, with bloody sputa, long-lasting hoarseness; general nervous irritability, irritability and increased frequency of the pulse, Repeated attacks of catarrh ought especially to excite sut . don, for they evidently indicate the period when the first tubercle, are deposited. Very often, however, the deposition may be going on 'or a long time without any apparent symptoms, in which case the supervf ition of a severe bronchial catarrli, which gets worse all the time, shews the sudden outbreak of phthisis, or, in otiier words, of the purulent disso ition of the tubercles. In young women the disease not unfrequently i^.*.ts in with all the symptoms of chlorosis, (green sickness) which may lead U> very injurious mistakes. The older the patients, the less distinctly n the beginning of the disease recognizable. Very seldom, however, the disease bieaky out suddenly in such a manner that an apparent fnl- ness of healtl) is suddenly followed by a state of illness, with all the characteristics of consumption; a more or less sickly condition almost alvays precedes the outbreak. It would be of great importance il the tirs'udeposiv of tubercles could be clearly made out by a physical explor- ation of the lungs. We only know of two tolerably reliable indications, early attention to which may be of the most decided importance to the treatment. One is a prolonged, although not very much louder expira- tory murmur, which is particularly important if it is heard during a slow expiration v,'ith closed mouth. The second is the so-called " respiration saccadee," jerking, wavy, cogged-wheeled respiration, which is most dis- tinctly perceived during an inspiration. Tht je sounds can be easily heurd when present by placing the ear close against the patient's naked breast oi back. In the place of an uniform blowing murmur, we hear an inspira- tory murmur at intervals, but not otherwise altered in any respect. Another reliable sign is if, during a slight catarrhal attack, the apices oJ the lungs exhibit symptoms of catarrhal irritation. Another sign is, when the expectoration looks like boaked sago, or is transparent, having the shape of fine, firm threads ; this is a symptom of chronic catarrh of tb© iinest bronchial ramifications. m CONSUMPTION. 611 The existence of a tolerably severe, protracted, acute bronchial catarrh, or a more or less violent spitting of l)h)0(l, (liainioytisis) generally, is an evident, and very seldom doubtful sign, that the phthisis lias set in. At the same time, the patients complain of unusual debility, stitches, or a peculiar drawing pain in the upper lobes of tlie lungs, i)cculiar rheu- matic pains in the arm of the affected side ; the respiration is accelerated the pulse very frequent ; this acceleration is very much increased by tlie least motion ; the existing fever very soon shows typical increase, setting in in the morning between nine and eleven, or in tlie eveuing between live and seven o'clock, or at both these periods, and sometimes attended with sucli complete remissions, that the fever has very mucli tlie appear- ance of an intermittent disease. From this beginning, the symptoms can be easily observed further In their character of tubercular phthisis, witli various modifications during tlieir cdurse, to which we will first call attention before describing the various local symptoms. The course of the disease, especially among individuals of a nu)re advanced age, is raarlced by stages. After the first evidently tubercular catarrh has slowly disappeared, a feeling of almost perfect health is again enjoyed by the patient, who is at most reminded of the slumbering danger by adry cough, or a dispositioji to shortness of breath after an unusual liulily exertion, or after talking. In the course of months, and sometimes not till years have elapsed, another catarrh breaks out, which likewise, ends without any untoward symptoms, and these changes continue until finally an acute attack of marked intensity terminates in fully developed phthisis. At the same time, nutrition may remain perfect for years, the })atient may retain his flesh and healthy complexion, or else he may lose his flesh gradually, and acquire a more or less anajmic (bloodless) appear- ance, A chronic, uniform course of phthisis occurs much less frequently after an acute catarrh. On the contrary, it sets in vv'ith very trifling symptoms, a slight, hacking cough, loss of flesh, palpitation of the heart, r'-Mrtness of breath, etc., and the patient already presents a complete pic- ture of phthisis, when all at once an acute catari ' ^ in, which is sud- denly transformed into the actual disease, or elst, acute catarrh ever takes place. The patients continue to fail almost nnperceptibly, hectic fever supervenes, a tuberculous diarrhoea and oedema (swelling of the extremities) make their ripearance, and death takes place amid symp- toms of complete exhaustion. A subacute course of the disease, quick consumption (phthisis florada) succeeds the initial catarrh sometimes imra ^diately, especially in the case of young individuals, and after confinement, likewise, after severe acute dibt^asps; very frequently it forms the cont'usion of the more chroni forms of phthisis. This subacute course is particularly distingui'.ied by intense hectic fever, tuberculous diarrhoea, disposition to pulmonary hemorrhage. The most vigorous patients fail within eight or ten weeks, nor is it at all pos3i^:'3 to arrest the course of the disease in \e least degree. The cough of consumptive persons varies exceedingly. At the begin- ning, ft constant short and hacking cough is very usually present, sonip' 612 CONSTITUTIONAL DISEASES WITHOUT INFECTION. \;i s,m times iuterrupted by severe paroxysms, resulting in tlie expectoration of a light-colored, scanty mucus; or else, the cough sets in in irregular paroxysms, which are generally excited by marked changes in the temperature, and by pulmonary efforts; these paroxysms often last for several hours, and end with retching ; the sago-like expectoration follows in a few hours. A cough that at once sets in, with a copious expectora- tion, is a rare occurrence. After suppuration has taken place, the cough becomes much kss wearing and spasmodic; the coughing lit readily results in copious expectoration. Between the more violent paroxysms, a CO, stant hacking takes place, during which the mucus rale (rattle) is distinctly heard. In very rare cases there is no cougl: during the whole course of the disease. Previous to the deposition of immerous tubercles and their purulent dissolution, the expectoration is without any characteristic features. Nevertheless, a continual expectoration of clear mucus is always a suspi- cious symptom ; but such an expectoration acquires significance when it is traversed by fine streaks of a yellowish color, and when, moreover, it frequently appears streaked with blood. Still more characteristic is tlie presence of sago-like, firm little lumps and fibres. Much less frequently liard, yellowish or greenish, cheesy little lumps are coughed up at an early period; they generally taste very badly, and frequently luivciui offensive odor. Sometimes the expectoration contains small lumps of calcareous matter, (chalk-like) tubercles, seldom however, previous to suppuration having fully set in ; usually after caverns have formed. The cavernous ex2>ectoration has a yellow-gray color, less frequently a greenish color, is firmly coherent ; In the water it forms irregular, shaggy balls, which slowly sink to the bottom ; it is surrounded hj a quantity of clear bronchial mucus, with which, however it docs not mix. The larynx and trachea seldom remain intact during the whole course of the dit ^ase ; they show more or less marked sympton)s of catarrhal irritation. At an early period of the disease, the voice ; ecomes husky, or loses its clearness and firmness of tone; at a later period, these organs become painful, according as the above described ulcers are located, and not unfrequently complete loss of voice sets in. The tendency to sudden changes of color is » striking i)henomenon only at the commencement of the disease. Very soon the pulse becomes frequent, and feebler than usual, it is acceleruted by every movement. In the last stage it almost always exceeds one hundred, sometimes rising to one hundrp'Jl and forty. It is only exceptionally that the pulse of consumptive patients is retarded, and then only occasionally, alternat- ing with a frequent pulse. As a rule, the pulse affords the host means of 'udging how Tar the patient's strength ha."} already been consumed by the disease. The diges^^'ve functions are generally very much impaired. Usually at an early period of the disease the appetite grows poorly, or cardialgic pains are experienced afte** eating, whi' re not unfrequently followed by distressing vomiting. The appetite ...idom remains natural; some- times, generally shortly previous to the patient's death, he experience, a morbidly increased hunger. Except in quick consumption, the f;cool8 generally remain natural for a long time; diarrhoea only sets in after the 1 CONSUMPTION. fii;? symptoms of extensive suppuration of tlie intestinal tubercles have become manifest. These diarrhceic stools are peculiar, partly papescent and part- ly watery, resembling mustard in color, and appearance ; most commonly the passages are accompanied by a quantity of gas, they frequently contain blood and pus, and are seldom colorless. They are not frequent, from three to six a day, generally two in the morning in (luick succession ; in the daytime they occur after the patient has partaken of nourishment. Sometimes they are preceded by slight colicky pains, at other times they are quite painless. They are always a bad symptom, for the longer tiie diarrhoea postpones, the longer is the patient's strength preserved. Tn the first period of the disease, the patient is sometimes troubled witli diarrhceic stools, but th«y generally abate in proportion as the pulmonai-y symptoms decrease in intensity; if the tendency to diarrhrea has once become established, the course of the disease is generally very rapid. The skin does not show any special symptoms; it is pale and some- times exhibits a yellowisli tint. At an early period of the disease the muscles begin to show symptoms of wasting away. A characteristic sign of phthisis is the bulbous tbicke*iing of the ends of the fingers; most like- ly this change takes place because the ends of the fingers do not parti'ci- pate in the general emaciation. What is peculiar, is, that in most consumptives the sexual passion is very much excited, especially in the case of men, and that the virile power continues so long unimpaired, in spite of the general emaciation. The menses remain natural for a long time ; if they cease, death may posi- tively be expected within a few months. The urinary secretions do not undergo any abnormal changes ; if sweats break out, the urine is of course diminished. Home and General Treatment and Prognosis. Although the prognosis in consumption is absolutely unfavorable, although the pros- pect of a case that had been diagnosed with positive certainty, is very slim, yet the labor of a family or physician in this direction is not without reward, since it may be in our power to postpone the fatal termination. Professional aid becomes still more important, if it is tendered at a period when the tubercular disease was still hidden, or had emerged into light with sufficient distinctness to be recognized in its true character with a tolerably reliable degree of certainty. Although success cannot be posi- tively promised at this period, yet it is our opinion that the formation of tubercles can either be prevented or that their further development can be stayed. After all, the case may perhaps be the same as that of other itcute or chronic diseases, which only become incurable after they are too far advanced. Unfortunately the aid of the physician or proper means is not sought until the suppurativa process has already set in, in other words, in the stage of phthisis, when nelp Is exceedingly doubtful. It cannot be denied that consun ption is curable at any period during its course, although such a result hippens very seldom after hectic fever has set in, and more particularly af(,ertheconsumptiveprocess has invaded the intestines and the larynx. For this reason no case should at once be abandoned as beyond the roach of successful treatment. A complete cure, that is. a complete reab&orption of the tubercular deposits, indeed. , 1, m " ! 4 tf {I n nil ^m I r ■% 614 CONSTITUTIONAL DISEASES WITHOUT INFECTION. cannot be expected; remnants of the disease will remain, and a new outbreak may take place at any time. Wliat we have said, shows that the treatment must aim at three objects: preventive treatment, the treatment of consumption as a consti- tutional disease, and the treatment of theacute intercurrent exacerbations and their most prominent symptoms. The preventive treatment has to embrace a vast range, if it is to be of any use. As mistakes in the first edu(;ation and care of children may promote, if not originate, scrofula, and as scrofula, may easily terminate in consumption, the means of prevention must necessarily go back to the first years of childhood. A correct mode of living from the earliest infancy is an excellent preventive against this dreaded disease; every puroiit should see to it that physical laws are properly obeyed in (he rearing of children, for this will at the same time prevent a legion of other diseases. A parent's duties in this respect are so much more sacred as so many false customs and wrong maxims have been grafted upon the education of tlie young by the present age. Unfortunately it cannot be denied (liat i);ueiits and physicians pay too little attention to tlie first development of childhood, and that they confine tlieir solicitude mucli mor'.! to the treatment of existing diseases than to their prevention. Of course, preventing diseases does not pay tiie physician. We have not space to exhaust the whole subject of prevention ; hence we have to limit ourselves to a statement of the most essential points. The diet should be regulated in accordance with the principles which are more and more universally recognized as conect. Above all, during the first two years the nourislimentshouldi)rincipally be milk; afterwards, otlier easily digested articles of diet may be added in suitable quantity and order. Potatoes should not by any means constitute the chief nour- ishment of children. But not only tlie quality, also the quantity of the food, which should be supplied at regular intervals, should have our care- ful attention. It may seem a small matter to bother about such trifles w.hen the children are robust and healthy, but it is not a small matter ; on the contrary, it is a subject of great importance. Besides proper diet, a salubrious home, fresh air, exercise, and cleanliness must likewise be provided for the little ones. The mental culture is likewise of the utmost importance. Daily experience shows that precocious development and continued mental exertions render children irritable, make them look pale, deprive them of their appetite, and predispose them for all sorts of bodily sufferings. These symptoms show themselves already, in the seventh year, but still more at the age of pubescence, particularly among females. How many individuals fall victims at an early age to an unreasonable and precocious mania for actjuiring knowledge! The only means of ■counteracting the absurd claims of our schools is gymnastics in all its forms, especially if it lays particular stress upon the cultivation of the respiratory muscles, but not by imitating tlie modern plan of practising neck-breaking tours de force, and straining the muscles to their utmost limits. A proper system of hardening children should likewise be pursued, with a view of rendering them capable, at an early period, of bearing abrupt changes of temperature, without being made sick by the exposure. If it is proper that all these rules should be enforced in the education wmm JJONSUMPTION, 61.^ of every child, it is still more /mportant that they should be strictly carried out in tlie case of scrofulous children, or children born of consumptive parents. At the age of pubescence all the signs denoting the accession of tuber- culosis, become more apparent, and the tuberculous liabit frequently shows its peculiar characteristics at an early age. To the above-stated rules a lew other important rules may be added. In the first place, the young people must be taught to breathe properly, not merely with one portion of the respiratory muscles. 2s'otliiug is more conducive to this end than early singing lessons, taking care to pay particular attention to a correct practice of the middle notes. It is during this period of development that gymnastics perform real miracles ; chamber-gymnastics in particular becomes an invaluable aid in the harmonious development of the muscles. However, in practising with the arras, heavy weights must not be used. The dress, likewise, deserves our attention ; it should be of such a style as not to interfere with the freedom of respiration. If a catarrh occurs, it must not be neglected; chlorosis (green-sickness) should likewise be carefully attended to. In selecting a trade or profession, male individuals should avoid such as are known to favor the development of consumption. Women should be cautioned against reckless dancing and the continued application to work that requires constant sitting. A rigid preventive treatment is likewise necessary, if symptoms of tubercles have broken out, and if the tendency to catarrh has at the same time become very prominent. Whatever involves an Increased activity on the part of the lungs, such as running, dancing, continued talking in large crowds, hurried going upstairs or ascending an eminence, should be strictly avoided at this stage; so sliould anything that interferes with the action of the lungs, such as continued stooping in a sitting posture, tight clothing, etc. The patient now ought to practice deep inspirations; a substantial, but simple diet, without any artificial stinmlants, is likewise indispensable. It being of essential importance that the patient should avoid all opportunities of being attacked with acute catarrh, he will have to avoid keen and cold winds, and provide himself with a respirator, (a piece of sponge fastened over the mouth when out on cold days will do) the usefulness of which has not yet been sufficiently recognized. The damper the atmosphere of the place where the i)atient resides, the more Important it is that he should wear flannel undershirts ; this rule applies more particularly to the female sex. A sojourn in crowded rooms that are ligiited with gas, and in damp and musty churches is exceedingly prejudicial. Proper ventilation and a moderate heating of the rooms should not escape our attention. At this period the food should be more simple and of a more digestible quality than ever; animal food deserves a decided preference. Milk now conmiends itself as an excellent nourish- ment, provided the patients are able to bear it, which is unfortunately not always the case. We must insist, that a woman suspected of consumption should never nurse her children at the breast. It behooves us likewise to direct attention to the circumstance that the mental labor and the mood and disposition of the patient are of the utmost importance to th« course of the disease. We doubt whether grief and care can cause tubewiles. but k'.n M ^ii H 616 CONSTITUTIONAL DISEASES WITHOUT INFECTION. V.!;„ what is absolutely certain is, that depression of spirits, sorrow and care, and continued chagrin accelerate the course of tuberculosis, and that a good deal of mental excitement likewise exerts a pernicious influence. Even a change for a few weeks only from their usual surroundings to a quiet and pleasant retreat, affects the patients beneficially. What we have said shows how much importance we attach to a cor- rectly-understood preventive treatment. Various medicines are likewise of importance during the course of consumption. HOMffiOPATHIC TREATMENT. In the flrst stage of the malady, when the tubercles are In a crude, unsoftened state, or when they are inflamed, and commencing to soften, the remedies by means of wliich the malady may be retarded, if not arrested, and, with due collateral precau- tions, kept harmless for years, are, chiefly, Aconitura, Bryonia, Belladonna, Lachesif, Ilepar, Spongia, Phosphorus, Dulcamara, Pulsatilla, Arsenicum, Nux-v., Hyoscyamus, Silicea, Calcarea c, Carbo v., Acidum nitricuni, and Sulphur. TJiese must be selected according to the aggravated symptoms of the case under treatment. Their leading indications may be gleaned from the chapters on "Cough," "Pleuritis," "Pneumonia," "Hemoptysis," and " Repertory." In the second stage, with more free, copious, and somewhat purulent expectoration, the most important remedies are: Acidum nitricum, Bilicea, Kali-c, Sulphur, Calcarea, Natrum-m., Mercurius, Lachesis, Phospliorus, Lycopodium, Carbo-v., Sambucus, Hepar sulphuris, Spongia, Cinchona, Ferrura, Conium, Zincum, Ammon-c, Laurocerasus, Graphites, Nitrum, lodium, Drosera, Plumbum, etc. In the third, or ulcerative stage, the same remedies as the foregoing, together with Guaiacum, Sepia, Stannum, Btaphysagria, Acidum phos- phoricum, Sanguinaria canadensis, are those by means of whicli the symptoms may be materially mitigated, and the fatal issue of the disease postponed. A few general indications for most of these will be found in thechapter on "Cough." When the colliquative sweats are particularly distressing, Sambucus, Stannum, Cinchona, Phosphorus, Arsenicum, Carbo v. et al., Silicea, Mercurius, Nitrum, Lachesis, Sulphur, and L^ao- podium, are the medicines which are of the greatest service. Tbi' remaining morbid symptoms must regulate their selection. When colp- quative diarrhoea predominates: China, Ferrum, Arsenicum, PhOB- phorus, Acid, Phosphoricum, and Sepia, are the most useful. (S^o "Diarrhoea.") ; While conducting the treatment of consumption, the state of the digestive functions, and in females the condition of the uterine system, likewise, must be strictly attended to. This is, liowever, u superfluous precaution to the homceopathic practitioner, as he is ever careful to pay due regard to every symptom, not only in this, but in every other disease. Should none of the remedies, above quoted, correspond to the derangements alluded to in particular cases, although they may be other- wise indicated, an intercurrent remedy may be selected from amongst those we have mentioned in tlie articles on "Dyspepsia," "Chlorosis," etc. The temperament and constitution of the patient ought also to claim attention in the selection of the remedies. SCROFtTLA. on In conclusion, it must be remarked, that as the irritation which is so repeatedly created in the luug.s by the viciaitudes of climate, so constantly occurring in most parts of this country, forms a great drawback to the more or less successful treatment of pulmonary consumption, it is of great moment that every possible means bo taken to avoid that pernicious influence. It has been much in vogue with many medical men to recommend warm climates, or well-sheltered situations, even althougli the atmosphere might be of humid and relaxing nature. But we confess that we are inclined to side with those who do not object to a somewhat bracing and cold atmosphere, provided it be dry, and not of variable temperature. Much, however, depends upon the peculiarity of the case — the air, as well as the food, which may be adapted to one patient, being often perfectly inappropriate, and, therefore, injurious to another. SCROFULA-SCROFULOSIS. This is a constitutional anomaly which it is as difficult to define as rheumatism, perhaps more so. Scrofula may be inherited from scrofulous parents, whose disease is not necessarily, but in a majority of cases, reproduced in the children. It may likewise be regarded as an inherited disease, if the parents were affected with some chronic disorder, (more especially the mother during pregnancy,) such as consumption, constitutional syphilis, fever and ague, mercurialism. Finally, there is every reason why scrofula should be regarded as inherited, when the disease breaks out among the offspring of marriages between near relatives, and after such marriages had been continued for several generations. Scrofula may likewise be acquired by exposure to influences that con- tinually impair the process of nutrition. Above all, it is a deficient sup- ply of food, or improper food generally, that develops scrofula in children, the more certainly the sooner the child was exposed to such an influence. This is the reason why children that are chiefly fed on farinaceous soups, bread, potatoes, easily become scrofulous, the mc -e certainly the smaller the quantity of milk they were allowed at the same time. Potatoes, and next to them, farinaceous food, are the articles of diet to which scrofula is chiefly attributed. Children who are nursed by healthy mothers, can likewise become scrofulous if they are fed too often, or if they are kept too long at the breast, which is so often done in the country by women who are anxious to prevent another conception. Scrofula is not perhaps directly caused, but decidedly promoted, not only by improper food, but likewise by an insufficient supply of fresh air, want of exercise, living in damp dwellings, inattention to the skin. If hereditary scrofula and the last^mentioned circumstances meet, scrofula reaches the acme of its development. In our opinion, improper nutrition is a much more frequent cause of scrofulosis than hereditary descent. Parents generally bring up their eliildren as they had been brought up themselves ; the absurdities of their own parents have become engrafted upon them with the mother's milk, and tl;e grandmother gener- »iS^i 1^' M ^^ mmtm ei8 CONSTITUTIONAL DISEASES WITHOUT INFECTION. 1. ally stands by the cradle as a faithful watch-dog to prevent the old rou- tine from being departed from in the least particular. In this point of view it is often proper to say, not that scrofula has been inherited, but that absurd views concerning the bringing up of children have been transmitted from one generation to another. As an evidence of the truth of tills statement, we mention the circumstance that the flrst-born in a family is apt to liave a feeble and sickly constitution, whereas children born at a subsequent period, are healthy; or that some children who were brought up on improper food, become scrofulous, whereas no sign of scro- fula is manifested in children with whom more rational maxims are pursued. Scrofulosis always breaks out in childhood. It seldom manifests itself before the second year. Children that are very large Mid bloated in the first two years, almost always become scrofulous at a iater period; children witli firm muscles and slender forms are scarcely ever attacked with the disease. Scrofulosis scarcely ever breaks out after the second dentition, still less frequently after the age of jiubescence. Symptoms and Ooitrsh. It is very difficult to furnish a complete picture of the scrofulous disease, for the reason that it manifests itself in so many different localities and diversified forms; hence a few general statements will have to sullice. Scrofula chiefly locates itself in the Lymphatic Glandular System. Either we find a more or less exten- sive hardened and thickened degeneration, or else a swelling tending to suppuration, the surrounding soft parts being more or less involved in this process. In the former case, tlie swollen glands may remain un- changed for many years, until they gradually disapjiear, most commonly at the age of pubescence, leaving only a few trifiing remnants of diseased structure. The infiammatory exudation is seldom deposited in an acute form; generally the glands swell slowly and without pain, tlie swelling sometimes even remains stationary, or else retrogrades, until gradually one portion of the gland becomes injected, fluctuates and breaks. The suppuration generally takes place very slowly, because the decomposition of the pus goes forward step by step. In otlier cases, especially in indi- viduals with sickly constitutions, a complete decomposition of the exuda- tion takes place before the swelling discharges ; in such a ease the discharge indeed takes place very rapidly, but other glands are attacked so much more speedily, one after the other, and the patient's strength is under- mined by hectic fever. The cervical and posterior cervical glands are generally attacked first and most extensively ; but the morbid process may likewise be transmitted to every otlier jiart of the body. It becomes most threatening, if the glands in contact with tlie bowels (mesenteric) or bronchial glands are invaded ; in such a case obstinate and severe catarrhal irritations may set in, which are often followed by hectic fever and death. If scrofula can be suspected, every chronic intestinal catarrh, or every chronic bronchitis, is not necessarily traceable to a scrofulous origin. The skin is very often the first organ that shows symptoms of the scrofulous taint. It is but too often the case that children who, up to the time when they were weaned, look fleshy and solid, after they are weaned are attacked by skin diseases ; the scabs are generally accompanied by at(- livi SCROFULA, 61!) obstinate ulcers, which constitute charucteristic symptoms of sciofulti. While the exanthem, which is most commonly confined to the liead, is still out, or soon after its disappearance, the gliinds become att'ected. The localization in the bones and joints is one of the most dangerous signs of scrofuloais. The inflammatory forms run avery protracted course, and it is only when the patient's constitution is in a v«?ry l)ad state, that those forms terminate in hectic fever and death, but, on the other hand, leave the afFected joints with an impaired mobility, stiflbned and de- formed. Scrofulous inflanunation of the vertebra is the most threatening, for it either leads to curvature of tlie rapine, or develops hectic fever by tha origination of congestive abscesses. Another symptom of scrofula is the sore eyes (ophthalmia) whicli we have already described in a previous chapter. It is either con lined to the mai'j!:in8 of the lids, or involves the wliole conjunctiva. Tiie ears of scro- fulouiL children have a peculiar inclination to discharge, with small sores (eczema) breaking out at the same time round the ears. The mucous membranes do not siiow any particular morbid symj)- toms, bureau extraordinary susceptibility tocatarrlis, especially the mucous^ membrane of the nose and throat. In the nose, tiie copious secre- tion is associated with soreness and ulceration, and a swelling of the whole nose, in which the upper lip generally participates in a nianiur that is exclusively peculiar to scrofula. In the mouth we notice frequent attacks of sore throat, with disposition to swelling of the tonsils. TliesB various localizations manifest themselves in most diversified combinations and successions, sometimes one at a time, and at otlier time- all together. Their course is always slow and dragging, suliject to many oscillations between remissions and exacerbations, but generally termin- ates in recovery, as long as the vital organ.-? remain unafTected by tiio disease, always, however, leaving some remnants of the disease behind. Even suppuration of the bones of the back (vertebrae) sometimes termin- ates in recovery with surprising rapidity. The general state of the organism is of importance, both to the course of the disease, as well as to the treatment. There are two kinds of scrof- ulous constitutions. The one active is distinguished by a lively circula- tion and a marked tendency to febrile afFeclions, Such children have a fine, transparent skin, flushed cheeks, witii great tendency to sudden changes of color in the face, an extreme nervous irritability, increased mental activity, melting, languishing eyes, delicate bones, and slightly- developed muscles. The torpid scrofulous constitution, on the contrary, is characterized by a diminished activity of the circulation and repro- duction, and great tendency to fat. The whole body of such a person looks bloated, especially tiie face, the features are coarse, the nose an<l upper lip are swollen, the bones, especially the skull, are large, and tiie limbs coarsely-shaped; otlier characteristics are: a distended abdomen flabby muscles, mental and bodily indolence, a dingy-looking, yellowisJ!- gray skin, disposition to canine voracity. From such general symptoms the speedy outbreak of local scrofulous aftections can be predicted jvitli tolerable certainty ; frequently, however, especially if a proper mode of living is pursued from an early period, the scrofulous habit disappears I \ 620 COMBTITUTtONAL UIWRASKH WITIKJUT INKEC■1»0^. V'^ I ill I \i^ 11 entirely, BomcftiiiioH ;it tlic iige of scivcn years, without having occasioned liny local diseases. Tiio treatment of- the various loeal scrofulous diseases has been discussed in oUier articles, and ail tliat remains for us to do here, is to consider tlic disease in its totality. Accordiuji to what we iiav(t said when treating of tlui I'auses of the disease, it is eviflent the casual indica- tion in scrofulosis occui)ies the (irst rani;. Hefore any uiedieal treatment can 1j(( thought oV, the mode of living has to he thoroughly changed. This change refers mostly to diet, hahitation, tixercnse in the o\)vu air, attention to the skin, etc. ; in cases of scinfulosis of active! [kusoiis, it has likewise to tak(! into special account the mental (hiveloiiment of the patient, which should newer he forced and pr(;mature, and should always go hand in hand with an abundanci^ of bodily ex(!rcis(!. In this respfjct it is difllcnlt to lay down spticific rules which might be adapted to one child, and decid- edly contrary to the coiislitution of another. The physician should care- fully investigate, and afterwards reuiedy the dt'fects of ediieation, but definite laws cannot be laid down to .such a result. The casual indication likewise includes measures having reference to a true and nsefid preventive treatment; hence, a i)artfnt or |)hysi(!iun shonhl make it his duty to watch over the education of his cliikiieu, in every possible direction and aspect of the (!ase. llow much trouble will a parent save himself by sucii a course, and how much care, anxietv, and sulfering to otiiers. For TRKATMKXT see: Ophthahnia, OtorrlKca, Nasal Catarrli, Diseases of the Liver, Diarrlwea, Tardiness in liCaruing to Walk, (Jough, Teething, Diseases of tlicf (i lands and Hones, Rickets, and the general article ou Preventive Treatiaent, which has Iteen prepared to meet the wants of aucU cases. (I I r c I' 1 o o o DIAGKAM OF THK FKMALK i'iSLVIS AND ITS 0KGAN8. P^ART TH IIl,TEEIV TU DISEASES PECULIAR TO WOMEN. CHAPTER XXX. DISEASES OF THE FEMALE SEXUAL ORGANS. iHi .\f*i MENSTB UA TION, By menstruation we understand a flow of blood from the female sex- ual organs recurring at regular intervals. It is a sign that the female organism has attained the faculty of conceiving, and depends upon the fol- lowing processes: The gradual maturing of an ovum (egg) in the ova- ries determines an increased afllux of blood to those organs. If this congestion has reached its acme, tlie other organs of the sexual system I)articii)ate in this hypenemia (congestion) to such an extent that the blood-vessels become rui)tured and a more or less considerable, discharge of blood tal^es place, accompanied by a sometimes more extensive and at other times more local detachment of the epithelial lining of the sexual organs. While the discharge of blood lasts, the matured ovum (egg? enters the fallopian tubes, which renders its fecundation possible. A discharge of blood need not necessarily accompany the passage of tho ovule into the tubes; otherwise how could a woman who is nursing her baby and does not see the least sign of a menstrual show, conceive again at such a time? That this has happened, is a fact established beyond tlie l)ossibility of a doubt. According to circumstances the mejises appear at times sooner, and at other times later. They are influenced by climate; the nearer to the equa- tor, the sooner the menstrual period appears; thoy are likewise influenced by the mode of living; in cities the menses appear sooner tlian anion",' country-girls; by tlie mental capacities; the more advanced the mental development, the earlier the menstrual functions make their appearance '■'he constitution exerts no particular influence; very robust girls some- t iti'.es menstruate very late, whereas feeble ones often menstruate prenia- I mely. According to the circumstance the menses may set in between the ages of ten and twenty years; in our climate they appear in cities between 1 lie ages of fourteen and sixteen, and in the country between the ages of sixteen and twenty years. The quantity of the menstrual blood is likewise variable and cannot he determined a priori; stout women sometimes lose a sma.l quantity of 621 ^i u ( ' ■if IMAGE EVALUATION TEST TARGET (MT-3) // ^/ V. 'V 1.0 I.I ■-li£ |50 = 1.8 1.25 1.4 1.6 ^ 6" - ► ^ <^ /a / ■e). .% % > v^ «>. /.^ '/ /fS^ PhotogiBphic Sciences Corporation W» °<1> ^•h"- 23 WEST MAIN STREET WEBSTER, N.Y. 14580 (716) 872-4503 K V 622 DISEASES OF THE FEMALE SEXUAL OROANS. blood, wheieas feeble and spare-built women lose a great deal. The quan- tity.is from two to eiglit ounces. Nor is the duration of the menstrual flow the same in all cases. It generally averages five days, but, without being considered abnormal, may last only two, or may be extended to eight or nine days. Sometimes the bleeding stops for a short time and then reappears again. The periodicity of the bleeding likewise raries. By far in the majority of cases it returns again every twenty-eighth day. In many cases there is an inter^'al of four weeks between the periods ; in a few cases we notice an interval of twenty-one uO thirty days. Four weeks may be considered the normal length of the interval between each two successive turns. The influence of the menses upon the general health is sometimes considerable, and at other times none at all. We notice hypersemia of the vagina and of the external pudendum, sometimes with increased secretion of mucus; tumefaction of the breasts with painful, knotty swelling of single milk ducts. During the menstrual flow tlie ner- vous system is much more sensitive and excitable, whence the follow- ing phenomena ; chilliness alternating with flashes of heat ; headache ; hemicrania, vertigo, languor, drowsiness without any ability to sleep; irritated, whining mood; loss of appetite, palpitation of the heart. In addition to these derangements, we often see a sickly-, gray complexion, efflorescences in the face, margins around the eyes; vomiting or nausea; altered voice. These phenomena usually occur only during the first twenty-four hours of the flow, after which they cease either suddenly or gradually. The total cessation of the menses take place indefinitely, some women mensturating regularly until the age of fifty-fl'^e, whereas others cease to menstruate when they are thirty years old. These diflTerences do not depend upon the time of the first appearance of menses, or upon the vigor of the individual, upon the number of times a v.'oman has conceived, nor even upon other morbid conditions. The final cessation la not bound by any rule, and may take place quite normally, betwen the ages of forty and fifty years. It may occur suddenly and completely, or in paroxysms; some periods, even to the number of ten or twelve, being skipped, after which the menses may occur again regularly for months, or a sort of hemorrhage may set in, whfch is again followed by a stoppage of the menses. As a rule the quan- tity of the menstrual flow is larger, as the period of a final cessation draws near, than in the preceding years. In the previous paragraphs we have only briefly alluded to the most important points. But they show satisfactorily the importance of the menstrual function to the female organism. Hence, it is that menstrual irregularities have, at all times, excited a lively interest among physi- cians, as well as lay-persons, to such an extent that they have been class- ified under special heads, although, in reality, they constitute a symp- tomatic manifestation of one and the same general or local disease. The question now is, when, in a general sense, menstruation may be said to be abnormal. The menses are abnormal in the first place, if they do not harmonize with one of the previously indicated periods; theyarelikewi.se ■il.mormalj if, for some cause or other, the usual duration of the menstrual ns! m MENSTRUATION. 623 flow in a given case is either shortened or lengthened. A woman who menstruates every twenty-first day, is not considered sicli;#)ut we consider a return of tlie menses every tweiity-first day ubnormal, if here- tofore they had occitrred every twenty-eightli day. Finally, whether the menstrual flow is to be considered abnormal, may deiiend upon the influence which it exerits upon the general organism. A supcnsion of the menses in the case of a young girl who, after being relieved from the prejudicial influences of school and city home, goes into the country, and there regains her blooming health, cannot be regarded ^ a morbid condition. Every attention should be given to the mind and feelings of the young woman ; her excited fancy should be controlled, and her nervous sensitiveness, and excitable temperament, which are so apt to cause disease, should be quieted. For this reason, a woman should be treated with kindness and attention, especially during pregnancy and the menstrual period. Every depressing emotion, chagrin, fright, anger, acts prejudicially upon persons in health, much more upon those who are diseased. We refer the reader to our article on hysteria, and to our subsequent article on chlorosis, where we shall show that a premature development of the mental faculties, and more particularly of the fancy, exerts a pernicious influence upon the constitution of the growing woman generally, and upon the normal functions of the sexual system in partic- ular. Woman's material mode of living deserves a closer attention. A wrong system has, in this respect, become a second nature to such an extent, that a physician is expected to allow his patients to indulge in their accustomed violations of a proper diet, on which account we invite him to pay particular attention to the following points in the treatment of female diseases. 1. "Women who lead a sedentary life, should be induced to take more exercise than usual, and to rouse themselves froii: their phlegmatic torpor. This is one of the first requisites of health; fiequent exercise in the open air, cleanliness, frequent bathing and washing, and frequent changes of linen. During tlie menses, every heating exercise, and every exposure to a cold should be avoided; likewise heavy farinaceous food, freshly baked bread; violent emotions, sexual intercourse, emetics, purga- tives, baths. This caution need not be carried so far as to compel healthy and robust women to lie down the first two days, and even to give up their accustomed walk. 2. A bad habit, that is indulged In by many ladies, is eating at any hour of the day- This practice is decidedly injurious to the success of any pood treatment, and should be abolished. Order is useful in all things, and likewise in our meals, and patients should be given to under- stand that they must partake every day of a warm dinner, at a fixed hour; breakfa,st and supper may consist of cold articles of food. 3. Too much sleep, and sleeping too often within twenty-four hours, can only be approved.of if the patients are very weak and anaemic; during sleep the body has to be kept perfectly unrestrained and easy, without the least inconvenience from the pressure of the ordinary clothing; otherwise, uleep will not exert the quickening influence that is expected St < : w 1 V, I' :,^ \: M 624 DISEASES oi' THE FEMALE SEXUAL ORGANS. from it. Females, especially, have the bad habit of lying down with a mass of clothing on. This practice not only prevents the body from getting warm, but interferes with the free circulation of the blood, and thus gives rise to other troubles, in addition to those already existing. Tight lacing is another censurable practice, which is often th( sole cause of menstrual irregularities. By going without corsets for a time, the woman will soon learn to keep her uack straight, without, any articial support. If corsets are worn too tightly, they compel the wearer to breathe with the upper portion of the thorax, the lower ribs not being allowed freely to expand, on account of the compression exerted upon them. This gives rise to ' incomplete respiration, an imperfect introduction of oxygen, and a diiiixuution of the elasticity of the plumonary vessels. Thus it is that corsets become a co-operating cause of many of the blood diseases of females. "When speaking of chlorosis and tuberculosis, we shall revert to this subject. 4. Regarding the function of the bowels, it is of importance that our female patients should never suppress an urging to stool, and that they should at least have one evacuation from the bowels every day. Women are much more afflicted with constipation than men; in most cases they are the authors of this exceedingly prejudicial state of the bowels, some- times on account of neglect, at other times from sheer laziness, again on account of sedentary habits, and finally, because they are ashamed of satisfying the call of nature. 5. Women should make it a rule to wash their parts, especially if affected with leucorrhcea, or other diseases, several times a day with cold water, and during the menstrual flow, with tepid water. More recently the Sitz-baths and the vaginal syringe are now in almost general use. These are not only excellent means of relief in many morbid conditions, but likewise, excellent means of prevention, and should be found in every lady's bed-chamber. Cold water is indeed the most reliable nervine at our disposal. DERANGEMENTS ATTENDANT UPON THE APPEARANCE OP THE MENSES. It must be self-evident, that the awakening of the sexual life, which is the greatest revolution which the female organism can undergo, is accom- panied by phenomena which very often partake of the nature of a luorbid process. The normal conditions under which the menses should first appear have been explained in a previous paragraph. A premature appearance of the menses always implies a feeble constitution and powerful sexual instinct. Hence, it is of the utmost importance not to accelerate this period because all the ailments which someti'nes befall young girls at this age, are supposed to originate in the tardy appearance of the catamenial discharge. Of course, where the delay is evi(?ently of a morbid character, nature should be assisted by such remedial means as will promote the men- strual flow. Such morbid phenomena are the more striking, the more sensitive and delicate the young woman who hud been reared in the bosom of luxury and ease. Although these ailments may not be very considerable, yet their removal often requires the interference of art. Sometimes a judicious diet is suflScient for this purpose, but in many cases medical agents have to be used. Such cases are characterized by tlie following symptoms : Conges tion of blood to the head, as indicated by heaviness of the head; rush o| n m MENSTRUATION. 62S blood to the chest, with palpitation of the heart, and sometimes attended with oppression of breathing; sensation of warmth and repletion in the abdomen ; feeling of indolence through tlie whole body ; occasional flashes of heat and red flushes in the luce; languid feeling in the legs and feet; pain in the small of the back and pelvic region ; drawing in the thighs, frequent urging to urinate. Tliese symptoms may be regarded as menstrual distresses, which are very speedily succeeded by an .ictual appearance of the menses and disappear with them. If these symptoms continue for a longer time without any menstrual show taking place, the patient will have to take a good deal of exercise in the open air, use more vegetable than animal diet, more liquids than usual, and spend her time as much as possible in cheerful company. If the above mentioned symptoms become more severe and continuous; if the rush of blood is more violent, causing anxiety, palpitation of the heart, constant heat, a restless sleep full of dreams and interrupted by sudden starts ; if the face looks bright-red, and the signs of cerebral hyper- emia and congestion of the organs of the chest becomes manifest ; we resort to remedies that have been indicated for such conditions in their respect- ive chapters. One of the leading remedies is undoubtedly Pulsatilla, especially if the congestive symptoms of the head and chest are accompa- nied by signs of abdominal and uterine congestion, as if a stone were oppressing the uterus, and the patient complains of chilliness, stretching of the extremities; yawning and other febrile symptoms may likewise be indicated by a certain train of symptoms. The above-mentioned dietetic rules should not be neglected vi^hile this medicine is used. Belladonna may be added to this group of remedies as one of its most prominent members, whereas Cliamomilla is very seldom indicated, Veratrum and Belladonna will often be required, the former, if the functional activity of the heart is very much impaired, as indicated by paleness of the countenance, great chilliness or constant alternation of chilliness and heat, anxious feelings; the latter if symptoms of cerebral congestion prevail, with bright redness of the face. If the young woman has reache d the age of pubescence and feels other- wise quite well, although the menses do not show the least sign of making their appearance, you would commit a great wrong to drench the organism with medicines; your duty will be to leave nature alone in determining the period for the appearance of the menses, more particularly if the organ- ism shows signs of being backward in its development. It is only if the organism is sufflcientl;; developed and the young woman's aje justifies the expectation that the menses ought to appear, that it is proper to hasten this process by the employment of suitable remedies. We give Pulsatilla, and if the indications are satisfactory, repeat the dose rather frequently, more particularly in cases where the non-appearance of the menses causes, without any other bodily ailments, an excessive nervous irritability, whin- ing, peevish, timorous dispositi>jn, paleness of the face and great flabbiness of the muscular tissue. Nux-vomica, ou the contrary, will be found appro- priate in persons of an opposite temperament, an irascible, choleric dispo- sition, a full habit without any decided congestions, redness of the cheeks and turgescence of the body. Dose: For any of the remedies, (homoeopathic) six pills, once in each day, dissolved in a teaspoonful of water. 40 !: i 1 t , ^' m '^F. ■■I DISEASES OF THE FEMALE SEXUAL ORaANS. BIN CHLOROSIS OB GREEN SICKNESS-EMANSIO MENSIUM. Chlorosis is a disease which occurs exclusively amoiif; females, chiefly between the ages of thirteen and twenty-four, seldom at a later period; if it does, it can be traced to secondary disturbances, such as oonfluements of young women, coming rapidly one after another, jnore epecially if the women nurse their own children. The disease sometimes breaks out previous to the first appearance of the menses, more frequently after several menstrual periods; as an entirely primary disease, it only breaks out among unmarried women. It is, in some degree, hereditary ; females of a pale complexion are more liable to be attacked with it ; though no constitution is exempt from the disease, although delicate individuals with irritable nerves are more susceptible to it. Amongother causes, we may mention: insufflcientex- ercise, mental exertions, without corresponding muscularactivity ; excite- ment of the fancy, especially when caused by novel-reading; excitement of the sexual instinct by onanism, improper converse with the other sex; deprivation of the open air, and interference with the free expansion of the chest by tight dresses. Chlorosis is very commonly met with among daughters of a tuberculous mother. Symptoms and Course.— This disease generally comes on very slowly, the patients become more irritable, they are apt to get tired after every little effort, they are liable to changes of color, the skin soon loses its bright lustre, and the patient complains of feeling chilly at an early period of the disease. Inasmuch as the disease may be characterized by a variety of symptoms, we will describe the derangemente as they appear in each special organ and system. The skin at times has the color of wax ; at other times it is rather yellowish, or of a dingy white, the veins being either not at all percept- ible, or but indistinctly so, the color of the cheeks may change quite often, within a very brief period of time. The visible mucous membranes are more or less without color. Swelling of the feet and limbs sometimes occur, but only in the highest grades of the disease. The following symptoms occur in the digestive range: impaired appetite, aversion to meat, longing for strange articles of diet, such as vinegar, chalk, cofTee, beans; bloating of the stomach after every meal, sourness of the stomach, and generally the bowels are ver;r torpid. In the nervous system v/e discover excessive irritability, neuralgia, hysteric symptoms, fitful mood. The breathing is accelerated, the least physical exertion causes dyspnoea (slit <'tness of breath,) sometimes to a very high degree. The circulation is accelerated, very seldom reta 1 ; disposition to palpitations of the heart, which are easily excited oy a physical eflfort. The menses are irregular, sometimes entirely suppressed, or very tardy, sometimes more profuse than usual, but always of a lighter color, or even quite colorless. Accompanying these symptoms, are pains of the most diversified kind, very generally uterine catari-h. The urine has a strikingly pale color. The patients generally sleep very soundly, and have to sleep a long time *hough sleep never refreshes them. One or the other of these derangements is generally wanting?. QREEN SICKNESS. r.27 The one characteristic symptom Is never absent : dyspnoea and palpi- tation of the heart from the least unusual efTorl, especially after going up stairs. The course of chlorosis is always more or less protracted, sometiincri very clironic. If no particular disturbances take place, the atfection can sometimes be cured in a few weeks; whereas, if the nxode of living which had acted as tlie exciting cause is persevered in, the trouble may continufe for years. The disease is most commonly more violent in summer than in the winter season. Uncomi^licatcd chlorosis always terminates in recovery. Among the complications, the simultaneous presence of consumption and scrofula are most threatening. We generally find tliat scrofuloiiH girls who are attacked with chlorosis recover their health to some extent for a year or two, after which they die of consumption, or phthisis may set in as a direct development of a protracted chlorosis. HOMCEOPATHIC TREATMENT. The leading remedies which have 'oeen found most useful in this affection are Pulsatilla, Sepia, Bryonia, Sulphur, Calcarea carb., Ferrum, Lycopodium, and Plumbum. Pulsatilla is peculiarly useful in chlorosis, when the derangement seems to have been excited by, or is connected with, indigestion ; and it is accompanied with headache, particularly in the side of the head, with shooting pains extending to the head and teeth, fsometimes shi/t/'ii:/ suddenly to tJie other side ; sallow complexion, difficulty of breathing, and sense of suffocation after the slightest movement; palpitation of the heart, coldness of the hands and feet, often changing to sudden heat; disposition to diarrhcea and leucorrhoia, pains in the loins, sensation of weight in tlie abdomen, almost contant chilliness and shivering, spasmsin the stomach, with nausea; inclination to vomit, and vomiting; hunger, with repug- nance to food; swelling of the feet and ankles, great fatigue, especially in the legs. This medicine is particularly adapted to females of mild disposition, disposed to be sad and tearful. Dose: Six pills every evening. Sepia is a remedy of very great value In this disease when there is a good deal of headache, sallow complexion, with dark colored spots ; frequent colic and pain, as if arising from bruises in the limbs, with a drawing, tearing pain in the thick muscles of the back part of the legs. It may follow Pulsatilla, with great advantage, or be given in alternation with that remedy. Dose : Six pills or a powder every morning. Bryonia, Frequent congestion of tlie head and chest, bleeding at the nose, dry cough, coldness and frequent shivering, sometimes alternating with dry and burning heat, constipation or colic, bitter taste in tlie mouth, tongue coated yellow, sense of pressure in the stomach, as if from a z*o\\e, Siilptiur is more particularly indicated when there is pressive and tensive pain in the back of the head, extending to tlie nape of the neck; humming in the head, pimples on the forehead and round the mouth ; pale and sickly complexion, with red spots on the cheeks; changeable appetite, with general emaciation; heaviness in the stomach, un.]* r the lower ribs and iu the abdomen; bowels irregular, great tendency lo 'i } i^ I 11 ' 626 DISEASES OF THE FEMALE SEXUAL ORGANS. take cold, iiiitability and inclination to be angry, redness and melancholy, with frequent weeping. Dose: Six pilla every other day. Calrni'ia Carb. is often of the most striking benefit in chlorosis. Sonittinic'S iv complete cure is effected by it alone, even in the worst cases, with (anlema) swelling of the extremities, and extreme dyspnoea. When there is complication with tubercular diatliesis, accompanied by cough, Sulphur ami Calcarea Curb., often i)r()ve highly beneficial in alternation, or if oppressive headache is complained of, Sepia may be given in alterna- tion. Sometimes menstruation docs not take place for some time after- wards, though the general health is very much improved under the em- ployment of the remedies prescribed. Dose: Six pills every morning. SCTPPBESSION OR DELAY OF THE MENSES. AMEN- ORBHCEA. This suppression either takes place during the flow, or in consequence of causes acting previous to the actual appearance. In the former case a cold may have operated; or cold washing may be the cause ; or the feet may have got chilled ; or the patient may not have been sufficiently pro- tected by her clothes; mental or moral emotions, vexations, chagrin, anger, fright, or dancing, sexual intercourse, dietetic transgressions may havft led to the suppression. Most of these causes, if operating shortly before the time when the menses were to come on, may cause their retention. A gradual suppression of the catamenia may take place in consequence of deficient nutrition, as well as of the abuse of warm beverages, and the con- tinued influence of depressing emotions. We have already shown that a change in the mode of living may superinduce a suspension of the menses, in the case of young women, without leading to derangements of the gen- eral health, The more sudden the suppression of the menses, the more violent the chsinges arising from such an occurrence. Some of the most prominent symptoms are: Violent headache, great anxiety and oppression of breathing, nose-bleed, spitting of blood, congestions of the head, heart, and lungs, and tlie like. In some cases, a suppression of this kind gives rise to acute uterine catarrh. If a physician is called in time, he will, of course, inquire what gave rise to the trouble, and will seek to remove the consequences of fright, mortification, anger, etc., by appropriately specific remedies. If the physician is not called until some time after the morbid symptoms have existed, the aforesaid remedies will no longer be appli- cable, and the constitutional condition generally will have to be acted upon by corresponding remedies, and you should follow the same course as a physician. ALLOPATHIC TREATMENT. Amenorrhoea. If the menstrual flow (menses) never has appeared, and the patient is strong and healthy, and there is no menstrual molimen (symptoms or sensations of menstruation) it is not prudent to resort to any interference. Every means should 1)g employed to strengthen and invigorate the system. The body, rather SUPPRESSION OF THR MENSES. 629 than the nienttu faculties, should be exercised. Life in the open air, and Ionics containing iron, siiould l)e given, if the patient is auicniic (having tliin blood.) Constipation should be corrected as directed in the treatment of that disease. The preparations containing Aloes are espec- ially appropriate. Scarcely ever is menstruation, (and menstrual sensations,) absent after nineteen or twenty years, unless there is a lack of development in soraeof the organs of generation. Tiiis is to be inferred, if invigorating measures after employment for some time, have proved ineffectual. Theadviceof a skillful physician should be always procured. Develop- ment of the womb to a^proper size has, in some cases, been induced by treatment. Retention of the menses is probable when regular symptoms of menstruation occur without the flow, and the abdomen of the jnitient gradually enlarges. The cause of retention may be absence of the vagina, an imperforate hymen or closure of the mouth of the womb. These may be overcome by the skill of tlie surgeon. If the general health is good, and the generative organs, vagina, uterus, and ovaries, are well, or reasonably developed, Iron may be effica- cious in establishing the menstrual flow. Persons who have amenorrhcea (suppression of menstruation,) are generally suffering from an indisposition of some kind, with which the amenorrhcea is associated, or dependent upon, ^.n some cases, the patient has fallen into ill health before the menses have ever appeared, and as a consequence, there is no attempt at menstruation. It is, therefore, perfect nonsense to attempt to bring on the monthly flow, or cure the amenorrhcea, while the general health remains impaired. In a patient sufTering from consumption, treatment ought not to be directed to menstruation at all, until the patient can be brought up to a good degree of general health, and then nature will establish the menses, if the system is able to sustain the discharge. It is a popular error that stoppage of the monthly courses is the cause of the ill-health whicli accompanies it, whereas, exactly the opposite is the truth ; the general indisposition has caused the suppression of the menses. In the treat- ment of these cases, the return of the monthly sickness is the final result to be attained. Improvement in other respects must be first attained, and, almost always, the rest will follow as a necessity under nature's order alone. If the patient is not surrounded by good hygiene, this is the first point to attain. She should have pure air, and exercise out of doors sliould be taken. This exercise, if taken for exercise, is apt to be neglected, and not be of a character which will make her of cheerful spirits ; recreations, tiuch as buggy riding, and walking with cheerful companions, or rambles in the fields or woods, will accomplish this, if not carried to a point which is fatiguing. When the patient becomes exhausted at her exercise, she is going a little too far. A sedentary occupation may sometimes need to be changed for a move active one. With persons who are unaccus- tomed to physical exercise, this habit must be cautiously and gradiAally begun. !l pll bSO DISEASES OP THE PEMALltl SEXUAL OR(»AN8. ,t;; |lli- Witli ,s\if»p unil factory girls, poor hygiene is most likely to be the cause ol'HUch u jjoor state of healtli as will prodiui'.uiienorrha'a. In these cases, while the use of medicines follosv the same rules us in other debili- tated patients, it is quite secondary to the Iniprovciuent of their bygenic circumstances. In schools, too little time is given to unrestraiiied life (exercise) in the open air, and too nmch time to (luiet mental work, and the anxiety of parents as to the intellectual development of their children, leading them to send them to school at too early an age, and crowding them too rapidly, is a prolific source of ill-health, and consequent amenorrhasa. If parents would not send their children to school until they were eight year sold, and then, if a large portion of the day was Appropriated by every student, to take such recreations as her inclinations lead her to, the breaking down and ill health in schools for girls, would be as rare as it is now common, provided eight full hours of the twenty-four were regularly spent in sleep. The importance of exercise is admitted, in tiieory, in these schools, but the amount is not regulated to the wants of each particular case. The long walk may be beneficial to the strong and well-nourished, if they are accustomed to such exercise. The girls not so strong and well-fed, may, in these very walks, lay the foundation for a serious disease. To make exercise most useful it must be pleasurable, and for that end restraint must be thrown off. Again exercise ought not to be violent. The gymnasium is productive of good if not carried to an extreme. It may do much harm. Such exercises as jumping are not to be indulged; occasional and moderate horseback riding is good, but carried to an extreme, it may do harm. Early hours, good nourishing food, of which animal food forms a large part, plenty of fresh air, and warm clothing are necessary to ensure good health, both before and after menstruation. The constipation and derangement of the digestive organs is generally an effect of the state of ill-health, which is to be corrected in the first place, before the patient can take such an amount of nourishment as will bring her body to a vigorous state, and maintain it there. Two or three Compound Rhubarb pills at night, followed by a Seidlitz Powder, or a dessertspoonful of Rochelle Salts, in Lemonade, in the morning, may be given once or twice a week, for a time; or, after the bowels have moved freely, from the use of three or four Compound Cathartic Pills, remedies may be used as are directed for constipation. The pills containing Aloes and Extract of Nux Vomica, are to be preferred. The circulation should be maintained by free, pleasurable exercise in the open air, sponging the skin with tepid or cool water, and rubbing briskly with a coarse or rough towel, until the skin is aglow, and warm clothing. It is very important to keep the feet, legs, and arms so well clothed that they will keep warm. The two remedies which are especially serviceable in building up the health to a point at which menstruation will occur in obedience to nature alone, are Iron and Quinine. One of the best forms for its efficacious administration is the Citrate of Iron and Quinine in doses of from two to five grains three times a day. It may be dissolved in Syrup of Ginger or SUPPRESSION OF THE MENSES. 031 Orange Flower water . Take of Citrate of Iron and Quinine from one and a half to three drains, Syrup of Qinger six ounces. Mix. Dose: A toaspoont'ul, or a teaspoonful and u half, three times a day. If the bitter taste is seriously objected to, one or two grain pills of the Sulphate of Quinine may be given two or three times a day, and the same quantity of the Soluble Citrate of Iron may be given in Holution with Cinnamon or Orange Flower water in the same proportions as directed for the Citrate of Iron and Quinine. Before buying the sugar or gelatine coated pills of Quinine one of these should be cut open with a knife, if they are good they will be soft under the coating. The Pyrophosphate of Iron answers the purpose very well. It can be given as follows: Take of Pyrophosphate of Iron two and a half drams, toutei' sufficient to dissolve, Symp of Orange sujjicdent to make six ounces. Mix. Dose: A teaspoonful three times a day. The Tincture Muriate of Iron has long deservedly enjoyed a reputa- tion in the cureof amenorrhoea, and is one of the most efteeluul. The dose is fifteen or twenty drops three times a day, largely diluted in sweetened water. After the use of Iron and Quinine for a time, if health is not restored it is well to change to the use of Iron with Strychnine. I'ake of the Ci- trate of Iron and strychnine seven scruples, water sufficient to dissolve, Syrup of Ginger or Orange a sufficient quantity to make six ounces. Mix. Dose: A teaspoonful three times a day. Each teaspoonful contains a fraction leas than a thirtieth of a grain of Strychnine. If the patient does not sufTe.- from impoverishment of the blood, or if they have recovered from tlie ananmia, from three to five dropsof Fowler's Solution, three times a day, may be given with benefit. Itseemsto restore the activity of the ovaries. The Chloride of Gold and Soda in pill, one twentieth of a grain em h, three times a day, is also thought to be benefi- cial, in the ame way. Dyspepsia must be treated as is directed in that disease. It may some- times be advisable to keep the patient for a time on a milk diet. Only such food should be given as is found by experiment to be readily diges- ted. Milk, beef tea, eggs beat up with sugar and water or milk, are some of the easiest digested and most nutritious articles of food. The object in treatment is first, to put the body in good health as the amenorrhoea is only a symptom of the state of ill health. If menstruation has been suddenly suppressed, it if. best to give a hot sitz (hip) bath, a copious drink of Ginger tea, place her in bed and give her a full dose of Dover's Powder's (ten or fifteen grains,) especially if she has had a child. A mustard plaster may be put over the lower part of her abdomen, and bottles of hot water about her hips and loins. The use of electricity has, in some instances, caused a return of the flow. A hot water injection into the rectum may be made. When the time for menstruation has passed, we must wait until just before the next period, when for three or four days a warm hip bath should be given night and morning. If there is no pregnancy some o^ tkose i!«'li'i .'ti , ' f "'^iitl li i %i Is li|: 682 DISEASES OK THE FEMALE SEXUAL OROAN9. i; r I Nil ii'ii remediea called cmenagogue (calculated to pronjote the (low of iiicubfrt,; may he given, if the physician deaires, hut ummo nmcli liiirni niuy he done with these, It is deemed proper not to give directions for their use in a popular book. When the mental emotions have heen the cause of the sudden sup- pression, Opium to the extent of producing quiet in doses of lialf a grain to a grain, is the best remedy. Laudanum in doses of ten to twenty drops, or Paregoric in doses of two teaspoonfuls may l)o given. Chronic suppression sl.ould be treated on tlie principles before given, viz : Correction of tlie general health, and from month to month encour- age the menstrual (low by the gentle measures Just enumerated HOMEOPATHIC TUEATMENT. Pulsaiilla should be employed when a suppression takes place from tlie sudden effects of a chill, when the8ym{)tonis genenilly correspond with those described under the head of that remedy, in the urliclo on Clilorosis. Dose: Six pills in a teaspoonful of water, night and morning, for a week (unless a change siiould sooner occur;) then pause eight days, after which the course may, if necessary, be repeated as before, and so on. CoccaluH in cases in which there arc habitually attacks of colic-like pains in the bowels at the periods at which the menstrual discharge should occur fit were regular, more especially if the patient complains of great weakness of the lower extremities languor and lassitude, precar- ious appetite, and generally also nausea, with much oppression at the chest and in the region of the stomach, etc.; especially when this functiomil derangement occurs in full-habited and apparently healthy persons, pui- ticularly if the suppression be traced to mental emotions. Dose: Afi for Puhatilla. Nux-inosch<ffa when the suppression is accompanied by spasms and other hysteric affections; disposition to sleep and faint away ; g.eat nervousness ; complete exhaustion after slight exertion; pains in the loins, etc. Dose: As directed for Pulsatilla. Caulophyllutn should be given when there are spasmodic, bearing- down pains; and sympathetic, cram py, spasmodic pains in the bladder, rectum, or bowels. Dose : As directed for Pulsatilla. VeratrtiiH should be administered in cases in which the convulsive and other symptoms incidental to the suppression, when caused by fright, have failed to yield to the last-named medicine ; and when there are pale, livid face; frequent nausea and vomiting; cold hands, feet, and nose ; great weakness, with fainting turns. Dose: As directed for Pulsatilla. Lycopoditun has proved of service in cases in which the patient complains of headache and giddiness; flatulent distention of the bowels before each period at which the secretion ought to have returned ; and habitual costiveness. Dose: As directed for Pulsatilla. Belladonna should be employed in cases which are associated with fullness of blood, determination of blood to the head, violent throbbing of the arteries of the head and neck, and uose-bleeci. MENORRHAGIA. 688 Dose : As directed for Puhatilla. Sulphur is one of tlio moat iiuportant remedies fo"* tlie treatment of cases wbicli tissunie u clironio and obstinate cliaracter, more particularly it' Hucli cases occur in persons of a feeble or exlmusted constitution, or who bear about tlieni, i'l a marked degree, tlie traces of a scrofulous habit of body, or who are alFected with the piles; or, again, when the prevailing Bymptoms tre such as have been described in detail under the head of this medicine, in thv article on "Chlorosis or Greeu-Sieliness." Dose: Six pills in a teaspoonful of water, tlie first thing in the morn- ing, for six days, (unloss change should sooner occur;) then pause ten days, after which the course may, if necessary, berepeate(^ as before, and so on. Sepia is also of great value, whether at the onset, or after the previous administration of Sulphur, for the treatment of chronic and difflcuh- cases, and for such as arc complicated witli scrofulous taint of constitu- tion, or which occur in otherwise feeble and exhausted subjects. Hepiais more especially appropriate when the prevailing symptoms are such aa have been described in detail under the head of this medicine, in the article on "Green-Sickness." Dose: Four pills, in other respects as directed for Sulphur. 'V'JI MENORBHAQIA-PROFUSE MENSTR UATION. The quantity of the menstrual discharge varies a great deal in differ- ent individuals. Tlie climate, constitution, and manner of living, have considerable influence. The duration of the discliarge, and the periods of return, are also varied. In some women, it continues from four to ten days, while in otlaers it lasts only a few hours; from three to six days is, however, the most usual period. The regularity is, in many cases exact, to a day, or even an hour; while in others, a variation of several days is a usual occurrence, witho it the slightest disturbance in tlie usual health resulting therefron: An excess of loss of me itrual blood, a true menorrhagia, does not occur as often as it may seen to those wlio .;omplain of it. To constitute menorrhagia, several circumstances have to occur that require to be carefully discriminated. The average of discharged blood has to exceed the ordinary loss quite considerably ; and then, again, we have to inquire whether the scantiness of the ordinary menstrual flow is not an abnor mal diminution in the present case. The menstrual flow is likewise considered too copious if it continues beyond the ordinary period, although thisneed not ne^-essarily imply that the menses are profuse. It is therefore, the morbid character of the menses that is necessary to deter- mine the disorder, for a copious flow of the menses cannot be considered abnormal as long as the constitutional harmony is in no resjiect disturbed by it. The causes of menorrhagia are quite numerous, of which it may be best to make mention of a few : Excess is occasioned by onanism, novel- reading, a constant dwelling of the fancy upon sexual things, and the habitual use of heating beverages. A few other important points have to be added: Under certain circumstances, a profuse flow of the oieusU-ual II •: 'I ■m .'ilM; i.ti ii 684 DISEASES OF THE FEMALE SEXUAL ORGANS. ■1 iiil blood becomes a reaf physiological necessity to the body ; for instance, if a larger supply of nourishment than the body requires for its normal support, causes a real plethora. Tliis can hardly be regarded as a morbid condition. A profuse flow is sometimes occasioned by changes in the uterus, such as acute or chronic inflammation of the womb, or some foreign growth in the uterine cavity. Nursing exerts a very particular influence. As a rule, nursing women do not menstruate; yet it may happen, even in the case of quite healthy mothers, that the menses reappear again permanently, in wliich case the flow is often very profuse. This is rot a normal condition, although it does not inconvenience all women. Menorrhagias that set in when the process of nursing is continued too long, are of an exceedingly threatening character. This accident occurs quite often where the women nurse their children for several years for the purpose of preventing conception, not thinking tliat by so doing they inflict permanent injury upon their health. We must not forget to record the fact that diseases of other organs, or of the general constitution, exert an influence upon the menses. Diseases such as typhus or scurvy, etc., tlie influence of heart disease or consumption, and all such diseases which alter the quality of the blood, must be considered. It is more especially heart disease that causes menorrhagia, so that the heart had better be carefully examined in every case of menorrhagia. Finally, the cessation of the menses, at the critical age, is almost always ushered in by profuse loss of blood. H0M(E0PATH1C TREATMENT. Ipecacuanha is one of the more generally useful medicines in severe cases of this derangement, as well as in flooding after labor, and may, in most instances, be administered first, unless there are strong indications for a preference being given to any of the others. Dose: Six globules in a teaspoonful of water, repeated at intervals of six hours, until amelioration or change. Sabina is indicated when the discliargo isexcessive, of a bright color, and occurs in full-habited females who are prone to miscarry; or when the subjoined symptoms prevail ; rheumatic pains in the head and limbs, great weakness; pains in the loins similar to those of labor. Dose: Six globules, as directed for Ipecacxmnha. China is of considerable utility wlicre there is great debility in con' sequence of a more copious menstrual discharge than is natural. Dose: Six globules in a tablespoonful of water, repeated at intervals of six hours, if necessary. Nux-vomica is especially appropriate for the following symptoms:— The discharge being of too frequent occurrence, too profuse, and of too long duration; and when it commonly stops for a day or so and then returns, attended with spasms in the belly; sometimes nausea and faint- ing, especially in the morning; pains in the limbs ; restlessness; irascibil- ity. Nux-vcmica is especially serviceable wliei he above symptoms occur in femal23 who are addicted to the daily or frequent use of coflTee, liquors and other stimulants, or have been extensively drugged by old-school practitioners. Dose: Six globules in a teaspoonful of water, repeated at intervals of four hours. \ PROFUSK MENSTRUATION 680 Chamomilla is frequently useful wher there Is ' a discharge of dark, (lotted blood, with severe colic, or pains like those of labor; great thirst; IKdeuess of the face, and coldness of the limbs. Dose: Six globules in a teaspoonful of water, repeated at intervals of six hours, until improvement or change, Ignatia is of considerable service in cases resembling the above, when i lie derangement happens in hysterical or sensitive females of mild and iincomplaining disposition ; or who have had a great deal of trouble. Dose : As for Chamomilla. Veratrunt is more particularly required for too early or too copious menstrul discharge, always attended with diarrljoea. Dose : Three globules, as directed for Chamomilla. Oelseminum is indicated in cases in which there is scarcely an inter- val between the periods; which are not, however, attended with much suffering; or, the flow having ceased, is brought on again by fright or other mental emotion. Dose : Three globules, as for Chamomilla, KreoHote will be found useful when the menstrual blood has a deci- dedly offensive odor, is too profuse, and lasts too long; the abdomen l.iecomes distended before the periods ; leucorrlicea, which excoriates the parts, between the periods. Dose: Three globules, as directed for C7ta?nomi7to. Diet and Regimen. Patients who are habitually affected with exces- sive menstrual discharge should live with great regularity, keeping early hours, taking regular, but moderate daily exercise i/i the open air (during the intervals) in favorable weather, and partaking of nothing but the most digestible, simplfe, and unstimulatiug diet, which, ai; the same time, should be of a nourishing and strengthening description. Emotions of all kindt; should be avoided as much as possible; and during the continuance of the discharge the serai-recumbent posture should be retained, and the body kept cool. Neitlier food nor drink should be taken Jiot ; the food should be as cool as it can be relished, or chiefly cold, and tlie beveiage quite cold. In addition to these directions, more explicit particulars may be derived from the article on "Eradicative Treatment,'' at p. 98. ALLOPATHIC TREATMENT. The successful treatment of meuorr- liagia will depend on the exact recognition of tlie profuse menstruation, and the use of appropriate means for eflTecting their removal. For tliis reason', if for no other, the skill of a physician is rec^uired to secure such a knowledge of the causes of the trouble, as will lead to intelligent and proper treatment. The general condition of the patient is to be looked after. If the blood is itnpoverished, the patient must be invigorated, and the general health improved by good hygiene, good food, pure air, and exercise, carried to the point of making the patient feel vigorous, never fatigued, etc. The directions given for tlie management of the condition known as "ansemia," are appropriate here. If the patient resides in a malarious, locality, anti-malarial treatment will be required, as two or three grains of Quinine three or four times a day, or a larger dose once or twice a day for a few days or a week, followed by such directions as are given in the tr.'atment of ague. The use of iron, as directed in tlie treatment of ttuaiiuiu and ague, is generally necessary. If the bowels are torpid and ■ll! .>>> M l'(< m; ::iA m IT' K M 6d8 DISEASES OP THE FEMALE SEXUAL ORGANS. inactive, they should be moved by a brisk cathartic, and during the day of the menstrual flow, a mixture of Epsom Salts and Aromatic Sulphuric Acid should be given, as: Take of Epsom Salts an ounce, Arotnatic Sulphuric Acid half an ounce, ^yrup three and a half ounces. Mix. Dose: A teaspoonful to a dessertspoonful, in water, four times a day. In cases due chiefly to debility, a half a dram of Sulphate of Iron may be added to the above formula. The dose will be the same, given three times a day. Two or three times a week a laxative pill may be taken, such as are directed for constipation, if the bowels are not sum- eiently active. The chronic congestion of the uterus requires attention when this exists, which is always the case in those instances not dependant on organic disease. The warm vaginal douche, as directed for leucorrhcea, is useful. Tonics are also required which contain Quinine, Iron, and Strychnine, as: Take of Citrate of Iron and Quinine, and of the Citrate of Iron and Strychnine, each'a dram and a half; Water of Orange Flotvei's four ounces. Mix. Dose : A teaspoonful three times a day. This niedicine may be sweetened with the addition of sugar or substi- tuting Syrup of Orange. The coexisting leucorrhcea must be treated as directed for that disease. Many a case of menorrhagia depends upon a flexion of the womb. It is astonishing sometimes, how quickly the excessive flow -will cease when this displacement is corrected. A chronic inflammation of the womb, resulting from sub-involution of the womb, (its failure to regain its natural size after confinement or miscarriage,) may cause this trouble. The most suitable constitutional treatment appears to be the daily use of the hot douche, and hot hip bath, and rest much of the time in the reclining posture. The tonic recom- mended for chronic congestion is suitable, with three or four doses a day of half a teaspoonful of Fluid Extract of Ergot. If, after this treatment has been continued through a whole interval, between times of menstru- ation, without benefit, it will be well to try Iodide of Potassium, instead of Strychnine, as in this formula : Take of Elixir of Cinchona and Pyrophospluite of Iron eiyht ounces, and add Iodide of Potassium flve drams. Mix. Dose: A teaspoonful to a desertspoonful three times a day. During the time of menstruation the use of Ergot as hereafter men- tioned, will be very serviceable. The daily use of the sponge bath is a most serviceable tonic, and should be always resorted to. After the bath, the body sliould be rubbed with a coarse towel until the skin is aglow. In THE Menoruhagia of the Climacteric Period (change of life) in addition to such treatment, sketched above, as the case may require; cold hip baths should be resorted to; its good effects are marked. The internal remedies may be given the same as for other causes. Applications of styptic medicines to the interior of the body of the womb, are called for incase of excessive hemorrhage. Thpsp will be made by a physician by 1 PROFUSE MENSTRUATION. 687 means of an intra uterine syringe, a probe wrapped with cotton, or other instrument for the purpose, after dilating tlie neclc with sponge tents. The best applications are the Licpiid Sub-Sulphate of Iron, a mixture of five drams of T 'piiate of Zinc in three drams of Glycerine. It is necesfc,../y to have the manner of living strictly regulated during the time of the menstrual flow. For two or three days before the expected period, and during the time, the patient ought to remain quiet in the recumbent position. The room should be cool and clothing light. The bowels kept open; the diet should be simple and plain, and the appe- tite for food or drink only moderately indulged, and the patient must refrain from the relations of the bed. These rules closely followed, will greatly diminish the flow. The internal remedies to be given during the excessive flow, are those which produce a contraction of the womb, and so closing the vessels and stopping the hemorrhage; and those having the power of arresting hemorrhage called Styptics. It is unnecessary, in my opinion, to mention any other remedy than Ergot for the purpose of • controlling an excessive menstrual flow; a teaspoonful of the fresh powder in ginger tea, or a tea- spoonful of the Fluid Extract in water, may be given four times in the twenty-four hours. Of styptics, ten grain doses of Gallic Acid with ten drops of Aromatic Sulphuric Acid in a wine glass of water, well sweet- ened, is useful, given three or four hours apart. Rue and Savin in doses of a grain, are highly recommended. They act, however, in a similar way to Ergot. Other styptics as directed for hemorrhage from the lungs or kidneys. In some cases, the flow may be so severe as to require arresting imme- diately, so that while the foregoing treatment is required, it is necessary to stop the flow by mechanical means, that is, the vagina must be plugged uj» tightly, so that no more blood can flow. A bivalve speculum is intro- duv^ed into the vagina, and a piece of lint slightly moistened with Glycer- ine, and then saturated with Liquid Sub-Sulphate of Iron is placed over the mouth of the womb, and two or three yards of bandage (previously wet with cold water and wrung out) packed into the vagina. It is all then held in place by a T bandage. Cloths wet with cold water, are laid over the pelvis occasionally. Cold water may be injected into the rectum. It is often necessary to support the woman under the exhaustion of the loss of blood, by giving stimulants of brandy, and nourishment of strong beef tea or milk, quite frequently, but in small quantities. Organic diseases causing menorrhagia demand their appropriate treatment, but as nothing can be done without the aid of a surgeon the description is not given here. ■ LEUCOBBHCEA— WHITES. CATABBH OF THE SEXUAL MUCOUS LINING. Simple catarrh is one of the most common derangements of the female sex. It originates in a variety of causes. In the first place, we have to mention as exciting causes, such as act directly upon the sexual organs— excesssive coition, and self-abuse, miscarriage, and to som(> extent confine- ments, which, if occurring in too rapid succession, almost always causes s i'^ 638 DISEASES OF THE FEMALE SEXUAL ORGANS. ii^ M leuconl) era, especially when after the last named causes, the patients per- sist in getting about too soon. Sudden and violent attacks of raginitis and leucorrhoea have been observed to arise from causes such as those which follow sudden suppres- sions of perspiration; of diarrhoeas, or of sudden suppression of milk, or in other instances, suppression of some eruption on the skin. The influence of cold, damp weather, or exposure to cold and damp from the location of the residence in a marshy district, or perhaps the nature of the house itself, (stone, with walls constantly moist on their inner surface) and from water standing in tlie cellar, especially when long con- tinued, is a powerful promoter of leucorrhoea. An entirely opposite, but not less numerous class of causes of this dis- ease, may be found in the high living, stimulating spices, condiments, and drinks in which many women indulge. Symptoms. At the first appearance of leucorrhoea, there are usually the indications of acute inflammation, pain, heat, and redness of the parts involved which may subside as the ischarge becomes more and more fully developed. With this discharge, a\ iiother acute or chronic, there will usually be more or less pain in the groins id hypogastrum (lower part of the abdomen) and in the lower part and .siuall of the back. The urethra will often become implicated; causing painful micturatiou (passing water) and sometimes causing almost inability to urinate, in the acute form. ALLOPATHIC TREATMENT. The treatment of Lecuhorrhcea or Whites must necessarily be directed first to the cause, as failure of the general health, as from consumption, or ansemia, (impoverishment of the blood.) The treatment will relate primarily to the treatment of consumption, for which directions will be given in the article on consumption ; or if the patient is anaemic, (pale, weak, and tired, espec- ially tired upon rising after full a night's rest,) the treatment will first be directed to the removal of the anaemic condition, by the use of tonic remedies, especially Iron. When the discharge is very profuse, and exhausting, the Phosphate or Hypophosphite of Lime, may be given with great advantage. During the general improvement of the body, tlie discharge diminishes. In Parrish's chemical food (Compound Syrup of the Phosphates,) we have both the Iron and Lime. The dose is a teaspoonful. It may be mixed with an e(iual part of Syrup of the Lacto- Phosphate of Lime, and a dessertspoonful given three times a day. The Compound Syrup of the Hypophosphites (Lime, Soda, Potash, and Iron,) meets the indications, and is agreeable to take. The dose is from a teaspoonful to a dessertspoonful, three times a day. If there is coilcky pains, or symptoms of dysentery, the Hypophosphites should be combined with Dilute Phosphoric Acid. Take of the Compound Syrup of HypopIwspMtes seven ounces, Dilute Phosphoric Acid one ounce. Mix Dose : One or two teaspoon fuls three times a day. It is a good rule to add the Dilute Phosphoric Acid to the Hypophos phites whenever they are given. In marshy districts, or when ague is prevalent. Quinine should be given for a week, alternated with Cinchonidias for a week, in dosesof two or three grains, three times a day ; or such other treatment as is suitable for Ague poisoning, given in the treatment of intermittent fever. Some- / LEUCOBRHOSA. 639 times a change of residence is necessary to retain better hygiene. Exalted activity of the sexual organs will demand an omission of the relations of tlie bed. Tliere are few cases of Leiicorrluea in wiiich the uterus is sound. The organ is relaxed, and probably enlarged, and the secretion of the mucus membrane increased, allowing a chronic inflammation, or congestion. Flexions (the womb bending on itself,) or other displace men ts of the organ, must be corrected by mechanical means. The skill of a physician is required, but if unavailable, it may be said here that the common ring pessory relieves more cases of displacement than any other instrument that can be used by the unskilled hand. The n«ck of the womb should rest within the ring after its introduction. The concave pessory ought not to be used as a rule; it makes a flexion worse, as do the stem pessories with a cup. Adjusted by a skilled person, some form of Dr. Hodge's bow pessory is suited to most displacements. Correction of the malposition of the womb relieves the congestion, and so does mudi towards curing the discharge. This caution must be added: an unsuit- able, or illy fitted supporter, is a positive injury. The enlargement and chronic iuflammation is generally caused by rising too soon from child- bed, or after an abortion. A long period of rest in bed is required after these events; four weeks will do, but sometimes a longer time is required. The binder, wide enough to reach from the ribs to the middle of the thighs, should be kept tightly pinned after delivery. After the lochia (flow,) ceases, the warm vaginal douche should be commenced. Consti- pation must be obviated, as directed for that trouble. The preparations containing Aloes are to be preferred. Diet should l)C nouri-shing, and th(,' exercise at first moderate. Too frequent pregnancies in women, liable to abortion, is another cause of chronic enlargement, and of a condition causing Whites. The womb must have rest after an abortion, as well a-! after confinement; this is necessary for months, sometimes. Too frequent menstruation is another cause to be obviated, if possible. In this chron?!' enlarged condition, a teaspoonful of the Fluid Extract of Ergot, with ten or fifteen drops of Tincture of Nux-vomica may be taken two or three times a day. Ten grains of the lodideof Potassium in sweetened Pepper- mint water, three times a day. is a beneficial remedy for this enlargement and for the chronic discharge. Iron may be indicated in the form mentioned above. Cliange of climate, and the use of mineral waters may sometimes be called for, but generally the indication is met by the Ilypophosphites recommended above. The kind and quantity of food should be regulated to meet the wants of the system. Sleep should be long and undisturbed. The skin must be ' -^t warm with flannels, bathing, rubbing, and out-door exercise. The bath should, as a rule, be warm and tepid, taken daily, ami followed immediately by cool bathing. The combined sitz and sponge bath is most generally api)lic;ible; aft^ ■ the bath the skin should be rubbed until it is aglow. If there is a poor reaction, or no reaction, tlie cool bath should not be used. Some are most benefited by the warm baths exclusively. While many cases of leucorrhoea can be cured without them, injectiouH are very valuable in treating this trouble, and sometimes they are a necessity. A long, flexible syringe, having a long vaginal tube, should be 11 640 DISEASES OF THE FEMALE SEXUAL OBaANS. selected, and used after. the form called the "douche.'' Thesyringeshould be filled and one end of the tube introduced into the vagina, and the other in the bucltet containing the fluid, which is raised considerably higher than the patient. The tube acta as a siphon. The Liglit of the bucket and the length of this column of fluid governs the force of the current. Tlie flex- ible tube should tlierefore be long. In this way, any quantity of fluid can be used at an injection without wearying the patient. She should lie upon her back, with her hips raised with a pillow, and a rubber cloth so arranged that the fluid may be conducted into a bucket. In the use of water injections, I have found warm water (as hot as can be borne) tlie best. The quantity allowed to flow through the vagina should b6 large ; one or two gallons frequently repeated. Sometimes the cold douche alter- nated with the hot douche, and less often the cold douche alone, gives better results. Tlie diseased surface is not generally the vagina, but the interior of the womb, which medicated injections do not reach. They are often, however, useful. The simple water injection should be used first, followed by a quart of the medicated injection. A strong tea, of White Oak Bark, with or without the addition of one or two teaspoonfuls of Alurn in the quart m.ay be used. One or two drams of Tannin and four drams of Alum to a quart of water, is often serviceable. One or two even teaspoonfuls (drams) of Sulphate of Zinc in a quart of water, may be used. It is often better to change the injection from time to time. If the flow is offensive, the Permanganate of Potash, two drams to the quart, or one dram of Carbolic Acid to the quart of water, may be used for an injection. If the discharge is irritating, bathing the external genitals with a solution of Soda or Borax will be useful. Many times the physician has to resort to topical applications to the neck of the womb and its cavity, for which the following preparations of Iodine and Tannin are highly useful : Take of loditie half a dram, lodkieof Potas- sium and Water, of each a sufjUiient quantity to dissolve the Iodine, Glycerine sufficient to make an ounce, tfwn add ttoo drams of Tannin, or such quantity as is desired. The Tincture of Iodine saturated with Tannin, is a very efficient application in chronic inflammation of tlie neck and interior of the womb, and in enlargement of the organ, so prolific of leucorrhoeal dis- charge. Also an excellent plan of local treatment, whicli must also be made by the physician, is, Idoform one dram. Tannin one ounce. Mix well. A sufficient quantity of this powder is to be packed dry around tlie neck. One of the most effectual applications in these same affections witli ulceration, and consequently, for the leucorrhcea, is the undiluted Car- bolic Acid, which may be applied to the neck and cavity of the womb with a probe wrapped with cotton, but by a physician only. Before mak- ing this internal application, the uterine (womb)* cavity should be dilated with a sponge tent. HOM(EOPATHIC TREATMENT. The radical cure of this disorder is attended with much difficulty, and can only be affected by long patient, and careful treatment in those cases in which it is incidental to serious derangements of the womb, or of its appendages. Pulsatilla is indicated when the discharge is thick like cream, or milky, and sometimes gives rise to a burning sensation ; when, moreover, it is associated with indigestion, and occurs in females of relaxed fibre and 'i LEUCORUUCcIA. 041 lymphatic teniperameiit, or in whom the monthly flow is irregular and scanty; the discharge is often worse when lying down. Done: Six globules in a teaspoonl'ul of water, morning and evening, for four days, (unless a decided change should sooner occur ;) then pause four days, after which the course may, if necessary, be repeated as before, and so on. Sepia should be selected when the affection occurs in delicate and exhausted females, the discharge being yellow or green, generally watery, and more or less acrid or corrosive ; and when it is accompanied by a ten- dency to profuse perspiration, particularly on sitting down, after v.alking Sepia is, also, additionally indicated, if the monthly discharges are irregu- lar; and, further, when bearing-down is often experienced. Dose: Four globules, in other respects as directed for Calcarea. China should be given when the discharge is very profuse, and gives rise to great debility; the menses seem to be suspended, or the leucorrhceal discharge occurs instead ; painful pressing towards the groins and anus. Dose : Four globules, as directed for Pulsatilla. ^8culus-hip (Buckeye,) is indicated where the whites are accom- panied by intense pain and lameness in the back and hips, so that it is almost impossible to rise after sitting, or to walk a long distance; consti- pation, and piles. Dose: Three globules, as directed for Pulsatilla. Kreosotum. The discharge precedes and follows the menses, and is greatest when standing or walking; it is yellow, offensive, acrid, and cor- rosive, causing soreness of the parts, and violent itching. Dose: Three globules, as directed for Pulsatilla. Podophyllum should be administered in cases in which the discharge is thick and transparent, and there is constipation, and a feeling of bearing, or pressing downwards on the genitals; falling of the womb, and protrusion of the intestine during stool. Dose : Three globules, as directed for Pulsatilla. Collinsonia is indicated by cases in which the discharge, which may be thick or thin, is accompanied by great itching of the parts; and there are obstinate constipation, and disordered and painful menstruation. Dose: Three globules, as directed for Pulsatilla. lodiutn may be found very useful in cases of long standing ; particu- larly in scrofulous subjects ; the whites are most abundant at or near tlie time for the menstrual flow ; and 'he discharge is so very acrid and corro- sive that not only are the adjacent parts made sore, but the underclothing is made rotten and destroyed. ' Dose: Six globules, as directed for Cahnrea. Diet and Regimen. The diet ought to be simple, but generally very nutritive. CoflTee and tea ought to be avoided, and cocoa or arrow- root substituted. Regular exposure to the benign influence of the fresh air is commendable, but over-fatigue and i)rolonged standing should be sedulously avoided. PROLAPSUS UTEBI— FALLING OF THE WOMB. This is one of the most common forms of uterine displacement. It oooura in three distinct, different degrees, to each of which some writers 41 In, f ■in m l\V2 DISEASKS OK TlIK KKMALE SEXUAL ORGANS. « on tho subject have attlxed ti different name. Thus, rdaxation^or simple disceut oftJie tmmh, Ih understood to indicate the first and least displace- ment downward, and to consist only in a simple bearing-down of the womb upon the upper portion of the vagina. \\\ prolapsus ntvri, thQ organ comes still lower down, and may present at the orifice of the vagina. In procerdentia uteri, there is actual protrusion of the organ, even the entire body of the womb being, in some cases, extended from the vulva. These are but different degrees of descent of the uterus in the line of the vagina. Upon examijiation of the same displaced uterus, at different times of the day, it may be found to be more or less prolapsed, according to the condition of active exercise, or quiet, in which the parts may have been for some hours previous. Symptoms. The principal and primarysymptomsof the descent of the womb are: dragging and aching pains in tiiesmallof the back, pulling and bearing-down pains in the lower part of the abdomen, sensation as if some- thing would issue from the vagina; sufferings much worse from walking, or other exercise; the pains are often noticed to have come immediately after some exertion of an unusual kind, and after some more than ordi- nary muscular effort; frequent calls to urinate, dysuria (painful urina- tion,) or even retention of urine. In the more fully developed forms of prolapsus, the history of the case, the attendant circumstances, and the external appearance of the mouth of the womb, and even of the entire body of the uterus itself, can hardly fail to render the diagnosis at once easy and certain. And if the falling of the womb is not so far developed as to give any such external signs, the severe aggravation from walking and from lifting, together with the relief experienced from lying down, render the case sufficiently clear. Should there be any doubt, however, the vaginal touch will verify the diagnosis. The Causes. Prolapsus of the womb may arise from various causes, such as over lifting or some other muscular exertion, or from an improper manner of dress, such as tight lacing, or the weight of heavy clothing drag- ging on the abdomen. Incase of married women who have borne chil- dren, many cases of falling of the womb are caused by mismanagement. Perhaps the bandage worn has been too tight, or has slipped up and the pressure has forced the bowels to press down upon the womb while in a relaxed condition, or perhaps, the patient has gotten up from the bed too soon after confinement ; the whole system being weak, it is very easy to do a little too much, and bring on injuries which are very often hard to relieve one's self of. In cases of displacement of the womb, the recumbent pos- ture is a necessary requirement, together with the properly selected remedy; a cure can very frequently be obtained. H0M(E0PATH1C TREATMENT. There is scarcely any remedy in the •whole Materia Medica that may not be found useful in these displacements but for fear of confusing the common reader, will mention only a few of the remedies which have proven, during several years of practice, to be the moat reliable. Bell., Chamomilla, Nux-vom., Platina, Puis., Sepia, Cantharis, C!on, Aeon., China and Arnica. Belladonna. Pressure, as though all the contents of the abdomen would issue through the genital organs. This is particularly felt early in i FALLING OK THE WOMB. 843 the morning; sensation of heiil and (liyiicsH in tlio vagina. Pains in th« pelvic region, wliicli coinij on suddenly and cease suddenly, or feeling in the back {18 if it would break, hindering motion, suppression of the stool and of urine. Chamomilla. Frequent pressure toward the uterus, like labor pains, with frequent desire to urinate, often passing large quantities of colorless urine. Frequent discharge of clotted blood, with tearing pain in the veins of the legs, and violent labor-like pains in the ute-" , Contrary to her condition in health, she is always out of humor, particu- larly at her menstrual periods, when she is headstrong, even unto quarreling. She can hardly speak a pleasant word, and has to restrain herself in order to do so. China. In cases where the prolapsus and attendant symptoms were superinduced by losses of fluids, particularly of blood. She has much ringing in the ears, a sense of distention in the abdomen, which la not relieved by eructations. Nux Vom. Prolapsus uteri, from straining by lifting. Pressure toward the genital organs, early in the morning, in bed, or during a walk, with a sensatio^i of drawing in the abdomen. Constipation of large hard, difficult stools, or small stools, wiLli frequent urging. Pain in the small of the back, preventing her from turning over in bed. Frequent urination ; she passes little, and often, with much burning pain. The prolapsus of longstanding is often accompanied with dry cough, and a sense of constriction around the lower part of the abdomen. Pulsatilla. Pressure in the abdomen and small of the back, as from a stone, with disposition of the lower limbs to go to sleep, when sitting, and attended with ineflTectual desire for stool. Menstrual colic, with great restlessness, tossing in every possible direction. Mild, tearful, yielding, disposition. She cries at every thing, is sad and desponding. Very bad taste in the mouth in the morning, nothing tastes good. She is pale and feeble. Cantharis. Burning in the vulva, and violent itching in the vagina. Almost constant desire to urinate, with cutting, burning, and passing of a few drops of urine, sometimes bloody, sometimes followed by a discharge of bloody mucus. Conitim. Induration and prolapsiis at the same time. Much nausea and vomiting. Vertigo, particularly when in a recumbent posi- tion, and in turning over. Intermittent flow at every emission of urine. The breasts become sore, enlarged, and painful at every menstrual period. This remedy alone, in many cases where the above symptoms are present, is sufficient to produce a cure. Aconite. If the prolapsus has occurred suddenly, and there is in con- sequence, great inflammation of the parts, with burning pain as if from hot coals; excessive sensibility to the least touch ; bitter, bilious vomiting, anguish, and cold perspiration, or hot and dry skin. Arnica, When the prolapsus has been caused by a concussion, and a bruised, sore feeling remains. She cannot walk erect on account of a bruised sore feeling in the uterine region. Dose : Each of the foregoing remedies may be given, six or eight pills every four hours. Ati if-' , ,,n 644 DISEASES OP THE FEMALB SEXUAL ORUANS. Plntlna. Piiiiiful senaitiveiiess und contiiiuiil pressure iind dragging; sensiitioii in ihw lower part of the Jibdoiuen, an I tlio tw))i.s veneris ^nd inter- nal orgiiiis, with internal chills and coldness. Tiiis, as proved by experi- ence, is one of the most effectual remedies fur prolapsis uteri, and takeu singly, or in alternation with some other remedy, will give good satisfac- tion. Dose: A small powder three times each day. Sepia. Painful stifTness, apparently in the uterus. Pressing in the uterus, oppressing the breathing; sensation as if everything would come outof the vagina and uterus. Sensation of weight in the arms, not relieved by an evacuation. Great sense of emptiness at the pit of the stomach. The urine deposits a clay-like sediment, which it is hard to remove from the chamber. Dose: To be administered the same as PZaiina. Platina in alternation with Conium or Belladonna is very beneficial. Dose: If given in alternation, every six hours. THE CHANGE OF LIFE-MENOPAUSE. After a certain number of years, woman lays aside those functions with which she has been endowed for the perpetuation of the species, and resumes once more, that exclusively individual life which had been her's when a child. The evening of lier days approaches, and if she has observed the precepts of wisdom, she may look forward to a long and placid period of rest, blessed with health, honored, yes, loved with a purer dame than any which she inspired in the bloom of youth and beauty. But ere this haven of rest is reached, there is a crisis to pass, which is ever the subject of anxious solicitude. The more common, and less scien- tific name for it is the change of life \ physicians know it as the menopause —the period of the cessation of the monthly flow. It is the epoch when the ovaries cease producing any more ova, and the woman, 'lecomes there- fore, incapable of bearing any more children. The age at which this occurs is variable. In this country, from forty to forty-six years is the most common, though instances are not at all unusual, where it does not take place until the half century has been turned, and we have known instances where women past sixty have con- tinued to have their periodical returns. Examples of early cessation are more rare. We rarely meet them earlier than thirty years, but healthy women have been observed in whom the flow had ceased as early as twenty eight. The physical change which is most apparent at this time, is the ten- dency to grow stout. The fat increases as the power of reproduction decreases. And here a curious observation comes in. We have said that when a girl changes to a woman a similar deposit of fat takes place, (though less in amount) which commences at the loins. This is the first sign of puberty. In the change of life, the first sign is visible at the lower part of the back of the neck, on a level with the bones known as the cerv- ical vertebra. There commences an accumulation of fat, which often grows to form two distinct prominences, and is an infallible index of the period of a woman's life. THE CHANUK OP LIFE. W5 The breasts do not usually partake of this increase, but become flat and hard; the substance of the gland losing its spongy texture. The legs and arms loose their roundness of outline, and where they do not grow fat, they wither up and leaemble tliose of the other sex. The abdo- men enlarges, even to the exte: \ occasionally, of loading the wife to believe tliat she is to be a mother— a delusion sometimes strengtlioned by the absence of the monthly sicliness. Finally, a perceptible tendency to a beard often manifests itself, the voice grows liarder, and tlie characteris- tics of the female sex become less and less distinct. In proportion as women enjoy good health, and especially, in propor- tion as the menses are normal in quantity, and regular in their return, may we expect to pass through the trying season of the change of life at about tlie usual age, or a little later, and with comparatively little suffer- ing; while in proportion as tlie healtii lias been poor, and especially, at the time of puberty, and the menses has been imperfectand irregular, shall we have reason to apprehond that the change of life will be, indeed, a critical period, and that it will require all the care and skill thatcan bo employed to go through it in safety, and with liealth improved, instead of being rendered much worse. For the change of life, once well passed, the woman settles down with a new form of life, and it may be with anew lease of life, and has a right to look forward to a happy old age. It is gratifying to know, that nearly all the threatening affections of the change of life can be avoided by such hygienic care, as one can render themselves, as they depend upon causes under the control of the individual. Symptoms of the Change of Life— vary in different individuals according to their respective temperament; for in this, as well as in other conditions, women present the plethoric, ( full of blood) the chlorotic, or nervous type- Thus, in those of the plethoric type, the symptoms will resemble those of congestion ; there may be flushes of heat, rush of blood to the face and head, uterine and other hemorrhages, leucorrhcea, and even diarrhoea. In those of the chlorotic type, the symptoms, which at or near the proper age, would indicate the approach of the change of life, are the sallow complexion, weak pulse, and various other indications of debility. In those of a nervous type is, as the change of life approaches, an evident disturbance of the equilibrium, not unlike that which, in similar cases, pre- cedes the monthly flow. Hence, the over-anxious look, the brimful eye, the terror struck expression, as if api)rehensive of seeing some frightful objects, the face bedewed with perspiration, and the remarkable tendency to hysteria, which are sometimes to be met with. In many cases, the change of life comes on so gradually, that the sys- tem accommodates itself to the new order of things with no shock to the nervous system, and without disturbing the accustomed harmony of the general circulation. In such cases, the intervals between the menstrual periods become more and more prolonged, and even the menstrual dis- charge itself, may gradually diminish in quantity. The most frequent, and least dangerous symptom, is an irregular return of the menstrual flow every week, or every two or three weeks, or every two, three or four or six months, and being more or less irregular as regards quality or quantity of menstrual blood. Serious and ala'-raing hemorrhages frequently set in, especially among plethoric and nervous womcni, or such as have indulged in sexual excesses. Sometimes these hemorrhages alternate with whitish I'r V "if fm !. rft ''it ■' 1 am DISEASES OF THE FEMALE SEXUAL OHOANS. I *■ A ! or yellowish leucorrhoja, which often has n fetid smell, is acrid .in(4 fxtremcly copious. This leucorrhooa may continue lonp after the men- Klriial discharge luis entirely cciised to appear. At this p(!riod, we not uiifrequently meet with colic, uterine cramps, pains in the sides, weight in (lie loins, or distressing itching ii. the parts. The most distressing diseases with which the change of life iF. attended, and often terminate fatally, are ulcers, and polypi of the uterus, and cancers of this organ and of the breast, also, pulmonary phtliisis, (or consumptit)n) likewise, takes a fresh development and frequently terminates fatally. TREATMENT. In this place, it will be sufficient to refer to the different disorders already described, such as hemorrliagc, flooding, diarrhoea, cancer, etc , and to their corresponding medicines, for tlie treat- ment of the various forms of disease tliat arise at the change of life. The lomedies most frequently useful in disorders of the critical age, vill bo found under the head of Menstrual Disorders, and other affcrtions which may bathe most prominent of those winch attend the change of life. !i MASTITIS— INFLAMMATION OF THE BREASTS. The mam msB constituting exclusively a part of the female organism, we prefer treating of inflammation of the manimro in this place, instead of ranging this disease among the diseases of the thoracic organs- Mastitis proper, only occurs duringor immediately after nursing. Tiie painful, sometimes rather extensive, hardened swellings of single por- t ions of the breasts, which sometimes occur among unmarried females or married women who are not nursing, especially about tiie time of tlie menses, are evidently transitory states of congestion wliich never termin- ate in suppuration. The cause of mastitis is always traceable to the impeded discharge of milk. By some cause or other, soreness, or a bad shape of tlie nipples, too feeble drawing of the child, one or more milk ducts become closed, the milk in tlie corresponding mammary lobule I )ncome8 stagnant, and an inflammatory process is the result. Another r.iuse of obstruction of the milk-duels, is the improper manner in wliicli S(^me women wear their clothes, owing to whicli, tlie breasts eitller iiaiig li)0 loosely, or a direct pressure is exerted upon them. Tiie doctrine tliat mastitis cai.