LIBRARY OF CONGRESS. L %p — §mm¥ 1* ajwifjSiifl UNITED STATES OF AMERICA. J 1AY „ m* * «* PURPURA . Purpura. BY George William Winterburn, Ph. D., M.D. Editor of the American Homceopathist. President of the American Obstetrical Society: Formerly Lecturer on Clinical Medicine, and Physician-in-Chief to the Manhattan Hospital: Fellow of the American Akademe; Member of the Academy of Anthropology, of the New York Academy of Sciences, of the American Institute of Hoimeopath3\ and of other Learned Societies, etc., etc. NEW YORK : A. L. CHATTERTON & CO. 1886. M Copyright, 1886, by Geo. W. Winterburn. TO PROF. SAMUEL LILIENTHAL, M. D. WHO, BY HIS PROFESSIONAL WORTH AND INDUSTRY, HAS DONE SO MUCH TO ESTABLISH SCIENTIFIC THERAPEUTICS, THIS VOLUME IS GRATE- FULLY DEDICATED. INDEX. Aconite in purpura, 145 Allen, Richard C, case, 130. Arnica, 157. Arnold, William, case, 87. Arsenicum. 104. Artificial production of pur- pura, the, 20. Begbie, J. Wharton, ob- servation in regard to terebinthina, 149. Belcher, Geo. E.,case, 140. Berberis, 215. Boyce, C. W., case, 84. Brown, Crichton, cases, 173. Brown, Dyce, observation on chloral, 178. Bryonia, 169. Buchmann, of Alvensleben, case, 186. Bumstead, Freeman J., case 183. Burnett, J. Compton, cases, 91. Cardiac debility as a cause of purpura, 18. Cheyne's theory, 22. China, 119. Chloral, 172. Clark, John H., cases, 158. Clary, W. J., cases, 74. Comstock, T. G., case, 151. Crotalus, 69. Cuprum, 190. Decker, W. M.. case, 193. Detwiler, H., case. 154. Diagnosis, 60. Doane, W*C, case, 144. Erigeron, 156. Etiolosrv. 1 Etiology, 14. Ferrum phosphoricum, 216. Fiske, W. M. L., case, 111. Fox, Tilbury, observation, 181. Frerich's theory, 22. Gage, J. L., cases, 118, 137, 1(55. Hale, E. M., cases, 156, 165. Hale, Dr. , of Hastings, Eng- land, case, 166. r :x d e x Hayward, J. W., cases, 73. Hetnigke, C, case, 112. Hering, Constantine, case, 102. Hoyne, TempleS., cases, 90. Hughes, Richard, observa- tion on mercurius, 185. — on the febrile form, 145. Hydrocyanic acid, 209. J \odum, 180. ahr, G. H. G., case, 105. .Jones, S. D., case, 111. Kali hydriodicum, 181. Kimball, L. Hough- ton, case, 147. Kippax, J. R., cases, 118, 157, 214, 218. Kissel, Dr., case, 192. Lachesis, 93. Ledum, 213. Ludlam, R., case, 209. Lycopodiuvi , 216. M organ, John C, case, 144, 164, 217. Ockford, G. M., case, 109. Okie, Dr., case, 142. Pathology, 22. Pease, G. M., cases, 97. Phosphorus, 77. Post-mortem appearances, 24. Price, Elias C, cases, 91, 171. Prognosis, 62. Purpura simplex, 52. — hemorrhagica, 54. — rheumatica, 57. R epertory, 219. Rhus, 128. Sanguinaria, 193. Secale, 112. Seward, John L. , cases, 99, 170. Small, A. E., cases. 66, 109. Sidphuric acid, 163. Symptoms, 25. T erebinthina, 149. Treatment, 63. Varieties, 51. Venesection in pur- pura, 145. WESSELHOEFT, CONRAD, case, 97. Williams, of Liverpool, case, 167. Winterburn, Geo. W., cas- es, 115, 121, 131, 204. PAGE I. Purpura. - 11 Etiology, - 14 Pathology, . 22 Symptoms, " , ■ 25 Varieties, . 51 Diagnosis, - 60 Prognosis, . - 62 Treatment, - 63 II. The Remedies and Their Indications. Crotalus, . 69 Phosphorus, - 77 Lachesis, ..... 93 Arsenicum, . 104 Secale, .... - 112 China, . 119 Rhus, : . - 128 Hamamelis, . 139 Terebinthina, . - 149 Erigeron, . 156 Arnica, . - 157 Sulphuric A.cid, . - 163 8 CONTENTS. ' PAGE Bryonia, - - - - - 169 Chloral, - - - - 172 Iodum, - - - - 180 Kali hydriodicum, - - - - 181 Mercurius, - - - - - - 185 Cuprum aceticum, - 190 Sanguinaria, - - - - - 193 Hydrocyanic acid, - 209 Ledum, - - 213 Berberis vulgaris, - 215 Lycopodium, _____ 216 Ferrum phosphoricum, - - 216 III. Therapeutic Digest, - - - - 219 IV. Index, - 5-6 PREFACE At the annual meeting of our State Society this year, the topic of the Materia Medica of Haemorrhage was selected as one of the special subjects for study, and to me was assigned the duty of writing up so much of that topic as pertained to Purpura hemorrhagica, a disease in which my experience was limited, and of which I knew very little. Conversation with professional associates developed the interesting fact that I was not alone in mental nebulosity on this subject, and I then set myself system- atically to work to study it up. The result is bound within these covers. I have endeavored to garner the experience and wisdom of the profession, and to present it in such a conven- ient shape that he who runs may read. There have been a number of interesting cases con- tributed at various times to periodical literature, and of these I have here presented all that have seemed to me to possess practical value, as far as I have been able to secure them ; and 10 PRE F ACE. I have waded through many hundreds of volumes for the results obtained. In addition to this, I have secured some thirty odd hereto- fore unpublished cases, many of them of great value as studies in therapeutics. In a word, while I have but four cases to report of my own, and indeed one of these has been added just as the manuscript is completed, I have been able, through the generosity of my con- freres, to place in orderly array so much that possesses intrinsic worth, that the subject is* lifted from therapeutic obscurity to compara- tive practical certainty. It was utterly outside of my intention to do more than present a creditable and useful paper to the society which honored me in its selection ; but the material soon outgrew the limits of such a report, and encouraged by the suggestions of those who desired to possess the therapeutics of this interesting disorder, in a convenient form, it is sent forth in its present shape. G. W. W., No. 29 West Twenty-Sixth St., New York, Nov. 2, 1885. PURPURA. The peculiar discoloration of tlie skin, from which this disorder takes its name, is caused by haemorrhage into the cutaneous substance. Extravasation of blood into the tissues, more especially into the skin and mucous membrane, is a symptom common to many affections. Thus in the course of malignant diseases, such as diphtheria, smallpox, or scarlatina, haemor- rhage into the tissues is by no means uncom- mon. A like condition is caused by certain corrosive drugs, such as phosphorus. A more persistent and characteristic haemorrhage is a factor in that sequence of symptoms which we denominate as scurvy. A bruise from external violence, presents all the objective symptoms of a purpuric spot, and the tiny ecchymoses resulting from the bites of fleas are of the same general type, as far as outward appearance goes. Text- book authorities have classified all 12 PURPURA. these conditions under the title purpura. Thus the ecchymoses from flea-bites are called pur- pura pulicosa ; those from external violence, purpura traumatica ; those accompanying scurvy, purpura scorbutica ; those from blood- changes induced by corrosive drugs, purpura toxica ; those occurring in malignant cases of smallpox, purpura variolosa; and so on, in variety too numerous to mention. Now, it is quite evident that such designations are mis- leading as they group together, under a generic name, unrelated disease-conditions, quite irrespective of etiological or pathological sig- nificance. If purpura is merely a local haemor- rhage, or a series of local haemorrhages, then it does not deserve to be classed as a disease, but is only a symptom, and the word purpura should be dropped from our nomenclature. Although none of the conditions designated above possess the qualities which entitle them to be set aside into a group of cases by them- selves, to which we might with propriety apply the term purpura, there are groups of symp- toms, indicating a morbid action of a definite character, but varying very greatly in intensity DEFINITION. 13 in different individuals, to which the term may be appropriately given. From this class will be excluded all the conditions heretofore des- ignated, not only because they do not present any definite etiological or pathological simil- iarity, but because these all occur as epi-phe- nomena, and not as in true purpura, where the extravasation is the pivotal, or key-note, symp- tom of the case. We do not, therefore, include in the definition of purpura, the effects of internal or external violence, the action of poisons, or the results of specific or contagious diseases. Purpura is a somewhat rare disorder. Seventy American and British homoeopathic physicians, who have each been in continuous practice for upwards of twenty years have only treated one hundred and forty-nine cases of the hemorrha- gic variety in all ; and yet these were selected from among the entire homoeopathic fraternity as the ones most likely from their hospital connection, and otherwise, to have been brought in contact with this disorder. And of thirty- four other physicians, who had been in practice an average of ten years, only seventeen had 14 PUKPIJEA. seen a case of hemorrhagic purpura, and but three of these had seen more than one. Still while purpura is by no means common, especial- ly in its severer forms, every practitioner is liable at any time to have such a case presented to him for diagnosis and treatment. Only a few years ago, three prominent physicians in this city diagnosed a case as hemorrhagic smallpox, which to their confusion, proved to be, on postmortem examination, purpura. Purpura, when fully developed is one of those unique diseases, which from its striking physical manifestations, takes a firm grasp upon the imagination of the beholder, and arouses consternation in the family of the sufferer. Human blood, even when the quantity is insignificant, is an object of terror to the general, and the doctor who can make a brillant cure of such a case, is already on the high road to professional success. ETIOLOGY. The cause of purpura has never been definitely determined. It occurs under diversified condi- tions, and all these have been in turn assigned ETIOLOGY. 15 as causes. Impure air, damp or miasmatic lodgings, improperly prepared or scanty food, fatiguing and laborious occupations, or intem- perance cannot reasonably be assigned as causes, though purpura is often consecutive to these ; yet many live among the most deleterious surroundings, never know what it is to have a decent meal, never recover from the fatigue of one day before compelled to begin the labors of the next, or imbibe to degradation and by continuous habit without inducing a vestige of this disorder. Jaundice, acute rheumatism, the exanthemata, and menstrual derangements, may each be followed by purpura, and are so followed in proportion of frequency to the order here named ; but then, it also occurs in persons apparently in good health, and in those who have not been exposed to any debilitating influences. Jaundice and purpura are so frequently associated, that the older writers, who were fond of giving names to things, and who seemed to be impressed with the idea that as soon as they had labeled a disease they had accomplised all that could be reasonably expected of them, used the term purpura 16 PURPURA. hepatica. Irregularities of menstruation cannot be classed as a cause of purpura, although it is a frequent concomitant of amenorrhcea. It is more than probably that both are symptomatic and not causative. It would seem in some of these cases as if the purpura was of the nature of a vicarious haemorrhage, as the purpuric patches have been known to disappear as soon as menstruation was established. Almost any of the chronic alterations in the viscera may be associated with purpura, more especially amyloid changes. It has been claimed that purpura depends upon some minute organism in the blood. Thus Watson Cheyne describes a plugging of the capillaries with masses of bacilli 1 ; and Petrone injected hypodermically into rabbits blood drawn from purpuric patients and thus produced widely distributed haemorr- hages. 2 It must be admitted that this would be a very convenient theory, from the fact that no other immediate cause of the disease is known ; but unfortunately for its value as a theory several varieties of micro-organisms lZiemssens' Cyclopcedia, xvii, 258. 2L0 Sperimentale, 51, 1883. ETIOLOGY. 17 have been described as thus occurring. This throws much doubt on the whole matter, and still leaves the question wide open. Purpura occurs in both sexes, and at any age, but is most frequent at the extremes of life. It might be easily confused in childhood with hsemophila ; l)ut purpura is not hered- itary, and generally occurs suddenly, without previous haemorrhages, while hsemophila can be easily diagnosed by the family history and the previous occurrence of haemorrhage. The hemorrhagic diathesis is more likely to afflict the female members of the family, but there is no such difference in the attacks of purpura. The only reason why purpura seems more particularly a disorder of childhood and senility is, that in the very young the tissues of the capillaries are extremely thin and soft, and in the aged they are very brittle, and so in both cases fracture is more probable than in those of mature but vigorous life. A. diet of salt meat, or an absence of vegetable food, has no influence in causing purpura ; this sufficiencly dif- ferentiates it from scurvy, and shows the inappropriateness of the term Icuid-scurvy which has been applied to it. 18 PURPURA. Not only is there obvious confusion as to the cause of the haemorrhage in these case, but there is likewise the same uncertainty as to how it is brought about. The escape of blood blobules from the capillaries, may take place by transudation without, rupture of the capillary tissues ; but even this presupposes some change either in the capillary or in the blood. At one time the disorder was ascribed to debility in the heart's action, and to defective nutrition of the circulatory system ; but it is evident that this cannot be a prime cause as extreme cardiac debility may exist for many years, and cause death, without purpura developing. Nevertheless, anything which tends to prevent ample nutrition of the lesser blood-vessels would facilitate the development of this disorder. As a rule, there must be some degenerative change in the capillaries, which makes them especially liable to give way under blood-pressure, although the initial morbid disturbance may have been in the blood itself. Dr. Wilson Fox has observed a case in which the capillaries were in process of lardaceous defeneration.' He observes, in regard to this, E T I O L o a Y . 19 as an explanation as to the manner in which purpura may arise : " Another very important question is, how far this affection of the capillaries can be logically considered to have been the cause of the haemorrhage. Any direct association of the two changes will probable be considered doubtful by many who know that lardaceous affections of tissues are rarely associated with haemorrhage : and further, that the changes in the parenchyma of organs and in mucous membranes thus affected is often preceded by a similar change in the smaller vessels 1 . The evidence as it stands at present is decidedly against such a theory of causation, unless one or two hypotheses may be admitted to explain the connection of the phenomena observed. (1) May this lardaceous degener- ation, which we know chiefly as a chronic disease, occur occasionally in a more acute form, and in this manner so rapidly alter the elasticity of the vessels, before their diminished calibre can have retarded, the flow of blood in the part, that rupture and iVirchow, Cellular Pathology, page 374. 