UNIVERSITY OF CALIFORNIA
ANDREW
SMITH
HALLIDIL:
REGENT
THE
HOMCSOPATHIC
THEORY AND PRACTICE
MEDICINE.
BY E. E. MAKCY, M.D.
Second Edition.
NEW-YORK:
WILLIAM RADDE, 322 BROADWAY
C. L. BADEMACHEB & SHEEK, 239 ARCH-STREET, PHILADELPHIA;
OTIS CLAFP, SCHOOL-STREET, BOSTON ;
J. G. WESSELHffiFT, 91 MARKET STREET, ST. LOUIS.
1852.
BIOLOGY
LIBRARY
ENTERED, according to Act of Congress, in the year 1852, by
WILLIAM RADDE,
In the Clerk's Office of the District Court for the Southern District of New-York
Angel), Engel & Hewitt,
Printers,
No. ISpruce-st,, N. Y.
PREFACE.
THE profession of the art and science of renewing and preserving
health has, in all periods and in all nations, been held to be of the
highest dignity, for the devotion and bravery necessary in those
who adopt it, as well as for its association, as ameliorator, with
almost every form of human suffering. In its widest and justest
acceptation, it may be said to be the sum of logic, since nearly all
knowledge, in metaphysics as well as in physics, is necessary to
the thorough understanding and the illustration of its various prin
ciples and phenomena.
In an age preeminently distinguished for intellectual as well as
for physical activity, the theories of disease and cure have shared
the general advancement, and the new doctrines that have obtained,
for their elucidation and practical application, demand a new lite
rature. Since the discoveries of the Newton of Medicine, old trea
tises, founded upon erroneous and soon to be obsolete hypotheses,
are, for the most part, comparatively valueless, except for purposes
of history. Everything is to be reconstructed. Much has indeed
been done in Europe and in this country, since the announcement
of the true laws of cure, yet so little in proportion to the neces
sity, that no apology will be required for this attempt to occupy
one of the chief places of dethroned but still unsilenced Error.
At the beginning of a system of Theory and Practice, produced
under such circumstances, and for such purposes, it is appropriate
to disclose briefly its leading characteristics, and especially the
positions it occupies in relation to points which may be considered
still unsettled and debateable. The grand proposition, similia
similibus curantur, is not only the basis of the homoeopathic me
thod, but is also, we believe, the hitherto unknown law of the most
successful treatment by the allopathists. Whether we advocate
the use of high or low attenuations, or believe in the topical and
material, or the dynamical and immaterial action of drugs, are
1 07338
v PREFACE.
matters of proportionably little importance, while we abide by this
fundamental doctrine in the practical application of remedies. The
physician of the old school, who cures delirium tremens with a
large dose of opium, acts as strictly in accordance with the theory
of Hahnemann, as he who cures it with a high attenuation of the
same drug, but with this diiference — that the treatment of the
former is attended with danger, and the restoration is slow, tedious,
and defective, while the primary specific impression by the philo
sophical process is slight, and the curative reaction of the organism
speedy, complete, and permanent.
Although the question of doses is of considerable importance in
individual cases, yet too much stress has been laid upon it by the
advocates of both high and low attenuations. We are constantly
presented with well-authenticated cures by the undiluted tinctures
and low dilutions, and have also as thoroughly understood and
successfully practised the high attenuations. We occasionally
see, too, that strong preparations afford prompt relief where the
weaker have failed, and vice versa. Some constitutions may be
powerfully acted on by a thirtieth, while others will not respond to
any weaker than a first dilution. The different conditions of the
tissues likewise offer the most varied and important modifications
with reference to the effects of agents. How absurd, then, to fix
upon this or that attenuation, and to make use of the term high or
low dilutionist, when we have to deal with organisms of every
possible grade of delicacy and susceptibility, and with morbid con
ditions which, in some instances, may be modified by even a men
tal emotion, and in others only by the strongest tinctures.
We say, therefore, to the true homoROpathist, let the grand max
im of HAHNEMANN, similia similibus curantur, be our prime and
constant rule of medical faith and practice ; but never attempt to
confine our doses within the narrow limits of the ultraists of either
party, for the unanswerable reason, that the susceptibilities of the
tissues to medicinal impressions vary in precise accordance with
the degrees of inflammation and nervous erethism. From a con
dition of health, or a slight irritation of the textures, up to a high
point of inflammatory action, or nervous excitability, there are
almost innumerable gradations of impressibility ; and he who would
prescribe wisely and successfully, must select his attenuations, and
order his repetitions with strict regard to these degrees. Of this
subject we have treated at some length in chapter VII.
In our observations on general pathology and therapeutics, we
have endeavoured to explain what we believe to be the true nature
of inflammation, and have pointed out some of the more general
means of avoiding and counteracting the causes of inflammatory
PREFACE. V
action. In forming many of our inferences, we have been indebted
to the recent labours of Liebig, Miiller, Matteucci, Flourens, Ma-
jendie, and Philip. Although the views advanced have no material
bearing upon the homoeopathic doctrine of cure, yet if they illus
trate this most important of the subjects connected with the mor
bid conditions of the economy, we shall have done well for medical
science. We are aware that Liebig has carried some of his che
mical hypotheses farther than facts or logic warrant, but admit
that many of his positions, as to the production of animal heat, the
metamorphoses of the tissues, the supply and waste of the con
stituents of the structures, and the phenomena of inflammation,
are in the main correct. If he errs in supposing that all the phe
nomena of life are attributable to chemical action, that the human
body is subject to the same laws as inert matter, and that the mass
of blood may be contaminated by contact with substances in de
composition with a similar kind of degeneration, he has also
shown truly that chemical action has at least an important influence
in the operations of the functions. Let not, therefore, his mistakes
prevent a rigid scrutiny of his opinions, that we may reject the
untenable, and appropriate the true.
Believing and advocating the doctrine of absorption and the
topical action of drugs, we have derived numerous arguments
for our views from the recent experiments of Matteucci, Flou
rens, Rau, Miiller, Blake, and Majendie. These profound in
vestigators have demonstrated that most medicinal substances pos
sess well defined specific properties, and that it is necessary to
their legitimate effects, that they be absorbed and conveyed by the
blood — as a medium merely — to the tissues for which they have
affinity, there to operate (probably upon the sentient nerves), by
actual contact. The very numerous and accurate experiments with
almost every known drug, instituted by these physiologists upon
animals, are quite conclusive as to the point of the absorption and
topical action of remedies. We have repeated many of their ex
periments, and have made a great variety of new ones for the
therapeutical illustration of the subject, and have thus formed from
facts alone, the conclusions we have here announced, as to the man
ner in which remedial agents operate. The scope and design of
this treatise will not permit a detail of these interesting experi
ments and their results, but we hope hereafter to submit them to
the public. In the meanwhile, attention is" invited to the chapter
in which we have treated of this subject.
There is another doctrine now entertained by a majority of the
physicians of both schools, but in no way connected with our
theory of cure, to which we have devoted special attention ; we
VI PREFACE.
mean that so often advanced respecting what are called " vital
properties " of parts — a nervous fluid — a dynamic influence, differ
ent from the soul. We object to these terms because they are
merely arbitrary, and are used to designate properties which have
no real existence ; because, as Matteucci well observes, they may
have no meaning, or may mean everything. The vitalists define
disease to consist in an alteration of the vital properties of parts.
But what are these vital properties 1 Are they material or spiritual ?
something or nothing 1 What is the nature and what are the pro
cesses of their influence 1 We are told that miasmata act dynamical
ly or spiritually upon the vital properties of the tissues ; but what are
miasmata but minute particles of vegetable matter, subdivided by
heat and moisture, and so diffused in imponderable forms through
the air 1 Have these atoms really lost their material form or
weight, and become annihilated ? Can a material substance, by any
means, be reduced into an immaterial nothing, and retain its iden
tity or individuality 1 In other words, can matter be transformed
into spirit ? Surely, no ; but we may subdivide substances so
minutely as not to be able, by our most delicate tests, to detect
them ; yet they may have affinities, and be capable of combina
tions with other atoms, and of producing other material effects
when brought into contact with certain tissues of the organism.
When these material 4not dynamic or spiritual) particles have
reached the structures to which they have specific relations, they
impress the sentient extremities of the nerves, so that the capil
laries and other parts over which these nerves preside, respond to
their impression, and there are chills, followed by inflammations.
It is evident, then, in this and other analogous instances, that a
material agent operates topically upon the tissues, thus impairing
the normal integrity of the parts, but not dynamically upon certain
(assumed) vital properties.
The general principles of allopathy we have briefly considered
and compared with those of homoeopathy ; but want of space has
prevented such elaborate discussion of these subjects as was de
manded by their interest and importance. We trust, however,
that what we have written may attract attention, particularly to
the real points at issue between the schools, and that the shafts of
our antagonists may hereafter be directed against our distinctive
principle of cure, rather than against our doses, and the exhibition
of our remedies.
Hahnemann, and some other writers of eminence, have ex
pressed doubts respecting the utility of the common classifications
of diseases, since descriptions must necessarily be general and
imperfect. In a therapeutical point of view, this distrust of clas-
PREFACE. Vll
sifications is reasonable, and it has probably arisen from the custom
with the old school, of bringing the symptoms of every disease
under some one general head, and prescribing for the congeries,
however diverse the separate elements, under a particular name.
For example, the allopathist called to a patient with febrile symp
toms, finds a rapid pulse, a hot and dry skin, headache, pains in
the back and loins, oppression at the praecordia, restlessness and
irritabilility, foul tongue, thirst, scanty and high-coloured urine,
confusion of ideas, and nightly delirium. He is now to arrange
these symptoms under one of the general heads of his classification,
but is at a loss whether to call it typhus, bilious, or inflammatory,
sthenic or asthenic. The case, however, admits of no delay, and
he arbitrarily decides that it is bilious, and bleeds, vomits, and
purges, well knowing that if it proves a typhus, he can persuade
himself and the patient's friends that it has degenerated from one
type into another. He forgets to make known that copious vene
section, emetics, and cathartics, are deemed by many of the most
intelligent of his own school, to be fatal in typhus, and attributes
all evils to the versatile and intractable nature of the malady, while
complacently appropriating to himself whatever credit may chance
to accrue from favourable symptoms. On the other hand, if he
had regarded the disease as a typhus, and pursued the expectant
or tonic treatment sanctioned in his school, and it had proved an
inflammatory fever, lesions might have taken place, and the pa
tient might have succumbed from the inefficiency of his remedies.
Objections of a similar nature apply in a majority of the classifi
cations treated by the allopathist. But while it is unquestionable
that all these are useless as guides in the application of remedies,
it must be conceded that they enable us to concentrate groups of
symptoms under appropriate heads, and thus to arrive more con
veniently at just conclusions respecting the nature of diseases.
Accordingly, in this treatise, we have adopted a classification
varying little from those usually employed, which we believe will
facilitate the true apprehension of disordered conditions. We
have described the diseases of the separate systems under the
same head, instead of treating of acute varieties in one part of the
work, and of chronic in another. This course has been deemed
proper on account of the difficulty, in many cases, of fixing the
line of demarcation between acute and chronic affections, and for
convenience of reference to, and of comparison of the different
diseases of the same system.
In arranging the symptoms which demand particular medicines,
we have adopted the following classification :
I. EXTERNAL INDICATIONS, or what have been designated by
Vlll PREFACE.
Marshall Hall as physical signs of disease. Under this head are
included all those signs which belong to the external or visible
appearance of the patient, and over which he has little or no con
trol, as the expression of countenance, colour and temperature of
the skin, pulsations of the heart and arteries, respiration, breath,
condition of the digestive and genito-urinary organs, attitude, ap
pearance of the eyes, and of the nose, lips, tongue, mouth, and
throat, the secretions, excretions, surface of the body, swellings,
(in relation to size, hardness, softness, elasticity, fluctuation, &c.,)
the condition of the muscles, (in relation to contractility, strength,
debility, and motion,) the voice, mode of expression, and appear
ance of discharges from the stomach, intestines, bladder, uterus,
vagina, nose, ears, eyes, mouth, and from abscesses, ulcers, &c.
These phenomena may always be observed without any descrip
tions by the patient or his friends, and, in many instances, without
the patient's consciousness ; and, as we have elsewhere shown,
they often indicate with much certainty the character of a malady.
In infants and children, and adults, who, from injury or disease,
become incapable of communicating their sufferings, they are of
the utmost importance, and will frequently be sufficient for our
direction in the exhibition of remedies.
II. PHYSICAL SENSATIONS, including most of those symptoms
which are commonly described as rational signs of disease. These
comprise pains of all descriptions, weaknesses, irritations, oppres
sions, obstructions, and all other uneasy or unnatural feelings,
and all circumstances connected with the approach, continuance,
aggravation, or remission of the patient's sufferings. For a know
ledge of them, we must rely for the most part upon verbal descrip
tions ; for the best method of procuring which, with truth and
exactness, we refer to Hahnemann's Organon, pages 125 to 133,
where our venerated teacher has pointed out with great minuteness
the necessary directions upon the whole subject of such investiga
tions.
III. MENTAL AND MORAL SYMPTOMS, including the condition of
the mental faculties, the disposition, temper, and all variations of
the intellectual and moral sentiments, from the normal standard.
This arrangement has been adopted with reference to convenience
in investigation, and in the selection of remedies. As some dis
eases are characterized by manifestations of one or more of the ex
ternal indications, and others by internal pains, or a perversion of
the mental and moral faculties, so different drugs develope corres
pondences in the organism. As it is an object that our remedies
should have as exact an affinity as possible to the symptoms, and
to these alone, the advantage of this classification of symptoms
vill be readily perceived.
PREFACE. IX
In descriptions of special symptoms created by different reme
dies, and presumed to indicate their therapeutical properties, we
have drawn freely from all reputable sources, whether European,
or American. In some instances, we have not hesitated to rely
upon drug-symptoms as described by accurate practitioners of the
other school, in cases of poisoning. Although little confidence can
be placed in their ordinary observations upon the diseased organ
ism in relation to this point, yet symptoms are occasionally re
corded during the operation of poisonous doses upon the healthy,
which could riot well be obtained in any other manner, and which
undoubtedly form an important addition to our knowledge of pure
drug-symptoms.
A difference of opinion exists in the philosophical school re
specting the most suitable form for the exhibition of remedies.
Some, entertaining a dread of medicinal aggravations, and be
lieving that the minutest quantity of an appropriate medicine is
sufficient to induce a curative reaction, employ, for the most part,
pellets that have been saturated with the drug. Others, having
less fear of these aggravations, and preferring to know with cer
tainty the precise quality and quantity of their doses, make use of
triturations, given dry, in small powders, and dilutions, either
mixed with pure water or dropped on sugar.
We have preferred powders and dilutions for the following
reasons :
I. A large number of medicinal substances evaporate so quickly,
that, after a time, many of their active particles must necessarily
escape.
II. Very small quantities of many drugs, when exposed a few
weeks to the action of the oxygen of the air, either become en
tirely neutralized, or so altered in their properties as to be no more
identical with the original drug. On this account, it is better to
impregnate larger quantities of the medium that less surface may
be exposed to the air, and thus to render it certain that a portion
of it retains particles of the drug unimpaired.
III. The importance of using our medicines in a form that shall
be certain to produce the requisite impressions upon the disordered
structures. We deem it an evil of much less magnitude to risk
the occasional induction of some temporary medicinal symptoms, —
thus being sure that the remedy has reached the affected tissue, —
than to administer it in such a form as to produce no visible effects,
leaving us in doubt for a time whether an impression has or has
not been made upon the affected parts. We do not deny that pel
lets, in many instances, may prove entirely efficient and satisfac
tory, and for non-professional use, perhaps they are the safest ;
X PREFACE.
but since we have it in our power to select forms which arc certain
to contain the active properties of drugs, and which enables us to
prescribe with greater exactness, we think that such forms should
be generally adopted by the profession. We are compelled, there
fore, with deference to many distinguished cotemporaries, to regard
the ideas which have so often been promulgated respecting medi
cinal aggravations, as altogether exaggerated and unworthy that
serious consideration with which they have often been received.
For further observation upon this subject, we refer to the chapter
on " Attenuations of Drugs and Repetitions of Doses," page 111.
Finally, if some of our opinions clash with those of our homoeo
pathic brethren, we have only to assure them that our only objects
have been to ascertain truth, and advance our science, and that we
shall always be willing to investigate facts, and to listen candidly
to arguments, and whenever convinced of errors, to acknowledge
and renounce them.
ERRATA.
On page 221, tenth line from the bottom, for " Inclination is also present,"
&c.t read — " Inclination to vomit is also present," <fec.
On page 239, Section XII., heading : — for " POPULAR," read — " PAPULAR."
In the Table of Contents, on page 13, Chapter XV is omitted, and Chapter
XVI is substituted. Chapter XVII should read Chapter XVI.
On page 35, second line from bottom, read medendi for modendi.
On page 93, sixteenth line from top, read attenuations for tenuations.
On page 94, first line, read Berzdius for Bergelius.
On page 200, tenth line from top, comma for period, and small w for
capital W.
On page 305, 24th, 27th, 29th, 30th, 82d, after first, second, third, fourth,
and fifth, small letters for capitals.
HOMEOPATHIC MEDICINES.
WM. RADDE, 322 Broadway, New- York, respectfully informs the Homoeo
pathic Physicians, and the friends of the System, that he is the sole Agent
for the Leipzig Central Homoeopathic Pharmacy, and that he has always on
hand a good assortment of the best Homoeopathic Medicines, in complete
sets or by single vials, in Tinctures, Dilutions and Triturations ; also,
Pocket Cases of Medicines; Physicians'1 and Family Medicine Chests to
Laurie's Domestic (60 to 82 Remedies)— EPP'S (58 Remedies)— BERING'S
(82 Remedies).— Small Pocket-Cases, at $3, with Family Guide and 27
Remedies. — Cases containing 415 Vials with Tinctures and Triturations for
Physicians.— Cases with 260 Vials of Tinctures and Triturations to Jahr's
New Manual, or Symptomen-Codex. — Physicians' Pocket Cases with 60 Vials
of Tinctures and Triturations.— Cases from 200 to 300 Vials with low and
high dilutions of medicated pellets. — Cases from 50 to 80 Vials of low and
high dilutions, etc., etc. Homoeopathic Chocolate. Refined Sugar of Milk,
pure Globules, etc. Arnica Tincture, the best specific remedy for bruises,
sprains, wounds, etc. Arnica Plaster, the best application for Corns, Urtica
urens, the best specific remedy for Burns. Also, Books, Pamphlets, and
Standard Worka on the System, in the English, French, and German Ian"
guages,
CONTENTS.
PAGE
Preface, ... iii
CHAPTER I
A glance at some of the prominent medical doctrines of the past
and present, ... 1
CHAPTER II.
General observations on pathology, .. . 7
CHAPTER III.
Doctrines respecting a vital principle, nervous fluid, dynamic influ
ence, etc., , , ; •:;. . . 22
CHAPTER IV.
Therapeutics, , , . . , . . 36
CHAPTER V.
Specific effects of morbific and remedial agents, . . 40
CHAPTER VI.
Primary and secondary action of drugs, ... 49
CHAPTER VII.
Susceptibilities of organs and tissues to the influence of remedial
agents, vastly greater in disease than in health, . 54
CHAPTER VIII.
Allopathy, . 61
CHAPTER IX.
HonwBopathy, . . . . . / 86
CHAPTER X.
Attenuations of drugs and repetitions of doses, . . Ill
CHAPTER XL
General diagnosis, . V , , . 122
CHAPTER XII
Fevers, . . , . . , . 132
CHAPTER XIII
Causes of fever, . .,'"'' '. ../ '-^V.''" ' "i,J . 136
CHAPTER XIV.
Intermittent fever, ' . , '. . ; ; > . 141
CHAPTER XVI.
Yellow fever, . . •---'-•- ^ > ^ '\','^. • 159
CHAPTER XVJL
Infantile remittent, ,. : ' . ' . : [. . 168
CHAPTER XVIL
Continued fever, . . . ' /' 172
CHAPTER XVIII. 176
CHAPTER XIX.
Hectic fever, J ;; ^ . - 196
B
XIV CONTENTS.
CHAPTER XX.
Of the febrile cutaneous diseases, , , . , 198
SECTION 1. Scarlatina. — Scarlet fever, . . 198
2. Rubeola.— Measles, . . . . 207
" 3. Variola. — Small pox, . . . 212
" 4. Varicella. — Chicken pox, . . . 217
" 5. Miliaria. — Miliary fever, l ,;f" 218
6. Roseola, . . 220
" 7. Urticaria. — Nettle rash, i * 221
" 8. Erysipelas, . . 227
9. The Plague, . 235
CHAPTER XXI.
Of the Chronic Cutaneous Diseases.
SECTION 10. Herpes —Tetter, ... 236
" 11. Pemphigus, ..... 238
12. Lichen, . ... 239
" 13. Scabies, Psora, Itch, .... 240
" 14. Ecthyma, ..... 242
" 15. Impetigo, . . . . . 243
" 16. Porrigo, . . . . . . 244
" 17. Squamous diseases. — Lepra, . . . 245
Psoriasis, .... 246
Pityriasis, . . . " . '" . ' ' \ 246
CHAPTER XXII.
Diseases of the Organs and Tissues connected with the Digestive
System.
SECTION 1. Glossitis. — Inflammation of the tongue, . 247
" 2. Tonsilitis. — Quinsy, . . . 248
" 3. Parotitis. — Mumps, . . . . 252
" 4. Gastritis, acute. — Inflammation of the stomach, 253
" 5. Gastritis, chronic. — Chronic inflammation of the
stomach. ''". i '" ". ''. . . 257
" 6. Dyspepsia — Indigestion, . . . 258
" 7. Hsematemesis. — Vomiting of blood, . 266
" 8. Gastralgia, Cardialgia. — Neuralgia of the stomach, 267
" 9. Enteritis. — Imflammation of the intestines, 268
" 10. Acute mucous enteritis. — Dysentery, . . 270
" 11. Peritonitis. — Inflammation of the peritoneum, 278
" 12. Colic. . .,r. .', ... 280
Flatulent colic, "M! " . . .v,» „ 281
Colica Pictonum. — Painter's colic, . . 282
" 18. Cholera asphyxia, — Asiatic cholera, ^^^ 286
" 14. Cholera morbus, ;T. ,', frv- » 295
" 15. Diarrhoea, . . 297
" 16. Haemorrhoids.— Piles, .... 299
. * 17. Acute hepatitis. — Inflammation of the liver, 302
Chr-onic " . . 308
CONTENTS. XV
CHAPTER XXIII.
Diseases of the Respiratory Organs.
General observations, . . . . . . 304
SECTION 1. Catarrh, or Cold, . . . , 306
Influenza, . . . ^'n . . 307
2. Cynanche Trachealis.— Croup, ••*w« fl ' .h 308
" 3. Bronchitis, .y AtttftJ- . vzvtlf. . 316
" 4. Pneumonia. — Lung fever, . 322
6. Pleuritis.— Pleurisy, . , .- • S28
" 6. Pertussis. — Whooping cough, !* . • 334
7. Asthma, . . . .' . ; /'.'"'': 336
" 8. Phthisis pulmonalis. — Consumption, . 341
9. Cough, •/ ' i 357
CHAPTER XXIV.
Diseases of the Heart and its Appendages.
SECTION 1. Angina pectoris, . ",•'/. . 359
" Carditis and Pericarditis, . " /' 361
CHAPTER XXV.
Diseases of the Brain and Nervous System.
SECTION 1. General observations, . . . 364
" 2. Encephalitis. — Inflammation of the brain, &c., 371
" 3. Ramollissement du cerveau. — Softening of the brain, 380
" 4. Hydrocephalus. — Dropsy of the brain, . 381
" 5. Epilepsy, ..... 383
6. Apoplexy, I £3 ' . : . . 387
" 7. Paralysis. — Palsy, £&did i *.:>. • •*.„', ,:*;. 392
" 8. Mania &, potu. — Delirium tremens, . .'.' 394
" 9. Insanity, , . . ;:. '.'. . 397
Mania, . . . ; . 399
Monomania, . . . . . 401
Dementia, . . •.-.., . 402
" 10. Inflammation of the spinal marrow and its mem
branes, . . . :H-T?> • 410
Tetanus, . ^^ , ,- .... . 410
Hydrophobia, . .j- . ., . . [ ,:. . 414
" 11. Chorea, .. .. .. ..',, ! 419
" 12. Hysteria.— Hysterics, *. ^ , . 421
" 13- Neuralgia, . . ,> .". 424
CHAPTER XXVI.
Diseases of the Urinary and Genital Organs.
SECTION 1. Nephritis. — Inflammation of the kidneys, . 432
" 2. Cystitis. — Inflammation of the bladder, -V 435
" 3. Diabetes, . . . '-!f . . 436
" 4. Enuresis. — Incontinence of urine, ^ 442
•' 5. Suppression and retention of urine, . . 443
" C. Dysuria, ..... 454
XVI CONTENTS.
SECTION 7. Urinary Calculi, .... 454
" 8. Urethritis. — Inflammation of the urethra, 465
9. Syphilis, ..... 482
" 10. Leucorrhoea. — Fluor albus. — Whites, , 496
" 11. Amenorrhoea, . . . . 503
" 12. Dysmenorrho3a. — Painful menstruation, . 513
" 13. Menorrhagia. — Uterine haemorrhage, . . 617
CHAPTER XXVII,
Diseases of the Fibrous and Muscular System.
SECTION 1. Acute rheumatism, . . . , 524
2. Arthritis.— Gout, ... 528
CHAPTER XXVIII.
SECTION 1. Hy drops. — Dropsy, . . , . 530
" 1. Anasarca. — Cellular dropsy, . . 538
" 2. Ascites. — Abdominal dropsy, . 539
" 3. Hydrothorax. — Dropsy of the chest, . 542
" 4. Ovarian dropsy, .... 543
" 5. Hydrocele. — Dropsy of the testicle, . 544
" 6. Hydrocephalus. — Dropsy of the brain, . 381
CHAPTER XXIX.
Chlorosis, ..... . 555
CHAPTER XXX.
Scrofula, . *M .'• " '' . , . , 566
CHAPTER XXXL
SECTION 1. Affections of the eye and its appendages, . 578
" 2. Affections of the tunica conjunctiva. — Acute oph
thalmia, , 580
" 3. Chronic ophthalmia, . . . . 587
4. Purulent « . . %.-< ... . 590
" 5. Gonorrhoeal " .«>': , 591
6. Scrofulous " . : ^ -' . 592
7. Granulated lids, .... 599
" 8. Opacity of the cornea, . . . 600
" 9. Affections of the deeper seated structures of the
eye. — Inflammation of the cornea, . . 601
" 10. Iritis, . . . . ' ,1 602
" 11. Amaurosis, . . . •'•"*£- . 605
" 12. Hydropthalmia. — Dropsy of the eye, . 611
" 13. Cataract, . . ^_ ^ : . 614
" 14. Fungus haematodes, and cancer of the eye, 617
" 15. Affections of the appendages of the eye. — Hordeo-
lum. — Stye, . 'i . . 621
" 16. Entropium and ectropium. — Inversion and eversion
of the eyelids, . . "•,*. . 622
" 17. Fistula Lachrymalis, . ... • ^q . 623
HOMEOPATHIC
THEORY AND PRACTICE OF MEDICINE.
CHAPTER I.
A GLANCE AT SOME OF THE PROMINENT MEDICAL DOC
TRINES OF THE PAST AND PRESENT.
IN tracing the history and philosophy of medical sci
ence, from the earliest periods to the present time, we
are presented with a singular spectacle. Commencing
with those pioneers in medical art, the Asclepiades,
we find that there has been a constant series of revo
lutions, in both the theory and practice of their noble
profession, down to the present day. Hypotheses have
been advanced and theories established by one genera
tion, to be admired and followed for a time, only to be
overthrown and superseded by others, which, in their
turn, were doomed to a similar fate. Each generation
has looked upon the generations which have passed,
commiserating their errors and delusions, while the
present doctrines have been complacently regarded
as correct, and destined to stand unchanged before
the investigations and discoveries of all future ages.
The grand cause of all this may be found in the
fact that these theories have been based upon con
jecture. Certain conditions have been assumed, and
1
2 GLANCE AT THE PROMINENT MEDICAL
certain states of the system supposed to exist, without
any real grounds for such assumptions or suppositions.
Instead of bringing facts to bear — facts susceptible of
demonstration — and raising thus their theories on a solid
foundation, each writer has given himself to subtle
and abstruse reasonings, taking for his data conjec
tural agencies and false positions in relation to the
structures and functions of the economy.
Notwithstanding, however, the great errors which
most of these doctrines have contained, the world has
derived, from their promulgation, many useful hints and
valuable suggestions. Indeed, as far as close and ac
curate observation of the phenomena of disease is con
cerned, the ancients were by no means inferior to the
moderns. Nor should posterity depreciate their labours
or detract from their fame : for when we bear in mind
the paucity of anatomical and chemical knowledge,
and the numerous disadvantages under which the ear
lier writers laboured, we cannot but admire their per
severing industry, and behold with astonishment the
amount of real truth which they discovered. Whe
ther the moderns, with all their improvements in
other sciences, have done as much for the advance
ment of medicine, is a question which we shall leave
for others to decide.
In contemplating the earlier history of medical doc
trines, we shall not fail to observe that many of the
pathological opinions of Hippocrates have prevailed
down to a very late period. Although the " father of
medicine" drew largely upon his imagination, in es
tablishing the humoral pathology, instead of trusting
exclusively to known truths, yet so great was the in
fluence which he acquired in the medical world, that
almost implicit reliance was placed on his views, both
pathological and therapeutical, for many centuries.
Unfortunately for mankind, many of his most valuable
ideas upon these subjects have been unappreciated
and almost entirely neglected. During the time of
Hippocrates, and even preceding his day, the import
ance of physical education was much dwelt upon, not
only as a means essential for the perfect development
and health of the body, but for the strength and activity
of 1hf intellect. To Herodicus, who appears to have
DOCTRINES OF THE PAST AND PRESENT. 3
been the inventor of the gymnastic treatment, ancient
Greece was indebted for the superior physical culture
which her sons enjoyed, and which conduced so ma
terially to her glory. The principals of these gymnas
tic schools were 'men skilled in medicine, and their
efforts were exerted to secure for their pupils the
highest possible state of physical and mental vigour.
Let us endeavour to emulate the practice of these
wise men, in this now unappreciated branch of educa
tion, and thus, by perfecting the development of the
body, in accordance with the dictates of nature, secure
to mankind more uninterrupted health and a higher
degree of intellectual power.
For some centuries subsequent to the death of Hip
pocrates, few real discoveries were made in medical
science. Although several men like Praxagoras of
Cos, Chrysippus, Herophilus, and Asclepiades, ad
vanced new hypotheses, and introduced, from time to
time, many innovations in practice, yet, in the main,
they were all advocates of the humoral pathology*
About a century before Christ, however, Themison,
the founder of the methodic sect, made his appear
ance. Discarding the doctrines of Hippocrates, he ad
vanced the opinion that all diseases arise from two
morbid states of the system, which are contrary to
each other — a state of constriction and a state of re
laxation. To these he afterwards added a third state,
compounded of the two former, which he termed the
mixed state. The remedies which he considered ap
plicable to these different conditions were relaxants
and astringents.
After Themison came the classic Celsus. Without
wedding himself to any particular theory, he made ju
dicious selections from the doctrines of his predeces
sors, and thus instituted his method of practice. He
conceived that diseases have a direct tendency to cure
themselves, and that the measures of the physician
should be so directed that the efforts of nature are not
interfered with, and that the remedies applied shall be
those which experience has shown to have a tendency
to aid the operations of nature. He classified the dif
ferent species of fever, and discarded the doctrine of
Hippocrates in regard to critical days : and by clearing'
4 GLANCE AT THE PROMINENT MEDICAL
away many of the absurdities of his predecessors, con
tributed much to simplify and correct the prevailing
doctrines. The expectant method of practice owes its
origin to this distinguished man.
After Celsus, a few bright stars shone out in the
medical firmament, shedding their rays of knowledge
over the world, until the second century after Christ,
when all were extinguished ; and medicine, in common
with the other sciences, slumbered through the dark
ages. Amongst those who were most conspicuous
in this earlier period, may be mentioned Aretseus,
Musa, Scribonius Largus, Andromachus, Rufus the
Ephesian, and, finally, Galen. These were all advo
cates of the humoral pathology, but to the latter must
be awarded the palm, not only for the able manner in
which he amplified and explained the doctrines of
Hippocrates, but for the immense number of practical
facts which he gave to science.
At the commencement of the sixteenth century, the
attention of physicians began to be more particularly
directed to the study of anatomy and chemistry, for
the purpose of elucidating the phenomena of disease,
and the operations of medicines. About this time
appeared Paracelsus, who boldly denounced all previ
ous theories, and ushered into the world a new doc
trine, founded upon chemical views. This celebrated
person taught that all living bodies were composed of
the same elements as other kinds of matter, and were
subject to the same chemical laws. These elements
were supposed to be sulphur, mercury, and salts; upon
a due proportion of which the health of the body was
believed to depend, and any variation from this pro
portion to constitute a cause of disease. He supposed
that a certain intelligence which he calls " archeus"
located in the stomach, presides over these elements,
and causes their good qualities to be assimilated to the
body, and the noxious principles to be rejected. This
" archeus," like the " phusis" of Hippocrates, served
an excellent purpose in filling the gap whenever no
plausible explanation could be found for the establish
ment of his absurd propositions.
To Paracelsus, however, is due the credit of having
first suggested the true therapeutical principle, to give
DOCTRINES OF THE PAST AND PRESENT. 5
those drugs for the cure of disease, which in health
give rise to a train of symptoms similar to those of
the malady. But the numerous erroneous notions
which he entertained respecting physiology. pathology,
and the specific effects of medicines, prevented the
practical development of the magnificent idea which
his mind had conceived.
The next reformer of note is Sydenham, who flourish
ed about the middle of the seventeeth century. He also
was a humoralist, and indulged largely in hypotheses;
but he contributed much to the advancement of science.
Until this period, the idea had prevailed that disease
consisted in an altered state of the fluids. Whether
disciples of Hippocrates and Galen, chemists, mechani
cians, or metaphysicians, all believed in the humoral
pathology. After Sydenham, however, Baglivi and
Hoffman appeared, and effected a change of an impor
tant character. With Baglivi originated the doctrine
that all morbid changes commenced in the solids, and
that the fluids were acted upon secondarily. Hoffman
embraced the views of Baglivi, but enlarged upon
them, and introduced the hypothesis that the " muscu
lar fibre is endowed wTith a certain degree of tone,
which constitutes its healthy state ; but from various
circumstances, this action may be morbidly impaired,
or increased, on the one hand, so as to generate spasm,
or morbidly diminished, until it arrives at the opposite
condition of atony."
Contemporary with Hoffman, was Stahl, who ad
vanced the idea of the existence of an independent
principle, which pervades the body, affording to it its
vital energies, and upon which the operations of the
economy depend. Not having acquired an accurate
knowledge of the chemical operations which are con
stantly going forward in the body, or any just ideas in
regard to the phenomena of life, it is not surprising
that this great man confounded the operations of the
intelligence with the vital principle. But however
erroneous may have been many of the ideas of Stahl,
his writings contain some entirely new and very valu
able truths.
Stahl supposed that the superintending principle,
the " anima" presides over the operations of the living
6 GLAXCE AT THE PROMINENT MEDICAL, ETC.
organism, having no exclusive location, but pervad
ing every part of the body, causing motion in the or
gans of motion, sensation in the organs of sense, and
all the phenomena of life, by a direct operation or in
fluence upon each particular part. Had he not been
imbued with the prevailing absurdities respecting a
" vital principle," a "nervous fluid," a " dynamic in
fluence," &c., this idea might have led to splendid re
sults ; but instead of recognising in this anima, the
soul, or intelligence, he confounded it with certain sup
posed spiritual or vital properties which pertained
alone to the body, and which he supposed were anni
hilated on the death of the body. Elsewhere we shall
again allude to this subject.
The brilliant intellect of Stahl also distinctly recog
nised the truth of similia similibus cur ant ur, and point
ed out its advantages over the then universal law of
cure, contraria contrariis opponenda. Had he, or Par
acelsus before him, adopted the course of Hahnemann
in experimenting with drugs, in health and in disease,
and by this means accumulated a sufficiency of facts —
the incontrovertible arguments in sustaining any theory
— homoeopathy would long since have been the only
system of medicine. Both these reformers were pos
sessed of gigantic intellects — genius, indeed, of the high
est order — and the most exalted moral courage, which
enabled them to disregard the ex-cathedra dogmas
of antiquity ; but they lacked that patient and self-
sacrificing devotion in pursuit of facts, and that un
bounded benevolence and love of mankind, which so
essentially characterized the career of Hahnemann.
To the latter therefore should be rendered all the
credit which attaches to this school of medicine.
Since the time of Stahl, physicians have formed
their therapeutical opinions mostly by observation of
phenomena, both in regard to the action of the organs
and the effects of remedies. The rapid advancement in
the knowledge of anatomy, physiology, pathology and
chemistry, has conduced much to call into existence
better ideas in the entire science, and to do away with
the mass of hypothetical rubbish which had been
accumulating for so many centuries. From the age
of Stahl each man began to rely more upon his own
GENERAL OBSERVATIONS ON PATHOLOGY. 7
observation in forming his views ; and the influence
of ancient names and ancient doctrines became less
powerful. In the list of innovators may be placed
the names of Haller, Sauvages, the " father of Noso
logy," Brown, Darwin, Bichat, Morgagni, Broussais,
and many other writers with whose doctrines we are
all familiar.
We have thus briefly alluded to a few of the more
eminent men of the past, not to enter into an exposition
of their peculi ar doctrines, but to illustrate the numerous
changes which have occurred in the theory and prac
tice of physic. And how few of the views of all
these great men are at this day deemed worthy of con
sideration ! How little have modern writers been able
to profit by this labour of centuries, in erecting a true
and uniform system of pathology and therapeutics !
Indeed, Allopathy at this moment, is entirely destitute
of any recognised theory. Her followers, for the most
part, are eclectics ; each man, like Celsus of old,
selecting' one idea here and another there, as best suits
his taste. Better far would it be for mankind, if they
would follow their illustrious examplar still further,
and trust more to the efforts of nature, and less to
the violent and uncertain effects of their applications.
CHAPTER II.
GENERAL OBSERVATIONS ON PATHOLOGY.
We shall now lay before our readers some views in
regard to general pathology and inflammation, which
we trust may conduce somewhat to the advancement
of our science. In offering these opinions to the
public, we have not the presumption to suppose that
we are about establishing any new theory ; but if we
succeed in throwing some new light upon the compli
cated operations of the human economy, our end
will be attained.
We hold that it is the province of the physician not
only to cure diseases, but to point out the surest me
thods of preventing them. In order to do this sue-
8 GENERAL OBSERVATIONS
cessfully, it is necessary that he appreciate those
conditions which constitute health, so as to guard
against the numerous causes of its disturbance. In all
living bodies, certain states are essential to this
condition. The most important of these states are —
1st, a soundness of the organs and tissues ; 2d, an
adequate supply of nutritious food ; 3d, pure air, that
the blood in the lungs may be oxygenated ; 4th, a
calm activity of mind, so that the requisite stimulus of
the intelligence shall produce its peculiar effects
upon all parts of the body ; 5th, an avoidance of the
various causes which debilitate, overtask, or in any way
impair the integrity of the nervous or muscular sys
tems ; 6th, the practice of those means which are cal
culated to ensure the due performance of all the
functions, as exercise, amusements, the cultivation of
a cheerful temper, bathing, and moderation and regu
larity in all the habits of life. Thus the functions
will be performed in a certain definite and uniform
manner, the requisite equilibrium between the supply
and waste of the body be retained, and that state se
cured by which health is constituted.
It should be firmly impressed upon the mind,
that the important offices of respiration, circulation,
digestion, assimilation, absorption, secretion, &c.,
are dependent upon the chemical action which is con
stantly going forward within the body, between the
elements of the tissues and the inspired oxygen on
one hand, and a uniform supply, through the nerves,
of spiritual stimuli on the other. When these ele
ments are supplied in due proportion, from the food
and the air, and no unnatural or injurious cause acts
on the system, health must result.
But if the quantity of oxygen absorbed to unite
with the elements of the tissues, is insufficient to gene
rate the natural amount of animal heat and motion, or
if the strength of one or more of the tissues becomes,
from any cause, so impaired as to be incapable of
offering the requisite resistance to the oxygen of the
blood, disease ensues. In the latter case, the impaired
state of the diseased structure does not offer sufficient
contractile power to prevent the intromission of red
globules into those parts which, in the normal state,
ON PATHOLOGY. *J
contain only the ordinary products of the transforma
tions of the tissues. The result is, that the pores are
obstructed, the sweat is retained in the system — thus
affording additional fuel for combustion, with the oxy
gen of the blood, and from the unnatural irritation
which it causes, giving rise to accelerated respiration,
circulation, and the other phenomena of fever. If the
resisting power of the tissues continues impaired for a
length of time, and the oxygen continues to act as
usual, disorganization must follow.
It has been proved that 32| ounces of oxygen enter
the system of an adult daily, the whole of which
goes into combination with the elements of the food,
and is thrown off through the lungs and skin in the
form of carbonic acid and watery vapour.
The same quantity of carbon and nitrogen is sup
plied to the blood from the elements of the food, to
reproduce the organs, which is lost by the waste or
exercise of the functions. According to Liebig, " the
quantity of oxygen absorbed determines the amount
of food necessary to be assimilated."
If then the food be properly digested and assimila
ted, a due quantity of pure air be respired, and the
normal integrity of the organs remain unimpaired,
all the structures will act with uniformity, and a
healthy equilibrium will result. To ensure a con
tinuance of such a condition, it is not only necessary
to avoid all of those causes which are directly
capable of disturbing this complicated series of func
tions, but to make use of those means which tend to
invigorate the system, and aid nature in her opera
tions. In civilized life, these sources of disturbance
are almost innumerable ; but in the progress of this
work, we shall endeavour to point out some of the
more prominent, and show in what manner they
operate in causing disease.
In the healthy state of the system, certain structures
possess the power of effectually excluding the red
globules of the blood ; thus preventing a too great
change of matter, which an event of this kind would
inevitably produce. This power is dependent, for its
normal action, upon the presence of two conditions,
viz., an adequate amount of resisting power in the
1*
10 GENERAL OBSERVATIONS
muscular fibres, which modern writers term contrac
tility, and an unimpaired state of the nerves, in order
that the intelligence may communicate with the ex
treme parts, and thus afford the muscular fibres an
additional stimulus or power of resistance. This sti
mulus, of which the nerves are the conductors, is an
agent of immense importance in modifying and altering
the functions of the structures. In the normal state,
its effects are apparent during the various perceptions
and emotions which are constantly agitating us.
When these two properties remain unimpaired, every
office must be duly performed.
It is true that the muscular or the nervous systems
may be tasked, for a short period, without detriment ;
provided, that a corresponding degree of rest be
allowed, for the weakened energies to be restored to
their natural state. This is witnessed in severe bodily
or mental labour ; the immediate effects of which are,
fatigue, lassitude, and diminished muscular and
nervous energy. If this be succeeded by a due allow
ance of sleep, the waste of force is repaired, and
the body resumes its healthy tone. If, however, this
labour be continued beyond a certain point, and the
requisite quantity of rest be withheld, the capillaries
lose their vitality, become incapable of resisting the
entrance of red blood, and inflammation, with fever,
is the consequence.
Indeed, it may be laid down as a general rule, that
most of those causes which are capable of producing
disease, act by impairing the muscular and nervous
force of the tissues to such an extent as to render them
incapable of excluding the red globules. We know
that these globules are charged with oxygen, and
that this gas, when in contact with parts of which the
elements consist of carbon and hydrogen, must effect
chemical changes. It matters not whether these
changes are produced within the body or in the air ;
the results are in both instances the same.
It has been proved by the experiments of Bichat,
Buniva, and Philip, that the capillaries of a healthy
living animal effectually resist the introduction of
tluids, even when a powerful syringe is used ; but as
the energies of the animal sink, they gradually lose
ON PATHOLOGY. 11
their power of resistance, and allow the fluid to pass
into them like " passive and yielding tubes." From
these experiments it is evident that the capillaries are
the first to lose their vitality, since the large arteries
have been observed to retain their contractile power
some hours after death. Thus it is that the first
manifestations of disturbing causes are upon the
surface, in the condition of chills, succeeded in a short
time by unnatural heat and inflammation. " Push
into the aorta of a living animal, by means of a sy
ringe, different fine fluids, and you will never see them
fill the capillary system, or issue by the exhalents ;
but when the experiment is performed soon after the
death of the animal, the fluid will pass readily into
the serous capillaries, and pass out by the exhalents,
excretory ducts, &c." — (Bichat.)
From the above facts it is evident, that whenever
the integrity of the extreme parts becomes impaired,
the introduction of the red globules is permitted,
which, according to chemical laws, must give rise to
increased evolution of heat, inflammation and thick
ening of the capillaries, and consequent obstruction to
the passage of the excretions. The retention of the
products of the combustion of the oxygen of the blood
and the elements of the food, is an additional source
of disturbance. These irritating substances induce
accelerated respirations, in order that sufficient oxygen
may be absorbed to neutralize them, and thus cause
exaltation of temperature, increased activity of the
organs, and the phenomena of fever.
In all our pathological inquiries, it is of the first
importance that we have a distinct appreciation of
the laws which produce and regulate the phenomena
of life, and, as far as practicable, of the influence of
external agents in modifying these phenomena.
First, the primary source of animal heat and mo
tion, is the chemical action which takes place in the
lungs. Secondly, when the blood arrives at the ex
treme vessels, other and important chemical changes
occur between the oxygen of the blood and the ele
ments of the tissues, giving rise to a great amount of
caloric and motion. Now as the combustion at the
lungs is the principal cause of propelling the blood
12 GENERAL OBSERVATIONS
through the arteries into the capillaries — so it is pro
bable that the combustion which occurs between the
oxygen of the red globules, and the elements of the
changed tissues at the extreme vessels, is the princi
pal source of the motive power which forces the
blood back through the veins to the heart and lungs.
There can be no chemical change without the evolu
tion of heat, no heat without expansion, and no ex
pansion without developing motive power. We are
obliged to reject the doctrine that the blood is brought
back through the veins to the heart, by a kind of suc
tion, which this organ exercises on account of the
vacuum which constantly occurs within its walls ; for
if this motive force is all located at the heart, there
is no way of accounting for the expenditure of the
large amount of motive power constantly generated at
the extreme points. We see two parts of the body
where combustion is constantly occurring, viz., the
lungs and the extreme vessels ; and when we remember
that the laws which govern chemical action, whether
in the body or the air, are similar, we can appreciate
the probable force which must be produced at these
extremities.
Since then the animal heat, motive force, &c., are
generated principally at the lungs, and in the capil
laries, it is evident that any cause which can disturb
the healthy operation of either of these important
parts must produce immediate and serious disturbance
throughout the whole system.
The agents capable of inducing disease here, are
numerous and dissimilar.
In hot climates, the atmosphere being highly rare
fied, a less volume of oxygen is absorbed at each in
spiration, and consequently a less quantity afforded to
enter into combination with the carbon of the system.
On this account we observe a greater prevalence of
liver and bilious affections in torrid than in temperate
latitudes. Unless extreme care be taken to avoid
animal food, liquors, and other articles which produce
a large amount of carbon, this element will so abound,
that the rarefied air which is inhaled will be wholly
inadequate to effect those changes which serve to re
tain the equilibrium between the supply and waste.
UN PATHOLOGY. 13
from the transformations of tissues. Here, a greater
quantity of the elements of nutrition are usually assi
milated than the inspired oxygen can decompose.
This excess of carbon and hydrogen being retained,
the nervous and muscular force of the tissues become
relaxed and enfeebled, so that from slight exciting
causes, diseases of a bilious or congestive character
are engendered.
We have said that the same quantity of carbon
and hydrogen should be supplied to the blood from
the elements of the food, to reproduce the organs,
which is lost by the waste or exercise of the functions.
That which is not acted upon by the oxygen in the
lungs and at the skin, is taken up by the veins, and
carried to the liver, \vhich separates those substances
(carbon, soda, &c.,) incapable of reproducing the
tissues, and finally depositing them in the gall-blad
der in the form of bile. When the amount of bile
exceeds the retentive capacity of the gall-bladder,
the surplus must run over, and a large portion of it
be conveyed into the system, thus impairing the integ
rity of the tissues, and laying the foundation of those
diseases incident to equinoctial latitudes.
In cold climates, a state of things the reverse of
this ensues. Here, the air being highly conden
sed, a large volume of oxygen is absorbed at each
inspiration, to combine with the carbon of the
system, and thus generate sufficient caloric to com
pensate for that which is abstracted by external cold.
For this condition, all causes which can impair the
normal state of the digestive organs must be avoided,
in order that a sufficient amount of carbon, &c., may be
assimilated, to combine with the oxygen and secure
the healthy equilibrium. The greater the exposure
to external cold, the larger must be the supply of
food and oxygen to make up for the loss of heat.
Cold, acting unduly upon the external parts of the
body, produces a train of symptoms similar to those
caused by miasmata and other noxious exhalations when
inhaled. The first effects in either instance, are to im
pair the energy of the extreme vessels, inducing constric
tion and chills, to be succeeded by diminished resisting
14 GENERAL OBSERVATIONS
power, and other phenomena which characterize in
flammation.
The increased action of the circulatory vessels
which usually follows the chills, has been referred by
some writers to the stimulus of a greater volume of
blood being thrown upon these organs than is natural,
and the increased heat which accompanies this exal
tation as a result of the action itself. No greater
error than this could be promulgated, for the entire
source of animal heat is chemical action, and all of
the involuntary motions must bear a direct ratio to
this evolution of heat. If the skin, lungs, brain, or
any other part, becomes from any cause incapa
ble of affording the normal resistance to the oxygen
which is constantly brought into contact with it,
an augmented chemical action must occur in it,
with the invariable concomitants, increased heat, con
gestion, and fever.
" If a given part of the body is acted upon by con
tinued and intense cold, while the other parts retain
their natural temperature, there occurs, after a time,
in consequence of the loss of heat, an accelerated
change of matter in the cooled parts. The momen
tum of the force of the vitality, in the parts which
are not cooled, is expended, as before, in mechanical
motion ; but the whole action of the inspired oxygen
is exerted on the cooled part. In the cooled 'part
of the bod}', the living tissues offer a less resistance
to the chemical action of the inspired oxygen : the
power of the oxygen to unite with the elements of
the tissues, is, at this part, exalted. In the cooled
part, the change of matter, and with it the disengage
ment of heat, increases ; while in other parts of the
body, the change of matter and the liberation of heat,
decrease. But when the cooled part, by the union of
the oxygen with the elements of the metamor
phosed tissues, has recovered its original tempera
ture, the resistance of its living parts to the oxygen
conveyed to them again increases, and as the resist
ance of other parts is now diminished, a more rapid
change of matter now occurs in them, their tempera
ture rises, and along with this, if the cause of the
change of matter continues to operate, a larger
ON PATHOLOGY. 15
amount of vital force becomes available for mechani
cal purposes. If the heat is abstracted from the
whole surface of the body, the whole action of the
oxygen will be directed to the skin, and in a short
time the change of matter must increase throughout
the body." — (Liebig.)
From these facts we are led to conclude, that a
large amount of those articles which abound in carbon
and hydrogen should be consumed in cold climates, in
order that sufficient materials may be constantly fur
nished to the tissues, to afford the requisite amount of
resistance to the inspired oxygen. This is the only
means by which the animal temperature can be kept
up sufficiently to counteract the loss of heat which is
constantly occasioned by external cold. Disease
must always occur, when cold so intense and protract
ed as to impair the normal resisting force of the tis
sues, is applied to the body, in such a manner as to
induce atony in the capillary vessels, chills, lassitude,
pain, and other symptoms of inflammation. One of
the most prolific causes of disease, in cold climates,
is generally active from without, in the form of sud
den changes of temperature, excessive exposure to
cold when the body is enfeebled, and in going from
heated rooms into the cold while perspiring. In these
instances the effects produced are, debility and con
striction of the extreme vessels, (chills,) lassitude, and
pains in the limbs and head, followed, as soon as re
action comes on, by accelerated respiration, circula
tion, and other symptoms which constitute fever. In
regard to the part or organ affected, much will depend
upon the predispositions and constitution of the patient.
As a general rule, however, the greatest impression
is usually made, and the force of the disease expended,
upon the most enfeebled part. If the lungs are pre
disposed to disease, the exciting cause will develop
pneumonia. If the brain or digestive organs have
been debilitated by excessive exercise, phrenitis or
gastritis will ensue. The same principle holds true with
regard to the other organs and structures of the
economy. If the whole system be in a normal and
sound state, atmospheric vicissitudes will common
ly merely predispose the organs to a disordered
10 (JENEKAL OBSERVATIONS
action from whatever farther exciting cause may occur.
But repeated exposure to sudden changes of tempera
ture, even in a sound state of the organs, may produce
actual disease.
The immediate effect of the above enumerated, as
well as of almost all other causes of disease, is to
impair the integrity of the capillaries to such
an extent as to render them incapable of excluding
the red globules. The intromission of these "car
riers of oxygen," must of necessity give rise to
an increased and unnatural change of matter, with its
concomitants, augmented heat and motion. This in
flammation of parts produces obstruction to the pas
sage of the excretions, causing them to be retained
within the system to serve as an additional source of
disturbance. The nature and activity of the exciting
cause, the part affected, and the constitution of the
patient, will determine the violence and danger of the
disease. ,
It may then be assumed with safety, that the chief
influences which predispose to disease in all countries,
are extremes of heat and cold, and abrupt changes of
temperature.
In cold latitudes, those affections prevail which are
induced by undue exposure to cold, and from the con
densed state of the air respired. Hence pneumonic
and other diseases of a purely inflammatory charac
ter.
In hot regions, where the respired air is highly
rarefied, we observe those disorders which proceed
from a deficiency of oxygen to neutralize the ele
ments of the food, and from exposure to the burning
rays of a torrid sun. Liver complaints, yellow and
congestive fevers, and those diseases which an excess
of carbon, circulating in the blood, would produce, are
here found in abundance.
The diseases of moderate latitudes are of a more
mixed character, milder; and more subservient to the
power of remedies. Here frequent and sudden at
mospheric changes exert the greatest influence in
disturbing the healthy equilibrium, and in inducing
disease.
Every living body possesses a certain definite and
ON PATHOLOGY. 17
limited capacity of resistance. This capacity can
only be taxed to a fixed point, without deranging
some of the functions and causing disease. We have
seen that the first and most essential requisite to en
sure health, is a due proportion between the elements
of the food and the inspired oxygen. Now, if mode
ration and regularity be exercised in all the duties and
habits of life, a sound state of the organs and a due
performance of all the functions will follow.
Among the parts of which the normal action is highly
essential to the well-being of the individual, and upon
which disturbing causes usually act, are the digestive
and respiratory organs, the skin, and nervous system.
Of these, the lungs and skin are by far the most fre
quently affected. Exposed incessantly to noxious
exhalations, impure air, extremes of heat and cold,
and sudden changes of temperature, it is not a
matter of surprise that most exciting causes operate
primarily upon one or both of these important parts.
Almost all inflammations of important organs are
ushered in with feelings of general lassitude, pains in
different parts of the body, irregular respirations, and
chills. It matters not whether the first impression has
been made by atmospheric changes — extremes of heat
or cold — or undue mental or corporeal exertion : one
important phenomenon is witnessed in nearly all in
stances, that is. a spasmodic or constricted state of the
extreme vessels. This constriction of the capillaries
is always attended with more or less debility, which
prevents them, when re-action comes on, from resist
ing the intromission of red blood. Thus result ob
struction to the excretions, accelerated change of
matter in these parts, and the other phenomena of
inflammation and fever. Now, whatever organ or
structure is most predisposed to diseased action, must
receive the greatest detriment from the retained se
cretions, and the exalted and unnatural action which
pervades the system.
According to many authors, the causes of inflamma
tion may be either predisposing or exciting. If two in
dividuals, one robust, and regular in his habits, and the
other delicate, and irregular, be exposed to the same
morbific influence, the former will escape, while the lat-
18 GENERAL OBSERVATIONS
ter will receive injury ; or, if the exciting cause be still
more active, an impression will be made upon the
first, which will predispose his system to disor
dered action, while in the latter, the same influence
will cause actual disease. If the morbific agent be
very virulent, actual disease may be induced in both
instances, but in different degrees of severity.
If this is true, it may be asked why it is that in hot
climates the robust are more liable to be attacked
with fevers, than those of a feeble appearance ? The
reason is obvious. The system of the vigorous man
abounds with those elements which, when properly
decomposed by oxygen, generate the vital activity,
and produce strength and health. Now, if he in
dulges his appetite as usual, while he inhales a highly
rarefied atmosphere, disease must of necessity result ;
for unless the amount of oxygen absorbed into the
system be proportionate to the elements of the food
assimilated, much of the latter must remain unacted
upon, and thus serve to contaminate the blood, and
derange the functions of the organs. Here, a cause
of disease exists, to which the feeble man is but little
exposed. His system is characterized by a deficiency
rather than an excess of carbon ; his digestive or
gans being so weak that no more of the elements of
nutrition are assimilated than the inspired oxygen can
neutralize. Thus, in his case, the equilibrium between
the supply and waste of matter is retained, and the
organs remain healthy.
In the first example, a strict abstinence from ani
mal food, liquors, and other articles abounding in car
bon, with care that the healthy function of the skin be
not disturbed, will secure as great freedom from dis
ease as in the other instance. It is not that the robust
man is necessarily more prone to disease than the other,
but because, either from ignorance or imprudence, he
often exposes himself uselessly to an exciting cause to
which the latter is not liable.
We contend that the man of stout frame and vigor
ous constitution is better able to resist diseases in all
climates than one of a more feeble organization, pro
vided, that he adapts himself by his habits and dietetic
regulations, to the climate in which he resides. The
ON PATHOLOGY. 19
grand essential consists in keeping up a due propor
tion between the elements of the food and the inspired
oxygen. So long as this proportion is preserved, a vast
amount of exposure can be sustained in any climate,
without detriment.
In northern latitudes, those who are feebly organ
ized, or of nervous or sanguine temperaments, suffer
far more than the robust and bilious. In such cases
it is necessary that the amount of carbon and hydro
gen assimilated to repair the waste of the tissues, be
very large, in order to supply the system with sufficient
material to resist the action of the absorbed oxygen.
Let it be remembered, that disease ensues whenever
any part of the body becomes incapable of afford
ing a definite amount of resistance to the action of
this gas. The principal source of this resistance is the
carbon and hydrogen of the changed tissues ; and if
no unusual or deleterious causes operate to depress
the system, all will be well. If, however, the digestive
organs become disordered, and assimilation checked —
the body being at the same time exposed to excessive
cold — the oxygen will act upon the debilitated struc
tures themselves, in order to find sufficient fuel for
combustion, so that the animal temperature may be
retained.
The phenomena of life depend upon the constant
operation of two antagonistic elements. Their pre
sence and activity, in suitable proportions, impart
heat, strength, and life, while the absence of one
makes the other an active agent in causing dis
organization and death. According to Lavoisier,
a quantity of oxygen is constantly being inspired
by the healthy adult, equal to 32± oz., or 40,037
cubic inches, daily, the tendency of which is to
neutralize and destroy the elements of the body. To
counteract this destructive agent, the elements of the
food are constantly being assimilated, and are finally
brought into contact with it. In this manner, so long
as the proportion between these agents is equal, those
chemical changes take place which generate the ani
mal heat, corporeal vigour, and motive power, serving
to keep in operation the whole machine and ensure the
normal action of every organ. The immense import-
20 GENERAL OBSERVATIONS
ance, then, of fully comprehending and appreciating the
mutual influence, and dependence upon each other, of
the respiratory and digestive organs, will be under
stood by all.
Extreme cold produces disease by permitting more
oxygen to be absorbed by the blood than can be de
composed by the products of the metamorphosed tis
sues. Those parts of the body possessing the least
vitality must then be acted upon, and inflammation,
and perhaps disorganization, ensue.
Extreme heat generates disease from causes direct
ly the opposite, viz., a deficiency of oxygen, to neu
tralize the assimilated carbon and hydrogen. In both
instances the nervous and muscular force of the capil
laries is so impaired as to render them incapable of
excluding from their structure the red globules. Ob
struction is thus caused, a large amount of heat is
evolved, and the redness, swelling, and pain, which
characterize inflammation, is present.
The primary cause of most inflammations is a dis
proportion between the action of the oxygen of the
blood and the elements of the changed tissues.
The cause of this disproportion — acting upon those
parts of the body most susceptible to its influence —
gives rise immediately to an impaired state of the
nerves and muscular fibres of the extreme vessels,
rendering them incapable of preventing the intromis
sion of the red blood. The first effect upon these ves
sels is stimulant ; indicated by contraction, or spasm, and
chills. This is soon followed by the secondary or atonic
stage, which is indicated by distention or congestion
of th.e capillaries with red blood, heat, redness, and
other symptoms, which show that the small vessels
have lost their power of resisting the entrance of the
destructive " carriers of oxygen. "« The immediate
cause of the disturbance and disorganization which
results in inflamed parts, is dependent solely upon the
chemical action of the oxygen of the red globules, upon
the elements of the affected structure. If this is the
case, it will be asked why, then, disturbance and in
flammation do not take place from the red globules in
the act of blushing, or from friction ? Because, in these
instances, the nervous and muscular force of the capil-
ON PATHOLOGY. 21
laries remains unimpaired, and they are thus enabled
speedily to throw off this temporary accession of red
blood, and resume their normal resistance to its further
entrance. It is only by impairing the resisting force of
these vessels, in such a manner that the arterial blood
continues to enter them, that 'inflammation can occur.
Even in the act of blushing, a perceptible increase
of heat is apparent, and when the emotion acts intense
ly, and for a considerable period, phenomena similar
to those which occur in very slight superficial inflam
mations, are observed ; as uneasy sensations, fulness,
perspiration, &c.
The virulence of the morbific influence acting upon
the extreme vessels, and the extent to which their re
sisting power is impaired, will determine the vio
lence and danger of the inflammation.
It has been ascertained by Wilson Philip and others,
" that where the inflammation of a part is greatest, the
vessels are more distended, and the motion of the
blood is slowest." This is owing, undoubtedly, to the
diminished contractile power of the capillaries ; and it
is probable, in inflammations of a congestive charac
ter, that this contractile or resisting power is almost
entirely destroyed. This fact is important, in a thera
peutical point of view, inasmuch as it directs us to
apply our remedies in such a manner as to restore the
loss of tone of the extreme vessels, as the most direct
method of cure. We shall hereafter take occasion to
advert to this subject again, when we shall dilate upon
it more fully.
22
CHAPTER III.
DOCTRINES RESPECTING A VITAL PRINCIPLE, NERVOUS
FLUID, DYNAMIC INFLUENCE, <fcc.
All authors upon physiology and medicine, have
written much about a " vital principle" a "nervous
force" &c. They speak of them as immaterial an(}
mysterious agents, which perform all of the most won
derful offices in the human economy. They are sup
posed to be distinct from the intelligence, or soul, and
to possess a kind of subtle and mysterious power,
which accomplishes all those difficult operations, in
the phenomena of life, which physiologists are unable
to understand or explain.
" There is not," says Paine, " in the whole range of
medical literature, one author, however devoted to
the physical and chemical views of life, who does
not evince the necessity of admitting a governing
vital principle, as a distinct entity, distinct from all
other things in nature. I say, there cannot be pro
duced one author of any consideration, who does not
summon to the aid of his discussion a vital principle,
whenever he touches upon the abstract phenomena
of life."
But what proof have we that such a principle
actuates the body? What good reason is there for
assuming the existence of a peculiar, immaterial
power, independent of the soul ? " To speak of the
vital forces, to give them a definition, to interpret
phenomena by their aid, and yet to be ignorant of the
laws which govern them, is doing nothing, or rather
is doing what is worse than nothing. It is to attempt
an impossibility, it is to content the mind to no pur
pose, to stop the search after truth. To state that the
liver separates the elements of the bile from the blood
by means of the vital force, is merely to assert that
the bile is formed in the liver. By thus varying the
expression, a dangerous illusion is established." —
(Matteucci on Living Beings, p. 29.)
We know that every part of the organism has its
. DOCTRINES RESPECTING A " VITAL PRINCIPLE," ETC. 23
own special function, the physical operation of which
we can fully comprehend ; but superadded to all of
these parts, there is, undoubtedly, a subtle and mys
terious agency, the soul. Shall we now add to the
system a power which was never disclosed by the
Creator — an assumed, vague, and indefinite principle,
concerning which we are entirely ignorant, and which
can serve no purpose but to cover up ignorance, and
securely conceal absurd hypotheses ? Shall we pre
tend that when God created man from clay, and
'* breathed into his nostrils the breath of life, and he
became a living soul" he also infused another prin
ciple, similar to but distinct and independent of the
soul ?
We are of opinion that much error has arisen
from the general idea, that the intelligence is es
tablished exclusively in the brain, and that it possesses
only certain limited powers. That its highest and
most important manifestations proceed from this organ,
there is no doubt, because the special senses are loca
ted here. Sight, hearing, smell, &c., are all recog
nised and appreciated here, because the organs through
which we are sensible of these phenomena, are in this
vicinity ; but in other parts it exercises its influence
directly and often independently of the brain and spi
nal cord.
In regard to the nature of the intelligence, or soul,
and how it acts upon the material parts, to aid in pro
ducing the phenomena of life, can never be known.
We are able to see its results and appreciate its won
derful influences, but the mode of its operation is abso
lutely inexplicable. It pervades every part of the
body, acting as a stimulus to each organ, giving rise
to sensation in the organs of sense, motion in the or
gans of motion, digestion, absorption, assimilation,
respiration, circulation, &c., in the organs provided for
these functions.
All modifications or derangements of structure,
alter the peculiar effects of this spiritual stimulus ;
for it acts only through the medium of the organs as
they actually exist. All deviations therefore from
the normal organization of parts, induces corres-
24 DOCTRINES RESPECTING A " VITAL PRINCIPLE," ETC. .
ponding alterations in the manifestations of the intel
ligence.
The soul has no particular location, but pervades
every portion of the nervous system, exercising a con
stant and direct influence over every organ and tissue.
This is clearly apparent from the experiments of
Philip, Stilling, Hall, and others, which prove "that
the power of the heart and vessels of circulation is
independent of the brain and spinal marrow," and
" that the power of the muscles of voluntary motion,
vessels of secretion, and peristaltic motion of the
stomach and intestines, are independent of the ner
vous system, and that their relation to this system is
of the same nature with that of the heart and vessels
of circulation — the nervous power influencing them in
no other way than as other stimuli' and sedatives do."
From these and other experiments, Dr. Philip supposes
that the vessels possess " a principle of motion inde
pendent of their elasticity," and identical with gal
vanism.
The experiments of Majendie have shown, " that
the hemispheres of the brain and cerebellum may be
removed in a mammiferous animal, and it will continue
to experience sensation, odours, sounds, and sapid im
pressions. Vision, however, is abolished."
Dr. Dowler, of New Orleans, has very recently in
stituted a series of experiments on the alligator,
which demonstrate in the clearest manner the position
which we have advanced, respecting the peculiar ope
ration of the soul, or intelligence, upon the organism.
In one experiment, Dr. D. divided the muscles of the
neck, the cervical vertebrae, and the, spinal cord, also
the spinal cord between the shoulders and hips, de
stroyed the sympathetic nerve, and removed the intes
tinal viscera, " yet, for a period of more than two
hours, the alligator exhibited complete intelligence,
volition, and voluntary motion in each and all divisions
of the body. It saw, felt, and defended itself ; showed
anger, fear, and even friendly attentions to its keeper,
a black boy" In another experiment, " the upper por
tion of the skull, including a horizontal stratum of
brain, was removed. The animal performed a series
of voluntary motions, intelligibly directed, to ward off
DOCTRINES RESPECTING A VITAL PRINCIPLE, ETC. 25
injuries. The entire brain and the medulla oblongata
were now removed*, without diminishing its power to
direct its limbs to any part that was pained by the
slightest touch of a pin or knife. A metallic rod was
passed many times within the spinal cor"d, completely
destroying the spinal marrow beyond the hips. It was
still found that both voluntary motion and sensation,
remained, though their manifestations were greatly
impaired." Dr. D. concludes from these and nume
rous other experiments of a similar nature, " that vo
luntary motion is neither directly communicated from
nor regulated by the brain, or the cerebellum ; that
the muscles, in connection with the spinal marrow,
perform voluntary motions for hours after having
been severed from the brain ; that these motions are
not only entirely independent of the brain, but may
take place, though imperfectly, after the destruction
of the cord itself; that the trunk, as well as the brain,
thinks, feels and wills, or displays psychological pheno
mena ; that the sensorium is not restricted to a single
point, but is diffused, though unequally, or in a dimin
ished degree, in the periphery of the body ; and that ac
tions which take place after decapitation, as described
above, are in absolute contrast to REFLEX ACTIONS, being
sensational, consentaneous, voluntary, and in other re
spects dissimilar." Is it any more wonderful that the
soul conduces to the phenomena of digestion, assimi
lation and appropriation, when the natural stimuli of
these organs are presented to them, than that sight
is appreciated when the natural stimuli of the eye,
the rays of light, are applied to this organ? Is it any
more singular that this spiritual stimulus should endow
^ach structure with power to exclude all noxious
substances, and select each its natural excitant, than
that the sense of hearing should only appreciate one
voice, in the midst of a hundred other voices and in
struments, whenever the will so directs ?
In order to acquire a correct idea of the functions
of life, it is necessary, in the first instance, to contem
plate the body as a perfect machine — adapted in every
part by a definite and special organization, to receive
different impressions according to the nature of the
substances or excitants presented, and the offices
2
26 DOCTRINES RESPECTING A VITAL PRINCIPLE, ETC.
which they are destined to perform. Without doubt
chemical and mechanical forces exercise an important
influence in the operations of this machine. The com
bustion of oxygen with the carbon at the lungs, and
in other parts of the system, must develop heat, ex
pansion and motive power, and mechanical causes
may operate somewhat in adding to this force, yet all
of these influences are wholly inadequate to accom
plish and perpetuate the more complicated phenomena
of life. It is then essential that another important
agency should be every where present, in order to
enable the organs to respond properly to their special
stimuli. Consequently we have " superadded to the
body" an intelligence which affords a specific stimulus
to every part ; acting solely through each particular
structure as it exists, and modified in its operation
according to the modifications or alterations in the
organs themselves. If the structure of the eye is
injured, an imperfect image will be formed upon the
retina, the intelligence will manifest itself through
this injured structure, and this sense altogether im
paired. If the structure of other organs be altered, so
that their natural stimuli cannot be brought to bear as
usual, the operation of the spiritual stimulus will be
modified in proportion, and disordered function result.
This stimulus acts at each particular part, specifi
cally, and in a measure independently of other parts,
causing irritability of different grades in the muscular
fibres, and exercising those peculiar properties every
where, which have been erroneously attributed to a
different and independent principle, the vital force.
The influence likewise which it exercises upon the
body as a cause of disease has never jet been properly
appreciated. This is due, first, to the erroneous sup
position that the operations of the soul are confined
to simple conception, judgment, comparison, and other
intellectual phenomena ; and, secondly, to the before-
mentioned arbitrary custom, derived from antiquity,
of attributing all other phenomena connected with
the organism, which cannot be explained by the known
laws of matter, to the agency of another influence, to
which Hippocrates gave the name of phusis, Paracel
sus and Van Helmonf of archcus. and Stahl of anima,
DOCTRINES RESPECTING A VITAL PRINCIPLE, ETC. 27
but which medical men of the present day designate
as the " vital principle " " vital properties" " vis vitce"
" vis insita" &c.
But what reason is there for limiting the influence
of the soul to the mere intellectual operations ? What
good reason for supposing that the soul is located
exclusively in the brain, and that the rest of the body
is only acted upon indirectly and secondarily by this
subtle and immaterial power ?
In the ordinary waking state, the operations of the
soul are manifested directly through the media of
all the physical structures, and these manifestations
are limited in extent and variety, and subject to cer
tain fixed laws, having reference to the structures and
the stimuli acting upon them. Thus, the power and
extent of vision is determined by the physical condi
tion of the eyes, and the brain (wrhich furnishes them
with bloodvessels and nerves), and the number and in
tensity of the rays of light which strike the retina.
Light, in this instance, is the material stimulus, which
passes through the structure of the eye in the same
manner as it passes through an optical instrument,
producing the reflection of images upon the retina in
a manner analogous to images formed in a camera ob-
scura. The soul takes immediate cognizance of these
images upon the retina, in precisely the same manner
that it recognises the images in the camera obscura. It
is worthy of note, that these images may be formed
upon the retina, and yet the soul be entirely uncon
scious of them : so may an absent-minded man look
into a camera obscura, filled with reflected figures, and
derive no impressions from them. Without this in
visible, incomprehensible, and eternal soul, the eye
would be but a mere optical instrument, perhaps
taking the first rank amongst such instruments, but
entirely on a par with them, and subject to similar
laws. No material agent, like electricity, magnetism,
galvanism, or what has been termed animal fluid,
could ever enable it to appreciate impressions, or per
form a single act of intelligence.
Every structure of the organism, whether situated
within the cranium, chest, abdomen, or in any other
part, is in a similar condition in relation to the soul,
28 DOCTRINES RESPECTING A VITAL PRINCIPLE, ETC.
and, without its presence and influence, is subject
only to the ordinary laws of matter. Let those che
mical theorists who suppose that the organism is ac
tuated by electricity, galvanism, magnetism or caloric,
instead of by an immaterial and incomprehensible
spirit, adduce a single example in which the former
agents have acted on matter in such a manner as to
produce an idea, or anything analogous to reason, and
we will then allow that such doctrines are worthy of
consideration.
It is the office of the soul to preside over the neces
sities of the physical man — to guard against and ward
off injurious influences, and to respond to all impres
sions made upon the textures. So long as the normal
physical condition exists, and no undue influence is
exerted upon the mind, a spiritual, or, (as others will
have it,) a vital equilibrium, is maintained throughout
the system ; but if a part be attacked by an enemy in
the form of inflammation, or if an undue impression
is made upon the mind, this equilibrium is disturbed —
the spiritual force is unequally distributed, and disor
dered action follows.
We append a few examples to illustrate the in
fluence of mental impressions in modifying the action
of the tissues : An individual in perfect health, and
undisturbed by any external influence, finds himself
in a gallery of paintings. At one point a devoted
daughter is seen braving the horrors of a foul dun
geon, to offer from her own breast sustenance to an
aged and starving father, and while we look, the lach
rymal glands are excited, and unbidden tears flow
freely. At another point, an inhuman monster has
seized an innocent child, and is in the act of dashing
out its brains against the wall, and while we gaze, the
blood mounts to the brain, the cheeks glow with in
dignation, and the heart throbs violently at the bare
contemplation of the outrage. Another tableau meets
the view, and we see the executioners in the act of
casting a struggling criminal into a den of poisonous
serpents, and, as we behold the reptiles coiled up for
a deadly spring, with fiery eyes and forked tongues,
the blood forsakes the surface, the stomach sickens,
the heart sinks, and a cold shudder steals over the
DOCTRINES RESPECTING A VITAL PRINCIPLE, ETC. 29 *
whole system. Another scene presents itself : we be
hold a table loaded with the most tempting viands
and fruits, and an immediate change occurs in the
salivary glands, the mouth fills with saliva, the stom
ach indicates its want, and a general perturbation of
the digestive system ensues. The mere sight of an
epileptic often induces a corresponding complaint in
others; the indulgence of bad habits in one member
of a family, like snuffling, distortion of the mouth,
eyes, &c., frequently bring about the same habits in
other members of the family. Violent emotions from
sudden intelligence, whether good or bad, often induce
diarrhoeas, syncope, catalepsy, apoplexy, mania, &c. ;
tear and apprehension are most powerful predisposing
causes of disease, and when excessive, often act as
exciting causes, particularly during the prevalence of
epidemic and contagious affections, as cholera as
phyxia, small-pox, yellow and typhus fevers, &c. Pro
tracted grief is a common cause of chronic diseases,
like dyspepsia, jaundice, neuralgia, hypochondria, pkthi-
sis pulmonalis, &c. Intense and exclusive application
to any given subject, eventually causes disease of the
brain and nervous system, and mental derangement.
The hypochondriac, who suffers under the effects of
some morbid fancy, continues to feed his malady by
pondering over his imaginary ailments ; the monoma
niac, as he dwells upon his delusion, fans the flame
which is consuming him. If an individual in the most
perfect health be told by several different persons that
he looks pale, haggard, and sick, it is more than pro
bable that the impression will exercise so powerful an
influence, that he will actually feel sick, and take to
his bed : we have witnessed more than one example
of this kind. In disease, also, the manner, bearing
and expression of the physician, often exert the most
surprising effects upon the patient, either in ameliora
ting or aggravating his malady. Most diseases are
attended with an exalted state of the nervous system,
and with a highly sensitive and irritable condition of
the mental faculties. In this condition, a doleful ex
pression of countenance, or words of doubt, discou
ragement and sadness, are often capable of plunging
the patient into the most profound state of mental
y DOCTRINES RESPECTING A VITAL PRINCIPLE, ETC.
and physical depression, and thus aggravating, to
a serious extent, his malady ; while on the other
hand, a cheerful face, a lively and agreeable manner,
and words of hope and encouragement, usually exer
cise an influence of the most favourable character,
and conduce very materially in bringing about a cura
tive reaction of the organism. It should never be for
gotten, that courage, hope, confidence, and a cheerful
state of mind, are powerful tonics, arid often enable
the healthy system to resist the influence of conta
gious, epidemic, and other noxious impressions, and
the sick organism to combat successfully the destruc
tive effects of disease ; while fear, apprehension, grief,
despair of recovery, sadness, and depression of spirits,
by impairing the resisting powers of the economy,
become both predisposing and exciting causes of dis
ease. Show me a physician who has attained a high
reputation in the treatment of difficult and dangerous
cases of disease, and I will have confidence that he
is one who carries a cheerful face ; who delights in
dwelling upon the bright and pleasant things of life,
rather than upon those which are gloomy and dismal ;
and who does not fail to infuse into his patients, and
all around him, confidence, hope, and comfort. The
expression and bearing of such a man always act as a
beacon of hope, to arouse the sinking energies of the
patient, and to encourage him to strive against the
depressing influence of his malady. In these, and
other analogous instances, it is the intelligence alone
which is operated on, and which diffuses it$ influence,
not over any vital properties of the organism, but
upon the respiratory, circulatory, digestive, and ner
vous systems.
We have, then, constantly operating upon the ma
chine, first, what may be termed the material, or natu
ral stimuli, and second, the immaterial, or spiritual
stimuli, both of which are absolutely essential to the
continued performance of the functions. In some
parts of the organism, these material excitants must
be constantly present, in order that the system may
be kept in operation. The heart and blood-vessels,
and the respiratory organs, must be incessantly acted
upon by the blood and atmospheric air, in order to
DOCTRINES RESPECTING A VITAL PRINCIPLE, ETC. 31
ensure life. Other parts, like the stomach, lacteals,
capillaries, &c., may be deprived of their natural
stimuli for a length of time without causing death,
but not without inducing derangement of function,
and disease. These material stimuli not only exercise
a highly important influence in the phenomena of life,
but it is upon them that morbific and other noxious
impressions are often made in causing disease. Ac
cording to Liebig, " the slightest action of a chemical
agent upon the blood, exercises an injurious influence."
Any material deviation, then, from the natural proper
ties of the inspired air, or the other stimulants of the
organism, must constitute a source of disease.
The other agency exerts a not less important in
fluence over all parts of the body, and gives rise to its
manifestations in accordance with the peculiar organ
ization and modification of each structure. This
property, which has been attributed to the " vital
principle," or " nervous force," is due solely to an im
material, or spiritual agency — the intelligence, or soul.
The operation of this intelligence upon the organs,
produces that peculiar state which enables them, when
supplied with their material stimuli, to accomplish
their functions. It manifests its power in the capilla
ry system in enabling these vessels to exclude the red
globules ; over the lacteals, in enabling them to ex
clude all but the nutritious portions of food ; over the
organs of involuntary motion, in enabling them to
respond with uniformity and regularity to their mate
rial excitants ; over the nerves of sensation and mo
tion, in enabling them to take cognizance of injurious
foreign impressions, and to exercise voluntary mo
tions ; over the organs of the special senses, in ena
bling them to appreciate sight, hearing, smell, taste,
and touch. This spiritual influence operates only
through the medium of these organs and tissues, de
veloping specific and harmonious manifestations, ac
cording to the peculiar use and structure of each part.
Under its guidance the molecules are appropriated, and
become a part of the organism. Through the same
influence the system is enabled to resist, to a certain
extent, morbific and other injurious impressions. It is
this stimulus which endows each tissue with its spe-
32 DOCTRINES RESPECTING A VITAL PRINCIPLE, ETC.
cific irritability, causing each part to recognise and
respond to its own natural material excitant, and offer
resistance to the application of all disturbing agen
cies.
The soul does not leave the body, until the struc
tures are so much injured, that the functions all cease
operation. Many organs may be destroyed, or ren
dered incapable of transmitting mental or spiritual
impressions, yet the intelligence, entire and unaltered
of itself, will still pervade the remaining portions of
the organism. It will still manifest itself just so far
as it finds normal organs and tissues to operate
through or manifest an influence upon. The material
parts alone may be impaired or obliterated, but so
long as there is life, the immaterial part must pervade
the body, unaltered, although its manifestations may
be entirely changed.
The objections which we have advanced in rela
tion to a vital principle, apply with equal force to
the arbitrary and improper use of what is termed
dynamic influence. Hahnernann, when • alluding, in
his Materia Medica, to the therapeutic power of the
sixtieth potency of thuja, remarks in a note as fol
lows: " The discovery that trituration and succussion
develop the medicinal properties of drugs, in propor
tion as these processes are carried on further, until
the material substance shall have been transformed,
as it were, into medicinal spirit, is of inexpressible
value, and so undeniable, that those who, from a
want of knowledge of the .resources of Nature, con
sider homoeopathic attenuations as mere mechanical
divisions of the original drug, must be struck dumb
whenever they consult experience."
We regret that the great Hahnemann has fallen
into the fatal and universal error of the allopaths,
since the days of Hippocrates, of calling things by
their wrung names, and of endeavouring to explain
phenomena which cannot be explained in the existing
state of science.
Experience teaches, that minute atoms of certain
drugs possess more power to impress the structures
of the organism, than larger quantities of the same
drug in a crude state.
DOCTRINES RESPECTING A VITAL PRINCIPLE, ETC. 33
Hahnemann, carrying his trituration and succussion
to a great extent, and still finding powerful remedial
effects, hastily and quite arbitrarily concludes, that
" the material substance has been transformed into a
medicinal spirit." This inference, in our humble
opinion, is altogether absurd and unwarrantable.
Who supposes it possible, that a material substance
can be transformed into a spiritual one ? Who sup
poses that matter can be reduced, by any process,
into any thing but matter, in a different state of at
tenuation ? Medicinal spirit, and dynamic proper
ties, are vague, and as we believe, absurd expres
sions, calculated to lend an air of mystery to ex
plicable phenomena, and lead to erroneous views re
specting homoeopathy. We unhesitatingly assert,
from positive observation in many instances, that high
attenuations of drugs possess the power to impress
the human organism, under certain circumstances ;
but what reason has Hahnemann, who made this im
portant discovery, to assert that such drugs have been
transformed, by trituration and succussion, into a
spirit, or an immaterial nothing 1 Because the present
knowledge of chemistry does not enable us to analyze
and detect minute, atoms of matter, has any man a
right, for this reason, to declare that a material sub
stance can be reduced into a spiritual and immaterial
one ? Because our scales are not sufficiently delicate
to weigh the medicinal atoms existing in high atten
uations, — or our optical instruments sufficiently
powerful to see them, shall we say that they abso
lutely have no weight, or that matter has been anni
hilated?
Are there any who suppose, that the miasmatic
particles which arise from vegetable decomposition
and produce fevers, or the contagious effluvium which
arises from smallpox, scarlet fever, or measles, or the
vapours which arise from ether, chloroform, hydro
cyanic acid, &c., have become obliterated, annihi
lated, and extinct, so that they possess no form,
weight or substantial existence whatever, as soon as
they escape into the air in imponderable atoms, though
becoming capable of impressing the structures of the
body so violently ? Are there any who doubt, that in
2*
34 DOCTRINES RESPECTING A VITAL PRINCIPLE, ETC.
all these instances, something material is introduced
into the blood, and conveyed to certain textures to
produce an impression by contact ? Let us rather
acknowledge that the still imperfect state of science
does not enable us to analyze and detect these mi
nutely attenuated atoms, rather than resort to an
absurdity, to cover our want of knowledge, by calling
them spiritual, vital, or dynamic.
The great stumbling-block which has always been
in the way of real advancement in medical know
ledge, is the propensity which has existed to explain
things which were difficult, or perhaps not at all
susceptible, of explanation, by vague and unmeaning
terms, instead of acknowledging our ignorance, and
awaiting farther developments in science. Shall we
say of atmospheric air, azote, oxygen, hydrogen, car
bonic acid, and other gases, that they are spiritual
and immaterial, and exercise their effects upon the
organism dynamically, simply because we cannot
weigh or behold the precise form and size of the mi
nute molecules of which these gases are composed ?
Is it supposed, when air is introduced into the lungs,
that an immaterial substance enters into chemical com
bination with the carbon of the blood, changing it
from a dark to a bright red colour, and giving rise
to the legitimate effects of chemical action between
two material substances, viz., caloric and expansion ?
When we pour a heavier into a lighter gas, as for
example, carbonic acid gas into common air, is it sup
posed that the former falls to the bottom and usurps
the place of the latter, by some vital, spiritual, or dy
namic influence, or simply by the force of gravity or
weight ? Or when the balloon, inflated with hydrogen,
rises into the clouds, does the phenomenon occur
through some immaterial agency, or because hydrogen
is lighter than oxygen and nitrogen, and is consequently
forced upwards by the pressure of these two combined
gases? And yet the atomic molecules, composing
these gases, are as much attenuated as the higher at
tenuations of a homo3opathic medicine. Science is
even progressed so far, that we can now compress cer
tain gases, like the carbonic acid gas, &c., into an
actual solid body.
DOCTRINES R INSPECTING A VITAL PRINCIPLE, ETC. 85
Spallanzani, Prevost and Dumas have proved, that
if three grains of the fecundating fluid of a frog be
dissolved in a pound of water, a single drop of this
solution is sufficient to vivify many thousands of eggs
by simple contact, and yet this globule of water only
contains 2,994,687,500th part of a grain ! In this case
an infinitesimal quantity of matter has impressed
other crude substances by contact, in such a manner
as to produce visible changes in these substances, — a
new action, and one the most wonderful in nature —
life. And the mtalist of the old and the dynamist of
the new school, would attribute this phenomenon to
some mysterious vital or dynamic influence : but can
these minute atoms of fluid be annihilated or termed
vital, dynamic, spiritual or immaterial properties of
the fluid, and the effects resulting from their contact
with the eggs, vital, dynamic or spiritual effects?
Because we cannot handle, smell or taste the atoms
dissolved in the globule of water, shall we assert that
some mysterious change has been wrought upon this
material substance, and that therefore it is not sub
ject to the ordinary laws of matter, but must operate
in a spiritual manner ? Common sense forbids.
If we take the thousandth part of a grain of an or
ganized substance and submit it to the lens of a pow
erful microscope, we behold all the separate parts of
its organization, and containing within itself innumer
able distinct nuclei, which may be again subdivided
into perfectly organized molecules, until the micro
scope can no longer appreciate the separate particles ;
and yet no one supposes that the substance ever be
comes annihilated or spiritualized. Even one part in
ten thousand of chloroform, may be detected in the
blood, by converting it at a red heat into chlorine
and hydrochloric acid. How true then the axiom of
Lavoisieur, Nothing is lost, nothing is created.
Away then with all unmeaning expressions, like
medicinal spirit, vital power, dynamization ; lefc us own
our ignorance respecting the precise changes which
drugs undergo by trituration and succussion, and their
exact methodus modendi, and no longer imitate allo
pathy, by resorting to spiritual subterfuges, in order to
36 THERAPEUTICS.
give some explanation of the great facts which Hah-
nemann has discovered, but which cannot yet be fully
explained or understood.
CHAPTER IV.
THERAPEUTICS.
At the present time, there exists no uniform or ge
neral system of therapeutics, because there is no the
ory of disease in which universal confidence is re
posed. The medical world being divided into several
distinct schools, each inculcating different doctrines
concerning pathology and the methods of cure, and
all endeavouring to sustain their favourite systems,
without much regard to accuracy respecting facts, or
to logic in their inductions, it is not surprising that the
science of medicine is so often looked upon by the
public with distrust and disrespect. We behold the
vitalist, denouncing the doctrines of the chemist and
mechanician, as inconsistent and highly dangerous in
practical operation, \vhile all agree in ridiculing that
system which is alone founded on accurate observa
tion of facts, homoeopathia.
It is doubtless true that many new and valuable
ideas may be derived from each of these conflicting
schools by the medical philosopher, whose sole object
is truth. Indeed, the coincidence of opinion between
the father of homoeopathia and many of the most
S [-eminent advocates of the vita) theory, like Paine,
ichat, Philip, &c., in regard to physiology and pa
thology, is remarkable. These eminent authors not
only agree respecting the " properties and laws of
healthy beings," but they concur as to the changes and
modifications which take place in diseased states of
the organism. Although they entertain totally differ
ent views concerning the practical application of re-
THERAPEUTICS!. 37
medics, it will be observed that the allopath often
adopts the precept " similia similibus" in effecting
his cures.
Nor are there men wanting, — men who stand high
in the ranks of allopathy, — who unhesitatingly place
the pathological and therapeutical doctrines of ho
moeopathy, far above those of either the chemical or
physical schools.
Thus, Paine, in his " Institutes of Medicine," ob
serves, " It is due to truth (fiat justitia mat coduni),
that the physiologist concede to the homcBopath that
his hypothetical views may be directed by an en
lightened* understanding of the properties and laws
of healthy beings. Upon this ground, indeed, his
hopes can alone repose ; and even his doctrines in
pathology and therapeutics are a thousandfold better,
more rational, more consistent, more conducive to
health and to life, than any or all of the tenets of the
chemical or physical schools."
We shall not be surprised at this concession, when
the opinions of Hahnemann are contrasted with those
of many allopathic authors who have written since
his day.
The vitalists hold, " that all disease consists in a
modification of the vital properties and a consequent
change of function, and is, therefore, only a variation
of the natural states ; that the artificial cure consists
in a restoration of these properties and functions by
making upon the former certain impressions which
enable them to obey their natural tendency to a state
of health ; that remedial agents of positive virtues
operate like the truly morbific, but less profoundly in
their therapeutical doses, and that the philosophy of
their cure consists in establishing, in a direct manner,
certain morbid alterations in the already diseased pro
perties and actions of life, which are more conducive
to the natural tendency that exists in the vital pro
perties to return from a morbid to their natural states."
(Paine.)
Hahnemann and many of his disciples also suppose
that* " it is solely the morbidly affected vital principle
* Hahnemann's Organon.
38 THERAPEUTICS.
which brings forth diseases ; that in disease this spon
taneous and immaterial vital principle, pervading the
physical organism, is primarily deranged by the dy
namic influence of a morbific agent, which is inimical
to life. Only this principle, thus disturbed, can give
to the organism its abnormal sensations and incline it
to the irregular actions which we call disease."
So also of the operation of remedies, Hahnemann
has it, " that the brief operation of the artificial mor
bific powers, which are denominated medicinal, al
though they are stronger than natural diseases, ren
ders it possible that they may, nevertheless, be more
easily overcome by the vital energies, than the latter,
which are weaker. Natural diseases, simply because
of their more tedious and burdensome operation, can
not be overcome by the unaided vital energies, until
they are more strongly aroused by the physician,
through the medium of a very similar, yet more pow
erful morbific agent — (a homoaopathist medicine).
Such an agent, upon its administration, urges, as it
were, the instinctive vital energies, and is substituted
for the natural morbid affection hitherto existing.
The vital energies now become affected by the medi
cine alone, yet transiently ; because the medicinal
disease is of a short duration."
The vitalists of both schools also suppose that natural,
morbific and remedial agents, possess certain peculiar
and distinct properties which enable them to exercise
an influence only on particular parts of the system,
through the means of particular nerves; "passing
over, in the fulfilment of this law, various intermediate
nerves of more direct anatomical connection." (Paine).
Although we are not advocates of the vital theory,
yet it must be conceded that this principle of elective
affinity is so universal, as applied to the operation of
morbific and remedial agents, that the influence which
any substance of either class exerts upon the organ
ism, may. with propriety, be denominated its specific
effect. The miasms of plague, of intermittent, yellow,
and certain other fevers ; the infection of conta
gious diseases ; the virus of hydrophobia, syphilis,
gonorrhea, &c., all produce peculiar and specific
effects upon the system. Each of these substances
THERAPEUTICS. 39
possesses the property of selecting that tissue for
which it has an affinity, and of expending its entire
primary action upon the particular part selected.
It is owing to .this specific law, that medical men
have been able to classify diseases ; to predict with
certainty, that exposure to the influence of particular
morbific agents, under certain circumstances, will
give rise to abnormal action in certain parts, attended
with a definite and uniform train of symptoms.
It is also in virtue of this specific law, that medi
cines may be administered which operate with cer
tainty upon particular tissues and organs, and effect
those primary and sympathetic modifications in dis
eased states of the organism, which enable nature to
bring about safe and speedy cures.
One of the chief objections urged against the thera
peutical doctrines of homoeopathia, is the supposed
" fallacy of reasoning from the effects of remedial
agents, upon healthy to morbid conditions." * The
reason adduced for this opinion, is the fact that dis
eased parts become modified in their action, and far
more susceptible to the operation of remedies, than
when healthy. This last statement is doubtless true,
and it stands, as we shall endeavour to show, at the
foundation of the homoeopathic method of administer
ing medicines.
Although the axiom, " contraria contrariis opponen-
da" is almost universal among the different schools of
allopathia, so far as theory is concerned, yet in prac
tice, the principle " similia similibus curantur" is, as
we have before observed, not unfrequently adopted.
In order that a clear understanding may be acquir
ed of the manner in which medicines operate, as ex
hibited by the old and new schools, we shall attempt
to demonstrate : —
1st. That most morbific and remedial agents operate
specifically and with much uniformity, both in health
and disease, as causative and curative agents.
2d. That all drugs produce upon the human body
primary and secondary effects, the first of which ap
pear speedily, and when the dose has not been exces-
* Paine's Institutes of Medicine.
40 SPECIFIC EFFECTS OF
sive, are of short duration, and are then succeeded by
the second, which are of an opposite character, and
permanent.
3d. That in disease, the susceptibjlity of the affect
ed parts to the action of remedies, is vastly greater
than of the same parts when in health.
4th. That medicines, \vhen administered in a crude
form and in large doses, according to the doctrines and
ordinary practice of the old school, whether applied
directly to the diseased organ or tissue, or to a heal
thy structure remote from the diseased part, are not
only incompetent to eradicate disease in a safe and
speedy manner, but generally serve to aggravate the
already existing symptoms, and by superinducing ad
ditional medicinal disease, complicate, to a serious ex
tent, the original natural affection.
5th. That when a curable natural disease has been
excited in the organism, attended with a definite train
of morbid symptoms, a medicine capable of causing
(in large doses) a similar series of symptoms, in
health, will become speedily curative of such natural
disease, if administered in the attenuated doses of
homoeopathy.
CHAPTER V.
SPECIFIC EFFECTS OF MORBIFIC AND REMEDIAL
AGENTS.
All are aware that the naturalpoisons of certain ani
mals ; the virus of hydrophobia, syphilis, gonorrhoBa and
sycosis ; the miasms of plague, and of yellow, typhus
and intermittent fevers ; the infection of contagious
diseases, &c., exercise, when introduced into the cir
culation, specific effects upon the human system, and
give rise to definite and easily recognised symptoms.
There are other morbific agents, like intense and
protracted heat and cold, atmospheric vicissitudes,
excessive physical and mental exertion, violent emo
tions, &c., that operate in a more general, but not less
MORBIFIC AND REMEDIAL AGENTS. 41
specific manner. Their operation, when carried so far
as to become morbific, induces debility of the nervous
system ; loss of irritability in the capillary vessels,
which makes them incapable of excluding the red glo
bules, and as a consequence, developing augmented
heat, swelling, redness, and pain.
Eberle, in his Practice of Medicine, asserts that
" the influence of almost every agent, whether morbi
fic or medicinal, appears to possess a kind of elective
affinity for some particular organ or structure of the
organization." This fact is so apparent, in regard to
morbific agents, that it scarcely requires notice ; but
there are many authors who still entertain doubts re
specting the specific action of medicines. An attentive
examination of the following facts, must, however, set
tle the question satisfactorily in the minds of all im
partial inquirers.
Remedial agents operate in the same specific man
ner, both in health and in disease ; but with the dif
ference that in the latter condition, only a very minute
quantity of the specific agent is requisite to produce a
salutary impression, on account of the augmented sus
ceptibility to remedial impressions, which diseased
parts acquire.
1. " A medicine administered in certain doses, and
during a certain period of time, can produce patholo
gical lesions analagous to those that characterize cer
tain diseases."
2. " This same medicine, given to a healthy indivi
dual, on the same principles, produces the character
istic symptoms of the diseases whose pathological le
sions it gives rise to."
3. " This medicine is a specific of these same dis
eases."
4. " Specificity is not therefore an isolated fact, but
the law which should guide medical treatment." —
[Des Specifiques en Medecine, Paris, 1847 ; par L. J. J.
Molin.]
The experiments of Majendie, Blake, Pereira, Rau,
Liebig, Miiller, Orfila, Griesselich, Molin, Matteucci,
and Philip, prove conclusively, that most morbific and
remedial agents produce their effects after having
been absorbed into the blood. It has also been proved
42 SPECIFIC EFFECTS OF
with equal certainty, that foreign substances, when
absorbed into the circulation, are conveyed to those
structures for which they have a special affinity, and
there make a specific impression, which modifies the
function of the part, according to the nature of the
agent and predisposition of the individual. The blood
serves as the conducting medium merely, and if the
absorbed substances do not possess the power of exer
cising an influence upon any tissue, they may continue
to circulate through the lungs until the inspired air
gradually neutralizes them, or they may remain for an
indefinite length of time, (as sometimes happens in cases
of hydrophobic virus and fever miasms, without affect
ing the system.) and yet retain their activity. The rea
son of this may be, that the tissues upon which they act,
are in so perfect a state of vigour, as to be able to resist
the power of the noxious agent, until some cause shall
enfeeble the part to be affected, and thus predispose
it to receive the injurious impression.
It will not be denied, that both in healthy and dis
eased states of the organism, cantharides, copaibiss,
cubebs, the turpentines, juniper, squills, colchicum,
digitalis, apis, mel, cajuputi, and most other diu
retics, produce their effects by acting directly, or
specifically, upon the kidneys, as topical irritants ;
that the preparations of mercury, nitric acid, iodine,
&c., exercise a direct and specific action upon the
glands, mucous membranes, and skin ; that senega,
phosphorus, ipecacuanha, tartarized antimony (whe
ther taken into the stomach or injected into the
veins), and many of the resins, exercise a specific
action upon the lungs ; that aloes, gamboge, colo-
cynth, act specifically upon the stomach and rectum,
while senna, rhubarb, scammony, jalap, and certain
other cathartics, spend their effects upon all portions
of the intestinal canal ; that ergot, savin, pulsatilla,
madder, tansy, &c., operate specifically upon the
uterus ; that belladonna, opium, stramonium, strych
nia, hyoscyamus, conia and coffea, impress speci
fically some portion of the nervous system ; and, in a
word, that almost every drug impresses certain tis
sues in preference to others, and that a knowledge of
the manifestations to which these different impres-
MORBIFIC AND REMEDIAL AGENTS. 43
sions give rise, can alone enable us to combat dis
eases. That the above enumerated substances are
actually absorbed, and exert a topical effect, is appa
rent from the fact that they have often been detected
in the blood, secretions, excretions, and even the solids
of the body.
It is asserted by Flourens, " that opium acts speci
fically on the cerebral lobes ; that belladonna, in a
limited dose, affects the tubercula quadrigemina, and
in a larger dose the cerebral lobes also ; that alcohol,
in a limited dose, acts exclusively on the cerebellum,
but in a larger quantity, it affects also neighbouring
parts ; and, lastly, that nux vomica more particularly
affects the medulla oblongata." He also states,
"that in birds it is possible to observe, through the
cranium, changes of colour (some alterations in the
vascular condition of the parts) which these agents
effect in the brain."
Pereira, in his Materia Medica, also declares that
"the ammoniacal, empyreumatic, and phosphoric
stimulants, containing ammonia and its salts, the
empyreumatic oils, phosphorus, musk, and casto-
reum, all agree in producing a primary and specific
effect on the nervous system, the energy and activity
of whose functions they exalt. On account of their
specific influence over the nervous system, they are
administered in various spasmodic or convulsive dis
eases, especially in hysteria, and also in epilepsy and
chorea. The beneficial influence of some of the vege
table tonics (as cinchona) in intermittent diseases,
should probably be referred to the specific effects of
these agents on the nervous system. The prepara
tions of arsenic, silver, copper, bismuth, zinc, &c.,
are usually, but, as I think, most improperly, denomi
nated tonics. They are agents which, in small and
repeated doses, as well as in large and poisonous
doses, specifically affect the nervous system."
We are also assured by Liebig, in his work on
animal chemistry, that *' we can by remedial agents
exercise an influence on every part of an organ by
substances possessing a well defined chemical ac
tion."
It will be observed that we have adopted, in part.
44 SPECIFIC EFFECTS OF
the views of Miiller, in regard to the operation of
morbific and remedial agents. This distinguished
physiologist supposes that the blood is only the " ve
hicle of introduction," and that as it passes through
the tissues of different organs, the medicinal particles
with which it is impregnated " act on one or more
parts which are endowed with a peculiar suscepti
bility to their influence. He also supposes "that a
change is effected in the composition of the organic
matter of the part acted on."
That medicinal substances induce modifications in
the functions of the organs, by topical action, is
proved, as we have before observed, from the fact
that the medicinal particles are often found in the
excretions of the affected part. The inference must
follow, from a careful consideration of all the facts
bearing upon the subject,* that the functions of the
organism are generally morbidly altered by the direct
action of noxious substances.
In regard to the mode in which these substances
operate, we suppose that their primary impression is
made upon the sentient extremities of the nerves, im
pairing their integrity, and rendering them incapable
of conducting the spiritual stimulus (which is an es
sential condition of irritability) to the extreme vessels.
It must be borne in mind, that in all inflammations,
the capillaries are the " instruments of disease ;" that
the primary impressions of all deleterious agents are
made upon these delicate structures, and that all of
our remedies must be directed with reference to the
state of these vessels, in curing disease. "Upon these
vessels all remedial agents exert their curative effects,
whether by their direct action, or through the in
strumentality of the nervous power." — (Paine).
The extreme terminations of the nerves are so
highly impressible, that the very minutest quantity of
a specific agent is capable of producing prompt and
decided effects, while the same agent would prove
powerless, if applied to the larger nerves. Thus it is
* For further proofs respecting the doctrine of absorption and topical
action of drugs, see the experiments of M filler, Tiedemann, Gmelin,
Majendie, Matteucci, Liebig, Ran, Flourens, Dutrochet, Blake, Herring,
Mayer, Christison, Orfila, and Dumas.
MORBIFIC AND REMEBIAL AGENT??. 45
that imponderable substances and mental emotions
are so often the causes of disease. Here we have one
reason, also, why medicines, when administered ho-
moeopathically, produce those happy modifications
in the affected parts which dispose them so speedily
to recovery. In connection with this, if we take into
consideration the extreme sensibility which diseased
parts acquire to the operation of medicinal agents,
we shall be unable to doubt the propriety of ad
ministering medicines according to the homoeopathic
method.
Miiller supposes that when impressions are made
by specific substances, " changes are effected in the
composition of the organic matter of the parts acted
on." Of this, however, there is no satisfactory evi
dence. On the contrary, we know positively that
very many cases of disease occur without giving
rise to any change whatever in the organic construc
tion of the parts affected.
One of the first indications generally observable in
an abnormal state of an organ or tissue, is a loss of
tone, or irritability and perverted function of the ca
pillary vessels. In the experiments performed upon
the blood, by Philip. Alston, and Gallois, it was ob
served that the smaller vessels were the first to suc
cumb to foreign influences, and then, if the potency
of the agent wrere increased, the larger vessels would
become affected.
Now, when we reflect, that irritability is dependent,
1st, upon a normal organization of parts ; 2d, a regular
and uniform supply of natural material stimuli, the ar
terial blood, &c. ; and 3d, a healthy action of the
mind, in order that the spiritual stimulus shall make
its due impression, we can readily conceive how slight
a cause, moral or physical, morbific or remedial, may
disturb or impair this irritability, and thus induce dis
ease. " Every part of the organism depends, for the
performance of its proper functions, on the receipt of
arterial blood and of nervous influence ; so alterations
in the supply of either of these essentials may modify
or even suspend the functions of a part." *
* Pereira's Mat. Med.
46 SPECIFIC EFFECTS OF
The nerves are simply the conductors of the intelli
gence, and so long as their integrity, tone, or conduct
ing power, remains unimpaired, this essential condition
of irritability will remain. If, however, any cause acts
upon them in such a manner as to injure or destroy
this important property, the stimulus of the superin
tending spirit, or as the vitalist would say, the nervous
power, is not transmitted, and, as a consequence, dis
ease must result from the absence of one of the im
portant requisites of irritability or contractility.
Injurious impressions may be made upon the ex
treme nerves, either by deleterious matters absorbed
into the blood, and brought into direct contact with
them, or by certain external applications, like electri
city, magnetism, heat, cold, and exercise.
Inflammation may be excited by the operation of
either of these causes, by a primary effect upon the
sentient extremities of the nerves, which induces loss
of tone and conducting power, and as a consequence,
loss of irritability and resisting power in the capillaries.
This impression is not made, as some theorists would
have it, upon an immaterial principle, but upon some
thing material, tangible, and demonstrable, viz., the
nerves themselves.
Poisons and other noxious substances, when taken
into the blood, are rapidly conveyed to all parts of the
body ; and when they arrive at the structures, upon
which they have a specific action, nature makes an
effort to expel them through these particular parts. If
the substance be active in its effects, the impression
which is made upon the minute nerves of the part,
will be in a corresponding manner severe. The length
of time required for foreign substances to produce their
effects, is extremely variable. Some articles, like se
veral of the salts of potash, juniper, the turpentines,
asparagus, indigo, madder, &c., arc expelled through
the urinary organs in a few moments, while other sub
stances may remain in the blood for an indefinite pe
riod of time, or until some predisposing cause shall
act upon the system in such a manner as to augment
its susceptibility, and place it in a condition to be affect
ed by the morbific agent. In some instances, the morbific
agent remains harmless in the circulation, for months,
MORBIFIC AND REMEDIAL AGENTS. 47
and even years, when suddenly, some tissue becoming
enfeebled and incapable of resisting the action of the
specific agent, the disease, in all of its violence, bursts
forth. In cases like these, it is quite evident that the
injurious impressions cannot be made upon the vital
properties of parts, for the effects must be sooner pro
pagated and rendered apparent. Neither can we sup
pose, with the advocates of the chemical hypothesis,
that the constituents of the blood become altered and
contaminated with the peculiar miasms or virus, for
such blood introduced into the circulation of a heal
thy individual gives rise to nothing like the original
disorder, We again repeat, that the blood is simply
the vehicle which conveys the poison, and that no ef
fects are produced, until the structure for which the
poison has the greatest affinity has become ready, from
some predisposing cause, to receive the impression of
the deleterious agent, and thus is specifically affect
ed.,
Why it is that morbific and remedial agents select
particular organs and tissues to exert their action upon,
we do not know ; but that such is the fact, all medical
observers will bear witness. Nor is it more surpris
ing than that some of the natural fluids, like the urine,
gastric juice, biie, &c., remain with impunity in some
parts of the body, while if they gain admission to other
parts, as the cellular substance, or peritoneum, they
occasion inflammation, sloughing, and death.
Some writers attribute the operation of medicines to
an electrical influence. " All bodies," says Bischoff,
" by contact with each other, act as electrics, without,
however, necessarily undergoing any chemical chan
ges. Therefore, when a medicine is applied to the or
ganism, its action is electrical." The instantaneous
effects of very minute quantities of hydrocyanic acid,
sulphureted hydrogen, and carbonic acid gases, and
of strychnia, conia and morphia, certainly bear a close
resemblance to the overwhelming shock of lightning,
and go far to sustain this opinion.
Whether remedies act as topical stimulants, or as
sedatives, dynamically or electrically, may admit of a
question ; but it is quite certain that their primary im
pressions are made upon so mo portion of the nervous
48 SPECIFIC EFFECTS OF
system, and generally on the extreme nerves of the
parts impressed, and those modifications of irritability
produced, which exert either a salutary or injurious
influence over the part acted on. Even in those in
stances where the primary influence has been exerted
upon some portion of the cerebro-spinal or ganglionic
systems, the capillaries receive an almost simultaneous
impression through the sympathetic nerves, which at
once gives rise to disordered function in these import
ant vessels.
Absorption may take place in almost every struc
ture of the body — lymphatics, lacteals, blood vessels,
skin, cellular substance, &c. ; but many circumstances
exert an influence in deterring the rapidity of the pro
cess, as well as the quantity absorbed.
Miiller asserts that " the more the matters are solu
ble, divided and fitted for entering into combination
with the organic juices, the more easily are they ab
sorbed." Absorption also varies according to £he
quantity of liquid which exists in the organism, and is
in the inverse ratio of the plethoric state of the animal.*'
Dutrochet and Edwards have demonstrated that ani
mals absorb water most rapidly after transpiration.
Majendie and Orfila have proved that dogs having
lost large quantities of blood, rapidly absorb strychnia
and die ; while those into whose veins large quanti
ties of water had been injected, remained unaffected by
the same amount of the poison. These facts will en
able us to understand why diseases are not easily con
tracted when an individual is in vigorous health, or
after a full meal.
" Within certain limits, absorption is in proportion
to the temperature of the absorbing body, and of the
body absorbed." (Matteucci.) Therefore, inflamma
tions of all kinds, fevers, &c., facilitate absorption.
For this reason it is, that in acute inflammatory diseases,
the higher attenuations prove efficient, which would
be productive of no effect in the ordinary condition of
the system.
Although, therefore, morbific or medicinal agents
may be absorbed into the mass of blood, on account of
protracted hunger and thirst, or other cause, it does
not follow that anv manifestations will be apparent;
PRIMARY AND SECONDARY ACTION OF DRUGS. P 49
for if the whole organism be in a sound and vigorous
-condition, it will resist the specific action of the sub
stance for an indefinite period. Therefore it is that
certain poisons often remain latent in the circulation
for months, and even years, without being able to ex
ercise their specific action, until some part of the sys
tem becomes disordered in such a manner as to be in
capable of longer resisting the noxious influence. In
many cases of absorption of morbific substances, where
the organism is healthy, it is probable, from their con
stant circulation through the lungs, where they come
in contact with that powerful decomposing agent, the
inspired oxygen, that they become neutralized after a
time, and their noxious qualities destroyed. On the
contrary, if the following conditions are present, viz.,
irritation, inflammation, fever, deranged digestion, de
bility from loss of fluids, insufficient nutriment, &c.,
the morbific agent will be absorbed with facility, and
speedily produce its specific impression.
CHAPTER VL
PRIMARY AND SECONDARY ACTION OF DRUGS.
HOMOEOPATHY teaches that the impressions which
drugs produce upon the organism, in health and in
disease, are analogous in their character. But there
is this important difference between healthy and
diseased structures, that large quantities of the drug
are required to produce appreciable impressions upon
the former, while the susceptibility of the latter is so
morbidly augmented that the most minute atoms of
the medicine are instantly effective. Not only so, but
even the natural material stimuli of the structures can
not be tolerated, but become immediate and additional
sources of disease, and if persisted in, of fatal disor
ganization.
If, then, we desire to know the precise effects of
drugs in disease, it is necessary to prove them by tak
ing large doses in health — doses sufficiently large to
affect the structures sensibly and decidedly. Even if
3
50 PRIMARY AND SECONDARY
contraria contrariis opponenda be adopted as the law of
practice, this is an important discovery, for we may then
administer the remedies with a full knowledge of the
parts they impress, and of the exact symptoms they
induce, and thus remove allopathy a single step from
empiricism. Some eminent writers of the old school
have distinctly recognised the importance of this sub
ject: Thus, Dr. Paris, in his Materia Medica, remarks,
that " observation and experiment upon the effects of
medicine are liable to a thousand fallacies, unless they
are carefully repeated under the various circumstances
of health and disease, in different climates, and on dif
ferent constitutions."
Professor Dunglison, on the seventh page of his
New Remedies, says, " To treat disease methodically
and effectively, the nature of the actions of the living
tissues, in both the healthy and morbid conditions,
must be correctly appreciated ; the effects, which the
articles of the Materia Medica are capable of exerting
under both those conditions, must be known from Ac
curate observation, and not until then can the prac
titioner prescribe with any well-founded prospect of
success."
Pereira assures us, " that in order to ascertain the
action of remedial agents on the living body, it is
necessary that we examine their influence both in
healthy and diseased conditions. For, by the first we
learn the positive or actual power of a medicine over
the body ; while, by the second, we see how that
power is modified by the presence of disease." —
(Pereira's Mat. Med. and Ther. Vol. 1, p. 126.)
Other equally distinguished allopathic writers now
entertain the same views upon this point, but without
taking into consideration some very important circum
stances connected with the provings. We have re
ference to the great fact inculcated by Hahnemann,
that all drugs exercise upon the organism two effects, a
primary and a secondary, and that these secondary
effects are always the reverse of the primary. A
knowledge of this truth will enable us to classify both
the primary and the curative results of medicines, and
thus more clearly to appreciate the phenomena which
should guide us \\\ their application. The primary
ACTION OF DRUGS. 51
symptoms make their appearance soon after the medi
cine has been taken into the stomach, and continue for
a longer or shorter period, according to the magnitude
of the dose, and the condition of the health, after which
they disappear, and the secondary or opposite series
of phenomena manifest themselves, and remain until
the organism recovers its equilibrium. But in a few
instances the power of drugs is displayed in such a
manner that these primary and secondary effects
appear in alternation for a considerable time, when the
primary symptoms yield to the secondary, or serious
organic derangements ensue. The mode of operation
in these instances, is probably analogous to that of the
miasm of intermittent fever, in producing alternate
chills and heat. Medicines of this description are
termed poly crests.
No one who has candidly tested the operation of
drugs with reference to this law, can for an instant
deny its truth and importance ; and the law applies
nT)t only to large doses of drugs, but to every other
cause which unduly impresses the structures ; that is,
in such a manner as to disturb that healthy balance in
the operations of the organs which constitutes health.
Let us examine the ordinary effects of cathartics in
health : first, the mucous membrane of the intestinal ca
nal is irritated or inflamed, and the natural consequence
of inflammation follows in the form of increased
mucous and serous secretion, increased peristaltic ac
tion, and a painful and loose state of the bowels : this
is the primary effect. After several thin discharges
from the bowels, a debility and a depression of the parts
occur (bearing an inverse ratio to the amount of
primary inflammation) ; the peristaltic action becomes
impaired or suspended, and constipation results as the
secondary effect of the drug.
There is no exception to this rule, unless the cathar
tic operates so violently as to produce a permanent
inflammation and disorganization of the mucous mem
brane, in which case the primary symptoms may be
continuous and constitute a permanent affection.
Even in cases of this kind, however, partial reactions
sometimes occur during the course of the malady, and
secondary symptoms are manifested, in the form of
52 PRIMARY AND SECONDARY
constipation alternating with diarrhoea. These violent
primary symptoms rarely continue beyond a few days
without resulting in serious structural lesion, or a
healthy and permanent reaction.
The primary effects of opium, in large doses, are to
induce sleep, lessen nervous and muscular sensi
bility, cause agreeable dreams, and diminish or sus
pend all of the secretions, with the exception of per
spiration, which is augmented. If the quantity taken
has been moderately large, a pleasurable excitement
for a short time precedes the soporific influence, as a
primary symptom. These first results continue from
twelve to forty-eight hours, according to the magni
tude of the dose, when the organism reacts ; the ex
hilaration is succeeded by depression, the sopor by
constant and prolonged wakefulness, morbid irritation
of the whole system, a return, in preternatural quan
tities, of all the secretions which had been suspended,
and a suppression of the cutaneous secretion, whic^Ji
had been morbidly augmented ; and the secondary
effects of the drug are thus manifested.
So long as diuretics continue to irritate the kidneys,
they are forcibly stimulated to pour out an unusual
quantity of urine ; but as soon as the specific is
omitted, the organism reacts against the temporary
irritation set up by the medicine, and a corresponding
diminution of the urinary secretion follows, until the
organ recruits from the previous overaction, and the
disturbed equilibrium is restored.
The primary operation of stimulants gives rise to
an exaltation of the mental and physical powers,
while a corresponding depression and abasement in
variably result as secondary consequences.
The primary operation of digitalis, in large doses,
is to retard the action of the heart and arteries. The
reaction of the system against the drug, or the second
ary effect, is an augmentation of this action.
The primary symptoms caused by aconite, are in-
tenser action of the circulatory vessels ; the secondary
consequence consists of a reduction of the pulsations,
in some instances as low as thirty-five in the minute.
The primary effect of intense cold, is to stimulate
and invigorate the whole system : and the secondary
ACTION OP DRUGS. 53
results are loss of muscular and mental energy, stupor,
and death.
This law of primary and secondary action applies
not only to medicinal, but to a large proportion of
morbific agents. On this supposition we may readily
account for the remissions and exacerbations which
are observed in most fevers. It is only when the
morbific influence has been very active, and the re
sulting inflammation violent, that no reactions or
remissions occur. It may nevertheless be set down as
a general law, that no structure of the human body
can be called into preternatural action, or stimulated
beyond a given point, without a speedy tendency to
reaction on the part of the organism. In severe forms
of disease, this reaction may not be apparent for
weeks, and perhaps until organic lesion occurs ; yet,
sooner or later, some reaction, with secondary symp
toms, manifests itself. There is a healthy point in the
functional actions of the organs — an equilibrium, if we
may be allowed the expression, of the respiratory,
circulatory, digestive, absorbent, assimilative, secre
tory, and excretory functions — which cannot be dis
turbed with impunity. Stimulate one of these beyond
its natural point, and a corresponding depression must
necessarily ensue before the normal balance is re
stored. Each tissue possesses only a definite amount
of resisting power, and therefore every undue expen
diture of this power entails future debility. Nature
is constantly striving to maintain the functions in
their natural condition, and this she accomplishes
by inducing in the different parts a reaction the re
verse of the disturbing cause, and bearing an inverse
ratio to this cause. The amount of strength and
resisting power which is acquired from the food, &c.,
is fixed and definite ; and this force is expended in
limited and definite quantities throughout the econ
omy, and thus secures the healthy performance of the
functions.
The practical deductions which legitimately arise
from these views of this subject, are of the most inte
resting character, as regards the application of reme
dies ; for if the ideas which have here been adduced
are correct, it is plain that the antipathic doctrine
54 SUSCEPTIBILITIES OF ORGANS, ETC.
of cure is erroneous, while the truth of the homoeo
pathic becomes equally apparent.
CHAPTER VII.
SUSCEPTIBILITIES OF ORGANS AND TISSUES TO THE IN
FLUENCE OF REMEDIAL AGENTS, VASTLY GREATER IN
DISEASE THAN IN HEALTH.
ONE of the principal arguments which has been ad
duced against Hahnemann's system of therapeutics,
is the supposed fallacy of judging of the effects of
medicines in disease, from their operation in health. It
is considered that the modifications which occur in
what are termed the " vital properties" of parts, in a
state of disease, also alter the action of remedial agents
in a corresponding manner.
The fact is incontrovertible, that tissues in a state
of inflammation, do acquire properties very different
from what they possess in the normal state ; but re
specting the nature of these acquired properties, nu
merous facts go to prove, firstly, that the parts actually
inflamed, become extremely sensitive to the impres
sions of specific remedies ; and, secondly, that the
facility of absorption is promoted throughout the whole
system. The recent experiments of Miiller and Mat-
teucci have demonstrated the fact, that in proportion
as the tone of the nervous and muscular systems be
comes impaired, or inflammation obtains, up to a cer
tain point, just in the same ratio will absorption be
promoted and foreign agents exercise their influence.
We have seen that inflammation consists in a
" congestion of the capillaries," induced by debility, and
the want of resisting power in these structures, to ex
clude the arterial blood, and that the effects of inflam
mation of a particular organ upon the general system,
are lassitude, pains, and other symptoms which indi
cate diminished nervous and muscular energy. That
condition, therefore, which is termed erethism, is not,
as is sometimes supposed, indicative of increased ner
vous energy, but results directly from loss of strength.
In health, the capillary vessels possess the power of
SUSCEPTIBILITIES OF ORGANS, ETC. 55
excluding all of those constituents of the blood except
the colourless fluid which is their natural stimulant.
Although the capacity of these minute tubes is suffi
ciently large to admit the red globules with ease, yet
they are endowed with a peculiar property which
enables them to resist their entrance.
Any cause, therefore, capable of impairing this
natural irritability, becomes a source of debility and
inflammation.
It has been proved that, in health, most medicinal
substances may become absorbed into the blood ; but
unless they possess some peculiarly noxious qualities,
they will act upon those parts for which they have a
specific affinity, and be thrown off in the form of excre
tions, causing in their passage through the structure
on which they act, only a slight and perhaps unappre-
ciable irritation.
When taken in disease, these same substances are
absorbed with far greater facility, and exercise the
same specific affinity for particular parts as in health ;
but with the difference, that they make impressions
upon the inflamed tissues, far more energetic and
strongly pronounced, than when taken in a healthy
state of the organism. Nor is this augmented suscep
tibility to the influence of remedies, confined to the
tissues primarily affected, but the whole system be
comes far more impressible than during health. It is
a well established law, that no one structure can be
inflamed, without giving rise secondarily to sympathet
ic symptoms in other parts of the economy. It mat
ters not whether the part primarily affected, be the
lungs, stomach, skin, or any other structure, the whole
system may be ultimately disordered, through remote,
contiguous or continuous sympathy. The connection
between the different parts of the human body, through
the media of the sympathetic nerves, is so close and
direct, that no organ can be acted on by a morbific
agent, without developing secondarily sympathetic
symptoms more or less violent, according to the nature
of the agent, the severity of the primary impression,
and the constitution of the individual. All of the or
gans are so designed and constructed by the Supreme
Architect, that, in health, a certain harmony of action
56 SUSCEPTIBILITIES OF ORGANS, BTGV
prevails throughout every part of the machine, caus
ing every function to be executed with uniformity, so
that no disturbance can accrue to any single part,
without impairing this healthy equilibrium,
Paine advances the following sentiments, which
have a powerful bearing upon this subject Probably
no allopath has ever written whose theoretical views
coincide so nearly with the doctrines of Hahnemann,
as those of this distinguished author ; and we only
wonder that their practical deductions should differ
so materially.
" It appears therefore to be a most important law,
that morbid states call into operation the function of
sympathy among organs, which, in their natural state,
manifest but feeble, and perhaps no direct relations
whatever y and that in consequence of morbid changes,
remedial agents will operate sympathetically through
the stomach, &c., upon remote parts, when they would
have no such effect in the healthy state of the organs-
New vital relations being developed by disease, our
remedies continue to operate through those acquired
relations so long as they exist."
Again, "In proportion, therefore, as the susceptibili
ty of the system at large is increased by morbid
changes, or predisposed by morbific influences, so, in a
general sense, will the alterative action of remedial
agents be felt in a corresponding manner."
Again, " It is one of the most important laws in
medicine, that the susceptibility of tissues and organs
to the action of remedial agents, is more or less affected
by disease. Many agents which operate powerfully
in certain morbid states, and in certain doses, both
locally and sympathetically, may be perfectly inert in
the natural states of the same organs."
Finally, "It is worthy of repetition, that such is the
analogy between morbific and remedial impressions,
that the organs which sustain the former are thus ren
dered susceptible of the latter, when they might other
wise be insensible to the same remedial agents, in
their appropriate remedial doses. Take many of the
most powerful agents, arsenic, tartarized antimony,
iodine, &c., and when administered in certain small
and repeated alterative doses, they bring about the
SUSCEPTIBILITIES OF ORGANS, ETC. 57
cure of the most obstinate and formidable conditions
of disease; while the same doses may not manifest
any action upon the system, or on any part of it, under
circumstances of health. This manifestly depends
upon an increased susceptibility of the organic proper
ties, in their diseased conditions, to the action of for
eign agents, and upon an increased disposition to un
dergo changes. This law, which unfolds a principle
latent in health, and by which morbid organic proper
ties acquire susceptibilities to salutary influences from
agents which in health would either produce no ef
fects, or lead to untoward results, and its ally, the
great recuperative principle, impose the highest obli
gation upon physicians to become medical philoso
phers."*
Most of the positions laid down by Dr. Paine, in the
above quotations, are doubtless correct ; but in all his
inductions, he is labouring under an important error
in supposing that morbific and remedial agents exer
cise their influence only upon certain immaterial prin
ciples or vital properties.
Can it be supposed that when tartarized antimony
or Ipecacuanha are taken into the stomach, in emetic
or diaphoretic doses, they act upon an immaterial pro
perty of this viscus, in causing emesis or diaphoresis ?
Can it be believed that the diuretics, copaibae, cubebs,
turpentine, &c., operate upon the vital properties of the
urinary apparatus, in producing diuresis, or that bel
ladonna, stramonium, strychnia, conia, alcohol, and the
vapours of ether, or chloroform, expend their force upon
thespiritual properties of the brain and nervous system ;
or that the preparations of mercury, iodine, &c., exer
cise their powerful influence upon the organism, by im
pressing immaterial, imponderable, or vital properties?
We think it is more consistent with known facts and
sound logic, to suppose that all such agents exert their
influence primarily upon the sentient extremities of
the nerves, modifying the functions of those parts which
they supply, increasing their susceptibility to the in
fluence of foreign agents, and thus establishing inflam
mation or a new action.
* Paine's Institutes of Medicine.
3*
58 SUSCEPTIBILITY OF ORGANS, ETC.
It has been remarked by Paine and others, that ar
senic, antimony, iodine, mercury, etc., given in certain
small and repeated doses, in disease, are productive of
decisive effects, while the same doses in health, would
exert no appreciable influence. For this reason, they
assert and would have us believe, that the conditions
and properties of diseased parts are so modified and
altered in all respects, as to be incapable of responding
to the action of those medicines which operate specifi
cally in health.
It is quite certain that most medicinal substances
may be taken in very small doses during health, with
out any apparent effect, on account of the power which
the system then possesses of resisting the aggressions
of slight foreign agents ; but if the same substances
be taken in large doses, most decided, powerful, and
specific results \vill follow in all stales of the system.
If taken in still smaller quantities, the effects are yet
perceptible, but less strongly marked. These results
will be unequal in point of intensity in normal and ab
normal states of the organism, according to the amount
of disease present ; but in all instances, their specific
operations will be uniform.
Tartarized antimony and ipecacuanJia, in large doses,
both in health and disease, exercise a specific influ
ence upon the stomach, lungs, and skin, as is indi
cated by vomiting and augmented secretions from the
respiratory organs and skin. In doses of one-sixth or
one-eighth of a grain, no effect is produced upon the
respiratory muscles or stomach, but the influence is
yet visible upon the skin. If the quantity be dimin
ished still farther, even to an attenuation of Hahne-
mann, the impression may not be perceptible, either
upon the stomach, lungs, or skin, yet we find them
capable of influencing the extreme nerves in a de
cided manner. It does not follow, because a patient
does not vomit, purge, or sweat, that a medicine has
no effect. On the contrary, we know that morbific
agents give rise to the most virulent diseases without
creating the slightest sensation in the system at the
period when the noxious impression is made. The
direct and sympathetic effects of such causes are,
however, severe and dangerous.
SUSCEPTIBILITIES OF OBGANS, ETC. 59
The experiences of a host of honourable and scientific
men have proved, beyond a doubt, that minute quanti
ties of medicinal agents may produce salutary influ
ences in the same manner ; and the law obtains with
regard to all specific medicines. The effects in these
instances may not indeed be sufficient to induce
emesis, catharsis, or other violent effects in any part
of the body; yet from the great sensibility of the
minute nervous ramifications, they must receive im
pressions and be modified in their action, when the
trunks, or larger branches of nerves, would remain
unaffected. Who shall decide when the quantity has
become too small to produce an effect upon the most
sensitive parts of the body ? Shall the allopath, be
cause he does not witness vomiting, purging, or
sweating; or the homoeopath, who from accurate ob
servation in numerous instances, notes from infinitesi
mal doses, prompt and decisive curative effects?
To illustrate our meaning more fully, we will sup
pose a certain medicine possesses the power, when
given in large doses, during health, of affecting a par
ticular tissue. The same substance, administered in
very small doses under the same circumstances, has
no apparent influence. If, now, the tissue for which it
has a specific affinity, becomes inflamed, its suscepti
bility is so acute, that an extremely minute quantity
of the specific agent is capable of making potent and
salutary impressions.
The other parts of the organism which become dis
ordered through the media of the sympathetic nerves,
also acquire an exalted sensibility which renders them
highly impressible, and capable of being acted upon
by infinitesimal quantities of specific medicinal agents.
Homoeopathic remedies, as Paine has well observed
of medicines generally, act only through these " ac
quired relations," and their power ceases as soon as
these acquired relations have been removed and
health re-established.
We shall appreciate, then, the importance of se
lecting a remedy which shall cover, not only the
symptoms resulting directly Yrom the tissue primarily
affected, but which shall embrace all of the remote
CO SUSCEPTIBILITY OF ORGANS, ETC.
sympathetic effects. In other words, we must pre
scribe for the " totality of the symptoms."
" It will now be apparent, from what has been said
in the preceding section, how it is that remedial
agents will call into salutary reacting, sympathies in
various parts of the body not affected by disease, but
whose susceptibilities are increased by morbific sym
pathies reflected from the seat of absolute disease,
and upon which parts the remedial agents might
otherwise be inoperative. Whatever, too, may be the
complexities of disease, the right remedy will be at
least compatible with the whole condition." *
"A particular state of one organ, such as inflamma
tion, or a secreting action in it, often causes the pro
duction of a similar state in other parts." And, " the
principle of the balance of sympathy teaches us how
we must avoid aggravating the morbid condition of
one organ by the means which we apply to another."f
An adherence in all cases to Hahnemann's axiom,
" similia similibus," in our remedial measures, is the
only means by which this last objection can be ob
viated with any certainty or success.
It is proper to remark, before concluding this chap
ter, that there are a few apparent, though not real
exceptions to the principles which we have advanced.
A most remarkable one is observed in the case of
tetanus, where enormous quantities of opium, both in
a crude form and in tincture, may be administered by
the stomach or rectum, without producing any mark
ed effect. This fact, however, by no means proves
that the susceptibility of the parls for which opium
is a specific, is diminished ; but it proves only that ab
sorption is prevented. If opium is injected into the
veins, under these circumstances, it has been found
by Majendie, Orfila, and Muller, that it exerts its
influence in the same manner and degree as when
taken during health.
We suppose, therefore, that in tetanus, the lacteals
and other absorbents, are in a state of spasm, and thus
mechanically exclude th£ entrance of all substances
* Paine's Institutes of Medicine,
f Miiller's Physiology
ALLOPATHY. 61
from their structure. In this manner, opiates and
other drugs are shut out of the circulation, and, con
sequently, cannot be brought into contact with those
parts of the nervous system upon which they exert
their specific force, and where alone they possess the
power of producing their legitimate effects.
All cases of this description, are simply apparent
exceptions to the general rule, and do not in the
slightest degree invalidate the general principles
which we have advanced.
CHAPTER VIII.
ALLOPATHY.
It would be very difficult at the present time, to
give an accurate definition of the above term. The
axiom which is adopted by .a portion of the disciples
of the allopathic school, and upon which their hypo
thetical doctrines are founded, is " contraria contrariis
opponenda." Although distinctions are recognised
between the antipathic or palliative, the allopathic or
heteropathic, and the chemical, methods of practice,
yet in point of fact, they may all, with propriety, be
resolved into one and the same school. All employ
venesection, emetics, purgatives, diaphoretics, and
alteratives, to reduce inflammations ; opium to allay
pain and suppress unnatural discharges ; bark, iron,
brandy, &c., as tonics ; blisters, setons, moxas, issues
and escharotics to produce counter-irritation ; revul
sives, derivatives, and indeed all of those means which
are termed allopathic.
Allopathists do not, however, uniformly adhere to
any of the above doctrines, but often unconsciously
encroach upon homoeopathic ground, and by practis
ing according to the law of " similia similibus" effect
their speediest and safest cures.
Thus, rhubarb and calomel, when administered in
large doses during health, cause irritation or inn1 am-
62 ALLOPATHY.
mation of the membranous tissue of the bowels, as is
indicated by griping pains, and discharges of watery
or mucous fluids ; yet these are favourite allopathic re
medies for diarrhoea and dysentery : copaibse, cubebs,
turpentine, and cantharides, when given in large and
repeated doses in health, induce inflammation of the
mucous membranes of the urino-genital apparatus;
yet these specific medicines are almost invariably
prescribed in the acute and chronic affections of
these parts : ipecacuanha in doses of twenty to thirty
grains, is the most common emetic of the old school ;
yet this same school are constantly in the habit of ad
ministering this drug in doses of one-twelfth or one-
sixteenth of a grain, in cases of obstinate nausea and
vomiting, with the most happy results : inhalations
also of the particles of ipecacuanha, cause asthma,
cough, dyspnoea, &c. ; yet it is a common remedy in
small quantities for the cure of these complaints:
excessive use of alcoholic liquors or opiates, often in
duces mania a potu ; yet opium and brandy, which
exercise the same specific effect upon the brain, are
the principal allopathic cures of this dangerous ma
lady : the preparations of mercury, when given in
considerable quantities, cause ulceration and some
times gangrene and sloughing of the mouth and
throat, pains in the muscles and bones, eruptions upon
the skin, and inflammation of the bowels, attended
with tenesmus, and mucous and bloody stools ; yet for
syphilitic and other ulcerations of the throat, pains in
the limbs, eruptions, and bowel affections, the use of
small doses of this mineral, in some form, is deemed
indispensable by the allopath. Sir Astley Cooper, in
his Lectures, observes,* " Children often contract sy
philis i?i utero, and within twenty-four hours after
their entrance into the world, have the palms of their
hands, the soles of their feet, and the nates, covered
with copper-coloured eruptions ; and the nails begin
to peel off', and if care be not taken, the little patient
will sink under the effects of the disease. In these
cases, you give the mother a quantity of mercury, the
influence of which is communicated to the child,
* Cooper's Manual of Surgery, by Castle.
ALLOPATHY. 63
through the medium of the milk, and it becomes
cured of the syphilitic disease." This is excellent
homceopathic treatment : the mercury in this in
stance is attenuated in the mother's milk to a very
great extent — probably to such a degree that no ana
lysis can detect it, or any scales weigh it, and yet Sir
Astley Cooper assures us that the infinitesimal quan
tity of mercury which finds its way to the milk of the
mother, is sufficient to effect a speedy cure upon the
child. In this instance nature, instead of art, attenu
ates the drug. Tartarized antimony exercises a spe
cific effect upon the lungs, stomach, and secretory
organs, causing, according to Majendie, an inflamma
tion or engorgement of the two first named organs,
whether taken into the stomach or injected into the
veins ; yet this is the sheet-anchor of allopathy in
pneumonia, pleurisy, and in the first stages of gastric
or bilious fevers. Arsenic has a specific influence when
taken in large doses, in health, upon the nervous
system, heart, skin, and alimentary canal ; and this is
an important old-school remedy in neuralgia, epi
lepsy, chorea, angina-pectoris, cutaneous affections,
and intermittent fevers. When nitrate of silver is ab
sorbed in health, it makes a specific impression upon
the nervous system and the corium ; allopathists em
ploy it in epilepsy, chorea, and in morbid sensibility
of the gastric and intestinal nerves. Large and re
peated doses of nux vomica or strychnia, taken in
health, produce " rigidity and convulsive contrac
tions" of the muscles ; yet in cases of traumatic te
tanus, strychnia has effected cures in the hands of al
lopathic physicians, in doses of TTT to ^V of a grain :*
its specific action under all circumstances, is upon the
cerebro-spinal system, and thus its efficacy when
properly exhibited in tetanus, epilepsy, chorea and hys
teria. Belladonna, taken in health, gives rise to inflam
mation of the throat and a scarlet eruption upon the
skin ; and yet this remedy is highly extolled and ex
tensively used by many leading men opposed to ho
moeopathy, as a prophylactic against scarlatina. An
* See report of tetanus cured with strychnia, by Dr. Fell. 8th number
of N. Y. Med. and Surg. Reporter.
64 ALLOPATHY.
eruption resembling psora is often produced by an
excessive use of sulphur and iodine ; still these are
the grand remedies in cutaneous affections of this
kind. Pereira prescribed prussic acid to a lady who
had been suffering for months from gastrodynia ; in
a few hours, to the astonishment of every one, she
was quite well. " It can hardly be imagined," says
Pereira, " that irritation of the stomach can be ra
pidly removed by a substance which is itself an ir
ritant" The direct application of blisters to surfaces
affected with rheumatic, erysipelatous, and other na
tural cutaneous inflammations, is constantly recom
mended at the present time by the Hippocrat ics.
" Erysipelas and other cutaneous inflammations may
be removed by the direct action of cantharides upon
the part inflamed. The remedial agent, in these
cases, varies the mode of inflammation, and thus in
troduces a modification in which the properties of
life are brought into recuperative action" (Paine 's
Institutes of Medicine) ; yet they affect a superlative
contempt for the law of " similia similibus curantur ! "
It is from experience alone that the old school phy
sicians have learned that ipecac., in doses of TV to TV
of a grain, arrests nausea and vomiting, and imparts
tone and vigour to the stomach ; that calomel, in do
ses of 2^ of a grain, is invaluable for the cure of in
flammation of the mucous membranes of the bowels:
" in cases of inflammation of the mucous tissue of the
intestines attended with frequent watery discharges,
there is nothing comparable with calomel, in doses
varying from the twentieth to the eighth of a grain,
once in four to twelve hours :" — (Paine' s Institutes of
Medicine.) That quinia, in doses of y1^ or -£•$ of a
grain, is more efficient in removing remittent and in
termittent fevers, and as a general tonic in diseased
states of the system, than when exhibited in quan
tities of from one to ten grains at a dose : "quinia in the
dose of 5 or 10 grains, may speedily arrest an inter
mittent fever by its febrifuge virtue ; but this is bad
practice, since, by its associate tonic virtue, it is
likely to increase or to induce local congestions ; thus
leaving the patient imperfectly cured, and subject to
relapses : I have seen, in my own family, the most
ALLOPATHY. 65
formidable grade of remittent fever, of long duration
and attended with the foregoing complications, ar
dent heat, thread-like pulse, loss of mind, &c., and
where hope of recovery had been abandoned, yield to
less than a grain of quinine, divided into sixteen do
ses" — (Paine's Institutes of Medicine) ; that strychnia,
in very minute quantities, will cure tetanus ; that the
class of remedies denominated alteratives, are capable
of producing powerful effects upon the organism, and
that too, in a manner altogether unknown and imper
ceptible.
But how do these physicians know that the vir
tues of these medicines cease at these points? Have
they ever made honest trials of them in a pure form,
and in doses of ¥V, T^, or a still smaller proportion
of a grain, and learned from actual observation that
they have then lost their power of impressing diseased
structures? We venture to affirm, never, or they
would long since have deserted the standard of allo
pathy.
This leaning towards the modern theory is not
altogether confined to the few practical cases which
we have cited, but some of their most eminent wri
ters have approached so near to the views of Hahne-
mann, that we are at a loss whether to rank their
theoretical doctrines as homeopathic or allopathic.
The distinguished Pereira. in his Materia Medica
and Therapeutics, \vrites as follows : " Unguents and
lotions are used in cutaneous diseases, ulcers, &c. ;
gargles in affections of the mouth and throat ; colly-
ria in opthalmic diseases ; and injections into the
vagina and uterus in affections of the urino-genital
organs. In all such cases, we can explain the therapeu
tical effect in no other way than by assuming that the
medicine sets up a new kind of action in the part affected,
and that the new action subsides when the use of the
medicine is suspended or desisted from"
This explanation is the true one. The medicines
in these cases, as welJ as in all other instances where
appropriate specific remedies are used, do " set up a
new kind of action in the part affected," creating a me
dicinal disease which supersedes the natural one.
The only fault we have to urge against allopathists
in the treatment of tbur and analogous cases, is,
thai they give orach too large doses, and thus create
m fer more wisies* mcifir 'mil disease than is necessary
to bring about their cures. Notwithstanding, how
ever, their errors in exhibiting mrdkiiif i in a erode
mad impure form, and in unnecessarily large doses,
we must give them the credit. (_&rt~ jmstitia rmaf
OKfaau) of occasionally timing dwra.se (although un
wittingly) in a - rational and consistent " manner.
Paine, in bis Institutes of Medicine, remarks. - thai
•bin the intestinal mucous tissue is affected with
that caadstiasi of disrasr which results in a preter-
namral watery *t en tion, aadcosaLii|Hi at gwacoations.
^lled diarrhoea, and rhnharb is administered
- - - " :. : ; : - ~ — -
a way as to determine an increase
. . . . . . ; . .
atmttommMstak^tJKimlatarimMttutmeiM
'" .- -..--- ' - . • - j- . . ::-.-•:
. -. - - - . - . .
: .
rfectt sm lie ritef properties ami mctiau -of the
mrc tkf semt *f tke mor^td cmutitic ms,
the practitioners of the
in the treatment of many .uibii diseases,
at homoeopathy, and hold up their
iaes as philo-
:---.--- : -.. _.l ^':_ .
too often belies your profession : yon
to be aUopaihUte and antipathists. whO e con-
the manner of
-L~ .. :i>: :-- :. :: -. .-.'z -y - .- ::.- -
retical doctrwes which have come to you from rode
and dark 1^1 n ibii liim 11 whii b bsir nt* iiml • ill
:; .- : ' - -. :• -.. - ..- \. .-:.>-.:_- -': : - .- - -. ^. I
hare stealthily, and, doubt 3 ess, in
im wittingly, abandoned your legiti-
Dand. and ptmduet mptm the principles of oar
heresy! Where if your pride, where your
You hare the boast of antiquitv yon
A1IXJPATHT. 67
have received your " bundle of ideas" from Hippo
crates and Galen, to whom you pay reverence and
allegiance : you disdain innovations, and despise dis
coveries and improvements ; you have withstood the
changes of more than two thousand years, and. by
your powerful dicta, have continually discouraged all
original induction, and endeavoured to crush in the
bud even,- advancement in medical knowledge.
Where is now your former pride, that you so often
practically abandon your time -sacred axiom, * comlrm-
ri/z contruriisr and adopt the new heresy. *• timilia
similibus T Perhaps the light of modern science and
discovery breaks, against your will, through the cre
vices of your unjointed and heterogeneous theories, or
you are startled from your propriety by the whelming
accumulations of fact which Hahnemann and his dis
ciples have displayed so bravely before the world :
or. possibly, the disrespect and abuse of some of the
most eminent and able of your caste, has impaired all
confidence in. and respect for. your own dogmas and
their applications, and you are at sea in search of a
system. Are we wrong ? If so. we have excuse in
the following, from the distinguished editor of the
British and Foreign Medical Review. Dr. Forbes,
\vho asserts :
" 1. That in a large proportion of the cases treated
by allopathic physicians, the disease is cured by na
ture, and not by them.
- 2. That in a less, but still not in a small propor
tion, the disease is cured by nature in spite of them :
in other words, their interference opposing instead of
assisting the cure.
- 3. That, consequently, in a considerable propor
tion of diseases, it would fare as well or better with
patients, in the actual condition of the medical art,
as more generally practised, if all remedies, at least
all active remedies, especially drugs, were abandoned.
We repeat our readiness to admit these inference-
just, and to abide the consequences of their adoption."
Beware, then, most ancient goddess, survivor of all
thine earlier contemporaries — of alchemy, and astrolo
gy — lest thou fall, and thy doctrines, handed down
through the dark ages, through the juggling temples
68 ALLOPATHY.
of idolatrous priests, be swallowed up in the deluge
of new facts and discoveries which the nineteenth
century is pouring upon the world. But, seriously, it
is a matter of no little surprise, that while anatomy
has made most rapid strides, unfolding the secrets
pertaining to the most minute structures of the ani
mal organism ; while botany and mineralogy have
displayed before our eyes the wonders of the vegeta
ble and mineral kingdoms, and pointed out the laws
of their formation, development, and even of their
very existence ; while chemistry has grasped some of
the most subtle agents in nature, and developed im
provements in the arts and sciences which have con
tinually startled and astonished the world, as well for
useful as for purely scientific results, — medicine, until
the time of Hahnemann, has been crushed under the
weight of antiquated doctrines, and the legalized
power and oppression of the schools.
We have thus far made allusion to that part only
of the allopathic practice which bears some approxi
mation to the correct method. In most of the in
stances enumerated, specific medicines are employed —
medicines that produce a similar state when given in
health, to that which they are to cure. Although
large quantities of crude and impure drugs are used
in these instances, and the medicinal diseases are
thus rendered violent and complicated, still it must be
admitted that occasional cures are accomplished.
But we come now to a more interesting and momen
tous part of our subject. It becomes our duty to lay
before our readers the doctrines and practice of allo
pathy, as they actually exist ; to note their many in
consistencies, and to point out some of the innumerable
evils which they entail upon mankind.
We have seen that in the treatment of disease, the
old school physicians make an indiscriminate use of
the palliative, heteropathic, and in a few instances, the
homoDopathic methods of practice.
A general idea prevails, that all diseases consist in
" local determinations of blood," and that no two af
fections of any consequence, can exist in different parts
of the same organism, at once. On this account it is,
that new diseases are created in healthy parts, for the
purpose of removing the primary natural one.
ALLOPATHY. 69
Physicians have been led to adopt this mode of rea
soning from observing that the spontaneous appear
ance of cutaneous eruptions, discharges of blood, pro
fuse perspirations, &c., occasionally afford relief to
morbidly affected internal organs. Without reflect
ing that these results are merely symptoms of the in
ternal disorders, and that the causes upon which these
signs depend are located in the blood, they attempt to
annihilate diseases, by imitating artificially these symp
toms.