> originate in dietetic transj^.-^ssions or cold, is a convenient supposition rallier than a scientific fact. WL.it happens with otner bscesses, is likewise, true in regard to abscesses of the mamma); in some cases they heal rapidly, in other cases they cause vast destructions of tissue. Mastitis is most apt to occur soon after confinement, or shortly after weaning the child; mastitis occurring at the latter period, is less apt to lead to the formation of abscesses. Symptoms. The disease never breaks out all at once. Generally, women experience, some time previous, a gradually increasing lain both spontaneously or while the child is nursing ; and a swelling soon develops itself Soon after. As a rule, the low r or lateral lobes are inflamed, very seldom the upper ones, and still less frequently both breasts. Sooner or later, sometimes in a few days, and at other times in some weeks, the painful spot becomes red and more sensitive, and the inflammation is 'in ■m INFLAMMATION OF THE BREASTS. 617 intense, the whole organism feels the effect of the inflammatory process, and shows its sympatiiy by fol)rile phenomena. Hoon tije infiltrated tissue sliows tlie signs of suppuration, tlie pus hc'ing discliarged tlirougii a small opening. As soon as tlie dlscliarge, wliicii is never complete, commences, tiae pai. • "iddenly cejiaes and tlie fel)rik! symptoms abate. The course of the inllanimation depends upon a variety of circuin- atances. If the inflaminalion is coniiiu't! to one lobe, the abscess most commonly diseliarges close to the nipi)lo, empties itself very rapidly and heals. If several lobes are inflamed, or the Inflamed lobe is situated near the base, the suppuration, swelling, and pi'in continue for - long time; months and ■ even years nuiy elapse before the abscess heals, which discharges through several openings near the nipple. Tliis disorder never hists less than two weeks, and, under corresponding circumstances may conti lue for months even, in its acute form. The treatment of mastitis includes, above everything else, a prophy- lactic treatment which bis to be commenced long before confinement, especially In the case of i)rimiparie (a woman with !ier first child.) The preservation and proper management of the nipples and of the mammso generally, should bo a constant subject of our attention. After confine- ment, if w-^men do not intend to nurse their children, they will have to dispense wah liciuids as much as possible. • Nursing women have to keep the following points constantly in view : the breasts must not he kept too warm, must not be enclosed in tight clothing, and must, by some suitable support, be prevented from dragging down ; every time after the l)aby has nursed, the nipple must be washed, but not be kept moist lietween the acta of nursing; the exce.ssive use of liquids whicli women fancy favor the secretion of milk, nmst be avoided; the child should be put to the breast as seldom as possible, for the more hungry it i^ the more vigorously it will draw and the more completely the breast will be emptied. At the same time tiie nipples will not be held so long in the child's mouth, and they will not be exposed so much to the risk of being made sore by the constant nursing. By following these instructions, and more particularly, by putting the child to the breast every two hours in tlie early period after confinement, mastitis will generally be prevented. You must do it. If the breasts have become hard and painful, the best remedy in the case of lying-in-women is Bryonia, less frequently. Belladonna, whereas, the latter medicine is better adapted to women who are weaning tlieir infants. We sometimes succeed in dispersing the stagnation of the milk by gently rubbing the indurated portion while the cliild is nursing. The same good effect is sometimes obtained by causing tlie milk to be drawn by an older, more vigorous child. In no event should the infant be all at once kept from the breast, even if nursing causes pain. It is only if the pain is very acute, and the hardness consideraole, that tlie infant should 110 longer be put to the diseased breast. Belladonna will now have to be .ulministered. As soon as redness has set in, the chances of scattering the infiammation are very slim; in some exceptional cases we may sometimes succeed in effecting this result by a few doses of Mercurius. Warm poul- tices should never be omitted; they sometimes favor the dispersion of the abscess as much as in other cases, they hasten the process of suppuration. Hepar sulphuris will promote the discharge of the pus. A great many i 4} iP' i»m !' * li ' * ]^ ' 1 1 ' 1 1 '■'I I I ^ 648 DISEASES OF THE FEMALE SEXUAL OBQANS. authorities teach to open the abscess at an early period in order to prevent the furtlier spread of the inflammation. We doubt whether such a pro- ceeding is justified by corresponding results: after opening the abscess, we have often seen the inflammation spread much more rapidly; in the most tedious cases of mastitis, the abscess had been opened in accordance virith this suggestion. In a fortnight at least, the discharge of pus ceases under the use of a few doses of Mercurius.and the sore heals. HOMCEOPATHIC TREATMENT. Bi^/onia is the principal remedy in this affection, before the inflammation becomes fully developed, espe- cially, when the breasts are liard, red, tense, and tumefied, and feel heavy; and when there is some degree of fever. ]>ose: Of a soluti'^n of six globules to four teaspoonfuls of water, give a teaspoonf ul e\ ary four hours. Belladonna is, however, required when the inflammation is more Intense, and the erysipelatous appearance of the skin is clearly defined, usually running in radi ; and is, in such instances, usually sufficient to subdue all such inflammatory symptoms. Dose : As directed for Bryonia. Sulphurm'dy be required, more especially for the treatment of scro- fulous subjects, and when the previous administration of Belladonna has been productive of partial or limited improvement, and evident suscej)ti- bility remaining, even if the active inflammatory symptoms have been allayed. It is also useful when, after the bursting of an abscess in the breast, the cavity is slow in healing up, and the discharge excessive. Dose : As for Bryonia. Graphites should be employed, particularly in scrofulous subjects where tlie breasts are in such bad condition from previous inflammations and abscesses, that the milk cannot flow, and its retention threatens inflammation and abscess. Graphites will, in most cases, ward off this diffi- culty. Should Graphite? fail, Phytolacca should be tried, no other remedy being more prominently indicated. Dose : As directed for Sulphur. Phytolacca-decandria will be found to be a most valuable remedy in many cases ; more particularly where the breasts are hard from the commencement of the disorder, sensitive to touch, and more or less pain- ful. Tt will also prove useful for Humps" in the breasts. Dose : As directed for Bryonia, use also, as an external application. Mercurias may be required after any of the foregoing medicines, when, notwithstanding the previous treatment, and the reduction of the inflammatory symptoms, a degree of induration sti" remains. Dose: As directed for Sulphur. Phosphorus is indicated when symptoms of threatening formation of matter (abscess,) such as increase in pain, with transitory chills, and throbbing in the breast ensue. Its immediate employment, under such circumstances, will often succeed in speedily relieving pain, and pr3vent- iug the ripening and bursting of the abscess. It is also indicated in severe cases where there are already fistulous ulcers formed, of blue appearance, and having callous edges; and the patient has hectic fever and night sweats. Dose: Three globules every six hours, until relief is obtained. i; OANCEH OF THE UTERUS. CARCINOMA UTERI— CANCER OF THE UTERUS. WJ In, by far, the majority of cases, this disease occurs beyond the age of forty, and is very seldom met with in women of a less advanced age. Feeble as well as robust, married as well as unmarried women are attacked '>y this terrible destroyer. Cancer of the uterus is.one of the most fre- ently occurring forms of carcinoma, and not unfrequently runs iti course as a solitary cancer. It is only in rare cases, that it breaks out in addition to cancerous degenerations of other organs. Cancer of the uterus is frequently mistaken, at the commencement, for menstrual disorder, leucorrhoea or clironic inflammation of the womb. The first symptoms usually menstrual derangements, cessation or a more frequent return of the menses, or in place of the menses we have irreyru- lar hemorrhages and leucorrhoea. The mistake is made the more easily, if the patient has not yet reached the critical period, so that these changes may be set down as results of a natural cessation of the monthly secretion. If the patient has passed through the critical period, a suGde nflow of blood takes place, at first iMsembling the menstrual flow, l)ut soon increasing to a. true hemorrhage. In the beginning, the patient often complains only of a feelingofweight,drawing in the pelvis, a pressing towards the sexual organs, or the pains are excited by bodily motion, a concussion, sexual intercoursf, touch. An examination shows the vaginal portion harder than in the noi- mal condition, of unusual resistance, swollen, niissiiapen, rugged and knotty, sensitive to pressure and readily bleeding. In the course of the disease, pains set in, which are, at first, only vague, and occur only now and then, but afterwards become more severe, and finally, especially ai night, exceedingly violent, pressing, stinging, lancinating, burning, not con- fined to the region ' the uterus, but spreading to the small of the back and thighs. Characterisl'c are the more or less violent, burning, and stinging-boring pains over the pubic bones, and in the small of the back along the hips and thighs, interfering with walking, and even sitting very often a burning pain is continually felt deep in the pelvis, accompa nied by fugitive stitches darting through the uterus. The neighboring lymphatic glands are generally larger and painful. At the beginning of the trouble, a serous, or slimy secretion flows from the vagina, having but little smell; more usually the discharge is copious, of a brownish-nnl, Buspicious-looking color, having a horrid smell, and excoriating the skin. The bleeding becomes more and more frequent and copious, tiie blood being mixed with detached portions of tissue. These hemorrhages con- sume the strength of the patient in a very short time. At this stage of tin* disease, the idioroiis dissolution of the cancer progresses very rapidly. The disease generally lasts for years, calculating from the first mani- festation of distinct symptoms, and without allowing for the inllucnce of special circumstances, such as confinement, which is one of the most per- nicious occurrences that can happen to a woman afilicted with cancer of the womb. It is inconceivable how it is possible for the organism to bea.- up for so long a time under a destructive malady, like cancer, without perishing. TREATMENT. No more than we reject thepossibilityofacure of can- cer generally, do we believe that cancer of the uterus is an incurable dis- ease, although it is difiicult to obtain certainty in this respect. 1)1 'III hi :!f :%^ li lii 6») DISEASES OF THE FEMALE SEXUAL ORGANS. Kreosotum. When the following symptoms are present: Obstinate leucorrhcea during frequently recurring losses of blood, with aching or pressing pains, and gradually appearing fetid discharge of a serous fluid or a bloody ichor. This is attended with burning or lancinating piains in the small ot t'^o back, and loins. When standing, she experiences a sensation as of a weight in the pelvis; coition is painful ; all the symptoms are worse it the time of the menses. Electrical stitches in the vagina, as if proceed- ing from the abdomen, causing the patient to start; voluptuous itching in the vagina, with burning and swelling of the external and internal labia ; ulcerative pain during coition ; the menses appear from four to ten days too soon, and continue for days, with a discharge of dark, coagulated blood, pains in the small of the back, and subsequent discharge of a pungont ar.'i bloody ichor; gnawing, itching and smarting in the parts; the mense.s stop for hours and days, but afterwards return again in a more fluid form and attended with violent, colicky pains. The pressing downwards, and the abdominal spasms continue after the mouses, more especially in the groin and pelvic region; bleeding from the uterus, and a continual cor- rosive leucorrhcea are not wanting. The pains are worse at night. Sen- sation of fainting on rising, with a peevish and desponding mood, and livid complexion. Arsenciutn-album has been given with excellent success in car- cinoma uteri. Arsenic can only be resorted to after the whole organism reflects the picture of a cancerous disease. However, it only palliates llio severe pains and the sleeplessness, and perhaps modifies the profiisn menorrhagia, which occurs every now and then in the course of the disease. Nitri-aciduifi is indicated in carcinoma uteri, as it is in many other inveterate dyscrasic conditions of tL organism. The most importaJit symptoms are: Irregular menses, they sometimes remain suspended for weeks and then appear again at short intervals; between the menses, copious leucorrhcea of a badly-colored, brownish appearance and offensive odor. The patient looks worn, feels nervous and is depressed in spirits. Obstructions in the portal circulation, such as hemorrhoids, indicate this drug. Acidum nitricum can, however, only be used as an intercurrent remedy at the commencement of the disease; if ichorous dissolution has commenced, this drug is no longer of any use. CARCINOMA MAMM^-CANCER OF THE BREAST. Next to the uterus, (womb) the breasts are the most fretiuently attackedljy cancer. The causes of this disease can scarcely ever be deter- mined with certainty. The influence of depressing emotions, which are 3o easily and so commonly succeeded by cancerous degeneration.s, or di.s eases, isa much more evident source of tho (iifliculty tlian the belief ol 'MUie, that it is the result of a bruise, from a blow or contusion. Cancer of tlie breast most commonly occurs between tlie ages of forty and fifty, about the period which is generally designated as a t-iiange oi life. Unmarried women or women who have not had children, Koem tt CANCER OK THIi BHEA8TS. 651 be more liable to it than married woiuen witli children. Before and after this period, it ia proportionally a rare occurrence. The coiuniencement of the disease is scarcely ever marked by pecu- liar morbid phenomena ; the patients generally do not notice anything out of the way, until v rably large tumor is perceived in the breast. It is at#rst round, smo .novable, grows with more or less rapidity, and loses its mobility in pioportion as it increases in size, and its surface becomes more uneven* At first, it is most commonly deep-seated, and gradually grows towards the surface, is sometimes entirely painless, or becomes painful only at the time of the menses, and when receiving some mechanical injury. If the cancer reaches the skin, it coalesces with it, after which, the pains are almost constantly felt. At the same time, the disorganizing process extends to the deeper tissues, and at an early stage, the axillary (arm pit) and other neighboring glands become involved. The patients now commence to feel constantly or at intervals, and par- ticularly at night, lancinating, boring pains in the affected part, which very soon become unbearable. The assimilative functions begin to suffer; the patients have a pale yellowish-gray appearance, the spirits are very much depressed. A characteristic sign, is the gradual effacement, and finally the complete retraction of the nipple, which discharges either spon- taneously or on pressure, a turbid, serous fluid. At the place where the cancerous growth first became interwoven with the skin, the latter, by slow degrees, loses its healthy color, and finally breaks. An irregular- shaped ulcer forms, showing a disposition to penetrate to the subjacent tissues ; the edges of the ulcer are infiltrated, have a sickly color and an uneven base, and secrete at first, a thin, serous, and afterwards an ichorus, purulent, bloody, and most commonly very fetid fluid. If the disease runs a slow course, the incipient ulcer often heals for a time, but again breaks open at a later period ; if the disease runs a rapid course, spongy and readily-bleeding excrescences are apt to shoot up from the bottom of the sore. If larger vessels become necrosed, hemorrhages take place, which are sometimes very profuse, at other times trifling. The further course of the disease, which, having arrived at this stage, always terminates fatally, depends upon the extension of the cancer, upon the invasion, by the carcinomatous process, of internal organs, upon the importance of the hemorrhage, and upon the loss of fluids in consequence of the ichorous discliarge. The duration of the whole disease varies considerably, ranging from two to twelve, and even more years. The younger the patient, the sooner she will succumb to the disease, and the more sudden the cancerous growth, the sooner it will destroy life. The prognosis is very bad, with scarcely an exception. In many respects, the diagnosis is liable to diflflculties, because vari- ous kinds of benign tumors may occur in the breast. An incipient can- cer cannot always be recognized as such, though it inay grow rapidly and be painful ; these two conditions never occur in the case of benign tumors. At a late period, the diagnosis is determined by the retraction of the nipple, the fluid which it discharges, the rugged uuevenness and immobility of the swelling, the participation of the neighboring glands in the disease, the failing of the whole organism without any increase of the 1 S K \S i mk fc'' , |i ! 11 1 (io2 DISEASES OF THE FEMALE SEXUAL OUOANS. secretory products. Nevertheless, there occur many cases of cancer, the tn e nature of which remains for a long time undetermined, and is clearly revealed only after the disease has run a long course. Cancer of the breast is generally considered a surgical disease ; it is supposed by most authors that internal treatment cannot reach it. The disease, at least in its incipiency, is considered purely local, and an onera- tion the only cure. For these and other reasons, having given you the means of selecting an intelligent and honest p'hysician and surgeon, we unhesitatingly conmiend you to his care and here oflTer no treatment. HOME REMEDIES. Take the juice of Sheep Sorrel, let it evaporate on a pewter plate to the consistence of a thick extract; apply this over the cancer. It is very painful but good. Another. Take equal parts of Sheep Sorrel, Poke Leaves and Yel- low Dock Root, beat them up in a mortar with a little water ; squeeze out all the fluid ; place it on a lead or pewter plate, and let it evaporate until it forms a thick extract. Apply to the cancer. This is a noted can- cer cure. Again: Make a ley of the ashes of Red Oak IJavk; boil down until it is as thick as molasses, and cover the cancer with it, In about an hour afterward cover it with a coat of Tar. Remove this in a few days, and if any protuberances remain in the womb, apply more of the Oak Bark Potash and the Tar plaster, and so on until the cancer is cured. Heal the ulcer with some common salve. CHAPTERXXXI. PREGNANCY. CONDENSED SIGNS OF PREGNANCY. The determination of pregnancy, at the earliest possible period, forms a most diftlcult problem, on account of the same symptoms having been known to exist through the influences of other derangements. Suspension of the menses is generally the flrst indication which leads the woman, in whom impregnation has been possible, to consider her- self enceinte. But tlie importance of this symptom will very greatly depend upon the attendant circumstances : if the woman has been very regular, and if the cessation of the menses promptly occur after some par- ticular sexual intercourse, the presumption of pregnancy will be very strong indeed. But if she has always been very irregular, the mere fact of the menses failing to make their appearance at a particular monthly period, will carry with it but little weight. Where the entire absence of the menses for two or three months occurs, from no other assignable cause, and where this suspension is attended with good health and appe- tite, and some perceptible increase in the size, or, on tlie other hand, per- ceptible sinking away of the abdomen, the conclusion of pregnancy may be cousidered to be well founded. ■^ the irly SIGNS OK PUKG NANCY. 058 Changes in the breasts very frequtMitly occur; they sometimes feci heavy, areinclined to itch, and llie arcolaaround the nippiehecomesdarlc- colorcd, and sometimes i)resent8 an oily ai)pearance. And yet, even these circumstances are far from affording unmistakahle evidences of pregnancy, since they have been known to arise in this combination from other causes. Anotlier symptom whicli may, and does often occur in tlie early montlis of pregnancy, is an itcliim? and irritation of tlie sexual parts ; though in newly-married women, tlie menses are sometimes suspended from irritation of the sexual organs when no conception has talien place, and at the same time, there may be an increase in the size of the abdo- men, and in the sensibility of the breasts; so that even this very strong combination of symptoms cannot be relied upon. Morning sickness forms, in very many women, the next sign of preg- nancy. As its name indicates, it is a morbid symptom, but on that account none the less valuable as a diagnostic sign. It arises from syjnpathy of the cceliac, or solar plexus, with the organic nervous system of the uterus. This morbid irritability may commence immediately after conception, but it generally sets in about the fifth or sixth week after conception, and ceases soon after the third month. It may become, in individuals, a positive indication of their being pregnant, since these persons learn by experience that tliese symptoms occur with certainty and regularity at a particular time after conception. Thus, in different persons, the presence or absence of morning sickness will have a very different diagnostic value. Still, where morning sickness makes its appearance persistantly attended with suppression of tlie menses, and in circumstances where there is a liability to impregnation, it can scarcely be attributed to any other more probable cause than pregnancy, and this indication will be strengthened by the character of the sickness itself. The appetite improves and is good through the day, in spite of the nausea, vomiting of a peculiar watery fluid, and sinking at tlie pit of the sto- mach, which occur and continue for a siiort time, only on first rising in the morning. The sickness and the fluids vomited up are different from those accompanying any otiier Llisorder, such as gastric or bilious fevers, for example. While morning sickness, from its peculiar character, brief daily appearance, usual temporary continuance, and final, sudden and perhaps unexpected disappearance, becomes, where it occurs, a valuable indication of pregnancy, its absence is hardly to be regarded as an opposite sign, as disturbances of tlie uterus, apart from pregnancy, may occasion it, and it sometimes follows suppression of the monthly flow from other causes than conception. Certain other derangements of the digestive organs, such as eructa- tions, heartburn, remarkable longings for some particlar article of food, or other substance not used as food ; and, on the other hand, aversion to some one or more of the common varieties of food, which may occur separately, or in connection with morning sickness, or even subsequently to it. The same may be said of salivation, whicli occurs, in some women about the fourth or sixtli week; in such cases, the frequent spitting will be equally diagnostic, whether the quantity be large or small. This sail- i< '111 'if t m 1 V, ?; Ili;;:j If' i: -i!!!' li «64 PREGNANCY. M ■ i li 1 . ji 1' 1 (I f<i 111 1 r ; < ^i' vation, dillVriiig from thaiwhiuh is produced by mercury by tlie absence of I'oul breath, sore gums and great jirostration ; it liecomes cliarac^terislic of pregnancy, just as tlie morning sickness, above described, does by reason of its being a sympathetic afltection. OBSKUVATIONS ON PKIiONANCY. This period may be regarded as one of tlie most interesting eras of a woman's life. She is now no longer acting for herself alone, but becomes invested with a new and serious responsibility, and upon some of the most apparently trifling of her actions, may depend the future health and happiness of a being bound to her by the fondest ties. From the mass of evidence collected by careful observers of the oper ations of nature, we are warranted in drawing the conclusion, that th' actions of the mother exercise a great influence over not only lie constitutional and physical, but also, the mental organization of lur offspring. Keeping this fact in view, we shall endeavor to point out tlie course that mothers, who prefer the welfare of their future oflsjtring tn their own indulgence, should pursue, and from which they will derive ;i double benefit, an improvement in their own health, with exemption from suffering, and the delight of seeing their children puss safely through the anxious period of infancy. Tlie leading causes of a weak and sickly child, are ill-health, or con stitutional taint of both or either of the parents; very early, or late mar- riages; great inequality between the ages of the parents; errors in dress, diet, and general habits of life, and lastly, powerful mental emotions. Females should seldom, at least in this country, enter into the mar- riage bond before their twenty-first or twenty-second year ; prior to that period their organization is scarcely ever fully developed ; those who marry at sixteen or eighteen years of age incur the risk of a severe after- suffering themselves, and also, of giving birth to weak and delicate children. How very often we see the first children of such marriages perish in infancy, or after contending through a childhood of continued delicacy, sink into a premature grave. Women who marry late in life incur considerable personal risk, and severe suffering in giving birth to children, and the offspring is seldom healthy. The children of old men, although by a young wife, are very often extremely delicate and suscepti- ble to illness; they do not unfrequently precede their father to the grave or linger but to drag on a miserable and wearisome existence. In concluding these observations, we may remark, that so far is the period of pregnancy from being destined for one of suffering or danger, that nature has taken every precaution for the protection of the female and her future offspring. While pregnancy runs its equable and uniform course, the expectant mother enjoys an almost complete exemption from the power of epidemic or infectious diseases, and even chronic complaints are frequently suspended ; in fact, with the exception of some slight mor- ning sickness, aftd occasional trifling uneasiness, a well-constituted organism should enjoy as good health during pregnancy as at any othei time; and many women pass through this period and give birth to vigor- ous children without even the most trifling inconvenience. Though, as we have said, nature seems during this period to adopt •very possible precaution for health and preservation of the parent and HYGIENE OF PUEaNANCY. 665 her future ofrs[)riiijif, yet are lier wise arrangeiuents too often rendered void by direct violation of lier laws. The expectant mother should therefore boar in mind, tliat the duty of leading a regular and systematic course, so essential to every individual, devolves upon her with double force, since every neglect or breach of these ordinances of nature upon her part is frequently visited with fearful energy upon her yet unborn infant. HYGIENE OF PREGNANCY. A few words on this subject, which is quite as important as the med- ical treatment of the disorders of i)regnancy, inasnmch as it is intended to prevent such disorders from occurring. In order that this j)eriod may be passed with as much comfort and its end accomplished as easily and safely as possible, all irregular and, I might say, intemperate habits, should be laid aside, and all pernicious practice abandoned. The pregnant woman should strive to cultivate for herself the utmost cheerfulness and tranquility of mind ; she should strive to be at peace with all the world, and at peace with herself, for her mental and moral state will surely be engrafted upon her offspring, the education of the future being commenced while yet in utero. And in this effort she should be seconded by her husband, whose responsibility is very great at this period— who.se conduct toward tlie wife of his bosom, at this period, acting upon her mental organization, will be transmitted to their joint offspring for weal or for woe. A pregnant woman, during the whole course of her pregnancy, will require more sleep than at other periods, and an ample allowance of the same should always be indulged in. And yet, at the same time, habits of slothfulness should be avoided. "Early to bed, and early to rise," applies with additional force at this juncture, and nine, or, at least, ten o'clock at night, should find her in bed, and six, or, at the least, seven o'clock in the morning, should find her up. Habits of regularity, in all things should be cultivated— regularity as to hours for sleeping and wak- ing — and regularity as to meals, exercise, stool, etc. Am AND ExEUciSE. Nothing tends more to the preservation of health, than a proper attention to these two important points, and yet, unfortunately, there are, perhaps, few more completely lost s^ghtof. During this epoch, carriage riding, alone, is not sufticient ; walking brings, not only the physical, but the whole of the organic muscles, into play, and communicates the increasing vigor of the mother to her off- spring ; therefore, walking is indispensable, and every day should find the expectant mother taking a walk, leisurely, and with the mind at ea.se; and this rule should be observed, even in cold and unpleasant weather, excepting when the walking is rendered dangerous from snow and ice. A walk is often an excellent remedy for the feeling of drowsi- ness and heaviness, which often creeps over a woman in this condition — a much better remedy than taking a nap or a prescription from the doctor. Some women take a great deal of exercise, yet, without corresponding benefit, from their work occupyirig them wholly indoors, showing the inutility of exercise in itself, unless combined with pure air. Others, again, injure their health, and frequently induce miscarriage, through ll!) k \^' <Kti I II; m^ ill II' ' n ill! lill i!' ' liii f f1 OM PUEONANCY. tlieir excessive levity and tlioughtlessneas, by unrestrained indulgence In active exercise, riding on horsebacli, dancing, etc. A woman ouglit to recollect, that, it'tlirough her own folly, slie has brought on miscarriage, the greatest possible care should be taken to prevent its recurrence; that a second attack increases her liability in future; and that she who has suflered twice or thrice from this misfortune, even when she escapes it, rarely attains her full time. Moreover, continued casualties of this nature frequently termin ite in premature death. Employment of the Mind, etc. Useful employment, reading, or use- ful and agreeable conversation, should engage the waking hours, not otherwise employed. In fact, I should like to impress upon the i/i^e/'CitoZlJortion of my readers, the importance of cultivating a proper condition of mental vitality, as well as physical. How important it is that the expecting mother, as a new thread of life is being spun within her, should think and do that alone which is good and right, for of a cer- tainty, her offspring will have woven into the tissues of its existence the resultant of what she is and does during her pregnancy. Experience has presented us with many instances in which the pre- dominant feeling in the mind of the mother, during pregnancy, has influence on the future mental organization of the child. The effect of any unpleasant or unsightly object upon the imagination of the mother, and the transmission of that eflfect to the offspring, evidenced in variou! mental or p^ ysical peculiarities, after birth, is a theory as old as tradition. Clothi.nu During Pkegnancy. The dress of the female should, of course, be suited to the season, and if she pass from a warm into a cold atmosphere, she ought to keep herself well protected to prevent the risk of taking cold. But, a point of far greater importance, is the adaptation of the clothing to the form, so as to preclude all unnecessary pressure upon any part of the body, that might interfere with the functions of those important organs which are destined for the birth and nourishment of the infant ; tight lacing (at all times most objectionable) is particu- larly injurious during this period, inasmuch as it interferes with the natural action of the body, and bearing directly upon the abdominal muscles, the blood-vessels, lymphatic, and the bowels, produces narrow- ness of the chest, disturbes the circulation, and causes derangements of the liver, and exercises a most distressing effect upon the breasts and uterus. Feniales, in their efforts to preserve the elegance of their form during pregnancy, are little aware that the constricting efforts thus exer- cised upon the abdominal muscles, destroy their elasticity, prevents a proper retraction after parturition, and thus proves one of the most com- mon causes of abdominal deformity. Moreover, to the vanity of their mothers in this and other respects, many, it is probable, owe their club- feet and other deformities ; and in addition to these evils, this practice not unfrequently deranges the position of the foetus— a displacement which, together with the consequent want of energy in the muscles, and the parts concerned, generally brings on protracted and dangerous labors. Besides, this continued pressure on the uterus is liable to bring on prema- ture labors. To tight lacing may be attributed the difficulty which so many mothers of the present day experience in suckling their infant, by the unnatural pressure deranging the process required for the subsequent 1« MOUNIWO KIC1CNKS3. 067 Becrctioii of milk; from this, ulno, urise sometimes, those dangerouHindur utions, euncera and other aHectiouH of the breuats and, ulao, retraction of the nipple, from whicli tlie act of sucicling ia rendered difficult, and in aome inatancea, impoaaible. Care alao should betaken not to wear anything tight about the limbs, such as wriat-banda or garters, even elaatic gartera H])anning the leg may be injurious, aa tlioy iuij)ede circulation, and encourage tiie development of various veins, to wliicli the syatein ia already prediapoaed, and which, in many inatances, become very i)alnful and troublesome. One fact in connection with this (luestion of dress, ia hero noteworthy, viz: that women in the latter months of pregnancy, complain of, nnd really suirer from coldnens of tlie abdomen, the protruding abdomen causing the cloth- ing to set olFto the extent of almost completely expoaing that i)art of the body to direct contact with the air. In view of thia, the clothing should be so adjusted, or an extra garment worn to obviate the difficulty. Notice of these matters are greatly beneficial, and are so apt to be considered ot minor or insignificant importance. Diet. The diet during pregnancy should be generous in meats, vegetables, and fruits, and at the same time plain. Excessive coffee and tea drinking should be laid aside. Sugar, salt, and spices should be taken in moderation ; stimulants of all kinds, especially such as wines, liquors, beer, etc., should be most strictly avoided. If, however, the female has been long habituated to wine it may be take»» in extreme moderation, and diluted witli water." QASTUIC DERANQEMENTS DURING PREaNANCY. Nausea and VoMiTiNa— Morning Sickness. In many women, nausea and vomiting set in at an early period of pregnancy, and are simply the result of a peculiar reflex irritation of the stomach; in tliese cases this affection usually continues but a short time. Next to the ces- sation of the catamenia, and especially in conjunction witii it, morning sickness becomes one of the earliest, as well as one of tlie most reliable, early signs of pregnancy ; while for all tliose wiio have ever before experienced it, there is little room for mistake in regard to its nature ; for, in each individual in whom it occurs, it has a uniform type and well remembered character. The nausea may occur at an early period in the morning, with unvarying regularity ; or in the evening, or at any period of the day, or even of the night. For each individual, it maintains, also, its uniformity as to the date of its first appearance ; in some, it appears very soon after conception; in others it begins toward the third or fourth month, and, in others again, it comes on only toward the close of gestation ; in tliese latter cases, it might have appeared, also, for a short time after concep- tion. In the duration there is, also, the same general variety and indi- vidual uniformity. Thus, in some women, it lasts bnt a few weeks — from six to eight at most; in others it continues for four or five months; while in some few most distressingly severe cases, this difficulty persists through the whole period of utero-geatation, unless relieved by art. The nausea and vomiting of pregnancy^ as already stated, are most apt to occur on first rising in the morning; sometimes these symptoms disappear in a few minutes, aometimea they last through the greater por- 42 n. '^.i:^ I'M!' ma m «i 1'"' i iii: ! dr>8 PttKONANCY. tlon of the day. In somi', tht> viiiiiitiiiK is very eiwy ; in otherH it Ih utteiult'd with very uevere retching, and even with other painful Hymj)- tonis. Tlio.se wiio vomit upon waking or rising in the morning, usually tlirow uj) some viseid, glairy matters, wliicli are generally eoloreil with a little bile, especially if tlie retching lias been very severe. Others vomit only after eating, occasionally after only one of the daily meals, but some times after all of them. Again, in .some unfortunate cases, the vomitings continue, even in the intervals of the repeats, everything taken into the .-.ti Hiach, wlicthcr li(iuid or solid, being immediately rejected. There are cases, finally, in whicii the mere thought of food, or the sight or smell of it, is sui!icient to induce the vomiting. In some cases, nearly all of the food taken seems to have been thrown up, even for months in succession, and yet a good delivery succeeds ut full term ; the repeateil and severe vomitings seeming to exert compara- tively little influence upon the general health. In like manner, preg- nant women may rise from the breakfast table, vomit, and return to their food as if nothing had hai)poned. Sucli characteristics, so ditt'erent from vomiting, arising from any other cause, almost conclusively indicates the presence of pregnancy. The diet and regimen of the pregnant woman should be carefully attended to ; such arti<des as best agree siiould be taken iu each csv.se, and equal care taken to avoid every un\vholesom(^ or irritating intluence. It has sometimes been fouml that the excessive irritability of the stomach, in pregnancy, is due to the presence of fumes from some neighl)oring manufactory, which, although insullii;ieut to induce any unpleasant ^yaiptoms in the orilintiry condition of the woman, very powerfully affect her when pregnant. TUEATMENT. The following remedies will be found to cover the principal forms of gastric derangements of pregnancy. For particular Indi tions, see " Heartburn." Antlmoniiiin mid. Nausea and vomiting, or only nausea with white-coated tongue. Watery stools, with occasional hard lumps; fright- ful vomiting with convulsions; belching, with taste of what has been eaten ; painful .sense of fullness of the stomach, which is sore on pres- sure. Dose: Six pills night and morning. Arsenicum. Very great debility and exhaustion ; the least effort causes exhaustion. Very pale white look. Bittern^.ss in the mouth, particularly after eating or drinking. Cold water seems to lie in the stomach until it gets warm, after which she vomits it, therefore she can- not drink it although she desires it. Feels cold, and wants to be in a warm room, or to be covered up warmly; very uneasy and restless ; vomiting of blackish or greenish matter. Dose : As for Anti. Crud. Bryonia. Nausea on waking in the morning. Nausea is usually relieved by keeping quiet; dry, parched lips, dry mouth and tongue; head aches as if it wouild split; ^tool of hard, dry feces as if burnt. All the symptoms worse from motion, better when still. Dose As for Anti. Crud. MOKNINO SICKNESS— IIKAUTHI-UN. 000 Calcarra Curb. Slio cannot Bleep ufter thn*e in the niorninK; heartburn uiid food eriictutiohs; Horcness oC the tongue, either oii the tip or sides, HO thiit Hhe eiin Hcureely eut or tulk. SjnHution us if the feet were coUl or diunp. Feels better from wuriiitli, und cannot bear cold uir. Vomiting of sour nuitter. Dose: As for Anti. Crud. Conltiiu. Vertigt), particularly on turning over in bed. Where the history of the case of vomiting reveals tlie fact of sweliing and soreneHU of the breasts with each menstrual period, an«l tlu- patient always feels worse after going to bed, so much so, that she is ohWged to sit up or walk about to get relief. The urine intermits at every How. Duse: 8ix pills three times a day. Ipecie. One continual sensi; of nausea all the time— not a moment's relief. Vomltingof large (luantlties of mucus. Diarrhoja and colic, dis- gust for food ; empty retching; vomiting of food, slime, or blood; sour vomiting, cutting pains about the umbilicus (navel). Dose: As for Conium. Nux voin. Nauseaand vomiting every morning with constipation; large difficult feces. Food and drinks have a fetid smell to her. Not much appetite, or canine hunger; aversion to water and bread. Longing for brandy, beer, etc. Bitter or sour taste. Vomiting of food, bile, of black or sour matter. Dose: As for Conium. PulHatilln, Pulsatioi a in the pit of thu stomach. Vomiting of mucus. Bad taae in the inouth every morning on waking; she has to wash it out, soon it is so Ijad she cannot bear it. Notliing tastes good to her. Absence of thirst; she does not relish as much water as usual. Nightly diarrluea; stools very changeable, loss of taste or bitter, fatty, saltish, sour, or sweetish ti'ste. Dose : As for Conium. ' Sepia. Vomiting of milky water or milky mucus. Sense of empti- ness at the pit of the stomach ; the thought of food* sickens her ; a sense of weight in the anus Eructations tasting like spoiled eggs. Taste as of manure. Aversion to meat. In the morning, nausea as if all the viscera were turning Inside out. Taste bitter or saltish. Disgust for all kinds of food. Constipation. Dose : Six pills night and morning. in 't„J ^. V U m m Mi u ■m m kr HEARTS URX—ACIJ>1TY— WATEBBBASH, These distressing forms of gastric disturbance sometimes make their appearance soon after conception, while In other cases they may not make their appearance until after the fourth month. Some women are rtimarkably subject to these symptoms when pregnant; in others they are manifested with less violence; In others not at all. There may be merely a burning sensation— heartburn In the throat— which indicates sympathetic Irritation ; or the severe forms of waterbrash with acidity which arise from more fully developed irritation. As in the nausea and vomiting of pregnancy, so in waterbrash, acidity, and heartburrt, every degree of intensity and variety "f manifestation and complication may be IN: noo PIIKO NANCY. s iNs .•4Ck!U in (lidl'ri'rit iiulividuul cuhi'h. HoinutimuH tlieHO diHturbanccs are louiul uct'oniiuiiiittl with, unci greiitiy ug>;ruvutlii^ tlie niiUHi'ii iiiul vomit- ing, vvliilu at otiier tinioH tiioy hwui to ai)[)t>ur inHteud of tiu> vomiting. As in tlie ('iihch of ordinary dy8i)t'j)8iu, tiit'Bo Huf!ering» are worwe after certain articlcH of food or drinli, hucIi um niouts, fat nioatHor gravies, niiil{, or fruit. In tlie more severe eases, nearly everything tliat is eaten Id'coint's Itut an added fuel to the l>urning (Ire. Still, a careful avoidance ol nil tliose articles vvhicli, whether solid or liquid, are found to disagree ujost. und u careful selection from the remedies given, will, us in cases of nuu- sea and voc'iting, go very far to remove the most distressing symptoms, ;uid eventually t«) s^ecure a great improvement in the general health. TREATMENT, ^inthuoniiiiu Crutlum, Nausea alone or nausea and friglitl'ul vomiting with convulsion. Belching, with a taste of what has lieen eaten. Thirst at night. Painful sense of fidlness of the sto- mach, which is sore on pressure. Dose: Eight pills every four hours. Arsenicum is very useful when there is very great debility and exhaustion. Very pale, white look. Sensation us of a stone in the sto- nuich. Vomiting of fluids as soon as she takes them. Exhausting diar- rhoea. Feels cold and wants to be in a warm room. Very uneasy and restless. Dose : As for Anti. Crud. Bi'f/onia is particularly indicated when there is distressing heart- I)urn, dry, pardied, lips, splitting headache. Stool of dry, hard feces, an if burnt. All the symptoms aggravated by motion. Dose: Six pills every three hours. Cairarca Carb. Heartburn and food eructations. Sensation as If the feet were damp and cold. Dose: As for Anti. Cnul. Coniuni. Vertigo on turning in bed. Eructations with heartburn. Terrible nausea ami vomiting. Wliere the history of the case reveals the fact of swelling and soreness of the breasts with each menstrual period, and the patient uJways feels worse after going to bed, and has to walk about to get relief. Dose: As for Bryonia. Sepia. The thought of food sickens her. Eructations tasting like bad eggs. Want of appetite. Taste bitter or saltish. Disgust for all kinds of food. Vomiting of food and bile. Constipation. Dose: Six pills every night and morning. CONSTIPATION OF PREGNANCY. \ Constipation Is a very common attendant upon pregnancy, so fre- quent that by some it is deemed almost a natural consequence. But It is much more apt to occur, and at the same time be more troublesome and obstinate, in pregnant women, whose habits of life are confining, and those who are naturally of a more costive habit. When It doep not arise from mechanical pressure exerted by the uterus upon the rectum, by wiiich its dimension Is lessened, and its "ctlon paralyzed, active exercise In the open air (avoiding indigestible i jU, strong coffee, and other stimu- I ill, TOOTIIAOHE DURING PllKONANOY. (Xj latln^ llquIdH,) Ih Hufflnlent to remove the complaint, or, p.t all eventM, rviidfr it IcHH troul)lt'M()iiu!. Wliuii imtiiro retiulreH further aHslMtiinco, the followiiiii? remedies liiivt! Kiven the bewt rtutinfaetlon In the numerouH < cm which I have treated. TllEATMilNT. Niix v. In women of wedentary hahltH, acuiistomed to the line of much eollee, wine, and rich and lii},'hiy-Hea.soned food, gener- aily. Stools larKc and didlcult; coliclty pains, or loud rumhiin^ or rol- ling in tlie bowels, (.'onslipation in persons who have been in the habit of using purgatives, llush of blooTl to the head during stool. Doso : Four pills every evening, dry on the tongue. Ignatia can be made use of when the same symptoms as given after Nux., with the addition of an empty feeling at the pit of the stomach; sighing and full of grief. Dose: Four pills every morning, dry on the tongue. Bi'j/outa. The stool Is mostly dark, dry and hard, as if burnt, and Is evacuate<l with much dilTlculty. The lips are parched and cracked. Much thirst. Mtinklng flatuh'nc Obstruction of the bowels from hard- ened stool. Stool too large to be evacuated without prin. Do.si-: The same as directed for N^tx. Sepia, Sensation of weiglit or heavy lump in theanus ; this Is a very characteristic indication, The stool is very difTlcult to pass, even with the most terrible and Involuntary strainings. Knotty and insufficient stool. Hepiu has given very marked I)enetit8. Dose: A powder each second night. I If Irl WA ii. % TOOTHACHE DURING PREGNANCY. Toothache is a common and very distressing accompaniment of preg- nancy, being In fact, only a particular form of neuralgia. If toothache occurs In sound teeth, as Is quite frequent, they should never be extracted, and only the greatest care should be used In extract- ing decayed ones, especially, If the patient be of a very nervous tempera- ment. The female should, as soon as she Is in proper state, put herself under proper treatment, for this Is a valuable indication oT some consti- tutional taint lurking In the system, and no remedies can be otherwise than palliative, until this tendency is eradicated, TREATMPINT. Atiinihia. (A'um) when the pains are excited by mastication, (chewing of the food,) and when tiiey are of a tearing nature, extending to the cheek bone, temple and forehead. Calrarea. Wlien the toothache is excited or aggravated by cold air, or anything hot or cold, and attended with painful sensation of tlie gums, and pulsatlve, gnawing, or throbbing pains which are aggravated by noise. Sepia. Is particularly indicated when there is pulsative, shooting, drawing toothache, with pain extending to tlie ears, or to the arms and fingers, excited l)y compressing theteetii or by cold air, and attended with swelling of the clieek, and enlargement or the glands under the lower jaw. \H\ V i iilll ||il| m i \t '■ r I ^ii 66i PREGNANCY. Mfif/ucsia Carhonica. Nocturnal pains in the teeth, insupportable wlien lying down, and compelling the patient to get up and walk; pains generally boring, burning, drawing, tearing, and resemblincr those of ulceration, attended with swelling of the cheek on the affected side. Dose: These remedies may be given every three hours, six pills at a dose, until relief, and then the time may be lengthened. The above are the four leading medicines, for this peculiar condition, though there are others which may be called for by particular symptoms, of which I will mention a few. Arsenicum, *^ Belladonna, Chamojnilla, Gelseminum, Ilyoscyamus, Merc. Sol., Nux-vom., Pulsatilla. SWELLING OF THE LOWER LIMBS— VARICOSE VEINS, This a very common attendant of pregnancy; it often occasions no little inconvenience, and is usually confined to the seventh, eighth and ninth months. It is supposed to arise, in most instances, from mechanical pressure alone, and to be free from constitutional disease. This is true in those cases where it is not accompanied by dropsical affetions. Standing and walking serve to aggravate this condition ; it becomes worse toward evening, gradually increases as pregnancy advances, and is often combined with a varicose state of veins. Many females suffer much during pregnancy from distention of veins in the thigh and other parts, which, becoming violent, eventually cause great pain and inconvenience. These varicose veins generally arise from obstructed circulation, caused by the pressure of the uterus upor the blood-vessels. Considerable alleviation is experienced by constant batliing with water or with diluted alcohol or brandy. Also, by bandaging from the foot upwards with a gentle and equal pressure, and by preserving a recumbent posture, which is required in severe forms of the complaint, accompanied with considerable swelling of the feet, ankles, etc. In order to afford relief we would recommend the following remedies. TREATMENT. Pulsatilla may bo given, particularly when there is excessive pain and swelling, with a good deal of inflammation, or when the veins are of a livid color which is imparted to the whole limb. Arnica is of great service when the occupations of the patient render it impossible for her to lay herself up, and avoid much standing and mov- ing about in discharge of her domestic duties. Pul<iaiilla and Arnica given in alternation, a dose every, day, will prove very beneficial in such cases. Nux-voinica when the affection is attended with constipation and piles, and irritability of temper. Dose: Six pills every evening. Arsenicum when the veins are attended with severe burning pain, with a sensation as if scalding water was running over them. Dose: Eight pills every second evening. Carho-veff., when Arsenicum is not sufficient to subdue the scalding burning sensation. Dose: As for Arsenictim, Belladonna. Varices with considerable erysipelatous inflammation. Dose: Six pills every four hours. ITCHING OF THE GENITALS— UKINARY DIFFICULTIES. 603 ITCinXG OF THE GENITALS.— {ritURITIS). Itching ot the genitals, which is a frequent attendant upon pregnancy is caused hy congestion of blood to the parts, and may often be relieved by bathing tlie parts with water la which borax has been dissolved, or with common soda and water. URINARY DIFFICULTIES AND DERANGEMENTS DUR- ING PREGNANCY. As gestation advances, the increasing size of the uterus causes it to press more and more against tlie bladder. Thus the capacity of that organ is diminished by tiie pressure which necessitates a much more frequent discharge of urine. The same frequent micturation results, too, from direct irritation of the neck of the bladder; causing hourly calls to pass water, which are sometimes but partially relieved by the flow of a few drops, only, at a time, or the irritation may amount to dysury, (painful urina- tion,) or even to a complete retention of urine. Where some displacement seems to be the cause, which may some- times be known by th'i suddeness of the onset of the difficulty, especially if it follows some accioent or over-exertion, the case should receive treat- ment for the difficulty, different than which arises from other causes, of which I will mention at the end of this article. Incontinence of urine sometimes appears, especially in the latter stages of pregnancy. When it ai)pears in the early months, it may result i'rom the pressure of the womb upon the neck of the bladder before it rises out of tlie pelvic cavity, causing the loss of tone of the part. This difficulty will often yield to the proper remedy, but if not, when it comes on in the early stage of pregnancy, it may be expected m disappear when quickening takes place, and the uterus emerges /rom the cavity of the pelvis. For the medical treatment of these difficulties, the following reme- dies should be studied. It is to be noted, likewise, that these remedies should be consulted and may be required for urinary difficulties occur- ring, not only during pregnancy, but before, during, and after parturition as well. TREATMENT. Aconite. Eetention of urine, with stitches in the region of the kidneys. Difficult and scanty emission, with pinching around the umbilicus (navel). Bright-red, hot urine. Desire to urinate, accompanied with great distress, fear and anxiety. Worse from exposure to dry, cold air. Dose : Six pills every half hour or hour owing to theseverity of thecase. Arnica. After passing a little urine she wishes to pass more, but is unable to do so at that time. Brown urine with brick-red sediment. A bruised and sore feeling exists across the lower part of the abdomen. Dose: Four or six pills every two or three hours. Cfintha. is. Very frequent urination, even sixtytimes an hour, with violent cutting pain, causing her fo scream. The urine is often bloody. The urine does not flow in a stream, but dribbles away, or passes drop by drop, with cutting and burning pains, and tenesmus of the bladder, which is agonizing in severity. Dose: Same as for ^co?wte, ' • Hi M "• \h m i 3M!i!| i\Mm m'A %A ™ii ,1? :!*, i 'I 664 PREGNANCY. t ml >', ' 'V Causticum. Frequent desire to urinate, a small portion passing away involuntarily. Involuntary passing of urine at night. Dose: As for Arnica. Coninm. The urine flows and stops, and flows and stops again, and so on. There are cutting pains during the How, and burning or smarting afterward. Vertigo, particularly on lying down. Dose : As for A mica. When the cause can he traced to displacement from accident or over- exertion. Belladonna and Platina have given me the best results. They are to be taken in alternation, every four hours. Complete rest will be necessary for a few days, in a case of that kind. MISCARRIAGE. Women who have suffered once from this affection are exceedingly subject to its recurrence, and this liability is still further increased after a second or a third attack. When it occurs before or about the third or fourth month it is attended with much le.ss pain or danger, although fre- quent miscarriages, owing to the abundant discharge that is generally present, break down the constitution, and frequently develop severe chro- nic diseases. When a miscarriage takes place at a later period it assumes a very serious ouilook, and is accompanied with a considerable degree of peril to the patient. Exciting Causes— Are sudden mental emotions, such as fright, grief or excessive joy, mechanical injuries, or excessive physical exertion, such as lifting too great a weight, reaching up high, going up or down stairs, long walks, riding on horseback or in carriage over rough roads, railway traveling at too great a speed, etc. Other causes are, a luxurious mode of life, fashionable habits, neglecting to take air and exercise, while an unhealthy state of the constitution, giving rise to numerous local and gene- ral derangements, is undoubtedly i\\Q predisposing cause. The Symptoms vary so much in particular cases, that it is almost impossible to give any particular train of symptoms — though most cases of miscarriage are preceded and attended by the following symptoms: A chilly sensation followed by fever with more or less bearing-down, par- ticularly when occurring late in pregnancy; also, severe pains in the belly; drawing and cutting pains in the groins; or pains frequently bearing resemblance to those of labor; discharge of viscid mucus and blood some- times bright red frequently mixed with clots; at other times dark and clotted followed by the emission of a thin, colorless fluid. Tl\,e miscarriage generally takes place during this discharge, which occasionally continues, if not properly checked, to flow for houns, therefore placing the sufferer in considerable jeopardy. After the child has been expelled, tlie flooding and pains generally disappeargradually ; but if a portion of the placenta (after- birth) be left within the womb, the pains may continue with more or less severity and irregularity, the flooding will frequently become excessive and alarming, and offensive, putrid discharges will take place from the vagina. When miscarriage is threatened, the individual tnust assume the recumbent posture, and in some cases, indeed, should be strictly confined 10 the bed, sleeping with few bedclothes ; the apartment should be kept MISCARBIAGE. 665 cool, and every means should bo employed to ensure perfect repose to the mind. In all cases of miscarriage, medical assistance should be summoned as promptly as possible; but as life may be lost in urgent cases before a phy- sician can be obtained, the following additional particulars should bo observed :— When the misfortune gives evidence of being unavoidable and the hemorrhage is excessive and is not promptly arrested, by properly selected medicines, the following directions should be observed: Apply cold to the abdomen in the form of cold cloths or sacks of ice or cloths wrung out of ice water, etc., which will frequently have the desired effect, by causing the womb to contract and discharge its contents. As perma- nent cessation of the flow cannot be expected until this is accomplished, and as it is frequently slow to dilate sufficiently for that purpose, the pas- sage should be plugged to prevent the flow until the womb is sufiiciently dilated. A piece of sponge of sufficient size, or a plug made of old muslin or linen rags with a string attached of sufficient length to disengage it when necessary, (called a tampon) may be used for the purpose, and should be cautiously inserted. The tampon should be large enough t) entirely fill the passage, so as to obstruct the flow of blood. At the same time the indicated remedy should be given, and frequently upon removing' the plugs, the womb will be found dilated and will expel its contents. The tampon, (plug) however, is only to be used in miscarriages occurring before the period of quickening, never afterwards. Another, and perhaps the best and safest plan to adopt for dilating the mouth of the womb is this: The patient should be placed upon the bed in the same position as for labor. The bed should first be protected with oil cloths or India rubber clolli so arranged as to guide a stream of water from the vulva into a pail or tu)> placed near the bed. Another pail must be provided containing tepid 'ater; with a common syringe, the warm water should be thrown diredlij upon the mouth of the tvovib. This operation irritates and softens the neck of the uterus, so that contractions set in in the course of an hour or two, and thus labor is provoked and takes place in the m6st natural manner possible, except when it occurs in nature's own way at full term. This operation should be repeated in the course of two hours, if the first experiment should not prove sufficient. This will fail unless the stream is directed upon the mouth of the womb. The following are remedies. ... TO PREVENT AND ERADICATE A TENDENCY TO MISCARRIAGE, Sabina is particularly applicable to women who habitually miscarry about the third montli. Feeling of sinking or faintness in the abdomen. Violent forcing or dragging pains extending from the back through to the pubis. • Dose: Six pills in a teaspoonful of water, repeated after the lapse of twelve hours, and again after the lapse of twenty-four hours, grad- ually lengthening the interval for each successive dose, until tiie p(Mi()d of danger is past,— being careful, however, to watch the effect of each administration to discontinue or lengthen the intervals as the case may require. Secale, Especially after miscarriage has already occurred more than once, and is generally more suitable to thin, scrawny, exhausted women; I' % ^■^m m ffll Ml (icr. PBEGEANCY. passive lieniorrhage with little or no pain. Great debiUty, feeble almost extinct pulse. Dose: Six globules, as directed for Hallna. Sejna, Painful sensation of emptiness at the pit of the iiiomach Senseof weight in the anus like a heavy ball. Yellow saddle across the nose. Pressing in the womb, with oppressed bi-eathing. V^vy fetid urine depositing a clay-colored sediment which adlieres to the vessel with great tenacity. Dose: As directed for (Sa6m. Viburnum Prun. Spasmodic pains shooting from the abdomen into the legs. Frequent and very early miscarriages, thus causing sterility. This remedy is almost specilic as a preventive for miscarriages. Dose: Six drops of the tincture to be taken every evening, in mild cases, in urgent ones, every morning, noon and evening. THE ACTUAL ATTACK. Arnica. When the symptoms have been excited by an accident- such as a fall, blow or concussion, and there is a sore, bruised feeling, tliis remedy will prove effectual, if administered as follows; Dose: Take six pills every ten, fifteen or twenty minutes, (in very urgent cases,) and subsequently every half hour, gradually extend- ing the intervals to three hours, and continuing the administration until decided improvement or change, Rims. If the symptoms have originated in a strain from lifting, pulling, or dragging a heavy weight. Pains worse in the latter part of the night. Dose: As for Arnica. Belladonna, Flushed face, red eyes, throbbing and heat in the head. Pain in the back, as if it would break. Severe bearing down, as if every- thing would fall out. Profuse discharge of blood, ..either very bright nor very dark colored. Pains which come on suddenly and ceases just as sud- denly. Great intolerence to light and noise. Dose: As for Arnica. Chamoniilla. Periodical pains resembling those of labor with dis- charge of dark colored or coagulated blood. Violent pains in the bowels extending to the sides, with frequent urination. Becomes almost furious about the pains. Hot i)erspiration about the head. Dose: In every respect as for Arnica. yttx-vom. Every pain produces a desire to evacuate the bowels, or to urinate. Much pain in small of the back, which is made worse by turn- ing in bed, writhing pains in the abdomen, accompanied by nausea or pains in Mie back or loins as if dislocated, constipation of large difficult stools. Persons of sedentary habits. ' ■ Dose: As for Arnica. Pulsatilla. Labor-like pains, attended with hemorrhage ; restless- ness. The discharge is arrested for a little while, then returns. witli redoubled violence. Suffocative spells. She craves fresh air, and is worse in a warm, close room. Inclination to be chilly, even in a warm ro<im. Mild, tearful women. Dose : As for Arnica. Ipecac. Profuse and continuous discharge of bright red blood, accompanied with a pressure downward. Cutting pains around the naval. TREATMENT BEFORE CONFINEMENT. Bfi7 Continual sense of nausea, without a moment's relief, disposition to faint. Dose: A\iiox Arnica. China. In weak and exhausted persons, when there is loss of fluids. After miscarriage, when tl'.ere has been loss of blood unto fainting, gid- diness, drowsiness and loss of conciousness. Heaviness of the head, ring- ing of the ears, and coldness of the extremities. Twitching and jerking of single muscles. Dose: As for Aimica. HOME REMEDIES. Something simple, and in almost every house, is Nutmeg, of which take one and grate into a bowl or cup, and pour boil- ing water on. Drink the tea. This often arrests very severe cases of hemorhages. TIIEATMENT BEFORE CONFINEMENT— PBEP AM ATION OF THE BREASTS. Young mothers frequently find much difficulty in nursing their infants in consquence of some defect or incapacity of the nipple. In -many instances, the structure of the breasts is disorganized by an ignorant nurse having compressed them in childhood, under the idea that such barbarous management was necessary to expel some of the contents of the breast ; mothers should be particularly watchful against this practice. The use of improper stays in after life, by which the skin is rendered so tender as to preclude suckling, often occurs. The first two cases are beyond the power of art, and if suckling be .attempted, hardening of the nipple and breast ensues, attended with severe suffering. Anotiicr difficulty frequently occurring, is a shortness or retraction of the nipple, so that it is impossble for the infant to take hold of it. I have fre(iuently had charge of young mothers whose nip- ples were so small that they were unable to nurse their babe. If this should be the case — if the nipple should be sunken instead of protruding- it has to be drawn out by means of some suitable instrument in the shape of shields, or an exhausting pump; a convenient one, in many instances, can be made in this way. Take a bottle with rather a large neck, pour hot water into it, then empty and quickly place the neck of the bottle over the nipple; the air cooling in the bottle will cause the nipple to draw down, and thus lengthen it. After the nipples have been drawn out, they have to be gently pressed and worked with the fingers in order to harden them, lest the delicate skiu should be injured by the sucking of the infant. During the two months previous to the expected conflnement,the nipples should be washed every day with cold water, borax and water, alum and water, or with rum or brandy. The whole breast should be washed quite frequently, more especially during pregnancy. It may, also, be here remarked, that when any ten- derness exists during the period of nursing, the shield should be resumed between the intervals of the infant being applied to the breast, and the bathing continued— due care being always taken to lave the nipple care- fully with tepid water before it is again offered to the child. Stiljthur will frequently be found useful if an eruption breaks out on the nipples, six pills the first thing in the morniug, after which the erup* tion generally disappears. '*> I'j nil m .'ii-;.i. M f, m 'H'l : it| «fi8 PREGNANCY. "} \\ I :f ^ .'ik iiiift i 1 iji? 1 i ii H i V' I ill PRECtTRSORY SIGNS OF PARTURITION. A few diiys, or even two weeks, before confinement, the uterus begins to descend. Until tlie thirty-eiglitli totlie thirty-ninth week of preg- nancy the uterus keeps rising in the abdominal cavity, and the breathing is very much interfered with. As soon as the uterus begins to descend, the breathing becomes freer, and the pit of the stomacli again becomes vis- ible ; but now the uterus presses upon the pelvis like a heavy burden, and the female feels as if her hips would come apart. The small of the back is par- ticularly affected by the presence of the child's head against the internal surface of the sacrum, which sometimes feels bruised and numb, in con- sequence. Another sign of impending parturition is the frequent and anxious urging to urinate, caused by the increasing pressure upon the bladder by tlie descending uterus. The last and most reliable sign of parturition is the appearance of the first labor pains, which may set in a few days pre- vious to the act of parturition, but which, generally, are i.ot felt until a few hours before the event. THE BOWELS. If the bowels have been constipated, an artificial evacuation previous to delivery, may be obtained bv a lavement of lukewarm water, repeated with a small quantity of linseed or sweet oil when necessary from a fail- ure in the first attempt to obtain the desired effect. Injection. If of lukewarm water simply, inject about a pint; if the addition of oil be necessary, to a pint of water add two tablespoon fuls of the oil ; shake them well together in a bottle, or other closed vessel, and inject the mixture. PREPARATION OF THE BED FOR LABOR. If the means allow, the confinement bed had better be arranged a r<,'w days previous to confinement, since at the last moment something might be forgotten, or a needful article might be wanting, because the hurry *nd anxiety of finding things are both unpleasant and injurious to the patient. The best thing for a patient to lie upon, is a simple matress, which should be sligb tly raised toward the head. The nates (hips) should be raised upon a cushion about a hand high, which may be covered with oil cloth or rubber cloth, or any common cushion may be used for the purpose, the object of which is to raise the body so as to procure the necessary space for an examination, and for the reception of the infant. The bed should be arranged so that every part of the body, from the nates to the head, is supported. The body being thus supported, the following rules may be observed in regard to the thighs and legs: It is better to have the space between the thighs and the foot-board of the bed just long enough so that the feet of the patient may press firmly against the foot-board; but if the space should prove too much, a foot-bench may be placed between the bed and the feet, so that she can press against it without drawing up the knees. It is sometimes necessary to have a cord or sheet attached to the foot of the bed, which the female may hold in her hands during the pains, *'or the hands are oftei) spasmodically contracted during the pains, and it PARTURITION OR LABOR. 069 affords the patient great relief to hold soinething firmly in the hands at such a time. Holding another person's hands, likewise, affords relief to the patient. Persons frequently arrange the confinement bed by the side of the regular bed, into which they are lifted soon after the act of parturition is iicconiplislied. However, those wlio do not find it convenient to prepare !i separate couch, must protect the matress by some old cloths, or oil or rubber cloths may be placed under them, to prevent the fiuids lost by the mother and child from soaking the matress. Even after parturition, it is best to leave the oil cloth under the patient, for the fiow of blood con- tinues quite freely for a few hours after labor. After preparing the bed for confinement, we will now consider— FALSE PAINS. False pains sometimes precede labor but a lew hours— but in many cases come on some days, or even weeks, before delivery, and chiefly differ from labor pains in these respects : they usually begin at the upper part of the womb, are seldom felt in the back, do not extend so greatly around the lower part of the body as the true pains, are eitlier on all the time or appear with great regularity, and do not cause the womb to become firm iind hard, while the true pains do. They are chiefly confined to the belly with sensibility to touch and movement, and in fact are very annoying. False pains can sometimes be distinguished from true ones by sitting over a vessel of warm water after which, if false, they will frequently abate, and if labor, they will continue with more regularity or strength. TREATMENT. Bryonia is indicated when there are pains in the loins resembling a dragging weight, much increa.sed by motion, with pains in the abdomen, preceding those in the back. This remedy is more par- ticularly indicated when the above symptoms have been excited by a fit of passion, or by taking cold. Dose: Of a solution of six globules to four teaspoonfuls of water give a teaspoonf ul. If soon after tlie administration of the first dose an aggravation of the pain ensues, pause until two or three more parox- ysms have occurred ; and if these succeeding pains prove to be of diminishing intensity or frequency, do not repeat the dose until re- lapse threatens. On the other hand, if no improvement is the result, repeat tlie dose after an interval of three hours, and so on, if the proper time for the expected time for labor is not nearly due— dis- continuing immediately on relief or change. Nux-vomica. When the exciting cause seems to be constipation or mental irritation, or too luxurious mode of living, stimulants or spirituous liquors, etc. Dose: As directed for Bryonia. Pulsatilla. Abdominal pains and pains in the loins resembling those from continued stooping, or pressure of a tight bandage, attended with painful dragging and aching in the thighs, constipation or relaxcition, mildness of temper or great sensibility; particularly when these pains seem to have arisen from indigestion brought on by rich indigestible food. Dose : As directed for Bryonia. "nil i ^■^.: Il'-f PARTUBTTION OB LABOR. During the first pains of the female, slie may remain dressed and out ol: bed, because a certain unrest drives her from place to place, and it I ! 1, li am 1 ■'■'■2 ^^Hj ^'' i ^fM^llSS ,;,;.p 11 !:!■' , : ■ J Hi 670 PUEaNANCy. would not be best to conflno lier to her bed. But iill things should V^ made ready; tlie attending physician should be sent for; w arm water should be at hand ; and in some convenient place in the sick room (all in one place,) the infant's linen bandages, and little strips of linen, should be kept all ready ; also, a pair of scissors and two pieces of string, each about one-half a yard long; the strings may either be tape, about a quar- ter of an inch wide, or cord of sufficient size and strength suitable for tying the cord attached to the infant ; a little fresh lard, or oil, some soap and pins, should also be at hand. Besides the attending physician and nui se, a friend may, likewise, be present in the sick room (if requested by the patient,) in order to comfort and quiet the sufferer. But all superfluous, persons, such as callers and children, must be ke2Jt away. If the pains become stronger, the female should lie down. Perhaps by this time the water may break, which may take place with a feeble report. A young woman who has never borne any children, should be warned of this event, so as not to get frightened by the suddenness of the occurrence. Nothing should be done, by irritating the neck of the womb, dilating the mouth of it, or by any other artificial means, to hasten the moment of delivery. This is the business of nature, who knows best when the right time has come for ushering the child into the world. Every arti- licial interference is contrary to law, and is more hurtful than useful. Of course, tliese rL-niarks apply o ly to natural labor. In preternatural labor, or those requiring mechanical mean.s, the conduct of the attending physi- cian depends entirely upon his or her own tact and knowledge. Tht parturient fenmle may adopt any position that is most comfortable toiler — jii the side or buck, with her limbs stretched out or raised; but she must not boar down during a pain, until the right time for it has come." Prempture bearing down may result in distressing weakness of the womb; ' not only the child, but the whole organ, is pressed by such untimely eftorts. No bearing-down should be resorted to until the mouth of the womb is dilated so that the infant's head is protruded at least half its length. At this period, the patient may assist nature by holding the breath and bearing-down during a pain, with her head bent forward, (never backward, lest she should give rise to the formation of Goitre). During the passage of the head through the soft parts, the perineum (bridge between the front and back passage) must be properly supported, lest rupture might take jjlace; at each pain, tlie attendant should place the palm of the hand against the perineum, without, however, making any pressure against it, until the perineum remains hard and globular, even between pains. At this season, the patient may contribute a great deal to a rapid and successful delivery by a suitable position of the body. As soon as the head shows a tendency to pass through the vulva, the patient should remain quietly on her back, with her feet firmly pressed against the foot-board, an'" legs extended and stretched apart a comfort- able distance. At this stage, all bearing-down may cease, lest a too rapid delivery of the head should rupture the perineum. After the head is born, and the shoulders are still within the vagina, a short pause generally takes place, which must not be broken by an^ ^emm PARTURITION OR LABOR. 671 improiter pulling on the head which may give rise to fatal dislocation of the vertebra). Supporting tlie head with one hand, the abdomen may be gently rubbed with the other, in case the pains should not come on again with sufficient speed. The patient may now rest assured that, by assisting the remaining efforts of nature, delivery will soon take place. Occasionally it has happened that parturient females, while com- pressing the teeth during a hard pain, have broken off a portion of the tooth, or have lost the whole of it; therefore, it is always best to have a handkerchief or napkin placed near her, which she may crowd into her mouth as soon as the pain is approaching, or if she should be surprised too suddenly, one of her attendants must do this office for her. THE placp: of thk accoucheur (physician^ at the bedside. As soon as the labor pains assume an expulsive character, the attend- ant should place himself or herself by the side of the bed where they can use the right hand most convenient, and should not leave the bed-side of the patient. We may assist the female, either sitting or standing, according as is most convenient. The patient should not be uncovered, as it is entirely unnecessary to expose the patient's person, and is also, risking the chance to take cold, which, at this time, would be very injur- ious. As soon as the little one makes its appearance into the world, it may be uncovered enough so that it may be wiped ofT with a soft cloth, which may be placed convenient for the purpose, but the mother need not be exposed, even at this time. THE CARE OF THE CHILD DURING LABOR. Immediately after the expulsion of the head, we should feel with one finger about the child's neck to see if the cord is around it ; in case it should be, u slight traction on the cord may loosen it from the placental end, so that it will slip over the child's head, leastwise will keep it from choking or strangling it. When the head is born, it should be carefully supported from the clots and other discharges from the uterus, patiently waiting for the work of nature to complete the delivery. After the expulsion of the child, it is better to turn its back to the mother, and let her covering fall between the child and herself, thus, at the same time bringing the child to our full view and completely protect- ing the mother from cold and exposure. A soft cloth should now be used to wipe the child's face, eyes, and mouth. It usually cries lustily as soon as it is born, but it should be permitted to lie undisturbed for^some four or five minutes, or until breathing is established. The cord siiould then be tied about three inches from the child and again about an inch further along the cord, and then cut betweeen tlie two places. The child should then be wrapped in a blanket and handed to a nurse to wash. After it has been properly washed and thoroughly dried, a piece of raw cotton, or cotton batting the size of the palm of the hand, should be laid on the abdomen just above the naval, the remnant of the cord laid on it witli its cut end pointing upward— the cotton being arranged so as to embrace the base of the cord— and another piece of cotton of the same size placed over the cord, the whole being kept in place by the usual belly baud. It ill. Hi Ill (;7; rUEGNANCY " fM •!va THE ATTENTIONS TO THE WOMAN AFTER LABOR. After the child has been handed to the nurse, the next care of the attendant is to look after the delivery of the placenta (after-birth); until it is removed, and the uterus is firmly contracted there is more or less danger or Hooding. In most cases, there is a short suppression of the pains immediately after the expulsion of tlie child, after which the pains return in u diminished degree, and the after-l)irth usually becomes detached, and either lies free in the vagina or is expelled without the vulva. If it should not be outside the vulva a very slight traction of the cord a little upward and outward, taking hold close up to the person, will be all that is necessary to disengage it, after which it should be care- fully scooped up and placed in a vessel ready for its reception. The woman should then be made comfortably dry, and a soft dry cloth should 1)6 applied to tlie vulva. She should then be straightened out a little in bed, and in all respects made as comfortable as possible, both mind and body must be kept in a state of perfect repose; every- thing which may tend to arouse the excitability of the patient, such as talking, noise, strong light, and odor must be carefully avoided, and the room kept at a moderate temperature. GENEKAL MANAGEMENT, DIET, ETC. In the first place, we would most severely disapprove of administering stimulating, and even spirituous beverages after delivery, which, far from possessing a strengthening pro])erty, tend only to excite tlie whole nerv- ous system. As a usual thing, for some time after parturition, nature calls for but little nourishment; it should be given only, and when the woman herself, expressly feels the need of it, and then let her partake of such nourishment as she particularly craves, (unless it should consist of rich meats, pastries, and vegetables wliicli create gasses in the stomach and bowels ;) however, we must allow nature to pursue her own course, whicli, as a general thing, prescribes but little nourishment for the first five or six days after delivery, and thereby avoids the necessary call- ing of the bowels into action, which state of constipation (if it may i)e so called) is ordained for the wisest purpose, and attended with the most beneficial results; the balance of the system is kept up by the passing off of effete matter in the shape of increased perspiration, etc. Then we cannot sufficiently condemn the use of physics, which only tend to promote irritation, and occasionally aid in bringing on puerperal fever and other evil consequences. In many cases, this artificial relax- ation, also, interferes with the proper secretion of milk. After the fourth or sixth day, nature generally acts spontaneously. When it appears neces- sary to afford mechanical assistance, we may do so by application of warm friction to the abdomen, or the employment of a lavement as directed to evacuate the bowels before confinement. When a costive state of the bowels continues so long as to cause inconvenience, the appropriate medicine may be selected and administered according to the directions for constipation of pregnant females. •" • '• ' ■-'' ' ■ AFTER PAINS. These pains, which frequently annoy the patient so much, especially if she be of highly nervous sensibility, and deprive her of the necessary AFTER PAINS— FLOODINQ— RETENTION OF URINE. C73 rest, ought, under such circumstances, to be subdued as soon as possilile ; by means of the following remedies, ood results will certainly follow. TREATMENT. Arnica employed internally, and also externally as a lotion, when there is a sore feeling all through the patient, as if from a bruise. The pains are not very severe, but there is a bruised, sore feeling, with pressure on the bladder, and retention of urine. Dose: Internal. Six pills every two hours, commencing immedi- ately after the delivery. Application— externally. To four table- spoonfuls of tepid water add fifteen drops of the concentrated Tinc- ture of Arnica, and apply to the parts. Chamomllla should be administered an hour after the second dose of Arnica when the after pains still continue to a severe extent, and the patient is highly excitable and sensitive. It is sometimes beneficial to alternate the two. Dose : Six pills repeated if necessary after the lapse of an hour from the first dose, then pause three hours and so on. Nu'jr-vomiva should be emi>loyed when the after pains are very severe and there is a continual inclination to relieve the bowels when lying down, hut passing away when rising, accompanied by inclination to cramp in dillerent parts of the body. Dose: As directed for Vhamomilla. Pulsatilla is to be preferred when the pains are protracted and the patient is of a mild, tearful disposition, but sensitive and easily alarmed about lierself ; the pains become worse towards evening. Dose: Six pills as directed for ChamomiUa. Secale is indicated in feeble, thin and delicate women when the pains are more particularly of a pressing or forcing nature, similar to labor pains. Dose: As directed for ChamomiUa. t 1 ^r. III It Vi<^^M>H^«^«* FLOODING. W th respect to the treatment of flooding or excessive oischarge of blood as incidental to delivery, it will require exactly the same medical and general treatment as is given in the article on miscarriage, page 642. It is to be remembered, however, that while in flooding after labor at /mW term, the application of cold to the abdomen is allowable in severe cases, while the tampon or plug is not to be resorted to. It may be mentioned, in addi tion, that pressure made upon the womb through the relaxed walls by clasping it with one or both hands equally and forcibly, but yet gently and without roughness, very frequently arrests the hemorrhage with great promptness. Injections of water as hot as can be borne, continued for some time, will produce the same good results. m RETENTION OF UBINE— SPASM OF THE BLADDER, During the passage of the child's head out of the womb, it is sometimes pressed against the bladder with so much force, that it causes an inflam- mation and irritation of this organ. The best remedy is Arnica. Next to Arnica, Cantharis, or Nux. Vom. 43 'I 1% 674 PREOMANCV. Dose: Four pills every Imlf hour, especially if iho urino passes off drop by drop, and the dlachargo oaust's pain. It may bo well to apply warm cloths or other warm applicutious to the parts, for tlie warmth will have a relaxing tendency. INCONTINENCE OK UHINE. An incapability of retaining the urine is, on the other hand, another not unusual sequel of protracted or severe labor. TREATMENT. The employment of Arnica, internally and .exter- nally, OS advised under the head of "After Pains" at page 672, is in the majority of cases, sufficient to overcome this weakness. When it fails to accomplish this object, the following remedies should be had recourse to: PulsatilUi is frequently successful in remedying the defect in from two to four days. Dose: Six globules three times a day, for two days. Belladonna may be given, If, in one or two days after the last dose of the foregoing medicine has been given, only partial relief has ensued. Dose: As directed for Pulsatilla. yi DURATION OF CONFINEMENT. Btrict attention should be paid to cleanliness and ventilation of the lying-in chamber. Everything that produces an offensive odor should be promptly removed from the room, and a draught of air sliould be allowed to pass through tlie room (not, however, across the patient's bed). The parts should b' ' d daily with lukewarm water so long as the dis- charge conf is should be performed under the bed-clothes. The aould make no exertion during the first three or four days, ' .ast until the proper secretion of milk ; after that time, she may be . cjiully moved from the bed t-o a couch, long enough for the bed to he aired a little. After the tenth day she may sit up out of bed, for a short time if she is able, which may lie lengthened gradually from day to day, as she gains strength. Thus, too, she may begin to walk, little by little until she gradually grows stronger and more accustomed to exer- cise. In summer, she may ride out during the third week; and in win- ter, during the fourth week, all things being favorable. CHAPTER XXXII. DISEASES FOLLOWING CONFINEMENT. SECRETION OF MILK. This Is one of the most interesting and remarkable changes occurring during the lying-in period. While the child is still in the uterus, all that pertains to the mother unites to effect its nourishment, growth and development there. Suddenly all this is interrupted, the child is expelled from the little world within, and has to flni nourishment else- "•i.^ ■pmt SECRETION OF MFI.K. 675 whete. NiiturcintoiulH i( (olK'HupplU-d.aslHfnio ,fronrthr^inatcrniiI blood, though tliroiigh (ho medium of miimmary t;l:in(lrt. Tlie reaction upon tl>e organi-sm, from tills ciuingo from tlio uteruH to tUo breast, cauHes what is cailfd milic foviT, in coii.si'(iu»iit'o of wliich tlicrc rcHults a dlsturbunco in the HyHtem. more or Icsa well mariced, according to tlieobHtaclea to be overcome. In Home cases appears chlll.s, fevers, heada(!hes, and a great variety of pains and suffering; while In others this period is passed witliout any of the above mentioned dlHturbunees. As a general thing, all the disturb- ances incident to the coming of the milk, are less when the child is applied to tlie breast as soon after delivery as is practicable. Much advan- tage is giiined both to the mother and child, by this method, since it serves to lessen tlieHudering of one from hunger, and the danger of the other from fever. SUl'PRKSSION OR SCANTY SECRETION OF THE MILK. It is of vast importance that the natural operations of the organism l)eculiar to tills condition proceed with regularity. Among these, the secretion of milk takes a prominent position, and its sudden suppression is apt to be followed by internal and local inllammatlon. How of blood to the head, hot and cold flashes, etc. The use of tiie following remedies uhould be employed according to their indications. TREATMENT. PnlHatUl i should be promptly employed in cases of sudden suppression of the secretion of milk, whatever cause has occa- sioned it ; and this medicine will freiiuently bo found sufficient to restore the natural flow of milk. Dose: Four pills repeated every four hours (or every eight, in very mild cases) until change. /J/7/o»i/<t is to be preferred when there is oppression at the chest or stitching pains in the chest or side, or more particularly if the suppres- sion can be traced to some sudden mental emotion, or to catching cold. Dose : As for PulsntiUn. Chutnomilla should be selected, if the patient be particularly irri- table and excitable, and the suppression be followed by intense flushing of heat or burning lieat of the hands and face, either with crimson flush or alternate flushing and paleness, or one cheek red and the other pale. Done : As for Pulsatilla. Belladonna should be given in cases in which the suppression is characterized by redness of the face, and general symptoms of congestion of the head, brejists feel heavy and appear red, and the redness running in streaks over tliem ; sensitiveness to noise, light, or touch. Dose : As for Pulsatilla. Aconite should be given if active feverish symptoms, such as hot, dry skin set in, and, under such circumstances, will remove the whole iisordered condiKon with promptitude. Dose'. Four pills every two hours. 1 iH (■ r Mil Hf » M»' h 'H I i i.v EXCESSIVE SECRETION OF THE MILK—GALACTOR- RH(EA. occasionally, on the other hand, it happens that too abundant a secre^ tion takes place, causing distention of the breasts with spontaneous flow iW ' i.'il: i 1 M 1 1 ; !j.i: ! ■' , I. ::fe ()76 DISEASES FOLLOWING CONFINEMENT. 1 .'1 1 1 1 1 1 I h 1 '< !i!;H! '1 j!;s^,-i 1 1 ; j 1 of milk, keeping the breasts constantly wet. Relief from such an uncom' fortabluHUite may be obtained by the appropriate remedy according.to the indications below. The function of lactation being one purely physi' ological,and provided for in the economy of suitable forces. Under thestim* uius ofmatenr ' .istinct and afFection most women enjoy perfect health during its cor.u lUiSMce. Many, indeed, are never so well as when giving suck to their c^ !(]ven. Under the inlluence of this process, there arises a greater activity of .'■' the functions at the same time, 1= .d, also, a greater strength of appetite, and corresponding energy of the digestive powers. The process of conversion of food is unusually rapid, the excess going to form milk. Where a greater amount is thus formed tlian is required, the .system becomes gradually exhausted, even in health. This over-pro- duction may be due simply to excess of vitality, while itniay result from the etrorts of nature to supply the required material support, even under difTculties. The following remedies will be found beneficial, as the indi- cations appear : TREATMENT. Aconite may be taken as a precautionary measure when there is high febrile action of the whole system, and we are igno- rant of the exciting cause. Dose: Take f ur globules repeated at intervals of four hours, until the frequency of the pulse is diminished and the skin becomes moist. JRhus-tox, frequently proves of much service where febrile symp- toms ari.se from distention of the breasts, induced by an excessiv secre- tion, and indications of wliat is generally termed milk fever (which, how- ever, frequently arises from other causes). Dove; Three globules every six hours until amelioration or change. Calcarea Carh. should be employed in cases in whicli excessive distention of the breasts, spontaneous emission of milk and loss of flesh occur without any marked and active fever symptoms— or after the pre- vious employment of Aconite or Rhus, when tlie fever symptoms have been allayed. Dose: Six pills as directed for Rhwi. Phosphorus is of especial value in cases of this kind, when there are marked signs of a tendency to consumption, and emaciation takes i>lace rapidly. Phosphorus is yet further indicated when there are sensations as of a rush of blood, with oppression ai- the chest, and sometimes even short, dry, hacking cough. Dose: Three pills as directed for iJ/ms. PERSPIRATION AFTER DELIVERY. The increased perspiration which takes place after child-birth, is as before mentioned, a substitute for the suspended action of the alimentary canal, consequently its sudden suppression is unavoidably followed by an injurious result, and not unfrequently followed by fever. Exciting Causes. Exposure to cold, or a sudden chill, or applying damp linen or clothing not well aired, are the most frequent causes. TREATMENT. Dulcamara should be promptly administered when the perspiration has been checked by a chill, and in such cases a single EXCESSIVE PERSPIRATION— MILK FEVER. G77 dose will often restore the action of the skin, and prevent further injuri- ous consequences. Dose: Four pills repeated, if there be a degree of effect after the lapse of three hours, but if no evident reaction should have occurred, pro- ceed with the next remedy. Bryonia is to be administered when extreme oppression at tlie cliest is present, or when there is a feeling of soreness and aching in all the limbs aggravated by movement. Dose: As directed for Dulcamara, Sulphur should be employed after the foregoing medicines, in cases in which such treatment is insufficient, and there is more especially intense heat of the skin %t.'1 distrese. Dose: As direeced for Dulcamara. EXCESSIVE PERSPIRATION. On the other hand, an excessive perspiration is equally as harmful ; it is chiefly injurious from the extreme debility and high susceptibility of taking cold which it occasions. It is generally brought about by keep- ing tlie room at too high a temperature, the use of too many bed-clothes, or by stinmlating beverages. TREATMENT. Our first care should be the removal of the exciting causes, after which, if it still continues excessive, the following remedies may be employed. China should be employed if the perspiration be of an exhausting "character and attended with great debility. Dose: Six globules every tliree liours. Aci(fnin Snlphurimnn is to be preferred when the perspiration is excessively profuse when lying still, but is diminished when moving about. Dose: As directed for C7< ma. MILK FEVER, The secretion of .nilk is considered an operation of nature and not one that requires medical aid for its regulation ; but occasionally suffer some slight uneasiness for r few days following confinement; and when any of the below mentioned group of symptoms present them- selves, the affection is known by tlie name of Milk Fever. Symptoms. Shiverings and heat terminating in perspiration ; the pulse is at first weak, changing to various phases, (sometimes quick and frequent,) at others soft and regular ; and in some instances the symp- toms are attended with a drawing pain in the baclt, extending to the breast, a disagreeable taste in the mouth, thirst, oppressive breathing, anxiety, headache, etc. Exciting Causes— are neglecting to put the infant to the breast sufficiently early, which allows the absorption of the milk into the cir- culation, mental emotions, fright or fjiger, and excessive talking. TREATMENT. Nature herself, if not distdrbed by improper treat- ment, will, in most cases, suffice to restore the equilibrium of the system ; k i> -H W ii I, mi % 678 DISEASES FOIiLOWING CONFINEMENT. hmifM should the affection become aggravated we may dread the setting in of puerperal fever. Aconite must be employed in all instances where considerable fever is present, and will usually remove all the symptoms. Dose: Give four' globules repeated after the lapse of three hours if necessary. Pulsatilla win be found particularly useful in severe cases, espe- cially when caused by taking cold, and appearing more like a rheumatic affection and have the general symptoms of milk fever. Dose: As directed for Aconite. Belladonna is very useful in particular cases in which complications with very severe disturbance of the brain, or when inflammatory action in the breast may supervene. Dose: Three globules repeated at intervals of four hours, until a degree of improvement sets in, and then at intervals of six hours. Ithuft. is also of considerable service when extreme fullness, tension and painfulness of the breasts, with excessive secretion of milk, attend the case. Dose: As directed for Belladonna. ji ^11 CHILD-BED FE FEB— PUERPERAL FEVER. This trouble is of so grave a nature that it is with reluctance that we approach the subject. Where it is atall possible, we would advise a skilled physician to be employed. As this work, however, will enter some home where no physician can be procured, it has been thought judicious to treat tile disease at sufficient length to beavailable in cases of emergency. Symptoms. This disease assumes various types an^ degrees, and has received various names. Usually the disease begins on the second, third, or fourth day, although in some cases it even appears later, as late even us the eighth or ninth. It sometimes >egins with a distinct chill, and again, there may be only slight chilliness, imperfect and merely noticed. The pulse is very rapid, full and soft. In some cases there is neither pain, distention nor tenderness of the abdomen ; while in others, the pain is very acute, the distention enormous, and the tenderness exquisite. Profuse sweating is a very common and distressing accompaniment of this disorder; the sweating of puerperal fever does not diminish the amount of urine, nor abate the quickness of the pulse. An intolerable thirst prevails, and the patient drinks immense quantities of whatever fluid she may be allowed. Dark spots appear on the wrists or other parta of the body. At first, the lochia may be unaffected; they may be even increased in quantity, but more commonly they are entirely suppressed. As the disease advances, usually about the third day, diarrhoea and vomiting may supervene. The patient becomes listless and languid, losing all interest in surrounding circumstances, and even in her child, and the expression of her face indicates anxiety and great prostration ; or, on the other hand, she may be unduly excited, nervous and trenmlous. If the disease )i presses in spite of treatment, delirium commonly supervenes. Rattling of the breathing, with enormous distention of the abdomen, are usually regarded as fatal symptoms. -rn CHILD-BED FEVER. 