20 P TT P P TT P A . hemorrhage ensue ? (2) Is it possible that this lardaceous change, occurring only in tracts of tissues, may throw such a stress on the collateral capillary circulation of the tissue around, that adjacent but comparatively unaffected capillaries give way \ Both theories derive some support from the observations made on the dissemination of the degeneration in this case, and also from the observations of Zenker, in a similar degeneration of the muscles in typhoid fever/' 1 Purpura has been artificial induced in a variety of ways. Simon has produced it by dividing some of the sympathetic ganglia in the neck of the frog ; softening of the tissues first occurring (Hilliard). It is possible that this fact may bring us very near the correct explanation. As there is no constant condition of the blood, or of the circulatory organs, or of tissues immediately affected by the extravasa- tion, which points surely to this disorder, it may well be that the cause back of all may be some abnormal state of the sympathetic nervous i Ueber die Verdnderuuyeu der willkuhr lichen Muskeln in Typhus Abdominalis. Leipeig, 1864. ETIOLOGY. 21 system. Thus Da Costa says that as the disease comes on frequently in the midst of seemingly excellent health, it cannot be merely a disease of the blood, but is possibly the result of im- paired power in the capillaries, through that part of the nervous system that controls them — the vasomotor system. Many drugs cause purpura : some of these pathognomonically. and others only in special cases, or particular individuals Tilbury Fox has shown that the injection of ammonia into the veins will cause extravasations of blood into various parts of the cutaneous surface, and haemorrhages from the mucous membranes. Virchow injected putrescent matter into veins, and saw resulting therefrom ecchymoses of the endocardium, of the lungs, liver, kidneys, and intestines. 1 Dr. Parkes has shown that an excess of iron in the blood tends to produce purpura : but this observation is of little prac- tical importance, as in a multitude of other instances it has been shown that the blood of purpuric patients does not contain an excess of i Quoted by Tilbury Fox in Reynold's System of Medicine, Vol. I, page 466. ■HMHI^HB 22 PURPURA. the ferric salts. Indeed almost every one of the natural constituents of the Wood have been found normal, excessive, and deficient in vari- ous purpuric patients ; thus proving absolutely nothing. Frerichs has suggested that there is an abnormal attraction between the capillaries and the blood, from whence arise obstruction and rupture. This is somewhat like Watson Cheyne's theory of the plugging up of the cap- illaries with bacilli ; but both propositions are wanting in real, good, solid facts to stand on. Hebra is of the opinion that temperature and clothing have much to do with the production of this disorder ; but this also seems a mere tanciful idea. Climate really has little or no influence on the development of this disorder. In fact, nothing positive can be advanced, the more careful the observer the more cautious his utterances, and while many theories have been discussed nothing definite is known of the cause of the disease of which cutaneous haemorrhage is the visible evidence. PATHOLOGY. Pathology gives us very little definite infer PATHOLOGY. 23 mation. Tt does tell us that these discolorations are real extravasations of blood into the cuta- neous tissue, and not merely the leaking through the capillary wall of the coloring matter ; that sometimes these hemorrhagic are quite extensive, invading the contiguous tissue of an entire limb; that in many cases they extend into the subcutaneous cellular tissue or even into the muscular structure ; that they very frequently invade the mucous and less frequently the serous tissues, and that there may be not only ecchymoses upon these, but actual haemorrhages, debilitating in severity or frequency, from the nasal passages, the buccal cavity, the pharynx, the stomach, or the intes- tines, and into the sacs surrounded by the pleura, the pericardium, or the peritoneum. Post-mortem examination usually shows the lun^s and brain to be in a normal condition ; the liver may be healthy, or it may be fatty, atrophic, or cancerous ; the spleen may be natural in dimension and consistence, or it may be hypertrophic or indurated ; the pelvis of the kidney often contains blood, and its parenchyma may be normal, or show amyloid 24 PURPURA. or other form of degeneration ; the capillaries of the skin have been observed to be degenerate from amyloid changes, and in other cases have been pronounced healthy ; while the general mass of the blood is in some cases entirely normal in appearance and characteristics, coagulating readily, and in other cases it is unusually fluid, and indisposed to coagulate. The white corpuscles have been seen to form a considerable proportion of die blood, and, again, they may be abnormally infrequent. And, finally, as stated by various observers, the fibrin may be excessive, deficient, or in due proportion. Thus there does not seem to be any recognized pathological change in this disorder, except the ecchymoses themselves, sufficiently constant to be determinate, or even indicative. But it by no means follows that there are no definite changes which take place in ordinary, uncomplicated purpura, and the confusion on this point has arisen mainly, if not wholly, from the fact that the cases which have been particularly studied were ones in which the purpuric condition was associated withother grave disorders. Thus the Wilson Fox SYMPTOMS. 25 case, of which so much has been said, was a very unfair specimen of purpura, as the man was far advanced in secondary syphilis, with severe ulceration of the pharynx and larynx, and with amyloid degeneration of the spleen, liver, kidneys, and intestines. Dr. Dickinson's first case was one of meningeal apoplexia, in a cachetic subject, who died on the third day of the attack. The second case was one of jaun- dice caused by the pressure of a hydatid cyst. Nothing of appreciable value can be learned from such cases, and I have been unable to find anywhere clear records of necropsies in cases of uncomplicated purpura. SYMPTOMS. Purpura may abruptly appear in persons of apparently robust and vigorous health ; or, it may be preceded for several days by malaise, headache, nausea, drowsiness, and pains in the back and limbs. If with this there is some elevation of the bodily temperature, the case will closely resemble the prodromal period of the exanthematous fevers. The purpuric spots or patches usually begin on the thigh, although 26 PURPURA. they may appear on any part of the cutaneous surface, or be so broadly sown as to have the appearance of having come out all over at once. In either event, the spots may differ greatly in size and outline. They may be stigmata or mere points, which unless very numerous are apt to escape detection. If the size vary from that of a pin's head up to that of a split pea, they are called petechue. Larger patches are termed ecchymoxes* unless they are long and narrow, resembling the black-and-blue whelt caused by the stroke of a whip, when they are known as ribices. When these various shaped spots first appear, they are usually definite in outline, but as the spot ages the margin gradu- ally becomes indistinct, and the eye is unable to precisely determine where the ecchymosis ends and healthy tissue begins. This may be caused either by the gradual extension of the patch, involving new tissue, or by the absorption of the extravasated luematin. Almost always, at first, not only is the definition of the outline of the patch abrupt, but it presents a certain geometric regularity. But in severe cases, these patches are apt to SYMPTOMS. 27 spread, by continued haemorrhage, and they then look just like an ordinary bruise. Tbe color varies according to the age of the spot. At first it is bright-red, like a place that is about to blister ; then it deepens through the crimson tints to violet, becomes deep purple, and at last blackish. Occasionally the erythematous stage is preceded by subcutaneous induration or oedema, as in the specific exanthema tons diseases These various stages may develop sedately, or follow upon each other s heels so quickly as to ripen in a single night. Id ordinary cases, each spot lasts about two weeks, fading gradually like an ordinary bruise. In a case, therefore, which has lasted for some days, the purpuric spots will be seen in all stages of development and degeneration. In more severe cases, the extra vasa ted blood may not be reabsorbed, and local gangrene may occur. It is in such cases, marked with unusual severity or extent of the haemorrhage, that blood-stained fluid escapes in sufficient amount beneath the cuticle to cause blebs; this has been termed purpura 'pemphigoides. If the disorder is limited to the cutaneous surface, 28 PURPURA. there is little danger to, and moderate disturbance of, the general health ; but when the mucous or serous surfaces are involved the case becomes at once most grave. This form of the disease is called purpura liwmorrhagica. It differs only from the simple form in being more extensive, but the mucous involvement produces haemorrhages from the parts affected — epistaxis, buccal bleeding, hsematemesis, hematuria, malsena, or haemoptysis, as the case may be— and these are often profuse, long-lasting, and exhausting. The following case is typical, barring the apparently inherited tendency to haemorrhage ; and is reproduced here from the American HomoeopatMst, of August, 1885, as a fair sample of a severe but not by any means necessarily fatal type of this unique disorder. It was reported by Dr. J. W. Angell, of Iowa Falls, Iowa. " December 7, 1884. Was called to visit Miss Addie H., aged 17, a daughter of one of my patrons, living here in the city, and was, there- fore, well acquainted with the young lady. She was a well developed young woman, pos- sessed of a lively, pleasant disposition, quick SYMPTOMS. 29 perception, black hair, dark eyes, with a clear, but always of a rather pallid, complexion. Menstruation, since its first appearance, in her fourteenth year, had never been quite regular, frequently too soon, too profuse, and some- times quite painful, and then again delayed beyond the fourth and fifth weeks : was quite subject to severe attacks of headache, confining her to the bed for hours at a time. Quite often troubled with epistaxis, as also was her mother when at her age. Bowels regular, and kidneys performing their functions properly. Digestive organs all healthy, and to all appearances Miss Addie enjoyed as good health as do the major- ity of girls of her age, and of American parent age, as was hers. Her residence is located on a lot adjoining a deep ravine, which is filled with brush and brambles, always moist, as it serves to carry off the surface water and re- ceives the underground drainage of a number of the surrounding lots in that vicinity, while the yard around the house contains many fruit, as well as native trees. The family has had considerable sickness since residing there, which has been for several years, and Miss 30 P IT R p TT K A . Addie had diphtheria three years since, and, during an epidemic of scarlatina, two years ago, her younger brother and sister were attacked with it, and her brother died of it. During the two months preceding the attack of her last sickness she had been more than usually troubled with headache, but still attended school and kept up with her class in her studies. Some time in November last, she was severely troubled by an eruption upon various parts of the skin, of an irritating character, resembling eczema simplex, but only upon one thigh, just above the knee, did it give her very much trouble. There, it seemed to assume the char- acter of small "blood boils," which gave her considerable pain. To these little boils, she applied a wash that is quite popular here, for the cure of all kinds of skin diseases, the princi- pal ingredient of which is corrosive sublimate, and its first application caused her to suffer intolerable pain, not only from the u boils," which became very much swollen, but all through the limb, up the whole length of the spine, and through the head, and exciting a feverish condition throughout the whole system. 8YIPTO M S . 31 These symptoms continued for a day or two, and then subsided, leaving those sore spots on the limb apparently better, as they were dried up, and not very painful. But in a day or two after she was surprised to notice the appear- ance, on nearly all parts of her skin, of an eruption of little red spots looking like Ilea, bites, from some of which, especially upon the back of her hands and lingers, would ooze a drop or two of blood ; and with these red spots w T ere many larger ones, dark and discolored, just like blood' blisters, some of them as large as a clime. None of these sf>ots upon the sur- face gave her any pain, nor felt sore upon pressure. These would disappear in a few hours, and then again reappear, as numerous as ever. A day or two fiom the first appearance of this eruption upon the surface, it appeared also in the buccal cavity, on her tongue, cheeks, lips and gums. Then she began to have fre- quent attacks of bleeding froin the nose ; sev- eral of them quite profuse, the blood flowing mostly from the right nostril. This state had continued for several days before I was called, 32 PURP UK A . for, as she otherwise was feeling quite well having a good appetite, bowels regular, sleeping well at night, with only a little dizzi- ness of the head once in a while, her mother thought it not necessary, and therefore made use of such remedies to restrain the nasal haem- orrhage as are so often effectual ; and thinking Addie was only going through a similar trouble to what her own had been at her age, did not think it necessary to resort to medical assist- ance. But, these frequent and profuse haem- orrhages from the nose persisting, and then the appearance of those blood blisters in her mouth, together with frequent darting pains of the head, told her that Addie was suffering from no ordinary complaint, and was in need of other treatment and remedies than she was able to give her, and, therefore, called me to her assistance. I found her on the morning of December 7th, sitting in her easy chair, busied with needle work, and in good spirits, cheerful and pleasant, as was her usual mood, but with an unwonted pallor to her countenance, which shocked me by its intensity. SYMPTOMS. 