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The
Practice of Medicine
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1837
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UNIVERSITY OF MICHIGAN
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Archie Fraser M. D.
Fehrary 6 1897
THE
Practice of Medicine,
A CONDENSED MANUAL FOR THE
BUSY PRACTITIONER.
BY
MARVIN A. CUSTIS, M. D.
T

PHILADELPHIA:
BOERICKE & TAFEL.
1896.
↑
PRINTED BY
T. B. & II. B. COCHRAN,
LANCASTER, PA,
COPYRIGHTED BY
BOERICKE & TAFEL.
1895.
PREFACE.
In presenting this Manual to the Profession the
aim has been to give them a practical volume on
the Practice of Medicine.
In the description of the diseases the latest
definite views of etiology and pathology have
been given; and, in the treatment, only those
remedies are mentioned that have a definite rela-
tion to the disease treated of.
The symptoms of each remedy have been
marked according to their estimated value; those
put in italics are "distinct and positive" symp-
toms; while those marked by an asterisk (*) are
the recognized "characteristic," or "key-note"'
symptoms; and, those left without a sign are the
ordinary symptoms of the drug,
The standard works of both schools have been
consulted in the preparation of this manual; and,
the indications for the remedies are those accepted
by the homoeopathic medical profession generally
as trustworthy and accurate.
634 East Capitol St., Wash., D. C.
July 4, 1895.
155066
M. A. C.
Diseases of the Respiratory System,
Diseases of the Nasal Passages,
Diseases of the Larynx,
Diseases of the Bronchial Tubes,
Diseases of the Lungs,
CONTENTS.
Diseases of the Pleura,
Diseases of the Digestive System,
Diseases of the Mouth,
Diseases of the Pharynx,
Diseases of the Stomach,
Diseases of the Intestines, .
Intestinal Parasites,
Diseases of the Appendix,
Diseases of the Rectum,
Diseases of the Peritoneum,
•
Diseases of the Liver, .
Diseases of the Kidneys,
Diseases of the Bladder,
Diseases of the Blood,
Diseases of the Circulatory System,
Diseases of the Pericardium,
B
Diseases of the Heart,
Chronic Valvular Diseases,
Neuroses of the Heart,
Diseases of the Arteries,
Index,
Specific Infectious Diseases,
Constitutional Diseases
Diseases of the Nervous System, .
•
Diseases of the Cerebral Membranes,
Diseases of the Cerebrum,
Diseases of the Spinal Cord, .
Diseases of the Nerves,
General or Functional Diseases,
•
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D
•
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•
•
•
•
PAGE.
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343
Diseases of the Nasal Passages.
ACUTE CORYZA.
Synonyms. Acute rhinitis; acute nasal ca-
tarrh; or, as is generally termed, "cold in the
head."
K
Definition.An acute catarrhal inflammation
of the mucous membrane of the nasal cavities.
Etiology.-Exposure to atmospheric changes.
The presence of some irritating substance in the
nasal cavities, such as tobacco, dust, etc.
symptom of another disease. Epidemic influ-
As a
ences.
Pathology. In the first stage we find the
mucous membranes congested, swollen, bright
red, and the secretions suppressed. This is soon.
followed by a flow of an irritating, thin, colorless
secretion, excoriating the lips and nose; this, in
turn, is followed by a flow of muco-purulent fluid.
Symptoms. At first, have peculiar lassitude,
slight dull frontal headache, and feeling of dry-
ness and stuffiness of the nose. Coryza is some-
times ushered in with chilliness, with more or less
fever. The nose in the beginning is generally
obstructed, so that breathing has to be performed
through the mouth. The discharge is first thin
and irritating, but later becomes copious and
muco-purulent.
2
2
DISEASES OF THE NASAL PASSAGES.
Duration. From a few days to two weeks.
Complications.-Conjunctivitis; pharyngitis;
laryngitis; catarrh of the eustachian tube.
Prognosis. Good.
Treatment-Is both abortive and curative.
Abortive. If upon the first signs of a com-
mencing cold the patient will go to bed and take
a cup of hot water and wrap himself up warmly
he will soon be in a sweat, which usually ends
the matter. The remedies for aborting a cold are
Aconite, Camphor, Gelsemium, Nux vomica.
REMEDIES.
Aconite. At the commencement of an attack, *particu-
larly if caused from an exposure to a dry, cold wind; and
we have chilliness, followed by feverish heat; or for
fever, after the chilliness has passed off. Headache,
lachrymation, sneezing, roaring in the ears. Sleepless-
fear of death.
* Tickling
ness, great restlessness, and
in larynx, with short, dry cough. Amelioration in open
air.
Ammonium Carb.-* Dry coryza, with stoppage of the
nose, especially at night, and lachrymation.
Arsenicum.-Coryza, with headache, restlessness, and
*prostration. *Distressing stoppage at the bridge of the
nose; stuffed cold, *the nose seems stopped up, and still
it runs (Nux vom.); fluent coryza, with frequent sneez-
ing, hoarseness, sleeplessness, and swollen nose.
fuse discharge of a watery, burning, and irritating mucus,
excoriating the lips and nose.
* Pro-
Arum Tri.-* Coryza, with discharge of burning, acrid
mucus, excoriating the nose and lips. * Constantly pick-
ing the nose until it bleeds.
Belladonna.-When there is a * sore throat associated
Face flushed.
with the coryza. *Throbbing headache.
*Sleepy, but cannot sleep.
Bryonia.—* Irritable; wants to keep perfectly quiet.
ACUTE CORYZA.
3
(M)
splitting
Fluent coryza, with frequent sneezing, and
headache. Stiff neck. * When the discharge has been
checked, and there develops a dull throbbing headache
of the frontal sinuses.
Carbo Veg.-For the first symptoms of a cold in robust
persons. Coryza, with hoarseness, and rawness in the
chest. Coryza * returns in the evening. * Ineffectual
attempts at sneezing.
Cepa. -* Profuse, watery, burning, and excoriating
discharge from the nose; *the discharge is very watery,
drops from the tip of the nose. Constant and violent
sueezing, particularly on entering a warm room.
Much
lachrymation, with swelling of the eyelids. Feeling of
oppression in middle and upper part of the chest.
(Cepa is very apt to drive the catarrh to the chest, in
which case study Phosphorus.)
Chamomilla.—For aborting coryza in children and
sensitive persons. *The patient is very spiteful and snap-
pish, and, if a child, it must be carried to be pacified.
*One cheek red, the other pale. The nose is stopped up,
with discharge of a hot, watery mucus. Sneezing. Feel-
ing as if coryza would appear.
Dulcamara.- -When the coryza is caused by exposure
to damp, cold air; and renewed by the slightest exposure.
*Worse in the open air, and better in a closed room.
Euphrasia. In coryza, with a bland discharge from the
nose, and an excoriating lachrymation.
Gelsemium. For a disposition to catch cold from every
change of weather. Colds during the spring and summer
months. Coryza, consisting of a watery, excoriating dis-
charge, making the edges of the nostrils red and sore.
Tingling in the nose; *with violent morning paroxysms
of sneezing. A feeling from the throat up into the left
nostril, like a stream of scalding water.
Hepar Sulph.-After the previous exhibition of Mer-
curius, or when that substance has been abused. When
the cold is renewed from every slight exposure to the air;
and the headache increased by motion. *Coryza, with
inflammatory swelling of the nose, painful like from a
4
DISEASES OF THE NASAL PASSAGES.
boil, particularly the wings of the nose. * Also when the
coryza affects only one nostril.
Kali Iod.—* Thin, unirritating coryza.
Magnesia Mur.-For the loss of smell and taste, which
often remain after an attack of coryza.
Mercurius.* Thin, watery coryza; with rawness and
soreness of the nose and throat; and constant sneezing.
*The patient has a disagreeable sense of warmth, but he
cannot bear the cold. *When the coryza is fully estab-
lished, with thick, unirritating, slimy discharge.
Nux Vomica.-For the first symptoms of coryza.
Cold
from exposure to dry, cold winds, as from sitting in cold
places, or on cold stones. There is alternate feverish-
ness and chilliness. * Dry coryza, violent sneezing, with
stopped up feeling of the nose; itching of the eustachian
tubes compels frequent swallowing, which keeps him
awake nights. *Suppressed catarrhal discharges, with
violent frontal headache. *The coryza is fluent in the
day, and dry at night. * Alternately free and obstructed
nasal passages.
*Sensitiveness of the scalp to touch,
ameliorated by covering. Catarrh better while in the
cool air, and aggravated while in a warm room.
Pulsatilla. When the coryza has become fully estab-
lished, with a thick, yellowish, or yellowish green dis-
charge, which is perfectly bland; associated with loss of
smell and taste.
Sambucus. Particularly for coryza of infants. *The
nose is perfectly dry, and completely obstructed.
CHRONIC CORYZA.
Synonyms. Chronic nasal catarrh; chronic
rhinitis.
Definition.-A chronic catarrhal inflammation
of the mucous membrane of the nasal cavities;
characterized by a sense of fullness in the nares,
with an excessive and persistent secretion of
mucus, and impairment of the sense of smell.
CHRONIC CORYZA.
5
Etiology. As a rule, the result of repeated
attacks of acute coryza. From the presence of
foreign bodies in the nasal passages. From the
inhalation of irritating atmosphere. As a sys-
temic dyscrasia, as in the case of syphilis, scrof-
ula, etc.
Varieties. There are two varieties of chronic
coryza, viz.: hypertrophic nasal catarrh and
atrophic nasal catarrh.
HYPERTROPHIC NASAL CATARRH
is a chronic catarrhal inflammation of the nasal
mucous membranes, characterized by hyper-
trophy of the nasal tissues and membranes, caus-
ing difficult respiration.
There are two stages of hypertrophic nasal ca-
tarrh: (1) the stage of congestion; (2) the stage
of true hypertrophy.
Symptoms. The symptoms of the stage of
engorgement are a profuse, watery nasal dis-
charge; stoppage of one or both nasal passages.
The stage of hypertrophy is characterized by
stoppage of the nose; a constant desire to
"hawk" to clear the nose and throat; discharge
of a thick, ropy mucus. The nose feels dry, as a
rule. With these symptoms, there are headaches
and neuralgias. Hearing is generally impaired,
and frequently the patient complains of "noises
- in the head."
Inspection. The tissues of the nasal cavities
will be found thickened and firm to the touch;
they may be indented, but will at once recover;
6
DISEASES OF THE NASAL PASSAGES.
the tissues will be darker in color than the normal
membrane. This thickening may be unevenly
distributed over the membranes of one or both
nasal cavities.
Prognosis. Good, if the patient is otherwise
healthy.
Treatment.-Locally, consists in keeping the
parts free from discharges by antiseptic sprays; in
correcting any malposition of the septum, and
possibly the removal of the hypertrophied tissue.
Remedies. Consult the remedies given at the
end of the chapter.
ATROPHIC NASAL CATARRH,
or ozæna, is a chronic catarrhal inflammation of
the nasal mucous membrane, characterized by
atrophy of the nasal tissues and membranes, with
decided fetid odor.
This form of catarrh generally follows the
hypertrophic variety.
Symptoms. There is great dryness of the
nose, with occasional expulsion of "clinkers,"
which may be blood-streaked; there is an offen-
sive odor from the parts. The sense of smell is
greatly impaired, if not entirely lost.
Inspection. The cavities are abnormally large,
due to the atrophied tissue. The membrane of
the nose is pale, dry, and glistening. There are
"plugs" adhering to the membranes.
Prognosis. Treatment affords wonderful help,
but seldom a complete cure.
Treatment.-Locally, the nasal passages must
CHRONIC CORYZA.
7
be kept clean, and the clinkers prevented from
forming by means of an alkaline spray.
REMEDIES
For chronic nasal catarrh:
Argentum Nitr.-Chilliness; stupefying headache; itch-
ing of the nose; discharge of pus, with clots of blood.
Small ulcers form in the nares. Thick, tenacious mucus
in the throat, compelling frequent hawking.
Arsenicum Iod.-In those of a tubercular diathesis.
Acrid discharges from the nose, with burning sensations.
Enlarged glands.
Aurum.-This is one of the best remedies for ozæna.
*In syphilitic catarrlıs. * Nasal bones very sore to the
touch. * Exceedingly fetid odor. * Patient_loathes life,
with desire to commit suicide.
Graphites.—In those inclined to obesity. Swelling and
dryness of the nose, with loss of smell. Discharge, from
the nose, of fetid, thick, yellow mucus, which often forms
hard masses or crusts. Nostrils are sore, cracked and
ulcerated.
Hydrastis. Soreness of the cartilaginous septum. Dull
headache. The air feels cold in the nose. Hawks clink-
Ozana with bloody, puru-
ers from the posterior nares.
lent discharges.
Kali Hyd.—If of syphilitic origin.
Kali Bich. Thick, tenacious, ropy discharge from
Plugs, slightly colored with blood, from posterior
nares. * Ulceration of the nasal membrane.
nares.
Lycopodium.—Atrophic variety. *Stoppage of the
nose at night.
*
Mercurius Prot.- - Base of the tongue covered with a
thick, dirty, yellow coating. Small ulcers on nose.
*Collection of much tenacious mucus in the throat, caus-
ing constant inclination to hawk and spit.
Nitric Acid.-Svphilitic ozæna.
Psorinum. When other remedies fail, and the case is
characterized by great fetor from the nose.
8
DISEASES OF THE NASAL PASSAGES.
со
Phosphorus.-The nose is swollen and sore. * Soreness
and rawness of the throat. * Great dryness of the throat,
it fairly glistens. The discharges are streaked with
blood.
Pulsatilla.
Thick, yellow or green discharge, asso-
ciated with loss of taste and smell.
Sepia. In those of a sallow complexion, with dark
hair. * Painful eruptions on tip of the nose. The clink-
ers are green and bloody. This drug is particularly use-
ful in the atrophic variety of catarrh.
*
Silicea. In those of a scrofulous diathesis. * Intoler-
able itching of the nose. * Great dryness of the mem-
branes of the nose; *ulcers high up in the nose, with
great sensitiveness to contact.
Sulphur.-Psoric dycrasia. * Skin rough, scaly and
scabby. * Smell before the nose as of an old catarrh.
Bloody discharge when blowing the nose. Ulcers and
scabs in the nose.
Diseases of the Larynx.
ACUTE CATARRHAL LARYNGITIS.
Synonyms. Catarrhal laryngitis; pseudo-
croup.
Definition.An acute catarrhal inflammation
of the mucous membrane of the larynx.
Etiology. Predisposition in weakly individ-
uals. Extension of an attack of coryza. Ex-
posure to atmospheric changes. Inhalation of
impure air. Presence of foreign bodies in larynx.
Injury to larynx. Straining the voice.
symptom of certain infectious diseases.
As a
Pathology.The mucous membrane of the
larynx is at first congested, then inflamed.
There is great dryness, owing to the arrested
gland function, but the membrane soon becomes
covered with mucus. The parts become greatly
swollen.
Symptoms.-The approach may be very in-
sidious; or it may be announced by slight rigors;
or it may be sudden, with rapid rise of the tem-
perature, with flushed face, dry, hot skin, fre-
quent and hard pulse, and more or less impedi-
ment to the respiration. There is decided pain
in the throat, with sense of constriction; or a feel-
ing of dryness; or irritation as from the presence
of a foreign body. Violent tickling, causing
10
DISEASES OF THE LARYNX.
cough, which is at first dry and spasmodic; but
later becomes loose, with expectoration. There
is great difficulty in swallowing. The voice soon
becomes hoarse, and may, if the swelling of the
mucous membrane be great, amount to complete
aphonia. The throat is very sensitive, and the
least touch often throws the patient into violent.
spasms.
Inspection. In the early part of the disease
inspection will reveal the whole larynx red and
congested; later there will be considerable œdema.
Complications.-Extension of the inflamma-
tion downwards, thereby leading to bronchitis,
pneumonia.
Prognosis. The tendency is to recovery. The
greater the cedema, the more grave becomes the
prognosis. The younger the patient, the more
doubtful the prognosis.
Treatment.-Confine patient to the bed. Have
the room of an even temperature, and keep the
atmosphere moist. Inhale steam. As a last
resort, when the cedema of the glottis threatens
life, scarification, or even tracheotomy, must be
performed.
REMEDIES.
Aconite - From dry, cold winds. *For the fever,
with dry, hot skin; restless; hard, metallic cough. *Loud
breathing during expiration. *During every cough-spell,
the patient grasps his throat.
Apis.-"Should cedema glottidis supervene, repeated
doses of Apis would give the best chance of averting
tracheotomy."-Hughes.
Belladonna.-When the attack sets in with great vio-
LARYNGITIS.
II
lence. * Violent fever, with flushed face, throbbing
carotids, and great heat of the skin.
Hepar Sulph.—When, after Aconite and Spongia, there
remains a loose, rattling cough. When symptoms of
ulceration of larynx comes on. Hoarseness.
*
Lachesis. Extreme sensitiveness of the throat to
touch, must pull away even the clothes.
* Ex-
Phosphorus. *For the tendency to relapse.
treme rawness of the larynx. For the hoarseness,.
which often remains after an attack of laryngitis.
Sambucus. For the suffocative attacks.
Spongia. In the majority of cases, follows Aconite.
* Respiration sawing, sounding like a saw driven through
a pine board.
*Must throw head back to breathe.
SIMPLE CHRONIC CATARRHAL
LARYNGITIS.
Synonyms. Simple chronic laryngitis; "cler-
gyman's sore throat."
Definition.-A chronic catarrhal inflammation
of the mucous membrane of the larynx, with ten-
dency to remain stationary.
Etiology.
As a sequelæ of acute laryngitis;
from extension of the catarrhal process from the
nose in nasal catarrh; improper use of the voice
in speaking, singing, etc.; mouth breathing;
abuse of tobacco or stimulants.
Pathology. The mucous membrane is dark,
or may be even blue, in appearance; nearly always
covered with mucus, but may be dry and shiny;
sometimes the membrane is covered with ulcera-
tions. The glands are large and prominent.
The vocal bands become either relaxed or stif-
fened.
Symptoms.-Dryness of the larynx, with sen-
12
DISEASES OF THE LARYNX.
sation of constriction. The voice easily tires
while speaking: becomes hoarse, and in some
cases can only speak in a whisper. There is a
hoarse cough, with scanty, viscid expectoration.
Treatment.-The body should be clothed
properly and the patient instructed how to use
the voice correctly. Cold water applied to the
neck night and morning is beneficial.
Remedies. Argentum nitr.; Arsenicum; Cal-
carea carb.; Carbo veg.; Hepar sulph.; Iodine;
Kali bich.; Nitric acid; Phosphorus; Sanguin-
aria; Selenium; Sulphur.
CHRONIC CATARRH OF THE LARYNX
IN PHTHISIS.
Synonyms.—Laryngitis phthisica; tubercular
laryngitis; throat consumption.
Definition.-An inflammation of the larynx,
generally associated with pulmonary tuberculosis,
characterized by pyriform swellings of the ary-
tenoid cartilages, and possibly ulceration, par-
ticularly in the interarytenoid spaces.
Etiology. In the great majority of cases is
secondary to pulmonary tuberculosis.
Pathology. The mucous membrane is at first
pale, followed by redness of hyperæmia and in-
flammation; this is sometimes followed by ulcera-
tion, which is usually confined to the inter-
arytenoid spaces.
Symptoms. Interference with respiration;
hoarseness; nervous cough, with slight expecto-
ration; and painful deglutition.
13
CATARRH OF THE LARYNX IN SYPHILIS.
Inspection. The mucous membrane is anæmic,
with patches of hyperæmia; ulceration, usually
confined to the interarytenoid spaces; and pyri-
form swellings of the arytenoid cartilages, which
is diagnostic of laryngeal phthisis.
Prognosis. Bad, but life can be prolonged by
careful prescribing.
Treatment.-Should be constitutional.
CHRONIC CATARRH OF THE LARYNX
IN SYPHILIS.
Synonym.-Syphilitic laryngitis.
Definition.-An inflammation of the larynx,
due to specific infection, characterized by condy-
lomata, syphilomata, or ulcers, which are gener-
ally symmetrically distributed.
Wh
Etiology Infection.
Pathology. A catarrhal inflammation, in
which the membrane of the larynx becomes livid
or deep red, usually in patches; or may have
gummatous tumors forming in rows; or ulcers,
showing the general characteristics of syphilitic
ulcers.
Symptoms. -Hoarseness; cough; and painful
deglutition.
Inspection.-Shows the membrane as described
under pathology; also, "two thick, red, narrow
bands of inflammation running along the edge of
the velum palate and stopping short equidistant
from the root of the uvula, and a symmetrical
distribution, in size, shape, and position, of brick-
red patches of inflammation in the oral cavities."
(Dr. Seiler.)
14
DISEASES OF THE LARYNX.
Treatment.-Must be constitutional.
CEDEMA GLOTTIDIS.
Synonyms.-Edematous laryngitis; cedema.
of the larynx; cedema of the glottis.
Definition.-An infiltration of serous fluids;
or of inflammatory products into the areola tissue.
of the larynx.
Etiology. Generally a secondary disease.
Those suffering from phthisis or syphilis are
predisposed to oedema glottidis. One attack pre-
disposes to another.
Pathology. There is an infiltration of serous
fluid into the cellular tissue of the larynx. This
infiltration occurs more especially at the base of
the epiglottis, and in the ary-epiglottic folds. The
oedematous swelling may entirely disappear after
death.
Symptoms. The first sign is difficult respira-
tion, particularly the inspiration; but later when
the infiltration spreads to the aryteno-epiglottid-
ean folds, epiglottis and cords, both the inspira-
tion and expiration become embarrassed.
Laryngoscopic Examination--Reveals the parts
swollen, tense and red, particularly at the ven-
tricular folds.
Prognosis.
By prompt homeopathic treatment
the prognosis is good, although the tendency of
the disease is deathward.
Treatment.-Patient must be confined to bed;
atmosphere to be kept moist. Patient may inhale
If dyspnoea becomes great, perform a low
steam.
SPASMODIC CROUP.
15
tracheotomy, or use intubation tube; scarification
being of doubtful utility.
Remedies.-Apis seems to be the best general
remedy, and its exhibition is often followed by
astonishing results; Dr. Hughes says: "Trust to
Apis." But if there should be high fever Aconite
must be used. If the cedema of the glottis is
associated with general dropsy, then Arsenicum.
When it is secondary to acute pharyngitis, Dr.
Irvins says he "knows of no remedy to take the
place of Sanguinaria."
SPASMODIC CROUP.
Mag
Synonyms. Spasmodic laryngitis; false
croup; catarrhal croup.
Definition.An inflammation of the larynx,
associated with spasm of the vocal cords.
Etiology. The young are especially predis-
posed to it. Hereditary. Causes which excite
laryngitis.
Pathology. Congestion of the mucous mem-
brane of the larynx.
Symptoms.-A sudden development, usually
in the night, of embarrassed respiration, with a
dry, ringing, suffocative cough. The skin, dur-
ing the paroxysm, is hot and dry. After a cer-
tain time, which varies according to the severity
of the paroxysm, the cough ceases, the skin be-
comes moist, the patient is relieved of the embar-
rassed respiration, and he falls off to sleep, to
awaken next morning feeling quite well There
may be two or more such paroxysms during the
16
DISEASES OF THE LARYNX.
same night. The paroxysms are apt to recur on
succeeding nights.
Prognosis. Recovery.
Treatment.-Apply cloths wrung out of hot
water to the neck. Hot foot bath. Plenty of
fresh air.
REMEDIES.
Aconitum.-At the very commencement of an attack,
especially if caused from exposure to dry, cold winds.
The patient is awakened with a hard, dry, spasmodic
cough. * Loud breathing during expiration, which ends
in a coughing spell. The skin becomes hot and dry, and
the patient feverish. A few doses of Aconite will, as a
rule, cut short the attack, and is generally the only medi-
cine needed.
Belladonna.—If the paroxysins show signs of * cerebral
irritation. *Flushed face; throbbing carotids; and drow-
siness. The child jumps and starts in its sleep.
Chamomilla.-* If one cheek is red, while the other is
pale. *The child is very irritable, cross, and must be
carried up and down the room to be pacified.
Hepar Sulph. After the previous employment of Aco-
nite, or Spongia, when the cough has become loose and
rattling; the air passages seem to be full of mucus.
Seems to be choking with every coughing spell. * When
the paroxysms are worse in the after part of the night,
toward morning. When the slightest uncovering, even
of a hand, brings on a spell of coughing.
*
Lachesis."This remedy has cured far advanced and
apparently hopeless cases of croup, indicated particularly
by very distressing aggravations, after sleeping, as if the
child were dying. Or the child, as it were, sleeps into
the croup and awakens with an attack." (Guernsey.)
Phosphorus. In advanced cases; the pulse thready
and intermittent. Aphonia, sinking of the strength, cold
sweat, and dropping of the jaws. *When there remains
a hoarseness after an attack of croup. *Tendency to
relapse.
MEMBRANEOUS CROUP.
17
*The cough is
Spongia.-After the use of Aconite.
hard, wheezing, and grating. * Can breathe better with
the head thrown back. *Terrible suffocative spells.
*The paroxysms come on, or are aggravated, in the early
part of the night, before midnight.
Tartar Emet.-When there is threatened paralysis of
the pneumo-gastric nerve. *The patient seems to be on
the point of suffocation. *There seems to be a large
quantity of mucus in the bronchial tubes, but none is ex-
pectorated. *Rattling of phlegm in the larynx at every
coughing spell, while little or no phlegm is expectorated.
MEMBRANEOUS CROUP,
Synonyms. Acute croupous laryngitis;
pseudo-membraneous laryngitis; true croup.
Definition. An inflammation of the larynx
and sometimes of the trachea, characterized by
the development of "faise membranes.”
Etiology.-Exposure to atmospheric changes.
The sudden retrocession of some eruptive disease.
Predisposition. Children, from dentition
puberty, are more susceptible to it than adults.
to
Pathology. Hyperæmia and inflammation of
the mucous membrane of the larynx, sometimes
that of the trachea, but rarely that of the fauces,
with the development of a fibrinous exudate,
which is not very adherent to the underlying
structures.
M
Microscopic Examination-Shows this mem-
brane to be composed of a net-work of fibrillæ,
the meshes of which are filled with pus cells.
Symptoms. The onset is very insidious, or it
may develop as an ordinary catarrh or laryngitis.
There is hoarseness, followed by difficult respira-
3
18
DISEASES OF THE LARYNX.
tion; dyspnea is extreme, the child has to labor
for its breath. We have fever, and all of its
attending symptoms. Dry cough, stridulous in
character, with a whistling sound during inspira-
tion. If we now examine the throat, we will find
a grayish-white membrane covering the larynx,
sometimes part of the trachea, but seldom the
fauces. After a certain time, which varies ac-
cording to the severity of the paroxysm, the res-
piration becomes easier; the hoarseness ceases;
the cough becomes loose, with expectoration of
shreds of the membrane; and the patient gradu-
ally recovers. But if the case is going to prove
fatal, the respiration becomes more embarrassed;
the cough gets inaudible; the face becomes
cyanosed; and finally, the patient dies from non-
aeration of the blood.
Duration.-An attack usually lasts from one
to five days, but it may be weeks before the voice
is entirely regained.
Differential Diagnosis.-From false croup by
the slowness of the onset; the elevated tempera-
ture; and the membraneous exudate.
From diphtheria by the absence of any con-
tagion; there being no constitutional symptoms as
prodroma; and no swelling of the gland.
Prognosis.-Grave. One of the most fatal
diseases of children."-Dr. Loomis.
Treatment. Place patient in large airy room;
keep temperature at 75° F., and the atmosphere
moist. Keep patient's strength up by giving
highly nutritious liquid diet; and give alcoholic
stimulants when the patient's condition demands
((
MEMBRANEOUS CROUP.
19
it. The inhalation of slaked, freshly burned
lime may assist in detaching the membrane.
May use peroxide of hydrogen as a gargle.
When symptoms point to non-aeration of the
blood let the patient inhale oxygen. As a last
resort perform a tracheotomy, or possibly intuba-
tion.
tion.
REMEDIES.
Acetic Acid.-Held in high repute by some. To be
used, in a weak solution, as a spray.
Aconite. At the commencement, before the exude has
formed; if there be fever, dry, hot skin, restlessness,
cough and loud breathing during expiration.
Belladonna.*If there is symptoms of cerebral irrita-
M
X
Bromine.-Especially in children having delicate skin,
blue eyes, and light hair. When the case is characterized
by great constitutional prostration, and much rattling
in the larynx when coughing, but no choking. Spas-
modic closure of the larynx, the child grasps for its
breath. *The exudation forms in the larynx, and ex-
tends to the trachea. *Cough is wheezing and rattling.
Iodine. This is one of our most potent remedies against
true croup; give internally and apply externally by
means of an atomizer, In children having a dark com-
plexion, dark hair, and eyes. *There is severe pain in
the chest and larynx, with hoarseness, or complete
aphoma. The child continuously grasps its throat. Cough
is dry, wheezing and sawing. *Coldness of the face in
fleshy babies.
*
Kaolin.- Extreme soreness of the chest..
Kali Bichromicum.—Suits light haired, plump and fat
children. A very slow and insidious onset. *The air
sounds as if passing through a metallic tube.
toration of a tough, stringy mucus. Considered almost a
specific for true croup by many physicians.
* Expec-
Sanguinaria Can.-* Dryness and burning of the throat,
20
DISEASES OF THE LARYNX.
sensation of swelling in the larynx, and expectoration of
thick mucus. * Metallic and croupy cough of a
ing, whistling" character.
" wheez-
LARYNGISMUS STRIDULUS.
Synonyms.-Spasm of the glottis; Kopp's
asthma; child crowing.
Definition.-A non-febrile, spasmodic affection
of the larynx, characterized by temporary spasm
of the abductors of the larynx, with great tend-
ency to recurrence.
Etiology. Irritation of teething. Gastro-
intestinal irritation. Hysteria. Cachectic chil-
dren are predisposed to it. Sequelae of whooping
cough. The pressure of tumors or aneurisms on
the recurrent laryngeal nerve.
Pathology. Not fully understood, but due
to some irritation to the superior laryngeal nerve.
Symptoms.-Onset sudden, generally during
the night. The patient awakes with dyspnea
and "crowing" respiration. Soon the respira-
tions cease, from closure of the glottis; the face
becomes cyanosed; the countenance anxious; and
frequently spasms of other parts of the body.
After a short while the spasm relaxes; the respi-
rations become normal; and the child shows no
signs, except fatigue, of its battle for life.
Differential Diagnosis.-The absence of fever
and hoarseness, the pure spasmodic character of
the paroxysm, will serve to distinguish it from
any similar disease.
Prognosis. In simple cases, favorable.
Treatment. Remove exciting cause if pos-
LARYNGISMUS STRIDULUS.
21
sible. During attacks, may apply hot and cold
applications alternately to larynx. Give Moschus,
Amyl nitrite, or Chloroform by inhalation. If
cyanosis becomes great give Oxygen gas.
Remedies.-Antimonium tart.; Arsenicum;
Belladonna; Bromium; Calcarea phos; Cuprum;
Gelsemium; Ipecacuanha; Lachesis; Phosphorus;
Sambucus.
Diseases of the Bronchial Tubes.
ACUTE CATARRHAL BRONCHITIS.
Synonyms.-Acute bronchitis; bronchial ca-
tarrh; "cold on the chest."
Definition.-An acute catarrhal inflammation
of the mucous membrane of the bronchial tubes.
Etiology.-Exposure to atmospheric changes;
the inhalation of irritating vapor, dust, etc.; the
extension of inflammation from the larynx; asso-
ciated secondarily with certain infectious diseases,
as measles, etc. Predisposing causes are: de-
bility; occupations which confine one to the
house; and the extremes of life.
Pathology. The process is generally found
only in the larger tubes, and usually in the tubes
of both sides. There is hyperæmia and conges-
tion of the mucous membrane, with redness,
swelling, and diminished secretion. Later, there
is a secretion of a yellowish or a whitish mucus,
containing pus-cells; the secretion may also con-
tain blood, due to rupture of some of the capil-
laries.
Symptoms.-The symptoms in the early stage
are those of an acute coryza; chilliness, alternat-
ing with flushes of heat; sore throat; hoarseness;
general malaise; and the patient complains of a
sore, aching, and bruised feeling. The tempera-
ACUTE CATARRHAL BRONCHITIS.
23
ture is but moderately elevated. As the bron-
chitis becomes established, there appears a raw,
burning pain behind the sternum, with sensation
of constriction and oppressed breathing, but no
dyspnoea. The cough, at first, is hard, dry,
and racking, and may be paroxysmal. The ex-
pectoration, at first, is very scant, frothy, and
may be streaked with blood. After the disease
has lasted several days the cough becomes loose
and the expectoration free. The character of the
expectoration now changes to a yellowish or pos-
sibly to a greenish cast, and is muco-purulent or
purulent. As the expectoration becomes free the
other symptoms subside and the patient finds
relief.
Physical Signs.-In mild attacks there are no
distinctive physical signs, but in severer forms we
find:
Inspection and palpation give negative results.
Percussion is normal, unless there is great
accumulation of mucus in the tubes, when there
is diminished normal resonance in the infra-
scapular space.
In
Auscultation.-Vocal resonance is normal.
the early stage the respiratory murmur is feeble,
and there is sibilant and sonorous râles over the
whole chest. In the later stage there are large
and small moist râles, which constantly change.
their locality, or they may temporarily disappear
after a severe paroxysin of coughing.
Differential Diagnosis.-The mode of onset,
and the physical signs, will prevent simple bron-
24
DISEASES OF THE BRONCHIAL TUBES.
chitis from being confounded with any other dis-
ease.
Complications. Emphysema; atelectasis;
catarrhal pneumonia; capillary bronchitis.
Sequelæ. Chronic bronchitis; circumscribed
capillary bronchitis.
Duration.-From two or three days to as
many weeks.
Prognosis. In uncomplicated cases, the prog-
nosis is favorable, except in the extremes of life.
When complicated with heart disease, or with
some infectious disease, the prognosis must be
based upon the general condition.
Treatment.-For the abortive treatment con-
sult chapter on coryza.
M
REMEDIES.
*
*
Aconite. At the commencement of an attack, particu-
larly if caused from exposure to dry, cold winds; and
there is fever, dry, hot skin, restless, tossing about, and
obstructed respiration. The cough is dry, hacking and
worse at nights. *The pulse is full, hard and strong.
Aconite in the first stage, to be followed by Mercurius
later, is often, according to Dr. Hering, the only medi-
cants needed.
K
Arsenicum.-When the patient has been reduced to
*extreme debility and exhaustion; particularly in the
aged. The case has been allowed to run on unchecked,
and there appear signs of pulmonary cedema,
Belladonna. In the first stage, particularly in children.
*There is high fever, flushed face, throbbing carotids,
oppression and constriction of the chest. * Disposition
to perspire. *The cough is paroxysmal and dry, from
tickling in throat; child cries before coughing.
Bryonia. --After the fever has been allayed, and the dis-
ease is located in the larger brochi. *The cough is hard,
ACUTE CATARRHAL BRONCHITIS.
25
*
dry, with sensation as if the chest would split and the
head would fly off; the patient desires to hold his chest
when coughing. There is hard and anxious breathing,
with constant inclination to take a deep inspiration; he
must sit erect. The patient is irritable, and dislikes to
move. *There is great dryness of the mouth and lips.
Chamomilla.— Particularly in children. * When the
child must be carried about to be pacified.
red, while the other is pale.
*
*One cheek
*
Ferrum Phos.-*The pulse is full and soft. Cough
with little or no expectoration; if any, it is apt to be
blood streaked. There is soreness and heat in the chest.
Schüssler says: "It takes the place of Acon. in the acute
inflammatory stage;" but it does not. The character of
the pulse will differentiate it from Acon.
Gelsemium.-In bronchitis occurring in the spring of
the year, or in cases occurring when the weather is warm,
damp and "relaxing." There is a considerable degree
of prostration, the patient is dull and drowsy.
* The
pulse is soft and weak. The cough is excited by a tick-
ling or roughness of the fauces; there is rawness and sore-
ness of the chest.
Hepar Sulph.-* Dry, spasmodic cough, usually coming
in paroxysms, with wheezing over the whole chest. *The
cough is excited by any attempt to draw a long breath, or
the uncovering of any portion of the body, even the
hands. Or, Hepar is useful after the previous employ-
ment of other medicines, *when the cough becomes
loose, hoarse, rattling and choking; it seems as if the
patient would choke in coughing.
Ipecacuanha.—When occurring in children.
*Cough,
with great rattling of mucus in the tubes; the chest seems
full of mucus, but does not yield to coughing.
* The
cough causes dyspnoea, almost unto suffocation; the
patient becomes livid in the face; and has sweat on the
forehead. *Constant nausea.
Mercurius. When the disease is just passing into sec-
ond stage.
*There is fever; alternate chills and heat,
and tendency to perspire, without relief. * Violent, rack-
26
DISEASES OF THE BRONCHIAL TUBES.
ing cough, worse at night, as if the head and chest would
burst.
*The
Nux Vomica,-
The patient is very irritable.
cough is dry and fatiguing, from titillation in the larynx,
worse after midnight; with pain in the stomach, and
soreness in the abdominal walls.
Phosphorus.--When the disease threatens to involve
the lung tissue. *There is great oppression and tight-
ness of the chest; anxiety; burning and rawness of the
chest. *The cough is dry, tickling, with trembling of
whole body. * Sensitiveness and dryness of the larynx.
Pulsatilla. In the second stage of the disease, or
*when the acute attack threatens to assume a chronic
form. * Expectorations are thick, copious, and easy;
*there is great soreness of the epigastric region. The
cough is loose during the day, with a dry, titillating
cough at night in a recumbent position.
*
Tartarus Emet. -When there is an enormous collec-
tion of mucus in the tubes, with difficult expectoration.
*The cough is loose and rattling; with dyspnea, and
fear of suffocation.
CHRONIC CATARRHAL BRONCHITIS.
Chronic bronchial catarrh; win-
Synonyms.
ter cough; chronic bronchitis.
Definition.-A chronic catarrhal inflammation
of the mucous membrane of the bronchial tubes;
generally due to some constitutional dyscrasia;
and has a great tendency to recurrence.
Etiology. It is either primary or secondary.
Primary, when due to exposure to atmospheric
changes or the inhalation of irritating atmos-
phere. Secondary, when due to some local
trouble; from constitutional causes, as syphilis,
rheumatism, gout, etc.; when it occurs as a com-
CHRONIC CATARRHAL BRONCHITIS.
27
plication of cardiac, renal or pulmonary troubles;
from chronic alcoholism.
Pathology. The chronic inflammation may
involve the whole, or only portions of the bron-
chi. The mucous membrane of the bronchi be-
comes reddish-bluish in color; and there is some-
times hypertrophy of both mucous membrane and
glands; with excessive secretion. In cases of
long standing there is irregular dilatation of the
tubes.
Varieties. (1) Mucous catarrh; (2) bron-
chorrhoea; (3) rheumatic bronchitis; (4) fetid
bronchitis; (5) dry catarrh.
Mucous Catarrh.-The mildest form, and gen-
erally appears in the winter. The cough is slight
and the expectoration is moderate in quantity.
Bronchorrhea.-There is excessive secretion,
may amount to from four to five pints in the
twenty-four hours. This variety is generally
found in the aged and those suffering from heart
disease.
Rheumatic Bronchitis.-Bronchitis, with rheu-
matic symptoms.
Felid Bronchitis.-When the expectoration has
an exceedingly fetid odor. This variety, which
is usually found in those who have a poor consti-
tution and in drunkards, is nearly always asso-
ciated with dilatation of the bronchi.
Dry Catarrh. This variety is generally found
complicated with emphysema, asthma, or gout,
and is characterized by a severe paroxysmal
cough, with scanty expectoration.
28
DISEASES OF THE BRONCHIAL TUBES.
Symptoms. The only characteristic symp-
toms of chronic bronchitis are: Cough, with ex-
pectoration; little or no fever; in fact, the gen-
eral health may not suffer to any extent.
Physical Diagnosis -Uncomplicated cases.
have large and small râles, which vary in charac-
ter.
Differential Diagnosis.-It is often difficult
to diagnose between chronic bronchitis and phth-
isis; but, remembering in phthisis there is rapid
emaciation, associated with certain physical signs.
which will be pointed out when considering that
disease, and above all the presence of the bacilli
tuberculosis in the sputum, one will not be led
into error.
Complications.-Dropsies; congestion of the
Sequelæ.-Pulmonary collapse; emphysema;
bronchiectasis; dilatation of the right ventricle of
the heart; and fibroid phthisis.
ble.
Prognosis.-Fair, if uncomplicated.
Treatment.—Remove the cause as far as possi-
Wear flannel next to the body. Let diet
be very nutritious. If possible go to a dry, warm
climate, as the southwest," or if there is emaci-
ation a sea voyage may prove beneficial.
liver.
CC
al
REMEDIES.
Aconite.-Dry cough, worse at night; every inspiration
seems to increase the cough; he is disturbed in his sleep
by the cough, which almost awakes him; he turns over,
and as soon as he is fairly settled down to sleep again the
cough recommences, and so continually repeats itself.
CHRONIC CATARRHAL BRONCHITIS.
29
·
C
In the dry form Aconite is one of our best remedies."
-Dr. Burt.
"
Antimonium Cru. —* When secondary to some stomach
trouble; with a thick milky-white coat on the tongue;
and nausea; * the cough has become loose, and is excited
from being in the sun, or looking into the fire.
Argentum Nitr.-Suits the dry form, particularly when
due to syphilis.
Arnica. If due to mechanical injuries.
Arsenicum. For the dry variety; when due to some
organic trouble, particularly of the heart; or complicated
with emphysema. *The cough is violent and dry, with
shortness of the breath and suffocative spells, worse at
night. There is rapid emaciation and debility, with
anguish and fear of death.
Arsenicum is, after Aconite, one of the most impor-
tant medicines in dry catarrh not of recent date."-Dr.
Meyhoffer.
S
Bryonia.-Rheumatic variety. *The cough is dry, at
night in bed, compelling one to spring up and assume an
erect posture at once (Dr. Guernsey). *Dry cough, with
pains in the chest, as if it would fly to pieces. * Patient
dreads motion; cannot sit up as it causes nausea; the lips
are dry and cracked.
Calcarea Carb.-Secondary bronchitis, due to scrofula or
phthisis; and complicated with emphysema. Cough
caused by sensation of plug, which moved up and down
in the throat. Cough dry, especially at night; violent,
first dry, afterwards with profuse salty expectoration,
with pain as if something had been torn loose from the
larynx, with rattling in the chest.
Carbo Veg.-Fetid variety. There is a great tendency
of the chest to perspire. * Bronchitis in the aged.
* Pro-
fuse expectoration of fetid matter.
Kali Bich.
stringy mucus.
Lycopodium.-When complicated with emphysema; or
when occurring in old people. The patient is quite
emaciated. Cough with excessive accumulation
of
*
When there is an expectoration of tough,
30
DISEASES OF THE BRONCHIAL TUBES.
mucus.
*The cough sounds loose, but the expectoration
is not easy.
* Cough worse from 4 to S P. M., on alternate
days, from exertion, stretching the arms out, stooping
and lying down, when lying on the (left) side, from eat-
ing and drinking cold things, in the wind or in the warm
room.
Senega.—Particularly in old people. * When there is
an enormous accumulation of phlegm, with a loose rat-
tling cough. Tendency to diarrhoea. Chest is painful
and sore.
Sepia.- - Particularly when reflex in women with some
uterine trouble; or from some stomach disease. Cough
every evening, not ceasing until he coughs loose a little
phlegm. Spasmodic dry cough, from tickling in the
chest.
Sulphur. -*This is our best remedy for cases of long
standing; with profuse secretion of mucus.
ACUTE CAPILLARY BRONCHITIS.
Synonyms. Broncho- pneumonia; bastard
pleurisy; suffocative catarrh.
Definition. An inflammation of the mucous
membrane of the small-sized bronchial tubes, or
bronchioles.
makakapar diy
Etiology. Generally secondary to acute bron-
chitis. Any of the causes of acute bronchitis.
As a complication of measles, whooping cough,
More common in the young and the aged.
Pathology. There is hyperemia and inflam-
mation of the finer bronchial tubes, with redness
and swelling, and exudation of tough, tenacious
etc.
mucus.
Symptoms. As capillary bronchitis is gener-
ally preceded by acute bronchitis, the invasion of
the inflammation to the smaller tubes is not
ACUTE CAPILLARY BRONCHITIS.
31
marked by any special symptoms. Or, there may
be a decided chill, fever, and great dyspnœa.
The temperature may rise to 105° F., with accel-
erated respiration and feeble pulse. As the dis-
ease becomes established the temperature may fall
a few degrees, but the respiration and the pulse
stays the same. The cough at first is dry and
paroxysmal, but later there is an expectoration
of a tough, tenacious mucus. When the disease
is fully established the lips, or possibly the whole
face, may become blue, with all the signs of im-
peded respiration.
Physical Signs.—Inspection, as described above.
Percussion.-Normal, except in that portion of
the lung which may be collapsed.
Auscultation.-Subcrepitant râles over the whole
chest in general capillary bronchitis, or in cir-
cumscribed areas in localized capillary bronchitis.
Differential Diagnosis. Simple catarrhal
bronchitis does not have the high temperature,
dyspnea, cyanosis, and the subcrepitant râle that
capillary bronchitis has.
From catarrhal pneumonia by the absence of
areas of consolidation.
Pulmonary adema has dullness on percussion,
and a characteristic expectoration.
Complications.-Catarrhal pneumonia; em-
physema; collapse of the lung.
Duration.-From ten hours to a week.
Prognosis.-Grave.
Treatment.-Confine the patient to bed, in a
room where the temperature is kept about 75° F.,
32
DISEASES OF THE BRONCHIAL TUBES.
and the atmosphere moistened with steam. Give
nutritious liquid diet. Keep system supported by
free stimulation; and if necessary, when cyanosis.
becomes marked, give oxygen gas by inhalation.
REMEDIES.
See indications for remedies as given under acute ca-
tarrhal bronchitis.
Aconite.-At the very commencement of an attack.
* Fever; dry, hot skin; anxious and restless, with tossing
about. The pulse is full and hard. * Incessant dry
cough, with irritation in the larynx. *The lungs feel as
if they would not expand.
Arsenicum.-Advanced cases, where there is great
prostration, with sinking of the vital forces, and tumultu-
ous action of the heart. *Oppression and difficulty of
breathing; suffocative attacks. When complicated with
oedema of the lungs, or emphysema.
* Face
Belladonna.- -* In cases with cerebral symptoms.
flushed, eyes red, skin hot, but a disposition to perspire.
High fever, skin fairly burns the examining hand. *The
child jerks and jumps in its sleep.
Bryonia. Generally of use after the previous employ-
ment of Aconite, when the fever has somewhat subsided,
and the cough has become looser. The patient is now
quiet, he does not want to move. *The cough is hard,
with pains in the head as if it would fly to pieces, and the
chest feels as if it would be torn asunder. * Cough worse
at night, compelling one to spring up in bed and hold
their chest.
*
C
Ferrum Phos.-In the first stages.
*When the pulse
is full and soft. * Cough is dry, or with a little expec-
toration, which is blood streaked.
Gelsemium. When the fever is of an intermittent or
remittent type. *The pulse is full and round, seems to
flow under the finger.
K
Ipecacuanha.-In the second stage. * Suffocative
cough; copious secretion of mucus, which nearly suffo-
CROUPOUS BRONCHITIS.
33
*The cough sounds loose,
Cough with vomiting
*
cates him during the cough.
but there is little expectoration.
of phlegm.
Lycopodium.-* When the cough sounds very loose,
with little expectoration; the patient is worse from 4 to
S P. M., and when lying on the left side.
Mercurius.-* Dry, racking cough, as if the whole in-
side of the chest were dry. *Cough worse when lying
on the right side, at night, or from the least draught of
air.
Phosphorus.-As soon as the inflammation threatens to
or actually does involve the lung tissue. See indications
as given under pneumonia.
Tartar Emet.-Our mainstay in this form of bronchitis.
* Great dyspnoea; wheezing respiration, constant rattling
of phlegm in the chest, but no expectoration.
* Sub-
crepitant râles heard through the entire chest.
* When
the cough ceases from weakness, but still there is rattling.
"Is unquestionably the great remedy for this danger-
ous form of bronchitis."-Dr. Nichol.
"The grand remedy for this dangerous disorder. Per-
fectly homoeopathic to both local and general condition.
I have almost invariably relied upon it single-handed,
and have seen desperate cases recover under its use."—
Dr. Hughes.
CROUPOUS BRONCHITIS.
Synonyms. - Fibrinous bronchitis; plastic
bronchitis; pseudo-membranous bronchitis; diph-
theritic bronchitis.
Definition.—An inflammation of the mucous
membrane of the bronchial tubes, characterized
by the formation of false membranes; it may be
either acute or chronic.
Often
Etiology. The causes are unknown.
due to the extension of membranous laryngitis to
the bronchial tubes. Found more often in the
4
34
DISEASES OF THE BRONCHIAL TUBES.
young, the male sex, and in those of feeble
health.
Pathology. Same as catarrhal bronchitis, plus
the exudate, which is fibrinous in character. The
exudate is in form of casts, white in color, and
sometimes blood-streaked. The microscope shows
these casts to be composed of a fibrillated mem-
brane, in the meshes of which are leucocytes, fat
globules and epithelial cells.
Symptoms.-Same as catarrhal bronchitis,
from which it can only be distinguished by the
expectoration of the false membrane or fibrinous
casts.
Duration. The acute form lasts from three to
fourteen days. The chronic form lasts about ten
days, to recur at intervals for years.
Sequelæ.-Pneumonia; pulmonary phthisis.
Prognosis. In the acute form the prognosis
must be guarded; more than one-half die (Dr.
Loomis). In the chronic form death is rarely
directly due to it, but a complete cure is doubtful.
Treatment.-Same as for catarrhal bronchitis
until the expectoration of the membrane, when
inhalation of the vapor of lime-water gives good
results.
Remedies.—Consult indications for remedies
as given under acute catarrhal bronchitis.
Bryonia, Bromine, Kali bich., Mercurius cor.,
and Spongia are particularly useful in this dis-
ease.
BRONCHIECTASIS.
35
BRONCHIECTASIS.
Synonyms-Dilatation of the bronchial tubes.
Definition. A dilatation of the bronchial
tubes, which is either general or circumscribed;
and, is usually associated with chronic bronchitis.
Etiology. Generally due to chronic bron-
chitis, or phthisis.
Pathology. From chronic inflammation the
bronchial tubes become weak and dilate from the
strain of coughing. This dilation is either cylin-
drical, when the whole tube is dilated; or, saccu-
lar, when the tube is dilated here and there.
chitis.
Symptoms. The symptoms are, for the most
part, those of the original disease. A paroxysmal
cough with a periodically occurring, profuse ex-
pectoration of offensive matter is very suggestive
of this disorder.
Physical Signs.-In the cylindrical variety the
physical signs are those of chronic bronchitis; in
the saccular variety the signs are those of a
tubercular cavity.
Prognosis.-Depends upon the cause. Perma-
nent cure is almost impossible.
Treatment.-The same as for chronic bron-
ASTHMA.
Synonyms. Bronchial asthma; spasmodic
asthma; nervous asthma.
Alge
Definition. A spasmodic contraction of the
circular fibres of the bronchial tubes; giving rise.
to paroxysmal attacks of dyspnoea.
35
DISEASES OF THE BRONCHIAL TUBES.
Etiology. Hereditary predisposition can be
traced in one-half of the cases. Among the ex-
citing causes are: (1) some direct irritation of the
respiratory mucous membrane; (2) from reflex
causes; (3) as a complication.
Pathology.—A pure neurosis. The paroxysm
is due to a spasmodic contraction of the circular
fibres of the bronchial tubes, with the consequent
narrowing of the same.
Symptoms.-Asthmatics, as a rule, from some
peculiar symptom characteristic to themselves,
know when a paroxysm is approaching. Fre-
quently the paroxysm is developed suddenly, and
generally during the night. The patient goes to
bed feeling well, and after sleeping for a certain.
time the wheezing commences, and he awakes
with violent dyspnoea. This dyspnoea compels
him to spring out of bed, he rushes for the win-
dow, he must have air, he feels as if he was
suffocating. He brings into play all of his ab-
dominal muscles to help get his breath, but to
no purpose. This exertion causes a profuse
sweat. The expression becomes anxious, the
face blue, and the extremities cold. The expira-
tion is twice as long as the inspiration. There is
a cough with a very scant, tenacious mucous ex-
pectoration. After from one-half to about three
hours the patient commences to expectorate more
freely, and is then relieved. The expectoration.
comes after the spasm has ceased. The expec-
toration consists of round pearl-like masses,
composed of fine spirals of mucous, known as
Curschmann's spirals." The paroxysm is now
((
P
ASTHMA,
37
over, to reappear at some future time. During
the interval, unless the asthma is complicated
with some other disease, the patient is compara-
tively well.
Physical Diagnosis.—Inspection shows labored
respiration, with the upper chest motionless; and,
the general appearance as noted when describing
a paroxysm.
Percussion yields hyper-resonance.
Auscultation, wheezing expiration, sibilant and
sonorous râles, which are constantly changing
their position.
Differential Diagnosis. From laryngeal af
fections by the absence of change of the voice, and
the presence of physical signs as given above.
From capillary bronchitis by the mode of the inva-
sion, and the absence of the subcrepitant râle.
From hay asthma by the absence of the coryza.
Sequelæ.-Emphysema.
Complications.-Passive pulmonary hyper-
æmia; cardiac hypertrophy.
If
Prognosis Favorable. Uncomplicated cases
rarely prove fatal, although prone to recur.
complicated the prognosis must be based upon the
cause of the asthma.
Treatment.—For the paroxysm, let the pa-
tient inhale Amyl nitrite; or, a few drops of
Chloroform. During the interval attend to the
general health.
REMEDIES.
Aconite. If caused from exposure to dry, cold winds;
or, from an existing bronchitis. *Full, hard and bound-
38
DISEASES OF THE BRONCHIAL TUBES.
ing pulse. * Great fear and anxiety of mind. Knows he
is going to die.
Ambra. Asthma, with cardiac symptoms. Wheezing
in the chest. Violent palpitation, with pressure in the
chest, as if a heavy lump lay there.
Arsenicum. For night attacks. *He awakes with
spasmodic constriction in the chest, seems as if he would
suffocate, panting and wheezing respiration, must incline
the chest forward. * Extreme exhaustion, anguish, rest-
lessness, and fear of death. *Cannot lie down for fear of
choking. Attacks from walking fast; or, ascending
stairs. *The more the patient seems on the point of suf-
focating, the more painful and distressing his restless-
ness, the more wheezing and louder his respiration, the
more Ars. will be found appropriate (Bachr).
'Undoubtedly the safest remedy for asthma."-Dr.
*
Bachr.
"It forms a most important remedy."-Dr. Laurie.
Acid. Hydrocy. One of the best remedies for the
attack.
Belladonna.—As a palliative in acute cases, when ac-
companied by symptoms of congestion to the head.
*
Bryonia. From suppressed rashes. *The attacks are
preceded by catarrhal symptoms. *Aggravated at night;
and, from any motion. *There is decided pain in the
chest, of a stitching character; inability to lie on the
right side; hard cough, with little expectoration.
Frequently suitable after Ipec. in acute asthma."
Dr. Jahr.
Cuprum. When the asthma is associated with spasms
in other parts of the body.
Drosera.-Asthma of consumptives.
>>
**
Hepar. In cases depending upon chronic bronchitis.
*The attack awakens the patient from sleep, with a
rattling cough, constriction of the chest, and severe
dyspnoea.
Ipecacuanha.-*To be given during an attack of asth-
ma. * Violent constriction of the chest; threatened suf-
focation; made worse from any motion. *The face is
ASTHMA.
39
very pale and cold. *Wheezing and rattling in the
chest. *The cough is very loose and rattling; but, there
is no expectoration. Disposition to vomit.
*
C
I always commence the treatment with Ipecacuanha.”
-Dr. Jahr.
"During the paroxysm, this remedy is one of the most
frequently useful."-Dr Laurie.
"If no exciting cause can be traced, Ipecacuanha
should be administered when bronchitic symptoms co-
exist."-Dr. Hughes.
One of the first remedies of which we think in an
attack of acute asthma, and it is worthy of the place it
holds."-Dr. Nichol.
Kali Bich. When based upon bronchiectasis. Worse
after midnight, from two to three A. M. Must sit up and
bend forward. * Relief from expectoration of tough,
stringy mucus.
*C
Lachesis. In women at the climacteric age. * Greatly
aggravated after sleep. *The throat is very sensitive,
* Great relief from expecto-
cannot bear to be touched.
ration of watery phlegm.
"This last symptom is a neglected characteristic of
Lachesis in asthma."-Dr. Farrington.
Lobelia.-Spasmodic or nervous asthma, aggravated
from any motion. * Attack preceded by sensation of
pricking over the whole body. There is a feeling of
great weakness in the stomach; and, sensation as of a
lump in the throat.
Lycopodium.-* Asthma from digestive disorders when
there is a great accumulation of gas in the abdomen; and,
relief from its passage.
Moschus.-*In hysterical subjects.
Nux Vom.-Simple spasmodic asthma, due to gastric
irritation. *There is oppression and constriction of the
lower part of the chest. Attacks occur after eating; or, at
night. *Patient is very irritable. Constant urging to
stool.
"About the best curative medicine we have for sim-
ple spasmodic asthma, where there is no bronchial lesion,
40
DISEASES OF THE BRONCHIAL TUBES.
but a standing reflex excitability of the pneumogastric to
impressions from without or through the stomach.”—Dr.
Hughes.
Pothos Fœtidus.-
"Worse from inhalation of dust, as
for example the inhalation of the dust in a hay-loft.".
Dr. Farrington.
Pulsatilla. In women with menstrual difficulties, par-
ticularly amenorrhoea; or, when caused from abuse of
sulphur waters.
Sambucus. Particularly in children. Nightly suffo-
cative attacks, with perspiration, and loud wheezing.
Spongia.-Severe asthma, aggravated from lying down.
Due to phthisis, or goitre.
{{
Useful only in asthma depending upon tuberculosis."
-Dr. Baehr.
- For chronic cases of asthma.
Sulphur. -*-
There is op-
pression of the chest, and shortness of the breath, on
bending the arms backward. *Constant heat on the top
of the head. Feels weak and faint at eleven A. M.
"A most universal remedy for asthma. There is scarcely
a case of asthma where Sulphur is not used."-Dr. Hart-
man.
M
HAY ASTHMA.
Synonyms.
Hay fever; yearly cold; rose
fever; rose cold; autumnal catarrh; pollen catarrh;
periodical vasomotor rhinitis.
Definition. A catarrhal inflammation of the
respiratory track, accompanied by a peculiar hy
peræsthesia of its mucous membrane.
Etiology. The result of irritation of the
Schneiderean membrane by the pollen of different
plants, particularly that of the grasses. The
peculiar sensitiveness of the respiratory mem-
brane to the pollen of plants is generally inherited.
Pathology. Two theories: (1) A pure
play play pa
.. .. .
HAY ASTHMA.
4I
neurosis; (2) due to irritation of a hyperæsthetic
nasal membrane; generally associated with hyper-
trophic rhinitis.
Symptoms.--The attack of hay fever is ushered
in by violent and prolonged fits of sneezing, with
constant tickling and irritation in the nose. A
copious discharge, from both the nose and the
eyes, is present. The eyes become red and
swollen. Attacks of asthma are often associated
with hay fever; but coryza, or bronchitis always
accompanies the hay fever.
Duration.-From six to eight weeks.
Prognosis. Never proves fatal; but, complete
cure is very doubtful.
Treatment.
Pet
The recognition and treatment
of any existing catarrh, or other cause. A change
of climate, the sea shore being the best. To stop
the violent paroxysms of sneezing, Dr. Gatchell
recommends plugging the nostrils with cotton,
not tight, but so that the air, in breathing, will
filter through. As a palliative, a solution of cocaine
applied to the nasal membrane will relieve the
sensitiveness to the pollen. As a prophylactic
Arsenicum or Cepa may be given for some time
before the expected time for the hay fever.
Remedies. See remedies as given under
coryza, bronchitis and asthma. Arsenicum,
Arsenicum iod., Ailanthus, Ambrosia, Artemisia,
Camphor, Cepa, Chininum ars., Euphrasia,
Grindelia, Ipecacuanha, Napthalin, Nux vom.,
Rosa damas, Sabadilla, Silicea, Sanguinaria,
Stitca pul., Sulphur.
42 DISEASES OF THE BRONCHIAL TUBES.
HÆMOPTYSIS.
Synonyms. Bronchial hemorrhage; bron-
broncho-pulmonary
hemorrhage;
chorrhagia;
"blood spitting."
Etiology.
Definition. The expectoration of blood.
Generally occurs in those suffering
from phthisis. From the inhalation of irritating
gases; breathing too rarified air; an aneurism
rupturing into the bronchial tube; a symptom of
scurvy, or hæmophilia; occasionally as vicarious
menstruation; traumatism; some obstructive dis-
ease of the heart, or liver. Hæmoptysis rarely
occurs without some definite cause.
Pathology. At the seat of the hemorrhage.
the bronchial mucous membrane will, at first, be
dark red in color, swollen and relaxed, and will
ooze blood upon slight pressure. The bronchial
tubes will be more or less filled with clotted blood.
After some time has elapsed the membrane will
become pale in color, or, as is often the case,
there will be no traces of the previous hemorrhage
to be found.
Symptoms. In a few cases there are no warn-
ing signs of the approaching hemorrhage. But
generally the patient experiences a sensation of
constriction in the chest, followed by a sensation
of warmth and tickling under the sternum; with
this there comes a peculiar sweetish taste in the
mouth, when upon spitting the patient will find
he is spitting warm, bright red, frothy blood.
