Presented in honor of Solon Richard Boynton Sr. M.D. COLLEGE OF OSTEOPATHIC PHYSICIANS AND SURGEONS LOS ANGELES, CALIFORNIA /fa HOMEOPATHIC TREATMENT BY B. F. JOSLIN, M.D., L.L.D., FELLOW OF THE ALBANY MEDICAL COLLEGE ; FELLOW AND CORRESPONDING MEMBER OF THE HOMEOPATHIC MEDICAL COLLEGE OF PENNSYL- VANIA, &C., &C. THIRD EDITION, WITH ADDITIONS. N E W - T B, K : PUBLISHED BY WILLIAM RADDE, No. 322 BROADWAY. PHILADELPHIA : RADEMACHER & SHEER. BOSTON : OTIS CLAPP.- LONDON : J. EPPS, 112 GBEAT RUSSELL-ST., BLOOMSBUBY.- MANCHESTER : HENHY TURNER, 41 PICCADILLY. 1804, Entered according to Act of Congress, in ilio year ISM, liv WILLIAM RADOK, la the Clerk's Office of tbe District Court of the Southern District of New-York. HENRY LUDWIU, Prinitr, CONTENTS. Page PREFACE AND INTRODUCTION, V CHAP. I. NATURE and PATHOLOGY of Cholera. Characteristics of the disease, 13 Physiology of Respiration, 16 Application to the Pathology of Cholera, 18 CHAP. II. .ETIOLOGY, especially of the Predisposing or occasion- al Causes. Preliminary setiological remarks, 30 Atmospheric heat, 32 Becoming chilled by cold air, or bathing, 35 The Night season, 37 Depressing passions, fatigue, fasting, and alcohol, 38 Abstinence from animal food, 40 Oppression of the digestive organs with food, 43 Crowded or insufficiently Ventilated Rooms, 44 Neglect of personal Cleanliness, 45 Ungeneralized facts, 46 Recapitulation 48 CHAP. III. DOCTRINE OF INFECTION. Error of the prevalent doctrine Indefiniteness of the problem, Influence of Dilution, Influence of Dose Influence of susceptibility, .* . . Routes and modes in which the Cholera travels, , CONTENTS. Page CHAP. IV. HYGIENE and PROPHYLAXIS. Articles hurtful to persons taking medicines, 61 Rules of Regimen, 62 Prophylactics, 65 CHAP. V. HISTORY OF TREATMENT, Or Statistical proofs of the success of Homoeopathy in Cholera, 67 Preliminary Remarks, 67 The Cholera Epidemic of 1831-32, 70 " " 1848-49 76 " in 1854, 97 CHAP. VI. EAKLY TREATMENT, Including that of the Premonitory Symptoms, and of the dis- ease at its onset, with rules for the general management, 100 Treatment of Premonitory Symptoms, &c., 100 " at the Commencement of Cholera, 102 Rules for the management of a Cholera patient, 108 CHAP. VII. SYMPTOMS and TREATMENT of the VARIETIES of CHOLERA. Law of cure, and repetition and magnitude of doses, 109 Symptoms of the 1st variety, Diarrhceic Cholera, 113 Treatment of Diarrhoeic Cholera, 115 Symptoms of the 2d variety, Gastric Cholera, 116 Treatment of Gastric Cholera, 117 Symptoms of the 3d variety, Spasmodic Cholera, 117 Treatment of Spasmodic Cholera, 118 Symptoms of the 4th variety, Dry Cholera, 119 Treatment of Dry Cholera, 120 Symptoms of the 5th variety, Acute Cholera, 120 Treatment of Acute Cholera, 121 Symptoms of the 6th jariety, Gastro- Enteric Cholera, 122 Treatment of Gastro-Enteric Cholera 123 CONTENTS. Page Symptoms of the 7th variety, Dysenteric Cholera, 123 Treatment of Dysenteric Cholera, 125 Symptoms of the 8th variety, Febrile Cholera, 120 Treatment of Febrile Cholera, 126 CHAP. VIII. SYMPTOMS and TREATMENT of the STAGES of CHOLERA. First Stage, stage of Invasion, 128 O * O * Second Stage, stage of full Development, 129 Third Stage, stage of Collapse, 130 Fourth Stage, stage of Reaction, 131 CHAP. IX. CASES OF CHOLERA AND CHOLEROID, WITH THEIR TREATMENT. Preliminary Remarks, 134 Cases of Choleroid Disease, 138 Cases of Diarrhoeic Cholera, 144 Cases of Gastric Cholera, 160 Cases of Spasmodic Cholera 162 Case of Dry Cholera, 168 Cases of Acute Cholera, 170 Case of Gastro-enteric Cholera, 176 Cases of Dysenteric Cholera, 176 Case of Febrile Cholera, 179 Case of Acute Choleroid, 180 CHAP. X. CHOLERA REPERTORY for SYMPTOMS AND GROUPS, with the values of the medicines distinguished. Explanation of the use of the Repertory 181 Mental Symptoms, Remedies for, 183 Head, remedies for symptoms relating to the, 184 Eyes, remedies for symptoms relating to the, 184 Face, remedies for symptoms relating to the, 185 Tongue, remedies for symptoms relating to the, 186 6 CONTENTS. Page Nausea and Thirst, remedies for, 187 Vomiting, remedies for, 187 Pains at the Stomach, remedies for, 188 Abdomen, remedies for symptoms relating to the, 189 Diarrhoea, remedies for 190 Urine, remedies for symptoms relating to the, 192 Voice, remedies for symptoms relating to the 193 Chest, remedies for symptoms relating to the, 193 Superior Extremities, remedies, &c 194 Inferior Extremities, remedies, &c 194 Skin, remedies for symptoms relating to the, 195 Perspiration and pulse, remedies relating to, 197 General and miscellaneous symptoms, remedies for, 198 CHAP. XI. AUXILIARY CHOLERA REPERTORY, alto adapted to Vomiting, Diarrhoea, Cholera Infantum and Dysentery. Explanation of the use of the Repertory, 199 VOMITING in general, 200 Character of the vomiting, 200 Its causes or conditions, 202 Its Concomitants, 203 Sensations (pains, &c.) at the Stomach and Epigastrium,. . . 204 DIARRHOEA in General, 206 Color of the Faeces 206 Odor of the Pieces, 207 Their Composition and Consistence, 207 Causes of Diarrhoea, 208 Concomitants of Diarrhoea, 209 Groups of Diarrhoeic Symptoms, 210 Cholera Infantum, 212 Dysentery, 212 Appendix I., 215 Appendix II., 239 Index, 245 PREFACE AND INTRODUCTION, THE favorable reception which the former editions of this book have met with, has encouraged the author in the labor of improving it, by such modifications and additions as were sug- gested by much experience in the epidemic of 1849. A great amount of practical matter has been added, including a chapter of illustrative cases, in 1849 and subsequent years, to the present month. The book has been used as a guide in the treatment of cho- lera, not only by the profession, but by many intelligent lay- men. In this rapid disease, for which our system affords the only effectual remedies, many families in localities where no homoeopathic physician can be soon procured, will find it ne- cessary at last to commence the treatment ; and some mem- bers of the profession who had been previously allopathic will be induced to prescribe homoeopathically for cholera. In consideration of the wants of these two classes, the more im- portant rules of treatment are given in a more particular and elementary form, than would be necessary for an experienced homoeopathic practitioner. The plain rules for prevention, preliminary treatment and nursing, may either be consulted directly by families, or employed by their physician as a safe and convenient basis for his instructions. The plan offers the advantage of a threefold arrangement of the principal medicines ; viz., with reference, 1st, to the varie- 8 INTRODUCTION. ties of cholera ; 3d, to its stages ; and 3d, to its symptoms as arranged in repertories. These last will give the work a permanent value, in treating the more frequent complaints of summer. The author has aimed to prepare for the use of practitioners a portable treatise, so full and systematic as to enable them to find with facility the remedy for every curable case of this disease. When we fail in our attempts at homoeopathic treatment, in any malady which is curable in the present state of the Mate- ria Medica, the fault is not in the law, but in its administra- tion. It is unjust in any one, to impute to Homoeopathy the disastrous consequences of his own ignorance, indolence or haste, and unwise to attempt by allopathic patches to strength- en his practice already sufficiently spurious, and conse- quently feeble. Such expedients emasculate his Homoeopathy. None will learn to swim who depend upon bladders under the arms. Eclecticism will be less resorted to, in proportion as the character of the profession shall become more elevated in intellect, industry and attainments, and physicians shall not consider a minute study of the case and of the Materia Medica too onerous, when human life depends on the correctness of the prescription. With Hahnemann's eulogium of the profession, he has connected a requirement and an injunction. " To the physician, whose province it is to vanquish the disease that brings its victim to the very borders of corporeal dissolution, and to produce as it were a second creation of life a greater work than almost all the other much-vaunted performances of mankind to him Nature in all her wide expanse, with all her sources and productions must lie open. Let all hold aloof from this most pious, this noblest of all secular professions, who are deficient in mind, in patient thought, in the requisite knowledge, or in tender philanthropy and a sense of duty." However great may be the general attainments of a physician, there is one kind of knowledge indispensable, that of the Ma- INTRODUCTION. teria Medica : and as none but a charlatan affects to be able to retain an adequate amount of it in his mind, the best phy- sicians study it at the bed-side of the sick, and partly in a re- pertory, a Materia Medica in which the symptoms have an or- derly arrangement, for convenience of reference and greater certainty in the selection of the lest remedy. The Homoeopathic Materia Medica is the true test of the correctness of conclusions drawn from Clinical experience ; indeed, it was originally the only guide to that practice which was attended with such splendid results in 1832. It was Hah- nemann's confidence in this, and in his law of cure, that en- abled him to publish the plan on which this fearful malady was successfully combated. With his usual sagacity, he pointed out the true prophylactics, and all the most important curatives, when this pestilence had not fallen under his own observation. Having discovered and demonstrated a universal, unerring, and everlasting law in medicine, he was prepared to encounter the strangest forms of disease as though they were familiar. The law is similia similibus curantur, like are cured by like ; or (to expand this brief and elliptical aphorism) diseases are cured by medicines which tend to excite affections similar to the diseases themselves. From the Greek opotov xddos (ho- moion pathos, affectus similis, the Latin term Homoeopathia, and the English Homoeopathy, are derived. We frequently hear persons who have no experience in Ho- moaopathy, or who at most have seen its effect in Chronic cases, saying, I would not dare to trust it if I were very sick, with a dangerous and rapid disease. I should want some- thing that would act powerfully and quickly. A potentized medicine selected in accordance with the Homoeopathic law, is that very thing. Thousands of physicians know it to be such ; and that in their own former Allceopathic practice, and in that of their brethren of the old school, no violent and rapid diseases have been cured as surely and promptly as they 10 INTRODUCTION. now cure them by the homoeopathic method. Large doses are not required to cure any disease whatever. Attenua- tion, whilst it weakens and ultimately nullifies poisons, as such, is in almost every substance essential to the full de- velopment of medicinal power ; and, in some substances, no medicinal .power whatever is manifested until the substance is rendered extremely dilute. This book will contain abundant experimental evidence of the efficacy of attenuated medicines in the treatment of Cholera. The great success of European physicians in the treatment of the Asiatic Cholera of 1832, and of many American physicians in 1849, was due to the use of attenuated medicines, as well as to the law of similitude which regulated their administration. If the author were charged with the duty of testing the relative merits of the ho- moeopathic and allopathic laws of cure before an impartial and intelligent tribunal of either school, and if his life depended upon obtaining a verdict in favor of Homoeopathy, he would not only select violent and rapid diseases, in preference to such as are mild and chronic, but would administer attenuated medicines, in small doses. As the potencies and doses recommended by Dr. QUIN of London, and on his authority in the former editions of this book, have with all who employed them in 1849, well sustain- ed the reputation gained in 1832, they have not been changed in the present edition.* In the present state of homoeopathic science they may be properly denominated the medium dilu- tions. Those who prefer lower or higher ones, will find no difficulty in using this book as a guide in the selection and administration of the remedies. The same number of globules and the same intervals between the doses, will be appropriate. New-York, July, 1854. * Other acknowledgements of some of the advantages, which this book has derived from the excellent French treatise, of this distinguished and venerated pioneer of sound Homoeopathy in England, aregiven on pages, 71, 121, 123, 123 and 170 INTRODUCTION. 11 LIST OF THE CHOLERA MEDICINES, WITH THE PROPER ATTENUATIONS. Names. Aconitum, 24th attenuation ; Arsenicum, 30th ; "*": Belladonna, 30th ; " Camphora, Tinct. & 3d, " Cantharis, 30th; " Carbo-v PAl HO] the coloring matter which contains carbon, are ar- ranged, whether in binary, ternary or quaternary combination, has never been determined ; but Brande, Engelhart and Michaelis have shown that the color- ing matter of the blood consists of an animal matter, associated with a minute quantity of iron and some earthy salts ; and this" animal matter, of which the coloring matter appears chiefly to consist, was found by Michaelis to contain more than fifty-three per cent, of carbon. Now in what degree the carbon of the coloring matter may vary in different kinds of blood, I find no satisfactory data for determining. The furnishing of these is, perhaps, a service which pathology has yet to expect from chemistry. But even conceding, that a given quantity of the coloring mat- ter of cholera blood, contains only the same amount of carbon as the same quantity of the coloring matter of normal blood, (and no one has pretended that it con- tains less,) it can, I think, be shown, that the whole amount of carbon in the coloring matter of the for- mer, far cxeceds the whole amount in the coloring matter of the latter. For according to the research- es of Dr. Thompson, professor of Chemistry in Glas- gow, the coloring matter of cholera blood, as deduced from the mean of his results, is "little short of four times the quantity of coloring matter of healthy blood." Dr. Clanny's proximate analysis afforded nearly the same result. This maybe reconciled witli the result of his destructive distillation in another instance, in which he obtained only about twice as OF CHOLERA. 21 much carbon from cholera blood as from healthy blood, by considering that both fibrine and albumen contain rather more than fifty per cent, of carbon, and that the great increase of coloring matter, is partly compensated by the diminution of the sum of these other carbonaceous principles. That this will explain the apparent discrepancy, might be shown by the numerical results. But that the change in the absolute amount of fibrine is small, compared with that of the coloring matter, is evident from Dr. Thompson's testimony, that the fibrine and coloring matter of healthy blood added together, amount to less than one-half the coloring matter in cholera blood. Notwithstanding all that has been said by the opponents of hyperanthraxis, I am unable to dis- cern, why the quantities of carbon obtained from two portions of blood, submitted under the same circum- stances, to destructive distillation in a close vessel, may not correctly show the relative proportions that actually existed in them. The only sound objection refers to the state in which the carbon existed. Now, that this vast accumulation of carbon in the blood of a cholera patient is absolute, and not merely a relative increase, resulting from incrassation, in consequence of the removal of its aqueous portion, by profuse evacuations or any other cause, we may readily convince ourselves from a comparison of the numerical results in Dr. Thompson's table, by which it will be found, that the proportional diminution of water in cholera blood is very small, compared either 22 NATURE AND PATHOLOGY with the proportional increase of coloring matter as shown by his experiments, or of carbon as shown by Dr. Clanny's. How then can it be true, that the ad- dition of the dejections to the blood would restore it to its normal condition ? Are not even Dr. O'Shaug- nessy's results with respect to the albumen, opposed to the above conclusion which has been drawn from his analysis ? The history of this epidemic is oppos- ed to it. It has been long since and repeatedly ob- served, by those who have been familiar with the dis- ease in its most malignant and perfect form, that the most rapid and intractable cases were generally at- tended with slight, if any, alvine evacuations. Not to cite other authorities, Mr. Orton, at Bombay, and other surgeons in that vicinity, stated that in many cases there was no purging, in some no vomiting, and in others neither, and that these were by far the most dangerous cases, and that the patients died under them, often in an hour or two ; and that, without spasms and with scarcely any vomiting or purging, all the secretions appeared to be in many cases en- tirely suspended.