679 As the disease advances, the womb, the peritonium and other organs, and tissues of the abdomen become involved in the prevailing inflamma- tion. The first symptoms of this disease are similar to those of "milk fever," but the distinction is to be made by the fact of absence of pain, and, more particularly by absence of tenderness in the abdomen. Causes. This disease may result in consequence of a chill occasioned by a draught of air, or other cause, or from the use of damp or wet linens, or it may be occasioned by violence ; or again, it may be impossible to assign any reason for its occurrence ; in which case we are led to believe that it is due to infection, or arises in consequence of some lurking taint or predisposition of the system. TREATMENT. Aconite should be employed, at first being indicated by the feeble condition, and by other circumstances; and will in very many instances, when promptly administered, particularly in those cases of a more simple form, serve to dissipate the entire disordered condition, and restore harmony to the system in an almost magical manner. Dose: Give four globules every hour, oi half hour, according to tho severity of the symptoms. If, at the end of twelve hours, the symp- toms have abated, the intervals may be extended two or three hours. Belladonna should be administered when the pain is violent and cramp-like, coming on suddenly and ceasing as suddenly, with swelling of the abdomen ; or the pains are forcing, as if the contents of the abdo- men would be forced out ; sensitiveness of the belly to the touch, she cannot even bear the jar of the bed ; redness of the face and eyes; headache; dry mouth with red tongue; sleeplessness and restiveness; delirious ; suppress- sion of the lochia or escape of red and fetid blood ; the breasts are red and inflamed, or swollen and empty. ^ Dose: As directed for ^coniiwm. Hyoscyatnus may be used in some cases of a similar nature to that indicative of Belladonna, but where the disease has been developed, by mental emotions, and is characterized by spasmodic symptoms, jerks and twitches, delirium, throwing off of the bed-clothes, and desire to be uncov- ered, etc., it is more particularly indicated. Dose : As for Aconite. . ' Bryonia will be f jund useful in cases in which the abdomen is. swollen equally and is sensitive to the touch; violent splitting headache the pains are aggravated by the slightest motion; sitting up, or even rais- ing the head, causes nausea and fainting; great thirst with desire for cold drinks ; the patient is irritable or restless, and apprehensive as to the results of her sickness. Dose : As for Aconite. JB7ii««-«oa;, is suitable when the fever is of a low typhus grade; the patient is very restless, constantly tossing about. The lochia is again tinged with blood, or clots of blood are discharged ; aching soreness and stiffness of the limbs ; the tongue is red. Dose : As for Aconite, MercuHus is iiulicated by dejected expression of countenance ; groat thirst; constant flow of saliva; lancinating, boring or pressive pains in the belly ; profuse sweat which does no relieve ; mucous or bloody diarrhoea or i i: H Ml G80 DISEASES FOLLOVVINU CONFINEMENT. HI ineffectual desire for stool ; very offensive wind; the symptoms are usually aggravated at night. Dose: Give six pills every two hours until improvement or change. Nux-vomica is suitable at the commencement, when tlie lochia has beon suddenly arrested by some mental emotion, such as vexation; fre- quent desire to urinate, with pain, scalding, and burning; heaviness and burning in the abdomen ; pain in the small of the back, worse in the morn- ing ; frequent and effectual in urging to stool ; despondency ; sleeplessness or else dreaming frightful dreams; the symptoms are usually aggravated early in the morning. Dose: As directed tor Mercurius. Colocynth will be found valuable when the abdomen is greatly dis- tended, and the pains are unbearable, being of a sharp, cutting or lancin- ating character, which cause the patient to draw the thighs up as close to the belly as possible ; diarrhoea with colicky pains aggravated-or excited by eating or drinking. Dose : As for Aconite. Chamoinilla is useful for cases in which the breasts are flaccid and without milk ; diarrhoea . pains in the abdomen like pains of labor ; general heat with redness of the face, or one cheek is red, and the other is not ; great agitation, impatience and nervous irritability. Dose: As for Mercurius. Arsenicum will prove valuable when there are great anguish; sudden prostration; sunken countenance, with a sallow complexion; extreme restlessness, and anguish with fear of death ; sleeplessness ; dry and par- ched lips; great thirst with desire to drink but little at a time ; burning heat in the abdomen ; feeble and intermittent pulse, with coldness and desire to be covered. Dose: As for Aconite. Secale is good where there is strong tendency to putrify ; the dis- charge is pus-like and offensive. Dose: As directed for Mercurius. Diet and Regimen. The most absolute repose of mind and body should be secured ; all noise should be shut out, the room darkened and a moderate temperature maintained; the room should be well ventilated, so as to have the air changed without admitting a cold draught. Purification of all aliment must be enforced, and the thirst allayed by small quantities of cold water, which should be iced in summer, or when vomiting is pres- ent. If the lochia is suppressed, flannels wrung out of warm water may be applied to the external genitals, or a tepid injection may be thrown into the rectum, if there be great constipation; but.it must be a small quantity, that the bowels may not be much disturbed. The infant should be removed and fed on cow's milk and water until the patient is out of danger. LOCHIAL DISCHARGE AND IBBEGULAEITIES, By the detachment of the placenta from the inner sides of the womb, the blood vessels are left open, and for some days after confinement, discharge blood; in six to eight days this changes to serum, and Anally to a white purulent mucus. This is the lochial discharge. In most cases it lasts from two to three, while in others, it continues several weeks. In •MUM ffffSH LOCUIAL UISCIIAUGE— DIAKRH(EA. 681 cases where it bf comes suppressed suddenly, it needs medical atteution, also wlien profuse and long continued. Causes. Profuse and protracted lochial discharge may be frequently traced to sitting up too soon after conflneraent, or to keeping the room too warm, or to mental emotions. TREATMENT. If, after nine days, the discharge continues profuse, containing pure blood, whereby an unnatural state is indicated, one or more of the following medicines may be required: FOR EXCESSIVE DISCIIAUGE. Bryonia is to be preferred when the discliarge 1j of a deep red color, and is attended with internal burning pain, in the region of the womb. Dose : Six globules, three times a day. Xuoc Vomica is usually required when a chill or the use of stimulants has produced the mischief, and the patient is affected with severe pains in the back, and a constant and fruitless urging to stool. Dose : As for Bryonia. Calcarea is iniost particularly indicated when troublesome itching of the parts is experienced ; or when the discharge is protracted, and occurs in women of full habit. Dose : As directed for Bryonia. Silicea should be employed when pure blood flows with the lochial discharge every time the infant is placed at the breast. Dose: As directed for Bryonia. SUPPRESSED DISCHARGE. Pulsatilla, When the lochial discharge is suddenly suppressed— which it sometimes is from a variety of causes— and from this cause puer- peral fever threatens to fnsue, the danger may frequently be warded oP'by the administration i this medicine. Dose: Four pills every four hours. Aconite will generally sufllce if promptly administered when the sudden suppression is caused by fright, and is attended with febrile syrai)- toms. Dose: Four globules every hour until relief. Dulcamara will be found beneficial when the suppression is caused by exposure to damp or cold. Dose: As {or Pulsatilla. Belladonna. Where sudden suppression is followed by congestion of the biain, with flushed face, delirium, etc. Dose: As (or Aconite. OFFENSIVE DISCHABGE. Carbo-veg. should be administered, if the discharge becomes thin, and offensive. Dose '. Six pills four times a day. Kreosote or Secale should be given twelve hours after the sixth dose of Carbo-veg., if the discharge should still continue offensive. Dose: As for Carbo-veg. DIABMIKEA OF LYING-IN WOMEN, Diarrhoea at this time is to be looked upon as a serious occurrence and immediate means must be eui ployed for its correction by proper remedies. IM i^i. \m % ..ft ijiir '31 M n82 DISEASES FOIAOWlNa CONFINEMENT. Dulcamara is generally Indicated by the cause of the trouble being a checlc of the naturally increased perspiration from a chill. Dose: Four globules administered every three hours. Phos. Acid is most effectual for the treatment of painless and almost involuntary evacuation. Dose: As directed for Dulcamara. Antitnoniurn-crud., is generally sufficient when the evacuations are thin, watery and offensive. The tongue is coated white. Dose : As for Dulcamara. Rheum is to be preferred in cases which, in addition to the indica- tions afforded for the last named remedy. The evacuations and the body emit a sour smell. Dose: As for Dulcamara. Phosphorus should be employed in very obstinate cases, when the discharge is watery and almost painless. Dose : As for Dulcamara. Veratrum should be given if the discharges are very profuse and watery, attended with much pain, chilliness, coldness of the surface and cold sweat on the face. Dose : As for Dulcamara. For cases in which neither of the medicines above mentioned have the desired effect, consult the article on " Diarrhoea " page 277. WEAKNESS AFTER DELIVERY, We frequently find our patient very weak after delivery, especially if there has been considerable loss of blood, for which the following remedies will prove effectual. TREATMENT. China ranks first of all and will generally be found efficient in restoring the vital energies; especially when there has been considerable loss of blood, or very profuse sweating. Dose: Give six pills every three hours for the first two days, after that give twice daily. Aconite should generally be given at first when there is nervous weakness, attended with great restlessness and want of sleep. Dose : As for China. Sepia. This remedy is indicated when there is a painful sensation of emptiness at the pit of the stomach. Icy coldness of the feet and hands; the urine deposits a very hard crusty sediment; flushes of heat and loss of appetite. Dose: Six pills once in six hours. Sulphur. Weak fainting spells coming frequently during the day; feels very faint and weak from eleven to twelve every morning ; flushes of heat; cold feet; heat on top of the head. ABDOMINAL DEFORMITY. PENDULOUS ABDOMEN. Abdominal deformity is more common to those women who have borne many children, or to those who present a disposition to corpulency. It may be caused by wearing tight stays, which have a tendency to relax SORE NIPPLES— INFLAMMATION OP THE BREASTS. 683 the abdominal muscles, and increase the existing disposition to this affec- tion ; or it may take place in consequence of a strain upon the muscles of the belly during pregnancy. ACCESSORY MEASURES. An elastic bandage laced at the back, and exerting an equal pressure over the whole of the abdomen may be worn with advantage. In some cases where there is a tendency to this affection, particularly in corpulent persons, we may, soon after deliverv, have recourse to mechanical aid by transferring the support of the abdominal muscles to the shoulder, by the aid of properly constructed apparatus ; but we must, in the strongest man- ner, object to this, or any other pressure being exercised upon the abdom- inal region during pregnancy, as such a measure is obviously calculated to entail injurious consequences upon the offspring. Diet and Regimen. Spare diet and regular exercise must, in all cases, be observed. soue nipples. In a previous chapter I have shown the necessity of preparing the nip- ples for their new function. In spite of all care, however, the nipples sometimesbecomesorethree, fouror six days after confinement, especially if the skin is very fine and delicate. This is a most distressing affection, because of the cracks opening whenever the child takes hold to suck. If the nipples are too short, the shield before mentioned should be worn between the interval of nursing. In case, however, the nipples should be insufficient, or their tenderness remain, in spite of treatment, nursing may yet be accomplished by using a proper shield, or artificial teat, numerous and excellent varieties of which may be procured. It is well to bathe the nipples with warm water and milk, or with borax water, as soon as the babe is done nursing, being sure to wash the breasts as soon as it is ready to nurse again. Arnica employed internal and externally. This remedy will very often obviate all further inconvenience, if used at the onset. Dose. (Internal). Four pills three times daily. Application (exter- nal). To a half teacupful of water add fifteen drops of concen- trated Tinoture uf Arnica with which a small strip of linen may be wet and applied to the nipple, this may be repeated three times aday. ChUmonnilla. The nipples are much inflamed, and are very tender, she can hardly endure the pain of nursing; she feels irritable and cross with impatience. Dose: Four pills three times daily. Sulphur should be given, if after nursing the nipples smart and burn badly ; they chap badly about the base and bleed. Dose: Six pills night and morning. / INFLAMMATION OF THE BREASTS. One of the greatest obstacles to nursing an infant is inflammation of the breasts. The breasts become red and inflamed, occasionally suppur- ating in some parts which open, and discharge, while others still remain hard, and inflamed, which either end in suppuration, or in the formation of hard lumps. M m k 1 m hil i m s:% i't- : «•', V m V IJI mum 684 DISEASES FOLLOWING CONFINEMENT. Causes which produce this disorder are numerous. Anything wliich may operate as un exciting cause to disturb the local secretion, such as fright, passion, cold, etc; though it not unfrequently arises without being able to trace it to any particular origin. Inflammation of the breasts fre- quently arises from not applying the infant to the breast soon enough after its birth; and occasionally from a sudden cessation of suckling, caused by the death of the infant, or from disinclination of the child to suck, or from other reasons. When the milk is copiously secreted, and either from inability on the part of the child, or from the obstruction of the milk tubes, or from deficiency of the nipple, the milk cannot be freely drawn in the natural way, every efl!brt should be made, without loss of time, to secure this end by such other means as may be possible. Sometimes the breast may be drawn by another child, or by a friend, or by young puppies. The proper remedy should be selected, and faithfully administered in order, as rapidly as possible, to remove all difficulty. In cold weather the breast should be warmly protected. If the inflammation is caused and kept up by a tender and ulcerated .state of the nipples, let these be particularly atten- ded to. in accordance with the directions already given. (For particulars see Mastitis, page 646). TREATMENT. Aconite. When a chill in dry cold air has been the exciting cause, and there is high fever prevailing. There is fear, anxiety, and restlessness, thirst for cold water, etc. Dose: Six pills every hour until the fever moderates. Belladonna. When the breasts feel heavy ; there are red streaks running like radii from a central point; she is occasionally chilly, a dull and stupid feeling prevails. It is well to alternate Aconite with this remedy. Dose : Four pills every two hours. Bryonia. Her breasts have a stony heaviness in them, they are hot, hard and painful, but not very red. She feels sick when first sitting up in a chair, and still more sick on standing up, rough dry lips, thirst, and constipation, stools dry looking as if burnt, she feels worse when moving, and wishes to keep still. Dose • As for Belladonna. Phosphoms. Inflammation of the breasts, threatening ulceration with cutting or stitching pain . Hectic fever and night sweats, deep ulcers with blue appearance. Dose: Six pills every six hours.. Sulphur. Tlie inflammation runs in streaks from the nipple, suppu- ration profuse, with chilliness in the fore part of the day md heat in the after part. Sometinaes piles in complication. The breasts ieel hot. She has night sweats, flushes, or heat, weak and faint spells, irresistible hunger at 11 A. M. Dose : Six pills every twelve hours. Another treatment of gathered breasts, which has never been known to fail, if employed as soon i\s threatened, is this: take of Chloroform and Glycerine equal parts. As the substances are of unequal weight, the vial containing them should be thoroughly shaken, the mixture quickly applied, and the part covered with oiled silk, or something equally impermeable, to prevent too rapid evaporation. I>ART F'OUn-TEEIVTIl '!m TREATMENT OF INFANTS. CHAPTER XXXIII. TREATMENT AFTER BIRTH, As soon as the child is born, it should be wrapped in a soft woolen cloth, it first being warmed, as care should be taken to gradually inure the infant to the temperature of the surrounding atmosphere. The skin should then be gently waslied with a little warm water; or it may be annointed with lard, using a little line toilet or castile soap in the water with which it is washed, but care must be used in the first washing, less it should get cliilled. It is best only to wash part of the body at a time, keeping the other parts protected. After washing, the skin ought to be dried iraniedi- iitt'.ly to avoid the risk of taking cold. The child should be bathed every day, gradually lowering the temperature of the water after weaning. The best time for bathing is in the morning, soon after being taken out of the bed. I wish I could impress every mother with the importance of dressing tlieir infants in a more suitable manner. The practice of bandaging and swathing the tender bodies of their infi* j, and loading them with a superfluity of clothing, which, by its weight and length, presses upon the lower extremities, and is frequently the cause of deformity and weakne: 3 in after life, and moreover causes rupture of both navel and groin. .Ii m.n 4 'i.t ■ 'i STILL-BORN CHILDREN— S USPENDED ANIMATION. Causes, In many cases this arises from diflicult parturition, pressure of the cord around the child's neck, natural debility arising from some scrof u? lous or syphilitic taint of either or both of the parents; or from accumula tion of mucus in the nose and throat ; or, if delivered with forceps, it might be caused by an injury from them; o;: again, it is caused by too sudden alteration of temperature, the action of the lungs not having commenced. TREATMENT. From whatever cause the apparent death or suspen- ded animation of the child should result, no time should be lost in making proper efforts to establish respiration. Mechanical Means to be employed, is to immerse the child sud- denly into cold water, or better still, cold or even iced water should be poured over it. In some, apparently lifeless children, pouring cold water on the head and letting it run down over the body, establishes the circula- 685 II ' -h' ':i! 680 TREATMENT OF INFANTS. tion and respiration; the child should then be wrapped in woolen blankets ut:i.il quite restored. Of course, in all those cases where the breathing is prevented by an accumulation of mucus in the throat and nose, such measures should 1)6 employed as to remove such obstructions. Should these methods fail, the one of which a Uescription may be found in the article on "Apparent Death from Suffocation," will have to be resorted to. Should tliis method fall, the lungs may be directly filled and respira- tion may be excited by an adult placing liis or her mouth directly over the mouth of the child, closing the child's nostrils between the thumb and forefinger of his hand and blowing aiv into the child's lungs, and, when filled, by gradually and carefully compressing the walls of the chest, emptying the lungs again. This should be repeated again not oftener than from ten to fifteen times a minute. This artificial resplnition, and all other methods employed to restore suni^ended animation, should be persevered In for some time, life having returned after the lapse of an hour from judicious and careful treatment. Medicinal Treatment. If the child should still continue to breathe feebly and imperfectly after animation has been restored, the fol- lowing remedies may be resorted to. Aconite if the child is warm, purplehued, pulseless, and breathless or nearly so. Dose: Two pills on the infant's tongue. Belladonna. The face is very red and the eyeballs are greatly in- jected. Dose : As for Aconite. China if the face Is pale, the infant small and of a delicate frame and in cases where the mother has had profuse hemorrhage. Dose . As for Aconite. Opium is good if improvement takes place slowly and the face is livid and bluish. Dose : As for Aconite. SWELLING OF THE HEAD. Immediately after birth the head of the infant appears more or leas swollen; this in most cases is but a trifiing affection, and will disappear of itself; medicinal treatment may sometimes be required. Arnica or Rhus, will usually be sufficient to hasten the swelling to subside; when it Is very extensive, it is necessary to resort to external application of the same remedies. Dose: Two pills repeated again in twelve hours. Application, (external) : To four tablespoonf uls of water add six drops of the tincture, and apply this lotion to the part, repeating the oper- ation after the lapse of twelve hours. If there should result an ichorous discharge and caries of the bone and prostration. Calcarea will in many cases produce a cure. Dose: Two pills every second day. Silicea is useful, if the trouble yields slowly to Calcarea, to finish the cure. Dose: Two pills as for CaZcarca. > | J iil lB!l l t « M !# »^«^Jl^~»>i■^~**«*H■^^^ BUPTUBE IN INFANTS— PROPER TIME FOR SUCKLING. 687 RVPTUBE IN fNFANTS. NAVAL RUPTURE. Hernia or rupture miiy be developed before blrtli and a predisposition to this affection may l)e observed in cliildren whose parents are slndlarly affected. The nieclianical treatment of naval rupture Is a.s follows:— Take a piece of lint or soft cloth just large enough, when folded five or six times, to cover the rupture effectually, then press in the protrusion and keep it reduced with the hand, until the compress is rightly adjusted and secured in Its position by means of two strips of adhesive plaster placed over the compress in the form of a cross. Another compress may be made by taking a button-mould about an inch or an inch and a quarter in diameter and cover it with a piece of soft linen ; apply and secure it the same as the before mentioned compress, or by a bandage made of suitable form to secure it properly. This disease being frequently brought on by violent fits of crying, to which delicate children are subject, the bandage may be worn for some time after the cure, as a precautionary measure against its return. It is best to administer a remedy or remedies in order to assist the mechanical measure, and in nearly every case whether subsequent treat- ment be required or not. Nux-voniica may be looked upon as a medicine of primary import- ance. Dose : Two pills every morning and evening. Aconite. This remedy is suitable when the infant feels hot and is restless; in that case it is best to give it in alternation with the Nux. Dose: Two pills in alternation with the Nux every six hours. C'hanioniUia is sometimes of service; more particularly when the Infant is very fretful and the motions of the bowels be too relaxed and of an unhealthy color, or if there be evidence of griping in the bowels. Dose : As for Nnx. Sulphur is also of great service after any of the previous remedies in obstinate cases when tliere has been partial improvement, but the treatment prescribed has been insufHcient to complete ti.3cure. It is also good for the treatment of soreness of the navel, remaining after the liga- ture has fallen off, or even before this takes place. Dose : As for Nux. Silicea should be given four days after the fourth dose of Sulphur, in cases of soreness of the na'el in which no decided improvement has been effected by the last named»medicine. Dose: As for Nux. RUPTURK IN THE GROIN. All the remedies just enumerated are just as good in those oases of rupture in the groin, which are occasionally met with. WHEN MAY THE CHILD BE PUT TO THE BREAST. Even before delivery the breasts secrete a milky fluid; the genuine milk is only secreted after delivery. In some instances it has been the custom to draw off this first milk and feed the child in the meantime on catnip tei. '^•* chamomile tea, cracker water, or thin soup, etc. Nothing 1 t 1 ' i 1 1 i . 'In, 1 1 t.}A 1 i ?i 688 TUEATMENT OF INrANTS. can be moro irratioiml or inhuman. Notliinjif is inoro calculutod to oxpol tlio lut'coniiuu (the excri'incntitious niullur discliurgcd from tlie l)owflH of a now l)orn infant), tlian tiic lirst millc, wliicii hua u uliglitly looHcning effect upon tlie ciiild's l>owel.s. It is evident tluit nature lias designed it so, else, why sliould tl»e millt l)e secreted and tlie child created with a desire to suck as soon as horn? After liavinjr a few hours rest, tlie mother may take a little nourish- ment, if slie should desire it. After this, the child may bo put to the breast; if tlie mother diould feel rested before, and the diild should desire, it can nurse liefore, and at all events do not let more than twelve hours elapse before lettinjj^ the child nurse. If the child was born in the evening; or nij^ht, it need not be put to tlie breast before morning, esj)ec- ittlly if the mother sleeps ; often lioth mother and child sleep till morning, but if it sliould wake and l)econio restless, it may lie fed on a few tea- spoonfuls of water and milk, of equal jmrta, sweetened. OBSEJt VATIONS ON THE SUCKLING OF THE INFANT, Conquist, whose o])inion in tliia respect we perfectly indorse, in bis "Outlines of Midwifery," remarks: "Unless very peculiar urgent reasons prohibit, a mother should sup- port her infant upon tlie milk she herself secretes. It is the dictate of reason, of nature, and of common sense. Were it otherwise, it is not prol)able that so abundant a supply of suitable food would be provided to meet thewants of an infant when it enters upon a new course of existence. It is difficult to estimate the mischief resulting from infants being dei)rived of their natural nourishment; for, Ijowever near tlie resem- blance may be between food artificially prepared and breast milk, still reason and observation demonstrate the superiority of the lattc;* to the former. As a further inducement it should be remembered that medical men concur in the opinion, that very rarely does a constitution suffer from secreting milk ; whilst the health of many a woman it, most materially improved by the performance of the duties of a nurse. Presuming that the laudable determination is formed to indulge the child with that nutriment which is designed for its support, it becomes necessary to state that unless very strong objections should exist, twelve hours should never elapse before the infant has been put to the breast. Instinct directs it what to do, and the advantages of allowing it to suck soon after birth are many and important, both to the mother and the child. By this commendable practice, the patient is generally, preserved from fever, from inflamed and broken breasts, and from the distressing and alarming consequences resulting from those complaints. If the breasts should not have secreted milk previous to delivery, the act of suckling will encourage and expedite the secretion. Thus tl-e mother will be saved from much of the pain connected with distended breasts, besides which, if the infant be not put to the nipple until th« breasts become full and tense, the nipple itself will sometimes almost dis- appear on account of its being stretclied, and without much and efiectual .... ii..iULj.LMmiiMBHa m ami Till! CHOICE OF A NURSE— DIET DURING NURSING. labor on tho part of tl)e child, It cannot be laid hold of; and even then the pain orulunid by tlui mother '3 exquisitely severe, and not unfrequently the causo of sore nipples." '1*1 THE CHOICE OF A NURSE, For those who cannot Rive suclt to their own children, the selection of a nurso v.s ->'' ^tent importance, and tlie medical attendant ought generally to bo coMSuited, and tlie following points merit parLjular attention: Slio alioukl b(3 of sound constitution and of good health, of full and moderate plumpness, with a fresh complexion, and clear eyelids, free from any appearance of redness, scurflness or- thickening. She sl'.ould be thor- oughly exempt from glandular enlargements, and possess deep red lips without cracks, sound white teeth, 'ind well formed, moderately firm breasts, witli nipples free from excoriation or appearance of eruptions; the clilld of the nuise is one of the ))est criterions to judge by— its being plump and healthy is a great point in her favor. Wo shotfld also endeavor to discover if she is free from any hereditary taint; she should, moreover, be of a mild, patient and equable temper, not irritable, or disposed to fits of passion, or nervous ; of regular and temperate habits, and fond of children. She ought also to be about the same age, and to have been delivered about the same time, or, at least, within three months of the same period as the mother; with respect to age, we must, of course, avoid extremes. A woman, hav- ing given birth to a child very late in life, should choose a nurse several years ner junior, and fully qualified for her duties; the reverse of the rule applita to extremely young.mothers. «'h!,.| DIET DURING NURSING. As regards the nurse's diet, it should be simple and easily digested, and she ought to live upon a proper proportion of animal and vegetable food. Nature generally provides for the increased call upon her powers by suppression of the menstrual discharge, and a moderate increase of appetite, which may be safely indulged ; but all food of a highly concentrated, heavy description, is injurious, causing the milk to become unsuited to the delicate digestion of tlie infant; the best guide, in the majority of cases, is the regular IIoma3pathic regimen, which may be consulted with advan- tage. Reference must, however, be had to constitution; thus, a strong woman of full habit will not require much animal food, and will have, generally speaking, a plentiful supply of good milk, if she drink nothing but gruel, barley water, toast water, cocoa, tea, etc,; whilst, on the other hand, a woman of somewhat delicate constitution and languid circulation, will want more nourishing food, milk, etc. But we cannot too strongly repudiate that too prevalent but deeply erroneous idea that womcm, during the period of sucking, necessarily require stimulants to keep up their strength ; under these impressions, both wine and malt liquors— and, among the latter, more particularly porter —are frequently resorted to. Porter is not only injurious, from its stimu- lating properties, but the deleterious effect which the different ingredients composing it produce upon the milk, forms one of the most prolific causes of ■ u I. „ "l.H i ( v fi>t «90 TREATMENT OF INFANTS. the many evils that attack infancy. We shall conclude this part of the sub- ject with a single quotation from a well-known medical writer; " There is an evil too generally prevalent, and most pernicious in its consequences on individuals and society, and by no means confined to mothers in the lowest classes of the community, which cannot be too severely reprobated; it is the wretched habit of taking wine or spirits to remove the languor present during pregnancy and suckling. It is a practice fraught with double mischief, being detrimental both to mother and child. The relief afforded is temporary, and is invariably followed by a degree of languor w'lichdemands a powerful stimulus, which at length weakens, and eventually destroyes the tone of the stomach, deteriorates the milk, and renders it altogether unfit to supply that nutriment which is essential to the existence and welfare of the child.'' m SUPPLEMENTARY DIET OF INFANTS, Unfortunately, some mothers do not possess sufficient milk for the proper nourishment of their offspring ; if this arises merely from a defi- ciency in the secretion, and the woman is in other respects healthy.we must have recourse to supplementary diet to make up for the diminished quan- tity of the natural nutriment. Goat's, ass's, and cow's milk are excellent substitutes, especiiilly tiie latter, diluted with one-third of water ; goat's milk being apparently objectionable from its peculiar aroma. The milk, therefore, of the cow ought, when possible, to be obtained, and, if given undiluted, to be boiled,— cow's milk being generally considered too heavy, which boiling in a great measure obviates; it ought also to be slightly sweetened, so as to resemble as closely as possible that of the nurse, and should, moreover, be about the same temperature, say from ninety-six to ninety-eightdegrees,— a point less regarded than it should be, and easily determinable by the thermometer. If any constitutional taint exists in the mother, the sooner the child is tran&ftrred to another breast, the bet- ter for both parties ; and if a nurse be not procurable, the above will gen- er?Uv prove sufficient nourishment until the front teeth appear, which is a clear indication that the digestive organs are prepared for more solid food; if, however, the milk diet appears to disagree with the infant, wemay give thin water gruel, or mix a little thin arrow-root, rusk, or well tosted bread in water, to which the milk may be afterwards added ; such alterations in diet are, however, but rarely required. We may here observe, that no portion of t'.ie milk ouglitto be retained for a subsequent meal, from the quickness with wliich it becomes sour; tlie same remark applies to any of the above preparations, in which milk forms the principal ingredient. In the cow's milk, at first diluted as above described, wenmy, after two or three weeks, gradually diminish the quantity of the water, as the digestive organs become stronger; but we cannot too stringently press the point, that, where it is at all practicable, the child ought to derive as great a portion of its nutriment as possible from the breast, no food being able efficiently to supply the place of that which nature intended for it at its birth. When it is necessary to give supplementary nourishment, a sucking- bottle ought to be used, as 'the best imitation of nature, in giving tli»^ DURATION OF SUCKLING— WEANING. 691 food slowly; parlicular care being taken to observe the utmost cleanli- ness. The child ought, in feeding, to be kept in a reclining, not supine position, as the latter frequently causes it to incur the risk of suffocation ; and when it evinces disinclination to its food, no more should be offered. The child should be accustomed to take its nourishment from each breast alternately ; as, if this precaution be not ado'^ted, inflammation is likely to arise in the breast not used, and the i.ild is apt to become crooked from being always retained in the same position. The physician is frequently asked how often the child ought to be applied to the breast; the best rule on this poin|^ is, to give the brea.st when the infant desires it, and to withdraw it when the child appears satisfied. As the infantincreases in strength, it may be easily accustomed to regular hours. It should not be permitted to " lie at the breasts " dur- ing the night ; which is a most pernicious practice for both mother and child. I'tM I Jh <\ll DURATION OF SUCKLING-WEANING, The period of suckling ought seldom to last longer than forty weekrj ; but in this we must be guided, in a great measure, by the constitution of the infant; weak, ill-conditioned children, in whom teeth are long in making their appearance, it has been recommended to continue at the breasts for eighteen months or even a longer period. Weaning ought, in fact, to be regulated by the constitution both of mother and child. T)ie full development of the front teeth, which in healthy children is from nine to ten months, but in delicate and scrofulous constitutions, is delayed for several months later, has been considered the best indi- cation of weaning; but this is by no means an unexceptionable rule, If the strength of the mother appears unequal to the task, and the supply of milk l^eglns to fall off, the child may be gradually weaned, even before the teeth appear; still, even when the supply is ample, and the mother and child are apparently strong, a continuance of suckling beyond the tenth month is generally injurious alike to parent and child.' Weaning should not take place sttddenly, hni the infant should be gradually accustomed to other food, and a less frequent administration of the breast, until entirely weaned; the time to commence this grad- ual course, is upon the first appearance of the front teeth, so that the weaning may terminate with their full development; thereby the secretion lessens by degrees, preventing all evil consequences of swollen or inrturiied breasts, and the child, also becomes quietly reconciled to the deprivation. Weaning ought not, however, to take place, if the child^suffers con- siderably from the irritation of teething, or any acute infantile disease. When, however, it is found absolutely necessary to wean, the above precautionary measures should be observed, both with respect to the mother and child. FOOD OF THE INFANT. After the child has been weaned, its nourishment should generally consist of the same simple food as before mentioned. The transition to a more substantial diet ought to be extremely gradual and guarded, and no material alteration made until after the appearance of the eye-teeth. V-:\^ • III iiiilii i" -i;! 692 TREATMENT OF INFANTS. SLEEP—SLEEPLESSNESS. From the inability of the infant itself to maintain a proper degree of warmth, it should sleep by its mother's or nurse's side, for at least the fust six weeks, parti(!ularly during winter or early spring. Care must be taken not to overburden it with bedclotlies, and to place it in such a posi- tion as to prevent it slipping under them, and thereby becoming exposed to the risk of breatliing a vitiated atmosphere, or even of suffocation; after six or eight weeks, when the organism becomes stronger, and ablo to preserve a proper degree of natural warmth, a separate bed or cradle will be more conducile to the health of the infant; this change ol' arrangement will be found beneficial to both parties— to the child, from its breathing a purer air; and the mother, being freed from the necessary watchfulness and restlessness consequent upon the child sleeping with her, will enjoy better health, and be more likely to secrete good and nutritious milk. Moreover, sleeping in the same bed with an adult, and particuJarly with an old person, is somewhat detrimental to the liealth, not only of infants, but even of children. As to the length of sleep allowed to the infants, the chief business of the first months of its existance being sleep and nourishment, we may safely leave the point to nature, and not attempt to coerce the inclinations of tlie child; if the infant is lively on waking, we may conclude it has not slept too much ; and as it increases in vigor, and is able to endure longer intervals of wakefullness, we may proceed (recollectin' at night is the proper period for sleep,) so to regulate its habits of taking its food and rest, as to accustom it to an uniform system, and particular hours, Chil- dren, up to two years of age, require rest during tlie day, and 'Jie nurse ought to endeavor to get them into the habit of taking it in the forenoon ; for, if it be taken in tlie afternoon, it generally interferes with the night's sleep. Whetlier by night or day, we must carefully exclude both light and noise from the nursery; f)r although tliey may be insutflcient to arouse the infant, still they caus^ its sleep to be disturbed and imrefre.sli- ing, and, by acting upon the neivous sensibility, predispose the child to convulsions or spasmodic attacks from slight accidental causes. It is true that, during the first irii ntti, ttie infant sleeps immediately on leaving the breast, and no evil co:;.icquences ensue; but it must be borne in mind, that it takes but a little at a time, and milk is at that time wisely adapted to its delicate digestion; but as the secretion becomes '•icher, and suited to the increasing power of those organs, it is Injurious to put tiio child asleep immediately after a full meal, for its rest is tlien uiKjuletaud disturbed, from the process of digestion being interfered witli, more particularly wii«n the nurse foolishly endeavors to force nature, by resorting to the baneful practice of rocking. Nothing causes greater annoyance and even anxiety to the mother, than a disposition to wakefulness on the part of her infant. A healtliy cliild shoulu always be prepared for its rest at the usual hours; if, insteaO of going to sleep, it appears restless, fretful, and disinclined for its accus- tomed rest, ;' is an evident indication of some derangement of the child'st general liealth; fre([uoutly, tiirough ignorance, nurses, instead of attend- ing to tills warning voice of nature, which, by the sleeplessness of tho Infant demands appropriate relief, endeavor tostifiv' it, and sometimes, t<( «: EXERCISE. 690 free themselves from a little temporary annoyance, administer opiates, often in tiie form of "carmiiuitives,'' " sootliing ssyrups,'' which induce an unrefresiiing slumber, and not uufrequently a deep stupor, mistaken for sleep, while the original evil still continues to make head against the vital power. This baneful practice has not only been the ruin of many constitutions in after life, but to it, conjoined with ianproper diet, stimu- lating or unwholesome drinks, quack medicines, together with the highly erroneous practice of a frequent administration of laxatives, in infant maladies, a considerable number of diseases and even deaths are annually attributable. Every mother should not only caution her nurse against the use of opiates, but use her utmost vigilance to detect any breach of her injunctions, which should be visited with the immediate discliarge of the person soofTending; for she must be truly unfitted for such an impor- tant trust, who, after being warned of its injurious tendency, will perse- vere in a practice placing in jeopardy the life of her infant charge. TREATMENT. Amongst the homoeopathic remedies which have been found the more generally useful in removing restlessness and sleep- lessness in children, the subjoined deserve especial notice. Coffea is very efficacious when the child seems unusually lively, restless and vakeful; but will commonly fail to answer its purpose when the nurse is in the daily habit of taking cofTee as a beverage. Dosh: Two globules, dry, at night and morning. Opium may be substituted for Coffea when the nurse is in the daily habit of taking cofTee, and is especially indicated if the face of the child looks red. Dose: As for Coffea. Chamotnilla will do good when the child is tormented with flatu- lence, and distention of the bowels, and appears to suffer from colic, indi- cated by drawing up the legs, screaming, etc. Dose : As for Coffea. Anonitutn is preferable to any of the preceding, when tiiere is gene- ral febrile heat and great restlessness. " Dose: Two globules, dry, on the tongue, three times each day. ADDITIONAL PAUTICULARS. The reader should further consult, if necessary, the general article on " Sleeplessness," and that on " Crying, Wakefulness, and Colic of Infants," in the subsequent pages. i^ EXERCISE. For the first six or seven months the groat business of nature'seems to be the proper development of the infant frame, and particularly of the respiratory and digestive organs. During tiiis period, also, the cartilage is gradually forming into bone, and the infant's delicate muscles are acquiring power and strength. We find, however, that consciousness is yet indisiinct, and the infant evinces no anxiety to indulge in voluntary motion, the nuiscles of the neck and back not possessing sufficient power to support the liead, or to keep the body in an erect position ; fortius reason, children during this period, should, when carried in the arms, be kept in a reclining position, so as to avoid an undue pressure upon tlie ■li^ f vt I'll !"':^! if <l! 1 „,J lil'^fit ■ 11 094 TREATMENT OF INFANTS. spinal column ; a neglect of tliis precaution, and a premature carrying of the infant in an upriglit position, is a too frequent cause of deformities of the spine, and derangement of tlu functions in after life. As its powers gradually develop, tlie infant seems inclined to exercise them, and evinces a desire to sit upright, which we may safely indulge, taking care not to overtask its strength hy keeping it sitting up during the greater part of the time it is awake. A careful attention to nature in this, as in all other cases is the hest guide. The practice of dandling the child in an upright posii'on, seems rather f to proceed from the pleasure of indulging the feeling of parental affection, than from any henefit tlie child can, hy any possibility, he expected to derive from it; in fact, it is highly injurious, even at a rather more advanced period, as exciting a premature involuntary exercise of the mus- cles, and consequent deformity. The act of respiration bringing into play a great variety of muscles, occasional crying seems sufficiently active exer- cise during this period. In mild spring and summer weather, the child may, under favoring circumstances, after the first fortnight has elapsed, be carried out into the air for a (juarter of an hour at a time, and the period of exercise grad- uallj' increased ; in fact, if the weather be fine, it can scarcely be too much in the open air. Should its birth occur in winter, advantage may be taken of a line day,after it is a mouth or five weeks old, as the frame is grad- ually ac<iuiring the power of generating heat; but, at the same time, great care must be taken to prevent its catching cold; and should the child exhibit tiie slightest sign of being affected by the atmosphere, the practice of carrying it out of doors should be immediately discontinued, and it should be carried up and down in a well ventilated room, the nurse mov- ing it quietly in her arras from side to side. Many children are lost through a foolish idea of making them hardy, by acustoraing them to endure cold ; this can occur only through ignorance; for nature, in very early infancy, does not possess sufficient energy of reaction to overcome the power of a sudden or long-continued cliill. We may recommend an occasional gen- tle friction of the hand over the body and limbs, which materially assists in the promotion of the circulation of the hlood, and will, in unfavorable weather, serve, in some measure, as a substitute for exercising the infant out of doors. The practice of assisting children to walk, or of exciting them to a premature exercise of their powers, is highly reprehensible, causing, in many cases, curvature of the limbs, the bones not yet being sufficiently formed to bear the burden imposed upon them. By allowing nature to act, the infant's power will hecome more gradually, but at the same time more fully developed; its carriage will he more lirni and erect, and its limbs straight and well formed; moreover, it will walk with greater con- fidence and independence, by the expiration of tlie first year, than those who have been taught to walk by the assistance of the nurse, leading strings, or mechanical inventions. BETAllDED STltEXGTH OF THE LIMBS. TREATMENT. Calearea curb, is, in the majority of cases, the appropriate medicine when the child continues to be feeble, and any INFLAMMATION OF THE EYES. eufi Attempt to walk, or the capability of sustaining an erect position, is unduly procrastinated. Dose: Two globules every morning, the first thing, for four davs (unless some condition requiring other treatment sliould sooircv arise); then pause eight days, after wliich repeat the course as before; then pause again for tliree weeks, and rej)eat the course once nior.-. But if within three weeks after completion of the third course, no very apparent change should have taken place, consider the following medicines. Silicea or Sulphur may be required after the previous employment of tl**lcarea, when the last named medicine has been productive of no very ai)parent improvement, more particularly if the child manifests a gener- ally feeble or scrofulous habit, and is alTected with enlargement of joints or tendency to curvature of the bones, or rickety affections. Dose : Of the remedy selected, give two globules, as directed for Cal- carea. CHAPTER XXXIV. ml 11^ 1 . iii iPh DISEASES OP INFANCY. INFLAMMATION OF THE EYES-OPHTHALMIA. New born infants and older children are subject to purulent ophthal- mia, or inflammation of the eyes. This disorder is always more or less serious, for, unless speedily cured, the inflammation may result in ulcera- tion, and the contents of the eye-balls be discharged, causing permanent deformity as well as hopeless blindness. The first indication ot the diseiise is, generally, the eyelids becoming glued together during sleep, with redness and swelling externally. The Causes are sudden exposure to the light of day, to cold, or the glare of a lamp or fires. _Many cases of inflammation of the eyes occur in babes whose mothers are affected with leucorrhcea, therefore we must conclude a discharge from the genitals of the mother is a very frequent cause of opthalmia in newborn infants; or it is sometimes epidemic; and no doubt many children who are what is commonly called " born blind," owe their misfortune to the neglect of proper precaution, in many cases the exter- nal indications of this affection being so slight as to escape observation. For additional particulars see page 180. TREATMENT. Aconite should be administered as soon as we become aware of the existence of this evil; a few doses will generally be found sufficient to subdue this affection in all mild cases. Dose: Two pills every four hours. Belladonna. The eyes look very red ; cannot bear the light ; open- ing the eyes only when in a dark place. This remedy is good to alternate with Aconite. Dose: As for Aconite. . : . " )!;. li n ^\ (,.»» , ...I p'ii.#iiil it ;!p| k^'' t-.',. ';'-! 1,; ,1 606 DISEASES OF INFANCY. Suljthur. There are pimples, more or less over the body; the eyes geem to itch very much. This remedy should be selected when we have reasou to suppose the constitution of one or both of the parents is affected. A little breast milk applied to the affected eyes of an infant often allorda speedy relief. Dose: Two pills repeated every twelve hours. HICCUP. This affection, though in itself of slight importance, frequently causes a considerable degree of uneasiness to the young mother. It generally arises from exposure of the body, even in a warm room, to the atmo- spheric air, even during the operation of dressing and undressing the new born child. Wrapping the infant warm in bed, or better still, applying it to the breast will generally lead to a cessation of the affection ; should it, how- ever, continue, the administration of a small quantity of white sugar, us much as will cover the end of a teaspoon, dissolved in a teaspoonful of water will frequently effectually remove the evil. Nux-voniica. Two pills placed in the mouth of the infant will arrest the trouble, if the other advice should fail. ALLOPATHIC TREATMENT. Hiccup is generally relieved by a sudden arrest of the attention, as by a reproof or a sudden expression of great surprise. Hot cloths wrung out of warm or hot water may be con- tinually applied, or a mustard and flaxseed poultice laid over the region of the diaphragm. The common internal remedies are cold water, snow, pounded ice, or ice cream. Anodyne and antispasmodic drugs are useful in this, as in other coughs. A combination of Chloral, Bromide of Potas- sium with or without an opiate, is generally effectual. Take of Hydrate of Chloral and Bromide of Potassium and Bicarbonate of Potash one scruple, Paregoric two 'drams. Peppermint Water suffl(dent to make two ounces. Mix. Dose: A teaspoon half full, to a dessertspoonful" every two or three hours. Obstinate cases will require professional advice. SNUFFLES, OB COLD IN THE HEAD—COBYZA, Snuffles, or cold in the head is one of the earliest and most common affections of the young infant. It consists of an inflammation of the mucous lining of the nose. The first that is known of it is, that the infant's nose is stopped up so as to hinder its breathing, hindering it in the action of sucking, by not allow^ing the breath to puss tlirough the nos- trils, obliging the infant to release the nipple in order to breathe, causing it to become fretful and irritable While this state continues, it has its influence against the infant's thriving, both by hindering it from taking a sufficient amount of nour- ishment, and by annoying the breathing of the child so as to disturb its sleep. When the nose is dry while administering a remedy, to remove the evil, relief may be obtained by oiling the nose on the outside and by COLIO OF INFANTS. 097 using a feather or camel's hair poneil on the Inside. Fresh hird, gooHP grease, cream, or a little breast milk will often aflbrd grateful relief. TREATMENT. Aconite. This remedy, if administered at first wheif there are febrile indications, will often cut short an attack of coryza. Pose: Two globules every two liours. Nux. The trouble is worse at nij,'ht, particularly toward morning of in the morning. Through the night the nose is very dry. Dose: As for Aconite. Eujthrasia. Profuse, fluent discharge and acrid discharge from th( eyes ; the eyes are much involved. Dose : As for Aconite. Chainotnilla. Where there is watery or mucus discharge; the child is quieted by carrying it up and down the room. One cheek red the other pale. Dose: An for Aconite. l*ulsatilla is indicated by thick, green or yellow bloody matter, like discharge from the nose attended \vith fretiuent sneezing. Worse towardif evening. Dose: Ah for Aconite. ALLOPATHIC TREATMENT. Cold in the head generally require* but little more than maintaining an equal temperature for a few days, when it naturally subsides. It is necestary to keep the nostrils ope» that the child may nurse. For this purpose, the nostrils may be moistened with Glycerine applied with a camel's hair i)encil. Nurses are in the liubit of provoking sneez' ing by dropping milk into the nostril, so clearing it out. and smearing the nose witli Olive or Almond Oil. A very useful application when the discharge tends to continue, is Tannin fifteen (jrains. Fluid Extract of Belladonna twenty dfQps, (Jly(xrine two drams. Mix, and apply with a camel's hair pencil two to four times a day after first cleansing the nos- tril witli a camel's hair brush and warm water. If the discharge is otlen- sive, a solution of one or two grains of Permanganate of Potash to the ounce should be used to cleanse the nostril. In chronic cases, the above mixture of Tannin may be used alternately with the dry powder or a solution of Alum, five grains to the ounce, may be employed. If the disease depends on scrofula, the following mixture may be given : Take of Iodide of Potassium sixteen grains, Pyrophosphate of Iron ten grains, water sufficient to make a solution, Syrup of Peppermint sufficient to make two ounces. Mix. Dose: A teaspoon half full, to a teaspoonful, three times a day. Or { three to five drops of the syrup of the Iodide of Iron may be given, CRYING AND WAKEFULNESS OF NEW BOBN INFANTS-- COLIC, Occasional crying of new born children is a wise provision to bring the respiratory organs into play, and to expand tlie chest. When, how- ever, the crying becomes excessive and threatens to prove i.ijurious, we must, in the first place, endeavor to discover its origin, which will fre- quently be found in some derangement in the infant's dress, a wet diaper 'm ml ilii-''' I ii Jill: m 698 DISEASES OF INFANCY. !i ':!M i> a or tight bandage, or perhaps It may feel thirsty and would like to be refreshed by a little cold water. Care and love will easily detect the cause of the child's cries, and a good, true mother will scarce ever lose her patience at such times. Sleeplessness is often. caused l)y similar circum- stances; tlie children sometimes lie with their heads too high, or tliey are too warm, or they are sometimes affected by nursing their motlier when slie is in a nervous and excited condition ; all these things nmst be considered. TREATMENT. Belladonna will frequently be found sufficient to remove the evil, when no exciting cause or guiding symptoms of disease present themselves, and the infant is peevish and irritable, affected with incessant whimpering and wakefulness, or prolonged flts of crying. The infant's face looks somewhat flushed. Dose: Two pills every three hours until relief or change. Chamomilla is of very great service, when the child appears to have griping pain (colic,) indicated by drawing up the limbs, contortions of the body and face; or when there is a yellowish, greenlsii watery discharge from the bowels, the child wants to be carried all the time. Dose : As for Belladonna. Co/fe.t cruda will generally prove beneficial, when the child Is exceedingly wakeful and bright, may be somewhat fretful or not. Dose: As for BeWulonna. Aconite should be employed when there is, in addition to the above mentioned symptoms, considerable dry heat of the skin, with extreme restlessness. Dose : As for Belladonna. Nux-immica will usually succeed in restoring ease, when flatulent colic, accompanied with violent flts of crying, drawing up of the legs and a costive state of the bowels, appears to be the cause of the disturb- ance. Dose: As directed for JBeZtoffowna. Pulsatilla is very suitable when the derangement arises from over- loading the stomach, or improper food, and the crying, or wakefulness, is accompanied with colic, wind and diarrhoea of stools, with no two that look alike. Dose : As foi Belladonna. ALLOPATHIC TREATMENT. Crying, when not dependant on hun- ger, fright, willfulness, or peevishness, is generally dependent on dyspeptic colic. These are loud and may be long. Whimpering, moaning, painful cries, depend on inllammatory or exhausting diseases. The smotliered cry depends on true or false croup. The treatment, therefore, will have reference to the causitive conditions. The use of soothing syrups is not free from danger, as they contain a Becret amount of Morphine, which is an unsafe drug to give to children, Simple restl^sness may be relieved by two to flve-grain doses of Bromide of Potassium dissolved in syrup. When necessary to give an anodyne, it is best to give Paregoric ; the doses of which is on the printed label, suited to the age. It can be given with the Bromide of Potassium, or an equal amount of Tincture of Hyos- VOMITINO OP MILK. C09 cyainus. But rather than by any drugs, should relief be obtained by correcting wlmtever derangement causes the crying. Colic may be temporarily relieved l)y a dose of I'uregoric suited to the age, given at suitable intervals of from half an hour to longer intervals, until the pain is relieved. Warm cloths or poultices, over tlie abdomen are useful. The principal treatment consists in correcting the derange- ment of the stomach and bowels. Irritation from unsuitable milk is a frecjucMit cause, as is noticed at the period of menstruation during lacta- tion ; the occurrence of another pregnancy, violent mental emotions, hard exhausting labor, errors of diet, or some other causes which render tlie breast milk unsuitable These causes suggest their own change. If the amount or quality of the breast milk is insutlicient, the trouble will be relieved by proper artificial feeding. An excess of acidity in the stomach, as shown by sour eructations (belchings) sjur and greenish stools, scat- tered, sometimes, with lumps of undigested material, call for alkalies Bufflclent to correct these symptoms. Tlie best is Bicarbonate of Soda in doses of one or two grains, or teaspoonful doses of Lime Water, given often enough to correct the sourness (acidity). Two to five grain doses of Pepsin, with an equal quantity of Bismuth may be given three or four times a day. The regulation of the diet to the exact wants of the system is the most important part of the treatment. Tliis will have to be accomplished somewhat by experiment. The milk for artificial, as tested by litmus paper, should be alkaline, and not used until sufficient lilme Water or Soda Is added to make it so. It should be perfectly fresh, and kept on lee to prevent any decomposition (souring,) or If this Is impossible, and it can- not be freshly milked each time It Is used, scalding will help to keep it, and is in this case, permissible. The juice of lean meat may frequently be given, instead of milk, with advantage, or raw lean beef, chopped fine and ground in a mortar, and strained through a sieve, may be salted or sweetened and fed a teaspoonful at a meal. It will frequently be digested when milk will not. In older children, the treatment will be the same for the relief of pain. If tlie irritating matter Is not removed by a free, loose stool, a tea- spoonful or a dessertspoonful of Castor Oil (mixed with an equal quantity of inodorous Glycerine, and flavored with a couple of drops of Oil of Win- tergreen or Cinnamon, to make it palatable,) should be given. tti^«idlli ' ,Vu VOMITING OF MILK-SOUB STOMACH— FLATULENCE. The infant, the same as the adult, is subject to attacks of indigestion, and the disorder in the one case bears a certain similarity to that in the other. Though vomiting in every case is by no means the result of indi- gestion, for when the stomach is simply overloaded or rather overfilled, it relievos itself of the excess by vomiting, and this act takes place with Httle effort and no suffering, the process of digestion still going on undis- turbed. When indigestion, colic, constipation or diarrhoea arises from impro- per food, in babies raised by hand— that is, from food which evidently ., m 11 |M li !f'i *:||t I liaiwii>| III iPjiii? •! 1 ill ifi 700 DISEASES OF INFANCY. does not agree with the chUd's Htornach— or even from unwliolesome ma- ternal milk, we will frequently iiuve to encounter many (lilHculties before we can select a suitable article of food that will agree with tiie delicate digestive apparatus of the babe. We should endeavor to make a good choice of food ; and if, having done so, we (hid that the choice has been a mistake, we should try again, not deHjjaringly, but .emembering alwaya that what is one baby's food is another baby's poison. TREATMENT. Ipecac. There is much sickness of the stomach ; the more constant the nausea, the more certain will Ii)ecac relieve; the stools look fermented. Dose: Two pills, repeated after a lapse of four hours. Chanionillla* The child is very irritable and fretful, mnat be carried all the time; distress after nursing ; sleepless starting and jerking wliile asleep ; stools smell like rotten eggs and are green, chopped, or consist of white and yellow mucus. Dose : As for Ipecac. Arsenicum. The food is tlu'own up as soon as taken into the sto- mach, and passes oft' through the bowels undigested ; the stools are offen- sive; much crying during and after nursing, «)r as soon as the child begins otake food. Emaciation and restlessness. Dose : As for Ipecac. Nux v'ttn. is indicated when vomiting of milk is attended with flatu- lence, constipation, uneasiness or irritability of temper. Dof-e: As for Ipecac. • Bryonia. Should be given the second dose of Nux after the lapse of four hours, if the symptoms mentioned in the last remedy have notentirely yielded to its action. Dose : As for Ipecac. ALLOPATHIC TREATMENT. Flatus will be relieved by alkalies, given as above, and care regarding food. Vomiting, except as a symptom of serious disease, and not simply a regurgitation from over-distention, of the stomach, will be relieved by tlie anie means occurring from over-distention ; the infant should be given a little less of that article of food at a time. With infants at the breast, it is generally of no consequence. FLATULENT DISTENTION OF THE BOWELS. STOMACH AND Gentle friction with the palm of the hand, which has been previously warmed, will often give grateful relief. It is best to begin at the lower right side of the bowels, passing the hand gently up the right side as high as the stomach, then across and down the left side and so on. At the same time the following remedies should be employed. Nux voin. should be employed at the onset for children of a spare, meagre habit, or who are more subject to a costive condition. Dose: One pill every two hours. Pulftatilla is to be preferred, if the children are of a relaxed habit or who are subject to discharge from the eyes and eyelids ; or particularly when diarrhoea is present. _..,,aaaMaa;s«gag.«E«««« MIIiK CRUST.— MILK SCAB. 701 ina- loio ciite i>nd 'H a Dose: As directed for Nnx. thnmontiUa should Ite administered four hours Jifter the third dose ofNi^or Piilsatillu, if no pcrmaiient relief should have resulted; and nioii) '^specially if convulsions or diarrhoja be developed as attendant synii'lonis. J)ose: Ah directed for iVtwj. 1)1 i:t. The diet must, at the same, time bo attended to and altered if of an indigestible nature and the suspected cause of the mischief. MILK CRUST.-CltUSTA LACTEA.—MILK SCAB. ' Dkscuiption and Hymptoms. This eruption occurs in children while nursing, and more commonly while teething, and appears to be very closely connected with that process. It commonly commences on the cheeks, and forehead, by the breaking out of a number of small yellowish pustules, (pimples) crowded together on a red surface. These pustules excite great itching, and are quickly broken, discharging a viscid fluid that dries, forming greenish-yellow scabs; the scabs are frequently rubbe'l off but form again; fresh crops of pustules appear around the scabs which quickly extend to the scalp, and even the face. The eruption appears behind the ears, and patches will sometimes appear also, upon the neck and breast. The discharge from the pustules is caught by the hair upon the head, and forma into small irregular friable masses, which may resemble tlie bruised yolk of a hard boiled egg. The pus' ules or achores, as the small Buperllcial ulcers which they form upon the skin are sometimes called, have an irregular form, contain a straw-colored fluid, rest upon an inflamed base, and are succeeded by a thin brown or yellowish scab. There is much irritation, heat and itching; the discbarge is very profuse, and with so much itching that it is easily rubbed off, leaving the surface raw and excoiiated. Whenever this discharge is brought in contact with the skin — in tlie face, where it trickles down on the breast, where it falls, and upon the backs of the hands, violently used by the child to rub with— it proves so iicrid as to produce there a fresh eruption. The same is true even of the arms of the nurse upon wliich the child rests its head at niglit. The itch- ing and burning acridity of the eruption, and discharge are much worse at night. All external application should be avoided, with the exception of a little sweet cream or olive oil, which has sometimes proved very grateful. Everything should be carefully avoided which would have a tendency to drive this eruption in, since it might result in some more serious trouble. TREATMENT. Aconite should always commence our treatment, when we And excessive restlessness and excitability produced by this aflfec- tion, and when the skin around the parts is red, inflamed and itching. Dose: Two pills repeated every two hours. Viola Tricolor. As soon as the benficial effect has resulted from the administration of Aconite; and six hours after the last dose of that medicine, it will be well to proceed with the remedy under consideration, which, in the simple and uncomplicated form of the disease, is often suf- ficient to effect a cure. Duse: Two globules every night and morning. Calcarea. Eruptions, with thick scabs, and yellow pus underneath. II ■■■■"» -I .*li4 m $m r '! 1 viliffi' 1 1 1 1 |i 1 !'i 1 flip ' H!| ui pi ;,i T02 DISEASES OF INFANOT. :M Stools having a chalky appearance. Sometimes the eruption appears in the form of a ring-worm. Dose: Two globules every morning. Graphites^ ahouM be given when a transparent, glutinous lluid exudes, which cuuhos tlie crusts to full ofT; the eruption appears more particularly on the chin and behind the ears ; emits a fetid odor, and itches intolerably. Dose: As directed for Viola Tricolor. Arsenicum is indicated when the eruption Is very dry and scaly and causes destruction of the hair. Dose: As directed for Viola Tricolor. JRhuH Tox. when the scalp is considerably afTected ; thick scales ; a bright edge of inflammation surrounds every portion of the eruption, and there is much itching, particularly ut night. Dose : As for Viola Tntvlor. Sulphur when the eruption extends more or less over the whole body, with much itching ; although the main affection appears on tlie head. Dose: As directed for C'oZcarea. Sepia. Eruption very moist; almost constantly discharging pus- like matter. The child often jerks its liead to and fro, seemingly from the itching. Dose: Two pills every evening. AFHTH^— THRUSH. The thrush often attacks the infant in the second week, and is char- acterized by the mouth and tongue being covered with minute whitish blisters, which are rubbed offby the action of sucking. A succession M these vesicles is constantly taking place as long as the disease lasts, and if not checked, becomes confluent and sometimes present an ulcerated appearance, or form a thin, white crust, which generally lines the whole cavity of the mouth, and in severe cases, extends to the throat, and even throughout the stomach and bowels. The affection, although of itself neither malignant nor dangerous frequently causes, not only considerable suffering to the child by prevent- ing it from suckling, but great pain and inconvenience to the mother by being communicated to the nipples and causing excoriations, etc. TREATMENT. Chamomilla. When the child exhibits much uneasiness, and must be carried all the time, this remedy will prove more beneficial. Dose : Two pills every three hours. Mercurius is to be recommended when there is more than usual raoi ire in the mouth. Tliere is inflammation in the whole cavity of the mou (1 ; the gums have ulcers on them. Dose: Two pills to be taken every four hours. Carbo veg. The mouth is very hot, the tongue almost immovable, and a sort of bloody saliva escapes occasionally. Dose : The same as for Mercurius. Sulphur, The child does not take its usually long sleep; it awaken.s in u 11(1 CONSTII'ATION. 70! often and the same synaptoms prevail, even after taking the other reme- dies. Dose: As for MermirUis. Bryonia , The mouth seems unusually dry with thirst; dry lips, rouph and crackod; the child does not like to take hold of the breast, but when once in its mouth and moistened, and it is fairly at work, it nurses well. Dose: The same as fov Chmnomilla. ExTEiiNAL Application.— The mouth should be cP'-'^fully washed after nursiup, with u soft old linen rag dipped in tepid water, or in water containiiiR a small quantity of Borax and Ilonev in solution. Pure molns- ses, applied by moana of a piece of old linen or muslin, or by tlie finger, coiistitutes one of the best he.illng washes, where one seems to be needed. ALLOPATHIC TREATMENT. Tiniusii: A good digestion and regu- larity of the bv»wels, should bo secured. Ti»e nourisnment of the child is generally insufficient, so tliat in cases of weakly infants, additional feeding is necessary. A little new creamy milk, the juice of lean meat, or freely ground lean beef may be given. For local use, a wash of Lime Water, a solution of Chlorate of Potash or Borax is appropriate. If ulceration occurs, the popular Golden Thread tea and Borax maybe used. Sulphurous Acid two drains in an ounce of water, may be applied with a linen mop. Other remedies are given on page 201, in the^treatment Stomatitis. l!ii! I««, Hi % 1. 'Ill i CONSTIPATION. Even very young infants are sometimes afifected with constipation; in fact, during the first two months of infantile life, constipation is frequent, while diarrhoea is comparatively rare. This maj be occasioned by some hereditary predisposition, and be maintained by the constantly imparted influence of a costive habit on the part of the nursing mother. In the medical treatment of the constipation of infants, recourse must p'.ways be bad to the cause. If this be found in the nursing mother, the proper remedies should first be administered to her. Should there be any- thin*; in her diet which may bo capable of rendering either her or her child constipated, this should also be attended to. With scarcely a single exception, cases of costiveness in nursing infants will be found dependent upon the influence of diet, hereditary and constitutional weakness and inaction of the bowels or actual derangement of the liver. MECHANICAL MEASURES. Before proceeding to enumerate the remedies, we may observe that an injection (lavement) of tepid water, or of some milk and water, may occa- sionally ba used, if necessary, to remove the obstruction of feces; or, a suppository consisting of a small strip of paper or linen, spirally twisted and lubricated with oil, may be introduced by a gentle rotary movement. If these means should fail at first, they should be repeated after the lapse of a few hours. Rubbing the stomach and bowels frequently in the course of the day with a warm hand sometimes assists the means employed. In order to overcome the constitutional tendency, it will be well to use the appropria4;e remedies. ; ii '-x II ll '04 DISEASES OF INFANCY. \>' MEDICINAL MEANS. Nux vom., wlien the stools ure large and difllcul^, or small, frequent and painful, with disturbed or restless sleep, frequent efTorts to evacuate llie atool without oflect. Dose: In ordinary eases j^ive two i)ills morning and evening for two days, tlien i)auHe two days. lirt/onia is suitable, if Ibo stools are very dry, as if burnt, and of a dark color; dry lips and nioulli, and there is alternation of constipation and diarrhcea. Tliis is a good remedy to alternate with Nux vom. Ik>se: As for Nux vom., or when alternate with Nux vom , give Bryo- nia, in the morning and Xnx wm., in the evening. Calcurca curb., is to 1;,' preferred when the stools ■■ e of a whitish or a clay color. £>ose : As for Nux vom. ALLOPATHIC TREATMENT. Constipation is best relieved by injec- tions of soap and water or cold water. I have known tcaspoonful doses of Olive Oil to relieve constipation in infants without being followed again by constipation- Kyrup of Rhubarb in doses of half a teasjwonful to a teaspoon ful and a half may be used. Fluid Extract of Senna in doses of ten to thirty drops in syrup is generally an effectual remedy in constipa- tion. Change in the diet which will overcome costiveness is ca!led for. To thi.s end fruit is indicated. It may be raw or cooked. If hard feces have lodged in the recitum (lower bowel) which the injec. tioiis do notremove, they should be broken down by the finger or removed witii the handle of a spoon. I n older children free exercise should be taken ; in cities the systema- tic use of gymnastics may be useful. Gobi wet packing of the abdomen often succeeds. Exercise and bathing and a diet with plenty of fruit will l)robably relieve. The Fluid Extract of Senna may be given, and for continued use Tincture of Nux Vomica and Belladonna will establish the habit of a regular stool. Take of TincJure of Nux Vomica and Tinnture of Bilhidoniiii fdcli tioo drams, Syrup of Orange Peel four drams. Mix. Bosr: One to twenty drops once a day according to the age of the child. DIABliHfEA OF INFANTS. Infantile diarrhrea constitutes one of the most fretjuent and serious of all diseases that occur iP in "ancy and childhood. Oi WwU alone diarrhofa docs not often prove directly fatal, but its long cor.tinuance seriously weakens the patient, and endangers the health, and it constitutes more- over a very grave comj)lication of other forms of disease. . ('auses of diarrhu;a are various; theintroduction intothestomach of in- appropriate indigestlole food; thederanged condition of themother's milk i nducedl)y mental emotions, imi)roper diet, or othercauseson thepartof the in ther ; fright mid exposure of the infant to cold ; and the improper use of laxatives etc., may bb enumerated as being the most frequent exciting causes of this disorder. It is well to notice closely as to the symptoms. A healthy infant at the breas.., pa-sses on an average from three to six motions in twenty-four hours ; but in some instances the evacuations are more frequent, yetwith- »mt in any degree alTecting the health of the child; in such caaes then. DIARRHOEA OF INFANTS. 7(VJ iquent aouate )r two id of a pation Bryo- hitiijli there ought to be little or no interference, so long a,s the stools remain free fro; i fetor, possessing merely the slightly acid smell, peculiar to unnatural indication. When, however, the stools become green, and watery, or yellow and watery, brown and frothy.as if fermented, mixed with phlegm or mucus, or consisting entirely of mucus, emit an offensive odor, and are generally preceded or accompanied by signs of suffering, it becomes neces- sary to have recourse to remedial aid. TREATMENT. Aconite should be employed when the skin is hot and dry ; and the child is restless; stools watery and often of a dark color: after the fever has subsided the diarrhoea will usually disappear also. T)ose: Give two pills every hour, until the fever abates, then gradu- ally lengthen the time. Antimoniutn crud. AVhen the tongue is coated white, and there is some nausea and watery discharges; sometimes there are hard lumps of feces with the water. Dose: Four pills every four hours. Chninonillla is almost indispensable in bowel complaints, when the following symptoms arc present; redness of the face or of one cheek, hardness and fulness of the belly, attended by severe colic : constant cry- ing and drawing up of its legs, wants to be carried. Its discharges smell like rotten eggs. Dose: Two pills every two hours. ArnLAlcuni is suitable when there is much exhaustion and rapid emaciation ; stools undigested, offensive, and painful immediately after taking nourishment; stools and vomiting at the same time. Do.sv? ; Tlie same as for Chamnmilhi. Bryonia. Diarrhoea from hot weather, or is aggravated by the return of every hot spell of weather. Dose : The same as for Vhamomilla. Calcarea Curb., is particularly suitable for children who have large heads and open fontanelles; the head perspires so much as to wet the pil- low far around. Muscles soft and llabby. D^se : As for Antimonium Crn/l. Carbo-vcff, should be administered when JBryonia fails. Dose: As f. lirj, jnia. PafsaUlla is suitable for diarrhoea arising from indigestion, or a chill. The stools are very changeable, no two alike, and are usi y worse at night. Dose : As for Chamojnilla. Ipecac is particularly good when there i, much nausea and vomiting, or almost constant nausea ; the stools are frequent. Tins remedy is par- ticularly i Mc:.ted at the time of weaning, or when food disajjrees. Dose: As for Chamomilla . Mercurius is characterized by the following symptoms; much pain ♦ 1 )re the stool, great relief afterwards ; stools frothy, slimy. )loody or dark green, with much straining. The child's legs and thighs are cold and clammy, particularly at night. Dose: Kh for Anti. Crud. Belladonna. When the child is very drowsy, half asleep and half awake, nmch moaning. Dose: As for A?iti. Cnul. 45 II? m 1 •|:| ]Viiy\ I )«».«|i 1 ' !'' ' %-, :('M '^ •ihi :l :■* ri'l 70G DISEASES OP INFANCY. Podopliylltim should be employed when the diarrhoea is worse in tl\e morning, stools green or watery, or which may be quite natural, only too frequent. This is particularly good when there is falling of the bowel. Dose: As for Anti. Crud. Sulphtir is particularly good for children who have delicate parents. Much redness around tlie anus, eruption of pimples upon the skin ; or, ir the child, afler getting better, under other remedies, always gets worse. Dose : As for Anti. Crud. Veratrum alb. Mi'oh exhaustion after every passage, with cold sweats upon the forehead, or upon the skin in general. Dose: As for Chamomilla. ALLOPArmc TREATMENT. For treatment of the diarrhoeas of chil- vlren, see Chapter XIII. i l| CHOLERA IKFANTUM-SVM3IER COMPLAINT. This is a special form of bowel complaint, which requires special notice. This disease very often proves fatal, even under the best of treat- ment, since it appears usually in the latter j)art of the summer, wlien tlie young infant's system is already somewhat exhausted by the previous heat ; when the air is impure and the weather sultry, or warm and damp, and seems to spring up lus an epidemic from some atmospheric miasm which is little less than malignant. In this, the worst form of infantile diarrhoea, all the symptoms seem equal in intensity and the disease runs a very rapid course. Children under two years are most liable to attack. Vomiting and diarrhoea form the most noticeable symptoms. The stomach is so irritable that it rejects immediately and son .times with great violence, everything that it receives. At first, the matter vomited consists of the ordinary contents of the stomach, but this does not con- tinue long; as the malady advances the matter vomited is tinged with bile and presents a greenish hue. The discharge from the bowels usually consists of a colorless or some- times greenish, inodorous and watery fiuid ; occasionally with shreds of mucus mixed with it. Tlie stools are usually discharged without effort — sometimes unconsciously— or are squirted out as though thrown from a syringe. Frequently there is considerable pain with straining, the infant manifesting its sufferings by a whining, plaintive cry, by restlessness and i)y drawing up and extending its limbs. As the disease advances vomit- ing becomes spontaneous md the matter ejected resembles that passing from the bowels, while tl;e number of stools increase. Sometimes there is a sudden lull in the whole force of the disease, or the diarrhoea may abate and the vomiting continue, or the opposite. There is extreme Ian. guor and prostration and generally very rapid emaciation ; which condi- tions, together with the vomiting and the diarrhoea as above described clearly and unmistakably point to cholera infantum. As the disease progresses, the discharges from bowels become still more frequent, are passed involuntarily, and are ually more profuse, lesembling dark-colored dirty water, or " washings of meat," and are very offensive; enuiciation becomes extreme; the eyes are languid and cold CHOLERA INFANTUM. 707 dull, or hollow and glassy, and the child takes no notice of surrounding objects or persons ; the lips are dry and shrivelled. In many cases, the child lies in an imperfect doze, with half-closed eyes, and entirely insen- sible to external itnpr'ssions. The abdomen frequently becomes disten- ded and hard, or is sunken or llaccid. Frequently, in fatal cases, the child falls into a complete state of stu- por, and convulsions ensue. It not unfrequently happens, particularly in children predisposed to affection of the brain, that in aw early stage of the disease, the brain becomes involved, and the child dies with all the symptoms of inflammation of the brain. Favouablk Symptoms are: An abatement of the fever, and the gradual restoration of an even temperature, with decreased frequency of the pulse; cessation of vomiting, and decrease in the number of evacua- tions, with a gradual return of the stool to a more natural condition and appearance; natural and peaceful sleep; desire for food; and a general im- provement in the appearance of the child, together with a return of playfulness. TKEA.Ti^ENT. Much of what has been said under the head of Treat- ment, in the preceding article on " Diarrhcca of Infants " (page 682,) may be made availal)le in selecting tlie roinoily suited to a case of cholera infantum, and that article should therefore be carefully consulted. The subjoined medicines, however, are those most frequently called for in the treatment of the disease under consideration, and are approved as of the utmost elllcacy when carefully soiected for the individual case. Aeonlfuin is very frequently indicated, and should be given, in cases in whii;"i there is febrile excitation, manifested l)y acceleration of the pulse, heat and dryness of the skin, and thirst. Under such circumstances it often hapi)ens that Aconitum, wiien promptly administered, not only removes the febrile indication, but, as well, cuts short the entire disease, and very promptly aids in restoring the babe to health. Dose: Two globules dry, on the tongue, every one or two hours, accor- ding to the severity of the symptoms, until nuinifest improvement or ciiange. K a favorable change slioul;! result, however slight, at once lengthen the intervals b'tween the doses to two, three, or four hours, as the case may be according to the existing condition, and Anally (!ea.se giving medicin.Mipon the exhibition of marked and decided amelioration and improvement. .Should, however, no evidence of improvement be nnmifested after the sixth dose, or should symptoms indicative of some other remedy sooner occur, proceed at once to theadministration of another and better indicated remedy. Arsenicum ia suited particularly to cases in which there is great weakness from the first, so that the child does not care to hold its head up; there is much thirst, while drinking induces vomiting and stool ; vomiting and purging occur at the same time, and greatly exhaust the child; the cinld has a pinched and distressed look, a»Ml is very restless, which restlessness, together with the other .symptom,i, ^c-^w worse after midnight ; coldness of the hands, feet, etc. Dose: In every particular as directed for Aconitum. fpecacuanhn si ould be given when tlie stools, whijh are very fre- quent, have a fermented appearance, or resemble greenish water ; and ^ i I 4* .4 •I I' 'it, III!' l| ^i'^' I'^llfl "08 DISEASES OF INFANOT. ■y;-r ill when, more particularly, nausea and vomiting predominate, the child seeming to be siok at its stomach, almost constantly. Dusa : in every particular as directed for Aconitum. Chainomilla will frequently prove useful in the early stages of some oases, ])artrcularly if the child be suffering from the Irritation incident to dentition; it is more particularly indicated by the presence of griping, colicky pains, with greenish stools; fretfulness and crossness, with desire to be carried. Dose. Two globules dry, on the tongue, every three hours, until manifest improvement or change. Verntruni is required in cases in which the purging and vomiting are almost constant and simultaneous, and are excited by even the small- est quantity of nourishment or drink ; motion even excites nausea; there is very great prostration, with coldness of the face and extremities, and cold sweat forming on the forehead, and an almost imperceptible pulse. Dose: As directed for Anonitum. Secale is indicated by a chain of symptoms very similar to those pointing to Veratrum, but is more particularly indicated by paleness of the face, with sunken eyes, dry heat of the body, restlessness, and sleei)lessness. Dose: As directed for Aconitum. Podophyllutn should be given in cases in which the dejections have an exceedingly offensive odor, and are passed most frequently in the morning; the child moans during sleep, lying with half-closed eyes, and rolls its head from side to side. Dose : In all respects as directed for Aconitum. MerciiriuH should be given, particularly at the commencement, if there be much colicAy pains, which are relieved by the purging, the stools being slimy or bloody; or, when there is a great deal of perspiration, par- ticularly on the thighs. Dose : As directed for Aconitum. Croton tig. should be administered in cases in which the stool is forcibly exi)elled, as though forced from a syringe, one gush and it ceases. Dose : As for Aconitum. Belladonna is required in some cases, particularly if there be great heat of surface, with flushed face, and evidences of a tendency to conges- tion of blood to the head ; the child is very thirsty, drinks hurriedly, and thrusts its hands constantly into its mouth. Dose : As lor Aconitum. (Jalcarca Carb. will prove valuable in cases in which the stools are whitish and watery; and have a sonr smell, as does the matter vomited ; there is great emaciation, while the abdomen is bloated ; the face has an old, wrinkled look ; the extremities are cold. It is especially adapted to scrofulous children, with retarded dentition, or where the case has become chronic. Dose. Two globules, dry on the tongue, repeated every four hours, until manifest improvement or cliauge. Sulphur may be calletl for, in cases similar to those indicative of Cal- carea, It should be given. likewise, Incases where the patient, having got better, relapses, and this process is again repeated, so that the case seems to linger, and has a tendency to become chronic. CHOLERA INFANTUM. 709 Pose: As directed for Calcarea. Bryonia, Nux vomica inay be called for in tlie treatment of this malady, in its earlier and later staffs. For discriminative indications for their use, consnlt, under the heading of each medicine, respectively, the article on " Diarrhrea of Infants. '' Diet and Rkqimkn. Very little nonrishraent will be taken by an infant sufferini': from cholera infantum. Breast-milk should constitute its chief source of food and drink, in cases in wliich the child suckles ; but in other cases, however, great care must be taken to avoid giving anything tlmt can add to the irritation already existing in the stomach and bowels. Pure dilute milk, boiled and sweetened, or thin, well boiled oat-meal gruel, will afford sufficient food and drink. Water may be given in'small quantities, if it does not excite vomiting ; in which latter case, the infant may be per- mitted to suck small pieces of ice from time to time, if its lips be parched and dry, or a small piece of ice may be enclosed in a linen rag, and the cliild allowed tosuck atit. Every effort should be made to sustain the nat- ural warratii of the body, particularly of the abdomen and lower extremi- ties, by the application of warmed woolen cloths; but the resort to the application of cloths wrung out of hot spirits, or claret wine, or other poul- tices, is highly objectionable, and should not be resorted to. ALLOPATHIC TREATMENT. In the cholera of infants, if vomiting aad purging have not emptied the stomach and bowels of their irritating contents, aa shown by undigested substances in the stools or vomited mat- ter, an emetic of three or five grains of Ipecac should be given in water, or a purge of three grains of Calomel should be given. The latter should be assisted in its operation by an injection of warm water. If no indigestible matter is noticjul, neither a purge iu>r an emetic should be given, but no time should be lost in stopping the discliarges. This is best and soonest done with Opium. One drop of Laudanum maybe given with a teaspoon- ful of Chalk Mixture, or three grains of Sub-Carbonate (or Nitrate) of Bismuth in a teaspoonful of Lime Water. This may be given every hour to a child a year old. To those younger Paregoric should be given instead of Laudanum. If neither Bismuth and Lime Water nor Chalk Mixture are at hand, tiie Opiate should be given with a grain or two of Bicarbonate (baking) Soda. The object is to tliminish the discharges from the stomach and bowels and improve their character. When the discharges are checked or the child begins to be stupid, the opiate siiould be discontinued or given less fre- quently. Wiien the vomiting has ceased, if the bowels continue moving, if the child is not inclined to be stupid an injection of two to live drops of Laudanum may be given, with half a teaspoonful of milk in a small hard rubber syringe. If the child is nursing it should be confined wholly to the breast, and then only allowed to draw small quantities at a time. If the breast milk is rejected, it can be allowed lean meat finely minced, pounded in a mortar and strained, which may be seasoned with salt. The white of eggs mixed with water, and rendered fdkaline with Bicarbonate of (baking) Soda, five to ten grains, is frequently well digested. The raw meat juice and white of egg are of great use when there is great prostration or emaciation. If the pulse weakens or collapse threatens, stimulants should be freely M %m ,iii. • i!r. ill ill llll?:flit;jj I I.! ■■! 1^^ il I': #-» V: ■■ . 710 DISEASES OP INFANCY. given. Brandy or Bonrbnn Whisky is best suited. The dose is fifteen or twenty drops to a teaspoonf ul given witli the milk, meat, or egg, and can l)e repeated at intervals varying from one to four hours. Stimulants are generally indicated early. Rice or barley water can be drunk ; small lumps of ice may be allowed. A warm poultice over tlio storaacli will be beneficial. Great heat of the skin will require ool sp )ngiiig. If the skin is cool, or cold, a warm bath of one hundreil to one hundred and four degrees, will be beneficial. Sometimes cholera infantum is caused from ill nourishment. In these ceases tiie acute symptoms are relieved by Opium as above directed, and better nourishment completes the cure. VVlien the disease occurs from the effects of heat, Bromide of Potassium is highly serviceable, and is thought l)y some to be generally applicable. Take of Bromide of Potash two scru- ples, Mucilage of Qum Arabic two ounces. Mix. Dose : From fifteen drops to a teaspoonf ul. Five grain doses of Cerium, an eighth of a drop of Creosote, or Carbolic Acid in water, are useful in r(Uieving the vomiting. Continued diarrluca will call for astringents as direitted for that disease. Anaemia (thin blood,) will require tonics, such as: Take of Citrate of Iron and Quinine ten to fifteen (jrains. Orange Water an I Peppermint Water each an ounce. Mix. Dose : Give a te;ispoon half full three or four times a day. If the cause of the disease is malarial, one or two grains of Quinine ought to be given at the first intermission. CHAFINO^EXCOBIATIONS. Excoriations, soreness, or chafing, frequently occurs in those partr of the skin of infants which are oitUer rubbed together in the natural move- ment of the limbs, or liable to be fretted by friction of the diaper or other article of clothing. Thus the groins, the surface between the genitals and the thighs, behind the ears, under the arms, and even the folds in the neck of rteshy children, may become the seat of these excoriations. Such tenderness of the skin is due, in the first place, iu a great part, at least, to taint in the constitution; and for its complete removal will re- quire, therefore, a suitable remedy. Against this affection, cleanliness is the best preventive, TREATMENT. Chamomilla will be found speedily effective if the child cries much, and requires to be carried continually up and down the room. Dose : Four globules night and morning, Mercurius. The excoriation is much worse" at night; it is very raw a: i bloody; the child does not sleep much. Dose : As for Chamomilla. Calcarea curb, will be suitable for very fat and flabby children. Dose: Two pills in the evening. OrnphiteH will be found useful when the afifected parts discharge a quantity of transparent glutinous fluid, ctipecially behind the ear* and between the thighs. Dos« : As for Calcarea carb. ASTHMA MILLAUI8. 711 Sepia. The skin is very delicate; the least injury tends to ulcera- tion. Dose : As for Calcarea carb. Sulphur. Tliere i« much it'ihing of theskin ingeneral'andof the parts affected. Dose: As for Calcarea carh. A most valuable ajiplieation to the excoriated parts of Infants is to take green tea and pulverize it to a fine powder and apply the same as any powder. ALLOPATHIC TREATMENT. Protecting the chafed or excoriated skin from irritation, will provide for its euro. If the trouble is caused by the discharges from tlie bowels or bladder, the napkin should be immediately removed and the child cleaned. These discharges must be rendered un- irritating by giving Bicarbonate of Soda, in doses of one or two grains, sufficiently often to accomplish the result. The raw surface on tlie skin may be dusted by starch, flour, Oxide of Zinc or Calomel, or the Beuzoated Oxide of Zinc Ointment may be ap- plied. ASTHMA OF INFANTS-ASTHMA MILLAMIS. Attacks children between two and eight (seldom infants at the breast or full grown persons,) is very similar to croup. The attack almost al- ways sets in in winter, in consequence of a cold; first at night, suddenly without any distinct premonitory symptoms, and sets in at once with t l>e most violent symptoms of suffocation without any rattling or wheez- ing. The pulse is hurried and small. If cough sets in it is short, rough, without gagging or expectoration ; the voice is hoarse, deglutition difii- cult. However, the child does not complain of a local obstacle in swal- lowing or breathing or of pain in the larynx or trachea, but of a dull pain or spasmodic drawing throughout the chest, as if caused by suffocating vapors. Slight spasms and change of color are noticed. A general ere- thism of the circulation and nervous system, scanty and pale urine hav- ing a sweetish odor. The patient is suddenly roused with a fearful look and an expression of anxiety in the altered features. The voice is deep, barking, hollow sounding, husky, very seldom wheezing or crowing. Daring the convulsive movements of the chest the labored inspirations of the cliest are suddenly followed by a noisy expulsion of the air. The face becomes dark-colored, the eye becomes staring and protruded, the veins oi" the neck and temples swell. If the attack does not destroy life it ends in a few hours with sneezing, eructations and vomiting. The breathing becomes easier, the peculiar sound disappears and, amid a general subsi- dence of the symptoms, the child falls into a quiet slumber from which it awakes exliausted and desponding. Generally a second attack sets in the following night, more violent than the former with increasing fever. The danger of sutTocation is greater, the face and lips become mottled blue, the shoulders are raised, and all the muscles of the thorax are violently worked. The face becomes more and more distorted, the nostrils dilate, the pulse becomes very rapid and intermits; the patient tosses about, ia t .,"^ 'k ■'■'-■'" «: i#l 1 - "rM I HI 1 ! 1 i 712 DISEASES OF INFANCY. covered with cold or lukewarm porspirution, feces and urine are i)aH.sed Involuntarily, but the coiisciouHiiess la undlHturbod; finally, the patient dies of suflbcation amid convulsions. Only a few children survive more than one attack, and death almost always sets in during the third or fourth attack. The attaokfl never terminate with expectoration. At^thma Millaris cannot well be confounded with croup, if we remem- ber that in croup tlie larynx is always tender to pressure, and that the patients bore their heads into tlie pillow, whereas in this disease the child sits erect and does not conii)lain of pain in tlie larynx, but of simsmodic constriction of the chest. In croup the breathing is fine and crowing ; in asthma millaris it is dgep and hollow. If the disease is speedily recognized subsequent attacks may be aver- ted and the present attack modified and alleviated by one of the following remedies. TREATMENT. Ipecacnnnhn. Sudden paroxysms of suffocation at night witli.a sensation of violent constriction in the chest, short and anx- ious inspirations and sudden and jerliing expirations, pale, bloated face with blue margins around tlie eyes; peevish mood. Sanhaciis nigra. Sudden starting up from sleep with a shriek, anxiety and trembling, sudden, wheezing inspirations which sometimes intermit, deep, hollow rough voice, liluish puffinessof the face and hands, protruded eyeballs with the mouth Iialf open. Anxious tossing about; heat without tliirst, hurried and tremulous pulse, torpor and copious, mostly cold sweat. On comparing those indications with tlie symptoms of the disease, it is readily seen that Tpecac-is only given to advantage in the beginning of the attack, and if tiie attack attains to its full development Sambucus has to be given. If the attack siiould set in again during the night following nothing can be expected of this agent, and it will be advisable to give Arsenicum. All these remedies liave to be given in the form of a watery solution— a dose every live or ten minutes. Other varieties of asthma can be most frequently controlled by Arsen- icum. For asthma, caused by the inhalation of sulphur, we give Pulsatilla. Asthma, caused by a fit of anger, or a cold, can be best relieved by Chamomilla or Nux-vom., the latter being more particularly indicated by a vehement disposition. For asthma, caused by the inhalation of stone dust, in the case of stone cutters, sculptors, etc., wegive Calc. Carb., Silic. or Sulphur. Calcarea Carb. is a main remedy for chronic asthmatic complaints, with disposition to draw a long breath, and sensation as if the breath were arrested between the shoulder blades. The distress is relieved by raising the shoulders. Mere stooping causes the breath to give out frequent par- oxysms of dry cough, at night especially. '»S SWELLING OF THE BREASTS. These organs in infants— more especially female infants—sometimes become swollen and hard, which is often the result of the absurd and wicked practice on the part of nurses, of squeezing tliem, under the erro- ■I ATROPHY— EMACIATION— MAUA8MUS. ri.1 neons opinion tliiit if tlie milk i.s not squeczeil outoftliern, tliey will not perform their proper functions in aftor lift-. Tliis pr.actice is a cruel one, and very often brings about tlie state of alfuirs it is intended to prevent, for by squeezing tlie gland, inllamniation, swelling, and perhaps suppuration and destruction follow, and the breast is rendered useless, and the source of a great deal of trouble and suffering in after life. TREATMENT. Aconite should bo given ; if there be much fever at, the onset this remedy may dispel the whole difficulty. Dose : Two pills every six hours. Arnica. The breasts are merely hard, with no apparent inflammation or if the redness has not appeared. Dose : The same as Aconite. Belladonna. If the breasts are very red and run in streaks to the adjoining parts. Dose : As for Aconite. Bryonia when the breasts are quite hard and of a pale red color. Dose : As for Aconite. Chamomilla, The child is very fretful ; the breasts are very tender to the touch. Dose : As for Aconite. IIej}ar Sul. will be useful if the matter or pus has already formed. Dose : As for Aconite. I» ATBOrUY— EMACIATION— MARASMUS. General Causes. Emaciation of infants and children usually arises from a predisposing constitutional cause, which frequently becomes de- veloped during tlie irritation of teething, or is called into activity by inap- propriate or unhealthy nourishiiuMit, cither from the breast, or in the form of supplementary diet, at an earlier period ; or again, and, unfortunately, not unusually, it is engendered or developed, and rendered more compli- cated, and almost incurable, at a somewhat more advanced age, by the per- nicious habit of a free and reiterated use of mercurial preparations, in the vain hope of bringing about a healthy state of the primary organs of diges- tion, when these have become deranged by repeated infractions of appro- priate rules, as to diet and general habits. The manifestation of worms, and the usual attendant symptoms of invermination, and the enlargement and induration of the mesenteric glands, are frequent, antecedent, occa- sional causes of the disease. TREATMENT. Sulphur is appropriate in almost all cases at the commencement of the treatment, wlien the disease has become fairly developed, or occurs in scrofulous children, but is more especially indica- ted by the following symptoms : Craving appetite for food and drink, watches eagerly for the cup or spoon, and clutches at them, thrusting everything into its mouth ; enlargement of the glands in the groin or arm- pits; slimy, excoriating diarrhcea, or obstinate constipation; pale com- plexion, sunken eyes ; jumping, starting, and screaming; restless sleep. Dose: Three globules every morning, the first thing, for ten days, unless decided change or new symptoms should sooner occur ; then pause five days, after which the course may, if still indicated, be repeated as before, and so on, until decided amelioration or change. Calcarea should either be employed at the onset, or after the pre- '% .> f m If Li ! I i|ii i|ii;;f^ 41 714 UlbKASKS OP INFANCY. vious administration of Sulphur (as just diracted), if the following aynip- t mis be more especially predominant, or should supervene ; or if, a)?ain, Sulphur should not have been productive of apparent improvement within eiylit days after the oompletlou of the second course. The indicative symptoms are : great emaciation, with craving appetite ; enlargement and induration of the mesenteric f,Mand3 and of the belly; great weakness, ilayoy evacuations, a dry and flabby skin ; too great a susceptibility of the nervous system ; large, open fontanelles; profuse sweat about the head; cough with rattling of mucus. Dose: Three globules, as directed for Sulphur. Chaniomilla is chiefly required when the followingsyraptoras occur: Frequent screaming, with drawing of the legs towards the stomach ; hard- ness and fullness of the belly ; great restlessness and feverishness ; acidity ; flatulence, frequent purging, the stools being of a deep grass-green, or very yellow color, or whitish, yellow and frothy, sometimes resembling beaten eggs, and of an offensive odor, often like that of rotten eggs ; occasional sickness, the matter vomited being more or less of a bilious description ; thirst ; want of appetite; frequent change of complexion. Dose : Three globules tlirice a day. Pulsatilla is indicated when less restlessness and peevishness pre- vail th;in under Chamomilla, and little or no thirst, with complete loss of appetite; or, on the contrary, voracious and inappeasable hunger, with acid or other disagreeable risings; or disi)osit!on to vomiting the contents of the stomach ; frequent papeseent stools of a greenish, bilious description ; or watery, slimy evacuations, at times of a light or whitish color; the <'hild is always better in the open air. Dose: As directed for Chamumilla. Antitnonium c. may be had recourse to, twelve hours after the last dose of the preceding reinedy, if no improvement has resulted; or this remedy may be preferred, from the commencement, if the child cannot dear to bo looked at, or touched by any one; or if its tongue be covered with a thick white coating. Dose: As directed for Chamomilla. Lpecacunnha is usually a most useful medicine, when nausea or copious and frequent vomiting form more prominent features in the case than purging; or, when there is both vomiting and purging; the substance ejected from the bowels being chiefly of a greenisli-yellow color, and often bearing resemblance to matter in a state of fermentation. Dose: As directed for Chamojnilla. Mercuriiis is required when the evacuations from the bowels are very frequent, but generally scanty and slimy, and usually attended with distressing straining; or greenish, sour-smelling, or fetid; also when small white ulcers make their appearance on the inner surface of the lips and cheeks, or on the tongue, etc.; when, with less flatulency, most of the symptoms mentioned under the head of Chamomilla are present; or, and more particularly, when the patient is affected with enlarged joints and glands, and distorted limbs— provided always these latter symptoms have not been induced, or at least materially aggravated by the abuse of Calo- mel, or other mercurial preparations, under allopathic treatment— this medicine is also of much efficacy. Dose : As directed for Sulphur. ATBOPUY— EMACIATION— MARASMUS. Via Niix-vomica, The interposition of cotiatipatioii, or alternate stutea of costiveiit'Hs and relaxation, with fickle, variable, or entire loss of appe- tite; regurKitations or vomiting, llatuloncy, acidity, excessive irrltahilily of temper, great feebleness, soreness of the mouth, or I'ormatiou of small white, ulcerative specks or spots, are all indicative symptoms for the em- ployment of this remedy. Dose: As directed for Chamomilla. Bryonia. Vomiting occurs almost immediately after eating ; consti- pation ; the child always feels cold ; the lips are dry and parched, and tlie nioiilli is dry. Dose: As directed for Chamomilla. Arsenicum is one of the most Important remedies; It Is indicated by dryness of skin, which resembles parchment; hollow eyes; desire to drink ot'teii, I)ut little at a time; excessive agitation and tossing, esi)ecl!ill3 >t night; short sleep, interrupted by jerks ; colic, with relaxed stools of greenish, brownish, or blackish color, or evacuations containing undiges- ted food ; night sweats; extreme prostration ; pale, waxy appearance. Dose: As directed for ;SwZp/mr. Baryta carb. is indicated by enlargement of the glands; of the nape of the neck ; tenderness of the belly, with tumefaction and Induratk m of tlie abdominal glands; continual desire to sleep; great Indolence, and aversion to exertion and amusement; dysenteric or loose stools, sometimes containing thread worms. Dose : As directed for Sulphur. Acidutn nitricuni Is chiefly required in cases which have been devel- oped or exacerbated by the abuse of mercurial preparations ; the bones nnd joints being swollen and tender, the mouth and gums more or le,s3 iiillamod and sore, the mesenteric and other glands much enlarged ; th« l)owels confined or much relaxed, and attended with straining. Dose: As directed for Sulphur. Pftos2)horuH is more or less useful, in cases with protracted and debil- itating watery diarrhoea, and when the mesenteric glands are diseased. Dose : As directed for Sulphur. Belladonna is to be preferred when the prevailing symptoms and conditions are as follows: capriciousness and obstinacy; nocturnal cough with rattling of phlegm ; enlargement of the glands of the neck ; unquiet sleep ; precocity of intellect ; (blue eyes and fair hair). Dose: As directed for Chamomilla. China is required for excessive emaciation ; voracity ; diarrhoea at night, or frequent, white, papescent motions, or evacuations of undigested matter; frequent perspirations, especially at night; great debility and languor; unrefreshlng sleep. Dose : As directed for Chamomilla. Cina is more particularly required when the patient suffers from worms ; or for wetting of the bed, insatiable appetite, etc. Dose : As directed for Chamomilla. Bhu.i should be selected, when there is slimy or sangulnous diarrhoea; debility, and excessive languor, with constant desire for the recumbent posture; great restlessness; the symptoms are all aggravated after mid- night. Dose : As directed for Cliamomilla. iti! m I !i 7] ^^ ^ ^^ % v'* "'Wv / IMAGE EVALUATION TEST TARGET (MT-S) 1.0 •IT IIIIM I.I u 14 1.8 1.25 1.4 ill 1.6 Photographic Sciences Corporation ^ /. ;% 23 WEST MAIN STREET WEBSTER, NY. 14580 (716) 872-4503 £p^ i rifi DISEASES OF INFANCY. Diet and Regimen When the disease is manifested in infants at the breast, recovery will, in many cases take place on the substitution of a good nurse of sound constitution, or of appropriate artificial feeding — such as goat's milk, or, sometimes, weak broths— for the faulty nutriment which has originated the disease. But when the child is of scrofulous constitution, and glandular enlargements, etc., have become developed, tlie addition of regular and appropriate medicinal treatment is required. Again, when the affection has been engendered by improper food, in children who are being reared by the hand, or who are past the age of infancy, if the progress of decay is not too fur advanct^d, and no organic disease be developed, a cure may, as in the loniicr ease, be accomplished by the correction of the main source of all the miscliief. The improj)er food oughti therefore, lo bo at oiico witliilrawn, or the (juantity reduced, if that has been too grtat. Goat's milk or cow's milk, wi.icli has previ- ously been boiled and diluted (one jiart of water to alout throe of good milk,) and, occasionally, chicken broth, or, to children of more advanced age, farinaceous food, generous beef tea, or mutton broth, free of fat, may be substituted for food of a more solid or indigestible nature, with which the child has been dieted. Pure air and regulated exercise, are also of great importance. ALLOPATHIC TREATMENT. Atrophy. A full discussion of the treatment of infantile atrophy (wasting away) would require considerable space. It may briefly be said to be caused by lack of proper nourishment. If the child is at the breast, the amount of breast milk is insufficient or its quality poor, or, from accidental causes, it is absolutely harmful. In the latter case, the child should be raised by a wet nurse, which is preferable, or weaned ; in the two former cases, it ought to be raised by a wet nurse, or artificially fed, in addition to the food it gets from the breast. For artificial feeding, milk is most suitable. The milk should be daily tested with, litnms paper, and if it is alkaline, i. e. turns red litmus paper slightly blue, it may be sweetened a little, and diluted as further directed and given to the baby, without further preparation. If it is not alkaline, sufficient Lime Water or Bicarbonate of Soda should be added to render it so. Previous to a month old, one-half water should be added to the milk ; at a month old, only a quarter part water should be added. A little cream should be, also, added to make up for the water. After four months, milk may be given plain, except that it should be rendered alkaline, if not naturally so, with Lime Water or Soda. Milk is the food for children. A child a month old should take a quart of milk a day j)repared as above; but not over a quarter of a pint at a time. Cow's or goat's milk should bo treated as above. If possible, the animal should be fed on grass and should have only pure water to drink and subject to no confinement. If the child should continue to waste after being suitably fed as above directed, other foods may be given as directed in the dyspepsia of infants treated with colic. Cod Liver Oil may also be given in doses of ten drops in the first place, gradually increased to a teaspoon ful. The tonic efi'ect of Iron and Quinine is of service. Take of Citrate of Iron and Quinhie Jlfteen grains, Syrup of Orange Peel and Peppermint Wa- ter Mch an ounce. Mix. DENTITION. 