The irritation generally causes cough, which
causes the patient to expectorate this frothy
HAY ASTHMA.
43
blood. The quantity of blood expectorated varies
from less than a drachm to a pound or over; some-
times so profuse as to gush out of the patient's
mouth and nose. During the hemorrhage, al-
though it may be comparatively slight, the patient.
becomes anxious, and often faints. Bronchial
hemorrhages are very apt to recur.
Physical Signs. - Generally negative; but,
there may be found moist bronchial râles.
Differential Diagnosis.-From epistaxis by
the inspection of the nasal passages; and, absence
of bright red, frothy blood.
From hæmatemesis, by the fact that in hæmop-
tysis the nausea and vomiting, if present, follows
the expectoration of the blood. In hæmoptysis
the blood is bright red, frothy and alkaline in
reaction; while in hæmatemesis the blood is
usually dark, coagulated and acid in reaction; and
there will be found no râles in hæmatemesis.
Sequelæ.-Broncho-pneumonia; acute phthisis.
Duration. From a few minutes to several
days.
Prognosis.
Hæmoptysis seldom proves
directly fatal; and, can often be quickly relieved
by the homeopathic remedy alone. But it is of a
bad import, as it is often a forerunner of phthisis;
or, signifies that phthisis has already commenced
to develop.
Treatment.-Absolute rest in bed, with head
and shoulders elevated. Avoid all excitement,
do not even let the patient talk.
Give patient
bits of ice to swallow; or, dissolve salt on his
tongue.
•
44 DISEASES OF THE BRONCHIAL TUBES.
REMEDIES.
Acalypha Ind. -* Violent, dry cough, followed by spit-
ting of blood, which is usually bright red.
Aconite.—* Acute hemorrhage of bright, red blood;
with symptoms of pulmonary congestion. * Great fear
and anxiety of mind; knows he is going to die.
* The
cough is dry and hacking.
Antimonium Crud.-"A gradually declining cough,
ending finally in a mere hacking, is very characteristic.'
-Dr. Fornias.
"}
Arnica.-* When due to mechanical injuries to the
chest. *The blood is dark and coagulated. * Face hot,
while body is cold.
*The
Belladonna. Hæmoptysis, with symptoms of cerebral
congestion. *Face flushed; throbbing carotids.
chest feels as if it were filled with blood; there is a con-
stant desire to cough, from tickling in the throat.
*The
blood feels very hot to the parts over which it passes.
Cactus Grand.-* When due to heart troubles.
is great arterial excitement, with a sensation of constric-
tion in the heart, as if bound by an iron band.
* There
China.- — When, with the loss of blood, there is ringing
in the ears, fainting, loss of sight, and extreme weakness.
*Taste of blood in the mouth.
Crocus. Passive hemorrhage; the blood is dark and
stringy. There is debility and palpitation of the heart.
Ferrum.—* Hemorrhage of bright, red blood, with fly-
ing pains in the chest, and pains between the shoulders;
heavy breathing. Great weakness. *The least motion
causes the face to become fiery red.
Hamamelis. Passive, venous hemorrhage.
* When-
ever the blood is dark, or clotted, and is raised without
effort, this medicine will surely check the hemorrhage.
This is well nigh a specific."—Dr. Burt.
"In passive hemorrhage of all parts, I have the utmost
confidence in its use."-Dr. Hughes.
Ipecacuanha.- Profuse discharge of bright, red blood,
from least motion, without cough. *The hæmoptysis is
preceded by a bubbling sensation in the chest.
* There
HEMORRHAGE OF THE LUNGS.
45
is tickling behind the sternum; long and continued nau-
sea; hard, heavy and oppressed breathing; and, a con-
tinual taste of blood in the mouth.
((
'Holds high rank."-Dr. Hughes.
"This is one of the most useful remedies.”—Dr. Burt.
Millefolium.—* Active hemorrhage, of bright red, frothy
blood; with little, or no, coughing; particularly in fleshy
people.
*
*
Phosphorus. In tall, slender persons; tubercular di-
athesis. There is a tight feeling in the chest; dry cough,
with trembling of the whole body. *Weakness and
emptiness of the abdomen, which is very distressing to
the patient. *The blood pours out freely, then ceases
for a time. When there is decided periodicity in the
appearance of the hæmoptysis; or, when the hæmoptysis
appears in dangerous fevers.
Pulsatilla. Particularly in females who are very
timid, and inclined to weep much; are constantly chilly;
and, have suppression of the menses. *There is a loose,
rattling cough, with expectoration of
blood; the blood is coughed up in pieces.
seems to suffocate in a warm room; they must have air,
they want the windows and doors open.
dark, coagulated
*The patient
Aggravation
*
in the evening.
Rhus Tox.—* After straining, lifting, or blowing of
instruments. The hemoptysis is accompanied by a dry,
teasing cough.
Sulphur. For chronic cases; to prevent relapse.
Tartar. Emet.-When after the attack there remains for
a long time a bloody, slimy expectoration.
Veratrum Vir.—* Active hemorrhage, from congestion
of the lungs; with full, bounding pulse.
HEMORRHAGE OF THE LUNGS.
There are two varieties: first, hemorrhage into
the lung, which is confined and outlined, with no
destruction of the lung tissue, which is called
"pulmonary infarction; second, hemorrhage
> }
46
DISEASES OF THE BRONCHIAL TUBES.
into the lung, which is diffused and not outlined,
with destruction of the lung tissue, which is called
"pulmonary apoplexy."
PULMONARY INFARCTION.
A defined hemorrhage into the lung, without
destruction of the lung tissue.
Etiology. Organic heart disease. Embolism
in one of the branches of the pulmonary arteries.
Pathology. The infarction is usually situated
in the inferior lobe of the lung, and near the
periphery; it is wedge-shaped, with the apex
pointing inward.
M
Symptoms. Are few and vague. If the in-
farction is small there may be only spitting of a
few small blood clots. If the infarction is large
there will be dyspnoea, cough and expectoration
of dark blood.
... .
Physical Signs.-Percussion reveals dullness
over site of the infarction; auscultation gives
bronchial breathing.
Prognosis. In simple cases, good.
Treatment.-Must treat the cause; and, pre-
scribe for the existing symptoms.
PULMONARY APOPLEXY.
A diffuse hemorrhage into the lung, with
destruction of the lung tissue.
Etiology. Most frequent cause is the rupture
of a thoracic aneurism; changes in the walls of
the arteries; traumatism; gun-shot wounds.
Pathology. The lung tissue is torn and per-
meated with blood. The blood may be either
fluid or clotted.
CONGESTION OF THE LUNGS.
47
Symptoms. The symptoms are those of col-
lapse.
Prognosis. Very few ever recover from the
immediate shock.
Treatment.—The same as for collapse.
CONGESTION OF THE LUNGS.
Synonyms.-Hyperæmia of the lungs.
Definition.-That condition where there is too
much blood in the lungs; it may be either active
or passive.
Etiology.-Active when due to increased cir-
culation; associated with violent action of the
heart; violent exercise; inhalation of an irritat-
ing atmosphere.
Passive when due to obstruction to the return
circulation.
Pathology.
The lung is swollen, from the
excess of blood; and, has a bright red appearance
in active hyperæmia, and a dark red appearance
in passive hyperæmia.
Symptoms.-Active hyperemia is announced
by severe dyspnoea and cough with a watery,
blood-streaked expectoration. Physical examina-
tion shows slight dullness and crepitant râles.
Passive hyperæmia. The dyspnoea develops
slowly, with cough, and watery, blood-streaked
expectoration. Often the surface of the body
becomes blue.
Duration. From five hours to about three
days.
Prognosis. Favorable in the active form;
must be guided by the cause in the passive form.
48
DISEASES OF THE BRONCHIAL TUBES.
Treatment.—In the active form, give perfect
quiet; light diet; and, sustain heart by stimulants
if necessary. In the passive form the treatment
must be directed to the primary cause.
REMEDIES.
Aconite. This drug will cure the majority of cases
very quickly. Fever; shortness of breath; dry, hacking
cough, with expectoration of bloody mucus.
*The
patient is anxious, tossing about, and knows he is going
to die.
"The main remedy."-Dr. Baehr.
Belladonna. -* When there is a flushed face, throbbing
carotids, and symptoms of brain irritation.
Veratrum Vir.- When there is great arterial excite-
ment. * Pulse is hard, strong, and quick. Rapid respi-
ration; dull burning in the region of the heart.
HYPOSTATIC CONGESTION.
Synonyms. Hypostatic pneumonia; spleniza-
tion of the lungs.
Definition.—A congestion which occurs in the
dependent portions of the lungs, generally bilat-
eral; and, found in diseases which necessitate a
confinement in one position for a long time.
Etiology. Any disease which necessitates a
protracted recumbent position.
Pathology. The lung tissue is dark red and
friable.
Symptoms. There are 110 characteristic
symptoms of this form of congestion.
Treatment. Consists in preventing its forma-
tion by constantly changing the position of the
patient. Friction of the skin will sometimes help.
Cardiac stimulants must be administered.
p
PULMONARY CEDEMA.
49
PULMONARY ŒDEMA.
Synonyms. Serous pneumonia; œdema of the
lungs; dropsy of the lungs; hydrops pulmonum.
Definition.-A serous exudation into the air-
vesicles, and into the interstitial tissue of the lung;
generally a secondary affection; and, is either
acute or chronic.
Etiology. Frequently complicates Bright's
disease. Increased heart action; congestion of
the lungs; alcoholic excesses; breathing irritative
atmosphere.
Pathology.
The cedema may be confined to
a portion of the lung, or it may extend to both
lungs; but it is generally found in the most
dependent portions of the lungs. The weight of
the lung is increased; and, upon opening the
thoracic cavity the lung does not collapse; the
lung pits upon pressure. In uncomplicated cases
the lung is paler than normal; but, when the
œdema is associated with pulmonary congestion
the lung will be red. Upon section the lung
exudes a frothy serum, which varies in color.
Symptoms. The main symptom is dyspnoea,
which may develop very suddenly. There is a
spasmodic, retching cough, with a watery, frothy
expectoration, more or less blood-streaked. Soon
cyanotic symptoms develop; and, finally the
patient dies of asphyxia.
Physical Examination.
Inspection. - De-
crease in respiratory motions; and, evidence of
severe dyspnoea.
5
50 DISEASES OF THE BRONCHIAL TUBES.
Percussion.—More or less dullness over the seat
of the oedema.
Feeble respiratory murmur;
Auscultation.
bubbling râles.
Differential Diagnosis. - May be distin-
guished from pneumonia and capillary bronchitis
by the mode of the invasion, there being no chill,
fever and pains, as in these two diseases. The
physical signs will serve to distinguish hydrothorax
from pulmonary edema.
Prognosis. Very grave. Often a final con-
dition in pneumonic inflammations and Bright's
disease.
Treatment.-Depends almost entirely upon
the original disease.
REMEDIES.
Aconite. If associated with fever; skin hot and dry;
very restless and anxious; fear of death; dyspnoea.
Ammonium Carb.-* Give on first signs of drowsiness.
"May prevent poisoning of the blood by carbonic
acid."-Dr. Bachr.
Arsenicum.. *When associated with general dropsy.
* Great prostration; restless, anxious and tosses about.
* Burning in the chest. *Cannot lie down from fear of
suffocation.
Carbo Veg.-Loud, rattling breathing; dyspnoea; great
anxiety, but not restless; cough in violent spells, with
profuse, watery expectoration. The breath becomes
cold.
*The patient wants to be fanned.
China. If from loss of fluids.
Ipecacuanha.--*If the cough is decidedly spasmodic.
*The lips and tongue become blue. * Rattling of mucous
in the bronchial tubes.
Phosphorus.—* When cedema of the lung develops dur-
ing the course of other diseases of the lungs. Difficult
CROUPOUS PNEUMONIA.
51
inspiration; chest feels full and heavy. *Tightness in
the chest. *Dyspnoea with fine râles.
"Sometimes has a brilliant effect."-Dr. Baehr.
'Edema following acute congestion."-Dr. Clarke.
Tartar Emet.-*The respiration becomes rapid, short
and difficult; seems as if suffocation was inevitable.
-X- Cyanotic symptoms develop. * Great dyspnoea, must
set up.
*Loud coarse râles; rattling of mucus in the
chest; may or may not expectorate. The bronchial tubes
are loaded with mucus.
"I have more than once seen the cedema subside
entirely under the use of this medicine."Dr. Hughes.
CROUPOUS PNEUMONIA.
Synonyms.-Acute lobar pneumonia; lung
fever; pleuro-pneumonia; pneumonitis.
Definition. An acute specific inflammation of
the vesicular structure of the lung, characterized
by an exudate of coagulable lymph into the air
vesicles, rendering them impervious to air.
Etiology. The exciting cause is Fränkel's
diplococcus pneumonia. The predisposing causes
are: The extremes of life, alcoholism, exposure
to atmospheric changes, any cause which lowers
the general vitality, or depresses the heart. One
attack renders the individual more liable to a
subsequent attack. Sometimes "epidemic."
M
Pathology. The inflammatory process most
frequently involves the inferior lobe of the right
side, rarely involves both lungs at the same time,
and generally extends to the surface of the lung
which joins the pleura.
There are three stages: (1) the stage of hyper-
æmia or engorgement; (2) of red hepatization or
52
DISEASES OF THE BRONCHIAL TUBES.
exudation; (3) of gray hepatization or resolution.
I. Stage of hyperæmia, or engorgement. In
this stage the lung is distended; firm to the touch;
increased in weight; of a dark brown color; and,
does not collapse on opening the thoracic cavity.
On section a thin, frothy, bloody serum exudes.
The microscope shows the capillaries distended
and tortuous, diminishing the lumen of the alveoli;
the air vesicles are more or less filled with epi-
thelial cells. The duration of this stage is about
three days.
II. Stage of red hepatization, or exudation.
That portion of the lung in which hepatization
has set in is very much swollen, of a dark red
color, and mottled. It is solid, firm and friable;
airless, and consequently there is no crepitation;
and, it rapidly sinks when placed in water. A
section will present a granular appearance, owing
to the coagulated lymph in the air vesicles; and a
dark fluid will ooze from the cut surface. A
microscopical examination will, if the section is
correctly prepared, show the diplococcus. The
fibrinous plugs filling the air vesicles will be seen
to be composed of fibrin, red blood corpuscles,
epithelial cells and leucocytes. The duration of
this stage is from three to seven or eight days.
III. Stage of gray hepatization, or resolution.
Owing to compression of the blood vessels, the
disappearance of the red blood corpuscles, the
appearance of leucocytes and fatty changes in
some of the inflammatory products, the dark red
appearance of the lungs, as seen in the second
CROUPOUS PNEUMONIA.
53
stage, gives place to a more mottled appearance;
and, the parts become gray in color. The solidi-
fied parts soften, may become a mere pulp; and, in
favorable cases absorbed. The air vesicle returns
to its normal condition. The duration of this
stage is from one to three weeks.
Instead of the favorable termination in resolu-
tion and absorption, there may be a termination
in: (1) abscess; (2) gangrene; (3) purulent in-
filtration; (4) or, rarely in chronic interstitial
pneumonia.
Symptoms. In a few cases there is loss of
appetite; general malaise, etc., preceding the
attacks; but, in the majority of cases pneumonia
begins suddenly with a sharp, well defined and
prolonged chill that lasts from two to three hours;
a rapid rise of the temperature, often reaching
105° F. in the first twenty-four hours, with slight
morning remissions, until the fifth, the seventh,
or the ninth day, when the temperature falls by
crisis-rarely by lysis. With this fever there is
experienced a severe pain in the affected side,
usually beneath the nipple, aggravated by cough-
ing, or by taking a deep inspiration. The pulse
is full, rapid and tense. There is severe dyspnoea;
rapid, shallow and panting respiration, that may
be from thirty to eighty per minute; the usual
ratio between the pulse and the respiration is lost
early in the disease, the ratio may be one to two.
A cough is soon developed; at first it is hard and
dry, with a frothy expectoration; but, about the
third day the expectoration changes to the charac-
54 DISEASES OF THE BRONCHIAL TUBES.
teristic tough, gelatinous and tenacious mucus,
"brick dust" or "rusty" in color. Microscopic-
ally the sputum contains blood corpuscles, leu-
cocytes, diplococci, and other micro-organisms.
There may be certain cerebral symptoms, the
most constant being headache, which usually
diminishes after the third day; sleeplessness; and
possibly slight delirium. The expression be-
comes anxious; the face flushed with a circum-
scribed flush over the malar bones, known as the
"pneumonic spot ;" and, often there is an hepetic
eruption over the cheeks and lips. The gastric
symptoms are unimportant. The urine is high
colored and scanty, with diminished chlorides, and
increased urea and uric acid.
Physical Examination. - Inspection. - First
and second stages show deficient respiratory
motion.
P
Third stage: In this stage the respiratory
movement commences to be apparent.
Palpation.-First stage: Slight increase of the
vocal fremitus.
Second stage: Great increase of the vocal fre-
mitus.
Third stage: The gradual diminishing of the
vocal fremitus.
Percussion.-First stage: Percussion note im-
paired; possibly tympanitic.
Second stage: Marked dullness, with sense of
resistance.
Third stage: The gradual subsidence of all
abnormal sounds.
CROUPOUS PNEUMONIA.
55
Auscultation.—First stage: Fine crepitant râles.
Second stage: Bronchial respiration and bron-
chophony.
Third stage: The abnormal signs disappear.
The bronchial respiration gives place to broncho-
vesicular breathing; there are large and small
moist râles.
Atypical Cases.-Typhoid Pneumonia is that
form of pneumonia which is accompanied by
typhoid symptoms; it is characterized by great
prostration, low form of fever, delirium, etc.
Bilious Pneumonia.-When pneumonia is com-
plicated with hepatic congestion.
Pneumonia of Drunkards.-In this form there.
is a severe maniacal delirium; in fact, almost
amounting to delirium tremens.
Senile Pneumonia.-In old persons pneumonia
may rapidly end fatally without warning. There
is generally little, or no dyspnoea, pain, or cough;
in fact, it is often difficult to make a correct
diagnosis.
Pneumonia in Children. Frequently com-
mences with convulsions and resembles menin-
gitis.
Differential Diagnosis.-Pulmonary edema
has not the chill, fever, and pain in the side that
characterizes pneumonia. In oedema the expec-
toration is watery, and does not contain the
diplococci.
Pleurisy has not so marked a chill, or so high a
fever as pneumonia. Attention to the physical
signs, and microscopical examination of the spu-
tum will differentiate the two diseases.
56 DISEASES OF THE BRONCHIAL TUBES.
Acute Phthisis.
Microscopical examination of
the sputum will reveal the presence of "bacilli
tuberculosis" in acute phthisis; and the diplo-
cocci in pneumonia.
Typhoid Fever.-Attention to the history of the
case and mode of invasion will prevent mistaking
pneumonia for typhoid fever.
Duration. The average duration of an attack
of pneumonia is from fourteen to twenty-five
days. Homœopathic treatment is capable of
arresting pneumonia in any of its stages; and,
under its influence the average duration of an
attack of pneumonia is only about ten days.
Prognosis. In acute, uncomplicated pneu-
monia the prognosis is good. In extremes of life
and in drunkards the prognosis is doubtful. The
unfavorable signs are: Continued temperature of
106° F.; a rise of temperature after the fourth
day; pulse of 130 or over, or if it should become
irregular; and, delirium after the sixth day.
Treatment.—Put patient to bed, may be
propped in a raised position. Keep the room at a
temperature of 70° F., and admit plenty of fresh
air. A dry, hot, hop poultice applied over the
affected portion of the lung will greatly relieve
the severe pains. Watch the heart, remember-
ing not to rely solely upon the wrist pulse, but
listen to the heart sounds, and as soon as signs of
failure of the heart appear, administer alcoholic
stimulants, and lastly oxygen gas.
The diet must be light and nutritious; milk
being the best article of food.
Schussler advises Ferrum phos. for the first
CROUPOUS PNEUMONIA.
57
stage; Kali mur. for the second stage; and Cal-
carea sulph. for the third stage.
REMEDIES.
Aconite.—* For the first or congestive stage. Sthenic
cases. * For the initiatory chill and fever; severe chill
and high fever; pulse full, hard, and strong.
* Severe
dyspnoea; dry, teasing cough, with tingling in the chest,
and watery or frothy sputum. * Severe sharp, stitching
pains, particularly when coughing.
*Restless, great
anxiety, and fear of death, knows he is going to die, pre-
dicts the day of his death.
*The disease progresses by
fits and starts.
"I uniformly begin with Aconite."-Dr. Holcombe.
"In the first stage, Aconite can do a great deal towards
cutting the whole disease short."-Dr. Jahr.
Ammonium Carb.-"When there is great debility, to-
gether with symptoms pointing to the formation of heart
clots."-Dr. Farrington.
Arsenicum.
* In advanced cases, where gangrene
threatens; or, there is a tendency to collapse. *Great ex-
haustion and prostration. Diarrhœa. *Anxious, tossing
about.
*Threat-
Belladonna.-*If with cerebral symptoms.
ened convulsions. *Face bloated and flushed; pupils
dilated; and throbbing of the carotids.
"In the case of very old people Belladonna is usually
preferable to Aconite at the outset; likewise in pneu-
monias of drunkards."-Dr. Baehr.
Bryonia.- -* After croupous exudation has taken place.
* After Aconite has reduced the more severe fever, and
relieved the extreme mental distress; and, there are signs
of perspiration. *The patient is now quiet and ex-
hausted; does not want to be moved; feels faint when
raised to a sitting posture. * Mild delirium, he talks of
his occupation, or desires to go home. * Dull frontal
headache. * Pressure on middle or lower part of the
sternum; bruised feeling in the chest; constriction in the
chest; wants to breathe deeply, but feels as if the lungs
58
DISEASES OF THE BRONCHIAL TUBES.
could not expand sufficiently. *Patient is relieved by
lying on the painful side. * Cough; must set up, and
hold the chest; violent stitching pains; expectoration of
a tough, tenacious mucus of the so-called "brick dust'
color; when expectorated it falls in a round jelly-like
lump *The liver becomes involved. *The tongue is
thickly coated with a white fur. * Great dryness of the
mouth, with thirst for large quantities of water at a time.
Pleuro-pneumonia-Bryonia is almost a specific."—
(4
Dr. Burt.
"The most essential remedy in second stage."-Dr.
Baehr.
"No remedy in the Materia Medica has a stronger
claim to a position among the anti-pneumonia remedies
than Bryonia, judging from both its provings and from
clinical experience."-Dr. Goodno.
'Bilious pneumonia has often yielded to Bryonia.".
Dr. Kreussler.
"
Carbo Veg. *In the third, or suppurative stage.
* Neglected cases; or, attacks in emphysematous persons.
*If collapse threatens. The face is hippocratic; nose
cold and pinched; hands and feet cold. The face is
bloated, with swelling of the facial veins" (Dr. Baehr).
Cold sweat. *The patient wants more air, they must be
fanned. *The pulse is small and frequent. * Their
breath becomes cold. -X Cough with rattling of mucus in
the chest, expectoration greenish, fetid and bloody.
* Bad smelling diarrhoea. In fact, all of the discharges
have a bad odor.
"If pneumonia assumes a chronic form; if abscess and
gangrene set in; if the sputa become fetid and badly
colored, no remedy is likely to afford the least help if
Carbo fails us."-Baehr.
Chelidonium.-Pneumonia with bilious, or gastric com-
plications. * Constant pain under the inner lower angle
of the right shoulder blade.
"My experience with it in pneumonia is, that, when
the liver is implicated, and the right lung is affected, it
CROUPOUS PNEUMONIA.
59
will prove useful, if a yellow, slimy diarrhoea is found."
-Dr. Hale.
*
Cuprum. To bring about a reaction when paralysis
of the lung threatens. *There are sudden attacks of
dyspnoea, followed by great exhaustion. The body be-
comes cold, with a cold viscid sweat.
Ferrum Phos.—
* Pneumonia
* The pulse
in feeble persons.
is full and soft. * Expectoration of pure blood; or, blood
streaked mucus.
Secondary pneumonia.
*Slight chill, low fever.
Hepar.-Third stage. *When the expectoration be-
comes purulent; abscess threatens.
"Preferable to other remedies after the third stage has
set it."-Dr. Baehr.
"
During resolution, pus forms and you have present
suppuration instead of the normal resolution."-Dr. Far-
rington.
Kali Sulph.-Third stage. * Expectoration is yellow.
* Great wheezing in the chest.
Lycopodium.-* In neglected cases; when suppuration
has taken place, with hectic symptoms. *The expecto-
ration is muco-purulent. * When coughing, it sounds as
if the whole parenchyma were softened; raises whole
mouthfuls of mucus at a time.
"When the inflammatory symptoms have been sub-
dued, but the expectoration presents a muco-purulent
appearance, and there is great prostration, with nocturnal
sweats, Lycopodium has been found very efficacious."
Dr. Laurie.
Mercurius. Bilious pneumonia. When pneumonia is
complicated with bronchitis. *When the fever has been
subdued; but, the pain and dyspnoea remain. Cough,
with blood-streaked expectoration. *Sharp, shooting
pains through the lower portion of the right lung to the
back. *Stools slimy, with tenesmus.
Phosphorus.-Has achieved success in all stages and in
all forms; but, especially in the stage of red hepatization
and in the typhoid form. In cases where the bronchial
symptoms are prominent; or, where oedema threatens.
60
DISEASES OF THE BRONCHIAL TUBES.
*
* A large portion of the lung is involved by the inflam-
mation, and there is extreme dyspnoea, but there is com-
paratively no pain. Dryness of the air passages; with
feeling of rawness in the upper part of the chest. *Tight-
ness across the chest. Cough hard and dry. * Expecto-
ration rusty, or brick-dust, in color; of a "dirty appear-
ance, resembling pus, but thinner; and when falling on a
hard surface will break and fly like thin batter” (Pier-
son). *Heat in the back, between the shoulder blades.
It always remains our sheet anchor in pneumonia.
Dr. Hirschel.
{{
"For the stage of hepatization, Phosphorus is the
prominent remedy."-Dr. Holcombe.
((
Occupies a high place in the treatment of this disease,
particularly if it takes a typhoid form."-Dr. Burt.
"When bronchial symptoms are prominent, it is almost
certain to be the remedy.”—Dr. Farrington.
Rhus Tox. When the pneumonia assumes a typhoid
form. *The patient is very restless, continually moving
about. *Dry, teasing cough, as if it would tear some-
thing loose in the chest; with prune-juice expectoration.
Sanguinaria. *When suppuration and hectic take
place. Cough, with rust-colored and offensive expecto-
ration. *Circumscribed redness of the cheeks.
* The
patient feels faint; weak, faint feeling about the heart.
Hot hands and feet. Dyspnoea, wants to breathe
deeply, but the effort causes pain in the right side of the
chest.
J
*
*
Sulphur,-* To promote resolution.
"A deficiency of reaction and a simultaneous absence
of such symptoms as point directly to the destruction of
the organic powers, constitute, in our opinion, the best
indications for Sulphur."-Dr. Baehr.
Tartar. Emet.—Will aid expectoration when resolution
begins to take place. * Great prostration of the vital
forces, especially after partial breaking down of the
exudation. * Dyspnea; fits of suffocation; must sit up.
*Cough, with a large accumulation of mucus in the bron-
chial tubes, but cannot expectorate. *Cough is loose,
CATARRHAL PNEUMONIA.
61
rattling, and suffocative. *Threatened paralysis; or,
œdema of the lungs.
"Produces a perfect picture of pleuro-pneumonia.”
Dr. Farrington.
"Suitable in cases characterized by the persistency of
hepatization, with difficult expectoration."-Dr. Jousset.
'Undoubtedly one of the most important remedies,
but only when pneumonia deviates from the normal
course."-Dr. Baehr.
"
Veratrum Vir.In the first, or congestive stage, with
great arterial excitement. Hard, prolonged chill; full,
bounding pulse. Short, dry, hacking cough. Difficult
and labored breathing. Faint feeling in the stomach.
"Veratrum viride comes in as an invaluable remedy in
those violent congestions which precede pneumonia. It
may even abort the whole disease.”—Dr. Farrington.
CATARRHAL PNEUMONIA.
Synonyms. — Lobular pneumonia; broncho-
pneumonia; ensular pneumonia.
Definition.—An acute catarrhal inflammation
of the terminal bronchioles and air vesicles of the
lung; the inflammation forming scattered points
of consolidation throughout the lung. Catarrhal
pneumonia may be acute or chronic; but, is gen-
erally a secondary disease.
Etiology. Usually secondary to bronchitis,
the inflammation traveling from the tubes to the
air cells. More frequent in the young, particu-
larly in the first three years of life. Frequently
follows measles, scarlet fever, whooping cough,
etc.
Pathology.
There is inflammation and swell-
ing of the mucous membrane of the bronchioles
and air vesicles; with excess of secretion. The
62
DISEASES OF THE LUNGS.
vesicles are filled with fibrin, leucocytes and epi-
thelial cells, forming small scattered nodules,
varying in size, of a reddish gray color, through-
out the lungs. There may be small areas of col-
lapsed lung, from the occlusion of the bronchus.
The nodules undergo fatty degeneration and are
absorbed. Catarrhal pneumonia usually involves
both lungs.
Symptoms. The acute variety is almost.
always found in children; while the sub-acute
and chronic varieties are found in adults.
The Acute Variety.-The first symptoms are
very indistinct, being masked by the preceding
disease. Catarrhal pneumonia is seldom ushered
in by a chill, but there is a gradual rise of tem-
perature, which is very irregular, and runs no
definite course. Dyspnoea is marked; the breath-
ing is rapid and labored. There is a short, hack-
ing cough, with muco-purulent expectoration.
The pulse becomes very rapid, may rise to 185
per minute.
The sub-acute and chronic varieties present the
same general symptoms as the acute. The symp-
toms of these varieties are not so marked, but
being of longer duration are more exhausting.
Physical Examination.-There are no char-
acteristic physical signs to denote catarrhal
bronchitis.
Differential Diagnosis.-Croupous pneumonia
has a sharp chill, followed by rapid rise of tem-
perature, and pain in the side to announce its
onset; while catarrhal pneumonia has no chill, no
CATARRHAL PNEUMONIA.
63
high fever, and no definite pain. Croupous pneu-
monia has rusty sputum, which contain the dip-
lococci; while catarrhal pneumonia has muco-
purulent sputum.
Capillary bronchitis is a primary disease, the
breathing is labored and hurried, with râles uni-
formly distributed over the chest; while catarrhal
pneumonia is a secondary disease, the breathing
panting, with râles over dull areas, or, in other
words, râles over the small points of consolidation.
Acute Phthisis.-The diagnosis is best made by
microscopical examination of the sputum, which,
in acute phthisis, will contain the bacilli and
elastic fibres.
Complications.-Capillary bronchitis; phthi-
sis; pleurisy; emphysema; intestinal catarrh.
Duration. The acute variety lasts from ten to
fourteen days; the chronic variety runs an in-
definite course.
Prognosis. Best to always give a guarded
prognosis. In children, the old, or, in weakly
persons, the prognosis is doubtful.
Treatment. Confine the patient to bed, and
frequently change his position. Keep the room
at an even temperature, and the atmosphere
moistened with steam.
The diet must be nutritious and liquid. Had
better administer stimulants throughout the dis-
ease.
Remedies. See remedies given under "Bron-
chitis" and "Croupous Pneumonia.
})
64
DISEASES OF THE LUNGS.
INTERSTITIAL PNEUMONIA.
Symptoms. Pulmonary induration; chronic
pneumonia; cirrhosis of the lung; fibroid pneu-
monia.
Definition.-A chronic fibroid induration of
the lung.
Etiology. Always a secondary disease. Gen-
erally found associated with phthisis, sometimes.
with pleurisy.
Pathology. There is an increase in the con-
nective tissue of the lung. The lung is smaller,
more solid, and firmer to the touch than normal.
On section, it presents a shining appearance;
and, when cut it gives a cracking sound.
Symptoms. Very hard to diagnose at the
beginning. Among its symptoms are: a constant
dyspnoea; cough, which may become paroxysmal;
with muco-purulent, fetid expectoration. The
fever is slight, or, it may assume the hectic form.
Physical Examination. Inspection. The
chest will be retracted on the affected side.
Percussion.-Dullness.
Auscultation.-Tubular breathing.
Duration.
For years.
Prognosis. The disease is incurable, although
it is never the direct cause of death. The patient
often lives for years in apparent good health,
except a slight dyspnoea.
Treatment. The treatment must be general.
Madag
GANGRENE OF THE LUNG.
Definition. A putrefactive process, which is
PULMONARY COLLAPSE.
65
either circumscribed or diffuse, with deathof the
lung tissue.
Etiology. Always a secondary disease, but is
directly caused by the presence of the bacteria of
putrefaction in the lung, which is carried there in
various ways.
Pathology. The affected portion of the lung
becomes soft, bluish-green in color, and extremely
fetid, generally breaking down into an ichorous
fluid, which may be expectorated; when expecto-
rated it leaves a cavity with ragged edges, filled
with bad-smelling fluid.
Symptoms. Being a secondary disease, its
commencement is obscured by the symptoms of
the orignal disease; but, an extremely fetid expec-
toration of gangrenous material is diagnostic.
Prognosis. Very grave. The circumscribed
form may be recovered from, but the diffuse form
is always fatal.
Treatment.-Good hygienic surroundings.
Diet to be highly nutritious. Stimulants must be
continually given to support the patient's system.
The medical treatment must be symptomatic.
Remedies. Arsenicum, Carbo veg., Crotalus,
Kreosotum, Lachesis, Silicea, Secale.
PULMONARY COLLAPSE.
Synonyms. Atelectasis.
Definition.—That condition of the lung char-
acterized by the absence of air in the alveoli.
Etiology. Generally follows some disease
which obstructs the bronchus, as capillary bron-
6
66
DISEASES OF THE LUNGS.
chitis or pneumonia. May be congenital; or,
mechanical, from pressure of tumors.
Symptoms. When occurring in the new-born
we find the child's breathing feeble, its face
purple, and extremities cold. When atelectasis
occurs in the course of other diseases there is a
sudden development of dyspnoea, cold extremi-
ties, and purplish face.
Prognosis. Depends upon existing circum-
stances. Severe cases are rarely recovered from.
Treatment.-Must be general.
PULMONARY EMPHYSEMA
Synonyms.-Vesicular emphysema.
Definition.-An abnormal distension of the
air-vesicles, or the interlobular cellular tissue of
the lung, with air.
Etiology. A weakness of the walls of the air
vesicles, which dilate under any extra strain, as
in the case of asthma, whooping-cough, or, in
those who play wind instruments, etc.
Varieties.-Vesicular and interlobular.
Pathology.-Vesicular emphysema prefers the
upper lobes of the lungs. The lungs are en-
larged, soft to the touch, lose their elasticity, and
do not collapse on opening the thorax. In the
vesicular form there is distension of the vesicles,
without rupture of the vesicular walls; or, perhaps
the walls between several vesicles may rupture
and form one large sack. In the interlobular
form there is rupture of the vesicles, allowing air
to escape into the interlobular cellular tissue.
PULMONARY EMPHYSEMA.
67
Symptoms. The most prominent symptom is
dyspnoea, which is aggravated by any exertion.
The face often assumes a purplish aspect, with
puffiness, and often becomes quite blue during a
fit of coughing.
Physical Examination.-Inspection.-Shows
the characteristic "barrel-shaped" chest.
Palpation.-Vocal fremitus diminished.
Percussion.
The percussion note is high
pitched.
Auscultation.-Inspiratory sound is short, with
a prolonged expiratory sound. Râles are heard,
due to the associated bronchitis.
Sequelæ.-Heart disease. Dropsy.
Prognosis. Rarely is the direct cause of
death.
Treatment.
Good hygenic surroundings.
Diet to be nutritious; particularly meats, with
small amount of fluids.
Remedies.-See those given under
chitis" and " Asthma."
"Bron-
Diseases of the Pleura.
PLEURISY.
Synonyms.-Pleuritis.
Definition.-A fibrinous inflammation of the
pleura; may be either acute, sub-acute or chronic.
Etiology.-Exposure to atmospheric changes;
traumatism; as a complication of some other dis-
ease; one attack predisposes to others.
Varieties. (1) Acute or dry pleurisy; (2)
sub-acute or pleurisy with effusion; (3) adhesive
pleurisy; (4) suppurative pleurisy or empyema.
Pathology. There is at first hyperæmia, fol-
lowed by inflammation of the pleural membranes,
which become red, swollen and rough; there is
also a fibrinous exudate; this is known as dry
pleurisy. If the exudate becomes more profuse,
and organizes into firm fibrinous bands, it is then
known as fibrinous pleurisy. If the pleural sur-
faces should become united by this exudate, then
it is called adhesive pleurisy. If the exudate is
very abundant, it will gravitate to the most de-
pendent portion of the pleural cavity, and is called
pleurisy with effusion. If the exudate, from the
admixture of pus cells, should become purulent,
of a greenish yellow color, the attack is called
purulent pleurisy or empyema. If from any
cause blood should become mixed with the
PLEURISY.
69
exudate, it is then called hemorrhagic pleurisy.
The exudate may finally be all absorbed if not,
and some exudate remains, we have what is called
chronic pleurisy.
Symptoms.-Acute Pleurisy.-Chill, followed
by a moderate fever, which may not be over 100°
F., and which runs no regular course; severe
"stitch" in the affected side, greatly aggravated
by any movement; a desire on the part of the
patient to lean forward and to the affected side; a
dry, teasing cough; a pale and anxious face; and
a "jerking'' respiration; are the symptoms which
point to an attack of acute pleurisy.
Subacute Pleurisy, or pleurisy with effusion.
As a rule its approach is very insidious; and, its
diagnosis must be based upon the physical signs.
Adhesive Pleurisy. Of long duration, and
generally found in rheumatic subjects. The
patient gradually, but steadily, becomes more
anæmic; dyspnoea, which also becomes gradually
worse; sense of constriction, with dull pain in the
affected side; a short, dry, hacking cough, which
the patient tries to suppress; and recurrent bron-
chial hemorrhages; are the main symptoms of
this form of pleurisy.
Suppurative Pleurisy, or empyema.-Begins
with a chill, which is often repeated; rapid rise in
the temperature; pain in the affected side; severe
dyspnea; and cough. The fever, very soon after
its commencement, assumes an hectic form, with
sweats and great prostration. The purulent effu-
sion may find an exit by: (1) an external open-
ing; (2) opening into the intestinal canal, and be
70
DISEASES OF THE PLEURA.
discharged through the bowels; (3) opening into
the lung, and be discharged through the bron-
chial tubes; (4) opening in the peritoneal cavity,
and followed by fatal peritonitis and syncope.
Physical Examination. - Inspection. - Re-
stricted chest movement on the affected side.
After effusion has taken place there will be bulg-
ing of the intercostal spaces on the affected side.
Percussion.-From dullness to complete flat-
ness, depending upon the amount of the effusion.
<
Auscultation.-Before effusion has taken place
there is a feeble respiratory murmur, with friction
sounds; as the effusion commences the respiratory
murmur decreases until it is finally lost, to gradu-
ally reappear as the effusion is absorbed.
Mensuration.- The affected side is several
inches larger than the other side.
Differential Diagnosis.- Pneumonia has a
sharp chill, rapid rise in temperature, a character-
istic "rusty" expectoration, a crepitant râle
heard at the end of inspiration; while pleurisy
has not such a well defined chill, and such high
fever, its expectoration is frothy, and it has fric-
tion sounds heard both on expiration and inspira-
tion.
((
Prognosis.-Good.
Treatment.-Absolute rest in bed. Diet to
be light and nutritious; plenty of water to appease
thirst. Hot poultices applied to the affected side
often relieve the severe pain; if not, may try
strapping." If dyspnoea becomes great then
will have to aspirate the fluid in the pleural
cavity.
PLEURISY.
71
REMEDIES.
Aconite.- For the initial chill, and fever.
* Chill,
followed by fever; dry, hot skin; full, bounding pulse;
great restlessness and anxiety; cough, with stitching
pains in the side. To be given until effusion begins.
(4
Sometimes removes it as by magic."-Dr. Jahr.
"In simple, acute pleurisy, the sufficient remedy.”—
Dr. Hughes.
"No remedy deserves to be more frequently used.".
Dr. Baehr.
“In many cases, when timely administered, alone suf-
cient to cure the disease."-Dr. Laurie.
K
Abrotanum.-After the previous use of Aconite and
Bryonia, when there is a pressure in the parts hindering
breathing.
Arnica.- *If the pleurisy arises from an injury. *If,
after the fever has been removed, there remains pain in
the chest, with oppressed breathing.
S
"
Apis. "In pleurisy with exudation, Apis is one of the
best remedies we have to bring about absorption of this
fluid. Apis and Sulphur will cure the majority of these
cases."-Dr. Farrington.
Arsenicum. For the second stage; a large accumula-
tion of effusion in the pleural cavity; great dyspnoea;
comparatively little pain; and, great prostration of the
strength.
"It will accomplish more than any other remedy in the
stage of effusion.-Dr. Mitchell.
Bryonia. After the more severe fever has been re-
duced by Aconite, and effusion has commenced.
*The
patient is now quiet; lies on the affected side, or, on the
back; and, does not want to move. *There are severe
stitching pains in the affected side, greatly aggravated by
any motion. Cough, with severe pain in the side and
chest; must hold his chest with his hands when cough-
ing. *Splitting headache. *Nausea and faintness on
attempting to sit up.
Under its influence the exudate scarcely ever pro-
gresses, and the pains rapidly subside."-Dr. Bachr.
72
DISEASES OF THE PLEURA.
"In the second stage of pleurisy, after the stage of
serous effusion has commenced, no remedy can equal
Bryonia.”—Dr. Burt.
<<
'As effusion begins, as indicated by the friction sounds
Bryonia comes in as an all sufficient remedy."
*
*
*
Dr. Farrington.
Belladonna. Has been recommended in cases where
the fever returns, and pain and dyspnoea continue, not-
withstanding the employment of Aconite."-Dr. Laurie.
Carbo Veg. —The patient is greatly prostrated and ema-
ciated; the exudation threatens to undergo purulent
degeneration, with hectic. When pleurisy complicates
Asthmatic attacks in cases of chronic
*C
chronic bronchitis.
pleurisy.
Hepar." If the effusion is rather of a plastic nature,
and if the disease has lasted for some time, or if a slow,
lentescent course is to be apprehended from the com-
mencement of the attack, I know of no better remedy
than Hepar."-Dr. Wurmb.
Mercurius.* Where the exudation changes into pus.
*Recurrent chills; nocturnal sweats, without relief; ag-
gravation of all the symptoms at night. * The pain and
dyspnoea keep up after the fever has been reduced.
Nitric Acid. If the pulse should increase with stoppage
of the pains.
Ranunculus Bulb.-Pains from adhesions; or, from
Violent stitching
thickening of the pleural membranes.
pains in the chest; great anxiety and dyspnoea.
Sabadilla. Pleurisy, with great paralytic debility.
Stitches in the side of chest, especially when inspiring or
coughing. Complains of coldness, with hot flushes inter-
vening.
"Follows Bryonia well in pleurisy, and has cured after
Aconite and Bryonia failed."—Dr. H. C. Allen,
Sulphur.-* When the pleurisy fails to respond to the
well chosen remedies. After Bryonia has removed the
severe pain, and there is left some sensitiveness, particu-
*It is the remedy
larly on motion or on exposure to air.
for the removal of the exudation.
HYDROTHORAX.
73
"It materially hastens the disappearance of the plastic
exudation.”—Dr. Baehr,
HYDROTHORAX.
Synonyms.-Thoracic dropsy; dropsy of the
pleura.
Definition. A non-inflammatory serous effu-
sion into the pleural cavity.
Etiology. Any cause which will produce gen-
eral dropsy.
Pathology. Without signs of inflammation
there appears a clear, yellow-green, serous effu-
sion into the pleural cavity. Generally bi-lateral.
The effusion may be in such quantity as to com-
press the lungs.
Symptoms. The constant symptom is dysp-
noea, which is generally aggravated from lying
down. If the effusion goes on unchecked the
patient will become cyanosed, from diminished
breathing capacity; and, there will be embarrassed
heart's action, from pressure of the effusion.
Physical Examination.-The physical signs
will be the same as those which denote pleural
effusion.
Prognosis. Being a secondary disease, the
prognosis must be based upon the original disease.
Treatment. Must be directed to removing
the primary cause. If the effusion is very
abundant, and threatens suffocation, will have to
aspirate.
Give Apis in recent cases; and, Sulphur in
chronic cases.
Remedies. Apis; Apocynum; Arsenicum;
Digitalis; Helleborus; Sulphur; Tartar emet.
74
DISEASES OF THE PLEURA.
HÆMATHORAX.
Synonyms.-Hæmatothorax.
Definition. An effusion of blood into the
pleural cavities.
Etiology. Always a secondary disease.
Treatment.—Same as for hydrothorax.
PNEUMATHORAX.
Definition.-Air in the pleural cavities.
Etiology. Generally due to the ulcerative
process of phthisis; traumatism. Often found in
cases of fracture of the ribs.
Pathology. The air in the pleural cavities is
always"deoxidized and rich in carbon dioxide;
it may contain sulphuretted hydrogen" (Loomis).
The amount of air in the cavities varies greatly.
The perforation and escape of air
into the pleural cavities is announced by sudden,
severe pain in the side; dyspnoea; and the symp-
toms of collapse.
Symptoms.
Physical
murmur.
A
Examination. — Inspection. —- In-
creased size and immobility of the affected part,
with bulging of the intercostal spaces.
Diminished or absence of vocal
Palpation.
fremitus.
Percussion.-Tympanitic note.
Auscultation. - Absence of the respiratory
Prognosis. Unfavorable; particularly when
complicating phthisis.
Treatment.—Must be on general principles.
DISEASES OF THE DIGESTIVE ORGANS.
Diseases of the Mouth.
mouth.
CATARRHAL STOMATITIS.
Synonyms. Simple stomatitis; catarrh of the
Definition.-A catarrhal inflammation of the
mucous membrane of the mouth; which may be
either acute or chronic.
Etiology. In children from irritation of teeth-
ing. From food being put into the mouth too
hot; or, from irritating food. Secondary to some
other general disease.
Pathology. The mucous membrane of the
buccal cavity becomes red, swollen, and, at first
dry, but later moist. The tongue is swollen and
heavily coated.
Symptoms. There is burning, smarting and
tingling in the mouth, which upon inspection is
found red and inflamed.
Treatment.—Strict cleanliness of the mouth;
a weak Boracic acid solution used as a wash often
proves beneficial.
If with fever Aconite; or, if with catarrhal
symptoms Belladonna; to be followed by Mer-
curius, cures the majority of simple cases.
75
76
DISEASES OF THE MOUTH.
FOLLICULAR STOMATITIS.
Synonyms.-Aphthous stomatitis: croupous
stomatitis; vesicular stomatitis.
Definition.-An inflammation of the mucous
follicles of the mouth.
Etiology. Same
causes as produce the
catarrhal form of stomatitis.
Pathology. The same pathological condition
is here presented as is found in catarrhal stomatitis,
plus the development of small vesicles on the
mucous membrane of the mouth. If these vesi-
cles should rupture they leave a grayish ulcer.
Symptoms. The general symptoms are the
same as found in the catarrhal form; but, on in-
spection the vesicles referred to above will be
seen.
Treatment.-Same as catarrhal fever.
Remedies. See remedies in Thrush.
ULCERATIVE STOMATITIS.
Synonym.
Noma.
Definition. An inflammation of the mucous
membrane of the mouth, affecting chiefly the
gums, causing ulceration.
Etiology. A disease of early life; probably
contagious.
Pathology. The gums are hyperæmic and
swollen; covered with a dirty colored deposit;
and, recede from the teeth. This deposit sepa-
rates from the gums, and leaves ulcers with
irregular edges.
Symptoms. There is pain and heat of the
S
GANGRENOUS STOMATITIS.
77
mouth. Salivation; with dribbling of offensive
saliva, mixed with blood and pieces of pulpy
matter. The gums will be seen, upon inspection,
to be ulcerated. The submaxillary glands will be
swollen.
Duration.-About one week.
Prognosis.-Recovery.
Treatment.-Same as for Thrush.
GANGRENOUS STOMATITIS.
Synonyms.--Cancrum oris; sloughing phage-
dæma of the mouth.
Definition.-An acute inflammation of the
mucous membrane of the cheek, characterized by
a hard, red swelling externally, and a sloughing
ulcer internally.
rare.
Etiology. A disease of childhood, fortunately
Due to bad hygienic surroundings; or, in
those convalescing from some specific disease.
Pathology.-A hard, red swelling appears
upon the cheek. Inside the mouth, there appears
a ragged ulcer, which soon shows signs of
gangrene.
Symptoms.-The same as catarrhal stomatitis;
together with the condition as described above.
Prognosis. Must be guarded. Death may
result from profound exhaustion.
Treatment. Must sustain the patient's
strength by nutritious diet, and stimulants if
necessary. The ulcer must be kept clean; wash
with borax solution; or better, the peroxide of
hydrogen. If the ulcer should be very bad, may
apply the actual cautery, or acid to it.
78
DISEASES OF THE MOUTH.
Arsenicum has given excellent results in this
fearful disease.
Remedies.-See under Thrush.
THRUSH.
Synonyms. Parasitic stomatitis; muquet;
sprue; white mouth.
Definition. An inflammation of the mouth,
caused by the saccharomyces albicans.
Etiology. In children the want of cleanliness.
of the mouth is generally the predisposing cause.
The exciting cause is the saccharomyces albicans.
Pathology.-Same as ulcerative stomatitis,
together with the appearance of "aphthæ," in
which is developed the saccharomyces albicans.
Symptoms. Same as catarrhal stomatitis;
together with the aphthæ.
Prognosis.-Good.
Sta
A
Duration. -About one week.
Complications.-Gastro-intestinal catarrh.
Treatment.-Strict cleanliness of the mouth.
Correct acidity of the mouth. Locally apply
borax and honey.
REMEDIES.
*
Aconite. If the attack should commence with fever;
dry, hot skin; restless, tosses about; bites his fists. Also
a green diarrhoea.
* Vomit-
Æthusa.-Aphthæ in the mouth and throat.
ing of milky substance, after which the child falls asleep.
Arum Tri. *The mouth burns, and is so raw and sore
that the child refuses to even drink. They cry if any-
thing is even offered them to eat. Putrid odor from the
mouth. * Picks the lips until they bleed.
Arsenicum.
When the parts assume a livid or pur-
GLOSSITIS.
79
plish appearance. * Great weakness and prostration.
Burning in the mouth. *Thirst for small quantities of
water frequently.
Baptisia. * Cases occurring in the last stage of
phthisis. Ulceration of the mouth. Profuse salivation;
gums loose, flabby, dark red, or purple.
* Can only
swallow liquids
*
Borax.- Great heat and dryness of the mouth; the
mucous membrane appears shrivelled. The child fre-
quently lets go the nipple, showing signs of pain in the
mouth. *Fears a downward inotion.
Bryonia.
The child does not like to take hold of the
breast, but after the mouth becomes moistened it nurses
well.
Carbo Veg.-The mouth is hot; tongue almost immov-
able.
Chamomilla.-In cases where the nervous symptoms
of this remedy appear.
Hepar. From the abuse of Mercury.
Hydrastis. Stomatitis after abuse of Mercury, or chlor-
ate of potash; in nursing women; or, in weakly children.
* Peppery taste; tongue feels as if it had been burnt; with
dark red appearance; and, with raised papillæ. Excess-
ive secretion of thick tenacious mucous.
Mercurius.-Cures the vast majority of cases, and should
be given as soon as ulceration is noticed. *There is much
salivation; and, an offensive odor from the mouth.
Staphysagria.—* When the ulcers seem to bleed readily.
Sulphur.-When the case does not respond to the in-
dicated remedy. *Tendency to relapse.
GLOSSITIS.
Definition.—An inflammation of the paren-
chyma of the tongue; may be either acute or
chronic.
Etiology. Generally due to some direct irri-
80
DISEASES OF THE MOUTH.
tation to the tongue. The chronic form appears
in the old without apparent cause.
Pathology. The tongue is hyperamic; fol-
lowed by inflammation; with redness and swell-
ing. The swelling is sometimes so great as to
force the tougue out of the mouth between the
teeth. There is a thick secretion which covers
the tongue; small abscesses may form on the
tongue.
Symptoms. Restlessness, anxiety and diffi-
cult deglutition accompanies the swelling of the
tongue. The swollen tongue forces the patient
to keep his mouth open. Inspection will show
the condition as described under pathology.
Duration. From two to seven days.
Prognosis. Good. But must bear in mind
the possibility of suffocation from the swollen
tongue.
Treatment.-
M
Aconite.-* If with fever.
Apis.--Dryness of the tongue. * Fiery redness of the
mouth; tongue looks glossy. *Stinging pains.
Arsenicum. If there is much prostration.
Cantharis.—If caused from a burn, or a scald.
—
REMEDIES.
Conium. From a contusion; here Conium is far
superior to Arnica.
Hepar. To be given as soon as signs of suppuration
appear.
Ad
Mercurius. The main remedy, and seldom fails to
cure Glossitis.
—
Sulphur. The best remedy for chronic cases of
glossitis.
Diseases of the Pharynx.
ACUTE TONSILLITIS.
Synonyms.-Quinsy; amygdalitis; phlegmo-
nous pharyngitis; angina tonsillaris; inflammation
of the tonsil.
Definition. An inflammation of the paren-
chyma of one or both tonsils; with tendency to
suppuration.
Etiology. A disease generally found in the
young.
A rheumatic diathesis, a previous attack,
or, hereditary, are the predisposing causes. The
exciting causes are: exposure to atmospheric
changes, the inhalation of impure air, or, poison-
ous gases.
Varieties.—(1) Simple or catarrhal; (2) follic-
ular or lacunar; (3) phlegmonous or quinsy.
Pathology. In the catarrhal form there is
hyperæmia, inflammation and swelling of the
gland; with excessive secretion of mucus, which
covers the parts.
In the follicular form the tonsil is covered with
small yellow or whitish nodules. These nodules
are composed of the secretion of the glands; and,
from the inflammation and swelling the nodules
are prevented from escaping from the crypts of
the tonsil. These nodules are finally expecto-
7
82
DISEASES OF THE PHARYNX.
rated as offensive, cheesy masses. Follicular ton-
sillitis is claimed by many to be infectious.
In the phlegmonous form there is a very high
grade of inflammation with infiltration, whereby
the tonsil becomes enormously swollen. Often
terminates in abscess, or in chronic hypertrophy
of the tonsil.
Symptoms.—In the catarrhal form there is
slight fever; slight dysphagia; some cough; and,
a discharge of mucus. The pain is not severe.
The tonsils are red and swollen.
In the follicular form there is a general feeling
of malaise, with more or less headache, preced-
ing the attack. There is sometimes severe fever.
Upon inspection the tonsils will be seen to be
covered with small white or yellow nodules,
which are characteristic of this form of tonsillitis.
In the phlegmonous form, or common quinsy,
there is an initiary chill; with rapid rise of the
temperature, which may rise to 105° F., with
morning remissions and evening exacerbations.
The tonsils are inflamed, red and swollen; with
severe pain. Swallowing is difficult; and, the
jaws are stiff. The breath is very offensive; the
tongue is thickly coated. There is a feeling as
if choking from the enlarged tonsils. These
symptoms after lasting for a certain time gradu-
ally subside, and the inflammation results in
resolution; but, often the inflammation results in
an abscess, which is characterized by a throbbing,
lancinating pain in the tonsil. When an abscess
forms, the pain is suddenly relieved when it
opens.
ACUTE TONSILLITIS
83
Sequelæ. Chronic enlargement of the tonsils;
more or less deafness; predisposition to recurrent
attacks.
Duration.
The catarrhal form lasts about two
days; the follicular and phlegmonous forms last
from four days to possibly two weeks.
Good.
Prognosis.
Treatment.-Rest. Light diet, such as milk,
gruels, etc. Local applications and scarification
are seldom necessary.
In the majority of cases, in the beginning,
Belladonna will check the disease, if the throat is
bright red; if the parts are dark red, with ulcera-
tions, and foul breath, Mercurius will cure; and,
Hepar to be given when suppuration threatens.
REMEDIES.
Aconite.-Only at the very commencement, when due
to exposure to dry cold winds; with fever; dry, hot skin;
restless and tossing about.
Apis. One of the best remedies for the follicular form.
* The tonsils are swollen; bright red; with burning, sting-
ing pains. Deep lacunar ulceration, with an erysipela-
tous or oedematous appearance. * Great dryness of the
throat, without thirst. *Tenacious mucus in the throat.
*
Baryta Carb. For the predisposition to quinsy.
*Tendency to suppuration. Chronic induration.
Baryta Mur. Chronic hoarseness from enlarged
tonsils.
Belladonna.-In the first stage.
Fever, with flushed
*
face; throbbing carotids; and headache. The throat is
swollen, of a bright red color, and dry. There is diffi-
cult deglutition. * Constant disposition to swallow, feels
as if he would choke, if he did not swallow.
*Fluid
return through the nose. *The throat feels as if too
narrow.
*
84
DISEASES OF THE PHARYNX.
Gelsemium.-When, with the fever, there is tingling in
the parts, with excessive physical prostration and aching
pains over the body.
Hepar. -*To be given as soon as an abscess begins to
form, to hasten suppuration. *There are acute throb-
bing and sticking pains in the tonsil, which is very sensi-
tive to the slightest touch.
Ignatia.—Considered by some physicians as specific for
the follicular variety.
Mercurius. To hasten the maturing of the abscess
after pus has formed. *There is dryness of the throat;
much salivation. *The throat is made worse from empty
swallowing. * The tonsils are dark red, with small ulcers.
Foul breath. Aggravation at night.
Silicea. *When the suppurating gland is long in
healing.
Sulphur.-For tendency to relapse.
HYPERTROPHY OF THE TONSILS.
Synonyms. Chronic swelling of the tonsil.
Etiology. Generally caused by repeated at-
tacks of tonsillitis. A scrofular or tubercular
diathesis predisposes to this hypertrophy.
Pathology. There are two varieties: (1)
Where there is an increase in the cellular ele-
ments, with little, or no, increase in the con-
nective tissue. This variety is generally found in
children. (2) An increase in the intercellular
tissue, with little, or no, increase in the cellular
elements; the resulting hypertrophy in this form
is hard, and is known as scirrhus."'
K
(C
Sequelæ.-Deafness, from pressure of the en-
larged glands upon the Eustachian tube; "pigeon
chest," from the interference to the free passage
of air into the lung.
ACUTE CATARRHAL PHARYNGITIS.
85
Prognosis.
Doubtful, as far as the reduction
of the tonsil is concerned by medication.
Treatment.-Must treat the patient.
Remedies.-Baryta iod.; Calcarea iod.; Cal-
carea phos.; Conium; Graphites; Lycopodium;
Mercurius iod.; Sulphur.
ACUTE CATARRHAL PHARYNGITIS.
Synonyms.-Angina catarrhalis; acute sore
throat.
Definition.-An acute inflammation of part,
or of all, of the mucous membranes of the phar-
ynx, soft palate, and uvula; attended with red-
ness and swelling.
Etiology.
-
Getting the feet wet is the cause of
many cases. Exposure to atmospheric changes;
inhalation of irritating atmosphere; presence of
too hot food in the mouth; exposure to infectious
diseases. Rheumatism and former attacks are
predisposing causes.
Pathology. The mucous membrane is red,
dry and swollen; the uvula is greatly enlarged;
and, the calibre of the pharynx is lessened.
Later, there is a discharge of a thick, tenacious
mucus. There may appear small nodules upon
the pharynx (follicular pharyngitis); or, in severe
cases a membrane may form (membranous phar-
yngitis); or, a pharyngitis may develop in the
course of the infectious fevers (infectious phar-
yngitis).
Symptoms.-General malaise; with more, or
less, fever; dryness of the throat, with pain on
86
DISEASES OF THE PHARYNX.
swallowing; and, the condition of the pharynx
noted above.
Prognosis.-Good.
Duration.-One week.
Treatment.- Same as tonsillitis.
Diseases of the Stomach.
ACUTE GASTRITIS.
Synonym.-Acute gastric catarrh.
Definition.An acute catarrhal inflammation
of the mucous membrane of the stomach.
Etiology. Almost always due to the direct
influence of some irritating substance in the
stomach.
Pathology.
The mucous membrane is swol-
len, dark-red in color, and covered with a thick,
glairy mucus, alkaline in reaction, and to the over-
secretion of the mucous glands of the stomach.
Symptoms. A general feeling of malaise,
with loss of appetite, dull headache, thickly
coated tongue, nausea, and perhaps, vomiting of
glairy mucus, are the symptoms during the first
stage of acute gastritis. The fever is never very
high. There is tenderness of the epigastrium;
constipation; and high colored urine.
Duration.-A couple of days.
Prognosis.-Good.
Treatment. Remove the cause if possible. If
due to the taking of poison, administer the proper
antidote. The stomach should be emptied by an
emetic. Give no food, except by enemata, until
convalescent. Can give bits of ice to check thirst.
88
DISEASES OF THE STOMACH.
REMEDIES.
Aconite.-* If with fever; full, hard pulse; restless; and
fear of death.
C
What Aconite is capable of accomplishing in this
affection, exceeds all belief.”—Dr. Jahr.
Arsenicum.-The main remedy in this disease; par-
ticularly in cases characterized by extreme prostration,
burning pains, and anguish. *Intense burning pains, as
if the parts were on fire; thirst, drinks little and often.
* Vomiting of everything taken into the stomach.
"Suitable in every form, from the mildest to the most
severe."-Dr. Baehr.