* Conceding the possibility, that in some cases, the contents of the alimentary canal may not have been examined, still, from what we know of its dimensions, and from the effects of equiva- lent evacuations in other diseases, a theory which can be defended only by a supposed accumulation in such cases, must be considered untenable. Has it *Good's Study of Med. I. 178. OP CHOLERA.'. 23 not been chiefly in those places which have been but slightly visited, that we find pathologists disposed to found a theory on profuse evacuations 1 Under such circumstances, these may perhaps merit all the atten- tion which has been bestowed upon them ; although the most fatal alterations of the blood, and the sup- pression of urine and other secretions, must often, if not always, depend upon another cause.* It is hardly necessary to remark, that the presence of an immense excess of carbon in the blood, mani- fests a defect in the decarbonizing process of the sys- tem. It may be less obvious, though hardly less cer- tain, that the observed absence of carbonic acid in the blood, in this disease, depends upon a similar cause. A considerable quantity of this gas exists in healthy blood ; and it might be asked, why the same cause, from which, in this disease, the blood retains its carbon, does not also make it retain the carbonic acid. I answer, it is because the carbonic acid elimi- * There is little doubt that the secretion of urine may be both in- creased and diminished, by some agencies which have no direct in- fluence on the action of the kidneys, or the quantity of serum in the blood. Even Dr. Cullen acknowledged his suspicion of this, opposed as it was to his favorite theory. His modesty and candor are worthy of the imitation of those who are ambitious of framing complete theories in medicine. He says, that "besides the increased quantity of water in the mass of the blood, or a stimulus particularly applied to the kidneys, there may be a medicine which, by a general operation on the system, may promote the secretion of urine. My candor obliges me to mention this ; but I do not find myself at pc* sent in a condition to prosecute the inquiry. Materia Med. vol. p. 556. 24 NATURE AND PATHOLOGY nated during respiration, derives its oxygen from the inspired air ; and when little or no oxygen is absorb- ed, we should expect little or no carbonic acid to be formed. From the absence or deficiency of carbonic acid, I should infer, that in this disease, there exists more difficulty in obtaining the advantages of in- spiration than those of expiration in forming car- bonic acid than in eliminating it. In the phenomena presented after death, there are many striking coincidences between Cholera and as- phyxia from other causes ; the same fluidity of the blood, for hours after death, the same tendency of the body after death to an increase of warmth and dimi- nution of lividity, as in cases where the respiration is suspended by hanging or drowning, or not estab- lished by a closure of the foramen ovale. I have known these phenomena to be presented after death in the case of a premature child, which was born at the end of the 7th month, and lived till the fourth day after its birth ; and I have observed some of them in cases of death by hanging and drowning, and I believe them to be characteristic of asphyxia. They frequently inspire the friends of the deceased with the vain hope of effecting a resuscitation. The following case will illustrate some of the fore- going remarks, as well as the effect produced on the blood by certain salts, which, since the experiments of Dr. Stevens, have been supposed to perform an important part in the function of respiration. A son of Mr. V. V., aetat. eighteen months, had fallen into OP CHOLERA. 25 a cistern of water, and lain, as was supposed, a quar- ter of an hour or more, and had been taken out ahout half an hour before my arrival. We attempted to re-establish respiration, by inflating the lungs, not only by the mouth, but by a pair of bellows fitted to a flexible tube which was introduced into the trachea. Other means were used, but to no effect. About twp hours after the death of the child, the jugular vein was opened. A dark-colored blood ran freely. Three or four ounces were taken. Its coagulability was so slight, that it required a plaster to arrest it. As the plasticity or coagulability of arterial blood as com- pared with venous, is a property acquired by respira- tion, it might be expected, that the supervenous blood- of Cholera and other species of asphyxia, would be more deficient in this property than ordina- ry venous blood. And such is the fact. In the above case, it coagulated very slowly and imperfectly after its removal from the vein, resembling, in this respect, the blood drawn during life from Cholera patients. After half an hour had elapsed, about one- third of it had not coagulated, although the tempera- ture of the air was about 70. The upper part, which had been exposed to the air, was coagulated to a certain depth, and its color at the surface had be- come rather brighter. On inclining the vessel, the dark, thick and uncoagulated fluid broke through the coagulated crust, and flowed sluggishly across it, presenting an appearance somewhat similar to that of Cholera blood, which from its consistence and NATURE AND PATHOLOGY blackness, has so often been compared to molasses and tar. The parts of the coagulum below the sur- face were also dark-colored. It appeared evident, that air favored coagulation, and was more essential to the production of the florid color, but did not ap- pear to effect the latter as readily and perfectly as in the case of normal or healthy blood. Muriate of so- da was then added to one portion, and carbonate of soda to another. The latter had a marked effect, rendering it florid. This experiment, and others made on normal venous blood, have convinced me that it is unphilosophical to infer from the effect of salts in reddening cholera blood, that the asphyxia which produces its dark color depends on the deficiency of saline ingredients in the blood, even though such de- ficiency should by analysis be shown to exist ; for in the case above mentioned, and in others alluded to, a similar change of color was produced by the salts, al- though there was no reason to suspect any greater deficiency of saline ingredients than ordinarily exists in venous blood. The circumstance that the color of the blood was less influenced by exposure to air than ordinary venous blood, shows that a defect in this property is not peculiar to Cholera, nor to disease of any kind, properly so called, but appears to be char- acteristic of asphyxia in general, whether induced by disease or suddenly caused by interrupting the respi- ration of an individual previously in health, when there have been no intestinal discharges to drain the salts from the system. OF CHOLERA. 27 I consider the defect in coagulability as also com- mon to all those cases where a want of due oxygena- tion is the sole or chief cause of, death. Excessive exercise and violent mental emotions, when they oc- cur suddenly, are said to produce this state of the blood ; and it appears to me an interesting fact, that these are also among the causes which tend to pre- vent its oxygenation. Another correspondence not less curious is, that in the foetus, whose respiration has never been established, the venous and arterial blood, like that of the victims of Cholera, is nearly identical ; the blood is not coagulable, has an unctu- ous feel, and does not take the vermilion color on ex- posure to the air ; and according to Fourcroy, it has its coloring matter darker and more abundant, and contains no fibrine. It therefore remarkably resem- bles Cholera blood. Would it not seem, from these facts and considerations, that the coagulation of the fibrine, and even its existence as such, are more de- pendent on respiration than has been hitherto sus- pected ; and that the deficiency of this principle, as well as the existence of most of the other peculiari- ties Avhich distinguish cholera blood from normal blood, result chiefly from its defective aeration, and are what might be expected in asphyxia from any other cause ? Dr. Good admits the want of coagula- bility of the blood in cases of electrical, and Brous- sais in cases of gaseous asphyxia. Combining these two authorities, relating respectively to asphyxia caused by lightning and that caused by the irrespira- 28 NATURE AND PATHOLOGY blc and deleterious gases, with my own observations on other varieties of asphyxia, I am led to infer the generality of the above law. That the tarry appear- ance of cholera blood results from want of aeration, is also confirmed by the fact, that the same appear- ance may be immediately produced by prussic acid, but never unless given in such doses as to occasion difficulty of breathing.* A defect in calorification and sanguification may exist, in a slight degree, in an early stage of the dis- ease, and not become the most obvious characteristic till the last. Before any profuse alvine evacuations had taken place, I have, in several instances, observed a coldness of the hands and feet, a blueness of the under eyelid, and a preternaturally dark color of the blood drawn from the arm. In this stage also, Dr. * Am. Jour, of Med. ScL vol. xi. p. 501, from a European Jour- nal. Dr. Hartwig, who made this discovery, blackened the blood by dim-rent acids, but could not, it appears, produce this effect by nitric acid. Ibid. I have, however, ascertained by experiment, that nitric aeid dues render the sanguineous coloring matter black as seen by riJJi-rtr.il (though not as seen by transmitted) light. Has this dis- tinction between the reflected and transmitted light been made by those Who "have experimented on the blood! By other experiments on blood more nearly normal, I have proved, that the effect of saline substances on the blood at one temperature, cannot be inferred from experiments made at another; and that the blackening of crass a- mcntum by hot water, is not, as has been asserted, dependent on the extraction of its saline matters ; and also, that the ch;i" color produced in the sanguineous coloring matter by he.-it. is not the result of the extrication of oxygen or any other gas. For tin periments, vide Transactions of the Medical Society of the State of New- York, vol. ii. p. 181. OF CHOLERA. 29 Baircl found the heat of the skin below the healthy standard. Dr. Mclntyre notices a slightly discolored state of the under eyelid, as among the most frequent premonitory symptoms. Others have observed, that the dark color of the skin frequently prevails as a premonitory symptom from one to ten days, whilst there is no peculiarity in the evacuations. That no other disease effects so remarkable a change in the composition, color and temperature of the blood, must be admitted ; also that these altera- tions are disproportionate to the amount of alvine evacuations, whether we compare different cases of this disease, or this disease with others ; although, neither the physiology of respiration, the chemistry of normal blood, nor the chemical pathology of Chole- ra, is so complete, as to justify any positive opinion as to the precise time, nor any complete theory of the manner, in which these changes commence. In- deed, the pathogeny of most diseases is obscure ; and pathology seldom detects the first links in the chain of morbid phenomena. In Cholera, it can hardly be considered more fortunate with respect to some of the subsequent ones. There is no complete theory ; and I do not offer the above as such. Fortunately for mankind, Hahnemann has discov- ered a law of cure which is not based upon pathologi- cal speculations. The want of such a law and of any reliable guide, is the real cause of the want of una- nimity and I may say the uncertainty, confusion and anarchy, that prevails in the allopathic school. 30 CAUSES These have, in the case of no disease, been more conspicuous than in relation to Cholera, and never more so than at the present time. CHAPTER II. M T I L GY, ESPECIALLY WITH REFERENCE TO THE PREDIS- POSING AND OCCASIONAL CAUSES. PRELIMINARY 2ETIOLOGICAL REMARKS. The peculiar cause of the Cholera is unknown. Hahnemann, and some other learned men, have thought it to be probably an animated miasm. It seems frequently to manifest some self-moving power, or at least to be capable of diffusing itself and of travelling, independently of transportation by hu- man beings, or by the wind. Whatever be its na- ture, whether animalcular, gaseous, or electrical, it must possess extreme tenuity to escape detection ; and its terrific potency is well calculated to rebuke the scepticism of those who sneer at the evidence of efficiency in attenuated medicines, and in everything not-cognizable by their senses of sight, smell, hear- ing, taste or touch. But as the nature of the cause of Cholera is in- volved in obscurity, and as I shall under the head of OF CHOLERA. 81 infection, give some views in relation to its propaga- tion, I shall here limit myself to its predisposing and occasional causes, as related to the pathological phenomena ahove considered. If we say that Cholera is attended with great de- pression of the vital forces, and that the predisposing causes are such as depress these forces or produce general debility, we make a statement which is, to a certain extent and in a certain sense, correct, but is deficient in definite meaning, and but partially true in any sense. If it were strictly and generally true, we should expect that individuals who were robust and muscular, and at the middle period of life, would, cseteris paribus, have a comparative immunity from the disease. But this is far from being the fact. The views about to be presented, not only refer to a definite function, but to a class of correspondences which are more marked in Cholera than in any other disease. There are many reasons for believing, that during the prevalence of Cholera there is some wide-spread miasm or other aerial epidemic influence tending to diminish the aeration of the blood. We have per- haps some indirect evidence, in the nearly simultane- ous prevalence of certain diseases in which the blood is similarly affected, though in an inferior degree. Is there not in many places, either antecedently, or subsequently, an increased prevalence of certain dis- eases Avhich are attended with dark blood, such as measles, and typhus and other malignant and occa- 32 CAUSKS sionally anomalous fevers? For weeks and months before the acknowledged incursion of Cholera, there are frequently cases of disease which in these re- spects nearly resemble it, as I am convinced by my own observations and those of many other physi- cians. But to give more satisfactory proof of this con- nexion between Cholera and respiration, I shall pro- ceed to examine, whether the history of Cholera does not present a class of etiological facts, which, con- sidered in connexion with the resulfs of experiments that have been made on respiration, without any re- ference to Cholera, tend to confirm the foregoing views with regard to one of its principal, if not es- sential features. ATMOSPHERIC HEAT. The influence of external heat on respiration was discovered by Crawford. His experiments and those of others have satisfactorily shown, that the quantity of oxygen consumed and of carbonic acid produced during respiration, is less as the temperature of the air is more elevated. All who have experimented on the subject, with but one exception, have detected this influence of temperature. Crawford found that a Guinea pig, confined in air at the temperature of 55 Fah., consumed double the quantity of oxygen which it did in air at 104. In the case of human respiration, Lavoisier and Seguin ascertained, that OF CHOLERA. 