33 I then learned the history of the case, as I have just related it, with the further one that she had noticed for several weeks previous. Whenever she. happened to merely prick herself with a pin, the blood would flow from it freely, and would do so for a long time before she could stop it. There was no difficulty in diagnosing the disease affecting her, but in answer to the question her mother put to me of, "What ails her, doctor?" I replied, " blood poison." I did not hesitate to give her a favorable prognosis, though I was fully impressed with the idea that this my third case of purpura hemorrhagica, was of far more doubtfulness as to its favorable termination than had been the two previous ones occuring with me in the early years of my practice, and while following that of my allopathic education. Those cases occurring in the malarial climate of Michigan, yielded to the influence of quinine and nitric acid, and why should not this ? I, therefore, prescribed those remedies, together with powered hamamelis. to be snuffed up the nostril, when bleeding. I found her pulse, beating 65, soft and sluggish, some pain in the 34 PURPURA. head, tongue coated with a dirty brown fur through the middle, but moist, with a large blood blister upon the inner side of one cheek, and on numerous parts of her arms and limbs those dark spots, and numerous little red pimples. Also, blood oozing from the gums of the lower front teeth. I also gave a wash of hamamelis for the mouth, with sulphate of quinine, one grain every two hours in alteration with nitric acid, 3x, 10 drops in half tumbler • water. At my next visit I found no material change in symptoms, except that the hamamelis had checked two attacks of nose bleed through the night, and that the blood blister on the cheek had disappeared. Pulse a little stronger and fuller. Ordered the same remedies continued. with free use of lemonade as a drink, and as her appetite was good, permitting her to partake freely of broiled beafsteak. Bowels as usual had moved freely during the morning. At my third visit learned she had had a profuse flow of blood from the nostril during the night, which hamamelis did not check, and, also the oozing from the gums was steady, and from several of these little red spots upon her SYMPTOMS. 35 forehead was oozing a little blood ; pulse SO, and weaker, more darting pains through her chest, and a steady ache all along the spine ; but still she was up and dressed, and enjoyed her food as usual ; evidently the disease was not yielding to the remedies. Omitted the quinine and nitric acid, and gave terebinthina, 6x, with phosphorus 12x, every hour in alternation, through the day, and with tannic acid as a styptic to the nostril. My next visit found an improvement in most of the symptoms as there had been no bleeding, and there was a better appearance of the tongue and mouth with a stronger pulse, and no new spots of ecchymosisupon the skin ; had slept well ; con- tinued the same treatment, My fourth visit, on the 11th, found her with the symptoms of the previous day unclianged, and thereupon ordered a continuance of the same potencies of terebinthina and phosphorus, and tannic acid, when needed. On the 12th was informed that there had been two attacks through the night of "nose bleed," which the application of tannic acid did not control, as it had previously done, and there was another 36 PURPURA. " blood blister" covering nearly one-half of the right side of the tongue ; and from the gums a steady oozing, with a cadaverous odor of breath ; pulse 85 and fluctuating. She also complained of more pain in her back and head, with a great sense of weakness in the morning when she first awoke, almost to faintness, but that left her as soon as she drank a cup of tea, and took nourishment, which she still relished as heartily as ever. Was up and dressed and was as cheerful and pleasant as usual ; bowels still regular in all their functions, and so, too, apparently, were the kidneys. Evidently this case was not disposed to yield to any of the reme. ies I had used thus far, neither to the allopathic nor homoeopathic, and I began to feel uneasy as to its finale. I can find but one single case of the kind reported in any of the medical journals of the homoeopathic school that I possess, and that is the American Homaiopathist, No. 2, Vol. 7, 1881, reported by H. Detwiler, M. D., which yielded apparently to terebinth ina 6x, which in this case failed to produce any effect. The slight references to this disease and its indicated remedies, by Jahr, Raue, Hunt and SYMPTOMS. 37 Marcy, are all so unsatisfactory that I did not feel much confidence in selecting any remedy mentioned by them, and as those I had used failed to respond to my expectations. I resorted again to Jahr's Symptomatology to find a guide. Cro talus horridus having so many of the symptoms in its pathogenesis that were present in this case, I determined to give it a trial, and prescribed the 6th, 10 drops in half tumbler of water, a teaspoonful every hour, with a wash for the mouth of ferri sulph., 10 grains to a pint of water. At my next visit I was satisfied with the apparent effects of my last remedy, as there had been no return of epistaxis and the buccal cavity was free from spots of ecchymosis, and oozing from the gums and also the petechial and ecchymotic eruption had disappeared from the skin ; pulse 80, not much pain in head or back, but still that faintness in the morning till food was taken, and that dizziness upon raising from the pillow or raising from her chair. Had rested and slept comfortably all night with her usual relish for tea, toast and beefsteak for breakfast, and the bad odor of her breath was not so perceptible. And though 38 purpura. I had noticed equal improvement once or twice while using previous remedies, which was soon lost, yet I felt quite sure that I had found the right remedy, and so continued it. She had now been under my treatment eight or nine days, and for the last two under the use of crotalus, which, seemingly, was control- ing her disease. I therefore left her on the 17th of the month, still using the same remedy, but at much longer intervals, and fully per- suaded that she w r ould need no other. Calling upon her again on the 20th was disappointed to learn that she had been troubled almost ever y night since my last call, with more or less epistaxis, though not to any great extent, but sufficient to create uneasiness in my mind, as it told me that the hemorrhagic dyscrasia of her system was still persistent. No more of that petechial eruption had made its appearance, nor was there any perceptible change in any other of the symptoms ; bowels still regular, rest and appetite good, and her spirits as lively and cheerful as ever, but the dizziness persisted, with more or less pain along the spine and through the head. I ordered the medicine, SYMPTOMS. 39 crotalus, to be given every two hours, with a continuance of the mouth wash of ferri sulph. The next day found the pulse 85, no bleeding from nose or gums, but a slight reappearance of the ecchymotic eruption. Ordered ledum 6x, 10 drops in one-half tumbler of water, to be given in alternation with crotalus. On the 22d found her symptoms again better, and made no change in the prescription of crotalus and ledum. The next day, the 24th, I found her about in the same condition that she had been for two days previous, and seem- ing convalescent. Ordering a continuance of the same remedies, but at longer intervals, left her thinking I had finally con- quered her disease. On the evening of the 2oth her father came to me with the report that " Addie was too free with her monthlies, that had come on that day, a week before her time," and asking " what she had better take to check them V ' I sent her viburnum opulus tincture, 20 drops to 4 ounces of water, a teaspoonful every half hour, and if, after the 5th dose there was no change, to give her in addition cinnamon 40 PURPURA. tea to drink of freely. Calling upon her the next morning at 8 o'clock, I was shocked to see the change that had taken place in her appear- ance since my last call on the 24th. Lying in bed, with a face as void of color as was the pillow on which it lay, apparently bloated, eyes sunken and dull, no longer lively, but stupid and drowsy, with pulse beating 130, weak and fluctuating, skin hot and dry, tongue with a dry, black coat, great pain through the head, throbbing in the temples and down the spine, and at intervals, severe uterine pains, with a steady flow of dark blood from it, and gushing at every movement of the body. The hemorrhage had been as copious from its first appearance at 3 o'clock p. m., of the day before as is usually met with in cases of child-birth, and the remedies I had ordered, though us^d faithfully, had not checked its flow in the least. Evidently the first indication was to check that haemorrhage. For that purpose I gave her five drops of erigeron oil, upon sugar, and ordered, it to be repeated every hour till a change or improvement should be seen, and then in drop doses until my return. At 12 M. SYMPTOMS. 41 I saw her again and found the flow had very greatly diminished during the "last two hours, and therefore continued the drop doses of eri- geron at every two hours. Calling at 5 p. m., was satisfied with the action of the remedy and continued it at longer intervals. Pulse 135, temperature high, pain in head, back and hypogastric region, very severe, with great thirst. Ordered aconite 3x, four pellets each hour. She did not take the erigeron. Next morning at eight o'clock saw her again, with symptons more encouraging, pulse down to 90, low x er temperature, less •hemorrhage but tongue still dry and black ; had rested well after twelve o'clock, less headache, with no pain in back or bowels ; had taken nourishment and with some relish. Continued the same treat- ment. At my evening call, at five o'clock, found a return of all the feverish conditions of the day before, but with a diminished flow from the uterus, except when she moved, then it gushed from her, but not so much. I reduced the quantity of the erigeron, and in alternation with aconite gave bryonia, as she was calling for copious draughts of water, and with some 42 PURPURA. pain through the chest. The next morning her fever was lower again, and thus kept up for the next six days the morning remission, with exacerbations in the afternoon and evening. Pulse in the morning always about 90 and up to 130 in the evening. Not having a clinical thermometer I can not give the exact temper- ature, but was sure that it was above 102° at its highest and never in the morning below 100° ; tongue covered with a dark dry coat at all times with a red tip and edges, and after the fifth day with soreness of teeth and gums ; much thirst, torpid bowels and scanty urine, with brick dust sediment. The menorrhagia steadily decreased from day to day, till on the ninth day the fever had subsided under the continued use of rhus 6x and baptisia 2x in alternation, when that entirely ceased and with no return of either nasal haemorrhage or petechial eruption, I flattered myself that my patient was now convalescent again, and with a return of strength would in a short time be fully restored to health. With the subsidence of fever her appetite returned, bowels and kidneys became regular, and for several days SYMPTOMS. 43 she seemed to be regaining her strength as fast as one could, convalescing from such a high grade of fever as hers had been. Only one symptom continued to give me uneasiness and that was her extreme prostration to almost perfect syncope when first waking in the morning, but that would subside immediately upon swallowing a little tea with a mouthful of toast. I watched her closely from day to day, but as no other symptoms except that and a too quick pulse, as high as SO always, and some- times higher, only indicated a want of strength, I did not feel doubtful of overcoming that want, and ordered arsenic 12x, four pellets three times -a day, together with as nourishing a diet of broths, buttered toast, and rich sweet cream as her stomach would bear ; and as that organ seemed perfect! y sound, there was no difficulty in that respect. In a few days more she had so far regained her strength as to enable her to be dressed and moved from her bedroom. Calling upon her on the 12th of June I was disturbed to find again that oozing from the lower gums and on her tongue another ^^^^HHH 44 PURPURA. of those large blood blisters, with other indications of that old hemorrhagic dyscrasia, which I had supposed was entirely subdued and would no longer trouble her. Aside from this, her symptoms were all satisfactory save that continued morning faintness and the quick, soft and fluctuating pulse of 85. She was sitting up fully dressed and with her usual flow of cheerful and happy spirits, with a good appetite and quiet and restful sleep every night. I ordered cro talus to be given in alteration with arsenic. On the 14th I found that oozing from the gums and the blister on her tongue had left her, but the night before she had a slight return of nose bleed, the first in over two weeks ; other symptoms about the same. Continued the same remedies. On the 15th her symptoms were more encouraging, so, also on the 16th and 17th, when upon visiting her in the morning of the latter day found her at the breakfast table enjoying a hearty meal and so apparently out of all danger that, after ordering for her a tonic in the form of fl. ex. hydrastis, 4 drachms and 1 drachm of coca leaves to a pint of water, SYMPTOMS. 45 a tea-spoonful to be taken before each meal, I dismissed the case, as I thought, cured. Soon after I left she complained of a severe headache and retired to her bed. That evening the menstrual how came on again very freely and with great pain along the back and over the hypogastric. Before morning the flow was excessive, and her mother gave her five drops of erigeron oil and repeated it in two hours. I saw her again at eight o'clock on the morning of the 18th and found her in great distress, all through her system, with the nienorrhagia worse than ever. As the erigeron had not checked it, I gave her fifteen drops of fluid extract of ergot, and repeated the dose in one half hour. This checked the discharge. Pulse up to 140 and feeble. Tongue again dry and heavily coated. In the evening I gave muriated tincture of iron, 10 gtts. in half a tumbler of water every thirty minutes, and continued it through the night. On the 19th there was less menorrhagia and less general distress, but great weakness and frequent fainting spells, and at times great nausea. Gave ipecac 5 gtts. in half a tumbler of water 46 PURPURA. and viburnum in alteration. On the 20th an improvement was apparent till evening, when again another spell of nose bleed reduced her very much. On the 21st found her extremely weak and discouraged, the menorrhagia still keeping up but not excessive, her pulse 140 with dry hot skin, tongue dark, dry and trembling, bowels torpid and tender upon pressure, great restless- ness and thirst, but less nausea. Continued the ipecac and viburnum at longer intervals. That night another attack of epistaxis set in and was persistent for several hours. Found her on the morning of the 22d still suffering from the last attack, Avith the pulse still higher and fluttering, with all the symptoms of dissolution increasing rapidly. At this point her parents decided to call in an allopathist and place her in his care, and I was relieved from further attendance upon the case ; and I must confess that I was not very deeply grieved at their decision, though I thought there was still a possibility if not a probability of her ultimate recovery. But she had become discouraged and desired to change, and as I SYMPTOMS. 