You will need no other treatinent."-Dr. Hughes.
((
'A sudden disappearance of the pains at the acme of
the disease, with distention of the abdomen, singultus,
coldness of the extremities, smallness of the pulse, points
to gangrene; under such circumstances Arsenicum is the
only remedy from which we may derive some faint
hope."-Dr. Kruessler.
"It produces a perfect picture of subacute gastritis."-
Dr. Farrington.
Belladonna. - If Aconite should fail to reduce the fever;
or, if the throat should also inflame.
Preferable to Aconite."-Dr. Baehr.
((
"If a typhoid coudition with delirium supervenes.
Dr. Jahr.
Bryonia. When caused from cold drinks.
* The region
of the stomach is very tender, cannot bear to be touched.
*The patient does not desire to be moved. *Nausea and
faintness on attempting to set up. Vomiting immediately
after eating. * Constipation. *The patient is very cross
*The lips are dry and cracked.
and irritable.
Cantharis.—Where there is intense burning pains; com-
plete stranguary and tenesmus of the cervix vesicæ.
Camphor. The disease breaks out suddenly with great
violence (Baehr).
Hyoscyamus.-If stupor and loss of consciousness have
set in (Jahr).
Ma
""
DYSPEPSIA.
89
Ipecacuanha. — In cases characterized by extreme
nausea and vomiting; with restlessness; and, difficulty of
breathing.
Nux Vom.-If from abuse of stimulants or coffee.
Phosphorus.* Sensation of weakness and emptiness
in the stomach. * Vomiting of food and mucus, mixed
with bile and blood. * Vomiting of water as soon as it
becomes warm in the stomach.
K
Synonyms. Indigestion.
Varieties. -(1) Atonic; (2) nervous;
catarrhal.
Ma
Kur t
DYSPEPSIA.
(3)
ATONIC DYSPEPSIA,
Definition. A train of symptoms caused by
a functional derangement of the digestive pro-
cess."―Loomis.
Etiology. The bolting of food; or, the eating
of too large a quantity of food.
Symptoms.-The symptoms vary consider-
ably. The appetite is capricious; or, may be
abnormal, or entirely lost. After eating there is
a feeling of fullness or distress in the stomach,
without actual pain; associated with flatulency;
heart burn; and, as a rule, constipation.
Treatment. Must regulate diet to each case.
For the remedies see end of chapter.
NERVOUS DYSPEPSIA.
Definition. That form of dyspepsia which is
due to a nervous condition, and found in those of
a nervous temperament.
Etiology.-Mental worry, or mental strain.
90
DISEASES OF THE STONACH.
Symptoms.-There are nervous symptoms,
such as headache, neuralgias, palpitation of the
heart, sleeplessness, etc. There is severe pain in
the stomach, which usually comes on when the
stomach is empty, and is relieved by eating. The
appetite is capricious; the tongue clean.
Treatment. The main treatment must be
directed to quieting the nervous system. Regu-
larity in habits, etc., are essential to the cure.
Often a sea voyage is beneficial.
Remedies.-See end of chapter.
CATARRHAL DYSPEPSIA.
M
Synonyms.
of the stomach.
Definition.-A chronic catarrhal inflammation
M
Chronic gastritis; chronic catarrh
of the mucous membrane of the stomach.
Etiology.
Any of the causes of acute gastritis,
or dyspepsia. Secondary to any disease which
produces passive congestion of the stomach, as
cirrhosis of the liver, valvular heart troubles, and
chronic lung diseases.
Pathology. The mucous membrane is of a
grayish color, often ecchymosed, and covered with
a thick, tenacious, gray mucus. The epithelium
undergo degeneration; while there is an over-
growth of connective tissue. The changes are
most marked at the pyloric extremity of the
stomach.
Symptoms. The first symptoms are those
common to gastritis. There is nausea and vomit-
ing; with acid eructation, or water-brash; vomit-
ing of acid mucus, particularly in the morning;
CATARRHAL DYSPEPSIA.
91
this vomit is mixed with butyric, acetic and
lactic acids; the normal acid of the stomach is
diminished. Great flatulency, which often causes
a swelling in the epigastrium. Finally, the gen-
eral nutrition suffers, and there is hypochon-
driasis. The skin becomes dry and shrivelled.
Prognosis.—Good, in uncomplicated cases.
Treatment. Remove cause if possible. Regu-
late mode of living. Have regular time for meals;
also, a regular time for sleep. Diet must be nutri-
tious, and, regulated to suit each case. The
washing out of the stomach may be practiced.
REMEDIES
For the various forms of dyspepsia:
Abies Nig.-Low spirited; melancholy. Total loss of
appetite in the morning, but great craving for food at
noon and night. Sensation of an undigested hard-boiled
egg, or some such uncomfortable substance, in the stom-
ach. Continual distressing constriction just above the pit
of the stomach as if everything were knotted up, or as
if a hard lump of undigested food remained there. A
painful sensation as if something were lodged in the
chest, mostly on the right side of the sternum, which had
to be coughed up, though nothing comes. Pain in the
stomach always comes after eating (Guernsey).
Anacardium.-* Great loss of memory; hypochondri-
acal. * Desire to curse and swear. *The pains are re-
lieved while eating, to again return in a couple of hours.
The patient has a constant desire to eat, because it re-
lieves his pains. Urging to stool, but with the effort
the desire passes away.
Antimonium Crud.-* In cases characterized by a thickly
coated white tongue.
Arsenicum. In cases occurring in drunkards; or, from
eating ices. *The patient is very restless and anxious.
*Terrible burning distress in the stomach; the epigastric
92
DISEASES OF THE STOMACH.
region is swollen and tender; heartburn; relief from hot
drinks. * Thirst for small quantities of water.
"It produces a perfect picture of subacute gastritis.'
Dr. Farrington.
"}
Bryonia. The Bryonia patient is cross, irritable. The
attack usually comes on in the summer. Desire for
things that cannot be had, or which are refused, or not
wanted when offered. *Immediately after eating there
is a hard pressure in the stomach as if there was a stone
in it; which sensation goes off with eructations.
* The
eructations occurring especially after a meal are putrid
or sour. * Nausea and faintness on rising from a recum-
bent position. * Vomiting soon after eating.
The
region of the stomach is very sensitive to touch.
* The
mouth is dry; the lips are parched, and cracked; the
tongue is coated white or gray; the patient has an enor-
mous thirst, wants large quantities of water at a time.
* Constipation; stool is hard, dry, burnt looking.
*
Capsicum.-Atonic dyspepsia, with relaxed mucous
membrane, much flatulency, and cold stomach.
Carbo Veg.-Particularly in elderly persons; or, after
dissipation. *Dull headache, particularly in the back
part of the head, worse in the mornings and after break-
fast. * Dreads to eat, because of the pain it causes.
*
China.
Burning in epigastrium, and deep in the abdomen,
spreading down to the small of the back and up to the
shoulders. * Cannot drink milk, it causes much flatu-
lency. * Excessive flatulency; abdomen swollen unto
bursting; eructations relieve. Nausea in the morning.
After a severe illness. *There is a bitter
taste; loss of appetite, even aversion to food; craves sour,
refreshing things, and stimulants. *The stomach is very
weak; digestion slow; the most innocent kind of food
disagrees, causing an enormous amount of gas to form in
the stomach. * There is pressure in the stomach; the
stomach feels as if packed; little, or no, relief from eruc-
tations. *Weakness and prostration after meals, with
desire to lie down.
*
Hepar. From abuse of Mercury.
*The plainest
M
CATARRHAL DYSPEPSIA.
93
kind of food disagrees. A longing for sour food and
condiments. *Constant sensation of water rising in the
cesophagus, as if he had eaten sour things. * Frequent,
but momentary, attacks of nausea; with flow of saliva in
the mouth.
"In the purely atonic form, Hepar is indicated."-Dr.
Farrington.
Hydrastis. -Chronic gastritis. *Atonic dyspepsia. Loss
of appetite. *Faintness and weakness at the stomach;
worse after eating. *Fullness and weight in the stomach
as from a stone. * Obstinate constipation; the stools are
covered with mucus. Dull headache, particularly in the
forehead. Sour eructations. *Dull, hard, thumping
fullness of chest, and dyspnoea, palpitation of heart;
even light pressure of hand over the pit of the stomach
will reveal strong pulsation.
เ
Will relieve when there is sinking sensation, palpita-
tion of the heart and mucus coated stools."—Dr. Farring-
ton.
*
Kali Phos.—-* Nervous dyspepsia. Great nervous de-
pression; the patient is weak and exhausted; weak feel-
ing in the stomach. Hunger immediately after eating.
Lycopodium. No appetite; constant sensation of
satiety; takes no food, because she feels so full. Hunger
returns immediately after eating. Excessive pressure in
the stomach. *Sour eructations. Constant fermenta-
tion in abdomen; with much rumbling, particularly in
the left hypochondria. Constipation.
Nux Vom. In cases from abuse of stimulants or coffee;
or, when occurring in those of sedentary habits. The
patient is cross, irritable, with desire for solitude; hypo-
chondriacal. Dull headache.
Aggravation of his symp-
toms about an hour after meals.
* Fullness and swelling
*
of the epigastrium after eating. Sour eructations.
* Vomiting, with violent retching. * Yellowness of the
whites of the eyes. Awakes about 4 A. M., lies awake
for some time, then falls into a dreamy sleep, and finally
awakes feeling tired.
94
DISEASES OF THE STOMACH.
"No other pathogenesis contain the symptoms of
gastric catarrlı more fully than Nux."-Dr. Baehr.
Natrum Mur.-Chronic cases in hypochondriacal sub-
jects. Great hunger, but no appetite. Pressure and dis-
tension of the stomach. Heartburn after eating.
* Great
longing for salt. *Aversion to bread. * Vomiting of
clear mucus.
Natrum Phos, -* Great acidity; sour eructations; vom-
iting of sour fluids. *There is a creamy or golden yellow
coating at the back part of the tongue. Pain in the
stomach, coming on after eating and lasts until the next
meal.
* As
"Acid dyspepsia is met by this remedy."-Dr. Dewey.
Phosphorus.- -* Weak, empty or gone sensation in the
abdomen. *Heat in the back between the shoulder
blades. Pressure above the pit of the stomach after eat-
ing. * Vomiting of food immediately after eating.
soon as water becomes warm in the stomach it is vomited.
Burning in the stomach, relieved by drinking water, but
the water is soon vomited.
"(
Renders excellent service in chronic catarrh of the
stomach."-Dr. Baehr.
"Where there is excessive flatulency, with frequent
palpitation, and intermittent pulse, accompanied with
much despondency, I have seen grand results from
Phosphorus."-Dr. Burt.
*The
Pulsatilla. From ice cream, fruits or pastry.
taste of the food, which is mostly sour, returns to, and
remains in, the mouth for a long time. Feeling of tight-
ness in the stomach. *The tongue is covered with a
tenacious mucus. Foul taste in the morning; must
rinse out the mouth. Heartburn. Constant nausea.
* Must loosen the clothes about the abdomen after eat-
ing.
*No thirst. *Constant chilliness.
Robina. * Excessive acidity of the stomach. * Eructa-
tions or vomiting of excessively sour fluid, setting the
teeth on edge.
on edge. Dull, heavy, squeezing pain in the
stomach after eating. Low-spirited; irritable.
Sepia.-Chronic
cases. * In females; incident to
GASTRALGIA.
95
uterine disease. *The skin has a dirty, yellow color.
The thought of food sickens her. * A faint, gone, sink-
ing feeling in the stomach, relieved by eating.
* Sense
of weight in the rectum. *Taste sour or bitter; longing
for acids, pickles, etc.
Sulphur.
Chronic cases; with tendency to relapse.
* Low-spirited. *Heat on vertex. *Feels faint and weak
from 11 to 12 A. M.; must eat something.
spells. Abdomen feels full and tight.
* Frequent faint
GASTRALGIA.
Synonyms. Gastrodynia; cardialgia; spasm
of the stomach; neuralgia of the stomach.
Definition. A painful paroxysmal affection of
the sensory nerves of the stomach, which has no
distinct pathological lesion.
Etiology.-General nervous depression. Hys-
teria.
Symptoms. Severe paroxysmal, agonizing
pain in the epigastrium, occurring generally when
the stomach is empty; the pain radiates to the
back. The pain is relieved by eating, from pres-
sure, and from the application of the constant
electric current. The attack lasts from a few
moments to several hours; it reappears at irregu-
lar intervals. Between the attacks the patient is
comparatively well.
Differential Diagnosis.-In Gastric ulcer the
pain and dyspeptic symptoms are continuous; the
pain is aggravated by eating and pressure; while
in gastralgia it is just opposite.
From Gastric cancer by the age of the patient,
history of the disease and character of the vomited
matter.
*་
96
DISEASES OF THE STOMACH.
Prognosis. Good; but may run a protracted
course.
Treatment.-During the interval correct all
disturbing influences; regulate diet.
During the attack apply hot applications over
the epigastrium.
REMEDIES.
Argentum Nit.-In delicate nervous women. From
any emotion; loss of sleep; etc. Feeling of a lump in
the stomach. Pains radiate from a sore spot in the stom-
ach. Great flatulency.
Arsenicum.-* Attacks preceded by restlessness. Severe
paroxysmal pain in the stomach. * Great burning in the
stomach; desire for sips of water.
44 Place it in the front rank."-Dr. Baehr.
'In the neuralgic variety .. my favorite medicine is
Arsenicum."-Dr. Hughes.
Bismuth.-Pressing, heaviness, as from a load, in one
spot in the stomach. Violent crampy pain in the stom-
ach. Burning. Violent ejection of the food.
*They
"The remedy for pure gastralgia.”—Dr. Farrington.
Chamomilla.-If arises from an attack of anger.
are very cross, irritable. *The attack is relieved by
drinking coffee.
"(
•
Ignatia. If from grief.
The attacks occur principally
at night. Pressure at the cardiac orifice of the stomach,
as if the food had lodged there.
"
Always commence the treatment in the cases of
females with Ignatia."-Dr. Juhr.
Nux Vom. This is the main remedy for this distress-
ing affection. *The patient is very irritable. Crampy,
constricting pains in the pit of the stomach, extending to
the back. Morning attacks.
Always commence the treatment in the case of males
with Nux.”—Dr. Jahr.
Oxalic Acid. Severe cutting pains.
A
GASTRIC ULCER.
97
M
GASTRIC ULCER.
Synonyms. Simple ulcer; perforating ulcer.
Definition.—An ulcer of the stomach, involv-
ing the mucous membrane or deeper structures.
Etiology. Found oftener in females than
males; and, between the ages of fifteen and thirty.
Anæmia and chlorosis. Habitual stooping posi-
tion, and grief, are the predisposing causes.
Pathology. There is, from some cause, ob-
struction to the circulation of some part of the
mucous membrane of the stomach, in consequence
of which the acid gastric juice attacks the part
and causes softening, foilowed by an ulcer. The
favorite situation is the posterior wall of the
stomach, near the pyloric end. The ulcer may
involve the mucous membrane or the deeper tis-
sues. The appearance of the ulcer is circular or
elliptical, as if punched out; it is conical, with
the apex toward the peritoneum. There are no
signs of inflammation around the ulcer.
Symptoms. At first the symptoms are those
of dyspepsia. The characteristic signs are: Pain,
burning or gnawing, confined to a small spot,
which can often be covered by the point of the
finger. The pain is aggravated by eating, and
on deep pressure. Vomiting, which for the time
being relieves the pain, consists at first of food;
later, has blood mixed with the vomit, due to the
ulcer eating into some of the blood vessels of the
stomach.
Jag
Differential Diagnosis. From cancer of the
stomach by history of the case, by the pains of
8
98
DISEASES OF THE STOMACH.
cancer being constant and lancinating, and not
painful from deep pressure. In cancer the vomit-
ing comes late in the disease, and does not relieve
the pains.
In cancer there is a tumor in the epi-
gastric region.
Chronic Gastritis.-The pains and tenderness
are diffused. Vomiting comes generally in the
morning, and is composed of glairy mucus.
Gastralgia. Has not the circumscribed pain,
and is aggravated from food.
Prognosis. Favorable, but must be guarded.
Treatment.-The thing to be desired is com-
plete rest of the stomach, which is obtained by
giving food per rectum. Continue feeding per
rectum for seven or eight weeks, then cautiously
allow milk, then broths and other liquid food. If
hæmatemesis should occur allow patient to eat
bits of ice. If perforation occurs give Opium to
quiet the motion of the stomach and the indicated
remedy. For the intense pains nothing equals
Atropine. Compare remedies for dyspepsia, car-
dialgia, and hæmatemesis.
REMEDIES.
Argentum Nitr.- Small spot between xythoid carti-
lage and the navel, sensitive to the slighest pressure; the
pain radiates in all directions; increase and decrease
gradual. *Time passes slowly.
*Fears the disease may
result seriously.
* Rest-
Arsenicum.—* Great prostration and weakness.
less, with tossing about. * Vomiting immediately after
eating or drinking. * Great burning in the stomach.
"Deserves to be classed in foremost rank."-Dr. Baehr.
"When ulcer is at pyloric end.”—Dr. Pope.
Atropine;"We know from experience that no medi-
GASTRIC CANCER.
99
cine is better calculated to subdue the frightful cardialgic
pain of ulcer of the stomach."—Dr. Baehr.
Carbo Veg.-Burning in the stomach, spreading down
to small of back and up to the shoulders. Pains parox-
ysmal, take away the breath. Vomiting of
Vomiting of sour, bloody
masses. Ameliorated from cold drinks.
"Has an excellent effect."-Dr. Baehr.
Kali bich. When the ulcer is at the cardiac end of the
stomach (Dr. Pope.).
X
Phosphorus. Regurgitation of food by the mouthfuls,
no nausea. Vomiting of food and mucus, mixed with
bile and blood. *Vomiting as soon as food or drinks
become warm in the stomach. Sense of great weakness
and emptiness in the abdomen.
"Afforded me the most essential aid."-Dr. Jahr.
Uranium Nitr.-To arrest the tendency to formation of
the ulcer.
Ka
GASTRIC CANCER.
Synonym. Cancer of the stomach.
Definition. A malignant growth affecting the
walls of the stomach.
Varieties. Scirrhus; medullary; epithelioma;
colloid.
Etiology. Obscure; but hereditary predispo-
sition plays an important part. More frequent in
males than females.
Pathology.
Generally primary, of the scir-
rhus variety, and situated at the pyloric extremity
of the stomach.
Symptoms.
Progressive indigestion, with
marked emaciation, and the peculiar cancerous
cachexia. Pain, which is dull, heavy, or lancin-
ating. Vomiting of the so-called 'coffee-
grounds." Tumor in epigastrium.
(C
100
DISEASES OF THE STOMACH.
Differential Diagnosis.-Its differential diag-
nosis from gastric catarrh, ulcer, etc., has been
considered.
Duration.-From one month to several years.
Prognosis. Bad.
Treatment. Good hygienic surroundings.
Liquid and highly nutritious food. Treat symp-
toms as they arise. Compare remedies for chronic
gastric catarrh, hæmatemesis.
Remedies.
Arsenicum; Hydrastis; Con-
durango.
Nothing equals Kreos. 30 for the vomiting.
HÆMATEMESIS.
Synonyms. Gastrorrhagia; gastric hemor-
rhage; blood vomiting.
Definition.—A symptom of various diseases,
and consists of an effusion of blood from the ves-
sels of the stomach.
Etiology.
From traumatism; poisons; gastric
ulcer or cancer; congestion of the liver or spleen;
vicarious menstruation; scurvy; purpura.
Symptoms. Slight cases possess no distinct
symptoms, and the only sign is the spitting of the
blood. In severe cases the patient has sensation
of warmth and fullness in the epigastrium, with
nausea and vomiting. Soon the countenance be-
comes pale, the extremities cold, and the pulse
small.
Differential Diagnosis.-Hamoptysis is pre-
ceded by bronchial symptoms, and the blood is
coughed up. In hæmoptysis there are râles heard
HÆMATEMESIS.
IOI
ease.
in the chest.
The blood in hæmoptysis is liquid,
bright and frothy, free from food and of an alka-
line reaction; whereas in hæmatemesis the blood
is dark and generally clotted, mixed with food
and bile, and of an acid reaction.
Prognosis. Of itself rarely causes death. The
prognosis must be based upon the associated dis-
Treatment.-Absolute rest.
Place patient in
bed, with feet slightly elevated. No food by the
mouth Give small bits of ice, and place ice bag
over epigastrium. Or, which I believe is better,
give hot water to drink and rub mustard over the
epigastrium.
REMEDIES.
Aconite. If with fever.
*
* Great fear and anxiety.
* Sudden excruciating pain, with gagging retching,
vomiting of blood; cold sweat on forehead (Hering).
Arnica. From mechanical injuries.
Arsenicum.-* Great anguish and extreme prostration;
with coldness of the surface of the body. The vomited
blood is dark almost black; may also have similar sub-
stance discharged from bowels.
Belladonna.-If with symptoms of cerebral congestion.
Carbo Veg. * Hippocratic face; breath cold; limbs
cold up to knees; pulse small and thread-like. Collapse.
Vomiting of bilious or bloody masses. * Wants to be
fanned. Frequent fainting.
China. For the weakness, etc., following the hemor-
rhage.
"
Hamamelis. -When the vomited blood is dark; sensa-
tion of trembling in the stomach; or fullness and gurgling
in the abdomen; feverish by spells; weak, quick pulse.
Have the utmost confidence in its use."-Dr. Hughes.
S
102
DISEASES OF THE STOMACH.
((
A number of excellent cures have been reported.
Dr. Hempel.
((
M
'Has been administered with surprisingly favorable
results."—Dr. Heinigke.
Ipecacuanha.-
.—* Sudden attacks with paleness of face.
*Constant nausea. *With every motion of the body a
cutting pain is felt in the abdomen running from left to
right.
"No medicine surpasses Ipecac. in the curative power;
in the most diversified cases, I have effected with this
remedy, if not a permanent cure, at least in ever case
considerable relief, which very often was instantaneous."
-Dr. Jahr.
<<
'No better nor more efficacious remedy."-Dr. Baehr.
"Deserves the preference."-Dr. Hughes.
Nux Vom.-* Attended with a great deal of retching.
* From some acute affection of the stomach (Baehr.).
Very irritable. * Constant desire for stool.
After sup-
pressed hemorrhoidal flow.
Phosphorus.—* Vomiting of dark acid matter; of dark
filamentous substances; looks like coffee-grounds or ink.
* Better from drinking cold water.
DILATATION OF THE STOMACH.
Synonyms. Pyloric obstruction; gastric dila-
tation.
Definition. An abnormal expansion of the
walls of the stomach.
Etiology.-Obstruction of the pylorus; from
excessive eating or drinking.
Pathology. The walls of the stomach may be
hypertrophied or thinned. The dilatation may be
uniform, or only in circumscribed areas, forming
pockets.
Symptoms. The symptoms of dyspepsia, with
the characteristic vomiting, i. e., vomiting every
DILATATION OF THE STOMACH.
103
two or three days, the vomit consisting of food
eaten the day before; the vomit is acid in reac-
tion and very fetid. Microscopically there is
sarcinæ and torulæ in abundance in the vomit.
Physical Signs.-Inspection.-Great bulging
over the epigastrium.
Percussion.-Increased gastric tympany.
Auscultation.-Succussion sound.
Prognosis.-Depends upon cause.
Treatment.-Diet to be light and nutritious, a
little food to be given at a time and often; very
little liquid food. Washing stomach may be
practiced. Operating for pyloric stenosis has been
performed.
Remedies. Consult those given for Gastric
Catarrh and Dyspepsia.
Diseases of the Intestines.
ENTERITIS.
Synonyms. Catarrhal enteritis; ileo-colitis;
intestinal catarrh; inflammation of the bowels.
Varieties.-(1) Acute; (2) chronic; (3) mem-
branous.
Definition.
A catarrhal inflammation of the
mucous membranes of the intestines.
Etiology. Generally due to the direct influ-
ence of irritating substances in the bowels.
From atmospheric changes. Accompanies certain
diseases of the liver, stomach and heart.
Pathology.-At first there is hyperæmia, with
redness, swelling and dryness of the part. The
dryness soon gives way to a thin, serous exuda-
tion, which causes liquid discharges from the
bowels. The glands of the bowels may ulcerate.
In chronic enteritis there is atrophy of the mucous
membrane and destruction of the glands. In the
membranous form there is formation of a false
membrane in the bowels.
Symptoms. Commences with feeling of gen-
eral malaise, followed by a slight fever; coated
tongue; tenderness of the abdomen; and possibly
nausea. But the characteristic symptom is loose
evacuations, at first fecal in character, but soon
become thin and watery. There is colicky pain
and rumbling in the abdomen.
DIARRHŒA.
105
ENTERO-COLITIS,
Or follicular enteritis. When the inflammation
involves the ileum and colon, and affects particu-
larly the lymphatic glands.
DIARRHOEA.
A condition where there is too frequent stools.
It is a symptom of many diseases.
Varieties.-Irritative Diarrhea.-Due to the
presence of some irritating substance in the bowel.
Inflammatory Diarrhea.-Due to inflammation
of the intestines.
Choleraic Diarrhea.-The diarrhea which pre-
cedes cholera.
Nervous Diarrhea.-Caused from some nervous
influence, as fright, worry, and when we have
to pass an examination.”
Symptomatic Diarrhea.-When appearing, as
a symptom, during the course of another disease.
Vicarious Diarrhea.—When the diarrhoea is
compensatory.
Critical Diarrhea.-When appearing at the
crisis of a disease.
ment.
Colliquative Diarrhea.—When appearing at the
end of some long, wasting disease.
Duration. From two days to one week. The
chronic form may last for years.
Prognosis.--Good under homoeopathic treat-
Treatment.-Absolute rest in bed. Let room
be well aired; the discharges, when evacuated,
immediately removed; hot, dry poultices to the
106
DISEASES OF THE INTESTINES.
abdomen if there should be any tenderness. The
diet to be liquid and nutritious; feed the patient.
little and often.
REMEDIES.
Aconite.* At the commencement of acute attacks;
with fever; dry, hot skin; hard, full pulse; restlessness,
anxiety and tossing about. *The stools are thin and fre-
quent. *The stools are watery; bloody; or green, like
chopped spinach.
Aloes. Considerable pain, gurgling and rumbling in
the abdomen. *The stools are thin, yellow and copious.
* Before stool there is feeling of insecurity in the rectum.
* After stool feels prostrated. * Aggravated in morning.
Arsenicum.— When there is rapid prostration; rest-
lessness; anguish, and tossing about. * Unquenchable
thirst; wants small amount of water frequently. * Burn-
ing pain in the abdomen. *The stools are worse after
midnight, and after eating. *The stools are thick, dark
green mucous; or are dark watery; frequent, scant and
offensive.
Belladonna.-At the commencement.
With symp-
toms of cerebral congestion; throbbing carotids; flushed
face; drowsiness, but cannot sleep. *During sleep the
patient is restless, starts up suddenly, and there is twitch-
ing of the muscles. *Head hot, while the hands and
feet are cold. * Abdomen sore to touch, cannot tolerate
the least jar, even of the bed.
Bryonia.
From hot weather, or it is aggravated by
the return of every spell of hot weather. *Diarrhoea in
the morning, as soon as he begins moving about. Stools
thin, brown fecal, bad odor.
*The stomach is swollen
*The stools are worse
*The stools are yellow,
China. -*Great weakness.
from wind; relieved by belching.
at night, and after eating.
watery, undigested and painless.
Croton Tig.-*The stools are yellow, watery, expelled
suddenly with force, and aggravated from both eating
and drinking.
CHOLERA MORBUS.
107
Hyoscyamus.-The stools are yellow, watery, painless;
with jerking of the muscles.
Ipecacuanha. * Constant nausea. * Stools
mucous; as if fermented. *The tongue is clean.
Mercurius.—* Violent tenesmus and continued urging,
never get done feeling. *Tenesmus during and after
stool. * Region of liver painful and sensitive to contact.
*Stools dark green, bilious.
Nux Vom. After previous drugging. Pain in the
back relieved after stool. The patient is cross, irritable.
The stool is thin, brown. * Constant urging to stool.
Phosphorus. * Chronic cases; painless, undigested;
with much thirst for water during the night. Watery
stools, pouring away as from a hydrant; with sensation
of emptiness and weakness in the abdomen. * Little
grains like boiled kernels of rice are seen with the stools.
Pulsatilla.-*
-Nightly attacks. * No thirst. * Bad taste
*The stools
A
*
green
in the mouth, particularly in the morning.
are constantly changing in character.
Rhus Tox. As soon as the disease assumes a typhoid
type. Tongue dry and rough, with red edges and
triangular red tip. Restlessness, must change position
often for relief. * Stools bloody water, like washings of
beef.
Sulphur.-* Aggravated in early morning, driving him
out of bed. *Tendency to relapse. * Stools are blood
streaked.
CHOLERA MORBUS.
Synonyms.-English cholera; sporadic chol-
era; cholera morbus.
Definition.-An acute sporadic affection of the
stomach and bowels, having no anatomical lesion.
Etiology. The eating of unripe fruits; sudden
checking the perspiration; drinking ice water
while the body is overheated.
Hot weather pre-
disposes to it.
108
DISEASES OF THE INTESTINES.
Symptoms. Onset is sudden and violent,
generally in the night, with vomiting and purg-
ing. At first the vomit consists of the ordinary
contents of the stomach, but soon becomes liquid
and green in color. The strength sinks, and a
cold perspiration breaks out over the body.
There are, as a rule, violent pains in the abdo-
men, and sometimes cramps in the limbs.
Differential Diagnosis.-Asiatic cholera is
epidemic, the stools have no fæcal odor, are of
the "rice water" character, and contain the
comma bacilli."
Acute enteritis commences slow, has high fever,
but not severe cramps.
From one hour to two days.
Duration.
Prognosis.-Good.
Treatment.—Confine patient to bed. If the
attack was caused by overeating, induce vomit-
ing, if it has not already taken place. Hot appli-
cations to the abdomen, or the drinking of hot
water often relieves. Bits of ice given the patient
will sometimes stop the vomiting. Give only
liquid food until the patient is fully recovered.
REMEDIES.
Arsenicum.. -*Rapid prostration; with violent vomit-
ing and purging, especially after eating or drinking.
* Violent burning in the stomach. *Thirst for small
quantity of water often. *Restless and anxious.
Colocynthis. Severe colicky pains, mostly around
the navel; has to bend double; great restlessness; and
loud screaming on changing position.
* Worse at in-
tervals of from five to ten minutes.
Cuprum.-* When the attack is associated with spasms
or cramps in the limbs.
CHOLERA INFANTUM.
109
Dioscorea. -Griping or crampy pains radiating upward
and downward until the whole body, including the
fingers and toes, became involved. * Violent twisting
colic, coming in paroxysms, worse while lying down, or
bending double, better on arising and walking.
Ipecacuanha.- Constant nausea. *Griping, as from
a hand, each finger seemingly sharply pressing into the
intestines. Cutting about the navel. Must scream and
toss about.
The most effectual remedy."—Dr. Jahr.
Nux Vom. The patient is very irritable.
retchings. * Ineffectual urging to stool.
(C
Podophyllum.—-*For painless cases.
“There is no remedy so surely indicated by painless
cholera morbus as Podoph."—Dr. Bell.
Veratrum Alb. When there appears a cold sweat on
the forehead; the nose pointed; the skin of the hands
wrinkled; and coldness of the limbs. *There are severe
vomiting and purging; with weakness and cramp of the
limbs.
da
*
CHOLERA INFANTUM.
* Violent
Synonym.-Summer complaint.
Definition.—An acute catarrhal inflammation
of the stomach and intestines, with irritation of
the sympathetic ganglia.
Etiology. High temperature of the summer.
Errors of diet. Dentition. Bad hygienic sur-
roundings.
padd
Pathology. The mucous membrane of the
stomach and intestines is inflamed and tumefied;
the follicles are swollen and softened. The intes-
tines usually contain a "rice water" fluid. There
is disturbance of the sympathetic nerves.
Symptoms. The onset inay be sudden or
gradual; as a rule, diarrhoea ushers in an attack.
IIO
DISEASES OF THE INTESTINES.
There is vomiting; the child can retain nothing
on its stomach. There is, at the very commence-
ment of an attack, great exhaustion and rapid
wasting of the tissues, and soon the child becomes
extremely emaciated. The stools, which are very
frequent, may average one every hour, are watery,
generally greenish, and may contain particles of
undigested food; they are sour and possess a
characteristic musty odor. There is high fever,
thirst, restlessness, and a rapid and feeble pulse,
and a scanty secretion of urine. In the last
stage symptoms of collapse may supervene.
Duration.-From a few hours to several weeks.
Prognosis. Must be guarded; but under
homoeopathic treatment, favorable.
Differential Diagnosis.-Entero-colitis has a
gradual onset, a moderate fever, and has not the
wasting characteristic of cholera infantum.
Treatment.-Give the child plenty of fresh
air; keep it out of doors if the weather permits;
if it lives in the city, then remove it to the coun-
try or seashore. Sponge frequently with tepid
water; and change its clothes often. The diet
must be regulated for each individual case; re-
membering that the mother's milk, if she be
If from any
healthy, is the child's best food.
cause the child does not nurse then the food must
be liquid and highly nutritious. Give stimulants
for the debility.
REMEDIES.
Æthusa-The child lies stretched out in an uncon-
scious condition, with dilated pupils and staring eyes.
* Great intolerance for milk; the child will take the milk,
CHOLERA INFANTUM.
III
but it will soon be vomited in large curds; after the
vomiting the child falls over exhausted. * Violent, sud-
den vomiting of a frothy white substance, resembling
milk. Stools yellow or greenish liquid; worse in the
morning. Spasms.
Apis. When the child inclines to stupor, with loud,
shrill screaming. *The tongue is dry, with redness of
*The abdomen
the buccal cavity, and absence of thirst.
is very tender to pressure. The stools are greenish and
mixed with mucus; worse in the morning; involuntary,
with every motion, as though the anus stood open.
*
worse
Arsenicum. -* Prostration and emaciation. *The child
is very restless, tosses about, and cries. The stools are
dark green, mucous; bloody; frequent and scant;
after eating or drinking; and at night, * after midnight.
* Great thirst for small quantities of water; but drinks
frequently. Vomiting immediately after drinking. Face
pale and cadaveric; the skin dry and shriveled.
*
Belladonna. In cases that show signs of cerebral irri-
tation. * Face flushed, pupils dilated; and throbbing of
the carotid. *The child starts and jumps in its sleep.
*The head, which the child rolls from side to side, is hot,
while the hands and feet are cold. The child is very
*The tongue is coated white, with red margins.
Benzoic Acid.-If, during an attack, the urinary dis-
charges become very scanty, and if the urine has a very
pungent, strong smell, and if the urine easily becomes
turbid (Lippe).
cross.
* The
Bryonia. When the attack is caused by or returns as
soon as the weather becomes hot. *Heat of the head,
with frequent tossing of the hands to the head.
lips are dry and parched. *Thirst for large quantity of
water at a time. The stools are brown, fecal; or copious,
dark green. * Vomiting immediately after drinking.
*The patient does not wish to be moved, wants to lie
perfectly quiet; every motion causes pain in the abdo-
men and a passage from the bowels. * Aggravated in the
morning, when beginning to be moved,
Calcarea Carb.-The stool is of less importance than
I 12
DISEASES OF THE INTESTINES.
tow.
the person and the concomitant symptoms (Dr. Bell).
* In children of a leuco-phlegmatic temperament; who
are fat; the skin dry and flabby; the muscles soft; face of
a pale chalky appearance; the hair is dry, and looks like
*The head is too large, with open fontanelles;
there is much perspiration on the head while sleeping,
wetting the pillow for quite a distance. The abdomen
is swollen and hard. *There is longing for eggs.
* Milk
disagrees, and if taken is soon vomited in the form of hard
curds; or, may pass from the bowels in curdled masses.
*
Ipecacuanha.- Constant sense of nausea; with pale
face; and oppressed breathing. Frequent epistaxis.
*The tongue is clean. Drowsiness, with starting and
jerking of the muscles during sleep. *The child screams
and tosses about. * Vomiting soon after eating or drink-
ing. *The stools are green mucous; dark, looking like
molasses; and fermented.
Frequently indicated at the commencement.”—Dr.
Farrington.
Natrum Sulphuricum.-Frequent attacks of violent
colic, with rumbling in the abdomen, relieved by the
violent discharge of yellow water with large quantities of
flatus. The stools are more frequent during the morn-
ing hours, after the child has been taken up and is moved
about, like Bryonia (Dr. Lippe).
Podophyllum.-Restless sleep; the child tosses about in
the bed. During sleep the child's eyes are only half
closed; there is moaning; grinding of the teeth; and roll-
ing of the head. Vomiting of frothy mucous; gagging
and retching. * Colic, with retraction of the abdominal
muscles. *The stools are greenish, watery, profuse,
gushing and offensive. * The passages are more frequent
at night than in the daytime.
Sulphur. Tendency to relapse; or, for cases that seem
to linger. *The attack commences after midnight. Pale
face; open fontanelles; stupor; no thirst; and suppressed
urinary secretion. * Aversion to washing. * Offensive
odor of the body despite frequent washing; the odor of
the stool follows the patient as if he had soiled himself.
"(
CONSTIPATION.
113
*The stools are watery, greenish, involuntary, and some-
times sour.
CONSTIPATION.
Synonym. Costiveness.
Definition. A retention of fecal matter; gen-
erally due to a deficiency in the peristalsis of the
large intestines; but, may be due to a deficiency
of intestinal or biliary secretion.
Etiology. Any disease which lessens peristal-
sis or the secretion of the intestines will cause
constipation. Dyspepsia; irregular living; cer-
tain foods; the abuse of laxative medicines; in-
testinal obstruction; and sedentary occupation,
will lead to costiveness.
Symptoms.-There are many reflex symptoms;
but, the characteristic symptom is the infrequent
movement of the bowels.
Treatment.
Remove the cause if possible.
Regulate the diet and habits of the patient; have
him take regular exercise; eat regularly; drink
plenty of water during the day, and drink a glass
of water before retiring at night; and have a reg-
ular time for defecation. Abdominal massage
has given excellent results; and, electricity has
cured many obstinate cases.
REMEDIES.
Alumen.. -No desire for stool for days.
* Feces dry,
hard and black.
“I have been led to use Alumen quite extensively in a
variety of ailments characterized by a most obstinate
constipation, which had been existing for a long time."
-Dr. Guernsey.
9
114
DISEASES OF THE INTESTINES.
Alumina.. -* Great inactivity of the rectum; must strain
to pass even a soft stool. * Constipation, from dryness of
the mucous membrane of the rectum.
Ammonium Mur.-* Stools are hard, crumbling, requir-
ing great effort to expel them; with severe burning and
smarting of the anus.
Anacardium.-* Urgent desire for stool, but with the
effort the desire passes away without an evacuation; the
rectum seems powerless; with sensation as if plugged.
Arnica. -Constipation from blows on the epigastrium.
Bryonia. When the patient is irritable; or, the con-
stipation occurs in hot weather; or, in those subject to
rheumatism -*- Constipation from dryness of the mucous
membrane of the intestines. *The stools are large, hard
and very dry, as if burnt; passed after much straining.
Causticum.-Frequent ineffectual efforts to stool, with
much pain, anxiety and redness of the face.
*
* Stools
pass better while standing. The stools are tough and
shining as if greased; the first part is hard and in pieces,
while the last part is soft. *Stools knotty, like sheep's
dung.
Graphites. Herpetic diathesis. * In women who have
delay of their menses. *The stool is hard, knotty; cov-
ered with mucous, or contains shreds of mucous; the knots
being united by mucous shreds. *There is much mucous
after stool.
Hydrastis. In debilitated persons; subject to taking
much laxative medicine. Stools are hard, lumpy, with
*
mucous.
"It is in cases where constipation stands alone, or is
itself the cause of the other existing ailments, that I find
the Hydrastis so valuable."--Dr. Hughes.
Ignatia—* Frequent sighing and full of grief. * Pro-
lapsus of the rectum with the stool.
Stabbing pain
from anus upwards into rectum after stool.
Magnesia Mur. -In infants during dentition. -X- Large,
hard stools passed with difficulty, and crumble at the
verge of the anus.
Natrum Mur.-"In tedious cases, where the above
CONSTIPATION.
115
remedies have failed, and there is no inclination what-
ever to evacuate."—Dr. Hering.
Nitric Acid Stools dry, or alternately dry and liquid;
passed without pain.
Nux Vom.--In those who have sedentary occupations;
or subject to piles; or from overeating; or from excessive
mental work. * Frequent ineffectual urging to stool,
*Stools are small, slimy or bloody.
Opium. In corpulent, good-humored women and chil-
dren. * Stools are composed of hard, round, black balls.
* Due to paresis of the intestines.
Phosphorus.—* The stools are long, slender, like a
dog's.
"For the constipation due to a gastric neurosis, and
when occurring in fevers and chronic diseases of the
circulatory and intestinal tract, with prostration of the
vital forces."—Dr. Strong.
Platina. -* Due to lead poisoning; or, while traveling.
*The stool adheres to the rectum and anus like soft clay;
with much straining. * Frequent urging, with expulsion
of only a small portion of feces.
Plumbum.--* With violent colic, or spasmodic pains in
the stomach. Stools are hard and lumpy. * Sensation
as if the anus was drawn upwards.
Sepia -In pregnant women; or, those subject to
uterine diseases. The stool is hard and knotty, like
sheep dung. * Unsuccessful urging to stool, only wind
and mucous passed. *Sensation as of a lump, or weight,
in the rectum. Pain in the rectum during, and for a
long time after, stool.
Silicea. -- Occurring with spinal disease; or, in women
during the menses. *Sensation as though fæces re-
mained in the rectum, which has not power to expel
them; when, after much violent effort of the abdominal
muscles, fæces have been nearly expelled, they suddenly
recede into the rectum."--Dr. Dunham.
Sulphur.-Chronic constipation. Frequent unsuccess-
ful desire for stool. *The first effort at stool is painful,
compelling one to desist. Stool is hard and knotty.
116
DISEASES OF THE INTESTINES.
INTESTINAL OBSTRUCTION.
CONGENITAL OCCLUSION
Is a surgical disease; which is recognized by
direct examination.
INTUSSUSCEPTION,
Or invagination, is the slipping of one portion of
the intestines into an adjacent portion. It is more
frequently found in the young, and in the male
sex. Its favorite seat is around the ileo-cæcal
valve.
Symptoms.
Vomit-
Onset sudden, with violent
spasms of the intestines; and constipation.
ing, which soon becomes stercoraceous.
domen is swollen and tender to touch.
symptoms of collapse.
The ab-
Finally,
Prognosis.-Very grave.
Treatment.-May inflate the intestines; or
inject warm water or oil; and such surgical means
as seem necessary.
Remedies.
Aconite; Arsenicum; Belladonna;
Carbo veg.; Cuprum; Nux vom.; Opium; Plum-
bum; Veratrum alb.
STRICTURE
May be due to contraction of cicatrices; or, to
infiltration of the intestinal walls. They are most
frequently found in the rectum; and, are generally
of a cancerous origin.
HERNIA
Is caused by a portion of the intestines slipping
through the diaphragm.
INTESTINAL COLIC.
117
TWISTING
The twist usually occurs around a
Or volvulus.
relaxed and lengthened mesentery.
UNNATURAL ACCUMULATIONS
May be caused by gall stones; or, from fecal im-
paction.
TUMORS.
Tumors of various kinds, but mostly cancers,
are found in the intestines.
INTESTINAL COLIC.
Synonyms. Enteralgia; tormina.
Definition.-A functional disorder of the intes-
tines, characterized by a spasmodic contraction of
the muscular coat of the intestines.
Etiology. The presence of irritating food
within the intestines; flatulency; or, abnormal
fecal accumulation. Sometimes reflex from other
disease.
Symptoms.-Severe twisting, tearing, cutting
or pressing pain in the umbilical region, spread-
ing over the whole abdomen. The pain is re-
lieved by pressure; and, momentarily by changing
the position. The attack lasts from a few minutes
to several hours.
A
Differential Diagnosis. — Peritonitis has a
high temperature; tenderness on pressure; and
constant pain.
Hepatic Colic has vomiting and jaundice; with
pain most severe in the epigastric region.
Nephritic Colic has pain along the ureters into
118
DISEASES OF THE INTESTINES.
the penis; with frequent desire to urinate; and
retraction of the testicles.
Uterine Colic has pain most severe in the hypo-
gastric region, tenderness, aggravated by pres-
sure; and associated with some menstrual irregu-
larity.
Treatment.
Inject hot water into the rectum.
Hot applications to the abdomen.
REMEDIES.
Aconite.—* If from a cold. Burning, cutting, darting
in the bowels; worse from least pressure. Abdomen
swollen. * Anxious and restless; with fear of death.
Belladonna.-* As if one spot in the intestines were
seized with nails; a griping, clutching, clawing pain.
*During the pain the transverse colon protrudes like a
pad, all the way across the abdomen.
Chamomilla.—* Very cross, does not want to be spoken
to. Abdomen distended with wind; the application of
heat relieves.
Colocynthis. For the majority of cases. Abdomen
tympanitic. * Severe colicky pains, mostly around the
navel; has to bend double, being worse in any other
position. * Great restlessness; and loud screaming on
moving. * Worse at intervals of from five to ten minutes.
* Seek relief by pressing the corner of a table, or the head
of a bed post, into the abdomen. The pain spreads from
the navel over the abdomen.
Dioscorea. *Violent twisting colic, in paroysms.
* The pains
*Severe cutting pains around the navel
radiate upward and downward until the whole body,
*The
including the fingers and toes, become involved.
colic is aggravated by lying down, or from bending
double (opposite to Coloc.).
M
Magnesia Phos.-Flatulent colic forcing the patient to
bend double; relieved by friction, warmth, and pressure;
accompanied by belching gas, which gives no relief.
INTESTINAL PARASITES.
119
Nux Vom. * From indigestible food. Hot drinks
relieve. * Frequent urging to stool.
Opium.-Cutting in the abdomen. Squeezing pains,
as if something were forced through a narrow space.
* The abdominal muscles are retracted, * Lead colic.
*
Plumbum.-Cutting, contractive pains, with restless-
ness and tossing about; better from rubbing or hard
pressure. *Abdomen hard as a stone; knots form in the
recti muscles. * Cold sweat and faintness. * Navel vio-
lently retracted. *Abdomen drawn in, as if by a string,
to the spine.
INTESTINAL PARASITES.
TAPEWORMS.
Tænia solium; bothriocephalus
Varieties.
latus; tænia medio-canellata.
Tania solium, or the "armed tapeworm, or
is the most common form
1
11
the "pork tapeworm
in this country.
The tania solium is derived from the hog; and,
is from one to ten yards in length; and consists
of a head, neck and a body. The head, or scolex,
has four cup-like, round projections, or suckers;
and two rows of hooklets. The neck is slender,
and measures from one-half to one inch in length.
The body is composed of segments, or joints,
which, near the neck, are round, but gradually
flatten as they form the body, until they become
nearly quadrilateral in shape. Each fully de-
veloped segment has both male and female sexual
organs, which are situated on the broad side of
the segment. These worms are found attached
to the upper third of the small intestines.
Bothriocephalus latus is supposed to come from
!
I 20
DISEASES OF THE INTESTINES.
fish. Its head has no suckers, or hooklets, but
has two split-like openings.
CC
Tania medio-canellata, or tænia saginata, or
the unarmed tapeworm" is larger, stronger
and thicker than the tænia solium; and comes
from the beef. The head has four suckers, but
no hooklets.
Symptoms.-There is often no symptoms pro-
duced by these worms. There may be vague
dyspeptic symptoms, with possible nervous phe-
nomena. The only positive sign is the presence of
the eggs, or segment of the worm, in the stool,
in the vomited matter.
or
Treatment. Must be treated symptomatically.
For the removal of the worm: let patient fast for
twelve hours, then give one of the following:
pumpkin seeds, dose two to three ounces; pellet-
ierine, the alkaloid of pomegranate, dose five
grains; kooso, dose one-half ounce; routera tinct.,
dose two to three teaspoonfuls; to be followed by
a purge in a few hours.
K
ROUND Worms.
Ascarius lumbricoides; oxyuris
Varieties.
vermicularis.
Ascaris lumbricoides is generally found in the
smal. intestines, but may be found in other locali-
ties. This round worm resembles an earth worm
in general shape. Its length is from ten to twenty
inches. Its head has a mouth with three semi-
lunar lips.
Oxyuris vermicularis resembles a piece of thread.
Generally found in the rectum.
APPENDICITIS.
I2I
Symptoms.
General dyspeptic symptoms.
Grinding of the teeth at night; night terrors;
picking at the nose; mucous stools; and nervous
phenomena.
Wedd
Treatment.-Santonin, 1x trit., two to five
grains every three hours, is well nigh specific.
APPENDICITIS.
In inflammations of the cæcal region there are:
Typhlitis, which is a catarrhal inflammation of
the cæcum.
Appendicitis is a catarrhal inflammation of the
appendix.
Perityphlitis is an inflammation of the serous
covering of the cæcum.
Etiology.-Typhlitis and appendicitis are gen-
erally caused by fecal empaction; or, from the
presence, in the bowel, of foreign or irritating
substances. Perityphlitis is always secondary to
appendicitis.
A
Symptoms. Irregular chilliness, with fever,
pain and tenderness in the right iliac fossa. Con-
stipation, which may give way to a diarrhoea.
Physical Diagnosis.-Palpation shows ten-
derness of the part; with, sometimes, localized
induration.
Prognosis. Favorable; but must be guarded.
Complications. — Peritonitis; perforation of
the appendix.
Treatment. Place patient in bed.
plications over the painful part often relieves.
pus threatens to form hasten it by the appropriate
remedy, and, as soon as formed, remove by as-
St Magdal
Hot ap-
If
122
DISEASES OF THE INTESTINES.
Some
pirator, or by free incision into the part.
surgeons advise immediate removal of the ap-
pendix as soon as appendicitis is diagnosed.
Remedies.-Aconite; Arsenicum; Belladonna;
Bryonia; Colocynthis; Hepar; Mercurius; Rhus
tox.; Sulphur.
PROCTITIS.
Synonym.-Rectitis.
Definition. A catarrhal inflammation of the
rectum.
Etiology.-Traumatism; the presence of for-
eign bodies in the rectum; dysentery; constipa-
tion; hemorrhoids.
Pathology. Similar to that of dysentery.
Symptoms. There is burning in the rectum,
with frequent urging to stool, and violent tenes-
mus. The stool contains mucous, and sometimes
blood.
Complications.-Peritonitis; periproctitis.
Prognosis.-Good.
Treatment.-Same as for dysentery.
DISEASES OF THE PERITONEUM.
PERITONITIS.
Definition.-A fibrinous inflammation of the
peritoneum.
Varieties. May be acute or chronic; primary
or secondary; or, sero-fibrinous, fibrinous, or
purulent.
Etiology. Exposure to atmospheric changes.
The extension, to the peritoneum, of inflamma-
tion of other organs. Traumatism. Perforation
of the stomach, intestines, etc. Septicemia, or
pyæmia.
The chronic variety is generally found in con-
nection with tuberculosis, cancer, or, possibly,
syphilis; or, may follow an acute attack.
Pathology. Hyperæmia, with redness of the
parts. The normal secretion is diminished, and
the membrane is dull looking; there is an exuda-
tion of febrin, which tends to glue the surfaces
together. Sometimes there is an effusion of
serum, varying from ounces to gallons, which
gravitates to the most dependent portion of the
peritoneal cavity; or, there may be an exudation
of pus.
In the chronic form the exudate forms into
fibrinous bands, adhering the parts together. The
membrane is thickened and hardened.
Symptoms.-Onset is sudden, with chill, and
124
DISEASES OF THE PERITONEUM.
moderate fever. The pulse is small, quick and
wiry. The abdomen is swollen, tense and hard;
it is sore and tender, even the pressure of the
bed clothes are unendurable. The patient lies on
the back, with the limbs flexed. The pain is
aggravated by every movement. Vomiting, which
is often an annoying symptom, may become
stercoraceous. Hiccough is also frequently pres-
ent. There is usually obstinate constipation;
and painful, or suppressed, urination.
Differential Diagnosis.-Acute enteritis has a
high fever; slight swelling of the abdomen; and
a diarrhoea.
Intestinal colic has no fever, nor vomiting; the
pain is paroxysmal, and relieved by pressure.
Intestinal obstruction has no fever; and no great
tenderness.
Acute gastritis begins with vomiting; the pain
is confined to the gastric region, with little or no
tympanitis.
Renal and hepatic colics have no fever; no tym-
panitis; and the pain is relieved by pressure.
Complications.-Intestinal obstruction; sepsis.
Duration.-About ten days.
Prognosis.—Favorable; but must be guarded.
Treatment. In the acute form the patient
must be confined to bed; perfect rest, bodily and
mentally, being essential to recovery.
Hot ap-
plications, or turpentine stupes, over the abdo-
men often relieves the severe pain and tenderness.
Some advise to give opium, so as to put a stop to
all intestinal motion, in that way they claim better
results, the "putting-the-bowels-in-a-splint "
>
PERITONITIS.
125
idea. Bits of ice may be given, and often checks
the excessive vomiting. The diet must be liquid,
returning gradually to solid food only after the
patient is fully recovered.
In the chronic form the treatment must be con-
stitutional. Painting the part with iodine helps
Sometimes paracentesis will have to
sometimes.
be performed.
REMEDIES.
Aconite. At the commencement of the disease; chill;
fever; with restlessness; anxiety; tossing about; and fear
of death. The pulse is full and frequent. The abdomen
swollen, and tender to touch; with cutting, burning or
tearing pains.
"
Indispensable."—Dr. Hughes.
"The chief remedy at the outset."-Dr. Jahr.
Arsenicum. Great weakness and prostration. There
is a cold and clammy sweat. *Anguish, and tossing
about. *Thirst, for small quantities of water frequently.
* Violent burning, or colicky pains in the abdomen.
* Persistent vomiting. *There is a copious and persistent
exudate.
Belladonna. When, with the fever, there is conges-
tion to the head or chest. *Face red and bloated; throb-
bing of the carotids. *Intolerance to both light and
noise. *Continual moaning, it seems to relieve the
patient. *Cramp and colic-like pains in the abdomen,
as if a hand had clutched some part, and was griping
(squeezing) it with force, causing great pain; or a feeling
as if the nails of the fingers were dug into the part.
*Pains which come and go quickly. * Vomiting of bile;
alternating with retching. * Drowsiness, sleepiness, but
cannot sleep. The abdomen is swollen, hot to the
touch, and very sensitive, even the pressure of the bed
clothes are intolerable; jarring the bed, or walking
heavily in the room, disturbs her very much.
Bryonia. When effusion threatens. *The fever is
S
*
126
DISEASES OF THE PERITONEUM.
now less, and the patient is irritable, desires to lie per-
fectly still, does not want to be disturbed. * Nausea and
faintness on sitting up. * Mouth and lips parched and
dry; great thirst. * Obstinate constipation.
* Sharp
stitching, or lancinating pains; aggravated from any
motion.
"When we desire to remove the effused fluid as soon as
possible."-Dr. Baehr.
Carbo Veg.-Threatened collapse.
"In the last extremity a potency of Carbo veg. will
often bridge a terrible chasm."-Dr. Conant.
Mercurius. Tendency to suppuration; or, to form
abscesses. * Frequent chilliness, with fever, followed by
copious sweats, which do not relieve. * Nocturnal sweats.
*Abdomen swollen, and sensitive to touch. * Patient is
worse at night. * Tongue swollen and moist, showing
the imprints of the teeth.
"Prevents the further spread of the suppurative pro-
cess."-Dr. Farrington.
It is the frequently exacerbating fever, with creeping
chills, and copious perspiration after the heat, which
points to Mercury."-Dr. Baehr.
Nux Vom. After the disappearance of the exudation;
to equalize the remaining trifling irregularities in the
digestive function, especially the torpor of the bowels
(Bachr).
Opium. For the paralytic weakness of the intestinal
canal; with unusual distension of the abdomen; obstinate
constipation; and retention of the urine.
Sulphur. To promote, or excite, the absorption of the
exuded fluid (Baehr).
Terebinthina.-* Excessive distension of the abdomen
with gas; rumbling in the bowels; and suppression of the
urinary secretion.
Veratrum Alb. When the patient is anxious; rest-
less; the countenance is unnatural; nose is pinched; and
there is a cold sweat on the forehead.
Burning in the
* Vomiting is very annoying; also diarrhoea.
abdomen.
*
ASCITES.
127
ASCITES.
Synonyms. - Hydroperitoneum; peritoneal
dropsy; dropsy of the abdomen.
Definition. An accumulation of serum in the
peritoneal cavity.
Etiology. From chronic peritonitis; inter-
stitial hepatitis; or, from valvular heart disease.
As a symptom of other diseases; or, as an expres-
sion of general dropsy.
Physical Signs.-Inspection. Enlargement of
the abdomen; swelling of the superficial veins;
and, more or less, obliteration of the navel.
Palpation.-Fluctuation.
Percussion.—Below the level of the liquid there
will be flatness, while above there will be a tym-
panitic note. The line of dullness will change
with the position of the patient.
Treatment. Remove cause if possible; and
direct treatment to the primary disease. Besides
surgical measures, consult the following
REMEDIES.
Aconite.- -*For acute febrile dropsies.
Acetic Acid.* Intense thirst; debility; dry, hot skin;
and frequent urination of large quantities of pale urine.
An undeservedly neglected remedy."-Dr. Farring-
C
ton.
Apis. -*There is a waxy hue, or transparency to the
skin. No thirst. The whole body feels sore and
bruised. Stinging pains. *Scant, dark, albuminous
urine.
"It is a leading remedy."-Dr. Jousset.
Apocynum Can.-* Bruised feeling in the abdomen.
*Terrible sinking feeling at the pit of the stomach.
128
DISEASES OF THE PERITONEUM.
* Great
*The urine is very scant and dark colored.
thirst, but water disagrees, and if taken, is vomited.
Arsenicum.—Dropsy from kidney, heart or liver dis-
*The patient is very much emaciated; very weak;
restless and anxious, particularly at night. Cannot lie
down. *Thirst, drinks often, but only small quantit' s
at a time. * Eating or drinking excites vomiting.
ease.
Suitable in all forms of dropsy.”—Dr. Baehr.
China.-* From debilitating diseases.
(4
Colchicum.—* With suppressed urine; or, with urine
containing blood and albumen.
Digitalis. From heart disease. *The skin is bluish;
the urine scant; and the characteristic pulse, which is a
slow, irregular pulse, excited by the least movement.
Helleborus.-Where there is no thirst.
dark, with coffee ground sediment.
in the stomach.
Iodine. -* Excessive loss of flesh, with canine hunger.
Cardiac anxiety, with trembling of the limbs. Urine is
dark and scanty.
*The urine is
* Sense of coldness
"Perfectly homœopathic to ascites.”—Dr. Jousset.
Pulsatilla." Ascites which is due to menstrual difficul-
ties, especially at puberty or at the menopause, is cured
by Pulsatilla.”—Dr. Jousset.
Sulphur.
-*-
From suppressed skin eruptions.
DISEASES OF THE LIVER.
HYPERÆMIA OF THE LIVER.
Varieties.—Active and passive hyperæmia.
Etiology. Active hyperemia is generally due
to errors of diet; indigestion; excessive eating
and drinking. Blows over the region of the liver
may cause active hyperæmia of that organ.
Malaria. The suppression of a habitual bloody
discharge. Often found in hot climates.
Passive hyperemia is due to some cardiac or
pulmonary disease which retards the venous cir-
culation. Incompetence of the tricuspids, or
stenosis of the mitral valves are the most frequent
causes. Emphysema and chronic bronchitis also
cause passive hyperæmia of the liver.
Pathology. In active hyperemia the liver is
swollen; abnormally full of blood; and from a
light to a dark red color. The liver is heavier
and smoother than normal; and has a shiny
appearance.
In passive hyperemia the liver presents a mot-
tled appearance, and is called a "nutmeg liver."
The mottling is due to congestion of the centre of
the lobule, or the area of the hepatic vein, while
the periphery of the lobule, or area of the portal
vein, is anæmic. If passive hyperæmia is long
standing there may be atrophy of the liver cells,
with increased growth of connective tissue; the
ΙΟ
130
DISEASES OF THE LIVER.
lobule will become deeply pigmented; this condi-
tion is called "cyanotic induration."
cyanotic induration." The liver,
which is at first swollen, may become contracted.
Symptoms. In active hyperemia there is a
feeling of malaise; loss of appetite; badly coated
tongue; bitter taste in the mouth; headache; and
possibly a slight jaundice. The liver is more or
less swollen; there is tenderness under the free
borders of the ribs; with sense of weight and
pressure in the right hypochondrium. There is
often severe pain in the right side, which runs to
the right shoulder.
Passive hyperemia has the same symptoms as
active hyperæmia, except it has a more gradual
onset, and is generally associated with gastro-
intestinal catarrh.
Duration.-About five days.
Prognosis. Acute hyperemia, recovery; while
in the passive hyperemia it depends upon the
cause.
Treatment.—Remove the cause, if possible.
Regulate the diet. During an acute attack con-
fine patient to bed; hot applications to the affected
side often prove helpful.
REMEDIES.
Belladonna.-If signs of inflammation should develop.
Carduus Mar.-"In infusion will be found an excellent
remedy."-Dr. Hempel.
Chamomilla.-If the attack comes from a fit of anger
or from chagrin.
Chelidonium.--- The liver is considerably congested; the
hypochondrium is very sensitive to pressure; pressure in
the region of the liver. There is dull headache; bilious
JAUNDICE.
131
eructations; and bad odor from the mouth. * Pains in
the region of the liver, shooting toward the back.