33 the quantity at 57 is to that at 82 as 1344 is to 1210. Delaroche, in his last series of experiments, made the average ratio about as six to five at the temperatures tried by him. He found, that by ele- vation of temperature, the production of carbonic acid was diminished, and the absorption of oxygen diminished in a still higher ratio. More recently Dr. Edwards has examined the effect of different seasons, and found that the long-continued actions of heat and cold affect the respiration as a vital function; the oxygen consumed being less in summer, even when the air in which the animal is confined at the time, is of the same density and temperature. More- over, from the experiments above related respecting the influence of sudden changes of temperature, as well as from the known effect of temperature on den- sity, it appears to me evident, that its physical chan- ges between winter and summer, must be such as to make the immediate influence of heat conspire with its gradual physiological effects, and render the con- sumption in winter and summer still more dispropor- tionate. The influence of heat in diminishing the consumption of oxygen may be considered as estab- lished. On the other hand, few facts are better established, than the influence of hot climates and the warm sea- son of the year in predisposing to Cholera. The epi- demic in 1817 which subsequently spread over a considerable portion of the globe, and arrived here in 1832 commenced in summer in the hot climate of 34 CAUSES Hindostan; it has generally, in all climates, been much checked if not extinguished by winter ; also on cold, elevated mountains. Its ravages in Mexico proved, that it can rise to a great height above the surface of the sea in warm climates. In Russia, the southern regions were those where it spread most widely and rapidly; and those towns which it entered at the end of autumn, suffered but slightly.* It is no evidence against these views, that it lingered in winter, in some of the highly-heated, ill-ventilated and filthy rooms of that country. Even in Persia and Asia Minor, the influence of winter on epidemic cholera was manifest during several successive years.t This influence of temperature has been confirmed by the progress of the disease on the western continent. In 1832, it commenced in spring, and until the autum- nal cold, nothing impeded its rapid march or changed its malignant character. Both were restored by the heat of the ensuing spring; and again suspended by winter. In its second tour in 1849, the influence of temperature was manifest. At the Quarantine on Staten Island, it disappeared at the commence- ment of the first severe cold of January ; and even the cold of December was sufficient to arrest it in the city of New- York, which had been slightly in- oculated. We owe our present immunity, our respite, to cold. The epidemic in New-Orleans in 1848, pre- vailed in its greatest intensity when the thermometer * Report of M. Moreau eing chilled (or taking cold) to check of perspiration ; for perspiration, as connected with the evaporation which attends it, is physically a cooling process ; and the check of it would immediately produce warmth, were it not for the operation of the principle above stated. It is well to add here a word of application, at a time when many exaggerate the advantages, and over- look the dangers, of powerful baths. This delusion will have its victims, especially during the prevalence of Cholera. Cleanliness may, and it should be pre- served, without making any strong or durable im- pression, either of heat or cold. This is the true criterion of safe ablution. In addition to the danger of excessive bathing to the community in general, there is one which should not be overlooked by those who are under Homoeopathic treatment, either for the cure of disease or for preparing their systems to re- sist the epidemic. Strongly-impressing baths dis- turb the action of remedies. Hahnemann justly con- sidered their present effect as analogous to that of large doses of drugs, and their frequent repetition, as tending to retard the cure of chronic diseases. I shall, under another head, give some rules for bath: OP CHOLERA. 37 in and repeat the above process with other important symptoms, combining them with each other and with some of those previously selected ; and in general, the making of various combinations and in various orders, will give greater security in the selection of the remedy. If there are two remedies which apply to all the known symptoms of the case, the selection may be determined by the type in which their names are here printed. If the remedy is doubtful, and there is time for study, consult Jahr's Manual, especially the New. One object in the construction of this Repertory has been to save part of the above labor, by occasionally combining the symptoms into such groups (of two or MENTAL SYMPTOMS. 183 three) as the disease more frequently presents. For ob- taining the remedies for these groups, the Materia Me- dica of Hahnemann, the Symptomen Codex and various Repertories have been consulted. The degree of em- phasis has been determined by the clinical experience of the school in Cholera. I have, however, italicised some medicines which rank high for the symptom in general, but are not known to be useful in Cholera. The em- phasis given to the medicines in this Repertory, has no reference to the 4th stage, nor to the inflammatory varie- ty, except where it is so stated. Medicines seldom used in any disease are omitted; also some for vomiting and diarrhoea, seldom used in Cholera, and found in Chapter XI. The concomitant symptoms in any one section of this Repertory, are generally arranged in the same order as the sections themselves. Where symptoms, relating to different parts of the body, are in the same paragraph, those of the superior parts, are put first, and the more general symptoms last. The paragraphs are arranged alphabetically ; but where the same symptom, (as cramp) refers to different parts of the body, these parts are put in the natural typographical order, from above downwards. MENTAL SYMPTOMS. Anguish, anxiety or inquietude: Aeon., ARS., bell., bry., CAMPH., CARB.-V., cans., cham., cic., coff., CUPR., dig., hyos., ign., ipec., kal., lack., laur., lye., mere., natr., natr.-m., nitr.-ac., nux, petr., PHOS., phos.-ac., puls., rhus, SEC., sep., strain., sulph., tart., VERAT. 184 CHOLERA REPERTORY. ~~ Apathy, or indifference : Ars., bell., calc., cham., chin., cic., hyos., lack., lye., mere., natr.-m., phos., PHOS.-AC., sep., staph. verat. Fear of Death, with internal Burnings, and tossing in the bed : ARS. Taciturnity, or repugnance to conversation: ARS., bell., bry., calc., cham., cic., coloc., cupr., ign., lach., mere., natr.-m., nux, phos.-ac., puls., rheum, stann., staph., sulph., sulph.-ac., VERAT. HEAD. Confusion in th^ head : Aeon., ars., bell., bry., calc., CAMPH., caus., chin., dig., mere., nux, op., phos.-ac., puls., rheum, rhus, sec., sep., sulph.-ac., tart., VERAT. Heaviness, or pressure in the head: Aeon., arn., ars., bell., bry., calc., CAMPH., carb.-v., cham., chin., cic., dulc., ign., ipec., lack., laur., lye., mere., natr.-m., nux, op., petr., PHOS., PHOS.-AC., puls., rheum., rhus, sep., sil., stann., sulph., tart., VERAT. Vertigo : Aeon., ant., am., ars., bell., bry., calc., CAMPH., carb.-v., caus., etc., cupr., dig., fer., graph., hep., hyos., ign., ipec., kal., lack., laur., lye., mere., nat., natr.-m., nux, op. ,petr., PHOS., PHOS.-AC., puls., rhus, SEC., sep., sil., stram., sulph., sulph.-ac., tart., thuj., VERAT. Vertigo with nausea and thirst : VERAT. Vertigo with stupor: Ars., bell., bry., calc., caus., kal., laur., lye., mere., natr.-m., nux, op., PHOS., phos.-ac., puls., rhus, SEC., sil., spig., stram., sulph., tart., VERAT. EYES. Eyes sunk in the orbits ; with livid semi-circles under them : ARS., calc., camph., cic., CUPR., kal., laur., PHOS., PHOS.-AC., SEC., sulph , VERAT. EYES. FACE. 185 Eyes sunk in the orbits; with hoarse voice: ARS., calc., camph., cic., CUPR., kal., laur., PHOS., phos.-ac., SEC., sulph., VERAT. Eyes Up-turned and Fixed : CAMPH., cic., VERAT. Pupils contracted : ARS., bell., cham., CAMPH., cicut., nux, puls., SECAL., sep., VERAT. FACE. Bluish color of the face : Aeon., ARS., bell., bry., CAMPH., cham., cic., con., CUPR., dig., dros., hep., hyos., ign., ipec., lach., lye., mere., op., phos, puls., samb., spong., staph., stram., tart., VERAT. Elvish and pale face: ARS., bell., bry., CAMPH., cic., con., CUPR., dig., dros., hep., hyos., ign., ipec., lach., lye., mere., op., PROS., puls., samb., spong., stram., TART., VERAT. Bluish color about the Eyes: ARS., calc., cham., chin,, CUPR., fer., graph., hep., ign., ipec., kal., lach., lye., mere., natr., nux, oleand., phos., PHOS.-AC., rhus, sabin., SEC., sep., spig., staph , stram., sulph., VERAT. Blueness of the lips : Ang.-spur., ars., camph. caus., berb., chin. -sulph , cupr., dig., lye., phos. Blueness of the lips, with corrugated and withered appearance of the skin: ARS., CAMPH., CUPR., lye., phos. Blueness under Eyes : Sleeps with eyes open: Ipec., PHOS. -AC., sulph., VERAT. Blueness of the face and lips ; Coldness of the lips : ARS., cupr., VERAT. Blueness of the face ; vomiting after drinking; pulse slow ; sweat clammy : VERAT. 186 CHOLERA REPERTORY. Cold Perspiration on the face : Carb.-v., rheum., nux, rhus, verat. Cold perspiration on the forehead during the evacua- tion: VERAT. Cold Perspiration on the Face and Limbs: CARB.-V. Coldness of the nose : Am., bell., plumb., verat. Coldness of the nose and hands : Bell., VERAT. Fades cholerica : ARS., camph., carb.-v., CUPR., ipec., laur., phos., phos.-ac., rhus, SEC., VERAT. Face choleric ; Voice hoarse : ARS., camph., CARB.-V., CUPR., latir., PHOS., phos.-ac. , rhus, sec. VERAT. Spasm of the Jaw : Bell., cham., CAMPH., cicut., CUPR., hydrocy., lach., laur., op., rhus, SEC., VERAT. TONGUE. Coats on the Tongue . Brown : Bell., CARB.-V., hyos., PHOS., rhus-rad., sabin., sulph. Mucous : Bell., cupr., dulc., lach., mere., PHOS.-AC. puls., sulph. Viscid: PHOS.-AC. White: Ant., arn., bell., bry., calc. carb.-v., cupr., dig., ign.. ipec., mere., nitr., nux, petr., puls., sabin., sec., sep., sulph. Yellowish: Bell., bry., carb.-v., cham., chin., coloc., IPEC., nux, plumb., puls., rhus-rad., verat. Coldness of the tongue : Ars., bell., camph., laur., natr.-m., sec., VERAT. Coldness of the tongue and breath: ARS., CARB.-V.. camph., VERAT. NAUSEA. AND THIRST. VOMITING. 187 Coldness of the tongue, with dryness of it and of the mouth : ARS., bell., camph., laur., SEC., VERAT. Coldness of the tongue, with cold sweat on the body : Ars., CAMPH., sec., VERAT. The same symptoms in a more advanced state of collapse : ARS., camph., carb.-v., CCPR., SEC., VERAT. Redness of the tongue: Ars., bell., bry., chain., hyos., lach., mix, rhus, stann., sulph., verat. Redness of the tip of the tongue, in the febrile variety, or in the 4th stage : RHUS-RAD. Tongue Red, and coated yellow: Bry., cham., nux, r.-rad., VERAT. Tongue Red ; Pulse Slow: Bell , rhus-rad. VERAT. NAUSEA AND THIRST. Nausea with thirst: Bell., PHOS., VERAT. Nausea with vertigo : CAMPH., mere., verat. Nausea with continued pain at the pit of the stomach: Aeon., ARS., bell., CAMPH., cham., CUPR., mere., natr.-m., nux, PHOS., puls., rhus, sulph., tart , VERAT. Nausea with diarrhoea: Ars., ipec., mere., PHOS. Thirst, violent: Aeon., ARS., bry., CAMPH., CARB.-V., cham., cic., CUPR., ipec., laur., mere., natr.-m., nux, phos , phos.-ac., SEC., stram., VERAT. Thirst, with nausea : PHOS., VERAT. VOMITING . Vomiting after a meal ; blueness of the lips : ARS., phos Vomiting after drinking ; with blueness of the face : ARS., VERAT. 188 CHOLERA REPERTORY. r~~ Vomiting after drinking: Am., ARS., bry., nux, puls., VERAT. Vomiting frothy: VERAT. Vomiting of a watery liquid, analogous to that of the stools, with pieces of mucus: ARS., bell., camph., CUPR., JATROPH., sec., IPEC., stram., VERAT. Vomiting with pain in the stomach : ARS., bry., camph., C.UPR., IPEC., lach., nux, PHOS., sulph., stram., tart., VERAT. Vomiting with Colic: Ars., CUPR., nux, PHOS., puls., stram., tart., VERAT. Vomiting with diarrhoea : Ars., cupr., jat., IpEC.,phos., sec., stram., tart., VERAT. Vomiting with Colic and Diarrhoea : ARS., CUPR., PHOS., stram., tart., VERAT. Vomiting with lassitude : Ars., camph., IPEC., phos., VERAT. PAINFUL SENSATIONS AT THE STOMACH AND PIT OF THE STOMACH. Anxiety, distension and pressure at the pit of the stomach: ARS. Burning in the stomach : ARS., bell., bry., camph., canth., CARB.-V., cham., cic., jat., laur., mere., nux, PHOS., phos.-ac., SEC., verat. Burning in the pit of the stomach : Aeon., ARS., bell., bry., laur., mere., nux, PHOS., sec., VERAT. 1 Burning Heat in the stomach or pit of stomach : ARS., CAMPH., HYDROC., PHOS. Burning sensation in the stomach and intestines, some- times extending along the oesophagus to the mouth : ARS. ABDOMEN. 189 Cramp in the stomach : Bell, bry., carb.-v., cham., CUPR., natr.-m., nux, PHOS., SEC., VERAT. Pressure and Anxiety at the pit of the stomach : ARS., CAMPH., cupr., IPEC , NUX-VOM., verat. Continued Pain at the pit of the stomach with nausea : Aeon., ARS.,belL, CAMPH., cham., CUPR., mere., natr.-m., nux, PHOS., rhus, sulph., tart., VERAT. Pain in the stomach, with vomiting: ARS., camph., CUPR,, IPEC., PHOS., TART., VERAT. Continued Pain in the pit of the Stomach with Rumb- lings in the intestines : Aeon., ars., bell., camph., CARB.-V., CUPR., jatroph., mere., natr.-m., nux, PHOS., PHOS.-AC., puls., rhus, SEC., sulph., tart-, VERAT. Pressive or aching pain at the pit of the stomach with liquid stools : Ars., CAMPH., cupr., PHOS., sec., tart., VERAT. Pressive or aching pain at the pit of the stomach, with cramps or other spasms in the extremities or elsewhere : CAMPH- , CUPR., phos-, phos.-ac., natr.-m., sec., tart., VERAT. Sensibility and Swelling of the pit of the stomach : Hep., lye., natr.-m., sulph. Painful sensibility of the pit of the stomach, with spasms of the extremities: Ars., CAMPH., CUPR., natr.-m. , phos., phos.-ac., tart., VERAT. ABDOMEN. Pains in the abdomen, with diarrhoea : ARS., cham., IPEC., laur., mere., merc.-c., natr.-m., nux, phos., rhus, stram., sulph., tart., VERAT. 190 CHOLERA REPERTORY. Rumblings in the intestines : Aeon., ars., bell., bry., canth.,CARB.-v.,cupr., jatroph., laur., lye., mere., natr.-in., nux, PHOS., PHOS.-AC., plumb., puls., rhus, sec., strain., sulph., tart., VBRAT. Rumblings in the intestines, with continued pain in the pit of the Stomach: Aeon., ars., bell., camph., CARB.-V., CUPR., jatroph., mere., natr.-m., nux, PHOS., PHOS.-AC., puls., rhus, SEC., sulph., tart., VERAT. Rumblings in the intestines, with liquid stools : Ars., jatroph., nux, petr., PHOS., PHOS.-AC., puls., rhus, sec., sulph., tart , VERAT. Throbbings in the abdomen : Caps., ign., op., plumb., sang., tart. DIARRHOEA. Diarrhoea, with a pasty tongue, which sticks to the fingers: PHOS.-AC. Diarrhoea with nausea: Ars., ipec., mere., PHOS. Diarrhoea with vomitings: Ars., cupr., jat., IPEC., PHOS., stram., tart., VERAT. Diarrhoea, with vomiting of the Food eaten, and of wa- tery liquid : ARS., CUPR., IPEC., PHOS., VERAT. Diarrhoea, with aching or pressure, at or near the pit of the Stomach: CAMPH., cham., CUPR., mere., natr.-m., PHOS., PHOS.-AC., sec., VERAT. Diarrhoea, with pain in the Abdomen: A.v.s.,cham., ipec., laur., mere., merc.-c., natr.-m., phos., stram., sulph., tart., VERAT. Diarrhoea, occasioning great Prostration of strength : ARS., bry., cAm., con., mere., PHOS., rheum, SECAL., sep., sulph. DIARRHCEA. 191 Diarrh&a occasioning great prostration of strength, in Aged persons : Con., SEGAL. Stools brown : Ars., CAMPH., merc.