47 had lost her confidence, it was better for her that some one else should be called in. Under the inspiring influence of hope she rallied for a few days and all were encouraged at the improvement of her symptoms, but they were not lasting and death closed the scene on the 4th of February ; no post-mortem. examination was held." This case is not presented as a good example in therapeutics. It was thus commented upon, editorially, in the issue of the journel in which it flrst appeared. Reviewing the case as it was seen by Dr. Angell on the morning of December 7. there is one remedy which seems to stand out so plainly indicated as to be unmistakable. The temper- ament of the patient, — black hair, dark eyes, clear, pale complexion, vivacious disposition ; the inherited tendency to haemorrhage — resembling her mother in this ; the frequent headaches and the present dizziness ; the menses, as a rule, too early, too profuse, and of too long duration, with colic and pains ; tlie eczema succeeded by blood-boils upon the skin and blood-blisters in the buccal cavity ; 48 PUTCPUKA. the severe haemorrhages from the nose ; and the copious and prolonged bleeding from small wounds — taken together form a vivid picture of Phosphorus. Unfortunately, Dr. Angell, yielding to the influences of his allopathic education, gives not the remedy denoted by the law of similia, but a course of remedies based upon their successful use in other cases, amid other surroundings, and which experience proves to him must have had pathological factors other than the case in hand. A half drachm or more of quinine seems to have been given with negative or perhaps even deleterious influence ; as the case grew steadily worse ; a less amount of the drug has been shown to cause purpuric spots, when given in febrile states (Vepau). Just how much the subsequent intractability of the case may have been due to the secondary effects of the drug cannot now be determined. Phosphorous 12, on the lOthinst., was a good prescription, only it was days too late ; but what can we say of the turpentine ? A careful study of the pathogenesis of terebinth ina SYMPTOMS. 49 fails to reveal a single indication for it in this case. There are cases of purpura in which it does good. Prof. Comstock, of St. Louis, has reported such an one in the North American Journal of Homoeopathy, 1861, and this is reproduced on another page. The action of turpentine upon the blood is just the reverse of phosphorus, crotalus and lachesis. In physi- ological doses it increases the coagulability of the blood, while all the indications in this case point to a morbid fluidity of the blood ; tur- pentine was, therefore, homceopathically, contra-indicated. In large doses it might have done some good ; but the sixth decimal !— was merely playing with fire. In a case of purpura with disordered digestion, tympanites, hema- turia, dryness and burning of the mucous membranes, headache with flushed face and violent thirst, emaciation with dropsy, terebin- thina, in one of the higher potencies, would doubtless prove curative. The improvement which seems to have set in as the result of phosphorus 12, did not continue long, and we can only conjecture why. Cer- tainly if the turpentine and the tannic acid 50 PURPURA. had any influence, it was merely as antidotal to the therapeutic power of phosphorus. Cro talus is a valuable remedy in purpura. Dr. J. W. Hayward has given two cases cured by it ; they will be found under that rubric; and t-he pathogenesis of the drug seems to ally it more closely to this disorder than any other drug in the materia medica. The mental con- dition of this patient was, however, very unlike crotalus. • The crotalus patient is anxious, agitated, stupid, and struggles with mental delusions and hallucinations ; but we have here a girl who is bright and happy — u as cheerful as ever " —although having daily the most depleting haemorrhages. Phosphorus has de- pression and irritability, but it also has joyful- ness, serenity, ready flow of (pleasing) ideas, thoughtfulness, vivacity and impetuosity. In lung disorders how often do we see mental and cesses for which phosphorous is the efficient spiritual elevation associated with morbid pro- remedy. Next to phosphorus, crotalus did seem well indicated, but we opine a grave mistake was made in changing from the former ; perhaps a SYMPTOMS. 51 change of potency was required to develop more fully the power of the remedy that had done good. But if crotalus was a proper choice, wherefore ledum ? We are afraid our doctor was just about an inch or two off his base. For now followed in quick succession viburnum, cinnamon, erigeron, aconite, bryonia, also at short intervals thereafter, rhus, baptisia, ar- senic, hydrastis, coco, then a return to erigeron, ergot, tincture of iron, ipecac, and then — anew doctor. The angel Gabriel couldn't have saved the case now, not to say anything about an Iowa Falls Angell. We can sympathize with and appreciate the doctor in his floundering about, for we have done considerable floundering about ourselves, with perhaps less excuse for our blundering ; but there is one hard-headed fact which experience has taught us, that in desperate cases unless we have the intuition to seize upon the pivotal symptom and apply the right remedy first^odi help the patient, for the doctor won 1 1 ! YAEIETIES. The differences existing between cases of purpura are due to individual idiocy ncrasy, 52 PURPURA. and to complicating influences. For purposes of study cases are assorted into varieties, the principal of which are simplex, hemorrhagica, and rheumatica, but these have merely a clinical import, just as we speak of mild and malignant types of scarlet fever, measles, or other exanthemata.* Purpura Simplex. — The mildest form of this disorder is that seen in persons past the middle term of life, whence it is sometimes called purpura senilis. It appears principally upon the thighs, legs, and forearm, in the form of small, round, bright-red spots. These are due to degeneration of the tissues, and may occur spontaneously, or as the result of pressure, undue exertion, or any influence which throws an unusual stress upon any portion of the cutaneous capillary system. Where it occurs spontaneously, the spots are rarely of any considerable size, and generally come in crops, a new set appearing as the former fades. When it develops in the predisposed from slight traumatism, the blotches are irregular in form and of larger size. Bateman relates a case in which theie was no VARIETIES. 53 constitutional disturbance, but in which " a constant series of these ecchymoses had appeared for a space of ten years. 3 ' In most of these patients the purpura is modified, and in some cases entirely vanishes, whenever the patient maintains for a few days, a recumbent position ; and indeed in all cases recumbency is advantageous, and in severe ones essential to a cure. This would seem to indicate that cardiac debility has something to do with this disorder, as a predisposing influence, as suggested by Buhl. In individuals of more robust constitution the ecchymoses may be preceded for a few days by lassitude, pain in the head and aching of the limbs ; but these concomitants are by no means constant factors. Where the only symptom noted is the mottling of the skin, this can be proven to be extra-vascular, and therefore hsemorrhagic, by the fact that it does not change color under pressure. Each spot, after remaining livid for about a week, gradually changes to bluish, greenish, and saffron tint, grows indistinct, and in another week is gone ; this opalescence is due to the slow 54 P U ?v P U R A . metamorphosis of the hsematin retained within the interspaces of the cutaneous structure. Purpura IlamorrJiagica. — The hemorrha- gic variety— called also Morbus Maculosus Werlhofii — is more likely to be preceded by I)remonitory symptoms than the one already discussed. These may come in the form of per- sistent or frequently recurring hemorrhages, such as nose-bleed, or bleeding from the gums ; or as bone-pains ; or as a subtle but pervasive langour. So far as the skin is concerned the manifestations of the disorder do not differ from those observed in the simple variety, save that they are more severe. The term hemorr- hagica is only applied when bleeding is a prom- inent factor in the case. This maybe from the skin itself, or from any of the mucous surfaces. The most common form is nose-bleed. The amount of blood-loss at any one time may be inconsiderable, but by long continuance the system be very much weakened, and vital power undermined. Bleeding from the gums is a frequent symptom, but not so characteristic as in scurvy. If the gums (in the cases where these bleed) be examined they will be found to V A RIETIES. 55 be covered with blackish scabs, beneath which the mucous membrane is pale and not swollen ; in scurvy the gums are swollen and spongy. In hemorrhagic purpura patches of extravasa- tion will be found upon free mucous surfaces, as oh the roof of the mouth, on the inside of the cheek, beneath the tongue, or in the pharynx ; or these may take the form of blood- blisters, which bursting break down in ulcera- tion. Hsematemasis is a much less frequent form of bleeding, though when it does occur is apt to be profuse and exhausting ; the diges- tion of aliment is interfered with, or altogether prevented, by the irritated state of the gastric mucous membrane. Bleeding from the bowels (melaena) is still more rare, and is not especial- ly significant except when associated with copious haemorrhage from other parts. Hema- turia is a very frequent complication, and is probably met with in more cases occurring in males than any other single hemorrhage save epistaxis. The blood may come from the bladder, the ureters, or the pelvis of the kid- ney ; generally the latter. Menorrhagia and metorrhagia are more common in women than 56 PU R P IT E A . hematuria. Haemorrhage into the conjunctiva is not uncommon. Bleeding from the ears oc- curs occasionally. Haemoptysis is rare. Blood is sometimes extravasated into the muscular tissue, into the parenchyma of the viscera, and death has occurred from cerebral and pulmon- ary apoplexia. At the beginning of the attack there is usually no fever, but if the disorder continues, and the patient is weakened by blood-loss, hec- tic is apt to supervene. The bodily tempera- ture may be normal in the morning, but rises in the evening to the neighborhood of 100 q Fahr. The pulse is usually weak, but quick- ened beyond the normal rate ; it may be inter- mittent ; in some cases arterial tension is sub- normal, with slowness in the rate. There is usually depression, both moral and physical, lie feels low-spirited and melancholic, with great lassitude and debility. Fainting or even syncope are not uncommon. As the disease progresses, anaemia becomes more and more manifest. The countenance becomes blanched ; the mucous membranes grow pale and blood- less ; the breathing, asthmatic and difficult ; VARIETIES. 57 the extremities, oedamatous ; there is a venous hum in the neck, tinnitus annum, and every sign of approaching dissolution. If the prima via is not invaded by the ecchy- moses, the digestive functions may remain quite unaffected. In other cases there is nausea and vomiting, epigastric pain and diarrhoea. Congestion in the various viscera may cause pains in the abdomen, chest, or back. Bright's disease is sometimes consecu- tive to purpura, although in some cases albu- minuria precedes the development of the cu taneous phenomena. Par pur a Rheumatica. — Many cases, espec- ially in children, are preceded or accompanied by pains in the joints, which simulate rheuma- tism ; these are also called pelosis rheumatica. Such a case usually begins with severe pain in a joint, with or without effusion. This lasts for several days, when numerous petechial spots appear about the affected joint, while the other parts of the body are entirely free, or pre- sent but a few isolated patches. The ecchymosed spots are slightly elevated, from the diffusion of coagulated fibrin, and are surrounded by a 58 P U R P IT R A . delicate halo. Not only the joints are swollen and painful, but also the long bones, the dor- sum of the hands and the sole of the feet are tender on pressure, so that the use of the extremi- ties, and especially walking, is painful and difficult. In many cases the pains alternate with the purpuric appearances ; as one grows more pronounced the other disappears, and this alternating of symptoms may go on for weeks or months. Albuminuria is often pres- ent, but not always. Occasionally the pur- puric patches, which in the so-called rheumatic variety are almost invariably round, are asso- ciated with vesicles containing bloody fluid, or with wheal like efflorescences resembling ery- thema nodosum. That these cases are not pri- marily rheumatic is demonstrable. The occur- rence of the joint-pains may be due to the presence of purpuric extravasations in the syn- ovial membranes, analogous to those which have been found in serous tissues elsewhere. Some of these cases assume an annual type, recurring each year at the same season. Henoch has observed a peculiar form of this variety of purpura, in which vomiting, intesti- VARIETIES. 59 nal haemorrhage, and colic, are also present. Here are three of his cases : 1. A. boy, aged fifteen ; gastro- duodenal catarrh, with slight jaundice in consequence of indigestion. A few days later, pains in the joints of the fingers ; a few days afterwards, purpura upon the thighs, with colic, vomiting, and black stools. At times the colic was ex- tremely severe ; region of transverse colon ten- der and distended. Moderate fever. Disap- pearance of the symptoms in five days, but a relapse at the end of three days ; convalescence in a week. Three relapses in the next few weeks, always attended with bloody stools. Finally, complete recovery. 