In regard to the first position, we affirm that their
premises are untrue. There are no facts which war
rant the statement, that "no two excessive determi
nations of blood can exist in the same individual at
the same time." Neither is it true, that the appear
ance of cutaneous eruptions, spontaneous sweats,
diarrhoea, and discharges of blood, are invariably,
or even generally, indications that the affected organ
is in process of restoration, or that the system at large
is recovering its lost energy and vigour ; since it often
occurs that the symptoms of the complaint are all ag
gravated, upon the supervention of either of the above
occurrences.
Dr. Wilson observes, that " there is often a remark
able tendency to the worst species of haemorrhages
from the bowels, towards the termination of fatal cases
of phrenitis."
Dr. Eberle, in his Practice of Physic, remarks, " On
the day preceding the fatal termination of a case of
phrenitis which came under my own observation, an
exceedingly copious discharge of dissolved blood took
place from the bowels, and on the following morning
the haemorrhage occurred also from the mouth and
gums."
Let us suppose a case of phrenitis. We have here,
an inflammation, or a congested state of the capilla
ries of the brain. To relieve this inflammation, and
withdraw a portion of the fluid which is concerned in
the congestion, blood-letting, both general and local,
is resorted to as a primary and indispensable process
of cure. By this means, the general strength is re
duced, the pulse increased or diminished in frequency,
and the temperature of the skin altered, but the con-
70 ALLOPATHY.
gestion still continues, and the morbid and debilitated
state of the extreme vessels (in which the disorder
alone resides) remains the same as before.
A resort .is then made to revulsives and counter-irri
tants, in order that new inflammations may be crea
ted in healthy structures, which shall supersede that
already existing in the brain. To effect this object,
purgatives of the drastic kind are exhibited, and blis
ters applied to the head, neck, and lower extremities,
in order that the intestinal canal, and portions of the
skin, shall be placed in a state of artificial inflamma
tion.
Let us understand the case clearly. We have a
disease consisting solely in a loss of tone and irrita
bility of the serous vessels of the brain, which prevents
them from excluding the red blood, and of performing
properly their functions. To obviate this condition, a
quantity of blood is abstracted, and artificial or me
dicinal inflammations are caused in the intestinal
canal, and upon different parts of the surface of the
body.
We now inquire in what manner these violent
means can, by any possibility, reach the seat of the
malady, and impart tone and vigour to the weakened
capillaries, so as to enable them to exclude from their
structure the red globules, and resume their healthy
function ?
All will concede that inflammation consists in loss
of tone and irritability in these vessels, and that no
cure can take place, until this impaired irritability is
restored. In inflammation, according to Philip, Hast
ings, Eberle, Wilson, and Allan, the capillaries of the
part are in a state of debility, and passive relaxation.
The immediate exciting cause of inflammation may
be either stimulant or sedative. In both instances the
impression is made upon the nervous filaments of the
capillaries, and if the cause acts as a stimulant, the
reaction which must follow this augmented action,
will leave these delicate nerves in a state of debility
proportionate to the amount of the previous excite
ment.
If the primary cause is directly sedative, no reaction
will occur, but a similar state of relaxation will obtain
as in .the former instance.
ALLOPATHY. 71
How, then, we repeat, can venesection, cathartics
and blisters affect the necessary object ? They do not
certainly prevent the red blood from still entering the
relaxed capillary tubes, for the whole remaining mass
must continue to circulate through the brain, as well
as other parts of the organism, every few minutes.
By lessening the quantity of blood, we also abstract
a portion of that natural stimulus of the organism,
which is one of the essential conditions of irritability.
" Every part of the organism depends, for the perform
ance of its proper functions, on the receipt of arterial
blood and of nervous influence ; so alterations in the sup
ply of either of these essentials, may modify or even sus
pend the functions of a part"*
How absurd and pernicious then, in inflammations,
the very essence of which is debility and loss of tone,
to detract from one of those conditions upon which
this very tone and vigour depends ! As well might you
remedy the breach through which the waters of a
raging torrent are madly rushing, by turning off from
its course a small quantity of this element. As well
attempt to suppress the leak of a storm-tossed vessel,
by diverting a portion of the stream on which she
floats, from its natural channel.
It is not the blood which is at fault ; but a portion
of the organism. Correct therefore the cause of the
disturbance by direct and appropriate specifics, and
you may then, and not until then, effect cures', safely
and philosophically. Seek not to deprive the system
of that fluid which is so essential to the organism, and
on whose integrity its functions depend ; for by so do
ing, the cause of the malady will remain untouched.
It is very true, that when a large quantity of blood
is abstracted, during inflammation, there will seem to
be in some instances an apparent amelioration of all
the symptoms, but this effect is only temporary ; for
as soon as reaction comes on, the enfeebled capillaries
again admit the destructive ** carriers of oxygen" as
before ; the state of congestion and inflammation re
mains, while the system at large has lost a portion of
that stimulus which conduces so materially, not only
* Pereira's Mat. Med.
ALLOPATHY.
to sustain the normal integrity of the functions in
health, but to aid in the restoration of enfeebled and
diseased parts. •
The remedies which stand next in importance in the
old school method of treating phrenitis, are revulsives
and counter-irritants. It is supposed that by exciting
the intestinal exhalents, inflaming the membrane of
the bowels, and portions of the skin, the circulation is
diverted from the brain and directed especially to
these parts.
But by this means is the brain in reality relieved ?
Is the whole mass of blood thus prevented from circu
lating as usual through this organ once in three or
four minutes, or the character of its red globules
changed ? By exhausting the energies and resisting
force of distant healthy structures, and creating sympa
thetic symptoms throughout the body — thus complica
ting the already existing disease, and impairing the en
tire nervous and muscular energies — are the inflamed
capillaries of the brain placed in a more favourable
condition to recover their impaired tone and irrita.-
bility ? Every man who has a correct idea of the
laws which govern the organism in health and disease,
and who is willing to banish prejudice and be guided
by common sense and true philosophy, must answer
in the negative.
We object to these remedies, however, not only be
cause they are incompetent to produce salutary im
pressions upon inflamed parts, but because of the
evils of a positive character to which they give rise.
The chief remedies of the old school, are the pre
parations of mercury, opium, antimony, and bark. In
a vast majority of all the cases treated by the prac
titioners of this school, one or more of these articles is
made use of. Indeed, scarcely a single malady of any
moment can be named, in which one of these medi
cines is not considered indispensable.
Let us then examine some of their effects, in allopa
thic doses, upon the healthy and diseased organism.
1. MERCURY.
This mineral is more -uncertain in its action, in all
states of the system, than nny other article in use. It
ALLOPATHY. 73
possesses the power in different constitutions, and un
der certain circumstances, of affecting nearly every
organ and tissue of the body ; and it is not in the
power of the most judicious physician to say before
hand, where or in what manner, it will exert its force.
Some of the more common deleterious effects of the
use of mercury, are, excessive salivation, ulccrativn,
gangrene and sloughing of the gums, mouth, and throat,
gastro-enteritis, mercurial erethism, dysentery, cutaneous
eruptions, inflammation of the periosteum and bones,
nodes, excessive derangement of the nervous system, pa
ralysis, tremors, necroses of the maxillary and other bones,
rheumatism and opthalmia.
When mercury is administered, even in a moderate
quantity, no human being can be at all certain that
one or more of these evil consequences will not result.
Indeed, it is the direct object, oftentimes, to produce
some of them, to operate as counter-irritants.
Whether it is employed in large or small quantities,
solid, or in the form of vapour, is of little importance,
so far as its power of affecting: the system is concerned.
The following, from the Ed. Med. and Surg. Journal,
illustrates the baneful influence of the vapour when in
haled : " In 1810, the Triumph man-of-war, and Phipps
schooner, received on board several tons of quicksilver,
saved from the wreck of a vessel near Cadiz. In con
sequence of the rotting of the bags the mercury es
caped, and the whole of the crews became more or less
affected. In the space of three weeks 200 men were
salivated, tivo died, and all the animals, cats, dogs,
sheep, fowls, a canary bird, — nay, even the rats, mice
and cockroaches, were destroyed."
The following cases resulting from the employment
of calomel, have come under my own observation, viz.,
three cases of necrosis of the inferior maxillary bones,
requiring the removal of portions of the jaw ; several
cases of gangrene and sloughing of the mouth and
throat, which have terminated fatally ; a number of
cases of mercurial palsy; numerous instances oful-
ceration of the nose, throat, &c. ; skin diseases, affec
tions of the bones, nodes, rheumatic affections, &c., &c.
Professor Chapman, after descanting upon the wo-
ful cffepts which have so often been produced by cal-
4
74 ALLOPATHY.
omel, and referring to many disgusting cases of mer
curial disease which have come under his own obser
vation, thus concludes : " Who is it thai, can stop the
career of mercury, at will, after it has taken the reins
in its own destructive and ungovernable hands ? He
who, for an ordinary cause, resigns the fate of his pa
tient to mercury, is a vile enemy to the sick ; and if
he is tolerably popular, will, in one successful season,
have paved the way for the business of life ; for he
has enough to do ever afterwards to stop the mercurial
breach of the constitutions of his dilapidated patients.
He has thrown himself in fearful proximity to death,
and has now to fight him at. arm's length as long as
the patient maintains a miserable existence."
And this dreadful poison is the most common, — yes,
the daily remedy of allopathy, for almost every dis
order, whether mild or severe, acute or chronic. This
is the agent with which artificial diseases are created
in healthy parts, to cure primary or natural ones !
This is the substance with which unfortunate mortals
are drugged, from the time they come into the world,
until their wretched and too often premature depart
ure, with its well-known and generally admitted evils
and dangers. — -from the contemplation of which the
well-instructed and experienced allopath shrinks with
instinctive dread, — .and its questionable value in most
instances of its prescription, it may justly detain our
attention. Calomel and opium are the common re
medies in the traditional practice. We shall see to
what degree they may be used in a practice that is
philosophical.
By glancing at the standard works on the practice
of medicine, it will be observed that there is scarcely
a single malady, either acute* or chronic, in which one
or both of these articles is not recommended as an im
portant if not indispensable means of cure. Taking
Eberle's Practice of Medicine — an approved allo
pathic work — as a fair illustration of their views and
practice, it will be seen that of the one hundred and
thirty-nine diseases, upon which these two volumes
treat, there are only ten, in which calomel or opium in
some form is not recommended. The following are
the nanus of these exempt diseases, viz : mumps,
ring- worm, nettle-rash, scurvy, chronic cystitis, hysteri-
ALLOPATHY. 75
tis, asphyxia, roseola, haematemesis, and nose-bleeding.
Nor are these remedies advised simply as auxiliaries
in the treatment, but in a large majority of cases, they
constitute the principal means of cure.
The allopath is taught to believe that mercury ex
cites the functions of all the organs — acts specifically
upon the liver, salivary glands, heart, lungs, and ner
vous system — and therefore that it may be administered
almost universally. Regardless of the secondary sym
pathetic affections to which it usually gives rise, he
attributes all of these symptoms to the natural disor
der, and if the patient succumbs before the combined
attacks of the primary disease and the medicinal one,
he consoles himself with the reflection that he has fol
lowed his authorities and prescribed as his predecessors
have done for centuries before him.
Ask him what are his views concerning inflamma
tion, and he answers that it consists in a debilitated
and congested state of the capillaries of the part affect
ed. Ask him what is the modus medendi of mercury
in the cure of inflammation, — how any of its effects
can reach the seat of the malady, the congested ca
pillaries, and restore to them their impaired tone and
healthy functions, — and he either avows his ignorance
or offers an unsatisfactory explanation.
2. OPIUM.
If we except calomel, this drug and its preparations
are more frequently used, by the medical men of the
old school, than any other article in the Materia Medi-
ca. Possessing the power, as it does in an eminent
degree, when exhibited in large doses, of covering
(not curing) symptoms, and of shutting the mouths
of clamorous and inquiring patients, it is used con
stantly and indiscriminately in nearly all protracted
maladies.
Let us then briefly examine ihe effects of opium in
health and disease, and see if irfpossesses the wonder
ful property of reaching every structure, and of coun
teracting so many diverse and contradictory symp
toms.
Its effects upon the human system, in medium doses,
are in the first instance stimulating, succeeded in a
short time by diminished sensibility and desire to sleep.
76 ALLOPATHY.
"This continues from eight to twelve hours, and is
followed by nausea, headache, tremors, and other
symptoms of diminished and irregular nervous energy.
All of the secretions, with the exception of that from the
skin, are either suspended or diminished"* These ef
fects, with a very few exceptions, are uniform under
all circumstances, so far as we can judge.
How, then, is this substance applicable to the
treatment of so many diseases ?
We have remarked that in all maladies, there exists
an inflammation of an acute or sub-acute character,
in some part of the organism, and it is the presence of
this inflammation which maintains and perpetuates
them.
We have also observed that all inflammations con
sist in a congested state of the capillaries of the part
affected, caused and kept up by a loss of tone, resist
ing power, or irritability, which disables them from
resisting the intromission of red blood.
It is apparent, then, that in order to prove efficient,
such remedies should be exhibited as are capable of
acting upon the seat of the complaint, and of restor
ing the delicate capillary nerves to their normal state
of integrity. Opium cannot accomplish this, for its
operation tends to impair the nervous energy, instead
of adding vigour, to dry up most of the secretions, in
stead of aiding nature to give vent to the poisonous and
pent up fluids, it induces nausea, headache, tremors,
and many other medicinal symptoms of sufficient se
verity to make a healthy man sick, or to complicate
to a serious extent any existing natural affection.
If it be urged that opiates have the power of allay
ing pain, while other more efficient measures are
pursued to effect the cures, we reply, that by covering
up the pain, the real state of the case is concealed ;
other new symptoms set in, which will be unnoticed
by the benumbed patient, while secondary sympa
thetic affections will be propagated to every part of
the body, aggravating and complicating the original
disorder.
Opium is also highly extolled in low forms of fever,
* Wood and Bacho, U. S. Diapen.
ALLOPATHY. 77
and other complaints, where the powers of the system
are in an exhausted condition. But let it be remem
bered, that the stimulating effect of this drug is of short
duration, and that the corresponding reaction or de
pression will bear an exact ratio to the previous ex
altation. This law is fundamental ; for the system
possesses but a definite and limited amount of vital
power, and is capable of resisting only a limited de
gree of unnatural action or disease, so that we can
readily perceive how opiates, and other stimulants,
must ultimately prove deleterious.
It is true that perspiration is promoted by the use of
this narcotic, but this does not cure. Sweating is
merely a symptom, and it may be favourable or other
wise. When excited artificially by medicine, it is not
productive of benefit, because this adds nothing to
wards invigorating the weakened capillaries.
" Perspiration induced by medicine is of little mo
ment, unless the remedy simultaneously impresses,
directly or indirectly, the parts diseased', and then the
salutary results, so far as the surface is concerned,
depend upon special vital influences exerted by the
remedy upon the skin and reacting sympathies. This
is exemplified by the profound effects of tartarized
antimony and ipecacuanha, the uselessness of hot
\vater, and the frequent pernicious results of the com
pound powder of ipecacuanha, when free perspiration
may follow the administration of either. The effect,
therefore, depends but very little upon the evacuation
from the skin, as produced by what are called su-
dorifics."*
It is proper to observe that opium may, and some
times does, effect cures in the hands of allopathists,
when given as a specific. Its curative virtues in ma
nia a potu and intoxication, even in large doses, are
well known. In these instances, the remedy impresses
directly the part diseased, and cures homos op at Ideally.
It is quite true that an infinitesimal quantity of the
drug, properly prepared, will always prove more effi
cient, speedy, and safe, in accomplishing the object,
and will not give rise to the unpleasant medicinal
* Paino's Inst. of Med.
78 ALLOPATHY.
symptoms which necessarily attend the employment
of large doses ; yet the fact must be conceded, that
clumsy and unscientific cures are occasionally effected
by the course alluded to.
An interesting case is related by Pereira, illustra
tive of this. " Opium is sometimes employed by
drunkards to relieve intoxication. I knew a medical
man addicted to drinking, and who for many years
was accustomed to take a large dose of laudanum
whenever he was intoxicated, and was called to see a
patient." The specific effects of the alcoholic stimu
lants and opium, given during health, are exerted as
remarked at page 43, upon the same organ ; and we
should therefore expect that a malady caused by the
excessive use of the one, might be cured by the specific
action of the other.
TARTARIZED ANTIMONY.
This salt has been several times formally banished
from the Materia Medica, on account of its dangerous
qualities, and as often revived again.
The Faculty of Medicine, at Paris, in 1566 and
1615, passed solemn decrees against it, as a virulent
poison, and these decrees were even sanctioned by
parliament, though afterwards formally reversed.*
Since this period, some have loudly extolled its vir
tues in the treatment of a great variety of diseases,
while others have as earnestly condemned its use, as
deleterious in all cases.
The celebrated Professor Nathan Smith, in his
Essay on Typhus Fever, remarks, " I have seen many
cases in which persons in the early stages of this
disease were moping about, not very sick, but far
from being well, and who, upon taking a dose of tar-
tarate of antimony, with the intention of breaking up
the disease, have been immediately confined to their beds."
He arrives at the conclusion, after much experience,
that " tartar emetic should not be used in this affec
tion, even at its commencement ; and in the latter
stages of the disease, that it is sometimes followed by
fatal consequences."
* Vale.
ALLOPATHY. 79
Iii emetic doses, tartarized antimony irritates the
stomach, causes congestion, and sometimes inflamma
tion of the lungs, attended with more or less constitu
tional disturbance. When it fails to produce emesis
speedily, it often acts violently upon the bowels, giv
ing rise to severe griping pains and watery evacua
tions. The tenderness of the stomach and intestines,
and the constitutional disturbance which succeeds its
emetic and cathartic operation, indicates the injury
which these delicate structures have sustained.
The primary impression of antimony is not the only
objection against its employment ; for, like calomel
and opium, it gives rise to numerous secondary symp
toms in remote parts, which tend to aggravate in a
serious manner any natural affection which may be
present. One of the most important of these secondary
evils, is dilatation of the ventricles of the heart. Hav
ing witnessed this result in several instances, one of
which occurred in my own family, my attention has
been particularly directed to the subject, and I am
fully of opinion that cases of this description, from the
use of antimony, are by no means unfrequent.
CINCHONA.
In intermittent fevers, general debility, and in cer
tain stages of most other affections, Peruvian bark and
its preparations are usually employed by the old
school. For the cure of the former, especially, quinine
is the remedy upon which universal reliance is placed ;
possessing the property, when used in large and re
peated doses, of speedily arresting the chills and fever,
it is constantly prescribed for this malady, without
the slightest knowledge of its processes, and without
any regard to the dangerous medicinal disorders which
it superinduces.
All allopathists who have had much experience in
the treatment of fever and ague, are aware that the
mere suppression of the paroxysms by no means re
stores the patient to health ; for in a great majority
of instances, he lingers for months or even years in a
diseased and miserable condition. In the?e cases it is
80 ALLOPATHY.
probable that a medicinal affection is induced by the
remedy, so serious in its character, as to supersede
temporarily the primary one. This is evident, from
the fact that after the effects of the medicine have
somewhat subsided, the original disorder again gene
rally makes its appearance. In some instances, how
ever, the medicinal affection is so severe as to consti
tute a permanent disease, and thus entirely usurp the
place of the fever.
" Experience shows that, though bark, and its alka
loids, in large doses, will often arrest intermittent fe
ver suddenly, such doses are liable either to induce
some congestion, especially of the liver or of the mu
cous tissue of the stomach, or will aggravate and es
tablish some co-existing congestion ; and thus while
the patient is for the present relieved of the fever, he
is dismissed with an insidious local complaint that not
only renders him a permanent invalid, (resulting often
in indurated enlargements,) but which local malady may,
and often does become, in process of time, the exciting
cause of another attack of fever. In respect to relapses,
it is nor, unfrequent that, when intermittents are sud
denly stopped by a large dose of quinine, the parox
ysms return as soon as the patient begins to exercise
much, or to take his ordinary food."*
We should naturally suppose that these untoward
results would deter practitioners from using so fre
quently these dangerous remedies ; or at all events,
as rarely and in as small quantities as possible.
On the contrary, it seems to be peculiar to allopathy,
that her advocates take credit to themselves, when
they succeed in administering this, as well as other
medicines, in larger doses than any of their contempora
ries, without destroying their patients. Indeed, so far
has this destructive system been carried, of experi
menting upon disease, that the enormous quantity of a
scruple and even half a dram of quinine has been ex
hibited at a dose, and repeated several times a day.
These monstrous quantities create f gastro-enteritic
irritation, nausea, griping, purging, head-ache, giddi-
* Paine's Inst, of Medicine. I Wood and Bache.
ALLOPATH Y. 81
ness, fever, somnolency, in some cases delirium, in
others stupor," &c. Paine asserts that he has wit
nessed many of these effects " from five grains only ;"
yet, as patients sometimes live in spite of this treat
ment, many persist in adopting these desperate inno
vations.
There are many other medicines employed by allo
pathy in the treatment of disease, besides those to
which we have alluded, but in general they serve on
ly as auxiliaries. In this list may be ranked diapho
retics, diuretics, expectorants, refrigerants, emmena-
gogues, emollients, errhines, &c., but the articles be
longing to each of these classes, in a crude state and in
large doses, are liable to important objections.
The fault of those medicines which operate spe
cifically, like diuretics, emmenagogues, &c., in the
hands of allopathists, is the aggravation which they
must necessarily cause, if the part acted upon be irri
tated or inflamed. This objection will.be clearly ap
preciated, when it is remembered how extremely sen
sitive to specific remedial impressions, organs and tis
sues become during inflammation.
The evils resulting from the use of those medicines
which are not specifics, are, first, their inability to
reach the seat of the complaint, and secondly, the
sympathetic derangements to which they give rise in
various parts of the body, the direct tendency of
which, is to retard and counteract the recuperative ef
forts of nature.
As an example of the first class, let us take the di
uretic copaibae, as a remedy for gonorrhoea. In this
example, the remedy doubtless impresses directly the
inflamed membrane of the urethra, but the impression
is so violent that either a decided increase of the in
flammation ensues, or the discharge is suddenly sup
pressed, and some other organ, as the bladder, kidneys,
testicles, or lungs, takes on diseased action. Indeed we
are decidedly of opinion, that not one genuine case of
virulent gonorrhoea can be adduced where a safe and
permanent cure has been effected by large doses of
this balsam.
A not unfrequent effect of copiaboe in moderate quan-
82 ALLOPATHY.
titles, is to excite serious disorder of the lungs. This
consequence I have often witnessed, and I have a pa
tient at this time, who assures me that he is unable to
take a single dose of it, without being afflicted with a
pain in his chest, and cough.
Gastric and intestinal disturbance, also, usually re
sult from its use. In some instances, a troublesome
eruption makes its appearance, rendering it necessary
to discontinue its employment for a time. And yet
with all of these artificial consequences, the disease is
very rarely, if ever, cured by this nauseous substance.
Diaphoretics were introduced into practice by the
advocates of the humoral pathology, under the sup
position that their sweating qualities would aid nature
in throwing off the morbid humours. When the hy
pothesis universally obtained that fevers were caused
by an excess of one of the four humours, blood, phlegm,
and yellow and black bile, and that this superabund
ance must be expelled through the pores of the skin,
kidneys, &c., it was a rational deduction that the em
ployment of diaphoretics and diuretics should conduce
essentially to aid nature in the cure.
But when more correct ideas in regard to the nature
and seat of diseases were introduced, and medical men
had learned that spontaneous sweating, diuresis, dis
charges of blood, diarrhoea, &c., in the latter stages of
diseases, occurred in consequence of a natural amend
ment or a sudden prostration in the powers of the af
fected parts, and not as an effect of the medicines, it is
a matter of surprise that these uncertain remedies
should have been retained.
The late Professor Nathan Smith, makes use of the
following language, replete with good sense : " As
there is more or less sweating in the decline of most
febrile diseases, and as a general perspiration is often
accompanied with other symptoms of amendment, it
has been looked upon as the natural cure of the disease.
Under this impression, it has been a pretty universal
practice to encourage sweating ; but with respect to
the grounds upon which this practice is founded, it is
a question whether the effect has not, in this case, been
mistaken for the cause ; that is, whether the sweating
is not the effect of the amendment, rather than the
ALLOPATHY. 83
cause of it ; and if so, it is still more questionable,
whether sweating, produced by art in the beginning
of the disease, would be attended with good effects.
In all cases, where I have seen this sweating regimen
adopted., the practice has been obviously injurious"
Many other eminent professors, as may be readily
proved, entertain similar views in regard to this
subject.
Physiology teaches us that no unusual disturbance,
no inflammation, and no functional derangement, can
accrue to any part of the body, whether by a moral,
physical, morbific, or medicinal agent, without being
followed by secondary sympathetic symptoms in re
mote parts, more or less severe according to the vio
lence of the exciting cause. The stomach and bowels,
more especially, being the grand centre of junction of
the ganglionic system of nerves, are so intimately
connected with all parts of 'the economy, that dis
turbances at either of these points are reflected
through the sympathetic nerves upon remote healthy
structures, thus complicating to a serious and often
fatal extent, any disorder which may already be pre
sent.
There is scarcely any part of the machine which is
not called into morbid sympathetic action, by de
rangements of the stomach and intestines. Even the
presence of bile, or acid, in unusual quantities, causes
pains in the head and limbs, nausea, and other affec
tions of a distressing nature, until the offending sub
stances are removed.
All of the organs and tissues are so closely con
nected by the nervous system, that it may be laid
down as a general rule, that no disorder can happen
to one part without implicating, more or less, other
parts, whether diseased or healthy.* " A particular
state of one organ, such as inflammation, or a se
creting action in it, often causes the production of a
similar state in other parts. The principle of the
balance of sympathy teaches us how we must avoid
aggravating the morbid condition of one organ by the
means which we apply to another"
* Miiller's Physiology.
84 ALLOPATHY.
How reasonable, then, to expect that artificial me
dicinal inflammations of the sensitive structures of
the economy, should give rise to secondary affections
of a grave and permanent character.
In conclusion, the theoretical and practical doc
trines of allopathy may be briefly summed up as fol
lows :
1 . In the rude ages of the world, when the arts and
sciences were in their infancy, — when vague, indefi
nite and absurd notions were entertained respecting
diseases, — when anatomy, chemistry, physiology, pa
thology, botany, and even correct methods of induc
tion, were entirely unknown, — when the imaginations
of men, instead of ascertained facts, were appealed to
in establishing theories, — and when systems of practice
were founded upon merely fanciful conjectures ; then
it was that blood-letting, cathartics, diaphoretics,
diuretics, refrigerants, revulsives, derivatives, counter-
irritants, and most of the other remedies of allopathy,
made their first appearance. As the pathological doc
trines of this period were all entirely erroneous, it is
but fair to conclude that their therapeutical inferences
must have been equally incorrect.
2. Whatever may have been the changes in respect
to the theory of disease, from age to age, long estab
lished customs, the force of habit, education, preju
dice, &c., have served to retain until our own period,
most of the violent, unnatural and pernicious methods
of treatment, invented and adopted by the founders of
medicine.
3. At the present time, everything pertaining to
the theory and practice of the old school is indefinite,
obscure, and uncertain. Scarcely two different allo-
pathists entertain the same views in regard to patho
logy, and not one can determine beforehand, with any
kind of certainty, precisely what effects his medicine
will produce ; yet, in the treatment of nearly all cases,
venesection, calomel, opium and antimony are empyri-
cally, and, we might almost say, universally employed.
In those cases where refrigerants, diuretics, expecto
rants, &c., are used, they can only be looked upon as
auxiliaries, and are usually administered without any
ALLOPATHY. 85
accurate knowledge as to whether they promote or
retard the designs of nature.
4. Owing to the absence of any generally received
or consistent theory of disease, allopathists are obliged
to prescribe at random. They strike at the name, and
not at the seat of maladies, where alone remedies can
prove efficient. Thus it is that patients are so often
reduced to the lowest point, by medicines, while the
disease continues its progress, unchecked.
5. Lastly, there is every reason to believe, that the
production of violent artificial diseases in healthy
structures, for the suppression of natural maladies, is,
upon the whole, far more productive of deleterious
than of beneficial consequences.
In view, therefore, of the present condition of the
medical art, we most earnestly request the allopath
to pause, and reflect deeply and seriously, before per
sisting in the use of venesection, revulsives, derivatives,
alteratives, and counter-irritants. Let him remember
that a high responsibility attaches to his position, —
that the welfare, happiness, and lives of his patients
hang upon his judgment and decision, — and that an
improper exhibition of remedies may so complicate
and aggravate the natural disease, as to consign his
patient to a premature grave. Let him look about,
candidly and impartially, and see if there are really
no improvements in the practice of the healing art,
since the times of Hippocrates and Galen. Let him
submit new discoveries and new doctrines to a rigid
practical test, and decide from the results — from the
cures effected — what system is most correct and best
calculated to promote the welfare of the human race.
Let him no longer reverence ancient doctrines and
ancient names, simply on account of their antiquity,
but seek after truth alone, whether of ancient or mo
dern discovery, and found his practice only upon this
certain basis.
86
CHAPTER IX.
HOMOEOPATHY.
When Hahnemann first promulgated to the world
his pathological and therapeutical views, their novel
ty, their entire variance from all preconceived opin
ions, and their alleged superiority over all other
systems, when applied to the practice of the healing
art, induced physicians to suppose the man mad, and
his ideas the offspring of a disordered imagination.
It was difficult to conceive that acute maladies
could be cured without venesection, emetics, cathar
tics, sudorifics, refrigerants, alteratives, and counter-
irritants, and on this account the great discoveries of
the father of homoeopathy were for many years coldly
received, and his arguments answered only by impu
dent sneers, or senseless ridicule.
Like the illustrious Fulton, who — when he an
nounced to his countrymen the powers of steam, and
first applied this agent to the propulsion of a vessel —
was declared, even by his nearest friends, insane, and
his projects visionary ; like Harvey, the discoverer
of the circulation of the blood, who was bitterly at
tacked " by the bigoted abettors of old established
systems, with whispers, inuendoes, and controversial
writings," and himself pronounced a reckless innova
tor, and unworthy of public confidence as a prac
titioner ; like Galileo, who, after demonstrating the
truth of the Copernican system, was persecuted by his
rivals, and twice compelled by the inquisition to ab
jure a system which he knew to be correct ; like
Columbus, Newton, Locke, Jenner, and many other
benefactors of the human race, Hahnemann has been
aspersed, and his doctrines, like theirs, have been ridi
culed, misrepresented, and contemned ; but time has
cast all the calumniators of Columbus, of Galileo, of
Newton, of Locke, of Harvey, of Jenner, of Fulton,
into a deserved oblivion, while the names of these
eminent persons stand high on the roll of fame, and
their discoveries remain to benefit the world.
The public of Europe and America are fast ren-
HOMCEOPATHY. 87
dering the same justice to Hahnemaiin and his doc
trines, and the time will ere long arrive, when the
united world \vill rank him by the side of those great
men to whom we have just alluded. It is even now
conceded by many eminent allopathic writers, that
the hypothetical doctrines of homceopathy are correct.
By referring to page 65, it will be observed that the
pathological views of Hahnemann, and some of the
professors of the old school, coincide in a very striking
manner. Indeed, it is a matter of doubt whether there
can be found in the medical ranks, two more staunch
advocates of the " vital theory," than Samuel Hahne
mann, the homoeopathist, and Martyn Paine, the allo-
pathist.
But when we come to the therapeutical inferences
deduced from these opinions, we find a wide and es
sential difference. The latter, in summing up his
method of treatment, has retained all of the violent
and barbarous remedies of antiquity, with very little
knowledge of their mode of operation upon the human
system, and with as little certainty as to whether they
will ameliorate or aggravate disease.
The former has pursued a different course. In con
sideration of the facts, that the action of no two medi
cines upon the economy is the same, — that almost
every agent exercises a peculiar and specific influence
upon certain structures only, and that this specific
effect obtains both in health and disease, he instituted
a series of accurate experiments during health, in
order to arrive at the pure effects of different medici
nal substances. The illustrious founder of homoeo
pathy not only tested the operation of medicines upon
his own person, but he induced others — men of science
and undoubted integrity in different parts of Europe — -
to make trials of the same substances, without in
forming them of the results of his own experiments ;
and when their observations were completed, he in
stituted comparisons, and found that the effects of the
medicines upon the different individuals were almost
uniformly the same. Having now ascertained with
certainty the pure effects of a number of articles
during health, he commenced exhibiting them for the
cure of diseases, in accordance with the principle
88 HOMOEOPATHY.
which he had conceived to be philosophical and true,
similia similibus curantur. We need not repeat, that
the results of these experiments were in the highest
degree satisfactory.
In the early part of his career, Hahnemann made
use of the pure mother tinctures, in ordinary doses,
but he observed that the primary effects were too ac
tive, — there usually occurring a temporary augmen
tation of the symptoms. This induced him to reduce
his doses until he came to make use of attenuations
and dilutions ; and he found, that when the medicines
were properly prepared, they still had their specific
action, and that disease was more speedily removed
than when stronger preparations were employed.
But the principal objection which was formerly,
and which still, to a considerable extent, is raised
against the system of homoeopathy, is the supposed
inefficiency of infinitesimal quantities of medicines
when administered as curative agents. Nor is this at
all surprising, for it has been customary for three
thousand years, when disturbance prevails in the hu
man citadel, to storm it with agents of destruction.
Blood is made to flow, the delicate membranes of the
stomach and intestines are raked with broadsides of
emetics and drastics, the nervous system is shattered
by narcotics and stimulants, and the functions of every
organ deranged by the showers of destructive allopa
thic missiles with which the enfeebled body is con
stantly assailed. By these summary means the dis
turbance is smothered, but the citadel is in decay,
its resources exhausted, its foundations impaired, and
its strength forever diminished.
Homoeopathy, however, resorts to a different mode
of procedure. In her remedial measures, she uses no
unnatural violence, nor seriously disturbs the function
of any organ ; but her remedies are exhibited with a
definite object ; the affected organ or tissue is acted
upon with almost mathematical certainty, and that
too without creating disease in healthy parts, or in
any way complicating the natural affection. But she
usually administers her medicaments in infinitesimal
doses, and we now come to the question wh ether such
minute quantities of matter are capable of producing
HOMOEOPATHY. " 89
salutary impressions upon the organism when labour
ing under disease ?
No one will deny that the human body during health
is constantly being acted upon and disturbed by in
fluences or agents so subtle, that neither the chemist
nor physiologist can analyze or even detect them.
The simple application of substances to the surface
of the body is sufficient to produce decided and per
manent effects. Turnbull says, that " so small a por
tion as the one hundredth part of a grain of aconite,
made into an ointment, and rubbed upon the skin, has
produced a sensation of heat, pricking, and numbness,
that has continued a whole day."
A leaf of tobacco applied to the wrist or sole of the
foot, will excite the action of the respiratory muscles,
blood-vessels, glands, and skin, causing nausea, vo
miting, &c.
If the leaves of hyoscyamus or belladonna be ap
plied to the eye, an effect will be produced which will
remain for several weeks. It is asserted by Pereira
and Sigmond, that " a dilatation of the pupils may be
produced by only approximating the leaves of hyoscya
mus or belladonna to the eyes."
It is also well known,* that " violent erysipelatous
inflammation over the whole surface of the body, is
often induced from approaching within a few yards of
several species of rhus."
The wild buffalo scents the hunter for a distance
of more than a mile, and hastens from the vicinity of
danger.
The carnivorous bird recognises the odoriferous par
ticles arising from a dead carcass, miles distant in the
air, and with hasty wing, pounces upon the prey.
The medicinal quality of cod liver oil (ol. jec.
aselli) consists of iodine distributed in infinitesimal
quantities throughout the oil. According to an analy
sis made by Falker, the iodine forms only the one-
forty-thousandth part of the oil, being about equal to
a third or fourth homoBopathic attenuation of iodine.
The value of this naturally attenuated medicine in the
treatment of scrofula and consumption, is at the pres-
* Paine's Inst. of Med.
90 " HOMOEOPATHY.
ent time generally conceded. The analyses of Stein,
De Jongh, and Balard, fully confirm that of Falker.
The very minutest quantity of the natural poison
of certain animals, the virus of hydrophobia, small
pox, kine-pox, syphilis, and gonorrhoea, is sufficient,
when placed in contact with an abraded or delicate
surface, or otherwise introduced into the system, to
give rise to all of their corresponding maladies. Other
diseases, like scabies, leprosy, &c., may be communica
ted by the mere touch, or from inhaling the breath of
an infected person.
Miasmata, animal exhalations, electricity, magnet
ism, heat, light, and even mental emotions, are all,
under certain circumstances, capable of disturbing the
organism and causing dangerous maladies, and yet, as
Liebig, in his Animal Chemistry, truly observes, " with
all our discoveries, we shall never know what light,
electricity, and magnetism are in their essence. We
can ascertain, however, the laws which regulate their
motion and rest, because these are manifested in phe
nomena. In like manner the laws of vitality, and of
all that disturbs, promotes, or alters it, may certainly
be discovered, although we shall never learn what life
is."
Let it be ever borne in mind, that most substances,
both in the organic and inorganic kingdoms, possess cer
tain active principles which are latent and unappreciable
in the natural state, and are only called forth and de
veloped by the influence of some agent or process, which
effects a transformation or metamorphosis of the crude
material.
Heat, electricity, and magnetism, become apparent
when certain physical substances operate upon each
other in such a manner as to disturb or change the
original state of cohesion of particles.
Caloric is a property common to all material sub
stances. In the natural state of these substances, this
active principle is latent, and cannot be appreciated
by the senses ; but if friction be used, this agent is set
free, and its power becomes manifest.
Electricity also, pervades all material bodies, and
only becomes sensible when the natural state of these
bodies is disturbed by friction.
HOMCEOPATHY.
91
It is probable, likewise, that iron and other sub
stances contain magnetism in a latent state, and only
require the operation of certain influences, to deve
lop in them the phenomena of magnetism. This is
evident from the fact, that u the same magnet may
successively magnetize any number of steel bars,
without losing any portion of its original virtue ;
from which it follows, that the magnet communicates
nothing to the bars, but only develops, by its in
fluence, some hidden principle"*
Large quantities of vegetable, animal, or mineral
substances, may be taken into the stomach in a crude
state, with impunity ; but if their elementary
particles become separated by decomposition, or
otherwise, and then introduced into the system, they
give rise to the most baneful results. It is a matter
of little consequence, whether this minute subdivision
of particles is effected by the action of solar heat
and moisture, by trituration, or succussion ; the ulti
mate effects are the same': The elements of the
substance are separated, the essence or medicinal
part is set free from the crude, material, and non-me
dicinal portions, and reduced to such a state of at
tenuation as to become readily absorbed, and yet
retain all the specific qualities pertaining to the ori
ginal agent.
Indeed, so minute and subtle are the miasms from
vegetable and animal decomposition, the exhalations
arising from contagious disorders, &c., that no one
has yet been able to appreciate their physical or
chemical properties, by the most accurate tests of
chemistry or optics. Who, however, for this reason,
will presume to deny or doubt their tremendous, al
though mysterious, power upon the human system ?
When ether or chloroform evaporates, the cohesion
between the particles of the liquid is destroyed ; its
elements float in the air, and are capable of impress
ing the organism in a much more powerful, and in a
totally different manner, from any impression which
could be produced by these constituents in a less at
tenuated state — as, for example, that of the original
* Beck's Chemistry.
92 HOMOEOPATHY.
liquid. If a large quantity of ether be swallowed,
but slight effects will result: but if an imponderable
quantity be introduced into the blood through the
lungs, in the form of vapour, it is immediately brought
into contact with the brain and nervous system, and
the most astonishing effects speedily ensue.
"If the 10,240th of a grain of tartrate of mercury
be diffused through the substance of a mere hard
sweet-pea, the beautiful germ of a graceful flowering
herb, which lies folded up in its horny pericarp, shall
never come out and be expanded, though you imbed
it in the softest mould, and solicit it by every art."
(Leuchs.)
Professor Doppler, of the Royal Institute of Prague,
in speaking of the modus operandi of infinitesimal
particles, writes thus : "From the moment in which
the substance of the atoms succumbs to the influence
of their surfaces, and apparently independent of the
law of gravitation, they move with the greatest faci
lity in every direction, and, as it were, become alive ;
from that moment only, in my opinion, drugs acquire
the capacity of penetrating the organism, and of ex
citing there a curative effect. For if drugs, prepared
in this manner, be brought in contact with the in
visible extremities of nerves, their hyper-microscopi
cal atoms will enter the organism at the same time
with their superficial electricity, and will, if the nerves
be in a perfectly natural state, be thrown out of the
system without impediment, after having penetrated
it in every direction. But if a body in a state of
health be accompanied by an activity of the nervous
system, perfectly unimpeded and equally free in every
direction, we cannot, on the other side, but presume,
that in a state of imperfect health the power of con
duction, proper to the nervous substance, will be ma
terially diminished, partially and in individual or
gans, either in consequence of a chemical change, or
for some other reasons. But to use rather a mate
rial, but, nevertheless, by no means unfit comparison,
as streams deposit the sand and pebbles they carry
along, on those spots only where their currents meet
with an impediment, and their rapidity seerns broken
by obstructions, so in a similar manner, in the dis-
HO.MCEOPATHY. 93
eased organism, may the electric currents, however
feeble, leave the atoms of drugs at the diseased spots,
where they, according to their individual properties,
exert either a curative or detrimental influence."
If, then, imponderable substances possess powers so
unequivocal and potent upon the healthy subject,
when the organs are in a high state of vigour, and
consequently in a good condition to resist the in
fluence of foreign impressions, why may we not
infer, with perfect propriety, that medicinal sub
stances, equally imponderable, are capable of im
pressing the organism during disease, when the af
fected structures are unusually susceptible to extra
neous influences ?
Homo30pathists suppose that the mode in which their
tenuations operate is analogous to that of infection by
miasms ; that the inert matter of the substance is
destroyed, and the active principle set free ; and that
the smallest quantity of this active principle, tritu
rated with sugar of milk, or diffused in water or
alcohol, is capable of communicating to the vehicles
its properties, and thus to the organism its peculiar
action.
The essential principles of all vegetable substan
ces constitute but a very small proportion of the ori
ginal crude article, and the more perfectly we sepa
rate these active from the inactive portions, the more
pure and powerful will the remedy become. Like ca
loric, electricity, and magnetism, the strength remains
latent in the crude state of the substance, and can
only be developed by the important agency of heat,
friction, or trituration.
Peach-blossoms, the bark of mountain-ash, the
kernels of peaches, cherries, and plums, bitter al
monds, &c., contain, in a latent condition, the active
poison known as prussic acid, which may readily
be obtained from either of these articles by a che
mical process.
Ipecacuanha is indebted for its virtues, to a prin
ciple called emetia. Pelletier found, upon analysis,
that the brown ipecacuanha bark contains only six
teen per cent, of impure emetia ; and the red bark
OF THE
.,.-.-, CM-TV
94 HOMGBOFATHY.
fourteen per cent. According to Bergelius, the im
pure emetia possesses only one-third the strength of
the pure. We therefore find, that of one hundred
parts of crude ipecacuanha, only five parts possess
the medicinal virtues of the drug. Nor is it at all
improbable, that farther researches will enable the
chemist to free this principle from other impurities,
and thus develop a still more potent medicine.
Opium contains but a very small per cent, of its
narcotic principle, morphia. The crude substance
contains, in addition to morphia, at least fourteen
other ingredients, all of which are destitute of any
particular virtues. Only about eight or nine per cent,
of morphia is obtained from Turkey opium, and this
is quite impure and unfit for use, containing nar-
cotina, &c.
Cinchona is composed of ten or twelve ingredients
of which, all but quinia and cinchonia, are inert.
Even these last, as usually obtained, are highly adul
terated, and do not by any means represent the active
principle of bark in its purity.
The same rule obtains in relation to most other
substances. The essential properties are distributed
but sparingly throughout ligneous, resinous, and
other matters, and it is only by the utmost care and
nicety, that we can separate and develop these pro
perties.
Indeed, there are many instances where the skill of
the chemist is unable, not only to develop artificially
certain principles of vegetable and animal substances,
but even to analyze them when they become sponta
neously disclosed by the action of heat and moisture.
Miasmata and other noxious exhalations are exam
ples of this kind.
It is a fundamental law of therapeutics, that the ac
tive properties of all medicinal substances can only be
manifested from their surfaces ; and it follows as a
consequence, if we would develop the full powers of
drugs, that they must be made to occupy as great a
surface as possible.
]f a compact piece of wood be ignited, but a small
blaze can be produced; while if the same wood be cut
into small portions, so as to expose a large surface, and
HOMCBOPATIIY. 95
then ignited, a large and powerful flame will appear.
Only a limited amount of electricity can be drawn
from a given surface of glass; but if the same glass
be made to occupy double the space, an additional
amount of the fluid may be set free.
If a hole be rapidly bored through an ordinary piece
of iron, the surface of each chip so detached will be
found to possess magnetic properties ; and a singular
circumstance connected with this, is the fact, that
when the boring is accomplished in a perpendicular di
rection, the chips are more highly magnetized than
when it is effected horizontally. Here, again, is an
instance where friction has developed properties en
tirely unappreciable in the natural state.
A single grain of matter may be made by trituration
to pervade every part of one hundred grains of sugar
of milk, and each molecule thus separated may be
still farther subdivided into corpuscules, which in their
turn may be diffused intimately through additional
quantities of the medium. In this manner only, can
we call forth all of the latent properties of drugs, and
reduce them to that state of attenuation which is com
patible with absorption, and which enables them to
exert those salutary specific influences which the
homoeopathic practitioner so uniformly observes.
Each atom thus minutely separated, retains the
power of exercising its specific influence upon the or
ganism. Quantity is of but little consequence, provi
ded that the substance is properly prepared ; for an
imponderable quantity in its highest state of develop
ment, is quite as capable of producing its peculiar
effects in certain conditions of the body, as a much
larger amount.
It is undoubtedly true that an atom, either morbific
or medicinal, which possesses an affinity for a partic
ular structure, is capable of communicating to such
structure its peculiar action, the influence being pro
pagated from one molecule to another, and each ac
quiring the properties of the original atom, until the
influence is expended.
Examples of this kind of action are constantly pre
sented to the physician in the form of continuous sym
pathy.
06 HOMOEOPATHY.
One inhalation of a noxious miasm, under favourable
circumstances, is as capable of causing its specific con
tagion, as a thousand, or more. One thousandth part
of a grain of a natural or morbid virus, is as capable
of imparting the peculiar action of the poison to all
parts of the organism susceptible to its influence, as a
larger quantity.
So also, when an atom of a medicine is absorbed
into the system and comes in contact with an organ or
tissue already diseased, upon which it exercises a spe
cific influence, it communicates to the surrounding
atoms its peculiar action until the whole tissue is in
volved, and thus, if the remedy be homoeopathic to
the malady, it will supersede the primary affection.
La Place and Berthollet have advanced the opinion,
that " a molecule, being put in motion, can communi
cate its motion to others, if in contact with them."
This law is applicable to both animate and inani
mate matter, under certain circumstances. Thus, the
smallest point of decayed vegetable or animal mat
ter, if placed in contact with healthy vegetable or ani
mal substances for which it has an affinity, will com
municate to the latter its own morbid action.
The smallest point of decay in a tooth, continually
propagates its peculiar action to the surrounding parts
until the whole tooth is destroyed, or the diseased por
tion is removed.
The slightest spark of fire, put in contact with a com
bustible material, communicates its action to all parts
susceptible of combustion.
A minute nucleus being once formed in the mineral
kingdom, possesses the power of attracting to itself in
a regular and uniform arrangement, all of those par
ticles near it, for which it has an affinity, and the dif
ferent varieties of minerals communicate to these par
ticles their own peculiar action and arrangement.
It is asserted by the supporters of the chemical hy
pothesis; " that substances in a state of putrefac
tion, by entering the blood, impart their peculiar action
to the constituents of that fluid, and all the sub
stances of the body are induced to undergo a modified
putrefaction."* Liebig affirms that " a body, the atoms
* Paris Pharmacologia.
HOMOEOPATHY. 97
of which are in a state of transformation, may impart
its peculiar condition to compounds with which it may
happen to communicate."
These assertions, however, are not sustained by
facts. There is no proof that the blood becomes con
taminated by the atoms which enter it in a state of
transformation ; nor is there any proof that such
atoms are capable of " imparting their peculiar con
ditions," indifferently to other " compounds with
which they may happen to communrcate."
Every substance in nature, whether morbific or
medicinal, possesses its own characteristic and dis
tinct mode of action, and is only able to exercise or
communicate this action, in a specific manner, to
particular structures. Thus, the contagion of scarla
tina imparts its peculiar action to the throat and skin.
The contagion of scabies acts exclusively upon the
skin. The miasms which occasion many kinds of
fever, appear to expend their effects upon the nervous
system. The virus of gonorrhoea is specific and uni
form in its results upon the mucous membrane of the
urethra. The virus of syphilis, although more gene
ral in its operation, affects only a certain class of
structures. All of these poisonous matters are incapa
ble of imparting their peculiar influence, unless they are
brought intp contact with those tissues for which they
possess a " kind of elective affinity" There is no rea
son to suppose, that in any instance we have named, the
blood itself is contaminated, but it serves merely as
the vehicle which conveys the morbid particles to the
different parts of the body.
What we have advanced in regard to the modus
opcrandi of morbific, is equally true of medicinal
agents. We have before shown that most drugs pos
sess well-defined specific actions, which can only be
manifested after having been conveyed by the blood
to their destined structures.
It will be perceived that the views here advanced
in regard to the mode of operation of morbific and
medicinal agents, differ essentially, not only from
those of the chemical school, but also from those of
most writers who havf hitherto appeared as advo-
88 HOMOEOPATHY.
cates of homoeopathy. From quotations made at
page 22, it will be observed that Hahnemann himself
is a firm advocate of the " vital theory." In common
with many distinguished writers of the old school, he
supposes all diseases to consist of certain alterations
of the ;< vital properties " of parts, and that medicines
cure these diseases by acting upon these (supposed)
immaterial properties in such a manner as to restore
them to a normal state. In advocating these doc
trines, Hahnemann has virtually rejected the theory
of absorption, the truth of which has been so amply
verified by Muller, Pereira, Blake, &c., and thus has
marred a portion of his beautiful system.
It may seem impossible, at a first view, that attenuated
drugs can be absorbed into the system, and exert their
influence topically on the different structures ; but in
support of this opinion we beg leave to submit the
following ideas.
Medicines, as has been previously remarked, are
often detected in those structures on which they have
exerted their effects. Mercury, iodine, sulphur, nitrate
of silver, the salts of lead, iron, bismuth, copper, &c.,
have all been found in different tissues of the econ
omy ; and even Liebig himself advises us that many
of these substances often form " permanent com
pounds with the different tissues." The same author
also remarks, " if by the introduction of a substance
certain abnormal conditions are rendered normal, it
will be impossible to reject the opinion, that this phe
nomena depends on a change in the composition of
the constituents of the diseased organism, a change in
which the elements of the remedy take a share."
The elements of the remedy do most certainly take
a share in this change, but only so far as the disorder
ed organ or tissue is concerned. It matters not whe
ther the specific agent be imponderable in quantity,
administered through the kings, stomach, or skin, or in
jected into the veins ; it seeks that part for which it
has an affinity, and there manifests its force.
I have known persons to become salivated by the
use of less than one-half of a grain of the first tritura-
tion of corrosive sublimate, given in divided doses.
This ran be explained in no other way than by
HOMOEOPATHY. 99
supposing that the remedy is rendered innoxious to
the absorbent vessels by the peculiar mode of prepa
ration ; for so small a quantity of the crude article
has never, to our knowledge, been known to produce
this result. By trituration, the crude particles of the
mineral are so minutely separated and diffused
through the vehicle, that the delicate absorbents ad
mit them into the circulation with facility, while in
an unprepared state the remedy would be recognised
as an irritant, and consequently excluded.
When salivation is produced by large doses of ca
lomel, or blue-mass, it is highly probable that evapo-
roiion occurs from the heat of the stomach and intes
tines, and that this vapour, impregnating the chyle, is
absorbed. It has been said by the opponents of ab
sorption, that the preparations of mercury cannot be
absorbed on account of their insoluble nature, and
therefore that salivation is caused by an impression
which is made upon the " vital properties" of the
stomach, and that this impression is reflected to the
salivary glands, through the sympathetic nerves. But
if the advocates of this doctrine will reflect that mer
cury evaporates at a common temperature, and that
this vapour, when inhaled, exerts all the specific ef
fects of the mineral, they must admit that when sub
mitted to the higher temperature of the stomach and
bowels, this evaporation and absorption will be aug
mented. " I believe," says Pereira, " with Buchan,
Orfila. and others, that metallic mercury, in the finely
divided state in which it must exist as vapour, is itself
poisonous"
An argument which we deem conclusive upon this
point, is from the fact that traces of mercury itself have
often been detected in the secretions, excretions, and
solids of the body ; and if any " vital properties "
have reflected the influence, they must have conveyed
the solid substance along bodily to the affected glands,
etc.
In considering the subject of absorption and the
topical action of attenuated drugs, it must be remem
bered that the absorbing structures are very delicate
and sensitive, so that they are enabled to exclude all
crude and irritating substances : and also that the ex-
100 HOMCEOPATHY.
treme terminations of the nerves, in all parts of the
body, are exquisitely susceptible to the influence of
specific foreign agents ; and a cause capable of
affecting powerfully these minute filaments, would be
entirely without energy and unappreciated, if brought
to bear upon the trunk or larger branches of the same
nerve.
Another fact illustrative of the truth of absorption
and topical action is, that substances always exercise
their specific effects more promptly and potently when
introduced directly into the mass of the blood, than
when taken by the stomach. " Medicinal or poison
ous agents, injected into the blood-vessels, exert the
same kind of specific influence over the functions of
certain organs, as when they are administered in the
usual way, but that their influence is more potent."*
Liebig also assures us, that " we can by remedial
agents exercise an influence on every part of an organ
by substances possessing a well-defined chemical ac
tion."
Here is a distinct recognition of the principle of
the topical or specific action of remedial agents, al
though the character of this action is supposed to be
chemical. Without entering into any discussion upon
this point, or attempting to explain how morbific or
remedial agents produce their peculiar effects, we
shall remain satisfied with the positions we have be
fore laid down, and simply refer our readers to the
numerous instances, within their own knowledge, of
the topical action of substances, both ponderable and
imponderable, with the addition of a few examples of
the latter, which can be understood and appreciated
by all.
1st. Odours. When odoriferous particles are brought
into contact with a certain nasal structure, (the schnei-
derian membrane,) the minute and sensitive nerves of
the part take cognizance of the stimulus, a decided
impression is made upon the whole membrane, and
an odour, agreeable or otherwise, according to the
nature of the exciting cause, is the result. In this
instance, physical, but imponderable particles, operate
* Pcreira, Mnt, Mod. and Tlier.
HOMCEOPATHY. 101
upon the nasal tissue by absolute contact, and impart
that peculiar action which enables us to appreciate
odours.
2d, Light. According to Sir Isaac Newton, light is
a physical, but imponderable compound, and can only
manifest its power when its atoms are in contact with
the organ of sight. These particles of light are the
natural stimulus of the eye, — material, imponderable,
specific. When this compound is separated into the
different primary rays, each particular ray, when
brought into contact with the eye, exercises a special
and distinct influence, giving rise to the perfect ap
preciation of the different colours of the prism. Here
again we are presented with an example of the spe
cific influence of imponderable atoms upon a certain
part of the system.
3d, Caloric. Newton also maintained that caloric is
" a distinct material substance, the particles of which
repel one another, and are attracted by all other sub
stances."
When caloric is given off by a heated body, its
atoms impart to all other atoms with which it comes
in contact, its o\vn peculiar action, and the sensation
of heat, with its attendant phenomena, expansion,
&c., is the consequence. Here we are afforded with
a still more striking instance of the power of an im
ponderable substance in altering and modifying the
character and properties of all substances upon which
it exercises its action. This active principle, present
in all bodies, hidden and unappreciable except when
set free by friction, percussion, mixture, electricity, or
combustion, possesses properties when thus liberated,
surpassing in power and influence every other sub
stance in nature ; yet it is more subtle and imponder
able than the most attenuated medicines of homreo-
pathy.
4th. Electricity, galvanism, magnetism, and the va
rious gases, are all material substances, and manifest
their influence physically by contact with the body.
It must not be supposed that light, heat, electricity,
magnetism, etc., are immaterial nothings — mere pro
perties of matter — because they cannot be weighed^
handled, and made subservient to all of those
102 HOMOEOPATHY.
which govern more crude substances. Nor must it
be supposed of drugs, that they possess no qualities
except those which are apparent in the crude state,
and can be fully appreciated by their nauseousness
of taste, rankness of smell, or power of raking the
stomach and intestines.
Modern science has demonstrated, that by friction,
percussion, mixture, &c., some of the most powerful
principles known may be liberated from substances,
which, in a crude state, are entirely harmless. It
has shown, that the more perfectly we can disencum
ber these principles from their inactive envelopes, the
more potent they become. It has shown that the
mass of ligneous, resinous, starchy, fatty, extractive,
and colouring matters, which surround and enclose
the active portions of vegetable substances, instead
of possessing medicinal properties, serve only to nau
seate and oppress the stomach and bowels, and thus
complicate any existing malady.
Pereira, and other authors opposed to our system,
have endeavoured to cover it with ridicule by entering
into a computation respecting the weight and strength
of the different attenuations. They have displayed
before us tabular views showing the strength of each
attenuation, and then assured us, without the trouble
of testing the question practically, that such exceed
ingly small doses of medicines can produce no effect
upon the system, but " that the supposed homoeopathic
cures are referable to a natural and spontaneous cure,
aided, in many cases, by a strict attention to diet and
regimen."* This is the principal argument urged
against the therapeutical doctrines of Hahnemann.
We beg leave, however, to request those gentlemen
who judge of the potency of substances by their
weight and dimensions, to enter into a still further cal
culation, and inform us which possesses the greatest
weight, the medicinal particles pertaining to a drop of
a thirtieth attenuation of homoeopathy, or the charge
of electricity, which lays prostrate and senseless the
strongest man — or the quantity of sulphuretted hydro
gen, or carbonic acid gas, requisite to cause immediate
* Pereira's Mat. Med. and Ther.
HOMCEOPATHY. 103
death when inhaled ? Which can be most readily
detected and appreciated by analysis, the atoms of a
high attenuation of Hahnemann, or the deleterious
miasms which arise from vegetable or animal decom
position ?
Which present the greatest difficulties in examina
tion and description, the physical structure of the par
ticles of a homoeopathic medicament, or that of ca
loric, or light ?
Will the respectable Hippocratic, who cannot re
cognise power in any material substance, unless it can
be weighed or handled, enter into a computation, and
inform us how much a poisonous dose of the vapour of
hydrocyanic acid, mercury, or lead, weighs ?
Let it be remembered, that not one atom of matter
in the whole universe can be annihilated : transfor
mations may be effected — the cohesion of particles
may be changed* — atoms in their ultimate state of
chemical combination may be physically divided into
molecules, and again subdivided into lesser atoms to
such an extent as to baffle detection from the most
perfect tests of chemistry or optics- — new powers may
be developed in these atoms, the exact operation of
which we may not at present be able to understand,
but in no instance can we destroy one single particle
of matter. We may effect an entire metamorphosis
of almost any solid substance, and diffuse its elements
in such a manner as to occupy and affect a very large
amount of space. The elements of a few grains of
gunpowder may be made with the aid of a few im
ponderable particles of caloric, to change their form,
and impregnate every portion of the atmosphere of a
large room. In like manner, a single grain of a vege
table or mineral substance may be transformed, and
its atoms diffused throughout large quantities of inert
materials, in such a manner as to impregnate them
in every part with medicinal properties, but in no in
stance can a single atom be annihilated. Until we
arrive at more accurate knowledge in relation to the
laws which govern the chemical and physical action
of the minute atoms of substances than we at present
* See Atomic Theories.
104 HOMCEOL'ATHY.
possess, let us not deny that they may be endowed
with properties and powers, (although their modus
medendi is a mystery to us,) capable of exercising an
important influence upon the human organism.
In regard to the preparation of medicines, there are
several points of difference worthy of particular no
tice, between the old and new schools.
1. Allopathy employs her drugs in a crude and
consequently inactive form ; wrhile homoeopathy makes
use only of their pure essential principles, unencum
bered by foreign matters.
2. Allopathy employs so great an amount of arti
ficial heat in her pharmaceutical operations, that a
large proportion of the active properties of her drugs
is expended in evaporation ; while homo3opathy
makes use only of expression, trituration, and suc-
cussion, and thus not only retains all of the virtues in
herent in the drug, but actually develops powers
which would have remained latent under other cir
cumstances.
3. On account of the peculiar mode of prepara
tion, the remedies' of allopathy are offensive to the
taste, nauseous to the stomach, and by their indigest
ible and irritating qualities, serve directly to induce
gastric and intestinal derangements, and other serious
medicinal symptoms. The medicines of homoeopathy
are liable to none of these objections.
4. For the reasons above enumerated, many of
the remedies of the old school are excluded by the
sensitive absorbents, on account of their irritating
qualities, and are thrown off with the faecal matters
as foreign substances ; having failed, in their passage
through the intestinal canal, of producing any other
effect than an irritation of the gastrointestinal
membrane. The attenuated remedies of homoeopathy,
being innocuous to the Jacteals and absorbents, are
readily admitted into the circulation and conveyed to
those parts upon which they exert a specific action,
thus impressing directly the organs or tissues actually
diseased. " No substances," says Martyn Paine, in his
Institutes of Medicine, " but such as exist in a fluid or
very attenuated state, are taken up by the lacteal s and
absorbents."
HOMOEOPATHY. 105
So, also, in the therapeutical application of reme
dies, \ve claim, as far as accurate scientific principles
and sound philosophy are concerned, that homoeo
pathy is vastly superior to allopathy. We shall
briefly reiterate some of the more prominent points
of difference in the practice of the two schools.
The system of homoeopathy is founded upon ra
tional and scientific principles, inasmuch as its
remedies are exhibited with a definite object, and the
results can in most cases be predicted with mathe
matical certainty.
The practice of allopathy must always be indirect,
uncertain, and empirical. The violence of the re
medies employed, necessarily induces medicinal and
sympathetic affections, which, mingling with the
symptoms of the natural disease, render it impossible
to distinguish between the two classes of symptoms,
or to judge whether the malady, or the medicine, or
both combined, are killing the patient. The fact*
that so few allopathic practitioners coincide precisely
in regard to the treatment of very many diseases,
proves conclusively that their system is one of guess
ing, rather than one founded on scientific knowledge
and ascertained facts.
Homoeopathic remedies being specific and certain
in their effects, operate only upon those parts which
are actually diseased. Without inflaming healthy
structures, debilitating the system, or disturbing the
function of any organ, they induce, when judiciously
exhibited, a new or alterative action in the part af
fected, of just sufficient severity to banish the natural
malady, while the new or medicinal action subsides
speedily and spontaneously.
According to the doctrines of homoeopathy, no two
diseases or kinds of inflammation can exist in the
same structure at the same time ; for whenever two
exciting causes act upon the same part, the one pos
sessing the most powerful action, must necessarily
banish and supersede the weaker. Therefore, in ac
cordance with the rules of our system, remedial im
pressions are always made directly upon the organ
or tissue affected, and a new kind of action set up
5*
106 HOMCEOPATHY.
which abolishes the disease and usurps temporarily
its place.
According to the strict tenets of the old school,
remedies should be exhibited in such a manner as to
impress structures which are healthy and remote from
the organ or tissue diseased, in order that revulsive,
derivative, or counter-irritating effects may be pro
duced, and thus serve to attract the fluids from the
natural affection to the artificial one. This plan of
treatment originated, as we have seen, from the sup
position that no two maladies of consequence could
exist in different parts of the same organism at the
same time. As this idea is at present universally con
ceded to be erroneous, we assert that a mode of prac
tice deduced from such false data, must of necessity
be unscientific and empirical.
By operating on healthy structures, the allopath ac
complishes little or nothing towards restoring the im
paired capillaries of the affected part to their ori
ginal condition of strength and resistance, and con
sequently his system must be entirely inadequate to
effect cures. We are, for this reason, forced to the
conclusion that the modern Celsus, Dr. Forbes, is cor
rect when he asserts, that " in a large proportion of
the cases treated by allopathic physicians, the disease
is cured by nature, and not by them."
It is a fundamental law of medicine, that no in
flammation can be created in any part of the body,
without giving rise to secondary sympathetic affec
tions in other and distant parts. It is evident, there
fore, that the greater the number of structures
affected with inflammation, whether natural or arti
ficial, the greater will be the number of sympathetic
symptoms, and consequently the more serious and
complicated the malady. Thus we perceive the
force of Dr. Forbes' remark, " that in not a small pro
portion of the cases treated by the physicians of the
old school, the disease is cured by nature, in spite of
them ; in other words, their interference opposing,
instead of assisting, Ihe cure."
We have before shown that organs and tissues be
come morbidly susceptible to the impressions of spe
cific remedial agents during inflammation ; therefore it
HOMOEOPATHY. 107
is that extremely minute quantities of specific medica
ments are capable of exercising powerful influences
daring disease, which, under circumstances of health,
would be productive of no effects whatsoever. This
is a truth of vast importance in the administration of
medicines, and should be thoroughly appreciated by
the practitioner who regards the welfare of his pa
tients. Let him remember that these acquired sus
ceptibilities are so great, that even the natural stimuli,
food, gastric juice, bile, light, &c., cannot be tolerated ;
and from this fact, take warning lest he inflicts injury
and counteracts the efforts of nature, by too active
medicines.
But as we have so frequently observed, it is not so
much our principle of cure, at which the shafts of the
old school are directed, as to the doctrine of small
doses. It is not because the adherents of allopathy
cannot make themselves acquainted with the powers
of attenuated drugs, but it is because their inveterate
prejudices will not allow them to investigate the facts
which are involved. They prefer to die of vomiting,
purging, and sweating, as their predecessors have done
for two thousand years, rather than to be cured quietly
under a new system. These individuals are not satisfied
unless they feel and see the poor body writhe and suffer
for the sin of being sick. What care they for any
interior or invisible action of a medicine, when they
can be cut. racked, and tortured, by the lancet, emetics,
cathartics, blisters and moxas, and that too, secundem
artem ? To be sure, they were not aware of any visible
effects when the morbid agent operated upon their sys
tems to produce the disease, but the curative part is in
their own hands, and they are determined to exercise
their privilege of a full and continual appreciation of
the whole modus operandi of the remedial process.
This part, nature has no power to cheat them of, but
Hippocrates now reigns, and they are resolved to exer
cise their ancient reserved rights, and bleed, puke,
purge, sweat and blister, ad libitum.
But why have our opponents dwelt so much upon
our doses ? Does not every homoeopath aim and intend
to give a sufficient quantity of the medicine at a time,
to effect a speedy cure ; and is not this quantity deter-
108 HOMOEOPATHY.
mined by experience of simple facts ? We have dif
ferent strengths or attenuations of each medicine, from
the strongest tincture up to the most minute attenua
tions, and every homoeopath selects that strength or
attenuation of the drug which most speedily and safely
cures his patient. The great point with him is, to se
lect such a medicine as shall be homoeopathic to the
symptoms of the disease, and then to administer just
enough of it to effect his object in the most safe and
speedy manner. He finds by experience — by a mass of
facts — that the tinctures and alkaloids, although often
capable of subduing disease, are less prompt, less effi
cient, and less safe than weaker preparations of the
drug. This easily demonstrated truth, was not the re
sult of theory or hypothesis, but originated with Hah
nemann, as we have already seen, through necessity,
on discovering that the tinctures which \vere first em
ployed by him, in accordance with his principle, often
produced too violent impressions upon the affected struc
tures. What cared Hahnemann — what care his disci
ples — whether they use one or twenty drops of a tincture,
or one grain of a twentieth attenuation ? Were twen
ty drops of a tincture, or twenty grains of a crude sub
stance, more efficient in curing sickness than one drop
or one grain of an attenuation, is there any man who
supposes that Hahnemann or his followers would not
have administered them in this form, in preference to
any other ? The chief glory of the founder of homoeo
pathy does not consist in the discovery of the efficacy
of small doses, but in the demonstration and practical
introduction of the great doctrine of curing maladies
by impressing diseased tissues with medicines which
operate specifically upon these tissues themselves, ra
ther than on distant parts.
It matters not, therefore, in regard to the homoeopa
thic law of cure, whether we use this or that strength,
provided the remedy is homoeopathic to the disease,
and exactly the requisite impression is produced upon
the affected parts. The man who cures a belladonna
headache with ten drops of the tincture, adheres to si-
milia similibus as much as he who cures with the thir
tieth attenuation of the medicine. The only question
to be decided is, which strength cures most safely and
HOMOEOPATHY. 109
•
quickly ; and if facts prove, as all homoeopaths believe,
that a preparation weaker than the tincture is by far the
most safe and efficient, then it is our duty to give these
preparations the preference. It is found, for example,
when repeated doses of tincture of belladonna are
given in acute inflammation of the brain, that the pri
mary symptoms from the drug manifest themselves too
violently — that it causes dangerous and protracted me
dicinal aggravation, and a tardy re-action of the organ
ism ; while a dilution of the remedy impresses mildly the
diseased structure, causing scarcely perceptible pri
mary symptoms, and is speedily followed by its seconda
ry or curative effects.
We shall conclude this chapter by quoting a few
observations of the distinguished modern chemist (an
allopathist) Kane, respecting the divisibility of matter,
and some of the phenomena witnessed when a very
high state of attenuation has been arrived at. We make
these extracts for the benefit of those whose " bundles
of ideas" are not already made up, trusting at least,
that they may have the effect of demonstrating to such
persons, that, not only morbific and medicinal powder
may exist in infinitesimal atoms of matter, but even
life itself.
" It has been proved that gold may be divided into
particles of at least Moojmo<x> of a square inch, and yet
possess the colour and all other characters of the
largest mass. If a grain of copper be dissolved in ni
tric acid, and then in water of ammonia, it will give a
decided violet colour to 392 cubic inches of water.
Even supposing that each portion of the liquor of the
size of a grain of sand, and of which there are a mil
lion in a cubic inch, contains only one particle of cop
per, the grain must have divided itself into 392 million
parts. . A single drop of a strong solution of indigo,
wherein at least 500,000 distinctly visible portions can
be shown, colours 1,000 cubic inches of water ; and as
this mass of water contains certainly 500,000 times
the bulk of the drop of the indigo solution, the par
ticles of indigo must be smaller than ^00,00^000,000 the
twenty-five hundred millionth of a cubic inch. A ra
ther more distinct experiment is the following : if we
dissolve a fragment of silver, of 0.01 of a cubic line in
110 HOMCEOPATHY.
size, in nitric acid, it will render distinctly milky, 500
cubic inches of a clear solution of common salt.
Hence the magnitude of each particle of silver cannot
exceed, but must rather fall far short of a billionth of
a cubic line. To render the idea of this degree of di
vision more distinct than the mere mention of so im
perfectly conceivable a number as a billion could af
fect, it may be added, that a man, to reckon with a
watch, counting day and night, a single billion of se
conds, would require 31,675 years."
According to Doppler, a cubic inch of brimstone,
broken into a million equal pieces, a sand grain each
in size, is magnified in sensible surface from six square
inches to more than six square feet. It is calculable
in this way, that, if each trituration of the homoso-
pathist diminishes his drug a hundred times (an ex
tremely moderate allowance), the sensible surface of a
single inch of sulphur, or any other drug, shall be two
square miles at the third trituration.
"In the organized kingdoms of nature, even this ex
cessive tenuity of matter is far surpassed. An Irish
girl has spun linen yarn of which a pound was 1,432
English miles in length, and of which, consequently,
17 Ibs. 13 ounces would have girt the globe ; a dis
tinctly visible portion of such thread could not have
weighed more than ^7/oso,m of a grain. Cotton has been
spun so that a pound of thread was 203,000 yards in
length, and wool 168 yards. And yet these, so far from
being ultimate particles of matter, must have contain
ed more than one vegetable or animal fibre ; that
fibre being of itself of complex organization, and built
up of an indefinitely great number of more simple
forms of matter.
" The microscope has, however, revealed to us still
greater wonders as to the degree of minuteness which
even complex bodies are capable of possessing. Each
new improvement in our instruments displays to us
new races of animals, too minute to be observed be
fore, and of which it would require the heaping toge
ther of millions upon millions to be visible to the naked
eye. And yet these animals live and feed, and have
their organs for locomotion and prehension, their ap
petites to gratify, their dangers to avoid. They possess
ATTENUATIONS OF DRUGS, ETC. Ill
circulating systems often highly complex, and blood,
with globules bearing to them, by analogy, the same
proportion in size, that our blood globules do to us ;
and yet these globules, themselves organized, possessed
of definite structure, lead us merely to a point where
all power of distinct conception ceases ; where we
discover that nothing is great or small but by com
parison ; and that presented by nature on the one hand
with magnitudes infinitely great, and on the other with
as inconceivable minuteness, it only remains to bow
down before the omnipotence of Nature's Lord, and
own our inability to understand him." (Kane's Chem
istry, by Draper, p. 19.)
CHAPTER X.
ATTENUATIONS OF DRUGS AND REPETITIONS OF DOSES.
In selecting our attenuations for the cure of disease,
the following circumstances are to be taken into con
sideration : 1, the age, sex, temperament, constitution,
and habits of life ; 2, the condition of the disordered
textures ; 3, the character of the drug to be employed.
(a) Age. Infants and children of tender years,
whose organisms have not become blunted by expo
sure to the ordinary stimuli of life, by improper food
and drinks, and by abuse of cathartics and opiates,
are in the most eminent degree impressible, and re
quire the highest attenuations. It is at this period
that the circulation is most active, the nervous system
most delicate, and the tissues most sensitive to the
influence of external agencies.
At the middle poriod of life, when the body has ar
rived at maturity, and all of the organs have acquired
their full strength and vigour, the resisting power
against both medicinal and morbific agencies is at its
maximum. The action of the circulatory vessels is
now moderate and stable, the nerves are strong, the
structures have become accustomed to all kinds of
112 ATTENUATIONS OF DRUGS, ETC.
stimuli, and the mind, which exercises so powerful an
influence over the body, acts calmly and judiciously.
At this period, our lower attenuations will often serve
us more efficiently than the higher.
During the decline of life, many circumstances
which have a tendency to modify the operation of
medicines, are to be considered. Individuals who
have passed their lives in intemperance, who have
been afflicted with frequent attacks of disease, and
whose systems are loaded with the cumulative poi
sons of drugs, usually acquire a remarkable obtuse-
ness and inactivity of the whole organism, so that the
very lowest attenuations are requisite to effect suita
ble impressions. On the other hand, many old peo
ple, upon the verge of second childhood, become
sensitive, irritable, and so intensely impressible, that
the higher preparations respond promptly and effect
ively.
(b) Sex. Females are more easily acted upon by
medicines than males, for several reasons. Perhaps
the most prominent one consists in their superior deli
cacy of organization : their circulation is more active,
their nervous systems more irritable, and their mental
powers more acute and quick, although less strong,
logical and independent than those of men. J. J.
Rousseau asserts, that a woman will leap to a conclu
sion which would require a man hours of severe
thought to arrive at. It is this susceptibility and de
licacy of organization which render the female more
impressible than the male sex, and which should
always have no inconsiderable weight in the selection
of attenuations.
(c) Temperament. The temperament also has an
important influence in the operation of medicines.
As most morbific and remedial agents produce their
effects upon the sentient extremities of the nerves, it
follows that a highly susceptible condition of the ner
vous system is most favourable to the prompt opera
tion of these causes. We therefore infer, that the
higher attenuations are better adapted to the nervous,
than to either of the other temperaments.
Next to the nervous temperament, in point of sus
ceptibility, may be ranked the sanguine. Individuals
ATTENUATIONS OF DRUGS, ETC. 113
of this temperament are characterized by great ac
tivity and energy, and by prominent development and
vigour of the vascular system.
The temperaments which are the least susceptible
to remedial impressions, are the bilious and lymphatic.
The former is characterized by large muscular devel
opments, tendency to biliary derangements, frequent
turns of melancholy, and great powers of endurance.
The latter is distinguished by a predominant activity
of the glandular system, by a flabby and relaxed con
dition of the muscles, and by a feeble and rather ob
tuse state of the nervous system. These tempera
ments sometimes require our lowest attenuations, es
pecially in chronic diseases.
Two or more of these temperaments often unite in
the same person, when we have what is termed a
mixed temperament. This variety may be considered,
upon the whole, the most favourable to health and
longevity, since no quality predominates, and the
functions of the organism are more equalized.
(d) Constitution, Attenuations must also be se
lected with a due regard to the constitutional pecu
liarities of each particular case. We know of several
persons who cannot take a blue pill, or a pill in
which calomel is a constituent, without being vio
lently salivated. There are others in whom opium
produces furious and protracted delirium, and cathar
sis, as primary effects ; others cannot carry ipeca-
cacuanha about their persons, or inhale the smallest
quantity of it, without attacks of asthma ; others
cannot approach the rhus plant without being poi
soned ; others cannot use shell fish, and certain other
sorts of food, without being afflicted with urticaria ;
the smell of hay causes asthma in some, and the de
licate fragrance of the rose, syncope, in others. On
the other hand, there are some organisms which can
scarcely be impressed with even large and continued
doses of medicines. Constitutions which have been
impaired by abuse of stimulants, drugs, tobacco, and
licentiousness, and in which there is an abasement
of the nervous and physical power, demand low at
tenuations. In a word, it will be found on rigid exa
mination, that each individual possesses some pecu-
114 ATTENUATIONS OF DRUGS, ETC.
liarities which it will be necessary to take into con
sideration, when we decide respecting the strength or
repetition of a remedy.
(c) Habits of life. We have read of persons who
were " music mad," but we have often seen those who
were medicine mad. The world is full of this class
of monomaniacs, who " pass away their time in des
canting on their own" diseases, and in filling their
bodies with all sorts of injurious and nauseous drugs.
After pursuing this course a long time, the system, by
habit, tolerates enormous quantities of the poisons
swallowed, and the structures lose, in a measure,
their susceptibility to medicinal impressions. It is
for this reason that the homo3Opathist experiences so
much difficulty in the management of cases of dys
pepsia, hypochondria, and constipation, which have
been induced by long continued abuse of cathartics ;
also in the affections of confirmed opium eaters, ha
bitual drunkards, and gourmands. Individuals of these
classes, require low attenuations. In the same cate
gory may be ranked those operatives who make a
free use of mercury, the salts of lead, the strong acids,
and other poisonous substances which evaporate at
the ordinary temperature.
Robust persons, who pass much time in active
exercise in the open air, will require stronger doses
than those of delicate organization and of studious
and sedentary habits.
2. The condition of the disordered textures. Those
parts of the system which are most amply supplied
with nerves, are, all other things being equal, most
susceptible to the operation of medicines. Thus the
eye is more readily impressed than the arm ; the
lungs, stomach and intestines, than the limbs and
joints, &c. Much, also, depends upon whether the
specific employed, is positive and decided in its ope
ration.
But there is another circumstance of vast moment
to be taken into consideration in the choice of our
attenuations, and to which we have elsewhere called
particular attention. We refer to the augmented sus
ceptibility to medicinal impressions which inflamed
structures acquire. We have shown that the con-
ATTENUATIONS OF DRUGS, ETC. 115
dition of inflamed tissues becomes entirely changed,
and that their acquired susceptibilities become so
morbidly increased, that even their natural stimuli
cannot be tolerated, but when allowed to operate, be
come additional and powerful sources of disease.
The natural and healthy material stimuli of the eye,
the ear, the lungs, the stomach, the bladder, &c., are
grateful during the normal state of these organs; but
let inflammation occur, and the smallest pencil of
light becomes intensely painful to the eye. as noises to
the ear, air to the lungs, food and drinks to the sto
mach, and urine to the bladder.
Nor is this augmented susceptibility confined to the
operation of the natural stimuli, but it applies with
still greater force to the action of specific medicines,
up to that point of inflammatory action when the sen
sitive extremities of the nerves succumb from inten
sity of excitement, and a condition bordering on pa
ralysis or gangrene obtains. It is sometimes difficult
to decide when this morbid erethism has arrived at its
maximum, and the atonic state commences ; but the
gradual subsidence of pain, appearances of effusion
or ulceration, and diminished sensibility of the affect
ed part, will afford us the best indications upon this
point. This fundamental law of homoeopathy, not
only serves to explain in the clearest possible manner
the astonishing effects of infinitesimal doses, but it
teaches an important practical fact, at present un
appreciated, but incontrovertible, and which stands at
the foundation of our therapeutical applications, viz.,
to ascend in our scale of attenuations in proportion to
the violence of the inflammation, until we arrive at that
point where the nerves of the diseased part have attained
their maximum of erethism, after which we must again
descend the scale in the same ratio.
This same law applies with equal force to all irri
tations of the nervous system, even when entirely un
attended with the usual phenomena of inflammation,
redness, swelling, heat, and pain. We have often
seen this nervous erethism so strongly pronounced —
and where there were no signs of vascular excite
ment — that a single grain of ipecacuanha, or the twen
tieth part of a grain of tartarized antimony, would
ATTENUATION OF DRUGS, ETC.
produce copious vomiting and purging ; or a drop of
the first dilution of nux vomica, induce involuntary
contractions of the muscles, especially of those parts
which were unusually irritable ; or a single grain of
jalap, rheum, calomel, or even a mental emotion, im
mediately cause diarrhoea ; or a cup of tea or coffee
taken in tine evening, prevent sleep for a whole night ;
or the inhalation of a few imponderable particles of
ipecacuanha, give rise to both its primary and second
ary specific effects upon the pulmonary organs.
There may be a few apparent exceptions to this
rule, as in the example already referred to respecting
the inefficiency of large quantities of opium and lau
danum in tetanus ; but these exceptions are suscep
tible of ready explanation. In this disease there exists
a peculiar preternatural excitement of the nerves,
which preside over the voluntary motions, and the
contractility of the tissues, which induces a spas
modic occlusion of those textures of the digestive canal
which, in the normal state, permit the absorption of
opiates. This is evident from the fact, that if lauda
num be injected into the veins during tetanus, the usual
effects are manifested. In this exception, therefore,
the drug is not absorbed, and of course cannot exercise
its specific effects upon the economy.
It is evident, then, that in the selection of attenua
tions for chronic diseases, the precise condition of
the nerves of the affected parts must always be taken
into consideration, since some chronic maladies are
characterized by a highly exalted nervous suscepti
bility, and call for the use of high attenuations ; while
in other cases, this susceptibility or impressibility re
mains at a low grade, and consequently will only
respond to low attenuations.
Dr. Lobethal, in alluding to this subject, makes use
of the following language: — "God be praised, the
times are passed when we adhere without examina
tion to the prescriptions of Hahnemann, and when we
administered the thirtieth dilation in every case, with
out any regard either to the species of the medicine, or
the individuality of the patient. The idea of greatness
or littleness is but relative ; we cannot say in a ge
neral manner, that some drops of the mother tincture
ATTENUATION OF DRUGS, ETC. 117
of a certain medicine will be a strong dose ; nor yet,
perhaps, that the twenty-fourth or thirtieth dynami-
zation of every medicine shall be regarded as a feeble
dose. The dose of each medicine should be strong-
enough to provoke the necessary reaction of the organ
ism, and, provided we are careful not to administer
a too heavy one. agreeable to take, and without dan
ger, we should always give a sufficient one.
" I am decidedly convinced, that in order to apply
the homoeopathic treatment with success, the physician
should take cognizance of the whole scale at his dis
posal, from the actual dose of the old school, up to the
highest dilutions of which any medicine is suscep
tible.
"We may establish it as a principle, that the admi
nistration of large or small doses is in inverse propor
tion to the richness in nerves of the individual organ
ism, and the species of diseased organ ; that is to
say, the more the sentient sphere of the organism, in a
given case, shows itself predominant, the more the
dose of the indicated specific medicine should be
feeble, and that the more the individual organism, or,
in a local affection, the diseased organ, is poor in
nerves, the more the doses should be large." — (Revue
Critique et Retrospective de la Matiere Medicate Spe-
cifique. Vol. iii., 1841).
Dr. G. H. Gross, of Germany, also observes, that
11 homoeopathia, as now accepted, has determined the
point, that the physician must exercise his judgment as
to the dose, varying it from the HIGHEST DILUTION down
tO ONE OR MORE DROPS OF THE UNDILUTED TINCTURE, ttS
individual cases may demand." *
"In the Vienna Homoeopathic Hospital, where a
chronic case is rarely seen, the dilutions usually given
by Dr. Fleischmann, range from the first to the sixth
of the decimal scale. At the Linz Hospital, Dr. Reiss,
though convinced of the efficacy of the highest dilu
tions, and occasionally prescribing them, treats the
majority of his patients with the same dilutions as
those employed by Fleischmann. In looking over the
* Dr. Gross wrote this in 1840 ; but during several years preceding his
death, he was a most decided advocate of the highest dilutions.
118 ATTENUATION OF DRUGS, ETC.
records of homoeopathic practice, we cannot help per
ceiving that of late years there has been a constant
downward tendency with respect to the dilutions (the
high potency novelty being left out of view). Not
only is this true with respect to the generality of
cases recorded, but also with respect to the practice
of individuals. The majority of those statistics to
which we so triumphantly appeal, are undoubtedly
derived from the employment of the lower dilutions."
(British Jour, of Horn. No. xxiii, p. 25,)
Dr. E. F. Ruckert, of Germany, also \vrites as fol
lows : " I am satisfied that the system (homoeopathia)
is still progressive, and has by no means attained its
perfection. In respect to doses, most generally, I make
use of the first dilutions, and never exceed the twelfth,
giving them in increased volume and repeating them
frequently. I have been more successful in this course
of treatment than formerlv in the use of the smaller
doses."
Similar views have recently been promulgated upon
this subject, by G. Schmid, Trinks, Griesselich, Watzke,
Madden, Bigel, Drysdale, Russell, and indeed by a ma
jority of our school, both in Europe and America.
We have not unfrequently been able to cure disease
with a high attenuation, after having failed with the
first and second dilutions of the same remedy ; but it
has been a much more common occurrence with us, to
effect cures with the first attenuation after having
been unsuccessful with the higher preparations. No
definite rules, therefore, can be given which will apply
in all cases, but every circumstance connected with
each particular case must be duly investigated, and
the physician then exercise his own best judgment.
3. The character of the medicine to be employed. — Cer
tain substances which are very feeble or even inert,
in their natural crude state, appear to acquire new
and potent qualities on trituration. Whether these
new properties are communicated to the minutely di
vided particles by a chemical combination with the
oxygen of the air, for which several, like carbon, gra
phite, sulphur, lime, &c., possess a very strong affin
ity, or whether they arise from the simple subdivision
of the atoms of the drug, we are unable to determine.
But these are thft medicines which have been found
ATTENUATION OF DRUGS, ETC. 119
especially serviceable when employed in high attenu
ations.
On the other hand, there is a class of medicines
so volatile in their nature, that trituration and expo
sure to the air and moisture, deprive them of their ac
tive principles. Amongst these articles may be rank
ed camphor, ammonia, bromine, nit. argenti, the
ethers, the volatile salts, &c. Medicines of this kind
should always be exhibited in the lower attenuations.
We must also be governed somewhat by the posi
tive or negative character of the specific employed.
Some medicines are very marked and prompt in their
specific operation,liketartarized antimony, phosphorus,
ipecacuanha, belladonna, aconite, hyoscyamus, stra
monium, opium, &c., and may ordinarily be used at
rather higher attenuations than those whose primary
effects are less prompt and strongly pronounced.
The advantages which we obtain from a minute
subdivision of crude substances, are as follows:
1st. We develop every part of the active principle-
pertaining to the substance, by breaking up all natu
ral organization or arrangement between its molecules,
and thus exposing a large amount of active surface
which would otherwise have remained latent.
2d. By distributing these molecules intimately
throughout an inert vehicle, (sugar or water,) they are
far more readily absorbed by the delicate lacteals and
absorbents, than coarse and irritating particles of mat
ter.
3d. When these minute atoms have been conveyed
by the blood to those parts with which they have an
affinity, they penetrate the smallest vessels, impress
the minutest sentient nerves, and become productive
of results entirely unattainable by drugs in a crude
form.
4th. During the act of subdivision, it is not impro
bable that the atoms of drugs sometimes become oxy-
dized, and thus acquire new and increased powers.
Finally, we infer, that no new properties are deve
loped by the homeopathic method of preparing drugs,
except such as arise from the mere subdivision of their
particles ; and that all ideas respecting spiritualization,
dynamizaiion, and magnetism, in the preparation of
medicines, are erronpons and untenable.
120 ATTENUATION OF DRUGS, ETC.
In regard to the repetition of doses, we are to be
guided by the acute or chronic nature of the malady,
the urgency and danger of the symptoms, and the ef
fects produced by the medicine.
In violent and dangerous acute diseases, like cholera-
asphyxia, convulsions, phrenitis, pleuritis, gastritis,
&c., the remedies should be repeated as often as
every fifteen, twenty, or thirty minutes — until an ag
gravation of the symptoms, (that is, some primary
effect of the drug), appears, or a perceptible ameliora
tion of the symptoms is apparent, when the medicine
should be omitted, in the first case, until the secondary
or curative symptoms have come on, and expended
themselves ; and in the latter, so long as amendment
continues. If the case demands it, recourse may again
be had to the same medicine ; or if new symptoms
have made their appearance, another appropriate
remedy may be selected.
In less urgent cases of acute disease, it will be suf
ficient to repeat the remedy every four, six, or eight
hours, until primary symptoms (aggravation) occur,
or amelioration of the symptoms evinces the secondary
or curative effects, when we may rest tranquil until
the amendment ceases, and the medicine has expended
its curative effect.
In chronic maladies, the remedy may be repeated
once in twelve or twenty-four hours, until an impres
sion is perceptible, either in the form of primary drug
symptoms, or of amelioration of the morbid condition.
When this result obtains, we may with great propriety
wait until the full effects of the medicine have sub
sided, before we repeat the dose. In these cases it is
far better to make use "of doses sufficiently strong, and
repeat them sufficiently often to induce decided pri
mary medicinal symptoms — even if we are obliged now
and then to give antidotes — rather than to remain for
weeks in doubt as to whether a suitable impression
has been produced by a single dose. It is very rare
that moderate drug symptoms are productive of un
pleasant consequences in chronic diseases, while the
reaction thus induced in the diseased tissue, usually
has the effect to bring about a much more speedy cure.
Indeed, we believe it may be set down as a
ATTENUATION OF DRUGS, ETC. 121
rule, that the sooner we can produce a moderate, but
decided medicinal action in a structure suffering from
chronic inflammation, the sooner will a curative reac
tion follow, and health result.
" It would therefore appear that experience has con
firmed the opinion of Hahnemann, that a certain
amount of aggravation is essential to the therapeutic
process ; in the vast majority of cases this does not
make itself known in any perceptible degree, but it
does occur in a certain, though small amount of cases,
sufficient to confirm its existence as an essential phe
nomenon. The cases in which it occurs with infini
tesimal doses are probably only those of excessive or
even idiosyncratic susceptibility, and even with these
it is a phenomenon of no danger, and only slight incon
venience. Hence we may conclude, that a normal
dose of homoeopathic medicines, sufficiently small to
avoid the liability to aggravation in a certain amount
of cases, and yet sufficient to cure best and quickest in
the majority of cases, is a mere chimera, and ought
not to be sought for ; but in seeking for doses the best
for the majority of cases, we must lay our account for
meeting with a certain number of aggravations, but
practically these latter are of no importance.
Likewise in the case of collateral symptoms, it is
affirmed by Hahnemann, that " we cannot arrange our
doses so as to escape the liability to them in a small
and practically unimportant degree." — (Dr. Brysdale :
British Jour, of Horn., No. xxiii., p. 22.)
In all cases of urgent acute disease, in which we can
find no single remedy which corresponds to the promi
nent symptoms, it is necessary to select a second reme
dy which shall cover the remaining symptoms, and ad
minister it in alternation with the first. Pneumonia
is often accompanied by cereirtf/inflammation ; typhus
fever, with serious disorder of the intestinal canal, the
lungs, the brain and nervous system ; intermittent
fever, with enlargement of the liver, jaundice, cough,
&c. ; and other maladies with affections in other parts
of the body, which are not strictly connected with the
original complaint. In examples of this kind, the al
ternation of remedies is both proper and necessary ; at
the same time it must be remembered, that it is far
122 GENERAL DIAGNOSIS.
more desirable that a single medicine should be chosen
which covers all the symptoms of the disease.
The same rule holds good with respect to giving
medicines in succession. Whenever the first remedy
fails in producing the required impression, or whenever
important new symptoms arise to which the original
drug does not correspond, we may resort to another
which accords with the totality of the symptoms.
A large proportion of homoeopathic physicians, both
of Europe and America, now advocate a frequent re
petition of doses in acute diseases, and in many in
stances give alternations of the remedies. Some of
those who have expressed themselves decidedly upon
this point, are, Drs. Gross, Schmid, Rau, Fleischmann,
Reiss,Ruckert,Lobethal, Hartmann,Russel, Hull,Neid-
hard, Gray, Currie, Trinks, Griesselich, Madden, Dud
geon, and Quin.
The erroneous ideas which were formerly enter
tained respecting the alternate employment of reme
dies, are at present nearly abandoned. So long as the
absurdity prevailed that our medicines operated in a
kind of spiritual manner, upon certain mysterious ap
pendages of the organism, termed " vital properties"
it was deemed unsafe to administer two remedies in
alternation, for fear of creating confusion among these
dynamic influences ; but since the laws of absorption,
and the specific topical action of drugs, have become
so fully established, there is no longer hesitation in
alternating medicines whenever symptoms appear to
require it.
CHAPTER XL
GENERAL DIAGNOSIS.
IT is a matter of the highest importance that the
homoBopath should be perfectly familiar with the most
approved methods of diagnosis, in order that he may
take advantage of every possible circumstance which
may facilitate his investigations of disease. Although
GENERAL DIAGNOSIS. 123
a patient may be competent in general to indicate the
exact seat of his pain, and thus enable the physician
to determine what organ or tissue is affected, this is
by no means true in all cases.
There are many maladies which are entirely unat
tended with pain, or any other local sign, by which
the physician can detect the suffering organ. In cases
of infants and young children, who are unable to indi
cate the locality of their sufferings, and in some
chronic affections, a knowledge of the external signs
is of vast importance. In all such cases a proper skill
in diagnosis will prepare the medical man to pene
trate the innnermost recesses of the organism, and to
understand its most profound secrets.
It is a singular and highly interesting fact, that the
pains of the different parts of the body impart to the
countenance certain characteristic and easily under
stood expressions. As these signs are involuntary,
and almost uniformly present, all will recognise their
importance as diagnostic phenomena,
In forming our diagnosis, it is essential in the first
instance to notice accurately every circumstance con
nected with the patient which is at all peculiar or
unnatural. The general expression of countenance,
the tone of voice and manner of speaking, the
figure, attitude, movements, etc., should be attentively
marked. At the same time, age, sex, temperament,
hereditary predisposition, occupation, habits of life,
whether labouring under the effects of any previous
malady or of mercury, and whether accustomed to the
constant use of opium, should all be duly considered.
The patient should then be permitted to detail his
symptoms after the manner pointed out by Hahnemann,
in his Organon, (pages 126-7). In cases of inability on
the part of the patient to enter into a description of
the case, the friends should be called upon to give all
of the information in their power, in regard to the rise
and progress of the disorder. An attentive perusal of
Hahnemann's advice upon this subject, is of the ut
most importance to the acquisition of a perfect por
traiture of every complaint.
Since, however, there are some instances in which
neither the patient nor friends are able to afford any
124 GENERAL DIAGNOSIS.
information respecting the nature or seat of the affec
tion, it is indispensable to acquire a knowledge of all
external and involuntary signs which can in any way
illustrate the character of the malady.
Allopathic writers have divided diagnostic signs
into those exhibited by the countenance ; the attitude ;
the nervous system ; the digestive organs ; the circu
latory system, ; the respiratory organs ; the skin ; the
lymphatic system ; the secretions.
As the countenance is an excellent index of what is
occurring in distant parts of the organism, we should
note attentively the expression of the eyes, nose,
mouth, and forehead, and also whether sadness, mo-
roseness, peevishness, despair, fear, grief, or joy, is
evinced. By heeding carefully these indications, we
shall be greatly assisted toward accurate opinions in
obscure and complicated cases.
Thus, contraction of the features, rapid dilatation
and contraction of the nostrils, dyspnoea, with expres
sion of anxiety, indicate acute inflammation of the re
spiratory organs.
Sharp features, and expression of anguish, " fore
head wrinkled, brows knit," eyes sunken, counte
nance pale, hollow cheeks, lips dry and bluish, indi
cate pain and severe inflammation of the abdominal
viscera.
General expression of countenance flushed and ex
cited, or dull and stupid ; eyes red and brilliant, or
dull and heavy ; pupils contracted or dilated ; pro
trusion of the eyes, with a wild expression ; mouth
drawn to one side ; twitchings of the eyelids and
muscles of the face, indicate inflammation of the cere
bral organs.
Expression anxious ; respiration difficult and rapid
during inspiration, while expiration is comparatively
easy ; symptoms worse after assuming the recumbent
posture; face swollen and livid; indicate hydrothorax.
Face flushed and swollen ; lips blue ; eyes promi
nent and unnatural ; face cold ; sudden startings in
sleep ; anxious expression ; indicate organic disease of
the heart.
Cheeks pale and blanched ; lips white, and puffy ; a
GENERAL DIAGNOSIS. 125
dark circle around the eye-lids ; expression of languor
and debility, indicate chlorosis.
Paleness and puffiness of the upper lip indicate
scrofula and verminous affections.
" Eyes and face red ; rapid respiration ; motions of
the nostrils rapid ;" indicate simple acute fevers.
FIGURE AND ATTITUDE.
Before alluding to the different attitudes assumed
by the body during disease, as diagnostic signs, we
shall take the liberty of digressing for a moment, in
order to touch upon the importance of a proper culti
vation of the physical powers, as a means for securing
the most perfect corporeal development and sym
metry.
In order that the organs may perform their functions
in a proper manner, it is absolutely indispensable that
the body should retain its normal structure and shape,
and remain unincumbered by any artificial appliances
which tend to impede the circulation or check the
free action of the muscles. Unfortunately for man
kind, it has been customary both in barbarous and
civilized countries, to distort artificially certain parts
of the body, under the absurd notion that they were
improving upon nature, and enhancing the beauty of
the figure which the Supreme Architect had formed in
his own image.
Amongst the savage tribes of the Rocky Mountains,
it is customary, and we suppose fashionable, for the
natives to flatten the forehead by long- continued arti
ficial pressure. This constitutes the ideal of savage
beauty, and is the common method of improving up
on the works of the Creator.
In other barbarous countries it is customary to slit
the ears and nose, and hang from them large quanti
ties of tin, brass, and other cheap ornaments. This,
with the requisite amount of tattooing and painting,
illustrates their notions of what the human figure
should be.
In China, the semi-barbarous inhabitants compress
the feet of their females, from birth, in such a manner
as to prevent their growth and development ; and in
126 GENERAL DIAGNOSIS.
this abominable distortion consists their idea of female
beauty. This is the Chinese improvement upon na
ture.
The Turks cram their women with "pil/au" after
the manner of stuffing geese, to cause enlargement of
the liver, for "pate defoi gras" — that they may be
come enormously fleshy, and thus present to the ad
miring eyes of their lords, figures of uniform dimen
sions in all directions. This is the Moslem's style of
female beauty.
In the highly civilized countries of Europe and
America, it is not customary to make use of artificial
contrivances to flatten the head, prevent the growth
and development of the feet, to slit the ears and nose,
or cram their women ; but, through the instrumental
ity of those " infernal machines,5' corsets and stays,
the sex deem it indispensable, in order to be genteel, to
compress entirely from its natural shape the most im
portant and vital part of the organism. These un
natural efforts at distortion are usually commenced at
an early period, and continued with perseverance,
until the figure has lost its natural symmetry, the
lungs are forced upwards, out of their just position,
and the abdominal viscera made to accommodate
themselves in the new situation to which they have
been reduced by art.
The civilized females of the present day, affect to
contemn the symmetrical figures which the Creator ori
ginally formed, and which the ancient sculptors de
lighted to represent in marble, and have chosen to
" improve" on these old-fashioned notions, by partially
cutting off the connection between the upper and low
er parts of the body ; thus reducing it from the shape
of those models of perfection, the Venus di Medici, and
the Venus of Milo, to that of a wasp or an hour-glass.
We have not only the authority of the ancients in
all those master-pieces of art in which they have il
lustrated their ideas of beauty, but the greatest of
modern sculptors, our illustrious countryman, Powers,
in a MS. letter before us, declines a suggestion that his
exquisite statue of Eve should be exhibited, because
his sense of harmonious proportion, as well as of
physical necessity, compelled him to present the moth-
GENERAL DIAGNOSIS. 127
er of mankind in the shape which the Creator approv
ed as the ultimate product and most perfect fruit of
divine intelligence and energy. "E ye," the sculptor
says, with satirical humour, " is an old-fashioned body,
and not so \vell formed and attractive as are her
grand-daughters, — at least some of them. She wears
her hair in a natural and most primitive manner,
drawn back from the temples, and hanging loose be
hind, thus exposing those very ugly features in women.
Her waist is quite too large for our modern notions of
beauty, and her feet, they are so very broad and large !
And did ever one see such long toes ! they have never
been wedged into form by the nice and pretty little
shoes worn by her lovely descendants. But Eve is
very stiff and unyielding in her disposition : she will not
allow her waist to be reduced by bandaging, because she
is far more comfortable as she z.v, and besides, she has
some regard for her health, which might suffer from such
restraints upon her lungs, heart, liver, fyc., fyc., fyc. I
could never prevail upon her to wear modern shoes,
for she dreads corns, which, she says, are neither con
venient nor ornamental. But some allowance ought'
to be made for these crude notions of hers,--— founded
as they are in the prejudices and absurdities of primi
tive days. Taking all these things into consideration,
I think it best that she should not be exhibited, as it
might subject me to censure, and severe criticisms, and
these, too, without pecuniary reward."
Singular perversion of taste ! wonderful and all-
powerful influence of fashion, which can induce
so many intelligent beings to suffer torture like sava
ges, for the purpose of distorting their bodies, and
bringing them into those artificial shapes which civil
ized nations denominate genteel and graceful !
Suppose a fashionable woman should apply corsets
and stays to a favourite monkey, or a pet lap-dog, and
so compress its body out of shape, would not the at
tempt be pronounced heartless, and its author, perhaps,
be indicted for cruelty to animals ? but when the same
barbarity is perpetrated upon a human being, it is
tolerated, because it is genteel and fashionable !
Were females the only sufferers from these cruel
practices, the sin would not be so great ; but their
128 GENERAL DIAGNOSIS.
posterity participates deeply in the consequences which
result from their criminal perversity. The flat and nar
row chests, the stooping gaits, and the pale or sallow
faces which greet us at every step, demonstrate the
extent of our physical degeneration.
But the female sex are not alone censurable. Too
great a proportion of the men, — of this country espe
cially, — become round-shouldered, crooked, and de
formed, from a want of free muscular exercise, and too
close an application to business, in constrained, bent,
and unnatural positions.
Physical education in latter times, has been quite
overlooked. Parents have commenced sending their
children to school in infancy, and their embryo minds
have been tasked with all kinds of mental exercise,
while their physical powers have been suffered to lan
guish in heated and ill- ventilated rooms. Thus they
have grown up with improved minds, but feeble, unde
veloped, and perhaps crooked, or mis-shaped bodies.
Let it ever be remembered, that the mind and body
exerciso an influence upon each other, and if wTe would
secure 10 the former its highest development, we must
cultivate and perfect the latter. In this respect we
may with advantage go back to antiquity, and copy
after Herodicus, in advancing physical education.
But to return to our subject: As in health the at
titude is erect, and those positions are assumed by the
body and limbs which indicate muscular strength, so
departures from the normal standard, induce corres
ponding alterations in the position and appearance
of the body.
Thus, tremors ; position upon the back, with a con
stant disposition to sink down towards the foot of the
bed, indicate extreme muscular debility.
Distressing dyspnosa, and sense of suffocation when
lying down ; constant desire to assume the erect pos
ture ; general agitation, cough, and appearance of
anxiety, indicate hydrothorax.
Common position upon the back ; rigidity and mor
bid involuntary contractions of the flexor muscles,
usually of the upper extremities, indicate softening
of the brain.
Position upon the back. " with the knees drawn up ;
GENERAL DIAGNOSIS. 129
head and shoulders a little elevated ; dread of motion,
indicate abdominal inflammation with acute pain.
Position upon the belly ; pressure of the abdomen
affording relief ; and very restless, indicate spasmodic
abdominal pains.
Rigidity, and involuntary contraction of the muscles
of the neck, back, and limbs, indicate inflammation or
irritation of the spinal cord.
In the advanced stages of acute diseases, position
upon the back, with the legs drawn up, indicate reten
tion of urine.
THE TONGUE.
Much information may be gained, in many instances,
from an examination of the tongue. The following
are a few of the diagnostic signs presented by this or
gan:
A clean, smooth, and bright red tongue, indicate in
flammation of the gastric or intestinal mucous membrane.
A clean and red tongue, with papilla prominent ; or
a furred tongue, with red papilla appearing through
the fur, indicate scarlatina.
A reddish, and tremulous tongue, indicates mania a
potu.
A thick and yellow fur covering the tongue, with
bitter taste, indicate biliary derangement.
A white fur upon the tongue, indicates slight simple
fever.
Acute symptomatic fevers, effect but little change in
the appearance of the tongue.
A relaxed, dilated, and tremulous tongue, indicates
congestive or nervous fevers.
A pale and flabby tongue, " with large papilla," in
dicate gastric debility — met with in chlorosis.
A sharp and pointed tongue, is often observed in
irritation and inflammation of the brain.
THE NERVOUS SYSTEM.
Tearing, throbbing, and aching pains — aggravated
by contact, pressure, or movement, indicate inflamma
tory action.
Twitchings of the limbs ; jerkingsand shocks of the
6*
130 GENERAL DIAGNOSIS.
tendons ; cramps ; convulsive movements ; violent
contortion of the body ; pains relieved by pressure ;
unattended with fever, indicate spasmodic pains.
Sharp and darting pains, unaccompanied by swell
ing, heat, or redness, indicate neuralgic pains.
Vague and wandering pains about the ancle often
indicate inflammation of the knee.
Pains also in other healthy parts, sometimes indi
cate inflammations in remote structures.
Wakefulness, indicates irritation of the nervous sys
tem.
Irresistible inclination to sleep, with stertorous
breathing, indicates compression, or serious disturb
ance of the brain.
Twitching of the muscles during sleep, and fre
quent waking from frightful dreams, indicate organic
disease of the heart ; also characteristic of verminous
irritation.
Sudden, rapid, and jerking movements of the head
and limbs, indicate cerebral irritation, mania a potu,
and some forms of insanity.
THE ALIMENTARY CANAL.
The alvine discharges will afford many useful hints
to the observing physician.
Thus, light or clay-coloured evacuations denote a
lack of bile.
Mucous and bloody stools indicate intestinal inflam
mation : if accompanied with tenesmus, and redness
or protrusion of the rectum, we may conclude that
the lower part of the canal is affected.
Watery stools, with slight pain, indicate irritation
of the bowels.
" Glairy, dark green evacuations, like chopped spin-
age, are characteristic of hydrocephalus"
Very dry and hard faeces indicate a relaxed and tor
pid state of the mucous membrane of the bowels.
THE RESPIRATORY ORGANS.
Using the abdominal muscles principally in respi
ration, indicates inflammation of the lungs.
Using the intercostal muscles alone, indicates ab
dominal inflammation.
GENERAL DIAGNOSIS. 131
Irregular respiration, with stertorous breathing, in
dicates compression of the brain.
Inspiration difficult, anxious and rapid, while expi
ration is comparatively easy, is peculiar to hydrotho-
rax.
Wheezing, short, panting and anxious respiration,
with contraction of the larynx, indicate asthma.
Paroxysms of rapid, short, suffocating and spasmodic
cough, indicate pertussis.
White, tenacious sputa, indicate chronic bronchitis.
Very thick, yellow, or greenish sputa, which sinks
in water, indicative of disorganization of the lungs.
THE SKIN.
A yellow skin indicates disordered liver.
A sallow skin occurs in chlorosis, and a few chronic
ills.
A pale and waxen skin denotes a deficiency of blood.
A blue or livid skin, in infants, indicates a pervious
foramen ovalc.
A hot and dry skin denote inflammation.
A cold skin, with internal heat, indicate internal
congestion.
• THE URINE.
Urine red and scanty denotes inflammation.
Urine clear, limpid, and abundant, in nervous affec
tions.
Urine depositing a sediment indicates biliary de
rangement.
The above are only a few of the more common and
well known diagnostic signs. Our only object is to
direct the attention of physicians to this subject, for
there are often many things about the general ap
pearance of a patient which are slight and indescriba
ble in themselves, but which will aid him materially
in forming his opinions.
In order, then, to arrive at a correct diagnosis, it is
necessary —
1. To note all external signs.
2. To ascertain the age, occupation, previous
habits, predispositions, and peculiarities of the pa~
tient
132 FEVERS.
3. To procure from the patient a spontaneous and
minute detail of his sufferings in his own language.
When the patient is unable or incompetent to afford
this information, get as accurate a description as pos
sible from those best acquainted with the history of
the case.
4. Ask such questions, and make such examinations
by the touch, pressure, sight, hearing, percussion, aus
cultation, &c., as may be necessary to perfect the
diagnosis.
CHAPTER XH.
FEVERS.
Much has been written, and many hypotheses have
been advanced, from time to time, concerning the
pathology of this important class of diseases. Within
the two past centuries, the changes of opinion in
regard to the nature and seat of fevers, have been
almost innumerable ; and yet. with all that has been
written, and the numerous bitter controversies wlych
have taken place, we are at the present moment but
little farther advanced as to any definite knowledge
upon the subject, than we were centuries ago. Indeed,
the opinions of the medical world at the present time,
are so much at variance, that it would not be difficult
to find men of distinction who advocate almost everv
doctrine which has ever been promulgated.
The old dogma that fevers arise from a concoction
of something injurious to the system, has even its ad
vocates ; thus, " substances in a state of putrefac
tion, by entering the blood, impart their peculiar ac
tion to the constituents of that fluid, and all the sub
stances of the body are induced to undergo a modified
putrefaction"* Again, Dr. Burne says, " that the ady-
namic or typhoid fever has no local seat ; that its na
ture is a morbid condition of the blood, produced by the
* Paris Pharmacologia.
FEVERS. 133
operation of a primary cause, the respiration of a con
taminated or tainted atmosphere."
Dr. Clancy and other authors believe the proximate
cause of fevers to be " a want of power in the system
to form blood."
Others still, like Clutterbuck and Broussais, have
contended that fevers of every denomination and de
gree, are the result of inflammation. They are sup
posed by these gentlemen to be topical affections, " the
general disorder of the system being only secondary
and sympathetic" The former located the seat of
fevers in the brain, the latter in the gastro-intestinal
mucous membrane.
The vitalists suppose that fevers, in common with
many other diseases, are owing to a morbid alteration
of what are termed the vital properties of the textures
affected.
Professor Mackintosh, of Edinburg, has advanced
the opinion, " that the effects of outward causes, and
inward irritations, in producing irregular determina
tions of blood, are the great agents in exciting diseases,
and especially fevers." He supposes " that the func
tions of almost all organs are embarrassed in fever
from the very beginning ; that internal determinations
of blood take place, which rouses the system to reac
tion, and thus causes fevers ; that inflammations of all
parts of the body will give rise to fever ; that inflam
mation may supervene during fever, without being the
primary cause of the febrile commotion ; that the
nervous system is involved as well as the vascular ;
and that the blood itself must be in a diseased cpndi-
tion."
A majority of the profession at the present day,
however, suppose with Cullen, that the prime causes
which produce them, act directly upon the nervous
system, and thus produce their pernicious results.
Our own opinion is, that fever is a combination of
symptoms that may arise from a disturbance of any
one or more parts of the body ; that the primary im
pression is made upon the extreme nerves of the part
acted on ; and that the whole system is affected to a
greater or less extent, secondarily, thus giving rise to
that congeries of symptoms which constitute fever.
134
FEVERS.
The skin, the nervous system, the circulation, the res
piration, the secretions, and indeed the whole body
partakes more or less in the general disturbance.
We suppose that the causes which produce fevers,
are specific -agents which operate by being absorbed
into the circulation, and (conveyed to those structures
for which they have an affinity or attraction, there im
parting those peculiar and specific actions which in
duce fevers.
The miasm which causes intermittent fever evi
dently impresses a different part of the organism from
that which induces typhus. So also the miasms of
yellow fever, the contagion of plague, smallpox, scar
let fever, &c., are all peculiar and specific morbific
agents, which exercise their influences upon the sys
tem in different ways and in a manner analogous to
medicinal agents. Whether this morbific influence is
exerted upon the brain, the nervous system, the blood,
the stomach, or the arterial coats, of one thing we are
quite certain, that the miasm of intermittent fever can
never cause plague, yellow, scarlet, or typhus fevers,
nor can the poison of either of these maladies give
rise to any disease except that of its own peculiar
type.
It is probable that the contagion arising from human
effluvia — of ship, jail, and hospital fevers, scarlatina,
smallpox, plague, and the different kinds of malaria —
are all distinct substances, composed of minute parti
cles of matter, each possessing its own peculiar proper
ties, and each exercising its own specific influence
when introduced into the human organism. Unless
this were true, we should see either of these affections
constantly giving rise to any of the others indiscrimi
nately.
In a perfectly healthy and vigorous state of the sys
tem, neither miasms nor contagious matters are capa
ble of producing their peculiar effects, and they may
continue to circulate harmlessly in the blood for
months, until the system is debilitated from some cause
and thus predisposed to their influence, or until their
noxious qualities shall have been neutralized by fre
quent contact with the air respired at the lungs. The
fact that physicians and other healthy persons so often
FEVERS. 135
expose themselves with impunity to all of the noxious
agents, proves conclusively that a certain state of pre
paration is an essential condition to their operation.
At present the pathology of fever is so little under
stood, that all opinions respecting its nature and seat
must be, to a considerable extent, vague and conjec
tural. In treating upon the different forms of fever,
therefore, we shall adopt the classification of Mackin
tosh, on account of its simplicity and the superior fa
cilities it affords for diagnosis. The following is the
arrangement :
1st. Intermittent fever.
2d. Remittent or yellow fever : infantile remittent.
3d. Continued fever, subdivided into four orders,
viz. : —
Fever from functional derangement.
" from inflammation.
" from congestion.
A mixed form of fever between these three last, but
in which congestion predominates, commonly denomi
nated typhus or synochus.
4th. Hectic fever.
5th. Fevers attended with eruptions, subdivided as
follows : Scarlet fever.
Measles.
Smallpox.
" " modified.
Chickenpox.
Miliary fever.
Roseola.
Urticaria.
Erysipelas.
6th. The plague.
In all of these fevers there are certain peculiar
characteristics which serve to distinguish them from
each other, and from all other maladies. Notwith
standing this, however, we scarcely ever find two
cases of the same type running precisely the same
course, or presenting precisely the same symptoms.
So many circumstances connected with the exciting
cause, as climate, age, sex, temperament, predisposi
tions, habits, &c., tend to modify the character of each
particular case, that all instances of the same malady
136 FEVERS.
must necessarily present different trains of symptoms.
It will readily be perceived, therefore, how impossi
ble it is to prescribe for the nftme of a disease instead
of symptoms. We also take this occasion to express
our opinion, that any classification of diseases what
ever, is valuable as an aid in diagnosis rather than in
the exhibition of remedies.
The course of a fever sometimes varies during its
progress from its commencement to its termination,
and on this account divisions are made into —
1. The forming stage.
2. The cold stage.
3. The hot stage.
4. The sweating stage.
5. Collapse.
This is a mere arbitrary division, which can by no
means be relied upon, for many fevers run their course
without the supervention of these stages. Let it ever
be impressed upon the mind, then, that these classifi
cations and divisions are entirely arbitrary and artifi
cial, and can only be used for the purpose of facilita
ting our diagnostic examinations.
CHAPTER XIII.
CAUSES OF FEVER
The causes of fever are either predisposing or ex
citing. Anything which debilitates the organism, or
impairs the tone and resisting power of the nervous
or muscular system, maybe denominated a predispo
sing cause of disease. Under this head may be ranked,
excessive physical or mental exertion, protracted
grief, anxiety, fear, chagrin and disappointment, de
privation of well ventilated dwellings, proper food,
clothing and exercise, over-indulgence in the plea
sures of the table, stimulating drinks, licentiousness,
want of cleanliness, and, finally, congenital causes,
and those connected with some hereditary predispo
sition.
CAUSES OF FEVER. 137
Those causes which induce fever by a direct im
pression, are termed exciting causes. Miasmata,
contagious and epidemic effluvia, noxious gases, ex
treme and protracted heat or cold, and sudden changes
of temperature, are examples of this class.
All of the causes, however, which we have ranked
under the head of predisposing, may, and often do be
come, under favourable circumstances, actual exciting
causes of fever.
It is equally true, also, as we have before observed,
that what are called exciting causes, do not usually
operate so as to produce fever, unless the system is
prepared or rendered susceptible to their influence by
debility, or some other predisposing cause.
The powers of the body may be taxed up to a cer
tain point, by moral or physical, morbific or remedial
agencies, without exciting actual disease ; but if the
influence be carried beyond this point, an impaired
condition of the capillaries acted on will ensue, with
the usual concomitants, inflammation and fever. Even
the natural maladies, scarlet fever, measles, smallpox,
chickenpox, and hooping cough, seldom make their
attacks unless the system is predisposed to receive
their impressions. Therefore, these disorders will
often attack one member of a family, while all of the
rest, who are equally exposed to the contagion, will
escape.
The same rule holds good in regard to the operation
of morbific, as of remedial agents, viz. : in proportion
to the departure of the organs and tissues from their
healthy standard, so will be the acquired susceptibili
ties of these structures to the influence of morbific
agents.
The importance, then, of a constant and regular
system of physical culture, and a rigid avoidance of
all those things which can in any way impair the
normal integrity of the organism, will be recognised.
Indeed, we believe that such a course might be pur
sued, as would secure an individual against disease
until his system should succumb from old age. Such
a course would involve a herculean task in our pre
sent state of physical degeneracy, yet it is not beyond
the bounds of possibility.
138 CAUSES OF FEVER.
A few of the means which we should recommend
to accomplish this object would be,
1st. A proper system of physical education.
The first and most essential condition for the enjoy
ment of perfect health, consists in a symmetrical and
well developed organization. In looking around upon
the world, how few do we behold who can boast of
unexceptionable physical conformations — how few
who have not some imperfection which might have
been avoided by an early and proper attention to phy
sical culture !
But how shall this bodily perfection be attained ?
We reply, by the universal establishment of free
public gymnasiums, where those athletic exercises can
be pursued which shall systematically develop and
strengthen every part of the body. We repeat, let
there be established, athletic sports, games, &e., suita
ble for all ages and conditions ; where the man of ma
ture years may occupy agreeably an occasional leisure
hour with physical and mental benefit ; where the
growing youth can correct all incipient bodily defects,
and acquire that development and expansion in every
Eart, which will enable all of the organs to act in a
*ee and healthy manner. Let us abolish " infant
schools" for the education of infant intellects, and es
tablish in their place infant gymnasiums for the culture
of their infant bodies. Let us see no more intellectual
" infant prodigies," writh their pale, sickly faces, and
their feeble and half-developed forms, but show us in
their stead, phijsical prodigies with their rosy cheeks,
their plump, firm, and well-grown muscles, and with
elasticity and buoyancy reminding us constantly of per
fect health. Show us your children of six, eight, or ten
years of age, wild, bouncing, and overflowing with ani
mal spirits, rather than your prim, well-mannered, deli
cate sickly, hot-house, and band-box specimens.
All physiologists agree as to the vast importance to
the young, of a great amount of exercise — free, spon
taneous, and unrestrained. It is a principle of their
natures, absolutely essential to their well-being, and
we must not permit the artificial customs or restraints
of society to prevent it.
Our remarks apply with more force to cities than
CAUSES OF FEVER. 139
to the country, for in the former everything is forced
and unnatural : children are born into hot-houses, and
reared in dwellings heated with Lehigh coal, to the
temperature of 75 or 80 degrees Fahrenheit. Here do
these unfortunates pass the best part of their existence,
encompassed by everything which is unnatural and
artificial, and inhaling an atmosphere deprived of a
portion of its oxygen, and impregnated with carbonic
and other noxious gases, until, while yet young in
years, they arrive at the conditions of old age, satiated
with the displays and luxuries of life, and reduced to
a miserable state of physical inefficiency.
It has been well remarked by physiologists, that if
the large cities were not constantly supplied with
healthy recruits from the country, they would soon be
come desert wastes. This remark is, beyond question,
true, and it is only necessary to look into any of our
large towns and behold the numerous worn-out and
impotent wrecks of the wealthy families who have
been inhabitants for two or three generations, to be
convinced of the fact.
The second means which we should advise to se
cure health would be, a correct system of dietetics.
The use of all kinds of animal and vegetable sub
stances which are perfectly pure, digestible, and
healthy, should be rigidly prohibited. In order to ac
complish this object, we do not believe that better
rules could be adopted, than those instituted and com
manded by Moses for the Jews. Amongst the articles
forbidden in the dietetic regulations of the great He
brew lawgiver, we find pork excluded, from the sup
position that the swine is unclean and unhealthy.
When we consider how frequently the janimal is af
fected with that dreadful malady, scrofula, and also
how filthy and disgusting are its habits, it is not sur
prising that any person who is at all particular as to
the quality of the food he consumes, and who possesses
ordinary powers of observation, should denounce this
nasty, offensive, and diseased animal, as unfit for food.
But this abominable stuff in all its different forms, is
consumed by Christians everywhere* Lard constitutes
the culinary expletive which serves to connect the in
gredients of almost every dish in one greasy union.
140 CAUSES OF FEVER.
Whether the uses of pork and its preparations, have
any agency in causing scrofula, we leave for others to
determine. An argument, however, which tends to
establish the affirmative, is in the fact, that amongst the
strict Jews, and all of those nations where the animal
is not used as food, this malady is scarcely known,
while in every country where it constitutes an article
of diet, scrofula abounds.
In a word, care in regard to the selection of proper
articles of food, suitable methods of cookery, avoidance
of fat and condiments, stimulant, narcotic, and hot
drinks, and regularity in partaking of meals, will ena
ble mankind to preserve the integrity and health of
those organs which are concerned in digestion and
assimilation, and thus avoid the numerous evils which
accrue from errors in diet.
Finally, we would recommend the establishment of
such a state of society as should recognise no pursuit
or custom as legal or respectable, except such as should
conduce directly to the health, morals, and general
welfare of the community.
MIASMATA, &C.
Numerous experiments have been made for the pur
pose of arriving at the chemical and physical proper
ties of miasmata, and contagious and epidemic effluvia,
but as yet, all investigations upon this subject have
proved futile. We only know that wrhen animal or
vegetable substances undergo decomposition, a prin
ciple is set free which diffuses itself in the atmosphere,
and which possesses the power when absorbed into the
system, of producing certain specific effects upon the
extreme nerves, which generate fever. The portion
which is thu*s liberated by the aid of heat and moisture,
constitutes, without doubt, the active principle of the
original crude substance, in its purest form and most
perfect state of development. This active principle is
as imponderable and attenuated as the preparations of
homoeopathy, and a few inhalations under favourable
circumstances are capable of causing fever : it is also
as specific and uniform in its operation and effects upon
the economy, as remedial agents themselves.
141
CHAPTER XIV.
INTERMITTENT FEVER.
We have observed that each type of fever is marked
by certain symptoms which distinguish it from all
other varieties. The type under consideration pre
sents its characteristics in a very striking manner.
Indeed, so great is the difference between intermittent
and other fevers, that some writers have withdrawn it
from the list of febrile diseases, and ranked it with
those connected with derangement of the cerebro-
spinal system. The regularity and distinctness of the
paroxysms, and the complete state of apyrexia between
the periods of attack, certainly offer some reason for
this course ; but, on the other hand, as the combina
tion of symptoms termed fever, is universally present
during the paroxysms, and since upon the whole it
bears a closer resemblance to febrile than neuralgic,
or ganglionic affections, we shall continue to adopt the
old classification.
In the different forms of intermittent fever, the in
terval which elapses between the commencement of
one paroxysm and another, varies ; some cases hav
ing an interval of 24, some 48, and others 72 hours
from one attack to another. From this circumstance
the different types have been designated — quotidian.
or V4 hour type ; tertian, or 48 hour type ; quartan, or
72 hour type. These have also been subdivided into
double quartan, double tertian, &c.
DIAGNOSIS. A paroxysm of intermittent fever is
composed of three stages, viz.: first, the cold; sec-*
ond the hot ; third, the sweating stages.
Preceding the cold stage, there usually occur gen
eral feelings of lassitude, debility, uneasiness, and
pains in the head, back, or loins, and sometimes slight
sensations of external or internal cold. There is also
a loss of appetite, disinclination to bodily or mental
exertion, and a constant disposition to stretch or yawn.
142 INTERMITTENT FEVER.
As the cold stage actually commences, the extremi
ties feel cold and contracted ; the surface becomes
pale, shrunken, rough, with diminished sensibility; a
sensation of cold along the spine, extending into the
thorax and abdomen ; the coldness soon diffuses itself
throughout the whole body ; universal tremors, exter
nal and internal ; chattering of the teeth; respiration
laborious, rapid, and imperfect ; oppression at the
prsecordia ; countenance pale, leaden, earthy, or livid,
shrunken, and expressive of anguish ; eyes dull and
sunken ; lips livid ; general sense of physical and men
tal prostration.
The pulse is variable : it may be slow, rapid, weak,
oppressed, or intermitting.
The temperature of the body is usually natural, with
the exception of the extremities.
The duration of this stage is exceedingly various ;
sometimes terminating in ten minutes, at other times,
lasting four or five hours.
Paroxysms occasionally occur without any well
marked cold stage, a slight trembling only being ex
perienced previous to the hot stage ; at other times
neuralgic or rheumatic pains, or coma, precede the
second stage.
Hot Stage. As soon as the chills begin to abate,
flushes of heat commence passing over the body, until,
in a short time, the hot stage is fully developed.
This stage is characterized by hot and dry skin ;
countenance flushed and full ; mouth dry, tongue
parched ; urgent thirst ; headache ; respiration rapid
and anxious ; general restlessness ; pains in different
parts of the body ; more or less disturbance of the
mind; pulse usually rapid, sharp, and bounding.
This stage also varies very much in duration, it
rarely terminating in less than four, and often con
tinuing twelve, and sixteen hours. In some instances
the hot stage even continues several days, when it be
comes a continued fever ; or it may assume the remit
tent form.
Sweating Stage. After the hot stage has run its
course, a perspiration makes its appearance upon the
forehead and extremities, which is soon diffused over
the whole body. As the sweating becomes more and
INTERMITTENT FEVER. 143
more profuse, the febrile symptoms, with the pains and
uneasy sensations, gradually subside, until the parox
ysm terminates in a perfect state of apyrexia or con
valescence.
The above is a general description of the ordinary
course of an intermittent paroxysm ; but in some in
stances these stages are reversed, or one or more of
them may be absent, or if present, only a few of the
symptoms enumerated will be recognised.
Writers have divided intermittents into four va
rieties, viz., first, the inflammatory ; second, the con
gestive ; third, the gastric ; fourth, the malignant inter
mittents.
This division is made from the fact that the differ
ent types, under certain circumstances, partake of
the general character which these terms indicate.
Thus, the inflammatory variety generally occurs dur
ing the winter and spring. Quotidians are more
prone to partake of this modification than tertians or
quartans. Patients labouring under this variety,
rarely enjoy perfect intermissions between the parox
ysms, and they are often left with permanent dis
orders of the liver, lungs, &c.
The congestive variety is very uncommon. It sel
dom attacks any except those of feeble, relaxed, and
exhausted constitutions, in whom there is not suffi
cient vigour to accomplish a perfect reaction. The
brain is the organ which usually suffers most, and
coma often supervenes during the cold stage, which
ends in death.
The gastric variety presents prominent symptoms
of gastric derangement from the first, a superabun
dance of the biliary secretion, furred and bitter
tongue, with nausea and vomiting. It is peculiar to
temperate latitudes, and usually occurs in the au
tumn. In this variety the liver is much affected,
and therefore we find chronic enlargements of this
organ often remaining after the paroxysms have been
subdued.
The malignant intermittents are peculiar to hot la
titudes. They are attended with extreme debility
from the onset ; respiration is feebly and imperfectly
performed, the blood is only partially oxygenated,
diarrhosa now and then ensues, and a rapid prostra-
144 INTERMITTENT FEVER.
tion of the powers of the system usually occurs, which,
in many instances, speedily proves fatal.
It has been noticed that chronic enlargements and
indurations of the liver and spleen, affections of the
lungs, dyspepsia, scirrhous indurations, &c., often suc
ceed fever and ague. These affections have been
looked upon as secondary consequences of the fever,
while, in point of fact, they are medicinal diseases,
superinduced by the abuse of mercury and bark.
These drugs are empyrically employed by the allo
path, for the cure of this malady in all its various
forms: Whether inflammatory symptoms predomi
nate, whether there is congestion of the brain, lungs,
or liver, or whether the system is exhausted by pre
vious debilitating causes, quinine and calomel in large
doses are the grand, and we might almost say, the
only remedies of allopathy. But do these violent
drugs actually cure the malady ? When the parox
ysms are arrested by the use of these herculean
doses, are the seeds of the disease eradicated, and is
there no danger of a relapse ? Let the candid prac
titioner of the old school answer.
It is the opinion even of some eminent allopaths,
that large doses of quinine often suspend chills
and fever, by superinducing in the liver or some other
important viscus, a serious medicinal inflammation or
congestion which usurps, temporarily, the place of
the intermittent. The effect of this truly allopathic
measure is, however, only of short duration, for the
paroxysms return again as soon as the artificial dis
ease has somewhat abated, or from some slight ex
citing cause. Thus will the paroxysms repeatedly
return, and be as often temporarily suspended, until
finally some permanent chronic malady will become
fastened upon the system and thus supersede the ori
ginal affection.
Is there a man in existence sufficiently robust to
swallow with impunity the quantities of antimony,
calomel, bark and quinine, which are usually pre
scribed by the old school in fever and ague ? Must
not some part of the organism necessarily succumb
before such formidable quantities of powerful medi
cines ? Let the stoutest allopath presume to try the
INTERMITTENT FEVER. 145
experiment upon his own person, and if he escapes
without inflammation of the stomach and intestines,
serious disease of the liver, lungs, spleen, or some
other organ, we will confess our error, and say that
large doses of quinine are innocent and harmless, and
that the preparations of mercury are manageable,
mild, and safe, when admitted into the human stom
ach.
Causes. — The most common cause of intermittent fever
is a peculiar miasm which arises during the progress
of vegetable decomposition, and which some authors
have termed koino miasmata. The term marsh miasm
is often used, but we deem it improper, as the mi asms
generated in elevated locations, are as capable of
causing the disease, as those formed in low and
marshy ground. The decomposition of vegetable
matters, by the aid of solar heat and moisture, is the
only condition requisite to develop the morbific prin
ciple.
Other causes occasionally give rise to fever and
ague, as intestinal irritation from indigestible food,
and worms, sudden suppression of old discharges, and
atmospheric vicissitudes.
Therapeutics. — The remedies most commonly made
use of in this malady, are china and arsenicum. The
following will also be found appropriate in many in
stances : — ipecacuanha, bryonia, eupatorium, perfoli-
atum, nux vomica, veratrum alb., belladonna, carbo
veg., pulsatilla, antimonium crud., ignatia, cocculus, la-
chesisj sabadilla, sulphur, cina, natrum mur., capsi
cum.
China. — External indications. — Yellowish colour of
the skin and face ; during the chill and heat, redness
of the face, and distention of the veins of the face and
head. " During the chill, bilious vomiting ; palpita
tion of the heart ; short cough." — (Hartlaub). " Du
ring the intermission, yellowish, clay-coloured counte
nance ; weak eyes ; fulness of the abdomen ; cough ;
anasarca. In tertian fever, with thick, brown, yellow-
coated tongue : countenance palish yellow during
the paroxysm and intermission ; swelling in the re
gion of the spleen ; eyes red and sensitive." — (Knorre.)
Quotidian fevers, with pale countenance : cold and
7
146 INTERMITTENT FEVER.
pale hands and feet, and retching np of mucus during
the chill ; while during the fever there are, red face,
full quick pulse, dry spasmodic cough.
Physical Sensations. — Paroxysm preceded by palpi
tation of the heart, sneezing, anguish, nausea, thirst,
bulimia, headache and colic. Thirst before and after
the shiverings, or during the sweating stage ; coldness
of the body, with congestion to the head ; soreness in
the region of the liver ; easy perspiration during sleep,
or when moving ; short cough ; for the most part no
thirst during the cold or hot stages. Hartlaub
has cured chills, external or internal, without thirst,
followed by heat with thirst ; and followed, or not,
by sweat ; or chills in some parts of the body, with
shuddering and heat in the head, terminating in
fever, intermingled with chill?, attended with thirst
and followed by sweat ; or no chills, but fever with
urgent thirst, and afterwards with perspiration. Hart-
mann advises china, when we have during the pa
roxysm throbbing pain in the head, extending to
the orbits ; vertigo ; nausea ; pain in the region of
the liver ; sharp pain in the chest ; short cough ;
aching pain in the abdomen during the chill ; pains
in the loins and legs. During the intermission, confu
sion of the head ; transient vertigo ; variable appe
tite ; thirst ; drowsiness after meals ; uneasy sensa
tion in the pit of the stomach ; nausea ; constipation ;
general debility. Knorre has cured the quotidian
type, with vertigo ; pale and cold hands and feet,
and retching of mucus, during the chill ; and pains
in the head, both sides, and pit of the stomach ; dry
and jarring cough, and drowsiness during the fever,
which is protracted and violent. Also, tertian fevers,
with violent chills, heat, and thirst, followed by per
spiration. During the paroxysm and intermission,
there were bitter taste, eructations, and vomiting ;
aching pains in the pit of the stomach, and in the re
gion of the spleen ; yellow and sickly aspect. Also
in tertian fever, when the chill is short and slight, but
followed by violent aching pain in the forehead, in
the right temple, and around the right eye ; general
heat ; intense thirst ; eyes hot, painful, and sensitive
to the light ; paroxysm commences in the forenoon.
INTERMITTENT FEVER. 147
lasts until evening, and is succeeded by perspiration
during the night.
Mental and moral symptoms. — Confusion of ideas
and drowsiness during the paroxysm and intermission ;
anxiety ; discouragement ; great activity of the mind ;
sometimes delirium.
Administration. — One drop of the third dilution in a
teaspoonful of water, may be given previous to the
chill, and during the forming stage. Should this
prove insufficient to remove the symptoms, the dose
may be repeated every four hours during the inter
missions.
Arsenicum. — External indications. — Face puffed and
earthy ; or countenance anxious, sunken, and of a yel
low tint ; pendiculations and drawing in the limbs
during the cold stage ; pungent and burning feel of
the skin during the fever ; dropsical swellings ; trem
bling of the limbs during the sweating stage ; pulse
irregular, or quick, weak, small, and frequent, or sup
pressed and trembling ; tongue bluish, white, or
bright red ; diminished urine ; night-sweats ; face
red during the fever, but pale and^unken during the
intermission.
Physical sensations. — Aggravation of existing symp
toms just previous to, or during the attack; paroxysms
imperfectly developed ; chills and heat alternating ;
periods of attack regular, and generally in the morn
ing or evening ; burning thirst, or adypsia ; fever of
either type ; burning in the stomach, sharp pains in
the limbs, chest, back and head, during the heat, with
difficulty of breathing ; during the sweating stage,
heaviness of the head, buzzing and ringing in the
ears ; between the cold and hot stage, drowsiness,
languor, thirst, nausea, vomiting and hiccup ; sweats
during sleep, or on waking in the morning. Dr.
Watzke has cured chills and thirst, followed by high
fever, urgent thirst, dizziness, confusion in the head,
and, finally, profuse perspiration without thirst.
During the apyrexia, pains in the chest and head ;
weakness and faintness ; small appetite ; abdomen
swollen, and affected with occasional colic pains. Dr.
Hartlaub has cured chills without thirst, followed by
fever with or without thirst, and then by perspiration :
148 INTERMITTENT FEVER.
bffore the chill, vertigo ; fainting ; pains in the side,
chest, abdomen and back ; stretching and yawning :
during the chill, anxiety ; pains in the head, back,
limbs, and pit of the stomach ; stretching and yawn
ing ; prostration ; nausea ; vomiting ; coldness of the
abdomen, oppression of the chest : during the fever,
delirium ; pain in the head ; vertigo on rising ; nausea ;
bitter taste ; aching pain in the region of the liver ;
aching and burning, extending from the pit. of the
stomach to the left hypochondrium ; oppression of the
chest : during the intermission, pale countenance ;
white tongue ; swelling of the hypochondrium and
abdomen ; cold, clammy sweat ; throbbing pain in the
forehead ; thirst ; no appetite ; nausea ; extreme de
bility ; pains in the head, chest, back, and limbs.
Mental and moral symptoms. — Depression of spirits,
and irritability previous to the attack ; anxiety, un
easiness, confusion of ideas, which gradually increase
until the sweating commences ; occasionally delirium
during the hot stage.
Administration. — Two drops of the sixth dilution in
an ounce of water, — a dessert spoonful once in six
hours during the apyrexia, until the symptoms have
disappeared. One dose of this remedy will often
prove successful where allopathic doses of crude cin
chona, and other articles, have produced no effect.
I have, in two instances, succeeded in curing cases
which have resisted the old school method for months,
with a single drop of the thirtieth attenuation.
Remarks. — Arsenicum is appropriate in any type of
fever and ague, provided the symptoms correspond,
although several authors especially commend it in the
tertian and quartan forms. Fleischmann employs
from the third to the sixth attenuation ; Watzke
generally gives the second, third and fourth dilutions.
Unless the patient is unusually susceptible, we prefer
the third to the sixth.
Ipecacuanha. — External indications. — Before the
shiverings, uneasiness, stretching and lassitude, with
cold sweat on the forehead ; tongue clean or loaded ;
during the apyrexia, countenance pale or yellowish.
Physical sensations. — Slight chills, followed by much
heat ; or. severe Chills with little heat : aggravation
INTERMITTENT FEVER. 149
of the rigours from external heat ; thirst only during
the chill ; nausea, vomiting, and other signs of gas
tric disturbance, manifest during the heat ; also, con
striction of the chest. Watzke advises ipecac., when
the chills are attended with thirst, confusion of ideas,
and dull pains in the head ; the hot stage, with thirst,
and sharp pains in the head ; the sweating stage, with
but little or no thirst ; the apyrcxia, with want of ap
petite, bitter taste, oppression at stomach, and pale
face. Hartlaub has cured slight and short chills,
without thirst, followed with violent fever with thirst,
and succeeded by profuse perspiration, or without
perspiration. Before the chill, pain in the back :
during the paroxysm, headache, dulness of intellect,
gastric derangement, nausea and vomiting, oppression,
contraction, pain in the chest, and cough : during the
intermission, bitter taste of food, much saliva, loss of
appetite, vomiting after eating, lassitude, sleepless
ness.
Mental and moral symptoms. — Before the chill, dul
ness of intellect and sleeplessness : during the chill,
confusion of ideas, irritability, impatience, and indis
position to mental effort.
Administration. — Same as china.
Remarks. — This remedy has been most frequently
used in fevers of the quotidian and tertian types. Lo-
bethal, Hartmann, Boenninghausen, Schmid, Fleisch-
mann, Watzke, Madden, Trinks, Elwert and Rummel,
have expressed themselves strongly in favour of the
low dilutions of ipecac, in this disease.
Bryonia. — External indications. — During the shiver-
ings, trembling and redness of the face : during the
heat, nausea, and tendency to keep the recumbent
posture : during the sweating period, frequent sighing
and cough.
Physical sensations. — Preceding the cold stage, ver
tigo, headache, and lassitude ; first stage, ushered in
with severe chills and trembling, with heat in the
head ; chilly stage, more violent than the hot, or,
slight but protracted chills, and some thirst ; second
stage, ushered in with flushes of heat and slight chills,
in alternation in the first instance, afterwards burn
ing heat and thirst ; universal dry heat, external and
150 INTERMITTENT FEVER.
internal ; spasmodic cough ; vertigo and headache
during the fever ; shooting pains in the side and ab
domen ; after the heat, profuse sweat ; oppression in
the chest, with dry cough ; tendency to sweat night
and morning ; during the apyrexia, constipation, thirst,
unhealthy yellowish complexion, and night sweats.
Mental and moral symptoms. — Irascibility, and dis
position to look on the dark side of affairs.
Administration. — Two drops of the third dilution in
an ounce of water, — a dessert spoonful two or three
times during the apyrexy.
Eupatorium perfoliatum. — This is a remedy which
we have found highly serviceable in many cases
which have been complicated by the abuse of calo
mel and quinine. It is particularly indicated when
the liver is much implicated. An intelligent friend of
mine, who resides at the West, in a fever and ague
district, informs me that he has for many years past
made use of a very small quantity of an exceedingly
weak infusion of this agent, as a prophylactic against
the disease, in his own family, and with complete
success. He also assures me, that he has often cured
with astonishing facility, cases which had baffled for
months the ordinary treatment, with a dose or two of
an infusion very slightly bitter.
The external indications are, yellow tinge of the
skin and eyes ; eyes dull, heavy and sunken ; lips
pale or bluish, dry and cracked.
Physical sensations. — Irregular development of the
paroxysms ; frequent slight chills previous to the com
mencement of the first stage : partial chills in the back
and extremities ; dizziness, heaviness and ringing in
the head, during the cold stage ; hot stage ushered in
with slight chills, alternating with flushes of heat, un
til in a short time the heat becomes general, attended
with headache, nausea, vomiting, pains in the chest
and stomach ; pains in the bones ; tenderness of the ab
domen on pressure ; loss of appetite ; sensation of fa
tigue, languor and debility ; constant inclination to
sleep ; nocturnal sweats.
Dr. Williamson advises eupatorium in the guotidrm
andtertian types, when the following symptoms are pre
sent : paroxysm commencing in the morning ; thirst
INTERMITTENT FEVER. 151
several hours before the chill, continuing during the
chill and heat ; stiffness of the fingers during the chill ;
soreness in the bones ; aching pain with moaning,
throughout the cold stage ; a greater amount of shi
vering during the chill than is warranted by the de
gree of coldness ; retching and vomiting of bile from
drinking ; vomiting after every draught ; vomiting at
the conclusion of the chill ; distressing pain in the
scorbiculus cordis throughout the chill and heat ; chill
beginning at nine o'clock in the morning ; throbbing
headache during the chill and heat ; violent pain in
the head and back before the chill ; inconsiderable
perspiration, or none at all ; fever in the forenoon, pre
ceded by thirst early in the morning, but no chill ; at
tended by fatiguing cough and not followed by sweat ;
loose cough in the intermission ; cough in the night
previous to the paroxysm ; yellowness of the skin.
Mental and moral symptoms. — During the paroxysm,
confusion of ideas and ringing in the ears ; discourage
ment ; indifference to life ; dull of conception, and
discontented during the apyrexy.
Administration. — One drop of the first dilution in a
spoonful of water, during the apyrexy. As a prophy
lactic against intermittents, one drop of the tincture
two or three times a week.
Nux vomica. — External indications. — During the
chills, skin, hands, feet, face and nails are cold and
bluish ; redness of one or both cheeks ; spasmodic con
tractions in the limbs ; yawnings and stretchings.
Sweat profuse, sometimes with a disagreeable acid
smell ; partial or one-sided sweat ; pulse hard, full and
frequent, or small, quick, or feeble, or intermittent ;
dryness of the lips ; tongue coated white or yellow.
Physical sensations. — First stage preceded by exter
nal and internal cold and yawning ; chills usually at
night, or in the morning ; aggravated by motion, drink
ing, or excitement ; pain and heat in the head ; thirst
for beer ; pains in the back and loins ; during the hot.
stage, headache, vertigo, thirst, nausea, pains in the
chest ; shivering on motion ; debility ; during the
sweating stage the symptoms are mitigated ; sweat
and chills alternately.
Watzke gives us the following indications: chills
INTERMITTENT FEVER.
with thirst ; headache, loss of consciousness, or deli
rium, painful and inflexible limbs, contracted feel of
the muscles. Chills last four or five hours, and not
followed by heat or perspiration. After the chill, ex
haustion ; pains in the hypochondria from distention ;
thirst and want of appetite ; tongue white ; feet swol
len ; sensation of heaviness wrhen walking. Or, chills
followed by heat and sweats ; with thirst ; anxiety ;
headache ; slight cough, with burning sensation in the
chest, worse during the chills and heat ; constipated
bowels ; loss of appetite ; craving for beer ; weakness
and faintness. Hartlaub has cured chills with or
without external coldness, and without thirst ; follow
ed by fever with thirst, and succeeded or not by per
spiration. The chill may be slight and short, or vio
lent and protracted, with shaking and chattering of
the teeth, and blue nails ; fever attended with perspi
ration about the head and neck. Or, shaking chills
with thirst, followed by fever with thirst, and by per
spiration ; chill preceded by thirst, coldness increased
by drinking. Or, alternating chill and fever ; motion
during the fever or swreat causes chills ; during the
chill, pain in the back (sacrum) ; during the fever,
headache, vertigo, red face, pain in the chest, vomit
ing of water, bile, slime and food ; red urine ; during
the intermission, headache ; vertigo ; trembling of the
head on motion ; pain in the forehead ; acid eructa
tions ; bad taste in the mouth, loss of appetite, disgust
for food ; much thirst ; pain in the pit of the stomach
after eating ; distention and pain of the belly ; consti
pation ; pressing at the neck of the bladder after urin
ating ; drawing in the limbs; weakness. Hartmann
employs it when, at the commencement of the parox
ysm, there are paralytic weakness of the limbs ; dis
ordered stomach ; vertigo, and sudden prostration of
strength.
Mental and moral symptoms. — During the chills, stu
pid or delirious ; during the fever, anxious, melancholy,
sad, timid, apprehensive of death. Occasionally mo
nomania during the progress of the disease.
Administration. — Two drops of the twelfth dilution
in an ounce of water — a dessert spoonful each night.
If a cure is not effected at the end of a week, give a
INTERMITTENT FEVER. 153
drop of the first dilution once in six hours, until the
symptoms disappear.