717 Dose: From fifteen to thirty drops three times a day. Pepsin or I.actated Pepsin in doses of two to five grains, after feeding or nursing, may be advantageous, or Liquid Pepsin (Sheffer's formula) may be tried as an aid to digestion. DENTITION. The development of teeth in their regular order, although a perfectly natural process, is often attended with much suffering. When dentition isj slow, retarded and difficult, it not only becomes of itself a serious disorder, but it involves also a lona; train of morbid symptoms and actual diseases which via jUixhMXiit the patient's strength, and finally destroy its life. The primary difficulty in such cases is in the nutrition, and as we often see in older children a remarkable backwardness in the development of the osse- ous (bone) system in general, so we often find in earlier periods of infantile life a corresponding slowness in the develoi)ment of the teeth. And both these forms of imperfect development occurring, as they often do, succes- sively in the same children, are to bo attributed to some profound consti- tutional taint which affects the nutrition. In order that our reader may judge of the deviation from the normal standard of dentition in any given instance, we propose to state here the mode and order of the appearance of the teeth in health. It should first be observed, however, that thereare anomalous cases of dentition in which the non-appearance of the teeth should not be regarded as requiring active interference, unless other morbid symptoms are present. The non-appear- anceof the teeth at the usual time, unless accompanied by symptoms indi- cative of constitutional disturbance, really furnishes less occasion for apprehension than their premature appearance would. Even in the con- dition of api)arently perfect health, some infants begin to cut their teeth very early, even by the third month, while in others this process com- mences at a very much later period. In the early months the infant's mouth is naturally dry ; this dryness is relieved by frequent nursing. But usually about the fourth or fifth month a very considerable change takes place in this respect; the mouth is now found constantly full of saliva, and the child is constantly drivel- ing — or drooling, as it is sometimes called— but no other indication appears of the approach of the teeth to the surface, except that the edge of the gums becomes broader than it was before. No further change may take place for many weeks, and it is generally near the end of the seventh month, oftener later than earlier, before the first teeth make their appearance. The middle incisors of the lower jaw are generally the first to pierce the gum; next in order appear the middle incisors of the upper jaw ; then the lateral incisors of the lower. The first molars next succeed, and often without any very definite order as to whether those of the upper or of the lower jaw are first visible, though in the majority of cases the lower molars are first to appear. The four canine (stomach and eye teeth com- monly called) teeth succeed, and lastly the four posterior molars, making in all the number of twenty deciduous teeth. There are, however, inter- vals of rest between the successive irruptions of teeth ; thus a period of alx or eight weeks generally intervenes between the lower and the upper :r-il I 718 DISEASES OF INFANCY. I'q'i*- i I 'lit ii middle Incisors; the lower lateral incisors come very soon after. But a pause of three or four moaths may occur before the hrst molar teeth make their aijpearunce; another of equal length may occur previous to the appearance of the canine teeth ; and still another before the first dentition is completed by the irruption of the lust molars. In some few cases the teeth come through so rciidily as to scarcely disturb the infant ; but more frequently indeed the mouth becomes hot and the gums look tumid, tense and shining, while the exact position of the tooth is marked sometimes before its appearance, by the prominenc.' of the gum; or the irruption of the teeth is preceded or accompanied by ii somewhatdifTerent condition of the mouth, in which there is much iieat and intense redness of the mucous membra* 9, an extremely copious flow of saliva, and a disposition to the format: of small aphthous ulcers on the tongue and on the inside of the lips, though the gums themselves may not be particularly swollen and painful. Either of these states is usually attended with some degree of febrile disturbance, and apparently witii considerable suflfering to the infant, who is constantly fretful and peevish, or cries out occasionally as if in pain. A third morbid condition of the mouth is sometimes seen, which is usually ushered in or attended by very considerable fever. The gums then become extremely hot and swolkii, and unusually tender, especially over some tooth or other in particular ; and in that situation we find the gum swollen up into a kind of lit; lo tumor. Small unhealthy ulcerations vsith a sloughy api:)earance oftii: form upon the summit of the gum, and especially around any tooth which has partially pierced through it. To this affection, which is often very painful and difflctflt of cure, the name of odontitis infantum has been applied. A single word with reference to lancing the gums. This operation is in almost all cases unnecessarily performed, and in many cases it proves positively injurious. And yet it sometimes alTords the most importiini and immediate relief. Where the gums are red and inflamed, in our opinion they never need to be lanced, but only when in their very slow- growth they have changed to a dense, firm and unyielding, cartilaginous formation, thick and of a whitish color, through which tll^ teeth vainly attempt to make their way, and the irritation of the child's system threatens to destroy its life by sheer exhaustion, or by inducing fatal con- vulsions. Before proceeding to indicate the remedies to be employed in disor- ders of dentition, we remark that the tooth does not mechanically cut its way out of the gum, but its growth causes slight pressure by the crown of the tooth, a pressure which excites the absorbents to remove the impedi- juent. In this manner the absorbents do ab.soIutely, when the infant is in a perfectly healthy condition, open up the way for the tooth to escape without pain or suffering. Now the duty of the physician, or the one act- ing as such, is so to direct the course of events, that the evolution of the teeth shall become as painless as any other process of development. All the laws of health should be rigidly enforced, and every prescription care- fully made and finally, when the period of dentition fairly commences, if suflTering is experienced, or difficulty arises, the following remedies should be carefully and particularly studied and administered. DENTITION. 710 ut a uake the ition Aconite. Constant restlessness as from distress, which no change of posture or circumstance seems to relieve. The child gnaws at its fingers or something else, cries, whines or frets much of the time. Its sleep is very much broken, and there are usually much heat about the head, and adry skin, sometimes with cold hands and feet. Soon after or whilst waking from sleep its cries of discomfort recommence. Accompanying this state of things sometimes there is constipation, when the stools are watery and dark-colored, jr bloody and slimy. The child is usually very thirsty and seems to be relieved very much by holding on to the cup con- taining cold water with its mouth, apparently for the purpose of cooling its gums. Dose : Two pills every three hours. Antimoniutn crud. When the stomach so sympathizes as to pre- sent prominent symptoms. Tongue white; nmch vomiting ; no thirst; stools composed of hard lumps and watery secretions passing together. Dose : Give two pills three times daily. Arsenicum alb. The child has undigested, foetid stools, and is emaciated ; dry and shriveled skin ; particularly restless after twelve at night. It has paroxysms of anguish day and night, during which it often fltrikeis its face or head with its little liand, as though that afforded relief. It often vomits all fluids soon after swallowing them, particularly water. It will only take a sip or two at a time, but very often. The child often has a pale, waxy look. Dose : Two pills every four hours. Belladonna. The child moans a great deal; violent starting or jumping of parts, or of the whole of the body whilst sleeping or waking ; convulsions, followed by very profound sleep ; agravation every afternoon ; very hot fever at night, often lasting all night, with delirium ; face and eyes red, and often with heat of the head. Dose: Two pills, to he repeated every two hours. Bryonia alb. Dry, parched lips ; dry mouth and constipation, the Btools being dark and dry, as if burnt. The child wishes to be kept very quiet ; seems to dread to be moved. If it be raised to the perpendiculai^ it often vomits ; seems faint, and wishes to lie baci: again ; vomits 'ts nourishment soon after taking it ; the gums look swollen, are hot and dry, though pale or light red. Dose : Two pills every four hoars. Calcarea Carb. The child has large open fontanelles. The head perspires during sleep so as to wet the pillow far around. Stools large, hard, and of a chalky appearance, or thin and' wh'tish. The child's feet are often cold and damp ; the abdomen is in some cases large, and little lump? are sometimes found about the neck • sometimes a loose rattling cough is present ; soft and flabby muscles. Dose: Two pills morning and evening. Cina. The child rubs its nose much, and is unusually hungry ; very restless in its sleep ; must be kept in motion nearly all the time by walking, or otherwise ; diarrhea ; stools occurring immediately or very soon after drinking; child very peevish, does not like io be looked at, spoken to, or even touched ; its urine, when it can be preserved in a ves- sel, or when seen in a puddle on the floor, soon turns white like milk ; •11'^ t.S-. '{ 1 ;bl ■m^ I 'i-iij Im riw vm \\ ' h -i lii 720 DISEASES OF INFANCY. restless ,il niglit ; frequent crying out, as from colicky pains, and calling for water. Done : As for Aconite. Chaiiioinilla. The child starts and jumps during sleep ; when awake it must be carried all tlie time, in order to soothe its sufferings ; some- times it will only sleep whilst being carried in the arms ; one red cheek, the other pale ; diarrhoea watery and slimy, or like chopped eggs and spinach, having the odor of x'otten eggs ; very thirsty ; likes to hold its mouth in cold water a long time when drinking ; the appetite is not as good as usual, and there is frequent vomiting of thin, sour milk. Dose : As for Aconite. Ilyoscyainus. Pressing of the gums together, with putting the hands to the jaws, putting the fingers t(^ the mouth, and other indications of pain in the jaws ; difficulty in swallowing ; convulsions, beginning with twitching of the muscles of the face, especially about the eyes ; dilation of the pupils ; deep sleep after the spasm goes off. Dose : Two pills to be given every two hours. Ipecac. Continual nausea, with occasional vomiting; diarrhoea; stools fermented hrd of many colors, as green as grass ; face pale, with olueness about the eyes. Dose : As for Hyoscyamus. Merc, Sol. Copious flow of saliva, and sometimes little blisters are seen on the tongue, gums and cheeks ; quite large ulcers are seen on the protruding gum. With the above conditions the nights are very trouble- some; stools usually slimy, bloody, green, and accompanied with strain- ing. A single dose of Merc, is often sufficient. yux vom. For teething children, being raised by artificial food, or wliose mothers indulge in highly seasoned food, wines, etc. ; worse about four in the morning; constipation, witli large difficult stools or they become small, frequent, lumpy or fluid ; bloody saliva often stains the pil- low when sleeping. Dose : Two pills four times each day. Podophyllum.. Grinding of such teeth as are already cut, with wor- rying and crying, often with painful diarrhoea; rolling of the head from side to side, with green stools, or frothy, undigested stools ; falling of the bowel with every stool ; voracious appetite ; food soon sours after eating ; much gagging as if it would vomit ; dicharge of carrion-like smelling stools. Dose: Give two pills every four hours. Stramonium. When the child's brain seems so afTected as to cause it to cease making its wants known except by motions ; it seems to shrink from the sight of objects when first presented, as if afraid; lonvulpions witli cries as if from being frightened by the sight of some hMeous ob- ject. Dose: Give two pills every two hours. Sulphur. White sour diarrhoea with redness about the anus; papu- lous eruptions on the skin, with much itching ; the child takes uo more long naps, as is its custom ; jumps in its sleep. Dose: Two pills each night and morning. SPASMS— CONVULSIONS. 721 calling awake some- cheek, jgs and lold its not as ^i :,;^ii SPASMS-CON FULSIOX8, Even in very young infants, spasms, or general convulsions, are of frequent occurrence. Tliey are present at tiie commencement of many diseases of children, and they attend the fatal termination of nearly all. Convulsions may be occasioned by morbid conditions of the nervous sys- tem— idiopatliic convulsions— or tliey may be merely sympathetic, symp- tomatic of disorders in other organs, especially in those of the alimen- tary canal (the whole canal through which the food passes). Among those of the nervous system, may be enumerated those which arise from pri- niiiry disease of the brain or other large nervous centers, and those which result from general exhaustion of the vital force, as in cases of difflcuU dentition and in the advanced stages of Whooping Cough ; among the lat- ter class of sympathetic convulsions may be enumerated those cases which arise from the irritation of intestinal worms, from the presence of un- wholesome food, such as curdled milk, and from the influences which are about to develop eruptive disorders or typhoid fevers. Convulsions which appear immediately after nursing, and especially if there is vomltingof curdled milk, it is then evident that the character of the milk is unsuitable. Such cases occur in the children, even of mothers perfectly healthy, if they t,'ive suck while in a state of high phy- sical excitement or mental distress. In cases which come on suddenly and without ai)parent cause, especially if the convulsions are associated with fever, stupefaction, and vomiting, there may be reason to apprehend the beginning of some eruptive disorder, such as scarlatina, measles, chickenpox, etc., and this opinion will be strengthened by the prevalence, of one or the other of these epidemics at the time. Many cases of the brain disorders commence with vomiting and convulsions. In such instances, upon minute inquiry, it will always be found that some indications of cerebral disorder have been i)resent for several days, and there is usually severe pain in the head immediately before the attack. In most cases, it will not be difficult to find out the exciting cause of the spasms, which may be suppression of some cutaneous eruption, or its too tardy appearance, direct injury of the head or some portion of the nervous suijstance, fright of the child, or evcii of the nurse, a feverish con- dition of the mother's milk, the influence of some epidemic miasm, the beginning of some brain difliculty, etc., etc. TREATMENT. Remove as ftir as ))03sib.le the exciting cause, whether it exists in tlie nurse or the child itself, avoid every excitement and keep the cli'ld perfectly quiet and free from every disturbing influence, of noise light, etc., and very carefully administer the remedy which pnpears to b« indicated by the nature of the case, and by the attendant conditions. Aconit".. High fever with dry, hot skin, anxiety and restlessness ing dentition, grinding of the teeth, and convulsive hiccough. DoS'" Four pills every half hour until the fever subsides, then every two, three, or four hours. Aitiica. Where the spasms arise from some mechanlcaC blow or in- jury ; from concussion of the brain, a blow or fall. Dose: Four pills every hour or two. Arsenicum. Spasms preceded by great restlessness and burning heat over 'he whole body. Extreme thirst, drinking little and often. Patient 4G ■'>'., '■t'i m ■iH I m i M T22 DISEASES OF INFANCY. lies motionless as if dead ; finally, the mouth is drawn first to one side and then to the other ; a violent jerk appears to pass through the whole body and consciousness gradually returns. Dose : The same as for Arnica. Belladonna. Heat of the head with flushed face, red eyes and dilated pupils. Starting and jiiiupiiig during sleep. Drowsiness with inability to sleep; convulsive motion of the mouth, facial muscles and eyes ; foam at the mouth and grating of the teeth ; drowsiness after the spasm. Dose : As for Acqnite. ChainomiUa. Stretching of the limbs with convulsions of the eX' tremities, eyes, eyelids, and tongue. Jerking and twitching during sleep. Redness of the face or one cheek red and the other pale. The child is very cross and fretful, must be carried all the time to be quieted. Hot sweat on the forehead and hairy scalp. Constant moaning and craving for drink. Dose: Four pills every one, two, or three hours. Cina. Spasms of the chest followed by rigidity of the limbs dr the whole body. Especially suited to children troubled with worms. Con- stantly picking and boring at the nose. Frequent swallowing, as if some- thing were in the throat. Dry hacking cough. Urine turns milky after standing. Dose: Four pills every three hours. Cu2)runi. Shrill cries during the attack. Drowsy and stupid during ^the intervals with nausea and vomiting of phlegm. After the convulsion the child screams, turns and twists in all directions. If caused from sup- pression of scarlatina, measles, or like eruptions Dose: Four pills or a small powder every two or three hours. Gelsetninnin. Spasms during dentition with sudden loud outcries. Nervous excitable persons who are very sensitive. Dose : The same as for Cuprum. Hifoscyamus. Convulsions with twitching and jerking of all the muscles, especially those about the face and eyes. Convulsive trembling and foam at the mouth. After sudden fright. Cough worse when lying down, relieved by sitting up. Dose : As for Cupi am. Ignatia. Suddea starting from a light sleep with loud screaming and trembling all over. Single parts seem to be convulsed, or single muscles here and there. The spasms return every day or every other day about the same hour. Dose: Four pills every two hours. Ipecac. Much nausea and vomiting accompanies the spasms. Espe- cially if caused by eating indigestible food, or when, during an eruptive fever, the eruption strikes in. Green, diarrhoeic stools. Dose: Four pills every hour or two. Opium, Trembling over the whole body and tossing about of the limbs. Loud screaming before or during the spasm. The child lies unconscious as if stunned, with heavy difficult breathing. Convulsions caused by fright. Dose : As for Ipecac. • ' SPASMS— CONVULSIONS. 722 Serafc. Twitcliing of sin^^le muscles. Twisting of tho head to and ft-o. CoJitortions of the hands and feet. Labored and anxious breathing. Thin scrawny children with shriveled skin. Dose : As for Ipecac. Stramonium. Convulsions from fright with tossing of the limbs and involuntary passages from the bowels and bladder. Awakens with a shrinking look as if afraid of the first object seen. Spasms caused by some iuppreased eruption, or if the eruption does not come out freely. Dose : As for Ipecac. VACCINATION. The customary place for vaccination to be performed, is on the outer side of the upper part of the left arm. Three to six points should be in- serted. In two or three days the swelling is noticed, and the fifth or sixth day tho vesicles are formed, which reach their greatest size from the seventh to the ninth day. This is the time to vaccinate from arm to arm. The crusts mature and are ready to drop off on about the twentieth day. The itching, burning, and pain occasioned by the vesicles, may be greatly relieved by brushing over them a mixture of one dram of Fluid Extract of Belladonna, with four drams of Olive Oil, or, if the inflammation is very intense, a cloth wet continually with a solution of fifteen grains ol Sugar of Lead, and five to ten grains of the Acetate of Morphine in a pint of rain water, can be constantly applied if the patient remains in bed. The feverishness and discomfort does not require any treatment. A child should be healthy when vaccinated. The vile disease. Syphilis, is the only constitutional affection which can l)e transmitted by vaccination, so that if it cannot be practiced from the arm of a healthy infant, having healthy parents, the lymph, or crust, from the heifer, (cow pox), should be used. A vaccination which is perfectly pure may arouse up a constitutional vice existing in the patient, and»giv« rise to eruptions or troublesome sores. Vaccination should be performed in infancy. Kevaccinations should be made when the child is from five to eight years old, and again before reaching adult life, and also through life when especial danger from small pox exists. ■l)\ P-A.I1T F'lF'TEElVTH^ SURGERY. CHAPTER XXXV* ACCIDENTS OF VARIOUS KINDS. i; ii 'I il i iU APPARENT DEATH. Asphyxia. In every instance where an individual lias, to all appear- ance, suddenly expired from external causes, animation may only be sus- pended. There are many cases, of course, wliere sudden death is no mere suspension of animation; but there are others wliere apparent death in far from uncommon ; in all cases, therefore, where ihere is the least uncertainty, care should be taken to do nothing that may cause death, and interment should be avoided until certain signs of putrefaction set in. Appabent Death prom Hunger. Give small injections of warm milk, repeatedly: great cure should be taken to give the food when the patient begins to rally, in the smallest possible quantity at a time. Milk may be given, drop by drop, and gradually be increased to a teaapoonful, and after some interval, a small quantity of beef tea, and a few drops of wine. After a sound sleep has succeeded, but not till then, a small meal may be given; but it is best that the patient should eat little at a time, but often. It must be borne in mind that for all persons suffering from starvation, eating too much and too hurriedly, is in the highest degree dangerous. Apparent Death from a FAiii,. Place the patient cautiously on a bed, with his head high, in a place where he can remain quiet. Put a little Arnica on his tongue, and wait till a medical man visits him t« see if there is any fracture, or whether there are still signs of life; bleeding may be here sometimes of benefit, but it requires great caution. Arnica may be repeated, and also administered in injections. If the patient luw been bled, give China or Quinine; but it is obvious that if much blood liiw been lost by the fall or wound, venesection would be injurious. Apparent Death from Suffocation, (hanging, pressure, choking). Remove all tight clothing. Put the patient in a proper position, the head and neck rather high, the neck quite easy, not bent forward. Begin by rubbing gently, but constantly, with cloths ; give an injection of a dozen or two globules, or a few drops of Opium, dissolved in a half pint of water • 724 AI'I'AKKNT DEATH. Tir, iui»l injt'oted .slowly. Tliis imiy bo ropoatod every riuarter of hii hour^ whilst the ribs are boiii^r rubbed gently. Hold, from time to time, a mirror before the mouth, (o see if the breath dims it; open the eyelidHand Hee if tlie eyes contract; put warm cloths on; hot stones, wrapped in blankets, to the feet, betwden the thighs, to the sides, neck, and shoulders. If, in an hour, no change is produced, take a bitter almond, iiound it fine, mix it in a pint of water, put a few spoonfuls into the mouth, or into the nose, and give the rest in injections. Apparent Dkath from Lightninq. The body should be iramedi- •itely removed into a current of fresh air; and cold water dashed frequent- ly on the neck, face and breast. If the body be cold, warmth, by friction, must be employed in the same manner as recommended for the drowned, in the next article; as well as the means therein prescribed for inflating the lungs. A few globules of Nux Vomica may be put upon the tongue, and repeated in half an '.our, when, if no effect is produced, a little Nux Vomica in water, rubbed on the neck, and some injected, may be of ser- vice. Or, better still, place the patient in a half-sitting, half-recumbent posture, in a cavity freshly dug in the earth, cover him over with newly excavated earth (leaving the face alone exposed, which should be turned towards the sun, until the lirst signs of returning animation become api>a- rent,) after which Nux-v. is to be had recourse to, as above directed. There is no doubt but that in many cases of apparent death from lightning, both in the case oi" man and animals, careful and persistent use of this simplest of nature's means will restore the apparently departed life. The writer hereof has succeeded in the case of a person who«had been supposed to be dead for three hours. If the fresh earth is not moist it should be slightly moistened. Apparent Dkath from Drowning. Dr. Marshall Hall's so-called "ready method " of recovering persons from apparent death by drowning, has proved so successful in some cases, when zealously and in 'efatigably employed, even after a submersion of half an hour's duration, that it ought always to be tried in the first instance. The following is a summary of his directions: RULES. 1. Treat the patient instantly, mi thesr- 1, in tlve open air, freely expos- ing the face, neck, and chest to the breeze, except in severe weather. 2. Send with all speed for medical aid, and for articles of clothing, blankets, etc. I. to clear the throat. 3. Place the patient gently on tlie face, with one wrist under the forehead. (All fluids and the tongue itself then fall forwards, and leave the entrance into the windpipe free.) II. to excite respiration. 4. Turn the patient slightly on his side and apply snuff, oi- other irritant, to the nostrils; and dash cold water on the face, previously rubbed briskly until it is warm. If there be no success, lose no time; but III. to imitatk respiration. 6. Replace the patient on the face. ^. Turn the body gently, but completely, on the side and a little be- 1:: , m ';■■>•; ■|)ll: •M ii f;. Tm AC<I DENTS OP VAUIOUS KINDS. yond, and tlicii i>n fho fiu'o iilternately ; repeating these nieosures dellber- titely, eincicMitly, .iiid perHcvoringly flfteo.n times in the nainute only. (VViu'ii the patient ri'imses on the chest, this cavity is corripresserf by the weiglit of tlio l)o(Jy, and eajpiration takes phice; when It is turned ou the side, tliis pressure is removed and tVispiration occurs). 7. When tlie prone position is resumed, malie equable l)ut efficient pressure alonr/ the spine; removing it immediately before rotation on the (tide, (The first measure augments the 6a;piration, and the second com« luences t/ispi ration). IV. TO INDUCE CIRCULATION AND WARMTH, CONTINUK THESE MEASURES. 8. Hub the limbs upwards, witli firm pressure and energy, using handlierc'liiefs, etc. 9. Replace the patient's wot clothing by such other covering as can be instantly procured, each bystander supplying a coat or a waistcoat. Meantime, and from tinio to time, V. AGAIN TO KXCITE INSPIRATION. 10. Let the surface of tlie hoily be Hlapped brisltly with the hand, or 11. Let cold water be daslied briskly on tiie surface, previously rubbed dry and warm. The measures formerly reconjmended, and now rejected by Dr. Hall, are "Removal of tiie patient, as i:ivolving dangerous loss of time; the bellows or any forcinj^ instruments, an*' the warm bath, as positively injurious; and galvanism and the inhalation of oxygen as useless. The inhalation of diluted pure ammonia has in it more of promise." Avoid all rough usage. Never hold up the body by the feet Do not roll the body on casks. Do not rub the body with salts or spirits. Do not inject smoke or infusion of tobacco, though injections of spirits and water may be used Another Method (Sylvester's) is: Lay the patient on his back, and, having pulled the tongue forward, draw the arms up slowly over the head, by which means the ribs are elevated by tne lar^e tleshy muscles of tlie chest, which are attached to the arms, and mspiration is produced; the arms are then to be brought down to the side of the chest, which they are to compress in aslight degree thereby inducing ea;i)irati()n. Tliese movements are to be repeated sia slowly as in the Marshall Hall method, and it is said that they give a more complete change of air to the lungs. The means employed should be persisted in for several hours, till there are signs of death. When symptoms of recovery begin to show themselves, stimulating injections of wine or brandy may be useful; but be careful not to admin- ister any liquids by the mouth until animation is fully restored, lest they pass into the lungs, and so suflbcate the patient. At this period the patient should never be left alone, as some have been lost from want of care, who otherwise might have been saved. Apparent Death from Being Frozen.— When a patient is found in a state of frost-bitten asphyxea, arising from exposure to intense cold, he should be moved with great gentleness and caution, to guard against any VKUrPlCATION OP DEATH. 727 injury, us fracture, etc., to u place of shelter, sucli as a fjarn, or unheated apartment, since only a moderate degree of heat might anniliilate all hope of rostoring animation ; at the same time, the patient ought to bo protected from the slightest draught. He shouM then, especially if the limbs have become stitTened by the frost, be covered over with snow to the hlght of several inches— the mouth and nostrils, alone, being left free. The patient ougnt to be put into such a position that the melted snow may run off readily, and its place be supplied by fresh. When there is no snow, a cold bath, the temperature of which lias been reduced l)y ice (or a bath of cold sea or salted water, fhnay be substituted, •\nd the body im- mersed therein for a few minutes. The process of thawing is, by these means, to be affected, and when every part has lost its rigidity, the patient should be undressed by degrees, or the clothes cut from the body, if requisite. As the muscular, or soft parts become pliable, they may be rubbed with snow until they become red; or the body should be wiped perfectly dry; if snow is not to be had placed iu llannel, in a moderately warm room, and rubbed with warm hands of several parties, simultaneously. In the event of no signs of returning animation declaring themselves soon after the forgoing treatment, small injections containing Camphor may be administered every quarter of an hour. As soon as any symptoms of ajjproaching restoration become perceptible, small injections of luke- warm black coffee (coffee without milk) may be thrown up the bowels, and as soon as the patient is able to swallow, a little coffee may be given in the quantity of a teaspoonf ul at a time. The measures above detailed ought to be persevered in for several hours, against the excessive pain which is generally experienced when life is restored, Carboveg. should be prescribed in repeated doses, and if it fails to relieve the suffering, Arsenicum maybe given. The party rescued must avoid sul)jecting himself to the heat of fire or stove for a consider- able ''^ngth of time after his recovery, as serious consecutive ailmeni, and particulifly disease of thd bones, is likely to follow. Apparent Death from Noxious Vapors.— The treatment consists in removing the body into a cool, fresh current of air; frequent'^' dashing cold water on the neck, face and breast; if the body be cc applying warmth, etc., as al)ove recommended in the case of drownmg; infla- tion of the lungs, early and judicious application of galvanism or electric- ity—after life has been restored. Op., or Aeon., may be given wiih advan- tage. ) I'll! !i|: •il'ii M ;l'l VERIFICATION OF DEATH. The prize of five thousand francs given by the Acadamy of Medicine, France, to be awarded to the discoverer of a simple and easy process by which any illiterate person might be able to ascertain, without a doubt, whether death had really and irrevocably taken place, was divided among four competitors. 1. If a portion of the body be rubbed with a coarse wet towel, or with the back of a knife, and then be left exposed to the ar, in the course of a few hours the skin will have become transparent and like parchment, if death has reallv occurred. 728 ACCIDENTS OF VARIOUS KINDS. 2. If a liglit 1)0 lield to the back of a finger at a moderate distance ;i blister will be formed ; if this contain sorosity, tliere is still life in the body. If the skin be touched with a piece of burning charcoal, if death is cc-ri- plete, it will become livid, a blister will be raised filled with vapor and having no serosity nor ai)pearance of reaction. Putrefaction is also satisfac- tory evidence of death, but this can not be waited foi. CONCUSSION OF THE BRAIN. In concussion of the brain, which may arise from a violent shaking of the brain or of the whole body, without any direct violence having l)een offered, or with such as a severe b!ow or fall on the head, the symp- toms vary, according to the degrei of injury which the brain has sus- tained. Symptoms. When the concussion is very severe, there is immediate deprivation of sense and power of motion, and death is the general result; but when slight, a temporary stunning or confusion, with more or less headache is produced, followed by increased action of the pulse, giddiness, and sickness. When, on the other hand, the violence done is greater than in the latter instance, though not so severe as to cause the fatal termina- tion alluded to above, we may divide the progress of the results of such accident into three distinct stages, us follows: The first stage, in wliich the patient is rendered insensible and inca- pable of movement; Ins limbs become cold; the pulse weak, slow and intermittent; tlie respiration laborious, but usually without snoring. The second stage, in which, as the patient begins to recover from this condition, the pulse and respiration improve, and warmth begins to be felt in the extremities; the sensibility to touch then returns, and the con- tents of the stomach are, in most cases ejected; still, he continues to remain in a dull, confused state, and inattentive to, or almost unconscious of, slight external impressions. On the gradual subsidence of the first effects of the concussion, the patient becomes enabled to respond to ques- tions spoken in a loud tone. The third stage. When the stupor has considerably or entirely abated inflammation of the brain, of an active character, will, in many cases then begin to develop itself, with all its sym2)toms, and if not checked, suppuration or effusion of blood within the head, preceded by sudden coldness and shivering, will result. This stage needs very close watching and care, as it may terminate fatally. TREATMENT. yl/'i*i'c<f is tlie specific remedy in all cases of injury arising from external violence, and its timely administration internally, simultaneouslj' with its externa) application (if there be a wound,) in cases of concusiiion of the brain, will, in most instances, if the injury be not very severe, suffice to remove all traces and evil consequences of such misfortunes. Application {external) : Add twenty drops of concentrated Tincture of Arnica to two tablespoon fuls of water, and bathe the parts with this lotion three times a day until the dispersion of the bruise, swelling, etc. Should the swelling pai.is, and other symptoms increa \ after one or two applica;i')MH, the lotion should be discontinued, until these symptoms of airgravation have subsided. Dose {internally) : A few dr i'.s in a little water every two or three hours, varying the time as the urgency of thecase appears to demand. I CONTUSION OF THE CHEST — SPRAINS. 729 'il"i!8 CO il ody. c*n- and 3fao- Wbou tlio contusion has been serious, tlie followin.*? symptoms usu- ally characterize tlie case: — Extreme restlessness or jactitation and irri- tability of temper, with sensibility of the eyes toligbt; small, quick pulse; delirium ; or coldness and shivering. The treatment which is called for in cases of this nature, Is identical with that which has already been detailed in the article on Inflammation of the Brain, to which the reader is referred for particulavs. After an injury to the head, particularly if it has been of a somewhat severe character, the patient ought not to be allowed to partake of any itimulating liquids, such as wine, spirits, until at least three or four weeks have elapsed, even though he may appear to have entirely recov- ered from the effectsof the accident. Ho ought, likewise, to bo kept quiet, and not be permitted to expose himself to excitement of any kind, other wise the most serious consequences may result. CONCUSSION OR CONTUSION OF THE CHEST. TIlEATjttENT. Arnica should be promptly employed, in those instances in which the chest has been injured by a contusion, or violent concussion, and when the following symptoms are tlie result: Soreness, or a sensation as if froiri incipient suppuration, with heat and throbbing, is experienced in some particular spot; fever, or alternate chilliness and lioat followed by fever, which become^j aggravated in the evening; sleep- lessnoHS or disturbed sleep, wit h goueral boat, and sometimes perspiration towards morning; short, dry cough which increases the pain, or cough with spitting of blood; furtiier, when the pain in the chest is rendered more acute by taking a full breath, laughing or sneezing, or when prick- ing pains or a sensation of fullness or pressure, as if caused by extrava- sated blood, is experienced, together with a feeling of constriction that obstructs the freedom of breathing. If the fever symptoms should be very intense, a dose of Aconitum should be given, either at the commence- ment or as an intercurrent. Dose: To be used as just directed for Concussion of the Brain. Quinine is not unfrequently of much service in completing the cure when a degree of delicacy of the chest remains behind, with tendency to suffer from shortness of breath, and a short dry cough, combined with paleness of the face, impaired appetite, and restless, unrefreshing sleep. Dose: A small powder oi one half grain, night and morning, for six days (or until earlier changoj) then pause four days, after which the course may, if necessary, be repeated as before, and so on. SPR A INS-PAR TIA L D ISLOCA TION. A sprain is .sometimes very painful. Very often they are the result of momentary displacement of th' hones, which strain or partially tear the ligaments which surround aiil iiold the joint in its proper position. They are accompanied frequently with some constitutional disturbance. The injured part swells and the membrane covering ends of the bones within the joint is usually involved. TREATMENT. The troitmont of sprains consists in restoring the bones to their natural position, (if necessary,) by extension and direct pressure, and applying a sDludoii of Arnica to the part, which must also be bandaged to support the limb and prevent recurrence of the accident i^i* 41 II i 1 ft ij t- 1 730 !il[ ACCIDENTS OP VARIOUS KINDS. A few (]r()[)s (two or three) of the same remedy, taken internally, will gretiily uf.sist in making a speedy recovery . Or if the sprain is attended with swelling and great pain Rhus-tox. may be taken alone or in alter- nation with Arnica, to great advantage. If a sprain originated by lifting heavy weights Rhus, will greatly assist. Use as directed for Am. Petro- leum (coal oil) is a good remedy in many cases; apply externally. Aconite must interpose within not less than one hour after the pre- vious internal use of either of .he other remedies here mentioned, when- ever the local pain, heat, and redness resulting from a severe sprain are attended with fever and restlessness. A small dose repeated every thirty minutes to two hours. In sprains and strains the recovery is usually very tedious, indeed, in many cases it is more so than ever, a broken bone, especially when by Bome unusual effort or sudden motion some of the libers of a muscle have been ruptured. In this last named case, position and rest is all important. The position should be such as will relax the injured muscle and allow the ends of the ruptured fibers to come in contact with each other, when that must be maintained until the ends so brought in contact shall unite. HEMORRHAGE— MEANS OF SUPPRESSING. The word hemorrhage, of course, means the escape of blood from any vessel in any part of the body, but here we only propose to speak of those bleedings which occur as a consequence of some accidental cutting or rupture from some external cause, of a blood vessel, in other words, those cases which occur in " minor surgery." Hemorrhageis of frequent occurrence and as a rule requires prompt action and presence of mind in those present, to prevent it from becoming seri- ous, and even imperiling life itself. The means of preventing and sup- pressing the flow of blood from an artery that has been cut or broken in any way are few and simple. For temporary means to stop bleeding from any artery in the arms or legs, a handkerchief or something of the kind passed around the limb (above the point of injury, through beneath which asmall stick, nail or wire is passed and then twisted around until it produces a good degree of pressure, will stop almost any case. This is an always present substitute for the tourniquet used by surgeons in like cases. Another means, always present, is direct pressure by means of the hands. On the upper extremities the circulation may be readily arrested with the fingers, by grasping the arm as shown in this cut. If their points are so ap- plied over the artery, a very slight force is sufficient, and any part of the arm above the elbow may be selected, although that shown in the cut is usually most conven- ient. This fact should be impressed on the mind of all, especially the young of both sexes, as it will perhaps be the means of saving life in case of serious hemorrhage. H KMO n H H A ( ) E — WO V NDS. vai If the iiccident should occur in the lower extremity, resort to the hand- kerchief and stick may be had recourse to, or the flow may be effectually stopped by making pressure on the artery near its passage from the body by means of the thumbs, applied as shown in this cut. If the pressure is made much lower down on the leg, uch additional force is necessary, and x./en then, if the thigh be fat and muscular, it may not always be entirely successful; but if this force is used as here directed and illustrated, there need be no fear of fatal hemor- rhage, even if all the arteries of the leg should be severed. As soon as possible, the end of the bleeding vessels should be secured by tying by means of any small, strone cord, as a thread of silk or strong spool cotton. We wish it to be distinctly un- derstood, that we do not mention these means as being superior to the means within the reach of the well prepared surgeon, but only as effectual means which will be present in any sudden emergency and so simple that any one may understand and apply them readily. 'MS 11 „.ft m '4 'ii 'Nil WOUNDS. Wounds are generally divided into, or classified as (1) incised, (2) lacer- ated, (3) contused, (4) punctured, (5) gunshot, and (6) poisoned wounds. (I.) By an incised wound is meantone which has been produced by a sharp instrument, as a sword, knife, etc., and is not accompanied with any con- tusion or laceration. Incised wounds, althougli more liable to be attended with a greater loss of blood, are, generally speaking, the least dangerous and the most easily healed. (2. ) Lacerated wounds are those in which the muscular fibers, instead of being divided by a sharp-cutting instrument have been torn asunder with some violence ; the edges, in place of being even Jind regular, are jagged and unequal. They are commonly attended with little or no bleeding, rarely heal without suppurating, and are frequently succeeded by violent inflam- mation. (3.) The terms contused wounds or bruises, are applied to those injuries which are occasioned l^y some blunt instrument, or hard, blunt surface being brought in violent collision with a part of the body. When severe, they are dangerous, from being prone to terminate in mortification and sloughing. (4.) Punctured wounds are those which have been caused by pointed instruments ; they partake more of the nature of lacerated than of incised •wounds, and are dangerous from the great depth to which they frequently penetrate, and the serious consequences they often entail. 'wii 782 ACCIDENTS OF VARIOUS KINDS, (6.) Gunsuot wuuiids partake of the cliai acter of livcei'ated and contused wounds. Degkee of the Injuky. Wounds of the arteries ai'e, for the most part, the moot serious: they are to be distinguished by tiie bright color of the blood, which, moreover, isf ucs very rapidly and in jets; while that from a vein flows in a smooth, uninterrupted stream, and has a darker hue. i lil'iit INCISED WOUNDS. TREATMENT. (Extern al.) In the treatment of wounds of a sovc; description, our first object is to arrest the flow of blood. By the; touruiqm i (an instrument used for this purpose), the ligature, compression, cold water or ice, and astringents, are all'appliances to this end. variously ap- propriate according to the degree or source of the hemorrli;!gt\ When theiujured vessels are of a small size, they spontaneously cease to bleed, or do so, at all events, as soon as the wound is dress^ d ; Imt when the discharge of blood is ccmsiderable, one or more of the subji)in('d i.easures mus^t be immediately resorted to for the purpose of arresting it. mechanical means— dukssincj. Wounds or Auteri>:s and Veins. Whoii, therefore, there is reason to conclude that an artery hus been wounded, a toiiriii(iuet should be applied around the limb to check the flow of blood ; Uw. exfernal wound must then be closed, covered with a graduated compress, and flrmly secured with a bandage When a proper tourniquet is not at hand, its place may be toler- ably well supplied by a handkerchief secured around the limb, and tight- ened by two or three turns ol a stick passed under the handkerchief, until the discharge of blood ceases; or the subslitute may consist of a cork cut longitudinally, and firmly fixed over the firtery, the site of which is readily to be found at the inner surface of the limb, in spare or emaciated sub- jects, by its pulsation ; but as, in robust and muscular patients it is more difficult to find the artery, it will, in such cases, be advisable first to tie a handkerchief or non-elastic garter tightly around the limb, above the wound, which will have the efiEect of rendering the artery more prominent. In order to make the compression of the cork more effectual, several plies of lint or linen, or a piece sufficiently large to form a few inches square and one in thickness, should be placed over the cork, (which should be held firmly in the required position during the preparation of the compress,)and the whole then tightened, and retained as long as may be requisite. The application of ice to the wound Is, also, of unequivocal service. Bleeding may, also, be arrested by Lioisliny the divided ends of the artery firmly by a pair of forceps, if tlie vessel be of small size; or by the application of lint saturated with "Monsell's Solution" (Persulphate of Iron) to the wound secured with a compress and bandage. This latter method is also well adapted to the arrest of bleeding from wounded veins. When the discharge of blood comes from a large artery, it must sooner or later be stopped by iigature. It is to be remembered that when an artery is wounded, compression is to be made between the wound and the heart ; and vice versa when a INCISED WOUNDS. 733 tused most lor of from iOVCi ii(liui cold y iip- wounded vein needs compression, as tlie blood flows through the arteries from the heart, and througli the veins, to the heart. It issomelimea neces- sary, in cases of wounded arteries, to make compression both above and below the wound. Wounds in the Mouth. Bleeding from wound, etc., in the mouth, Boraetimes requires the application of styptics, "such as alcohol, kreosote water, "Mousell's Solution," etc. The same may be said of slight superficial wounds, as also of fungous tumors, and other diseased surfaces, when cold water fails to answer the purpose. Copious discharge of blood after the extraction 'of a tooth is, usually readily suppressed by pushing a compress of lint into the hollow space left ; or by the aidof styptics, when requisite. A simple, and sometimes extreme- ly efficacious mode of checking the flow of blood, is by replacing the extract- ed tooth, and keeping it in its former position, until the risk of further dis- charge of blood is obviated. The next step to be taken in wounds of every description, after the hem- orrhage is stopped, is to remove all extranous matter, such as sand, frag- ments of glass, splinters, etc. ; then to relax the muscles by placing the injur- ed limb or part, in sucli a ijosjition that the wound may not be made to gape ; finally, to bring the lips or sides of the wound in accurate contact, and keep them so by bandnges, plasters, stitches, etc. Bandages are usually indis- pensable in (looi), and even in small, superficial incised wounds ; but care must be taken not to apply them too tightly nor when there is excessive inllitnunation. Stitches are commonly found necessary in wounds of the face or belly, and sometimes of the hands, and in old people generally. In ti'e young and vigorous they are seldom called for, and may be even improper and hurtful when the patient is of an irritable habit of body. Strips of adhe- sive plaster— cut narrow and sutTiciently long to retain their hold as firmly as possible, and act with the required compressive power— form, in the niiijority of incised wounds, the most frequently useful means of bringing tlie sides into close approximation, and effecting adhesion. It sometimes happens, however, that even incised wounds, particularly when deep and of considerable magnitude, terminate in suppuration. It is consequently necessary to leave intervening spaces between the slips of plaster, to admit of the exit of the matter in such an event. Again, when it is found impracticable to cleanse the wound of all foreign substances, it ought to be only lightly, and so to speak, incompletely dressed, as it will be neces- sary to renew the dressings repeatedly. In some cases it is necessary to dilate the wound, to facilitate the abstraction of a splinter, etc. When it is necessary to dress the wound, and the compress is found adherent, it is advisable to remove it with caution and gen^'^ness, in order to avoid tear- ing asunder the closing wound-; the em> jyment of tepid water will facilitate the separation of the linen. It is best to keep all wounds as much secluded from the external atmosi)liero as possible. TREATMENT (Internal or Constitutional.) Arnica 's the first remedy in the constitutional treatment of wounds of all kinds, and it internal administration should commence as soon as the patient has been Rendered as comfortable as circumstances will admit. Dose : Eight pills in a teaspoonful of water, to be repearted every two to six hours, if necessary. S ■ir f84 ACCIDENTS OF VARIOUS KINDS. Aconitum is found necesscary, if the patient be robust and strong, and synpatlietic fever runs high. Dose: Six pills in a teaspoonful of water, every one to three hours, until the fever indications have abated. China is required for the treatment of those serious injuries by which very severe lo«s of blood isoccasloned, resulting in all the signs of extreme cxhauHtion, characterized by severe and repeated faintingfits, with deadly paleness of the face or livid appearance of the countenance, twitching of the tendons, etc. In cases in which reaction does not speedily follow the first dose of this medicine, two or three teaspoonfuls of good wine should be administered, after which, if a general improvement takes place, the next medicine should be subsequently employed. But if, on the other hand, the wine only acts as a temporary stimulant, the dose of China must be repeated before proceeding with further treatment. Dose. Six pills in a teaspoonful of water, followed in half an hour, if the patient does not rally, by the administration of a tea»spoonf ul of wine (repeated three tiniea, at intervals of five minutes). After which, if the patient sinks again, repeat the dose of China as before. But if the worst symptoms have subsided, proceed with the admin- istration of Arnica. "When matter (pus) forms in incised wounds, ^e same treatment must be pursued as is described under the head of Lacerated Wounds. il!' ill I' LACERATED WOUNDS. TREATMENT. (External or Local.) In the treatment of lacer- ated wounds, we must, after having carefully cleansed them, closely ap- proximate all the parts that will admit of the process, and retain them in their places by means of plasters and an appropriate position of the body or limb, for the purpose of endeavoring to unite them by the first intention. If the laceration be extensive, and arteries of any considerable magnitude have been divided, they must be secured by ligature. During the process of sloughing, which commonly ensues, the wound must be closely watched as secondary bleeding is liable to ensue. Arnica and Calendula {Concentrated Tincture) are of great impor- tance in the treatment of Lacerated, Contused, and other wounds. When the discharge of blood is profuse, and the wound is of such a character as threatens to leave a severe scar, or to terminate in extensive suppuration before healing, Calendula is found most efficacious, and will frequently greatly modify the .severity of the symptoms. AVhen, on the other hand, the parts are severely bruised, and show adisposition toturn black in the neighborhood of the wound, or when the wound is slight. Arnica is to be preferred, except in per.sonsin whom it produces inflammation of the skin or is apt to develop a rasli. Calendula has likewise been found to be a useful application, dminj^ the healing process, when the granulations are excessive or redundant. Applimti'm: To sixteen parts of water, add one of the concentrated Tincture of Arnica or Calendula (as the case may be,) and saturate therewith a pad made of linen rag, which place carefully over the wound, remoistcning and reapplying the same as often as may be necessary, and urs, CONTUSED WOUNDS On BRUISES. CONTUSED WOUNDS Oil BRUISES. 73:5 TREATMENT. (Exteunal). In cases in which gangrene ensues from very severe injuries, by contusion, notwithstanding the appropriate treat- ment us below directed, the question of amputation is at once presented, and the services of a surgeon should be had without delay. In cusi;,s in which the membrane investing the bone (the periosteum) has been injured by a contusion, if effused blood or matter is evidently pent up beneath it, and the sufFering attendant upon the injury is very intense, an incision may be necessary, whereby the effused fluid may be allowed to escape, the constitutional treatment being, at the same time, pursued as appropriate to the symptoms and conditions of the case. Hot Water.* In the first instance, the only external application in cases of contusion should consist of hot water. In those very severe cases in which the injured part has been squeezed out of shape, or otherwise absolutely disfigured, the application of the hot water should be continued simultaneously with the appropriate constitutional treatment, a remark which also applies to such cases as have demanded recourse to a surgical operation. AppUaation : Bathe the part freely with hot water for five minu ,es, repeating the operation in the course of three hours ; or otherwise satumte a linen i-ag with hot water, place it over the part, cover'ng the wliole with oiled silk, and remoistening the rag as fasted It becomes dry. Arnica (ConcentraUd Tincture) should be applied, when there is con- siderable extravasation of blood, to promote absorption and otherwise forward the cure. AppliraWm : To ten parts of water add one of the concentrated Tinc- ture of Arnica, and bathe the parts well with this lotion every three hours, until evident indications of amelioration. Ithus-tox., {Concentrated Tincture) is to be preferred in cases in which the joints, synovial membranes, or tendons are injured by a contusion, and this remedy should be employed, simultaneously with its internal administration, at the onset in such instances. AppU<:atio7i : To sixteen parts of water add one of the Concentrated Tincture of Rhns-tox., saturating a piece of linen rag with this lotion and applying it to the parts injured, covered with oiled silk, and remoistening this dressing as often as it becomes dry, until the pain and other symptoms abate (suspending the application, however, and substituting iiot water, as above directed, if an eruption should bo developed in the parts). TREATMENT. (Constitutional.) Arnica. This medicine must be administered internally, during the first period, and whilst hot water or the Tincture of Arnica, only, is being applied externally to the parts. In very severe cases even, in which the contusion has been so violent as to squeeze the limb nearly flat, or otherwise to disfigure it, this medicine should be emi)loyed at the onset. When amputation has become neces- sary and has been performed, Arnica is generally to be recommended as the appropriate medicine for constitutional treatment. Dose : Six globules in a teaspoonful of water, repeated after two to four hours. *Tr water is applied m hot as can bo borue to any injury that is likely to caure a black btb. it will prevent it from becoming black. nii'S; 1' 'il 'ilb'^J ;, III m '\ 736 ACCIDENTS OP VARIOUS KINDS. Rhns-toxicodendron is to be preforred simultaneously with the exteriuil iitliuiiilstration of the same medicine, for the treatment of coses in which the joints, synovial mumbranes, or tendons have been especially injured by the contusion. Dose: Six globules, sis directed for Arnica. ^lrsert«cw/i< nuiy be ^'mi)loyed in those very severe cases in which gangrene threatens to ensue, and the skin has assumed a livid and black appearance, if indeed, amputation be not absolutely necessary. 80 long as tiierc is a prospect of avoiding the loss of the limb, the employment of this and the successive medicines should not be neglected. Dose: Six globules in a teaspoonful of water, repeated at intervals of three hours until some degree of improvement or change becomes apparent. PUNCTURED WOUNDS. The external treatment of punctured wounds is the same as directed for wounds in general, but unless compression can bo made by means of a bandage or adhesive plaster through the whole extent of the wounds, tiio effort should notbe niade to obtain healing by first intention, (without the formation of pus). If the wound is deep or so situated as to be in danger of producing lock-jaw, it will be necessary to resort to such constitutional treatment as is recorded under the head of Lock Jaw, in this work. Ap- plications of cold water are always useful in cases where there is much fever in the wound. !i-l!li ■ GUNSHOT WOUNDS— SPLINTERS, ETC. When splinters of bone, a ball or other foreign substances are lodged in the wound, they should be extracted with as little irritation as possi- ble, if they press upon some important organ or i)art. If they do not .so rest as to endanger some important part, they may be allowed to remain (if deep seated and so difficult to reacli as to necessarily occasion a high degree of irritation in the effort to extract them,) until loosened by suppur- ation, which will be hastened by appropriate treatment. Cold water constitutes one of the most generally useful of local appli- caticms, in cases of gunshot or similar wounds. Saturate a linen or old cotton rag, or lint pad with cold water and apjdy it to the part, constant- ly reiuoistcning the pad as it becomes dry or hot. If there is added a little Arnica Tincture to the water, the benefit will be marked. About twenty drops of tincture to each three tablespoonfuls of water. Calendula used in the same way is good, in many cases even better than Arnica, especially where the latter is known to irritate the skin of the patient. "BANDAGES. Bandages are always necessary in fractures of bones, and often in sprains and in varicose veins and .sores on the extremities, usually, although I i," III"" 'I m n If 'In M K ''«ii 1 i; fii ■MUSCLES AND TENDONS OF THE HAND LIABLK ro ACCIDENT. m II It r f I BANDAGES. m very Improperly called "fever sores." Of all the different bandages none excel the "roller," and to make and apply it neatly is an accomplishment that all should have. It is to be prepared from a piece of muslin of the reqixisite length and width by tearing it from the piece, and then vinding it into a neat cylindrical form by hand; this is accomplished by fold? -qj one end of the band Ave or six times on itself, so that it may form a sort of axis, then roll it a few turns on the thigh to give it size, then place tlie cylinder between the thumb and forefinger of the left hand, allow the band .to run over the right foreflnger, holding firmly between the thumb and finger of that hand so as to make traction, and tigliten tlie cylinder. Having thus arranged it, give a rotary motion to the hand, and cause the cylinder to revolve upon its axis by means of the fingers and tiuunb of the left hand, while at the same time the right thumb -Mid forefinger are moved partially around the cylinder itself, which, by this movement, is soon formed of tlie required size. The spiral bandage is that which is most frequently used in the treat- ment of all affections, either .of the extremities or trunk. In applying this bandage, each turn is made to cover about one-third of tlie one which preceded it, and as most parts to which it is applied are conical in shape, especially in the extremities, it is obvious that in ascending from the lower to the upper portion of them, and in applying the spiral bandage it must be done so tas to cause the pressure to be uniform through its whole extent ; to accomplish this we make what we call reverse turns, which is done as follows : Apply the end of the band to the limb at the smallest part to which you wish to apply it, and continue to make simple spiral turns, until you approach the enlarged portion of the limb. Then apply two fingers of the free hand to that portion of the bandage which is already in contact with the limb, not to assist in forming the reverse or to fold it down, but to prevent the turns already applied from slipping or becom- ing relaxed while the reverse is being made. See that no more of the bandage is unrolled than will enable you to separate the cylinder a short distance (four or six inches) from the limb ; let that portion of the band- age be loose which is between the fingers, holding the band to the limb and the body of the cylinder ; turn the hand holding the roller from being squarely back down to a point where the palm is down, by motion of the wrist alone without moving the fingers from the cylinder at all ; as shown in this cut. Take especial care to make no traction nor to sink the cylinder below the level of the limb, till the fold or reverse is made, when it may again proceed up the limb. It should always ascend spirally and only cover in about one-third of the preced ing turn. Keep each turn and each reverse parallel with its fellow. 47 m 4 > 11 m 1 1 ■'5»l .^Hll >'(')ilH>i 738 ACCIDENTS OF VARIOUS KINDS. FRACTURES— BROKEN BONES. As soon as a limb or other bones are discovered to be fractured, the patient ought to be placed on a litter of any kind wiiich happens to be at hand, such as a shutter or board, and removed to some nel>?hborin>? place of shelter, or to his own abode, if it be not too far diH^tuit, and ii surgeon sent for at once. Great care and gentleness ought to be exercised in lifting and handling the patient, and in transporting him from one place to another; otherwise a fracture originally of the simple kind is liable to be converted into a compound, or at least into a complicated one; for laceration of the soft parts is likely to occur from the action of tlie sharp and jagg(>d ('(lujcH and ends of the broken bone or bones, whereby the prohiibilitie.s of recovery will be nuide more doubtful and perha})8 unfavorable, especially if the accident lias happened to a debilitated or aged person. BIBCHANICAL MEASURES. For Simple Fractukks. In the cjise of a simple fracture, the adjust- ment of the ends of the bones to their natural position should be ertected by placing the limb in the position best calculated to relax the principal nuiseles attached to the broken bone; it should then be gradually exten- ded until the ujiper and lower fragments are brought into their proper position. After that is accomplished, splints of pasteboard or light wood held in position by means of carefully applied bandages, (see cut on page 715) to remain until the union of the broken bone is well secured. For Comi^ouni) Fuacturic. The ends of the bones have l)een forced through the fiesh and must be carefully cleaned and returned to their natural position. The parts of lione should be held m their position by means of splints and bandages as dircfted above for simple fracture. In fracture complicated with a wounded artery or dislocated joint, the artery sliould be tied, to stop the heniorrhagc, and the dislocation reduced before the bone is set. This variety refjuires nion. care and cool- ness than the other varieties do. It is always desirable that a </ood sur- geon should be secured in the case of any fracture. After fracture of the bones of the arms and legs, which is so readily known by anyone, by means of the changed length and position of the att'ected extremity, as compared with the other, and by the hearing or feeling of the snap at the moment of accident, also by the grating sound and sensation produced by moving the one part of the bone against th? otiiOi— fracture of the clavicle (collar l)one) is the most frequent, or at any rate a very common occurrence. '"I-*^!!^ V F'^H^'^Hb^ ^^^i^f ^^ usually takes place near its middle, "~\L.:|f^^^^^^^HM^f^^ and is the result of force applied either ^ ,_ g |^^i«jlli directly or indirectly. The fracture is ^^ j^^^^^^^P^lv^ easily discovered by passing the finger . . .f*-« r"r^ ^^ ^ ir along the collar bone; the natural line ' ||g^^ ri'i;i.ii" ^,-^1^ ^^ ^'^6 bone is observed to be interrup- ted, and the broken ends re percep- tible; the shoulder falls forwards and inwards. Theouter fragment is drawn downwards by the action of the muscles; by pressing the shoulder o ^ m ill 'i ii ill Jii ii t: f» -■ft! ,;SHf TH£ MUSCLES OV TUK BODY AS SKJBN FBOM THE EaU^Ef. 739 II :f I > ft '■ 1 ' ii 1 Ii rr ; 1 1 '1 I I ! . I «*£ MUSCLES OF TUB BODY AS VIEWED xrtOM ■F-v.IITNR BURNS AND SCALDS. 741 upwards and outwards a grating (crepitus) can be felt at the point of frac- ture. Treatment of this fracture consists in adjusting the broken extremities of the bone, by forcing the shoulder upwards, outwards, and backwards, and retaining it in this position. Tiie following mechanical app' nee is a good and simple one for accomplisning this object. A padded belt is placed around eacli shoulder and drawn together on tl|fi back by a strap, and the arm below the elbow placed in a sling. Or, a folded towel is placed in the arm pit and a bandage passed fi'om shoulder to shoulder, forming a figure oo (see adjoining cut) across the shoulders. BUBNS AND SCALDS. There are several varieties. The first variety causes a mere redness of the skin and soon passes away without causing the skin to come off at all. The second variety causes the skin to rise in blisters, which are filled with serum ; if slight these soon dry up and lieal, but if the skin is much injured, may be followed by obstinate ulcers. The third variety causes the destruction of the parts and although perliaps not causing as much, if any, pain, is by far the most dangerous, and serious consequences may follow. The constitutional disturbances and the period of danger following deep burns or scalds have been divided into three stag'^ , 1. Depression and Congestion, during the first four or five days; 2. Re<iction nd Inflam- mation, in which the patient may sink with an affection of the head, chest or abdomen ; and, 3. Suppuration and Exhaustion which may continue from the second week to the close, and is often associated with hectic fever or pleurisy. The danger of burns and scalds often depend more on the extent of surface involved, than upon the dei)th of the injury. Burns or scalds in the trunk, neck, or head are far more dangerous than those of an equal extent in the extremities. Children suffer more severely from these acci- dents than adults. TREATMENT. A most important object to be kept in view and attained as nearly as possible, is to cover the injured part with some suit- able material that will exclude the atmospheric air, which covering should not be removed until the cure is complete. The following local applica- tions jire recommended. A thin sheet of smooth (not glazed) cotton bat- ting sliould be applied to the denuded parts and not removed ; this may be satiinited from time to time with a mixture of Carbolic Acid one part, to Olive Oil six parts; then cover this with several thicknesses of the same cotton batting. As a domestic remedy these should be kept on hand, always ready for burns and scalds. Another and a very excellent remedy is Extract of Witch Hazel (Ham- msemillas), Pond^s Extract, which should be applied in the same manner as just directed for the Carbolic Acid and Olive Oil. , m '■\ ill f' !i^ ; i''l, , , I'iift' ! n I 742 ACC1DENT8 Ol' VAUIUUS KINDS, Tincture of Canthat'idcs (Spanish Fly) ten drops to an ounce of water applied also by means of the cotton wool, is especially useful when blisters are forming or have just formed. See under the head of " Tincture of Cantharis " page 98. Also " Caustif nm <»r liirae Water," page 94; "Raw Cotton," page 94; " The Soap Plaster," page 94; "Flour,'' page 95. SUNSTROKE-SUN FEVER— COUP DE SOLEIL. This is a paralysis of all the functions of the brain, occurring either gradually or suddenly, excited hfy heat, generally following exposure to the direct rays of the sun, particularly when to this exposure is added the pressure of tight and unsuitable clothing. Symptoms. The affection is generally preceded by premonitory symp- toms, such as thirst, heat, and dryness of the skin, vertigo, congestion ol' the eyes, frequent desire to pass water; fainting follows and is often instantly fatal, or insensibility and loud (stertorous) breathing occur either with or without convulsions. In both varieties the number of deaths is ])roportionately great and a very unusual congestion of the lungs is the most common morbid condition found after death. TREATMENT. For medical treatment see "Congestion of the Brain" pages 117 to 122. H03IE TREATMENT. It is now agreed that sunstroke results from a depressed, and not, as formerly supposed, from an excited or stimulated condition of the nervous system and its center. The treatment therefore is to apply cold water by pouring, or cold coiapresses constantly applied over the head, neck and chest, or by pounded ice applied to l..o same localities. Prevention. Clothes should be light and loose, especially about the neck. Green leaves in the hat or cool cloths applied to the head are good, and simple preventives. Another and very important means is to abstaiji from drinking any kind of spirits, a^ it undoubtedly predisposes to attacks of sunstroke by the depression which must and does always follow the first effects (i. e. stimulation). Seven tenths of all who die from sun- stroke are habitual drinkers and a much smaller percentage recover than among non-drinkers. : : STINGS OF INSECTS, Such as the Bee, Wasp, and ITornet, are sometimes very painful, but rarely dangerous, except when the part attacked is very sensitive, as the eye, or else a very important organ, or the number of insects attacking the person is so great as to produce general poisonous symptoms. TREATMENT. First, extract the sting, if it has been left in the wound. Second, apply slices of the common onion, each slice being removed as soon as it becomes saturated with the poison, and another applied in its place. MusQUiTOEs may be prevented troubling in the night, by rubbing a little good soap on the hands and face befoie going to bed. A little Oil of Pennyroyal or Cedar so applied is also efficient. DROPST. 743 lunce of 111 when hncture "Raw eitlicr jsure to Ided the ■y synip- stion or is OfttMl ireitluT eaths is s is tho e Brain'' s from a imilated herefore •ipplied A.V.' same bout the re good, ) ab.staiai • attacks low the )m sun- '^er than ful, but , as the ing the wound, as soon place. 3bing a e Oil of DBOPSY. We have assigned this place to this class of diseases, because the treat- ment of dropsy is so uniformly the same that a separate description of the disease, as developed in special organs or systems would have led to many useless repetitions. Dropsy is never an independent or primary disease, bu*^ 'ays follows or is properly a symptom or resultof other diseases, althoi ■ „ sometimes appears to be of a primary character. In general, all couw.aons which, in tlie long run, interfere witli the circulation, or retain the water in the blood, lead to dropsy ; likewise any other conditions that result in a con- dition of 8ur])lus or want of blood. In most cases, however, something else has to become associated with these conditions, otherwise it would be difficult to comprehend why many conditions which we meet in practice should be able to continue so long before resulting in the development of dropsy. We are unacquainted with the nature of this soinething; whether it is a relaxation of the coats of the vessels, or a more copious supply of water in the blood, or whatever else, we have not yet been able to find out. Most likely it is from this unknown cause that dropsy, which is the result of a general wasting away of the llesh, without any special cause, takes ))Iace so frequently as seen in many cases. In accordance with tiie above-mentioned three classes of causes dropsy sets in, if the flow of the venous blood into the heart is interfered with ; i f the ci rculation is obstructed by a clot in the larger trunks of the veins (as for Instance in consequence of inflammation of the veins in the lower extremity, in the case of lying-in women; dropsy arising from inflamma- tion of the great portal vein ;) in the case of pulmonary aflfections imped- ing the circulation of the blood through the lungs; in consequence of afTections of the liver resulting from obstructions of the circulation of the blood into the liver. In tlie case of kidney affections, if the function of the kidneys is very much interfered with; in chlorosis (green sickness) aflTections of the spleen, like fever and ague, after copious losses of blood, or after severe, debilitating diseases, in general in conditions of debility of a high order. Symptoms. At the onset dropsy is more or less local ; as a rule, it commences with a swelling around the the ankles, less frequently in the face ; dropsy of the abdomen takes place only when the liver is diseased. In this case, it may remain localized as such; in the former case it gradu- ally spreads over the whole body just beneath the skin, then unites with dropsy of the abdomen, and finally with oedema (dropsy) of the lungs or brain, in which case death soon results. Dropsical eflfusions are generally accompanied, and sometimes pre- ceded by prostration, and by decrease of the urinary secretions. The urine is dark, thick, becoming cloudy in a short time; the quantity is sometimes rery scanty. All the other watery secretions are likewise less, or they are entirely suspended ; the stools are very dry, the skin is dry and cracks easily, appears incapable of perspiration ; the mucous mem- branes are likewise dry, on which account the patient is often tormented by a distressing thirst. Dropsy at times develops itself very speedily and universally, some- times slowly and progressing very gradually. It is especially afternephri- if iiii Si! ft til n !>. w 744 FOOD FOR INFANTS AND INVALIDS. tls (Inflammation of the kidneys) that water accumulates very rapidly ; it collects most slowly in company with affections of tiie lungs. Tlie course of the disease is at times uninterrupted, leading speedily-to death, or else it makes pauses, a portion of the serum that liad heen poured out into tlae cavities, or beneath the skin being reabsorbed. This may result from a transitory cessation or diminution of the obstruction in the circulation, or from copious discharges of urine, watery discharges from the bowels, oozing through cracks in the skin, or from a general invigor- ationofthe whole organism. Death generally takes place by oedema(drop3y) of the lungs or brain. Recovery is attended with copious discharges of urine, very rarely with diarrhoea alone. (See Index.) CHAPTER XXXVI. i!H FOOD FOR INFANTS AND INVALIDS. FOOD FOB I^FAN^TS. In is a sad fact, true nevertheless, that at least half the children at the present time are deprived of their proper sustenance and left to the tender mercies of wet nurses or the bottle. Between the two evils it is difficult to say whicli is the least, but unless a superior nurse can be found — one intel- ligent and tliorouglily clean in lier personal habits— we should say choose the last, and bring the child up by hand. It is our opinion, and the conviction is borne out by every mother's experience, that the moral, mental, and spiritual, as well as physical con- dition of a child is greatly inlluenced during its nursing period. Mothers who nurse their own children know that it is of the greatest importance to the quiet and liealthful condition of the child, that they should be free from all sources of agitation, anxiety and irritability. Overwork, giving way to fretfulness, or being subjected to the unrea- sonable temper and caprices of others, frequently induces a state of mind that shows itself plainly in the uneasiness and disquiet it produces in the infant, and would be seen with still greater distinctness were women accustomed to tract" results more strictly to their causes. If this is the case with the mother, if her mental and spiritual condi- tion finds itself reflected so minutely in the Itsrhts and shadows of the little life which is dependent upon her, why should it not receive a color- ing from the milk whicli it derives from a dull, coarse, appetite-loving wet nurse of the ordinary stamp? Two thirds of these nurses make a necessity of strong tea and cofTee, and malt liquors two or three times a day; they areoften anything but scrupulous in their personal habits, and so accustomed to the exercise of a violent will, by virtue of their office, aa to be unwilling to bear the slightest control or contradiction. These are not the influences which a thoughtful mother would like to have her child drink in with its milk, and for reasons here mentioned, we would FOOD FOR INFANTS. 746 all the more earnestly advise you to use the directions for the " Choice of a Nurse," on page 689. We believe it to be a misfortune, the extent of whicli is not at all rea- lized, when the motlier cannot nurse her own cliild. The mother's milk containsall the elements necessary for its proper growlli in every direc- tion, and no substitute caJi be found for it ; but wliere tliis is impossible, unless, as before remarked, a very superior nurse can be obtained, it is safer to trust to tbe simple food wliich at least sustains life and does no hurt if given at right times and in proper quantities, leaving the mental and spiritual activities unimpeded, tliougli probably subject to a slower growth than if aided by the sympathetic magnetism of the mother's nature. STARCHY FOOD. Such as arrowroot, sago, corn starch and the like is commonly held to be very healthy and nutritious for infants, yet the experience of every physician, furnishes numerous instances of feeble sickly children that are so fed, while the number is small that survive it. The reason of this is, that the digestive organs of infants are not sufficiently powerful to con- vert the starchy matter into nourishment; it therefore only serves to clog and impede the action of the system, while the little victim is gradually being starved on the trifle of sustenance which it can obtain from what- ever sugar and milk is given with the other food. RNGLisii "pap." English and French babies, when brought up by hand, are fed almost altogether on " pap," wliicb is made in England in the following way: Boiling water is poured oti a small piece of tiie crumby part of white light bread. This is covered up for a moment, and then the water poured off. The softened bread is then put in a little porcelain stewpan, with a trifle more of water and allowed to boil up, and it is then a pulp. A lump of white sugar and a little cold milk added, brings it precisely up to the ideas of most young Britishers, who grow very stout and healthy upon it. This is excellent food where the mother is capable of partly nursing her child. French pap is made of flour instead of bread, which is decidedly objectionable, as it is not only less agreeable but umch less easily digested, cow's MILK. A diet of cow's milk exclusively, is not good; it is too rich and very apt to provoke eruptive diseases. But if the bottle is preferred to spoon feeding, good cow's milk may be given, diluted with one half to one third of boiling water and sweetened slightly with white sugar. Use only of one good cow's milk. An excellent change from this consists of a thin strained gruel from the best prepared barley, with a little milk and sugar added. A little sugar is necessary in infants' food, but be particularly careful not to make it sweet, as this causes continual thirst as well as disorders of the child's stomach. infant's broth. After the baby is three months old, it may occasionally be treated to a little clear chicken or mutton broth, made in the following manner: Cut »'il m : !.::■■ i^' 746 FOOD FOR INFANT, INVALIDS. up a pound of lean mutton into small pieces, and put them into a small jar, cover them witli cold water, set the jar into a kettle of warm water and let it come to a boiling point, and simmer the mutton until the strength is extracted. One pound of meat should make a quart of broth. Bimmerat least six hours, strain and put in a littlesalt, but no other spice. Treat part of a chicken in the same way for chicken broth. BABY PUDDING. Grate a little stale bread, pour some boiling milk upon it, cover, and when it becomes a pulp, stir into it the yolk of an egg and a grain of salt. The quantity should fill a teacup in which boil it fifteen minutes. ESSENTIALS FOR A BABY. Warm, sensible clotliing, quiet, with food and sleep at regular inter- vals, are the essentials to health and comfort of babies. FOOD FOR YOUNG CHILDREN. The great danger in feeding young children does not lie so mucli in the food as in the preparation or want of preparation. A hard indigestible potato is bad for them, and a little tender stewed meat is good, but if the potato were maslied and mealy, and the meat hard and tough the case would be just the reverse. The principal danger is in their swallowing indigestible substances, and wliether these are hard apples or lumpy potatoes, tough meat or sad bread, rich cakes or nuts, makes very little difference, the irritation and derangement produced is the same. Meat for children under the age of ten years, should be cooked very tender and cut up very small or given in the form of soup. Potatoes should be mashed, apnles roasted or stewed, and, if very ripe andmellow,may be eaten raw, and if bread andmilkcould form their break- fast and some kind of mush with milk their supper, they would be all the better for it, for the rest of their lives. children's tie. Cover thebottom of a pie dish witli slices of bread and butter, cover that with fresh berries sprinkled with sugar or with stewed fruit, fresh or dried. Set it in the oven fifteen or twenty minutes. Sift a little sugar over it when it comes out. BROWN MUSH FOR SUPPER. Stir into a quart of boiling water, a teaspoonful of salt, and Graham flour enough to make it as thick as corn meal mush. Let it boil gently half an hour, keeping it covered. Eat witli cream, or milk and sugar. BREAD and milk. Cut or break up stale bread into small pieces and let them come to a boil in milk. It makes an excellent breakfast for children, with a slice of toast or without. CRANBERRIES. Should be stewed soft, strained through a colander which will pass everything but the skin ; boil up a second time with the sugar and set away to cool. They may then be eaten with impunity by the most delicat c qhildren. small water Lil the L>roth. si)ice. inter- i FOOD FOR INVALIDS. 747 FOOD FOR INVALIDS. The diet for inviilidsdcpentlsHo much upon tlie condition of the patient, that only tlie most general directions can be siven ; the special application must bo left in every case to the judgment of the nurse, provided she have good natural sense. NeaLness.cleaidiness, and promptitude, are the great requisites inaaick chamber. Tiie best prei)ared food is spoiled by want of care and punctu- ality in placing it before tlie patient. Where persons are ill their senses are often preternaturally acute; slight marks of neglect which would not be noticed at another time, become extremely offensive; and a few minutes delay, not only seems unpardonable, but is sometimes really injurious. Patience, tact, and nat- ural kindness of disposition are essential qualities in a good nurse, and when to these are added hrmness and good judgment, tlie sum total in this lino has been reached. As a general rule, however, one half of the nurses injure their patients by absurd restrictions, and the other half by foolish indulgences. GRUEL. This simple refreshment is invaluable in sickness, and is made with little trouble and less expense, yet is very seldom prepared exactly right. One tablespoonful of tine Indian or oat meal, mixed smooth with cold water anda little salt ; pour upon this a pint oi boiling water, and turn into a sauci'-pan to boil gently for half an hour; thin it with boiling water if it thickens too much, and stir frequently; when it is done a tablespoonful of cream or a little new milk may be put in to cool it after straining, but if the patient's stomach is weak, it is best without either. Some persons like it sweetened and a little nutmeg added, but to many it is more palatable plain. PANADA. Break into a bowl three good sized crackers (arrow root or oat meal are nice) broken into small pieces; pour upon them boiling water and cover close for a minute, then add a teaspoonful of white sugar and a little pure milk. It is an excellent breakfast or supper for a child or an invalid. Instead of t\w milk the juice of a lemon may be squeezed in and another teaspoonful of sugar added, if there is fever. "soft" toast. Some invalids like this very much indeed, and nearly all do when it is nicely made. Toast well but not too brown, a couple of thin slices of bread; put them on a warm plate and pour over boiling water; cover quickly with another plate of the same sizi' and drain the water off; remove the upper plate, butter the toast, put it in the oven one minute and then cover again •with a hot plate and serve at once. EGCx TOAST. Make a soft toast and have ready one or more fresh eggs, which have been boiled twenty mSnnt^?,; remove the sheila, cut them in slices and place upon the toast, with a little butter, pepper and salt; without the butter they may be eaten with impunity by the most delicate invalid, as an egg cooked for twenty minutes is really more easy of digestion than one that is termed "boiled soft." il h mil \m mi i; J ^ III |r«<i»i 748 FOOD FOU INFANTS AND INVALIDS. SOFT BOILED EGOS. Fresh eggs for iiiviilitls wlio like them cooked soft, should be put in a pan of boiling water, and set (Jii a piirL of the stove where tliey will not boil for several minutes. At tiie end of that time they will be like jelly, perfectly soft, but beautifully done and quite digestible by even weak stomachs. DHY TOAST. Cut your slices of bread even, and not too thick. Toast before a clear fire, a nice light brown. Cover with a napkin and serve quickly while it is hot. Dry toast is not always good for invalids, especially when tlie bowels are confined and it is desirable to keep them open. In this case Graham bread not toasted is much better. MILK TOAST. This is a favorite dish with nearly all sick people, when they are get- ting well. Cut stale bread in rather thin slices, toast a fine brown and lay them in a deep dish. Meanwhile boil a quart of new milk in a lined sauce- pan in which you have first put a very little cold water, to prevent burn- ing. As soon as it boils pour it over the toast, cover, and serve quick. For an invalid no butter should be put in the milk. Some people put in a thickening of flour, but this spoils it for many. THICKENED MILK With a little milk, mix smooth a tables "oonful of flour and a pinch of salt. Pour upon it a quart of boiling milk, and when it is thoroughly mixed put all back into the saucepan and boil up at once, being careful not to burn, and stirring all the time, to keep it perfectly smooth and free from lumps. Serve with slices of dry toast. It is excellent for diarrhoea; this alone will often cure it by scorching the flour before mixing with the milk which makes it into (Carb. V). MILK AND EGGS. Beat up a fresh egg with a grain of salt, pour upon it a pint of boiling milk, stirring it all the time. Serve hot with or without toast. It is good in case of weakness for an early breakfast, or for a traveler before starting on a journey. BEEF TEA. Cut upa pound of rump steak into small pieces, and put it into a bottle (wide mouthed fruit jar) putting a very small quantity of lul^ewarm water into the bottle with it, cork tightly and put the bottle into a kettle of warm water; the water should be allowed to boil for a considerable time; the bottle should then be removed and tiie juice drained off. The tea may be salted a little and a teaspoonful given at a time. OYSTER SOUP. Make a little broth of lean veal or mutton, simmer with it some root or essence of celery. Strain it, put on the fire and when it boils throw in the oysters with their liquor, and a trifle of pepper and salt. Serve it as soon as it comes to a boil, on little squares of toast. BROILED TENDERLOIN. This is a choice piece from a sirloin steak, and is highly enjoyed when 1 ■r, ■ ■ M, is FOOD FOR INVALIDS, 749 the patient is becoming convalescent. Cut out the round piece from tlie inside of a sirloin stejilc, l)roil it quiclt over a Ijrigiit Are, upon a small, lit!ated gridiron, turn it, witli its gravy, upon a piece of fredlily made toast sprinkle with salt and pepper, but no butter, place between two hot plates, and serve directly, A tender mutton chop or half the breast of a chicken may be served the same way, only the chicken will require longer, and somewhat slower cooking, ARROW ROOT GRUEL, Add a teaspoonful of arrow root to half a pint of boiling water; mix well, add half a pint of milk and boil together for two or three minutes; sweeten to the taste, A little lemon juice or wine may be added. MUTTON TKA. Take one pound of miiLton, remove the fat and cut tlie meat in small pieces; pour half a pint of boiling water over it. and let it stand near a (ii(( for lialf an liour, and tiien boil for one liour, strain througli a sieve or cloth, add salt to suit the taste, A very nourishing diet, CHICKEN BROTH, Take half a chicken, remove all tlie fat, cut tlie meat up into small pieces, and break the bones ; put into a vessel with three pints of boiling water; boil for one hour, season with salt and strain. WATER GRUEL. Corn or oat meal two tablespoon fuls, water one quart; boil for ten or lifteen mintites, and add sugar, or salt, if desired by the patient, RICE GRUEL, Ground rice one heaping tablespoonful, ground cinnamon half a tea- spoonful, water one quart; boil slowly for fifteen or twenty minutes, add the cinnamon when it is nearly done boiling, strain and sweeten, SAGO GRUEL. Sago, two tablespoonfuls, water one pint, boil until it thickens, fre- quently stirring. Wine, sugar, and nutmeg may be used, if desirable, TAPIOCA CUP PUDDING. This is very light and delicate for invalids. An even tablespoonful of tapioca soaked for two hours in nearly a cup of new milk. Stir into this the yolk of a fresh egg, a little sugar, a grain of salt and bake in a cup for fifteen minutes, A little jelly may be eaten with it or a few fresh straw- berries. INVALID CUP PUDDING. One tablespoonful of flour, one egg; mix with cold milk and apinchof salt to a batter. Boil fifteen minutes in a buttered cup. Eat with sauce, fruits, or plain sugar. INVALID APPLE PIE, Slice up one or more nice, tart apples in a saucer, sweeten with white sugar and cover with a moderately tliick slice of bread, buttered slightly on the under side. When the bivad is nicely browned, the apples, if of a tender kind and thinly sliced, will be done. I f M m %W M m I ri .! ■ VM !; 760 FOOD FOR INFANTS AND INVALIDS. ROAST APPLES. These can nearly always be eaten with safety, when they are eaten with relish. Choose good sized, fair apples of a tart and juicy, but not of a sour kind. Rub them off clean, and put them in ruthor ii slow oven, which may increase in wanntli, so that they sliall be thoroughly done in an hour. When so soft tliat tlie savory pulp breaks through the browned skin in every direction, take tiiem out, sift white sugar over them, and carry one at a time on a saucer to the patient. STEWED PRUNES. These are extremely good in small pox, measles, scarlet fever, and the like, both as food and medicine. Get the box prunes, as they will not need washing, and because they are generally of u mucli better quality than the open sort. Soak them for an hour in cold water, then put them in a porce- lain lined saucepan with a little more water if necessary and a little coffee or cruslied sugar. Cover and let them stew slowly an hour, or until they are swollen large and quite soft. They are excellent as an accompaniment to breakfast for a sick woman. LEMONADE. This is invaluable in fevers and also in rheumatic affections. Rub the lemons soft, cut them half througli the center and squeeze out the juice. Take out the seeds with a teaspoon, '^iit two tablespoonfuls of white sugar to each lemon and fill up with cold or boiling water according as you desire the lemonade hot or cold. Two medium sized lemons will make a l)int or more. APPLE WATER. Roast two tart apples un'.i! they are soft, put them in a pitcher, pour upon them a pint of cold water and let it stand in a cool place an hour. It 13 used in fevers and eruptive diseases and does not require sweetening. TO. r WATER. Toast slightly a piece of bread and add to it boiling water ; it may be sweetened, if preferred, and flavored with a little lemon or orange peel. FLAX SEED TEA. Take an ounce of flaxseed and a little i)ouiided licorice root and pour on a pint of boiling water; place the vessel near a fire for four hours; strain through a linen or cotton cloth. BAULEY COFFEE. Roast barley until well brown, and boil a tablespoonf ul of it in a pint of water for five minutes; strain and add a little sugar if desired. This is a nourishing drink toward the close of fever and during convalescence. OAT MEAL COFFEE. Mix common oat meal and water to form cake. Bake it until it is brown, then grind it in a cofTee mill ; take about a tablespoonful for one pint of water and boil it five minutes. This is good for checking obstinate vomiting or distress in the stomach, when caused by drinking too much ice water. FOOD Fon INVALIDS. m KICK WATER. Take two ounces of rice andtwoquiirts of water; boil an hour or so and add a little su^ar; a little uutiut'K or loaion may be used to tlavor, if the patient likes it. MUCILAGE OF KLM nAIlK. Place about a teuspoonful of ground elm bark in a pint of cold water; tlii« may l)e drank after an liour or two. If mm-i) agreeable to the patient, it may be flavored with lemon juice or essence of lemon. Is very beneficial in cases of inllammation of the stomach or bladder, etc. AJiUM wnKY. Take a lint of sweet milk and add a teaspoonful of powdered alum, then boil and strain; this is useful in diarrhoja, dysentery, and inflamma- tion of the stomach. The curd forms an excellent poultice for inflamma- tion of the eyes. MU.STARD WHEY. Take a tablespoonful of mustard seed, and one pint of sweet milk, boil together for a few minutes and separate the curd. This is a very useful drink in dropsy. VINEGAR WHEY. Take a pint of milk and one teaspoonful of good vinegar ; boil them together for u few minutes antl separate the curd. RENNET WIIEY. Take one quart of new milk and a large spoonful of renne^; heat the milk and then add the rennet, after which boil until the curd separates, which is to be skimmed. ORANGE WIIEY. Take a pint of milk, the juice of one orange with a portion of the peel, boil the milk then add the orange to it and let it stand until coagulation take» i)lace, then strain. I' ■Nil 111 M w TABLE OF REMEDIES. PT If 1 ii 1i With the abbreviations UHed in writing prescriptions, the full Latin (Teclinicul) nameH, und one or more of tne common Engli.sh names, with tlieir antidotes on the opposite pages. Read aciuss t?Hs and the next page after each number. AltimEViAIION 1 A bies Can 2 Ac 3 iEscul 4 Agar M 5 Ag!ius (J A I Rub 7 Alum 8 Am bra G 9 Amm C 10 Amm Mur 11 Auac 12 Ant C 13 Apis Mell 14 Aralia H 15 Arg Fol 10 Arj? Nit 17 Am Mont 18 Ars Alb 10 Aris Virg 20 Arum T ;il Asa 22 Asarum 23 Aselep 1 24 A sulci) S 2o Atroj) 2(j Aurum F 27 Aur Mur .28 BapTlnct 29 Baryta 30 Bell 31 Borax 32 Bov 33 Brom 34 Broom 35 Bry Alb 3(> (Ihinca 37 Cal Carb 38 Cal Caus 39 Cal Phos 40 Calen Off 41 Cae Grand 42 Camph 43 Cann Sat 44 Canth LATIN. Abies Canadensis Aconitum Napellus ^seuluH Glabra Agricus Musearius AguuH Castus All! us llubra Alumina Ai.ibra Grisea .^ mmoninm Carbonicum Ammonium Muriaticum Anaf^ardium Aiitimoiiium Crudum Apia Mel lifica Aralia Itacemosa Argontum Foliatum Argentum Nitricum Arni.'a Montana Arseiiifum Album Aristoloclila Virginia Arum rrii)liylum Asafii.tida Asarum Europseum Asclej>ias Inoarnata Asclej/ias Syriaea Atropin Aurum Foliatum Aurum V riaticum Bajitisia Tinctora i5aryta Carbonica Belladonna Borax Bovista Bromium Spartium Scopariuni Bryonia Alba Chinca Calcarea Carbonica Calcarea Caustica Calcarea Phosphorica Calondnla OlTicMnalis Cactus Grandillorus Camphora Cannabis .Sativa Cantharides 752 ENOMSH NAME. Hemlock Pino Monk's Hood. Wolfs Bane Ohio Buckeye Bug agaric. Amanita Chaste-tree Tag Alder Argilla. Clay, Ox. of Alumfiu Ambergris Carbonate of Ammonia Muriate of Ammonia Malacca Bean Crude Antimony Honey Bee Spikenard Silver Foil Nitrate of Silver Leopard's Banc Arsenic Virginia Snakeroot Indian Turnip Asafuitida Common Aaarabacca Swamp Milkweed ^ Common Milkweed Alkaloid of Belladonna Gold Muriate of Gold Wild Indigo Carbonate t)f Baryta Deadly Nightshade Biborate of Soda Putr-ball Bromine 15 room White Bryony Chinca-root Carbonate of Lime Caustic Lime Phosphate of Lime Marsh Marigold Night-blooming Cereus Camphor Hemp Spanish Fly TABLE OF ANTIDOTES AND DISEASES. Before the appear t lie iiaint's of antidotes to tlie medleineg named on the opposite page and uiivi- the in oat-h liiie the name of u few of tlu' diseuHe.s, diseased parts, or conditions, wliicli tlie remedy named after I lie (corresponding' number on the opposite jiage is known to cure. Of course the few diseases named here does not, byuny means, com- prise all which the remedy named will cure. ANTIDOTKS. DISEASES. 1 Coffee. — Dyflpepaia, Palpitation of the heart, 2 Vinegar, tToffee.— Fevers, Lungs, (Jrouj). Heart Disease, Neuralgia. 3 Nux Vom.— Piles, Lunie Hack, Constipation, Spasms. 4 Halt, Ether.— Apoplexy, Chorea, Delirium Tremens. 5 Wine, Coffee.— Impotence, Scanty fSecrelion of Milk 6 Sulphur.— Skin Diseases. 7 Ipecac, Soda. — Leucorrhoea, Lead Colic, Constiimtion. 8 Camphor.— Hysterics, Hard hearing, Dry Chough. \i (Camphor, Lemon-juice.— Syphilis. Dysmenorrha'u, Spasms, Epilepsy. 10 Oil, Elm Bark.— ('atarrh. Consumption, Dinrrhcea. 11 Camphor.— Weakness of Mind, Heart Disease. 12 Mercurius, Puis.— Weakness ol Digestion, Scald Head. l.'{ Arnica, Onion. — Diseases of the Kidneys, Dropsy. 14 (Umlclfuga. Nux.— CI ravel, i.encorriKjoa, Dry Cough. 15 Pulsatilla, Merc. — Melancholy, Plieuniatism of Joints. 16 Common Salt. — GonorrluL'a, ("racked Nipples, Epilepsy, Diarrhoea. 17 Vinegar, C'amphor— Bruises, Swelling of the (Hands, Lungs. 18 Iron, Ipecac— Diarrhtva, Fever and Ague, (Obstinate Skin Diseases. 19 ("amphor.— Sick Headache, Piles, Dyspepsia, 20 Onion.— Salivation, Inlhimmation of Mouth and Throat, Asthma. 21 Camphor.— Hysterics, Dy8pe|)sia, Premature Menses. 22 Vinegar, Camphor. — C'olic, Vomiting. 23 Pulsatilla.— Asthma, Pleurisy, Diarrhoea, Cough, Catarrh. 24 Hryonia. — Headache, Dropsy, Inlhienza, Rheumatism. * 25 Coffee. — Neuralgia, Spasms, Paralysis, Whooping Cough. 26 Merc, White of Eggs. — Diseases of the bones, Sexual Organs, Glands. 27 Nitric Acid.— Chronic Catarrh, Dropsy, Syphilis. 28 Bryonia. — Typhoid Fever, Diphtheria, Dysentery. 29 Soda or Magnesia in Vinegar. — Scrofulous swellings, Rickets. SO Vomit, Coffee — Diseases of Brain, Nerves, Glands, Lungs, Skin. 31 Mercurius.— Sore Mouth, Menses during Nursing, Liver Spots. 32 Cami)hor. — Externally to stop bh'eding. Headache. 33 White of Egg.— Consumption, Cronj), Dysentery. 34 Rhus tox,— Nursing Sore Mouth, Mercurial Salivation, Childbed Fever. 35 (Coffee, Camphor.— Rheumatism. I'neumonia, Constipation, Typhus. 36 Cantharis.— Eructations, Vomiting, Burning Urine. 37 Camphor.— Scrofula. Slow Teething of Infants. Profuse Menses. 38 Bryonia.— Coughs, Croup, Ulcers, Curvature of the Spine. 39 Nitric Acid. — Herpes, Discharge from Ear, Chronic Bronchitis. 40 — WoiTNDS, Colic, Cancer. 41 Verat Vir\de.— Heart Disease, Pneumonia, Fever and Ague. 42 Opium, Vinegar. — Cholera. Influenza, Hysterics, Headache. 43 Lemonade. — Gall Stones, Burning Urine. Nose Bleed. 44 Camphor.- Bloody Urine, Dysentery, Kidney Diseases. 48 768 iilU<'hl 764 TABLE OF REMEDIES. ABBREVIATION. LATIN. ENGLISH m !i li ' 45 Cap Ann 4() Carbo A 47 Carbo V 48 Curdu Mar 49 Caul Thai 50 Cans 51 Cepa 52 Cera Virg 63 CMiain 54 Chel Maj 55 Chini Uni 5U Chi 57 Chi Hy 58 Cic Vir 59 Cini Rac 60 Cin 61 Cist C 62 Clem 03 Cocc 64 Coc Cac 65 Coff 66 Colchi Au 67 Col 68 Collin Can 69 Con 70 Corn Flor 71 Cro 72 Crotal 73 Crot Ole 74 Cup Met 75 CuprAc 76 Cupr yul 77 Cyp Pub 78 Daph 79 Dijri 80 Dor T. Lin 81 Bros 82 Dulc 83 Euc Glob 84 Eup 85 Euphor 86 Euj)Iua 87 Ferr 88 Ferr Ace 89 Ferr Mur 90 Fil M 91 Gel Semp 92 Graph 93 Glo 94 Ham a 95 Hede Pul 96 Helleb 97 Hep Sul 98 Hy Acid 99 Hydras Can 100 Hyos 101 Hyp Perf 102 Ign 103 Indigo 104 lod 105 Ip 106 Iris Ver Capsicum Annum Cayenne Pepper Carbo Animals Animal Charcoal Carbo Vegetabilis Vegetable Cljarcoal Carduus Mariua Common Thistle CaulophyllumThalictroidesBlue Berry Hoot Causticum Cepa Cerasus Virginica Chamoniilla Vulgaris Cheludonim ^lajus Chimaphila Unibellata China Cliloral Hydrate Cicuta virosa Cimicifuga Kacemosa Cin a Cistus Canadensis Clematis Erecta Coccuhis Indicus Coccus Cacti Coffea Cruda Colchicum Autumnale Colocynthis Collinsonia Canadensis Conium Maculatum Corn us Florida Crocus Crotalus Horridus Crotoiiius Oleum Cuprum Metallicum Cui)rum Aceticum Cui)rurn Sulph Cypripediuin Pubescens Daphne Indica Digitalis Purpurea Doryphora Ten Lina5 Drosera Dulcamara Eucalyptus Globulus Eupatorium Euphorbium Euj)lirasia Ferrum Metallicum Ferrum Aceticum Ferrum Muriaticum Fiiix Mas Gelseminum Sempervirens Graphites Glonoine Hamamelis Virginiana Hedeonia Pulegioides Helleborus Niger Jlepar Sulphuris Hydrocyani Acidum Hydrastis Canadensis Hyoscyamus Niger Hypericum Perforatum Ignatia Amara Indigo lodium Ipecacuanha Iris Versicolor Caustic Tincture Common Onion Wild Cherry (rod) Common Cbanioniile Garden Celandine Prince's Pine, Wintergreen Peruvian Bark Chloral Water Hemlock Black iSnakeroot Worm-seed Rock Rose Virgin's Bower Seeds of Cocculus Cochineal Raw (^olfee Meadow ISfilTron Bitter Cucumber Cure All, Richweed Spotted Hemlock Dogwood, Box Tree Saffron Rattlesnake Poison Croton Oil Copper Acetate of Copper Sulphate of Copper Bleeding Heart Indian Daphne Fox-glove Colorado Potato Bug ►Sun-dew Bitter-sweet Blue Gum Tree Boneset, Ague Weed Spurge Eye-bright Iron Acetate of Iron Muriate of Iron Male Fern Yellow Jeseamine Black Lead Nitro-Glycerine Witch Hazel Penny Royal Christmas Rose Sulphuretof Lime Prussic Acid Golden Seal, Yellow Puccooti Black Henbane St. John's Wort St. Ignatius' Bean Indigo Iodine Ipecac Blue Flag m TABLE OF ANTIDOTES AND DISEASES. 755 Mil!) ANTIDOTES. DISEASES. 45 Cuniphor.— Chronic Dysentery, Fever luul Af^ue, Dyt.pepsla. it!.— Cancer, Goitre. Offensive breatli or discharges. id 47 18 49 50 51 Arseni Arsenic- Nux V.- FulsatiUt m 67 Curdiulyia, Ulcers, Burns, Flatulence, Dyspepsia. Jaundice, (hill Stones, Cough, Pleurisy. .—False Tains, Tedious Labor, Dysnienorrhcea, Colic. Coffee.— Chronic Hoarseness, Cold Feet, Insanity, Coffee.— Stings of Insects, Poisoned Wounds, Frozen Parts. 52 Ammonium.— iSlow Fevers, Dyspepsia, Ulcers, Whooping Cough. 53 Aconite, Coffee.— Children's Diseases, Spasmodic Pains, Neuralgia. 54 Sulphur.— Headache, Warts, P>uptions, Jaundice. Cantharis.— Dropsy from Disease of the Kidneys, Constipation. Arsenic, Verat Alb.— Foralldiseasesof PeriodicRecurrence. Weakness Ammonia.— Insanity, Sleeplessness, Neuralgia, Lock Jaw. 58 Tobacco. — Epilepsy, Mania, Defective Eyesight. 59 Coffee.— Menses too Profuse, Chorea, Rheumatism. GO Ipecac— Worms, Whooping Cough, Spasms, Catarrh. 61 Belladonna.— Foul Breath, Chronic Diarrhoea, White Swelling 62 Mercurius.— Orchitis, Old Foul Ulcers, Syphilis. 63 Camphor.— Menstrual Colic, Sea Sickness, Nausea, Asthma. 64 Tea, Wine, Ipic. — Vomiting, Cough, Palpitation of the Heart. 65 Aconite. — Nervous Diseases, Cardialgia, Dyspepsia. 66 Vinegar, Honey.— Gout, Burning Urine, Cramps of Calves of Legs. 67 Camphor, Coffee.— Colic, Dysentery, Costiveness, N. aralgia, 68 Nux Vom.— Piles, Diarrhoea, Chronic Constipation. 69 Coffee. — Apoplexy, Amenorrhoea, Catarrh. 70 Quinine.— Sour Stomach, Intermittent Fever. 71 Aconite. — Hysteria, U terine Hemorrhage. 72 Arsenic. Ammonia, Spirits.— Headache, Skin Diseases. 73 Opium, Mucilaginous drinks,— Constipation, Eczema, 74 Emetics, White of Eggs. — Epilepsy, Insanity, Vomiting, Asthma. 75 MUk, Iron Filings,— Jaundice, Colic, Croup. 76 I )ecac.— Emaciation, Rage, Vertigo, 77 Tea,— Excessive Menial Labor, St, Vitus' Dance. 78 Vinegar, Camphor.— Itching Eruptions, Pains in Bones. 79 Emetics, Wine, Ammonia.— Heart Disease, Bloody Cough, Dropsy. 80 Jimsou Weed. — Vomiting, Dysentery, Night-Mare. 81 Camphor.— Whooping Cough, Consumption, Cough. 82 Camphor.— Salivation, Hives, Bright's Disease, Hoarseness. 83 Qu'inine.— Intermittent Fevers, Asthma from Heart Disease. 84 Ipecac, Nux.— Fevers: Intermittent, Spotted, Remittent, Influenza 85 Lobelia,— Spasms, Diarrhoea. Cholera Morbus, 86 Belladonna.— Chronic Sore Eves, Ophthalmia, Sneezing. 87 Arsenic, China.— Nursing Sore Mouth, Diarrhoea, Chlorosis. 88 Kreasote.— Consum,)tion, Dropsy, Excessive Menstruation. 89 Pulsatilla, Arsenicum.— Catarrh of the Bladder, Wetting the Bed. 90 Lemon.— Tape Worms. 91 Belladonna.— Headache, Dumb Ague, Convulsions, After Pams. 92 Nux, Wine,— Chronic Eruptions, Catarrh of the Ear, Salt Rheum. 93 Coffee,— Sunstroke, Congestive Headache, Nervous Diseases 94 Arnica,— Burns, Scalds, Bleedings, Varicose Veins. 95 Turpentine,— Nausea, Whites, Amenorrhoea from a Cold. 96 Camphor,— Dropsy of the bi-ain. Scanty Menses. 97 Vinegar.— Typhus„Scrofula, Skin, Glands, Profuse Menses. 98 Ammonia, Cold AfFuaion.— Epilepsy, Apoplexy, Cholera, Phthisis. 99 Ammonia,— Headache, Catarrh, Consti')atioM, Leucorrhcea. too CofTee, Bell— Hysterics, Hydrophobia, Braiw Fever. 101 Pulsatilla.— Congestion of the Blood to the Head, Pamful Menses. 102 Camphor, Lemon.— Hemicrania, Spinal Irritation, Convulsions. 103 Belladonna.— Epilepsy, Chorea, Vomiting, Colic. , 104 CoflTee, Starch.— Goitre, Enlarged Glands, Liver Complaints. 105 CoflTee.— Vomiting, Asthma. Diarrhoea, Fever and Ague. 106 Veratrum Alb.— Summe Complaint, Morning Sickness. ^^;t!Sl '1 Hfii iM TABLE OF BEMKDIES. .\I!I!JvKVI\TION, ]f)7 J; dap 108 .Tii!>-('in KM) Kali Jii IK) Kali Car 1 if !■) 1 If 1; !!;5 I I ' !i7 118 11!) iMili Hi Kioj'so Ko!r.-:so I.a.'ii Laiir Lv.l Pai ]■><) Ma.-x Car ■••^l Ma.u- Mm- i2J J.r iii'^aii 12;'. Ui Ills Can 124 Mcnv \-S> Mcpii I2() Mcr Viv 127 Mer Sol 125 IVfci Dill i2l) Mer !od i;;() .Mir ("orr i:3l 3.1c7, !:12 Morph MV.] Muscll lU iMiir Ac i;]-) Nat Car KJC) Nat Mur 1S7 Nil Acid l;js Nux Jug i;'.i) Nit 14!) XiixMoscli 141 Nux Vom !42 Olcaii 14:! ()! Jex' 144 Oi Jlic 14.-) Of) 1 Hi Petro 147 Plios Ac 148 Piios 141) Piiy ir.u Plat \-,l Plumb 152 Plumb Act i:>'.i Pod Pel 154 Polv Punc 155 Pills 150 Rau B 157 Kan S 158 Kliod 159 Rhus Tox 3(J0 UhusGlab 1(»1 Rum Cri3 102 Rutii G 10;^ Sabad 104 Sabin 105 Samb 166 Hang 167 Scut Lat 168 Sec LATIN. Jalapa JufTJanH Ciuerea Kali Bicliiomicum Kali Carbouicura Kali Ilitiiodicum Ivroasotuni Kousso Laciiesis Lauidcci'asus Lt'duiu Palustre Liliuui Ti,nriuum Lycopoiliiim Clavatum LobsMia Mauiiesia ('jirbonica Ma.n'ueyia Muriatica M;ui.i;aiuun Mcuispcriniiiu Cauadense Men van t lies Trifoliata Mephitis Pdturius Mi^'curius Vivus Mcrcui'ius .Solubil's M^i'diriiis Dulcis M"rc!iVius fo(li(l« Men II ri us Corrosivut M' i^ercMH)) M<)ii)liiiim Most'llUK Muriatis Acidum Natruni Carijonicum Natriiin Muriaticura Nitri Acidum Nux Jiifjlans Nitrum Nux Moscbata Nux Vomica Oleander Oleuiri Jecoris Oleuiu Kicini Opium Petroleum Pliospiiorl Acidum I'botiphorus Phytolacca Decandra Piatina Plumbum Piumbuu) Aceticum Podopliyllum Pelltaum Polygonum Punctaturo Pulsatilla Ranunculus Bulbosus Ranunculus ticelaratus Rliododendroii Chrysantb m Rhus Toxicodendron Rnus GJiabrum Rumex Ci'ispus Ruta Graveolens Sabadilla Sabina Sambucus Nigra Sanguinaria Canadensis Scuttellaria Latertiora Secale Cornutum ENGLISH. Jalap Butternut. White Walnut. Bichromate of I'otash Carbonate of J'otush Iodide of Potassium ('reasote Kousso Snake Poison Cherry Laurel Marsh-tea Tiger-spotted Ijlly Club Moss Indian Tobacco, Asthma-weed Caibonate of Magnesia Muriate of Magnesia Maufiaiuise .SarsijpiU'illa liuck Hean Hkunk ^lercury. Quicksilver Holuble Mercury Calomel Iodide of Mercury Cc'rro.sive Sublimate Mezereon Morphia i/lusk Muriatic Acid Carlmnate of Soda Kitchen Salt Nitric Acid Walnut Shell Nitre, Saltpetre Nutmeg Vomic Nut Oleatider Cod Liver Oil Castor Oil Opium Rock Oil Phosphoiic Acid Pl!OH))horus Poke Root, Poke Berry Piatina LeaiJ Acetate of Lead May Apple Smai tweed, Water Pepper Wind .Flower Buttercup Malignimt Crowfoot Siberian Rose Poison Sutoaeh C()U)nion Su»racl» Yellow Dock Rue Mexican Barlev Savin Elder Blood Root BkuU Cap Ergot ij, TABLE OF ANTIDOTKS AND DISEASES. 7.^J iea ANTIDOTKS. DISK ASKS. 107 Rhuburl).— Constipation, Suiall Doses for Diarrliooii of Fnfanta 108 Mayapplc Hoot.— Quinsy, Camp, Diarrluva, Kult Uluniiii. 10!) IoiUik;.— Ckoup, Coii/^li, iiloody ("alarrli. 110 Vinegar, Wine.— Con.suniptiun! ^\'iloopiIlfr <'ouf,'li, Dy.spepsia 111 Tobat'co.— Brain Fevor, f?oru 'JMiroaL, (joiirc, <'ancer 11:! Milk, Muc;ila<.re.— Diabete.s, Foul .Smcliiiu-- Discharges Eurns. ll'{ (;off'c(;— Tape Worms. 114 Ammonia, Arsenic— Fevers and (."onvilsions. ll.j Ammonia, (^oid Airusioiis.— Pneumonia, (iamcrene. Apoi>ipxv IM Camplior— Inseel JUles and .Stinjr.s, V/lioojiinj:- Cougli, A-ue. 117 Hepi.a.— Menses too i)rofu8e and too often. Sterility. " 118 Camplior.— l<]xcoriationsof Infants, (iray*'!, Dloatl'ii','', U'eers ' 110 Ipeeac— Croup, Astiima. Vomiting, Sielv Headaclie. '" 120 Table .Salt.— Menstrual Dillieuliies, Diarrluea of J'regnancy. 121 (Jalcarea. — Worms, Leueorrlura, I'terine Sjiasnis. 122 Cotree, Iperae.— Exeoriatin;^' Leueorriio.-a, Full of the Womb. 12.5 Bryonia.— Jjiver CJomjdaint, Kkin Diseases, Drojwy. 121 Cumplior. — JNIalarial Diseases, JJheumatisni. 12') v'anii)har. — Sick Headache, Hysterics. 12!! {}c)ld, Iodine. — Glands, Ulcers, Diarrlifra, Flux, r.iver. 1-7 Nitric Acid. — Diseases of Females. Sore Moutii and Throat. l-iS Chloride of Potash . — Putrid Sore Throat, Biliousness, Diseased Boneg i2' Ilepar Sul. — Diphtheria, (ioitre, Hardened Glands. 1 ') WhiteofEyjijH.— Bloody Flux. Oplilhalniia, Syjjhilis. liowel Compl'ts lol I'.Iercurius, ^lilk —Bones, Skin, l>o\vels, Hectic Fever. ! i2 Quick JOmetics.— Used to ]m)duce slec]) and relieve jiain. I'i! Cami)hor.— Hysterics, Nervous Headache. Asthma. I'il Sulphur. — Scrofula, l)ii)htherla, Tyj-'hus, Ulcers, I'l") Vincjj;ar. — Glandular S\veliim!;s, Scrofulous Sores. 13) Nitrate of Silver.— Fever and Ague, Constipation, Hemorrhage. l;7 Cami)hor, Conium.— Syphilis, Fistula, IJver Coinphunt, Diabetes bi"> Arnica. — Boils, Fever and Ague, Leucorrhoea. b'50 Hepar 8ul., Sul{)hur.— Dysiiepsia, Cardialgia, Diarrhaas, Gravel. 1-1 1 Caraway Seed. — Hysterics, DysnienorrlujL'a. 1 !l Emetictj, Coffee.- Cramps. Convulsions, Neuralgia, P" ibctes, Ague. 142 Camphor. — Paralysis, Vertigo, Insanity. 1 13 — Wasting I^iseases. 144 — Is a mild Catluutic. 14-> CoflTee. — Apoi)lexy, Mania, Lead Colic, TTernia, Sleeplessness. 14() Nux.— Weakness of the Bladder, (Tiilblains, Herpes, Sore Throat. 147 Cfimphor, Colt'. — Onanism, Epilepsy, Diabetes, Consumption, Scurvy. 145 Milk, Magnesia. — One of t lie most generally useful renjedies. 140 lUoodroot. — SaltKheuni, Dii)htheria, Piles, llheumalism. b'iO Pulsatilla. — Excessive Menses, Catalep.sy, Falling of the V\'omb. l')l Opium, Alum. — Paralysis, Colic, Dysentery, Sterility. 152 Vinegar and Magnesia. — Headache, Convulsions, Poss of Right. IM Arnica. — Bilious Headache, Dysjiepsia, (,'olic. Diarrhoea, Piles, 151 Pulsatilla.— Dysentery, A menorriioea, Sprains, Bruises. 155 Co/fee. — This reinedyis the woman's friend. 156 — External ai)plications to old sores. 167 Camplior. — Gangrene, Cancer of the Stomach, Dandruff. 158 Lobelia.— r'hroiii(! Rheumatism, Asthma, Ophthalmia. 159 Lobelia; internal and external.— Erysipelas, Pneumonia, Typhua, 1(50 Borax.— Rheunuitism, Night Sweats. Scurvy, Bleeding, Piles. Ifil Belladonna.— Epistaxis, Diarrhwa. Colic, Hich. 162 Camphor.— Worn>s, I'tirine Irri^gularities, Weak Eyes from Readiug. 163 (^,ina,— Tape Worm. Neuralgic Rheumatism, Fever. 164 Elm Bark.— Miscarriage, Uterine Hemorrhage, Dysuria. 165 —Cold in the Head, of Infants; Externally for Burns. l(ii> Bryoiiia.— Sick Headache. Vonnling, .laundice, Croup, Pneumonia, ](i7 Coffee. — Delirium Tremens, Chorea, .Simstroke. J68 Cftniphor. — Tedious Labor, Blood Diseases Generally. f58 ADBRKVIATION. TABLE OF RE ::i>IES. 169 170 171 172 173 174 17f> 170 177 178 179 180 181 182 183 184 185 im 187 188 189 190 J91 192 193 194 195 19(5 197 198 199 200 Sen Sen Aur Sep Sil Spig Spong Squi Stan Staph Strain Sul Sul Ac Symp Tabac Tarax Tar Em Terel) 01 Teu M V Thu Trios Perfo UrtU Val Off Van Verba Ver Alb Ver Vir Viburn Pru Vine Vio Tri Xanthoxl Zin Sul Zinc liATIN. Senega Senecio Aurans Sepia Silicea Spigelia Spongia Tosta Squilla Maritima Stannum Staphysagria Stramonium Sulphur Sulphuris Acidum Symphituni Officinale Tobacum Taraxicum Tartarus Emeticus Terebintliiiia Oleum Teucriuni Maruni Varum Thuya Occidentalis Triosteuni I'erfoliatum Urtica Urens Valeriana Officinalis Varioiin Verbascum Thapsus Veratrum Album Veratrum Viride Viburnum Prunifolium Vinca Minor Viola Tricolor Xanthoxylum Fraxincum Zincum Sulphas Ziucum ENOTjISH. Rattlesn.ake Boot Ragweed Cuttle Fish Juice Silica Pink Root Burnt Sponge Squills Tin Stave's Acre Jimstown Weed Sulphur Sulphuric Acid Common Comtrey Tobacco Dandelion Tartar Emetic Spirits of Turpentine Cat Mint Tree of Life. Arbor Vita? White Ginseng Nettle Valerian Cowpox Virus Mullein White Hellebore Black Haw American Hellebore Periwinkle Pansy Prickly Ash Sulphate of Zino Zinc J I >* I'. li'^^ m^ ^ 4- TABLE OF ANTIDOTrS AND DISEASES. 