2. A boy, aged four ; suffering from colic, tenesmus, and scanty, bloody stools. At the same time large patches of purpura on the elbows and thighs. Improvement in three days, but new patches on scrotum and pre- puce. A few days later another attack of diarrhoea, with streaks of blood and severe colic, then constipation and fresh exacerbation of purpura. Entire duration three weeks. 3. A healthy girl, aged twelve ; for a week 60 PURPURA. rheumatic pains in the limbs, followed by ten- derness and swelling of the wrist and ankle- joints, with slight fever : heart intact. A few days later purpura on the abdomen and lower extremities ; very severe colic, repeated vomit- ing, and bloody diarrhoea. Disappearance of the symptoms in five days. Four relapses within a month ; finally, complete recovery. Purpura sometimes supervenes on other skin affections, whence arise the types which are called pur par a urticans, purpura papulosa, and so on. Ollivier mentions a somewhat anomalous type in which large ecchymoses appeared in successive crops, associated with general oedema and severe enteritis. The Irish purpuric disease described by Lin- gen, in the British Medical Journal, 1867, ap- pears to have been a contagious disorder, and consequently not allied to the one here con- sidered. DIAGNOSIS. The diagnosis of purpura is comparatively easy, although there are several disorders with which it might be confounded. It may be dis- DIAGNOSIS. 61 tinguished from the /uejiorrhagic diathesisbj the fact, that in this latter the blood escapes from a contusion, wound or ulcer, and is nota- ble for the profusion of the loss without visible adequate cause ; while in purpura the tendency is toward numerous spots of extravasation on all parts of the cutaneous and mucous surfaces. The hemorrhagic diathesis is usually an here- ditary tendency and shows itself in early life ; on the other hand, purpura is never a family trait, and is peculiarly a disorder of the mid- dle-aged and senile. Purpura is more likely to be mistaken for scurvy, but in this latter disorder the gums are spongy and sore, the joints stiffened, the limbs swollen and painful, and the complexion pale and sallow ; while in purpura very often there is an abscence of any obvious signs of ill- health. Scurvy is always caused by a lack of fresh vegetables in the daily allowance of food, and is not likely to occur singly ; neither of these propositions are true of purpura. A fresh vegetable diet at once begins an improvement iu the scorbutic patient and prevents the ap- pearance of new hemorrhagic spots, but diet has 'no suchjrindly influence over purpura. 62 P U R P U R A . Purpura can be easily differentiated from hemorrhagic measles by the coryza and bron- chitis of the latter ; from ty pitas by the history of the case, the cerebral complications, and the insignificant size of the spots and their even distribution over the body ; from the ecchy- moses of traumatism by the local character and larger size of the spot in the latter ; from flea-bites, which in unhealthy persons often maintain their petechial character even for weeks, from their uniformity of size and ap- pearance, and the presence of the minute point of puncture in the center of the petechia ; and from non-luemorrhagic eruptions by not fading under pressure. PROGNOSIS. Purpura is a malignant disorder. Mild cases usually recover, but relapses are frequent, and when associated with haemorrhage^ generally fatal ; death occurring from the consecutive haemorrhage, or from the debility resulting therefrom ; or, occasionally, from pulmonary or cerebral apoplexia. The extravasated blood, when not quickly absorbed, acts upon the tissues as an irritant, excites inflammation, or leads on TREATMENT. 63 to gangrene. Death may result either from the debility thus induced, or from #py rem ia. TREATMENT. The general rules governing the selection of the appropriate remedy apply in purpura as in all other disorders of the human economy. Although I have endeavored to bring together, for easy comparison, all those drugs which are known to possess relationship to ecchymoses, 'it is quite possible that in any given case the practitioner will need to go outside of even this rather formidable list for the remedy homoeo- pathic to the case. There is, of course, no such thing as a remedy for purpura. It is obvious that what will speedily cure one case will have no in- fluence over another; and that here, as elsewhere, success can only come through the careful col- lating of all the symptoms of the case, and ap- plying thereto the remedy selected according to the method of Hahnemann, wdiatever it may be, or how far it may carry us outside of pre- conceived notions of the appropriate. In treating these cases due regard must be had ta the circumstances of the patient ante- 64 PTT'KPIJRA. cedent to the attack. IT the diet has been un- suitable, or deficient in any nutritive element, this must be corrected. While the proper amount and quality of the food to be ad ministered to the patient can only be deter- mined after all the factors of the case are known, a well-regulated diet, as a rule, is made up of a due proportion of animal and vegetable food, to which may be added at dinner a glass of sound claret, tokay, or Speer 1 sport, according to the taste of the patient, or the judgment of the physician ; but it must not be overlooked that in some cases, even a small quantity of alcohol does harm. Where the debility is very great, a milk diet may be the most advanta- geous. For many cases, this may be improved by adding a level spoonful of Beef Peptonoids to each goblet of milk. A preparation has recently been put upon the market, a dry pow- der extract of malt, which combines nicely with milk, soups, and liquid foods in general, and adds to their palatableness and nutritive quali- ties. The aim must be to more than make up, by easily assimilated foods, for the blood loss, in order that the patient may re-act from the debilitating tendencies of the complaint. TREATMENT. 65 Rest is another important factor in the treat- ment of these cases ; so much so, that even in simple purpura it will be sometimes impossible to effect a cure unless the patient maintain a recumbent position. A case may apparently completely recover, but as soon as the patient goes about again the spots immediately return. This is a frequent cause of relapse. Local measures are not often required, even when the haemorrhage is severe. The appro- priate remedy will control this, and all other untoward symptoms. Still where there is great loss of blood, pressure, the tampon, or cold applications may be resorted to as tem- porary expedients. When the ecchymoses are principally upon the extremities, careful band- aging of the limb may be found useful. Ther3 is one very important point in the treatment of purpura which cannot be too strongly enforced — the prevention of bruising or any form of traumatism. Even in the sim- plest cases the greatest care is desirable to prevent abrasion of the skin or mucous sur- faces, or rupture of superficial blood-vessels, or the hemorrhagic character of the disease 66 PURPURA. will be made manifest. The venerable Dr. A. E. Small, of Chicago, has related to me the following cases, which should serve as a warn- ing to every practitioner : A child, apparently robust and playful, aged ten months, was brought to him by its mother, with a request for him to lance its gums, in or- der to hasten the process of dentition. He observed a few ecchymosed spots upon the lower extremities, and declined acceding to the mother' s request. She took the child to another physician, who applied the lancet. A pro- fuse and persistent haemorrhage ensued, and in ^spite of all that could be done to avert it, the child bled to death. In another case which came under his observation, a gentleman of feeble constitution complained of great de- bility and soreness, in spots, about the llesln^ portion of the upper and lower extremities. On the surface of these sub-cutaneous sore spots there was a purplish hue, which looked suspicious. He at the same time appeared to suffer from a caries tooth, which contrary to advice he had extracted. A hemorrhage from the gums set in, and with great difficulty it was T E E A T M E 1ST T . 67 arrested, after two or three'weeks styptic treat- ment. Feeling convinced that the whole sys- tem was suffering from the hemorrhagic dia- thesis, it was obvious enough that this condi- tion must be changed before the effect would cease ; and appropriate medication having been administered to this end, the patient fully recovered. There had been no previous disease that could possibly generate the diathesis ; it had sprung up spontaneously. THE REMEDIES AND THEIR INDICA- TIONS. CROTALUS. Skin. — Ecchymoses. Purpura hemorrhagica. Petechise. 1. Patches of ecchymoses in the course of the small blood-vessels, like the foliage on the branches of a tree. The poison had a marked effect in producing extravasations of blood. [From application of the dilute venom to the mesentery of a cat. Brustto^t and Fayrer; Proceedings Royal Society, vol. xxiii. page 270, 1875], 2. After nine days the fever abated, and he began to mend ; but his hand and arm was spotted like a snake, and continued so all sum- mer. In the autumn his arm swelled, gathered, and burst ; and then away went the poison, spots and all. [After a bite on the hand in February. J. Briejntal ; Lond. Philosophi- cal Transactions, vol. ix, page 229]. 3. The child soon after being bitten became disfigured by yellow and dark-colored spots on the skin. These symptoms disappeared in the 70 CRO TALUS. winter ; but at the return of the same period of the year they reappeared ; the hands and feet swelled, and the child died. [Constat- tine Hering ; Symptom 3312]. 4. Annually after the bite, at the same time of the year, the pains, swelling and fever re - turned, with blue and yellow spots on the body. [Schcepf, quoted by C. Heking; Symp- tom 3313]. 5. Face discolored ; blood issued from nose, eyes, and ears, and from stomach in the vomit. [Spix, quoted by C. Hering ; Symptom 2656]. 6. Thirty-six hours after a bite on the leg the whole side up to the arm became black with the effused blood, so much so that those who saw him observed that he looked like the snake that had bitten him. [A. Gr. Miller ; Boston Medical and Surgical Journal, 1833, vol. viii, page 240]. 7. A good deal of subcutaneous, submuscu- lar, and intermuscular sanguineous extravasa- tion, of a dark-purple color, in neighborhood of bite. [Post-mortem, shortly after death from bite on back of neck. Sieveking ; Medical Times and Gazette, vol. v, page 130]. Concomitants. — Purpura, especially on the lower extremities, and in debilitated states of the system, and in broken-down constitutions, such as exists in chronic alcoholism. CONGO 31 IT ANT SYMPTOMS. 71 General soreness. Easily tired by slight exertion. Tremulous weakness, as from impending evil. Faintness. Drowsy, but cannot sleep ; generally feels worse after sleep. Sadness and melancholy. The pulse is sluggish, feeble, thread-like, w r eak, wavy, trembling, and scarcely percepti- ble. Debility of the heart. A feeling as if the heart tumbled over. Bleeding from the anus and the other open- ings of the body. Coldness and insensibility of the skin. Skin usually dry and cold. Skin like thin parchment. Skin, except where discolored, of a leaden, pallid appearance. Oozing of blood from the pores of the skin. Relationships. — The action of crotalus is very similar to lachesis, naja, elaps, and other venoms, and the distinctions between them are mainly relative. Dr. Fayrer draws the following comparison* : " In all cases where *On the Nature and Physiological Action of Crotalus venom, as compared with that of Naja Tripudians and other Indian venomous snakes. 72 CROTALUS. the blood forms a firm coagulum after death, the poison is of a coluber ; and in all cases where it remains perfectly fluid it is of a viper. We may take the naja tripudians as heading the scale of those poisons whose action upon the blood produces a coagulum, and the crota- lus as the synonym for the opposite class, whose action on the blood produces permanent fluidity. It is probable that the action of all the snake poisons ranges between those two ex- tremes." Naja has more nervous phenomena, and cro- talus more tendency to slough than any of the other venoms. Lachesis has a cold and clam- my skin, while that of crotalus is cold and dry. Those who survive the bite of the crota- lus suffer more permanently than from any other snake-poison. The chronic effects of crotalus are more apt to develop on the right side of the body, and those of lachesis on the left. Crotalus acts more intensely on stout people than on lean, and on white persons than on negroes. Comments. — The crotalus hemorrhage is evidently due to disorganization of the blood, and is not a mere topical effect. The discolora- tion produced by this haemorrhage varies from black through all the shades of greenish, blue- ish, yellow and mottled, the same as is seen in COMMENTS. 73 the successive stages of purpura. After death, in chronic cases of poisoning, tissues and structures at a considerable distance from the original wound are frequently found thorough- ly infiltrated with decomposed blood, and in a state of gangrene. The blood is fluid, dark in color, and not co- aguable, and appears to leak through the vas- cular walls and escape into the surrounding tissues, or effuse from the surface of the mucous membranes, or into the serous sacs en- closed by the pleura, pericardium, or perito- neum, as if the blood-vessels had no power to retain within them the circulating fluid ; as if the entire system was in a state of dissolu- tion. The liver is enlarged and lardaceous ; the kidneys are granular ; and in fact the whole organization is permeated with the effects of the venom. In purpuric cases of the zymotic diseases crotalus is perhaps the most generally and the most frequently indicated remedy yet discov- ered (Haywaed). Clinical, — The following cases are reported by Pr. J. W. Hay ward, of Liverpool, Eng.: 1. Mr. L., aged 62, a bachelor, of rather ir- regular habits, especially as to alcohol, and living in a very isolated way with an old mother ; after having been in a weak and low 74 CROTALUS. condition for some time, noticed small purple spots appearing on his legs ; and very soon both legs, from the knees to the ankles, became cov- ered with ecchymoses ; there was also some bleeding with his stools, and his general circu- lation was very languid. Crotalus 6 was or- dered four times a day, and some out-of-door exercise. All the ecchymoses had disappeared, his stools were free from blood, and he was in a much better state of health within four weeks. 