Remarks. — Nux is particularly applicable to the quo
tidian and tertian types. If the individual has been a
hard drinker, or luxurious and sedentary in his habits,
the indications are still stronger.
Arnica. — External indications. — Inclination to re
main quiet.
Physical sensations. — Chills occur in the evening ;
thirst ; contraction of the features. In the hot stage,
pain in the back and limbs ; shiverings from the
slightest exposure ; the hot and sweating stages slight
and of short duration. In the apyrexia, pain in the
stomach ; loss of appetite and general appearance of
wretchedness and debility.
Mental and moral symptoms. — Obstinate ; reckless ;
quarrelsome.
Administration. — My friend Dr. Shue, has been ac
customed to exhibit this remedy in alternation with
ipecacuanha, with marked benefit. It may be given
at the first attenuation — a few drops every four hours
during the apyrexy.
Veratrum album. — External indications. — Cold and
clammy perspirations on the forehead : shuddering.
In the hot stage, coma and red or purplish cheeks ;
pulse slow, and almost extinct, or small, quick, and in
termittent ; tongue red and dry.
Physical sensations. — General coldness of the whole
body ; cold stage of short duration, and attended with
shivering ; vertigo ; nausea ; pains in the back and
loins ; thirst for cold water ; the second stage more
protracted, and accompanied with headache ; short
dry cough ; fever with external coldness ; urine dark
coloured ; diarrhoea or constipation ; coma ; in the
third stage, profuse perspiration, with thirst and drow
siness.
Hermann prescribes veratrutn, when the chills are
followed by sweat, and afterwards coldness. Or, chills
alternating with fever, with thirst ; vertigo ; nausea,
and pain in the back, succeeded by fever with deli
rium ; flushed face, and tendency to sleep. After the
paroxysm, morbid appetite. Or, cold stage, without
the hot or sweating stage.
7*
154 INTERMITTENT FEVER.
Mental and moral symptoms. — In the cold stage, con
fusion of ideas ; in the hot stage, coma ; during the
apyrexy, restlessness, and sometimes mental alien
ation.
Administration. — One drop of the first dilution in an
ounce of water — a table spoonful two or three times
between the paroxysms.
Belladonna. — External indications. — Face pale and
bloated during the cold fit : eyes red and injected ;
face red ; pulsations of the carotids ; veins of the fore
head swollen ; and some perspiration during the heat.
Physical sensations. — Shiverings and heat alternat
ing ; rigours followed by heat ; during the fever, burn
ing thirst ; headache ; shootings in the temples ; great
sensibility to impressions ; delirium ; sweat of the
parts covered only ; stitches in the chest ; dimness of
sight.
Mental and moral symptoms. Quarrelsome and
passionate during the paroxysm ; or, great agitation ;
mistrustful ; constant dread of evil ; visions of fright
ful or ludicrous objects ; delirium.
Administration. — A drop of the third dilution in
water, every four hours between the paroxysms.
Carbo veg. — ^External indications : Before the chill,
pale face ; cold feet and hands ; during the fever, red
face ; during the intermission, nocturnal sweat ; cold
sweat on the face and limbs.
Physical sensations. — Tertian type, kept up by
roused psora ; rigours, preceded by throbbing of the
temples ; rending in the teeth and bones ; and at
tended with thirst and sense of prostration ; hot stage,
attended with thirst, or absence of thirst; headache;
vertigo ; impaired vision ; nausea ; pains in the sto
mach and chest ; acid sweats in the morning : in
the intermission, paleness ; emaciation ; distention of
the stomach; headache; loss of appetite ; lassitude
and disturbed sleep.
Mental and moral symptoms. — Anxiety and fear in
the evening ; intellect dull.
Administration. — One grain of the third trituration
in two ounces of water, a tablespoon ful once in four
hours during the apyrexia.
INTERMITTENT FEVER. 155
Remarks. — This remedy was supposed by Hahne-
mann to be of especial service, in those old and obsti
nate cases of intermittent fever, which appeared to
be connected with a psoric miasm lurking in the
system. Hartlaub has found it curative in similar
cases. It is adapted to the tertian type.
Pulsalilla. — External indications. — Face pale dur
ing the cold stage ; face red and bloated in the hot
stage, sometimes with sweat on the face ; swelling of
the veins ; anxious and rapid respiration ; eyes dull,
and cloudy ; inclination to remain in the recumbent
posture ; pulse quick and small, or full and slow, or
feeble and suppressed ; tongue coated, whitish, gray
ish, or yellowish.
Physical sensations. — Chills in the evening or af
ternoon ; vertigo, pain and heaviness in the head ;
sensation of cold from slight exposure ; irregular dif
fusion of heat, chiefly in the face, or on one side ;
absence of thirst: after the paroxysm, headache, op
pression of the chest, moist cough, bitter taste.
Or, according to Lobethal, Hartmann arid Watzke,
chills without thirst; fever, with thirst, and dull
headache ; sweating very slight. Or, chilis com
mencing with vomiting, with slight thirst during the
cold, hot and sweating stages ; diarfhcBa ; loss of ap
petite.
Mental and moral symptoms. — Daring the paroxysm,
anxiety ; sadness ; taciturn ; apprehension ; dread of
sudden death : great depression of spirits during the
apyrexia.
Administration. — Two drops of the first dilution in
an ounce of water, — a dessert spoonful three or four
times during the apyrexia.
Remarks. — When the attacks have been incited by
abuse of fat and indigestible food, or are connecte'd
with any derangement of the menstrual function, pul-
satiila is appropriate. It has been most frequently
employed in the quartan type.
Antimonium crudam. — External indications. — Face
and eyes of a yellowish hue ; yellow or whitish fur
upon the tongue ; pulse quick or slow.
Physical sensations. — Tertian type ; short chills,
followed by fever, with pain in the chest and pit of
156 INTERMITTENT FEVER.
the stomach ; predominance of gastric or bilious
symptoms ; frequent nausea and vomiting ; bitter
taste in the mouth ; thirst ; diarrhoea ; distention of
the stomach.
Mental and moral symptoms. — During the apyrexy,
indifference to life ; during the paroxysm, peevish ;
dread of misfortune ; out of humour.
Administration. — Two drops of the third dilution in
an ounce of water, — a tablespoonful once in six hours
during the intermission.
Ignatia. — External indications. — During the chill,
pale or sunken face ; bilious vomiting : during the
second stage, pale face, or one cheek red and the
other pale : during the intermission, lips dry and
cracked ; countenance pale ; hard, dry stools ; nettle-
rash ; pulse variable ; tongue white.
Physical sensations, — Rigours, with thirst for cold
water ; nausea and vomiting ; pain in the back and
limbs ; oppression at the chest ; loose, short cough ;
coldness, relieved by external heat ; heat general
during the second stage ; vertigo ; headache ; pain in
the back and limbs ; drowsy ; absence of thirst during
the hot and sweating period ; during the intermission,
pressing and shooting pains in the head, back, and
limbs ; loss of appetite.
Mental and moral symptoms. — Occasionally delirious
during the fever ; suppressed grief, with sighing ;
timid, sad, irresolute, and inclined to weep during the
apyrexy.
Administration. — Same as belladonna.
Cocculus. — External indications. — Trembling during
the first stage ; redness of the cheeks during the heat ;
pulse full, hard and frequent ; tongue clean or loaded.
Physical sensations. — Transient chills ; skin hot to
the touch, in the first stage ; burning heat in the
cheeks ; cramps in the loins and stomach, and but
slight fever in the second stage ; apyrexy, accompa
nied with vertigo ; dull pain in the head, and general
debility.
Mental and moral symptoms. — Apprehension of ap
proaching evil ; fear of death, during the paroxysm ;
sadness and discouragement during the apyrexy.
Administration. — Two drops of the third dilution, in
INTERMITTENT FEVER. 157
an ounce of water — a tablespoonful every four hours
between the paroxysms.
Lachesis. — External indications. — Face pale, or lead
en, discoloured or yellowish, during the cold stage and
the intermission ; red spots on the cheeks while the
fever is on ; blue circle round the eyes ; red swelling
of the face ; agitation and tossing in the cold and hot
stages ; pulse intermittent, or feeble and frequent ;
tongue dry in the second stage.
Physical sensations. — Most of the time, icy coldness
of the limbs ; rigours only partial ; pains in the limbs ;
fever at night or in the evening, with headache and
great debility ; oppression at the chest ; severe pains
in the limbs ; thirst, and sometimes bilious vomiting.
Mental and moral symptoms. — In the apyrexy, melan
choly, violent jealousy ; weakness of memory : during
the paroxysm, delirium ; loquacity ; irritability.
Administration. — One grain of the third trituration
in two ounces of water — a dessert spoonful every
twelve hours until the desired effect is obtained.
Sabadilla. — External indications. — In the cold stage,
trembling of the limbs, spasmodic cough : in the hot
stage, yawning and stretching ; pulse variable ;
tongue natural.
Physical sensations. — The different stages imper
fectly developed; external coldness with shivering;
dry cough, pains in the chest, limbs and bones in the
first stage : during the apyrexia, dull pains, with sense
of fatigue.
Mental and moral symptoms. — During the paroxysm,
inability to collect or arrange the thoughts ; delusions
of the imagination with respect to oneself; delirium.
Remarks. — This remedy is useful when the malady
has been preceded for some time by gastric derange
ment, or in cases complicated by abuse of quinine.
Administration. — Same as veratrum.
Sulphur. — External indications. — Countenance pale
or hot during the first stage ; circumscribed redness
of the cheeks during the second stage ; sweat upon the
head, face, and hands ; eruptions or scabs upon the
face, hands, or limbs ; pulse hard, full and quick ;
tongue natural.
Physical sensations. — Previous to the first stage,
158 INTERMITTENT FEVER.
thirst and lassitude ; chilliness in the evening or at
nightt and sometimes in the afternoon ; shiverings in
the back, chest and arms, with coldness of the hands,
feet and nose ; heat attended with thirst ; burning
sensation in the hands and feet ; bruised and tired
feelings in the limbs ; palpitation of the heart ; per
spiration easily excited in the head, neck, hands, &c.
Mental and moral symptoms. — In the apyrexy, sad
ness, with frequent inclination to weep ; during the
paroxysm, irritable and peevish ; thoughts incline to
religious subjects.
Administration. — One grain of the first trituration in
four parts — a powder every twelve or twenty-four
hours until decided amendment or aggravation of
symptoms ensue.
Remarks. — Sulphur has most often been employed
in the quotidian type. In many cases of fever and
ague occurring in psoric subjects, it will also prove
eminently serviceable.
Cina. — Hermann and Gross have found cina cura
tive when during the paroxysm there are, pale coun
tenance ; canine appetite; headache; nausea; foul
breath : during the intermission, cold surface ; morbid
appetite ; lassitude ; occasional sweats.
Hartlaub advises capsic im in chills with thirst ;
headache ; mucous vomiting ; flow of saliva ; great and
painful swelling of the spleen ; rending pains in the
back, loins, and knees ; yawning and stretching ; fever,
with or without thirst ; headache ; bad taste ; cutting
pains in the belly ; pains in the chest, back, and legs ;
after the fever, slight or profuse sweat ; in the inter
mission, ash-coloured countenance ; swelling of the
spleen and the feet ; constant chilliness and coldness ;
drawing pains in different parts when in the air ;
useful in relapses after abuse of quinine.
The same writer commends natrum mur, in chills
with little or no thirst ; sharp pains in the forehead,
back, and bones ; short breath ; yawning and sleepi
ness, followerd by fever, with great thirst ; severe
rending or throbbing pains in the head and forehead ;
in the intermission, yellowish face ; white tongue ;
hard and scanty stools ; swollen stomach ; headache ;
weak eyes ; bitter taste ; no appetite ; great thirst ;
YELLOW FEVER. 159
pit of the stomach painful to the touch; sleepy in the
day time, but sleepless at night ; lassitude and debili
ty. It also cures tertian and quotidian types, with
chills only.
Administration. — A drop of the first dilution once in
four hours between the paroxysms.
CHAPTER XVI.
YELLOW FEVER.
This fever is exceedingly uncertain in its course, vio
lence, and duration. It may strike its victim suddenly
prostrate, overwhelming in its severity the whole sys
tem, and thus preventing a single rally of the circula
tory vessels ; or it may advance mildly, differing but
little from an ordinary attack of remitting fever. In
some instances it bears a strong resemblance to the
higher grades of bilious fever. Much depends upon
the peculiar circumstances of the individual attacked.
If he is recently from a temperate climate, and unac
customed to hot regions, he will be more susceptible
to the action of the poison than if he had been pre
viously acclimated.
Medical men have supposed that after a certain
period of exposure, the system becomes so completely
accustomed to the miasm, that it loses all suscepti
bility to its influence, and in this manner the process
of acclimation is accomplished. There is doubtless
some truth in this idea, but there are other causes
which exercise quite as important an influence in this
process. Those persons who abandon a temperate for
a residence in a tropical climate, do so in that physi
cal condition which the requirements, habits, and re
gimen of the former naturally generate. In a previous
chapter we have seen, that in cold regions, where the
atmosphere is highly condensed, a large amount of
animal food is requisite to supply the system with suffi
cient carbon and hydrogen to resist and neutralize the
160 YELLOW FEVER.
action of the inspired oxygen. With these habits,
appropriate only where a condensed atmosphere is re
spired, individuals seek the tropics, with bodies abound
ing in carbon, and continuing, in most instances, their
accustomed regimen of animal food and stimulants,
thus burdening their systems with an amount of the
elements of nutrition far greater than the oxygen con
tained in the rarefied air which they inhale can de
compose.
It is probable, therefore, that one of the chief predis
posing causes of yellow fever, is the presence of a
greater amount of carbon in the system than the in
spired air can properly act upon. The exact equili
brium between the supply of the elements of the food
and the absorbed oxygen, is disturbed ; the carbon pre
dominates, and all of those derangements which pro
ceed from a superabundance of this agent, necessarily
ensue.
The inhabitants of tropical latitudes have compara
tively but little desire for animal food, but prefer fari
naceous diet, vegetables and fruits : in this manner
naturally securing to themselves a due proportion be
tween the elements assimilated and the oxygen ab
sorbed ; while the inhabitants of the north find it ne
cessary to consume large quantities of meat and other
articles abounding in the elements of nutrition, in order
to preserve a healthy equilibrium. We therefore most
strongly urge it upon those who remove from cold to
hot climates, to adapt their systems by appropriate
regimen, and strict temperance in all things, for the
change, and we confidently predict that they will en
joy as great an immunity from this dreadful" scourge,
as the natives themselves.
Diagnosis. The premonitory symptoms of yellow
fever are giddiness, wandering pains in the back and
limbs, slight chills, nausea, and frequent sensations of
faintness.
After these symptoms have continued a few hours, a
decided reaction occurs : the circulation becomes
excited, the face flushed, the eyes red, there are vio
lent pains in the head, back, loins, and extremities,
distress of stomach, and vomiting of acid bilious mat
ters, the surface becomes dry and burning hot, mouth
YELLOW FEVEfi. 161
and throat dry, with intense thirst, and sometimes de
lirium.
The duration of this paroxysm is usually about
twenty-four hours, although occasionally it continues
two or three days, after which there is a remission of
all the symptoms, except a distressed sensation in the
stomach, with nausea and vomiting. The patient re
mains in this state with a considerable degree of com
fort for a few hours, when there is a recurrence of
many of the former symptoms in an aggravated form.
The stomach now becomes extremely painful and sen
sitive, vomiting is violent and incessant, the fluids
ejected are of a darker colour, the skin and eyes ac
quire a yellow tinge, and the mind becomes confused
and wandering.
The duration of this second stage varies from twelve
to forty-eight hours, with sometimes slight remissions
towards the termination of the paroxysm, when the
third or last stage sets in. This stage is character
ized by the complete development of the dreaded
" black vomit." At this period, the powers of the sys
tem all sink rapidly ; the pulse flags, and perhaps in
termits ; the tongue becomes dry, black and shrivelled ;
the breathing irregular and laborious ; cramps seize
the calves of the legs and the bowels ; the whole counte
nance loses its natural, lifelike expression ; the extrem
ities become cold ; colliquative sweats, diarrhoea,
haemorrhages, and loss of intellect occur, and, finally,
dissolution ends the scene.
This is only a brief outline of the more ordinary
symptoms and course of the malady, and will, we
trust, serve to aid the inexperienced practitioner in
his diagnosis. Each case, however, must necessarily
present modifications according to the predisposition,
habits, and peculiar circumstances of the individual
attacked.
Causes. — When animal and vegetable matters are
submitted, for a considerable length of time, to the
daily influence of intense solar heat, and a certain
amount of moisture in the crowded and filthy streets
of cities, or other confined places, a miasm is gene
rated, which, under favourable circumstances, will
ause yellow fever. Concerning the nature of this
162 YELLOW FEVER.
miasm we know nothing ; but it is evident, that the
continued high degree of temperature to which these
substances are exposed, and the confinement of their
noxious emanations within the walls of crowded cities
developes a more virulent morbific agent than is the
case when the same matters are exposed in the open
country, or to a more irregular and less intense heat,
such as usually occurs in more temperate localities.
There are several other causes which act as pow
erful predisposing influences, one of the most impor
tant of which, as before mentioned, is the too free use
of animal food and stimulants. We may also include
in this category, irregular habits, mental anxiety, de
pression of spirits, fear, grief, exposure to night air
or to a burning sun, and, indeed, whatever else tends
to debilitate the organism.
Therapeutics. — The remedies most commonly appli
cable to the treatment of this affection are, ipecacu
anha, belladonna, bryonia, rhus, arsenicum, and aconite.
The other medicines likely to prove serviceable are,
nux vomica, mercurius, veratrutn, china, sulphur, can-
tharides, carbo vcg., and crotalus. The late and much
lamented Dr. Taft, of New Orleans, was eminently
successful in his treatment of the yellow fever as it
occurred in that city. Sometime since, we had the
pleasure of perusing a letter from a highly intelligent
gentleman of New Orleans, in which he states, that
the success of Dr. T. was so great in this malady, as
to attract the marked attention of a large number of
citizens ; and the writer expresses a deliberate opin
ion, that a new and favourable era would soon have
occurred in the management of this formidable affec
tion, if the able and accomplished Taft had survived.
The remedies which. this physician found most suc
cessful, and upon which he chiefly relied, were
aconite, ipecacuanha, belladonna, and bryonia, in the
first, and sometimes second stages ; in the second and
third stages, in addition to the above, rlius tox., arsen
icum, veratrum, cantharidcs, carbo vcg., nux vom. These
medicines were usually employed at the first attenu
ation, and frequently repeated, either singly or in al
ternation, as the circumstances of each case appeared
to require.
YELLOW FEVER. 103
When the first symptoms declare themselves, as
dizziness, slight chills, pains in the back and limbs,
uneasy sensations at the epigastrium, with nausea,
vomiting, and sensation of faintness, ipecacuanha, at
the third attenuation, should be immediately exhibited.
This remedy may also be found serviceable during the
second and third stages, in alternation with some
other article. Should the malady continue to pro
gress, the following medicines should be considered,
and, in proper cases, promptly administered.
Belladonna. — External indications. — Glowing red
ness and bloated appearance of the face ; eyes red
and sparkling, or fixed, glistening, and prominent ;
tongue loaded with whitish mucus, or yellowish, or
brownish ; pulse variable.
Physical sensations. — Dry burning heat ; sharp, dart
ing and shooting pains in the head ; violent throbbings
in the head ; burning thirst ; painful heaviness and
cramp-like pains in the back, loins, and legs ; pressure,
cramp-like, and contractive pains in the stomach ; in
clination to vomit, or violent vomitings.
Mental and moral symptoms. — During the remission,
melancholy; dejection: when reaction comes on,
great agitation, with continual tossing and anguish.
Administration. — Belladonna is for the most part ap
plicable to the first stage of yellow fever. One drop
of the third potency may be given once in one, two,
three, or four hours, according to the violence of the
symptoms.
Bryonia. — External indications. — Skin yellow ; eyes
red, or dull and glassy, or sparkling and filled with
tears ; tongue dry, and loaded with a white or yellow
coating : pulse rapid, and full, or weak and rapid.
Physical sensations. — Severe pain and burning sen
sation in the stomach ; vomiting, particularly after
drinking; burning thirst; pains in the back and
limbs ; headache aggravated by movement ; eyes
painful on motion ; sense of fulness and oppression in
the stomach and intestines.
Menial and moral symptoms. — Anxiety, with dread
and apprehension respecting the future ; loss of memo
ry ; delirium.
Administration. — Two drops of the first dilution in
164 YELLOW FEVER.
an ounce of water, — a dessert spoonful every two
hours until an impression is produced.
R/ius. — External indications. — Surface of a dirty yel
low colour ; eyes glazed and sunken ; tongue dry and
black; lips dry and brownish ; pulse quick and small ;
loquacious delirium, or coma with stertorous breath
ing ; constant moaning.
Physical sensations. — Distressing pain and burning
in the stomach ; nausea and vomiting ; paralysis of
the lower extremities ; spasms in the abdomen ; want
of power over the abdominal muscles; colic; diar
rhoea ; difficulty in deglutition, and pain on swallowing.
Mental and moral symptoms. — Intellect dull and
clouded ; constant uneasiness ; delirium.
Administration. — Two drops of the third dilution in
an ounce of water, — a dessert spoonful at a dose, and
repeated as the symptoms require. In cases where
this dilution is not sufficiently prompt or active, the
first dilution may be substituted in drop doses.
Arsenicum. — External indications. — Face of a yel
lowish or bluish colour ; eyes dull and sunken, with a
dark mark under them ; sclerotica yellow ; nose
pointed ; coldness of the body, with cold and clammy
sweat ; lips and tongue brown or black ; colliquative
sweats ; pulse irregular, or quick, weak, small and
frequent, or suppressed and trembling.
Physical sensations. — Sense of extreme debility ;
dull , throbbing, stunning, or shooting pains in the
head ; burning or sharp and darting in the epigastrium,
or in the region of the liver ; limbs feel stiff and use
less ; frequent evacuations, with tenesmus, or painless
and involuntary ; oppression at the chest, with rapid
and anxious respiration; cramps in the calves of the
legs ; great oppression at the stomach, with violent
vomiting, especially after drinking ; drawing and
cramp-like pains in the abdomen ; sensation as if a
weight was pressing upon the abdomen.
Mental and moral symptoms. — Indifference ; weak
ness of memory ; stupidity ; delirium, with great flow
of ideas ; loss of consciousness and of sense ; raving.
Administration. — In urgent cases, a drop of the third
dilution may be exhibited every half hour, until some
change is produced in the symptoms. In less danger-
YELLOW FEVER. 165
cms instances, the intervals of administration may be
lengthened as circumstances require.
Aconite. — External indications. — Suitable in the first
and second stages, when there are burning and dry
skin ; red cheeks ; full and rapid pulse ; red and sen
sitive eyes ; tongue natural or covered with a whitish
slimy coat ; lips and mouth dry ; vomiting of mucus
and bile ; urine dark red.
Physical sensations. — Violent febrile reaction ; sen
sation of intense heat ; great thirst ; acute pains in
the temples, forehead, or on one side of the head ; ver
tigo on rising, eyes weak and sensitive to light ; pains
and soreness in the back and limbs ; nausea ; general
sense of debility ; great heat and irritability of the
stomach ; short and anxious respiration.
Mental and moral symptoms. — When the fever is on,
great anguish, anxiety, and restlessness ; for the most
part nightly delirium.
Administration. — A drop of the first dilution may be
given in water every two hours, until the active febrile
symptoms abate. Aconite and belladonna may some
times be alternated with benefit in the first period of
the disease.
Remarks. — In a majority of cases, a few doses of
this remedy will be found indispensable, during the
first reaction. This corresponds with the experience
of several physicians with whom we have communi
cated upon the subject, and whose opportunities of
observation have been ample. Dr. Hempel thinks it
probable that aconite is the only specific for this dis
ease.
Nux vomica. — External indications. — Skin yellow ;
face pale or yellowish, especially round the nose and
mouth ; lower part of the sclerotica yellow ; eyes in
flamed with redness of the conjunctiva ; eyes surround
ed with a dark circle and full of tears ; tongue with a
thick white or yellow fur, or dry, cracked, and brown,
with red edges ; pulse variable.
Physical sensations. — Burning pains in the stomach ;
pressure or cramp-like pains in the epigastrium ; vom
iting of acid, bilious, or mucous matters ; frequent and
violent hiccough* ; eyes sensitive to light ; vertigo, or
pains in the head ; tremours of the limbs : cramps in
166 YELLOW FEVER,
different parts ; thirst for beer, brandy, or some stimu
lant ; contraction of the abdominal muscles ; loose dis
charges of slimy or bilious matters or blood ; burning
pains at the neck of the bladder, with difficulty in
urinating ; coldness, paralysis, and cramps in the legs ;
feet benumbed and cramped.
Mental and moral symptoms. — Excessive anxiety, un
easiness, fear of death ; despair, or loss of conscious
ness and delirium, with moaning or muttering.
Administration. — Two drops of the third dilution in
an ounce of water, — a dessert spoonful once in from
two to six hours.
Mercurius. — External indications. — Yellow colour
of the skin ; eyes red, blood vessels of sclerotica inject
ed ; eyes sensitive to light ; paralysis of one or more
limbs ; tongue with moist thick white fur, or dry and
brown mucus ; faeces variable ; pulse irregular, or
quick, strong, and intermittent, or weak and trem
bling.
Physical sensations. — Excessive inclination to sleep,
or restlessness from nervous irritation ; sense of fatigue
and debility; rapid loss of strength; dizziness, or vio
lent pain in the head ; violent convulsive vomiting of
mucous and bilious matters ; burning pain and tender
ness of the stomach ; constipation, or diarrhoea with
discharges of mucus, bile, or blood ; coldness of the
arms and legs, with cramps ; excitability and sensi
bility of all the organs.
Mental and moral sy?npto?ns. — Anguish and agita
tion ; weakness of memory ; apprehensions ; discour
agement ; moroseness ; raving.
Administration. — A grain of the third trituration in
an ounce of water — a dessert spoonful every two, four
or six hours.
Veratrum alb. External indications. — Face of a yel
lowish or* bluish colour, cold and covered with cold
perspiration ; eyes dull, clouded, yellowish and wa
tery ; lips and tongue dry, brown, and cracked ; hic
cough ; coldness of the hands and feet ; trembling and
cramps of the feet, hands, and legs ; evacuations loose,
blackish or yellowish ; pulse slow and almost extinct,
or small, quick, and intermittent.
Physical sensations. — General prostration of strength :
YELLOW FEVL:R. 1C7
confusion of head, or vertigo ; deafness ; difficult deg
lutition ; intense thirst ; violent vomiting of green bile
and mucus, or black bile and blood ; burning in the
stomach ; great exhaustion ; cramps in the stomach,
abdomen, and limbs ; diarrhoea.
Mental and moral symptoms. — Timid ; despondent ;
restless ; loss of sense : coma or violent delirium.
Administration. — A drop of the third dilution in an
ounce of water ; a dessert spoonful frequently repeat
ed, until an effect is apparent.
Sulphur. — External indications. — Face pale, or yel
lowish ; eyes red, or yellowish ; aphtha3 in the mouth ;
tongue dry, rough, and reddish, or with white or
brownish coat ; pulse hard, quick, and full ; fa3ces
whitish, greenish, or brownish, bloody or purulent.
Physical sensations. — Dizziness, or sharp pains in
the head ; itching and burning pain in the eyes ; roar
ing in the ears ; nausea, with trembling and weak
ness ; vomiting of bilious, acid, bloody, or blackish
matters ; pressure and pain in the stomach ; pains in
the back and loins.
Mental and moral symptoms. — Melancholy ; sad ;
timid ; undecided ; wandering.
Administration. — A grain of the third trituration in
an ounce of water ; a dessert spoonful every four
or six hours, extending or diminishing the intervals
according to the exigencies of the case.
Cantharides is sometimes indicated in the third
stage with complete insensibility, cramps in the ab
dominal muscles and legs, suppression of urine, has-
morrhages from the stomach and bowels, and cold
sweat on the hands and feet. It may be employed at
the first dilution, a drop every half hour, until a de
cided impression is produced.
Carbo veg. and crotalus, have both proved cura
tive in the third stage of yellow fever, and should
always receive due attention in grave cases.
168
CHAPTER XVII.
INFANTILE REMITTENT.
THIS is a disease peculiar to childhood, and is usu
ally caused by the use of unhealthy and indigestible
food, the irritation of teething, worms, repelled erup
tions, sudden drying up of ulcers, discharges, &c.
The affection is characterized by prominent disorder
of the stomach and intestines, in most instances, but
occasionally the brain or lungs seem to be chiefly
affected. In all cases, however, whichever part the
disease may seize upon, there occur regular remissions
and exacerbations.
Diagnosis. — The malady under consideration makes
its appearance with the premonitory symptoms of
ordinary fever, as slight chills, restlessness, thirst, and
wandering pains in the back, bowels, and limbs.
When the hot stage is fully developed, the patient re
fers most of his sufferings to the stomach and intes
tines : they become painful, tender upon pressure, and
there is either obstinate constipation or diarrhoea. The
evacuations are usually darkish, offensive, and indi
cative of a deficiency of bile. When the disease is
concentrated in the stomach, there is burning thirst,
with vomiting of liquids as soon as swallowed ; the
tongue is usually covered with a moist, whitish fur,
and red at the edges. If the inflammation be not
promptly arrested, but is permitted to progress with
out the aid of appropriate remedies, lesions will occur
in the digestive tube, or disorder of the brain or lungs
will be very likely to supervene.
Causes. — Undue exposure to cold, sudden changes
of temperature, improper food, worms, teething, re
pelled eruptions, abrupt suppression of accustomed
discharges, and the injudicious use of irritating medi
cines.
Therapeutics. — The remedies suitable for the treat
ment of this affection, are, in the first instance, the
higher dilutions of aconite, followed bv those medi-
INFANTILE REMITTENT. 169
cines which accord with the peculiar symptoms of
each case. As soon as the fever has been sufficiently
subdued by the former medicine, some of the following
articles may be resorted to with advantage : ipecacu
anha, cina, chamomila, mercurius, belladonna, arsenicum,
pulsatilla, nux vomica, spigelia, sulphur.
Since in most instances the gastro-intestinal mu
cous membrane is the seat of the malady, it will be
necessary to make a free use of ipecac., mere., puls.,
mix, cham., dulc. Should the brain or lungs become
involved, belladonna, bryon., nux, opium, and stramon.,
will prove efficient remedies.
Dr. Drysdale has found this fever, as it occurs in
England, exceedingly intractable, notwithstanding the
most assiduous care and attention on the part of both
physician and friends. In children of scrofulous con
stitutions, Dr. D. has known the disease to persist for
months, in spite of every remedial measure. In cases
of this description, he advises sulphur, calcarea, arse
nicum, and silicea.
In highly impressible and irritable children, we have
often witnessed an almost constant tendency to febrile
attacks, during dentition. The alimentary canal, the
brain, and the nervous system, appear to remain in
such a condition of erethism, that the slightest exciting
causes, as errors in diet, worms, suddenly checked per
spiration, &c., serve to develop the affection. In in
stances of this kind, aconite, belladonna, and chamomela
are peculiarly appropriate, and will generally enable
us to subdue permanently this morbid excitability.
These remedies should be given in drop doses of the
twelfth to the sixteenth dilution, once in twelve hours,
until every sign of undue irritability has disappeared.
Hartmann commends a few doses of coffea cruda, or of
col. carb. when this erethism is obstinate, and has con
tinued for a long time.
If the febrile attack has already made considerable
progress, with excessive irritability of the stomach,
and immediate ejection of every thing which enters it,
however simple ; distention, pain, and tenderness of
the stomach and bowels upon pressure ; hot and dry
skin ; burning thirst ; tongue covered with a whitish
fur, and red at, the edges ; great restlessness and irri-
8
170 INFANTILE KEMlTTENT.
tability ; loathing of food ; dark, yellow, slimy, or green
diarrhoea, we may give a grain of the third trituration
of ipecacuanha, or a drop of the sixth dilution of chamo-
mela, once in two hours, as long as is deemed neces
sary.
If the disease is still farther advanced, and the coun
tenance has assumed a pale, or dingy, sunken and
cadaverous aspect ; dark and puffy appearance under
the eyes ; coldness and dryness of the skin, or cold
clammy sweat ; burning pains in the stomach and in
testines ; thirst ; constant nausea ; the smallest quan
tity of food or drink, increasing the burning and dis
tress, until they are rejected ; watery diarrhoea, with
smarting and tenesmus ; great prostration ; frightful
dreams, anguish and uneasiness, especially at night ;
dark, dry and trembling tongue ; black and dry lips ;
grinding of the teeth, we should employ arsenicum at
the twelfth dilution — a drop in a teaspoonful of water
every two hours, until the requisite effect is produced.
When in addition to the symptoms enumerated
above, the child is exceedingly restless, and sensitive
to light on the slightest noise ; with flushed cheeks ;
red, glistening and protruded eyes : hot head ; con
stant raising of the hands to the head ; rolling of the
head from side to side ; sudden starts from sleep, with
screams ; spasmodic twitches in different parts ; dila
ted or contracted pupils ; short and oppressed respira
tion, we should administer belladonna at the twelfth
dilution — a drop in water, every two hours, until a
decided impression is evident.
When the fever is accompanied by obstinate consti
pation ; frequent desire to urinate ; burning heat of the
whole body ; morning exacerbations ; rigidity of the
limbs ; or drawing, contractive sensations through the
body ; occasional spasms ; frequent trembling both
sleeping and after an exertion ; shudderings and chills
from the least contact of cold air ; great sensitiveness
of the whole body ; unpleasant symptoms often ex
cited by motion or contact ; and indications of gastric
or bilious disorder, we may employ nux vom. at the
twelfth dilution — a drop in water, every two, three, or
four hours, as circumstances require.
When the malady has been caused bv the irritation
INFANTILE REMITTENT. 171
of worms, it will be necessary to use cina or spigelia.
These medicines may be employed at the third attenua
tion, and a dose given three or four times daily until
the morbid disposition of the alimentary canal is cor
rected.
Bryonia is applicable in cases attended with disor
der of the pulmonary tissues. In addition to biliary
and gastric derangement, there should be dry racking
cough ; stitches in the chest and sides ; painful, anxious,
and hurried respiration ; bruised pains, and soreness
in the limbs ; pains aggravated by motion or contact ;
hot skin ; thirst ; alternating heat and chills ; nightly
delirium ; irritable and quarrelsome. This remedy
may be used at the sixth dilution — a drop once in two
to four hours.
Dulcamara is the specific when the fever can be
traced to exposure to wet and cold, which has caused
a sudden check to the perspiration. In these cases,
the force of the disease is expended upon the mucous
membranes of the digestive and respiratory organs, as
is indicated by watery diarrhoea, pains in the stomach
and bowels, oppression at the chest, dry coryza, cough,
and difficult respiration. Its administration is the
same as bryonia.
If the attack is attributable to abuse of fat, crude
and indigestible food, and is accompanied with promi
nent gastric derangement, pulsatilla should be em
ployed at the sixth dilution — a drop every four hours
until the disturbance is corrected.
CHAPTER XVII.
CONTINUED FEVER,
In this class of fevers may be included those aris
ing from functional derangement, from inflammation,
from congestion, and typhus.
FEVER FROM FUNCTIONAL DERANGEMENT.
Diagnosis. — This is generally the mildest and least
dangerous of all the continued fevers. It commences
with slight chills, alternating with flushes of heat,
lassitude, restless nights, wandering pains in the head,
back and limbs, which are soon succeeded by in
creased action of the heart and arteries, dry and hot
skin, thirst, furred tongue, scanty and high-coloured
urine, and moderate derangement of almost every
function. If the malady is met at the onset with
suitable remedies, its progress is cut short, and imme
diate convalescence ensues ; but if it be allowed to
continue unopposed, although it occasionally subsides
spontaneously, it generally terminates in one of the
other forms of continued fever.
Causes. — Overloading the stomach with fat, crude,
and indigestible food, insufficient clothing, irregular
habits, dwelling in damp and ill-ventilated houses,
and the habitual and intemperate use of coffee, tea,
and tobacco.
Therapeutics. — Aconite, from the first to the third dilu
tion, if administered early, is sufficient to cure most
cases of this form of fever ; but if the disorder is
neglected until inflammation or congestion occurs in
some structure, then those medicines which operate
specifically upon the parts affected, are to be em
ployed, selecting those, of course, the pathogenetic
symptoms of which cover the most perfectly those of
the malady.
CONTINUED FEVER. 173
FEVER FROM INFLAMMATION.
Diagnosis. — In this form of fever the general symp
toms, as hot and dry skin, rapid and full pulse, dys
pnoea, thirst, nausea, oppression at the epigastrium,
restlessness, furred and dry tongue, are present ; but
the symptoms which more particularly characterize
the disease, are determined by the organ which is
prominently affected.
When the inflammation is located in the mem
branes of the brain, the face becomes flushed, the
eyes red and sparkling or protruded, staring, and dis
torted, the carotids throb violently, pupils contracted
or dilated, expression unnatural, furious delirium,
pulse full, rapid, and bounding, and finally if the dis
order progresses, sopor, muttering delirium, subsultus
tendinum, and convulsions.
If the disease attacks the lungs, we shall have ra
pid, anxious, and oppressed respiration, shooting pains
in the thorax, troublesome cough, with difficult ex
pectoration, pain and soreness during inspiration, and
perhaps other symptoms pertaining to inflammation
of the pulmonic structures.
If the gastro-intestinal membrane be affected, we
shall have the signs peculiar to inflammation of this
tissue, as nausea and vomiting, pains in the bowels,
increased on pressure, tongue red. countenance ex
pressive of anguish, thirst, bowels hot and swollen.
Causes. — Atmospheric vicissitudes, extremes of cold
or heat, errors in diet, arid over-exertion. Inflamma
tory fever often succeeds neglected or mismanaged
fevers from functional derangement, especially in
cases where some organ has been previously debili
tated, and in this manner rendered susceptible to in
flammatory action. Indeed, it is probable that inflam
mations seldom occur in parts which are perfectly
healthy and vigorous, but that when the exciting
causes of fever operate in these cases, they merely
give rise to slight and easily remedied functional de
rangements. Whenever, therefore, any structure of
the organism is in a state of unnatural irritation or
debility, this constitutes a powerful predisposing
cause of inflammatory fever, which only requires
174 CONTINUED FEVER.
>
some farther morbific influence to ensure its full de
velopment.
Therapeutics. — As in this form of fever there is an
exaltation of most of the functions, and particularly
of the circulatory vessels, aconite is an indispensable
remedy, always in the onset and frequently during
the course of the malady. This remedy, as all are
aware, exerts a peculiar power over the action of
the heart and arteries, and is, therefore, particularly
appropriate in those cases distinguished from the
first, by full and rapid pulse, hot and dry skin,
thirst, <fec.
In those instances where cerebral disorder predom
inates, belladonna, opium, and stramon.0 will be found
essential in the treatment, either alone, or in alter
nation with aconite.
If the pulmonary tissues are inflamed, suitable re
medies may be found in bryon., tart, ant., ipecac., and
phosphorus.
For gastro-enteritic inflammation, recourse . must
be had to one or more of the following medicines,
viz. : mere., nux, ipecac., puls., dulc., cham., ars., and
verat.
Administration. — In the selection of remedies, much
depends upon "the age, sex, temperament, as well as
the peculiarities of each particular case. For chil
dren and adults who are very impressible, we advise
the higher potencies ; while in cases of vigorous and
unsusceptible persons, the very lowest attenuations
will prove most efficient.
In regard to the repetition of doses, no definite rules
can be prescribed beforehand ; everything must of
necessity depend upon the nature and violence of the
disease, and the effect which each particular dose
produces.
FEVER FROM CONGESTION.
Diagnosis. — The precursory stage of congestive
fever is characterized by restlessness, irritability, in
disposition to mental or bodily exertion, fatigue from
the slightest exercise, vertigo, giddiness, apprehension,
pulse often below the natural standard. This stage
continues from a few hours to six or seven days, when
the second period fully developes itself.
CONTINUED FEVER. 175
The symptoms will now be modified in accordance
.with the organ which sustains the violence of the
attack. If the brain be the suffering structure, the
patient will complain of headache, oppression or
tightness in the head, pupils contracted or dilated, the
ideas confused, the pulse slow and labouring, and,
finally, coma, paralysis, and convulsions may super
vene.
When the bowels are the seat of the congestion,
we shall observe an anxious and distressed expression
of countenance, eyes sunken and glazed, more or less
nausea and vomiting, bowels burning hot, and tender
on pressure, while the extremities are cold ; tongue
slightly coated with a whitish or reddish fur ; uneasi
ness, with constant desire to change position ; frequent
sighing; bowels constipated or relaxed; and, finally,
spasms and stupor, with stertorous breathing.
If the disease concentrates in the lungs, there will
be rapid, laborious, and obstructed respiration ; pulse
irregular or intermitting ; cough ; face and skin pur
ple from imperfect decarbonization of the blood ; sur
face cold, and pains in the chest.
In all of these varieties of congestion, the physical
and mental energies of the system are below the
natural standard, the pulse is generally unusually slow
and feeble, the function of the lungs is imperfectly
executed, there is an unequal distribution of heat, and
diminution of sensibility throughout the body.
Causes. — Excessive cold, atmospheric changes,
drinking large quantities of cold water when the body
is heated, insufficient clothing, improper food, severe
mental or physical exertion, sudden news, grief, fear,
depression, disappointment, mortification, &c.
Therapeutics. — The remedies which have been used
with most success in congestive fever, are, for the
cerebral form, bell., aeon., op., stram., hyos., conium
mac., coff., mosch., and camph.
For the abdominal form, ipecac., verat., ars., nux,
cuprum, mere., phos., carb. v., secale cor.
For the pulmonary form, bryon., aeon., phos., lack.,
seneg., rhus tox., tart, em., hyos., ammon. carb.
Administration. — Congestive fevers often attack the
organism suddenly and violently, and if not promptly
176 TYPHUS.
arrested, run on to a speedy and fatal termination.
In severe cases, therefore, as soon as the remedy has
been selected which is homoeopathic to the malady,
it should be repeated at short intervals until a decided
impression is made upon the symptoms. After a rea
sonable time, if no effects are apparent, give a still
stronger dose, or change the medicine.
Let it be remembered, in all violent maladies,
that our object is, to produce a specific effect upon
the diseased structure as soon as possible, in order
that we may supersede the morbid by a healthy medi
cinal action. We need have no fear in this fever of
creating too great a medicinal aggravation, for there
is a low grade of erethism and impressibility of the
whole organism, and we can readily apply an anti
dote to any over-action which may be excited, and
thus control its influence, while, if we permit the
natural affection to make progress from a too timid
and sparing an exhibition of remedies, disorganization
will be likely to ensue.
In this form of fever, we generally employ the first,
second, and third attenuations, — the dilutions in drop,
and the triturations in grain doses.
CHAPTER XVIII.
LTYPHUS.
Few diseases have attracted more attention and
been the cause of more bitter controversies in the
medical world, than typhus fever. While some have
maintained that it is a malady peculiar to the cold
seasons of temperate latitudes, and caused by exhala
tions of animal or vegetable matters in a state of pu
trefaction,* others assert with equal confidence that it
occurs in all climates, at all seasons, at every period
from infancy to old age; and that it does not arise
* Dewees, Bancroft, <fcc.
TYPHUS. 177
from any specific cause (sui generis), but may proceed
from marsh miasms, animal exhalations, intense cold,
errors in diet, over-exercise, and a variety of other
causes.* Some suppose it contagious, and others non-
contagious.
Respecting its nature and seat, it has had the hon
our of being located by different medical writers in
every part of the body, from the crown of the head
to the soles of the feet. At one time the whole
world placed it in the blood : then another generation
of theorists arose who seated it in the solids : at
another period all the world, of France, made the dis
covery that its place was the gastro-intestinal mu
cous membrane, and that Hippocrates, Galen, Celsus,
Stahl, Boerhaave, Cullen, Hoffman, Brown, et omne
id genus, had been labouring under a succession of er
rors upon the subject for more than two thousand years.
Still later, some theorists have found out that its posi
tion is in the brain and nervous system, while a few
very sensible persons have arrived at the conclusion
that the exact nature and seat of typhus is yet involved
in obscurity.
At the present moment there are a great variety of
opinions respecting it. One class of medical men sup
pose it to be a disease affecting principally the brain
and ganglionic system of nerves. Another class sup
pose its action to be in " the mucous membranes and
lymphatic glands, especially those of the ileum,
whence it has been termed typhus abdominalis."-\
Others still suppose it to be a disease of a dynamic
character, or an affection of the "vital properties" of
the system. In regard to this last supposition, it can
not be refuted, because it means nothing at all. It is
as senseless and absurd as it would be to attribute it
to a derangement of the electric, magnetic, galvanic,
or any other " properties" which we may assume that
the organism possesses.
The malady assumes different characteristics ac
cording to the predisposition of the individual when
exposed to the influence of the contagion. If his sys-
* Naiham Smith, Macintosh, <fec. j- Hartmann,
8*
178 TYPHUS.
tern has been debilitated by over-exertion of body or
mind, by grief, care, misfortune, disappointment or
shame, the brain and nervous system will be promi
nently affected, and we shall be presented with that
variety termed cerebral typhus.
Should the stomach and intestines happen to be in
a state of irritation and debility, when the contagion
is absorbed, they will receive the impression, and we
shall have what is denominated abdominal typhus.
If the organ predisposed be the lungs, the morbific
agent will spend its effects at this point, and pneumo
typhus be the result.
So long, however, as the \vhole organism remains
in a perfectly sound and vigorous condition, with the
mind cheerful and moderately active, it will be able
to resist the influence of the miasm, and in all proba
bility escape the malady. The law is fundamental,
and cannot be too often inculcated, that just in propor
tion as the organism, or any part of it, diverges from
the normal standard, in the same ratio wrili the sus
ceptibility of such affected structures to morbific or
remedial influences, be increased.
Diagnosis. — The symptoms which appear at the
commencement of typhus, are, lassitude, debility,
sense of fatigue, impaired memory, slight chills, alter
nating with flushes of heat, dull pains in the head,
back and limbs, loss of appetite, and melancholy.
These symptoms often continue one or two weeks, the
patient not feeling sick enough to take his bed, or
sufficiently well to attend to his occupation, when he
becomes more restless during the night, delirium sets
in, he is obliged to keep his bed from debility, his
tongue, which was at first coated with a thin, white
fur, becomes dark, dry, and cracked, and as the disease
advances, the old fur passes off, leaving the surface
red, glazed, and dry. As the disease progresses, the
eyes become suffused, the countenance loses its natu
ral expression, the muscles are weak and tremulous,
a viscid saliva is secreted, which collects and dries
upon the lips and teeth, the surface acquires a dingy
colour, there are subsultus tendinum, defective vision,
partial loss of hearing, a tendency to slide down to
the foot of the bed, involuntary discharges from the
TYPHUS.
bowels and bladder, picking at the bedclothes, low
muttering delirium, and, finally, coma, convulsions
and death.
The symptoms and course of the complaint will, of
course, be modified in accordance with the severity of
the attack, the part affected, and the plan of treat
ment pursued.
If we may be allowed to judge from the opinions
which have from time to time been expressed by some
of the eldest, most experienced, and distinguished
members of the old school, upon this subject, we
will say, that the course of treatment ordinarily re
commended and pursued by allopathists, is productive
of far more injury than benefit, in typhus. In proof
of this, we quote from a monograph upon typhus
fever, by the late Professor Nathan Smith, of Yale
College, published in 183L
After commenting upon the various contradictory
methods of treatment advised by different authors, as
the antiphlogistic, stimulant, tonic, derivative, &c.,he
asserts : " I am clearly of opinion, that we had better
leave the disease (typhus) to cure itself, as remedies,
especially powerful ones, are more likely to do harm
than good."
In another place he declared : that " the use of pow
erful means, with a view of curing this disease, is
liable to do great mischief."
These are not the hasty opinions of a mere theoret
ical man of books, but tKey are the matured senti
ments <jf one who enjoyed an immense practice in
several of the different New England states, for a
period of more than forty years. Many other more
recent authors have not hesitated to avow similar
views, and, although they do not yet admit the truths
of the new law of cure, they entertain an entire lack
of confidence in the therapeutical doctrines of the old
system, so far as typhus, and many other maladies, are
concerned.
It may, then, with much propriety be affirmed, that
serious injury is often inflicted in typhus by allopathic
treatment, and that many of the symptoms above
-enumerated are aggravated, if not actually superin
duced, by blood-letting, counter-irritants, and power
ful drugs.
180 TYPHU?.
Causes. — The presumption is very strong, that the
cause of typhus is a specific agent, sui generis, and
that it is set free from the animal body during the
course of a fever, or when a number of individuals
are crowded together in close, filthy, and ill-ventilated
apartments. This specific poison rarely, if ever,
makes a serious impression, unless the organism is
previously predisposed to its influence. When all of
the organs are in a normal condition, and operate in
a healthy manner, an equilibrium is maintained
throughout the system which enables it to resist the
action of noxious agents. The ideas which we have
here advanced in regard to the specific nature of ty
phus contagion, were maintained by a number of
medical men many years ago, amongst whom may be
named the distinguished gentleman to whom we have
before alluded, Dr. Nathan Smith.
The reasons adduced by this careful observer of
nature in support of his opinion, are as follows : "On
the Connecticut river, for two hundred miles from
north to south, and on all its tributary streams on both
sides, for an hundred miles in width, there has been
no instance of any person's having contracted the in
termitting fever, from the first settlement of the coun
try to the present time ; and yet the typhus fever has
prevailed, more or less, in every township within that
tract of country."
If, as many writers assert, the miasms of intermit
tent, yellow, and typhus fevers are analogous, should
we not constantly witness these maladies running into
each other, or assuming indiscriminately these differ
ent forms in the same location 1
But a still stronger reason is brought forward by
Dr. Smith to sustain his position : he asserts that
" there is a remarkable odour arising from a person
affected with this disease, so peculiar, that I feel as
sured, that upon entering a room blindfolded, where a
person has been confined for some length of time, I
should be able to distinguish it from all other febrile
affections. This is an additional circumstance in
favour of the existence of the specific cause assigned
above, as several other diseases which arise from con
tagion are attended by an odour peculiar to each,
TYPHUS. 181
which, when once fixed in the mind, enables a person
to recognise their presence ever after. This is strong
ly evinced in smallpox, measles, malignant sore throat,
It is also a fact worthy of note, and one which bears
strongly upon this point, that typhus fever was entire
ly unknown to the savage tribes of America, previous
to the settlement of the whites ; and, even at the pre
sent time, those bands which have not been contami
nated by the civilizing aggressions of the usurpers of
the soil, but continue their wild, roving, active and
simple modes of life, are not at all subject to this
fever. The moment, however, they forsake their sim
ple and primitive customs, and adopt our dissipated
and enervating habits, enclosing themselves in close,
ill-ventilated, and heated apartments, and stuffing
themselves with spirits, greasy and indigestible food,
coffee, tea, condiments, and tobacco, they become
affected with contagious and miasmatic disorders, and
often die in great numbers. This fact goes to prove
that typhus is a disease pertaining exclusively to
civilized life, and that it requires the unnatural and
artificial customs and habits of the white race to ensure
its generation.
But as the constituents of animal and vegetable
substances are so nearly identical, it is highly proba
ble that the typhus poison may also arise from vege
table decomposition in close and heated apartments.
Of one thing we may be assured, respecting both ani
mal and vegetable matters : that when decomposition
occurs in dark, damp, and confined places, a far more
active and virulent miasm is generated, than when
the same substances undergo transformations in the
open air.
Therapeutics. — In the management of inflammatory
typhus, the liberal use of cold water, both internally and
externally, will be found highly beneficial. This im
portant agent has been hitherto quite too much over
looked in the treatment of fevers, for there is no
doubt of its immense power as a curative agent,
when judiciously employed. This is by no means a
modern remedy, as many suppose, but its frequent use
was strenuously recommended and actually adopted
182 TYPHUS.
for many years, by one of the most eminent and suc
cessful * physicians of New England, as long ago as
1796. The following quotations will show the views
then entertained respecting this agent.
" The most effectual method of reducing the
temperature of the body, is by the use of cold
water, which may be taken internally, or applied
externally."
"The only effectual method of cooling the body
in these cases (hot stage of typhus), is by the use of
cold water applied externally ; by this means we can
lessen the heat to any degree we please."
" The method which I have adopted, is to turn
down the bed clothes, and to dash from a pint to a
gallon of cold water on the patient's head, face and
body, so as to wet both the bed and body linen
thoroughly. As soon as the linen and bed clothes are
dry, if the heat returns again, the water should
be again and again applied until the heat is sub
dued."
We are aware that physicians have been deterred
from the free external use of cold water in fevers,
through fear of aggravating existing inflammations,
causing metastases. congestions, &c., by repelling the
blood from the surface to the internal organs, but the
danger from this cause is purely imaginary : for cold
water, externally applied, not only operates by ab
stracting the superfluous heat, and reducing the ani
mal temperature, but it also acts as a tonic, imparting
tone and vigour to the debilitated and relaxed capil
laries in which the morbid action is supposed to
reside.
In slight cases, frequent sponging of the surface
will be sufficient to accomplish our object ; but in more
severe instances, the method adopted by Prof. Smith
may be resorted to.
By adopting this course of treatment, while at the
same time we administer appropriate remedies, the
disease will run a milder course, and most of those
grave symptoms which are too often witnessed, will
be absent. It has been a question whether typhus
* Treatise on Typhus, by N. Smith.
TYPHUS. 183
can ever be cut short by remedies ; some maintain
ing that it may be broken up in the first stage, while
others are of opinion, that it must have its course.
Upon this point, Dr. Drysdale observes as follows :
" We do not believe it possible to cure typhus ; all
we can do is, to conduct it to a favourable termina
tion by carefully watching, and curing all the inter-
current affections so apt to appear in it, by judicious
management. At the same time we have always
given the remedies usually recommended, especially
rhusy bryonia and arsenicum ; and we believe that the
convalescence will be much hastened by judicious
treatment." Dr. D. advises the use of brandy and
wine in addition to our remedies during the stage of
collapse ; " especially when there is great want of ani
mal heat, and the pulse is very quick and small, at
tended with much trembling of the hands and con
stant muttering delirium."
The appropriate medicines will be determined by
the form which the malady assumes, and the exact na
ture of each particular case.
TYPHUS CEREBRALIS.
Belladonna, bryonia, aconite, opium, and rhus, will
cover most of the symptoms which are ordinarily pre
sent in this form. The following are the indications
for these medicines.
Belladonna. — External indications. — Countenance
flushed and bloated ; eyes red and sparkling, or dull and
turbid ; or pale, brownish and glassy; wild expression,
stupid, fixed, or wandering look ; visible pulsation of
the carotids ; respiration irregular, short and quick,
or slow and deep ; pupils contracted or dilated, gene
rally immovable ; pulse variable, but generally quick
and resisting; tongue red, moist or dry, or yellowish
white ; breath offensive ; urine brownish or red ;
spasms; distortion of the face and eyes; head very
hot, while the extremities are cool.
Physical sensations. — Fulness and heavy pain in
the head ; vertigo ; dizziness ; violent throbbings in
the head ; strong pulsation of the carotids, and ar
teries of the head ; double vision, sparks before the
184 TYPHUS*
eyes, or weak sight ; humming in the ears ; inflam
mation of the throat, chest, and abdomen ; pains,
heaviness, or numbness of the limbs ; palpitation of
the heart : pressure and cramp-like pains in the sto
mach ; dryness of the mouth ; adypsia, or thirst ; con
tinued watchfulness or lethargy ; constipation, or
diarrhoea with tenesmus ; constant moaning.
Mental and moral symptoms. — State of mind apa
thetic ; or irritability of temper ; illusions of the sen
ses, and frightful visions ; or gloomy, suspicious ;
constant moaning, or drowsiness ; profound coma.
Administration. — A drop of the third dilution in
water once in two hours, until the desired impression
is produced.
Remarks. — Belladonna is indicated in typhus, pre
senting a sub-synochal character. It is contra-
indicated in great depression of the cerebral and
nervous energy ; but applies in vascular and nervous
erethism.
Bryonici. — External indications. — Face red, burn
ing, and swollen ; eyes red and swollen, or dull,
glassy, turbid, or sparkling and suffused ; dryness of the
nose ; groans ; respiration difficult, short, rapid, anxious,
or sighing ; thick and tenacious expectoration ; pete-
chiae ; mouth dry ; tongue dry, and coated with a
dirty or yellowish fur; lips brown and dry; trem
bling of the limbs, and appearance of great weariness
and debility ; pulse variable ; urine pale, or brownish
and without sediment.
Physical sensations. — Fulness, heaviness, and pres
sure in the head, from within outwards, worse on
movement ; confusion and dull pains in the head ; ver
tigo ; buzzing in the ears ; dulness or acuteness of
hearing ; sensation of dryness in the throat ; profuse
sweat during the heat ; bitter, sour, or putrid taste ;
thirst ; nausea ; hiccough, or pressure at the stomach ;
constipation ; abdomen inflated ; weariness and pains
in the back, loins, and limbs, aggravated by motion ;
abdominal pains ; drowsy during the day; restless in
the night, with delirium.
Mental and moral symptoms. — Irascibility ; passion ;
fear of the future ; anxiety ; fear ; stupidity ; delirium,
TYPHUS. 185
with raving respecting business ; visions on closing
the eyes.
Administration. — Same as belladonna.
Remarks. — Bryonia is applicable in the cerebral and
abdominal varieties, and in typhoid pneumonia, es
pecially in the first period before the muscular and
nervous strength have become materially depressed.
After the system is reduced to a certain extent, it may
be alternated with one of the other remedies with be
nefit. Bryonia may often follow belladonna with pro
priety.
Aconite. — In the first stages of this, as well as in
most other maladies in which there is excessive action
of the circulatory vessels, aconite is an indispensable
remedy. Its properties and uses are so well known,
that we shall add nothing respecting it in this place,
excepting a simple caution to the inexperienced prac
titioner, that while endeavouring to reduce the force
of the general circulation, he should not neglect im
portant local inflammations. It may be administered
in the same manner as belladonna.
Opium. — External indications. — Face dark red, or
brownish, hot and bloated ; pupils dilated and immov
able ; lower jaw hanging from relaxation ; lethargy,
with snoring ; mouth and eyes open ; irregular and
slow respiration; pulse slow or suppressed; bluish
colour of the skin ; convulsive movements of the
limbs ; offensive black faeces ; involuntary evacu
ations ; urine scanty, high coloured, depositing a brick-
dust sediment.
Physical sensations. — Sensation of great heaviness
in the head, vertigo, dizziness, buzzing in the ears ;
general diminution, or entire loss of sensibility ; cloudi
ness of sight ; paralysis of the tongue ; sensation of
weight and pulsations in the stomach and abdomen ;
difficulty in evacuating the bladder ; great oppression
at the chest ; hoarse, dry cough, with bloody expec
toration ; troublesome itching of the skin ; convul
sions.
Mental and moral symptoms. — Stupor ; loss of con
sciousness ; delirium ; frightful visions.
Administration. — A drop of the third dilution in an
ounce of water — a table spoonful once in two hours.
OF THE
186 TYPHUS.
until a medicinal aggravation or an amendment oc
curs, — afterwards repeat according to the exigencies
of the case.
Rhus tox. — This remedy is particularly adapted to
the nervous forms of typhus, and may often" be used
with advantage in cerebral typhus after iryowici or«c-
onite, or in ganglionic typhus, when the following symp
toms present themselves :
External indication*. — Petechice ; face red and swol
len ; blue circle around the eyes ; nose pointed ; lips
dry. brownish or black ; eyes red, with viscid secretion
at the angles ; eyes fixed and dull ; nose dry, swollen,
and tender when touched ; tongue dry, red, or dark ;
mouth filled with viscid mucus, which collects upon
the teeth, forming sordes ; constipation or diarrhoea ;
teeth white, dry, and shining ; colour and consistence
of faeces variable ; retention or incontinence of urine ;
clear, red, or turbid urine ; paralysis of the lower ex
tremities ; pulse quick and small ; coma, with snoring
or moaning.
Physical sensations — Stupefaction ; vertigo ; dizzi
ness ; bruised sensation within the head ; soreness of
the scalp ; painful oppression in the stomach ; pulsa
tions in the epigastric region ; spasms and pinchings
in the abdomen ; pains in different parts as if from a
bruise, worse during repose, or at night, and relieved
by movement ; great weakness ; tendency to faint-
ness ; pain and difficulty in swallowing ; tenesrnus,
with loose, slimy, frothy, sanguineous, white, yellow,
or red evacuations ; constant and pressing desire to
urinate ; oppression at the chest, with difficult respi
ration ; soreness in the limbs, back, and neck, when
touched or at rest ; raw feeling in the throat and
chest ; excessive weakness, tremblings, sweats.
Mental and moral symptoms. — Muttering delirium,
or coma somnolentum, with snoring ; anguish and
dejection in the evening and at night ; inclination to
weep ; fear of death ; frequent sighing.
Administration. — A drop of the first dilution in an
ounce of water : a dessert spoonful every two or four
hours. If no decided effect ensues after a reasonable
time, give a drop of the mother tincture in a table-
spoonful of water, repeating as may be necessary.
TYPHUS. 187
Mcrcurius vivus has been successfully employed in
cases where there is great weakness, rapid sinking of
strength, profuse perspiration, fainting fits, trembling
and numbness of the limbs, cramps, and convulsive
movements, great agitation and uneasiness of body
and mind.
PNEUMO TYPHUS.
The medicines which have proved most efficient in
this form of typhus, are, aconite, bryonia, phosphorus,
ammonia, carb., acid phosph., and mcrcurius viv.
When the affection is characterized by accelerated
circulation, great heat of skin, thirst, difficult, anxious,
short and rapid breathing, with painful stitches in the
chest and side when inspiring; cough on motion;
lull, hard, and rapid pulse, aconite should be exhibited.
A dose of the third dilution every hour or two, until
an impression is made upon the symptoms.
After aconite has been administered, and symptoms
remain unsubdued, it will, be necessary to resort to
some of the following remedies, the indications for
which we proceed to describe.
Bryonia. — External indications. — Same as under
cerebral typhus. -4.
Physical sensations. — Confusion, fulness, heaviness,
and swimming in the head ; headache, aggravated, by
movement or opening the eyes ; respiration difficult,
short, anxious, rapid, or sighing ; oppression of the
chest ; stinging in the chest when coughing, or
breathing deeply. Shooting pains in the chest,
side, and abdomen ; pains in the limbs on movement ;
nose swollen, dry, and painful to the touch ; throat
dry, with sharp pains when touched or in motion ;
nausea and oppression at the stomach ; constipation
and diarrhoea alternating, the one in the night, and
the other during the day ; urine scanty and high
coloured ; cough, with stingings or stitches in the
chest and side, with yellowish or bloody expectora
tion, or pains in the head ; shooting pains under the
left shoulder-blade when coughing ; tongue dry, con
tracted, dark, or yellow ; pulse rapid and full, or
quick, weak, and irregular.
188 TYPHUS.
Mental and moral symptoms. — Same as under cere
bral typhus.
Administration. — Same as under cerebral typhus.
Phosphorus. — External indications. — Yellow, brown,
coppery, or bluish spots upon the skin ; viscid secre
tion about the eyes, particularly at night ; quivering
of the eyelids ; dryness and obstruction of the nose ;
face pale, dingy, or red and bloated ; eyes sunken and
surrounded by a dark circle ; lips dry and bluish ;
ulcers at the corners of the mouth ; tongue with a
dry and dark, or whitish fur ; respiration irregular,
laborious, noisy, or panting ; pulse quick and hard.
Physical sensations. — Stunning headache, vertigo,
and dizziness, worse in the morning ; smarting or
burning sensation in the eyes ; throbbing in the ears ;
deafness ; offensive discharge from the nose ; dryness
and raw sensation in the throat ; nausea and pains
in the stomach; uneasiness and painful contraction
of the abdomen ; stitches and roughness in the chest ;
expectoration of mucus, slimy, sanguineous, or puru
lent matter ; sharp pains in the shoulder-blades ; stiff
ness of the neck ; trembling, coldness, and numbness
of the limbs ; great oppression at the chest, with dis
tressed and anxious respiration.
Mental and moral symptoms. — Despondency, an
guish, and fear, especially at night ; disposition to
weep or laugh.
Administration. — A drop of the third dilution in an
ounce of water ; a dessert spoonful once in two to
six hours, until an effect is perceptible.
Ammonium carl). — External indications. — Miliary
eruptions, or redness of the skin ; eyes dry ; nose ob
structed with dry coryza ; face pale and bloated ;
lips dry and dark-coloured ; faeces in small, hard
lumps ; respiration short and anxious ; breath offen
sive ; tongue covered with slime or vesicles ; pulse
weak and rapid.
Physical sensations. — Great restlessness at night ;
drowsy during the day ; disturbed sleep at night, with
frightful dreams ; pains in the head ; nausea ; ring
ing in the ears, worse at night ; sensation of excori
ation in the mouth and throat ; constant thirst ; con
stipation and itching at the amis ; frequent desire to
TYPHUS. 189
urinate during the night ; hoarse, or short dry cough,
with tickling and roughness in the throat ; mucous
and sanguineous expectoration ; sharp pains in the
chest and sides, on coughing, breathing, or moving ;
drawing pains in the nape of the neck and small of
the back ; extremities stiff and numb ; cramps, cold
ness, and swelling of the feet ; excessive weakness of
the limbs ; right side worse than the left.
Mental and moral symptoms. — Discouragement ;
anxiety ; apprehension ; anguish ; sad, weak, timid ;
mental distress, worse at night.
Administration. — A grain of the first trituration
every two, four, or six hours, as the nature of the case
requires.
Acid Phosphoric. — External indications. — Eruption
of small pimples on the skin ; redness of the skin ;
coma ; eyes dull, glassy, fixed, with pupils dilated ;
coryza, with redness of the nostrils ; face pale, or
covered with pimples ; teeth yellow ; gums swollen
and bleeding ; tongue covered with thick and adhe
sive mucus ; faeces hard, knotted, and slimy ; urine
clear or white, depositing a white sediment ; pulse
quick and weak.
Physical sensations. — Great physical and mental
prostration ; pains in the chest, abdomen, and head,
worse during repose, relieved by motion ; head con
fused, bewildered with pains when moving it ; eyes
weak and sensitive to candle-light ; music painful to
the ears ; cheeks hot and burning ; nausea and op
pression at the stomach ; diarrhoea, frequent inclina
tion to urinate ; tightness and oppression in the chest ;
cough, with purulent expectoration ; sharp pains in
the chest ; burning sensation in the hands and feet.
Mental and moral symptoms. — Indifferent ; taciturn ;
peevish ; stupid.
Administration. — Suitable in some cases of advanced
pneumo typhus. A dose of the third dilution may be
given once in four to six hours.
The following medicines should be named as ap
propriate under certain circumstances, in pneumo
typhus, viz., lachesis, tart., emet., senega, mere., lobel.
inflat.
190 TYPHUS.
TYPHUS ABDOM1NALIS.
From the close analogy of appearances produced
upon the intestinal canal, by fatal doses of arsenicum
and by fatal abdominal typhus, it would be a natural
conclusion that arsenicum is for this disease a valua
ble homoeopathic remedy. There has been, however,
a wide difference of opinion upon this question, be
tween some of our most eminent practitioners. Many,
like Hausmann, Fleishmann, Gumpendorf, Staph,
Jahr, Henderson, Laurie, Currie, and Hartmann, have
eulogized arsenicum for this form of typhus, in the
most enthusiastic manner ; at the same time a very
few, as Wurmb, Lorentz, &c., have denied that it
possesses any special curative properties in any stage
of the malady.
But the weight of testimony is so much in favour of
the advocates of arsenicum- in abdominal typhus, that
we shall not enter into any discussion of the question,
but simply express the opinion, that in all cases of the
genuine forms of this disease, arsenicum, when exhibit
ed judiciously, will prove a remedy of immense im
portance. Indeed, we believe in those cases of ulcera-
tion of the mucous membrane of the ileum, Peyer's
glands, &c., and in those instances where the blood be
comes congested in different parts of the intestinal ca
nal, giving rise eventually to sphacelation if unop
posed, that arsenicum is a specific of positive and de
cided power. In support of this opinion, we refer
with full confidence to the numerous hospital and pri
vate reports, which have been presented to the public
in the last few years.
In relation to the cause or causes of the ulcers so
often discovered by the Hippocratics in autopsieal ex
aminations of those who have died of typhus abdomi-
nalis, an allopathic* physician of forty years' standing
in Massachusetts, makes the following very pertinent
inquiries in a late number of the Boston Medical and
Surgical Journal : After expressing himself as " fully
persuaded that one of the great secrets of curing pa
tients is not to kill them," he proceeds : — " I should like
to be informed whether there is not danger in giving
* Silas Brown, M. D.
TYPHUS. 191
inwardly, in any quantity, strychnia, creosote, prus-
sic acid, nitrate of silver, and a host of other virulent
caustic poisons ; and whether some of them \vouldnot
have a tendency to cauterize or constringe the delicate
absorbents and other vessels of the digestive organs ;
and whether such medicines have congeniality or
affinity enough with the membranous and vascular por
tions with which they come in contact, to become sana
tive medical agents ; or whether they would not have
a tendency to produce obstructions mid those ulcers
which we meet with in the post-mortem examinations of
those subjects who die of typhus fever" He requests
an answer, and we venture the suggestion that if he
adopts an affirmative one, he will be in little danger
• of error. But to proceed with our description :
Arsenicum. — External indications. — Skin dry or yel
lowish, or cold and bluish ; reddish or dark spots on
the skin ; petechiae ; eyes dull, glazed, and sunken ;
pupils contracted ; face shrunken, ho!lo\v, pale, and
cadaverous, or yellowish, bluish, or leaden coloured ;
expression of countenance distorted and unnatural ;
cold sweat on the forehead ; lips dark, dry, and
cracked ; teeth dry, white, and shining ; sordes upon
the teeth ; tongue dry, shrivelled, bluish or black, with
trembling and inability to protrude it ; faeces variable,
generally loose, darkish, or greenish, and fetid ; invol
untary discharges of faeces and urine ; urine reddish,
brownish, yellow, or turbid ; tympanitis ; guggling
noise of liquids swallowed ; respiration short and
anxious ; cramps in the legs ; pulse irregular, or
quick, weak, small, and frequent, or feeble and trem
bling ; voice sepulchral and tremulous ; coma or low
muttering delirium; trembling of the limbs ; subsultus
tendinum ; sometimes deafness ; hippocratic counte
nance ; colliquative sweats.
Physical sensations. — Extreme debility or complete
prostration ; burning and heat at the pit of the stomach
and epigastrium; nausea, and vomiting, especially
after eating or drinking ; violent pains and burnings
in the abdomen, generally on the left side ; sometimes
only pain on pressure ; pains in the right hypochon-
drium ; stitches in the side with anxious and difficult
breathing : universal loss of strength, and excessive
193 TYPHUS.
restlessness ; stools dark, greenish, putrid, fetid and
involuntary ; head painful, weak, confused, as if
stunned ; distention of the abdomen ; stiffness of the
limbs.
Mental and moral symptoms. The patient is dis
satisfied, restless, anxious, discouraged ; or muttering ;
delirious ; sleep disturbed, with unpleasant visions.
Administration. In extreme cases, a grain of the
second or third trituration may be given every half
hour, gradually lengthening the intervals as circum
stances require.
Remarks. Arsenicum is especially serviceable in
the third stage of abdominal typhus, when ulcers have
formed. It will also frequently apply in the second
stage, when the bowels become relaxed.
Carbo vegetabilis, is also a remedy of importance in
the last stages of abdominal, and in all stages of putrid
typhus. In the former, it may sometimes be exhibited
in alternation with arsenicum, with good effect. The
following are the external indications: — hippocratic
countenance ; face pale, yellowish, or dingy ; eyes
sunken and glazed, with nocturnal agglutination ; lips
dry and cracked ; tongue dry, dark, and tremulous ;
position upon the back ; cold, clammy sweat ; pulse
rapid, trembling, and almost imperceptible ; trem
blings and jerkings of the limbs; urine red and high-
coloured ; faeces putrid and offensive.
Physical sensations. — An entire prostration of the
animal powers ; heavy, pressing, or drawing pains in
the head ; ulceration and bleeding of the gums ; rat
tling in the throat ; cramp-like, pressing, or burning
pains in the stomach and intestines ; burning pains
and oppression at the chest ; rigidity, or complete pa
ralysis and relaxation of the nape of the neck and
limbs ; bowels swollen and tender on pressure ; feet,
legs, and hands cold ; numbness of the limbs.
Mental and moral symptoms. — Coma, or sleepless
ness, with muttering delirium ; mind dull, confused,
wandering, or stupid.
Administration. — A dose of the third trituration
may be given in water, every half hour, in extreme
cases, until the necessary impression is made.
Hartrnann speaks in high terms of staphijsagria in
TYPHUS. 193
the first stage of the disease, when the following symp
toms appear : " Sordes on the teeth, pale and bleed
ing gums, with painful swelling of the gums, and rapid
decay of the teeth ; vanishing of thoughts and ideas,
weakness of memory, dulness of mind, great indiffer
ence and ill humour ; vertigo, with stupifying head
ache ; dimness of the eyes, itching, stinging, and heat
in the canthi ; fulness in the pit of the stomach, with
frequent hiccough and vomiting ; tension across the
hypochondria, oppressing the breathing ; pressure,
weight, and tension in the abdomen ; cutting pain in
the bowels, with nausea ; copious diarrhosic stools."
Muriatic acid is a highly important remedy in many
cases of advanced typhus, when the patient is stupid,
unconscious of surrounding occurrences, and extreme
ly prostrate. Other symptoms are, constant tendency
to settle down towards the foot of the bed, low mut
tering delirium, groaning in sleep, moaning, picking at
the bed-clothes ; inability to protrude the tongue, dry
heat, with transient and partial sweats, general unea
siness, "depression of the lower jaw, digging with the
head into the^pillow, turning up of the whites of the
eyes, slavering, &c." (Hempel.) We may employ the
first to the third dilution — a drop in a drachm of water,
every two hours as long as necessary.
Dr. Kidd found phosphorus a valuable remedy in the
treatment of the typhus which devastated Ireland dur
ing 1847 and 48. Rhus tox\, bryonia and arsenicum are
likewise highly commended by the doctor, when,
" from the very commencement, the heat of skin and
acceleration of pulse are very inconsiderable, and in
the middle and latter stages, are almost invariably be
low the natural standard. For two or three days the
patient would labour under lassitude and languor, with-
loss of appetite and of sleep, the tongue being general
ly the first index of the probable mischief in store.
About the fourth or fifth day, the disease being generally
well marked, with a very slight heat of skin, which
felt soft and clammy, being covered with moisture,
(not like the ordinary feel of a perspiring skin, but as
if the skin were damped, and by some contrivance all
evaporation prevented,) the pulse very little, if at all
altered, except in strength, which even at this period
194 TYPHUS.
would be somewhat deficient ; the tongue presented
a most characteristic appearance : in general dry, hard,
and glazed, like brown leather, or deeply covered with
brown or blackish fur. In some cases it appeared
soft, moist, and tremulous, covered with a perfect and
uniform layer of pure white paste or mucus, (this in
general omened a very severe and dangerous form of
the disease,) the gums and teeth became covered with
brownish incrustations, thirst being incessant and in
satiable, with nausea and vomiting ; in many cases
abdominal symptoms, as tension and tympanitic re
sonance of the abdominal walls, with tenderness and
shooting pain over either iliac region, (in general the
right ;) bowels seldom costive, in general relaxed,
with or without pain ; urine in a few cases suppressed,
in most unchanged ; head in general implicated : in
most from the beginning, with aching and heaviness
at the forehead, throbbing at the temples, vertigo,
sense of emptiness and bewilderment ; delirium, mostly
at night, with low muttering, or with stupid, heavy
insensibility, and incoherence of speech. The eyes
appeared dull, inanimate, and listless, with the head
instinctively turned from the light. In a few cases,
towards their termination, a peculiar sort of stolid
deafness supervened, which gradually disappeared as
convalescence advanced.
" Almost invariably the lower extremities were com
plained of as being dead and numbed, rendering the
least motion impossible, (but without any actual pain,)
the feet and legs feeling cold and damp.
" General debility and prostration set in early in the
disease, and proved the most obstinate of the symp
toms."*
Dr. K. relied upon the four medicines above named,
in this form of the malady, and the results show a
mortality of less than two per cent. His success in
the numerous cases of continued fever which came
under his care, was no less gratifying. The low di
lutions were employed for the most part ; but in a few
cases drop doses of the tinctures were deemed neces
sary.
* Truths and their Reception. <fec., by J. Kidd, M. D., London, 1 849.
TYPHUS. 195
The other medicines necessary in the treatment of
certain stages of this, as well as the other forms of
typhus, are : rhus tox., acid, nit., nux vom., secale cor.,
mere., op., camph., china, nux mos., valer., stram., hyos.,
and lack. These remedies will all occasionally be
called into requisition, so that their effects upon the
human system should be well understood and appre
ciated.
It will be observed that we have divided typhus
into but three varieties. Other authors add a typhus
putridus. typhus contagiosus, typhus lentus, typhus pe-
techialis, &c. In practice, however, we seldom find
any one of these forms distinct and unmixed ; but the
brain, nervous system, lungs, and abdominal viscera
partake more or less in the general disturbance, caus
ing each particular case to present peculiar and di
verse symptoms. So in regard to the treatment of this
fever, it will often be found, from its commencement
to its termination, to require one or more of the medi
cines which we have placed under each form of the
malady. The sympathetic connections are so strongly
pronounced, between the important organs in which
the different varieties of typhus are located, that one
cannot be affected without imparting disorder to the
ofliers.
Physiologists note it as a curious fact, that no two
human faces are exactly alike, and it may be asserted
with equal safety, that no two instances of typhus
fever ever presented, from first to last, precisely the
same symptoms. Therefore it is, that in all cases of
this, as well as of other maladies, we must trust to
symptoms alone, and be guided by them in the appli
cation of our remedies, rather than by the name of the
disease. Our nomenclatures and classifications un
questionably facilitate the investigations and diagno
sis of complicated cases, but they can be of very little
importance in the practical exhibition of medicines.
196
CHAPTER XIX.
HECTIC FEVER.
Diagnosis. — The ordinary symptoms of this fever,
are : daily febrile paroxysms, general debility, ema
ciation, skin pale, face often tinged with the " hectic
flush," irritable stomach, loss of appetite, moderate
thirst, night sweats, tendency to perspire through the
day, diarrhoBa, pulse quick, small, and sharp.
Causes. — The combination of symptoms denomi
nated hectic fever, in most cases, proceed from long
continued and profuse suppuration ; but they may
arise from protracted local irritation without suppu
ration. Some writers suppose that hectic can only
proceed from the absorption of pus, but this is erro
neous, as the symptoms of hectic often make their
appearance before suppuration occurs. In nearly all
instances, it is a secondary affection consequent upon
either protracted disease in some vital part, some of
the joints, or of some extensive surface. It proceeds
more readily from diseases of the " bones, ligaments,
and tendons, than from those of the muscles, skin,
cellular membrane, &c." *
It may, then, be considered as a constitutional dis
turbance, originated and kept up by some previous
local disease, and which cannot be permanently cured
until the original cause upon which it is dependent, is
eradicated or removed.
In those cases where it is kept up by incurable dis
eases of the joints, bones of the extremities, or other
parts which can be safely removed by the surgeon,
amputation or excision should^be at once resorted to,
and the hectic symptoms will speedily disappear.
Mr. Hunter remarks, that " a hectic pulse at one hun
dred and twenty has been known to sink to ninety in
a few hours after the removal of the hectic cause."
Several instances have occurred in my own practice,
in which an almost immediate and entire cessation
* Sir A. Cooper.
HECTIC FEVER. 197
of the hectic symptoms, such as sleepless nights,
febrile paroxysms, night sweats, diarrhoea, rapid pulse,
&c., has resulted from amputation or excision of the
offending parts.
When the original cause is a suppuration of some
important organ like the lungs, liver, stomach, &c.,
our prognosis must generally be unfavourable. In
these instances it is of the utmost importance to the
homo30pathic practitioner that he makes a thorough
investigation of all remote causes, in order to arrive
at an accurate knowledge of the latent and original
sources of the malady. He will thus be able to
direct his remedial applications with judgment,
and afford to his patients the only possible chance of
cure.
Therapeutics. — In the selection of remedies, every
thing must of necessity depend upon the original
cause, — its ?seat, nature, and violence ; and upon the
secondary consequences to which it gives rise. It
should always be a prime object, to direct our most
potent remedies with perseverance against the local
affection ; and if any latent or apparent influences
exist, against these also.
If we are called to a case of hectic fever, proceed
ing from an inflammation of a scrofulous character,
advantage will be derived from the use of some of
the following medicines : sulphur, aurum mur., calca-
rea, china, iodine, oL jecor., aseL, acid, nit., acid, mur.,
acid.phos., phos.,arsenicum, silicea, and mercurius.
In cases proceeding from syphilitic or mercurial
diseases ^f the bones, ligaments, &c., the medicines
adapted to the cure of these disorders should be se
lected.
If a chronic miasm, whether psoric or otherwise,
has originated the disturbance, then strike deeply at
the original cause with antipsorics, as well as at pre
sent symptoms, and good results may accrue in appa
rently desperate cases.
198
CHAPTER XX.
OF THE FEBRILE CUTANEOUS DISEASES.
EXANTHEMATA.
These fevers, like some of those heretofore describ
ed, can only arise from certain specific morbific con
tagions which give rise to uniform and readily re
cognised symptoms. They all commence with gene
ral febrile disturbance, followed sooner or later by
eruptions, and other characteristic symptoms, which
serve to distinguish each particular variety.
A peculiarity attending this class of diseases, is,
that a single attack usually renders the subject safe
against any future action of the morbific poison. I
have, however, witnessed two or three well marked
examples of second attacks of scarlatina in the same
individuals.
The maladies which we shall notice under this
head, are, Scarlatina, Rubeola, Variola, Varicella, Mi-
liar y fever 9 Roseola, Urticaria, Erysipelas, Plague.
SECTION I.
SCARLATINA. SCARLET FEVER.
This fever has been divided into three varieties,
namely: first, Scarlatina simplex; second, /Scarlatina
anginosa ; third, Scarlatina maligna.
In its simple form, scarlet fever is not attended
with danger, but runs its course mildly like a simple
continued fever, and terminates in five or six days in
convalescence.
In the other varieties, however, inflammations and
congestions often supervene soon after the attack,
and if not promptly met by suitable remedies, gan
grene, sloughing, and fatal disorganizations occur in
the throat, larynx, and other important parts of the
organism.
Scarlet fever is of much more frequent occurrence
FEBRILE CUTANEOUS DISEASES. 199
in the fall and winter, than during the summer
months. Its attacks are usually confined to children
passed the nursing period, and persons under twenty
years of age ; but it may occur at all ages from in
fancy to old age.
1. SCARLATINA SIMPLEX.
Diagnosis. — Shiverings, succeeded by heat, mode
rate thirst, frequent pulse, slight soreness of the
throat, nausea, loss of appetite, headache : — After
these symptoms have continued about forty-eight
hours, a scarlet eruption makes its appearance upon
the face, extending gradually downwards to the neck,
trunk, and extremities. This eruption consists of an
immense number of fine pimples (aptly compared by
Dr. Armstrong to a boiled lobster shell), either run
ning together and diffusing themselves uniformly over
the skin, or appearing in patches in different parts of
the body. Upon the appearance of this eruption,
many of the unpleasant symptoms, like nausea, op
pression at the stomach, dyspnoea, &c., abate, and the
case thus progresses until the fourth or fift'h day of
the fever, when desquamation of the cuticle takes
place, and a happy convalescence usually ensues.
2. SCARLATINA ANGINOSA.
Diagnosis. — The anginose variety of scarlet fever
is ushered in with chilliness and shiverings, succeeded
by intense heat and pungency of the skin, frequent
and hard pulse, nausea, vomiting, headache, sore
throat, painful deglutition, intense thirst, pain and ten
derness of the epigastrium, abdomen tender, pain and
stiffness in the neck, tongue covered with a whitish
or yellowish fur, through which the papillae are seen
red, inflamed, and prominent ; fauces, throat, and ton
sils swollen, deep red, inflamed, or ulcerated ; eyes
red and injected, voice thick and hoarse, sometimes
dyspnoea and cough, and universal tenderness of the
whole surface.
These symptoms continue an indefinite period, vary
ing from two to five days, when the eruption shows
itself, either uniformly diffused over the body, or in
200 FEBRILE CUTANEOUS DISEASES.
irregular blotches. If the disease progresses favour
ably, the skin desquamates in from six to eight days
from the commencement of the fever, the febrile symp
toms all subside, the ulcers in the throat granulate
kindly, and a speedy convalescence obtains. On
the contrary, if the eruption prematurely disappears
from the surface, the ulcers assume a foul and unhealthy
appearance, secreting an acrid and highly irritat
ing fluid ; while the fever continues to rage with un
abated severity. We may have a supervention of ab
dominal, bronchial, or cerebral inflammation, which
will complicate the malady in a serious and perhaps fa
tal manner.
" In this fever, the temperature, as indicated by the
thermometer, rises several degrees higher than in any
other."* The pulse is also more rapid and strong than
in almost any other fever, indicating conclusively that
it is an affection of an inflammatory character.
3. SCARLATINA MALIGNA.
Diagnosis. — Scarlatina maligna was formerly known
under the name of " putrid sore throat," and is at pre
sent designated by some writers as scarlatina typhoides.
It is unquestionably one of the most dangerous mala
dies with which the physician has to contend. It ge
nerally commences with the common precursory
symptoms of the anginose form, which, however, very
soon give way for a train of symptoms bearing a close
resemblance to typhus. The eruption is either entirely
wanting, or makes its appearance only partially, in
irregular blotches of a pale colour ; the heat of the
skin often subsides below the natural standard ; the
pulse becomes very frequent and weak ; the counte
nance assumes a besotted expression ; the eyes become
dull and suffused ; the throat is filled with ash-colour
ed ulcers ; fauces, larynx, and bronchia inflamed and
swollen ; an acrid discharge issues from the nostrils ;
the tongue, at first red, soon becomes dry and black ;
the surface, in the advanced stages, acquires a dark
red or mahogany colour, and petechise, diarrhoea, and
haemorrhages finally ensue. The ulcers in the throat
* Southwood Smith, on Fever.
FEBRILE CUTANEOUS DISEASES. 201
often slough and extend in all directions, involving in
their ravages the cartilages of the larynx and the soft
parts within the nostrils.
If the disease seizes particularly upon the brain,
lungs, or abdominal viscera, there will be a predomi
nance of those symptoms which characterize the disor
ders of these particular parts. From the tendency of
this malady to these different organs, some authors
have subdivided scarlatina maligna into the inflamma
tory, congestive, and mixed varieties. Examples have
occasionally occurred in my own practice, in which,
in the very onset of the malady, those symptoms have
appeared, indicating congestion of the brain, — as
coma ; slow, oppressed, and noisy respiration; sighing;
face pale or livid, skin cold, pulse slow and irregular,
pupils contracted or dilated. In these cases, the erup
tion seldom comes out well, but is of a pale colour,
and shows itself irregularly in different parts of the
body.
In other instances the inflammation seizes upon the
laryngeal, bronchial, or intestinal mucous membranes,
thus often deciding the case against the patient, when
the local affection of the throat seemed to be progress
ing favourably.
Causes. — Scarlatina can only proceed from a speci
fic morbific contagion, respecting the nature of which
we are entirely ignorant. Whether this contagion is
generated and diffused solely by those suffering under
the disease, or whether, as some pathologists assert, it
may be generated in the atmosphere independently of
the animal body, is a question which admits of discus
sion, although we entertain the former opinion. Of
this we are confident, that when the agent is infinites-
imally diffused in the air, it is capable of being ab
sorbed into the circulation, and of producing its speci
fic morbific effects upon the organism.
Some have doubted the contagiousness of this affec
tion, because certain individuals of families occasionally
escape, while others are affected ; but let it be remem
bered, that this happens now and then in smallpox,
plague, typhus, and all other maladies which are uni
versally deemed contagious.
We have before observed, that the contagion of ty-
9*
202 FEBRILE CUTANEOUS DISEASES.
phus cannot make a serious impression upon the or
ganism, so long as every part is in a perfect state of
health and vigour. The same remark will apply with
equal truth to the disease under consideration. In
these cases, the tissues on which the poison operates,
are stronger than the noxious influence, and are thus
enabled to resist its action until some cause predisposes
the system to receive the impression.
Therapeutics. — The provings of belladonna upon the
healthy subject, as well as the numerous successful
experiments made at the bedside of the sick, have
stamped it as a remedy of distinguished importance in
the treatment of scarlet fever. It has even been extol
led by eminent practitioners of the old school, and in
some instances adopted, both as a remedy in this dis
ease, and as a valuable prophylactic against it.
In the scarlatina simplex, an occasional dose of this
medicine at the third attenuation, will suffice to conduct
the patient safely through the malady. Should the fe
brile symptoms run high, the belladonna may be ad
vantageously preceded by aconite.
In the anginose form, where there is intense inflam
matory excitement, swelling and soreness of the
throat, painful deglutition, quick pulse, burning hot
skin, nausea, tenderness at the epigastrium, belladonna
is still the grand remedy. If the fever assumes a vio
lent character, evincing a tendency to excite inflam
matory action in any particular structure, aconite may
here also be administered with advantage, either by
itself, or in alternation with belladonna. So long as
the local inflammation in the throat is retained within
due bounds, and the eruption shows itself in a proper
manner, remaining out a sufficient length of time, we
shall receive ample aid from these potent remedies.
We take the liberty of introducing the following spe
cial symptoms of belladonna, from Drs. Curre, Her
mann, Laurie, &c. :
External indications. — Spots of a scarlet or deep
red colour on the face, or other parts of the body ;
swelling of the submaxillary glands, and those of the
neck ; eyes red, sparkling, and convulsed, or fixed,
shining, and prominent ; pupils dilated or contracted ;
tongue red, hot, and dry, or white in the centre, with
FEBRILE CUTANEOUS DISEASES. 803
red edges; throat, tonsils, uvula, and velum-palati
dry, inflamed and swollen ; suppuration of the tonsils ;
strong pulsations of the temporal arteries ; inflamma
tion of the stomach and abdomen ; constipation, or
involuntary evacuations ; urine turbid, of a brownish
red or yellow colour, with a red or whitish sediment ;
pulse small and quick, or strong and quick, or full and
slow, or small and slow, or hard and tense ; pulsations
of the carotids ; face hot, red, and bloated ; sweat
with the heat, or after it.
Physical sensations. — Vertigo, confusion, fulness,
heaviness, pressure ; shooting or expansive pain in the
head, aggravated by motion of the head or eyes, by
contact, and by cold air, mitigated by holding the
head back, and by supporting it ; mouth dry and hot ;
dryness and burning in the throat, with painful and
difficult deglutition ; loss of appetite ; nausea and
vomiting ; great thirst ; sense of fulness and distention
in the stomach and abdomen after eating ; drawing
pains in the back and shoulders ; difficult respiration ;
violent cough ; shiverings, alternating with heat, or
followed by heat, worse in the evening or night;
adypsia, or excessive thirst ; dry, burning heat.
Mental and moral symptoms. — Great agitation and
tossing about ; anguish and inquietude in the after
noon and night ; delirium, with muttering, groans, and
cries ; vivid and frightful dreams ; starting from sleep
with fright, groans, and cries ; ill humour and irrita
bility.
The same writers give us the following special in
dications for the employment of aconite:
External indications. — Face red, hot, and bloated,
or alternately red and pale ; skin dry and hot ; fore
head cold, and tips of the ears hot ; deep redness of
the throat ; bilious or mucous vomitings ; urine scanty,
deep red, with brick-coloured sediment ; pulse hard,
frequent, and accelerated ; respiration rapid and
difficult.
Physical sensations. — Oppressive or throbbing pains
in the head, aggravated by motion ; talking, rising up,
&c, ; better in the open air ; great sensibility of the
affected parts to the touch, or on movement ; pains in
the joints and limbs ; fainting and weakness ; ex-
204 FEBRILE CUTANEOUS DISEASES.
treme thirst ; coldness of the surface, with internal
heat, or burning over the whole body ; pain in the
throat, and difficult deglutition ; burning and prickling
in the throat in swallowing ; bitter or putrid taste ;
loss of appetite ; sense of swelling, weight, or pres
sure in the prsecordial region ; hot and burning urine ;
bruised pains in the loins, back, and nape of the neck.
Mental and moral symptoms. — Discouragement and
agitation ; noise appears insupportable ; humour
changeable : at one time sad, depressed, irritable, con
tradictory, despairing, at other times excited, gay, and
full of hope ; inquietude under disease, and even des
pair respecting a cure.
If there is slight fever through the day, but an in
crease in the evening, with sleeplessness, sadness, des
pondency, and tears, ipecacuanha is our remedy. The
following are the particular symptoms which point to
this medicine :
External indications. — Face pale, sallow, yellowish,
and bloated, with livid circles round the eyes ; tongue
loaded with a white or yellowish fur ; profuse secre
tion of saliva ; vomiting of green, bilious, acid, slimy,
or gelatinous matter ; sweat ; fetid breath ; turbid
urine, with sediment like brickdust.
Physical sensations. — Nausea and vomiting of drinks
or food ; no appetite ; insipid and clammy taste ;
adypsia ; violent itching of the skin ; empty risings ;
great uneasiness in the stomach and epigastrium ;
feeling of emptiness and flaccidity in the stomach ;
sensation of debility in the bowels, worse on motion ;
colic, with agitation ; tossing, with cries ; diarrhoea,
with nausea; griping and vomiting.
Mental and moral symptoms. — Anxiety and fear of
death ; moroseness ; cries, and howling ; vague desire
for different things.
When the disease commences with prominent de
rangement of the stomach and bowels, headache, ver
tigo, shiverings, weakness, nausea, and nose-bleed,
soon succeeded by hasty, anxious, and oppressed res
piration, mucous vomiting, taste of food, longing for
acids, spirits, or beer ; flatulence ; adypsia, or great
thirst ; constant anxiety, moaning, or sighing, and dis
turbed sleep, pulsatilla is appropriate.
FEBRILE CUTANEOUS DISEASES. 205
Scarlatina occurring in individuals of decidedly
scrofulous dyscrasias, will sometimes require the em
ployment of sulphur, or calcarea carb.
Dr. Elb, of Dresden, advises zinc in those cases
where paralysis of the brain is threatened, or when it
already exists. He has likewise used it with success
in the malignant form, with violent delirium, alterna
ting with sopor ; icy coldness of the skin from sunken
vitality ; small and frequent pulse, and fixed and stu
pid expression of the eyes. Dr. E. usually employs
the first trituration in grain doses every two to six
hours.
Occasionally, troublesome ulcers form in the mouth,
throat, and upon the tonsils, covered with ash-coloured
sloughs ; deglutition becomes exceedingly difficult,
and is attended with a stinging pain ; the fluids which
the patient attempts to swallow, often escaping
through his mouth and nose, with perhaps an acrid
discharge from the nostrils, and profuse secretion of
saliva. Under these circumstances, mercurius is a
proper remedy.
In malignant scarlet fever, where, in addition to the
above symptoms, we have inflamed, swollen, and ten
der salivary glands, dark-coloured ulcers, with a de
cided tendency to slough and extend, together with
great debility, lassitude, tremours, obtuseness of intel
lect, cold extremities, and other signs of a typhoid
condition, muriatic, or nitric acid, from the first to the
third dilution, should be exhibited.
If, at the same time, there should be present a con
siderable amount of pulmonary or cerebral excitement,
indicated by delirium, restlessness, contracted or di
lated pupils, heaviness and dull pain in the head on
motion, difficult, anxious, and sighing respiration, sen
sation of weight and pressure upon the chest, trou
blesome, hacking cough, with soreness and sensitive
ness of the whole surface, bryonia, third dilution, may
be called into requisition.
Arsenicum is a remedy of great power in the ad
vanced stages of malignant scarlatina, where there
are extreme prostration, pain in the stomach and abdo
men, diarrhoea, eruption of a livid or mahogany
colour, ulcers dark and foul, tongue and lips dry and
206 FEBRILE CUTANEOUS DISEASES.
black, pulse extremely frequent and weak, cold, clam
my sweats, hippocratic countenance. This remedy
has often rescued patients from the grave who have
been given over in despair by physicians of the old
school.
Should profound coma supervene during the course
of the malady, with snoring and open mouth, open
and convulsed eyes, red and puffed face, hanging jaw,
difficult, slow, or intermittent respiration, convulsive
movements of different muscles, retention of urine,
&c., opium will be found the best specific. We are
satisfied that this is an agent which will rarely dis
appoint our expectations in instances of this descrip
tion.
When the rash suddenly disappears during the
eruptive stage, Drs. Schmidt, Hartmann, and others,
recommend very highly acetat, cuprum as a specific
against this symptom. Sulphur, iodine, bryonia, phos
phorus, and belladonna also deserve consideration, and
will, in some cases, promptly restore eruptions which
have been prematurely repelled.
The other remedies which may be consulted in
cases where those above described do not accord with
the symptoms, are, ipecac., nux v.f carb. veg., rhus tox.,
stram.,phos., Itreosote, hyos.
For the troublesome sequela which sometimes fol
low scarlet fever, as dropsical affections, purulent
otorrh&a, deafness, furunculi, enlargements and suppu
ration of the glands of the neck, axilla, and groin,
appropriate remedies may be found in apis., mel., ars.,
dig., hellebore, sulph., hep., senega, cham., aur. mur.,
and mere.
Administration. — We most commonly employ the
first, second, and third attenuations ; but in young
and impressible children, we often resort to the higher
dilutions with the most satisfactory results. Some
cases are characterized from the commencement by a
high state of vascular and nervous excitement, while
others evince a loss of vascular and nervous power,
and a very low grade of impressibility. The propriety,
therefore, of the employment of both the high and
low attenuations, in different instances, is evident. If
dilutions are used, a drop may be given at a dose, in
FEBRILE CUTANEOUS DISEASES. 207
a drachm of water ; but if the triturations are select
ed, one grain is a suitable dose, given dry or in water.
We advise a frequent repetition of the dose until
decided changes arise from the remedy, or until we
are satisfied that it is not producing the required
effect upon the disordered structures.
SECTION II.
RUBEOLA. MEASLES.
Formerly, measles and scarlet fever were described
and treated as one and the same disease, the differ
ences which were observed in different cases being
ascribed to modifications originating from peculiari
ties of constitution, the state of the atmosphere, and
other accidental causes. About fifty years ago, how
ever, Withering, and several other writers, recognised
a distinction between them ; and measles, for the first
time, was accurately described and ranked as a dis
tinct malady.
As it generally occurs, it is unattended with danger,
unless interfered with by purgatives, emetics, and in
fusions. Fortunately, it is confined for the most part
to children, for when adults are the subjects of at
tack, it is far more severe and dangerous. Like scar
latina, one attack renders the subject secure against
any future operation of the contagion.
Diagnosis. — Tlfe precursory symptoms of measles
are similar to those of ordinary catarrhal fever : as
lassitude, chilliness, sneezing, coryza, red and watery
eyes, headache, nausea, slight soreness of the throat,
short, hoarse cough, pain and soreness in the chest ;
dyspnosa, heat, and thirst. These symptoms continue
with more or less severity for four or five days, when
the eruption makes its appearance, commencing at
the forehead, and proceeding gradually downwards to
the neck, breast, arms, body, and lower extremities.
About the period of the eruptive stage, there is usual
ly an increase of the febrile symptoms, which continue
for four or five days, when a bran-like scurf is cast
off from the surface, and the fever subsides. During
the fever, the cough is often very trublesome, and
sometimes terminates in inflammation of the bronchia
208 FEBRILE CUTANEOUS DISEASES.
or lungs. Schroen thus describes the malady : "Small,
scattered, red spots, in the centre of which we ge
nerally find a small pimple. These spots soon be
come confluent, and spread over the whole body, after
being preceded by catarrhal fever, for three or four
days, attended with redness of the mucous membrane
of the mouth, with cough, catarrh, dread of light, and
flow of tears. They disappear upon pressure, and
develope themselves again from the centre towards
the periphery, after the pressure is removed. The
pimple becomes a small yellow prominence in the
course of sixteen hours, when a scurfy desquamation
commences."
The attentive observer will have no difficulty in
distinguishing this malady from scarlatina, by the
following marks of difference : the primary symptoms
of measles are red and watery eyes, sneezing, fluent
coryza, short cough and some hoarseness. These
signs, which are almost uniformly present in this dis
ease, are usually wanting in scarlet fever. In the
general character and appearance of the eruption also
there is a marked difference. The scarlatina rash is
composed of innumerable fine pimples, resembling in
appearance the shell of a boiled lobster, uniformly
diffused over the surface, and of a bright scarlet colour.
The eruption of measles appears in spots (sometimes
papular) resembling flea-bites, which run together and
form semi-lunar patches. There iS a roughness or
elevation where the eruption exists, perceptible to the
touch : and which is not usually observed in scar
latina. But one of the best marks of distinction is the
difference in the colour of the rash, that of measles
being a purplish, or darkish scarlet, while that of
scarlet fever is a light scarlet.
Measles is a disease which, under different circum
stances, assumes a great variety of forms, both as to
its general character and violence. During some
seasons it prevails as a mild and simple affection, re
quiring little or no treatment ; while at other periods
it assumes a highly inflammatory, congestive, or
typhous character. Sometimes almost all cases seem
to have a tendency to run on to pneumonia ; at other
times cerebral or typhoid symptoms predominate ; in
FEBRILE CUTANEOUS DISEASES. 209
still other instances, gastric disorder prevails ; but in
the great mass of cases, the malady is mild and trac
table.
In contemplating the numerous varieties of this, as
well as of most other diseases, the impartial physician
must acknowledge the utter uncertainty and empyri-
cism of prescriptions guided only by the name of a
disease.
Causes. — In common with the other contagious dis
orders, measles arises from a specific morbific conta
gion. This has been amply proved by Home, Dewees,
Speranza, and Majendie, who, in numerous instances,
succeeded in communicating this affection by inocu
lation. The season of the year, the condition of the
atmosphere, and the peculiar circumstances of the
individuals exposed, exercise a powerful and perhaps
controlling influence, in determining the character of
the epidemic. When measles prevail during seasons
of influenza, typhus, or dysentery, the disease will par
take of the peculiar character of the existing epidemic,
and its course be modified accordingly.
Therapeutics. — The most common medicines in the
treatment of measles, are, aeon., andpuls. : next in im
portance stand bry., bell., ipecac., mere., sulph., cup. ac.9
rhus, ac., phos., ars., cham., fyc.
Schroen recognises five different varieties of measles,
founded upon the characteristic symptoms present in
each given case : viz., first, the simple or ercthistic, in
which aconite is the appropriate remedy ; second, the
inflammatory, requiring the use of aconite, bryonia, and
belladonna ; third, the gastric, demanding the employ
ment of pulsatilla, cliamomela, ipecacuanha, and vera-
trum ; fourth, the typhus, or irregular, calling for rhus
tox., china, nux vom., and belladonna ; fifth, the septic, or
malignant, corresponding with acid, phos., acid, sulph.,
acid, mur., opii, and arsenicum.
At the commencement of an attack, when heat,
thirst, quick pulse, red, inflamed, and watery eyes,
sneezing, fluent coryza, cough, dyspnoea, oppression at
the chest, and sore throat are present, aconite at the
third potency is the most suitable remedy. So long
as the disease progresses mildly, running through its
regular stages in due form, no other medicine will be
210 FEBRILE CUTANEOUS DISEASE?!.
requisite to complete the cure. Even in those com
plications which call for the use of other medicines,
as pneumonia, croup, cerebral or gastric disturbance,
whether occurring before, during, or subsequent to the
eruption, should the inflammatory excitement run
high, aconite will still be required. Its repetition
must, of course, be subject to the circumstances of
each particular case.
When there exists a predominance of catarrhal
symptoms, and a tardiness in the appearance of the
eruption, we have an appropriate remedy in pulsatilla.
This medicine may often succeed aconite with peculiar
advantage in the catarrhal forms of more than ordinary
severity. In these cases, some writers claim for this
agent important prophylactic properties. It is also a
valuable in retrocession of measles, attended with one
or more of the following symptoms : hoarseness, swell
ing of the parotids, puffiness of the face, pain in the
ears, discharges from the ears, hardness of hearing,
dry short cough, great restlessness, pains in the head,
back, and loins, and mu(5ous diarrhosa.
Dr. Croserio believes pulsatilla to be especially
adapted to measles, not only as a remedy, but as a
prophylactic. He asserts that " it is to this disease,
almost what belladonna is to scarlet fever. The pre
cursory symptoms of measles accord perfectly with
the febrile symptoms of pulsatilla, viz., chills, heat,
lassitude, throbbing pains in the head, anxiety, nausea,
vomiting of bile or glairy mucus, violent coryza, red
eyes, lachrymation, photophobia, &c. Then follow
pricking of the skin, red spots like flea-bites, excoria
tion and creeping in the throat, difficult deglutition,
dry, fatiguing cough, epistaxis, &c. If given in the
precursoiy stage, I have often seen the disease termi
nate in abundant perspiration in twenty- four hours."
Belladonna is indicated when the throat is much
inflamed and swollen, with very painful and difficult
deglutition, short, hacking, throat cough, inflamed
eyes, nervous, uneasy and sometimes delirious, hurried
respiration, headache, intense thirst, dry hot skin, and
signs of cerebral disturbance. It has likewise been
recommended in cases of sudden disappearance of the
eruption after having been out one or two days.
FEBRILE CUTANEOUS DISEASES. 211
" When the eruption suddenly disappears and is
succeeded by fever, violent headache and breathless-
ness, great benefit will be derived from the adminis
tration of aconite and arsenicum alternately ; and
afterwards, when the head appears to be the chief
point of attack, indicated by excruciating headache,
screaming or moaning during the night, belladonna and
cuprum aceticum, repeated every hour or two, will
afford marked relief." — (British Jour, of Horn., No.
xxiv., p. 232.)
Bryonia will apply in cases attended with marked
pectoral symptoms, like stitches or darting pains in the
side and chest, anxious, sighing, difficult and painful
respiration, and very great general uneasiness.
Hartmann says, that bryonia " is also a powerful rem
edy in retrocessent measles, in reproducing the eruption
on the surface, or in rendering its disappearance
harmless. In these cases I give bryonia in the fifteenth
dilution, and notice that it is chiefly indicated, if after
the retrocession of the eruption, a morbid affection of
the eyes supervenes, which resembles that which I
lately noticed when speaking of ophthalmia."
Ipecacuanha should be administered when there is
gastric disorder, indicated by nausea, vomiting, pain
and oppression in the stomach, and inability to retain
food or drinks.
For the ulcers which sometimes form in the mouth
and throat, also the glandular swellings which occur
in the neck, mercurius is a valuable specific.
As a remedy for the restoration of retrocessent mea
sles, as well as for the inflammatory affections of the
eyes, which now and then remain as sequela of this
malady, sulphur is sometimes a remedy of the highest
importance. Many cases, after having apparently
ran their courses in a mild and regular manner, leave
the patient with some annoying dreg, like discharges
from the ears, weak eyes, eruptions of various kinds,
or chronic cough, with profuse expectoration, which
are attributable to somemiasm which has been roused
during the course of the disease. For the cure of cases
of this description, sulphur is an indispensable agent.
We occasionally meet with nervous or typhoid
symptoms which render the use of ars., rhus tox., strain..
212 FEBRILE CUTANEOUS DISEASES.
op., and phos. necessary. Whatever symptoms present
themselves, the judicious physician will be able to se
lect from the great number of medicines of which the
pure effects are known, those that are precisely
homoBopathic to the malady.
Administration. — In cases of children, we employ
from the third to the sixth attenuations ; and in those
of adults, from the first to the third. Our repetitions
must be governed by the nature of the case, and the
effects produced by the medicine.
SECTION III.
VARIOLA. SMALLPOX.
Two varieties of this disease have generally been
recognised by pathologists ; one termed distinct and
the other confluent. The former is more mild and less
dangerous than the latter, being attended with less se
vere constitutional disturbance, and having detached,
distinct, and fewer pustules, which are surrounded by a
pale red areola. The confluent variety, by the pus
tules running together and meeting each other, pre
sents the appearance of a uniform and homogeneous
swelling, from which it has derived its name.
Diagnosis. — Smallpox may, with propriety, be di
vided into the following stages or periods, viz. : 1, the
primary fever ; 2, the eruptive stage ; 3, the maturing
period ; 4, the period of exsiccation.
The primary fever in the distinct variety is ushered
in with lassitude, rigours, pains in the head, back, and
loins, slight sore throat, soon followed by nausea and
vomiting, pain at the epigastrium, often severe, with ten
derness on pressure, hot and dry skin, thirst, scanty and
high-coloured urine ; these symptoms continue for
about three days, when there is a supervention of the
Eruptive stage. — The eruption first comes out in
small red spots or points, which, in the course of forty-
eight hours, become rounded into pimples with vesi
cles upon their tops and slight depressions in the cen
tre. They show themselves first upon the face, and
then in regular succession upon the scalp, neck, arms,
breast, body, and lower extremities, requiring about
twenty-four hours for the full development of the erup-
FEBRILE CUTANEOUS DISEASES. 213
tion. After this period, there is a marked remission
of all the febrile symptoms, which continues for three
or four days, when the
Maturing or suppurative period commences. There
is now a renewal of the febrile disturbance still more
violent than at first, which commonly continues during
the remaining course of the disease. This period con
tinues from three to five days, when the serous fluid
within the pustules acquires a purulent character,
becoming thick and yellow. On the tenth or eleventh
day, the pustules burst, giving vent to the matter
which collects upon the surface of the pock, forming
hard dark scabs or crusts, which in a few days fall off,
leaving the skin scurfy and sometimes pitted.
Now commences the period of exsiccation, which oc
cupies from three to five days ; after which, if the ma
lady has pursued a moderate course, the morbid symp
toms all subside, and convalescence ensues. Thus it
will be perceived, that the regular course of the dis
ease occupies about fifteen days ; this course, however,
is subject to modifications from a great variety of
causes, such as the supervention of pneumonia, bron
chitis, ophthalmia, abdominal inflammations, disease
of the glands, retrocession of the eruption, &c.
In the confluent variety, the primary fever is of a
more violent character, the eruptive period more irre
gular, usually commencing at the end of two days
from the onset of the malady ; there are often spas
modic twitchings of the muscles, at or previous to the
appearance of the pustules, the secondary or suppu
rative fever frequently assumes a typhoid form, saliva
tion occurs about the period of the eruption, after
which the tongue, mouth and throat become dry and
dark, pocks form in the mouth, throat, larynx, pharynx,
rectum, and urethra, and occasionally symptoms mani
fest themselves which indicate a high degree of ma
lignancy. The face is often much swollen and dis
figured from the pustules running into each other, so
that the eyes become entirely closed, and the nostrils
obstructed. The matter of the pustules is of a dusky
colour, and is sometimes so acrid as to irritate the sur
rounding skin.
What has been denominated varioloid, is nothing:
214 FEBRILE CUTANEOUS DISEASES.
more or less than an exceedingly mild form of small
pox, modified by previous vaccination, or some other
accidental influence. The primary fever is very mild,
the eruption distributed over the body in patches, the
suppurating process slight and imperfect, attended
with little or no secondary fever.
Causes. — All agree that variola proceeds from a
specific morbific poison, sui generis. There are, how
ever, causes constantly in operation, which exert a
powerful influence in modifying or aggravating the
character of the malady, respecting the nature of
which, authors are not so well acquainted. At some
periods, smallpox is characterized by a high degree of
putridity, the symptoms assuming a low typhoid form,
and a majority of the cases proving speedily fatal in
spite of all remedial measures. At other seasons we
may have a predominance of pulmonary or cerebral
symptoms, attended with a high grade of synochal
fever, and requiring a very different course of treat
ment from the form above mentioned. Again it may
run its course in a regular and moderate manner,
without serious complication from disturbance of any
capital organ, and demanding but little aid from re
medial agents.
Some writers have supposed that these different
modifications were owing to certain occult condi
tions in the atmosphere, and also tha,t the existence
at the same time of other epidemics, has a material
influence over the character and progress of small
pox. This is doubtless true ; but there are other
causes more under our control, which are of no less
importance, as predisposing agents to the more vio
lent forms of the malady. The most prominent of
these, are, small and ill-ventilated dwellings, a lack
of healthy and nutritious food, want of cleanliness,
insufficient clothing, immoderate use of ales, and im
pure liquors, and the pernicious custom of crowding
together in the same apartments, a number of indi
viduals, who thus inhale, a good part of. the time, a
vitiated and unhealthy air.
The fatality of the disorder, when it seizes upon
this degraded class, indicates the importance of the
influences fust, enumerated, in aggravating the char-
FEBRILE CUTANEOUS DISEASES. 215
acter of the malady. Does it not, then, behoove the
guardians of the public health, during the prevalence
of contagious affections, to look well to these dele
terious agencies, and purge their towns of the filth,
the dissipation, and the other corruptions of these
hot-beds of contagion ?
Therapeutics. — The following are the ordinary me
dicines used in the treatment of smallpox, namely,
aconite, belladonna, rhus tox., vaccinin, variolin, sulphur,
opium, mercurius, bryonia, pulsatilla, nux vom., carbo
veg., arsenicum.
Aconite, second or third dilution, is the proper me
dicine during the primary fever, provided the attack
is regular, and there exists no tendency to inflamma
tion or congestion of any important organ.
In case the eruption is slow in making its appear
ance, or the process should be attended with great in
ternal oppression, either rhus or sulphur, at the third
attenuation, may be exhibited — a dose every three or
four hours.
Belladonna is the specific, when, during any part
of the malady, inflammation or congestion attacks
the brain. In cases of this description, this remedy
exercises a two-fold effect ; first, by its special action
upon the cerebral organs, and second, by its power of
forcing and of retaining the eruption upon the sur
face. The third dilution may be used in these in
stances — one drop every two hours until amelioration
of the symptoms is evident.
Dr. Liedbeck of Stockholm considers tart, antim.
our most valuable remedy in smallpox. When taken
in large doses, it produces dryness, heat and redness
in the throat, internal eruptions, large pustules (with
depressions in their centres) in the mouth, throat, la
rynx, and trachea : therefore, Dr. L. infers, that " it
is as much the specific remedy for the smallpox, ac
cording to homoeopathic principles, as mercury is that
for syphilis." The second trituration may be used —
one grain every two to six hours, as circumstances re
quire.
Sulphur at the commencement of the attack, and
about the period of desiccation, will often prove ex
ceedingly serviceable in determining: the eruption to
216 FEBRILE CUTANEOUS DISEASES.
the surface, and in disposing it to progress kindly. In
individuals who suffer from a psoric taint, it cannot
well be dispensed with. It may be administered at
the third trituration, in grain doses, and repeated
sufficiently often to ensure the kindly progress of the
eruption.
Vaccinin and variolin have been highly extolled
within the past three or four years, as a remedy in
all stages of this affection. It is said, that, by the
use of these agents, variola is rendered a very mild
and harmless disease. It is claimed by those who
have made considerable use of them, that all of the
stages of the malady are shortened in duration, and
that a majority of the cases thus treated, resemble
varioloid more than real smallpox. These medicines
may be used in the form of trituration, of the third
attenuation.
Bryonia will be called for if pneumonic symptoms
obtain. This remedy will also prove serviceable in
typhoid forms, attended with gastric or biliary de
rangements.
Bryonia may be administered in mild cases, at the
third dilution, and in. severe congestive forms at the
first — a drop every two or three hours in water.
Mcrcurius viv., third trituration, should be admin
istered, if salivation, ulcerated throat, or diarrhoea
with bloody stools, and tenesmus, occur. It is also a
remedy of value during the suppurative stage, and in
the ophthalmias which often accompany and succeed
the variolous attack.
Opium, at the third dilution, will always be appro
priate whenever coma, and nervous sensibility, ster
torous respiration, convulsive movements, and im
paired muscular action supervene during the progress
of the malady.
In cases of great malignancy, with a gangrenous
tendency, and other symptoms evincing a low typhus
grade, carlo veg., acid, nit., acid, mur., or arsenicum,
may prove serviceable when all hopes from other
remedies have been abandoned. From the first to
the third attenuations should be employed in these
instances. The age, sex, temperament, and the pe-
FEBRILE CUTANEOUS DISEASES. 217
culiar circumstances connected with each particular
case, must determine the proper strength of the medi
cine and the frequency of its repetition.
SECTION IV,
VARICELLA. CHICKENPOX.
Diagnosis. — There are a few points of similarity
between the milder cases of smallpox and the more
severe forms of varicella, which require an acute ob
server to discriminate between them during the early
part of an attack. Both diseases commence with a
similar primary fever, which continues until the erup
tion makes its appearance ; the pustules in both in
stances resemble each other ; both are likewise conta
gious, and communicable by inoculation.
At the eruptive period, however, an attentive ob
server will perceive that the resemblance usually
ceases, for the pustules of variola make their appear
ance in a uniform manner, first on the face, then suc
cessively upon the neck, arms, breast, body, and lower
extremities, occupying* usually but twenty-four hours
for the completion of the eruption, while the pustules
of varicella come out in repeated series, first upon
the breast, then upon the* face, head, arms, body, and
lower extremities, and require three or four days
before the eruption is complete. Therefore, we often
observe during the progress of the latter, some vesi
cles drying up, some in a state of partial development,
while others are but making their first appearance.
The vesicles of chickenpox contain a whitish or yel
lowish lymph, which seldom advances far towards
the suppurating stage ; and even in those cases where
pus is formed, there is never any secondary or suppu-
rative fever, as in variola.
Causes. — Varicella, like the other contagious dis
orders, is a distinct affection, and proceeds from a
peculiar specific cause. This is apparent, from the
fact that inoculation with varicellous matter never
gives rise to any other malady than varicella itself.
It is not only a much milder disease than smallpox,
or varioloid, but is of much shorter duration, running
10
218 FEBRILE CUTANEOUS DISEASES.
its course generally in six or seven days, when the
pocks all disappear, leaving smooth surfaces.
Therapeutics. — Varicella, as it commonly occurs,
requires no medicinal treatment: a due regard to diet,
and avoidance of exposure to cold, dampness, &c.,
being only necessary to ensure its safe progress.
In cases where the malady assumes unusual sever
ity, manifested by a high grade of febrile excitement,
determinations of blood to the brain, lungs, or abdom
inal organs, then the medicines which are homoeo
pathic to the existing symptoms may be administered.
The remedies which have been most frequently
used in these cases, are, aeon., caff., bell., mere., rhus
tox., and sulph. The strength of the medicines, as
well as the repetitions of doses, the same- as under
modified smallpox.
SECTION V.
MILIARIA. MILIARY FEVER.
Diagnosis. — This disease is ushered in with lassi
tude, slight creeping chills, pain in the loins and lower
extremities, oppression at the precordia, cough, gene
ral uneasiness, more or less heat and thirst, rapid
pulse, and high-coloured urine. These precursory
symptoms continue about fiv% days, when a very fine
eruption, resembling millet seeds, makes its appear
ance on different parts of the body. The little vesi
cles which compose this eruption are round, hard, and
transparent, becoming after a time opaque. As they
are about coming out, there is an itching, stinging,
and burning sensation in the skin, the oppression at
the chest and stomach is increased in severity, and, in
general, a profuse perspiration of a disagreeable, sour
odour, breaks out over the whole surface. After two
or three days the vesicles become opaque, then soon
dry up and fall off in the form of scurf.
Some writers consider miliary fever as a purely
symptomatic affection, while others, with equal tenaci
ty, maintain that it often occurs idiopathically. Ac
cording to my own opinion, it is not at all improbable
that it may be dependent upon some latent miasm,
which only requires an exciting cause, like puerperal
FEBRILE CUTANEOUS DISEASES. 219
fever, heating and stimulating ptisans, undue expo
sure in heated and close rooms, &c., to call it into
action. I am confirmed in this opinion from the fact,
that in nearly every case with which I have been
made acquainted, where the eruption has retroceded,
whether by improper use of external lotions, or other
wise, there has been a supervention of some serious
internal disorder.
If this view of the cause of the malady be correct,
the therapeutical indications are evident, and the pru
dent physician will use every effort which our specific
medicines afford, to aid nature in casting off the poi
son from the system through the medium of the skin.
Therapeutics. — In conjunction with our internal
remedies, it is essential that the patient be kept in a
dry apartment, of uniform temperature, and be con
fined to a strict dietetic regimen. By these means,
we shall prevent the retrocession of the rash from
the sudden application of external cold, and avoid
those unpleasant complications which errors in diet
are so apt to induce.
A strict adherence to the above rules, with an oc
casional dose of aconite, third dilution, will generally
suffice for the cure of this complaint.
After the eruption has manifested itself, if the pa
tient is troubled with a train of nervous symptoms,
like sleeplessness, general uneasiness, partial loss of
power over the voluntary muscles, spasmodic twitch-
ings, and constant desire to change position, a dose of
the sixth dilution of hyoscyamus may be given, and
repeated as circumstances require.
Should the brain become affected in any stage of
the disease, belladonna may be exhibited in the same
manner as advised under measles.
Chamomela, at the tenth potency, should always be
administered when infants and children are the sub
jects of attack. If the malady commences with strong
febrile excitement, this medicine may be preceded by
aconite.
Bryonia is also highly recommended in cases of
miliaria in infants and parturient women. It may be
administered in the same manner as bell.
Ipecacuanha will apply when the eruption is ac-
220 FEBRILE CUTANEOUS DISEASES.
companied with laborious and noisy respiration, nau
sea, or vomiting, groaning, aversion to food, chilli
ness, alternating with flashes of heat, and sweet, in
sipid taste. The third trituration should be employed
— one grain every four or six hours until the symp
toms yield.
SECTION VI.
ROSEOLA.
Diagnosis. — This is one of the mildest and least
dangerous of all the eruptive fevers. It is character
ized by an eruption or efflorescence of a rose colour,
preceded and accompanied by some slight symptoms
of febrile disturbance. The rash shows itself on the
third or fourth day of the fever, and comes out in dis
tinct and irregular spots upon different parts of the
surface, or the spots run together, giving to the skin
an almost uniform redness. The cuticle is neither
elevated, nor is there any appearance of papulae ;
but a simple blush of a rose colour, characterizes the
eruption, and serves as a mark of distinction between
it and that of other diseases of this kind. The appear
ance of the rash is often attended with itching and
tingling, which are present more or less until the erup
tion vanishes, which is usually in five or six days, with
out desquamation of the cuticle or any unpleasant
after symptoms.
Causes. — Roseola is for the most part confined to in
fants and females. It arises from undue exposure to
cold, after having been confined in a warm room, in
digestible food, dentition, gastro-intestinal irritation,
and the abuse of stimulating infusions, cathartics, &c.
Therapeutics. — Rigid dietetic regulations, a moder
ate, dry, and equal temperature, mental and physical
rest and quietness, and an entire exclusion of all " herb
teas," and such other " domestic remedies," so called,
as are commonly suggested by the officious ignorance
of old women. A regard to these rules will suffice to
secure the patient from any ill consequence of this na
turally mild and simple affection.
FEBRILE CUTANEOUS DISEASES. 221
SECTION VII.
URTICARIA. NETTLE RASH.
Diagnosis. — The primary symptoms of urticaria are,
languor, oppression, and sickness at stomach, foul
tongue, bitter taste, giddiness, creeping chills, succeeded
by preternatural heat of skin and thirst. During the
early period of the disease, elevated, circular, and
florid spots or weals, each with a whitish spot or point
in its centre, appear, sometimes in only one part of the
body, at other times generally diffused over the whole
surface. These weals are attended with an exceed
ingly annoying itching, stinging, and burning sensa
tion, somewhat resembling the stings of nettles. The
itching, as well as the febrile excitement, is always
worse in the evening or during the night ; but when
the eruption is upon the surface, the nausea and dis
tress at the stomach abate, and do not return until
another eruptive period, unless there is a sudden re
trocession of the weals.
In some instances the eruption appears suddenly
without any febrile or other premonitory symptoms,
and without any apparent exciting cause. At other
times, certain articles of food, like shell-fish, porgies,
esculent vegetables, acid fruits, or stimulants like wine,
spirits, hot ptisans, condiments, or frictions upon the
skin, seem to become its exciting causes. It usually
terminates in a few days, but now and then it persists
many months, sometimes apparent upon the skin, at
others suppressed.
" Its sudden disappearance without leaving a trace
behind, and its equally sudden reappearance, are quite
characteristic. Inclination is also present in all the
varieties of this disease, and vomiting frequently oc
curs as a crisis." — (Schrocn.)
Some nosologists have divided this malady into two,
and some into four varieties ; and others, like Bate-
man, and a few of the older writers, have gone so far
as to recognise and describe seven : but these fine and
arbitrary distinctions are not founded in nature, and
therefore offer no aid in diagnosis ; while, on the other
hand, there is danger that they may confuse and em-
222 FEBRILE CUTANEOUS DISEASES.
barrass the inexperienced practitioner. We know that
the eruption is very irregular in regard to the periods
of its appearance, and also in the size, form, general
aspect, and diffusion of the weals, yet, we see no neces
sity for complicating our classification with so many
varieties, for we might with as much propriety go
on with divisions, adinfinitum, as to stop after having
described six or seven genera, since the most acute
nosologist will scarcely be able to discover any two
cases presenting precisely the same symptoms in all
respects.
If, however, we were to adopt any classification, it
would be that of Schroen, who distinguishes two forms
of the malady, the acute and the chronic. Under the first
form, he includes : first, urticaria maculosa, or spots of
different degrees of redness, attended with sensation of
formication and intense itching ; second, urticaria vesi-
cularis, or vesicular prominences,with empty and almost
transparent apices ; third, urticaria tuberosa, or hard,
tense, and painful tuberosities, generally appearing in
the night. Amongst the chronic varieties, he ranks urti
caria evanida, resembling the urticaria tuberosa, ap
pearing on exposure to cold, and disappearing on the
application of warmth. This variety sometimes con
tinues for weeks, and even months.
Causes. — We entertain the opinion that the remote
cause of nettle rash consists of a specific miasm,
either generated within the organism, or introduced
from without, and which is liable to be roused into
action by numerous exciting causes. The proofs of
this are numerous, and we think satisfactory ; for if it
were merely an effect or symptom of one of the various
exciting causes, like indigestible food, certain kinds of
fish, acid fruits, vegetables, wines, liquors, &c., it would
disappear as soon as the exciting cause wras with
drawn, and all irritation from this source obviated ;
but in very many instances no such result takes place,
and after the noxious article has been entirely re
moved, and the part previously deranged restored to its
usual normal condition, there is a persistence of the
urticaria for months, and even years ; it appearing and
disappearing at frequent intervals, without the slight
est apparent reason.
FEBRILE CUTANEOUS DISEASES. 223
Another fact which sustains the position we have
advanced, is, that if the eruption be suddenly repelled
by the use of lotions, or cathartics, serious internal
disorders frequently supervene as a consequence of
the retrocession, which terminate, if the weals are not
reproduced either spontaneously or artificially, in disso
lution. A painful case, illustrative of this position,
came under my observation a few years since. The
patient was a lovely and highly interesting young
lady, who from some slight exciting cause was af
flicted with urticaria, although previously she had re
mained for many years in excellent health. The
malady annoyed her by turns for more than three
months, when, from the application of a lead-water
lotion, the external symptoms suddenly vanished,
leaving in their place wandering pains in the chest
and side, some cough, fits of oppression at the chest,
and difficulty of breathing. These symptoms of pul
monary disturbance continued to increase until she
was pronounced by two eminent physicians of a
neighbouring city to be past cure, with tubercular
consumption. About this period the case came under
my charge, in what seemed to be the last stages of
consumption, Notwithstanding, however, the un
promising condition of affairs, my patient slowly but
gradually recruited, so that in six or seven months the
abscess which had existed in one lobe of her lungs
was healed, and the lungs, with her whole system,
were restored to a comparatively sound and healthy
state. In this condition she continued for nearly two
years, when a second attack of urticaria supervened,
affording still farther relief for a few days, from all
remaining difficulties, when the rash permanently
disappeared. From this time her symptoms were all
aggravated, her old complaints returned, the lungs
became again ulcerated, so that in a few months the
malady advanced to a fatal termination. Is this an
isolated instance ? Without doubt, the experience of
almost every physician could furnish one or more
cases of the same description.
This example offers conclusive proof to my own
mind, that an intimate connection existed between the
two diseases, and that whenever the rash was upon
FEBRILE CUTANEOUS DISEASES.
the surface, nothing disturbed the lungs ; while the
moment retrocession ensued, pulmonary symptoms
manifested themselves. If urticaria is a purely local
disease, depending upon a distention or spasm of the
extreme cutaneous vessels, how can the suppression of
such local inflammation affect so seriously internal
organs ?
It must be confessed, that our knowledge respecting
the causes and intimate nature of cutaneous affec
tions, is at present quite limited ; but when we take
into consideration the fact that so many internal con
stitutional maladies take their exit through the sur
face in the form of eruption, we are constrained to
believe that this is almost uniformly only a symptom
of some internal constitutional disorder.
Therapeutics. — As it is of the first importance in all
cutaneous diseases, that the eruption should be urged
and retained upon the surface, in order that the miasrn
may not fall upon any vital organ, we should select
our remedies chiefly from those which exercise a spe
cific action upon the skin.
Another point of no less importance in the manage
ment of eruptive fevers, consists in securing for the
patient a dry, moderate, and equable temperature.
This precaution, combined with cleanliness, and a
placid and composed frame of mind, will always aid
us materially in our therapeutical measures.
The medicines which are the most appropriate for
the treatment of this complaint are, aeon., sulph., dulc.,
rhus., calc., carb., lycop., nat. mur., acid, nit., puls.,
ignat., ipecac.
Aconite will only be required in those cases which
are attended with undue febrile action. It may be
administered as advised, under measles.
Sulphur. — This medicine should always be prescrib
ed in cases occurring in individuals of a marked scro
fulous dyscrasia, when the following symptoms obtain.
External Indications. — General appearance of debi
lity ; pale, sallow, and sickly expression of face ; red
ness of the margins of the eyelids ; swellings of the
glands of the neck.
Physical Sensations. — Eruption and violent itchings
occurring in the night, from the heat of the bed, and
FEBRILE CUTANEOtTS DISEASES. 225
occasionally from exposure to cold air ; great sensi
tiveness to cold ; dizziness and pains in the head ;
spasmodic twitchings of the eyelids ; bad taste in the
mouth ; nausea ; pyrosis ; weakness and oppression
at the chest.
Mental and moral symptoms. — Melancholy ; sadness ;
irritability.
Administration. — One grain of the third trituration
in two ounces of distilled water, — a dessert spoonful
once in twelve hours.
Dulcamara is useful in urticaria, which proceeds
from taking cold, and is attended with nausea, vomit
ing, oppression at the stomach, heat of skin, thirst,
bitter taste, diarrhoea, and great general uneasiness.
The symptoms are aggravated at night, during repose,
and by the heat of a room ; but they disappear in the
open air.
Administration. — A drop of the third dilution, in a
small quantity of water, may be given once in six to
twelve hours.
Rhus tox. — Eruption, attended with itching and
burning during inaction, or on entering a room from
the open air ; disappearance of the weals, on exer
cise, followed by shifting rheumatic pains, pains and
pressure in the stomach, difficult respiration, short
breath in the evening, agitation and anguish. This
medicine is particularly applicable in urticaria vesi-
cularis.
Administration. — Same as dulcamara.
Calcarca carbonica is indicated in cases where the
rash vanishes on going into the fresh air, and excited
by the application of cold water : face yellow, upper
lip swollen, skin rough and covered with goose pim
ples, stunning lateral pains in the*head, with nausea
and vertigo at night, or in the morning, on waking,
with faintness ; anxiety, anguish, apprehension.
Remarks. — Calcarea carbonica is suitable in obsti
nate chronic urticaria, especially when occurring in
scrofulous or cachectic constitutions. It is sometimes
necessary to persist in the use of this remedy for
several weeks.
Administration. — A drop of the third dilution in an
ounce of water, — a dessert spoonful once or twice in
the twenty-four hours.
10*
226 FEBRILE CUTANEOUS DISEASES.
Lycopodium. — Rash and itching during repose, head
ache in the afternoon or at night, smarting of the eyes
by candle-light, nausea when in a hot room, relieved
in the air, silent and peevish.
Administration. — Same as calcarea carbonica,
Natrum mur., at the sixth potency, may be pre
scribed, when there are languor, uneasiness, nausea,
headache, weakness when lying down at night, re
lieved on rising in the morning, eruption coming out
after violent exercise.
Nitric acid, third dilution, will be proper for patients
of a consumptive or scrofulous habit, afflicted with
debilitating night sweats, weak, enfeebled, subject to
haemorrhages from the bowels, lungs, nose, &c., and
rash caused by exposure to cold air. A drop should
be prescribed two or three times daily.
Pulsatilla, sixth dilution, when the elevations are
redder than the skin, when the itching is of a burning
or pricking character, worse at night in bed, in a hot
room, or by scratching ; better in the open air ; worse
every other evening ; heaviness and disposition to
numbness in the limbs; great sensibility to the open air.
Ignatia, sixth dilution, is particularly adapted to
attacks occurring in nervous and hysterical females :
the eruption is brought out by exercise, and is often
preceded by nervous symptoms ; there is also fulness
and pressure of the head, with sparks before the eyes ;
also sighing, and irregular respirations.
Ipecacuanha, third trituration, is useful in cases at
tended with excessive vomiting, oppression at the
chest, and dyspnea ; it is also a valuable remedy in
asthma from suppressed urticarias.
Other remedies worthy of consideration are, arseni-
cum, balsam copaibce, iodine and bryonia in the chronic
forms ; and in the acute varieties, clematis, staphysagria,
and belladonna., for urticaria vesicularis ; urtica and
hepar sulphur, for urticaria tuberosa ; mercurius, iodine,
aurum mur. and sepia, for urticaria maculosa.
Administration.— The above remedies may be given
dissolved in pure water. They may be repeated in
six, eight, or twelve hours, according to the urgency of
the symptoms. In all cases of this description, where
a latent miasm is suspected to exist, a persevering and
judicious course of anti-psoric treatment, should be
FBBB1LB CtJTAlCEOffS DISEASES. 231
%
Causes. — There is much difference of opinion re
specting the causes of erysipelas. Some attribute it
to a local cutaneous vice ; some to a degeneration of
the blood in consequence of improper food, abuse of
stimulants, &c. ; some to a derangement of the biliary
organs ; some to atmospheric influences ; while others
entertain the opinion that it is dependent upon a pe
culiar dyscrasia which is constantly present as a pre
disposing cause. This opinion appears to us reason
able ; but whether this dyscrasia is in all instances
hereditary, or whether it may be acquired by intem
perance, unwholesome food, or from contaminated air,
we are as yet unable to determine.
The more common exciting causes of erysipelas
are, debility and loss of resisting power, from disease,
abuse of stimulants, violent emotions of the mind, un
due exposure to cold, certain states of the atmosphere,
accouchement, disordered stomach and bowels, confine
ment in close and crowded apartments, and wounds.
Eberle asserts that " the inflammation which is pro
duced by the recent leaves of the rhus toxicodendron,
is strictly of an erysipelatous character." This, how
ever, is an error, for although a close similarity exists
between the two inflammations, the careful observer
will be able to distinguish decided marks of differ
ence.
Therapeutics. — The important medicines in the
treatment of erysipelas, are, rhus toxicodendron, bella
donna, aconite, sulphur, opium, graph., arsenicum, carbo
vegetabilis, mere., phosphorus, pulsatilla, acid phospho
rus, acid nitric, sit, china, hep. sulph., lack., bryonia,
chamomela, clem., and euphorb.
Rhus toxicodendron. — External indications. — In
flammation confined to the skin ; numerous vesicular
blotches, attended with itching and burning sensation ;
swelling and redness of the face, worse in the eyelids,
around the eyes, and in the lobules of the ears, at
tended with burning and itching ; swelling in the
scalp ; erysipelatous inflammation of the scrotum in
new-born children ; distinct or confluent vesicles, con
taining an acrid, limpid, or yellowish fluid, with red
ness of the skin over the whole surface of the body ;
partial or entire closure of the eyelids ; swelling and
FfMJRJLE <2tTTAWGOUS
hardness of the alee nasi ; gangrenous ulcers ; hot
and dry skin ; rapid and full pulse ; urine small in
quantity, dark and turbid.
Physical sensations. — Burning, itching, and stinging
of the affected parts, aggravated by scratching ; irri
tation and sometimes excoriation of the skin from con
tact of the vesicular discharge ; the itching and burn
ing sensations worse in the evening ; stiffness and
sense of immobility in the swollen parts ; bruised feel
ing in the limbs and back ; general sensation of heat,
both externally and internally, occasionally interrupted
by slight rigours ; mouth filled with saliva, or dry,
with or without thirst ; dryness and obstruction of the
nose, relieved by drafts of cold air, or by being fan
ned ; painful pulsations in the internal ears, when
resting on the affected side ; scalp swollen and painful
to the touch ; eyes painful on motion ; dull heavy pain
in the head, aggravated by motion or stooping.
Mental and moral symptoms. — Obtuseness of intel
lect, stupefaction, and weakness of memory ; sadness,
anxiety, and despondency towards evening, and during
the night ; nightly delirium.
Administration. — A drop of the second or third di
lution in water, once in two to four hoars.
Remarks. — Ruoff and Schroen consider rhus particu
larly applicable in vesicular erysipelas which is con
fined to the skin ; but if symptoms indicative of se
rious cerebral disorder are present, they prefer bella
donna. It has been used with success in infantile
erysipelas.
Belladonna. — External indications. — Skin swollen,
red, hot, and painful ; cheeks, eyelids, nose, lips, and
forehead, swollen, tense, shining, and painful to the
touch ; eyes red, prominent, and glistening, or dull and
cloudy ; pupils dilated or contracted ; whole head
swollen and painful ; obstruction of the nostrils ; in
flammation and enlargement of the parotid glands ;
hardness of hearing ; redness and swelling of the
tonsils and throat; urine scanty, dark, yellow, or
reddish, clear or turbid ; vesicular inflammation, with
intense febrile excitement ; tongue and lips dry ; sor-
des upon the teeth ; occasionally spasms, tremblings,
and rigidity of the limbs ; pulse generally full and
quick.
FEBRILE CUTANEOUS DISEASES.
Physical sensations. — Tension and pressure, or
sharp, throbbing pains in the head ; scalp very pain
ful, especially on pressure ; violent heat and burning:
of the inflamed parts ; dryness, smarting, or burning
of the eyes ; disordered vision ; stitching and throb
bing pains in the ears, both externally and internally ;
roaring and humming in the ears : mouth and throat
dry, hot, and painful ; sticking and burning sensation
in the throat when swallowing ; aversion to food and
drinks, or violent thirst for cold drinks ; bad taste in
the mouth, bitter eructations, and other signs showing-
biliary and gastric derangement ; short, anxious, and
difficult inspirations ; great weariness and uneasiness ;
pains worse in the afternoon and at night, and ag
gravated by contact or movement.
Mental and moral symptoms. — Vertigo, confusion of
ideas, or loss of consciousness, or delirium, violent at
night, but moderate during the day ; or melancholy,
despondent, and apathetic.
Administration. — A drop of the third dilution in
water every two or three hours, according to the
severity of the symptoms.
Remarks. — It was chiefly from the employment of
belladonna and aconite, that Listen produced the suc
cessful results in the North London Hospital, and in
private practice, to which we have already alluded.
We believe it to be our most valuable remedy in those
cases which have been excited by intemperance and
violent emotions of the mind. It is applicable also in
nearly all cases of erysipelas \vhere there exists pro
minent cerebral disorder. In these cases, should it
not cover all of the important symptoms, we may give
some other appropriate medicine in alternation.
Whenever febrile symptoms are strongly pro
nounced, and there exists a decidedly augmented ac
tion of the circulatory vessels, aconite will be required,
either alone or in alternation with some other remedy.
It should be used in the first, second, or third dilutions
— a drop in water as often as the exigencies of the
case may demand.
Opium is indicated in those cases which supervene
during pneumonia, typhoid, and other fevers, and pre
sent the following signs : profound coma ; stertorous
234 FEBRILE CUTANEOUS DISEASES.
respiration ; eyes dull and watery ; pupils dilated and
immovable ; general appearance stupid and besotted ;
spasmodic motions in different parts of the body ;
pulse slow and feeble, or slow, intermittent, and full ;
inability to rouse the patient. The second or third
dilution may be employed — a drop every half hour
until an impression is produced.
When ulcers have formed, and there is a disposition
to gangrenous degeneration, we must refer to ars.,
carb., veg., sulph., lack., euphorb., sil, clam., acid., nit.
and acid phos.
In erysipelas phlegmonodes, when the inflammation
is extending into the cellular tissue, our best remedies
are bell., graph., hep-sulph., mere., phos., sil., and
sulph.
If the inflammation exhibits a tendency to shift from
place to place, and is attended with gastric or intesti
nal derangement, and constantly shifting pains, pulsa-
tilla will prove specific.
Bryonia has been strongly recommended when the
inflammation takes place about the joints, and is ac
companied by rheumatic pains.
China will often prove serviceable during convales
cence from severe and protracted attacks, when the
energies of the system have been exhausted, and
there is great irritability of the nervous system. Some
of the signs which point to this medicine, are emacia
tion, osdema of the limbs, deficiency of animal heat,
pale countenance, great debility, ringing in the ears,
disturbed sleep.
External applications to the affected surfaces, in the
form of blisters, and of nit. of silver, have sometimes
been employed with success by gentlemen of the old
school, and as they are in accordance with our prin
ciple of cure, it becomes us to give them all due atten
tion.
Respecting the administration of the remedies above
enumerated, we suggest, as a general rule, the em
ployment of the first, second, and third attenuations ;
but in cases of infants and young children, we may go
up to the tenth or twelfth dilution. In acute cases,
the dose should be repeated once in two to four hours ;
but in the chronic varieties, two or three times daily
will suffice.
FEBRILE CUTANEOUS DISEASES. 235
SECTION IX.
THE PLAGUE.
The plague is said to resemble in many respects
malignant typhus ; the only phenomena which serve
to distinguish it from this fever, being the numerous
buboes and carbuncles which appear on the body.
By many it is supposed to be really nothing more or
less than a genuine typhus fever, rendered peculiarly
putrid and malignant by the atmospheric and other
influences which prevail in Egypt and the other orien
tal nations in which it has prevailed. As in the worst
grades of typhus, maculae, petechiae, diarrhoea, haemor
rhages from the bowels, &c., generally supervene in
the advanced stages of the disorder, in addition to the
buboes and carbuncles.
Our knowledge in relation to this disease is so
limited, it being derived solely from the imperfect de
scriptions we have seen, by other writers, that no at
tempt will here be made to detail its symptoms. But
if we may be allowed to judge of its nature from those
phenomena which seem to be characteristic, we sup
pose the following remedies will correspond with its
manifestations, and prove to it homosopathic, namely :
arsen., acid nit., rhus tox., veratrum, mere., bell, chin.,
ipecac., carb. veg.
236
CHAPTER XXI.
OF THE CHRONIC CUTANEOUS DISEASES.
VESICULAR VARIETIES.
SECTION X.
HERPES TETTER.
Diagnosis. — The eruption consists of groups of small
vesicles, situated upon red and inflamed bases, and
separated from each other by sound portions of skin.
As the vesicles increase in size, the colourless fluid
which they contained in the first instance, becomes
gradually opaque, and in two or three weeks dries up
into thin crusts which scale off. When the eruption
makes its appearance, there is an unpleasant burning
and crawling sensation, which soon settles into a deep-
seated, and in some cases, severe pain. It may be
confined to a single point, or extend, in clusters of dif
ferent sizes, over a large surface.
Another variety of tetter, is often observed to com
mence in the form of broad and irregular clusters of
small vesicles, sometimes seated on swollen and in
flamed bases, and shortly becoming confluent ; or the
eruption may appear in distinct groups and unattend
ed with any inflammation or swelling of the surround
ing skin. In the first form, when the inflammation is
somewhat active, the vesicles often burst and dis
charge their contents, leaving troublesome ulcers at
their bases. This variety is sometimes described under
the term eczema, or humid tetter.
According to Bateman, most kinds of herpes pass
through a " regular course of increase, maturation,
and decline, and terminate in about ten, twelve, or
fourteen days. The eruption is preceded, when it is ex
tensive, by considerable constitutional disorder, and is
accompanied by a sensation of heat and tingling, and
sometimes by severe pains in the parts affected."
Herpes has been subdivided into many different spe
cies, on account of presenting some points of distinc
tion when attacking different parts of the body.
THE CHRONIC CUTANEOUS DISEASES, ETC. 237
Thus, when the vesicles appear upon the lips during
colds, fevers, and inflammations of the mucous mem
branes of the pulmonary or digestive apparatus, the
disease is termed herpes labialis. The eruption in this
instance, is usually of a more inactive and unhealthy
character, than when it occurs in other parts of the
body. The matter which escapes from the vesicles
is purulent or sanious, and concretes into black
crusts.
When the eruption consists of a narrow belt of ve
sicles, extending partly around the body, or over the
shoulder, it receives the appellation of herpes zoster,
or shingles.
Another, and very common form, is thus described
by Schroen : " An inflamed red ring, commonly per
fectly circular, and upon which numerous small glo
bular vesicles appear, which, though at first perfectly
transparent, soon become turbid ; these burst, and dis
charge a thin fluid, which forms a slight lamellated crust
that soon becomes detached, leaving a bright red
mark. Sometimes the fluid is absorbed, and the vesi
cles fade and fall off in thin, scurfy exfoliations. The
duration of the disease is about seven or eight days for
each ring ; but as successive rings appear and go
through a similar course, it may last between two or
three weeks." Schoenlein supposes that a repulsion of
this eruption predisposes the patient to fungus hozma-
todes. This variety is called herpes circinnatus, or ring
worm.
Other subdivisions have been made into herpes prce-
puti alls, herpes iris, herpes phlyctcenodes, &c.; but since
the nature of the malady is the same in all these va
rieties, and as the modifications which occur are de
pendent in a great measure upon the peculiar struc
ture of the affected parts, we do not deem it necessary
to enter into a more minute exposition of the details
pertaining to each species.
Causes. — Errors in diet ; immoderate use of fat, rich,
and indigestible food ; a morbid condition of the cu
taneous excretion ; local irritations from external in
juries, and the application of acrid substances. It
has been observed that those who have suffered from
attacks of syphilis, scrofula, scurvy, or who have taken
238 THE CHRONIC CUTANEOUS DISEASES, ETC.
much mercury, are most prone to the disease. In these
cases, a predisposition is established in the skin, so
that, from slight causes, herpetic eruptions are ex
cited.