* Pain
under inferior angle of the right scapular.
Iris.-Headache. Loss of taste and appetite. Nausea
and vomiting. Burning aud cutting in the right hypo-
chondrium, worse from motion.
Lachesis.—In cases occurring in drunkards. Acute
pain in the liver. *The region of the liver is very sensi-
tive; cannot bear any pressure about the hypochondria;
must loosen the clothes.
Leptandra.-Great distress and aching pains in the
liver. *The stools are very black, like tar. *Tongue is
coated yellow. *Soreness of the head and eyeballs.
Mercurius Dulc.—When due to surfeit.—(Clarke.)
Nux Vom.-* When due to high living; abdominal
plethora; or debauchery. *The patient is very irritable.
*The tongue is comparatively clean on its first half, while
the posterior half is coated with a thick fur. *Sour taste
in the morning, though the food and drink taste natural.
The liver is swollen, sensitive, with pressure and stinging
pains; must have the clothes loose around the waist.
"The most frequent homoeopathic remedy.' - Dr.
Bachr.
Podophyllum.-Fullness and twisting pain in the right
hypochondrium, with sensation of heat. * Alternate
diarrhoea and constipation. * Offensive odor from the
mouth. * Rubs and strokes the hypochondrium with the
hands. Prolapsus ani.
Sepia. For women in the critical years (Baehr.).
Sulphur.-Chronic cases.
Holds the first rank."-Dr. Baehr.
*k
JAUNDICE.
Synonym.-Icterus.
Definition. A yellow discoloration of the tis-
sues of the body, due to the presence of bile pig-
ment.
Varieties.—(1) Hepatogenous, or obstructive
132
DISEASES OF THE LIVER.
jaundice; (2) Hæmatogenous, or non-obstructive
jaundice.
Etiology. Hepatogenous jaundice is developed
whenever the passage of bile into the ductus
communis, or into the intestines, is checked by
some mechanical means, such as, inflammatory
product in the duct, biliary calculi, cancer, etc.
Hæmatogenous jaundice is due to the several
fevers, septicemia, etc.
Symptoms.-Jaundice is manifested by the
discoloration of the tissues and fluids of the body.
The discoloration begins in the conjunctiva. The
urine is dark in color. The stools are very light
in color. There may be nervous symptoms.
CATARRHAL JAUNDICE.
Synonyms. Catarrh of the bile ducts; catar-
rhal hepatitis.
Definition.-A catarrhal inflammation of the
mucous membrane of the bile ducts and of the
duodenum.
Etiology. It may be due to exposure to
atmospheric changes; but it is generally the re-
sult of the extension of the inflammation of a
gastro-duodenal catarrh into the bile ducts.
From the irritation caused by the presence of
calculi, or parasites, in the ducts. As a compli-
cation of certain diseases, as syphilis, pyæmia,
malaria, etc.
Pathology. The disease generally begins in
the duodenum and extends inward into the
ducts. There is hyperæmia, followed by inflam-
mation, and swelling of the mucous membrane of
CATARRHAL JAUNDICE.
133
the ducts; there is an excessive secretion of
mucous, which covers the membrane, and ob-
structs the flow of bile. The bile being retained,
soon stains the liver substance; and, is taken up
by the blood. Sometimes pus forms, causing
small abscesses.
Symptoms.-The symptoms, at first, are those
of gastro-duodenal catarrh, followed by the symp-
toms of jaundice.
Duration. The acute symptoms usually last
several days; but the jaundice may continue for
five or six weeks.
Prognosis. Recovery.
appar val
Treatment.-Rest in bed. Liquid diet, par-
ticularly milk; avoid meats and starchy foods;
drink plenty of water. Hot applications often
relieve the pains.
REMEDIES.
Aconite. *Acute cases, where there is fever, restless-
ness, and anxiety; knows she is going to die, predicts the
day. * Pressure or contraction in the region of the liver,
with oppressed breathing. * Stools white; with dark red
urine. Alternate slimy stools and constipation.
'In all recent cases, if there is much fever, I com-
mence the treatment with Acon."-Dr. Jahr.
Arsenicum.- -* When from some liver disease; malig-
nant cases.
Bryonia. Fever; chilliness on moving. *Mouth and
lips dry and parched, with desire to continually moisten
them; thirst for large quantities of water. * Sharp stitches
in the right hypochondrium, worse from any motion, and
better from lying on the right side. *Nausea and faint-
ness when attempting to set up.
'Specially indicated by extreme languor, or rather by
a general feeling of illness.”—Dr. Baehr.
134
DISEASES OF THE LIVER.
Carduus Mar.-Dull headache, bitter taste in the mouth,
tongue white, especially in the middle, with the tip and
edges red. There is nausea with vomiting of an acid
green fluid. The stools are bilious and the urine golden
yellow. There is an uncomfortable fullness in the region
of the liver (Farrington).
Chamomilla.—Particularly in young children; or
*where the jaundice is caused from a fit of anger, or
chagrin.
Chelidonium. * Jaundice from portal hyperæmia,
gall-stones, or, from catarrh of the bile ducts. Pain in
the region of the liver, shooting toward the back. Sen-
sitiveness of the hypochondrium. Bitter taste.
* Pain
in the right shoulder.
"No better remedy."-Dr. Hale.
"Has made many brilliant cures."-Dr. Burt.
China. -* When jaundice arises from gastro-duodenal
catarrh; loss of vital fluids; weakness, from long sick-
ness; sexual abuse; or from malaria. Periodical jaun-
dice. *The liver is congested, swollen, and painful;
worse from contact. *The patient is worse every other
day. *The stools are white, and are passed with much
fetid flatus.
"Will commonly ward off the development of an in-
cipient attack of jaundice."-Dr. Laurie.
* Slow,
Digitalis. Jaundice from some heart disease.
*
irregular pulse. Pressure and soreness in the region of
the liver. *Constant nausea and retching. *The stools
are white, gray or clay colored.
"Acts admirably."—Dr. Farrington.
Hydrastis. When due to the extension of a gastro-
duodenal catarrh. *There is great debility; with sensa-
tion of sinking and prostration at the epigastrium. Stools
light colored; urine dark.
Iodine. Complexion yellow; or, soon changing to
brown. Region of liver sore to touch.
(C
Chronic jaundice not due to obstruction.”—Dr. J. H.
Clarke.
Mercurius. * The tongue is swollen, moist and shows
CATARRHAL JAUNDICE.
135
the imprint of the teeth. * Very offensive odor from the
mouth. *The skin is dirty, yellow. * Itching all over
body, worse at night, when warm in bed. Clay colored
stools. The region of the liver is very sore to touch.
"A specific remedy in a great number of cases."-Dr.
Laurie.
'Simple jaundice, from catarrh of the bile ducts.".
Dr. J. H. Clarke.
One of the most frequently indicated remedies, with
or without fever."-Dr. Raue.
(
Mercurius Dulc.-Nearly specific in cases that present
the general mercurius symptoms.
Myrica Cer. Despondency, dull heavy headache, worse
in the morning; the eyes and sclerotic have a dirty, dingy,
yellowish hue, the lids being abnormally red; the tongue
is coated a dirty yellow (Farrington).
Nitric Acid.—When in consequence of chronic derange-
ment of the liver (Raue).
Nux Vom. Sedentary habits. * Very irritable, de-
sires to be alone. Liver swollen, indurated, sensitive,
with pressure and stinging, cannot endure the pressure
of the clothes around the waist. Fainting spells. Con-
stipation, with frequent, ineffectual efforts.
Phosphorus. Jaundice complicating pneumonia; brain
disease; or, nervous excitement.
Podophyllum.-Complicating pneumonia, or highly
developed affections of the brain (Bachr). Hyperæmia
of the liver, with fullness, soreness and pain. Alternate
constipation and diarrhoea.
"Excellent in moderate attacks of jaundice without
fever, or in chronic jaundice not much interfering with
the general health."-Dr. Hempel.
Sepia. In chronic jaundice with frequent recurring
paroxysms (Baehr).
M
Sulphur.-Only in chronic cases, and then only, if
material changes exist in the structure of the liver
(Baehr).
136
DISEASES OF THE LIVER.
INTERSTITIAL HEPATITIS.
Synonyms. Sclerosis of the liver; cirrhosis of
the liver; hob-nailed liver; gin-drinkers' liver;
granular liver; gouty liver.
Definition.-A chronic inflammation of the
interstitial tissue of the liver, resulting in an
increase of connective tissue, with atrophy of the
secreting cells.
Etiology. Sometimes develops without as-
signable cause; but the abuse of alcoholic stimu-
lants and the continued use of exceedingly highly
seasoned foods are the most prolific causes of
interstitial hepatitis. Often found associated with
syphilis, gout, rheumatism, malaria and phthisis.
Chronic heart and lung diseases, which produce.
hyperæmia of the liver, if long continued, may
develop cirrhosis of the liver. Male sex and
middle life are predisposing causes.
Varieties. (1) Atrophic cirrhosis; (2) hyper-
trophic cirrhosis.
Pathology.-Atrophic Cirrhosis.-First stage :
Hyperæmia of the liver; with formation of a soft,
pulpy matter, which first appears in the portal
canals. This mass is composed of round cells,
which soon form new connective tissue. In this
stage the liver is enlarged, its surface smooth, and
the capsule thickened.
pg
Second stage: This new connective tissue
presses upon the portal capillaries and liver cells,
causing the cells to undergo fatty degeneration;
and the connective tissue contracting decreases
the size of the liver, the surface of which becomes
INTERSTITIAL HEPATITIS.
137
nodulated. The liver, in this stage, is small,
hard, irregular in outline, and pale in color.
Hypertrophic Cirrhosis is when the above
changes take place in an abnormally enlarged
liver. The term is also applied when the changes
start from the periphery of the capillary bile-
ducts.
Symptoms. The symptoms of the first stage
are those of congestion of the liver and gastro-
intestinal catarrh; with, perhaps, hemorrhages
from the stomach and bowels, and development
of piles. In the second stage there is progressive
emaciation; ascites appears; swelling of the
superficial veins of the abdomen, particularly
around the umbilicus, forming the "caput me-
dusæ.'' The skin is rough, has a muddy appear-
ance, and may, or may not, be jaundiced. The
spleen is usually enlarged.
Physical Diagnosis.-Inspection.—In the late
stage there will be a muddy appearence to the
skin; ascites; and enlarged abdominal veins.
Palpation. In the early stage the liver will be
smooth, or finely granular; while in the late stage
it will be uneven, granular, with firm, sharp
edges.
Percussion.—In the early stage there is in-
creased area of hepatic dullness; while in late
stage there is diminished area of hepatic dullness
and signs of ascites.
Differential Diagnosis.-Fatty Liver has not
the symptoms of dyspepsia; or, gastro-intestinal.
catarrh; nor has it the emaciation; or ascites.
Cancer of the Liver has the general cancerous
138
DISEASES OF THE LIVER.
cachexia; has no ascites; no enlargement of the
abdominal veins; and has marked tenderness over
the liver; and no enlargement of the spleen.
Duration.-Many years; but, after the dropsy
has once commenced, its duration is usually only
a couple of years.
Prognosis. In the first stage it can be cured;
but, after contraction of the liver has once begun
it is then a progressive disease.
Treatment.-Light, nutritious foods, a milk
diet is very beneficial; positively no alcoholic
stimulants. The first stage is treated the same as
hyperæmia of the liver; also, consult treatment
for dyspepsia.
REMEDIES.
Aurum.-Cirrhosis of the liver; ascites; stools gray.
*The patient is bent of suicide.
Carduus Mar.-"Tincture, four drops, four times a
day."
Hydrocotyle Asiat.-Cirrhosis of liver; hypertrophy
and induration of connective tissue; obstruction in the
whole hepatic region; slight pain in upper portion of
liver; crampy pains in stomach, without nausea (Lilien-
thal.).
Lycopodium.—In cases presenting the usual stomach
and bowel symptoms of this remedy.
(6
Ascites, from liver affections, particularly after abuse
of alcohol.”—Dr. Lilienthal.
Particularly adapted to the treatment of cirrhosis.'
Dr. Bachr.
Muriatic Acid.-In last stage. Typhoid condition.
Patient becomes drowsy. Great emaciation.
(
Useful in the last stage of dropsy from cirrhosis of the
liver."-Dr. Farrington.
>>
>>
Phosphorus.-Liver is hard, large, with subsequent
atrophy. * Vomiting, as soon as any food taken becomes
SUPPURATIVE HEPATITIS.
139
warm in the stomach.
Vomiting of blood; of sour
matter. *Weak, empty, or gone sensation felt in the
whole abdominal cavity. * Stools watery, pours away as
from a hydrant.
"
A true simile to the disease."-Dr. Hughes.
"Clearly indicated in two varieties of cirrhosis, i. e.,
atrophic and hypertrophic."—Dr. Jousset.
"
Chronic phosphorus poisoning produces an inter-
stitial hepatitis, with hypertrophy first, followed by an
atrophy of the liver and a granular aspect."-Dr.
Wagner.
SUPPURATIVE HEPATITIS.
Synonyms.-Abscess of the liver; parenchy-
matous hepatitis.
Definition. A suppurative inflammation of
the hepatic cells, resulting in the formation of one.
or more abscesses.
Etiology. The main cause is septic emboli
finding their way to the liver, through the portal
vein, from the ulcers of dysentery, typhlitis,
typhoid fever, or from ulcers of the stomach.
Pathology.-Hyperæmia of the liver, followed
by purulent inflammation. The hepatic cells
undergo softening, and degenerate into pus, form-
ing abscesses. These abscesses may be single or
multiple; may remain separate, or several may
unite forming a large abscess. The pus, if the
abscess is small, may be absorbed; or it may be
spontaneously evacuated through the bronchial
tubes, or through the intestines. When recovery
occurs there is a dense cicatrix at the site of the
abscess.
Symptoms. Very obscure; sometimes even
without local or constitutional symptoms to point
140
DISEASES OF THE LIVER.
to its existence (Loomis).
Generally manifested
by the usual symptoms of suppuration, together
with an enlarged and tender liver. Fluctuation
may be detected if the abscess is large.
Differential Diagnosis.-Hydatids of the liver
is a slow disease; with very little pain; none of
the symptoms of suppuration; but, it has upon
percussion a hydatid fremitus; and the aspirator
draws off fluid containing "hooklets."
Cancer of the liver shows a cancerous cachexia;
history of cancer; the liver is nodular; and there
is no hectic.
Duration.-From two weeks to as many
months.
Prognosis.-Pyæmic abscesses are generally
fatal. Abscesses from other causes may terminate
favorably. As a rule the prognosis is bad.
Treatment. Must observe the general hy-
gienic rules. The diet must be nutritious. As
soon as pus is detected, it must be drawn off by
means of the aspirator.
Remedies. Arsenicum; Belladonna; China;
Hepar; Kali carb.; Lachesis; Mercurius; Silicea;
Vipera tor.
Dr. Lippe recommends Theridion cur. for the
vertigo and nausea associated with abscess of the
liver.
ACUTE YELLOW ATROPHY.
Synonyms. Diffuse or general parenchyma-
tous hepatitis; malignant jaundice; icterus gravis.
Definition.—An acute, diffuse inflammation of
ACUTE YELLOW ATROPHY.
141
the liver substance, resulting in destruction of its
tissues.
Etiology. Its definite cause is not known.
Pregnancy, chronic alcoholism, syphilis, malaria,
grief, or excessive mental work, are predisposing
causes. It may be infectious.
Pathology.-Congestion, followed by diffuse
inflammation of the liver substance, which leads.
to a granular condition, and fatty degeneration,
with destruction of the liver cells. The liver is
reduced to two-thirds or one-half of its normal
size. The capsule becomes shrivelled. The
spleen is enlarged; the blood contains urea; and
the urine contains bile-pigments, leucin and
tyrosin.
Symptoms. The early symptoms are those of
gastro-intestinal catarrh, followed by the symp-
toms of catarrhal jaundice. Following the jaun-
dice, there are severe nervous symptoms, as head-
ache, delirium, or even convulsions. Hame-
temesis is common. The area of hepatic dullness
is diminished.
Differential Diagnosis.-Catarrhal jaundice
has not the severe nervous symptoms, the hæma-
temesis, nor the small liver.
Bilious remittent fever commences with a chill,
followed by fever and sweat; with regular remis-
sion of symptoms.
Duration.-Variable; but, after the appearance
of the jaundice, about a week.
Prognosis.-Recovery very doubtful.
Treatment.-Observe general hygienic and
dietetic rules. Treat symptoms as they arise.
142
DISEASES OF THE LIVER.
Consult chapters on jaundice, hæmetemesis and
dyspepsia.
REMEDIES.
Lachesis.- "Its action is perfectly homoeopathic to this
disease."-Dr. Jousset.
Phosphorus."The only promising remedy for this
disease."-Dr. Hughes.
The pathogenesis of Phosphorus is so similar to
malignant icterus that this disease has been taken for
Phosphorus poisoning."-Dr. Jousset.
Crotalus may be studied.
AMYLOID LIVER.
Synonyms.-Waxy liver; lardaceous liver;
albuminoid liver.
Definition. An amyloid degeneration of the
liver, causing great swelling of the organ.
Etiology. Always a secondary disease. Pro-
longed tuberculous ulceration, chronic bone dis-
ease, and syphilis, are the usual causes.
Pathology. The liver is uniformly enlarged;
is firm and resistant to touch. The degenerative
process begins in the walls of the capillaries, and
then spreads to the connective tissue. Upon
applying a dilute solution of Iodine to the cut
surface, the tissue changes to a beautiful ma-
hogany-red color, which shows the presence of
amyloid material.
Symptoms.-There are no characteristic symp-
toms. It is recognized by the slow and gradual
enlargement of the liver in all directions. The
liver is painless, and there is no jaundice.
Duration. -Months or years.
HEPATIC CANCER.
143
Prognosis. A progressive disease; although
when due to syphilis it may be cured.
Treatment.-Must be directed to the cause.
If due to syphilis, Nitric acid and Aurum will
help. If due to suppuration, or bone disease,
Calcarea carb. and Silicea will help.
HEPATIC CANCER.
Synonym.-Carcinoma hepatitis.
Etiology. Primary or secondary. Primary
cancers are due to hereditary predisposition.
Secondary cancers are due to the extension from
other organs. Traumatism, middle life, and male
sex, are predisposing causes.
Varieties. Medullary, or encephaloid; scir-
rhus: melanotic; colloid.
Pathology. The cancer development is gen-
erally nodular; but, may be diffused. The liver
is greatly enlarged, dark in color, and its surface
is nodulated; the nodules being umbilicated.
Symptoms.-The early symptoms are vague
and obscure. The diagnostic symptoms are: an
enlarged liver, which is nodulated, the nodules
being umbilicated; the great pain and tenderness
of the liver; the jaundice; and the cancerous
cachexia.
Differential Diagnosis.-Hydatids of the liver
cause no pain, nor tenderness, nor gastric disturb-
ances. The liver in hydatids is soft and smooth.
Abscess of the liver has symptoms of suppura-
tion; and the liver is not nodulated.
Duration.-One year.
Prognosis. The disease is incurable.
M
144
DISEASES OF THE LIVER.
Treatment.-Must be general.
Remedy.-Hydrastis is mentioned by several
authors, as a remedy to be tried.
HYDATIDS OF THE LIVER.
Synonyms.-Echinococcus of the liver.
Definition.-Are cysts due to the development
in the liver of the embryos of the tænia echeno-
coccus (Loomis).
Etiology. Due to the entrance into the stom-
ach or intestines, and then into the liver, by way
of the portal vein, of the tænia echenococcus.
The tænia echenococcus is a small tape worm
found in the intestines of the dog.
Symptoms.-Very vague. The liver is swollen,
soft and smooth; with little or no pain. Physi-
cal examination elicits the "hydatid fremitus,"
or thrill. The positive diagnosis is the with-
drawing from the cyst, by means of the aspirator,
of a fluid containing hooklets.
Duration.-From three to five years.
Prognosis. Must be guarded.
Treatment. Treat symptoms as they arise.
Should the tumor become very large, then surgi-
cal interference is indicated.
BILIARY CALCULI.
Synonyms. Hepatic calculi; cholelithiasis;
gall stones.
Definition. Concretions formed in the gall
bladder, or in the biliary ducts, and composed of
bile elements.
Etiology. Sedentary habits; diet of nitro-
BILIARY CALCULI.
145
genous or fatty foods; the female sex; middle
life; and any disease which obstructs the flow of
the bile; are predisposing causes.
Pathology. The number of gall stones in any
one case varies; the average being about fifty; in
size, they also vary from the size of a grain of
sand to the size of an egg. A gall stone has a
central nucleus made up of bile pigment, and on
section shows successive layers. Seventy-five per
cent. of a gall stone is cholesterin.
Symptoms. The passage of a calculus
through the duct gives rise to hepatic colic. The
attack may appear at any time. It consists of
severe pain in the region of the gall bladder,
shooting to the back and to the right shoulder.
There is nausea and vomiting. The expression
is anxious; the features are pinched; and often a
cold sweat breaks out. The pain is suddenly
relieved by the passage of the calculus into the
intestine. Jaundice usually follows the attack.
The stools are light in color. If the calculus
should become impacted, it will set up inflamma-
tion, ulceration, and, possibly, perforation of the
duct.
Differential Diagnosis.-Gastralgia usually
comes after eating; the pain is referred to the
epigastric region; and the stools are normal.
Intestinal colic has no vomiting, nor jaundice;
the pains are most severe in the umbilical region,
and are colicky in character; feces are normal.
Renal colic has pain along the course of the
ureters to the testicles. There is continual desire
II
146
DISEASES OF THE LIVER.
to urinate; the urine containing blood and gravel.
There is no jaundice.
Prognosis.
Good.
With proper treatment
the tendency to recurrence can be eradicated.
Treatment. For the colic: apply hot applica-
tions to the part; administer warm olive oil; and,
if necessary, give morphine, or an anesthetic.
During the interval insist upon daily outdoor
exercise. Restrict all nitrogenous and fatty foods;
give a prolonged course of alkaline mineral water;
and give China 3x, or higher.
REMEDIES.
During the colic is the most impor-
tant remedy."—Dr. Raue.
Berberis. To be tried when other remedies fail to
relieve.
Calcarea Carb.-Will relive the pain during the colic.
"It has never failed me."-Dr. Hughes.
China. With the proper diet, this remedy is almost
certain to eradicate the tendency to gall stones.
"I give usually China, 6x, six pills twice a day, till ten
doses are taken then six pills every other day, till ten
doses are taken; then every third day, till ten doses are
taken; and so on, till at length the dose is taken once a
month. I have not failed to cure, in a single instance,
permanently and radically, every patient, with gall stone
colic, who has taken the remedy as directed."-Dr. D.
Thayer.
Belladonna.
Ether. For the colic, put twelve drops of ether in one-
half a glass of water and give teaspoonful, every ten to
fifteen minutes (Allen).
DISEASES OF THE KIDNEYS.
URÆMIA.
Synonyms. — Uramic convulsions; uræmic
poisoning; uræmic coma.
Definition. The name applied to a group of
symptoms resulting from the retention of toxic
materials in the blood which should have been
eliminated by the kidneys (Stevens.).
Etiology. Any condition which suppresses
the renal secretion.
Symptoms.-Uræmia is developed slowly, or
suddenly. A decrease in the urinary secretion,
although just before a paroxysm the flow may be
normal, and slight oedema in various parts of the
body, generally precede an attack. There is nausea
and vomiting; severe headache; vertigo; drowsi-
ness; and possibly slight delirium; this is called
the gastro-intestinal form. But, if there should
be spasms, resembling epileptiform convulsions,
it is called the convulsive form, or uræmic convul-
sions. The delirium may give way to a gradually
advancing stupor, with, finally, a state of complete
insensibility, which is known as the cerebral form,
or uræmic coma.
There is a peculiar urinous odor about the
patient. The urine is either diminished, or
entirely suppressed; and contains albumen and
casts. The face is pale or waxy in appearance;
148
DISEASES OF THE KIDNEYS.
the pulse is rapid; the temperature is at first
raised, but soon becomes sub-normal.
Differential Dignosis. - Epilepsy.-Has a
history of epilepsy; an initial cry; there is no
œdema; and the urine is normal.
Apoplexy. Here the coma precedes the con-
vulsions; the urine is normal; there is no œdema·
the attack is followed by paralysis; and there is
not the peculiar urinous odor about the patient.
Prognosis. A very serious disease. Must
always be guarded.
Treatment.-If it occurs in childbed the labor
must be terminated at once. The bladder must
be emptied by use of the catheter. Restore the
action of the kidneys, if possible; place patient in
hot pack; produce free diaphoresis; and free
purgation. The former, by the use of one-eighth
of a grain of Pilocarpine, until free sweating.
occurs; the latter by the use of Croton oil. Dur-
ing the convulsion give Morphine hypodermically;
or, possibly, will have to administer an anæs-
thetic. Kreosote often helps the nausea and
vomiting. The diet, after an attack, must be,
for some time, liquid; preferably a milk diet.
Remedies. Ammonium carb,; Arsenicum;
Cantharis; Carbolic acid; Cuprum acet.; Hydro.
acid; Kreosotum; Plumbum.
RENAL HYPERÆMIA.
Synonyms. Congestion of the kidney; ca-
tarrhal nephritis.
Definition.-An increase in the amount of
blood in the kidneys.
RENAL HYPERÆMIA.
149
Varieties. Active, or acute; passive, or
chronic.
Etiology.-Active hyperemia is caused from
exposure of the body to atmospheric changes.
Traumatism. The use of certain drugs, as, Can-
tharides. Turpentine, Cubebs, Copaiba, etc.
Passive hyperæmia.—Organic diseases of the
heart, which interferes with the return venous
circulation. Chronic lung disease, as emphy-
sema, fibroid phthisis, etc. Pregnancy and ab-
dominal tumors.
Pathology. Active hyperemia is chiefly con-
fined to the renal arteries. The kidney is en-
larged, increased in weight and darker than
normal. The congestion may involve the whole,
or only a portion, of the kidney; but, it is usually
found at the base of the pyramids.
K
In passive hyperemia the veins are overcharged
with blood. The kidney is, as a rule, not swol-
len; but, it is firmer to touch than normal; and
its surface is smooth; but, if the congestion is
long continued its surface will become uneven.
Symptoms. Active hyperemia has pain over
the region of the kidney; constant desire to
urinate; the urine being scanty, high colored,
high specific gravity, and containing albumen
and casts.
Passive hyperemia is diagnosed by the presence
of albuminous, bloody urine, with dropsical
symptoms.
Prognosis. Good in the active form; in the
passive form the prognosis depends upon the
cause.
150
DISEASES OF THE KIDNEYS.
Treatment.--Active hyperæmia.—Confine the
patient to bed; hot applications to the region of
the kidney; give plenty of bland fluids to drink.
No solid food while the congestion is going on.
For the remedies consult those given for acute
nephritis.
Passive hyperæmia.-The treatment must be
directed against the primary disease.
ACUTE NEPHRITIS.
Synonyms.-Acute Bright's disease; acute
desquamative nephritis; acute tubal nephritis;
acute catarrhal nephritis; acute parenchymatous
nephritis.
Definition.-An acute inflammation of the
kidney, involving especially the uriniferous
tubules.
Etiology. Exposure to atmospheric changes.
Certain acute diseases, as scarlet fever, diph-
theria, smallpox, etc. The abuse of certain
drugs, as Cantharides, Copaiba, Turpentine, etc.
Pathology.--The kidneys are swollen, soft,
and of a red color. Their surfaces are smooth,
and have a mottled appearance. The capsule is
easily detached. Upon section there is seen red
points, corresponding to the situations of the
malpighian tufts, scattered over the kidney. The
tubules are filled with leucocytes and fibrin.
Symptoms. More or less fever, with dull
pain in the back, nausea and persistent vomiting,
usually ushers in an attack. The skin becomes
harsh and dry. Pain in the kidneys, extending
down the ureters. The urine is scant and high
ACUTE NEPHRITIS.
151
colored, with frequent desire to pass it. Dropsy,
appearing first in the face, but soon extending
over the body. Dyspnoea, and if the disease is
not checked, there will be delirium, coma and
convulsions due to the non-elimination of urea.
Microscopical Examination. The urine
affords the only positive signs of acute nephritis.
The urine is scant, high colored, and of a high
specific gravity; the urea is diminished. There
is albumen; epithelial, bloody, and, possibly, hya-
line casts; also, free epithelial cells and blood
discs.
Differential Diagnosis.-Diagnosis must be
based upon urinary examination.
Duration.-From one week to three months.
Prognosis. Recovery is the rule.
Treatment. Rest in bed. Liquid diet; milk
being the best diet. Encourage the drinking of
plenty of water. No stimulants. Hot applica-
tions may be applied over the kidneys. Keep
the skin active.
REMEDIES.
Aconite.- - Fever, with anxiety and restlessness. The
skin is dry. Nausea and vomiting. The renal region is
sensitive to touch, with shooting pains. Urination is
painful; scanty discharge.
"At the commencement is often a useful remedy."-
Dr. Marcy.
Apis.-Constant dull pain in the region of the kidneys,
particularly on pressure. Urine scant, painful and
bloody. The abdominal walls are very sore to touch,
with stinging pains. *Edematous swelling of the face
and limbs.
Arsenicum.-
.-* The skin is very dry, and emaciation is
152
DISEASES OF THE KIDNEYS.
marked. *There is extreme restlessness and anxiety.
The face is pale and waxy. Edema of the face. Fre-
quent desire to urinate. The urine is scanty, high col-
ored and albuminous; with blood discs and casts of the
uriniferous tubules.
Belladonna.-* Great arterial excitement. * Headache
and vomiting. Shooting pains in the kidneys, extending
to the bladder. * Pains appear and disappear suddenly.
* Urine scanty; blood red in color.
'This is the remedy in the beginning."-Dr. Jousset.
Cantharis.-Vomiting, with violent retching and severe
colic. Burning in the abdomen. * Cutting and burn-
ing in the urethra. Urine high colored, scanty, albu-
minous, and bloody; with casts and epithelial cells; con-
stant desire to urinate, but only a few drops pass at a
time.
(C
*
(C
This remedy causes an acute inflammation of the
kidney. Dr. Jousset.
Terebinthina. Pressure on the kidneys.
scanty, bloody, with coffee-ground sediment.
urine is albuminous; bloody, the blood is thoroughly
mixed with the urine.
* Urine
* The
CHRONIC BRIGHT'S DISEASE.
There are two varieties: (1) Parenchymatous
nephritis, which affects more particularly the
tubules of the kidneys, characterized by per-
sistent dropsy; (2) interstitial nephritis affecting
the connective tissue of the kidney, characterized
by changes in the blood vessels, hypertrophy of
the heart, and very seldom has dropsy. The
amyloid kidney is, by some, called a form of
Bright's disease, but it is in reality a degenera-
tion, depending upon suppuration, or other dis-
ease.
CHRONIC PARENCHYMATOUS NEPHRITIS. 153
CHRONIC PARENCHYMATOUS
NEPHRITIS.
Synonyms. Chronic
Chronic catarrhal nephritis;
chronic tubal nephritis; large white kidney;
chronic Bright's disease.
M
All Cata
Definition.-A chronic inflammation of the
kidneys; characterized by albuminuria and
dropsy.
Etiology. Its exact cause is not known; it
may follow an attack of acute nephritis. Male
sex, early adult life, alcoholism, syphilis, phthisis,
lead poisoning, and mercurialism are predispos-
ing causes.
Pathology. The kidney in the first stage
becomes greatly swollen, anæmic, and from a
yellow white to a pure white color, this is known
as the large white kidney. The capsule is thinned
and non-adherent. There is a slight increased
growth of connective tissue. The tubes are
dilated with cells and casts.
In the second stage, owing to contraction of the
connective tissue, the kidney becomes smaller,
and has a granular appearance.
The capsule is
now thickened and adherent.
small white kidney.
This is called the
Symptoms. The onset is slow. The patient.
has more or less dyspeptic symptoms, and in-
testinal disorders. There is continual and pro-
gressive loss of strength and flesh; the skin is
dry and harsh, and of a peculiar sallow appear-
ance. There is a persistent dropsy, appearing,
as a rule, first under the eyes, but soon becomes
154
DISEASES OF THE KIDNEYS.
general over the body.
Cardiac hypertrophy and
retinitis are common.
The disease has marked
remissions, sometimes for years; but, some
oedema, and traces of albumen in the urine, can
always be found.
The urine is, as a rule, diminished in quantity;
but, sometimes it is normal in both quantity and
color. It is albuminous; and contains hyaline,
granular, epithelial and fatty casts.
Differential Diagnosis.-With a careful ex-
amination of the urine, and the history of the
patient, no mistakes should be made.
Complications.-The retinitis and heart dis-
ease referred to above. Pneumonia; peritonitis;
and meningitis.
Duration.-Indefinite.
Prognosis. Doubtful. Although recoveries.
are said to have taken place.
Treatment.—Rest, both mentally and bodily,
must be insisted upon. The body must be kept
warm; it is wise to wear woollen underwear.
Frequent bathing is beneficial, The diet should
be non-nitrogenous; and, if possible, a milk diet;
buttermilk has proven useful in some cases; stim-
ulants must be restricted.
Remedies. Apis; Argentum nitr.; Arsenicum;
Cantharis; Digitalis; Helonias; Mercurius cor.;
Phosphorus; Terebinthina.
L
INTERSTITIAL NEPHRITIS.
Synonyms. Cirrhotic Bright's disease; scle-
rosis of the kidney; gouty kidney; contracted
INTERSTITIAL NEPHRITIS.
155
kidney; granular kidney; red, granular kidney;
small, red kidney.
Definition.
A chronic inflammation of the
kidneys, with an increased growth of connective
tissue, which contracts, reducing the size of the
kidney, and causing atrophy of its structures.
Etiology. A disease of middle life. Gout,
rheumatism, alcoholism and syphilis are its chief
causes.
Pathology. The kidneys are reduced in size,
red in color and granular in appearance. The
capsules are thickened, and adhere to the kidneys.
by bands of connective tissue, so that it is impos-
sible to dissect away the capsule without tearing
the kidney. Upon section, the kidneys are firm
and resistant. There is an overgrowth of con-
nective tissue, which contracts, and diminishes
the thickness of the cortical substance, in which
cysts are found. There is also an overgrowth of
connective tissue in the arteries throughout the
body, causing hypertrophy of the heart.
Symptoms. Its approach is very insidious
and slow; often eluding recognition. Progressive
loss of strength, anæmia, and various stomach
and intestinal troubles are complained of. There
is cardiac hypertrophy, with a pulse that has a
very high tension; palpitation; vertigo; and in-
somnia. Dropsy is not marked, and is often
absent. There may be total or partial blindness,
from albuminuric retinitis. White, glistening
spots or patches, with definite outlines, around.
the macula lutea are diagnostic of a contracted
kidney.
156
DISEASES OF THE KIDNEYS.
The urine is pale, yellow in color, increased in
quantity, and, of a low specific gravity. The
quantity of albumen in the urine varies; indeed,
it frequently disappears for the time being. The
microscope reveals hyaline and a few granular
casts in the urine.
Differential Diagnosis.-Distinguished from
the other forms of kidney affections by the in-
creased quantity of urine, which is of a pale color,
and of a low specific gravity; the variable amount
of albumen, and the presence of hyaline casts;
with cardiac hypertrophy, and a high tension
pulse.
Complications.-Heart disease; albuminuric
retinitis; apoplexy; uræmia; pneumonia; bron-
chitis.
Duration. An incurable disease; but, with
careful attention, life may be prolonged for years.
Prognosis. As far as a cure goes, bad; but
life may be enjoyed for an indefinite time.
Treatment.-The treatment is the same as for
chronic parenchymatous nephritis.
Plumbum met. is the remedy for
Remedies.
this form of Bright's disease.
"Iodium, and especially Iodide of Sodium,
have, in my hands and those of many other phy-
sicians, produced a veritable and durable amelio-
ration, not only of the symptoms of artero-scle-
rosis, but also of those of interstitial nephritis."—
Dr. Jousset.
Wa
AMYLOID KIDNEY.
157
AMYLOID KIDNEY.
Synonyms.--Waxy kidney; lardaceous kidney.
Definition. A chronic amyloid degeneration
of the kidneys, whereby their tissues become infil-
trated with amyloid material.
Etiology. The main causes are: Prolonged
suppuration, particularly of the bones; phthisis;
syphilis; and cancer.
Pathology.-Amyloid changes in the kindeys.
are always associated with like changes in other
organs. The changes begin in the arteries, but
go to the tubes and the cells of the kidneys.
The kidneys are swollen, pale in color, and soft
to touch. A solution of Iodine coming in contact
with amyloid material will cause it to turn a
mahogany color.
Symptoms.-The first symptoms are very
vague; but, somewhat resemble those found in
parenchymatous nephritis. Dropsy is not a
prominent symptom. The liver and spleen are
greatly enlarged.
The urine is increased in quantity, light in
color, and has a low specific gravity. Albumen.
is found in large quantities; there are hyaline,
fatty, and fine granular casts.
Differential Diagnosis.-The character of the
urine with the previous history of chronic suppu-
ration, tuberculosis, or syphilis, and the enlarge-
ment of the liver and spleen, will render diagnosis
easy.
Prognosis.
longed for a considerable time.
Treatment.—Must be based upon the cause.
Incurable; but life may be pro-
158
DISEASES OF THE KIDNEYS.
+
PYELITIS.
Synonyms.-Pyonephrosis; pyelonephritis.
Definition.-An acute or chronic catarrhal in-
flammation of the mucous membrane of the pelvis
of the kidney.
Etiology Rarely an idiopathic disease. The
presence of a stone in the kidney, causing me-
chanical irritation, is a very frequent cause. From
some infectious disease, as typhoid fever, diph-
theria, scarlet fever, etc.
The extension of an
inflammation from the bladder through the
ureters. Tumors pressing upon the ureters may
prevent the passage of the urine, which decom-
poses, sets up pyelitis.
Pathology.-Hyperæmia followed by inflam-
mation of the mucous membrane of the pelvis of
the kidney, which becomes red, swollen, and
covered with a secretion of mucous and pus; there
may be extravasations of blood. If the inflam-
mation becomes chronic, it will cause a suppura-
tive inflammation which is known as pyelonephritis;
or, the discharge may accumulate in the pelvis of
the kidney causing dilatation, this is called pro-
nephrosis.
Symptoms.-Rigors; fever; severe pain in the
back; possibly soreness on pressure over the
affected kidney; and, a constant desire to pass
urine, with pain; are the symptoms that accom-
panies the commencement of pyelitis.
The urine is acid; mixed with blood, mucous
and epithelial cells; and contains traces of albu-
men.
HYDRONEPHROSIS.
159
Differential Diagnosis.-Cystitis has pain.
more particularly over the bladder; the urine is
alkaline; and contains but little pus.
In perinephritic abscess, the urine is normal.
Prognosis. Must be guarded.
Treatment.-Absolute rest in bed. Hot appli-
cations to the affected part. Drink quantities of
water, particularly the alkaline mineral waters.
The diet must be liquid; milk diet being the best.
The cause must be removed, if possible.
REMEDIES.
Consult those given for Nephritis.
Cantharis.
Indicated both by pathogenesy and clini-
cal experience."-Dr. Jousset.
Mercurius Cor." Has a decided curative influence
when given in small doses."—Dr. Hale.
Uva Ursi.The most effective remedy." Dr.
Hughes.
HYDRONEPHROSIS.
Definition. A non-inflammatory affection of
the pelvis of the kidney, causing its dilatation.
Etiology. Any disease, or condition, which
obstructs the free passage of the urine from the
kidney.
Symptoms. In slight cases, or, where only
one kidney is affected, there are seldom symptoms
to denote its presence. In advanced cases, a
tumor will be found in the region of the affected
kidney. This tumor is soft to the touch, yields
a dull percussion note, and, if the aspirator is
used, we will obtain a clear fluid.
Treatment.-Must be symptomatic. If the
tumor becomes very large, must aspirate.
160
DISEASES OF THE KIDNEYS.
RENAL CALCULUS.
Synonyms-Nephrolithiasis; renal gravel.
Definition.—A concretion found in the kidney,
formed by the precipitation of certain ingredients
of the urine.
Etiology. Very obscure. Hereditary plays
an important part. Oftener found in males than
in females.
Varieties. (1) Uric acid is the variety found
most frequently; it is hard, smooth, and red in
color; found particularly in those of a gouty
diathesis.
(2) Oxalate of lime, or mulberry calculus, is
hard, rough in outline and dark in color.
(3) Urates, found in children.
(4) Phosphatic calculi are soft, and have a
chalky appearance.
(5) Xanthine.
(6) Cystine.
(7) Mixed.
Symptoms. The presence of a calculus in the
kidney often gives rise to no symptoms, except,
perhaps, a dull pain in the lumbar region of the
side affected; which pain may extend down the
ureter to the testicle in the male, or, to the labia
in the female.
When the calculus passes down the ureter, it
causes violent spasmodic pains; the paroxysm is
called renal colic.
Renal colic comes suddenly, with severe pain in
the back, which follows the course of the ureters;
extending into the penis, testicle, or, in the female,
RENAL CALCULUS.
161
into the labia. There is tenesmus of the bladder;
constant urging to urinate; and, possibly, retrac-
tion of the testicle on the affected side. With
these symptoms the face becomes pale, the feat-
ures pinched, the pulse weak, and a cold sweat
breaks out. There is sometimes fainting. After
an indefinite time, the pain suddenly ceases, be-
cause the stone has passed into the bladder.
Duration. The colic lasts from a few minutes
to several hours.
Prognosis. The prognosis is good, if no com-
plications arises. If the stone should become
impacted a very grave condition will supervene.
Treatment. During the interval we must treat
the symptoms as they arise; and, put the patient
under proper hygienic surroundings and dietetic
rules.
The attack. - Apply hot applications to the
loins; hot hip bath; let him drink plenty of
water; and, if remedies fail to relieve the pains,
give Morphine by subcutaneous injection. Pass-
ing a sound into the bladder is claimed to succeed
in relieving the pain when the most heroic meas-
ures have failed.
Remedies. Arnica; Arsenicum; Belladonna;
Berberis; Cantharis; Dioscorea; Lycopodium;
Nux vom.; Opium; Pareira brava; Piper;
Tabacum.
î
Berberis tinct., will relieve the colic in a
majority of cases.
12
162
DISEASES OF THE KIDNEYS.
HÆMATURIA.
Synonym. Blood in the urine.
Definition.
blood.
Etiology.
Inflammation of the kidneys, ure-
ters, bladder or urethra. Vicarious menstrua-
tion. Traumatism. Any general blood disease.
Prognosis. Depends upon the cause.
Treatment. Rest in bed. Liquid diet; drink
plenty of water. When a large blood clot has
formed in the bladder it may be dissolved by
pepsin, or by peroxide of hydrogen; or, better
still, as Dr. Keyes says: "Let it alone; no harm
can come of it. It will dissolve and come away."
The passage of urine containing
K
Arsenicum. Urine scanty, passed with difficulty, burn-
ing during the discharge. Urine dark brown; turbid;
mixed with pus and blood.
REMEDIES.
"An efficient remedy, both in the acute and chronic
forms. The general symptoms should indicate and sanc-
tion its emp.oyment."-Dr. Baehr.
From the abuse of Cantharides.
Camphor.
Cantharis.
*
Excessive burning distress in the urethra,
with constant desire to urinate. *The urine is high
colored, bloody, and albuminous. Painful evacuation,
by drops, of bloody urine, and, at times, of pure blood.
"It inay be had recourse to in almost all cases where
we are uncertain as to the exciting cause of the dis-
order."-Dr. Laurie.
Hamamelis. - *From passive congestion of the kidneys;
dull pain in renal region. * Great amount of prostration.
"Of real value in many cases."-Dr. Hale.
"An excellent drug for hæmaturia."-Dr. Farrington.
Ipecacuanha. When there is continued nausea; op-
pressed breathing; and, cutting in the abdomen.
CYSTITIS.
163
Lycopodium.—* When associated with gravel or chronic
catarrh of the bladder. *Cutting pains in the bladder.
"Only adapted to the chronic form when existing in
decrepit individuals, in connection with chronic catarrhal
affections of the urinary organs."-Dr. Baehr.
Mezereum.* Preceded by crampy pain in the bladder.
"Can be used when the pains are trifling and the blood
rarely or never coagulated."—Dr. Berjeau.
Millefolium. Urine bloody; blood forms a cake in the
vessel. Pain in region of left kidney, then bloody urine.
"Has shown great excellence as a specific remedy in
hæmaturia, with painfulness of the kidneys.”—Dr.
Backr.
Nitric Acid.-* For active hæmaturia. * Urging after,
with shuddering along the spine during, urination.
Terebinthina.*The blood is intimately mixed with
the urine, which has a dirty brown, red, or even a black-
ish color (Baehr). Urine bloody, with coffee-ground
sediment.
*
CYSTITIS.
Synonyms, Catarrh of the bladder; inflam-
mation of the bladder.
Definition.An inflammation of the mucous
membrane of the urinary bladder; it may be acute
or chronic in its course; or may be catarrhal,
croupous or diphtheritic in character.
Etiology. Nearly always a secondary disease,
idiopathic cystitis being a rare disease.
The acute form may result from irritation of a
foreign body in the bladder; the retention of
urine, which decomposes, sets up severe attacks;
the extension of an urethritis to the bladder; or,
the extension of a pyelitis to the bladder; often
secondary to certain diseases, as scarlet fever,
diphtheria, gout, rheumatism, etc.; as a compli-
164
DISEASES OF THE KIDNEYS.
cation to certain nervous diseases, particularly
myelitis; and, possibly, traumatism.
The chronic form is generally a sequelæ to an
But gout, Bright's disease, etc.,
acute attack.
may cause it.
Pathology. There is hyperæmia of the parts,
with redness and swelling; the membrane is cov-
ered with desquamated epithelium and leucocytes;
and, sometimes there is rupture of the capillaries.
The inflammation here, whether catarrhal, croup-
ous, or diphtheritic, is the same as found in any
mucous membrane.
In chronic cystitis the membrane is livid, with a
thick coat of mucus, or muco-pus. The muscular
coat of the bladder becomes hypertrophied,
Symptoms. Acute cystitis is announced by
rigors; rise of temperature; severe pain in the
bladder; frequent and painful urination; the urine
being voided drop by drop, followed by severe
straining. The urine is mixed with mucus, pus,
and possibly blood; is alkaline in reaction; and,
sometimes fetid.
Chronic cystitis has very little acute pain; but,
has a constant dull pain in the bladder; with con-
tinued desire to urinate; the urine contains viscid
mucus, or muco-pus.
Duration. — Acute cystitis lasts five or six
days; while chronic cystitis may last for years.
Prognosis.—Acute cystitis is generally cura-
ble; the prognosis of chronic cystitis must always
be based upon the cause; after hypertrophy of the
bladder has taken place, it is incurable.
Treatment.-Acute form: Absolute rest in
CYSTITIS.
165
bed. Hot applications over the region of the
bladder. Keep the bowels open. No stimulants,
or highly seasoned food; milk diet is the best.
Drink large quantities of soft water.
Chronic form: The bladder must be emptied at
least four times a day. Wash out the bladder
with tepid water; or, with a solution of Hydras-
tis. Drink alkaline mineral waters.
REMEDIES.
Aconite.- -* When cystitis sets in with fever; restless-
ness; and anxiety. Sensitiveness of the renal region.
Frequent desire to urinate; the urine being suppressed or
retained; micturition painful, the urine passed drop by
drop. Pressure in the bladder; stitches in the region of
the kidneys.
"Often removes the whole trouble in a very short
time."-Dr. Jahr.
"In rheumatic cystitis, is the true specific remedy.".
Dr. Hempel.
Arsenicum.—When the disease runs a rapid course,
with threatening symptoms; more particularly in chronic
cystitis. * When the extraordinary ischuria gives rise to
violent distension of the bladder, and threatens paralysis.
Belladonna. *Fever, with flushed face, and throbbing
carotids. The region of the bladder is very sensitive to
the least pressure or jar. *Frequent desire to urinate;
the urine is hot and red; constant dribbling of the urine.
*Sensation of a worm in the bladder.
*
Camphor. If from the use of Cantharides; Turpen-
tine; or, Copaiba.
Cannabis. If from gonorrhoea. Symptoms are simi-
lar to those of Cantharis except not so intense. To be
given if Chantharis has afforded no relief within twenty-
four hours (Kruessler).
* Vio-
Cantharis - Bladder very sensitive; with severe burn-
ing pains. * Soreness of the bladder on motion.
lent pains in the bladder, with frequent urging to urinate;
166
DISEASES OF THE KIDNEYS.
intolerable tenesmus.
Constant desire to urinate, with
pains so severe that they make the patient scream aloud.
*The urine is scanty, voided by drops, high colored, and
often bloody.
"Its greatest remedy."-Dr. Hughes.
"The most important remedy against the acute form."
-Dr. Baehr.
"Indicated in acute cystitis more frequently than all
other remedies put together."-Dr. Farrington.
Chimaphila.—* Dysuria. *Frequent urination at night.
* Urine high colored, containing a copious, ropy, mucous
sediment; sometimes fetid.
"The best remedy in the chronic form."-Dr. Ruddock.
"No medicine has been so serviceable for me in cases.
remarkable for the great amount of muco-purulent dis-
charge, and the absence of pain, as Chimaphila.”—Dr.
Hale.
Conium. -* Causes chronic cystitis, with intermittent
urination. The urine flows and stops (Farrington).
Dulcamara.—* Chronic form; especially when caused
from a cold, or from dampness. Constant desire to uri-
nate felt deep in the abdomen. Painful pressing about
the bladder and urethra. *Urine very offensive, and dis-
charged by drops; containing mucus sediment.
"
Has a specific influence on the lining membrane of
the bladder, causing catarrh of that organ.”—Dr. Far-
rington.
Hyoscyamus.
*When the attack is sporadic, rather
than inflammatory.
Mercurius. * Region of the bladder sore to the touch;
urine passes in a thin stream, or in drops; and contains
blood and pus.
Nux Vom.-For the pains or difficulties which remain
after the removal of the inflammation (Jahr).
Pareira Brava.-Violent pains in the bladder and penis.
Constant urging to urinate; can only urinate by getting
upon the knees.
Pulsatilla. Pressure on the bladder, as if the bladder
were too full, causing continued desire to urinate.
CYSTITIS.
167
* Region of the bladder is externally hot and red; the
patient complains of pressure; and a cutting and urging
in this region (Jahr). *Cannot retain the urine. Sedi-
ment reddish, bloody or mucous; jelly-like, sticking to
the vessel.
""
'A first-class remedy in cystitis."—Dr. Farrington.
Sulphur.-Obstinate cases; tendency to relapse. Urine
fetid; with greasy looking pellicle on it. Deposits a
thick, tough mucous, which sticks to the bottom of the
vessel.
Uva Ursi." Indicated when there is a great inertia of
the bladder, and it fails to expel all the mucus.-Dr.
Hale.
:
DISEASES OF THE BLOOD.
ANÆMIA.
Definition.
A condition of the blood in which
the amount, as a whole, is diminished; or, when
the number of the red corpuscles, or, one or more
of the blood constituents, especially albumen and
hæmoglobin, are diminished; this condition may
be general or local.
Varieties. (1) Symptomatic or secondary
anæmia; (2) primary, essential or cytogenic
anæmia.
SYMPTOMATIC ANÆMIA.
Etiology. May be congenital; or, from inani-
tion, due to the improper assimilation of the food;
or, from some cause which interferes with proper
reception of the food; loss of vital fluids; certain
organic diseases which drain the albuminous.
elements of the blood, as Bright's disease, phthi-
sis, etc.; toxic anæmia, due to certain poisons
acting on the blood, as lead, arsenic and mercury;
or, the poison of syphilis, malaria, or prolonged
use of quinine, etc.
Pathology. The blood is brighter in color,
and more fluid than normal. There is a defi-
ciency in the blood of red corpuscles and hæmo-
globin. The tissues throughout the body are.
SYMPTOMATIC ANÆMIA.
169
bloodless; and, in some cases, show signs of fatty
degeneration.
Symptoms.-General loss of strength and
flesh; the complexion is pale and waxy; the
mucous membranes have a pale bloodless appear-
ance. The appetite fails; the respiration is hur-
ried; the pulse is full and soft; there is palpita-
tion of the heart, with anæmic murmurs; and
sometimes dropsy, which usually commences in
the feet. There is also headache, vertigo, and
possibly fainting.
Prognosis.—Must be based upon the cause.
Treatment.-The cause must be found, and
removed, if possible. Good hygienic surround-
ings, and nutritious diet, must be prescribed.
REMEDIES.
Arsenicum.. -* Great weakness and emaciation; clay
colored face; blue margins around the eyes. * Weakness
of all the limbs. * Complete indisposition, desire to rest
all the time. * Wants to be in a warm room.
China.-Acute cases. * From loss of vital fluids. * *Ring-
ing in the ears; tendency to faint.
Ferrum. Very weak and much debilitated.
* The face
and lips are pale. The face flushes upon the least ex-
ertion or emotion. Palpitation of the heart; bellow sound
of the heart; anæmic murmurs of the blood vessels.
proved by walking slowly.
* Im-
"The treatment an anæmia by iron is one of the few
satisfactory and certain things in modern medicine.”
Dr. Hughes.
(
Anæmia under the mask of plethora and congestion,
accompanied by a whitish color of the mucous mem-
branes."-Dr. Goullon.
Natrum Mur.-* Very sad, weeping; consolation aggra-
vates; with palpitation and intermittent pulse. Sallow
170
DISEASES OF THE BLOOD.
\
complexion. Nettle rash, after every exertion. Emacia-
tion; and weariness, easliy fatigued; complete physical
and mental prostration.
Picric Acid. "With marked indisposition to bodily or
mental exertion, and great increase of urates and phos-
phates in the urine."-Dr. J. H. Clarke.
Phosphoric Acid.-* Nervous debility. * Complete in-
difference to everything.
"The great sphere of Phos. acid is in debility of the
nerves of animal life, from seminal loss, profuse per-
spiration, leucorrhoea, or excessive grief."-Dr. Burt.
PRIMARY ANÆMIA.
Definition. An idiopathic anæmia.
Varieties. (1) Chlorosis; (2) pernicious.
anæmia.
Magdal
CHLOROSIS.
Synonym.-Green sickness.
Definition. A form of primary anæmia, gen-
erally occurring in females at the age of puberty,
characterized by the relative decrease of hæmo-
globin.
Etiology. Obscure; is claimed by some to be
a neurosis.
Pathology.-Same as anæmia.
Symptoms. The disease comes on very grad-
ual, with the usual symptoms of anæmia. There
is, however, very little emaciation. The skin
becomes yellowish or greenish; the face is swollen;
and the mucous membranes are pale. Palpitation;
dyspnoea; and a dry cough are common symp-
toms. There is nearly always some uterine
troubles, or menstrual irregularities. The patient
is nervous, melancholy, and irritable. The blood
CHLOROSIS.
171
is paler than normal; and there is diminution of
hæmoglobin, and red corpuscles in the blood.
Differential Diagnosis.-Anæmia has emacia-
tion; pale skin; and has no cough or dyspnœa;
while chlorosis has no emaciation; a greenish
skin; and, has cough and dyspnoea.
Complications -Phthisis; heart disease; ulcer
of the stomach; amenorrhoea.
Duration.-Variable.
Prognosis. Favorable; but must be guarded.
Treatment.-Regulate the habits, and diet of
the patient; give plenty of outdoor exercise;
occupy the mind in light and pleasant work.
REMEDIES.
Aconite. If complicated with tuberculosis; such
patients are apt to have a dark, sallow complexion some-
times with a greenish tint and deep flushes on the cheeks;
they are troubled with palpitation; dyspnoea; and stitch-
ing pains in the chest (Hempel).
Arsenicum.-Excessive anxiety and restlessness. Ex-
treme prostration. Periodical headache. * Dyspnoea, as
if the air passages were constricted. Menses suppressed.
Leucorrhoea acrid, corrosive, thick yellow, excoriating
the parts.
Belladonna. Frequent paroxysms of headache in the
fore part of the head; the headache is accompanied by
bright flushes on the cheeks, deep sparkling looks; heat
in the head; such patients are apt to be of a lymphatic
disposition and passive turn of mind (Hempel).
Calcarea Carb.-"In cases of chlorosis which date back
from the time of childhood, and are, to a certain extent,
the continuation of the scrofulous symptoms of earlier
years. This form is most common in girls twelve to six-
teen years, at the commencement of the period of devel-
opment, of leuco-phlegmatic habit, with tendency to
obesity, disposed to chronic catarrh and diarrhoea, with
M
172
DISEASES OF THE BLOOD.
great weakness of the spine and tendency to curvature."
-Dr. Muller.
"Of the most striking benefit in chlorosis.”—Dr.
Laurie.
Cuprum." After abuse of Iron; worse in hot weather."
-Dr. Farrington.
Ferrum.-Patient very weak and very much debili-
tated. * Face and lipe pale, ashy, or greenish; upon the
least emotion or exertion the face becomes red and
flushed. Vertigo. Ringing in the ears; palpitation of
the heart and dyspnoea. Better from walking slowly
about, notwithstanding weakness obliges the patient to
lie down. Great chilliness. Amenorrhoea.
*
"A real specific for simple, uncomplicated chlorosis."
-Dr. Baehr,
Graphites.-Congestion of the head; with roaring in
the ears; dark red flushing of the face; oppression at the
chest; and feeling of anxiety when in recumbent posture.
Menses too late, pale and scanty. Constipation. Ten-
dency to obesity.
Natrum Mur.-In old and inveterate cases; great ema-
ciation; easily fatigued; complete mental and physical
prostration. The skin is dirty-colored, dry, withered and
inactive. Irregular action of the heart; pulse intermit-
tent; and oppression of the chest. Very sad and de-
pressed. Menses too late and scanty. Morning head-
aches. Obstinate constipation.
Pulsatilla.—In those with blue eyes; very affectionate;
easily excited to tears; with fitful moods; of a very yield-
ing disposition; lymphatic constitution; roundness of form,
and inclined to quiet grief (Burt.). Constant chilliness;
hands and feet cold. Strong desire for open air. Palpi-
tation of the heart. Menses too late, scanty, and of short
duration; or with milky leucorrhoea.
"The law of similarity would be false if this remedy
did not in many cases effect a cure or alleviation of the
disease."-Dr. Muller.
"If no special indications prevail, I commence the
treatment with Puls."-Dr. Jahr.
PROGRESSIVE PERNICIOUS ANÆMIA.
173
Sepia.-Countenance pale; face dirty yellow, with
dark-colored spots. * Severe headache, which is apt to
come on in terrific shocks. Pains in the uterus; bearing
down, comes from back to abdomen; causes oppression
of breathing; crosses the limbs to prevent the protrusion
of the parts. Peculiar faint sinking at the pit of the
stomach, not painful to pressure. Menses too late and
too scanty; suppressed; amenorrhoea. Leucorrhoea, yel-
low or greenish water; much itching in the genital
organs; stitches in neck of womb. Constipation, stool
insufficient, retarded, like sheep-dung; unsuccessful urg-
ing to stool, only wind and mucus passed; sensation of
lump or weight in the rectum, not relieved by evacuation.
May be regarded as an excellent remedy for the
paroxysms of hemicrania, which constitute a source of
distress to chlorotic females with brown hair and lively
temperaments."-Dr. Baehr.
""
Sulphur. Heat on the top of the head, palms of the
hands, and soles of the feet. Constipation; unsatisfactory
and scant stool. Menses too late and of too short dura-
tion, too scanty or suppressed; with constipation and
nightly restlessness. Leucorrhoea.
Valeriana. When complicated with hysteria, or with
excessive nervousness.
PROGRESSIVE PERNICIOUS ANÆMIA.
Synonyms.-Idiopathic anæmia; anæmia of
fatty heart; progressive anæmia; pernicious.
anæmia.
Definition. A progressive form of anæmia,
with no discoverable cause.
Pathology. The blood is pale and scant; with
very little tendency toward coagulation. The
relative number of red corpuscles in the blood are
diminished; while the number of white corpuscles
show no change, and the hæmoglobin is rela-
tively increased. The red corpuscles show quite
174
DISEASES OF THE BLOOD.
a difference in their shape and size; some being
large and possibly nucleated; others are small;
and some are irregular in outline. There are
fatty changes in the organs throughout the body;
and sometimes spots of ecchymosis.
Symptoms.-Pernicions anæmia has an insidi-
ous onset, with the general symptoms of anæmia,
except there is no emaciation. The complexion
becomes lemon yellow or straw colored; there is
dyspnoea; and, gastro-intestinal symptoms. The
whole disease tends downward, and no treatment
seems to cause a stay in its downward course.
Differential Diagnosis. Simple anæmia, has
great emaciation, and yields to treatment; but,
an examination of the blood will decide.
Chlorosis is generally found in girls at puberty;
the skin has a greenish tint; while pernicious
anæmia cases have a lemon-yellow color.
Leucocythemia has enlargement of the spleen
and lymphatic glands.
In all cases an examination of the blood will
give the deciding signs.
Duration.
From a couple of months to as
many years.
Prognosis. A downward disease; recovery
rarely occurs.
Treatment. Place patient under proper hy-
gienic and dietetic rules; and treat the symptoms
as they arise.
KAT
Arsenic, pushed to its physiological limit, is
being greatly extolled by the other school of
medicine.
Remedies. Consult anæmia.
LEUCOCYTHÆMIA.
175
LEUCOCYTHÆMIA.
Synonym.-Leucemia.
Definition.-That form of anæmia character-
ized by an excess of white corpuscles in the
blood, and enlargement of the spleen and lym-
phatic glands, and certain changes in the bone-
marrow.
Varieties
(1) Splenic leucemia, when the
spleen is greatly enlarged from the hyperplasia.