-c., sulph., tart., VERAT. Stools greenish: ARS., bell., canth., cham., ipec., laur., mere., nux, PHOS., PHOS.-AC., sulph., VERAT. Stools grey, or slightly whitish : Aeon., ars., bell., carb.-v., cham., lach., mere., PHOS., PHOS.-AC., puls., rhus, sulph., verat. Stools liquid : Arn., ars-, carb.-v., chin., cic.,jat., lach., meph., PHOS., PHOS.-AC., SEC., VERAT. Stools liquid and whitish : Ars., camph., cupr., jat., PHOS., PHOS.-AC., sec., VERAT. Liquid and whitish stools, with white coat of tongue : Cupr., PHOS., SEC. Liquid stools, with continued pain at the pit of the stomach: Ars., CAMPH., chin., cupr., PHOS., VERAT. Liquid stools, with rumblings in the intestines : Ars,, jat., nux, petr., PHOS., PHOS.-AC., puls., rhus, sec., sulph., tart., VERAT. Stools liquid ; evacuation painful, (attended with colic) : ARS., carb.-v; PHOS., spig., staph., VERAT. IStools liquid ; evacuation painless : ARS., carb.-v., chin., cic., PHOS., PHOS.-AC., SEC., spig., VERAT. Stools mucous and watery: Ars., bell., chin., ipec., nux, PHOS., PHOS.-AC., puls., rhus, SEC., sulph.-ac., tart., VERAT. Rice-water stools, or stools like whey or water, with whitish or greyish flocks in it : Ars., CAMPH, cupr., ipec., jat., PHOS., PHOS.-AC., secal., VERAT. If there is inflammation, consult also, Aeon., bry., and rhus. 192 CHOLERA REPERTORY. Rice-water stools, or watery, greyish, whitish and floc- culent stools, with great thirst : ARS., carnph., cupr., ipec., PHOS., PHOS.-AC., VERAT. If in the febrile variety, or in the 4th stage : Aeon., bry., or rhus. Stools whitish : Aeon., ars., camph., bell., c ham., chin., cupr., ipec., jat., mere., nux, PHOS., PHOS.-AC., sec., sulph., verat. Watery and white flocky stools, with cramps and thirst : Aeon., ars. t bry., CAMPR., CUPR., ipec. phos., phos.-ac., rhus, SEC., VERAT. Watery and white-flocky stools, with clonic spasms: (spasmodic movements) and thirst: Aeon., ARS., bry., CAMPH., CUPR., ipec., phos., phos.-ac., SEC., VERAT. Whitish Flocks in serous stools, with pulse scarcely perceptible: Aeon., ARS., bry., CAMPH., PHOS. -AC., rhus, SEC., VERAT. Liquid stools, with white flocks and grains, having the consistence and color of tallow : PHOS. Stools yellowish: Ars., cham., ipec., mere., PHOS., PHOS.-AC., puls., tart., verat. Yellowish stools, especially in an early stage of the disease: Ars., cham., ipec., mere., PHOS., PHOS.-AC., tart., VERAT. URINE. Retention of urine : CAMPH., CANTH., lach.,op., plumb., VERAT. Retention of Urine, with ineffectual desire to urinate ; at the commencement of the stage of reaction: CANTH., verat. VOICE. CHEST. 193 Urine scantily secreted, or suppressed : Ars., camph., CARB.-V , CUPR., ipec., SEC., stram., VERAT. The same symptom in the consecutive fever : BELL., carb.-v., RHUS, stram. Secretion of urine diminished ; with cramps in the calves of the legs : ARS., calc.. CAMPH., cann., carb^-v., coff., coloc., con., CUPR., graph., hyos., lach., lye., mere., natr., nux, petr., rhus, sec., sep., sil., sulph., VERAT. VOICE. Voice hoarse: ARS., bell., bry., calc., camph., CARB.- V., caus., cham., chin., etc., CUPR., dros., graph., hep., laur., mere., natr.-m., nux, PHOS., phos.-ac., puls., rhus, sec., spong., sulph., VERAT. Voice hoarse ; face choleric : ARS., camph., CARB.-V., CUPR., laur., PHOS., phos.-ac., rhus, SEC., VERAT. Voice lost, (aphonia) : Ant., bell., CARB.-V., caus., cham., chin., CUPR., dros., hep., kal., lach., laur., mere., natr.-m., nux, petr., PROS., puls., sep., sil., spong., stann., sulph., VERAT. CHEST. Anguish in the chest : Aeon., ARS., bell., bry., camph., carb.-v., cic., CUPR , hydrocyan., ipec., jatroph., laur., natr.-m., phos., PHOS.-AC., rhus, stram., VERAT. Breath cold: CARB.-V. And, according to some clinical observations, ars., camph., verat. Constriction (spasmodic) of the chest : CAMPH., caus., CUPR., fer., IPEC., lach., nitr.-ac., nux, op., PROS., phos.- ac., puls., spig., stram., sulph., VERAT. 194 CHOLERA REPERTORY. Cramps or tonic spasms in the chest : Ars., bell., CAMPH., caus., CIC., CUPR., fer., graph., hyos., IPEC., kal., mere., nux, op., PHOS., phos.-ac., puls., SEC., sep., stram., sulph., VERAT. Cramps in the muscles of the chest, with continual vomitings, and with the eyes turned upwards: CAMPH., CIC., VERAT. Respiration laborious ; cold and blue skin : ARS., CAMPH., CARB.-V., CUPR., ipec., sec., VERAT. SUPERIOR EXTREMITIES. Cramps in the upper arms : Phos.-ac., SEC. Cramps in the forearms : Laur., phos.-ac. , SEC. Cramps in the ivrist : Phos-ac. Coldness of the hands : Aeon., bell., cham., ipec., natr.~ m., nux, petr., phos., sulph., tart., VERAT. Cramps in the hands : Bell., calc., cann., coloc., graph., laur., phos-ac., SEC., strara. Cramps in the fingers : Am., ars., calc., cann., coff., dros., fer., lye., nux, phos., phos.-ac., SEC., stann. staph., sulph., VERAT. Cramps in the fingers, with clamminess of the tongue and skin : PHOS-AC. Cramps in the fingers, with clammy perspiration : Ars., fer., lye., nux, phos., phos-ac., VERAT. INFERIOR EXTREMITIES. Coldness of the feet : Aeon., bell., calc., caus., dig., graph., ipec., kal., lach., lye., mere., natr., natr.-m., nitr.-ac., petr., PHOS., plat., plumb., rhod., rhus-rad., sep., sil., sulph., tart., VERAT. Cramps in the nates : VERAT. SKIN. 195 Cramps in the hips: Coloc., phos-ac. Cramps in the thighs: CAMPH., cann., hyos. ipec., mere., petr., phos.-ac., rhus, sep., VERAT. Cramps in the hams : Calc., cann., phos. Cramps in the legs : Carb.-v., coloc., CUPR., JAT., phos.-ac. Cramps in the calves of the legs : Ars., bry., calc., CAMPH., cann., carb.-v., cham., coff., coloc., CUPR., graph., hyos., JAT., lach., lye., merc.,natr., nitr.-ac., nux, petr., PHOS., rhus, sec., sep., sil., sol.-n., staph., sulph., tart,, VERAT. Cramps in the calves of the legs, with burning heat in the stomach, or pit of stomach : ARS., CAMPH.. PHOS. Cramps in the calves of the legs, with diminished se- cretion of urine : Ars., calc., CAMPH., cann.,, carb.-v., coff., coloc., CUPR., graph., hyos., lach., lye., magn., mere., na^r., mix, petr., rhus, sec., sep., sil., staph., sulph., VERAT. Cramps in the calves; coldness of the feet: Calc., graph., lach., lye., mere., natr., nitr., ac., petr. , PHOS., rhus- rad., sep., sil., sulph., tart., VERAT. Cramps in the feel: CAMPH., caus., graph., lye., natr., nux, sec., stram., sulph. Cramps in the feet, with burning in the stomach, or pit of stomach: CAMPH. Cramps in the soles of the feet: Calc., carb.-v., coff., fer., hep., petr., phos.-ac., plumb., sec., sil., staph., sulph. Cramps in the toes : Calc., fer., hep., lye., mere., nux, phos.-ac., SEC., sulph. SKIN. . Blueness of the skin : Aeon., am., ARS., bell., bry., 196 CHOLERA REPERTORY. calc., camph., CARB.-V., CUPR., dig., lack., mere., natr.-m., nux, op., phos., phos.-ac., plumb., puls., rhus, SEC., sil., spong., thuj., VERAT. Blueness of the skin in different parts, and withered ap- pearance of it: ARS., bry., calc., CAMPH., CUPR., mere., nux, phos., phos.-ac., SECAL., sil., spong., VERAT. Coldness of the skin : Aeon., ant., am., ars., bell., bry., calc., CAMPH., cann., canth., CARB.-V., caus., cham., chin., cic., cupr., dros., dulc., fer., graph., hell., hep., hyos., ign., IPEC., kal.. Inch., laur., lye., mere., mez., natr., natr.-m., nitr.-ac., nux, op., petr., PHOS., phos.-ac., plumb., puls., rhus, sabad., sabin., sec., sep., sil., spig., spong., stann., staph., stram., sulph., tart., thuj., VERAT. The medicines which correspond both to coldness and blueness (of the skin), respectively or collectively, are : Aeon., arn., ARS., bell., bry., calc., CAMPH., CARB.-T., CUPR., lack., mere., natr.-m., nux, op., PHOS., PHOS.-AC., plumb., puls., rhus, SEC., sil , spong., thuj , VERAT. Skin cold and bluish, and covered with cold perspira- tion: ARS., camph., carb.-v., CUPR., ipec., SECAL., VE- RAT. Coldness of the skin, with mental indifference or tran- quillity: ARS., ipec., NATR.-M., VERAT. Withered or wrinkled skin : Ant., ARS., bry., cole., camph., cham., chin., CUPR., fer., graph., hell., hyos., iod., kal., lye., mere., mur.-ac., nux, phos., PHOS.-AC., rheum., SEC., sep., sil., spig., spong., strain., sulph., VERAT. The medicines which correspond, respectively or col- lectively, to blueness, coldness, and shrivelled state of the skin, are: ARS., bry., calc., CAMPH., CUPR., mere., nux, PHOS., PHOS.-AC., SEC., sil., spong., VERAT. PERSPIRATION AND PULSE. 197 The medicines which, on the ground of clinical experi- ence, have been more especially recommended for this combination of symptoms, in the stage of collapse in cho- lera, are: ARS., CAMPH., CAKB.-V., CUPH., hydrocy., jat., SEC., VERAT. PERSPIRATION AND PULSE. Perspiration, cold: Aeon., ARS, bell., bry., calc., CAMPH., canth., CARB.-T., cham., chin., cin., cofF., CUPR., dulc., hell., hep., hyos., ign., IPKC., lach., lye., mere., natr., nitr.-ac., nux, op., petr., phos., phos.-ac., plumb., puls., rheum., rhus, sabad , SEC., sep., sil., spig., stram., sulph , thuj., tart., VERAT. Perspiration, viscid, clammy : ARS., camph., daph., fer., hep., jat., lach., lye., mere., nux, phos., phos.-ac., plumb., sec., VERAT. Perspiration clammy, with slow pulse : CAMPH., mere., VERAT. Perspiration clammy, with spasmodic movements o the jaw : CAMPH., mere., nux, phos., plumb., SEC. VE- RAT. Pulse feeble and frequent : Ars., CARB.-V., lach., nux, rhus-rad. Pulse Feeble and Slow, in the 1st stage : CAMPH., cann., dig., LAUR., mere., puls., rhus.-rad., VERAT. Pulse Feeble and Slow, in the 4th stage ; Camph., cann., dig., laur., mere., puls., R.-RAD., VERAT. Pulse feeble and small: ARS., CAMPH., chin., dig., LACH., nux, PHOS.-AC., puls., RHUS, VERAT. Pulse scarcely perceptible, with watery and white-flocky stools: Aeon., ARS., bry., CAMPH., PHOS.-AC,, rhus, SEC., VERAT. 198 CHOLERA REPERTORY. GENERAL AND MISCELLANEOUS SYMPTOMS. Burning internally, and tossing, with fear of death : ARS. Burnings in the stomach and abdomen, with anguish and tossing: ARS., CAMPH. Cholera followed by cerebral and abdominal affections : BELL. Collapse so complete, that no vomiting, diarrhoea, or spasms remain, though some or all of them have existed previously; ARS., camph., CARB.-V., CUPR., HYDRO- CY., laur., verat. Collapse, without previous or present vomiting, or diar- rhoea : CAMPH., CARV.-v.,.hydrocy., laur., VERAT. Cramps or other Spasms at night : Ars., camph., calc., cin., CUPR., hyos., ipec., kal., lye., mere., op., SEC. Cramps in the stomach and extremities, with coldness of the body in an early stage, with but little diarrhoea : CAMPH. Spasms, Clonic, (convulsions) : Ars., bell., bry., calc., CAMPH., canth , carb.-v., caus., cham., cic., con., CUPR., hyos., ign., ipec., cal., lye., mere., natr.-m., op., phos., phos.-ac., plat., rhus, SEC., sep , sil.,stann., STRAM., tart., sulph., VERAT. Spasms, severe and clonic, with but little diarrhoea or vomiting: Ars., CAMPH., CUPR., ipec., sec., VERAT. Spasms, Tonic, (Tetanus, Cramps, &c.) : Ars., bell., caus., cham., Cic., CUPR., ign., ipec., lye., mere., petr., phos., plat., rhus, SEC., sep., stram., sulph., VERAT. Spasms, severe and tonic, with but little diarrhoea or vomiting : CAMPH., CUPR., ipec., SEC., VERAT. GENERAL AND MISCELLANEOUS SYMPTOMS. 199 Spasms or Cramps, in the extremities or elsewhere, with weight, pressire pain or aching, at the pit of the stomach : CAMPH., CUPR., natr.-m., phos., phos.-ac., sec., tart., VE- RAT. Spasms of the extremities, with painful sensibility of the pit of the stomach: Ars., CAMPH., CUPR., natr.-m., phos., phos.-ac., tart., VERAT. Spasms return at night : Cuprum, SECALE. Excessive and sudden debility: Ars., carb.-v., ^CUPR., ipcc., lach., laitr., nux, PHOS., PHOS.-AC., sec., VERAT. The patient worse after midnight, or early in the morn- ing : Aeon., ARS., bell., canth., CARB.-V., CUPR., kal., lach., mere., natr., natr.-m., nux, petr., PHOS., PHOS.-AC., RHUS, sec., stram., sulph., tart., VERAT. The patient made worse by movement : Aeon., ARS. BELL., bry., CAMPH., canth., carb.-v., cic., CUPR., dig., hyos., IPEC., kal., lach., laur., mere., natr.-m., nux, petr., PHOS., PHOS.-AC., plumb., rhus, rod., SEC., stram., sulph., tart., VERAT. CHAPTER XI. GASTRIC AND INTESTINAL REPERTORY.* AUXILIARY TO THE CHOLERA REPERTORY, AND ADAPTED ALSO TO VOMITING AND DIARRHfEA IN GENERAL, AND TO CHOLERA INFANTUM AND DYSENTERY. EXPLANATION OF THE USE OF THE REPERTORY. THE arrangement of the symptoms of each section, is in general alphabetical. * Taken chiefly from Jahr's excellent Manual, with some modifi- cations. 200 CHOLERA KKPRRTORY. The mode of obtaining the remedy for a group, is the same in this, as in the Cholera Repertory. The medi- cines seldom required, are here omitted. The emphasis in Chapter XL, has no special reference to Cholera; but in the treatment of this disease, this chapter may be con- sulted, when any case presents symptoms contained in this, but not in the Cholera Repertory; and that Reper- tory may be used as auxiliary to this and in general prac- tice ; for the medicines there enumerated apply to the symptoms, in whatever disease they may occur. The 30th, will in general be a suitable dilution for most medicines, in ordinary gastric and intestinal diseases, for which this Repertory (Chap. XI,) is more especially con- structed. VOMITING IN GENERAL. Aeon., ant., am., ars., bell., bry., calc., camph., cann., canth., carb.-v., cham., chin., cic., cin., coff., colch., coloc., cupr.j dros., dulc., fer., graph., hep., hyos., ign., ipec., lach., laur., lye., mere., natr.-m., nitr.-ac.. nux, phos., plumb., puls., sec., sep., *t7., stann., stram., sulph , tart., verat. CHARACTER OF THE VOMITING. Vomiting : Acrid : Arg., ipec. Bilious, bitter: Aeon., ant., ars., bry., camph., cann., colch,, cupr., dros., grat., ipec., lach., mere., nux., phos., puls., sec., sep., stann., stram., sulph., verat, Bitterish-Sour : Grat., ipec., puls. Blackish : Ars., calc., chin., hell., laur., nux, phoV, plumb., sec., sulph., verat. of Blood: Aeon., am., ars., bell., bry., calc., CHARACTER OF THE VOMITING. 201 camph., canth., carb.-v. t caus., chin., cupr., dros., fer., hep., hyos., lack., lye., mez., nux, op., phos., plumb., puls., sulph., verat., zinc. of Blood clotted: Am., caus. Vomiting of Blood; sour regurgitations : Ars., calc., carb.-v., lye., nux, phos., plumb., puls., sulph. Vomiting Brownish : Ars., bis. Vomiting of what has been drank: Aeon., ant., arn., ,ars., bry., cham., chin., dulc.,^tpec., nux, puls., sec., sil., sulph., tart., verat. of what has been eaten : Ant., ars., bell., bry., calc., chin., colch., coloc., cupr., dros., fer., hyos., ign., ipec., lach., laur., lye., natr.-m., nux, phos., plumb., puls., Sep., sil., stann., sulph., verat. of Excrement: Bell., bry., nux, op., plumb. Frothy : jEth., verat. Gelatinous: Ipec. Green: Aeon., ars., cann., ipec., lach., phos., plumb., puls., verat. - Milky: ^Eth. ^. of Milk used: jEth., samb. of Mucus: Aeon., aeth., ars., bell., bor., bry., cham., chin., cupr., dig., dros., dulc., hyos., ipec., lach., mere., nux, phos., puls., sulph., verat. of Bloody Mucus: Aeon., hep., hyos., lach., nitr. of Green Mucus; Aeon., ars., ipec., lach., phos., puls., verat. Painful: Asar., tart. Periodical: Cupr., nux. Salt: Magn., natr.-s. Vomiting Sour: Ars., bell., bor., calc., caus., cham., 202 CHOLERA REPERTORY. chin., fer., graph., hep., ipec., lye., nux, phos., phos.-ac., puls., sass., stram., sulph., tab., tart., thuj., verat. Vomiting Violent : Ars., bell., cupr., iod., lach., nux, plumb., tart., verat. Watery : Ars., bell., caus., chin., cupr., hyos., /nt., magn., sil., stann., stram., sulph. -ac., tab., verat. Yellowish: Ars., iod., oleand., plumb. Yellow, wilh tinge of Green : Oleand., verat. CAUSES OR CONDITIONS OF THE VOMITING. Vomiting after acids : Fer. after Bread: Nitr.-ac. from the motion of a carriage: Ars., cocc., nux, petr., sil., sulph. after a Chill : Bell. Vomiting after Drinking; Arn., ars., bry., nux, puls., sil. relieved by Drinking: Cupr. bitter after Drinking: Ars., nux., sil., verat. Vomiting after Eating: Ars., calc., fer., iod., ipec., lach., nux, phos., puls., sep., sil., stann., sulph., verat. Evening (in the): Bell., bry., phos., puls., sulph. Morning (in the) : Bar.-m., dig., dros., nux, sil., sulph. Night (at): Ars., bry., caus., dig., dros., fer., lye., mere., mur.