2. Mr. B., aged 48, who had lived freely in youth and had syphilis. From 24 years of age to 35 he suffered on and off with hematemesis and mel^ena, followed by general debility and weak heart with chronic rheumatism, head- ache, constipation, attacks of vertigo, jaundice, etc., and when about 44 he became invalided, and suffered much with dizziness, fainting and irregular action of the heart ; and pete- chia now broke out over the whole body, especially the lower extremities. Several rem- edies were used, but he benfitted most under mercury, kali, phosphorus, and crotalus. It was whilst taking crotalus 6 that his petechia disappeared, and he made most progress. He made a good recovery ; and is now, at 52, in fairly good health. The following cases were furnished to me by Dr. W. J. Clary, of Chicago : C L O I C A L CASES. 75 3. This patient was a young lady aet. 19 years, of consumptive habit. This case had red spots in the eyes, some in the mouth, a few on the chest, arms and hands. She spat small clots from the mouth, frequencly. Having never seen a case of the kind I did not f ully comprehend the condition. Two days later I was called in haste to see her on account of a severe haemorrhage from the bowels. The dis- charge of blood had increased in the mouth, also the number of spots on the surface of the body. When I arrived she had passed about six quarts of fluid from the bowels, consisting of bloody water and soft broken clots. I gave crotalus, as it seemed to be the only remedy indicated by the symptom : Haemorrhage from every orifice of the body. I gave the 6th dilu- tion in water, a dose every two hours. The next .day the symptoms were so much improved that but little doubt of recovery re- mained. The haemorrhage from the bowels had ceased, less blood in the mouth, spots were fading. Improvement continued steadily until the eighth day the patient was discharged. There was no return of the symptoms. Shortly afterwards the patient passed out of . my hands to be treated by a person who promised to surely cure her of consump- tion. She died in about six months. A 76 CEOTALUS. friend of the family remarked to me about the time of the treatment of the young lady for purpura that she acted just like two cases he had seen die from rattlesnake bite. 4. The second case was a girl aged 11 years, who appeared as though she had been severely bruised on various parts of the body, especially on the face, arms and chest. Some of suggil- lations were as large as the palm of my hand. There was some swelling where the suggilla- tions appeared. No red spots appeared. I gave cro talus 6 every four hours. All ap- pearance of the disease vanished in ten days. 5. The third case, a girl set. 7. was taken sick, and as nothing serious was apprehended no physician was called until haemorrhage oc- curred from the bowels. I found the patient pale and weak, with slight fever. The charac- teristic red spots appeared, mostly on the upper part of the body. I gave . crotalus 6 about one week. The patient appeared to be fully re- covered and was discharged. A few days after I w T as called again, as the disease had returned. I found her with violent fever, unconscious and very restless, pulse frequent and tense. I gave arsenicum. The patient died in less than two hours in a spasm. 6. The fourth case was a girl aged 13, who CLIJSTICAL CASES. 77 was attacked suddenly with violent fever and pain in the head. I gave aconite and bella- donna, and ordered bathing and cool applica- tions to the head to allay the great heat from the fever. During the night, near morning, she had profuse haemorrhage from the bowels. For this condition an allopathic physician was called. He told the parents that there was no chance for the patient to recover. I gave a fa- vorable prognosis and treated the case. I gave crotalus 6 a dose every U\o hours, with orders to lengthen the intervals if she improved. After a few hours the haemorrhage ceased, to return no more. Improvement was rapid, and in a few days I discharged the patient. The spots in the eyes and mouth, and on the face, arms and chest, were present at my second visit or immediately on the occurrence of the haemorrhage. PHOSPHORUS. Skin. — Ecchymoses. Petechia. Gangrenous patches. 1. Red patches upon the arms. Insensibility of the skin of the extremities. Ecchymoses on the costal pleura. Ecchymoses on the peri- toneum with bloody serum in its cavity. The spleen enlarged, softened, and with ecchy- moses under its serous coat. Ecchymoses on 78 PHOSPHORUS. the mucous membrane of the bladder. Sub peritoneal ecchymoses on the uterus and its appendages, and also between the laminae of the mesenterjr. [Post-mortem on Maria Le- blanc, who on the evening of June 5, 1856, six hours after eating, swallowed the combustible matter of a box of matches dissolved in a cup of coffee. Died on 15th inst. Prof. Leudet. Archives Generate de Medicin, March, 1857, This case, says W. H. Holcombe, M. D., North American Journal of Homceopathy, vol. vii, page 140, remarkably illustrates the power of phosphorus to produce those blood- metamorphoses or those modifications of the ca- pillary system, perhaps both at once, which result in haemorrhages, either by ecchymoses into the tissues, or by exudations into the cavi- ties. Orfila, in his treatise on Toxicology, says that the petechial eruptions of phosphorus are red, while those of arsenic are black or blue]. 2. The skin was yellow ; the subcutaneous veins of the abdomen and the upper part of the thighs were protuberant and arborescent ; the scrotum was completely covered with ecchymoses. About the cardiac and pyloric orifices there were black, or rather marbled, spots, which were genuine ecchymoses. [Poi- soning by ten centigrammes of phosphorus, dissolved in hot water. Died six days subse- PATHOGEKESY. 79 quently. Orfila ; Treatise on Toxicology. Report of Dr. Woebe]. 3. The cutaneous surface exhibited numer- ous patches of livid discoloration. There were numerous extravasations on the pleura, mesen- tery, and other tissues. [Grirl of 13, who took an unknown quantity of phosphorus paste. British Journal of Homoeopathy. Vol. xxi, page 460]. 4. The lungs showed many patches of blood extravasation ; the sub-pleural cellular tissue had numerous ecchymoses, and the cellular tissue of the mediastinum presented the same appearances ; in the pleura was bloody serum ; the sub-peritoneal cellular tissue presented patches of ecchymoses ; the mucous membrane of the pelvis of the kidney was covered with spots of ecchymoses. [Soldier, aged 21, who in order to commit suicide took the ends of six ordinary packets of phosphorus matches. American Journal of Medical Sciences , Jan- uary, 1858.] 5. Very large ecchymoses of extravasated blood under the serous membrane of the lungs, both costal and visceral ; the lungs presented here and there small ecchymoses ; the pericar- dium and endocardium also exhibited ecchy- mosed spots ; and there were small ecchymoses 80 PHOSPHORUS. in the substance of the liver. [A case of sui- cide accomplished by swallowing the inflam- mable material of four boxes of lucifer- matches, scraped off into a wine-glass full of brandy. Prof. Leitdet ; Archives Generate de Medicin, March, 1857]. 6. The mucous membrane of the larynx and trachea were covered with patches of ecchy- moses, as was also the pleura ; beneath the cap- sule of Glisson there were numerous spots like petechia, and extravasations under the an- terior surface of the capsule of the kidney. [Augustus K., aged 30, March 14, 1865, put the ends of eight packs of phosphorus matches into a glass of hot water, let them lie a quarter of an hour, and drank about three-quarters of the so- lution. Dr. Vo^Pastatt, Breslau. Virchow's Archives, xxxiv, 3]. 7. Erythematous and hemorrhagic patches occur in the skin with a gOod deal of irritation and hyperesthesia ; this hemorrhagic infiltra- tion of the skin is accompanied by similar patches in the serous membranes and other tissues : ecchymoses and gangrenous spots are found in the intestinal tract. [Constitutional effects of poisonous doses of phosphorus. Chas. D. F. Phillips, Materia Medica and Therapeutics. Vol. I, pages 38 and 41]. PATHOGEIESY. 81 8. The eccliymoses occur in all parts of the body, but are apt to be especially pronounced in the mediastinum and the serous membranes. [H. C. Wood, Treatise on Therapeutics, 1883,. page 112]. 9. It has been found that in dogs, after death from phosphorus, the blood does not pass into the veins, but remains in the arteries ; showing that the capillaries are occluded, impervious, or disorganized. [Prof. Schiff, Archives fur Exper. Path, und Ther. Bd. I, page 347]. 10. About thirty little red specks not quite as large as the head of a pin, upon the anterior part of the back of the left hand and upon the fingers of the same hand, especially the third and fourth, as if the blood had settled under the skin, without sensation, coming out at 10 A. M., and lasting all day. [Observation of Dr. B. FrsrcKE, from a dose of phosphorus, 80 m.] Concomitants. — Sadness recurring regularly at twilight. Great timidity associated with a sense of ex- treme fatigue. Oversensitive ro external impressions : light, odors, noises, contact. Aversion to coition, or irresistible desire. Difficulty of falling asleep ; followed by frightful dreams. 82 PHOSPHORUS. Sensation of weakness and emptiness in the abdomen. Great longing for acids and spicy things. Constipation ; the foeces being slender, long, narrow, dry, tough, and hard like a dog's; voided with great difficulty. Hemorrhoids, burn like fire and bleed pro- fusely. Glycosuria. Albuminuria. Palpitation of the heart, even while sitting. Remarkable paleness of the skin and mucous membranes. Lips and eyelids cedematous. Nose-bleed and other haemorrhages. Slight wounds bleed easily. Ataxic symptoms with cardiac and respira- tory derangements. Aggravations. — Changes in the weather and emotional excitement are apt to have a de- pressing influence on the phosphorus patient. Relationships. — Phosphorus is best suited to elderly persons, rather than to children, unless these have grown rapidly ; to fair com- plexioned persons of sensitive disposition and quick perceptions. Comments. — Phosphorus may be useful in purpura hemorrhagica caused by blood- COMMENTS. 83 changes or by fatty degeneration. In a case of phosphorus poisoning observed by Fried- richs an exanthema of an exquisitely hemorr- hagic character, on the lower extremities, was associated with an unmistakable change in the character of the blood-disks. Very few of these were normal in form or size. Many of them were oblong and were compressed as from ligatures ; this process continuing until they were actually divided into two uneven parts, and this went on until, finally, blood-disks of very minute diameter were formed. This de- composition of the blood was very evident, even on the most cursory examination, as it became very dark in color and lost all power of coagulation. Phosphorus sets up an acute fatty degenera. tion in every part of the body, and this causes a suspension of the functions of the liver and kidneys. Some similar change is present in the capillaries in cases of purpura. In that recorded by Dr. William Fox in the British and Foreign Medical and Chlrurglcal Re- ritw, October, I860, he states that u sections of the skin near, but not in the parts affected with hemorrhagic extravasations, gave either with Schnitzels solution (chloride of zinc and iodine) or with iodine alone, or iodine and sulphuric acid, a most intense reddish-browm, 84 PHOSPHORUS. in portions between the fat, besides corres- ponding to the course of the capillaries. This colorization did not pass much into the papil- lae. The color, with Schultze's reagent was somewhat evanescent ; but that with iodine lasted from forty-eight to seventy-two hours, and in some preparations the marking out of the capillaries was beautifully affected in this manner. This change was not constantly met with in all portions of the skin tested ; but was best marked in portions taken in close prox- imity to the affected spots. In some of these parts, in which I succeeded in isolating por- tions of the capillaries and smaller arteries, I found that they broke up very easily, that some presented a peculiar glistening, waxy look, while others had a non-granular appear- ance, in no degree corresponding to the ap- pearances observed in health." Phosphorus produces almost identical changes in the mu- cous and serous tissues, and to a less degree in the skin, and will prove of especial usefulness w T here the internal evidences of the disease, as shown by haemorrhages from the nose, gums, kidney, or rectum, are more pronounced than the extravasations into the cutaneons tissue. Clinical. — The following case is reported by Dr. C. W. Boyce in the American Homoe- opathic Review, for June, 1865, page 566. CLINICAL CASES. 85 1. Gertrude Clark, aged seven, was a perfectly liealthy child, who had never been sick since she was born until the present disease. About March 12, I860, the pillow on which she had slept at night would be found, in the morning, somewhat stained with blood. After a few days she began to spit bloody saliva, and on examination, March 17, she was found to have small spots of extravasated blood all over the body. When she had • the least hurt there would immediately follow a large spot in the vicinity, which would be quite black from the extravasated blood. Any little scratch bled profusely and continuously. The accidental scratch of a pin would bleed so as to saturate cloth after cloth. Little red points appeared on the tongue and on the whole buccal cavity, and these oozed continuously. Blood settled beneath the conjunctiva, and the eyes ap- peared entirely " bloodshot." The breath became peculiarly offensive. The discharge from the mouth of bloody saliva was filled with shreds of decomposed and disorganized blood. The pulse was regular but quick. The appe- tite was good and she slept well. She was inclined to play and only became exhausted after considerable exertion. She had been en- tirely well before, for all that her parents had seen, and, but for the blood, they would not 86 PHOSPHORUS.- have at first known that anything was the mat- ter. This was the condition on March 17. It had been five or six days coming on. The ap- pearance was frightful ; even ordinary hand- ling would leave the marks of the fingers, as though a powerful blow had been struck on the child, and these spots were inclined to extend indefinitely. A slight knock from a doll baby's head near the eye involved the whole eye and its surroundings in a black un- sightly spot. All the secretions were bloody. On investigating the case, several remedies presented claims for use, but Hahnemann's great characteristic indication for phosphorus, "small wounds bleed much," led to the inves- tigation of this remedy ; that and the following symptoms were found to correspond : Small wounds bleed much. The gums bleed from small causes. Much bleeding from the nose from exertion, and especially when straining at stool. Blows much blood from the nose. Swelled and easily bleeding gums. The saliva is bloody mucus. Great discharge of blood from rectum at stool. Expectoration of bloody mucus. Extravasation of blood from all the tissues. Vicarious haemorrhages. CLINICAL CASES. 