(2) Lymphatic leucemia, when the lymphatic
glands are enlarged from
from the hyperplasia.
(3) Myelogenic leucemia, when the medulla of
the bones are involved.
M
Etiology. The real cause is unknown; early
adult life, male sex, and hereditary, are predis-
posing causes.
Pathology. The number of white corpuscles
in the blood are greatly increased; the blood is
pale in color; its specific gravity and coagulability
are diminished. The spleen is enlarged and
firm; the lymphatic glands are swollen, but soft;
and, in the myelogenic form there is certain
changes in the bone-marrow.
P
Symptoms. The symptoms of the onset are
identical with those of anæmia, plus the enlarge-
ment of the spleen or lymphatic glands, or tender-
ness of the bones, especially the ribs and sternum.
The patient has a pale, waxy appearance.
a microscopic examination of the blood will de-
cide the diagnosis.
But,
Differential Diagnosis.-The diagnosis must
be based upon microscopical examination of the
blood.
176
DISEASES OF THE BLOOD.
Duration.-From one to three years.
Prognosis. Incurable; but the disease may
be stayed for a time.
Treatment. Must be general. See treatment
for anæmia.
Remedies. Arsenic is given by the old school
with apparent result.
Natrum sulph. and Thuja are recommended by
Grauvogl.
PSEUDO-LEUCÆMIA.
Pseudo-leucocythæmia; Hodg-
Synonyms.
kin's disease; malignant lymphona; lymphatic
anæmia; lymphadenosis.
Definition. That form of anæmia character-
ized by progressive enlargement of the lymphatic
glands throughout the body, without an increase
of the white corpuscles of the blood.
Etiology. The direct cause is unknown; but,
youth and the male sex are predisposing causes.
Pathology. Increased growth of the lymph
glands throughout the body. The spleen and
liver are hypertrophied; the marrow of the long
bones may be converted into a rich lymphoid
tissue (Osler).
▬▬▬▬▬▬▬▬▬▬
Symptoms. The same as simple anæmia,
with swelling of the lymphatic glands; the swell-
ing usually commencing with the glands of the
neck, arm-pit or groin. The blood shows only
the changes of simple anæmia.
Duration.-About one year.
Prognosis. It is a fatal disease.
Treatment.—If the infected glands are small,
ADDISON'S DISEASE.
177
Arsenic is said to have a decided
remove them.
influence on this disease.
Consult treatment of anæmia.
ADDISON'S DISEASE.
Synonyms. Melasma supra-renalis; "the
bronzed skin disease."
Definition. A constitutional disease charac-
terized by degenerative changes in the supra-
renal capsules, or semi-lunar ganglia, accompa-
nied by pigmentation of the skin.
Etiology. Unknown; there is said to be some
connection between Addison's disease and tuber-
culosis.
.
Pathology. The nature of the destructive
process of the supra-renal capsules is tubercular.
Changes are also found in the semi-lunar ganglia
and branches of the sympathetic nerve; and the
peculiar pigmentation of the skin.
Symptoms. Similar to those of a mild attack
of anæmia; except, there is seldom emaciation;
with this there is the characteristic bronzing of
the skin and mucous membranes.
Duration.-About two years.
Prognosis. Unfavorable.
Treatment.-Must be symptomatic.
SCURVY.
-
Synonym. Scorbutus.
Definition.--A form of malnutrition due to a
deficiency of vegetables in the diet, characterized
by debility, spongy gums, and hemorrhagic ten-
dency.
13
178
DISEASES OF THE BLOOD.
Etiology.-Occurs when fresh vegetables are
withheld from the diet.
Pathology. The exact nature is unknown.
Symptoms.--Those of anæmia; the gums soon
become swollen, spongy, and bleed; the teeth
loosen; and there is decided fetor to the breath.
Ecchymosed spots cover the body; and hemor-
rhages are common.
Prognosis.
Good.
Treatment. Confine patient to the bed; room
to be freely ventilated. Give the juice of several
lemons daily; let diet be varied; give fresh vege-
tables.
Remedies. Mercurius and Carbo veg. are the
main remedies.
HÆMOPHILLA.
Synonyms.-Hemorrhagic diathesis; Bleed-
er's disease.
Definition.-An hereditary disease character-
ized by a tendency to immoderate bleeding.
Hereditary.
Etiology.
Pathology.-Unknown.
Symptoms. The characteristic symptom is
the free and excessive bleeding after slight in-
juries, or spontaneous bleeding from the nose,
mouth, etc. There is swelling of the joints,
probably due to blood extravasation within the
joint.
Prognosis. Unfavorable; although life may
be prolonged.
Treatment. For the hemorrhage use the reg-
ular surgical means.
PURPURA HEMORRHAGICA.
179
Remedies. Phosphorus is the main remedy.
Compare: Arsenicum; China; Crocus; Erig-
eron; Lachesis; Natrum sulph.; Secale.
PURPURA HEMORRHAGICA.
Synonyms. Morbus maculosus; morbus mac-
ulosus Werlhofii.
Definition. A general disease characterized
by extravasation of blood into the skin.
Pathology.
Etiology. Its origin is obscure; but, female
sex and early adult life are predisposing causes.
The extravasations of blood are
due to either changes in the walls of the blood-
vessels, due to vaso-motor disturbances; or, to
changes in the blood itself; or, both; the exact
changes are unknown.
Symptoms. The disease is announced by a
general feeling of malaise. Soon there is devel-
oped a crop of hemorrhagic spots over the body,
but, chiefly upon the extremities and trunk.
These spots vary in size and color; their color do
not change upon pressure; they do not itch; nor
do they desquamate, or suppurate.
Prognosis.
Good.
Treatment.-Give patient plenty of fresh air;
diet to be nutritious.
Remedies. Aconite; Arnica; Arsenicum;
Baryta carb.; Bryonia; Crotalis; Ferrum phos.;
Hamamelis; Lachesis; Ledum; Mercurius; Phos-
phorus; Rhus; Secale; Sulphuric acid.
DISEASES OF
OF CIRCULATORY SYSTEM.
Diseases of the Pericardium.
PERICARDITIS.
Definition.-An inflammation of the pericar-
dium; which may be primary or secondary; cir-
cumscribed or diffused.
Etiology. Rarely idiopathic. From exposure
to atmospheric changes; injuries to the chest
wall; extension of an inflammation from neigh-
boring organs; secondary to certain diseases due
to blood changes, as rheumatism, scarlet fever,
smallpox, typhoid fever, or Bright's disease.
Pathology.-Hyperæmia and inflammation of
the membrane, which becomes red, swollen,
loses its glistening appearance and is roughened
from an exudate of fibrin; should the disease
be here checked it is called dry pericarditis. But,
should the inflammatory process continue there is
formed an abundant exudate of a sero-fibrinous,
fibrinous, or purulent nature; this is called peri-
carditis with effusion. The exudate, in favorable
cases, becomes absorbed; or, the fibrinous exu-
date may organize and form adhesive bands;
binding the pericardial surfaces together; and,
the surfaces are thickened by layers of lymph;
this is called adhesive pericarditis.
PERICARDITIS.
181
Symptoms. Idiopathic pericarditis begins
with a chill, fever, nausea and perhaps vomiting;
and præcordial pain. When it develops as a
secondary disease there are no marked symptoms
to denote its onset. Moderate fever, pain and
tenderness in the præcordial region, dry cough,
dyspnoea and palpitation, will, when appearing
during the course of another disease, call atten-
tion to the heart. If the exudate is purulent
there are symptoms of hectic fever with the above
symptoms.
Physical Signs.-Inspection.-First stage, or
dry pericarditis, negative.
Second stage, or pericarditis with effusion.
Bulging of the præcordia; diminished respiratory
murmur over the præcordial space; heart's im-
pulse feeble and displaced.
Adhesive Pericarditis.-Increased area of car-
diac impulse; systolic retraction of the apex re-
gion; and Friedreich's sign-diastolic collapse of
the jugular vein.
Palpation.-First stage: Sometimes a friction
fremitus.
Second stage: Confirms the result of inspection.
The apex beat is feeble, or lost; it is raised, and
pushed to the left.
Percussion.-First stage: Normal.
Second stage: Increased area of dullness; the
amount of increase depending upon the quantity
of fluid.
Auscultation.—First stage: Pericardial friction
sounds, which are characteristic of dry peri-
carditis.
182
DISEASES OF CIRCULATORY SYSTEM.
Second stage: The heart's sounds are feeble,
muffled, and distant. The friction sounds heard
in the first stage may disappear.
Differential Diagnosis.-Acute endocarditis
has no friction sounds, but has a blowing murmur
which is widely diffused, and the heart's impulse
is strong.
Cardiac enlargement has no friction sounds; the
area of dullness is increased, but does not extend
beyond the apex beat; and the sounds are dis-
tinct.
Acute pleurisy has severe acute pain, aggra-
vated by movement; and friction sounds which
disappear upon holding the breath.
Complications.-Edema of the lungs; car-
diac hypertrophy, or dilatation.
Duration. Several days to three weeks.
Prognosis. Good; except, when complicated
with Bright's disease, or with septic fevers.
Treatment.-Absolute rest in bed. Hot ap-
plications to the seat of pain. When effusion has
formed apply blisters to the præcordia; and, para-
centesis of the pericardium when the effusion is
so great as to interfere with the function of other
organs; or, when the effusion is purulent. Diet
to be liquid and nutritious. No stimulants, un-
less especially called for by urgent symptoms.
REMEDIES.
Aconite.- -For the first stage; or, until the effusion
sets in. *When it begins with fever; pulse full, hard
and strong; or, weak, quick, like a thread. * Palpitation
of the heart. Stitching pains and anxiety about the
præcordia. Oppression about the heart. * Great anxi-
*
PERICARDITIS.
183
ety; tosses about; knows he is going to die; frequent
sighing and taking a deep breath. Tendency to faint.
Cannot lie on the right side.
C
'Indicated in the first stage of the disease, or until
the exudative process is completed."-Dr. Hale.
46
The remedy for the beginning."—Dr. Jousset.
"Will always be the principal remedy."-Dr. Kreuss-
ler.
"In true inflammation of the heart (carditis, peri-
carditis) Acon. 30th, as usual in a watery solution, gen-
erally accomplishes everything that can be desired.
Dr. Jahr.
>>
In every pericarditis and endocarditis, whether pri-
mary or secondary, Aconite is the first and most import-
ant remedy, whenever the inflammation sets in with
febrile phenomena.”—Dr. Bachr.
"
Arsenicum.—* From repelled measles, scarlet fever,
anæmia, or pyæmia. * Pericardial effusion. * Excessive
and great prostration; pulse is rapid, weak, small, can
hardly be counted. *Palpitation of the heart, cannot lie
down; dyspnea; fainting spells. *Anguish, with toss-
ing about.
Burning pains. *Thirst.
"Its place is when the action of Aconite and Cactus
terminate, and when the dyspnoea, weak and irregular
pulse, with considerable diminution of the arterial ten-
sion indicate a state of great gravity."-Dr. Jousset.
Belladonna.-*Face flushed; pupils dilated. Pressure
on the cardiac region, which arrests the breathing, and
causes a sense of anxiety. Gurgling at the heart.
* Vio-
lent palpitation of the heart, reverberating through the
head. * Violent throbbing of the carotids and temporal
arteries. Pulse full, hard and tense.
*
*
Bryonia. -* Complicated with rheumatism, pneumonia,
or pleurisy. When the exudate is fibrinous. Oppres-
sion in the region of the heart. *Cramp and stitching
pains in the region of the heart, aggravated from the
least motion. * Patient wants to lie perfectly still.
* The
heart beats violently and rapidly. *The pulse is full,
hard and tense; at times intermittent.
184
DISEASES OF CIRCULATORY SYSTEM.
"The pathological picture developed by the superin-
vention of pericarditis during pneumonia or pleurisy,
generally corresponds very fully with the pathogenesis
of Bryonia."-Dr. Bachr.
Cactus Grand.—* Sensation of constriction in the heart,
as if an iron band prevents its normal movements. * Prick-
ing pains impeding breathing, and movement of the body
oppression; cannot lie on the left side. The face is blue.
* Great dyspnoea. * Very irregular action of the heart;
pulse quick, hard and tense.
Digitalis.-Sub-acute cases. * Onset gradual; no par-
ticular local pain. *When there is a copious effusion of
serum. * Violent and increasing dyspnœa.
* Bluish ap-
pearance of the face.
Very faint, empty feeling at the
pit of the stomaclı, feels as if dying. Violent, but not
very rapid beating of the heart; pulse small, irregular,
slow; becoming accelerated, full and hard from every
motion. * Pulse intermitting the third, fifth or seventh
beat. * Sensation as if the heart would stop beating if
one moved. * Edema of the feet and legs.
'An excellent remedy."-Dr. Baehr.
Iodium.—* To remove the exudation.
oppressive pain in the region of the heart.
pitation, worse from the least exertion.
the heart were squeezed together.
((
accelerated.
Constant heavy,
Violent pal-
Sensation as if
Pulse large, hard and
"Deserves attention where all that remains to be done
is to remove the exudation."-Dr. Baehr.
(C
It removes the plastic and serous exudation; I prefer
the Iodide of potassa."-Dr. Hale.
Lachesis. * Aggravation after sleep.
Palpitation.
* Must
* Can bear no pressure on the throat or chest.
set up, or lie on the right side. *Numbness of the left
arm. Fainting. Constrictive sensation about the heart.
Naja.—*
-*After the inflammation has been subdued, to
help to restore the heart to its normal state.
Nitrum." If it sets in in company with active pul-
monary congestion, or as a symptom of Bright's disease,
or associated with acute rheumatism."-Dr Baehr.
HYDROPERICARDIUM.
185
Spigelia.—* Rheumatic pericarditis. * Violent palpita-
tion of the heart, so violent that the walls of the chest
are raised. * Waving, or trembling palpitation; not
synchronous with the pulse; purring over the heart;
trembling of the carotids. Anxiety. *Stitches about the
heart. Oppression of the chest. * Dyspnoea; can only
lie on the right side, trunk raised; the least motion pro-
duces great suffocation; with anxiety. *Tendency to
syncope.
Has the highest reputation."-Dr. Hughes.
"Adapted to rheumatic pericarditis, likewise to sero-
plastic pericarditis, during its whole course, especially if
the patient complains of an intense local pain, and the
affection is evidently characterized by all the signs of
cardiac inflammation."-Dr. Baehr.
"
*C
Sulphur. No remedy is better able than Sulphur to
effect the reabsorption of an exudation that had already
existed for a time."-Dr. Baehr.
"You may give Sulphur with great confidence where
there is plastic exudation, if the inflammation seems to
linger.”—Dr. Hale.
Veratrum Alb.- Symptoms of collapse. Oppression
about the heart, with dyspnoea, and anguish. Violent
action of the heart. * Cold sweat on the forehead.
HYDROPERICARDIUM.
Synonym.-Dropsy of the pericardium.
Definition.
A sero-albuminous effusion into
the pericardial sac, non-inflammatory in character,
and when absorbed leaves no trace behind it
(Loomis).
Etiology.-A symptom of general dropsy.
From chronic renal or cardiac disease.
Symptoms and physical signs are the same as
those which characterize the stage of effusion in
pericarditis.
186
DISEASES OF CIRCULATORY SYSTEM.
Treatment. Must be guided by the cause.
Consult Pericarditis.
HÆMOPERICARDIUM.
Definition.-Blood in the pericardial sac.
Etiology. Traumatism; wounds of the heart;
rupture of an aneurism.
Symptoms. Same as hydropericardium. But,
death follows so quickly from heart failure, due
to compression, that there are no special symptoms
developed.
Treatment.-No special treatment.
PNEUMOPERICARDIUM.
Definition.-Air in the pericardial sac.
Etiology. Perforating wounds of the thorax;
M
or, rupture from the lung.
Symptoms.-Percussion, will give tympany
over the præcordia.
Treatment.-No special treatment.
Diseases of the Heart.
ENDOCARDITIS.
Synonym. Valvulitis.
Definition.-An inflammation of the endo-
cardium, or lining membrane of the heart, gen-
erally confined to the valves.
Etiology. Rarely idiopathic. Generally a
complication of rheumatism, specific fevers,
Bright's disease, etc
ACUTE MYOCARDITIS.
187
Varieties. (I) Acute, or exudate endocardi-
tis; (II) ulcerative, or malignant endocarditis;
(III) chronic, or interstitial endocarditis.
Pathology. The disease in the adult is gen-
erally confined to the left side of the heart; while
in fœtal life it confines itself to the right heart.
In the acute form there is hyperæmia, and exuda-
tion of lymph and serum, causing swelling of the
valves, which become red, lustreless, and rough-
ened from a growth of vegetations. In the ulcer-
ative form the inflammation goes on to ulceration,
causing softening of the tissues, and forms ulcers
and abscesses. In the interstitial form the valves
become thickened and hardened from the over-
growth of fibrous tissue.
Symptoms. Characteristic subjective symp-
toms are wanting; the only positive signs are
those furnished by auscultation, i. e., murmurs
over the various cardiac orifices, and a prolonga-
tion of the heart sound.
Differential Diagnosis.-Must be based upon
physical examination.
Prognosis.-Good, as far as life is concerned,
except the ulcerative form which is generally
fatal; but always results in more or less damage
to the valves.
Treatment.-See Pericarditis.
gja
———----———་
ACUTE MYOCARDITIS
J
Synonym.-Carditis.
Definition.—An acute inflammation of the
heart muscle.
Etiology. An extension of the inflammation
188
DISEASES OF CIRCULATORY SYSTEM.
of an endocarditis, or a pericarditis to the heart
muscle. May be due to rheumatism, Bright's
disease, or, to any of the causes of pericarditis.
Pathology. The muscle substance is at first
dark, but soon changes to a grayish color. The
muscle is soft, and swollen from an infiltration of
serum; and may break down into a fine granular
mass; and, abscesses may form. Microscopical
examination will reveal a fatty degeneration of
the fibres of the muscle, and an infiltration of the
connective tissue with leucocytes. The walls of
the heart thus become weakened, and aneurisms
may form.
Symptoms.-There are no characteristic symp-
toms, or physical signs, of myocarditis. The
symptoms are all negative rather than positive.
A rapid, small, compressible and irregular pulse,
coming on suddenly in any disease where myo-
carditis may develop, will lead one to believe of
the existence of inflammation of the heart mus-
cle. There is also severe dyspnœa, pain and dis-
tress about the heart.
Duration. From a few hours to several days.
Treatment.—Same as in pericarditis.
CHRONIC MYOCARDITIS.
Synonyms.-Fibroid heart; chronic inter-
stitial myocarditis; cardio-sclerosis.
Definition.—An increased growth of fibroid
tissue in the heart.
Etiology. Caused, in the majority of cases,
from sclerosis of the coronary arteries. Rheuma-
CARDIAC HYPERTROPHY.
189
tism, gout, syphilis, alcoholism, and diseases of
the kidneys are predisposing causes.
Pathology.
The process involves more fre-
quently the walls of the ventricle. The heart is
enlarged or dilated. The new tissue is dense,
firm, and of a grayish-white color.
Symptoms. No special symptoms.
Treatment.-No special treatment.
CARDIAC HYPERTROPHY.
Definition.—Increased growth of the muscular
tissue of the heart.
Etiology. Excessive muscular exertion; over-
work of the heart, as in regurgitant valvular dis-
eases, or stenosis of the valves; or, from obstruc-
tion to the systemic circulation, as in emphysema,
Bright's disease, etc.; excessive use of tobacco,
coffee, tea, or stimulants.
Varieties.(I) Simple hypertrophy. Increas-
ed thickness of the muscles, the cavities remain-
ing normal; (II) Eccentric hypertrophy (hyper-
trophy with dilatation). Increased thickness of
the muscles, the capacity of the cavities also in-
creased; (III) Concentric hypertrophy. Increased
thickness of the muscles, the capacity of the cavi-
ties being diminished; this form is rare.
Pathology. The weight of the heart is greatly
increased; the muscles are firm, deep red in color,
and resistant. The hypertrophy may involve
both sides of the heart, but usually affects only
the left side.
Symptoms.
Increased and forcible heart
action; the arteries containing an increased
190
DISEASES OF CIRCULATORY SYSTEM.
amount of blood, while the veins have not
enough. The pulse is full, hard and bounding.
The face flushes easily; the eyes are prominent;
and the carotids visibly pulsate. There may be
headache, vertigo and a dry cough.
Physical Diagnosis.—Inspection.—Increased
area of cardiac impulse; bulging of the præcar-
dium.
Palpation.-Impulse heaving, lifting.
Percussion.-Area of cardiac dullness increased.
Ausculation.-The cardiac sounds are muffled,
prolonged and loud.
Differential Diagnosis.-In cardiac dilatation
the pulse will be weak and feeble; the apex beat
will be indistinct; and, the face pale.
Sequelæ.-Dilatation of the heart; apoplexy;
fatty heart.
Prognosis.-Depends upon the existing valvu-
lar lesion; or, upon other cause.
Treatment. Remove cause, if possible. Reg-
ulate diet and habits of the patient; let him do
no violent exercise, or fatiguing work. The diet
must be simple, and free from spices, coffee, tea
and liquors. The patient should lead a quiet life,
free from emotions.
Medical treatment must be directed to the
cause.
DILATATION OF THE HEART.
Definition.-An increase in the size of the
heart due to dilation of its walls.
Etiology. The causes are: increased pressure
FATTY INFILTRATION OF HEART.
191
within the cavities; and weaken resistance, from
weakness of the muscular walls.
Varieties. (I) Simple dilatation. The cavi-
ties enlarged, the walls normal; (II) Hypertrophic
dilatation. The cavities enlarge, and the walls
increased in thickness; (III) Atrophic dilatation.
The cavities enlarged, the walls decreased in
thickness.
Pathology. The process usually involves the
right side of the heart; but, may involve both
sides; and is, as a rule, associated with hyper-
trophy. The heart, from the hypertrophy, is
heavier than normal; its muscles are pale and
soft.
Physical Diagnosis.-Inspection.—Increased
area of cardiac impulse.
Palpation.-Weak cardiac impulse.
Percussion.-Area of cardiac dullness increased.
Auscultation.-Heart sounds are feeble; the
sounds are of nearly the same length, it being
hard to distinguish them.
Prognosis.
Bad.
Treatment.-See treatment for hypertrophy
of the heart.
FATTY INFILTRATION OF THE
HEART.
This is simply a part of general obesity; and
consist of an abnormal accumulation of sub-peri-
cardial fat; and often seriously interferes with the
action of the heart.
The treatment is practically an "anti-fat "
treatment; the same as for general obesity.
192 DISEASES OF CIRCULATORY SYSTEM.
FATTY HEART.
Synonym. — Fatty degeneration of the heart.
Definition. A fatty degeneration of the heart
muscle.
Etiology.
Anything that interferes with the
nutrition of the heart; obstruction of the coronary
arteries from any cause; old age; Bright's dis-
ease; alcoholism; cancer; phthisis; phosphorus
poisoning.
Pathology.
The muscle-fibres are infiltrated
with fat granules; and, the muscle becomes soft,
pale in color, and easily torn. In marked cases
a few drops of oil may be squeezed from the
muscles.
Symptoms. Are those of heart failure. Its
onset is very gradual; the patient easily fatigues
from the slightest exertion, which causes severe
dyspnoea, palpitation and a smothered feeling
about the heart. The patient is irritable; feels
depressed; suffers from vertigo; and, various
pulmonary and gastro-intestinal symptoms. The
Cheyne-Stokes breathing," which is a sort of
sighing breathing, and the arcus senilis are present
in advanced cases. The pulse is feeble, rapid
and irregular. Attacks of fainting are dangerous
signs in the disease. Death is, as a rule, sudden.
Physical Diagnosis.-Not characteristic. The
apex beat is not marked; and the first sound will
be almost inaudible.
Prognosis.-Bad; death may occur at any
time from the slightest exertion.
Treatment.-Must be general; and, the same
AORTIC INSUFFICIENCY.
193
as for fatty accumulation in other portions of the
body.
Arsenicum, and more particularly Phosphorus,
are the main remedies.
Chronic Valvular Diseases.
AORTIC INSUFFICIENCY.
Synonym.-Aortic regurgitation.
Definition. Inability of the aortic valves to
prevent a return of the blood to the ventricle.
Etiology.-Endocarditis; constant muscular
strain, as in athletes, hence often called the
"athletic heart;" and alcoholic excesses. More
common in males than females.
ܙ
Pathology. The valves may be torn, or per-
forated from ulceration; the segments are hard,
and shrunken. The blood regurgitates into the
left ventricle, which, together with the regular
supply of blood from the left auricle, overfills the
ventricle, resulting, after a time, in dilating it,
and finally hypertrophy results; the heart may
enlarge considerably; and, has been called the
"ox heart.”
Magy
Symptoms.-Pulse.-There is violent and visi-
ble pulsation of the vessels of the head, neck and
upper extremities, with the "Corrigan pulse,"
water-hammer pulse, or, collapsing pulse, i. e.,
full, forcible impulse, which quickly declines.
Physical Signs.-Inspection.-Increased area
14
194
DISEASES OF CIRCULATORY SYSTEM.
and force of the apex beat; and, the visible pul-
sation of the arteries as noted above.
Palpation.-Strong cardiac impulse; displace-
ment of the apex beat downward, and toward the
left.
Percussion.-Area of dullness increased, espe-
cially toward the left.
Auscultation.-Diastolic murmur, with greatest
intensity at sternal end of the right second inter-
costal space; it is transmitted downward and
toward the apex.
Sequelæ. Hypertrophy of the heart; mitral
insufficiency.
Complication.-Angina pectoris.
Prognosis.-Good, as long as compensatory
hypertrophy lasts; death is usually sudden.
Treatment.-Regulate patient's habits; no
heavy work; nor, heavy meals; and no stimu-
lants.
Remedies.-Aconite; Aurum; Baryta carb.;
Belladonna; Cactus; Convallaria; Iodine; Lache-
sis; Laurocerasus; Spigelia; Zincum.
AORTIC STENOSIS
Synonym.-Aortic obstruction.
Definition. As its name implies, is an ob-
struction, from thickening of the aortic valve, to
the passage of blood into the aorta from the left
ventricle.
Etiology.-Rheumatic endocarditis is its chief
cause. Male sex and adult life are predisposing
causes.
Pathology. The valves may have vegetations
MITRAL INSUFFICIENCY.
195
on them which obstruct the orifice. Or, the
valve may, from inflammation, become swollen,
hard and rigid; or, the segments may adhere,
thus narrowing the orifice, and obstructing the
free passage of blood.
Physical Examination. Inspection. In-
creased area of cardiac impulse.
Palpation.-Apex beat is strong, has a lifting
sensation, and is displaced downward, and to the
left.
Percussion. -Increased area of cardiac dullness,
especially to the left.
Auscultation.-Systolic murmur, with greatest
intensity at sternal end of second right costal car-
tilage; murmur transmitted to the great vessels.
Sequelæ.-Dilatation of the left ventricle;
mitral insufficiency.
Prognosis.-Good, as long as compensation
lasts.
Treatment.—Must be general.
Remedies.-Aconite; Antimonium tart.; Ar-
senicum; Cactus; Nux vom.; Phosphorus; Ve-
ratrum alb.
MITRAL INSUFFICIENCY
Synonym.-Mitral regurgitation.
Definition.-An inability of the mitral valves
to perfectly close the mitral orifice.
Etiology. Rheumatic endocarditis is its most
frequent cause.
Pathology. The segments are, from inflam-
matory action, contracted and narrow, and possi-
bly shortened; or, the dilation of the left ven-
196
DISEASES OF CIRCULATORY SYSTEM.
tricle may be so great as to interfere with the
proper closure of the valves.
Signs.-Inspection.-Increased area
Physical
of cardiac impulse.
Palpation. The apex beat is displaced down-
ward, and to the left.
Percussion.-Increased area of cardiac dullness.
Auscultation.-Systolic murmur, with its great-
est intensity at the apex, and transmitted to the
left axilla, and to the inferior angle of the
scapular.
Sequelæ.-Dilatation of the auricle; hyper-
trophy of right ventricle; hypertrophy of the
liver; dropsy.
Prognosis.-Good, so long as compensation
Treatment.-No special treatment.
lasts.
MITRAL STENOSIS.
Synonym.-Mitral obstruction.
Definition.-That condition of the mitral
valves which obstructs the flow of blood through
the mitral orifice.
Etiology.-Rheumatism is the most frequent
cause.
Pathology.-Rheumatic endocarditis usually
leaves the valves thick and hard; or, the valves
may be glued together at their margins, or have
vegetations on them; thus obstructing the free
passage of blood through the orifice.
Physical Diagnosis. - Inspection. - Feeble
cardiac impulse.
Palpation.-Rough, purring thrill.
TRICUSPID INSUFFICIENCY.
197
Percussion.-The cardiac dullness is increased
upward.
Auscultation.—A harsh, churning, presystolic
murmur, with greatest intensity a little above
apex.
Sequelæ. Thinning of the walls of the left
ventricle; dilation, followed by hypertrophy of
left auricle; hypertrophy of the right ventricle;
pulmonary congestion.
Prognosis. Good, as far as life is concerned.
Treatment.-Must be based upon cause; and
treat the complications as they arise.
TRICUSPID INSUFFICIENCY, OR TRI-
CUSPID REGURGITATION.
When the tricuspid valves fail, from any cause,
to perfectly close the tricuspid orifice. As a rule,
is secondary to mitral troubles; and from dilata-
tion of the right ventricle.
<
TRICUSPID STENOSIS, OR TRICUSPID
OBSTRUCTION.
When the tricuspid valves, from any cause,
obstructs the passage of blood through the tri-
cuspid orifice. This disease is very rare; and
never occurs except when there is mitral obstruc-
tion.
PULMONARY INSUFFICIENCY, OR
PULMONARY REGURGITATION.
Very rare, its occurrence is doubted by some,
and usually congenital.
198
DISEASES OF CIRCULATORY SYSTEM.
PULMONARY STENOSIS, OR PUL-
MONARY OBSTRUCTION.
Also a rare lesion; and always congenital.
Neuroses of the Heart.
cure.
PALPITATION.
Synonym.-Irritable heart.
Etiology.-Excitement; mental emotion; dys-
pepsia; heart disease; uterine disease; abuse of
condiments, tea, coffee, tobacco, or alcohol; hys-
teria.
Differential Diagnosis.-In palpitation of the
heart there are none of the physical signs which
denote the other diseases of the heart.
Prognosis.-Good; the remedies generally
Treatment. Must remove cause; let patient
be kept quiet; correct diet; and treat the patient,
as palpitation of the heart is usually simply a
symptom.
Remedies.
Aconite; Argentum nit.; Arseni-
cum; Aurum; Baryta mur.; Belladonna; Cal-
carea; Causticum; China; Coffea; Cuprum; Ig-
natia; Iod.; Kali carb.; Kalmia; Lachesis;
Lycopodium; Mercurius; Natrum mur.; Nitric
acid; Phosphorus; Pulsatilla; Rhus; Sepia; Spi-
gelia; Spongia; Sulphur; Thuja; Veratrum.
TACHYCARDIA, OR SLOW HEART.
199
TACHYCARDIA, OR RAPID HEART.
This is a rapid, paroxysmal action of the heart;
with no pathological lesions.
BRADYCARDIA, OR SLOW HEART.
A slowness in the action of the heart; often as-
sociated with heart disease; disease of the coro-
nary arteries; and, in those convalescence from
acute diseases.
ARRHYTHMIA, OR IRREGULAR
HEART.
An irregularity in the pulsations of the heart.
Usually merely a symptom.
ANGINA PECTORIS.
Synonyms.-Neuralgia of the heart; steno-
cardia; "breast-pang."
Definition.—A paroxysmal disease, charac-
terized by severe pain in the heart, extending
into the upper extremities.
Etiology. A disease of adult life; and occurs.
more especially in the male sex. Heredity may
play a part in its cause. Diseases of the heart,
especially fatty heart, and those diseases which
offer resistance to the coronary circulation;
arterio-sclerosis; alcoholism; abuse of tobacco;
syphilis; Bright's disease; rheumatism; and gout;
are predisposing causes.
Pathology. There are no characteristic le-
sions; various valvular lesions, and fatty heart
may occur.
Symptoms. May come on at any time, but
200
DISEASES OF CIRCULATORY SYSTEM.
usually at night, or after some bodily exertion, or
mental emotion. The attack is sudden, with
severe agonizing pain in the præcordium, a sen-
sation of constriction, as from an iron hand; the
pain radiates to the shoulder, and down the arm;
accompanied with numbness and tingling. The
pulse is, as a rule, almost normal. The attack
lasts several seconds, after which the patient may
feel quite well. In the height of a paroxysm the
patient may faint, and die from syncope.
Prognosis. Life may be prolonged, but sooner
or later the patient dies from the disease.
Treatment. During the interval between the
paroxysms regulate the patient's mode of life and
diet; let him lead a quiet life free from bodily
strain, and mental worry; his diet must be light
and nutritious; no stimulants, or highly seasoned
food, no tobacco.
During the attack, if time permits, place patient.
in horizontal position; admit plenty of fresh air;
apply hot applications to the præcordia, and heat
to the extremities; let him inhale a few drops of
Nitrite of Amyl; and if no relief is obtained in a
few moments, then, administer Chloroform;
stimulants must be given.
REMEDIES.
Aconite. Suffocative constriction of chest, so distress-
ing that he sweats from agony; pain in the heart, going
in all directions, goes down left arm; followed by tin-
gling and numbness. *The pulse is full and tense.
*Anxiety, and fear of death, knows he is going to die.
'Recent cases attended with great anxiety and shoot-
ing, and particularly in plethoric persons, Aconite is evi-
dently the remedy."-Dr. Small.
(6
ANGINA PECTORIS.
201
Actea Race."When the pains radiate all over the
chest and are associated with cerebral congestion and
unconsciousness. The face is livid and the art feels as
if bound tightly to the body."-Dr. Farrington.
Arsenicum. The remedy to be given during the inter-
val to eradicate the disposition. The attacks appear
periodically. * Attacks, with extreme anguish, restless-
ness, tossing about. *Fear of death, useless to take
medicine, knows he is going to die. *The pain radiates
from the heart, all over the chest, and down the arın.
*There is great suffering, he holds his breath for relief;
cold sweat breaks out over his face. * Must lean forward
in order to breathe; the least motion takes away his
breath. *The pulse is weak and irregular.
(
Not only the actual paroxysms, but the disease, gen-
erally finds in Arsenicum its appropriate remedy, pro-
vided the disorder is not complicated with structural
changes of the heart and the large arteries, or other
extensive disorganizations.”—Dr. Hartman.
"
Belladonna. —As a palliative in acute cases; particularly
when complicated with organic heart disease.
Cactus Grand. —Pricking pains impeding breathing and
movements of the body. *Sensation of constriction in
the heart, as if an iron band prevented its normal move-
ments. *Pains in the apex of the heart shooting down
the left arm to the ends of the fingers. Dyspnoea; op-
pressed breathing. * Irregularity of the heart's action,
at times frequent, at others slow; great irritation of the
cardiac nerves; enlarged left ventricle. Pulse quick,
throbbing, tense and hard. *Cries, knows not why, con-
solation aggravates. *Fears he has some organic heart
disease, and that it will prove fatal.
Takes the front rank as a homoeopathic remedy in
angina pectoris.”—Dr. Hale.
Cuprum. Sudden attacks, with cold face, blue lips,
and general coldness.
Digitalis. Chronic cases, particularly those occurring
in old people. The attacks occur frequently and sud-
denly; each attack seeming harder than the preceding
202
DISEASES OF CIRCULATORY SYSTEM.
one.
* Deadly anguish and oppression of the heart;
great fear and anxiety; sensation as if the heart would
stop beating if he moved. *Tendency to faint. The
pain extends to the head and arm. The pulse is slow,
irregular, and intermittent.
Gelsemium.-"For angina pectoris depending upon
fatty degeneration of the heart, Gelsem, and Bell. are
good palliatives."-Dr. Hempel.
Glonoine." Not only a valuable palliative in angina,
but is of great value during the interval. I refer to its
physiological action. The dose should be sufficient to
give a soft, full pulse, without causing disagreeable
headache."-Dr. Hale.
Hydrocyanic Acid.-Should be studied; is valuable in
recent cases; with fainting spells.
*
Lachesis. Worse after sleep; seems to sleep into an
attack. * Palpitation, can bear no pressure on throat or
chest; must sit up or lie on the right side; numbness of
the left arm, fainting, anxiety.
Rhus Tox.-Caused by straining the heart; or, from
rheumatic endocarditis. *Sticking pain in the heart,
with soreness; numbness and lameness of the left arın.
*
Spigelia. - Great oppression and anxiety. Organic
heart disease. * Severe stitching, stabbing pains in the
heart, worse on every motion. * Purring feeling over
the heart. * Palpitation so severe that it lifts the walls
of the chest; can only lie on the right side, with the
trunk raised. *Suffocative spells on least motion.
*Tendency to syncope.
The principal remedy."-Dr. Jousset.
Tabacum.-* Death-like paleness of the face, with sick
stomach, features pinched. *Sudden præcordial anxiety.
*Palpitation in attacks at night; tightness across chest.
*Icy coldness of the legs, from knees to toes.
Veratrum Alb. Suffocative constriction of chest, so
distressing that he sweats from agony. General prostra-
tion.
* Cramps in the limbs.
"
*
ARTERIO SCLEROSIS.
203
Disease.
ARTERIO SCLEROSIS.
Synonyms.-Atheroma; Gull and Sutton's
Definition. An overgrowth of connective
tissue of the arteries, causing them to become
thickened and friable.
Etiology.-A disease of advanced life; and
found chiefly in the male sex. Alcoholism,
gout, rheumatism, Bright's disease, and syphilis
are the predisposing causes.
Pathology. The intima inflames, and from a
new growth of cellular elements, becomes thick-
ened, often irregularly in patches. This new
growth causes the arteries to become enlarged,
tortuous, rigid, and friable; with more or less,
fatty degeneration of the other coats. These
changes are usually in the aorta; but, the coron-
ary, cerebral, and the arteries of the extremities,
are also affected. This rigidity of the arteries
hinders the circulation, raises the arterial tension
and causes hypertrophy of the left ventricle.
Symptoms.--The symptoms naturally vary
greatly depending upon the artery affected, and
the degree of the degeneration. The peripheral
arteries may be felt to be hard and irregular in
outline; the pulse is feeble. Associated with this
we have the hypertrophied left ventricle.
Sequelæ.-Angina pectoris; cerebral apoplexy;
gangrene; nephritis.
Prognosis.-Incurable, but may be relieved.
Treatment.-Hygienic. Let patient have a
204.
DISEASES OF CIRCULATORY SYSTEM.
quiet life free from excitement, and treat the
symptoms as they arise.
Dr. Hale says: "Aurum is an excellent remedy
in arterio sclerosis in which there is an element of
vaso-motor constriction."
SPECIFIC INFECTIOUS DISEASES.
TYPHOID FEVER.
Synonyms. Enteric fever; typhus abdomi-
nalis; nervous fever; gastric fever; autumnal
fever.
Definition.—An acute infectious disease, caus-
ed by a specific poison; characterized by a con-
stant lesion in Peyer's patches, mesenteric glands,
and spleen; and a characteristic roseolar eruption
on the abdomen.
Etiology.-Predisposing Causes-Youth and
early adult life, rare in infants and those over
fifty years of age; autumn season, particularly
after a dry, hot summer; and, individual suscep-
tibility.
Exciting Cause. The bacillus of Eberth. This
bacillus, says Osler, "is rather short, thick,
motile bacillus, with rounded ends, in one of
which, sometimes in both (particularly in cul-
tures), there can be seen a glistening round body,
believed to be a spore; but these polar structures
are probably only areas of dense protoplasm."
The poison gains entrance into the body through
the alimentary canal, it being denied that the
poison can be carried through the air, in the food,
more especially in meat, drinking water and milk.
The poison, in the first place, originates in the
body, is given off mainly through the bowels,
206
SPECIFIC INFECTIOUS DISEASES.
but, to some extent through the lungs, and re-
quires, before it can communicate the disease to
others, a stay for a certian time in decomposing
organic material; it then infects the drinking
water, which is the main medium of transmission
of the poison to man.
Pathology.There is a catarrhal inflamma-
tion of the mucous membrane of the bowels; the
spleen is greatly enlarged; a parenchymatous
degeneration of the liver, kidneys, and particu-
larly the heart; but, the characteristic lesion is
found in Peyer's patches and solitary glands of
the intestines, particularly those situated in the
lower part of the ileum.
The changes in the glands have four stages:
1. Stage of hyperplasia, infiltration, or swelling.
From the irritation of the typhoid poision there is
hyperæmia, followed by inflammation of Peyer's
patches; the patches become red and hardened;
following this, there is a cell proliferation which
causes swelling; the swelling now presses upon
the blood vessels, cuts off the blood supply, and
the parts become pale.
2. Stage of necrosis, softening or sloughing.
When resolution is no longer possible in the
lymph follicles, there appears an "anæmic necro-
sis" from the blood supply being cut off, from
pressure on the vessels. Sloughs form and are
discharged.
3. Stage of ulceration. The sloughs, which
begin separating at the edges of the glands,
finally, about the third week, separate and leave
irregular ulcers.
TYPHOID fever.
207
4. Stage of cicatrization, or healing. This
stage, as its name implies, is when the ulcers are
healing, which occurs about the twenty-first day.
The ulcers, when healed, are usually depressed
and pigmented.
Symptoms.- Prodromal Stage-The onset of
typhoid fever is very insidious; it begins with a
feeling of malaise; headache, usually in the occi-
put; more or less deafness; nose bleed; and, a
profound sense of weakness; with slight chilli-
ness, particularly on motion. This stage may
last from a few days to several weeks.
During the first week of the disease, which
begins with the commencement of the fever, there
is an aggravation of the symptoms of the pro-
dromal stage; with symptoms of irritation of the
gastro-intestinal canal. There is tenderness, and
possibly swelling of the abdomen, especially the
right side, with gurgling in the right iliac fossa
upon pressure. The temperature has a gradual
rise, with daily remissions; the evening tempera-
ture being some couple degrees higher than the
morning temperature, and about a degree higher
than that of the previous evening; and reaches
the maximum temperature about the seventh day.
The pulse is frequent, and often dicrotic. Diar-
rhoea, consisting of the so-called "pea soup
discharges, begins in this week, if it has not
already appeared. Towards the end of this week
there appears, upon the abdomen and chest, a
characteristic eruption, resembling flea bites, ap-
pearing in crops, each crop lasting about four
208
SPECIFIC INFECTIOUS DISEASES.
days; the eruption disappears upon pressure, and
after death.
Second week. The fever, during this week,
continues with slight morning remissions; the
pulse is fast, but compressible, and has lost its
dicrotic character. Subsultus tendinum, stupor,
delirium, which is usually mild, and worse at
night, and enlargement of the spleen, appear
during this week. There is decided bronchial
irritation, manifested by a short, dry cough with
bronchial râles. The face becomes pale, the eyes
are suffused, and a flush appears upon the cheeks.
Third week. The symptoms of the second
week are more pronounced. If the case is pro-
gressing favorable, the fever will show a more
marked morning remission, with a lower daily
maximum temperature. The patient is now
greatly emaciated, and extremely weak; with
great liability to relapse and complications, espec-
ially intestinal hemorrhages.
Fourth week. This is the week of convales-
cence. The symptoms gradually disappear; the
patient regains his appetite, his tongue cleans, the
diarrhoea stops, and he slowly regains his strength.
If convalescence be delayed the following weeks
will show irregular fever, with symptoms of the
third week.
Complications.-Intestinal hemorrhage, due
to the ulcer in the bowel eating into a blood ves-
sel, is the most frequent complication; the hemor-
rhage may vary in quantity, from a few drops to
a pint of blood. The hemorrhage is preceded by
a sudden fall in the temperature.
TYPHOID FEVER.
209
Perforation of the gut, setting up fatal peri-
tonitis may occur. Lobar pneumonia; hypostatic
congestion of the lungs; nephritis; cystitis; and
bed sores; are frequent complications.
Differential Diagnosis.-Acute miliary tuber-
culosis has a high fever, without the peculiar rise
of typhoid fever, and dyspnoea, but has no en-
larged spleen, nor eruption. Microscopic exami-
nation of the sputum of tuberculosis will reveal
the characteristic bacilli.
Septicamia has repeated chills, followed by
sweats early in its course; the temperature is very
irregular; and there is no eruption.
Ulcerative endocarditis has rapid onset, with
irregular temperature; and cardiac murmurs.
Trichinosis has no characteristic temperature,
no eruption, but has severe muscular pains and
tenderness.
Sequelæ.--Paralysis; dropsy; dysentery; men-
tal weakness; phlebitis.
Prognosis. Must be guarded. Death usually
occurs about the third week, from physical or
cardiac exhaustion, or, from some complication.
Pregnant females when attacked with this fever
abort and die in a few days, in the majority of
The mortality, under homoeopathic treat-
ment, is about four per cent.
cases.
The unfavorable signs are: A high temperature
early in the disease; a temperature with but
slight remissions; a severe and persistent diar-
rhoea; marked cerebral symptoms, such as coma,
persistent delirium, and subsultus tendinum;
weak heart; and repeated hemorrhages.
P
15
210
SPECIFIC INFECTIOUS DISEASES.
The favorable signs are: A low temperature,
not over 105° F. on the ninth day; a good pulse,
with a strong heart; constipation; mild delirium;
and no complications.
Treatment.-Confine the patient to bed, pre-
ferably on a hair mattress, as soon as typhoid
fever is suspected; insist upon absolute rest, use
bed pan.
Have the room provided for free ven-
tilation, and keep the temperature about 75° F.
The patient, and everything about him, must be
kept clean. The patient, several times a day,
should have a sponge bath, composed of equal
parts of alcohol and water; the linen must be
changed daily. For the high temperature use
the cold bath, or cold pack. Disinfect all dis-
charges as soon as passed, and have them imme-
diately removed from the sick room. Guard
against bed sores; move the patient every few
hours; wash any reddened places with boracic
acid solution. Wash mouth out frequently to
ward off sordes on the teeth. And, watch the
heart.
Diet. The diet, from the first symptom of
typhoid fever until the temperature has been
normal one week, must be liquid and nutritious,
given in small quantities, and frequently, every
two hours. The best diet is the "milk diet;"
give small amount of diluted milk, every two
hours, day and night; adults may take from two
to four pints of diluted milk in the twenty-four
hours. When giving milk the stools of the
patient must be watched to detect the passage of
any milk undigested. If the milk is not digested
TYPHOID fever.
2II
it may be peptonized; or, may give broths, or
albumen whey. Water, in moderate amounts,
may be given the patient. Stimulants must not
be given until indicated by the profound weak-
ness, and particularly by the weakness of the
first sound of the heart; when given, watch the
result carefully and give just enough to obtain
the result sought for.
REMEDIES.
A
Absinthium.-"Sleeplessness of typhoid fever when
there is congestion at the base of the brain.”—Dr. Far-
rington.
Alumen.
clots of blood are passed (Hering).
Alumina.-When Bryonia, though indicated, does not
act deep enough (Gosewitsch).
Apis.-
The patient's face is flushed; the skin is dry
and hot; little or no thirst. * Prostration is marked, and
comes early in the disease; the weakness is profound, he
slides down in the bed. Stupor, with mild, muttering
delirium. * Abdomen is swollen, and very sensitive to
touch. *The tongue catches in the teeth when attempt-
ing to protrude it; and trembles.
Tongue is dry, red
and cracked; coated on the dorsum, and has blisters on
the edges.
Hemorrhage from the bowels, when large
Arnica. -Patient in a very low condition; face dark;
head hot, while rest of body is decidedly cooler; drowsy;
stupid; complete indifference; falls asleep while answer-
ing questions. Complaining of the bed feeling hard,
he tosses about to find a soft place.
* Involuntary pas-
sages from both bowels and bladder.
"i
Occupies a middle rank between Rhus and Bryonia."
-Dr. Baehr,
Arsenicum.. * For the second stage, when the intes-
tinal ulceration is under full headway.
*There is high
fever; the patient is very irritable, anxious, restless, and
fears death. *The face is pale and shrunken, cadaveric;
212
SPECIFIC INFECTIOUS DISEASES.
the lips are dry, cracked, and dark in color; he picks his
lips; sordes form on the teeth. *The pulse is very small,
almost imperceptible. * Extreme prostration of strength
and emaciation. Picking at the bed clothes. * The ab-
domen is very much swollen and tender, with gurgling.
* Diarrhea, the passages being very fetid. There may
be retention of urine, the bladder swelling to such an
extent that rupture threatens. * Hemorrhages from the
bowels, consisting of dark, watery blood; with anxiety
and restlessness. Worse after midnight. When Arseni-
cum seems indicated and fails, study Sulphur.
*
"Whatever other remedies are used, this should be
given all through the course of the disease unless the
attack is a very mild one."-Dr. Hale.
"The most disappointing medicine I have prescribed
in typhoid fever."-Dr. Goodno.
"Do not give it early in the course of typhoid affec-
tions, unless the symptoms clearly call for it."-Dr.
Farrington.
Baptisia. -Claimed that it will, if given as soon as
typhoid is suspected, cut the disease short, this I doubt.
*Face is dark red, with a besotted expression, looking
like one intoxicated. *Stupid, dull, confusion of ideas;
goes to sleep while answering questions. Feels scat-
tered about, must toss about in order to get himself to-
gether. * Dull aching pain all over the body. * Pulse is
full and soft. *The tongue is brown, blackish, and dry.
*The breath is offensive; everything about the patient
seems to be fetid. * Diarrhoea of dark fluid, exceedingly
fetid.
The king of all remedies for typhoid. No remedy
can supplant it in the first stage."-Dr. Burt.
44
Typifies a fever which is decidedly typhoid in its
tendency."-Dr. Farrington.
*
Belladonna. With marked cerebral symptoms. The
face is flushed, the pupils dilated, the carotid pulsates.
* Intolerance of noise or light. * Delirium early in the
disease. * Troublesome bronchial irritation and cough.
* Wants to strike, bite and kick.
C
TYPHOID FEVER.
213
Bryonia. The face is red and swollen; the lips are
dry, brown and cracked; the mouth is also dry, without
thirst, or thirst of large quantities of water; the tongue,
at first, is coated white in the middle, with clean edges,
but later, the coating is brown, and the tongue becomes
very dry, with a bitter taste in the mouth. There is a
dull, throbbing, stupefying headache, often associated
with sharp pains over the eyes; headache as if the head
would split, aggravated from the least movement, even
turning the eyes aggravates the headache. * Constantly
puts his hand to his head. * Drowsy all the time; on
closing his eyes he sees persons and is surprised, on open-
ing his eyes, to find they are not there. *Delirium day
and night, wants to escape, wants to go home, talks of
his business. *Nausea and faintness on rising.
* Abdo-
men distended, and tender to the touch. Constipation;
of little value after diarrhoea has set in.
'Clinical evidence of the pre-eminent value of Bryonia
at this period (the first week) is overwhelming.”—Dr.
Goodno.
"
Calcarea Carb.—* For persistent diarrhea; or nose-
bleed. * When the rash does not develop; and the abdo-
men swells and becomes tympanitic; he is very restless.
*Cannot sleep; frightened by imaginary objects.
Indicated when the rash will not appear, and the
patient goes into a sort of stupor."-Dr. Farrington.
Carbo Veg.- Last stage; stage of collapse. *Colloqua-
tive diarrhoea. *Face pale, sunken, cold, and hippocratic;
the breath is cold; the extremities are cold, and may be
covered with a cold sweat. *Great prostration, the
patient wants more air; wants to be fanned all the time.
Symptoms of heart failure.
"Often at the brink of death a saviour, in those states
of collapse, dissolution of blood, and paralytic conditions,
which seem rapidly to invade the whole organism.”—Dr.
Rauc.
((
Colchicum. It seems to stand in typhoid conditions
between Arsenium and Cinchona, having the excessive
214
SPECIFIC INFECTIOUS DISEASES.
weakness of the former remedy and the marked tympany
of the latter (Farrington).
Eupatorium Perf.-If there should be severe pains in
the bones.
Gelsemium.-*Stage of invasion; or, during the first
week of the fever. * Sense of extreme prostration; tremb-
ling from weakness. *Cases where the nervous symp-
toms are prominent. * Soreness and bruised feeling over
the body. The face is red and suffused; drowsy, the
eyelids are heavy, he cannot keep them open.
* Dull
pain, or a strange feeling, in the head, with jerking of
the muscles. * Pulse full and weak.
Hamamelis.—* Hemorrhage, from the bowels, of dark,
sometimes coagulated, and offensive blood; with soreness,
and bruised feeling in the abdomen.
Hyoscyamus. * Delirium, which
awake; sees people who are not present.
of the bladder and bowels. *Subsultus tendinum.
continues while
*Loss of power
Lycopodium.-On about the fourteenth day of the fully
developed fever, when the rash belonging to the fully
developed disease does not appear and the patient sinks
into an unconscious state with muttering delirium, pick-
ing at the bed clothes, distended abdomen with great
rumbling of flatus, constipation, sudden jerking of the
limbs here and there, involuntary urination or retention
of urine (Farrington).
Mercurius. Contra-indicated in typhoid fever, except
for marked icteroid scorbutic symptom (Hering).
-X-
Muriatic Acid.- Extreme prostration, with constant
tendency to slide down in the bed. * Unconscious; low
muttering delirium. Stupid sleep, groans, lower jaw
dropped. *Tongue is shrunken, dry like leather; the
tongue is almost paralyzed, can hardly speak.
* Invol-
untary passages from bowels and bladder.
Nitric Acid. Hemorrhage from the bowels; with
great sensitiveness of the abdomen; and, fainting on
motion.
头
​Opium. The face is swollen and of a dark red, or
purplish color.
* Drowsy. * Complete coma, can not be
TYPHUS FEVER.
215
aroused, or only with the greatest difficulty. *Stertorous
breathing.
Phosphoric Acid.-* Great debility, with complete in-
difference to everything. * Persistent diarrhoea. * Quiet
stupor.
Phosphorus. When pneumonia symptoms develop.
Pulsatilla. When diarrhoea ushers in an attack; or,
appears early in the disease. * Bitter taste; tongue coated
white; nausea and vomiting. Worse toward evening.
*
Rhus Tox.-* Intestinal stage; after diarrhoea has set
in. Prostration; restless; disturbed anxious sleep with
frightful dreams; picking at the bed clothes. * Face is
dark and livid; the eyes are injected.
The tongue is
dry, red and smooth; red triangular tip. * Worse after
midnight.
an
Stramonium. - For high grade of delirium
Terebinthina. -*Tympanites; and hemorrhage of the
bowels.
Zinc.—* Threaten paralysis of the brain.
TYPHUS FEVER.
Synonyms. Ship fever; jail fever; hospital
fever; camp fever; exanthematic typhus.
Definition. A highly contagious febrile dis-
ease, characterized by a sudden onset, high fever,
petechial eruption, marked nervous symptoms,
and termination by crisis in about two weeks.
Etiology.-Rarely seen in America, except
among sailors and emigrants in seaport towns; is
common in Great Britain. The special germ has
not been discovered. Over-crowding, bad hy-
giene, impure drinking water, and poor food, are
predisposing causes.
Pathology. No positive lesion. The blood is
dark, fluid; the muscles are stained a deep red
color, and there is a granular degeneration.
216
SPECIFIC INFECTIOUS DISEASES.
Symptoms. The period of incubation is
about ten days.
There may, or may not, be premonitory symp-
toms.
The attack: The onset is sudden, with a short,
sharp chill, or chills, and chilliness during the
first couple of days of the disease; this chill is
followed by a severe fever, which reaches its
highest point about the fourth day of the attack,
and there are slight remissions in the fever.
With the fever, there are severe nervous symp-
toms, delirium, excessive prostration, fearful pains
in the head and extremities, and symptoms of
gastric irritation.
Stage of eruption: From the third to the fifth.
day of the disease an eruption develops, first upon
the abdomen, then spreading to the chest and ex-
tremities. The eruption is rose-colored, measly
in appearance, with a decided mottling of the skin.
The spots soon become hemorrhagic, and do not
disappear upon pressure.
J
Stage of decline: The disease ends by crisis,
usually on the fourteenth day, and sequelæ are
rare.
Differential Diagnosis.-Typhoid fever has a
gradual onset, with a gradual rising fever with
characteristic and marked daily remissions. Ty-
phoid fever has severe abdominal symptoms,
diarrhoea, hemorrhages, and enlarged spleen.
The eruption of typhoid fever is rose colored, no
mottling, appears in crops, and disappears upon
pressure.
Cerebro-spinal meningitis has severe occipital
YELLOW FEVER.
217
headache, which continues during the delirium,
and muscular rigidity appears early; paralysis
are common; and there is no characteristic erup-
tion.
Duration.-About two weeks.
Complications.-Pneumonia; swelling of the
parotid glands.
Prognosis. Favorable.
fever.
Treatment.-Isolate patient; have room pro-
vided for good ventilation, for the patient needs
plenty of fresh air. Disinfect all discharges.
The diet must be liquid and nutritious.
Remedies. Consult those given for typhoid
YELLOW FEVER.
Synonyms.-Yellow jack; black vomit; Medi-
terranean fever.
Definition.An acute infectious febrile dis-
ease, caused by a specific virus, and character-
ized by yellowness of the skin and hemorrhages.
Etiology. A disease of the tropics. Its spe-
cific cause is unknown. The infection may be
carried about in the clothes; and, it finds its way
into the system through either the alimentary
canal or respiratory tract. One attack usually
protects the individual from future infections.
Occurs more frequently in white persons, and
those of the male sex.
Pathology. There is no pathognomonic
lesion. Jaundice, altered blood, and degenera-
tion of the internal organs, are found.
Symptoms. The duration of the period of
Ad
218
SPECIFIC INFECTIOUS DISEASES.
incubation varies according to the severity of the
epidemic; it usually lasts from one to six days.
The first or febrile stage: The duration of this
stage is about three days. The onset is sudden,
marked by a chill, rapid rise of temperature, the
face is flushed, there are severe pains in the head
and in various parts of the body. There is gastric
irritability; the urine becomes scant and often
albuminous. A peculiar odor is perceptible about
the patient on the second day. Following this
stage there is a remission, known as
The second stage, or that of remission, when the
temperature rapidly subsides, the pains leave,
and, in short, convalescence sets in, and the
patient, in favorable cases, soon is well; but, after
a few hours to several days, in a great number of
cases, the patient goes into the second febrile
attack, known as
The third stage, or that of collapse: The fever
rises rapidly, with all of the symptoms of the
first stage; the skin now becomes yellow; the
gastric irritability is greatly exaggerated, the
nausea and vomiting intense; the vomit consists
of mucus and dark blood mixed, and is called the
"black vomit." May be hemorrhages from all
of the mucous surfaces. The urine is scant, and
contains albumen and tube casts. The stools
also contain dark blood. Exhaustion, ending in
death of the patient, may terminate this stage;
or, the patient may recover, gradually regaining
his former health.
Duration.-Seldom over one week.
Differential Diagnosis.-Relapsing fever has
YELLOW FEVER.
219
an enlarged spleen, which is tender to touch;
there is little or no jaundice; no black vomit; but
there is spirilli in the blood.
Pernicious malarial fever has remission within
the twenty-four hours, has no peculiar vomiting,
and no albumen or tube casts in the urine.
Remittent fever has daily remissions, no black
vomit, and has enlargement of the spleen.
Acute yellow atrophy of the liver commences
without chill as a simple jaundice, with the liver
diminished in size, and the urine contains leucin
and tyrosin.
Prognosis. Must be guarded; the mortality
varies in different epidemics.
Treatment.-Isolate patient in a large, airy
room; confine him to bed; disinfect all dis-
charges; keep him, and all things about him,
clean.
Diet: Until the second period it is best to give
no food whatever; then give nothing but nutri-
tious liquid foods, until convalescence is fully
established. Stimulants may be given when
called for by the prostration and cardiac failure.
REMEDIES.
*The skin is
*The patient
Aconite.- - For the fever at the onset.
hot and dry, the pulse full and hard.
anxious, and restless; tosses about; with fear of death.
Argentum Nitr.-Third stage. *When there is vomit-
ing of brownish masses, with coffee-ground-like flakes.
"For the hemorrhages from the gastric mucous mem-
brane."-Dr. Holcombe.
Arsenicum.-Third stage. Face livid; nose pinched
and cold. *The tongue is dry, brown or black; like a
piece of red leather. * Great prostration. * Vomiting
220
SPECIFIC INFECTIOUS DISEASES.
immediately after eating or drinking. * Frequent and
violent vomiting, with apprehension of death. Urine
burning, scant and high-colored; containing albumen
and casts; passed with difficulty.
"The lesions of Arsenic are remarkably similar to
those of yellow fever."-Dr. Holcombe.
Belladonna. -Symptoms of cerebral congestion. *Vio-
lent fever; dry and very hot skin; pulse full and strong;
with visible pulsation of the carotids. *The face is red;
the eyes sparkle. * Delirium, with desire to strike and
bite.
Bryonia. -*The second stage; for the prominent gas-
tric symptoms. *Headache, as if the head were split-
ting; nausea and faintness on attempting to rise; tongue
heavily coated. Constipation.
(C
Camphor.- If the chill was violent, or persisted long,
I ordered Tincture of Camphor every ten minutes in
drop doses."-Dr. Holcombe.
Cantharis. For the strangury.
Crotalus.
For the "black vomit."
Lachesis. Dr. Holcome says: "When Belladonna and
Arsenic produced no amelioration, a change to Arsenic
and Lachesis brought about the desired amendment."
Phosphorus.—Should be studied.
Tartar Emetic.—* Prolonged and distressing nausea.
Veratrum Alb.-* To allay the vomiting and abdominal
pains (Holcombe).