750 ANTIDOTES. DISEASES. 16!) 170 171 172 173 174 17o 17G 177 178 179 180 181 182 183 184 185 180 187 188 189 190 191 192 193 194 195 196 197 198 199 200 Aril , Bell.— Diabetes, Chronic Cough. l'iil-!itilla— Hay Asthma, Coryza. Briglit's Disease, Dropsy. Lf...oii Juice.— Menstrual Ditticulties. Siclt Headache, Ozeiia. Camphor.— Old Ulcers, Diseased lioncs. (loffee.- Nervous Side Pleadaclio, Neuralgia, Worms, Toothache. (Jamplior.— Croup, lloarsoness, Spitting Blood. Camplior.— Heaioptiiysis, Broncliitis, Diabetes, Cough. Pulsatilla.— Cardiaigia, Mucous Consumption. Camphor.— Tootliacjhe, Uheuinatism of Joints and Muscles. Lobelia.— Brain Fever, Spasms, Hydrophobia, Asthma. Aconite, Puis.— Useful in Scrofulous and Skin Diseases. Magnesia, T.enion Juice.— Night Sweats, Bed Sores, Mercurial Salivat'n — Api)lied Externally for old Ulcers. Lobelia, CoUee. — Hernia, Sea Sickness, Renal Colic. Vinegar. — Torpid Liver, Flatulence, Plives. Tannin, Ipecac— Croup, Smallpox, Cough, Pneumonia, Yellow Fever. Coffee,— Bloody Urine, Ilheuniatism, Tyi)hus, Worms. Camphor.— Colic and Wakefulness of Infants. Sas.safras.— Cancer of the Womb, Syphilis, Gonorrhoea. Ipecac. — Bilious Colic, Asthma, Rlieumatism, Bilious Fever. Belladonna. — Hives, Burns, Gravel, Dysentery. Coffee. — Nervous Pains, Epilepsy, Rheumatism. Smallpox. — This is the only reliable article for Vaccination. — Piles, Varicose Veins, Fever Sores. Camphor. — Cholera, Cramps, Vomiting, Colic. Coffee. — Female Diseases, Fevers, Use instead of Aconite. Pulsatilla.— Hysteria, Cancer, After Pains, Prevents Miscarriage. Sulphur.— Eruptions and Skin Diseases —Scald Head, Fetid Urine. Ammonia. — Salivation, Amenorrhoea, Catarrh. Hepar Sul., Ignatia.— Somnambulism. Nervous Diseases. Hepar Sul., Ignatia.— Red Eyelids, Spasms, Paralysis, Pimples. § .Mi* 18 ri m liut 'hi III 'i Ml FAI^T SIXTKEIVTH, CHAPTER XXXVII. LIST OF ALL THE SYMPTOMS DEVELOPED BY DIFFERENT DIS- EASES; arran(,;ed in relation to the part of the BODY AFFECTED AND THE SY3IPT0MS OF EACH PART FOLLOW EACH OTHER IN ALPHABETICAL ORDER. THE REPERTORY. This Repertory is to be used in sijlectiiiLf u remedy to cure some disease or symptom of disease. It can he almost a.s well used wlieii you do not know any name for the tvoul)l<>, as when you^do, liavinj^ only to learn all of the symptoms you can, botli those that can He seen and those which can only be felt.and writing each symiitom on a linehy itself, you proceed tolind each symptom in the Keiiertory, and llien note ou the slip of paper you liave your symptom down on, on "tlie saiin; line wiMi v\\c\\ synijjtom v\w abbreviated names of the remedies that appear in I his Full Faced Black Type. If you do not find any of that type following your symptom, take; tlie remedies appearing' in Italics, and if none of tlieni.then the Uoman or com- mon type. (For dose, etc., of remedy nehctid, .v. ,- J'tKje 87-88 unit Imkx). Full Faced Typo indicates remedies which are known to be the most certain to cure the symptom they follow . Italic ty\)e indicates remed' s that are good, but not so good as tliose in full faced type. Roman, or common type, are used for remedies having a very general reference to tho symi)toiHs which they follow. Here is an cxaiiiple of a case of scarlet fever arranged and the remedy selected; l)y reference to the pages of the Repertory named you will be uble to understand it easily: 1. Throat (Pliarynx) Redness of, page 26. 2. Throat Swelling, page 20 3. Urine Red (Scanty) page 81 4. Palate, Redness of, page 2.5 5. Headache as if head would burst, p. 6. 6. Delirium, page 2 . 7. Skin Red, Burning, page 122 8. Scarlet Rash, page 124 Accn. Bell.. Can... Ars... Bell.. Ars... Bry... Aeon . Apis.. Bell.. Merc. Bry.. Chi... Ign.. Merc Bell.. Bry.. Carbv .... Bell.. Calc. Sil... Spig,. Bell.. Bry.. Op.... Acoii . Bell.. Bell.. Sil .. . Bry.. Dulc. In the above case you will read ily see that Belladonna is the only remedy that appears in f nil fatied type after every symjjtom, and it may bereliedon to cure the case, vntlwutfail. 8om(>times there will be no remedy in the full faced type after every symjjtom, then take the one that approaches most nearly to it, being careful to get all the symptoms down. 760 I. MIND AND DISPOSITION. CONDITION OF THE MIND General Symptoms. AMOEOUS : Ant crud. Canth. Graph. Hyosc Ign. Lye. Nux vom. Phospli. Plat. Puis. Sil. Stram. Ve- ratr. ANXIETY, FEAR: Aco. Am. Ars. Aur. Bell. Bry. Calc. Carb. veget. Cham. Cocc. Graph. Hell. Ign. Lye. Nux vom. Puis. Rhus. Sep. Stram. Sulph. Veratr. BOLDNESS : Ign. Op. Puis. DISTRUSTFUL : Bar. BeU. Canst. Cic. Dros. Hell. Hyosc. Lye Ph. ac. Pals. Sulph. ac. FITFUL MOOD: Aur. Carb. an. Ferr. Graph. Ign. Kali. Plat. Stram. Sulph. ao. Zinc. GENTLE : Cocc Croc. Ign. Lycop. Puis. Sil. Sulph. GREEDY: Ars. Lye. Natr. c. Puis. Sep. HAUGHTY: Lycop. Plat. Stram. Teratr. HOPELESS : Ars. Aur. Calc. Caust. Cham. Con. Graph. Ign. Lye. Puis. Rhus. Sulph. INDIFFERENT: Chin. Cocc. Con. Ign. Natr. mur. Phos. Ph. ac Puis. Sep. IRRITABLE MOOD: Aeon. Aur. Bell. Bry. Cham. Coff. Ign. N. mm-. N. Yom. Phosph. Puis. Sep. Sulph. Veratr. JOCOSE MOOD : Aur. BeU. Cann. Carb. an. Coff. Croc Hyosc. Natr. c Op. Phosph. Plat. Puis. Stram. Veratr. Zinc. PEEVISH : Alum. Aur. Calc Caust. Cham. Con. Ign. Lye. Merc. Natr. c, Nitr. ac. Phosph. Plat. Puis. Sil. Sulph. SAD: Aeon. Bellad, Cham. Graph. Ign. Lye. Natr. m. Plat. Puis. Bh\u. ,. AS CAUSED BY DISEASB. SERIOUS MOOD: Cocc Led. Sulph. ac. Thuj. C.Toudiness. CLOUDINESS: Bell. Bry. Cann. Canth. Caps. Chin. Cocc. Carb veg. Caust. Hyosc. Ign. Ipee. Kali. N. vom. Op. Veratr. CONFUSION : Ant. er. Ars. BeU. Bry on. Canth. China. Euplir. Ferr. Ign. Kali. Natr. carb. Nux vom. Phosph. Ph. ac. Puis. Rhus. Sec. com. Spig. Staph. Zinc. DIZZINESS: Aeon. Alum. Anac. Ars. Aur. BeU. Bry. Calc. Carb. veg. Caust. Cliina. Coloc. Con. Graph. Lye. Natr. mur. Nitr. ac. N. vom. Op. Phosph. Phos. ac Puis. Sep. SU. Sulph. Veratr. DULLNESS: Aeon. Calc Canth. Hyosc. Petr, Sep. Stram. Sulph. Zinc INTOXICATION: Agaric. Antim. crud. Arg. Ars. Asar. Aur. Bell. Bry. Camph. Caps. Caust. Cham. Cio. Cocc Coff. Con. Croc. Ferr. Graph. Hyosc. Ign. Ipec. Led. N. vom. Ph. ac. Op. Puis. Rhus. Sec com. SU. Stram. Veratr. LOSS OF CONSCIOUSNESS : Aj's. BeU. Calc. Canth. fiyosc. Nitr. ac. N. vom. Ph. ac Rhus. Sti'am. Veratr. STUPEFACTION: Aeon. Ars. Asa BeU. Bry. Calc. Camph. Caps. Caust. Cham. Coff. Con. Cupr. Dule. Ferr. Graph. Lye. Hell. Hy- osc. Ipee. N. vom. Opium. Phosph. Ph. ac Rhus. Sepia. Stram. Sulph. VANISHING OF SENSES: Ars. Bell. Calc. Camph. Cic. Cupr. Graph. Hyosc. N. vom. Stram. VERTIGO : Ars. BeU. Bry. Camph. Cann. Caps. Cham. Chin. Op. Ph. -;.. .)' ,,„.i ![| M t'i > II ij y iti til i;^ MIND AND DISPOSITION. ac. Puis. Rhus. Sep. Sec corn. Sil. Spong. Sulph. Teratr. Mental "Weaknesses. ABSENCE OF MIND : Anac. Am. Bell. Caust. Cupr. Hell. Hep. Hy- 08C. Ign. Lye. Merc. Natr. mur. Op. Ph. ao. Rhus. Sep. AVARICE: Puis. COMPREHENSION, ready: Coff. Op. Valer. — heavy: Ambra. Camph. Chain. Con. Lye. Nitr. ac. Op. Ph. ac. Zinc. DELIRIUM: Ars. Aiir. Bell. Bry. Camphora. Canth. Cham. Cina. Con. Cupr. Dulc. Hyosc. Op. Phosph. Pliosph. ac. Plat. Rhus. Sec. cor. Stram. Sulph. Vcratr. — with frightful specters : Bell. ^nocturnal, raving about the day's business: Bry. — without consciousness : Hyosc. Puis. — loquacious, with open eyes : Coloc. Op. Veratr. — quiet, with stupefaction : Ph. ac —with anxiety, fear of death, over- estimation of one's self : Plat. — bland, with loss of recollection: Rhus. — without consciousness, often ter- minating in rage : Sec com. —various, shameless, haughty : Strain, —religious, haughty : Veratr. —with disposition to escape: Bry. Cocc. Stram. DERANGEMENT, mental: BeU. Canth. Cupr. Hyosc. Op. Plumb. Stram. Veratr. EXCITEMENT of the fancy: Aeon. Ambr. Anac. Ant. Crud. Am. Bell. Chin. Coff. Hyosc. Lachesis. Op. Phosph. Phosph. ac Pulsat. Stram. EXHAUSTION from mental labor: 4urum, Cham. Colch. Natr. Nux Tom. Phosph. Puis. Sil. Spig. Spong. Staph. — nervous : Aur. Bell. Calc Dig. lod. Natr. c. N. vom. Phosph. Sep. Staph. Sulph. Zinc. FOREBODINGS : Aeon. Spig. FOREBODING of death: Stram. Veratr. ILLUSIONS OF THE FANCY: Bell. Bryon. Caust. HoU. Op. Phosph. Rhus. Stapli. Stram. ILLUSIONS OF SENSE: Bell. Op. Phosph. Ph. ac. Plat. Sec Stann. Stram. — slow flow of : Cann. Chin. Ipec. N. vom. Op. Rhus. Ruta. Spig. Veratr. INSENSIBILITY: Hell. Hyosc. Op. Ph. ac Sec. Corn. Stram. INSANITY: Aeon. Agar. Ant. crud. Ars. Bell. Cann. Canth. Coccul. Con. Cupr. Dulc. Hyosc. Opium. Sec com. Stram. Sulph. Veratr. Zinc. — with haughtiness : Hyoscyam. Stram. Veratr. — mirthful: Crocus. Ign. Stram,. — mild : Croc. Veratr. — religious: Veratr. — tal' ve: Stram. — furious : Hyosc Stram. LAUGHTER: BeUad. Crocus. Hy- osc Stram. Veratr. LOSS OF RECOLLECTION: Aeon. Alum. Anac. Arg. Am. Bar. Bell. Bry. Calc Camph. Cannah. Cham. China. Con. Cupr. Dig. Hell. Hyosc. Ign. Natr. mur. N. vom. Opium. Phosph. Plat. Rhus. Ruta. Sep. Silicea. Stann. Staph. Stram. LOSS OF CONSCIOUSNESS: Agar. Bell. Bryon. Canth. Cham. Cocc. Cupr. Hyosc. Ipec. Nux vom. Op. Rhus. Stram. Verat. MISTAKES IN TALKING: Chaiii. Chin. Con. Croc. Ign. Lacb. LjQ. MIND AND DISPOSITION. Natr. mur. N. vom. Puis. Sep. Sil. RAOE: Aeon. Agar. Ars. Bell. Carnpli. Cann. Canth. Cham. Coc- ciil. Croc. Cupr. Drosera. Hyosc. Opium. Petr. Plumb. Euto. Sec. corn. Straui. Veratr. SHAMELESSNESS: Hyosc. N. vom. Op. Stram. Verat. WANDERING OF THE MIND: Aeon. Am. Aur. Bell. Canst. Cham. Cocc. Croc. Hell. Ign. Kali. Natrum mur. Phosph. Ph. ac. Plat. Sep. Stann. Sulphur. "Verat, WEAKNESS OF MIND : Bar. Bell. Defects of Memory. FORGETFUL : Aeon. Alum. Anac. Am. Ars. Bar. Bell. Colchic. Coccul. Digit. Hell. Hyosc. Ign. Laches. Lye. Natr. mur. Petr. Phosph. Plat. Rhus. Rhododend. Sec. com. Silic. Spig. Staph. Stram. Sulph. Veratr. Viol. odor. MEMORY, involuntary : Hyosc. —quick: Aeon. Coff. Hyoscyam. Lach. Op. Viol. odor. —defective : Aeon. Anac. Am. Bell. Bryon. Calc Camph. Cocc. Graph. Hyosc. Puis. Sep. Spigel. Stram. Solph. Teratr. —feeble: Aeon. Alum. Ambr. Anac. Ars. Aur. Bell. Bryon. Calc. Caust. Colch. Cupr. Dig. Graph. Hep. Hyosc. Ign. Lye. Natr. mur. Op. Plat. Pulsat. Rhus. Sep. Spigel. Staph. Stram. Sulph* Veratr. — loss of: Bell. Camph. Con. iZt/osc. Nat. mur. Op. Stram. Verati*. MEMORY, decrease of : Anac. Ars. ' Aur. Bell. Hell. Hyosc. Op. Stram. Veratr. Mental Derangements. ANGER, also with vehemence: Cham. —with fright. Aeon. — with feeling of coldness: Ars. — with subsequent ill-luimor : Bry. — with silent grief : Ign. — with irascible mind : N. vom. —with pushing away that which one holds in one's hand : Staphis. — with mental derangement: Vera- trum. ANXIETY AND FRIGHT. — with joyful surprise : Coff. — with subsequent starting during sleep : Hyosc. — followed by grief or spasms : Ign. — followed by anxiety or nocturnal pains : Merc. — with fear, heat of the head, and spasms: Op. — followed by mental confusion: Plat. — followed by diarrhoea : Puis, — with suffocative fits and blueisb face : Samb. — with involuntary stool and icy coldness : Veratr. GRIEF. — caused by mortification and foJ.- lowed by mental confusion : Bell. — with shame and suppressed anger : Ign. — with nocturnal anxiety and com- plaints : Merc. — followed by spasms : Op. — with emaciation, drowsiness, and morning-sweats: Ph. ac. GRIEF, with apprehensions for the future and day-drowsiness : Staph. HOMESICKNESS. — with flushed face and sleepless- ness: Caps. — with noctural anxiety and sweat: Merc. — with emaciation and morning- sweat, drowsiness : Ph. ac JEALOUSY. — with vehemence and delirium : Hy osc • — insane, with distrust : Lach. : tl MIND AND DISPOSITION. ~ UNFORTUNATE LOVE. —with thoughts of smcide : Aur. — mth joolousy and loquacity: lly- osc. — with silent griof : I^rn. — with desponding mood : Lacli. — with emaciation and morning- sweat: Ph. ac —with unmerited mortification : Staph. WRATH. — with cries, hiemoptisis, palpitation : Am. — with loss of consciousness or delir- iimi : Bell. —with flushed cheeks, thirst : Bry. —hot sweat about the head, spasms : Chaui. — thirst, vomiting of bile, chilliness heat : Xiix voni. — laughter, weeping, anxiety: Plat. — with internal chilhuoss, no thirst, but dizziness : Puis. — on accoimt of unmerited humilia- tion, whole body sore : Staphis. Mental Derangement, FOREBODINGS OF DEATH. — with foretelling of the day of death: Aeon. FOREBODINGS OF DEATH, with anxiety and restlessness : Bell. — alternating with fits of rage: Strain. HYSTERIA AND HYPOCHON- DRIA, — with anxiety, disposition to sui- cide: Am*. — caused by suppression of the sexu- al instinct : Con. — with fitful mood, sleeplessness: Ign. — of those who lead a sedentary life and revel at night, with consti- pation: N. vom. —after Tmmerited insults, with flatu- lency: Staph. — with tremulous and excossive Bensi- tivenosa: Valer. RAGE, — timorous, with frightful spectra: BcU. —amorous, Avith shameless gestures: Caiitli. — with haughty manners and Bpasros; Cupr. — with furious jealousy : Hyosc. — mth amorous tenderness and jeal ousy: Lach. — silent, with rehgious melancholy: Lye. — with frightful visions, alternating with stupor : Op. — censorious, with trembling and spasms: Plat. — raving, with frightful spectra: Strain. — w. wicked imprecations: Veratr. SUICIDE, DISPOSITION TO, — with amorous fancies : Ant. crud. — with nocturnal anguish and despair: Ars. — w. religious melancholy : Aur. — w. anxiety, restlessness, frightful spectra: Bell. SUICIDE, DISPOSITION TO, with silent anguish, fear of death : Puis, — with stupefaction of the head, rest- lessness: Rhus. SOMNAMBULISM, — with prediction of the day of death : Aeon. — with intense^fancy, and dullness of feeling: Op. — with clairvoyance, iiicrca;:;ed sensi- bility: Phosph. Vortigo. According to its nature. GENEBALLY: Aco. Ambr. Arn. Bell. Bry. Calc. Camph. Cann. Garb. veg. Cic. Core. Coff. Cupr. Dig. Oraph. Hell. Hep. Ipec Merc. HEAD. > \ Mosch. lye Natr. Natr. mur. Nitr. NUr. ac. N. vom. Op. Petr. I'hosph. Ph. ac. Plat. Puh. Rhus. Sec. Com. Spic. Staph. Stravi, Stonn. Sulph. Thuj. Verat. Zinc. ilS IF FALLING : Aeon. Am. Ars. Cnuii. Cham. Cic. Cor.,. Croc. Heix Ign. Ipeo. Nitr. ac. N. roni. Op. PuIh. Sec. cor. SU. Spig. Sulph. Staph. Strom. AS IF FALLING BACKWARD : Bry. Camph. Chin. N. vom. Ph. ac. Rliiis. Spig. Stram. AS IF FALLING SIDEWISE: Arsen. Cann. Caust. Con, Eiiphr. N. vom. Puis. Staph. SiUph. AS IF FALLING TO RIGHT SIDE: Aeon. Ars. Calc. Rhus. Buta. AS IF FALLING TO LEFT SIDE: Aur. Bell. Spig. Zinc. AS IF FALLING FORWARD: Am. Caus. Cic. Cupr. Ferr. Graph. Natr. mur. Petr. Ph. ac. Puis. Rhus. Sil. Spig. Sulph. TURNING: Acou. Arn. BeU. Bnj. Calc Cprb. veg. Caust. Chel. Cic. Cocc. Croc. Cupr. Ferr. Merc. Mur. ac. Natr. mur. N. vom. Ph. acid. Puis. Rhod. Rhus. Sep. Sil. TURNING IN A CIRCLE : Aco7iit. Bell. Brtj. Calc. Caustic. Cic. Con. Ferr. Hell. Kali. Merc. Nux. vom. Op. Puis. Rhus. Sep. StapJi Yeratr. Vertigo. With accompany iny ailments. ANXIETY: Ignat. Op. Rhus. Rho- tlod. ERUCTATIONS : N. vom. EYES, gauzy before : Luur. Sabin. COLIC : Coloe. Petr. Sidy. Slravi. DEAFNESS : N. vom. Ptdn. DIM SIGHT : Stram. DIARRHCEA : Chum. Stram. CHILLINESS : Cocc. Plumb. Rhus. Veratr. FAINTING: Bar. Bryon. Cauth. Chamom. Croc. Hep. Ign. Laiu:, N. vom. Plat. Sabad. HEAT: Aeon. Arg. Bry. Croc. Ign. Laiu'. Led. Merc. Nux vom. Pit/.s. Stram. HEADACHE : Aur. Bar. Calc. Cou. Canth. Cupr. Ferr. Graph. Hep. Igu. Lach. N. vom. Puis. Strum. NAUSEA: Aeon. Ant. crud. Arg. Arn. Bar. Boll Bry. Chin. Coff. Calc. Coccul. Ferr. Hyosc. N. vom. Puis. Petr. PhoHph. Sil. 3pig. NOSE, BLEEDING: Acou. Ant. crud. Sulph. OBSCURED VISION: Aeon. Arg. Bell. Canth. Cham. Cic. Croc. Dulc. Fen-. Hyoac. N. vou. Natr. mur. Nit. .ac. Op. Puis. Phosphor. Merc. Sec. ?omut. Stram. Sulph. PALE FAC:^:: Puis SWEAT: Rhus. — cold: Ign. Veratr. VOMITING : Calc. Graph. Hyosc. YAWNING: Agar. Petr. II II. HEAD. Internal. MENINGITIS: Ac&n. Am. Bell. Bry. Camph. Canth. Crotal. Cupr. Glonoin. Hell. Hyos. Laches. Mercur. Op. Phosph. Stram. (See general Index). CONCUSSION OF BRAIN: Am. Bell. Cic. Merc. Ph. ac. Sep. a EKAD. & II" 1 r,! HYDROCEPHALUS. — acuto : Aeon. Bell. Bry. Hell. Merc. Op. Sulph. — clironic : Ars. Hell. Sulph. HEADACHE. Sensations as if the brain were distended : Bell. Caps. — Lke a band around the head : Aeon. Carb. veg. Mercur. Nitr. ac. Plat. Spig. Sulph. BEATING: Aco. Ars. Asar. Aur. Bell. Bryon. Calc. Caps. Carb. veg- et. Caust. Chain. Coco. Hyosc. Ifni* Ipeo. Lycopod. Nltr. ac. Phospli. Puis. Rhus. Sep. Silic. Sulph. Ye- ralr, — as if the brnin were moved : Aeon. Ars. Bell. Bry. Croc. Kali. Rhcnm. Spig. —rush of blood: Aeon. Amhr. Ant. crud. Am. Asa f. Bar. Bell. Bry. Camph. Cmm. Canth. Chin. Coff. Calc. Carb. vcfj. Caust. Coloc. Dig. Feir. Graph. Hell. Hyosc. Ign. lod. Kali. Lack. Lye. Merc. Natr. Nitr. ac. Nux voni. Op. Plumb. I^ulsat. Phospli. Rhus. Sep. Sil. Sulph Spong. Staph. Strani. Thuj. Vale Veratr. ^boring: Ant. crud. Bell. Arg. Calc. Cocc. Chin. I)ulc. Hepar. Ipec. Ign. Plat. Staph. Phosph. ac. Bhodod. Sep. Sil. Spig. Strani. Sulph. —OS if bruised: Aeon. Ars. Aur. Camph. Chum. Chin. Coff. Euphr. Hell. Ignat. Ipec Phoaph. Nux vom. Puis. Ehus. Sep. Veratr. — as if it would burst: Ant. crud. Asar. Bar. Bellad. Calc Caps. Cham. Cliln. Coff. Con. Ign. Natr. mur. Nux vom. Phosphor. Rhus. Sep. Sil. Spig. Sjjong. Sulph. —burning: Aeon. Am. BelL Bry. Cupr. Hell. Ipec. Merc. Natr. N. vom. Phosph. Ph. ac. Rhus. Sec corn. Spig. Staph. Stann. Veratr. — buzzing : Caust. Cocc. Plios. Sulpli. Veratr. — crawling : Aconit. Ar7i. Bar. Cocc. Hyosc. Puis, Rhus. Sulph. Thuj. — digging: Agar. Aur. Bar. Bnj. Dulc. Ign. N. vom. Spig. — drawing: Aeon. Aur. Bell. Calc. Carb. veg. Chain. Cina. Coloc. Cupr. Dulc. Ornph. Hell. Lye. Ipec. N. vom. Nitr. ac. Petr. Phit. Puis. Rhus. Sep. SU. Sulph. Veratr. DULL HEADACHE : Antimon. crud. Bry. Calc. Carb. veg. Chin. Camph. Cocc. Coff. Dulc. Hell. Ign. Natr. mur. Ph. ac. Plat. Puis. Veratr. Zinc. HEAVINESS OF HEAD: Aeon. Arn. Asa f. Agar. Alum. Ars, Bell. Bry. Camph. Cann. Cham. Chin. CIc. Coccul. Coff. Croc. Cupr. Calc. Carb. veg. Caust. Con. Digit. Dulc. Bros. Euphr. Fe flpll. Hyosc. Ign. Ipec. Kah. ' c Natr. mur. Nitr. acid. ,. Opium. Petr. Plumb. Puis- , Phosph. Ph. ac. Plat. Sablii. Spig. Spong. Staph. Stram. Silic Stann. Sulph. Thuj. Veratr. HAMMERING: Calc Chin. Coff. Lach. Natr. mur. Phosph. Sil. Sulph. HEAT : Aconit. Alum. Am. Bell. Bry. Calc. Canth. Caustic. China. Coff. Dig. Dro "^ulc. Euphr. Hell. Hyosc. Ign. Ipec. Lycop. Merc. Natr. mur. Nitr. ac. N. vom. Petr. Phosphor. Plumb. Puis. Rhus. Sep. Sil. Stann. Stram. Sulph. HEMICRANIA : Asar. BRY. Chin. Coloc. Ign. Ipec. N. vom. Rhus. Sep. AS AFTER INTOXICATION: Bryon. Merc. Natr. mur. Puis. JERKS: Ambr. Bell. Bry. Cala M ( HEAD. Veratr. >8. SU|||||. ar. Cocc. Thuj. «r. Jjnj, !ll. Calc. Coloc. L'U. Lye. )tr. Plut. Sulpli. utlmon. Chin. Holl. hit. Puis. Dig. Mur. ac. Natr. mur. N. vom. Puis. Petr. Phos. Splc. Hponif. Sop. Stann. Thuj. Valer. SIMPLE PAIN: Aeon. Am. Bar. Bell. Calc. Cunth. Carb. veg. Chiu. Cocc. Croc. Cupr. Hell. Hyosc. lod. Laoh. Lycop. Merc. Mur. ac. Natr. c. Natr. mur. Nitr. Nux vom. Op. Ph. acid. Plumb. Puis, lihtis. Sop. 811. Spig. Strain. Sulph. Valor. AS FROM A NAIL (clavus :) Aeon. Agar. CofT. Hop. Igm. N. vom. Rata. Thuj. PRESSING ASUNDER: Aeon. Bar. Bell. Bry. Calc. Ign. Lye. Merc. Natr. mur. Nitr. Nux vom. Sep. SU. Spig. Stann. Staph. PRESSING TOGETHER: Aliun. Asa fcBt. Bry. Calc. Cina. Cocc. Graph. Hell. Phosph. ac. Sil. Staph. PULSATING: Bell. Bryon. Chin. Petr. Phosph. Puis. Rhus. Sulph. PRESSURE : Aeon. Ambr. Arg. Am. Asaf. Asar. Anac. Ars. Aur. Bell. Bryon. Calc. Caps. Cham. Chin. Oic. Cina. Cocc. Coflf. Croc. Dig. Hell. Hyosc. lod. Ign. Ipec. Lach. Merc. Mur. ac. N. vom. Natr. carb. Natr. mur. Nitr. ac. Petr. Pulsat. Phosphor. Phosph. ac. Plat. Spig. Sep. Sil. Stann. Staph. Sulph. Valer. Zinc. ROARING: Aur. Ferr. Graph. Phosph. Sulph. STINGING : Aeon. Ambr. Arg. Am. Asa f. Alum. Ars. Bar. Bell. Bov. Bry. Canth. Caps. Chamom. Chin. Cic. Calc. Caust. Con. Dulc. Ferr. Hep. Ign. Ipec. Natr. mur. N. vom. Petros. Phosph. Plumb. Puis. Ph. ac~ Rhus. Sabad. Selen. Staph. Sep. Sil. Sulph. Thuj. STUPEFYING: Anac. Ars. Ant. crud. Am. Bell. Bov. Cann. Cic. Cina. Calcar. Hyosc. Ign. Mur. ac. Phosph. Nntr. carb. Nitr. Ph. ac. PI.it. Ruta. Sabad. Sopia. Stann. Staph. Verb. Zmc. TEARING: Alum. Ambr. Anac. Ant. crud. Arg. Am. Asar. Bell. Bry. Calc. Camph, Canthar. Caps, Carb. veget. Caust. Cham. Clibi. Cocc. Coff. Coloc. Con. Ijfn. Ipec. Lycop. Mur. ac. Natr. mur. N. vom. Ph. ac. Puis. Rhus. Sil. Spig. Sulph. TWITCHING : Am. Bell. Bry. Carb. veg. Caust. Chin. Ign. N. vom. Ph. ac. Staph. Sulph. VIBRATING: Lye. Nitr. i\c. Nux vom, Sil Stann. According to the Part of the Head FRONT PART OF THE HEAD: Aeon. Ahim, Ambr. Anac. Antim. crnd. Arg. Arn. Arsen. Asafoet. Asar. Aur. Bar. Bell. Bry. Camph. Calc. Cann. Canth. Caps. Carb. veg. Caustic. Cham. Chin. Cicc. Cina. Coce. Coff. Colch. Coloc. Con. Croc. Cupr. Dig. Bros. Dulc. Euphr. Ferr. Graph. Hell. Hyosc. Ign. lod. Ipec. Kali. Lye. Merc. Natr. mur. Nux vom. Op, Phosph. Plat. Plumb. Puis. Rhodod. Bhus. Sabln. Samb. Sep. SU. Spig. Spong. Staph. Stann. Sulph. Veratr. Zinc. TEMPLES : Aeon. Agar. Alum. Ant. crud. Arg. Arn. Asaf. Asar. Bell. Bry. Calc. Camph. Cann. Canth. Caps. Chamom. Chin. Cina. Cocc. Con. Cupr. Dig. Euphr. Hell. Hep. Ign. Lach. Nitr. ao. Op. Phosph. Phos. ac. Rheum. Rhus. Rhodod. Sabin. Spig. Spong. Stann. Staph. VERTEX: Aeon. Ambr. Ant. crud. Arg. Am. Asa f. Aur. Bell. Bry. Cann. Canth. Caps. Caust. Chin. Cina. Cocc Coff. Coloc. Con. Croc. HBAO. m , 7'-i J if:-f|:V' IR Cupr. Ferr. Graph. Hell. Ign. lod. Ipec. Lach. N. vom. Phosph. Ph- ac. Plat. Sabin. Samb. Sep. Sil. Spig. Spong. Stann. Staph. Stram. Sulph. Thuj. Veratrum. OCCIPUT : Aeon. Ambr. Arg. Am. Asa f. Asar. Aur. Bar. Bell. Bry. Calc. Camph. Cann. Canth. Caps. Carb. veg. Chin. Cic. CoS. rolcliic Croc. Cupr. Dig. Dros. Hell. Hij- osc. Ign. Ipec. Lye. Mercur. Mosch. Niir. Nux Vom. Op. Pelr. Plat. Puis. Rhu!^. Sabin. f amb. Splg. Spong. Staph. Stann. julph. Thuj. BIGHT SIDE: Aeon. Alum. Ant. crud. Arg. Arn. Asa f. Bell. Bry. Camph. Canth. Canst. Chin. Clu. Coccul. Colchic. Croc. Dig. Dros. , Graph. Hep. Ign. Kali. Lach. Lye. Nux vom. Phosph. Ph. ac. Plumb. Puis. Ehus. Sabad. Sabin. Sil. Spig. Spong. Sulph. Thuj. LEFT SIDE: Aeon. Ambr. Ant. crud. Argent. Arn. Ana f. Asar. Aur. Bell. Bry. Calc. Camph. Cann. Caps. Carb. veg. Chin. Cic. Cin. Coce. Coloc. Croc. Cupr. Dig. Dulc. Dros. Euphorb. IVrr. Hell. Hyosc. lod. Lach. Merc. Nitr. Nitr. ac. Nux vom. Plumb. Puis. Petr. Plat. Bhodod. Rhus. Sabin. Samb. Sec. cor. Sep. Spigel. Spong. Staph. Stann. Sulph. Veratr. External. BLOTCHES : Ant. crud. Ars. Aur. Hep. Natr. mur. Nux vom. Phosph. SU. Thuj. BLOATING: Ars. Sulph. BOILS : Bell. Rhus. Am. BURNING: Arn. Ars. Bar. BeU. Bry. Caps. Carb. veg. Coloc. Dulc. Dros. Graph. Phoaph. Plat. Sabad. Sil. Spig. Spong. Staph. Stann. Sulph. Veratr. CHILLINESS: Bar. Calcar. Garb, veg. Dulc. KuU. N. vom. Ph. acid. Spig. Staph. Veratr. COLDNESS: Agaric. Alum. Bar. Calc. ^ ;. ^ph. Ph. ac. Rhod. Ve- ratr. — feeling ■ ' . Asar. Cann. Lach. Ve- ratr. DRAWING: Agar. Bar. Bell. Calc. Canth. Chin. Ignat. N. vom. Ph- ac. Puis. Rhus. Staph. ERUPTION : Anac. Ars. Aur. Bar. Calc. Carb. veg. Cic. Con. Graph. Hep. Kali. Merc. Natr. mur. Petr. Rhus. GNAWING : Caps. Dros. Thuj. HAIR FALLING OUT: Ambr. Ant. crud. Ars. Aur. Bar. Bell. Calcar. Canth. Carb. veg. Caust. Con. Ferr. Graph. Hep. Ign. lod. KaU. Lye. Merc. Natr. mur. Nitr. ac. Petr. Phosph. Plumb. Sec. cor. Sep. Sil. Staph. Sulpli. HAIR AS IF PULLED: Aeon. Alum. Arn. Bar. Bry. Canth. Kali. Lye. Mur. ac. Nitr. Phosph. Ph. ac. Rhus. HERPES: Alwnina. Graph. Petr. Rhus. ITCHING: Agar. Alum. Arg. Am. Ars. Asar. Aur. Bar. Bell. Bry. Calc. Caps. Carb. veg. Caustic. Chin. Conium. Dros. (jraph. Hep. Kali. Merc. Lye. Mur. ac. Natr. mur. Petr. Phosphor. Puis. Rhod. Rhus. Ruta. Sabad. Sep. Sil. Spig. Staph. Sulph. Thuj. Veratr. Zinc. LICE: Oleaud. Sabad. Staph. Fine Comb. PAIN AS IF CONTUSED: Am. Ipec. Rhus. Ruta. PAINFULNESS : Arsen. Bell. Calc. Caust. Hell. Merc. N. vom. Rhod. Rhus. Thuj. PIMPLES: Ars. Bar. Bell. KaU. Mur. ac. Natr. c. Petr. Rhus. Sil. Zinc, tifiSi BYES. 9 ItlLJS SCALES ON THE SCALP: Cal- car. Fhosph. Bhus. Staph. SCURFS: Ars. Bry. Calc Ferr. Graph. Hep. Lye. Merc. Natr. mur. Petr. Bhus. Buta. Sil. Staph. Sulph. AS IF THE SKIN ADHERED: Am. SWEAT : Bar.BeU. Bry. Calc. Cham. Chin. Coloc. Ipec. Graph. Hepar. Nux vom. Merc. Natr. mur. Nitr. ac. Op. Petr. Fhosph. Phosph. ac. Plumb, Puis. Rheum. Rhus. Euta. Sec. com. Sep. Silic Spig. Sulph. Valer. STINGING: Agar. Alum. Ant. cr. Am. Asa f. Aur. Bar. Bell. Cantli. Caust. Chin. Digit. Hep. lod. Kali. Natr. mur. Nitr. ac. Phosph. Phos. ac. Sabad. Spigel. Staph. Sulph. Thuj. Veratr. SWELLING: Ars. Bell. Cham. Caust. Cup. Dig. Euphorb. Op. Phosph. Puis. Bhus. Sep. Stram. Sulph. TEARING: Agar. Alum. Ambr. Bar. Bell. CaU: Digit. Graph. Lycop, Merc. Natr. Rhus. Ruta. Sabin. Sep. Staph. TENDENCY TO COLD: KslL Natrum mur. TINGLING: Aeon. Am. Arsen. Carb. veg. Ferr. N. vom. Rhod. Sabad. Spig. TREIV^LING OF HEAD; Cic Coc Ign. III. EYES. Visual Power. AMAUROSIS: Bellad. Calo. Cann. CWn. Cocc. (Con.) Dig. Dulc. Hy- 08C. (N. vom.) Mercur. Nitr. ac. Phos. Plumb. Fuls. Bhus. Ruta. Sec. com. Sil. Spig. Stram. Sulph. — incipient: Aurum. Cliiiia. Caust. Dulc. Hyosc. Natr. mur. Puis. Sulph. BLINDNESS: Ant. crud. Phosph. Sil. Veratr. BLURRED : Bell. Bry. China. Dros. Graph. Hyoscyair.. Lycopod. Natr. mur. Sil. Stram. CATARACT: Baryta. Cann. Caust. Conium. Euplir. Hyosc. Nitr. acid. Op. Puis. Ruta. Sil. Sulph. DAZZLING: Con. Dig. Dros. Ign. Kali. Lye. Merc. Nitr. ac. Ph. ac. SU. Stram. Sulph. GLAUCOMA: Phosph. HEMERALOPIA: Bellad. Dig. dy osc Mere. Yeratr. 49 ILLUSIONS OF COLOR: — pale: Dig. — blue: Bellad. Stram. Sulph. Zinc. — checkered : Euphorbium. Kali. Nitr. Sulph. — colored streaks : Con. — fiery yellow : Ph. ac. — yellow: Ars. Canth. Dig. Kali. Sulph. Santon. — gold-colored : Bell. Hyosc. — green : Dig. Merc. —red: Bell. Cann. Con. Croc. Dig. Hep. Hyosc. Spig. Stram. SulpJ . — black : Caps. Chin. Cic. Cocc. Merc. Phosph. Staph. — white : Cann. Dig. Kali. Ph. ac. — halo around the light, many-col- ored: Bell. — gray : Phosph. Sep. — green : Phosph. Sep. Zino. — bright: Calc. — ruin-bold: Nitr. —red: Bell. — black: Phosph. 'i •II Hi IHit 'I' > II I m If M r' '■ \| i I ur I,' !i»' I to KTE8. ILLUSIONS OF SIZE, SHAPE, DISTANCE. — seeing double: Agar. Aur. Bell. Cic. Digitalis. Euphorb. Graph. Hyosc Nitr. acid. Merc. Petr. Puis. Secale com. Sulph. Yeratr. — seeing things half : Aur. Oalc. Lye. Mur. ac. Natr. mur. VISION, false: Hyosc — larger: Hyosc. Staph. — brighter: Camph. Hyosc. N. vom. — smaller : Hyosc. — slanting: Stram. — confused: Stram. OPTICAL ILLUSIONS OF THINGS NOT PRESENT: — ^flashes : Croc. Natr. Spig. — flashes, black : Staph. — gray covering : Phosphor. Sll. — threads: Con. — feathers: Calc. Lye Natr. Natr. mur, Spig. — fire : Bar. Bell. Bry. Dig. Dulcam. Natr. mur. Ph. ac. Spig. Staph. Stram. Veratr. — spots, dark: Calcar. C.\rb. reg. Caust. Con. Dig. Kali. Lye. Natr. mur. Nitr. ac Petr. Phosph. Sec. com. Sep. Sil. Sulph. ^gauze: Asa f. Alum. Ars. Aur. Bryonia. Caust. Cina. Croc. Drosera Euphorbium. Euphr. Hyosc. Ign. Lye. Natr. mur. Opium. Petr. Phosph. Plat. Bhod. Bhus. Sabin. Bee. com. Sep. Stram. Sulphur. Thuj. — sparks: Arsenic. Aur Bar. l*ell. Bry. Calcarea. Caust. Coloc. Croc. Dig. Dulc. Kali. N. vom. Op. Petr. Sil. Spig. Veratr. ^Hjobwebs: Agar. Caust. — figures: Camph. Samb. — mist : Aeon. Agar. Alumina. Ambr. Arg. Bell. Bry, Cann. Caust. Croc. Dig. Graph. Kali. Merc Natr. mur. Ph. ac. Plat. Plumbum, Puis, i ta. Sec. com. Spig. Staph. Stram. Sulph. — point : Calc. Con. Dig. Kali. Merc Natr. mur. Nitr. ac. N. vom. Petr. Phosphor. Sulph. — halo aroimd light : Staph. LONG-SIGHTED: Alum. 5eii. Bry. Calc Caustic. Con. Dros. Hyosc. Lye. Natr. mur. N. vom. Petr. Sil. Spigelia. Sulph, AS IF THINGS WERE MOVING: Bell. Con. Cic. Euphr. Hyosc. Ign, Merc. Sabad. Stram. PHOTOPHOBIA : Aeon. Alum. Arn. Ars, Bellad. Bry, Camph. Cham, China. Cic. Cina. Coflf. Con, Croc. Enphras, Graph. Hell. Hep, Ign. Eali. Lycopod. Merc Mur. ac. Nitr. ac. N, vom. Ph. ac. Puis, Sep, Sil. Sulph, SQUINTING : Alumina. BeUad, Hy- osc. Puis. Sec. com. SENSITIVENESS: Aeon. Antim. crud. Bell. Chin. Coff. Hell. Ign. N. Tom. Spig. SHORT-SIGHTEDNESS: Agar. Anac. Calcar. Carb veg. Chin. Con. Euphr. Graphites. Hyosc Natr. mur. Nitr. ac. Phos. Ph. ac Plumb. Puis. Buta. Stranion. Yaler. Thuj. STARING AT ONE POINT: CIcu- ta. Cocc Ruta. Stram. VIBRATIONS: Arsen. BeU. Calc. Carb. veg. Caust. Cham. Con. Dig. Graph, Hell. Ign. Lye Mur. ac. N. vom. Petr. Phosph. Ph. ac. Pulsat. Sec. com. Sep. Staph. Sulph. VISION, sudden blackness of: Aeon. Alum. Arg. Ars. Asa foet. Atrc Aur. Bell. Bry. Calc Carb. veg. Oaust. Canth. Caps. Cham. Cic Cina. Croc. Dros. Dulcam. Ferr. Graph. Hepar. Hyosc. Lye Merc. Natr. mur, Nitr. Nitr. ao. N. vom. Op. Phosph. Plumb. Pols* Sabin. BYXS. 11 t Sec. cor. Staph. Stram. Sep. Sulph. VISION, dim: Alum. Bellad. Cham- om. Chel. Bheum. Euta. Sabad. ^pale : China. Oroc. Dros. Petr. Puis. Bhus. SU. —obscured: Aeon. Agair. Arn. Ars. Asar. Aur. Bar. Bell. Bryou. Calc. Camph. Caps. Caustic. Cham. Cic. Con. Cupr. Dig. Dros. Euphr. Ferr. Syosc. lod. Kali. Lye. Natr. mur. Nitr. ac. Nux vom. Op. Phosphor. Plat. Pulsat. Buta. Sil. Spig. Strain. Sulph. Thuj. — vanishirig of: Agar. Bell. Calc. Cic Con. Hep. Hyosc Merc Natr. m. Nitr. N. vom. Op. Phosph. Puis. Sec. corn. Spig. Staph. Stram. Veratr. —weak: Asar. Agaric Alum. Ars. Bar. Bell. Calc Can. Caps. Carb. veg. Chin. Con. Croc. Dros. Graph. Hep. lod. Lye Hyos. Ign. Natr. mur. Nitr. ac. Petr. Phosph. Ph. ac. Plumb. Bhus. Buta. Sec. corn. Sep. Sil. Staph. Sensations. In the eye-balls and eye generally. AGGLUTINATION : Alumina. BeU. Bry. Calcar. Carb. veg. Caustic Croc. Euphorb. Hep. Ign. Kali. Lye Nat. mur. Nitr. ac. Nux vom. Phosph. Plumb. Pulsat. Bhus. Bu- ta. Sep. SUic Stann. Staph. Sulph. Thuj. BUBNING : Aeon. Agar. Alum. Ars. Am. Aur. Asa f. Bar.. Bell. Bry. Calc Canth. Col. Con. Caps. Cham. Chin. Cic. Croc. Dig. Dros. Ferr. Graph. Hell. Ign. Kali. Lye. Mur. 5C. Nitr. ac. Nux vom. Phosph. Plumb. Pulsat. Bhod. Bhus. Buta. Sep. Sil. Spigel. Spong. Staph. Stram. Sulph. Thi\j. COBNEA, spots on : Apis. Ars. Aur. Calc Can. Chel. Con. Euphr. Hep. Lye. N. Yom. Sep. SiL — obscixration of : Ang. Cann. Caps. Chel. Chin. Nitr. ac. Op. Plumb. Puis. Sulph. — ulcers on : Euphr. Buta. DBYNESS : Agar. Asa f. Asax. Bar. Bell. Bry. Caust. Croc. Euph. KaU. Lye. Natr. mur. Nux vom. Phosph. Puis. Spig. Staph. Sulph. Veratr. DISTOBTION: Aeon. Amic. Ars. Bell. Bry. Camph. Canth. Cham. Cic Cocc. Cupr. Hell. Hyosc Opium. Petr. Plat. Plumb. Pulsat. Sec corn. Spig. Stan. Stram. Sulph. Veratr. ECCHYMOSIS: Am. Cham. Nux vom. Plumb. EYE-GUM. Agar. Alum. Calcar. Caust. Cham. Chin. Con. Dros. Euphorb. Graph. Hep. Lye. Nitr. ac. Phosph. ac. Sil. Spig. Sulph. EYES, blood flows from: Cham. Euphr. N. vom. Buta. — gum: Euphr. Ign. Puis. FUNGUS H^MAT: Apis. Bell. Calc. Lye Sep. Sil. GLAZED: Bell. Cocc. Croc. Op. Ph. ac. Spig. HCEMOEBHAGE : BeU. Cham. Euphr. N. vom. INFLAMMATION: Aeon. Ambr. Apis. Arn. Ars. Bar. BeU. Bry. Calc. Camph. Canth. Carb. veg. Cham. Ciiin. Coloc. Con. Cupr. Dig. Dulc. Eupliras. Euphorb. Ferr. Graph. Hep. Hyosc. Ignat. Ipec. Kali. Lye. Merc Natr. mur. Nitr. ac N. vom. Opiiun. Phosph. Ph. ac Plumb. Puis. Bhus. Sep. SiL Spig. Staph. Sulph. Veratr. LACHBYMATION: Aeon. Agar. Alum. Ambr. Anac. Am. Ars. Asar. Bar. BeU. Bry. Calc Camph. Canth. Caps. Carb. veget. Caust. Chelid. Chin. Cina. Coff. Coloc Con. Croc. Digit. Euphr. Fer. Graph. HeU. Hep. Ign. KaU. e. Lach. Lye Merc Natr. mar. Nux m v\\t 'Hi M ETEB. 1 1 I # Tom. Op. Petr. Phosph. Ph. ac. Plat. Puis. Rhodod. Rhus. Ruta. Sabadilla. Seneg. Sep. Sil. Spig. Spong. Sta7i. Staph. Stram. Sulph. Valer. Veratr. Zinc. LAOHRYMATION, smarting : Aeon. Bell. Calc Carb. veg. Con. Dig. Euphr. Graph. Lycop. Natr. mur. Phosph. oc. Rhus. Sabiu. Spig. Staph. Sulph. LOOKS, anxious : Strain. — staring : Aeon. Am. Bryon. Camph. Canth. Cic Cina. Cocc Cupr. Hell. Hyosc Nujc vom. Op. Sec com. Spig. Stram. Veratr. — disturbed: Camphor. Capr. Op. Sec. com. Stram. Verat. — wild: Cupr, Hyosc. Opium. Sec. com. MOTIONS, convulsive: Canthar. Cham. Cupr. Hyosc. — ^involuntary: Spig. Stram. PAIN, simple: Aeon. Amlc. Bar. Bell. Bry. Calc. Canth. Carb. veg. Cin. Croc. Dig. Euphr. Petr. Phosph. Plat. Plumb. Pulsat. Ehus. Ruta. Sabin. Sep. Sil. Spig. Stann. Staph. Veratr. PELLICLE ON EYES: Cann.Eu- phras. Puis. Ruta. PRESSURE, outward: Aeon. Asa foet. Asar. Aur. Calc. Camph. Cann. Canth. Con. Hell. Ign. N. vom. Rhus. Spig. Staph. — ^inward: Agaric. Anac. Aur. Bry. Calc. Caust. Kali. Ph. acid. Spig. —as from a foreign body: Ambr. Anac. Am. Ars. Asa f. Aur. Bar. Bell. Calc. Caps. Carb. veg. Caust. China. Cina. Cocc. Con. Croc. Ferr. Hyosc. Ign. Merc. Natr. mur. Nitr. ac. Petr. Phosph. Ph. ac. Plat. Plumb. Puis. Rhus. Sep. Sil. Spig. Stann. — together: Arg. Sabin. Verat. PROTRUDED: Aeon. Am. Ars. Aur. BelL Oanth. Caps. Oin. Cooc. Con. Cupr. Hep. Hyoscyam. Op. Rhus. 9pigel- Spong. Staph. Stram. Verat. PUPILS, dilated : Aeon. Agar. Anac, Am. Ars. Asa f. Aur. Bell. Calc. Camph. Canth. Caps. Caust. Chin. Cina. Con. Croc. Cupr. Dig. Dros. Hell. Hep. Hyosc Ign. Ipec Mur. ac. Nitr. ac. Nux vom. Petr. Ph. ac. Plumb. Pulsat. Sec. com. Spig. Stann. Staphys. Stram. Veratr. Zinc — contracted: Aeon. Agar. Anac. Am. Ars. Aur. Bell. Calcar. Camph. Canthar. Capsic. Cham. Chin. CIc Cina. Cocc. Croc. Dig. Dros. Hell. Hyosc Ign. Mur. ac. Natr. carb. Ph. ac. Plumb. Puis. Sec. com. Staph. Stram. Stann. Sulph. Thuj. Veratr. — immovable: Aeon. Baryt. Bell, Cham. Chin. Cupr. Dig. Fen*. Hyosc Op. Plumb. Seneg. Spig. Stram. — suddenly dilating and contracting: Bar. PUS: Ars. Bry. Euphorb. Hep. N. Yom. Ruta. RUSH OF BLOOD TO EYES: Aur. Bell. Plumb. Sep. Spig. SMARTING: Ambr. Agar. Alum. Ars. Bell. Bry. Calc. Canth. Carb. veg. Caust. Chin. Con. Croc. Droser. Euphr. Graph. Hell. Hep. KaU. Lye. Merc Mur. ac. Nitr. ac. Nux vom. Phosph. Ph. ac. Rhus. Sep. SU. Staph. Sulph. Thuj. Val. SPARKLING: Aeon. BeU. Bry(m. Hyosc Op. Stram. SPOTS ON EYES: Euphr. Nux vom. Puis. Ruta. SQUINTING: Alwm. Bell. Hyosc Puis. Sec. com. SUNKEN: Ambra. Camph. Chin. Clc Cupr. Dros. Ferr. Hyosc. Op. Sec. com. Spong. Staph. Veratr. SWELLING: Ars. Bry. Garb. veg. jJ i! EYKS. 18 Hep. N. vom. Phosph. Plumb. Rhus. Buta. Stram. Sulphur. ULCERATION: Ambr. Am. Calc. Caps. Cham. Lye. Phosphor. Sil. Spong. Staph. Sulph. VEINS ENGORGED : Aeon. Ambr. Spig. VEINS, red : Euphr. WHITES, blueness of: Veratr. WHITES, yellowness of: Aeon. Ambr. Ant. crud. Arsenic. Bell. Bry. Canth. Cliam. Chin. Cocc. Con. Ferr. Ign. N. vom. Op. Phosph. ^ Ph. ac. Plumb. Puis, Rhus. Seji. Sulph. — without lustre : Asa f . Asar. China. Ferr. Hyose. Merc. Ph. ac. Sabin. Veratr. In the eye-brows. DRAWING : Bell. Caust. Dros. Hell. Rhus. ERUPTION: Cuprum. Kali. Selen. Sil. Spong. Stann. Thuj. FALLING OF LASHES : Agarieus. Plumb. Selen. ITCHING: Agar. Alum. Caust. China.I/!?e/en. Silic. Spigelia. Sulph. SWELLING: Kali. TWITCHING: Caustic KaU. Zinc. WARTS: Caust. At the eye-lids. (u. BignifleB upper, I. lower lid ; r. right, 1. left ; whore these Bigns are wanting, both lids are meant.) EYE-GUM: Dros. Ferr. Rhoum. Rhus. Staph. AGGLUTINATION: Aeon. Agar. Bell. Bry. Cale. Causticum. ('ham. Con. Dig. Drosera. Euphr. Ferr. Graph. Ign. Kali. Mur. ac. Natrum. miu-. Nux vom. Phosphor. Plat. Puis. Rhus. Sep. Silicea. Spigel. Staph. Stramonium. Sulph. Veratr. BLUENESS: Dig. BURNING: Ambr. Asar. Ars. Bell. Bry. Caps. Con. Graphit. KaU. Nux vom. Ph. ac. Rhus. Smeg. Spig. Stann. ECCHYMOSIS: Apis. Arn. INFLAMMATION: Aco. Apis. Ars. Bell. Bryonia. Calc. Carb. veg. Caust. Cham. Dig. Euphr. Hep. Hyosc. Ign. Lye. N. vom. Pulsat. Rhus. Sep. Spig. Spong. Staph. Stramonium. Sulph. Thuj. Veratr. ITCHING: Ambr. Ars. BeUad. Bry. Calc. Camph. Carb. veg. Caustic. Cocc. Drosera. Euphorb. Euphrasia. Lye. Nux vom. Phosph. Rhus. Spong. Staph. Sulph. Veratr. — u. : Bar. Carb. an. Cin. Croc. Sil. Staph. — 1. : Caust. Lach. Petr. Ruta. PARALYSIS: BeUad. Cocc Nitr. ac. Rhus. Sepia). Spig. Stram. Ve- ratr. PIMPLES : Hep. Lye. Petr. Rhu8. Sulph. — u. : Hep. — u. r. : Canth. Lyo. — u. 1. : Chel. — 1. : Natr. mur. Seneg. — 1. 1. : Alum. SMARTING: Camph. Carb. veg. Caust. Ign. Rhus. Spig. — u. r. : Rhus. — u. 1. : Aur. SPASMS. Alum. Ambr. BeU. Croc Hyosc. Rhododendr. Sep. Sil. STYES: Ambr. Apis. Digit. Ferr. Lye. Puis. Rhus. Sep. Stann. Staph. SWELLING: Aco. Am. Ars. Bar. Bell. Bry. Calearea. Caust. Cham. Euphr. Ferr. Hyosc. Ign. N. vom. Phosphor. Pulsatilla. Rhus. Ruta. Sen. Spong. Stram. Sulph. Valer. — u. : Aco. Asar. Natr. c. Sep. Sil. Sulph. — 1. : Ars. Aur. Bell. Bry. Croc. Dig. Lach. Op. Ph. ae. Rhus. Sep. AS IF SWOLLEN: Aconitnm. Croc. Rhus. Valer. ! '\ !'!.. f 111 14 SABS. TETTER: Bry. Rhus. Sep. ULCERATION: Colch. Croc. Ign. Lye. Nux vom. Phosph. Puis. Rhus. Silicea. Splg. Staph. Stram. — 1. : Colch. Natr. mur. In the canthi. (ComerB of the oye ABSCESS, int.: Bjy. AGGLUTINATION : Phosph. Staph BLUEISH, int. : Aur. Saasap. BURNING : Alum. Staun. Staph. — int.: Agar. Asar. Aur. Bar. Bell. Calc. Graph. Hell. Natr. mur. Phosph. Ph. ac. Rhodod. — ext. : Carbo anim. Cina. Kali. Sep. Spig. Siront. Sulph. EYE-GUM: Agar. Ant. crud. Calc. Caust. Coff. Dig. Euphr. Graph. Ipec. N. vom. Staph. Thuj. —ext.: Chin. Euphorhium. Ipec. Sabad. Staph. — int. : Agar. Euphras. Helleb. Rhus. Sil. Staph. FISTULA LACHRYM: Calc.Chel. Fetr. Pulsatilla. Ruta. Stann. Staph. GUM: Natr. mnr. INFLAMMATION : Aco. Alum. Are. Cham. Enphr. Ign. N. vom. Phosph. Puis. — int. : Agar. Merc. — ext.: Calc. STYE: Puis. Sep — int. r. : Natr. mur. ITCHING: Arg. Am. Calc. Caust. Cina. Hell. Hyosc. Natr. mur. Plat. Puis. — int: Bellad. Caust. Con. Lye. Nitr. ac. Nux vom. Pulsatilla. Ruta. Sep. Staph. LACHRYMATION : Petr. Silicea. Thuj. PRESSURE, as from a foreign body, 1. : Agar. Bar. Con. Ignat. Nitr. ac. PUS: Cham. Cina. Graph. N. vom. Puis. Staph. SMARTING: Carb. veg. Mur. ac. N. vom. Sep. Sil. — int.: Con. Graph. Hell. Eali. N. vom. Puis. Staph. — ext.: Camphora. Ign. JV. vom. Sulph. IV. EARS. On the Ears. BORING : Alum. Aur. Baryta. Bell. Caust. Euphr. Helleb. FT ,t. Plum- bum. Sil. Spigel. Stann. DISCHARGE, of blood: Bryonia. Cic Graph. Mercurius. Petr. Phosph. — of pus; Alum. Aur. Bellad. Bov. Calc Caustic. Kali. Lye. Merc. Petr. Pnlsat. Sep. Sulph. — humor: Asa foet. Caust. Mercur. Natr. mur. Phosph. Sep. ERUPTION: Agar. Bar. Clc Chin. Kali. Petr. Phosphor. Pulsatilla. Sep. Sil. Spongia. Snlph. — behind the ears: Antim. crud. Canth. Chin. Puis. Sabad. Staph. EAR-WAX, liquid : Merc. — blood-red: Con. — hard: Selcn. Soft water. — pappy: Lach. —deficient: Calcar. Carb. veg. — increased: Agar. Calc. Con. Selen. Sep. Sil. HEAT : Aco. Alum. Ars. Asar. Bel- lad. Bry. Cak: Cantharis. Capsic. Carb. veg. Chin. Hep. Ignat. Kali. Merc. Natr. mur. Petr. Ph. ac. Pals. Sabin. Sep. Sil. ITCHING: Agar. Alum. Ambr. BAB8. IS Ant. or, Arg. Bar. Bell. Oalc. Carb. veg. OauBt. Coloc. Con. Caps. Graph. Hep. Ign. Kali. Lyaoj'- Mur. ac. Natrum mur. Nitr. ao. Nux vomica. Petr. Phosjyhor. Phosphor, ao. Plat. Pulsat. Khod- od. Bhus. Sambuc. Selen. Sep. Sit Spigel. Stann. Sulph. ITCHING of external ear: Arg. Spig. — of lobule: Argent. Sabadilla. Ve- ratr. INFLAMMATION: Aeon. Bryon. Kali. Lye. Mere. N. vom. Ph. ae. Pals. Sil. Spong. PAROTID GLANDS, pains on: Arg. Brjr. Cham. Chin. Cocc. Hyose. Ign. Merc. Phosphor. Puis. Rhus. Sabad. — pressure: Merc. — inflammation : Chamom. Rhus. —swelling: Bar. Bell. Bry. Carb. veg. Chamom. Chin. Cocc. Con. Dulc. Hyose. Ign. Merc. Nitr. ac. Phosph. Puis. Rhus. Sepiffi. Sil. Sulph. —hardness: Rhus. — painfulness : Puis, —stitches: Bell. China. Con. Ign. Nitr. ac. Pulsat. Sep. Sulph. STITCHES: Alum. Ant. cr. Am. Ars. ]iar. Bell. Bry. Calc. Cann. Cant . Capsio. Carbo. veg. Caust Ohamom. China. Colch. Coloc. Con. Bros. Dulc. Ferr. Graph. Hell. Hep. Ign. Ipec. Kali. Lycopod. Merc. Natr. mur. Nux vom. Petr. Platin. Plumb. Ph. ac. Puis. Rhodod. Sep. Sil. Splgel. Spong. Stann. Staph. Sulphur. Veratr. Zinc. SWELLING : Ant. crud. Calcarea. Oaust. Kali. Lyeop. Merc. Natr. mur. Nitr. ac. Ph. ac. Puis. Rhus. Sep. Silic. Spong. Zinc. TEASING: Aconit. Agar. Alum. Ambr. Anac. Arn. Anr. Bar. Bel- lad. Camph. Cantharis. Capsic. Cham. Chin. Carbo. veg. Caust. Con. Cupr. Dros. Dulcam. Graph. Hyose. Kali. Lye. Merc. Mur. ac. Nitr. ac. N. vom. Plat. Plumb. Ph. ac. Pulsat. Stawn. Spigelia. Sulph. Zbie. — behind the ears: Alumina. Ambr. Arg. Bar. Belladonna. Canth. Caps. Plumb. Rhus. Sop. Sil. TENESMUS : Ambr. Anacard. Am. Ars. Asar. Bell. Carb. veg. Caustic. Coloc. Conium. Cham. Cina. Colch. Croc. Dros. Dulc. Hell. Knli. Lyo. Merc. Mur. ac. Nitr. ac. N. vom. Phosph. Plat. Puis. Rhodod. Rhus. Sabad. Sep. Spig. Spong. Stann. Sulph. Thuj. ULCERS: Alum. Camph. Kali. Mere. Puis. Ruta. Spongia. Stann. Hearing. DEAFNESS: Ambr. Ant. crud. Am. Plumb. Puis. Sec. com. Veratr. FLUTTERING: Bell. Cupr. Mere. Plat. Spig. GROANING: Puis. Sabad. HiEMORRHAGE: BeU. HAMMERING: Spig. HARD HEARING: Ambr. Anac. Ant. crud. Am. Arson. Asar. Aur. Bar. Bell. Bry. Calc. Caust. Cham- om. Chin. Cic. Coccul. Croc. Dulc. Bros. Graph. Hyose. Ign. lod. Kali. Lye. Merc. Natr. m. Nitr. ac. Petr. Phosph. Ph. ac Puis. Ruta. Sabad. Sec. eor. Sep. Sil. Spig. Spong. Stram. Stann. Sulph. Veratr. — to human speech : Ars. Phosph. HUMMING: Aur. Bell. Bryon. Caust. Con. Laches. Lycop. Natr. mur. N. vom. Puis. Sabad. Sept Spig. Sulph. m if 7!'i 16 XOBK. » I *»:■ Illusions of Clearing. ROARING: Aeon. Ambr. Ant. cnid. Am. Ars. Asar. Aur. Bell. Bryon. Calc Cann. Carb. veg. Caust. Cio. Cocc Colchic. Con. Graph. Ignat. Kali. Lye. Merc. Nltr. ac N. vom. Op. Phosph. Ph. ac. Plat. PiUs. Rhus. Sec. corn. Sep. Sil. Staph. Sulph. Thuj. Veratr. INTOLERANCE OF MUSIC : Aeon. Cham. Coff. Ign. Viol. od. REPORTS: Graph. Kali. Natr. c. Rhus. Sabad. Sil. Staph. Zinc. RINGING: Alum. Arsen. Calc. Clemat. Kali. Lycop. Phosph. Rhod. Sil. Sulph. Valer. Zinc. RUSHING: Aur. Bar. Bell. Cocc. Con. Cham. Dulc. Kali. Natr. mur. Nux vom. Puis. Rhodod. Stann. RINGING : Aeon. Agaric, Anac. Am. Ars. Asa f. Aur. Bar. Bell. Bry. Calc. Camp. Cann. Canthar. Carb. veg. Caustic. Cham. Chin. Cio. Con. Inilc. Graph. Kali. Ignat. Lye Mercur. Natr. mur. N. vom. Op. Petr. Plat. Ph. ao. Puis. Bhus. Sep, Silic. Stan/n. Staph. Snlph. Feratr. SENSITIVE HEARING, excessive: Anac. Bell. Carb. veg. Coff. Graph. Ign. Lye Nttx vom. Phoa. Ph. ac, Sep. SuliJh. SENSITIVENESS TO SOUND: Aco. Bell. Chin. Coff. Colch. Con. Ign. lod. Merc. Natr. carb. Nitr. ao. N. vom. Ph. ac. Puis. Sil. Spig. Zinc SENSITIVENESS TO MUSIC: Aeon. Cham. CoflF. Ign. WHIZZING: Aeon.: Agar. Alum. Anac. Arn. Ars. Asar. Aur. Bar. Bell. Bry. Calc. Canth. Carb. veg. Caust. Chamom. Chin. Cupr. Ferr. Hep. Kali. Lye. Merc. Natr. mur. Nux vom. Op. Petr. Phosph. Puis. Rhod. Ruta. Sec. com. Sep. Spig. Sulph. Yerat. Zino. V. NOSE. On the Nose. BLACK PORES : Nit. ac. Salph. BLOOD BLOWN FROM THE NOSE: Agar. Alum. Ambr. Ars. Asar. Bar. Canth. Caps. Caust. Dros. Graph. Hep. Kali. Lach. Lye. Natrum mur. Nu^ vom. Petr. Phosph. Phos. ac. Puis. Sep. Silic. Sulph. BOILS : Alum. Carb. an. Arnica. BONE-PAIN: Aur. Hyosc. Lach. Merc. CANCER: Aur. Calear. Sep. Salph. COLDNESS: Am. Bellad. China. Dros. Ign. N. vom. Plumb. Veratr. DISCHARGE OF PUS : Aur. Cina. Lach. Phosph. ac. Puis. DULL : Anac. Calc. Caps. Carb. an. Ipec. Kali. Nux vom. Puis. Rhodod. HAEMORRHAGE : Aeon. Cann, Conium, Croc, Led. Rhus. Sabin, INFLAMMATION: Agar. Arnica. Ars. Aur. Bellad. Cann. Cam-th. Lach. Merc. Natr. mur. Plumb. Rhus. Sulph. ITCHING: Agar. Alumina. Am. Bell. Bov. Calc. Carbo veg. Caust. Cannab. Caps. Coloc. Con. Chel. Chin. Cina. Kali. Lye. Hell. Ign. Laches. Merc. Mur. ac. Nux vom. Platina. Plumb. Phosph. Phosphor. ac. Santon. Sambuc. Selen. Seneg. Sep. Silic. Spig. Staph. Zinc. NOSE BLEED: Aconlt. Agaric. FAOB. 17 Alum. Ambr. Ant. cnid. Arg. Arn. Ars. Bar. Bell. Bry. Calc. Cann. Canth. Caps. Garb. veg. Causti- cum. Cham. Chbi. Cina. CofT. Colch. Con. Croc. Cupr. Dig. Dros. Dulcamara. Ferr. Graphit. Hep. Hyosc. Ipec. Kali. Lach. Lycop. Merc Mosch. Natr. mur. Nitr. ac. N. Tom. Petr. Phos. Ph. ac. Pulsat. Bhod. Rhus. Rata. Sabad. Sabiu. Sambuo. Sasaap. Secale com. Seneg. Sep. Silicea. Spong. Stan- num. Sulphur. Thuj. Veratr. POLYPI: Teucr. mar. SCURFS IN NOSE : Alumina. Ant. crud. Am. Aur. Bry. Canth. Cham. CIc Cocc. Hepar. Hyosc. Ignat. Kali. Lachesis. Merc. Nux Yom. Ph. acid. Puis. Selen. Sil. Spigelia. Staph. Thuj. ^under the nose : Bar. Kali. Smell. SMELL, of blood: Sil. — sensitive: Aeon. Aur. Bar. Bell, Cham. Chin. Cocc Colch. Graph. Kali. Lycop. K vom. Phosph. Plumb, —putrid: Aur. Bellad. Calc. Merc. Solph. —fine, extremely : Aeon. Agar. Aur. Bell. Chin. Cocculus. Coff. Con. N. vom. — of lime: Sulph. — of foul cheese : N. vom. —deficient : Anac. Bell. Hep. Hyoie. Nat. mur. Op. Plumb. Pulsat. Ruta. Sec. com. Sep. SlI. Zinc —catarrhal: Graph. Merc. Puis. Sulph. —fetid: Belladonna. Phosph. Sep. SWELLING: Arn. Ars. Aur. BeU. Bry. Calc. Cann. Canth. Caust. Cham. Chel. Cocc. Lye. Merc. Natr. mur. Nitr. ac. Phosphor. Ph. acid. Puis. Rhus. Sep. Spigelia. Stann. Stram. Zinc. SWELLING OF BONES: Anr. TETTER: mms. Spig. TWITCHING: Agar. Arnica. Aur. Caps. Con. Hyoscyam. Plat. Puis. ULCERATED NOSTRILS: Anac. Ant. crud. Am. Aur. Bell. Bryon. Calc. Cham. Cocc. Graph. Hep. Hyosc. Ign. Lach. Lye. Merc. Natr. mur. Nitric acid. N. vom. Phosph. Phosph. ac. Puis. Sep. Spig. Stann. Staph. Zinc. — exter. nose : Puis. WARTS: Caust. lilt ii 'i,if VI. FACE. Color and External Ap- pearance. ACNE ROSACEA (red pimples): Arsenic. Cann. C. an. Veratr. -blue: Aco. Ars. Asar. Bryon. Camph. Cham. Cic. Ciua. Con. Capr. Dros. Hyosc. Ign. Ipecac. Mercurius. Op. Samb. Spongia. Sferamon. Veratr. — margins around eyes: Auao.Arsen. Ciilcar. Cham. China. Cina. Cocc Cupr. Graph. Hep. Ignat. Ipecac. Kali. Lach. Lycop. Merc. Phosph. Phosph. acid. Rhus. Sabad. Sabin. Sec. com. Staph. Stram. Sulphur. Veratr. — brown, changing to : Bryon. Hyosc. lod. Op. Sec. corn. Stram. — bloated: Aco. Arnic Aur. Bar. Bell. Bry. Cham. China. Cina. Cocc Cupr. Dig. Dros. Dulcamara. PI Ifr VAOl. V -n Ferr. Hyosc Ipec Kali. Led. Lyo. Merc. Natr. o. Nux vom. Op. Phosph. Plmnbum. Bhus. Sep. Spig. Spon^ia. Staph. Strain. COMPLEXION, changing : Aco. Bell. Bov. Capsic. Cham. Chm. Clna. Crocus. Hyoso. Ign. Led. Opium. Natr. o. Fhosph. Ph. ac Yeratr. Zinc. — jaundiced : Aeon, Ambra. Ant. crud. Am. Are. Bry. Calc. Causticum. Canth. Cham. Chel. Chin. Cina. Con. Croc Ferr. Graph. Hell. Hep. Ign. Jod. KalL Lye. Merc Natrum. mur. Nitr. ac. N. vom. Op. Petr. Plumb. Puis. BhuB. Secale corn. Sep. 8plgella. Veratr. '—shining: Aumm. Plumbum. Bhus. Selen. —sallow: Bryon. Carb. veg. Ferr. Bfcrc Phosphor. Sec. corn. — sickly: Anac. Bryon. Calc. Canth. Oaust. Chin. Cina. Colch. Cupr. Kali. N. vom. Plumb, Phosph. Ph. ac. Puis. Bhus. Sec com. Silicea. Spigel. Stann. Staph. Sxilph. Ve- ratr. Zinc, —red: Aeon. Arg. Arnica. Ars. Bar. Bell. Bryon. Calcar. Camph. Cann. Canth. Capsic Caustic. Cham. China. Cic. Cina. Cocc Coff. Croc. Cupr. Drosera. Euphr. Dig. Dulc Ferr. Hyosc. Hep. Ign. Ipec. Laur. Lyo. Merc Mur. ac Natr. c. N. Tom. Op. Petr. Phosph. Plat. Plumb. Puis. Bhus. Kuta, Snbad. Sabina. Sep, Sil. Secale comut. Spigel. Spong. Stannum. Stramon. Sulphur. Thuj. Veratr. Zinc. red and bluish: Aco. Bell. Bry. Hep. Merc. Opium. Phosphor. — red, burning cheeks: Aeon. Aiii. Bellad. Bry. Cannab. Caps. 0. an. Cham. China. Cina. Cocc Coffea. Dnlc Hell. Ign. Kali. Lycop. Merc N. vom. Op. Plat. Sabad. Samf'. Stann. Stram. Valer. — red un one side : Aeon. Am. Cann. Canth. Cham. Chin. Ign. Ipec. N. vom. Pulsat. Rheum. — red, erysipdatouH : Bellad. (Cal- car,) Ciiniphur. Chum. Lach. Bhas. Ruta. Strum, — sallow: Arson. Bry. Canth. Chin. Cic. Euph. Ferr. Hyoso. Ignat. Ipec. Merc. Natr. mur, Niix vom. Op, Plumb, I'hosph. Sec. com. Sil,. EYES, sunken: Ambr, Arsen. Cal- car, Camph. ('hina. Cic. Cupr. Coloc DroH. Ferr. Hyosc Jod, Lye Nitr. ac. Op, Phosphor, Pli. acid. Sec com. Sponrjia. Stannum. Staphys. Siilph. Verat. FEATURES, altered: Ars. Bellad. Camph. Canth. Chamom. Colch. Rhus. Sj)i(j. Veratmm. FRECKLES: Calc Kali, Lye Natr. 0. PhoHph, PALE: Aionitum. Ambr. Anac. Am. Am. Bell. Bry. Calc. Camph. Cann. Canth. Caps, Carb, veg. Cham. Cliina. Cic. Cina. Coloc Con. Cocc. Cupr. Dig, Euphorb, Euphr. Femim. Graphit. Helleb. Hyosc. Ign. Jod, Ii)ec Kali. Laches, Led. Lye. Merc. Nux vom. Op. Plum- bum. Petr. Phos. Ph. ac. Puis. Rhus. Sahin. Sec com. Sep. Sil< ioea. Spigelia. Si>ong. Stann. Stram. Sulph. Teurr. mar. Veratr. Zinc. SPOTS, yellow: Calc, Hell, Lyo. Natr, e. Phosph, Sepia. — red: Alumina, Ambr, Bellad. Cimth, Croc, Lye, Mei'c. Nu.\ vom. Op. Phosph. Sabadilla, if5amb, Sil. Sulph. Zinc. — white : Ars. Merc. Natr. c. SWELLING : Alum. Ars. Bell. Bry. Calc. Canth, Cnrb, veg. Chamom. Dulc Graph. Hell. Hyosc. Kali. Lycop. Natr. mm-. Nitr. ac. Op. Petr. Phoaph, Rhus. Samb. Sep. Stram, wkom. If Sensations. In the face generally. BLOTCHES: Antim. crud. Canth. Cic, Hell. Lach. Led. N. vom. Op. Pulfl. Viol. tr. BOILS: Alum. Arn. Boll. Dry. Chin. Laur. Led. BONES, inflammation of : Staph, —swelling of : Sil. Spig. — paina of : Asa f . Caps. Chel. COLDNESS : Asar. Camphor. Cunth. Cham. Clna. Dros. Hyosc. Ign. Ipecac Rhus. Veratr. CONVULSIONS: Bell. Calcarea. Camphora. Canth. Cham. Cupr. Dig. Ipec. Phosphor. Rheum. , Stram. Sulph. CRAMPY FEELING : Bellacl. Cina. ' Cocc. Dig. Dulc. Hyosc. Kah. Nitric acid. Platina. Rhus. Spongia. Stannum. Thuj. Va- leriana. ORUSTA LACTEA: Ambr. Arsen. Bar. Bellad. Bry. Hep. Ledum. Hercnr. Rhus. Sassap. Staph. Yiol. tr. ERUPTION: Alum. Anac. Ars. Aur. Bar. Calcar. Carb. veg. Caust. Chamom. CIc Colch. Coloc. Con- ium. Dulc. Graph. Kali. Lachesis. Led. Lye Merc Natr. mur. Petr. Plumb. Ph. ac. RhuH. Sep. Silic. Stann. Staph. Veratr. Viola, tr. —on the lips: Aco. Ant. cr. Arn. Bar. Bell. Bov. Bry. Cann. Canth. Caps. Caustic. Chin. Coloc. Con. Dulc. Hep. Hyosc. Ignat. Ipec. Kali. Led. Mur. acid. Ntix vom. Rhus. Samb. SciU. Spigelia. Spong. Staphys. Sulphur. Veratrum. Zinc —around the mouth : Ant. crud. Bar. Bov. Calc. Carbo veget. Cocc. Graph. Petr. Phosphor. Ph. ac. Bhod. Rhus. Sep. Sil. Staph. Veratr. Zinc. — around tke earn: Ant. cnid. Mur. uo Petrol. Phosphor. Sulph. —on the forehead : Agar. Ambr. Ant. crud. Arn. Baryta. Bov. Calc. Canthar. Carbo veget. Chamom. Clfim. Coccul. Euphorb. Hell. Hep. Led. Mur. ac. Natrum mur. Rheum. Rhod. Rhus. Sep. Sil. Staph. Sulph. ERYSIPELAS : Rhus. Beli. FEELING OF COLDNESS : .4m. Bar. Merc. Mosch. Phosph. Plat. Rhod. Ra:t. gsel. FLASHES OF HisAT: Ambr. Arnica. A^a feat. C an. Cocc. Graph, ttyo Nitr. acid. Petr. tj::apii.. -ffeucr. mar. Thuj. Valer. ) £LyjA.T : Aeon. Agar. Alumina. Ambr. Anac. Am. Ars. Asaf. Asa*". Bar Bellad. Bov. Bry. Calc. Camph. Cann. Canthar. Caps. Carbo veget. Caust. Cham. Chin. Cina. Cocc Coffea. Coloc. Con. Croc. Cupr. Digital. Di'osera. Dulcam. Euphr. Ferr. Graphit. Hell. Hepar. Hyosc, Ign. Ipec. Kali. Led. Lye. Merc. Mur. ac. Natrum mur. Nitr. ac. Niix vom. Op. Peti*. Platina. Plumb. Phos. Ph. ac. Puis. Rheum. Rhod. Rhus. Buta. Sabad. Sabina. Samb Sassap. Senega. Sep. Scill. Sil. Spig. Spong. Stann. Staph. Stram- on . Tar. Thuj. Veratr. Viol. tr. HERPES: Bar. Bov. Calc. Carbo veg. Caustic. Chel. Graph. Led. Natr. c. Nitr. ac. Pet. Phosph. Rhus. Sabad. Sep. Sil. — on the cheek : Ambra. Anac. Bar. Bov. Bryon. Caustic. Merc. — on the chin : Bov. Chel. N. vom. — on the lips (cold blisters) : Rhus. — on the temples : Alum. ITCHING: Agar. Alumin. Ambr. Arg. Amio. Asa f. Aur. Bry. Bov. Calc Cx%)s. Carbo veg. Caustic. Clem. Coloc. Con. Dulc. Graph. ^Ifnif! k ill If iA M ^ \i 20 FAOS. |l, I!' » Kali. Lach. Lye. N. vom. Opium. Petr. Phosph. Ph. ao. Plat. Plumb. RhuH. Buta. Sabadilla. Sabin. Sas- sap. Sep. Sil. Sulph. Yoratrum. Zino. MUSCLES, twitching of: Bell. PROSOPALGIA: Aconit. Alumina. Asa f. Aur. Bar. Bell. Bry. t'alc. Caps. Chin. Clna. Coloh. Coloc Con. Daph. Graph. Kali. Lye Mur. ac. Nltr. ac Nux vomica. FhoHpli. Sep. Spigrelia. Stann. Staph. Valer. Veratr. Verb. PULSATIONS : Agar. Cann. Cham. Clem. Croc. Hell. TEARING: Agar. Alum. Ambr. Arg. Aur. Bell. Bry. Calc. Carb. veg. Chel. Cina. Colch. Con. Daph. Dig. Dulcam. Euphorbiuni. Oraph. Kali. Led. Lye Merc. Mur. ac. Natr. c. Nitr. ac. Phosph. Plumb. Rhus. Sassap. Senega. Be]piee).Stilig. Spigelia. Spong. Staph. Sulphur. Thuj. Teucrium mar. Zinc. PIMPLES : Agar. Ambra. Ang. Ant. crud. Arsen. Bar. Bellad. Bov. Calc. Caps. Carbo veg. Caust. Coco. Con. Drosera. Graph. KalL Lye. Natrum mur. Nux vom. Nitr. ac Petr. Pho8. Ph. ac. Rhus. Sassap. Sep. Sil. Sulph. Stann. Staph. Ve- ratr. Zinc. — around the eyes: Calc. Hep. Ign. Merc. Petr. Sil. Staph. Sulph. — on tho cheeks : Ant. crudum. Am. Calc. Canth. Carbo veg. Caust. Cham. Cina. Dulcam. Hyosc. Nux vom. Phosphor. Sassap. Sabina. Sep. Staph. Valer. Veratr. — on tho chin: Ambr. Antimon. crudum. Bellad. Calc. Canth. Caust. Cic. Clem. Con. Dros. Dulc. Hep. Hyosc. Lye. Nitr. ac. Nux vom. Rhus. Sabina. Sil. Spigelia. ^^oong. Sulphur. Thuj. Veratr. SENSATION OF HEAT: Am. Asa f . Bar. Bell. Bry. Oamph. Croc. DroH. Euphr. Ipeo. Merc. Nvjc vom. Petr. Platina. Rheum. Rhus. Ruta. Sabadilla. Spong. Stramom. Thuj. SPASMS: Ambr. Carbo vegetab. Caniph. Cann. Cham. Cocc. Cupr. Dig. Hop. Op. ScpifB. Stram. STITCHES : Agar. Arg. Asa f. Asar. Aur. Bar. Bry. Calad. Canth. China. Cocc. Con. Dig. Graph. Ign. Kali. Lye. Merc. Natr. mur. Nitr. ac. Petr. Phosph. Plat. Plumbum. Rhod. Rhus. Sabad. Sabin. Sop. Sil. Spigelia. Spongla. Staph. Stann. Sulph. Thuj. Veratr. Verb. SWEAT: Aeon. Ambra. Arg. Am. Ars. Asa f. Bell. Bry. Calc. Camph. Cann. Capsic. Carb. veg. Cham. China. Cina. Coccul. Coff. Con. Croc. Cupr. Dulc. Drosera. Hell. Hep. Hyosc Ignatia. Ipic. Laiir. Led. Lycop. Merc. Natr. mur. N. vom. Op. Petrol. Plat. Pulsat. Rheum. Rhus. Sambucus. Sassap. Sop. Spong. Staph. Stram. Stann. Sulphur. Thuj. Valer. Veratr. — cold, on the forehead: Bry. CIn. Cupr. Ii)ec Rheum. Veratr. TENSION r Aconit. Alum, Am. Asaf. Aur. Bar. Bry. Calc. Canth- aris. Chel. Colch. Con. Euphorb. Laurocer. Led. Lye N. vom. Petr. Platina. Phosph. Ph. ac. Pulsatilla. Rheum. Rhus. Sabiul. Samb. Sep. SiJong. Veratr. Verb. Viol. od. THROBBING: Am. BeUad. Cric. Sabad. Staph. TITILLATION : Bell. Cann. Coloc. Laur. Phosph. ULCERS : Ars. Bry. Merc. VESICLES : Alum. Ant. or. Bar. Cantharis. C. an. Caust. Euphorb. Graph. Nitric acid. Petr. Plumb. Phosph. Rhus. Sepia3. Silicea. Sulph. Valer. Zinc. VAOB. 21 WARMTH, feeling of: Asa fcot. Asar. Cann. Oautharid. Chin. Oocc. OofF. Croc. Laur. Plioa. ac. Puis. Somb. Soncg. Valer. On the Hpa. (u. sigoiflcB upp«r U]) ; 1. lower Up, and o. cor- ner of the luoutb.) BLACK: Aconit. Uryoii, Chin. Mer- cur. PhoHph. acid. Veratr. BLUE : Agar. Ars. Caust. Ciua. Con. Cupr. Dig. Op. Fhosph. Stramou. Veratr. BLISTERS, bloody: Natr. inur. Dry. I<j7i. Ph. ac. Plat. — u. : Kali. Rhus. —1. : Ara. Bry. Rhus. BURNING: Agar. Anac. Arnica. Ars. Dry. Caps. C. an. Chin. Hyosc. Kali. Merc Muriatic ac. N. yoiu. Phosph. Bhod. Jihus. Sabad. Sulph. Thuj. — u. : Ant. crud. Bar. Caustic. Daph. Graph. Merc. Natr. c. Bhus, Sa- bad. Sep. Splgel. Staph. Veratr. ^1.: Asa f. Bar. Bellad. Bov. Bry. Clem. Daph. Graphit. llaU. Phosph. Phosphor, acid. Sabad. — c. : A" .\ Ooloo. Daph. Droa. Natr.c. Zinc. CANCER: Ars. (Bryon.) Clem. Con. Sil. CHAPPING : Alum. Arn. Bry. Calc. Caps. Carbo \eg. Cham. Chin. Colch. Croc. Ign. Nux vom. Fhos. Pulsatilla. Staph. Veratr. Zinc. — u. : Caust. Natr. mur. Sab. Selen. — 1. : Cham. Chin. Daph. Dros. Graph. Natr. mur. Nux vom. Phosph. Ph. ac. Puis. CONTRACTION: Calc. Sec. corn. DEADNESS, u. : Calc. DISTORTION: BeUad. Graphit. Nux vom. Bee. com. DRY : Aco. Agar. Alum. Ambr. Anac. Am. Ars. Bar. Bell. Bry, Calad. Cann. Cauth. 0. cm. Oham. China. Com. Croc. Cycl. Dros. Graphite*. HyoHc. Ign. Merc. Mur. ac. Nux vom. PhoHph. Tlat. Puis. Rhodod. EhUH. Stram. Thuj. Veratr. Zinc, — u. : Amm. Plat. Sulph. — 1. : Daph. Merc. Sabin. ERUPTION, vesicular: Alumina. Canth. Lnur. Natrum mur. Rhus. — u. : Amm. mur. Ars. Carbo veg. Cic. Con. Graph, Hell. Laur. Mur. ac. Plat. Seneg. Sil. Stront. Valer. — 1. : Aur. Bell. Bry. Carbo veg. Clem. Kali. Laur. Mur. ac. Natr. mur. Phos. Plat. Rhodod. Sassap. Sepia. Staph. Sulph. — 0. : Caust. Daph. Laurocer. Seneg. GLANDS, indurated: Con. Sulph. Zinc. — ulcerated: Ign. HEAT: Ambr. Am. Bell. Canth. Carbo an. Daph. Hep. Sep. HERPES : Anac. Ars. Rhus. Sep. — u. : Phosph. Sep. — 1.: Sop. — c. : Carbo veg. Phosph. Sep. PALE : Ferr. KaU. Lye. Valer. PEELING OFF : Alum. BeU. Canth. Caps. Cham. Con, Daphne. Nux vom. Platina. Plimib. Puis. — u. : Sulph. — 1. : Daph. Kah. Natrum mur. PIMPLES: Cann. Caps. China. Dulc. Hyosc. Ipec. Kali. Mur. ac. Nux vovi. Rlius. Spong. — u. : Aco. Ant. crud. Am. Bell. Calc. Cai'bo veg. Capsicum. Caust. Dig. KaU. Led. Lycop. Nux vom. Rhus. Sassap. Sep. Scill. Silicea. Staphys. Thuj. Zinc. — 1. : Bell. Bry. Calc. Capsic. Caust. Ign. Merc. Mur. acid. Natrum c. Ji/tw s- Samb. Sil. Spig. — c. : Antim. crud. Bar. Bellad. Calo. Cann. Canth. Caustic Coloo. Phosph. Rhod. Rhus. Veratr. PRESSURE, u.: Sulph. ac. — 1. : Valer. '^I (if, :;iij aa FACE. ll«l BHAGADES: Arn. Bryonia. Conn. Caps. Croc. Igii. Plat. Pula. — u. : Agar. Kali. Natr. uiur. Ph. ac- Sabad. —1. : Bry. Cham. Nux vomica. Puis. Plat. Sulph. — c. : Ant. crud. Merc. BOUGH: Anac. Calo. Mur. acid. Plat. — u. : Calc. Sulph. — 1. : Merc. Natr. mur. SCUBFS- Ars. Bar. Bryon. Cann. Cham. igu. Mur. ac. N. vom. Staph. Sulph. — u. : Ars. Cic. Eali. Mercur. Petr. Sii. Staph. Sulph. — 1. : Alum. Calc. Natrum mur. Ph. ac. Sulph. — c. : Calc. Graph. Ign. Sil. SPASM: Ambr. Bellad. CauBt. KaU. Merc. Plat. SWELLING : Am. Alum. Aur. Bell. Bry. Carbo veg. Caps. Chin. Dig. Natr. mur. Opium. Bhus. Stram. — u. : Argent. Bar. Bell. Bov. Canth Carbo veg. Con. Daph. Graph. Hej). Kali. Lye. Merc. Natr. mur. Nitr. ac. Petr. Phosph. Rhus. Staphys. Sil. Sulph. ThuJ. Zinc. — 1. : Alum. Asa f . Calc. Caust. Daph. Lye. Mur. ac. Natrum mur. Piils. Sep. SU. TEEMBLING: Stram. Sulph. —1. : Am. Con. TWITCHING : Arsenic. Cham. Dulc. — u. : Carho veg. Natr. c. Plat. Sabad. Thuj. Zinc. — 1.: Bry. TUBEBCLES: Bell. Caust. Con. Sep. Sil. Sulpli. — u. : Arsenicum. Magnes. o. — 1. : Ign. Sep. — c. : Bry. Stront. ULCEEATION, c. ULCERS : Ars. Bar. Graphit. : Calc. Bellad. Capsic. Cham. Chin. Cic. Con. Dulc. Graph. Natr. mur. Nitr. ac. N. x)om. Staph. Sulph. — u. : Caps. Caust. Daph. Kali. Mer<». Staph. — 1. : Bry. Caps. Ign. Lye. Merc Nux vom. Phosphor. Phos. ac. Puis. Sep. Sil. Staph. Zinc. — c. : Am. Bell. Graph. Hep. Ign. Merc. Nux vom. Natr. mur. Phospli. Sil. Zinc. Lower jaw a''.id articulation of the jato. BONE, swelling of: Sil. CONTRACTION: Nux vom. Puis Stann. CRAMP : Alum. Asa feet. Asar. BeU. Chtimom. Cocc. Colch. Ignat. Kali. Merc. Mur. ac. N. vom. Plat. Rhus. Spig. Spong. Stann. Sulph. — in the joint: Aeon. Arnica. Bell. Bry. Calc. Camph. Canthar. Cic Colchic. Con. Hyosc. Ign. Laur. Merc N. vom. Op. Phosph. Plat, Plumb. Rhus. Sec com. Spig. Stram. Sulph. Verat. CRACKING: Nitr. acid. Rhus. Sa- bad. DEPRESSION: Op. DISLOCATION: Ign. Petr, Ph. ac. Bhus. Staph. PAIN, arthritic : Caust. — crampy : Digit. Plat. Sassap. Spong. Stann. PRESSURE: Ambr. Am. Asar. Aur. Bry. Chin. Coff. Cupr. Dro.s. Ign. Led. Phosph. Sabin. Sassap. Spig. Veratr. RIGIDITY: Bellad. Caust Cocc. Euphr. Graph. Hyosc. Merc. Ntu- vom. Petr. Sassap. Sep. Thuj. SWELLING : Aeon. Arn. Ars. Staph, Veratr. TEARING : Agar. Anac. Am. Aur. Bar. Bell. Bov. Bry. Canth. Carb. anim. Chin. Cocc. Coff. Colch. Droser. Graph. Laur. Mercur. Nux ) I TEETH AND GUMS. Tom. Phosphor. Plumb. Puis. Sas- sap. Spig. Stannr /Stt/p/i. TWITCHING: Am. Bell. Bryon. Canth. Cliin. Cina. Con. Tgn. Rhus. Sabin. Valer. Chin. BURNING: Anac. Ant. crud. Bov. Canth. Caust. Rhus. Spong. COLDNESS: Veratr. CRAMP: Bell. DRAWING : Caust. Cupr. HERPES: Boy. Chelid. Natr. mur. Nux vom. Sil. ITCHING: Alum. Con. Dig. Kali. Lyc. Natr. mur. Op. Phosph. Plat. Puis. Sossap. Soill. Spig. Stro»t. Sulph. Zinc. NUMB FEELING: Asa f . Plat. PIMPLES: Ambr. Anac. Ant. or. Bell. Calc. Canth. Caust. Cic. Clem. Con. Dros. Dulc. Graph. Hyosc. Lyc. Merc. N. vom. Nitr. ac. Rhus. Sabiu. Sassap. Sil. Spig. Spong. Sulph. Thuj. Veratr. Zinc. PUSTULES : Merc. Oleand. Sabin. Zinc. SWELLING: Carb. veg. TEARING : Aur. Caust. Plat, ULCERS: Hep. VESICLES: Hep. VI. TEETH AND GUMS. Teeth. BLACK: Ignat. Merc. Plumb. Sep. Staph. BLEEDING: Ambr. Bar. Graph. Phosph. Ph. ac. Sulph. Zinc. BRITTLE: Lach. Plumb. Sabad. Staph. DECAY : Amm. Carb. an. Sil. DULL : Agar. Caps. Nitr. acid. Pnls. Spong. Staph. PALLING OUT: Ars. Bry. Merc N. vom. Plumb. Sec. com. FETID: Calc. Carb. veg. Daph. Graph. Kali. GRITTING : Aeon. Ant. crud. Ars. Bar. Bellad. Canth. Caust. Chainoin. Cic. Coff. Con. Hyosc. Ig«. Merc. Plumb. Sec. com. Sep. Stram. Yeratr. HOLLOW: Aaai-. Calcar. Daph. Hyosc. Plumb. Phosph. Sabad. Selen. Sep. Sil. Staph. LOOSE: Aeon. Am. Bry. Camph. Cham. Chin. Cocc. Hyoscyam. N. Tom. Op. Puis. Rheum. Ehus. Staph. Veratr. MUCUS ON TEETH: Alum. Am. Bov. Bry. Cham. Daph. lod. Plumb. Selen. SMOOTH: Phosph. Selen. TEETHING: Aeon. Am. Bryon. Chamom. Cic, Cina. Coff. Cupr. Hyosc Ign. Ipec. N. vom. Op. Puis. Rhus. Stram. TOOTHACHE, see Index. YELLOW: lod. Lyc. Nitr. ao. Gums. BLUE: Sabad. BLEEDING: Agar. Alum. Ambr. Ang. Bar. Bellad. Bov. Calc. Carb. veget. Caustic. Con. Euphr. Graph. lod. Kali. Ly'•'^'^, Merc Natr. mur. Nitr. ac. N. voui. Phosph. Ph. ac. Ruta. Sep, Staph. Sulph. Zinc. BURNING: Bell. Chamom. Merc Mur. ac. N. vom. Petr. Puis. Rhu«. Sep. CORRODED : Merc Staph. FISTULA : Calc. Canth. Caust. Natr. mur. Petr. Puis. Sil. w im Is ill MOUTH. ij: GROWTHS: Staph. HEAT : Bell. Lye. INDENTED: Merc. INFLAMED : Bov. lod. Natr. mur. N. vom. Petr. Phosph. Sil. PALE: Carb. on. Merc. Nitr. acid. Plumb. Sabin. Staph. PUTRID: Ambr. Nux. vom. Staph. RECEDING : Bov. Carb. veg. Graph. Merc. Natr. carb. Phosph. Ph. ac. Rhus. Sep. Staph. REDNESS: Carbo au. Iodine Merc. Nitr. Sep. SENSITIVE: Amm. Ang. Arsen. Carbo veg. Caust. Natr. mur. Phosph. Puis. SPONGY: Ang. Bry. Graph. Merc N. vom. Staph. SCURVY: Cic. N. vom. Staphys. ^ee Index.) SUPPURATION: Caiith. Caust. Liich. Merc. Petr. SWOLLEN: Aliun. Ambr. Ang. Bar. Bellad. Bism. Bov. Calc. Carbo an. Carbo veg. Caps. Caust. Cham. Chin. Cocc. Graphites. Hep. Hyosc. Joel. Kalic. Lach. Lye. Merc Mur. ac. Natr. mur. N. vom. Nitr. ac. Petr. Phosph. Plumb. Puis. Sabin. Sep. Sil. Spig. Spong. Staph. Sulpli. TUBERCLES: Caust. Phosph. ac. Plumb. Staph. ULCERATED: Alum. Aurum. Bov. Calcar. Kali. Kail bichr. Lyo. Merc. Millef. N. vovi. Phosph. Sabin. Stann. Staph. Zinc. VESICLES: Bellad. Calc. Canth. Daph. Nux vom. Petr. Sep. Staph. WHITE: Merc. Staph. ? Vin. MOUTH. III.. .; ! Buccal Cavity. APHTHA : Bry. Caust. Cham. Chin. Ipec. Merc. Nitr. ac. Nux vom. Sulphur. Sniph. ac. BLISTERS: Ambr. Anao. Canth. Calc. Caps. Jod. Merc. Nitr. acid. Phosph. Spong. Staph. Thuj. BLUE : Cic. Merc. BLEEDING : Bell. Canth. Mancin- nella. Millefol. BURNING: Asa f. Asar. Bellad. Bov. Carbo veget. Cantharis. Cham. Cupr. Merc. Petr. Phos. Plumb. Spong. Sulph. Veratr. BREATH, sour : Nux vom. — bad. Aeon. Ambr. Aru. Agar. Anr. Bar. Bell. Bry. Camph. Canth. Oapsio. Gale. Carbo anim. Carbo Teget. Cham. Chin. Croc. Digital Ferr. Oraphit. Kali. c. Hyoso. Igu. Ipec Merc. N. vom. Petr. Plumb. Puis. Sepia). Spigel. Stram. Sulph- ur. Zinc DRYNESS : Aco. Ambr. Amm. Ars. Aur. Antim. crud. Am. Asa f. Asar. Bar. Bell. Bry. Calc. Carbo veg. Cann. Canth. Capsic. Cb.rn-.. China. Cina. Cocc Coflfea. Ci.Vu. Croc. Ferr. Hyosc. Ign. Ipec. Kali c. Kali bichr. Lye. Mur. ac. Merc Natrum o. Nitr. Nitr. ac. N. vomica. Petr. Phosph. Phosph. ac. Bhod. Plumb. Puis. Sabad. Sassap. Seneg. Sep. Sil. Spig. Strum. Sulph. Thuj. Veratr. Zinc. FOULNESS: Am. Ars. Aur. BeU. Bov. Bryou. Oapsio. Carb. veg. Cliam. Chin. Crotal. Graph. Hyosc. lod. Merc N. vom. Nitr. ac Pols. Ruu. Sabin. Spigelia. Staph. JROWTHS: Staph. MOUTH. 26 HEAT: Amm. Calc. Camphora. Carbo veg. Cham. Mercur. Natr. c. Phoaph. Plumb. Sil. Sulph. INFLAMED : Aeon. Bismuthum. Brom. Calad. Cauth. Colch. I^ii. N. vom. Verair. ROUGH : Carbo veg. Caustic. Cina. Cocc. Dig. Ipec. Millefol. Ph. ac. SKIN DETACHED : Merc. SWELLING : Auiiii. Causticum. Oanth. Merc. Sep. Zinc. TRISMUS: Calc. Con. Phosphor. Sulph. ULCERS: Arg. Graphites. Kali bichr. Merc. Natr. mur. Nitr. ac. N. vom. Opium. Petr. Phosph. Plumb. SepisQ. Sil. Staph. Zinc. Nitr. Palate. BLISTERS: lod. Nux vom. ac. Phosph. Spig. BURNING: Carbo veget. Camph. Oann. Canth. Caustic. Cocc. Mur. ac. Phosph. Phosph. ac. Rhodod. Senary. Spig. Staph. Thuj. DRYNiiSS: Camph. Cann. Cina. Cocx HeU. Merc. Nux vom. Op. Plumbum. Samb. Sepise. Staph. Siram. Sulph. Veratr. INFLAMMATION : N. vom. PEELING OFF: Amm. Euphorb. REDNESS: Ars. BeU. Canth. SMARTING: Carbo veget. Coloc. Canth. Cham. China. Kali c. Merc. Seneg. Zinc. SORE: Daph. Nitr. ac. Phosph. acid. STINGING: Bar. Camph. Caust. Coloc. Ign. Kali c. Phosphor. Staph. Zinc. SWELLING: Apis. Ars. BeU. Caps. Chin. Merc. Natr. mur. N. vom. Seneg. Stram. ULCERS: Apis. Aur. Kali biclir. Merc. Natr. mur. Nitr. ac. Ph. ac. SU. 60 WHITE: Meru, Piiarjmx. (Compare Larynx.) APHTHJE : Spong. Staph. BALL, hysteric: Calc. Causticum. Graph. Igu. Kali c. Natrum mur. Plumb. Sep. Sil. Sulph. Valer. BURNING : Aco. Alum. Amm. Ars. Arn. Asa feet. Bellad. Calc. Camph. Cannabis. Canth. Carbo veg. Caus- ticum. Cham. Cocc. Con. Digital. Dros. Euphorb. Graphites. Hyosc. lod. Merc. Nitr, ac. N. vom. Petr. Phosphor, Puis. Bhod. Sabad. Seneg. Stram. Sec corn. Spongia. Sulph. Veratr. CONTRACTION: Aco. Alum. Arg. Ars. A&a foet. Bellad Calc. Caus- ticum. Chin. Cic. Daph. Hyosc. Merc. Natnmi muriat. Phos. Sabad. Stram. Sulph. Veratr. CROUP, gangrenous ; Ars. Chin. — membraneous: Aco. Brom. Cham. Dros. Hep. Iodine. Phosph. Samb. Spoug. — disposition to: Lycopod. Phosph. DEGLUTITION DIFFICULT: Aconit. Arg. Arn. Asar. Bell. Bry. Calc. Canth. Carbo vegetab. Cham. Chin. Hyosc. Ign. Ipec. Kali bichr. Merc. Natr. mur. Nitr. Nux vom. Op. Phosph. Ph. ac. Puis. Pyro c. Sabad. Spong. Stramon. Sulph. Thuj. — desire for : Bell. Caust. Con. Ipec. Merc Seneg. Sabad. Thuj. —painful: Aeon. Alum. Arg. Ars. Asa f . Bar. Bell. Bry. Calc Camph. Canthar. Caps. Carbo veg. Causti- cum. Cham. China. Cocc. Cofifea. Croc. Ferr. Graph. Hell. Hep. Ign. Ipec. Kali c. Lycopod. Merc Natr. mur. N. vom. Petr. Phosph. Ph. ac. Puis. Rhus. Rtita. Sabad. Sabin. :i\l i6 MOUTH. ||f Sep. Seneg. Sil. Spig. Staph. Siram. Sulph. Zinc. DEYNESS: Agaric. Alumina. Ambr. Aiiac. Ant. crud. Ars. Asa f. Bar. Bell. Bry. Calad. Calc Canth. Caust. Cham. Cocc Colch. Cupr. Hyosc. Ign. Ipec. Kali c. Lye. Merc: Mur. ao. Natr. mur. Nitr. ac. N. vom. Op. Petr. Fhosph. Ph. ac. Plat. Plumb. Puis. Rhus. Sabad. Sabina. Sec. corn. Sepiro. Sil. Spoiigio. Stann. Staph. Strain. Thuj. Sulpli. INFLAMMATION: Aeon. Agar. Apis. Alum. Arg. Ars. Bar. Bell. Brj. Canth. Caps. Chani. Con. Euphorb. lod. Lach. Lye. Mercur. Petr. Phosph. Ph. ac. Puis. Euta. Seneg. Sep. LUMP IN THROAT: Ambr. Ant. crud. Am. Ars. Bell. Calc. Caust. Oroc. Hep. Mercur. Natr. m. Plumb. Sabad. Sab. Sep. PARALYSIS : Aco. Bell. Cocc Ipec. Plumb. Sep. AS IF A PLUG IN THROAT: Amm. Bar. Chamom. Crocc. Ferr. Hep. Ign. Merc. Mur. ac. Natr. mur. Nux voni. Sep. Sulph. REDNESS : Aco. Alum. Apis. Bell. Canth. Merc. Nltr. ac. Spong. ROLLING OF DRINKS, audible: Cuprum. Laur. ROUGH: .^ ;on. Avohr. Antim. crud. Arg. Ars, Bar. Bryon. Carbo veget. Caustic. China. Coccul. Dros, Euphr. Graph. Hep. Hell. Hyosc. Ign. Ipec. Mur. acid. Natr. c. N. Tom. Phosph. Ph. ac. Plat. Plimib. Rhod. Rhus. Sabad. Sassap. Sen- ega. Spong. Stann. Staph. Sulph. Thuj. Verair. SCRAPING: Alum. Anac. Arg. Ars. Bry. Carbo an. Cocc. Croc. Dros. Dulcam. Kali c. Hyosc. N. vom. Puis. Rhus. Sabad. Stann. Thuj. Teratr. SMARTING: Ambr. Carbo veget. Dros. Hyosc. N. vom. Ph. ac. Sep, SORE THROAT, chronic: Ammon, Arg. Bar. Bov. Dulc. Luch. Jiyc Nitr. Pulsatilla. Rhus. Zinc. — in measles : Carbo veg. HEAT: BeUad. Cham. Duicam. Euphr. Ferr. Hyosc. Iodine. Jlfer- cur. Natrumc. Nitric ac. Phosphor. Rhododend. Sepia). Stram. SPASM: Alumina. Carbo veget. Caps. Con. Dig. Graph. Ipec. Phosphor. Sassap. Sepise. Stram. Sulph. Veratr. SWELLING: Aco. Arg. Bellad. Bry. Carbo animalis. Cham. Chb. Hep. Hyosc. Iodine. Ign. Lye. Merc. Petr. Spig. Stann. Sulph. AS IF SWOLLEN: Veratr. ULCERS : Arg. Calc lod. Ign. Merc. Nitr. ac. UVULA INFLAMED: Apis. BeU. Brom. Millefol. Mercur. Ruta. Zinc — elongated: Caps. Chel. Croc. Plat. Sabad. Sulph. — swollen: Bell. Calc. China. Coff. Dulc. Kali bichr. Lycop. Merc N. Yom. Pulsatilla. Sabad. Seneg. Sil. Sulphur. Zinc. Saliva. FRONT OF MOUTH: BeU. Calc. Camph. Canth. Chamom. Cic Cocc. Cupr. Hyosc. Ign. Laur. Op. Plumb. Sec. com. Stram. Veratr. — bloody: Cantharis. Hyosc Pyro- carb. Sec comut. Stram. MUCUS, bitter: Am. •~bloody: Alum. Amm. Bism. lod. Lye. Mercur. Phosphor. Sec. com. Selen. Sulphur. Stram. Thuj. Ziuc. — foul: Bellad. Bov. Calcarea. Carbo veg. Cham. China. Sep. Ziuc. — yellow: Bry. Spig. —gray: Arg. — green : Carbo vegetab. Colch. Natr. mur. Plumb. Ziuo. MOUTH. 27 ,^>flalt : Aliun. Amm. Bovista. Graph. N. vom. Phos. Rhus. Sulph. sour: Plumb. —sweetish: Asar. - -taating badly : Merc. -^smelling badly : Chin. Ignat. Puis. ■ Eheuin. ^viscid: Alum. Ambr. Auao. Ant. crud. Arg. Asar. Bell. Bnj. Camph. Caps. Chamom. Coif. Dulc. Euphr. .lod. Igii. Merc. Nux vom. Phosph. Ph. ac. Plumb. Pulsat. Rhus. Samb. SALIVATION : A7it crud. Agar. Alum. Apis. Bellad. Broni. Bry. Camph. Canth. Cham. Chin. Cocc. Colcliic. Con. Cyc. Bros. Dulc. Euplir. Ferr. Hell. Hyosc. Ign. lod. Kali c. Ipec Merc Mtrum ac. Nux vom. Op. Phosph. Plumb. Puis. Rhus. Strain. Veratr. SALIVA, bitter: Am. Ars. Merc. Thuj. —frothy: Ant. crud. Bell. Bry. Cam- phora. Canth. Cic. Cocc. Ign. Ipec. Phosph. Plumbimi. Sil. Sabin. Sec. com. Spigelia. Stravi. —watery : Asarum. Camphora. Colch. Dig. Bros. Hell. lod. Ipec. Lach. Nux vom. Phosph. Plumb. Staph. — increased flow: Aeon. Aliun. Arg. Asar. Bar. Bell. Bov. Brom. Bry. Calc. Camph. Canth. Carb. veget. C "istic.jCham. Chin. Cocc. Colchie. Lros. Dulc. Graph. Hell. Hep. Hyosc. Ign. Ipec. Merc. Natr. mur. N. vom. Phosph. Pulsat. Rlius. Sep. Spig. Spoug. Staph. Stniui. Sulph. Veratr. Tongue. BLACK: Ars, Chin. Op. Sec. corn. BLOTCHES: Apis. Dros. Lyeop. Phosph. BLISTERS . Amm. Arg. Ars. Apis. Bar. Bell. Brom. Bry. Gale. Canth. C. an. Caust. Cham. Chin. Croc. Graph. HeU. KaU carb. Mur. ac. Natr. mur. Nitr. ac. N. vom. Phosph. Puis. Sabad. Sep. Spig. Spong. Staph. BLUE: Ars. Dig. Lach. Mur. acid. Sabad. BURNING: Aeon. Alum. Argent. Ars. Asar. Bar. Bell. Bry. Calc. Canth. Carb. an. Caust. Chin. Coff. Coloc. Croc. Graph. Hyosc. Ign. Kali carb. Merc. Natr. mur. Op. Phosph. Ph. ac. Plat. Plumb. lihodod. Sabad. Spig, Spong. Sulph. Veratr. CANCER: Apis. Ars. COATED, brown : Arsen. BeU. Bry. Carb. veg. Crotal. Mancin. Plumb. Sabin. Sec. cor. Sulph. —yellow: Aeon. Alum. Am. Ars. Bellad. Bry. Cann. Chamom. Chin. Cocc. Kail bichr. Lach. Merc Nitr. acid. Sabad. Sabina. Senec. Stann. Zinc. — like a crust : Chin. — like fur : Merc. Puis. — frothy: Plumb. — sUmy: Aeon. Agar. Bell. Canth. Chamom. Cliin. Cina. Ignat. Merc. Nitr. Nux vom. Phosph. Plumb. Puis. Sec corn. Sep. Sil. Stann. —dirty : Aeon. Ant. crud. Am. Chin. — blackish: Ars. Brj'. Merc Sec corn. — white: Aeon. Agar. Alum. Anac. Ant. crud. Ars. Asar. Arn. Bell. Brj'on. Calcar. Canth. Cann. Carb. veg. Cham. Cliin. Cina. Croc. Dig. Euphr. Ign. Ipec. Merc. Mur. ac. Nat. mur. Petr. Phosph. Plumb. Puis. Rheum. Rut. Sabad. Sabin. Sassap. Selen. Seneg. Spigel. Staph. Sulphur. Veratr. Zinc CRACKS : Bar. Calc. Ign. Merc. CRACKED : Bar. BeU. Bryon. Calc. Cham. Chin. Plum^ Ph. ac. Sec. corn. Spig. •i : ■ 1 .t^''-: I I «!P' 28 MODTH. U^ \(.M- l»! If DRY : Aeon. Ambr. Arn. Ars. Bell. Bry. Calc, Canth. Carb. veg. Canst. Cham. Cocc. Coflf. Con. Diilc. Kali carb. Lyv. Hell. Hijosc. Ipec. Lacli. Merc. N. vom. Op. Phosi^h. Ph. ac. Plumb. Puis. Elms. Sep. Staph. Stiam. Siilph. Veratr. Zinc. HEAT : Aeon. Bellad. Canth. Carbo veget. Plumb. Pulsat. Stram. Sulph. HEAVY: Anac. Bell. Calc. Carb. veget. Merc. Mur. ac. Natr. mur. Plumb. N. vom. Buta. INDENTED: Merc. INFLAMMATION: Aconit. Arn. Canthar. Cham. Nux vom. Plumb. PAPILLA, erect: Croc. Oleand. — inflamed: Bell. PARALYSIS: Aeon. Bar. Cocc. Crotal. Dulcam. Ipec. Hyosc. Laur. Mur. ac. N. vom. Op. Rhus. Rut. Sec. cor. Stram. PEELING OFF: Spig. RANULA: Ambr. Calc Natr. mur. Nitr. ac. Staph. RED : Cham. Veratr. ROUGHNESS: Aeon. Alum. Bar. Calc. Carb. veg. Cocc. Dulc. Graph. Hyosc. Merc. Phosph. Sep. Stram. Sulph. SMARTING: Aeon. Arn. Arsen. Asar. Bell. Cham. Chin. Coloo. Croc. Dros. Ign. Ipec. Natr. mur. Op. Sep. Sulph. Zinc. SORE : Agar. Ars. Canth. Cic. Dig. Kali c. Lye. Merc. Mur. acid. Natr. mur. Nitr. ac. Op. Sen. Sil. SUPPURATION: Canth. Mancin. SWELLING : Anac. Apis. Ars. Bell. Bryou. Calad. Chin. Cic. Dig. Dros. Glonoin. Hell. Merc. Natr. mur. Plumb. Pyrocarh. Ruta. Sabad. Sec. Sil. Stram. Veratr. TONGUE PROTRUDED : Aco. Plumb. TREMBLING: Bell. Phos. ac Stram. TWITCHES: Sec, corn. ULCERS: Amm. Apis. Arsen. Canth. Chin. Cic. Dros. Kali bichr. Lye. Mur. ac. Merc Natr. mur. Nitr. ac. Op. — at the edge of tongue: Caust. Merc. Nitr. ac. Thuj. —under the tongue : Lye. WHITE : Arsen. Canth. Coloc. Hell. Kali carb. Nitr. ac. Nux vom. Oi), Petr. Phosphor. Puis. Sep. Sulph. Veratr. WITHERING: Veratr. Speech. DUMB: Cicuta. Pyrocarb. Stram. SPEECH, impeded: Aeon. Anac. Arg. Am. Ars. Bell. Bry. Calc. Cann. Canth. Carb. veg. CausU Cocc Conium. Dulc. Hyosc. Ign. Lye Merc. Mur. ac. Natr. miu-. N. vom. Op. Plumb. Petr. Phos- phor. Sec cor. Spong. Staun. Strain. Sulph. Veratr. Zinc. — hurried : Aeon. Bry. Hep. Merc. — stuttering: Cocc. Stram. — slow: Thuj. — low tone: Bell. Canth. Chamom. Chin. Hep. N. vom. Op. Sec. com. Staph. — nasal: Bry. SPEECHLESS: Am. Ars. Bar. Bell. Bryon. China. Con. Crotal. Cupr. Hyosc Lye. Merc. Mur. ac. N, vom. Op. Phosph. Plumb. Puis. Ruta. Sec. com. Stram. Veratr. STUTTERING: Aco. Arn. Bell. Cham. Euphr. Hell. Opium. Sec com. Stram. Vei^at. STAMMERING: Euphr. VOICE, clear: Chin. Secale com Spong. Stram. Veratr. — low: Ant. crud. Canth. Ign. Nux vom. Op. Puis. Secale com. Spong. Veratr. APPETITE. 29 Caust. —indistinct : Bry. Cann. Cocc. Hyosc. Sec corn. Stravu Veratr. — lofls of: Antimon. crud. Cann. Dros. Hyosc. Lach. Plumb. Ruta. Spong. Veratr. IX. APPETITE. LOSS OF APPET-ITE : Aco. Agar. Alumina. Ant. crud. Arg. Am. Ars. Bar. Bell. Bry. Calc. Canth. Carbo vegetabil. Caustic. Cham. China. Cic. Cocc. Coff. Colch. Con. Croc. Cupr. (lycl. Dig. Dros. Dulc. Ferr. Graphites. Hell. Hep. Hyosc. Ign. Ipec. Lach. Lye Merc. Natr. nnir. Nux vom. Op. Phosphor. Plat. Puis. Rhodod. Rhus. Biita. Sabad. Sec. com, Sep. Sll. Spigel. Spong. Stann. Staph. Sulph. Thuj. Veratr. Zinc. AVERSION TO BEER: Bell. Cham. China. Cocc N. vomica. Phosph. Spig. Spong. Stann. Sulph. —to brandy : Ign. Merc. —to bread: Con. Ign. Lycopod. Natr. mur. Nitr, ac. Nux vom. Phosph. Ph. ac. Puis. Rhus. Sep. Sulph. —to brown bread: Kali c. Lye. N. vom. Puis. Sulph. —to solid food : Ferr. Mercur. Staph. —to fat food : Ar.s. Bell. Bry. Calc. Carbo veg. Drosera. Hell. Hep. Merc. Natrum mur. Petr. Pulsatilla. Psorin. Rhus. Sep. Sulph. -fish: Crraph. Xinc. --meat: Alum. Arn. Ars. Aur. Bry. Calc. Carbo veget. Causticum. Ferr. Graph. Ign. Kali bicher. Lijc. Mercur. Mur. ac. Natr. mur. Nitr. ac. N. vom. Op. Petr. Plat. Puis. Rhus. Sahad. Sepise. Sil. Sulph. Zinc, —broth: Arn. Ars. Belladonna. Graph. Rhus. — vegetables: Hell. — coffee: Bellad. Bry. Calc Carbo veget. Cham. China. Coflf. Dulc. Lye. Merc. Natr. mur. N. vom. Phosphor. Rhus. Sahad. Spig. —to milk: Am. Bell. Bryon. Calc. Carho veg. Cina. Ign. Natr. c. Nux vom. Phosphor. Pulsat. Sep. Sil. Stann. Sulph. — sour things: Bellad. Cocc. Ferr. Ign. Nux vom. Ph. ac. Sabad. Sulph. — salt things: Carbo veg. Graph, Selen. — sweet things: Ars. Caust. Graph. Merc. Nitr. ac, Phos. Sulph. Zinc. — to water: Bellad. Brom. Bryon. Canth. Caust. China. Lye. Natrum mur. N. vom. Stram. — to wine: Ign. Lach. Merc. Rhus. Sabad. Sulphur. DESIRE FOR BEER : Aeon. Bry. Calc. Causticum. China. Cocc. Graph. Lach. Merc. Natr. c. N. vom. Op. Petr. Ph. ac. Pulsat. Rhus. Sabad. Spig. Spong. Sulph. Zinc. — bitter things : Dig. Natrum mur. — brandy : Aco. Arg. Ars. Bov. Bry, Calc. China. Cic. Hep. Mur. ac. N. voin. Op. Puis. Selen. Sep. Spigel Stajyh. Sulph. Sulph. ac. — bread : Ars. Bell. Bov. Ferr. Hell. Igu. Natr. m. Plumb. Puis. Staph. — broad and butter : Ferr. Ign. Merc. — something refreshing: Carbo an. Caust. Cocc. Phosph. Ph. ac. Pulsat. Rheum. Valer. , Hi m M TABTK. Ml !u — for fat food : Nitr. ac. Nux vom. — for meat : Hell. Sulph. —liquids : Ferr. Merc. Staph. Snlph. — pastry: Plixmb. — smoked things : Caust. — vegetables : Alum. Magrnes. carl). — cucumbers: Ant. crud. Veratr. — herrings : Nitric ac. Veratr. — cheese: Ign. — coffee : Ars. Aur. Bryon. Capsicum. China. Colch. Con. Mosch. Selen. — chalk : Nitr. ac N. voni. — sweet things : Amm. Calcar. Carbo veg. Chin. Ipec. Kali c. Lye. Natr. c. Nux vom. Petr. Rheum. Rhus. Sabad. Sulph. — farinaceous: Sabad. — milk: Anac. Ars. Aur. Bov. Bry. Calc. Chel. Mercur. Natr. mur. Nux vom. Ph. ac. Rhus. Sabad. Sabina. SiL Staph. — fruit: Alum. China. IgnaU Puis. Sulph. ac. Veratr. — juicy: Ph. ac — salt: Calc. Carbo veg. Caust. Conium. Nitric acid. Phosph. Ve- ratr. — sour: Antim. crud. Am. Ars. Bry. C. an. Chaui. China. Con. Dig. Hep. Ign. Kali c. Lach. Phosph. Puis. Sabin. Sec. com. Sep. Strain. Sulph. Veratr. — wheat bread : Aur. — warm food : Cycl. Ferrum. Ltjc. — wine : Aco. Arg. Bov. Bryon. Calc. Chin. Cic Hep. Lach. Pulsat. Sep. Spigelia. Staph. Sulph. BAD EFFECTS OF FOOD OR DRINK: see Index. HUNGER : Agar. Alum. Antim. crud. Arg. Are. Aur. Bellad. Bryon. Calc Canth. Carbo veg. Cham. China. Cinju Cocc. Coff. Grapli. Hell. Hyosc. Ign. Lye. Merc, Miu. ac. Natr. mur. Nu^ vom. Op. Petr. Phosphor. Plat. Plumb. Puis. Rhus. Sabad. Secale com. Sep. Sil. Spong. Staph. ^Veratr. — without appetite : Ars. Bellad. Bry. Calc. Chui. Dulc. Hell. Ign. Lye. Natr. uiur. Nux vom. Op. Puis. Rhus. Sil. Sulph. Veratr. — canine: Ars. Bryon. Calc. Cham. Chin. Cina. Cocc. Graph. Hell. Hy- osc. Iodine. Lye. Natr. mur. N. vom. Op. Phosph. Puis. Bhus. Sep. Sil. Spig. Sulph. Veratr. THIRST: Aeon. Ant. crud. Am. Ars. Bell. Bryon. Calc Canth. Carb. veg. Caust. Cham. Chin. Cina. Coffea. Crocus. Crotal. Cupr. Dros. Dulc. Ferr. Hep. Hyosc. Ign. Kali bichr. Merc. Natr. mur. Nux vom. Plumb, lihus. Sec. comut. Silic. Stram. Sulph. Verair. — loss of : Ambr. Apis. Arson. Bellad. Camph. Canth. Chin. Con. HeU. Hep. Lycop. N. mosch. Oleand. Op. Ph. ac. Puis. Rhus. Sep. Spig. Spong. Staph. — with aversion to drinks : Am. Bell. Canth. Caust. Hyos. Lach. Lye. Natr. nv i . Nux vom. Rhus. Samb. Stram. — none, but desire to drink: Ars. Camph. Cocc. Coloc. Graph. Man- cin. Phosph. X. TASTE. TASTE, bitter: Aconit. Alum. Ant. crud. Arg. Am. Ars. Aur. Bar. Bell. Bov. Bry. Calcar. Canth. Carb. veg. Cham. Chin. Cocc. Coff. Croc. Cupr. Dig. Glonoin. Hyosc. Ign. Ipec. Kali c Lye Merc Mur. J ■i BRU0TATI0N8. 81 flo. Natr. mur. Nltr. ac. Nux vom. Op. Petr. FhoHph. Pulsut. Bhotl- odend. Rhus. Sabad. Sabin. Sec com. Sepioe. Silic. Spong. Staph. Stram. Sulph. Veratr. —of food : Ars. Bryon. Camph. Chin. Ferr. Hell. Hep. Ign. Ph. ac. Puis. Sabin. Staph. Stram. —of blood : Alum. Ar.H. Canth. Ferr. Ipec Kali carb. lihus. Sabin. Zinc. —burnt : Bryon. Cyclam. Laur. Puis. Saill. Sulph. of pus: Bros. Merc. Natr. carb. Pula. —nauseous : Bry. Ohel. N. vom. Puis, Valer. -earth: Caps, Ferr. Hep. Merc. Puis, -flat: Agar. Alum. Ant. crud. Ars. Asaf. Aur. Bell, Bry. Caps. Chin. Coloo. Dig. Dulc. Euphorb. Ign« Ipec. Natr. mur. Op. Ph. ac. Puis, Ehus, Sec, com. Stann. Staph. —foul : Aeon. Arn. Ars. Aur. Bellad. Bry. Cham. Con. Cupr. Ign. Kail carb. Lycop. Merc. Mur. ac. N. Toin. Ph. ac. Puis. Rhus. Spig. Staph. Veratr. —of foul eggs: Acon. Arn. — biUous: Acon. Bry. Chani. Puis. Veratr. — of cheese : Chin. — chalky : Ign. Nux mosch. — insipi' , Acon. Alum. Ars. Bell. Ilry. Caps. Chin. Euphros. lj?n. Kali c. Op. Pelr. Pliosph. Sabin. Spig, Stixnn. Staph. Valer. —salt: Alum, Ars. Bar. Bell, Calc. Carl), vcg. Chin. Coff, Croc. lod. Merc. Pills. Khodod. Sulph. — sour: Acon. Alum. Ars. Aur. Bar. Bell, Calc. Canth. Caps. C. an. Con. Chamom, Chin, Cocc. CrotaU Graph. Ignat. Kali c. Kali bichr. Lye. Merc. Nitr. ac. Nux vom. Pyrot'Arb. Phosph. Puis. Ehus. Sei>. Sll. Sulph. — slimy: Alnm. Arn. Arsen. Bell. Cham. Chin. Cocc, Dig, Hell, Hep, Lye Merc. Nux vom, Petr. Phosph. Ph, ac, Ehus. Sep. Sulph. — sweetish: Alum, Aur. Bell. Bry. Canth. Chin. Coff. Croc. Cupr. Ferr, Kail c. Lye. Merc. N. vom. Phosph.Plat. Plumb. Puis. Sabad. Spong, Sulph. Zinc, — offensive: Ars. Broni. Bry. Calc. Canth. Chin, Cocc, Dros, Ign, Merc. Natr. mur. iV^u.rDoin, Phosph, Pulsat. Sep. Spig. Stann. Sulph. Zinc, — lost: Alum. Anac. Ant, cr. Bell. Bry, Calc. Hyosc, Ipec, Kali o Lye- Merc, Natr. mur. Bhodod. Sec. com. Sep. Silic. Stram. Sulph. Ve- ratr. XL ERUCTATIONS. ERUCTATIONS, bitter: Alum. Ar- iiica. Ars. Bar. Bell, Bry. Cham. Chin, Calc Carb. veg. Cocc. Droser. Hyosc. Ign. Kali carb. Lye. Merc Mur. ac. N. vom. Phosph, Pulsat. Sil. Spong. Starvn. Sulph. Veratr. <-foul: Acon. Am. Bellad. Brom. C. an. Cocc. Merc. Mur. ac. N. vom. Phosph. Puis. Sep. Sulph. -after eating: Antim. crud. Bellad. Bry. Camph, Canth, Chin, Oina, Cocc. Coff, Crotal. Euphr, Ferr. Graph. Ign. Natr, mur, Phosph. Pulsal. Rhus. Sil. Sulph. Thig. -biUous : Ai-n. Bryon. Cocc. Dros. 82 HKARTBUBN AND BEOUBOITATION. il^ N. vom. PuIb. Spong. Veratr — hot : Mancin. — spasmodic : Ferr. Nux TOin. FIiOHpIi. Buta. — loud : Ant. crud. Canst, Con. Kali c. Petr. Phosph. Plat. Piils. —empty: Aeon. Agar. Ahim. Ambr. Ant. crud. Am. Ars. Bar. Bell. Bryon. Calc. Cann. Canthar. Carb. Teg. Causi. Coloc. Con. Obamom. China. Cocc. Coflf. Colchic. Croc. Dulc. Euphorh. Graphit. Hell. lod. Ign. Ipec. Kali c Lye. Merc Mlllefol. Natr. mur. N. vom. Phosphor. Plumb. Plat. Rhus. Buta. Sabad. Sabin. Sep. SII. Spig. Spong. Staphis. Teratr. —sour: Ambr. Arsen. Bar. Bell. Bry. Calcar. Carb. Teg. Cham. Chin. Con. Dros. Dig. Graph. Ignat. Kail c. Kali blchr. Lye. Merciir. Natr. mur. N. vom. Op. Posph. Puis. Sabin. Sil. Stann. Sulph. Sulph. ar. Zinc. — fetid : Bism. Cocc. Merc N. vom. Sulph. Thuj. — incomplete: Am. Bell. Canth. Cina. Cocc. Con. Hyosc. Mille/ol. Natr. mur. Ph. ac. Ehus. Sabad. — suppressed: Aconit. Alum. Ambr. Bar. Bell. Calc. Canthar. Caustic. C. an. Cocc. Con. Hyosc. Ign. Kali carb. N. vom. Phosph, Plat. Plumb. Puis. Sulph. — repulsive : Asa f . Cina. Nat. mur. Ph. ac. Plumb. XII. HEARTBURN, REGURGITATION, HEABTBUEN : Agaricus. Alumina. Ambr. Ant. crud. Arg. Am. Bar, Bell. Calc Capsic Carbo veg. Caust. Cham. Chin. Croc. Crotal. Con. Dig. Didc. Ferr. Graph. lod. Ign. Lye. Merc. Natrum mur. N. Tom. Petr. BEGUBGITATION, bitter: Arnica. Bar. Bry. I>ro.s, Ign. Ntix vom. Phosph. Puis. Ehod. ~of blood : Canth. Chin. Merc. N. vom. — salt : Am. Lye. Veratr. — sour : Alum. Calc. Con. Dros. Nux vom. Petr. Plumb. Puis. Ehus. Sabin. Spong. Zinc. — of food : Antim. crud. Arnica. Beli. Bry. Camph. Canth. Carbo veget. Cham. Dulc. Ferr. Ign. Lye. Merc. Nux Yom. Phosph. Plumb. Puis. Sep. Sulph. — of water: Aco. Arg. Am. Bar. Bryon. Cann, Caust. Cina. Hep. Kali c. Merc. Nux vom. Petr. Phosph. Plumb. Puis. Sulph. ac. EISING: Alumina. BeUad. Calc. Chin. Phosph. Pulsat. Ehus. Sabad. Stann. — hot : Asa f . Canth. Carbo veg. Cio- Coflfea. Croc. Dulc. HpJL Merc- Nux vom. Plat. — cold: Veratr. — sweet: Aco. Chin. Plat. Mero Stann. — burning: Arsenic. Bov. Calc. Carbo veget. Croc. Hep. Hell. Lyci Nux vom. Phosph. Sabbia. Secalff com. Sep. Sil. Staph. Sulph. Thuj. Verat. Zinc. WATEE-BEASH, bitter: CheUdon, Graph. Nux mosch. Sulph. — sour: Bell. Calc. C. an. Con. Natrum c. Sulph. — general: Ant. crud. Arsenic. Bry. Carbo veg. Chin. Cina. Cocc. li Chin. Ignat. ''ercur, I. Puis. Sulph. vom. mur. NAUSEA AND VOMITING. 88 («raph. Hell. Ign. Kali c. Lye. Merc. Niix vom. Staph. Sulph. ^more fully ' Aco. Alum. Ars. Bar. Bryo. Calc. Canth. CariM) veg. Caustic. Cic Cina. Cocc. Dro8. Ferr. Hop. Ign. Kali o. Lye. Natr. mur. Nitr. ac. Nux vom. Pctr. Phoa. Puis. Sabud. Sep. 811. Spig. Staph. Sulphur. Veratr. -with shuddering: SiL —with hiccup : Aconit. Agar. Alum. Ant. crud. Arg. Ars. Asar. Bar. Bell. Bov. Bry. Calc. Canu. Canth. Carlo veg. Causticum. Cham. Cic. • Cina. Cocc. Coff. Colchicum. Con. CupK Dig. Dro.H. Dulcam. Euijhr. Euphorb. Graph. lod. Kali c. Merc. Natr. mur. N. vom. Op. Phosph. Pulsat, Samb. Sep. Spong. Staph. Stram. Sulph. Veratr, m. NAUSEA, TOfflTING. LOATHING: Aco. Ant. crud. Arg. Am. Asar. Bar. Bell. Bry. Canth. Cham. Chfai. Cocc. Colch. Cnpr. Digit. Dulc. Ferr. Hep. Ign. Ipe<'. Kali c. Merc. Nux vom. Op. Phosph. Plumb. Puis. Ehod. Sc- calel com. Sep. Sil. Spigel. Stram. Sulph. ac. TAUSEA, generally: Aco. Alum. Ant. crud. Aivj. Am. Ars. Bell. Bry. Calc. Cann. Carbo veg. Caus- tic. Cham. China. Cocc. Coff. Con. Oroc. Cupr. Dig. Dros. Dulc. Glonoin. Hep. Ign. Ipec. Kali c. Lye. Mosch. Mercur. Mancin. Natr. mur. Nux vom. Petr "'"losph. Ph. ac. Puis. Rhus. Ruta. Sabad. Sep. SU. Staph. Sulph. Veratr. — in the chest : Aco. Bry. . >?. Merc. Nux vom. Rhus. Sec. o/>m. Staph, —in the throat: Aco. Ars. Bell. China. "Cocc. Cofifea. Cupr. Cycl. Ferr. Merc. Ph. ac Puis. Rhus. Spig. Stann. Staph. Sulph. Valer. —in the stomach : Aconit. Am. Asar. Calc.(Cann. Cantharis. Cham. Chin. Cic. Cocc. Croc. Cupr. Hell. Jpcc. Kali carb. L]/c. Merc. Natr. nuir. Nnx vom. Phosphor. Puis, Rhus. Sil. Sulph. Veratr. — in the abdomen: Bell. Bry. Cocc. Cupr. Hell. Hep. Puis. Rheum. Samb. Sil. Staph, QUALMISHNESS: Aco. Arnica. Ars. Bar. Bellad. Bry. Calc. Caps. Carbo veg. Caustic. Cham. China. Cina. Coffea. Croc. Digit. Euphr. Hep. Ign. Ipec. KaU c. Lye. Natr. c Nitr. ac. Nux vom. Petrol. Phos- phor. Plat. Pulsat. Rhus. Sabad. Sil. Staph. Sulph. Thuj. Veratr. Zinc. RETCHING: Aco. Ant. crud. Arg. Am. Ars. Asar. Bell. Bryon. Canth. Chin. Cocc. Cupr. Dig. Dulc. Glonoin. Hyosc. Ipec. Lyc.Natram. mur. Plumb. Pulsat. Sabin. Secale com. Sulph. Veratr. VOMIT, inclination to: Aeon. Ant. crud. Ai'g. Am. Ars. Aiu. Asar. Bell. Bryon. Cann. Canth. C. veg. Cham. China. Cocc Coffea. Croc. Cupr. Dig. Ferr. Graph. Hep. Hyosc. Hell. Ign. lod. Ipec. Kali bichr. Lye. Merc. Mur. ac. N. vom. Op. Plat. Plumb. Puis. Pyro carb. Rhus. Sabina. Secale corn. Sep. X ■'' !■■ .>3r' i;i I: h Li i;i 34 NAtJBHA AND VOMTITOO. (tl I!' til ;i ,11 8il. Spig. Spong. Stapn. Strain. 8ulph. Thuj. Veratruni. —anxious : Aco. Calc. Caustic. Kail c Loch. Lye. Nitrum ac. Plumb. Sabad. VOMITING, generally : Antliiw crud. Arg. Arn. Arsen. Anar. Bar. Bell. Bryon. Calc. Camph. Cann. C'aii- thar. Caps. Cham. Chin. Cina. Cocc Coffea. Colch. Con. Ciipr. Dig. Bros. Dale. Euphorh. Fcrr. Graph. Holl. Hep. Hyosc. Ipcc. Iodine. Kali c. Lack. Lye. Mor- cur. N. vom. PhoHph. Ph. ac. Op. Plumb. Puis. Rutn, Sabhi. Sec. com. Sep. 811. Sulph. Veratr. Zinc, —bitter: Bryo. Cann. Canth. Chnni. Chin. Coco. Cupr. Ipec. Sec. corn. Sep. Sil. Sulph. Thuj. Voratr. — bloody: Aco. Am. Arsenic. Brij. Camph. Cann. Canth. Chin. Cupr. Bros. Ferr. Hyosc Iimh;. Lye. Nux TOm. Op. Plumb. Pulsat. BhuH. Sepiffi. Stann. Veratr. Zinc. — of brown substance: Arsenic. Bism. — bilious: Aeon. Ant. cnidum. Ars. BelL Blsm. Brjro. Camph. Cann. Canth. Cham. Colch. Con. Cupr. Dig. Dros. Bulc. Hyosc. Ipec. Iodine. Kali blchr. Lye. Merc Natr. mur. N. vom. Phosph. Puis. Sab. Sec com. Sep. Sil. Stann. Stram. Teratr. Zinc. — yellow: Arsen. Bryon. Cann. Colehic. lod. Ipec. Plumbum. Veratr. — yellow-green : Arsen. Bryon. Bulc. Ipec. Veratr. —of drinks: Ant. crud. Bulc. Ipec. >— green : Aco. Ars. Asar. Bry, Cann. Chamom. Crotal. Cupr. Digitalis. Hell. Hep. Hyosc. hpi, Ipec N. vom. Op. Plumb. Pulsat. Stram Veratr. — violent : Cupr. Ipec. Veratr. — greou-blackish : Plumb. Petr. • Phosph. — of \irino: Op. —of fooces : Bry. N. vom. Op. Plumb. — sour: Ars. Aaar. Bellad. Calc. CauHt. Cham. Chin. Cocc. Forr. GraphiieH. Hep. ipec Lye. Nux vom. Op. Phosph. Psorln. Puhat. Sabin, Secolo comut. Stann. Stram. Sulph. Veratr. — frothy: Veratr. — of mucus: Aeon. Ant. crud. Ars. Bar. Bell. Bry. Caun. Cham. Chin. Cocc. Cupr. Big. Bulc Ferr. Graphit. Hop. Hyonr. Ign. Ipcc Lye. Merc N. vom. Pulsat. Phosph. Sec. comut. Sil. Stram. Sulph. Veratr. — of food: Antim. mid. Arn. Ars. Bell. Bryon. Calc C'rf?i</(. Chamom. Chin. Chuu Cocc. Coffea. Coloc Dig. BroH. Ferr. Grapliites. Hyosc Ign. Ipec Kali blchr. Kali c. Lach. Lycop. Merc N. voin. Op. Phos. ac. Plumb. Puis. Pyro carb. Sabin. Sep. Sil. Stan. Sulph. Veratr. — fetid: Cupr. Ipec. Plumb. Sec. corn. Veratr. — watery : Asar. Bry. Cannab. China. Cupr. Dros. Ferr. Hyosc. Ipec. Pulsat. Stram. Veratr. — black : Ars. Calc. Camphora. Chin. Hep. Ipec. Lye. Mancln. Nux vom. Op. Petr. Phosph. Plumb. Secalo corn. Stram. Sulph. Sulph. ac. Veratr. — of worms: Aco. Anac. Ars. CIna. Coff. Ferr. Hyoscyam. Merc. Na- trum mur. Sabad. Secale com. Sil. Spigelia. Veratr. « '■'111 XIY. STOMACH AND PIT OF STOMACH. 1. Stomach. ACIDITY : Con. Graph. Sil. Sulph. acid. Zinc. AS IF BLOATED: Ahim. Hcllaa. Bov. Chin. Con. Croc. Diilc. Forr. HoU. lod. Kali bich. Lye. Nitr. iic. Niux viosch. Op. Petr. Phosph. Sab. Stann. Zinc. BURNING: Aeon. Ambr. Arg. Ars. Asa f. Bar. Bell. Bry. CahiU. Cal- car. Cauiph. Cnnth. Cups. C'aib. veg. Chin. Cic. Colch. Con. Croc. Digit. Eiiphorb. Graphit. Ignat. lod. Nux vom. Petr. Phosph. Phosph. ac. Sabad. Sec. coniiit. Sep. Sil. Sulph. —at the pylorns : N. vom. CANCER : Ars. Lye. N. vom. —as if something alivo in it: Cror, COLD : Ars. N. vom. Puis. Vcratr. COLDNESS: Alum. Arsen. Bar. Caps. Con. Graph. Ign. Natr. mur. Phosph. Sabad. Sulph. Sulph. ac. CONSTRICTION: Aco..4/?im. Bry. Bellad. Calc. Carb. veg. Chin. Con. Cocc. Euphorb. Lycop. Nux vom. Phosph. Plumb. Sil. Sulph. CONTRACTION OF PYLORUS: Ars. Euphorb. Ign. Nitr. ac. Nux vom. Phosph. Zinc. CRAMP: Ars. Ambr. Ant. crud. Am. Asa fast. Bar. Bellad. Brom. Bry. Calc Carb. veg. Cnust. Cha« mom. Chin. Cocc. Con. Cupr. Dig. Euphorb. Ferr. Hyosc. lod. Ign. IlMM!. Kali carb. Lye. Merc. Natr. c. Natr. mur. N. vom. Petr. Phosphor. Plumb. Puis. Psoriu. Sabad. Sec. corn. Seneg. Sep. Sil. Stann. Staph. Sulph. Sulphur, acid. Thuj. Valer. 'VfiTJiii'i' CRAMPY PAINS : Arn! Caust. Eti- phorb. Ign. Kali carb. Nux vora. Puis. CUTTING: Abara. Antim. or. Arg. A.sa f. Calc. Cann. Canth. Choi. Digit. Kali carb. Petr. Phosph. Stann. Sulph. EMPTY FEELING: Alum. Bar. Bry. Carbo veg. Canst. Chin. Dig. Graph. Ign. Ipec. lod. Kivli c. Knli bichr. Lye. Mur. ac. Natr. mur. N. vom. Petr. Phosph. Platin. Pliunb. Rhus. Sep. Veratr. FLATULi'iiNCE, feeling of: Arnica. Ars. Croc. N. mosch. FULLNESS, feeling of: Aco. Alum. Arn. Asa f. Asar. Bar. Bov. Calc. Canth. Carb. veg. Cham. Chin. Cocc. Ferr. Hell. lod. Kali c. Ign. Lach. Lye. Merc. N. vom. Opium. Petr. Phosphor. Puis. Rhus. Sa- bina. Sepite. Silicea. Stann. Sulph. Sulpli. ac. Valer. GRIPING : Caustic. Euphorb. Graph. Natr. carb. Pliosph. Sil. Stann. HEAT: Aco. Ars. Camph. Canth. Cocc. Con. Digit. Euphorb. Mm:. ac. Plumb. Phos. Sulph. INFLAMMATION: Aco. Ant. cr. Arsen. Bell. Brj'. Canth. Chin. Cic. Colchic. Hyosc. Ipec Nux vom. Phosph. Plumb. Puis. Sabad. Sec. (•or. Stram. Veratr. MOVEMENTS : Cocc. Cupr. lod. PINCHING: Argent. Arn. Asar. Bry. Canthar. Con. Croc. Dulcam. Hell. Nitr. ac. Rhus. Sep. Stann. Sulph. PRESSURE: Aeon. Agar. Ambr. Ant. crud. Am. Anac. Asa foet. Asar. Ars. Bar. Bell. Bov. Bryon. Calc. Canth. Carb. v. Caust. Cham. Chin. Cic Cocc. Coloc. Con. Crotal. Cupr. Dig. Ferr. Hell. Hep. Ign. Ipec. lod. Kali c Lye. Mercur. iiiHi n ' 1i 1 BPi 86 STOMACH AND PIT OF STOMACH. Wi Mur. ac. Natr. mnr. Nux yom. Op. Petr. Phosph. Ph. ac Plat, Plumb. Puis. Rhus. Sabin. Sec. corn. Sep. Spigel. Spong. Staph. Strain. SlI. Stann. Sulph. Veratr. PBESSURE AS FROM A STONE : Aco. Alum. Am. Ars. Bar. Bry. Calc. Carbo veget. Cham. Dig. Ferr. Kali c. Mere. N. vom. Op. Puis. Sepise. Sil. Staph. SiUpli. RUMBLING: Am. Arsen. Croc. Graph. Kali c. Natr. c. Phos. Ph. ac. Sep. Stann. Zinc. TEARING: Am. ^r.s. Puis. WEAK DIGESTION : Bar. Bryon. Calc Canth. Carbo an. Caust. Con. Dhin. Cupnim. Dig. Graph. Hyosc. Ign. Lye. Merc. Natr. c. N. rom. Op. iretr. PhospL. Pnlsat. Ruta. Valer. Veratr. Zinc. WRENCHING: Am. Calc Carbo veg. Caust. Chin. Cocc. Lye, N. Tom. Petr. Phosph. Puis. Sulph. Sulph. ac. 2. Pit of Stomach. ANXIETY: Ars. Bry. Calcarea. Cann. Canth. Cham. Chin. Cic. Con. Fcrr. Ign. Mercur. N. Torn. Pulsat. Salad. Sabina. Sec. corn. Stram. Stann. Sulph. BURNING: Ambr. Ant. cradum. 'Arg. Ars. Bry. Caps. Cham. Kali bichro. Mancin. Met'c. Natr. raur. Nux Tom. Phosphor. Pyro carb. Sec com. Sep. Sil. Veratrum. Zinc. CONSTRICTION: Agar. Alumina. Asar. Calc. Carbo veg. Digit. Dros. Kali c. Merc. Natrum mur. Plat. Rhus. Suiph. Zinc, CRAMP: Hyosc. Kali c. Nitric ac. Phosph. CUTTING: Anac. Bellad. Bnjon. Cann. Digit, Kali c. Mercur. Nitr. Phosphor. Sulphur. Valer. DIGGING: Arn. Chin. Cina. KaJic. Natr. mur, Phos. Sabad. Sulph. GNAWING: Glonoin. OPPRESSION: Ars. Ant. cmdum. Bell. Bry. China. Cocc. Hyosc. Platina. Plumb. Rhus. Sec. com. Staph. PBESSURE : Aeon. Anac. Am. Ars. Asar. Aur. Bar. Bellad. Bry. Caps. Carbo veget. Caust. Cham. China, Cocc. Cupr. Dig. Graphites. Hell. Hyosc. Ign. Ipse. Kali c. Lye. Merc. N. vom. Natrum mur. Petr. Phosph. Plat. Puis. Rliod.. Rhus. Sec. com. Sep. (Spigr.lStann. Staph. Sulphur. Valer. Veratr. PULSATIONS: Asa f. Cann, Cic lod. Merc, Puis, Rhus. Thuj, SENSITIVENESS: Alumina. Am. Bry. Camph. Canth. Carbo vege- tabilis. Cupr. Ferr, Hell. Hyosc. Kali c. Natrum c. Nux vom. Sec cornut. Spong, Stann. Veratr. STITCHES: Aconit. Anac. Am. Bar. Bell. Bryon. Calad. Canth. Caps. Choi. China. Cocc. Coff. Cupr. Dig. Dulc. Euphr. Graphit. Ign. Iodine. I|)ec Kali c. Natrum mur. Phosph. Plat. Plumb, Puis. Rhus. Sabin. Sep. Sil. Spig. Staph. * Stann, Sulph. Zinc, SWEAT: BelL Nux vom, Secalo com, SWELLING-. A.rfl. Aur. Bellad. Bryon. Calc Chaiiii. Cic. Coff. Fcrr. Hell. Kali c. Lye N. vom. Natr. mur. Op, Sabina, THROBBING : Arn. Ars. Asa f. Bell. Cann. Carbo veg. Cham. Cic Dros. Ferr. Ipec. Phos. Puis. Rhus. Sep. Sulph. TENSION : Aeon. Anac. Arsenic. Bry. Clmnu Cocc. Dros. Dulc. Hep. Kali c. Lycop. Mercur. Pulsat. Phosphor. Rheum. Sabin. Staphy sag. Stann. Sulph. Veratr. XV. HYPOCHONDRIA. 37 Lalic. (Z. Bignifles region ol the liver; S. region of spleen ; S. both Bides.; BUBNING : Aco. Alum. Bryon. Crotal. Ign, Mur. ac. Phosph. Phosph. ac. Plat. Secale corn. Sulph. —S.: Caun. Chel. Graph. Ign. Seneg. Spig. — B.: Laur. KaJi carb. Mercur. Sulph. CONSTRICTION, L: Aco. Asa f. Asar. Dros. Ign. DISTENTION, L: Am. BryoH. Lye. Merc. Sep. —S.: Merc. Natr. c. Nitr. ac. — B.: Calc. Cham. Ign. FLATULENCE: Cham. Chin. Colch. Igu. Nuxvom. Puis. Veratr. HARDNESS, L. : Am. Bryon. Calc. C^nu. Graph. Merc. Mur. niagn. —S.: lod. INFLAMMATION, L.: Aco. Bell. Bry. Cantli. Cham. Cocc. Ignat. Merc. Nux vom. Puis. Sec. corn. —S.: Aeon. Ars. Dros. Ferr. N. vom. Plumb. — B.: Aco. Canth. Niix vom. PRESSURE, L.: Aco. Ambr. Am. Ars. Asa f. Bar. Calc. Carbo veg. Camphor. Chamom. Chin. Cocc. Con. Graph. Ign. Iodine. Kali c. Lycop. Merc. Mur. niagn. Natr. mur. N. vom. Petr. Phosph. Rata. Sabad. Sabina. Sepia). Stann. Staph. Sulph. Veratr. Zinc. ~S.: Alum. Arn. Asa f. Bell. Camph. Cann. Chin. Con. Ign. Lycop. Mur. ac. Natrum mur. Petr. Plat Rheum. Rhodod. Rhus. Sassap. Sepiffi. Stann. Zinc, — -B.; Aco. Alum. Arn. ^sc/, Camph. Caps. Cham. Chin. Cocc. Con. Ign^ N. vom. Ph. ac. Rhodod. Sec. com. Spong. Staph. Veratr. Zinc. STITCHES, L.: Aco. Agar. Alum. Arn. Asa f. Bell. Bov. Bry. Calc. Camph. Canth. Carbo veget. Caust. Chin. Cocc. Con. Dulc. Graphites. Hyosc. Ipec. lod. Kali c. Laur. Lye. Merc. Mosch. Miu:. ac. Natr. c, N. vom. Phosphor. Platina. Plumb. Psorin. Ehus. Sep. Sil Sabad. Spig. Spong. Sulph. Zinc. — S.: Aco. Agar. Am. Arsen. Aur. Bar. Bry. Caust. Chin. Glonoin. Hep. Ignat. Ipec. Mur. ac. Na- trum mur. Ph. ac. Plumb. Rhodod. Seleu. Spig. Sil. Sulph. SWELLING, L.: Cann. China. N. mosch. — S.: Ign. N. mosch. Ruta. — B.: Aco. Alum. Arn. Arsenic. Bry. Canth. Chin. Ferr. Ipec. Phosph. Plumb. Pulsat. Sil. Spig. TENSION, L.: Ars. Brom.Bry. Calc. Carbo veg. Causticum. Ferr. Lye. N. vom. Sulph. Veratr. — S.: Camph. Con. Merc. Rhus. Zinc. — B.: Aco. \nt crud. Asa f. Calc. Cham. Uu. 1. Conium. Ferr. Hell. Lye. N. Vom. Op. Puis. Staph. Veratr. WARMTH, feeUng of: Sabad. XVI. ABDOlf^N. Sensations. ALIVE, as of something: Cu. . Croc. Hyosc. Ign. Merc. Plumb. Spong. Thuj. BALL, ascending: Aeon. Ignatia. Plumb. BLOATING: Aeon. Alum. Am- bra. Antim. cruu. Arg. Am. Ars. Asa f. Aur. Bar. Bell. Bry. Calc. Canth. Capsicum. Carbo an. Carbo vegetab. Caust. Cham. Chin. Cic. Cina. Cocc. Coloc. Con. Croc. Cupr. »f 88 ABDOMEN. u Dulc. Euphorbium. Euphr. Ferr. Oraphit. Hell.^ Hep. Hyosc. lod. Ign. Ipec. Kali c. Lachesis. Lye. Merc Mur. ac. Natr. nuir. N. vonu Op. Petr. Fhospli. Phos. ac. Plati- na. Plumb. Piilsat. Rheum. Bhod. Rhus. Ruta. Sabina. Sec. cornut. Sep. Sil. Spigel. Spong. Siannum. Staph. Strani. Sulphur. Thuj, Valer. Veratruni. Zinc. BOUNDING, as of something; Croc. BRUISING PAIN: Asa feet. Aur. Camph. Oann. Cina. Coccul. Coloc. Con. (Ferr.) Hell. Heft. s. c. Ign. Niix vom. Op. Phos. 'Isa- tilla. Samb. Sep. Staph. S. am. Sulph. Valer. Verat. BURNING: Aeo. Alum. (Ambr.) Arg. Am. Ars. Asa f. Bell. Bry. Camph. Canth. Caps. Carbo vegetab. Caust. Cham. Coccul. Coloc. Cuprum. Euphorb. Euphr. Graphites. Ipec. Kali c. Laches. Merc. N. voni. Phospli. acid. Plat. Plumb. (Puis.) Rhus. Sabad. Sabhi. Sec. cornut. Sep. 911. Spigelia. Spong. Stann. (Thuj.) Veratr. COLDNESS: Alum. Ambr. Ars. Kali c. Merc. Phos. Plumb. Ruta. Secale cornut. Sulphur. Zinc. CLOTHES TOO TIGHT, aa if the: Nux vom. CRAMPY FEELING : Ambr. Arsen. Carbo veget. Coccul. Coloc, Con. Graph. Phosph. Ph. ac. COLIC: Aco. Alum. Am. Acnen. Asa f. Atir. Bar. Bry. Cam.phora. Cann. Canth. Cham. Chin. Cocc. Coff. Coloc. Con. Cupr. Digit. Euphorb. Ferr. Hell. Hep. sulph. Hyosc. Ign. lod. Kali c Mur. ac. N. vom. Op. Plumbum. Puis. Ruta. SecHle com. Staph. Strain. Veratr. CONTRACTION: Arg. Aur. Bell. Calc. Carbo an. Carbo veget China. Coccul. Coloc. Con. Dig. Euphorbium. Ferr. Graph. Hep sulph. Ignatia. Jpec. Kali c. Lack Lycop. Nitric acid. N. Yoni. Petr. Phosphor. Ph. ac. Platina. Plumb. Rheum. Rhus. Sabad. Sabin. Sec. corn. Sep. Spig. Sulph. Thuj. CRAMPS: Alum. Ambr. Arsen. Aur. Bell. Bryon. Caustic. Chamom. Chin. Coccul. Coff. Con. Cupr. Digitalis. Euphorb. Ferr. Hep. su]"h. Hyosc. Ign. Ipec. Iodine. Kali c. Mosch. Mur. ac. N. vom. Plumb. Pulsat. Rhus. Sec corn. Spong. Stann. Staph. Stramon. Thuj. Valer. Veratr. CREEPING: Asa f. Carbo veget. Caust. Chin. Plat. Stann. Zinc. CUTTING: Alum. Ambra. Ant. crud. Arg. Am. Ars. Asa f. Bar. (Bell.) Bryon. Calc. Camph. Canth. Carbo an. Carbo veg. Caust. Cham. Chin. Cina. Coccul. Coff. Coloc Con. Croc Cupr. Dig. Bros. Dulc. Graph. Hep. sulph. Hyosc. IgnaU Ipec. lod. iMch. Lye. Merc Mur. ac. Natr. mur. Nltr. ac. N. vom. Op. Petr. Phosph. Ph. ac. Plat. Plumb. Puis. Rheum. Rhus. Sabad. Sabin. Selen. Senia5. Sil. Spig. Spong. Staph. Sulphur. Valer. Verat. Zinc. DIGGING: Alum. Arn. Ars. Asaf. Bell. Calc. Cina. Coloc. Con. Dig. Dulc. Graph. Kali c. Phosph. Phosph. ac Rheum. Rhod. Rhus. Sabadilla. Sep. Spig. Spong. Stann. Valer. DRAWING: Aco. Ars. Asa feet. Bar. Bry. Calc. Camph. Cann. Caps. Carbo veget. Chamom. Chin. Cic. Coccul. Coniiun. Cupr. Dros. Graph. Hep. s. c. Hyoso. Ign. lod. Lye. Nitruiu ac. N. vom. Op. Plat. Plumb. Puis. Rheum. Rho- dod. Rhus. Ruta. Sabin. Sep. ^g^^a^ ABDOMSK. 89 5 veget on. Dig. ph. Hep i c. Lack inn. Petr. a. Plumb. ibin. Sec. :iiuj. r. Arsen. Chamoiu. n. Cupr. rr. Hep. Iodine. N. voiii. ec corn. Stramon. 30 veget. Zinc. ra. Ant. a f. Bar. 7i. Canth. ist. Cham. >«. Coloc ^s. Dulc. sc. Ignat, ire. Mnr. , N. voni. ac. Plat. js. Sabad. il. Spig. r. Valer. JS. Asa f. Con. Dig. Phosph. 3(1. RhllH. Spong. Asa foot, li. Cann. Chamom. un. Cupr. mso. Ign. vom. Op. cm. Rho- In. Sep. iSpig. Stann. Staph. Stramon. Thuj. Valer. Verair. DBOPSY: Aeon. Ambr. Am, Ars. Bry. Oamph. Canth. Cliina. Dulc. Ferr. Hell, Kali c. Lye, Merc NiuK vom. Spong. DYSENTERIC PAIN: Am.Brxjon. Rhus. EMPTY FEELING: Ant. crudum. Am. Carbo veg. Caust. Cham. Cina. Cocc. Coloc, Croc. Dulc. Euphorb. Kali c. Lach. Merc. Mur. ac. N. vom. Phosphor. Pulsat. Rhus. Sabad. Sep. Stann. Zinc. FLATULENCE, moving about: Ant. cnid. Bell. Bry. Cann. Canth. Caps. Carbo an. Caust. Chin. Cina. Cofif. Croc. Dig. Euphorb. Hell. Hep. sulph. N. vom. Plat. Plumb. Fnlsat. Sabad. Stann. Staph. Sulph. FULLNESS: Alum. Ant. crudum. Am. Ars. Asa f. Aur. Bar. Calc. Camph. Cann. Canth. Cham. China. CIc Coffea. Coloc. Con. Croc. Dig. Ferr. Graph. Hell. Hyosc. Ignatia. Kali c. Lye. Mur. ac. Natrum mur. N. vom. Phosph. Phos. ac. Plat. Plumbum. Piilsat. Rheum. RhoG. Rhus. Sil. Spig. Spong. Svjan. Sulphur. Thuj. Valer. Zinc. ftURGLING: Alum. Ambr. Asa f , Carbo veg. Cham. Croc. Dig. Graph. Hell. Lye. Merc. Nux vom. Ph. ac. Plat. Plumbum. Sep. Stann. Valer. Zinc. GRIPING: Aconit. Bell. Cham. Ooloo. Con. Hep. s. Ipec. N. vom. Phosph. Pulsat. Sil. Stann. —colicky: Bry. Canth. Euphorb. Plumb. Ruta. Sil. HARDNESS: Alum. Ars. Be^ad. Calc. Caps. Caustic. Cham. Chbui. •^oloc Con. Cupr. Ferr. Orapliit. Hep. Bulph. Hyosc. Kali c. Marc. Phosph. numb. Puis. Sec com. Sep. Sil. Sulphur. Viler. Veratr. HEAT: Bellacl Bry cm. Calcarea. Camph. Canth. Carb. an. Caibo veg. Cic. CLiu Digit. Euphorb. Graph. Ipec. Lye Phosphor. Plumb.BMi&. Sil. Spong. Stann. Sulph. Zinc. HEAVINESS: Ambr. Asa f. Aur. Bell. Camph. Ferr. Graph. Hell. (Ipec.) Merc. N. vom. Op. Puis. Bhod. Rhus. Sec. com. Sep, Staph. INACTIVITY: Champhor. Cham- om. Kali c. Nux vom. Op, Staph. INDURATIONS: China. Lycop. Plumb. INFLAMMATION: Aeon. Arsm. Bellad. Bryon. Canth. Cham. Chin. Cic. Ipec. Jf. vom. Phosph. Plumb. Puis. Rhus. Sabina. Spongia. Stram. Yeratr. LABORLIKE-PAIN: kco.Asa.foet. Aur. Camph. Carbo vegetab. Cham, Cina. Coff. Cupr. Ferr. Hyoscyam. Ign. Ipec. Kallc Nux vom. Op, Puis. Rhus. Sabina. Sec. com. LARGE : Antim. crud. Calc. Caust. Coloc. Hep. sulph. Kali c. Sep. Staph. Thuj. LEAD-COLIC: Hyoscyamus. Op. Stram. MOVEMENTS, internal: Coloc. Croc. Cupr. Dig. lod. Nux vom. Thuj. Valer. Veratr. NAU.^EA : Bryon. Cic. Coccul. Croc. Cu])r. Hell. Ipec. Rheum. Ruta. Sa.ub. Silic. Stannum. Staph. PAIN, diarrhoeic: Ambr. Antim. omd. Arg. Asaf. Bar. Bellad. Bry. Calc. Canth. Carbo an. Carbo veg. Cham. Chin. Coff. Dig. Graph. Hell Ign. Kali c. Merc. N. vom. Njtr. ac. Op. Petr. Phosph. Plat. Pulsat. Rhod, Rhus. Sabin. Sec. com. Sep. Spigel. Staph. Vera- trum. Zinc. '" )l ill f i: . §' ill! I I' K 11 i^ 40 ABDOMEN. r —simple : Aco. Ant. crua. Arg. Ars. Bar. Bell. Bryon. Calc. Canth. Carbo veg. Causticum. Cham. China. Cic. Coloc. Con. Cupr. Bros. Euphorb. Euphr. Graphit. Hell. Hyosc. Ign. Ipec. lod. Kali c. Lye. Merc. Nitr, ac. Nux vom. Op. Petr. Phosph. Plat. Plumb. Puis. Rheum. Bhus. Buta. Samb. Sac: com. Sep. Sil. Spig. Stann. Sul- phur. Veratr. Zinc. PINCHING: Alum. Ant. cr. Ars. Asa f. Aur. Bar. BelL Bry. Calc. Cann. Canth. Carb. v. Caust. Chamom. Chin. Clc. Cina. Cocc Coloc. (Coflf.) Croc. Cupr. Dig. Bros. Dulc. Euphr. Graph. Hell. Hep. Hyois. Ign. Ipec. Kali c. Lye Merc. Mur. ac. Natr. mur. Nitr. ac. N. vom. Petr. Phosph. Ph. ac. Plat. Plumb. Puis. Bheum. Rhus. Rut. Sabacl. Samb. Sep. Silic. Spigel. Spong. Stann. Staph. Sulph. Valer. Veratr. Zinc. PEESSUEE: Aeon. Alum. Ambr. Antim. crud. Arg. Am. Ars. Asa f. Aur. Bell. Bry. Calc. Camph. Caps. Carb. v. Chin. Cina. Cocc. Coff. Coloc. Con. Croc. Cupr. Dig. Ferr. Hep. I^rn. lod. KaU c. Lye. Merc. Mosch. Mur. ac. Nitr. ac. N. vom. Opium. Petr. Phosph. Plumb. Pulsatilla. Bheum. Rhus. Euta. Sabad. Sabin. Samb. Sep. Sll. Spig. Staph. Valer. Veratr. Zinc, ^-outwards: Aeon. Asaf. Bell. Cann. Dulc. Kali carb. Lye. Mercur. Nitr. acid. Nux vom. Eheum. Thuj. —inwards: Bry. Bell. Eheum. Zinc. — as from a stone : Cupr. Hyosc. N. vom. Op. Puis. Sabad. PEESSING: Alum. Argonv. Chin. Coff. Coloc. Euphr. Ign. lod. Plat. Pulsat. Euta. Sulph. Thuj. Valer. Zinc PULSATION: AJum. Calc. Lycop. Mer«. Ziuo. QUALMISHNESS : Bar. Calc. Carb. veg. Ipec. Phosph. Plat. Eho- dodend. Spong. Veratr. EING ABOUND NAVEL, as if: Puis. SENSITIVENESS: Aeonit. Am. Bry. Canth. Cham. Cic. Coflf. Dulc. Mosch, Pulsat. Secale cornut. Stram. Valer. Veratr. SHOCKS: Am. Cannab. Platina. Stann. SOEE PAIN: Aeon. Alum. Ars. Bar. Bellad. Calc. Carb. veg. China. Cic. Coloc. Con. Croc. Euphorb. Kali c. Natr. mur. Nujc vom. Phosph. Sep. Stann. Sulph. Zinc. STITCHES : Alum. Ars. Asa f. Bell. Bryon. Calc. Cann. Canthar. Caps. Caust. Cham. China. Cina. Coccul. Con. Croc. Cupr. Dig. Ferr. Graph. Hell. Ign. (Ipec.) Kali carb. Merc. Nitr. ac. Nux vom. Phosph. Phosph. ac. Plumb. Puis. Ehodod. Euta. Sabad. Sep. Spig. Stann. Staph. Sulphur. Thuj. Veratr. Zinc. SWELLING: Aeon. Ant. crud. Ars. Bryon. Cann. Canth. Cham. Chin. Coloc. Con. Kali carb. Op. Plumb. Sec. corn. Sulph. TEAEING: Alum. Am. Ars. Aur. Bry. Calc. Canth. Carb. an. Carb. veg. Caustic. Cham. Chin. Coccul. Coloc. Con. Dig. Hell. (Ign.) Ipec. lod. Kali carb. Lye. Mei'c. N. vom. Phosph. Plumb. Pulsat. Ehus. Buta. Samb. Sil. Spig. Stram. Thuj. Veratr. Zinc. TENSION: Amn. Alum. Ambr. Ant. crud. Am. Are. Asa f. Bar. Bell. Calc. Caps. Carb. an. Carb. veg. Chin. Coloc. Graph. Hyosc. Ign. lod. Lye. Nitr. ac. N. vom. Opium. Petr. Plat. Plumb. Pulsat. Rheum. Ehododend. Sec. com. Sep. Sll. Spong. Stann. Staph. Stram Sulph. Thuj. ABDOMEN. it aa if: TWITCHING: Aur. Canth. Caust. Chin. Coff. Con. Dig. Graph. Ign. Kali c. Phosph. Rhus. THROBBING: Arn. Cann. Canth. Chin. Dulc. Ign. Kali c. Op. Plat. Selen. ULCERS: Cupr. Plumb. ULCERATIVE PAINS : Cann. Chin. Coccul. Cupr. Dig. Hell. Merc. Nitr. ac. Rhus. Sabad. Sep. Stann. UNEASINESS: Calcar. Dulc. Eu- phorb. Ipec. Kali c. Nitr. ac. Phosph. Plat. Sabin. Sep. URGING: Asa f. Bell. Calc. Carb. vog. Coloc. Dig. Dulc. Graph. Ign. lod. Kali carb. Phosph. Puis. Sep. Thuj. WARMTH: Canth. Caps. Cina. Coff. lod. Ipec. N. vom. Phos. Sabin. Sec. com. WEAK FEELING: Aeon. Carb. an. (Ferr.) Ign. Phosph. Platina. Rhodod. Sen. Stann. Zinc. WRITHING : Alum. Ars. Asa f. Bryon. Calc. Caps. Cina. Con. Dros. Dulc. Merc. Plat. Plumb. Rhus. Ruta. Sabad. Sabin. Silic. Staphys. Valer. Veratr. Region of the Abdomen. ABDOMEN, lower: Alum. Anibra. Ant. crud. Arg. Am. Arsen. Asa f. Aur. Bar. Bell. Bry. Calc. Campli. Cann. Canth. Caps. Carbo an. Cai'b. veg. Caust. Cham. Chin. Cic. Cina. Coccul. Coff. Coluc. Con. Croc. Cupr. Dig. Dulc. Ferr. Hell. Hepar. Hyosc. Ign. lod. Kali c. Lye. Merc. Natr. mur. Nitr. ac. N. vom. Pliosph. Ph. ac. Plat. Plumb. Puis. Rheum. Rhod. Rhus. Ruta. Sabad. Sabin. Sambuc. S< p. Silic. Spigel. Spong. Stann. Staph. Sulph. Thuj. Valer. Veratr. Zinc. —aides of : Aconitum. Alum. Ambr. 51 Antim.crud.Arg. Am. Ars. Asaf. Aur. Bar. Bell. Bry. Calc. Cavi- phor. Cann. Canth. Caps. Carb. an. Carb. v. Canst. Cham. Chin. Cina. Coccul. Coff. Croc Dig. Dros. Dulc. Euphorb. Ferr. Grapliit. Hell. Hep. s. c. Hyosc. Ign. Ipec. Ir I. Kalic. Lye. Mercur. Moschus. Natr. mur. Nitr. ac N. vom. Opium. Petr. Phosph. Plat. Plumb. Puis. Rheum. Rhodod. Rhus. Ruta. Sabad. Samb. Sep. Sil. Spig. Spong. Stann. Staph. Sulph. Thiy. Valer. Zhic EPIGASTRIUM: Aco. Ambr. Ant. crud. Arn. Ars. Asa f. Aur. Bar. Bell. Bry. Calc Camph. Cann. Canth. Caps. Carbo veg. Caust. Chamom. China. Cina. Coccul. Coloc. Con. Croc. Cuprum. Dig. Dros. Dulc. Euphr. Hell. Hep. sulph. Hyosc. Ignat. Ipec. lod. Kali c. Lycop. Mercur. Mosch. Mur. acid. Natr. mur. N. vom. Op. Petr. Phosph. Ph. ac. Plat. Plumb. Puis. Rhodod. Rhus. Sabad. Samb. Sep. Sil. Spig. Spong. Stannum. Staph. Sulph. Thuj. Valer. Veratr. Zinc. LUMBAR REGION: Aeon. Ambr. Ant. crud. Arg. Am. Aurum. Asa f. Calc. Cann. Canth. Carbo an. Carbo veg. Cham. China. Cina. Coccul. Coloc. Dig. Euphorb. Ign. lod. KaliJJc. Lye. Merc. Nitr. ac. Nux vom. Plumb. Pulsatilla. Rheum. Rhus. Rnta. Sab. Sec com. Sep. Spig. Spongia. Staph. Sulph. Thuj. Valer. Zinc. UMBILICAL REGION : Ac«). Alum. Ambr. Ant. crud. Arn. Asaf. 'Rat. Bell. Bry. Calc. Cann. Canth. Caps. Carbo an. Carbo veg. Causticum. Cham. Chin. Cina. Coccul. Color. Con. Dig. Dulcam. Graph. Hep. sulph. Hyo3c. IgntU ' lit '$ 42 CATARRH. Ipec. lod. Kali carb. Merc. Mosch. Mur. acid. Nux vom. Op. Pliospli. Fii. ac Platina. Plumb. Falsat. Bheum. Bhod. Bhas. Buta. Sahina. Sep. Sil. Spigel. Spongia Stann. Staph. Sulph. Tliuj. Valer. Veratr. Zinc. XVII. CATARRH. ■•-»"' 1^ im Sensations. H^ATAREH: Alum. Ambr. Antim. crud. Arg. Asa £. Ars. Bar. Bell. Bry. Calc. Camphor. Oanth. Caps. Carbo vegetab. Caust. Chiu. Cina. Coccul. Coloc. iCupr. Bros. Eaphorb. Euphr. Graphlt. Hell. Ign. lod. Kali c. Lack. Lye Merc. N. Tom. Natrum mur. Nitric acid. Petr. Phosphor. Ph. ac. Plat. Plumb. Puis. Bhod. Rhus. Selen. Sep. Sil. Splg. Spong. Stannum. Staph. Sulph. Thuj. Yeratrum. Zbic. — on one side : N. vom. Puis. — alternately fluent and stopped : Nux vom. Puis. — in the day time : N. vom. CATARRH, generally : Aeon. Am. Camph. Coccul. N. vom. PulS' Sabad. CATARRHAL FEVER: Aeon. BeUad. Bryon. Camph. Cham. Coff. Graph. Hep. s. Mercur. Nitric ac. N. vom. Rhus. Sabad. Sep. Spig. CATARRHAL DISCHARGE DE- LAYED: Calc CATARRHAL FEELING: Ambr. Ant. crud. Arg. Bry. Cann. Carbo an. Carbo veg. Cic. Coflf. Ign. Ipec. Merci Mur. ac. Nitr. ac. Phopph. Sabin. Thuj. CORYZA : Aeon. Alum. Ambr. Ars. Bar. Bellad. Bry. Calo. Camphor. Cann. Capsicum. Carb. an* Carb. veg. Caust. Cham. China. Coff. Con. Cupr. Big. Dulc. Graphites. Hep. sulph. Ign. Ipec. Kali c. Lye. Mosch. Mur. ac. Nair. mur. NItr. ac N. vom. Op. Petr. Phosph. Plat. Pulsat. Rhod. Sabin. Samb. Sep. Sil. Spig. Spong. Stannum. Sulph. Thuj. Zinc. — on side : Nux vom. — of infants: Samb. — evening and morning : Nux vom* DRY NOSE: Ambr. Bar. Bellad. Bry. Calc. Canth. Cic. Con. Dulc. Graph. Hyosc. Ignat. Ipec. Lye. Merc Mur. acid. Natr. mur. NItr. ac (Nux vom.) Petr. Phosph. Rhod. Sep. Sil. Spig. Sulphur. Veratr. Zinc DRY NOSE, without being stopped: Sep. — upper nostrils : Sabad. — front nostrils : Spig. MUCUS FROM THE NOSE, dis- charge of: Cham. Euphorb. Phos. Rhod. — arrest of discharge : Euphorb. Ph. ae. Rhod. NASAL MUCUS FROM THE POSTER. NARES, corrosive. Ars. Nux vom. Nitr. ac. Sil. — smarting: Ars. Sulph. without catarrh : Rhus. Sabad Selen. Spig. involuntary : Rhus. — bloody: Ambra. Bar. Canth. Caps. Caust. (Coccul.) Cupr. Graph. Kali c. Lach. Lycop. Merc. Natr. mur. Nitrum ac. N. vom. Petr. Phospb Ph. ac. Puis. Sabad. Sep. Sil. Spig. Sulph. Thvj. CATARRH. 48 ^burning: Arsen. Piilsai. Sulph. — tluck : Alum. Ant. crud. Bar. Calc. Gruph. Mivr. ac. Nutr. miir. Nitr. ac. Puis. Sabad. Sclen. Stnpli. Sulph. — thin: Camph. Capsic. Khus. Staph. —transparent: Sabad. — punilent: Calc. Cina. Con. Graph. Lach. Merc. Puis. and yellow : Calc. Cicuta. Con. SiUph. - —gelatinous: Selen, —yellow: Cic. Puis. Selen. — yellow-green : Natr. Phosph. Puis. Sabad. ftnd bloody : Sep. — yoUowish: Alum. Ant. crud. Bar. Bell. Graph. Nitr. ac. Puis. Spig. •^ and watery : Sep. - -greenish : Puis. Spig. — clear: Sabad. -An little lumps: Selen. —acrid : N. vom. Spig. pus : Merc. water : Ars. Lach. Lycop. Mur. ac. N. vom. Sil. — odor of catarrh : Puis. —suppressed: Spong. —fetid : Bellad. Calc Caustic.Graphit. Hep. s. Lye. Mercur. Nitr. ac. Puis. Sep. —indurated: Bryon. Lach. Sep. Staph, —increased: Arg. Bar. Calcar. Canth. Carbo veg. Cic. Cina. Coflf. Con. Euphr. Graph. lod. Lach. Mur. ac. Nux vom. Petr. Phosph. Plat. Rhod. Rhus. Sabad. SciU. Selen. Sil. Zinc, —watery: Alum. Bellad. Carbo an. Cliina. Coff. Con. Graphit. Ign. led. Lach. Mercur. Mur. ac. N. vom. Phosphor. Plumb. Rhus. Staph. Sulph. —white : Spig. —tenacious : Alumina. Canthar. Graph. Sabad. Sep. Spig. SNEEZr.NG: Alum. Ambr. Aat. crud. Arg. Arn. Ars. Asa f. Bar. Bellad. liov. Brxj. Calc, Cann, Canth. Carbo animalis. Carbo veg, CauHt. Chin. Cina. Coccul. Con. Croc. Dros. Dulc. Euphorb. Euphr. Graph. Hell. Hep. sulph. lod. Ipec. Kali c. Lac/i. Lye. Merc'. Mosch. Mur. ac. Natr. mur. Nitric acid. JV. vom. Petr. Phosph. Rhod. Rhus. Ruta. Sabad. Sepias. Sil. Spigel. Spong. Stannuvi. Staph. Sulph. Thuj. Veratr. Zinc. —troublesome: Phosph. Sulph. — racking: Sabad. —violent : Aconit. Bar. Capsic. Chin. Merc. Rhus. Sabad. —vehement: Cina. Puis. Rhus. Sabad. Valer. Veratr. — spasmodic; Rhus. —after tingling in nose : Ambr. Car- bo veget. Dros. Mur. acid. Nitr. ac. Puis. Spig. Zinc. — painful : Aeon. Dros. — without catan-h : Alum. Ars. Calo. Carbo veg. Caust. Cic. Con. Dros. Euphorb. Hyosc. lod. Lye. Mer- cur. Nitric acid. Phosph. Stann. Staiih. Zinc. — dry: Chin. — excessive : Bry. Merc. Sil. — suppressed : Aconitum. Alum. Carbo veg. Caust. Cocc. Natr. mur. Plumb. SU. Zinc. — desire for : Ambra. Carbo veg. Mur. ac. Phos. Sil. Sulph. Zinc. — — ineflTectual : Canth, Carbo veg. Caust. Euphorb. Hell. Lye. Phosph. Plat. Plumb. Sil. SNIFFLING: Sep. STOPPAGE OF NOSE: Alum. Ambra. Ant. crud. Arg. Aur. Bar. Bell. Bry. Calcarea. Carbo veg. Caustic. Cham. Chin. Cic. Cinn. Con. Digit. Graph. (Ign.) lod. . Kali 0. Lach. Lye. Merc. Mosch. Natr. mur. Nitr. ac. N. vom. Op. )»';'! I , t , a CATAItRH. il • i mm ._- a.. 1^1* Petr. rhos2)h. Plumbum. Puis. Jiliod. (lllms.)Snnib. .Sep. Sil. Spig. S!