87 So many of the symptoms were found in phosphorus that it was given in the case March 18. Up to this time the hemorrhagic condition had grown rapidly worse. So very weak had she become that she tottered when attempting to walk, and she was obliged to sit down. For twenty-four hours after the phos- phorus was given there was no change in the condition. This dose held the case exactly the same. March 19. Phosphorus was again given. Immediately the disease began to diminish, and the blood disappeared as it had appeared. Thus two doses of phosphorus 200 cured this really dangerous disease. The subjoined two cases are from an article by Dr. William Arnold, of Heidelberg, in the Ho I a. VierteljahrscJirift) Vol. v., page 167. 2. The son of cooper Q. was attacked with purpura in August, 1852, having been ailing for several days previously. I had seen him eight days before, and found him a lively, strong, well-nourished boy of good appearance, with no sign of any scrofulous or other diathesis ; but whose appearance showed that he was ac- customed to spend the greater part of the day in the open air. Xo cause could be assigned, except that in the warm days previous to his 88 PHOSPHORUS. attack he had been a good part of the time playing in the river, and should we wish to assign this as the cause, it is strange that none of his companions, among whom were several weakly ones, were similarly affected. When 1 saw the patient for the first time, he was in bed, complained of weakness, and was covered with reddish spots and stripes, being most numerous on parts covered usually by the clothes. Face and hands were free. Frequent epistaxis, occasionally some bleeding from the gums, although no spots could be discovered in the mouth. Aside from the feeling of weak- ness no symptom of general disease. August 21, I ordered phosphorus 2 x ; the rooms to be well ventilated, and light digest- ible food to be given. Aug. 23. Condition decidedly improved. No haemorrhage in the last twelve hours, and the spots are lighter colored and lessened in number. At the same time the boy was out of bed, felt less tired, and according to the parents the boy was livelier and appetite was returning. I repeated the medicine, a spoonful every three hours. Aug. 26. I found the boy playing in the garden, he felt well. No more epistaxis. The spots had partially disappeared, the balance were paler. No more medication and drugs, CLINICAL CASES. 89 and in five days no trace of the disease could be discovered. 3. On the 4th of February I was called to see the daughter of Mrs. C. N., a girl of eight years. She is well nourished, and was until now in perfect health. Her constitution might be called a lymphatic one, with some tendency to scrofulosis. JMo cause for her sickness can be ascertained, unless you wish to assign as the cause the sudden death of her father. How much the child was affected by this, is difficult to judge, as she is accustomed to sit quietly by herself, and is not very demonstrative. The mother noted no change in her, until on the morning of February 4, a haemorrhage from the nose and mouth set in. Upon closer observa- tion she noticed a number of spots and stripes on the whole body, although the little one made no complaint. Upon examination, I found not alone spots on the entire body, but likewise on tongue and palate. Haemorrhages were frequent from the nose and mouth with- out any apparent cause, especially when clear- ing the throat or coughing, which w r ould occur after waking from a short sleep. Some blood was lost with the stools, the stools having the appearance of being covered with a thin layer of blood. In spite of this, no disturbance of any organ could be discovered ; 90 PHOSPHORUS. there was no fever nor pain ; the child only felt somewhat weakened from the loss of blood. I prescribed phosphorus 2 x. Feb. 6. I called upon the patient and ascer- tained that after the third dose the haemor- rhages from nose and mouth had ceased, that upon awakening she had coughed up no more blood. On examination I found the spots on body and mouth lessened in intensity. The same medicine was ordered, every three hours one-half tablespoonful, and on the 9th of February, I was happy in being able to dis- charge the patient, as far as taking medicine was concerned. No trace of haemorrhage for several days. The spots had either entirely disappeared, or left slight red or yellow-red color of the skin. These disappeared without any medication, so that fourteen days later, when I again visited the child, no trace of spots or of any appearance of sickness could be dis- covered. The following cases were furnished to me by Prof. Temple S. Hoyne, M. D., of Chicago : 4. The patient was a boy about sixteen years old, and comparatively healthy. He was very fond of meat, but disliked vegetables and would hardly ever touch them. There were extravas- ations of blood beneath the skin of the arm, chest, and other portions of the body. The CLINICAL CASES. 92 slightest breaking of the skin was followed by profuse bleeding, and the drawing of a tooth caused an excessive and prolonged haemorrhage. Lemons and other fruits were ordered in connection with phosphorus 200, and the boy recovered completely. 5. A case of purpura, which I saw in con- sultation with Dr. Ballard, of this city, was accompanied by profuse hemorrhage, which, after finally being controlled by plugging the nostrils, was followed by an alarming bleeding from the lungs and stomach. Even touching the lips would bring on haemorrhage from the mouth. Phosphorus 200 stopped these haemor- rhages, and really saved the girl's life. Dr. Elias C. Price, of Baltimore, sends me the following observations : 6. I have seen numerous cases of another variety, on the legs of old persons. These spots look like real blood blisters, of a very bright-red color. The smaller ones are perfectly round. They vary in size from that of a No 30 pellet to two inches in diameter. Phosphorus has generally cured this condition in a very short time. Dr. J. Comp ton Burnett, of London, published the two following cases in the Homoeopathic World, February, 1873 : 92 PHOSPHORUS. 7. About a month since a boy of ten was brought to me for treatment. His mother stated that on the day previous, there had been a rather profuse discharge of blood from his nose and mouth. The conjunctiva of the right eye was suffused with extravasated blood, and the whole neighborhood of the right eye was ecchymosed. There were likewise ecchymoses on the nose, cheeks and forehead. In fact, it looked as if my patient had made considerable practical experience of a pugilistic kind. This he, however, stoutly denied, and no history of an accident could be made out. There were no purpuric spots to be detected. Inclining to the view that it was traumatic, I prescribed arnica mountana. At the second consultation, a week subsequently, the mother stated that the boy had again had haemorrhages from the mouth and nose ; the objective symptoms were the same as at the former visit. I now prescribed phosphorus 1. Since then there have been no further haemorrhages, and the ecchymoses have disappeared. 8. About five weeks since Eliza R., set. seven, was brought by her mother, who stated the child had repeatedly had bleeding from the left ear. On examination I found the whole surface of the body dotted with characteristic purpuric spots, in size varying from that of the CLINICAL CASES. scarcely perceptible to that of a four- penny piece. There were considerable constitutional disturbance and anorexia.The meatus auditorius externes of the left side was partially occluded with blood clots, which were dry and adherent to the walls. Prescribed aconitum and phosphor- us in four- hourly alternations. JN T o further extravasation took place, and the patient was discharged cured a fortnight since. 9. Dr. Penoyer, of Kenosha, Wis., while passing along the street was called in by Dr. Farr to see a case of purpura to which he had just been called, but for which he had not prescribed. After looking over the case Dr. Penoyer suggested phosphorus cc. in solution, as the case presented a startling resemblance to phosphorus toxicosis. At Dr. Farr's request he prepared the remedy, which was given as directed. The disease disappeared rapidly and the patient was discharged convalescent in three days. LACHESIS. Skin. 1. Scarlet-red spots as large as the hand on the right chest, shoulder, and arm, with great thirst, rapid pulse, short breath, coated tongue. [Within twenty-four hours after the administration of Lachesis 30 for cancer of the right breast. Gross, in Hering's Denies- 94 LACHESIS. thrift der N. Am. Abaci, der Horn. Htilk., 1837.] 2. A red burning spot on the thumb. [Effect of 30th dilution. Ibid.] 3. Red spots like bug bites, over the short ribs and towards the umbilicus. [Effect of 30th dilution ; Wesselhceft. Ibid.] 4. Sensitive spots as large as a quarter dollar, with dark blue-red margins and dry scurf. [Effects of 30th dilution ; Hcenig. Ibid.] 5. Small red points here and there on the fingers, which itch very much. [Effects of the 2d trituration. Ibid.] 6. After incessant itching there appeared a round, red, v;ery hard bunch on the back of the middle finger, lasting a long time, without vesicles and without suppuration. * * * Six weeks later, after a blow on the bunch (which had almost entirely disappeared) it bled unusually profusely. [Effects of 30th dilution. Ibid.] 7. Various eruptions, burning and itching. [Ibid.] 8. Gangrene. [From a bite. Ibid.] 9. Trickling of blood from the nose ; in very many cases, and in various diseases. [Ibid.] COMMENTS. 95 Concomitants. — Aggravation of all symptoms after sleep. Loquaciousness. Vertigo in the morning on waking. Headache extending into the root of the nose. Black flickering before the eyes. Dryness in the throat, without thirst. External throat very sensitive to touch. Great physical and mental exhaustion. Icy coldness of the feet. Comments. — The similarity between lachesis and other venoms has been discussed under cro talus. The above citations from the provings show very little relation to purpura, yet lachesis exerts a powerful decomposing influ- ence on the blood, and causes gangrene in the muscles and viscera. The principle difference between lachesis and crotalus is that the former has more of the neurotic element (Burt). When purpura sets in with an intense prostra- tion, which bears down before it alike the mental and vital forces, lachesis will probably be helpful. The blood is black and not coaguable ; the affected parts are bluish, and everywhere there is a tendency toward gangrene; the patient is exhausted by the constant aching pains in the extremities, by the intense febrile paroxysms, and by a persistent insomnia, which is aggravated by the fact that the patient is 96 LACHESIS. afraid to sleep, as lie feels so much worse afterwards. Says Dr. P. Jousset, in the North American Journal of Homoeopathy, Vol. ix, page 229 : " Lachesis corresponds to the more malignant form of purpura hemorrhagica. Its patho- genesis gives us, haemorrhages and blood- extra- vasations in different organs ; ecchymoses ; red and black spots on the skin ; epistaxis ; haematemesis ; melanosis ; haemoptysis ; great lassitude with lipothymia and syncope ; considerable prostration ; pulse small, weak ; perceptible fever." Dr. Richard Hughes, in his Pharmacody- namics, Fourth edition (1880), page 604, says of the serpent venoms, that lachesis should be borne in mind as a remedy : 1st. Whenever jaundice, primary or second- ary, is accompanied with ecchymoses and haem- orrhages. Here it compares with phosphorus, which would supplant it when the liver was intimately affected, as in acute atrophy of that organ. 2d. Whenever the purpuric condition super- venes upon other diseases, as typhus or variola, constituting their hemorrhagic form, arsenic is tolerably homoeopathic, but is hardly rapid enough in its action. CLINICAL CASES. 97 3d. When the epidemic cerebrospinal menengitis appears in the form known as "malignant purpuric" or "spotted fever." Here the prostration is long and intense ; the febrile reaction slight ; and the appearance of petechia constant, with sometimes haemorrhages. Clinical. — Prof. Conrad Wesselhoeft reports the following case in the British Journal of Homoeopathy, 1864, page 491. 1. Mr. C. H., 22, married, of fair complex- ion, light hair, blue eyes, for some time has had upon his legs from the knees downward purplish or bluish-black circular spots, vary- ing from a five cent piece to that of a dime, very painful to touch ; at the same time the entire portion of the legs pain as if burned. His perspiration emitted an odor like that of putrescent wine, his breath was likewise very offensive ; slept all night but was restless; pros- tration after slight exertion and desire to lie down were prominent symptoms. Lachesis, 3 doses cured ; three months after patient feels perfectly well. Prof. G-. M. Pease, M. D., of the San Francisco college, has sent me the following cases : 2. In 1881, I had a very interesting case of purpura to treat, which had been under the treat- ment of an Allopathic physician for some time 98 LACHESIS. without relief. The patient was a young lady y about twenty-five years of age. She had had for some time crops of purpuric spots, varying* in size from that of a pin's head to a silver dol- lar, coming out very plentifully upon the arms and legs, and less freely upon the body. Slight pinching at almost any point would bring the blood to the surface, and sometimes it would ooze through. Merely scratching any uncol- ored spot would be speedily followed by an extravasation of blood at that point. She had a headache every morning, with a sticky, gum- my collection in the mouth after a night's sleep — that is so much of sleep as she got, for she was at frequent intervals awakened in the night by churning and itching of the purpuric spots, and upon spots at which the extravasa- tion was about caking place. Her menses had for some time been scanty ; and she was so de- bilitated that her strength seemed all gone. Lachesis 200 was given at the first visit, and the next day there was some evidence of improve- ment. On the third day I called again and found her so nearly well that I dismissed the case, subject to being called if needed. In about two weeks thereafter she came to my office and stated that there were no fresh spots after the second day, and that nearly all the old ones had now disappeared, the few remaining were CLINICAL CASES. 