Therapeutics. — When the eruption attacks the face,
head, body, or extremities, our best remedies are, sul
phur, calcarea carb., silicea, carbo veg., sepia, rhus tox.,
belladonna, lycopodium, iodine, graphites, aurum mur.
Herpes of the lips should be treated with arsenicum,
acid phos., graphites, phosphorus, hepar sulphur.
If the eruption appears upon the scrotum or prepuce,
the appropriate medicines are mercurius, arsenicum,
sulphur, calcarea carb., conium, rhus tox.
Nearly all cases which occur may be cured by sul
phur, calcarea carb., sepia, and mercurius ; but should
these remedies disappoint us, there will be no diffi
culty in making an appropriate selection from the
medicines first enumerated.
Administration. — For the most part, we rely upon
the first, second, and third attenuations ; and prescribe
drop doses of the dilutions, or grain doses of the tritu-
rations, twice daily until a satisfactory amendment is
evident.
SECTION XI.
PEMPHIGUS.
Diagnosis — This is also a vesicular affection, cha
racterized by the appearance of single vesicles of
large size upon the legs, and occasionally upon other
parts of the body. ' The vesicles are filled with a yel
low or straw-coloured fluid, and are seated upon an
inflamed, hard, and red base. This disease occurs
during the course of fevers, or in old and enfeebled
persons, after undue exposure to cold, or improper in
dulgence in stimulants or indigestible food. " I have
frequently seen," wrrites Mackintosh, *' large bullae
take place in the course of slight, as well as severe
fevers ; but instead of considering them thereby en
titled to any specific character, I have always looked
upon their occurrence as an accidental circumstance,
and have made no difference in the treatment of the
original disease. The appearance of the vesicles is
THE CHRONIC CUTANEOUS DISEASES, ETC. 239
sometimes preceded by slight chills, followed by tran
sient flushes of heat, and other signs indicative of mild
constitutional disturbance. In these instances the in
teguments at the base of the vesicles are hard,
swollen, and painful. The ordinary duration of the
eruption is from one to two weeks ; but in some in
stances the vesicles continue to appear for months.
Therapeutics. — Sulphur, rhus, arsenicum, dulcamara,
iodine, acid nit., and mercurius.
Administration. — The medicines may be employed
in the same manner as advised in herpes.
SECTION XII.
POPULAR VARIETIES. LICHEN.
Diagnosis. — Many kinds of this malady are de
scribed by writers, although the general character of
the eruption is in all instances the same. Willan
gives us seven different forms ; and other authors de
scribe even a greater number. But the propriety of
these minute subdivisions is very questionable, since
some slight distinctions might be made in almost all
cases which occur, and thus lead to a very extensive
and inconvenient classification.
The eruption consists of numerous small papillae
upon the breast, arms, and limbs, in the first instance,
which afterwards spread over the whole surface of
the body, attended with tingling and itching, especi
ally when exposed to heat, or when covered up warm
ly in bed. The eruption is generally preceded by slight
febrile excitement, and symptoms of gastric or intes
tinal disorder. The bases of the papillae are red, in
flamed, and painful, but they do not often suppurate,
or become filled with serum, but continue about eight
or nine days, when they dry up, and fall off in the
form of scurf.
The eruption which is so often seen in infants
during the period of dentition, and known as " the red
gum," is a form of lichen. In these cases the colour of
the papillae may be red or white.
Sometimes the eruption appears in the palms of the
hands, the arms and legs, when it receives the vulgar
appellation of salt rheum
240 THE CHRONIC CUTANEOUS DISEASES, ETC.
The eruption now and then comes out in a mild
form upon the trunk or extremities, attended with
heat, and troublesome itching on becoming heated, or
from rubbing or scratching, but entirely unattended by
febrile excitement. This variety is familiarly known
under the designation of prickly heat.
Causes. — Irritation of the stomach and intestines
from errors in diet, worms, and teething. Also pro
tracted exposure to a hot fire ; going into the cool air,
after long exertion while in a profuse perspiration ;
or, sometimes from entering a hot apartment, after
having been exposed for a long time to intense cold.
Therapeutics. — The following medicines will suffice
for the cure of all forms of this complaint : sulphur,
graphites, calcarea carb., sepia, iodine, antimonium tart.,
copaiba bah., acid phos., chamomela, dulcamara, rhus
tox., hepar sulphur.
Administration. — Same as for herpes.
PRURIGO.
Diagnosis. — Prurigo is believed by some authors to
be a severe form of lichen. The papillae are, how
ever, larger, " more isolated and distinct, and scattered
over larger surfaces" than those of that affection. The
eruption is sometimes of a red or pinkish colour, at
other times white, like the surrounding skin, and at
tended with the most intense itching and stinging.
The papillae are most commonly distributed about the
labia pudendi, but the disease is not unfrequently ob
served in other parts of the body.
The causes and treatment are the same as those
described under lichen.
SECTION XIII.
PUSTULAR VARIETIES I SCABIES. PSORA. ITCH.
Diagnosis. — The great diversity of appearances
which this disease is constantly presenting, renders a
complete description almost impossible. It has
been regarded by some writers of note, as papular,
by others as pustular, but by the majority as vesi
cular. It consists of a pustular, papular, or vesicular
eruption, generally situated between the fingers, on
THE CHRONIC CUTANEOUS DISEASES, ETC. 241
the wrists, near the joints, but sometimes extending
over the whole body. The eruption is attended with
almost constant itohing, which is aggravated by
scratching, or by the heat of a fire, or of the bed. The
disorder is decidedly contagious in its character, and
according to Schroen, li never gets well of itself ; but
will last for years, and may exist upon the skin a whole
life-time, if its cure is neglected." This author re
cognises four distinct forms :
1. Scabies sicca, or pimply, or dry itch, most com
mon in adults. This form, when repelled, often gives
rise to " nervous apoplexy, ascites, or chronic hydro-
cephalus, and it is best treated by sulphur, mercury,
causticum, carbo vcg.,psoricum, sepia, lachesis, and vera-
2. Scabies vesicularis, or common itch, occurring most
commonly in highlands, — very rarely in low and
swampy districts. When this form is abruptly repelled,
it gives rise to serious affections of the cerebral and
pulmonary organs, and to the nervous system. Sul
phur is undoubtedly the appropriate specific, and
should be given at the first trituration. In obstinate
cases we may employ one or more of the following
medicines: psoricum, sepia, hepar sulph., arsenicum,
rhus, mercuriusj iodine, copaibaj, calcarea carb.
3. Scabies purulenta, appearing in the form of yellow
and prominent pustules between the fingers and toes.
In this form, Schroen advises sulphur, antimonium tart.,
sepia, cicuta, lycopodium, and mercurius.
4. Crusta serpiginosa, — " This form resembles crustea
lactea, but is marked by the appearance of small vesi
cles behind the ears, which burst, forming a thin
dark-coloured scab, from which an acrid fluid is se
creted." The face, neck, arms, and trunk eventually
become involved. For the cure of this form Schroen
advises sulphur, clematis erec., calcarea carb., lycopo-
dium, and arsenicum.
Causes. — By many the disease is supposed to be
owing to the presence in the skin of minute animal-
cula, of the species acarus scabei. It has likewise
been attributed to want of cleanliness, and the use of
unwholesome food.
Administration. — The remedies should be given at
11
242 THE CHRONIC CUTANEOUS DISEASES, ETC.
the first or second attenuation, and repeated two or
three times a day until the eruption disappears. In
recent cases, Hartmann, Schroen, and Schmid, employ
the tinctures and the first dilutions ; but in obstinate
cases they employ from the third to the sixth attenua
tions.
SECTION XIV.
ECTHYMA.
Diagnosis. — This disease originates from a morbid
condition of the skin, which supervenes during the
course of eruptive, and other fevers, venereal diseases,
scrofula, scurvy, &c. The pustules are of considera
ble size, seated upon swollen, bright red. and painful
bases, and never running together, but always pre
serving a distinct character. After a few days the
pustules become covered with hard, and dark or
greenish scabs, which, in one or two weeks, dry up
and disappear. Ecthyma has been subdivided into
several distinct varieties, on account of some trifling,
and as we believe, unimportant modifications which
the eruptions occasionally present, from peculiarities
of age, constitution, disease, and habits of life. The
most common of these varieties are :
1. Ecthyma vulgare, "consisting of a partial erup
tion of small, hard pustules, on the neck, shoulders, or
extremities, which is completed in about three days.
They enlarge and inflame, form pus, and then scabs.
These eventually dry, fall off, and leave no mark be
hind. They are chiefly seen in young persons whose
health has been impaired."
2. Ecthyma luridum, with pustules, " larger, more
diffused, more repeated, and fixed upon a hard, eleva
ted base of a peculiar dark red colour/'*
2 Kr.thyma infantile, occurring generally in in
fants of delicate, or scrofulous constitutions, or in those
whose systems have been enfeebled by abuse of drugs.
4. Ec'hyma cachecticum, peculiar to individuals
who are suffering under a venereal, scrofulous, or
psoric taint.
* Hall
THE CHRONIC CUTANEOUS DISEASES, ETC. 243
EUPIA,
Is another pustular affection, often resembling very
closely ecthyma. Bateman describes it thus : " an
eruption of flat, distinct vesicles, with bases slightly
inflamed, containing a sanious fluid, the scabs accu
mulating, sometimes in a conical form, easily rubbed
off, and soon reproduced." Although this author de
scribes the eruption as vesicular, it is now generally
conceded that the disease is for the most part pustular.
The eruption may be distinguished from that of ecthy
ma, by the appearance of the scabs, and the ulcera-
tions which frequently occur. Several varieties have
been described, but we do not deem it necessary or
useful to enter into a particular enumeration of all the
minute points of difference in the various cases which
present themselves, since the general character of the
eruption is sufficiently marked to enable the careful
observer to detect its true nature without difficulty.
Therapeutics. — The medicines usually employed in
the above complaints are, sulphur, sepia, mercurius,
rhus, antimonium tart., silicea, hepar sulph., aurum
?nur., arsenicum, iodine, calcarea carb., dulcamara.
Administration. — Attenuations and repetitions of
doses, the same as in scabies.
SECTION XV.
IMPETIGO.
Diagnosis. — The eruption consists of clusters of
small pustules, vesicular in the first instance, but soon
becoming purulent. After a few days the pustules
burst, and thick and dark yellow scabs remain. The
skin around the pustules is somewhat swollen, in
flamed, and painful, and when the secretion from the
ruptured pimples is acrid, the patient is often annoyed
with an exceedingly disagreeable burning and itching
sensation. Willan, Bateman, Rayer, Schroen, and
several other eminent writers on cutaneous affections,
recognise five different varieties :
1. Impetigo figurata, occurring generally in children
during dentition, and in " young men and women of
lymphatic or sanguine-lymphatic temperaments."
Raver advises lycopodium, sepia, sulphur, rhus tox.,
244 THE CHRONIC CUTANEOUS DISEASES, ETC.
graphite, calcarea carb., dulcamara and petroleum in this
form of the disease.
2. Impetigo sparsa. — In this variety the pustules are
isolated, and dispersed over the shoulders, buttocks,
face, and scalp, or legs. It generally " appears in the
fall and winter, and disappears in spring and sum
mer." — (Bateman.) Mercurius, sulphur, cicuta, and
lachesis will be found specific in this form.
3. Impetigo erysipelatodes. — The eruption is usually
a disease of the face, and bears some resemblance to
erysipelas in the first instance, but soon changes to a
pustular character. The scabs which form on the
pustules are of a dirty yellow or greenish colour, and
are kept soft by the secretion which is under them.
Schroen considers belladonna, rhus tox., mercurius, and
arsenicum,the proper remedies for this form.
4. Impetigo scabida. — This is a severe form, attended
with more inflammation and pain in the affected parts,
and more extensive ulceration and discharge, than
either of the other varieties. We may employ, hepar
sulph., mercurius, arsenicum, and iodine.
5. Impetigo larvalis, or crusta lac tea. " Common
amongst young sucklings ; characterized by an erup
tion upon the cheek, of superficial, more or less con
fluent pustules, united in groups, attended with slight
itching, and followed by yellowish and green — gen
erally thin and lamellated, at times, however, with
thick and soft crusts, that when loosened, leave a red
and inflamed surface, which is quickly covered with
new crusts. The best remedies are, sulphur and rhus
tox." (Schroen,) or dulcamara, lycopodium, and sepia,
(Knorre,) or graphites and mezereum, (Lobethal.)
Administration. — In the same manner as in herpes.
SECTION XYI.
PORRIGO.
This is a contagious disorder, and presents itself in
the form of " straw-coloured pustules, sometimes cir
cumscribed, sometimes diffused ; generally, but not al
ways confined to the head ; the pustules break and
give issue to a fluid which concretes into yellowish or
brownish, thin or thick, crusts or scabs." — (Hall.) — It
THE CHRONIC CUTANEOUS DISEASES, ETC. 245
commonly makes its appearance upon the scalp and face,
but may occur in any other part of the body. The dis
ease has been subdivided into several different varieties,
but the divisions are of no practical utility, and tend
directly to create confusion and embarrassment.
In some constitutions, the eruption becomes so exten
sive and severe, as to give rise to troublesome ulcer-
ations, and considerable constitutional disturbance.
In cases of this kind, as well indeed as in all others,
the utmost care should be taken to ensure cleanliness,
so that the secreted fluid shall not accumulate, and
thus serve to perpetuate the disorder. The principal
remedies are sulphur, rhus toxicodendron, calcarea, car-
bo vegetabilis, sepia, graphite, and arsenicum.
ACNE,
Is another pustular affection, making its appearance
generally upon the nose, face, forehead, and shoulders,
first in the form of a thickening redness, and indura
tion of the integuments, from which eventually pro
ceed suppurating points or tubercles. The parts af
fected often acquire a depth of redness and a con-
spicuousness which much annoy the patient. Plumbe
supposes that the malady consists in a diseased con
dition of the sebaceous follicles, induced by excessive
indulgence in the pleasures of the table, sedentary ha
bits, &c. Sometimes it is violent, and extensive in
flammation and suppuration occur. The remedies
enumerated under porrigo will apply in it.
Administration. — The doses and repetitions of the
medicines, the same as in scabies.
SECTION XVII.
SQUAMOUS DISEASES LEPRA.
Diagnosis. — This disease is characterized by the
appearance of spots of various sizes, with red and in
flamed borders, slightly raised above the surrounding
skin, and covered with scurfy, bran-like flakes or
scales, which are constantly falling off, to be repro
duced. In some instances, a raw and tender surface
remains after the scales have fallen, attended with
severe itching and smarting, on rubbing or scratching,
246 THE CHRONIC CUTANEOUS DISEASES, ETC.
or on exposure to a high heat. The eruption is unat
tended by any febrile disturbance, but is not unfre-
quently associated with scrofulous or venereal taints,
and an impaired condition of the digestive apparatus.
The causes which tend to render the eruption severe,
extensive, and permanent, are want of cleanliness,
constant exposure to a hot sun, and unwholesome food.
PSORIASIS.
Mackintosh regards psoriasis as an aggravated form
of lepra. According to Hall, it " dinners from lepra
chiefly in the irregular form, in the diffusion of the
scaly patches, and in the absence of its inflamed bor
ders, depressed centres, and regular oval or circular
forms. The subjacent surface is also more tender,
more easily denuded, and more prone to become affect
ed by fissures*" The disease attacks the scalp, face,
the arms, the legs, the palms of the hands, the lips, the
prepuce and the scrotum. Occasionally the inflam
matory action runs so high that the parts become much
swollen and highly painful. In these cases there is
usually a considerable secretion from the eruption.
PITYRIASIS.
Simple pityriasis is most commonly confined to the
hairy scalp, and displays itself in the form of a su
perficial bran-like scurf, which may easily be removed
by a comb or a brush, but which is speedily repro
duced. In mild cases, and with ordinary care, the
disease may continue with but slight annoyance for
many years, or it may be roused into a more active
and troublesome form by general debility, attacks of
eruptive fever, and by the relaxing effects of a hot cli
mate.
Therapeutics. — We consider sulphur, iodine, conium,
calcarea, carbo vegetabilis and sepia, the best remedies
for the above diseases. Arsenicum, graphites, acid
nit., phosphorus, lycopodium, natrum mur., copaibce,
argenti nit., aurum mur., and hepar sulph., have like
wise been employed with success.
Administration. — The first, second, and third at
tenuations should be employed — a dose each day until
the morbid action is subdued.
247
CHAPTER XXII.
DISEASES OF THE ORGAN'S AND TISSUES CONNECTED
WITH THE DIGESTIVE SYSTEM.
SECTION I.
GLOSSITIS. INFLAMMATION OF THE TONGUE.
Inflammation of the tongue is by no means a com
mon affection, but cases now and then occur in which
this organ is so enormously inflamed and swollen, as
to place the sufferer in imminent danger of suffocation.
It may arise spontaneously, with but few and slight
premonitory symptoms of its approach, or it may pro
ceed from derangements of the stomach, sudden
changes of temperature, and the application of irrita
ting or poisonous substances. Generally it runs its
course rapidly, and if not met by prompt and efficient
measures, will so fill the mouth and throat as to sus
pend respiration.
Diagnosis. — Previous to the pain and swelling of the
tongue, the patient is affected with slight chills, loss
of appetite, lassitude, indications of disordered stomach,
dull pains in the head and back, succeeded with throb
bing and aching pains in the tongue, heat of skin, and
rapid pulse. The tongue now commences swelling,
and often progresses, if the inflammation is not ar
rested, to an alarming extent. It is usually red and
dry, but in some instances continues moist through all
the disease.
Causes. — Derangements of the stomach, exposure to
strong currents of air, mercurial salivation, smallpox,
the application of irritating substances, stings of in
sects, and certain poisons.
Tfierapeutics. — The physician is sometimes sum
moned to cases of this description, where the danger
of suffocation is so threatening, as hardly to render it
prudent to await the operation of remedies. In these
instances free and deep incisions should be made into
the substance of the tongue in a parallel direction,
248 DISEASES OF THE ORGANS AND TISSUES
which will afford prompt temporary relief, and thus
allow us time for the action of our specific remedies.
The medicines which will apply specifically in these
cases are, mere., bell., plumb., aur., and hep.
Mercurius sol. — External indications. — Expression
of countenance, anxious and terrified ; tongue inflamed,
swollen, red, dry or moist ; respiration exceedingly
difficult ; pulse rapid and full ; constant inclination
to keep an upright position ; skin hot and dry.
Physical sensations. — Febrile symptoms ; heat, thirst,
pains in the head, back and limbs ; throbbing, sting
ing, or aching pains in the tongue ; mouth and throat
filled with the swollen organ, giving rise to a dread
ful sense of suffocation ; symptoms somewhat aggra
vated during the night ; rapid sinking of strength ; re
spiration rather better in the air, and on gentle motion ;
deglutition partially or entirely suspended.
Mental and moral symptoms. — Excessive anguish,
apprehension, and constant and insurmountable dread
of immediate suffocation.
Administration. — Divide two grains of the third tri-
turation into six equal parts — one powder dry upon
the tongue every half hour in urgent cases, until there
is relief or a medicinal aggravation. In less severe
cases the medicine may be given once in twro, four, or
six hours, according to the symptoms.
Belladonna. — External indications. — Face red ; eyes
bloodshot, or suffused ; tongue inflamed, red, dry, and
swollen ; violent pulsations of the carotid and tem
poral arteries ; pulse rapid and bounding.
Physical sensations. — Congestion of blood to the
head ; throbbing pain in the head ; eyes sensitive to
light ; skin hot and dry, thirst ; throbbing, darting, or
drawing pains in the tongue ; difficult and anxious
respiration ; deglutition extremely difficult or entirely
suspended ; sense of suffocation.
Mental and moral symptoms. — Great agitation ; fear
of death ; anxious and depressed.
Administration. — A drop of the third dilution on
two grains of sugar of milk : divide into four equal
parts, and exhibit one dry upon the tongue once in
one, two, or three hours, as the urgency of the case
demands.
CONNECTED WITH THE DIGESTIVE SYSTEM. 249
Plumbum is appropriate in cases of chronic swelling
of the tongue, with numbness and partial paralysis.
Convulsive tremors and general muscular debility are
other indications for* the employment of this remedy.
In cases of glossitis proceeding from the abuse of
mercury, recourse may be had to aurum muriatic, and
hepar sulph. If the inflammation be owing to a wound
or injury, arnica is the proper remedy.
SECTION II.
TONSILITIS. QUINSY.
Diagnosis. — Febrile symptoms, succeeded in a few
hours by soreness of the throat, painful deglutition,
swelling and redness of the tonsils, uvula, and soft
palate. As the tonsils continue to enlarge, deglutition
and respiration become more difficult, the voice is
changed, the pains increase in severity, extending
often through the eustachian tubes into the ears, the
tongue becomes covered with a thick yellow fur, there
is an abundance of viscid saliva on the tongue and
tonsils, the breath acquires an exceedingly offensive
odour, which, according to Mackintosh, proceeds from
sebaceous matter escaping from the mucous follicles.
The disease may terminate in resolution, suppura
tion, or in permanent induration. When the appro
priate remedies are administered at the commence
ment, the inflammation usually resolves itself without
suppuration. If no medicines are given, or those only
which are inappropriate, the disorder usually pro
gresses until suppuration ensues, when an artificial
opening is made, or the tonsil bursts spontaneously,
and the swelling and inflammation gradually subside.
Not unfrequently the tonsils become affected with
chronic enlargements and indurations, from frequent
and partially subdued acute attacks, which prove ex
ceedingly troublesome by their proneness to take on
acute inflammation from the slightest exciting causes.
There is reason to suppose that chronic enlarge
ments of the tonsils often lead to coughs and expecto
ration of muco-purulent matter, which are confounded
with and erroneously attributed to chronic bronchi
tis, &c.
11*
250 DISEASES OF THE ORGANS AND TISSUES
Causes. — The predisposing causes are : scrofulous
dyscrasia, irritability, and chronic enlargement of the
tonsils from mercurial salivations, and derangements
of the stomach and bowels. The common exciting
causes are, cold, atmospheric vicissitudes, wet-feet.
Therapeutics. — The best remedies for acute tonsilitis
are, belladonna, mercurius, aconite, baryta ca?'b., nux,
pulsatilla, and hepar sulph.
Belladonna. — External indications. — Cheeks flushed ;
violent pulsations of the carotids ; enlargement of
tonsils perceptible on the outside of the throat ; ton
sils, uvula, and soft palate, inflamed, dark, red, and
swollen ; tongue dry, or covered with a thick trans
parent and tenacious mucus ; skin hot ; pulse full,
hard, and frequent ; voice hoarse, stifled, or sup
pressed.
Physical sensations. — Headache ; burning and shoot
ing pains in the throat when swallowing ; constant
inclination to swallow ; choking sensation ; tonsils
painful to the touch ; putrid or bitter taste ; thirst ;
eyes sensitive to the light ; stitches extending into the
ears ; deafness from obstruction of the orifice of the
eustachian tube ; burning fever.
Mental and moral symptoms. — Uneasiness and de
jection, worse at night, and occasionally delirium.
Administration. — Two drops of the third dilution to
two grains of sugar of milk. Divide into six parts
and exhibit one dry once in two to four hours as long
as necessary.
Mercurius. — External indications. — Offensive, pu
trid odour from the mouth ; tongue covered with a thick
yellow fur ; mouth dry or filled with viscid saliva ;
uvula elongated and red ; tonsils and soft palate dark
red, inflamed and enlarged ; roots of the tongue red
and swollen ; ulcers in the mouth and throat ; en
largement of the parotid or submaxillary glands ; pulse
frequent and moderately full.
Physical sensations. — Heat, alternating with chills ;
frequent profuse sweats ; stinging and shooting pain
in the throat, particularly when swallowing ; very
great difficulty in swallowing, although frequent
inclination ; glands of the neck painful on motion of
the jaws, at sight of savoury food, or on swallowing ;
CONNECTED WITH THE DIGESTIVE SYSTEM. 251
the pains and difficulty of deglutition worse at night ;
pains darting through the eustachian tube to the ears
and parotid glands ; loss of appetite and disgust for
food ; putrid or coppery taste ; thirst for cold drinks ;
symptoms mitigated during repose in bed.
Mental and moral symptoms. — Morose ; dejected ;
uneasy ; out of humour.
Administration. — Divide four grains of the third
trituration into six powders — give one dry, upon the
tongue, once in four to six hours until an impression
is apparent.
Aconite is a suitable remedy in cases of tonsilitis
attended with a high grade of arterial reaction, painful
deglutition, bright redness of the fauces, uvula and
tonsils, with pricking or burning pains when swallow
ing.
Administration. — A drop of the third dilution to two
grains of sugar of milk. Divide into four parts and
exhibit one dry, once in two hours until the symptoms
abate.
Baryta carb. maybe given in cases of eatarrhal ton
silitis, where there is suppuration of the tonsils, swol
len and elongated uvula, raw scraping or shooting
pain on swallowing, obstruction, as if by a plug in the
throat, bad taste, offensive breath, especially in the
morning, and discharge of sebaceous matter from the
follicles of the throat.
Administration. — Same as aconite.
When derangement of the stomach appears to be
the prime predisposing cause of the complaint, and
when the symptoms of the acute attack are, scraping
pains during deglutition, or when inhaling cold air ;
obstruction from the enlarged tonsils, choking and
spasmodic contractions of the throat when swallowing,
nux vomica is the specific remedy. It may be admin
istered at the third dilution, by means of sugar, like
aconite.
Pulsatilla will apply in cases arising from a chill
by being wet, wet feet, &c. The signs for this remedy
are, burning, scraping, smarting or shooting pains in
the throat when swallowing, deglutition obstructed
by viscid mucus which adheres to the tonsils and
fauces, pains worse in the afternoon and evening, bitr
252 DISEASES OF THE ORGANS AND TISSUES
ter or saltish taste in the mouth, loss of appetite, un
natural taste of food, tongue furred with a thick yel
low coat, and breath offensive.
Administration. — A drop of the third dilution on su:
gar. Divide into four parts, and let one be given dry,
once in four hours until the desired effect is produced.
Hep. sulphur has been much employed by our Eng
lish brethren, in those habitual cases of inflammation
and suppuration of the tonsils, which appear to owe
their origin to a scrofulous dyscrasia. This medicine
occasionally arrests the disease and prevents suppura
tion, after belladonna, mercurius, and aconite have
entirely failed to produce an impression. It may be
given in grain doses, at the third trituration, once in
two hours.
SECTION III.
•••
PAROTITIS. 1HUMF8.
This affection is classed by writers as an epidemic.
It is more prone to attack children than adults, and
generally makes its appearance during cold and damp
seasons. Its cause is a specific morbific contagion,
which may be generated during certain peculiar con
ditions of the atmosphere, or it may be communicated
from the bodies of those having the disorder.
Diagnosis. — Slight febrile disturbance, followed by
swelling and pain in one or both parotid glands. Un
der favourable circumstances the local affection con
tinues to progress until the end of the fourth day, at
which time the inflammation and swelling have
reached their height : when the tumefaction and pain
gradually subside, until at the end of about seven or
eight days from the commencement, all traces of the
complaint have departed. As soon as the inflammation
has fairly declared itself in the glands, the patient ex
periences much difficulty and pain in moving his jaws,
masticating, or even at the sight of savoury food.
It is highly important during its progress, that there
be no exposure on the part of the patient, either to
cold or dampness, nor from any undue mental or physi
cal excitement. In this manner we may guard against
those troublesome metastasis to the brain, mamma.
CONNECTED WITH THE DIGESTIVE SYSTEM. 253
and testes, which sometimes supervene from improper
exposure, external applications, &c.
Therapeutics. — But little medicinal treatment is re
quired in this malady, provided the precautions just
alluded to are heeded ; a few doses of the sixth dilution
of mercurius sol. being all that is necessary to conduct
the patient happily through the attack.
Sometimes, however, coma and other alarming symp
toms of cerebral disorder, suddenly appear from me
tastasis of the disease to the brain, which require the
prompt administration of belladonna, opium, or other
cerebral specifics. More commonly, however, the
metastasis occurs to the mamma or testes, causing in
flammation, swelling, induration, and occasionally
suppuration in these glands. The remedies in these
cases are mere., so/., bell., nux, puls., and aeon. See
the particular indications for these medicines under
" Inflammation of the mamma and testes."
SECTION IV.
GASTRITIS. INFLAMMATION OF THE STOMACH.
Diagnosis. — Burning, pricking, or lancinating pains
in the stomach, nausea and vomiting, great soreness,
tenderness, and pain on motion or pressure, intense
thirst for cold drinks, which are ejected almost as soon
as swallowed, affording some temporary relief, prick
ing and soreness in the throat and oesophagus, tongue
red at the tip and on the edges, and covered through
the centre with a white or yellowish fur, position
mostly upon the back or side, with the limbs drawn
up and the abdominal muscles relaxed, great depres
sion, anxiety, and fear of death ; pulse rapid, sharp,
contracted, sometimes almost threadlike ; bowels con
stipated ; disgust for food and warm drink, either of
which are expelled as soon as received into the stom
ach ; and in severe cases, delirium, and fever of a syno-
chal grade. There is an unusual fulness in the epi
gastric region, and often of the abdomen. As the dis
ease progresses, the extremities become cold, the fea
tures contracted and sunken, the eyes glazed or suf
fused, and finally diarrhoea, cold sweats, coma, and
convulsions supervene.
254 DISEASES OF THE ORGANS AND TISSUES
When death occurs, it is usually caused by ulcera-
tion or sphacelation of some portion of the mucous and
sub-mucous coats of the stomach.
Causes. — Excessive use of highly seasoned food,
stimulating drinks, the introduction of irritating sub
stances into the stomach, poisons, injuries, and the
use of emetics, drastics, stimulants, and other medici
nal poisons with which the allopathic practice, gov
erned by no scientific method, frequently induces this
and other diseases, and destroys the existence it is in
tended to preserve.
Therapeutics. — The ordinary remedies used in the
treatment of gastritis, are, arsenicum, veratrum, nux,
pulsatilla, aconite, iodium, ipecacuanha.
Arsenicum. — External indications. — Countenance
contracted, sunken, and expressive of anguish and
anxiety ; stomach swollen and hot to the touch ; po
sition upon the back ; respiration short, rapid, and
suppressed ; tongue red and clean, or red on the
edges with a dirty fur in the centre ; pulse contract
ed, tense, and frequent ; voice hoarse, stifled, and sup
pressed ; skin dry and hot, with perhaps cold and
clammy extremities.
Physical sensations. — Burning, sharp, or shooting
pains in the stomach ; aggravation of the sufferings
from motion, pressure, coughing, and inspiration ;
scraping and burning pain in the throat and oesopha-
gus ; great prostration ; weakness and trembling of
the limbs ; urgent thirst for cold drinks ; persistent
nausea and vomiting ; all food and drinks speedily and
violently rejected ; exceeding tenderness in the epi
gastric region on pressure ; respiration suppressed and
painful.
Mental and moral symptoms. — Intense anxiety, an
guish, depression, and despair ; expectation of speedy
death ; sometimes delirium.
Administration. — Two drops of the sixth dilution in
an ounce of water ; a dessert spoonful once in two to
four hours, until the proper impression is made upon
the inflammation.
Veratrum. — External indications. — Hippocratic
countenance ; nose pointed ; eyes sunken and glazed ;
lips bluish and dry; tongue red at the tip and on the
CONNECTED WITH THE DIGESTIVE SYSTEM.
edges, with a dark, dry fur running through the cen
tre ; pulse quick, weak, and almost imperceptible ;
stomach and abdomen distended ; extremities cold,
and covered with a clammy sweat ; position on the
back, with the knees drawn up ; hiccough ; and whole
appearance indicative of extreme prostration.
Physical sensations. — Feeling of great exhaustion ;
burning pain in the stomach ; rough, dry, and scrap
ing sensation in the throat, rendering deglutition diffi
cult and painful ; great soreness in the epigastric re
gion ; short, troublesome cough ; severe and contin
ued nausea and vomiting ; great dread of warm food
and drinks ; intense thirst for cold drinks ; inability
to retain anything upon the stomach ; spasmodic con
tractions of the throat, oesophagus, and abdominal
muscles ; hiccough ; painful respiration.
Mental and moral symptoms. — Excessive dejection,
discouragement, and sadness ; fear of death, complete
despair ; delirium.
Administration. — In urgent cases we may give a
dose of the sixth dilution, in water, once in one hour,
until an amendment declares itself, or there occurs a
well pronounced medicinal aggravation. We may
then await the result, and hold ourselves in readiness
to repeat this, or whatever other medicine may be ap
propriate, as the circumstances of the case may re
quire.
Nux vomica. — External indications. — Face bloated ;
eyelids red, weak, and watery ; stomach distended ;
tongue tremulous, red, and clean, or furred with a
whitish coat in the centre ; offensive breath ; frequent
hiccough ; pulse frequent, small, and feeble.
Physical sensations. — Burning pain in the stomach,
with pulsations and spasmodic contractions in the
epigastric region ; nausea and vomiting, aggravated
after eating or drinking ; tenderness arid pain in the
pit of the stomach when pressed, or during movement ;
contraction and obstruction in the oesophagus when
attempting to swallow ; painful sensation of distention
of the stomach ; dizziness and confusion of the head,
on rising from the recumbent position, or in attempting
to walk ; sour or bitter eructations.
. Mental and moral symptoms. — Great uneasiness and
256 DISEASES OF THE ORGANS AND TISSUES
anxiety ; morose, peevish, sad, and often disposition
to commit suicide.
Administration. — This medicine is peculiarly appro
priate in those cases which are induced by abuse of
coffee, wine, spirits, condiments, and stimulating food.
One drop of the sixth dilution to an ounce of water ;
a tablespoonful once in two to four hours, so long as
the symptoms remain stationary. Occasionally we
shall have conjoined with the above symptoms, cere
bral disorder, indicated by delirium, optical illusions,
and great derangement of the nervous system. In
such instances an occasional dose of belladonna will
prove specific.
Pulsatilla is a valuable remedy when the inflam
mation is brought on by the use of crude, indigestible,
and irritating food. It covers the following symp
toms : pressing or shooting pains in the stomach ;
pulsations in the pit of the stomach ; epigastrium
sensitive, and painful to the touch, or on pressure ;
nausea and vomiting after eating or drinking;
nausea and disagreeable feeling, extending even to
the oesophagus and throat ; regurgitation of food ;
eructations ; hiccough ; painful distention of the
stomach ; pulse quick and small ; and bitter taste in
the mouth.
Aconite, at the third to the sixth dilution, will do
good service when the febrile symptoms run high ; to
be repeated often until amendment ensues, either
alone or in alternation with the gastric specifics, as
the nature of the case demands.
Iodine, at the third potency, has afforded relief in
inflammations of the stomach caused by abuse of mer
cury and other irritating drugs. The indications for
its use are, frequent nausea ; vomitings, especially
after eating ; burning pains and pulsations in the
stomach, pyrosis, sour eructations, contraction and
burning of the oesophagus ; pulse frequent, small and
hard. Colchicum is an important remedy in cases of
metastases of rheumatism to the stomach. It acts
specifically as an irritant to the stomach, even when
injected into the veins.
A single dose of ipecacuanha, at the sixth potency,
will sometimes afford prompt relief in cases where
CONNECTED WITH THE DIGESTIVE SYSTEM. 257
vomiting is violent and incessant. It is applicable
in inflammation caused by excessive doses of tarlarized
antimony, corrosive sublimate, arsenic, &c., for the pur
pose of allaying the excessive irritation and vomiting
which follow poisonous doses of these articles.
SECTION V.
CHRONIC GASTRITIS. CHRONIC INFLAMMATION OF THE
STOMACH. ^
Diagnosis. — Many of the symptoms of this malady
are similar in character to those which occur in
the acute form, but there is a material difference in
regard to their grade of violence in the two diseases.
Sometimes chronic gastritis is the result of a partially
subdued acute attack, which from various causes is
kept up for a long period in this state of sub-acute in
flammation. At other times it comes on slowly and
insidiously, from a combination of causes operating at
the same time. Amongst the symptoms which usually
attend this complaint, may be enumerated these :—
pain and tenderness in some particular part of the
stomach, excited by pressure, or by certain kinds of
food and drinks ; frequent vomiting of food and drink
soon after they are swallowed ; loss of appetite, pu
trid taste in the mouth ; thirst ; fetid breath ; acid or
bitter eructations ; acidity ; distention of the stomach
with wind, which causes distressing vertigo, and pains
in the epigastric and hypochondriac region ; tongue
red and clean, or furred in the middle with a dirty fur ;
melancholy ; peevishness ; irritability ; discourage
ment ; and, finally, hectic fever, emaciation, sudden
prostration, and death.
Causes. — The most powerful predisposing causes of
this malady are, protracted sufferings under the de
pressing mental emotions and the habitual use of irri
tating drugs. It often succeeds to acute gastritis
which has been but partially subdued ; it may also
arise from high living, the abuse of wine, liquors,
coffee, &c., repelled eruptions, metastases of rheuma
tism and gout, injuries, and occasionally as a conse
quence of other diseases which have been badly
managed.
Therapeutics. — The medicines to which we have
259 DISEASES OF THE ORGANS AND TISSUES
alluded under acute gastritis, will be the most appli-.
cable in the ordinary forms of the chronic variety.
The following medicines will likewise cover many
symptoms of sub-acute gastritis, namely, bismuthum,
baryta muriatis, bryonia, cuprum met., digitalis pur-
purea, hyoscyamus, ignatia, mercurius, phosphorus,
arnica.
SECTION VI.
DYSPEPSIA. INDIGESTION.
Diagnosis. — This very troublesome malady, regard
ed for some reason as one of the banes of good society,
manifests itself under so many different aspects, and
is so entirely irregular in its causes, modes of attack,
progress, violence, and duration, that there is a wide
difference of opinion amongst physicians in regard to
its true nature. While some have referred it to a
sub-acute inflammation of the mucous coat of the stom
ach, others have considered it as in the liver, the
cardiac nerves, or the secretory apparatus of the stom
ach. The nature and precise location of dyspepsia
have been, and still are, to a considerable extent, in
volved in obscurity, and it is a consequence of this that
its victims have received so little sympathy or charity
either from medical men or from non-professional ob
servers. It is a disease, nevertheless, which in its dif
ferent phases displays symptoms and sufferings almost
innumerable, as is proved from the circumstance of its
having been confounded with chronic gastritis, car-
dialgia, bilious affections, liver complaint, &c. At one
time the patient will attribute his sufferings to his
head, and entertain the most alarming apprehensions
of apoplexy ; at another, to his respiratory organs, and
imagine he has consumption; again, he describes his
malady as in the liver, or the stomach, or the bowels,
or the spleen ; and thus he continues on from month
to month, or from year to year, a martyr to the most
distressing chronic affection to which humanity is sub
ject.
Dyspepsia may make its appearance in a gradual
and almost imperceptible manner, or it may supervene
suddenly in a severe form without previous warning.
It may so affect the system as to remind one constantly
CONNECTED WITH THE DIGESTIVE SYSTEM. 259
of its existence, or its symptoms may only manifest
themselves after the use of certain indigestible articles
of food, or protracted depression of spirits.
Amongst the more common symptoms of this com
plaint may be mentioned, tenderness and distention
of the epigastrium, acidity, flatulency, eructations,
sense of weight and fulness in the stomach after eat
ing ; also quick breathing, sensitiveness at the pit of the
stomach from pressure, tight clothing, &c., pyrosis,
vertigo, giddiness, sensation when walking as if the
pavement were rising up immediately in front ; consti
pation, pressure in the stomach and epigastrium,
haemorrhoids, sallow or yellow complexion, distention
of the abdomen with flatus, loss of ambition and
energy, sad, desponding, dread and apprehension re
specting the future, frequent inclination to commit
suicide, nights restless and disturbed by unpleasant
dreams. In the advanced stages of indigestion, there
often supervenes a troublesome cough, attended with
occasional pains in the chest, and mucous or muco-
purulent expectoration, which some writers have
termed dyspeptic phthisis. It is probable, in these
cases, that the disease is confined to the mucous mem
branes of the respiratory organs, being a continuation
or extension of the gastric disturbance, to the pulmo
nary mucous tissues.
The character of the gastric sensations is so diverse
in different cases, that scarcely a pain or a sensation
can be described, which has not been experienced by
the dyspeptic. It is often conjoined with cardialgia,
chronic gastritis, or chronic hepatitis, and therefore
some symptoms of either of these diseases may be
present in any given case.
Our own opinion is, that indigestion is not attributa
ble solely to sub-acute gastric irritation, or disease of
the cardiac nerves, or of the intestinal canal, or de
rangement of the gastric secretion, but to a combina
tion of all these maladies. This is satisfactorily
evinced from the fact, that in the worst forms of indi
gestion, many of the principal symptoms of each of
these disorders are uniformly present.
Causes. — Protracted depression of spirits, whether
occasioned by want of occupation, deprivation of the
260 DISEASES OF THE ORGANS AND TISSUES
accustomed mental and physical exercise, pecuniary
misfortune, loss of friends, disappointment, or mortifi
cation, is a prominent cause of dyspepsia. This cause
is very general and extended in its operation, affecting
not only the mucous structure of the stomach, but the
liver, the bowels, the cardiac nerves, and in some in
stances the whole nervous system. It is to this variety
of indigestion that should be attributed many of those
hypochondriacal affections, which are often referred
exclusively to disorder of the liver.
Next in importance to the above, may be named,
the abuse of rich and highly seasoned food, stimula
ting drinks, coffee, tea, tobacco, irregular eating hours,
and inattention to the daily faecal evacuations.
When chronic gastritis becomes complicated with
cardialgia, chronic hepatitis, &c., the resulting malady
will be dyspepsia. Another common cause of this
complaint, and one to which we desire to direct par
ticular attention, is the habitual use of cathartics.
The belief has so long and so generally obtained, that
all of the ills of the organism can be expelled forcibly
by inflaming and raking the sensitive and delicate
coats of the stomach and bowels with cathartics, that
it will be no light task to change opinions which have
become (if I may be allowed the expression), constitu
tional. If, however, the intelligent reader will remem
ber that dyspepsia consists in an irritated and weak
ened state of the nerves, and the mucous coat of the
stomach, together with disorder of the liver, he cannot
fail to perceive that the effect of purgatives must be
injurious rather than beneficial. We are quite aware
that some temporary relief is occasionally afforded by
cathartics, but innumerable facts warrant the asser
tion that this slight alleviation is always at the expense
of renewed and vastly increased future suffering, and
that each new dose communicates an additional im
petus to the advancement of the disease towards
fatal disorganization.
Another not unfrequent cause of indigestion, is re
pelled cutaneous diseases, like erysipelas, &c. I have
met with a number of well-marked cases of this de
scription, in which alleviation of all the symptoms uni
formly occurred when the eruption was upon the sur
face.
CONNECTED WITH THE DI6ESTIVE SYSTEM. 261
Therapeutics. — An essential condition in the treat
ment of dyspepsia is the maintenance on the part of
the patient, of a healthy, active, and cheerful state of
mind. Unless this be accomplished, our remedies will
either be of only temporary service, or entirely un
availing. Next in importance, is a course of rigid
dietetic regulations. In proposing a bill of fare for the
dyspeptic, much must depend upon the circumstances
of each particular case. If the patient is of a highly
bilious temperament, a much more simple diet will be
requisite, than for one who is nervous or sanguine.
As a general rule, an intelligent person will be able
to select a suitable diet for himself, by observing at
tentively the effects which different articles exert upon
his constitution.
Another equally important condition in the treat
ment of this complaint, is perfect regularity in all the
habits of life, as eating, sleeping, alvine evacuations,
exercise, &c. First, sufficient sleep should be allowed,
to enable the system to recover entirely from the fa
tigues of the preceding day; second, moderate and agree
able exercise should be taken for an hour or so, pre
vious to breakfast, bearing in mind that exercise, in
order to be beneficial, must not be undertaken and per
formed as a task, but as a pleasant recreation ; third,
in partaking of our food, we should never forget, while
we are thus repairing the waste of the body, from the
exercise of the functions, &c., that this also was in
tended by our Creator to be a source of pleasure to
us. Let the rational man, therefore, and especially
the dyspeptic, never eat with disordered rapidity, but
slowly, so that, masticated properly, his food may be
taken into the stomach in a fit condition for the pro
cesses of digestion. This is the true philosophy of eat
ing. Finally, at a certain hour every day, perhaps after
breakfast, an evacuation from the bowels should be
solicited. It matters not whether the inclination be
uniformly present, let the patient never fail in his
readiness, and the bowels will soon form the habit of
responding. So much are we the creatures of habit,
that we can train our bodies, our organs, our appe
tites, tastes, &c., to almost anything we desire, by a
steady persistence in our object.
262 DISEASES OF THE ORGANS AND TISSUES
The most approved remedies for the different grades
of indigestion, are, nux, sulph.,puls., bry., lycopod., calc.
carb., sepia, graph., ignat.
Nux vomica is well adapted to the cases which oc
cur in sanguine or bilious temperaments, and which
have been induced by " high living," sedentary habits,
undue mental exertion, irregularity in eating, sleeping,
&c. The external indications for nux, are, florid or
pale, sallow or yellow complexion ; general expression
of countenance, anxious and sad, care-worn ; tongue
dry, or covered with a whitish coat ; occasional ful
ness in the region of the stomach and bowels.
Physical sensations. — Distress at the stomach after
eating ; nausea and vomiting of food ; eructations ;
pyrosis ; distressing sense of debility ; irritability of
the nervous system, with constant inclination to roam
about ; symptoms worse after meals, and in the even
ing ; constipation ; haemorrhoids ; tenderness at the
pit of the stomach on pressure ; vertigo, dizziness, or
swimming in the head, particularly when rising in the
morning, or on walking about ; cramp-like pains at
the pit of the stomach, sometimes extending upwards
to the diaphragm and oesophagus.
Mental and moral symptoms. — Confirmed hypochon
dria ; constant dread of approaching misfortune ; in
clination to look upon the dark side of everything ;
trifles exaggerated into matters of importance ; urgent
inclination, at times, to commit suicide ; excessive ner
vous irritability.
When dyspepsia consists simply of impaired activity
of the nerves of the stomach, from the causes just
named, nux is without doubt the appropriate specific ;
but it is an almost invariable occurrence, that this con
dition of the stomach is attended with more or less de
rangement of the nervous system, manifested by loss
of animation and energy ; depression of spirits ; an in
vincible tendency to look on the dark side of affairs,
and an indefinable sense of dissatisfaction, dread, and
uneasiness, which impairs the appetite, disturbs the
sleep, and almost unfits the individual for the ordinary
duties of life. When this condition of the nervous sys
tem has existed for a considerable time, it receives the
name of hypochondria. For this complication, nux
CONNECTED WITH THE DIGESTIVE SYSTEM. 263
alone is insufficient, but one or more of the medicines
hereafter ennumerated, will be required.
Administration. — In cases of this description, we usu
ally prescribe nux vomica from the third to the sixth
potency ; a dose to be given each night, as long as
may be necessary.
Sulphur is peculiarly adapted to the treatment of
cases occurring in persons of a scrofulous dyscrasia,
and to cases which appear to be connected with ery-
sipelatous and other eruptive affections. Dyspeptic
symptoms occasionally supervene upon the disappear
ance of erysipelatous and other eruptions from the sur
face, also from the sudden suppression of long continu
ed haemorrhoidal discharges. In many cases of this
kind, sulphur will be found a valuable remedy.
The external marks wich indicate this medicine, are,
pale or sallow countenance; light hair; blue eyes;
thin skin ; white teeth ; glandular swellings ; erup
tions ; weak eyes, and the other signs of scrofulous dia
thesis.
Physical sensations. — Distention and distress of the
stomach after eating ; nausea ; vomiting ; pyrosis ;
frequent eructations, acid or bitter ; the symptoms oc
curring, for the most part, on the disappearance of some
eruption or accustomed discharge, and going off onfhe
reappearance of these eruptions or discharges.
Mental and moral symptoms. — Sadness ; irritability ;
moroseness.
Administration. — This medicine may be administer
ed at the third attenuation, in the morning and mid
dle of the afternoon.
Pulsatilla, at the third potency,isa valuable remedy
in dyspepsia occurring in females, especially when the
malady is complicated with deranged menstruation.
If the disorder has arisen from excessive use of greasy
and indigestible food, wine, &c., it will also prove a
suitable remedy.
Bryonia, at the third attenuation, is well adapted to
persons of a bilious temperament, with black hair,
dark complexions, and black eyes. The particular in
dications for its employment, are, yellowness of the
skin and eyes ; tongue covered with a yellowish fur ;
bitter taste ; vomiting or regurgitation of food soon
264 DISEASES OF THE ORGANS AND TISSUES
after eating ; sensation of fulness and burning in the
stomach after meals ; fulness and pains in the region
of the liver ; urine high-coloured ; head confused and
giddy ; pressure in the head ; loss of memory ; inabil
ity to transact business ; great despondency ; frequent
inclination to commit suicide ; constant sighing ; sleep
less nights, or sleep disturbed by unpleasant dreams.
Lycopodium, calcarea carb., and sepia, may be given
in mild cases of indigestion, occurring in weakly fe
males and children, and persons of a lymphatic or
scrofulous constitution. It may be exhibited at the
third attenuation — a dose each day as long as may be
necessary. In cases where the above remedies are in
dicated, a highly nutritious regimen may be enjoined
with great advantage, also the constant employment
of all those means which tend to invigorate the sys
tem, like active exercise, sea air, and bathing ; fre
quent amusement for mind and body, &c.
Graphite is valuable in dyspeptic symptoms which
appear to be connected with scrofulous or arthritic af
fections. It will be found particularly serviceable
when they supervene upon the sudden disappearance
of eruptions from the skin, or the sudden suppression
of old discharges, or the drying up of old sores.
Administration. — Same as lycopodium.
Ignatia. — We have witnessed much benefit from the
use of this medicine in indigestion afflicting persons of
a nervous temperament. It covers the following
symptoms, viz : countenance pale or sallow ; eyes con
stantly in motion ; general expression indicative of
anguish and despair ; frequent sighing ; constant in
clination to move about ; confusion of ideas ; loss of
memory ; pressure and other bad feelings in the head ;
distress at the stomach after eating ; appetite variable ;
tongue covered with a thin white fur ; entire despair
of recovery ; feels as if getting worse every day ; dread
of misfortune, coming want, &c. : frequent inclination
to commit suicide ; disinclination to see or converse
with friends or acquaintances ; seeks solitude, and
broods over imaginary troubles.
This medicine may be given at the third attenua
tion, a drop once in twelve hours, until an impression is
made upon the malady.
CONNECTED WITH THE DIGESTIVE SYSTEM. 865
In cases where the nervous system is so much in
volved that the patient desires to die, and continually
contemplates suicide, rather than suffer longer from
his morbid and unfounded imaginings, and the wretch
edness and anguish which tortures him day and night,
aurum muriate, at the first or second trituration, will be
found a remedy of the utmost importance. One grain
may be given twice daily until an amendment occurs.
The occasional use of mild aperients in certain
cases of dyspepsia, as well as in convulsions, diar
rhoea, <fcc., caused by the presence of indigestible food
in the stomach and bowels, may be advisable for the
same reason that paracentesis is recommended in ur
gent cases of abdominal or thoracic dropsy. By
evacuating the unnatural accumulations, we not
only place the disordered parts in a more favourable
condition to recover their lost energy, but we also
secure a much better state of things for the operation
of our remedies. In obstinate constipation, for ex
ample, the indurated and impacted fecal matter some
times induces so great an inactivity of the muscular
and nervous structure of the intestinal canal, as to
amount almost to paralysis. In these cases, both high
and low attenuations now and then prove inefficient ;
and it is here that mild aperients and injections will
sometimes prove serviceable, not, however as curative
agents, but by speedily removing a cause of disease,
and thus placing the affected parts in the best possible
condition to ensure the proper action of a homoeopathic
medicine.
The observations of Dr. Madden, of Brighton, are so
just respecting this subject, and so much to the point,
that we take pleasure in quoting them in this connec*
tion. "But it not unfrequently happens, that the be
nefit gained by an immediate unloading of the bowels
more than compensates for the subsequent increased
tendency to constipation. This is acknowledged by
all in the case of poisoning. No homoeopathist hesi^
tates to give emetics and purges when a person has
swallowed a substance which, if not speedily re
moved, will cause death ; but does not the same hold
good with an indigestible meal ? It is no doubt true
that our remedies are often sufficient of themselves to
12
266 DISEASES OF THE ORGANS AND TISSUES'
overcome the evil influence of are occasional excess at
table ? yet I am convinced that it not infrequently
happens, especially in childhood, th-at a judicious
aperient would at once remove a state of things
which, if treated otherwise, would entail an illness-
requiring several days to overcome. There is much
unreasonable prejudice among homeopathic practi
tioners on this point ; they will unhesitatingly con
demn the use of the mildest medicinal aperient, and
yet will order their patients to- eat prunes, figs, roasted
apples, green vegetables, brown bread, &c^ in the
hopes of producing the same result, But where is
the difference ? A dose of castor oil, far example,
produces an increased action of the bowels, in virtue
of its being an indigestible oil, which passes through
the whole intestinal tube unchanged, and perhaps-
exerting some slight irritating effect on the mucous
membrane ; whereas the aliments above named pro
duce the same results, in virtue of their having either
a large indigestible residuum which irritates by itsr
presence, or by their containing vegetable acids, which
directly and specifically irritate the mucous^ memv
brane. The result, therefore, is similar in both eases.'r
— British Jour, of Horn. No. xxix, p. 311.
In conclusion, we deem it proper to observe, that
aperients should never be employed except in very
urgent cases, or in those where our attenuations have
failed of producing the required effect. In all in
stances it is to be looked upon as a mere temporary
expedient.
SECTION VII,
H^EMATEMESIS. — VOMITING OF BLOOD.
Diagnosis. — Previous to the vomiting there is ex
perienced a sense of weight, fulness, pressure, and
disturbance in the stomach, nausea, faintness, debility r
general uneasiness, giddiness and confusion in the
head,, roaring in the earsy anxiety, bitter or saltish
taste in the mouth, loss of appetite, occasional chills,
and sometimes pains in the stomach, side, or chest.
The pulse is for the most part small and contracted,
though now and then full and bounding,
CONNECTED WITH THE DIGESTIVE SYSTEM. 267
** The haemorrhage no doubt generally occurs from
the mucous membrane of the stomach, but it is
thought also to proceed in some cases from the liver
or spleen. When the blood comes from the former
organ, it passes along the common bile duct into
the duodenum, and thence regurgitates into the stom
ach. When the spleen is the source of the haemor
rhage, if this be ever the case, the blood, it is sup
posed, gains admission into the stomach through the
vassa brevia." — (Dewees).
The appearance of the blood which is thrown up
varies, being in some instances liquid and bright red,
at other times black, or coagulated. If the haemor
rhage proceeds directly from the rupture of a blood
vessel in the stomach, it will be red and liquid ; but
if it has been conveyed from the liver or spleen into
this organ, it will be black and perhaps coagulated.
The quantity of blood which is sometimes vomited
from the stomach is very great. I have in several in
stances witnessed the loss of two, three, and even four
quarts from this organ without any very serious in
convenience, and that too in persons whose constitu
tions had been impaired from long-continued intempe
rance. A not uncommon result of these profuse
evacuations is, however, the supervention of dropsy,
and I am able to call to mind two instances of this
description.
Causes. — Intemperance, suppression of accustomed
discharges, as haemorrhoids, catamenia, &c. : conges
tions and engorgements of the. liver, spleen and pan
creas, schirrous and other ulcerations of the gastro-
mucous membrane, violent inflammations, whether
caused by active drugs or mechanical injuries.
Therapeutics. — The principal medicines for the
treatment of this malady are, aconite, nux vomica,
pulsatilla, ipecacuanha, arnica, veratrum, arsenicum.
SECTION VIII.
CARUALGIA. OASTRALGIA.
Cardalgia, as we have seen, is usually a symptom
of dyspepsia, although writers have classed it as a
distinct malady, having no necessary connection with
268 DISEASES OF THE ORGANS AND TISSUES
this disorder. The intimate relation between the
nerves and membranes of the stomach and the liver,
and those which their functions sustain towards each
other, incline us to the opinion that derangements of
either of these parts of the organism must involve, to
a greater or lesser extent, each of the others. The
seat of cardalgia is in the nerves of the stomach,
and as the healthy tone of the mucous membrane,
&c., is dependent upon the normal integrity of the
nerves which supply this organ, their mutual depend
ence will be readily perceived.
Diagnosis. — Pinching, gnawing, and cramp-like
pains in the stomach, often extending into the back
and loins, relieved on pressure at the epigastrium, or
when the abdominal muscles are relaxed, faintness,
anxiety, appetite natural, or but slightly impaired,
pulse natural ; food may be taken into the stomach
with impunity ; pains of a more severe character than
those which occur in chronic gastritis, although there
is no feeling of heat or thirst,
Causes. — Highly seasoned or crude and indigestible
food, abuse of stimulants, coffee and tobacco, irregu
larity in eating, and the use of narcotic and other
drugs.
Therapeutics. — The following medicines will cover
all symptoms which may be present in any case of
cardalgia, viz., nux vomica, pulsatilla, acid hydrocy
anic, carbo veg., chamomela, cocculus. argentum, sul
phur, causticum, and bryonia. For the treatment of
other symptoms with which the disease may be com
plicated, the reader is referred to the chapter on dys
pepsia.
Administration. — The remedies may be exhibited
from the third to the sixth potency, and at intervals of
six to twelve hours, until the desired effect is pro
duced.
SECTION IX.
ENTERITIS.
Under this head we shall proceed to describe two
varieties of intestinal inflammation, the peritoneal and
muscular, and that of the mucous membrane. The
CONNECTED WITH THE DIGESTIVE SYSTEM. '^69
older writers have confounded peritoneal enteritis
with ordinary acute peritonitis, but the researches of
modern pathologists have pointed out the true location
and nature of these different maladies.
PERITONEAL ENTERITIS,
Diagnosis. — Lassitude, rigours, chills, acute pain in
some part of the abdomen, swelling and exceeding ten
derness in the affected part, nausea, vomiting, obsti
nate and persistent constipation, urgent thirst, bitter
taste, loss of appetite, parched mouth, hot skin, inspi
rations short and painful, position on the back with
knees drawn up, and inclination to preserve the re
cumbent posture, pulse frequent, tense, contracted,
and irregular, urine scanty and high coloured.
The above symptoms will be modified according to
the particular location of the inflammation. If the
small intestines are the principal seat of the disorder,
symptoms will obtain which simulate gastritis: if the
colon be the part affected, we may expect symptoms
resembling hepatitis to be present. This form of en
teritis is violent and rapid in its course, and according
to most writers is " peculiarly prone to terminate in
gangrene. When this termination is about taking
place, the pain suddenly subsides, the pulse sinks rap
idly, the countenance becomes pale and cadaverous,
the extremities cold, the surface covered with a cold
clammy sweat, and hiccough, slight delirium, and oc
casionally convulsions, close the scene. This affec
tion is seldom protracted beyond the seventh or eighth
day, without terminating either in resolution or in
death."— Eberle.
Causes. — The employment of irritating cathartics,
like calomel, jalap, croton oil, aloes, scarnmony, colo-
cynth, colchicum, gamboge, &c., poisons, alcoholic
liquors, sudden suppression of accustomed discharges,
repelled eruptions, worms, external injuries, persistent
constipation, atmospheric changes.
Therapeutics. — Arsenicum, veratrum, aloes, aconite,
nux vom., lycopodium, opium, ipecacuanha, sulphur,
plumbum, rhus tox., ac. cuprum.
Administration. — The principal remedies in the
treatment of thismaladv, are arsenicum and veratrum.
270 DISEASES OP THE ORGANS AND TISSUES.
They may be exhibited at the third potency, at inter
vals of one to four hours, according to the severity of
the symptoms. Should vomiting be very violent and
persistent, after the proper administration of arsenicum
or veratrum, recourse should be had to ipecac., third
attenuation. When the inflammation attacks the
large intestines, aloes and plumbum may be given in
some cases, at the third dilution, after veratrum and
arsenicum. If the disorder has arisen from repelled
eruptions, or metastasis of rheumatism, gout, erysipe
las, &c., we may resort to sulphur, rhus, or ac. cuprum,
as circumstances require. During the course of the
disease, aconite will occasionally be found useful in
controlling the action of the heart and arteries. It-
may be given at the second potency, either alone or
in alternation with arsenicum or veratrum, according
to the symptoms.
Auxiliary to the above remedies, the employment
of fomentations, either of warm or cold water, as the
case may demand, will prove of eminent service.
Cloths should be wrung out, and applied over the af
fected part, (care being taken to protect the body linen
and bed-clothes,) renewing them once in fifteen or
twenty minutes, when the inflammation and pain are
severe.
SECTION X.
ACUTE MUCOUS ENTERITIS. DYSENTERY.
Diagnosis. — This disease sometimes commences with
griping pains in the bowels, with frequent discharges of
mucus or mucus mixed with blood, attended during the
evacuations with more or less straining and burning
pain. After the first two or three evacuations, nothing
but mucus, or mucus and blood, are passed. Occa
sionally the griping and diarrhoea are preceded by
lassitude, chills, weakness and pains in the limbs,
thirst, bad taste in the mouth, furred tongue, hot and
dry skin, frequent and hard pulse, anxiety, and general
restlessness. The disease is peculiarly apt to be
ushered in with these last-named symptoms, when it
has been caused by sudden suppression of perspiration,
atmospheric vicissitudes, or miasmatic influences.
WITH THE DIGESTIVE SYSTEM. 271
The appearance of the fluids discharged, will depend
anuch upon the climate, temperament, the exciting
cause, and the particular portion *of the intestinal
<;anal affected. If the small intestines are chiefly dis
ordered, the evacuations will consist of dark watery
matter, mixed with mucus and blood, while inflamma
tion of the colon and rectum will give rise to dis
charges of pure mucus and blood, preceded and attend
ed with distressing tormina, and inclination to remain
<a good part of the time &t stool. These discharges,
which are highly offensive, afford some temporary re
lief te the patient, only to be renewed with increased
severity. There are tenderness of the bowels on pres
sure, pain and burning in making water, inclination
to lie upon the back, with the knees drawn up, great
depression of spirits, short and painful inspirations,
universal heat and dryness of the skin, more or less
derangement in the function of the liver, indicated by
an icterode hue of the skin, and the absence of bile in
the evacuations, rapid emaciation, loss of strength,
and increasing disinclination to physical effort. As
the disease advances towards a fatal termination, the
countenance assumes a contracted and cadaverous ex
pression, the pulse sinks, the evacuations become more
foetid, and are discharged involuntarily, the pains
abate or cease entirely, a cold sweat occurs, hiccough,
delirium, cramps, and extreme prostration obtain,
and then death,
Causes. — Atmospheric vicissitudes, deranged func
tion of the liver, abrupt checks to perspiration,
"koino miasmata have frequently an unequivocal
agency in the production of this disease," (Eberle), — the
irritation of teething, worms, and drastic drugs, crude
vegetables and unripe or decayed fruits.
Prognosis. — The prognosis of dysentery will vary
according to the climate, the location, the season of
year, the constitution of the patient, and its compli
cations with typhus, cholera, or other contagious mal
adies.
Hot and damp regions, abounding in luxuriant veg
etation which is constantly undergoing decomposition,
and filling the air with miasmatic particles, predispose
the system to dysenteric aifections, and serve to ren-
272 DISEASES OP THE ©RGANS AND TISSUES
der them violent and dangerous. Low, marshy, and
damp situations favour the formation of the disease,
more than eleva&d and dry locations. It is far more
common, severe, and fatal in the months of July and
August, in this country, than at any other period of the
year ; and it is rare that individuals who are strongly
predisposed to it, entirely escape during these months.
When it is succeeded or accompanied with typhoid
symptoms, or when it occurs as a symptom of typhus
fever, it may be looked on as a malady of the most dan
gerous character, and one which will require the most
judiciously directed resources of our art. In these in
stances we have to combat, not only the local intesti
nal disorder, but also constitutional symptoms of the
greatest severity. During the prevalence of Asiatic
cholera, dysentery has been observed to assume a more
malignant form than in those years when this destruc
tive epidemic has not prevailed. While the cholera
was destroying its thousands weekly in our large
cities, during the last summer, a malignant dysentery
prevailed in most of the smaller cities and towns,
sweeping off numbers entirely unprecedented. In
these last examples, the epidemic influence was not
sufficiently active to generate the actual cholera
asphyxia, but it conduced to aggravate very mate
rially, the type of dysentery.
Therapeutics. — Mercurius, arsenicum, chamomela,pul-
satilla, colocynlh, aconite, ipecacuanha, nux vomica,
carlo veg., sulphur, dulcamara, aloes, acid nit., acid mur.
Mercurius corrosive. — External indications. — Anx
ious expression of countenance ; features distorted by
pain ; knees drawn up ; head and shoulders elevated,
or bent forward ; fulness of the abdomen ; skin hot and
dry ; tongue dry and dirty ; pulse frequent and tense ;
inspirations short and imperfect, and effected princi
pally with the muscles of the chest ; evacuations of
pure blood, or mucus mixed with blood, or dark and
bilious and foetid.
Physical sensations. — Sharp, cutting pains in the
bowels, accompanied with very frequent and urgent
desire to go to stool, and tenesmus ; desire to remain
long at stool ; abdomen excessively painful on pressure,
with constant sensation of distention ; dryness of the
CONNECTED WITH THE DIGESTIVE SYSTEM. 273
mouth and throat, with intense thirst ; involuntary
tvvitchings of the muscles on going to sleep ; pain at
the neck of the bladder in urinating ; cheeks and
abdomen hot and flushed, while the extremities are
cold ; drawings, pinchings, or cramps in the limbs,
often deep seated ; pains increased at each inspi
ration ; shivering on the least exposure ; aggravation
of the symptoms at night ; sense of pain and fatigue
in the joints.
Mental and moral symptoms. — Out of humour ; irri
table ; petulant ; desponding ; reckless.
Administration. — One grain of the third trituration
may be given every hour until the violence of the dis
ease is subdued, when the intervals may be lengthened,
or the medicine suspended, according to the exigencies
of the case. Some writers advise, an alternation of
this remedy with colocynth, where the indications
point to the latter as well as the former medicine.
We have occasionally prescribed these articles in
alternation with unequivocal benefit.
Mercurius sol. — This form of mercury is more par
ticularly adapted to the treatment of those cases
which are principally located in the upper portion of
the intestinal canal, the external indications for which
are, yellowish colour of the skin ; offensive breath ;
tongue covered with a white, thick, tenacious mucus ;
distention in the superior part of the abdomen ; eva
cuations of foetid mucus and bilious matter, of a green
or darkish colour, or of bloody mucus; prolapsus of
the rectum, which is red and inflamed ; urine of a
deep red or brown colour and offensive ; position,
respiration, pulse, temperature, thirst, &c., same as
under mere. cor.
Physical sensations. — Violent cutting pains in the
abdomen, accompanied by shivering, during and after
the evacuations ; great tenderness on pressure, in the
region of the small intestines ; frequent desire to
evacuate the bowels, accompanied by violent tenes*
mus ; discharges small in quantity ; aggravation of
pains at night ; frequent and urgent desire to urinate ;
nausea and vomiting, with pain in the stomach ; thirst
for cold drinks ; cramps and contractions in the
umbilical region ; weakness and rapid sinking of
274 DISEASES OF THE ORGANS AND TISSUES
strength ; painful sense of distention in the abdomen ;
sense of fatigue and great weakness in the limbs.
Mental and moral symptoms. — Morose ; irritable ;
great anguish and discouragement ; peevish ; quarrel
some.
Administration. — Same as mere. cor.
Remarks. — In malignant dysentery, mercurius sol.
and nitric acid are unquestionably remedies of the
highest importance. In all cases where the symptoms
are not covered by one of them, but are entirely so
by both, or when either administered singly, does not
promptly arrest the disorder, we may use them in
alternation with every prospect of success.
The following are the external indications of nitric
acid: countenance pale or flushed, and indicative of
anguish and anxiety ; evacuations bloody, slimy, and
fetid ; abdomen distended ; urine red, or dark and tur
bid ; body hot, while the extremities are perhaps cold ;
pulse hard and frequent.
Physical sensations. — Frequent evacuations with
severe tenesmus. and urging to urinate ; headache ;
fever ; thirst ; sweat during the night and occasionally
in the day time ; sense of fulness and pain in the
abdomen ; general character of the disease typhoid.
Mental and moral symptoms. — Sometimes delirium ;
or anxiety, fear, apprehension, depression, and sleep-
lesness.
Administration. — We may give a drop of the second
or third dilution in water, after each evacuation : or
when used in alternation with mercurius, after every
other discharge from the bowels.
Mercurius viv. — This medicine covers the same
range of symptoms as the mere, sol., and may be sub
stituted for it, if desired, in the treatment of dysentery.
Its mode of administration is also the same.
Arsenicum alb. — Where dysentery has arisen from
the abuse of drastic and other debilitating medicines,
after excessive loss of blood, or after the organism has
been enfeebled from' previous disease, arsenicum will
often prove an efficient remedy. It is also peculiarly
useful in dysenteric affections, occurring in individuals
of a nervous, dropsical, or lymphatic constitution, and
when the disense is attended with typhoid complica
tions.
CONNECTED WITH THE DIGESTIVE SYSTEM. 275
External indications. — General appearance of de
bility and prostration ; trembling or stiffness of the
limbs ; face pale or yellowish, hollow and cadaverous ;
position on the back, with tendency to sink to the foot
of the bed ; eyes dull and sunken ; lips dry and dark-
coloured; tongue dry and brownish ; abdomen swollen
and hard, or tympanitic ; faeces offensive, putrid, and
variable in colour, but generally slimy and streaked
with blood, or greenish or darkish ; skin cold and
bluish, or dry and shrivelled ; breathing short and op
pressed ; pulse frequent, small, thready, sometimes
irregular.
Physical sensations. — Violent, sharp and cramp-like
pains in the abdomen, accompanied with nausea and
vomiting ; sensation of fulness and burning in the
bowels ; frequent eructations ; flatulency ; frequent
evacuations with some tenesmus, burning pain at the
anus, and nausea; retention of urine, or burning pain
in making water ; pain increased by the slightest mo
tion ; faintness upon the least exertion ; great tender
ness of the abdomen ; colliquative sweats ; entire
inability to sit up, or make any effort ; puffiness of the
eyes or cheeks ; disturbed sleep, with constant jerking
of the limbs, and tossing.
Mental and moral symptoms. — Sad ; desponding ;
anxious; discouraged; irritability, impatience; de
lirium ; loss of consciousness.
Administration. — One grain of the first trituration to
two ounces of distilled water — a teaspoonful once in
two or three hours until the required effect is pro
duced.
Chamomela. — A useful remedy in dysenteric affec
tions arising from a sudden chill, from difficult and
protracted dentition, from violent grief or passion. It
applies especially to affections of this nature which
occur in women and children, and when judiciously
prescribed, will often act promptly and efficiently.
Laurie has found it of service after aconite in cases
attended with inflammatory symptoms, which have
been partially subdued by this medicine. It may be
given at the third potency, as circumstances require.
Pulsatilla. — This remedy has been highly recom
mended in fall dysenteries, and in some cases of chronic
276 DISEASES OP THE ORGANS AND TISSUES
dysentery. The indications for its use are, nausea,
vomiting, bad feeling in the head ; bruised sensation
in the integuments of the abdomen ; cutting pains in
the bowels, with discharges of sanguineous mucus ;
pain in the small of the back; chilliness, especially
towards night ; bad taste in the mouth ; eructations,
acid or bitter; prickling or numbnesss of the skin ; con
stant inclination to sleep during the day ; yellow tinge
of the skin.
Administration. — Four drops of the third dilution
to an ounce of distilled water — a dessert spoonful
every two, four or six hours in acute cases. One dose
every afternoon in chronic dysentery.
Colocynth should be exhibited in cramp-like, colicky
pains in the bowels, with inflammation of the whole
abdomen ; slimy or bilious evacuations, with pains
and contractions at the rectum ; bitter taste, with ur
gent desire for cold drinks ; nausea and vomiting of
bilious fluids ; shooting and cramp-like pains on one
side of the body; pains in the head, and throbbing of
the temporal arteries.
Administration. — Same as chamomela.
Nux vom. sometimes effects speedy cures in protrac
ted dysenteric discharges, which appear to be kept up
from relaxation and loss of tone in the abdominal mu
cous membrane rather than from actual inflammation.
By imparting tone and vigour to the enfeebled nerves
of the stomach and intestines, it cures the disease, and
enables these organs to resume their healthy functions.
The indications for its employment are, fulness antl
disterition of the abdomen ; contractive or cramp-like
pains in the umbilical, epigastric, or hypochondriac
region ; frequent small evacuations of mucous and
bloody matters ; contractive pain in the rectum during
the discharges ; bowels and cheeks hot ; thirst ; faeces
putrid and offensive.
Administration. — A drop of the third potency may
be given every two to six hours, as the urgency of the
symptoms demand, until an impression upon the dis
ease is apparent.
Another medicine which has proved highly servicea
ble in my hands, is aloes soc. The indications for its
use are similar to those of cohcynth ; .and in some
CONNECTED WITH THE DIGESTIVE SYSTEM. 277
cases where colocynth, has failed to afford the desired
relief, this medicine has succeeded promptly.
Rau has also used aloes with distinguished success
in purely inflammatory dysentery. The external indi
cations are : abdomen distended and tender to the
touch ; stools slimy and mixed with blood, or thin and
watery ; urine scanty and high-coloured ; tongue red
and dry ; pulse full and rapid ; skin hot and dry, &c.
Physical sensations. — Severe pressing, cutting and
burning pains in the lower part of the abdomen ; vio
lent tenesmus and smarting in the rectum, during the
evacuations, with sharp pains extending to the sacrum
and abdomen ; high fever ; pain in urinating, &c.
Mental and moral symptoms. — Anxiety and general
indications of nervous excitement.
Administration. — Same as chamomela.
Dulcamara may be used in dysentery arising from
cold, and attended with cutting pains in the intestines,
bloody discharges, burning and itching at the rectum,
heat of skin and thirst. It may be prescribed at the
third potency — a dose once in two to six hours, accord
ing to circumstances.
Carbo veg. may succeed or alternate with arsenicum
in certain low forms of dysentery, when the former
does not act with sufficient efficiency. It may be given
for the same train of symptoms, and at the same po
tency as arsenicum.
Sulphur is a remedy which deserves consideration
in instances where the more ordinary remedies fail in
affording prompt relief, and especially, if any latent
miasm is suspected to have conduced to the disease,
or prevented the usual action of the medicines admin
istered. It is also often serviceable in the dysenteries
of hasmorrhoidal patients.
Sulphuric acidhas been highly commended inputrid
dysentery. The external indications are : thin, bloody,
and very foetid stools ; red, or darkish urine, turbid,
or depositing a dirty sediment ; burning hot skin ;
apthse; petechise ; blood-blisters; vomiting of water
and food.
Physical sensations. — Frequent inclination to go to
stool, with severe tenesmus, nausea, and vomiting ;
desire for acids, fresh fruit, &e.
278 DISEASES OF THE ORGANS AND TISSUES
Mental and moral symptoms. — Indifferent, or irrita
ble ; irascible and peevish. It may be given in the
same manner as nitric acid.
Belladonna is indicated in inflammatory dysentery,
with determination of blood to the head, and delirium.
There is constant tenesmus, but nothing is evacuated,
with violent fever, vomiting, tympanitic distention of
the abdomen, &c.
In bilious, catarrhal, erethistic, and rheumatic forms of
dysentery, examine colocy., puls., nux vom., cup.,cham.,
chin., rhus,, sulph., ip., dale., euph., canth., ant. crud.,
rheum.
When the malady degenerates into a chronic form,
our best remedies are, phos., acid nit., sulph., china,
lach., acid phos., calc. carb., verat., mere. ,f err., and colo-
cynth.
We have often observed the most decided benefit
follow the employment of enemata of cold water, in
dysenteric inflammations. They may be administered
after each evacuation, in suitable cases, and when
they afford evident relief.
SECTION XL
ACUTE PERITONITIS.
Diagnosis. — Three varieties of this disease have
been recognised, viz. : first, natural peritonitis ; second,
puerperal peritonitis ; third, chronic peritonitis. We
shall, however, include under the present head, each
variety, detailing, as we proceed, the characteristic
symptoms pertaining to all of the different forms of the
malady.
Acute peritonitis is usually ushered in with more or
less of the ordinary symptoms of fever, as lassitude,
irregular chills, succeeded by flushes of heat, headache,
frequent pulse, uneasiness, or pressure in the region of
the stomach, nausea, and loss of appetite. These
symptoms are speedily succeeded, and occasionally
accompanied, by a pain and tenderness in the abdo
men, either confined to circumscribed points, or uni
versally diffused over its whole extent. Generally
the abdomen is excessively tender and painful upon
pressure, often rendering the weight of the bedclothes
CONNECTED WITH THE DIGESTIVE SYSTEM. 279
intolerable ; but in some instances, the pain is slight
from the commencement to the fatal termination of
the malady. The tongue is moist and covered with a
white fur, in the first instance, which soon becomes
dark and dry in the centre, with red edges. The
bowels are constipated, but may be readily acted upon
by appropriate remedies. The pulse is commonly
frequent, tense, corded, and wiry, though in some in
stances it varies but little from the natural standard.
This, like most other inflammations of the abdominal
viscera, imparts to the countenance a contracted,
sharp, and anxious expression, indicative of both acute
physical and mental suffering. The patient inclines
to relax those muscles which operate upon the abdomi
nal parietes, and on this account we find him with his
legs drawn up, his head and shoulders elevated, and
his respiration short, imperfect, and exercised almost
entirely by the muscles of the chest.
Puerperal peritonitis is that form of the disease
which occurs in females after confinement, and is
known as puerperal fever. It differs from ordinary
peritonitis, in being more sudden and violent in it's
attack, and in having a tendency to run its course with
greater rapidity. Among the first symptoms are pain
and tenderness in the hypogastric region, occurring
soon after delivery, and succeeded by chills, &c.
Some authors assert that the lochia are almost inva
riably suppressed, while others of equal eminence,
assure us that this discharge is often but little affected,
and never entirely suspended. The secretion of milk
is also either partially or entirely suppressed ; and
if the secretion has not yet taken place, it does not
occur at all. In many cases of both forms of this dis
ease, the brain is affected at an early period, and de
mands special attention.
In regard to the precise character which this malady
may be likely to assume, much will depend upon the
peculiar constitution and circumstances of the indi
vidual, the season of year, the prevalence of epidemic
or contagious influences, &c. " There is also an en
tire extinction of the maternal feeling," (Deiuees,) * and
* Dr. Dewees considers this one of the most remarkable circumstances
attending this disease.
280 DISEASE* OF THE ORGANS AND TISSUES
frequent inclination to pass water, which is often at
tended with pain. The duration of this malady is
from twenty-four hours to two or three weeks.
Chronic peritonitis, although often consequent upon
a partially subdued acute attack, may also arise inde
pendently from sudden changes of temperature, insuffi
cient clothing, irritating fojod, external injuries, sur
gical operations, and chronic bowel complaints. Many
of the symptoms of this disease are like those of dys
pepsia, as sensation of fulness, distention, weight, and
occasional pains in the region of the stomach and
bowels, constipation, loss of appetite, depression of
spirits, restlessness at night, distress and pains, aggra
vated after eating, emaciation, thirst, frequent pulse,
foul tongue, &c. This form of peritonitis may termi
nate in a few weeks, or it may run on for a year or
more, and then result in ulcerations opening into the
intestines.
Causes. — Certain occult conditions of the atmos
phere, undue exposure to cold, excessive physical ex
ertion, injuries, labour, miscarriage, over-exertion when
the organism is weakened by previous disease, atmos
pheric vicissitudes, metastases of rheumatism, and
gout, suppressed discharges, &c.
Therapeutics. — The most approved remedies in the
treatment of peritonitis are, aconite, belladonna, bryonia,
arnica, bismuth., chamomela, coffea, colocynth, ipecacu
anha, mercurius, mix vom., pulsatilla, rhus tox., sulphuris,
veratrum.
Administration. — We advise the employment of the
three first attenuations — and a repetition of the dose
every one, two, or three hours, according to the ur
gency of the case.
SECTION XII.
COLIC.
Under this head, we shall describe three varieties :
first, bilious colic; second, flatulent colic; third, pain-
ter's colic.
1. BILIOUS COLIC.
Diagnosis. — The first symptoms of this disease, are
CONNECTED WITH THE DIGESTIVE SYSTEM. 281
headache ; nausea; bitter taste ; bilious vomiting ; foul
tongue ; loss of appetite ; thirst, and uneasiness in the
bowels. These symptoms are speedily followed by
severe griping, twisting, or shooting pains in the um
bilical region ; hot skin ; painful distention of the
stomach and abdomen ; obstinate constipation, and
finally, tenderness of the abdomen ; yellow cast of the
skin and eyes ; coldness and torpor of the extremities ;
cold sweats ; feeble or extinct pulse, and other signs
indicative of a fatal termination of the disorder. Du
ring the first stage of the malady, the patient involun
tarily makes firm pressure over the navel, which af
fords temporary relief, and it is by this symptom that
we may distinguish the disease from inflammation of
the bowels, in which pressure is attended with an ag
gravation of the pain.
Causes.*— Deranged function of the liver, is supposed
to be the chief cause of this complaint, but what the
precise nature of this derangement consists in, we
know not. Dewees supposes that the liver is in a state
of morbid activity, and secretes bile of an acrid quality,
which serves to irritate the stomach and intestines,
and thus induce the disease. Gregory, Eberle, John
son, &c., assert that this organ is in a torpid condition,
and consequently secreting only a small amount of
bile, thus leaving the ingesta to be only partially
acted upon by one of its natural solvents, and
thereby rendering the half digested food an irritant
to the digestive organs. From the fact of its occur
ring only at particular periods of the year, it is rea
sonable to conclude that atmospheric causes exert
some influence in its production.
It is quite evident, however, that derangement of
the liver is intimately connected with genuine bilious
colic, and it therefore behooves those who have been
afflicted, to take every precaution to ensure a healthy
condition of this organ.
2. FLATULENT COLIC.
Diagnosis. — Flatulent colic may be distinguished
from the variety last described, by the greater disten
tion of the stomach and bowels with flatus ; frequent
eructations ; borborygmus ; the pain, although as severe
282 DISEASES OF THE ORGANS AND TISSUES
as in bilious colic, yet coming on more in paroxysms,
absence of nausea and bilious vomiting, and from the
fact that it usually occurs an hour or two after eating
something indigestible,
Causes. — Indigestible food, unripe or decayed fruits ;
beer ; mental emotions, or any other cause capable of
morbidly altering or suspending for a time, the healthy
action of the stomach and bowels, in such a manner
as to cause them to generate an unusual quantity of
gas.
3. COLICA PICTONUM. PAINTERS COLIC.
Diagnosis. — Lead colic commences with feelings of
lassitude ; dull pains in the head ; loss of appetite ; bad
taste in the mouth ; wandering pains in the bowels
and limbs ; transient chills, and depression of spirits.
After these symptoms have existed for some time, the
pain in the region of the umbilicus becomes exceed
ingly severe, obliging the patient to make firm pres
sure against the abdomen, with the body in a bent posi
tion ; indeed, so intolerable is the pain, that the patient
is unable to remain quiet in any position. He is now
in a state of great agitation and excitement, and feels
confident that he must die unless speedily relieved. It
is important to observe, that in all the varieties of colic,
the skin is cool or not above the natural standard, and
sometimes covered with a cold sweat. The pulse, al
so, exhibits but little arterial excitement. These last
symptoms, together with the relief which firm pressure
upon the abdomen affords, in the early stages of the
malady, indicates its spasmodic character, and will
serve to distinguish it from enteritis and other inflam
matory conditions of the abdominal viscera.
Therapeutics. — The specifics for the different kinds
of colic, are, colocy nth, plumbum, mix vomica, arsenicum,
chamomela, hyoscyamus, stramonium, veratrum, cocculus,
senna, cokhicum, phosphorus, pulsatilla.
Auxiliary to the above remedies, we beg leave to
impress upon the practitioner the importance of fo
mentations and enemata of warm water. These mea
sures, conjoined in certain cases with the tepid bath,
are worthy of high consideration, and should never be
lost sight of in the treatment of this, as well as other
CONNECTED WITH THE DIGESTIVE SYSTEM. 283
maladies of a spasmodic character. The fomentations
should not only be applied to the abdomen, but to the
extremities, more especially if these parts are cold and
inclined to cramp. In moderate cases, fomentations,
together with an ordinary enema, and the proper spe
cific, will suffice to effect a speedy cure ; but if the
case has been very violent and obstinate from neglect
or mismanagement, by calomel and opium, a general
bath, with very copious injections of warm water while
immersed in the water, cannot be too highly recom
mended. Indeed, we have in several instances, ob
served the abdominal spasms to relax, the pains to
cease, and free evacuations of faecal matter and of
wind to occur, while the patient was yet in the bath.
By adopting this course, we secure the advantage of
internal, as well as external fomentations, and thus
bring a safe, yet efficient remedy, to bear directly upon
the parts affected. All who have practically tested
the soothing influence of warm water applications
upon the nervous system, when in a state of unnatural
erethism, will appreciate the truth of our remarks.
The medicine which is most generally applicable in
the treatment of colic, is colocynth. It is particularly
appropriate when the complaint has been caused by a
chill, by mental emotions, as grief, indigestion, morti-*
fication, &c., also when biliary derangement has been
the exciting cause.
The external indications are, inflation of the abdomen ;
position of the body bent forward, so as to relax the
abdominal muscles ; cramps in the calves of the legs ;
general agitation ; temperature of the skin, about the
natural standard, or cold and covered with sweat ;
pulse natural, or but slightly increased in frequency ;
tongue covered with a yellowish fur, or natural ; face
pale and indicative of intense suffering ; rigidity and
contraction of the abdominal muscles, as well as of the
tendons in other parts of the body.
Physical sensations. — Violent cramp-like contraction
or cutting pains in the abdomen, generally in the re
gion of the umbilicus ; painful cramps in the calves
of the legs ; sensation of faintness, with coldness and
shuddering ; bitter or insipid taste in the mouth ; nau
sea ; loss of appetite ; disgust for drinks ; constant in-
284 DISEASES OF THE ORGANS AND TISSUES
clination to move about, to grasp objects violently,
and to make pressure against the abdomen ; empty
eructations ; pains in the back and loins, especially
semilateral ; obstinate constipation, or small and loose
evacuations.
Mental and moral symptoms. — Most intense anguish
and agitation ; dejection ; extreme restlessness and de
sire to move about ; fear of speedy death.
Administration. — From the first to the sixth dilution
may be employed according to the age, sex, constitu
tion, temperament, and severity of the disease. A
dose may be given every half hour in urgent cases,
until amendment or medicinal aggravation occurs, to
be resumed and repeated as the exigencies of the case
may require.
Plumbum. — On account of the very marked and
decided specific action of lead upon the colon and
ileum, whether introduced into the blood through the
stomach, rectum, lungs, or skin, this drug is peculiarly
appropriate for the treatment of some of the varieties
of colic. The practitioner will, of course, avoid ex
hibiting it in that variety of colic which has been
caused by the absorption of lead. The following are its
External indications. — Rigidity and contraction of
*the abdominal muscles ; hard ridges, or elevations in
the abdomen ; borborygmus ; frequent expulsion of
offensive flatus ; eructations ; tremblings, jerkings, or
cramps of the limbs ; face and skin pale, bluish, or
yellow ; surface cold, and covered with clammy
sweat ; mouth dry or moist, and clammy ; pulse weak,
and somewhat frequent ; body bent double.
Physical sensations. — Violent constructive, shooting,
or pinching pains in the umbilical region ; constant
and urgent desire to eructate and expel flatus ; chilli
ness or shuddering during the paroxysms : sensation
of faintness ; torpor, numbness, stiffness, and weak
ness in the limbs ; desire to press the abdomen against
something hard ; extremities cold ; dizziness ; sweet
ish or bitter taste ; thirst ; vomiting of bilious or faecal
matters ; pressure and cramps in the stomach ; obsti
nate constipation ; evacuations, scybalous and difficult
to expel ; shooting pains in the loins, and back, and
limbs ; cramps in the feet, excessive agitation and
restlessness.
CONNECTED WITH THE DIGESTIVE SYSTEM. 285
Mental and moral symptoms. — Very great anguish
and uneasiness ; melancholy ; discouragement ; im
patience.
Administration. — Same as Colocynth.
Nux vomica is very useful in colic, arising from tor
por of the liver, indicated by deficient secretion of
bile, indigestion, flatulence, &c. It is also useful in
flatulent colic, occurring in dyspeptic subjects after
the use of improper articles of food. In cases where
nux is indicated, the face is pale or yellowish, the
stools, previous to the attack, light and clay-coloured,
the abdomen distended, there are frequent eructations,
hiccough, sharp and cramp-like pains in the stomach
and bowels, rumbling in the bowels, giddiness, sen
sitiveness of the stomach and abdomen when pressed
upon.
Administration. — This medicine may be used at the
second or third attenuation ; a dose once in half an
hour to two hours until relief is obtained.
Arsenicum is specific in colic pains coming on in
regular paroxysms, and attended with decided remis
sions. In extreme cases, it may also be resorted to
with advantage, where the powers of the system have
been exhausted, and other remedies seem to be inca
pable of arresting the disease. The first to the third
potency may be used, and repeated as circumstances
appear to require.
Chamomela is advised by Hahnemann in the colics
of pregnant and parturient women, of new-born in
fants, and of children during dentition. It is also re
commended for the colics of nervous and hysterical
females. If this medicine does not afford the desired
relief, resort may be had to hyoscyamus, stramonium,
or senna.
Administration. — A dose of the third to the sixth
dilution every hour or two as long as necessary.
Veratrum, cocculus, and colchicum, will often prove
valuable in spasmodic and flatulent colic occurring in
nervous and hysterical females, and in persons of a
mild and phlegmatic temperament. In instances
where the above described remedies do not corres
pond, let the indications of these articles be considered.
Pulsatilla is principally useful in colics arising from
286 DISEASES or THE ORGANS AND TISSUES
the abuse of crude, esculent vegetables, unripe fruits,
and abuse of fat and greasy articles of food. The
pains are very severe, and usually occur a few hours
after eating, attended with borborygmus, and the
expulsion of large quantities of flatus. We have often
seen the most prompt relief follow a single drop of
the tincture, and we have rarely been obliged to re
peat the dose more than two or three times.
Phosphorus will apply to cases occurring in persons
of a feeble organization, who have been weakened
by long-continued gastric affections, and especially for
those who are afflicted with disease of the mesenteric
glands. A dose of the third trituration may be ad
ministered every two hours until relief ensues.
SECTION XIII.
ASIATIC CHOLERA.
When the Asiatic cholera first pursued its destruc
tive course amongst the millions of Europe and Amer
ica, the disciples of the ancient school of medicine
stood aghast and almost powerless before the awful
scourge, their best resources often hastening rather
than retarding the work of the destroying angel.
Destitute of an accurate or reasonable system of
practice, without any definite rules of action, or any
true knowledge of the operation of medicines, the al
lopath brought to the treatment of the malady his
vague, indefinite, and uncertain remedial theories ;
and in contemplating the numerous and contradictory
modes of treatment advised and adopted by different
eminent persons of this description, — the ridiculous,
and often fatal experiments, by means of which they
hoped to guess out and blunder on to some actual reme
dy — we are forcibly reminded of the entire worthless-
ness and unsoundness of their system. Here was a vio
lent and relentless enemy, seizing its victim with un
wonted energy, and pursuing its deathly course with
rapid strides — one requiring active, prompt, and de
cided processes to stay its fatal ravages, — and what
course did the allopath adopt in the fearful crisis ? Did
he attack symptom after symptom with medicines
which possessed specific, uniform, and decided effects,
CONNECTED WITH THE DIGESTIVE SYSTEM. 287
and thus repel the invader step by step 1 Did he ad
minister his stimulants, opiates, mercurials, and coun
ter-irritants with that confidence which an exact
and correct system of medicine must naturally inspire ?
Let their results and confessions everywhere answer.
It is universally conceded, at the present time, that
homoeopathy is far more efficient in the treatment of
cholera than any other mode of practice. During
its prevalence in Europe, from 1831 until its disap
pearance, the average mortality of cases under this
treatment was about one in twelve, while under allo
pathic treatment, the average was one in three. In
Germany, Russia, France, and other European king
doms where our system had become known, even dis
tinguished gentlemen of the old school were forced to
admit its vast superiority over their own system ; and
it was undoubtedly this superior efficacy and success
which caused so many distinguished men of Europe to
investigate the claims of the doctrine of " similia si-
milibus" renounce the fallacies of Hippocrates and
Galen, and throw their influence on the side of truth.
Being a disease of extreme violence, and having a
tendency to run its course with great rapidity, there
was no time to apply remedies according to the prin
ciple contraria contrariis, nor would its severity per
mit the additional waste of strength and nervous
energy which ever follow opiates, stimulants, and
counter-irritants. A positive specific, a real antidote,
could alone reach the seat of the disease, and arrest
its progress ; and to the disciples of Hahnemann is
due the credit of bringing forward these specifics, and
demonstrating to the world their tremendous power
and efficiency over this world-wide scourge.
Diagnosis. — Asiatic cholera varies much in its mode
of attack, violence, and duration. It may seize its
victim in such a manner as to produce an immediate
prostration of strength, together with most of those
symptoms which indicate an almost total loss of vital
ity, as a sunken and cadaverous expression of counte
nance, small and almost imperceptible pulse, surface
of a bluish tinge, and cold, cramps in the calves of
the legs and fingers, burning in the stomach and
throat, extreme anguish or stupidity, vomiting, diar>
288 DISEASES OF THE ORGANS AND TISSUES
rhoea, and an almost entire loss of power over the
voluntary muscles. Other cases set in with vertigo,
humming in the ears, oppression and burning pain at
the pit of the stomach, nausea, vomiting, griping, and
purging of a liquid resembling " rice water," which
are soon succeeded by oppression of the chest, diffi
culty of breathing, cramp-like pains in the extremities
and abdominal muscles, intense thirst, great loss of
strength, bluish colour of the lips, nails, and skin,
pulse almost imperceptible, hippocratic countenance,
delirium, cold, icy skin, profuse sweats, weak, hoarse
voice, and sometimes sopor, with eyes half open and
fixed, with partial or total loss of consciousness. A
few or the whole of these symptoms may be present
in any given case, according to the constitutional, pre
disposing, and exciting causes which may exist.
Causes. — A. peculiar subtle" poison, capable of being
conveyed by currents of wind from place to place,
either dissolved in aqueous vapour, or in some other
manner, and possibly, by attaching itself to articles of
clothing, &c., capable of communication in this
way. Whether this infinitesimal, imponderable mor
bific agent is generated during the prevalence of some
peculiar conditions of the atmosphere, from vegetable
or animal matters in a state of partial or total decom
position, or from some other source, is as yet a matter
of speculation. Like most other of the more potent
agents in nature, the particles of the poison are in so
minute a state of subdivision, and so subtilely diffused
in the air, that in the present imperfect condition of the
sciences, we are entirely unable to investigate or appre
ciate their nature. That the cause or agent is material,
however, no one can for a moment doubt ; for it must
be something or nothing ; if it is the former, it must be
composed of minute particles or atoms of matter,
which, by being absorbed, produce those specific ef
fects which constitute cholera. If it is contended that
the cause is not material, but simply a property of
matter; something spiritual, unreal, intangible, and
yet capable of producing powerful impressions ; we
say proofs of this view are wanting, and we reason
upon fallacious, if not absurd data. We hear much
said respecting the "properties of matter" when ab-
CONNECTED WITH THE DIGESTIVE SYSTEM. 289
struse subjects are the topics under consideration, and
this unmeaning phrase serves the purpose of explain
ing everything which is obscure, and cannot be ex
plained by the existing knowledge concerning the
nature of certain imponderable substances. Proper
ties of matter are merely effects produced upon the
organism by actual contact of material atoms, and
must never be substituted or confounded with the
agent — the morbific cause itself. Let medical men,
therefore, confess their ignorance respecting the
causes and physical character of those imponderable
atoms, which so often contaminate the atmosphere,
and by being absorbed into the blood, induce those
baneful specific diseases which so sorely afflict man
kind.
Therapeutics. — Dr. Lobethal, of Germany, who had
charge of a large cholera hospital (allopathic) during
the prevalence of the epidemic in 1831, and who
treated an immense number of cholera patients homce-
opathically in the summer of 1847, and again in 1819,
observes : " It has been reserved to the ' specific '
healing art, generally known under the name of ho
moeopathy, to stand the test of practical observation,
and to demonstrate its superiority in combatting this
fearful disease, (cholera,) the appearance of which,
followed by an immense number of well substantiated
cures, has tended in the highest degree to the spread
of the new healing art. In 1831, 1 learned from experi
ence that the various methods of treatment pursued
in the old school, in spite of all the science on which
it was based, led, on the average, to very unfavourable
results ; whereas in 1848 and 1849, by adopting the
homoeopathic treatment, / lost but few out of a very
great number of patients."
When the cholera is preceded by nausea ; loss of
appetite ; constant borborygmus ; violent thirst ;
slight febrile symptoms ; frequent thin watery dis
charges ; absence of pain in the bowels, and other
symptoms, generally known under the term " chole
rine" Dr. Lobethal has derived marked benefit from
the use of phosphoric acid, repeated every two or three
hours until the symptoms are better. If the above
symptoms are attended with coated tongue, vomiting,
13
290 DISEASES OF THE ORGANS AND TISSUES
debility, and indigestion, ipecac., of the third dilution,
is required.
When cholera has actually made its appearance, a
remedy which covers the exact symptoms of the case,
ought to be immediately exhibited. Our best reme
dies are verat., ars., cup., camph., canth., curb. v.
In the forming stage of cholera, and in cholerine,
with cramps in the calves of the legs, give tincture of
camphor ; " and for aching or burning in the epigas
trium, ac. phos., ars., cup., phos., ver. ; for rumbling in
the belly, ac. phos., ver., phos. ; for diarrhoea, ac. phos.,
tors., ip., phos., sec., sulph., ver." — (Nusser).
In the third stage, or collapse, ars., phos., verat.,
carh. v., laurocer., &c., are to be used.
During the prevalence of the epidemic in England
and France in 1848-9, and in America in 1849, almost
every individual experienced unusual intestinal irri
tation and disposition to diarrhoea. In the large cities,
especially, very few exceptions to this rule could be
found. Even the most strict regard to diet, and
avoidance of all exposure, was no security against '
this weakness and rumbling of the bowels, and a cer
tain lassitude and uneasiness which constantly at
tended it. Most of these cases subsided without any
serious disturbance ; others passed into cholerine, which
could generally be controlled when promptly taken in
hand ; while those cases which were neglected, or im
properly managed, usually terminated in cholera. In
rare instances, individuals would be attacked sudden
ly and violently, without any apparent premonitory
symptoms, but cases of this description have almost
invariably occurred in those whose constitutions were
impaired from intemperance, disease, o-r who had
been deprived of proper repose, by mental application,
excitement, fear, &c.
Dr. Hencke found camphor a positive specific in the
spasmodic form of cholera. " when the patients were
suddenly taken with rigor, and even cold in the back,
which was soon followed by faintness and weakness,
sinking sensation in the stomach, vertigo, nausea^
arching, contracting puiv. in the epigastrium, gagging,
vomiting, spasms in the calves, general tonic spasms,
disappearance of the natural warmth, therefore cold-
CONNECTED WITH THE DIGESTIVE SYSTEM. 291
ness of the hands and the whole body, depression of the
pulse, which could hardly be felt, lividity of the lips,
anxious expression of the countenance, &c., sometimes
diarrhasa." Dr. H. advises that the patient be well
covered, and dry heat applied to his body and limbs,
and that strong spirits oi% camphor be given in drop
doses every five minutes, until reaction occurs, warmth
returns, and perspiration sets in. Dry frictions may at
the same time be employed. As soon as we observe
signs of reaction, we must either omit the remedy, or
if the urgency of the case demands further remedial
means, give the camphor at the first or second dilution
until reaction is fully established. It was a very com
mon occurrence for patients to be taken in the night,
generally after midnight, with cramps in the stomach,
nausea, vomiting and purging of a watery fluid, with
out pain or effort on the part of the patient ; sense of
exhaustion and debility, and great anxiety. If these
symptoms were not speedily arrested, there soon suc
ceeded extreme prostration, almost constant vomiting
and purging of rice-coloured fluid ; contractive or
burning pains in the stomach ; coldness of the sur
face ; spasms or cramps in the calves and other parts
of the body ; countenance sunken, altered in expres
sion, and indicative of extreme anxiety ; voice feeble
or hoarse ; marbled appearance of the skin ; skin
shrunken and shrivelled ; cold breath ; cold and pasty
sweat ; burning thirst ; marked loss of power in the
circulatory and respiratory organs.
Camphor, veratrum, arsenicum, cuprum, acid hydro-
cianic, secale, laurocerasus, and carlo veg., have been
most successful in the epidemic of 1848 and 1849,
both in Europe and America.
Dr. Griesselich, of St. Petersburgh, considers vera
trum by far the most important remedy in cholera. In
Russia, this remedy was so notoriously efficacious,
" that the homoeopathic drug shops were overrun by al
lopathic physicians and druggists to procure it."
Dr. G. found acid phos. exceedingly efficacious in
cholerine.
In fully developed cholera asphyxia, as it occurred
at Breslau in. 1848 and 1849. Dr. Schweikert, of Bres-
lau, found ver. first, and secale first, a drop every five
292 DISEASES OF THE ORGANS AND TISSUES
minutes, in alternation, more commonly indicated than
any other remedies. When asphyxia took place, Dr.
S. relied upon ac. phos., either alone or in alternation
with secale ; but in a few cases he used linct. phos.,
first or second dilution, with success.
Probably in no part of America did the cholera
rage with more violence in 1849, than at Cincinnati,
Ohio. Two physicians, Drs. Pulte and Ehrmann, treat
ed 1,116 genuine cholera patients, in all stages of the
disease, and with a loss of only thirty-five — two Amer
icans and thirty-three Germans. These gentlemen
also treated 1,350 cases of cholerine, and many cases
of malignant dysentery, after the subsidence of the
cholera, without the loss of a single patient. Of the
cases of genuine cholera asphyxia, 538 had vomiting,
diarrhoea, and cramps — 70 of these being in a state
of collapse, and the balance, 578, presented with vo
miting and rice-water discharges. These last being
subjected to prompt treatment, were speedily re
stored without the supervention of more serious symp
toms.
The treatment adopted by Drs. P. and E. was as
follows : in the first stage of the malady, tinct. camphor,
one or two drops every five minutes for one to two
hours, or until profuse perspiration ensued, which
should be kept up for several hours, care being taken
to keep the patient well covered. This remedy was
perfectly effectual in almost every case during the
early part of the disease. In the second stage, when
cramps, general prostration, and rapid sinking of the
.physical energies appeared, veratrum when the cramps
were in the lower extremities ; cuprum, if in the
bowels and breast, and secale cornutum, were relied
on. The latter medicine was found of eminent serv
ice in elderly people. In cases of decided collapse,
arsenicum and carlo veg. were the remedies em
ployed. Mild frictions of the extremities with the
hands alone, were the onlv external means made use
of.
In St. Louis, New Orleans, and other cities of the
west and south, a similar plan of treatment was
adopted by homoeopathic physicians, and with results
CONNECTED WITH THE DIGESTIVE SYSTEM. 293
which, for the most part, compare favourably with
those detailed by Drs. Pulte and Ehrmann.
During the prevalence of cholera, much may be
done towards warding off its attacks, and thus disarm
ing it of a portion of its terrors. The most important
rule which we would inculcate, is the cultivation of
presence of mind under all circumstances, cheerful
ness, contempt of danger, and strict temperance and
regularity in all the habits of life. Other precautions
are, frequent ablutions, so as to ensure perfect clean
liness, and a healthy action of skin, careful ventilation,
frequent changes of body linen, moderate and agree
able exercise, good company, and a clear conscience.
As a prophylactic, many European authors have
highly recommended camphor in tincture, in doses of
a drop or two once or twice in twenty-four hours.
From its extensive application as a medicinal anti
dote, we are disposed to believe that it may possess
virtues of a high order, as an antidote against the
poison of cholera.
The medicines which have been found, upon the
whole, most serviceable in the treatment of this ma
lady, as it occurs in different localities, and in its
various forms, are, veratrum, cuprum, arsenicum, and
camphor. Symptoms often supervene, also, which call
for the exhibition of secede cornutum, nux vomica,
phosphorus, phosphoric acid, ipecacuanha, and carlo
veg.
Veratrum. — External indications.— General coldness
of the surface of the body ; cold perspiration on the
face, and sometimes over the whole surface ; skin
white, or of a bluish tinge; bluish colour around the
nails, and of the lips ; contraction of the muscles of
the extremities ; nausea, vomiting, and purging ; face
pale, sunken, and hippocratic ; nose cold and pointed ;
breath cold ; pulse almost imperceptible ; general
appearance of prostration.
Physical sensations. — Painful cramps in the limbs ;
sensation of extreme debility and faintness ; nausea ;
vomiting and purging ; vertigo and confusion in the
head ; constrictive pain in the throat ; oppressive and
burning pain at the pit of the stomach ; painful con
traction of the abdomen ; oppression in the chest ;
294 DISEASES OF THE ORGANS AND TISSCJES
fulness and pressure in the region of the heart ; ob
structed respiration ; rumbling and griping in the
bowels ; thirst ; great restlessness.
Mental and moral symptoms. — Excessive dejection,
anguish and despair ; constant disposition to turn from
side to side, or otherwise to change position ; some
times loss of memory and stupidity.
Administration. — The first to the sixth dilution should
be employed, a dose every ten, fifteen, or twenty
minutes in urgent cases, and extending the intervals
as the symptoms demand.
Arsenicum alb. — External indications. — Skin of a
pale or bluish colour, and cold ; face wan and cada
verous ; eyes sunken; nose pointed; general expres
sion of countenance unnatural and indicative of pain ;
lips bluish, or black and dry ; trembling or stiffness
in the limbs ; skin cold and covered with a clammy
sweat, or dry and shrivelled ; pulse very weak, irregu
lar, and trembling ; watery discharges by vomiting
and purging.
Physical sensations. — Burning pain in the stomach,
worse after vomiting ; cramps in the calves of the
legs, toes and fingers ; dizziness ; nausea ; frequent
inclination to vomit and purge ; rumbling in the
bowels ; ringing in the ears ; feeling of extreme de
bility ; very great restlessness and agitation ; intense
thirst, which affords but slight relief; spasmodic con
traction and burning in the throat and oesophagus ;
cramp-like pains in the stomach and abdomen ; fre
quent desire to pass water, or retention of urine ; diffi
culty of respiration, with hoarseness ; general sensation
of coldness and loss of vitality.
Mental and moral symptoms. — Intense anguish, anx
iety and discouragement ; dread of death ; constant
uneasiness ; confusion of ideas ; delirium.
Administration. — The lower potencies of this medi
cine should be used, and in urgent cases, the doses
may be repeated once in fifteen or twenty minutes un
til the symptoms yield. Some writers extol it highly
in alternation with veratrum, and where either of these
remedies does not afford prompt relief by itself, by all
means let them be given in alternation.
Camphor. — It is not alone as a prophylactic that this
CONNECTED WITH THE DIGESTIVE SYSTEM. 295
medicine has been advised. Hahnemann made use of
it in all stages of cholera, but he found it particularly
successful in the first stages of the malady, when ver
tigo, extreme weakness, cramps in the calves of the
legs and muscles of the abdomen, burning and heat
in the stomach, convulsive distortion of the features,
eyes sunken, face and hands bluish and cold, anguish,
dulness, loss of consciousness, and hoarse ness, were pre
sent. It has been found most useful in those cases
which have been almost entirely unattended with nau-
sea,vomiting, and diarrhoea. It has in some instances re*
stored patients who were apparently in articulo mortis.
Secale corn, and cuprum are appropriate remedies
when there are distortion of the limbs; jerking and con
vulsive movements in the limbs ; great desire to sleep ;
great coldness in the back, abdomen, and limbs ; cold
clammy perspiration ; suppression of urine, and pains
in the extremities.
Nux vomica may be used when the principal suffer
ings seem to be in the stomach, as anguish and op
pression at the pit of the stomach, and severe spasms
in the stomach, also tenesmus with an increase of the
spasms at each discharge.
In some severe cases where the previous remedies
have failed to afford relief, the practitioner should take
into consideration, phos., phos. acid, ipecac., carb. veg.
canth., sulph. ether, chloric ether, fyc.
SECTION XIV.
SPORADIC CHOLERA. CHOLERA MORBUS.
Diagnosis. — Distressing nausea and vomiting, with
great fulness and oppression at the stomach ; severe
griping or colic pains in the umbilical region ; frequent
watery discharges; twisting and cramps in the ab
dominal muscles and calves of the legs ; tongue slight
ly furred ; pulse quick and weak ; countenance ex
pressive of suffering and anxiety.
Causes. — Torpor of the liver ; obstruction of the bil
iary ducts ; unripe or decayed fruits ; crude esculent
vegetables ; constant exposure to a cold and damp at
mosphere.
Therapeutics. — The most efficacious medicines in the
296 DISEASES OF THE ORGANS AND TISSUES
treatment of this complaint, are, veratrum, arsenicum,
colocynth, chamomela, pulsatilla, ipecacuanha.
Veratrum alb. — External indications. — Countenance
pale or bluish, cold and disfigured ; eyes sunken ; nose
pointed ; mouth parched, lips dry or cracked, and of a
dark colour ; surface cold, or hot and dry ; contraction
of the muscles of the abdomen and extremities ; pulse
frequent and very weak ; cold sweats ; evacuations
watery, light, greenish, or brownish.
Physical sensations. — Severe cutting pain in the um
bilical region ; violent nausea and vomiting, with
diarrhoea ; burning sensation in the stomach ; speedy
rejection of food or drinks ; stomach and abdomen
tender on pressure ; cramps in the abdomen and in
the extremities ; extreme prostration ; great oppres
sion and distress at the stomach ; intense thirst ; gen
eral uneasiness.
Mental and moral symptoms. — Excessive anguish ;
fear of death ; despair of recovery ; delirium.
Administration. — This medicine may be used at from
the first to the third dilution — a dose every half hour,
in urgent cases, until the requisite impression is pro
duced. In slight cases, two or three doses of the third
dilution, at intervals of two to four hours, will suffice
for the cure.
Arsenicum alb. — The indications for this remedy are
somewhat similar to those of veratrum, but it is espe
cially useful when the disease is violent from the com
mencement, attended with an almost immediate pros
tration of strength ; trembling of the limbs ; severe
burning pain in the stomach ; constant nausea and
vomiting ; diarrhoea ; ringing in the ears ; vertigo ;
giddiness ; great anguish and restlessness ; skin dry
or cold, and bluish ; hippocratic countenance ; eyes
sunken, dim, and suffused ; thirst ; distress from swal
lowing the blandest liquids ; tongue and lips dry, dark,
and cracked ; breath cold ; excessive anguish, anxiety
and despair.
Administration. — Same as veratrum.
Colocynth will occasionally serve us in cases attend
ed with moderate nausea, vomiting and purging ; vio
lent cramp-like pains in the region of the navel ;
cramps in the extremities ; tongue loaded with a yel-
CONNECTED WITH THE DIGESTIVE SYSTEM. 297
low fur ; bitter taste in the mouth ; great dejection
and anxiety, and general restlessness. It may be
given at the third potency every two hours, gradually
lengthening the intervals as the pains subside.
Chamomela has been highly recommended when the
disease has been " excited by a fit of passion." The
symptoms which point to this remedy, are, frequent
vomiting of food, or of mucous, sour, or bitter substan
ces ; great anguish and pressure at the pit of the stom
ach ; cramps in the calves of the legs when lying down ;
tearing and cutting pains in the abdomen.
Administration. — Same as colocynth.
Pulsatilla is chiefly useful in cholera which has been
induced by the abuse of fat, crude, and indigestible
food. In cases of this description, it is often promptly
serviceable, administered at the first or second dilu
tion, as circumstances require.
Ipecacuanha is the remedy when vomiting is the
most prominent and troublesome symptom. It may
be given at the third potency every half hour, until
the symptoms abate — afterwards, as the exigences of
the case demand.
SECTION XV.
DIARRHCEA.
Diagnosis. — Looseness of the bowels, with or with
out griping pains ; discharges feculent, or thin and
watery ; respiration, circulation, skin, and the organs
generally in a natural condition.
Causes. — Dentition, worms, irritating articles of
food, cold, mental emotions, hectic fever, repelled
eruptions, epidemic influences, &c.
Therapeutics. — For the diarrhoeas which supervene
during dentition, suitable remedies will be found in
chamomela, ipecacuanha, dulcamara, mercurius, sulphur,
calcarea card., rheum, coffea, and aconite.
When the disease has been caused by the use of fat
and indigestible food, and the discharges are pulta-
ceous, mucous, liquid, or foetid, attended with burning
or excoriation of the anus, nausea, regurgitation, colic,
and aggravation of the symptoms in the night, p-ulsa-
satilla is appropriate.
Duknwara is a remedy of the very highest value,
13*
298 DISEASES OF THE ORGANS AND TISSUES
in diarrhoeas, and it covers a much wider range of
symptoms than has generally been attributed to it.
It has been employed principally in watery diarrhoeas,
which have arisen from cold ; but we have used it
with distinguished success in bowel complaints which
have been caused by teething, worms, repelled erup
tions, errors in diet, &c., and in which there were mu
cous, slimy, bilious, greenish and sanguineous evacua
tions. Dr. Rummel expresses the opinion that nine-
tenths of all cases of diarrhoea may be cured with dul
camara, and we are satisfied that he is not very wide of
the mark. It may be employed in the first or second
dilution, and given in drop doses, with water, after each
evacuation.
If the complaint appears to be characterized by
prominent biliary derangement, specific medicines
will be found in mercurius, chamomela, pulsatilla, nux
vom., arsenicum, and bryonia.
If the discharges are mucous, slimy, or sanguineous,
and preceded and accompanied by griping and tenes-
mus, our best remedies are, acid nit., and mercurius sol.,
in alternation. We may use the third attenuations, —
a dose after each evacuation. Other remedies are,
arsenicum, ipecacuanha, sulphur, acid phos., acid sulph.,
petroleum, colocynth, veratrum, phosphorus, and dulca
mara.
\. For the diarrhoeas which supervene during dentition,
suitable remedies will be found in chamomela, calcarea
carb., ipecacuanha, rheum, magnesia carb., coffea, dul
camara, mercurius, sulphur.
When bowel complaints arise in consequence of
violent mental emotions, we employ chamomela, ignatia,
colocynth, veratrum, antimonium crud., coffea, mix vom.,
phosphorus, arsenicum, pulsatilla, and ferrum.
If the discharges can be traced to the presence of
worms, we give sulphur, cina, spigelta, aloes, mercurius,
nux vom., carbo veg., ferrum.
For the diarrhoeas which occur during hectic fevers,
especially if connected with a scrofulous dyscrasia, the
appropriate medicines are, sulphur, calcarea carb., acid
nit., acid phos., iodine, ferrum, mercurius, sepia, katmia.
For painless chronic diarrhoea, we suggest phospho
rus, ferrum, veratrum, china, natrum mur., acid nit., sul
phur, lachesis, lycopodium. graphite, arsenicum.
CONNECTED WITH THE DIGESTIVE SYSTEM. 299
When the diarrhoea occurs during dentition and is
connected with some chronic cutaneous affection, it
will be necessary to exhibit sulphur, either alone, or
in alternation with dulcamara, chamomela, or mercurius.
It has not unfrequently occurred to us, that after mer
curius, chamomela, and other apparently appropriate
medicines have failed in arresting the relax, a few
doses of sulphur has either put a stop to the malady,
or placed the system in such a condition that it will
respond readily to the remedies first employed.
Administration. — Our attenuations may range from
the first to the sixth — one drop, if a dilution, or a grain,
if a trituration, after each evacuation.
SECTION XVI.
HAEMORRHOIDS. PILES.
Diagnosis. — This very common and troublesome
complaint will probably demand the attention of the
physician more frequently than any other single mala
dy ; nor, when we consider the causes which originate
it, and their almost constant and universal prevalence,
shall we be surprised at this. Any cause which
operates upon the rectum in such a manner as to im
pair the integrity of its vascular and muscular struc
tures, may induce the disease. The effects in these
cases are, a permanent dilatation of the veins, and a re
laxation of the mucous membrane of the part, causing
tumours of various sizes, at the verge of the anus, and
within the rectum, and in some instances, a protrusion
of a portion of the rectum itself. When this last result
obtains, we are presented with the disease known as
prolapsus ani.
Hsemorrhoidal tumours may be external or internal —
hard or soft — sensible or insensible. Their general
appearance, in regard to colour, size, &c., will depend
much upon the amount of inflammation present, the
causes which have been in operation, and the length
of time which has elapsed since the commencement
of the malady. During a *' fit of the piles," the tumours
are usually red, or purple, inflamed, and painful, the
pain is of a severe kind, aggravated to an almost in
tolerable degree when at stool, and accompanied by
'^TI®%\
± THE *J\
UNIVERSITY 3
300 DISEASES OF THE ORGANS AND TISSUES
tenesmus and frequent discharges of blood. The lo
cation and character of the pains vary much in dif
ferent cases, being sometimes confined to the tumours
themselves, and at others extending upwards into the
intestines, or into the perineum, down the thighs, &c.
The pains may be itching, burning, aching, throbbing,
darting, or shooting — constant, or only when at stool,
or on sitting down.
When the mucous membrane of the rectum is much
relaxed, we almost always have as a complication,
prolapsus ani. Although this complaint sometimes
originates independently of any haemorrhoidal en
largements, in the majority of cases the two diseases
are conjoined ; and this is explicable from the circum
stance that the causes of both are generally the same.
The most common of these causes is habitual constipa
tion, induced for the most part, by the reprehensible
practice of inattention to daily alvine evacuations.
We have before observed that the protracted presence
of indurated faecal matters in the rectum gives rise to
a semi-paralytic condition, which impairs the tone of
the parts, and thus induces constipation, piles, and pro-
lapsus ani. The evils, then, to which this condition of
the lower bowels give rise, may be summed up as fol
lows : first, constipation, and the numerous and grave
consequences which often result from it. in the form of
determinations of blood to the brain, lungs, and intes
tinal canal ; also mania, hypochondria, neuralgia,
dyspepsia, bowel affections, colic, fistula in ano, &c. ;
second, piles, and its train of unpleasant symptoms ;
third, prolapsus ani.
Causes. — Other causes of these affections, in ad
dition to the one already mentioned, are abuse of ca
thartics which operate specifically upon the lower
portion of the intestinal tube, excessive exercise on
horseback, long continuance in tho standing posture,
or in certain other constrained positions, protracted
bowel complaints, general debility, dyscrasias, seden
tary habits, indulgence in highly seasoned food, wines
and liquors.
Therapeutics. — The first object with the physician in
the treatment of haemorrhoids, should be to ascertain
the cause or causes upon which the malady depends.
CONNECTED WITH THE DIGESTIVE SYSTEM. 301
so that immediate and efficient measures may be
taken to remove them. In a majority of instances the
disease is unquestionably connected with constipation ;
which should therefore receive a due share of atten
tion. Nothing can remove the torpid condition of the
bowel, upon which the constipation depends, unless all
indurated faecal matters be removed daily, in order
that sufficient time may elapse to enable the debilita
ted parts to recover their impaired tone. The first
step necessary to secure this result, is to adopt suitable
dietetic regulations. In many instances this alone
will suffice to regulate the bowels, and thus to remove
all traces of the haemorrhoidal affection. Amongst
the articles of food which we particularly commend
in these cases, is bread made from unbolted wheat. A
liberal and daily use of this highly nutritious substance,
and of other articles of a similar character, with an
occasional indulgence in ripe and wholesome fruits,
will often surpass our most sanguine expectations in
abolishing diseases of the rectum. Should these sim
ple means alone prove ineffectual after a thorough trial,
we may then call in the aid of enemeta of cold water.
This last resource will rarely disappoint us, provided
the case is recent, and the cause has not been very long
in operation. When the ha^morrhoidal tumours are
much inflamed and very painful, great service will fre
quently be derived from external applications of cold
water, and in some instances, of ice enclosed in a linen
cloth, and applied to the parts as long as may be
deemed expedient. In troublesome cases of prolapsus
ani, also, these applications and injections will some
times afford prompt relief.
The medicines which are entitled to the highest con
sideration in the complaints under consideration are,
mix vcmica, sulphur, rhus toxicod., sepia, bryonia, ly co-
podium, opium) pulsatilla, aloes, carbo regetabilis, and
calcarea carb.
Nux vomica is appropriate when the disease has
been caused by inactive and sedentary habits, high
living, or the depressing mental emotions, and is at
tended by constipation, prolapsus, and general loss of
power over tho muscular structure of the recturr.
302 DISEASES OF THE ORGANS AND TISSUES
The second or third trituration may be employed — one
grain every night as long as is deemed expedient.
Sulphur is well adapted to cases occurring in indi
viduals tainted with syphilis, scrofula, psora, or mer
cury. If the piles bleed frequently and profusely, and
there exists considerable inflammation of the surround
ing mucous membrane, with darting pains up the
bowel, tenesmus, discharges of mucus or of faecal mat
ters mixed with blood and mucus, this medicine will
generally prove effective. It should be given at the
third attenuation — one grain morning and evening
until the desired effect is produced.
Rhus tox., in alternation with sulphur or nux, has
been eminently useful in piles and prolapsus conjoined,
which appeared to be connected with some latent impu
rity of the blood. We are accustomed to use the first or
second attenuations in these cases — giving a dose daily,
and changing the medicine every other week.
When the haemorrhoidal tumours protrude, and are
inflamed, red and painful, with profuse haemorrhage
during each evacuation, we may consider acid nit.,
acid mur., aloes, calcarea carb., and sepia.
If the disease arises during pregnancy, and constipa
tion is unusually obstinate, we advise pulsatilla, opium,
bryonia and platina.
Administration. — This malady responds most satis
factorily to the first, second, and third attenuations —
given in grain or drop doses once or twice in twenty-
four hours.
SECTION XVII.
ACUTE HEPATITIS. INFLAMMATION OF THE LIVER.
Diagnosis. — When the disease occupies the convex
surface of the liver, we shall have fulness and severe
pain in the region of the liver, increased on pressure,
either of a sharp, aching, or burning character ; pains
extending into the chest, under the clavicle, between
the shoulder blades, into the top of the right shoulder,
and sometimes down the arm ; short, dry cough ;
dyspnrea ; difficulty in lying upon the left side ; hot
and dry skin ; thirst ; scanty and high- coloured urine ;
constipation ; clay-coloured evacuations ; full, hard,
CONNECTED WITH THE DIGESTIVE SYSTEM. 303
and frequent pulse ; headache, and more or less men
tal disorder. If the inflammation is in the concave
portion of the liver, we shall have, in addition to the
symptoms already enumerated, distressing nausea and
•^omiting ; tongue covered with a white or yellow fur ;
bitter taste ; urgent thirst; an aggravation of the pain
in the hypochondrium on pressure ; urine scanty, and
of a dark yellow or saffron colour ; eyes and skin
tinged with yellow ; bowels constipated or relaxed ;
pains in the back and limbs ; ideas confused ; mind
clouded or delirious.
In most instances of acute hepatitis, it is highly
probable that the peritoneal covering of the liver is
implicated to a greater or less extent, and this may
serve to render the pains more severe, and the accom
panying symptoms more violent.
CHRONIC HEPATITIS.
Diagnosis. — The symptoms of chronic liver com
plaint are somewhat similar to those of the acute
form, but much more mild in their character. For
example, the pain in the right hypochondrium is dull,
heavy, and dragging, that in the shoulder and arm of
a vague and heavy kind; the skin is somewhat hot
and dry ; the tongue furred ; the countenance and
albuginea yellow ; the urine and perspiration of a
dark or yellowish colour ; the bowels costive, some
times alternating with relax ; evacuations light ; oc
casional cramp-like pains in the stomach ; great
weakness and loss of energy throughout the entire
system ; inclination to sleep a good part of the time ;
trembling of the knees on the slightest exercise ; de
jection and indifference to life ; enlargement and in
duration of the liver.
Causes. — This is a disease of hot rather than of
temperate latitudes, and may arise from a too free use
of animal food, stimulating drinks, and other articles
abounding in carbon. As the blood passes through
the liver, its office is to separate the carbon, <fcc.,
which is not wanted in the system. We can, there
fore, readily perceive how prone this important organ
must be to be overtasked, in so rarefied a tempera
ture, unless the utmost care is taken to retain the or-
304 DISEASES OF THE RESPIRATORY ORGANS.
gans in a healthy state, as well as to avoid highly
seasoned animal food, stimulants, &c,
The chronic form of hepatitis often follows, and is
a consequence of dyspepsia. Indeed, there are but
few, if any, cases of the latter disorder, which are
entirely unattended with derangement of the liver.
Want of exercise, depression of spirits, misfortune,
sudden suppression of perspiration, accustomed dis
charges, &c., may often exercise a powerful influence
in inducing this disease.
Therapeutics. — Aconite, mercurius, china, eupatorium,
perfoliatum, mix vomica, bryonia, sulphur, conium, ta
raxacum, pulsatilla, lachesis.
Administration. — The medicines may be used from
the first to the sixth attenuations, and repeated, in
acute cases, every two, four, or six hours according to
circumstances. In chronic hepatitis, a dose of the
appropriate specific should be given once or twice in
the twenty-four hours, at the same time inculcating
the importance of rigid dietetic regulations.
In chronic hepatitis, there is a peculiarly dry and
harsh state of the skin, and on this account we strong
ly advise the daily use of cold sponging, or bathing, to
be followed by vigorous exercise, in order that the
pores may be opened, and the cutaneous functions
thus restored.
CHAPTER XXIII.
DISEASES OF THE RESPIRATORY ORGANS.
GENERAL OBSERVATIONS.
In all of our investigations touching affections of
the lungs and their appendages, whether acute or
chronic, a few preliminary inquiries are essential, in
order that we may be able to arrive at accurate opin
ions respecting the seat, nature, treatment, and proba-
bl? termination of each particular case. Although
DISEASES OF THE RESPIRATORY ORGANS. 305
we are to be governed, as a general rule, by symptoms,
yet certain constitutional or accidental peculiarities,
connected with a given train of symptoms, might in
duce us to select one specific in preference to another,
which was equally homoeopathic to the disease. Thus,
cough, copious expectoration, pains in the chest, and
tickling in the throat, &c., which had followed imme
diately upon the suppression of some chronic eruption,
might be completely covered by bryonia, ipecacuanha,
phosphorus, phosphoric acid, staphysagria, silicea, &c.,
so far as the mere symptoms are concerned ; but who
would not prefer, in cases of this description, sulphur,
or some other specific which would have a tendency
to reproduce the eruption, while, at the same time, it
would be perfectly homoBopathic to these indications ?
So in regard to temperament, habits of life, occupa
tion, medicinal symptoms, age, sex, climate, &c., our
remedies should always be selected in such a manner
as to bear upon any occult miasm, or other latent
cause which may be operating upon the organism,
and thus either directly or indirectly aggravating and
complicating the apparent symptoms.
When called to treat lung diseases, therefore, let
the physician inquire, first, Is there any hereditary pre
disposition on the part of the patient to scrofula, con
sumption, dropsy, erysipelas, nettle-rash, syphilis, &c.?
Second, Is the chest well developed and symmetrical, so
that the lungs can have ample room to perform their
functions? Third, Is the subject, during health, put
out of breath by slight exertion ? Fourth, Has the ma
lady supervened on, or shortly after the disappear
ance of an eruption ? Fifth, Do all parts of the chest
dilate equally and properly during inspiration, and is
the respiration natural during health ?
Respecting this last question, it is proper to observe
that a difference of opinion exists amongst authors,
Laennec considering respiration natural •' when the
anterior and lateral parts of the chest dilate equally,
distinctly, yet moderately, during inspiration, and
when the number of inspirations, in a state of repose,
is from twelve to fifteen in the minute ;" while An-
dral, Broussais, Miiller, Forbes, and others, suppose
that Laennec has placed the mean number of inspi-
306 DISEASES OF THE RESPIRATORY ORGANS.
rations too low. These gentlemen assure us that the
" mean average of respirations is more than sixteen
or eighteen in the minute, in the healthy adult, and
that most persons in health breathe from eighteen to
twenty-four times in a minute." From much obser
vation in reference to this subject, we are disposed to
adopt the opinion of Laennec, rather than that of
Andral, &c., and therefore estimate the mean number
of respirations in a healthy adult at fifteen or sixte-en
in a minute.
We beg leave in this place to recommend, in strong
terms, the use of auscultation and percussion in the
investigation of chest diseases, if for no other reason
than to form an accurate diagnosis and prognosis. In
order to acquire skill in the use of the stethoscope,
percussion, &c., a patient and careful course of study
and practice upon both healthy and diseased subjects,
is indispensable. By this means, the physician will be
able to pronounce with certainty the seat and nature
of the malady, and its probable termination. As we
advance in our descriptions of the different affections
of the respiratory organs, we shall point out the pe
culiar sounds elicited by percussion and auscultation,
in the several varieties of disease.
SECTION I.
CATARRH, CORYZA, OR COLD.
Diagnosis. — This disease consists of an inflamma
tion of the mucous membrane lining the frontal
sinuses and the nostrils. It usually commences with
lassitude, a sense of coldness, slight shiverings, sneez
ing ; dull and heavy feeling in the head, succeeded in
a short time by lachrymation ; more or less obstruc
tion in the nose ; sense of fulness, or pain in the
region of the frontal cavities ; swelling or inflamma
tion of the nostrils ; nose dry and tender, or constant
discharge of mucus, of a mild, burning, or corrosive
character ; eyes inflamed, watery, and sensitive to
light ; buzzing, or roaring in the ears ; drowsiness,
heaviness, and dull pains in the head ; chills, alter
nating with flushes of heat ; pains and soreness in the
limbs and bones ; thirst, worse in the night ; cold
DISEASES OP THE RESPIRATORY ORGANS. 307
sores upon the lips ; stupid, languid, and indifferent,
or irritable and ill-humoured.
When the inflammation extends to the mucous
membrane of the throat, larynx, and trachea, it has
received the name of
INFLUENZA, (iNFLUENZE DELL ARIA,) OR, INFLUENCE OF
THE COLD.
In addition to the symptoms just enumerated, we
have, febrile symptoms ; hoarseness ; severe cough,
either dry and racking, or hollow and loose ; wheezing,
or difficult respiration ; impaired appetite ; soreness,
oppression, or stitches in the throat and chest on
coughing ; incapacity for mental or physical exertion ;
bowels constipated or relaxed.
Sometimes the inflammation appears to extend to
the membrane of the thorax and of the bronchial
tubes, giving rise to sharp, stitching pains, or a sen
sation of rawness in these parts, severe and painful
chest cough, thick, tenacious, and semi-purulent ex
pectoration, oppression of the chest, and difficult res
piration. In these instances, the inflammation is of a
lower grade than obtains in acute bronchitis, pleuritis,
or laryngitis, and, consequently, the symptoms are
more slight and less dangerous. In some cases, the
disease commences with soreness and burning in the
scorbiculus cordis, which gradually extends to the
chest and throat, nose and head, when coryza, ob
struction of the nose, and other signs of influenza,
manifest themselves.
Therapeutics. — The chief remedies are, nux, arseni-
cum, mercurius, dulcamara, ammonium, carbon, ipecac
uanha, causticum, belladonna, bryonia, pulsatilla, chamo-
mela. When the complaint is attended with marked
febrile excitement from the first, our treatment should
always commence with aconite ; but when the local
symptoms manifest themselves without much consti
tutional disturbance, we may commence with the ap
propriate local specific immediately.
For common cold, with evening chills, sneezing,
free discharge of thick, yellow, green, or offensive
matter, loss of smell, taste, and appetite, pain and
fulness in the region of the frontal sinuses, pulsatilla
is specific.
308 DISEASES OF THE RESPIRATORY ORGANS.
Drs. Shue and Taft have found tartar emetic, at the
first or second attenuation, the most efficient remedy
in the early part of the influenzas which usually pre
vail in this region.
Nux vomica, ipecacuanha, and arsenicum, will also
be found appropriate in many instances of the com
plaint, as it occurs in this latitude.
My friend, Dr. Shue, has employed sabina with
excellent success in several cases of chronic catarrh
occurring in females. The cases which have responded
the most promptly to this remedy, have been those in
which the catarrhal discharge appeared to alternate
with leucorrhcea, disappearing when the fluor albus
was profuse, and returning again at every suppres
sion or material diminution of the discharge.
If hoarseness be an attendant symptom, and pro
ceeds from an inflammation of the mucous membrane
of the larynx, causticum, bryonia, capsicum, carbo veg.,
mercurius, rhus tox. and belladonna are our best re
medies.
When the hoarseness has arisen from loss of tone
of the nerves of the throat, an alternation of carbo
veg. with mix vom., will usually prove curative. Bel
ladonna, causticum, and mercurius will also occasion
ally demand our attention.
" Hoarseness, with bruised and pricking sensation
in the larynx, coryza, moist cough, pain in the chest,
and complete loss of voice, responds to pulsatilla." —
Croserio.
Administration. — We usually prescribe from the first
to the third attenuations ; the doses to be repeated, in
severe cases, once in two to four hours, according to
circumstances, and in chronic cases, once or twice
daily.
SECTION II.
CYNANCHE TRACHEALIS. CROUP.
Until the present century this disease was confound
ed with hooping cough, asthma, and bronchitis, and
the fatal cases were supposed to be violent forms of
one of these maladies.
In the hands of the allopath, croup has ever proved
DISEASES OF THE RESPIRATORY ORGANS. 309
a most formidable and fatal disease. Acting, in the
application of their remedial measures, only indirectly
upon the part affected, by venesection, leeches, blisters,
emetics, mercurial cathartics, expectorants, &c., it is
not a matter of surprise that they are so often baffled
in subduing a malady of so violent a character as the
one under consideration.
It is especially in diseases of this nature, that the
truth and value of a system of practice may be satis
factorily tested ; for it is here that a prompt, efficient,
and specific remedy is imperatively demanded, in order
that the progressing inflammation may be at once ar
rested, and the patient saved. These are the cases
which try the truth and soundness of a theory : which
convince the public, — who appreciate facts, if they do
not comprehend abstruse theories — which school pos
sess the knowledge and skill that should command
approbation and support. On the result of these tests
we are willing to rest the claims of homcBOpathy.
Indeed, the records of the homoeopathic practice show
conclusively a large balance in its favour, over the
other systems, in all maladies of an acute as well as
chronic character.
Croup rarely occurs after the age of seven years,
and may therefore be accounted a disease almost pe
culiar to childhood. Its seat is the mucous membrane
of the larynx, trachea and bronchia, and sometimes
of the fauces and palate.
Diagnosis. — Croup may with propriety be divided
into ^wo principal varieties, viz. : first, the false,
pseudo, or non-membranous ; comprising, however, un
der this head, the spasmodic, catarrhal, and slightly
inflammatory kinds ; and second, the true, or mem
branous croup.
Some recent writers have distinguished^bwr distinct
varieties, each one forming a distinct and independent
disease, and not liable to run into either of the other
forms.
It is doubtless true that these several varieties do
often exist as distinct and clearly defined maladies,
and that the remedies homoeopathic to these varieties
are also entirely distinct, but we are by no means cer
tain that the different forms do not run into each other.
310 DISEASES OP THE KESPIRATORY ORGANS.
Be this as it may, it is of importance that an accu
rate knowledge should be acquired respecting the
seat, nature and symptoms of the malady in all its
forms, so that we can exhibit without delay a remedy
which shall be truly specific and homoeopathic. First,
False or non-membranous croup.
Spasmodic croup usually makes its appearance sud
denly, with considerable difficulty of breathing, noisy
and wheezing inspirations, a short, dry, hoarse cough,
occurring but rarely, and an entire absence of febrile
symptoms.
Catarrhal croup also commences suddenly, with a
" croupy cough, hoarse voice, shrill, wheezing, and
sonorous inspirations, oppression and tightness at the
chest, and sudden attacks of dyspnoBa ; but in a few
days the croupy character will wear off of itself, leaving
simple catarrhal symptoms only." — (Watson.)
In the simple inflammatory croup, in addition to the
loud, harsh, and wheezing respiration, and hoarse,
croupy cough, we have usually sore throat, some thirst,
and nightly febrile exacerbations. This, like the pre
ceding variety, will often wear off spontaneously,
leaving only some slight symptoms behind.
An important peculiarity of all the varieties of false
croup, consists in the suddenness of their attacks.
Children may retire to their beds in the most perfect
health, and yet in an hour or two be disturbed from a
sound sleep with an apparently alarming attack of
croup. It is important, however, that all should be
aware that these seemingly dangerous cases are much
less to be dreaded than those which make their ap
pearance in a more slow and insidious manner, as will
be seen by the following description of the true croup.
In all of the varieties above described, although there
may be very difficult, laboured, anxious, and wheezing
respiration, hoarse, harsh, and croupy cough, hoarse
voice, and the patient may seem to be in imminent
danger of suffocation, yet the fact that the attack has
occurred suddenly, and that the cough bears no re
semblance to the dreadful metallic cough of real croup,
will afford us sure indications of its nature, and enable
us to assure those interested that the attack will
speedily be subdued.
DISEASES OF THE RESPIRATORY ORGANS. 311
Second, True or membranous croup is usually ushered
in with the ordinary symptoms of catarrh, as chilliness,
sneezing, some soreness of the throat, hot skin, thirst,
slightly accelerated pulse, hoarse voice, and some little
impediment in respiration. At this period a whistling
or " buzzing sound may be heard at the rima glottidis,
by placing the ear upon the back of the neck, or over
the larynx." — (Ware.) Even at this early period the
commencement of the false membrane may be ob
served upon the tonsils, and sometimes upon the uvula
and pharynx, \vhich gradually increases in thickness
and strength unless the peculiar inflammation be ar
rested.
As the disease advances, the febrile symptoms in
crease, the respiration gradually becomes more la
boured and difficult, the inspirations, particularly after
coughing, being slow, sawing, sonorous or ringing,
while the expirations are quick, the cough is dry and
gives forth a metallic sound, the voice becomes more
shrill, the pulse is frequent and small, the expression
of countenance swollen and anxious, the head is thrown
back, the extremities are cold, while the rest of the
body retains its exalted temperature, there is often a
profuse perspiration, until finally the respiration is so
much impeded that the blood is but slightly oxygena
ted, the cheeks and lips become livid, the eyes red and
sunken, the pulse extremely small and frequent, the
whole organism prostrated, and the child expires in a
state of asphyxia or suffocation.
In membranous croup the inflammation is of a pe
culiar character ; for from the very commencement
of the attack, the mucous membrane continues to pour
out coagulable lymph, which becomes adherent to the
parts affected, forming the tough artificial tube known
as the false membrane. We believe that the progress
of this fictitious formation is never entirely arrested
until a healthy medicinal inflammation is made to
supersede the peculiar morbid action.
" The false membrane which so frequently forms on
blisters, is, of itself, sufficient to prove that it is much
less to the degree than to the nature of the inflamma
tion, that we are to attribute this concretion or coagu
lation of pus in certain cases." — (Laennec.)
312 DISEASES OF THE RESPIRATORY ORGANS.
Causes. — A cold and damp atmosphere, wet feet,
and exposure to the air which blows from seas and
lakes. It appears to be necessary also that there
should be a certain predisposition on the part of the
patient, in order to contract the disease, since all of
the children of some families are constantly liable to
its attacks, while those of other families, constantly
exposed to precisely the same influences, are exempted.
This predisposition may frequently be traced back
through several generations, while in other families
the reverse is true, no instances of the malady having
ever been known to exist in them. Croup sometimes
follows as a sequence of scarlatina, measles, &c., and
has by some writers been confounded with the former
disease, and from this circumstance has originated the
idea of its contagious nature.
Therapeutics :
Spasmodic croup. — Aconite, spongia, hyoscyamus,
belladonna, nux, musk, cuprum, ipecacuanha, camphor
and lobelia inflat.
Catarrhal croup. — Aconite, tartar emetic, spongia,
hepar sulph, drosera, lachesis, sambucus, chamomile, and
nux.
Simple inflammatory croup. — Aconite, spongia, hepar,
tartar emetic, phosphorus, iodine, and belladonna.
True or membraneous croup. — Kali,bichrom, bromine,
ammonia, caustic, hepar sulph., argentum nit., sambucus,
spongia and iodine, senega, tartar emetic.
We introduce the following excellent indications for
the employment of spongia, hep. sulph., bromine, caustic
ammon., bichrom, and potash, arranged by several ho-
moBopathic physicians in Pressburgh, and translated
by Ch. J. Hempel, M. D., for the Homooeopathic Ex
aminer.
SPONGIA — CROUP.
" Hollow cough ; with expectoration ; with pain in
the chest and trachea ; roughness in the throat ;
(night-cough with weeping expression) ; breathing ag
gravated, as from a plug in the throat, slow or quick ;
panting ; larynx painful, as if from pressure — worse
when touched ; scratching, burning, and constrictive
sensation in the larynx ; painful feeling of swelling in
B1SBASES <OF THE RESPIRATORY ORGANS, 313
£he cervical glands near the larynx and trachea;
stinging in the throat and sensation in the outer
parts of the neck, as if something were pressing out,
morning and evening ; painful tension, on the left side
of and near the apple of Adam, when turning the
head to the right side ; the eyes are sunken ; the urine
deposits a thick, grayish- white sediment; general
•morning sweat; pulse quick and hard; drowsiness;
lassitude of the whole body; out of humour; every
thing puts him out of humour, even talking and an
swering questions."
KEPAR CROUF.
" Violent fits ef cough, as if one would suffocate or
vomit; deep; occasioned by tightness of breathing;
fiusky, accompanied with painful soreness of the
chest at every turn of cough ; violent ; the air rushing
violently against the larynx, which causes a pain in
that part ; scraping ; scratching ; with mucous ex
pectoration ; the cough being occasioned by titillation
in the throat, or by a scraping in the trachea;
increased unto vomiting by a deep inspiration;
weakness of the organs of speech and chest, pre
venting her from talking aloud; short breathing;
pressure in the throat, occasioning a constrictive feel
ing, as if he should be suffocated ; urine pale, clear
while being emitted, afterwards becoming turbid and
thick, depositing a white sediment: or flocculent, tur
bid while being emitted; dark-yellow : burning dur
ing emission ; great, unconquerable drowsiness ; pro*
fuse sweat day and night ; viscid, profuse night sweat ;
sweat before midnight; sad; apprehensive; inclined
to weep,"
BROMINE €ROTJF,
** Formation of pseudo membrane in the larynx and
trachea ; spasm in the larynx occasioning suffocation ;
cough with croup-sound, hoarse, wheezing, fatiguing,
not permitting one to utter a word ; accompanied with
sneezing ; with violent suffocative fits ; respiration
characterized by mucous rattling ; wheezing ; alter
nately slow and suffocative, and hurried and superfi
cial ; laboured ; painful ; oppressed ; gasping for air ;
14
314 DISEASES OF THE RESPIRATORY ORGANS.
heat in the face ; increased secretion of urine ; pulse
rather hard ; slow at first, afterwards accelerated."
CAUSTIC AMMONIA CROUP.
" Deep, weak voice ; fatiguing, interrupted speech ;
increased secretion of mucus in the bronchi ; violent
cough, with copious expectoration of mucus, especially
after drinking ; difficult, rattling, laboured breathing ;
stertorous breathing ; suffocative fits ; spasm of the
chest."
BICHROMATE OF POTASH CROUP.
" Symptoms approach gradually and insidiously ; at
first, slight difficulty of breathing when the mouth is
closed ; slight elevation of temperature ; pulse irregu
lar and intermittent, or frequent and small ; as the
disease progresses, the difficulty of breathing increas
es ; the sound of the air as it passes through the
trachea is shrill, whistling, as if it passed through a
metallic tube ; voice hoarse ; cough not frequent, but
hoarse, dry, barking, and metallic ; deglutition painful ;
tonsils and larynx red, swollen, and covered with an
appearance of false membrane ; after a time, breath
ing affected in part by the action of the abdominal
muscles, and those of the neck and shoulder blades ;
head inclined backwards ; breath offensive ; finally,
diminished temperature of the skin ; prostration ;
stupor."
The medicines, of which the pathogeneti? symptoms
we have here detailed, are those which are most
completely specific against croup. It is true that the
other articles alluded to, as aconite, iodine, belladonna,
nux, hyoscyamas, sambucus, tartar emetic, lachesis, phos
phorus, drosera, arsenicum, &c., cover many of the
symptoms usually present, especially in non-mem
braneous croup, but they cannot be considered posi
tive and reliable specifics against the disease fully de
veloped. So far, however, as certain special indica
tions are concerned, these medicines may often be em
ployed with very great advantage,
The following is Dr. Bosh's method of treating
croup : " If the disease begins, as it frequently does,
with an inflammatory fever, then I give first, accord-
DISEASES OF THE RESPIRATORY ORGANS. 315
ing to circumstances, every quarter to half hour, one
to two drops of aconite (the dilution second or third,
depending upon the age), and then I let the child rest
from one to two hours, when I give the remedy, which
I found in my practice to be the main remedy, spongia,
first, second, or third dilutions, according to the seve
rity of the disease ; eight drops in four ounces of
water, of this every quarter to half hour, or, in less in
tense cases only every hour, half a table spoonful. If
the disease has proceeded further, and paralytic signs
are perceptible (by continued obstruction of the respi
ration, congestions to the brain, &c.), then I give
spongia alternately with phosphorus. If, notwith
standing these means, the disease increases, I give
spongia in alternation with tartar stibiatus."
Tartar emetic is not only useful in the early stage of
croup, but it is also indicated when there are signs in
dicative of partial paralysis of the pneumo-gastric
nerve, viz., face livid and cold ; cold sweat on the
forehead or body ; respiration exceedingly difficult,
short, hoarse, shrill, or whistling ; head thrown back ;
pulse small and rapid, or feeble and slow ; great
weakness, anxiety, and uneasiness ; difficulty in swal
lowing ; short, hoarse, and barking cough ; disposi
tion to sleep. The remedy should be given in the first
attenuation, and the dose repeated every twenty or
thirty minutes, until relief is obtained.
In spasmodic croup, Dr. Dunsford relies upon aconite,
hyoscyamus and belladonna.