-ac., nux, phos., puls., sulph., verat. in Pregnancy: Aeon., ars., con., fer., ipec., kreos., lach., magn.-m., natr.-m., n.-mos., nux, petr., phos., puls., Sep., verat. Vomiting after Smoking or Stooping: Ipec. from the motion of a Ship: Ars., cocc., nux, petr., sil., sulph. after Sucking : Sil. CONCOMITANTS OP THE VOMITING. 203 CONCOMITANTS OF THE VOMITING. Vomiting with Anxiety: Ant., ars., nux. offensive Breath : Ipec. Choking: Hyos. Colic: Ars., bry., nux, plumb., puls., stram., tart., verat. Convulsions: Ant., cupr., hyos., mere. Cries : Ars. fear of Death: Ars. Diarrhoea : JEih., ant., ars., bell., coloc., cupr., jat., ipec., lach., phos., rheum., stram., tart., verat. pains in the Ears : Puls. Eructations : Caus., mur.-ac. Eyes convulsed: Cic. Face, pale: Puls., tart. perspiration on th,e Face: Camph., sulph. Feet, cold : Kreos., phos. Feet, numb: Phos. Hands, cold: Kreos., phos., verat. Hands, hot : Verat. Hands, numb : Phos. Heat: Ars., bell., ipec., verat. Hiccough: Bry. Legs, cramped: Nux. desire to lie down: Verat. Nausea : Nux, sulph., verat. Pain in the back: Puls. Pain in the stomach: Ars., cupr., hyos., ipec., lach., op., phos., plumb., sulph., tart., verat. Perspiration: Ipec., sulph. Perspiration, cold; Camph. 204 CHOLERA REPERTORY. Vomiting, with rumbling: Puls. Shivering: Bry., phos. ,puls. t tart., sulpb. Shivering in the evening: Bry., phos., sulph. Shuddering : Verat. Sight, obscure : Lach. Sleepiness: Tart. Taste, bitter: Puls. * Thirst : Ipec. Throat, burning : Arg., puls. Trembling : Nux, tart. Vertigo : Hyos., natr.-s. Weakness: Ars., hyos., ipec., phos., verat . SENSATIONS (PAINS, &c.,) AT THE STOMACH AND PIT OF THE STOMACH. Burning in the pit of the stomach: Aeon., ant., ars., bell., bry., laur., mere., nux, phos., sec., sep., sil., sulph., verat. In the stomach: Ars., bell., bry., camph., canth., caps., carb.-v., cham., cic., graph., ign., laur., mere. merc.-c., nitr., nux, phos., phos.-ac., salad., sec., sep., sulph., verat. Cold sensation in the Stomach or pit : Ars., bell., ign., lach., laur., phos., phos.-ac., rhus, sulph. Cramp : (See spasmodic pains.) Sensation of Emptiness in the Stomach: Ant., ign., petr., sep., tart., verat. Sensation of Fulness in the Stomach and pit : Arn., bar.-c., bell., carb.-v., cham., grat., hell., kal., lye., nux, petr., phos,, sulph. after a meal: Also, chin., mere., puls., sep., sil. Pressure in the pit of the stomach: Aeon., am., ars. STOMACH. 205 bell., camph., cham., chin., coff., coloc , cupr., hep., ign., mere., natr.-m., nitr., nux, phos., phos.-ac., prun., puls., ran., ran.-sc., rhod., rhus, scp., stann., sulph. ^tart., verat. Pressure in the stomach : Aeon., agar., anac., arn., ars., bar.-c., bell., bis., bry., calc., canth., carb.-an., carb.-v., cham., chin., etc., coff., coloc. , fer., graph. ,grat., hep., iod., ipec., lack., laur., led., lye., mere., mez., mosch., natr., natr.- m., nux, par., petr., phos., plat., plumb., puls., rhod., rhus, sabin., sec., sen., sep., sil., spig., squill., stann., stram., sulph., tart. Pain in the Pit of the Stomach, and in the chest, after a meal : Bry. Pain in the Stomach and chest, after a meal : Chin., lach., phos. Shootings in the pit of the Stomach : Arn., bell., bry., kal, nit-ac., phos., puls., rhus., sep., sulph., tart. In the stomach : Bell., bry., coff, ign., kal., plat., sep., sulph. Spasmodic pains in the stomach : Ant., ars., bell., bis., bry., cole., carb.-a , carb.-v., caus., cham., chin., cocc., coff., con., cupr., fer., graph., hyos., kal., lach., lye., mere., natr.-m., nux, phos., puls., sec., sep., sulph., verat. Swelling of the pit of the stomach: Aeon., calc., hep., lye., sulph. Sensation of swelling there : Bry. Tenderness of the stomach and region of the stomach : Am.-c., am. -in., ant., ars., bar.-c., bry., calc., camph., canth., carb.-v.. caus., colch., coloc., hep., hyos., kreos., lach., lye., magn.-m., mere., natr., natr.-m., nux, ol.-an., phos., phos.-ac., puls., rhus-rad., sil., spong., stann., sulph., sulph. -ac., tart., tereb., verat. 10 206 CHOLERA REPERTORY. Tension in the Pit of the stomach: Acon.,.ant., cham., nux. in the Stomach: Aeon., bry.,carb.-v.,kal., mere., staph. Throlbings in the region of the stomach : Aeon., bell., kal., puls., rhus., sep., sulph., tart., thuy. DIARRHCEA IN GENERAL. Aeon., alum., am.-m., ant., am., ars., bell., bor., bry., calc., carb.-v., cham., chin., cic., coff., coloc., con., cupr., dig., dros., dulc., fer., graph., hep., hyos., ign., ipec., lack., laur., lye., mere., natr.-m., nitr.-ac., nux., petr., phos., phos-ac., puls., rheum., rhus., sep., sil., strain. , sulph., sulph. -ac., verat. % COLOR OF THE FAECES- Color, Black : Ars., bry., calc., camph., chin., ipec., mere., nux., op., phos., str am., sulph., sulph.-ac., VBrat. Brownish : Ars., camph., dulc., magn., magn.-m., merc.-c., rheum., rhus-rad., sulph., verat. Clay-like: Calc., hep. Greyish : Merc., phos., phos.-ac., rheum. Greenish i Ars., bell., cham., coloc., dulc., hep., ipec., magn., magn.-m., mere., merc.-c., nux., phos., phos.-ac., puls., rheum., sep., sulph., sulph.-ac., verat. Pale : Carb.-v., lye. Whitish: Aeon., ars., calc., caust., cham., chin., colch., cop., dig., hep., ign., iod., nux., phos., phos.-ac., puh., rhus, spig., spong., sulph. ODOR OF THE FJ3CES. 207 White, like milk : Am., bell., dulc., mere., nux, rheum. White, like flocks : Vide, Cholera Repertory. White, in streaks : Rhus-tox. Yellowish : Ars., calc., cham., chin., coco-., coloc., ign., ipec., mere., phos , plumb., puls., sulph., terb. Yellow, in streaks : Rhus-tox. ODOR OF THE FAECES. Odor : Corpse-like : Sil., Carb.-v. Foetid: Ars., calc., cham., coloc., lach., mere., merc.-c., nitr.-ac., nux, op., phos.-ac., plumb., rheum., sep., squill., sulph. -ac., tab. Putrid: Ars., bry., carb.-v., cham., chin., coloc., graph., mere., nitr.-ac., nux, sep., sulph., sulph.-ac. Sour: Arn., calc., coloc., graph., magn., mere., rheum., sep., sulph. COMPOSITION AND CONSISTENCE OF THE FAECES. Faeces : acrid: Ars., cham., fer., lach., mere , puls. sass., verat. Bilious : Ars., dulc., ipec., mere., merc.-c., puls. Bloody: Arn., ars., caps., carb.-v., colch., coloc., dulc., ipec., lacb., mere.-, merc.-c., nitr.-ac.. nux. Coated with Blood : Con., magn.-m., nux, squill., thuy. Burning : Ars., lach., mere. Clay-like : Calc. Corrosive : See Acrid. not Digested: Arn., ars., bry., calc., cham., chin., 208 CHOLERA REPERTORY. con., fer., lach., mere., nitr.-ac., oleand., phos., phos.-ac., squill., sulph. not Digested at night, or after meals : Chin. Fermented : Ipec., sabad. Frothy : Calc., coloc., iod., lach., mere., op., rhus., sulph .-ac. Gelatinous : Rhus., sep. Purulent: Am., bell., calc., canth., chin., clem., cocc., con., ignat., iod., kal., lye., mere., nux, petr., puls., sabin., sec., sil., sulph. Slimy : Ang., arn., ars., bell., caps., carb.-v. cham., chin., coloc., dulc., fer., graph., hell., iod., ipec., kal., mere., nitr.-ac., nux, phos., phos.-ac., puls., rheum., rhus., sec., sep., squill., stann., sulph., tart., verat. Viscous ; sticky : Calc., carb.-v., caust., hep., lach., mere., nux., plumb., sass., verat. Watery: Aeon., ant., arn., ars., bell., calc., cham., chin., for., hyos., jat., ipec., lach., nux., petr., phos., phos,-ac., puls., rhus., sec., sulph., tart., verat. CAUSES, OR CONDITIONS OF DIARRHOEA. Diarrhoea : from Acid things : Lach. after taking Cojd : Sell., bry., caust., cham., chin., dulc., mere., n.-mos., nux., puls , sulph., verat. in the Coolness of the evening : Merc. in Damp weather : Lach., rhod. Day and Night : Sulph. after Drinking: Ars., cin. in the Evening : Caust., kal., lach., mere. CONCOMITANTS OP DIARRHO3A. 209 Diarrhoea, in Feeble persons : Chin. , fer. , rhus, phos.-ac., sec . after Fruits : Chin., lach., rhod. from Grief: Ign. from Indigestion: Ant., coff.. ipec., puls., nux. after a Meal : Ars., chin., lach., verat. after Milk: Dry., lye., sep., sulph. in the Morning : Bry. at Night: Ars., bry., cham., chin., dulc., lach., mere., mosch., puls., rhus., sulph., verat. of Old persons : Ant., bry., phos., sec. of Pregnant females: Ant., dulc., hyos., lye., petr., phos., sep., sulph. of Scrofulous persons : Ars., bar.-c., cole., chin., dulc., lye., sep., sil., sulph. when Sleeping : Arn., puls., rhus. during Warm Weather : Lach. CONCOMITANTS OF D I A R R H OZ A . Diarrhoea with: Abdomen distended: Graph., sulph., verat. Anguish : Ant., lach., mere. excoriation of the Anus : Cham., mere., sass. Colic, cutting: Aeon., agar., ang., ant., ars., asa., bar.-c., bry., cann., canth., cham., coloc., dulc., hep., ipec., lach., mere., merc.-c., mez., nux., petr., puls., rat., rheum., rhus., stront., sulph., verat. alternately with Constipation: Bry., lach., nui., rhus. with Cries and tears, in Children: Carb.-v., cham., ipec., rheum., sulph. Debility : Ars., chin., ipec., phos-., sep , verat. 210 CHOLERA REPERTORY. Diarrhoea, Eructations : Con., dulc., mere. Heat: Merc. pain in the Limbs : Am.-m., rhus. pain in the Loins : Nux. Nausea: Ars., bell., ip., lach., mere. cold Perspiration on the face : Merc. Shiverings: merc.,puh., sulph. pain in the Stomach : Bell., bry. Tenesmus : Ars., ipec., lach., mere., nux., rheum., rhus., sulph. Thirst : Ars , dulc. Vomitings : Ars., bell., coloc., cupr., dulc., ipec., lach., phos., rheum., stram., tart., verat. THE MORE USUAL GROUPS OF DIARRHCEIC SYMPTOMS.* Acrid and brown stools : Ars., verat. Black and green stools : Ars., ipec., mere., phos., sulph.-ac., verat. Blackish stools after abuse of ipecac : Chin. Bloody, mucous and foetid stools : Lach., merc.-c., sulph., sulph.-ac. Brown and green stools : Ars., dulc., magn., magn.-m., merc.-c., sulph., verat. * These, being nature's groupings, are of more practical value, than those which are formed merely from the Materia Medica, with- out reference to any observation of their actual occurrence in natural disease. The author, like most practitioners, has observed all of them in the latter, and most of them a great number of times. Those who practice accurately, often study to find the remedies adapted to groups : if they recorded and preserved the results of their calculations, the aggregate of those collected by different physicians would form a valuable repertory for general practice. DIARRHCEIC GROUPS. 211 Brown and watery stools : Ars., dulc., sulph., tart. Brown stools, with nausea from movement : Ars. Clay-colored and frothy stools in diarrhoea : Calc., rhus-rad. Diarrhoea after fruit ; with sighing respiration : Lach. at night, with distension of the stomach and ab- domen after meals: Bor., bry., caust., cham., chin., dulc., kal., lach., mere., puls., rhus-tox., sulph. during dentition ; white coat on the tongue ; yel- lowish stools : Calc., ipec., mere., sulph. painless and at night: Ars., bor., bry., canth., cham., chin., dulc., mere., puls., rhus-tox., sulph., verat. with colic and at night : Ars., bor., bry., cham., dulc., lach., mere., puls., rhus-tox., sulph., verat. with colic and tenderness of the abdomen : Aeon., canth., cham,, merc.-c., nux, puls., rhus-rad., stram., sulph., terb., verat. with colic ; stools foetid : Ars., bry., coloc., ip*ec., lach., mere., nux, stram., sulph. with colic; stools green: Ars., bor., coloc., phos., puls., verat. with white coat on the tongue, and yellow stools ; Amb., calc., ign., ipec., mere., oleand., petr., phos., puls., sulph. with involuntary evacuations at night : Ars., bry., chin., lach., mere., puls., rhus-tox., sulph., verat. with sweat on the face, nausea and stiffness of the neck, and pain in it when moving it : Camph. 212 CHOLERA REPERTORY. Foetid and green stools: Ars., cbam., coloc., Inch., mere., merc.-c., nux, sep., sulph., sulph.-ac. tab. Foetid stools, in diarrhoea with colic : Ars., bry., coloc., ipec., lach., mere., nux, stram., sulph. Frothy and involuntary stools, in diarrhoea : Chin.. mere., op., rhus-lox., su/ph. Green and slimy stools : Ars., bell., bor., canth., chain., coloc., dulc., ipec., laur., mere., nux, phos., puls., sep., stan., sulph., sulph.-ac., tab. Green, slimy and undigested stools : Ars., bor., cham., nitr.-'dc.,phos., phos.-ac., rheum, sulph., sulph-ac. Green, sour and undigested stools : Merc., sulph. Watery stools, in diarrhoea with colic : Ars., cham., dulc., lach., nux, puls., rhus-tox., sulph , Watery stools with brown coat on the tongue, and vomiting at night : Bell., phos., sulph. CHOLERA INFANTUM, DIARRHCEA OR CHOLERA MORBUS OF INFANTS,* Cholera Infantum in general: Aeon., ars., bell., bry., calct, cham., dulc., hep., ipec., mere., nux, puls., sep., sulph., verat. Cholera Infantum, with : Abdomen distended : Ars., bell., bry., cham., mere., nux, puls., sep., sulph. distended, and pained during the evacuations : Ars., bry., cham., mere., nux, sep., sulph. Cholera Infantum, with Cerebral disease : Bell. * The disease called Cholera Infantum, by American physicians, prevails during the hot season in the Middle States, and is often fata in citiea. DYSENTERY. 213 Cholera Infantum, with Fever, thirst, hot and dry skin, pulse hard, and frequent : Aeon.* with Stools green : Ars., bell., cham., dulc., ipec., mere., nux, puls., sep., sulph., verat. with Stools yellow and slimy: Ars., cham., ipec., mere., puls., sulph. with Vomiting diarrhoea and Slimy Stools : Ars., bell., ipec., rheum, verat. It is unnecessary to dwell longer on Cholera Infantum in particular, inasmuch as the other parts of this Reper- tory afford a sufficient guide for the treatment of this dis- ease ; especially if the remedies for each symptom of the case be compared with the list given (at the head of this section,) as the remedies for Cholera Infantum in general. It is not, however, necessary to be confined to them, if the whole group of symptoms indicates some other remedy. Symptomatology, here as elsewhere, is the grand basis of treatment. DYSENTERY. Dysentery in general: Aeon., ars., bell., bry., canth., caps., carb.-v., cham., chin., colch., coloc., dulc., ipec., mere, merc.-c., nitr.-ac., nux, phos., puls., rhus, sulph., verat. Dysentery with dryness of the Lips : ^cn.,bell., bry., chin., lach., mere., nux, rhus, sulph. with tenderness of Stomach and Abdomen: Nux, puls., sulph. * At the commencement of the treatment, Aconite is generally advisable. 214 CHOLERA REPERTORY. Dysentery, with tenderness of Abdomen : Aeon., bell., cham., mere., nux, puts., sulph. with Stools of Bloody mucus, sometimes Green : Merc., merr.-c., nux, puls., sulph. with Burning in the Abdomen and Soles : Merc. with Bloody mucous Stools and Tenesraus : Lach. mere., merc.-c., nux, rhus., sulph. For other symptoms and groups in any particular case of dysentery, see other sections of this Repertory, and compare the medicines, under each symptom of the case, with those for dysentery in general. APPENDIX I. AN ESSAY ON EPIDEMIC CHOLERA, BY B. F. JOSLIN, JR., M.D. PRESENTED TO THE UNIVERSITY OF THE CITY OF NEW-YORK, FOR THE DEGREE OF DOCTOR OF MEDICINE. SESSION 1851-2." THE early history of the Cholera is involved in some obscurity ; for while some contend that it has existed in this country and in Europe only during a comparatively recent period, others believe firmly, that the epidemics with which we have been visited were only a more general prevalence of the Cholera Morbus, which is always more or less preva- lent during the warmer months. In the descrip- tions of Cholera Morbus contained in the older books, the evacuations both from the stomach and bowels, are described as consisting " chiefly of bile." Any person who has seen the epidemic cholera, knows that in it the evacuations ' are characterized by an entire absence of this fluid ; that though in rare cases, the dejections may be slightly tinged with bile, still in no case which they would consider as epidemic Cholera, are the matters ejected from the 216 APPENDIX. body decidedly bilious. A comparison of the symp- toms enumerated as belonging to Cholera morbus, and those of epidemic or malignant Cholera, will I think, be sufficient to convince any one, that those diseases, though resembling each other in some par- ticulars, are nevertheless not identical. The testi- mony of medical men \vho had had long experience, and who witnessed the first epidemic of Cholera, proves that the disease was one which they had not previously been accustomed to meet in practice. Watson says, (Prac. of Med. p. 407,) "the late Dr. Babington told me that it was quite new to him. He had for a very long period been in exten- sive practice in those parts of the metropolis and its vicinity where the epidemic Cholera jaged most : and when it first came among us, he had the curiosity to ask every medical man whom he met, whether he had seen any case of the Cholera, and if the answer was " Yes," he went on to inquire, whether before that year the person had ever met with the same complaint : and the reply was always, without a single exception "No." Dr. Ackerly, who was physi- cian to one of the Cholera hospitals in New- York, during the epidemic of 1832, says in his report, that "nothing like the late epidemic and malignant Chole- ra has occurred to my notice in twenty-four years practice." Among those who believe epidemic cholera to be a disease essentially different from Cholera morbus, it has been a question whether it first originated in AN ESSAY ON EPIDEMIC CHOLERA. 