A
CEREBRO-SPINAL FEVER.
Synonyms. Epidemic cerebro spinal menin-
gitis; spotted fever; petechial fever; malignant
purpuric fever.
Definition. A specific infectious disease, char-
acterized by inflammation of the membranes of
the brain and spinal cord.
Etiology. No doubt due to a micro-organism
though, as yet, no positive proof; in the menin-
CEREBRO-SPINAL FEVER.
221
geal exudation there is found a coccus similar to
the pneumo-coccus which some think is the cause.
Slightly, if at all, contagious. Youth, winter
climate, and bad hygienic surroundings, are pre-
disposing causes.
Varieties. Common form; fulminant form;
abortive form.
Pathology.-Hyperemia of the membranes of
the brain and spinal cord, followed by exudative
inflammation; this exudation closes the cavities
between the membranes; and, causes pressure on
the brain and cord.
Symptoms. As a rule, the onset, in the
common form, is sudden with chill, followed by an
irregular fever; with nausea and vomiting, which
may be very troublesome; extreme prostration;
severe pains in the head, particularly in the occi-
pital region; the pains extend into the back.
Soon, there develops painful stiffness and tonic
spasm of the muscles of the neck and back, with
hyperesthesia of the skin. The fever reaches its
height in from one to three days; delirium is
almost always present, sometimes stupor and
coma. Partial or total deafness; twitching of the
eyes, and, particularly strabismus are present.
A petechial rash develops during the second or
third day; and herpes labialis is quite a constant
symptom. These symptoms last from four to
seven days, when the fever declines, and other
symptoms gradually disappear. Convalescence
is always slow and irregular.
The fulminant form proves fatal in a few hours.
from collapse.
222
SPECIFIC INFECTIOUS DISEASES.
The abortive form sets in with symptoms of the
common form, but the patient recovers in a few
days.
Complications.-Pneumonia; inflammation of
the heart; typhoid fever; pleurisy.
Sequelæ.-More or less deafness; impaired
vision; persistent headache.
Differential Diagnosis.-Tubercular menin-
gitis is usually secondary to general tuberculosis;
its onset is not sudden.
Typhoid fever has a gradual onset; with gen-
eral feeling of malaise; a characteristic tempera-
ture; and other decided symptoms that are not
found in cerebro-spinal fever.
Duration. The fulminant form lasts a few
hours; the abortive form a few days; the common
form a few weeks.
Prognosis. Must be guarded; death usually
takes place, in fatal cases, during the first five
days of the disease.
Treatment. Confine patient to bed; keep
everything quiet in the room; secure diaphoresis.
early, by means of the hot bath, or by giving
Jaborandi, Alcohol or Aconite. Ice bag to head
and along spine has proven beneficial. Diet must
be liquid and nutritious.
▬▬
REMEDIES.
Actea Race.-For spasmodic symptoms after the acute
stage has passed.
Alcohol.-Pure deodorized 95 per cent. alcohol; two
teaspoonfuls in 4 3 of water; dose, teaspoonful every half
hour.
Saves the patient from sinking into death, before the
RELAPSING FEVER.
223
-
ordinary remedies could have time to act, * * * and cuts
the disease short in its progress."-Dr. B. W. James.
Ammonium Carb.-"The patient is stricken down by
the violenceof the poison and falls into a stupid non-react-
ive state. He is cold, and the surface of the body is cyano-
tic. The pulse is very weak. In just such cases, you should
give Ain. c., which will bring about a reaction."-Dr
Farrington.
X
Arsenicum.—* Violent pains in stomach and bowels
Signs of decomposition of the blood.
Belladonna.-*For cerebral congestion.
Cicuta -The remedy for this disease.
mental torpor. Head jerks and twitches.
sensitive to light. *Spasmodic drawing of the head
backward. *Tonic spasm of the cervical muscles. Sud-
denly becomes stiff and immovable. *Tonic spasm
renewed from the slightest touch.
Dull, stupid,
Eyes are very
Cuprum Acet.-"If the symptoms were more promi-
nently cerebral."-Dr. Goodno.
Gelsemium. In the first stage; as soon as the disease
declares itself. * Occipital headache; dull stupid feeling;
profound weakness; and other symptoms which corre-
spond to the onset of this disease.
Hydrocyanic Acid.-* For the fulminant form.
Stramonium.-* For the violent spasms.
Veratrum Vir.-Sometimes given for the early symp-
toms.
RELAPSING FEVER.
Synonyms.-Famine fever; spirillum fever;
febris recurrens; seven-day fever.”
Definition. An acute infectious disease caused
by the spirochete of Obermeier, having febrile
paroxysms which last from four to six days, and
are followed by a remission of the same duration.
Etiology. A highly contagious disease.
Directly caused by the spirochete of Obermeier,
(4
224
SPECIFIC INFECTIOUS DISEASES.
which twist and rotate in the blood during the
fever. The indirect causes are any causes which
would predispose to typhus or typhoid fever.
Pathology.--No characteristic lesion. Micro-
scopical examination of the blood during the fever
will show the cork-screw organisms referred to
above.
Symptoms. There are no prodromes. The
attack begins suddenly with chill, followed by
rapid rise in temperature, the fever remaining
high for six or seven days, when it terminates by
crisis. With this fever there is headache, pain
over the body, vomiting, etc. In five or six days
more, the patient has a second attack, similar to
the first, which ends in six or seven days by
crisis. This may keep up until the patient has
four or five paroxysms before convalescence sets
in.
Differential. Diagnosis.-The characteristic
course of the fever, and the cork-screw organisms
found in the blood, will prevent mistakes being
made.
Prognosis. Favorable.
Treatment.-Isolate patient. Rest in bed;
liquid diet.
Remedies.--Aconite; Baptisia; Bryonia; Cimi-
cifuga; Eupatorum perf; Rhus tox.; Sulphur.
p
DENGUE.
Synonyms.-Break-bone fever; dandy fever.
Definition. An acute, infectious, epidemic
disease, characterized by febrile paroxysms, with
P
INFLUENZA.
225
pains over the body, and sometimes a cutaneous
rash.
Etiology. Not known.
Symptoms.-Onset sudden, with chilliness,
followed by fever, with severe aching in the
joints, and over the body. There is headache,
and gastric symptoms. After two to four days,
the temperature declines, and for three or four
days, the patient is free from fever and severe
pain. During this apyretic period there is often
an eruption over the body. A second attack,
similar to the first, sets in suddenly after several
days of no-fever" period. Convalescence
**
usually sets in after the second attack.
Duration.-One week.
Prognosis. -Very favorable.
Treatment.
diet.
tox.
Remedies.
Consult influenza.
Aconite; Bryonia; Eupatorium perf.; Rhus
Rest in bed; and nutritious liquid
A
INFLUENZA.
Synonyms. La grippe; epidemic catarrh;
catarrhal fever.
Definition.--An acute, specific, infectious fever,
characterized by intense pains over the body,
catarrh of the respiratory tract, and great ex-
haustion.
Etiology. Spreads from Russia where it
occurs as epidemics. Nothing seems to influence
its course. Directly due, presumably, to the
bacillus of Pfeiffer.
16
226
SPECIFIC INFECTIOUS DISEASES.
Pathology. No special lesions.
Symptoms. Similar to the symptoms of
bronchitis, except, influenza has higher fever,
and severe pains throughout the body, with
gastro-intestinal irritation, and profound pros-
tration.
Complications.-Pneumonia; bronchitis; neu-
ritis; kidney disease; insanity; cardiac weakness.
Duration.-From five to six days.
Prognosis. In uncomplicated cases, good. If
complicated, the prognosis must be based upon
the general condition.
Treatment. Rest in bed; and liquid diet.
REMEDIES.
Consult indication for remedies in bronchitis.
Aconite. Sthenic cases; high fever; full, bounding
pulse; anxiety; restlessness, and fear of death.
Arsenicum.-Dr. Hughes considers this the specific
J
remedy.
Bryonia. Severe frontal headache *The patient is
very irritable; desires to be alone. Fever; with full,
hard pulse; *lips dry and cracked; the patient has a con-
stant desire to wet them with his tongue. Tongue heavily
coated. * Prostration; nausea and faintness upon sitting
*The limbs feel heavy; with weakness and weari-
ness in them. *Cough dry, with pains in the sternum.
up.
"An efficient medicine when the bronchial mucous
membrane is attacked and the general pains are torment-
ing."-Dr. Goodno.
Eupatorium Perf.-* For the "bone-pains."
Gelsemium. This is the best remedy for the early stage.
* Great prostration; with dull pains throughout the body.
Pulse is soft, frequent and almost imperceptible.
(C
In early stage
generally the most efficient
remedy."-Dr. Goodne.
Rhus Tox.-For Typhoid symptoms.
FEBRICULA.
227
FEBRICULA.
Synonyms. Simple continued fever; ephem-
eral fever; irritative fever.
Etiology.
Definition. A simple idiopathic fever.
Excessive bodily work; exposure
to the sun, or excessive cold; excitement; and
errors of diet.
Symptoms.-Onset sudden with chill, fever,
lassitude, headache, and all the symptoms of
fever. This lasts for a few days, to possibly a
week, when the fever declines by lysis or crisis.
Prognosis.-Good.
Treatment. Rest in bed, with liquid food,
and a few doses of Aconite generally cures this
disease.
MALARIAL FEVER.
S
Definition.—A specific, non-contagious dis-
ease, invariably associated with, and probably
excited by, the hæmatozoa of Lazeran, and char-
acterized by splenic enlargement, by fever with
periodic intermissions or remissions, and by a
tendency to extreme anæmia (Stevens).
Etiology. Exciting Cause: The hæmatozoon
of Lazeran.
Predisposing Causes: The spring and autumn
months; residence in a low, badly drained locality,
or, near a marsh; exposure to night and early
morning air.
Varieties. (I) Intermittent fever; (II) re-
mittent fever; (III) pernicious malarial fever;
228
SPECIFIC INFECTIOUS DISEASES.
(IV) malarial cachexia; (V) masked intermit-
tent fever.
Pathology. The microbes which are the ex-
citing cause of malarial fever are of animal origin,
belonging to the protozoons. Various shapes
have been found, and are generally within the
red blood corpuscle. It is their action on these
corpuscles which cause the anæmia which is such
a constant attendant on malarial.
There are
changes in the spleen and liver.
Kad
INTERMITTENT FEVER.
Synonyms.-Ague; chills and fever.
Definition.-That form of malarial fever in
which the paroxysm has three distinct stages, i. e.,
chill, fever and sweat.
Varieties. Quotidian when there is one parox-
ysm daily; tertian, a paroxysm every other day;
quartan, a paroxysm every fourth day. When
there are two paroxysms daily the variety is
called double quotidian.
Symptoms.-There are three stages.
Cold Stage.-Begins with malaise, headache,
nausea, and desire to stretch; soon there is a well
marked chill, the features of the patient become
pinched, the lips blue, skin pale, with goose-
flesh; this is soon followed by the
Hot Stage, which gradually comes on as the
chill leaves. This stage is marked with a high
fever, headache, nausea and vomiting, intense
thirst, severe pains in the head and over the body.
The face is flushed; the urine is scanty.
After
INTERMITTENT FEVER.
229
lasting for several hours, the hot stage is followed
by the
Sweating Stage.-The fever gradually subsides,
the pain decreases, a sweat breaks out, and
usually, the patient falls into a refreshing sleep,
and awakens feeling fairly well.
Differential Diagnosis.-Intermittent fever
can be recognized by its stages, the chill, fever
and sweat, the enlarged spleen, and the presence
of the hæmatozoa in the blood.
Favorable.
Prognosis.
Treatment. If the patient lives in a malarious
district, he should avoid the night air, and sleep
in the upper story of the house. If possible
should remove to a more healthy place.
REMEDIES.
Some physicians advise Aconite or Veratrum vir. to be
given during the cold stage. The best way to admin-
ister the medicine is one dose dry on tongue just after
the paroxysm, not to be repeated until after the next
paroxysm.
The quickest way to check intermittent fever is by giv-
ing a full dose, say ten to fifteen grains, of Quinine about
one hour before the expected chill; but, if you want to
cure the patient you must give the indicated remedy; the
best help to find this remedy is Allen's Therapeutics of
Intermittent Fever, from which the following indications
are taken:
Apis.—Chill, in afternoon (3 to 4) with thirst; oppres-
sion at the chest as though the patient would smother,
worse in a warm room.
Fever.-Oppression of the chest as if smothering; heat
most severe in the hands, chest and epigastric region.
Nettle rash.
230
SPECIFIC INFECTIOUS DISEASES.
Sweat. This stage is often absent; particularly in old
protracted cases. Alternates with dryness of the skin.
Arnica. -Prodrome.-Thirst for large quantities of cold
water; and drawing pains as if in the periosteum.
Chill with severe pain in the body, as if bruised; must
change his position frequently, the bed feels hard. Thirst.
Fever with less thirst than during the chill. Chilly
from the least uncovering.
Sweat sour offensive, like mouldy earth.
For cases badly managed, and maltreated with Quinine.
Arsenicum. Prodrome - Yawning and stretching;
weakness. and, sleepiness night before paroxysm.
Chill, in afternoon from one to two; anticipates one
hour every other day. Chill not clearly defined; exterual
warmth relieves. Thirst for small quantities of water.
Heat intense long lasting, with insatiable thirst.
less, anxious. Vomiting.
Rest-
M
M
Sweat with thirst; drinking causes vomiting. Sweat
is sometimes cold and clammy.
For the "dumb ague" after abuse of Quinine.
Capsicum.-Prodrome.-Thirst.
Chill.-Five to six P. M. every day; begins in back,
between the shoulders; must have something hot to back.
Thirst, drinking causes shivering and chilliness. Chill
relieved by motion.
Fever without thirst; tendency to perspire.
Sweat, no thirst. General.
China.-Prodrome.-Thirst; hunger; debility; palpita-
tion of the heart.
Chill general over the body; no thirst; or, if water is
taken it increases the chill; pain in the liver.
Fever without thirst; general heat, with distended
veins, congested headache, desire to uncover, but chilly
when uncovered. Hunger; sleepy after eating.
Sweat with great thirst. Sweat is profuse, debilitating.
Eupatorium Perf.—Prodrome.-Thirst, but drinking
causes nausea and vomiting, and hastens the chill; pain
over the body.
Chill.-In the morning, seven to nine A. M.; with
INTERMITTENT FEVER.
231
thirst; yawning and stretching; backache and bone pains;
vomiting of bile.
Fever.-Pains increase.
Sweat scanty; the headache continues for several hours
after the fever is gone.
Gelsemium.-Chill.-Begins in the extremities; runs
up the back from loins to nape of neck, and following
each other in rapid wave-like succession from sacrum to
occiput. Wants to be held. Falls asieep during the
chill, or as the chill is passing off.
Fever. No thirst. Periodic fever, without chill.
Ipecacuanha.-Prodrome.-Nausea.
Chill.-With thirst; oppressed breathing; nausea.
Fever.—Unusually long lasting, over whole body, with
alternate coldness and paleness of face. Nausea and
vomiting, Dry cough.
Sweat. Profuse.
After abuse of Quinine.
Natrum Mur.-Prodrome.-Patient dreads the chill.
Chill.-Ten to eleven A. M. Violent chill; with thirst;
headache, blue lips and nails; nausea and vomiting.
Fever.-Hammering headache; stupefaction and un-
consciousness. Prostration, must lie down.
Sweat.-Profuse, gradually relieving all pains.
Nux Vom.-*Chilliness during all stages from motion,
or uncovering.
Opium. Sleep during the different stages.
*
Rhus. A dry, teasing, fatiguing cough, coming on first
sometimes hours before, and continuing during the chill
(Dunham).
Veratrum Alb.-Chill at six A. M.
Long lasting; with
thirst. Face cold, collapsed. Extremities cold. Great
exhaustion and sinking of strength; pulse small and
weak.
T
Heat.-Cold sweat on the forehead.
Sweat. With deadly pale face.
Particularly useful for pernicious cases.
232
SPECIFIC INFECTIOUS DISEASES.
REMITTENT FEVER.
Synonyms. Bilious remittent fever; typho-
malarial fever.
Definition.—That form of malarial fever in
which the temperature remits, never reaching
normal during the continuance of the disease.
Etiology.—Occurs particularly in hot climates.
Symptoms. Similar to those of intermittent
fever, except the fever is remittent and not inter-
mittent. During the remission the temperature is
always several degrees above normal, with symp-
toms of general disturbance.
Duration.-About two weeks.
Differential Diagnosis.--Must be based upon
the character of the fever; and, microscopical
examination of the blood.
Prognosis.
Good.
Treatment. The patient should be confined
to bed, with a liquid diet.
Remedies. Consult Intermittent Fever reme-
dies.
PERNICIOUS MALARIAL FEVER.
Synonyms.
Congestive chills; malignant
malaria.
Definition. A pernicious, malignant form of
malaria, which may be of the intermittent or
remittent form; occurring principally in the
tropics; and having congestion of the internal
organs.
Varieties. (1) Comatose; (2) algid; (3)
hemorrhagic.
ter
MALARIAL CACHEXIA.
233
Symptoms.-Comatose form: In this form the
disease seems to spend its force on the brain;
there is violent delirium; followed by a deep
coma. The patient may rapidly sink and die in
a few hours; or, may regain consciousness and
experience another attack.
Algid form: Onset is characterized with gastric
symptoms; nausea and vomiting, and extreme
prostration; purging. The entire surface of the
body is cold; the features are pinched; the breath
may be cold; the temperature is often sub-
normal; and the patient dies in collapse.
Hemorrhagic form: Sometimes occurs as an
epidemic. Characterized by hemorrhages from
the mucous surfaces, particularly the surfaces of
the kidneys; jaundice may be present.
Duration.-One week.
Prognosis. Must be guarded; patient seldom
lives after the third paroxysm.
Treatment. Must bring about reaction.
Many advise large doses of Quinine; heat to body
and extremities; and stimulants.
Remedies. Consult those given for Intermit-
tent Fever.
KA
. .. .
MALARIAL CACHEXIA.
Definition. The chronic form of malaria,
characterized by anæmia, and enlarged spleen.
Etiology. As a rule, is due to repeated acute
attacks of malaria.
Symptoms.-Those of anæmia; with enlarged
spleen; and neuralgias in different parts of the
body.
234
SPECIFIC INFECTIOUS DISEASES.
Prognosis.-Guarded.
Treatment.-Must be suited to each case.
MASKED INTERMITTENT FEVER.
A term applied to symptoms depending upon
the malarial poison, yet, there is no decided mala-
rial paroxysm.
Treatment. Must be symptomatic.
PAROTITIS.
Synonym.-Mumps.
Definition. An acute, specific, infectious dis-
ease, characterized by inflammation of one or
both parotid glands.
Etiology. No doubt due to a specific poison,
contained in the saliva; but the poison has not
been isolated. A disease of youth. As a rule
one attack protects from future attacks.
S
Pathology.There is inflammation and infil-
tration of one or both parotid glands, causing
them to swell; they never suppurate. There
may be metastasis to the mammæ and testes.
Symptoms. The period of incubation is about
ten days. The disease is ushered in with malaise,
chilliness, followed by moderate fever, stiffness
of the jaws, and swelling of the glands. The
swelling is first observed below and in front of
the ear; after about five days, the gland gradu-
ally resumes its normal size.
Prognosis.
Treatment.
M
Good.
Rest and liquid diet.
Remedies.—Mercurius is the principal remedy;
but, if the disease sets in with fever give Aconite;
':.
WHOOPING COUGH.
235
if the swelling becomes very red, give Belladonna;
if the swelling becomes very hard, Carbo veg.;
for metastasis to mammæ or testes, Pulsatilla.
WHOOPING COUGH.
Synonym.-Pertussis.
Definition.
A contagious disease, character-
ized by a peculiar, paroxysmal cough, ending in
a prolonged, crowing or whooping inspiration.
Etiology. A contagious disease; from direct
contact with the specific poison, which is pre-
sumed to be in the expectoration, and possibly in
the expired air. More often found in the winter
and spring months; and often associated with
measles. A disease of childhood; one attack pro-
tects the individual from future invasions.
Pathology. There is an inflammation of the
respiratory mucous membrane, but nothing pecu-
liar. The paroxysmal cough is caused from irri-
tation of the pneumogastric nerve.
Symptoms.-There are three stages.
"
Catarrhal stage: This stage lasts several weeks;
and, is similar to an ordinary coryza and bron-
chitis.
Paroxysmal stage begins with the first
whoop;" and, lasts from two to four weeks.
The cough now becomes paroxysmal, ending in a
crowing, or whooping inspiration. During the
cough, the face becomes blue; the eyes are in-
jected; and the veins are distended. Vomiting
often occurs; and, sometimes hemorrhages. Ulcer
under the tongue frequently occurs.
236 SPECIFIC INFECTIOUS DISEASES.
Terminal stage: Here the cough loses its par-
oxysmal character, and becomes loose; and, other
symptoms subside. This stage lasts several
weeks.
Complications.-Pneumonia; bronchitis; em-
physema.
Differential Diagnosis.-Can only be made.
after the paroxysmal stage has set in, then by the
peculiar cough, ending in vomiting.
Prognosis.-Good.
Treatment.—Protect child from colds; give
good, nutritious food.
Remedies.-Aconite; Belladonna; Carbo veg.;
Cina; Coralium rub.; Cuprum; Drosera; Hepar;
Ipecacuanha; Kali carb.; Mephitis; Naphthalin;
Pulsatilla; Veratrum alb.
-
DIPHTHERIA.
Diphtheritis; malignant sore
Synonyms.
throat; malignant quinsy.
Definition. An acute, contagious disease,
caused by the Klebs-Loeffler bacillus, character-
ized by the formation, usually in the throat, of
false membrane.
Etiology.-Exciting causes : Klebs-Loeffler
bacillus; which is contained in the secretion of
the throat, and is thus given off-not by the
breath.
Youth; autumn season; defective drainage; or,
any bad sanitary surroundings; and a previous
attack; are predisposing causes.
Pathology. The characteristic membrane is
usually found upon the tonsils and pillars of the
DIPHTHERIA.
237
fauces; but may, and often does, extend to adja-
cent parts.
This membrane is of a dirty-gray
color; and dips deep into the mucous membrane,
from which it is hard to separate, and when
separated always leaves a raw bleeding surface.
There may be ulcers form; and, possibly gan-
grene of the part. The lymphatic glands of the
neck, and the spleen are swollen. The blood is
dark and fluid. Parenchymatous degeneration
of the internal organs occur.
The
Symptoms. The period of incubation is about
ten days. The onset of diphtheria is announced
by a regular febrile attack; with profound pros-
tration; soreness of the throat; constant desire to
hawk. The tonsils are swollen, upon which will
be found the membrane. Pieces of the membrane
may be coughed up. There is a very offensive
breath, due to the diphtheric process. The
glands of the neck are swollen and tender.
membrane may extend into the nose, called nasal
diphtheria, and causes epistaxis, and a yellow
offensive discharge from the nose, ulcerating the
upper lip. If it should extend to the larynx
(laryngeal diphtheria) it will cause hoarseness;
croupy cough; dyspnoea; and stridulous breath-
ing. If the membrane forms upon the external
mucous membrane it is called cutaneous diphtheria.
Complications.-Pneumonia; capillary bron-
chitis; inflammation of the heart.
M
Sequelæ.-Paralysis.
Duration.-About ten days.
Differential Diagnosis.-Must be based upon
the microscopical examination of the membrane.
238
SPECIFIC INFECTIOUS DISEASES.
Prognosis.-Guarded. Nasal and laryngeal
parieties of diphtheria are very fatal.
Treatment.-Isolate the patient; have the
room upon the upper floor, well ventilated, the
atmosphere kept moist; remove all carpets, rugs,
and other furniture that are not in use. Confine
Let
patient to the bed. Disinfect everything.
patient inhale steam; or, possibly have small bits
of ice. See that his kidneys are kept active.
Local treatment is best left alone. But, lactic
acid solution, peroxide of hydrogen, and diluted
alcohol, have been recommended.
Laryngeal diphtheria may demand intubation
of the larynx; or even tracheotomy.
The paralysis must be treated with the electric
current.
Diet is of first importance; the patient must be
sustained; the food must be liquid and highly
nutritious, preferably milk; must give small
quantities, at regular intervals, day and night; if
the patient cannot swallow then give food by
enemata. Stimulants are usually required for
the profound prostration and symptoms of heart
failure.
REMEDIES.
Antitoxine.-Wonderful results are said to follow the
use of this agent. Given a case of diphtheria, inject
Antitoxine, and in no time your patient is well, or—but,
if your Antitoxine is pure there is no "or;" so they say.
Apis.—*The case is distinguished by the profound
prostration which sets in at the very onset, and the small
amount of pain which accompanies the exudation. The
membrane is of a dirty-gray color. The patient cannot
bear heat.
DIPHTHERIA.
239
Arum Tri.-Whole throat raw and sore. *The dis-
charges from the nose and mouth are very acrid and
excoriate the skin wherever they come into contact with
it. *Picks his lips until they bleed.
Belladonna.-Only at the very commencement, when
there is a dry, sore throat; with cerebral symptoms.
Bromine. The diphtheria begins in the larynx and
comes up.
Bryonia. To develop the case.
Cantharis.
prominent.
In cases where its urinary symptoms are
Diphtherinum.—“If your apparently well-indicated
remedy fails in post-diphtheric paralysis think of Diph-
therinum; it has been found to work well in many of
these cases."-Dr. Allen.
Kali Bich.- *Croupy cough, in paroxysms, with expec-
toration of viscid, tough mucus, which may be drawn out
into long strings. Great fetor. * Yellow exudation with
a clean tongue.
*Pains shoot into the ear. The mem-
brane is dirty-yellow, tough and stringy.
Ci
In nasal diphtheria I find it specific; in laryngeal
diphtheria it does all that medicine can do."-Dr.
Hughes.
Lac Can.-* Membrane diffused like the lid of a pepper-
box, and dry. Exudate begins on the left side and goes
to the right. * After the throat began to improve, the
disease seemed to work through the whole alimentary
canal. * Great prostration.
Lachesis.
Exudate begins on the left side and spreads
to the right. The throat is very sensitive to touch, or
pressure. *Hawking and spitting from mucus in the
throat. * Sleeps into an aggravation. Pain extending
into the ear when swallowing.
Aching over whole
body.
Lachnanthes.-Neck very stiff and painful, drawn to
one side.
Lycopodium.-* Exudate begins on the right.
vation of all symptoms from 4 to 8 P. M.
awaking from sleep, is cross.
*
*Aggra-
*The child, on
240
SPECIFIC INFECTIOUS DISEASES.
Mercurius Cyan.-Putrid diphtheria, extending all over
the mouth, fauces, pharynx, etc. * Salivation. This is
the routine remedy for diphtheria; and, it has cured
many desperate cases.
Mercurius Proto. * Great swelling of the salivary
glands, with dirty yellow coating on the tongue.
Phytolacca.* Violent aching over the body.
exhaustion. * Excessive fetor of the breath.
* Great
* Feeling
as if a ball of red-hot iron had lodged in the throat. Dif-
ficult deglutition.
*The fauces look like venous con-
gestion.
Rhus Tox.-*Should a typhoid condition set in.
* Bloody saliva runs out of the mouth during sleep.
Zincum. To bring about a reaction.
SMALLPOX.
V
Synonym. Variola.
Definition. An acute, contagious disease,
characterized by an initial febrile movement,
severe pains in the back, vomiting, and a peculiar
eruption, which passes through the stages of
papule, vesicle, and pustule, and a secondary
fever.
Etiology. The contagion of smallpox has not,
as yet, been discovered. It is contained in the
pustule, and the excretions and exhalations of
the patient. The contagion is evidently active
during all the stages.
Varieties. Discrete; confluent; malignant;
varioloid.
p
Symptoms.-Discrete Form.-Period of incu-
bation is about ten days. The attack begins.
with a hard chill, severe frontal headache, pains
in the back and limbs, and vomiting. The fever
rapidly rises; and there is great prostration.
SMALLPOX.
241
!
This fever is called the inttial fever, and lasts
until the appearance of the eruption, when it
declines, and the other symptoms subside. About
the fourth day of the disease there appears an
eruption of coarse red spots, appearing first on
the forehead, at the border of the hair, and on the
wrist. In a couple of days these spots are con-
verted into papules, and feel like shot beneath
the skin. About the sixth day of the disease the
papules become vesicles, which are umbilicated,
and are divided into compartments by fibrinous
partitions. On the eighth day of the disease the
vesicles become pustules, and soon have a red
halo around them; at this time there is a peculiar
odor to the patient. After a couple of days scab-
bing begins, and on the eighteenth to the twen
tieth day the scabs begin to drop off, leaving red,
glistening pits. With the advent of the pustules
on the eighth day there is another rapid rise of
temperature, the fever of suppuration, the amount
of rise depending upon the number of pustules;
this fever usually lasts four or five days, when
convalescence begins.
Confluent Form.-Begins with the same initial
symptoms as the discrete form; except, possibly
the symptoms may be more severe. The rash
appears on the fourth, possibly on the third day.
The fever now abates some, but not so much as
in the discrete form. The pustules unite, and
form large patches; distorting the features terri-
bly. The secondary fever, or fever of suppura-
tion, is very severe, and runs an irregular course;
with it there is violent delirium, and often stupor;
MORE.
17
242
SPECIFIC INFECTIOUS DISEASES.
diarrhoea is frequently present. Convalescence is
delayed and irregular. The confluent form often
leaves deafness, bad vision and terrible pitting.
Malignant Form.-The poison seems to pros-
trate the patient at once, and he never rallies,
dying even before the eruption appears. Or, if
the eruption appears, the pustules become filled
with blood. Hemorrhages are very common in
this form of smallpox.
Varioloid, or modified smallpox. Smallpox
appearing in one protected by vaccination, or by
a previous attack of smallpox, runs a very short
and mild course, with no secondary fever, this
form is known as varioloid.
Complications.--Laryngitis; pneumonia; pleu-
risy; myocarditis; dysentery; boils; abscesses.
Sequelæ.-Defective vision and hearing.
Differential Diagnosis.-Chickenpox.—The
fever follows the eruption, and the vesicles do
not pustulate, nor are they umbilicated.
Scarlet Fever begins with headache, vomiting
and sore throat; the eruption appears earlier than
in smallpox, and does not have the characteristic
changes that denote smallpox.
Prognosis. In the discrete and varioloid
forms favorable. In the confluent and malignant
forms, must be guarded. If appearing in preg-
nant females, smallpox is nearly always fatal.
Treatment.If called to see the case early
you should, if you can conscientiously do so,
vaccinate the patient and rest of the family, if
they have not been lately successfully vaccinated.
The patient must be isolated; the room must be
SMALLPOX.
243
devoid of all unnecessary furniture, carpets, cur-
tains, etc.; it must be well ventilated and kept
cool, about 65° F.; and kept dark. The patient
must be confined to bed, upon a mattress; the
patient and everything around him must be kept
clean. Disinfect everything; the peculiar odor
may be destroyed by carbolic acid in saucers
placed around the room. Protect the eruption
from injury; let patient's hands be padded to
keep from scratching the eruption. To prevent
pitting, there are many things advised, painting
each pustule with collodium, or a five to ten per
cent. solution of Ichthyol seem to have some
result, vaseline applied to each pustule also helps
to keep in check the itching at any rate. Lint,
soaked in a very weak solution of Bichloride of
Mercury, applied to the face in the form of a
mask, is about the best application. They now
claim by keeping certain colored rays of light
from the patient will prevent pitting. But, if
the pustules have dipped deep enough, there is
nothing that will prevent pitting. The nose and
mouth of the patient must be frequently washed
with some mild antiseptic solution.
The eyes
also must be frequently bathed with boracic acid
solution. Give frequent baths during convales-
cence for they help to loosen the scabs.
Diet.-Must be liquid and nutritious.
REMEDIES.
Aconite. For the initial fever.
strong; the patient anxious and restless.
Antimonium Tart.-This is the medicine for this dis-
* Given early it will reduce the fever, the pustules
ease.
Pulse is full and
244
SPECIFIC INFECTIOUS DISEASES.
-X-
will run their normal course, and leave very little or no
pitting. Especially useful for pulmonary and gastric
disturbances. * Abortive power is claimed for it.
'Given early it mitigates the severity of the disease."
-Dr. Gatchell.
Enjoys a greater reputation in the treatment of small-
pox than does any other medicine."-Dr. Goodno.
"The chief remedy in all stages of the disease.”—Dr.
Hale.
((
Arsenicum. For desperate cases; the skin becomes
blue; the eruption is hemorrhagic, and dark.
* Great
prostration; the pulse is small, thread-like.
black smallpox.
* So called
Belladonna.-Preferred to Aconite, by some, for the in-
itial fever. * Congestion to the head; throbbing carotids.
*Starts and jumps in his sleep, and other well known
symptoms of this drug.
Camphor. Sudden sinking of the vital forces.
Coffea. *For extreme nervousness.
Mercurius. For the suppurative fever.
as soon as pus appears in the eruption.
Opium. Excessive drowsiness; stertorous breathing.
Rhus Tox.-* Eruptive stage; the skin is inflamed with
stinging, burning and itching.
"Invaluable, often modifies in considerable degree the
cutaneous inflammation and thus favorably influencing
the future of the case."-Dr. Goodno.
Stramonium.-* For the violent delirium.
Sarracenia.Extensive claims have been made for this
drug; it is credited for having cured and modified small-
pox in all of its stages.
Sulphur.
*
For the itching during the drying stage.
Thuja. Recommended by Bonninghausen.
Vaccininum. Has given a number of physicians good
results as a routine medicine.
* To be given
VACCINIA.
Synonyms.-Vaccination; cowpox.
Definition.-A general disease with constitu-
VACCINIA.
245
tional disturbance, and a local manifestation,
which affords, more or less, protection from
smallpox.
Bovine Virus is obtained from the udder of the
calf while enduring an attack of cowpox.
Humanized Virus is obtained from the vesicle
of a person who has been vaccinated.
Mode of Vaccinating.-Render arm aseptic;
then scratch with lancet, or the ivory point, the
skin until it is just ready to bleed, when the virus
must be rubbed in.
1
Time to Vaccinate.-About the third month
of life, then about the seventh year, and again at
puberty, and after any exposure to the contagion
of smallpox. More scars of vaccination, less
liability to take smallpox."
(C
Symptoms. There are some constitutional
symptoms; and often a rash over the body. On
the second, or third day after vaccination there
appears at the seat of vaccination a papule, with
a reddish areola. In about three days the pap-
ule becomes a vesicle, which is umbilicated. In
a few more days the vesicle becomes a pustule.
In a few days more, or about the tenth day, the
pustule begins to dry, and the areola fades; and,
in two days the scab has formed. About the
third week the scab becomes detached, leaving
the "scar.'
Treatment.-If there is considerable constitu-
tional disturbance, confine patient to bed, with
liquid diet; and, treat the symptoms as they
arise.
246
SPECIFIC INFECTIOUS DISEASES.
Remedies.-Silicea and Thuja are given after
vaccination by many physicians.
VARICELLA.
Synonym.-Chickenpox.
Definition. An acute, contagious, febrile dis-
ease, characterized by a vesicular eruption.
Etiology. Exact cause not known. It is a
disease of childhood. Has no relation to small-
pox.
Symptoms. The period of incubation is about
ten days. The attack commences with slight
constitutional disturbance, and, a vesicular rash.
within the first day. The vesicles first appear
upon the trunk, rarely upon the face. These
vesicles appear in crops of several days' duration;
the vesicles dry and scab by the fifth day, they
seldom leave scars, and, rarely become pustular.
Duration.-One week.
Prognosis. Rarely cause death.
Treatment. Rest in bed, and light diet, if
the symptoms are severe enough to demand it.
Remedies. Aconite, if there is much fever;
otherwise, Rhus tox. accomplishes all that is
desired.
SCARLET FEVER.
Synonym.
Scarlatina.
Definition. An acute contagious disease,
characterized by a rash and a sore throat.
Etiology. The specific cause has not been
discovered. The contagion is usually conveyed
SCARLET FEVER.
247
by fomites, or carried in the air, or in the food,
particularly milk. A disease of childhood, but
adults are frequently attacked. One attack gen-
erally gives immunity from subsequent infection.
Varieties. Simple; anginoid; malignant.
Pathology. There are no specific lesions.
There is a true dermatitis; a granular degenera-
tion of the muscles; and, changes in the glandu-
lar structures throughout the body.
Symptoms. The period of incubation is from
a few hours to some two weeks, usually about
five days. An attack is ushered in with chilli-
ness, rarely a defined chill, or, in young children,
with a convulsion; there is a rapid rise in tem-
perature, often reaching 105° F. during the first
day; severe headache; vomiting, usually pro-
jectile in character; and a sore throat. The
pulse is very high. At the end of the first, or
beginning of the second day, there appears a
bright, red rash; appearing first upon the neck
and chest, but, rapidly spreads over the body;
and there is no intervening healthy skin; the
rash disappears upon hard pressure. The skin is
very hot to touch; the throat is violently inflamed;
and the glands of the neck are swollen. There is
intense headache; possibly delirium. The tongue.
now has raised papillæ, giving it the "strawberry"
character. The fever is severe for some five days,
when it declines by lysis; and the eruption begins
to fade; in from six to nine days desquamation
begins, and continues for some one to two weeks.
The convalescence is usually slow.
Anginoid Form.-This is the so-called
"throat
248
SPECIFIC INFECTIOUS DISEASES.
form '' of scarlet fever. Together with the above
symptoms, there is violent inflammation, and pos-
sibly ulceration, of the throat; the tonsils swell
and may have false membranes on them; and the
glands of the neck are also swollen.
Malignant Form.-The onset is marked by a
violent chill; exceedingly high temperature, may
reach 108° to 110° F.; delirium, followed by
coma; and the rash, if it appears, is dark in color.
Often death occurs before the appearance of the
rash.
Complications.- Nephritis; inflammation of
the heart, or ear; ophthalmia; adenitis; pneu-
monia.
Sequelæ.
rhoea; Bright's disease.
Chronic throat or ear disease; diar-
Differential Diagnosis.-Acute dermatitis has
not the high fever; nor the sore throat; nor the
enlarged glands; that characterize scarlet fever.
Diphtheria has a membraneous and adherent
exudation; the fever is not high; and, seldom a
rash.
Measles commences as an ordinary coryza; the
eruption appears late; and first upon the face; is
papular; and arranged in crescentic patches.
Duration.-From three to four weeks.
Prognosis. If uncomplicated, good; other-
wise, must be guarded.
Treatment. Isolate the patient, and confine
him to bed, in a large, upper room, which must
be well ventilated, and kept cool; and thoroughly
disinfect everything. The patient must be bathed
several times a day; and his linen changed, at
j
SCARLET FEVER.
249
least, every day. Encourage him to drink plenty
of water. Examine the urine for kidney compli-
cations. When the eruption appears apply car-
bolized vaseline or cocoa-butter; this keeps down
the itching, and helps the patient to be more
comfortable. The diet must be liquid, preferably
a milk diet. Belladonna may be used as a pro-
phylaxis.
REMEDIES.
Aconite.-* Only at the commencement of the fever,
dry, hot skin; restlessness; full, hard pulse.
Ailanthus. The child becomes drowsy and stupid;
headache, with hot, dark-red face. *The throat is swol-
len; there is an excoriating nasal discharge. *The rash
is scant; and of a dark, bluish color. * Violent vomiting.
* Malignant cases.
Apis. Very high fever, with drowsiness; and ner-
vous restlessness.
The throat
The throat is swollen; the mouth and
tongue are very red; and the tongue has blisters on it.
*The rash is of the miliary kind. *The urine is scanty;
and dropsical symptoms are present.
Arsenicum. When the eruption does not come out.
properly; or, suddenly becomes pale; the skin cold; and,
rapid prostration; with, or without convulsions.
*Rest-
less and anxious; with thirst. *For the dropsy.
Belladonna. * For the fever; particularly, if with signs
of cerebral congestion; injected eyes; throbbing carotids;
and, smooth eruption.
T
Bryonia. To develop the eruption.
Calcarea Carb.-When the rash is either undeveloped,
or else recedes, leaving the face unnaturally pale and
bloated (Farrington).
*
Cuprum Acet.- Signs of metastasis to the brain.
* Retrocession of the eruption, with vomiting and con-
vulsions.
*
Mercurius. The glands are greatly swollen. Ulcera-
250
SPECIFIC INFECTIOUS DISEASES.
tion of the throat. *
prostration.
Opium. Drowsiness; stertorous breathing; and vomit-
*
ing.
Rhus Tox.-* Typhoid symptoms. The rash is dark-
colored and itches. Child becomes drowsy and restless;
tongue red and smooth; fauces dark-red and oedematous.
"No medicine with which I am acquainted is as gener-
ally valuable in scarlet fever."-Dr. Goodno.
Sulphur. -* Bright redness of the whole body.
lent itching.
tion.
Salivation; fetor of the breath; and
"Ever since I had an opportunity of testing the excel
lence of Hering's advice to give Sulphur if the skin looks
red like a boiled lobster, I have employed Sulphur, even
if this redness was not yet visible, in the precursory stage
of the disease, following it up sometimes with Calcarea,
by which means I have succeeded in many cases in im-
parting to the exanthema a benign character so that no
other treatment was required to secure an easy termina-
tion of the disease without any further dangerous com-
plication."-Dr. Jahr.
Zincum.-Threatened paralysis of the brain.
MEASLES.
*Vio-
Synonyms.--Rubeola; morbilli.
Definition.-An acute, contagious disease,
characterized by an initial coryza, fever and erup-
P
Etiology. Its specific cause is, as yet, un-
known. The contagion can be carried in the
clothes. As a rule, it is an epidemic disease, and
attacks children. One attack is generally pre-
ventive against future infection.
Pathology. No special lesion.
Symptoms. The incubative stage is about
one week. The attack begins as a severe cold in
(
MEASLES.
251
the head.
There is chilliness; discharge from
the nose, and eyes; the eyes become suffused;
headache; and, pains throughout the body.
Fever rises rapidly during the first day, but
remits on the second day for several days; the
other symptoms continuing. In several days, or,
on the fourth day of the disease, there appears an
eruption, first upon the face, then rapidly spread-
ing over the body. This eruption is composed of
small papules, slightly elevated, with a pale-red
border, arranged in crescentic patches, with
healthy skin between them. With the appear-
ance of the eruption the fever again rises; the
discharges from the respiratory track becomes
thick; the inflammation may extend to the bron-
chial tubes. After the eruption is out for several
days, it begins to fade, and desquamates in branny
scales; and, the fever falls by crisis as the erup-
tion fades.
Malignant, hemorrhagic, or black measles: The
eruption assumes a vesicular form, and becomes
hemorrhagic. There is great prostration; and
hemorrhages are common.
Complications.--Bronchitis; pneumonia; stom-
ach trouble; ophthalmia.
Sequelæ. Scrofula and tuberculosis.
J
Differential Diagnosis.--The onset with ca-
tarrhal symptoms; the rash appearing on the
fourth day, and first upon the face; the rash be-
ing papular in character, arranged in crescentic
patches; with branny desquamation; will serve to
prevent mistakes being made.
Duration.-From ten days to two weeks.
252
SPECIFIC INFECTIOUS DISEASES.
Prognosis.-Good. Black measles are very
fatal.
Treatment.-Isolate the patient to prevent
the disease from spreading. Have the room well
ventilated; protect patient's eyes from the light,
by screens, or smoked glasses. Confine the pa-
tient to bed; give frequent sponge baths. For
the itching of the skin, apply vaseline or cocoa-
butter. Diet to be light and liquid.
Remedies. For the fever, restlessness, etc.,
Aconite is the remedy; and, when the fever abates
some, and the catarrhal symptoms are pro-
nounced, Pulsatilla. If the eyes are much in-
flamed, with watery discharge, Euphrasia. For
the severe bronchitis, Bryonia. Eruption re-
tarded, with nausea and oppressed breathing,
Ipecacuanha. Black measles usually call for
Arsenicum.
Ng
ROTHELEN.
Synonyms.-Rubella; German measles; epi-
demic measles; epidemic roseola.
Definition.-An acute, contagious disease,
characterized by a slight febrile attack, swelling
of the lymphatic glands of the neck, and, a char-
acteristic eruption.
Etiology. Its specific cause is unknown.
Highly contagious; and usually attacks children;
one attack prevents subsequent attacks. Appears,
as a rule, in epidemics.
Symptoms.-The stage of incubation is from
one to three weeks.
weeks. The onset is not marked, in
ERYSIPELAS
253
fact, it is often so mild that the eruption is the
first symptom to attract the attention. The onset
may be marked by a slight fever; drowsiness;
malaise; headache, and sore throat. The glands.
in the neck and adjacent parts are swollen. On
the second or third day there is a rash, which
varies in character, but usually of a pale red
color, appearing first on the face; this rash lasts.
only a couple of days, when it disappears, with or
without desquamating. The fever ends in lysis.
Duration.-About one week.
Prognosis. Good.
Treatment.-Same as for measles.
ERYSIPELAS.
Synonym.-St. Anthony's fire.
Definition.-An acute, specific, contagious dis-
ease, caused by streptococci, and having a char-
acteristic inflammation of the skin.
Etiology. The exciting cause is the streptococ-
cus erysipelosus. The predisposing causes are:
any disease which lowers the vitality of a person;
woman, during the puerperal state; those suffer-
ing from wounds; and, a previous attack.
Pathology.-A dermititis, with inflammatory
œdema; and the lympth spaces of the skin are
filled with the streptococci.
A
Symptoms. The stage of incubation varies
from one day to a week. The onset may begin
with chilliness, malaise, slight fever, with ting-
ling in the part about to be affected. Usually,
however, the onset is marked by a distinct chill,
254
SPECIFIC INFECTIOUS DISEASES.
followed by rapid rise of temperature, often
delirium; during the first twenty-four hours, the
locality to be affected; which is generally about
the nose, or on the cheek, becomes swollen, from
the œdema, it is red and shiny in appearance,
with a well developed line of demarcation between
the diseased and healthy skin. There is a sensa-
tion of tension, and tingling in the part. The
swelling, even on the second day, may be so
severe as to close the eyes. Vesicles, filled with
clear serum, often form on the part; and several
vesicles may unite forming one large bulb. About
the fifth day the eruption begins to fade, the
temperature falls by crisis, and the other symp-
toms gradually subside. Relapses are very com-
mon.
Erysipelas ambulans is when the erysiplas
wanders."
Erysipelas phlegmonous is when the œdema is
very great.
Complications. - Septicemia; albuminuria;
ulcerative endocarditis; pneumonia.
Differential Diagnosis.-By paying attention
to the development of the disease, and the char-
acteristic appearance of the part, no mistake
should occur.
Duration.-From five to seven days.
Prognosis. Favorable, if there is no compli-
cations.
Treatment. The patient must be isolated.
Confine the patient to bed; give frequent sponge
baths. It is far better to use no local treatment;
but, cloths wrung out of Bichloride of Mercury
M
ERYSIPELAS.
255
solution (1:5000) may be applied to the diseased
part; or, Ichthyol, in Collodion, may be applied;
or, simply rye flour. The diet has to be liquid
and nutritious. Stimulants are seldom necessary.
Aconite.-
- For the initial chill and fever. * The skin
is red, shining, hot and swollen; with tingling and burn-
ing.
"
REMEDIES.
In phlegmonous erysipelas our first reliance must be
on Aconite."-Dr. Hughes.
Ammonium Carb.-* In old people; with cerebral symp-
toms.
Apis.-* When the swelling begins about the right eye
and spreads to the left. *The parts are at first of a pink
color, but soon become purple. *Edema must always
be present. Fever is high, the skin is hot and dry; and
rarely any thirst. When the mouth and fauces are
affected. *Burning and stinging pains. Urine dark
colored and scanty.
44
Preferred if oedema is marked, or the inflamed sur-
face pale."-Dr. Goodno.
Arsenicum.~* Great prostration of strength; typhoid
symptoms; the parts become dark, with tendency to
gangrene.
Belladonna. -* With cerebral irritation; throbbing caro-
tids; injected eyes; jumps and starts in his sleep.
*The
part is slightly, if at all, swollen; the skin is bright red in
color, shiny and smooth. *The pains are violent; par-
ticularly with deep throbbing. *No tendency to œdema
or to form vesicles.
"In the ordinary smooth variety with active inflamma-
tory changes, Belladonna is of undoubted value."-Dr.
Goodno.
'Almost the only remedy indicated in the red, smooth,
phlegmonous variety."-Dr. Hale.
"A true picture of phlegmonous erysipelas.”—Dr.
Farrington.
256
SPECIFIC INFECTIOUS DISEASES.
-*-
Cantharis. Vesicular erysipelas; the vesicles contain-
ing an excoriating fluid.
Graphites." Wandering" erysipelas; to eradate the
predisposition to erysipelas; and, after the abuse of
Iodine.
"Seems to be the most generally efficient." - Dr.
Goodno.
Hepar Sulph. To be given to promote suppuration, if
it should threaten.
Rhus Tox.—* Vesicular erysipelas; particularly when it
affects the scalp and face. *The erysipelas commences
on the left side and goes to the right. *The part is dark
red in color; with burning and stinging.
"A perfect picture of vesicular erysipelas."-Dr. Far-
rington.
"Our best remedy for vesicular erysipelas.”—Dr.
Laurie.
colitis.
DYSENTERY.
Synonyms. Bloody flux; intestinal flux;
Definition. An acute, catarrhal or croupous,
inflammation of the mucous membrane of the
colon, characterized by fever, bloody stools, and
violent tenesmus.
Varieties.-Acute catarrhal; tropical or amnœ-
bic; malignant or diphtheric; malarial.
Etiology.-Impure air, bad hygienic surround-
ings; exposure to atmospheric changes; malaria.
The summer and early autumn are predisposing
causes. Dysentery is an infectious disease. The
discharge of a dysenteric patient having under.
gone certain changes of decomposition seem to
develop a specific dysenteric miasm. The tropi-
cal form is excited by the Amaba coli (Lösch).
(
DYSENTERY.
257
Pathology. There is hyperæmia and inflam-
mation of the mucous membrane of the colon,
with redness and swelling. The swelling of the
mucous membrane closes the follicles, which also
become swollen from the retention of their con-
tents. Often, some of the capillaries in the walls
of the follicles rupture and fills them with blood.
The follicles may discharge their contents and
form ulcers. In the amabic dysentery we find
amaba in these ulcers. In the malignant form
there is the formation of a false membrane, which
ulcerates and sloughs off.
Nag
Symptoms. Generally ushered in by distinct
rigors, followed by fever. Soon there is frequent
calls to evacuate the bowels; at first the stools
are diarrhoeic, but soon change into mucus, or
bloody mucus, with the peculiar dysenteric odor.
In the amabic form we find the amaba coli in the
stools; while in the malignant form we find the
false membrane. The frequency of the stool
varies from only a few to forty or fifty, or even
more, in the twenty-four hours; the average
number being about ten. There is soon devel-
oped with the stool a painful bearing-down sensa-
tion in the abdomen; it may be so severe as to
cause fainting. Also, there may be retention or
painful passing of the urine. With these charac-
teristic symptoms there is nausea, vomiting and
other gastric symptoms. The patient loses
strength, becomes anæmic to the extreme, and in
severe cases have typhoid symptoms.
Differential Diagnosis.--Acute intestinal ca-
18
258 SPECIFIC INFECTIOUS DISEASES.
tarrh has no bloody discharges and no tenesmus.
Complications.-Abscess of the liver; peri-
tonitis; typhoid fever.
Duration. About ten days; but often lasts
from three to five weeks. Homœopathic treat-
ment may cut it short in any stage.
Prognosis.-Must be guarded; but if uncom-
plicated, good.
Treatment. Place the patient in a large,
well ventilated room. Insist upon absolute rest
in the recumbent position; use bed pans; and dis.
infect all discharges as soon as passed. Warm
applications over the abdomen, or intestinal irri-
gation with warm water, or warm water with the
white of an egg beaten in it, often proves very
soothing to the patient. The diet must be liquid
and highly nutritious; going back to solid food
very cautiously after the patient is fully conva-
lescent.
REMEDIES.
Aconite. At the very commencement; with fever, anx-
iety, restlessness, and fear of death, knows he is going to
die. The pulse is full and hard. The stools are bloody,
slimy, mucous, scant and frequent; with tenesmus.
*
"In the very beginning, is often able to cut short dys-
entery, without any other remedy."-Dr. Bell.
"If sets in with violent fever, Acon. in many cases
cures the whole disease in two or three days."-Dr.
Jahr.
(C
The main remedy."-Dr. Lutze.
Aloes.-*Violent tenesmus. *The stool consists of lumps
of mucous, or bloody mucous. *Sense of weakness in the.
rectum, as if the stool would escape involuntarily. *Weak-
ness and faintness after stool.
Arsenicum.
* In the late stage, when there is extreme
i
DYSENTERY.
259
prostration; anguish; restlessness; and fear of death.
*Violent, burning thirst, drinks little and often. *Rapid
and scarcely perceptible pulse. *The stools are dark,
watery, frequent and offensive.
Baptisia. As soon as the disease shows a typhoid tend-
ency. *Face dark red, with a besotted look. *Cannot
sleep; feels scattered about; tosses about to get himself
together. *Sore, bruised feeling over the whole body.
*Tongue dry, coated yellow-brown in the centre, with
red, shining edges.
*The stools are pure blood, very
offensive, and often painless.
"Extended clinical observation has proved its value
when dysentery assumes the typhoid type.”—Dr. Bell.
"When the discharges are offensive, and contain blood,
and are attended by tenesmus, but with a significant
absence of pain, showing an alarming depression of
vitality."-Dr. Farrington.
Belladonna.-*Flushed face; dilated pupils; throbbing
of the carotids. *Head hot, hands and feet cold. The
child is stupid, drowsy; starting; twitching of the mus-
cles during sleep. * The abdomen is very sensitive to
touch. The passages are bloody, and frequent.
Often the only remedy required for severe cases of
infantile dysentery.”—Dr. Bell.
Cantharis. Anxious, restless. Violent pains in the
abdomen. *Burning in the abdomen. *Stools white or
pale reddish mucous, like scrapings of the intestines;
bloody mucous. Tenesmus. *Frequent, painful, in
effectual desire to urinate. * Retention of the urine.
Capsicum. -Stools mucous; streaked with blood; ex-
pelled with force. *Thirst, drinking causes shuddering.
*Tenesmus after stool.
Colocynthis.*Intense cutting, griping, or squeezing
in the intestines; aggravated from eating or drinking,
relieved by bending double. Stools mucous or bloody.
Ipecacuanha.—* Constant sense of nausea. * Stools
bloody; dark, almost black, looking like frothy molasses.
Kali Bich.-*The tongue is dry, red, smooth and
cracked. Debility, with desire to lie down. *The stools
44
Add
260
SPECIFIC INFECTIOUS DISEASES.
are bloody, jelly-like; look like chopped up blood and
mucous. *Occurs periodically every year.
Mercurius Cor.-Cold face and hands, with small feeble
pulse. Distension and soreness of the pit of the stomach.
* Continual urging to stool; with a never-get-done feel-
ing; must strain. *Faint, sickish, colicky pain in the
abdomen, ameliorated by the stool, and prolonged tenes-
mus after the stool. * Stool bloody; slimy; containing
shreds of mucous membrane; they are scanty and fre-
quent; with continued urging. * Tenesmus vesicæ.
*Faintness and weakness.
The first place."-Dr. Goodno.
Our great remedy *** an exact similimum to all
the essential features of an ordinary attack of dysentery."
Dr. Hughes.
'May safely be regarded as a specific remedy for the
whole process "-Dr. Bachr.
Nux Vom.-* The patient is irritable and desires to be
left alone; wants to lie down. The stools are thin,
bloody mucous; and with each evacuation of blood and
mucous there is a small portion of natural fæces passed
(Guernsey). *Severe pain in the back, and tenesmus
before stool, with complete relief after stool.
Rhus Tox. *In late stage when dysentery shows
tendency to assume the typhoid form. *The patient is
restless; wants to constantly change his position.
*The
tongue is dry and rough, with red edges and triangular
red tip. * Excessive craving for milk. * Laborious
dreams of excessive bodily exertion. * The stools are
thin, bloody, jelly-like mucous; bloody water, like wash-
ings of beef.
*
Sulphur. Tendency to relapse; or, when our well-
chosen remedies fail to act.
CHOLERA.
Synonyms. Asiatic cholera; epidemic cholera;
malignant cholera.
Definition.—An acute, specific, infectious dis-
(
CHOLERA.
261
ease, usually epidemic, caused by the comma
bacillus of Koch, and characterized by violent
purging of a characteristic "rice-water" fluid,
cramps, and symptoms of collapse.
Etiology.-Exciting Cause--Comma bacillus
of Koch. The bacilli are given off from the
body through the bowels; and, contaminating
the water used for drinking, finds an entrance
into the body.
Intemperance, bad hygienic surroundings,
summer season, and old age, are predisposing
causes.
Pathology. There are no characteristic
lesions. After death the body will stay warm for
quite a while; rigor mortis sets in early; and often
there are violent muscular contractions, which
may move the corpse. The body will be shrunk-
en; the arteries empty, and the veins distended.
The intestinal mucous membrane is pale; but, the
glands are congested, and swollen, possibly ulcer-
ated; the intestinal track contains rice water'
fluid, and the peculiar bacilli.
Symptoms. The stage of incubation lasts for
several days. The attack has three stages: (1)
invasion; (2) collapse; (3) reaction.
Stage of Invasion. This stage may last for a
couple of days; the patient complaining of ma-
laise, headache, weakness; he has several diar-
rhoeic stools each day, with rumbling in the
abdomen, and slight pain.
Mga
CC
>
ally
Stage of Collapse.-This stage lasts from a few
hours to several days. The diarrhoea now be-
comes profuse, frequently gushing, consisting of
262
SPECIFIC INFECTIOUS DISEASES.
the characteristic "rice water' fluid. The body
becomes cold and shriveled; the temperature of
the axilla, and temperature per rectum varies.
several degrees. There is violent vomiting; and
terrible cramps of the muscles throughout the
body.
Stage of Reaction.-The surface temperature
rises; the vomiting ceases; the passages from the
bowels are not so frequent, and are more natural;
the other symptoms gradually disappear; and,
convalescence begins.
CHOLERA SICCA.
Sometimes collapse, followed by death, sets in
without the characteristic "rice water" dis-
charges; this is called cholera sicca.
CHOLERINE.
When the patient only experiences the first
stage, convalescence setting in before the second
stage is reached.
Complications.-Pneumonia; pleurisy; neph-
ritis; parotitis; abscesses.
Differential Diagnosis.
Microscopical ex-
amination of the stools will decide the diagnosis.
Prognosis. Must be based upon the character
of the prevailing epidemic; and, must always be
guarded.
Treatment.Confine the patient to bed im-
mediately upon the first sign of cholera; better
give him no food whatever until the disease is
under control; then only nutritious liquid food;
ice may be allowed in moderate quantities.
(
CHOLERA.
263
Disinfect all discharges; all bed linen; etc. As
soon as patient becomes cold apply artificial heat.
Some advise the injection into the rectum of
several pints of water.
REMEDIES.
Arsenicum.-*Sudden prostration, with sinking of the
vital forces. *Violent vomiting and purging. *Surface
of the body cold. internally the patient is very hot, burns
like fire. *Great anguish, restless, fear of death. *Thirst,
drinks little and often. Dyspnoea. Suppression of the
urine.
+4
The medicine most trusted in collapse."-Dr.
Hughes.
"Arsenicum also excites intestinal disease which is
almost identical with cholera Asiatica.-Dr. Farrington.
"Rapid cases where cholera algida at once sets in with-
out any premonitory symptoms."-Dr. Baehr.
Camphora.
At the commencement. *Onset sudden;
and the disease rapidly becomes worse; the patient is at
the very onset overwhelmed by the poison, even before
the diarrhoea sets in: the skin is cold and blue, yet does
not want to be covered; extreme prostration; and per-
haps a nausea and vomiting. *Burning in the abdomen;
with great anguish.
"Perfectly homeopathic to cholera in the state of
invasion.”—Dr. Hughes.
"It is the first stage that camphor affords instantane-
ous relief."-Dr. Hahnemann.
"A complete photograph of cholera."-Dr. John
Davis.
"The specific against cholera."-Dr. Rubini.
Carbo Veg. In the later stages, with symptoms of
collapse. *The diarrhea, vomiting, and cramps have
stopped, and the patient lies as if dead; no signs of re-
action. The face is pale, the lips blue, body cold, even
the breath may be cold; the pulse is hardly perceptible,
threadlike; wants to be fanned.
264
SPECIFIC INFECTIOUS DISEASES.
"In the course of the disease when no special medicine
is decidedly indicated."-Dr. Baehr.
Cuprum Acet.-*When the diarrhoea, vomiting and
cramps are severe. *The body is cold; the skin blue;
terrible dyspnoea. *Symptoms of paralysis of the organ-
ism; gurgling and rumbling in the bowels, particularly
when the diarrhoea has stopped. *Cold water relieves
the vomiting.
"For the stage of full development."-Dr. Goodno.
Confessedly the best remedy for the choleraic cramps,
and for the vomiting also, when this is a prominent fea-
ture."-Dr. Hughes.
"
Hydrocyanic Acid. "The only remedy when, along
with pulselessness, the respiration is slow, deep, gasping
or difficult and spasmodic, taking place at long intervals,
the patient appearing dead in the intermediate time. If
any remedy is entitled to be spoken of as a charin, it is
this. It would seem at times to restore animation to a
corpse."-Dr. Sircar.
Jatropha Cur.-Has been recommended for cholera.
Terebinthina.-*Persistent suppression of the urine.