When, in addition to high febrile excitement, the
local croupy symptoms are urgent, we must alter
nate the proper local specific with aconite. In this
way we may often give spongia, or hcpar sulph. and
aconite advantageously in the first instance, or tartar
emetic and aconite. When the disease obstinately re
sists aconite, spongia, hepar sulph., tartar emetic, both
alone and in alternation, we may consult phosphorus,
lachesis, sambucus, senega pol., &c.
As we progress in the knowledge of medicinal sub
stances, a still greater number of pure specifics will
undoubtedly be added to our Materia Medica.
Before taking leave of this subject, we ask attention
particularly to the employment of one remedy pre-
316 DISEASES OF THE RESPIRATOKY ORGANS.
viously named, for the cure of membraneous croup.
We refer to the nitrate of silver as a direct application
to the affected membrane. For some years, we have
been in the habit of employing a strong solution of
this salt, by means of a sponge moistened with it
and introduced into the larynx ; and in several in
stances the most satisfactory results have followed.
This remedy has been used to a considerable extent
by French allopathists, and within the last few years
by a number of American physicians, and in many
cases they have saved life when every other means
had failed. The principle on which it cures, how
ever, is strictly homoeopathic, for it is due solely to
the medicinal, or artificial action of the remedy, that
the morbid croupy inflammation is superseded, and the
false membrane gradually destroyed and expelled.
It may be used in any stage of true croup, and will
sometimes succeed in effecting a cure when every in
ternal remedy has failed.
A little tact will enable the physician to apply the
solution to the larynx, or trachea, in an efficient man
ner, and with perfect safety. For minute directions
upon the subject, the reader may consult " Trousseau
and Belloc," and Dr. Green's work upon Bronchitis,
&c., published in New York.
Administration. — In the treatment of croup, we
generally employ the lower potencies. In regard to
the repetition of doses, no definite rules can be given,
but the practitioner must be guided by the variety of
the disease, the severity of the symptoms, and the
effects of his remedies.
SECTION III.
A CUTE BRONCHITIS.
This complaint is of most frequent occurrence in old
age and in childhood. Its seat is in the mucous mem
brane of the bronchia, but authors assure us that the
bronchial inflammation is always accompanied with
considerable " sanguineous congestion of the lungs,"
Effusion into the substance of the lungs, is peculiarly
apt to occur in this disease, and it is to this circum
stance that its danger is to be attributed.
DISEASES OF THE RESPIRATORY ORGANS. 317
Diagnosis. — Constriction and aching sensation, ex
tending over the whole chest ; breathing very much
oppressed, quick, anxious, irregular, laboured ; the
voluntary muscles of respiration often called into
play ; expectoration at first dry, soon becomes viscid
and frothy, and sometimes streaked with blood ; more
or less cough, hoarse and painful in children ;
throbbing pain in the forehead and aching pain in the
eyes, aggravated on coughing ; face red or pallid ;
tongue moist, and covered with a white fur ; bowels
costive ; temperature of the skin nearly natural, but
sometimes hot and dry ; pulse at first but little in
creased in frequency, becoming, as the disease ad
vances, very rapid ; urine scanty and high coloured ;
vertigo ; rattling in the throat and chest ; wheezing
respiration. As the malady approaches towards a fatal
termination, the skin becomes suffused with a cold per
spiration ; the cheeks and lips pale and livid ; the ex
tremities cold ; rattling and sense of suffocation in the
throat ; extreme prostration and complete insensi
bility.
The peculiar respiration (the mucous rale or rattle
of Laennec) which is so apparent in bronchitis, is ow
ing to the " passage of air through the diseased secre
tion of the air-passages, and may be heard by placing
the ear to the chest, long before it becomes so severe
as to be distinguished by any other means.7' — Mclntosh.
The inflammation in bronchitis is of a much more
intense character than that which is present in catarrh
or influenza, and there is always more or less sanguin
eous congestion of the lungs. Many of the more ur
gent symptoms of the complaint are due to this last
circumstance, like the great difficulty of breathing ;
the painful sense of tightness ; stricture and oppres
sion in the chest ; wheezing respiration ; severe cough ;
pallid countenance ; vertigo ; pain in the head, &c.
During the progress of this disease, the substance of
the lungs often becomes hepatized.
CHRONIC BRONCHITIS.
Chronic bronchitis is at the present time an exceed
ingly common and fashionable disease. From the
fact of its occurring for the most part in clergymen,
318 DISEASES OF THE RESPIRATORY ORGANS.
lawyers, and other public speakers, it has acquired
" caste" and therefore, it may be that every slight af
fection of the respiratory apparatus is now denomi
nated bronchitis. It occurs at all periods of life, and in
general, is insidious in its approach, though it occa
sionally succeeds to acute bronchitis.
When the disease follows an acute attack, the pa
tient will be left with some cough ; expectoration of
viscid or puriform sputa ; dyspnoea on the slightest ex
ertion ; nocturnal exacerbations of fever ; emaciation,
and in some instances hectic symptoms.
The stethoscope usually gives us the sound of the
crepitous ronchus at certain points, and now and then
over the whole chest, while at the same time the re
spiratory murmur may often be heard.
Those cases which come on more insidiously, will
be often found complicated with chronic laryngitis, in
dicated by hoarseness of the voice ; raw or scraping
sensation in the larynx, and extending over the chest ;
copious expectoration of opaque or purulent sputa,
which affords relief to the patient ; hoarse, hollow, and
painful cough ; increased susceptibility to changes of
temperature ; night sweats, and general debility.
When the expectoration is copious, we shall have
the crepitous ronchus, either at isolated points or over
the whole chest ; but if there is no expectoration, then
the sound which will be elicited by auscultation, re
sembles snoring, and has been termed " dry sonorous
rattle ;" or in some instances, the " sibilous rattle" like
the chirping of birds. Laennec also mentions a " click
ing" sound, which he compares to the action of a valve.
Percussion affords us no aid in our investigations of
bronchitis, but pressure with the hand upon the chest,
will often enable us to detect the mucous rattle with
out difficulty.
Causes. — Protracted exposure to cold ; alternations
from heat to cold ; inhalations of dust and other irrita
tive substances ; insufficient clothing, and improper
exposure of the throat and neck, after much talking,
public speaking, or singing.
We believe that one great cause of the very fre
quent occurrence of chronic bronchitis, may be
found in the reprehensible fashion of shaving the
beard. That this ornament was given by the Creator
DISEASES OF THE RESPIRATORY ORGANS. 319
for some useful purpose, there can be no doubt, for in
fashioning the human body, he gave nothing unbecom
ing a perfect man, nothing useless, nothing superfluous.
Hair being an imperfect conductor of caloric, is ad
mirably calculated to retain the animal warmth of
that part of the body which is so constantly and ne
cessarily exposed to the weather, and thus to protect
this important portion of the respiratory passage from
the injurious effects of sudden checks of perspiration.
When one exercises for hours his vocal organs, with
the unremitted activity of a public declamation, the
pores of the skin, in the vicinity of the throat and
chest, become relaxed, so that when he enters the
open air, the whole force of the atmosphere bears upon
these parts, and he sooner or later contracts a bron
chitis ; while, had he the flowing beard with which
his Maker has endowed him, uncut, to protect these
important parts, he would escape any degree of ex
posure unharmed.
The fact that Jews and other people who wear the
beard long, are but rarely afflicted with bronchitis and
analogous disorders, suggests a powerful argument in
support of these views.
Therapeutics. — The medicines most worthy of con
sideration in the treatment of acute and chronic bron
chitis, are, aconite, tartar emetic, belladonna, bryonia,
hepar sulphur, carbo vegetabilis, spongia, ammonium
carb., rhus tox.. mercurius, sulphur, sambucus, arseni-
cum, digitalis, hyoscyamus, pulsatilla.
As in other inflammatory diseases, aconite is also in
dicated in acute bronchitis, whenever there is a rapid
and full pulse, hot skin, and other symptoms indicative
of a high state of febrile excitement. It may be given
at the second or third potency, and repeated every
hour until a decided amendment ensues.
Tartar emetic is indicated when there are severe
paroxysms of coughing, with suffocating obstruction
of respiration ; wheezing respiration ; mucous ron-
chus ; very great shortness of breath, with anxious
oppression at the chest ; great anxiety and agitation ;
palpitation of the heart ; pain in the back and loins ;
pressure on the eyes ; pains in the head ; thirst.
Administration. — A grain of the first trituration of
320 DISEASES OF THE RESPIRATORY ORGANS
tartar emetic, to four ounces of water — -a tea spoonful
every oner two, three, or four hours,, as the urgency of
the symptoms may demand.
In cases of acute bronchitis in which the predomin
ant symptoms are, oppression and weight at the chest ;
short, anxious and rapid respiration ; shaking, spas
modic cough, and decided cerebral disturbance from
the commencement, belladonna is- our most valuable
remedy.
Administration. — Like that of aconite.
The indications which point to bryonia, are, nead-
ache aggravated by movement ; pressure in the eyes ;
dryness in the throat ; respiration difficult, short, and
anxious ;• pressure on the chest as if from a weight ?
stingings in the chest ; cough with stingings in the
chest, or with severe aching pains in the head. In the
acute attacks of children, with suffocative cough, very
great oppression at the chest, exceedingly difficulty
rapid, and anxious or sighing respiration, loud mu-
eous ronchus, rapid pulse, hot skin, thirst, great
agitation and anxiety? this remedy is also especially
called for.
It may be exhibited at the first to the sixth potency,
and frequently repeated until the disease subsides.
The practitioner may sometimes alternate it with
aconite, with benefit. Pulsatilla is indicated in bron
chitis when the cough is dry in the first part of the
complaint, but soon becomes moist, " with easy ex
pectoration of abundant yellow and bitter, or saline
and disgusting matter ; sometimes with nausea or
retching, or a sensation of reversion in the stomach, as
if about to vomit. The cough occurs principally at
night, on lying down ; proceeds from a tickling or
itching in the larynx, or by scraping and dryness in
the trachea, accompanied with fatiguing pains in the
abdomen, and stitches in the back, shoulders, sides, or
chest, and relieved on rising up in bed." — (Croserio).
It may be given in the same manner as bryonia.
In chronic bronchitis, characterized by anxious,
hoarse, and wheezing respiration, much aggravated
on lying down ; attacks of suffocation, which force the
patient to throw the head back, in order to take
breath ; dyspnoea ; dry, rough, and hollow cough ;
DISEASES OF THE RESPIRATORY ORGANS. 321
cough, with expectoration of mucus ; hoarseness of
voice ; exacerbations of fever in the after part of the
day, succeeded by night sweats, hepar sulph. is an
important specific. In cases which seem to have been
connected with suppression of salt rheum, or other
eruptive disease, or metastases of arthritic inflamma
tions, this remedy should always be borne in mind.
It is also useful in those cases which threaten to
terminate in tubercular consumption.
The third trituration may be used : a dose from
two to four times in twenty-four hours.
When bronchitis is complicated with angina trache-
alis, we may resort to spongia tosta with confidence,
either alone or in alternation with hepar sulph. If
febrile symptoms run high, these remedies should be
preceded by aconite.
When suffocation is threatened from loss of tone
and power .of the respiratory organs, rendering them
incapable of expelling the morbid secretions which
obstruct the free entrance of air into the pulmonary
structure, ammonium carb., rhus tox., sambucus, arseni-
cum, digitalis, hyoscyamus, and stannum, are worthy of
careful examination. In making our selection from
these medicines, regard should not only be had to the
actual symptoms present, but to the temperament,
hereditary predisposition, and the remote cause of the
malady. For example, if in any given case the in
dications actually present, point equally to hepar
sulph. and rhus tox., but the attack was found to be
connected with a repelled eruption, our choice would
evidently rest upon the former medicine ; while if
the disease was found to be dependent upon an
arthritic habit, rhus would be the appropriate re
medy.
In the last stages of acute bronchitis, when there is
danger that the malady will run into the chronic
form, sulphur has been highly lauded by many emi
nent practitioners. If the disease occurs in persons of
lymphatic constitutions, and subject to eruptions,
swelling of the glands, &c., this remedy can scarcely
be dispensed with during the progress of the attack.
For the profuse and debilitating sweats which now
and then occur during the continuance of the symp-
14*
322 DISEASES OF THE RESPIRATORY ORGANS.
toms, valuable specifics will be found in mercurius,
acid nit., and acid phos. Many physicians have com
mended carbo veg. in the strongest terms, in chronic
bronchitis, and it has doubtless effected many excel
lent cures. It may be used at the third attenuation,
one grain once or twice daily.
SECTION IV.
PNEUMONIA. LUNG FEVER.
Diagnosis. — The symptoms of lung fever vary so
much in different cases, that an exact portrait, which
shall be recognisable in all instances, can hardly be
given. The signs, however, which are more particu
larly characteristic, may be enumerated as follows :
dull or deep-seated pain, or a tightness in the chest ;
frequent short cough, with expectoration of a viscid,
tenacious matter, of a yellow, green, or pale colour,
sometimes tinged with blood ; rapid and difficult
respiration ; inclination for the most part to lie upon
the affected side, or the back ; great heat of the skin ;
headache ; thirst ; rapid and full pulse (though this
last symptom is by no means uniformly present, as
the disease sometimes runs on to a fatal* termination
without any material change in the pulse) ; general
restlessness ; urine scanty, very red, and sometimes
scalding. The character of the expectoration during
the first stage of the malady is supposed by many to
afford a characteristic mark of the malady ; and it is
from this circumstance that Laennec has denominated
the sputa expectorated, pneumonic, or glutinous.
During the stage of hepatization, the sputa diminish
in quantity, become lighter in colour, and less trans
parent, until finally, when the third stage supervenes,
expectoration of almost a mucous character occurs.
Sometimes pneumonia is complicated by more or
less derangement of the biliary organs, when we shall
have superadded to the lung affection the symptoms
indicative of such derangement. This variety of the
complaint is termed bilious pneumonia.
M. Saucerotte recognises a kind of latent pneumo
nia, depending upon a certain peculiarity of constitu
tion, entirely unlike ordinary pneumonia, and which
DISEASES OF THE RESPIRATORY ORGANS. 323
seems to commence by the second stage, or that of
hepatization. His description of the disease is as
follows : First, " Premonitory symptoms, either entirely
absent, or of slight importance, consisting of lassitude,
with shivering, loss of appetite, and but little fever."
Second, "Symptoms. The temperature of the skin is
not sensibly augmented ; the pungent heat of ordi
nary pneumonia seldom present ; pulse usually but
little affected ; respiration natural, and no pain in the
chest. Percussion always elicits a dull sound over a
considerable extent, and bronchial respiration is
audible over the same locality. In some cases, slight
crepitation may be heard around the hepatized spot."
Third. " Progress and duration variable. In some
cases we have seen the disease linger for six or seven
weeks. When the case terminates favourably, the
dulness gradually disappears, and the bronchial
souffle is replaced by crepitation ; respiration be
comes more free, and the general aspect of the patient
improves.
Fourth. " Diagnosis. — Pleurisy is the affection with
which latent pneumonia is apt to be confounded. In
chronic pleurisy, however, there is more constantly a
pain in the side, and the region of the dulness varies
with the position of the patient, Apoplexy, and the
bulging of the intercostal spaces, shortly clear up the
diagnosis. The history of the case distinguishes it
from phthisis.
Fifth. " Causes. — For the most part, exposure to
cold."
Although Dr. Saucerotte is a practitioner of the old
school, his sole internal remedy in this affection is
tartar emetic, our own specific in similar cases.
Viewed anatomically, inflammation of the substance
of the lungs presents, according to Laennec, three dif
ferent degrees, or stages, which he designates, first,
engorgement, or congestion ; second, hepatization ;
third, purulent infiltration.
In the first degree, the lung loses in a measure its
crepitous feel, is of a livid colour, and more solid than
natural.
In the second degree, the lung presents the appear
ance of liver ; it is not crepitous, is heavier than in
324 DISEASES OF THE RESPIRATORY ORGANS.
the first degree, and shows a granular appearance when
cut into, or torn asunder. Laennec, Andral, and Louis,
suppose this hepatization to be owing to the con
version of the air-cells into solid grains, by the hard
ening of a concrete fluid, which is poured out during
the inflammation ; while Dr. Williams supposes that
*' these granulations contain no viscid mucus, but con
sist of little bunches of vesicles, which have been ob
literated by the swelling of their membranous tunics,
and the enlargement of their blood vessels."
In the third degree, the external appearance of the
lung is similar to that of the second degree, but of a
lighter colour. The same heavy, hard, and granular
character obtains, but when the lung is cut into, a
yellowish and purulent matter makes its appearance.
*As the disease advances, the granular condition dis
appears, and purulent abscesses take its place.
The phenomena elicited by auscultation and per
cussion, during the stage of engorgement, are the ere-
pitous rhonchus, the respiratory sound being yet audible,
and the ordinary healthy sound on percussion.
As soon as hepatization has occurred, percussion
over the affected part yields a dull sound, and neithjer
the respiratory murmur nor the ere pitous rhonchus
can longer be heard. There are certain other sounds,
like bronchophony, a kind of blowing, &c., which
may exist in certain cases of hepatization, but these
signs are so vague and uncertain, that immense prac
tice is requisite to enable the physician to form an
accurate judgment respecting them.
After the third stage has existed a little time, and
the pus begins to soften, the mucous rhonchus may
be heard in the bronchi. In some instances the pus is
not expectorated or absorbed, but forms an abscess in
some part of the pulmonary tissue. We shall then
Irnve a mucous rhonchus over the sea.t of the abscess,
also pectoriloquy, and what, is termed a *' bronchial
or cavernous cough/'
When the disease terminates favourably, and reso
lution takes place, it will be found that the lungs
gradually and by successive degrees, return to their
original state, as is indicated by the diminution of the
erepitons rhonehns, and the return of the natural re*
DISEASES OF THE RESPIRATORY ORGANS. 325
spiratory sound, when the inflammation had ceased at
the first stage ; also by the reappearance of the cre-
pitous rhonchus, &c., when the malady had progressed
to the second and third stages.
Causes. — Lung fever is a disease peculiar to tem
perate and cold latitudes, and usually occurs during
the winter months. The usual causes are, undue ex
posure to intense cold, sudden suppression of perspira
tion, epidemic influences, and the inhalation of noxious
vapours or gases. Laennec and Forbes assert that
pneumonia is sometimes induced by the bite of the rat
tle snake, (crotalus horridus,) and of other venomous
serpents ; and that it may also arise from the " injec
tion of various medicinal substances into the veins."
These assertions go far to prove a specific operation of
these substances upon the respiratory organs, and may
afford a valuable hint respecting their homoeopathic
application in pneumonia.
Therapeutics. — The prominent medicines for the
treatment of pneumonia, are, aconite, bryonia, bella
donna, tartar emetic, phosphorus, ipecacuanha, sambucus,
sulphur, lachesis, rlius tox., arsenicum, mercurius, acid
phosphoric, arnica.
In the first stage of the disease, when symptoms in
dicative of a high grade of febrile excitement are pres
ent, as hot and dry skin, great thirst, rapid and hard
pulse, scanty and high coloured urine, &c., aconite and
belladonna may be given in alternation, until the in
flammatory symptoms subside. These remedies are
often alone sufficient to break up the disease in this
stage ; and even when they fail of effecting a complete
cure, they generally moderate most essentially the
lever, and mitigate all the other symptoms.
If, after the subsidence of these symptoms, stitches
in the side, difficult and anxious respiration, find trou
blesome cough continue to harass the patient, re
course must be had to bryonia.
When, however, the second stage, or hepatization
has occurred, indicated by dull sound on percussion,
bronchial respiration, &c., we should at once have re
course to tartar emetic or phosphorus.
The external indications which point to the use of
emetic tartar, flre, dull sound on percussion : absence of
326 DISEASES OF THI RESPIRATORY ORGANS.
the respiratory murmur, or bronchophony ; skin cold,
and covered with a clammy sweat ; considerable ex
pectoration of a yellowish or brownish colour, and
mixed with blood ; pulse small, soft and frequent ;
tongue covered with a dry and dark fur, and perhaps
red at the edges.
Physical sensations. — " Great oppression and diffi
culty of breathing ; cough loose, and accompanied
with rattling of mucus ;" — (Midler) — burning under
the sternum, and sometimes as high up as the throat ;
sensation as if the chest were lined with velvet ; want
of air and want of breath previous to the paroxysms
of coughing ; also pneumonia biliosa, with gastric and
bilious symptoms, as yellow tinge of skin ; yellow or
brownish fur upon the tongue ; bitter taste ; nausea
and bilious vomiting ; yellow or dark urine ; headache ;
general sensation of lassitude and debility.
Mental and moral symptoms. — Anxiety ; restlessness ;
confusion of ideas; sometimes furious delirium.
Administration. — A grain of tartar emetic to six
ounces of pure water — a teaspoonful every one, two,
three or four hours as required.
Phosphorus has been highly extolled also in the
second stage of pneumonia, and in certain cases of
pleuro-pneumonia, where aconite and bryonia have
lailed in effecting a cure. Dr. Fleischmann has used it
successfully in all stages of lung fever.
Buchner, Griesselich, Homer, Bosch, and Shellham-
mer, have employed it with advantage when the third
stage had set in with great prostration, livid or hip-
pocratic countenance, sunken eyes, cold, viscid sweats,
tremulous and feeble pulse, dry and dark lips and
tongue, difficult expectoration of a brown or rust
colour, extreme anguish, subsultus tendinum, muttering
or furious delirium, with grasping at flocks, sense of
suffocation, and involuntary stools.
Miiller describes the special pathogenetic symp
toms of phosphorus, having reference to pneumonia,
as follows : " Sticking and violent stitches in various
parts of the chest, left and right side, sometimes ac
companied with burning, in rest and during motion,
especially when sitting and taking an inspiration ;
pain in the chest, especially during an inspiration ;
DISEASES OF THE RESPIRATORY ORGANS. 3S7
itching in the interior of the chest, with dry cough ;
feeling of heaviness in the chest ; anxiety in the
chest, with arrest of breathing, and beating in the
right side of the chest ; great oppression of breathing ;
great shortness of breath ; oppressive tightness, and
tensive sensation in the chest, as if a band were en
circling it ; tension and dryness in the chest ; con-
strictive clawing and pressing in the upper part of
the chest ; loud, rattling breathing ; dry, hollow cough,
without expectoration ; a sort of hacking cough, with
huskiness of the chest, and expectoration of some
mucus ; cough, with expectoration of transparent
mucus, accompanied with tensive pain, and after
wards with sticking pain in the chest; fatiguing
cough, with white, tenacious expectoration ; the ex
pectorated mucus is streaked with blood ; bloody ex
pectoration, with mucus, accompanied with short,
slight cough ; coughing up small clots of pus, with
smarting burning behind the sternum ; sticking pain
in the pit of the stomach when coughing, compelling
one to lay the hand upon the pit ; short breath after
every turn of cough."
From the above it will be seen that phosphorus in
cludes a greater range of symptoms than tartar emetic.
In typhoid pneumonia, especially, it is often of distin
guished service where hepatization has occurred, and
the symptoms point to the third stage.
Administration. — It may be employed at the first,
second, or third attenuation, and the dose repeated
according to circumstances.
In typhoid pneumonia, as well as in cases attended
from the first with great debility and prostration of
the energies of the system, rhus tox. will be found a
remedy of much efficiency, either alone, or in alterna
tion with some other specific. Should the case be
complicated with pains in the chest or side, of a rheu
matic character, rhus rad. may occasionally be em
ployed with advantage. This medicine is usually
given after aconite and bryonia.
Sulphur is an important remedy in certain pro
tracted cases of pneumonia occurring in" psoric or
scrofulous subjects, and which threaten to terminate
in phthisis. Indeed, in most of those cases of chronic
328 DISEASES OF THE RESPIRATORY ORGANS.
pneumonia which seem to have arrived at a fixed
point, the patient neither improving nor apparently re
trograding, we should always bear in mind this pow
erful antipsoric.
When the disease has reduced the patient, notwith
standing our remedies, to a state of extreme prostra
tion, with very short breath on the slightest exertion,
dry and dark tongue and lips, extreme anguish, stitches
in the side, great thirst, diarrhoea, ringing and buzzing
in the ears, arsenicum is the proper remedy. In ex
amples of this description, the remedy should be fre
quently repeated until a decided impression is pro
duced.
If the pulmonary inflammation threatens to run
into gangrene, as will be indicated by fetid and green
ish, or dark expectoration, arsenicum is appropriate,
as are also sometimes carbo veg. and china.
Pneumonia occurring in old and feeble persons, and
attended with symptoms showing a low grade of in
flammatory action, will require the use of phosphorus,
ipecacuanha, sambucus, verairum, mix vom., china, bel
ladonna, lachesis, lycopodium, and cantharis.
Arnica is applicable in pulmonary inflammations
proceeding from mechanical injuries.
The symptoms of pneumonia and bronchitis com
bined, will be covered by tartar emetic, aconite, mercu-
rius, phosphorus, capsicum, bryonia, carbo veg.,pulsatilla,
senega, and nux vom.
We usually select one of the low attenuations, and
repeat the dose once in two, three, or four hours, until
a marked impression is produced upon the symptoms.
SECTION V.
PLEURITIS. PLEURISY.
Diagnosis. — This malady commences with lassitude,
chills, and other febrile symptoms, succeeded in a
short time by the following local phenomena : " The
stitch, dyspnoea, cough, and recumbency on the af
fected side/' — Laennec. Dr. Wurm, of Vienna, main
tains, however, that " the posture of the patient is
usually upon the back." The inspirations are short,
iMpid, arid attended with severe sharp stitches, unless
DISEASES OP THE RESPIRATORY ORGANS. 329
the inflammation be very slight, in which case, but
little alteration will be observed in the breathing ;
there is often experienced a sense of tightness and
oppression at the chest; there is generally little or no
cough unless the lungs or the bronchia are involved,
when there occurs a short and dry cough, with but a
small quantity of glairy expectoration, and very pain
ful ; the pulse is rapid and full ; skin hot and dry ;
urine scanty, and of a deep red or dark colour ; the
pain is almost invariably confined to one side of the
chest, and increased by inspiration, coughing, and
movement ; urgent thirst ; great dyspnoea ; constant
inclination to lie upon the affected side or back ; ab
dominal respiration, and pain in the intercostal spaces
on pressure. These symptoms are speedily succeeded
by others, which indicate that effusion has taken place.
Laennec, Johnson, and Mackintosh believe that effu
sion commences as soon as the inflammation is estab
lished ; while others, equally eminent, contend that a
considerable period elapses before it occurs. But the
weight of testimony seems to be in favour of the opin
ion of the former gentlemen. Amongst the signs
which are characteristic of pleurisy with effusion, are,
increased size of the affected part of the chest, appa
rent to the eye, or by mensuration ; also aegophony,
perceptible by the stethoscope from the commence
ment of the inflammation, or after a moderate quan
tity of fluid has been effused, disappearing when the
effusion becomes very large in quantity, and re-ap
pearing as absorption takes place, and the liquid di
minishes ; dull sound on percussion, and failure of the
respiratory murmur in the affected side.
Should the lungs happen to be involved, the sputa
will be tinged or streaked with blood, and more co
pious than in simple pleuritis. Other symptoms will
also obtain which characterize pleuro-pneumonia.
The effusion in pleurisy may be either of a plastic,
serous, or haemorrhagic character. The severity of
the febrile, and other symptoms, will depend upon the
rapidity of the effusion, and its quality and quantity.
Causes. — Atmospheric vicissitudes, sudden checking
of the perspiration, metastases of rheumatism, erysi
pelas, gout, &c., mechanical injuries, surgical opera-
330 DISEASES OP THE RESPIRATORY ORGANS.
tions upon cancerous and scrofulous parts. We have
witnessed two cases of pleurisy which supervened as
a consequence of surgical operations. One of these
cases occurred after amputation of the thigh for a
malignant disease of the leg, and proved speedily
fatal. The other case came on about two weeks
after excising a large fungous tumour from the breast
of a female, which also proved fatal. Both of these
cases were unusually violent, and ran their course
with very great rapidity. It is worthy of remark, that
in both, the wounds by the operation were progressing
as favourably as usual. Whether pleurisy, in these
instances, is attributable, as some writers suppose, to
the absorption of pus into the system, or to some other
cause, we are at a loss to determine ; but that the
disease is peculiarly violent and fatal, has been ob
served by all who have witnessed its occurrence.
Therapeutics. — The most valuable remedies in the
treatment of pleurisy, are, aconite, bryonia, tartar
emetic, phosphorus, arsenicum, rhus tox., and arnica.
During the progress of the disorder, we should also
bear in mind sulphur, scillae,rhus rad., lachesis, silicea,
and china.
Aconite is eminently appropriate, either alone or in
alternation with other specifics, whenever the inflam
matory action runs high, accompanied with hot skin,
quick and full pulse, urgent thirst, and general sus
pension of the secretory functions. Wurm and Trinks
commend it in the highest terms in that variety of
pleuritis which is characterized by the plastic nature
of the effusion, and the severity of its inflammatory
fever. It should be exhibited at the very commence
ment of the disease, and in the lowest potencies, and
repeated, in urgent cases, every hour until the fever
subsides.
Bryonia is a specific of great value in the malady
under consideration, and the power which it possesses
of promptly controlling and subduing the most violent
cases of pleurisy, is a matter of astonishment to us,
who formerly believed copious and repeated venesec
tions to be the only safe means of effecting a cure.
We have treated a great number of cases, in which
bryonia has been our chief remedy, and we have not
DISEASES OP THE RESPIRATORY ORGANS. 331
failed in a single case, but our cures have been far
more prompt, pleasant, and satisfactory, than we ever
effected under the old treatment. The effusion has
invariably been more speedily absorbed, and the pleura
arid lungs, as well as the system at large, have more
perfectly recovered their original tone and vigour,
than in cases which have been treated by the old
method. Nor will this appear at all strange, when it
is remembered, that by one method, the structure ac
tually diseased is alone acted upon, while by the other,
the whole organism is subjected to the influence of the
most powerful medicines, impairing the integrity and
vigour of almost every part, without producing any
certain or decided effect upon the pleura, or any other
pulmonary tissue.
Let the sceptical allopath prove upon his own per
son in health, the pure effects of bryonia, tartar emetic,
phosphorus, lachesis, scillce, &c., upon the respiratory
organs, and then test them judiciously in cases of dis
ease after the homoeopathic principle, similia similibus,
and he will forever abandon the uncertainties and
dangers of the lancet, mercurials, counter-irritations,
&c.
Bryonia may follow or alternate with aconite,
advantageously. The external indications are, cheeks
flushed and hot, dry or moist ; respirations short and
rapid, and performed principally with the abdominal
muscles ; position upon the affected side ; pulse quick
and full ; tongue dry ; breath hot ; urine scanty, and
red or dark ; dull sound on percussion of the affected
side ; respiratory murmur indistinct or entirely want
ing.
Physical sensations. — Stinging, shooting, or burning
pains in the side, aggravated on inspiration, coughing,
on rnpvement ; respiration difficult, short, anxious, and
rapid ; sense of tightness ; a weight or oppression at
the, chest ; painful cough, dry or with expectoration of
a glairy sputa, sometimes tinged with blood ; great
heat of skin, alternating with frequent coldness and
shivering ; urgent thirst ; pain in the intercostal spaces
on pressure ; weariness and inclination to retain the
recumbent position.
332 DISEASES OF THE RESPIRATORY ORGANS.
Mental and moral symptoms. — Anxious, apprehensive,
desponding ; fear ; irritability ; peevishness ; restless
ness.
Administration. — A dose of the first dilution every
hour, alone or in alternation with aconite,, until the
pain, difficulty of breathing, &c., are relieved.
Tartar emetic. — According to Majendie, this medi
cine possesses the specific power of causing engorge
ment and inflammation of the lungs when given in
large doses. There can be no doubt that it is an ab
solute and decided specific over the respiratory organs
as well as the gastro-intestinal membrane. This has
been demonstrated by Cloquit, Miiller, Majendie,
Gross, and others, by autopsicai examinations, and by
numerous provings upon persons in health.
It is a common remedy with the old school, in affec
tions of the respiratory organs ; yet they are entirely
ignorant of its curative action. It is only necessary
to refer to the unsatisfactory and contradictory opinions
of Laennec, Rasori, Broussais, Eberle, Payne, Blake,
and Barbier, upon this subject, to be convinced of the
utter want of accurate knowledge and uncertainty of
principle amongst allopathists in the administration of
medicines.
The homoeopathist, on the contrary, demonstrates by
numerous provings in health, that it exerts a specific
force upon the lungs and their appendages, and he
therefore gives it in inflammations of these organs
with confidence and success. With him there is no
random and crude speculation — no breaking down of
the organism by violence, hoping in the general ruin
to cruhh the malady, but having a definite object, and
seeing his goal, he quietly, safely, and surely attains it.
The external indications for tartar emetic, are : face
flushed, hot and dry, or pale, wan and anxious, and
covered with sweat ; respirations short and obstructed ;
surface burning hot and dry, or cold and bathed with
cold perspiration ; pulse quick, weak, or full ; tongue
moist and clean, or loaded with a white or brown fur ;
urine scalding hot, red or brown ; mucous or bloody
expectoration ; general appearance indicative of great
anxiety and physical prostration.
Physical sensations. — Respiration short, difficult, ob-
DISEASES OF THE RESPIRATORY ORGANS. 333
structed, and attended with stinging or shooting pains ;
cough with expectoration of mucus, sometimes ting
ed with blood ; violent throbbing of the heart ; cold
ness and shivering whenever the bed clothes are raised,
or on motion ; fever with adypsia, or moderate
thirst ; lassitude, debility, and disposition to syncope ;
trembling of the limbs, from the slightest exertion ;
sense of suffocation.
Mental and moral symptoms. — Agitation ; apprehen
sion ; discouragement ; despair.
Administration. — From half a grain to a grain of
the tartar emetic, may be dissolved in a tumblerful of
pure water, and given in teaspoonful doses, every
one, two, three, or four hours, as the urgency of the
case demands.
Phosphorus. — External indications. — Countenance
pale, alternating with redness ; eyes hollow and sur
rounded by a blue circle ; respiration short, difficult,
and noisy ; tongue dry ; pulse quick and hard ; ex
pectoration slimy or bloody.
Physical sensations. — Respiration rapid, short, and
difficult ; lancinating pains in the chest, mostly on the
left side ; sharp pains on pressing the intercostal
spaces ; anguish, fulness and tension of the chest ;
palpitation of the heart ; dry, shaking cough, or cough
with expectoration of bloody mucus ; weakness, pain
and trembling of the limbs ; mouth and throat dry ;
thirst.
Mental and moral symptoms. — Uneasiness ; melan
choly ; anguish ; dread of the future ; indifference to
everything ; passionate and irritable.
Administration. — Same as bryonia.
After the more violent febrile symptoms have sub
sided, and those of effusion into the cavity of the pleura
remain, — as enlargement of the affected side, dull
sound on percussion, absence ef the respiratory mur
mur, oppression and constriction of the chest, difficult
and short breathing, with occasional attacks of suffo
cation, dry cough, coldness of the body, clammy sweats,
anxiety and general sense of prostration, arsenicum is
our remedy. It may be given in these cases, at the
third potency, a dose once in two to four hours, length
ening the intervals as improvement occurs.
334 DISEASES OF THE RESPIRATORY ORGANS.
Rhus tox. is sometimes useful after the febrile
symptoms have subsided, and there yet remain wan
dering pains in the chest, shortness of breath, and gen
eral debility. In cases also which have arisen from
metastases of rheumatism or gout, this remedy is pe
culiarly appropriate. It may be administered in the
same manner as bryonia.
When inflammation of the pleura has arisen from a
contusion, bruise, or other injury, arnica, both in
ternally and externally, is our best specific. For in
ternal exhibition, we may use one of the lower dilu
tions; externally, a lotion made of a drachm of the tinc
ture to twelve ounces of water.
The other medicines to which we desire to call
attention, and which will often be found highly ser
viceable in some of the sequela of pleuritis, are, sul
phur, scillae, mar., rhus rad., lachesis, silicea, and china.
Sulphur especially, is recommended by Wurm, in
plastic pleurisy, and in cases complicated with pneu
monia and hepatization, after aconite has moderated
the more active symptoms. He uses the tincture.
SECTION VI.
PERTUSSIS. WHOOPING COUGH.
Diagnosis. — Most writers recognise three distinct
stages in whooping cough, viz. : first, the forming
stage, presenting symptoms like ordinary catarrh, as
sneezing, watery eyes, dry cough, headache, constric
tion and oppression at the chest, feverish nights, &c.,
which continue for two or three weeks, when the sec
ond or convulsive stage sets in. At this period of the
malady, there are violent paroxyms of cough of a con
vulsive and suffocative character. This cough is dis
tinguished from others by a peculiar stridulous or
whooping sound, which occurs during inspiration,
while the expirations are interrupted by frequent fits
of coughing. This whooping sound is owing to a spas
modic contraction of the glottis, which renders res
piration very difficult, and gives rise to a sense of
obstruction and impending suffocation. This spasm
and contraction, together with a tickling in the throat,
come on previous to the paroxysms, and subside some-
DISEASES OF THE RESPIRATORY OR6ANS. 335
•what after the coughing has ceased. The duration of
the paroxysms varies from one to five minutes, at
the termination of which there is often vomiting or
expectoration of mucus. This stage usually acquires
its greatest degree of violence in from one to two
weeks, and its continuance is from five to six weeks,
when the third, or stage of declension^ commences. At
this period all of the symptoms gradually become mild
er ; the paroxyms are less frequent, — the cough less
urgent ; the contraction and obstruction less strongly
marked, until at the end of two to four weeks, under
favourable circumstances, all of the symptoms have
disappeared.
Causes. — Pertussis is unquestionably attributable to
the absorption into the organism of a miasm of a spe
cific nature. We know nothing of its chemical or
physical character, but in this, like other maladies,
the system must be rendered susceptible by previous
preparation, or predisposition, to enable the miasm to
exercise its specific effects and induce the phenomena
of whooping cough.
Whether this specific miasm operates primarily upon
the mucous membrane of the air passages, the stom
ach, the diaphragm, the lungs, or the eighth pair of
nerves, we are unable to decide in a satisfactory man
ner. It would seem that the advocates of each par
ticular opinion in regard to its primary location, have
found in their autopsical examinations, appearances
which indicated that there had been inflammation in
each of the structures alluded to. That the pneumo
gastric and other nerves, as well as the membrane of
the glottis, larynx, &c., are involved, either as a prima
ry or secondary effect of the contagion, there can be
no question.
The causes which act upon the organism in such a
manner as to render it susceptible to the action of the
miasm, are, atmospheric vicissitudes, colds, debility
and chronic diseases of the respiratory organs, inhala
tion of irritating substances, fatigue and exhaustion of
the physical or nervous system.
Therapeutics. — In the first stage of the malady the
ordinary remedies for catarrh are appropriate, as nux
336 DISEASES OP THE RESPIRATORY ORGAN?.
vom., chamomela, belladonna, ipecacuanha, mercurius,
aconite, dulcamara, pulsatilla, arnica, bryonia, fyc.
In the second, or convulsive stage, the best remedies
are, tartar emetic, veratrum alb., carbo veg., chamomela,
cuprum acetat., sambucus nig., conium mac., drosera,
hyoscyamus, ipecacuanha, nux vom.
In the third stage, we may consult, in addition to
the medicines already enumerated, pulsatilla, hepar
sulph., sulphur, lachesis, arsenicum, sepia, acid phos.,
and china.
Dr. Bosh speaks very strongly in favour of cuprum
metallicum in firmly developed whooping cough.
" In simple whooping cough of children under one
year of age, I give in the morning and evening, cuprum
third, one grain ; in older children, cuprum second, one
grain twice a day, and in this way the disease was
generally removed under gradually decreasing cough
ing turns." When the cough is complicated with
symptoms arising from dentition, or other affections
disconnected with the cough, these symptoms should
be met by appropriate remedies, either alone, or in
alternation with cuprum.
Administration. — Our attenuations may range from
the first to the sixth, in this disease, according to the
age, temperament, and impressibility of the patient.
The doses should be repeated at intervals of six or
eight hours.
SECTION VII.
ASTHMA.
Diagnosis. — For a week or two previous to an at
tack of asthma, the patient will often be troubled with
sneezing every morning, itching at the inner canthi of
the eyes, irritation of the throat, with constant dispo
sition to hem or hack, lassitude, dull pains in the head,
back, and limbs, loss of appetite, dry hacking cough,
and great depression of spirits.
The attack most commonly commences during the
night, with tightness and constriction about the chest;
urgent and distressing dyspnoea, aggravated by the
slightest movement ; inspirations short and strong,
while the expirations are long, laboured, and wheez-
DISEASES OF THE RESPIRATORY ORGANS. 337
ing ; great and rapid movement of the nostrils ; coun
tenance bloated and livid, and indicative of intense
distress and anxiety ; inclination to retain the erect
position ; even during the forming symptoms, inability
to lie upon the right side or back ; more or less prick
ling or burning heat after the attack commences, ag
gravated by scratching ; symptoms aggravated by eat
ing even bread ; respiration very difficult, as if from
want of air, yet the wind from a fan or the draft from
a door or window, stops the breath, and cannot be
borne ; face and forehead livid, or pale ; sharp pain
through the temples ; inability to lie upon a feather
bed from the first ; during the paroxysm must con
stantly retain the erect posture ; the dyspnoea, &c.,
worse in the night, and remitting during the day ; dry
cough in the first instance, sometimes but not always,
followed in a few hours by expectoration of a viscid
mucus; perfume of flowers, hay, &c., increases the
symptoms, and almost puts a stop to the breath during
the paroxysm ; extremities cold ; respiration through
the mouth ; attacks brought on from excitement, par
ticularly grief and fear ; also certain odours or irritating
substances inhaled ; palpitation during the attack ;
the asthma occurs for the most part during the season
of flowers ; tongue foul ; breath offensive ; eructa
tions ; flatulency ; urgent desire for cool, fresh air ;
pulse variable.
Causes. — It has been often observed that asthma al
most always occurs in individuals who are suffering
from some chronic miasm. In numerous instances
we have been able to trace a direct connection be
tween an attack of urticaria, but partially developed,
and then suddenly suppressed, and asthma. Indeed,
it may be safely asserted, that a majority of the cases
of true asthma, are attributable to this or some other
miasm, which has been thrown, from some exciting
cause, upon some portion of the respiratory apparatus.
We are confirmed in this opinion, from the fact that
in several instances where an attack of asthma has
been seriously threatened, and even commenced, w«
have been able to cut it short by administering a re
medy like puls-j bry., and cup. acet., which had the ef-
15
338 DISEASES OP THE RESPIRATORY ORGANS.
feet to develop the nettle rash, and thus relieve the
air passages.
Other causes, which are, properly speaking, excit
ing causes, may be enumerated, as humid easterly
winds, atmospheric vicissitudes, inhalation of certain
medicinal and other irritating substances, like ipecac.,
the odours of certain plants, and electricity in the air,
the inhalation of the imponderable particles of which
often causes severe paroxysms of the malady ; also in
digestible food, anger, fear, the irritation of pregnancy,
spinal disease, sedentary habits, &c.
Therapeutics. — Pulsatilla, ipecacuanha, arsenicum,
bryonia, nux vomica, belladonna, china, sulphur, lobelia
inflata, coffea, digitalis, and acid hydrocyanic? are the
principal remedies in this complaint.
Pulsatilla. — This remedy is indicated in cases oc
curring in persons of a mild temper, light complexion,
hair and eyes, from suppressed or confined rash, ces
sation or other derangement of the menses, and inha
lation of the vapour of sulphur. The external indica
tions are: short, suffocating, and extremely difficult
respiration, as if from want of sufficient air, or choked
by some irritating substance ; the patient is obliged
to retain the erect posture ; his movements are rapid,
and his whole appearance indicates great distress and
anxiety ; tongue loaded with a thick coating ; breath
offensive ; frequent eructations ; hiccough ; counte
nance pale, sometimes alternating with redness ; at
tacks usually coming on in the night during sleep.
Physical sensations. — Cramp-like and constrictive
tension of the chest or larynx ; respiration impeded
and distressing, increased by motion, walking in the
open air, or by eating ; short spasmodic cough ; nau
sea ; palpitation of the heart ; sensation of fulness and
distention in the stomach ; throbbing pain in the fore
head ; bad taste in the mouth ; cramp-like pains in
the abdomen ; itching, burning, or prickling sensation
in the skin, in the evening or during the night ; pains
in the limbs ; nausea and vomiting ; smarting or burn
ing pain in the canthi, and pressure in the eyeballs.
Mental and moral symptoms. — Very great depression
of spirits, and melancholy from the onset of the symp-
DISEASES OF THE RESPIRATORY ORGANS. 839
toms ; intense anxiety, agitation and dread of suffoca
tion during the paroxysms.
Administration. — From the third to the sixth dilu
tion may be used — a dose every half hour in urgent
cases — until aggravation or amendment occurs.
Ipecacuanha. — In asthma caused by the suppression
of miliaria, urticaria, and by the inhalation of irritat
ing vapours, ipecacuanha at the first to the third at
tenuation, may be exhibited. The signs which par
ticularly indicate this medicine, are, spasmodic con
traction of the larynx and chest ; anxious, sighing, or
panting respiration ; palpitation of the heart ; air
seems full of dust ; face pale ; extremities cold ; nau
sea ; vomiting ; coated tongue ; insipid or bitter taste ;
dry, spasmodic cough ; irritability, impatience and
fear of death.
Arsenicum alb., is a valuable remedy in bad cases
occurring from suppressed eruptions or catarrh, also
in persons of feeble or impaired constitutions, whether
from excesses, previous sickness, or old age. The fol
lowing symptoms point especially to this medicine, viz. :
feeling of extreme lassitude and debility ; difficult,
stifling dyspnoea, with attacks of suffocation ; spas
modic constriction of the larynx and chest : respiration
short, anxious, and wheezing ; irregular throbbings of
the heart ; sufferings aggravated at night by lying
down, movement, eating, mental excitements, or ex
posure to the cool fresh air ; distention and cramp-like
pains in the abdomen ; frequent eructations ; nausea ;
vomiting ; burning sensation at the stomach ; foetid
breath ; smarting or burning sensation in the throat ;
pressive burning pains in the eyes ; face pale or bluish ;
anxious and desponding. The first to the third tritu-
ration may be employed, regulating the repetition ac
cording to the urgency of the symptoms.
Bryonia is applicable in cases arising from sup
pressed eruptions, or rashes but partially developed.
It is also appropriate in cases complicated with catar-
rhal and pulmonary disorder.
The paroxysm usually occurs in the night ; the res
piration is difficult, short, sighing, impeded by sting-
ings in the chest, and aggravated by exercise ; there
are oppressive, tensive or contractive pain in the chest:
340 DISEASES OF THE RESPIRATOR? ORGANS.
cramp-like pains, cuttings or shootings in the abdo
men ; bitter or acid eructations ; throbbing or pres-
sive pains in the head, increased by movement ; pres
sure and burning pain in the eyes on motion. It may
be exhibited in the same manner as pulsatilla.
Asthma which has been caused by derangement of
the digestive functions, excessive study and watching,
sedentary habits, and abuse of drugs, liquors, coffee,
&c., may often be cured by the use of nux.
The nux symptoms are, weight and constriction at
the chest ; great difficulty of breathing, aggravation
of the symptoms in the night, on walking, eating, or
lying down in the evening ; heat and burning in the
chest ; bitter and acid eructations ; pressure and con
tractive pains in the stomach and epigastrium ; pal
pitation of the heart ; short, dry, spasmodic cough,
sometimes attended with a scraping in the throat ;
fetid breath ; loaded tongue ; heartburn ; distention
of the abdomen after eating ; heaviness, or tearing,
throbbing, drawing or jerking pains in the head ; fre
quent sneezing, with coryza ; hypochondria, anxiety
and irritability. It may be employed like pulsatilla.
Belladonna has been especially recommended in
cases occurring in females of an irritable constitution,
also in cases where there exists a tendency to spasms,
or any organic lesion. Hartmann asserts that " it often
proves radically curative after the exhibition of some
intercurrent remedy, particularly in cases which have
not become too chronic by repeated relapses, under
which circumstances we must have recourse to sul
phur, calcarea, or some other proper antipsoric."
It is particularly called for when the paroxysms
come on in fits of short, difficult, irregular, and suffo
cating respiration, accompanied by dry cough ; pres
sure on the chest; violent beatings of the heart ; ver
tigo, swimming or darting pains in the head ; pains
in the small of the back and limbs ; cramps in different
parts of the body ; anxiety, irritability, and fretful-
ness.
A dose of the second or third dilution every hour or
two until an impression is produced.
Chamomela is an important remedy in the flatulent
asthma of children, also that following a suppressed
DISEASES OF THE RESPIRATORY ORGANS. 341
catarrh. It is likewise specific in those attacks which
are caused by anger, grief, fear, &c., in adults. Among
the symptoms which point to it, may be mentioned,
distention and sense of fulness of the stomach and
bowels ; pressure, anxiety, and fulness in the region
of the heart ; short, wheezing respiration ; great rest
lessness ; dry irritating cough ; bad taste ; tainted
breath.
Administration. — Same as of belladonna.
Lobelia inflata is a remedy of great value in cases of
spasmodic asthma induced by humidity, and certain
other conditions of the atmosphere. It is indicated
when the attack is preceded or accompanied by a kind
of " prickly sensation through the whole system, even
to the extremities of the fingers and toes ;'' constric
tion across the chest; short, anxious and wheezing
respiration ; nausea ; vomiting ; sense of prostration ;
trembling of the limbs ; giddiness and headache ; spas
modic cough ; burning sensation in passing urine ; in
termittent pulse ; cramp-like pains in the abdomen ;
cold sweats.
Administration. — Potencies from the third to the
sixth, — a dose every two to four hours, as the symp
toms require.
In cases of asthma of long standing, and which
appear to be connected with some chronic miasm
lurking in the organism, sulphur, digitalis, acid hydro-
cyanic, calcarea, &c., are worthy of consideration, and
will sometimes effect cures when the other medicines
enumerated have disappointed our expectations.
There are other remedies, like coffea, ignatia, stramo
nium, china, arsenic, arnica, &c., which should always
be borne in mind by the practitioner, for instances may
occur in certain complicated cases, where one or more
of them will be required.
SECTION VIII.
PHTHISIS PULMONALIS. CONSUMPTION.
We come now to the consideration of that disease
which has proved the most destructive of human life
of all that claim the attention of the profession. Slow,
insidious, and gentle in its progress, from causes
342 DISEASES OF THE RESPIRATORY ORGANS.
which have been in operation for years, it steadily
draws its victims to the brink of the grave, before they
have an apprehension of danger, or are conscious of
even serious indisposition. We are accustomed to
regard with terror the yellow fever, because its sub
jects are seized suddenly, and destroyed by a single
blow. But if this fearful agent of death possesses, in
the torrid climates to which it is almost always con
fined, a nearly indiscriminate and unlimited dominion,
during two or three of the sultriest months of summer,
consumption, with its deliberate and almost invisible
step, traverses all the world, destroying in its treach
erous and fatal embrace innumerable numbers, of
every age, and sex, and condition. The yellow fever
indeed strikes suddenly and violently, and leaves the
patient no hope or consolation ; but consumption
quietly and gently fastens its chains upon its victims,
while brightening the intellect, charming the spirit,
and tinting the cheeks with the colours of the lily and
the rose, distracting their attention with songs of hope
and security ; and the poison pervades its subject
organs, and the deluded patient sooner or later awakes,
from his fancied safety, scarcely in time to realize his
peril ere he yields his life.
How few physicians are there, of extensive practice,
whose diaries might not furnish histories of the most
touching pathos, in connection with the treatment of
this disease, which (it may be by a perversity of the
judgment) seems to fulfil its mission in disappointing
the fondest expectations, and in blighting the fairest
creations of human loveliness ! A maiden, perhaps,
becomes the belle of the season, in which she makes
her entrance into the gay world. To an assured po
sition of the highest elevation in society, she brings
the most exquisite physical beauty, and grace and
elegance of manner, and the finest and rarest moral
and mental endowments, subtlest intelligence and
quickest wit, and a sweetness of disposition which
crowns a sudden admiration with the dearest and
most permanent affection. When Hope comes to her
with the most enchanting promises, the Angel of 111
approaches also, in the guise of consumption, and the
two contend until the last is victor, and his triumph is
DISEASES OP THE RESPIRATORY ORGANS. 343
celebrated with all the displays of unaffected wo. Or
it is a young man, who has scaled the difficult heights
that obstructed an ambitious vision, and is about to
grasp the prize upon which his eagle eye has been
steadily fixed through years of varying toils and
storms. The moment he dares to dream of rest, the
enemy that has dogged his steps, unseen, through half
his career, is disclosed, and leads him from the pre
sence of Hope into that of Despair. With what a
profound interest must the physician contemplate a
disease of which the path is constantly thus marked !
True tubercular phthisis, when once fully developed,
is beyond question incurable by medical means. The
physician may palliate symptoms, and often protract
for a considerable period the fatal termination of the
malady, but he cannot remove those foreign accumu
lations which constitute tubercles, either by a gradual
absorption or in any other manner, so as to prevent the
formation of ulcerous excavations, nor can he heal
these ulcerous cavities when once formed, since they
are constantly being disturbed and irritated by the in
cessant motions of the lungs. The few instances of
spontaneous cures of ulcerated lungs, reported by
Laennec and others, are only exceptions to the gene
ral principle which we have advanced. Much, how
ever, may be done in the early stages of phthisis, while
the tubercles are yet small, and but slightly irritated,
to retain them in a latent condition for an indefinite
number of years. We are aware that in some in
stances there will be great difficulty, even on the part
of the physician, in detecting the insidious advances
of the disease at this early period, but by watching
with great care every slight indication of disturbance
connected with the respiratory organs, by ascertaining
whether any hereditary predisposition exists in the
family, by examining the physical conformation of the
chest, the respirations, as relates to their strength,
freedom, number per minute, and whether unduly in
creased by exercise ; and finally, by investigating
minutely the previous history of the individual, in
order to be able to judge whether any cause may have
been in operation which might originate the disorder,
we may be able to advise such measures as shall re-
344 DISEASES OF THE RESPIRATORY ORGANS.
tain the tubercles in a latent and undeveloped condi
tion, and thus for years prolong life.
The most common period for the occurrence of
phthisis is between the ages of eighteen and thirty ;
and it is probable that more deaths occur in persons
under the age of eighteen, than after thirty. It is
calculated by Drs. Forbes and Clark, " that above one
quarter part of the individuals who die before the age
of puberty, die with tubercles !" It is also estimated
by the latter gentleman, " that the maximum of mor
tality in this disease is at thirty, and that from this
point it gradually diminishes." No age, however, is
exempt from it ; for infancy, childhood, youth, man
hood, and extreme old age, are all more or less sub
ject to its withering attacks.
Females also suffer more from the malady than
males, as is shown by the statistical facts which have
been published by Louis, Forbes, Skoda, Laennec,
Andral, Clark, Young, and others. Nor is this at all
surprising, when we reflect upon the education, and
the habits of life of the women of civilized countries.
Born and reared during infancy in hot-houses, where
the invigorating breath of heaven rarely penetrates ;
their childish intellects crammed with ideas which
they are unable to understand, while their physical
frames are permitted to wither in crowded school
rooms, without that free and abundant exercise and
indulgence in childish sports, which are so absolutely
essential to their growth and well being ; submitted at
the period of puberty to those instruments of torture
and distortion, stays, in order that the symmetrical
figures which God in his wisdom has given them, may
be contracted sufficiently to meet the ideas of an
abominable fashion ; rejecting constant and vigorous
exercise in the open air, early hours, regular habits,
and all of those means which tend to promote physical
strength and vigour : is it strange, in view of these
things, that the seeds of phthisis are so often and so
early planted ?
There are habits also prevalent among the youth of
the male sex, which conduce in an alarming degree to
generate and develope phthisical affections. The vice
to which we allude, from false delicacy, from its soli-
DISEASES OF THJ5 RESPIRATORY ORGANS. 345
tary nature, and from the very gradual manner in
which it impairs the nervous system and undermines
the constitution, has either been entirely overlooked,
or but slightly touched upon by writers. But unless
we are much deceived, a very large number of con
sumptive cases, especially in young men, are attribut
able to onanism, as their remote cause ; and we are
sure that those who have minutely investigated the
previous histories of consumptive patients, will fully
coincide with us.
It is quite true that there are many other habits and
customs which pertain to refined society, that also
have their effect in engendering phthisis, but we be
lieve that the cause just touched upon has been pro
ductive of more evil amongst the youth of the male
sex, than any two other causes combined. This cause
applies, to some slight extent, to females, but, com
pared with the male sex, it is trivial and unimportant,
for the reason that women are, by nature, purer, less
sensual, and less addicted to gross, carnal, and beastly
thoughts, than a vast majority of the other sex.
Let parents, then, banish all mawkish delicacy upon
this subject, and caution their children against this
dreadful evil. Let them talk plainly, and display be
fore their minds the inevitable consequences, in the
form of consumption, idiocy, lumbar abscess, &c., to
which an indulgence in this degrading and pernicious
vice so surely leads.
There are many other causes of phthisis which we
might here dilate upon, but we shall allude to them
under the head of " causes of phthisis"
The appearance of the tuberculous formations vary
in different subjects, some being small as millet
seeds, and irregular in shape, either distinct or running
into each other, of the consistence of cheese, and of
a light yellowish colour. This variety, which is by far
the most common, has been termed the miliary tuber
cle.
Another variety is called the granular tubercle,
which, according to Laennec, is only the ordinary tu
bercle in its first stage. Bayle and Mclntosh enter
tain different opinions, the former believing the mili
ary granulations to be distinct from tubercles, while
15*
346 DISEASES OF THE RESPIRATORY ORGANS.
the latter supposes them to be genuine tubercles, but
sui generis.
Bayle, Laennec, and others, also assert that they
have met with a few cases which they term encysted
tubercle. Other writers speak of the occasional oc
currence of this variety of tubercle, it being semi-
transparent, whitish, and in consistence like hard
cheese.
Laennec describes, likewise, three kinds of tubercu
lous infiltration, viz., the irregular, the gray, and the
yellow. This infiltration is generally formed around
tuberculous excavations, but it may exist where there
are no tubercles. It is sometimes found in large
masses, " occupying the whole lobe of the lung, and
having no connection with the miliary tubercle." — Me
Intosh.
Respecting the nature and cause of these tubercu
lous formations, there is a wide difference of opinion.
Broussais supposed that irritation, or inflammation,
were only " degrees of the same affection, and that
they may produce, indifferently, tubercles, encephaloid
cancer, melanosis, fibrous, bony, cartilaginous growths,
&c."
Laennec and Andral maintain that they are " ac
cidental productions, foreign to the natural organiza
tion of the lungs," and caused by an aberration in the
nutrition of the organ.
Others are of opinion that tubercles are primitively
hydatids.
In the first stage of development, tuberculous mat
ter is " a gray, semi-transparent substance, which
gradually becomes yellow, opaque, and very dense.
Afterwards it softens, and gradually acquires a fluid
ity nearly equal to that of pus ; it being then expelled
through the bronchi, cavities are left, vulgarly known
by the name of ulcers of the lungs, but which I shall
designate tuberculous excavations" — Laennec.
Whether these accidental formations are inorganic
substances deposited in the pulmonary structure, like
pus or calculous concretions, by a kind of exudation,
or whether they are organized, and possess life and
vitality, cannot easily be determined. We incline,
however, to the latter opinion.
DISEASES OF THE RESPIRATORY ORGANS. 347
For a more particular description of the morbid
appearances found on dissection, the reader is referred
to the writings of Louis, Laennec, Skoda, Bayle,
Forbes, and Clarke.
Diagnosis. — One of the first symptoms which an
nounces the approach of phthisis, is an undue short
ness of breath after exercise. If, in addition to this,
there are haemoptysis, wandering pains, constriction
and tightness at the chest, great sensitiveness of the
lungs to cold air, a dry morning cough, a dull sound
in the clavicular region on percussion, and a partial
or total absence of the respiratory murmur, the most
serious apprehensions may be entertained.
Let all remember, also, that it is only at this early
stage of the malady, that our preventive and remedial
measures can be brought to bear with any assurance
of success, and on this account, we shall dwell par
ticularly upon these primary indications, trusting that
we may in this way impress upon the minds of all
their vital importance.
In all of our investigations of diseases of the chest,
it is a matter of importance, in the first instance, to
ascertain whether any hereditary predisposition ex
ists on the part of the patient to tuberculous affec
tions. Secondly, whether from occupation, previous
habits, excesses, protracted mental anxiety and de
pression, and frequent exposure, without a sufficient
supply of wholesome, nutritious food, the patient has
not acquired those peculiarities of constitution which
render him susceptible to attacks of phthisis ; and,
thirdly, whether the physical development of the chest
is such that the lungs can have ample room to exer
cise their functions.
In making up our diagnosis in the early stage of
any given case, much will depend upon the presence
or absence of these remote causes, for most of the
symptoms enumerated may exist in a man with a
large and well formed chest, and with no hereditary
or acquired predisposition to the malady, and yet ex
cite no serious apprehensions, while the same symp
toms in an individual with a narrow, flat, and ill-
shaped thorax, with a predisposition to the disease,
would induce us to form a diagnosis of an entirely
348 DISEASES OF THE RESPIRATORY ORGANS.
different character. Commencing, then, with the
primitive symptoms of consumption, we shall notice
first —
The respiration. " Healthy respiration," according
to Marshall Hall, *< is performed with ease and free
dom, and without the aid of the auxiliary muscles, in
any of the usual positions of the body. It is effected
by a nearly equal elevation of the ribs, and depression
of the diaphragm, except in females, in whom the
thorax is observed to move more than in men ; each
side of the thorax moves also in an equal degree,
and inspiration and expiration occupy nearly equal
spaces of time."
Laennec considers the respiration natural "when
the anterior and lateral parts of the chest dilate
equally, distinctly, yet moderately, during inspiration,
and when the number of inspirations in a state of
repose is from twelve to fifteen in the minute."
Andral puts the mean average of respirations in a
healthy adult, at more than sixteen or eighteen in the
minute, Majendie at twenty, and some writers even
as high as twenty-six.
Taking, then, the mean number of respirations of a
healthy adult to be eighteen per minute, and bearing
in mind the natural movements of the healthy thorax
during inspiration and expiration, we shall be enabled
to form a pretty satisfactory opinion respecting the
condition of the respiratory organs, by judicious com
parisons of different stages of disease with the sup
posed natural standard.
We are convinced, from much observation, that
Laennec, Andral, and Louis, have laid quite too little
stress upon this important indication ; for, although
individuals may now and then be short breathed who
have no tendency towards diseases of the lungs, yet,
when taken in conjunction with an hereditary predis
position, unusual susceptibility of the lungs to cold,
slight, dry, hacking cough, narrow or flat chest, or oc
casional wandering pains in the chest, we may be
certain that mischief is threatened.
A very fleshy person, or one afflicted with disease
of the heart, and certain other maladies, may be short
breathed after slight exercise, but these cases can
DISEASES OF THE RESPIRATORY ORGANS. 349
never be mistaken by the observing physician as
phthisical, since the history of the case, as well as the
general aspect of the patient, sufficiently mark the
distinction in all instances.
Whenever, therefore, an individual has more than
the usual number of respirations during repose, the
expirations and inspirations being unequal in point of
time, and is put out of breath after the slightest exer
cise, it is the duty of the physician to ascertain the
cause of this unusual action, and whether consump
tion is not insidiously approaching. Is his chest large,
full, and well developed, — are its movements natural
during inspiration and expiration, — is scrofula heredi
tary in his family, — is he troubled with tightness or
pains in the thorax, — is he subject to cough upon the
slightest exposure, — is he inclined to stoop when sit
ting or walking, — is his respiration sighing, — has he a
slight morning cough, — finally, is the sound in the
clavicular region, or in any other part of the chest,
dull on percussion, and is the natural respiratory mur
mur absent at this, or any other point? Upon the
presence or absence of these symptoms will depend
our diagnosis. Taken as a whole, they indicate
clearly the existence of phthisis pulmonalis ; and
where there is a family tendency to phthisis, even dull
sound on percussion, and absence of the respiratory
murmur, with dyspnosa after ascending a stairs, or
other moderate exercise, will warrant the opinion that
tubercles exist in the lungs. If, furthermore, one or
more of the other signs enumerated obtain, our opin
ion must be still more decided and unfavourable.
Physical conformation of the thorax. — One of the
causes which especially favours the formation and de
velopment of tubercles, is a small, flat, and contracted
chest. This want of symmetry and proportion may
be owing to natural organization, or it may be ac
quired from indulgence in sedentary habits, stooping,
a neglect to keep the body in the erect posture, and
to breathe in that full, free, and vigorous manner
which is so essential to the development and well-
being of the lungs.
If the thorax is naturally contracted and ill-shaped,
a suitable course of physical culture should be promptly
350 DISEASES OP THE RESPIRATORY ORGANS.
adopted and persisted in until it has acquired sufficient
size and symmetry. This result is practicable in all
cases by steady perseverance and energy on the part
of the patient.
The means of accomplishing this desirable end, are
gymnastic and other exercises which particularly bring
into action the muscles of the chest, constant exercise
with the body erect, in the open air, the habit of tak
ing long, free and full inspirations in order that all
portions of the lungs may constantly receive a due
proportion of air, and thus execute their functions
properly, and lastly, the use of tubes for the purpose of
exercising more efficiently the pulmonary organs. By
a regular and systematic employment of these means,
the size of the chest may be increased to a surprising
extent, and the lungs made to acquire a degree of
strength and vigour which could have been attained
by no other method.
There are other instances where well-formed chests
are contracted, distorted, and weakened, by the wear
ing of tight clothing, stays, fyc., and by sedentary oc
cupations and habits, with the body constantly inclined
forward and bent over. These pernicious habits are
so commonly indulged in, and have become so much
a part of our social system, that their important in
fluences, — their baneful consequences upon the most
vital part of the organism, are almost entirely over
looked. Yet no one who reasons at all, can be
unaware of the dangerous and undermining effects of
these things ; and to those whose pride, or indolence,
or imbecility, still prompts them to persist in such
habits, we would say, and without much sympathy for
their sufferings, " you have sown the wind, and you
shall reap the whirlwind."
Hereditary and acquired predisposition to phthisis. —
An alarming circumstance connected with the his
tory of any individual, even when no symptoms point
to an approaching consumption, is an hereditary pre
disposition to tuberculous disease of the lungs. To
know that the seeds of a dreadful malady are implant
ed in the system, liable at any moment to be roused
into activity by the numerous exciting causes which
prevail, is enough, one would naturally suppose, to
DISEASES OP THE RESPIRATORY ORGANS. 351
call forth all of the energies of the individual in order
that he may escape the threatened evil ; — yet how few
under such circumstances use proper means of pre
vention, and exercise that care and attention towards
themselves which these cases require !
But the root of the evil must be traced farther back
to those injudicious marriage connections, where one
or both of the parties are labouring under a scrofulous
taint. It appears singular that intelligent persons of
this description should be willing to enter the matri
monial state, when they are so certain of entailing upon
their offspsring, disease, misery, and an early death;
yet how often do we see the desire for temporary self-
gratification, for riches, display, or pride, outweigh the
potent reason named, and induce the unfortunate vic
tim of the malady, to plunge herself and her children
into almost certain future suffering !
A predisposition to phthisical affections is often ac
quired by constant exposure in small, damp, anj ill-
ventilated habitations, insufficient clothing, scanty and
unwholesome food, free use of pork, incessant occupa
tion in close rooms and constrained positions, onanism,
protracted depression of spirits, and certain occupa
tions, like the stone-cutter, scythe-grinder, &c.
All of these causes exert a powerful influence in
bringing the system into that condition which renders
it peculiarly susceptible to tuberculous formations in
the lungs, and for this reason, should be avoided as
much as possible by individuals, and should receive
the attention of all benevolent men.
Amongst the first signs which should lead us to sus
pect latent phthisis, are, an ill-formed thorax, respira
tions above the natural standard, and greatly acceler
ated on slight exercise, and the existence of an heredi
tary taint. Whenever these signs obtain, the chest
should be at once explored by auscultation, and per
cussion, so that if tubercles are discovered, immediate
measures may be taken to keep back or prevent their
development. Sometimes a slight dry cough, with
tightness and pains in the lungs, are the first symptoms
which announce the affection : at other times the dis
ease supervenes suddenly, after a pleurisy, or an in
fluenza, or some other acute malady. In the majority
352 DISEASES OP THE RESPIRATORY ORGANS.
of instances, however, the symptoms occur in the order
enumerated, viz., habitual shortness of breath, especi
ally after exertion, short and dry cough, burning in
the palms of the hands and soles of the feet, constric
tion and pains in the chest on inspiration, sensitiveness
of the lungs to cold. These symptoms may remain
stationary for months or years, when from some exci
ting cause the pulse becomes unnaturally frequent,
there are febrile exacerbations in the evening, and gen
erally about noon, the respiration becomes more rapid
and laborious, being often executed by the diaphragm,
the anterior and lateral parts of the chest dilate
unequally during inspiration and expiration, particu
larly in the recumbent posture, the catemenia in fe
male subjects cease, a mucous expectoration occurs,
profuse night sweats and diarrhoaa set in, the body
wastes away, the expectoration becomes gradually
more purulent and abundant, the body is bent forward ;
as the tubercles soften, the guggling or rattle of the
matter may be heard either with the naked ear or the
stethoscope, the cough is cavernous, the respiration and
rattle also become cavernous, and pectoriloquism is
heard as soon as the softened tuberculous matter is
thrown off, and the cavity becomes empty ; the sound
on percussion still continues dull, but now and then a
peculiar metallic sound is evident. As the disease
progresses towards the last stage, and the cavities ac
quire a large size, the respiration, voice and cough
give forth the peculiar hollow, metallic sound or buz
zing, termed amphoric resonance. The whole body
now presents the appearance of extreme emaciation,
the face is pale, cadaverous, and frequently tinged
with a waxen or lemon hue, the lips and roots of the
nails are bluish, the nose pointed, the voice becomes
hoarse, the mouth and throat apthous. the feet osdema-
tous, occasional delirium at night, and a continual
failing of the physical powers, until death ensues.
Hasmoptysis, though not a necessary attendant upon
phthisis, is of general occurrence during some part of
its course : it may occur at any period of the disease,
but most commonly it is one of the first symptoms.
Causes of Phthisis. — The causes of consumption
DISEASES OF THE RESPIRATORY ORGANS. 353
may be divided into, first, the constitutional ; second,
the accidental ; and third, the exciting.
Under the first head may be included, first, heredi
tary scrofulous taint ; second, hereditary impurities of
the blood of a syphilitic, erysipelatous, or psoric char
acter ; third, imperfect organization of the thorax,
feeble constitution ; and fourth, a melancholy nervous
temperament.
The most prominent accidental causes, are, confine
ment in close, crowded, and ill ventilated apartments,
protracted mental depression, insufficient nourishment,
unwholesome food, intemperance, damp and unpro
tected habitations, onanism, the habit of stooping, and
thus contracting the capacity of the chest, tight cloth
ing, late hours, over-excitement, abuse of drugs, es
pecially mercury and opium, excesses in venery, want
of exercise, and abuse of tobacco.
The exciting causes, are, atmospheric vicissitudes,
suppression of the perspiration by cold, imperfectly
subdued acute diseases of the pulmonary organs, re
pelled cutaneous eruptions, inhalation of irritating
vapours, etc., external injuries. Of these proximate
causes, Eberle, Laennec, and others, consider cold by
far the most common and dangerous. It is probable,
however, that cold of itself is by no means so injurious
as these gentlemen have supposed, but that the sud
den alternations from heat to cold which obtain in
temperate latitudes, exert far more influence in engen
dering phthisis, than the severe but steady cold of more
northern regions. Indeed, some recent writers have
strongly recommended a change from temperate to
cold latitudes, as more advantageous to consumptive
subjects than a warm climate. In this opinion we do
not coincide, since the highly condensed air of the
former must act as a constant and powerful stimulus
to the already irritable tubercles. We much prefer a
warm, mild, and equable climate in these cases.
Therapeutics. — In all cases when it is well ascer
tained that tubercles exist in the lungs, either in a
latent or partially developed state, the following course
should be adopted, as far as circumstances will ad
mit, viz. :
First, an immediate removal to an equable, mild,
354 DISEASES OF THE RESPIRATORY ORGANS.
dry, and healthy climate. In making this selection,
we should choose the interior of the country, rather
than the coast, in order, as far as possible, to be away
from the influence of the breezes which blow from the
ocean.
Second, constant exercise in the open air. By this
we do not mean that snail-like moping around, with
the body coiled up, and a countenance the picture of
melancholy and despair ; but that vigorous, free and
cheerful exercise which invigorates and expands the
physical powers, and cheers the mind. Exercise, to
be beneficial, should be employed in such a manner as
to bring all of the muscles into moderate and agreea
ble action, and as a pleasant recreation, rather than a
necessary task. By this means the organism is
strengthened, the circulation equalized, the "blue-
devils" exorcised, and the pulmonary organs placed in
the best possible condition to recover themselves.
In pursuing this course of physical exercise, regard
should also be had to those gymnastic and other sports
which tend to expand and strengthen the thorax. Too
much cannot be said with reference to the importance
of this subject, also the erect position of the body, and
the habitual custom of taking deep and free inspira
tions; for the muscles of the chest, as well as of other
parts of the body, waste away and become enervated,
without constant exercise in a natural manner.
In connection with this course, we must strongly
advise the frequent use of breathing tubes. Having
experienced decided benefit in our own person from
the employment of this kind of exercise of the lungs,
and having often seen it adopted by others with prompt
and marked advantage, we speak confidently of its
efficacy in debility of the pulmonary organs.
Third, persons of a consumptive habit should make
use of highly nutritious food. The articles which
are particularly to be avoided, arepor/r, in all its
diversified forms, as ham, sausages, lard, &c., all fish
not having scales, like eels, catfish, clams, crabs, lob
sters, &c., and oily and greasy food generally.
How far a free use of pork may exert an influence
in generating tubercles, we know not, but the follow
ing fact is not without significance, viz. : The Jews
DISEASES OF THE RESPIRATORY ORGANS. 355
and all other tribes and nations that are prohibited
by their religion from using the swine as an article of
food, are almost uniformly exempt from scrofula and
consumption. The very common occurrence of tuber
culous formations in this filthy animal, would seem to
be presumptive evidence that it is peculiarly subject
to scrofula. We commend therefore to the consump
tive a strict adherence to the dietetic regulations
which were advised by Moses of old to his brethren,
the Hebrews, as being most conducive to health and
longevity.
Fourth, as an important means for promoting a
healthy action of the skin, and equalizing the cir
culation, too much cannot be written in praise of ex
ternal applications of cold water. These applications
should be employed daily, either in the form of baths,
sponging, or the wet sheets ; in many instances the
greatest service will be derived from using cold water
applications to the chest in such a manner as to bring
out an eruption.
The effect of this remedy is to impart tone and
vigour to the cutaneous structures, and to allay in a
decided manner nervous irritation.
Fifth, another valuable preventive, as well as reme
dial agent in lung affections, consists in the cultiva
tion of a cheerful and happy disposition. The invalid
must never brood over his ailments, for by gloomy
ponderings upon his case, he is quite prone to exagge
rate symptoms, imagine complaints which have no
existence, and thus detract from his prospect of re
covery.
Laennec ranks the depressing emotions as one of
the most prominent accidental causes of phthisis, and
we are quite satisfied that he has not over-estimated
their importance.
Sixth, (and finally), we commend a strict avoidance
of all excesses, whether in the pleasures of the table,
wine, and liquors, or in the indulgence of any thing
which over-stimulates and fatigues mind or body.
In conjunction with the above measures, some one
of the following medicines may be occasionally ex
hibited with benefit ; making the selection, of course,
according to the peculiar character of the indications
356 DISEASES OF THE RESPIRATORY ORGANS.
which may be present, viz. : ol. jecoris aselli, sulphur,
hepar sulph., calcarea carb., mercurius, stannum, ferrum,
silicea, sepia, phosphorus, acid phos., acid nit., lycopo-
dium, lachesis, iodine, iod. potassce, arnica, belladonna,
sambucus and china. Of these medicines the oleum
jecoris aselli is probably the most valuable, and should
receive more attention from the advocates of homoeo
pathy than it has hitherto done. Holding its active
principle, iodine, in a most excellent state of attenua
tion, the infinitesimal atoms of the drug with its oily
vehicle are absorbed and conveyed to the lungs, where
the most happy curative effects are often produced.
We think the point clear, that iodine is the only real
curative agent in these cases ; although it is by no
means improbable that its medium, the animal oil,
which is composed principally of carbon and hydrogen,
may serve the purpose of neutralizing a portion of the
inspired oxygen, which would otherwise act upon the
weakened lungs themselves. In administering this
medicine, therefore, let it be borne in mind, that the oil
is not the medicinal agent, but the mere vehicle by
means of which the real remedy, iodine, is introduced
into the system. Two drachms of the oil may be pre
scribed three or four times daily.
Sulphur and hepar sulphur, should always be selected
when the pulmonary affection can be clearly traced to
abruptly suppressed psora, whatever may be the gen
eral character of the symptoms. If, however, symp
toms are present which point strongly to some other
medicine, an alternation may be resorted to. •
Consumption occasionally arises in those whose
lungs are naturally weak and irritable, in consequence
of violent and protracted syphilitic attacks. In these
instances, the most suitable remedies are mercurius,
acid nit., potassce iodide, and hepar sulphur.
When phthisis is threatened during the progress of
chlorosis, or in consequence of masturbation, or exces
sive venery, the appropriate medicines are, phosphorus,
acid phosph., calcarea carb., china, silicea, and ferrum.
For uncomplicated scrofulous consumption, our most
reliable remedies are, unquestionably, oleum jecoris
aselli, calcarea carb., iodine, sulphur, hepar sulphur.,
sepia, lachesis, phosphorus, and silicea.
DISEASES OF THE RESPIRATORY ORGANS. 357
Administration. — The first, second, and third at
tenuations are most efficient in all stages of phthisis —
the doses to be repeated from two to four times in
twenty-four hours, until the required specific impres
sion is produced.
It is to be regretted that as yet so few positive spe
cifics have been discovered for the cure of tubercular
phthisis, but we are sanguine in the belief that many
such remedies will, sooner or later, be found. In the
meantime let us be on the alert to attain these much
coveted desiderata.
SECTION IX.
COUGH.
In most instances, cough is one of the symptoms of
inflammatory action, either of the parenchyma of the
lungs, or of some membrane connected with the re
spiratory organs ; but coughs occasionally arise and
reduce the patient to a very low state of hectic fever,
without the presence of any inflammatory action, ex
cept that which is produced by the act of coughing,
from an elongation and relaxation of the uvula, from
the pressure of tumours and swellings in the throat,
trachea, or thorax, from hypertrophy and other organic
affections of the heart, -and from accumulations of se
rum or pus within the thorax.
We have in several instances speedily succeeded in
removing troublesome coughs, and of restoring patients
to health, who were apparently in the last stages of pul
monary consumption, by clipping off* a portion of an
elongated uvula. It is not uncommon that protracted
and troublesome coughs are promptly cured by the
removal of tumours in the neck, by the puncturing of
abscesses in the throat or chest, or by evacuating from
the thorax an effused fluid. It behooves us, therefore,
in all cases of cough, where the cause is not perfectly
apparent, to make our investigations with reference
to the above enumerated complications, in order that
surgical measures may be resorted to on all suitable
occasions.
It is to be feared that errors are sometimes commit
ted by gentlemen of our school, in underrating the
358 DISEASES OF THE RESPIRATORY ORGANS.
value and importance of surgery, as a means of cur
ing disease. When the cause is of such a nature that
our remedies are at best slow and uncertain, while a
speedy and safe removal may be effected by a surgi
cal operation, we should never hesitate in our choice.
Even in cases like paracentesis abdominalis. or para-
centesis thorasis, where only a troublesome symptom
is removed, we often accomplish much good by plac
ing the patient in the best possible condition for the
favourable operation of remedial agents. But in the
examples of obstinate tumours and abscesses, pressing
unduly upon some part of the respiratory apparatus,
the aid of the surgeon is often indispensable.
Many individuals are troubled with coughs in
temperate latitudes from an inherent debility of the
lungs, and a wrant of vigour to resist the stimulating
influence of cold air. Such persons often succumb
eventually from phthisis, without having experienced
any actual inflammation of the pulmonary structure.
Others, from excesses of various kinds, acquire a pre
disposition to coughs, from the most trivial exciting
causes.
Therapeutics. — Appropriate medicines for all ordi
nary kinds of cough, may be selected from those already
referred to, when treating of the different affections of
the respiratory organs.
359
CHAPTER XXIV.
DISEASES OF THE HEART AKD ITS APPENDAGES,
THE heart and its appendages are subject to several
kinds of morbid action, which authors have described
under the terms angina pectoris, hypertrophy, and dila
tation of the heart, diseases of the valves, carditis, and
pericarditis, and palpitation. Many of the symptoms
of these affections are similar, but we shall endeavour,
in the following brief description, to point out a suffi
cient number of signs to enable the physician to form
a ready and accurate diagnosis in all cases.
SECTION I.
ANGINA PECTORIS.
Diagnosis. — At the commencement of the disease,
the patient experiences occasional sharp pains in the
region of the heart, especially after active exercise,
or when putting the muscles of the chest upon the
stretch. After a time, the pains recur more frequently,
continue for a longer period, and are accompanied by
palpitation, attacks of syncope, sense of suffocation-,
and tightness in the chest, and great difficulty of
breathing. The attacks are usually excited by violent
physical exertions, mental emotions, and deranged
stomach, from abuse of stimulants and of indigestible
food. In very severe cases, there are almost constant
dyspncea, pains extending down the arms and into the
back, very frequent and alarming attacks of syncope
and suffocation, pale and haggard, or livid and exceed
ingly anxious expression of countenance. If the dis
ease is not arrested, the patient generally expires sud
denly in one of these distressing paroxysms.
When angina pectoris proceeds from hypertrophy of
the heart, we shall observe, in addition to the symp
toms just named, powerful pulsations of the heart,
which are visible at a distance, full and vibrating
pulse, and dull sound on percussion.
If the disorder has arisen from dilatation of tlte ven-
360 DISEASES OF THE HEART AND ITS APPENDAGES.
trides, there will be swelling and visible pulsation of
the jugular veins, a loud and distinct sound on apply
ing the ear over the fifth and sixth ribs, vertigo, fre
quent turns of syncope, palpitation and dyspnoea, pulse
weak and tremulous.
When angina pectoris is connected with disease of
the valves of the heart, the following signs will be pre-.
sent : great dyspnoea on the slightest exertion, frequent
and violent palpitations, pulse feeble and irregular,
livid and unnatural appearance of the countenance,
oedematous swelling of the feet and ancles, and " a
permanent sawing or rasping, or filing sound over the
valves of the heart, especially after depletion and
rest."— (Swett.)
Causes. — Angina pectoris may proceed from some
organic disease connected with the heart, like ossifica
tion of the coronary arteries, or of the valves of the
heart, dilatation or hypertrophy of the heart, obstruct
ed circulation from an accumulation of fat about the
organ, from the pressure of the tumours, or from asth
ma. Very often, however, it is a purely sympathetic
affection, and entirely disconnected with any struc
tural disorder of the heart or its appendages. In these
instances, the nerves which supply the heart are af
fected in such a manner that slight exciting causes,
as errors in diet, mental emotions, or ascending a flight
of stairs, induce the paroxysms.
Therapeutics. — In the selection of remedies, strict
regard should be had to the remote and exciting
causes of each case. If the symptoms are the result
of some organic affection of the heart, like those to
which we have alluded, our prognosis must be, for
the most part, unfavourable, and we can only reason
ably expect to palliate the sufferings of the patient.
But if the remote cause consists simply of a diseased
condition of the par vagum, or of the cardiac nerves,
which renders them liable to become morbidly excited
from trivial causes, we may prescribe medicines with
every prospect of ultimate success. The most reliable
specifics in this malady, are aconite, digitalis, hepar
sulphuris, lachesis, nux vom., veratrum, sepia, sambucus,
ipecacuanha, pulsatilla, arsenicum, aurum.
The attenuations should be selected with reference
DISEASES OF THE HEART AND ITS APPENDAGKS. 361
to the impressibility of the patient, and the medicine
persisted in, at suitable intervals, during the continu
ance of the complaint.
SECTION II.
CARDITIS AND PERICARDITIS.
Diagnosis. — Inflammation of the fleshy substance of
the heart, uncomplicated by disease of the pericardium,
of the pleura, or of the aorta, is an occurrence so rarely
met with, that some authors have described under one
general head, the symptoms resulting from inflamma
tions of the heart and its appendages. The signs
usually present in carditis, often render our diagnosis
very obscure, on account of their resemblance to affec
tions of the lungs, and of the pleura, and of their fre
quent complication with the latter. Frank believes
that much of the uncertainty which prevails respecting
cardiac affections, is attributable to the general ne
glect of the profession in investigating the movements
of the heart during disease, and in examining its mor
bid appearances in those who have died in consequence
of diseases of the chest. " II n'est pas douteux que, si
les hommes de 1'art observaient avec la meme attention
les mouvements et les vibrations du cc&ur que les batte-
ments des arteres, s'ils multipliaient leurs recherclies sur
les cadavres, Us viendraient a bout de dissiper les
epaisses tenebres qui environnent les maladies de Vorgane
central dc la circulation" — (Frank.)
The ordinary symptoms of inflammation of the heart
and its envelop, the pericardium, are acute pains in the
region of the heart, increased by motion, or on assuming
the horizontal posture, sense of fulness and oppression
in the chest, palpitation, from the slightest exertion, or
from mental excitement ; rapid, difficult, and irregular
respiration; short, dry, spasmodic cough ; rapid, small,
irregular, and intermittent pulsations of the heart and
arteries ; great anxiety, dread of suffocation, " absence
of the respiratory murmur, and dull sound on percus
sion." — (Hall.) General febrile disturbance almost
always accompanies the inflammation, although the
heat is unequally distributed, some parts being in
tensely hot, while other parts are cold. The counte-
16
362 DISEASES OF THE HEART AND ITS APPENDAGES.
nance is always expressive of anxiety and distress, the
patient is desponding, irritable, and restless, and ex
periences alarming palpitations, faintness on rising up
in bed, or on talking.
Causes. — Protracted grief, anxiety, or mortification,
violent muscular efforts, external injuries, asthmatic,
and other pulmonary affections, metastases of rheuma
tism, or gout.
Therapeutics. — Digitalis, aconite, bryonia, arnica,
cannabis, pulsatilla, lachesis, spigelia, iodine, and arseni-
cum, are the medicines commonly employed in this
malady.
Digitalis, on account of its specific power over the
sympathetic nerve, and the cardiac plexus, is especially
adapted to those cases of pericarditis which have
been caused by violent emotions, and protracted grief,
care, and anxiety. The special indications are, sharp
stitches, or contractive pains in the region of the
heart ; uneasy sensations in the left side of the chest,
often extending to the shoulder and arm ; palpitations
excited, by talking, movement, or on laying down,
particularly on the left side ; pulse rapid, weak, and
irregular, or slow, soft, and intermittent ; sense of op
pression and anguish in the thorax ; general weakness ;
frequent attacks of faintness ; respiration slow, diffi
cult, and unsatisfactory, or short, painful and sighing;
frequent flushes of heat in the chest, face, and head,
while the extremities remain cold ; general feeling of
anxiety and despondency. A drop of the second or
third dilution should be prescribed, in \vater, every two
hours.
Aconite is a suitable remedy, when the movements
of the heart and arteries are more rapid and vigorous
than in health, and when the congestion to the heart
is accompanied by an unusual degree of erethism.
The pains in the cardiac region are of a constrictive,
oppressive or lancinating character ; the breathing is
short, anxious, and laboured ; the pulse is rapid, strong,
and intermittent ; the action of the heart is exalted,
and often irregular ; febrile symptoms are strongly
pronounced ; the patient inclines to sit with his body
bent forward, in order to relax the muscles of the
thorax, and thus to obviate the liability of pain from
DISEASES OF THE HEART AND ITS APPENDAGES. 363
this cause. The first or second dilution of aconite may
be selected, and a single drop administered in water,
every two, three, or four hours, as the nature of the
case demands.
Bryonia will occasionally be required, in inflamma
tions of the heart and its appendages, which are com
plicated by disorder of the pulmonary structures. It
will likewise prove serviceable in cases which are con
nected with rheumatism or gout. The following are
its indications : drawing and stitching pains in the
chest, aggravated by breathing, or by movement ; rap
id, anxious, and painful respiration ; dry, spasmodic,
and painful cough ; lancinating pains extending into
the shoulders and back, between the shoulder-blades ;
oppression in the chest, which causes frequent sighing ;
determinations of blood to the chest, and head ; rapid,
weak, and intermittent pulse ; anxious, depressed, and
irritable. Its administration is the same as aconite.
Arnica is chiefly useful when the inflammation has
been caused by external injuries, like contusions,
wounds, &c. The special indications are, lancinating
pains in the region of the heart ; oppression at the
chest ; great difficulty of breathing ; short, dry, and
irritating cough ; sharp pains through the heart, which
cause faintness ; irregular action of the heart ; pains,
and dyspnoea, increased by mental or physical exertion.
It may be given the same as aconite.
Cannabis, pulsatilla, lachesis, iodine, and arsenicum,
have been employed with success, in cardiac inflam
mations which have, arisen from suppression of erup
tions, or the drying up of old ulcers. They may be used
at the second or third attenuations — the repetitions of
doses to be governed by the urgency of the symptoms,
and the medicinal or other effects produced.
Should the disease terminate in dropsy of the peri
cardium, our best remedies are, arsenicum, apis meL
and iodine. We prefer the first or second attenuations
— a dose once in six hours until an impression is
evident.
364
CHAPTER XXV.
DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
SECTION I.
GENERAL OBSERVATIONS.
IF the soul of man manifests itself through the
healthy organism in a certain definite manner, and
if these manifestations are modified precisely in ac
cordance with the abnormal conditions which the or
gans and tissues may acquire, the importance of a cor
rect understanding of the exact healthy functions of
all the structures, and of their alterations during dis
ease, will be duly appreciated. Unfortunately for
science, the profusion of hypotheses, the arbitrary as
sumption of ancient ideas for facts, as well as the in
herent difficulties attending the pathology of diseases
of the cerebro-spinal system, have until recently re
tarded the onward progress relative to their nature
and treatment. Until Sir Charles Bell demonstrated
that the nerves which arise from the posterior column
of the spinal marrow were devoted to sensation ; those
from its anterior column, to muscular contraction ;
while the middle column gives origin to the respiratory
nerves, the most erroneous and contradictory notions
were entertained respecting the functions and diseases
of the nervous system.
Majendie, Flourens. Abercrombie, Hall, Solly, Ser-
res, Bennett and Andral have also thrown much light
upon the functions of particular portions of the brain ;
but much yet remains to be done in this important
field of discovery, and it is only* by banishing from
our medical vocabulary all vague and obscure ex
pressions, and contemplating the body as a complica
ted machine, actuated and kept in operation by an in
telligence which pervades every part, and in conjunc
tion with its material stimuli, giving rise to sight in
the organ of sight, — hearing, taste, smell, digestion,
assimilation, calorification, motion, &c., in their several
organs ; — and perceptions, memory, comparisons and
DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 365
ratiocination, by their operation upon a combination
of organs, that we can arrive at accurate conclusions.
The cerebral organs may be affected throughout
their whole extent, or in isolated parts alone ; but
whatever condition obtains, diseases of certain sections
of the cranium usually give rise to peculiar and well
defined symptoms. Thus, compression of the brain,
whether from effused blood, serum or pus, depression of
a portion of the cranium, or a congested and relaxed
condition of the cerebral vessels, give rise to coma,
with slow pulse and stertorous respiration : organic
lesions of the brain, to paralysis of one or more parts
of the body, depending upon the extent of the lesion
and the part affected : irritation of the brain, to con
vulsions : disease of the cortical substance or hemi
spherical ganglia, to delirium and mania : of the medul
lary or tubular structure, to convulsions : effusion with
in the ventricles, to dementia : effusion upon the sur
face of the brain, to lethargy : inflammation of either
lateral lobe of the cerebellum, to paralysis of the lower
extremity of the opposite side: inflammation of the
middle lobe, to erection of the penis, (Hall :) of the
arachnoid and pia-mater, to delirium : ramollissement, to
torpor of the intellectual faculties and loss of muscular
power.
So strongly marked are these signs, that pathologists
have made somewhat minute classifications of the dis
eases of the brain, as of the arachnoid, of the pia-mater,
of the cortical, or the medullary part, the base, the tuber-
annulare, the hemispheres and the cerebellum. But it
is to be observed in most cerebral affections, that in
flammations of particular structures rarely exist un
complicated with more or less disease of the surround
ing parts, and on this account we meet with a great
diversity of symptoms during their progress. For this
reason, if no other, it is more consistent to prescribe
for the totality of the symptoms than for the mere name
of the disease. By the former course we pursue a de
finite object, and apply our remedies with an assurance
of success, even if we are in error respecting the pa
thology of the case ; while by the latter method, we
are liable to mistake the location and nature of the
malady, and thus adopt a pernicious mode of practice.
366 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
For example, by mistaking the cerebral symptoms of
a typhus fever for encephalitis, or the ancsmic condi
tion of the brain which obtains in true delirium tre-
mens, in some cases of apoplexy, in epilepsy, and in
ramollissement, for acute inflammation, and resorting to
the usual remedies for the cure of the latter, viz. :
copious venesections, the most disastrous results
might be apprehended. It is now a well-ascertained
fact, that delirium, coma, hydrocephalus, and one form
of ramollissement, may result from an ancemic, as well
as an inflammatory condition of the brain. Drs. Aber-
crombie and Marshall Hall recognise still another
comatose condition independent of disease of the brain,
and arising from exhaustion of the general system oc
curring during the last stages of certain diseases ; but
from the fact that this coma generally occurs after
protracted bowel complaints where opium has been
used as the principal remedy, we are of opinion that a
real cerebral disease has been superinduced by the
remedy.
For the cure of the symptoms above named, arising
from an ancsmic condition of the brain, tonics, stimu
lants and a nutritious regimen are deemed essential by
the practitioners of the old school. Blood-letting and
antiphlogistics in these cases, are fatal. But when
the same symptoms arise from an inflammatory con
dition of the encephalon, a treatment directly the re
verse, is supposed to be necessary to save life, like
venesection, leeching, purging, blisters, &c. Now
when we contemplate the great uncertainty attending
the diagnosis in these two forms of disease, and the
danger which must attend mistakes in treatment ori
ginating from errors respecting the peculiar condition
of the brain, is it strange that people have no more
confidence in allopathy ?
We have before remarked, that morbific substances,
in order to develop diseased action in the organism,
must be taken into the blood and conveyed to those
tissues upon which they exert a specific morbific in
fluence, there producing those alterations (probably
upon the sentient extremities of the nerves) which con
stitute disease. It is only necessary to refer to the
axamples to which we have alluded in another part
DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 367
of this work, to render this supposition entirely proba
ble.
It is also equally evident, from the multitude of ex
periments by Miiller, Majendie, Orfila, Pereira, Hah-
nemann, Trinks, Philips, Flourens, and Bichat, that
poisonous drugs and all medicinal substances operate
in the same manner in producing their specific poison
ous or medicinal effects.
There are other causes constantly operating upon
the system, of a character entirely different from those
to which allusion has just been made, and which may
with propriety be termed spiritual or dynamic. Thus,
violent mental disturbance may cause epilepsy or apo
plexy — chagrin and grief, biliary derangements, jaun
dice, and dyspepsia — sudden news, whether good or
bad, diarrhoea — anger, fear, disappointment, and ill
news, sometimes instantly destroy the appetite ; fear
and apprehension, predispose to contagious disorders ;
the sight of blood induces syncope ; and of human suf
fering, pain and disorder in the stomach. In these
cases, the unusual mental excitement determines an
unnatural amount of blood to certain parts, the blood
vessels and nerves of such parts are oppressed, and
disease results. ^
But it is of vast importance that these spiritual or
dynamic causes be not confounded with those which
are material and imponderable. Let us not deceive
ourselves and the world, by classing them where they
do not belong, simply because our limited knowledge
of the sciences renders us as yet incapable of appreci
ating the nature and the precise mode of operation of
the latter !
Although cerebral affections may arise under fa
vourable circumstances, from the absorption of mor
bific and medicinal substances, and from spiritual or
dynamic influences, yet the latter rank first in import
ance, especially in what are termed chronic cerebral
maladies. In the treatment of brain diseases, therefore,
too much importance cannot be attached to an accu
rate knowledge of these causes ; for it is only by their
prompt removal, together with a judicious application
of remedial agents, that we can expect complete suc
cess.
368 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
The curious reader will find much to amuse, if not
instruct, by tracing the medical history of cerebral ma
ladies from Hippocrates to the present time. Through
out all of this period, notwithstanding the numerous
changes of opinion respecting their nature, causes, &e.?
one striking fact will always be observed, viz. : that
the treatment for all of these complaints has remained
almost the same as first instituted by that very respect
able heathen philosopher, Hippocrates, until the pe
riod of Hahnemann.
In proof of the singular tenacity with which the med
ical world has clung to the opinions of the ancients,
we may cite the doctrines of eminent physicians as
late as the time of Sydenham, who supposed the cause
of many brain diseases, as lethargy, coma, paralysis,
&c., to consist in a " viscid condition of the blood and
lymph, which obstructed the pores of the brain, and dulled
the animal spirits. While the viscid blood forces its way
into the brain, through the two carotids, it leaves in its
passage a slimy matter, through which the animal spirits
passing, stick by the way, and so the pores of the brain
are obstructed.1' — (Sydenham and Salmon, Prac. Phys.,
p. 203.)
Their in<Jications of cure, were : first, " to evacuate
the redundancy of phlegm and choler, or to carry off that
vicious acid which has created the viscosity of the blood.
Second,' to alter the present dyscrasia of the blood. Third,
to open the pores of the brain now obstructed, and give a
free passage to the spirits. Fourth, to strengthen the
weakened parts, quicken the dull spirits, and increase
their store or stock." — (Ibid.)
To fulfil these indications of cure, the fathers of al
lopathy adopted almost precisely the same treatment
as that which prevails with their brethren of the pre
sent day, viz. : blood-letting, emetics, cathartics, " to
purge off the phlegm and choler," antimonials and alter
atives, " to cut up the gross phlegm, dissolve the coagu-
lums of the blood and humours, and excite the animal
spirits to a brisker and more lively air." Paracelsus
and Van Helmont particularly commended opiates and
narcotics in chronic affections of the brain. If we re
fer to the most recent writers on insanity and other
cerebral affections, we shall find not only the same
DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 369
remedies retained, but the same diversity of opinions
respecting the application of these remedies ; some
trusting to venesection and purges, some to tonics,
while others depend upon opiates and narcotics.
In a book which is now before me, published in the
year of our Lord, 1587, by "Andrew Boord, Doctor of
Physic — an Englishman," our sapient author supposes
that maniacs are possessed of devils, and advises for
their cure, in addition to blood-letting, cathartics, &c.,
that they should be sent to Rome to be made whole.
" For within the precincts of St. Peter's Church, without
St. Peter's Chapel, standeth a pillar of white marble,
grated round about with iron, to the which our Lord
Jesus Christ did lie in himself at his delivery unto Pi
late, as the Romans doth say, to the which "pillar, all
those that be possessed of the devil, out of divers coun
tries and nations, be brought thither, and as they say
at Rome, such persons be made there whole." It was
a matter of doubt, however, whether the pillar or the
priest (who accompanies the patient within the enclo
sure) effected the cure, though we believe the weight
of argument was in favour of the priest.
The same writer supposes the cause of phrenitis to
consist of " water or wind enclosed in the head," and
the remedies were " to purge the head with sternuta
tories, and the bowels with physic."
Modern pathologists have discovered that maniacs
are not possessed of devils, — that phrenitis is not ow
ing to " wind being enclosed in the head," — that coma,
lethargy, and paralysis, are not caused by " viscid
blood rushing into the brain through the two carotids,
and leaving in its passage a slimy matter, through
which the animal spirits passing, stick by the way,"
but they have demonstrated that inflammation, irrita
tion, organic lesion, and compression, give rise to the
phenomena which characterize the different diseases
of the brain. But notwithstanding this change of
opinion in a pathological point of view, the therapeu
tical doctrines remain the same as formerly, with the
single exception of advising maniacs to be sent to the
marble pillar at Rome.
Blood-letting, probably to let out the'" slimy " part
of the blood : emetics and purgatives, to " purge off
16*
370 DISEASES OF" THE BRAIN AND NERVOUS SYSTEM.
the phlegm and choler," irritating and inflaming the
intestinal canal in order to cure a disease located in
the brain, and now and then an opiate to cover up
symptoms when too troublesome, are still resorted to
by gentlemen of the old school.
It is to be hoped that the time is not far distant
when all such indirect and unreasonable practices for
the cure of diseases, will be entirely superseded by
the more direct and philosophical method of treatment
which has been instituted by the father of homcBO-
pathia and his disciples.
Probably in no class of maladies has allopathy been
so much at fault as in her classification of cerebral"
affections. Each author who has written upon the
subject, has taken upon himself to promulgate patho
logical views different from those of his predecessors,
and from these views to form new classifications and
new modes of treatment. While some nosologists
recognise inflammations of the arachnoid, of the pia
mater, of the cineritious, or cortical substance, of the
medullary, or tubular structure, of the different lobes
of the cerebellum, of the tuber-annulare, &c«, as dis
tinct diseases, requiring different modes of treatment;
others, as Frank,* describe inflammation of the hem
ispheres of the brain, the cerebellum, and their
common envelopes, as a single disease, under the
general term encephalitis, and demanding for its cure a
definite course of treatment. Thus, " L 'inflammation
du cerveau, du cervelet, de Icur envcloppes communes, ne
presente pas, selon la difference de son siege, des symp-
tomes distinctifs surs et constants" So also Solly, in his
work on the human brain, at page 322, remarks, " I
have long felt convinced that there is no such thing as
inflammation of the pia mater, independent of the
brain, and that much mischief has accrued from our
systematic writers treating of inflammation of the
membranes of the brain as distinct from inflammation
of the brain itself," The same writer lays down the
following broad principles, viz., ** that inflammation of
the brain is a depressing disease, and that, as a gene
ral rule, general blood-letting is not often admissible.
* Traite de Medicine-pra clique, pnge 116.
DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 371
That, although blood-letting may sometimes* be at
tended with benefit at the time, the good derived from
it is seldom permanent." Again, '* // n'existe pas de
signes certains qui annoncent le siege de Vencep halite,
qui caracterisent la phlogose superficielle et Finflamma-
tion phlegmoneuse avec tendance a la suppuration, Ces
varietes rfojfrent pas des caracteres dijferentiels assez
constants pour distinguer la frenesie de la cephalite.
L'invasion subite de la douleur, la violence de la fievre,
lastapeur des organes des sens et de V entendement,
bientot suivie de ^extinction de leurs facultes, ne prou-
ventpas I'inflammationde lapulpe cerebrale. — (Frank)."
In view of these radical differences of opinion, and
from the generally acknowledged fact, that no single
structure within the cranium can become inflamed,
without involving to a greater or less extent other
portions of the cerebral region, we shall adopt the
following classification: First, encephalitis, embracing
acute inflammation of the hemispheres, the cerebel
lum, and their membranes ; under which head we
shall point out, as clearly as possible, the peculiar
symptoms which are supposed to characterize affec
tions of these different parts. Second, the diseases
which occasionally result from encephalitis, as ra-
mollissement, hydrocephalus. and epilepsy. Third, apo
plexy and paralysis. Fourth, delirium tremens. Fifth,
insanity.
SECTION II.
ENCEPHALITIS.
Diagnosis. — There are certain symptoms which are
common to the first stages of all acute inflammations
of the cerebral organs ; and which, taken by them
selves, afford no indication of the actual seat of the
disorder. These symptoms are, a vague sensation of
coldness in the first instance, perhaps succeeded by
occasional flushes of heat, lassitude, anxiety, sadness,
irritability, often alternating with great exaltation of
the intellectual faculties ; hilarity, sudden bursts of
laughter, petulance, unwonted impudence and vul
garity ; redness of the skin, heat, pain, pressure or ten
sion in the head ; strong pulsations of the carotid
372 DISEASES OF THE BRATN AND NERVOUS SYSTEM.
and temporal arteries ; singing noises in the head,
vertigo, weakness of memory, frightful dreams, fan
tastic visions when awake ; trembling of the limbs,
nausea, vomiting ; eyes bloodshot, great sensibility to
light ; constant wakefulness ; acuteness, or dulness of
hearing ; mouth and tongue dry ; urine^copious, yel
low, and thin as water*
The symptoms which usually obtain in the second
stages of these aifections are, stupidity, coma, paraly
sis, eyes suffused and dull, besotted expression of
countenance, strabismus, position upon the back, pu
pils dilated, suppression of urine, and general loss of
muscular power.
The signs which are supposed to be peculiar to the
first stage of inflammation of the cortical substance,
or hemispherical ganglion, and the membranes of the
brain, are, early derangement of the intellectual facul
ties, fixed pain in the upper part of the head ; hot and
dry skin, conjunctiva injected and red ; eyes brilliant,
ferocious, fixed, and intolerant to light ; | tone rough,
violent, and defiant ; face red and swollen ; inclination
to do himself or others injury ; great exaltation of
muscular strength ; strong pulsations of the carotid
and temporal arteries ; constant wakefulness ; con
tinued and rapid motions of the head ; impatience, irri
tability, and constant agitation.
The first stage of inflammation of the medullary
substance of the brain, is recognised by the following
symptoms : vague chills ; deep-seated headache, or
vertigo ; vomiting, lassitude, trembling of the limbs ;
convulsions before any signs of mental disorder, anxi
ety, sadness, great agitation, arms continually raised
towards the head, position mostly upon the back,
noises in the head. This disease is so insidious in its
approach, that convulsions may occur as the very first
symptom. In instances like this, it is probable that
inflammation exists in the medullary substance alone,
without involving in the slightest degree the gray
matter of the convolutions surrounding this part, or
the envelopes of the brain. We are forced to this
conclusion if we adopt the opinions of Bouilland, Solly,
Duchatelet, Hall, and Bennett, who suppose the cinr-
rilious, or cortical substance of the brain, to be " im-
DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 373
mediately connected with the intellectual powers,"
while the medullary portion presides over the muscu
lar powers of the organism. Therefore, after an in
jury to the head, if the intellect is only impaired, we
may be certain that the hemispherical ganglion is
the seat of the injury, while if, in addition, there are
involuntary convulsive motions of the muscles soon
after the accident, we may be equally sure that the
medullary substance has also received detriment.
Inflammation of the medullary structure is more
prone than either of the other cerebral inflammations,
to terminate rapidly in softening, and for this reason it
is incumbent upon physicians to exercise the greatest
care in their investigations of this class of maladies,
and to apply their remedial measures with due
promptness.
The most prominent secondary symptoms of disease
of this portion of the brain are, muscular paralysis,
and loss of sensation in the parts affected.
According to Marshal Hall, " disease of a lateral lobe
of the cerebellum induces paralysis of the opposite
side, and chiefly of the lower extremity. Disease of
the middle lobe of the cerebellum is denoted by erec
tion of the penis. Disease of the medulla oblongata
induces paralysis of the respiratory muscles, and con
sequently, when complete, instant death."
We have now enumerated those symptoms which
are supposed to characterize the inflammations of the
different cerebral structures, and in this connection,
we call the attention of homoeopathic practitioners
especially to this subject, with reference to the thera
peutical application of medicines. Flourens has de
monstrated, by experiments upon birds, that belladonna,
opium, and alcohol, uniformly exercise a specific ac
tion upon certain portions of the brain. Hahnemann
and his disciples have also proved that large doses of
these articles taken in health, uniformly give rise to
those physical and mental manifestations which pa-
thologists have shown to proceed from disease of these
same parts. When, therefore, in our provings of
drugs, it is observed that the prominent symptoms are,
derangement of the intellectual faculties, exaltation of
the mental and muscular powers, eyes bloodshot, and
374 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
expression furious and defiant, manner violent and
overbearing, voice loud and rough, throbbing pain in
the head, face red and swollen, we may be certain
that a specific effect has been produced upon the cor
tical substance of the brain. If, instead of these
symptoms, we are presented with convulsions, pa
ralysis, and general depression of the powers of the
system, we may infer that the drug has acted specifi
cally upon the medullary portion of the brain. The
same law obtains in relation to those symptoms which
characterize diseases of the different lobes of the
cerebellum of the medulla oblongata, of the different
portions of the spinal marrow, of the nerves, and
indeed of all other parts of the organism.
In our selection of remedies, therefore, we should
always endeavour to choose those of which the action
has been shown, by pathological facts, as well as by
provings, to be positively specific upon the structure
affected.
Causes. — Solly has very justly observed, in his trea
tise on the human brain, that " there is no single cause
which so frequently produces inflammation of the hem
ispherical ganglion, or meningitis, as sudden emotion,
whether of joy or fear. The latter is, however, much
more common." Other causes are, fractures and con
tusions of the cranium; insufficient sleep; intense and
protracted thought upon a particular subject, disap
pointed love or ambition ; repelled eruptions, whether
by natural causes or by the abuse of ointments ; ex
posure to cold, or to a burning sun ; abuse of opium,
and spiritous liquors ; metastases of rheumatism, gout,
or erysipelas, and suppression of the lochial and other
habitual discharges. It often arises during the progress
of pneumonia, scarlatina, erysipelas, otitis, and bowel
affections. The most common predisposing causes
are, plethora, a passionate and excitable disposition,
want of exercise, high living, and abuse of stimulants.
Therapeutics. — In the treatment of this class of dis
eases, it is of especial importance that due regard be
paid to the causes which may have conduced to the
attack. An encephalitis which has followed imme
diately upon the suppression of a lochial discharge,
an habitual nasal ha-morrhage, or the retrocession of
DISEASES OP THE BRAIN AND NERVOUS SYSTEM. 375
an eruption by improper external applications, not
only requires a remedy which shall cover all of the
manifest symptoms, but one which, at the same time,
shall operate in such a manner as to bring back the
original discharge, or eruption. If disappointment,
pecuniary embarrassments, fright, or political or re
ligious excitement, has been the exciting cause, the
mind of the patient should be soothed and attracted
into new and agreeable trains of thought. By these
means we shall prepare the organism to receive our
remedies in the most favourable manner.
The principal remedies employed in encephalitis,
are, belladonna, aconite, opium, hyoscyamus, stramonium,
moschus, chamomela, laurocerasus, and ignatia, for in
flammation of the medullary substance alone : mos~
elms, plumbum, acid oxalic, nux vomica, opium, and
oleander, for paralysis : rhus rad., rhus tox.. bryonia,
and belladonna, for metastasis, or extension of rheuma
tism to the brain : spigelia, cuprum acetat., tartar
emetic, bryonia, sulphur, tabac., and beJladonna, when
the disease has arisen in consequence of repelled
eruptions.
Belladonna will be required when the disease pre
sents itself as follows : febrile symptoms, accompa
nied with dry ness of the mouth, tongue, and throat ;
difficult deglutition, nausea, vomiting; confusion of
the head; giddiness; dilatation of the pupils; injec
tion of the conjunctiva ; eyes suffused, brilliant, fu
rious, and protruded ; imperfect vision ; gay delirium ;
increased secretion of urine, and frequent desire to
evacuate the bladder ; heaviness, pressure, or throb
bing pain in the head ; roaring in the ears ; vertigo,
with nausea.
When children are the subjects of attack, Dr. Bigel
gives the following excellent indications for the use
of belladonna : " The children constantly press their
heads into their pillows, they are startled by the least
noise or light, there are, snoring sleep, great heat of
the head, face red and puffed, with visible beating of
the arteries of the head and neck, swollen veins, and
occasionally hydrophobic phenomena."
During the period of dentition, and directly after
being weaned, children are particularly prone to at-
376 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
tacks of inflammation of the brain. At this age, the
child is exceedingly sensitive, and there is an unusual
tendency of blood towards the brain ; but if the signs
of cerebral disturbance be closely watched, we shall
find no difficulty in combating them successfully at
the onset with belladonna. We have often employed
this remedy with satisfactory results when the follow
ing phenomena were present :
External indications. — Face hot, red, and swollen ;
eyes red, sparkling, and fixed, or half open and dis
torted ; pupils contracted ; visible throbbing of the
carotid and temporal arteries ; veins of the head dis
tended ; constant boring with the head into the pil
lows ; paralysis of one or more parts ; convulsive
movements ; rapid, small, or intermittent pulse ; sub-
sultus tendinum ; distortion of the features ; grinding
of the teeth ; tongue bright red, and cracked ; urine
scanty or suppressed.
Physical sensations. — Sharp, throbbing, or confused
pain in the head ; great restlessness and agitation ;
intolerance to sound and light ; thirst ; head and face
very hot ; limbs cold, with internal burning heat ;
roaring or humming in the ears ; deafness ; inability
to speak or to swallow ; nausea and vomiting during
the course of the disease ; sparks, flashes, or visions
before the eyes.
Mental and moral symptoms. — Great sensitiveness
of the nervous system ; violent delirium at night ;
profound sleep ; mania ; hydrophobic symptoms.
Belladonna is likewise especially necessary in in
flammations of the brain, proceeding from metastases
of scarlatina, measles, erysipelas, and smallpox.
Its specific action is upon the cortical substance,
the tubercula quadrigemina, and the membranes of
the brain. When febrile symptoms are strongly pro
nounced, it should be preceded by aconite, or given in
alternation with it.
Administration. — We advise from the first to the
third attenuation for adults, and from the third to the
sixth for children. As a general rule, the dose may
be repeated every two hours until the required im
pression is produced upon the inflamed structure.
There is no proof that aconite affects specifically
DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 377
either the brain or its envelopes. In autopsical ex
aminations of those who have died from having acci
dentally taken poisonous doses, no traces of inflam
mation have been found in the cortical substance, or
the membranes of the brain, and but slight marks of
action in the medullary structure. The prominent
symptoms to which large doses give rise, are, " numb
ness and tingling of the parts about the mouth and
throat, and of the extremities, vomiting, contracted
pupil, and failure of the circulation." — Pereira, Ma-
teria Medica, vol. ii., p. 153. The intellectual powers
remain unaffected, and neither convulsions nor stupor
usually occur.
Dr. Lombard, of Geneva, in his clinical practice,
and in his experiments on animals, found that the in
ternal exhibition of aconite, generally had the effect
of " rendering the pulsations less frequent, without
irregularity, and, consequently, that it exerted a de
cidedly sedative effect upon the heart ; whence he
infers that it is a proper remedy in inflammatory af
fections in general."
Others have observed, that its primary effect was to
stimulate the action of the heart and arteries, and
cause a universal glow over the surface ; while the
secondary effect wras decidedly sedative upon the cir
culatory vessels.
Its effects are so manifest upon the action of the
heart and arteries, that its use will be of eminent
service in all those cases of encephalitis, or conges
tion, dependent upon a plethoric state of the system,
or organic disease of the heart. It should also be
given during the existence of active febrile symptoms,
in all cerebral affections, and generally in alternation
with some positive specific, in order that the malady
may be met at all points. Attenuation and repetition
of doses the same as belladonna.
Opium. It is conceded by both schools, that opium,
when exhibited in moderate doses, exercises upon the
human constitution two different effects — a primary,
and a secondary — which are of directly opposite cha
racters. The first of these effects is invariably stimu
lant, as is evinced by such phenomena as increased
force and frequency of the pulse, dryness of the mouth
378 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
and throat, a pleasant glow upon the skin, exaltation
of the mental faculties and of the muscular system,
a sense of intoxication, and temporary retention of
the stools.
The secondary manifestations are, general diminu
tion of sensibility throughout the body, a feeling of
relaxation and calmness, tremulousness in the limbs,
disinclination to exercise, pulse full and slow, drowsi
ness, dryness of the mouth and throat, thirst, nausea,
and, finally, if a large dose has been taken, slow and
laborious respiration, spasmodic contractions of the
muscles, eyes half closed, pupils dilated or contracted,
and insensible to the light, bloated, suffused, and be
sotted expression of countenance, cold and clammy
extremities, respiration gasping, rattling, stertorous,
face pale, sunken, and deathlike, rigidity of the jaws,
entire insensibility to external impressions, pulse
thready, and almost entirely imperceptible.
Wood and Bache suppose " that the active principle
of opium is conveyed into the circulation, and operates
upon the brain, and probably upon the nervous system
at large, by immediate contact with their interior struc
tured—Wood 4- Baches U. S. Dis., p. 476.
Opium is generally supposed to cause death by sus
pending the " cerebral influence necessary to sustain
the respiratory function ; and it is supposed, also, that
the heart ceases to act in consequence of the cessa
tion of respiration." — Brodie.
From these facts, we infer that the specific action
of opium is principally upon the medulla oblongata,
although the other symptoms indicate that there has
been some action upon other parts of the brain, and
also upon the skin, and lungs.
In autopsical examinations of those who have died
from the effects of this substance, extravasated blood
has been found in the brain, distention of the sinuses,
and of all the cerebral vessels, but it is probable that
many of these appearances are results of the impeded
respiration, the imperfect decarbonization of the blood,
and the impaired circulation which have arisen from a
paralysis of that portion of the cerebral mass which
presides over the respiratory functions, rather than
from any specific operation of the opium upon these
different structures.
DISEASES OP THE BRAIN AND NERVOUS SYSTEM. 379
Opium, in small doses, has always been observed to
excite the venereal propensities, and has been used
for this purpose for a long period by the Turks, Chi
nese, and Egyptians. This fact, viewed phrenologi-
cally, affords another proof of its specific action upon
the cerebellum.
In proof that the active principle of opium is ab
sorbed) and operates by actual contact in producing its
specific effects, we quote the following from Pereira
and Barbier : ** The odour of opium is frequently re
cognisable in the secretions, exhalations, and breaths
of persons poisoned by it, and the secretions, in some
cases, appear to possess narcotic properties."
My own opinion, derived from post-mortem examina
tions of those who have been poisoned by opium, and
from the effects to which it usually gives rise, is, that
it exercises, first, a specific action upon the cerebellum
and medulla oblongata. If the drug be taken in mod
erate doses, this action is in the first instance, excitant,
producing venereal desires, erections, accelerated re
spirations, circulation, and augmented muscular force ;
and secondarily, sedative, as is shown by the languid,
relaxed and calm state of the whole system, the dimi
nution in the number of respirations, and in the action
of the circulatory vessels. If taken in very large
doses, the parts appear to be paralyzed at once, and
all of those organs the functions of which are depend
ent upon the integrity of this part of the brain, cease
to act.
Another specific effect of opium is upon the skin,
as is evinced by the perspiration and its odour, and
the eruption to which it occasionally gives rise.
Nor is it at all improbable that it may operate
somewhat upon the par vagum, or the lungs them
selves.
The most prominent indications, therefore, for the
use of opium, are, exaltation of the physical and men
tal powers, succeeded by depression and calmness, dry
throat and mouth, agreeable reveries, dreams, pulse
at first rapid and full, afterwards slow and feeble,
drowsiness, disinclination to muscular exertion, slow,
irregular and stertorous respiration, profound coma,
pallid, sunken and ghastly face, immoveable, contracted,
or dilated pupils, rigidity of the jaws, cold and clammy
380 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
extremities, complete insensibility to external impres
sions, and sometimes convulsive twitchings, extinction
of the pulse, interrupted and gasping respiration, and
finally death. It may be administered in the same
manner as belladonna.
Hyoscyamus, stramonium, and musk, are applicable
in cases attended with complete loss of sense, convul
sive or spasmodic movements ; closed eyes, low mut
tering delirium, constant movements with the hands,
dilatation of the pupils, rapid and anxious respiration,
frequent sighing.
If inflammation of the brain has arisen in conse
quence of a suppressed otorrhoea, sulphur should be
employed. In those cases which occur in children
from teething, chamomela, belladonna, and aconite, are
our most reliable remedies.
In cases of metastases or extensions of rheumatic
inflammations to the brain, rhus rad. and rhus tox.
are our best remedies.
Cuprum acetat, should be given, in cases which have
arisen from repelled eruptions.
When encephalitis threatens to run into dropsy of
the brain, mercurius sol. is the best remedy to coun
teract the tendency to effusion.
If the disease has arisen from exposure to the sun,
repeated doses of camphor are highly recommended.
Administration. — Our attenuations may range from
the first to the sixth, and the doses repeated every two,
three, or four hours, according to the severity of the
symptoms.
SECTION III.
RAMOLL1SSEMENT DU CERVEAU. SOFTENING OF THE BRAIN.
It is not yet decided whether ramollissement, or soft
ening of the brain, proceeds from inflammation, or is a
disease, sui generis. Many of the French pathologists
suppose it to be the result of inflammation ; while
others, as Rostan, believe it to be a disease, sui generis.
Abercrombie believes it may arise from either inflam
mation, or from a condition of the cerebral structure
analogous to those parts which have become gan
grenous in other parts of the body, while Solly sup-
DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 381
poses that it may arise from inflammation, from a
total failure of the circulation, and from " local and
general anaemia." Dr. Burnett recognises two kinds of
cerebral and spinal softening, an inflammatory and
a non-inflammatory, and " which may always be dis
tinguished from each other by means of the micro
scope."
Inflammation of the tubular structure is more prone
to terminate in softening than any other portion of the
brain, and it is usually very insidious in its approach.
Diagnosis. — Softening of the brain may supervene
suddenly upon an attack of acute inflammation, like
hydrocephalus, or it may make its appearance in a
gradual and imperceptible manner. Some of the
characteristic symptoms of ramollissement are, in
sensibility, dilated pupils, slight muttering delirium,
paralysis, contraction of the flexor muscles, constipa
tion, and a urinous smell.
Those cases which have arisen from an anaemic
condition of the brain, or from an obliteration of the
arteries which supply this organ, are usually slow in
their progress, and manifest themselves by a gradual
failure of the memory, drowsiness, an oedematous
state of the body, occasional wandering of the mind,
especially during the night, general languor, slow,
dragging, and imperfect articulation, constipation, loss
of energy and ambition, and an almost entire absence
of pain or febrile symptoms.
Ramollissement, from whatever cause it may pro
ceed, is seldom cured. As remedies, however, we sug
gest opium, hyoscyamus, china, secale cornutum, carbo
vegetabilis, belladonna, nux vomica.
SECTION IV.
ACUTE HYDROCEPHALUS.
Diagnosis. — This is a malady almost peculiar to in
fancy and childhood. The symptoms which indicate
its approach, are neither very uniform nor regular.
Indeed, so various and uncertain are these symptoms,
that some writers suppose the effusion to be dependent
upon a debilitated condition of the membranes, analo-
382 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
gous to dropsy, while others attribute it to inflamma
tion in all cases.
It may appear suddenly, with most of the phenome
na which we have designated as characteristic of
encephalitis, viz., febrile symptoms, quick pulse, fits
of screaming, expression bold and furious, eyes blood
shot and brilliant, great heat of the head, nausea, vom
iting, noise and light painful, convulsions, ending in
coma and death, in a few days. In cases of this de
scription, there exists unquestionably acute inflamma
tion of the meninges of the brain, and the effusion
commences almost simultaneously with the inflamma
tion.
In other instances, the disease approaches insidi
ously, presenting no marked symptoms for some days.
The child will perhaps be observed to be petulant, to
complain of some pain in the head, to become easily
fatigued, to have occasional flushes of heat, to be rest
less at night, occasionally to grind the teeth, to have
lost the appetite, and to prefer the recumbent position.
After these symptoms have continued for an indefinite
period, the more serious signs of effusion present
themselves, as general diminution of sensibility, less
frequent and more irregular pulse, greater debility,
constant inclination to keep the bed, or to be held in
the arms, dilatation or contraction of the pupils, fre
quent sighs, strabismus, or an unnatural expression of
the eyes, turning inwards of the feet and hands, slight
convulsive twitchings of the face, upper lip, and arms,
automatic movements of the hands towards the head,
rolling of the head from side to side, constant motion
of the lips, convulsions, paralysis, and coma.
Chronic hydrocephalus, is usually the result of a very
slight inflammatory action, which has progressed very
slowly and insidiously. The indications which mark
this affection are, gradual emaciation, feebleness,
unnatural enlargement of the head, occasional giddi
ness, and now and then strabismus.
Therapeutics. — The medicines which we would sug
gest in this affection are, belladonna, digitalis, nux
vomica, phosphorus, stramonium, tartar emetic, veratrum
and aconite.
During the first stage of the acute variety, our most
DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 383
reliable remedies are, aconite and belladonna. They
should be given as often as once in two hours, until a
maniiest effect has been produced, after which we may
repeat as circumstances require.
If the inflammation has not been promptly subdued
by the use of aconite and belladonna, but signs of
effusion manifest themselves in the form of" deep red,
or almost brown face ; eyes rolling in their orbits,
sometimes closed, and at others wide open ; lips dry ;
tongue covered with a brownish yellow fur ; tension
and swelling of the belly ; constipation ; generally, re
tention of urine, or difficulty in passing it ; respiration
quick, anxious, and sighing ; deglutition difficult ; skin
of the whole body dry and burning, bryonia acts sur
prisingly." — (Bigel.)
Helleborus nig., has been successfully employed in
many apparently hopeless cases, which were attended
with coldness, and insensibility of the surface ; rapid
and feeble pulse ; convulsions and spasmodic rigidity
of the limbs ; face pale and swollen; constant rolling
of the head from side to side ; moaning ; general pros
tration.
After decided marks of effusion obtain, digitalis,
mercurius sol., belladonna, veratrum and arnica deserve
our consideration.
Nux vomica and stramonium will be required when
great agitation, flushed face, convulsions, strabismus,
haggard and staring look, involuntary twitchings of
the muscles, dilated or contracted pupils, groaning
and crying, and opisthotonos, are present.
Phosphorus and tartar emetic will be found useful in
hydrocephalus, depending upon metastasis of some
disease to the brain, and in cases occurring in worn
out constitutions.
Administration. — The first, second, and third at
tenuations should be used, and the doses repeated
once in from four to six hours.
SECTION V.
EPILEPSY.
Diagnosis. — The symptoms of epilepsy are exceed
ingly variable. Sometimes premonitory symptoms are
present, like headache, giddiness, ringing in the ears,
384 DISEASES OF TPIE BRAIN AND NERVOUS SYSTEM.
aura epileptica, or prickling sensation extending from
the extremities to the head, drawing inwards of the
thumbs towards the palms of the hands, and sensation
of fulness of the head ; but more frequently the sub
ject is struck down without any warning. When the
attack comes on, the patient falls suddenly ; there are
violent convulsive movements, with loss of conscious
ness ; the face and eyes become distorted ; the tongue
is often bitten, and in consequence we see blood and
froth issue from the mouth ; stertorous and difficult
respiration ; the muscles of one side are often more
agitated than those of the other, and pulse weak, fre
quent and irregular ; after the paroxysms have sub
sided, the patient usually sleeps profoundly for eight
or ten hours, and sometimes remains for a considerable
period in a feeble and languid state, with headache
and occasional delirium, but more commonly he very
speedily recovers his usual state of health and vigour.
The seat of epilepsy is supposed by some to be in
the tubular structure of the brain, while others sup
pose that it may arise from irritation of the spinal
marrow, but nothing is known with certainty upon the
subject. The pathology of epilepsy is still involved in
obscurity.
Causes of Epilepsy. — Organic affections of the brain,
abnormal osseous deposites within the cranium, ill
formed cranium, diseases of the heart, fractures of the
skull, violent mental disturbances, secondary syphilis,
mercurial affections, derangement of the stomach and
bowels, onanism, suppressed eruptions, habitual dis
charges, and excesses in the use of liquors ; prolonged
abstinence from sexual intercourse, as well as its im
moderate indulgence ; and the sight of other epilep
tics.
Prognosis. — Epilepsy which occurs in infancy and
childhood, from fright or suppressed eruptions, is cura
ble. When the cause is abstinence from sexual inter
course, a cure may often be effected, by marrying :
on the other hand, those cases which proceed from or
ganic affections within the cranium, from long con
tinued masturbation, and from disease of the heart,
more especially if they occur after the age of twenty-
five years, or if they have continued for several years,
DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 385
are generally incurable. As a general rule, idiopathic
epilepsy is more difficult of cure than the symptomatic.
Therapeutics. — When called to a person labouring
under an epileptic attack, we should at once loose all
of the clothing, in order that the blood may have free
circulation to and from the head, as well as in other
parts of the body. We should also place a cork or
some soft substance between the teeth, to save the
tongue and tips from being wounded by the convulsive
movements of the jaws. The patient should be placed
in bed and restrained just sufficiently to prevent him
doing himself personal injury during the convulsions.
When the paroxysm is preceded by an aura, the at
tack may sometimes be warded off by tying a ligature
firmly just above the part where the aura commences.
It is a general impression amongst homoeopathic
practitioners, that anti-psorics alone are capable of
effecting a permanent cure of epilepsy. This is true
with regard to those cases which are connected with
syphilis, mercurial affections, and impurities of the
blood, but when the disease has been caused by injury
to the cranium, by mental excitements, by onanism, or
by excesses in liquors or venery, it is apparent that a
different course of treatment is requisite.
The most important remedies in the treatment of
epilepsy are, belladonna, sulphur, mercurius, stramo
nium, aconite, china, ignatia, coffea, phosphorus, arnica,
opium, nux vomica, hyoscyamus, agaricus, ipecacuanha,
cicuta, silicca, argentum, cocculus, cuprum, camphor.
Belladonna. — Hartmann has found this remedy spe
cific for the following symptoms, viz.: " great irrita
bility of the whole nervous system, so that the patient
is startled at the merest trifle ; he becomes peevish
and sensitive, and is affected by tremors and twitch -
ings in the muscles ; restless sleep, which is disturbed
by frightful dreams; hyper-sensibility of the eyes,
sparks and flashes before the eyes ; also dyplopia and
myopia, stammering speech, with congestion of blood
to the head, and nervous distention ; vertigo, with
roaring in the ears ; convulsions of particular muscular
parts, subsultus, distortion of the face," &c. Belladonna
will be generally applicable in those cases which have
been induced by fright, or other mental emotions.
17
386 DISEASES OF THE BBAIN AND NERVOUS SYSTEM.
Sulphur and mercurius are proper when there is rea
son to suspect a psoric or syphilitic taint as the cause
of the malady. These remedies should be persevered
in until all trace of the impure taint has been eradi
cated.
Stramonium, ignatia, hyoscyamus, or coffea may be
administered during an attack. These remedies are
appropriate in cases caused by chagrin, fright, or mor
tification.
Camphor is indicated in epileptic attacks caused by
taking cold, or by vexation, — particularly if congestion
of the brain is threatened ; when caused by fright,
artemisia, at the first or second dilution, has been found
curative ; when occurring in sensitive children, during
the period of dentition, chamomela, coffea, and hyos-
cyamus are the specifics ; in the epilepsies of nervous
and impressible subjects, with distortion of the limbs
and face, bloodshot eyes, foaming at the mouth, livid
face, and protracted loss of consciousness, cicuta and
stramonium are our best remedies ; epilepsy induced
by unusual excitements, worms, exposure to a high
degree of heat, and attended with sudden loss of con
sciousness, and of muscular power, screams, violent
convulsive movements of the limbs, gnashing of the
teeth, frothing at the mouth, livid face and forehead,
bloodshot eyes, and irregular spasmodic twitches in
various parts of the body, may generally be cured by
hyoscyamus, ignatia and corculus ; nux vomica is an
invaluable remedy when the complaint proceeds from
abuse of stimulants, venereal pleasures, sedentary
habits, undue mental exertion, disordered stomach, or
worms ; in the epilepsies of drunkards, opium may
often succeed nux with advantage ; frequently recur
ring epileptic fits have often been permanently cured
by Dr. Dunsford, with argentum nit., belladonna, agari-
cus, moschus, and silicea ; when the fit arises during
the course of an eruptive fever, in consequence of a
retrocession of the eruption, caused by cold, we may
employ ipecacuanha, cuprum, and belladonna.
China and phosphorus should be given in epilepsy
which has followed protracted masturbation, or ex-
ce'sses in venery. The latter may also be used in
DISEASES Of THE BRAIN AND NERVOUS SYSTEM. 38T
cases proceeding from osseous deposites within the
cranium.
Opium and nux vomica. — For the epilepsies of ine
briates these medicines are important, and will often
effect permanent cures, after the previous habits of in
temperance are corrected.
When the cause consists of an injury to the head,
arnica is our chief remedy — this medicine should be
used externally as well as internally.
If the paroxysms have been caused by fright, grief,
chagrin, or from some sympathetic emotion, we may
often prevent an attack (homoeopathically) by exer
cising the patient with some more potent mental in
fluence, which shall supersede the original cause. It
was upon this principle that Boerhaave cured a num
ber of epileptics, at the hospital for orphans of Harlem,
who had been attacked in consequence of fright from
seeing an epileptic brought into the hospital during a
paroxysm. In these instances Boerhaave had a red-
hot poker kept ready, in order, as he assured these
girls, that he might apply it to their heads, as soon as
there was any indication of an attack. The fright
caused by this idea entirely overwhelmed the other
cause, and an immediate cure was generally the re
sult.
Administration. — We commonly advise the lower
attenuations, and administer the remedy once or twice
daily, until a cure is effected.
SECTION VI.
APOPLEXY.
Apoplexy may occur as an idiopathic, or as a symp
tomatic affection, and in an inflammatory or an ady-
namic form. We may also, with propriety, divide it
into three varieties, the sanguineous, or extravasation
of blood upon the brain, the serous, or effusion of se
rum, and finally the simple apoplexy, produced by ab
normal distention of the vessels of the brain. The
symptoms will vary according to the extent of the ef
fusion, and the part of the brain in which the extrava
sation is located. If the fluid is so situated as to make
pressure upon the hemispheres, there will be a sudden
388 DISEASES OP THE BRAIN AND NERVOUS SYSTEM*
loss of consciousness, coma, and stertorous respiration.
If the effusion occurs upon the surface of the vertex of
the brain, the symptoms, according to Abercrombie,
will be moderate in the first instance, but as the effu
sion increases, comatose symptoms come on, and the
patient succumbs ; when the"effusion occurs near the
base of the brain, there is no coma or loss of conscious
ness, but we find loss of speech and paralysis. It is
most common at the age of fifty or sixty years, but it
sometimes occurs in subjects of twenty five or thirty
years.
Although this formidable malady is, in general,
sudden and overwhelming in its attack, yet, fortu
nately, in the great majority of cases, especially of the
inflammatory form, there are well pronounced pre
monitory symptoms for days, and sometimes for weeks
preceding its onset, such as vertigo, drowsiness,
throbbing pain, or sensation of numbness in the
head, frequent flushing of the cheeks, unusual heat
in the head, and disinclination to bodily or men
tal exertion. These symptoms, therefore, should al
ways receive prompt attention, when occurring in
those who are predisposed to apoplexy, in order that
the threatened danger may be averted in due time.
Causes. — Apoplexy occurs most frequently in large
towns, amongst the opulent and luxurious. The im
pure air of cities, acts as a powerful predisposing
cause, and, in connection with the numerous vices
prevalent in a patrician society, as want of exercise,
high living, excesses in the use of stimulants, and the
pleasures of love, affords a solution of the fact of its
more frequent occurrence in towns than in the coun
try.
The most common proximate causes of sanguineous,
and of simple apoplexy, are, want of exercise, excesses
in eating, drinking, love, suppression of an habitual
nasal haemorrhage, unnatural fulness of the blood-ves
sels of the brain from any cause, violent mental emo
tions, excessive study, and great physical exertion.
The most favourable condition for the occurrence of
serous apoplexy, is, general debility and innervation,
whether from insufficient nutriment, excessive mental
or bodily labour, sickness, old age, long continued
DISEASES OP THE BRAIN AND NERVOUS SYSTEM. 380
intemperance, abuse of drugs, or the depressing emo
tions.
Frank asserts that it is not rare to find serous and
sanguinous effusion in the same brain, and he has de
tailed several instances of this kind which have fallen
under his own observation.
Diagnosis. — Inflammatory apoplexy is for the most
part confined to individuals of a sanguine tempera
ment, plethoric, with short thick necks, vigorous cir
culation, and a great amount of animal heat. The
attack is often preceded by vertigo, unusual heat
about the head, face red and full, eyes injected and
troubled with muscae volitantes. The invasion of the
malady is so sudden, that the patient is struck down
instantly, deprived of all consciousness and power of
voluntary motion. The respiration becomes stertorous,
the cheeks and lips puffed out at each expiration, the
pulse slow and full, pupils dilated, face red or livid,
or purplish, throbbing of the carotid and temporal ar
teries, eyelids convulsed, either closed or half open,
paralysis of the muscles of one side, or of the face on
ly, and distention of the veins of the head and neck. Af
ter a time the breathing becomes less stertorous, the pulse
more soft, and some signs of returning consciousness
indicate convalescence ; or, as more often happens, these
symptoms become more grave, and the vital forces
continue to fail, until the patient sinks under the dis
ease.
Some of the marks which characterize serous apo
plexy, are, general appearance of debility, face pale
and haggard, pulse below the natural standard in fre
quency and fulness, surface cool and clammy, pupils
contracted or dilated, loss of consciousness, and paral
ysis of one or more parts.
If the patient recovers from the more serious symp
toms of this malady, there usually remains for a long
time, a paralytic condition of one or more parts of the
body.
Therapeutics. — We commend the following medi
cines in apoplexy : belladonna, opium, rhus toxicoden-
dron, cojfea, phosphorus, laurocerasus, acid hydrocyanic,
and protoxide of nitrogen.
Belladonna. — External indications. — Profound coma ;
390 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
stertorous respiration ; face swollen, bluish or dark-
red ; spasmodic movements of the lips ; distention of
the veins of the head and neck ; visible throbbing of
the carotid and temporal arteries ; dilatation of the
pupils ; injection of the conjunctiva ; grinding of the
teeth ; suppression or involuntary discharge of urine ;
paralysis and immobility of one limb, or of one side of
the body.
Physical sensations. — If the patient is sufficiently
conscious to note his sensations, belladonna will cover
confusion of the senses ; vertigo ; throbbing pains in
the head ; loss of memory ; heaviness and pressure in
the head ; cramp-like pains in the face and limbs ;
dimness of sight ; double vision ; deep-seated pain in
the orbits ; roaring in the ears ; hardness of hearing ;
loss of taste, or putrid taste ; constipation ; lameness
and weakness of the extremities ; painful sensitive
ness of the whole surface to the touch ; drowsiness,
disturbed sleep ; great sensitiveness to cold ; aggra
vation of the pains by movement or by contact.
Mental and moral symptoms. — Despondency ; dejec
tion of spirits ; apathy ; irritability.
Administration. — In grave cases, a drop of the se
cond potency may be given every half hour, or every
hour, until the effect is manifest. When there is only
a predisposition to the malady, a drop once in six or
eight hours will suffice.
Opium. — External indications. — Face red, bloated,
and swollen, or pale and sunken ; expression of coun
tenance stupid and besotted ; distortion of the mouth ;
dropping of the under lip; eyes half closed, pupils di
lated, and insensible to light ; irregular and snoring
respiration ; profound coma, with stertorous and
rattling respiration ; convulsive and spasmodic mo
tions ; bluish colour of the lips and nails ; general re
laxation of the muscles ; coldness of the extremities,
with heat in the head.
Physical sensations. — Stupidity, imbecility and dul-
ness of the mental faculties and senses ; drowsiness ;
vertigo ; giddiness ; buzzing in the ears ; heaviness,
pressure, and tightness in the head ; congestion of
blood to the head ; visions ; dryness of the mouth ;
paralysis of the muscles of the throat and tongue :
DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 391
constipation, or involuntary stools ; suppression of
urine ; numbness and insensibility ; weakness ; lan
guor ; general diminution of power throughout the
organism.
Mental and moral symptoms. — High spirits, succeed
ed by depression ; calmness ; agreeable reflections ;
pleasant fancies ; taciturnity ; courage ; confidence ;
contempt of danger, and finally by coma, with sterto
rous breathing.
Administration. — A drop of the third dilution in
water, or on sugar, and repeated according to the ur
gency of the case.
Rhus toxicodendron and laurocerasus are applicable in
some cases of adynamic apoplexy, after belladonna or
opium. It is specific for the secondary effects, which
have not been removed by the last named medicines ;
like great prostration ; paroxysms of fainting ; bruised
pains in the affected parts ; numbness ; stiffness ;
paralysis ; cramps ; great sensitiveness to cold air ;
tingling and twitchings in the limbs ; irresistible
drowsiness.
Administration. — A drop of the third dilution once
in six or eight hours.
In the adynamic apoplexy of old people, phosphorus
is a valuable remedy. The symptoms which point
to its use are, general appearance of debility and
prostration ; face pale and sickly ; eyes sunken ; tor
por of the mental and physical powers ; coldness ;
paralytic weakness ; tremor of the hands, and feeble
pulse.
Administration. — Same as rhus.
Coffea, ignatia, and nux vomica, may be exhibited
to remove the premonitory symptoms of adynamic
apoplex}^. The vapour of the nitrous oxyde gas may
be inhaled with advantage in cases which are cha
racterized at the commencement by great exhilaration,
increase of muscular force, constant desire for loco
motion, and succeeded by profound sleep, or sleep dis
turbed by visions. This remedy should be administer
ed in such a manner as to produce a decided impres
sion.
392 DISEASES OP THE BRAIN AND NERVOUS SYSTEM.
SECTION VII.
PARALYSIS. PALSY.
Paralysis is characterized by a partial or total loss
of voluntary motion or of sensation. In some cases
both sensation and voluntary motion are destroyed.
These symptoms occur without coma, loss of con
sciousness, or much derangement of the intellectual
powers, if we except an occasional weakness of me
mory. It may follow apoplexy, or arise from disease
of the spinal marrow. When it succeeds to an apo
plectic attack, there is usually a paralysis of one side
of the body, which is termed hemiplegia. Palsy of
the lower part of the body, or paraplegia, may arise
from disease of the brain, or spinal marrow, though
most commonly the former organ is the seat of the
affection. Partial or local palsy affects some particu
lar part of the body, as an arm, wrist, or the 'face.
The muscles of the face are most often affected. This
variety may arise from the pressure of a tumour, from
mechanical injury, or from disease of the portia dura.
We sometimes see a palsied state of the wrists, which
has been termed lead palsy, from the supposition that
it owes its origin to the absorption of lead into the
system. We have no doubt but that the absorption of
lead may induce this palsy of the wrists ; but in most
of the cases which have fallen under our observation,
we have been unable to trace the cause of the ma
lady to this drug. On the contrary, we have in
several instances known it follow long exposure to
cold and wet, in the act of driving. In three instances
this result has occurred in individuals in perfect health.
In one instance, the exposure took place after a course
of blue pills.
Diagnosis. — When there is only a loss of voluntary
motion, the part affected wastes away, and becomes
soft from want of use, while sensation may remain
natural, or, as sometimes happens, there will be a
morbid sensibility, or a bruised and painful feeling in
the part affected. I have known this morbid sensibi
lity in two or three cases to be exceedingly trouble
some, rendering it impossible for the patient to move,
DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 393
or be moved, without great pain. In some cases, there
is an entire loss of sensation, as well as voluntary mo
tion. Often, when the sensibility of the part is only
partially destroyed, formication is experienced in the
parts affected.
The loss of muscular power and of sensation will in
all instances bear a direct ratio to the extent and se
verity of the original affection and the part affected.
Therapeutics. — Rhus toxicodendron, arnica, nux vo-
mica, ruta, sulphur, electro-magnetism. All of these
medicines, with the exception of ruta and sulphur,
are made use of as chief remedies by allopathic, as
well as homoeopathic practitioners.
Rhus may be used in cases of paralysis, when there
is great sensitiveness to cold air ; general debility ;
tingling or itching in the paralyzed parts ; languor ;
constant desire to lie in bed ; fainting fits.
Arnica may be given to paralytics with feeble or
impaired constitutions, whose pains are aggravated by
motion or talking ; with painful sensitiveness of the
whole body ; tremors of the limbs ; relaxation and
general debility ; hemiplegia.
Nux vomica is suitable for paralysis occurring in
sanguine or choleric individuals. The indications
for its use are, paralysis, especially of the lower ex
tremities ; trembling of the limbs ; painful contrac
tive sensations ; cramps and spasmodic twitchings in
the parts ; languor ; heaviness and stiffness of the
limbs ; great sensitiveness to cold air ; paralysis
which has been induced from abuse of stimulants,
coffee, or narcotics ; or where the predisposing cause
has been want of exercise, with severe and protracted
mental labour.
Ruta has been highly extolled as a remedy for
rheumatic paralysis of the tarsal and carpal joints. It
is also indicated in local paralysis, which has followed
surgical operations, or which is owing to injury or
pressure upon some particular nerve.
We have found sulphur of eminent service in cases
of paralysis, accompanied by great irritability and
sensitiveness of the rectum, and causing excruciating
pains during every attempt at an alvine evacuation.
In all of those oases of palsy which have resisted
17*
394 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
our treatment by internal remedies, we should have
recourse to electro-magnetism. This agent, when pro
perly and perseveringly applied, will often effect
cures after all other means have failed. This potent
remedy should always be applied, however, under the
direction of a judicious physician ; for it is an agent
capable of doing serious injury when improperly em
ployed.
We also suggest baryta carb., cocculus, lachesis,
plumbum, pulsatilla, bryonia, conium maculatum.
Administration. — The remedies may be exhibited at
from the first to the third attenuations, — a dose once or
twice daily.
SECTION VIII.
DELIRIUM TREMENS. MANIA A POTU.
Dr. Solly, in his treatise on the human brain, classi
fies delirium as an anaemic affection of the brain.
Amongst other reasons for this conclusion, he asserts
that in all cases which he has examined after death,
he •' has invariably found the hemispherical ganglion
pale and bloodless ; the venous canals were generally
full ; and occasionally the arachnoid thickened, as if
it had been the subject of chronic inflammation." A
judicious distinction is made by this author, and some
others of recent date, between the delirium which is
produced by the sudden withdrawal of stimulants
after a long and free indulgence, and that which may
be excited in any person by an excessive temporary
use of stimulants. The former he terms true delirium
tremens, which depends upon an anaemic condition of
the hemispherical ganglion ; and the latter, delirium
ebriosorum, depending upon a congested state of the
same structure.
Dr. Solly enumerates the following as a few of the
marks of distinction between the two maladies. "The
head and skin generally are cool and moist in delirium
tremens. dry and hot in delirium ebriosorum. The pu
pil varies in both according to the stage ; in the early
stage of both it is generally contracted, in the latter
stage dilated. The conjunctiva red and injected in
delirium ebriosorum ; the reverse in delirium tremens.
DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 395
The mental derangement in the former is more allied
to an exalted, excited state of intellect ; in the latter
it approaches fatuity and depression. The tongue is
generally pale and furred in delirium tremens, some
times unnaturally clean and red ; in delirium ebrioso-
rum it is usually dry, and sometimes brown, but this is
no certain guide. The pulse is most uncertain ; but,
upon the whole, there is less power in the beat of the
artery, and that more varied, in delirium tremens than
in delirium ebriosorum."
Diagnosis. — True delirium tremens is characterized
by a wild expression of countenance ; eyes fixed in
tently and earnestly upon some imaginary object in
the room ; constant endeavours to grasp or to avoid
these visionary images ; motions sudden and rapid ;
tremour of the hands and limbs, also of the tongue
when protruded ; tongue flabby and moist ; pulse
nearly natural ; skin cool and often covered with
perspiration ; constant desire to move about ; inability
to concentrate the thoughts for any length of time ;
entire inability to sleep ; mind wandering and deli
rious ; bowels regular ; face bloated ; absence of
thirst, heat, and other febrile symptoms ; general ap
pearance of debility.
Delirium ebriosorum may be recognised by the un
natural heat and dry ness of the skin ; face flushed ;
conjunctiva red and injected ; expression fierce and
excited ; pulse frequent and full ; tongue dry and red,
or brown ; boisterous delirium ; increase of muscular
strength ; strong pulsations in the carotid and tempo
ral arteries ; pupils first contracted, afterwards dilated ;
inability to sleep night or day.
Causes. — Excessive and protracted use of poor
liquors, abuse of opium, and other narcotics. The
proximate cause of the malady is the sudden with
drawal of the accustomed stimulant. Delirium ebri
osorum arises from an excessive temporary use of
liquors. Alcohol, being decidedly specific in its action
upon the brain, is manifestly capable, when abused,
of producing an inflammation of this organ, and, con
sequently, the symptoms which characterize delirium
ebriosorum. A long- continued abuse of this stimu
lant induces an anaemic condition of the brain and
396 DISEASES OP THE BRAIN AND NERVOCS SYSTEM.
nervous system, thus developing the legitimate secon
dary effect of the article, while its temporary abuse
induces the legitimate primary effects which wre ob
serve in delirium ebriosorum.
Therapeutics. — Opium, nux vom., belladonna, hyoscy-
amus, stramonium, ether vapour, chloroform, protoxide
of nitrogen.
Opium. — External indications. — Skin cold and cov
ered with sweat- ; tongue moist and red ; wild and
staring expression ; motions rapid and constant ; grasp
ing at imaginary visions ; pulse rather below the
natural standard ; tremour of the hands and limbs ;
unsteadiness in moving about ; face pale and bloated.
Physical sensations. — Tormented with frightful or
fantastic visions ; giddiness ; confusion of ideas ; ina
bility to compose or to concentrate the mind, or to
sleep ; sensation of numbness or prickling in different
parts of the body.
Mental and moral symptoms. — Delirium ; frightful
or fantastic visions ; confusion of ideas ; stupefaction :
gloomy feeling ; inclination to commit suicide.
Nux vom, — External indications. — Trembling of the
limbs : spasmodic twitchings in different parts of the
body ; countenance pale and bloated ; tongue white
and moist ; vomiting ; surface covered with sweat.
Physical sensations. — Constant uneasiness, anguish,
and desire to run away ; troublesome visions ; pres
sure and burning at the stomach ; constipation ; ver
tigo ; headache ; cold extremities ; head cold or hot ;
sensation of debility or faintness.
Mental and moral symptoms. — Silent ; apprehensive
of death ; confusion of ideas ; depression of spirits ;
desire to be in the open air.
Belladonna is well adapted for the cure of delirium
ebriosorum, occurring in individuals of a full, plethor
ic habit, and presenting the following symptoms : con
gestion of blood to the head ; heat and pain in the
head ; flushed face ; injected eyes ; boisterous deli
rium ; insomnia ; strong pulsations of the carotid and
temporal arteries ; great nervous erethism ; tongue
and mouth red, hot, and dry ; thirst ; trembling of the
}imbs ; cramplike pains; starting suddenly from
DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 397
sleep ; failure of memory ; pain in the neck and limbs ;
sparks before the eyes ; visions.
Stramonium and hyoscyamus may be exhibited in
cases complicated with epileptic paroxysms, when
there are, convulsive movements ; subsultus tendi-
num ; fainting fits ; muttering delirium ; picking at
imaginary objects ; suppression of the secretions ;
extreme irritability ; constant and rapid motions ;
contraction and stretching of the limbs ; irascible ;
noisy, and difficult to manage.
Administration, — In urgent cases, the remedies may
be given at the second or third attenuations every
hour until the symptoms begin to yield.
The vapour of sulph. ether, of chloroform, and the
nitrous oxyde gas, may be inhaled with advantage in
cases which are characterized in the commencement
by great mental exhilaration ; increased muscular
force ; constant desire to move about rapidly, to dance,
to sing, to leap, to fight, or do something extravagant ;
flushed cheeks ; accelerated respiration : frequent
pulse, succeeded in a short time by profound sleep, or
sleep disturbed by visions ; general insensibility to
external impressions, with pallid and deathlike expres
sion of countenance.
These remedies are admirable specifics in this af
fection, and we have known their exhibition in seve
ral instances of serious mania a potu, effect the most
speedy and happy cures. They should never be ad
ministered except through the advice, and under the
personal superintendence of a medical man.
SECTION IX.
INSANITY.
If it be true, that the cortical substance of the brain
is the exclusive seat of the intellectual faculties, it
follows, that diseases of this structure must be suc
ceeded by more or less mental disturbance.
Insanity is supposed to be hereditary, and, so far as
a general similarity between parent and child, rela
ting to physical conformation and temperament, is
concerned, there may be an hereditary influence ; but
the inheritance bv children of the mental and moral
398 DISEASES OP THE BRAIN AND NERVOUS SYSTEM.
imperfections of parents, appears to us to admit of
much doubt. When the infant enters the world, his
physical organization is complete, and all of the or
gans exercise their functions in a healthy and uniform
manner, while for a long period there are but few, if
any, of those manifestations denominated intellectual.
On the contrary, the intellect, as it gradually mani
fests itself in the child, even until its full development
in the adult, constantly exhibits the influence and the
impressions which have been produced by circum
stances, as early associations, parental example, edu
cation, habits of action and thought, poverty, riches,
hardships, indulgence, &c. The proximate cause of
insanity is not a derangement of the mind, but an ac
tual disease of the cortical substance of the brain, and,
in order to avoid the consequences of this diseased
condition, it is only necessary to avoid all of those
causes capable of producing inflammation or irrita
tion of this structure. So, in effecting a cure, it is
necessary to act with our medicines upon the organ
diseased, rather than upon the mental aberration.
My respected preceptor, Dr. Brigham, in his sixth
Annual Report to the Managers of the New York
State Lunatic Asylum, inculcates the importance of
early physical and moral education, in order that in
sanity may be averted in those who are physically
predisposed to it. Doctor Brigham observes: "Great
pains should be taken to form a character not subject
to strong emotions, to passions, and caprice. The ut
most attention should be given to securing a good
bodily constitution. Such children should be confined
but little at school ; they should be encouraged to run
about the fields, and take much exercise in the open
air, and thus secure the equal and proper development
of all the organs of the body. They should not have
the intellect unduly tasked. Very early cultivation of
the mind, and the excitement of the feelings by the
strife for the praise and the honour awarded to great
efforts of mind and memory, are injurious to all chil
dren, and to those who inherit a tendency to nervous
diseases, or insanity, most pernicious. In after life,
persons thus predisposed to insanity, should be careful
to avoid engaging in any exciting or perplexing busi-
DISEASES OP THE BRAIN AND NERVOUS SYSTEM. 399
ness or study, and should strive, under all circum
stances, to preserve great equanimity of temper.''
The impression has always obtained, until within
the last century, that insane persons were possessed
of evil spirits, and that all remedial measures must
be directed towards expelling from the body the tor
menting demon. It is only of very recent date that
correct doctrines have been inculcated in regard to
the true nature and seat of this grievous malady; but
the researches of Pinel, Esquirol, and Connolly have
conduced much to enlighten the profession upon this
previously mysterious subject, and to point out suc
cessful modes of treatment.
The different varieties of mental alienation have
been classified as follows :
1 . — MANIA,
Consisting of an entire perversion and derangement
of the intellectual and moral qualities. The patient
seizes at the same time upon topics the most dissimi
lar, passing from one to the other without order or ar
rangement, and reasons, draws inferences and forms
opinions, without any regard to logic or common sense.
The intellect is deranged on all subjects, and the moral
qualities indicate their perversion, by ferocity, unna
tural hatreds, rage, quarrelsomeness, continual desire
to do mischief, and an urgent propensity to carry into
immediate effect any fancy which may strike the imagi
nation. At the same time the patient is perfectly con
scious of his identity, — has a kind of an idea of right
and wrong, and is fully aware of what he is doing :
but the mind operates through a diseased organ, the
healthy equilibrium is lost, vague and absurd fancies
take the place of reason, and the individual is impel
led to obey the dictates of his diseased imaginings.
Mania is usually unaccompanied by fever, except, per
haps, at its very commencement, although there is a
great exaltation of the mental and muscular powers.
It has also been observed that maniacs are capable of
enduring the most severe bodily inflictions, and the
most intense cold, without evincing much conscious
ness of pain, — also extreme and protracted hunger and
thirst, without serious inconvenience.
400 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
Dr. Brigham remarks, that " insanity often com
mences in a very insidious manner. Some appear to
be deranged only as regards their feelings or moral
qualities. They are noticed to be different from what
they formerly were ; to be more restless and sleepless,
or unnaturally morose and irritable. Some manifest
an unfounded dread of evil, say but little, shun society,
and are suspicious of their dearest friends and rela
tives, while others are unusually vivacious and plea
sant, or quarrelsome and abusive. Such changes of
character and habits, will usually be found to be sub
sequent to some reverse of fortune, loss of friends, or
sickness, and should excite alarm. Persons thus af
fected, will converse rationally, and in company, or
before strangers, will conceal their peculiarities, and
thus are known to be insane but to very few, until
some violent act leads to an investigation, and then
it is found they have long been partially deranged.
This is the case with most of those who commit sui
cide. Often insanity exists, in a slight degree, for
months, and is only noticed by the most intimate
friends or relatives, and then suddenly assume an
alarming form, leading, in some instances, to homicide,
and in others, to self-destruction."*
Frank asserts, 4i that mania may alternate with hy
pochondria, melancholia, or dementia. That it may
be continued, remittent, or intermittent. Intermittent
mania returns every eight days, every month, every
three months, every year, every two years, &c." Ac
cording to the same author, " mania may terminate
by various crises : mucous or bloody stools, vomitings,
ptyalism, leucorrhoea, epistaxis, re-establishment of
the menses or of suppressed hemorrhoids, varices,
eruptions, erysipelas, and boils. It may terminate by
continued or intermittent fevers. It may degenerate
into melancholia, or dementia. The diseases with
which maniacs finally succumb, are cerebral fever,
apoplexy, inflammation of the rneninges, phthisis pul-
monalis, and ulceration of the intestines ;" complete
exhaustion, also, of the physical and mental forces, is
a common termination of insanity.
*Dr. B.'s Eighth Annual Report.
DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 401
2. — MONOMANIA,
Is characterized by derangement upon some particu
lar subject which constantly occupies the thoughts fo
the almost entire exclusion of everything else. When
the patient's attention is diverted from the subject of
his insanity, he reasons correctly and converses ration
ally upon all other topics presented to him ; and even
upon the subject of his derangement, he reasons con
sistently upon his false data. Monomania may be of a
gay or of a sad character, but in a majority of instan
ces, the monomaniac dwells upon a painful train of
ideas. Sometimes a prey to the most absurd fears
and dreads, as of poverty, being violently killed, suicide,
homicide, of having committed the unpardonable sin, or
of some serious impending calamity ; sometimes he
imagines himself a clock and stands in a corner of the
room through the day, swinging his arms like a pen
dulum ; or an animal, and imitates, as far as he is able,
its peculiarities ; or that he has no legs or arms, and
therefore refuses to walk or help himself; or that he is
full, and therefore cannot eat or drink any more ; or.
like J. J. Rousseau, that all men are his enemies, and
are seeking to ruin him. At other times he imagines
himself to be the Saviour, or a great prophet, or the
emperor of the world, or some renowned statesman,
philosopher, or general, and swells about issuing or
ders suitable to his fancied dignity.
Monomania may exist in a light form for a long
period, without attracting particular attention. We
have at the present time, under our care, two patients
who have tormented themselves a good part of the
time, for years, and have reduced themselves to a
wretched state of health, with the dread of committing
suicide or homicide, and yet they have had the firm
ness to conceal their morbid condition from their
friends. We have known other individuals who have
been thrown into phthisis pulmonalis, by silently
brooding for a long time over some apprehended mis
fortune, like loss of property. The mind, like the body,
requires rest and diversion ; one set of muscles cannot
be constantly exercised without becoming impaired in
their functions, nor can the mind dwell upon a single
402 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
train of ideas exclusively and for a long time, without
becoming deranged.
• This malady, like mania, may be continued, remit
tent, or intermittent. The cure is generally preceded
by some crisis, either physical or moral. The physical
crises are, eruptions, sweats, vomitings, and diarrhoeas,
tumours, fevers, acute inflammations of the brain.
The moral crises consist of all those emotions or pas
sions which, by violently impressing the brain, are
capable of exciting a new action which shall supersede
the morbid affection. Under this head may be ranked,
sudden and startling news, fright, rage, violent grief,
3. - DEMENTIA.
In this variety of insanity, the intellectual faculties
are all impaired — the power to concentrate the
thoughts, to arrange and compare ideas, or to draw
inferences, is lost. The past is a blank to the unfor
tunate victim, and thus, tamily, friends, home, the as
sociations of early years, as well as the cares and
pleasures of maturity, are all forgotten. Yet the irri
tation of the cerebral structure often incessantly im
pels the patient to move about, and to give utterance
to the random and incoherent images which are con
stantly passing through his brain. Some are silent
and almost insensible to everything around them. If
articles are presented or topics of interest broached for
their attention, apparently no impression is produced,
but the mind still pursues its incoherent wanderings.
This form of insanity is more difficult of cure than
either of the others, for the causes are usually so gradu
al and insidious that the cerebral mass becomes hope
lessly disorganized, or the meninges permanently thick
ened and adherent to the cranium, before serious
alarm is taken. If, however, the malady is attacked
within the first few months or the first year, hopes of
cure may be entertained. Dr. Brigham asserts that " in
sanity is rarely cured after it has uninterruptedly con
tinued two years, though there is always hope if the
patient is vigorous and the form of insanity varies."
Causes. — In examining the tables of the supposed
causes of insanity, as published in the reports issuing
DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 403
from the different insane hospitals of Europe and
America, we find a very great variety ; but we agree
with Dr. Brigham that the general causes of insanity
may, with propriety, be divided into moral and physi
cal. Under the head of physical causes should be
included, injuries to the brain, from falls, blows upon
the head, &c. ; all morbid or medicinal substances
which, when absorbed, exert a specific action and are
capable of powerfully impressing the cerebral organs,
like irritating gases, as carbonic acid, and nitrous oxyde
gas ; vapours, like ether vapour and chloroform ; also
alcoholic liquors, opiates, and other narcotics ; mercu
ry, electric shocks, sun strokes, excessive labour,
violent exertions, straining, masturbation, protracted
sea sickness, exposure to violent heat, sudden exposure
to cold water, other diseases, repelled eruptions, ex
cesses in sexual pleasures, drying up of old ulcers, or of
accustomed issues, turn of life, suppression of the
menstrual or lochial discharge, metastases of rheuma
tism, gout, or other disease, syphilis.
The moral causes comprise, over-exertion of the
intellectual powers, .violent emotions, excessive and
protracted grief, mortification, disappointed love and
ambition ; jealousy, remorse, anxiety, exclusive and
protracted thought upon a single subject, or a single
train of ideas, religious enthusiasm, vivid and unre
strained imagination, improper mental education.
Amongst the physical causes enumerated, it is well
known that many of them exercise a decidedly specific
action upon the brain, as for example, opium, belladon
na, alcoholic liquors, the nitrous oxyde, and carbonic
acid gases, the vapours of ether and chloroform, &c.
Opium eating is set down in works upon insanity as
one of the causes of the malady, and yet this remedy
has often effected cures, both in the hands of the allo-
pathist and the homoBopathist. The vapours of ether
and chloroform have caused insanity, and they have
also effected cures. Alcohol causes one kind of de
rangement, (delirium tremens,) and yet it is an efficient
remedy in effecting cures, in the hands of all practition
ers. Taking these facts into consideration, we can
easily explain the modus medendi of these cures, viz.,
404 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
the application of remedies in accordance with the only
true principle of cure, similia similibus curantur.
Want of sleep is ranked by Dr. Brigham as the " most
frequent and immediate cause of insanity, and one of
the most important to guard against."
Dr. B. dwells upon this cause with much earnest
ness, and endeavours to impress upon all, the vast im
portance of " securing sound and abundant sleep."
" Long continued wakefulness," says Dr. B., " disor
ders the whole system. The appetite becomes impaired,
the secretions diminished or changed, the mind de
jected, and soon waking dreams occur, and strange
phantoms appear, which at firs*t may be transient, but
ultimately take possession of the mind, and madness
or death ensues." — (Sixth Annual Report of the New-
York Lunatic Asylum, by Dr. Brigham.)
Pathology of insanity. — Induration of the brain
from long continued sub-acute inflammation, is a fre
quent cause of insanity. In recent and slight cases of
this malady, the intellectual faculties exhibit no very
prominent derangement, but as the induration pro
gresses and extends, the hallucination becomes more
strongly pronounced', until eventually complete fatuity
is the consequence. Solly believes that chronic in
flammation of the dura mater is a very frequent cause
of insanity. In post-mortem examinations of those
who have died demented, Esquirol has observed soft
ening or increase of the density of the brain, adhe-
rences of the arachnoid, thickenings, atrophy and de
fective organization of the brain or cranium.
In monomania, Pinel, Frank, and Esquirol assure us
" that organic lesions of the lungs and abdominal
viscera, are more frequent than alterations of the
brain."
The latter writer supposes displacements of the
transverse colon, to be amongst the most common of
these derangements, and this is supposed to account
for the constipation and the pains in the epigastric
region, which are usually present in this variety
of insanity.
Many cases have been reported, in which no organic
lesions have been found after death, either in the brain
or the abdominal cavity, and on this account some
DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 405
authors recognise a nervous or vital monomania. It is
probable, however, in all cases of mental derangement,
that either the brain or its membranes are in a diseased
condition, although our ordinary modes of examina
tion may not enable us in all cases to detect it.
Therapeutics. — Our means of cure are, moral and
medicinal. We have seen that a majority of the proxi
mate causes of mental alienation consists in undue
exercise of the emotions and passions. It is then
reasonable to suppose that suitable moral influences
may conduce much towards removing the morbid im
pressions.
Our general course of moral treatment should con
sist in calming and soothing the mind, and by present
ing an entirely new train of associations and ideas,
gradually divert the mind from its morbid channel,
until the diseased encephalon shall recover its tone,
and the impressions made upon it, produce their legi
timate results. So important is it to abstract the mind
from all accustomed associations and thoughts, that it
is a matter of extreme difficulty to cure deranged per
sons so long as they are permitted to remain with their
friends or in their usual residences. For this reason
alone, an early removal to an insane hospital should
be insisted upon, in order that proper restraints may be
imposed, and the ideas directed in such a manner as to
fill the mind with new impressions to the exclusion of
thaold ones.
In order to accomplish this object eifectually, it is
essential to investigate the peculiarities of each par
ticular case, so that new and different trains of thought
may be perseveringly kept before the patient.
We take occasion in this place to translate the
admirable remarks of Frank upon this point : " The
physician should endeavour to substitute a new passion
in the place of the dominant one : for example, hope
for despair, mildness for rage, etc. He should carefully
prohibit monomaniacs .from listening to mystical lec
tures or conversations, and all religious discussions. In
the mean time, when the delirium consists in the fear
of the judgments of God, or want of confidence in his
mercy, we can sometimes cure the patient by instruct
ing him in the true principles of religion. But it is
406 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
not necessary to insist, if the melancholic, instead of
relishing the solid reasons which we give him, finds
in these conversations a new aliment to his delirium.
The consolations of religion are always useful to per
sons whom reverses of fortune, domestic chagrins, un
fortunate love, etc., have plunged into a melancholic
state. We have seen a case of melancholia with pro
pensity to suicide, fixed by excess of study and of
onanism ; the patient suffered moreover much from
hypochondria. Voyages, distractions, and rigid diet
produced only momentary relief. The consolations of
religion, a rigorous observance of continence and of
other Christian virtues, gradually operated a cure. We
have re-examined this patient at the end of six years :
he enjoys perfect health, and when a sad idea comes
to darken his imagination, the most simple practice of
religion suffices to restore to his mind calmness and
serenity. Religion is capable of operating similar
cures daily ; it acts upon the heart of man with much
more force than all the arguments of philosophy. But
its happy influence is unknown to the incredulous, and
as we do not think that the proofs of religion can be sub
mitted to the discussion of a lunatic, we reserve the
succours contained in the evo.ngelical moral, to pious
minds, or at least to believers, whom different causes
have plunged into melancholy. As for unbelievers,
we can only offer them beautiful maxims, and the cold
consolations of philosophy." — (Medecine Practique, par
J. P. Frank.)
Monomaniacs may sometimes be cured, however,
by indulging them in their delusions, and encouraging
them in the hope of being able to remove the cause.
The late Dr. George McLellan once had a case in
point : a highly intelligent merchant was firmly pos
sessed with the idea that there was a living eel in his
stomach, and he so tormented himself with the delu
sion, that he became seriously ill, and was obliged to
abandon his business. He had employed many emi
nent physicians, who all ridiculed his delusion, and
endeavoured to convince him of its absurdity, but all to
no effect ; the idea continued firmly fixed, and his
*fc^eneral health continued to suffer, when as a last re-
or ort, and in disgust at the ignorance and obstinacy of
DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 407
all physicians, he called in Dr. McLellan, who, on
investigating his case, decided ^to indulge the patient
in his delusion, and accordingly assured him that he
had a monstrous living eel in his stomach, but that he
could give him a medicine which would destroy the
animal, and carry it off by way of the bowels. Ac
cordingly a long prescription was written, amounting
to a powerful drastic purgative, and the patient di
rected to take it. At its operation, the attendant was
advised to slip a mutilated eel into the vessel, and con
vince the invalid that it had passed from him. The
stratagem succeeded admirably, and the man was
directly restored to health, mental and bodily.
Frank mentions the case of an individual " who
did not wish to urinate for fear of producing a new
deluge : he was told that if he persisted in his sad re
solution, a fire would occur and burn up the universe.
He hastened to urinate, and his delirium vanished."
Another monomaniac believed himself damned : one
of his friends, habited as an angel, entered his cham
ber during his sleep, holding in one hand a flambeau,
and in the other a glistening sword. He announced to
him, in behalf of God, the pardon of his crimes, and
the patient was restored to health. Another mono
maniac imagined that there were rabbit-burrows in
his head. To cure this illusion, they made a crucial
incision in his scalp, and showed him bloody rabbits,
which they told him had retired by the wound."
Much, however, must depend upon the peculiar cir
cumstances attending each particular case, in apply
ing our moral treatment ; but as a general rule, uni
form kindness, respectful treatment, proper discipline,
and a perseverance in all of those means which tend
to direct the mind into new channels, like games,
music, gymnastic exercises, mechanical or agricultural
labour, exhibitions, etc., will enhance very materially
our success in the treatment of this class of maladies.
The employment of baths are highly recommended
by some authors. As the daily habit of general
bathing is considered at the present day not only es
sential to health, but to personal cleanliness and de
cency, we deem it as unnecessary to allude to tb-
habitual attention to this important duty, as it woulg
be to allude to the importance and propriety of othe
408 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
personal habits, like washing the hands and face,
or changing the linen. Tepid or cold baths may be
employed, as the condition of the patient demands ;
but as the healthy function of the skin is so often de
ranged in insanity, and as nothing conduces so much
to restore and preserve this function as frequent bath
ing, its importance will be readily appreciated. Dur
ing the first stages of mania, or at other periods when
there exists great excitement, with hot skin and fre
quent pulse, the cold shower-bath, or the cold dash,
may be employed with decided advantage. Some
discrimination, however, is requisite in using these
more powerful applications.
The most certain specifics which we possess for the
cure of insanity, are, opium, belladonna, nux vomica,
aconite, ignatia, hyoscyamus, stramonium, pulsatilla,
veratrum, platina, coniam, helleborus, aurum mur.
Opium is suitable in cases of dementia, attended with
stupefaction of the senses ; general loss of mind and
sensation ; indifference to pain or pleasure ; strange
visions ; laborious respiration; constipation ; face
pale, or red, or brownish ; diminished temperature of
the skin ; full and slow pulse ; spasmodic motions and
trembling of the limbs.
Belladonna. — External indications. — Furious and
violent derangement, or merry and silly craziness ;
face red and hot ; expression gay, or ferocious with
fixed look ; eyes brilliant, pupils dilated ; head hot ;
spasms ; starlings ; sanguine choleric temperament ;
impressible nervous system.
Physical sensations. — Vertigo ; headache from con
gestion of blood to the head ; sleeplessness, with great
uneasiness and anguish ; frightful dreams, starting
one suddenly from sleep ; spasms or stiffness of the
limbs ; constant inclination to change the position of
the limbs ; visions ; thirst ; general sensation of un
easiness and discontent.
Mental and moral symptoms. — Furious mania ; rage ;
or sadness, despair, and fear of death.
Pathological anatomy. — Congestion of the vessels of
the brain ; injection of the vessels of the dura mater,
pia mater, and substance of the brain with black
blood.
DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 409
Nux vomica is suitable for suicidal monomania, at
tended with great anguish, and desire to go from place
to place ; also in nervous hypochondria, arising from
derangement of the stomach and liver ; also mental
derangement, arising from abuse of liquors ; from
mortification ; from excessive study ; from suppressed
haemorrhoids. It is sometimes useful to remove the
constipation which is so frequently present in insanity.
When there are frequent and full pulse, hot and dry
skin, thirst, and other febrile symptoms, with conges
tion of blood to the head, and a general exaltation of
the muscular and mental powers, aconite may be em
ployed to remove this condition.
Ignatia is recommended in melancholy and fixed
mania, occurring in individuals of a mild disposition,
sad or cheerful, and occasioned by fright, despair, an
guish, grief, chagrin. A relaxed, exhausted, and feeble
condition of the body also requires it.
Pulsatilla is indicated in puerperal melancholy, and
when it occurs during pregnancy, with anxiety, pain in
the head, sleeplessness, pressure at the heart, general
uneasiness, vague desire to escape, incoherent talk,
sadness and distrust.
Stramonium is applicable in derangement with
spasmodic symptoms ; in puerperal mania ; in timid
mania, with staring look, desire to escape, screeching,
frightful visions, heat, redness and moisture of the
skin ; in loquacious mania, with great mirthfulness,
laughter, high-flown speeches, and ridiculous motions ;
also in religious monomania, with great depression of
spirits, despair of salvation, and desire to converse
upon the subject. It is also sometimes useful in
" rage, with furious delirium."
Veratrum is proper in hypochondriac, suicidal, and
religious melancholy ; in puerperal mania ; in mania
with lewdness and lascivious speeches, and in some
cases of furious mania. This remedy is especially
indicated when the derangement partakes of an in
termittent character.
For the treatment of suicidal monomania, accom
panied with extreme depression of spirits, unrefresh-
ing sleep from frightful dreams, dread of some im
pending calamity, loss of ambition and energy, dimi-
18
410 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
nution of virile strength, and a constant disposition to
dwell upon imaginary ailments, muriate of gold is a
remedy worthy of the very highest consideration.
Indeed, in cases of this description, no other medicine
can bear any comparison with it.
Platina is excellent for females of excitable temper
ament, and with strong sexual desire, It has cured
melancholy, with great timidity and depression of
spirits, all persons seeming to be demons ; or with
vanity ; trembling of the hands and feet ; anguish at
the heart ; absence of mind ; dread of death ; furor
uterinus ; constipation ; small and feeble pulse.
There are other remedies which may be consulted
in the different varieties of insanity, like the vapours
of ether and chloroform, the nitrous oxyde gas, &c.
But as we have not had sufficient experience in the
use of these, we shall not now attempt to point out the
symptoms which demand their use.
Administration. — As a general rule, the above me
dicines may be given at the first or second attenua
tions, every twelve or twenty- four hours until there is
a medicinal aggravation, or an amelioration of the
symptoms.
SECTION X.
INFLAMMATION OF THE SPINAL MARROW, AND ITS
MEMBRANES.
Under this head we include tetanus and hydrophobia.
I . TETANUS.
We understand by the term tetanus, sudden morbid
contractions or cramps of many muscles of the body,
with rigidity and loss of voluntary motion in the af
fected parts. This morbid contraction and rigidity
may affect the muscles of almost every portion of the
body, or it may be confined to the muscles of a single
part, like the lower jaw, when the affection receives
the name of trismus ; or to the extensors of the back,
giving rise to recurvation of the body, when it is termed
opisthotonos ; or to those of the front part of the body,
causing incurvation, termed emprosthotonos ; or to the
muscles of the side, causing a lateral curvature, and
called pleurothotonos.
DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 411
Tetanus is much more common in hot than in tem
perate latitudes, and generally selects for its victims
individuals of a nervous and irritable temperament,
or those whose constitutions have been impaired by
the abuse of stimulants, or exposure to a vitiated at
mosphere.
There are two varieties of tetanus, the traumatic,
and the idiopathic. The usual exciting causes of the
former are, punctured and lacerated wounds, causing
injury or partial division of the nerves ; and of the
latter, general debility of the nervous system from
long continued illness, or protracted derangement of
the different functions of the organism.
Diagnosis. — This malady generally commences with
uneasiness at the prsecordia ; stiffness and tension in
the muscles of the back of the neck, back, and loins,
and some difficulty in deglutition and in articulation.
This contraction and stiffness gradually increases ;
the sensation of uneasiness in the chest becomes
changed to violent and painful contractions about the
ensiform cartilage ; the pains and cramps extend to the
back, jaws, and limbs ; the appetite fails ; the counte
nance assumes a flushed and anxious appearance ; the
bowels are constipated ; the mind remains sound until
the last stage of the disease, and the body will be
rigidly drawn into such a position as will enable us to
decide what particular class of muscles are affected,
and which of the varieties of tetanus is present.
Traumatic tetanus is always a dangerous affection,
but hopes of cure may be entertained when unusual
pains in the wound or cicatrix, with pains extending
along the limbs in the direction of the contracted
parts, occur simultaneously with the first symptoms of
the complaint. But if the symptoms continue to make
steady progress, while the original wound is cicatrized,
and no pain or disturbance is experienced either at
this point, or extending from it, the case may be
looked upon as highly dangerous.
Idiopathic tetanus proceeds from constitutional
causes, and is far less dangerous than the traumatic
variety. Its approach is also more gradual, and at
tended with less pain, but when the contraction and
rigidity of the parts take place, they remain in this
412 DISEASES OF THE BRAIN AND JJKRVOUS SYSTEM.
condition a longer time than in the other form of the
disease. The violent contractive pains about the en-
siform cartilage, and in the nape of the neck, which
are so characteristic of traumatic tetanus, are also
absent in this variety. Indeed, we have seen cases
where no pains or uneasy sensations were experienced
in any part of the body, except from the constrained
positions of the parts affected with the morbid con
traction.
Causes. — Punctured and lacerated wounds, which
partially divide one or more nerves, is one of the most
common causes. The admission of cold air into
wounds, sudden check to the perspiration after long
and fatiguing exercise under a hot sun, the irritations
of splintered bones, or other foreign substances in
contact with nerves and tendons, amputations, and
blows upon the spine, are all occasional causes of
traumatic tetanus.
The exciting causes of idiopathic tetanus are, sup
pressed menstruation, or other habitual discharge,
low fevers, over-exertion of mind or body, too close
confinement in small and ill ventilated apartments,
sitting in unnatural and constrained positions, tight
lacing.
Therapeutics. — A preliminary step in the treatment
of tetanus, should always be to remove, as far as pos
sible, whatever causes may have operated towards
inducing the disease, or which may continue to exert
an irritating effect after its full formation. The causes
of this character arc, the presence of irritating spicula
of bone, of needles, of dirt, of rust, or any other for
eign substance, in contact with the nerves and ten
dons ; abuse of stimulants, the wearing of too tight
clothing, foul air, exposure to sudden changes of tem
perature, especially from intense heat to coldness and
humidity. When there is reason to suspect the pre
sence of a foreign body in a cicatrized wound, after
the appearance of tetanic symptoms, we should at
once cut down and endeavour to extract the obnoxious
substance ; and in case nothing can be found, to apply
spirits of turpentine, or some escharotic, in order to
ensure suppuration in the wound. This important
surgical resource should always be resorted to in
DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 413
cases of this description, for it is not an uncommon
occurrence to perceive the immediate disappearance of
incipient tetanic symptoms, on the removal of a for
eign substance from the wounded part.
The remedies most appropriate in the treatment of
tetanus, are, nux vomica, belladonna, arnica, stramo
nium, cicuta, hyoscyamus, opium, pulsatilla, sulphur.
Nux vomica, from its decidedly specific action upon
the spinal marrow, and its membranes, as well as
from its pathogenesis, and the appearance of individ
uals who have been poisoned with it, is evidently a
remedy of importance in this dangerous malady. It
is especially called for when the spasms are frequent
and short, consciousness is perfect, and there are
cramp-like pains in the region of the stomach, con
stipation, and loss of appetite, and when the patient
has been addicted to the abuse of stimulants.
Belladonna, succeeded by pulsatilla, may be given
in idiopathic tetanus which has arisen from deranged
menstruation, or other* causes connected with the
utero-genital system, and where the extremities are
for the most part affected with the morbid contrac
tions. It may also be sometimes given in the last
stages of traumatic tetanus, when there is delirium,
dilated pupils, and great mental anguish.
Arnica should be used both internally and exter
nally, in all injuries which threaten to lead to tetanus.
This remedy possesses the power of warding it off,
when it might otherwise have occurred without its
use, and should always be resorted to when danger is
anticipated from a wound.
When we find great rigidity of the extremities,
contraction of the thumbs or fingers, wild and fixed
look, painful and difficult respiration and deglutition,
we may give stramonium in alternation with hyoscya
mus or cicuta.
Many writers speak in favourable terms of warm
baths in the treatment of this affection. We have
seen the most unequivocal advantage follow general
bathing, and a thorough application of fomentations
to the affected parts, and to the spine. We can call
to mind two cases where life was apparently saved
by the persevering application of these hot fomenta-
414 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
tions, together with frictions along the course of the
spine.
We take occasion in this place to suggest to the
profession the use of the saliva of rabid animals as a
remedy in this affection. It has been found by Majen-
die and Brechet, that if this saliva be introduced un
der the skin, or into the blood of animals, that the
animal so impregnated contracts the hydrophobia.
Why should it not then be employed in those maladies
which are characterized by symptoms similar to those
of rabies?
Other medicines which may demand attention are,
veratrum, moschus, phosphorus, china, ignatia, lachesis,
acid hydrocyanic, camphor, plumbum.
Administration. — We advise from the third to the
sixth attenuations in this affection — a dose every hour
until the system responds in a satisfactory manner,
after which we must be governed by circumstances.
2. HYDROPHOBIA.
The term hydrophobia, or dread of water, is given
to that dreadful malady which follows the bite of a
rabid animal, and the introduction of its saliva into
the blood. A dread of water is commonly a promi
nent and characteristic symptom of the disease, but it
is by no means one which is invariably present. Cases
are reported by Hunter, Frank, and Eberle, in which
no unpleasant consequences followed the use of drinks,
from the commencement to the fatal termination of
the disorder. We, ourselves, have seen a rabid dog
that would, without hesitation, plunge into water and
drink during the whole course of the disease, without
exciting spasmodic contractions, or any other disagree
able symptom.
Rabies originates spontaneously in animals of the
canine species, like the dog, the fox, the wolf, &c., and
appears to consist of a morbid deterioration of the
saliva. The precise nature of this deterioration, or of
the specific poison which this fluid contains, is at pre
sent entirely unknown ; but in regard to its specific
action upon some portion of the nervous centres, there
remains no doubt, although morbid anatomists have
hitherto failed to detect the peculiar diseased appear-
DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 415
ances to which it gives rise. Perhaps this may be ac
counted for when we call to mind the proneness of
pathologists to regard congestion of the blood-vessels,
redness, effusion, softening, or induration, as the only
morbid appearances indicative of previous disease,
while in point of fact, if we may trust the pathological
investigations of Dr. Hugh Bennett, by means of the
microscope, " important changes may take place in the
cerebral substance, spinal marrow, &c., inappreciable
to the naked eye, but clearly discernible with the
microscope." — (Ed. Med. and Surg. Jour., vol. 58, p.
58 and 60."
The redness of the fauces and oesophagus which is
often observed in men and animals dead of hydropho
bia, is attributable rather to the irritation consequent
upon the intense and unindulged thirst which was pre
sent during the attack, than to any specific action of
the virus upon these parts.
The virus of rabies is formed and is active, for
the most part, in the saliva, but a sufficient quantity is
absorbed into the general circulation to produce the
morbid impression upon the spinal marrow which con
stitutes the chief fact of the disease. Could we con
fine the virus to the saliva of the mouth, and prevent
its admission into the circulation, no evil effects would
result ; but place the smallest quantity in a position
where absorption can take place, and it will be con
veyed with unerring certainty to the part which pos
sesses a specific affinity for it, and there produce its le
gitimate morbid impression.
Some writers suppose that the poison does not enter
the general circulation, because the N. American In
dians, the inhabitants of the country of Mantone, &c.t
often eat the flesh of hydrophobic animals with im
punity ; but this proves nothing, for the lacteals and
absorbents of the digestive apparatus, reject this sub
stance as an irritant, and it is carried off with the fae
ces, without producing any impression.
Mclntosh believes that tetanus is often mistaken for
hydrophobia, when dread of liquids is one of the
symptoms of the former ; and when we reflect that the
teeth of dogs usually inflict such punctured or lacerated
416 DISEASES OP THE BRAIN AND NERVOUS SYSTEM.
wounds, as often give rise to tetanus, the opinion seems
plausible.
Hydrophobia usually makes its appearance in from
twenty to sixty days after the bite, although well au
thenticated cases are recorded in which the virus has
remained dormant in the system for years, when it has
finally developed itself from some constitutional dis
turbance, and the patient has succumbed with all the
symptoms of hydrophobia.
Diagnosis. — At an uncertain period, varying from
three to nine weeks from the reception of the wound, the
first symptoms of hydrophobia make their appearance,
usually in the bitten part, which presents a livid and
slightly swollen appearance, and attended with burn
ing heat or shooting pains which dart from the seat of
the injury to the neighbouring parts. These symp
toms are speedily succeeded by rigours, lassitude, great
depression of spirits, anxiety, watchfulness, irritability,
giddiness ; eyes red, brilliant and sensitive to light, un
easy sensations at the stomach, tension at the chest,
difficulty of deglutition, and slightly oppressed respi
ration. As the disease advances, the cramps about
the throat, neck, and chest, become more and more vio
lent, until the mere sight of a liquid, or of a shining sub
stance, will produce the most painful paroxysms :
there is a viscid saliva constantly secreted which com
pels the victim to be continually spitting, while at the
same time he is tormented with a dryness in the mouth
and throat, and an intense thirst, which he is unable
to allay, on account of the spasmodic contractions
which occur whenever drinks are presented to him.
The skin is hot and dry, the cicatrix opens and pre
sents an unhealthy appearance, the respiration be
comes more and more difficult, the voice becomes
changed, the pulse nearly natural, the body affected
with tremours or slight spasmodic twitchings, vague
pains extend up from the lower part of the spine to
the head, and finally the countenance becomes pale
and haggard, the eyes sunken yet still brilliant, there
are palpitation of the heart, wandering delirium, con
stant inclination to bite, extreme anxiety and uneasi
ness, sinking of the pulse, loss of voice, clammy sweat,
DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 417
and finally, the sufferer sinks into a lethargy, or into
convulsions, and dies.
The disease commonly terminates in from two to
eight days from its first approach.
Therapeutics. — The most certain preventive means
after the bite of a rabid animal, is to excise imme
diately and thoroughly, the wounded part. This se
vere measure can only prove available unless resorted
to within a very short period — say fifteen or twenty
minutes after the infliction of the bite. If a longer time
than this has elapsed, we should advise free incisions up
on the wounded points, and after they have bled freely,
and been suitably washed and cleansed, the applica
tion of the caustic alkali. Some surgeons speak in
high terms of the application of the red-hot iron, of
the butter of antimony, of corrosive sublimate, of chlo
ride of zinc, &c. ; but in my opinion, the prompt use
of the knife, and of caustic potash, will prove more
efficient and less painful than the other applications.
Nor do I give this advice from theory alone, for I
had occasion, some five years since, to test the practical
operation of these severe measures upon my own per
son. In July, 1844, I was bitten in the leg, without
'provocation, by a dog which came tearing past me at
a furious rate, with fierce and brilliant expression of
the eyes, tail pendant between the legs, foam at
the mouth, and hair standing erect upon the back.
Without any delay, I excised the bitten part, and
applied the caustic potash to the wound, in the most
thorough manner ; after which, 1 dressed and bound
up the limb, congratulating myself on my prompt
ness, and probable escape from this most dreadful ma-
lad}". Inquiries were now instituted to ascertain
something respecting the course and the whereabouts
of the " mad dog," when to my surprise, and indeed
I may say indignation, 1 was informed that the ani
mal was not rabid, but "dreadful ugly." The course
adopted, however, was a prudent and safe one, and I
should most certainly do the same again under similar
circumstances, on the principle "that an ounce of pre
vention is worth a pound of cure." As the matter ac
tually turned out, I was tormented with a painful limb
for two or three months unnecessarily ; but had the
]8*
418 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
animal proved to have been rabid, then the result
would have been the saving of my life.
No specific has yet been discovered for the cure of
hydrophobia, although many articles have been at dif
ferent periods brought into notice by the old school,
as for example, mercury, burnt lichen, and black pepper,
the purple-flowered anagallis, oil of valerian, opium,
musk, ignatia, camphor, cantharides, stramonium, nux
vomica, and belladonna.
Professor Munch has given the last named medicine
to several who had been bitten by rabid dogs, and not
one was attacked with rabies. Hahnemann also ad
ministered it with success, both as a prophylactic and
as a curative remedy.
In consulting the pathogenesis of belladonna, we find
amongst the most prominent symptoms to which it
gives rise, are dryness and constriction of the mouth
and fauces, accumulation of a tough mucus about
the mouth, deglutition difficult or even impossible, in
jected and glassy eyes, articulation difficult, voice
changed, giddiness, trembling and weakness of the
whole body ; mouth and jaws spasmodically affected,
intense thirst, nausea, and finally, previous to death,
" a feeble pulse, cold extremities, subsultus tendinum,
tremours, deep coma or delirium, and sometimes con
vulsions/'
From the above description, it is apparent that this
medicine induces a close correspondence to the most
marked symptoms of hydrophobia, and therefore it is
entitled to our earnest consideration, when called to
cases of this description.
When the disease is fully formed, and there are, se
vere convulsions, with sense of impending suffocation,
dryness of the mouth and fauces, extreme difficulty
of deglutition, dread or horror even at the sight of
liquids, delirium, rage, and fury, we may likewise
consult stramonium, nux vomica, hyoscyamus, lachesis,
cantharides, and veratrum.
The medicines may be administered in the same
manner as advised in tetanus
DISEASES OP THE BRAIN AND NERVOUS SYSTEM. 419
SECTION XL
CHOREA.
Chorea occurs, for the most part, in girls of feeble
constitutions and of irritable nervous temperaments,
and between the ages of five and fourteen. The dis
ease is recognised by almost constant involuntary
movements of the muscles affected, while in the wak
ing state, either with or without derangement of the in
tellect. From its resemblance to raphania, it has been
sometimes confounded with it. It also presents many
marks of similarity to epilepsy and hysteria, and is
probably somewhat analogous to these maladies in its
location and nature. The affection is not usually at
tended with danger, and terminates at the period of
puberty ; but when it has existed for a number of years,
accompanied by perversion of the intellectual facul
ties, permanent idiocy, or at least an impaired under
standing, may result. Finally, the disease may oc
casionally occur at any period of life, and in indivi
duals of both sexes.
Diagnosis. — Generally, for months previous to the
occurrence of the involuntary motions which charac
terize this disease, it will be found that the child has
suffered from constipation, oppression in the region of
the stomach and chest, vertigo, and other bad feelings
in the head, appetite morbidly increased or depressed,
occasional flushes of fever during the night, palpita
tion of the heart,' nervousness, irritability, and coldness
of the feet. The involuntary motions commence by
slight twitchings in the muscles of the face, which soon
become strongly pronounced and extend to a greater
or less extent to other parts of the body, as one en
tire side, or one arm or leg. When the limbs are af
fected, the walk becomes awkward and unsteady, and
the arms fail to obey the commands of the will, while
involuntary gestures and motions are continually made
without reason or point, thus causing the individual
to present a most ludicrous appearance. The patient
may remain in this condition for years, without the
occurrence of any other serious consequences, unless
the intellect becomes impaired, when a total loss of
420 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
mind may result. Some cases are attended with diffi
cult respiration, dysuria, vague pains in the limbs,
confusion of ideas, and failure of memory.
Causes. — A naturally delicate constitution or one
which has been impaired by abuse of medicines, and a
nervous temperament, are conditions most favourable
to the production of chorea. Probably, the most fre
quent exciting cause is the repercussion of some
chronic cutaneous eruption. Many facts are on re
cord which go to prove this ; as, for example, the
cases cited by Hahnemann, Stapf, Pouchet, Frank,
&c., where the malady has arisen in consequence of
sudden drying up of tetter, plica polonica, herpes,
scald-head, psora, or some habitual discharge. Other
exciting causes are, the depressing passions, fear and
terror, masturbation, irritation of the bowels from
worms and faecal accumulations, cold, insufficient
nutriment, and excessive loss of blood.
Therapeutics. — In all cases of chorea the patient
should be removed to the country, where she may en
joy pure and salubrious air, abundant exercise, and a
plain, but highly nutritious regimen.
The remedies for chorea are, stramonium, belladonna,
cuprum acetat, sulphur, calcarea carb., hyoscyamus, rhus,
nux vomica, ignatia. lycopodium, phosphorus, china,
ferrum.
If the disease has been caused by fright or terror,
and we find great contortions of the face, eyes, and
limbs, head thrown back, or drawn frequently to the
left side, oppressed respiration, wild and staring ex
pression, convulsive laughter or weeping, restless
ness, convulsive twitchings of the muscles, anxiety,
pale face, features sunken, small pulse, and delirium,
we may select one of the following medicines : stramo
nium, belladonna, hyoscyamus, and ignatia.
When the symptoms have followed the drying up of
chronic cutaneous eruptions, cuprum acetate, sulphur and
lycopodium, will be called for ; if they have set in after
measles, calcarea carb. is proper ; if the cause can be
traced to t>nam&tti,pho3pkorU8 and china are applicable ;
if they have arisen from constipation, and collections
of faecal matter in the intestines, nux vomica and sul
phur-are, the best; remedies ; if the malady has been
DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 421e
induced by excessive loss of blood, or by general de
bility, we advise, ferrum, china, acid phosph., acid
nitr., and rhus toxicodendron.
Administration. — In chorea, the whole nervous sys
tem is in a morbidly impressible condition, and will
generally respond readily to the higher attenuations.
We usually commence with the twelfth dilutions, and
administer a dose once or twice daily, until a suitable
impression is made upon the symptoms.
SECTION XII.
HYSTERIA.
Sydenham, Stahl, Van Swieten,Sprengel, and Frank,
regard hysteria and hypochondria as substantially the
same affection. The two maladies unquestionably
bear a very close resemblance to each other in many
respects ; as, for example, the almost infinite variety
and similarity of the symptoms which they present,
and the proneness of the subjects of both diseases to
exaggerate trivial or even imaginary ailments into
disorders of magnitude.
But there are marks of distinction between them
equally important, which refute conclusively the opi
nion respecting their identity.
Pure hypochondria almost invariably occurs in in
dividuals of a lymphatic and bilious temperament.
Their dispositions are generally gloomy and morose,
find ever inclining to " look on the dark side." Hope,
confidence, cheerfulness, enter but sparingly into their
dispositions ; they are not addicted to " building
castles in the air ;" never behold anything bright,
agreeable, or desirable in the future ; but, looking
with distrust and aversion upon mankind, and obsti
nately fixing their thoughts upon some dreadful im
pending calamity, which they are sure will overtake
them sooner or later, they either drag out a miserable
existence, suffering mentally almost every evil, or
terminate their woes by suicide.
Hysteria, on the contrary, usually occurs in females
of a nervous, or nervous-sanguine temperament, with
cheerful, lively, and ardent dispositions, vivid imagi
nations, and highly impressible organizations.
UNIVERSITY /
/
422 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
Hypochondria is uniform and continuous in its
course, and presents but slight variations from day to
day. Hysteria occurs in paroxysms, with intervals of
greater or less duration, of passable bodily health and
excellent spirits.
Hypochondria is always connected with disorder of
the stomach and liver. Hysteria is owing to an irri
tation or erethism of the whole nervous system.
Writers have always regarded the seat of hysteria
as in the uterine and sexual organs, because it has usu
ally been associated with derangement of the functions
of these organs. It occurs after the period of puberty,
in females of a nervous, or nervous-sanguine tempera
ment, with strong sexual propensities, and is accom
panied with deranged menstruation, dysuria, sexual
excitement, or pains in the pelvic region. Yet the
malady is, in my opinion, one of a purely nervous
character, consisting of an erethism of the whole
nervous system, and capable of being brought into ac
tive operation by any exciting cause which may ope
rate upon the economy, like deranged menstruation,
the depressing emotions, fright, terror, mortification,
dread, chagrin, disappointed love, undue excitement of
the sexual organs, &c.
This peculiar irritable condition of the nervous
system may exist for an indefinite length of time,
without any actual development of proper hysteric
symptoms, provided the above named exciting causes
do not operate.
Diagnosis. — Sometimes the first symptoms of hyste
ria are flatulency, pains, or distressing sensations in
the stomach, bowels, chest, head, and back ; faintness,
vertigo, bitter taste, eructations, dysury, anxiety, de
pression of spirits, difficulty of breathing, sense of suf
focation from something like a ball rising in the
throat, (or globus hystericus), ringing in the ears, deli
rium, or loss of consciousness. Symptoms of this kind
take place in individuals of a feeble and purely ner
vous temperament, and the delirium and loss of con
sciousness appear to take the place of convulsions.
In others, of a nervous-sanguine temperament, with
robust constitutions, the convulsive paroxysms come
on by slight twitehinsfs of the muscles of the mouth
DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 423
and eyes, with wild expression, eyes rolled up, con
vulsive laughing, crying, or sobbing, constant attempts
to pull out the hair, to strike the breast or some other
part, and to bite ; difficult and laborious respiration,
succeeded in a short time by the most violent con
vulsions. ;
In other instances the paroxysms are preceded by a
croupy-cough, or colic pains, or pains in the head,
chest, back, or pelvis.
In some cases the paroxysm takes place suddenly,
without any warning symptoms, and the patient may
suffer a series of dreadful convulsions, with only brief
intervals of consciousness, for many hours, and then
be restored speedily to all her mental and bodily
faculties.
It would be useless to attempt a detail of all the
phenomena which may occur in hysteria, and we shall
in conclusion only observe, that the peculiar condition
of the nervous system upon which the disease is de
pendent, and the convulsive paroxysms to which this
morbid state gives rise, should command our principal
attention in the treatment of the malady.
Causes. — The predisposing causes are, a delicate,
nervous temperament, too much confinement in close
and heated apartments, the frequent perusal of excit
ing works of fiction, attendance on theatrical exhibi
tions, tight lacing, want of exercise, premature task
ing of the mind to the neglect of the body, habitual in
dulgence in lascivious thoughts, nervousness, luxu
rious living.
Amongst the exciting causes may be mentioned,
violent mental impressions of any kind, whether pro
duced by the sight of disagreeable objects, or the smell
of disagreeable odours, or the hearing of sudden noises,
discordant sounds, or by terror, fright, anger, rage,
grief, chagrin, mortification, and disappointed love or
ambition.
Hamilton supposes the presence of irritating and
indigestible substances in the intestines is a common
exciting cause of hysteria.
Other exciting causes are, sudden suppression of
the menstrual discharge, too profuse evacuations, and
Irneorrhoea.
424 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
Therapeutics.-— For the cure of hysteria arising from
a torpid state of the bowels, and an accumulation of
undigested faecal matter, and attended with putrid or
sour taste, bitter or acid eructations, flatulency, ful
ness, distention and pain in the epigastrium, con
stipation, nausea, weakness, languor, faintness, head
ache, giddiness, confusion of ideas, strong tendency to
convulsions, nux vomica and sulphur are the proper
remedies.
When the attacks appear to have been excited by
derangement of the uterine functions, the most suit
able remedies will be pulsatilla, sabina, and silicea.
If the exciting cause has been terror, fright, anger,
disappointment; mortification, or any violent mental
excitement, ignatia, hyoscyamus, aurum, belladonna,
cojfea, will each cover most of the symptoms.
Administration. — The remedies should be adminis
tered at the third dilution, during the paroxysm, by
placing a drop upon the tongue at short intervals, or
by smelling ; but during the intervals, a drop once
in twelve hours, until the desired impression is pro
duced.
SECTION XIII.
NEURALGIA.
By the term neuralgia, we designate all of those
painful affections, in different parts of the body, of a
purely nervous character. This disease may attack
every system of nerves, and every structure of the or
ganism, whether external or internal. Different
names have been given to it, derived from the
particular structures affected, but as the real na
ture of the disease is always the same, in whatever
part it may be located, and as the points of its attack
are almost innumerable, there is a manifest difficulty
and impropriety in endeavouring to effect a minute
classification. The most common seat of neuralgia
is in the first, second and third branches of the fifth
pair of nerves, and in the portio-dura. When the dis
ease is confined to the facial portions of these nerves, it
is recognised under the name of tic douloureux ; when
its location is in the nerves of the stomach, gastrodinia ;
DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 425
when in the first branch of the fifth pair of nerves,
nervous headache ; when in the nerves of the feet and
legs, neuralgia pedis ; when in those of the mammae,
neuralgia mammce ; when to those of the heart, angina
pectoris, &c. But as these various names only tend
to complicate our classification, and render com
plex what is in reality simple, we shall treat of all
these nervous attacks under the general appellation of
neuralgia.
Diagnosis. — The following are the general charac
teristics of neuralgia : sudden paroxysms of exceed
ingly acute pain in some particular nerve, with vio
lent lancinating pains extending along the ramifica
tions of the nerve in different directions, attended with
turgescence of the blood vessels in the vicinity of the
part chiefly affected, but without fever. The pains
are so sudden and severe as to resemble electric shocks,
and they often give rise to spasmodic contortions or
twitchings of th-e muscles of the face when the
branches of the fifth and the facial branch of the
seventh pair of nerves are the seat of the pains. The
pains are sometimes aggravated by the slightest move
ment, or by the gentlest touch, although firm pressure
causes no pain. The particular nerve or nerves in
volved, can always be pointed out with exactness,
because the principal seat of the attack is always in
some portion of a nerve, and radiates thence along
its different ramifications ; and from this circumstance
surgeons have occasionally excised with success por
tions of nervous trunks to effect cures ; but this severe
measure should never be resorted to, when suitable
homoeopathic specifics can be so readily procured.
In facial neuralgia, there are often lachrymation ;
increased flow of saliva ; spasmodic twitchings of the
mouth, cheeks, and eyelids ; spasmodic closing of the
eyelids ; unusual heat and tension in the side affected ;
stiffness in the jaw and neck ; increase of pain by
light, noise, motion, touch, talking, or eating ; heat or
coldness of the body ; vertigo ; and confusion of
ideas.
When the head is the seat of the attack, we may
have violent periodical pains in some part of the head,
darting along the nervous ramifications; nausea;
426 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
vomiting ; extreme sensitiveness to the touch, cold air,
sounds and light ; humming in the ears ; sense of heat
and fulness in the affected part ; floats before the eyes
on the slightest attempt to use them ; aversion to
food ; confusion of ideas ; disinclination to converse,
or to listen to others.
When neuralgia affects the superior or inferior
extremities, back or mammaB, the symptoms will
be fewer on account of the less number of sympathetic
connections existing between these parts. In these
instances, the violent lancinating pains, occurring in
paroxysms, and increased by the slightest contact, and
by motion, and unaccompanied with actual inflamma
tion, are the symptoms which especially mark the
complaint.
For the symptoms of neuralgia affecting internal
organs, we refer our readers to the articles upon gas-
trodinia and angina pectoris.
Causes. — Pathological researches have as yet
thrown but little light upon the nature of neuralgia.
Many excellent observers have instituted rigid autop-
sical examinations, in order to ascertain its precise
nature and location, but their labours for the most
part have proved fruitless ; since no lesions or other
marks of diseased action have been discovered, either
in the nerves or their envelopes, at all sufficient to
account for the symptoms.
Dr. Macculloch believes neuralgia to be a malarious
disease ; this opinion is founded upon the fact of its
frequent occurrence in marshy districts, and in loca
tions where intermittent fever abounds. It is probable,
however, in these cases, that the miasmatic influence
operates merely to excite or to call into active opera
tion a diseased condition of the nerves, latent it is true,
but already existing. The malaria operates in these
instances, as the immediate exciting cause, and in a
manner similar to impure air, errors in diet, excessive
mental or physical labour, abuse of narcotics or stimu
lants, over-excitement, fatigue, exhaustion, great loss
of fluids, and the depressing emotions. The remote
cause and the real nature of the disorder remain un
explained. A conclusive fact in refutation of the views
of McCulloch respecting the malarious origin of the
DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 427
disease, is its common occurrence in New England,
where intermittent fevers do not prevail.
Neuralgic pains sometimes arise from the pressure
of tumours and exostoses, the irritation of decayed
and ulcerated teeth, and also from mechanical inju
ries. In these instances we may generally remove the
cause by surgical means, and thus cure the disorder.
Therapeutics. — The specific medicines for the cure
of neuralgia, are, arsenicum, belladonna, colocynth, nux
vomica, aconite, china, arnica, bryonia, calcarea carb.,
hepar sulph., phosphorus, acid hydrocianic, pulsatilla,
sepia, sulphur, spigelia, stramonium, mercurius.
Arsenicum. — External indications. — Temperament,
leuco-phlegmatic, lymphatic, or bilious and choleric,
or nervous, with disposition to melancholy ; general
appearance of debility and exhaustion ; countenance
pale and sunken, or bloated and red ; features distort
ed ; lips bluish ; twitchings of the muscles of the face,
lips, and eyelids ; tongue white ; coldness of the ex
tremities ; anasarca ; emaciation ; trembling of the
limbs ; cramps in the extremities ; pulse small.
Physical sensations. — Paroxysms of excruciating
pain in the head, particularly in the forehead over the
root of the nose, — over the left eye, — in one side of the
head, — in one eye : pains aggravated from the slight
est movement or touch ; scalp sensitive to touch or
to motion of the hair ; roaring in the ears during the
pain ; mouth dry ; thirst or adypsia ; bad taste in the
mouth ; aversion to food ; nausea, eructations, hic
cough ; pressure, heat or burning, or cramplike sen
sations in the stomach ; drawings and cramps in the
arms and legs ; cramps in the fingers ; rigidity of the
hands ; violent lancinating pains in different parts of
the body, aggravated by movement or touch, attended
with paralytic weakness, contractive sensations, faint-
ness, coldness, shuddering and trembling.
Mental and moral symptoms. — Fits of violent an
guish ; fear ; dread, with tremours ; impaired memory ;
inability to think or collect the thoughts ; dizziness ;
vertigo ; general uneasiness.
Administration. — A dose of the second or third tri-
turation, every half hour until an aggravation or ame
lioration of the symptoms occurs.
428 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
Belladonna. — This medicine is well adapted to the
'* diseases of women and children, whose nervous sys
tems are in a state of erethism." The external indi
cations are, sanguine and choleric temperament ; gen
eral appearance indicative of a full and plethoric
habit ; cheeks red and swollen ; eyelids spasmodically
closed : spasms and startings in different parts of the
body ; distortion of the face ; trembling and rigidity
of the limbs.
Physical sensations. — Great sensitiveness to cold air
and light ; headache, compelling to close the eyes ;
acute throbbing pains in the forehead ; semi-lateral
headache ; pains aggravated by movement, noise,
light or cold air ; lancinating pains in the orbit ; spasms
of the eyes ; violent stitches in the parotid gland, ex
tending to the external and internal ear ; roaring in
the ears ; paroxysms of tearing, digging toothache ;
toothache of pregnant females ; neuralgic pains dart
ing from the side of the face to the teeth and ears, of
a tearing, or lancinating, or digging character, with
heat and redness of the part affected ; toothache oc
curring after eating, from contact with cold air, from
study, from pressure upon a decayed tooth, from eat
ing, and from swelling and ulceration of the gums ;
darting pains in the lower jaw, and in the glands of
the affected parts, from a decayed and hollow tooth ;
toothache with drawing in the ear ; neuralgia affect
ing the crural nerve ; cutting, darting, and tearing in
the left thigh when sitting ; lancinating pains in the
right thigh when sitting ; tearing and lancinating
pains in the region of the tibia, extending to the calf
of the leg and sole of the foot ; neuralgic pains in the
back and shoulders.
Mental and moral symptoms. — Anguish ; desponden
cy ; great irritability ; vertigo ; confusion of ideas ;
delirium; inclination for firm pressure upon the head,
which affords relief, while slight touches increase the
pains.
Administration. — A drop of the second or third di
lution on sugar or in water every half hour, until a
decided impression is produced.
Colocynth. — Dr. Watzke remarks as follows respect
ing the therapeutic action of colocynth in neuralgic af-
DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 429
fections : — " The curative sphere of action of colocynth
in the new system, is almost confined to a few neural
gia and hypercesthenice, and of these, almost exclusive
ly those which affect the trigeminus, the caliac plexus,
and the lumbar and femoral nerves. First : the he-
micrania and prosopalgise which colocynth cures, pro
ceed from an exaltation of sensibility dependent on
rheumatic, gouty, or gastric irritation, or on conges
tion of the fifth pair of nerves, in all cases on a purely
functional affection of the sensitive filaments. Colo
cynth is of no use in organic prosopalgiae, from grow
ing out of the teeth, hypertrophy of the bones of the
skull or face, tumours, &c.
" Second : the neuralgia of the co3liac plexus and
its branches, are particularly likely to be quickly and
permanently removed by colocynth when they occur
as substantive affections, not caused by derangements
of the stomach, but by cold, vexation, or anger, occur
ring during the period of evolution ; complicated with
spinal irritation and neuralgia of the great nerves of
the thigh, with haemorrhoids, chronic diarrhoea, or ver
micular symptoms."
Colocynth is adapted to dry, bilious and choleric-
melancholy temperaments. It is especially suitable
in cases of neuralgia, confined to certain parts of the
left side of the body. The paroxysms are usually at
tended with spasms, twitchings, and contractive sen
sations ; and the lancinations are sudden, violent, and
extend to a distance from the starting point.
Administration. — A drop of the third dilution in wa
ter, every hour, until its effects are apparent.
Nux Vomica. — External indications. — Temperament
sanguine or choleric ; disposition lively, artful and
malicious ; face pale or highly coloured ; contractions
of the hands and feet ; coldness of the body, especially
after drinking ; trembling of the limbs ; fainting fits,
spasmodic twitchings in different parts of the body ;
better adapted to males than females.
Physical sensations. — Periodical and intermittent
pains ; excessive sensibility of the affected parts to
external impressions of all kinds ; periodical head
ache every morning after rising, increasing until noon,
then gradually diminishing until night, when the pain
430 DISEASES OF THE BRAIN AND NERVOUS SYSTEM.
ceases \ the pains are drawing, tearing, compressive,
affecting the whole head, or the forehead, or the part
just above the root of the nose ; headache accompa
nied with confusion of ideas, nausea, bitter eructa
tions, vomitings, constipation ; scalp painful and sensi
tive to touch or cold air ; tearing pains in the facial
and infra orbital nerves ; ringing in the ears ; tooth
ache in sound and decayed teeth ; pains of a sticking,
drawing, tearing, jerking, or digging character, aggra
vated by cold air and drinks, by study and meditation,
and relieved by rest and warmth ; toothache from
cold, and from extraction of a tooth ; drawing tooth
ache in several teeth ; looseness of the teeth ; swelling
of the gums ; drawing toothache in a hollow tooth,
with pains extending to the face and temples ; gastro-
dynia attended with violent, cramp-like, contractive
and tearing pains in the stomach ; pleurodinia ; con
tractions and cramps in the hands, feet and limbs ;
coldness of the hands and feet ; painful contractive
sensations throughout the body ; faintness ; languor,
and indisposition to mental or physical exertion.
Mental and moral symptoms. — Great sensitiveness to
external impressions ; melancholy ; sadness ; appre
hension ; anxiety ; petulancy ; indisposition to mental
exertion.
Administration. — This medicine may be employed
in the same manner as Belladonna.
We have occasionally employed Aconite with ad
vantage in neuralgia, accompanied with great ere
thism of the vascular system, flushes of heat, conges
tion of the head, chest, and heart. Whenever the
function of the heart appears to be affected in neural
gia, this remedy will generally prove useful.
When neuralgia has arisen from excessive loss of
the fluids of the body, we may refer to china, phosphor us,
calcarea carb., and sepia.
When the disease appears to be connected with
scrofula, exostoses of the bones, chronic cutaneous af
fections, abuse of mercury, constitutional syphilis,
glandular and other tumours, reference should be
made to sulphur, mercurius, hepar sulph., sepia and
aurum muriaticum.
In neuralgic attacks of the heart, or stomach, or
DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 431
uterus, our best remedies are nux vomica, acid hydro
cyanic, pulsatilla and colocynth.
Neuralgia from mechanical injuries, will commonly
yield to arnica, aconite and calendula.
For a more particular description of the neuralgic
symptoms pertaining to special organs, and the mode
of treatment, we refer to. the diseases of the different
organs and tissues in other parts of this work.
Administration. — A wide range of attenuations
should be employed in neuralgia, in order that we may
adapt our remedies precisely to the degree of erethism
present in each particular case. When the pains are
very acute, the dose may be repeated every hour until
relief is obtained, or until a medicinal aggravation
admonishes us to discontinue the medicine.
432
CHAPTER XXVI.
DISEASES OF THE URINARY AND GENITAL ORGANS.
SECTION I.
NEPHRITIS. INFLAMMATION OF THE KIDNEYS.
Diagnosis. — Inflammation of the kidneys commen
ces with the ordinary febrile symptoms, like slight
chills, hot and dry skin, thirst, frequent and hard pulse,
either accompanied from the first, or speedily succeed
ed by deep-seated, aching pain in the region of the
kidneys, which soon becomes acute and pulsative ;
urine scanty and high-colored ; entire inability to lie
upon the healthy side or upon the stomach ; position
mostly upon the back when reclining, or on the affect
ed side, with the dorsal and lumbar muscles flexed ;
inability to lie upon the diseased side with the muscles
extended ; severe pains upon rising up to the erect
posture, or from the concussions arising from riding,
walking, or running ; when the disease is strongly
pronounced, there are, absolute inability to walk, or
even to stand upon the feet; pressure over the inflam
ed kidney does not cause pain, but any motions which
call into exercise the deep-seated dorsal or lumbar
muscles, excite acute pain ; the inflammation gener
ally attacks the left kidney; both kidneys are rarely
affected at the same time in the first instance ; the
pain at first is aching, compressive and dull, but often
becoming, in severe cases, violent and lancinating ;
the pains extend along the ureters to the bladder, or
follow the spermatic cord to the testicles ; the urine is
very scanty, bloody, purulent or red, or watery ; con
stant desire to urinate ; there are nausea, eructations,
vomitings, flatulence, constipation : pains in the rec
tum, from contiguous sympathy ; tenesmus ; swelling
and heat over the affected side ; when complicated
with calculi, there will be retraction of the testicle ;
numbness of the thigh ; anxiety, and more severe con
stitutional disturbance.
AND GENITAL ORGANS. 433
Nephritis may readily be distinguished from lumba
go, inflammation of the psoas muscle, and neuralgia,
by the character and direction of the pains which fol
low the ureters to the vcsiculce seminales, or the sper
matic cords to the testicles ; also by the nausea, vo
miting, constant desire to urinate ; the partial, and in
some cases almost entire suppression of the urinary
secretion ; the sympathetic pains in the rectum ; and
the increase of pain whenever any of the muscles
which bear upon the kidneys are extended.
The terminations of nephritis are, resolution, sup
puration, induration, schirrus, or gangrene. The dura
tion of the acute stage is usually from six to nine days,
when one of the above terminations usually obtains.
Its termination in resolution is indicated by a grad
ual return of all the functions to a more healthy
state ; increased secretion of urine, which deposits an
abundant sediment ; moderate and general perspira
tion ; subsidence of the pains ; ability to lay on either
side, or to walk without difficulty.
When suppuration has taken place, the pains be
come less severe ; there are chills, or shiverings ; dull
throbbing in the region of the kidneys ; sometimes ap
pearance of pus in the urine ; a sensation of numbness
and weight in the affected side ; a partial subsidence
of the febrile symptoms ; and occasionally an ab
scess, which may be recognised by swelling and fluc
tuation in the part.
The purulent matter may be discharged by the
ureters into the bladder, or find its way between the
lumbar, or the internal crural muscles, to the thigh, or
it may find its way by ulceration into the cavity of the
spleen, the liver, or the colon, or it may burst exter
nally.
In these cases fistulous passages are apt to remain
for a long period, giving issue to the pus and urine.
In a very few instances, after the acute symptoms
have subsided, there remains a chronic induration of
the kidneys, which in the end degenerates into a true
schirrus. In other rare instances, when the inflamma
tion has been exceedingly violent, and suitable remedial
measures have not been employed, the vitality of the
19
434 DISEASES OF THE URINARY
part becomes destroyed, and gangrene is the result.
The occurrence of gangrene is recognised by the pale,
sunken, and deathlike expression of countenance, cold,
clammy sweats, universal prostration, constant vomit
ing, delirium, small and frequent pulse, absence of
pain, hiccough, and dark and foetid urine. Whenever
either of the last described occurrences take place, no
hopes of cure should be entertained.
Causes. — External injuries, strains from violent ex
ercise or lifting heavy weights, the irritation of calculi,
sudden check to the perspiration from cold, abuse of
medicinal or morbid substances which operate speci
fically upon the kidneys.
Therapeutics. — Frequent external applications of
cold water over the inflamed kidney will be of great
service in abstracting the superfluous animal heat, and
thus allaying the inflammation. The water should be
applied quite cold, and repeated until the temperature
of the part is permanently diminished, and the pain
has in a measure subsided.
The specific medicines are, cantharides, cannabis,
tmsilago petus., aconite, copaiba?, terelrinlhina, bella
donna, arnica, nux vomica, and pulsatilla.
As soon as we are called to a case of nephritis, we
should have immediate recourse to aconite, either
alone or in alternation with one of the other specifics,
and continue it until the febrile symptoms have sub
sided. In slight cases, aconite alone as an internal
remedy, together with thorough external applications
of cold water, will suffice.
If the inflammation be of a severe grade, and there
are tearing, drawing, and pulsative pains in the region
of the kidneys, extending to the bladder and testicle,
constant desire to urinate, scanty secretion of high-
coloured urine, inability to lay on the affected side,
tenesmus, colic-pains, urine tinged with blood, painful
micturition, aconite in alternation with the third dilu
tion of cantharides, or cannabis, or terebinth, or tussila-
go petus., or bals. copaib., may be exhibited.
Arnica is suitable for inflammation of the kidneys,
caused by external injuries, concussions, sprains from
lifting, &c.
AND GENITAL ORGANS. 435
When there is reason to suspect that suppuration is
about commencing, sulphur, sepia, and hjcopodium, may
be used with advantage.
SECTION II.
CYSTITIS. INFLAMMATION OF THE BLADDER.
Diagnosis. — Inflammation of the bladder commences
like nephritis, with shiverings or chills, frequent pulse,
hot and dry skin, anxiety, thirst, urine scanty and
high-coloured, nausea, vomiting, eructations, and con
stipation. In a short time, the patient experiences
deep-seated lancinating pains in the hypogastric re
gion, frequent desire to urinate, each effort giving rise
to increased pain, great anxiety, and uneasiness. As
the inflammation extends, the pains become more se
vere, and there are a continual burning sensation in the
bladder, with painful pulsations ; acute pain on mak
ing pressure in the vicinity of the inflammation, and
when attempting to urinate ; sense of weight in the
hypogastric region ; acute or dragging pains in the
loins, the ureters, the perineum, and the anus ; swel
ling and distention of the abdomen ; great difficulty in
voiding the faeces, on account of the sympathetic in
flammation of the rectum ; all movements of the mus
cles which bear upon the bladder excite increased
pains; and finally rigours, cadaverous expression, cold
extremities, delirium and convulsions. If the inflam
mation be confined to the neck of the bladder, there
will be an almost entire suppression of the urinary
discharge ; constant ineffectual and exceedingly pain
ful efforts to urinate ; and violent pain in the perineum.
If the ureters become involved, pains are frequently
felt as high as the kidneys ; the secretion of urine
becomes more deranged, the suppression is more de
cided, and the attempts tb void the urine still more
painful. When the \vhole interior surface of the blad
der is affected, the urine is red and tinged with blood,
and a severe burning and throbbing pain is experi
enced. Occasionally the external surface of the organ
becomes inflamed, either on one side, on its anterior
or posterior, or its superior or inferior part ; in which
436 DISEASES OF THE URINARY
cases the symptoms will be in correspondence with the
location of the malady.
Cystitis may terminate in chronic inflammation of
the bladder, in resolution, suppuration, or gangrene.
The signs which indicate these different termina
tions, are similar to those described under nephritis.
Causes. — Injuries resulting from child-birth, from
the use of instruments during accouchement, from
blows, concussions and falls, from gravel, stone, abuse
of diuretics, metastases of erysipelas, rheumatism, or
gonorrhoea, the use of stimulating injections into the
urethra, prolonged retention of urine, introduction of
catheters and sounds into the bladder, suppression of
the menses, and extension of inflammation from neigh
bouring parts.
Therapeutics. — Aconite, cantharides, cannabis, thuya
occiden, terebinthina, copaibce, tussilago petus., and
asparagus, are our best specifics. They may be em
ployed at the first, second and third attenuations,
either alone or in alternation with aconite, and the
doses repeated as the urgency of the symptoms shall
require.
SECTION III.
DIABETES.
Numerous hypotheses have been offered respecting
the seat and nature of this singular malady, but
neither of them appears to afford a satisfactory expla
nation of all its phenomena. The affection has been
referred to a morbid condition of the kidneys alone,
also to derangement of the stomach, of the liver, to
a defect in the fluids, to suppressed perspiration, to
an imperfect animalization of the blood, to the re
trograde action of the lymphatics, and to an unnatural
waste of the body, thus calling into increased activity
the digestive and assimilative functions to supply the
waste. Galen, who saw but two cases of diabetes
during his life, supposed that it was caused by an
inflammation of the kidneys, " which made them draw
much serum from the emulgents." Aretseus attributed
it to a feeble and relaxed condition of the kidneys,
" which weakens the retentive faculty." Actius be-
AND GENITAL ORGANS. 437
lieved that the cause consisted in " an afflux of sharp
or salt humours, which continually stimulated the
veins to expulsion." Van Helmont attributed it to a
paralysis of the muscles of the bladder. Willis, who
first pointed out the saccharine character of the urine,
thought it was caused by " the dissolution and over-
lax frame of the blood, whereby it loses its serum
before it has done its office." Sylvius says : " the
disease arises from a sharp volatile salt, either re
ceived from without, or inbred in the parts." Cullen,
Sydenham, Rollo, and Home, regarded the affection
as '* dependent primarily on a disordered state of the
digestive organs, in conjunction with a defect in the
assimilating functions."
This last opinion is probably the correct one, and
much credit is due to Bouchardat for having first
pointed out the changes which certain aliments un
dergo in consequence of this disordered state of the
digestive apparatus. Dr. B. broached the opinion,
that " in diabetes, starch was converted in the intes
tines into sugar, which passed into the blood and
urine." Hence, a diet composed chiefly of neutral
azotised substances, to the exclusion of starch, has
been recommended for the cure of this disease, and,
in some instances, with success.
It may, then, be safely assumed, that the primary
cause of diabetes consists, first, in a morbid state of
the digestive and assimilative organs, which favours
the formation of dextrine, or sugar, from the starchy
or farinaceous substances introduced into the alimen
tary canal, and its absorption into the blood and urine.
The following are a few of the reasons for this
opinion : Diabetes is usually attended from the first,
with a disordered state of the digestive organs, as is
indicated by uneasy sensations in the stomach after
eating, impaired or morbidly increased appetite, eruc
tations, nausea, vomiting, bad taste, and dryness of the
mouth and tongue.
The function of the stomach is exceedingly com
plicated, and is inflamed, perhaps, more than any
other organ of the body, by the numerous natural or
artificial circumstances which constantly operate
upon living beings. When the organism is in a sound
438 DISEASES OF THE URINARY
condition, and no disturbing causes exercise an in
fluence, the digestive apparatus elaborates thoroughly
a certain amount of chyle, and the assimilative organs
take it up and appropriate it in a certain manner.
But these functions may be impaired, suspended, or
even unduly increased, by moral and physical causes.
Ill news, grief, chagrin, mortification, disappointment,
anger, fear, dread, apprehension, and disagreeable
sights, often suspend both digestion and assimilation.
These functions may also be impaired or suspended
from the abuse of drugs, stimulants, tobacco, coffee,
tea, sedentary habits, excessive bodily fatigue, want
of sleep, the irritation of vitiated bile, or of the gas
tric fluid, or of acids, excesses in eating, or the use of
indigestible food, inflammation, &c. They may also
be morbidly increased by tonics and stimulants, like
bark, the preparations of iron, the bitter infusions,
wine, alcoholic liquors, cordials, and condiments.
In the malady under consideration, the digestive
organs are in a peculiar condition. The thirst is in
tense, and the appetite voracious, yet the digestive
function is perverted, the aliments are imperfectly
converted into chyle, a superabundance of saccharine
matter is elaborated, while the activity of the absorb
ents is astonishingly increased.
That farinaceous aliments are really converted into
sugar in the stomachs of diabetic patients, is evident
from the fact that traces of it have been detected in
the matters ejected by them after the use of farina
ceous food. It is also proved from the circumstance,
that when this kind of food is withheld, both the se
cretion of urine and its saccharine character is mate
rially diminished.
Matteucci has demonstrated, that " starchy sub
stances, when introduced into the stomach and intes
tines of diabetic patients, are converted into dextrine,
or sugar, by the saliva, or pancreatic juice, and are
then absorbed directly into the blood, either in this
form, or after having been converted into lactic acid."
The experiments of Dutrochet, Cuna, and Mat
teucci have proved that different liquids may pass
through the stomach, membranes, skin, and other ani
mal tissues, by absorption, imbibition, endosmose, or
AND GENITAL ORGANS. 439
exosmos*, the activity and direction of these pheno
mena depending upon the character and position of
the fluid used, and the physiological condition of the
structure acted on. Thus, " azotised neutral sub
stances dissolved in the stomach by the acid liquid,
or by the catalytic action of pepsine, pass into the
blood merely by the imbibition of the coats of the
capillary bloodvessels of the stomach." Water, and
alcoholic drinks, introduced into the stomach, are also
absorbed ; they do not pass beyond this viscus, nor
are they to be found in the chyle, yet they reach the
blood."
In diabetes, the digestive organs appear to have
lost the power to elaborate healthy chyle, and also
the absorbents of resisting the entrance of the sac
charine fluids formed by this perverted action.
Whether the nature of this morbid condition is of an
inflammatory or non-inflammatory character, whether
dependent upon exalted action or laxity, loss of tone
or paralysis of the affected parts, is somewhat prob
lematical, although we incline to the opinion, that the
disease is essentially dependent upon a relaxed and
enfeebled condition of the digestive and assimilative
functions.
But an objection will be urged to the above views,
because the quantity of sugar found in the urine of
diabetic persons is not at all proportionate to that of
the fecula taken as aliment ; but this argument falls
to the ground when we reflect that the uric acid and
the urea derived from the rapid metamorphosis of the
tissues, is likewise converted into sugar, and passes,
with the fluids arising from these changes, through
the blood and kidneys, thus contributing to make up
the enormous quantity of saccharine fluid which is
observed in this affection. Prout has shown that the
constituent elements of urea and sugar are the same,
and exist in similar proportions ; from which fact, we
can readily comprehend the change from one sub
stance to the other, and the affinity exercised by the
saccharine fluid circulating in the blood, upon the
urea arising from the transformation of the tissues.
Second. As a consequence of this primary derange
ment of the digestive and assimilative functions, the
440 DISEASES OF THE URINARY
saccharine fluids formed, are transmitted rapidly
through the blood, absorbing, during their course, the
changed urea, and, finally, eliminated by the kidneys.
It is the office of the kidneys to separate from the or
ganism all substances incapable of further use,
whether such useless substances are the product of
the natural secretions, or of the transformations of
the tissues. Now, as sugar is a substance foreign
and injurious to the blood, it is taken up as fast as
formed, and conveyed speedily to the kidneys, which
separate it, after which it passes off through the blad
der. This is evident from the fact, that when a solu
tion of sugar is injected into the veins of an animal,
it does not remain in the blood, but makes its appear
ance very speedily in the urine. It is on this account
that it is so difficult to detect sugar in the blood of
diabetic patients, although traces of it have been found
by Dr. Capezzuoli, not only in the blood, but in the
contents of an abscess of a diabetic patient.
When more saccharine matter is absorbed than can
be speedily eliminated by the kidneys, it is highly
probable that it passes off through the liver, the sali
vary glands, the pancreas, and even into abscesses,
rather than remain in the mass of the blood.
Third. The kidneys themselves being constantly
acted upon by a fluid unlike their natural stimuli, be
come irritated, their vessels enlarged, and thus excited
into unnatural activity. This fluid also often gives rise
to an inflammation about the orifice of the urethra.
Diagnosis. — In tracing the progress of diabetes, and
noting carefully the symptoms which are especially
characteristic, it will be found that a very intimate
connection necessarily exists between these symptoms
and the pathological conditions above described.
In the first instance, there are indications of de
rangement of the digestive apparatus, as morbid ap
petite, distress in the stomach after eating, flatulent
distention, acidity, eructations, nausea, heartburn,
lassitude, and debility.
When the disease is fully formed, the prominent
symptoms are, urgent and insatiable thirst, voracious
appetite, hot and harsh skin, and the elimination of an
unusually large quantity of urine abounding in sac
charine matter.
AND GENITAL ORGANS. 441
As the disease advances, the tongue is clammy and
white, or clean and red ; there is distress after eating ;
a peculiar hay-like odour issues from the body and
lungs ; there are pain and weakness, and sometimes
swelling, in the loins ; anxiety ; peevishness ; despon
dency ; impaired memory ; vertigo ; constipation ; in
flammation about the glans penis and the orifice of
the urethra ; rapid and great emaciation ; loss of
strength ; impotence ; coldness of the extremities ;
difficulty of breathing ; dropsical effusions ; weak and
frequent pulse ; great prostration of all the powers.
Diabetic urine is of a straw colour, of a disagreea
ble odour, and a sweetish taste. The quantity voided
in different cases varies very much, some patients
voiding as much as fifty or even one hundred pounds
in twenty-four hours, while others pass only eight or
ten pounds during the same period. The average
quantity voided in twenty-four hours may safely be
placed at about fifteen pounds.
Diabetes usually continues for months, and some
times for years, before it terminates fatally. Hitherto
it has been almost invariably fatal ; but may we not
hope that the discoveries which have been recently
made, and which are still being made, in organic
chemistry, as well as in the practice of medicine, will
enable us yet to understand and conquer this singular
and intractable malady?
Therapeutics. — If the theory which we have ad
vanced respecting the nature of diabetes is correct, it
follows as a consequence, that one of our most im
portant therapeutical indications consists in pointing
out a proper system of dietetics. We have seen that
through a perverted action of the digestive apparatus,
all the farinaceous or starchy substances consumed
become converted into sugar, and thus afford material
for the perpetuation of the malady. A rigid absti
nence from everything of a feculent nature should
therefore be insisted on, while, at the same time, a
diet as nutritious as possible should be enjoined, con
sisting of beef, mutton, venison, fowls, game, fish,
animal soups, jellies, and articles of this nature. We
commend most strongly as valuable auxiliary means
in this affection, sea voyages, and frequent applica-
19*
442 DISEASES OF THE URINARY
tions to the whole surface of the body, of salt water.
The free use of ice, gradually dissolved in the mouth,
will also prove serviceable in allaying the intense
thirst which consumes the patient.
The internal remedies which have been found most
successful in this disease are, acid phosphoric, carbo
vegetabilis, nux vomica, acid muriatic, baryta muriate,
belladonna, uva ursa, rhus rad., conium mac., digitalis,
and opium.
Our experience has been so limited in the homeo
pathic treatment of diabetes, that we shall refrain
from extending our observations respecting the espe
cial indications and the practical employment of each
particular remedy, but refer our readers to the
provings, and mode of employment, by different medi
cal men, for further information and suggestion upon
the subject.
SECTION IV.
ENURESIS. INCONTINENCE OF URINE.
Diagnosis. — This affection may be recognised by a
partial or total loss of power to retain in the bladder
the secreted urine. When the loss of voluntary power
over the muscles concerned is total, the mine contin
ues to dribble away as fast as secreted, becoming thus
an incessant source of trouble and annoyance.
If the loss of power be only partial, the urine can
be retained until a given amount is accumulated,
when the patient is suddenly compelled to yield to the
pressing demand, sans ceremonie. In other instances,
the incontinence is troublesome only during sleep, and
appears to be excited by dreams, constrained posi
tions, &c.
The malady is unaccompanied by febrile symptoms
or pains, and usually occurs as a symptom of some
other disease.
Causes. — Complete enuresis may be caused by pa
ralysis of the sphincter of the bladder from constitu
tional causes, from external injuries, from tedious and
protracted labours, from the pressure of tumours, from
calculous deposits, and from abuse of diuretics.
Partial enuresis is a common complaint amongst
AND GENITAL ORGANS. 443
children, and is particularly troublesome in the night
during sleep. It has too often been attributed to
habit, and negligence of proper efforts to restrain the
discharge on the part of children, and for this reason,
external applications, in the form of " spanking," and
" essence of birch," have been employed, but so far as
our knowledge extends, without advantage. The
disease in these cases is undoubtedly associated with
irritation at the neck of the bladder, originated by
acrid urine, gravel, the irritation of worms in the rec
tum, etc.
Therapeutics. — Cantharides, cannabis, uva ursa, nux
vomica, cicuta vir., sulphur, calcarea carb., pulsatilla,
and rhus, are the chief remedies.
For the cure of paralytic enuresis, recourse should
be had to cantharides, nux vom., rhus and uva ursa.
When the disease occurs in children, our best reme
dies are, cantharides, calcarea carb., and sulphur.
When from external injuries, difficult accouchements,
or the irritation of calculi, we may prescribe arnica,
pulsatilla, rhus, and cicuta virosa.
Administration. — The remedies should be used at
the first or second attenuations, and a dose given once
or twice daily as long as necessary.
SECTION V.
SUPPRESSION AND RETENTION OF URINE.
The causes capable of giving rise to suppression or
retention of urine are so various and diversified, and
the circumstances attending the course and progress
of different cases so numerous, that our description
must necessarily be confined to the more prominent
symptoms and occurrences connected with the malady.
By the term retention of urine, we mean to include
all of those cases in which the urine is secreted by the
kidneys as usual, but where the power to evacuate the
bladder is lost ; while suppression of urine corresponds
with the affection known as ischuria renalis, in which
the secreting function of the kidneys is either partially
or totally destroyed.
Ischuria renalis is always attended with danger,
from the peculiar tendency which exists in the brain
444 DISEASES OF THE URINARY
to take on diseased action. When there is an entire
suppression of the urinary secretion, from paraly
sis of the kidneys, coma and effusion upon the brain
occur very speedily. In cases of this description, the
saliva, the sweat, the pulmonary exhalations, the bile,
the pancreatic and gastric fluids, become impregnated
with a fluid possessing the appearance, taste and
odour of urine. It has also been observed, that the
liquid effused upon the brain, possesses a decidedly
urinous smell. In cases of the disease dependent on
inflammation of the kidneys, we shall have febrile
symptoms, hot and dry skin, thirst, nausea, vomiting,
rapid pulse, tenderness of the abdomen on pressure,
swelling and pain in the region of the kidneys, fre
quent desire to urinate, and the passage of the small
quantity secreted, causing great pain, urinous taste in
the mouth, urinous odour of the sweat, anxiety and
general uneasiness. If the suppression be total, the
symptoms will be still more grave, and there will be
early indications of serious cerebral disorder, in the
form of delirium, rapidly succeeded by coma and
effusion.
On the other hand, in suppression, depending upon
paralysis of the kidneys, the febrile symptoms may be
very slight, and there may be an entire absence of
pain and uneasiness in the region of the kidneys or in
the abdomen, and no desire to urinate. In these
instances, the danger is no less imminent than in the
other variety, for fatal oppression of the brain almost
invariably ensues, if the malady persists more than
two days. Cases, however, are recorded, of almost
total suppression for two or three months, in which the
patients have been restored to health, but such in
stances are of rare occurrence, and should only be
considered in the light of exceptions to the general
law of the disease.
Suppression now and then occurs from the presence
of calculi or gravel in the structures of the kidneys, thus
causing a mechanical obstruction to the healthy per
formance of their functions. In these cases the for
eign bodies may operate by causing inflammation,
spasms, induration, or ulceration. They give rise to
swelling, pains, sensation of weight and uneasiness in
AND GENITAL ORGANS. 445
the vicinity of the kidneys, to numbness of the thighs,
retraction of the testicles, abdominal tenderness, con
stipation, frequent inclination to urinate, pain and
tenesmus in passing water, anxiety, irritability, febrile
symptoms, nausea, vomitings, hiccoughs, pain in the
lumbar region, pain and tension in the perineum, scald
ing in the urethra, pulse full and frequent, difficulty of
breathing, sighing, delirium, convulsions.
Ischuria may be distinguished from retention of
urine from the circumstance, that in the latter disease,
the bladder is distended and rises up above the pubis,
offering to the pressure of the hand a firm and resist
ing body, while in the former complaint this viscus is
empty, falls down below the pubis, and affords no
resistance or fluctuation.
Retention of urine may arise from inflammation, from
stricture of the urethra, from paralysis of the bladder,
from enlargement and inflammation of the prostate
gland, from mechanical injuries to the bladder, from
abuse of stimulating diuretics, from inflammation of
the rectum, from the pressure of tumours, from dis
placements of the uterus, from calculi, from the lodge
ment of gravel or a stone in the ureters or in the
urethra, from thickening and obstruction of the ureters,
from too long continued retention of the urine, and
from spasms.
The general symptoms of retention are, distention of
the bladder, and its elevation above the pubis, pains
in the region of the bladder, with pressing desire and
frequent ineffectual attempts to urinate, anxiety, gen
eral uneasiness, and more or less constitutional dis
turbance.
As retention is generally but a symptom of some
other malady, we are often presented with constitu
tional disturbances during an attack, in no way de
pendent upon this affection. We may cite as exam
ples of this kind, diseases of the brain and spinal
marrow, which may have preceded the retention for
months, protracted calculous affections, chronic in
flammations of the bladder and of the prostate gland,
constitutional effects of onanism, retroversion of the
uterus, and the effects of previous mechanical injuries.
From these facts it is apparent that there may exist an
446 DISEASES OJb THE URINARY
almost endless variety of symptoms during the pro
gress of the different cases of retention which are con
stantly occurring.
When the malady arises from simple inflammation
of the neck of the bladder or of the bladder itself, not
complicated by any previous disease, the symptoms
are, hot skin ; frequent and hard pulse ; thirst ; pain
in the region of the bladder and in the perineum, in
creased by pressure ; restlessness ; anxiety ; constipa
tion ; frequent inclination to pass water, with violent,
painful and ineffectual straining ; shooting pains ex
tending up the ureters towards the kidneys, or along
the spermatic chords towards the testicles ; headache ;
nausea ; oppression at the prrecordia ; and general
feeling of fulness and distention of abdomen.
Retention caused by paralysis, on the other hand, is
accompanied by but few of these symptoms. Indeed,
many cases are recorded, where the accumulations of
urine have reached an enormous amount, before the pa
tients were aware of it. Other instances are mentioned
where the distention has been so gradual and painless
as to cause it to be mistaken for ascites, and in more
than one instance of this description, paracentecis ab-
dominalis has been resorted to as a curative means.
In cases like these, fifteen or twenty pints have occa
sionally been drawn off by the catheter at a single
operation. It is not an uncommon result in these over-
distentions, for the bladder to become united by adhesive
inflammation to the umbilicus, and afterwards to dis
charge itself through this part by ulceration. The
same occurrence sometimes takes place into the rec
tum, vagina, and even into the abdominal cavity. In
these cases, the danger from peritoneal inflammation,
and from gangrene, is imminent.
Retention may arise from spasmodic contractions
about the neck of the bladder, giving rise to most vio
lent and painful attempts to urinate, bearing-down
pains, frequent painful erections, great sensitiveness
of the urethra and perineum. In this variety of re
tention, it is always very difficult and sometimes ab
solutely impossible to pass a catheter, without pre
viously allaying the irritation by fomentations or by
the employment of suitable medicines.
AND GENITAL ORGANS. 447
Spasmodic retention, although sudden and violent
in its onset, is not usually a dangerous affection. The
essence of the disease consists in an irritation about
the neck of the bladder, and is dependent upon in
flammation of the prostate, of the rectum, of the ure
thra, or some other neighbouring structure, from
which it has been propagated by contiguous sym
pathy.
But the most difficult cases of retention with which
the physician meets, are those caused by strictures of
the urethra, and enlargements of the prostate gland.
The practitioner, during his professional career, will
sometimes be called to cases of each of these maladies,
where nothing but an incision into the membraneous
portion of the urethra, through the stricture, or the
puncture of the bladder, will save life. In these cases,
great judgment, decision, and surgical skill, are indis
pensable to the safety of the patient. This will be con
ceded when we think of the rapidity with which reten
tion may terminate in fatal cerebral disease, ulceration,
and gangrene. By these observations, we by no means
desire to deter the physician from the employment of
every medicinal means in his power, so long as they
can be applied without endangering the life of the pa
tient ; but there is a point beyond which we cannot
safely pass without resorting to one of the operations
just alluded to, and in making up a correct decision
upon this point, the best judgment and the highest
professional knowledge are requisite. I cannot bet
ter illustrate this subject than by detailing the history
of a case which came under my observation during an
early part of my professional career :
Mr. B., aged forty years, of robust constitution, had
been operated upon fourteen years previously, for
stricture in the membraneous part of the urethra. An
incision had then been made through the strictured
part, a catheter introduced and allowed to remain
a good portion of the time for several weeks, but for
some unknown reason, the opening made by the knife
did not heal, and a iistulous passage was formed,
through which the urinn has passed for the most part
of the time since that ;>c;'iod. For two or three years
previous to his coming under my care, this fistulous
448 DISEASES OF THE URINARY
passage had been gradually contracting, and he expe
rienced, at times, retention, which could only be
obviated by baths, fomentations, injections, relax
ing medicines, and the skilful use of the probe.
Several times, however, I succeeded in relieving him
of the attacks, by these means ; but on one occasion,
being in the country, and having contracted a cold
from wetting his feet, the retention recurred, accom
panied with unusual inflammation and tumefaction in
the fistulous tract. Persevering efforts were made by
his medical attendant, to allay the inflammation, relax
the parts, and to draw off the water by means of ca
theters and probes, for nearly two days, but without
success. The symptoms now becoming very urgent,
he returned home and placed himself under the care
of Dr. Brigham and myself. We found great disten-
tion of the bladder, constant desire to urinate, bearing-
down pains in the region of the bladder, expression
exceedingly anxious and care-worn, eyes sunken,
mouth and throat dry, thirst, pulse rapid and feeble,
great prostration, nausea, hiccough, delirium, frequent
sighing, exhalation from the surface of the body of a
urinous smell, coldness of the extremities, and a slug
gish and unhealthy appearance at the orifice of the
fistula.
After resorting to the usual remedies in such cases,
and making repeated attempts with the catheter and
probe, we decided, although it was then midnight, that
an incision must be made through the perineum with
out further delay. This was speedily effected, and
the patient's life thus saved, while had we delayed a
few hours more, gangrene or congestion of the brain
would probably have resulted.
We also have in mind, a case of retention, from en
largement of the prostate, which proved fatal in con
sequence of an absolute refusal, on the part of the pa
tient, to .submit to the operation of puncturing the
bladder. In this instance, the swelling and inflamma
tion of the gland were so great, together with a con
stant tendency to spasmodic contraction of the neck of
the bladder, whenever the catheter came in contact
with the part, that all efforts at introduction, aided by
baths, fomentations, and relaxants, were of no avail.
AND GENITAL ORGANS. 449
Here, a timely puncture of the bladder, would have
saved the patient's life.
We are well aware of the practical skill and tact
necessary to effect an introduction of a catheter in
these cases, and of the importance of securing the ser
vices of a skilful and experienced surgeon ; but cases
sometimes occur which baffle the most eminent sur
geons in their attempts to pass a catheter by an en
larged prostate.
Retention sometimes occurs from obstruction of the
ureters, by gravel, calculi, by thickening and indura
tion of their walls, by hydatids and other unnatural
formations, by the pressure of tumours in their vicinity,
and by occlusion from adhesive inflammation. The
following signs indicate the existence of this variety of
disease : unusual fulness, pain and sensation of weight
in the vicinity of the kidneys, tension along the track
of the ureters, nausea, vomiting, retraction of the tes
ticles, pain along the spermatic cord, collapsed state
of the bladder, no resistance to the introduction of the
catheter, absence of urine in the bladder, and more or
less constitutional disturbance. When the obstruction
is complete, the ureters and the kidneys become so
much dilated that urine to the amount of two or three
pints, sometimes accumulates in them, before conges
tion, ulceration, or gangrene supervene.
Retention not unfrequently arises in females, from a
retroversion of the uterus, from the presence within the
vagina of polypi, hydatids, of schirrous enlargements,
from injuries arising during difficult accouchements,
from the irritation caused by acrid secretions, from the
presence of hardened fseces in the rectum, and from
adhesion occurring between the walls of the vagina,
in consequence of inflammation and sloughing of the
mucous membrane.
Causes. — The most frequent proximate cause of re
tention, is inflammation of some portion of the bladder.
Amongst the more prominent causes of this inflamma
tion, are, metastases of gout and rheumatism, abuse of
diuretics, mechanical injuries, injections, venereal dis
eases, calculi, acrid urine, strains, and extension of in
flammation from neighbouring parts.
The causes which rank next in importance, are
450 DISEASES OP THE URINARY
strictures of the urethra. They occur at all periods of
life, and always require the interference of the sur
geon for their removal.
Enlargement of the prostate gland, is a frequent cause
of retention in old men. The remote cause can gene
rally be traced to excesses in sexual indulgence
during early life. This gland may become enlarged
from mere inflammation and engorgement of its struc
ture, or from schirrus degeneration. Affections of the
prostate are usually called into activity by undue ex
posure to cold and wet, by abuse of stimulants, and
by neglect of timely urinary evacuations.
Other causes, some of which have • already been al
luded to, are, retroversion of the uterus, obstruction of
the ureters from foreign bodies, occlusion of the ureters
from adhesive inflammation, paralysis of the bladder,
from injury or disease of the brain -or spinal marrow,
from undue retention of urine, from mechanical inju
ries, from abuse of drugs, from metastases of gout,
thickening of the mucous membrane of the bladder,
tumours and excrescences near the neck of the bladder,
repercussed eruptions, pressure upon the bladder by
tumours in its vicinity, schirrus of the bladder or rec
tum, accumulations of hardened faeces in the rectum,
suppression of the menses, phymosis, ulcers, external
injuries, blows, contusions, and falls, leucorrhoea and
gonorrliO3a.
Therapeutics. — In all cases of suppression or reten
tion, where there can exist a possible doubt in regard
to the true nature of the case, we should avail our
selves, without delay, of the use of the catheter. If
this instrument passes without difficulty into the ca
vity of the bladder, and no discharge of urine follows
its introduction, we may be certain that the cause and
seat of the difficulty is not in this viscus ; while if a
free discharge takes place through the catheter, afford
ing immediate relief to the distention, pain, and other
unpleasant symptoms which had previously existed,
we may be assured that the bladder, the prostate
gland, or some part of the urethra, is the seat of the
complaint.
To ensure an accurate diagnosis, then, we in the first
instance ascertain whether or not a catheter can be
passed into the bladder.
AND GENITAL ORGANS. 451
Second. If it can be, whether easily or otherwise.
Third. How large an instrument can be passed.
Fourth. If a discharge of urine follows the intro
duction.
Fifth. If the operation is attended with pain.
Another important step in forming our diagnosis,
consists in procuring from the patient or his friends, a
minute history of his case, and every circumstance
connected with the individual, which might have a
bearing upon it. Thus, if we are called to an old man,
whose malady has approached gradually, who has had
no febrile symptoms and little pain, where no resist
ance is offered to the introduction of a full-sized ca
theter, and where a large quantity of urine flows off,
affording immediate relief to the uneasy feelings, we
may with confidence pronounce the cause, paralysis of
the bladder. The same law obtains in cases of re
tention succeeding injuries, or diseases of the spinal
marrow.
If we have a case where the catheter passes into
the bladder with great difficulty, on account of some
obstruction near its neck, we then inquire whether
there exists a stricture, a spasmodic contraction of the
neck of the bladder, or an enlarged prostate gland.
The following circumstances will enable us to decide
the question satisfactorily:
Stricture approaches gradually, as is indicated by
the gradual contraction of the stream of urine, the
frequent and sometimes constant presence of a gleety
discharge, and a sensation, after passing water, as if
a few drops still remained behind.
Enlarged prostate occurs, for the most part, in old
men, is attended with pulsative pain over the bladder,
weight in the perineum, constant inclination to uri
nate, with much straining, fever, and general uneasi
ness. By introducing the finger into the rectum, we
may often detect the enlargement by actual touch.
Spasmodic contraction of the neck of the bladder
usually proceeds from inflammation of some neigh
bouring structure, as the prostate gland, the rectum,
and the urethra. Spasms of this part may arise also
from the irritation of gravel and calculi. The pre-
452 DISEASES OF THE URINARY
vious history of the case will enable us to decide as to
the real cause of the spasmodic affection.
Retention, from stricture of the urethra, can only be
permanently cured by the gradual dilatation of the
contracted part by bougies. Temporary relief may
sometimes be afforded by the use of medicines, but the
only permanent cure is by artificial dilatation. But
much may be done towards effecting cures in cases of
diseased prostate, by a judicious employment of spe
cific medicines. Many cases of this description owe
their origin to scrofula, or to a venereal taint, or to
abuse of mercury, or to schirrous degeneration, for
which reason our prescriptions should be made with
reference to these peculiar states of the system, as
well as to the more immediate symptoms of the com
plaint.
With regard to the other causes of retention, the
importance of a minute investigation into all the cir
cumstances of each case, cannot be too strongly in
sisted on ; for much of our success will depend upon
an early removal of those causes which have operated
to induce the retention, and which perhaps continue
to exist to perpetuate the malady.
If a retention has . been caused by a metastasis of
gout or rheumatism, our selection of remedies should
be made with reference to these general diseases, as
well as to the more urgent local symptoms. If the
cause can be traced to a displacement of the uterus, to
impacted faeces in the rectum, to inflammation of any
of the surrounding tissues, to the presence of asca-
rides in the rectum, to excrescences about the neck of
the bladder, to imperforate hymen, to unnatural ad
hesions within the vagina, to the impaction of a stone
in the urethra, our attention should be immediately
directed towards the removal of these remote causes.
The following medicines will cover all of the symp
toms which occur in suppression or retention of urine:
cantharides, cannabis, uva ursi, solidago virga aurea,
acid phosphoric, rhus rad., aconite, pulsatilla, nux vo-
mica, arnica, belladonna, oleum terebinthina, tussilago
perluss., camphora, agnus castus, arsenicum, sulphur,
iodine, electro-magnetism.
Cantharides and cannabis are indicated in supprcs-
AND GENITAL ORGANS. 453
sion from chronic inflammation of the kidneys, and in
retention from long continued irritation of the neck of
the bladder. They may also be employed in suppres
sion and retention from acute inflammation of the
kidneys and bladder, after the febrile symptoms have
been subdued by aconite. Hahnemann advises them
in retention from paralysis of the neck of the bladder,
and in cases of chronic intention arising from thicken
ing and induration of the mucous membrane.
Arnica is our best remedy when the functions of the
kidney and bladder have been impaired or suspended
by mechanical injuries, falls, contusions, sprains,
blows, and concussions, or by the irritation of calculi.
Rhus rad., belladonna, and solidago virga aurea, are
applicable when the disorder has proceeded from me-
tastases of gout or rheumatism. These medicines
may be alternated with aconite when the inflamma
tory symptoms run high.
Agnus castus is an excellent specific in retention
in consequence of paralysis of the bladder. Nux
vomica, tussilago, arsenicum and oleum terebinth., are
remedies which should command attention in para
lytic retention.
Spasmodic retentions are readily cured by camphor,
belladonna, and aconite.
When gravel or calculi are the exciting causes of
the affection, we advise the employment of uva ursi,
solidago virga aurea, and belladonna.
Affections of the prostate gland may be met by
pulsatilla, sulphur, aconite, rhus rad., arsenicum and
iodine.
Retention from onanism, or excesses in venery, are
treated best with acid phosphoric, agnus castus, can-
tharides, cannabis, rhus rad., and arnica.
Administration. — The lower attenuations should be
employed in these affections, and the doses repeated
every two, three, or four hours, until the medicinal
effect is perceptible. Auxiliary to the above medi
cinal treatment, we make a thorough use of warm
baths, fomentations, bland, diluent drinks, injections
by the rectum, and lastly, though by no means the
least important means, electro-magnetism. This power
ful remedy should only be employed after the inflam-
454 DISEASES OF THE URINARY
matory symptoms have been reduced, and then with
extreme care and moderation.
SECTION VI.
DYSURIA.
Diagnosis. — In this complaint the urine can be
voided at will, but it usually passes away in a small
spiral, or divided stream, or drop by drop, each act
being attended with burning and cutting pains at the
neck of the bladder. There is a frequent inclination
to urinate, and sensations of pressure and tenesmus,
which constantly urge the patient to void his urine.
The inflammation is confined to the neck of the blad
der, and does not often give rise to constitutional dis
turbance.
Causes. — Perhaps the most frequent cause of dysuria
is the absorption of cantharides. This substance
exercises a specific influence so decidedly upon the neck
of the bladder, that even a sufficient quantity may be
absorbed from the external application of blisters to
cause the malady. Other causes are, stimulating in
jections, abuse of stimulants and condiments, onanism,
extension of gonorrhoaal inflammation, cold, turpen
tine, worms in the rectum, gravel, and calculi.
Therapeutics. — Camphor is the specific against dy-
sury caused by the absorption of cantharides. When
arising from other causes, cannabis, uva ursi, digitalis,
solidago virga aurea, cantharides, and terebinth, are
worthy of confidence.
Administration. — Same as in retention, &c.
SECTION VII.
URINARY CALCULI.
There is not space in a manual of this description for
the careful consideration which is demanded for this dis
ease by its importance ; but we shall endeavour to glance
hastily at the most prominent doctrines at present in
vogue, with a view of attracting attention more par
ticularly to the subject, rather than from any expecta
tion of affording a satisfactory explanation of the
phenomena attending the formation and development
AND GENITAL ORGANS. 455
of calculous concretions. Chemistry has indeed af
forded us much accurate knowledge respecting the
composition of the different varieties of calculi, but
we still remain in ignorance of the real causes and
nature of the abnormal action, the peculiar condition
of the organism requisite to originate this action, and
of the specific medicines capable of effecting cures.
The data upon which modern physicians have found
ed their prescriptions, may be more scientific and ac
curate than those of the ancients, but we are not aware
that the practical results which they have obtained are
in any degree more decided or favourable. The an
cient allopathists attributed the formation of stone to
the union of the "terrestrial and tartarous parts of the
blood with the clamminess of the viscous lymph a, that
continually flows by with the urine, and further com
pacted together by the salts with which the urine is
leaden"* And for the cure, they prescribed venesection,
opiates, mercurials, diuretic infusions and decoctions,
and " litliontriptics" or " stone-dissolving remedies."
Modern allopathy attributes calculous depositions to
a superabundance of uric acid, of the phosphates of
lime, magnesia, and ammonia, oxalate of lime, <fec., in
the blood and urine, and they also prescribe blood
letting, opiates, mercurials, diuretics, and " stone-dis
solving remedies" but with no more success than their
heathen predecessors. To what extent homoeopathy
may be able to combat this formidable disease, time
alone can determine ; but so far as the limited ob
servations and experience of our practitioners extend,
in this class of affections, our method of practice has
been highly satisfactory. Our system is especially
adapted to correct those peculiar diatheses upon
which the formation of calculi depend.
Calculous affections have been observed to prevail
in some countries more than others : even in some
portions of the same country they may be common,
while in other sections they will be unknown. The
disease is rarely seen in very cold or very hot latitudes.
English surgeons assert that it never originates in the
East Indies, and it is supposed to be of very rare oc
currence in the northern kingdoms of Europe.
* Salmon.
456 DISEASES OF THE URINARY
Children and old people are most subject to the dis
ease, and it seizes especially upon those in whom gout
is hereditary. Indeed this gouty diathesis is so com
mon in individuals afflicted with calculi, that many
suppose that the urine exercises but little if any influ
ence in their formation, but that metastases of gout to
the mucous membrane of the urinary passages, deter
mine the formations of these calculous concretions. —
Thus, Frank, in his " Traite de Prac. de Med.," p. 367,
vol. ii," says : " The attacks of calculous affections,
like those of gout, are preceded and accompanied by
languor of the stomach, nausea, oppression, eructa
tions, borborigrni. In inveterate gout, this phlegma-
sia gives rise to calcareous concretions, formed of a
material combined with uric acid, and which do not
differ from urinary calculi except in consistency and
form. Suppose now that fixed gout, which produces
calcareous concretions in the articulations of the
great toe, attacks the mucous membrane of the blad
der, may it not become the source of calculi in this vis-
Calculi have been found in the brain, lungs, liver,
spleen, gall, bladder, uterus, the articulations and the
soft parts of nearly every portion of the organism, but
the urinary organs are by far the most common seat
of these formations. Several years since I saw taken
from the upper part of the left lobe of the lung of a
miller, two concretions of a chalky appearance, but
hard and tough, and of the size of a goose-egg. Con
cretions of lithate of ammonia are also common in all
parts of the body, in gouty patients.
Prout has divided the mechanical deposits from the
urine into three classes : First, Pulverulent, or amor
phous sediments. Second, Chrystaline sediments, usu
ally denominated gravel. Third, Solid concretions or
calculi, formed by the aggregation of these sediments.
The sediments of the first class are held in solution
by the urine until it is discharged from the bladder,
when they are gradually deposited in a state of fine
brown or yellow powder. These sediments are gen
erally composed of " two species of neutral saline
compounds ; viz., the lithates of ammonia, soda, and
lime, tinged more or less with the colouring principle
AND GENITAL OBGANS. 457
of the urine, and with the purpurates of the same ba
ses, and constituting what are usually denominated
pink and laterilious sediments; and secondly, the
earthy phosphates, namely, the phosphate of lime, and
the triple phosphate of magnesia and ammonia, con
stituting, for the most part, sediments nearly white.
The two species of sediments are frequently mixed to
gether."— (Prout.)
The sediments of the second class, or gravel, are
found in the urine in regularly crystallized grains, va
rying in form and colour in accordance with the con
stituents of which they are composed. The lithic acid
crystals are much the most common, and may be dis
tinguished by their red colour. The crystals of the
triple phosphate of ammonia and of magnesia are of
a white colour, while those of the oxalate of lime are
black or dark green.
Prout supposes that two-thirds of the whole number
of calculi originate from lithic acid ; and when we bear
in mind the constant presence of this acid in the urin
ary organs, and its proneness to form hard, inodorous
concretions of a yellowish or brown colour, the suppo
sition will not appear unreasonable.
Chemists have described many different varieties of
calculi, amongst which the following are the most com
mon: —
First, The lithic or uric acid calculus, formed by con
centric lamellae, presenting a light brown or reddish
colour, and a general appearance something like wood.
These calculi are infusible by the blow-pipe, but may
be slowly evaporated, until a slight residue of white
ash remains. They are soluble in alkaline solutions,
which, on this account, are supposed to be valuable as
remedial agents, but they are not dissolved by muri
atic or sulphuric acids. The lithic acid diathesis pre
vails in childhood and at about the age of forty or fifty,
and the urine voided in these cases is generally acid,
and the sabulous sediment of a red colour.
Second. The calculi of most common occurrence af
ter the variety last described, are those composed of a
triple combination of phosphoric acid, magnesia, and
ammonia. They are of a lightish gray colour, indis
tinctly laminated, with an " uneven surface and cov-
20
458 DISEASES ©F THE URINARY
ered with small shining crystals." This variety is
not soluble in alkaline solutions, but may be partially
dissolved by muriatic, nitric, and sulphuric acids, and
imperfectly fused by the blow-pipe. The urine in these
cases is very fetid, and the sediment deposited of a
white colour, " resembling mortar." Sir Astley Cooper
asserts that this kind of calculus is very apt to be re
produced after lithotomy, and on this account advises
the postponement of operations in these cases until the
morbid diathesis is corrected.
Third. Not a very uncommon variety is the mulber
ry calculus, of a dark brown colour, uneven surface,
and very compact, heavy and hard. It consists of ox-
alate of lime, and is partially soluble in muriatic and
sulphuric acids, but the alkaline solutions have no ef
fect upon it.
Fourth. The phosphate of lime calculus is in a few
instances found pure, but usually it exists in combina
tion with uric acid and phosphate of magnesia and
ammonia. It is laminated, polished, of a pale brown
colour, soluble in muriatic or nitric acid, and may be
fused by the blow-pipe. They are of small size, and
are generally found in the prostate gland.
Fifth. The cystic oxyde calculus is another variety
of rare occurrence, of a yellowish hue, not laminated,
soluble in acids and alkaline solutions, and emitting
under the blow-pipe a fetid odour.
Sixth. There is also the fusible calculus, composed
of a mixture of the triple phosphate of magnesia and
ammonia, and of the phosphate of lime ; of a white
colour, and fusible by the blow-pipe. This kind of
calculous deposit is occasionally seen between the
foreskin and glans-penis in old cases of phymosis.
Seventh. The constituents of the different kinds of
calculi are sometimes deposited in distinct alternate
layers in the same stone, when it is called the alterna
ting calculus.
Other varieties have been described, like the com
pound calculi, the carbonate of lime calculus, the lithate
of ammonia calculus, &c.
The presence in the bladder or kidneys of any solid
.substance, whether introduced artificially, or formed
naturally from lithic acid concretions, or clots of blood,
AND GENITAL ORGANS. 459
favours the formation of calculi. Whether the cause
of these deposits in the urinary organs, is attributable
to the peculiar composition, or the compact structure,
or the comparative temperature of the nuclei, we
are unable to determine : but all are aware of the fact,
that catheters, bullets, splinters, or other solid substan
ces, accidentally introduced into the bladder, become
speedily coated over with the urinary sediments, which
are converted into hard crusts.
Calculi are more frequently observed in the male,
than in the female sex ; but this circumstance has
been attributed to the difference in the structure of the
urethra in the two sexes, rather than to a difference in
the original diathesis. The urethra of the female be
ing short and easily dilated, gives passage without
difficulty to gravel and small calculi, which in the long
and contracted male organs would be obstructed either
by causing spasmodic contractions, or from an actual
want of room to pass.
It is said that the right kidney is far more common
ly the seat of these formations than the left, that their
form is generally spheroidical, and that their ave
rage weight is from one to two ounces. Sir Astley
Cooper, however, expresses the opinion that a majori
ty of urinary calculi weigh less than one ounce each.
Calculi may originate in the kidneys, the bladder,
or the prostate gland, but the first organ is the prima
ry seat of a large majority of cases, as is evident from
the fact that the pains are almost always confined to
the region of one of the kidneys in the first instance.
It is probable that the nuclei of most stones found in
the bladder, are first formed in the kidneys, and then
conveyed through the ureters into this viscus, to serve
as the foundation of still farther deposits from the
urine.
Diagnosis. — A calculus may remain in the kidney
or bladder for a long time, without exciting much pain
or uneasiness. The patient experiences perhaps a
more frequent inclination to urinate than natural, and
after violent exercise on horseback or in a carriage,
has temporary pains in the region of the organ affect
ed, but in other respects he feels well. This state of
things may exist for an indefinite length of time, when,
460 DISEASES OF THE URINARY
if the stone is situated in the kidney, some exciting
cause may operate, and give rise to what is denomi
nated a "fit of the stone." In these instances the pa
tient is usually attacked suddenly, with severe cutting
pains in the region of the kidney, which increases as
the stone passes along the ureter to the bladder, some
times extending to the groin, the cremaster muscle,
or along the crural nerve, as it passes over the nerves
connected with these parts. During the paroxysm,
the pain is often of the most violent and intolerable
character, and is accompanied with continual nausea,
vomiting, inability to retain any thing upon the sto
mach, frequent desire to urinate, high coloured and
sometimes bloody urine, bent position of the body, with
the muscles flexed as much as possible, heartburn,
painful retraction of the testicle, irritable bladder,
and febrile symptoms. There is often a remission of
these symptoms for a longer or shorter period, during
the descent of the stone through the ureters, and the
paroxysm now and then comes on, and subsides sud
denly and permanently, the stone not having effected
an entrance into the ureter.
After the stone has passed into the bladder, we
have the following train of symptoms : frequent incli
nation to urinate, " the patient making the first por
tion with ease, and complaining of great pain coming
on when the last drops are expelled." — (Earle.) Sud
den stoppage of the current of urine, in consequence
of the stone moving in front of the urethra, itching
and tingling at the extremity of the penis, difficulty
or absolute inability of retaining the faeces when uri
nating, on account of the sympathetic irritation of
the rectum, "sense of weight and pressure at the
lower part of the pelvis," dull pain at the neck of the
bladder, bloody, mucous, or purulent urine, pains in
the region of the bladder increased by exercise, espe
cially riding on horseback or in a jolting carriage,
febrile symptoms, irritability, loss of appetite, emacia
tion, inability to sleep or rest quietly, night or day.
In boys, the prepuce generally becomes much elon
gated, from their constant habit of pulling at it, to
relieve the itching in the glans. After the stone has
continued in the bladder for a considerable time, this
AND GENITAL ORGANS. 461
organ becomes very much contracted, its coats be
come thickened and diseased, and the patient sinks
under the constitutional derangement consequent
upon the protracted irritation of the foreign body.
It will be observed that all of the symptoms which
we have enumerated, are similated by the affections
of the urinary organs. Thus, simple nephritis gives
rise to the symptoms of calculus in the kidneys ; and
inflammation of the prostate gland and bladder, to
those of stone in the bladder. But in some instances
the patient can actually feel the motion of the calcu
lus, as he turns over from one side to the other. This
circumstance, taken in connection with the abrupt
stoppage of the stream when urinating, in conse
quence of the stone getting before the urethra, and
the occurrence of severe pain after the urine has been
mostly evacuated, in consequence of the stone coming
into more direct contact with the walls of the bladder,
will enable us to decide with much certainty respect
ing the presence of a stone.
But the only positive indication of a calculus is our
ability to strike it with a sound introduced into the
bladder, and a prudent surgeon will never cut for the
stone unless he can/ee/ it with his sound immediately
before he commences his operation.
Therapeutics. — Our therapeutical measures may be
classed under four heads.
First. To correct the diathesis on which the mor
bid sediments depend.
Second. To relieve the distress and suffering at
tendant on the presence in the urinary organs of gra
vel or stone.
Third. To dissolve the stone.
Fourth. To extract it, either by lithotomy, or by
the aid of Civiale's lithotriptor.
The first object may be attained by removing the
causes upon which the diathesis depends. Some of
the more prominent of these causes are, errors in diet,
including quality and quantity of food, and irregu
larity in hours of taking meals, abuse of stimulants,
use of water abounding in lime, excessive mental or
bodily fatigue, undue exposure to atmospheric vicissi
tudes, insufficient nutriment, the depressing passions,
462 DISEASES OF THE URINARY
tendency to gout and rheumatism, dyspepsia, and dis
ease of the urinary organs.
When the depositions depend upon a lithic acid dia
thesis, every thing of an acid nature should be avoid
ed; a large quantity of animal food should be en
joined, and baths, frictions, and abundant exercise
taken, to ensure a healthy action of the skin.
The phosphatic diathesis may depend upon a loss of
tone in the digestive organs, too free use of animal
food, profuse sweats, use of lime water, and over-
exertion, mental or physical. Here a farinaceous
and vegetable diet, and a free use of fruit and acids,
should be advised. If the depositions arise from gout
attacking the mucous membrane of the bladder, the
suitable medicines will speedily dissipate the morbid
condition, When the diathesis appears to proceed
from general debility, or derangement in the digest
ive or assimilative functions, our dietetic regulations,
as well as our medicines, should be prescribed with
reference to these conditions.
In all calculous affections, a cheerful state of mind,
with country air, or a sea-voyage to a hot or cold lati
tude, will prove serviceable.
To fulfil the second and third indications as far as
possible, we shall, farther on, point out those reme
dies which we deem most suitable. But it is matter
of much doubt whether there are at present any
remedies known, capable of dissolving a calculus
in the urinary organs after it has attained a con
siderable size. We may be able to correct the
diathesis upon which the morbid sediments depend,
and to enable the urinary organs to expel calculi
of small size ; but the dissolution of a large stone
in the bladder has never yet been effected. Such
can only be removed by crushing them according
to the method of Civiale, &c., so that the fragments
will pass off by the urine, or by the operation of
lithotomy. For the details concerning these im
portant operations, we refer the reader to the standard
works on Surgery.
The principal medicines in the treatment of urinary
concretions, are cannabis, uva ursi, nux vomica, sarsa-
parilla, lycopodium, calcarea carb., phosphorus, aspara-
AND GENITAL ORGANS. 463
gine, monarda punctata, alchemilla arveusis, chininum
sulph., alisma plantago.
Cannabis and uva ursi are excellent remedies dur
ing a fit of the gravel, accompanied with painful mic
turition ; discharge of slimy, purulent or bloody urine ;
burning in the bladder and urethra during and after
micturition ; and itching at the extremity of the glans
penis.
Dr. Gross has highly commended the employment
of nux vomica and sarsaparilla for the cure of gravel
and calculous affections. So far as the former remedy
is concerned, my own experience coincides with that
of Dr. Gross. I have in several instances prescribed
nux vomica with unequivocal benefit, in calculous af
fections which apparently originated from chronic
derangement of the digestive organs. In one case,
likewise, where the patient experienced the most se
vere spasmodic pains from the passage of a calculus
from the kidney to the bladder, with constant nausea,
vomiting, painful and bloody micturition, and high-
coloured urine, the most prompt and happy results fol
lowed the use of nux.
This remedy is decidedly indicated when lithiasis
arises from dyspeptic symptoms, sedentary occupa
tions, abuse of stimulants, excesses in eating, and also
for the acute constrictive and spasmodic pains which
proceed from the irritation of a calculus when passing
from one point to another.
Lycopodium is adapted to patients of a lymphatic
temperament, and who have been subject to chronic
affections of the mucous membranes. The lycopodium
pains occur mostly in the urethra and perineum^ and
are of a burning, smarting, or cutting character during
micturition. The urine is of a dark colour, very foetid
and deposites a red or yellowish sand.
Calcarea carb. is suitable for the calculous affec
tions of scrofulous or chlorotic children. It is indica
ted when the pains in the urinary organs, and the
desire to pass water, are worse during the night, and
the urine is of a dark colour, foetid, and deposites a
white sediment. Calcarea is also indicated in debility
of the assimilative functions, emaciation, and great
weakness and exhaustion of the whole system.
464 DISEASES OF THE URINARY
Phosphorus may be given in lithiasis occurring in
broken down constitutions from loss of fluids, and in
old and debilitated subjects. The phosphorus symp
toms are characterized by loss of power over the uri
nary organs, involuntary passing of urine and fasces
at the same time, sudden interruptions of the course of
the urine, desire to urinate, with dull pains in the
hypogastrium, emission by the urine of an ammoniacal
odour, and deposites of a whitish or brick-dust sedi
ment.
We have exhibited asparagus in two cases of lithia
sis dependent upon a gouty diathesis with marked
success. In one of these cases the calculous symptoms
all disappeared in a few weeks after commencing the
medicine, and the morbid character which the urine
had presented for several years, was entirely changed
to a healthy condition. We are inclined to believe
that asparagus is a remedy of much greater power in
urinary affections and in dropsies, than has ever been
attributed to it. Our experience with it in those
maladies has been somewhat extensive, and generally
of a most satisfactory character. It is especially
called for when there is frequent inclination to urinate ;
burning and cutting in the urethra and kidneys ; dull
drawing pains in the groin ; tenderness and pain in
the perineum ; sensation as if urine was passing off,
after all has been discharged ; urine straw-coloured
or brown, with a very offensive smell, and a whitish
sediment ; palpitation of the heart ; rapid and oppress
ed respiration on the slightest exertion.
Monarda punctata, alchemilla arveusis, and alisma
plantago, also cover most of the symptoms enumerated
under asparagus, and may sometimes succeed this
remedy with advantage.
Chininum sulph. is recommended when there are mi
nute crystallized grains in the urine, of a reddish or
yellowish colour ; increased flow of acrid and offensive
urine ; emaciation ; irritability and much constitu
tional disturbance.
Administration. — During the violent paroxysms
which occur in calculous diseases, we may employ
the medicines from the first to the third attenuation,
and repeat every hour until the desired impression is
AND GENITAL ORGANS. 465
produced. But under ordinary circumstances, a dose
once in twelve or twenty-four hours will suffice.
SECTION VIII.
URETHRITIS. INFLAMMATION OF THE URETHRA.
The term gonorrhoea, derived from two Greek words,
yW, semen, and £«*>, to flow, is very generally used by
American and English physicians to designate this
malady. Dr. Swediaur, perceiving the erroneous im
pression which this definition might convey, substitu
ted another term no less etymologically inaccurate,
blennorrhcza, or blennorrhagia, derived from two other
Greek words, BA/W*, mucus, and '^e*, to flow. But as
modern researches have demonstrated that the in
voluntary discharge which is a characteristic of this
disease, does not consist of semen or mucus, but of a
purulent and infectious matter, we think the erro
neous terms commonly employed to designate the com
plaint, should be abolished. Many reasons may be
adduced against naming the affection from the sup
posed character of the discharge ; for, notwithstand
ing as a general rule it is decidedly purulent, cases
occasionally occur where, from the intensity of the
inflammation, there is no discharge at all, and consti
tuting that form of the disease denominated by French
writers, " blennorrhagie seche" The matter is like
wise sometimes composed of a mixture of pus, mucus,
semen and blood. For these reasons we prefer to
make use of the more general term, urethritis. In
flammation of the urethra may indeed arise from other
causes than the application of infectious matter during
an impure connection, and present all of the symp
toms peculiar to the venereal inflammation, but the
malady is none the less urethritis on this account, al
though the secretion accompanying the inflammation
is not infectious. So may an inflammation of the eye
owe its origin to the application of venereal matter,
external irritants, atmospheric changes, injuries, scro
fula, and abuse of stimulants, and yet notwithstand
ing these different causes, the disease is none the less
ophthalmia.
All secreting surfaces are liable to be irritated when
20*
466 DISEASES OF THE URINARY
operated on by certain unnatural stimuli. The mu
cous membrane of the throat, the bronchia, the lungs,
the nostrils, the frontal sinuses, and the conjunctiva of
the eye, are all subject to different grades and kinds
of inflammation, and their secretions to become changed
in quality and quantity, according to the morbid cause
which has been in operation. The lining membrane
of the urethra is also subject to the same laws : it may
become inflamed and pour out a purulent discharge
from the presence of calculi in the bladder, from gout
and rheumatism, from acrid urine, from the absorption
of certain diuretics, from ulcers, from mechanical in
juries, and finally from the application of infectious
matter during an impure coition. In a very large ma
jority of cases, urethritis arises from the cause last
enumerated. This morbid virus induces a specific in
flammation in the urethra, of so troublesome and in
veterate a character as often to baffle all the remedial
measures of the most skilful and experienced medical
men. The inflammation is supposed by some to be of
the erysipelatous kind, and generally attacks the
lacunas of the urethra.
All who have had much experience in this disease,
will agree with me that it is one of the most intracta
ble with which we have to deal : Mackintosh as
sures us " that he has been more annoyed and dis
gusted in conducting the treatment of gonorrhoea than
of any other affection."
We are at present in ignorance respecting the
primary source of infectious urethritis, but the doctrine
entertained by the ancients, and so strenuously advo
cated by John Hunter, and his cotemporaries, in regard
to the identity of the gonorrhoeal and syphilitic virus,
is now universally abandoned. The disease under
consideration, is one of a purely local character, and if
left to itself, under favourable circumstances, will ulti
mately terminate in spontaneous recovery. It is a
matter of doubt whether ulcers of the urethra ever
proceed from this inflammation, when entirely uncom
plicated, but it is probable that the few cases which
have been reported by Sir Astley Cooper and others,
in which the malady was connected with ulcerations,
AND GENITAL ORGANS. 467
were attributable to the application of the virus of
both affections.
We have, in several instances, inoculated individu
als with the matter of infectious urethritis, but have
never been able to produce a chancre or any well-
marked constitutional symptoms. We have, in one
instance, also witne&sed the introc'u ition of the gonor-
rhoaal virus into the blood, but without giving rise to
any appreciable effects. While on the other hand, it
is well known, that if syphilitic virus be inoculated
or introduced directly into the mass of the blood, the
symptoms of syphilis speedily result. The application
of gonorrhoeal matter to the eye, gives rise to a very
violent and dangerous purulent ophthalmia ; while the
application of syphilitic virus to this organ, causes an
ulcer generally circumscribed, and unaccompanied by
violent or dangerous inflammation of the surrounding
parts. The application of the former to the anus,
causes inflammation, with augmented secretion, and
change in its character from mucus to pus ; the ap
plication of the syphilitic poison, causes chancre and
its concomitants.
Urethritis is often suspended during attacks of acute
disease, but it invariably reappears again after the
subsidence of the febrile symptoms.
From these facts it may be fairly inferred, that
gonorrhoeal matter contains a specific morbid principle,
capable of producing a peculiar inflammation and dis
charge, when brought in contact with mucous sur
faces. This inflammation and discharge present a
uniform appearance quite unlike what occurs in leu-
corrhoea, in several particulars. The matter of the
former is infectious, while that of the latter is non-in
fectious ; the inflammation of the former is of the erysip-
elatous kind, while the condition of the mucous mem
brane in the latter is more allied to relaxation and
debility than to inflammation ; the former can only
arise from the contact of gonorrhoeal matter with a
mucous surface, while the latter never proceeds from
any cause of this kind, but from constitutional weak
ness, confinements, excesses in venery, want of exer
cise, and other debilitating habits.
We may also infer, from what has been observed,
DISEASES OF THE URINARY
that the syphilitic matter likewise contains a specific
morbid virus, sui generis, and only capable of exciting
chancre, when applied to abraded or delicate surfaces.
It should always be remembered, that every morbid
substance capable of impressing the organism, con
tains a certain specific morbid principle, which usually
operates in a definite manner, causing a uniform train
of symptoms, and requiring a certain specific medicinal
agent to effect a prompt cure. These morbid princi
ples only exist in infinitesimal quantities in their
media, and on this account we are unable to detect
or analyze them, but we ought none the less to acknowl
edge their presence, appreciate their influence, and en
deavour, if possible, to discover their specific antidotes.
Diagnosis. — The ordinary period at which infec
tious urethritis makes its appearance after an impure
connection, is from two to four days. We have known
it to commence in a few instances, in eight or ten
hours after exposure, and we have likewise occasion
ally observed an interval of six weeks to elapse before
its onset. Some constitutions possess the power of
resisting the action of the poison to such a degree as
to constitute an almost entire exemption from the dis
ease. Other individuals are so little susceptible, that
if pains be taken to urinate and perform thorough ablu
tion soon after the sin, no ill consequences result.
Others again are so highly susceptible, either from
natural organization, or from abuse of stimulants, that
almost the very touch of a contaminated female
speedily communicates the inflammation.
The disease commences by a tingling or itching
sensation at the orifice of the urethra, which is noticed
especially when urinating. In a short time, the lips of
the urethra become red and swollen ; the blood-vessels
of the organ distended ; the inflammation increases
and extends up the passage for an inch or two ; there
is a burning or scalding pain on passing water ; an
increased secretion takes place from the part aifected,
at first of a mucous character, but as the inflammation
increases presenting a purulent appearance, of a yel
low colour, or if the disease is violent, green and sani-
ous. The urine, which often contains some thread
like substances, arising from the inflammatory action,
AND GENITAL ORGANS. 469
flows from the urethra in a diminished, spiral or di
vided stream.
In a, first attack, the inflammation does not usually
confine itself to the extremity of the urethra, but ex
tends along the canal to the prostate gland, and even
to the bladder itself. Not unfrequently it attacks the
glans penis and the frsenum, in which case it often
occasions an effusion between the foreskin and glans,
and phymosis. «
When the inflammation is intense, and extends up
as far as the neck of the bladder, there is a frequent
and urgent desire to urinate, the ardor urince becomes
more extensive and painful, involuntary and painful
erections occur, chiefly during the night, and some
times cause distressing emissions of semen ; sympa
thetic irritation is communicated to the perineum, oc
casioning painful sensations when evacuating the
bowels, or the bladder ; there is more or less inflam
mation and effusion of lymph into the corpora spon-
giosa, giving rise to those adhesions and painful con
tractions termed chordee ; the glands of the groin be
come irritated and enlarged, and there is a partial or
even total suppression of the discharge, in which lat
ter case the disease is termed dry urethritis, or the
" blenorrhagie seche " of the French.
In old sinners, the inflammation is quite prone to
attack the prostate gland, and give rise to those un
pleasant symptoms which we have enumerated when
alluding to affections of this structure.
As we have before remarked, if the disease be left
to itself, and the patient is strictly prudent and tem
perate, a spontaneous recovery will eventually take
place ; but from improper medical treatment, undue
exposure, or excesses of different kinds, the disease
often terminates in gleet, strictures, abscesses, dis
eased prostate, irritable bladder, hernia humoralis,
inflammation of the testicle and epididymis, or bubo.
The acute stage of urethritis, under ordinary cir
cumstances, terminates in from one to three weeks,
when, if suitable remedies have been employed, the
discharge ceases, and the parts speedily recover their
tone ; but in the majority of instances, the acute
470 DISEASES OF THE URINARY
stage runs into a chronic inflammation, when it re
ceives the name of
GLEET.
In this stage of the disorder, the painful symptoms
peculiar to the first period, ardor urince, frequent in
clination to urinate, chordee, spasmodic pains in the
region of the perineum, and the heat and swelling of
the penis, subside, and we observe little else than an
increase and alteration in the character of the secre
tion from the urethra. This discharge, which during
the acute symptoms was purulent, and of a yellow or
greenish colour, now presents a light mucous appear
ance, sometimes transparent and ropy. The charac
ter of this discharge, however, is often temporarily
changed again to a purulent matter of a yellow or
even green colour, sometimes sanious, from over-ex
ercise, excesses in drinking or eating, sexual inter
course, and exposure to protracted heat or cold. The
discharge of a simple gleet usually proceeds from
the lacunae of the urethra. Some writers have pro
mulgated the dangerous doctrine, that the matter of a
gleet is not infectious ; but this is an error, for we have
known many well authenticated instances where
virulent urethritis has arisen from the application of
gleety matter.
When a gleet has been permitted to continue for a
long time, and particularly if the case has been inju
diciously treated by inordinate doses of copaibae, cu-
bebs, turpentine, and the endless train of irritating
injections, there often supervenes a
STRICTURE OF THE URETHRA.
A stricture may occur during the height of acute
urethritis, from tumefaction of the mucous membrane
of the canal, or from the irritation caused by improper
or unskilful introduction of bougies, and by strong
injections. The obstruction in some cases of this
description is so complete, that very painful reten
tions of urine, with its accompanying symptoms, su
pervene, requiring the most prompt remedial mea
sures in order to ward off the necessity of puncturing
the bladder. This variety of stricture may be re-
AND GENITAL ORGANS. 471
moved in a short time by proper medicines, without
the aid of a surgeon.
There is a second variety of stricture not necessa
rily connected with infectious urethritis, termed spas
modic stricture. The disease consists in a sudden
spasmodic contraction of some portion of the urinary
canal, which impedes the flow of urine, and sometimes
causes a partial retention. These spasmodic contrac
tions may arise from mechanical injuries, diseased
prostate, or stimulating diuretics, but they are for the
most part connected with permanent stricture.
The third variety of stricture, which is by far the
most common and serious, is termed the permanent
stricture. Its approach is so gradual and impercepti
ble, that individuals rarely suspect anything of the
kind, until it has made considerable progress. The
disease arises from a gradual thickening of the mu
cous membrane of the urethra, from badly treated or
long continued inflammation.
The first symptoms observable in this stricture are,
a sensation after urinating as if a few drops remained
behind ; stream diminished in size, and issuing from
the urethra in a spiral form, or split in several parts ;
straining to pass the water more rapidly through the
obstructed canal ; aggravation of all the symptoms
on wetting the feet, taking cold, over-exercise, fatigue,
and venereal excesses. In this stricture, there is
always more or less discharge of a ropy kind of mu
cus, which is often temporarily changed by excesses,
into a purulent or bloody matter. This complaint is
quite apt to induce inguinal hernia, from the straining
efforts employed in urinating.
It is probable that two-thirds of the cases treated
as simple gleets, and which so frequently baffle the
physician, are, in reality, dependent solely on this
kind of stricture.
In bad cases of permanent stricture, the urine is
passed drop by drop, the distention and pain in the
region of the bladder become very severe, much con
stitutional irritation occurs, and the patient is unable
to rest day or night. Whenever this state of things
obtains, immediate recourse should be had to bougies.
The removal of a permanent stricture can only be
472 DISEASES OF THE URINARY
accomplished by means of the knife, or the applica
tion of caustic, or by gradual dilation by means of
bougies. The cure by the latter means is, at the pre
sent time, almost universally recommended.
Almost all strictures are located far up the canal of
the urethra, behind its bulb, but they may occur near
the extremity of the penis, or three, four, or five inches
above this point.
An occasional consequence of stricture is,
FISTULA IN PERINEO.
When the contraction is so great as to cause con
siderable obstruction to the passage of the urine, this
fluid is forced by the frequent and violent efforts at
expulsion, into the parts back of the stricture, in such
a manner as to form a kind of cul de sac, which, from
constant distention, eventually ulcerates an opening
externally, and a perineal fistula is formed.
Abscesses also arise sometimes from inflammation
and tumefaction of the lymphatic glands in other
parts of the urethra. These little swellings may
open into the urethra, or discharge themselves exter
nally. The most common seat of these abscesses is
near the freenum, or opposite the scrotum.
DISEASED PROSTATE,
May also be ranked amongst the occasional conse
quences of repeated attacks of urethritis. During the
continuance of the latter affection, not only the
urethra, but the prostate, the bladder, and the tes
ticles, receive an unusual supply of blood, in conse
quence of which they become irritated, and often en
larged, from depositions of coagulable lymph. This
condition of things may exist without attracting much
attention until the individual is advanced in years,
when a scirrhous degeneration, or an abscess, is ex
ceedingly apt to result. Either lobe of the prostate
may become enlarged separately, or the whole three
may be involved ; but the most troublesome symptoms
arise from an enlargement of the middle lobe, on ac
count of its proximity to the orifice of the urinary
canal.
Sir Astley Cooper was of opinion, that enlargement
AND GENITAL ORGANS. 473
of this gland is attributable to advanced age, rather
than disease ; but from the fact, that persons who
have been afflicted in this manner have almost inva
riably been subject to repeated venereal attacks in
early life, we may fairly infer, that a predisposition is
always established in the structure, which renders it
liable to take on diseased action when the powers of
the organism have become impaired by age.
Enlargement of the lateral lobes of the prostate
may be readily detected by introducing the finger into
the rectum. The middle lobe may always be felt by
the catheter when much enlarged, and it will gene
rally be found exceedingly difficult to pass it by the
gland into the bladder. By directing the point of the
instrument, (which should be of medium size,) slightly
upwards, and depressing the handle at the proper
time, the object may usually be accomplished. But
of all others, these cases require great delicacy of
touch and practical tact, to enable the operator to
succeed facilely, and without doing injury to the
irritated parts.
Diseases of the prostate are quite liable to become
aggravated by over-exertion, riding, acrid urine, expo
sure to wet and cold, and stimulating drinks.
Another exceedingly unpleasant consequence of
neglected or badly treated urethritis, is the disease
termed
IRRITABLE BLADDER.
This affection arises from long continued inflamma-
tion,which in the end so impairs the function of the blad
der, that the presence of a very small quantity of urine
forces it to contract, and thus forms an incontinence
of urine. Although this condition of the bladder may
arise from numerous causes which have already been
enumerated, it not unfrequently proceeds from exten
sion of urethritic inflammation to this organ, and
from protracted use of diuretics. The malady is
readily distinguished from stone, by the relief which
always follows the evacuation of the bladder, while
this operation aggravates the painful sensations in
the latter affection.
This disease generally baffles all the resources of
474 DISEASES OF THE URINARY
allopathy, but we take pleasure in appealing to the
philosophic practice whether the same remark is just
with reference to homoeopathy.
The next malady to which we shall allude in con
nection with urethritis, is
HERNIA HUMORALIS.
During the acute stage of urethritis, the inflamma
tion sometimes extends even to the spermatic chord,
the epididymis, and the testicle. This is very apt to
occur when the discharge is suddenly arrested by ir
ritating injections, especially when the inflammation
pervades the whole extent of the canal. When the
substance of the testicle becomes involved, the pain
is very severe, and febrile symptoms more or less
grave, set in. This inflammation may terminate in
resolution, suppuration, or chronic enlargement and
induration. In those instances where suppuration
occurs, the abscesses usually break externally, and
form fistulous passages which are difficult to cure, on
account of the continual irritation kept up by the se
cretion of semen, a portion of which is constantly
being discharged through these ulcerated openings.
Chronic enlargements of the testicles should com
mand our early attention, on account of their strong
tendency to terminate in scirrhous degenerations.
In urethritis, and other affections of the urino-geni-
tal apparatus, the prudent physician will always ad
vise the use of the suspensory bandage, as a precau
tionary measure.
When the urethritis is so severe as to affect the
lymphatic glands of the penis, the disease may be
propagated to several of the glands of the groin,
when we have a
BUBO.
These buboes are called sympathetic? in contradis
tinction to those which proceed from syphilitic infec
tion. The frequent occurrence of such tumours
during the course of urethritis, probably first led
medical men to confound this disease with syphilis. But,
on close examination, the sympathetic bubo will be
AND GENITAL ORGANS. 475
found to be composed of several enlarged glands, while
that of syphilis is an enlargement of a single gland.
The sympathetic bubo is not usually attended with
great pain, nor does it run on to suppuration, unless
the patient is decidedly scrofulous ; while syphilitic
bubo is attended with much inflammation and pain,
and is very prone to advance to the suppurative stage.
A very large majority of sympathetic buboes subside
spontaneously, and require no medicinal treatment.
In females, all of the symptoms of the disease are
lighter than in the male sex. Indeed, the similarity
between this affection and leucorrlic&a is so great, that
it is sometimes a matter of great difficulty to distin
guish them.
Mr. Travers asserts, that the urethra itself is rarely
affected in females, but that the inflammation attacks
the clitoris, the inferior commissure of the labia and
rapha, the nymphae, and the parts (Cowper's glands)
around the orifice of the urethra.
In the worst form of the complaint, as it occurs in
women, the labia, the nymphae, and the clitoris, be
come swollen and painful, the inflammation extends
to the womb and bladder, and there will be frequent
inclination to urinate, severe scalding by the water,
and a purulent, irritating discharge. But all of these
symptoms are often met with in inflammatory leucor-
rho3a, and the discharge itself even acquires so acrid
a character as to become capable of propagating a
similar discharge by contact with the male organ.
We have, in more than one instance, been consulted
by parties of the highest respectability, in relation to
purulent discharges, and scalding of the urine, which
have been contracted from the wife, but by explaining
the circumstance just alluded to, have been able to
dissipate the most unjust suspicions, and to restore
confidence and harmony which must have been utterly
destroyed without such explanation.
The following are the surest diagnostic marks, with
which we are acquainted, between the two diseases :
Ieucorrho3a is gradual in its progress, and may be
generally traced to constitutional debility, or to diffi
cult and protracted labours, or mechanical injuries
during accouchement. It is usually accompanied also
476 DISEASES OF THE URINARY
by prolapsus uteri, or dragging pain, or tired feel
ing in the left side, bearing down pains, and general
feelings of relaxation and debility.
Gonorrhoeal inflammation is sudden and rapid in
its approach, and attacks individuals in the soundest
health : the symptoms acquire their greatest severity
in one or two weeks, and the discharge causes a deep-
coloured (yellow or greenish) stain upon the linen,
surrounded by a palish yellow border.
A careful attention to the history of each individual
case, will aid us materially in forming a correct diag
nosis.
Therapeutics. — Infectious urethritis is at the present
time almost universally looked upon as a purely local
disease, — confined in its first stages to a small portion
of the mucous membrane of the urethra. It is true
that the inflammation often extends up the urinary
canal to the prostate gland, and to the bladder ; but
it is highly probable that these secondary symptoms
are owing to bad treatment, or imprudence on the
part of patients, rather than to the natural and legiti
mate tendency of the malady. We adopt this opinion
from having often observed spontaneous cures occur
in six or eight weeks without medicine of any kind,
and without any structure but the urethra becoming
affected, — the patients having simply placed them
selves under a rigid dietetic regimen.
It may be questioned whether any internal remedy
is now known, which can be considered a true and
certain specific for the cure of this local inflammation.