217 India in 1817, or had been endemic there for a much longer period. That the disease which we know by the several designations of Epidemic, Malignant, or Asiatic Cholera, was known in India previous to the commencement there of the epidemic which traversed a great portion of the globe from 1817 to 1833 or 34, is probable from the evidence of resident -surgeons and early writers. As early as 1629, BONTIUS, a Dutch physician, wrote at Batavia, an account of what he calls " Cholera Morbus ;" but from his description it appears to have more nearly resembled epidemic cholera. He says "this disease is attended with a weak pulse, difficult respiration, and coldness of the extreme paj-ts ; to which are joined great internal heat, insatiable thirst, perpetual watching, and rest- less and incessant tossing of the body. If together with these symptoms, a cold and foetid sweat should break forth, it is certain that death is at hand." In his description of Cholera Morbus he says nothing of the spasms of the extremities, but he speaks of a person who died of this disease, as having died in convulsions. He also witnessed a disease that he calls " Spasm," which there is reason to think was nothing but the spasmodic variety of Cholera. Dr. PAISLEY, writing at Madras, in 1774, speaks of " Cholera Morbus" as being " often epidemic," and accompanied with "sudden prostration of strength, and spasms over the whole surface of the body" He attributes the disease to the ef- 218 APPENDIX. fects of "highly putrid bile;" but his description contains no information in regard to the appearance of the evacuations : his opinion as to the cause of the disease appears to be merely hypothetical. SON- NERAT, who travelled in India, between the years 1774 and 1781, speaks of several epidemics of dis- ease, the symptoms of which, as he relates them, very nearly resemble the Cholera as it has appeared in this country. He says, " the symptoms of this disorder were a watery flux, accompanied with vomit- ing and extreme faintness, a burning thirst, an op- pression of the breast, and suppression of urine. Sometimes the diseased felt violent colicky pains ; often lost his speech and recollection, or became deaf; the pulse was small" Another epidemic, occurring two years _after, "first showed itself By a watery flux, which came in an instant ; and sometimes cut the diseased off in less than four and twenty hours. Those who were attacked had thirty evacuations in five or six hours ; which reduced them to such a state of weakness that they could neither speak nor move. They were often without pulse ; the hands and ears were cold; the face lengthened ; the sinking" of the cavity of the socket of the eye was the sign of death; they felt neither pains in the stomach, colics, nor gripings. The greatest pain was a burning thirst" An English surgeon, Mr. CURTIS, in India, in 1782, described a disease which occurred in the national vessel to which he was attached. He enurnera'tesfflnost of the more striking phenomena; AN ESSAY ON EPIDEMIC CHOLERA. 219 of the cholera as being present in the disease he witnessed ; as, general tonic spasms, the evacuations consisting of " nothing but a thin watery matter, or mucus ;" coldness of the extremities, and subse- quently of the whole body ; the pulse " sometimes sunk so much -as not to be felt at the wrist, in two or three hours after the spasms came on /" " in many, the stomach became so irritable that nothing could be got to rest upon it ; but every thing that was drank was spouted out immediately ; without straining or retching. His account of the appearance of the hands in ex- treme collapse is characteristic. " The hands now begin to put on a striking and peculiar appearance. The nails of the fingers became - livid, and bent inwards ; the skin of the palms became white, bleached, and wrinkled up into folds, as if long soaked in cold water ; the effect, no doubt, of the profuse cold sweat, which is one of the most per- nicious and fatal symptoms of the disease." He also speaks of patients retaining possession of their faculties "to the last moment of their life, even when the whole body had become perfectly cold, and all pulsation of the heart had ceased for a long time to be distinguishable." This disease can be shown to have been present in some part of India, during the period which elapsed between the last mentioned date and the year 1817, when it seems to have at- tracted more general attention than it had done at any previous time. From the above extracts we may 220 APPENDIX. conclude, that a disease similar to that which has visited us during the past twenty years, has heen prevalent in various parts of India as an epidemic, at intervals during two centuries ; and it is not unlikely for a longer period, though anterior to this we have no records. In August, 1817, the Cholera appeared almost si- multaneously in Calcutta and Jessore, in Hindostan, places about sixty miles apart. It is somewhat difficult to determine the exact point at which this epidemic took its start ; but it is certain that within three months after its appearance in the above places, scarcely a spot existed within several thousand miles, in which it had not committed its ravages. In some localities the mass of the population was said to have been sen- sibly diminished. It is not my design to detail the routes pursued by this fearful scourge ; suffice it to say, that its general course was westerly, though marked by many deviations. Whether Cholera is or is not contagious, it very certainly has some other means than contagion of propagating itself; and its history has shown that neither non-intercourse nor rigid quarantine regula- tions were sufficient to stop its progress. I do not intend to enter fully into the discussion of the con- tagiousness of this disease, but will however relate the particulars of one instance, which illustrates my own view of this subject. On the second of Decem- ber, 1848, the ship New-York, arrived at the quaran- tine, Staten Island. According to the report of AN ESSAY OF EPIDEMIC CHOLERA. 221 Dr. WHITING, health officer, this vessel had started from Havre with 345 passengers. About a week previ- ously to arrival here, when off the coast of Nova Scotia, a number of cases of disease resembling Asiatic Cholera occurred, which terminated very sud- denly. Out of seventeen cases, seven died. Subse- quently to these persons having been taken to the hospital, there occurred in the latter place seventy- nine cases, out of whom forty-five died, making in all ninety-six cases and fifty-two deaths. Several of these cases were persons not having been passengers of the New-York. Among the latter was one of the nurses of the Institution. This is perhaps as fair an instance as could have been selected for an illustra- tion of the peculiar habitudes of this disease. Here were a number of persons completely isolated, as a body, from the influence of contagion, and at a distance from any point at which the Cholera was then pre- vailing : it would be difficult to suppose any but] an atmospheric origin in this instance. But further ; the ship arriving at quarantine, where no cases of this disease had previously occurred, the disease still continues, and even attacks some who had never been in the infected ship: From whence did these last receive the infection ? This last circumstance would seem to indicate that the Cholera was conta- gious, in a slight degree. From the above facts I deduce the following conclusions : 1st, that Cholera is propagated by means other than contagion ; 2d, that under circumstances favorable for its develop- 222 APPENDIX. ment, the presence of cases in the immediate neigh borhood acts as an exciting cause. It is also worthy of being noted in this connection, that at least three persons died of Cholera in the City between the sixth and the twentieth of the same month, the first of whom had previously been discharged as cured from the quarantine hospital. We may assume that Cholera is produced by a definite poison, without aknowledging the truth of any of the various hypotheses which have been brought forward respecting its absolute nature. This poison we know only by its effects ; what it is, whether ponderable or imponderable, we know not : our only knowledge is derived from the effects which it produces upon the human system. Whether we suppose it to be, like variola, generated in the course of the disease and propagated by contagion, or pro- duced by a generally diffused miasm, we may^still consider it to be the effect of a specific poison. Acting under more or less favorable circumstances, we see this poison producing proportionate results : for though we might suppose the existence of this poison at all times, still without the cooperation of certain predisposing causes, its effect would not be general. That much of this specific poison does at all times exist in those localities which have been visited of late years by the disease, to me appears improbable ; for as we have seen that there is no proof of its having often shown itself by the produc- tion of its effect, it must have remained latent under AN ESSAY ON EPIDEMIC CHOLERA. 223 a multitude of circumstances which during the pre- sence of an epidemic of Cholera seem to act strongly as predisposing causes. This remark is applicable to the periods intervening between the occurrence of the several epidemics, as well as to times previous to the first and subsequent to the last. The predisposing causes may be comprised under the meteorological influences, the influence of locality, of age, of individual habits, and manner of- living. Meteorological variations have in numerous in- stances preceded the appearance of Cholera. Those conditions of the atmosphere which have appeared most'to favor its development are, unusual conditions of heat and moisture, and alterations in its electrical condition. Thus its appearance would be preceded by long-continued storms of rain and wind, or by thunder storms. In other instances it has been known to succeed a long continuance of dry hot weather, especially if this state be succeeded by a sudden fall of rain. The localities which have been most severely visited, have been low damp situations. Places sit- uated near marches and upon the borders of rivers have been especially distinguished during the course of an epidemic. Persons at about the middle period of life are more liable to an attack of this disease than either children or the aged. Young children are not un- frequently, during an epidemic, attacked with symp- toms of the first and second stages of Cholera; but 224 APPENDIX. in them it rarely terminates in collapse ; it is more common in these cases for the disease to run into a chronic diarrhoea accompanied with vomiting, into, in fact, Cholera infantum. The following are tables, compiled from reports of the physicians having charge of Cholera hospitals, during the epidemics of 1832 and 1849. I have been unable to comprise all the reports of either epidemic ; as only -those arranged according to a uniform plan would answer my purpose. Of 590 patients admitted into the Park hospital, during the epidemic of 1832, there were 11 patients between the ages of 1 and 10 years, 49 " " " " 10 " 20 " 178* " " " " " 20 " 30 " 174 " " " " " 30 " 40 " 91 " " " 40 50 " 53 " " " " " 50 " 60 " 28 " " " " " GO " 70 " 6 " " " " " 70 " 90 " Of 407 patients admitted into the Eivington-street hospital, 5 were between the ages of 1 month and 1 year, 42 " " " u " 1 year and 10 years, 4^ CC J0 .. .. 20 " 116 " " " " " 20 " " 30 " 102 " '* " " " 30 " " 40 " 66 " " " " " 40 " " 50 " 21 " " " " " 50 " " 60 " AN ESSAY OF EPIDEMIC CHOLERA. 225 Of 281 patients in Corlear's Hook hospital, there were 25 under 14 years of age, 9 between 14 and 20 years, 84 " 20 " 30 " 88 " 30 ' 40 " 47 " 40 " 50 " 12 50 60 " 14 60 " 70 " 2 who were over 70 years of age. From the above it will be perceived, that there is very little difference between the liability of persons to an attack of Cholera between 20 and 30 years and of those between 30 and 40 years. The fore- going are from the reports of the epidemic of 1832, It is interesting to observe how nearly the following, taken from the reports of 1849, resemble them. Centre-street hospital received 483 cases : 53 under 20 years of age, 279 between 20 and 40 years of age, 141 " 40 " 60 " " " 10 " ' 60 " 70 " " " Thirteenth-street hospital received 275 patients, of whom 63 were under 20 years of age, 157 between 20 and 40 years, 48 " 40 " 60 " 7 " 60 " 80 " 226 APPENDIX. The remarkable similarity in regard to the rela- tive proportion of those attacked at certain ages in 1832 and 1849, is shown in the following synopsis of the preceding tables. In 1832, 14 per cent, of those attacked were under 20 years of age, 58 per cent, were between 20 and 40 years, 22 " " " 40 " 60 " 4 " were over 60 years of age. In 1849, 15 percent, were under 20 years, 60 " . between 20 and 40 years, 21 " " 40 " 60 " 2 " were over 60 years. Thus it will be perceived, that the greatest number attacked were of persons between the ages of 20 and 40 years. "In proportion to the number of persons living at a certain age, probably a less number are attacked of those under 20 years, than during any other period of the same length. It would appear as if the aged were in some degree exempt from its influence ; but if we take into consideration the small proportion of persons in a city over 60 years of age, it will be seen that their liability to Cholera is quite as great as that of those under 20. To illustrate the comparative mortality of certain ages I have pre- pared the following tables by combining the hospital reports of 1832 and 1849. AN ESSAY OF EPIDEMIC CHOLERA. 227 Under 10 years 58 31 27 46 Between 10 and 20 years . 122 79 43 35 20 " 40 " 788 367 421 53 40 " 60 " 194 72 122 63 Over 60 years 27 11 16 69 The mortality increases from youth to old age, as shown by the per-centage in this tahle. The consideration of the influence of the habits and manner of living which predispose to this com- plaint, is important as guiding us to a knowledge of the true means of prevention. Not being wholly arrested in its progress by non-intercourse with af- fected localities, nor often held in check by quaran- tine regulations, it is evident that the security, either of individuals, or of masses of men, is only to be at- tained by removing from themselves, as far as possi- ble, every cause which may be liable to act as a pre- disponent. Any thing which tends to diminish the general tone of the system, acts as a predisposing cause ; irregularity of living, or dissipation of any kind, long watching with the sick, exposure to night air, and anxiety of mind, are all unfavorable. Of all occupations, that of a physician during the preva- lence of an epidemic of Cholera, pre-eminently dis- poses to an attack ; liable to be called upon at all hours of the day to visit the sick, not unfrequently 228 APPENDIX. in crowded and ill-ventilated apartments, compelled to undergo fatigue and loss of sleep, and to take his meals at irregular hours, it is not surprising that many of this profession are numbered among its vic- tims. Nurses and those who attend upon the sick are of course exposed in some degree, not so much in consequence of the infectious character of the disease, as owing to the fact that such persons are liable to be deprived of proper rest and pure air. When several persons occupy one room not very well venti- lated, as is too frequently the case in large cities, they are very much exposed during an epidemic, par- ticularly if the situation be low and damp. I have remarked that the dissipated were frequent subjects. This is the case ; but of all vices none predisposes in so great a degree as intemperance : this has been remarked by almost every writer upon Cholera. Of 1615 cases received into Cholera hospitals in the epidemic of 1832, 1023 were decidedly intemperate, a proportion of nearly two-thirds : of the remainder, 482 were intemperate : and of 110 cases, it was not known whether they were intemperate or not ; it is probable that a proportion were. Both in the epi- demic of 1832 and in that of 1849, the Cholera in New- York first appeared and was more fatal in the locality known as the " Five Points ;" a fact which illustjates what has been previously said of its pre- disposing causes ; this place possessing in itself all the elements best fitted for its reception, being low and damp, and the inhabitants filthy in the last de- AN ESSAY ON EPIDEMIC CHOLERA. 