Veratrum Alb -The attack begins with vomiting,
purging and violent cramps. *Terrible weakness, es-
pecially after vomiting. *The patient is cold, covered
with cold sweat, particularly on the forehead. Pulse
small, almost imperceptible. *Thirst for cold water.
*Cutting in the abdomen.
"Most important remedy for cholera.-Dr. Baehr.
Fully indicated during the first and second stages."
-Dr. Hale.
((
"Cases marked by profuse vomiting and purging, with
coldness indeed, but without deadly callapse and liv-
idity."-Dr. Hughes.
LEPROSY.
Synonyms.
Lepræ; Elephantiasis Græ-
Definition. — A chronic infectious disease
corum.
DROPSY.
265
caused by the bacillus lepra, characterized by the
presence of tubercular nodules in the skin and
mucous membranes (tubercular leprosy) or by
changes in the nerves (anæsthetic leprosy) At
first these forms may be separate, but ultimately
both are combined, and in the characteristic tuber-
cular form there are disturbances of sensation
(Osler).
Etiology. The exciting cause is the bacillus
lepræ. Very little, and nothing definite, is
known of its etiology.
Symptoms. Tubercular Leprosy. Here and
there over the body patches of erythema appear,
these patches are hyperæsthetic and pigmented,
soon the patches develop into tubercles, which
may ulcerate and form ulcers. The hair falls out;
and changes in the throat cause alteration in the
voice.
Anesthetic Leprosy.-Areas of hyperæsthesia,
followed by anæsthesia, develop over the body
from the disease attacking the nerves. Bullæ
may form; the muscles waste away; and a degree
of paralysis develops.
Duration.-Years.
Prognosis. Ultimate recovery almost im-
possible; though life may be prolonged for a con-
siderable time
Treatment. Isolate patient. Provide for
good hygenic surrounding and nutrious food;
and treat symptoms as they arise.
Remedies.
"The principal internal remedies
are Hydrocotyle, Hoangnan, and Piper Methysti-
cum."-Dr. Kippax.
266
SPECIFIC INFECTIOUS DISEASES.
RABIES.
Synonyms. Hydrophobia; lyssa; la rage.
Definition.-An acute, infectious disease of
animals, caused by a specific poison, as yet un-
known, and given to man by inoculation.
Etiology.-Always caused, in man, by direct
inoculation.
Symptoms. In man.
tion varies greatly, from
months.
There are three stages.
First Stage, or premonitory stage. The wound
generally begins to be irritable; the patient feels.
depressed; he is excitable, the least noise startles
him; swallowing becomes difficult; these symp-
toms last for several days, when the
Second Stage, or stage of excitement, sets in.
There is now decided hyperæsthesia; spasms,
particularly of the muscles of the throat, excited
by the sight, sound, or thinking of water; the
spasm lasts about one-half hour. There is violent
and furious delerium, he strikes and bites those.
around him.
The stage of incuba-
three weeks to six
Third Stage, or paralytic stage. This stage
seldom lasts over twenty hours.
The spasms
and delirium subside; the patient lies motionless;
the mind becomes clouded; paralysis sets in; and
death, from syncope, ends life.
Prognosis. Very unfavorable.
Treatment. Immediately upon being bitten.
have the wound washed out, and cauterized; and
(
TETANUS.
267
give belladonna, or hydrophobium; or, if pre-
ferred, give the "Pasteur treatment.”
For the convulsions, give such remedies as
seem indicated. Dr. Hering says: "Give
Lachesis."
7
REMEDIES.
Belladonna.—The leading remedy for this distressing
disease. To be given as soon as the person is bitten; is
also an excellent remedy for the spasms.
Arsenicum, Hyoscyamus, Lachesis, Mercurius, Stram-
onium, and Scutellaria are among the remedies to be
studied.
TETANUS.
Synonyms.-Lockjaw; trismus.
Definition.-An acute infectious disease, caus-
ed by the bacillus of tetanus, and characterized
by paroxysms of tonic convulsions.
Etiology. The direct cause is the tetanus
bacillus, which usually gains an entrance into
the body through a wound.
Symptoms. There are spasms, excited by
the least cause, affecting first the muscles of the
jaw, neck and back, then the other muscles of the
body. Dyspnoea is frequently present. Pain
throughout the body is violent; the mind is clear;
death usually results from inability to take food.
Prognosis. Very unfavorable.
Treatment.-Attend to the surgical treatment
of the wound.
The patient must be kept quiet and free from
all excitement and noise; the room to be dark-
ened, and free from drafts.
268
SPECIFIC INFECTIOUS DISEASES.
It is very important to have the patient well
nourished; give highly nutritious, liquid food,
administering a small amount of food at a time
but give it often. If the spasms affects the mus-
cles of the jaws, causing them to become locked,
then have a tooth pulled so as to admit the food,
or, give the food per rectum.
The lower triturations of Strychnia, or Aconite
in idiopathic cases, seem to have a favorable in-
fluence in this disease. But Arnica, Arsenicum,
Belladonna, Cicuta, Cuprum, Hydrocyanic acid,
Hyoscyamus, Ignatia, Lachesis, Rhus, and Stra-
monium, should be studied.
TUBERCULOSIS.
Definition.—An infectious disease, caused by
the bacillus tuberculosis, the lesions of which are
characterized by nodular bodies called tubercles,
or diffuse infiltrations of tuberculous tissue which
undergo caseation or sclerosis, and may finally
ulcerate, or in some situations calcify (Osler).
Etiology. No race of man is spared from this
disease; animals, particularly the bovines, are also
attacked.
The predisposing causes are: any disease which
lowers the vitality of the person; hereditary influ-
ences; indoor life; bad hygienic surroundings;
certain occupations, as, stone cutting, etc.; early
adult life; and, an attack of influenza.
The exciting cause is the bacillus tuberculosis.
This bacillus was first discovered by Koch, in
1882. It is a numb (having a length of about
TUBERCULOSIS.
269
one-half the diameter of a red corpuscle), rod
shaped, immobile bacillus, with rounded ends,
slightly curved, and when stained looks beaded.
It stains very slowly, but when once stained it
resists the action of acids more than any other
bacillus, except that of leprosy; it is this charac-
teristic that helps to detect it under the micro-
scope.
The bacillus gains admission into the body
through the respiratory track and alimentary
canal; direct hereditary transmission is denied by
some physicians. The expired air of a tubercu-
lous patient is not infective. But, the bacilli are
found in the expectoration, which, when dried,
float in the air, and are taken into the lungs;
this is the most frequent way that the bacillus
finds entrance into the human body. By way of
the alimentary canal it is taken in with the food,
particularly infected beef, and the drinking of
infected milk.
Pathology. The irritation, from the presence
of the bacilli, causes the formation of small gray-
ish nodules known as miliary tubercles.
Miliary tubercles are composed of epithelioid
cells, lymphoid or round cells, often, but not
always, giant cells, a reticulum, particularly at
the periphery of the tubercle, formed from the
connective tissue matrix, and the tubercle bacillus.
In the centre of the tubercle, degenerative
changes commence, from the blood supply being
´cut off. The cells lose their outlines and nuclei,
and no longer stain; finally there is left a yellow-
ish, structureless, cheesy mass, in which the
Ada
270
SPECIFIC INFECTIOUS DISEASES.
bacilli are very abundant. This mass may soften
and be discharged through the bronchial tube,
and leave behind a cavity; or, it may become
encapsulated, and, finally calcified.
The tubercle sometimes undergoes a sclerotic
process, becoming hard and firm.
Infiltrating tubercle is a diffuse inflammation,
with a collection of non-vascular cells, separated
by an ordinary round cell infiltration which, from
the presence of the bacilli, undergoes cheesy de-
generation.
ACUTE OR MILIARY TUBERCULOSIS.
Synonyms. Acute phthisis; galloping con-
sumption.
Definition.-An acute infectious disease, char-
acterized by a scattered eruption of miliary tuber-
cles throughout the body.
Etiology. The causes are those given under
tuberculosis.” There is no known reason why
the disease should pursue the rapid course that it
does.
((
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ܕ
Varieties. (1) General or typhoid; (2) pul-
monary; (3) meningeal.
GENERAL OR TYPHOID FORM.
In this form there is a general infection. The
patient has all of the symptoms of typhoid fever,
except the fever has no regular course.
There
is great prostration, bronchitis, dyspnoea, cyano-
sis, and finally coma.
The absence of the characteristic temperature,
ACUTE OR MILIARY TUBERCULOSIS.
271
eruption, and diarrhoea will serve to differentiate
it from typhoid fever.
PULMONABY FORM.
en-
Frequently, in children, develops after measles
or whooping cough; or, in those suffering from
chronic phthisis. This variety has marked and
prominent pulmonary symptoms; and, usually
begins as a severe bronchitis. There is chilliness,
followed by fever; great prostration; cough, with
expectoration; severe dyspnoea; cyanois;
larged spleen; and, no special physical signs.
Duration. From one to several months.
Prognosis.--Very few, if any, recoveries.
Treatment.-Must be upon general principles;
and treat the symptoms as they arise.
Remedies.-Arsenicum; Calcarea carb.; Iodine;
Phosphorus; Theridion.
MENINGEAL FORM
(Tuberculous meningitis; basilar meningitis;
acute hydrocephalus; dropsy of the brain) is
when the tubercles develop in the membranes of
the brain. It more frequently attacks those from
two to four years of age, and is generally a part
of a general tuberculosis.
Pathology. The tubercles are found prin-
cipally in the pia-mater of the base of the brain;
and, in the arteries of the sylvian fissure. The
lateral ventricles become distended with a serous,
or sero-fibrinous fluid; and the convolutions are
flattened.
Symptoms. The child complains of malaise;
272
SPECIFIC INFECTIOUS DISEASES.
loss of appetite; it becomes dull and drowsy;
the disposition changes, it is irritable, evey noise
seems to fret the child. These symptoms may
last two weeks before the active symptoms of the
disease develop.
The onset may be marked by a chill, or a
spasm, followed by a moderate fever. There is
always present severe headache and vomiting;
the pulse is, at first, very rapid, but soon becomes
slow and irregular. The pupils are contracted.
The child frequently puts its hands to its head,
uttering a shrill cry, the "hydrocephalic cry.
} }
The above symptoms soon change; the violent
headache gives way to a stupor; possibly with
delirium. The pupils become dilated, sluggish,
and, often one pupil is dilated more than the
other. The muscles of the face twitch; the head
is retracted; the abdominal muscles are contract-
ed, causing the abdomen to become "boat shape."
Constipation is obstinate.
Finally the stage of paralysis sets in. Coma
deepens; convulsions are often present. The
muscles of the back are contracted. The eyeballs
are rolled back, showing only the whites of the
eyes. The constipation gives way to diarrhoea;
and, finally a typhoid condition sets in which
usually ends in the patient's death.
Duration.-From one to five or six weeks.
Prognosis.—A very fatal disease.
Treatment. Put patient to bed; have the
room darkened; have no noise, or anything to
disturb the sick one. The diet must be liquid
and nutritious. Cold water applied to the head,
ACUTE OR MILIARY TUBERCULOSIS.
273
and shaving the scalp and applying iodoforın,
have been recommended.
REMEDIES.
Apis. Particularly in the first, or irritative stage.
*The child is very cross; it cries; bores its head into the
pillow; and shrieks out with the pain. *There is squint;
grinding of the teeth; twitching of one side, while the
other is paralyzed. *The urine is very scant.
"Especially suitable to cases of hydrocephalus.”—Dr.
Guernsey.
"Bears a close resemblance to tubercular meningitis."
Dr. Goodno.
"One of the best remedies in tubercular meningitis.
** In some cases, there is a peculiarity of apis, that is
slowness of action. Sometimes you will have to wait
three or four days before you notice any effects. The
favorable action of the remedy is first shown by increased
flow of urine."-Dr. Farrington.
Apocynum. In the stage of effusion. *The head is
large; the forehead projects; the fontanelles are open;
squinting; sight of one eye is lost, the other slightly sen-
sible; paralysis of one side. Constant motion of one leg
and arm. Urine suppressed.
Argentum Nitr. - Last stage. Recommended by Dr.
Grauvogl.
Belladonna. -*In the first stage, until effusion sets in.
*There is great heat of the body; the face is flushed; the
eyes are injected and sparkling; the carotids throb; con-
stantly moans; drowsy; starts and jumps in the sleep;
very sensitive to light and noise; bores the head into
the pillow.
"The sheet anchor after vomiting sets in; and is the
proper medicine as long as effusion keeps off."-Dr.
Hughes.
Bryonia.-Useful from the first signs of cerebral effu-
sion, until symptoms of paralysis sets it. *The child is
very irritable; the face is dark; the lips are dry and
parched, and he constantly wets them with his tongue;
19
274
SPECIFIC INFECTIOUS DISEASES.
constant motion of the jaws as if chewing; nausea and
faintness on sitting up.
Calcarea Carb. -The child is of a leuco-phlegmatic
temperment. *The head is large; the fontanelles are
open; the face is pale; the abdomen is abnormally large.
*The child is sluggish in all its movements; it sweats
about its head during sleep. * Terrible screaming with-
out apparent cause. *The urine is strong.
Calcarea Phos.-Must be differentiated from the car-
bonate. The child is thin, with sunken, flabby abdomen;
has dark skin and hair; the carbonate prefers those of
light complexion and hair.
Cuprum. In the stage of effusion.
* When cramps
and spasms are prominent symptoms. Irregular pulse.
Helleborus.-After the exudation has set in.
*The
patient is unconscious; rolls his head from side to side;
starts and screams. The lower jaw sinks down; the fore-
head is in folds, and bathed in a cold sweat. * Automatic
motion of one arm and one leg. The pupils are dilated;
and, there is strabismus. Desire for cold water.
* Urine scanty and dark with coffee-ground sediment; or,
entirely suppressed.
"Cases in which apathy is the prominent feature."
Dr. Goodno.
Iodine. Mentioned by Dr. Jousset as a remedy for the
incipient stage.
Iodoform.- -"Stands at the head. This drug has in
several instances produced symptoms indistinguishable
from meningitis.”—Dr. Goodno.
Opium.Coma, with stertorous breathing.
Sulphur.-On general principles.
Zincum.-Threatened paralysis of the brain.
PULMONARY TUBERCULOSIS.
Synonyms. Phthisis pulmonalis; phthisis;
consumption,
Varieties.
(2) chronic phthisis; (3) fibroid phthisis.
(1) Acute pneumonic phthisis;
ACUTE PNEUMONIC PHTHISIS.
275
ACUTE PNEUMONIC PHTHISIS.
Definition. That form of pulmonary tuber-
culosis, which is characterized by areas of con-
solidation in the lung, which areas, from the ac-
tion of the bacilli, undergo caseous degeneration,
softening, ulceration, and excavation, leaving
cavities in the lung.
Pathology. There are areas of consolidation,
varying in size, caused by the accompanying
pneumonia, or brocho-pneumonia. These areas
are usually more in one lung than the other; and,
as a rule, near the apex of the lung, and extend
toward the base of the lung. Owing to the pres-
ence of the bacillus these areas instead of under-
going the ordinary fatty degeneration, undergo
caseous degeneration, softening, ulceration, and
excavation, forming cavities in the lung.
Symptoms.-The disease sets in as a pneu-
monia, or a broncho-pneumonia, which seems to
run its regular course, until the time for the crisis,
when, instead of the crisis, the patient becomes
worse, the temperature rises and becomes irregu-
lar, the loss of strength is marked, there are
night sweats, dyspnoea, severe cough with pro-
fuse muco-purulent expectoration, which is often
blood-streaked. Microscopical examination of
the sputum will show elastic fibres and tubercle
bacilli.
CHRONIC (ULCERATIVE) PHTHISIS.
Definition. That form of pulmonary tuber-
culosis, which is characterized by deposition of
276
SPECIFIC INFECTIOUS DISEASES.
tubercle in the lung, the tubercles undergoing
softening and ulceration.
Pathology. The tubercle, with the different
degenerations it undergoes, has been described in
the first part of the chapter. In chronic ulcera-
tive phthisis we find in the lung, tubercles, both
the nodular and infiltrating forms, tubercles
which have undergone caseous degeneration and
softening, cavities, and pneumonic areas. The
tubercles, at first, are found in the upper lobe of
the lung, near the apex, but soon extended down-
ward. There is nearly always a chronic pleurisy
associated with this form of phthisis.
Symptoms.-The disease has no regular mode
of onset. Gastric irritability, anæmia, and ema-
ciation, followed by a slow fever and increased
pulse, pains in the chest, dry hacking cough, and
hæmoptysis, are the symptoms generally found
during the developing stage of the tubercle.
Soon the cough becomes loose, with muco-puru-
lent expectoration; the expectoration under the
microscope will be found to contain elastic fibres
and the bacilli; the fever becomes very irregular;
hectic; night sweats; dyspnoea; these symptoms
appear when the tubercle has undergone sof-
tening,
The above symptoms increase; the emaciation
marked; there is œdema of the feet; and other
signs of failing circulation; and the patient grows
worse day by day until finally death closes the
scene.
Physical Examination. - Inspection. The
chest is long and narrow, with wide intercostal
—
FIBROID PHTHISIS.
277
spaces; or, the chest may be flattened; the scapu-
læ project; and, the respiratory movements are
limited.
Palpation-Diminished respiratory movement;
increased vocal fremitus.
Percussion. — Dullness, particularly upon and
above the clavicles. Tympany, and "cracked-
pot'' resonance denote cavities.
Auscultation.—(1) Feebleness of the respira-
tory sounds; (2) prolonged expiration; (3) harh-
ness or roughness of respiration; (4) cogged-
wheel breathing; (5) râles; (6) signs associated
with cavities; (7) signs relative to the pleura.
Complications. - Diseases of other organs
from the irritation of the bacilli.
Prognosis. Unfavorable; but, life may be
prolonged by proper medication, and change of
climate, etc.
FIBROID PHTHISIS.
This form is clinically identical with interstitial
pneumonia, to which the reader is referred.
Diagnosis. The diagnosis of phthisis must
be based upon the physical signs, and upon the
microscopical examination of the expectoration.
Prognosis. Must always be guarded.
Duration.-Average about four years.
A
Treatment. Disinfect all expectorations.
Have the patient removed to a dry, cool atmos-
phere, where there is little rainfall, and no sudden
changes in temperature; as a rule, an elevation
P
278
SPECIFIC INFECTIOUS DISEASES.
of about 2,000 feet is beneficial. Have the patient
wear flannel next to the skin. Let the patient
practically live out doors; practice deep breath-
ing; and take daily walks or rides, except in bad
weather. Take sponge baths several times a
week.
Diet.-Above all things guard against stom-
ach trouble. The diet must be nutritious, and
easy of digestion; milk and buttermilk are ex-
cellent articles of food for consumptives. The
patient must take fat in some form, cod liver oil
answering the purpose. Alcoholic stimulants
should not be used, unless absolutely necessary.
Remedies.-Ammonium carb.; Arsenicum;
Belladonna; Calcarea carb.; Calcarea phos.; Carbo
veg.; China; Conium; Drosera; Ferrum; Codine;
Kali hyd.; Kreosote; Lycopodium; Mercurius;
Nitric acid; Phosphorus; Pulsatilla; Rhus tox.;
Sanguinaria, Sepia; Silicea; Stannum; Sulphur.
}
CONSTITUTIONAL DISEASES.
RHEUMATIC FEVER.
Synonyms.-Inflammatory rheumatism; acute
articular rheumatism.
Definition. An acute, constitutional disease,
characterized by fever, inflammation and swell-
ing of one or more joints of the body.
Etiology. The exciting cause is still unknown.
The predisposing causes are: exposure to atmos-
pheric changes; having had a previous attack;
hereditary; spring season; occupation which ex-
poses one to cold and wet; adult life; and, male
sex.
Pathology. There
are no characteristic
lesions. Inflammation of the affected joint, with
swelling of the synovial membrane; and, the
synovial sack is filled with turbid albuminous
fluid. The blood has an excess of febrin.
Symptoms.-Onset usually sudden with chilli-
ness, rapid rise in temperature, often reaching
104° F. during the first day, with pain and
tenderness of some joint, generally the large
joints are the ones affected first. Symptoms of
gastric disturbance are present. The joint is red,
painful, and swollen; the disease has a tendency
to go from joint to joint; it will subdue in one
joint while growing worse in another. There is
P
280
CONSTITUTIONAL DISEASES.
a sour, acid sweat. The urine is diminished,
high colored, very acid, and contains an excess
of urates. The heart is very liable to inflam-
mation.
Complications.-Inflammation of the heart;
pleurisy; meningitis.
Differential Diagnosis.-Gonorrheal rheuma-
tism has not the high fever; nor are so many
joints affected; nor does it have the sour sweats;
but, it has the history of gonorrhoea.
Gout has not the high fever, nor the heart
complications.
Duration. Uncomplicated cases last from one
to three weeks.
Prognosis.-Uncomplicated cases rarely prove
Treatment. The patient must be confined to
bed, between blankets, in order to avoid changes
in temperature; have room well ventilated, but
avoid draughts. The affected part enclosed in
cotton; or, hot fomentations applied, will some-
times relieve the pain. The heart must be
watched from the first. May give warm baths,
but must be careful not to chill the patient. The
diet must be liquid and nutritious; milk is the best
food. Encourage the drinking of water; small
quantities of lemonade are harmless; barley water
is good to quench the thirst. Broths may be
given. But, meats and stimulants must not be
given.
fatal.
K
}
REMEDIES.
Aconite. The medicine to be given when the fever is
high, with dry skin, and a frequent, hard and full pulse.
RHEUMATIC FEVER.
281
*The patient is irritable, anxious, and restless; tosses
about, and knows he is going to die. Great thirst.
The joint is swollen, red and very sensitive; there are
shooting and tearing pains in the joint; worse at night.
"The main remedy."-Dr. Baehr.
"The first remedy."-Dr. Lutze.
"Favorite remedy in the beginning of acute attacks."
-Dr. Hale.
'Homoeopathic, not only to the fever, but also to the
local affections induced by the rheumatic poison."-Dr.
Hughes.
Actea Race. In females with uterine trouble.
*
Arnica. — Bruised feeling, as if lying on something
hard; as if the diseased part were resting on a hard board.
*The joint is hard, swollen and red; with soreness, and
bruised feeling; with great fear of being touched, or even
the possibility of being touched; there is unmbness and
lameness of the joint.
Arsenicum. In tedious cases, when the patient be-
comes weak and exhausted. *Relief from external
warmth. *Thirst for small quantities of water frequently.
Belladonna. When the fever is high with tendency to
cerebral irritation. *The fever is high, with dry hot
skin, thirst, and throbbing of the carotids.
* The joint
is swollen, red and shiny; with tearing, shooting pains.
*The pains come and go quickly.
fever is not as
* The patient
*The pulse
Bryonia. To follow aconite, when the
high, but the local inflammation is intense.
is irritable, does not want to be spoken to.
is full and strong. The part is hot, pale or dark red;
with stitching or tearing pains, aggravated from motion.
*He wants to remain perfectly quiet, the least motion
aggravates. *There is a sour sweat. (If bryonia fails
to help, study Cantharis. )
Caulophyllum.-"Especially suited to rheumatism of
the phalangeal and metacarpal joints, particularly in
females."-Dr. Farrington.
Mercurius. When the inflammation is obstinate in
one joint. The patient is worse from the warmth of
""
ker
282
CONSTITUTIONAL DISEASES.
the bed. *The joint is not much swollen, or a sort of
puffy swelling, but it is very red and painful.
* The
pains are worse at night, particularly about midnight
and toward morning. *Profuse sweats, without relief.
"The more frequent relapses set in, he more especially
is mercurius indicated."-Dr. Bachr.
Pulsatilla.* Sub-acute cases. Very little, if any fever.
The patient is chilly, yet heat makes him worse, wants
the open air. * Wandering rheumatism, the pains rapidly
shift from part to part. *There is little swelling or red-
ness. * Worse in the evening.
"The chief indication for its use is the flying character
of the inflammation, going from one joint to another,
the pale redness of the swelling and the slight fever.".
Dr. Hale.
Rhus Tox.-* Especially when caused from exposure
to wet. *The patient is very restless, must constantly
move, it relieves him. The parts are red and swollen;
with drawing and tearing pains. * Paralytic weakness or
trembling of the limbs, when attempting to move them.
External warmth relieves.
Sulphur.-"To prevent the lingering of convalescence,
or the passing of the disease into a chronic form."-Dr.
Hughes.
CHRONIC RHEUMATISM.
Etiology. This form of rheumatism, as a
rule, commences as a chronic affection; seldom
results from acute rheumatism. Comes on in
elderly persons, those poorly nourished, and those
who are constantly exposed to the weather.
Pathology. The movement of the joint is
restricted from the thickening of the tendons and
ligaments; and the muscles around the joint;
atrophy
Symptoms.-The general health may not be
MUSCULAR RHEUMATISM.
283
impaired. The disease usually attacks several
joints; they become painful and stiff; seldom have
redness and swelling. The pains are worse in
the morning, but become better after moving
around; they are also aggravated before stormy
weather. The joints may become anchylosed.
Prognosis. Perfect cure is rare; but medi-
cines will give great relief.
Treatment. Let patient, if possible, remove
to a dry climate; regulate his diet; let him wear
flannel underwear; massage may be tried.
Remedies. Bryonia; China; Chelidonia; Dul-
camaria: Colchicum; Ferrum; Hamamelis; Kali
Hyd.; Kali bich.; Ledum; Lycopodium; Mercu-
rius; Nux vom.; Phytolacca; Pulsatilla; Rho-
dodendron; Rhus tox; Sulphur; Thuya; Vera-
trum alb.
MUSCULAR RHEUMATISM.
Synonym.-Myalgia.
Definition. A disease affecting the voluntary
muscles, causing pain, tenderness and stiffness of
the part.
Etiology. Any of the causes of acute rheu-
matism; but, exposure to atmospheric changes
is its main cause.
Symptoms. All the symptoms are local; there
is intense pain in the affected muscle, the part be-
comes stiff. The pain may or may not be con-
stant.
Varieties. Lumbago. - The
The most frequent
form. The disease attacks the muscles of the
lumbar region.
284
CONSTITUTIONAL DISEASES.
Torticollis.-(Wry or stiff neck).-When the
disease attacks the sterno-mastoid muscles. The
head is usually inclined to one side.
Pleurodynia.-When the disease is in the in-
tercostal muscles; usually on the left side.
There are other forms, but the above are the
most important.
Prognosis. With careful attention, the dis-
ease may be eradicated from the system.
Treatment. Rest of the affected part. Ad-
hesive straps may be applied to the chest in
pleurodynia.
Remedies.-Consult rheumatism.
gout.
ARTHRITIS DEFORMANS.
Synonyms.
Definition. A chronic, progressive disease,
without constitutional symptoms, characterized
by partial destruction and deformities of the
joints.
Rheumatoid arthritis; rheumatic
Etiology. The exciting cause is unknown.
The predisposing causes are: Middle life; female
continued mental worry; and, possibly
sex;
hereditary.
Pathology. The cartilaginous articular ends
of the bones become soft, thinned and finally ab-
sorbed, this leaves the ends of the bones bare,
which become hard and smooth. The sides of the
bone have nodules developed upon them which
causes the bone to become rough and irregular.
The ligaments about the joint arc thickened.
GOUT.
285
The joint often becomes greatly deformed, and,
immovable.
Symptoms. The disease is either acute or
chronic.
Acute Form.-In the acute form there is fever,
with possibly redness of the joints; usually sev-
eral joints are affected.
Chronic Form. The metacarpo-phalangeal
joints are the first joints to be attacked; but, the
disease travels from joint to joint. The affected
joint is swollen, and stiff; they creak on being
moved. The muscles about the joint atrophy,
which, together with the atrophy of cartilages
above referred to, and the nodular growth, deform
the joint considerably.
Differential Diagnosis. Gout has chalky
deposits in the joints; and uric acid in the urine.
Chronic rheumatism as a rule first attacks the
large joints, and does not travel from joint to
joint as does rheumatic arthritis.
Prognosis. Absolute cure improbable. The
disease may, however, be stayed for quite a time;
its tendency is to steadily progress in paroxysms.
Treatment.-Must be symptomatic.
Mag
GOUT.
Synonym.-Podogia.
Definition.-A constitutional disease, some-
what resembling rheumatism, characterized by
the presence of uric acid in the blood, and the
deposit of urate of soda in and about the joint.
Etiology. The predisposing causes are: Adult
286
CONSTITUTIONAL DISEASES.
life; male sex; hereditary; excessive indulgence
in malt liquors; excessive eating, particularly the
excessive eating of meats; and, working in lead.
Pathology.-Gout usually commences in the
great toe. The process consists of chalky de-
posits (urate of soda), not only upon, but in, the
articular cartilages; in advanced cases these de-
posits occur in the parts about the joint. These
deposits cause the joint to inflame and swell; the
joint soon becomes quite deformed and stiffened,
finally anchylosed. The blood contains uric acid;
an interstitial nephritis develops; and a certain
degree of artero-sclerosis, with the resulting
hypertrophy of the left ventricle, will be found.
Varieties. Acute and chronic.
Symptoms.-Acute Gout.-An attack of acute
gout is preceded by constitutional symptoms as:
Malaise, dyspepsia, headache, etc. The attack
begins, as a rule, in the night toward morning.
The first symptom is excruciating pain in the
great toe, usually on the right foot; the symp-
toms resemble rheumatism; there is some fever,
swelling, redness, and tenderness of the affected
joint. The symptoms subdue somewhat by morn-
ing, and are seldom present during the day, but
commence again the following night. The attack
usually lasts some five days.
Chronic Gout.-The onset is slow, joint after
joint is gradually involved; the chalky deposits
gradually appear, deforming the joint and causing
it to become stiff. The disease attacks the feet
first, then the hands. There are few, if any,
constitutional symptoms. Interstitial nephritis
GOUT.
287
develops causing the urine to become copious,
pale, of a low specific gravity, and containing
albumen and hyaline casts. Arterio-sclerosis and
its train of symptoms are also present.
Complications.—Interstital nephritis; artero-
sclerosis, with hypertrophy of the heart; chronic
bronchitis.
Differential Diagnosis. Attention to its
mode of onset, and symptoms of the attack,
should prevent making a wrong diagnosis.
Prognosis. The prognosis is usually based
upon the condition of the kidneys and circulative
organs.
-
Treatment.-During an acute attack the joint
may be wrapped in cotton; hot fomentations
may be applied.
A person subject to gout should wear flannel
underwear; take regular exercise; live out of
doors as much as possible; see that the skin is
kept active, Turkish baths are beneficial; regu-
late the diet; the diet should consist mainly of
fruits, vegetables, and farinaceous articles; avoid-
ing starches and saccharine articles; positively no
liquors. Fish, eggs and oysters are allowable.
Remedies. Acute Attacks. -Aconite; Arnica;
Belladonna; Bryonia; China; Ferrum; Mercu-
rius; Nux vom.; Pulsatilla; Rhus tox.; Sabina.
Chronic Cases.-Ammonium phos.; Arnica;
Argentum nitr.; Calcarea carb.; Causticum; Col-
chicum; Colocynthis; Iodium; Ledum; Mercu-
rius; Mezereum; Phosphoric acid; Rhododen-
dron; Rhus tox.; Sulphur.
288
CONSTITUTIONAL DISEASES.
DIABETES MELLITUS.
Synonym.-Glycosuria.
Definition.
A disorder of nutrition, charac-
terized by the constant presence of sugar in the
urine, associated with progressive loss of strength
and flesh.
Etiology. Hereditary; adult life; male sex;
prolonged mental anxiety; and, dietetic errors;
are predisposing causes.
Pathology.
No characteristic lesions. There
are several theories: One, that it is due to pan-
creatic trouble; another, that it is due to certain
vaso-motor disturbances, coming from the sympa-
thetic nervous system.
Symptoms. — Cases vary greatly in their
symptoms; but, headache, malaise, an unquench-
able thirst, and frequent urination are the first
symptoms to direct our attention to diabetes.
Despite the good appetite the patient constantly
loses flesh; the skin is harsh and dry, itching,
particularly about the genitalia, is very annoying;
and dyspeptic symptoms are present; but, exami-
nation of the urine will be the crucial test.
The urine is greatly increased, pale in color, of
a sweetish odor, the sp. gr. is high, from 1.025
to 1.050; and upon chemical examination sugar
will be found.
Sequelæ. Phthisis; gangrene; defective vis-
ion; and, skin troubles.
Differential Diagnosis.-A careful examina-
tion of the urine will prevent mistakes being made.
Duration.-Years.
DIABETES INSIPIDUS.
289
Prognosis. Cure is rare; although life may
be prolonged for years.
Treatment. The patient should be warmly
clad in flannels; his skin should be kept active:
should have no worry; moderate out door exercise
is beneficial. Regulation of the diet is very
important. The starchy and saccharine articles
must be prohibited; a milk diet is often very
beneficial.
Food allowable.-Vegetables.-All green vege-
tables.
Meats.—Of all kinds; fish; poultry; oysters;
eggs.
Fruits.-Acid fruits.
Bread. That made from gluten or bran flour.
Drinks.-Water; milk; buttermilk; dry wines;
plenty of soft water; lemonade; coffee, without
sugar.
Remedies. Argentum nitr.; Arsenicum;
Helonias; Natrum mur.; Phosphoric acid; Plum-
bum; Terebinthina; Uranium nitr.
DIABETES INSIPIDUS.
Synonym.
Polyuria.
Definition. A chronic affection characterized
by the excretion of enormous amounts or pale
urine, of low specific gravity, and free from sugar
and albumen.
Etiology. The predisposing causes are: Early
adult life; male sex; hereditary; emotions.
Pathology. No definite lesions. The ex-
cessive flow of urine is probably due to paralysis
20
290
CONSTITUTIONAL DISEASES.
of the muscular coat of the renal vessels, result-
ing in their dilatation.
Symptoms. The main symptom is the pass-
age of large amounts of pale, clear urine, of
low specific gravity, 1002 to 1005, free from sugar
and albumen. There are some general symp-
toms, such as malaise, headache, thirst, etc.
Differential Diagnosis.-The diagnosis must
be based upon the examination of the urine.
Duration.-Indefinite.
Prognosis. Very few cases are cured.
Treatment.-Hygienic and dietetic treatment
same as for diabetes mellitus.
Remedies. Compare those given for diabetes
mellitus.
TRICHINOSIS.
Synonyms.-Trichine; trichinæ spiralis.
Definition.-A train of symptoms due to the
presence of the trichinæ in the structures of the
body.
Etiology.-Trichinæ are small worms found in
the hog. Infected meat is eaten by a person, the
worm is freed in the stomach, they migrate to the
muscles, and are soon encapsulated.
Symptoms. The general symptoms are those
of gastro-intestinal irritation, with typhoid symp-
toms.
Treatment.-If the infected meat has been
eaten only some couple of days give a purgative.
The treatment must be general.
Remedies.-Compare those given for typhoid
fever.
LITHAMIA.
291
LITHÆMIA.
Synonyms.-Lithiasis; Lithic-acid diathesis;
uric-acid diathesis; latent gout.
A
Definition. A constitutional disease, caused
by the presence of lithic or uric acid in the fluids
of the body, and characterized by dyspepsia and
various nervous symptoms.
Indigestion; sedentary life; con-
pr
Etiology.
stant mental worry; errors of diet.
Pathology.
The nitrogenous products, in-
stead of being converted into soluble urea, are,
from some fault in assimilation, converted into in-
soluble lithic or uric acid; in some way the pres-
ence, in the fluids of the body, of these products
of imperfect oxidation affect the nervous system.
Symptoms. There is dyspepsia; headache;
vertigo; and various nervous symptoms; but, the
chief symptoms are found in the urinary organs.
The urine is scanty, high-colored, high specific
gravity, and contains an excess of uric acid,
which may be combined with ammonium and
sodium forming acid urates, or, may occur in
the urine in the form of brick dust sediment.
This causes the urine to become irritative, so we
have various symptoms, such as pain after urin-
ating, pain in the region of the kidneys, etc.
Prognosis. Good.
Treatment.-The mode of life must be regu-
lated; walks, and moderate exercise are bene-
ficial. Daily baths to keep skin active. Regu-
late diet; and restrict the amount eaten; let diet
292
CONSTITUTIONAL DISEASES.
be mainly vegetables; no stimulants; drink plenty
of water.
Consult remedies given for dyspepsia.
Remedies.-Argentum nitr.; Berberis, Cheli-
donium; China; Locopodium; Natrum mur.; Phos-
phorus; Sepia; Spigelia; Sulphur.
Thapsi bursa pastoris is almost specific for the
hemorrhage occurring from lithæmia.-Dr. Hale.
DISEASES OF THE NERVOUS SYSTEM.
Diseases of the Cerebral
Membranes.
mater.
PACHYMENINGITIS.
Definition. — An inflammation of the dura
Varieties. --There are two varieties: (1) Pachy-
meningitis externa when the inflammation in-
volves the outer layer of the dura mater, or the
layer which serves as a periosteal covering of the
cranial bones; (2) pachymeningitis interna when
the internal layer of the dura mater is involved.
Etiology.—Pachymeningitis externa is always
a secondary disease; as a rule, resulting from
wounds of the skull.
Pachymeningitis interna also often comes from.
injuries to the skull. Chronic otitis; suppurative
inflammation of the orbit; syphilis; erysipelas;
chronic alcoholism; and, Bright's disease; are
among its causes.
Pathology. Pachymeningitis externa.-The
external layer of the dura mater is hyperæmic, it
softens, and is covered with ecchymotic points.
The membrane finally becomes thickened from
▬▬▬▬▬▬▬▬▬
294
DISEASES OF THE NERVOUS SYSTEM.
new connective tissue which causes it to adhere
to the cranial bones. There may be a purulent
inflammation, in which case the membrane is
thin, soft and pus forms.
Pachymeningitis interna.-Here it is the in-
ternal layer of the dura mater that is inflamed.
In chronic cases there is a new layer of organized
tissue covering the dura. There are
three
forms of this trouble: (1) Pseudo-membraneous;
(2) purulent; (3) hemorrhagic.
Symptoms.-There are no characteristic symp-
toms. Headache, dizziness, photophobia, delir-
ium, etc., following diseases of the internal ear,
or injuries to the scalp, will lead us to suspect this
trouble.
Treatment.-A surgical disease.
Trephining
Treatment must be symp-
is usually necessary.
tomatic.
ACUTE MENINGITIS.
Synonyms.-Acute leptomeningitis; arachni-
tis; cerebral fever.
Definition. An acute, non-specific inflamma-
tion of the pia mater.
Etiology. Sometimes idiopathic; but, as a
rule, it follows injuries to the head. It occurs
more frequently in early adult life; and, in the
male sex.
Frequently excited by acute alcohol-
ism, pneumonia, ulcerative endocarditis, Bright's
disease, and, rheumatism; often occurs during the
course of infectious diseases, as: whooping cough,
erysipelas, scarlet fever, measles, etc.
Pathology. The inflammation is generally
ACUTE MENINGITIS.
295
confined to the convexity, but sometimes involves
the base. The membranes are red, thickened, and
lose their glistening appearance; the blood vessels
are injected; and, there is an exudation of a
serous, or sero-purulent fluid.
Symptoms.
The onset is marked by a mod-
erate fever, irregular in character; severe and
persistent headache; projectile vomiting; and,
delirium. There is vertigo; photophobia; twitch-
ing of the muscles; and, jerking of the limbs.
Soon however the stage of depression sets in; the
patient becomes quiet, the delirium gives place to
stupor and coma; the pulse is now slow and inter-
mittent; the bowels and bladder move involun-
tarily; and finally the patient dies in spasms or
coma.
Prognosis. Unfavorable.
Treatment.—Put patient to bed; have the
room well ventilated, quiet, and darkened. Re-
lieve the bowels by enemata, if constipation sets
in. Often advisable to shave the head; and,
possibly apply cold applications. The diet must
be liquid.
Arnica should be given if caused by trauma-
tism; otherwise Belladonna is usually indicated
in the beginning, with fever, delirium, headache,
and symptoms of congestion to the head, until
symptoms of effusion occur, when Bryonia come
in, the face is now suffused, and there are tear-
ing, shooting pains in the head; when convul-
sions set in Cuprum is indicated.
For remedies and their indications see those
given for the meningeal form of acute tuberculosis.
Diseases of the Cerebrum
CONGESTION OF THE BRAIN.
Synonyms. Cerebral hyperæmia; cerebral
congestion.
Definition. An abnormal increase in the
amount of blood within the capillaries of the
brain.
Varieties. Active and passive.
Etiology.-Active hyperemia is caused by vio-
lent action of the heart, as in fevers, etc., in cer-
tain gastric troubles, use of alcohol, and nitro-
glycerine.
Passive hyperæmia occurs from some obstruc-
tion to the return circulation of the brain, such
as the pressure of tumors, certain heart and lung
disease.
Symptoms.-Active hyperemia has headache,
restlessness, the eyes glistens and are often in-
jected; the carotid arteries throb; the face is red
and often bloated; and there may, or may not, be
delirium.
Passive hyperamia may have no symptoms pe-
culiar to itself; but a constant dull headache, with
an irritable disposition, and a confused feeling in
the head, are generally presents.
Prognosis. Acute cases are cured; passive
form must be based upon the cause.
CEREBRAL ANEMIA.
297
Treatment. Put patient to bed; avoid all ex-
citement; and a liquid diet.
Belladonna is the remedy in the majority of
cases; but, Aconite, Veratrum vir., and Glonoine,
may be called for.
The treatment for passive hyperæmia must be
based upon the cause.
CEREBRAL ANÆMIA.
Definition. An abnormal decrease in the
amount of blood within the capillaries of the
brain; general when the blood supply is dimin-
ished to all the vessels; or partial when limited
to some particular vessel.
Etiology.
From general anæmia; hemor-
rhages; heart disease; or from mechanical inter-
ference with the cerebral circulation. Partial
cerebral anæmia is generally due to thrombi or
emboli.
M
Symptoms. The anæmia may be either acute
or chronic.
Acute anæmia usually follows hemorrhages, sud-
den mental emotion, etc. Its symptoms are:
dizziness, dimness of vision, oppression of the
chest, ringing in the ears, and, finally fainting.
Chronic anemia comes with dull headache,
heaviness in the head, indisposition to work, sen-
sitiveness to light and noise, dilated pupils, and,
generally melancholia.
M
Treatment.-Acute form.-Place patient in
horizontal position; friction to body; stimulants;
and, possibly the transfusion of blood.
298
DISEASES OF THE CEREBRUM.
Chronic form.-The treatment must be based
upon the cause.
Remedies. Arsenicum; Calcarea phos. ;
China; Ferrum; Phosphoric acid.
CEREBRAL THROMBOSIS AND
EMBOLISM.
Etiology. Cerebral Thrombi are clots which
form in the cerebral vessels, and obstruct the
blood circulation. They are caused from any
condition that slows the blood current.
Cerebral emboli are clots formed in some portion
of the body, and carried, by the blood current, to
the brain. They may be carried to any artery,
but they are generally carried to the left middle
cerebral artery. They are, as a rule, formed in
the heart, during an attack of endocarditis.
Pathology. The secondary changes following
a thrombus and those following an embolus are
the same.
The direct result is anæmia of that
portion of the brain supplied by the vessel which
is plugged by the deposit. This anæmia is fol-
lowed by softening of the brain substance, which
may be absorbed leaving a scar, or it may re-
main unchanged, or may form a cyst. Suppura-
tion will result if the embolus comes from some
infective area, as ulcerative endocarditis.
Symptoms. They vary greatly, depending
upon the vessel affected. The symptoms follow-
ing an attack are similar to those of cerebral soft-
ening.
Differential Diagnosis.—A positive diagnosis
can seldom be given.
CEREBRAL SOFTENING.
299
Prognosis.-Perfect recovery is rare.
Treatment.-No special treatment.
CEREBRAL SOFTENING.
Synonym.-Softening of the brain.
Definition. A degeneration of the brain-sub-
stance, usually involving only the white matter.
Etiology. Local softening results from em-
boli or thrombi. But, general softening is usually
from age, chronic alcoholism, or syphilis.
Pathology. The affected portion of the brain
becomes whiter than normal, or, from extravasa-
tion of blood, it may be red. As the degenera-
tion progresses the parts are infiltrated with serum,
they become soft, and the nerve-elements are de-
stroyed. Inflammation may set up in the soften-
ed areas. Or, the softened parts may remain un-
changed, or, may form into cysts.
Symptoms.-There are no special symptoms;
and of necessity the symptoms vary greatly.
Failing memory, vertigo, headaches, etc., are
present. Paralytic symptoms are often observed.
Prognosis. A progressive disease when the
softening is general.
M
Treatment.-Based upon general principles.
Phosphorus is recommended by several authori-
ties as a remedy for this disease.
CEREBRAL APOPLEXY.
Synonym. Cerebral hemorrhage.
Definition. The rupture of a cerebral vessel,
with escape of blood into the cerebral substance.
M
300
DISEASES OF THE CEREBRUM.
Etiology. Any disease that leads to degener-
ation of the arteries, as Bright's disease, rheuma-
tism, gout, chronic alcoholism, etc. Age is an
important factor, rare in those under forty.
Hereditary seems to play a part. The immediate
cause is frequently some sudden excitement, an
emotion.
Pathology. The rupture of the blood vessel,
which is frequently the middle cerebral, is gen-
erally preceded by a miliary aneurism. The
amount of blood escaping varies greatly; it forms
a clot, composed of coagulated blood and disin-
tergrated brain substance, from the size of a pin
head to one filling a whole hemisphere. The clot
at first is quite dark, but, soon changes color,
and may finally become nearly yellow. Inflam-
mation is often set up in the brain substance
around the clot; and a wall is formed confining it.
The clot may be entirely absorbed, the new con-
nective tissue wall contracting, and leaving only
a scar; or, there may be a cyst, containing a clear
straw colored fluid formed.
Symptoms. Prodromal symptoms, such as
headache, dizziness, etc., may be present; but,
usually the patient is suddenly stricken down un-
conscious; with a flushed, swollen face; injected
eyes; pupils dilated, and often irregularly dilated;
stertorous breathing; often a sub-normal tempera-
ture; and a full, slow pulse. In severe cases the
patient soon sinks into a deep coma, which may
prove fatal in a very short time. In cases not
immediately fatal the patient regains conscious-
ness, after a certain time varying from a few
CEREBRAL APOPLEXY.
301
minutes to several days; there is now pains in the
head, delirium, fever, and hemiplegia. The par-
alysis may disappear in very light cases, but,
usually there is some permanent impairment of
function.
Differential Diagnosis.-Stupor from Alcohol.
-The coma is not so profound as in apoplexy,
and the patient can be aroused; there is no ster-
torous breathing; and, the pulse is feeble, while
in apoplexy it is full and slow.
Opium Poisoning.-The coma comes on gradu-
ally; the pupils are contracted; and the pulse and
respiration are very slow.
Prognosis. Always grave.
Treatment. Prophylaxis. Those who are
subject to this disease, should avoid all excite-
ment and emotion; no excesses; their diet must
be simple, but nutritious; and no stimulant or
highly seasoned food should be taken.
The attack.-When a person is stricken down
with apoplexy, have him removed to a quiet, cool
place, where plenty of fresh air is obtainable;
loosen all clothes, particularly about the neck;
have the head and shoulders elevated, and let him
lie on the paralyzed side; heat may be applied
to the extremities and possibly the head; al-
though, ice is usually recommended for the head.
Above all let the patient have absolute rest, do
not bother him trying to arouse him, or bother
him in any other way.
The diet must be light and nutritious; animal
food is harmful; and highly seasoned food and
stimulants are positively forbidden.
302
DISEASES OF THE CEREBRUM.
Aconite.-* To be given immediately, if there is great
arterial excitement; the pulse is hard, strong, bounding.
* Cases occurring in persons of a plethoric habit.
(<
Almost certainly have a beneficial effect." - Dr.
Bartlett.
"The first remedy to be employed in sudden and vio-
lent attacks."-Dr. Small.
Arnica. The best medicine to give, after the acute
symptoms have been relieved, to promote the re-absorp-
tion of the effused blood. *The pulse is full and strong.
*Severe aching soreness throughout the body. *Head hot,
while the rest of the body is cool. *Involuntary discharges
from both bladder and rectum. * Paralysis, particularly
(C
REMEDIES.
on the left side.
Occupies the first rank as a medicine to accelerate the
absorption of the apoplectic effusion."-Dr. Baehr.
Baryta Carb.-*In old persons. *For the paralysis,
particularly when the tongue is implicated, remaining
after an attack, particularly in elderly persons; they be-
come childish. Paralysis on right side. It assists in its
(the clot) absorption and the removal of the consequences
of the pressure (Dr. Hale).
Belladonna. -*At the very commencement, when there
are symptoms of cerebral congestion. *Face swollen,
bloated, and red in color; the eyes are injected; pupils
dilated; throbbing of the carotid and temporal arteries.
* Drowsiness; complete loss of consciousness.
"My first resource is always to belladonna if the con-
sciousness is entirely suspended "-Dr. Jahr.
"
Scarcely one case of apoplexy where this remedy is
not suitable, and sometimes has a magic effect."-Dr.
Baehr.
Glonoine." Cases in which the arterial tension is high
and there is co-existing kidney disease.”—Dr. Bartlett.
Hyoscyamus.. *If with involuntary evacuation from
the bowels and bladder.
"Almost specific for these symptoms."-Dr. Jahr.
K
CEREBRAL ABSCESS.
303
Nux Vom.-*For the prodromic symptoms; particu-
larly in those of sedentary habits, or those who abuse
stimulants.
Opium. Early in the attack; the patient lies in a pro-
found stupor, cannot be aroused; the lower jaw is de-
pressed; the eyes are half open, the pupils are dilated or
contracted; the face is bloated and dark red in color;
there is stertorous breathing, and, a full, slow pulse.
*
"If the patient continually grasp at their heads, I rely
especially upon opium.”—Dr. Jahr.
"A most important remedy in almost all severe attacks."
-Dr. Laurie.
(6
'Opium is to be thought of by the color of the face,
by the stertorous breathing, and by tetanic rigidity of
the body."-Dr. Farrington.
Sulphur. To promote absorption of the clot.
'Comes into play where the action of arnica termin-
ates."-Dr. Bachr.
**
For the paralysis remaining after an attack of apoplexy:
Causticum; Cuprum; Cocculus; Plumbum; Zinc.
Electricity and massage may be tried; but not until all
symptoms of irritation have disappeared.
CEREBRAL ABSCESS.
Synonym. Suppurative encephalitis.
Definition. A suppurative inflammation of
the brain substance.
Etiology. Nearly always a secondary disease.
Due to extension of inflammation from near parts,
or, from suppurative inflammation in distant parts;
or, from traumatism.
Varieties.—(1) Primary; (2) secondary.
Pathology.--One or more abscesses may form;
in size they also vary greatly. Acute abscesses
are generally diffuse; while chronic abscess are
encapsulated. The tissues about an abscess are
soft and infiltrated.
304
DISEASES OF THE CEREBRUM.
Symptoms. Acute cases come on with rigors,
fever, vomiting, and delirium; this is soon fol-
lowed by severe headache, paralysis, optic neu-
ritis and finally coma.
Chronic cases have no sudden onset, but have
persistent headache, loss of memory, paralysis,
and symptoms of exhaustion.
Differential Diagnosis. The diagnosis of
cerebral abscess is very difficult.
Prognosis. Doubtful.
Treatment.-When the abscess can be local-
ized the skull must be trephined and the pus with-
drawn.
Remedies. Aconite; Belladonna; Hepar;
Mercurius; Silicea; Sulphur.
sensory.
My
Sp
APHASIA.
Definition. The loss of power to express
ideas in language.
Varieties.-There are two forms: Motor and
Map
Make
MOTOR OR ATAXIC APHASIA.
The patient cannot make sentences; although
he knows objects about him, and can reflect after
another, or, can write what he wishes to say.
Agraphia. The loss of power of expressing
the thoughts in writing.
Alexia. The inability to express in words
written or printed matter.
SENSORY APHASIA.
In this form the patient does not recognize the
objects about him.
VERTIGO.
305
Mind-blindness.-Does not recognize the use of
things seen.
Mind-deafness.-Does not interpret the sounds
heard.
Word-blindness. The inability to recognize
written or printed matter.
Word-deafness. - The inability to understand
spoken language.
M
PARAPHASIA.
When the wrong word is used to express the
thought.
Treatment.
Must begin, and try to teach
them word after word, and in this way success
may be obtained.
VERTIGO.
Synonyms.-Dizziness; swimming in the head;
giddiness.
Definition. That condition in which the pa-
tient, or the objects about him, appear to be in
motion.
Nervous Vertigo.-Caused from various brain
diseases; particularly from tumors of the brain.
Ocular Vertigo.-From eye trouble; particu-
larly eye-strain.
Auditory Vertigo, or Meniere's disease, caused
from disease of the semi-circular canals.
Gastric Vertigo.-Vertigo reflex from gastric, or
intestinal irritation.
Prognosis -Must be based upon the cause.
Treatment.-Depends upon the cause, which
must be found, and, if possible, removed.
306
DISEASES OF THE CEREBRUM.
Nervous Vertigo is relieved by: Ambra, Theri-
dion, Zizia, Coffea, Ignatia, Moschus, Nux mos.,
and Zincum.
Ocular Vertigo is cured when the eye-strain is
relieved by the proper glasses. Ruta and Phy-
ostigma help to relieve the strained ocular
muscle.
Auditory Vertigo.—Gelsemium and Stramoni-
um, but more particularly Causticum, are the
remedies for this variety of vertigo.
Gastric Vertigo.-Nux vom. is nearly specific
for gastric vertigo.
MIGRAINE.
Synonyms.-Hemicrania; megrin; sick head-
Definition. A paroxysmal, circumscribed
headache, with vaso-motor and sensory symp-
toms.
ache.
Etiology.-As a rule, appears in those of a
nervous disposition; and is usually inherited.
Women are more often victims than men.
Symptoms. The symptoms are those of a
violent headache, with chilliness, nausea, irri-
tability, intolerance of light and noise. The
paroxysm comes on irregularly, and lasts from
one to several hours. The pains are usually
limited to one side of the head, particularly the
left side.
Prognosis. Absolute cure is denied by some,
Treatment. The preventive treatment con-
sists in regulating the diet and mode of life of
SUNSTROKE.
307
the patient; have them avoid all excitement and
emotions. Correct any gastric or nervous condi-
tion.
During the attack, let patient lie down in a
quiet, darken room; only liquid food.
Remedies.-Belladonna; Chelidonium; Chion-
anthus; Gelsemium; Glonoine; Iris vers.; Ipecac-
uanha; Naja; Nux vom.; Podophyllum; San-
guinaria; Sepia; Silicea; Spigelia.
For the Attack.-Chionanthus, Gelsemium, Iris,
and Sanguinaria are the main remedies.
SUNSTROKE.
Varieties. (1) Heat exhaustion; (2) thermic
fever or sunstroke.
Etiology.-Heat exhaustion is due to exposure
to extreme heat, not necessarily the direct rays of
the sun.
Thermic fever is due to exposure to the direct
rays of the sun.
Symptoms.-Heat Exhaustion.-There is ex-
treme weakness, restlessness, dimness of vision,
cool skin, sub-normal temperature, pulse small
and feeble, and symptoms of collapse.
Thermic Fever. The patient may be stricken
down, and die almost immediately. The patient
becomes insensible, the skin dry and hot, shallow
breathing, high temperature and death may follow
in a few hours.
Prognosis. Must be guarded.
Treatment. Have patient removed to cool
quiet place; loosen all clothes about his body;
308
DISEASES OF THE CEREBRUM.
apply hot applications to head and limbs; many
advise a cold pack in the case of sunstroke; stim-
ulants if called for. Give some liquid food as
soon as the patient can swallow. Nitrite of amyl,
or Ammonia, may be given by inhalation, in ex-
treme cases.
Remedies.-Aconite; Belladonna; Glonoine;
Natrum mur.; Veratrum vir.
CHRONIC HYDROCEPHALUS.
Definition.—An abnormal accumulation of
fluid within the ventricles of the brain.
Etiology. There are two kinds of chronic
hydrocephalus:
K
(1) Congenital Hydrocephalus.-Its true cause
is unknown. It is a disease of infancy, and often
appears at birth. The abnormal size of the head
is what attracts attention. The fontanelles are
open; and the superficial veins are distended.
(2) Acquired Chronic Hydrocephalus. - This
may develop at any age; sometimes idiopathic,
but usually results from the presence of tumors,
meningitis, or from general dropsy.
Duration. From few months to three years.
Prognosis. Very grave.
Treatment. Consult treatment for acute
hydrocephalus.
K
Diseases of the Spinal Cord.
PACHYMENINGITIS SPINALIS.
Definition. An inflammation of the spinal
dura mater.
Etiology. Secondary to inflammation else-
where; exposure to cold and wet; constitutional
diseases as gout, syphilis, etc.
Pathology. The membranes are swollen, and
the spinal fluid is increased. The membranes
may become adherent.
Symptoms. The onset is rather slow, with
chilliness, feverishness, severe dull pains in the
extremities, the back often becomes rigid, and a
gradual appearing paraplegia, the parts wasting
away.
Prognosis. Unfavorable.
Treatment.-Must be based upon the cause.
LEPTOMENINGITIS SPINALIS.
Synonyms. Spinal meningitis.
Definition. A simple inflammation of the
spinal pia mater.
Etiology. Due to tuberculosis; or, from in-
fectious diseases as, smallpox, etc.; and possibly
from exposure to cold.
padd
Pathology. The membranes are congested;
and swollen from serous infiltration; and in
310
DISEASES OF THE SPINAL CORD.
chronic cases the membranes are very thick and
glued together.
Symptoms. The symptoms are similar to
those of pachymeningitis spinalis. Chilliness,
moderate fever, severe pain in the back, which is
very tender to touch, girdle pains, increased
reflexes, and a gradually appearing paralysis, are
symptoms of this form of inflammation.
Madag
Prognosis. -Very grave.
Treatment.-Must be symptomatic.
ACUTE MYELITIS.
Synonym.-Acute diffuse myelitis.
Definition. An acute inflammation of the
substance of the cord.
Varieties. (1) Central myelitis when the in-
flammation attacks more especially the gray
matter; (2) transverse myelitis when only a
transverse section is involved; (3) diffuse myelitis
when the process involves a whole section.
Etiology.-May follow injuries to the cord;
secondary to infectious diseases; alcoholism; syph-
ilis; and exposure to wet and cold.
Pathology. Hyperæmia followed by inflam-
mation of the substance of the cord; the parts
become red from blood extravasation; and soft
from serous exudation. The nerve elements
undergo degeneration.
D
Symptoms.-Onset is ushered in by chilliness,
followed by fever, with motor and sensory dis-
turbances. Severe pains in the back, aggravated
by pressure, with neuralgic pains in the limbs;
ACUTE MYELITIS.
311
the limbs feel heavy; there is a sensation of form-
ication, followed by anesthesia, finally paralysis
sets in, with wasting of the paralyzed muscles.
Electro-contractibility of the affected part is also
lost. At the upper border of the inflammation
there is a girdle pain; above which the parts are
hyperæsthesic. The sphincters of both the bowels
and bladder are implicated, so we find involuntary
evacuations from both. The urine is generally
ammoniacal, causing cystitis. The skin becomes
dry and harsh; and bed sores form rapidly.
Differential Diagnosis.-Spinal hyperamia
has decidedly milder symptoms, the paralysis,
which is slight, is not accompanied with wasting,
or diminished electro-contractibility; nor, does the
paralysis usually involve the sphincters.
Spinal apoplexy has sudden paralysis with acute
pain in the cord.
Landry's disease, or acute ascending paralysis,
has no trophic phenomena, has ascending paraly-
sis, and normal electric reactions.
-
Hysterical paraplegia has no trophic changes,
or altered reflexes.
Prognosis. Unfavorable.
Treatment. Patient must be put to bed, and
kept quiet, free from all excitement. Frequent
baths; and especial care to prevent bed sores from
forming. Hot fomentations may be applied to
the spine. Attention must be given to bladder
and bowels, and, if necessary the catheter and
enemas must be used. The diet must be liquid
and nutritious.
Remedies. Aconite; Abrotanum; Arnica;
ggg
312
DISEASES OF THE SPINAL CORD.
Arsenicum; Belladonna, Cuprum ars.; Dulcamara;
Mercurius; Nux vom.; Picric acid; Rhus tox.;
Sulphur.
MYELITIS OF THE ANTERIOR HORNS.
Synonyms. Polio-myelitis anterior; infantile
spinal paralysis; atrophic spinal paralysis.
Definition.—An inflammation of the anterior
horns of the gray matter of the cord, occurring
usually in children, and characterized by fever,
and paralysis with atrophy.
Etiology. Its true cause is unknown.
Pathology. The disease is often limited to
the cervical and lumbar enlargements. The first
changes are hyperæmia, with exudation, and soft-
ening of the anterior horns of the gray matter,
and atrophy of the multipolar cells and anterior
nerve roots. In time, connective tissue growth
replaces the degenerated multipolar cells.
Symptoms. The onset is usually sudden;
there may be some fever, irregular in character.
Sometimes the first symptom is paralysis; this
may involve one or more limbs, generally the
lower limbs; the affected limb has a lowered tem-
perature, and appears cyanosed. There is rapid
and extreme wasting of the paralyzed part; with
the "reaction of degeneration." The bladder is
seldom involved; nor are there any sensory dis-
turbances.
Differential Diagnosis.-The rapid develop-
ment of the paralysis, the atrophy, the reaction
of degeneration, and the lack of sensory dis-
turbances will distinguish this disease from others.
PROGRESSIVE MUSCULAR ATROPHY.
313
Prognosis. The paralysis has a tendency to
improve to a certain extent; but, complete re-
covery from the paralysis is very rare.
Treatment.-Confined to bed during the acute
stage; let patient have complete rest; and no ex-
citement. Electricity and massage may be tried
for the paralysis.