(nui. (Stuph.) Stram. Suliih. Thuj. Ziud. — behind: Staph. — iu front : Arg. Spi}?. — iu ouo nostril: Ignat. Sabad. Staph. — as from a leaf liigh up: Ignat. Mur. ac. — feeling of : Plumb. Slrnm. — by ulceration every night: Lycop. Accompanying Ailments. ABDOMEN, burning on: Carb. v. — mmbling in : Phosph. — stitchea iu : Carb. veg. BACK-ACHE : Kali carb. CHEEKS, rednesa of one half: Cham. N. vom. STUPEFACTION: Hell. CHEST, simple pain in: Aconit. Bry. Caust. — roughness : Carb. veg. Sulph. — stitches: Merc. — pain, as if flying to pieces: Cina. Sil. — constriction of : Phosph. CHILLINESS: Caust. Graph. Sulph. — and heat altem. : Graph. COLIC: Ci>lc. — aching: Aeon. Canth. COUGH: Bell. Cupr. Nitr. ac. N. vom. Suli>h. — desire to, in throat: Petr. Sep. Sulph. DIAREHCEA: Sep. DRAWING IN THE ARMS: Sep. DRY LARYNX: N. vom. DRY MOUTH: N. vom. DROWSINESS: Cham. N. vom. Petr. DULL FEELING IN HEAD: Cham : Hell. DYSPNCEA: Sep. EARS, buzzing in the: Rhodod. Sep. — pains in the : Am. Lach. Puis. EYES, pain in the : Sep. —red : Vcratr. —weeping : Alum. Carbo veget. Chiu. Euphr. N. vom. Staphys. Voratr. — lids, rod : Subiwl. — closed by gum : Caust. —smarting in the corners of • Carb. veg. FACE, bloated : N. vom. Staph. — hot : N. vom. Rhodo/l. FEVER CHILL: Bry. Caps. Cha- mom. N. vom. Puis. Spong. — heat: Spig. HEAD, burning in: Calc. HeU.^|/c. N. vom. Phosph. — simple pain in: Aeon. Byron. Calc. Caust. Chin. Cic. Cina. Euphr. Graph. Hell. Kali c. Lach. Lye. Nitr. ac. N. vom. Phosph. Puis. Rhodod. Sep. Spig. Thuj. — stitches: Sabad. — cloudiness: Staph. — contraction: Sabad. —dull: Chin. Dulc. Euphr. HelL Lye. rhoxph. Rhodod. HOARSENESS: Ars. Caust. Kali carb. Nitr. ac. N. vom. Puis. Spig. HOT HANDS AND FEET : N. vom. — at night : Lye. LANGUOR: Graph. Sep. LIMBS, pains in the: Calc. Caust. Ipec. — distortion of : Phosph. LIPS, corrosive : Cnnu. — chapped: Chamom. HeU. Staph. — itching: Hell. LOSS, of appetite: Phosph. — of wueil : Arn. Cina. Coccul. Hell. N. vom. Puis. Rhod. Sabad. Spig. Staph. — of taste: Puis. Sabad. NAUSEA: Graph. NOSE, sensitive: Calcar. China. N. vom. —burning : (Am.) Puis. — inflammation : Lycop. Merc. Stann. BREATHINQ, RESPIRATION. 46 .—biting in the : Garb. veg. Euphorb. — ulceration: Chain. ^swelling: Bi'y. Cham. Puis. Rhus. Spig. —heat : N. vom. —itching : Nux vom. Sabad. Spig. under the nose : Hell. — titillation : Capsic. Garb. veg. Nnx vom. Puis. Sabad. Sep. Staph, —scraping : N. vom. —soreness: Lack. Nu.\ voiii. Puis. Spig. — sore pain; Ghina. Nitr. acid. N. vom. Staph. NOSTRILS, ulcerated: Bry. Gale. Cocoul. Ign. Lye. Merc. Petr. Puis. PHOTOPHOBIA: Puis. SICK FEELING ALL OVER: Phosph. SLEEPLESSNESS: Ars. SUBMAXI]^LARY GLAND, pains iu the : Graph. THIGHS, drawing in the : Sep. THIRST : Cham. Graph. Lye. THROAT, inflamed: Phosph. —creeping iu : Kali c. — simple pain iu : Nux vom. — feeling of roughness : iV. vom. Nitr. ac. Phosph. Rhodod. THROAT, stitches iu: Nitr. ac. —scraping in : N. vom. — mucus in : N. vom. TOOTH- AGHE : Ghin. Lach. UPPER LIP, inflamed: Lye. URINE, flow of: Veratr. VERTIGO : Ghin. N. vom. WHINING MOOD : Puis. «pig. YAWNING: Bry. Gupr. HeU. ,.1'. :: x\ XVllI. BREATHING, RESPIRATION. Sensations. ASTHMA: Acq. Ant. crud. Aru. Ars. Asa f. Aur. Bell. Bry. Cale. Capsic Garb. anim. Garb. veg. Cham. Chin. Cic. Gina. Goccul. Goloc. Con. Cupr. Dig. Dros. Euphorb. Euphras. Ferr. (irapldt. Hyoso. Ignat. Ipec. lod. Kali c. Lye Mere. Mur. ac. Nalr. mur. Nitr. ac Nux vom. Op. Petr. Phosph. Plat. Plumb. Puis. Rheum. Rhod. Buta. Sabin. Sec. cor. Sep. Sil. SpicJ(Spong.) Stann. Staph. Sulpli. Thuj. Veratr. Zinc. — spasmodic : Aconitum. Ambr. Caust. Cham. Ghin. Goffea. Cupr. Ferr. Ii)ec Kuli c Mosch. N. vom. Op. Puis. Samb. Veratr. BREATHING, moaning: Ipecac (See also : groaning.) —Anxious: Aeon. Am. Ars. Bellad. Bryo* Camph. Cham. Coif. Ferr. Hep. s. Igu. Ipec N. vom. Op. Phosph. Plat. Plumb. Puis. Rhus. Samb. Socalo corn. Spig. Spong. Staph. Strum. Thuj. —intermittent: Camph. Op. — wheezing: Cham. Chuia. Nitr. ac. — noisy: Aeon. Ghiu. —hurried: Ipec. Samb. —labored : Aco. Ign. Spong. —hot: Aco. Ant. crud. Bry. Brom. Cham. Coffoa. Ferr. Natnim mur. Platina. Rhus. Sabad. Sidph. —cold : (Carbo vegetab.) Chin. Rhus. — cooling in trachea: Arn. —panting: Arn. Camph. Cupr. i/je*;. Nitr. ac. Op. Phosph. Sil. Spong. Stann. —small: Bell. — spasmodic: Puis, —slow: Aconit. Camph. Ghina. Cic. Hyosc. Ign. Nux vom. Op. Spong. Staph. ir at 46 BREATHINO, BESPIBATION. —loud: Aco. Cina. Op. Veratr —low: Ign. ^deficient: Bell. Caraiih. Cau- tliaris. Caustic. Cic. Coccul. Dig. Ferr. Hell. Isii. Ipec. lod. Merc. Nux vom. Platina. Puis. Bhus. Spig. Spoug. Stanii. Staph. Yemtr. — faint: Chiu. Nitr. ac. Opium. Phosph. Veratr. — wheezing: Calc. —piping: Alum. Ambra. Cann. Cham. China. Cina. Cocc. Coloc. Hep. suljih. lod. Kail c. Lye. Natr. mur. Nux vom. Phosph. Plumbum. Sabad. Sainb. Sep. Spo7ic. Siilpli. — having an odor: Ars. Aur. Natrum mur. Nitr. add. Petr. pungent: Dros. foul: Aru. Arsen. Aur. Bry. Cham. Chin. Graph. lod. Nitr. ac. Puis. Ruta. Sabin. Sep. Spig. like milk : Spong. sour : (Cham.) Nux vom. like sulphur : Nux vom. ■ fetid: Aco. Ambr. Am, Aur. Bar. Bellad. Bryo, Camph. Canth. Caps. Carbo animal. Carbo vegetab. Cham. Chin. Croc. Ferr. Grajjh. Hyosc. Ign. Ipoc. Kali c. Merc. N. vom. Petr. Plumb. Puis. Rheum. Sep. Spig. Staun. Stram. Sulpli. Zinc. BREATHING, short: Aeon. Alum. Arn. Ars. Asa f. Aur. Bar. Bell. Bry. Calc. Campli. Cann. Canth. Carbo veg. Canst. Cham. Chin. Cic. Cina. Coccul. Coffoa. Coloc. Con. Cupr. Digit. Euphorb. Eu- phrasia. Ferr. Hepar. sulph. Hyosc. Ign. Ipec Kali carb. Lijcop. Merc. Natr. mur. Nitr. ac. N. vcm. Oj). Petr. Phosph. Plat. Plumbum. Puis. Rhod. Rhus. Ruta. Sabad. Sabina. Samb. Sec. corn. Sep. Sil. Spig. Spoug. Staiuu Stram. Sulph. Veratr. Zinc; —heavy: Aco. Alumina. Arg. Arn. Ars. Asa f. Aur. Bar. Bell. Bry. (!alc Camph. Cann. Canth. Caps. Carb. veg. Caust. Chin. Cic. Cina. Coccul. Con. Croc. Cupr. Dig. Dros. Euphr. Ferr. Graph. Hell. Hep. s. HyoHc. Iodine. Kali c. Lye. Merc. Nux vom. Op. Phosph. Ph. ac. Plat. Plumb. Pulsal. Rhod. Rhus. Sabad. Sec. com, Solon. Sep. Sil. Spig. Spoug. Staun. Staphysag. Stram. Sulph. Thuj. Valer. Veratr. — deep: Ant. crud. Aru. Aurum. Bell. Bry. Camph. Cann. Caps. Cham. Chin. Cic. Dig. Dros. Hull. Hep. suljjh. Ign. I|)ec. Kali c. Merc. Mosch. Mur. ac. N. vom. Op. Phos. Plat. Plmnbum. Rhus. Selen. (Sil.) Spong. Stann. — disposed to draw along: Croc. Cupr. Hell. Luch. Mosch. Rhus. Sabin. Selen. Stram. BREATH, stoppage of: Asa fcBt. Bell. China. Cic. Coflf. Dros. Mosch. Opium. Pulsat. Ruta. Zinc. — incarceration of: Aco. Arn. Bar. Bellad. Bryon. Calc Camph. Cann. Canth. Capsic. Carbo an. Cina. Cocc. Croc. (!upr, Bros. Euphr. Ipec. Kali ciu-b. Mosch. Natr. mur. Nitric ac. Op. Phosph. Plat. Plumb. Puis. Rhus. Ruta. Sabin. Sep. .Sil. Spig. Spong. Staphya. Stram. Sulphur. Veratr. BREATHING, oppressed: Aconit. Alum. Ambr. Ant. crudum. Arg. Arn. Ars. Asaf. Aur. Bar. Bellad. Bryon. Calc. Camph. Cann. Canth. Caps. Carbo an. Carb. veg. Caust. Cham. Chin. Cina. Ccccul. Cojf. Coloc. Con. Croc. Cupr. Digitalis. Dros. Dulc. Ferr. Graph. Hell. Hep. sulph. Hyosc Ignatia. Ipec lod. Kali c. Lycop. Merc. Mosch. Mur. ac. Natr. mur. Nitric ac. N. voMi. Op. Petr. Phosph. Phoa. ac. BBKATHINO, RESPIRATION. 47 Croc. Rhus. Plat Plumo. Puis. (Rheum.) Rhod. Rhus. Ruta. Sabad. Sabinu. Samb. Sec. com. Sepiae Sil. Splgr. Stann. Staph. Stram. Sulph. Thuj. Toler. Veratr. Zinc. EXPIRATION, blowing: Chin. '-^low: (Arnica.) Oamphora. Ohain. Ohin. Hell. Ign. —quick : Chin. Ign. Stram. — sniflling: Rhus, —difficult: Ipec. —strong: Caps. Ohin. INSPIRATION, slow: Ferr. Iguat. Op. Staph. Stram. —stertorous : Nux vomica. Op. Puis. Rheum. ^quick: (Arnica.) ( Camphor? ) Cham. Ign. —difficult : Chin. Cina, Coccul. Fen\ Ign. Staph. Veratr. —liko urine: Graph, —rattling: Aeon. Am. Bell. Bry. Calo, Cann. Carbo an. Causl. Cham. Chin. Cina. Croc. Cupr. Ferr. Hyo8c. Ipec. Lye Op. Petr. Samb. Sepiso. Spong. Stannum. Stram. — hiccuping : Asa f . Op. Sec. com. —stertorous: Bellad. Cham. Chin. Coccul. Cupr. Hep. sulph. Ig^i. Kali c. Natr. mur.Nitric acid. Nux vom. Op. Petr. Sep. Stanuum. Stram. Sulpli. — painful: Aeon. Arn. Arsenic. Bry. Chin, —quick: Aeon. Asa f. Bell. Bryon. Cupr. Dig. Hell. Hep. s. Ign. Ipec. N. vom. Op. Samb. Secale comut. Spongr. Stram. Veratr. —sniffling: Arn. China. Nux vom. Rhus. Sabin. —sighing: Ant. crud. Capsicum. Chin. Coccul. Op. Secale corn. Selen. Stram. EXPIRATION, groaning: Bell. Bry. Cham. Cina. CoccuL Cupr. Ign. Kali c. Mur. ao. Nux vom. Op. Sec. corn. Strain. — inequal : Coccul. Ignat. Ipec. Op. Sec. com. —imperceptible: Veratr. — irregiUar: Bell. — intemipted : Aeon. Cham. Cio. Cina. Cupr. Ignat. Op. Puis. Phosph. — suppressed: Cupr. SUFFOCATING FITS: Aeon. Ant. crud. Ars. Bell. Bryon. Camph. Cami. Causticum. Cham. Cliln. Coccul. Coff. Con. Cupr. Digit. Hep. sulph. Hyosc. Ignat. Ipec. Lach. Mosch. Nux vom. Op. Plat. Plumb. Puis. Rhus. Sabad. Samb. Sec. corn. Spoug. Staph. Sulph. Veratr, Causes of the Impeded Respiration. ABDOMEN, flatulence: Capsic. Cham. Ign. — unpleasant feel : Ars. — simple pain : Arn. Bry. Ign. Ruta. — swelling: Bry. —pinching: Rhus. Spig. — cutting: Puis. — weight liko a stone : N. vom. --stitches: Croc. Dros. Mosch. Nux vom. Puh. Ruta. —fullness : Cann. Caps. Cham. Clihi. Phosph. — compression: Staph. — crying: Cupr. Rhus. Samb. — simple pain in : Stannum. — jerks iu : Calc. ANXIETY: Aco. Arnica. Croc. N. vom. Puis. Rhus. Ruta. Valer. Veratr. — fits of : Ars. Lye. Stann. ARMS ABOVE THE HEAD, rais- ing the: Cupr. BACK- ACHE: Arg. Cann. Lwh. Ruta. Sep. (Staph.) —dislocation-pain in : Petr, .I'J I $ ' 1'r .'.'■\ I IMAGE EVALUATION TEST TARGET (MT-3) // // 4?, 4^ 1.0 I.I 1.25 112.8 IM 11= i-4 ill 1.6 if m 6" P^. <^ //. /: "c^l <^,^\^ % 4 4^^^ '/ Photographic Sciences Corporation 23 WEST MAIN STREET WEBSTER, N.Y. 14S80 (716) 872-4503 4. iP V % .V f<p ^%*i> <^,^<> '^^ 48 *: 1 ^i & BRBATHINa, RESPIRATION. imple pain in : Puis. Selen. — fltitches in : Nux vom. Pula BLADDER, stitches in : Anr. BREATHING, nasal: Puis. CHAGRIN: Ars. Cham. CHEST, oppression in : Aconlt. Arn. Cann. Cic. Cin. Coccul. Coff. Bros. Ign. Merc. N. vom. Puis. Bhus. Sabad. Spigel. Teratr. -pressnre in the : Argent. Am. Asaf. Bellad. Camph. Cann.Caust. Cham. Chin. CIc Ign. N. vom. Rheum. Ruta. Sabad. Samb. Spig. Staph. Stram. Yaler. — spasm in the : Petr. —empty feeling: Stann. — faintness in the : Stann. — heaviness in the: Plat, ^-tension in the : Merc. Mur. ao. ^-stitches in the: Aur. Carbo veg. Mere. Stann. — fullness in the : Sep. — contraction in the : Sep. — as if oppressed by a load : Rheum. Sabad. Spig. — tdcerativepain: Staph, —throbbing in : Asaf. — spasms in : Asa f oet. Cupr. Plumb, —pressing in : Ign. Veratr. —mucus in: Cina. —pain generally : Selen. —weight in ; Cann. Ign. Rhus. —tension in : Cann. Cic Coccul. Puis. Rhus. Staph, —stitches in: Aeon. Arg. Asaf. Bry- on. Canth. Caps. Chin. Dros. Plumb. Ruta. Spig. Staph. Veratr. — shocks in : Caim. —fullness in: Aeon. Ant. or. Cat)s. Puis. Ruta. Veratr. — as if bruised: N. vom, — di-awing in : N. vom. — contraction in : Am. Asa f . Cau- thar. Capsic. Chin. Coccul. Capr. Hell. Ipec. MoHchus. N. vom. Op. Spig. Staph. Verntr. COUGH: Ars. Bry.CoccM?. Cuprum. Dros. N. vom. Petr. Rhus. Sil. Spig, Veratr. —dry: Cupr. Ipec N. vom, Rhus.. Sep.. CRAMP, in left side: Merc. DREAMS, anxious ; Graph. — as from dust : Ipec. EPIGASTRIUM, pain in: Arsenic. Coccul; Hell. Pulsat. Sep. Staph. FLATULENCE: Cham. Nux vom. Puis. HEAD, dull: Sep. — ache: Am. HEART, stitches in the : Cham. Petr. (Puis.) — region of, pain in the: N. vom. (Puis.) HYPOCHONDRIA, sweUing in: Cham. Ign. — pain in : Chin. Puis. Staph. LARYNX, mucus in : Chin. Cupr. — contraction: Sabad. Spougp. LIVER, pain in : Sep. LUNGS, weak: Stann. MORTIFICATION: Ign. Staph. NAPE OF NECK, drawing and stinging in: Sep. NAUSEA: Rhus. Samb. NOSE, dry: Canth. ODORS, strong: Phosph. PALPITATION OF HEART : Spig RECTUM, stitches in : Sulph. RIBS, pains under the : Sep. RISING, from abdomen : Valer. SCAPULiE, pressure in : Rhus. — pressure when leaning against : Sep. —stitches : Puis. Sep. , . — dislocation-pain: Petr. — drawing : Rhus. Ruta. STITCHES IN RIGHT SIDE: Graph. SPLEEN, pain in : Ruta. — stitches in : Arn. STOMACH, anxiety in pit of: Can- nab. Ferr. Sahad. Strain. — pressure in pit of: Am. Bry. Camph. Chomom. Chin. Cic. Coc- OOUQE. 4S cul. Helleb. Hyosc. Ignat. Mosch. Nux YOUi. Rhus. Samb. . -cramp in pit of : Sulph. —simple pain in pit of: Amic. Cina. Helleb. N. vom. Pulsat. Ruta. Sabad. —feeling as if swollen in pit of : Rhus. — stitches in pit of: Chin. Phosph. Spig. —warmth in ditto : Bry. — digging in ditto : Chin. —griping: Phosph. •^pain in: Caps. Cham. Rhus. — fullness in : Chin. Coccul. LIKE VAPORS OF SULPHUR: Groc. Mosch. TRACHEA, obstacle in: Cannab Spong. — tickUng: Rhus. — mucus in : Cupr, Ruta. VeratrunL — contraction of : Cantli. Ipec. Puis. THROAT, as if larger: Veratr. —scraping in: Sabad. — like a plug: Spong. —constriction : Canth. N. vom. Puis* Veratr. — rising in : Cann. Stann. — Uke a foreign body in : Cic. — mucus in: Aur. — dryness: Petr. — constriction : Cham. Coccul. THROAT-PIT, constriction in: Rhus. XIX. COUGH. Character of the ©ough. COUGE, ^n general: Aco. Ambr. Bell. Calc. Cann. Cantharia. Caps. , Carbo an. Carbo veget. Causticum. Cham. Chin. Cina. Coccul. Coloc. Con. Digital. Dros. Ferr. Euphorb. Graphites. Hep. s. Ignat. lod. Ipec. Elali c. Lye. Mercur. Mur. ac. Natr. mur. Nitric ac. Op. Petr. Phosph, Phos. ac. Plumb. Puis. Rhus. Ruta. Sabin. Sep. Sil. Spig. Spong. Staph. Sulph. -with expectoration: Ambr. Ant. crud. Arg:. (Am.) Ars. Asa f . Bell. Bry. Calc. Carbo veg. Caust. Cham. China. Cic. Cina. Con. (Croc.) Dros. Euphorbium. Euphr. Ferr. Graph. Hepar s. Ipec. Kali c. Lye. Merc. N. vom. Natrum mur. Petr. Phosph. Ph. ac. Pliunbum. Puis. Rheum. Rhus. Ruta. Sabad. Sabin. Secale cornut. Selen. Sep. Sil. Spigelia. Spong. Staph. Stront. Sulph. Te- ratr. —with easy expectoration: Argent. ': Euphr. Plumb. Puis. Staph. — with diflScult expectoration: Ambr. Ars. Aur. Bry. Camph. Cann. Canth. Caust. Cham. Cina. Dros, Euphr. Hjosc, Ign. lod. Kali c. Nux vom. Phosph. Plumb. Ptils. Sep. Stann. Staph. Sulph.Zinc. — without expectoration: Aconit. Alum. Ambr. Antini. crud. Am. Ai-s. Asa feet. Bar. Bellad. Bry. Calc. Cann. Canth. Caps. Carbo an. Carbo veg. Caust. Cham. China. Coff. Coloc. Con. Croc. Cupr. Digit. Dros. Euphorb. Fen\ Graphit. Hell. Hep. s. Hyosc. Ignat. lod. Ipec. Kali c. Lycop. Mur. ac. Merc N. vom. up. Petr. Phosph. Phos. ac. Plat. Plumb. Pulsat. Rheimi. Rhod. Rhus. Sabad. Sep. Sil. Spi- gel. Spong. Stann. Sulphur. Veratr. Zinc, —anxious : Aeon. Cina. Coff. Rhus. —fatiguing: Cocculus. Crocus. Ipec. N. vom. Rhus, -barking : Dros. Spong. ■ i -dull: Araen. Bar. Bell. Oaiboveg. if :4 4 •a'^^ it ,;■ 1 ' 1: ill ■■', I .■ills i- ' 1 5!«!. ,;'i . - '1 00 oouaH. !nri Euphorb. Hep. s. Kali c. Lyo.Petr. Phosph. Sep. —close: Asaf.Bry. Chamom. Coc- col. Sabad. — rockint;: Antim. crud. Ipec Pols. Bhus. —suffocative: Aco. Bry. Cham. Cupr. Ipec Op. Spigilia. Spong. —violent: Ambra. Cina. Con. Hep. s. Ign. Ipec Merc. N. vom. Phosph. Buta. Sabad. Spig. Spong. Stann. —hoarse: Aco. Ambr. Asa f. Brom. Chin. Cina. Drosera. 8amb. Spong. Veratr. —hollow: Aco. (Bell.) Caust. Cina. Euphorb. Heparsulph. Ign. Ipec Opium. P/iosp/i. Sambucos. Spig. Spong. Veratr. — hacking: Aeon. Alum. Ars. Cann. Canth. China. Ooffea. Coloo. Cupr. DroB. Euphorb. Hell. Hyosc. Ealic. Natrum mur. Op. Phosph. Plumb. Bhus. Stann. Sulph. Thuj. . and dry: Alum. Arg. Am. Ars. Bell. Canth. Capsic Carbo an. Caust. Cina. Con. Graph. Ign. Phosph. Sahad. Sabin. Sulph. Veratr. Zinc, —irritating: Coff. Ign. — spasmodic: Aconit. Ambr. Bell. Bry. Carbo veg. Chin. Cina. Con. Ferr. Hyosc Ignatla. Ipec N. vom. Phosph. Plumbum. Puis. Sep. SiL Staph. —short: Aco. Alumina. Arg. Arn. Ars. Aur. Bell. Canth. Carbo vege- tabilis. Caust. Coff. Euphorb. Ign. Ipec Merc Mur. acid. Nux vom. Natr. mur. Phosph. Platlna. Puis. Rhus. Sabad. Spigel. Spong. —scraping: Nux vomica. Puis. Sabad. — deep : Ambra. Ars. Drosera. Hep. s. Petr. Phos. Samb. Spong. Stann. Veratr. —unceasing: Cupr. Droser. Hyosc. Ipec —titillating: Alum. Arn. Asa f. Calc, Canth. Caust. Chamom. Chin. Con. Hyosc. lod. Kali. Mere. Nux vom. Natrum mar. Nitric ac. Phosph. Bhus. Stann. Staph. — with vomiting: Alumin. Arg. Ar- son. Asa f. Aur. Brj/. Calc. Carbo an. Carbo veget. Cina. Coccul. Coff. Dig. Dulc. lod. Nitric ac. Phosph. Plat. Puis. Bhus. Spong. Stann. Staphys. Zinc. — whooping: Aeon. Ambra. Am. Ars. Bell. Byron. Cham. China. Cina. Con. Cupr. Bros. Euphr. Hep. s« Hyosc Ign. Ipecac. Eali c Mosch. Mur. ac. N. vom. Opium. Phosph. Puis. Bhus. Buta. Sep. Spong. Sulph. Veratr. Expectoration. ACEID: Puis. BITTEE: Ars. Cham. Drosera. Ni. trie sf. Puis. BLOODY: Aeon. Alum. Am. Ars. Bell. Bry. Calc. Canth. China. Cina. Con. Croc Cupr. Daph. Dig. Bros« era. Bulc Ferr. Hepar sulph. Hy« osc lod. Ipec (Eali c.) Lye Merc. Jtfwn ac. Nitric ac. Op. Phos. Plumb. Puis. Rhus. Sabad. Sabina. Sec corn. Selen. Sep. Sil. Staphys. Stram. Sulphur. Zinc BLOOD, brown: Bry. Rhus. — tiiick: Cupr. — thin : Ferr. Sabln. — coagulated: Am. Bryonia. Canth. Nux vom. Nitric acid. Puis. Sep. — bright-red: Am. Cantharis. Chin. Bros. Hyoscyam. Rhus. Sabad. Sa* blna. Sep. Sil. — frothy: Am. Bros. Ferr. — black: Arn. Canthar. China. Croc Nux vom. Nitric acid. Puis. BILIOUS: Puis. TASTING OF OLD CATARRH: Ignat. Puis. Sulph. Zinc. COOL: Cann. Phosph. (Sulph.) COPIOUS: Alum. Bry. Gaust. Cle. OOCQH. $1 Cina. Bros. Euphr. Ferr. Graph. Eali o. Lye Puis. Sep. S?!. Stan- num. Sulph. HAVING A FOUL TASTE: Cal- carea. Carbo veg. Cham. Cupr. Ferr. Fhosph. Pulsat. Sepiae. Stanu. Ziuo. PBOTHY: Op. Phosphor. Plumb. Sil. GRANULAR: Chin. Phosphor. Sep. GLOBULAR: Thi^. GRAY : Ambra. Lycop. Sepise. Thiij. GREEN : Ars. Cann. Carb. veg. Ferr. Hyosc. Lycop. Puis. Sep. Stann. ThiU. INDURATED: lod. INODOROUS: Arg. LIVER-COLORED : Puis. HAVING A METALLIC TASTE: Ipec. MUCUS, bloody: Alum. Am. Ars, Bry. Chin. Con. Dros. Ferr. lod. Ipecac Opium. Phosph. Sabin. Sec. com. Selen. Sil. Spong. Ziuc. '—transparent; Ars. China< Sil. —yellow: Bry. Dros. Puis. —gray: Ambr. —blackish: Lye. —dry: Bry. Plumb, —•white : Ambr. Argent. Ciwa. Phosph. Rhus. Sep. Spong. — tenacious: Antim. crud. Ars. Bell. Bryon. Cann. Canth. Carbo veget. Caust. Cham. Coccul. Euphr. lod. N. vom. Phosph. Puis. Ruta. Samb. Sep. Staph. Veratr. Zinc. HAWKING UP OF MUCUS: (See Larynx.) NAUSEOUS: Dros. (Puis.) PURULENT: Bell. Calc Chin. Con. Dros. Ferr. Lycop. Eali c. Natr. mur. Fhos. Ph. ac (Puis.) Ruta. Sep. Sil. Staph. Zinc. SALT : Alum. Ambr. Ars. Bar. Cann. Oarbo veg. (Drosera.) Graph. Lye. Phos. Puis. Sep. Stonn. Sulph. SOUR: Calc. Phosph. Ph. ao. SLIMY : Alumina. Ambr. Arg. Ars. Aur. Bar. Bell. Bryo. Calc. Caps. Caust. Chamom. Chhi. Cina. (Croc.) Digit. Euphr. Ferr. Hep. s. Hyosc. led. Ipec. Merc. Mur. acid. N'^itr. mur. Op. Phosphor. Plumb. Puis. Rheum. Rhod. Rhus. Sabin. Sec. corn. Selen. Sep. Sil. Spigelia. Spongia. Htann. Staph. Sulph. Z.'iic. HAVING A BAD SMELL: Arsen. Calc. Staun. — • — taste: Ars. Stann. LIKE STARCH: Arg. Bar. SWEETISH: Calc. Ferr. Nuxvoro Phosph. Stann. TASTELESS: Arg. TENACIOUS: Alum. Ars. Carbo veg.Caust.Dulc, lod. KaU c. Phospk Sep. Stann. Zinc. THICK : Arg. Ipec. Lye. Phos. Stann. Sulph. Zinc. TITILLATING: Caust, LIKE TOBACCO : Puis. TUBERCLES, browuish: Phos. VISCID: (Rhus.) WATERY: Arg. ' WHITISH-YELLOW : Lyc.Phosph. ac. YELLOW: Ars. Bryo. Calc Droa Ign. Lye. Phosphor. Puis. Sep Spong. Stann, Staph. Tiny. Exciting Causes. AS FROM THE ABDOMEN: Ve- ratr. BY OPEx^ AIR: Ars. Lye. Phoeph. IN — — : Bry. Coccul. Ipecac N. vom. (Rhus.) Spig. BY GETTING ANGRY: (Cham.) FROM ASCENDING: Arg. N. vom. BY BARING ONE SELF : N. vom. BY DRAWING ALONG BREATH : Dulc. Hep. s. BREATHING : Bellad. Coloc. Dulc. Graphit. Hepar sulph. Natr. mur. Sulph. Nil -it^: ■.:^t f '% hi •I-;, li W OOUOH. i BY BENDING IN THE CHEST: Fhos. acid. AFTEB CHAGRIN: Aco. Bry. IN COLD AIR: Aco. Bry. Carbo veg. Hepar sulph. Phosphor. Spoug. BY TAKING COLD: Bryo. Cupr. Bros. Ipec Op. N. voni. Rlius. FROM TAKING COLD : Carbo veg. Dub. Hep. s. Petr. Phosphor. BY CONTRACTION OF ABDO- MEN: Bros. BY GETTING COOL : Am. Rhus. AFTER CRYING: Ain. AFTER DRINKING: Aeon. Ar- senic. Bry. Cocciil. Ferr. Hep. sulph. Lye. N. voui. Op. (Phosph.) FROM DRINKING COFFEE: Capsic. Cham. Coccul. Igu. N. vom. FROM DRYNESS : Puis. BY FEELING OF DRYNESS: Merc. AFTER EATING: , BelL Bryon. Chin. (Dig.) Ferr. N. voni. Opium. (Puis.) Ruta. Staph. Ziiic WHEN EATING: Carbo vegetabil. CoccaL (Puis.) Sep. BY EMOTIONS : Aeon. Am. Bry, Cham. Nux vom. Op. Rhus. Staph. AFTER ERUCTATION : Staph. BY EXPIRATION: Cann. N. vom. AS FROM FEATHER-DUST: Bellad. Calc Cina. Ign. BY HEAT OF BODY: (Aco.) BY GETTING HEATED : Aco. Bry. Ipec. N. vom. Thuj. AS FROM A HAIR ON THE TONGUE : Sil. HYPOCHONDRIA, irritation in: Thuj. — inspiration : Cina. Croc. Ipec. Puis. deep: Bry, Cina. Ipec. IRRITATION, generally: Aconlt. Alum. Arg. Arn. Ars. Asaf. Bar. Bellad. Bryon. Calc Cann. Carbo an. Carbo veget. Caust. Cham. China. Cina. Coccul. Coloc. Con. Croc. Dig. Euphorb. Ferr. Graphit. Hepar s. Hyosc* Ignat. lod. Ipec. Lye. N. vom. Nitric ac. Petr. Phosph. Pulsat. Rhodod. Sabin. Sep. Sil. Spig. Staiin. Staph. Sul- phur. Thiy. Zinc. Veratr. BY AN IRRITATION IN THE LARYNX: Aco. Alum. Am. Ar- sen. Bar. Bry. Canth. Caps. Carlo an. Carbo veget. Cham. Cina. Coccul. Cofif. Dros. Hep. s. lyn. lod. Ipec. Mere. Mur. ac. N. vom. Pulsat. Sabad. Sabin. Sep. Sil. Spongio. Staph. Sulph. FROM IRRITATION IN THE REGION OF THErVOIDlBODY : (Iodine.) Spong. FROM IRRITATION IN THE STOMACH: Bell. Bry. Merc. BY LAUGHING : Arg. Chin. Stann. BY LOSS OF BREATH: Aur. Coccul. J>roH. Euphr. Hep. sulph. Ign. Ipec. Nux vom. Spig. AFTER LYING DOWN: N. vom. Puis. Rhus. Ruta. Sabad. Staph. WHEN LYING DOWN : Ambr. Ars. Bellad. Cham. Coccul. Con. Dros. Ferr. Hyosc, Ignat. Ipec. Merc. Phosph. Puh. Rhus. Sabad. in bed : Cham. Ferr. Nux vom. Puis. Rhus. on the back : "S. vom. on left side : Aeon. Bryon. Ipec Phosph. Puis. on right side: Aco, Carbo aa Ipec. FROM MENTAL LABOR: Ignat. N. vom* BY MOTir Am. Ars. Bryon. Ferr. K, vom. BY MUCUS : Cham. Cina. Puis. BY MUCUS ON CHEST : Caustic. Staun, BY MUCUS IN TRACHEA: N. vom. FROM N A.USF \ : (Bry.) N. vom. OODOB. M WHILE NURSING: Chin. Ferr. DURING PREGNANCY: Ipecac. Fuls. BY PRESSURE: lod. BY READING : N. vom. BY READING ALOUD: Nitric acid. Phosph. IN REST: Caps. Dros. Euphorb. Ferr. Hyosc. N. vom. Phosph. Puis. Rhus. Samb. BEFORE RISING: N. vom. IN THE ROOM: Arg. Bry. Croc. Puis. Spig. IN SCREAMING: Arn. BY SHOCKS : N. vom. W^EN SITTING: HeU. Phosph. IN SLEEP: Arn. BeU. Calcarea. Cham. Lach. Nitr. ac. Sep. WHEN SMOKING: Aeon. Bryon. Coloo. Ferr. Hell. Ign. Nux vom. P etr. Spong. Staph. WHEN STEPPING INTO WA- TER: Spig. BY STITCHES: Aconit. Bryon. N. vom. WHEN STOOPING: Arg. Caust. Hep. s. Spig. BY SUFFOCATIVE FITS: Cham- om. Ipec. Puis. AS FROM VAPOR OF SULPH. Cai-bo veg. Chin. Ign. Lye. Puis. FROM SWALLOWING: Op. FROM TALKING: Bar. Cham. China. Hep. s. Ign. Ipec. Merc. Phosphor. Stann. Rhus. WHEN TEETHI'^G: Chamom. Cina. Hyosc. Ipec. Rhus. THROAT, as if swollen: Ars. — scraping in : Ambr. Croc, '-roughness in: Bry. Nitx vom. Plumb. Rhus. Sabad. —irritation: Coff. — scraping in: Puis. Sab. — mucus in : Caustic. Chamom. Coc- onl. Euphr. ^stitches in : Cham. Stann. —dryness in : Bry. Dros. Puis. Rhua. Stann. —constriction in : CoccuL Ign. —rising in: Cham. THROAT-PIT, tickling in: Bella. Cann. Cham. Coccul. Ign. Phos. ao. Puis. —pain generally : N. vom. STOMACH, tickling in pit of: Bar. Bell. Bry. Hep. s. Natr.' mur. Phosph. ac. BY TICKLING IN THROAT : Dig. N. vom. BY TITILLATION IN THROAT: Anibra. Bryon. Calc. Caustic. Chin. Euphorb. Hepar sulph. lod. Ziuc. HIP, twitching in : Ars. ON WAKING: Ign. Nux vom. Puis. Rhus. WHEN WALKING: Alumina. Ars. Carbo veget. Ferr. Natruiii niur. AFTER WALKING IN THE OPEN AIR : Ferr. Ipec. WHEN GETTING WARM IN BED : Cham. N. vom. Puis. BY WEAKNESS: Stann. WORSE BY COUGH : Ign. BY YAWNING: Arn. N. vom. Accompansring Ailments, ABDOMEN, pain in: Dron. Lyo. N. vom. Phosph. Ph. ac. SiL Ve- ratr. —cutting in: Veratr. — stitches in: Ars. Sep. Veratr. —shocks in : Natr. mur. — bruised in: Arsen. N. vom. Pals. — contraction: Dros. — pain in muscles of : Hyosc. — stitches in sides of : Arn. ABDOMINAL RING, stitches in: Veratr. ANXIETY: Aeon. Ciua. Coffea. Rhus. ASTHMA: Arn. Carb. v. Caust. Coccul. Dig. Eiiphorb. Ferr. Ipec. H f4' ' ft il ■ » " 'k 81 COUGH. Natr. mur. Phoiphor. Rhodod. Rhus. Sep. Veratr. BACK, stitches in: Ago. Chiu.Merc. Puis. Sep. BLADDER, pain in : Caps. BREATHma, breath, hot: Ant. cr. — snorting : Chin. —fetid: Caps. ~want of: Ferr. Ipec. —incarceration of : Aeon. Am. Bar. Bryon. Calc>« Gina. Cupr. Ipec. Mere. Nat. mur. Sil. Spig. CATARRH: Bell. CERVICAL GLANDS, pain in: Natr. muriat. CHCKING: Carbo veget. Droser. Hep. snlph. Ipec N. vom. Puis. Sep. Sulph. CHEEKS, drawing in : Carb. veg. CHILLINESS : Calcar. Carbo veg. Con. Phosph. Sulph. ^ COLIC : Arnbr. Arsen. Canth. Coloc. Con. Droser. (Ferr.) Ipec. Lycop. N. vom. Phosph. Sep. Stann. Ve- ratr. CONCUSSING THE BODY: Ant. cr. Ipec. Puis. Rhus. CONSCIOUSNESS, loss of: Cina. CONSUMPTION: China. Ferr. N. vom. Puis. CRYING : Amic. BeUad. Cina. Hep. 8. OHEST, oppression in : Rhus. Veratr. -burning in : Ant. crud. Carb. veg. Canst. Cina. Ferr. Phos. Ph. ac. Spong. —pressure in: Carb.'veg. Chin. lod. Ph. ac. Sil. — as if shaken: Rhus. — ulcerative pain : Staph, —as if hollow: Sep. Zinc. ' itching : Ambr. -- coldness in : Zino. -.-cramp in: Cina. - scraping in : Ruta. Staph. - roughness : (Am.) Carb. veg. Kail carb. Lye. Sep, —rattling: Bell Ciemst. Cham. COUGH, —pains generally: Ambr. Ars. Bel« lad. Carb. veg. Caustic. Cham. Cina. Coff. Dig. Dros. Kali carb. Lye. Merc. Mur. ac. N. vom. Nat. mur. Nitr. ac. Phosph. Ph. ac Puis. Sep. Spong. Snlph. Veratr. — relieved by pressure: Phosph. — cutting : Natr. mur. Sulph. —excoriated, as if: Carbo. veg. Lyo. Phosph. Sep. Spong. —heaviness: Zinc, —tension in : Phosph. Rhus, —stitches in: Aco. Am. .irs. Bell. Bry. Cann. Chin. Coff. Con. Drgs. Merc Nux vom. Natr. mur. Pulsat. Rhus. Sabad. Sep. Zinc. —fullness: Sabin. —qualmishness: Rhus. —as if sore: Alum. (Am.) Bar. Carb. veg. Cau^t. Cina. Hepar sulph. Ipec. Lye. Mur. ac. Nux vom. Nitr. acid. Phosph. Sep. Silic. Spig. Spong. Stann. Sulph. — pain as if bruised : Am. — as if flying to pieces : Arsen. Bry. Caps. Merc. Zinc. — drawing: Caps, —contraction: Dros. EAR-ACHE : Caps. (N. vom.) EPYGASTRIUM, pain in: Ambra. Bros. N. vom. — stitches in: Sep. ERECTIONS : Cann. Canth. ERETHISM, vascular: Am. Chin. ERUCTATIONS: uimbr. Veratr. EYES, obscured: Coff. — sparks before : Kali. — tears in : Cina.JPuls. Sabad. FACE, blue:«Ipec.j;Op. Veratr. — pale: Cina. —hot: Bell. Ipec.'Sulph. — sweat in : Ipec. —distorted: Spong. FAUCES, burning in: Caort. Ph. acid. COUQH. 6fi tr. —sore feeling in : Caust. FALLING DOWN: Ipec. FOREHEAD, cold sweat on : Veratr. HANDS, swellirg of: Aeon. — coldness of : Sulph. HEAD, pressure in : Alum. Bry, Con. Nitr. ao. Pliosph. Ruta, — as if shaken: Rhus.. — heat in: Ars. Ipec. Sulph. — tearing in : Alum. Calc. Sep. — pain generally: Aco. Bell. Bry. Chin. Con. Lye. Sabad. — stitches in : Aliun. Am. Bry. Calc. Carb. veg. Con. Ruta. Sabad. — shocks in : Arsen. Ipecac Lye. Natr. miir. Rhus. — as if bruised: Sulph. — as if flying to pieces : Bryon. Capa. Merc. Nuxvom. Natr. mur. Phosph. Ph. acid. Sep. Sulph. — contractive pain in : Petr. HEAT : Am. BeU. Nux vom. Sabad. HOARSENESS: Aco. Ambr. Asa feet. Chin. Cina. Droser. Samh. Sponi?. Stann. Verat. ILL-HUMOR: (Bell.) (Spong.) LARYNX, tdcerative pain in: Car- bo veg. — orawUng: Sabin. — irritation in: Coccul. —pain generally : Spon?. — stitches : Kali c. Phosph. —as if sore: Arg. Bry. Carboveg. Hep. sulph. Ign. EaU c. Natr. mur. Sep. LARYNX, as'if torn: Staph. LIMBS, pain in : Caps. MOUTH, dry: Coccul. NAPE OF NECK, pain in: Bell. NAUSEA: Bryo. Caps. Drosera. Ipec Merc. N. vom. Puis. Ruta. NOSEBLEED: Aco. I>ros. Merc. Puis. PAIN IN ARM: Dig. Puis. PALPITATION OF HEART: Ar- nlc Calc PAIN AS PROM HERNIA: Petr. — aa from fatigue : Puis, —generally: Ambra. Droser. N. vonu — tension: Hell, -stitches: Aco. Ars. Bryon. Phosph. Sabad. Sulph. — aa if bruised: Bry. — contraction in : Bros. —hip : Ars. Bellad. Caustic. Rhus. PRESSURE IN HYPOCHON- DRIA : Coccul. Spong. Valer. PENIS, pain in the: (Ign.) PTYALISM: Veratr. RECTUM, stitches in: Nitric ac. RESTLESSNESS: Aconit. Co£f. Samb. RIBS AS IF BRUISED : Am. SALIVA, bloody: Dros. SCREAMING: Op. Samb. SHORTNESS OF BREATH: Bry. SHOULDi;p, stitches in: Puis. — blade, stitches in : Mercur. Sep. SIDE, stitches in: Aco. Bry. Puis. Zinc. SLEEPLESSNESS : Hyosc Lycop. N. vom. Puis. Rhus. Sabad. SNEEZING: BeU. Bryo. Hepar sulph. SMALL OF BACK, pain in: Merc. — stitches in : Aco. Am. Nitric acid. SPERMATIC CORD, stitches in: Veratr. START, tendency to: Aco. STERNUM, pain of : Bell. Chin. Sop. Sil. STOMACH, pressure in: Lye. — pain in: Bry. Hell. Ipecac. Lye. Phosph. Pals. Rhus. Ruta. Sabad. Sep. — pressure in pit of: Phosph. — simple pain : SepioB. Stannum. Thiy. — pain generally : Ambr. Bryo. Ipec. —stitches : Ars. Bry. Phosph. Sulph. — qualmishness: Ign. — sore pain : Bry. — as if bruised: Stann. — contraction: Ars. ! ! 56 LARYNX AND TRACHEA. I ' SUFFOCATIVE FITS : Aco. Bryon. Cham. Ciipr. Hep. s. Ii)ec, Op. Spig. Spong. SWEAT : Ars. Dig. Hep. siilph. Ipcc. Ehus. Sabad. Spong. TASTE IN MOUTH, aa of blood: Bell. Rhus. — bad: Caps. TEETH, gritting of: Bell. TOOTH-ACHE: Lye. TREMBLING OF WHOLE BODY : Fhosph. TESTICLES, pain in: Zhic THROAT, bitter taste in : Rhus. — burning in : Mur. ac. Phosph. — pressure in ; Caps. — inflammation: Aco. Cham. Ijjec. Nux vom. Puis. — ulcerative pain : Caps. — as if BwoUen : Caps. Puis. — itching: Ambr. — titUlation : Bry. Kali c. — scraping: Ambr. Bell. Bry. Croc. Hep. s. .—roughness: Carboan. Caust. Hep. s. Kali c. Phosphor. Bhod. Sep. Spong. — pain generally: Caps. Hepar s. Natr. mur. Phosph. Sil. Sulph, --stitches in: Bryo. Nitric acid. Phosph. —dryness : Puis. Rhus. — sore pain : Ambra. Phosphor. Sep. THROAT-PIT, pain in: N. vom. THROBBING IN ARTERIES : Calc THYROID GIVND, itching in: Ambra. —CARTILAGE, titiUation in : Puis. TOSSING ABOUT : Aeon. Am. TRACHEA, itching in: Ambr. N. vom. — tickling in : Cham. Sabin. — pain generally : Camph. Chin. Ign. N. vom. Spong. — shocks: Bry. Cina. — as if sore: Ant.crud. Bryon. Cann. Caust. Chin. Nux vom. Natr. mur. Plumb. Stann. — as if torn : Staph. ULCERS, pain in: Con. UMBILICUS, pain in: Ambr. URINATE, urging to : Ipec. URINATION, involuntary: Antim. crud. Bry. Puis. Spong. Staph. Veratr. URINE, retention of : Ipec. VERTIGO : Aco. Coff. VOMITING, in general: Arnica. (Bell.) Bry. Calc Capsic. Carho veg- Con. Cuprum. Bros. Hep. s. lod. Ipec Kali c. Nux vom. Phosph. ac. (Puis.) Sabad. /Sep. — bitter: Cham. Sep. —of food: Bryo. (Dig.) Dros. Ferr. Natr. mur. (Rhus.) — of mucus : Dros. Hyosc. — sweet: Calo. —of water: Dros. WATERBRASH: Amb. Ars. Bry. Spig. Staph. WEAKNESS : Chin. Ferr. Veratr. YAWNING: Op. ,.u XX. LARYNX AND TRACHEA. Sensations. 1. Larynx. AIR, rising of : Lye. i. . . ; .! APHONIA: BeU. Carb. veg. Caust. Hep. sulph. Merc. Natr. mnr. Phos. Plat. BURNING : Canth. Chamom. Spong. CHOKING: Cupr. Bros. CONSTRICTION : Camphor. Cham. [ rerr. lahtotc and tbaohea. 67 Coccul. CoiT. Ipec. MohcIi. N. vom. Pliunb, Puis. Spong. Veratr. CONTRACTION: Spong. CONTUSIVE TAIN : Ruta. COUGH, desire to: Aeon. Arnica. Bry. Canth. Caps. Cham. Cliia. Coccul. Cofif. Droaer. Ign. Ipec. N. vom. Puis. Sabad. Sabin. Spong. Staph. CRAMPY FEELING: Cham. Nux vom. CRAWLING: Sabin. CROUP, gangrenous: Chhi. — membranous: Aco. Cham. Bros. Lach.'Snmb. Spong. DRYNESS: Alum. Carb. an. Con. Hyoso. Nuxlvom. Natr. mur. Petr. Phosph. Spong. Sulphur. Zinc. FOOD GETS INTO THE LAR- YNX: Aco. Cann. Bhus. Veratr. HAWKING UP MUCUS: Alumina. Ambr. Ant. crud. Arg. Aur. Bry on. Calc. Camph. Cann. Canth. Carb. an. Caust. Cham. Chin. Cina. Coc- cul. Croc. Dig. Dulc. Hyosc. lod. Kali c Lach. Lye. N. vom. Natr. mur. Phosph. Plumb. Rhod. Rhus. Sabad. Sabin. Samb. belen. Spig. 8tann. Staph. Sulph. Yaler. HEAT: Ant. rmd. Canth. lod. HOARSENESS: Aeon. Alumina. Ambr. Am. Ars. Asa f . Bell. Bry- on. Calc Camph. Canth. Caps. Carb. an. Carb. veg. Caust. Cham. Chin. Cic. Coff. Con. Croc. Cupr. Dig. Bros. Ferr. Graph. Hep. Ign. lod. Kali c. Lach. Lycop. Merc. Mur. ac. Nux vom. Natr. mur. Nit7\ ac. Op. Petr. Phosph. Ph. ac. Plat. Plumb. Puis. Rhus. Sabad. Samb. Sec. com. Selen. Sep. Sil. Spig. Spong. Stann. Staph. Stramon. Sulph. Thtij. Teratr. Zinc. INFLAmiATION: Aeon. Bros. Ipec. N. vom. Puis. Spong. ITCHING: Ambra. Con. Nux vom. 62 MUCUS, accumulation of: Alum. Arg. Ars. Calc Carb, an. Caust. Cham. Chin. Cina. Coccul. Coff. Dig. Hyosc. lod. Kali c. Lye. Nux vom. Natr. mur. Phosph. Samb. Sop. Stann. PHTHISIS OF LARYNX: Ambra. Carb. veg. Caust. Cupr. Dros. Ign. lod. Lach. Merc. Nux vom. Pulsat. Spong. Stann. Sulph. AS OF A PLUG: Bar. Kali c. PRESSURE: Bar. BeUad. Capsic Carb. veg. Cic. Graph. AS IF RAW: Arg. Puis. ROUGHNESS: Alum. Ambr. Ara. Bell. Canth. Caps. Carb. veg. Caust. Chin. Coff. Kali c. Mur. ac. N. vom. Natr. mur. Phosph. Phos. ac. Plumb. Pills. Rhod. Rhus. Sabad. Sil. Spong. Stann. Sulph. Zinc AS IF SCRAPED: N.vom. PuhaU Sabad. Veratr. SCRAPING: Alumin. Carbo veg. Ign. Kali c. Natr. mur. Nitr. acid. Rhus. Sabad. Spong. Staph. SENSITIVENESS: BeU. Laches. Phosph. Sulph. Hepar. sulph. lod. Phosph. Sep. Spong. Zinc SIMPLE PAIN: Aeon. Canthar. Hep. s. lod. Lach. N. vom. Spong. AS OF A SOFT BODY: Dros. SORE FEELING: Arg. Bry. Carb. veg. Caust. China. Graph. Ign. lod. Kali c. Natr. mur. Puis. Sep. SPASM: Mosch. Veratr. STITCHES: Capsic. China. Dros. Hyosc. lod. Kali c. Nitr. ac. Phosph. Spig. Zinc. AS IF STOPPED UP: Spong. LIKE VAPOR OF SULPH. : Mosch. SWELLING: lod. Sil. AS IF SWOLLEN: Cans. lod. TEARING: Ign. TENSION: Spong. TICKLING : Oalcar. Carb. veg. Con. Hep, s. Ipec. Merc Sabin. Zlmc 1, ll ill! i f 4 I hi i li ^ 't i KXTEBNAL NECK AND NAPE OF THE NECK. TINGLING: Con. Dros. Graphit. lod. Kali c. Natr. mur. Sep. Zinc. VOICE, raised: Stann. --impure: Baryta. Carbo vcg. Caust. tiraphiU Merc. Natr. uiur. Suljpb. S. Trachea. BUKNING : Euphorb. Phosphor. Bhus. Sulph. Zinc. COLDNESS : Camph. Sulph. AS IF CONSTRICTED: Ars.Ignat. Jpec. Mosch. N. \om. Puis. Rhus. AS IF CONTRACTED: Coccul. Lach. Staph. COUGH, desire to: Aeon. Arg. Am. Asa feet, Bryon. Cann. Cham. China. Cina. Coco. Croc. Ferr. Hy- 08C. Ignatia. Ipec. Ntix vom. Puis, Sabina. Spig. Staph. Veratr. CROUP ::Hep. Phosph.. DRYNESS: Alum. Carbo veget. Canst. Cina. Phosph. Puis. Rhod. Sep. Sulph. Zinc. FEELING OF : Camph. Causticum. Phosph. Puis. Stann. HEAT: lod. INFLAMMATION: icon. Capsic. Con. Drosera. lod. Ipecac. Spong. ITCHING: Ambr. N. vom. Puis. MUCUS, accumulated : Alumina. Arg. "Aur. Bar. Bell. Calc Camph. Cann. Capsicum. Caust* Coccul. Cnpnun* Hepar s. Hyosc. Ignatia. lod. Lye N. vom. Natmm mur. Nitric ac. Op. Phosphor. Phmib. Puis. Samb. Stann. Sulph. Zinc. (See larynx.) NUMB FEELING: Aco. SIMPLE PAIN: Camph. Capsic. Carbo an. Chin. Ign. N. vom. Phosph. Puis. Spoilt^. , y , PHTHISIS OF TRACHEA: Aco. Arg. Am. Calc Caust. Chamom. Cupnmi. Dros. Ferr. Hep. Lyo. N. vom. Nitric ac Phosph. Puis. Ehu^. Spong. StAnn. Sulph. l\.rair. PRESSURE: £ar, Graph. Phosph. Thuj. ROUGHNESS: Alum. Carbo veg. Caust. Dig. Gra})h. lod. Kali c. Mur. ac. N. vom. Natrum mur. Ni- tric ac. Phosphor. Plumb. Puis, Rhodod. Rhus. Stann. Sulph. Zinc. (See larynx.) AS OF A FOREIGN BODY : Cann. Cic. Hyosc. SCRAPING: Alum. Antim. crud. Canth. Carbo veget. Caustic. Graph. Hep. 8. Elali c. Lye. Mur. ac. Nitr. ac. Pulsatilla. Stann. Sulph. AS IF SCRAPED: N. Tom. Puis. Rhus. Veratr. SENSITIVENESS: Phosph. SHOCKS: Bry. Cina. AS IF GONE TO SLEEP : A-^. AS IF SORB: Ant. crud. Bryon. Cann. Caust. Cham. China. lod. N. vom. Natrum muriat. Phosph. Plumbum. Rhus. Sil. Stann, STITCHES: Ant. crud. Arg. Bar. Bell. Caps. Ipec Thuj. AS IF STOPPED UP : Rhus. AS OF VAPORS OF SULPH.: Puis. TICKLING: Aconit. Arn. Capsic. Cina. Ferr. Ipec. N. vom. Puis. Rhus. Sdbin. Veratr. TINGLING: Arn. Calc. Carbo veg. Dros. Euphorb. Iodine. Kali c. Lye. Petr. Phosphor. Platina. Sep- iso. Sil. Stann. Thi^. AS IF TORN: Staph. XXI. EXTERNAL NECK AND NAPE OF THE NECK. Sensations. 2. Neck. BLOTCHES : Sec. com, BOILS: Am. Caust. Sep. BURNING: Ferr. Ign. AS IF BRUISED: Am. Cic. Hep s. Sabin. COLD FEELING: Phosph. EXTKUNAL NECK AND NAPE OF THE NECK. 6B A: Aco. 3hamom. , Lyo. N. Is. Bhu8. air. PhoBph. irbo veg. . Kali c. mur. Ni- lb. Fula, Iph, Zinc. Y: Cann. im. crud. io.Graph. . ao. Nitr. Iph. om. Puis. iph. ?: A-o. L Brvon. la. lod. N. Phosph. %nn. Arg. Bar. hiis. JULPH.: Capsic. onu Puis. arbo TCg. Kali c. tina. Sep- iCR. ic. Hep ■h. CRAMP: Cio. CUTTING : Graph. Ruta. Samv,. DRAWING: Aco. Ant. crud. Am. Asa f. Bell. Bry. Camphor. Cantha- ria. Chin. Cic. Coccul. Croc. DvUc. Graph. KaU. Nux vom. Natr. mur. Nitr. ac. Ph. ac. Puis. Khod. Sabin. Spig. Spong. Staph. Voratr. ERUPTION: Ant. crud. Ars. Aur. Bry. Canth. Dig. Hep. sulph. Merc. Ph. ac. Puis. Splg. Spong, Staph. Tlmj. Veratr. AS IF THE FLESH WERE DE- TACHED: N. vom. GLANDS, boring in: Boll. Pulsat. Sabad. — pressure in : Aur. Bell. Chin. Cina. Coccul. Igrt. Mercur. Rhus, i '"am. —simple pain in: Alum. Ambra. Am. Bry. Calcar. Carbo veget. Caust* China. Cic. Con. Graph. Hell. Ignat. KJi c. Lye. Merc. N. vom. Natr. mur. Nitr, ac. Phos. Ph. ac Pulsatilla.! Rhus. Selen. Sep. Sil. Spig. Spong. Stann. Staph. Thuj. — suppuration : Bell. Hyoso. Sll. — sensitiveness : Arnic. Aumm. Spong. — inflammation ; Bar. Bell. Canth. Kali c. Kitric ac '^umb. Veratr. —swelling : Ahim. libra. Arg. Am Asa f. Aur. Bar Bell. Bry. Calc, Camph. Canth. Carbo veg. Cham. Chhia. Cic [Coccul. Con. Bulcam. Ferr. Graph. Hepar s. Ign. lod. Lye Merc. Mur. ac. Natr. mur. Nitr. ac Petr. Pliosph. Ph. ac. Plumb. Puis. RhiM. Sabad. Sep. Sil. Spigel. Spont,'. Stann. Staph. Sulphur. Thuj. Veratr. Zinc. feeling of: Spong. Staph. -hard swelling: Coccul. Plumb. Rhus. Spij. Staph. '-itching : Con. Ant. crud. — tickling : Kali o. --pinchintf': Bry. Veratr. — creeping: Con. —as if air pns.«ied through : Spongia. — as if L'xcoriated : Con. — as if pressed together : Ign. GOITRE: Ambr. Siwn^. —as if swollen : Spong. —largo : Calc. Carbo an. Caust. ImI. Kali c. Lycop. Natr. mur. * —pressing: Spon^. —hard : lod. Spon?. — movements in : Spong. —pressing out: Spong. —as if alive : Spong. —painful : lod. Plat. —stitching : Iodine. SpoHf^a. Uulph. —larger: lod. — constriction in : lod. HEAD DRAWN TO ONE SIDE: Chin. Cupr. Hyoso. HEAT: Calc. Caust. Cham. Ign. Sep. Sulph. ITCHING : Alum. Bry. Carbo veg. Ign. Natrum mur. Nitric ac. Op. Puis. Rhus. Stann, Thuj. LAMENESS: Dig. Lye. Sulph. PAIN: laming: Coco. — rheiunatic : Aco. lod. Rhod. Staph. — as of sore : Bry. Cic. Veratr. —in lower vertebra) : Con. —simple: Bell. Bry. Calc. Caps. Caust. Ferr. Graphit. Kali c. Lach. Nux vom. Phosph. Ph. ac. Sabin. Sil. Zinc. AS IF PRESSED OUT: Spong. PRESSING: Sil. PRESSURE: Aco. Ant, crud. Arg. Am. Aur. Bell. Calc. Cann. Carbc veg. Caust. Ign. Kali c. Lach. Lyj. Nitr. ac. Ph. ac. Sabin. Spoocf. Staph. Veratrftm. Zinc. RESTLESSNESS: Thuj. SCRAPING: Ars. SLEEP, gone to : Carbo an. SPASM : Ant. crad. Spong. SPOTS, yellow: lod. —red: Bell. Carbo veg. OoccuL Nt vom. Sep. Stann. ;il«! i M^ "if.. i\' 60 EXTERNAL NECK AND NAPE OB" THE NKOK. STIFFNESS: Alum/Anc Argent. Ars. Bell. Bryon. Calcar. Camph. Carbo an. Causticum. China. Cic. Concm. Croc. Cupr. Dig. Ferr. Graph. Hell. Lye. Merc. Natr. mur. Nitric ac. Petr. Phosph. Phosph. ac. Rhus. Sil. Spong. Staphys. Thuj. Veratr. Zinc. STITCHES: Aco.^Ant. crud. Aur. Bell. Bry. Canih. Chin. Cina. Coc- cul. Cupr. Dig. Graphites. Hep. s. Kali c. Phos. Samb. Spig. Spong. Staphys. Thuj. Veratr. Zinc. SWEAT: Cann. Cham. Coflf. Ipse. N. vom. Rhus. SWELLING, of bones: Calc. SWELLING : Alum. Ars. Bell, Calc Caustic Cic. lod. Lye Merc. Nitr. ac. Phos. Rhus. Sil. Zinc, —external: Alum. Am. Ars. Bar. Caustic Croc. Hyosc. lod. Lye. Puis. Rhod. —hard : Caust. Lye N. Vom. TEARING: Am. Aur. Carbo veg. Cham. Cupr. lod. Kali c. Lye. Merc Phos. Plumb. Sabin. Selen. Spong. Staph. Sulphur. Zinc TENSION: uirj/. Am. Bar. Bell. Bry. Calc. Camph. Caustic. Cic. Dig. Graph. lod. Plumb. Puis. Rhod. Rhus. Spigelia. Spong. Staph. Sulph. Zinc. THROBBING OF CAROTIDS: Opium. Spong. — of arteries: BrII. Hepar s. Op. Spong. AS IF TIED TOO FAST: Am. TINGLING: Spong. TWITCHINGS: Canthar ^pongia. Zinc. — convxdsive: Phosph. ULCERS : Ars. Hyosc. Lycop. Sec. com. ULCERATIVE PAIN : Graph. Puis. VEINS, swelling of: Op. Thuj. WEAKNESS : Arnica. Coccul. Staph. Veratr. AS FROM A WRONG POSITION: Dulc. Thuj. Zinc. 3. Nape of the Neck. BEATING: Con. BLOTCHES: Hep. BOILS : Am. Sil. BORING: Bar. BURNING: Am. Bar. Calcarca. Carbo veget. Ignatia. Mercur. Ph. ac, COLDNESS, feeUng of: Sulph. CONTRACTION: Puis. CRACKING: Spong. CRAMP : Ant. crad. CRAMPY FEELING: Thuj. Sil. CRAMPY STIFFNESS: Zinc. CRAWLING: Dulc. CUTTING: Dig. DRAWING: Alum. Ambra. Ant. crud. Asa foet. JBell. Camphor. Cann. Caps. Chin. Coloc. Con. Dig. Hyosc. Kalic. Lycop. Merc. Mosch. Nux vom. Ph. ac. Plumb. Pulsa- tilla. Rhodod. Rhus. Ruta. Sep. Staph. Sulph. Thuj. Zinc. ERUPTION: Bar. Bellad. Bryon. Caust. Cham. Hep. Lycop. Sep. Sil. Staph. GLANDS: see Neck. GRASPING: Lye HEAT : Ign. Lach. Phosph. HERPES: Hyosc. ITCHING: Carb. veg. Nitr. acid. Rhodod. Rhus. Sep. Sil. Staph. LAMING PAIN: Cina. Nux vom. Spig. Staph. Veratr. AS OF A LOAD : N. vom. Rhtts. AS IF THE FLESH WERE LOOSE: Aco. NAPE OF NECK, stiff: Aconit. Arg. Ars. Bar. Bell. Bry. Calc Camph. Canth. Caps. Carb. an. Caust, Chin. Coloc. Dig. Dros. Dulc. Graph. Hell Hyosc. Ign, Kali c Lach. Lye Merc. N. vom. Natr. mur. Nitr. ac Petr. Phos. Ph. ac. Plat. Puis. Rhod. Rhus. Sec. oortu OEBST. 61 Sep. Sil. Spigel. Spong. Stann. Staph, feulph. Thuj. Veratr. Zinc. PAIN, crampy : Am. — rheumatic: Aeon. Asa f. Grapliit. lod. Merc. Nux YOin. Puis. Bhod. Rhus. Staph. Veratr. — simple: Aeon. Bry. Cann. Chin. Dulc. Graph. Hyosc. Ipec. Kali. Merc. NuxlJvom. Natr. mur. Petros. Phosphor. Bhodod. Sabad. Sep. Spigel Stann. —as if tired: Rhus. — ulcerative : Puis. PRESSURE: Ambr. Asa f. Bar. Bell. Bry. Carb. veg. Coccul. Coloc. Dig. Euphorb. Graph. Laches. Lycop. Merc. Mosch. Natr. mur. Phosph. Ph. ac. Rheum. Rhus. Samb. Spong. Staph. Thuj. PULLING IN MUSCLES: Coloc. PUSTULES: Staph. RASH: Caust. SARCOMA : Bar. Calc. SENSITIVENESS: N. vom. AS IF GONE TO SLEEP : Rhus. Spig. SPOTS, yellow: lod. —red : Carb. veg. Sep. Stann. STEATOMA: Bar. Puis. STITCHES : Aeon. Alum. Am. Bar. Bellad. Calc. Camph. Cann. Chin. Coccul. Graph. Ign. Merc. Phosph. ac. Puis. Rhus. Sepiae. Stann. Staphys. Sulpli. AS IF STRAINED: DiUc. Nux vom. Puis. Zinc. SWEAT: Chin. N. vom. Sulph. AS IF SWOLLEN; Sep. TEARING: Asa f. Camph. Canih. Carb. veg. Graph. Ign. Kali c. Nux vom. Natr. Phosph. Plumb. Sil. Spig. Sulph. TENSION: Alumi7i. Amic. Aur. Bar. Bryon. Calcar. Camph. Canth. Carb. an. Caust. Con. Dig. Euphorb. Graph. Hyosc. lod. Ipec. Kali c. Mosch. Nitr. acid. Plat. Plumb. Pulsat. Rlius. Sep. Sil. Staph. Sulph. Thuj. Zinc. TETANUS: Op. TWITCHING: Asa f. Caps, Chest. Natur. mur. Ph. ac. Sulph. MUSCLES, twitching of: Arg. ULCERS: SU. UNSTEADINESS: Aeon. WEIGHT : N. vom. Petr. Phos. RMis. Sabin. Samb. # XXII. CHEST. |. Arg. iph. VausL iDulc. lall c iNatr. \h. ac ooni. Sensations. 1. Internal Chest. ANXIETY: Aeon. Am. Asa f. Bry. Camph. Cann. Caps. Chin. Coccul. Ignat. Lach. Mosch. N. vom. Pul- sat. Rhus. Samb. Sec. e. Spig. Spong. Staph. Valer. Veratr. AS IF A BAND AROUND : Sabad. Sabin. BLOOD, of erethism: Alum. Carb. veg. N. vom. Plumb. Rhod. Sep, SpoDji;. Thuj. AS IF THE BLOOD DID NOT CIRCULATE: Sabad. AS IF BOUNDING: Croc BORING: Aconit. Alum. Asa f. Cina. Kalic. Mur. ac. VhJaxi. Rhus. Spig. Staph. Thuj. BURNING: Aeon. Alum. Ambr. Ant. crud. Arg. Arn. Ars. Asa f. Bar. Bell. Bry. Calc. Cantli. Cai^bo veget. Caust, Giamom. Chin. Cic. Cina. Coccul. Coff. Con. Dros. Ferr. Graph. Hyosc. Ign. lod. Lach. i I 62 CHEST. Lyc. Merc. Mosch. Mur. acid Nux vom. Phosph. Ph. ac. Flat. Ruta. Sabad. Sabin. Sec, com. Sep. Spong. Stann. Sulpli. Zinc. CATARRH: Arn. Cann. Ign. Nux vom. CHILLINESS: Bry. Nati-. AS IF CONCUSSED : Rhus. COOLING, pleasant: Ruta. CONSTRICTION: Aconit. Alumi- na. Am. Ars. Asa f. Bell. Cann. Caps. Carb. an. Cliam. Cocvul. Coloc. Cupr, Digit. Droser. Fei'r. Hell. Igimt. Mosch. Nux vom. Natr. mur. Op. Phosph. Ph. ac. Puis. Plat. Bhodod. Rhus. Ruta. Spig. Stiinii. Stram. Sulph. Veratr. CRAMPY PAIN : Puis. Veratr. CRAMPY FEELING: Aco. Bell. Bry. Canth. Carbo. an. Cham. Cina. Dulc. Hyosc. Kali c. Mur. ac. Nux vom. Plat. Rhod. Stann. Thuj. Veratr. CUTTING: Alum. Arg. Arn. Aur. Bell. Calc. Caust. Chin. Con. Dig. Dulc. Kali 0. Lyc. Merc. Mur. ac. Ph. ac. Plat. Pulsat. Ruta. Sabin. Samb. Spigelia. Spong. Stann. Sulph. Veratr. Zinc. DIGGING: Arnica. Cann. Cina. Dulc. Ferr. Petr. Stann. AS IF DILATED : Bry. Stann. DRAWING INWARD : Cham. DROPSY : Aeon. Ambra. Am. Ars. Bry. Caps. Chin. Ferr. Hell. Ipec. Kali carb. Op. Rhus. Sabad. Spig. Veratr. —of chest: Ars. Carbo \eg, Coloc Con. Dig-. Duic. Kali c. Lyc. Mur. ac. Stann. DRYNESS, feehug of: Alumina. , Canth. Ferr. Phosph. Stram. AS IF EMPTY: Coccul. Stanib AS IF FALLING: N. vom. FERMENTING: Phosph. FULLNESS: Aeon. Antim. crud. Am. Bar. Canth. Caps. Con. Ferr. Ign. Lyc. Mosch. Nitr. ac. Phosph. Puis. Rhus. Ruta. Sabad. Sabina. SepiiB, Sulph. Veratr. GNAWING : Arg. Ruta. GRIPING: Veratr. GURGLING: Cina. KaU c. Natr. mur. Ruta. HAMMERING: Phosph. HEAT : Arn. Ars. Aur. Bellad. Bry, Calc. Caust. Chin. Cic. N. vom. Nitric ac. Opium. Puis. Rhus. Ruta. Spongia. Stann. Sulph. HEAVINESS: Aeon. Alum. Bar. Bry. Calc. lod. Phosph. Plat. Rhpd. Sabad. Samb. Sepice. Staph. Sulph. Zinc. INFLAMMATION : Acouit. Am. Bry. Cann. Hyosc. N. vom. Puis. Rlius. Ruta. Sec. com. Spong. ITCHING: Carbo veg. Kali carb. Phosph. Ph. ac. JERKS : Cann. Croc. Con. Lyc. Va- ler. — as if living : Croc as if loose : Bry. as if the lungs adhered: Euph. Thuj. LUNGS, as if less dilatable: Asaf. Bry. Ciuii. — suppurating: Plumb. Puis. — ^inflammation of: Aco. Bell. Bry. Lyc. Phosph. Puis. Rhus. Sepite. Sulphur. Tart. emet. — phtliisis of: Bry on. Calcar. Carbo veg. Chhia. Con. Dulc. FeiT. Graph. lod. Kali c Lyci Natmm mur. Phosph. Pulsat. Ruta. Samb* Sep. Spig. Stann. NAUSEA : Aeon. Arg. Asa feet. Bry. Croc. Nux vom. Rhus. Staph. PAIN, as if excoriated : Alum. Ars. Bar. Bry. Calc. Carb. veg. Caust. Cic. Cina. Graph. Ipec. Kali c. Lyc. Merc. Mur. ac. Natrum mur. Nitric acid. Phosph. Phosph. ac. Rhus. Sabina. Sep. Sil. Spongia. Stann. Staph. Sulph. Valer. Zinc. '■'■Li ' if! Bry. OHSST. 63 if bruised: Aco. Alum. Ambr. Ariu Bar. Camph. Caust. Chamom. Chin. Con. Ferr. Kali c. Merc. Phosph. Rhod. Spig. Spoiig. Stan- ni Thuj. Zinc. — aau flying to pieces: Bry. Cina, —drawing: Asa f. Cann. Capsic. Car- bo veg. Cham. Chin. Coccul. Con. Digit. Dulc. Kali c. Nm: vom. Ni- tric ac. Op. Plat. Puis. Ruta. Sep. Sil. Spig. Spong. Stann. — simple : Alum. Am. Ars. Bar. Calc. Caps. Carbo anim. Carlo vej. Caustic. Cham. Chin. Cina. Coloc. Conium. Croc. Dulc. Ferr. Graph- ites, lod. Lye. Mosch. Mur. acid. Nitric ac. Phosph. Puhat. Rhod. Ruta. Selen. Sep. Sil. Spig. Spong. Stann. Sulphur. Veratr. Zinc. PINCHING: Alum. BeUad. Carbo veg. Cina. Dulc. Ign. Kali c. Phos. ac. Samb. Spig. Spong. Thuj. PRESSING: Alum. Ambra. Brtj. Graph. Ign. Nitr. ac. Phos]ih. Sulph. Veratr. — asunder: Euphorb. PRESSURE FROM WITHOUT: Cann.(7/j,m. Coccul. Ign. N. vom. — — within: Arg. Asa f. Bell. Bryon. Cina. Dulc. Valer. Zinc. — as from a load: Arg. N. vom. Rheum. Sabad. Samb. Sjiig. AS IN THE LOWER PART OF THE CHEST: Alum. Am. Asa foet. Chin. Cic. Croc. Hyosc. Plum- bum. Ruta. Sabad. Zinc. PULSATING: Alum. Bryou. Dig. Dulc. AS IP RAW: Ambr. Am. Arsen. Bryou. Chin. Coccul. Dig. Hell. N. vom. Natr. mur. Rhus. Zinc. RESTLESSNESS : Bell. Chin. Staph. Thuj. RUSH OP BLOOD: Aeon, Aru. Bry. Carbo veget. Coccul. Ciipr. Ferr. Hyosc Niix vom. Natrum laur. Puis. Rhod. Sep. Spong. Thuj. SHOCKS : Aconit. Calc. Cann. Croc. Dulc. Mur. acid. Plat. Ruta. SHUDDERING: Aeon. SPASM: Aconit. Arg. Asa feet. Bry. Calc. Cham. Cina. Coccul. Coll. Cupr. Dig. Ferr. Ipec. Kali c. Lye. Mosch. Nitr. ac. Petr. Phos. Puis. Sec. com. Sep. Sulph. Thuj. Zinc. STITCHES, in left side: Aconit. Alum. Ayit. cruel. Arg. Am. Aaaf. Bell. Bry. Calc. Camphor. Cann. Canth. Caps. Carb. veg. Ca^lHt. Chin. Cic. Cina. Coccul. Con. Croc. Dig. I>ulc. Euphorh. Graph. Hell. Ign. Ipec. Kali c. Lye. Merc. Mosch. Mm\ ac. Natr. mur. Phosph. Ph. ac. Plat. Plumb. Puis. Rhus. Rufa. Sabad. Sabin. Samb. Sep. Spigel. Siwng. Stann. Staphys. Sulph. Thuj. Valer. Veratr. Zinc. —in right side : Aeon. Alum. Ambr. Ant. crad. Arg. Am. Asa f. Bell. Bry. Canth. Carb. an. Carb. veg. Caustic. China. Cina. Coccul. Co- loc. Con. Croc. Dig. Dulc. Graph. Hyosc. Ign. lod. kali carb. Merc Natr. mur. Nitr. ac. Op. Phosph. Ph. ac. Plumb. Rhuy. Ruta. Sabad. Sep. Sil. Spig. Spong, Stann. Staph Sulph. Thuj. Veratr. Zinc — in middle of chest: Aco. Alum* Ant. orud. Bry. Cham. Chin. lod. Phosph. Plumb. — in diaphragm : Spig. — in sternum; Aeon. Arg. Am. Aur. Bell. Bry. Calc. Canth. Capsic. Caustic. China. Con. Dulc. Ferr. Graph. Hep. Lye. Natr. mur. Nitr. ac. Phosph. Ph. ac. Plumb Jbiu. Spig. Sulph. — from the chest through the back : Aeon. Ambr. Bryon. Canth. Carb. Carb. veg. Chin. Coccul. Ferr. Ly- cop. Plumb. Sabin. Sil. Spig. Sulph. —from within: Argent. Asa f. Bry. Canth. Cai'b. veg. Chin. Muriat. ac. f1 PI' ft jji)!' ■ I 64 OHXBT. ■ !l Nitrio ao. Sabad. Splgr. Spong. Valer. AS IF STOPPED UP: Bry. TEARING: Arg. CantUar. Carbo veg. Caust. Con. Dulc. Graph. Kali c. Merc. Natr. mur. Op. Petr. Phosph. Puis. Bhus. Spig. Stram. Zinc TENSION: Arg. Ars. BeU. Bry. Cann. Caustic. Cham. Cic Coccul. Con. Dig. Dulc. Euphcrb. Graph. Ign. Lye. Mur. acid. N. Torn. Natr. mur. Phosphor. Pulsat. Bheuin. Rhod. Rhus. Buta. Sabin. Sep. Spig. Stann. Staph. Solph. Zinc. THROBBING: Aeon. Asa f. Bar. Bell. Bry. Can/n. Capa. Chamom. Coff. Digit. Graj . Ign. N. vom. Phosph. SU. SulpL Thuj. Veratr. Zinc TICKLING: Bar. Cham. Chin.[KaU carb. Phosph. Stann. Yeratr. AS IF TOO TIGHT: ReU. Pulsat. Spig. TIGHTNESS, feeUng of: Puis. TINGLING: Aeon. Arsen. Coloc. Phosph. ac. Sep. Spig. Spong. Stann. Thuj. TEEMBLING: KaU carb. Phosph. Buta. Sabin. TWITCHING: Cina. Coloc. Croc. Dulc. Kali c. Lye. Natr. mur. Sep. Spig. Valer. ULCEBATIVE PAIN: Bry. Puis. Staph. WABMTH: Bry. Coff. HeU. »ux vom. Veratr. — unpleaaant : Alum. Euphorb Natr. mur. — feeling of : Merc. WEAKNESS: lod. Kali o. Plat. Rhus. Stann. Sulph. — feeling of: Car6o veflf. Chin. Plat. Stann. Staph. ASrPWEABY: Am.' Carb. veg. Spong. i 1 WRENCHING: Bamb. 2. External Chest. BLUE SKIN NEAB CLAVICLE: Thuj. BOILS : Arn. Chin. BUBNING : Ambr. Arsen. Asa f . Bar. Bell, Canth. Caps. Croc. Digit. Droser. Euphorb. Ferr. Mur. ac. N. vom. Phosph. Ph. ac. Plat. Bheum. Rhus. Selen. Sulph. Zinc. BONE-PAIN: Chin. CHILLINESS: Spig. CONTBACTION: Am. Baph. Bry. Dig. N. vom. Op. Plat. Bhod. Bhus. Spig. CONTUSIVEPAIN: Ant. cr. Arn. CBACKLING: Rheum. CRAMPY FEELING: Aeon. Arg. Calc. Cham. Cina. Dig. Dulc. Nitr. ac. Plat. Sep. Veratr. CREEPING: Arn. Dros. CREEPING CHILL: N. vom. DRAWING : Aeon. Asa f . Carb. veg. Cupr. Dig. Dulc. Lycop. Mur. ac. N. vom. Puis. Bhus. Spig. Stann, Zinc. GNAWING: Arg. Calcar. Buta. Spong. HEAT: Cham. Cic. Dig. PiUs. HEBPES : Ars. Lye. Petrol. Staph. INSENSIBILITY: Bhus. ITCHING: Alum. Ant. crud. Bar. Calcar. Canth. Capsic. Carb. v. Caust. Chin. Coccul. Con. Kali c. Lye. Natr. mur. Op. Phosph. Puis. Sep. Spong. Staph. Veratr, — of the sides of chest : Alum. Am. Canth. Cic. Nitr. acid. Spong. JEBKING: China. Platin. Pulsat. Stann. Stram. LAMING PAIN: N. vom. PAIN, as if contused: Con. Dulc. Merc. Mur. ac. Natr. mur. ' " — as if sprained : Arn. Coccul. —as if sore : Bar. Bryon. Sep. StapL Veratr. — as if bruised: Arn. Chin. Ign, Merc. N. vom. Natr. mur. IWtr. ac. i i. 1 CHEST. 06 'S Phosph. Ph. ac. Bheum. Spig. Staph. Sulph. —simple: Ant. cr. Bry. Cann. Cap- ale. Chin. Cupr. Dulc. Natr. mm-. Phosph. Ph. acid. Puis. Khodod. Rhus. Sabin. Sep. Silic. Staphys. Sulph. Veratr. PECKING: Ruta. PIMPLES: Ant. crud. Aur. Bell. Bry. Canth. Coccid. Con. Hep. Ph. ac. Plumb. Rhus. Staph. PINCHING: Nux vom. Phosphor. Rhod. Samb. PRESSURE: Alum. Ambra. 'Arg. Am. Asa f. Aur. iBry. Campli. Canthar. Chin. Cina. Coccul. Cupr. Dulc. Dros. Hyosc. N. vom. Plumb. Rheum. Ruta. Sabin. Spig, Stann. Staphys. Sulphur. Valer. Veratr. Zinc, —from without: Rhus. PRICKLING: Plat. PULLING: Phosph. RASH: Ant. crud. Staph. Valer. Veratr. REDNESS : Aur. Bell. RHEUMATIC PAIN: Ambr. Bry. Spig. RIBS RAISED : Spig. SENSITIVENESS : Cann. Canthar. N. vom. Sulph. SHUDDERING: Chin. Cina. Nux vom. Plat. Ruta. Spig. Staph. AS IF TOO SHORT : N. vom. GONE TO SLEEP : Merc. SPASMS : Cic. Puis. Strani. Veratr. SPOTS, brown: Carbo veg. —yellow : Ars. Phosph. ;d : Bell. Carbo veg. Coccul. Lye. Sabad. STITCHES: Am. Asa foet. Aur. Bell. Bry. Calc. Camph. Cann. Canth. Caust. Chin. Coccv Con. Croc. Dros. Dulcam. Euphorb. Hep. Mur. ac. Nux vom. Nitr. ac. Phosph. Ph. ac. Plumb. Puis. Rheum. Rlius. Ruta. Salad. Sabin. Sil. Spig. Spong. Stann. Staph. Sulph. Teuc. Veratr. Zinc. SWEAT : Arg. Aw. BeU. CalcCanth. CIlIh. Coccul. Euphr. Hep. Ipec. Lye. Merc. Phos. Ph. ac. Plumb. Rhus. Sabad. Sec. corn. Selm. Sep. SWELLING: Brj-on. Culc. Can. Dulc. lod. Rhus. Sep. Sil. Sulpli. TEARING: Ambr. Bry. Camph. Dulc. led. Kali c. Lye. Merc. N. vom. Rhod. Sabin. Spig. —near the clavicle : Lye. Stann. TENSION : Asa f. Cham. China. Dig. Dros. Dulcan. Euphorb. Ferr. lod. Merc. Mur. ac. N. vom. Natnim mur, Pliospli. Puh. Rhodod. Rhus. Sablna. Spig. Stann. Tlmj. TUBERCLES : Cami. Caust. TWITCHING: Merc. Spig. ULCERS : Ars. Hep. Sulph. ULCERATIVE PAIN: Bry. Puis. WARMTH : N. vom. Rhus. WRENCHING: Puis. 5. Axlllx. {Arm pit.) BURNING: Carbo veg. CRAWLING: <7o?i. Mezer. DAMPNESS : Carbo an. Sulph. DRAWING: Bell. Sil. AS IF EXCORIATED: Con. INDURATION: lod. INFLAMMATION : Nitric ac. Petr. Phosph. Sulph. ITCHING: Carbo an. Carbo veg. Caust. Con. Dig. Kali. Phos. Sep. PAIN GENERALLY: Bellad. Car- bo veg. Con. Nitric ac. Sil. SENSITIVENESS : Nitr. ac. STITCHES: Arn. Con. Sulph. SUPPURATION : Calc. Coloc. Hep. Petr. Sil. Sulph. SWEAT: Dulc. KaJi. Natr. mur. . Phosph. Rhod. Sep. Sulph. SWELLING: BellaA. Calc. Phosph. lod. Hep. Lye. Natrum mur. Ni- tric ac. Petr. Phosph. Sep. Sulpli. 91, II ! if I' II 66 \ OHSST. Breasts. 4. Mammary glands. BLOTCHES : Bell. Calc Carb. Carbo an. Chomom. Con. Dulc. Graph. Lye. Phos. Ruta. SU. Sulph. CANCER: Amica. Ars. Oalcar. Car- bo an. Carbo veg. Oaust. Kali. Lye. Nitric ac. Phosph. Rhus. Sep. Sil. Sulph. CONTUSION: Am. CRAWLING: Con. DRAWING: Cham. ERYSIPELAS : Aco. BeU. Bry. Phosph. Sil. AS IF EXCORIATED : Con. HARDNESS : Ambr. Bryonia. Cham. Con. Phosphor. Plumb. SU. Sulph. HEAT : BeU. Bry. Cann. INDURATION, see Tubercles. INFLAMMATION: Aconit. Arn. Bry. Carbo veget. Cham. Con. 'Phosph. Pulsat. Sil. Sulph. ITCHING: Caust. Con. Kali. N. vom. Plumb. Rhus. MILK, bitter andjyellow : Rheum. — blueish: Lack. —too fat: Puis. —setting in: Puis. —fever : Aeon. Am. Bryo. Cham. Coff. Ign. N. vom. Op. Puis. Rhus. — excessive flow of : Aconit. Chin. —vanishing of: Agn. Bryon. Calc. Cham. Puis. Rhus. Sec. corn. Zinc. — increase of : Bryon. N. vom. Puis. — stoppage of : BeU. —flow of: Bell. Calc. Puis. PAIN, simple : Cann. Chamom. Coloc. Con. Mercur. SUie. Veratr. PRESSURE: Bell. Ph. ac. Pulsat. Sabin. SHUDDERING: Coccul. N. vom. TOO SMALL: Cham. STITCHES : Alum. Bar. Bellad. Con. Nux vom. Natr. mur. Plumb. Sep. Veratr. Zinc. SWELLING : BeU. Bry. Cham. Con. Dulc. Mere. Phosph. Plumb. Puis. Ruta. Sabina. Sil. Sulph. TEARING : Bar. Cham. TENSION: Puis. ULCERS: Hep. Merc Phos. Sil. Sulph. ULCERATIVE PAIN : Merc. WITHERING: Chamom. Con. lod. 5. Nipples. BURNING: Cic. Graph. SulpJi. CREEPING: Sabin. DISCHARGE OF BLOOD AND HUMOR: Lye. Plumb. HARDNESS: Merc. INDURATION : Bry. INFLAMMATION : Aco. Bryon. Cham. Phosph. Puis. Sil. Sulph. ITCHING: Con. Pulsatilla. Rhus. Sabad. PAIN, simple: Graphit. Nux vom. Rheum. Sulph. RHAGADES : Am. GraphU. Sulph. SENSITIVENESS : N. vom. SHOCKS: Bry. SORENESS: Arn. Calc. carbon. Cham. Graph. Lye. Puis. Sulph. SORE PAIN: Calc. Zinc. STITCHES : Camph. Cann. Coccul. Ign. Lye. Mur. ac. Rheum. Sabin. Sulph. SWELLING: 3Terc. ULCERATION: Cham. 6. Heart and region of the heart. ANXIETY : Aeon. Aium. Ambr, Ars. Aur. Calc Cann. Canth. Chamom. Cina. Coccul. Croc. Cupr. Ferr. Graph. Hell Lye. N. vom. Nitric ac. Op. Phosph. Plumbum. Fuhat, Rhus. Sec. corn. Sep. Sil. Stram. Sulph. Veratr. BEATS OF THE HEART, inter- mittent: Bry. Chin. Digital. Kali. Natr. mur. SulpJi. — slow. Arn. —quick : Am. Asa f . Sabin. — unequal : Asa f . Sabin. — imperceptible : Rhus. Verat. OHEST. 67 -HStrougor: Ars. Aur. Calcar. Chin. Digr* Dulcam. Hjosc. Phoaph. Sa* bina. Spigel. Yeratr. —full: Aeon. BURNING: Carb. veg. Op. Puis. CONTUSIVEPAIN: Natrvmur. CRAWLING: Canth. DRAWING: Canth. EXCITEMENT, vascular: Carbo veg. Nux vom. Sulph. HEART, trembling of: Aur. Bell. Calc. Camph. Cina. Rhus. Sep. Spig. — throbbing in the region of the: Ars. Bar. Calc. Hell. Lycop. Phos- phor. Sep. Sil. Sulphui. Zinc. HUMMING: Spig. INFLAMMATION' Aeon. Arsen. Bry. Cdnn. Coceul. Spic. Puis. Rheum. JERKING: Arn. N. vom. Plumb. OPPRESSION: Bell. Cham. Nux vom. Spig. PALPITATION, generally: Aeon. Alum. Amh. Am. Ars. Aur, Bar. Bell. Bryon. Calear. Camph. Cann. Canth. Carbo an. Carho veg. Caust. Cham. China. Coceul. Coloc. Con. Croc. Gupr. Dig. Graph. Hell. Igu. lod. Ipec. Kali. Lye. Merc Mur. ao. Natrum niur. Nitric ac. Nux vom. Petr. Fhosph. Phos. acid. Plumb. Puis. Rhus. Sabad. Sabin. Secale com. Sep. Sil. Spig. Spong. Staph. Sulph. Thuj. Valer. Yeratr. Zinc —with anguish: Aeon. Alum. Ars. Aur. Calc. Cann. Caust. Cham. Chin. Coceul. Coloc. Dig. Graph. Kali. Lye Mosch. Natr. mur. Nux vom. Phosphor. Plat. Plumb. Puis. Sec. com. Sep. Sil. Sulphm:, Spi- geL Thuj. Veratr. —without anxiety : Carbo anim. Ipec. Sulph. Thuj. Zinc —perceptible: Plumbum. Rhus. Sa- bin. Yeratr. —audible: Camph. Dig. Spig. — spasmodic: Sec. corn. —visible: Con. Dulc. (?rap/a<es. lod. Rhus. Secale corn. Spig. Sulpii. Thuj. PAIN, simple: Conn. Cantharis. Cham. Puis. Ruta. Thuj. PRESSURE: Aco. Arn. Ars. Asa f. Bell. Cann. Canth. Cham. Con. Graph. Kali. Lye. Natr. vc^xr. Nux vom. Piilsat. Rhus. Spig. QUALMISHNESS: Cham. N. vom. RUSH OF BLOOD: Aeon. Asa f. Carbo veg. Cham. FeiT. Lye. Nux vom. Nitric ac. Phosph. Puis. Sep. Sulph. ^ STITCHES: Am. Aur. Calcar. Canth. Capsic. Carbo veget. Caust. Cham. China. Croc. Igu. Mur. ao. Nux vom. Nitric ac. Petr. Plumb. Rhus. Sep. Spig. Sulph. Valer. Zinc. TEARING: Canth. Lye. WARMTH: Cann. Veratr. — feeling of : Rhod. WEAK FEELING: Rhus. WEIGHT: Croc. Puis. According to Situation and Circumstances. 1. Aggravated. IN THE OPEN AIR: Ambr. Bryon. Caust. China. Coceul. Coffea. Con. Euphorb. Graph. Ignat. Lye. Merc. Natr. mur. Nux vom. Rhus. Sabad. Sep. Spig. Stann. Staph. WHEN ASCENDING : BeU. Graph. N. vom. Sep. T^ ;. Zinc. the stairs : N. vom. Rhus. Ruta. Spong. Staph. WHEN BREATHING: Aeon. Ant. crud. Arg. Am. Ars. Asa f. Aur. Bryo. Calc Cann. Caps. Chamom. China. Cina. Coceul. Dulc. Dros. Graphit. Hep. Hyosc. Lycop. Mer- cur. Natr. mur. Nitr. ac. Puis. Sepi. Spig. Stann. ii 68 OBSST WHEN DRAWING A LONG BREATH : Calc. Merc. Natr. mur. AFTER A COLD: Aeon. Bryou. Carbo veg. Cham. N. vom. Rhus. IN THE COLD: Rhus. Sabad. IN COLD AIR: Acouit. Bryonia. Carbo veg. Coccul. Rhus. Sabad. Spong. BY CONTACT: Aeon. Arg. Arn. Bar. Bry. Calc. Canth. Caps. Carbo veg. Cham. Chin. Coccul. Cupr. Dros. Dulc. Graph. Merc. Nux vom. Phosph. Ph. ac. Plumb. Rhod. Rhxis. Ruta. Sabin. Spig. Staph. Sulphur. Veratr. AFTER CONTUSIONS : Arn. Puis. Rhus. Ruta. WHEN COUGHING: Aco. Alum. Ambr. Ant. crud. Am. Ars. Bar. - Bryon. Calc. Cannab. Caps. Carbo veget. Caustic. Cham. Chin. Cina. Cofif. Con. Dig. Dros. Ferr. led. Kali. Lye. Merc. Mur. ac. Na tr, mur. Nitric ac. N.vom. Phosph. Phosph. ac. Puis. Rhus. Ruta. Sabad. Sa- bina. Sep. Sil. Spigel. Spongia. Staiin. Staph. Veratr. AFTER COUGHING: Cina. Ferr. IN DAMP WEATHER: Carb.veg. etab. DURING DIGESTION: Lye. WHEN DRINKING: Chin. AFTER DRINKING: Am. China. Coccul. Con. Cupr. Nux vom. Veratr. BY DRINKING COLD : ThuJ. AFTER DRINKING BEER: Sep. wine : Ant. crud. Nux vom. WHEN EATING: Amic. China. Coccul. Ign. Phosph. AFTER EATING: Aconit. Ambra. Ant. cmd. Arn. Asa f. Bry. Canth. Caps. Carbo an. Caust. Chamom. Chin. Coccul. Con. Ferr. Hyosc. Ign. Lye. Merc. Nux vom. Phos. Puis. Rhus. Ruta. Sep. T/iwj. Valer. Veratr. Zinc. BY EATING WARM FOOD: Eu- phorbium. BY GETTING WARM IN BED: Chamom. Puis. lilius. BY EMOTIONS: Phosph. BY BODILY EXERTIONS : N, vom. Rhus. Spong. AFTER EXPECTORATING : Zinc. WHEN FALLING ASLEEP: SiU. BEFORE THE FEVER: Chin. DURING THE FEVER : Aeon. Bryon. Chin. Ipec. — the cliiU: Bry. Ipet. N.vom. Puis. Rhus. — the heat : Aeon. Caps. China. Ipec. Nux vom. Puis. AFTER A FRIGHT: Aeon. Cha- mom. Ign. Op. BETWEEN THE INSPIRATION: Ign. Merc. Spig. WHEN LIFTING: Bar. Kali. Lye. AFTER LYING DOWN: Hell. Ig- nat. Nixx vom. Puis. Rhus. Sabad, Stram. WHEN LYING DOWN: Ant. crud. Asa f. Calc. Canth. Carbo veg. Cham. Ferr. Natr. mur. Nitr. ao. Puis. Rhus. Selen. Sulph. BY ^MENTAL LABOR: Ign. K vom. Sep. BEFORE THE MENSES: Cwpr. Puis. Spong. DURING THE MENSES: BeU. Caustic. Cham. Graph. Phcv^phor. Puis. DURING MOTION: Aeon. Alum. Arg. Arn. Bell. Bry. Calc. Camph. Cann. Capsic. Carbo veg. Cham. Cliin. Coccul. Con. Dig. Euphorb. Ferr. Graphit. Hep. Ign. lod. lyc. Mercur. Natrima mur. Nitric ac. NuxYoni. Op.rhospli. Ph.ac. Puis. Rhodod. Ruta. Sabina. Samb. Sep. Spigel. Spongia. Stann. Staph. SiUph. Veratr. Zinc. -i- -. WHEN MOVING THE ARMS: Dig. Plumb. Puis. I » ' '$ CHEST. BY MUSIC : Nux vom. Staph. DUBING NOSE BLEED: Carbo veg. WITH NAUSEA : BeU. BY PRESSING ON THE ABDO- MEN: Asaf. BY EXTERNAL PRESSURE: An- tim. cruel. Bry. CJibi. Cina. N. vom. Buta. Spongia. Staphys. Va- ler. WHEN RAISING ONE'S-SELF: Aco. Arg. Bry. Caiin. Cic. Dig. Ign. Stann. Staph. WHEN RISING FROM BED: Ant. orud. Plat. Stann. Staph. from a seat : Sil. AFTER RISING: Nux_vom. Puis. Rhus. Spig. WHEN READING: Chin. loud : Coccul. DURING REST: Arg. Am. BeU. Caps. Cham. Chin. Ferr. Natr. mur. Phos. ac. Puis. Rhus. Ruta. Samb. Stann. IN THE ROOM: Bry. Croc. Puis. Rhodo(T. Spig. BY RUNNING: Bry. Cina. Nux vom. Sil. BY SINGING: Staiui. * WHEN SITTING: Arg. Ars. Asa foet. Bell. Calc. Caps. Carbo anim. Carb. veg. Chin. Cina. Coloc. Bros. Dulc. Euphorh. Ferr. Merc. Mur. ao. Phos. Puis. Rhus. Ruta. Sabacl Silic. Spigel. Spong. Stann. Staph. Sulph. Thuj. Valer. crooked : Argent. China. Rhod. Rhus. Spig. Spong. erect: Aeon. Natr. mur. AFTER SLEEPING : Aconit. Ainbr. Bryon. Calcar. Chin. Coccul. Euphr. Ignat. Nux vom.Op. Rheum. Sabad. BY SMOKING: Cic. Ign. Spong. Staph. WHEN SNEEZING: Aeon. Bryon. Cina. Merc. Sil. WHEN STANDING : Carb. an. Con. Euphorh. Natr. mur. Stann. Sulph. Zinc. BY MAKING A WRONG STEP: Bry. Puis. Spig. BY STIMULANTS: Stann. BEFORE STOOL: Spir^ DURING STOOL: Spi^. AFTER STOOL: Sil. WHEN STOPPING THE BREATH: Dros. Merc. Spig. WHEN EXPIRING AIR: Arabr. Ant. cr. Arg. Ars. Aur. Bnj. Cai-b. veg. Cham. Chin. Cic. Cina. Ign. lod. Mur. ac. Phosph. ac. Ruta. Sabad. Sep. Spigel. Stann. Staph. Zinc. WHEN INSPIRING AIR: Aco. Ars. Am. Aur. Bar. Bry. Calc. Caniph. Cann. C'ani/i. Cr\)s. Carb.v. Canst. Cham. Cliin. Cic. Cina. Coc- cul. Coloc. Con. Dulc. Euphras. Hell. Hyosc. lod. Kail. Lye. Merc. Mur. ac. Natr. mur. Nitr. ac. Op. Phos. Ph. ac. Plat. Plumb. Pulsat. Rhus. Buta. Sabacl Sabin. Sep, Sil. Spigel. Spong. Stann. Sulph. Valer. Veratr. Zinc. WHEN DRAWING A LONG BREATH : Aeon. Arg. Am. Bryon. Canth. Caps. Cina. Dros. Ign. Puis. Rhus. Sabin. Spig. WHEN STOOPING: Aeon. Alum. Arg, Am. Asa f. Bry. Cann. Caps. Carb. veg. Chin. Coccul. Coloc. Dig. Dros. Hell. Ign. Merc. Nitr. ac. N. vom. Phos. Ph. ac. Puis. Rhodod. Rhus. Silic. Spigel. Spong. Stann. Staph. Valer. Zinc. WHEN STRAINING: Rhus. WHEN TALKING: Bry. Cann. Canth. Chin. Coccul. Ignat. Puis. Rhus. Stram. WHEN TALKING LOUD : Carb. v. KaU. Mur. acid. Natr. mur. Stann. BY TIGHT CLOTHES: N. vom. Spong. 1 jf.- •■ 4k i<\ if,, I- . 70 BACK. m BY TUENING TO THE RIGHT SIDE: Spig. WHEN TUBNING IN BED: Aeon. Cann. Caps. Oarb. \cj. Nux vom. Staph. BEFORE VOMITING: Cupr. WHEN WAKING: Ant. cr. Am. Dig. Euphr. Ign." Puis. Rhus. Sa- bad. WHEN WALKING: Aconit. Arn. Bryon. Camph. Caps. Cliin. Cic. Coccul. Ferr. Ign. Nux vom. Ruta. Spigel. Spong. Staph. Valer. Ve- ratr. AFTER WALKING: Pulsat. Rhus. Valer. WHEN WALKING IN THE OPEN AIR: Bry. Chin. Coflf. N. vom. Bhus. Spig. Spong. Staph. AFTER WALKING IN THE OPEN AIR: Ferr. N. vom. Rlnis. Sabad. WHEN WALKING FAST: Chin. Spig. WHEN WRITING: Asa f. Chin. Coccul. Valer. 2. Relieved. IN THE OPEN AIR: Bry. Natr. mur. Puis. BY WARM AIR: Carb. veg. BY BENDING BACK . Aeon. Cann. N. vom. Puis. BY BREATHING : Asa f . Cina. BY EXPIRATIONS: Cina. Merc. BY INSPIRATIONS: Cina. Merc. BY DRAWING A LONG BREATH : Dig. Stann. DURING CONTACT: Mur. ac. AFTER DRINKING: Bry. Ferr. AFTER EATING: Bry. Rhus. Sa- bad. AFTER ERUCTATIONS: Ambt Canthar. Kali. N. vom. Petr. Sep. Zinc. AFTER EMISSION OF FLATU- LENCE: Spig. Stram. Veratr. BY FRICTION: Calc. WHEN LYING DOWN : Alum. Bry. Canth. lod. N%u>c vom. Sabad. Zinc. on one side : Alimi. on the back : Am. Bry. Ign. Puh. Sabad. on the painful side : Ambr. Am. Bry. Cham. Ign. Nux vom. Puis. on the painless side : Ign. N. vom. BY MOTION : Arg. Am. Cham. Cina. Dros. Euphorb. Mur. ac. Ph. ac. Plumb. Puis. Rhus. Sabad. Sep. BY PRESSURE EXTERNALLY: Asa f. Bi-y. Chin. Cina. Dros. Ign. Puis. Veratr. DURING REST: Arn. Bry. Chin. N. vom. Sabin. Staph. BY RISING: Canth. Carb. anim. Dulc. N. vom. Puis. Rhus. IN THE ROOM : Bry. Cham. Nux vom. BY* SITTING UP: Alum. Asa f. China. Dig. Puis. Spig. WHEN SITTING : Alum. Bry. Caps N. vom. WHEN STANDING: Chin. Cicut, Ruta. BY STOOPING: Chin. Ign. Valer. AFTER SWEAT: Canthar. Cham. N. vom. Puis. WHEN WALKING: Chin. Cicut. Dros. Ferr. Mosch. Plumb. Puis. Bhus. Ruta. Staph. XXIII. BACK. : Sensations. • - 1. Scapulce. (Shoulder Blade.) BOILS : Amm. mui. Led. BURNING: Aeon. Bar. Carb. veg. Chel. led. Lye. Sep. Sil. Sulph. Veratr. BACK. 71 OHILLINESS : Alum. RhuB. OONTllAOTION : Chin. Lach. Lye. EhuH. Viol. trio. ORAMPY FEELING: Baryt. Bel- lad. Kali. Merc. Rhus. CRAWLING: Laur. CUTTING: Oalcar. carbon. Rhus. Sulph. ac. DISLOCATION PAIN : Chin. Coloo. Mur. ao. Petr. Pliunb. Rhod. ERUPTION: BeU. Bryon. Canst. Lye. Merc. Phosph. Ph. acid. Squilla. GNAWING: Alum. Merc. Phos.ac. HEAT : Mur. ao. Puis. HEAVINESS: Meryanth. ITCHING: Amm. mur. Am. Bell. Daph. Laur. Mercur. Oloand. Spig. Stront. PAIN, as if soro : Coloc. Plat. . bruised: Anac. Bar. China. Hell. Kali. Merc. Natr. mur. N. vom. Sulph. Thuj. PRESSURE: Anac. Am. BeUad. Bry. CaJc. Caust. Chin. Laur. Mur. ac. Seneg. Sil. Sulphur. Stann. Zinc. RIGIDITY: Ang. Bellad. Caustic. Led. AS IF GONE TO SLEEP : Anac. STITCHES: Alumin. Amm. mur. Anac. Asa f. Aur. Bry. Bell. Bov. Camph. Cann. Canthar. Caps. Caust. Chin. Cina. Cocc. Colch. Dulo. Ferr. Hep. Kali. Lach. Laur. Mur. acid. Natr. Natr. mur. Nitr. Nitric ao. N. vom. Plumb. Puis. Ran. bulb. Sabad. Samb. Sassap. Sepise. Spig. Spong. Btannum. Thuj. Zinc. TEARING AND D1.AWING : Alum. Anac. Asa f. Aur. Calc. carb. Carbo veg. Caust. Chamom. Dulc. Lach. Lye. Mur. magn- Phos. Plumb. Rhod. Rhus. Sep. Stann. TENSION: Alum. Bar. Carbo an. Coloo. Colch. Kali. Kreosot. Natr. Rhus. Sep. Sil. Sulph. THROBBING: Baryt. Kali. More. Phosph. TUBERCLES : Amm. mur. TINGLING: Anac. Dulc. Sabad. Sil. TWITCHING: Calc. carb. Phosph. Rhuii. Squilla. S. Back. AS IF ALIVE: Plumb. BORING : Aconit. Agar. Coccul. Spig. Thuj. BURNING: Aeon. Agar. Arnica. Ars. Bar. Carbo an. Carbo veg. Chel. Lye. Merc. Mur. ac. NUrLo ac. Nuxvom. Phosphor. Plat. Sep. SU. Sulph. Veratr. CHILL: Bellad. Calc. carb. Dulc. Lach. Lye. Nu^ vom. Phosph, Rhus. Sep. Sil. Stann. Sulph. COLD FEELING: Carbo vegeU Con. Mur. ac. CRAMPY FEELING: Carbo vege- tab. Euphr. Merc. Nitr. Puis. CRAWLING: Aeon. Bell. Graphit. Laur. Natr. See. corn. CURVATURE OF THE SPINE: Bell. Calc. carb. Lycop. Merc. Puis. Rhus. Sil. Staphys. Sulph. CUTTING: Calc. carb. Sep. Sil. DIGGING: Aeon. Sep. DISLOCATION-PAIN: Agar. Ar- nie. Calcar. Cocc. Mur. ac. Rhus. SiUph. ERUPTION: Bar. BeU. Calc. carb. Carbo veg. Caust. Cocc. Led. Merc. Natr. mur. Pulsat. Sel, Sep. Squil- la. Sulph. HEAT: Con. Merc. Natrum mur. Phosph. ac. Puis. Sulph. HEAVINESS: Ambra. Carbo veg. Phosph. Sep. Sulph. ITCHlNG: Alumina. Amm. mur. Baryt. Calc. carb. Causticum. Daphne. Laur. Kali. Lycop. Merc. Ill II ■m.^ ip I I 79 BACK. Nftlr. Nitric ao. Phos. Sasaap. Sil. Sulph. Thuj. JEllKS: Ciilc. carl). Stajih. LAMENESS: Agiir. Coco. Natr. imir. riiosph. MUSCLES, twitching of : Curbo vog. OnSTHOTONOS : Ang. Brll. Can- thar. Cham. Clvut. Ign. Nux voni. Op. RhuH. Stann. Strnm. TAIN, Eoro: Kali. Plat. Staph, —as if braised : Agar. Alumina. Amm. mur. Ai'7i. Ars. China. Dros. Lach. Merc. Natr. mur. N. vom. Rhus. Ruta. Stann. Strain. Veratr. —simple : Agar. Alum. Arsen. Asa f . Aur. Bov. Calc. carb. Caun. Carbo animalis. Hyosc. Kreos. Lye. Hep. Lach. Natr. mur. Nitric ac. N. vcii. Op. Petr. Sep. Sil. Sulph. Veratr. PRESSURE: Aconit. Agar. Aru. Bell. Calc. carb. Carbo veget. Canst. Cocc. Dulc. Graphit. Kali. Lye. Mur. ac. Natrum mur. Nux vom. Pulsat. Bhuti. Sep. Stannum. Staph. Vei'atr. Zinc. AS IF GONE TO SLEEP : Mer- cur. Phosph. RIGIDITY: Aug. Petr. SHUDDERING: Ang. BeU. Canth. Chcl. Cocc. Daph. Colchic. Graph. Lach. Led. Natr. mur. Nux vom. Puis. Rhus. Sabad. Staph. Sulph. Thuj. SPASM: Agar. Bell. lod.'Xj/c?. SPOTS : Sep. Carbo veg. STIFFNESS : Agar. Alum. Caro veg. Caust. Kali. Led. Nux vom. Petr. Pulsatilla. Sep. Sulph. STITCHES : Aeon. Ant. crud. Ar- gent. Am. Asa f. Bry. Calc. carb. Cann. Caps. Caust. Chin. Colch. Con. Cycl. Dros. Dulc. Hep. Kali. Lachesis. Lycop. Muriatic acid. Natr. Oleand. Pkina. Plumb. Puis Rhus. Rhod. Sabin. Spig. Sil. Stann. Thuj. Valer. Verb. SWEAT : Chin. Ipoc. Lye. Nux vom. Phosph. Pulsat. Scpiso. Stram. SiUph. SWELLING: Baryt. Bell. Puis. Staph. TEARING AND DRAWING: Aco- nit. Ars. Bell. Bry. Calc. carb. Canth. Caps. Carbo veg. Caustic. Cina. Cham. Cocc. Ferr. Hep. Kali. Lach. Led. Lye. Mang. Mez. Natr. Natr. mur. N. vom., Op. Phosph. Fwls.'Rhtis. Sep. Sil. Stann. Stram. Sulph. TENSION: Amm. mur. BeU. Con. Hep. Mosch. Natr. Natrum mur. Sulph. ZLic. TETANUS : Ang. Clcut. Nux vom. Op. Petr. Plumb. THROBBING: Baryt. Lye. Phos. Puis. TREMBLING: Ccff. Merc. TUBERCLES : Ant. crad. Caust. WARMTH, feeling of: Carbo veg. Coff. Laur. WEAKNESS : Agar. Am. Carb. veg. Lach. Lyo. Nitric ac. N. vom. Pe- trol. Phos. Plat. Sulph. Sec com. 3. Small of the back. BORING: Aeon. BURNING : Aoon. Mur. ac. Nux vom. Phosphor. Rhus. Sepito. Thuj. CHILLINESS : Lach. Lycop. Puis. Sabin. COLDNESS: Carbo veg. Spong. — feeling of : Hell. CONTUSIVE PAIN: Am. Ruta. CRACKING: Sulph. Zinc. CRAWLING: Ahmu. Menyanthes. Sassap. CRAMPY FEELING : Bryon. Caust. Chin. Nux vom. CUTTING: Aur. Bellad. Canthar. Natr. Natr.. mur. Puis. Zinc. ERUPTION: Calc. carb. Natrum. Sep. Thuj. GNAWING; Sulph. Amm. Canth. Phos. STOOL AND ANU8. 78 GRIPING : Cham. Graph. More. ITCHING : Carboveget. Caust. Kiili. Merc. Nutr. inur. ./EllKS : Asar. Bry. Chin. Rhus. LVMENESS: Co<:v. Dxilv. Laoh. Natr. vin)'. Niixvom. Solon. Hih NUMB FEELING : Carbo vog. Plat. Spong. AS IF FLASHING THROUGH : Nalrum vmr. PAIN, as if dislocatecl : Agaric. Arn. Rhus. Sulph. — — soro : Caust. Natr, Sulph. ac. bniised : Aco. Alum. Amm. mur. Arg. Arn. Aur. Bryon. Can.st. Cham. Cina. Oraph. Ign. Lack. Magn. mur. Nux mosch. Nux vom. Platiua. Rhus. Ruta. Stront. Sulph. Thuj. Veratr. — simple ; Aconit. Agar. Amm. mur. Am. Baryt. Bov. Bry. Calc. rarb. Carbo an. China. Kali. Ign. Ipoc. Led. Lycop. N. vom. Puis. Petr. Rhod. Rhus. Ruta. Sabadilla. Sepise. Stront. Sulph. Zinc. PRESSURE: Aeon. Bryon. Carlio veg. Caust. Graph. Kali. Lach. Lye. Meti. Mosch. Nitric acid. Puis. Rhus. Sep. Spong. Staphys. Sulph. Veratr. PULSATIONS: Caust. Natr. mur. SPASMODIC PAIN: BoUad. Cocc. Hil. Sulph. STIFFNESS: Acou. Ambra.Amm. HI iir. Bar y t.Bell Bry. Caxhovegot. t'uustk'. Kah. Lach. Lycop. Pulsat. Itlius. Sil. Sulph. STITCHES: Aeon. Arabra. Anoc. Arg. Arn. Bell. Bn/.Canthar. Carbo vcg. Carbo an. Caust. Chin. Cocc. Con. Graph. Igu. lod. Lach. Lyo. Magn. carb. Merc. Natr, Natr. mur. Nux vom. Phos. ac. Puis. Rhuj. Sab. Sep. Sil. Stront. Tart. Thuj. TEARING AND DRAWING: Alum. Ars. Baryt. Bry. Culo. carb. Canth. Carbo veg. Caustic Cham. Chin. Cocc. Hep, Kali. Kreos. Lach. Lye. Natriim mur. Niix vom. Phosph. ac. Rhus. Sab, Sep. Sil. Sponga. Stann. Strara, Stront, TENSION : Aeon. Barit. Carbo veg. Caustic. Nitrio ac. Nux vom. Sil. Thuj. THROBBING: Graphit. Ign. Nux vom. Natr. mur. Sep. TWITCHING: Calc. carb. Caustic, Chin. Con. Puis. Staph WEAKNESS : Ars. Cocc. Lach. Merc, Natrum mur, Nux vom. Phosph, Sep. XXIV. STOOL AND ANUS. I i Constipation. 1. ChnrncLcr of Stool ACRID: Ars. Bry. Cham. Lach. Merc. Puis. Veratr. ASH-COLORED: Asar. Dig. BILIOUS: Arsen. Chamom. Chin. Dulc. Ipec. Merc. Puis. Sulph. Veratr. BLACK: Ars. Calc, c. Camph. Chin. Cupr, Hep. Merc. Op. Squill. Stram. Veratr. 53 BLOODY: Ant. crud. Am. Ars. Asar. Bry. Canth. Carb. veg. Chin. Cupr. Dale. Ipec. Lye. Merc. Nitr. ac. N. mosch. N. vom. Phosph. Puis. Rhus. Sep. Sil. Sulph. acid. Tart. Veratr. BLOOD, Uned with: Alum. Ambr. Con. Bry. Ipec. Merc. Nv^ vom. Puis. Rhus. Thuj. BROWN : Amic. Bryon. Chin. Mer- T4 STOOL AND ANTJ8. El m^ f cur. Blieum. Sec. Squill. Sulph. Veratr BRIGHT-COLORED : Anac. Caibo veg. Caust. BURNING : Ars. Lack. Merc. CADAVEROUS SMELL: Bism. Curb. veg. Stram. CLAYEY: Calc. Carb. CONSTIPATED : Aeon. Amm.mur. Am. Aur. Bar. Bell. Bry. Calc. carb. Cann. Canth. Carho veg Caustic. Cham, Chill. Cina. Coccul. Coloc. Con. Crot. Daph. Ferr. Graph. Hep. Kali bich. Lack. Laur. Lye. Merc. Mosch. Natr. mur. Nux vom. Op. Plat. Plum. Puis. Rhodod. Elms. Sabad. Seneg. Sep. Sil. Spong. Staph. Stram. Sulph. Thuj. Veratr. Zinc. DIARRHCEIC: Aeon. Amm. mur. Ant. crud. Ant. carb. Ai*8. Asa feet. Aur. Bell. Bism. Bry. Calc. carb. Calad. Caps. Carb. veg. Carb. an. Chamom. Chin. Coloc. Cicut. Cocc. Coflfea. Cupr. Dulc Fei^r. Graph. Hep. Hell. Hyosc. Ign. Ipec. Lach. Lye. Magn. carb. Merc. Natr. Natr. rtur.NVr. acid.'N. mosch.. N. vom. Op. Petr. Phosph, Phosph. ac. . P«ils. Ran. seel. Rheum. Ehodod. Rhus. Sabad. Sec. Sepia). Spigel. Spong. Squill. Stann. Staph. Stram. Sulph. Tartar. Valer.Verati*. Zinc. DIARRHOEA, from cold: Bell. Bry. Cham. Dulc. Merc. Nux vom. Puis. Ehus. Sulph. — after drinking beer : Ferrum. Rhus. — after eating : Arsen. China. Coloc. Lach. —after getting heated : Bryon. Coflf. Nux vom. — after a fright : Aco. Op. Ferat. — after a fit of joy ; Coff. Op. —•with vomiting: Antim. tart. Ars. Asar. Cupr. Ipec. Nu^vom. Phos. Bheum. Veratr. — after eating fruit : Ars. Chin. Puis. — after eating milk : Bry. Lye. Sulph. — after a cold drink : Ars. Bry. Carb. veg. Pula. — after drinking: Arsen. Caps. N. vom. — of children: Cham. Ipecac. Merc. Rheum. Sulph. — chronic : Amen. Calc. Cantli. Chin. Graph. Ipec. Nitr. ac. Phosph. Rhus. Sulph. — nocturnal : Ars. Bry. Cham. Chin. Dulc. KaU. Merc. Phosphor. Puis. Rhus. Sulph. Veratr. — dysenteric : Ar,H. Caps. Carb. veg. Coloc. Chamom. Colchic. Merc. N. vom. Op. Pulsat. Rhus. Sulph. Fe- ratr. — frothy: Calcar. carb. China. Rhus. Sulph. — painless: Ai'sen. Carbo veg. Cha- mom. Chin. Ferr. Hyosc. Lye Merc. Op. Phosph. Sec. Sulph. Stram. — watery : Ant. crud. Ant. tart. Ars. Calc. Carb. Caps. Cham. China. Cupr. Ferr. HeUeb. Hyosc. Ipec. Natr. TQMx.Nuxvom. Petr. Phosph. Ph. ac. Puis. Rhus. Sec. cor. Sulph. Tart. Veratr. — spirting: Ars. Merc. N. vom. DIFFICULT: Amm. mur. Anac. Ant. Am. Aur. Bar. Bry. Canth. Carb. V. Chin. Cocc. Graph. Hep. Ign K.ali. Lye. Magn. mur. Natr. mur. Nttx mosch. Nux vom. Oleand. Petrol. Phosph. Plat. Pul- sat, Rhodod. Ruta. Sassap. Silic. Staph. Sulph. Thuj. FERIMENTED: Ipec. FETID : Ars. Bry, Calc. Carbo veg. Cliin. Lach. Mei^c. Nitr. acid. Puis, Sil, Sulph. WITH FLOCKS : Ipec. Veratr. HAVING A FOUL SMELL : Ars, Bry. Carb. v. Cluim. Chin. Nit» ac. N. vom. Sec cor. Sulph* momaitmmr STOOL AND ANUS. 7S i FREQUENT, too: Anac. Am. .-ins. Bellud. C'alc carb. Caps. Cham. Chin. Coco. Coff. Coloc. Dulc. Ferr. Graph. Ignat. Naiv. mur. Nitr. ac. N. vom. Phospli. Ph. ac. Petr. Puis. Ran. seel. Rhua. Silic. Thnj. Valer. GRAYISH: Asar. Digit. Mercur. Phosph. ac. Rheum. GREENISH: Arnen. Aur. Bellad. Cliaiii. Cupr. Bide. Ipec. Merc. riiospli. Phos. ac. FuIh. Stann. Siilph. Veratr. HA RD : Agar. Amm. Amm. mur. Ant. crud. Asa foet. Aur. Bar. Bell. Bry. Calc. carb. Canu. Carb. vog. Caustic. Cham. Cina. Cocctil, Con. Daph. Oraph. Hyosc. Guaj. Hep. Ign. Kali. Laur. Led. Lycop. Magn. mur. Merc. Natr. mur. N. vom. Op. Peir. Phosph. Phosph. acid. Plumb. Puis. Rheum. Rho- dod. Rhus. Ruta. Sabad. Sec. corn. Selen. Sep. Sil. Spong. Stann. Staph. Sr'pli. Sulph. acid. Thuj. Veratr. v«rb. HARD AND LOOSE ALTER- NATELY: Ant. crud. Ars. lod. N. vom. INSUFFICIENT: Anac. Alum. Arn. Ars. Calc Chin. Daph. Hep. Eali. Lach. Lye. Mur. magn. Natr. N. vom. Sep. Sil. Sulph. INVOLUNTARY: Aeon. Am. Bell. Calc. C/im. flT/osc'.Lach. Nat. mur. N. vom. Oj). Phosph. ac. Rhus. Sec. com. Sulph. Veratr. —at urinating : Mur. ac. — during sleep : Arn. Puis. Rhus. LEAD-COLORED : Plumb. LOOSE: Ant. crud. Canth. Chin. Ign. Merc. N. mosch. Rheum. Sep. Sulph. LUMPY: Agar. Bar. BeU. Graphit. Lach. Magn. mur. Nux vom. Op. Plumb. Sil. Sulph. Sulph. ac. Thuj. PAPESCENT : Agar. Antim. crud. Am. Asa i. Bell. Chin. Daph. Dros. Euphorb. Lach. Mezer. Nitr. Phosph. ac. Puis. Rheum. Rhod. Seleu. Sil. Sulph. Tart. PITCH, Hke; Hep. Lach. Merc. Sassap. PURULENT: Arn. Canthar. lod. Lach. Merc. Sulph. SHEEP-DUNG, hke: Brom. Magn. inm\ Plumb. SLIMY: Agar. Amm. m. Ant. cr. Aru. Ars. Asar. Bell. Bor. Canth. Caps. Cham. Carb. veg. Color. Chin. C-^lcli. Dulc. Graph. Hell. Hyosc. Kali. Ipec. Merc. Mur. magn. Natr. mur. N. vom. Phosph* Ph. ac. Puis. Rhus. Ruta. Sec. Spig. Stann. Staph. Sulph. Tart. Veratr. SMARTING: Merc. Pm?.s. SMELLING SOUR: Calc. carb. Chamom. Dulc. Hep. SOFT: Aeon. Amm. mm*. Antim. crud. Bryon. Calc. Carb. an. Carb. veg. Chin. Cocc. Coff. Co7i. Dros. Dulc. Graph. Guaj. KaU. Mur. ac. Natr. mur. Nitr. Mtr. ac. Phosph. Ph. ac. Puis. Rhod.od. Sep. Sulph. Veratr. Viol. trie. Zinc. STIRRED EGGS, like: [Chamom. Chin. Merc. N. mosch. Pulsat. Rhus. Sulph. Viol. trie. TENACIOUS: Ars. Caust. HeU. Kali. ir(r/)e.s. Mercur. Plumb. Zinc. UNDIGESTED : yl?i<im. rn«?. Arn. Arseyi. Bryon. Cham. Chin. Ferr. Lach. Merc. Nitr. ac. Oleand. Phosph. Ph. ac. Sulph. Veratr. WITH TiENIA: Calc. Carb. veg. Filix m. Graph. Magn. mur. Merc- N. i5om. Petrol. Sabad.^dh. Stann. Sulph. Valer. WITH ASCARIDES: Aconit. Asar. Calcar. Cham. Chin. Cina. Ferr. Ignat. Merc. N. vom. Squill. Spong. (Sw/p/(.Teucr. "Ill ,!« ii t* u: ill 76 STOOL AND ANUS. WITH LUMBRIOI: Aconit. Anac. Bell. Calc. curb. Chiun. Ciciit. Cilia. Graph. Lyeop. Merc. Natr. mur. Niix vom. Rtita. Snbad. Sec. corn. Spigc'l. Sulph. Val. WHITISH: Acou. Ars. Caustic. Oliam. Chill. Colch. Digital. lod. Merc. Nux vom. Plumb. PJiosph. Pulsat. Rhus. Sec. Spong. Sulph. Veratr. YELLOWISH: Ars. Asa ioet. Calc. carb. Chamom. China. Coloc. Cocc. Diilcaiii. Merc. Petr. Phospli. Puis. Rhus. Veratrum. 8. Accompanying Ailvients. a. BEFORE STOOL. BACK-ACHE: Veratr. COLIC: Agar. Amm. mur. Ant. tart. Ars. Asar. Bry. Canth. CJt in. Croc. Dig. Kali. Ignat. Laur. Merc. Nitr. Nux vom. Petr. Puis. Rheum. Rhus. Stann. Staph. Sulph. Verat. CHILLINESS: Mercur. Nux vom. Veratr. DREAD OF MEN: Ambr, FLATULENCE, distreso from : Agar. Amm. mur. Am. Calc. phosph. Dulc. Ferr. Phosph. Ph. ac. Puis. Sjiig. Stront. HEAT: Merc. Phosph. NAUSEA : Aeon. Rhtis. Veratr. PAINS IN THE ANUS: Carbo anim. Colchic. Kali. Lach. Oleand. Phosph. Plat. RECTUM, pain in: Nux vomica. Puis. Rhus. SMALL OF BACK, pain in: Dulc. Sulph. PROSTATIC JUICE, discharge of: Selen. Sulph. Ph. ac. RUSH OF BLOOD TO THE HEAD: Opium. SCREAMING OF CHILDREN: Cham. Rheum. Rhus. SWEAT : Aeon. Bell. URGING TO STOOL: Cocc. Con. Lnch. Merc. Rhv^. Sil. Staphys. Thuj. VOanTING : Ant. tai-t. Veratr. b. DURING STOOL. BACK-ACHE: Puis. CHILLINESS: Veratr. COLIC: Agar. Amm. mur. Anac. Ant. crtid. Am. Am. Asafoet. Bry. Calad. Canth. Carbo an. Cham. Cupr. Dulc. Drosera. Fenv Graph. Hep. Ignat. Ipec. Kali. Merc. Natr. mur. Nitric ac. Nux vom. Phosphor. Plumb. Puis. Rheum. Rlius. Sep. Spig. Sulph. Sulph. ac. Veratr. DROWSINESS : Nux mosch. FAINTING: Petr. Sassap. Spig. FLATULENCE, discharge of : Calc. carb. Calc. phosph. Cocc. Sab. Staxjh. — distress from: Amvi.murlat. Arn. Hyosc. Nux vomica. Sab. Spong. HEAT : Rhus. Sulph. LABOR-LIKE PAIN: Op. NAUSEA: Ant. tart. Ars. Asar. Cupr. Hell. Merc. Nitric acid. Prun. Sulph. Veratr. PALPITATION OF HEART : Ant. tart. Nitric acid. PROSTATIC JUICE, discharge of: Ign. Phosph. ac. Sil. RECTUM, pain in: Asai-. Calcar. Merc. Magn. mur. N. vom. Puis. Sab. Sulph. Veratr. — falling of : Ars. Asar. Calcar. Daph. Ignatia. Merc. Nux vom. Puis. Ruta. Scpiffi. Sulph. RUMBLING IN BOWELS: Ar- senic. Calc. carb. Lycoji. Olean- der. Phosph. Phosph. acid. Sulph. acid. RUSH OF BLOOD TO THE HEAD: Rhus. SHUDDERING: Bell. Nitric acid. Rheuvx. Veratr. SWEAT: Bell. Mercur. Stramon. Veratr, STOOL AND ANUS. 77 nd. TENESMUS: Aeon. Am. Colch. Laur. Merc. Nux vom. Op, Rbiis. Selen. Sulph. Veratr. THIKST : Ars. Cham. Chin. VARICE" '-otrusion of: Angust. Kali. V. Nux vom. VERTIGO: Cham. Veratr. VOMITING: Arg. Ant. tart. Ars. Cupr. Kali bichr. Ipec. Rheum. Sulph. Veratr. WEAKNESS, feeling of: Veratr. C. AFTER STOOL. ANIXETY: Caust. AS IF BRUISED: Calc. CHILLINESS : Canth. Mezer. Puis. CHILL : Daph. Mez. Plat. COLIC: Agar. Amm. mur. Anac. Carlo veget. Con. Dros. Dulc, lod. Kali bichr. Lye. Nux vom. Natr. mur. Op. Phos. Pulsat. Rheum. Stann. Sulph. Veratr. CONGESTION OF THE HEAD: Lach. DROWSINESS : Nux moseh. ERUCTATIONS: Baryt. Merc. FLATULENCE, discharge of : Agar. Calc. Carbo veget. Hep. Lye. Jfux vom. Phosph. Puis. Sulphur. Thuj. HEAD-ACHE: Ambr. Sab. Sil. LANGUOR: Am. Ars. Bry. Calc. carb. Chin. Colic. Cuprum. Daph. Ferr. Hyosc. Ipec. Laeh. Lye. Phosph. Puis. Sec. com. Veratr. MUCUS, discharge of: Asarum. Merc. Phosph, Stann. NAUSEA: Aeon. Caust. Veratr. SMALL OF BACK, pain in: :?uls. PALPITATION OF THE HEART : Caustic. Con. RECTUM, pressure in : Hellebor. Ignat. — pain in : Cham. Nux vom. — constriction of : Nux vom. — prolapsus of : Merc. SWEAT: Aeon. Caust. TENESMUS: Capsic. Ipec. Merc. Nitr. Phospi). iZ/iewm.Ehus. Sulph, Staph. THIRST: Caps. VERTIGO : Carbo an. Zinc. VOMITING: Veratr. 5. Anus, with rectum and perineum. a. ANUS AND RECTUM. BLEEDING BETWEEN STOOL: Alum. Ant. cruel. Caps. Carbo veij. Merc. Phosph. Puis. Sabin. ^ep. Stram. Sulph. BORING IN THE RECTUM: Va- ler. BURNING IN THE ANUS: Am- mon. mur. Ant. tart. Ars. Baryt. Bov. Bry. Caps. Carbo anim. Carbo veget. China. Cocc. Coloc. Graph. lod. Ipec. Kali. Laur. Merc. Mur. ac. Natr. Natr. mur. Nitric ac. N. vom.Oleand. Phosph. Puis. Sepioe. Stront. Siilpli. Thuj. Verat. — in the rectum : Alumina. Axir. Ars. Calc. Carbo an. China. Con. Eu- phorb. Lye. Mur. ac. Magn. mur. Natr. mur. Nitric ac. Petr. Phosph. Puis. Sep. Stront. Sulph. Veratr. CONTRACTION : Camph. Conium. Natr. mm*. Nux vom. Op. — in annus: Alum. Ang. Carbo an. Cocc. Graph. Ign. Nitric ac. Nii.x vovi. Plumb. Sec. Sep. Sulpli. — in rectum : Amm. Bell. Calc. Chin. Coloc. Ferr. Ign. iVwaJiJom. Phosph. Sep. Thuj. CREEPING : Calc. Colchic. Croc. Kali. Natr. Nux vom. Plat. Rhus. Sabad. Sej). Zinc. CUTTING IN ANUS : Arsen. Chin. Caust. Kali. Laur. Lye. Natr. Nux vom. Phosph. Staphys. Sulph. —in rectum: Canth. Caust. Chin. Lye. Mang. Nux vom. Phosph. Sep' Sulph. DRAWING IN: Plumb. EXCORIATION : 'Cham. Graph. i*fl HI 1 78 STOOL AND ANNUS. —in anus : Alum. Amm. Arsen. Graph. Hep. Mei'v. Nux vom. Phosph. Puis. Sassap. Veratr. — in rectum : Camph. Natrum mur. Phosph. Ph. ac. Puis. EIG WARTS: Nitric acid. Sabina. Tlmj. FISTULA RECTI : Calc. Caust. Petr. Sil. Sulph. GNAWING : Ang. Merc. Phosph. HEAT: Canth. Con. HERPES : Natr. mur. ITCHING IN ANUS : Aeon. Alum. Ambr. Ant. crud. Baryt. Bell. Bry. Calc. Car bo veg. Caust. China. CIna. Croc. Euph. Ign. Kali. Lye. Merc. Nitric ac. Nux vom. Op. Phosjihor. Platin. Rhus. Sabad. Sassap. /Sep. Sil. Stann. Staph. Sulph. Teuc. Thuj. Zinc. — in rectum : Aco. Ambr. Asar. Bell. Cic. Cin. Chin. Euphorb. Fer-r. Ign. Nitric ac. Nux vom. Ruta. Sabad. Sep. Sil. Spigel. Stann. Stilph. Teuc. Valer. MUCUS, discharge of, between stool : Antim. Caps. China. Colchic. Hell. (jrrapli. Merc. Phosph. Puis. Rhus. Sep. Spig. Sulpli. Tart. PAIN, simple : Aconit. Canthar. Car- bo an. Caust. Lye. Merc. Natr. mur. Nux vom. Phosph. Seneg. — in rectum : Aeon. Ambr. Camphor. Merc. Magn. mur. Sep. PINCHING: Merc. Natrum mur. Sabad. PRESSURE IN ANUS: Aeon. Baryt. Calc. Cyclam. Laur. Nitric ac.Nuxvom.Fetv. Pl^osphor. Puis. Seneg. Staph. — in rectum : Arn. Bell. China. Kali. Lye. Nitric ac. Nux vom. Opium. Phosph. Sen. Stann. RECTUM, prolapsus of: Antim. crud. Ars. Asar. Bry. Colch. Dulc. Ign. Lach. Merc. Natrum muriat. Niix vom. Ruta. Sep. Sulph. REMAINING OPEN, always : Phos. SORENESS: Ars. Carho an. Cau- stic. Hep. Graph. Merc. Nitric ac. Phosph. Sep. Sulph. — pain as of: Amm. Ars. Caust. Graph. Hep. Ign. Mur acid. Natr. mur. Nux vom. Phosph. Puis. Sep. Sjjongia. Sulphur. Veratr. SPASM, (in anus): Colch. Lach. Kali biclir. — in rectum : Calc. Caust. Chin. Colcli. Lach. Lye. SPHINCTER ANI, kmeness of: Bell. Cole. Hyosc. STITCHES IN ANUS : Aeon. Ars. Bry. Cantli. Carbo an. Carbo veg. Chin. Con. Croc Graph. Ign. Ipec. Kali. Lye. Natrum. Natr. iniir. N. vom. Phos. Phosph. ac. Plat. Ran. bulb. Sab. Sep. Sil. Sulph. — in rectum : Alum. Ant. tart. Bell. Bov. Carbo an. Caustic. Chin, Grai)h. Ign. Lye. Magn. mur. Natr. mur. Nux vom. Phosph. Puis. Ru- ta. Sep). Sil. Sulph. Valer. SWELLING: Camph. Graph. Hep. Ign. Nux vom. TEARING IN THE ANUS : Colchic. Daph. KaU. Nux vom. Phos. ac. Sep. Thuj. — in rectum : Carbo veg. China. Lye. Kali. Nux vom. Phosph. ac. Ruta. Sabad. TENESMUS: Aeon. Am. Arsen. Bellad. Bov. Calc. Canthar. Caps. Colch. Daph. Euphorbium. Hep. Ipec. Kali. Laur. Merc. Natr. Ni- tric ac. Nux vom. Phosph. Plat. Rheum. Rhus. Ruta. Sep. Stapli. SHl2)}iur. Veratr. Zinc. THROBBING: Grat. Lach. Natr. mtir. TORPOR: Alum. Carb. veg. Chin. Ign. Kali. Lycop. Natr. mur. Nux vom. Op. Ruta. Sep. Staph. Thuj. Veratr. ULCERS : Caust. Sassap. URINE AND URINARY ORGANS. 79 « UBGINa TO STOOL : Alum. Anac. Am. Ars. Asa f. Bar. Bellacl. Calc. Camph. Canth. Garb. v. Caustic. Ooccul. Colch. Coloc. Co7i. FeiT. Graphit. Hej)ar. Hyosc. Igu. Kali. Lack. Lye. Merc Magn. mur. Na- trum. Natr. mur. Nitr. ac. N. mosch. N. vom. Petr. Phos. Puis, llheum. Rhodod. Rhus. Ruta. [Sabad. Sep. SU. Stann, Staph. Sulphur. Veratr. Verb. — ^with emission of flatulence: Cail>. an. Lach. — with falling of rectum : Ruta. Merc. — at night: Merc. Puis. Sulph — with erections : Thuj. — painful: Ars. Caust. Sulph. — inefifectual: Aeon. Anac. Am. Asa f. Bell. Calc. Carb. Caps. Carb. veg. Caust. Coccul. Colch. Con. Graph. Hell. Ign. Lach. Lye. Kali bicli. Merc Magn. mur. Natr. Natr. mur. Nitr. ac. Nux vom. Phosph. Plumb. Pulsat. Rheum. Rhun. Ruta, Sa- bad. Sassap. Sep. Sil. Spig. Stann. Staph. Strain. Sulph. Thuj. Veratr. VARICES : Ambra. Amnion, mur. Anac. Anthn. crud. Ant. tart. Ars. Bar. Bell. Brom. Calc. Caps. Carb. an. Carb. veg. Caust. Coloc. Ferr. Graph. Hell. Ignat. Kali. Lach. Lye. Magn. Merc. Mur. a«. Natr. mur. Nitr. ac. Nux vom. Phosph. Ph. ac. 'Plumb. Puis. Rhus. Sabin. Sep. Sil. Stram. Sulph. Sulph, ac. Thuj. — protruding: Calc. Caustic. Ferr. Graph. Merc. Puis. Sep. Sulph. ThvQ. —with colic : Carl), veg. Nux vom. Sulph. —blue : Carb. veg. Mur. ac. —blind: Ars. Cham. Ign. Nux vom. PuL-i. Sulph. Veratr. —bleeding: Aconit. Amin. Aniim. crud. Bell. Calc. Caps. Curb, vig Chin. Cupr. Ferr. Ipec. Ign. Merc. Nux vom. Phosph. Puis. Sab. Sep. Strain. Sulph. —burning: Ant. crud. Arsen. Calc, carb. Caps. Carb. an. Graph. Nitr. ac. Sulph. ac. —inflamed : Acoit. Ai'seu. Nux vom. Sulph. —swollen : Aliun. Calcar. carb. Carb. veg. Graph. Nux vorru Puis. —ulcerated: Nux vom. Puis. Sulpii. —itching: Aeon. Graph. Phospl:.. Sulph. Sulph. ac. — humid: Sulph. — excoiiated: Cham. — stinging: Ars. Baryt. Caust. Puis. — suppressed flow of : Carb. veg.^. vom. Sulph. — as if sore: Merc. Mur. ac. Phosph. Puis. Stann. b. PERINEUM. BURNING : Ant. crud. Rhodod. CONTRACTION: Sep. Sulph. CUTTING: Lye. N. vom. HERPES: Petr. INFLAMMATION : Plumb. ITCHING: Agn. Ars. Carb. veg. N. vom. Petr. Seneg. Tarax. PAIN, simple : Caust. Lye. Phos. SORENESS: Carb. v. Merc. Rhoil. STITCHES : Alum. Merc, Nat. Sep. TEARING: Daph. XXV. URINE AND URINARY ORGANS. 1. Quality Thereof. iCRID : Ant. tart. Am. Borax. Cal- car. Cann. Canth. Caust. Clem. Creos. Graph. Hep. lod. Kali. Merc Natr. mur. Rhus. Sassap. Seneg. Thuj. Verat. •}t % . I' 'I' J I I' lii^- 00 URINE AND URINARY ORGANS. i* i AMMONIACAL : Asa f. Carbo veg. Creos. lod. Mosch. Nitr. acid. Petr. Phosh. BILIOUS: Valer. BLOODY : Aeon. Ambr. Ant. tart. Am. Ars. Cole. carb. Cann. C'anth. Capsic. Carbo veg. Cldn. Coloc. Con. Hep. Ipec. Lye. Merc. Mezer. Nitr. acid. Niix vom. Op. Phospli. Ph. ac. Pills. Sec. com. Sep. Squil- la. Sulph. Zinc. BROWN: Aeon. Ambr. Am. Ars. Asa /. Bell. Bry. Calc. Caust. Colch. Big. Merc. Nitr. ac. Petr. Phoaph. Rhodod. Puis. Sep. Sulph. Tart. Valer. BURNING: Aeon. Arsen.', Camph. Cann. Canthar. Caps. Creos. Digit. Hep. Merc. Phosph. Staph. Veratr. BLACKISH: Colch. CAT'S URINE, smelling like: Viol. tart. — like garlic : Phosph. — sour. Ambr. Calcar. Graph. MeiT. Natr. — pungent : Asa|f . Bor. Merc. — likejsulphur : Phosph. —foul: Carbo veg. Dulc. Merc. Nitr. ac. Phosph. ac. Puis. Rhod. Sulph. Viol. trie. — like violets : N. mosch. Tereb. CLEAR : Amm. muriat. Euphr. Hy- osc. Laches. Nitr. Squill. Stramm. COLD : Agar. Nitric acid. COLORLESS (see pale) : Puis. COPIOUS: Aeon. Alum. Ambra. Amm. mur. Arg. Am. Ars. Aur. Baryt. Bell. Bism. Bryo. Canth. Carbo veg. Carbo an. Chin. Cieut. Clem. Coloc. Creos. Cycl. Daph. Digital. Euph. Guaj. Hyosc. Ign. lod. Laur. Led. Lycopod. M. arct. Merc. Mur. ac. Natrum. Nitric. Oleand. Petr. Phosph. Phosph. ac. Pulsat. Rhus. Sab. Sassnr. Selen. Senega.'Spig. Sqnilla. Staph. Sulph. Tar. Thuj. Valer. Verat. Verb. Vi- ola trie. Vit. LIKE CURD : Ambr. Cina. DARK: Aco. Ant. tart. Arn. Asa f. Bell. Bry. Carlo veg. Chin. Colch. Dig. Hell. Hep. lod. Ipec. Lach. Lycop. M. arct. Meiv. Nitnc acid. Op. Phosph. lihus. Selen. Sep. Staph. Sulphur. Tart. Veratr. DIMINISHED: Aco. Agar. Ambr. Ammon. mur. Ant. tart. Am. Ars. Aur. Bell. Bry. Caleareaearb. Canti. Canth. Carbo veg. Caust. Cham. Chin. Coccul. Coff. Colch. Con.Cupr. Daph. Dig. DuU: Graph. Grat. Hell. Hep. Hyosc. lod. Ipecac. Kali Laur. Led. Lye. More. Mur. acid. Nitric ac. Nux mosch. Nux vomica. Op. Petr. Phosph. Phosphoric ac. Plumbum. Puis. Ruta. Sabad. Sas- sap. Sec. com. Selon. Seneg. Squil- la. Stannum. Htaph. Stram. Stront. Sulph. Veratr. Zinc. FIBRES, full of: Cann. FIERY: Aeon. Bry. Cann. Colch. Plumb. LIKE FLOUR: Calc. Graph. Mep. Natrum mur. FROTHY: Lach. Laur. Lycopod. Seneg. GREENISH: Ars. Camph. Iodine. KaU. Rhod. Ruta. Veratr. HOT: Aeon. Ars. Bry. Canthar. Cham.^Colchie. Duleam. .fiTep. Lach. Nitric ac. INODOROUS : Ambr. Dros. LIGHT-YELLOW: Ambra. China. Sec. corn. LITTLE AT A TIME: Aconit. Agar. Bell. Canii. Canth. Caust. Colchic. Dig. Euphorb. Holl. Hyosc. lod. Kali. Laur. Led. Merc. Nitric ac. Nux vom. Oji. Petr. Phosph. Puis. Rhus. Ruta. Sil. Staph. Sulph. Tart. Veratr. LOAM-COLORED : Anac. Canthar. Ign. Sabad. Sassap. Sep. Sulphur. Zinc. nBINR AND URINARY ORGANS. 81 MILKY: Aur. Cnrho ve<j. Diilc. lod. PhOHph. (IC. OPALESCENT : Iodine. Phosphor. Puis. PALE : Agar. Alum. Airn. Aur. Bell. Bism. Canth. Chel. Chin. Coce. Colchic. Coloc. Con. Creos. Dig. Hep. Ignat. lod. Lach. Laur. Mur. acid. Nitr. N. j'ugl. Nux vom. 01. an. Par. Phosph. PIios. ac. Pulsat. Rhod. Rhus. Sassap. Secale corn. Staph. Stram. Strontia. Sulph. Sulph. ac. Zinc. PURULENT: Cunn. Canth. Clem. Lye. Nux vom. Sahln. Sep. RED: Aco. Ant. crud. Antlm. tart. Am. Bell. Bry. Calc. Camph. Cunn. Canth. Carb. veg. Chin. Colrh. Coloc. Con. Dig. Hep, Ipec. Kali bichr. Merc. Nux vom. Op. Phos. Plumbum, Puis. Sassap. Sep. SU. Squilla, Staph. Sulph. SEDIMENTOUS: Aconit. Alum. Ambr. Ant. crud. Am. Arsen. Aur. Baryt.Bry.CaZc. car6. Camph.Cuun. Canth. Carbo an. Carboveg. Caust. Cham. Chin. Chinin. Cicut. Col- chic. Coloc. Con. Creos. Dulcam. Graph. Hep. Hyoscyam. lod. Ipec. Kali. Lach. Laur. Lol. tem. Lye. Many. Mercur. Mezer. Natr. iniir. Nitr. Nitric ac. Nuxmosch. Oleand. 01. an. Opium. iPetr. Phosph. Phospli. ac. Puis. Rhus. Ruta. Sas- sap. Selen. Seneg. Sepia?. Sil. Spong. Squilla. Stilph. Sulph. <v?. Tar. Thuj. Valer. Zinc. SEDIMENT, blueish : Prun. ^-bloody : Aconit. Calcar. carb. Cann. Canth. Caps. Coloc. Dulc. Lye. Merc. Phosphor. Phospli. ac. Puis. Sep. Sulph. Sulph. ac. Zinc. — brown : Ambr. Lach. Vnler. —thick : Camph. Laur. Mercur. Se- cale com. Spong. Sulphur, Valer. —dark: lod. —purulent : Canthar. Clem. Con. Lyo. Puis. Sep. —fibrous : Cann. Canth. Cham. Merc iMezer. Sassap. Seneg. Tart. Zinc. — flocculent: Camiub. Cham. Merc. Nitr. Nitric ao. Seneg. Tart. — gelatinous: Puis, —yellow : Ammon. mur, Bry. Cham. Chin. Cupr.Lyc. Phos. Sil. Spong. Sulph. Sulph. ac. Zinc. — of yellow sand: Sil. —gray : Ant. tart. Con. Spong. —gravelly: Ambra. Ant. crud. Calc. carh. Cantli. Chin. Lach. Lye. Natr. mur. Nitric acid. Nux mosch. Nnx vom. Op, Phosph. Puis. Ruta. Sas- sap. Sep. Sil. Thuj. Yaler. Zinc. — clayey— Amm. m. Anac. Kali. Sas- .srtj). Sep. Stilph. Sulph. ac. Zinc. —floury: Ant. tart. Calc. Graph. Merc. Hyos. Natr. mur. Phosph. ac. Tart. — reddish : Aeon. Ambr. Amm. mur. Ant. crud. Am. Ballad, Caiitli. Chin. Coloc. Con. Creos, Dulc. Graph, lod. Ipec. KaU. Lach. Lye. Mang. Mez. Natr. mur. Nitr. ac. Op. Petr. Phosph. Puis. Sec. corn. Selen. Sep. Sil. Squill. Thtij. Yaler. - -like blood : Amm. — like red sand : Natr, mur, Nitr, ac. Sil, — sUmy: Ant. crud. Ai's. Aur, Bry. Calc. carb. Carb. veg. Caust. Chin. Cina. Coloc. Con. I)ulc. Hep. Ipec. Merc. Natr. j^atr. vnir. Nitr, acid. N. vom. Phospli. Phosph. ac. Puis. Rheum. Sassap. Seneg. Sulphur, Valer. — turbid: Alum. Con. Rhus. Zinc. — violet: Puis. — whitish : Amm. Baryt. Bell. Calcar. Canth. Caps. Colch. Coloc. Con. Dulc. Graph. Hejh Ignat. Nitr. ac Oleand. Petr. Phosph. Phosph. ac. Prun. Puis. Rhodod. Rhus. Sep, Spig. Spong, Sidph. Valer. Zinc. i m f, SI *;}»'•■ 1^ n)f. ll i p 82 URINE AND URINARY ORQANS. I — whitish-turbid : Con. Bhus. — cloudy: Ahim. Amhr. Bryon. Oaust. Kali. Luur. Merc. i\'/^/'. Petr. Phosph. ac Plat. Seuog. Tkuj. Valer. — brick-dust : Aeon. Am. Chin. l\icii. Puis. TENACIOUS : Canth. Cupr. CreoH. Dulc. Phosph. ac. THICK: Camph. Con. Dulc. lod. Nuoc vom. Plumb. Sabad. Senog. Sulph. ac. TUEBID: Amhr. Anao. Ant. tart. Ars. Aur. Bell. Cann. Canth. Cai'- bo an. China. Chlorof. (ina. Clem. Colch. Coloc. Con. Cycl. Dig. Dulc. Hep. lynat. lad. Kali. Laoli, Lye. Merc. Mosch. Mur. ac. Nitr. acid. Phosjih. Plumb. Pulsat. lihu.s. Sabad.. Sassap. Sep. Sulph. Sulph. ac. Valei. Veratr. Zinc. — becoming: Ambr. Ang. Am. Aur. Kry. Caust. Chnni. Cina. Con, Dig. Graph. Hep. lod. Laur. Merciir. Mezer. Nitr. Petr. Phosph. nt*. Ehus. Sassap. Seneg. Sepise. Sulph. Thuj. Valer. WHITISH: Ang. Arn. Aur. Cann. Carh. veg.< Chia. Con, led. More. Phosph. Ph. ac. Rhus. Sas.saj). Sulph. WHITISH-YELLOW: Amm. Phos. WHITISH-GKEEN: Camph. WHITISH-TURBID : Cann. China. Con. YELLOW: Ant. crud. Arn. Ars. Bell. Br-y. Canth. Cham. Chin. Daph. Hyosc. Iodine. Ipec. Laoli. Led. Magn. ni. Nitr. Petr. Rheum. Samb. Saasap. Veratr. Zinc. 2. Urine After Stool. BURNING URINE : Cann. Canthi j-. Caps. N. mosch. Puis. Staph. Veiratr. DIABETES : Acoyi. Argent. Bell. Cann. Cupr. Clem. Dig. Hyosc. Led. Nitr. ac. Pulsat. Rhus. SquiH. Stram. Tar. Veratr. — with emaciation: Merc. — with head-ache : Veratr. — with back-ache : Phosph. ac. — with sweat : Aeon. Bell. i^riCTURITION, nocturnal: Agaric. Ambr. Amm. mur. Anac. Arn. Ars. Bry. Bov. Calc. Canth. Con. Graph. Fad. Kali. Lach. Lye. Natl'. Natr. ni. Nitr. ac. Puis. Rhus. Ruia. Sep. Sll. Stront. SiUph. Thuj, Zinc, —too frequent: Aeon, Anac, Ant. crud, Arg. Arn. Ars. Aur. Bar. Bell, Bry. Calc. carh. Calc. jjhosph. Camph. Can. Caps. Canst. Chel. Chin. Cojf. Con. Creos. Cyclam. Diiph. Euphorb. Graph. Hell. Hyosc. Ig7i. lod. Kali. Laches. Led. Lijc. M. austr. Mere. Mur. ac. Natr. Natr. mur. Nit N. vom. Oleand. Petr. Phosph. Phosph. ao. Plumb. Rhns. Sassap. Selen. Sil. ' Spig. Spong. Squill. Staph. SiUph. Tar. Thuj. Valer. Veratr. Verb. — difficult : Aeon. Agar. BeUad. Camph. Cann. Canth. Cic, Dig. Euphorb. Hyosc. Hep. Nux mosch. Op. Phosph, Plumb, Sec, corn, Thuj, — too seldom: Aeon. Agar. Ammon, mur. Apis. Arn. Arsen, Aur. Bell. Bry. Campji. Canthar. Carb. veg. Chin, Cic. Colch. Cupr. Dig. Graph. Hep. HijoHC. lod. Laur. Led. M. austr. Mane. Merc. Nitr. ac. N. vom. Op. Phoa, Plumb. Puk. Ruta. Sec. corn. Squill. Staph. Stram. Sulph. ac. Verat. —drop by drop: Agar. Am. Bell. Camph. Cann. Caatli. Caps. Caust. Chin. Clem. Colchic. Con. Dig. Dros. Dulc. Euphorb. Graph, M. austr. Merc. N. mosch. Nusc vom. Petr. Phosph. ac. Puis. Rhus. Ruta. Sil. Staph. Stram. Sulph. Thuj. URINE /viSl) UUINARY ORGANS. 83 veg. iph. Bell. !aust. Dig. M. vom. luta. — interrupted : Agar. Carb. an. Cuiist. Clem. Con. Dulc. Led. M. amh: Op. Phosph. acid. Puis. Sulph. Thuj. Zinc. involuntary : Aeon. Ant. tnrt. Am. Ars. Bell. Bry. Calc. Cunthar. Carb. veg. Canst. Chin. Cic. Clun. Creos. Dig. Dulc. Ferr. Hep. Hyosc. lod. Lacli. Laur. Led. Lijc. M. austr. Merc. Nalr. mur. Nitr. ac. Nux vom. Petr. Phosph. ac. Puis. Rhus. Ruta. Sep. Sil. Spig. Squill. Strain. Sulph. Veratr. when coughing: Bry. Caust. Natr. mur. Veratr. —at night, in bed : Aeon. Ars. Bell. Bry. Carb. v. Caust. Cham. Cliia. Con. M. austr. Natr. Op. Puis. Rhus. Ruta. Sep. Sil. Strflan. Sulph. in the first sleep : fifep. —in the day-time : Ferr. ISCHURIA: Aconit. Agar. Am. Aur. Bellad. Camph. Cann. Canthar. Chin. Cic. Coloc. Con. Dig. Eu- phorb. Graphit. Hep. Hyosc. Laur. Lycop. Nitric ac. Nux vom. Op. Plumbum. Pulsat. Ruta. Sabina. Stram. Sulph. Veratr. Zinc. STREAM, double : Canth. —thin : Camph. Canth. China. Led. Mercm-. Puis. Spongia. Staph, —scattering: Cann. Canth. —alow: Camph. Merc. I*lat. — strong; Agn. Cic. Vit. TENESMUS OF BLADDER: Aco- nit. Am. Camphor, Cann. Canth. Caps. Colch.Merc. NwTVom. Puis. Sabin. Sassap. Squilla. Sil. Viol, trie. URGING TO URINATE: Aeon. Agar. Alum. Ambra. Ammon. mur. Ant. tart. Arg. Am. Avs. Bar. Bell. Bor. Bovist. Bry. Calc. carb. Cann. Canth. Caspic. Carbo an. Caust. Charaom. Cicut. Cocc. Colcliic. Coloc. Con. Copaiv. Creos. Dig. Dulc. Euphorbiimi. dlrapli. Guuj. Hell. JIijosc. Ignat. lod. Ipco. Kali, bichr. Laoh. Lycop. M. iiustr. Mur. magn. Men. Merc. Mur. ac. Natr. Nitric, ac. N. jugl. N. voni. Petr. P/to.sp/t. Phos. ae. Plumb. Pills. Rhod. E/tiA.s'. Ruta. SabaiVtlhi. Sahlna. Sambuc. Sassap. Sclen. Sep. Sil. Spig. N(iuiII. Stunu. Staph. Sulphur. Tar. Tart. Thuj. Veratr. Zinc. —with scanty discharge : Aeon. Anac. Ant. (Tiul. Antim. tart. Bell. Bry. Calc. carb. Cann. Canth. Caps. Carb. veg. Caust. Cocc. ColcJi. Cuprum. Con. Digit. Dros. Euphorb. Hell. Hyosc. lod. Led. M. aunir. Men. Merc. Natr. Nitric ac. Nux moscli. Nux vom. Petr. Pliosph. Phosph. acid. Plumb. Puis. Ruta. Sabad. Samb. Sassap. Staph. Sulph. Ve- ratr. — with copious discharge : Agar. Alum. Ant. tart. Arg. Ars. Bellad. Bism. Carbo an. Cin. Calc. Cycl. Creos. Lach. Mur. ac. Nalr. mur. Rhus. Spig. Squilla. Stann. Sulph. Tar. Verb. Viol. trie, —irresistible : Barijt. Bell. Bry. Calc. Chin. Ign. Merc. Nltr. ac. Phosph. Pliosph. acid. Pulsat. Rhus. Euta. Squilla. —ineffectual: Aco. Arnica. Camph. Canth. Caps. Caust. Cham. Chin. Dig. Hell. Hyosc. Merc. Mur. acid. mix vom. Petr. Ph. ac. Plumb. Pulsat. Sabina. Sassap. Sec. corn. Sep. Squill. Sulph. 3. A.ccompanying Ail- ments. a. Before iirinatlon. BURNING IN THE URETHRA: Arn. Cann. Natr. Nux vom. Puis- Zinc. in k i I ill' ■.if V ft I fm 84 URINl. AND TTHINAllV OUOANS. ■U- \ti CUTTING IN THE URETHRA: Cauth. — in tlio abdonion • Puis. DRAWING IN RENAL B.T70I0N : Clem. — in ijonis : Cic. GENERALLY: -4m. Bor. Bryan. BoUad. Ciinth. Chin. Cic. Coloc. Criios. Digit. Dulc. Hep. Kiix voiii. Pkosph. ac. Plumb. PiiIh, Rhod. Rhus. Sulphur. Tar. PAIN IN THE BLADDER: Nux vom. SORE PAIN IN URETHRA : Cop. Nnx vom. Phosph. STINGING IN THE BLADDER: Canth. TEARING IN THE GLANS : Chin. b. jyuring tirinaiion. BURNING IN BLADDER : Aconit. Camph. Lach. Staph, ^in urethra: Ambra. Ars. Bar. Calc. Cann. Cmith. Canst. Cham. Clem, Chin. Colrh. Dulc. Ferr. Hop. Ipec. Kali bichr. Merc. Nitric ac^ Nu\ vom. PhoHph. ac. Puis. Sabad. Sas- nap. Sep. Staph. Sulphur. Thuj. Veratr. • GENERALLY: Aeon. Anac. Apis. Ars. Bell. Bor. Bry. Calcar. Camph. Cunn. Cantlmr. Caps. Carbo veg. Caust. Chin. Clem. Colrh. Con. Cupr. Dig. Dulcam. Graph. Hell. Hep. Ipef. Kali. Lye. Mur. magn. Merc. Mezer. Mur. ac. Natr. mur. Nitric ac. Nux vom. Petr. Phosph. Phosph. ac. Puis. Rhod. Rhus. Sassap. Sec. corn. Seneg. Sop. Spigel. Staph. Stram. Sulph. Thuj. Veratr. Zinc. GNAWING IN URETHRA : Caust. HEAT IN URETHRA : Caust. ITCnmG IN URETHRA: Alum. Ambra. Am. Canth. Daph. Lye. Natr. mur. Nux vom. Thuj. LANCINATIONS IN URETHRA : Ant. crud. Calc. Canth. Con. Dig. Graph. More. Phos. ac. Puis. Zinc —in bladder: Canth. Lye. Thuj. —in renal region : Canth. Merc. OS COCCYX, pain in: Graph. PRESSURE IN,BLADDER: Aeon. Con. Nitric ac. Spig. Stayhys. Veratr. Zinc, —in tho urethra: Canth. Puis. — in renal region : Bell. Lyo. PROSTATIC JUICE, discharge of: Natr. Pho.sph. ac. STITCHES IN BLADDER: Canth. Lye. Sulph. —in urethra: Bry. Can. Cnnth. Chin. Clem. Con. Ci\pr. Daph. Grapli. Ign. Lach. iVferc. Natr. mur. Suli)li. Thuj. — in kidneys : Aeo. Bell. Canth. Hep. Phosi^h. ac. — in bowels : Nitric ac. STOOL INVOLUNTARY : Muriat. ac. Squill. c. After urination. BURNING IN URETHRA: Con. Graphit. Lye. Merc. Nitric acid. Rhod. Sulph. CUTTING IN URETHRA : Cantli. Con. Staph. Sulph. DRIBBLING OF URINE: Bryou. Calc. carl). Lach. Petr. Selen. Tlmj. DRIBBLING OF BLOOD: Dai)li. Zinc. GENERALLY: Anac. Antim. tart. Am. Asa f. Aur. Bell. Calud. Calc Cann. Cnnth. Capsic. Chi7i. Chui. Coloc. Con. Creos. Dig. Hep. Kali. Lach. Lye. M. arct. Mereur. Mur. ac. Natr. Natr. iiuir. Nitr. ac. Kur vom. Par. Phos. Plat. Puis. Rhod. Ruta. Selen. Seneg. Sep. Stann. Staph. Sulph. Thiy. Veratr. Ziiic ITCHING IN URETHRA: Canth Lye. Sassap. MUCUS, discharge ^)f.- Con. Natr. mur. NAUSEA: Dig. rhlNE AND URINARY ORGANS. PRESSURE IN URETHRA : Stuun. —on tho bladder : Con. Stiiim, Ziiio. SORENESS IN URETHRA: Nux v<}m. Tlmj. STITCHES IN URETHRA: Arii. Caps. Mei'c. Miu'iat. acid. Phospli. V(!ratr. —in bladder: Guaj. — iukidnoys: .Vmbr. TEARING IN URETHRA: Carbo vog. Lye. URETHRA, us of a drop in: Lact Thuj. URGING TO URINATE: Rar. Dig. Mercur. Rnta. Stanu. Stapli. Zinc. critiJsiAitY oita^vjsrs. 1. Bladder. BURNING : Aeon. Ars. Canth Lach. N. vom. Phosijli. ac. Puis. Stapli. CATARRH: Ant. Dicla. Nux vom. Pnls. Sulph. CONSTICTION: Caps. Cic. Phos. ac. Puis. Sassap. CUTTING: Canth. Fali. Lye. Nux vom. Puis. Thuj. DRAWING : Calad. Rhod. FULLNESS, feeling of: Caladimn. Rnta. GENERALLY : Aco.i. Alum. Ambr. Anl. crud. Am. Ars. Aurum. Bell. Bry. Calc. Camph. Cann. Canth. Caps. Carbo vegot. Chin. Cic. Coff. Clem. Colch. Dig. Dulo. Graph. Hyosc. Ign. Kali. Lyoop. M. aiistr. Merc. Mezer. Natr. niur. Nitr. ac. N. vom. Phosph. Plxos. ac. Puis. Rhus. Ituta. Sabin. Sassap. Sep. Staph. Sulph. Thuj. Zinc. HEMORRHOIDS: Aconit. Borax. Carbo veg. Dulcam. Nux vom. Puis. Sulph. INFLAMMATION : Aconit. Camph. Canth. Dig. Merc. N. vov\. PuIh. Sqiiilla. Sulph. — of neck of bladder: Aconituvi. Canth. Con. Dig. Nux vom. Puis. Sulph. INSENSIBLE : M. austr. Stann. PARALYSIS : ^lr.s. Bell. Canth. Cic. Dale. Hyosc. Laur. M. auKtr. PRESSING: Alum. Carbo voget. Chin. Colch. Nux vom. PULSATION: Canth. PRESSING: Hyosc. PRESSURE: Asar. Bellad. Bryon. f'am2ih. Ciivbovo^. Con.Igv. Lach. Natr. mur. Nitric acid. Pulsat. Sas- sap. Sep. Squilla. Staph. Zinc. REI*.\XED : Mur. ac. SPASMS: Asa f. Cumph. Canth. Caps. Phospli. ac. Sep. SPASMODIC PAIN : Prun. STITCHING: Aur. Canth. Cham. Guaj. Lye. Puis. Rhus. STONE : Arab. Ant. crud. Calc. carb. Cann. Lye. Nux vom. Phos2)h. Rnta. Sassap. Sil. SUPPURATION: Canth. Puis. SAVELLING OF NECK OP BLADDER: Puis. THICJCENING: Dulc. 2. Urethra. BURNING: Arsen. Baryt. Bryon. Calc. carb. Cann. Canth. Caust. Clem. Cok'h. Cupr. Tpec. Kali hichr. Lye. Mercur. Natr. Nitric ac. Petr. Phosph. Phosph. acid. Sassap. Sepise. Staph. Sulph. Thuj I Ij , I 1 it .11 'i\ ' I IM TmiNK AND TintNARY onOANB. I r CUTTING: Ant. <rmJ. Cole. Corb. Oann. Cmilh. Catho veg. Colchic. Con. Cn\n'.l)l(i. Ignut, [,yi: Merc. Niix vom. Fliosph. at: llhod. Sop. Sniph. Thuj. DISCHAllOE: Agu. Cole, carbon. Caiiii. Cantliar. Cnjix. Dulc. Hop. Merc. Nltr, ne, Niix vom. Potr. Pu/.s. Sa«8ap. Hulphur, Thuj. —bloody : i jalc. carbon. Lycop. Merc. Nitrio ac. Zino. — thick: Merc. — purulent: Cann. Canthar. Clom. Morciir. Nitric acid. Sassap. Sulph. Thuj. —yellowish: Cann. Merciir. Natr. mur. Nitric ac. Thuj. — greenish : Merc. Nitric ac. -slimy: Ant. Cann. Caps. Dulc. Merc. Mczor. Niiidc ac. Phos. ac. Pills. Sulph. —watery: Cann. Merc. Sulph. DRAWING : Cole. Kali. Lye. Puis. Subad. Sulph. Zinc. » GENERALLY: Aeon. Alum. Ant. cnid. Antim. tart. Am. Arg. nitr. Aur. Bov. Bryon. Calc. carb. Cann. Canth. Capsicum. Caust. Chel. China. Clem. Coflf. Colch. Con. Cop. Cupr. Dulc. Ferr. Graph. Hep. Ign. Kali. Lach. Lycop. M. austr. Merc. Mozer. Natriim mur. Nitric ac. Nux vomica. Phosph. Phosph. ac. Pub). Rhus. Sabin. Sep. Staph. Sulph^ir. Thuj. Ve- ratr. Zinc. INFLAMMATION: Aeon. Bovista. Cann. Canth. Clem. Digital. Hyosc. Merc. Nux vom. Puis. Squilla. Sulph. ITCHING: Agar. Am. Bov. Bry. Canth. Chin. Lye. Merc. Natrum mur. Nux vom. Suljjh. Thuj. PRESSURE: Canth. Colch. Nux vom. Puis. PULSATING : Canth. Merc. SORENESS, 08 from: Bar. Daph. Natr. mur. Phosphor. Teucr. Zinc. SPASM: Chin. Carbo an. STITCHING: Am. Bryon. Cann. Canth. Capsic. Con. Cuprum. Do2)h. Graph. Ign. lod. Lach. Lye. Merc. Mur. ac. Natrum mur. Nux vom. Phosphor, ac. Squilla. Sulph. Thuj. STRICTURE; Camph. Canth. Carbo veg. Clem. Dulc. Lyo. N. vom. Petr. Puis. Rhus. Sulph. SWELLING: Cantliar. Merc. Nitr. Rhus. TEARING: Cann. Carbo vegetab. Clem. Colch. Lycop. Natrum. Sas- sai>. Sulph. TICKLING: Canth. TWITCHING: Con. Natr. Phosph. ULCER : Merc. Nitric ac. 3. Kidneys. BURNING: Bell. DRAWING: Clem. GENERALLY: Aeon. Alum. Bell. Cann. Oantli. Carbo veget. Clem. Colchic. Hep. Kali. Lye Nitric ac. Nux vomica. Phosph. Phosph. ac. Pulsat. Rheum. Ran. seel. Sassap. Sep. Sulph. Thuj. Zinc. GRAVEL: Alum. Calcar. carbon. Cann. Canth. Lye. Nitric ac. Nur vom. Petr. Phosph. Ruta. Sil. Sas- sap. Sulph. INFLAMMATION: Bell. Cann. Canthar. Hep. Lye. N. vom. Puis. JERKING: Canth. PULSATIONS: Canth. PRESSURE: Thuj. Zinc. AS IF SORE : Zinc. SPASMODIC PAINS : Sulph. STITCHES: Aeon. Bell. Canthar Hep. Kali. Phosph. ac. Zinc, XXVI. SEXUAL ORGANS ANB FUNCTIONS. 1. Penis. BLUENESS: Arn. BURNING: Cnnth. Euphorbinm. Merc. Mur. ac. Plumb. COLDNESS: Lye. Mere. Sulph. DEADNESS : Lye. Merc. DRAWING: Cnnlli. Cic. Jod. Kuli. M. austr. More. Ran. bc. Zinc. ERUPTION: Graph. Phosph. acid. GANGRENE: Ars. Caufch. GENERALLY: Alum. Ambr. Auiir Ant. crud. Am. Ais. Bovista. Bvx. Calc. carb. Camphor. Ca...... Caiilli. Caps. Carbo veg. Caust. Chin. Clem. Colch. Con. Cupr. Dig. Ferr. Graph. Hep. Ign. locliuo. Ipoc. Kali. Lach. Lyo, M. au.slr. Merc. Mezer. Mur. ac. Natr. Natrum mur. Nux vom. Op. Phosphor. Phosph. ac. Plal. Plumbum. Puis. Ran. Rhus. Sabin. Selen. Sep. Sil. Spigel. Staph. Sulph. Tln\j. Viol. trie. Zinc. GONORRHOEA: Cann. Cantharis. Cap.'). Clem. Dulc. Ferr. Lye. Mt'rc. Natr. mur. Nitric ac. Nux vom. Puis. Sabina. Sec. corn. (?) Selen. Sulph. Thuj. —acute : Cann. Canth. Merc Nitr. ac. — chronic : Cann. Capsic. Dulc. Ferr. Merc Nitr. ac. N. vom. Sep. Sulph. —green : Cann. Merc, —white : Cann. Caps. Ferr. —clear: Merc. Sulph. —yellow: Cann. Merc. Nitric ac. Sulph. INFLAMMATION : Canthar. Merc. Plumb. Sulph. ITCHING : Ars. Con. Spig. Sulph. PAIN AS IF BRUISED : Arn. PRESSURE: Viol. trie. PUSTULES. Bovist. REDNESS: Am. Cann. RELAXED: Calc. /-;/(■. Merc. Prun. SORE, painful as if: Arn. Cann. Cicut. SPASM: N.moHch. STITCHES : Asa foot. Lye. Merc. Pul-s. >S>ty. Sulph. Thuj. SWELLING : Arn. Cann. Vanlhar. Merc. Plumb. TEARING: Con. Kali. M. austr. More. Thuj. L' WITCHING: Lye. TENSION : Arn. Graph. ULCJER: jvlerc. 2. Glans. BURNING : Ara. Cann. Chin. Lye. Merc. Stanu. Tart. COLDNESS : Lye. Merc. CREEPING: Alum. Merc. Natr. mur. Tart. CUTTING: Lye. Thuj. DAMPNESS: Alum. Lye. Merc Natr. mur. Nitr. ac N. vom. SuljJh. Thuj- DRAWING: Alum. Asa foot. lotl. Lye. ERUPTION: Calad. Lycop. Nitr. Potr. Sep. FORMICATION: Alum. GENERALLY: Alum. Antim. cmd. Ars. Calc. carb. Cann. Canth. Carb. veg. Canst. Chin. Colch. Dig. Graph. Ign. lod. Lach. Kali. Lye. M. austr. 3Iorc. Mez. Natr. Natr. mur. Nitr. ac N. vom. Petr. Phosph. Puis. Rhus. Sabin. Sep. Sil. Stann. Staph. Sulph. Thuj. HARDNESS: Cann. INFLAMMATION: Arnic. Cannab. Cupr. Merc. Rhus. ITCHING: Ambr. Angust. Ars. Cauu. Euphr. Hell. lod. Maug. ir 'I I \ ' 'I I ^t 88 SEXUAL ORGANS AND FUNCTIONS. Merc. Natr. Nitr. ac. N. vom. Phoaph. ac. Sep. Sil. Thuj. PKESSUBE: Lye. Viol. trie. REDNESS: Arsen. Cann. Merc. Sabin. SMEGMA: Mere. Nitr. ac. SORENESS, as from: Nux vom. Sabin. SPOTS, red: Cann. Carbo veg. Lach. Nitr. ac SWELLING: Ars. Cann. Canth. Merc. Rhus. — on one side: Spig. STITCHES: Aeon. Am. Ars. Eu- phorb. Euphr. Lycop. Merc. Phosph. Rhod. Sabin. Sulph. Thuj. TEARING: Daph. Euphorb. Kali. Lye. Merc. TUBERCLES: Hell. ULCERS: Merc. Nitr. ac. Sep. Sulph. Thuj. — chancrous: Merc Nitr. ac. Rhus. Sulph. Thuj. ULCERATIVE PAIN: Ambr. Ign. VESICLES: Merc. Phosph. acid. Rhus. 3. Prepuce. BURNING: Arson. Cann. Merc. N. vom. CREEPING : Croc. Merc. Ph. ac. DRYNESS : Calad. Ign. Sil. ERUPTION: Aur. Graph. Merc Nitr. ac. Rhus. Sulph. GENERALLY: Aeon. Arn.] Arsen. Calad. Calc. carb. Cannab. Canth. Caust. Chin. Euphorb. Graph. Hep. Ign. Lach. Lye. M. arct. Merc. Mezer. Natr. mur. Nitr. ac. Nux vom. Pliosph. ac. Plumb. Puis. Rhod. Rhus. Selen. Sep. Sil. Staph. Suljjh. Thuj. Viol. trie. Zinc. HARDNESS: Lach. Merc. Sulph. HERPES : Caust. Dulc. Hep. Merc. Nitr. ac. Phosph. ac. Sep. INFLAMMATION: Calc. carb. Cann. Merc. Nitr. ac. Sulph. ITCHING: Aeo. Agar. Brj-. Calad Carb. veg. Cann. Caust. Euphras. Merc. Nitr. ac. N. vom. Puis. Sep. Sil. SuU)h. Thuj. PAIN AS IF SORE : Calad. Cham. Ign. N. vom. PARAPHIMOSIS : Bell. Coloc. Ign. M. arct. Merc. N. vom. PHIMOSIS : Canuab. Canthar. Merc. Nitr. ac. Rhus. SulpJi. Thuj. REDNESS : Calc. Cann. Mere. SCURFS : Caust. Nitr. ac. (Comp. Herpes.) STITCHES: Ars. Brj'. Cann. Eu phras. Hep. Merc. Puis. SMARTING: CalaO. Merc. Nux vom. Puis. SPOTS, red: Nitr. ac. Rhus. SORENESS: Calad. Cann. Carbo veg. Ign. Nitr. ac. N. vom. STRICTURE: Cann. Merc Sep. Sulph. SUPPURATION: Merc. SWELLING: Calad. Cann. Graph. Mercur. Nitric ac. Rhus. Sulph. Thuj. ULCERS: Aurum. Caustic. Hep. Merc. Nitric ac. Rhus. Sep. Sulph. Thuj. — chancrous: Kali bichr. Mercur. Nitric ac. Rhus. Thuj. VESICLES : Merc. Rhus. 4. Testicles. BURNING : lod. Plat. Staph. COLD FEELING: Merc. CONSTRICTION: N. vom. Plumb. DRAWING: Amm. Clem. Ipecac. M. arct. Merc. Phos. Puis. Rhod. Staph. Zinc. DWINDLING : Aur. Lye. GENERALLY: Agn. Amm. Antim. crud. Arn. Aur. Bell. Calc. carb. Canth. Carbo veg. Caustic. Chin. Clem. Cocc. Con. Dig. Graph. Ignat. lod. Kali. Lye. M. auslr. •^■■■- SEXUAL ORGANS AND FDNOTIONS. Merc. Natrum. J Itrlc ac. Nux vom. Phos. Phosph. ac Plat. Plumbum. Puis. Rhod. Ehuo. Selen. Sep. Sll. Spong. Staph. Sulph. Tar. TIiuj. Zinc. GNAWING: Plat. HANGING DOWN: Nltr. ac. Puis. HARDNESS : Agn. Arg. Aniica. Aur. Clem. lod. Merc. N. vom. Rhod. Spong. HEAT: Arn. — feeling of : Sulph. ac. HEENIA : Lach. N. vom. Elius. INDURATION: Amvi. Ignatia. M. auatr. Plumb. INFLAMMATION: ^co. Aur. Clem. Lye. Mereur. Ntix vom. Puis. Staph. Zinc. ITCHING : lod. Ign. Merc. Nux vom. Spig. JERKS : M. austr. PAIN AS IF BRUISED : Am. Clem. Con. Dig. PEESSING T.O,WAKD THE TESTICLES: lod. PRESSURE: Aur. Bism. Cannab. Caust. Ign. Lach. Phos. ac. Puis. Squilla, Staph. Zinc. SENSITIVENESS: Arn. Asa feet. Cann. Phosph. ac. Zinc. SPASM: Phosph. STITCHES : Arn. Bell. Merc. Nux vom. Rhod. Spig. Thuj. SWELLING: Arn. Arsen. Aur. Can- thar. China. Clem. Con. lod. Luc. Merc. Nitric acid. Nux vom. Puis. Rhod. Ruta. Spong. Staph. Zinc, —of epidydimis : Sulph. TEARING : Chin. M. austr. Phos. ac. Puis. Staph. TENSION: Arn. Sulph. TURNING: Sabad. r Scrotum. BLUENESS: Am. BURNING: Euphorb. Rhod. CONTRACTION: Petr. Puis. 54 COLDNESS: Caps. CREEPING: Arn. Carboveg. Selen. Thuj. DAMPNESS: Petr. Rhus. SmM,. ERUPTION: Peir. Phosphor, ac. Rhus. ERYSIPELAS: Ar.H. GENERALLY: Aeon. Ambr. Ant. cnid. Arn. Ars. Baryt. Bell. Calc. carl). Camphor. Cannab. Carbo veg. Caust. Chin. Clem. Con. Eu- phorb. Graph. Hep. Ign. led. Kali. Lye. M. austr. Mezer. Natr. Nitric ac. Nux vom. Petr. Phosph. Phos. ac. Plumbum. Puis. Rhodod. Rhus. Selen. Sep. Sil. Staphys. Sulph. Thuj. Viol. tiic. Zinc. HERPES : Calc. carb. Dulc. Petr. HYDROCELE: Arn. Graph. Nux vom. Puis. Rhodod. Rhus. Sil. INFLAMMATION : Ars. Phosph. ac. Plumb. ITCHING : Ambr. Amm. Aurum. Baryt. China. Cocc. Graphit. Lye. Meph. Nux vom. Petr. Pulsat. Rhodod. Ehus. Selen. Staph. PAIN AS IE BRUISED : Aeon. Arn. Kali. PULLING: Petr. BASH: Ehus. EEDNESS : Puis. RELAXED: Chin. Lye. SHEIVELING: Rhod. SOEENESS: Arn. Petr. Plumb. Sulpli. STITCHES: Arn. Merc. Sulphur. Thuj. SWELLING: Am. Canth. Carbo veg. Graph. Plumbum. Puis. Ehus. Sep. SWEAT : Baryt. Ignat. Ehodod. Thuj. TENSION: Arn. 6. Spermatic Chord, BUENING: Staph. DEAWING: Agn. Canthar. Clem. $ III 1 1 if 'I f": fO SEXUAL OROAN8 AND FUNCTIONS. if' I i' |i ° M i M. austr. Merc. ^. voni. Pids. Rhod. GENERALLY: Alum. Amm. mur. Aut. crudum. Am. Cuntlmr. C'leiii. lod. Kali. M. niisir. Mercnr. Nitric ac. Nux vom. Phosph. acid. Plumb. Puis. Sabin. Spomj. Staphys.Thni. Veratr. HARDNESS : Phosph. ac. PRESSURE: Nux mosch. Bpong. Sulph. Thuj. STITCHES : Amm. mur. Am. Grat. Staph. Thuj. SWELLING: Cann. Phos. Puis. Spong. TEARING: Colch. Puis. TENSION: Cann. M. aiastr. THROBBING : Amm. mur. TWITCHING: Plumb. 