Many medicines have been brought forward by both
schools as worthy of our entire confidence, but not one
of them has yet stood the test of practical experiment,
— not one has been able to control the symptoms, or
remove the complaint with any degree of certainty.
On the contrary, many of them have repeatedly been
observed to aggravate the inflammation, causing it to
extend to the neighbouring structures, and thus se
riously to complicate this naturally simple disease.
The ordinary plan of treatment, according to the
old-school method, is in ihejirst stage to bleed, leech,
foment, physic with mercurials, or the neutral salts,
and to nauseate, sweat, and prostrate the system with
AND GENITAL ORGANS. 477
antimonials. In other words, it is deemed necessary
to punish the whole organism ; — to inflame the bowels
with cathartics, — to impair the tone of the stomach
by nauseating doses of antimony, — to debilitate the
capillaries by profuse sweats, — to abstract the life-
giving principle from the veins, — and to reduce the
patient to a state of prostration and positive illness,
in order to reach a little circumscribed inflammation
in the urethra ! After the patient has been reduced
secundem artem, the custom is then to administer enor
mous doses of balsam copaibce, cubebs, turpentine, lyttce,
iodine, and nitre, internally, and to make use of stimu
lating injections of zinc, lead, copper, mercury, nitrate
of silver, oil of vitriol, chloride of lime, and diluted
sulphuric acid, ad libitum. Balsam copaibce is the
medicine employed in most instances, and as it oper
ates specifically upon the stomach and the respiratory
organs, we often observe the most serious affections
of these organs arise in consequence of its free and
protracted use. Who that has made use of this remedy
to any great extent, has not witnessed the occurrence
of troublesome dyspeptic symptoms, of haemoptysis, of
cough, and other indications of dangerous pulmonary
disorder, from it ?
Cases however occur, in which the symptoms of
urethritis cease under the use of this, and the other
diuretics alluded to, but such instances are rare, and
the remark of the celebrated Dr. Forbes respecting
allopathic remedies in general, will hold good here,
viz. : that " the patient gets well in spite of the doc
tor."
We shall not discuss the propriety of the antiphlo
gistic course adopted during the acute stage, for we
believe that all whose prejudices will permit them to
exercise that admirable requisite, common sense, will
perceive at a glance the folly of tormenting and pros
trating the whole body for the sake of acting upon a
simple local inflammation, which, when left to itself,
never terminates in ulceration or disorganization of
the tissue affected, but in spontaneous recovery.
And what shall we say of the homoeopathic reme
dies which are usually employed in the treatment of
this complaint ? Why, simply that the true specific
478 DISEASES OF THE URINARY
has not yet been discovered. We have tested these
medicines in numerous instances, both the high and
low attenuations, and we regret to announce as the
result of our observations, that they have proved but
little more successful than the pernicious applications
of the old school.
We are quite aware that it is much easier to find
fault with prevailing methods of practice, than to pro
pose and introduce better new ones. But if we suc
ceed in attracting the attention of physicians more
particularly to the subject, and putting them on the
qui vive to find out a positive specific, our object will
be accomplished. In the mean time we shall point
out the course of treatment which we have found most
successful in the different stages of the malady.
For therapeutical purposes the disease may be
classified as follows :
First. The preventive period, — or that which inter
venes between the exposure and the first symptoms of
the malady. The average duration of this period is
about three days.
Second. The forming stage, — or the period which
elapses from the commencement of the prickling, tin
gling, or itching sensation, with slight redness and
swelling of the lips of the urethra, and a slight oozing
of mucus or limpid matter, up to the period when the
inflammation has extended to the fossa navicularis, and
become strongly pronounced, with a purulent dis
charge of a yellow or greenish colour. This stage
usually lasts from twelve to forty-eight hours.
Third. The acute or inflammatory stage, — including
the period which commences at the termination of the
last stage, and the subsidence of the ardor urince, the
acute inflammation of the urethra, the swelling and
tenderness of the penis, and the change of the yellow
or greenish secretion, to one of a light transparent and
ropy, or a muco-purulent character. The natural du
ration of this stage, when proper restrictions are used
as to diet, stimulants, and exercise, is from one to two
weeks.
Fourth. The chronic stage, or that form of the ma
lady termed gleet.
Now, as our object, in accordance with the homce-
AND GENITAL ORGANS. 479
pathic doctrine of cure, is to produce in the tissue mor
bidly affected, a new and healthy medicinal action,
which shall supersede the morbid inflammation, we
apply our remedies directly to the diseased part,
instead of bringing them in contact with it through
the stomach, blood, and kidneys. The malady is not
constitutional, — there is no other structure of the
economy affected, or upon which we wish to act, — but
our sole object is to prevent or to remove a simple
local inflammation.
Our remedies then, during the first or preventive
period, are the occasional injections into the urethra,
of a solution of nitrate of silver, (in the proportion of
two or three grains to the ounce of distilled water.) or of
sulphate of zinc, in the proportion of four grains to the
ounce of water. The occasional use of these injections
after an impure coition, with strict temperance and
quiet, will usually prevent the occurrence of the dis
ease. These remedies neutralize the absorbed virus
before it has time to impair the function of the mem
brane with which it is in contact, and thus its power
to do injury is summarily destroyed.
There is also a certain and speedy cure for the se
cond or forming stage. The symptoms of this stage,
as we have seen, are a tingling or itching at the end
of the urethra, with a slight redness, and a slightly in
creased secretion of mucus. The remedy for this stage,
is a saturated solution of nitrate of silver, a small quan
tity of which is to be applied, by means of a small
glass syringe, or by a small bit of sponge, to the ure
thra for an inch in extent. The solution should be de
licately and rapidly applied, and a quantity used just
sufficient to give the portion of the membrane touched,
a white cast. This causes a smart but healthy medi
cinal inflammation which subsides in about 24 hours,
leaving the structure cured. This course is strictly
homoeopathic, for we impress directly the tissue affect
ed, produce a powerful medicinal aggravation of the
symptoms, and overwhelm the disease by substi
tuting temporarily, another inflammatory action. No
unpleasant consequences ever result from the use of
this remedy, when it is employed before the com
mencement of the third or acute stage. Our experience
480 DISEASES OF THE URINARY
with this solution has been extensive, and we there
fore confidently recommend it as a perfectly safe and
sure remedy in this stage of the complaint.
During the third or acute stage, it is a question whe
ther any remedies, either general or topical, can be
employed with any material advantage, with the ex
ception of the internal use of aconite, which may be
given to shorten the inflammatory stage. This medi
cine is particulary applicable when febrile symptoms
are present. Throughout this stage, the patient should
be restricted to the most rigid vegetable or farina
ceous diet, to cold water, and prohibited from taking
much exercise. Ablutions with cold water, should be
often employed, in order to keep the parts as free as
possible from the irritating discharge. After the ur
gent symptoms have subsided under the use of aconite,
and the other means we have just pointed out, and
the fourth or chronic stage has commenced, we may re
sort to injections composed of one grain of sulphate of
zinci to I viii. of water. These injections, in order to
be efficient, must be repeated every half-hour during
the day, until the discharge ceases. It will be of no
service to use this solution three or four times in the
day, for the chief object is to wash out the urethra as
fast as the matter forms, and thus prevent the constant
reabsorption which would otherwise take place.
The principal reason why urethritis is so difficult to
cure, when once fully established, is, that the matter
itself being infectious, and liable to be constantly re-
absorbed, thus operates as a continual exciting cause.
If at any given instant the whole urethra could be
restored to perfect health, a single drop of the morbid
secretion which it had been pouring out, applied to
the part, would be sufficient to re-excite the disease in
all its violence. It is evident, then, that the discharge
must be arrested abruptly by the remedy employed, or
we must use our injections sufficiently often to dilute
and remove the virus as fast as formed, and at the same
time to change the morbid action of the membrane to a
healthy medicinal action.
In regard to the plan of making an application to
the urethra, of a medicine so powerful as to arrest the
discharge suddenly, like the solution mentioned under
AND GENITAL ORGANS. 481
our second head, it is attended in this stage of the af
fection with many dangers. The canal of the urethra
is generally affected so high up as to render the cer
tain application of this or any other sufficiently power
ful solution entirely impracticable.
But the other method, to which we have alluded, is
one of entire feasibility and safety, and is for the most
part attended with success, when the discharge is en
tirely unconnected with a stricture. It is proper to
observe that, in all cases, the patient should urinate
previous to the use of- injections. Another injection
which we have sometimes used with marked success
in this stage, is a mixture of calomel and olive oil, in
the proportion of a drachm to the ounce, once or twice
a day, until the cessation of the diseased action.
If, however, notwithstanding the thorough and per
severing employment of the zinc solution and the mix
ture of calomel and oil, the discharge still continues,
recourse should be had to the introduction of bougies,
either plain or smeared with a cerate containing a
sufficient quantity of pulverized nitrate of silver. These
should be carefully introduced two or three times a
week, until we have stimulated the diseased mem
brane to a natural and healthy action.
The above plan of treatment, we believe to be more
efficient, safe, and consonant with the true princi
ple of cure, than any other which has yet been
promulgated : yet, we do not claim for it infallibility.
We can only assure our readers that we have tho
roughly tested every theory and process which has been
proposed by either school, and that after all of this
practical experience, we have presented them with
what we deem the best method of treatment in this
disgusting malady.
For the information of those who desire to make use
of internal remedies either alone or in combination
with injections, we name the following medicines as
the best with which we are at present acquainted :
cannabis, cantharides, lussilago pcrtus., cubebce, mercu-
rius sol.,pctroselinum, aconite, acid nit., sepia, terebinth.,
copaiba, pulsatilla, nux vomica, sulphur, ferrum.
The remedies which should be consulted in irritable
bladder, are, cantharidcs. cannabis, lycopodium, mercu-
21
482 DISEASES OF THE URINARY
rius, uva ursa, terebinthina, pulsatilla, copaiba, cubebce,
sulphur, iodine, and camphor.
Inflammation of the testicles and epydidimis : —
Our first care in this complaint, should be to suspend*
the inflamed organ by means of a suitable apparatus,
in such a manner as to afford complete support in all
positions, and thus prevent the enlarged gland from
dragging upon the spermatic chord. The recumbent
posture should be strictly enjoined, and we should
have constantly applied to the parts, cloths wet with
cold water. As soon as the cloths are warmed by
contact with the inflamed testicle, they should be again
dipped and reapplied until the heat and inflammation
have disappeared.
If the disease has arisen from sudden suppression of
urethritis, or from the use of powerful injections during
the acute stage, we may give mercurius, aconite, nux
vomica, spongia, clematis, or iodine. '
When it has been caused by the injudicious intro
duction of bougies, arnica, aconite, and pulsatilla, will
be found applicable.
In cases where the inflammation has degenerated
into a chronic induration of the testicles, our best reme
dies are, aurum, acid nitric, rhododendron, sulphur, mer
curius, spigelia, iodine, and cicuta.
SECTION IX.
SYPHILIS.
Much discussion has taken place respecting the first
introduction of this disease into Europe. Some main
tain that the followers of Columbus brought it with
them from America ; others that it was communicated
by the Spaniards to the French, during the siege of
Naples, by Charles VIII., in 1495. It appears, how
ever, that occasional allusion is made in different parts
of the scriptures, to a disease of the sexual organs,
capable of being propagated by coition, contact, &c.
In Leviticus, Moses mentions such an affection, and
speaks of those afflicted as being polluted and unfit
to associate with the healthy. David also describes
one variety of syphilis in the thirty- fourth psalm. He-
roditus, too, speaks of an affection of the sexual organs
AND GENITAL ORGANS. 483
which the Scythians contracted from the women with
whom they had connection, after profaning the temple
of Venus Urania. Later writers, Salicetus, Gordoneus,
and Valereus, who flourished about the year 1250, al
lude to an infectious disorder of the genitals, proceed
ing from the copulation of men writh unclean prosti
tutes. Many reputable authors have entertained the
opinion that the ancient leprosy was nothing more than
syphilis, renderedjsevere by exposure, hardship, insuf
ficient nourishment, and improper medical treatment.
But an objection has been urged against this view, from
the supposition that leprosy could be communicated
by contact with an infected person, — by drinking from
the same cup, by inhaling his breath, or even sitting
at the same table with him. It is no less true that sy
philis occasionally presents a character equally viru
lent and diffusible. During a great portion of the six
teenth century, it was so contagious in some parts of
Europe, that it was communicated by lying in the
same bed, by the clothes, gloves, money, or breath of
the patient. A variety of syphilis also prevailed in
Canada some years ago. of so virulent a nature, that it
was communicated by the breath, and by contact.
We fully concur with Dr. Thompson, who "thinks it
probable that the disease has existed, more or less, and
under different grades of severity, in all ages, and that
it has been thousands of times generated de novo by
impure sexual intercourse."
The causes which may have conduced to vary its
character at different periods, are numerous ; and we
suggest the following as a few of them.
It has been observed that exposure of the body to
a cold, humid atmosphere, excessive fatigue, changes
of diet and of climate, unwholesome food and ne
glect of cleanliness, favour the rapid progress and
destructiveness of the malady; while a dry, warm and
equable temperature, cleanliness, nutritious food, and
comfortable lodgings, are circumstances which con
duce to render it comparatively mild. These facts
go far to explain the reason of its great violence
amongst those ancient tribes who were accustom
ed to dwell in tents, and to move about from place
to place ; and who were so negligent in their habits of
484 DISEASES OF THE URINARY
living, their food and their persons, that Moses
deemed it necessary to make rigid laws in regard to
the selection of food and the habit of personal ablu
tions. When we reflect that persons who were sup
posed to be leprous, were immediately driven out of
the camp — away from all intercourse with the
healthy — and thus forced to undergo every exposure
in respect to raiment, shelter and food, we cannot be
surprised that the disease, supposing it to have been
syphilis, should so often have assumed a frightful
.aspect.
Its violence during the siege of Naples in 1495,
may also be explained, when we bear in mind the
forced marches, the changes of climate and of diet,
and the constant excitement and fatigue to which the
soldiers were exposed. The same severity marked
its prevalence in the British army in Portugal, while
the natives themselves were but slightly affected, al
though exposed to similar contamination.
One of our army surgeons recently informed me
that the same difficulty was experienced among our
soldiers during the Mexican campaign in 1847 and
1848 : they contracted the disorder, while the Mexi
cans experienced but slight inconvenience, although
exposed to the same virus. The argument also holds
good with respect to sailors who are so constantly
subjected to the vicissitudes of temperature, the nox
ious air of vessels, and the stale, salt regimen which
is used at sea.
May it not, then, be fairly inferred, that whatever
causes impair the forces of the organism, serve also
to render it less able to resist the deleterious influ
ence of the syphilitic poison ?
In regard to the doctrine of Hahnemann respect
ing the identity of syphilis and sycosis, we agree with
Hartmann, that the mass of evidence upon the sub
ject renders it almost conclusive that the two dis
eases are distinct in their nature. The origin
of each is in a specific morbid poison capable of
impressing the organism in a distinct and peculiar
manner.
Diagnosis. — There are unquestionably a great va
riety of ulcers which make their appearance upon
AND GENITAL ORGANS. 485
the genitals after impure connections, which are not
syphilitic, and which will heal over without causing
constitutional symptoms, simply by the aid of mild
dressings. The true syphilitic chancre is now of rare
occurrence, but the great majority of those intract
able ulcers which are looked upon as real venereal
chancres, are nothing more, primarily, than simple
non-infectious sores, which have been converted into
an unhealthy condition by the use of mercury. Who
can doubt this fact when he contemplates the dread
ful effects which a course of mercury often produces
on the healthy organism ? Who could be tempted, in
health, to take the enormous quantities of this drug
wrhich are deemed necessary for the cure of syphilis ?
Let the provings of it — let the horrible consequences
which its accidental absorption sometimes occa
sions upon the surface, — in the mucous membranes,
— the bones, — the glands and the nervous system,
answer. For our part, we would prefer the foul
syphilitic poison itself, rather than the uncontrollable
ravages of such an enemy as mercury, in allopathic
administrations, is admitted to be by the fair-minded
of those even who most earnestly defend its use.
In order to be fully convinced that many of the ef
fects of mercury are improperly attributed to the
action of the syphilitic virus, it is only necessary to
regard carefully the symptoms which are constantly
presented to our observation in what are called ve
nereal affections, and to notice the opinions of many
of the most eminent medical observers.
Thus, Sir Astley Cooper,* in his lectures, used to
observe, "do not think that it is a rare occurrence
for the penis to be destroyed by mercury ; no, a
chancre that has remained weeks in a healthy state,
shall become irritable, and, by maltreatment, by the
injudicious and improper use of mercury, shall
slough, and end in the destruction of the penis ; this
is not a rare case, and is attributed to the venereal
disease, but in reality is an effect of the improper use
of mercury" The great Hahnemann, in his remarks
upon syphilis and sycosis, constantly alludes to the
* Castle's Manual of Surg., p. 280.
*
486 DISEASES OF THE URINARY
pernicious results of the abuse of this drug in the hands
of the allopathist.
There can be no question that those dreadful muti
lations of the penis, of the nose, the palate, the eyes,
of the surface of the body, and the nodes and caries
of the bones, which we occasionally observe, are all
effects of mercury and not of syphilis ; and it is
in the highest degree probable that the immunity en
joyed by the Portuguese, the Mexicans, and certain
other nations, from the severe forms of this malady, is
attributable solely to the fact that they use no mer
cury in its treatment.
Chancre. — The primary chancre usually presents
itself on some part of the genital organs, in from
three to seven days after contamination, in the form
of a darkish red pimple, attended with slight itching,
and surrounded with an erysipelatous blush. In a
short time matter forms in the centre of the pimple,
and an excavated ulcer, with a yellowish surface,
hard and ragged edges, and an indurated base, makes
its appearance, marking the sore as a true chancre.
The most common seat of primary chancre is on the
inside of the foreskin arid the corona glandis, but
it occasionally occurs on the glands and the exter
nal parts of the genitals.
Many varieties of venereal chancre have been de
scribed by authors, as the simple, the indolent, the irri
table, the sloughing, the indurated, the phagedenic of
Carmichael, the superficial of Mr. Evans, the Hun-
terian,&LC. ; but as these diversities in the appearance
of the chancre are not owing to any difference in
the character of the virus, but to the condition of the
patient as regards constitution, temperament, and
mode of life, at the period of contamination, we should
abstain from making those minute classifications
which some writers have attempted.
The circumstances which may operate to modify
the character and appearance of a simple chancre, or
which may conduce to develop primarily an intractable
and destructive one, are numerous.
Individuals whose constitutions have been im
paired by abuse of stimulants, undue exposure,
hardship and fatigue, and insufficient, nourishment,
AND GENITAL ORGANS. 487
are liable to be attacked from the first with that
variety which is denominated the indurated slough
ing chancre.
Those whose systems have been loaded with mer
cury, and enfeebled by previous disease, are peculiarly
subject to that description which is termed irritable and
sloughing. Persons who go from temperate to tropical
climates, are especially in danger of the phagedenic
variety. Scrofula and scurvy also predispose the
system to this form of it.
The simple chancre is by far the most common, par
ticularly in temperate latitudes, and usually occurs to
individuals of a sound constitution. Some have sup
posed the cause of this variety to consist in " go-
norrhoaal matter, and other morbid vaginal secre
tions," brought in contact with the penis during
coition ; but of this there is no proof. The simple
ulcer very often becomes converted into an irritable,
sloughing, or erysipelalous one, by some excess or
imprudence which impairs the vigour of the body, or
by the abuse of mercury. On the other hand, so long
as the constitution remains sound and unimpaired,
resistance is offered to the action of the virus, and the
secondary impression which it makes will be very
slight, and in some instances imperceptible. It is in
cases of this description that we sometimes witness
spontaneous cures of what was originally true syphi
litic contamination.
The most certain marks of a true syphilitic chancre
are, the excavated surface, the hard, ragged edges, and
the indurated base. These appearances, taken in con
nection with the previous history of the case, will ge
nerally enable us to decide with sufficient certainty
respecting the character of the sore ; but where any
doubt exists, we would most strongly commend the
practice discovered and successfully adopted by Ricord
of Paris, of inoculating a sound part with the matter
from the suspected ulcer. In case a second chancre
is produced by this operation, there will no longer re
main a question in regard to the true nature of the
malady.
After the syphilitic poison has passed from the
chancre through the absorbent glands of the groin,
488 DISEASES OF THE URINARY
into the blood, it possesses a specific affinity for
only three parts of the body, viz., " the mucous mem
brane of the throat and nose ; the skin, or surface of
the body ; and the bones, with their periosteal cover
ings."* Thus, it will be remarked, that the internal
organs are never impressed by this virus ; and this
fact should induce the allopath to pause before he
loads the system with a poison which spares scarcely
a single structure during its operation.
The secondary, or specific effects of the syphilitic virus,
after its entrance into the blood, are :
First. Upon the mucous membrane of the mouth
and throat, which becomes red and inflamed, and
covered in some parts with pimples, which soon de
generate into ulcers, resembling in many respects the
primary simple chancre. These ulcerations extend
into the nostrils, and sometimes even into the larynx
itself, giving rise to loss of voice, severe cough, vio
lent constitutional disturbance, and death. In cases
which have been improperly treated, the bony palate
and the nasal bones become affected, and exfoliate,
and thus cause those disgusting mutilations of the nose
and face which so often stare the old school physician
in the face.
Second. Another part of the body acted on by the
absorbed virus is the skin. Its manifestations in this
case are, slightly elevated copper-coloured eruptions
of different sizes, attended with uneasy or itching
sensations, sometimes covered with a kind of scurf or
scale, or, in other instances, with incrustations and
ulcerations. These eruptions make their appearance
on the face, head, breast, palms of the hands, and
arms. Eruptions which are called tubercular, often
appear on the scalp, the eyebrows, the breast, back,
and arms, and ultimately form very troublesome
ulcers* In healthy subjects these secondary eruptions
are not very troublesome, being simply copper-
coloured blotches, covered with a thin scurf; but in
irritable and impaired constitutions they often assume
the character of foul and sloughing ulcers. The par
ticular variety of these secondary eruptions will be
* Sir A. Cooper's Lectures.
AND GENITAL ORGANS. 489
determined by the peculiarities of constitution in each
individual case, and not from any original difference
in the virus itself.
Third. Another, and the last portion of the organism
capable of being impressed by the absorbed venereal
poison, is the osseous structure, with its periosteal
covering. The morbid inflammation in the first in
stance seizes upon the periosteum, causing severe
nocturnal pains, and some tumefaction in the affected
region. If the malady continues to increase, an
osseous deposit will be formed between the perios
teum and the bone, constituting what is termed the
venereal node. This node, in its early stages, does not
usually give rise to much inflammation of the sur
rounding skin, nor is it attended with a great amount
of pain, but after it has existed for a considerable time,
and particularly if the patient has been drugged with
mercurial preparations, it becomes quite painful, es
pecially during the night. The ordinary location of
venereal nodes is on the anterior portion of the tibia,
or on the surface of the cranial bones.
We believe that the above-enumerated symptoms
constitute all of the legitimate effects resulting from
the action of the absorbed syphilitic virus. The great
variety of eruptions and ulcerations described by
Hartmann and others, are attributable to other causes,
operating either by themselves, or in conjunction with
the venereal poison. It is of vast importance in af
fections of this description, to distinguish with all
possible accuracy between the syphilitic action and
that of mercury, scrofula, and other causes. Far
ther on we shall endeavour to make this distinction as
clear as possible.
Bubo. — Another primary manifestation of syphilis
consists in an enlargement of one or more of the ab
sorbent glands of the groin, termed bubo. This en
largement usually succeeds the chancre, and is caused
by the absorption of the virus of the latter. It is rare
in real syphilis that more than one gland in each
groin becomes affected with the virus, although some
of the other glands now and then become slightly
swollen from sympathy. The swelling ordinarily
partakes of an inflammatory character, and if not op-.
490 DISEASES OF THE URINARY
posed by appropriate remedies, runs on to suppura
tion, and sometimes to sloughing.
The disease has been supposed to be purely local,
until after the swelling in the groin has proceeded to
the suppurative stage ; but this is evidently erroneous,
from the fact that secondary symptoms not unfre-
quently occur, without there having been any previ
ous enlargement of the gland in the groin.
Bubo sometimes makes its appearance without the
previous existence of a chancre, but such instances
are by no means common. Swellings of a non-
venereal character may likewise occur in the groin
from a strain, or from too great violence during the
indulgence of sexual passion. But as chancre for
the most part precedes the bubo, there will rarely oc
cur any difficulty in our diagnosis.
Therapeutics. — Hahnemann, Gross. Hartmann, Hun
ter, Abernethy, and many other distinguished members
of the profession, entertained the opinion that the con
stitutional symptoms of syphilis are always progress
ive, and never disappear, unless opposed by medicine ;
but the fact is now completely established, not only
that mercury is not necessary for the cure of either the
primary or secondary symptoms, but that they often
terminate in a spontaneous cure without any medicine.
We are assured by Dr. Fergusson and other surgeons
who have observed the disease in Portugal, that the
natives cure themselves permanently of the primary
symptoms by simple topical applications ; and of the
secondary effects, by decoctions of sarsaparilla and
sudorifics. They remark, that " the virulence of the
disease has there been so much mitigated, that, after
running a certain course (commonly a mild one)
through the respective order of parts, according to the
known laws of its progress, it exhausts itself, and
ceases spontaneously.'11 — (Med. and Chir. Trans., vol. iv.
pp. 2-5). This is still further corroborated by the
numerous cures of the primary and constitutional
symptoms recorded by Messrs. Rose, Dease, Hennen,
Guthrie, Good, and Whympor, without mercury, or
any other means than simple dressings. In the cases
which they describe, no caries of the bones occurred, as
is so commonly observed when mercury is used, " and
AND GENITAL ORGANF. 491
in no instance was there that uniform progress, with
unrelenting fury, from one order of symptoms, and
parts affected, to another, which is considered as an
essential characteristic of true syphilis." — (Med. and
Chir. Trans., vol. viii., p. 422).
Hahnemann, and most of his disciples, as well as
Hunter and other eminent allopathists, entertained an
opinion that the chancre is simply the vicarious symp
tom of the internal disease, and that by removing this
ulcer by external applications, " the disease is forced to
embody itself externally, in the more troublesome and
speedily suppurating bubo. And after this, too, has
been removed, as is foolishly done, by external treat
ment, the disease is forced to manifest itself through
out the organism with all the secondary symptoms of
a fully developed syphilis. This unavoidable develop
ment of the internal syphilitic disease generally takes
place after the lapse of two or three months." — (Hah
nemann s Chronic Diseases, p* 116).
We speak advisedly when we pronounce this last as
sumption altogether erroneous ; for we have repeatedly
seen true venereal chancres cured by topical treatment
alone, while the patients have remained entirely free
from any secondary manifestations for years after
wards. When a student of medicine, the author
passed some time at the United States Marine Hos
pital, Chelsea, then under the superintendence of the
able and accomplished Dr. Stedman. In this in
stitution, the internal use of mercury had been dis
pensed with in the cure of syphilis, for several years
previous to my entrance ; and I ascertained that it was
a very rare occurrence to observe secondary symptoms
in those who had been cured at this hospital, although
patients were constantly returning with other com
plaints, who had been cured of chancre years pre
vious. The treatment chiefly relied on consisted of
topical applications of a mild and simple character, the
internal use of decoctions of sarsaparilla, and a rigid
regimen. The ordinary period for the cure of primary
chancre, was from three to four weeks ; and for bubo,
from six to eight weeks.
So long as a chancre exists, the matter generated
in the contaminated part continues to be re-absorbed.
492 DISEASES OF THE URINARY
and thus to supply new fuel to the mass of the blood ;
it is therefore important to change the morbid action
of the ulcer, and heal it up as soon as possible. The
matter formed in ulcers of the mucous membrane of
the throat, which have arisen from the constitutional
effects of syphilis, is also capable of propagating the
disease by contact with abraded surfaces, or by being
directly re-absorbed into the blood. There is reason
to believe, therefore, if all these ulcers be speedily
healed by topical treatment, so that the blood shall
only contain a given quantity of the virus, this limited
amount will gradually become diluted, by the constant
addition of new and healthy blood, and by its frequent
circulation through the lungs, so that its power to im
press the structures is finally lost, and the parts which
have already been affected, gradually recover their
health and tone.
In advocating the practice of topical applications,
however, we by no means wish to be understood as
placing entire reliance upon them, to the exclusion of
internal remedies. We only assert that local applica
tions are capable of effecting speedy cures of chancres,
thus of destroying these sources of contamination, and
placing the blood in the most favourable condition to
be purified by the inspired oxygen, by the newly formed
blood, and by remedial agents. A morbid action is
set up in the chancre, which causes it to generate
matter of a virulent quality. This is evident from the
fact that the matter of buboes and other venereal
abscesses, as well as the blood of syphilitic persons,
is incapable of causing contamination in the healthy.
We repeat, then, heal the chancres as soon as possible,
by destroying their morbid action, with some local ap
plication which shall induce a healthy medicinal action.,
and we have already done much towards abridging
the power of the disease. Our admirable specifics
will, then, readily accomplish what remains to be
done in perfecting a cure.
The remedial agents which we have found most
useful in the management of syphilis are, (topical,)
nit. argenti^ acid nit., zinc chlorid., liydrg., prcecip ,
rub. creosote, and (internal,) the preparations of mercury,
AND GENITAL ORGANS. 403
aurum mur., thuya, acid nit., sulphur, hepar sulph.. sar-
saparilla, silicea, mezereum, hyd. potasses.
In the treatment of chancre, our attention should be
directed in the first instance to the cauterization of the
sore, in order to change as speedily as possible the
morbid action. For this purpose, either of the first
named medicines may be employed, although in most
cases we prefer the nitrate of silver in substance.
After a healthy action has been excited in the ulcer,
by these applications, lotions of simple water may be
employed until the cure is established. It will be well
to keep a dossil of lint moistened with water constant
ly upon the ulcer. This course, in conjunction with
the remedies advised below, will generally effect
speedy and permanent restoration.
Of the internal remedies, mercury is the most im
portant. By comparing the pure effects of the differ
ent preparations of this drug upon the healthy human
organization, with the constitutional effects of the
syphilitic virus, it will be observed that the former
are capable of causing all the symptoms of the latter,
as well as many others which are peculiar to the drug:.
According to Pereira, the following are the effects of
mercury in large doses :
First. On the mucous membrane of the nose and
throat: ulcer ations of the mouth, gums, throat, tonsils4,
and nose, which are often followed by extensive
sloughing of the parts.
Second. On the skin or surface of the body : eczema
mercuriale, erythema mercuriale, lepra mercurialis, ery
sipelas mercuriale, spilosis mercurialis, miliaria mercuri
alis, and other cutaneous eruptions which bear a close
resemblance to herpes, impetigo, psydrasia, and the
copper-coloured eruptions of syphilis.
Third. On the bones and their periosteal coverings :
" inflammation of the bones or periosteum, and the
consequent production of nodes (symphoresis periostei
mercurialis")
By the above it will be seen that all of those parts
capable of being impressed by the venereal virus, are
also acted on by mercury. That the operation of the
latter is often more violent and destructive than the
former, will not at this day be questioned.
494 DISEASES OF THE URINARY
But in addition to the symptoms just enumerated,
mercury, in large doses, causes almost innumerable
other symptoms, which have no bearing upon the sub
ject of this chapter, except as indicating its danger in
the hands of allopathists.
We have quoted above from an eminent allopathic
writer, in order that every reader may be convinced
of the analogy between the effects of the venereal
poison and of mercury, upon the human constitution,
and to show the difficulty of distinguishing between
syphilitic and mercurial symptoms, in the old school
mode of practice.
For an accurate and complete description of the
pure effects of mercury upon the healthy organism,
we refer to the provings of Hahnemann and other
homoBopathists.
Hahnemann preferred the fluid quicksilver, carried
up to the decilionth degree, over all other preparations,
in the treatment of both primary and secondary
syphilis.
For the cure of primary chancre, Hartmann recom
mends the first or third trituration of mercurius sol., in
doses of one grain, night and morning. If no improve
ment occurs within the first eight days, he gives a
lower trituration, or, if necessary, a low trituration of
mere, prcecip. rub., in doses of one-sixth of a grain, two
or three times a day. In the Hunterian, phagedenic,
and the elevated indurated chancres, Hartmann em
ploys the red precipitate, in its lower attenuations, from
the first.
Dr. C. Miiller, of Leipsic, is also most decidedly in
favour of the red precipitate or the hydr. sulph. rub., in
the treatment of syphilitic chancres and buboes, in
whatever state they may present themselves. He
advises a grain of the first trituration, to be given
twice a day until the ulcers have nearly healed. For
painful nodes and other syphilitic affections of the
bones, hydriodate of potash is advised.
I have also made use of the precipitate at the third
attenuation, with marked advantage, in uncomplica
ted syphilis. I have known the best results, also, from
the hydr. murtcor., in both the primary and secondary
forms of the malady. For the cure of troublesome
AND GENITAL ORGANS. 495
secondary symptoms, in the forms of cutaneous erup
tions, glandular enlargements, and nodes, theprotiodide
of mercury has extraordinary power. Speedy cures
have been effected by it after the other mercurial pre
parations had failed. It may be used at the third
attenuation, in doses of a grain, twice a day, until the
eruptions disappear*
When syphilis is complicated by psora, scrofula, or
any other chronic disease, suitable remedies should be
alternated \vith the mercurials.
Muriate of gold ranks next in importance to mercury,
as a remedy in secondary syphilis. The late Dr. Taft,
of New Orleans, employed it in secondary ulcers and
eruptions which would not yield to mercury, with the
most gratifying results. In syphilitic eruptions of long
standing, we have often administered it with entire
success. The second or third trituration may be em
ployed, in half grain doses, night and morning, as long
as necessary.
Nitric acid will be serviceable in many cases of
ill conditioned chancres, which seem to withstand the
curative force of mercury. It is also of great value in
protracted secondary cases, accompanied with emaci
ation, debility, caries of the bones, unhealthy ulcers
upon the surface, and great derangement of the ner
vous system. If these symptoms have been aggrava
ted by abuse of mercurials, the indication is still
stronger for the acid. The first, second and third di
lutions are to be preferred in these cases, a dose to be
given twice daily until the disease yields.
Sulphur, hepar sulph., and hydr. sulph. rub., are the
proper specifics when the chancre occurs in psoric
constitutions. As a general rule, the two first should
be alternated with some mercurial preparation.
Hyd. potassce is eminently worthy of consideration
in the indolent glandular swellings which sometimes
originate from a combination of syphilis and scrofula.
It is also an efficient medicine in the treatment of
venereal nodes.
Silicea, mezereum and sarsaparilla are often valuable
auxiliaries in syphilis complicated with scrofula.
These medicines should also be given in alternation
with some other suitable specific.
496 DISEASES OF THE URINARY
In conclusion, we call attention to the following re
liable mark of cure, alluded to by Hahnemann in his
Chronic Diseases : " So long as the original spot upon
which the chancre had been developed, exhibits a red
dish morbid-looking, red, or bluish scar, we may be
sure that the internal disease is not completely cured ;
whereas, if the chancre has been removed by the in
ternal remedy, the original spot of the chancre can no
longer be traced, on account of that spot being covered
by as healthy-coloured a skin as the rest of the body."
SECTION X.
LEUCORRHCEA FLUOR ALDUS. WHITES.
Diagnosis. — This disease is characterized by a dis
charge, from the utero-vaginal structure, of a mucous
or purulent character, of a white, yellow, or greenish
colour, either thin and watery, or of the consistence of
starch or gelatine. This discharge, in contradistinc
tion to that of gonorrhoea, arises from a benignant mor
bid action, and is non-contagious. The assertion of
Hartmann, respecting the identity of gonorrhoeal and
leucorrhoEal inflammations — the difference, in his view,
consisting only in the location of the disease — is evi
dently erroneous. This author defines gonorrhoea to
consist of an inflammation of the female urethra, and
leucorrhoea of a similar inflammation of the mucous
membrane of the vagina or uterus. The opinion falls
to the ground when we reflect that the latter disease
not unfrequently extends to the urethral mucous mem
brane, giving rise to ardor urinae, burning pain on pass
ing water, heat, fulness, and swelling of the part, and
a purulent discharge, which is non-contagious. Leu-
corrhoeal inflammation always originates from causes
which have impaired the healthy tone of the mucous
membrane ; gonorrhoeal inflammation, on the other
hand, may arise from the simple contact of a drop of
gonorrhoeal matter with the most sound and healthy
membrane. The former is the result of an ordinary
inflammation, which is analogous in its character to
that of catarrh and chronic bronchitis : the latter pro
ceeds only from the application of a specific infectious
matter, which developes a particular morbid inflam
mation, and a contagious purulent secretion.
AND GENITAL ORGANS. 497
The character of the discharge and of the symptoms,
will depend upon the location of the disease, its causes,
and the amount of inflammation present. Inflamma
tion of the cervix uteri, for example, causes a discharge
of " white mucus, and when the inflammation is in
tense, tinged with blood." — (Hall) Acute vaginal or
urethral inflammation gives rise to a purulent dis
charge of a yellow or greenish colour, sometimes tinged
with blood. A more chronic affection of the same
parts induces a thinner, more glairy, and muco-purulent
secretion. Scirrhus uteri causes an ichorous, bloody
and foetid discharge. In chlorotics, with deranged
menstruation, the secretion is thin, serous, acrid, and
of a lightish or straw colour. The discharge which
often accompanies pregnancy, is thick, glairy, and
white or yellowish ; but in some instances after ac
couchement, more particularly in scrofulous and ca
chectic subjects, the matter is ichorous and highly ir
ritating to the parts with which it comes in contact.
In polypi of the uterus or vagina, the discharge is at
first mucous, but when the tumours have attained some
size, it becomes tinged with blood, and in some cases
of this kind profuse haemorrhages occur. The signs
which denote the existence of these tumours, are, sense
of weight and fulness in the uterus, dragging pains in
the small of the back, bearing down pains, and turns
of profuse haemorrhage.
In light cases of leucorrhoea, the discharge is usually
thin, glairy, transparent, and starchy ; but when the
disease is thoroughly seated, and the patient is of a
delicate or cachectic habit, the fluid may be muco-
purulent, serous, sanious, and of a white, yellow, or
greenish colour.
As a general rule, the discharge is worse about the
period of the monthly sickness, owing probably to the
increased determination of blood to the parts during
this natural phenomenon.
The diseases which are ordinarily accompanied by
leucorrhosa are, amenorrhoea, chlorosis, polypus and
scirrhus uteri, dysmenorrhoea, menorrhagia, prolapsus
uteri, and chronic inflammations of the uterus, vagina
or urethra.
When the affection is inveterate,' and attended with
DISEASES OF THE URINARY
an abundant discharge, the whole system becomes
injuriously affected : the face assumes a pale or sal
low colour ; the eyes are surrounded with dark or
leaden-coloured circles ; the functions of the stomach
and bowels are impaired ; the patient experiences a
weary and dragging sensation in the left side ; there
are also dull pains in the back, loins, and abdomen ;
cold extremities ; nausea ; palpitation and dyspnoea
after exercising ; lassitude ; debility ; feeble pulse ;
loss of physical and mental energy ; partial or total
suppression of the menses ; increase or diminution of
the sexual propensity.
These are the symptoms to which protracted and
severe attacks of leucorrhoea give rise ; but the mala
dy may exist for years, in a mild form, without the
development of any of these consequences.
This disease is far more common in cities amongst
the rich, indolent, luxurious, and dissipated, than in
the country. Indeed, the small number of births, and
the frequent miscarriages occurring in large towns,
are attributable in a great measure to the very com
mon prevalence of this weakness.
LeucorrhoBa has been considered as one of the symp
toms of prolapsus uteri ; but we are of opinion that in
very many instances, the latter is a consequence, rather
than a cause of the former. This opinion derives sup
port from the fact that fluor albus often exists for years
before the signs of prolapsus manifest themselves :
and it is probably from this circumstance that the
tone of the uterus becomes impaired, and the muscles
and ligaments gradually lose their strength and con
tractility.
Leucorrhoea occurs at all periods of life, but is most
common after puberty, and previous to the " change
of life," when so many causes are constantly conspiring
to induce free determinations of blood to the utero-
genital organs.
Causes. — The conditions which predispose to attacks
of leucorrhosa, may be enumerated as follows : a lym
phatic temperament ; a scrofulous dyscrasia ; general
debility and relaxation of the muscular and membra
nous structures, whether from natural organization, or
previous disease.
AND GENITAL ORGANS. 499
Amongst the more immediate causes may be men
tioned, an inactive and luxurious mode of life ; im
moderate sexual indulgence ; abortions ; congestions
and inflammations of the uterus and vagina ; men
strual derangements ; want of cleanliness ; a humid
atmosphere ; scirrhus uteri ; polypi and other abnor
mal growths in the uterus ; metastases of rheumatism ;
herpes ; hcemorrhoidal, catarrhal, and bronchial in
flammations ; the uterine debility and relaxation con
sequent on parturition, and too early exercise after
confinement ; neglect of mothers to exercise the of
fice of nursing ; and finally, according to Marshall
Hall, undue lactation.
All of these causes doubtless exercise an influence in
the production of fluor albus, but in the vast majority
of cases the disease may be justly attributed to the
combined operation of several of these influences,
rather than to any single one. We may almost pre
dict beforehand, that the child, born of parents who
have always lived in compactly populous cities, and
have indulged in their artificial habits, will sooner or
later be afflicted with leucorrhcea. This is but one
of the signs which indicate the gradual but sure pro
gress of degeneration to which the luxurious and dis
solute habits of large towns inevitably lead. In the
first instance, indolence, stimulating drinks, over
heated apartments, exciting theatrical exhibitions,
romances, pictures, statuary, etc., all tend to divert
the mind towards sensual enjoyments. Deprived in a
great measure of those pure and sublime pictures
which nature has so lavishly scattered throughout the
country, to please the sight, to elevate the mind, and
to ennoble and purify the whole being ; and of the
thousand sources of happiness which pertain to coun
try life ; they turn to artificial pleasures, and reap the
fruits which are ever entailed by a violation of natural
laws.
Is it strange then that fluor albus is so common in
cities ? that the degenerate offspring of these artificial
human beings should grow up so puny, so weak, men
tally and physically; so prone to disease, and soinca-
pable of performing properly those functions for which
nature has designed them ? If any one doubts the in-
500 DISEASES OF THE URINARY
ferences which these remarks suggest, let him but ob
serve the families of the wealthy and luxurious, who
have inhabited large cities for two or three genera
tions, and he will doubt no longer.
Prognosis. — Leucorrhcea often leads to prolapsus
uteri, amenorrhoea, menorrhagia, abortion, anasarca,
hysteria, and general debility, but it very rarely ter
minates fatally. By impairing in a gradual manner
the energies of the system, it predisposes it to take on
serious disordered action from slight causes, and thus
becomes indirectly an important morbid agent- When
the complaint is recent, and occurs in females of a ro
bust constitution, from some temporary congestion,
difficult parturition, or mechanical injury, we may ex
pect to remove it, by the aid of suitable remedies, in a
short period ; but if the patient be of a lymphatic tem
perament, of a delicate, lax and scrofulous constitution,
and subject to irregular menstruation, the disease will
most probably baffle our best curative efforts, and per
sist, with a greater or less degree of severity, during
life. In individuals of this description, the most insig
nificant causes are capable of inciting and perpetuat
ing the weakening discharge, so that, in many cases,
it will prove a hopeless task to attempt to remove all
the influences which exercise an injurious bearing up
on the case. Even when the affection exists as a
mere symptom of some other disease, it seldom sub
sides \vith the other symptoms, but is quite prone to
degenerate into a chronic fluor albus.
Therapeutics — There are several conditions which
are absolutely essential to the successful treatment of
" whites," the most important of which are, abundant
active exercise in the open air ; an avoidance of all ex
cesses in venery, and in the pleasures of the table ; a
withdrawal of the thoughts and affections from exciting
spectacles, from crowded balls and parties, from las
civious imaginings, from romances, and intrigues ; and
lastly, frequent daily ablutions, in order to ensure the
most perfect cleanliness of the utero-genital organs.
The vast importance of this last point cannot be too
strongly insisted upon, for without a rigid attention to
cleanliness, all our efforts will prove futile. The mor
bid secretion is at best sufficiently irritating, but when
AND GENITAL ORGANS. 501
it is permitted to accumulate and remain for a long
time in contact with the mucous membrane, it be
comes partially decomposed, fetid, and highly perni
cious to the well-being of the parts. On this account,
the constant and thorough use of local applications of
tepid or cold water, as circumstances require, should
be strictly enjoined. We may then carry out our re
medial measures in all their details, with a reasona
ble prospect of success.
We call attention to the following remedies : Cal-
carea carb., sulphur, stannum, sepia, iodine, pulsatilla,
alumina, lycopodium, phosphorus, cocculus, sabince, secale
cor., china, arnica, bovista, aconite, mercurius, nux
vom., silicea, psoricum, copaibce, mezereum, and manga-
num.
Calcarea carb. is suitable in chronic leucorrhoea,
affecting weak, scrofulous and cachectic females, and
particularly indicated when the menses are too fre
quent and too profuse. The discharge is milky, trans
parent, mucilaginous, starchy, unirritating, and ac
companied with itching of the parts, especially the
pudendum ; also lassitude ; depression of spirits ; pains
in the chest and back ; cough ; and general debility.
When the complaint arises from a scrofulous, or
psoric taint, antipsorics, like sulphur, stannum, and io
dine, will be required. The discharge in these cases
is thin or yellowish, and highly irritating to the parts
with which it comes in contact. The strength is also
much impaired, and there are indications of pulmona
ry and scrofulous disorder, such as hectic fever ; ema
ciation ; loss of appetite ; wandering pains in the
chest ; cough ; profuse mucous or purulent expecto
ration ; feeble and rapid pulse ; night-sweats.
Sepia is suitable for females who are naturally del
icate and sensitive, with clear and transparent com
plexions. The discharge is mucous, white, yellowish,
or watery, mild or acrid in its nature, most abundant
just before or just subsequent to the menses, and at
tended with itching and stitching pains in the genital
organs.
Pulsalilla is an admirable remedy in leucorrhoBa
accompanying pregnancy. It is also useful when the
disease occurs about the period of the monthly courses.
502 DISEASES OF THE URINARY
The discharge may be thin, acrid, and burning, or
thick, white, and tenacious, like the white of eggs.
Shifting flatulent pains in the abdomen still farther
point to pulsatilla.
Alumina has proved successful in several varieties
of fluor albus ; but is particularly indicated when the
discharge is very profuse and acrid, most abundant
during the day when walking, and previous to the
menstrual periods, and attended with a burning and
itching sensation in the genital organs and rectum.
Fluor albus brought on by masturbation, and occur
ring at intervals, with a milky, serous, ichorous, or
reddish discharge, will be best covered by lycopodium,
phosphorus, or cocculus. These remedies are suitable
to lymphatic temperaments, to those who are highly
sensitive to cold, and subject to catarrhal affections,
and whose nervous systems have been morbidly ex
cited.
Sabince and secale cornutum are proper in fluor al
bus depending upon weakness of the utero-vaginal
structure ; also when arising from suppression of the
menses ; from miscarriage ; from severe and protract
ed labours ; polypi, and prolapsus uteri. The discharge
is attended with itching of the pudendum, and inordi
nate sexual propensity.
China will serve our purpose when the complaint
originates from excessive loss of blood, or other ani
mal fluids, extreme debility from fevers, acute inflam
mations, abuse of drugs, insufficient nutriment, and
respiration of foul air.
Bovista is applicable in fluor albus occurring after
the catamenia, with discharge of a thick, glairy, and
tenacious matter, of a yellow or greenish colour, and
highly corrosive.
Arnica is indispensable in leucorrhoea originating
from mechanical injuries during accouchement, from
polypi, hydatids, and other morbid growths in the
uterus or vagina, prolapsus uteri, and undue mechan
ical pressure from without.
Aconite corresponds to plethoric and sanguine con
stitutions, and to females who are subject to conges
tions and haemorrhages from different organs. The
discharge is purulent, yellow or greenish, and attended
AND GENITAL ORGANS. 503
with ardor urinae, heat, pain, and fulness in the geni
tal organs, quick and full pulse, hot skin, and other
febrile symptoms.
When there is reason to suspect that the discharge
is from a syphilitic origin, whether it be mucous,
watery, or purulent, mild or corrosive, mercurius is
our best remedy.
Nux vom. is recommended when the disease arises
from irregular menstruation, abuse of stimulants, rich
and indigestible food, with a very profuse sanguineous
or yellowish and fetid mucous discharge, and attended
with cramplike pains in the abdomen, constipation,
sinking at the stomach, and palpitation of the heart.
Cases may occur which will require the use of sili-
cea,psoricum,copaibce, mezereum, manganum, nitric acid,
to which the reader is 'referred.
Administration. — We advise the employment of the
first, second, and third attenuations, the dose to be
repeated once in twenty-four hours until primary or
secondary medicinal symptoms appear, when we may
await the result for some days, or so long as the
amendment continues. When the symptoms become
stationary, we may again resort to the remedy.
SECTION XI.
AMENORRHGEA.
General description. — Many of the symptoms of
this complaint bear a close resemblance to those of
chlorosis, and it is on this account, probably, that
some authors have confounded the two maladies. As
retention or suppression of the menses is a very com
mon and prominent symptom of chlorosis, it is not
surprising that it has been deemed a cause of chlorotic
symptoms, rather than as a mere symptom. But the
fallacy of this doctrine will be evident, when we re
flect that chlorosis occurs in males, in young children,
and in females whose catamenial functions are regu
lar through the whole course of the disease.
Two kinds of menstrual irregularity are generally
included under the above head : first, retention of the
catamenial flux beyond the natural period, from con-
504 DISEASES OF THE URINARY
stitutional causes or mechanical obstruction ; and
second, partial or total suppression of already estab
lished courses, from phthisis, chronic hepatitis, general
debility, chlorosis, fevers, and exposure to cold and
dampness.
It is not improbable that the same causes which
contribute to the development of chlorosis, also ope
rate to prevent the usual menstrual flux at the period
of puberty, and thus to establish one variety of ame-
norrhcea. Natural delicacy of constitution, a highly
impressible nervous system, and a lymphatic temper
ament, are 'general conditions which precede and ac
company both maladies, although amenorrhcea some
times occurs in the most robust females.
The revolution which nature causes in the female
organism at the period of puberty, ought always to
become manifest in the menstrual flux ; but the causes
which often operate to retard it, and thus to thwart
the kind efforts of nature, are numerous and diversified.
Singular phenomena are sometimes observed at the
period of puberty in relation to this periodical evacu
ation ; for, in the place of the usual uterine secretion,
fluxes now and then take place from the top of the
head, the ends of the fingers, the soles of the feet, the
stomach, intestines, nose, and other parts of the body,
and apparently assuming the place of the monthly
periods. Occasionally the supplementary secretion
occurs in the form of ulcers, enlargement and irrita
tion of certain veins, and eruptions.
The menstrual discharge varies much in its quan
tity and character. In hot climates, puberty arrives
earlier, and the discharge is more abundant, than in
temperate latitudes*
When the discharge comes on at the proper period,
but is deficient in quantity, or is composed of serum,
mucus, or pus, other parts of the economy suffer, as
by pains in the back, pelvis, limbs, and head, until
the period has passed, after which the sufferings abate
until the succeeding epoch, and are then renewed.
This deficient secretion may continue for months and
even years, without giving rise to any structural le
sion, or any other symptoms than those enumerated,
when some new circumstance, like marriage, a sea-
AND GENITAL ORGANS. 505
voyage, or change of climate, may restore the func
tion to its natural condition.
Puberty, with its usual accompaniment, the men
strual flux, does not occur in cold regions until the age
of fifteen or sixteen years, while in tropical countries,
it arrives at the age of eight, nine, and ten years.
Frank* records cases where the courses appeared in
children of one, three, and four years. This physician
also treated, at Pavia, a woman who had given birth
to three children without ever having had a menstrual
or lochial discharge. Many cases of this kind are
mentioned by other writers, who also allude to the
masculine organization and characteristics of these
women, such as firmness of muscle, harshness of voice,
and smallness of the breasts.
From these facts we infer with Frank and others,
that the menstrual function is not absolutely essential
to the occurrence of conception, and that a woman
may go through her whole term of pregnancy, and
finally give birth to a healthy child, without any de
velopment whatever of the catamenial function.
Frank, in his Practice of Medicine, expresses the
same opinion : " Nous concluons de ces observations
que I'apparition des menstnies est, a la verite, un des
principaux signes qui annoncent le de veloppment de
1'organe uterin et 1'abord du sang dans ses vaisseaux,
mais que la conception et la nutrition du foetus pen-
vent egalement s'operer, quoique cette fonction pe-
riodique ne soit pas encore etablie ; que la fecondite
depend d'une autre cause, d'un principe analogue a
celui dont elle derive chez les femelles des animaux ;
que la nature a soumis en general toutes les femmes
bien organisees au tribut menstruel, mais qu'elle ne
Texige pas toujours avec la meme rigueur sous peine
de sterilite."
In regard to the natural duration of the catamenial
discharge, nothing definite can be advanced, since so
much depends upon the constitution, the climate, and
the habits of life ; but the average duration is about
three or four days.
Diagnosis. — As the period approaches when the girl
* Traite de Mcd. Practique, vol. ii., p. 253.
22
506 DISEASES OP THE URINARY
is to become a woman, new ideas, new thoughts, and
new desires take possession of her mind. Instead of
amusing herself with her doll, she prefers to enjoy,
although with much coyness and timidity, the society
of an attractive young friend of the other sex ; in
stead of the romping freedom of the child, we now
observe the retiring manners and the burning blushes
of the maiden. Her physical developments, also,
become more symmetrical, perfect, and pleasing to
the eye, and she looks forward into the dim vista of
life with deeper interest, higher aspirations, and a
more proper appreciation of the responsible duties
she may be called upon to fulfil.
If, in conjunction with these physical and moral
changes, the catamenial discharge makes its appear
ance naturally and regularly, the girl retains her
health and vigour ; but if the period passes by with
out the usual development of the monthly tribute, we
are presented with the following symptoms of
RETENTION OP THE MENSES.
Pale, waxlike, or sullen and sickly countenance;
furred tongue, and foul breath in the morning ; varia
ble and sometimes morbid appetite ; nausea, general
debility, lassitude, and sense of fatigue ; pains in the
small of the back, pelvis, abdomen, head, side, and
limbs ; disinclination to mental or physical exertion ;
coldness of the feet ; constipation ; leucorrhoea ; de
pression of spirits ; sad and weeping mood ; distress
in the stomach after eating ; distention of the abdo
men ; faiiitness ; palpitation of the heart after exer
cise ; rapid pulse ; headache ; vertigo ; roaring in the
ears ; nightly wake fulness ; hysteric symptoms ; pee
vishness and irritability ; haemorrhages from the nose,
stomach, lungs, and rectum ; supplementary dis
charges from certain parts of the body.
SUPPRESSION OF THE MENSES,
May arise from a natural cause, like pregnancy, or
from general debility resulting from excessive loss of
blood, chronic and acute diseases, inordinate mucus,
purulent and seminal discharges, polypi, venereal ex
cesses, constant and severe muscular exertion, and
AND GENITAL ORGANS. 507
mechanical obstructions ; or it may occur suddenly
during the flux from violent emotions of the mind,
exposure to cold and dampness, cold baths, or any
other cause which abruptly shocks the system.
The symptoms which follow suppression are usually
more acute and dangerous than those of retention of
the courses. It is not uncommon for the former to
induce serious haemorrhages from the lungs and stom
ach, also inflammations and congestions of the brain,
lungs, uterus, and liver ; while in the latter, the symp
toms arise so gradually, that the organism in some
measure adapts itself to the morbid condition, and
thus escapes the inflammatory and febrile attacks
which are so common in suppression.
Suppression occurs in the most sound and robust
constitutions, as well as in those that are weakly : re
tention but rarely happens in healthy and vigorous
subjects, but follows usually as a consequence of ori
ginal delicacy of constitution, or of some long stand
ing chronic affection. The symptoms of the former
are more violent than those of the latter, but upon the
whole, less dangerous to life, and more readily con
trolled by medicines.
In cases where the monthly secretion takes place,
but is retained in the uterus from some mechanical
obstruction, the blood often preserves its fluidity and
freshness for a long period. This is owing to the ex
clusion of the oxygen of the air, the presence of which
is essential to the process of decomposition.
Causes. — Natural or acquired delicacy of constitu
tion, combined with a lymphatic temperament, and a
highly sensitive nervous system, is by far the most
common cause of retarded menstruation. A certain
amount of stamina, of physical and nervous energy,
is essential to the healthy performance of the func
tions, and so long as the organism is without the
proper supply of this force, all of the functions must
be imperfectly executed.
Structural lesions which give rise to profuse puru
lent, mucous, or sanguineous discharges, operate both
as causes of retention and suppression. In this class
may be included, tuberculous ulcerations of the lungs,
508 DISEASES OF THE URINARY
chronic bronchitis, abscesses of the liver, and lumbar
abscess.
Other causes of retention, are, malformations of the
uterine organs, or the vagina, like imperforate os
tincae, imperforate hymen, malorganization of the
ovaries or fallopian tubes, unnatural growths in the
uterus or vagina which oppose an obstruction to the
passage of the menstrual secretion.
Dr. Mclntosh divides the mechanical obstructions to
the discharge of the menstrual fluid, into two classes,
viz. : " those occasioned by cohesion of the sides of the
vagina and labia, and an imperforate hymen, and those
caused by an imperfect or imperforated state of the os
uteri itself. All these cases are comparatively rare,
but few men can have been in extensive practice for
twenty years, without meeting with several, and there
fore they require some notice in this place. In the
first set of cases, in addition to the constitutional symp
toms and local pain already mentioned, there is great
fulness, distention, and a sense of weight in the pas
sages, accompanied sometimes with severe pain, and
a feeling of bursting ; straining at stool and micturi
tion, together with enlargement of the abdomen, which
excites suspicion of pregnancy. The nature of the
case can only be determined by examination, and can
be relieved only by the knife.
" In the second set of cases, there is greater difficulty
in detecting the state of parts, from the natural im
pediment to an examination which exists at the orifice
of the vagina ; but I may mention, at least as a curious
coincidence, that in the only two cases of imperforated
os uteri which have fallen within my observation,
there was no hymen, and the passages easily admitted
the introduction of two fingers." Dr. M. punctured
the os uteri, in one of these cases, and afterwards di
lated the passage with bougies, until the discharge
found free exit, when all of the unpleasant symptoms
subsided, and the patient was restored to perfect regu
larity and excellent health. The other patient, whose
delicacy forbade the operation, gradually sank under
her symptoms and died. I have met with one case of
retention, from adhesion of the walls of the vagina.
The patient was a healthy young married lady whose
AND GENITAL ORGANS. 509
menstruations had been regular until she became preg
nant, after which they ceased, and she advanced as
usual until the fifth month, when she had the misfor
tune to miscarry. During the delivery of the foetus,
so much violence occurred to the parts, that inflamma
tion and sloughing of the vagina followed, adhesions
took place between the vaginal walls, and the passage
became entirely closed to the escape of the menstrual
fluid. The patient experienced for many months most
severe pains in the pelvis, abdomen,back, and especially
at the monthly periods ; many severe constitutional
symptoms set in, and she became reduced to a very
low state of health. A free incision through the cica-
trix, gave vent to a large quantity of fluid blood, ex
hibiting but slight signs of decomposition, and the pa
tient speedily regained her health.
The most harmless cause of suppression, is that
which arises from pregnancy. But although this is a
natural cause, its constitutional effects are manifested
in the form of frequent nausea, morning sickness,
ptyalism, &c. These symptoms, although quite trouble
some and annoying to the patient, serve the important
purpose of guarding the brain, lungs, and other vital
parts, from dangerous inflammations and congestions.
One of the most notable causes of suppression du
ring the flow of the courses, is abrupt exposure to cold.
This obstruction is apt to arise in going suddenly from
a warm room after exercise, and when the pores are
open, into the cold air. It is also caused by plunging
the limbs or body into cold water during the period.
Insufficient clothing and thin shoes may also be men
tioned as common causes.
Violent emotions of the mind, vehement anger, ter
ror, sudden joy, intense grief, revolting sights, and
electric shocks, may likewise be reckoned as frequent
causes of obstruction or suppression of menses during
the period.
It has been asserted that severe physical exertion
often induces suppression, and the fact that habitual
dancers are subject to but slight catamenial dischar
ges, has been adduced as a proof of the assertion. We
are inclined to credit this statement, from reflecting
that operatives who labour long and hard, have but a
510 DISEASES OF THE URINARY
very slight seminal secretion, and consequently but
little inclination for sexual enjoyment ; while he who
enjoys his otium cum dignitate, abounds in this secre
tion, and experiences frequent amorous desires. The
same result may happen to females, with reference to
their monthly secretion, and yet no unpleasant conse
quences arise from the diminution or suppression of the
discharge, since a sufficient amount of the vital stimuli
has already been expended in severe muscular exer
cise.
Prognosis. — Retention proceeding from a natural
lack of constitutional vigour, is always difficult to
cure ; but where no serious organic difficulty exists,
we may generally hope for ultimate success. In cases,
however, which are complicated with chronic pulmo
nary disease, dropsical affections, and organic disease
of the heart or liver, the prognosis must always be un
favourable. Retention from imperforated os uteri, or
hymen, and from vaginal adhesions and polypi, are all
readily cured by surgical means.
When suppression arises as a symptom of some
chronic disease, especially if it has persisted for seve
ral months, we shall, for the most part, find the case
incurable ; when, on the contrary, it has arisen from
an acute disorder, the cure may be easily accom
plished.
Obstructions which are consequences of anger, grief,
fright, jealousy, or exposure to wet and cold, may also
be speedily restored by suitable specifics.
In forming an opinion respecting the probable ter
mination of amenorrhcea, it should always be borne in
mind, that it is almost invariably either a symptom of
some other disease, or that it owes its origin to a ge
neral lack of constitutional vigour. Much, therefore,
depends upon the general condition of the system, and
upon the curable or incurable nature of the malady
which causes the menstrual derangement, as to whe
ther our prognosis be favourable or otherwise.
Therapeutics. — In the management of amenorrhoea,
our first attention should always be directed to the re
moval of the cause upon which it depends. Those
cases of retarded menstruation dependent upon a want
of constitutional vigour, will derive material benefit
AND GENITAL ORGANS. 511
from well regulated exercise, nutritious diet, change
of scene and of climate, sea air, sea voyages, and bath
ing. Retention from mechanical obstructions, can on
ly be cured by the aid of the surgeon.
But in suppression or obstruction, unattended with
any serious local complication, and originating from
exposure to cold, mental emotions, suddenly checked
perspiration, cold drinks, fevers, &c., we may afford
the most prompt relief by the employment of suit
able remedies.
We call attention to the following medicines : pul-
satilla, sabince, china, calcarea carb.,ferrum, graphites,
conium, serpentaria virg., sulphur, sepia.
Pulsatilla is adapted to females of a mild, timid, and
amiable disposition, who are easily excited to tears or
to laughter. It may be used in cases where menstru
ation is delayed a few days beyond the natural period,
in abrupt suppression of the courses, from cold bath
ing, wet feet, sudden suppression of perspiration from
cold air, violent passions and emotions, and in fevers,
in alternation with other suitable medicines. It is
also valuable in partial obstructions, accompanied
with dyspeptic and hysteric symptoms. The general
indications are, lassitude, weariness of the limbs, un
pleasant arterial pulsations in different parts of the
body, congestion, anxiety, and oppression of the chest
and heart, after exercise, and in the night when in the
recumbent posture : variable appetite ; coldness of
the feet ; sleeplessness ; pains in the back ; weeping
mood ; vertigo or giddiness ; colicky pains in the ab
domen.
Sabina is only useful in that irregular variety of
amenorrhoea in which the menses appear too soon, and
too profusely for a few hours, and are then suppressed
either temporarily or permanently. The kind of
amenorrhoea in which this medicine is applicable, is
for the most part induced by a hyposthenic condition of
the uterus.
China and ferrum are especially serviceable in re
tarded menstruation dependent on constitutional de
bility, whether natural or acquired. The general in
dications for their use, are, pale, sallow, or cachectic
countenance ; emaciation ; muscles soft and flabby ; ra-
512 DISEASES OF THE URINARY
pid circulation ; rapid and difficult respiration after
exercise ; palpitation of the heart, excited by mental
emotions, exercise, or eating heartily ; lassitude, de
bility, and general indisposition to think or act ; tran
sient pains in the chest, back, side, pelvis, and limbs ;
swelling and pain in the hepatic region ; bitter taste ;
feeble appetite ; impaired digestion ; nightly restless
ness ; leucorrhoea.
Calcarea carb., sulphur, graphite, c.onium, and sepia,
are indicated in the catamenial irregularities of scrof
ulous, rickety, and syphilitic subjects. The history of
each case will enable us to decide respecting the pre
cise nature of the disease upon which the amenorrhoea
is dependent, and thus render it easy to select an anti-
psoric which shall gradually remove the original cause
of disorder, and cure the patient. As a general rule,
calcarea carb. agrees best with young persons whose
menses appear too soon, while sulphur, graphite, coni-
um and sepia may be exhibited at all ages, but for the
most part, in cases of retarded and suppressed men
struation.
Serpentaria virg. — We have often used this medi
cine in suppressed and obstructed menses, from cold,
violent emotions, and the debility consequent on fe
vers, with marked success. A recent cure of amenor-
rho3a, verging on chlorosis, has also come under my
observation, which, taken in connection with the other
examples alluded to, convince me that it is a specific
of much value in disorders of this character.
As a majority of the cases of amenorrhoea have their
origin in some inherent constitutional vice, and are, iii
reality, but mere symptoms of some other affection, it
is of importance that our attention be directed to all
of the remote and slight symptoms which may exer
cise an influence upon the economy, as well as to the
more immediate and visible signs of the malady.
Administration. — When the menstrual derangement
has approached gradually, and is evidently a symp
tom of some general disease, like scrofula, chlorosis,
phthisis pulmonalis, dropsy, or chronic hepatitis, the
remedies must be selected with reference to these mal
adies, and the same attenuations and repetitions em
ployed as advised under these different affections. —
AND GENITAL ORGANS. 513
As a general rule, in these cases, we employ the first,
second, and third attenuations, and repeat the dose
but rarely ; but in abrupt obstructions, occurring in
females of a robust constitution, from undue expo
sures, or over-excitement, we make use of the first or
second attenuations, and repeat every two, three, or
four hours until wre are satisfied with the effect pro
duced.
SECTION XII.
DYSMENORRHO3A. PAINFUL MENSTRUATION.
Diagnosis. — Painful menstruation is of most com
mon occurrence in females of sanguineous and robust
constitutions, and of ardent and animated tempera
ments. The monthly flux makes its appearance at
the usual period, but generally in small quantity, often
.becoming entirely suppressed for several hours, and
then reappearing to a greater or less extent, perhaps
again to be suppressed. Females subject to dysme-
norrhoea, are almost invariably troubled with constipa
tion, and frequent headaches, from rush of blood to
the brain, in the interval between the catamenial pe
riods.
The usual symptoms attending dysmenorrhoea, are,
severe bearing-down pains in the uterine region, sim
ilar to the pains of labour, and coming on in parox
ysms ; constant aching in the small part of the back,
the loins, the pelvis, and the limbs ; accelerated ac
tion of the heart and arteries ; flushed cheeks ; head
ache ; cutting and pressing pains in the abdomen ;
flatulence ; spasmodic sensation in the region of the
stomach; nausea; eructations; oppression in the
chest ; anxiety and irritability ; scanty discharge of
blood which is not coagulable, and containing lymph,
and shreds of a membranous structure, or clots of dark
blood.
Causes. — The chief causes of dysmenorrhcea, are, an
inflamed condition of the secretory vessels of the ute
rus, an unnaturally small os tincce, and inveterate con
stipation. Of these causes, the first is the most com
mon, and occurs in females of a full plethoric habit,
of fancies easily excited to activity, who are fond of
22*
514 DISEASES OF THE URINARY
the pleasures of the table, of love, and shows, and who
prefer to pass their time in heated parlours, or crowded
ball-rooms, rather than in active exercise out of doors.
When we reflect upon the habits and the mode of life
which the customs of refined society impose upon
young females, we shall no longer wonder that this
important function of the uterus should so often be
come disordered. The foolish mother, anxious that
her child should grow up according to the laws of
a false elegance, with a shape of body moulded to suit
the code of fashion, rather than in those once approved
proportions which the Creator gave her, envelopes her
in corsets and stays, pressing the abdominal viscera
downward upon the bladder and uterus, and the tho
racic organs upwards towards the throat, and thus
moulds a waist sufficiently small and wasp-like to meet
the requirements of a sham gentility. In carrying out
this wicked whalebone and buckram system, the im-.
portant functions of circulation, respiration, digestion,
and menstruation are of no sort of consequence to the
deluded victim or her friends, when compared with
the imperative demands of fashion. God made the
human body of precisely the right proportions for the
healthful exercise of all the organs ; civilized woman
baffles this ordination by mechanical devices, and
makes of the form an artificial thing, recognised and
known as a specimen of gentility, the functions of
which are subject to continual derangements, by con
sumption, chlorosis, dysmenorrhcea, amenorrhoea, con
stipation, and organic affections of the heart. After
the innocent young girl has been thus cheated, not by
" dissembling nature," but by a fashionable mother,
" out of her fair proportions," it is deemed necessary,
in order to complete her education, to prim her up
within the crowded walls of a boarding-school ; to
cram her mind with some ten or twelve studies at a
time, including, of course, music, and the current lite
rature ; and to neglect active exercise, wit, fun, mirth,
and other health-promoters, as vulgar. In this man
ner the countenance acquires that pale and distingue
cast so much coveted, and the body that frail and en
feebled state so common in cities.
Another cause which occasionally gives rise to pain-
AND GENITAL ORGANS. 515
ful menstruation, is an unnaturally small os tincce,
Dr. Mackintosh supposes this to be a very common
cause of dysmenorrhoea, and details numerous cases
of the kind which have come under his own observa
tion. When the painful symptoms do not yield read
ily to the proper remedies, an examination should be
made, and if the fault is in the o* tinea, our efforts
should be immediately directed to the dilatation of
the part with bougies.
The other causes which should be particularly no
ticed, are collections of indurated faecal matter in the
colon and rectum, uterine polypi, exposure to cold,
and rheumatic affections of the uterus.
Therapeutics. — Abundant active exercise in the open
air, regular hours, a plain regimen, abstinence from
wine, coffee, and green tea, and a temperature not ex
ceeding 68° Fahr., within doors, are prime conditions
to the successful treatment of dysmenorrho3a. By at
tending rigidly to these important points, constipation
will be obviated, the circulation of the blood equaliz
ed, the animal heat uniformly diffused, and all undue
determinations of blood prevented. If, however, ob
stinate congestions have already set in, a few doses of
a suitable specific will soon restore the organism to
its normal condition.
The medicines to which we call attention, are aco
nite, pulsatilla, secale cornut., belladonna, nux vom.,pla-
tina, f err urn, cocculus, sabina, conium, graphite.
Dysmenorrhosa arising from an inflammatory con
dition of the uterus, and attended \vith marked febrile
symptoms, quick pulse, hot skin, thirst, rapid respira
tion, headache and general restlessness, demands the
employment of aconite.
If the menses are scanty, and accompanied with
cutting pains in the uterine region, abdomen, back,
and loins, vertigo, loss of appetite, chilliness, nausea,
and discharge of thick, black blood, alternating with
short discharges of bright red blood, we may resort to
pulsatilla. If the pains shift about from one point to
another, the indications are still stronger. Pulsatilla
also operates best when the derangement has arisen
from fright, grief, mortification, or from exposure to
wet and cold.
UNIVERSITY /
C\f /
516 DISEASES OF THE URINARY
When the menstrual irregularity proceeds from
uterine congestion, and presents us with the following
tableau of symptoms, viz., violent spasmodic, or bear
ing-down pains from the small of the back to the ute
rus, with tenesmus and pressure on the bladder and
rectum, coldness of the extremities, rapid and feeble
pulse, frequent and severe contractions of the uterus,
secale cornutum should be employed.
Belladonna is an admirable remedy when the pa
tient is of a plethoric habit and sanguine tempera
ment, and the disorder has originated from some
violent mental emotion, and is attended with serious
determination to the brain. It may sometimes be
employed with advantage in alternation with aconite.
Nux vomica is valuable in scanty and painful men
struation, from uterine congestion, arising from scy-
balous accumulations in the colon and rectum. The
pains are of a spasmodic character, and extend from
the uterus to the neck of the bladder, and into the ab
domen. Considerable gastric derangement usually
attends this variety of dysmenorrhoea.
Platina, ferrum, or sabince, are applicable in that
variety in which the menstrual discharge is sufficient,
or even inordinate in quantity, but is attended with
severe bearing-down pains in the uterine region, cut
ting pains in the back, loins, and thighs, pressure in
the groins, cramps in the abdomen, blood dark, and
containing membraneous shreds, and too frequent ap
pearance of the menses.
For uterine and abdominal spasms, nausea, faint-
ness, impeded respiration, and a scanty discharge of
coagulated blood, mixed with mucus, we may give
cocculus or conium.
Graphite is an important remedy when the menses
appear too late, and are too scanty. The uterine dis
charge is thick and dark, there are severe labour-like
pains in the pelvis, also cutting pains in the abdomen,
small of the back and hips, vertigo, constipation, chil
liness, cold hands and feet, flatulence, and general
lassitude and debility.
Administration. — The medicines may be employed
at the first, second and third attenuations, and repeated
every two hours during the more severe symptoms.
AND GENITAL ORGANS. 517
The remedy should also be given once in two or three
days during the intervals between the monthly epochs.
SECTION XIII.
MENORRHAGIA. UTERINE HAEMORRHAGE.
Diagnosis. — Profuse uterine haemorrhages may take
place at any period of life from puberty to extreme
old age, and in every variety of constitution. But the
most common kind of menorrhagia to which the at
tention of the physician is called, is that which hap
pens during the monthly periods, from a congestion
or relaxation of the uterine secretory vessels. A cer
tain amount of menstrual fluid is secreted each month,
and this natural quantity is determined by the temper
ament, constitution, and habits of life of each parti
cular subject. Thus, robust and plethoric females,
who live richly and drink wine, may lose a large
quantity of blood at each period, and suffer no incon
venience from it ; while individuals of delicate and re
laxed constitutions, would immediately experience ill
effects from so profuse a flow. It is when this
healthy, natural flux becomes morbidly augmented,
that we apply to it the designation of uterine hcemor-
rhage, and deem it necessary to employ medicinal
means.
Dangerous uterine haemorrhages often occur during
pregnancy, from disturbance or rupture of the mem
branes or of the placenta, and also from concussions,
blows, violent exercise, fright, anger, cathartics, and
emmenagogues.
The symptoms which precede menorrhagia, occur
ring at the menstrual periods, are, general uneasiness
and dissatisfaction, petulancy, lassitude, sense of ful
ness and oppression in the head, weariness and wan
dering pains in the back, loins, and inferior extre
mities, sense of weight and pressure in the pelvis,
chilliness, unnatural determinations of blood, cold
feet, rapid pulse, and impaired appetite.
The symptoms attendant on the flux, will depend
entirely upon the nature of the case, the constitution,
and the amount of blood lost in each instance. In
light cases of menorrhagia, the patient only experi-
518 DISEASES OF THE URINARY
ences a general sense of lassitude, debility, and
weariness, faintness, tired and uneasy sensations in
the back and limbs, indisposition to exercise, a faint
and deathlike feeling at the pit of the stomach, pale
ness of the face, cold extremities, and feeble and un
satisfactory respiration.
In more serious cases the patient becomes almost
exsanguineous ; the face, lips, and surface become
blanched ; the muscular strength entirely prostrated ;
every attempt to move or converse induces immediate
syncope ; there is more or less determination of blood
to the brain, as is evinced by sharp pains, delirium,
ringing in the ears, and throbbings of the carotid and
temporal arteries ; the vision is impaired, floats circu
late before the eyes, respiration is oppressed, palpita
tion of the heart ensues from exercise or emotions ;
pulse rapid and extremely feeble ; general coldness of
the surface ; great and undefinable uneasiness and
nervous irritation. The blood gushes upon every ex
ertion to change position, and on coughing, sneezing,
or vomiting. After the patient has become reduced
by its loss to a very low state, frequent and pro
tracted fainting turns come on ; respiration and cir
culation become almost suspended ; the blood clots at
the mouths of the uterine vessels, and thus the flood
ing is temporarily arrested. As soon, however, as the
organism reacts, these clots are liable to be expelled
by the contractile efforts of the uterus, and the flow
ing to re-appear. These different conditions may oc
cur several times during the progress of the disorder,
until finally the patient is so completely prostrate,
that there is no re-action, the clots are not expelled,
and time is allowed for the uterine vessels to recover
themselves sufficiently to resist any further morbid
secretion. Cases of this description are not uncom
mon, and the cures are often erroneously attributed to
monstrous doses of opium and sugar of lead, rather
than to the kind offices of nature in inducing syncope,
and a consequent coagulation of the blood in the
uterus.
We have enumerated amongst the symptoms of the
complaint, determination of blood to the head, and in
flammation of the brain. These symptoms have been
AND GENITAL ORGANS. 519
so often observed in connection with profuse haemor
rhages, and the question has been so often discussed,
in regard to the propriety of blood-letting for the cure
of a cerebral inflammation which has been caused by
excessive loss of blood, that no one will deny the fact,
that these symptoms actually occur as a direct conse
quence of menorrhagia. Examples of this kind should
teach the important truth, that excessive loss of blood is
always a powerful predisposing cause, and in very many
instances a direct exciting cause of inflammations of
the brain, lungs, and other structures. It ought also to
induce the exercise of a little reason in therapeutical
measures, rather than a persistence in the empirical
routine of the old school, of venesection, opiates, and
astringents.
Menorrhagia originating in organic derangements
of the uterus, like indurations, cancers, tumours, and
ulcers, will be accompanied with the symptoms pecu
liar to these different maladies, in addition to their
ordinary signs. Cases of this description will require
careful attention, both in a diagnostic and in a thera
peutical point of view. Thus, if the disease be de
pendent on a scrofulous or psoric diathesis, or a
syphilitic taint, our remedies must be directed as well
to these original and general causes, as to those which
are more immediate and local. By this means we
may strike the silent and invisible enemy, while sub
duing others which are manifest to our senses.
Causes. — We include among the remote causes of
this affection, improper physical and moral education,
excesses in eating and drinking ; insufficient nutri
ment ; scrofulous, syphilitic, or psoric taints ; pressure
of the abdominal viscera downwards upon the uterus,
by mechanical contrivances ; an ardent sanguine
temperament, and a plethoric habit, or a lymphatic,
venous temperament, and a relaxed habit.
The proximate causes are, irritation, congestion, or
inflammation of the secretory vessels of the uterus ;
the various disturbances and injuries occurring during
pregnancy, and from accouchement, cancers, ulcers, tu
mours, indulgence in the pleasures of love, and of
stimulating drinks during the catamenial period.
Prognosis, — A favourable termination may be ex-
520 DISEA-SES OF THE URINARY
pected when no organic affection exists, if the patient
is moderately robust, and the disease depends upon
simple local inflammation, or the accidents arising
from pregnancy and accouchement. Many of the
floodings, however, which proceed from miscarriage,
from abnormal positions of the foetus and placenta,
and from accidents during delivery, require prompt,
bold, and judicious efforts on the part of the ac
coucheur to rescue the patient from fatal prostration.
But no woman need bleed to death under any of these
circumstances, if there is proper knowledge and de
cision on the part of the physician.
The circumstances which must render our prog
nosis unfavourable are, chronic induration or soften
ing of the uterus, cancerous and other incurable ulcer-
ations and tumours, and morbid growths within the
viscus. But even in these apparently hopeless cases,
we should never despair, for the resources of homoBO-
pathy sometimes surpass our most sanguine expecta
tions.
Therapeutics. — After having removed, as far as pos
sible, all disturbing causes, a suitable remedy may be
selected fromplatina,pulsatilla,belladonna, ipecacuanha,
sabina, secale cor.,ferrum met., arnica, china, chamomela,
sepia, bryonia, nux vom., carbo animal., acid phns.,
hyoscyamus, crocus sat., creosote.
Platina is particularly suited to females of a sensi
tive and impressible organization, and who suffer from
too frequent and too profuse catemenia. The flow is
accompanied, and occasionally preceded, by cutting
and pressing pains in the abdomen, back, and pelvis ;
dull pains in the groin and thighs ; sensation of ful
ness in the uterus ; chills alternating with flushes of
heat ; unusual sensitiveness of the genital organs ;
headache ; sadness ; debility ; restlessness ; leucor-
rhoea ; menstrual discharge red and fluid, or dark,
thick, and coming away in clots. This remedy is ap
plicable in menorrhagia arising from induration or
cancer of the womb.
Pulsatilla is useful in menorrhagia occurring in fe
males at the ''turn of life," or from schirrus uteri, or
from simple passive congestion of the uterus, or during
pregnancy and accouchement. The blood is generally
AND GENITAL ORGANS. 521
dark and coagulated, and is expelled only at intervals,
but in large quantities. In profuse haemorrhages
after delivery, when the uterus does not contract,
and the patient is much prostrated from pain and
loss of blood, pulsatilla is an excellent remedy. It
may also be given in menorrhagia characterized by
inconstant and shifting pains in the back, loins, abdo
men and pelvis.
Belladonna is our best remedy in superabundant
menstruation proceeding from irritation and active
congestion of the uterine vessels, and also in uterine
inflammations consequent upon abortions, violent
passions, or protracted continence. It is an invaluable
remedy in cerebral inflammations arising from exces
sive uterine haemorrhage.
The general indications for belladonna are, a ple
thoric habit ; ardent, sanguine temperament ; frequent
determination of blood to the head ; strong passions ;
pressing pains in the small of the back and the abdo
men ; sense of fulness in the uterus ; full and rather
rapid pulse ; vertigo and pains in the head ; nausea ;
ringing in the ears ; partial loss of consciousness ; in
flammation of the womb ; profuse discharge of bright
red blood ; flushed cheeks ; brilliant and congested
eyes ; scliirrus uteri. Belladonna has been advised in
alternation with arnica or platina, when the pains
resemble those of labour, and there is a profuse dis
charge of bright red blood.
Ipecacuanha may be exhibited when the catamenia
appear every two or three weeks, attended with pres
sure in the uterine region, and profuse discharge of
fresh blood.
Sabina is indicated in menorrhagia during and after
miscarriage, and at the menstrual period. The flood
ing is accompanied with bearing down pains in the
abdomen and pelvis ; abdominal spasms ; pain in the
uterus ; ardor urinon. and profuse discharges of dark
and coagulated blood, or of fluid red blood. Sabina is
especially useful in protracted uterine haemorrhages
arising from a loss of tone in the vessels of the uterus,
whether from previous disease or the weight and pres
sure of the foetus in utero.
Secale cornutum is recommended in hemorrhages
522 DISEASES OF THE URINARY
arising from passive congestion of the uterus, cachec
tic habit, and debility, and want of tone in the uterus,
from difficult parturition or disease. The general in
dications are, pale face ; cold surface ; feeble pulse ;
white lips ; pains and tenesmus in the rectum and
bladder; discharge of dark and offensive blood, in
creased on motion, coughing, or sneezing ; great pros
tration ; numbness ; spasms ; humming in the ears ;
obscuration of vision ; loss of contractive power in the
uterus.
Ferrum met. is indicated in profuse haemorrhages
after parturition and at the monthly epochs. The dis
charge is attended with spasmodic and labour-like
pains in the loins and uterine region ; flushed cheeks ;
hard and fall pulse ; hot skin ; headache ; hot and
scanty urine ; constipation ; shudderings.
Arnica is our remedy in menorrhagia, originating
from mechanical injuries during pregnancy or delivery,
or from blows, falls, contusions, strains, etc.
China is applicable in haemorrhage proceeding
from an asthenic condition of the uterus. It is espe
cially useful in enfeebled and cachectic females, who
flow too profusely after parturition, from an atonic
condition of the uterus and its non-contraction. A
general appearance of debility and exhaustion ;
blanched countenance ; discharge of serous or thick,
dark, and clotted blood ; pale, sunken countenance ;
restlessness ; constant fainting turns ; soft and flabby
muscles ; coldness of the extremities ; and rapid and
feeble pulse, point to this remedy.
Chamomela is adapted to bilious and nervous con
stitutions, and may be employed in menorrhagia, at
tended with pains and pressure in the pelvis ; ardor
urinae ; tearing pains in the small of the back, uterus,
and legs, with frequent discharges of coagulated blood.
It has also been highly commended in uterine hasmor-
rhages occurring at the change of life. Females of
an angry, violent and quarrelsome disposition derive
most benefit from this drug.
Sepia may be used in cases proceeding from scrofu
lous and schirrous affections of the uterine organs.
It is likewise advised in protracted chronic cases
AND GENITAL ORGANS. 523
where the system has become much exhausted from
previous disease and suffering.
Bryonia agrees with bilious and choleric females,
and is commended in menorrhagia attended with
stitching pains in the head, back, and pit of the stom
ach, when stooping, or stepping.
Nux vo?n. wrill apply in cases of menorrhagia from
uterine congestion, accompanied with spasmodic pains
in the uterus, and a discharge of clots of dark red blood.
Carbo animal, has been successfully used in a few
cases of moderate uterine haemorrhage, from chronic
induration of the uterus.
Acid phosph. is specific in too profuse menstruation,
attended with swelling and pain in the liver.
Hyoscyamus is specific in superabundant menstrua
tion of hysterical females, who experience before and
during the continuance of the flow, general spasms,
convulsive laughing or weeping, twitching or trem
bling of the limbs, headache, and occasional delirium.
The discharge is bright red.
Crocus sat. corresponds to active or passive uterine
haemorrhages. It is useful after miscarriage, when
the discharge is very profuse, dark, and viscid, and the
patient is anxious, feeble, chilly, faint, sick at stomach,
restless, thirsty, and annoyed with palpitation of the
heart, vertigo, impaired vision, vague pains in the
back and pelvis, and unpleasant dreams. Movement
and coughing increase the haemorrhage.
Kreosote is advised in passive uterine haemorrhages
originating in scirrhous degenerations of the uterus, or
in general laxity of the uterine vessels. The menses
appear too early, are too profuse, and accompanied
with a leucorrhoeal or ichorous discharge, which irri
tate the parts with which it comes in contact.
Administration. — In urgent cases of uterine haemor
rhage, we give the first attenuations, and repeat every
half-hour until medicinal symptoms appear, or the
flooding abates. In less dangerous cases, we repeat
every two, three, or four hours, so long as is necessary.
With the internal remedies, cold water may be ap
plied to the pelvic region by means of cloths. The
hips must be elevated and supported, while the head
and shoulders are lowered, and the patient be kept
cool, quiet, and free from excitement.
524
CHAPTER XXVII.
DISEASES OF THE FIBROUS AND MUSCULAR SYSTEM.
SECTION I.
ACUTE RHEUMATISM.
Diagnosis. — Acute rheumatism usually commences
after an abrupt suppression of perspiration, in conse
quence of exposure to wet, cold, or to a highly variable
temperature. It first manifests itself in the form of
slight chills, lassitude, and general uneasiness, which
are soon succeeded by swelling, redness, pain, and
augmented heat in the part affected. The pains vary
much in character, being sometimes aching and gnaw
ing, at others, lancinating and darting, or dull and
throbbing, or numb, pungent, and prickling, and ag
gravated by movement, by exposure to drafts of cold
air, and by the pressure, or touch of the hand. In the
first instance, rheumatism seizes upon the fibrous tex
tures, but as the inflammatory action becomes devel
oped, other tissues become involved, the capillaries of
the neighbouring parts become distended with red
blood, and the usual phenomena are present. The
larger joints are more subject to rheumatic inflam
mation than other parts of the body, although it is not
uncommon for the inflammation to commence in the
head, neck, chest, arms, or legs, and gradually ex
tend into the neighbouring joints. The more common
accompanying symptoms of acute rheumatism are,
bitter taste in the mouth, coated tongue, rapid and full
pulse, moderately hot skin, thirst, scanty, high-coloured
and sedimentitious urine, intense pain on moving the
affected part, anxious and distressed expression of
countenance, and occasional perspiration.
Rheumatic inflammations are liable to shift from
joint to joint, and sometimes to fix upon important in
ternal organs, like the brain and its membranes, the
pulmonary structures, and the heart, and its appen
dages. So long as the malady confines itself to the
joints, or to the external parts of the body, it is unat-
DISEASES OF THE FIBROUS, ETC. 525
tended with danger to life ; but when metastases occur
to important internal organs, the disease becomes in
an eminent degree perilous.
Acute rheumatism occurs for the most part, in young,
healthy, and robust subjects, and can be generally
traced to undue exposure to cold, or to a wet and varia
ble atmosphere.
Chronic rheumatism differs from the acute form in
many respects ; as for example, absence of febrile
symptoms ; the fixed character of the pains ; no per
ceptible swelling or redness in the affected parts ; the
pains sometimes aggravated, and at other times ame
liorated by walking, and other exercises ; great sensi
bility of the diseased tissues to changes of temperature,
to humidity, and to cold ; dryness and inactivity of
the skin ; rigidity in the parts, most apparent when
attempting to move, or to walk, after having been
quiet for a considerable period ; sedimentitious urine ;
weakness, trembling, or numbness of the disordered
parts.
Therapeutics. — We enumerate as the principal reme
dies, rhus, bryonia, aconite, colchicumj belladonna, pul-
satilla, dulcamara, mercurius, nux vomica, phosphorus,
calcarea carbonica, veratrum, hepar sulphur, arnica,
colocynth, lycopodium, sulphur.
Rhus tox. — External indications. — The integuments
about the joints swollen and red ; surface of the body
hot and moist ; tongue dry and red ; pulse frequent,
and hard ; urine dark, or red, and turbid.
Physical sensations. — Drawing and tearing, or ten
sive stinging and dragging pains in the affected parts,
increased by exposure to cold, by rest, and by move
ment after having been for some time quiet ; rigidity,
lameness, and weakness of the muscles in the vicinity
of the diseased textures ; increase of the febrile symp
toms, and of the pains, at night, in bed ; perspiration,
especially during the pains ; pains alleviated by ex
ercise ; throbbing, and burning in the knees, or ancles ;
painful involuntary contractions of the muscles of the
calves of the legs ; chronic rheumatic pains occurring
early in the morning, and disappearing on moving
about.
526 DISEASES OF THE FIBROUS
Mental and moral symptoms. — Intellect unimpaired ;
disposition irritable and impatient.
Administration. — One drop of the first dilution may
be given in a dessert spoonful of water, every two or
three hours, until the pains begin to subside, or until
a medicinal action is produced upon the inflamed tis
sue.
Bryonia. — External indications. — Swelling and red
ness of the inflamed textures ; countenance pale or
sallow, or flushed and hot ; tongue covered with a
white or yellow fur ; hot and dry surface, or perspi
ration of an acid character after exercise ; considerable
thirst, frequent and soft pulse ; red or yellowish urine;
position such as to relax the muscles bearing upon
the diseased parts.
Physical sensations. — Pains of a tearing, throbbing,
or lancinating character, aggravated by movement, by
the touch, by the contact of cold air, and by eating ;
a relaxed state of the muscles, and perfect rest, affords
almost entire relief from suffering ; bitter taste, or
dryness of the mouth, with thirst ; nausea ; bilious
vomiting ; severe pulsating headache ; morbid sensi
bility of the whole surface to the touch ; stitching
pains in the region of the liver, and in the intercostal
muscles ; symptoms worse during the night.
Mental and moral symptoms. — General uneasiness,
anxiety, and irritability ; sleeplessness.
Administration. — The second or third dilution may
be employed — a dose every two, three, or four hours,
as the symptoms appear to require. For the active
febrile symptoms which occasionally accompany the
affection, we are in the habit of prescribing aconite
and bnjonia in alternation, with satisfactory results.
Colchicum is a valuable remedy in both acute and
chronic rheumatism. The pains are lancinating,
jerking, or tearing, worse in the night, and increased
by care, anxiety, or movement : or, there may be only
stiffness and lameness in the joints, when attempting
to walk, with oadematous swellings of the parts in the
vicinity of the inflammation. Dr. Schroen commends
colchicum in those cases which resist the clearly indi
cated medicines, provided the skin is moist, and the
urine is turbid. Dr. S. advises it to be given in the
AMD MUSCULAR SYSTEM. 527
form of vini seminis colchici, and in doses of twelve
drops daily. We have found a single drop of the first
dilution, repeated once in from three to six hours, ac
cording to the acute or chronic nature of the case,
very efficacious, in several obstinate cases which had
resisted the action of other medicines.
Belladonna will prove an excellent remedy, in rheuma
tic attacks accompanied with a high degree of nervous
irritability, and a morbid activity of the cerebral or
gans. The pains are very severe, especially at night,
increased by touch, or by remaining too long in one
position.
Pulsatilla is indicated when the pains shift rapidly
from one part to another, and are unattended with
any great swelling or redness of the integuments ; al
so, in chronic rheumatism characterized by weakness,
rigidity, coldness, and sensation of weight in the dis
ordered structures.
Dulcamara often proves speedily curative in rheu
matic inflammations which have been caused by ex
posure to cold and dampness. The affected parts usu
ally feel as if bruised or beaten, and after remaining
for some time in one position, are attacked with se
vere pains which do not subside until the patient
moves about. The pains are most common in the
back, and in the joints of the arms and legs.
In cases of frequently recurring rheumatism, of
scrofulous or psoric subjects, we must use one or
more of the following medicines : calcarea carbonica,
sulphur, lycopodium, mercurius.
When the disease has become chronic and invete
rate, and abnormal depositions occur about the joints,
with thickening of the membraneous tissues, and per
manent rigidity, weakness, and tenderness on motion,
a persevering employment of rhus, or hepar sulphur,
or mix, or phosphorus, or veratrum, or lachesis, will in
duce curative results of the most satisfactory charac
ter.
Other medicines which have occasionally proved
successful in rheumatic affections, are, colocynth, io
dine, ferrum, china, arsenicum, arnica, carbo vegetabilis,
and hyoscyamus.
Administration. — In the acute form of the malady,
528 DISEASES OF THE FIBROUS
we employ from the third to the sixth attenuations,
and repeat the doses every two hours until a medicinal
impression is evident. In chronic rheumatism, we
prefer the first attenuation, and prescribe a dose once
or twice daily.
SECTION II.
ARTHRITIS. GOUT.
Although rheumatism and gout are described by
authors as different diseases, it is altogether probable
that the nature of the inflammatory action is the same
in both instances. When this peculiar inflammation
seizes upon the young and robust, and pervades the
larger joints and the muscular structures, it receives
the name of rheumatism ; but when individuals ad
vanced in life, are the subjects of attack, and it ap
pears in the small joints, it is recognised as gout.
A fit of the gout is almost always preceded by some
gastric or intestinal derangement, like impaired appe
tite, furred tongue, bitter taste, acid or bitter eructa
tions, flatulent distention of the stomach and intestines,
and occasionally diarrhrea. The inflammation is, for
the most part, situated in the ball of the great toe, but
it may attack any of the smaller joints, and as the dis
ease advances, the veins in the vicinity of the pain
become distended ; the integuments swollen, cedema-
tous, arid of a bright scarlet colour ; the pains become
severe, of a darting, throbbing, or a persistent ach
ing and burning character, increased by contact or by
movement ; there is an almost entire loss of muscular
power of the affected parts ; the pains are worse du
ring the night, and accompanied during this period by
active febrile symptoms ; nearly all the functions of
the organism are sympathetically deranged ; the urine
is small in quantity, high coloured, and becomes tur
bid on standing ; the patient is restless, irritable, and
morbidly sensitive to moral and physical impressions.
The disorder usually arrives at its maximum of inten
sity, in two or three days from the commencement of
the inflammation. At this period, the whole toe, and
sometimes the foot itself, become oedematous, and the
numbness and prickling are frequently experienced in
AND MUSCULAR SVSTBM.
the swollen textures, especially during the day : the
pains and the nightly febrile exacerbations, now com
mence subsiding, until at the end of from seven to ten
days, the active inflammatory symptoms have disap
peared and left the patient with a debilitated and
cedematous limb.
When the paroxysms of acute gout occur very fre
quently, they serve, after a time, to impair the consti
tution, to cause permanent thickenings of the articu
lar membranes, or cretaceous deposits about the joints,
and to induce that condition of the parts which leads
to chronic gout. This form of the complaint is cha
racterized by dull, burning, or tensive pains, oedema,
thickening of the membranes of the affected joint,
with rigidity, weakness, and partial loss of muscular
power ; more or less gastric derangement, augmented
sensibility of the mind and body to external impres
sions, depression of spirits, and general restlessness
and irritability.
Causes. — Gout is generally supposed to be heredi
tary, although cases are constantly occurring in which
no natural predisposition can be traced. There is no
doubt, however, that in the majority of instances, an
hereditary predisposition exists. The exciting causes
of gout, are, high-living, want of sufficient exercise,
abuse of stimulants, especially wines, and general ir
ritability of the nervous system, from loss of rest, and
irregularity in eating.
Therapeutics. — The principal remedies for acute gout,
are, bryonia, nux vomica, colchicum, bell., aconite, rhus,
pulsatilla, actcea spicata, actcca racemosa, guaiacum, ar
nica, arsenicum,, china, ledum, sabince, cantharides. For
chronic gout, the best remedies are, calcarea carbonica,
sulphur, phosphoric acid, aururn muriate, iodine, hepar
sulphur, phosphorus, mercurius, sepia, silicea.
It will very commonly happen that several of these
medicines will cover most of the manifest symptoms
which are usually present in gout, but in making our
selection, the strictest regard should be had to all re
mote and exciting causes which may have exercised
an influence in originating the malady, in order that
we may strike deeply at the foundation of the disturb-
23
530 HYDROPS. DROPSY.
ance, as well as at the more immediate and visible
phenomena.
In prescribing for gout, we may be governed by the
general indications for the different medicines, as
pointed out in the last section.
CHAPTER XXVIII.
HYDRO PS. — DROPSY.
SECTION I.
General description. — Dropsy is generally but a mere
symptom of some other affection. Its proximate cause
consists in an inflammation, congestion, or exalted
action of the capillary extremities of the arterial ves
sels of the serous and cellular membranes,, and a tor
por or inactivity of the venous absorbents of the same
parts.
The remote and general causes of dropsy are, exces
sive loss of blood, and other animal fluids ; general
debility resulting from disease, mechanical injuries,
obstructions of the liver, spleen, kidneys, veins, lungs;
abuse of drugs and stimulating drinks. At first view,
an inflammation or congestion of the serous exha-
lents, would seem to be incompatible with general
debility, arising from excessive loss of blood, and dis
eases of the liver, kidneys, lungs, spleen, &c., but the
fact is now well established, that these circumstances
actually favour the formation of these very capillary
inflammations and congestions.
Some writers maintain that serous effusions do not
occur until the active inflammatory symptoms are pass
ing off, and a state of sub-acute inflammation obtains ;
while others, like Laennec, and Johnson, lay it down
as a fundamental law of serous membranes, " that
they begin to effuse the moment they become in
flamed." It is true that acute inflammations of serous
membranes often occur and subside without leaving
any traces of effusion, but this is owing to the fact,
HVTDROPS. DROPSY. 531
that, during the general febrile excitement, the venous
absorbents of the affected cavities, being equally
irritated with the exhalents, exercise their functions
with preternatural activity, thus conveying off the
fluid as fast as exhaled, and securing the equilibrium
between exhalation and absorption. After the inflam
matory symptoms have subsided, if the exhalents and
absorbents both recover their tone, health returns ;
but, as frequently happens, if the latter remain feeble,,
while the former return to their normal state, the
healthy balance is lost, and dropsy is the result.
In health, " the cellular tissue and all of those cavi
ties lined by serous membranes, are continually lubri
cated by a fluid which exhales from the capillary ex
tremities of the arterial vessels." — (Frank.} This
fluid serves to render the parts soft, pliable, and mo
bile, and to prevent the adhesive inflammation which
would otherwise occur from friction during the move
ments of the body. These exhalents give out nearly a
given quantity of vapour, and a due equilibrium is
established between the amount secreted for the use
of the organism, and that which is afterwards taken
up by the venous extremities, and thrown off by the
skin, kidneys, salivary glands and intestines. So long
as this proportion is maintained, all goes on well ; but
whenever any of the serous membranes, like the peri
toneum, the pleura, the pericardium, or the arachnoid,
secrete more fluid than is required for the wants of the
economy, or than can be absorbed by the venous ex
tremities, then drafts are made upon other and healthy
parts to supply the increased demand. On this ac
count the perspiration becomes suppressed, and the
skin dry and husky, the saliva scanty and viscid, the
urinary secretions small, high-coloured, fetid, and sed-
imentitious, the stools scanty and difficult, and the
functions generally deranged.
In cases of dropsy arising from excessive loss of
blood or starvation, the normal physical condition of
this fluid is changed, — the impression it produces upon
the structures is altered, and a superabundance of
serum is poured out into the cavities and the cellular
tissue. This increased exhalation may be due either
to the greater affinity which the serous membranes
532 HYDROPS. DROPSY.
exert upon the altered blood, or to an irritation of the
capillary extremities which induces an exaltation of
their exhaling function. The experiments of Mat-
teucci teach us, that different fluids pass through the
animal membranes in definite quantities and with
certain degrees of rapidity, according to the char
acter of the fluids used and the condition of the tissue
operated upon. These different phenomena are termed
endosmose and exosmose, and it is by no means im
probable that some varieties of dropsy may be par
tially dependent upon this peculiar action.
Another very important circumstance connected
with the formation of dropsies, is alluded to by Eberle,
in his Practice of Medicine, viz., "I have already
observed, that immediately after a profuse loss of
blood, absorption goes on with unusual activity.
The blood-vessels are rapidly replenished with crude
fluids ; for the absorbents being extremely active,
nearly all .the aqueous fluids, received into the stom
ach, are speedily absorbed into the circulation ; and
this is especially favoured by the very great thirst
which almost always occurs after excessive sanguine
ous losses. The blood being thus inordinately supplied
with a crude and watery fluid, becomes more irritating
to the heart and capillaries, and diluted to such a degree
as to pass off more rapidly by the exhalents." Direct
experiments on animals have proved that artificial
dropsies may be produced, by abstracting blood, and
drenching them with water. On the other hand, Ma-
jendie and Matteucci have equally demonstrated, that a
fulness of the blood-vessels very materially retards, and
in some instances, entirely suppresses the function of
absorption.
We think, then, it may be safely concluded, that
in every case of dropsy, there are two simulta
neous morbid conditions present, namely, increased
exhalation, and decreased absorption, and that, although
irritation and congestion of the exhalents are generally
indispensable conditions to this morbid action, yet that
effusion may result in certain cases simply from an
alteration in the character and quantity of the blood,
by endosmose.
Dropsies are acute or chronic, primitive or seconda-
HVDROPS. DROPSY. 533
ry, simple or complicated ; and the character of the
effusion is dependent upon the age, sex, and constitu
tion of the patient, and the nature of each particular
case. Generally, however, the fluid is composed of
albuminous matter dissolved in more or less water,
with different phosphates and carbonates and a little
sulphur, (Frank,) of an oily character, of a citron,
orange, or straw colour, and of a consistency semi-
gelatinous, or like the white of eggs. But these ap
pearances are sometimes subject to variations, as cases
are reported in which the liquid was brown, white,
green, purulent, bloody, saccharine, urinous, and in
some instances containing substances like hydatids,
and bits of membrane.
Much light is sometimes thrown upon the nature
and causes of dropsy, by an examination of the urine.
In certain cases of anasarca, for example, it is found
that the urine coagulates on the application of heat,
and from this circumstance we may suspect the exist
ence of the disease so ably described by Dr. Bright,
under the name of granulated kidney. The application
of heat in these cases, first causes the urme to become
milky, and afterwards to present a curdled, or flaky
appearance. "In hydrothorax following scarlatina,
the urine is mixed with cruorine ; in hydrothorax de
pending upon degeneration of the spleen and liver, the
urine contains a large quanity of urea and uric acid,
rosic acid and purpurate." — (Hartmann.) In other
instances we find the urine loaded with albumen.
In acute dropsies the effusion does not occur until
the active inflammatory symptoms are passing off,
and a condition of sub-acute inflammation supervenes.
In these cases, also, the exhalation takes place with
more rapidity, and is attended with more painful
symptoms, than in the chronic varieties. Now and
then slight accumulations take place, which remain
stationary for years, when they entirely disappear, or
the morbid condition of the exhalants returns, and the
disease advances to its full development. Instances of
this description are often observed in hydrocele, and
in ovarian dropsy.
An excellent diagnostic arrangement of the dropsies
534 HYDROPS. DROPSY.
has been made by Marshall Hall, founded upon their
causes, viz :
" 1. INFLAMMATORY DROPSY.
" First. . The history. — This form of dropsy generally
takes place rather suddenly, and is to be traced to
exposure to wet and cold."
" Second. The symptoms consist in the appearance
of diffuse, tense anasarca, generally with dyspnoea,
and frequently with the signs of effusion into the head,
thorax, or abdomen, and with a coagulable and oc
casionally a sanguineous condition of the urine,"
" Third. The morbid anatomy varies according as the
dropsy is confined to the cellular membrane, or ex
tended to the serous membranes ; in the latter case there
is frequently the effusion of coagulable lymph, as well
as of serum, from the serous surfaces. The kidney,
in protracted cases, becomes disorganized, granular,
scabrous, etc."
" 2. EXANTHEMATOUS DROPSY.
*' First. .T^e history. — This form of dropsy succeeds
to some exanthematous diseases, but by far most fre
quently to scarlatina"
" Second. The symptoms are similar to those just de
tailed as designating inflammatory dropsy ; there is the
same disposition to effusions into the brain, thorax
and abdomen."
" 3. DROPSY FROM EXHAUSTION.
" First. The history and symptoms. — This form of
dropsy is known by being traced to the loss of blood.
It occurs in the form of anasarca, and of effusion into
the cavities. I do not know whether the urine be
coagulable."
" Second. A similar form of dropsy is induced in
cases of neglected chlorosis."
"4. DROPSY FROM DEBILITY.
" First. The history and symptoms sufficiently estab
lish and distinguish this form of dropsy. The patient
has frequently had returns of dropsical affection, and
HYDROPS. DROPSY. 535
has a pale and cachectic appearance. The urine
coagulates into brownish flakes by exposure to heat."
" 5. DROPSY FROM OBSTRUCTION IN THE FLOW
OF VENOUS BLOOD.
" This form of dropsy arises from —
" First. Disease of the heart, especially of the valves"
" Second. Disease of the lungs."
" Third. Disease of the liver, especially the ' cirrhose.' "
" Fourth. Pressure, or disease, of the veins them
selves"
" The history and symptoms. — This kind of dropsy is
distinguished by ascertaining the seat and nature of the
original disease. Like the rest, it assumes the form of
anasarca, and of effusion into the serous cavities, and
into the cellular membrane of the internal organs, as
the lungs, intestines, &c. The urine is not coagulable"
"6. DROPSY FROM DISEASE OF THE KIDNEYS.
" For the detection of this species of dropsy, the
profession and mankind are indebted to Dr. Bright."
" First. The symptoms. — It is distinguished by the
coagulable condition of the urine. The urine is apt
sometimes to be sanguineous."
" Second. The complications. — There is, in this kind
of dropsy, occasionally —
" First. An attack of apoplexy ; and frequently,
" Second. Inflammation of the serous membranes, and
especially of the pleura."
" The liver is usually found free from disease.
" The morbid anatomy. — Dr. Bright describes three
kinds of this disease of the kidney. In the first, the
kidney loses its usual firmness, and becomes of a yel
low mottled appearance externally. The size of the
kidney is not materially altered. In the second, the
whole cortical part is converted into a granulated tex
ture, and there appears to be a copious morbid inter
stitial deposit of an opaque white substance. The
kidney is generally rather larger than natural. In the
third, the kidney is rough and scabrous externally, and
rises in numerous projections not much exceeding a
large pin's head, yellow, red, and purplish ; it is hard
and inclined to be tabulated, and its texture approaches
536 HYDROPS. DROPSY.
to a semi-cartilaginous firmness ; there appears, in
short, a contraction of every part of the organ, with
less interstitial deposite than in the last variety."
General diagnosis. — The symptoms most commonly
observed in dropsy are, sensation of weight, oppression,
fulness, and uneasiness in the part affected, with more
or less disturbance of the neighbouring tissues ; dys
pnoea and sense of suffocation after attaining the hori
zontal posture, and after active exercise ; general
feeling of debility, and disinclination to bodily or men
tal exertion ; partial, and in some instances, almost
total suppression of the urinary, salivary, and perspi
ratory secretions ; impaired appetite ; feeble digestion ;
rare and scanty alvine discharges ; thirst ; countenance
pale, sallow, or cachectic ; emaciation ; ** diminution
of animal heat, sensation, and motion," (Frank,) gen
eral derangement of nearly all the functions.
In cellular dropsy, the affected part is swollen, the
skin presents a smooth and shining appearance, with
blue veins traversing it in different directions, and pres
sure with the finger causes a deep indentation or pit,
which remains for a considerable time. There is also
an apparent diminution in the temperature of the part,
and a sensation of weight and tension is experienced,
rather than of acute pain. The accumulation of
serum becomes so great in some instances as to burst
through the integuments, and thus partially discharge
itself.
In acute dropsies of the serous membranes, the symp
toms are more active. Here we have general febrile
disturbance ; acute tenderness and pain in the disor
dered part, especially on pressure, or contact of light
clothing ; urgent thirst ; hot and dry skin ; urine very
scanty and high-coloured ; saliva viscid, tenacious,
and small in quantity ; loss of appetite ; furred tongue ;
rapid sinking of the physical energies. These acute
symptoms often subside, and leave the inflamed mem
brane in a state of sub- acute inflammation, thus de
veloping a well-pronounced chronic dropsy.
It will be observed in our previous description of
symptoms, that we have included a diminution of the
urinary, salivary, and intestinal secretions, as charac
teristic of this malady : but these signs are not inva-
HYDROPS. DROPSY. 537
riably present, for in a few instances we have wit
nessed an abundant and natural urinary and salivary
secretion during the continuance of the complaint.
So, also, one or more of the other symptoms described
may be wanting, and yet the dropsical affection pro
ceed to a fatal termination ; but these circumstances
are rather to be looked upon in the light of exceptions,
than as general occurrences.
Prognosis. — Our prognosis must depend much upon
the cause and nature of each particular case. Simple
cellular or serous dropsies, uncomplicated with disor
ganization of any of the important organs, are, for the
most part, curable. In this class we may rank exan-
thematous dropsies, and those which have arisen from
loss of blood, from acute diseases in which no serious
organic derangement has occurred, and from abuse of
mercury and other drugs. In these cases, a speedy
removal of the causes which have conduced to the
disease, with pure air, a generous diet, and a judicious
course of homoeopathic medicines, will generally ena
ble us to remove permanently the morbid accumulation.
On the contrary, if the effusion has arisen from an
organic affection of a vital organ, like the heart, the
liver, the lungs, the kidney, or from incurable obstruc
tion in the veins, our prognosis must be unfavourable.
In these cases of complicated dropsy, our remedial ef
forts must be adapted to the remote general disease,
as well as to the immediate symptoms of the malady.
Although the chances of cure are small in cases of this
description, yet, as recoveries do occasionally take
place in individuals of naturally vigorous constitu
tions, and in those who are tenacious of life, we should
never prostrate our patients by discouragement and a
grim visage, but constantly point them to a beacon of
hope in the dim distance By this means, we secure
a powerful auxiliary to co-operate \vith us in our
efforts to bring about those changes in the organism
which may lead to a cure.
We come now to treat of the different species of
dropsy, viz. :
First. Anasarca. Second. Ascites.
Third. Hydro thorax. Fourth. Hydrocephalus,
Fifth. Ovarian dropsy. Sixth.
*
538 HYDROPS. DROPSY.
1. ANASARCA. CELLULAR DROPSY.
Diagnosis. — The term anasarca is used to designate
that variety of dropsical effusion which takes place
from the exhalents of the sub-cutaneous cellular tis
sue. The malady first manifests itself in the inferior
extremities, particularly after standing or walking for
some time, and it gradually extends upwards until the
whole sub-cutaneous cellular tissue of the organism
becomes involved. The tumefaction is usually soft,
doughy, and inelastic, pitting on pressure, and the
skin is white, shining, and below the medium temper
ature. The swelling disappears, in a great measure,
after the patient has been for some time in the recum
bent position, but returns again when he has resumed
the erect posture. Cellular dropsy may exist for
years without causing serious inconvenience, when
confined to the inferior extremities, but it is rare that
the whole cellular surface becomes involved, unless
some vital disorganization exists, or the energies of
the system have become dangerously impaired.
The cases of anasarca attended with the least dan
ger, are those arising from scarlatina, pregnancy, loss of
blood, debility consequent upon convalescence from
acute diseases, abuse of arsenic and mercury, enlarged
inguinal glands, the pressure of tumours, or any other
curable cause which operates to prevent the free re
turn of the venous blood.
Effusions of this kind may very properly be termed
passive dropsies, for we agree with Dewees, " that
there are both active and passive dropsies, or rather
dropsies that depend upon an increase of action or of
inflammation, and others where there may be a mere
loss of balance between the exhalation and absorp
tion."
In cases of dropsy arising from venous obstruc
tion, for example, the venous absorbents below the
seat of the obstruction, are preternaturally distended
with blood, and, as a consequence, their powers of
absorption proportionally diminished, while the arte
rial exhalents exercise their function with the usual
activity. In this manner the equilibrium between ex
halation and absorption is destroyed, and dropsical
HYDROPS. DROPSY. 539
accumulations obtain. So in phthisis pulmonalis, and
affections of the heart, the blood being but imperfect
ly decarbonized in its passage through these diseased
organs, becomes congested in the venous absorbents,
and thus gives rise to diminished absorption, and con
sequent serous accumulations.
Anasarca is not usually attended with much con
stitutional disturbance, or with symptoms that are
painful. There are present, however, coldness of the
surface, and diminished secretion of urine and sweat.
The countenance is also pale and sallow, and the
general appearance indicates ill-health. Not unfre-
quently the effusion continues to increase until the
affected parts become enormously distended, and fi
nally crack and give issue to the accumulated serum.
When this happens in erysipelatous or syphilitic sub
jects, sloughing and gangrenous ulcers sometimes su
pervene, which prove highly troublesome and danger
ous.
Causes. — The peculiar condition consequent upon
scarlatina, measles, phthisis pulmonalis, chlorosis, and
diseases of the heart ; venous obstructions caused by
the gravid uterus, by the pressure of tumours, enlarg
ed glands, ligatures, and mechanical injuries, sudden
and excessive loss of blood, abuse of stimulants,
arsenic and mercury.
2. ASCITES, OR ABDOMINAL DROPSY.
Diagnosis. — Dropsy of the' belly may arise suddenly
in consequence of acute peritoneal inflammation, and
be attended with the ordinary symptoms of other
febrile diseases, or it may make its appearance in a
gradual and imperceptible manner, unattended by any
notable constitutional disturbance. During attacks of
peritonitis, there is an increased exhalation from the
inflamed serous vessels, from the very commencement
of the disease, and so long as the whole organism
labours under the exalted action incident upon the
fever, the venous absorbents dispose of this super
abundance of serum ; but after the active symptoms
have subsided, a corresponding depression obtains in
all parts of the economy, except, perhaps, the affected
540 HVDROPS. — Diiorsv.
membrane, in which there still may remain a sub-
acute inflammation and its consequence, a preter
natural effusion of serum. In vigorous constitutions,
the absorbents continue to remove the exhalation as
fast as formed ; but in feeble, delicate, or scrofulous
subjects, the function of absorption often languishes,
the equilibrium between the exhaling and absorbing-
functions is destroyed, and an ascites is the result.
The signs which characterize abdominal dropsy are,
gradual enlargement of the abdomen, first observed in
the epigastric region, and afterwards extending over
the whole abdomen ; tenderness on pressure ; diffi
culty of breathing on taking exercise, and some time
after lying down ; distinct fluctuation on percussion ;
sallow and unhealthy complexion ; dry skin ; scanty
secretion of high-coloured and sedimentitious urine ;
foul tongue, with a small secretion of viscid saliva ;
impaired appetite ; constipation, or relax ; sensation
of weight and stiffness, particularly when attempting
to move about, or bend the body ; general feeling of
languor and debility.
The only diseases which are liable to be confounded
with ascites, are pregnancy and tympanitis ; but the
history and circumstances of each case will enable us
to distinguish with sufficient facility and certainty be
tween the different maladies. In ascites, the situation
of the swelling, the fluctuation on percussion, the
suppression of urine, dry skin, and the previous his
tory of the case, will mark the nature of the com
plaint ; and in pregnancy, the gradual swelling at the
lower part of the abdomen, the suppression of the
menses, nausea and vomiting ; the absence of fluctu
ation on percussion, and the motion of the child, will
render our diagnosis accurate. Nor will the acute
physician ever mistake tympanitic distention for
ascites : for percussion, auscultation, and an absence
of the characteristic symptoms of dropsy, will enable
him to decide at once in regard to the real nature of
the case. Indeed, we can hardly conceive how cer
tain eminent surgeons should have been led to perform
the operation of what they have afterwards facetious
ly termed " dry tapping" when the distinguishing
HYDROPS. DROPSY. 541
marks between tympanitic and aqueous distention are
so easily recognised.
Authors have described several distinct varieties of
abdominal dropsy, and have named each according to
its precise location ; thus, sub-cutaneous ascites, in
which the effusion takes place in a circumscribed
cavity or sac in front of the abdominal muscles ; va
ginal ascites, arising from a puncture or other injury
to the aponeurosis of the muscles, and causing effusion
into the sheath of the muscle ; peritoneal ascites, or
effusion within the serous cavity, and in some rare in
stances, on the outside of the membrane ; Jiydatid as
cites, in which the water is enclosed in one or more
thin vesicles ; also dropsy of the epiploon, of the me
sentery, of the intestines, of the liver, of the spleen, of
the gall-bladder, and encysted ascites. This minute
classification is, however, quite unnecessary for prac
tical purposes, since ascites is often complicated not
only with several of these varieties, but with hydro-
thorax, anasarca, and general dropsy. It is so very
rare that we find the above-named organs affected
separately, that we question the propriety of recog
nising in them distinct species of dropsy, although it
is of some importance to be aware of the fact that
these distinct effusions may occur.
Causes. — The most common causes of ascites are peri
toneal inflammation, affections ofthe liver, and abuse of
stimulating drinks. It may also proceed from venous
obstruction, general debility in consequence of disease,
loss of blood, and abuse of drugs.
Prognosis. — Our opinion respecting the probable
termination of ascites will be determined by the fol
lowing circumstances : old age, and a constitution im
paired by previous disease or by excesses, must al
ways render our prognosis unfavourable. Dropsies
complicated with incurable functional derangement of
the liver, or other vital organs, and venous obstruc
tions, are for the most part beyond the reach of medi
cine. On the other hand, ascites consequent upon
acute inflammation of the peritoneum, loss of blood,
abuse of stimulants and drugs, and the debility arising
from fevers and other acute diseases, may generally
be set down ns rumble. When the maladv occurs in
542 IIYDROPS. DROPSY.
young and naturally robust constitutions, our prognosis
will be still more favourable, and in some instances,
may afford grounds of encouragement in highly com
plicated cases.
Paracentesis abdominis, or tapping. — This operation
should always be deferred as long as possible, in order
to allow a reasonable time for the action of medicines.
If, however, the accumulation becomes very great,
and the symptoms are so urgent as to prevent all ex
ercise, destroy rest in a sitting or recumbent posture,
and thus serve to wear out the energies of the system,
the operation should not longer be delayed. At the
same time, the most judicious medicinal treatment
should be perseveringly directed to both the proxi
mate and remote symptoms of the malady. The ope
ration of tapping is of itself simple, and entirely unat
tended with danger when proper precautions are used ;
but as the effusion usually takes place with much
more rapidity, after the serum has been evacuated, than
before, it will be apparent that paracentesis abdominis
should only be had recourse to when the symptoms
are particularly urgent.
3. HYDROTHORAX, OR DROPSY OF THE CHEST.
Hydrothorax is either idiopathic, or symptomatic of
some other organic disease. By far the most common
source of the affection, and one which constitutes a
serious complication, is organic disease of the heart.
Another frequent cause of dropsy of the chest, is pro
tracted pleuritic inflammation. Dropsy of the heart
generally co-exists with hydrothorax, and it is for this
reason that we so often find the pulse very irregular.
The symptoms are most urgent during the night, after
the patient has remained some time in the recumbent
posture. The breathing becomes rapid, laborious, and
grunting, with frequent sighing, sudden starting during
sleep, anxious and distressed expression of counte
nance, face pallid and wax-like ; small secretion of
high-coloured urine ; puffiness of the face and extremi
ties ; fulness of the chest ; dull sound on percussion.
Dyspnoea occurring from the slightest exercise, or
from lying down, sudden starting up with fright, du
ring sleep, dull sound on percussion, and irregular
HYDROPS. DROPSY. 543
pulsations of the heart, will enable us to recognise the
affection without difficulty.
Laennec assures us that hydrothorax accompanies
many acute and chronic diseases, and that " its pre
sence announces the approach of death, which it often
precedes only a few moments." That these effusions
do sometimes occur but a short period before death,
from organic affections of the heart, and possibly of
other organs, we entertain no doubt, for several cases
have come under our observation, strongly corrobora
tive of this fact.
As dropsy of the heart is so constant an attendant
on hydrothorax, and the symptoms of each so constant
ly similate each other, it is unnecessary to enter into
a separate description of this malady. When the ef
fusion originates from an affection of the heart, or the
pericardium, there will always be a predominance of
those symptoms which characterize cardaic disease,
and afford us a sure guide in forming our diagnosis.
Paracentesis thoracis may, in some instances, be re
sorted to with unequivocal advantage, for the relief of
purulent collections within the thorax, but very rarely
in hydrothorax. We have in two instances saved life by
a prompt resort to this operation, where matter had
accumulated in the chest, and the patients were at the
point of death from suffocation ; but in thoracic drop
sies, very slight encouragement can be offered from
its performance, although in extreme cases it is, not to
be lost sight of, since recoveries have now and then
taken place after the operation.
4. OVARIAN DROPSY.
Iii this species of dropsy, the effusion takes place
from the internal face of the membrane which encloses
the ovarium. The swelling is first observed in the
iliac region, in the form of a small elastic tumour, and
unattended with pain, uneasiness, or constitutional
disturbance. The enlargement generally progresses
very slowly, extending upwards towards the kidney
of the affected side, then crossing the abdomen to the
opposite side, until ultimately it comes to occupy the
whole of the abdomen. No serious inconvenience is
experienced, until the tumour has attained such a size
544 HYDROPS. DROPSY.
as to encroach upon the bladder, stomach, diaphragm,
intestines, and the larger blood-vessels, thus giving
rise to difficulty in urinating, sense of weight and un
easiness in the stomach, dyspnoea, colicky pains in the
bowels, pains in the side and chest, diminution of the
secretions, and oedema of the feet and ankles.
The tumour often remains stationary, and almost
unnoticed for twenty or thirty years, when some sud
den exciting cause will operate, and the swelling ra
pidly attain an enormous size.
The contents of ovarian tumours vary much in their
character, being sometimes serous, sometimes albumi
nous, or purulent, or sebaceous, or fatty, or composed
in part of organized structures. Dr. Clapp, Surgeon
to Exeter Hospital, has recently reported a case in
which the contents of the tumour " consisted of teeth,
hair, bony deposit, some transparent masses of a cel
lular structure, (as examined by the microscope,) se
rum, sebaceous matter, and granular fat, which were
contained in numerous small cysts. Teeth were found
in all parts of the tumour, and were counted to the
number of forty-three ; some were contained in cysts,
others were imbedded in the semi-transparent masses,
and two or three were growing from the walls of the
parent cyst. In one part, a few were imbedded in a
mass of bone, bearing a strong resemblance to an
upper jaw united in the mesial line."
Fluctuation can rarely be perceived in the swelling
until it has attained a considerable size, but the loca
tion of the tumour, and the absence of pain or other
unpleasant symptoms, will enable us to form a correct
opinion in the early stage of the complaint.
5. HYDROCELE, OR DROPSY OF THE TESTICLE.
A description of this disease is appropriate to sur
gery rather than to medicine, but as the usual method
of cure serves to corroborate the truth ofsimiliasimili-
bus, we make some allusion to the subject in this place.
The fluid of hydrocele is situated within the tunica
vaginalis testis, commencing at the lower part of the
scrotum, and gradually extending upwards until it
reaches the external abdominal ring. The tumour is
pyriform in shape, firm and elastic to the touch, and
HYDROPS. DROPSY. 545
unattended with pain. It is only troublesome from its
bulk and weight.
Much difficulty is sometimes experienced in distin
guishing this disease from enlargements of the testi
cle, and in more than one instance, we have seen this
gland destroyed by injudicious attempts to draw off
wafer from chronic enlargements of the substance of
the gland. Generally, dropsy of the testicle may
be recognised by its peculiar elasticity, its lightness,
form, its origin at the lower part of the scrotum,
and its gradual extension upwards, and, lastly, by its
transparency. By placing the swelling in front of a
lighted lamp in a dark room, its character will be
apparent from its transparency. But in some cases,
from the great thickness of the tunica vaginalis, or the
dark colour and density of the enclosed fluid, no
transparency can be perceived. In these instances,
we must be guided by the fluctuation, lightness, form,
painlessness, and general history of the case.
Accumulations of fluid also occur within the mem
brane of the spermatic chord, constituting the disease
known as spcrmatocele. This is a local affection,
analogous in its nature to hydrocele.
Hydrocele occasionally occurs as a congenital dis
ease, arising from an imperfect closure of the tunica
vaginalis, and thus permitting the fluids of the abdo
men to descend into its cavity.
Operation.— The most successful means of treating
hydrocele is to evacuate the serum by means of the
trochar and canula, and then to create a healthy me
dicinal action in the tunica vaginalis, with suitable
injections. Merely drawing off the fluid is of no
avail in effecting a cure, for the morbid condition of
the membrane still remains, and the exhalents again
fill up the cavity. Change then the morbid condition
of the structure, and supersede it by a new and
different action, and you will cure the disease. But
it will be said, that by applying our remedies directly
to the structure, we are obliged to create more in
flammation than is necessary in order to effect a cure.
Show us, then, how it can be effected by internal
remedies, with any kind of certainty, — point us to a
S46 HYDROPS. DROPSY.
specific which will reach the case, and we will be of
the first to adopt it.
The most reliable medicine we have ever used as an
injection, is a mixture of one part of tincture of iodine
to two parts of water. Let this be injected within
the tunic, and remain for five or ten minutes, or until
sharp pains are experienced in the gland and* the
spermatic chord, after which, carefully permit the
fluid to escape from the canula. The use of iodine is
not apt to be followed by sloughing, or undue inflam
mation, yet it almost invariably suffices to effect a
permanent cure.
Other injections have been highly extolled by sur
geons, as solutions of alum, zinc and lead, port-wine,
&c.,but they have too often failed in my hands to in
spire me with confidence in their virtues, while uni
form success has given me every reason to be satisfied
with the iodine,
For an account of hydrocephalus, we refer to
page 381 of this work.
Therapeutics. — It has been already observed, that
dropsy is usually but a symptom of some other mala
dy. Some of the causes winch induce it, operate for
a certain length of time, and then subside sponta
neously, together with its symptoms of effusion.
Amongst this class of causes may be placed, preg
nancy, temporary pressure of tumours, intermittent
fevers, and inordinate doses of arsenic.
Another class of causes which demands the gravest
attention of the physician, consists of functional de
rangements of important organs, impaired constitu
tions, protracted debility from excessive loss of animal
fluids, habitual intemperance, general cachectic habit
of body, chlorosis.
The first indication of cure consists in removing,
as far as is practicable, the cause of the dropsy. To do
this successfully, it is necessary to enter into a minute
investigation respecting the private habits of the pa
tient, as well as the present symptoms. By this means,
abuse of stimulants, of drugs, and excesses of all
kinds, may be guarded against, which otherwise
would have operated unfavourably during our cura
tive efforts.
HYDROPS. DROPSY. 547
As a general rule, pure air, moderate exercise, an
agreeable state of mind, a light and nutritious diet,
and a sufficient quantity of warm clothing, should be
enjoined. A change of location, or a sea- voyage, are
often powerful auxiliaries in the treatment.
When dropsy depends upon incurable organic af
fections of the heart or liver, much may be done to
wards palliating the symptoms and protracting the
patient's life, by an avoidance of all those causes
which tend to aggravate the primary source of the
disease, such as undue physical exertion, violent emo
tions and passions, &c.
Our efforts should also be directed, without cessa
tion, towards changing the morbid condition of the
membrane upon which the dropsy is dependent. Our
remedies, therefore, must cover the remote as well as
the proximate symptoms of the malady.
The remedies which we deem most valuable in the
treatment of dropsical effusions, are, apis mel., arseni-
cum alb., digitalis, china, hellebore, colchicum, dulcama
ra, asparagus, canlharides, scillce, hyd. potasses, mercu-
rius, uva ursa, elaterium.
In ascites and hydrothorax, the first trituration of
the common honey-bee has proved astonishingly effica
cious in our hands. The influence which this remedy
exercises upon the urinary organs, as well as upon
the peritoneum and pleura, is of the most prompt and
decided character. In large doses, it causes a sense
of fulness, constriction, or of suffocation in the thorax ;
difficult and anxious respiration ; pain and tenderness
of the abdomen, increased on pressure or by contact ;
symptoms worse in the horizontal posture ; great se
cretion of urine, which is pale or of a straw colour,
and deposites a reddish or brick-coloured sediment ;
frequent desire to urinate, and strangury.
Our method of preparing the medicine is as follows :
Enclose the bees in a close vessel, and expose them to
a temperature of 90° (Fahr.), until all moisture has
escaped from them, and they are sufficiently dry to
pulverize readily ; we then triturate five grains of
this powder with one hundred grains of sugar of milk
for the usual period, and administer the trituration in
grain doses from two to four times in twenty-four
548 HYDROPS. — DROPSY.
hours. Whether the active principle of this substance
consists solely of the virus connected with the sting
of the insect, or whether other parts possess active
properties, we know not : our opinion, however, in
clines to the former view.
We quote the following case, which occurred in
the practice of Dr. Taft, of Hartford. The patient, a
boy of twelve years of age, was attacked in July,
1849, with dysentery. After several weeks of medi
cation under an allopathic physician, the acute symp
toms subsided, and the evacuations gradually assumed
their natural state, but there remained an unnatural
fulness and tenderness of the abdomen, some difficulty
of respiration, especially on assuming the recumbent
position, a dry and harsh skin, and a materially dimi
nished secretion of urine. Notwithstanding the per
severing employment of the usual allopathic routine
of cathartics, mercurials, and diuretics, the patient
continued to grow worse, his abdomen became very
much distended with serum, and very tender to the
touch, or from even the pressure of the bed-clothes ;
the respiration became exceedingly laborious and
difficult, obliging the sufferer to remain for a good
portion of the nights in his chair ; impaired appetite,
an almost entire suppression of urine, emaciation,
debility, small and rapid pulse, anxious expression,
and other signs accumulated.
In this condition he came under the care of Dr. Taft,
who administered digitalis, arsenicum, dulcamara, mer-
curius, china, sulphur, hellebore, as the symptoms ap
peared to indicate, but without any amelioration of
the symptoms. In the meantime, the increasing diffi
culty of respiration, loss of rest, of appetite, and
pain, had reduced the patient to so serious a condition,
that I was called in council with Dr. Taft, in order to
decide respecting the propriety of paracentecis abdo-
minis. In consideration of the urgency of the symp
toms, and the inefficiency of the remedies which had
been used, I evacuated the effused fluid, amounting to
sixteen pounds, and advised a second trial ot'arsenicum
and digitalis. No effects, however, resulted from their
use : the secretion of urine remained the same, the
skin dry and husky, the abdominal effusion continued,
HYBROPS. DROPSY. 549
the oppression of the chest, sense of suffocation and
difficulty of breathing gradually increased, and signs
of thoracic effusion began to be exhibited. Recourse
was now had to the powder above alluded to, and
with the most speedy and marked results. After two
or three doses, a large quantity of urine was passed,
and the symptoms were all ameliorated. After the
remedy had been continued for two weeks, all traces
of effusion disappeared, the appetite and strength be
gan to improve, and the respiration became natural
and easy. The patient continued to convalesce without
any further unfavourable indication, until perfect
health was restored. We have witnessed the effects of
this remedy in two other cases of ascites, in one case
of protracted general dropsy, and in one case of hy-
drothorax. and with the same favourable results. The
powder of dried honey-bees has long been used as a
remedy in dropsies by the aborigines of our country.
Arsenicum. — External indications. — General appear
ance of exhaustion and debility; pallid, waxen, and
sickly countenance ; cheeks, lips, and eyelids bloated
and puffy, causing a marked alteration in the expres
sion ; dropsical swellings of the extremities and abdo
men ; mouth and tongue dry ; tongue tremulous, red,
bluish, or covered with a white coat ; urine scanty,
dark, and turbid or slimy ; general coldness and dry-
ness of the skin ; general anasarca, with discharging
vesicles on different parts of the affected surface ;
emaciation ; dark coloured spots or blisters on differ
ent parts of the body ; pulse small, feeble, and inter
mittent.
Physical sensations. — General sense of prostration ;
great nervous sensibility ; paralytic feeling in the
swollen parts ; palpitation of the heart ; turns of faint-
ness ; great difficulty of breathing when exercising,
and after lying down ; restlessness ; anguish and op
pression in the thorax and epigastric region ; hum
ming and roaring in the ears and head ; bad taste in
the mouth ; loss of appetite ; dry ness of the mouth
and tongue ; thirst ; tenderness of the abdomen on
pressure; difficult and scanty alvine discharges, or
slight diarrhoea ; frequent desire to urinate, although
but a small quantity is secreted ; anxious, difficult,
550 HYDROPS. DROPSY.
and rapid respiration while in the recumbent posture ;
heaviness and stiffness of the limbs and body ; dis
turbed sleep, from impeded respiration, dreams ;
chilliness, alternating now and then with flushes of
heat ; diminution of sensation and power in the
swollen parts ; symptoms worse after eating, exercise,
and lying down.
Mental and moral symptoms. — General mental unea
siness ; fits of anguish and discouragement ; disincli
nation to remain long in one position ; apprehension
that it is impossible to recover.
Digitalis. — External indications. — This remedy has
been found curative in general anasarca, ascites, and
hydrothorax originating in organic disease of the heart ;
also, paleness of the face ; blue lips ; swelling of the
eyelids ; coated tongue ; scanty secretion of high-col
oured urine ; strong and visible pulsations of the
heart ; irregularity of the pulse ; general paleness of
the skin.
Physical sensations. — Vertigo ; pressure in the fore
head and vertex ; ringing and hissing in the ears ; want
of appetite ; flat taste in the mouth ; thirst ; pressure
in the stomach ; distention of the abdomen, with
stitching pains ; pressure at the neck of the bladder,
with frequent desire to urinate ; throbbing in the
chest ; sharp stitches in the region of the heart ; res
piration anxious and difficult on walking or lying
down ; lassitude and diminished sensation in the in
ferior extremities ; constant inclination to sleep ; dis
turbed sleep ; faintness.
Mental and moral symptoms. — Dulness of intellect ;
vertigo ; forgetfulness ; gloomy, peevish and indiffer
ent.
Remarks. — Digitalis has proved most advantageous
in dropsy consequent on organic disease of the heart,
and in anasarca following scarlatina. Dr. Kurtz con
siders digitalis in decoction an excellent remedy in
this complaint, and that the dilutions are useless.
Scilla has been employed successfully in ascites
and anasarca, by Hartmann, Currie,*Noack and Trinks.
Hahnemann did not entertain a high opinion of this
substance as a remedy 'for dropsy, since its primary
effect was to stimulate the kidneys and cause a co-
HYDROPS. DROPSY. 551
pious emission of urine, while its secondary effect was
always the opposite of this, viz., to suspend almost
entirely the urinary secretion.
China. — External indications. — Countenance pale or
sallow, sunken and sickly ; general appearance of
languor and debility ; dropsical swellings in one or
more parts of the body ; enlargement and induration
of the liver ; emaciation ; dryness of the skin, mouth
and tongue ; urine scanty, pale or dark coloured, and
depositing a brick-dust sediment ; coldness of the
whole surface of the body; skin yellow ; tremour in
the limbs when attempting to walk.
Physical sensations. — Exhaustion arising from pro
tracted acute diseases, from excessive loss of blood,
and from abuse of drugs ; pain and tenderness in the
region of the liver ; heaviness and pressure in the
head, from within outwards ; humming and ringing in
the ears ; bitter or flat insipid taste ; loss of appetite ;
thirst for cold water and acids ; oppression of the stom
ach and abdomen, especially after eating or drinking ;
constipation ; respiration short, rapid, and at times
suffocative ; nights restless, and sleep disturbed by
dreams ; great sensitiveness to cold ; frequent shud
dering, when drinking cold water, or when exposed to
the air; swelling and stiffness of the limbs ; weariness
of the limbs, with constant desire to change position ;
symptoms aggravated by contact, by eating, and at
night.
Mental and moral symptoms. — Low spirited, nervous
and irritable ; sometimes anxious, gloomy and appre
hensive of evil, and at other times indifferent, taciturn,
and stupid ; confusion of ideas ; disinclination to
physical or mental labour.
Remarks. — China will be found curative in those
dropsies which are the result of simple debility which
has been caused by loss of animal fluids, protracted
illness, and abuse of cathartics. It may also be exhi
bited in anasarca consequent on attacks of intermit
tent and other fevers.
Hellebore. — External indications. — Face and lips
swollen, and of a pale or yellowish cast : fluctuating
swelling of the abdomen ; general anasarca ; spasmo
dic or convulsive movements of the head and limbs :
KYDKOFS. DROPSY.
twitching of the eyelids ; dulness and stupor ; coldness
of the surface ; suppression of urine.
Physical sensations. — Throbbing or compressive pain
in the head ; oppression at the chest and stomach ;
cramplike pains in the abdomen ; frequent desire to
urinate, with scanty emission ; loss of appetite ; nausea,
and pain in the stomach and bowels, followed by a
loose alvine evacuation ; short, dry cough ; difficul
ty of breathing; sharp stitches in the head, chest and
abdomen ; heaviness and rigidity of the limbs ; symp
toms better in the open air.
Mental and moral symptoms. — Dulness of intellect ;
weakness of memory ; painful stupefaction of the
head ; frequent sighing and moaning ; giddiness on
rising up, or walking ; confusion of ideas.
Remarks. — Hellebore is particularly commended in
dropsies complicated with intermittent fever, after the
fever has been cured by ars.9 also in anasarca and
ascites of children, arising from scarlatina. It has
effected prompt cures of dropsical effusions upon the
brain, attended with convulsive motions of the head
and limbs.
Colchicum. — External indications. — Face yellow and
cedematous ; dropsical swelling of the abdomen ;
oedema of the feet and legs ; visible palpitation of the
heart; skin dry and cold, or alternating with heat dur
ing the night; rapid and difficult respiration; pulse
full and hard, or quick and small ; urine scanty, and
dark coloured.
Physical sensations. — Nausea, burning and icy cold
ness of the stomach ; distention of the abdomen, with
pressure and colicky pains ; abdomen tender on pres
sure ; loose and painful stools ; oppression of the chest ;
palpitation of the heart ; tearing pains and stiffness in
the back, side, and limbs; drowsy during the day, but
restless nights ; symptoms worse during the night ;
also aggravated by mental labour.
Mental and moral symptoms. — Tendency to exag
gerate symptoms ; absence of mind ; forgetfulness ;
dissatisfaction from slight causes.
Remarks. — This remedy is useful in dropsical swell
ings caused by atmospheric vicissitudes, excessive
mental labour, sudden suppression of the perspiration,
HYDROPS. DROPSY. 553
and in anasarca consequent upon scarlatina and
measles.
Dulcamara. — External indications. — Face, abdomen,
and limbs bloated ; urine small in quantity, turbid, and
fetid ; heat and dryness of the skin ; empty eructations.
Physical sensations. — Loss of appetite ; dry mouth
and tongue ; great thirst for cold drinks ; empty eruc
tations after meals ; nausea ; restless, hot and fever
ish during the night ; constipation ; catarrhal symp
toms ; symptoms worse at night, better on motion.
Mental and moral symptoms. — Irritable and angry
disposition ; also scrofulous and phlegmatic constitu
tions, and great sensitiveness to cold.
Remarks. — Applicable in dropsies which have arisen
from exposure to cold, and general anasarca conse
quent on fever and ague, scarlatina, and rheumatic
fever.
Asparagus. — External indications. — Countenance
pale, waxlike, and bloated ; general expression of anx
iety and distress ; unusual fulness of the chest ; cold
ness of the surface ; suppression of the perspiration ;
urine scanty, straw-coloured, and offensive to the
smell ; visible throbbing of the heart, especially in
the night ; rapid, laborious, and sighing respiration ;
pulse feeble and irregular.
Physical sensations. — Feeble appetite ; sense of
fulness and oppression after eating or drinking ; pal
pitation of the heart ; great oppression of the chest,
and rapid and difficult breathing, increased after being
in bed for some time ; sleep uneasy and disturbed by
the oppressed respiration ; constant inclination to be
carried about in the arms by a child ; great languor
and disinclination to physical or mental exertion ;
stitching pains in the region of the chest.
Moral symptoms. — Fretful and peevish ; disturbed
by trifles ; constant anxiety and apprehension.
Remarks. — In two cases of hydrothorax following
acute attacks of peripneumonia, in children of three
and five years of age, I have found asparagus of sig
nal service after several other remedies had failed.
One of these cases was complicated with an organic
affection of the heart, and an almost entire removal
of the cardiac symptoms followed the cure of the
24
554 HYDROPS. DROPSY.
dropsy. We are quite convinced that this remedy
will prove one of great efficiency in the treatment of
hydrothorax and general dropsy, and we respectfully
urge it upon the attention of practitioners. It should
always be advised in dropsies as an article of food.
Cantharides is recommended in dropsy caused by
tonic spasm of the neck of the bladder, and by per
verted action of the kidneys. It may also be admi
nistered in effusion occurring in the last stages of
acute and chronic diseases, as a palliative.
Hyd. potasses is adapted to oadematous swellings
resulting from the pressure of enlarged glands upon
the veins. It has likewise proved highly beneficial
when administered by me for the relief of dropsy
arising from Dr. Bright's granulated kidney.
Mercurius has been praised as a valuable remedy
in chronic hydrothorax, and in ascites from diseased
liver. It is worthy of attention in ovarian dropsy,
and effusions dependent upon enlargement of the
spleen.
Uva ursa has cured several cases of ascites depend
ent upon abuse of stimulating drinks, and abuse of
drugs. Its influence in restoring the urinary secre
tions is usually very prompt and satisfactory.
Other remedies which have occasionally been found
useful in dropsies are, elaterium, rhus tox., lycopodium,
bryonia, ol. tiglii, potassce nit., iodine, solanum nig.
phosphorus, baccce juniper.
Administration. — In the treatment of acute dropsies,
we advise the employment of the third to the sixth
attenuations, and a repetition of the dose every two
or four hours until effects from the medicine are ap
parent. In chronic dropsies, we employ the first to the
third attenuations, and repeat once or twice in twenty-
four hours until a suitable impression is produced.
555
CHAPTER XXIX.
CHLOROSIS.
General description. — Young unmarried females, of
delicate lymphatic constitutions, slight figures, and
highly impressible nervous systems, are by far most
liable to attacks of chlorosis. In a majority of in
stances, it will be found that chlorotic girls have been
remarkable, from birth, for delicacy of organization,
daintiness of appetite, feebleness of digestion, and
undue sensibility of the whole system. So long as
this nervous sensibility is not overtasked, and no im
portant causes operate to derange the delicate equili
brium upon which the proper operation of the func
tions depends, the individual enjoys passably good
health ; but when the period of puberty arrives, and
nature calls for her monthly tribute from the vital
fluid itself, — when new thoughts and new desires
powerfully stimulate the system, — when, in fine, the
important change of the whole organism, during the
establishment of the catamenial function, occurs, then
the frail balance is destroyed, the digestive, absorbent,
and assimilative functions fail, and those symptoms
which mark chlorosis make their appearance.
The disease sometimes attacks married females
even when considerably advanced in years ; and it
has likewise been observed in girls of two or three
years of age ; but cases of these kinds are of extreme
ly rare occurrence. Men of studious and sedentary
habits, especially those who have never taken much
exercise, have been occasionally subjected to it.
Chlorosis is more common in cold than in warm
climates. This circumstance is attributable, in part,
to the pernicious custom at the north, of keeping chil
dren a large portion of the year in close rooms, at a
temperature of 75 to 80° Fahrenheit, thus preventing
that free development of the body which would result
from pure air and abundant exercise. Another reason
offers itself in the fact, that persons of frail, nervous,
and lymphatic constitutions, cannot often withstand
556 CHLOROSIS.
the severities of a temperate latitude, without suffer
ing more or less from disorders of the glandular and
membranous structures.
Diagnosis. — The symptoms commonly observed du
ring the forming stage of chlorosis are, derangement
of the stomach and bowels, manifested by a pale and
bloated appearance of the tongue, foul breath, partial
or total loss of appetite, morbid craving for certain
indigestible articles, like coal, chalk, clay, acids, pen
cils, etc. ; torpid state of the bowels ; tympanitic dis-
tention of the abdomen, accompanied with occasional
griping pains ; faecal discharges, composed of crude
and imperfectly digested substances, unnatural in
colour and consistence.
Soon after the appearance of these symptoms, if
;he disease continues, the patient becomes listless, ir
ritable, fond of solitude, and disinclined to bodily or
mental exertion ; the menstrual function becomes de
ranged ; the face pale and tumid ; the lips lose their
colour ; the eyelids are swollen and surrounded by a
dark, greenish, or yellowish circle ; emaciation com
mences ; the debility and lassitude become more ap
parent ; many nervous and hysteric symptoms mani
fest themselves ; dyspnoea, and palpitation of the
heart, or " fluttering about the pra3cordia," (Hall,)
occur from ascending stairs, from rapid walking, or
violent mental emotions ; the patient is troubled with
vertigo, giddiness, and ringing in the ears and head ;
sleep is disturbed by unpleasant dreams ; the spirits
become depressed, and the ambition and energy are
superseded by apathy and indifference.