Remedies-Aconite for the initial fever, but as
soon as paralysis sets in we must change to Gelse-
mium; and if inflammatory symptoms continue
to Belladonna.
PROGRESSIVE MUSCULAR ATROPHY.
Synonyms.
Chronic polio-myelitis anterior;
chronic polio-myelitis; amyotrophic lateral sclero-
sis; wasting palsy: chronic spinal muscular
atrophy.
Definition. A disease characterized by
atrophy of the ganglion cells of the anterior
horns with wasting of the corresponding muscles.
Pathology. There is atrophy and degenera-
tion of the large multipolar cells in the anterior
cornea, and also of the anterior nerve root fibres;
new connective tissue being formed. Sometimes
the sclerosis extends to the lateral columns (amyo-
trophic lateral sclerosis). The muscles also de-
generate and have an overgrowth of new con-
nective tissue.
Symptoms.
Prodromal symptoms such as,
dull aching, coldness, and weakness of the parts
about to be affected are sometimes observed. The
atrophy usually begins in the small muscles of
314
DISEASES OF THE SPINAL CORD.
the thumb, causing the ball of the thumb to be-
come flat; next, the atrophy attacks the interossei
muscles; these alterations cause the hand to have
the "claw-like" appearance. From the hand the
atrophy travels to the forearm, involving the
flexor, more than the extensor, muscles; then
to the shoulder. The lower limbs are, as a rule,
involved only late in the disease. The rec-
tum and bladder are not involved; nor are there
any sensory disturbances. The atrophy has a
tendency to become symmetrical. Fibrillary
twitchings, excited by exposure to draughts of air,
or from slightly tapping the affected muscles, are
frequently present early in the disease. The
atrophy involves muscle after muscle until the
subject is entirely wasted, the bones stand out
prominently, in fact, he is indeed, a "living
skeleton."
Prognosis. Often a progressive disease; but,
may be sometimes stayed in its progress. The
duration is indefinite.
Treatment.-Must be general.
Hypodermic injections of Strichnine is recom-
mended by Gowers.
Electricity may be tried; although Osler says.
he never has seen the slightest benefit from it.
Massage has given good results.
Plumbum is recommended by several authors
as the homœopathic remedy for this disease; but
Argentum nitr., Arnica, Gelsemium, Phos-
phorus, and Sulphur, may be tried.
M
BULBAR PARALYSIS.
315
BULBAR PARALYSIS.
Synonyms.-Glosso-labio-laryngeal paralysis;
progressive bulbar paralysis.
Definition. A degeneration of the motor
nuclei of the medulla oblongata, usually second-
ary, causing paralysis of the muscles of the
tongue, lips, larynx, and pharynx.
Etiology. The acute form results from hemor-
rhages in the medulla; or, from inflammatory
softening of the medulla.
The chronic form may come from exposure to
cold; certain constitutional diseases; or, from the
extension of the degenerative process of other
diseases.
Symptoms.-The disease comes on very in-
sidiously. Difficulty in articulation is the first
symptom to attract attention; this is caused by
the beginning paralysis in the tongue; the tongue
becomes flabby and shrunken from the atrophy.
The paralysis then attacks the lips, which also
atrophies; then the palate, pharynx, and larynx
become involved. There is salivation; inability
to swallow; and other symptoms from the paraly-
sis. Atrophy is marked in the affected muscles.
Differential Diagnosis. Its characteristic
onset, involving the muscles it does, prevents
mistakes.
Ma
Prognosis.
Treatment.
Remedies.
cyamus; Plumbum.
Unfavorable.
Must be symptomatic.
Causticum; Gelsemium; Hyos-
316
DISEASES OF THE SPINAL CORD.
SPINAL SCLEROSIS.
Synonym.-Duchenne's disease.
Definition. An overgrowth of connective
tissue in the spinal cord, associated with degen-
eration of the nerve elements.
Etiology.
Hereditary; syphilis; alcoholism;
exposure to wet and cold; traumatism; male sex;
mineral poisoning.
Pathology.-Degeneration and atrophy of the
nerve elements; the degeneration following a
longitudinal direction; with an overgrowth of
connective tissue.
Varieties.—(1) Locomotor ataxia, posterior
sclerosis; (2) lateral sclerosis; (3) ataxic para-
plegia; (4) disseminated cerebro-spinal sclerosis.
LOCOMOTOR ATAXIA.
Synonyms.-Tabes darsalis; posterior spinal
sclerosis.
Definition. A sclerosis of the posterior col-
umns of the spinal cord, characterized by inco-
ordination, loss of tendon reflexes, and severe
lightning pains.
Pathology. This is a sclerosis of the posterior
columns of the cord. The posterior columns are
grayish and shrunken; the nerve elements have
degenerated, and an overgrowth of connective
tissue has taken their places. These changes are
also frequently found in the brain and peripheral
nerves.
Symptoms.-The onset is very insidious; there
are -gastro-intestinal disturbances. indisposition,
LOCOMOTOR ATAXIA.
317
etc.; soon, however, there are experienced, more
particularly in the legs, sharp, stabbing, light-
ning pains, coming and going very quickly, often
leaving a burning sensation. The absence of the
knee-jerk (Westphal's symptom) is an early and
characteristic symptom. Certain ocular symp-
toms are also prominent, as: Ptosis; optic
atrophy, which may end in total blindness; and
the "Argyll Robertson pupil," which is a pupil
that responds for accommodation, but does not
respond to light. These are the symptoms that
denote the commencement of an attack of posterior
sclerosis; and, they may continue for years before
more marked symptoms declare themselves.
When the ataxic stage arrives there is loss of
inco-ordination, with anesthesia of the limbs,
and sensation of formication. The patient is
unable to stand erect, or walk in a straight line
with closed eyes; when trying to stand with closed
eyes he sways to and fro, and almost falls (Rom-
berg's symptom). When walking he must con-
stantly watch his feet; and, not being able to
judge the proper distance, he raises his feet too
high, and brings them down with a stamp; the
whole foot flat on the ground. He throws his
legs about when walking in a very peculiar and
characteristic way. These symptoms continue
until the patient is unable to walk without assist-
ance. With this loss of inco-ordination there is
no loss of muscular power; the muscles may,
however, waste from want of use. The joints
also suffer; there is a serous effusion, with swell-
ing of the joints, particularly the knee (Charcat
318
DISEASES OF THE SPINAL CORD.
Joint), sometimes causing spontaneous disloca-
tion. Perforating ulcer of the foot often occurs.
Incontinence of urine is frequently present. In
the first stage the sexual desire may be increased,
but later it is usually lost.
There are often certain neuralgic attacks, called
crisis, as: Gastric crisis when there is severe pain
in the stomach with vomiting, etc.; laryngeal
crisis has severe dyspnoea; renal crisis resembles
renal colic; and so on.
The above symptoms last for an indefinite
period, often years; but, finally the paralytic
stage comes on and the patient becomes paralyzed
and hence bed ridden, often living for years in
such condition.
Differential Diagnosis.-Careful attention to
the symptoms no mistake should be made; the
absence of the knee jerk, the inco-ordination, and
the Argyll-Robertson pupil are characteristic of
this disease.
Prognosis.
Directly rarely fatal; but a com-
plete cure is doubtful; although, the patient can
be helped in almost every stage.
Treatment. Place patient under good hygenic
conditions; rest is important; must be free from
excitement and worry. Diet is to be nutritious
and easy of digestion. Any stomach or bowel
symptom must receive immediate attention. Gal-
vanism to the spine, and faradism to the wasted
muscle have been of benefit.
In the first stage, when there are decided
lightning pains, coming and going quickly, Bella-
donna will help; but, for the fully developed case,
PRIMARY LATERAL SCLEROSIS.
319
with inco-ordination, etc., Argentum nitr. is the
remedy.
Remedies.-Esculus; Arsenicum; Causticum;
Gelsemium; Nux vom.; Phosphorus; Plumbum;
Rhus tox.; Sulphur; Zincum.
PRIMARY LATERAL SCLEROSIS.
Synonyms.-Lateral sclerosis; primary spastic
paraplegia.
Definition. A primary sclerosis of the lateral
or pyramidal tracts, characterized by rigidity of
the paralyzed muscle and increased reflexes.
Pathology. The exact pathological condition
is unknown, presumably it is a sclerosis of the
lateral tracts of the cord.
Symptoms. The onset is very insidious; a
dull aching pain, weakness, and slight loss of
power of the lower limbs, with cramps and stiff-
ness, are the first symptoms to attract attention.
The paralysis begins in the lower limb and pro-
gresses very slowly; the sensation is normal; and,
there is no atrophy of the affected muscles. The
knee-jerk is greatly exaggerated; the rectal
clonus, and the ankle clonus are obtainable.
They are reflex contractions in the affected mus-
cles when attempting to use them; these contrac-
tions causes the limbs to become rigid. When
walking the patient drags his limbs, the knees are
together and the toe catches in the pavement;
the limb is used as a whole on account of the
rigidity of the muscles.
Prognosis. Unfavorable.
320 DISEASES OF THE SPINAL CORD.
Treatment.-Must be based upon general prin-
ciples. Massage is beneficial; electricity is of no
benefit in this disease.
Remedies. Argentum nitr.;
Zincum.
ATAXIC PARAPLEGIA.
Definition.-A sclerosis of both the posterior
and lateral columns of the cord.
Nux vom.;
Pathology.—There is a sclerosis of the pos-
terior and lateral columns. The changes in the
posterior column are more pronounced in the
dorsal region; and, the posterior root zones are
not especially involved.
Symptoms. The symptoms are, to a certain
extent, a combination of ataxia and spastic para-
plegia. The onset is slow with a dull aching
pain in the lower limbs; there is loss of co-ordina-
tion, paralysis comes on, and finally the part be-
comes rigid. The reflexes are increased; and
there are no sensory disturbances.
Prognosis.
Unfavorable.
Treatment.—Consult locomotor ataxia.
DISSEMINATED CEREBRO-SPINAL
SCLEROSIS.
rosis.
Synonyms. Multiple sclerosis; insular scle-
Definition. A disease characterized by
patches of sclerosis scattered through the brain
and cord.
CAISSON DISEASE.
321
Pathology.-There are scattered foci of scle-
rosis, varying in size and outline, throughout the
brain and cord.
Symptoms.
The symptoms vary greatly.
The onset is very slow. There are various pains
in the limbs, headache and possibly vertigo.
Weakness, which soon amounts to paralysis, is
experienced in the legs. There is loss of co-
ordination, causing the "waddle" gait when walk-
ing. A tremor, "jerky" in character, comes
on when attempting voluntary movement; the
tremor entirely ceasing when at rest. The speech
is slow, scanning. Nystagmus is also present.
The course of the disease is long, with decided re-
missions.
Prognosis.
Unfavorable.
ܕ
Treatment.-Consult locomotor ataxia.
CAISSON DISEASE.
1.
ad
Synonym. Dever's paralysis.
Definition.-A disease caused by the too sud-
den return to the normal atmospheric pressure of
those who have been subjected to an increased
atmospheric pressure.
Pathology. Not known; the lesions resemble
disseminated myelitis.
Symptoms.-The symptoms may appear sud-
denly, or may not develop for several hours, after
making the sudden change in atmospheric pres
sure; the onset is marked by pain, especially
severe in the limbs, nausea and vomiting. The
skin becomes cool, with a cool sweat; the pulse
322
DISEASES OF THE SPINAL CORD.
*
small and compressible. There are both motor
and sensory paralysis, particularly a paraplegia.
The sphincters are often involved. The disease
lasts for an indefinite time, but recovery is the
rule.
Treatment. In coming through the locks at
least five minutes should be allowed for each lock
(A. H. Smith). For the attack, inhalations of
oxygen and compressed air may be tried. The
treatment must be similar to that for myelitis.
ACUTE ASCENDING PARALYSIS.
Synonym.-Landry's disease.
Definition. Motor paralysis, beginning in the
lower limbs and rapidly extending to the arms
and body; there is no atrophy or loss of sensation.
Etiology. The real cause is unknown.
Pathology.-No characteristic lesions.
Symptoms.--A sensation of weakness in the
legs, which rapidly increases until, sometimes, in
a few hours a paralysis develops. The paralysis
begins in the feet and ascends, involving the legs,
trunk, arms, muscles of respiration and degluti-
tion. The reflexes are lost. There is no atrophy.
The electrical reactions are normal. There are
no sensory symptoms. The bladder and rectum
are seldom involved. The diagnosis of this dis-
ease is often difficult.
Prognosis.
Unfavorable.
Treatment. There is no special treatment.
HEREDITARY ATAXIA.
Synonym.-Friedreich's ataxia.
HEREDITARY ATAXIA.
323
Definition. A sclerosis of the posterior and
lateral columns of the cord, which is observed in
certain families; it resembles locomotor ataxia.
Symptoms. The disease comes on, as a rule,
early in life. There is inco-ordination, beginning
in the legs, but quickly extending to the arms.
The gait of one walking is like the gait of a per-
son intoxicated. Nystagmus is present. There
is deformity of the feet, talipis equinus being
frequently present.
Prognosis.-Cures are rare; but the disease
runs a very long course.
Treatment.-No special treatment.
p
Diseases of the Nerves.
NEURITIS.
Definition.-An inflammation of the nerves.
Etiology. Traumatism is its chief cause; ex-
posure to cold and wet; or, from an extension of
an inflammation.
M
Pathology. The separate parts of the nerve
may be inflamed, but, usually the whole nerve is
involved. The nerve is red and swollen, with
granular degeneration.
Symptoms.-The onset may be slow or rapid.
There is pain along the course of the nerve; the
nerve is sensitive to pressure. There is a burn-
ing, tingling and numbness in the region supplied
by the affected nerve.
Differential Diagnosis.-Neuralgia has an
intermittent pain; and usually no tenderness.
Favorable.
Prognosis.
Treatment. Must be symptomatic.
MULTIPLE NEURITIS.
Synonyms.-Polyneuritis; beri beri.
Definition. A parenchymatous inflammation
of several symmetrical nerves, either simultan-
eously or in succession.
Etiology. Exposure to wet and cold; alco-
K
NEURALGIA.
325
holism; malaria; syphilis; certain constitutional
diseases, as, rheumatism, typhoid fever, diabetes,
etc.
M
Symptoms. The same as simple neuritis,
except the symptoms are more widely distributed.
Prognosis.—Favorable.
Treatment.-Must be symptomatic.
NEURALGIA.
Etiology.-Exposure to atmospheric changes;
traumatism; malaria; rheumatism; syphilis; gout;
from reflex irritation; hereditary.
TRIFACIAL NEURALGIA.
(Tic-douloureux; prosopalgia.) This consists
of severe paroxysmal pains in the course of the
trifacial nerve, particularly on the left side.
Treatment.—Hot fomentations to the part.
Recent cases give Aconite; or, Belladonna if
the pains come and go quickly, the face flushing
with every pain. Spigelia if the left side is
affected; and the pains are tearing, shooting;
with lachrymation, etc.; if right sided then Kal-
mia often cures. If reflex from gastic disturb-
ance Kali bich, or Nux vom. come in; or, reflex
from liver trouble Chelidonium should be tried.
If purely nervous, or complicated with malaria,
nothing excels Arsenicum.
INTERCOSTAL NEURALGIA.
The pain follows the course of the intercostal
nerves.
326
DISEASES OF THE NERVES.
Treatment.-Heat may be applied to the part;
or, the tincture of Aconite may be used externally.
Ranunculus bulb. is almost specific for this form
of neuralgia, except when due to reflex irritation
from the womb or ovaries, in which case Actea
race. is specific.
SCIATICA.
Definition. An inflammation of the sciatic
nerve, characterized by severe pain along the
course of the nerve.
Etiology. A disease of adult life; attacking
males oftener than females. Exposure to atmos-
pheric changes. Certain constitutional causes as
rheumatism, gout and syphilis.
Symptoms. Consists of severe pain in the
nerve, which may set in either suddenly or grad-
ually. The pain is of a gnawing or burning
character, felt first in the back of the thigh, but
soon extends down the whole limb along the
course of the nerve to its remotest distributions.
The nerve is sensitive to touch, worse at night,
on motion, and before a storm.
The attack may
last for several months, when the muscles may
become atrophied.
-The affected limb must have
Prognosis. -Responds, as a rule, to the in-
dicated remedy.
Treatment.
rest.
Hot applications often afford relief. Re-
move cause if possible. Nerve-stretching has
proved beneficial. Galvanism, after the acute
symptoms have been relieved, gives good results.
j
SCIATICA.
327
REMEDIES.
Actea Race.-When due to uterine irritation.
* The
Arsenicum.-Especially useful for chronic cases.
patient is restless and anxious; moves about. *Tearing
pains; pain from hip down posterior part of leg to knee.
*External warmth relieves.
"As near a specific as any remedy can come.”—Dr.
Hart.
In
Chamomilla.—* When the pains make the patient irrit-
able; they are snappish, can't give a civil answer.
nervous persons. *There are drawing tearing pains;
aggravated at night, and from external warmth. Pain
from the left ischium to the os calcis and sole of the foot,
with cramp-like tension of the muscles.
Colocynthis.-*For recent cases; the pain comes sud-
denly, is constant in character, and becomes intolerable
in paroxysms. Sharp shooting, tearing pain, extending
down the course of the sciatic nerve, followed by numb-
ness. Crampy pain in the affected hip, as though the
parts were screwed in a vise, lies upon the affected side,
with knee bent up.
""
'One of our best remedies."-Dr. Farrington.
An important remedy."-Dr. Laurie.
Gnaphalium.- When the intense pain in the nerve
alternates with numbness.
A good remedy."-Dr. Bartlett.
Kali Hyd. For cases due to syphilis.
Lycopodium.-* Obstinate, chronic cases.
weakness of the affected limb.
"C
Stiffness and
*Violent jerks of the
limb. Obstinate constipation.
Rhus Tox.-* Chronic cases; aggravated dung fest,
relieved by motion; sensation of numbness. Rubbing,
or external warmth relieves. * Caused from exposure to
inclement weather.
'Rarely fails in chronic cases. "-Dr. Ruddock.
Staphysagria. — Important remedy when sciatica
occurs in elderly people.
*
Sulphur. For obstinate cases, great tendency to
relapse.
328
DISEASES OF THE NERVES.
FACIAL PARALYSIS
Synonyms.-Bell's palsy.
Definition.-A paralysis of the seventh pair
of cranial nerves.
Etiology. Its main cause is exposure to at-
mospheric changes; particularly the exposure of
the face to cold winds. Traumatism, tumors,
and certain constitutional disorders may also
cause it.
Symptoms. The onset is generally sudden,
with paralysis of the muscles of the face on the
affected side. The expression on the affected
side is lost. The wrinkles are obliterated, the
eye is wide open and staring; tears flow down the
cheek; the mouth is drawn toward the unaffected
side; and speech is very difficult. The reflexes
are lost.
Differential Diagnosis.-In Bell's palsy there.
are no cerebral symptoms, which will distinguish
it from other like diseases.
Prognosis. Partial recovery is the rule; few,
indeed, make complete recoveries.
Faradiza-
Treatment. The cause should be removed if
possible. Give the affected side rest.
tion of the affected muscles. after acute symp.
toms have been removed, gives good results.
REMEDIES.
Aconite. Acute cases caused from exposure to dry
cold winds. *Numbness and tingling of the parts, par-
ticularly the lips. The patient is anxious and restless.
Causticum and Rhus Tox.-For the remaining paralysis,
after the acute symptoms have been relieved.
Hypericum. If from injury to the nerve.
de
Kali Hyd. If from syphilis.
Ja
General or Functional Diseases.
CHOREA.
Synonyms.—St. Vitus's dance.
Definition. A disease, occurring mainly in
children, characterized by irregular, involuntary
movements of the muscles, often accompanied by
weakness of the mind.
Etiology.-Youth; female sex; and heredi-
tary; are predisposing causes. May be caused
by reflex irritation from dentition; mental excite-
ment; ocular defect; self-abuse; and an adherent
prepuce. Sometimes develops during the first
five months of pregnancy.
Symptoms. The onset is gradual, often com-
mencing with simply irregular movements of the
feet, or constant movement of the hands; one
side is nearly always worse than the other; and
the arms are worse than the legs. The move-
ments cease during sleep. After the disease has
progressed for awhile the movements in the
muscles of the legs interfere with walking; and
those in the arms make the hands almost useless
for holding things. The speech is altered and
difficult from the constant movement of the
tongue. The memory is weakened; the disposi-
tion changes, the child becomes cross and irrita-
ble. The general health suffers; the patient be-
comes very anæmic.
S
330 GENERAL OR FUNCTIONAL DISEASES.
Sequelæ. -Mental impairment.
Duration. Variable; average about three
months.
Prognosis. A cure is the rule; although, re-
lapses are common.
Treatment.-Absolute rest of both body and
mind. Plenty of exercise in the open air is
essential. The cause should be found, and if
possible, removed. Galvanism has proved bene-
ficial.
Remedies. Actea race.; Agaricus; Arseni-
cum; Causticum; Cuprum; Hyoscyamus; Mygale;
Stramonium; Tarantula; Zincum; Zizia.
HYSTERIA.
Definition.-A state in which ideas control
the body and produce morbid chances in its
functions (Möbius).
Etiology.-Occurs mainly in females, particu-
larly at the time of puberty, and later at the
menopause. Prolonged mental excitement,
worry, etc.; self-abuse; want of out-door exer-
cise; and, any cause which depresses the vitality,
are predisposing causes. Hereditary plays an
important part.
Symptoms. For convenience the symptoms.
may be divided into the convulsive, and non-con-
vulsive.
Convulsive Hysteria.-The hysterical fits, in a
majority of cases, come on after some emotional
excitement; with violent crying, sobbing, laugh-
ing; or, alternate laughing and crying; and pecu-
HYSTERIA.
331
liar jerking and twitching of the limbs, the arms
and legs are thrown about in a very grotesque
manner. With these symptoms there is a con-
striction of the throat, a sensation of a ball in the
throat (globus hystericus). The patient is seem-
ingly unconscious; but, it is only apparent, she
knowing everything going on around her. In
falling, hysterical subjects seldom hurt them-
selves; nor, do they bite their tongne; nor is
there any elevation of temperature during the
paroxysms. The patient, during the paroxysm,
frequently struggles hard; kicks and strikes those
about her. The paroxysm ends with moaning,
crying, sighing, laughter; and often with profuse
urination of pale, clear urine, of low specific
gravity, the "hysterical urine," as it is often
called. Wakefulness usually follows the par-
oxysm.
The convulsions may closely resemble true
epilepsy in character; but, no matter how fre-
quently they appear there are no constitutional
symptoms. This form is called hystero-epilepsy.
Non-convulsive Hysteria.-The symptoms of
hysteria vary greatly; seldom do we see two cases
presenting the same symptoms. The patient is
irritable, emotional, and, frequently entertains
an exhalted opinion of herself. She believes she
is very sick; she magnifies all her sufferings; and
is constantly moaning and groaning. They often
simulate some form of paralysis; hyperesthesia is
very common; anesthesia is also observed. The
joints often suffer, as the so-called "hysterical
knee.'
ܕ
332 GENERAL OR FUNCTIONAL DISEASES.
Differential Diagnosis. The previous his-
tory of the patient, and remembering that in this
disease there is hyperæsthesia; mental disturb-
ances; and that in the paroxysm the patient
usually protects herself from injury; that uncon-
sciousness is only apparent; that there is the globus
hystericus; the normal temperature; the want of
muscular rigidity; and the peculiar polyuria;
Will prevent mistakes being made.
Prognosis. Rarely fatal; but, so far as a
complete cure is concerned, had better give a
guarded prognosis.
Treatment.-First, of all things, remove the
patient from her friends, and her accustomed
surroundings; second, give the patient absolute
rest; third, regulate the diet, eating mainly veg-
etables. Rest, of body and mind, is important;
all excitements must be avoided; frequent baths
and massage are useful.
M
The Attack.-Unloosen all clothing; dash cold
water in the face; and let them smell Camphor,
or Ammonia.
Moschus usually cuts short the paroxysm.
Ignatia is given during the non-convulsive period,
and is considered a specific by many, especially
indicated in those who are full of grief, constantly
moaning and sighing; if the globus hystericus is a
prominent symptom then Asafatida cures. Rem-
edies in this disease seems to act best in the lower
dilutions.
Other remedies, such as: Aurum; Belladonna;
Castoreum; Coffea; Cocculus; Gelsemium; Hyos-
NEURASTHENIA.
333
cyamus; Nux mos.; Platinum; Sepia; Valerium;
Zincum; and, in fact, every medicine in the materia
medica, must be studied.
tem.
NEURASTHENIA.
Synonyms.-Nervous prostration.
Definition.-A weakness of the nervous sys-
Etiology.-Chronic diseases which lowers the
patient's vitality; excessive and constant mental
worry; self-abuse; excesses of any kind, and a
hereditary pre-disposition to a weakened nervous
system.
Symptoms. The first symptoms are those of
general mental and physical prostration. The
patient finds his usual vocation burdensome, he
cannot do his accustomed work well; cannot con-
centrate his mind; can not rememember well.
The least work of any kind soon tires him. He
becomes depressed, low-spirited, irritable; his
sleep is disturbed; there may he vertigo, and
headache. There is palpitation of the heart.
Various pains are experienced throughout the
body. Often there are many of the symptoms of
hysteria; also, many of the symptoms of lithæ-
mia.
St
Prognosis.—Good.
Treatment.-Must be largely hygienic and
dietetic. The patient must have rest, away from
cares and troubles, his surroundings must be
pleasant. Regulate his daily exercise Sleep,
which is very essential to those suffering from
334 GENERAL OR FUNCTIONAL DISEASES.
nervous exhaustion, must be obtained. The
cause must be discovered, and, removed, if pos-
sible. The diet must be nutritious and easily di-
gested. Galvanism and massage are valuable
helps to the cure.
Remedies.-Argentum nitr.; Aletris; Calcarea;
Ignatia; Helonias; Nux vom.; Phosphorus;
Phosphoric acid; Picric acid; Pulsatilla; Strich-
nia sulph.; Sulphur.
EPILEPSY.
Definition.-A chronic disease of the nervous
system characterized by sudden attacks of un-
consciousness, associated with more or less gen-
eral convulsions.
Etiology. Its etiology is not definitely known.
Hereditary is an important factor. Occurs in
young persons, about the time of puberty, affect-
ing equally both sexes. Injuries to the cranium
also cause epilepsy. Parents who are syphilitic,
and who suffer from chronic alcoholism, often
beget epileptic children.
Varieties.—(1) Grand mal; (2) petit mal;
(3) Jacksonian epilepsy.
Symptoms.-Grand Mal.-This form is pre-
ceded by definite symptoms, peculiar to each case,
called the aura epileptica. This aura consists in
certain odd sensations in different portions of
the body; for instance, a very common aura is
the sensation of a mouse running up the arm; or,
an indescribable feeling in the pit of the stomach;
etc. The onset is sudden; as a rule, the patient,
EPILEPSY.
335
with a sharp, shrill, scream, the epileptic cry,
falls unconscious, with twitchings of the various
muscles, which is soon followed by tonic spasms.
The head is drawn to one side; the limbs are ex-
tended; the teeth clenched; and the hands tightly
closed. The patient froths at the mouth; and
often the tongue is bitten. After a few seconds
the violent spasm relaxes somewhat and the con-
tractions become clonic, or intermittent. This
irregular and intermittent contraction causes the
limbs to jerk and often the body itself is moved.
Involuntary evacuations from both the bowels.
and bladder occur. The face at first, is pale, but
later is cyanosed, and finally during the coma is
conjested. This clonic condition lasts for a few
minutes; and is followed by a state of coma.
The spasm is now gone; the face is congested;
the patient falls into a sleep, and awakens in a
few hours, feeling no worse for his experience
than a slight mental confusion.
Petit Mal.-Epilepsy without the convulsions,
as Olser puts it. The patient may experience a
slight vertigo, or a momentary unconscious spell;
followed by a slight mental confusion.
Jacksonian Epilepsy.-In this variety the pa-
tient retains consciousness. The spasm begins
in some one portion of the body, and gradually
spreads until the whole body is convulsed.
If the convulsions should follow each other in
such rapid succession that the patient does not re-
gain consciousness between them the condition is
called "status epilepticus."
336 GENERAL OR FUNCTIONAL DISEASES.
Differential Diagnosis.-The peculiarities of
the attack as given above will prevent mistakes
in diagnosis. The sudden onset, the tonic, fol-
lowed by clonic spasms, then coma, finally heavy
sleep, are characteristic.
Prognosis. Unfavorable as regards a com-
plete cure; but, help may be given nearly all cases.
Treatment. The exciting cause should be
found, and removed if possible. The patient
must avoid all excitement, and guard against
bodily fatigue. The diet must be light and nutri-
tious; a vegetable diet is highly recommended.
During the attack protect patient from injury;
place a piece of cork, or handkerchief between
the teeth to keep from biting the tongue. The
inhalation of nitrite of amyl will often cut short
an attack; in very severe spasms Chloroform may
be inhaled.
Remedies.-Belladonna; Bufo; Calcarea carb.;
Cannabis; Cicuta; Cuprum; Ignatia; Opium;
Silicea.
Bromide of potassium in large and increasing
doses stops the re-appearance of the spasms.
Surgical interference, especially in the Jack-
sonian variety, promises good results.
PARALYSIS AGITANS.
Synonyms. Parkinson's disease; shaking.
palsy.
Definition. A chronic disease of the nervous
system, characterized by tremor, progressive
weakness and more or less rigidity of the affected
muscle, and a peculiar gait.
PARALYSIS AGITANS,
337
Etiology. Not known. Occurs more fre-
quently in women than in men; and usually in
those over fifty years of age.
Symptoms.-Gradual onset; tremor being the
first symptom to attract attention. The tremor
begins, usually, in one set of muscles, particularly
in the hand, and may be controlled by will at
first; the tremor ceases during voluntary move-
ment and during sleep. At first, the tremor is
paroxysmal, but soon becomes constant; seldom
does the tremor attack the head. The hand is
held as if in the act of "rolling a piece of paper
or, crumbling bread." Following the tremor
is weakness and rigidity of the muscles. This
rigidity gives the patient a characteristic gait,
known as festination, that is, when attempting to
walk, the steps grow faster and faster, with tend-
ency to run forward, until the patient either falls,
or finds some support. His back is bowed, his
head is bent forward, and the arms are held away
from the body. The voice is expressionless; he
has a difficulty in commencing to speak, but,
when once started he speaks very rapid. The
intellect is unimpaired.
Differential Diagnosis.-The characteristic
tremor, gait and attitude, combined with weak-
ness and rigidity of the muscles, should prevent
errors of diagnosis.
((
""
Prognosis.-A complete cure is rare; but, the
disease can be, in a great number of cases, stayed
in its progress.
The course of the disease is long
and indefinite.
338 GENERAL OR FUNCTIONAL DISEASES.
Treatment.-Must be general; the diet must
be nutritious. Massage gives good results.
Remedies.- Tarantula. "The pathogenesis of
this remedy shows it to be the true similimum of
this disease."-Dr. Hart.
EXOPHTHALMIC GOITRE,
Synonyms.-Basedow's disease; Grave's dis-
Definition. A nervous disease of doubtful
origin, but presumed to be due to some fault in
the sympathetic nervous system, characterized by
hypertrophy of the thyroid gland, protrusion of
the eyeballs, and palpitation of the heart.
Symptoms.-The first symptom is the swell-
ing of the thyroid gland; which may be confined
to one lobe, or both lobes may be involved.
With the swelling of the gland there is pulsation
and a peculiar purring thrill. The patient gradu-
ally loses strength, becomes nervous, irritable and
depressed in spirits. The eyeballs protrude from
the dilatation of the vessels back of the eyes.
The vision is unaffected.
ease.
<
Prognosis.-Fairly good.
Treatment. The patient must have quiet and
rest; free from all excitement and worry. The
diet must be nutritious. Painting the gland with
Iodine has been recommended.
Galvanic current
to the neck is beneficial.
Remedies. Dr. Jousset recommends Bella-
donna; Dr. Lilienthal mentions Natrum mur. and
Lycopus; Dr. Hughes speaks of Iodine.
My
THOMSEN'S DISEASE.
339
THOMSEN'S DISEASE.
Synonyms. Congenital myotonia.
Definition. A disease characterized by tonic
spasms of the muscles, caused by voluntary
movements.
Etiology. Its cause is unknown; it appears in
certain families, from one generation to another;
particularly in the male.
Symptoms.-The disease appears in infancy.
It is manifest when the patient attempts to put a
muscle into action, when the muscle becomes
rigid, which rigidity lasts for a few seconds, when
the movement may be made. This disease is
usually limited to the muscles of the limbs.
Prognosis. Incurable; although relief may
be given.
Treatment.-Must be general.
RAYNAUD'S DISEASE.
Synonyms.-Symmetrical gangrene; local as-
phyxia.
Definition.-A disease due to vaso-motor in-
fluences, characterized by local anæmia, conges-
tion, and finally in fully developed cases, gan-
grene.
Etiology. Not known.
Symptoms.-The onset of the disease is
usually sudden. The affected part, which is
generally the finger or toe, becomes bloodless,
hence pale in color, very cold to the touch,
shrunken, and anæsthetic. This is the stage of
local anæmia; which, however, is soon followed
M
340
GENERAL OR FUNCTIONAL DISEASES.
by the stage of local congestion. The part now
becomes very red, hot to the touch, and swollen.
Pain now appears from the swelling. The stage
of local gangrene comes on with the formation of
large blots, the part becomes dark, and gangrene
forms; a line of demarkation is usually well
formed; the dead tissue is sloughed off; and, the
part heals by granulations. The symmetry of
this disease is characteristic. If it involves the
fingers, there will be one on each hand; or, a toe
on each foot, etc.
Prognosis. Seldom kills; but, is a very per-
sistent disease; and, very liable to return, even if
cured.
Treatment. The hygienic surroundings and
diet, must be regulated for each case.
Arsenicum; Argentum nitr.; Crotalus; Lache.
sis; Secale; Sulphur; are remedies which should
be studied.
PSEUDO-HYPERTROPHIC PAR-
ALYSIS.
Synonym.-Pseudo-muscular hypertrophy.
Definition. A disease, of hereditary tendency,
appearing more particularly in children, charact-
erized by degeneration, with hypertrophy of the
muscles, and progressive paralysis.
Etiology. The disease attacks children, par-
ticularly the boys, of certain families. Its real
cause is unknown.
Pathology. There is a true atrophy of the
muscle-fibres, with a deposit of fat and connect-
PSEUDO-HYPERTROPHIC PARALYSIS.
341
ive tissue elements causing a pseudo-hypertrophy.
The cord is affected secondarily.
Symptoms.
The disease generally declares
itself when the child commences to walk; the
muscles are plump but there is excessive weak-
ness; the child stumbles and always wants sup-
port. The muscles enlarge, particularly those of
the lower limbs. In standing the child has his
feet apart, the shoulders thrown back, protruding
the stomach, and curving the back. When at-
tempting to rise he must help himself by grasping
his knees, then his legs, then his thigh, until
finally he is erect. This has been called climb-
ing up his thighs." The muscles are paralyzed,
yet the pseudo-hypertrophy gives the child an
appearance of excessive strength.
(C
beneficial.
Prognosis. Incurable; although the patient
may live for years.
Treatment.-Must be general. Massage is
Abdominal dropsy,
typhus,
Abscess, cerebral,
hepatic,
Acute articular rheumatism
Bright's disease,
bulbar paralysis,
coryza,
gastric catarrh,
gastritis, .
laryngitis,
lobar pneumonia,
meningitis,
pharyngitis,
tuberculosis,
uræmia,
yellow atrophy,
Addison's disease,
Agraphia,
Ague,
·
•
Albuminoid liver,
INDEX.
Alexia,
Amoeba coli, .
cerebral,
cytogenic,
essential,
fatty heart, of, .
•
•
Amygdalitis,.
Amyloid kidney,.
liver,
Amytrophic lateral sclerosis,
Anæmia,.
4
•
•
•
*
•
*
•
+
PAGE.
127
205
303
139
279
150
315
I
87
87
9
SI
294
85
270
147
140
177
304
228
142
304
256
SI
157
142
313
168
297
168
168
173
343
344
INDEX.
Anæmia, idiopathic,
lymphatic,
pernicious,.
primary,.
secondary,
symptomatic,
varieties of,
Angina catarrhalis,
pectoris,
tonsillaris,
Aortic insufficiency,
obstruction,
regurgitation,
stenosis,
Aphasia, .
ataxic,
motor,
sensory.
Aphthous stomatitis,
Apoplexy, cerebral,
•
•
pulmonary,
Appendicitis,
Arachnitis,
•
1
•
·
•
·
bronchial,
•
•
•
·
Ascending paralysis,
Ascites,
Asthma,
•
•
Argyll-Robertson pupil,
Arrhythmia,.
Arteries, diseases of,
Artero-sclerosis,
Arthritis deformans,
Articular rheumatism,
Ascaris lumbricoides, .
hay,
Kopp's,
nervous,
spasmodic, .
Ataxia, hereditary, .
·
►
•
•
•
•
•
•
•
•
4
•
173
176
173
170
168
168
168
85
199
81
193
194
193
194
304
304
304
304
76
299
46
121
294
317
199
203
203
284
279
120
322
127
35
35
40
20
35
35
316
INDEX.
345
Ataxia, locomotor, .
Ataxic paraplegia,
Atelectasis,
Atheroma,
Atonic dyspepsia,
Atrophic spinal paralysis,
Atrophy, acute yellow,.
Aura epileptica,
Autumnal catarrh,
fever,
•
Bacillus, comma,
Klebs-Loeffler,
of Eberth,.
of Pfeiffer,
tuberculosis,
Basedow's disease,
Bastard pleurisy, .
Bell's palsy,
Beri beri,
•
•
•
•
·
A
-
·
•
•
Bile-ducts, catarrh of,
Biliary calculi, .
colic,
Bilious remittent fever,.
Black vomit,
•
Blood, diseases of,
urine, in the,
vomiting,
vessels, diseases of, .
Bloody flux,.
Bothriocephalus latus,
Bowels, diseases of,
Bladder, inflammation of,
catarrh of, .
Bleeders' disease,
•
•
-
•
D
Brachycardia, see bradycardia.
Bradycardia,
Brain, abscess of,
anæmia of, .
congestion of,
·
4
•
•
•
·
•
•
•
322
320
65
•
203
88
312
140
334
40
205
261
236
205
225
268
338
30
328
324
132
144
144
232
217
163
163
178
168
162
100
203
256
119
104
199
303
297
1 296
•
346
INDEX.
Brain, diseases of,
softening of,.
Break-bone fever,
Breast-pang,
Bright's disease, acute,
·
capillary,
catarrhal,
chronic,
croupons,
diphtheric,..
chronic,
cirrhotic, .
Bronchial catarrh, acute,
catarrh, chronic, .
hemorrhage,
fibrinous,
plastic,
Bronchial tubes, dilatation of,
Bronchiectasis, .
Bronchitis, acute,
•
•
•
·
A
▸
•
•
pseudo-membraneous,
Broncho-pneumonia,
Bronchorrhagia,
Bronzed-skin disease,
Bulbar paralysis,
Caissons' disease,
Calculi, biliary,
•
•
hepatic,
renal,
Camp fever,
Cancer, liver, of the,
stomach, of the,
Cancrum oris,
Capillary bronchitis,
Carcinoma, liver, of the,
stomach, of the,
Cardiac dilatation,
•
·
•
•
fatty degeneration,
hypertrophy,
•
•
•
•
•
•
*
•
296
299
224
199
150
152
154
22
26
42
w nw windo
35
35
22
30
22
26
33
33
33
33
33
30
42
177
315
321
144
144
160
215
143
99
77
30
143
99
190
192
189
INDEX.
347
Cardiac, irritability,
neuralgia,
valvular diseases,
Cardialgia,.
Cardio-sclerosis,
Carditis, .
Catarrh, autumnal,
·
bile ducts, of the,
bladder, of the,
bronchial, acute,
chronic,
epidemic,
gastric, acute,
•
•
1
•
chronic, see dyspepsia.
mouth, of the,.
nasal, acute,
atrophic,
chronic,
hypertrophic,
•
•
Cerebral, abscess,
pollen,
rectum, of the,
suffocative,
Catarrhal, dyspepsia,
enteritis,
fever,
jaundice,
laryngitis, acute,.
chronic,
nephritis,
pharyngitis,
pneumonia,
stomatitis,
•
•
•
•
•
•
•
anæmia,.
apoplexy,
congestion,
embolism,
fever,
hemorrhage,.
•
•
·
·
❤
•
*
•
•
•
·
►
198
199
193
95
188
187
40
132
163
22
26
225
87
75
I
6
4
5
40
122
30
89
104
225
132
9
II
150
85
61
75
303
297
299
296
298
294
299
348
INDEX.
Cerebral, hyperæmia,
softening,
thrombosis,
Cerebro-spinal fever,
meningitis,
Chicken-pox,
Child crowing,
Chills and fever, ·
Chlorosis,
Cholelithiasis,
Cholera,
Asiatic,
English,
epidemic,
infantum,
malignant, .
morbus,
sporadic,
Cholerine,
Chorea,
Chronic gastric catarrh, see dyspepsia.
nasal catarrh,
pneumonia,
•
•
!
•
•
Cold, rose,
Colic, biliary,
Cirrhosis, kidney, of the,
lungs, of the,
liver, of the,
•
•
Clergyman's sore throat,
Cold on the chest,
in the head,
hepatic,
intestinal,
•
.
renal,
Colitis,
Coma, uræmic,
Comma bacillus,
•
•
•
*
·
·
•
Congenital myotoma, .
Congestion, cerebral,
•
•
·
•
•
•
·
•
296
299
298
220
220
246
20
228-
170
144
260
260
107
260
109
260
107
107
262
329
4
64
154
64
136
II
22
I
40
183
183
117
160
256
147
261
339
296
*
INDEX.
349
Congestion, hepatic,
pulmonary,
renal,
Congestive chills,
Constipation,
Consumption,
throat, .
Convulsion, uræmic,
Contracted kidney, .
Coryza, acute,
chronic,
Costiveness,
Cowpox
Croup, catarrhal,
false,
membranous, .
pseudo-membranous,
spasmodic,
true,.
•
·
Diarrhoea,
•
•
·
•
•
Croupous bronchitis, .
•
•
laryngitis,
pneumonia,
stomatitis,
Curschmann's spirals,
•
•
Cystitis,
Dandy fever,
Dengue,
Diabetes, insipidus,
mellitus.
•
•
•
varieties of,
Diathesis hemorrhagic,
cardiac,
gastric,
Diphtheria,
Diphtheric bronchitis,
lithic acid,.
Digestive system, diseases of,
Dilatation, bronchial,.
.
•
•
•
·
*
•
·
•
•
129
47
148
232
113
275
12
147
154
I
4
113
244
15
15
17
9
15
17
33
17
51
76
36
163
224
224
289
288
105
105
178
291
75
35
190
102
236
33
350
INDEX.
Disease, Addison's
Basedow's,.
bleeders'.
Bright's,.
bronzed-skin,
Caisson,
Duchenne's,
Friedreich's,
arteries,
bladder,
blood,
•
•
Graves',
•
Gull and Sutton,
Hodgkin's, .
Landry's..
Meniere's,
Parkinson's,
Raynaud's,
Thomsen's,
Diseases of the appendix,
•
•
•
bronchial tubes,
cerebral membrane,
•
•
cerebrum,
circulatory system,
constitutional,
digestive system,
heart,
.
•
intestines,
kidney,
larynx,
liver,
lungs,
mouth,
nasal passages,
nerves,
nervous system,
•
•
pericardium,
peritoneum,
pharynx, .
•
•
•
•
•
•
D
•
•
•
·
•
་
·
•
•
•
•
177
338
178
150
177
321
316
322
338
203
126
322
305
336
339
339
121
203
163
168
22
293
296
180
279
75
186
104
147
9
129
45
75
I
324
293
180
123
81
INDEX.
351
Diseases of the pleura,
rectum,
respiratory system,
specific infectious,
spinal cord,
stomach,.
pericardial,
peritoneal, .
pleural,
Disseminated cerebral spinal sclerosis,
Dizziness,
Dropsy, abdominal,
Duchenne's disease,
Dura-mater, inflammation of,
Dysentery,.
Dyspepsia,.
atonic,.
catarrhal,
•
acute,
chronic,
nervous,
Echinococcus of the liver,
Elephantiasis Græcorum,
Embolism, cerebral,
Emphysema,.
Encephalitis,.
Endocarditis,
•
·
exudative,
interstitial,
malignant, .
ulcerative,
varieties of,
"
acute,
catarrhal,
chronic,
·
English cholera, .
Euteralgia, .
Enteric fever,
Enteritis,
•
►
•
•
•
•
→
•
•
•
•
•
·
•
1
•
❤
68
122
I
205
309
87
320
305
127
185
127
73
316
293
256
88
88
89
88
144
264
298
66
303
186
187
187
187
187
187
187
187
104
117
205
104
104
104
104
352
INDEX.
1
Enteritis, membranous, .
varieties of,
Entero-colitis,
Ephemeral fever,.
Epidemic catarrh,
cerebro-spinal meningitis,
measles,
roseola,
•
Epilepsy,
Erysipelas, .
ambulans
phlegmonous,
Exanthematic typhus,
Exopthalmic goitre,
•
•
•
·
Facial paralysis,
Famine fever,
Fatty heart,
Fatty infiltration of the heart,
•
autumnal,
break-bone,
catarrhal,
cerebral, .
cerebro-spinal,
congestive,
dandy,
enteric,
Febricula,
Fever, abdominal typhus,
•
•
•
•
•
ephemeral,
epidemic cerebro-spinal,
famine,
gastric,
hay,
intermittent,
irritative,
jail,.
lung,
malarial, .
Mediterranean,
·
•
•
·
·
•
•
·
·
·
I04
104
105
227
225
220
252
252
334
253
254
254
215
338
328
223
192
191
227
205
205
224
225
294
220
232
224
205
227
220
223
205
40
228
227
215
51
227
217
INDEX.
353
Fever, nervous,
pernicious malarial,
relapsing,
remittent,
rheumatic,
scarlet,
ship,
simple continued,
spirillum,
spotted,
thermic,
typhoid,
typhus,
yellow,
•
↓
Fibroid heart,
Fibroid pneumonia,
Fibrinous bronchitis,
Follicular stomatitis,
Friedreich's ataxia,
•
•
Gall stones,
Galloping consumption,
Gangrene of the lung,
symmetrical,.
catarrh,
dilatation,
fever,
#
•
Gangrenous stomatitis,
Gastralgia, .
Gastric cancer,
•
•
hemorrhage,
neuralgia,
ulcer,
·
Gastritis,
Gastrodynia,
Gastrorrhagia,
German measles,
Gin-drinker's liver,
Glossitis,
•
•
•
Glosso-labio-laryngeal paralysis,
·
•
4
A
•
•
•
205
232
223
232
279
246
215
227
223
220
307
203
215
217
188
64
33
76
322
144
270
64
339
77
95
99
87
102
205
100
95
97
87
95
100
252
136
79
315
354
INDEX.
Glottis, oedema of the,
spasm of the,
Glycosuria,
Goitre, exopthalmic,
Gout,
latent,
rheumatic, .
Gouty liver,
kidney,
Grand mal,
Granular liver,
kidney,
•
Gravel,
Graves' disease,
Grippe, la, .
Green sickness,
Gull and Sutton disease,
·
Hæmatemesis,
Hæmathorax,
Hæmaturia,
Hæmopericardium,
Hæmophilia,
Hæmoptysis,
Hay asthma,
fever,
Headache, sick,
Heart, dilatation of,
•
·
diseases of, .
fatty degeneration of,
•
hypertrophy of,
inflammation of,
•
irregular,
irritable,
neuralgia of,
palpitation of,
rapid,
slow,
valvular diseases of,
Heat exhaustion,
►
•
•
•
•
•
•
*
•
•
14
20
288
338
285
291
284
136
154
334
136
154
160
338
225
170
203
100
74
162
186
178
42
40
40
306
190
186
192
189
187
199
128
199
128
199
199
193
307
INDEX.
355
Hemicrania,
Hemorrhage, bronchial,
cerebral,.
gastric,
pulmonary,
renal,
Hemorrhagic diathesis,
Hepatic calculi,
•
cancer,
colic,
Hepatitis, diffuse or general parenchymatous,
interstitial,
parenchymatous,
suppurative,
Hereditary ataxia,
Hernia of the intestines,
Hodgkin's disease,
Hooping cough,
Hospital fever,
Hydatids of the liver,
Hydrocephalus, acute,
chronic,
Hydronephrosis,
Hydropericardium, .
Hydroperitoneum,
Hydrothorax,
Hydrophobia,
Hydrops-pulmonum,
•
•
L
+
·
•
•
•
•
Hyperæmia, see congestion.
Hypertrophy of the heart,
Hypostatic congestion,
pneumonia,
Hysteria,
Hystero-epilepsy,
Icterus,
gravis,
Ileo-colitis,
Indigestion,
Induration, pulmonary,
·
•
•
น
•
•
*
306
42
299
100
45
162
178
144
143
144
140
136
139
139
322
116
126
235
215
144
271
308
159
185
127
73
266
49
189
48
48
330
331
131
140
105
88
64
356
INDEX.
Infarction, pulmonary,
Infantile spinal paralysis,
Inflammatory rheumatism,
Influenza,
Insular sclerosis,
Intercostal neuralgia,
Intermittent fever,
Interstitial hepatitis,
nephritis,
pneumonia,
•
Intestinal catarrh,
colic,
hernia,
#
Irritable heart, .
Irritative fever,
obstruction,
occlusion,
parasites,
stricture,
twisting,
Intestines, diseases of,
Intussusception,
1
Jacksonian epilepsy,
Jail fever,
Jaundice,
catarrhal,
malignant,
•
Kidney, amyloid,
congestion of,
contracted, .
•
•
•
·
•
inflammation of, .
lardaceous,
red, sinall,.
sclerosis of,
•
·
•
dilatation of the pelvis of, .
diseases of,.
granular,
gouty,.
•
•
*
·
·
▼
•
46
312
279
225
320
325
228
136
154
64
104
117
116
116
116
119
116
117
I04
116
198
227
335
215
131
132
140
157
148
154
159
147
154
154
150
157
154
154
INDEX.
357
Kidney, waxy,
white, large, .
Kopp's asthma,
Landry's disease, .
La grippe,
La rage,
Larynx, diseases of,
inflammation of,
•
•
•
•
œdema,
Laryngismus stridulous,
Laryngitis, acute catarrhal,
chronic catarrhal,
croupous,
oedematous,
•
•
•
tubercular,
syphilitica, .
Lardaceous kidney,
liver,
pseudo-membraneous,
•
Lateral sclerosis,
Lepræ,
Leprosy,.
•
Leucæmia, .
lymphatic,
myelogenic,
pseudo-,
splenic,
Leucocythæmia,
pseudo,
Lithæmia,
Lithic-acid diathesis,
Leptomeningitis, acute,.
spinalis,
·
4
·
•
•
•
•
Liver, abscess of,
albuminoid,
amyloid,.
atrophy, acute yellow,
cancer of,
congestion,
•
•
1
•
→
157
153
20
322
225
266
9
9
14
20
9
II
17
14
17
12
13
157
142
319
264
264
294
209
175
175
175
176
175
175
176
291
291
139
142
142
140
143
129
358
INDEX.
Liver, cirrhosis,
atrophic,.
hypertrophic,
diseases of,.
echinococcus,
gin-drinkers',
granular,
gouty,.
hob-nail,
hydatids of
inflammation of,
lardaceous,
nutmeg,
sclerosis of,
waxy,
•
•
▸
Lockjaw,
Locomotor ataxia,
Lumbago,
Lung fever,
Lungs, cirrhosis, of,
•
collapse of, .
congestion of,
consumption of,
•
diseases of,.
gangrene, of.
hemorrhage of, .
hyperæmia of,
oedema of,
·
•
1
splenization of, .
Lymphadenosis,
Lyssa,
Malarial cachexia,
•
black,
、 epidemic,
fever,
Malignant malaria,
quinsy,
會
​•
Masked intermittent fever,
Measles,
•
•
•
•
•
•
·
•
*
•
•
•
•
·
136
136
137
129
144
136
136
136
136
144
139
142
129
136
142
267
316
283
SI
64
65
47
275
45
64
45
47
49
48
176
266
233
227
232
236
234
250
251
252
INDEX.
359
Measles, German,
hemorrhagic,
malignant, .
Mediterranean fever,
Melasma supra-renalis,
Membranous croup,
Meniere's disease,
Meningitis, acute,
basilar,
cerebro-spinal,
spinal, .
tuberculous,
⇓
•
Morbilli,,
Morbus maculosus,
Mouth, catarrhi of,
•
Migraine,
Mitral insufficiency or regurgitation,
stenosis or obstruction,
Muguet,
Myalgia,.
Myelitis, acute,
•
diseases of, .
Multiple neuritis,
Multiple sclerosis,
Mumps,
Muscular atrophy, progressive,
·
•
Myocarditis, acute,
chronic
•
•
•
•
of the anterior horns of the cord,
•
•
Myotonia, congenital,
Nasal catarrh, acute,
atrophic,
chronic,
hypertrophic,
Nephritis, acute,
catarrhal,
chronic,
interstitial, .
Nephrolithiasis,
•
·
•
·
•
•
•
•
•
•
252
251
251
217
177
17
305
294
271
220
309
271
306
195
196
250
179
25
75
324
320
234
313
78
283
310
312
187
188
339
I
6
4
5
150
150
153
154
160
360
INDEX.
Nervous dyspepsia,
fever,
prostration,
Neuralgia,
heart, of the,
intercostal,
stomach, of the,
trifacial,
Neurasthenia,
Neuritis, .
•
multiple,.
Noma,.
Nose, diseases of, .
Nutmeg liver,
Occlusion of the intestines,
Edema, glottis, of the,
lung, of the,
Pachymeningitis.
spinalis,
Palpitation,
Palsy, Bell's,.
shaking,
wasting,
Paralysis agitans,
ascending, .
•
•
•
·
·
atrophic spinal,
Bell's, .
bulbar,
Dever's,
Duchenne's,
facial,
•
•
•
glosso-labio-laryngeal,
infantile spinal,
Landry's,
spastic spinal,
Paraphasia,
Paraplegia, ataxic,
`spastic,
·
pseudo-hypertrophic,
►
•
·
•
•
·
•
·
•
•
瞎
​•
❤
•
88
205
333
325
199
325
95
325
333
324
324
76
I
129
116
14
49
293
309
198
328
336
313
336
322
312
328
315
321
316
328
315
312
322
340
319
305
320
319
INDEX.
361
Parasites, intestinal,
Parasitic stomatitis,
Parkinson's disease,
Parotitis,
Pericarditis,
Pericardium, air in,
blood in,
diseases of,.
dropsy of,
inflammation of,
•
Periodical vasomotor rhinitis,
Peritoneum, diseases of,
Peritoneal dropsy,
Peritonitis,
Perityphlitis,
Pernicious anæmia,
malarial fever,
•
acute,
chronic, .
ulcerative,
•
Pertussis,
Petit mal,
Phagedæma of the mouth,
Pharyngitis, acute,
phlegmonous,
Pharynx, diseases of,
Phlegmonous pharyngitis,
Phthisis,
•
•
►
•
•
•
fibroid,
Florida,
laryngeal,
miliary, .
pneumonic,
pulmonalis,
typhoid form of,
Plastic bronchitis,
Pleura, diseases of,
•
❤
•
dropsy of,
inflammation of,
•
•
·
•
•
•
•
•
►
•
•
•
ii9
78
336
173
232
235
335
77
85
81
81
8r
268-274
270
275
275
277
270
12
234
180
186
186
180
185
180
40
123
127
123
121
270
275
274
270
33
68
73
68
362
INDEX.
Pleural cavity, air in,
blood in,.
Pleurisy,
bastard,
varieties of,
Pleurodynia.
Pleuro-pneumonia,
Pneumonia,
broncho-,
catarrhal,
chronic,
•
croupous,
ensular,
fibroid,
·
•
hypostatic, .
interstitial,
•
lobar,
lobular,
serous,
Pneumonitis,
Pneumopericardium,
Pneumothorax,
Podogia, .
Polio-myelitis, anterior,
chronic,
Pollen catarrh,
Polyneuritis,
Polyuria,
Posterior spinal sclerosis,
Proctitis,
Progressive muscular atrophy,
•
•
•
•
·
pernicious anæmia,
Prosopalgia,
Pseudo-croup, .
•
▸
hypertrophic paralysis,
leucæmia,
•
•
leucocythæmia,
membranous bronchitis,
Pulmonary apoplexy,.
•
•
·
74
74
68
30
68
284
51
64
61
61
64
51
61
64
48
64
51
61
49
51
186
74
285
312
313
40
324
289
316
II2
313
173
325
9
340
176
176
33
46
INDEX.
363
Pulmonary, collapse,
emphysema,
induration, .
infaction,
œdema,
•
Pulmonary insufficiency or regurgitation,
stenosis or obstruction,
Purpura hemorrhagica,
Pyelitis,
Pyelonephritis,.
Pyloric obstruction,
Pyonephrosis,
Quinsy,
malignant, .
Renal calculus, .
•
Rabies,
Raynaud's disease,
Rectitis,
Rectum, diseases of,
Relapsing fever,
Remittent fever,
colic,
gravel,.
hyperæmia,
•
.
Rubella,
Rubeola,.
•
·
Rotheln, .
Round worms,
·
Rheumatic fever,.
gout,
Rheumatism, articular,
chronic,
•
•
•
•
•
inflammatory,
muscular,
Rheumatoid, arthritis,
Rhinitis, acute,
·
•
•
chronic,
periodical vaso-motor,
•
•
•
•
•
·
65
66
64
46
49
197
198
179
158
158
102
158
SI
236
266
339
122
122
223
232
160
160
160
160
279
284
279
282
279
283
284
I
4
40
252
120
252
250
364
INDEX.
St. Vitus' dance,
St. Anthony's fever,
I
Scarlatina,
Scarlet fever,
Sciatica,.
Sclerosis, amyotrophic lateral,
·
•
•
cerebro-spinal, .
disseminated,
→
kidney, of the, .
lateral.
liver, of the,
multiple
posterior.
spinal,.
Scorbutus
Scurvy,
Shaking palsy, .
Ship fever,.
Sick headache, .
Small pox,
Softening of the brain,
•
Sore throat,
Spasm of the glottis,
of the stomach,
Spasmodic croup,
Spastic paraplegia,
Spinal meningitis,
muscular atrophy,
paralysis, infantile,
sclerosis, .
Spirillum fever,
Sporadic cholera, .
Spotted fever,
Sprue,.
Status epilepticus,
Stenocardia,
Stomach, cancer of,
dilatation of, .
diseases of
·
•
•
· 329
253
246
246
326
•
•
·
•
•
•
•
•
313
320
320
154
319
136
320
316
316
177
177
316
215
306
240
299
85
20
95
15
319
309
313
312
316
223
107
220
78
335
199
99
102
87
INDEX.
365
Stomach, hemorrhage from,
inflammation of,
neuralgia of,
spasm of,
ulcer of, .
Stomatitis, aphthous,
catarrhal,
croupous,
follicular,
gangrenous,
parasitic,
ulcerative,
vesicular,
Tachycardia, .
Tapeworm,
Tetanus,.
Thermic fever,
►
•
•
Stricture of the intestines,
Suffocative catarrh,
Summer complaint,
Sunstroke,.
Symmetrical gangrene,
Syphilitic laryngitis,
Tabes doralis,
Thomsen's disease,
Thoracic dropsy,
Throat consumption,
Thrombosis, cerebral,
Thrush,
Tonsillitis,
Tormina,
Torticollis,.
Trichinæ,
•
•
•
•
•
*
Tic-douloureux,
Tinea solium,
Tongue, inflammation of,
Tonsils, hypertrophy of,
inflammation of, .
swelling of,
•
•
•
100
86
95
95
97
76
75
76
76
77
78
76
76
116
30
109
307
339
13
316
179
119
267
307
339
73
12
298
78
325
119
79
84
SI
SI
SI
117
284
290
366
INDEX.
Trichinosis,
Tricuspid, insufficiency or regurgitation, .
stenosis or obstruction, .
Trifacial neuralgia, .
Trismus,
Tubercle, bacilli,
Tuberculosis,
acute,
acute pneumonic,
•
chronic,
fibroid,
pulmonary,
Typhlitis,
Typho-malarial fever,
•
•
Typhoid fever,
Typhus, abdominalis,
exanthematic,
Valvulitis,
Varicella,
Variola,
Varioloid,
Vertigo,.
fever,
Ulcer, gastric,
Ulcerative stomatitis,
Uræmia,
•
•
•
•
+
coma,
uræmic convulsions,
•
auditory,
gastric,
nervous,
ocular,
poisoning, .
Uric acid diathesis,
Vaccination,
Vaccinia,
Valvular disease of the heart.
•
•
•
·
•
·
Vesicular emphysema,
Valvulus,
•
►
•
·
•
·
"
•
•
*
•
296
197
197
325
267
268
268
270
275
275
277
274
121
232
203
2057
215
215
97
76
147
147
147
147
219
244
244
193
186
246
246
242
305
305
305
305
305
66
117
INDEX.
367
Wasting palsy,
Waxy kidney,
liver,
•
round,
tape,
thread,
Wry-neck,
·
White mouth,
Whooping cough,
Winter cough,
Worms, intestinal,
·
Yearly cold, .
Yellow atrophy of the liver, acute,
Yellow fever,
jack,
·
.
•
•
•
313
157
78
78
235
25
119
120
119
121
284
40
140
217
217
{
1
Filmed by Preservation 1990


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