229 gree. Among the occasional causes, we may enume- rate the eating of indigestible food, exposure to great fatigue, and a depressed state of the mind. For the purpose of description, we may divide Cholera into three stages or periods. The first stage I shall call choleroid, it may be also called the inci- pient stage. The second is the period of full devel- opment, and the third the stage of collapse ; should the patient survive this stage, we will have the period of reaction. Either of these stages, choleroid, full development, or collapse, may occur without being preceded or succeeded by either of the others. This remark is more strictly true as applied to the first two periods ; though numerous cases of collapse have occurred, without having been preceded by any pre- cursory symptoms sufficient to excite apprehension either in physician or patient. The term cholerine is usually applied to the diarrhoea which prevails during the presence of an epidemic of Cholera, and which is properly the first stage of the disease. I have employed the term choleroid as designating the first stage, for the purpose of including a class of ca- 'ses in which no diarrhoea exists. I shall define cho- leroid to be the occurrence of one or more of any of the symptoms of Cholera in an individual, only not sufficiently numerous or severe to justify us in con- sidering it as a case of fully developed Cholera. The diarrhoea which prevails during an epidemic of this disease, does not differ in its character from the di- arrhea which prevails at other times when no Cholera 11 230 APPENDIX. exists. The evacuations may consist of ordinary faecal matter, or they may be large and watery ; they are scarcely attended with pain or uncomfortable sen- sation to the patient : this I consider to be the most distinctive character of the diarrhoea preceding Cho- lera. During the epidemic of 1849, instances occur- red, in which persons would be affected with some very curious symptoms, apparently in consequence of the presence of the Cholera poison. These persons were affected by some among the more peculiar symp- toms of Cholera. These cases are, I am satisfied, to be ranked with the diarrhoea, which we have been considering as effects of the Cholera poison, so modi- fied by circumstances at not to produce its full effect. It was not unusual for persons to be troubled with slight spasms of the gastrocnemii, or of other volun- tary muscles ; these taking place in persons who were not ordinarily subject to them. But the more interesting cases, were those in which I observed symptoms of a more advanced period of the disease : thus a large number of persons had cold tongues, im- parting a sensation to the touch like that of a frog's belly : and in one instance I observed the tongue to be not only cold, but of a bluish-black color, appear- ing as if it had been covered with ink. In my own person, I experienced some symptoms of a similar character to the above, which occurred several times during the continuance of the epidemic in New- York ; and it may be as well to state, that I have never ex- perienced them at any other time. The symptom AN ESSAY ON EPIDEMIC CHOLERA. 231 most marked in my own case, was a blue color of the last phalynx of the fingers. The blue color was very decided, not unlike that of indigo. It was accompa- nied by some degree of corrugation, the appearance being precisely similar to that observed in collapse; it was generally attended with vertigo, which is not an unfrequent symptom in Cholera. These symp- toms would last some minutes. I observed similar phenomena in other persons, only in less degree. The duration of the choleric stage may be only a few hours, or it may be several days. It is in this stage, that the disease has by all physicians been found most amenable to treatment, but owing to the salu- tary effect attributed to evacuations ; under all pos- sible circumstances, by the ignorant, this period ia frequently altogether neglected, and the disease al- lowed to become fully developed before active means for relief are resorted to. In the fully developed stage, the evacuations be- come large and colorless, or whitish and contain albu- minous particles ; they resemble water in which rice has been boiled, with particles of rice floating or set- tling in it. The patient ejects matters from the stomach of a similar character to those dejected. The matters vomited are ejected suddenly, generally with- out retching or nausea, and are frequently expelled with such force as to carry them to the distance of several yards. The evacuations frequently amount in quantity to several gallons, though the quantity does not have any relation to the severity of the attack. 232 APPENDIX. I remember one case, which I saw in 1849, in which the patient was in collapse in three hours after the first symptoms were observed, and in which the pa- tient died in about seven hours ; the whole of the matters expelled from the stomach and bowels not exceeding three pints, and of a light brown color. Spasms of the voluntary muscles occur in this stage, which affect the abdominal muscles, the calves of the legs, the thighs, and frequently the muscles of the upper extremities and chest. Occasionally all the voluntary muscles will be affected. The pulse during this stage is generally less frequent than in health ; it is not unusual to find it no more than 50 or 60 beats in a minute. The pulse does not vary much from its natural fulness until the disease is considera- bly advanced. The symptoms of this period may continue from one to twelve hours. When the disease is about to terminate favorably, the spasms disappear, the vomiting ceases, the dejections become tinged with bile, and perhaps acquire some consistence, or they stop entirely ; in which event the patient may have no evacuations during the period of convales- cence, which maybe twenty-four or forty-eight hours. In some instances, the patients may have copious evacuations from the alimentary canal, without spasms ; these are called the Diarrhcuic cases. We have also the Gastric variety, when vomiting is the prominent symptom ; also the Spasmodic cases, in which there may be no evacuations of any kind only cramps. These designations are recognized by some authors, AN ESSAY ON EPIDEMIC CHOLERA. 233 and are convenient in description ; all agreeing in one particular, in their tendency to collapse, if not soon relieved by appropriate medical treatment. There is a class of cases which have been included in the designation Cholera sicca dry Cholera: these are the instances in which we have the symptoms of col- lapse, without its having been preceded by any eva- cuation or other precursory symptom. Collapse signifies an almost total suspension of the powers of organic life, not necessarily attended with loss of consciousness or impairment of the mental powers. It is the opposite condition to coma, in which all the functions of organic life are carried on, while the functions of animal life are totally sus- pended ; we have a total suspension of the functions of the two principal secretory organs of the animal system, viz : the liver and the kidneys, two of the characteristic symptoms being an entire absence of bile in the evacuations, and a total suppression of urine, so that the patient will not pass the smallest quantity during the period of collapse. The other secretions are diminished, if not altogether suspend- ed ; thus though there may be the greatest suffering from spasms of the voluntary muscles, or from a sen- sation of internal heat, and from an insatiable thirst, the patient will not shed tears. There is an appa- rent exception to the absence of secretions, in the discharges from the alimentary canal ; but even this" is suspended in extreme collapse. The functions of respiration and circulation, though not entirely sus- 234 APPENDIX. pended, are nevertheless carried on in an extremely imperfect manner ; the principal objects of these func- tions, viz : the oxygenation of the blood and the main- tenance of a uniform temperature, being but par- tially accomplished ; as is shown by the blue color of the surface, by the coldness of air expired from the lungs, and by the general coldness of the body. We must, however, consider that the mechanical portion of these functions is carried on more perfectly than the vital or chemical. These functions are not whol- ly subservient to the direction of the forces of orga- nic life, but the function of respiration at least, is to a considerable extent under the direction of the will. While the functions of organic life are affected in so remarkable a degree, we have those of animal life re- maining almost entire. The sentient faculties remain in many cases almost until respiration ceases ; the patient can feel, see, hear, smell or taste, nearly to the last. The voice, being a function connected with respiration, is weak and sometimes scarcely audible, partly in consequence I presume of the diminished quantity of air taken into and expired from the lungs. The muscular system remains in great measure unim- paired, the patient being capable of performing many acts of voluntary motion. In complete collapse, as seen in some cases of Asiatic Cholera, the features are pinched and the eyes appear sunken ; the skin is of a bluish color, the whole surface being covered with a cold clammy sweat, imparting a sensation of icey coldness to the AN ESSAY ON EPIDEMIC CHOLERA. 235 touch, the hands are corrugated, appearing as though they had been soaked in water for some time ; hence this appearance has been called the "ivasher woman's hands:" the voice is peculiar, so that it has been known as the " Vox Cholerica ;" it becomes husky and faint ; the breath is cold. The pulse is general- ly frequent, small and quick, sometimes intermittent and irregular. In many cases the pulse remains imperceptible for several hours, in other instances where it is not totally imperceptible, the sensation which it imparts to the touch may be compared to that which would be produced if the finger were placed upon one point of an exceedingly fine wire, tightly drawn between two fixed points, while some- thing were drawn quickly across another point of the wire, producing minute vibrations. This I think illustrates the pulse of collapse, as nearly as possi- ble. The evacuations from the stomach and bowels be- come less and less frequent, as the symptoms of this stage appear, and in most cases cease entirely a few hours before death, in which in a majority of cases, collapse terminates. The spasms frequently continue after collapse has appeared, though they very generally cease a short time previous to death. The secretion of urine, which becomes diminished in the stage of full development, is entirely suppressed in collapse, and in post-mortem examinations the bladder is uni- formly found empty. In this stage an insatiable thirst in many cases torments the patients, they 236 APPENDIX. taking drink frequently, but in small quantities ; and while the external surface is cold to the touch, the patient complains of an internal burning. Among the characteristic symptoms of Cholera, is to be enu- merated the stoical indifference which the patient manifests in regard to the final result of the disease. This apathy exists during the first stage, and increa- ses with the progress of the malady. The period of collapse lasts from two to twelve hours, and it may terminate in death, or be succeeded by reaction. Among the symptoms .from which we may infer that reaction is about being established there are : a return of the natural warmth to the surface, and the pulse reappearing and becoming full and regular. A very important symptom is the re- turn of the secretion of urine. The breath, which before was cold, becomes warm, and in fact all the symptoms which constitute collapse disappear. It frequently happens that reaction does not stop until some degree of febrile action is set up ; and here again we have another period of danger, arising from excessive reaction. In this period, the patient may have inflammation or congestion of any of the important organs of life, or again, it may be followed by continued fever. The most frequent inflammations are dysentery and inflammation of the brain. In the foregoing description of Cholera, I have spoken of it as though it consisted of three clearly defined stages or periods : in a number of cases we find the disease running its course with as much AM iiSSAY ON KP.DEMIC CHGLKRA 237 regularity as the previous description would imply, but in a larger proportion of the cases which occur, this is not true, the symptoms described as belonging to the several periods being combined in every va- riety. Thus it can be said that no two cases are precisely similar. The results of post-mortem examinations have thrown little light upon the nature of this disease ; as but few of the lesions observed were constant. The only appearances which were constantly observed in autopsies of Cholera patients, were more or less of the rice-water and ricey matters in the alimentary canal, similar in appearance to that which had pre- viously been ejected, and a thick black substance re- sembling in appearance tar, filling the veins, and the bladder was uniformly found empty and contracted. Spasmodic movements of the limbs have been ob- served to take place after respiration had ceased. Instances of this kind are probably of not very fre- quent occurrence, as very little mention is made of them in works upon Cholera. My own attention was drawn to the fact by the following .case which occurred in New- York on the 29th of May. 1849, about fifteen days after the first appearance of the epidemic in the city. The patient was the wife of a respectable me- chanic, and was of perfectly temperate habits ; age 40 years. She was attacked about ten, P. M., May 28th, having previously partaken of radishes for her supper that evening, which seemed to have been the occasional cause of her sickness. Symptoms : rice- 11* water evacuations per anum ; vomiting of a serous and slightly milky liquid, with pieces of radish, cramps in extremities, chiefly in calves and thighs. Tongue cold ; urine suppressed ; eyes upturned and fixed a part of the time ; tongue covered with whitish coat, which afterwards became yellowish. The pulse was feeble, and became insensible two hours before death. Breath cold ; feet, face and hands cold and moist, except palms, which retain some heat. Epi- gastrium swollen, painful and sensitive. Died about eleven and a half, A. M., 29th inst. After respira- tion had ceased half an hour, spasmodic movements occurred in her right arm ; her fore-arm became flexed upon her arm ; flexion of the fingers also took place. These motions were repeated a number of times, leading the friends to suppose that life was not extinct, and causing them to send for medical as- sistance. Another curious phenomenon, is the return of warmth to the surface, and its continuance for a considerable time