7. Prostate Gland. HARDNESS: lod. INFLAMMATION : Agn. lod. Merc. Puis. PROSTATIC JUICE, discharge of: Alum. Anac. Calcar. Con. Hej>. Lxjcop. Nitric acid. Petr. Phospli. Jic. Plat. Selen. Sep. Sil. Staph. Sulph. Zinc, '-when urinating: Anac. Ciilc. Sep. Sulph. -at stool: Alum. Calcar. Hep. Ign. Selen. SU. Sulph. -after stool : Selen. -before stool : Selen. — with relaxed parts: Calvarra. Phospli. ac. SWELLING: Puis. 8. Greneral Symptoms. COLDNESS: Agn. Capsic. Lycop. Merc. ERUPTION: Aur. Cakd. Caustic. Dulc. Graph. Merc. Nitric ac. Petr. Phosph. ac. Rhus. Sep. Sil. Sulph. Thuj. — on the hairy part of [the parts : Ka- li, bichr. Lach. FETID SMELL : Natr. mur. Sassap. riGWARTS: Euphr. Lye. Nitric ac. Phosph. ac. Sabin. Sassap. Thiy. — bleeding: Thuj. — flat : Nitric ac. Thuj. — like cock's-crest : Nitric acid. Tlnij. —humid: Nitric acid. Sulph. Tlnij. —dry: N. vom. Sulph. Thuj. GANGRENE: Ars. Canth. HAIR, falling off: Natrum mur. Nitric ac. Rhus. Selen. HERPES: Aur. Dulc. Nitric acid. Petr. Phosph. ac. Sulph. RELAXED: Calc. Lye. Phos. ac. Selen. SWEAT : Calad. Merc. Phos. ac. Sep. Sulph. Thuj. WEAKNESS : Agn. Calc. Lycop. Mang. Sep. Sulph. 9. Sexual Instinct, Functions. ERECTIONS: Agar. Alum. Ambr Anac. Am. Ars. Aur. Baryt. Bell. Bov. Calc. carb. Cann. Canth. Caps. Carbo animal. Carbo veg. Chin. Clem. Colch. Con. Dig. (jraph. Ig- natia. Kali. Lach. Lycop. M. arct. Mur. magn. Merc. Mosch. Natr. Natr. mur. Nitric ac. Nux vom. Op, Phos. Phosjjh. ac. Plat. Plumbum. Puis. Rhus. Sabin. Sep. Sil. Spig. Staph. Sulph. acid. Tar. Thuj. Viol. trie. Zinc. — in the evening.: N. vom. Phos. Staph. — in the morning : Ambr. Anac. Arn. Brom. Caps. Lach. Natrum. N. vom. Phos. Plumb. Puis. Rhus. Thuj. Vit. —at night: Canth. Merc. Natr. mur. Nitric ac. Plumb. Puis. Staph. Sxilph. ac. Zinc. — in the day-time: Cann. Uyosc. Lach. Puis. SEXUAL OHQANS AND FUNCTIONS. 91 •^y and night : Canth. "too short : Calad. Calc. Con. Helen. -deficient: Agn. Calad. Camphor. Cou. Graph. Hell. Lach.Lnc. Magu. carb. Nux mosch. Puis. Teucr. Vit. —too feeble : Barijt. Caladiiim. Lach- esis. Lye. Mercur. Selen. Sulph. ' -too strong: Canthar. Creos. Lach. Natr. mur. Nux vom. Op. P'los. Puis. Sabin. Zinc. —too painful: Cann. Canth. Grai)h. Ign. Kali. Merc. Nitric ao. Nu.r vom. Plumb. Sabad. Sulph. Thuj. — without sexual lust : Ambra. Calad. Cann. Caps. Graphit. Lach. Magn. Natrum muriat. Phosph. ac. Sabad. Sabin. Sil. Spig. SEMEN BLOODY: Caust. Canth. Led. Merc, -thin: Selen. — inodorous: Selen. — watery: Led. Sulph. — flow of: Agar. Alum. Anao. Arg. Am. Ars. Aur. Baryt. Bell. Bism. Bov. Brom. Calad. Calc. Canth. Carbo an. Car bo veg. Caustic. China. Cicut. Co».. Ferr. Graphites. Guaj. Kali. Lach. Led. Lye. Magn. Merc. Natr. Natr. mur. Nitric ac. Nux mosch. Nux vom. Op. Petr. Phosph. Pliosph. ac Puis. Ran. bulb. Rhus.Euta. Sangv. Selen. Sep. Silicea. Stann. Staph. Sulphur. Thuj. Verb. Vit. Zinc. J in the day-time : Canthar. Car- bo an. Caust. Graph. Lach. not taking place during inter- course: Calad. Graph. Kali. Lach. Lye. — —-with relaxed penis : Bellad. Con. Graph. Mosch. N. vom. M. arct. Plumb. Selen. at stool : Phosph. ac. weakening: Baryt. Carbo an. vhin. Kali. Lach. Lye. Nux vom. Phosph. Phosph. ac. —too soon: Bor. Calad. Calcar. Lye Phosph. ,s'e/. Zinc, —too often : Bai-. Calc. carbon. Canlh Carbo veg. Chin. Ci; Con. Kaii. Lye Nitric ac. Petr. Phospli. Pliosph. ac. Sep. Sil. Sulph. —during the siesta: Alumina. Causi, Clem. Mercur. Staph. Sulph. —without force: Canthar. Con. Phosph. Selen. —deficient: Calad. Calc. Camphor. Kali. Lach Lye. Natr. mur. —followed by languor: Baryt. Calc. carb. by anxiety : Carbo an. by head-ache: Calcar. Lach. Sil. irresistible desire : Rhus. heaviness in the limbs next day : PiUs. amorous fancies : Alumina. Ars. Aur. Baryt. Bism. Calc. Chin. Grat. Led. Natr. Nux vom. Ole- and. Op. Phosphor. Plumb. Sa- bad. Samb. Sassap. Sil. Staph. Viol. trie. SEMEN, followed by dryness of the skin: Baryt. contractive feeling in urethra: Thuj. voluptuous dreams : Calcar. ph. Kali carb. — early in the morning: Lach. N. vom. Plumb. Puis. — after midnight : Samb. — several nights in succession: Aur. Caust. Carb. an. Con. — after onanism: Calc. Carbo veg. Chin. Natr. mur. Ph. ac. Sep. Staph, —without dreams : Anao. Ant. cnid. Bism. Calc. Cic. Guaj. Phosph. Puis. Ran. sc. Ruta. Stann. Verb. Zinc. fancies: Phosph. thrill : Anac. Natr. Carb. Sulph. ac. Plat, —painful: Calc. Cann. Canth. CI in, Mosch. Natr. carb. Sassap. Tlidj. i ." i: ,r j; ■■I- ili 92 BEXUAL OKQANS AND FUNCTIONS. 1 I — with cutting in urethra : Bor. —with cutting in urothni afterwards : Niitr. mur. —too late: Agar. Calc. Lack. Lxjc. Petr. SEXUAL INTERCOURSE, aver- sion to : Agar. Cann. Caust. Clemat. Kali. Lye. Phosph. Rhod. —desire for: Calcar. Caiilh. Chin. Lach. Mosch. Phos. Puis. Staun. Veratr. — falls asleep during : Bar. Lye. —followed by mental languor : Calc. Sep. by pain in urethra : Canth. by dullness of head : Bov. Chin. Lye. by ill-humor : Petr. by back-ache : N. vom. — with relaxed j)enis: Con. Lye. N. vom. — followed by weakness : Agar. Calc. Kali. Lycop. Niir. ac. Selen. by sweat : Agar. by bruised feeling: Sil. by tremor of the legs : Calc. carb. SEXUAL LUST : Calc. carb, Caiilh. Carb. veg. Chin. Grajjh. Hyosc. Lach. Mosch. Natr. mur. N. vom. Phosph. Plat. Puis. Sep. Stann. Stram. Veratr. Zinc. SEXUAL DESIRE TOO STRONG : Agar. Alum. Ant. crud. Aur. Baryt. Bov. Calc. Cann. Canth. Carb.veg. China. Coff. Con. Dig. Dulc. Fcrr. Graph. Hyosc. Ign^Iod. Kali. Lach. Lycop. Mane. M. arct. M. anst. Men. Merc Mosch, Natr. nuir. N. vom. Oj). Petr. Phos. Plat. Plumb. Pills. Rhus. Ruta. Sabin. Sep. Sil. Staph. Stram. S7ilph.\erair. Zinc. SEXUAL DESIRE, like priapism: Canth. Graph. Natr. mur. N vom. Phosph. Plat. Puis. Staph. — Uke satyriasis: Canth. Mere, N. vom, Phosph. Sulph. Verat. — deficient : Amm. mur. Bellad. Bor. Calc. carb. Camph. Con. Graph. Hep. Kali. Lach. Lye. Magn. c. Nitr. ac. Phosphor, ac. Rhod. Stann. Sulph. — too feeble : Alum. Ambr. Bar. Bell. Bor. Calad. Calc. Carbo an. Caust. Clem. Ferr. Graph. Hep. Kal. Lact. Lye. Magn. c. Mur. ac. Natr. mur. Nitr. ac. Op. Petr. Phosph. ac. Rhod. Selen. Sep. Spong. Stann. Sulph. Teucr. — with impotence : Agar. Graph. Se- len. SEXUAL POWER, too feeble : Agar. Bar. Calad. Calc. Canth. Chin. Con. Ijjnat, Mang. N. mosch. Selen. (Sep, Sulph. Vit. deficient : Agar. Agn. Ant. crud. Baryt. Calad. Calc. Camph. Cann. Carb. V. Caust. Chin. Chlor. Con. Cupr. m. Ferr. Graph. Hep. Ign. lod. Laches. Lye. Mosch. Miir. acid. Natr. mur. Nitr. acid. N. mosch. N. vom. Phosph. Plumb. Rhus. Selen. Sep. ^i\.Sulph.1h.u}. Vit. Zinc. FJEMA.LB SEJ^TJAL ORG^JSTS AJSTJD FUNCTION'S. A. SEXUAL ORGANS. 1. External Organs. APHTHA: Carb. veg. BURNING: Calc. Ca?i//i. Carbo veg. Caust. Kali. Lye. M. austr. N. yom. Petr. Sabin. Sil. Staph. Sulph. Thuj. DAMPNESS : Atir. Sulph. ERUPTIONS: Calc. Caust. Dulc. Graph. Merc, Nux vom. Petr. Rhua Sep. Staph. Sulph. Veratr. SEXUAL ORaANS AND KUNCTIONS. 98 GENEEALLY: Aeon. Agar. Alum. Ainbr. Amin. Aut. crud. Aru. Asa f. Aur. Bar. Bell. Bry. Culo. Cauth. Carbo veg. Cham. Chin. Coif. Cun. Creos. Dulc. Ferr. Graph. Hyoso. Kali. Lye. Meph. Merc Nutr. Mali: mar. Nit7'. ac. Nux vom. Petr. Phosph. Platin. Pnlsat. Khus. Sec. corn. Sep. Sihc. StajjJi. Sulplt. Thiij. Veratr. GNAWING : Kali. Lye. Nux vom. HAIR, falling out : Natr. mur. Nitr. ac. HEAT: Aur. Canth Carbo veg. M. austr. Merc. Nux vom. I rCHING : Agar. Alum. Ambr. Calc. Carbo veget. C'/vo.s. Con. Dulc. Kali bichr. Kali curb. Lye. Merc. Natr. mur. Nux vom. Sep. Staphys. Sll. Sulph. NETTLE-RASH : Ant. tart. PAINFULLNESS : Kali bichr. Merc. Staph. PIMPLES : Graph. Kali. Merc. PUSTULES : Bry. Merc. REDNESS: Carbo veg. SWELLING: Ambra. Amm. Aur. Cauth. Carbo veg. Meph. Mercur. Nitric ac. Nux vom. Sec. corn. Sep. Thuj. SORENESS: Ambr. Amm. Carbo veget. Caust. Daph. Graph. Hep. Kalic bichr. Lye. Meix. Petr. Rhus. Sep. Sil. Sulph. Thuj. SORE PAIN : Ambr. Brom. Cham. Creos. Ferr. m. Rhus. Thuj. STITCHES : Aur. Con. Croc. Gra- phit. M. austr. Merc. PhosjjJi. Sep. Staph. Thuj. TUBERCLES : Cale. Mere. Phos. ULCER: Graph. Merc. Nitric ac. Sec. corn. Sep. Thuj. VARICES: Calc. carb. Cai-bo veg. Lye. VESICLES: GrrtiWi. Staph. 2. Vagina. BURNING: Aur. Cham. Hyosc. Lye. Sulph. Thuj. CONTRACTION: Mosch. Ehu.s. Sep. Thuj. DRYNESS : Bell. Lye. GENERALLY: Alum. Ambra. Aur. Ars. Bell. Calc- Canth. Capsie. Car- bo veg. Caust. China. Coif. Con. Creos. Dulc. Ferr. Ferr. m. Graph. Hep. Iodine. Kah. Lye. Mur. magn. Mercur. Natr. Natr. mur. Nitric ac. N. vom. Petr. Phosph. Plat. Puis. Rhus. Sabina. Secale corn. Sep. Sil. Staun. Staph. Sulph. Sulph. acid. Thuj. HEAT: Aur. Creos. Merc. INDURATIONS: Bell. Sep. INFLAMMATION: Merc. Nitric acid. —with swelling: Merc. ITCHING: Con. Creos. Sulph. — with volui)tuous feeling : Creos. LABOR-LIKE PRESSING: Croc. Moschus. Sil. PAIN DURING INTERCOURSE: Ferr. PROLAPSUS: Creos. Ferr. Merc. Nux vom. Sep. Stann. SORENESS : Hyosc. KaU bichr. — with burning : Hyosc. —painful: Ferr. in. Rhus. SPASMODIC PAIN : Nux vomica. Staph. STITCHES : Ars. Berb. Con. Mur. ae. Nitric ac. Puis. Rhus. SWELLING: Kali bichr. Merc. 3. Uterus. CANCER: Ars. Bell. Calc. Carb. an. Clematis. Creos. Graph. lod. Kreo- sota. Lach. Phosph. Rhus. Sahin. Sec. corn. Sil. Sulph. Thuj. , CONTRACTION: Sep. Thuj. CORROSIVE ULCERATION OF OS TINC^: Ars. Bell. MeiX. Ni- tric ae. Sep. Thuj. !>'' r*» 'i ■' Hi : 'I fill li Si 94 SEXUAL ORGANS aaVD FUNCTIONh. '.|-' CUTTING TN THE OS UTERI: Puis. DESCENSION : Sec. corn. DISTENSION : Lye. Phosphor, ac. Sep. DRAWING: PiUs. Rhus. GENERALLY: Acou. Antim. crud. Am. Asa f. Aur. IJcll. Bov. Bryon. Calc. Carbo cm. Carbo veg. Caust. Chum. China. Cocv. Coflf. Con. Cre- os. Croc. Jerr. Geum urb. Ch'aph. Hyoscyam. Ign. lod. Ipecac. Kali. Lacn. Magn. carb. Magn. mur. Mosch. Natr. Natr. mur. Niix mosch. Nux vom. Oi>. Phosph. ac. Plat. Puis. Rhus. Sabadilla. Snbina. Sec. corn. Sep. Stann. Stram. Sulphur. Thuj. Zinc. HEMORRHAGE: Aeon. Arg. nit. Alo(5. Am. Bell. Bnj. Calc. Canth. Carbo an. Carbo veg. Cham. Chin. Coffea. Creos. Croc. Ferr. Hyosc. lod. Ipec Lxjc. Mag. m. BI. austr. Merc. Mill. Natr. carb. Nitric ac. Nux mosch. Nux vom. Phosph. Plat. Psor. Pulsat. Rhus. Sabin. Sec. corn. Sep. Sil. Squill. Stram. Sulph. INDURATION: Aur. Bell. Carb. an. Chin. Clem. Cocc. Con. lod. Magn. mur. Rhus. Sep. Staph. INFLAMMATION: Aeon. Bellad. Bry. Canth. Cham. Chin. Coff. Con. Dulc. Ign. Lach. Mei'c. Nux vom. Plat. Puis. Sabin. Sec. com. LABOR-LIKE PAIN: Cham. Mur. ac. Op. Sec, corn. Sep. POLYPI: Calc. Staph. Thuj. PROLAPSUS : Aur. Bell. Calc. Cre- os. Merc. N. vom. Sep. Stann. PUTREFACTION: Carbo an. Sec. corn. SENSITIVENESS OF NECK OF UTERUS: Chin. SORE, pain as if: Mur. oc. Rhus. SPASMS : Bell. Bryon. Caustic. Chamom. Cic. Cocc Con. Oeum urb. Hyosc. Iguatla. Magn. Magn. mur. Natr. mur. Nux vom. Plai Pulsat. Sep. Stann. SPASMODIC PAIN: Coco. Iguut Nux vom. Tiiuj. STITCHES: ^^liuiat. acid. Phosph. Plat. SWELLING: Bell Merc. N. vom. Sec. Sep. 4. Qvaries. DROPSY: Apis. Ars. Canthar. Dul- cam. lod. Mercur. Sepiai. Staph.(?) GENERALLY: Acou. Agar. Ambr. Ant. crud. Apis. Ars. Asa f. Aur. Bell. Canth. Carlo an. Carbo veg. Chin. Coloc. Con. Graph. Hyosc. Ign. lod. Kali. Lach. Lye. Merc. Mezer. Nux vom. Plat. Plumb. Ran. bulb. Sabin. Sassap. See. corn. Sep. Staph. Sulphur. Thi^j. Vit. Zinc. INDURATION: Apis. Aur. Bellad. Carbo an. lod. Lach. INFLAMMATION : Aconit. Ambra. Ant. carb. Apis. Ars. Bell, Bry. Canth. China. Coloc. Con. Dulc. Ign. Lach. Mercw, . Plat. Puis. Sa- bin. Staph. SENSITIVENESS : Apis. Plat. SWELLING: Apis. Graph. Iod.(?) Lach. 5. General Symptoms. FIG WARTS : Nitric ac. Thiy. PAIN AS IF BRUISED: Bar. m. PRESSING TOWARDS THE PARTS: Bell. Bov. Cliin. Clia- mom. Con. Croc. Graph. Ipec. Kali. Merc. Mosch. Natr. Plat. Pul- sat. Sep. Sulph. Thuj. RUSH OF BLOOD: Bell. China. Croc. Ign. Nux vom. Phosph. Plat, Sec. com. Sulph. SORENESS BETWEEN THE THIGHS: Arsen. Caust. Creos. Graph. Hep. Lye. Nitric acid Phosph. Rhod. Sep. Sulph. WEIGHT, feeling of: Nu. vom. SEXUAL ORGANb AND FUNCTIONS. 95 SEXUAL FUNCTIONS ANP INSTINCT. BLOOD, loss of, between the pe- riods: Ambr. Am. Bell. Bov. Calc. Jf^am. "^hin. Coc. Coff. Croc. Hyosc. l^ali. Ipecac. Merc. Mugn. mur. Nux vom. Petr. riiosphor, Prun. BJnis. Sabln. Sec. corn. Sep. Sil. Sulph. Strain, ^of pregnant females: Cham. Cocc. Kali. Phosph. Sabhia. Sec. corn. — of nursing females : Sil. INTERCOURSE, aversion to : Canu. Canst. Chlor. Cub. Kali. Lye. Natr. mur. Petr. Phosph. — desire for: Calc. Creos. Kali. Sa- bin. Sulph. ac. — with pains : Creos. Ferr. mm'. Kali. — with too ready conception: Bor. Canth. Merc. Natr. — with nausea : Sil. — without thrill : Ferr. m. MISCARRIAGE: Aco. Apis. Arn. Asar. Bell. Bry. Calc. Calend. Canth. Caps. Carbo an. Carbo veg. Chain. China. Cocc. Croc, Cycl. Ferrum. Hyosc. Ipec. lod. Kali Lach. Lycop. Merc. Nitric ac. Xux mosch. Nux vom. Op. Phosph. Plat. Plumbum. PmZ.s. Rhus. Ruia. Sabiu. Sec. corn. Sep. Sil. Sulph. Zinc. — disposed to : Asar. Calcarea. Carb. veg. Cocc. Creos. Ferr. Kali carb. Lye. Nux mosch. Plumb. Puis. Ru- ta. Sabln. Sabad. Sep. Sil. Sulph. —of chlorotic femalci! : Carbo veg. Chin. Ferr. Sep. Sulph. — with congestion of blood to the womb : Bell. N. vom. Plat. Sep. — withjspasms: Cham. Hyosc. Ipec. Nux vom. —with leucorrhooa : Calc. Ferr. Sep. Sulph. — at the outset of pregnancy: Sahin. Confinement, Ailments Incident to. AFTER-PAINS TOO VIOLENT, LONG: ylrn. Bryou. Bell. Calr. carb. Cham. ('off. Cupr. Ferr. Ign. Kill). Kux vom. Fills. Ehus. Ruta. Sabiiia. Sep. Sulph. INJURY OF PARTS DURING DELIVERY: Aru. PAINS SPURIOUS: Bell. Cham. Cocc. Coff. Cupv. Hyofic. Igu. Ipec. Kali. Kux vionch. Nii.v vom. Op. Puis. Sec. com. Sep. Stann. with urging on the rectum : Nux VOUl . violent : Aeon. Coff. with contraction of the womb: BeU. —too feeble: Ar7i. BeU. Camphor. Carb. veg. Cham. Chin. Cocc. Coff. Graph. Ign. Kali. Lyo. Miiga, mur. Mosch. Natr. Natr. mur. N. mosch. Nux vom. Op. Puis. Rhus. Ruta. See. corn. Sep. Sulph. Sulph. a*. after a fright : Op. of feeble persons : Sec. corn. with spasmodic pains : Puis. — too strong : Aeon. Arn. Aur. Bell. Cham. Cocc. Coff. Con. Hyosc. N. vom. Sec. corn. Sep. PLACENTA ADHERING : Bell. Puis. Sec. corn. SEXUAL INSTINCT EXCITED : Bell. Calo. Canth. Chin. Coff. Con. Creos. Ferr. Graph, llyose. Kah. Mane. Mosch. Nux vom. Plat. Phosph. Fills. Stram. Sulph. Sulph. ac. Thuj. Veratr. Zinc. — unto nymphomania : Bell, Canthar. Hyose. Merc. Natr. mur. Fhosph. Plat. Puis. Eaph. sat. Stram. Yeratr. SPASMS : Bel!. Cham. Cic. Cocc. iTi/o.s'c. Ignat. Ipecac, Mosch. Plat. Stram. Veratr. 'I I I HI 'I •'' f in ;j?' Ill 96 SKXUAL ORGANS AND FUNCTIONS. UTERINE HAEMORRHAGE : Bell. Cliamom. Chiu. Croc. Ferr. Ipec. Plat. Sabin. Sec. com. Menses. MENSES, pale, watery : Alum. Am. Bell. Berb. Bov. Calc. Carb. an. Carbo veg. Cocc. Con. Creos. Dig. Ferr. Orapli. Hell. Hyosc. Ipec. Kali. Led. Lxjc. Magn. Munc. M. austr. Merc, Kalr. m. Nitr. ac. N. moscli. Phosph. Tlat. Puis. Rhus. Sabin. Sec. corn. Sep. Snlph. Tart. — brown : Bry. Calc. Carh. veg. Cou. Rhus. — thick: Arn. Croc. Cupr. MagJi. r N. mosch. N. voin. Plat. Puis. Sulph. —dark, black : ylniw.Ant. crud. Arn. Asar. Bell. Bism. Bry. Canth. Carb. an. Carb. veg. Cham. Chin. Creos. Croc. Ferr. Ign. Lach. Magn. Nitr. Nitr. ac. Nux voiu. 01. an. Plat. Puis. Sec. corn. Selcn. Sep. Sulph. —thin: Fen-. Graph. Sabin. Sec. corn, —flesh colored : Sabin. Stront. .00 soon: Alum. Amhr. Amvi. Arn. Asa f. Asar. Bell. Bor. Bov. Bry. Calc. Canth. Carb. an. Carb. veg. Chum. Chn. Cin. Cocc. Colch. Coloc. Con, Creos. Croc. Dulcam. Ferr. Fluor, ac. Gent. Graph. Grat. Hell. Hep. lyn. lod, Ipec. Kali. Laur, Led. Lye. Magn. M. au.str. Mang. Mosch. Mur. ac. Natr. mur. Nitr. ac. Nux mosch. Nux vom. Petr. Piiosph. Phosph. ac. Plat. Puis. Rhod. Rhus. Sabin. Sec. vom. Sep. Silic. Spong. Stann. Staph. Sulph. Sulph. ac. Veratr. Zinc. — light-colored : Arn. Bell. Bry. Calc. Canth. Carb. veg. Dros. Dulc. Hyosc. Led. M. austr. Phosph. Rhus. Sabin. Sec. corn, Stront. -too short : Annn. Bar. Con. Dulc. Graph. Lai Ii. Magn. mur. M. arct. Mang. Mercur. Phosph. Plat. Puis. Ruta. Sulph. -too long; Aeon. Ax^. Asar. Bar. Bryon. Canth. Carb. an. Cau.st. Chin. Cofif. Croc. Cupr. Dule. Ferr. Ign. Lye. M. austr. Natr. mur. Nux vom. Phospli. Plat. Puis. Sabin. Sec. corn. Sil. ^ Sulph. Sulph. acid. -at night: Bov. Magn. carb. Sabin. -by fits and starts: Cham. Puis. Sabin. -acrid: Amvi. carb. Ars. Cantli. Carb, V. Graph. Kali. Nitr. Phosph. Puis. Sassap. Silic. Sulph. Sulph. ac. -frothy: Arn. Ferr. Ipec. -slimy: Cocc, Puis. -too scanty: Aco, Alum. -4mm. Arn. Asa. Baryt. Bor. B7'y. Calc. Carb. veg. Caust. Cicut. Coccul. Con. Creos. Crot. Cupr. Dig. Dulc. Ferr, Graphit. Ign, lod. Kali. KaU hydr. Lach. Lye. M. arct, Magn. Merc. Natr. mur. 01. an. Phosph. Puis. Ruta. Subad. Sassap. Sep. SU. Staph. SulpJt. Veratr. Vit. Zinc, -too late: Aeon. Amm. Ast. Aur. Bell. Bry. Caust. Chamom. Cliel Cic. Cocc. Con. Croc. Cupr. Dulc. FeiT, (iraph. Hyosc. Hyp, lod. Kali. Lach. Lye. Magn. Merc. Natr. carb. Natr. mur. Nic. Nitr. ac. Nux mosch. Petr. Phosph, Puis. Rhus. Sabad. Sabin. Sassap. Sep. Silic. Stront, Sulph. Vitr. Zinc. -too copious: Avo. Agar. Amhr. Amm. mur. Ant, cr. Arg, nitr. Ars, Bar. carb. Bell. Bor. Bry. Calc. Canth. Carb. v. Cham. Chel, Chin. Cina. Coff. Creos. Croc. Cycl, Dulc. Ferr. Hyosc. Ign. lod. Ipec. Laur. Led. Lye. M. austr. Merc. Mosch. Mur, ac. Natr. mur. Nitr. ac. N. mosch. Nux voui. Phell. SEXUAL ORQANa AND FITNCTIOKS. •7 Phosph. Platin. Plumb. Ehus. Ruta. Sabin. Samb. Sec. corn. Sep. Sil. Spong. Strain. Sulpli. Sidph. ac. Verat. Vine. Zinc. — too copious at nignt : Amm. carb. —lumpy: Avim. carb. Am. Bell Canth. Cham. Chiu. Croc. Terr. Fluor, ac. Hyosc. Ipcr. N. vom. Flat. Puis. RhuH. Sabina. Stram. Stront. — irregular : Cocc. lod. N. vom. Puis. Euta. —suppressed: Aeon. Agn. Alum. Amm, Ars. Baryt. Bell. Bry. Calc. Caust. Cham. Chin. Cocc. Coloc. Con. Croc. Cupr. Dulc. Ferr. Grapli. Hyosc. Ign. lod. KaU carb. Lye. M. arct. Magn. mur. Mercnr. Natr. mur. N. mosch. Pteon. Petr. PhoHph. Puis. Ehod. Rhus. Euta. Sabad. Sang. Sassap. Sep. Slllc. Staphys. Stram. Sulph. Valer. Verat. Vit. Zinc. — of young girls, delaying: Bry. Calc. Caust. Cocc. Con. Dulo. Graph. Kali. Lack. Lye. Mag-n. Natr. mur. Petr. Puis. Sabin. Sep. Stramon. Sulph. —fetid: Bell. Bry. Carb. an. Cham. Chin. Croc Ign. Kali. Merc. Phos. Eheum. Sabin. Sil. Sec. corn, —repeating: Alum. Bry. Ferr. M arct. Natr. mur. N. vom. Phosph. Ph. ac. Puis. Rhus, Sep. Veratr. Zinc. Menses and the Accompa- nying Ailments. 1. Previous to the menses. ABDOMEN, distended : Amnion. mur. Creos. Lye. —distention : Creos. Lye. ANXIETY: Ammon. Cocc. Con. Merc. Natr. mur. Stann. BACK-ACHE: Ann. Bar. Brom. Calc. Causl. Hyosc. Magnes. carb. Mosch. Nitr. N. mosch. Nux vom. Spong. BREAST, spasm of: Cocc. Cupr. BREASTS SWOLLEN: Bry. Calc. —painful: Calc. Con. BURNING IN PUDENDUM: Calc. CANINE HUNGER: Mugu. curb. CARDIALGIA: Lach. Nux mosch. Puis. Sep. CATARRH : Giaph. Puis. CHILL; Lye. Puh. Veralr. COLDNESS OF THE TRUNKS: Mang. COLIC: Amm. Bell. Calc. Cham. Puis. Sop. — labor-like: Hyosc. — with fainting : Sep. —with vomiting : Puis, —with pressing : Magn. carb. COLIC: Alum. Amm. mur. Cham. Croc. Ferr. Hyosc. Nux vom. 01. an. Plat. Puis. COUGH: Graph. Sulph. PuZ.s. DELIRIUM: X(/r. Hyosc. DIARRHOEA: i3ov. Sil. Veratr. DREAMS: Calc. Caust. Con. DROWSINESS : Ptds. EXCITED NERVES : Creos. Lye. ERUPTION IN NAPE OF NECK: Carbo veg. EXPECTORATION, bloody: Phos. FACE HOT : Alum. Lye. — pale: Puis. — blre: Veratr. — bloated: Chin. IN GENERAL : Alum. Amm. Asar. Bar. Bry. Calc Carbo veg. Caustic. Cham. Chin. Coccul. Cofif. Con. Creos. Cuprum. Ferr. Glon. Graph. lod. Kali. Lach. Lye. Mane. Mang. Merc. Mur. ac. Natr. mur. N. mosch. Nux vom. 01. an. Phosphor. Phos. ac. Plat. Puis. Rhus. Sep. Sulph. Sulph. ac. Veratr. GUMS SWOLLEN: Baryt. Mercur Phosph. HARD HEARING: Creos. % f \i Ik ' li. Ill" w SEXUAL ORO Vfl AND FUNCTIONS. ! HEAD-ACHE: Carbo ce<j. Ciiiir. Ferr. lod. Lach. Natr. mur. Sulpb. Veratr. HEARTBURN: Sulph. HEAT: Culc. INCLINATION TO VOMIT: Ve- ratr. ITCHING HERPES : Carbo veg. — of the parts : Graph. Sulpb. LABOR-LIKE PAIN: Rhus. Plaf. LANGUOR: Alum. Nux mosch. LAUGHTER: Hyosc. LEGS WEARY AND HEAVY: Bar. Lye. LEUCORRHCEA: Alum. Culcar. Ferr. Sulph. LIMBS AS IF BRUISED : Nitric acid. LIVER, stitches in : Con. — pains in the : Nux mosch. LOSS OF APPETITE: Bell. LOSS OF CONSCIOUSNESS: China. Sep. MELANCHOLY: Caust. Lye. Nntr. niur. NAUSEA: Veratr. NOSEBLEED: Sulph. Veratr. PAINS IN THE BREASTS : Co7i. PALPITATION OF HEART: Al- umina. Cupr. lod. Sep. Spong. PEEVISH: Cham. Notr. mur. PRESSING TOWARD THE PARTS : Magn. carb. Plat. PUPILS DILATED : Lye. RUSH: Dulc. RESTLESSNESS : Creos. Kali carb. RUSH OF BLOOD: Alum. Cupr. Mauc. Merc. — to the head : Merc. SENSITIVENESS: Sep. SHUDDERING: Sep. SLEEP, RESTLESS : Alum. SORENESS OF PARTS: Kali carbon. Sil. SPASMS, abdominal: Cham. Cupr. SPASMS: Cham, Cocc. Coff. Cupr. Hj'ose. Merc. — hysteric: Hyosc. — in abdomen : Carbo veget. Cham. 2. At the appearance of the «ie»se» COLIC : Graph. Staph. DIARRHCEA: Veratr. FLATULENCE: Staph. IN GENERAL : Aco. Bryon. Causl. Cham. Graph. Hyosc. Ign. Iodine. Merc. Natr. mur. Plat. Puis. Sep. Sil. HEAD-ACHE: Hyosc. NAUSEA: Hyosc. PAINS IN LIMBS : Sep, SPASMS : Aeon. Cham. Coff. Plat. SWEAT: Hyosc. URGING TO URINATE : Sassap. VOMiffING: Carbo veget. Phosph. Puis. 3. During the menses. ABDOMEN DISTENDED: Alum- ina. Natr. Zinc. — co'dness in: Kali carb. — pinching in : Alum. — pressure in : Cocc. Con. Nux vom. Sec. coi'n. — cutting in : Sulph. ANXIETY : Bell. Natr. mur. Zinc. BACK-ACHE: Amm. carb. Caust. Lye. BLOODY EXPECTORATION: Phos. BURNING IN ANUS: Amm. mur. BURNING IN THE HANDS AND FEET: Carbo veg. Calc. COLIC: Alum. Amm. Bar. Bell Calc. Carbo an. Carbo veg. Cham. Cocc. Con. Graph. Kali. Ign. Lach. Lye. Magn. carb. Natr. Nitr. Nva; vom. Phos. Plat. Sec. corn. Sil. Stront. Sulph. Zinc. CONSTIPATION: Natr. mur. Sil. CONVULSIONS : Chin. Chavi. DELIRIUM: Hyosc. DISCHARGE OF BLOOD AT STOOL : Amm. mur. EARS, humming in : Petr. Verat. 8KXUAL OROAN8 AND FUNCTIONS. 99 ERUCTATION: Bry. Graph. Xali carb. J jYES, agglutinated : Cole. carb. - -black before the : Puis. IRRUPTION: Kali. Sil. I' ACE, pale : Amm. Graph. Lye. Puis. -blue: Veratr. —color of, changing : Zinc, —jaundiced: Caust. TAINTING: Ign. Lye. Natr. mur. Nux vom. FEVER (chill and heat) : Natr. mur. Phosph. CHILL : Graph. Nux vom. Fuln. — and shaking : Natr. carb. FLATULENCE : Cocc. Kali carb. IN GENERAL: Aeon. ^Z?^m. ^mm. carb. Amm. mur. Bell. Bov. Cah: Canth. Carbo an. Caust. Cham. Chin. Cocc. Coffea. Con. Creos. Cupr. Graph. Hyosc. Ign. Kali. Laches. Lye. Magn. m. Mur. ac. Natr. Natr. mur. Nux vom. Phospli. Plat. Pulsat. Sabin. Sep. Sil. Stan- num. Sulph. Veratr. Zinc. GUMS SWOLLEN : Merc. Nitr. ac. HEAD : congestion of : Calcarea. Caust. Chin. Con. Glon. lod. Merc. Plio^ph. —ache: Alum. Bry. Calear. Carbo veg. Graph. Hyoscyam. Kali carb. Laur, Lye. Magn. carb. Natr. mur. Nux vom. Phosph. Puis. Plat. SepisB. Sulph. Veratr. — heat in : Calc. Cham. HEAT : Magn. mur. N. vom. Sep. LANGUOR: Alum. Bov. Carbo an. Graph. Ign. lod. Kali. Magn. carb. Magn. mur. Nux vom. Petr. Puis. Phosphor. Sec. corn. Zinc. LEGS, languor in the : Sulph. — drawing in the : Spong. LEUCORRHCEA: Coccul. LIMBS AS IF BRUISED: Phosph. BODY AS IF BRUISED: Ambr. Conium. Petr. SMALL OF BACK AS IF BRUISED: Caust. LIMBS, cold: Cham. —pain in: Bry. Con. (Jruph. IVIagu. niiu'. Nux vom. Sep. Voratr. LOINS, pain in: Bcrb. Sn: corn. LOSS OF CONSCIOUSNESS: Cham. LOSS OF APPETITE : C'wpr.Mugn. carb. LOWER LIMBS GO TO SLEEP : Puis. LOWER LIMBS, pain in the : Clia- mom. Nitr. Veratr. — bluencss of the : Ambr. MELANCHOLY : Mane. Natr. mur. Sep. MENTAL DERANGEMENT : Hy- osc. Veratr. NAUSEA . 1 .mm. Calo. Graph. Lye. Magn. carb. N. vom. Phosph. Puis. Veratr. — with water-brash : Puis. NIGHT-SWEAT : Bell. Graph. NOSE-BLEED: Sep. OPPRESSION : Bell. Ign. Nitr. ac. PAIN, labor-like : Cham. Graph. Hy- osc. Lacli. Sabin. PALPITATION OF HEART : Crot. Ign. lod. Phospli. Sep. PARTS, burning in the: Rhus. Sil. — itching in the : Hep. Lycop. Sulph. Zinc. —pains in the : Canth. Sep. PRESSING DOWNY/ ARD : Amm. carb. PRESSURE IN PIT OF STOM- ACH: C'aiJ«. Sulph. — in small of back : Puis. —in vertex: Calc. caust. DIARRHCEA : Amm. mur. Bov. RESTLESSNESS : Plat. Sep. RUSH OF BLOOD TO THE HEAD : Calc. Chin. SLEEP, restless : Alum. Calear. Kali carb. SLEEPLESSNESS : Amm. Sep. Hi i ■li- 1- I |:| '^' *ft" :.:•■ li P 100 SEXUAL ORQANS AND FUNCTIONS. i? f ;i .« SMAXiL OF BACK, pains in : Amra. Amm. miir. Boll. Berb. Ciih'. Carbo vegetabil. Chain. C'occ. Croos. Croc. Graph. Ign. lod. Kali. lAtch. Lijr. Natr. Niix v<tin. Phospli. J'ulti. Hq- cale corn. Sulpli. SNEEZING : Magn. carb. SORENESS BETWEEN THE THIGHS : Graph. Kali carh. Urn- sap. — of the parts : Graph. Kali carbon. Sil. SPASMS : Aeon. Cliniii. Core. Coff. Cupr. Hyosr. Ign. Lach. Nitric ac. Puis. — in abdomen : Cham. Coco. Graph. Mane. Nux vom. PuU. Sulph. — with jsressuro down : Sep. — in the chest : Phosiih. Puis. STITCHES IN THE PARTS : Sul- phur, acid. STOMACH, pressure in : Amm. Biy. Puis. Sassap. SWEAT : Graph. Hyosc. Magn. mur. SWOLLEN CHEEKS ; Graph. ST ^. TEN FEET: Calcar. Graph. HS, pain in "the : Con. Magn. aiur. Sassap. THIRST: Nitr. Veratr. TOOTH-ACHE : Amm. Calc. Cham. Carbo vegel. Kali. Laur. Phosph. Sep. TREMBLING : Hyosc. Sil. TRISMUS: Hyosc. URGING TO STOOL, ineffectual: Calc. Pu' URINATIx-iS, involuntary: Calcar. carb. URINATE, urging to : Puis. Sahin. VERTIGO: Calc. Caustic. Iodine. Phospli. Pals. Veratr. VOMITING : Ammon. mur. Carbo veg. Lye. Phosph. WHINING MOOD : Plat. Zinc. YAWNING: Bell. Carbo animal. Phosph. 4. After the menseH. ANXIETY: Phosph. BACK, coldness in : Kali. CARDIALGIA : KoU carb. CHILL : Graph. Puis. COLIC : Graph. Lyo. Nux vom. DIARRHCEA: Graph. ERYSIPELAS: Strom. EXHAUSTION: Alum. • FAINTNESS : Alum. Phos. Plat. IN GENERAL: Alum. Berb. Bar. Bryon. Calc. Carbo an. Con. Creos. Cupr. Urnpli. Kali. Lye. Tlerc. Natr. viur. Nux vom. Pho.^ph. Phosph. acid. Plat. Puis. Sep. Sil. Stramon. Veratr. Zinc. HEAD, heavy : Natr. mur. LEUCORRHCEA: Alum. Bov. Canth. Creos. Merc. Phosph. acid. — bloody: Sil. — yellowish: Phosph. acid. PALPITATION: lod. PARTS, pain in the: Creos. Natr. mur. PRESSING TO THE PARTS: Creos. RELAXED: Alum. SMALL OF BACK, pain in : Magn. carb. Puis. SPASMS, abdominal: Creos. STERILITY: Amm. Calc. Canii. Canst. Cic. Co7i. Croc. Ferr. Graph. Merc. Natr. mur. Phosph. Plat. Plumb. Puis. Ruta. Sabin. Sepia:. Sulph. Sulph. ac. STOOL, bloody: Graph. TOOTH-ACHE : Calc. MogP. VOLHTING: PiUs. 'Whites. LEUCORRHCEA : Alum. Ambra. Amm. Amra. mur. Anac. Aut. crudum. Ars. Bell. Bor. Bov. Bry. Calc. Carbo an. Carbo veg. Canst. Cham. Chin. Coccul. Cou. Croos. Drosera. Ferr. Graph. Guaj. Hep. lod. Kali. Lye. Magn. Magn. mur. SEXUAL OnOANS AND FUNCTIONS. 101 Merc. Meier. Nalr. Nutruni nmr. Nitrio ac. Nux vom. Pelr. Vhoajili. Puisat. Run. bulb. Rutu. Sah'ma. S».s8ap. Sop. Sll. Hciuill. Stiinmim. ^ulph. Hulph. u(!. Thuj. Vit. Zinc. 1. According to lln Quality. LEUCORRHCEA, old: lod. — sniurtiiig: Cluim. Ferr. Lach. J'kottph. More. * — bliatoring: Phosph. — pule-yellow : Merc. corr. —bloody: Canth. Carbovcgot. Chin. Cove. Creos. Nitrio oo. Sep. Sulph. ao. — blood-red : Chin. Lye. — brown: Amm. mur. Carb. an. Nitric ac. — burning: Calv. Carbo an. Con. Creos. Puis. Sulph. ac. —thick : Ars. Bov. Caust. Kali bichr. Natr. mur. Vain, Sabina. Zinc. —thick-slimy: Bov. Con. —thin: Carbo vcg. 01. an. PuIn. Sulph. —transparent ; Sep. Stann. Sulph. ac. —purulent: Calc. Chin. Covciil. Creos. Ign. Merc Nitric uc. Sabin. Sep. —albuminous; Ammon. muriat. Bor. Bov. Mez. Petr. Plat. — staining the linen : Creos. — flesh-colored ; Cocc. Nitr. ac. — yellow: Aeon. Alum. Araen. Bov. Carbo an. Cham. Creos. Kali carb. Kali bichr. Lycop. Natr. Nux vom. Sabin. Sep. Stann. Sulph. — staining yellow : Carb. an. — ^yellow-green: Bov. — greenish : Bov. Carbo veget. Lach. Merc. Sep. — green-reddish : Sep. —ichorous: Sabin. —itching: Alum. Ars. Calc. Creos. Kali. Merc Natr. m. Sabin. Sep. — milky. Amm. Calc Carbo veg. Creos. Ferr. Lye. Phos. Puis. Sll. Sabin. Cocc. —milk-colored ; Carbo vpg. — roddiwh: Ca.car. China. Nitrio ac. riio.-^ph. —in fits and starts. Cidf,. Cham. Lye. — arrid: Ahmi. Amn. Arsen. Bov. Calc. Carl), imj. Cham. Con. Crco.s. Ferr. Ign. lod. Kali. Kali, hy.lr. Lye. Mpit. Mozor. Nalr. mur. Pliospli. Puis. Ran. biUb. Ruta. Sep. Sll. Sulph. —slimy: Alum. Amm. m, Uor. Bov. Calrnr. Coceul. Croos. Daph. Ferr. Untph. Guaj. Lacli. Magn. Merc. Mezer. Natr. Natr. mur. Nitr. acid. N. vom. 01. an. Plumb. Puis. Sabin. Sassap. Stann. Sulph. Thuj. Zino. — painless : Creos. N . vom. Puis, —excoriating : Alum. Natr. mur. — starch like : Sabin. —fetid : Chin. Creos. Natr. Nitr. ac. N. vom. Salrbi. Sep. — watery: Amm. Ant. tart. Carb. veg. Cham. Creos. ^(Jrapli. Merc. Mezer. Mur. ac. Puis. Sep. Sll. —white, slimy : Graph. — tenacious: Acori. Par. Bov. Mezer. Phosph. Sabin. Stann, 2. Accompanying Ailments. ABDOMEN, distended: Amm. m. Sep. — pains in: Bell. Caustic. Con, Creos. Ign. Lye. Magn. mur. Puis. Sil. Sulph. labor-like: Dros. AT URINATING: Sil. AFTER URINATING: Carb. veg. DISCHARGED IN THE MORN- ING : Natr. mur. FACE, pale: Ars. PwZs.Sep. IN GENERAL : Alum. Ambr. Amm. mur. Ars. Bell. Bov. Calc. Carb. an. Caust. C'nam. Cocc. Cou. Cop, Creos. Ferr. Graph. Ign. Kali Lye. Magn. Magn. mur. Merc. Natr. mur. Phosph. ac. Prun. Puis. Sabin. Sec. corn. Sep. Sil. Sulph. Sulph. ac. Zinc. I' III f HI 'ii 11 loa UPPER EXTREMITIES. PRESSING DOWN : Natr. miir. SMALL OF BACK, pains in : Bai-. Caitat. Graphit. Kali. Magn. mur. SPASMS, abdominal: Magn. mv/r. STITCHES IN UTERUS : Sep. WEAKNESS: Alum. Oroos. Sep. XXVIl. EXTREMITIES. :>' i. UJPFER. Arm-Pit. BORING : Arg. Phospli. BURNING : (^arho veg. Cocc. Men. Phospli. Plumb. Puis. Ehus. Sep. CREAKING : Croc. Daph. Merc. CRAWLING: Cocc. DISLOCATION-PAIN : Magn. Phos. ERUPTION: Alum. Ant. crudum. Kali. Sulph. IN GENERAL : Aeon. Alum. Ambr. Amm. mur. Asa feet. Bell. Bry. Carbo veg. Caust. Chin. Colch. Creos. Digit. Euphorb. Ferr. Kali. Lach. Laur. Led. Lycop. Magn. Magn. mur. Merc. Mezer. Natr. Nux vom. Phosph. Puis. Ehocl. Rims. Sep. Sil. SquiU. Stann. Stron.. Sulph. Thuj. Viola, tricol. Zinc. HEAVINESS : Aeon. Am. Phosph. Puis. ITCHING: Caustic. Magn. Ignat. Natr. Op. LAMENESS : Lach. Puis. Gil. MUSCLES, twitching of: Croc. Spig. Spong. PAIN AS IF BRUISED: Aco. Alum. Ooccul. Ferr. Ign. Lye. Magn. Plumb. Spig. Sulph. Zinc. PAIN, simple : Bry. Daph. Graphit. KaJi. Magn. --laming: Ambr. Chin. Euphor- bium. Mur. ac. Nux vom. PRESSURE: Am. Bell. Bryon. Caust. Colch. Creos. Digital. Laur. Lycop. Natr. Oleand. Phosph. ac. Ran. bulb. Rhus. Sep. Staph. Sulph. Zinc. RAISED: Merc. GONE TO SLEEP: Ferr. SPOTS, brown : Ant. crad. STITCHES: Aeon. Alum. Asa f. Bell. Bry. Calc. Caust. Cicc. Cocc. Ferr. Graph. Guaj. Ign. Kali. Lach. Laur. Lye. Nitric aeid. Phos. Plumb. Pulsat. Rhus. Sil. Staph. Stann. Sulph. Thuj. Zinc. Veratr. SWELLING: Aeon. — feeling of: Hell. TEARING: Aeon. Ambr. Argent. Bell. Bov. Brif. Caust. Canth. Carb. veg. Chin. Graph. lod. Kali. Lain-. Led. Lye. Natrum mur. Nux vom. Phos. Rhus. Stront. Zinc. TENSION: Dig. Euphorb. Hyosc. Kali. Petr. Teucr. Zinc. THROBBING: Daph. Magn. mur. Rhod. Sulph. Tar. Arms. Upper arms.*) BLUE SKIN: Cupr. Lach. Sejale corn. Veratr. BORING : Canth. Plumb. Rhus. BURNING: Agaric. Aur. Borax. Carbo veg. Dulc. Kali. Lach. Nux vom. Phosph. RJius. Sep. Zinc. BONE-PAINS: Bar. BeU. Lycop. Merc. Nitric ac. Thuj. COLDNESS: Bell. Camph. Cham. Hyosc. KaU bichr. Rhus. Veratr *) U. means Uppor, L. Ix>wer arms. UPPER EXTREMITIES. 108 jyoop. "foeling of: Graph. Rhtis. Sec. com. CONTRACTION : Bism. Calc. CONTUSIVE PAIN : Cyd. HeU. CONVULSIONS: Bell. Cluimom. Cocc. Qupr. Hyosc. Ipecac. Oii. Rhus. Squill. Secale com. Stram. Veratr. ORAMPY : Calc. Cin. Dulc. Men. Oleaiid. Phosph. Valer. CREEPING: Bell. Cocc. Sec. corn. Sep. ERUPTION : Ant. crudum. Caw. Carbo veg. Dulc. Kali. Phos. ar. Sep. ERYSIPELAS : Bell. Rhus. FAINTNESS : Alumin. Anac. Am. Asar. Calcar. Cupr. Cycl. Guaj. Ign. Kali. Led. Natr. miir, N, vom. Plat. Plumb. Rhod. Sep. Stann. Valer. IN GENERAL: Amm. mur. Antim. crud. Asa foet. Aur. Bell. Bi-yon. Canth. Carbo an. Carbo veg. Chcl. Clem. Cocciil. Con. Cupr. Dig. Ferr. Hep. Ign. lod. Kali. Lacli. Lycop. M. arct. Mang. Mezer. Mur. acid. Natr. mur. Nitv. Oloand. Peh-. Plumb. Phos. Puis. Rhodod. Rhus. Selen. Sep. Sil. Stann. Staphys. Sulph. Sulphur, ac. Valer. HEAT : Bryon. Natr. mur. Nitr. acid. FEELING OF HEAT : Bry. Graph. Nitric ac. Stap) HERPES : KaU carb. Natr. mur. Sulph. — U. and L. : Bov. Con. Diilc, Graph. Natr. muriat. Phospli. Sil. ITCHING: Daph. Dulc. Euphorb. Lach. Laur. M. austr. Nux vom. Oleand. Ran. sc Ruta. Stront. Thuj. JERKS : Anacard. Oleand. Ruta. Stann. LAMENESS: Agar. Bism. Canat. Ohel. Cocc. Kali. Lack. Nnx V( m. Fhos. ac. Staph. MUSCLES, twitching of : Coccul Men. A'aler. NUMBNESS : Aiiibr. Aur. BeU Cham. Coccul. lod. Plat. Puis. Veratr. PAIN, simple : Agar. Baryt. Bell Bry. Calc. Cupr. Graph. Puis. Zinc, —laming: Bell. Chamom. Dig. A^^rr^r. mur. Rhod. Sil. Zinc. -as if dislocated: Alum. Bry. Eu- phorb. Rliod. —as if bruised: Bellad. Coccul. Cycl. Daph. Fen-. Hep. M. austr. Magn. mur. Natrum mur. Nitric ac. Plat. Plumbum. Puis. Sep. Sulph. Thuj. Veratr. PARALYSIS : Agar. Bell. Caustic. Chel. Lacli. Oleand. Rhus. PRESSURE : Ammon. mur. Anac. Arg. Asa foct. Aur. Bell. Calcar, Camph. Cycl. Daph. Euphorb. L(>'\ Nux vom. Petr. Puis. Rhod. Sabiu. Standi. Staphys. Sulph. Vit. GONE TO SLEEP: Ambr. Baryi. Cham. Coccixl. Croc. Graph. Ignat, Kaili. Lach. Lycop. Magn. mur. Nux vom. Petr. Rhus. Sec. corn. Se}>. Sil. SPASMS: Bell. Cuprum. Ipec. Sec. corn. SPOTS, red: Plat Bhus. Sulph. STIFFNESS : Amm. mur. Caust. Jinx vom. Oleand. Sassap. Rhus. STITCHES : Aeon. Aliun. Antim. crud. Arn. Asa f. Bell. Bry. Canth. Cocc. Con. Dulc. Ferr. Guaj. Kali. Laur. Mang. N. mosch. Phosj^h. Phosph. acid. Puis. Rhod. Rhus. Sabina. SqniU Stann. Staph. Sulph. Tar. Thuj. SWEAT: Asar. Ipec. SWELLING : Antim. crud. Bell. Bry. Hell. Rhus. SWELLING OF BONES : Bhus. Sil. Sulph. i xl' •1 . I? I ill ^^ iiil m k 104 UPPER EXTBEMITIES. M^ TEARING : Agar. Amm. mur. Anac. Arn. Aur. Bell. Bryori. Canth. Carbo an. Caustic Chel. China. Cin. Con. Digit. Bros. Ferr. Guaj. Kali. Led. Lye. Mur. ac. Magues. mur. Nitr. Nux vom. Phonjth. Plumb. Puis. Rhus. Sabina. Sassap. Sil. Stann. Staphys. Sulph. Zinc. TENSION : Ant. crud. Asa tot. Bry. Dig. liaur. Bhus. TREMBLING: Ars. Bry. Capsic. Causi. Cicut. Hyoso. M. arct. Op. Petr. Phosph. Puis. Rhus. Sabad. Sil. Spig. Sulph. Veratrum. TUBERCLES : Ant. crud. Arsenic. Calc. Cocc. Nitric ac. Staph. TUMORS: Ant. crud. Ars. Caust. Natr. mur. Nitric ac. ULCERS : Lach. Rhus. Shoulder-Joint. BEATING : Magn. Merc. Thuj. BURNING : Brom. Graph. CONTUSIVE PAIN: Dros. CREAKING: Ant. tart. Bar. Cic. Croc. Fen-. Merc. Thuj. DISLOCATED, as if: Magn. DRAWING: Asa f. Carbo veget. Cham. Magn. mur. Staph. FEELING OF WEAKNESS : Dros. — of heaviness: Puis. IN GENERAL: Am. Asa f. Bry. Calc. Carbo veg. Caust. Croc. Dros. Ferr. Ign. Kali. Lach. Lye. Led. Merc. Natrum mur. Nux vom. Pulsat. Rhus. Staph. Sulph. Ve- ratrum. Vit. Zinc. HEAT, feeling of: Brom. INFLAMMATION: ^con. Bry. Led. Puis. Rhus. JERKING: Puis. JERKS : Colch. Sil. LAMENESS: Lye. Puis. Stann, PAIN AS IF DISLOCATED : Alu- min. Ambr. Arn. Caps. Croc. Ign. Natr. mur. Petr. Puis. Rhod. Rhus. Sabina. Sep. Spigel. Thuj — an if bruised: Ferr. Ign. KaU. Num vom. — simple : Aco. Calc. Croc. Ign. Natr. mur. Phosph. —laming: EnphoTh. Nux vom. Puis. Staph. PRESSURE: Bism. Bryon. Calcar. Dros. KaU. Laur. Led. Staph. Vit. STIFFNESS: Caust. Euphorbium. Staph. STITCHES : Asa foet. Bry. Calcar. Coccul. Crot. FeiT. Graphit. Hell. Ignat. lod. Laur. Led. Mercur. Puis. Staph. Stront. Sulph. ac. Thuj. SWELLING: Aeon. Bry. Hep. TEARING : Ambr. Argent. Bism. Bry. Carbo veg. Caust. Ferr. Graph. Ign. Led. Merc. Phos. Puis. Rhus. Sabin. Sulph. Vit. TENSION: Asa f. Bov. Bry. Eu« phorb. Laur. Lye. Zinc. Arm-Pit. BURNING: Carbo veg. Caust. CUTTING: Kali. ERUPTION : Lye. Merc. Natrum mur. Nitric ac. Petr. Sep. GLANDULAR SWELLINGS : Bel- lad. Calc. Hep. lod. Mercur. Natr. mur. Nitric ac. Sulph. Rhus. Staph, SORENESS: Carbo veg. SORE, as if: Tcucr. STITCHES : Am. Canth. Graph. Men. Staph. Zinc. SWEAT : Hep. Kali. Lach. Merc. Nitric ac. Phosph. Rhus. Sep. TEARING: Colch. KaU. Natr. mur Lower Arm, BLUE SKIN: Samb. BORING: Asa f. Natr. Phosph. ac Ran. 8C. BURNING: Agar. Amm. mur. Asa feet. Carb. veget. Euphorb. Graph. Merc. Mur. ac. Oleander. Rhus. Suli)h. Zinc. UPPER I'.XTnEMlTIES. 105 BONE-PAIN: Kali bichr. Natr. miir. Spong. CHILL: Ign. Puis. Khus. COLDNESS: Bry, Nux vom. Ehus. CONTUSIVEPAIN: Dros. CRAMPY : Anac. Cin. Conium. Ole- and. Plat. Rhodod. Ruta. Valer. CREEPING: Am. Bell Cocc. Cou. Merc. Op. Set*, com.. DEADNESS : Nux vom. ERUPTION : Ammon. mur. CiOad. Caust. Lach. Lye. Merc. Nitr. ac. Phosph. ao. Sil. Stapliys. Sulph. Thuj. Zinc. FAINTNESS : Nux vom. Rhus. IN GENERAL : Aeon. Agar. Alum. Amra. mur. Anac. Arg. Am. Asa f. Bell. Baryt. Bism. Bi'yon. Calad. Calc Camph. Cauth. Carbo an. Canst. Chamom. China. Cic. Cin. Colchic. Con. Creos. Croc. Cupr. Dale. Ferr. Graph. Guaj. Hep. Ily- 08C. Ign. Kali carb. Laur. Lye. M. arct. Mang. Merc Mezer. Moseh. Mur. ac. Natr. Nitr. Nitric ac. Nux vom. Oleand. Phosph. Phosph. ac. Plumb. Puis. Ran. sc. Ehod. Rhus. Buta. Sabin. Sassap. Selen. Sep. Sil. Spig. Squill. Statin. Staph. Sulph. Tar. Teucr.T/iwj. Valer. Vit. Zinc. HEAT: Bry. HEAVINESS : Anac. Aur. Croc. M. austr. Phos. ac. Sulph. HERPES: Con. Magn. Mer<\ Nux vom. INSENSIBILITY: Stront. ITCHING • Agar. Amm. mur. Carb. an. Caust. Dvlc. Hyosc. Laur. Merc. Puis. Ran. Rhus. Spig. Sulph. JERKS : Dulc. LAMENESS: Bellad. Calc. Cau.^t. Dulcam. Lach. Lyeop. Sil. Sulpli. PAIN AS IF BRUISED : Con. Croc. Mur. ao. Rhus. Ruta. Zinc. -~e8 if dislocated : Coccul. Led. ^M if iora : Am. Oio. Rhus. 55 — Kimple: Croc. Baryt. Bellad. Calc. Graph. Phosph. —laming: Baryt. Bism. Cycl. Dulc. Mosch. Natr. mm-. Nux vom. lluta. Sil. Staph. Stront. Zinc. PBESSUEE: Anac. Am f. Baryt. Bhmuth. Camph. Cocc. M. arct. Mang. Oleander. Plat. Prun. Ruta. Sahin. Spigel. Staphys. Verb. RASH : Merc. Selen, SHOCKS: Oleand. SPOTS, blueish: Sulph. ac. Thuj. —red: Vit. STITCHES: Aconit. Anac. Ant. crud. Am. Anaf. Bell. Bov. Bryon. Calc. Carbo an. Caustic Cicut. Cycl. Dig. [Hyosc. Lyeop. Mugn. Mero. Mosch. Oleand. Phosphor. Phosph. ac. Ran. bulb. Sabin. Sas- sap. Spig. Staph. Stram. Tar. Thuj. SWELLING: Bry. Calc. Caust. Lyo. Nux vom. Rhus. TEARING: Aeon. Alum. Ammon. mur. Anac. Arg. Asa f. Aur. Baryt. Bell. Bism. Bry. Canth. Carbo veg. Caust. Cina. Colch. Cupr. Cycl. Daph. Dig. Graph. Grat. Guaj. Kali. Lach. Lyeop. Mur.ac. Magn. miur. Natr. mur. Nitric ac. Phosph. Puis. Ran. bulb. Rhod. Rhu^. Sas- sap. Sil. Stannum. Staph. Stront. Sulph. Teucr. Thuj. Valer. Zinc. TENSION: Anac. Am. Caustic. Co- loc. Dig. Kah. Led. Puis. Stront. Sulph. Zinc. THROBBING: Sabad. TREMBLING : Caustic. Nitric ac. Rhus. TUBERCLES: Coccul. — miUary: Agar. WARTS : Calc. Sil. WEAKNESS : Dulcam. Nux Tom. 7.7m.s. Elbov7 and Joint BONE-PAIN, nocturnal: Lye BORING: Caust. Thuj. t\ V 1: 11 i . mi. ii'\ ^ .'06 UPPER ];XTREMITIES. Ml 1 1 31!: BURNING: Asa fait. Oarbo luiimal. Carbo veg. Calc. jjhoaph. Mercur. •Mill. Nitr. Phosph. Plut. Rhus. Svdph. BRUISING PAIN: Caust. Dulcam. Fuls. Ruta. Sulpli. Veratr. CONTRACTION: Caust. Laur. Sec. <!orn. CJONTUSIVE PAIN: Caustic. Dros. Ruta. TEARING: Alum. Amhr. Aur. Bov. Canih. China. Colchic. Daph. lod. Kali carb. Kali bichr. Laur. Lye. Merc. Mur. ac. Nitr. Nux mosch. Fulsat. Rhus. Ruta. Sassap. Sil. Stront. Sulph. Zinc. CREAKING: Ant. crud. Conimn. Merc. M. arct. Sulph. DISLOCATION PAIN : Am. Mang. Rhus. ERUPTION: Dulc. Hyosc. Merc. Sabin. Staph. Sulph. FAINT FEELING: Led GNAWING: Dulc. ITCHING: Agar. Alum. Caustic. Laur. Merc. Nair. Phosphor. Rhus. Sulph. —in the bend of the elbow: Canth. Laur. Spig. JERKING: Bellad. Caustic. Croc. Natr. mux. Nitric ac. Rhus. Veratr. LAMENESS : Bell. Graph. PAIN, simple: Cupr. Dig. Laur. Phosph. Puis. Sulph. ac. — laming : Bell. Cham. Coccul, Daph. Sabin. Staph. Stront. PARALYSIS: Dulc. Petr. PRESSURE: Alum. Argent. Hep. Led. Zinc. STEATOMA: Hep. STIFFNESS: Kali carb. M. arct. M. austr. Stanu. Thuj. STITCHES : Asa f. BeUad. Bryon. Coccul. Coloc. Hell. Kali. Laur. Merc. Mur. ac. Nux mosch. Phosph. Rhod. Sabin. Spig. Spong. Thuj. SWELLING: Bryon. Hep. Lach. Verutr. Vit. TENSION: Daph. Dros. Mur. ac Puis. Rhiis. Stunn. Sulph. THROBBING : Rhus. Thuj. TUBERCLES : Caust. Mur. ao. WEAKNESS : Staph. Sulph. Bend of the Elbcw. IN GENERAL: Amm. mur. Anac. Am. Bell. Canth. Caust. Clem. Con. Cupr. Dros. Graph. lod. Kali. Laur. Lye. Men. Petr. Phosph. Puis. Sep. Spig. Sulphur. Thuj. Valer. Zinc. Tip of the Elbo^TT. IN GENERAL: Agar. Alum. Bry. Carbo an. Causticum. Graph. Hop. Merc. Mur. ac. Oleand. Phosphor. ac. Rhus. Sabina. Spong. Stann. ^Wrist-Joints. BORING: Hell. Rhod. COLD FEELING: Rhus. CREAKING : Con. Merc. Selm. DISLOCATION-PAIN: Am. Boy. Bry. Calc 0. Caust. Graph. Ign. Lye. Nux vom. Rhodod. Rhus. Ruta. Sabin. Stannum. Staph. Sulph. ERUPTION: Mer<'. Calc. phosph. Rhus. Sulph. EXCORIATION: Sulph. GANGLIA : Magn. m. Sil. IN GENERAL : Aeon. Amm. Anac. Am. Ars. Asa f. Bism. Bov. Bry. Calc. c Calc. phosph. Carbo veg. Caustic. Choi. Colch. Creos- Cycl. Dig. Euphrasia. Qraph. Hep. Hyosc. lod. Knll. Led. Lye. Mang. Merc. Mezer. Nitr. Phosphor. Puis. Rhod. Rhus. Ruta. Sabin. Sas»ap. Selen. Sep. Sil. Staphys. Stront. Sulphur. Teucr. Thuj. Verb. Zinc. ITCHING: Amm. mur. WANT OF MOBILITY: Sep. UPPER ISXTRfiMITIES. ar. lOT :)mc. NODE?, gouty: Calc. c. Lye, NUMBNESS: Bov. Croc. SPOTS: Kali. Petr. STIFFNESS: BeUad. Caust. Chel. Lach. Led. Lye. Puis. Bhod. Ruta. Sabina. Sep. Sulphur. Thuj. STITCHES: Alum. Arn. Bryon. Calc. c. Caust. Con. Grapliit. Hell. Kali. Laur. Mere. Katr. mur. Nux vom. Rat. Sep. Sil. Squill. Sulph. SWELLING: Bry. Calc. TEARING: Baryt. Bov. Calc. c. Carbo veg. Cliel.Grat. Kali. Lach. Mezer. Ol. an. Phosph. Plumb. Puis. Rhod. Sabina. Sulph. Teucr. TENSION: Amm. carb. Spongia. Zinc. TREMBLING: Aeon. TWITCHING: Bar. Bhus. Sulph. Valer. PAIN : Aeon. Ammon. Asa feet. Hyosc. Merc. Nitr. Sulph. — laming: Aconit. Asar. Bism. Eu- phorb. Kali. Led. Nux vom. • — as if sprained : Am. Calc. c. Puis. Rhod. — 88 if bruised: Cale. phosphor. Caust. Nitric ac. Puis. Ruta. PRESSURE : Led. Nitr. ac. Stann. Zinc. WEAKNESS: Merc. Phosph. Hands. BEATING: Sabad. BLISTERS : Amm. mur. Arg. nitr. Bell. Canth. Clem. Hep. KaU. Lach. Natr. mur. Rhus. Sep. Squill. Sulph. BLUENESS: Aco. Camph. Cupr. Lach. Nux vom. Rhus. Samb. Ve- ratrum. BOILS: Calc. carb. Hep. Lycop. Merc. BURNING: Aeon. Anae. Aurum. Bryon. Calc. Chiu. Hell. Kali. Lach. Laur. Nux mosch. Nux vom. Op. Phosph. Sec. com. Sep. Squill. Stann. Staphys. Sulph. Zinc. BRITTLE, akin: (iraph. Natr. mur. CHILBLAINS : Agac. Nitr. ac. Petr. Phosph. Puis. Staun. Sulph. CHILLINESS: Ambr. Anac. Merc. Nux vom. Petr. COLDNESS: Acori. Agar. Ambr. Arn. iur. Bar. Bell. Calc. c. Camph. Cann. Caustic. Cham. Cliln. Cr'ot. Cuprum. Cycl. Daph. Dig. Dros. Ferr. Hell. led. Ipecac. Kali. M. arct. Mang. Nitric ac. Nux vom. Phosph. Puis. Ranunc. bulb. Rhus. Samb. Sep. Spigeha. Sulph. Thuj. Veratr. Vit. — feeUng of: Rhus. Sec. corn. CONTRACTION: Cann. Cin. Jlfe)-c. Nux vom. Pruu, Sec. corn. CRAMPY FEELING: Aeon. Ambr. Anae. Asa f. Aur. Calc. carb. Cauu. Eu2)hr. Graph. Lycop. Mang. Men. Mercur. Mosch. Nitr. Nux vom. Plat. Sil. Spig. Spong. Strum. CREEPING: Arn. Ars. Bar. Bell. Caust. Croc. Lach. Laur. Nux vom. Phosph. Plat. Rhodod. Ruta. Sec. com. Spig. Sulphur. Veratr. — as if gone to sleep : Bry. DEADNESS: Calc. Cou. Laches. Nux vom. Phosph. Rhus. Sec. corn. Sil. Zinc. DESQUAMATION OF HANDS: Amm. Barr. Ferr. Merc. Phosph. ac. Sep. Sulph. DISLOCATION-PAIN: Bar. Rhus. DRY PALMS OF HANDS : Bism. DRYNESS: Lye. Natriun. Sabad Sulph. EMACIATION : Graph. Gratiola. Selen. ERUPTION: Alum. Antim. crud. Ars. Canth. Carbo vegeU Cic. Hep. Lyv. Merc. Mur. ac. Nitric ac Rhus. Secale corn. Selen. Spig. Staph. Sulphur. Sulph. ac. Zinc. ERYSIf^ELAS: Ran. bulb. B/itw. It I i I'll it' Hi P Ill iiii:; I; hf 109 UPPEE KXTREMITIES. IN GENERAL : Aeon. Agar. Ambr. Ainrn. Anac. Arg. Am. Ars. Asa f. Aur. Bar. Bell. Bism. Bry. Calc Carbo veg. Caustic. Chamom. Chin. Ooccul. Creos. Cupr. Dig. Dulc. Ferr. Graph. Jlep. Ipec. Kali. Lach. Laiir. Led. Lye. M. aret. Mang. Men. Mei'c. Mur. ac. Natrum. Natr. mur. Nux vom. Op. Petr. Phosph. Phosph. ac. Plumb. Puis. Ran. bulb. Rhod. Rhus. Ruta. Samb. Sec. com. Selen. Sep. Sil. Spig. Stann. Staph. Sulph. Veratr. Verb. Zinc. HEAVINESS: Bov. Oaust. Nitric. Phosph. HEAT : Aeon. Bry. Carb. veg. Ooc- cul. Graph. Hell. Hepar. Led. Lye. Nitric ac. N. vom. Phosph. Sep. Stann. Staph. Zinc. HERPES: Ambr. Bov. Calcarea. Clem. Dulc. Merc. Natr. mur. Sas- sap. Sep. Sulph. Zinc. INSENSIBILITY: BeU. Lye Natr. mur. Rhus. Sec comut. Stann. Stront. Zinc. ITCH: Merc. Sep. Selen. Sulph. ITCHING : Aur. Bov. Cann. Caustic. Cina. Ooccul. Hep. Kali. Nitric ac. Phosph. ac. Plat. Plumb. Bhu^. Sulph. Veratr. JERKS: Valer. NODES, arthritic: Calc. carbon. Calc. phosph. Led. Lye. Rhod. Rhus. Sep. Sulph. NUMBNESS : Asa feet. Ooccul. Car- bo veg. Lach. Lye. Puis. Rhus. Ruta. PAIN : Agar. Daph. Nux vom. Plumb. — laming: Bell. Bism. Caustic. Cycl. Dig. Nux vom. Sil. Vit. PARALYSIS: Ambr. Grot Cupr. Lach. Natr. mur. Nux vom. Phos- . phor. Plumb. Rhus. Sil. Zinc. PARCHED SKIN: Lycop. Phosph. acid. PRESSURE : Asa f. Cah: phosph. Carbo veg. Cycl. Hep. Kali. Mea. Nitric ac. Staph. Zinc. REDNESS: DiUc. Fluor, ac. Nux vom. Sabad. Sangn. Staph. RHAGADES: Cycl. Graphit. Petr. Sulph. ROUGH: Aluvi. Kali. Nitric ac. Phosph. ac. GONE TO SLEEP : Ambra. Baryt. Carbo an. Croc. Fluor, acid. Graph. Kali. Lach. Lycop. M. austr. Natr. mur. N. vom. Phosph. Puis. Sec. com. Sil. Veratr. SORE, pain as if: Gale. c. Nitric ac. Rhus. BRUISED, pain as if: Carbo veg. Dros. Ruta. SPASM: Bell. Caust. Sec. corn. SPASMODIC FEELING: Anac. BeU. Caust. Plat. — paiu : Anac. Caustic. Lycop. Spig. SPOTS : Ant. tart. Nitr. ae. Sej). — red: Merc. Sep. STIFFNESS: Ars. lellad. Caust. Cham. Coloc. Croc. Mercur. Rhus. Zinc. STITCHES : Aconit. Ang. Arn. Asa f. Bellad. Calc. phosphor. Carbo an. Caust. Caps. Chel. Cina. Hell. Graph. Lach. Led. Lye. Mosch. Magn. viur. Par. Phimb. Squill. Stann. SWEAT: Ant. tart. Calcar, c. Cann. Chamom. Coccul. Con. Laur. Natr. mur. Nitric acid. Nux vom. Phosph. Sulph. Veratr. — cold: Caps. Sep. — in palm of hands: Aeon. Bar. Calc. c. Con. Dulc. Fluor, ac. Ignat. Laur. Merc. N^liJC vom. Rheum. SWELLING: Aconit. Ars. Bell. Bry. Calcar. Caust. China. Coccul. Dig. Ferr. Hep. Lach. Lye. Merc Nux vom. Phosph. Rhus. Ruta. Sec. corn. Stann. Sulph. — uoctumal: Dros. UPPER r.Xir.EMITrEB. 109 TEARma AND DRAWING: Agaric. Amm. Arn. Ars. Aiir. Bel- lad. Calo. Canth. Carbo veget. Caust. Chamom. Chel. Chinu. Colch. Cnpnun. Digit. Graph. Grat. lod. Kali. Lack. Lour. Led. Lye Mang. Mur. acid. Natr. mur. mtr. Petr. PhoU. Phos. Plumb. Rheum. Rhod. Ehu.s. Snhin. Selen. Sep. Siiig. Stann. Sulph. Teucr. Verb. Zinc. TENSION: Bell. Oaiith. Caustic. Chin. Hyp. Zinc. TREMBLING: Agar. Anac. Ant. tart. A7's. Bell. Bism. Bryon. Calc. c. Caustic, dhin. Civ, Covciil. Coffea. Crotal. Ferr. magn. Ilyos- cynm. lod. Kail. Lach. Led. Nitr. ac. Oleand. Op. Phosph. Plat. Plumb, Rhus. Sil. Spong. Stan- num. Stram. Sulph. Zinc. TUBERCLES: Ars. Calc. CocciU. Lye. Natrum mur. Nitric ac. Jihus. TWITCHING : Anac. Bar. m. Amf. Bell. Cina. Cupr. Graph. Ignat. Lach. Laur. Meph. Natr. Op. Plat. Ran. bulb. Sep. Stann. Sulph. ac. Vit. ULCERS: Ars. Lye. Sil. Sulph. URTICARIA: Hep. VARICOSE VEINS : Alumin. Arn. Calc. Chel.]Chin. Laur. Men. Ntix vom. Op. Phosph. Puis. Rheum. Rhod. Stront. Sulphur. Thuj. CRACKED VEINS: Alum. Calc. Creos. Graph. Lacli. Magn. c. Merc. Natrum mur. Nitric ac. Petr. Sil. Sulph. Zhic VESICLES: Daph. WARTS: Calc. c. Caust. Dulcam. Rhus. Sep. Thuj. WEAKNESS: Calc. Carb. veg. Caust. Chin. Cupr. Hell. Nitr. Nv^ vom. Phosphor. Sil. Tab. Zinc. YELLOWNESS • Oanth. Ign. Merc. Spig. Fingers. BLOTCHES: Lach. Lye. Staph. BURNING: Asa f. Aim. Calcar. Caust. Con. Dig. KaJi. Liich. Natr. Nitric ac. Nux vomica. Oleand. Plat. Sil. Sulph. Sulphur, ac. Ve- ratr. BONE-PAIN: Fluor, ac. CHAPPING: Fluor, ac. Natriun mur. Petr. Sil. CHAPPING OF SKIN: Pe<r. CHILBLAINS : Agar. Croc. Nitr. ac. Nux vom. Petr. Pw/.s. Rhus. Sulph. COLDNESS : Antim. tart. Calad. Cham. Chel. Digit. Hell. Lye. Mur. ac. Merc. Rhod. Suljdi. Tar. Thuj. CONTRACTION: Ambra. Auacard. Antim. tart. Arg. Bism. Calc. Caus- tic. Cina. Colchio. Coloc. Graph. Lye. Merc. Nux vom. Plat. Rhus. Euta. Sec. com. Sep. Sil. CONTRACTION OF TENDONS : Cnu.'it. CRAMPY FEELING : Anacard. Arn. Ars. Asa f. Calc. Cin. Coccul, Cycl. Euphr. Graphit. Ignat. Lye. Mur. ac. Mosch. Nux vom. Oleand. Phosph. Plat. Rhus. Stann. Staph. STilphiur. Veratr. CREAKING: Bar. Caps. Nitr. CREEPING : Aeon. Ambr. Amm. mur. Ars. Calc. Caust. Cina. Croc. Graphit. Kali. M. arct. Magn. Natr. mur. Opirmi.Plat. Ban. bulb. Rhod. Rhus. See. com. Sep. Si'.. Sulph. Thuj. Veratr. Verb. — in the tips of the fingers : Aco. Anmion. mur. Croc. M. austr. Sec. corn. Sep. Thuj. — as of ants: Sec. corn, —as if gone to sleep: Miur. ac. DEADNESS : Agar. Calc. Caust. Cio. Con. Hpp. Lyeop. Merc. Nitrio ac. Phosph. ac. Puis. Bhus. Sec. com. Sulphur. Thuj. Veratr. 1" n \y 'i\\} lit: iili n lif 110 UPPER EXTIIBMITIK& 1 f if: I '{I ^'y' h' — gangrenous: Sec. corn. — of tips of fingers: Ant. tart. Chel. DESQUAMATION OF THE SKIN : Amm. mur. — on tlie tips of the fingers : Sabadilla. DISLOCATION-PAIN : BeU. Cham. Ign. Natr. mur. Phosphor. Spig. Sulph. DRYNESS OF TIPS OF FIN- GERS : Ant. tart. ERUPTION: Antim. crud. Baryt. Canthar. Caust. Clem. Cycl. Daph. Graph.Lach. Lyc.Mur. ac. PhoH.ac. Phimb. Puis. Rhus. Spigel. Squill. Veratr. Zinc. — between the fingers: Graph. Sulph. acid. ERYSIPELAS : Lye. Rhod. —of the tips of fingers : Thuj. EXHAUSTION: Sil. Rhus. HEAT : Sabad. Thuj. IN GENERAL : Aeon. Alum. Ambr. Amin. mur. Anac. Antim. tart. Am. Ars. Asa f. Baryt. Bell, Bism. Bor. Bry. Calcar. Canth. Carbo vegetab. Caust. Cham. Chel. Cic. Cina. Coc- cul. Colch. Creos. Croc. Cyclam. Dros. Ferr. Graph. Hell. He^). Ign. Kali. Lach. Lye. M. arct. M. austr. Magn. Mercur. Mosch. Natr. Natr. mur. Nux vom. Oleancl. Pliosph. Puis. Ban. Rhodod. Rhus. Ruta. Sabad. Sec. com. Sep. Sll. Spigel. Stann. Staphys. Stront. Sulphur. Teucr. Thuj. Valer. Veratr. Verb. Vit. Zinc. HERPES : Ambr. Merc. Nitric ac. Ran. bulb. INFLAMMATION : Aco. Con. Hep. Kali. Lye. Merc. Puis. Ran. SU. INSENSIBILITY: Digit. Ferr. N. vom. Plioy.ph. Rhus. Sec. corn. — of tips of fingers : Ant. tart. Cham. Ferr. M. austr. Staph. ITCHING : Agar. Alum. Aur. Calc. Cnmph. Caust. Chel. Con. Cyrl. Lach. Lye. Nux vomica. Oleander. Phosph. Plumb.^ls. Rhod. Sulph. ac. Zinc. Veratr. ITCHING, between the fingers : Aur. Lach. Plumb. Rhod. —at the tips of fingers : Ambra. Ant. crud. Sulph. ac. Spig. LAMENESS: Carbo veg. — of the thumb: Kali. NODES, arthritic: Graph. Lye. NUMBNESS: Ang. Calc. Caust. Con. Cina. Euphr. Ferr. Graph. Kali. Lach. Lycopod. Phosph. Plat. Rhus. Sw. com. Sil. Staph. Sulj>h. PAIN : Caust. Led. Sassap. Veratr. — as if bruised : Aram, carbon. Cina, Natr. mur. Nitric ac. — laming: Bellad. Cycl. Digit. Kali. Mosch. Sabin. Sil. PARALYSIS: Calc. Bryon. KaU. Lach. Phosph. PRESSURE : Asa f. Bell. Con. Cycl. Dig. Hell. Hyosc. Ran. Rhod. Ruta. Sassap. Staphys. Tar. Teiicr. Vit. Zinc. ilEDNESS : Agar. Kttx vomica. RIGIDITY: Ats. Merc. GOING TO SLEEP : Aeon. Ambra. Amm. mur. Aur. Bar. Cak: Carbo an. Cham. Cina. Croc. Dig. Graph. led. Kali. Lach. Lye. Merc. Magn. mur. Natr. mur. Nux vom. Par. Petr. Phosph. Plumb. Puis. Bhus. Saasap. Sec. corn. Sei». Sil. Staph. Sulphur. Thuj. Veratr. SORE BETWEEN THE FIN- GERS: Graphites. SPASM: Bellad. Chamom. Hyper. Ign. Nux vom. Rhus. Veratr. SPASMODI' FEELING: Anac. Bell. Caust. Digit. Nux vom. Plat. Rhod. SPOTS, yellow : Con. Petr. Sabadillu. — dark : Ant. tart. • — red: Plimib. Zinc. STITCHES: Ambr. Ammon. mur. Anac. Ai'n. Bryon. Carbo an. Car- bo veg. Caust. Colch. Croc. Daph. UPPER KXTnRMITIES. Ill Dig. Graph. Kali, Lack. Lye. Merc. Mur. ac. Natruni mur. Nux vom. Oleand. Petr. Phosph. Ran. Hc. Rhod. Rhus. Sabad. Sassap. Stann. Staph. Hulith, ac. Teucr. Thvj. Verb, Zinc. SWELLING : Avim. caro. Arsenic. Bry. Calc. Hep. lod. Lack. Lye. Magu. Merc jNitr. Nux vom. Phosph. Ran. seel. Rhus. Sil. Sulph. Thuj. —feeUng as of a : Bell. TEARING: Agar. Amhr. Amman, mur. Arsen. Aur, Bell. Bism. Canth. Carbo vej?. Caust Ohel. Colch. Dapli. Hell. Ign. led. Kali. Lach. Laur. Lye. Magn. Merc. Mur. ac. Natrum mur. Nitr. 01. an. Par. Phos. ac. Plumb. Ran. bulb. Bhod. Sabin. Sil. Spig. Stann. Staph. Sulph. Teucr. Zinc. TENSION : Canth. lod. Phosph. Plumb. Puis. Veratr. THROBBING: Carbo veget Crot. Sil. Sabad. Teucr. THUMB GOES TO SLEEP : KaU. Plumb. — clenched : Bell. Cham. Hyose. Ig" Rhus. TREMBLING: Ambr. Bry. Rhus. Stront. TWITCHING : Alum. Amm. mnr. Anac. Bry. Caust. Cham. Cic. Cin. Crotal. Cnpr. Dig. Ign. Lycop. M. austr. Merc. 01. an. Phosph. Phunb. Rheum. Rhod. Rhus. Sabad. Stann. Sulph. Sulph. ac. ULCERS: Alum. Ars. Caust. Lye. Natrum mur. Ran. bulb. Sil. Sulpli. URTICARIA: Hep. WARTS: Caust. Lach. Lycopod. Petr. Sep. Sulph. WEAKNESS: Carbo veget. Hell. Nitr. Rhus. Sil. YELLOWjiltuming: Chel. Finger-Joints. BORING: HeU. OEAMP-PAIN : Euphr. Magan. Plat. oiill)h. CREAKING: Baryt. Caps. Moph. Nitr. DISLOCATION-PAIN: Natrum mur. Phosph. Sulph. DRY, as if: Puis. IN GENERAL: Ambr. Amm. Am-. Bell. Culc. Caps. Ciubo veg. CausU Cham. Chin. Colch. Con. Creos. Drosera. Graph. Hell. IIcji. Ignat. Kali. Led. Lye. Mang. Merc. Natr. rn wr.^Nitr. Nitric ac. Nux vomica. Oleand. Phcsph.Plat. Puh. Rhod. Illtus. liuia. ^'(!p. Sil. Spirj. Spong* Staph. Sulph. Sulijh. ac. NODES, gouty: C'alcar. Clem. Rep. Lijc. Rhod. Staph. PAIN: KaU. Sil. Sulph —laming: Bell. Calc. PRESSURE; Led. Merc. Zinc. REDNESS: Lye. Spong. STIFFNESS: Aur. Ars. Carbo an. Caust. Graph. Hep. L^oopod. Rhus. Sep. Sulph. STITCHES: Am. Bar. Bry. Carbo veg. Con. Hell. Ign. Men. Nitric ac. Rhus. Sabin. Sepias. Sulph. ac. SWELLING: Euphr. Hep. Lycop. Nitric ac. TEARING: Agar. Ammon. Anac. Aur. Bell. Bryon. Carbo veg. Caust. Chel. Colch. Hell. Kali. Led. Lye. Phosph. acid. Plat. Puis. Rheum. Rhodod. Rhus. Ruta. Sabin. Samb. Spig. Staph. Sulpli. Teucr. Zinc. TENSION : lod. Nitric ac. Puis. Sep. ULCERS: Sep. Tips of Fingers. IN GENERAL : Ambr. Ammon. mur. Ant. tart. Asa f. Bor. Calc. Chel. Croc. Hep. Lach. M. austr. Phos. Pulsati Rhus. Sec. corn. Sep. Sil. Spig. Staph. Sulphur. Teucr. Thiij. Veratr. If I I!! ■a > III I 0' V\ 112 LOWER KXTItBMlTIES. Finger-Nails. ALTERED COLOR: Ars. Mur. ac. BLUE: Ohel. Chin. Ohlor. Crotal. Dig. Nux vom. Petr. DISTORTION: Graph. Sep. S' >'h. EXFOLIATION : Graphit. Mercnr. Sulph. IN GENERAL: Alum. Ant. crud. Arsen. Bar. Bism. Bor. Bov. Cole. Caust. Chel. Colch. Cou. Crotal. Digit. Graph. Hep. Kali, iodine. Lack. M. austr. Merc. Natr. mur. Nitr. Nitric ac. Nux vom. Phosph. Pulsat. Ran. bulb. Sabad. Sep. Sil. Sulph. Sulph. ac. Thuj. GNAWING: Alum. GROWTH, Blow: Ant. cra<l. HANG-NAELS: Natr. mur. Rhus. Stann. Salph. NAILS, brittle: Graphit. Mercur. Thuj. — growing in : Sil. Sulph. PRESSURE : Calc. Caust. TEARING UNDER THE NAILS: Sil. — all round : Ambr. Lye. THICKENING : Graph. Sabad. ULCERATED: Alum. Aram. Bar. Calcar. Conium. Hep. Kali. Laches. Lycopod. Mercur. M. austr. Natr. mur. Petr. Phosph. Sepiae. SIlic Sulph. Thuj. ULCERATIVE PAIN: BeUad.Con. Graph. Hep. Kali. Jtfjjrc.Pkt. Puis. Sil. Sulph. Sulph. acid. Thuj. YELLOWNESS : Ambr. Con. Merc. Nux vom. LOWBR MJ^TJIBMITIBS. Extremities. (t. Blgnlfles tbigb, 1. leg.) IN GENERAL : Anac. Arn. Bellad. Bry. Calc c Calc. phosph. Carbo veg. Caustic China. Colchio. Crot. Dig. Graphit. Guaj. Ignat. lod. Kali bichr. Kali curb. Lach. Led. Lycop. Merc Mezer. Mosch. Mur. ac. Natr. Natr. mur. N. tohi. Oleand. 01. an. Phosph. acid. Plat. Plumb. Pnls. Bhodod. Rhus. Ruta. Sabin. Sep. Sil. Spigel. Spong. Staph. Sulph. Thuj. Valer. Viol. tr. Thighs. BLOTCHES: Calc. c. Lach. Merc. Staph. BOILS : Hep. Sep. Sil. BORING : Am. Rhus. Staph. BURNING: Asa f. Carbo animal. Carbo veget. Daph. Euphorb. Kali. Nux vom. Phoa. Plumb. Rhus. Sil. Sulph. Zinc. CABJES : Asa f. Aur. Calc. c. Hep. Merc. Nitric ac. Phos. Sep. Sil. Sulph. COLDNESS (t. and 1.) : Ars. Bell. Cnlad. Calc. c. Camph. Carbo veg. Daph. Led. Lye Nitric acid. Nux vovt. Op. PxUs. Sec. com. Sep. Sulph. Veratr. — feeling of : Helleb. M. austr. Oleand. — feeling of (t. and 1.) : Camph. Carb. veg. Chin. Merc. Natr. Sec. com. CONTUSrVE PAIN (t. and I): Am. Euphorb. Led. Nux mosch. Rhod. Ruta. CONVULSIONS (t. and 1.) : Cham. Caustic. Cuprum. Hyosc. Ign, Ipeo. Men. Op. Plumbum. iJ/m.s. Sec. com. 8tram. CRAMPS: Asar. Chin. Colch. — (t. and 1.) : Bell. Bism. Cina. Cupr. Lach. Nux vom. Rhus. Sec com. Strain. LOWKR rXTIiRMITlRS. lift OBAMPY FEELING: Angust. Ain. Gale. c. Cycl. Digit, (iraphit. HyoHC. Lycopod. Men. Petv. Phos- phor. Rhtift. Sop. Valer. Vi>ratr. CREEPING: Arsenio. Boll. Clnaj. Mane. Rhus. Sec. corn. CUTTING (t. and 1.): Aliun. Boll. Bry. Graph. Lycop. Natr. Sil. Sulph. ac. DISLOCATION-PAIN (t. and 1.) : Carbo veg. Caiist. Led. Natr. mur. Rhus. EMACIATION: Arg. uitr. Arson. Calc, c. China. lod. Lach. Merc. Nux vom. Selm. ERUPTION: Clem. Euphorb. Gra- phic Kali. Lye. Merc. Natr. niur. Rhus. Sil. Sulph. EXTERNAL SIDE: Anar. Asa f. BoUad. Caustic. Coccul. Euphorb. Merc. Mezer. N. vom. Phosph. ac. Rhus. Stann. Sulph. Zinc. POSTERIOR SIDE : Alum. A7itim. rrud. Calc. c. Canth. Carbo veget. Caust. Con. Euphob. Graph. Ign. Kali. Led. Lye. Men. Merc. Mezer. Phosph. Phosph. ac hus. Selen. Sep. Stann. Staph. ISulph. Veratr. Ziuc. INTERNAL SIDE : Ant. crud. Asa f. (!aic. c Carbo veg. Caust. Gray It. Hep. lod.Kali. M. austr. Merc. Mur. acid. Nitric ac. Oleand. Petroleum. Rhod. Sabin. Selen. Stann. Staph. Sulph. Tar. Thuj. ANTERIOR SIDE : Anac. Ang. Ar- gent. Asa fiBt. Bar. Cann. Chin. Digit. Euphorb. Kali. Lye. Men. Mur. ac. Natrum mur. Nux vom. Olean. Phos. ac. Sabin. Sil. 8poug. Stann. Thuj. Valer. FAINT FEELING : Am. Ars. Bry. Chiu. Crot. Dig. Guaj. Hell. Kali. ■ Laur. Oleand. Phosph. ac. Plat. Rhodod. Ruta. Spig. Veratr. — (t. and 1.) : Agar. Alum. Ambra. Ainrn . Amm. mur. Arson. Asar. Boll. Bryon. Cal*. c. Cam, (Jamt Chhia. Con. Croc. Graph. Hell. Ign. Ipfic. Lach. Laur. Led. Lye. Nitr. a''. Nux moscl... Nux rom. Phosph. Ph. ac. Plat. Plumb. Puis. Rhcylod. Jihus.'RMt&. Sec. corn. Sep. St'ont. Sulph. Zinc. FORMICATION: Ast. Bel'a<h Nux vom. Sec. corn. IN GENERAL: Agar. Ambr. ^nac. Ant. tart. Arn. Asa f. Asfir. Prli. Bry. Cnlc. c. Caps. Carbo an. Car- linveg. Canst, Chel. (!hhi. Cocc. Colchic. Creos. CrotaJ. Cycl. Eu- phorb. Graph. Guaj. Hell. Hep. Ign. Kah. Lach. Led. M. austr. Merc. Alczer. Mosch. Mur. ac. Nalr. mur. Nitric ac. Nux vom. Oleand. Phbs. ac. Plat. Puis. Ran. bulb, Rhodod. Rhus- Sabin. Selen. Sejt. Sil. Spigel. Spoyirj. Stann. Staph. Suiph. Thuj. Zinc. HEAT : Aconit. Bryon. Caustic. Sulpli. HEAVINESS : Alum. Ambr. Bry. Calc. c Cann. Carbo veget. Graph. Hell. Ign. lod. Kali. Lach. Lact. M. arct. Natrum mur. Nux vom. Puis. Rhus. Ruta. Sep. Spig. Stann. Sniphur. Sulph. ac. HEBPEb : Olraph. Lye. Merc. Staph. Sulph. Zinc. INSENSIBILITY (t. and 1.): Ambr. Ars. Asar. Carbo veg. Lach. Lye. Oloand. Op. Rhus. Sec. corn. ITCHING: Agar. Ant. crud. Ars. Calc. c. Carbo vog. Cic. Dig. Eu- phorb. Graph. Lach. Led. M. arct. Merc. Natrum mur. Nitric ac. N. jugl. Nux vom. Oleand. Rhod. Sec. corn. Sil. Spiy. Staphys. Sulphm". Thuj. Veratr. Zinc. JERKS (t. and 1.) : Antim. tart. Cal- car. c. Cic. Cic^s. Euphr. Merc. Phosph. Stram. Sulph. Sulph. ac. LAMENESS : Causticum. CoccuL Oleand. N. * IH 1^ )i ^ m I !|| i m m LOWED BXTUBHITIEB. — (t. and l.>: Bell. Bry. Caust. Coo cul. Dig. lod. Lack. Mane. Natr. mur, N. voin. JRhvs. Buta. S(h;. com. Sep. Sil. Suljth. Zinc. MUSCLES RELAXED (t. and I.) : Ambr. (^alc c. Carho ve<j. Foir. lod. Mere. Nux vom. Pho82)h. ac. NODES, gouty: Ant. crud. Calc. c. Calc. ph. Lycop. Bhua. Staph. Sulph. NUMBNESS : Carbo veget. Ferr. Graph. Spong. — (t. and 1.): Ang. Asa f. Calc. c. Carbo veg. Cocoul. lod. Kali. Lack. Merc. N. Tom. Plat. Rhufi. Sulph. Veratr. PAIN (t. and 1.) : Am. Auacard. Aur. Calcar. c. Carbo veg. C!upr. Daph. Graph. Lycop. Mur. ac. NitrU; ac. Phosphor. Rhus. Sil. Stann. SuipA. —laming : Carbo veg. t'aust. Cina. Coccul. Ign. Natr. mur. Ntuc vom. Rhus. Sep. — aa if sore (t. and 1.) : Auac. Am. Calcar. o. China. Graph. Kali. Led. Lycop. Nux vom. Rhod. Staph. Sulph. — as if bruised; Bry. Bell. Calc. c. Vaust. Coccul. Cuprum. Graph. Guaj. Hep. Led. Men. Natr. Jf. vom. Phosph. ac. Plat. Puis. Buta. Sepifio. Spig. Sulph. Tar. Valer. Veratrum. (t. and 1.) : Bry. Bell. Cauthar. Carbo veg. Croc. Graph. Laur. Natr, Nux mosch. Sep. SIl. Stann. PBESSURE: Agar. Caps. Digital. Guaj. Led. Men. Mosch. Mur. ac. Nitric, ac. Oleand. Ph. ac. Sabin. Sassap. Sil. Stann. Verb. PULSATIONS : Asa fast. Coccul. Plat. SHUDDERING: Cann. Chin. Ign. Phosph. Puis. GONE TO SLEEP: Ambra. Canth. Cham. Coccul. Croc. M. arct. Mosch. Nux vom. Oleander. Puis. Rhus. Sec. corn. Verotr. SORENESS BETWEEN THE THIGHS: (Jrnpli. Kali. Morcur. Rhod. Solon. Sulph. SPOTS, rod: Graph. Merc. STAGGERING : Asar. CocoiU. HeU. Ign. lod. Nhx vom. Oleander. Op. Rhus. Sec. corn. Stram. Veratr. STIFFNESS: Ar.<. Graphit. Ignat. Natr. mur. Oleand. Rhod. — (t. and 1.): Alum. Ang. Hall. Calcc Canst. Cic. Ferr. Ign. Kali. Lod. Merc. Nal7\ mur. Phosph. Rhu>(. Sop. Sulph. STITCHING : Aco. Am. Asa fat. Hell. Bry. Calo. c. Caustic. Coccul. Con. Eui^hr. Grai)h. Guiij. Ilyosc. Laur. Mangan. Mon. Nux vomica. Oleand. Phos. RIiuh. Sabad. Sas- Hap, Sep. Spig. Spoiig. Stann. Staph. Sulph. Tar. Tlmj. Viol. tr. Zinc. STRETCHY FEELING: Bellad. Daph. Phosph. ac. SWEAT : Carbo an. Merc. N. vom. Rhus. ThuJ. — (t. and 1.) : Asa f. Hep. Phos. Sep. Veratr. SWELLING (t and 1.) : Amn. Bry. Calc. c. Carb. veg. Chin. Colch. Dulcam. Jlrll. Lye. Mere. Phosph. Soc. corn. Sep. Sil. Sulph. SWELLING OF BONES (t and 1.): Asa f. Aur. Calc. o. Calc. pli. Dulc. lod. Lijc. IVtcrc. Phospli. Phosph. nc. Rhus. SU. Staph. Siiljih. TEARING AND DRAWING : Aga- ric. Alum. Amui. mur. Anac. Asa f. Aur. BcUad. Bry. Calc c. Canth. Carbo an. Criuit. Chamom. China. Coccul. Colchic. Daph. Thtlc. Eu- phorb. Graph. Guaj. Kali. Lycop. Merc. Mezer. Natr. mur. Niir. ar. Nux vom. Phos. ac. Plat. Plunih. Ptils. Rhus. Sepia). SU. Stann. Sulpli. Valer. Zinc. . II lOTHCn liXTURMITIKfl. US TENSION : Am. Oalc. o. Carbo teg. Oreos. Ouaj. Lyo. Merc. Men. Ni- tric od. Petr. Bhod. Rhus. Sabin. — t. and 1. : Alum. Carbo anim. Oaiiat. Chain. Dnlcam. lod. Kali. Lyo. Natr. mur. Pulnat. Sep. Sulph. Zinc. THROBBING (t. and 1.): Antim. tart. Asa f. Boll. Brora. Bry. Dig. Kali. M. anstr. Natrum mux. Phos- phor. Rhus. RiUa. Siilph. TREMBLING (t. and 1.) : Ammon. mnr. Am. Calc. c. Carbo veg. Oauat. Clc, Con. Digit. Graph. Lack. Mercur. Natr. Nnx mosch. Ntiaevom. PZai. Plumb. Puis. Rhus. Sil. TWITCHING: Agn. Arn. A.'ia f. CauHt. China. Graph. Laches. Lye. Mang. Nux vom. Phos. Puis. Rheum. Rhus. Sep. Sil. Staph. Sulph. Valer. Veratr. ULCERS : Calc. SU. Thuj. — t. and 1. : Calc. Carbo veget. Graph. Lyo. Merc. Natrum. Nitric ac. Petr. Rhus. Si lie. Salph. UNEASINESS (t. and 1.): Ars. Cann. Carbo veg. Caustic. Chin. Con. Graph. Kali. Lach. Merc Nux vom. Phosphor. Plat. Ruta. Sep. Sulph. VARICOSE VEINS (t. and 1.): Ambra. Am. Ars. Calc. c. Carbo veg. Ferr. Graph. Lye. M. austr. Puis. Sulph. Zinc. Legs. BOILS: Hep. Merc. Magn. carb. Nux vom. Sil. Sulph. BORING: Anacard. Aur. Mercur. Staph. BURNING: Agar. Arsen. Asa f. Carbo veg. Caust. Crot. Kali. Lyo. Nux vom. Phosph. ac. Rhus. Sep. Tar. Teuor. Zinc. COLD FEELING: Ambra. Mosch. Puis. Valer. CONTRACTION : Ars. Canth. Cocc. Ly<: Nux vom. CRAMP (in calves): Alum. Amhra. Ang. Ars. Calf. carb. Camph. Carb. veg. Chamom. Cin. Coloc. Cupr. Dulc. Forr, Graph. Hep. Hyosc. Ign. Laches. Ltsd. Lij<\ M. austr. Men. Natr. Natr. mnr. Nitric nc. N. jug I. N. vom. Petr. Rhodod. Rhus. Samb. Hik". corn. Sep. Sil. Stram. Sulphur. Veratr. Zinc. CREEPING: Bell. Cic. Ipeo. Nux vom. Rlnis. Sec. com. CUTTING. Calc. c. Phos. ac. Thuj. (cumpt. t.) DIGGING: Spig. EMACIATION : Phos. ac. Bamb. ERYSIPELAS : Arn. Rhus. Sulph. FAINTNESS: Natr. mur. Oloand. Plat. Staun. FLESH LOOSE, as if: Nux vom. Rhus. IN GENERAL: Aco. Ambr. Amm. mur. Anac. Ant. crud. Antim. tart. Ars. Asa f. Bell. Bryon. Calc. c Carbo veg. Canth. Caust. Cham. Chel. Conium. Creos. Ctipr. Cycl. Dig. Euphorb. Ferr. Graph. Hypsc. Ign. Ipec. Kali. Lach. Led. Lye M. austr. Men. Mercur. Mezer. Natr. N. vom. Oleand. Phosph. Phosph. ac. Plumb. Puis. Rhod. Rhus. Sabin. Sec. corn. Sep. SU, Spigel. Spongia. Staph. Sulph. Tar. Valer. Veratr. Vit. HEAT : Aeon. Bell. Bry. Guaj. Hyosc. HEAVINESS: Ars. Bell. Camph. Ferr. Ign. Ipec. Laur. Lye. Rhus. Veratr. (comp. t.) HERPES : Lye. Plumb. Staph. Sulph. Zinc. ITCHING: Agar. Asa f. Aurum. Calc. c. Chel. Dulcam. Daph. Kali. Lach. Laur. Lyt: Natr. Op. Sabin. Sil. Staph. Sulph. LAMENESS : Agar. Ars. Carb. veg. NODES, gouty: Antim. crud. Rhus. Sulph. Staph. I i m V tt lull 116 LOWKB rXTllKMITIES. NUMBNESS: Alum. Graph. Kali. Sil. (comp. t.) PAIN AS IF SORE : See t. — as if bruised: Aluviina. Asar. Calc. 0. Caust, Croc. Digital. Ferr. Phosph. Plunib. Sepias, (comp. t.) PRESSURE : Agar. Am. Ars. Anaf. Bell. Camph. Cupr. Cylc. Ign. Led. Mang. Niix mosch. Nux vom. Phos. ac. Bhvs. Ruta. Sep. Stann. Tar. Valer. Zinc. PULSATIONS: Asa foetida. Plat. Stann. RIGIDITY, feeling of (t. and 1.): Cham. Coccul. SHUDDERING: Kali. GONE TO SLEEP: Asa f. Cicuta. ign. Laur. Nine vom. Plumb. Samb. SPOTS, blue: Am. Lach. — ^yeUow: Stann. — red : Aeon. Calc. c. Conium. Merc. Sulph. ac. STIFFNESS: Ferr. Ipec, Petr. (comp. t.) STITCHING: Amm. mur. Anac. Ant. cried. Am. Asa f. Bell. Bry. Calc. c. Carbo an. Caustic. Chin- Graph. Hell. Ign. Kali. M. arct. Men. Mur. ac. Natr. mur. Nux vom. Plumb. Phosphor. Plat. BhvAS. Ruta. Spig. Staph. Sulph. Valer. SWEAT: Euphorb. Hyosc. Merciu-. (comp. t.) SWELLING: Aconit. Asa f. Ferr. Led. Puis. TEARING AND DRAWING : Agar. Alum. Ambr. Ant. tart. Arn. Ars. Bell. Bryon. Calc. c. Carbo an. Carbo veg. Caust. Cham. Colch. Croc. Dulcam. Euphorb. Ferr. Graph. Iguat. Kali. Lach. Lye. M. austr. Mezer. Magn. mur. Natnim. Nux vom. Phosph. Puis. Rhod. Rhus. Sassap. Sep. Silicea. Spong. Staph. Sulph. Valer. Zinc. TENSION: Asa f. B7'y. Calc. c. Chamom. Coco. Graph. Ign. Kali. N. vom. Puis. Rhus. Spig. Valer. (comp. t.) TICKLING: Laur. TREMBLING: See t. TWITCHING: Anac. Arsen. Asar BeUad. Cina. Cupr. Graph. Hyosc. Lycop. M. austr. Men. Op. Petr. Plumb. ULCERS: Ars. Calc. c. Graphlt. Lach. Lye. Buta. Staph. ULCERATIVE PAIN: Puis. UNEASINESS : See t. Heels. IN GENERAL: Amnion, mur. Ant. crud. Arg. Arn. Calc. c. Caust. Coloc. Cycl. Oraphit. Ign. KaU. Led. Lycop. M. arct. Merc. Jiatr. Nitric ac. Petr. Piilsat. A^Chodod. Rhus. Sabin. Sec. com. Selen. Sep. Sil. Spongia. Stann. Stront. Sulph. Valer. Viola, trie. Feet. BENT INWARDS : Sol. n. BOILS : Calc. c. Merc. BURNING : Arn. Ars. Calc c Coc- cul. Crotal. Graph. Hep. Lye. Merc. Natr. Natruni mur. Phos. ac. Puis. Rhus. Sec com. Sep. Sil. Stann. Tar. CHILBLAINS: Ant. crml. Cham. Nitr. ac. Nux vom. Petr. Phosph. Puis. Rhus. Sulph. COLD, Uable to take : Co7i. Sil. COLDNESS: Ambra. Arum. vwr. Ant. cmd. Ant. tart. Arn. Poll. Calad. Calc. c. Caustic. Chcl. Chin. Coff. Con. Daph. Digit. Graph. Ign. Ipec. Kali. Lach. Lye. Men. Mur. ac. Natr. Nux vom. Oleand. Petr. Phosph. Pills. Rhodod. Rhus. Sabin. Samb. Sepl»B. Sil. Squilla. Stann. Sulph. Veratr. CORNS: Ant. crud. Aim. Calc. c. Caust. Ign. Lye. Nux vom. Pids. Ran. sc. Rhus. Sep. Sil* Sulph. LOWER EXTBKMITIES. 117 Valer. CRAMPY FEELING : Calo. c. Cal- ad. Caust. Graph. Hop. Laches. Lye. Natr. mur. IVtr. Sil. Sitlph. — in the soles : Calc. c. Chelid. Ferr. Euphorb. Natr. c. Selen. Sil. Sulph. CREEPING: Arn. BeU. Caustic. Dulc. Graph. Ign. Natr. Ntunvom. Phosph. Rhodod. Rhus. Sec. com. Sep. Staun. DEADNESS: Ant. crud. Arsenic. Calc. c. N. voiu. Rhus. Sec. corn. Sil. DESQUAMATION: Dulc. DRY SOLES OF FEET : Bism. EXHAUSTION, feeling of: BeUad. Bov. Cham.^Croc. Ferr, Lye. Phos. Plat. Rhus. Zhic. ERUPTION: Graph. Petr. SiUph. ERYSIPELAS : Niix vom. iHilv. FETOS : Plumb. Sil. IN GENERAL: Aeon. Anac. Am. Ars. Asa f. Aur. Bai-yt. Bell. Bry. Calc c Camph. Caiv o ve.^. CausU Cham. Conium. Crtus. Cupnun. Ferr. Graph. Hep. Ign. Kali. Led. Lye Merc. Natr. Natr. mur. Nux vom. Petr. Phoaph. Plumb. Puis. Ehofd. Rhus. Ruta. Samb. Secale corn. Sep. Sil.Sta.iin.Stront. Sulph. Verat. Zinc. GOUT: Arn. Bryon. Graph. Lach. Led. Lye. Nux vom. Oleand. Rhus. Ruta. Sahin. Vcratr. HEAT: Aeon. Am. Bin/on. Calc. c. Carbo anim. Led. Nux vom. Puh. Phosph. Sep. Sulph. — of the soles : Anac. Nux vomica. Sangn. ITCHING: .tvgar. Asa f . BeL Calc.c. Coocul. Lach. Lycop. Puis. Selen. Stann. LAMENESS: Oleander. Phosphor. Plumb. NUMBNESS : Bryon. Carbo veget. Con. Op. Phosph. ac PAIN AS IF BRUISED : Bry. Laur. Magn. 0. ~UH if sprained: Am. Carbo veg. PKiiHSURE: Asaf. BeUad. Bryon. Graph. Led. Nux vom. Pia<. Stann. Sulph. ac. PULSATIONS: Ran. bulb. RIGF- FEELING: Asa feet. GOI;^ i'O SLEEP: Alum.Ammon. mur. Ant. tart. Bar. Cocc. Euphorb. Graph. Kali Lach. Laur. Lycop. Nux vom. Oleand. Plumb. Mod. Sep. Sil. STIFFNESS: Ambr. Ars. Led. SPASM: Bar. Bell. Nux vom. Rhus. Secale corn. STITCHES: Alum. Am. Asa feet. BeUad. Bryon. Calc c Carlo veg. Chin. Graph. Ign. Kali. Meph. Mur. ac. Natr. Natrum mur. Nitr. acid. Phosph. Ran. sc. Sep. Sil. Sulph. SWEAT: Bar. Calc. c. Cann. Carbo veg. Cupr. Graph. Ipec. Kali. Led. Lycop. Magn. mur. Merc. Nitr. ac. N. jugl. Ph. ac. Pulsat. Sep. SIL Squill. Sulph. —of the soles of feet: Am. Chin. Plumb. SWELLING: Amm. c. Am. Ars. Asa f. Bell. Bry. Calc. carb. Caps. Caust. Cham. China. Cocc. Crotal. Digit. Ferr. Graph. Kali. Lach. Led. Lye. Merc. Natr. Natr. mur. Petr. Phosph. Puis. Rhod. Rhus. Sec com. Sep. Sil. Stann. Staph. Sulph. TEARING AND DRAWING: Al- um. Ant. crad. Am. BeUad. Bism. Bov. Carbo veg. Caustic. Chin. Colch. Ferr. Graphit. Hep. Lach. Lycop. Merc. Natr. Natr. mur. Ni- tric acid. Phosph. ac Rhodod. Si'. Spig. Stann. Stram. Sulph. TENSION: Br^j. Led. Rhus. Sulph TICKLING : Laur. Rhod. Sil. TREMBLING: Am. Ars. Coflfea. Stram. Veratr. Zino. II *A ! if i ^i |ih .if t f: 118 LOWEB EXXXiEMITIEB. T^VITCHING: Am. Chin. Cupr. Grapliit. Ign. Ipev. Laur. Phosph. ^^'CJ^ Veratr. ULCERS: Ars. Ipec. Lack. Merc. Ruta. Sec. corn. Sulpb. ULCERATIVE PAIN : Bry. Graph. UNEASINESS: Am. Bar. Carbo veg. Rhus. Tarsal Joints. BEATING : Arg. Ruta. BEND, liable to: Carbo an. Na- trum. Natrum mur. Nitric ac. Nux vom. Rhus. BORING: Spig. BURNING: Calc. Euphorb. Sul- phur. CREAKING: Camph. KaU bichr. Petr. IN GENERAL: ^mbr. Am. Arsen. Bry. Calc. v. Carbo animal. Caust. Creoa. Cycl. Bros. Graph. Hep. Ign. Kali. Led. Lycop. Mang. Merc. Mezer. Nutr. mur. Nitric ac. Feir. Phos. Puis. Rhus. Ruta. Sep. Sil. Spig. Staph. Stront. Sulph. Zinc. ITCHING : Daph. KaU. Oleand. Helen. LAMENESS : Natr. mur. Oleand. PAIN AS IF SPRAINED: A^-n. Bry. Carbo veg. Caust. Oros. Led. Men. Natr. Nux vom. Prun. Rhus. Sulph. Valer. — as if bruised : Calcarea. Ut-p. "^ -!er. — as from weariness : Croc. Nux vo^v. PRESSURE : Camph. Daph. Led. Natr. Spig. PULLING : Caust. Spig. SPASM: Aia-Iod. STIFFNESS : Capsic. Cau.Ht. Chel. Ignat. Kali. Led. Lye. Petr. Rhus. Ruta. Sep. Sulph. STITCHES : Am. Ars. Asa f. Bov. Bry. Caustic. Kali. Oleand. Rhus. Spig. Sulph. SWELLING : Arsen. Asa f . Brymi. Calc. .!. Led. Lye. Merc. Rhod. Rhus. Sulph. TEARING AND DRAWING : Agar. Am. Arsen. Colch. Euphorb. Kali. Merc. Fuls. Pwm. bulb. Rhod. Rhus. Spong. Zinc. TENSION : Bry. Lijc. Sep. Zinc. WEAK FEELING: Calc. c. Carbo an. Merc. Dorsum of Feet. IN GENERAL: Asa f. Bry. Cam- phor. Caust. Hep. Lycop. Mercur. Mur. ac. Natr. Par. Puis. Rhus. Spig. Sulphur. Tar. Thuj. Zinc. Soles of Feet. IN GENERAL: Ambr. Anac. Am. Ars. Bell. Bry. (!alcar. c Carbo veg. Caust. Creos. Cuprum. Graph. Lye Mercur. Mur. ac. Natr. Petr. Phosph. Phosph. ac. Phell. Phivih. Pulsat. Rhus. Sil. Stront. Sulph. Tar. .ir Li^ and Joint. BORING : Am. Cin. Merc. BURNING : BeU. Carbo veg. Heli Rhus Ruta. Sep. '• aler. CREAKING : Ana-i. Camph. CRAMPY FEELING: £eZiod. Plat. Sulph. CUTTING: Alum. Gael. o. IN GENERAL : Aeon. Amm. Ant. crud. Ant. tart. Am. Bellad. Bry. Calc c Carbo veget. Caust. Coc- cul. Coloc. Creos. Ferr. Hell. Ign. Ipec. Kali. Led. Lye. M. austr. Mercur. Natr. mur. Nitric ac. N. vom. Pho.H2>h. Phosjih. ac. Pulsat. Rhus. Ruta. Sep. Silicea. Stront. Sulph. Teucr. Veratr. HIP-DISEASE : Bry. Calcar. c. Caust. Coloc. Hepar. Merc Nitric ao. Phosph. ac. Rhus. Ruta. Sil. Sulph. (See Limping, spont.) ISC HI AS : Aconlt. Bell. Bry on. Caust. Chamom. Coloc. Led. Merc. Nux vom. Puis. Rhus. Buia. Sa- biu. Sep. Sulph. LOWER EXTBEMITIEH. !'^ If 119 ITCHING; Caustic. Led. Natrum. Sep. LAMENESS: Cham. Lyo. Veratr. LIMPING, spontaneous : Aconit. Bell. Cab. c. Caual. Coloc. Lye. Mero. Rhus. Euta. Stai)h. Sulph. Zinc. (See Hip-disease.) NUMBNESS: Lach. Stapli. PAIN, simple : J uo. Ball, Cham. Led. Nux vom. Ehod. Rhus, liuta. — laming: Bell. Cina. Coccul. Lach. Natr. mur. — as if sprained : Amm. m. Am. Bry. CausL Cham. Euphorb. Ipec. Na- trum mur. Nux vom. Rhus. — as if sore : £!ic. — as if bruised: Alum. Am. Bry. Caust. Croc. Ferr. Lach. Natr. Natr. mur. Phos. ac. Ruta. Sep. Zinc. PRESSURE : Am. Asar. Caustic. Coccul. Euphorb. Led. Nux vom. Ruta. Sabadilla. Sep. Stann. PULLING : Natr. mur. STIFFNESS : Bell. Caust. Chamom. Ign. Led. Sep. Staph. STITCHES : Alum. Bellad. Bryon. Calc. c. Caust. Coccul. Ferr. Graph. Ign. Led. Natr. mur. Nux vom. Rhus. Sll. Zinc. SWELLING: Bry. Sep. TEARING AND DRAWING: Alum. Ant. crud. Bry. Carlo veg. Caust. Con. Dulc. Euphorb. Kali. Lyo. Merc. Natr. Natr. mur. Rhod. Rhus. Sep. Zinc. TENSION : Bell. Lye. Natr. mur. Nitr. ac. Puis. Rhus. TWITCHING: Calc. carb. Coccul. Mezer. N. vom. Sep. Sil. Sulph. WEARINESS, feeUng of: Thuj. Knee and Joint. ANEURYSM IN BEND OF KNEE: Carboveg. BORING: Caust. Canth. BURNING : Asa feet. Tabac. Carbo Teg, Lye. Mur. ao. Phosph. Sulph. COLDNESS : Aeon. Arsen. Chin- Daph. Puis. Sep. Sulph, — foehng of : Dig. Veratr. CONTRACTION : Carbo an. Lycop. Merc. Rhus. Sil. Sulph. CONTRACTIVE FEELING IN HAM-STRINGS : Con. Nitric ac. Rhus. Ruta. Sulph. Veratr. CREAKING : Camph. Caust. Coc- cul. Led. Nitric ac. Nux vom. Petr. Rhus. Selen. Sulph. CRAMPY : Bellad. Brymi. CausU Oleand. CREEPING: Rhus. CUTTING : Graphit. Tax. Thuj. Veratr. ERUPTION: Hep. Kali. Lye. Nux vom. Phosph. ac. Thuj. FUNGUS OF THE KNEE: AnU crud. Ars. Bell. Bry. Calc. c. lod. Kali hydr. Led. Lycop. Merc. Phosph. Puis. Rhodod. Rhus. Sep. Sil. Sulph. IN GENERAL: Aco. Ambr. Amm. Amm. mur. Anac. Ant. crud. Arg. Am. Ars. Asa f. Asar. Bry. Calc c Calc. phosph. Caps. Carbo veg. Caustic. Chin. Colch. Con. Ferr. Cycl. Graph. Hep. lod. Kali. Lachesis. Led. Lye. Mane. M. austr. Merc. Natr. Natrum mur. Nitric ac. Nux mosch. Nux vom. Petr. Phos, Plmnb. Puis. Rheum. Ehod. Rhus. Ruta. Sabad. Sep. Sil. Spigel. Stann. Staph. Sulph. Tar. Valer. Veratr. Vit. Zinc. GIVPTG WAY, hable to: Arnica. P.ell. Camph. Caust. Chin. N. vom. Ehod. Rhus. Ruta. Sulphur. HEAT, feeUng of : Aur. m. Calc. c. Ign. HEAVINESS: Chin. Rhus. Verat. HEEPES : Calc. c. Natr. Natr. mur. Petr. Sulph. — in the bend of the knee : Calc. c. Graph. Natr. Natrum mur. Pflor. Sulph. 1^ I fe I I 120 LOWER EXTKEMITIES. I: i: ITCHING: Asa fcot. Caust. KaU. Lye. Miir. ac. Nitric ac. — iu bend of the knee : Natr. Nux vom. Sassap. JEllKS : M. austr. Spig. Sulph. ac. PAIN AS IF DISLOCATED : Agar. Am. Cauat. Ipec. Men. Nitric ac. ThoB. Rhus. Spig. Staph. — as if sore : Carbo an. Caustic. Nux vom. Sulph. — as if bruised Amm. carbon. Ars. Aurum. Camph. Graph. Hep. Jatr. Led. N^iuc vom. Rhus. Buta. Stann. Veratr. Zinc. PRESSURE : Alum. Asa f. BeUud. Calc. V. Chel. Oycl. Led. Magn. mur. M. austr. Rheum. Staun. ^ulph. Thuj. PRICKLING: Aur. m. PULLING : Caust. Natr. mur. SHOCK IN THE BEND OF THE KNEE: Veratr. GONE TO SLEEP : Carbo veir. SPASM: Ruta. Sulph. SPOTS, red: Lye. Petr. Ehus. SPRAIN, liable to: Nux vom. Rhus. STIFFNESS : Ambr. ?Ammon. mur. Ars. Bell. Bry. Calc. Caps. Caust. Coloc. Graph. Hell. Ignat. Kali. Lach. Led. Lye Natr. mur. Nux vom. Petr. Fhosph. Pulsat. Rhus. Sassap. Sep. Stann. Snlph. STITCHES : Alumina. Ant. crud. Am. Asa f. Bell. Bry. Calc. Carbo an. Caust. Chel. Cocc. Con. Graph. Hell. Kali. Lach. Laur. Led. Natr. mur. Nitric ac. Petr. Phos. Puis. . Rhus. Sassap. Sep. Sil. Stann. Staphysag. Tab. Thuj.Valer. Veratr. SWEAT: Calc. Led. SWELLING: Ars. Bryon. Calc. c Calc. phosph. Chin. .Coocul. Ferr. Graph. Hep. Kali hydr. lod. Lach. Led. Lye Mur. ac. Nitric ac. Nux vom. Phos. Puis. Rhod. Rhus. Sep. 8U. Salpb. TEARING AND DRAWING: Aconit. Agar. Aliun. Anac. Am. Bell. Benz. ac. Bryon. Calc. carb. Calc. phosph. Canth. Carbo an. Caust. Cham. China. Clem. Colch. Crot. Euphorb. lod. Kali. Kali bichr. Lach. Laur. Led. Lycop. M. austr. Merc. Mur. ac. Natnun. Nitr. Phos. Vnh Rhod. Rhus. Sep. Sil. Spig. Stront. Sulphur. Zinc. TENSION: Am. Bryon. Caustic. Graph. Kali. Laches. Led. Nitric ac. Nu^ vom. Phosph. Puis. Rhus. Sep. Sulph. THROBBING: Calc. o. Ruta. TUBERCLES : Calc. c. Chin. Led. Lye. Nux vom. TWITCHING: Bell. Caps. Caust. Chin. Laur. Plumb. Sulphur. Veratr. UNSTEADINESS: Aconit. Arnica. Carbo veg. Nux vom. Rhus. WANT OF MOBILITY: Graph. WEAK FEELING: Aconit. Arnica. Asar. Bryon. Caust. Chin. Con. Cupr. Ferr. Ign. Lach. Led. Lye. Merc. Natrum mur. Nitric ac. Plat. Puis. Stann. Staph. Sulph. Veratr. ' WEARINESS : Asar. Cocc. Coalun. Nux mosch. PuLsat. Ruta. Nails. IN GENERAL: Alum. Ars. Caust. Graph. Hep. Hell. Mercur. Natr. Natrum mur. Nux vom. Phosph. ac. Sabad. Sep. Sil. Sulph. Tibia. IN GENERAL: Agar. Anac. Am. Ars. Asa f. Bell. Calc. Caustic. Coloc. Con. Creos. Dulc. Graph. Kah. Lach. Lycopod. Mang. Merc Mezer. Mur. ac. Phos. Puis. Rhod. Rhus. Sabiu. Sep. Sil. Spong. Tar. Zinc. LOWER EXT.IIMITIES. 12) Calves. IN GENERAL: Alum. Amhr. Ant. crud. Ars. Asa f. Bry. Calc Caps. Caustic. Cham. Coloc. Croc. Cuin: Ferr. Graph. Hyosc. Ign. Led. Lye. M. austr. Mang. Merc. Natr. Natr. mur. Nitr. Uf. Nvjcvom. Petr. Puis. Rhus. Sabina. Sec, corn. /Sep. Hil Spig. Siann. Staph. Sulphur. Tor. Valer. Veratr. Toes. BORING : Merc. Ran. so. BURNING: Am. Dulc. Nitric ac. Nux vom. Staph, —in the toe-balls : Bry. CHILBLAINS, blisters: Axa. Nitric ac. Petr. CHILBLAINS: Agar. A mm. Ant- crud. Caust. Nitr. ac Nux vom. Petr. Phosph. Puis. Rhus. Sulph. COLDNESS : Calad. Sulph. CONTRACTION: Cham. Ferrum. Hyosc. Nitr. Niix vom. Lye. Merc. Plat. CRAMPY : Amm. Am. carb. Bar. c. Calc. Caust. Ferr. Hyosc. Ign. Ljc. Mosch. Nux vom. Plat. Sulph. CREEPING: Alum. Asa f. Caust. Hep. Lach. Plat. Plumbum. Rhod. Sec. com. DEADNESS : Cycl. Sec. com. IN GENERAL: Agar. Amm. Am. Aur. Calcar. Carbo an. Carho veg. Caust. Colch. Graph. Eah. Magn. carb. Merc. Mezer. Natrum mur. Nitric ac. Petr. Phosph. Phos. ac. Plat. Ran. seel. Sabin. Sec. com. Sil Sulph. ITCHING: Ambr. Cycl. Daph. Hep. Nux vom. Paeon. Pulsat. Stront. Staph. JERKS : Anac. Am. NUMBNESS: Am. Crot. Phospli. 50 —of toe-balls: Puis. PAIN AS W BRUISED : Aur. Sulph. PRESSURE: Asa f. Cycl. Graph. Nux vom, PRICKLING: Aeon. Ant, tart. REDNESS: Carbo veg. GONE TO SLEEP: Cham. Nux vom. Rhus. SORENESS: Graph. Natr. Ban. bulb. Sil. SPASMS : Bar, m, Cham. Nux vom. 01. an, STIFFNESS: Sec. com. SU. Sulph STITCHES: Am. At a fait. Calcar. Carbo veget. Caustic, Cocc. Graph. Lycopod. Natr. mur, Oleand. Puis. Ran, bulb. Ban. sc. Sil. Veratr. Zinc. SWEAT: Am. -S«. SWELLING : Am. Carbo veg. Graph. Merc. Nitric acid. Phosph. Sabin. Sulph. — of toe-balls: Daph, Led. TEARING AND DRAWING : Agar. Amm. mur. Am, Ars, Asar. Camph. Caust. Chin. Cicuta. Cyrl. Hep. Kali. Lach. Led. Lye. Par. Phoa. Puis. Bhus. Sil. Sulph. Stront. Vit. Zinc. Valer. TICKLING: Ambr. TWITCHING: Asa /.Chin. Cupr. Merc. Ran. sc. ULCERS : Ars. Cauatic, Graph. Petr. Sep. Toe-Joints. IN GENERAL: Am. Aur. Bism. Calc. Caust. Cham. China. Conium. Cycl. Graph. Hep. Kali. Led. Lye. Merc. Phos. Puis. Rhod, Bhus. Buia. Sabin. Sep. Sil. Staph. Sulph. Teucr. Valer. Zinc, ir !itl ■: il! '1 "^^ if' t \\\ .,.: \.'^ 122 XXYIIl. SKIN AND EXTERNAL SYMPTOMS. Rf il ABSCESSES, acute: ^rs.Bell. Hep. Lack. Merc Phospk. Fulsat. Sil. Siilph. - -chronic : Calc c. Calc. ph. Cou. Hep. Lacli. lod. Lycop. Merc. Ni- tric ac. Pliospli. Sil. Staph. Sulpii. Thuj. BED-SOKES: Agar. Arn. Baryt. Calc. c. Carbo veg. Caustic. Chin. Cic. Crcos. Ferr. GraphlL Hoijur. Ign. Lach. Lycop. Mercur. Nitric ao. Petr. Tuls. Rhus. Buta. Sep. Sihc. Sulph. Sulph. ac. BITING IN THE SKIN: Ant.crud. Bar. Canth. Cham. Dig. Graphit. Kali. Led. Lye. Nux vom. Oleaiid. Plat. Pulsat. Ran. sc. Rhus. Buta. Spong. Staph. Veratr. Vit. BLOATING: Ant. crud. Ars. BeU. Bryon. Calc. c. Caps. Cupr. Dulu. Ferr. Graph. Kali. Lycop. Merc. Mosch. Oleand. Op. Pulsat. Rhus. Spig. Staph. Sulph. BLOODY-TUMORS : Bryon. Merc. Sec. corn. — blisters : Ars. Canth. Secale corn. SiUph. BLOTCHES: Apis. Creos. Dulr. Natr. mur. Rhus. Sulph. BOILS: Ant. crud. Arn. Bellad. Calc. a. Carbo anim. Euphorh. Hep. Lach. Led. Lye. Merc Mur. ac. NItr. ac. Phosph. Phosph. ac. Sec. com. Sep. Sil. Staph. Sulph. Sulph. ac. Thuj. BLOTCHES: Agar. Ant. crudum. Ars. Bell. Bry. Calc. c Carbo anim, Caust. Con. Daj)h. Diilc. Graphit. Hep. lod. Lach. Led. Lye. Magn. Mang. Mezer. Natrum mur. Oleand. Petr. Phosphor. Puis. Rhus. Ruta. Sec. corn. Sep. Sil. Staph. Sulph. Thuj. Verat. BURNING OF SKIN: AconiLAm. Ars. Asa f. Aur. Aur. mur. BelL Bryon. Calc. Camph. Caps. Ctsfxi veg. Caust. Cic. Coccul. Creos. Cupr. Dig. Euphorb. Ferr. Hep. Ign. Kali. Lacli. Lye. Merc Nitr. ac. Nux vom. Op. Phosph. Pule. lihus. Secale corn. Sep. Sil. Spig. Staph. Sulph. Sulph. ac. Veratr. Viola, tr. COLOR OF THE SKIN, blue. Ar.^en. Bell. Cina. Con. Cupr. Dip. Jlydr. ac. Lach. Merc. Op. Phosph. ac. Sec. corn. Veratr. pale : Bellad. Calc Chin. Coccul. Ferr. Graph. Kali. Lycop. Nitricac. Nux vom. Plat. Pulsat* Sep, Spigel. Sulph. yellow : Ambr. Ars. Bell. Bryon. Canth. Carbo vegetab. Cham. China. Con. Ferr. Ign. Lye. Merc. N. vom. Op. Plumb. Puis. Rhus. Sep. Spig. Sulph. Veratr. red: Aeonit. Am. Bell. Bry. Canth. Dulc, Graph. Lye. Merc. N. vom. Op. Phos. ac. Bhns. Ruta. Secale com. Stram. Vit. — sallow: Calc. Ferr. lod. Laches. Merc. Natr. c. Phos. Sec com. Sep. COMEDONES: Calcar. c. Natr. Natrum mur. Ni^^ic ac. Selen. Sulph. CONTUSIVE PAIN: Am. Rhus. Sulph. ac. CRACKING OF THE SKIN: Alumin. Arn. Calc. c Cham. Creos. Hep. Kali. Lach. Lye. Natr. Natr. mur. Nitri.. at;. Petrol Puis. Rhus. Sep. Sil. .*';5phur. Zino. CRUSTA LACTFA.: Calc Carbc veg. Dulc. Graph. Lye. Merc Rhus. Sassap. Staph. DAMP SKIN: Alum. Ars. Calc Carbo veget. i>ic. Clem. Dulc Graph. Lye. Merc. Nitric ac, Peti Rhus. Sepia}, i^ll. Sulph. SKIN AND EXT'iUNAr, STMPTOMa. 123 DESQUAMATION: Aeon. Amiii. Amm. mm'. Arseu. Aur. Bell. Bov. Caustic. Clem. Dulc. Graph. Hell. lod. Mercur. Mezer. Oleand. Phos, Phos. ac. Puis. Rhus. Secale corn. Sep. Sil. Staph. Veratr. Eruption. IN GENERAL : Aeon. Amm. carb. Ant. crud. Arn. Ars. Aurum. Bar. Bov, Bry. Calc. carb. Canth. Carb. an. Carlo veget. Gaunt. Cic. €leiu. Con. Cuprum. Cycl. Bulc. Ferr. Oraphit. Hell. Hep. Ipec. Kali. Lack. Lye. Magu. c. Magn. m. Merc. Natr. Natr. mur. Nitric ac. Nux vom. Oleander. Petr. Phosph. ac. Puis. Rhod. Fhiis. Sassap. Selen. Sepice. Sil. Spigelia. Staph. Stront. Sulphur. Sulph. ac. Thuj. Viola, tr. Zinc. ERUPTION, peeling off; Ammon. Bell. Clem. Hell. Led. Merc. Mezer. Phosph. SepisB. Sil. Staph. -smarting: Bry. Calc. Calc. caust. Caust. Euphorb. Lach. Led. Mezer. Natr. mur. Puis. Sil. Spong. Sulph. ' vesicular: Ant. crud. Ars. Bry. Canth. Carbo an. Caustic. Clem. Dulc Graphit. Hell. Hep. Kali. Lach. Natr. Natr. mur. Nitr. ac. Phosph. Ran. bulb. Rhus. Secale corn. Sep. Sulph. ■^ gangrenous : Arsen. Carbo veg. Oamph. Sec corn. — purulent : Ant. tart. Ars. Asa feet. Calc. Clem. Dulc. Hep. Kali bichr. Lye. Merc. Natr. Natr. mur. Nitric ao. Puis. Rhus. Sec. corn. Sep. Sil. Staph. Sulph. Zinc, —humid: Alum. Ars. Bovista. Carbo on. Carbo veg. Caust. Clem. Dulc. Grayh. Hep. Kali. Lach. Lye. Nitr. •c Petr, Rhus. Selen. Sep. Sil. Staph. Sulph. Sulph. ac. -flat: Ara. Asa f. Bell. Lach. Ly,. Natr. Nitric ac. Phosph. ac. Selen. Sep. Sil. —corrosive : Ars. Baryt. Borax. Calc. Cham. Cou. Grapliit. Hep, Kah. Lach. Mercur. Natr, Nitric ac. Pe- trol. RMis. Sep. Sil. Staph, —yellowish: Creos, Euphorb. Merc. Nitr. ac. —miliary: Agar. Ars. Carbo veyet. Graph. Hep. Led. Natr. mur. Nux vom. Zinc, —itching : Aco. Ant. crud. Ant. tart. Ars. Bry. Canth. Caustic. Cham. Clem. Graphit. Ignat. Kali. Lach. Mercur. Mezer, Nitric ac. Oleand. Ran. bulb. Rhus. Sep. SU. Staph. Sulph. Veratr. — coppery : Arsen. Carbo an. Creos. Lach. "Merc. Rhus. Veratr. — nettle-rash: Aco. Apis. Ars. Bell. Bry. Calc. c. Caustic. Cepa. Cop. Dulc. Hep. Ipec. Lye. Natr. mur. Puis, Rhus. Secale corn, Petr. Sep, Sn ph. Veratr, —scurfy: Alum. Ant. crudum. Bell, Calc. c. Carbo anim. Carbo veg. Cic. Con. Dulcam. Graph. Hep. Lye. Mercur. Puis. Rhus. /Sassrtp. Sepice. Sil. Sulph. — scaly: Amm. mur. Ars. Aur. Bell. Bry, Calc. c. Cleui. Dulc Graph. Led. Lycopod. Mercur. Oleand. Phosphor. "Phosph. ac. Puis. Rhus. Sep. Sulph, — dry : Bar. Calc c. Carbo veg. Cupr, Dulc. Graph. Led. Lycop. Magn, c. Mercur. Phosph. Sep. Sil. Staph. Veratr. — rickly : Bor. Calc. c. Cham. Graph. Hep. Merc. Natrum. Nitr. ac. Petr, RiMK. Sil. HERPES, generally: Alumhi. Ambr. Arseu. Bov. Bryon. Calc. c Caibo veget. Caustic. Chel. Clem. Chlor. Conium. Creos. Dulc, Fluor, ac. Graphit. Hep. Kali. Lach. Led. Lye. Merc Natr. Natr. m\a:. Nitric acid. i (1 m 1 'II ■ \\ t n I* J* I" fc: 111 I . 1 124 8K1N AND EXI'KllNAIj SYMPTOMS. Oleander. Petr. Rhus. Phosph. St'p. Silic. Spig. Staph. Siilpli. —suppurating: Dale. Lycop. Merc. Rhus. Sep. Sil. Sulph. — humid : Bov. Calcar. c. Clem. Con. tiraphit. Hep. Lach. Lye. Natr. Nitric ac. Rhus. Sej). Sil. Sulph. — spi-eading: Ars. Calc. Graph.ljyc. Merc. Nitr. Petr. Rhus. Sil. Sulph. — furf uraceous : Ai-s. Cnlcar. Dulc. Graphit. Sep. Sil. Sulphur. — crusty: Bar. Bov. Calc c Cloui. Co7i. Dulc. Uraphit. Lach. Lye- Merc. Rhus. Sep. Sulph. — pustulous: Oreos. Mercur. Sulph. — ring-shaped: Natr. Natrum mui-. Sep. --scaly: Ars. Clem. Dulcam. Merc. Phosph. Bhus. Sulph. — syphilitic: Aur. Merc. Nitric ac. Thuj. — grape-shaped: Calc. o. —dry: Ars. Bov. Calc. carb. Dulc. Graph. Led. Lye. Merc. Bhus. Sepise. Sil. Sulphur. Veratr. MEASLES: Aeon. Ars. Bell. Bry. Coff. Dulcam. lod. Ipec. Mercur. Phoei)h. Puis. Rhus. Sulph. MILIARLi, white : Ars. Bryon. Ipec. Nux vom. Sulph. Valer. —of lying-in women : Bry. Ipec. PIMPLES: A7it. crud. Ars. Bry. Calc. c Ca ^h. Caustic. Chamom. Con. Dulc. Oraph. Kali. Merc. Natr. Natrum mur. Nitric ac. Phosph. Ptils. Rhus. Sep. Sil. Spong. Staph. Sulphar. Sulph. ac. Thuj. Zinc. PUBPLE-BASH: Aco. Bell. Coff. Sulph. PUSTULES : Ant. crud. Ant tart. Am. Ars. Bell. Bryon. Caust. CIc. Clem. Dulcam. Hyosc. Merc. Nitr. ac. Petr. Pulsat. Rhus. Sil Staphys. Sulph. RASH : Aeon. Ant. <rud. Ant. tart. Am. Ars. Bell. Bry. Canth. Carlo veg. Cuusticum. Cham. Coflfea. Graph. Ipec. Lach. Merc. Phos- phor, ac. Puis. Rhus. Selen. Staph. Sulphur. Veratr. RUBEOLA : Aeon. Bell. Bry. Coff. Merc. Puis. Rhus. SCARLET-RASH: Aconit- Bell. Bry. Coff. Dulc Ipecac. Merc. Phosph. Sulph. -suppressed : Apis. Bry. Phos. Sul- plinr. SMALL-POX: Ant. crud. Antim. Tart. Am. Ars, Bell. Canthar, Mercur. Puis. Rhus. Sil. Sulph. — spurious : Bell. Merc. Pulsat. Rhus. — black : Ars. Rhus. Sec. com. Sep. Sil. SPOTS, blue: Am. Ars. Bry. Con. Orot. Lach. Nitric ac. Nux mosch. Nux vom. Op. Phosph. Rhus. Sec. com. Sulphur, ac. — bloody (Petechia) : Arnica. Ars. Bell. Bry. Calc. Conium. Crot. Ferr. Hyosc. Laches. Led. Nitric ac. Nux vomica. Phosph. Puis. Rhus. Ruta. Sec. corn. Sep. Sil. Sulphur. Sulph. ac. — brown red: Cann. Nitr. ac — raised : Merc. — yellow : Am. Ars. Conium. Ferr. lod. Lach. Lycop. Petr. Phosph. Sep. Sulph. greenish: Am. Con. Crot. Ruta. Sep. — liver-colored : Ant. crud. Am. Calc. Carbo veg. Con. Dulc. Ferr. Lye. Merc Natrum. Nitric ac. Nux vom. Phosph. Sep, Sulph. — mottled : Crot. Thuj. — dark-red : Natr. mur. Thuj. — red : Amm. Am. Bell. Bry. Calc. Carbo veg. Coccul. Cycl. Dulc. Graph. Kali. Lach. Lye. Magn. Merc. Nitr. ac. Phoi. Bhus. Sabad. sm /M BKIN AND EXTERNAL SYMPTOMS. 126 Sep. Sil. Stilphur. Sulph. ac — soarlfifc-red : Amrti. BcU. — blaf k : Grot. Lack. Sec. com. — violet: Veratr. —white: Alum. Ars. Phospic. Sop. Sil. Sulph. VARICELLA : ^mt. crua. Ant. tart. Bryon. Carbo veg. Ipec. Led. Merc. PhIsiiI. BhuK. Sop. Sil ZONA: Ars. Graph. Mercur. Rhus. Sil. Sulph. Excrescences. CHILBLAINS: Agar. Ant. crud. Am. Carbo an. C/mm. Lycop. Nitr. I'etr. I'ho.'^pli. Puis. Rhus. Sulph. Sulph. ac Thuj. —blistered: Cepa. Nitric ac. Rhu.'i. — lilue-red: Arn. Puli^. — inflamed: Cham. Nitric ac. Puis. Sulph. --itching: Nitric acid. Nux vom. SiUph. FUNGUS HiEMATODES: Arson. Gale. Carbo an. Carbo veg. Larh. Lycop. Merc. Nitric acid. Phospli. Sil. SiUph. Thuj. FUNGUS MEDULLARIS: Carbo an. Phosph. Sil. FUNGUS ARTICULARIS : Antiin. crud. Ars. Creos. lod. Lach. RhuR. Sil. Staph. Sulph. GANGLIA : Amm. c. Calo. c. Phos. Sil. Zinc. MOLES: Calc. Carbo veg. More Phosph. Sep. Sil. Sulph. Sulph. ac. ThiU. NOMA : Aur. mur. Creos. Fluor, ac. lod. Sec. corn. POLYPI: Aur. Calc Con. Rep. liyc. Merc. Nitric ac. Phosph. Puis. Sil. Staph. Sulphior. Teucr. Thuj. STEATOMA: Antim. crud. Baryt. Calc. c. Graph. Hep. Nitric ac. Sabin. Sil. Sulph. SYCOSIG WARTS : Calcar. Lycop. Nitric ac. Phosph. ac. Sabina. Thig. — homy: Ant. crud. I WARTS : Ars. Bar. Bell Bor. Calc. Cniist. Copa. Duh: Hep. Knli bichr. Lach. Lye. Natr. Nltr. ac. Petr. Phos. ac. lihUH Ruta. Sangn. Sep. Wil. Staph. Sulph. TlnJ. —bleeding: Natr. c. Nitric ac. Sulph. ac. Thuj. —burning: ArHen. Petr. Rhus. Thuj. — Huppurating: Caust. Hep. Sil. —inflamed: Calo. Natr. c. Nitr. acid Rhus. Sil. - flat : Calc. c. Dulc. --podimculated: Dulc. Lye. Sabin. Thuj. —horny: Ant. crud. Natr. carb. Sulph. Thuj. —small : Calc. Rhus. Sulph. —painful : Calc. c. Nitric acid. Sulph. Thuj. —split: Lye. Nitric ac. Phosph. ac. Thuj. ERYSIPELAS: Aeon. Am. Arsen. Bell. Pry. Cnlc. c. Camyh. Canth. Carbo an. Graph. Hey. lod. Larh. Merc. Nitric ac. Phos. Puis. Rhus. Sabad. Sep. Sulyh. —vesicular: ^ns.piell. Canth. Graph. Lach. Phosphor. Puis. Rhus. Sey. Sulph. —flying: Bell Puis. Rhus, —smooth : Aeon. Amm. Bell. Merc. —with sweUing: Amm. Apis. Ars. Bar. Bell. Bryon. Calc. <jlraph. Hep. Lycop. Merc. Nitric acid. Phosph. Rhus. Sulph. FORMICATION: Arn. Bar. Carbo veg. Bell Kali. Laur. Lycop. Mur. ac. Natrum. Nux vom. Oleand.P/io.s. ac. Plat. Puis. Rhod. Rims. Secale corn. Sep. Spig. Staph. Sulph. FRECKLES: Aluni. Antim crud. Calc c. Graph. Lye. Merc. Natr, Puis. Sep. Sulph. GANGRENE, humid: Ars. China. Hell. Phosph. Sec. com. —hot : Ars. Carbo veg. Sec. com. —cold: Ai-s, Asa f. Carbo an. Fitter. ? ! ii ' - si I' I * 5 ^ ii 126 8KIN AND EXTKRNAr. SYMPTOMS. !' ac. Plumb. Hecnio corn. Sil. Squill. Sulpli. HANG-NAILS: Calc. Marc. Natr. miir. Rhus. Stann. Sulphur. ITCH : Aut. crud. Ars. Cole. Carho veg. Caust. Dulcara. Graph. Lach. Mang. M«rc. Phosph. ac.P.sor. Se- lon. Sop. Sulph. Veratr. — grea«y: (!au3t. Merc. ITCHING: Aron. Alum. Ambra. Ant. crud. Arg. Ana f. Bar. Calad. CaJr. c. Cantli. Carbo veg, Cauat. Chcl. Cic. Clem, Con. Cycl. Eu- phorb. Ferr, Graph. Hep. Ign. Kali. Lach. Led. Lye. Magn. mur, Merc. Mvir. ac. Natr. mur. Nux vom. Ole- ander. Op. Phos. Plat. Puis. Rhod. Rhus. Ruta. Sangn. Selen. Sep. Spig. Spong, Staph, Sulph. Sul- phur, ac, Thnj. Vil. NUMBNESS: Ambr. Anac. Cham. Lach. Lycop, Nu.r vom. Oleand. Phosph. Phosijli, ac. Plat. Puis. Rhus. Secale com. Sulph. PAIN, as if sore: Alum. Arnica. Bryon. Canth. Caust. Cic. Colcli. Graph. Hep. Ign. Kali. Merc. Natr. mur. Petr. Phosph. Puis. Rhus. Sejj. Sulph. Sulph. ac. Zinc. PITYRIASIS : Ars. Merc. Oleander. Sabad. Sulph. PORES, black: Graph. Natr. Nitric ac. Sulph. PRICKLING: Agar. Bellad. Croc. Mezer. Plat. Sabad. Sulph. Zinc. PUS, bloody : Ars. Asa f. Carbo veg. Hep. Koli.Lach.Lijc. Merc Nitr. ac. Puis. Sil. Sulph. Sulph. ac. • broTvuish : Curb. veg. Con. Rhus. Sil. — — thick : Hep. Merc. Sfl. thin : Asa foot. Carbo veg. Caust. Merc. Puis. Sil. Sulph. yellow : Ars. Bryon. Calc. Carlw veget. Caust. Cic. Hep. Lycop. Merc Phosphor. Puis. Sep. Sil. Staph. Sulph. yollow-groon : Sil. gray : Caust. Lye. Sil. greenish : Asa f. Caustic. Merc. Puis. Rhus. Sil. ichorous: Ai-s. Asa foot. Carbo ve.j. Chin. Graph. Merc. Nitrio ac. Phcs. Rhus. Sangn. Sil. with mites : Sabad. Sil. copious : Arsen. Asa fnet. Canth. Calc. Merc Puis. Rhus. Sep. Sil. sour-smelling : Hej). acrid : Ai*8. Caustic. Clem. Merc Nitric ac. Rhus. Sep. Sil. fetid : Ars. Asa foet. Carbo vog. Chin. Graph. Hep. Lach. Lye. Merc. Nitric ac. SII. Sulph. Sec. com. watery : Ars. Asa foci. Caustic. Merc Nitric ac. Ran. sc. Rhus, Sil. Sidph. — —white Uke milk : Calc. Hell. Lye. Puis. Sulph. — too little: Calc. Dulcam. Hep. Lach. Merc. Phos. Plumb. Sil. viscous : Arsen. Con. Mercur. Viola tr. SKIN, dry: Aconit. Amm. Am. Ars. Bell. Bry. Calc. carb. Cham. China. Colch. Dulc. Graphit. Hep. Hyosc. lod. Kail. Led. Lye. Merc. Natruin. Nitric ac. Nux viosch. Op. Phosph. Phosph. ac. Puis. Rhus. Sec. com. Seneg. Squill. Sil. Staph. Sulph. Verb. — hard: Ant. crud. Arsen. Dulcam. Graph. Lach. Phosph. Rhus. Sep. Sil. — rough : Apis. Bellad. Calc c lod. Merc. Natr. Rhus. Sep. Sulph. — ^vrinlded : Ambr. Ant. crud. Calc c Camphor. Cupr. Hell. lod. Lye Phosph. ac Rhus. Sec corn. Sep. Spig. Veratr. — relaxed: Calc. carb. Caps. Chin. Coccul. Cuprum. Ferr. Graphit. Hell. lod. Ijach. Lye. Merc. Natr. Sec com. Sulphur. Veratr. BKIN AND EXTKRNAI- SYMPTOMS. 127 — Bonsitivc: Aynr. Ars. Ana f, JJcJI. Calc Ctti'bo uii. Cai-bo vog. Cauat. Chin. Fcrr. Hop. Ign. Lucli. Led. Lye. Natr. luur. Nitric uc. Nu.i: vom. Petr. Pliosph. ac. Pw/,s. Ran. bulb. Ehux. SlI. Spig. Tluij. T emir. to contact : Bell. Bryon. Camph. Oolch. Nux vom. Puis. Spig. humid nir: Amiii. carb. Cab: c. Carbo veg. Dulcam. N. moscli. Puis. Rhod. Rhus. to cold air: Amni. c. Calc. c Carbo veg. Canst. Lyo. Nu'- vom. Bliod. Sec. com. Sep. — -to warm air: Calcar. Pula. Sep. STITCHES : Aeon. Am. Arsen. Bar. Bell. Bry. Calc. (^anth. Cauat. Coo cul. Con. Dulcam. Graph. Hell.|Jj/w. Lycopod. Merc. Nitric nc Nux • vom. Oleand. Puis, Ran. sc. Rhus. Sabad. /Sep. Spong. Staphys. Sulph. Tar. Thn}. viola tr. SWELLING IN GENERAL : Aiit. rriid. Apl8. Arn. Ars. Aur. mur. Bell.Brj, Calc. c Calc. ph. Canth. Chin. Colchic. Con. Dig. Dulc. Ferr. Hell. Iodine. Kali. Lach. Led. Lye. Merc. Nitric ac. Op. Phos. Plumb. Puh. Lliodod. Rhus. Ruta. Somb. Sep. Sil. Sulph. -r-pale : Arn. Bry. Calc. Chin. Ferr. Lach. Lye. Merc. Puis. Rhus. Sep. — inflamed: Aeon. Ar.'i. Asa f. Bell. Bry. Caustic. Hep. Lach. Merc. Nitr. ac. Puis. Rhus. Ruta. SU. Sulph. — hard: Arn. Ars. Asa f. Bell. Bnj. Carlo an. Caustic. Con. Hep. Lach. Phosph. Puh. Rhus. Sabin. Stront. Sulph. —cold : Ai-s. Chin. Con. Lach. Puis. Sec. com. - erysipelatous : Apis. Bell. Merc. Rhus. — dropsical: Anl. crud. Apis. Ars. Aurnm mur. Bell. Bry. Canth. Cepa. China. Con. Dig. Dulc. Ferr. Hell. I(k1. Kiili. Lrd. Lijr. Mennr. Nitric ac. PhoHph. 7'i//.s. Kho.1. Rhus. Sanib. Squill. Smeg. Sep, Siilph. Ulcers. IN GENERAL : ' ut. crud. Arsm. A:a fa>t. Anr. Bell. Bryon. CuU-. c, Calc. ph. Carbo an. Carbo veg. Canst. Cham. Con. Creos. Hep. lod. Kali. Lach. Lye. Merc. Natr. Nitr. ac. Nux vom. Petr. Phosph. Ph. ac. Puis. Rhus. Ruta. Saugu. Sec. ' com. Sassap. Sep. Sil. Staph. Hir.pli. Thuj. ULCERS, blueish: Ars. Aur. Con. Hep. Lach. Merc. Sec. com. — bleed, liable to : Are. Asa f . CariM veg. Con. Hep. Lach. Lye. Merc Nitric ac. Pho,sph. Puis. Sil. Sulph. Sulph. ac —burning : Ars. Asa f. Bell. Carbo veg. Caust. Clem. Hep. Lijc. Merc. Mur. acid. Nux vom. Nitric acid. Phosph. Puis. Rhus. Sil. Suli>h. —fistulous : Antim. crud. Apis, ^.srt /. Bell. Calc. c. Caust. Con. Lye. Merc. Nitric acid. Phosph. Puis. Sil, Sulph. —flat : Ars. Lach. Sil. — with swelling : Ars. Bell. Bry. Hep. Kali. Merc. Nitric ac. Puis. Rhus. Sep. Sil. Siilpli. —hard swelling : Ai-s. Asa fwt. Bell, Calc. Con. Hep. Lach. Lye. Merc. Puis. Sangn. Sil. — margins evested : Ars. Asa f. Hep. Mere. Petr. Rhus. Sil. Sulph. — itching : Ant. tart. Ars. Caustic. Chin. Hep. Lye. Nitric ac. Phosph. ac. Puis. Rhus. Sil. Sulph. — cancerous : Ars. Ast. Carb. an. Car- bo veg. Con. Creos. Graph. Hep. Lach. Merciur. Rhus. Sil. Sulph. — mercurial: Alum. Asa feet. Carb. veg. Fluor, ac. Hepar. Lach. Lycop. Mezer. Nitric ac. Sassap. Sulph. Thuj. r m 128 BUCEP, PRRAM8. — solt-rlionm, like : ArH. (Iraph. Lye, Sep. Sil. Sulph. — painful : Arii. Ars. Aku feel. Carbo veg. Caust. Cham. Con. Croos. tiraph. He}). Lack. Lycop. Merc. Nitric ac. Petr. Phospli. Phos. no. Puis. Sabin. Sep. Sil. Sulph. Verafcr. — painless : Ars. Bellad. Carbo an. Carbo veg. Cic. Con. Hyosc. Lach. Lye. Oleand. Phosph. Phosph. ao. Puis. Sec corn. Sulph. — with ash-colored base: Merciir. Nitric ac. Thuj. — spongy: Ars. Carbo an. Carbo veg. Clem. Lach. Merc. Petr. Phosph. Sep. Sil. Sulphur. Thuj. — lardaceoun : Hep. Mercur. Nitric nc. — stitches in ulcers : Ars. Bell. Jiry. Carbo veg. Graph. Hep. Lyr. Mer- cur. Nitric acid. Petr. Pulsat. SlU Sulph. -syphilitic : ^ttr.jCarbo veg. Fluor. acid. Kali bichr. Nitric acid. Merc. Phos. ao. Sangn. Thuj. —deep : Ana f. Calc. c. Con. Hep. Lach. Lye. Merc. Nitric ac. Pula. Sil. Sulph. — insensible: Ars. Calc. carb. Carbo veg. Con. Iodine. Lach. Laur. Lye. Phosph. ac. Sec. com. Sil. —unhealthy: Calc. c. Cham. Chel. Hep. Lacli. Mercur. Petr. Rhus. Sil. Staph. —ulcerative pain: ^sa/. Calc. Graph. Phos. Puis. Rhus. SIL Sulph. Zinc. — suppurating: Arsni. Amfcri. Calc. c. Canthar. Carbo veg. Caustic. Con. Creos. Graph. Hep. Lye. Merc. Mur. ac. Nitric ac. Puis. Ilhiis. Buta. Sec. corn. Sc}). Sil. Staphy.^. Sulph. Sulph. ac. — with proud flesh: Ar,'<. Carbo an. ( 'lumi. Croos. Graph. Hep. Lach. Merc. Petr. Sep. Sil. Sxdi)h. — painfully soro: Ars. Bell. Colcar. Graph. Hep. Merc. Nux vom. Puis. Sep. Sulph. — Hhaggy: LiM!h. Merc. Phosph. ac. Thuj. VABICES : Ant. tart. Arn. Ars. Cnrbo veg. Caust. Ferrum. Graph. Lach. Lye. Nttrum mur. Pulsat. Wpig. Snlph. Thuj. VEINS, swelling of: ylm.Bell. Chin. Croc. Ferr. Graph. Hyosc. Phos. Pulsat. Sulph. Thvj. WOUNDS : Am. Carbo veget. Hep. Lach. Merc. Phosphor. Puis. Khun. Staph. Sulphur. Sulph. ac. Zinc. — bleeding: Arn. Laches. Photi^ih. Sulph. Sulph. ac. —cut: Am. Staph. Sulph. m: — contused : Am. Con. Hepar. lllnis. Rutu. Sulph. ac. — punctured: Carbo veget. Cic. Cmt. Hep. Nitric ac. by insects: Aconit. Apis. Am. Bell. Cnlad. Lach. Merc. Seneg. — bums: Aco. Am. -4r.«. Canthar. Carbo veg. Caustic Creos. Sulph. ac. Urtic nr. XXII SLEEP, DREAMS. CLAIRVOYANT STATE: Aconit. Op.PhoHph. Sil. Sulph. DROWSINESS, in the evening: Ant. tart. Ai*8. Asa f. Bar. Bell. Bov. Calc c. China. Cin. Con. Croc Crotal. Ign. Kali. Lacht Laur* Nfitr. mur. N. vom. Phosph. Ph. ac Pnb. Rhus. Selen. Sil. Valer. — in the morning : Ant. crudum. Am. Asa f. Calc c. Caust. Con. Orapb. Kali. Merc. Natr. Natr. mur. ^ux YOin, Phosphor. Phosph. ac, Pula. .^* SLEEP, DREAMS. 129 lid Bhns. Sep. Sil. Spig. Strain. Sulph. -in tlie afternoon: Aijnr. Canthar. Oauflt. Chin. Coflf. ('ror. Oraphit. • Guaj. Iguat. Kali. Lacli. Lanr. Lycoj). Mur. ac. Natr. Natr. mnr. N. vom. 01. an. Phosph. Pulsat. BhuH. Sop, Sil. Staph. Sulph. Thnj. Veratr. Viol. tr. Zinc. — in the day-timo : Agar. Arabr. Amvi. carl). Anae. Ant. <rud. Ant. Inrt. Ars. Asa f. Aur. Bell. liry. Calc. c. Canthar, t'arbo veg. Caust, Cham. China. Coccul. Con. Croc. Dulc. Ferr. Gent. Graph. HcU. Ign. Kali. Lad. Laur. Led. Tvi/c. Mercnr. Mosch. Natr. Natr. mur. Nitr. ac. N. mosch. N. vom. Op. Phosph. Phosphor, ac. Pulsat. Ran. bulb. llhouin. Rhus. Sabad. Helen. Si'p. Sil. Stram. Sulph. Tart. Teratruni. Viola tr. —in the forenoon: Agar. Ant. crud. Ant. tart. Cannabis. Carbo vcget. Fluor, ac. Graphit. Kail. Laches. Mosch. Natrum. Sabad. Sassai?. Sepia3. Snlph. — excessive" Aut. tart. Coif. Croc. N, mosch. Op. Phosph. ac. FALLING ASLEEP TOO LATE : Alum. Anac. Ant, tart. Ar.s. Bellad. Bry. Calad. Calc. e. Carbo an Car- bo veg. Canst. Chin. Creos. Graphit. Guaj. Ignat, Lach. Led. Lye. Merc. Natrum carb. Natr. mar. N. vom. Petr. Phosphor. Puis. Bhus. Selen. Sep. Sil. Spig. Stann. Sulph. Positions in Sleep. ARMS ABOVE THE HEAD: Calc. c. N. vom. Plat. Pols. Ve- ratr. ON THE STOMACH: Bell. Coc- cul. Ign. Stram. LEGS STRETCHED : Bellad. Cham. Puis. —drawn up: Carbo veg. Cham. Plat. Puis. only one : Stann. HAND UNDER THE OCCIPUT- f(l7l. —under the head: Antivi. tart. Ats. N. vom. Pulsat. Spigcl. Viol. od. BOTH HANDS UNDER THE OC- CIPUT: Ambr. KNEES SPREAD: C'/iam. M. arct. Plat. Viol. od. HEAD DRAWN BACK :i<fi//.Cina. Hell, Hyosc. Ign. — incUncd forward : Cic. Puis. Staph. Viol, od. —stooping: Am. Spong. —toward the back: Ambr. Ant. tart. Ars. Bry. Calc. c. China. Cic. Ferr. Ign. Lye. Nux vom. Phosph. Puis. Bhus. Stram. Sulph. —on one side: Par. Merc. Natr. Nux vom. Phosph. Spigel. Sulph. —to left side: Lye. Natr. carb. Pliosph. —|p right side: Merc. Phosph. SITTING: Aeon. Ars. Lye. Puis. Sulph. SLEEP, with nightmare: Calcar. Caust. Puis. Sulph. —with starting up : Ars. Bell. Cham. Cina. Coff. Grapliit. Igii. Ipecac. Kali. Lyvop. Op. Samb. Sulph. — with screaming : Antim. tart. Bell. Cham. Bheum. Zinc. — with eyes half open : Cin. Ipec. Op. —stupid: Ant. tart. Bell. Calad. Calc. c. Camphor. Cic. Con. Croc. Graph. Ign. Led. N. mosch. Nux vom. Op. Phosph. Puis. Sec. corn. Spig. Valer. — with throwing off the cover : Cham. Con. Puis, — sound : Ant. crud. Antim. tart. Ars. BeU. Camph, Cic, Croc, Ign. Led. Mosch. N. mosch. Op. Phosphor. ac. Puis. Sec. com. Selen. Stram. Veratr. — with grasping at flocks : Ant. tart. Ars. Hyosc. r ■if M 130 SLBEF, DREAMS. y . ! -early : Anac. Ant. tart. Awa f . Cnlc Caust. Con. Croc. Oraph. Ignat. Kali. Laiir. Lye. Merc. Natr. N. vom. Phosphor. Phosph. ac. Pula. Sep. Sil. Sulph. Veratr. -settling down in bed : Muriat. acid, -tossing about : Arsen. BcH. Cham. Cin. Hep. Laches. Rheum. Ehus. -too long: Am. Bcllad. Cala. Carbo yeget. Coccul. Hyosc. Kali. Ign. Merc. K vom. Phos. Phosph. ac. Plat. Sep. Verat. -too light: Anac. Ars. Bry. Carbo veg. Chin. Fen. Ignat. Merc. N. vom. Ol. an. Selen. Sil. -with open|mouth : Cin. Merc. Rhus, -with soi::inambuli8m : Bryon. Phos. Sulph. -with talking: Alum. Arnica. Bell. Carbo an. Cham. Magn. c. Niix vom. Puis. Ehus. Sil. Sulph. -sliunber-like : Graph. m -with snoring : (Jamplr. Cham. Chin. Dulc. Fluor, uc. Graph. Hep. Op. Sil. Sulph. Stram. -loud talking : N.vom. -with moaning : Alum. Cham. Ign. Merc. Op. -with involuntary stool : Amic. -unrefreshing : Aeon. Alum. Ambr. Ant. tart. Bellad. Bry. C'alc. Cann. Carbo veg. Caust. Chel. Chin. Cic. Cou. Croc. Ferr. Oraph. Ilep. Ign. KaU. Lach. Lye. Magn. mur. Merc. Natr. Katr. mur. Nitric t \ N. vom. Op. Pe*^^r. Phorph. Phosph. acdd. Puh. Rhus. Secale corm. Selen. Sil. F,pigel. Staphys. Sulph. Viola trie, -restless: Ag/t. Alum. Antim. tar^. Ars. Asa f . Aur Bar. Bell. Bor. Bry. Calc. Cane. Cann. Caustic. Cina. Cham. China. Coccul. Coff. Coloc. Creos. Daph. Pig. I)uU'41hi. Fcrr. Graph. Hep. Ign. Kali. Lach. Lye. !iJang. More. Mosch. Mur, nc. Natr. Nitric ac. Nicv vom. Petr. Phosph. Puis. Bat. Rheum. Bhod. Rhus. Sa- bad. Sec. com. Sep. Sil. Sulphur. Tereb. Thuj. Ferair. Viola tr. — interrupted: Ars. Cina. Cocc. Ign. Kali. Merc. Pulsat. Bints. Sulpli. SLEEPLESSNESS : Aeon. Ambra. Anac. Ars. Bar. Bell. Bry. Calc. c. Camph. Cann. Caust. Chum. Cliin. Cin. Coir. Con. Creos. Daph. Dig. Dulc. Ferr. Fluor, ac. Graph. Hep. Hydr. ac. Hyosc. Ign. Kaii, Lach. Led. Lycrr. Mere. Mosch. Katr. Nux vom. .Ojj. O'eand. Phosphor. Puis. Rhod. Rhus. Sangn. Seleu. Sep. Sil. Squill. Sulph. Sulph. ac. Thuj. Valer, Yerat. Vine. — before midnight : Ara. Bellad. Bry. Calc. c. Carbo nuim. Carho vcgei. Chin. Con. Cycl. Graphlt. Ign. Kali. Laches. Lye. Merc Natr. Ni- tric acid. Phosphor. Pulsat. Ilhiis. Selen. Sep. Sil. Spig. Staph. Sulpli, Valer. — after nudnight : Ars. Asa foct. Aur. Capsic. Cojfea. Hep. Hyosc. Kali. Lach. Lye. Merc. Nnirum. Nitric lui.Nux -yonj. Plat. Pulsnt. Rhodnd. Rhu8.Samb.Spp.-St^Sulph.ac.Tlnii. SOPOR: Agn. Ant. crud. Ant. tart. Am. Bar. Bell. Brom. Camph. Cic. Con. Croc Graphit. Hell. Ign. Kah. Lact.Laur. Merc. Mosch. N. mosch. Op. Phosph. ac. Plumb. Puis. Sec. com. Veratr, Vit. WAKING, too ear'y : Ars. Asa f(Kt. Bryon, Culc. c. Coflf. Croc. Dulc. Hop. Ifif'i. Kail. Lye, Magn, Mur. ac. Natr. carbon. N. voui. Phosph. ac. Ran. bulb. Rhod. Sep. S'l — frequent : Ambra. Ant. crad. Arn. Ars. Bell. Bisra. Calc. c. Cann. Car- bo anim. Caust. Cham. Chin. Cic. Coflf. Dig. Fluor, ac. Graph. Hep. Kali. Lye. Maug. More. Nitric ac. Nux vom. I hell. Pliosph. Piilsat. Rhus. Rutu. Samb. Seleu. Sep. Sil. Staph. Sulphur. SuljL:h. ac. Tereb. Teucrium. Zinc. SLEEP, DREAMS. 131 —difficult: Antim. tart. Con, Nitric ac. Op. Ehu8. — too late : Am. Calc. Oaustic. China. Con. Graph. Kali. Lach. Laur. Move. Natr. carb. Niix voni. Oloan. Pliospli. Phosph. ac ^Pulsat. Sep. Sil. Sulph. YJ WNING : Ant. tart. Ars. Bellad. Bry. Calc. c. Carist. Chamom. Cln. Ooccul. Creos. Croc. Ferr. Hell. Ign. Kali. Laur. Lye. iVitxr. ac. Natr. Natr. mtir. N. vom. Op. Phoa. Pills. Rhxis. Sep. Sil. Stann. Staph. SiUph. Veratr. — with stretching : Ars. Calc. c. Caust. Cham. Ig7i. Tpec Kwr vom. Puis. Rhus. Spongia. Staph. Valer. — spasmodic : Ign. Plat. Ehus. Dreams. IN GENERAL: Aeon. Alum. Am- bra. Ant. tart. Am. Bellad. Bry. Calc. Caps. Carbo veget. Cham. Chin. Cic. Con. Croc. Graph. Hell. Hep. Tgnat. Kali. Lach. Laur. Lye. M. ai-ct. Magn. Mang. Merc. Na- truni. Natr. mur. Nitric ac. N. vom. Op. Par. Phoaphor. Phon. ac. Puis. Ban. sc. Ehua. Sabad. Sec. corn. Sep. Jil. Stann. Staph. Stram. Sulph. Thui. Valer. Vit. ANXIOUS . con. Ambr. Anne. Am. Ars. Aur. Bar. Bellad. Calc. c. Cann. Cnrbo veg. Caust. Chamom. Chin. Con. Creos. Fluor, acid. GrapliU. Hep. lod. Ign. Kali. Lye. Mann. carb. Merc. Natr. Natrium mur. N. >im. Op. Phot^ph. Psor. Puis. Hhus. Sassa]). Sep. Stram. Sulphur. Teucr. Tlinj. Veratr. DREAMS, of thieves: Aur. Magn. m. Merc. Veratr. — of falling : Bell. Digit. Ignat. Merc. Phosph. ac. Tiny. into water : Ferr. Magu. c. — of lire: Alum. Anao. Antim. tart. Calc. carb. Hep. Phign. Magn. mur. Phos. Rhus. Splg. —of war: Hyosc. Magn. carb. Thuj. — of animals : Aru. Hyosc. Nujc vom. —of \vild animals: Niix vom. —of death : CocciU. KaU carb. Nux vom. Plat, —of dead bodies: Anac. Ars. Aur. Brom. Calc. c. Graphit. lod. Kali. Magn. carb. Phos. ac. Sulph. ac. Thig. —of poisoning: Natr. mur. —of imprisonment: Clem. —of dead persons : Natr. carb. Sulph. acid. — of water: ^mm. mwj*. Arsen. Ferr. Graphit. Ign. Magn. <nrb. Moic. Natr. Nitr. Sil. — of quarreling : Am. Calcar. Cham. Magn. carb. N. vom. Phosph. Puts. Selen. Stann. —vexing: Ambra. Ars. A.'<ar. Caust. Cham. Con. Hep. Ign. Natr. Nux vom. Phell. Phosph. Rhus. Stapjh. Sulph. — pleasant : Agar. Alum. Ant. crud. Calc. c. Carbo veget. Coccul. Cojf. Croc. Graphit. Ignat. Kali. Lach. Mercur. Natr. Natr. mur. Nux vom. Op. Phosph. Puis. Sep. Sil. Stapli. Sulph. Viol. tr. — of flowers : Natr. c. — )f fine coimtry : 01. an. — of gold : Cycl. Magn. c. — of journeys: Crot. Lach. i. n. carb. Op. — of dancing: Magn. carb. — coi tinued : Calc. carb. Ign. Natr. c. Puis. — nauseous: Amm. carb. Natr. mur. Zinc. — that can be remembered: Bellad. Natr. mur. Phosph. —frightful : Calcar. c. China. Graph. Kali. Lye. Nu.v vom. Op. Phosph. Puis. — lusi-'vious: Antim. crud. Cole. c. Canth. Chel. Con. Graphit. Ignat. If t I ill ! I' I 4! ^ i! '"i ' 1 1 1^ 4t, I it, r 1 , 132 GENERAL SYMPTOMS. II M Kali. Lack. Lye. Merc. Natr. Natr. mur. Nux vom. Oleand. Op. Plat. Plumbum. Puis. Sep. Staph. Thuj. Vine. Viol. tr. -indifferent: Chin. Ign. Ntix vom. Pills. Stront. Sulph. -half-awake: Op. -vivifl : Anac. Am. Ars.fBell. Cftlc, c Oanthar. Cham. Cic. Coffea. Con. Fluor, ae. Ignat. Laeh. Lye. Magn. carl). Mang. Merv. Natr. Natruni luur. Petr. Phosphor. Pulsat. Rhus. Euti . Sil. SquiU. Sulph. -merry: Caust. Laur. Op. -fanciful : Calc. c. Kaii. Lach. Natr, Nitric ac. — wandering : Calc C. Kali. Lye. Natr. Natr. mnr. Nux vom. Sulph. — sad : Ign. Laur. Natr. c. Op. Phos. Zinc. — that cannot be remembered ; Aur. Bellad. Cic. Hell. Ign. lod. Lach. Lye. Merc. Natr. Natr. mur. 01. an. Plat. Ehus. Samb. Selen. Spig. Sulph. Tar, Veratr. — confused: Bar. Calc. c. Chin. Cic, Crot. Hell. Led. M. austr. Natr. Petr. Phos. Puh. Spig. Stann. — wakeful: Aeon. Am. Bell. Cham. Lach. Merc. Nux vom. Op. Phos. ac. Stram. XXX. GENERAL SYMHOMS. (All the pftlna which belong exclusively or mor > particularly to a certain part should be looked for under chat head.) AGGEAVATION, in the afternoon: Agar. Alum. Ant. ci'ud. Asa f . Bell. Bism. Calc. Canth. Car ho veget. Caustic. Cic. Coccul. Coloc. Con. CreoH, Ferr. Hell. Ign. Lach. Laur, Lyo, Mosch. Nitr. Nitric ac. Niuc vom. Op. Phoaph. Puis. Euta. Selen. Seneg. Sil. Spig. Staph. Teucr. Thi^j. Veratr. ii:iinc. — in the open air : Agar. Ambr. Am. Bar. Calc. Camph. Carb. an. ('ham. Chin. Coccul. Coff. Ferr. Guaj. Ign. Lach. Lye. M. austr. Mur. ac. Natr. Nitric ac. N. mo.sch. N. vom. Op. Phosph. ac. Rhus. Selen. Sil. Sjdg. &taph. Stram Sulph. ac. Thuj. Viol. tr. — when alone ; Ars. Kali, Lye. Stram. — before breakfast : Ar m. mur. Bar. Calc. Cann. Caustic. Croc Ferr. Ign. lod. Kali. Laches. Lye. Nux vom. Plat. Plumb. Ehus. Sabad. Spigel. Staph. Vuler. Verb, —by changing po«'9 position : Cajps. Carbo veg. Ferr. Lach. Lycopod. Phoxph. PuU. Ehus. — when chewing : Alimi. Amm. Amm. mur. Bell. Brij. Calc. China. Euplu-. Hep. Ignat. Man^. Meii. Natr mur. Nitric ac. Oleand. Phosph. Phosph. ac. Puis. Rhus. Sabin. Sep. Staph Sulph. ac. Thiy. Zinc. — in the cold: Aco. Amm. Am. Arg. Ars. Aur. Bar. Bellad. Camph. Carbo veg. Caust. Cic. Con. Dulc. Greph. Hell. Hep. Hj'oscyam. Ign. Kali. Magn. Magn. muriat. M(),<ch. Nux vom. Petr. Phos. Rhod. Rhus. Sabad. Sep. Sil. Spong. Squill. Stront. Sulphur, ac. Voratr. —in company: Bar. Hell. Lye. Natr. Phosph. Plumbum. Sep. Stann. — by contact: Aeon. Aug. Am. Ars. Bell, Bov. Bry. Cann. Carbo veg. Cham. Chel. Cin. Coccul. Colch. Ciipr. Femim. Graph. Hell. Hep. Hyosc. '. Lye. Magn. mur. Merc. Mezer. Js uric ac. Nux vom. Oleand. QEMKRAL SYMPTOMS. 183 Phosph. acid. Pulsat, Ran, bulb. Bhodod. Blius. Sabiii. See, corn. Sep. Sil. Splg. Staph. Stram. Sulph. Tart, eniet. Ver<^ tr. —gentle contact: Bell. China. Niix vom. — by crying : Am. Bell. Cham. Cupr. Lacli. Puis. Veratr. — by a draught of air: Bellad. Calc. Cham. Chill. Hep. Ign. Kali. Led. Natr. Nux vom. Puis. Khus. Selen. Sep. Sillc. Sulph. — drinking coffee : Canth. Caustic. Cham. Coccul. Ign. Lye. Merc. Nux vom. Pulsat. Rhus. Sulph. cold liquids: Ant. crud. Ars. Caustic. Con. Graph. Ign. Lye. Mang. Merc. Nux mosch. Nux vom. Rhod. Rhus. Sulph.yerair. —after drinking: Ars. Bry. Cham. China. Coccul. Coloc. Con. Croc. Dros. Ferr. Hej). Igii. Merc. Mezer. Natr. Nair. viur. Nux vom. Puis. Rhus. Ruta. Squill.;Sep. Sil. Sulph. T^rt. emet. Veratr. — while drinking : Anac. Ar.nen. Bell. Bry. Canth. Colch. Hyosc. Ign. lod. Lat'h. Mercur. Phosph. Rhus. Sep. Sulph. Stram. — drinking beer: Ferr. Lye. N. vom. Puis. lihti)^: Stram, Sulph. Verat. —drinking tea : Ferr. Selen. warm liquids : Ambr. Anac. Bell. Bryon. Carbo vog. Cham, flell. Kali Mezer. Phosphor. Pulsat. Spig. Sulph. ac. cold water : Arsen. Bell. Canth. Croc. Ign. Lye. Natrum. N. vovi. Phos. ac. Rhod. Rhus. Sulph. Sulph. ac. Veratnun. wine : Ant. crud. Ars. Calc. Coff. Lach. Lye Natr. Natr. mur. Nux vom. Op. Ran. bulb. Selen. Sil. Zm-. vinegar: Ant. crud. Ars. Ferr. Lach. Nux vor i. Sulph. —before eating : Ambr. Calc. Chel. Croc. Ferr. Graph. Ign. lod. Kaa Lach. Laur. Natr. Phosph. Plumb. Puis. Rhus. Sahad. Sulph. while eating : Amm. Ars. Bar. Bry. Calc. Carbo an. Carbo veg. Cham. Coccul. Graph. Hep. Kali. Lach. Lycop. M. arct. Natr. Natr. mw\ Nitric ac. Phosph. Puis. Rhod. Sep. Thuj. Veratr. —after eating : Ammon. mur. Anac. Ars. Asa f . Bryou. Calc. Carb. veg. Caust. Cham. China. Con. Graph. Hyosc. lod. Kali. Lycopod. Merc. Mur. ac. Natr. Natrum mur. Ni- tric acid. Nux vom. Posph. Pulsat. Rhus. Sep. Sil. Sulph. Sulph. ac. Veratrum. Zinc. —by eating bread : Bry. China. Kali. Natrum mur. Nux vom. Puis. Rhus. Sep. Staphysag. Sulph. Zinc. eggs: Ferr. fat: Ars. Cai'bo veget. Cycl Ferr. Hell. Magn. mur. Nitric ac. N. vom. Pulsat. Sep. Suljth. Tar. Thuj. fish: Kah. Plumb. smoked meat : Calc SU. — -vegetables: Ars. Bryon. Hell. Lye. Natr. Puis. Verat. honey : Natr. — -peas and beans : Bry. Calc. Lye. Natr. mur. Petr. Puis. meat: Carb. an. Ferr, Puis- Staph. Sulph. oysters : Lye. pastry : Carbo veg. Puis. roots : Calc. Lye. Puis. onions : Natr. Thuj. potatoes : Veratr. farinaceous food : Sulph. milk: Amhr. Arsen. Bryon. Calc. Cham. China. Con. Ign. Kali. Lye, Nu^r. Natr. mur. Nitr. ac. N. vom. Sarub. Sep. Spong. Sulph. fruit: Arsen. 