As the disease advances, all these symptoms become
more strongly pronounced, and confirmed chlorosis is
developed. The whole surface of the body now as
sumes a smooth and puffy appearance ; the skin is
dry, pale or yellowish, or lead-coloured ; the muscles
soft and flabby ; the feet and ankles cedematous ; the
countenance very pallid and waxlike ; the prolabia of
a lilac colour ; tongue clean, bloodless, and semi-
transparent ; conjunctiva of a clear white colour, or
slightly tinged with blue ; pulse feeble and somewhat
rapid; occasional pains in the head, chest, stomach,
side and abdomen ; throbbing of the carotid arteries,
CHLOROSIS. 557
perceptible to the sight and hearing ; violent palpita
tion of the heart ; dyspnoea, and " fluttering about the
praecordia," after the slightest physical or mental ex
ertion, and often during the night ; catamenial secre
tion, superseded by a profuse leucorrhoeal discharge;
slight hacking cough on rising in the morning, and
after exercise ; frequent loose discharges from the
bowels of a dark or black colour, and very fetid ;
extreme prostration of all the energies ; marked de
rangement of the functions of the liver, kidneys, skin,
and, indeed, of nearly every part of the body.
It is not an uncommon occurrence for some of these
symptoms to assume a serious local aspect during the
progress of the complaint, and thus present highly
troublesome and dangerous complications. Marshall
Hall enumerates these complications as follows :
First, pain in the head ; second, cough and dysp
noea ; third, palpitation of the heart ; fourth, pain
and tenderness of the side ; fifth, pain and tender
ness of the abdomen ; sixth, constipation ; seventh,
diarrhoea ; eighth, meloena ; ninth, menqrrhagia ;
tenth, tendency to hsemorrhagy ; eleventh, purpura ;
twelfth, leucorrhoea ; thirteenth, hysteric affec
tions ; fourteenth, oedema, anasarca, erythema no-
dosum.
It should be borne in mind, that all of these compli
cations are nothing more than symptoms of the origi
nal malady, and are to be treated only as such. We
have deemed it important to direct special attention
to these symptoms, to guard the inexperienced physi
cian against mistaking them for distinct and inde
pendent affections. When either of them is particu
larly prominent, the careless diagnostician is apt to
form an incorrect opinion of the case. Thus, frequent
pains in the chest, violent palpitation of the heart on
the slightest exertion, and an irregular or intermittent
pulse, have often caused medical men to mistake an
ordinary chlorosis for an organic affection of the heart :
so have the cough and dyspnoea, and the gastric and
abdominal derangements, which accompany chlorosis,
been mistaken for phthisis pulmonalis and dyspepsia.
We have included amongst the signs of chlorosis,
suppression of the menses, but this is by no means an
558 CHLOROSIS.
invariable symptom, as numerous cases are reported
in which the catamenial secretion was perfectly natu
ral and regular during the whole course of the com
plaint. We may safely infer, therefore, that it is not
dependent on retention of the menses, as some writers
have supposed.
We have already seen that many of the symptoms
of chlorosis strongly resemble those of organic affec
tions of the heart, pulmonary phthisis, dyspepsia, liver
complaint, and dropsy, but a minute examination of
the history and symptoms of each case, will always
enable us to form a correct diagnosis. Thus, disease
of the heart is attended with more pain, and more
febrile disturbance, than chlorosis : the expression of
the eyes, and the appearance of the prolabia and
tongue are also widely different. The pure white
colour of the conjunctiva, and the. bilious and dark
colour of the faeces, will sufficiently mark the disease
from chronic hepatitis. From consumption of the lungs,
we may also recognise it, by the absence of febrile
exacerbations, the flushed cheek, the copious purulent
expectoration, and the more general emaciation which
occurs in the former. There are also numerous symp
toms by which we may readily distinguish it from
dyspepsia and dropsy.
Causes. — There are several points connected with
chlorosis worthy of much consideration in a patholo
gical and therapeutical point of view, viz. : first, the
prominent gastric and intestinal derangement at the
commencement of the malady ; second, the small
quantity of crassimentum in the blood ; and third, the
peculiar state of the capillary system, which gives
rise to a haemorrhagic tendency.
From the history of chlorosis, it appears that the
stomach and bowels are the first structures to take on
disordered action. For some time previous to the ap
pearance of the pale, waxlike and tumid countenance,
the puffiness of the eyelids, the loss of flesh, suppres
sion of the menses, and other signs of confirmed chlo
rosis, we observe an impaired and delicate appetite,
flabby and coated tongue, foul breath, imperfect di
gestion of the food, unnatural stools, and all those
traits which characterize a feeble and imperfect per-
CHLOROSIS. 559
formance of the digestive, absorbent, and assimilative
functions. The symptoms which succeed are such as
naturally result from such gastric and intestinal de
rangement.
These facts go far towards explaining the small
amount of crassimentum contained in the blood of
chlorotic patients. If digestion, absorption, and as
similation were normally executed, would not the
blood receive its due proportion of crassimentum, and
the muscles and integuments their appropriate supply
of the red globules ? The organs of the body are
dependent for healthy action upon the stimuli of these
red globules, which abound in oxygen, and serve to
communicate to all parts of the organism its animal
heat and consequent vitality. Whenever, therefore,
any cause operates upon the digestive and absorbent
organs in such a manner as to suspend their functions,
the blood must fail of its due supply of red globules,
and a derangement of all the organs ensue.
In some chlorotic patients, there is a peculiar ten
dency to haemorrhages from the nose, the lungs, the
stomach, and the uterus. Bloody discharges have
been known 'from the head, the side, palms of the
hands, and limbs, in instances assuming a periodical
form, and taking the place of the menstrual discharge.
On this account, the disease has been attributed by
some to a laxity of the capillaries, and a consequent
inability to exclude the red globules ; but this relaxed
condition of these vessels is owing to an absence of
their healthy natural stimuli, the " oxygen carriers,"
rather than to any primary derangement in the capil
lary vessels themselves.
Other causes which may contribute to the develop
ment of chlorosis, in constitutions predisposed to it,
are, close confinement in overheated and ill-ventilated
apartments ; studious and sedentary habits ; protract
ed grief, anxiety, or fatigue ; parturition, and its after
effects; leucorrhoea ; amenorrhoea ; unsatisfied love;
masturbation ; prolonged continence ; frequent haem
orrhages ; crude and indigestible food ; chronic in
flammation of the intestinal canal ; enlargement and
inaction of the mesenteric glands.
Prognosis. — This will depend principally upon the
560 CHLOROSIS.
natural stamina of the patient, and the severity of
the local symptoms. A frail and delicate constitution,
a highly susceptible nervous system, a decided predis
position to glandular and membranous disease, and
an inherent debility of the digestive apparatus, are
circumstances calculated to render the prognosis un
favourable. Patients of this description are rarely
able to withstand the important changes which the
economy undergoes at the period of puberty, without
serious local disease, and often organic degenerations
of some vital part.
On the other hand, if the patient be of a naturally
robust and sound constitution, even if the chlorotic
symptoms are quite severe, we may generally predict
an ultimate recovery. Here we may trace all the
causes of the malady, and bend our efforts to their
removal with a prospect of success, and thus restore
the system to its original health and vigour ; while a
body which " has been sent into this breathing world
before its time, but half made up," cannot be re
modelled into one of " fair proportions " and vigour, by
any resources of the physician, although much may
be done towards prolonging life, and securing a mode
rately comfortable state of existence.
Pathology. — In the autopsical examinations of those
who have died of chlorosis, the most notable signs of
disease are found in the blood, the muscles, and the
surface of the body. The blood of chlorotics appears
to be deprived, in a great measure, of the red mate
rial, and its place supplied by a superabundance of
serum. This condition exists to a greater or less de
gree during the whole course of the disease, and it
is on this account that the muscles after death pre
sent a peculiarly pale and bloodless appearance, and
the skin a palish yellow or waxlike tinge. Unnatural
appearances are sometimes found in the chest and
alimentary canal, in the form of enlargement and di
lation of the ventricles of the heart, chronic inflam
mation of the lungs, the stomach, and the intestines,
flabby and shrunken appearance of the liver and
spleen, and unusual accumulations of serous fluid in
the cavities, and in the cellular tissue.
Therapeutics. — In the treatment of chlorosis, we
CHLOROSIS. 56 J
find of especial importance, frequent exercise in the
open air, either by gestation or moderate walking, a
highly digestible and nutritious regimen, and fresh or
salt water baths. It is very desirable that chlorotic
patients pass their winters in warm and equable cli
mates, that exercise in the open air may be taken
with advantage at all seasons. This is necessary on
account of their extreme sensitiveness to the cold,
which is often a serious obstacle against exposure to
the low temperature of northern winters. The influ
ence of sea air is often very beneficial to patients ac
customed to inland districts, and vice versa. Short
sea-voyages may sometimes be advised in the warm
summer months, but caution should be exercised that
the changes be not too abrupt.
General bathing is also useful when properly em
ployed. We should commence with tepid baths of
fresh or salt water, and gradually diminish the tem
perature as the strength will admit, until an ordinary
cold bath can be advantageously sustained. Sensi
tiveness to applications of cold water, will frequently
deter the patient from a persevering use of this pow
erful remedy, and rigid directions should therefore be
given upon the subject.
A regimen of the most digestible and nutritious
meats, as mutton, venison, beef, game, and fowls, with
rich animal soups, should be enjoined. Other nutri
tious food which the stomach will digest may like
wise be eaten. Wine, porter, and Scotch ale may be
used at meals if agreeable to the invalid. In a word,
all of those articles which are calculated to enrich
the blood with the red globules, may be resorted to.
The remedies best adapted to meet chlorotic symp
toms are, china, sulphur, nux vomica, pulsatilla, sepia,
ferrum carb., platina, calcarea carb., conium, arsenicum,
veratrum.
China. — External indications. — Countenance pale or
livid ; lips blackish and shrivelled ; mouth and tongue
slimy ; skin yellowish ; oedematous swellings of the
limbs ; faeces hard or soft, foetid, mixed with undigest
ed food, and of a dark or black colour ; offensive
breath ; copious leucorrhoeal discharge ; menstrual
fluid scanty, and possessing but little colour ; sup-
24*
562 CHLOROSIS.
pression of the menses ; haemorrhages from the nose,
mouth and lungs ; pulse feeble and more rapid than
natural ; general appearance indicative of an exsan-
guious and debilitated condition.
Physical sensations. — Vertigo, worse when walking
or during motion ; humming in the ears ; disagreea
ble taste in the mouth, generally bitter or insipid ;
unnatural appetite ; canine hunger ; pressure in the
stomach after eating ; distention of the abdomen from
wind or water ; morbid sexual desire, with nightly
pollutions ; difficult and rapid respiration ; throbbing
in the sternum ; palpitation of the heart ; constant in
clination to move the limbs ; excessive sensitiveness
of the whole nervous system, with general feeling of
lassitude and debility ; great dread of cold air ; drow
siness during the day, but restlessness at night ; sleep
disturbed by frightful dreams.
Mental and moral symptoms. — Nervous, irritable,
dissatisfied, taciturn, out of humour ; indisposition to
mental exertion ; suspicious of dislike and abuse.
Remarks. — China is eminently a specific in chlorosis
accompanied or induced by profuse loss of animal
fluids, from epistaxis, haemoptysis, haemorrhoids, mas
turbation, involuntary emissions of semen, leucorrhoea,
and diarrhoea. It is one of our best remedies when
the disease is uncomplicated by any serious local de
rangement, and where simple debility of the whole
organism is its essential characteristic.
Sulphur. — External indications. — Face pale and
bloated ; eyes surrounded by blue or greenish margins ;
swelling of the upper eyelid ; glandular swellings
about the neck and lower jaw ; mouth and tongue
slimy ; foetid breath ; distention of the stomach and
abdomen ; discharges from the bowels brown, and
mixed with undigested food ; acrid leucorrhoeal dis
charge ; profuse expectoration ; short and rapid respi
ration ; oedema of the feet and ancles ; surface of the
body covered with yellowish or brown spots.
Physical sensations. — Vertigo, dizziness and dulness
in the head ; humming or roaring in the ears ; putrid
or bitter taste in the morning ; loss of appetite ; crav
ing for sweet or sour articles only ; pressure of the
stomach and abdomen, and dyspno3a after eating ;
CHLOROSIF. 563
throbbing at the pit of the stomach, with faintness ;
morbid sexual desire, with feeble power of accom
plishment ; frequent involuntary emissions ; menses
too early and too profuse ; burning leucorrhoeal dis
charge ; weakness of the chest when talking ; short
and difficult breathing on exercise, and on retiring to
bed in the night ; frequent palpitation of the heart ;
stitches and pains in the chest when moving the arms;
coldness of the feet ; drowsiness in the day time, but
wakefulness and restlessness during the night ; vivid
dreams ; night sweats ; constant inclination to change
position ; general nervous irritation ; sensitiveness to
cold ; internal coldness ; lassitude and sensations of
faintness, — all of which symptoms are without acute
pain, and are mitigated by rest, and worse during
motion.
Mental and moral symptoms. — Sadness, despondency,
and inclination to weep without cause ; ill humour,
obstinacy, sadness, silence, and frequent moaning.
Remarks. — This medicine is advised for chlorotics of
a lymphatic temperament, and those subject to fre
quent haemorrhages. Also in chlorosis complicated
with tuberculous ulceration of the lungs.
Nux vomica. — External indications. — Pale, yellow
ish, or clay-coloured complexion ; sclerotica natural ;
cheeks and eyelids swollen ; tongue white ; foetid
breath ; faeces foetid and dark-coloured ; discharges of
blood from the rectum ; moaning and incoherent mut
tering during sleep.
Physical sensations. — Vertigo, giddiness, or sense of
intoxication ; tenderness of the scalp ; ringing and
hissing in the ears ; putrid, or bitter, or sour taste in
the mouth ; aversion to food of all kinds, and to tea
and coffee ; distention and oppression of the stomach
after eating ; nausea ; bitter or sour eructations ;
throbbing sensation in the region of the stomach ; flatu
lent distention of the abdomen, and colicky pains after
eating or drinking ; bleeding and painful haemorrhoids ;
great irritability of the sexual organs, especially after
waking in the morning ; menses too early, and scanty ;
frequent turns of nausea and faintness during the men
strual flux ; asthmatic respiration when walking, and
at night in bed ; palpitation of the heart after a gen-
is meal ; painful shocks in the praecordial region :
564 CHLOROSIS.
sensitiveness of the whole surface of the body ; trem
bling in the limbs when walking ; sleep disturbed by
dreams, and so unrefreshing that the patient feels
worse in the morning than in the evening ; coldness
of the feet.
Mental and moral symptoms. — Great sensibility to
impressions ; noise, bright lights, and strong odours
intolerable ; sad ; anxious ; quarrelsome ; taciturn :
apprehensive of death.
Remarks. — When chlorosis is preceded and accom
panied by marked derangement of the alimentary
canal, more particularly if the patient is of studious
and sedentary habits, and has indulged freely in wines,
coffee, or tobacco, nux vomica is indicated. Those
who are naturally somewhat robust, and of a quar
relsome, ardent and vehement temperament, will be
more benefited by it than persons of a mild and
phlegmatic temperament.
Pulsatilla. — External indications. — Face pale ; eye
lids puffy ; tongue white and covered with viscid mu
cus ; pulsation at the pit of the stomach, perceptible to
the pressure of the hand ; stools loose, green, slimy, or
bloody ; acrid, thin leucorrhoea ; scanty menstrual dis
charge ; rapid breathing after eating or on lying
down ; coldness of the hands and feet.
Physical sensations. — Vertigo, resembling intoxica
tion ; bad taste in the mouth in the morning ; loss of
appetite ; absence of thirst ; nausea ; frequent eruc
tations of wind, tasting of the ingesta ; beating and
fluttering in the stomach ; cutting pains in the side
and abdomen ; suppression of the menses, with gene
ral coldness of the body and nausea ; asthmatic op
pression of the chest after eating, or when lying on the
side in the recumbent posture ; pain and weakness in
the small of the back ; disagreeable pulsation of the
arteries of the whole body ; tremulousness ; weari
ness ; restlessness during the night ; palpitation of the
heart, after eating or talking.
Mental and moral symptoms. — Anxiety; disgust of
everything ; sullenness ; whimsicalness ; dissatisfac
tion.
Remarks.— Pulsatilla is adapted to chlorotics who
have been irregular in menstruation, and are of a
CHLOROSIS.' 565
mild, timid, yielding, or sad disposition. When there
is a total suppression of the menses, with much pain
in the small of the back, frequent turns of chilliness,
and absence of thirst, it will be indispensable, either
by itself, or in alternation with some other medicine.
Sepia. — External indications. — Swollen and puffy
appearance of the whole body ; face puffy, pale or
yellow ; eyes surrounded by blue or greenish margins ;
tongue coated with a white fur ; fostid breath ; men
ses too early and scanty ; yellowish, watery, or mu
cus leucorrhoBa ; cold feet and hands when in bed in
the evening.
Physical sensations. — Painful beating in the head ;
roaring in the ears ; no appetite, or morbid desire for
all kinds of food ; absence of thirst ; pain in the side
and region of the liver ; great sexual inclination ; fre
quent dyspnoea ; cough with mucus expectoration ;
stitches in the chest and side ; weakness and stiffness
in the small of the back ; restless sleep, with frequent
waking ; skin tender and sensitive ; sweat on walk
ing ; sensitiveness to cold air ; weary, faint, and dis
couraged ; symptoms worse at night and when at rest ;
palpitation of the heart, and intermittent pulse.
Mental and moral symptoms. — Weakness of memory ;
inability to think or reason ; giddiness from walking ;
melancholy, discouragement, and irritability.
Remarks. — Chlorosis of nervous and delicate females,
with a thin and delicate skin, and in whom menstru
ation has always been irregular, may be cured by se
pia. If the patient sweats profusely when walking,
and is particularly sensitive to cold air, this remedy is.
still more necessary.
In inveterate cases, attended with extreme prostra
tion, trembling of the limbs, coldness of the surface,
entire suppression of the menses, dropsical swellings,
great difficulty of breathing, palpitation of the heart,
loose state of the bowels, frequent and protracted turns
of faintness, we may examine ferrum arsen. and vera-
trum. Carb. calc. and platina are indicated when the
menses are too frequent and abundant. These medi
cines are especially adapted to young female organ
isms.
Administration. — The remedies should generally be
566 SCROFULA.
employed at the first, second and third attenuations, and
a dose administered once or twice daily, until there is
an apparent effect. No repetition should be allowed
so long as the slightest amendment is perceptible.
CHAPTER XXX.
SCROFULA.
This disease was described by the Greeks under the
appellation *ot£u6ts, from xe7f«$, hog, and by the Latins,
(scrophules from scropha, female swine). This name
had its origin in the well-known fact, that scrofula
was a disease peculiar to the above named animal.
The blood of scrofulous subjects has been found to
differ materially from that of healthy individuals. In
the former, there is a superabundance of serum and a
deficiency of the fibrous portion, and the solids which
are generated from this blood are, in consequence,
lax, feeble, and incapable of resisting exposure, fa
tigue and disease.
Scrofula is for the most part hereditary, but the phy
sician is frequently presented with well marked cases
of the acquired disease. The circumstances which fa
vour the formation of an original scrofulous dyscrasia,
are, cold and damp habitations, want of healthy and
nutritious food, constant confinement at labour in
close and ill-ventilated rooms, and finally, the use of
pork in all its forms as a principal article of food.
Respecting this last cause, we submit a few remarks :
Since the time of Moses, a large portion of mankind
have looked upon the swine as an impure animal, un
fit for food. Its impurity consists of a disorder of a
purely scrofulous character which is inherent and pe
culiar to it, and is constantly being developed, espe
cially during confinement and subjection to the ordi
nary modes of feeding. Probably no animal is more
filthy in its habits or more disgusting for its selection
SCROFULA. 567
of food. Let the pork-eater contemplate an instant,
the customary mode of rearing the domestic swine,
and observe what offal, filth, putridity, scourings from
everything foul and corrupt, constantly swell his dis
eased carcase. Let him see in the slaughter house,
how often the internal organs and the surface of the
vile carcases will be studded with tuberculous forma
tions, or scrofula, and then return to pork " like a dog
to his vomit," if he chooses.
A strong corroboration of our views is found in the
fact, that in all of those countries where the swine is
forbidden to be used as food, scrofula is almost un
known. The same law obtains with the Jews, who,
abiding by the precepts of their religion, inhabit almost
every climate and country, and are scarcely ever
afflicted with scrofula.
It is absurd to argue that flesh contaminated with
the scrofulous miasm, cannot communicate to the
healthy body, after digestion, its morbid particles.
The poison pervades every atom of the affected flesh,
and no washing or digestion can destroy or banish the
noxious quality.
Scrofula is most common in temperate latitudes,
where the changes of temperature are abrupt, and
where the atmosphere is much of the time loaded
with moisture. The miasm operates upon almost
every structure : glands, skin, ligaments, membranes,
muscles, and bones, all succumb to its attacks.
Diagnosis. — The signs which are supposed to indi
cate the scrofulous habit, are, precosity of intellect ;
blonde hair ; light complexion ; blue eyes ; soft and
delicate cheeks ; lips thick and red ; " frequent swell
ing of the upper lip and nose ;" edges of the eyelids red
and prone to inflammation ; scurf and eruptions on the
scalp ; large head ; sensitiveness to cold ; ends of the
fingers blunt instead of tapering ; muscles soft and
flabby ; strong inclination for venereal pleasures.
These marks are generally supposed to characterize
the scrofulous habit, but it has occurred to us to wit
ness far more cases of scrofula in individuals the very
opposite of this description ; but whether or not this
is the result of accident, or whether an erroneous im
pression has prevailed upon this subject, we know not.
568 SCROFULA.
Amongst the most common and simple manifestations
of scrofula may be ranked, glandular swellings of the
neck.
These enlargements occur very frequently during
childhood, in the form of what are vulgarly termed,
" kernels," on different parts of the neck. They are
excited into activity by taking cold, by currents of air
upon the neck, by measles, scarlatina, and whooping-
cough, and either remain for a long time stationary
and inactive, or run on to more violent inflammation
and suppuration. These swellings sometimes attain
a very large size, involving most of the glands of the
neck, and remain in this condition for many years.
More frequently, however, owing to injudicious allo
pathic treatment, the swellings are dispersed^by exter
nal applications, the malady is forced to embody itself
upon the lungs, and a fatal phthisis pulmonalis is the
result. Another form in which scrofula developes
itself, especially in children, is that of
Strumous, or Scrofulous Ophthalmia.
This disease is characterized by extreme sensitive
ness of the affected organs to light. Even the slight
est ray causes intense pain, and the little patient
makes every effort to avoid exposure. During the in
flammation an eruption usually makes its appearance
on the cheeks, in the vicinity of the eyes, and which
often extends to the very organs themselves, thus
giving rise to troublesome and dangerous ulcers.
These ulcers not unfrequently extend until the struc
ture of the eye becomes so far impaired, that total
blindness ensues.
The next form of scrofula to which we shall call at
tention, is that in which the joints become affected.
The most important of these affections are the
White Swelling, (Arthrocace), and the Hip-disease.
The approach of these maladies is commonly grad
ual and insidious. Occasional pains are complained
of in the diseased joint, after exercise ; the motions of
the limb gradually become impaired, and vague pains
SCROFULA. 569
are experienced in the neighbouring joints, which
sometimes induce the belief that healthy parts are
the seat of the inflammation. As the disease ad
vances, the ligaments, cartilages, and other structures
composing the joint, become so much thickened by
the inflammatory action, that the limb after a time
becomes stiff, and the joint immovable. In some in
stances the inflammation is arrested at this point, the
suppurative process is prevented, and a recovery by
what is called anchylosis takes place. But in the ma
jority of cases the disorder proceeds on to suppura
tion, the whole structure of the joint becomes involved
in this action, a profuse discharge of matter takes
place from the part, constitutional disturbance is
manifest in the form of emaciation, debility, night-
sweats, and other symptoms of hectic fever, and the
patient soon succumbs. Scrofulous affections of the
joints are very difficult of detection in their early
stages. The pains are so vague and indefinite, as
scarcely to attract attention ; there is little or no
swelling or discoloration over the disordered part ;
and there is no derangement of the general health
which indicates that the organism is suffering under
a serious malady. It is for this reason that the dis
ease is allowed to make serious progress before its
true nature is suspected. Like its near relative, the
consumption, it strikes silently, but deeply and fatally.
Another scrofulous disease, common in infancy, is
known as
Strumous Disease of the Mesenteric Glands.
The characteristic signs of this malady are, wasting
of the limbs, pale and attenuated appearance of the
skin, tumefaction and tenderness of the abdomen,
sunken eyes, irregular state of the bowels, variable
appetite, passage of partially digested food, general
irritability. After the disorder is seated, the process
of absorption is suspended, so that only a small
amount of nutriment arrives at the blood, and the
sufferer is soon reduced to that condition which med
ical men recognise as marasmus.
Although the mesenteric glands sometimes suppu-
570 SCROFULA.
rate, yet much more frequently the victims to mesen-
teric disease die from actual starvation. The only
hope of cure in these cases is, a detection of the ma
lady at its onset, and the services of a thoroughly
competent physician.
In a previous chapter, we have had occasion to
treat of another, and perhaps the most dangerous form
of scrofula, under the head of phthisis pulmonalis, or
tubercular consumption, to which we refer the reader.
There are numerous other scrofulous affections of
the different parts of the organism, as the brain, the
liver, the skin, the spleen, and the spinal marrow.
The admirable works of Hartmann and Schoenlein
may be consulted with advantage with reference to
this subject.
Hahnemann has included scrofula as a form of
psora, but evidently on insufficient grounds. Psora is
contagious, scrofula non-contagious. The matter of
a psoric eruption is capable of communicating its
similitude by inoculation ; that of scrofula is innoc
uous when inoculated. Psora, in its specific devel
opment upon the skin, assumes the appearance of a
vesicular eruption ; scrofula makes its appearance in
the form of extensive ulcers, abscesses, &c. The
psoric miasm exercises its specific affinity upon the
skin ; the scrofulous miasm upon the glandular sys
tem. Psora is no respecter of persons, but attacks all
constitutions, temperaments, and organizations alike ;
scrofula is supposed to select its subjects from those
who are daintily formed, and possess some peculiari
ties of organization ; psora is readily cured by anti-
psorics ; scrofula always requires much time, and is
often absolutely incurable by any course of treatment.
Psora cannot be artificially acquired by any particu
lar mode of life, or any particular food ; with scrofula
it is the reverse. Finally, the development of the
psoric miasm, when it is clear and apparent, is always
specific and uniform, viz., in vesicular eruptions of a
peculiar appearance upon the surface, and the ma
lady is unequivocally contagious ; while the develop
ment of the scrofulous miasm is subject to very great
variations, but for the most part attacking the glands,
rather than the skin, and decidedly non-contagious.
SCROFULA. 571
Causes. — The scrofulous habit is, in most instances,
inherited. In its hereditary subjects we may notice
from birth a radical unsoundness of constitution, an
irritability, sensitiveness to slight exposures, prone-
ness to catarrhal difficulties, and an inability to resist
diseases, which is not apparent in healthy children.
The acquired scrofulous habit is generally amongst
the poor, who are ill-fed, clad, and housed. We have
before alluded to the causes which especially induce
this variety of the disease ; they are also the chief
exciting influences of the hereditary dyscrasia. At
mospheric vicissitudes, abuse of stimulants, excesses
in venery, onanism, intestinal irritation, excessive
mental and physical occupation, scarlatina, measles,
abuse of mercury, iodine, and other drugs which un
duly stimulate the glandular system, also excite the
latent disorder.
Therapeutics. — It has been observed that scrofulous
persons are peculiarly sensitive to cold, and that
abrupt changes from heat to cold, in a moist region,
are especially calculated to call into active operation
the latent malady. For this reason it behooves those
who are liable to the affection, whether by heredi
tary or acquired predisposition, to dwell, if possible, in
a warm and equable climate. When the lungs be
come affected, this course will often be necessary, in
order to save life. In all scrofulous diseases, too
much stress cannot well be laid upon the importance
of a mild, dry, and uniform temperature.
The food of scrofulous subjects should always be of
the most nutritious character, in order that a due pro
portion of fibrine may be introduced into the blood.
Fresh meats, like beef, mutton, venison, fowls, and
veal, should constitute the principal articles of food ;
and bread, rice, and other farinaceous substances,
should be made to take the place of watery and suc
culent vegetables. Porter, ale, and light wines may
also be used moderately with advantage.
Much exercise in the open air is also essential. In
taking exercise, it is of the utmost importance that
the mind should be agreeably occupied, for if we walk
or ride as a task, we shall obtain very little benefit.
Bathing, both in fresh and salt water, is also a
572 SCROFULA.
means of securing a healthy action of the skin, and of
imparting tone and vigour to the whole system.
The clothing should always be adapted to the sea
son, and in temperate and cold latitudes we strongly
advise the buckskin wrapper, to be worn over a thin
linen, silk, or Canton flannel under-shirt. We com
mend the use of these garments, during the winter,
from personal experience.
The remedies most deserving of confidence in the
treatment of scrofula, in its various forms, are, sul
phur, heparsulph., mercurius, iodine, baryta, dulcamara,
conium, belladonna, lycopodium, sepia, calcarea carb.,
rhus tox., aurum mur.9 china, ferrum iodid., mere.,
oleum jecoris aselli.
Sulphur. — External indications. — Scrofulous ulcers
on different parts of the surface ; humid eruptions be
hind the ears ; purulent discharges from the ears ;
scrofulous ophthalmia of children, with eruptions
about the eyes, and ulcers on the cornea ; chronic
enlargement of the tonsils ; enlarged ovaria ; swelling
of the axillary glands ; swelled nose ; frequent nose
bleed ; swelled upper-lip ; swelling of the glands un
der the lower jaw ; enlargement and suppuration of
the inguinal glands ; swelling of the posterior cervical
glands ; white swelling of the knee ; emaciation.
Physical sensations — Chronic inflammation of the
eye-lids ; scrofulous ophthalmia, attended with great
intolerance of light, and sense of fulness and disten-
tion of the lids ; pulmonary cough, with sticking pains
in the chest, and copious purulent expectoration ; in
flammation and pain in the knee and hip-joints ; itch
ing pimples upon the scalp, and pain at the roots of
the hairs ; stitching pains in the ears and in the pa
rotid glands ; painful swelling of the upper lip and
wings of the nose ; pain in the region of the liver
after exercise ; pain in the abdomen on pressure, and
in the inguinal glands ; sensation of weariness and
fatigue in all the limbs ; want of vitality ; sensitive
ness to cold ; pains worse during cold weather.
Mental and moral symptoms. — Despondency alter
nating with gayety ; irritable, indolent, and discon
tented.
SCROFULA. 573
Administration. — One grain of the third trituration
every twenty-four hours, until a response is manifest.
Rhus tox. — External indications. — Tinea capitis ;
soft tubercles on the hairy scalp ; scrofulous ophthal
mia, with photophobia, and an eruption about the
eyes ; chronic swelling and induration of the parotid
gland, the axillary, and other glands ; enlargement of
the bones ; herpetic and moist or dry scurfy eruptions
in different parts of the body ; swelling and other
signs of inflammation in the hip and knee joints.
Physical sensations. — Pain in the hip joint, increased
on pressing the trochanter major, and attended with
shortening of the limb, and alternating pains in the
knee ; pains of white swelling, and scrofulous affec
tions of the ancle joint ; scalp painful to the touch, or
from moving the hair backwards ; inflammation and
tenderness of the edges of the eyelids; eyes sensitive
to light ; eyelids itch and feel swollen ; crusty erup
tion in the nose, and about the mouth ; repugnance to
bread and other food ; stitches in the side ; short,
anxious, and painful cough ; oppression of the chest ;
glandular swellings painful when touched ; stiffness
and lameness of the limbs ; very sensitive to the open
air ; pains worst during inaction, or in the cold air.
Mental and moral symptoms. — 111 humour ; languor ;
disinclination to all mental or bodily exertion.
Administration. — A drop of the third dilution each
day, as long as may be deemed necessary.
Iodine. — External indications. — Enlargement of the
cervical, parotid, thyroid, and tonsil glands ; scrofulous
inflammation of the knee, with swelling, heat and red
ness ; elongated and enlarged uvula ; induration of the
os uteri ; glandular indurations in different parts of the
body ; rough and dry skin ; general emaciation ; with
hectic appearance.
Physical sensations. — Catarrhal affections of the
mucous membranes depending on scrofula ; swelling
and pain in the liver ; inflammation in the knee, with
stitches and burning, and increased pain on motion of
the joint or from pressure ; contraction of the oeso
phagus from enlargement and inflammation of the
glands and mucous membrane, with stitching pains
during deglutition ; enlarged mesenteric glands ; tumid
574 SCROFULA.
abdomen, with pains on pressure ; swelling and pain
in the bronchial glands ; glandular swellings about the
neck and axilla, painful, especially on pressure ;
itching pimples on the arms and chest ; general de
bility ; hectic fever ; pains aggravated by exercise, by
contact and by warmth.
Mental and moral symptoms. — Nervous irritability
and increased sensitiveness to external impressions.
Administration. — Same as rhus.
Baryta mur. — External indications. — Chronic indu
ration of the cervical glands ; scrofulous eruptions and
ulcerations ; tinea capitis ; enlargement of the liver,
of the testes, and of the mammae ; chronic inflamma
tion of the eyelids.
Physical sensations. — Itching eruptions of the scalp ;
general emaciation and debility ; scrofulous disease of
the throat, aggravated after every cold ; scrofulous
affections of the ears, attended with throbbing and
itching, and discharge of purulent matter ; inflamma
tion and suppuration of the tonsils ; pains in the af
fected joints and in the long bones ; liability to sore
throat after every cold ; disease of the mesenteric glands
in children ; pains mostly on the left side, when sitting,
and relieved by exercise in the open air ; adapted to
old men and young children.
Mental and moral symptoms. — Imbecility ; absence
of mind ; impaired intellectual powers.
Administration. — The second or third attenuation
may be selected — a dose daily — until the requisite im
pression is produced.
Dulcamara. — External indications. — Moist and sup
purating herpes, forming crusts, or scurvy, bran-like
eruptions; swellings of the cervical and submaxillary,
and inguinal glands; swelling of the calf of the leg;
emaciation ; scrofulous inflammation of the eyelids.
Physical sensations. — Pains in the enlarged glands,
particularly on motion ; great susceptibility to cold ;
pains in the joints on exposure to cold ; pains worse
during rest ; paralysis of the upper eyelids ; phthisis
pulmonalis, before the tubercles commence softening ;
pulmonary symptoms brought on by repeated colds ;
pains in the chest ; febrile symptoms ; lassitude ;
bruised sensations.
SCROFULA. 575
Mental and moral symptoms. — Disposition restless,
angry, and quarrelsome.
Administration. — In the same manner as baryta.
Conium mac. — External indications. — Swelling, in
duration and suppuration of the external glands ; ma
lignant scrofula ; caries of the bones ; scrofulous
photophobia ; diseased rnesenteric glands in children ;
enlargement and induration of the liver and pancreas.
Physical sensations. — Scrofulous swellings, which
evince a disposition to run into scirrhous degenera
tions ; pains in the bones, and in the malignant ulcer-
ations; inflammation, swelling and pain in the ovaries ;
painful swellings of the uterus ; pain in the region of
the liver, when walking; purulent expectoration from
softened tubercles ; intolerance to light, in consequence
of scrofulous opthalmia; dull pain in the knee, when
stepping ; bruised and sore feeling in the calves of the
legs ; pains worse during rest, and in the night.
Mental and moral symptoms. — Dulness of intellect ;
want of memory ; irritability.
Remarks. — For indurated glands, Dr. Johannsen as
serts, that "conium, in the second dilution, stands high
est as a remedy, and next to it, mercurius so/."
Administration. — We advise the third attenuation —
a dose daily until its effects are apparent.
Belladonna. — External indications. — Glandular
swellings, with suppuration ; ulcers ; emaciation ; in
flammation and swelling of the bones ; eyelids in
flamed ; ulcers upon the cornea ; photophobia ; swell
ing of the lips, nose, tongue, uvula, tonsils ; bleeding
at the nose ; swollen and spongy gums.
Physical sensations. — Inflammation and pain in the
enlarged glands, and in the periosteum and bones ;
diseased mesenteric glands, with atrophy; inflamma
tion of the eyes, with heat, redness, and great intoler
ance to light ; pain in the ball of the eye ; double vis
ion ; roaring in the ears ; painful swelling of the paro
tid gland ; soreness of the throat ; impeded deglutition ;
lameness of the limbs when moved ; smarting and
burning pains in the hip joint, increased by contact or
motion, and during the night; painful ulcers on the
skin ; sensitiveness to cold air ; adapted to the scrofu-
576 SCROFULA.
lous affections of children and females of a mild tem
per.
Mental and moral symptoms. — irritability ; amorous,
nervous, excitable, talkative.
Administration. — Same as conium.
Lycopodium. — For the scrofulous dyscrasia, and es
pecially where the periosteum, bones, and cervical
glands are affected. This remedy is adapted to lym
phatic constitutions.
Sepia will be found an efficacious remedy in scrofu
lous females, who are troubled with irregularities in
the menstrual functions. It has been employed suc
cessfully in indurations of the uterus, corrosive leu-
corrhoea, and in pulmonary phthisis with profuse puru
lent expectoration.
Calcarea carb. — According to Hahnemann, carbon
ate of lime is indispensable in those cases where the
menses appear too early and are too profuse. It is
also appropriate in young persons of scrofulous habits.
In children presenting the usual marks of the scrofu
lous dyscrasia, it is one of our most valuable remedies.
It is highly recommended likewise in the scrofulous
ophthalmias of children, particularly after ulcers have
formed on the cornea. Also in marasmus arising from
diseased mesenteric glands, it is an admirable remedy
in alternation with iodine. Scrofulous eruptions and
ulcers of children often yield to this remedy, after
sulphur, mercurius, and hepar sulphuris have been used
in vain.
Hcpar sulphuris is adapted to the cure of scrofu
lous tumours in a state of suppuration, to scrofulous
ophthalmia with profuse lachrymation, and much mu
cous discharge from the meibomian glands, and in
coxalgia, after a purulent discharge has occurred.
This medicine is proper for scrofulous and lymphatic
constitutions.
Mercurius. — This remedy is advised by Hahnemann
in scrofula combined with syphilis. The glandular in
flammations will be characterized by a diffused red
ness, much swelling, and gnawing, stinging or darting
pains, worse at night in bed. It should be consulted
in affections of the bones, the joints, the eyes, and in
eruptions and ulcers upon the surface. The following
SCROFULA. 577
preparations of mercurius, we especially commend in
scrofula : mere, sol., iod. mere., and mere, prcecip. rub.
Aurum mur., ferrum and china are worthy of consid
eration in protracted and obstinate cases, where the
strength of the patient has become much impaired,
and but little impression has been made by the previ
ous remedies.
Hartmann observes that he has " derived essential
benefit from oleum jecoris aselli in every form of the
disease, especially in the precursory stage, when no
particular organ was affected : the patient looked pale,
emaciated, the muscles became flabby, the patient
showed an aversion to meat and vegetables, and want
ed to eat bread and butter all the time. I gave it in
teaspoonful doses, morning and evening, almost al
ways with success. In scrofulous affections of
bones it likewise proved useful, but less so in other
forms of the disease." — (Hartmanrfs Chronic Diseases,
vol. iii., p. 54.)
Dr. J. H. Bennett, of London, has found the cod liver
oil (oleum jecoris aselli) of great service in scrofulous
cases characterized by general or local atrophy. But
in scrofulous affections in which the general health
and strength are unimpaired, and the digestive func
tions are not deranged, Dr. B. advises iodine. We have
employed the oil in doses of a drachm, three times daily,
with eminent success, in almost every form of scro
fula.
For scrofulous ulcers with callous edges, and fistulas,
silicea alone, or in alternation \viihphosphorus, acidphos.
and conium, was found by Dr. Johannsen most useful.
When the ulcers are greenish and offensive, carbo
veg. or mercurius dulc., is advised.
In scrofulous ophthalmia, indurated glands, and dis
eases of the bones, arsenicum, conium, mercurius sol., car-
bo animal. Jieparsulph,a,i].d aurum,me the best remedies.
" Arsenicum is one of the most important remedies
in scrofula, for removing indurations of the glands,
and deformities of the bones, for regulating the dis
charges from the bowels, and for restoring the skin to
a healthy state. Also, in scrofulous ophthalmia it is
of great service." (Dr. Johannsen. Homoeopathic Jour
nal, vol. 1, No. 11.)
25
578 AFFECTIONS OF THE EYE
Afl ministration. — As a general rule, the first to the
third attenuations should be selected, and the doses
repeated once or twice daily, until a satisfactory im
pression is produced upon the affected structures.
CHAPTER XXXI.
AFFECTIONS OF THE EYE AND ITS APPENDAGES.
SECTION I.
The eye, in the immediate vicinity of the brain, con
nected with this organ by the optic nerve, endowed
with numerous delicate membranes, nerves and blood
vessels, with its lens, its aqueous and vitreous humours
to conduct and modify the luminous rays in their pas
sage to the retina, — all disposed in the most consum
mate manner to serve the end designed, — may be
looked upon as a most complex and perfect optical
instrument. It is the mirror in which are reflected the
various tableaux of external objects, for the satisfaction
of the soul within, causing it to respond to such im
pressions so that the most indifferent spectator may
look into its depths, and see the manifestations of the
perceptive faculties.
The impressions of external objects, derived through
this medium, constitute our principal sources of know
ledge and of pleasure. Without this faculty, we learn
only by vague comparisons, suggested by touch, taste,
smell, and hearing, by which all our conceptions are
more or less perverted and indefinite. It is through
the medium of vision, that the child first acquires a
just idea of colours, distance, proportion, magnitude,
&c., and begins to reason and act by a comparison of
his different impressions. It is through the eye alone
that we appreciate the infinite variety of expression
in the '* human face divine," and become incited to
sympathy, love, pity, charity, admiration, fear, hope,
hate* anger, and other emotions ; that we enjoy the
AND ITS APPENDAGES. 579
beauties and sublimities of nature ; that we become
acquainted with the wonders of art and science ; and,
by contrasting objects with each other, that we are
able to enrich our minds with whatever elevates us in
dignity of being and capacities of happiness.
The eye is, perhaps, more delicate of organization, and
yet, from its situation, more exposed, than any other,
to external causes of disturbance. How important then
that we obtain accurate ideas relative to its structure
and functions, and the disorders to which it is liable,
that we may be able to protect it when well, and
promptly to cure it when diseased.
In our description of the diseases of the eye and its
appendages, we shall adopt this classification :
First. Affections of the tunica conjunctiva, or outer
covering of the eye, including — First, acute ophthal
mia ; second, chronic ophthalmia ; third, purulent oph
thalmia ; fourth, gonorrhasal ophthalmia ; fifth, stru-
mous or scrofulous ophthalmia ; sixth, granulated lids;
and, seventh, opacity of the cornea.
Second. Affections of the deeper seated structures
of the eye, including — First, inflammation of the cor
nea ; second, iritis ; third, amaurosis ; fourth, hy-
dropthalmia, or dropsy of the eye; fifth, cataract;
and, sixth, fungus hcematodes, and cancer of the eye.
Third. Affections of the appendages of the eye,
including — First, hordeolum or stye; second, entro-
pium, or inversion of the eyelids ; third, ectropium, or
eversion of the eyelids ; and, fourth, fistula lachry-
malis.
This classification is deemed sufficient for all prac
tical purposes, and much less liable to lead to confu
sion than one more extended. We shall point out the
prominent affections of each structure of the eye, and
endeavour, in enumerating the causes, to make the
reader acquainted with every thing of interest con
nected with each particular subject.
Ophthalmia may be primitive or symptomatic, —
acute or chronic, — and its causes, local or constitu
tional. Its manifestations also may be confined to the
eye itself, or sympathetic symptoms may declare them
selves in the head, stomach, and other parts of the
580 AFFECTIONS OF THE EYE
economy. These developments will depend much
upon the constitution, temperament and habits of the
patient, the causes which have operated to produce
the malady, the severity of the inflammation, and the
tissue affected. It is worthy of note, however, that
when a particular tissue of one eye is diseased, the
corresponding structure of the other eye is exceedingly
prone to a similar morbid action, from sympathy. This
may be accounted for from the fact that the eye re
ceives its nerves and blood-vessels directly from the
brain, by which the sympathetic communication be
tween the two organs is rendered very rapid and in
tense.
Finally, we direct special attention to the therapeu
tical connection existing between morbid conditions
of particular tissues, and primitive medicinal symp
toms, upon the same tissues, in health. We have
already a few specifics which impress certain struc
tures only, and we trust that the time is not distant
when medicines will be discovered capable of acting
surely and specifically upon each separate part of the
eye or its appendages. Fortunately, a few of our
drugs have a wide range of action upon the visual
organs, so that we shall be able, even now, to find
specifics which correspond with almost any morbid
symptoms that may present themselves.
SECTION II.
AFFECTIONS OF THE TUNICA CONJUNCTIVA.
ACUTE OPHTHALMIA.
Diagnosis. — One of the first local signs of simple in
flammation of the conjunctiva, is an injection with
red blood, of a number of the vessels which naturally
admit only a white fluid. This gives to the eye that
slight appearance of redness and distention of vessels,
which characterizes the first stage of acute ophthalmia.
The eye now becomes more than usually sensitive to
light, smoke, and dust ; tears are easily excited ; a
feeling is experienced similar to that produced by par
ticles of sand or dust lodged under the upper eyelid,
causing the patient to constantly rub the eye in order
AND ITS APPENDAGES. 581
to remove what he supposes to be a foreign substance ;
a sense of heat, fulness, stiffness and tingling is felt in
the globe and edges of the lids ; and slight pains begin
to shoot through the eye. At first but a part of the
vessels become injected, but as the inflammation in
creases, the anastomosing branches become involved,
until finally the whole eye presents a uniform appear
ance of deep redness, swelling, and turgidity. At this
period of the disease, the functions of the eye are all
more or less perverted ; there are acute pains in the
ball ; great intolerance to light ; a profuse secretion
of scalding tears ; disordered vision ; agglutination
of the lids in the morning from matter secreted by
the meibomian glands ; intense pain on moving the lids ;
distressing sense of distention, weight, and rigidity of
the whole organ, and diminished power of motion. ,
The symptoms thus far detailed, are purely local
and include all of the symptoms which are present
from the commencement to the termination of many
cases of simple acute ophthalmia. But in the majority
of instances, the whole system sympathises with the
local affection, and we are presented with the follow
ing additional train of constitutional or sympathetic
symptoms : acute pains extending from the eye into
the temples and anterior portion of the brain ; slight
chills, followed by accelerated circulation and respi
ration ; hot and dry skin ; determination of blood to
the head and face ; nausea ; loss of appetite ; lassi
tude ; general irritability ; physical weakness ; and
other indications of febrile excitement.
During the progress of the inflammation, a peculiar
appearance is often observed above the cornea, in the
form of a circular elevation termed chemosis. This
arises from the precaution which nature has taken to
protect the cornea from the injurious effects of ophthal
mia, by fixing the conjunctiva more firmly upon this
portion of the globe, than upon the other parts. By
this peculiar construction, the distention of vessels and
effusions resulting from violent inflammations, are
principally manifested in the first instance, without
the cornea, and thus in some measure protecting this
important part from the injury it might otherwise
sustain.
582 AFFECTIONS OF THE EYE
The severity of the symptoms will depend much
upon the constitution of the patient, and the nature of
the exciting cause. The disease may terminate in a
cure, without any marked alteration in the appear
ance of the eye, or it may result in effusion, caus
ing an elevation of the conjunctiva above the cornea;
or in adhesion of some portion of the conjunctiva
covering the cornea, and giving rise to those appear
ances known as nebula, albugo, leucoma, and opacity ;
or in suppuration, from the surface of the conjunctiva ;
or in ulceration of some part of the cornea ; or in
sloughing of the cornea. These appearances will be
more particularly described in our article on opacity
of the cornea.
Causes. — Undue exposure to intense heat or cold ;
inordinate use of the eyes by a glaring or dim light ;
the application to the eyes of irritating foreign sub
stances ; mechanical injuries ; extension of contigu
ous inflammations to the eyes ; sudden changes of
temperature ; metastases of gout and rheumatism.
Prognosis. — If appropriate remedies are adminis
tered in the early stage of the complaint, and before
any organic lesion has taken place, we may gener
ally predict a speedy and perfect cure. On the con
trary, if effusion, ulceration, or the adhesive process
of the conjunctiva over the cornea, has commenced,
we must be more guarded in our prognosis, for under
these circumstances the malady often ends either
in impaired vision, or a total loss of sight.
Much information may be derived respecting the
probable termination of the malady, by a careful ex
amination of the causes which have been, or may still
be in operation, and of the temperament and constitu
tion of the patient. For example, an individual of an
irritable and nervous temperament, and of a delicate
organization, may be affected with the most violent
local and constitutional symptoms for a considerable
period, without endangering the integrity of the eye ;
while a sanguine, plethoric, and robust patient might
experience no constitutional effects, and but moderate
local symptoms, and yet speedily suffer from serious
disorganization of one or more of the tissues. Much
will also depend upon our ability to remove all causes
AND ITS APPENDAGES. 583
which may have conduced to the complaint, and to
enforce upon our patients the necessary restraints and
attention during the treatment.
Therapeutics. — The first therapeutical indication is
to confine the patient to an apartment in which the
light is mostly excluded. It must be remembered that
this natural stimulus of the healthy eye, becomes,
during an acute inflammation of its tissues, a powerful
irritant — a morbid agent capable of aggravating and
perpetuating the disease. As the inflamed stomach
cannot tolerate its natural stimulus, the food, so the in
flamed eye cannot endure with impunity, its ordinary
stimulus, the light. Perfect cleanliness should be
enjoined, and an exclusion of all dust, vapours, smoke,
and bright rays of light. In making applications to
the eye, great care should be taken to avoid compres
sion of the inflamed part, in order that the circulation
may remain unobstructed, and that sufficient air may
be admitted to the parts.
Respecting local applications, we entertain the most
exalted opinion of cold water. This may be applied
by means of a few folds of soft linen cloth, which may
be frequently dipped in the water, and after being
partly wrung out, laid loosely over the eye and the sur
rounding parts. This application may be persisted
in at suitable intervals, until the active symptoms have
subsided, and a state of sub-acute inflammation occurs,
when recourse may be had, if deemed necessary, to
collyria of a slightly stimulating character, like weak
solutions of zinc, nit. argenti, lead, or copper. In mak
ing use of these last named articles, we should only
employ a strength sufficient to create a decided medi
cinal action, and omit the application when this effect
is apparent, and so long as the consequent reaction or
amendment continues ; for external remedies, when ju
diciously employed, are subject to the same laws of
primary and secondary action, as when administered
internally. We shall say more upon this subject under
chronic ophthalmia.
The medicines to which we call particular atten
tion are, belladonna, aconite, arsenicum, sulphur, digi
talis, euphrasia, pulsatilla, arnica, spigelia, mercurius
sol., graphite, lycopodium.
K OF TH-
UNIVERSITY
/-% C *.
584 AFFECTIONS OF THE EYE
Belladonna. — External indications. — Redness,
swelling, and protrusion of the ball of the eye ; che-
mosis ; swelling of the lids ; frequent discharge of
hot and salt tears, or dryness of the eyes ; spasmo
dic closure of the lids; flushed cheeks; throbbing of
the carotid and temporal arteries ; full and rapid
pulse ; hot and dry skin.
Physical sensations. — Great intolerance to light;
pain, burning, and smarting in the eyes ; heaviness,
pressure and throbbing in the ball and lids ; sharp
pains in the orbits, extending into the brain ; tearing
pains in the eyes from within, outwards ; dimness and
obstruction of vision ; spasmodic sensations in the
eyes.
Mental and moral symptoms. — Nervousness ; irrita
bility ; disinclination to mental labour.
Remarks. — Belladonna is suitable in ophthalmia oc
curring in sanguine and irritable persons, from con
gestions of blood to the eyes in consequence of ex
posure to cold, excessive use of the eyes, metastases of
rheumatism and gout. It is particularly useful when
constitutional symptoms show themselves in the form
of acute or throbbing pains in the head and temples,
hot skin, rapid pulse, flushed cheeks, dilated pupils,
and perverted vision.
Aconite. — External indications. — Vessels of the con
junctiva injected with red blood ; lids red and swollen ;
chemosis ; dilation of the pupils ; lachrymation, worse
on the slightest exposure to light, dust, or smoke ; pho
tophobia ; flushed cheeks ; hard and rapid pulse ; hot
and dry skin, and other febrile symptoms.
Physical sensations. — Very great intolerance to light ;
pressing, stinging, burning, or exceedingly acute pains
in the eyes ; eyeball feels bruised, and pressed into
the orbit ; stinging and smarting of the lids ; eyes
very hot, and filled with scalding tears, or preterna-
turally dry ; pressure, or sharp, beating, or stinging
pains in the head and temples ; impaired vision, as
from a gauze before the eyes ; general febrile disturb
ance.
Mental and moral sy7nptoms. — Much mental excite
ment ; fear and apprehension in regard to the probable
result of the case.
AND ITS APPENDAGES. 585
Re?narks. — This remedy is particularly called for
when the local inflammation is very intense, and the
constitutional symptoms run high. It operates most
happily in plethoric, bilious, and sanguine individuals,
who are subject to determinations of blood to the face,
head, and lungs. It is appropriate in ophthalmias
caused by colds, by the introductions of foreign sub
stances into the eye, and by rheumatism and gout.
Arsenicum. — External indications. — Conjunctiva
much congested, and of a dark-red colour ; osdematous
swelling of the lids ; profuse lachrymation ; tears hot
and corrosive to the cheeks ; lids dry and red ; eyelids
partially closed from the great swelling ; nightly ag
glutination ; spasmodic movements of the lids, on ex
posure to light ; ulcers on the cornea.
Physical sensations. — Sensation as if sand had be
come lodged in the eye ; tearing, burning, or stinging
in the ball and lids, aggravated by motion, or on ex
posure to light ; throbbing in the eyes when lying
down ; impaired vision ; weakness, weariness, and
tremour of the lids ; great intolerance to light ; con
stant inclination to rub the eyes.
Mental and moral symptoms. — Mind weakened, and
whole system rendered nervous and irritable, by pain
and suffering.
Remarks. — Arsenicum is applicable to those cases
which arise in weakly and nervous constitutions,
where the pains are severe, and the disease is unusually
obstinate. In this variety of ophthalmia, the local and
sympathetic symptoms are very troublesome, but there-
is much less danger of serious organic lesions than in
most other forms of the malady. It is advised in
ophthalmia arising from cold, rheumatism and gout.
Sulphur. — External indications. — Injection of the
vessels of the conjunctiva ; redness and swelling of
the lids ; lachrymation, or preternatural dryness of the
eyes ; morning agglutination of the lids ; photopho
bia ; eyes swollen and prominent; cornea dim; lids
oadematous ; distention of the conjunctiva from effusion.
Physical sensations. — Pressure of the eyeballs, worse
on moving them ; pressure, burning, and itching of
the lids ; intolerance to the rays of the sun ; twitching
of the lids; trembling of the eyes ; painful dryness of
586 AFFECTIONS OF THE EYE
the margins of the lids ; bruised feeling of the eyes,
on motion ; sensation of sand under the upper lid, on
motion; dimness of sight.
Mental and moral symptoms. — Sensitive ; despond
ent ; out of humour.
Remarks. — Sulphur is adapted to lymphatic tem
peraments — a scrofulous or psoric dyscrasia, and may
be employed in ophthalmia caused by repelled erup
tions, abuse of mercury, or irritating matters intro
duced into the eye.
Digitalis. — External indications. — In tense redness of
the conjunctiva ; inflammation of the meibomian glands ;
swelling of the lids ; constant and profuse lachryma-
tion ; photophobia ; dryness of the nose ; morning ag
glutination of the lids ; tears hot and corrosive ; coun
tenance bloated.
Physicial sensations. — Aching, throbbing, burning,
pressing, or stitching pains in the affected eyeball,
worse when moving or touching it ; feeling as of sand
under the lids ; discharge of hot and irritating tears,
on exposure to the open air or to light ; intolerance
to light ; dimness of sight ; eyes constantly hot and
painful ; objects all appear unnatural ; visions before
the eyes.
Mental and moral symptoms. — The predominant
mental traits are, despondency and mental languor.
Remarks. — Digitalis is suited to sanguine tempera
ments, and also to persons of a scrofulous habit. It
has been successfully employed in ophthalmias conse
quent on colds, scrofula, and gout. Euphrasia also
corresponds to most of the symptoms enumerated un
der digitalis, and may sometimes be substituted to
advantage in the place of this last remedy, when the
desired effect is not promptly produced.
Pulsatilla is appropriate in catarrhal or rheumatic
ophthalmia, attended with pressure and burning in the
eyes, as if from sand ; redness and swelling of the con
junctiva and lids : coryza ; profuse lachrymation in
the wind or open air ; burning and itching of the eyes,
inducing a disposition to rub them ; photophobia ; in
flammation, and secretion of mucus from the meibomian
glands ; dimness of sight ; morning agglutination.
Arnica is indispensable in ophthalmic inflammations
AND ITS APPENDAGES. 587
caused by mechanical injuries of the eye, or of the
parts in its vicinity. The remedy may be used both
internally and externally.
Spigelia is especially adapted to rheumatic and ar
thritic ophthalmia ; the pains are of a pressive or
stitching character, and aggravated by movement ;
the vessels of the conjunctiva are much congested ;
the cornea is dim ; aching pains are experienced in
the eye when touched, extending deep into the orbit ;
the upper lids swollen and stiff.
Mercurius sol. is proper in catarrhal and rheu
matic ophthalmia. Its indications are, inflammation
of the eyes, attended with burning, smarting, heat,
and pressure, worse in the open air ; sensation as if
sand were under the upper lid ; profuse lachrymation ;
photophobia ; darting pains in the eyeballs ; redness
and swelling of the lids ; dimness of vision ; pains
worse when moving or touching the eye ; boring pains
in the eyes and surrounding parts.
Other remedies are, graphite, lycopodium, nux vomica,
calcarea carb., colocynth, rhus, cocculus, cannabis, and
dulcamara, to which the reader is referred.
Administration. — In very acute cases, we advise the
third attenuation, and a repetition of the dose every
two hours until the desired impression is produced.
In more mild forms of the disease, we use the first or
second attenuations, and repeat every six or eight
hours, as long as is deemed necessary.
SECTION III.
CHRONIC OPHTHALMIA.
Chronic ophthalmia may arise in consequence of
the subsidence of the active symptoms of the acute
form of the disease, and the persistence of a condition
of sub-acute inflammation, or from causes which ope
rate gradually, and induce an atonic state of the parts,
and a low grade of morbid action. It may continue
in this chronic state for years, without causing any
notable organic derangement, the only difficulty ex
perienced, being a weak, sensitive, and irritable con
dition of the eyes.
Diagnosis, — When chronic ophthalmia succeeds the
588 AFFECTIONS OF THE EYE
acute, it will be found that a part of the vessels of the
conjunctiva have recovered their tone and now circu
late only the white blood, as formerly, while the lar
ger vessels remain injected with red blood. These
larger vessels, during the progress of the disorder, be
come so much distended by the intromission of the red
globules, that a varicose dilatation often remains for
a long period after the acute stage has been passed,
and thus establishes the chronic malady. One of the
prominent local symptoms, therefore, of chronic oph
thalmia, as distinguished from the acute variety, is,
the moderately congested state of the vessels, which
renders the conjunctiva partly red and partly white.
The eye is also much less sensitive to light, dust, and
smoke ; tears are not so easily excited ; vision is im
proved ; there is an absence of pain, burning, and heat ;
tears are not so hot and acrid ; the swelling of the lids
is diminished, and all febrile and sympathetic symp
toms have disappeared. But the eye is more sensitive
than natural to light ; the edges of the lids are red or
purple ; nightly agglutination occurs ; the patient is
unable to use the eyes long at a time ; objects often
float before the eyes, obstructing vision ; the lids itch
and tingle, mostly in the morning on rising ; flow of
tears caused by cold air, light, wind, smoke, dust, and
vapours.
Causes. — Acute inflammation ; habitual intemper
ance ; constant exposure to irritating vapours ; me-
tastases of rheumatism and gout ; external injuries ;
repelled eruptions ; protracted exposure to cold in a
region of snow ; excessive use of the eyes by a strong
or dim light.
Prognosis. — Unless adhesions have taken place be
tween the conjunctiva and cornea, or ulcers, cica-
trixes, or effusions, have formed, so as to obstruct the
rays of light, we may expect a ready cure of the dis
ease. If, however, disorganization has already occur
red, and vision has become obstructed, we may predict
a cure of the morbid inflammatory action, but only a
partial restoration of sight. Habitual chronic ophthal
mias, proceeding from intemperance, constant expo
sure of the eyes to stimulating vapours, etc., may
readily be cured by removing the exciting causes, and
AND ITS APPENDAGES. 589
having recourse to the appropriate local and internal
remedies.
Therapeutics. — It is in this variety of ophthalmia,
that we may expect to derive most benefit from the
use of stimulating collyria. The object of all remedies,
as has before been observed, is to create a healthy
medicinal action in the diseased part, which shall su
persede the morbid action, and thus secure a cure.
But we have also seen that this medicinal effect must
be two-fold in order to prove curative : or, in other
words, there must be a primary and a secondary effect,
the former analogous to that of the disease, and the
latter, the reverse, or curative. Whenever these two
conditions result from the application of remedies, in
ternal or local, a cure may be expected. Care, how
ever, must always be observed, that the medicines be
so adapted to the nature of the case, that the primary
symptoms shall be of short duration, and succeeded
by the legitimate, opposite, or curative reaction.
In deciding, therefore, respecting the proper strength
of a local application to an inflamed eye, we may fol
low the maxims of Hahnemann, or, what will answer
as well, adopt the following rule inculcated by Sir
Astley Cooper, in regard to the use of collyria, viz :
" To judge how far the stimulus may be carried, the
criterion is exceedingly simple ; if you find that a cer
tain degree of smarting and pain is produced, which
soon subsides and leaves the patient much more easy
than before, you may be convinced that the collyrium
is beneficial ; if, on .the other hand, the patient expe
riences a great degree of pain, which does not subside
speedily, and the vessels become turgid, you may be
assured that the collyrium is doing harm, and that the
quantity of stimulus ought to be diminished."
The best local stimulus we ever employed, in clearly
pronounced chronic inflammation of the eyes, is the
wine of opium, (vinum opii), a single drop to be intro
duced into the eye once or twice in twenty-four hours,
until there is a permanent reaction. When the se
condary symptoms do not speedily appear after the
application, we may then have recourse to a weak
solution of sulphate, of zinc, or of nitrate of siloer. If
these fail, a dilution of aconite may be tried.
590 AFFECTIONS OF THE EYE
The internal remedies are, arsenicum, belladonna,
calcarea carbonica, sulphur, rhus, silicea, nux vomica,
graphite, phosphorus.
The indications for the use of these different medi
cines will be found under acute ophthalmia. The prin
cipal difference between the two forms of the malady,
consists in degree rather than in the quality of the
symptoms.
Respecting the administration and repetition of
doses, we prefer the first, second, and third attenua
tions, and advise a repetition once in twenty-four
hours, until an impression is produced.
SECTION IV.
PURULENT OPHTHALMIA.
Diagnosis. — This variety of ophthalmia is more vio
lent and destructive, and runs its course with much
greater rapidity, than that which we have described.
It is characterized by a profuse purulent secretion
from the conjunctiva, which collects and hardens
about the lids, gluing them together, and in this way
acts as a constant irritant to the inflamed part. The
disease commences like the simple acute ophthalmia,
with itching, stinging, or burning sensations in the
lids and globe, lachrymation, sensitiveness to light, red
ness of the conjunctiva, which soon increase to an in
tense villous redness, swelling of the lids, sensations as
if foreign substances, like sand or sticks, were in the
eye, and more or less indistinctness of vision. These
symptoms augment very rapidly in intensity. The
tingling sensations change to severe pains through the
eye, sometimes extending to the temples, and even the
brain itself; there is chemosis, the lachrymation be
comes changed into a profuse secretion of pus, either
yellow or greenish ; the intolerance to light becomes
more marked, the lids are very much swollen, and
discharge much purulent matter, and there is almost a
total obstruction of sight. Constitutional symptoms
frequently occur, as in simple ophthalmia, in the form
of headache, nausea, quick pulse, hot skin, general
prostration, &c. This acute stage terminates in a
short period in a sub-acute inflammation, or in ulcer-
AND ITS APPENDAGES. 591
ation and sloughing. When the former termination
happens, there is a gradual subsidence of all the
symptoms, and the disease remains for an indefinite
period in this atonic state, after which the eye may
recover its tone and healthy function. But if sloughing
takes place, the destructive process may run on to a
total destruction of the part, unless energetic mea
sures are used to arrest its progress.
Causes. — Sudden alternations from heat to cold ;
endemic and epidemic influences ; the irritation of
hot sand introduced into the eyes ; metastases of
rheumatism, gout, scarlatina, small-pox, and measles ;
abuse of mercury ; the morbid vaginal secretion to
which the eyes of new-born children are sometimes
exposed.
SECTION V.
GONORRHGEAL OPHTHALMIA.
Diagnosis. — This variety of inflammation attacks
the conjunctiva also, and is attended with symptoms
very similar to those of purulent ophthalmia, but of
much greater intensity. This disease is supposed to
be the most violent and destructive of any to which
the eye is subject, and it is not uncommon so see it
proceed to the entire destruction of vision, notwith
standing the most early and energetic attempts to cure
it. There is especial danger, in gonorrhoeal ophthal
mia, of a speedy formation of ulcers of the cornea,
and of rapid sloughing through the tunics of the eye.
Whenever, therefore, we are called to a case of this
description, with intense inflammation and redness of
the eyes, greatly swollen lids, very abundant dis
charge of pus, or a dry and burning state of the con
junctiva and lids ; excruciating pains in the eyes and
head ; chemosis ; great intolerance to light ; hot skin ;
nausea ; thirst ; and other febrile symptoms ; it be
comes us to exercise the utmost vigilance in our re
medial measures, in order to save the eyes from ulcer-
ation and sloughing. Farther on we shall detail a
method of treatment which will generally be found
successful, even in the most severe cases. Nothing,
however, but the strictest attention to everv minute
592 AFFECTIONS OF THE EYE
symptom of the case, and a constant watch over
medicinal effects, will ensure success.
The cause of this affection is unquestionably the ap
plication to the eyes of gonorrhoea! matter, and not, as
some suppose, a metastasis of the disease to the eyes.
Another variety of purulent ophthalmia to which it
is proper to allude, is that which occurs in infants
shortly after birth. This disease is supposed to arise
from the contact of the vaginal secretion of the mat
ter with the eyes of the child during birth. The
symptoms generally first make their appearance in
about two weeks after birth, but they may occur be
fore or several weeks after this period. The symp
toms are similar to those of purulent ophthalmia, but,
for the most part, the inflammation is less intense, and
there is much less danger of the speedy supervention
of ulcers of the cornea. It is quite true that ulcera-
tion and sloughing ultimately occur in these cases ;
but a longer time is afforded for our remedial efforts to
take effect, and of course the prospect of cure thus en
hanced.
SECTION VI.
STRUMOUS, OR SCROFULOUS OPHTHALMIA.
Diagnosis. — Scrofulous ophthalmia presents several
symptoms which are quite characteristic, and by the
aid of which we may always form a ready and accurate
diagnosis. The disease occurs in subjects of a scrofu
lous habit, and is accompanied with the general signs
peculiar to struma, in addition to the local symptoms.
Indeed, these general marks will often aid materially
in forming our opinion, particularly in slight cases.
The light and clear complexion, blonde hair, blue
eyes, tendency to glandular swellings of the neck, the
tumid upper lip, eruptions during childhood behind
the ears and upon the head, sensitiveness to cold, dis
position to cough after colds, frequent pains and dis
charges from the ears, indicate the strumous dyscra-
sia, which often determine and develop inflammations
of the scrofulous kind.
The peculiar symptoms which distinguish this in
flammation are, the almost absolute intolerance to
AND ITS APPENDAGES. 593
light ; the violent spasmodic closure of the lids on the
slightest exposure of the eyes to it, and the strumous
eruptions which generally make their appearance in
the neighbourhood of the eyes. The light is com
monly so painful, and the dread of exposure to it is so
great, that it is exceedingly difficult to make a
thorough examination in children, and, as a general
rule, it is better to trust to the voluntary efforts of the
patient, in a moderate light, rather than resort to
much violence in attempting to force open the eyes.
Usually, by obtaining the confidence of the patient,
we can persuade such a display of the globes as will
sufficiently satisfy us in regard to the case. The
vessels of the conjunctiva are generally much inject
ed ; there is a considerable discharge of purulent
matter ; the balls are stiff and painful ; the lids
swollen : vision impaired by the inflammation, or by
ulcers on the cornea ; one or more ulcers form on the
conjunctiva covering the cornea ; and, if the symp
toms continue to increase, the sight is finally de
stroyed.
The disease varies much in its progress ; is some
times attended with but little redness of the conjunc
tiva, but slight pains in the globes, and but a mod
erate secretion of pus ; at other times, during the
formation of a.n ulcer, all these symptoms increase in
intensity, until the case nearly resembles one of acute
purulent ophthalmia. It is of far more common oc
currence in children than in adults.
Causes. — The constitutional cause, as we have seen,
is a strumous dyscrasia. The local, or exciting
causes are, atmospheric vicissitudes ; undue exposure
to cold, light, dust, smoke, and irritating vapours ; ne
glect of cleanliness.
Prognosis. — Severe purulent ophthalmia under the
most favourable circumstances, for the application of
remedies, is highly dangerous. The chief peril
against which we have to guard, is ulceration of the
cornea. Before this has taken place, and especially if
the cornea appears bright, we may entertain hopes of
a favourable termination of the case ; but if these
opaque specks form while the inflammation retains its
intensity, we must be prepared for a partial or total
594 AFFECTIONS OF THE EYE
loss of vision. Of the different kinds of ophthalmia,
the gonorrhoeal is unquestionably the most rapid in its
progress, and dangerous in its character. Here, no
thing but the most consummate judgment and cool
ness, with constant attention, can avert serious conse
quences. The other varieties of the malady are not
quite so rapid and destructive, but they demand the
most skilful and energetic efforts to ward off injuri
ous results.
As a general rule, if we are called during the
early stages of the complaint, and exhibit the ap
propriate specifics judiciously and boldly, little diffi
culty will be experienced in inducing a speedy and
happy issue to either of the varieties ; unfortunately,
however, the physician is rarely called until the dis
ease is so far advanced that ulceration cannot be pre
vented. It is evident, then, that the prognosis will de
pend upon the intensity of the disease, the complica
tions which have occurred, the time it has existed,
the constitution of the patient, and the remote and ex
citing causes.
Therapeutics. — The only local application which can
be advantageously used during the acute stage of pu
rulent ophthalmia, is pure water, either cold or tepid.
This may be employed as a lotion to the parts, during
the course of the acute symptoms, as the judgment of
the adviser shall dictate. When the chronic stage
has set in, recourse may occasionally be had to stimu
lating collyria, like vinum opii, solutions of sulph.,
zinc, nitr. argenti, sulph., cuprum, acetat., plumbi, and
aconite ; but in regard to these applications, the same
rules apply with full force here, that we have pre
sented under the head of simple acute ophthalmia,
when alluding to the use of collyria.
The following remedies will cover all of the symp
toms which obtain in the different varieties of puru
lent ophthalmia : arsenicum, belladonna, sulphur, rhus
toxicodendron, calcarea carbonica, aconite, mercurius
sol., graphite, phosphorus, spigelia, digitalis, acid nitr. ,
hepar sulphur., causticum.
Arsenicum will prove curative in purulent ophthal
mia, with much vascular congestion of the conjunc
tiva : swelling of the lids ; nightly agglutination ;
AND ITS APPENDAGES. 595
photophobia ; pressure and burning pains in the eye
balls, aggravated by moving the eyes : nebulous spots
and ulcers on the cornea.
Belladonna is an admirable remedy in scrofulous in
flammation of the eyes, with very great intolerance to
light ; a constant inclination to remain in the dark, or
to plunge the eyes into a pillow or some other soft
article ; purulent discharge ; great swelling of the
lids ; spasmodic closure of the lids on exposure to
light; chemosis ; tearing, throbbing, smarting, or
stitching pains in the eyes ; roaring in the ears ; hot,
dry skin ; thirst ; nightly agglutination ; throbbing of
the carotid and temporal .arteries ; pains in the tem
ples and head; ulcers on the cornea; dimness of
vision. We have cured several cases of purulent
ophthalmia of infants, characterized by great intole
rance to light, intense inflammation, throbbing of the
carotid and temporal arteries, flushed cheeks, hot skin,
and other indications of inordinate vascular excite
ment, with belladonna, succeeded by mercurius. We
deem belladonna one of our most valuable medicines
in nearly all of the acute inflammations of the
eye. The effects arising from the application of a
small quantity of the extract to the eyebrows or tem
ples, are sufficient to demonstrate its marked specific
action upon the structures of the eye. We have found
it eminently serviceable in ophthalmia neonatorum,
and in acute ophthalmia.
Sulphur is an invaluable remedy in several kinds of
purulent ophthalmia. It is adapted to the chronic
forms, with atonic distention of the conjunctival
vessels ; swollen and oedematous condition of the
lids, with purulent discharge ; suppurating ulcers on
the cornea ; sensation of itching, burning, and heat in
the eyes and lids ; troublesome agglutination in the
morning ; diminished power of motion of the upper
lids ; pustules of the cornea ; sensitiveness to the
light of the sun ; swollen upper lip ; eruptions behind
the ears, and on the scalp and face ; pressure and
burning pain in the eyes ; impaired vision. Sulphur
is one of those remedies \vhich will be required
more or less frequently in all varieties of ophthal
mia, not only to combat those local symptoms which
596 AFFECTIONS OF THE EYE
especially correspond with it, but to correct mor
bid conditions of a more general and latent cha
racter. Sulphur may occasionally be used with de
cided advantage in alternation with remedies which
appear to cover all of the manifest symptoms, but
•which do not produce prompt impressions when given
singly.
Rhus tox. is useful in rheumatic, scrofulous, and ca-
tarrhal ophthalmia, with much inflammation and swell
ing of the lids ; redness of the balls of the eyes ; profuse
secretion of mucus or pus from the eyes and lids ;
osdematous swelling of the lids and the parts surround
ing the eyes ; morning agglutination, with increased
redness of the eyes ; pain on turning the balls ; lach-
rymation ; photophobia.
Dr. Dudgeon considers rhus toxicodendron one of
the most important remedies in catarrha], erysipela-
tous, scrofulous, and exanthematic ophthalmia. Many
allopathic physicians commend the tincture of rhus in
scrofulous ophthalmia. We can bear witness to the
value of this medicine in scrofulous ophthalmia, and
in chronic ophthalmia which is kept up by a dyscrasia
of an erysipelatous character.
Calcarea carbonica has been successfully employed
in every variety of purulent conjunctival inflammation.
Its chief indications are, inflammation, redness, and pu
rulent secretion from the eyeballs ; swelling and red
ness of the eyelids ; nightly, and sometimes daily,
agglutination of the lids ; great intolerance to light;
nebulous specks and ulcers on the cornea ; inclination
to keep the eyes in darkness ; scrofulous eruptions
upon the face and scalp ; glandular swellings of the
neck ; swelling of the upper lips and nostrils ; pus
tules on the cornea ; pressing or aching pains in the
eyes ; corrosive inflammation in the edges of the lids ;
acrid lachrymation ; general appearance indicative of
the scrofulous dyscrasia. Dr. Dudgeon expresses the
opinion that calcarea " is one of our most impor
tant ophthalmic medicines, and is surpassed by
none in its applicability to the generality of cases
of scrofulous inflammation, whether of the eye it
self, or its lids ; and is indispensable where there
AXD ITS APPENDAGES. 597
is marked scrhfuloiis diathesis, indicated by swell
ings of the glands," &c.
Aconite may often precede other remedies in every
variety of purulent ophthalmia, when the inflammation
runs high, and gives rise to febrile symptoms. Intense
redness and swelling of the affected parts ; acute
pains ; accelerated circulation ; violent photophobia ;
headache ; hot and dry skin ; Thirst ; flushed cheeks ;
throbbing of the arteries about the neck, head and face ;
loss of appetite ; and perverted vision, point to the em
ployment of aconite. In some instances it may be al
ternated with belladonna to advantage.
Mercurius sol. has proved successful in my hands
in gonorrhceal, scrofulous, and infantile ophthalmia ;
the remedy having been preceded by aconite. The
symptoms were, violent inflammation, and redness of
the eyes ; great intolerance to light ; profuse acrid or
purulent secretion from the balls and lids ; spasmodic
closure of the lids ; heat in the eyes ; cutting and
burning pains in the parts ; ulcers on the cornea ; cor
nea dim and misty ; sight impaired ; frequent agglu
tination of the lids ; gummy and scurfy matter on the
edges of the lids.
Graphite is one of our best remedies in scrofulous
ophthalmia, with excessive intolerance to light ; chronic
congestion of the conjunctiva ; purulent secretion from
the balls and lids ; frequent agglutination of the lids ;
ulcers on the cornea ; porrigo in the face ; eyelids
much inflamed, red, and painful ; inability to open
the eyes before a strong light ; constant desire to keep
the eyes covered ; symptoms worse by day-light than
by candle-light ; general appearance indicative of a
scrofulous diathesis.
Phosphorus is sometimes useful in obstinate and pro
tracted cases of atonic ophthalmias, \vhich have re
sisted the ordinary remedies. There is generally in
flammation and moderate redness of the eyes ; con
siderable secretion of viscid mucus; sensitiveness of
the eyes to light ; heat, burning and itching of the
eyes ; lachrymation during the day ; frequent and sud
den attacks of blindness during the day ; floats before
the eyes ; weakness and indistinctness of vision.
Spigelia is advised in purulent inflammation, prin-
598 AFFECTIONS OF THE EYE
cipally affecting the eyelids, with sharp pains in the
lids ; pressure and pain in the eyeballs during motion ;
distention and paralysis of the upper lids ; painful ul-
ceration of the edges of the lids ; dimness of the cor
nea ; general loss of power over the eyes. Rummel
speaks highly of spigelia in rheumatic and gouty in
flammations attacking the cornea.
Digitalis is recommended in conjunctival ophthal-
mise arising from colds, with acute inflammation, red
ness, sharp stitches, photophobia, secretion of puru
lent matter, and obstruction and dryness of the nose.
Nitric acid and hepar sulph. are the best specifics
for the removal of mercurial ophthalmia, following the
abuse of this drug in syphilis and other diseases. The
symptoms are, inflammation, swelling and redness of
the conjunctiva and lids ; secretion of viscid mucus or
pus ; burning and smarting sensation in the eyes ;
photophobia, dark and unhealthy ulcers on the cornea ;
paralysis of the upper eyelids ; tears easily excited ;
nightly agglutination ; muscae volitantes and sparks
before the eyes ; difficulty and pain in moving the
eyes ; pains in the bones and soft parts of the forehead
and face.
We have employed chininum sulph., at the first tri-
turation, in several obstinate cases of strumous and
chronic ophthalmia, with entire success. When the
malady assumes an intermittent character, it will gen
erally prove promptly curative.
Lobethal has employed euphrasia with much suc
cess in rheumatic, strumous, and catarrhal ophthalmia,
where there was "considerable mucous secretion in the
inflamed organ ; as also in blennorrhoeas of the eyes,
in all which cases I employ euphrasia at once, inter
nally and externally ; in the former case, one drop of
the pure tincture ; in the latter, as a collyrium, from
two to five drops in four ounces of water."
Lycopodium is well adapted to scrofulous or catarrhal
ophthalmia, and in obstinate cases of ophthalmia
neonatorum. Hahnemann mentions " nocturnal ag
glutination, and lachrymation by day/' as prominent
indications for the use of lycopodium.
We have employed aurum with excellent effects in
several cases of mercurial and syphilitic ophthalmia.
AND ITS APPENDAGES. 599
Some authors recommend it highly in scrofulous oph
thalmia.
Other remedies are, causficum, sepia, silicea, staphy-
sagria, china, and chamomilla.
Administration. — In acute cases, we prefer the first,
second, and third attenuations, and in the chronic stage,
the first attenuation. The remedy should be repeated
in the more violent forms of the complaint, every half
hour, until we are satisfied with the impression ; but
in chronic inflammations, a repetition once in twelve
or twenty-four hours will suffice. During the treat
ment we should never neglect the external use of
pure water, or milk and water, either cold or tepid.
SECTION VII.
GRANULATED LIDS.
Diagnosis. — Fleshy elevations sometimes occur on
that portion of the conjunctiva which lines the eye
lids, resembling in all respects granulations, and by
their irritating effects upon the ball of the eye, give
rise to troublesome inflammation, ulceration, and now
and then to loss of sight. This affection has more
frequently baffled the surgeons of the old school, than
any other pertaining to the eye. Venesection, leech
ing, cupping, blistering, moxas, cathartics, alteratives,
stimulating collyria, and caustic applications, have all
been found entirely inefficient in its treatment, and
the patients are generally doomed to a wretched ex
istence, one or more years, until disorganization of the
eyes, by ulceration, leaves them in perpetual darkness.
By homoeopathy, however, a new and healthy action
can be created in the affected structure, which shall
overcome and supersede the morbid action.
These morbid granulations usually arise from an
acute or sub-acute inflammaiion of the conjunctiva
occurring in individuals whose constitutions have be
come impaired and tainted by protracted syphilitic,
gonorrhoeal, psoric, or scrofulous complaints. The
granulations are rough and uneven, secrete an abun
dance of pus, which serves to irritate and weaken the
eyes, and on every motion of the lids, operate on the
balls as foreign substances, thus keeping up a per-
600 AFFECTIONS OF THE EYE
petual inflammation, and sooner or later leading to
ulceration of the cornea. The disease is for the most
part confined to the upper lids, although we have seen,
in some instances, the conjunctiva of the lower lids
rough and granulated.
Occasionally we may detect the true character of
the complaint by the thickness of the lids, and their
roughness and unevenness to the touch ; but the only
certain method of investigation consists in turning
over the lids, and thus exposing the palpebral conjunc
tiva to the sight.
This disease very often proceeds to a fatal disor
ganization of the eye, without a true knowledge on
the part of the physician, respecting the nature of the
case. It is usually mistaken for one of the varieties
of purulent ophthalmia.
Therapeutics. — The remedies in this disease are
both local and constitutional. The only local specific
is the sulphate, of copper in substance, a small piece
of which is to be smoothly polished, and rubbed
lightly over the granulations once or twice a day,
following each application with a camel's-hair brush
filled with pure water, A persevering use of this
substance will, as we know from much experience in
these cases, cure the most inveterate forms of the
complaint.
In conjunction with the above means, we may em
ploy one of the following medicines : sulphur, calcarea
carbonica, hepar sulph., iodine, graphite, and acid nit.,
as internal remedies.
In selecting our internal remedy, regard must be
had to the cause, as well as the symptoms of the dis
ease. We advise the first attenuations, and the dose
to be repeated once in twelve or twenty-four hours as
long as necessary.
SECTION VIII.
OPACITY OF THE CORNEA.
Diagnosis. — Opacities or specks upon the cornea
vary much in size and appearance. Various appel
lations have been given to these different opacities,
as nebula, leucoma, albugo, &,c., depending upon the
AND ITS APPENDAGES. 601
nature of the cause, and the particular tissue affected.
The opacity may consist of slight misty or opaque
spots, diffused over a part or even the whole of the
cornea, of a light colour, such as are caused by a per
verted secretion of the inner lamina, and termed
nebula; or of small and circumscribed spots, of a
pearl colour, and entirely opaque, caused by a kind of
false membrane under the conjunctiva, and termed
leucoma ; or of cicatrixes resulting from the healing
of ulcers and wounds of the cornea, and termed al
bugo.
When the disease consists of a simple diffused
nebulous opacity, we can distinguish through it the
pupil and iris, and the rays of light pass to the retina
so as to give rise to imperfect vision ; but the other
kinds of opacity do not permit the passage of lumi
nous rays, and, consequently, when situated in front
of the pupil, destroy or seriously impair vision.
The two first varieties are caused by purulent oph
thalmia and granulated lids, and are results most to
be dreaded, especially in constitutions tainted with
scrofula, syphilis, psora, or mercury.
Therapeutics. — The best local stimulus is a collyrium
composed of one grain of sulphate of zinc to four
ounces of water. A few drops of this may be put
into the affected eye from two to four times in twen
ty-four hours until the opacity begins to disappear,
when we should omit it so long as amendment con
tinues.
The internal remedies* most to be relied on are,
calcarea carbonica, iodine, mercurius, sulphur, sepia,
arnica, hepar sulphuris, acid nit., aurum muriaticum.
Attenuations and repetitions the same as in chronic
ophthalmia.
SECTION IX.
AFFECTIONS OF THE DEEPER SEATED STRUCTURES OF THE
EYE.
INFLAMMATION OF THE CORNEA.
Diagnosis. — Inflammation of the cornea may exist
as an independent affection, or it may occur during
the progress of iritis, and other acute derangements
26
602 AFFECTIONS OF THE EYE
of the internal textures of the eye. Soon after the
inflammation sets in, a number of the serous vessels
are observed to carry red blood ; the cornea loses its
brilliancy ; the eyes become sensitive to light ; a pro
fuse secretion of tears is induced from exposure to
cold air, light, dust, and smoke ; tension and pains
are experienced in the eye ; yellow spots, composed of
pus, are observed between the lamellae of the cornea
by looking obliquely through the eye ; these abscesses,
if the disease continues, eventually burst internally,
and discharge their contents into the anterior cham
ber, or externally, and form those troublesome ulcers
of the cornea which so often endanger sight. When
these ulcers are small, and confined to the anterior
portion of the cornea, they may often be cured with
out material injury to the eye ; but when the ulce-
ration pervades the whole lamellated structure of the
cornea, it is not uncommon for the aqueous humour to
escape through the opening, and even the iris itself
to protrude.
SECTION X.
IRITIS.
Diagnosis. — This peculiar affection of the eye is
by no means easy of detection, on account of the situ
ation of the iris, and the small number of external
symptoms which characterize the complaint. Inflam
mation of this texture is, however, more productive of
constitutional or febrile symptoms than affections of
the external tunics. This may in part be owing to
the loose attachment of the conjunctiva to the eye,
and the more ample scope for effusions into the sub
jacent cellular tissue.
Iritis commences with a dull, pressing, heavy and
deep-seated pain in the orbit ; contracted pupil ;
change of the natural colour of the iris to a dark,
greenish, or reddish colour ; a moderate rose-coloured
blush of the conjunctiva ; diminished power of vision,
and considerable sensibility to light.
As the disease advances, the pains become acute,
and extend from the eye into the temples and to the
top of the head ; the contraction is more strongly
AND ITS APPENDAGES. 603
pronounced ; sparks and luminous flashes pass through
and before the eyes ; the nervous system is excited ;
the pulse accelerated ; the skin hot and dry ; the in
testinal and urinary secretions are partially sup
pressed, and there are other indications of constitu
tional disturbance.
After these severe symptoms have continued some
time, the iris presents an irregular, angular, and thick
ened appearance, and is covered with specks of yellow
lymph. Small abscesses now form on the iris, which
ultimately burst into the anterior chamber, which is
afterwards usually absorbed. If extensive adhesions
have formed between the iris and the capsule of the
lens, or if the more deep-seated parts have become
involved in the disease, an almost total loss of sight is
the common result.
In some instances, the inflammation extends from
the iris to the retina, the choroides, the cornea, and
finally involves the whole internal structure of the
eye, when the malady will present symptoms charac
teristic of the inflammation of these different struc
tures. In cases of this description, the symptoms are
of the most violent character, the pains are exceed
ingly acute and painfully throbbing, there is a very
rapid contraction of the pupil, the sight is speedily
extinguished, the constitutional signs are very urgent,
and the patient is always in imminent danger of rapid
and permanent loss of vision.
Causes. — The most common cause of iritis is the
abuse of mercury. Syphilis has been often assigned
as a cause of it, but, we believe, without just reason.
It has often been observed during the treatment of
syphilis by mercury, but, we think, never in syphilitic
diseases where mercury has not been employed.
Other causes are, mechanical injuries, rheumatism,
gout, excessive use of the eyes over minute objects.
Therapeutics. — The most appropriate remedies are,
hepar sulphur., acid nit., muriat. aurum, cocculus,calca-
rca carbonica, nux vomica, belladonna, conium, lycopo-
dium, staphysagria, arnica, aconite.
Hepar salphuris, acid nitric, and aarum muriaticum,
are curative in iritis arising from abuse of mercury,
with aching, throbbing, and tearing pains in the orbit,
604 AFFECTIONS OF THE EYE
sometimes extending to the top of the head ; pains in
the bones about the eyes ; fiery sparks before the
eyes ; intolerance to light ; contracted pupil ; partial
or entire loss of vision ; dark or greenish colour of
the iris ; spots of yellow lymph, or ulcers on the iris ;
febrile disturbance.
Cocculus, nux vomica, and belladonna, are indicated
in arthritic and rheumatic iritis, accompanied with
deep-seated, lancinating, tearing, or contractive pains
in the ball, and extending to the top of the head ; in
voluntary spasmodic movements of the globe : irre
gular contraction of the pupil ; discoloured and puck
ered iris ; photophobia ; pains aggravated on moving
the eyes, or stooping ; luminous specks or darkobjpcts
float before the retina ; greatly impaired vision ; effu
sion of blood and matter into the anterior chamber
of the eye ; indications of gastric derangement, and
of general constitutional disturbance.
Calcarea carbonica, conium, lycopodium, and staphy-
sagria, are appropriate in iritic inflammations con
nected with a scrofulous diathesis. These remedies
cover greenish or yellowish colour of the iris ; pupil
much contracted and distorted ; ulcers which have
opened internally or externally ; outward distention
of the iris ; adhesions of the iris to the capsule of the
lens ; moderate participation of all the structures of
the eye in the morbid action ; photophobia ; vision
destroyed or much impaired ; difficulty in distinguish
ing the iris from effusion of lymph and pus into the
anterior chamber of the eye ; great general irritabil
ity ; aching, throbbing, lancinating, or pressing pains
in the eye ; rapid and irritable pulse ; restlessness ;
hot skin ; loss of appetite ; mental and physical pros
tration.
Arnica is necessary when the disease can be traced
to a wound, or to any other mechanical injury of the
eye. It may also be properly employed in cases which
proceed from sudden exposure of the eyes to an in
tense and glaring light.
Aconite will often be required, either alone, or in
alternation with one of the other remedies, to control
undue febrile excitement, and to remove the violent
congestion which now and then occurs in iritis.
AND ITS APPENDAGES. 605
Administration. — The remedies may be employed
at the first, second, and third attenuations, depending
upon the age and susceptibility of the patient, and the
violence of the inflammation. The dose should be
repeated in acute cases every two hours, until we are
certain of a medicinal impression upon the diseased
texture. In less urgent cases, a repetition will suffice
once or twice in twenty-four hours.
SECTION XI.
AMAUROSIS.
Diagnosis. — The partial or total loss of sight which
particularly characterizes this disease, is principally
dependent upon a diseased condition of the optic nerve
and retina, although other structures occasionally par
ticipate in the disease. Amaurosis occurs at all ages,
and in both sexes, but is most common at the period
of the cessation of the menses in females, and at the
age of forty or fifty years in males. The chief cir
cumstances which predispose to it are, a plethoric
and sanguine temperament, hereditary disposition,
tendency to sanguineous congestions to the head and
eyes, and an impaired constitution from abuse of drugs,
stimulating drinks, and excesses in venery.
Physicians of the old school are much divided re
specting the nature and treatment of amaurosis. some
supposing it to be a debility requiring tonics and stim
ulants, while others describe it as an inflammatory
affection, demanding an antiphlogistic course of treat
ment. In view of these discordant opinions, and em-
pyrical methods, it is not surprising that so few amau-
rotic patients are cured by allopathy.
Amaurosis may be imperfect or perfect. In the
former there is a partial, and in the latter a total loss
of sight. In the first, the patient sees as through a
gauze, or but half of the object, or double, or only
when the eye is in a particular position with respect to
the object ; while in the last, the patient cannot dis
tinguish day from night.
The signs of the approach of the disease are, pain
in the forehead and temples, diminishing with the ad
vance of the amaurosis, and ceasing when it has be-
606 AFFECTIONS OF THE EYE
come complete; vertigo ; weakness and cloudiness of
vision, apparent when looking at distant or at minute
objects ; sparks and moats, or musca3 volitantes, float
before the eyes, annoying the patient, and impairing
the sight ; in reading or writing, a stronger light than
usual is demanded ; a slight diminution in the bril
liancy of the pupil.
After these precursory symptoms, the loss of vision
gradually becomes more complete, until after months
or years, there remains a condition of settled and
more or less perfect amaurosis. In other instances,
the disease advances with rapidity, and terminates in
partial or total blindness in a few days. But it is not
an uncommon occurrence for complete amaurosis to
follow instantaneously, leaving the victim in blindness
so profound that he cannot distinguish light from
darkness. When either of these three conditions ob
tains, there are usually but few signs which indicate
the presence of so serious an affection, the principal
being, a dilated and immovable pupil, a loss of con
tractile power in the iris, and occasionally slight stra
bismus. But even these signs are not uniformly pre
sent, for cases of complete amaurosis are reported in
which the pupil remained natural, or became preter
natural ly contracted and mobile on exposure to light,
and in which the iris and all other visible parts of the
organ were in a normal condition. The colour of the
pupil in this disease is ordinarily jet black, with, per
haps, a very slight diminution of its natural brilliancy,
but it sometimes presents a red, greenish, or white
and cloudy appearance. Cases of this last description
are often mistaken for incipient cataract, and when
the loss of sight is but partial, it is not easy to distin
guish between the two maladies ; but the following
characteristics will afford us material assistance in
deciding the matter. In cataract, the dense white ap
pearance is situated immediately behind the pupil,
while in amaurosis the cloud is more deep-seated. In
the former, the flame of a candle appears to be sur
rounded by a thin, white, diffused mist or cloud,
" which increases with the distance of the light,"
while in the latter, " a halo or iris appears to encircle
or emanate from the mist, the flame seeming to be
split when at a distance." — Stephenson.
AND ITS APPENDAGES. 607
The shape of the pupil is usually round, but some
what more dilated than in the normal state, thus al
lowing a large number of luminous rays to enter the
eye. In a few cases, it loses its circular form, and
becomes angular.
Amaurosis is attributed by most writers to a para
lytic condition of the optic nerve, retina, or to some
disease of the thalami nervorum opticorum ; but does
not the peculiar immovable condition of the pupil and
iris, when their natural stimulus, the light, strikes
them, indicate a loss of sensibility and contractility in
these structures ? And does not the partial loss of
voluntary motion over the globe, which sometimes
occurs during the complaint, indicate a loss of tone in
the whole organ ?
We have mentioned, as one of the precursory symp
toms of amaurosis, floats and muscae volitantes before
the eyes. In the imperfect form of the disease, these
appearances vary much in their character, and are a
source of great annoyance to the patient. Sometimes
a single black speck obstructs the sight ; sometimes
there is an appearance as if a dark gauze or net-work
were before the eyes ; sometimes as if flies, small ob
jects of different forms, sparks, fireballs, and various
coloured lights, were moving there in various direc
tions. The objects are more troublesome in a strong
light than in dark situations, being in the former of a
black or sombre colour, and in the latter, presenting
themselves in the appearance of sudden flashes of
light or fire.
We are occasionally presented with the disease in
an intermittent form, and, in rare instances, as a tem
porary attendant of some particular morbid condition
of the system, like pregnancy, disordered menstrua
tion, hysteria, worms, and the irritation of indigestible
food.
In addition to the symptoms already described, we
sometimes observe in young and plethoric amaurotics,
strongly pronounced determination of blood to the
head and eyes, a constant stupifying headache, more
or less redness and congestion of the eyeballs, sensi
tiveness of the eyes to light, a full and hard pulse, a
sense of fulness, tension, and pain in the affected eye.
608 AFFECTIONS OF THE EYE
It is a point worthy of note, that black eyes are far
more subject to amaurosis than blue or gray eyes.
Beer supposes that where one blue or gray eye be
comes affected with it, at least twenty-five or thirty
black ones suffer. No satisfactory explanation has
ever been suggested for this comparative exemption
of blue and gray eyes.
Causes. — The causes of amaurosis may operate
upon the brain itself, upon the optic nerve, or the re
tina. They may be divided into constitutional and
local causes. In the first class we include, repeated
and protracted determinations of blood to the head
and eyes, by unusual physical or mental exertion ;
pregnancy ; suppression of natural or habitual dis
charges ; violent vomiting ; excessive indulgence in
venery ; onanism ; unbridled anger, grief, and other
passions ; abuse of stimulants ; large doses of opium,
lead, belladonna, hyoscyamus, stramonium ; abuse of
bitter medicines, as quassia, cinchona, chamomela,
chicory, &c. ; exercise in a hot sun ; general debility ;
derangement of the digestive organs ; the depressing
emotions ; the pressure of tumours upon the vessels
of the neck in such a manner as to prevent the return
of blood from the brain.
We include in the second class, morbid growths
within the orbit ; mechanical injuries of the eye ;
sudden transitions from darkness to a brilliant light :
lightning ; frequent use of optical instruments, like
the telescope and microscope ; exostoses within the
cranium ; sanguineous effusion upon the brain ; inju
ries of the head.
Prognosis. — When the disease is dependent on some
cause which can be readily removed, if recent, and
the patient is young and healthy, we may predict a
favourable termination. If, however, the cause has
been long in operation, the Joss of sight has been very
gradual, the constitution is much impaired, and the
cause cannot be speedily removed, the prognosis must
be unfavourable. Amaurosis depending on morbid
growths within the orbit or cranium, may be con
sidered incurable ; but when it depends upon a slight
effusion upon the brain, or the pressure of a tumour
upon the jugular vein of the neck, we may often effect
AND ITS APPENDAGES. 609
a cure by causing the effused fluid to be absorbed or
removed by an operation, or the extraction of the
offending tumour. We once cured1 a case of several
months' duration, by removing from the neck a tumour
of the size of an orange, and thus renewing the free
course of blood from the head. The sight returned
almost immediately after the operation. The loss of
sight which sometimes accompanies pregnancy and
intermittent diseases, often subsides spontaneously on
the birth of the infant, or the cure of the disease. A
favourable prognosis may commonly be entertained
in those recent cases which depend on congestion of
the optic nerve, retina, or thalami nervorum optico-
rum, arising from general plethora, suppressed men
struation, or haemorrhoids. The effects also of me
chanical injuries, lacerations, contusions and blows
upon the eye, may frequently be cured.
Therapeutics. — The specifics for the different forms
of amaurosis are, belladonna, nux vom., china, phos
phorus, ruta grav., stramonium, sulphur, euphrasia, ar
nica, cannabis, hyoscyamus.
Belladonna. — External indications. — Pupil dilated
and immovable ; strabismus ; pupil black and round
or angular ; partial or total loss of vision ; listless
expression.
Physical sensations. — Power of vision diminished or
extinct ; sensation of weight and pressure in the eye
ball ; throbbing or stupifying headache ; objects ap
pear double, or wrong side up, or half concealed, or
blurred, or surrounded by a fog or mist ; dark, fiery
and red bodies float before the eyes ; bright flashes
before the eyes ; the candle seems surrounded by a
halo of different colours, but in which the red pre
dominates.
Mental and moral symptoms. — Mood generally irri
table, but high spirits alternating \vith despondency.
Remarks. — This remedy is called for in amaurotics
of full and plethoric habits, and where the malady
has been caused by inflammation or congestion of the
optic nerve, retina, or some part of the brain.
Nux vomica. — External indications. — Pupils con
tracted, sometimes dilated ; spasmodic motions of the
eyeball; photophobia.
26*
GJO
AFFECTIONS OF THE EYE
Physical sensations. — Intermittent obscuration of
vision ; black or gray moats before the eyes ; stupi-
fying headache ; weakness of sight, worse in the light
of day ; luminous vibrations on the side of the eye ;
vertigo.
Mental and moral symptoms. — Disposition melan
cholic and hypochondriacal.
Remarks. — Nux is applicable in amaurotic com
plaints arising from excess of study and abuse of
stimulants and opium. It is also indicated for tempo
rary loss of sight, which sometimes accompanies in
termittent diseases.
China. — External indications. — Pupils dilated and
insensible, or slightly contracted ; a white cloud deep
within the eye ; photophobia.
Physical sensations. — Indistinct and confused vision ;
muscae volitantes ; sudden obscurations of sight ; only
the outlines of objects can be discerned ; general de
bility ; irritability ; morbid sensitiveness of the whole
system.
Mental and moral symptoms. — Disposition cheerful
and languid.
Remarks. — China will apply when the disease is of
a purely atonic character, and has originated from
excessive loss of blood or pus, or from protracted
chronic or acute diseases.
Phosphorus. — External indications. — Pupils and eyes
natural.
Physical sensations. — Sudden attacks of blindness
during the day ; distant objects appear to be envel-
loped in smoke or mist ; black spots before the eyes ;
diminished vision ; he sees as through a net-work or
gauze ; sparks before the eyes in the dark ; tremulous
vision ; luminous vibrations before the eyes ; the
flame of a candle seems to be surrounded by a green
halo.
Mental and moral symptoms. — Spirits gloomy, de
jected, and without any cheerful reaction.
Remarks. — In amaurosis consequent upon onanism,
loss of animal fluids, and in impoverished old people,
phosphorus is an excellent remedy.
Ruta grav. — External indications. — Pupils contract
ed ; involuntary movements of the balls of the eyes ;
spasms of the lids.
AND ITS APPENDAGES. 611
Physical sensations. — Sense of weight and pressure
in the eyeballs ; weakness of the eyes ; inclination to
read or write by a very strong light ; rnuscse voli-
tantes ; red halo surrounding the flame of a candle ;
cloudy vision ; weariness of the eyes.
Mental and moral symptoms. — Indifferent, irresolute
and peevish.
Remarks. — Amaurotic complaints arising from abuse
of the eyes with optical instruments, in reading fine
print, or working at small objects, and also from con
tusions, and other mechanical injuries, will require
the use of ruta.
Stramonium. — External indications. — Pupils dilated
and immovable ; eyes staring, and somnolent or glis
tening.
Physical sensations. — Sense of weight and tension
in the eyes ; obscuration of sight ; objects appear
small or double ; black colours appear gray ; sparks
and specks float before the eyes ; objects seem sur
rounded with a red or light border ; cloudy vision ;
vertigo ; headache.
Mental and moral symptoms. — Disposition irritable
and touchy ; hysterical and cataleptic.
Remarks. — Stramonium is suitable in paralytic af
fections of the optic nerve and retina, connected with
deranged menstruation, hysteria, epilepsy, and cata
lepsy.
In incipient amaurosis, and frequent and sudden and
short attacks of blindness, wre may refer to sulphur,
euphrasia, arnica, cannabis, hyoscyamus, conium, aurum,
digitalis.
Administration. — -We are in the habit of employing
from the first to the sixth attenuations. Repetitions
should not be made more than once or twice in the
twenty-four hours. As soon as an impression is ap
parent, we should await the result before administer
ing again.
SECTION XII.
HYDEOPHTHALMIA, OR DROPSY OF THE EYE.
Diagnosis. — This disorder proceeds from the forma
tion of a preternatural quantity of the aqueous or the
612 AFFECTIONS OF THE EYE
vitreous humours, while the absorbent vessels convey
into the circulation only their customary amount of
these secretions ; or the humours may be formed as
usual, bat owing to some defect or loss of power of
the absorbents, the natural quantity is not taken up
and carried into the circulation. But it is highly prob
able, in most cases, that the disease is dependent on a
morbid condition of both the secerning and absorbent
vessels, and that the normal equilibrium between se
cretion and absorption becomes thereby destroyed.
This idea receives confirmation from the fact, that
most dropsies of the eye can be traced to previous
inflammation of the internal textures of the organ.
The unnatural accumulation may be confined to
the aqueous humour in the anterior chamber, or to the
vitreous humour in the posterior chamber, or both hu
mours may be affected at the same time. When the
aqueous humour is alone involved, the disease may
be recognised by the following marks : dimensions of
the cornea larger than natural ; increased size of the
anterior chamber of the eye ; turbid appearance of
the aqueous humour ; partial or total loss of motion
of the iris ; pupil natural and immovable ; iris less
brilliant than natural ; sense of weight and tension in
the eyeball ; weakness of sight ; perversion of vision,
either in the form of presbyopia or myopia ; general
loss of voluntary motion over the ball ; partial or to
tal loss of vision.
When there is a preternatural accumulation of the
vitreous humour, the enlargement of the globe is
more deep-seated ; the ball assumes a conical shape ;
the cornea is unusually prominent ; the pupil is con
tracted ; there is a diminution of vision ; myopia ;
deep-seated pains ; tension and heaviness ; impaired
motion of the eyeball ; and eventually, total blindness.
When the disease consists of an unnatural accumu
lation of both humours, we shall have a combination
of symptoms including nearly all described under the
aqueous and vitreous varieties of dropsy. After the
vitreous humour has been for some time affected, its
character is changed, and it acquires a soft and usual
ly a watery appearance.
In many cases, the eye attains a size so enormous
AND ITS APPENDAGES. 613
as to protrude far from the orbit, and it is thus ren
dered quite impossible to close the lids over it. In
this condition the patient has a frightful appearance,
and the organ itself, from its exposure, is constantly
irritated and inflamed.
Causes. — The immediate cause of dropsies of the
eye, is an undue action in the arteries which secrete
the humours, and a diminished action of the absorbent
vessels ; or, sometimes, an inordinate aqueous or vi
treous secretion, with a normal action of the absorb
ents.
Hydrophthalmia is generally supposed to depend
upon some constitutional cause, like general dropsy,
hydrocephalus, chlorosis, or secondary syphilis ; but
as a general rule, it may be traced to some previous
inflammation of the internal structures of the eye.
In infants and young children, it is often exceedingly
difficult to discover the real cause, especially when
the external indications are obscure, and, on this ac
count, the earlier history of the case can rarely be
ascertained ; but in adults, we shall often be able to
discover previous sub-acute inflammation in the inter
nal structures.
Prognosis. — The allopathists deem this disease,
when fully formed, incurable. They find that no shed
ding of blood, no punishment of the stomach, bowels,
salivary glands, skin, or other inoffensive parts of the
body, can cure or palliate it. That the prognosis is
unfavourable, we do not deny ; but we believe the
disease may often be cured in its early stages. I have
treated but two cases homoeopathically ; and but one
with a favourable result. This was of six months'
standing, confined to the aqueous humour, and with
but moderate distention of the cornea : the other case
involved both humours, had continued more than a
year, and had arrived at the condition termed " ox
eye," when the treatment was commenced. In this
instance paracentecis became necessary, and the pa
tient ultimately lost the eye.
So long as the disease is confined to its incipient
stage, and even after the unnatural accumulation has
commenced, provided no serous disorganization has
taken place in the important tissues of the eye, we
614 AFFECTIONS OF THE EYE
may predict a favourable result ; but if organic lesions
have occurred, and the accumulation in the anterior
or posterior chamber is considerable, with total loss of
sight, our prognosis must be unfavourable.
Therapeutics. — If the dropsy depends upon a con
stitutional fault, our remedies must be addressed to
the remote difficulties. So long as these continue, mere
local means will be inadequate to accomplish our ob
ject ; but constitutional and local remedies may be used
in alternation with probable advantage. If the eye be
much distended, and medicines do not act with suffi
cient promptness and energy, the operation of para-
centesis may be made to evacuate the superabundant
humours, after which, the remedies will generally
prove sufficiently powerful.
We believe the following to be the best at present
known : belladonna, china, pulsatilla, mercurius, hyos-
cyamus, stramonium, conium, nux vom., arsenicum,
plumbum, aconite, sepia, sulphur.
It is doubtful whether either of these exercises a
positively specific influence upon the secretory and
absorbent vessels affected in hydrophthalmia, but they
are capable of acting upon the generally morbid con
dition upon which the local disorder depends, and thus
aid in arresting its progress, and occasionally in ef
fecting cures.
Administration. — In the same manner as advised in
amaurosis.
SECTION XIII.
CATARACT.
Diagnosis. — Strictly speaking, this disease belongs
to the province of surgery rather than that of medi
cine ; but as homcEopathy promises results somewhat
important in a medicinal point of view, we take the
liberty of writing a few words respecting the malady
in this place.
By the term cataract is understood, an opacity of
the chrystalline lens, or its capsule, which causes an
obscuration, or a total loss of vision. Authors recog
nise and describe several varieties, both of the lenti
cular and capsular cataract, and amongst these, the
most common are —
AND ITS APPENDAGES. 615
First. The firm or hard cataract, peculiar to old
people, and recognised by its amber colour, small size,
and by its density and hardness. Vision is never to
tally destroyed in these cases, and the structures of
the eye retain their natural contractility.
Second. The fluid or milky cataract, caused by a
change of the lens into a white and semi-fluid mass,
of so large a size as to nearly obliterate the posterior
chamber, impair the motions of the pupil, and prevent
the admission of rays of light.
Third. The soft or caseous cataract, which presents
an appearance somewhat similar to the last variety,
with the lens much enlarged, of a cheesy consistence,
and of a light gray or sea-green colour, obliteration
of the posterior chamber, impaired motion of the pu
pil and iris, and either partial or total blindness. The
lens, in this variety, always presents an appearance
of more firmness and consistence than in the milky
cataract, and the dark irregular spots or lines which
sometimes traverse it, remain the same in all posi
tions of the head, while those which are now and
then observed in the milky variety, change their lo
cation with every motion of the eyes.
Fourth. Capsular cataract, consisting of an opacity
of the capsule of the chrystalline lens. The opacity
commences at the margin of the pupil, in the form
of " distinct, white, shining points, specks or streaks ;
its colour, therefore, is always very light, and never
altogether uniform, even when the disease is com
pletely formed." — Beer. When this kind of cataract
occurs in children at or soon after birth, it is called
congenital cataract.
The capsular cataract does not generally continue
for a long period before the lens becomes involved
also in the opacity. When the disease has been pre
ceded by a good deal of inflammatory action, we may
find cohesions of the anterior capsule of the lens with
the urea ; or of the posterior layer of the capsule
with the membrana hyaloidea ; or of the whole of
the capsule with the lens ; or all the three species of
adhesion may exist together." — Beer, p. 318.
Cataract is sometimes complicated with amaurosis.
This complication is not always easy of detection, on
616 AFFECTIONS OF THE EYE
account of the symptoms of these diseases bearing so
close a resemblance. When the lens or its capsule
are alone affected, the opacity is immediately behind
the pupil, the iris and pupil possess some degree of
mobility, and there is some little appreciation of light ;
but when amaurosis is conjoined with cataract, we
have the same appearance of the lens or capsule, but
a dilated and immovable pupil, an insensible and im
movable state of the iris, and an absolute loss of
vision.
The first intimation we have of a forming cataract,
is defective vision when attempting to read fine print,
or to look at minute objects. As the disease advances,
all objects appear indistinct ; a mist is constantly be
fore the affected eye ; a strong light is required to
read or write ; a small speck now commences just
behind the centre of the pupil, and continues to extend
until the opacity entirely obstructs the passage of rays
of light to the eye ; when the opacity is complete, a
black ring is seen around the edge of the pupil, and
the sight continues to diminish until blindness results.
Causes. — Frequent and long-continued use of the
eyes in reading fine print, writing, or looking at mi
nute objects by a strong light; congestion of blood to
the eyes, from exercise in a hot sun, in furnaces, and
other places where hot and bright fires are kept up ;
exposure of the eyes to irritating fumes and vapours,
like sulphurous acid, chlorine and other gases, and
the vapours of sulphuric ether, alcohol, nitric, sulphur
ic and muriatic acids, hereditary predisposition, me
chanical injuries, wounds of the capsule or lens.
Prognosis. — When the cataract is confined to the
lens, or to its capsule, and no complications exist from
unnatural adhesions, from amaurotic symptoms, or
from serious constitutional disturbance, a favourable
issue may be expected. On the other hand, a dilated
pupil, an immovable iris, a profound blindness, which
has been disproportionate to the gradually forming
opacity, unnatural adhesions of the capsule, and an
irritable and vitiated constitution, will render our
prognosis unfavourable.
Therapeutics. — Before resorting to the operation of
couching:* or extraction, as is so often done bv the old
AND ITS APPENDAGES. 617
school surgeons, we should always give our medicines
a fair trial. It is quite true that we have but few
remedies which simulate this affection in their patho-
genesis, yet the successful results which have been
observed from the use of medicines in a few cases,
render it incumbent on us to avail ourselves of them
on all proper occasions.
After a thorough trial with medicines, if there is no
prospect of amendment, the patient should be turned
over to the surgeon for the necessary operation.
In a few cases of incipient cataract, much benefit
has followed the local employment of sulphuric ether
vapour to the eye, and should our internal remedies
prove fruitless, there can be no objection to a trial of
this substance.
As internal remedies, we suggest, conium, pulsatilla,
magnesia carb., sulphur, cannabis, phosphorus, digitalis,
spigelia, euphrasia.
Conium and cannabis may be exhibited when the
cataract has arisen from a wound, or other injury to
the eye.
Magnesia carb., pulsatilla, digitalis, and phosphorus,
have proved curative in capsulo-lenticular cataract,
either with or without abnormal adhesions, also in
opacity of the lens or capsule alone. These remedies
are useful when the disease has been accompanied
with ophthalmia.
Salpliur is appropriate in those cases which seem
to be connected with a scrofulous or psoric diathesis.
It has also been found curative in cataract compli
cated with amaurosis. Euphrasia or spigelia may
sometimes be alternated with sulphur with benefit.
Administration. — The same as in amaurosis.
SECTION XIV.
FUNGUS H.EMATODES, AND CANCER OF THE EYE.
Diagnosis. — Fungus luzmatodes has always been
confounded with scirrhus, or cancer, until Burns, Hey,
and Abernethy pointed out the characteristics of the
two diseases, both in respect to their formation and
development, as well as their pathology. They pos
sess several qualities in common, like malignancy, in-
618 AFFECTIONS OF THE EYE
evitable tendency to the destruction of the affected
parts, the power of contaminating the whole system,
and giving .rise ultimately to fatal constitutional
symptoms ; but in other respects, they are entirely
dissimilar. Fungus haematodes is not usually attend
ed with the severe stinging and lancinating pains of
cancer ; its texture is spongy and elastic, and is soft
and apparently fluctuating under the touch, while the
scirrhus is hard and stony. When fully formed, the
fungous tumour is of the consistence of brain, is of a
dark and livid hue, and bleeds on the slightest touch,
while the substance of cancer is hard, fibrous, and
cartilaginous ; at its commencement, and during its
development, the fungus is knotty and unequal, and
thus affords a sign which distinguishes it from can
cerous and other tumours. Fungus is more prone to
occur in young subjects, while cancer is for the most
part confined to persons past the middle age. Fungus
of the eye commences in the posterior chamber, while
cancer of the eye attacks primarily the conjunctiva
or lachrymal gland. The progress of fungus is more
rapid and destructive than that of cancer.
The first symptom observed in fungus haematodes,
is defective vision, and, on looking into the eye, a
small shining spot is perceived at the bottom of it.
This nucleus of the disease commences in the re
tina and optic nerve, is traversed by branches of the
central artery of the retina, and progresses from
within outwards through the vitreous humour, ab
sorbing it in its course, until it arrives near the iris,
when it presents a dark amber or greenish hue, and is
apt to be mistaken for cataract. As the enlargement
increases, the ball of the eye becomes prominent, ir
regular, and knotty, the cornea ulcerates, and the
disease displays itself externally in the form of a soft,
medullary, and purple fungus, bleeding at the least
touch. The pupil becomes dilated and immovable in
the early part of the complaint, and also somewhat
changed in colour, which becomes a strongly pro
nounced amber or brown when the swelling arrives
at the iris. The sclerotica soon acquires a dark blue
colour, is crossed by dilated veins, and is sometimes
attacked by the malady as well as the cornea. After
AND ITS APPENDAGES. 619
the fungus has shown itself externally, the absorbent
glands of the jaw and neck become affected with a
medullary degeneration ; the countenance assumes a
sallow and cadaverous appearance ; general debility
and nervous irritation occur ; loss of appetite ; im
paired digestion ; nausea ; irritable stomach ; rest
lessness, and the usual symptoms of hectic fever ter
minate the patient's existence.
Cancer of the eye, as we have before remarked,
generally attacks persons advanced in life. This
disease, unlike fungus haernatodes, commences in the
conjunctiva, caruncula lachrymalis, or lachrymal
gland, in the form of a hard warty excrescence, which
continues for an indefinite period, sometimes attended
with twinging and lancinating pains, at other times
free from all uneasy feelings, until finally its interior
structure becomes altered in texture, "an ichorous
matter forms within the swelling, which gradually
makes its way to the surface, and thus develops the
first stage of ulceration. When arrived at this point,
vision is destroyed, an irregular fungous mass shoots
up from the ulcerated point, highly vascular, of a red,
brown, or livid colour, and easily excited to haemor
rhage. As the mass increases, the tissues of the eye
become distended ; the ulceration and sloughing ad
vance ; severe lancinating pains dart through the
globe ; the appetite is impaired ; the patient loses
fiesh, strength, and courage ; sleep is disturbed; the
countenance assumes an anxious, distressed, and sal
low appearance ; hectic fever sets in, and the sufferer
speedily yields to the last result.
Hitherto the diseases under consideration have
usually been deemed incurable by internal remedies,
and on this account surgeons have advised the early
extirpation of all suspected tumours, hoping in this
way to eradicate the affection while it is local, and
before the mass of blood becomes contaminated. But
it must be admitted, even \vhen the operation has
been resorted to early, and under the most favourable
circumstances, that a lamentable want of success has,
for the most part, followed all surgical measures.
Stealthy and insidious at their commencement, they
gradually glide along, depositing in all surrounding
620 AFFECTIONS OF THE EYE
textures their destructive and fatal poison, until dis
organization begins, when the livid, foul, and de
structive phenomena appear in their hideousness, ra
pidly communicating their influence through the whole
organism, and baffling all efforts of the physician and
surgeon.
But though experience has so little of promise, we
cannot admit that there are no remedies in the whole
range of the materia medica capable of counteracting
this morbid influence. We may yet find some medi
cine sufficiently specific to cure these diseases during
their forming stage. We believe, indeed, that homoeo-
patby will, ere long, accomplish all that we require in
this matter. Only a limited number of well authenti
cated homoeopathic cures of true medullary fungus,
or of cancer, have been reported ; but the results in
these few cases should inspire us with some confi
dence of success, especially during the early period
of the maladies.
Causes. — The immediate cause of medullary fungus
and of cancer is involved in doubt. Some have sug
gested the operation of animalculae, others of a subtle
poison, and others of a kind of unhealthy inflamma
tion caused by some constitutional defect. Sir Astley
Cooper supposes the morbid degeneration always to
be " preceded by a disposition in the constitution to
its production."
There is unquestionably a specific morbid action in
the tumour itself, but whether this is owing to some
poison which acts specifically upon the particular part
alone, or to some constitutional vice, we are unde
cided. That there are drugs capable of neutralizing
this morbid influence, whether it be constitutional or
local, we entertain no doubt.
The exciting causes are blows, contusions, obstruc
tions of blood from pressure, and mechanical injuries
generally, although the disease often originates with
out any apparent or traceable cause.
Prognosis. — In our present state of knowledge, the
prognosis must be generally unfavourable ; but not
many years will elapse before this state of things will
change, and we shall be able to meet the complaint
with sure and efficient specifics.
AND ITS APPENDAGES. 621
Therapeutics. — Having had but little personal expe
rience in regard to the homoeopathic treatment of
these affections, we shall simply allude to the medi
cines which appear to us most appropriate, and refer
the reader to the reports of cases which have been
cured by other practitioners.
Belladonna has cured malignant disease of the eye,
attended with violent pains in the eyeball ; a red
shining point in the posterior chamber; pupils dilated
and immovable ; loss of vision ; unusual hardness of
the substance of the eye ; iris of a dark colour, and
covered with injected bloodvessels.
Malignant affections of the eye have also been
cured by conium, carbo vegetabilis, arsenicum, mercu-
rius, acid nit., calcarea carbonica, and iodine.
Administration. — The same as in amaurosis.
SECTION XV.
AFFECTIONS OF THE APPENDAGES OF THE EYE.
HORDEOLUM. — -STYE.
Diagnosis. — This is a small boil-like swelling in the
edge of the eyelid, resembling in size and general ap
pearance a barleycorn. It generally commences in
the follicles of Meibomius, near the angle of the eye,
soon assumes a dark red or purple colour, and becomes
quite painful from the violence of the accompanying
inflammation. The inflammation sometimes confines
itself to the cellular membrane, and advances very
slowly to the suppurative stage, thus causing not only
highly troublesome local pains, but a considerable
degree of febrile disturbance. In these cases, gan
grene and sloughing of the cellular membrane is apt
to occur, and either protract the cure, or leave the
part in a condition liable to take on a renewed mor
bid action from the smallest exciting cause. In other
instances, suppuration occurs speedily, the abscess
bursts and discharges itself freely, and a prompt cure
results.
Causes. — Use of highly spiced, fat, and stimulating
food ; disordered stomach and bowels ; abuse of the
eyes in reading, writing, or sewing by gas-lights ;
scrofulous, psoric, and other impurities of the blood.
622 AFFECTIONS OF THE EYE
Therapeutics. — The appropriate remedies are, sul
phur, pulsatilla, staphysagria, sepia, ly cop odium. We
usually employ the third attenuation, and administer
a dose twice daily until the swelling and inflamma
tion disappear.
SECTION XVI.
ENTROPIUM. INVERSION OF THE EYELIDS.
Diagnosis. — This affection consists of an unnatural
turning inwards of the whole or a portion of the tar
sus and eyelashes, in such a manner as to keep up a
constant irritation of the globe, and thus generate a
troublesome chronic ophthalmia. If the disease is
allowed to continue for any length of time, the cornea
loses its brilliancy, its vessels become injected, and
ulcers form ; there is continual lachrymation ; partial
or entire loss of vision ; great pain and annoyance
from the presence of the offending eyelashes.
Causes. — Cicatrices arising from previous ulceration
of the tarsi ; chronic ophthalmias ; relaxation and
paralysis of the lids ; ulceration of the ciliary glands.
ECTROPIUM. EVERSION OF THE EYELIDS.
Diagnosis. — Eversion of the lids may be caused by
a swelling and relaxation of the lining membrane of
the eyelid, which presses the edge of the lid forward
until it becomes everted, or by a contraction of the
skin of the lid, in consequence of the healing of
wounds, ulcers, carbuncles, burns, boils, etc. The
consequences of eversion are, constant exposure of
the globe to external irritating causes ; chronic in
flammation of the eye ; frequent discharge of tears ;
dryness of the ball ; photophobia ; nebulous spots
and ulcers of the cornea.
Causes. — The principal causes of eversion in conse
quence of swelling of the lining membrane of the lid,
are, protracted chronic ophthalmias of a scrofulous
nature ; relaxation from intemperance or old age ; a
diseased state of the follicles of Meibomius ; morbid
growths in the part. Other causes of eversion are,
cicatrices on the skin of the lid arising from incisions,
burns, ulcers, smallpox pustules, and carbuncles.
AND ITS APPENDAGES. 623
Therapeutics — The medicines which have been
commended in these affections are, hepar sulphur,
mercurius sol., calcarea carb., digitalis, borax.
Should these remedies disappoint our expectations,
a portion of the lid should be excised, in such a man
ner, and in such a situation that the healing cicatrix
will restore the displaced tarsi and cilia to their nor
mal position. The operation is simple, unattended
with danger, and quite efficient. If opacity or ulcer-
ation of the cornea has already commenced when we
are first called to the case, it will be advisable to
have recourse to the operation without delay, and
correct all local or constitutional faults afterwards,
with suitable medicines.
The attenuations and repetitions of doses the same
as in amaurosis.
SECTION XVII.
FISTULA LACHRYMALIS.
Diagnosis. — Under this head authors generally in
clude, obstruction of the puncta lachrymalis and of
the lachrymal canals, inflammation and suppuration
of the lining membrane of the lachrymal sac, and
inflammation, thickening, and obstructions of the
membrane lining the ductus ad nasum.
In the most simple form of the complaint, there
will be merely an obstruction of the puncta, arising
from disease of the Meibomian glands, or of the eye
lids, and a consequent interruption to the passage of
tears to the lachrymal sac. The manifest symptoms
in this instance will be, a continual watering of the
eye and overflow of tears upon the cheek, weakness
of vision, and an undue dryness of the nostril of the
affected side.
Another form of the complaint commences in the
lachrymal sac, manifesting itself in the form of a
small, hard, and circumscribed swelling, apparently
within the sac. This swelling is quite tender to the
touch, and gradually increases in size until suppura
tion occurs, when the parts over and around the tu
mour acquire a red and shining appearance, not un
like erysipelas. During the early period of the in-
624 AFFECTIONS OF THE EYE
flammation, the puncta are closed, and tears are
forced over upon the cheek. The inflammation also
extends down the nasal canal, causing a degree of
tenderness, dryness, and obstruction in the duct and
nostril. If the suppurative process continues un
checked, the sac, after becoming much distended,
bursts, and gives gradual exit to the enclosed pus,
thus reducing the swelling, and developing a fistula
of the lachrymal sac. During the suppurative process,
the inflammatory action frequently extends to the ex
ternal textures of the eye, and if the patient be scro
fulous or highly irritable, some constitutional disturb
ance may be present.
If the disease is permitted to increase, or if inju
dicious surgical interference has seriously injured the
affected tissues, we may expect adhesive inflamma
tion between the walls of the membrane of the nasal
duct, and permanent obstruction to the passage of
tears to the nostril, and also a closure of the lachry
mal canals. When this state of things happens, the
tears run over the cheek as fast as formed, and we
are presented with the disease termed stillicidium
lachrymarum.
Still another form of the malady consists in a pri
mary inflammation and thickening of the membrane
of the ductus ad nasum, which gives rise to a partial
or total obstruction to the passage of the tears, and
their consequent accumulation in the lachrymal sac.
This undue lachrymal accumulation induces disten-
tion of the part, and, after a time, inflammation of its
lining membrane, and the other consequences which
we have before enumerated. This form of fistula is
dependent upon some disease of the nostril, like sy
philitic, scrofulous, mercurial, and cancerous ulcera-
tions, or inflammation of the nasal membrane from
other causes.
When the malady is fully developed, it is difficult
to decide in which particular structure the inflamma
tion originated ; but our diagnosis will always be
facilitated by carefully considering the causes of the
affection, and the previous inflammations. In what
ever part it commences, the inflammation is certain
to extend, sooner or later, to the contiguous struc
ture*?.
AND ITS APPENDAGES. 625
Causes. — Scarpa advanced the idea, that all forms
of fistula lachrymal is were attributable to a disease
of the minute glands of Meibornius, or an inflamma
tion of the lining membrane of the eyelid. This idea
has been partially refuted by several eminent ocu
lists, but there is, notwithstanding, much truth in the
theory. According to our own observations, those
forms of fistula which have originated in the puncta,
or lachrymal sac, have been preceded by an inflam-
ntation of the Meibomian glands, or of the conjunc
tiva of the eyelids ; but where the disease has origi
nated in the ductus ad nasum, it may generally be
traced to a previous inflammation, ulceration, or in
jury to the mucous membrane of the nostril.
The remote causes which predispose to the affec
tion are, a scrofulous, syphilitic, or mercurial taint ;
general debility and tendency to membranous inflam
mations ; caries of the nasal bones ; fractures and
other injuries in the region of the lachrymal sac and
nasal duct ; chronic ophthalmia ; pressure of tumours
against the lachrymal sac and the puncta.
Prognosis. — Previous to suppuration of the sac, and
if there is only a partial obstruction in the lachrymal
canals, we may anticipate a prompt cure by internal
remedies. But if the puncta and nasal duct be en
tirely closed, and the suppurative stage in the sac is
far advanced, our prognosis must be unfavourable or
evasive. Much, however, must always depend upon
the condition of the system, and the causes and com
plications which influence each particular case.
Therapeutics. — Various methods have been pro
posed by surgeons for the cure of fistula lachrymalis,
but they have proved for the most part unsatisfactory.
The different surgical means which have been most
commended are, the introduction of a tube or style
into the nasal duct ; the injection of the sac and na
sal canal, through the puncta, by means of Anel's
syringe, and the introduction of quicksilver. That
cures have now and then followed each of these me
thods, we do not deny ; but the numerous instances of
permanent aggravation of the malady by their em
ployment, render it probable that there has been
altogether more injury than benefit from their intro-
27
626 AFFECTIONS OF THE EYE, ETC.
duction into surgical practice. The same opinion is
at this time entertained by several distinguished oph
thalmic surgeons. It therefore becomes us to inves
tigate all of the causes and accompanying symptoms
of each particular case, that we may better select
remedies, and thus combat with a prospect of success
the remote as well as the immediate symptoms.
The following medicines have been found curative
in the various forms and stages of the complaint :
calcarea carb., acid nit., hepar sulph., silicia, aurum,
petroleum, belladonna, iodine, digitalis, lachesis, lycopo-
dium, kali carb., natrum carb.
The lower attenuations are always to be preferred,
and the dose repeated every twelve or twenty-four
hours until the disordered tissues are suitably im
pressed.
THE END.
INDEX.
A. PAGE
Abdomen, dropsy of, - - 539
" tympanitic distention of, 259
Abdominal typhus, - - 190
Acne, 245
Acute ophthalmia, - - 580
Acute rheumatism, - - 524
Albugo, - - - 582, 601
Allopathy, - - - - 61
Amaurosis, - 605
Amenorrho3a, - - - 503
Anasarca, - - - - 538
Angina pectoris, ... 359
" tonsillaris, - - 249
" parotitis, - - 252
" maligna, - - - 200
Apoplexy, - - 387
Arachnitis, - - - - 371
Arthritis, - - - - 528
Ascites, .... 539
Asiatic cholera, - - - 286
Asthma, - - - 336
Attenuations of drugs, <fcc., - 111
B.
Bilious colic, - - - 280
" fever, - - - 172
Bladder, inflammation of, - 435
" paralysis of, - 446, 451
" calculi of, - - 454
" irritable, - 473
" suppuration of, - 436
Bowels, inflammation of, 269, 270
" looseness of, - - 297
" torpor of, - - 258
" griping pains of, - 280
" haemorrhage from, - 270
" protrusion of, - • 299
" flatulent distention of, 258
Brain, diseases of, -" - 364
" inflammation of, - 371
" softening of, - - 380
" dropsy of, - 381
" extravasation of blood
upon, - - - 387
PAGE
Brain, effusion of serum upon, 389
" induration of, - - 404
Bright's granulated kidney, 533,535
Bronchitis, acute, - - -316
" chronic, - - 317
Bubo, .... 474,489
C.
Calculi, .... 454
Calculi of the bladder, 457, 459, 460
" of the kidneys, - 459,460
" of the prostate gland, 458,459
Cancer of the eye, - - 617
Cardialgia, - 267
Carditis, - - - - 361
Cataract, - - - - 614
Catarrh, .... 306
Causes of disease, general, - 36
" " of fever, - - - 136
Cellular dropsy, - r - 538
Cerebral typnus, - - - 183
Cerebritis, - 380
Cerveau, ramollissement du, - 380
Chancre, .... 435
Chest, dropsy of, - - - 542
Chemosis, - - - - 581
Chicken pox, - - - 217
Chlorosis, - 555
Cholera asphyxia, ,-.-, - 286
" morbus, - - - 295
" infanturn,- - - 297
Chorea, - - - - 419
Chronic ophthalmia - - 587
Colic, bilious, ... 280
" flatulent, - - - 281
" painter's, - - - 282
Cold, - -.- - - 306
Conjunctiva, acute inflamma
tion of, - 580
" chronic do. do. 587
granulations of, - 599
Constipation, - - - 258
628
INDEX,
Consumption, pulmonary, - 341
Continued fever, - - 172
Convulsions, - - 383, 421
Cornea, inflammation of, - 601
" ulcers of, - - - 582
" opacity of, - - 600
Coryza, - - - - 306
Cough, 357
" whooping, - - - 334
Croup, - 308
Cutaneous diseases, febrile, - 198
" " chronic, - 235
Cynanche larvngea, - - 307
trachealis, - - 308
Cystitis, 435
D.
Delirium tremens, 394
Dementia, - - - - 402
Diabetes, - - - - 436
Diagnosis, general, - - 122
Diarrhoea, - - - - 297
Dilatation of the heart, - - 359
Diseases, common causes of, - 36
Diseases of the cutaneous system 198
" " digestive system, 247
" " respiratory do. 304
" " circulating do. 359
Diseases of the brain and ner
vous system, - - - 364
Diseases of the spinal marrow
and its membranes, - * 410
Diseases of the urinary and
genital organs, - - 432
Diseases of the fibrous and
muscular system, - 5 24
Diseases of the serous exhal-
ent vessels, - - 530
Diseases of lymphatic system, 555
Diseases of the assimilative or
gans, - -566
Diseases of the eye and its
appendages, - - - 578
Dispepsia, see Dyspepsia.
Doctrines, medical, &c. - I
Doses, repetition of, - 111
Dropsy, general, - - - 530
" of the abdomen, - 539
" brain, - - 381
" chest, - - 542
« eye, - - 611
" " ovarium, - 543
" " testicle, - 544
Drugs, primary and secondary
action of, - - - 49
Drugs, attenuations of,
Dysentery, -
Dysmenorrhcea, -
Dyspepsia,
Dysuria,
PAGE
- Ill
- 270
- 513
- 258
- 464
Ecthyma, -
Ectropium, -
Eczema, -
Encephalitis,
Enteritis, acute peritoneal, -
" mucous,
chronic do. -
Entropium,
Enuresis, -
Epilepsy,
Eruptive diseases, acute,
" chronic,
Erysipelas, -
Exanthemata,
Eye, diseases of, -
" acute inflammation of, -
" chronic " " -
" purulent "
'• gonorrhceal " " -
" scrofulous "
" dropsy of, -
" fungus haematodes, and
cancer of,
" blindness of, (see cata
ract, amaurosis, granu
lated lids, opacity of the
cornea, cancer, etc.)
242
622
242
371
269
270
270
622
442
383
198
235
227
198
578
580
587
590
591
592
611
- 617
Fever,
F.
- 132
" intermittent, - - 141
" yellow, - - - 159
" continued, .. -; . - 172
" infantile remittent, - 168
" typhus, - - 176
" from functional derange
ment, - - -
Fever, from congestion,
" from inflammation,
" hectic, ...
" scarlet, - - , -
" lung,
" brain,
" miliary, - V
" puerperal,
Fistula lachrymalis,
" in perineo, •-. •-,
Flatulence, -
172
174
173
198
322
371
218
.278
623
472
259
INDEX,
629
PAGE
496
617
Fluor albus,
Fungus haematodes,
a
Gastritis, acute, - - - 253
" chronic, - -257
Gastralgia, gastrodinia, - 267
General diagnosis, - - 122
" dropsy, - - - 530
Genital organs, diseases of, - 432
Gleet, 470
Glossitis, . ... 247
Gonorrhoea, - - - - 465
Gonorrhoea! ophthalmia, - 591
Gout, acute, - - - 528
" chronic, - - - 529
Granulations of the eyelids, 599
Gravel, - - - - 454
Granulated kidney, Bright's 533, 535
H.
Hsematemesis, - - - 266
Haemorrhage from the lungs, 352
" " " stomach, 266
" " bowels, 270
" " •' uterus, 517
" " urethra, 466
Haemorrhoids, - - - 299
Haemoptysis, - - - 352
Heart, diseases of, - - 359
" dilatation of, - - 359
" disease of the valves of, 360
" inflammation of the en
velop of, - - - 361
Heart, palpitation of, 360, 361
" dropsy of, - - 542
Hectic fever, - - - 196
Hepatitis, acute, - - - 302
chronic, - - 303
Hernia humoralis, - - 474
Herpes, - - - 236
Hip-disease, - - - 568
Homoeopathy, - - - 86
Hooping cough, - - - 384
Hordeolum, -' - • - 621
Hydatids of the uterus, - 497
Hydrocephalus, acute, - 381
" chronic, - 382
Hydrothorax, - - 542
Hydrophobia, - - - 414
Hydrocele, - - > - 544
Hydrophthalmia, - - - 611
Hydrops, - - - - 530
Hypertrophy of the heart, - 359
Hypochondria, - - - 401
Hysteria,
PAGE
421
Indigestion, - ,-'.;. - 258
Impetigo, - - - - 243
Inflammation, - - - ' 1
" of the brain, - 371
" " lungs, - 322
" " pleura, - 328
" •' heart and
its appendages, 359
Inflammation of the stomach, 253
" " " liver, - 302
" " bowels, 269,270
" " kidneys, 432
" " bladder, 435
" " uterus, 51 3, 519
" " eye and
its appendages, 578
Inflammation of the spinal
marrow and its membranes, 410
Inflammation of the joints, - 568
" " urethra, 465
" " inguinal
glands, 474
Inflammation of the tonsils, 249
" " parotid
glands, 252
Inflammation of the tongue, 247
" '• peritoneum, 278
" " prostate
gland, 472
" " " bronchia, 316
" " testes, 482
Incontinence of urine, - - 442
Infantile remittent, - - 168
Influenza, - 307
Ileus, - - -;-" - - 271
Insanity, .... 397
Intermittent fever, - - 141
Intestines, inflammation of, - 270
Inversion of the eyelids, - 622
Irritable bladder, - - 473
Ischuria, - - - - 443
Itch, - - - » - - 240
Jaundice,
J.
K,
303
Kidney, Bright's disease of, 533, 535
Kidneys, inflammation of, - 432
" suppuration of, - 433
" induration of, - 433
" schirrhus of, - - 433
630
INDEX.
Kidneys, gangrene of, -
PAGE
434
PAGE
Ovarian dropsy, - - 643
L.
P.
Lachrymal fistula,
623
Painter's colic,
282
Lepra,
245
Painful menstruation, -
513
Leucoma, - - - 582, 601
Palpitation, -
359
Lids, granulated,
599
Papular diseases, - - -
239
Leucorrhoaa, - - 475,
496
Paralysis, palsy, - - -
392
Lichen, -
232
Parotitis, -
252
Liver, inflammation of. -
302
Pathology, general observa
Lung fever, -
322
tions on,
7
Lungs, bleeding from, -
352
Pemphigus, -
238
" tubercles of,
345
Pericarditis,
361
ulcerations of,
346
Peritoneal enteritis,
269
" hepatization of,
323
Peritonitis, acute, -
278
•' congestion of, -
323
chronic,
280
" purulent infiltration of,
324
Pertussis, - - - -
334
Phthisis pulmonalis,
341
M.
Phrenitis, -
371
Mania,
399
Phymosis, - - - -
469
Mania a potu, ...
394
Piles,
299
Marasmus, -
669
Pityriasis, -
246
Measles, -
207
Plague, . ...
235
Medical doctrines, &c., -
1
Pleurisy, pleuritis,
328
Melancholia,
401
Pneumonia, -
322
Menses, suppression of, -
503
Porrigo,
244
" retention of,
503
Primary and secondary action
" scanty, -
513
of drugs,
49
painful, -
513
Prolapsus ani, -
299
" profuse, -
517
" uteri, a - -
498
Menorrhagia, -
517
Prostate gland, diseases of, 450,
472
Miasmata, - - - -
140
Prurigo, -
240
Miliary fever, Miliaria, -
218
Psora, - - - - -
240
Monomania,
401
Psoriasis, -
246
Mucous enteritis, - - -
270
Puerperal fever, -
278
Mumps, . ...
252
Pulmonary consumption,
341
" affections, -
304
N.
Purulent ophthalmia, -
590
Nephritis, -
432
Pustular diseases,
240
Nervous system, diseases of, -
364
Pyrosis, -
258
Nettle rash, - - - - 221
Neuralgia, - 424
Nebula, - - - 582,601
0.
Ophthalmia, acute, - - 580
" chronic, - - 587
" purulent, - - 690
" gonorrhceal, - 591
strumous, scrofu
lous, - - - - 592
Opacity of the cornea, - - 600
Opisthotonos, - - - 410
Os uteri, imperforate, - .508
Ovarian disease, - 643
Quinsy,
Q.
11.
249
380
Ramollissement du cerveau, -
Remedial agents, specific ef
fects of, - 40
Remittent fever, - - - 168
" infantile, - 168
Repetitions of doses, - - 1 1 1
Respiratory organs, diseases of, 304
Retention of the menses, 603, 506
" urine, - - 443
Rheumatism, acute, - - 524
INDEX.
631
Rheumatism chronic,
Roseola,
Rubeola,
Rupia,
S.
Scabies,
Scarlet fever,
Scarlatina, -
Scarlatina simplex,
" anginosa,
" maligna,
Schirrus of the eye,
PAGE
- 525
- 220
- 207
- 243
- 240
- 198
- 198
- 199
- 199
- 200
- 617
uterus, - 619,497
Scrofula, - - - - 566
Scrofulous ophthalmia, 568, 592
" disease of the me-
senteric glands, - - 569
Secondary syphilis, - - 488
Serous exhalent vessels, dis
eases of, 530
Skin, acute diseases of, - 198
" chronic diseases of, - 235
Sloughing of the cornea, - 582
Smallpox, - - - - 212
Softening of the brain, - - 380
Specific eflfects of morbific and
remedial agents, 40
Squamous diseases, - - 245
Spinal marrow, inflammation
of, - - - 'J - 410
Sporadic cholera, - 295
Strictures of the urethra, - 470
St. Anthony's fire, - - 227
Stomach, acute inflammation
of, .... 253
Stomach, chronic inflammation
of, .... 257
Stomach, neuralgia of, - - 267
" acidity of, - - 259
Suppression of the menses, 503, 606
" urine, - 443
Susceptibilities of parts great
est in disease, - 64
Stye, - - - 621
Syphilis, - -' - - 482
T.
Tetanus,
Testes, inflammation of,
" dropsy of,
Tetter,
Therapeutics,
The plague, -
PAGE
Tic douloureux, - - 424
Tongue, iuflammation of - 247
Tonsils, inflammation of - 249
Tonsilitis, - ... 249
Trachealis cynanche, - 308
Typhus, - - 176
" cerebralis, - 183
" pneumo, - - - 187
" abdominalis, - - 190
U.
Ulcers of the cornea, - - 682
" " " surface, - - 488
" " " throat, <fec. - 488
" " " lungs, - - 346
Urethritis, - - - 465
Urethra, inflammation of, - 465
" strictures of, - 452, 470
Urinary calculi, - - - 454
" organs, diseases of, - 432
Urine, incontinence of, - - 442
" suppression of, - - 443
" scalding of the, - - 466
" increased secretion of, 436
" bloody, - - - 467
" saccharine, - - 440
" coagulable, -»• - 533
Urticaria, - - - - 221
Uterus, inflammation of, 513, 519
" hemorrhage from, - 517
" scirrhus of, - - 497
•' prolapsus of, - - 498
" polypi of, - - 497
" hydatidsof, - - 497
" congestion of, . 613,519
Valves of the heart, diseases
of, l > ".:.»• .-. - 360
Varicella. - » • • * . 217
Variola, - - • . 212
Venereal disease, - - - 482
" node, - - - 489
Vital principle, <fec., doctrines
respecting, - - - 22
Vomiting of blood, - - 266
W
410 White swelling, -
482 Whites,
544
236 Y
36 Yellow fever,
236
568
496
- 159
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the French Work of Jahr. With origiual contributions by Chas J. Hempel, M.D.
Cloth, $2.
HEMPEL, CHAS. J. The Homoeopathic Domestic Physician. By C. J. Hem-
pel, M. D. Second Edition, revised and considerably enlarged by the Author. —
Cloth, 50 cts.
JAHR'S NEW MANUAL OF HOMCEOPATHIC PRACTICE, Edited, with
Annotations, by A. Gerald Hull, M. D. This is the fourth American edition
of a very celebrated work, by the eminent Homoeopathic Professor Jahr, and it is
considered the best practical compendium of this extraordinary science that has
yet been composed.
Complete Repertory, one volume, bound, $3.
JAHR'S NEW MANUAL, originally published under the name of Symp-
tomen-Codex. (Digest of Symptoms.) This work is intended to facilitate a'com-
parison of the parallel symptoms of the various homoeopathic agents, thereby ena
bling the practitioner to discover the characteristic symptoms of each drug, and to
determine with ease and correctness what remedy is most homoeopathic to the ex
isting group of symptoms. Translated, with important and extensive additions
from various sources, by Charles Julius Hempel, M. D.", assisted by James M. Quin,
M. D. ; with revisions and clinical notes by John F. Gray, M. D. ; contributions by
Drs. A. Gerald Hull, and George W. Cook, M. D., of New- York ; and Drs. C. Bering,
J. Jeanes, C. Neidhard, W. Williamson, and J. Kitchen, of Philadelphia. With a
Preface by Constantino Hering, M. D., 2 vols. Bound, 1848. $11 00.
LAURIE, DR. J., HOMCEOPATHIC DOMESTIC MEDICINE, with the
Treatment and Diseases of Females, Infants, Children, and Adults. 5th American
edition, much enlarged with additions by A. Gerald Hull, M. D. 1849. Bound, $1 50.
LAURIE, DR. J., ELEMENTS OF HOMCEOPATHIC PRACTICE OF PHY
SIC. An Appendix to Laurie's Domesti c, containing also all the diseases of URIN
ARY AND GENITAL ORGANS. Bound, 1849. $125.
JAHR'S CLINICAL GUIDE, or, Pocket Repertory. Translated from the
German, by Chas. J. Hempel, M. D., bound, (just published). $1 50.
HAHNEMANN'S ORGANON OF HOMOEOPATHIC MEDICINE, 3d Ameri
can edition, with improvements and additions from the last German edition, and
Dr. C. Hering's introductory remarks, 1848. Bound, $1 00.
RAU'S ORGANON, of the specific healing art of Homoeopathy. Translated
by Chas. J. Hempel, M. D. 1848. $125.
HAHNEMANN, DR., MATERIA MEDIC A PUR A, Translated and edited
by Charles Julius Hempel, M. D. 4 vols. 1846. $6.
E. STAFF'S ADDITIONS TO THE MATERIA MEDICA PURA. Translat
ed by C. J. Hempel, M. D. $1 50.
HAHNEMAMN, DR. S., THE CHRONIC DISEASES, their specific Nature
and Homoeopathic Treatment. Translated and edited by Chas. J. Hempel, M. D.,
with a Preface, by Constantine Hering, M. D., Philadelphia. 8vo. 5 vols. Bound.
1845. $7.
TRANSACTIONS OF THE AMERICAN INSTITUTE OF HOMOEOPATHY.
J84H. Bound. $150.
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