after respiration has ceased. The temperature of the corpse, which previously to death was externally cold, becomes, in many cases after respiration has ceased, so warm as to impart to the touch a sensation of heat. APPENDIX II. HOMOEOPATHIC CHOLERA HOSPITAL. As the Cholera has now reappeared in New- York and many other places, the republication of certain remarks, made on the above subject in 1849, is deemed seasonable and proper. As a majority of the medical profession retain the same prejudices, the friends of humanity and justice, here and elsewhere, will be again liable to encounter similar obstacles, in carrying out their plans for the relief of the poor, who are especi- ally liable to become victims of this pestilence. The great success of the homoeopathic treatment in the cholera of 1849, by attenuated medicines, is now extensively known. When the epidemic had disappeared, the Board of Health of the city of New- York, through its Sanatary Committee, made a Re- port in which reasons were assigned for refusing to establish a homoeopathic cholera hospital, for which a petition had been presented by hundreds of our re- spectable citizens. Some of the reasons were assigned by the Sanatary Committee, others by their Medical Counsel, com- posed of several physicians of high rank. The parts 240 APPENDIX. referred to in the letter, are quot<*l in the words of the authors. It will be seen that (to use the language of a dis- tinguished writer) '' though the Board, even while thus deciding, profess not to be competent to decide, they seem to consider themselves competent to sneer." The Medical Counsel, in their report to the Sana- tary Committee, say, that " By intelligent and well-educated physicians ge- nerally, Homoeopathy is looked upon as a species of empiricism. It is neither practised by them, nor countenanced by them. Concurring entirely with their professional brethren on this subject, the under- signed conceive that the public authorities of our city would not consult either their own dignity or the public good, by lending the sanction of their name or influence to Homoeopathy or any other irregular mode of practice." The Committee say, that " In adopting this report, the Sanatary Committee do not wish to be considered as expressing any opinion either in favor or against what is commonly denomi- nated Homoeopathy. This they viewed as a subject entirely beyond their province." After some other remarks, they end by saying, " Taking this view of the subject, the committee felt it to be their duty to have nothing to do with medicine, except as they found it embodied in what is understood and known both by the public, as well as physicians, as the regular profession. While in HOMOEOPATHIC CHOLERA HOSPITAL. 241 this way they paid all suitable respect to so honor- able a profession as that of medicine, the committee felt that they did no injustice to those who suppose themselves in advance of the age, and profess them- selves gifted with superior knowledge and wisdom." LETTER To the Sanatary Committee of the Board of Health of the City of New- York : GENTLEMEN : In the report of your proceedings recently published, you assign reasons for not es- tablishing a Homoeopathic Cholera Hospital. Not- withstanding the equivocal compliment which you bestow on the homceopathists, as " those who sup- pose themselves in advance of the age, and profess themselves gifted with superior knowledge and wis- dom," I shall assume that you intended "no injus- tice" toward either of the two great medical parties into which the community, as well as the regular pro- fession, is divided. The regular medical profession includes all those who have pursued the course of medical studies pre- scribed by the laws of the State, and complied with all the professional requirements of the medical col- leges and medical societies which the State has esta- blished. The diplomas held by the homoeopathic physicians of New-York, afford proof that they have passed these ordeals. 242 APPENUiX. As such are the only tests of professional re- gularity recognised under this or any civilized go- vernment, I cannot presume that you " suppose" yourselves so far " in advance of the age, and pro- fess" yourselves " gifted with" such " superior know- ledge and wisdom" as to impose, intentionally, a new test not recognised by those laws from which you derive all your authority. How is it, then, that you refused to place one of the cholera hospitals under the care of regular homoeopathic physicians, on the ground that " the committee felt it to be their duty to have nothing to do with medicine, except as they found it embodied in what is understood and known, both by the public as well as physicians, as the re- gular profession ?" Is it possible that you were de- ceived by a mere name, which some physicians have assumed for themselves, and persuaded their friends to appropriate to them ? Regularity, in its proper sense, is an excellent thing : so are Catholicism and democracy : but I doubt whether you have all re- solved to have nothing to do with religion, except as you find it embodied in the Catholic church, or with politics, except as you find it embodied in the demo- cratic party. You must mean, either that the homoeopathic phy- sicians constitute no part of the regular profession, or else that they constitute only a minority. The first position I have shown to be untenable. In con- sidering the second, I assume that minorities have rights, on which no agents of government can properly HOMCEOPATHIC CHOLERA HOSPITAL. 243 trample. During a pestilence, the homoeopathic citi- zens of New-York can justly claim, that a due pro- portion of what they have contributed to the funds of the city, be appropriated to the use of a homoeo- pathic hospital. They have a right to dictate what provision shall be made for the treatment of the in- digent and stranger of their own medical faith, so far as this can be conceded without infringing the rights of others. In regard to this last point, you were not requested to refrain from establishing as many alloeo- pathic hospitals as you deemed expedient, nor to compel any patient to enter the homoeopathic. The statement of the main objection which your medical counsel urged against Homoeopathy may be ambiguous ; but it is susceptible of only two con- structions : one is that " it is neither practised" "nor countenanced by' ; a majority of " intelligent and well- educated physicians." This proves no more than the equally notorious fact, that it is neither practised nor countenanced by the majority of stupid and unedu- cated physicians. Alloeopathy has more great men and more small ones ; for the same reason that white sheep have more wool than black ones. The only other meaning of which the statement of the " counsel", is susceptible, is, that Homoeopathy " is neither practised" " nor countenanced by" any intelligent and well-educated physicians. Is this the assertion of the medical counsel, a majority (i. e. two) of whose members are medical professors, who are annually recommending homoeopathic medical 244 APPENDIX. students as qualified to receive the degree of doctor of medicine ? From these and similar allosopathic professors, the homoeopathic physicians now practis- ing have received their credentials. When a pro- fessor affirms that his own certificate is false, to which of his statements shall we give credence ? The case reminds us of the problem which exercised the sophists. When a man says, I lie, does he lie or does he speak the truth? Neither the committee nor their counsel have at- tempted to refute the statistics hy which the petition was sustained, nor to deny that Homooeopathy af- fords the best method of curing the sick, however much the "public authorities" might, by rejecting it, "consult their own dignity," and thus, indirectly, "the public good." Of their objections, I am not able to perceive any which are not substantially in- cluded in those which I have answered. If there is an appearance of mystification or muddiness in the whole train of their reasoning, I have too much re- spect for them to attribute it to anything else than the unavoidable difficulties attending the defence of a weak cause. B. F. JOSLIN, M.D. NEW- YORK, Nov. 17, 1849. INDEX. A. Page Acute cholera, cases of 170 its symptoms and treatment 120 ^Etiology, especially with reference to the predisposing or occa- sional causes of cholera 30 Ages, relative liability to an attack at different 223 mortality at different 226 Alcohol, predisposes to cholera 38 Animal food, during the epidemic 40 Ancient and modern epidemic cholera identical 216 Appendix 1 215 II 239 Atmospheric heat, a cause of cholera 32 Attenuated Camphor useful 107, 124, 148, 157, 160, 180 Auxiliary cholera repertory 199 . B. Bathing, its uses and abuses 36 Becoming chilled by cold air, or bathing 35 Blood in asphyxia, original observations and experiments on, 24, 28 its color and composition in cholera 18 Blueness of the skin, in choleroid 141, 180 .. .. remedies for, in cholera 195 Board of Health in 1849. . 78, 240 246 INDEX. c. Page Camphor, effects of high potencies of 107 how to be used for children 125 rules for its administration 103 size and repetition of the dose of 103 Case of acute choleroid in 1854, with its treatment 180 dry cholera, with its treatment 168 febrile cholera, with its treatment 179 gastro-enteric cholera, with its treatment 176 Cases in New-York in 1854 153 of acute cholera, with their treatment 170 of choleroid disease, with their treatment 138 of diarrhoeic cholera, with their treatment 144 of dysenteric cholera, with their treatment 176 of gastric cholera, with their treatment 160 of spasmodic cholera, with their treatment 162 Causes of cholera 30 of cholera recapitulated 49 Characteristic of cholera 13 Cholera infantum, remedies for 212 in 1832, history of treatment of 70 1849, cases and their treatment 144 -- history of treatment of 76 1854, cases and their treatment 153 in Honduras 97 Cholerine 100 Choleroid, cases of 188 Choleroid, what it is 137 Circular issued by homoeopathic physicians 87 Cleanliness, neglect of 45 Cold bathing, reason why under some circumstances, it is a pre- disposing cause 35 Collapse, its treatment 1 30 Composition and consistence of the faces 207 Contagion and poison quantitatively considered 51, 55 INDEX. 247 Page Contagion of cholera 50, 220 Contagiousness of cholera, how destroyed by dilution 53 Contents, table of 3 Cramps in Cholera, how treated 118 Crowded or insufficiently ventilated rooms 44 D. Dark color of the blood in cholera 18 Depressing passions, how they render the system more liable to cholera 38 Diarrhoeic cholera, symptoms and treatment 113 Dilution, its influence on infection 53 Dysentery, remedies for 213 Domestic and professional treatment of cholera at its onset in any form 102 and professional treatment of premonitory symptoms. . 100 Dose of cholera, is one of the elements in the problem of its in- fectiousness 55 Doses of medicine, repetition of 103, 110 Dry cholera, how distinguished 119 how treated 120 Dysenteric cholera, its symptoms 123 its treatment 125 E. Early history of cholera 215 treatment of cholera 100 Epidemic and sporadic, remarks on the terms 135 cholera and cholera morbus, not identical 13, 215 Errors that prevail in regard to contagion 50 Essential cause of cholera, imperceptible except by its effects. . 30 its effects before and after an epidemic 31 Etiology of cholera 30 Exercise, when violent, is a predisposing cause 38 Explanation of the auxiliary cholera repertory 199 of the cholera repertory 181 248 INDEX. F. Page Fatigue, a predisposing cause of cholera ". 38 Fasting during the epidemic 38 Febrile cholera, its symptoms ' 126 its treatment 126 Food, the kinds of, forbidden.' 61, 63 Forms in which cholera appears 109 G. Gastric cholera, its symptoms and treatment 116 G astro-enteric cholera, its symptoms 122 its treatment 123 General average of the results of homoeopathic treatment in cholera , 94 Generalization of the causes of cholera 30 Groups of diarrhoeic symptoms in cholera, with their remedies. . 190 of symptoms in diarrhoea with their remedies 210 H. Head symptoms in cholera, remedies for 184 Health, how to preserve 61 Heat, effect of. 32 High potencies of camphor, effects of 107 temperature, effects of 32 History of homoeopathic and allopathic treatment of cholera. . . 67 Homoeopathy in cholera, proofs of its relative success 67 Honduras, cholera in 97 Hospital, homoeopathic for cholera patients 84, 240 Hygiene 61 Hygienic rules ; . . . . 62 I. Indefiniteness of the usual statement of the problem of the infectiousness of cholera 52 Indigestion, a cause of cholera 43 Infection, the true doctrine of 50 INDEX. 249 Page Influence of degrees of dilution of the poison 53 Intestinal symptoms in cholera, repertory for 189 with or without cholera, repertory for 206 L. Law of cure 109 M. Management of a cholera patient, rules for the 108 Mental symptoms, in cholera, remedies for 183 N. Nature of cholera 13 Neglect of personal cleanliness 45 Night, one reason why it is a predisposing cause 37 0. Occasional causes of cholera 32 Oppression of the digestive organs 43 Over-eating an occasional cause 43 P. Passions, predispose to cholera 38 Pathology of cholera 18 Per centage of deaths in New- York, remarks on 83 of deaths under homoeopathy and allopathy in 1832 70 1849 76 Physiology of respiration 16 Poisons are such by dose, not in essence 55 Popular and medical errors in regard to infection or contagion . 50 Powders, plain directions as to the best mode of taking them. . 102 Predisposing causes of cholera 32 Prevention of cholera, by what medicines 65 by what regimen 62 Preventive medicines, what, and how to be used 65 Progress of cholera epidemics 60 Proportion of, of cases, cured in 1832 70 1849 . .76 250 INDEX. Q. Page Quarantine, the effect of 60 R. Remedies for cholera infantum 212 Remedies for cholera with affections of the abdomen 189 chest 193 eyes 184 face 185 head 184 limbs 194 mind 183 pulse 197 skin 195 tongue 186 urine 192 voice 193 Remedies for cholera with cramps 194, 198 thirst and nausea 187 diarrhoea 190 nausea and thirst 187 pains in the stomach 188 perspiration 197 spasms 194, 198 vomiting. . . . '. 187 Remedies for diarrhoea from certain causes 208 with or without cholera 206 other symptoms 210 stools of certain colors 206 stools of certain odor 207 for dysentery 213 stomach pains 204 vomiting according to its causes 202 character 200 to the symptoms which ac- company it 203 for vomiting, with or without cholera 200 INDEX. 251 Page Repertories, explanation of the mode of using 181 Repertory for cholera especially 181 for vomiting and diarrhoea, with or without cholera. . 199 Repetition of doses 103, 110 Respiration, physiology of 16 applied to the pathology of cholera 18 Results of homoeopathic treatment, summary of 94 Rooms for cholera patients, how to select and use 54 Rules for the preservation of health during the epidemic 62 S. Stages of cholera 128 Statistics of cholera, homoeopathic and allopathic 67 Spasmodic cholera, how treated 118 Susceptibility, cateris paribus, determines whether the disease shall be taken 58 Symptoms and treatment of the usual varieties of cholera 113 T. Tables illustrating the relative mortality at different ages 227 number of attacks at different ages 224 Table of contents 3 Treatment, during collapse 130 during convalescence from cholera 134 of acute cholera 121 of affections succeeding reaction from cholera 131 of cholera by families at its commencement 102 in the forming or choleroid stage 100 when fully developed 102, 129 when it begins to be developed 102 with dysentery 125 with vomiting and purging 123, 187, 190 of diarrhoeic cholera 115, 190 of dry cholera 120 of febrile cholera.. .126 52 INDEX. f i'age Treatment of gastric cholera 1 17, 187 of premonitory symptoms 100 of spasmodic cholera 118, 194, 198 of the different varieties of cholera 113 of vomiting in cholera 117, 187 V. Varieties of cholera, their symptoms and treatment 113 Ventilation, the want of, operates in two ways 44 Vomiting and purging in cholera, how treated 123, 187, 190 in cholera, how treated 117 remedies for the different kinds of, in cholera 187 in general 200 Date Due Jill