'rfry. Carbo veg Chin. Magn. .nur. Puis. Rhod. Selen. Veratr. lis i \ i: . !' ■1; ; )'i 134 aKnBKM. SVMl'TOMS. !l! IIM lit I -^ — turnips: PmZs. salt food : Carbo veg. Lye. BOUT food: Ant. crud. Ars. Ferr. Natr. Nux vom. Sep. Sulph. sweet : Cham. Ignat. Natr. Jlf ere. — by eructations: Cann. €hauioni. Coccul. Kali. Laches. Phosph. Plumb. Khus. Sabin. Sep. — in the evening: Ambr. Amm. Ant. crud. Am. Ars. Asa f. Bell. Bry. Calad. Calcar. Caps. Cai-bo veg. Caust. Coff. C'olch. Croc. Dulcam. Euphr. Ferr. Hell. Ilyosc. Ignat. lod. Lach. Lycop. M. austr. Magn. Men. Merc. Nitr. nc. Petr. Phosph. Plat. Puis. Ban. sc. Rhod. Rhus. Selen. Sep. Sil. Sulphur. Sulph. ac. Tail;, emet. Thiij. Zinc. — during expirations: Bry. Caustic. Colchic. Dig. Ign. lod. Oleand. Puis. Sep. Spigel. Veratr. Viol. od. — in the fall : Chin. Colchicum. Rhus. Veratr. —in a feather-bed: Aur. Coloc. Lycopod. Mang. Merc. Pulsat. Rhus. Sulph. -in the forenoon: Alum. Ambra. Ant. crud. Argent. Bar. C'alc Cann. Carb. vegetab. Caust. Coc- cul. Con. Euphorb. Ferr. Graph. Guaj. Hep. Ign. Kali. Laur. Lyv. Magn. mur. Mang. Nux mosch. Nux vom. Phosph. Phosph. ac Puis. Ehus. Sabad. Selen. Sepiw. Sil. Spig. Staph. Sulphur. Sulph. ac. Viol. tr. , —when hungry : Aur. Graphit. lod. KaJi. inspiration: Aconit. Anac. Arn. Bry. Calc. Chamon. Croc. Ouaj. Hyosc. Ipec. Lye. Merc. Mosch. Oleand. Rhus. Sabad. Sabina. Selen. Squill. Spong. Sulph. —by laughing: Ars. Bell. Bor. Carbo veg. Chin. Con. Nux vom. Phosph. Stann. — in bright light : Ant. crudum. Bell» Calc. Cham. China. Co£fea. Con. Croc. Euphr. Graph. Hep. Ign. Lye. Magn. mur. Merc. Natr. Nux vom. Phosphor. Phosph. ac. Pul- sat. Khus. Sep. Sil. Spig. Strain. Sulph. -when looking in the bright light : Bry. BeU. Calc Kali. Me7X'. Phosph. Zinc. down : Calc. Spig. up : Calc. Graphit. Puis. Selen. Sil. Thuj. sidewise : BelL lying down : Ambra. Amm. mur. Ars. Asaf. Aur. Aur. mur. Bry. Canth. Caps. Chamom. Coloc. Ooniiun. Croc. Dros. Dulc.Ferr. Igra. Kail. Lye. Magn. mur. Men. Mur. ac. Natr. Op. Phos. ac. Plat. Puis. Rhod. Rhus. Savil. Selerti. Sepiro. Stann. Stront. Sulph. Tar. Tart. emet. Teuci. in bed : Alum. Ambr. Ant. emu. Ars. Aur. BeUiul. Bor. Culo. Carbo veg. Chavi. Chin. Ciua. Coflf. Coloc. Dros. Ferr. Graph. Ign. lod. Kali. Led. Lyeop. Magn. Mang. Merc. Mur. ac. Nitric ac. Nux vom. Phosph. Plat. Puis. mod. Rhus. Sarab. Sec. corn. Selen. Sep. Sil. Spig. Sulphur. Tart, emet. Veratr. Viol. od. on the back : Am. Canth. Caust. Chain. Chin. Cuprum. Ign. lod. Kali. Lach. Mercur. N. vom. Phos. Puis. Rhus. Sep. Sulph. Thuj. — ^^n the side : Aeon. Anac. Arn. Bry. Calad. Calc. Carbo an. Con. Ferr. Ign. Kali. L\jr. Merc. N. vom. Puis. Seneg. Stann. Sulph. Viol.tr. on the painful side : Aeon. Am, Ars. Bar. Calad. Caustic. Chin. Graph. Hep. lod. Kali. Lye, ii: GSaiBfiAL SYMPTOMS. f i! 186 Magn. Nitr. ac. N. moHch, N. vom. Phoijphor. Phosph. ac. Ruta. Seleu. Sil. Spcng. Thuj. .— — on tho painless side: Ambr. Am. Bry. Calcar. Caustic. Cham. Color. Ignat. Kali. M. austr. Pula. Rhus. Stanii. — afHr lying down in the evening: Ambr. Amm. Ar.'i. Am*. Caustic. Cham. Coff. Dros. Dulc. Ferr. Hyosc. Ign. Kali. Lye Magn. Magn. mur. Nitric ac. Plat. Plumb. Puis. Rhus. Savib. Seneg. Sepia',. Stront. Sulph. Tar. emet. Veratr, Viol. od. —at new-moon : Calc. Caustic. Cupr. Lye. Sep. Sil. — at fiill-moon: Calc. Graph. Natr. Sil. Sulph. — in the morning: Aeon. Ambr. Amm. mur. Ant. cruU. Aur. Calad. Calc. Oarb. an. Carb. veg. Chel. Cic?. Coccul. Coflfea, Con. Croc. Dulcaui, Euphr. Graph. Hep. Hyosc. Ign. lod. Kali. Lye. M. austr. Natr. Natr. mur. Nitr. Nitric ac. N. vom. Op. Petr. Phosph. Phosph. ac. Rheum. Rhodod. Rhus. Selen. Sep. Squill. Staph. Sulphur. Tar. Tati. emet. Veratr. -during motion: Auac. Am. Asar. tlell. Bry. Camphor. Carb. vey. (Jhel. Coccul. CoU'hic. Croo. Grapli. Hell. Hep. lud. Led. M. au-str. Mercur. Natr. Natr. mur. Nitric ac. N. vom. Petr. Phosphor. Rhod. Rhus. Sabad. Sec. corn. Selen. Squill. Spig. Spongia. Htaph. Sulph. ac. —at the beginning of motion: taps. Caust. Con. Ferrum. Lye. Phosph. Puis. Rhus. Samb. at night: Aeon. Ambr. Ang. Ant. crud. Arn. Arsen. Aur. Bell. Bry. Oalc. Camph. Canth. Caps. Carbo ftn. Cauat. Cham. Chin. Coff. CoJch. Con. Croc. Cupr. Dulcam. Ferr. Graph. Hell. Hep. Ign. lod. Kail. Lach. Lycop. Magn. Magn. mur. Maug. Merc. Mezer. Natr. mur. Ni- tricac Nux vom. Op. Phosphor. Plumb. Samb. Secale com. Selen. Sil. Staphys. Strout. Sulph. Tar. emet. Thuj. -wlienmu'siug: Aeon. Bell. Bryon. Calcar. Cham. China. Con. Dale. KaU. Merc. Phos. ac. Pulsat. Rhus. Sep. Sil. Staph. Sulph. —by suppressed persijiration: Bell. Bryon. Calc. Cham. Chin. Dulc. Kali. Lye. Merc. Nux vom. Oleand. Phosphor. Phosph. ac. Rhus. Sec. corn. Sep. Sil. Sulph. —by external pressure: Agar. Ang. Ant. crud. Bar. Bry. Cann. Carbo veg. Cilia. Cupr. Hepar. Ign. lod. Lach. Lye. Mosch. Natrum mur. Oleand. Plat. Ruta. Sabin. Selen. Sep. Sil. Spoug. Staph. Stramou. Sulph. Verb. —raising the trank: Aeon. Arn. Ars. Bell. Bry. Cham. Cliiua. < ic. Cou. Ferr. Ignat. Mur. ac. N. vom. Op. Phosph. Puis. Rhus. Squill. Spong. Sulph. Sulph. ac. —by reading: Asa f. Bar. Bell. Calc Chin. Coflf. Con. Croc. Graph. Ign. Kali. Lye. Natr. Natr. mur. Nux vom. Phos. Sil. Sulph. Sulph. ac. Vit. — iluring reA : Arsen. Asa foet. Aur. Calc. Cap.^. Chin. Coloc. Con. Dul- cam. Euphorb. Ferr. Ignat. Kali. Lach. Lye. Mosch. Natrum. Nitr. Oleand. Op. Phosphor, ac. Plat. Puis. Rhod. Rhus. Sabad. Samb. Selen. Sep. Stannum.' Stront. Tar. Thuj. Vtder. Veratrum. Viol. tr. —when rising from a seat : Bell Bry. Cidcar. Caps. Carbo veget. Cham. Coccul. Con. Ferr. Graph. Ign. Laches. Laur. Lye. Natr. mur, N^ix vom. Phos. Pvlsat. Rhus. Selen. Spig. Tart. emet. Thuj. •I fd it W. i' '■ ii"*!; t3d OKNERAI- SYMPTOMS. ••iu the room: Aeon. Alunthici. Anac. Ant. vrud. Asa foet. Asar. Calo. Carbo veget. Cic. Con. Croc« Graph. Hell. lod. Lye. Magn. Mezer. Natrum m\ir. Phosph. Plumb. Puis. Ran. sc. Fthodod. Sabina. Selen. Spong. Stann. Ve- ratr. Vit. -by running : Am. Ars. Bell. Bry. Caust Ign. Led. Natr. mur. N. vom. Oleand. Sil. Sulph. -by sexual intercourse : Calad. £ali. Selen. -after sexual intercourse : Agar. Calad. Calc. Chin. KalL Natr. Petr. Phos. ac. Selen. Sep. Staph, -when sitting: Agar. Ambr. Ant. crad. Asa f. Aur. Bar. Calc. Caps. Chin. Cina. Coflf. C'ou. Cuprum. Cycl. Dulc Euphorb. Graph. Ignat. lod. Lach. Lye. M. arct. Magn. wwr. Muriat. ac.^air. Ni- tric ac. Oleand. Phosph. ac. Pla- tina. Puis. Bhod. Rhus. Sabad. Soneg. Sep. Spong. Sulph. ac. Tar. Thuj. Veratrum. Verb. Viol. tr. -Hmoking tobacco : Ant. crud. Calo. China. Etiphr. Ignat. Lach. Nit r vom. Puis. Rhus. Ruta. Selen. Spong. Staph. -in the spring: Ambr. Bellad. Calc. Carbo veg. Lye. Natr. mur. PuIh. Rhus. Sulph. Veratrum. -when standing: Alum. Aur. Cal- car. Cann. Caustic. Coloc. Con. Cyel. Euphr. Ferrum. Graph. Ign. Laur. Ltic. Magn. mur. Mosch. Natr. Oleander. Op. Phosph. ac Puis. Rhod. Rhus. Samb. Se]>. Staphys, Sulph. Tar. Valer. Ve- ratr. -when stooping: Aco. Amin. Arn. Bar. Bry. Calc. Caps. Cham. C'oj'- cnl. Croc. Graph. Hep. Ipec. Kali. Mang. Mercur. Nitr. Oleander. Fetr. Plumb. Bhod. Seneg. Sej^t. Sil. Splge^ Stront. Tewcr. Thuj. Valer. —in the sir 'mer: Antim. crud. Bell. Bry. Carlj veget. Lach. Lye. Natr. Natr. mu*" Puis. Selen. Veratr. — in the sun : Antim. tTud. Camphor. Euphr. Graphit. Ipecac. Luch. Natr. Pul at. Selen. — after suppressed catarrh: Bry. Calc. Carbo veg. Chin. Con. Dulv. Graph. Ipec. Lye. Merc. Natr. mur. Nitric ac. Nux voni. Phospli. Puis. Rhod. Sep. Sil. Sulph. Sulph. ac. — when swallowing : Aeon. Ars. Bur. Bell. Bry. Camph. Chin. Coccul, Coffea. Croc. Hep. Hyosc. Kali. Magn. Merc Nitric acid. Nux vovi. Petr. Phos. Puis. Rhus. Sassap. Sep. Spig. Staph. Thuj. Veratrum. —after swaUo^wing: Ambr. Bry. Cham. Hep. Ign. lod. Nitric ac. N. voni. Phos. Pulsnt. Rhus. Ziiic. — between the acts of swallowing: Ambra. Am. Graphit. Ign. Lack. Laur. Mei'i : Nux vom. Phosph. ac. Sabin. Spong. Stann. Staph, -when sweating: Aeon. Arsen. Bry. Caust. Cham. Cocc. Dig. Ferr. Ign. Ipec. Lycop. More. Natr. Nux vom. Of). Phosph. Pnlaat. Rhus. Selen. Sep. Stram. Sulph. Tart. em. Thuj. Veratr. —when talking : Ambr. Arnica. Bell. Calc Cann. Cham. Chin. Coccul. Dig. Dulc. Graph. Ign. lod. Lyr. Mang. Merc. Natrum. Natr. mtir. Phosph. Phosph. ac Rhus. Selen. Sep. Sulph. —during a thunder-storm : Lach. Na- trum. Phosph. Rhod. Sil. —after uncovering one's self: Ant. cmd. Ars. Aur. Bell. Cham. China. Cic. Clem. Colchic. Graph. Hep. Hyosc. Ign. Lach. Natr. Natr. miu-. Nux mosch. Nux vom. Puis. Rhod. Rhus. Samb. Sil. Stram. Stront. 4fc GENERAL SYMPTOMS. 187 ry. ni. len. .nt. na. ep. iXU'. od. —from vomiting'. Ars. Asar. Bryon. (Jupr. Ipec. Nux vom. Plumb. Tills. Sap. Bil. Sulphur. Verai7\ -on waking: Ainbra. Amni. mur. Am. Am, Bryon. Calad. C'alc. Car- bo veg. C'iiiiHt. Chin. Cocciil. Digit. (jraphit. Ilepar. Jf//i. Kail. Magn. mm". Merc. Natr. Natr. inur. Nitric acid. Nux vom. Phosphor. Puhat. Rhus. Sabin. Samb. Sep Ice. Staph. Stront. Sulph. —walking fast : Am. Ars. Bell. Bry. Caust. Cupr. Led. Lye. Nux vom. Oleander. Rhus. Silic. Spig. Squill Sniph. ■ -Avhen walking out iuto the cold air : Ars. Caust. Mosch. Nux vom. Ran. bulb. Sabad. -in warmth : Ambr. Ant. crud.5Boll. Calad. Curb. veg. Cham. Coc. Dro.^. Graph. Ign. lod. Ipec. Lach. Led. Lye. Merc. Natr. mur. Nux mosch. Op. Phosi)h. ac. Piilsat. Rhus. Sec corn. Selen. Senega. Sep. Staph. Tart. emct. Thuj. -by watching : Amhra. Coccul. Merc. N. vom. Puis. Seltm. Sep. — after getting wet ; Ars. Bell. Bry. Calc. Colch. Dulcam. Ipec. Lye. N. uioscli. Pulsat. Rhus. Sec. corn. (Sep. Sul2)h. -by a change of weather ; Ammon. Jiry. Cale. Dulr. Graphit. Mang. Nux mosch. Phosph. Puis. Ehod. Rhus. Sep. Sll. Sulph. —damp weather: Ammo7i. Am*. Calc. Carbo veg. Chin. Dale. Feir. Lach. Laur. Lye. Merc. Mui-iat. ac. Nitric ac. Nux mosch. Puis. Rhod. Rhus. Rata. Seneg. (Spij/.Staphys, Sulph. Veralr. —in stormy weather : Arsenic. Cham. Lach. Lye. Miu:. ac. Natr. N. mosch. Nux vom. Pho.^. Puis. Rhod. Rhus. Spig. Sulph. —in dvy weather : Asar. Bellad. Bry, Carho veg. Caustic. Cham. Hep. r)7 Ippc. Mur. ac. Nitric ac. Nux vom. I'hd.^l'h. Sabad. Sil. Spong. —by wet : Amm. Aiil. crud. BcUad. Calc. C'au/Vi. Carbo veg. Clem. Dulo. Lye. Mere. Nitric ac. Nux vom. Phosph. Puis. IHius. Sep. SH. Spig. Staph. Strout. Sulph. —in winter: Aeon. Ars. Aur. Bar, Boll. Bry. 6V/?<.s/. Cham. Coccul. Con. Dulcam. Hell. Hep. Ign. Kali. Lijc. Mere. Nux mosch. Nux vom. Pii/.s. Rhod. Rhus, Sep. Sulphiu:. Veinlr. —when writing : Anac. Asa f. Calc Carbo veget. Coccul. Graph. Ign. Kali. Lye. Natr. Natr. mur. Nux vom. Phosph. Ruta. Sil. Spong. Zinc. Amelioration of the Pains. IN THE OPEN AIR: Alum. Anac. Asa f. Aur. Bar. Caun. Carbo veg. Con. Croc. Graph. Hell. Ign. lod. Kah. Lyeop. Magn. Mezer. Natr. Phosph. Plat. Puis. Sabln. Selen. Scpia3. Spong. Stront. Sulph. Ve- ratr. Vit. BY BORING INTO THE EAR OR NOSE: Lach. x\atr. Phosph. Thuj. BEFORE BREAKFAST : Caust Cham. Chin. Con. Kali Lye. Natr. unir. N. mosch. Phosph. Phosph. ac. Sabin. Selen. Sil. Sulph. ac. Zinc. BY DEEP BREATHING: Ign. Lacli. Oleaud. Spig. WHEN CHEWING : Bryon. Chin. Spig. IN THE COLD: Ambra Ant. tart. Asar. Cin. Croc. Dros. Graph. Io»l. Kah. Led. Lye. Merc: Natr. Nutr. mur. Plat. Puis. Rhus. Sec. corn. • Sep. Sulph. Thuj. Verair. BY CONTACT : Anac. Asa f. Calf. CJirb. Cycl. Drosera. Lycop. Mang. il i r- m *(■ 138 OENEUAL SYMPTOMS. Mur. acid. Natr. Fhosph. Sulph, Thuj. IN THE DAEK : Bar. Bell. Cale. curb. China. Con. Croc. Kuphr. Graph. Iguut. Kali. Lye. Morcur. Natr. Fho^ph. Pliosph. ue. Puis. Sopia3. >Sil. Sulph. AFTEE DIUNKING: Bry. Graph. Pkosph. lihua. Stl. AFTER EATING: Calc. v. Canu. Chel. Ferr. Graph. lyn. lod. KaU. Lach. Merc. Natruin. Flioa. Sqiull. Stront. Veralr. WHEN EATING: Amhr. Anacard. China. Croc. Ferr. Graphit. Inru. lod. Lach. Merc. Nnx vom. Puis. Spig. Staph. Tar. Zinc. BY ERUCTATIONS : Ant. tart. Bai-. Carbo veg. Coccul. Graphit. Ij?n. Kali. Lach. Lye. Natr. Nux vom. Sll. SiUph. BY FOOD AND DRINK, bread : Cuust. Natr. — vinegar: Fuls. --meat: Veratr. — coffee: Ars. Cham. —cold food : Bell. Bry. Cham. Ferr. Kali. Laches. M. austr. Merc. Fhosph. Phosphor, ac. Puis. —warm food : Am. Cou. Graph. Ign. Lye. Mur. ac. N. mosch. Nux vom. Rhus. Sulph. Veratrum. —cold water : Bry. Caustic. Phosph. Fuls. Sep. — warm water : Nux vom. Rhus. — wine: Con. Lach. Op. BY IMPOSING ONE'S HAND: Bell. Croc. Natr. BY MENTAL LABOR: Croc. Ferr. Natr. BY BODILY LABOR: Ign. Natr. Rhus. Sep. BY LEANING AGAINST : Carbo • veg. Ferr. KaU. Staph. IN THE LIGHT: Calc. c. Carbo an. Carbo veg. Con. Plat. Stront. WHEN LYING DOWN : Alum. Ambra. Arn. Bell. Bry. Calc. c Canth. Caust. Coccul. Colch. Croc. Dig. Graph. Hep. lod. Merc. Natr. Natr. mur. N. vom. Oleaud. Phos. ac. Sassap. Squill. Sec. corn, Stan- num. Straph. Strain. in bed : Bell. Bry. Canth. Caust. Cic. Cin. Con. Dig. Fen-. Lach. Lye. Natrum mur. Nitric ac. Nux vom. Pliosphor. Rhus. Sabad. Squill. Selon. Sil. Staph. Stram. Veratr. on the back: Aeon. Bry. Calc. c. Carbo an. Con. Creos. Fen-. Ign. Kali. Lye. Natr. mur. Nice vom. Plat. Sepia). Stann. Sulph. on the side : Arn. Ars. Biy. Cham. Cupr. lod. Lach. Natr. N. vom. Fho.sph. lihtis. Sop. on the affected side : Bry. Cham. Ign. Kali. Fuls. Rhus. on the painless side : Aeon. Ars. Bar. Bell. Graph. Hep. foil. Nux vom. Phos. Ruta. Sil. Sulph. Thuj. - — with the head high : Ant. tart. Ars. Cann. China. Hep. Niu vom. Puis. Splg. bent double: Coloc. Pulsat. Rheum. IN THE EVENING, after l.>'ing down: Bar. Bell. Bry. Cale. c. Carbo veg. Cic. Cin. Croc. Graph. Hell. Hep. lod. Natr. mur. Nux vomica. Oleand. Rheiun. Rhodod. Secalocoru. Squill. Stajjh. BY MOTION : Ambr. Asa f. Aur. Caps. Chumom. Cou. Cycl. Dulc. Ferr. Fluor, ac. Lach. Lye. Merc. Mosch. Nltr. Op. Fhosphor. ac. Puis. Rhodod. Khus. Sabad. Samb. SepioB. Sulph. Tar. Valer. Verb. BY CONTINUED MOTION: Con, Ferr. Kali. Lye. Fuls. Sil. Valer. Veratr. BY EXTERNAL PRESSURE: Amm. mur. Anac. Ars. Aur. Brii. OENEUAL HYMPTOMa. 130 Oanth. Ohel. Con. Dulaara. Graph. Ign. Kali. Ma<jn. niur. Men. Miir. ac. Natr. Nux vorn. Phosphor, ac Plumb. Rhus. Sulphur. Sulph. uc. Veratr. Vit. tY RAISING ONE'S SELF: Aut. tart. Arsen. Calc. c. Cham, Cliiuii. Dig. Ign. Kali Lye. Oleand. Fids. Samb. Sep. Sil. Sulph. WHEN READING: Natr. IN REST: Agar. Auac. Ant. tart. Asar. Arti. Bell. Bry. Calad. Carbo an. Carbo veg. Caustic. Chel. Coff. Colvh. Croc. Ferr. Graph. Hell. lod. Ipec. Led. Mang. Merc. Natr. mur. Nux mosch. N. vom. Pliosph. Plat. Rhtniiu. Rhod. Seloi. Si)igcl. Squill. Staph. Sulph. ae. WHEN RIDING IN A CAR- RIAGE : (Jrapli. Nllric a<: IN THE MORNING AFTER RIS- ING : Ambr. Ant. tart. Ava. Bell. Calad. Carbo anirn. Cycl. Euphorh. Ferr. Graph. Ljn. lod. Kali. Led. Lijc. Mang. Mercur. Morzcr. Natr. Nux vom. Pliosph. Pulsat. Ji7/?i.s'. Selon. Sei). Sidphur. Veratrv.Viola od. IN THE ROOM: Agar. Amm. mur. Ars. Boll. Calc. carb. Campli. Caun. Carbo an. Carbo veg. Cham. Chin. Coccul. Con. Creos. Ferr. Guaj. ' Ign. Lach. M. austr. Natr. Nitr. ac. N. mosch. Nux vom. Oleand. P> tr. Rheum. Ruta. Selen. Sil. Spig. Stram. Sulph. ac. Teucr. Valer BY SCRATCHING: Asa M. Bry. ^alc. c. Caust. Cic. Cijcl. Ign. Led. itfur. ac. Natr. Oleand. Phosphor. Ruta. Sulph. Sulph. ac. Thuj. BY SLEEP : Ars. Ipec. N'^ vom. Phosph. Puis. WHEN SITTING: Bryon. Calad. Camph. Caun. Chamom. Cic. Ooffea. Colch. Croc. Hell. Hyosc. Tod. Merc. Mezer. N. mosch. Nux vom. P/io.s/)/i. Rheum. Rhus. Squil[. Secale corn. Staph. WHEN STANDING: Autun. tiirt. A.sar. Bell. Calad. Calcar. c. Coccul. Colchic. Croc. Hell. Ilcp. lod. Iprr. Led. Mercur. Mur. ac. N. vom. Phos. Ruta. S(|uill. Selen. S))ic Vit IN SOCIETY: Arsen. KaU. Lye. Stram. IN SWALLOWING: Ambr. Graph. Ign. Lach. Led. Merc. Nux vom. Pulsat. Squill. Spongla. Staph. IN SWEATING: Calad. (ham. Clom. Graph. Hep. Lye. Nitr. ac. NiLv vom. Oleand. Khus. Selen.. Stram. Thuj. Veratr. BY UNCOVERING ONE'S SELF; Calc. c. Chamom. Ferr. Ignat. lod. Lye. Phosph. Puis. Secalo corn. Spi (J. \{^raU\ ON WAKING: Ars. Calad. Hell. Nux vom. Phosph. Pidsat. Sep. Thuj. WHEN WALKING FAST: Ignat. Natr. mur. Sep. BY THE WARM STOVE: Ars. Axir. Caust. Con. Hep. Ign. Kali. Magu. N. vom. Ehod. Bhus. Stront. Sulph. BY WASHING: Amm. mur. Ars. Asar. Caust. Chel. Pulsat. Ehod. Spig. the face: Asar. Mezer. Saba- diila. BY WEEPING: Anac. Ign. Lye. IN DAMP WEATHER: Aeon. ^sar. Canst. Hep. Ipec. N. vom. Sil. Spoug. IN DRY WEATHER: Ant. crudum. Calc. carl). Chin. Dulcam. Ferr. Lach. Lye. Merc. Natr. N. mosch. Pulsat. Rhus. Sidph. Veratr. BY WIPING WITH THE HAND: Asa foet. Calc. c. Cina. Cycl. Ign. Natr. Phosph. Plumb. Fids. Thuj. '■i'T . m § \ %.• 140 aEMERAI, HYMFTOMB. II IN WARMTH: Aeon. Amm. Am. Ars. Anr. Bar. Bell. (,!nm>h. Corbo voget. ('«ust. China. Cio. Cocvul. Dulc. Fernim. Ciniph. UoU. Hep. Hyoscyniu. Iffrii. Kull. Loch. M. (luxlv. Miign. More. Moncli. Natr. N. moHcli. Niix voinicu. Vviv. IMioh. llhod. RhuH. Sahaif. Siimb. Hciuill. 811. StaphyH. Stroyit. Sulpli. ac-. Voral. Zinc. AN.^MTA: Am. Ars. Bell. Bry. Calc.c. Cnrbnveg. Chamom. Cliln. Con. Forr. lyii,. lod. Kali. Lach. Lye. More. Natr. Nnir. mur. Nitric. 00. N. vom. PhoHpli. ue. Puis. RIuih. Sc^p. Sil. Squill. Stapll. Sulphur. Kiili)li. Hc. Vcratr. ANEURYSMS: Carbo veg. Porr. Graph. Kali. Lach. Lyv. Puis. Siilph. APPARENT DEATH: Arn.BoUad. Carbo veg. Chain. Chin. Lack. Nux vom. Op. Tart. omet. APOPLEXY: Aeon. Am. Baryt. Bell. Calc. Camph. Caust. Cliin. CoccalI. ColT. Dig. Forr. Uyosc. IjM^c. Lach. Ijycop. Merc. N. vom. Puis. Ithti.'<. Sil. Strain. Tart, eviet. V(*ratr. ATROPHY: Ars. Baryt. Bollad. (!alc. c Cliina. Cina. lod. Ipcc. Lach. More. Ntix vom. Rhus. Sil. Sulph. BONES, affections of, in general: Aru. ArH. Asa foit. Aur. Boll. Calc. carb. Calc phospli. Carbo vegot. China. Con. Diilc. Graphit. Hep. lod. Kuli bichr. Lm-h. Ljcop. Tlfwv. Mezer. Nilrio ac Pho.sph. Pulflat. Rhns. Euia. Sabin. S(H!. com. Sil. Spong. Staphysag. Siilph. Sul2)h. ac. Thuj. — swelling : Ana f. Aur. Calc. Dulc. Guaj. Hep. Lye. Merc. Nitric acid. Phosphor. Puis, lihus. Ruta. SU. Staph. Sulphur. — fractures: Am. Asa f.^Calc. Lyoop A7i.a.s. Jiutn. Sil. Syniphyt. Bulph. — iuUiuuniation • Asa fuit. Aur. Bell. ('ale. Chin. Hei). Lycop. Merc. Ni- tric^ ac. /V(o.s/*/t. Sil. Hiilph. — jxiin**- ArH.AHaf. Aur. JUir. ('alcar. ('hina.Cic. Daph. Fluor, ae. hnvh. L\ie. More. Nitric ac. P/ion. PIidh- l)h()r. ao. Plumb. Ruta. Sil. Staph. Sulph. — curvature: Asa fo't. Bollad. ('ale. Calc. phospli. Ht'p. Jo<l. Lye. Merc. Phosph. Phuub. RhuH. Sil. Sulph. — caries: Arwon. Asa foil. Aur. Calc. Fluor, oc. Hep. Lye. Mere. Nitric. ac. Pliosph. riiOKph. ae. Ruta. Sep. Sil. Spong. Sulph. BLUE DISEASE : Aco. Arn. ArH. Aur. Belhid. Camph. ('orho vnjcl. Chin. Con. Cuprum. DIk'H. Forr. Ipeeae. Lach. Mer<\ Nux vom. Op. Phosph. Pulaat. RIiiih. See eorii. Vcratr. BOUNDING, as of something: Croc. BURNS: Ant. crad. Am. Ars. Curb. veg. Caust. CreoH. Laches. Seen I r torn. Strain. CHAGRIN, consequences of: Aco. Ars. Tiry. Cliani. Cliin. CofV. Colne. N. vom. Pliosph. Ph. ac. J'lat. Staph. — suppressed: Tgn. Phosph. ae. — with wrath : Coloc. Staj'h. N. vom. CHAMOMILE, cxccesivo uho <iI': Aeon. ('off. Ign. Puis. Nuon vom. CHILDREN, diseases of: Aeon. Bur. Bell. Bryon. Calcar. Cham. ('in. Coff. Drosera. Hep. Hell. Tgn. lod. Ipcc. Mere. Nux mosch. Nux vom. Puis. liheum. Sihc. Si)ongia Sulph. CHINA, aliments from abuse of: Am. ArH. Bell. Calc. c. Cantliar. Cfirbo veg. Ferr. Ipcc. Lach. Lye Merc. Natr. viur. N. vom. Sep. Puis. Sulphur. Vcratr. (»RNKUAI, HYMPT0M9. 141 CHOLERINE ; tlllOLEillO Acou. Aaar. Cin. (!u|)r. OHOLERA: Aut. tart. Ars. Asiir. Oomph. Uarbo vcuct. ('ii|H'. Diilc. Hydr. nc Jatr. Iiu-cm'.. Luuh. Niix vom. PhoHjfh. Ph. ac;. Sev. corn. Vcralr. ; Ury. I'iiIh. KIiuh. TKMI'KIIAMENT: Jiry. OmiHt. ('hmii. IlyoMc. Kiili. /,(((■/(. Niitniiu. Nitrit! iic. Nii\ voiii. (>//. i'/io.syi/io/'. OHLOROHIS; lioU. Ciilc. ciirli. Cami>h. ('kin. ('oi'ciil. Coniiim. (//•o<. Ft'iT. (Intphit. llcll. Ikii. Kiili. /var/i. Lyr. Niitr. mur. Nitric w!. Nuj: voiii. Vial, riiimb. I'lils. Hep. Btaph. Siilph. Valtr. COLD, taking: Aion. Ant. criid. Arrt. BvU. Bry. <!ttlc. Caimt. ( lumi. Cort'. DnU'ani. /^v*. Ipoc. Jlff/v. N. Tom. PhoHph. Puis. Hlnis. Sil. Snliih. — liable to tnko: Aconll. Jk.ll. liry. €uN'. Carbo vog. (Jaunl. (!liiiiii. China. Dro.^. \Mv. Urp.liyi^.Mirr. Natrum. Nitric ar. Niix vom, ruin. lihu>i. Sop. Bil. Sidph. COMPLAENTH, pcrioaical: Arnic. Jrs. Bell. Ury. Carbo vogot. Chin. If^ii. Ipcc. Natrum nuir. N. vom. Pnls. IlIiiiH. Spiy. Sulpli. CONCUSSION: Arii. Hell. J5ry. Cic. Con. Nnx vomica. Ukn.s. Veratr. AILMENTS INCIDEN'l TO CON- FINEMENT: Aconit. JyiL Ar- nica. lU'll. Bry. VuU: Vhaui. Chinii. Cojf. Jfcp- llyosc. Igiiat. V/(/f. Jlfflrc. N. VOIII. Op. Phosph. ao. Flat. Puis. llhuH. Se<'. corn. Sil. Sulph. Voratr. CONGESTIONS OP BLOOD: Aeon. Amm. Am. Asa f. Anr. Hell. Bry. Calr. (\ Carbo v(!g(!tab. Chin. Croi-. Cupr. Dig. Fcrr. Graph. HyoHC. Kali. Lycop. M<tc. Natr. mur. Nitric ac. N. vom. Op. I'lioxph. I'uIh. IlhuH. Snncg. Sop. .SV7. Htrani. Sulpli. Sulph. oo. Vcratnnn. I'iohi /;•. CONTUSIONS: .Icon. Arg. Arii. Cic. Con. Led. OliMinil Pctr. ruin. Kliodod. Uliat<. Itulii. Sulph. Sulph. (It: CLIAWLINO: IIHI. Caloar. Sop. Sulph. DEBILITY, ncrvouH: Am. Baryt. IM\. Calr. Carbo v«'ji;»'t. Chum. Chin. Coll". CnpruMi. (Irapli, llyo.^i; Ign. /()(/. fpcc!. Lach. Lye. i arct. Morcur. Nalr. Nab'. 7rt,»r. Nitric ao. Nux nioHch. N. vom. IMioh. I'Iios])Ii. ac. riat. J'ulnnt. lUiiis. Sn: corn.. Schiii. Sil. Staiin. Stnini. Valor. ycratr, DRUNKARDS, ailmontH o, . Aeon. Arti. Jkll. Calc. (!arbo vcgot. //|/- o.s'c. Ign. Lach. Nalruiii. Natr. mur. Niix vom. Op. BuIh. JUiuh. Sil. Slrarn. Siilidi. DRYNESS OF INNER PARTS: AfDU. Ambr. Arn. Ana f. Hcllad. Ury. ('ahul.VaW. Carbo vcg. Cliam. Cio. Con. Croc. Dulv. (inipli. lly- o.s'c, Ign. Lyi\ Magn. mur. Muug. Men: Natrum. Natr. mur. Nilria acid, NiuJ ?//o.s(7(. Niix vom. Par. I'liosph. PuIh. JUiuh. Sand). Sec. corn,. Si'.iny. Scpiai. Sil. Spony. Strain. Sulph. Vvralr. /inc. EMACIATION: Andmi. Aniuiurd. Ai-H. liar. Bry. Calc. carb. Cantiiar. C'arhn v<'y. Chamniii. (!liin. Chlor. Cilia. Coccnl. Cupr. Dulc. Fen: (Jrapliit. Hep. Jyn. lod. Ipcui. Laclu'.i'.. Lye More. Nalr. Natr. mur. Nilria ac N. vom. PhoHpli. i'/io.s. ac. Plumb. PuIh. Sec. corn. Solon. Sil. Slann. Slaphyn. Siiiph. Veratr. EXCESSES, conscqucnccB of: Ajkv- card. Am. Ikiv. Calc. carb. Carhu vr.y. Chin. Coiilum. Kail. Inch. Morcur. Natr. Natr. mur. N. vom. jiiji m \\ IT'?. i\M 1 L ttM IMAGE EVALUATION TEST TARGET (MT-3) 1.0 I.I "- IIIIIM |50 '""^^ ^ 1^ M 1.8 1.25 1.4 1.6 •^ 6" - ► m ^ /2 v: % > o / M Photograpliic Sciences Corporation <^ % V > 23 WEST MAIN STREET WEBSTER, N.Y. 14580 (716) 873-4503 5?. ^ O^^ 142 GENERAL SYMPTOMS. Phosph. Phosph. ac. Puis. Rhus. Sec. corn. Sep. Sil. Staph. Sulph. Thuj. Veratr. FAINTING: Aeon. Am. Arsenic. Bell. Bryon. Calc. Camphor. Canu. Carbo veget. Chaviom. China. Coc- cul. Coff. Creos. Dig. Ferr. Hep. Hyosc. Ign. Ipec. Ladi. Laur. Mbsch. N. mosch. N. vom. Op. Petr. Phosph. Phosph. ac. Pulsat. Ran. sc. Rhus. Sangn. Secale corn. Sep. Sil. Spig. Stramon. Tart. emet. Veratr. Viola od. FAT, tendency to get : Antim. crud. Ars. Calcar. Caps^^ Croc. Cupr. Ferr.lGraphit.ILach.Lyc.jlMerc.jOp. Pulsat. Spong. Sulph-YcxQix. FEAR, consequences of: Aeon. Bell. Hyosc. Ign. Lach. Op. Puis. Verat. FEMALES, diseases of : Aeon. Agar. Alum. Ambra. Arnica. Bell. Bor. Calcar.Caps. Caustic. Cham. Chin. Cic. Coccul. Con. Croc. Ferruni. Graph. Hyoscyam. Ign. Ipec. Kali. Lach, Magn. inur. Merc. Mosch. Nux mosch. Nux vom. Plat. Puis. Rhus. Sabin. Sec. corn. Selen. Sep. Spongia. Stann. Sulph. Valer. Veratr. Fever, General Charac- ter of. FEVER, bilious: Aeon. Ant. crud. Ant. tart. Ars. Bry. Bellad. Chain. Coccul. Coloc. CreoH. Ign. Ipec. Merc. Natrum mur. N. vom. Puis. Sulph. Verat. — catarrhal : Aeon. Ars. Bry. Bellad. Canst. Chamom. Con. Dulc. Ijiec. Lach. Magn. mur. Merc. N. vom. Puis. Rhus. Sulph. — gastric: Ant. crud. Antim. tart. Ars. Aur. Bell. Bry. Cham. Coccul. Coloc. Hepar. Ignat. Ipec. Mercur. Magn. c. N. vom. Phosph. ac. Puis. Rhus. Sulph. Veratr. — yellow : Aeon. Ars. Bell. Bry. Grot Ipec. Mercur. Nux vom. Puis. Rhus. Sulph. —puerperal : Aeon. Bell. Bry. Cham. Nux vom. Puis. RhtLs. —-milk : Aeon. Bell. Calc. Coff. Puis. — nervous: Aeon. Arn. Arsen. Bell. Bry. Camph. ChamOm. Hyosc. Ign. Lye. Mercur. Mur. acid. N. vom. Op. Phosphor, ac. Rhus. Stram. Veratr. — rheumatic: Aeon. Am. Ars. Bell. Bry. Caustic. Cliam. Colch. Dul- cam. Ipecac. Mercur. N. vom. Puis. Rhus. SU. Sulph. — wound : Aeon. Aim, Bry. — dentition: Aeon. Bell. Calc. Cha- mom. Merc. Nux vom. Sulph. — hectic: Arsen. Calc. China. Coc" cul. Cupr. Dig. Ign. lod. Ipec. Kali. Laches. Lye. Nux vom. Fhospli. Phosph. ac. Puis. Sil. Staph. Sulph. — typhus, abdominal: Aconit. Ars. Bell. Bry. Merc. Nux vom. Phosph. ac. RhiiS. — typhus, cerebral: Aeon. Arn. Ars. Bell. Bry. Carbo veget. Cliin. Crot. Hyosc. Lach. Mercur. Mar. ac. N. vom. Op. Phosph. Phosp)h. ac. Pulsat. Rhus. Sulph. Veratr. — typhus, putrid: Ars. Ana /. Bry. Carbo veget. Chin. Fcrr. Graph. Hep. Ipec. Lach. Merc. Mur. ac. Nux vom. Op. Phos. ac. Rhus. FLUIDS, ill effecU of loss of: Calc. Carbo veg. Chin. Ciu. Con. Lach. Lye. Natr. Natr. mur. Nitric ac Nux vom. PhoKph. ac. Sulph. Sulph. ac. Thuj. Veratr. FREEZING, consequences of : Aco. Ai*s. Bry. Carbo veg. Laches. Ni- tric ac. Sulph. ac. Fever, According to Par- ticular Symptoms. BURNING: Arsen. Bry. Rhus. Ve- ratr. GENEUAI. SYMPTOMS. 143 CHILLINESS IN GENERAL: Ambra. Ant. tart. Arn. Ars. Bryon. Calc. Canth. Cham. China. Cin. Colch. Cui)r. Ferr. Graph. Hoii. Ign. Ipec. Lach. Lye. Merc. Mozer. Nair. mur. Nux vom. Phosph. Phosph. ac. Puis. Ehus. Sabad. Sassap. Sep. Sll. Spig. Sulph. Thuj. Veratr. —external : Arn. Chin. Lycop. Merc. Nux vom. Plios. lihus. Veratr. — semi-lateral : Ant. tart. Bry. Cmist. Ignat. Lye. Nux vom. Puis. Pihus. Spig. —internal: Anac. Ars. Bellad. Bry. Calc. Chamom. China. Hell. Ignat. Ipec. Lach. Lnur. Lycop, N. vom. Phosph. Pnlsat. Squill. Sep. Thuj. Vera tr. — ^\'ith shaking : Aeon. Bryon. Caps. Cham. Chin. Ign. Ipec. Niix vom. KhiiK. Veratr. HEAT IN GENERAL: Aco. Amm. mur. Anac. Antim tart. Arn. Ai*s. Bell. Bry. Calc. Canth. Carb. veg. Caust. Cham. Chin. Cin. Coflfea. Con. Cijcl. Ferr. Graph. Hell. Hep. Ign. Ipec. Kali. Lach. Magn. mur. Merc. Mosch. Mur. ac. Nltr. ac. Nux vom. Op. Phosph. Phosph. ac. Pul-i. Rhus. Sabad. Sil. Squill. Stannum. Staph. Strani. Sulphur. Sulph. ac. Veratr. —external : Aeon. Ars= Bell. Bry. Calc. Camphor. Carho veg. Cham. Cic. Coceiil. CofF. Coloc. Digit. Dulc. Euphorb. Hell. Hyosc. Ign. Kali. Lach. Lyr. Mang. Merc. Mur. ac. Nux vom. Op. Phosph. Puis. Rhus. Sep. Sil. Squill. Stram. Sulph. Zinc, —flashes of : Am. Calc. caro. Chin. Graph. lod. Kali. Lycop. Natnmi. Nux vnm. Phosph. Plat. Puis. Rhus. Ruta. Sep. Staun. Sulph. Thuj. —semi-lateral : Am. Bell. Bry. Croc. Ignatia Lye. Nux vom. Phosph Puis. lihUH. Sulph. —internal : Aeon. Am. Ars. Bell, Biy. Calc. Canth. Carho veg. Caust. Cham. Cic. China. Coloc. Con. Graphit. Hell. Ipec. Lye. Magn. mur. Nitric ac. Nux vom. Phosph. Phosphor, ac. Puis. Rhus. Sahad. Samb. Sec. corn. Spig. Spong. Stann. Yeratr. Zinc. LOSS OF C0NSCI0USNES6: Bell. Bry. Carbo veg. Hell. Hyosc. Lach. Op. Phos. ac. Ehus. Stram. LOSS OF THmST: Arit. tart. Ars. Canth. Carbo veg. Caust. Chiu. Hell. Ipec. Merc. Puis. PULSE, intermittent: Aeon. Ars. Bry. Dig. Kali. Lach. Natr. mur. Op. Pliosph. ac. Sec. corn. Stram. Sulph. — filiform : Colch. Lach. Veratr. — large : Aeon. Bell. Bry. Cupr. Dig. Forr. Hyosc. Ign. Merc. Nitr. Nux vom. Pliosph. Spig. Stram. Veratr. — hard: Aco7i. Arn. Bar. Bell. Bry. Canth. Chin. Digit. FeiT. Hyosc. Ign. Merc. Nux vom. Phosph. ac. Sabin. Samb. Sil. Strara. Veratr. — small: Aeon. Ant. tart. Ars. Bar. Bell. Calc. carh. Camph. Carbo veg. China. Cina. Cocc. Cupr. lod. Ipec. Kali. Lach. Laur. Merc. Natr. mur. Op Phosph. acid. Plat. Puis. Sec corn. Sil. Stram. Sulphur. Sulph. ac. Veratr. — slow: Ambr. Ant. crud. An f tart. Ai*s. Bell. Camph. Canthar. Cic. Con. Dig. Hell. Ign. Kali. Laur. Mosch. Op. Puis. Ehodod. Sec. corn. Sep. Stram. Veratr. —slower than the beats of the heart : Cann. Dig. Hell. Sec. com. Veratr. —quick: Aco. Ant. tart. Am. Ars. Asa f. Bell. Bism. Bry. Carbo vog. Coloc. Croc. Dig. Hyosc Ignat. r"'i-l 1^- m lU OliNKUAL JSYMl'XOMJi. lod. Lach. M. uustr. Merc. Nitric acid. Nux voin. I'liosph. I'hospli,. ac. Pulsat. EJxus. Samb. Sll. Spong. Starin. Striiiu. Wulphur. Veratr. Zinc. — imperceptible: Aconit. Ars. Car- bo vey. Coccul. Cupr. Ferr. Ipec. Liich. Merc. Op. Sec. corn. Sll. Stann. Veratr. -irregular: J , . Antiin. crud. Ars. Capa. Chin. Digital. Hyosc. Kali. Lacli. Nat7'. mur. Op. Fhosph. ac, Flumb. Sec. com. Stram. Sulphur. Veratr. —soft: Ant. tart. Am. Baryt. Bel- lad. Carbo veg. China. Coccul. Cuprum. Iodine. Kali. Laur. Merc. Op. Phosphor. Plat. Sec. coru. Veratr. —tremulous : Arsen. Calc. Cic. Kali. Phosph. Bliua. Sang n. S^jig. SHIVERING: Aivii. vlns. Asa feet. Aurum. Bell. Calad. Canth. Caps. Cham. China. Coccul. Croc. Cycl. Fen-. Graph. Hep. Ign. KaU. Merciir. Mezcr. Natr. Nitr. Nux A»m. Pulfi. Rheura. Rhus. Sabad. Sec. coru. Sop. Staph. Valer. Ve- ratr. STRETCHING : Ars. Ipec. N. vom. Rhus. SWEAT, in general: Aco. Ambr. Amm. mur. Ant. tart. Ars. Bur. Bell. Brij. Calc. Canth. Caps. Carbo an. Cai'bo vcget Caust. Chain. Chlor. Chin. Cojf. Con. Dig. Dros. Ferr. Graph. Guaj. Hep. Hyosc. Ignat. Kali. Lye. M. austr. Magn. mur. Merc. Natrum. Natr. mur. Nitric ac. Nux voni. Phosj>h. Phosphor, ac. Puis. Rhoum. Rhod. Rhus. Sabad. 8amb. Selen. Sepia). Sit. Staph. Stram. 3ulph. Tar. Thui. Veratr. IRRITABILITY, bodily: Aeon. Am. Asar. Aur. Bell. Bry. Canthar. Cham. Chin. Coffea. Cupr. Ferr. Hyosc. Ign. Lach. M. arct. Merc. Natr. Kux voin. Phosph. Pulsat. Rhus. Selen. Sil. Spong. Staphys. Veratr. — want of: Anar. Ars, Bism. Calc. Caniph. Carb. vcgct. Cic. C<)n. Croc. Dulc. Ferr. Graph. Hyosc. lyn. lod. Ipec. Kali. LaciL Laur. Lycop. Magn. Merc. Nitric aa. Nux mosch. Oleand. Op. Plios. ar. Rhod. Sec. com. Sep. Stai^h. Stram. Sulph. JAUNDICE : Aeon. Ambr. Ant. crud. Ars. Aur. Aurum mur. IBollad. Bry. Canth. Carbo vcget. Cham. Chin. Con. Croc. Dig. Ferr. Hep. Ignat. Lach. Lycop. Merc. Nitric ac. Nux vom. Op. Pulsat. Rhus. Sulph. Sep. Veratr. • JEALOUSY, ailments from : Ilyos- cyam. Ignat. Lach. N. vom. Phos. ac. Puis. Staph. JOY, consoquoncea of excessive Aeon, Coffen. Op. LANGUOR: Antim. crud. Calc. c Carbo veget. Coccul. Ignat. Iodine. Kali. Lach. Lye. Mcrcur. Mosch. Natr. Natr. imir. Op. Pliosplior, Phosph. ac. Plat. Pulsat. Seleji. Sencg. Sulph. Teucr. Thuj. A^aler. LAZINESS: Alum. Arsen. Baryt. Bell. Bryon. Chhia. Coccul. Guaj. lod. Kali. Laeh. Merc. Mur. ac. Natr. Natrum mur. N. vom. Ole- ander. Phos. ac. Puis. Sec. corn. Se- len. .'.>/-'. Zinc. LIMPING : Boll. Calc. Caust. Coloc. Merc. PiUsat. Rhodod. Rhus. Sep. Sulphur. LOCHIA, morbidly altered : Bellad. Calcar. Con. Nux vom. Plat. Puis. Sec. com. MARASMUS OF OLD PEOPLE: Ant. tart. Bar. Calc. c. Con. Clean. Op. Phosph. Phosph. ac. Rhus. Se- cale corn. MELANCHOLY TEMPERA- MENTS : Ars. Aur. Belkd. Calc. GENERAL HYMPTOMS. U5 I;* China. Graph. Ignat. Lacli. Lycop, Merc. Nalr. Niix voiu. Phospli. iic. Puis. Sep. Sil. ycralr. MOTION, dread of: Ant. tart. Ars. Bar. Boll. Calad. Capn. Chin. Diilc. Hell. I<jn. Lacli. Lye. Merc. Nutr. Natr. mur. Niix voiii. Sulplu Thuj. MUCOUS MEMBllANES, diseases of the: ^l/u»(. ^'iy>/«. Araeuic. Boll. Bnj. Calc. Caps. Caustic, dliam. China. Chlor. Diilc. Euplu-. Fluor. av. Hep. Ign. Lye Merc. Mi;r. ac. Natr. miir. Nitric acid. Niixvom. Phosph. Pulsat. Rhus. Saugii. S^p. Sil. Stann. Snlpli. Sulpli. ac. MUSCULAR TWITCHINGS: Am- I bra. A.^d f. Boll. Clem. Coloc. Croc. Cuprum. Graph. Tod. Kali. Lach. Mezer. Natr. Natr. nmr. Plat. Bhus. Secale corn. Sil. Sponcj. SiUpluu:. Sulph. ac. Viola tr. Zinc. GLANDULAR AFFECTIONS: Ammoii. mur. Apis, Arsenic. A^u; Baryt. Bell. Calc. carb. Carbo an. Carbo ve<jet. Cham. Coccul. Con. Dale. Graph. Hop. lod. Kali. Lijc Merc. Natr. Natr. mvir. Nitric ac. Nux vom. Phosph. Phos. ac. Plumb. Ban. bulb. Bhun. Bcp. Sil. Spong. Staph. Sulph. Sulph. ac. Thuj. GOUT: Aeon. Ant. crud. Arg. Aryi. Ars. Asa f. Aiir. Baryt. Bell. Bry. Calc. carb. Calc. phosphor. Caps. Carbo an. Carbo vcg. Canst. Cham. Chin. Colch. Dig. Dulcom. Fcrr. Graj)h. Hep. Ignat. lod. Kali, car- bo7i. Kali bichr. TiCd. liVc. M. austr. Merc. Mezer. Natr. Natrum mur. N«x vom. Phosjihor. Puis. Khodod. Rhus. Sabina. Sassap. Seji. Sil. Spong. Staphys. Sulph. Thuj. Ye- ratr. Vit. Zinc. ■ GRASPING AT FLOCKS: Arson. Bell. Hell. Ilyosc. lod. Muriat. ac. Op. Phosph. ac. Rhus. Strain. BHEATED, consequences of getting : Aeon. Bell. Bry. Calc. Carbo. veg, KaU. Lyv. Nux vom. Pula. Sil. HEAVINESS OF THE BODY; Cliin. Lach. Kah. Natr. Natr. mur. Phosph. Sup. Stann. HUNGER, ill effects of: Ant. crud. Ars. Bry. Calc carb. Chin. Ipec. Pids. Sulph. HYDROPHOBIA: Lobelia. Arsen. Boll. Canthar. ifycsc. Lach. Phos. Stram. HYPOCHONDRIA: Asa foot. Aur. BeUad. Calc. Cauth. Caust. Cham. Cina. Coccul. Con. Fcrr. Graphit. Igiiatia. Iodine. Lach. Lye. Magn. mur. Merc. Mill. Mosch. Natrum. Natrum mm-. Nijc moHcli. N. vom. Phosph. ac. Plat. Puis. Sabin. Sep. Staph. Sulph. Valcr. Veratr. HYSTERIA: Agn. Asa f. Aurum. Bell. Calcar. Caustic. Coccul. Con. Ignatia. Lach. Nux luosch. Phosph. Plat. Puis. Sep. Sil. Sulph. Valer. Viola od. INDURATIONS: Arn. Ars. Aur. Bell. Calc. Camphor. Carbo an. Cham. Chin. Clem. Con. Dulc. Ferr. Grapliil. Hep. Iodine. Lach. Lye. Magii. mur. Pliospli. Plumb. Puis. Sep. *S'//. Sulph. Thuj. INFLAMMATIONS: Aeon. Antim. Q.v\\(!i.Anl. tart.kvn. Arsenic. Bell. Bry. Calc. Cannab. Canth. Carbo voget. Chum. Co7i. Creos. Cupr. Dig. Dros. Dulc. Euphorb. Euphr. Hcpar. ITyose. lod. Ipecac. Kuh. Lach. Lye. Mugu. carb. Mere. Mur. ac. Nitr. Nitr. ac. Niix vom. Phos. Plumb. Puis. Filuis.Ruia. Sec. com. Sep. Spong. Squill. Sidph. Sulph. ac. Veratr. NERVOUS EXCITEMENT : Ambr. Bell. Calc. c. Cham. Chin. Coffea. Ferr. lod. Laur. Merc. Nux vom. Phosph. Phosph. ac, Pxds. Bhus. Sep. Sulph. Valer. Voratr. Hr 140 GKNliRAL SYMPTOMS. NEUBALGIA : Aeon. Amic. Arsen. Bellad. JJnj. Calc. Capsic. Cham. Cocvul. Cofl". Colchic. Hep. Igiiat. Kali. Men: 'Mezer. Na I r. Nnx voni. Puis. Rhus. Spig. Staph. Sulph. Thuj. Valer. Veratr. NODES, gouty : Aiitlm crud. Arnica. Bryon. Calc. carbon. Calc. Fhospli. Oaust. Graph. Hepar. Led. Lyoop. Mercur. Nnx vom. Pulaat. Rhodod. Bhus. Staph. Sulph. ONANISM, consequences of: Calc. Carlo veg. Carbo animal. China. Coccul. Con. Kali. Lach. Lycop. Merc. Natr. Natr. mur. Nux vom. Oleand. Plios. Phosph. ac. Pulsat. Bhus. Sil. Staph. Sulph. Thuj. PAINS, wandering : Am. Bell. Chin. Mang. N. mosch. Puis. Rhod. Bhus. Sabin. Sep. Sulphiu-. PABALYSIS : Anac. Am. Asar. Bar. Bell. Bry. Calc. Caps. Carbo veg. Caust. China. Cic. Core. Con. Croc. Crot. Dig. Dit/c. Ferr. Fluor. acid. Hyosc. Ign. Kali. Lach. Laiir. Lye. Magn. mur. Merc. Natr. Natr. mur. Nitric ac. Khx vom. Oleand. Op. Phosph. Plumb. Pulf. Rhus. Sec. corn. Sil. Stann. Strain. Sulph. Veratr. Zinc. PHLEGMATIC TEMPEBA- MENTS : Bell. Caps. Chin. lod. Lach. Merc. Natr. Natr. mur. Nitric ac. Puis. Sulph. PLETHOBA : Aeon. Arn. Aur. Bell. Bry. Calc. Chin. Dig. Fsrr. Graph. Hyosc. Kali. Lycop. Natr. mur. Nitric ac. Nux vojn. Phosph. Puis. Bhus. Stram. Sulph. POISONING WITH ALUM: Puis. Veratr. — with arsenic : Carbo veget. China. Ferr. Hep. Ipec. Lach. Lye. Nux vom. Sulph. Veratr. — ^with lead: Alum. Bell. Nux vom. Op. Plat. ^ — with eolchieum : Coccul. Nux vom Puis. — with iron : Ars. Hep. Ipecac. I'uls. — with adipic poison : Ai'seriic. PIioh. acid. — with! fish-poison : Bell. Camphor. — with honey: Camph. — with iodine : Arsen. Bellad. China. Phosph. Sulph. — with toad-poison: Ars. (?) — with copper: Bell. Hepar. Ipec. N. vom. — with ojiium : BeU. Coff. Nux vom. — with phosphonxs : Coff. Nux vom. Sulph. — with mushroom : Carbo veget. Coff. Puis. — with mercury: Am. Aur. Bell. Carlo veg. Cham. Chin. Diilc. Hep. Iodine. Kali^ bichr. Lach. Lye. NItr. nc. Mezer. Phos. ac. Sil. Staph. Sulph. Thuj. — with sal. ammoniac : Coff. N. vom. — with sarsapariUa : Bell. Merc. Sulph. — with acids: Aeon. liry. Op. Puis, — with sulphui' : Arsen. Mercur. Puis. Sil. — with stramoniimi : Coff. Hyoscyam. Nux vom. — with poison-vine : Bell. Bry. Merc. Suljjh. — with alcohol : Coff. Nux vom. — n-ith sausage-poison: Arsen. Bell. Bry. — with tin : Carbo veget, Hep. Puis. P.'-f.EGNANCY, ailments incident to : Aoo. Bell. Bnj. Calc. Cha ). Con. Hyosc. Lach. Lye. N. >o:si. Phos. Plat. Puis. Sep. Sulph.^a- ratr. BAPHANIA: Arsen. Bell. China. Hyosc. lod. Op. Bhus. Secale corn. Sol. nigr. Stram. BHEUMATISM: Aco. Arn. Ars. Bell. Bry. Carb. veg. Caustic. Cham. China. Colch. Hep. Ignat. KaR GRNEUAL SYMl'TOMS. 141 hichr. Lach. Lye. Merc. Nitric ac. Niix vom. I'lilsat. Rhodod. KInis. Sassap. ^Sf'.^). tSpigel. Siilpli. Tliiij. Veratr. RIDING IN A CAKRIAGE, ail- ments from : Ara. Carbo veg. Coc- cul. Colch. Ferr. Ign. Natr. Petr. Psor. Sil. Sulph. PJCKETS: Asa f. Bell. Calc. c. Calc. phospli. Lye. Mere. Fhosph. Pulsat. Rhus. Silic. Sulpli. SALT, ill effects of eating too much ; Carbo veg. Merc. Nux vom. SANGUIN TEMPERAMENT: Aeon. Arn. Bry. Bell. Cham. Hyoscyain. Ign, Nux vom. Rhus. Sulph. Sulph. ac. Veratrum. Zinc. SOURVY: Amm. mur. Ars. Aur. Bor. Calc. Carbo an. Carbo veg'. Creos. Hep. lod. Mercur. Mur. ac. Natruni mur. Nitric ac. Nux vom. Slllc. Staph. Sulph. Sulp]t. ac. SEA-SICKNESS: Ars. Coccul. (!reos. Ipecac. Petr. Rhus. Sulph. Veratr. SEDENTARY HABITS, iU eflFects of: Aco. Carbo veg. Calc. Ignat. Natr. Natrum mur. N. vom. PuLs. Sulpli. 8EMILATERAL AILMENTS, left side: Aeon. Alum. Amm. mur. Apis. Arn. Asa f. Asar. Bry. Calc. Cann. Chin. Cic. Colch. Coloc. Croc. Cupr. Daph. Dulc. Ign. lod. Lach. L]fc. Mercur. Natr. Nitric ac. Nux mosch. Nux vom. Petr. Phos. Bhod. Selen. Sep, Spig. Sulphur. Sulphur, ac. Tar. Tart. emet. Thuj. Veratr. Viola od. —right side : Agar. Alum. Bar. Belh Bism, Brom, Bry. Canth. Carbo an. Caust. Cina. Con. Crot. Dig. Dros. Hepar. Ignat. Kali. Led. M. arct. Mosch. Oleand. Phosph, ac. Plumb. Rhns. Ruta. Sabad. Sabina. Sangn. Sil. Spongia. Staph. Stront. Sulph. ac. Tai-t. emet. Thuj. \'it. —cross-wise : Affar. Mangan. Sil. SENSATION AS IF BLOWN UP- ON BY WIND : Nux vom. OU. audcr. Rhus. Stram. —as if congealing: Bellad. Cic. Cin. Dros. Hyosc. Led. Puis. Sec. com. Sir am. —as if growing larger : Af»a feet. Bell. Ignat. Laur. Phospli. Puis. Rhus, —as of a hair: Lycop. Natr. vinr. Sulph. —as of growing smaller : Calc. Croc, —as of something alive: Croc. Ign. Lach. Mercur. Sec. com. Sulph. Thuj. SPANISH FLIES, iU effects of : Cam ph. SPASMS, generally : Aeon. Ang. Arn, Ars, yl«a /. Bell, Bry. Calc. carb. Campli. Caust. Chain. Cic. Cina. Coccul. Coff. Con. Croc. Cupr. Hell. IIjosc. Ign. Ipec. Lach. Laur. Lycoji. Merc. Mosch. Nii.v mosch. Nux vom. Op. Plat. Plumb. Puis. Rhus. Ruta. Sec. corn. Stanii. Strani. Sulph. Tart. emet. Veratr. Zinc. — in the evening : Caust. Cina. Laur. Nux vom. Puis. Stann. Stram. — with anxiety : Ars. Bell. Calc. Cham. Cin. Cupr. Hyosc. Ign. Lach. Puis, Vei^atr. — with dyspnoea : Ang. Bell. Camph. Cupr. Ign. Ipec. Nux vom. Op. Pids. —■with staring eyes : Bell. Hyoscyam. Nux vom. Op, Sec. corn, Stram. — with contortion of the eyes : Aeon. Bell. Coccul, Cuprum. Hyosc. Igii. Lach. —with upwards: Bell. Ignat. Lach. —with downwards : Cic. Lach. —with sidewise : Bell. Caust. Hyosc. Lach. — glazed eyes : Coccul, —half open eyes : Caust, Cina, Ipec. —with eyes protruded : Hyoso. 148 OENERAIi SYMPTOMS. -with ejes closed: Bell. Cham. Coc- cul. Croc. Hyosc. Merc, Nalr. mur. Op. -after repelled eniptiona : Calc. Canst. Lach. Nixx vom. Sivlph. -with bloated bowels : Calc. Cham. Ciu. Merc. -wi^h violent movements : Calc. Cln. Cupr. Hell. Hyosc. Op. Stram. -from contact : Bell. Coecul. Stram. -with loss of sense : Bell. Carapli. Cic. Clua. Cupr. Hyosc. Ign. I'liei: Loch. Niix vom. Op. Sil. Stann. Stram. -with nausea : Ipec. Nux vom. Puis. Tart. emet. Veratr. -with clenched thumb : Bell. Hyosc. Ign. Lach. Merc, -with delirium: Bell. Crot. Hyosc. Op. -with diarrhoea : Chin. Hyosc. -with thirst : Cham. Nux vom. -with eclampsia : Bell. Caust. Chain. Cic. Cin. Ignat. Hyosc. Laur. Nux mosch. Nux voin. Op. Phosph. Sec. corn. -epileptic : Agar. Ars. Bell, Calc, c. Camph. Causth^ Cham. Cic. Cina. Coecul. Cupr. Glon. Hepar. Hyosc. Ign, Lnch, Merc. Nitr. ac. N. vom. Op, Plumb. Puis. Rhus. Sec. com. Sil. Stann. Strain. Sulph. Verat. -with vomiting: Cupr. Ipecac. Nux vom. Puis. Sec. com. -with danger, of suffocation : Cupr. Ign. Nux vom. Op. -with yawning : Ign. Veratr. -after emotions : Ballad. Coff. HyoB- cyam, Ign. Nux vom. - with pale face : Ipec. Natrum. Sil. Stann. -with blue .face: Camphor. Cupr. Cin. Op. Veratr. -yellow face: Cic. Nux vom. —red face: Bell. Ign. Stram. -with cold sweat in the face : Cocc. —with distorted features : Belladona Cham. Coecul. Ipecac. Stram. Ve- ratr, — with invohmtary emission of ixrine : Caust. Coecul. Hyosc. —with palpitation of the heart: Lach. Sec. corn. Spig. — with heat : Boll. Cham. Nux vom. — with seausation of hunger : Hyosc, — hysteric : A^ir. Belladona. Caustic Cham. CoccnJ. Coff. Cupr. rsn.atia. Ipec. Mosch. Nux vom. Plat. Puis. Slrnm. Veratr. — internal: Calc. carb. Caust. Cocc. Coloc. Graph. Ipecac. Ma(jn mur. Stann. — with deUrium: Bell. Ciu, — with coldness of the body: Cin. Hyosc. Puis. Veratr. — with coldness of thelimbs : Caust. Hyosc. Op. Veratr. — cataleptic : Agar. Bell. Cham. Cic. Hyosc. Ipec, Strain. Veratr. — with locked jaw: Bell. Hyoscyam, Lach. Ntix vom. Opium. Plat. Ve- ratr. —of children : Bellad. Calcar. Cham. Cina. Coffea. Ipec. Nux vom. Op. Sulph. — clonic : Agr. Ambr. j!i rnica. Arsen. Bar. Bellad. Calc. Camph. Canthar. Caust. Cham. Cic. Cina. Coecul. Con. Cupr. Hell. Hyosc. Ign. Ipec. Laches. Kali. Magn. Merc. N. vom. Op. Phosph.iJ/ms, Sec. corn. Sepia;. Stann.] Stram. Sulph. Veratr. — with movements of the head : Bell. Cham. Cic. Hell. Lach. Op. Stram, — opisthotonic : Ign. — preceded by head-ache: Bell. Hy- oscyam. Lach. Nux vom. — succeeded by head-acho: BeUad. Cina. — with contraction of the hmbs : Hy- oscyam. —with laughter: Bellad. Ca/c. CatMt Ign. Lach. GENERAL SYMPTOMS. U9 . with creeping as of a mouse: Bell. Sulph. —with colic: Caustic. Cham. Cin Ciipr. Merc. Sulph. SWEAT, anxious: Am. Ars, Calc. Oliam. Terr. Igu. Merc. Natr. Niix voiii. Phos. Puls.Jilms.^Sep. Spong. Stramon. Sulph. Veratr. —bloody : Lach. Lye. Nux vom. —musty smell : N. vom. Puis. Rhus. —exhausting; Ambra. Arsen. Bryon. Calc. Carbo an. Chin. Digit. Ferr. Hep. Io«l. Lye. Mercnr. Natr. mur. Nitric acid. Nux vom. Phosphor. Sninb. Sep. Staun. Sulph. Veratr. —fatty: Bryon. China. Merc. Selen. — staining the hnen: Ars. Graphit. Merc. Selen. — yellow: Graph. Lach. Merc. — somilateral : Cham. Chin. Nux vom. Piilx. —smelling like juniper : Sep. — cold: Aeon. Amm. mur. Ant. tart. Arn. Ars. Bryon. Calcar. Camph. Cannab. Carbo veg. China. Cin. Coccul. Ciipr. Dnlc. Hell. Hep. Ign. Ipec. Lach. Lye. M. arct. Mercur. Nux vom. Piih. Rheum. Ehus. Sa- bad. Sec. corn. Sep. Staph. Sulph. Veratr. — smelUng like old cheese : Plumbum. — viscous : Aeon. Ant. tart. Ars. Bry. Cham. Daph. Ferr. Hep. locJ. Lye. Merc. Phosph. Phosjjh. ac. Plumb. Sec. corn. Veratr. ' -red : Arn. Cole. Dulc. Lycop. Nux vom. -sour smelling : Arn. Asar. Bellad. Cham. Ferr. Hep. Ignat. loil. ipec. Kali. Xj/c. Merc. Nitric ac. Rhus. Sep. Sil. Sulph. Veratr. —stinging: Cham. Con. —fetid : Ammon. mur. Baryt. Canth. Con. Dulc. Ferr. Fluor, ac. Graph. Hep. Kali. Led. Lye. Mere. Nitric. ac. Nux vom. Phosph. Puis. Ehus. Selen. Sep. Staph, Veratr. —having an urinous smell: Canthai. Nitric ac. —smelling like onion : Bov. Lycop. —in the morning: Op. Nux vom. Plat, —with open mouth : Mosch. Op. —with distorted mouth: Bellad.'Sux vom. Op. Siram. — followed by weariness : Bell. —at night: Bell. Calc. carbon. Calc. caust. Cham. Cin. Ign. Merc. Op. Sulph. —during new-moon: Calc. Caustic. Cupr. Sil. — falling down unconscious: Bell. Cupr. — after onanism: Calc. China. Coo- cul. Lach. Lye. N. vom. Op. Staph. Sulph. Veratr. — with dilated pupils: Bellad. Calc. Cic. Cin. — during the menoes : Coccul. Cupr. Ignat. Nux vom. Plat. Puis. — with rattling breathing: Ipec. Lach. Nux vom. — in the back : Bell. Ign. Ipec. Op. Rhus. — falling backwards: Bell. — with froth at the mouth : Chamom. Cupr. Hyosc. Ign. Lach. Nux vom. —with froth at the mouth, bloody: Lach. Op. Pyrocarb. —during sleep : Bellad. Calcar. caust. Cin. Sil. —followed by drowsiness: Bell. I>ros. Ign. Lach. Op. —after a fright : Bellad. Coffca. Ignat. Lach. Op. Nux vom. Veratr. —with a scream : Cina. Crot. H«osc. Lach. Nux vom. Op. Sulph. —followed by weakness : Bell. Calc. Cic. Sec. corn. Veratr. —with sticky sweat on the head: Camph. —tetanic: Aconit. ^rs. Bell. Camph. Cic. Cupr. Ign. Ipec. Laur. Op. ^^ m 150 GKNEUAI. HYMPTOMS. Plat. Rhus. Secale com. Stram. Vcratr. — Saint Vitixs' dance, chorea: licll. Canst. Cocml. Croc. Cupr. Jfiio.-^c Tgn.'Lach.. Jjaui. Nuxvom. (Stram. Zino. — after an injury : Am. PiUsat. Rhub. Snlph. —alternately reel and pole : Igii. — ^vitk crying : Hell. Caust. Cuprum. Ign. Lach. Puis. •of lying-in females: Bell. Chamom. Coff. Hyosc. Ign. Puis, •-caused by worms: Calc. Chi. Hy- osc. Merc. N. vom. Sulpli. —dentition: Bell. Calc. Cofif. Cham. Ign.,Jlfer('. Sulph. — with gritting of the teeth: Cin. Coff. Hyosc. — \vith trembling : Cupr. Lach. —with twitching: Bell. Calc Caust. Cham. Clna. Cuprum. Hyosc. Ij,'ii. Ipecac. Lach. Merc. Op. Plumb. Rhus. Sec. com. Stram. Sulphur. Veratrum. SPIRITS OF CAMPHOR, ill effects of: Coff. Op. STRAINING BY LITTING, ill ef- fects of : Am. Bryon. Calc. Coccul. Con. Graph. Lye. Natr. Niiric ac. Nux vom. Phosph. Phos. ac. Rhus. Ruta. SU. Sulph. Sulph. ac. SWEAT, ill effects of suppression of sweat: Aeon. Bell. Bry. Cham. Chhi. Dulcam. Lach. Nux vom. Pulsat. SU. Sulpli. TEA, ill effects of: China. Ferrum. Lach. THIRST : Aeon. Ars. Bellad. Bryon. Canth. Cham. Ipecac. Merc. Nux Tom. Puis. Ehus. Sulph. Veratr. TOBACCO, ill effects of: Cham. CoccuL Nux vom. UNEASINESS, bodily: AconUum. Anac. Ar.s. Asar. Bellad. Bry. Calc. Cann. Curbo vt-g. CliHin. Chin. Cof- fcu. Croc. Cupr. Fcrr. Graph. By- oscyam. Ljn. lod. KuU. Lijcop. M. austr. Merc. Mur. ac. Natr. N. vom. Op. Phos. Plat. Klnis. Samb. Sep. Sil. Staph. Stram. Sulph. I'cratr. VASCULAR ERETHISM: Aconit Anibra. Am. Aimim. Bellad. Bnv Bry. Cidc. c. Carbo veget. Caustic. China. Con., Crews. Ferr. IIcii. lod. Kali. Lycop. Natrum mur. N. vom. Op. Petr. rhosph. Rhus. Sassap. Septic. Sil. Slann. Sididi. WALK, difficulty of learning to walk : Calcar. Mcrcur. Sil. SuliiJi. WEAKNESS, general: Agar. Amm. Aiiac. Arn. Ars. Bell. Brom. Calc Carb. an. Carbo verj. China. Cocc. Conium. Ferr. Fluor, no. Grnpldt. Ipecac. Kail. Laicli. Lycop. Mugn. mur. Merc. Natr. Natr. mur. Nitric ac. Nux vom. Oleand. Op. Phosph. Phosph. ac. Plat. Puis. Ilhus. See. corn. Scpiso. Sil. Staph. Sul^jhur. Veratr. WEANING, ailments from: Bellad. Bry. Calc. Puis. WEARINESS : Arn. Ars. Bell. Calc. Cann. Caust. Chin. Coccul. Coffea. Con. Croc. Ferr. Graph. Hep. Ign. Ipec. Kah. Lycop. Merc. Natr. Nux vom. Oleand. Phosi:)h. Plat. Puis. Rhod. Rhus. Spong. Sulph. Tart. em. Thuj. Veratr. — consequences of : Arn. Bry. Cojf. Rhus. Puis. WHITE, red parts turning: Arsen. Bor. Calc. Ferr. Hell. Mei-cur. Ni trie oc. Nux vom. Phos. Secale com. Staph. Sulph. Sulph. ac. WOUNDS : Arn. Calendul. Hyper. BURNS: Arnica. Urtica. PAIN FROM BURNS : Ars. Causi II. r'- INDEX. INDEX TO UEPEllTOltY, Oil LIST OF SYMPTOMS. Abdomen, morbid symptoms in 37 Abscesses >. i27 Acne rosacea 17 Acid stomach 35 After pains, abnormal 95 Aggravation of pains 132-137 Amaurosis 9 Amelioration of pains I37 Auremia 140 Aneurysm 140 Anger, etlects of 3 Anus, excoriated 77 Anus and rectum, affections of 77 Anxietyand fright, eflects of 3 Aphonia, loss of voice 56 Aphthsn , 24 Apoplexy 140 Apparent death 140 Appetite, loss of 29 Arms and armpits.... 102 Asthma 45 Atrophy.. 140 Aversion to various kinds of food and drink 29 Axilla3, symptoms in 65 B Back, morbid feelings in re- gion of 70-71 Bad effects of food or drink. 30 Ball, hysteric 25 Bed sores 122 Black pores on nose 16 Blackness of vision, sudden 9 Bladder, affections of 85 Bladder, catarrh of the 85 Bladder, inflammation of. . , 85 BloN'hes 122 Blue disease 140 Blurred sight 9 Bones, afiections of 140 Brain, concussion of 5 Brain, inflammation of 5 Breath and breathing, abnor- mal Ah Burns ■//; i^y Calves of the legs, symptoms of Cancer of the breast. . . '. '. .' .' .'.' Cancer of the lips Cancer of the nose Cancer of the stomach Cancer of the tongue Cantliaris, ill eflects of Cardialgia Carles Cataract ..\ Catarrh * Cutarrh, accompanying ail- ments of Catarrhal fever Cliagrin, consequences of. ... Chapping of lips Chaniomilla, ill efi'ects of. . . Chest, morbid symptoms of. Chilblains China, ill effects of Cholera, Asiatic Cholerine Colic, various kinds of Color, illusions of Comedones Confinement, ailments dur- ing and after Consciousness, loss of Constipation Contusions Cornea, spots on Coryza Cough, various kinds of.. . . . Cough, causes of Cough, accompanying ail- ments of Cracking of skin Cracking of tongue Cramp of the stomach Croup, disposed to.... 121 21 10 35 27 147 38 140 9 44 42 140 21 140 61 121 140 141 141 38 9 122 95 1-2 74 141 11 42 51-59 51-52 53-50 122 27 35 2a If; ill It 151 152 INDEX TO REriOUTORY. Croup, variouH forms of 57-68 Croup, k'augrenous 25 Cruata lactu 19 D Deafness 15 Debility, nervous 141 Delirium 2 Desire for certain kinds of food and drink 20 Diabetes insipidus 82 Dlarrli(ra 74 Dilation of pupils 12 Dreams 1,31 Dropsy of the abdomen 39 Dry coryza of Infanta 141 Dysentery 42 E Earache 14 Ears, inflammation of 15 Ears, pains in 15 Ecchymosis in eyes 11 Emotions, causing disease. . 3 Epistaxis. 16 Eructations 31 Erections 90 Eruptions on various parts. 8-21-19 Erysipelas 125 Erysipelas of mammte 60 Erysipglas of scrotum 89 Eyelids, paralysis of 13 Eyelids, spasm of 13 Eyelids, inflammation of.. . . 13 Eyes, affections of the 9 Eyes, inflammation of the, . 11 Eyes, swollen 12 Eyes, ulcerated 13 Exhaustion from mental la- bor 2 Expectoration, various kinds 50-51 Extremities, symptoms of. .. 102 Extremities, lower, symp- toms of 112 Extremities, upper, symp- toms of 102 F Face, eruption in 19-21 Face, swelling of 18 Fat, tendency to get 142 Fear, consequences of 142 Feet, symptoms of 116 Feet, dorsum , symptoms of , . 118 Feet, soles, symptoms of,... 118 Females, diseases of, 92 Fever, bilious 142 Fever, catarrhal, 42-142 ' " " 142 142 142 142 142 142 Fever, dentition. Fever, gastric Fever, hectic Fever, milk Fever, puerperal,. Fever, rheumatic. Fovor, wound Fovor, y«'l[()w ' I'ovor, j)iirticular svmptoma of Figwarts at anus V* Figwurts on private parts... Fin,,'('rH, Hvniptoms ot Finger Joints, symptoms of.. Finger nails, symptoms of.. Finger ti|)S, symptoms of. . . Fitful...........: Fistula lachrymalis Fistula dentalis l''reel<Ies T'orebodings Freezing, consequences of.. . Fright Fungi, articular, hsematodea, meduliaris Fungus, hjematodes of eye. . Cfanglia (Jaugrene (Jlans, atlVctionsof the (Jlands, aflcctions of 59- Glaucoma (loitre Gonorrhoea Gout Gravel Grief, ill effects of. H Hemorrhage from earb Hemorrliage from eyes Hemorrhage from nose Hemorrhage, uterine Hands, s.ymptoms of Hang-nails Hard hearing Head, peculiar sensations in external Head, trembling of Headache Headache, various forms of. Hearing, defects of Hearing, illusions of Heart, inflammation of Heart, affections of, aggra» vated by Heartburn Heels, symptoms of Heineralopia Heniicrania Herpes Herpes in face Hip joint Hoarseness Hunger, abnormal Hunger, ill effects of Hj'drocephalus Hydrophobia Hypochondria 142 142 142 75 94 109 111 112 HI 1 14 23 18-125 2 142 3 119 11 12.5 87-125 87-88 60-146 % 59 87 145 86 3 15 11 "8 94 107 112 15 6 9 6 6 15 10 G7 67 32 115 9 (.' 123 li) 118 57 30 145 6 145 145 INDRX TO nKPERTOnv. H ypocliondriac region, mor- bid sdiisiitions in tlio Hystoriii Hysteric ball. I 1 llusiona of color 1 llusions of hearing . . , I llusions, optical Illusions of size, shape, dis- tance Illusionboftiiingsnotprps'nt Indurations InHammations Inllaunnation of bladder.... Inllammation of tlie bowels. Inrtammation of the ears . . . Inl'.ammation of the eyes... Inllammation of eyelids Inllammation of the heart. . Inllammation of the larynx. Inllammation of mamma!... Inllammation of mouth Inflammation of nose Inflammation of ovaries Inflammation of palate Inflammation of pharynx. . . Inflanuimtion of the tongue. Inflammation of trachea. . . . Inflammation of urethra — Insanity.. Intoxication Ischuria Itch Itching of scalp 37 4-145 25 9 10 10 10 10 145 145 85 39 15 11 13 G7 51 GO lir, 10 04 35 2() 28 57 86 2 1 S3 12(5 Jaundice 18- Jaws, affections of the Jealousy Jealousy, ailments from joy, consequences of K Kidneys, affections of Knee-joints, symptoms of. .. L Lachrymation Larynx, inflammation of... Xiarynx.morbid sensations in Larynx, phthisis of Lips, affections of the Jiips, cancer of the Lips, eruptions on I iips, rhagades of Lips, swelling of Locliia, derangement of Long-sighted Loss of blood between peri- ods Loss of consciousness. ...... Loss of voice, see aphonia .. Lumbago, see small of back. 58 -144 144 144 86 119 11 57 56 57 21 21 21 22 22 144 12 95 2 56 12 M Mammjc, cancer of Maumia), erysipelas of Mamma), inflammation of. .. Mammre, swelling of Mammary glands, afl'eetions of >ilc:isles JNIemory, defects of Meningitis Menses, character of Mental dorungements Micturition, nocturnal Micturition, abnormal Micturition, at night in bed Miliaria Milk, defects of Mi nddorangementand weak- ness of Miscarriage Moles ;Moles in utti. aS, see polypi . . Ikloutli, aft'octions of the Aloutli. inflammation of Mucus, dropping of, fnmi pos- terior nares N Nape of the neck, stii". Neck, stiff Nervousness Neural<,na Nii)pleH, affections of Nii)ples. sore Nodes gouty Noma Nose, affections of Nose, dry ^" e, inflamed ,se, polypus of the .^ose, st()pi)age oT Nose, Hwelling.oi the Nose, ulceration of o Ol^scu ration, see blackness. . Onanism, consequences of. .. Opisthotonos Optical illusions Ovaries, atl'cctions of Ovarian dropsy P Pains, spurious labor Tains, wandering Palate, afl'eetions of Palpitation Paralysis Paralysis of eyelids Pellicle on the eyes Penis, affections of — Perineuui, affections of, see anus • Pharynx, affections ot 96 108 06 66 ()6 66 ()6 123 3 5 97 3 82 s;{ 83 124 66 1 91 125 91 24 25 72 60 60 145 146 66 66 146 1ST 16 42-48 16 17 43 17 17 11 146 72 10 94 94 95 14(i 25 57 14fi ];; 12 81 79 25 i|.' 154 INDEX TO RErKRTCnY. Pharynx, Inflammation of.. 26 Ph()toi)hobia 10 Ph tliiHislaryngea, (see Phthi- sis of larynx). 57 Pimples in faco 20 Pityriasis 120 Placenta, adhesion of 95 Plethora 146 Poisoniot? with various sub- stances 140 Polypi Of the nose. ..;► 17 Pores, olack 126 Pregnancy, ailments inci- dent to 146 Prepuce, affections of. 88 Prosopalgia 20 Prostate gland, affections of 90 Pudendum, affections of ex- ternal 92-93 Pupils, contracted ... 12 Pupils, dilated 12 Ftyalisni (see salivation) 27 Purple rasli 124 Pus, various kinds of 126 Pustules 124 Q Qualmishness 33 R Rage 4 i;aphania M6 IJash 124 Regurgitation, (see Rising).. 32 Reports in ears 16 Rh.'igadesof lips, (see Chap- ping) 21 Rhachitis 147 Rheumatism 146 Rickets 147 Risings 32 Rubeola 124 Rush of blood 6 S Saliva, morbid 26 Salt, ill effects of 147 Scaly head 9 Scales on scalp 9 Scapula?, morbid feelings in region of 10 8oarlet-rasii 12^1 Scrotum, ii (Ret ions of 89 Scurfs on head 9 Scurfs in noso 17 Scurvy 147 Seasickness 147 Sedentary habits, ill-effects of... 147 Sediment in urine 81 Semen, morbid character of the 91 Sexual desire, unnatural — 92 Sexual instinct of females, excited ••• 95 Sexual intercourse of females aversion to 9,") Sexual weakness 92 .Shortsighted 10 Shoulder joints, symptoms of ]04 Skin, character of the 122 Skin, symptoms of 12:> Sleep, character and accom- panying conditions of 128-1 L'. Sleeplessness l;!i' Small of back, morbid sensa- tions in Tii Smallpox Wi Sneezing 4". Somnambulism 4 Sopor 130 Sore nipples 60 Sore throat, see also Angina faucium , 25 Spasms 147 Spasm of the eyelids 13 Spasms, uterine 'J i Speech, impeded 2.S Spermatic cord, affections of .'ill Spine, curvature of 7! Spots 124 Spots on cornea 11-12 Squinting 12 Stammering 28 Stiff neck 60 Stomach, acid 35 Stomach, cancer of 35 Stomach, cramp of the 35 Stomach, schirrus of 35 Stomach and pit of stomach morbid sensations .. ^5-36 Stone in bladder 85 Stool, ailments accompany- ing 76 Stool, character of 73-75 Stoppage of nose 43 Stuttering 2S Styes 14 Suftbcative fits 47 Suicide, disposition to i Sweat 149-150 Sweat, ill effects of suppress'd l-)(j Swellings 1-7 Swelling of eyes 12 Swelling of eyelids 13 Swelling of face IH Swelling of lips '^■i Swelling of mammae OO Swelling'- of the nose 17 Swell i n^ of the ovaries 104 Swelling of tongue 2S Sycosic warts l--» T Tarsal joints, symptoms of. . 118 Taste, morbid '50 Tea, ill effects of 150 Teeth and gums, affections of the 2.3 INDEX TO RKPEUTOUY. Teething 23 Temper, defects of \ j Tenesinus of anus '.* 77 Testicles, ullections of 88 Tbighs, symptoms of 119 Thirst, abnormal '. 30 Tibia, symptoms of 120 Tobacco, ill eflects of 150 Toes, nails and jc nts 120-121 Tongue, affections of 27 Tongue, cancer of the 27 Tongue, cracked 27 Tongue, inflammation of 28 Tongue, swelling of 28 Trachea, inllammation of.. , 56 Trachea, morbid sensations in • 57 Trembling of the head 9 Typhus, abdominal 142 Typluis, cerebral 142 Typhus, putrid 142 u [Jlceration of eyes 13 li Iceration of the nose 17 lUcers 41 T Ireth ra, afiections of 85 Urethra, discharges from. . ,. 86 Urinary organs, afiections of 79 Urinate, urging to 82 Urine, morbid sensations ac- companying the emission of 83 Urine, quality of 79-82 Uterus, diseases of 93 Uterus, falling of Uterus, hemorrhage from..". Uterus, inilammation of. Uterus, putrefaction of Uterus, spasms of V Vagina, afTections of Vagina, inllammation of Vanishing of sight, see black- ness Varicella ....*".". Varices Varices at anus '. Vertigo '* Vertigo, accompanying ail- ments of Vision, sudden blackness of. Vomiting Vomit, inclination to w Wandering of the mind "Waking, see sleeplessness. . . Warts Weakness, general Weak back W^eak digestion Weakness, sexual Weaning Wounds Wrath Wrist-joints, symptoms of ' z Zona 155 !)-! 9-1 94 94 94 9.'] 93 11 12.': 128 79 4 5 10 34 33 3 130 125 150 72 35 92 150 128-150 n 106 il t 125 GENERAL INDEX. A bdomen, pain in the tJibdomiiial deformity after labor Abdomen pendulous Abdomen, diseases of Abortion (see miscarriage)... Abscess of the liver Abscess PsousPsoitis Abscess neucleatus A bilious constitution Acclimation Accessory or palliative treat- ment Aching pains in the back (Lumbago) Accidents of various kinds... " rules for restoration after drowning Accidents, to excite breathing after Acidity, sour stomach during pregnancy Acidity, sour stomach, etc., of infants Aconite as an external appli- cation A constitution in which the skin is liable to become dis- eased Acute contagious diseases Acute articular rheumatism. Acna Rosacea— Gutta rosacea Adenitis (see inflammation of the glands) Administration of Homoeo- pathic medicines A dry wiry constitution A feeble constitution After edects of small pox After efTeets of scarlet fever.. After elfects of typhus fever. After etT'ects of cliolera After pains Age and the conditions qual- ifying it Age, different periods of. Ague, see intermittent Fever Air as a modifier of disease... Air and exercise during preg- nancy...- A lax lymphatic constitution Alcoholism •-.. 800 GS2 681.' 24U fi()4 342 517 51;; 2G 110 87 484 724 725 725 G59 699 93 £7 521 694 508 494 80 26 26 542 534 577 592 672 29 29, 30 544 106 ' 655 27 144, 146 Aliments allowed during treatment Alimonts prohil)ited during treatment „ Alma v,iiey A nieiiorrha'a (scanty menses) An apoploelic constitution... Ananiiia of tlie brain Analogous remedies, table of A nervouij con.stitution Angina (sore throiU.) Angina pectoris Animation suspended (seeap- parent (loath) Antharax Antidotes, table of Anthony's,St. fire (erysipelas) Ai)hthous sore throat Aphthous sore thorat, allo- pathic treatment Aphthous sore throat, homoB' opathic treatment Aphtha; Apoplectic constitution Appetite, the, and its indica- tions Apoplexy as a symptom of disetise Apoplexy Apoplexy allopathic treatm't Apoplexy honni^pathic treat- ment Apopli'xy home treatment. Apparent death Apparent death from hunger Api)!irent death from a fall... Apparent death from suffo- cation Apparent death from light- ning Apparent death from drown- ing Apples, roast Apjde water Arnica, external application of Arsenicum, external applica- tion of in bed sores Artof feeling the i)uise Arteries and veins, diseases of the Arteries, diseases of the 109 110 751 628 2(j 122 8(i 2(1 21 S 468 724 514 753 49S 218 220 £21 21(1 2() ■!!t 0- 12[ 125 126 IL'.S 721 724 724 724 (25 750 750 OL 9r, 470 470 Be( 016 ORNEhAl. INDEX. Arteries {uul veins, wounds of the Arthritic rheuniutisni .' Arrowroot gruel Asiatic cholera .* Asthma Asthma, allopathic trcatm't for Asthma, hoinceopathic trcat^ ment for Asthma, home treatment for Asthma, hay (hay fever) Asthmatic atreotioiis as a complication of smallpox... Asthma of infants Asphyxia (see ap])arent death) Atmospheric and other inliu- ences of disease Atrophy of infants Auraepileptica Author's preface, first edit'n Author's preface,3eveuth edi- tion Baby, essentials for ahy pudding Back, aching pain in the (Lumbago) Back, crick in the Bandages for ulcers and sores Bandages, elastic, to be used after labor Barl)er's itch Barley coffee Batli, regulations for Batli, hot fresh water Bath, cold, salt and fresh wa- ter Bath for infants, tempera- ture for Bathing, precautions to be observed in Bathing, cold, wlien benefi- cial Beating of the heart (see pal- pitation) Bed wetting, the, of young cliildren Bedsores Beef tea Belching eructations Bilious constitution Bilious comj)laints Bilious or sick headaches Bilious fever Bilious fever, allopathic treat- ment for Bilious fever, homoeopathic treatment for Bilious colic Biliary calculi Blackish, dry, furred and trennilous tongue 732 698 749 687 439 440 442 443 442 512 711 724 32 713 148 8 746 746 484 484 736 683 607 750 95 95 96 98 97 96 462 368 578 748 265 26 240 265 289 290 200 •■12 . I'.j 51 Bhulder, inn:inimation of the Jiluclder, ciironic intlaninui- tion of the Bladder, spasm of the...*....'.'..!" Bladder, paralysis of the Bladder, stone or gravel in the Bhidder, spasm of tiie.'aft'e'r labor Bleeding of tlie nose.....'.'.".'.'.'.'!' 131ee(ling of the lungs ! Bleeding from the womb Bleeding from wounds Bleeding piles Bleeding from the stom'ach.'.'! Blindness Blindness, treatment for...'.'."! Pjlood,the condition of the,as an importantsign of the na- ture of the disease Blood, spontaneous dischar- gesof Bloodshot eye JMood, vomiting of Blood, vomitiiigol", allopathic treatment for Blood, vomiting of, homoeo- pathic treatment for Blood, spitting of Blood, discharges of, from the nose Bloody urine liloody Uux, (see Dysentery).. Blotches milk, milk scab Boils Boils and glandular swellings in connection with small- pox. B".i 8 of the nose, ulceration of the Bones, broken Bones, diseases of the Bottle nose Bowels, diseases of the ]5owels, inliammation of the Bowels of infants, flatulent distention of Bowel complaints of infants. Bowels, looseness of the af- ter measles Bowels, looseness of the after smallpox Bowels constipation of the.... I3owels, constipation alterna- ting with looseness Bowels, confinement of the during pregnancy Brain, nerves, sensations, and senses and their ind'cationa Brain, diseases of tho 13rain, congestion of blood to the Brain, passive congestion oi 917 36 1 364 370 372 3(52 073 210 402 G78 7;i:^ 8I(i 26() 188 189 40 41 191 266 268 269 402 210 366 300 701 513 512 204 738 476 508 277 296 700 704 527 542 326 330 660 61 113 117 120 918 GENERAL INDEX. Brain, lack of blood to tlie.... 122 Jjniiii, i 11 Hum ni ut ion of the - 134 Br hi fever 134 Brain fever, allopathic treat- ment for 135 Brain fever, homoeopathic treatment for 137 Brain, droiwy of the 139 Brain, water on the 139 Brain, water on the, treat- ment for 140 Brain and nervous systems sympathetic affections of. . 243 Brain tJie, in dyspepsia 261 Brain, concussion of the 728 Breatiiing and its indications in disease 44 Breath the, in health 44 Breathing, diflicult, and its meaning 45 Breatli offensive 46 Breathing, diflicult, treatm't of 208 Breathing, to excite or assist in after accident 725 Breatliing, frequent, slow, quick, tardy, deep, or long small or short, difficult, . moaning or sighing, oppres- sed, panting, suffocative, warm, cold, unequal, noisy, fetid or offensive, etc., and what is meant by these terms 44, 45 Breasts, inflammation of th€!l)4G,683 Breasts, ulceration of tiie 646 Breasts, preparation of the, before confinement 667 Breasts, swelling of the, of infants 712 Breasts, cancer of the 660 Bread and milk 746 Briglit's disease of the kid- neys 355 Bright's disease of the kid- neys, allopathic treatment 358 Bronchitis, Inflammation of the bronchial tubes 406 Bronchitis, iiiHammatory . . .. 408 Bronchitis, inllaminatory, al- lopathic treatment, 410 Bronchitis, inflammatory, ho- mxopathifi treatment 412 Bronchitis, capillary 412 Bronchitis of children 414 Bronchitis, home treatment. 414 lironchitis, chronic 415 Bronchitis, chronic, allo- patliic treatment 417 Bronchitis, chronic, homoeo- piitliic treatment 410 Bronchial catarrh 415 Broth for infants 745 Broth, chicken 710 Bruises or contused wounds. TAa Buzzing in the ears 201 Bunions 520 Burns and scalds 741 Calculi, renal 36? alculi, biliary, (gall-stones) 346 Camp fever, (see typhus) 355 Calendula ott'., as an external application 03 Cancer of the liver 348 Cancer of the breast 650 Cancer of the uterus (womb). 640 Canker of the mouth 215 Canker of tlie mouth, allopa- thic treatment 217 C ink r of the mouth, homoe- opathic treatment 218 ( inker of the mouth, home •'^atment 218 Ca. laris or caiitharides as an external application 03 Capillary bronchitis 412 Carho veg'etabilisas an exter- nal application 95 Carbuncle 514 Carcinoma hepatis, cancer of the liver 348 Carcinoma uteri 649 Carcinoma mamma; 650 Cardialgia. 270 Caries of the bone 479 Catalepsy 156 Catarrhal ophthalmia 180 Catarrhal inflammation of the eyelids 180 Catarrh of the head 204 Catarriial constitution 27 Catarrhal dysentery "99 Catarrh or common cold. . . . =i«^0 Catarrhal fever 380 Catarrhal fever, allopathic treatment 380 Catarrhal fever, homoeopatLic treatment 383 Catarrh, i>ronchial .. 415 Catarrh, Epidemic, — Influ- enza •. 420 Catarrh, epidemic— Influenza allopathic threatment 421 Catarrh, epidemic— Influenza homoeopathic treatment. . . 422 Catarrh of the sexual mucous lining, Leucorrhoea 637 Catarrli of the bladder, (see clironic inflammation) 364 Causes of disease 32 Causticum or lime water for burns 94 Cerebral system, diseases of the IIT GENERAL INDEX. Cephalalgia, TToadacho ifi7 Corebro sjiiiial inoningitis, Spotted lever ns Corebro-spimil incningitis, al- lopathic trealinent 115 Ceiebro-spiiialim'iiiugitisho- niceopathic treat 111 out ]16 Chapter I How to investi- gate the condition of the patient and determine the nature of disease 25 Chapter II Investigation of the disease 32 Chapter III Investigation of tlie disease contin- ued 72 Cliaptor IVDiet and manner ofliving 78 Chai)ter V Administration and repetition of homceopa- ihu- r.5medies f . . . 80 Chapter VI Cerebro Spinal meningitis 113 Chapter VII The brain and nerves 167 Chapter VIII Diseases of the eye 180 Chapter IX Diseases of the ear 195 Chapter X Diseases of the nose 204 Chapter XI Diseases of the mouth and throat 215 Chapter XII Diseases of the stomach 240 Cliapter Xltl Diseases of the intestines 277 Chapter XIV Diseases of the liver 338 Chapter XV Diseases of the spleen 349 Chapter XVI Diseases of the kidneys 352 Chai)ter XVII Diseases of the bladder 364 Chapter XVIII Diseases of the niiile sexual organs — 373 Cliapter XIX Diseases of the larynx and trachea... 380 Chapter XX Diseases of the lungs — 400 Chapter XXI Dist ^esofthe Pleura 446 Chaiiter XXII Diseases of tlie organs of circulation. .. 455 Chaiiter XXIII Diseases of the arteries and veins 470 Chapter XXIV Diseases of the bones, muscles and joints 476 Chapter XXV Diseases of the glands 494 Chapter XXVI Diseases of the skin , 497 Chapter XX Vri Acute con- tagious diseases.... Chapter XXV 11 1 Epidemic and endemic infectious diseasco. Chapter XXIX "' Constitu- tional diseases without defi- nite infection.... Chapter XXX Diseases" oif the teinale sexual organs. Chapter XXXI Pregnan- cy Chapter XXXII Diseases tollowing conthiement.. Chapter XXXIII Infants treatment alter birth Chapter XXXIV Diseases of infancy Cliapter XXXV Accidents of various kinds Chapter XXXVI Food" "for infants and invalids Chapter XXXVII TheReper- tory Changeoflife ',',', Change of life, symptoms of the Chafing of infants (Iliarcoal „ Characteristics, individual.. . Chest, sounds from the Chest, concussion of Chest, contusion of Childhood, periods of Children, derangements of the stomach of Children, fits of little Children, still-born Children, young, food for. . . . Children '.s pie Children, sleeplessness of. . . . Children and infants, treat- ment of 085,695 Children, bowel complaints of 701 Children derangements of during teething 717 Children, convulsionsof. .. .. 7U1 Child, care of during labor. . 671 Child-bed fever 678 Child, when may it be put to the breast «87 Chicken-pox 5^'i Cliickeu broth - 749 Chil'olains 519 Chill and f' ver as symptoms 06-68 Chill and! /er 514 Chlorosis (ureen sickness) — 0:i6 Cholelithiasis (see gall stone) 346 Choice of habitation 102 Choleric temperament 28 Cholera morbus 285 Cholera morbus, allopathic treatment » 288 919 521 544 695 621 652 67; 68.S 695 721 741 7G0 6-11 615 710 95 .SI 75 729 72;> 30 260 155 6S5 716 7-16 692 m !)L'0 GENERAL INDEX. riioU-ra morbus., bomceopa- tliic treutnient 287 IJluilora, asiatic 587 ( holera, maliunant 587 Cholera, epidemic. 5S7 Cholera, causes of oSS Cholera, after eft'ects of 502 Cholera infantum 7()(j Chorea Kit Chorea, allopathic treatment 104 Chorea, homoeopathic treat- ment 105 Chronic articular rheunui- tism 590 Clironicrheumatism of joints 001 Cineliona tincture, applica- tion externally 95 Cirrhosis, see chronic inflam- mation of the liver 343 Cleanliness, value of in pre- vention of disease 106 Climate, modilication of 102 Clothing and habits 80 (!lot!Hng during pregnancy... 050 Clotliing, see apparel 101 Coffee, barley 750 ( 'oltee, oatmeal 750 Cold in the head 204 Cold in the head, allopathic treatment for 205 C<»ld in the liead, homoeopa- thic treatment for 206 Cold in the head, home treat- ment for 209 Cold, constitutional tendency to take 208 Cold in the head, of infants. . ODO Colic ,'U)[i Colic, various forms of 310 Colic, from worms 315 Colic, crying and wakefulness of infants 007 Common cold 380 Common coldallopathictreat- ment ". 380 Commoa cold, homoeopathic treatment 383 Complicated forms of scarlet fever 533 Complication and after-efTects of smallpox 542 Complexion the, its indica- tion ,. 74 Concussion of the brain 728 Concussion of the chest 720 (Condensed signs of pregn'ncy 052 Conditions which qualify the age 20 Conlinement or labor 009 Confinement, duration of . . . . 074 Confinement, diseases follow- ing 674 Coutlueut smallpox 540 Congestion of blood to the brain Congestion of Idood to the lungs Congestion of the liver Constitution and lis varieties Constitution, feeble Con.stitu tion , bi 1 ious Constitution, apoi)lectic Constitution, a nervous Constitution, ch'y, wiry Constitution l;ix, lymphatic. Constitution in wliich the skin is liable to become dis- <^as^'d Constitution, rheumatic Constitution, Consumptive. . Constitutional diseases ("onstitutional diseases with- out definite infection Constipatfon Constii)ation, allopathic treat- ment Constipation, lioniceopathic treatment Constii)ati()n alternating with looseness Constipation of aged persons Constii)ation alter purging.. Constipation during 2)regn'n- cy • Constipation of infants Consumption Consumj)tion, preventive treatment for Contagious diseases. Contagious diseases, sanitary rules of the N. Y. Hoard of Health Contents, table of Convalescence after typhus.. Convulsions of infants Convulsions and spasms aa symptoms Cojiper nose Corns Cory /.a Coryza, snnfties of infants. . . Costiveness, its indications. . Costiveness, see constipation. Cotton wool as an external application. . . Coughs, their indications..- Cough, treatment of Cough, nervous Coupdesoleil, (see sunstroke) Coughs, after measles Coughs, in connection with smallpox Cough, whooping Cow's milk for infants Cowpox (see vaccination.).. Coxalgia ^see hip disease). . .. 117 400 2<; 20 20 20 20 2') 20 27 27 521 5!),) 320 320 328 330 331 331 000 703 007 615 521 52.J 10 2;' 57(i 721 r).s ^m ■)2(; 201 0!)i; 47 320 91 72 3S8 388 742 627 542 423 745 723 48ti GKNKUAL INDEX. Coxalgiu, ullopatliic tmit- men l Coxalgiu, honioeoimtliic trout- ment. Cranberries for children...*.' Critical sweat Crick in the buck .... Cross-eyes [ Croup, laryngitis '. Croup, laryngitis, allopathic treatment Croup, laryngitis, homoeopa- thic treatment Croup, false .' Croup, true [[ Crusta lactea * Crying and wakefulness of new born infants Cup pudding, tapioca Cup pudding, invalids' Cutaneous diseases (see disea- ses of the skin) Cuts (see wounds) Cystitis, inllammation of the bladder Cystospasmus, spasm of the bladder Dand.-ufT. oatness Deafness, allopathic treat- ment ,.. Deafness, homocoj)athic treat- ment Death, apparent, from hun- ^ ger Death, apparent, from a fall. Death, apparent from suffo- cation Death, apparent, from light- ning Death, apparent, from drown- _i»g Death, apparent, from being frozen Death, apparent, from nox- ious vapors Death, verification of Decline, first period of Dedication Deforming rheumatism Delay of the menses.... ... Delirium, its indications.... Delirium tremens Delirium tremens, allopathic treatment Delirium tremens, homu3o- pathic treatment Delivery, perspiration after. Delivery, weakness after — Delivery, treatment ail'.'r.. . , Dentition, teething Depression of spirits ■1S7 488 7U) 71 484 ]!)i) im 398 ;5!)i) ; <).■, 7Ul uf)7 74!) 749 497 7;ii 3G4 ;;70 r.().5 I9(j 197 199 724 725 725 726 727 727 30 3 598 628 52 144 145 146 ()76 082 allo- with 072 717 201 Deranf,reMu.n)s attendant "" •■''*' '"••■''' Jippearance Oi (ho Illcii.sos Doraiigeuiciit of the stomach I'liiri'lid'a DiairlKj.ii, h o m (jeop a t'li 'ic Irc'iiliin'iit I)iun'l-(i-;i, its indications'." Diarrhoni, ciu'uruf. DiiiniK.'ii of children patliictroatnient... Diarrliii'ii altcnuiting constipation DiairlKca of lying-i,; womeii L>i:irrli(i.a of infaiity, descrip- tion !ui'l lioniojopiithic Ircalniont Di;i,tj,iiosis .'.".'.'.'.'."* Diet and niiinnor of living.*.' p;ct, riil.'.s for, «ynoiijiis...'.'. rict (lurinji- nursing Diet, Hii) plt;)aeutury of in' flints __ Dillicwlt breathing.".'.'. .'!t.".'.i DigestiveruMclioii.s and their indicaiioiis Diuc-;! ion. deranged .,[ Dilation of tJ.'c veins ...', Dilaiion of the veins, allopa- tiiic treatment Dilation of the veins, homoe- ojialiiic treatment Diplitlieriii Dii)hthcria, allopathic treat- ment DiplitJieria, honiceopathic treatment Discharges of blood, sponta- neous Discharge from the ear Discharge of blood from the lu:igs Diseases to whicli the patient is especially liable Disea.s , I be {)art or organ Visually affocteil Disease, il!vesll!^^•lti<)n of Disease.', consideration of the cause ol"... , . Disea.se, general character of Disea.se, tiie causes of Diseases of the brain, spinal cord, and nervous system. . Diseases of the bead. Diseases of the eye Diseases of the car Diseases of the nose Diseases of the mouth and tliroat Diseases of the stomach Diseases of the intestines. . . OL'J 024 2r>7 277 278 2S1 47 279 28(i 081 7(M '. h 109 089 690 43 47 240 47] 473 474 227 229 232 41 196 402 31 32 32 32 34 32 113 107 IHO 190 20^ 215 2-10 I ..% 922 GENERAL INDEX. Diseases of the liver and Hpleen Diaciiacs of tlie liidneys Diseases of tlie bladder Diseases of tlie male sexual orjijans Diseases of the respiratory ()rL,fans Diseases of the larynx and trachea Diseases of the lungs Diseases of the pleura Diseases of the organs of cir- culation Diseases of the heart Diseases of the arteries and veins Diseases of single systems. . . Diseases of the bones, mus- cles and Joints Diseases ot the glands Diseases of the skin Diseases of the arteries Diseases of the veins Diseases, epidemic and en- demic infectious Diseases, acute contagious... Diseases, constitutional, without definite infection. Diseases of the female sexual organs Diseases following confine- ment. Dislocations, partial Division and repetition of doses Doses and their division Dose for an adult DOS';* for infants and chil- dren Doses for internal remedies. Dose of globules (pills) Dose of tinctures Do.se of triturations Dose, to insure a proper Dose, for eradicative treat- ment Drainage, to prevent disease Dropsy of the brain Dropsy of the brain, congen- ital Dropsy' of the brain, allopa- tliic treatment Dropsy of the brain, homoeo- pathic treatment. Dropsy of the chest Dropsicalswellingsafter scar- let fever Dropsy Dry, wiry constitution Drowning, apparent death from..... Dura^^ion of confinement. . . . 364 37,! 380 380 400 440 455 455 470 470 476 404 497 470 470 544 521 50r, 621 G74 729 85 85 84 84 83 84 84 87 108 102 139 140 140 140 450 534 743 26 725 674 Duration of suckling — wean- ing Dysentery, catarrhal Dysentery, eiiidemic Dysentery, allopathic treat- ment Dysentery, horn coo pat hie treatment Dysnieiiorrhma (painful menstruation) Dysi)epsia DysiH>i>sia, allopathic treat- ment Dysjiepsia, h om aiopathio treatment Ear, diseases of the ar, indammation of the... Ear, discharge from Ear, neuralgia of Ear, hummingor buzzing in Earache Earache, rheumatic or ner- vous Eclampsia, sjiasiiis of infants Eczema Eggs, allowed in sickness... Eggs, soft boiled Eggs and milk Egg toast, how to make .... Electricity in paralysis of the eye : Electricity in colic Elm bark mucilage Emaciation of infants Emansio mensium ?]mv)ty pulse Employment of the mind during pregnancy English ''pap " Enlargement of the heart. .. Enteritis — Inllammation of the bowels Enteritis, allopathic treat- ment Enteritis, homoiopathic treatment Enteralgia Enteric fever Enteric fever, homoeopathic division and treatment of. Enteritis as a complication of measles Enuresis nocturni Epidemic and endemic infec- tious diseases Epidemic catarrh Epidemic cholera ICpileptic vertigo Epilepsy Epilepsy, allopathic treat- ment 01 )1 ."•liO uOI 307 210 2")(l 195 1<'5 19(i 198 201 19.J 200 15', 511 lllli 74 S 7.1S 747 189 315 751 713 02(5 37 fi5() 7-15 -KiT 290 2^17 299 3(19 555 5fi4 523 3()8 .544 420 587 M9 i47 150 eKNKriAIi INDKX. 1 !).■") Epllci>syi honimopnthid troat- ineiit Epilepsy, onjinisiu as a cause Kpi-^taxiH Enulicative and preventive treatment Eructations — IJelcliing Essentials for a baby Evacuations, their inciica- tious Excess of blood to tlie brain Excess of l)Iood (o the brain allopathic treatment Excess of blood to tiie brain homcoopatliic treatment. .. Excessive secretion of milk. Excessive perspiration af- ter delivery Excoriation of the nipples.. Excoriation of infants Exercise, the value of in pre- vention of disease Exercise of infants Expectoration, and its indi- cations External remedies and appli- cations External application of a poultice External application of a fomentation External application of Ar- nica. . Exteriuil application of cal- endula External application of riius. External application, for in- cised wounds. External application, for lac- erated wounds External ai)pUcation, for contused wounds or bruises External api)lication, for punctured wounds External ai)plication, for gunshot wounds, splinters, etc External application, for dis- locations External application, for sprains External ajiplication, for burns or scalds External application, for stings of insects Erysipelas Erynipp'.as, allopathic treat- mhtii Erysipelas, homoeopathic treatment Erysipelas, home treatment. Erysipelas, of infants Erysipelas, Bymptomatic... bW 14!» 1^10 98, 107 71() 47 117 120 121 67.'5 676 683 710 106 (m 77 92 92 92 92 93 93 732 734 785 736 736 729 729 741 742 498 601 602 503 600 600 Erysipelas, wandering... Erysipelas, dovialions from tlie common course of. hrysipeliis, fever " Erysipelas, susceptibility to. jn Die face.... ^. ' Krytliema-Siuiple "minesa of tile skin Eye, tile, affords a n'mlVitude ol syinptoms and indica- tions in di.seaso Kye, di.seases of the* .' .' ..".]" Kye, inllaumiation of the.".".', '.ye, weeiiing or watery Eye, bloodsliot Eye, cro.ssed .....'. Eyes, inllamination of the, of infants Fiice, ache. ace, ague ]. Facial iierpes .',,[[ Fainting, its indications. .*.'.". I''all.api>arciil (ica!li from a. Falling down of the bowel. . Falling of the womb Falling sickness— Epilepsy.. False jtains before labor Fat, excessive Fatty degeneration of the heart Favus— .Scald head Feeble pulse F(!el)le constitution I'Vlon or wliitlow Females, affections peculiar 5(!0 499 49!) 603 497 69, to. Female sexual organs, dis- eases of the Ferunculus— Jioils Ferunculus, malignant i"'etid or ofFcn.sive l)reath. . . . Fetid discharges after labor. P'ever, general remarks on.. Fever, general treatment and diet during PY'ver, gastric or bilious Fever, gastric or bilious, al- lopatliic treatment Fever, gastric or bilious, ho- mreopathic treatment Fever, catarrhal Fever, scarlet Fever, .scarlet, symptoms and course of Fever, scarlet, urajniia in... Fever and ague Fever, intermittent Fever, intermittent, allopa- thic treatment Fever, intermittent, homoeo- pathic treatment Fever, iutiummatory IH) ]!i() lid 192 695 ir.\ ]T.i 50'.) .")2 724 33 1 64! 147 669 76 465 515 37 26 519 621 621 51.". 614 46 68! 287 288 289 290 293 627 62« 531 644 64^1 546 5.50 554 924 OKNERAL INDEX. Fever, ( yplioid •V>'> Fever, ttiitcrii! •'>•'•} FevL-r, tyjihus •'>•"'•"> Fever, yellow ""J-^' Fever, nay 442 Fever, ery.sipelus 49ii Fever, milk (J77 Fever, child-bed or puerperal J)"^ Fever, 8un 7L' Fever, brain 1-^ I Fever, spotted, see Meningi- tis ll-'< Fever, remittent -9*' Fevers, the urine foretells the changes at next crisis 4- First signs ol' approaching labor ^<j^ Fistula laehrynialis 15)'^ Fits of little eiiildren 155 Flatulency, its indications.. 48 Flatulence of infants 6% Fhitulent distention of the stomach and bowels of in- fants 700 Flaxseed tea '.50 i^'Icsh, loss of or unhealthy increase of .'. 70 Flour asan external applica- tion for burns and scalds. . •_*5 Flooding after labor 07.'> Flux— Dj'sentcria -Wl Flux— Uysenteria, allopathic treatment ^01 F'lux — Dysenteria.homoeopa- thic treatment "507 Fly, Spanish, as an outward application 03 Fomentations, application of *J- Food, see aliments 101 Food of infants 744 Food for invalids 747 Food for young children. . . . 740 Foot, inflammation of the joints of the 498 F ract u res of bon es TdH Freezing, apparent death from 720 Frequent pulse ii7 Frozen limbs 5i'0 Full pulse 37 Gal actor rhcea (;7o all-stone 340 Galling— Excoriation of in- fants 710 Gastric or bilioua fever 289 Gastric or bilious fever, allo- pathic treatment 290 Gastric or bilious fever, hom- oeopathic treatment 293 Gastric derangements during i)ret{uauey . . , 657 General habits and method ofliving (Jeneral remarks on fever.... General treatment and diet during fever Glandular H\vellin),Mintl boils in connection with sniall- l)OX Glands, congloate,di8caseH of the Gonitis (iowt (iranuhir ophthalmia Gravel (ireen sickness— Chlorosis. .. (irief, see mental ciiinlioiiH. . (iroaniiig as a synijiinm Groin, rupture of the, of in- fants (Iruel, how to iii.iko (Jruel, arrow-root Gruel, water Gruel, rice Gruel, sa^o (iunshot wounds (Uitla rosacea Habits of liviuir abils iiiiii clclliiii'.'^ lliibits <.:' rciiiilarily Ihibits (iurir.!^' iire<j;nancy llanitatioii, cUoice of Hicmaleiuesis Ihemorrlioids Hicmorrlioids, a 1 lo path ic treatment Hiemorr holds, lioma3opathio treatment Ilajinorriioids, homo treat- ment Ilaimoptysis, see Spitting of blood Hard pulse Hardness of hearing 1 lay fever Hay Astluna Head, diseases of the Head, cold in the Head, cold in the, allopathic treatment Head, cold in the, homoeopa- thic treatment Head, swelling of the, of in- fants Head, congestion of blood to the Head, cold in the, of infants. Head, dropsy of the, seedroj)- sy of the brain Headache Headache, allopathic treat- ment 31 1187 liRH 4!) •I:- 1 (;. CSV 7-!: 7!! I 711. 7r.t 71! I 7;;ti rm vn m IIH) TwH KIJ 2(i() 310 311) 311) 319 402 37 ]!)() 412 412 11)7 201 20) 117 139 1(17 Headache, h o m co o p a t h 1 c trt'iUinent Ileaiiiu'lio, neuralgic Ileadaclie, bilious iir nii'k. ...109 Heat and oold— eliill and fev- er as symptoms Heat, exposure to (sunstroke) Ilearinp, the, as a symptom in disease Hearing, hardness of Ileart, diseases of the Heart, inllammation of the. . Heart, palpitation of the. . . . Heart, fatty degeneration of the Heart, hypertrophy of tlio.. Heart, enlargement of the. .. Heartburn Helminthiasis — Worms Hematuria Hematuria, alloi)atliic treat- ment Hematuria, honueopat hie treatment. Hemicrania or moj;rim Hemorrliau:** I'roni llio lungs Hemorrhage from the stom- ach Hemorrhage from the nose.. Hemorrhage rr(<iu the womb .«ee llooding Hemorrhage from wounds, iiieiins of stopi)ing I [emorrhage from extracting a tooth hereditary disease ill ruia, .see rupture Herpes— Tetter Herpes— Tetter, of the face.. Heri)es, zoster. Zona Herpes iris and circinnatus.. Hiccup as a symptom of dis- ease Hiccup, general article on. .. Hiccup, treatment for Hiccup of infants Hip-joint,inflammat'n of the Hives — Urticaria Hoarseness as a symptom. .. Homoeopathic medicines, their administration, repe- tition, doses, preservation, etc Home, choice of (see habita- tion) Honeycomb tetter Hordeolum— Stye Hot fresh water l)ath Humming or buzzing in tlie ears Hunger.apparent death from Hydroeophnlurt -'V a L e r on the brain 170 ItiH ,26.5 60 742 71 190 45,5 4.5.5 402 46.5 407 407 0.5'.) .'51^0 aot) 307 307 107 402 26() 211 673 730 733 29 687 509 509 90 510 60 443 444 696 486 503 75 SO .51~, lU- 9.5 2(11 139 OENRUAIi INDKX. iry(ir()eepImlus,allopivthic treatment ■,, Hydroeep....lus. hoi/i^opul " tine treatment i,,, Hygiene of pregnancy. .'.'.'.'. ' «--. Hyperiemia of the brain.. ' I'l; Hypenemia of the brain, aU lopatiue treatment.... ion llyperu'mia of the brain ho- mo-opalliic treatment.... p'l Hypertropliy of (he lieart. . '. 407 iiyi.oeiioiulriacal afleetions. 2(il HyHterics jq^ Hysterics, allopathic "tVeatl nieiit 1(52 Hysteries, h o m OB o pa t'h'i'c treatment J59 Hysterics, homo measures.." 102 Ineised wounds 702 neontiiieiiee of urine.*. .*.'.'.* aJiis Indieation.s of tlie pulse.... 35 37 Indieationsoftlie urine ...'. ' 41 Indications of tlio breathing 44 Indications of the digestive functions 47 IndieationsoftheevacuaVions 47 Indications of wind in the stomach .jy Indications of nausea' and vomiting 43 Indicafioiis of tliirst . ." '." 50 Indications of tlie tongue... 51 Indications of motion and rest -,G Indications of tlie sensations 01 Indications of tearfulness and laughter 70 Indications of coughs 72 Indigestion 240, 211 Individual cliaraeteristics. .. 31 Infants, treatment of 68.5 Infants, swelling of tlie head of 680 Infants, rupture of 087 Infants, rupture of navel of. 087 Infants, rupture of gr'.in.... 687 Infants, when may .liey be put to the breast.' 687 Infants, observations on the suckling of 688 Infants, fond for 691,744 Infants, sleeplessness of 092 Infants, liiecup of 690 Infants, snuffles of 690 Infants, vomiting of milk of 099 infants, sou'' stomach of. . . . 699 I nfants, erysipelas of 500 Infants, tlatulenee of 699 Infants, tlatulent distention of tbestomaeli and bowels 700 Tnfaiil;^, aplithre-Thrush of. 702 In fiints, nursing sore mouth 702 ■ft I 096 GENERAL INDEX. Infants, oonstipatlon of Vo.'J Infants, (liarrho'ii of 7()t lnfantH,sununerc'onij)laintof 7(''! Inl'ants, cliartng— Excoria- tionsof 71(1 Infants, aHthnia of 711 Infants, sw el ling of the breasts of 7lL' Infants, atrophy— E m a c I a- tionof 7];{ Infants, teethinj? of 717 Infants, spasms of 721 Infants, broth 745 Infants, inflammation of the eyes of G9o In fancy, diseases of 695 Inllaniniation of the brain. . 134 Intlannnation of the brain allopathic treatment for. .. 135 Intlannnation of tlie brain, Ijoma'opathic treatment. . 137 Intlannnation of the eyes.... 180 Inllammation of the eyes, allopathic treatment 182 Inllammation of the eyes, ho- nucopathic treatment 180 Inllammation of tlie Iris. . . 181 Inllammation of the ear 105 Inllammation of tlie nose .. 210 Inllannnation of the mouth. 215 Inllammation of the tonsils. 221 Inllammation of the bowels. 296 Inllammation of the bowels, allopathic treatment 207 Inllammation of tlie bowels lionuBopathic treatment. .. 290 Intlamniation of the perito- neum 332 Inllammation of the perito- neum, allopathic treatm't. 334 Inllammation of the perito- neum, homoeopathic treat- ment. 3rt5 Tntlammation of the liver. .. 338 Inllam;aatioti of the iiver, al- lopathic treatment 339 Inliainniation of the liver, homteopathic treatment.... 340 Inllammation of the spleen.. 349 Tnnanimation of the kidneys 352 Inllammation of the kidneys allopathic treatment 358 Intlannnation of the kidneys homoeopathic treatment.. . .354 Inllammation of the bladder 8(34 f nllanimation of the testes. . 373 Jiillammation of tlie larynx. 385 Inflammation of the IJron- chial tubes 406 Inflammation of tlie lungs. 429 Inflammation of the pleura. . 446 Inflammation of the womb see Leucorrhoea 0..7 Innammation of the veins. .. 470 Inflammation of the l)onc.s and j)eri(wti'um 47^ Inflammation of tlie joints. '. 485 Inflammation of the liipjoiut 48(1 Inflammatiou of the knee .joint 480 Inllammation of the joints of tlie foot 4!),'( Inllammation of the broHHVH.646,(i8;i Inllammatory l)roncliitis 408 Inllammatory Jaundice Sic Inllainniatory fuver 5,",! Inllucnza .ii.'(i Influenza, allopathic treat^ ment. 4i;i Influenza, homa'opathia treiitmont 422 Inieeiions, rules for .' H7 InjurieM, see wotuids 731 Inseets, st'ngs of 712 Intermittent i)ulse .''.7 Intermittent fever 514 Internal remedies and doses O Intestines, diseasesof 277 Inti;()I)IM)ti<)n, Dr. Beau's. . 11, 15 Invalids, food for 744 Invalids' cup pudding 74!) Invalids, apple pie 749 Investi^at'n of disease (diag- nosis) 32 Investigation of urine, the jiroper time for 42 Investigation of the patient. 25 Invermination— Worms .'520 Iteh, l)arbers' 507 Itch— Scabies 610 Itching of the genitals dur- ing pregnancy 063 Jaundice 343 aundice, allopathic treat- ment 344 Jaun.'.ice homoeopathic treat- ment 34;; Jaw, locked 14-, Joints, diseases of the 473 Joints, inllammation of the. 485 Joints, rheumatism of the.. . 595 Kidneys, diseases of the ... 352 idneys, inflammation of the =. 352 Kidneys, inflammat'n of the allopathic treatment 353 'vidneys, homoeopathic treat- ment 354 Kidneys, Bright's disease of 355 Knee joint, inflammation of. 480 Knee joint, inflammation of allopath ic treatment 490 Knee joint, inflammation of honia'opathic treatment. .. 492 OBNKBAL INDEX. Labor, first slpn? of fifis iilior. prepuruti.^ I of the bed lor 0(1H Lubor, or parturition 0(0 Labor, caroofcbiUl durlut?. 071 Labor, tho attoiitioiiH to tho woman ulter 072 Labor, j?ciit'ral inanayenient diet, c'tr 672 Labor, Hood inf? after 67;5 Labor, retention of the urine after 673 I^abor, incontinenc6 of urine after 674 Labor, preparation of the breasts before 667 Labor, false j)alns before. . . . 66!> Labor, after pains of 672 Labor, duration of conflne- nient 674 IjUbor, excessive perspiration after 677 Labor, milk fever aftoi 677 Lal)()r, ehild-bcd fever after. 678 Labor, irrej^nilar disciiarges of the lochia after 680 Labor, diarrha-a after 681 Labor, weakness after 682 J .acorated wounds 734 Laclirymal saek, obstruction or fistula of the IflO Lar^e pulse 37 Larynji^it is— croup 393 Laruigitis, allopathic treat- ment 393 Laryngitis, homoeopathic treatment 399 Larynx and trachea, diseases of the 380 Larynx, intlainmation of the 385 Laughter and tearfulness and what they indicate. . .. 76 Leuchorrhoea— Whites 637 Lemonade 750 Life, the change of in females 644 Ligiitning, apparent death from 725 Limbs, retarded strength of, in infants 694 Limbs, frozen 520 Lime water, external applica- tion of 94 Liver, diseases of the 338 Liver complaint silS Liver, inflammation of the. . 33H Liver, abscess of the 342 Liver, chronic inflammation of the 3.13 Liver, cancer of the 3.:,s Living, habits of ]o] Living, manner of life 31 Lonhial discharge and irreg- 'ularitiesof , est) Lochial discharge, cxcessivo Loehial disolmrge, .suppres- Lochial discharge^ offensive j.iO('k-jaw J.ock-jaw, alloimthic' Vr'eat- nicnt I.ock-jaw honiceopatiiic treat- nient Lock-jaw, of in fiin'tH. .".'.'.".* Loss of eonHcioiisness, its Yiil dicatiouHindlHease Loss of or unhealthy increase of lltKh Loni;oneBs of the bowels dur- ing Smallpox Lujubago, crick in tiie back! JiUngs, di.sease.< of the .' Lungs, congestion of the..'.'. LungH, congestion of the, al- lopathic treatment Lungs, congestion of the, ho- nui'opatliic treatment Lungs, bleeding from the... JiUngs, inttammation of the. Lungs, inllammation of the of children Lymphatic tumors '.'.'. .. Male sexual organs, diseases of the Malignant cholera *. .' Mammaj (breasts) inflamma- tion of the Mania a potu— Delirium Tre- mens ^lanismuH, of infants Marrow, inflammation of tlie Mastitis (inflammation of the breasts) ,. Maturity, flrst period of Maternity (see Pregnancy).. Means to be employed agai nst cholera Measles— Morbili Measles— Morbili, allopathic treatment ilia^U's— Morbili, homoeopa- tlii irtatment Measles, after effects of Measles, enteritis as a compli- cation of Medicines, when to be taken Medicines, homoeopathic rules for preserving Medicines, systematic table of rules forgiving. Ill egrim— Headache Melancliolic temperament.. Meningilis, cerebro-spinalii. Meningitis, cerebrale Meiiinjiitis, chronic Monorrhagia M7 681 681 081 141 142 14* 14.*^ 62 70 642 484 400 400 400 401 4(12 429 436 494 373 587 683 U4 7i;{ 478 040 662 694 521 524 626 527 523 87 87 89 167 28 IL'^ 134 130 633 928 GENERMi INDEX. Menorrhasia, mechanical nieiiDs lor suppressing 037 Menopause — tUiange of life. . 6 44 Menstruation 02i Menses, derangements upon the appearance of tlie G24 Menses, suppressed, delayed or scanty 628 M enses, profuse 63o Metliod of living, general liabits 31 Milk, secretion of *he .... 07 ! iMilk, scanty secretion ( "tho OTo Milli, suppression of tlie C7") Milk, excessive seci-etion of the O-rri Milk fever 67. Milk, vomiting of, by infants 690 Milk scab, milk crust 701 Milk, cow's for infants 74o Milk toast 748 Milk, thickened 748 Milk and eggs 748 Mind, employment of the during pregnancy 650 Miscarriage 604 Miscarriage, to prevent a ten- dency to 605 Modified smallpox 641 Monthly Ikix or periodical discharges of females 621 Morbus divinas 147 Morbus herculeus — Epilepsy 147 Morbus Brightii S,>> Morbili — Measles o2I Morbili, allopathic trcatm'nt 52! Morbili, homoeopathic treat- ment 520 Morning sickness during pregnancy . . 057 Motion or rest as symptoms <50 Mouth, diseases of the 215 Mouth, canker of the 215 Mouth, inflammation of the. 215 Mouth, wounds of the 733 Mucilage of elm bark 751 Mumps , 234 !Mump3 following other dis- eases 235 Mumps, treatment 23f'. Muscles, diseases of the. .... 470 Mush, brown, for supper 740 Mustard whey 751 Mutton tea 74!i Myelitis, see inflammation of the marrow 478 Nasitis-Tnflammation of the nose 210 Xausea and vomiting, their indications 48 Nausea, general article on . . . 264 Naval rupture of ill fjuity.. ., 687 Near-sighted 192 Necrosis (death of bone) 47fl >.'epiuitis— Inflammation of the kidneys 352 Nerves, brain. sensations and senses and tlieir indications 52 Nervous or rheumatic ear- aclie 200 Neuralgic headache it'jS Neuralgic lieadache, allopa- tliic treatment IGS Neuralgic headache, honuco- ])atliic treatment 170 Neuralgia 173 Neuralgia, allopathic treat- ment 174 Neuralgia, homoeopathic trealnient 170 Neuralgia of the ear 108 Nipi)les, !-ioro (iK3 Nose, diseaseti of tlie L'O ( Nose, polypi of tho 2U' Nose, inllaiiiniation of the.. 210 Nose, bleeding from the 210 Nose, lileediiig fiom tlie, allo- pathic treatment 211 Nose, hieeding from the, ho- m(iM)pathic treat nieiit . 212 Nose, bleeding from the, home treatment 214 Nose, bottle 508 Nose, copper 5i»8 Nurse, tlie choice of a OHO Nursing, diet during 080 Nursing sore mouth of in- fants'. 702 Oatmeal coffee 750 Ijservationson jiregnancy. 651 Observations on the suckling of infants 688 01)stipation, see Constipation 320 Odontalgia— Toot haclie 230 ( )nensi ve or fetid breatli — 40 Onanism as a cause of epi- lepsy 140 Oi>htlialmia i'^ Ophthalmia, purulent 181 ()l)lithalmia, granular 184 Oi)hllialniia, chronic 184 Ophthalmia, of infants 185,005 Olihthaluiia, scrofulous 185 Organs of respiration, disea- ses of ^80 Orange whey ''-''^ Orchitis S73 Ostitis— Inflammation ofthe bones 4"'"' Otitis— Infl'mat'n of the ear lOo Otorrhaa— Discharge from the ear J^f' Overheating l]'-;' Oyster soup for invalids '^^ GENERAL INDEX. Pain in the teeth 230 i ains of various kinds as symptoms 61, 0,5 rains, false, before labor 609 Pain in the cl ^st or painful respiration 1 what it in dicates 45 Pain in the bowels 309 Pain, absence or sudden sup- pression of 62 Pain, intermittent and what it indicates 63 Pain, inflammatory or ner- vous 64 Pain in the nerves of the face 178 Painful and difficult menstru- ation 03o Printers' colic ;?]() Palsy or paralysis i;j(j Patient, condition of the, -.lethod of investigating..., 25 Palliative treatment 87 Palpitation of the heart -}()2 Parturition, treatment before 6()7 Part first, diagnosis and prog- nosis 25 Part second. Diseases of the brain and nerves 113 Part third, Diseases of the head '><]! Part fourth, the gate i5 Part fifth, the digestive func- tions 240 Part sixth. Diseases of the liver and spleen.. oi^S Part seventh, Disea-sos of the kidneys and bladder 352 Part eighth. Diseases of the male sexual organs 373 Part ninth, Diseases of the respiratory organs 380 Part tenth," Diseases of the organs of circulation 455 Part eleventh, Diseases of single systems 470 Part twelfth, Constitutional diseases 521 Part thirteenth. Diseases })o- culiar to women (!2l Part fourteenth. Treatment of infants 0S5 Part fifteenth. Surgery 724 Part sixteenth, Repertory 7on Panada, how to make 71" Paralysis as a symptom i'>" Paralysis 130 Paralysis, allopathic treat- ment 130 Paralysis, h o m re o p a t ii i c treatment 133 Paralysis, liome treatment... 133 Paralysis of tl\e face 132 59 Paralysis of the insane... Paralysis, infantile Paralysis of the bladder.... ParoUtis Parotitis, treatment for...... ' ;;pap," English ......;:: i "tieutgeneral investigation of Passive congestion of "tlie brain Pendulous abdomen..........."! Pepsin, formula for making." Periods of life Period of approaching ma- turity Period of decline .....''. Peritonitis Peritonitis, allopatliic treat- ment Peritonitis, homoeopathic treatment Periostitis Perspiration after delivery... Perspiration after delivery, excessive Pertussis— Whooping cough. Phkgmatic temperament Phi jbitis— Inflammation of the veins Phrenitis Phthisis- Consumjit ion JMe, children's Pie, invalids' ai)ple Piles Piles, allopatliic treatment-.. Piles, homwopathic treat- ment Pityriasis Plethoric const itut ion Pleura, diseases of the Pleura, innainmation of the Pleuritis Pleurisy Pleurisy, allo]i!ithic treatm't Pleurisy, homa'opatliio treat- ment Pleurisy of infants Pneumonia Pneumonia, allopathic treat- ment... Pneumonia, homceopath ic treatment Pneumonia, of young c h i 1- dren I'oisons, their antidotes— see table of remedies Polypi of the nose Position of tlie patient as a symptom Potencies (strength) of medi- cine Pott's disease Poultice, application of 929 133 132 372 234 236 745 25 120 682 495 29, 30 ;:o 30 334 336 478 676 677 423 29 ^0 134 607 746 749 310 316 319 505 25 440 446 446 446 448 453 452 429 433 437 436 752 210 58 85 476 92 1^:";.. ^1 I 980 GENERAL INDEX. Pox, small rww Pox, chicken '54,^ ^Precaution'- ''.o insure proper doses 87 Preface to First Edition 5 Preface to Second Edition 4 Pregnancy 652 Pregnancy, condensed signs of 652 Pregnancy, observations on.. 6.S4 Pregnancy, hygiene of 655 Pregnancy, employment of the mind during 656 Pregnancy, gastric derange- ment during 657 Pregnancy, nausea and vom- iting of 657 Pregnancy, clothingand hab- its during 666 Pregjiancy, constipation dur- ing 660 Pregnancy, toothache dur- ing 661 Pregnancy, urinary difficul- ties during 663 Preservative measures against cholera 594 Preventive and eradicative treatment 98 Profuse menstruation 633 Prognosis ' 26 Prolapsus uteri 641 Prolapsus ani 331 Proof spirits of wine as an application for burns 94 Pruritis-Itcliing of the geni- tals 663 Prunes, stewed 7.50 Psoriasis 506 Psous psoitis 517 Pudding for babies 746 Pudding, tapioca cup 749 Pudding, invalid's cup 749 Puerperal fever 678 Purulent ophthalmia 181 Pustula nigra 514 Pyrosis 659 Auick J ulse 37 vfuiek breathing 45 oTiinsy 221 Quinsy, allopathic treatm'nt 224 Quinsy, homoeopathic treat- ment 225 Rash, nettle 603 ash, scarlet 527 Raw cotton as an external application 94 Red, dry and glassy tongue. 51 Redness, swelling, heat, and tingling of the skin (erysi- pelas) 498 Regularity of habits IM Regulations, general, for diet and regimen 78 Regulations and remarks re- specting internal remedies and their application 83 Regulations respecting the bath 95 Regurgitation of milk, acid- ity, etc., of infants 699 Relaxation of the bowels dur- ing i'rcgr/i.rtncj/ 277 Relaxation of the bowels of lying-in women 681 Remediesand doses, remarks etc., respecting them 83 Remedies, table of analogous 86 Remedies, table of, with La- tin and English names, an- tidotes, etc 752 Remedies and applications, external, remarks etc., re- specting 92 Remittent or bilious fever. . . 289 Renal calculi 362 Rennetwhey 751 Repertory 760 Repetition and selection of medicines 81 Respiratory organs, diseases -f 380 K.,..t, its indications SR Restlessness as a symptom.. 57 Retarded strength of the limbs 694 Rheumatic or catarrhal con- stitution 27 Rheumatic or nervous ear- ache 200 Rheumatism, articular 5W Hheumatism of the joints — 594 Rheumatism, chronic '^S6 Rheumatism, deforming '^^8 Rheumatism, arthritic 598 Rheumatism, chronic of the ioints 601 Rheunuitism of the sciatic nerve 605 Rheumatism of the back- Lumbago 484 Rhus tox. as an external ap- plication 9'^ Rickets 480 Rickets, home and mechani- cal measures for 481 Rickets, allopathic treatm't. 481 Rickets, homoeopathic treat- ment 48J Rice gruel 749 Rice water '^' Ringing and buzzing in the ears ~^^ Ringworm ^''* Be: GENERAL INDEX. 83 86 752 81 27 48J 749 751 £01 510 Boast awples for invalids vso Rose — Erysipelas 4<)h Rules for preserving lionioeo- pattiic medicines 87 Rules for diet, under treatm't .'u., Rules for injections Rules for restoring persons after accidents 725 Rupture in infants 687 Rupture, navel, of infants... G87 Rupture, groin, of infants. . . 687 Saliva, its indications 77 alt wat-jr bath, cold 96 SaltRheum 511 Sago gruel 741) Sanguine constitution 25 Sanguine temperament 28 Scabies — Itch 516 Scab, milk— milk crust 701 Scald head 515 Scalds and burns 741 Scarlet fever — Scarlatina. . . . 527 Scarlet fever, complicated forms of 533 Scarlet fever, after effects of 534 Scarlet fever, symptoms and course of 528 Scarlet fever, urtemia in 531 Scarlet fever. Belladonna as a preventive 532 Scarlet rash 527 Scarlatina 527 Scanty secretion of milk 675 Scanty or suppressed men- strual flow 628 Sciatic rheumatism • 605 Scorbutis 238 Scrofulous ophthalmia 185 Scrofula, Scrofulosis 617 Scurvy.... 238 Secretion of the milk 674 Secretion of the milk, sup- pressed after delivery 675 Secretion of the milk, exces- sive after delivery 675 Selection, repetition and ad- ministration of the medi- cines 81 Selection of a nurse 689 Sensations of discomfort. ... 66 Sensations of anxiety, their indications 68 Sensations and Lenses 52 Sexes, the, and their distinc- tions 29 Sexual organs, male, disea- ses of the 373 Sexual organs, female, disea- ses of the 621 Shingles 510 Short-eightedness 188 Slok headache -^^ Sickness at the stomach, nau- sea and vomiting, indica- tions afforded by Sickness in the morning, dur- ing pregnancy Sickness, green, predisposing causes and treatment of. . . Sight, the Sight, short ......'.' Signs of pregnancy. . . ..".".'.'.'. Skin, diseases of the Skin, simple redness of the, erythema Skin, inflammation of the, with swelling, heat, red- ness and tingling, (erysipe- las) Sleep, its character as a symp- tom Sleep, sleeplessness of infants Slow pulse Slow breathing Sluggish pulse Small pulse Smallpox— Variola Smallpox, allopathic treat- ment Smallpox, homceopathic treatment Smallpox, confluent Smallpox, modifled Smallpox, complications and after-effects of Smallpox, boils during Smallpox, cough during Smallpox, asthma during. . . Smallpox, looseness of the bowels during Smallpox, mode of living during Smell, the sense of Sneezing, yawning, groaning etc., their indications Singultus Snuffles, cold in the head, of infants Soap plaster as an applica- cation for burns Soft pulse Soft toast, how to make Sore throat— Angina Sore throat, allopathic treat- ment • •• Sore throat, homceopathic treatment Sore throat, ulcerated Sore nipples •••,•■ Sore mouth, nursing of in- fants. Sores or ulcers • • • .• Sounds from chest and indi- cations Sour btomach.see Heartburn. 931 43 657 626 70 188 652 497 497 498 58 692 37 45 37 37 535 537 539 540 541 .542 542 542 542 542 542 71 76 443 696 94 37 747 218 220 221 221 683 702 494 75 669 t^ ^' i% II ) 982 GKNEIIAL INDEX. Sour stomach of infanta . '«>>) (SpaniHli tiy as an outwani application 93 Spasm of tlje stomach 210 Spasm of the stomach, allo- pathic treatment 271 Spasm of the stomach, hom- OBoi)athic treatment 272 Spasm of the bladder 370 Spasm of the bladder, after labor G73 Spasms and convulsions as symjjtoms 58 Spasms of infants 721 Speech and voice, and tlieir indications 75 Speech, loss of as a symptom 7G Spermatorrhuiu 374 Spine, disease of the 478 Spirits, depression of the 261 Spitting of blood 402 Spitting of blood, allopathic treatment 403 Spitting of blood, hom(Eoi)a- thic treatment 401 Spleen, inflammation of the 349 Spotted fever 113 Spotted fever allopathic treat- ment 115 Spotted fever, homceopathic treatment IIG Sprains 729 Stammering as a symptom. . 75 St. Anthony's lire, erysipelas 498 Stenocardia 468 Stenocardia, allopathic treat- ment 469 Stenocardia, home treatment 470 Stillborn children 6^5 Stings of lusecls 742 Stomatitis 215 Stomach, diseases of the 240 Stomach, derangement"; of the, not habitual 2S7 Stomach, derangements of the, of children 260 Stomach, hemorrhage from 200 Stomach, spasm of the 270 Stomach, spasm of the, allo- pathic treatment 271 Stomach, spasm of the homoe- opathic treatment 272 Stomach of infants, flatulent distention of 700 Stomach, sickness at the, nausea . 264 Stone in the bladder 362 Stone, inflammation of the kidneys connected with. ... ;52 Stone cutters' asthma 712 Stoppage of the bowels— Con- stipation 826 Strains or sprains in general 729 Strabismus (();< Strength, retarded of the limbs 1)04 .Slioiig pulse ." 87 St. Vitus' dance— Chorea. '. . . 1G4 St. Vitus' dance, allopathic treatment 164 St. Vitus' dance, homoeoj)a- thic treatment 1G5 Suckling, duration of;wean- ^ ing... 691 Suckling of the infant, gene- ral oljservations — (Jb8 Suflocation, apparent deuth from 724 Sunmier complaint of infants 706 Sunstroke, sun fever 742 Supper, brown mush for 746 Suppression oi' perspiration after delivery 077 Suppression or delay of the menses 628 Suppression or scanty secre- tion of milk 675 Surgery 724 Suspension of doses 85 Suspended animation 685 Sweat, its indication 73 Sweat, critical 74 Swelling of the limbs during pregnancy 662 Swelling of the head of inf'ts 68*' Swelling of the breasts of in- fants "12 Swollen cracked and furrowed or swollen and indented, swollen and red tongue — 61 Swooning— Fainting 62, 54 Stye 192 Sycosis mentagra 607 Symptoms exhibited by irri- tation of the lining or nm- cous membrane of the sto- mach 246 Synij)toms exhibited by irri- tation of the nerves of the stomach 248 Symptoms of the change of life 644 Symptomatic erysipelas 600 Sympathetic aflectioft of the brain and nervous system. 261 Synochia. 654 Synochial or inflammatory fever 654 Synovitis, see inflammation ofthejoints 486 Synopsis of the rules for diet under treatment 109 Systematic table of rules for the administration of doses 8* Table of analogous remedies VA able of contents 16 6ENRRAL INDEX i'.K>. 1t>4 ■12 T«ble of remedies with their Jlnglish and Latin names •iud tlieir antidotes 752 Tape worm 824 'Xape worm, allopathic treat- ment 325 Tape worm, home treatment 325 Tupioea cup pudding 749 'rardineas in breatliing, its indications 26 Tarsus 4U3 Taste, the, its indications... 71 Tearfulness and laughter. . . 76 Tea, beef, for invalids 748 Tea, mutton, for invalids ... 740 Tea, liaxseed, for invalids--. 750 Teeth, pain in the 236 Teething of infants 717 Temperament, sanguine 28 Temperament, choleric 28 Temperament, melancholic. 28 Temperament, phlegmatic. 29 Temperaments and tlieir var- ieties 28 Temperature of bath for in- fants 98 Tenderloin, broiled, for in- valids 748 Testes, inflammation of the. 373 Testes, inflammation of the, treatment for 374 Tetanus— Lock-jaw 141 Tetanusallopatnic treatment 142 Tetanus, homoeopathic treat- ment 143 Tetter, scaly 506 Tetter— Herpes 609 Tetter, honeycomb 615 The antecedents of a patient's liuuily ii9 The sexes and their distinc- tions 29 The age and conditions which qualify it 29 Tlie part or organ usually diseased 32 The pulse; its varieties and indications 35 The art of feeling the pulse. . 35 The condition of the blood-.. 40 The urine; its varieties and indications 41, 42 Tile healthy appearance of urine 41 The proper time for investi- gating the urine 42 The breath in health . . 44 The digestive functions. . . . ..^",240 The evacuations, and indica-- tions 47 The appetite and its indicf tions 49 The tongue, its indications.. 6i The sensations and their in- dications The organs of sense, tlieir in- dications The complex'n,it3 indication the voice and speech, its in- dications The saliva, its indications.'!'. The expectoration, its indica- tions The habits of living! ! . ! ! Tliechangeof life Thickened milk '."..' Thirst, its indications ! Throat, aphthous sore Throi't, to clear the, after ac- cident Thrush— Aphtha' .'..'.'.. Thrush— Aphthic of infants. Time etc., for investigating the urine as a clue to the nature of the disease Toast, soft, how to make. . . , Toast, egg, how to make Toast, dry, how to make Toast, milk, how to make. . . Toa.st, water Tonsils, inflammation of the Tonsils, chronicenlargemeut of the Tonsilitis Tongue, the, and its indica- tions Tongue, furred, yellow, cleai, dry, red, glazed, swollen, cracked, furrowed, inden- ted, tremulous, blackish, and tlieir indications Toothache Toothache during pregnancy Tooth, bleeding after extrac- tion Transpiration from the skin its indication Trance Treatment, preventive and eradicative Treatment of infants Treatment after birth Treinbling as a symptom. . .. Tremens delirium Trismus Trismus, allopathic treatm't Trismus, homcEopathic treat- ment Tuberculosis Tuberculous meningitis Tumors, lymphatic Tussis convulsiva Typhoid fever Typhoid and typhus fever, homoeopathic division and treatment • 088 «1 69 74 76 77 77 101 644 748 60 218 725 216 702 42 747 747 748 748 750 221 224 221,224 61 51 236 661 733 73 156 98 685 685 60 144 141 142 144 607 136 494 423 656 664 mw^ 984 OEN£RAL IND1<;X. (I ■ ill TyphuH fever o^s Typhus characterized by stu- por 576 Typhus, ahdonunal 568 Typhus, convalescence and debility after 676 Typhus, after effects of 677 Ulcers, lymphatic tumors diseases of the cinglo- bate Inlands 494 Ulcerated sore throat 212 Unequal pulse iM Uremia in scarlet fever .... 6;U Urine and its varieties 41 Urine, healthy appearance of 41 Urine, bloody 366 Urine, proper time for inves- tigating 42 Urine, its variations, the in- dications 42 Urine, retention after labor.. 673 Urine, inability to hold after labor 674 Urine, the foretells — the change at crisis 42 Urinary difficulties during pregnancy 663 Urtica Diocia.or Urtica Urens externally applied 94 l^rlicaria, 503 Uterus, cancer of the 649 Vaccination 723 arieties of temperaments. 28 Varicose veins 471 Varicose veins, during preg- nancy 662 Varices 471 Variola— Smallpox 535 Varioloid 641 Veins, diseases of the 470 Veins, inflammation of the. . 470 Veins, varicose 471 Veins, dilation of. 471 Verification of death 727 Vinegar whey 751 Voice and speech, and their indications 75 Voice, loss of, as a symptom. 75 Vomiting, its indications in disease 48 Vomiting of blood 266 Vomiting during pregnancy 655 Vomiting of milk by infants 699 Wakefulness of infants. . . . 697 andering erysipelas 500 Warmth, to restore after ac- cident 725 Water, pure as a necessity for health 106 Water on the brain 139 Water on the brain, allo- pathic treatment 140 "Water on the brain, homoeo- pathic treatment \^^\ Watery, or weeping eye i9o Waterbrash during j)reg'n(;y 659 "Water, gruel for invalids 749 Water, apple for invalids 750 Water, toast for invalids 750 Water, rice for invaUds 751 Weakness after delivery 0«ii Weaning of infants 691 Weeping eye 190 Wetting the bed, see Enuresis nocturni 308 When medicines should be taken 87 Whey, alum 751 Whey, mustard 751 Whey, vinegar 751 Whey, rennet 761 Whey, orange 751 White swelling 489 Whites, leuchorrhoea 6^7 Whitlow, or felon 519 Whooping cough 4J.I Whooping cough, allopathic treatment 426 Whooping cough, homoeopa- thic treatment 427 Wind in stomach and bowels, as a symptom 48 Windpipe, diseases of the. . , 380 Womb* falling of the 641 Womb, cancer of the 649 Womb, inflammation of the see Leuchorrhoea 637 Women, diseases peculiar to. 621 Worm colic 316 Worms— Helminthiasis 320 Worms, allopathic treatment for 321 Worms, homoeopathic treat- ment for 322 Worms, tape 324 Worms, pin, (thread worms) 321 Worms, long round 322 Wounds 731 Wounds, incised 732 Wounds, manner of dressing 732 Wounds of arteries and veins 732 Wounds of the mouth 733 Wounds, lacerated 734 Wounds, contused bruises... 735 Wounds, gun shot 736 Wounds, punctured 730 Yawning, as a symptom — _77 el low fever ^'^ Yellow fever, its symptoms. 581 Yellow fever, allopathic treatment ^*" Yellow fever, homoeopatic treatment ^^ Young children, food ton. ... 7*» AGENTS WANTED FOR THE MOST VALUABLE ANDJALABLE BOOKS The sale of popular books, by canvassers, gives pleasant and profitable employment to a large number of persons, and if the lx)oks are of a merito- rious character, the business is a most useful and honorable one. 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