99 hardly to be seen. Four years have passed and she has had no return of the trouble ; nor has she had any other sickness. The Allopath- ic doctor who had previously treated her, who happened to be a personal friend, was so as- tounded that he asked me how it was done. 3. Another case lately, not so severe as the- above, but having many of the same character- istics, has also . yielded promptly to lachesis. In the cases of purpura which I have had to- treat, lachesis has been more frequently indi- cated than any other remedy. Dr. John L. Seward, of Orange, N. J., pub- lished the following case in the American Homceopatlust, October, 1885 : 4. The following case came under my obser- vation, soon after I settled in Orange, about twelve years ago : This patient was a lady, about 40 years of age, a school-teacher by profession, and a woman of considerable energy. She was a very decided brunette, with dark complexion and black hair, a heavy frame, but now thin and flabby. She had always had very profuse menses, even from girlhood, and while she had had many doctors she was in no wise benefitted, but rather grew worse. Coming into the com- munity as a stranger, no one else having helped 100 LACHESIS. her, she determined to try me. When sent for I found her flowing very profusely, the blood being dark and partially coagulated, and at- tended wi'th labor-like pressing from the small of the back downward and through the geni- tals. The pains were periodical, each being fol- lowed by a gush of clotted blood. Her sleep was restless, and, indeed, for the most part, she was drowsy, but unable to get into any real, quiet sleep. She w-as extremely irritable and peevish, and presented so strongly the mental characteristics of chamomilla, that I gave that remedy in the two hundredth potency. This seemed to control the haemorrhage, and the period lasted for a much shorter time than had been her habit. Before the time for her next period she went on a visit to Syracuse, where she remained three months^ and had several severe haemor- rhages. On her return to South Orange, I was sent for, but the case made very poor progress. Again in six weeks she was taken with another severe haemorrhage, and became so reduced and weak as to thoroughly alarm me. Her mother then told me about the purpuric spots with which she was affected, and upon examination I found a number of splotches of extravasated blood upon the chest, abdomen and back, irreg- ular in shape, and about half the size of the CLIKICAL CASES. 101 palm of my hand. There were none of these spots upon the extremities or neck, they being confined both then and at all times, to the surface of the trunk. I found, upon inquiry, that all her life she would bruise very easily, that the slightest knock, or even pressure upon the skin, would cause a black and bine mark, which would continue to spread until it had become quite large, and that ever since she was a young lady, these spots had also occurred spontaneously upon the body. She had also from her youth up been subject to violent nose- bleed, and always carried three or four hand- kerchiefs at a time, for which she had frequent occasion. We had now got along to the mid- dle of March, and the weather was quite cold, yet she insisted upon having the windows all open, and the attendants went about with their overcoats and other out-door wraps on ; j^et she did not seem to feel the cold. I gave her, at various times, arsenic, phosphorus, bryonia, and chamomilla, on general principles, without apparently accomplishing any good. She had become so weak that she could be fed only with liquid, peptonized food, and I became so wor- ried about her that I fell into the habit of stay- ing at the house nights. I noticed one night that after she had been in a little doze, that she awoke with a suffocative sensation. In- 102 LACH E SIS. stantly there flashed into my mind — Lacliesis ; and I then could see many strong resemblances between that remedy and this case, which had not occurred to me before. I had a little of the two hundredth potency with me, and I fixed some in water, and began its administration. She improved rapidly and steadily from that date, and made a complete recovery. The pur- puric spots disappeared and never returned ; she became less susceptible to bruises than ever before in her life ; she had no more epis taxis ; her menstruation became almost normal as to amount, frequency and painlessness ; and she passed through the menopause without trouble. This case was among my first successes, and wonderfully confirmed me in my belief in the homoeopathic law. The following case is probably not purpura, but it serves to illustrate the direction in which lachesis may be applied with advantage. It was published by Dr. Constantine Hering in ArcJiiv. fur die Horn. Ileil/iunst, vol. xvi : 5. A young man, weakened by disease and by medicine, bad suffered much from pains in the bones (probably mercurial syphilitic) of the right arm, which had been still further weakened by the fracture of the clavicle. After he had been cured of this pain as well as of CLIJSTICAL CASES. 103 caries of the upper jaw, and had remained perfectly well during four months of the coldest weather, that is, from December to March, he was attacked without any ascribed cause, except that he had taken a piece of ice in his hand, suddenly,one morning, with the following affection : Swelling of the back of the right hand, extending down the lingers ; the whole after a few minutes became quite livid. After being wetted with hot brandy it went off : but after some days it returned as suddenly as be- fore, and much more severe, and then it appeared every day, each day earlier than the foregoing, and continued three or four hours. It begins with severe itching and creeping ; the hand becomes blue and gradually darker, and has the appearance of a contusion on the worst part, but more transparent ; it is at parts mottled ; the hand looks as if it was stuffed, it is so hard. The affection now goes from the middle of the back of the hand, over all the fingers, the hand is ice-cold, but seems to him burning hot, it is very sensitive to pressure, and he can bear nothing to lie upon it ; burning and pricking in the finger ends ; the heat of the stove relieves the pain, but increases the -creeping sensation. Lachesis cured. 104 ARSENICUM. Skin. — Petechia. Ecchymoses. 1. Small ecchymoses, or rather petechias [Roth's collection of poison cases.] 2. Blue spots on the abdomen, genital or- gans, and white of the eye. [Kaiser ; poison- ing of a whole family by arsenic] 3. Purple petechia on chest and neck. [A. McLeod ; in Edinburgh Medical and Surgi- cal Journal, vol. xv, page 553.] 4. Eruption resembling red petechia, from the size of a flea bite up to that of a lentil, sharply circumscribed, in the evening, painful, dry, moist, and burning after scratching. [Symptom from Hahnemann.] 5. Numerous petechial spots over the skin of the trunk and thighs. [Dr. Vitry ; Ann. d } Hy- giene et de Medicin. Legal, 1846,] 6. Small spots of purpura on neck. [A fam- ily poisoned by arsenic in food. Dublin Quart, Journal of Medical Science, 1851 ] 7. Purple patches gradually covered his arm and side. [From making arsenical candles. Dublin Medical Press, vol. xiii, page 61.] Concomitants. — Great restlessness ; rapid emaciation ; burning thirst. Burning pains everywhere. COMMENTS. 105 (Edematous tendencies. Excoriating discharges ; eyes, nose, ears. Suffocation when lying ; must sit up. Constant uneasiness ; cannot lie still ; must change position. Frequent starting during sleep. Worse at night ; relieved by warmth. Comments. — Arsenicum presents in a very characteristic manner the more salient features of purpura hsemorrhagica ; petechia occur on various parts of the body, and multiple haemorrhages from the various organs. It holds a position very little inferior to the serpent venoms, and corresponds to a very dangerous form of the disorder. Arsenic causes a pro- gressive decrease in both the white and red cor- puscles of the blood. The petechia seen upon the skin are accompanied by ecchymoses in the lungs, pleurae, pericardium, and heart. In chronic arsenical poisoning there is fatty de- generation of both the liver and the kidney. Clinical. — Jahr, in Forty Years'" Practice, relates the following desperate case, which is interesting in itself, and because it illustrates how even the most competent sometimes final cure by a fluke, after apparently well-selected remedies have failed. 1. One evening I was called to a young lady 106 ARSENICUM. who had been living in extreme indigence for some six weeks, and had only had a very Scanty supply of nourishment on three or four days in the week. One of her relatives con- ducted me to her to relieve her of a terrible menorrhagia that had weakened her to such an extent that she was unable to leave her bed. I prescribed china 30th, two globules in a few tablespoonf uls of water, a teaspoonful of which solution was to be taken every half hour until I should see her again early next morning. Next morning the menorrhagia was not only unimproved, but haemorrhages from the nose and mouth had supervened ; on the skin general- ly no spots could as yet be perceived. I now prescribed phosphorus 30th, two globules in water, to be taken in the same manner as the china, and, in case of improvement, to be con- tinued every hour until my evening visit. During the day I received a written message that the haemorrhage continued to increase all the time, and that the patient fell from one syncope into another. Not being at home when this message arrived, I did not see my pa- tient again until evening, when I found her in a most desperate condition. With the haem- orrhages from the uterus, mouth and nose, spots and blisters of the size of a dollar had become associated in the mouth and on the CLINICAL CASES. 107 skin of the whole body ; pure blood oozed from these spots, and the patient, who still re- tained her full consciousness, lay like a corpse, with death-like pallor of the hippocratic coun- tenance, dull, lustreless eyes, and icy-coldness of the whole body, as if perfectly inanimate. Although I had not a ray of hope of saving her, yet I placed two globules of arsenicum, 30th. dry on her tongne, leaving at the same time a watery solution of the same dose, with instructions to administer it in the same man- ner as either of the other remedies, and, if anything untoward should happen, to send for me in the night. I was not sent for, but next morning at seven o'clock I received a note that had been written the evening previous, shortly after my departure, and wherein I was re- quested not to trouble myself with any further visits, and that an old-school physician had been sent for. I heard nothing farther of my patient and thought her in her grave, when six months afterwards a young couple walked into my office, and I was asked by the young man, who was a stranger to me, whether I re- membered a dying young woman whom I had treated for haemorrhage. I replied yes, and said, moreover, that if no other physician had been sent for, and my last prescription had been continued, she would j)robably still 108 ARSENICUM. be in the land of the living. " She did con- tinue your medicine," now interrupted the pale young woman, but who otherwise seemed to .enjoy good health; "she continued your medicine, and the medicine of the other doc- tor was poured out of the window, and this is the reason why she now stands here before jou y restored to life and health, and married, and wishes to know how much she owes you." When I heard these words I was scarcely able te believe my senses ; nevertheless, she was the identical person. The more I looked at her and heard her talk, the better I recognized the voice and features of my former patient, and I now heard for the first time that the physician, whom one of her relatives had sent for, had told the family that nothing could be done for the young lady, and that she would certainly die over night ; nevertheless, he was willing to leave a prescription and to call again the fol- lowing morning. Before his prescription ar- rived from the pharmacy the two globules of arsenicum had already effected a consider- able decrease of the haemorrhage, and the fam- ily concluded to continue my watery solution of arsenicum, and, the improvement pro- gressing all the time, to have it renewed by the apothecary, so that eight days after my last visit the patient was completely restored. CLIIICAL CASES. 109 Such miracles are performed even by the smallest doses of appropriately-selected reme- dies. Dr. Geo. M. Ockford reported the following case in the American Homoeopathist, August, 1885. 2. I have had but two cases of purpura all told. One was in a woman, aged sixty-five, w r ko had always worked very hard and lived very poorly, and whose system had been completely broken down by these adverse influences and numer- ous attacks of intermittent fever. She was anaemic and cachectic. Before the appearance of the purpuric spots there had been languor, a profound sense of weakness and weariness, and considerable digestive derangement, includ- ing pain in the pit of the stomach and tender- ness on pressure. The purpuric extravasations were mainly upon the extremities, although one or two spots appeared upon the body, but no petechia upon the face were observed. I gave her arsenicum, 3 x trituration, which speediJy removed the extravasations and cured the case. Prof. A. E. Small, M. D., has sent me the following report of a case : 3. A young man, 18 years of age, nervous- 110 ARSENICUM. bilious temperament, contracted a cold live years ago last March. After a few days a feb- rile condition ensued, marked by a peculiar prostration. He had been for some time at hard study in preparation to enter Harvard University, and the chief symptom manifest at first, appeared to be exhaustion from too close application to his studies. After a few days, however, spots of purpura were noticed on his arms and body, and epistaxis was an accom- paniment. These ecchymosed spots became quite numerous, varying in size, as that from a dime to a half-dollar. The case was diagnosed as genuine purpura haemorrhagica, or morbus maculosus Werlhofii. The extreme weakness of this patient suggested the employment of arsenicum, which w T as administered in the third decimal trituration, twice a day, while the external surroundings of the patient were made as pleasant as possible and favorable to recovery. China was also prescribed after arsenicum, and finally, bryonia. The patient recovered, and entered Harvard College, but was obliged to leave during tine senior year, on account of threatened tuberculosis. He has since been under my care, and I date the com- mencement of his lung trouble to the siege of purpura he passed through before he entered college. CLINICAL CASES. Ill The following case was reported to me by Dr. W. M. L. Fiske, of Brooklyn, New York: 4. The patient was a foreman in the shoe shop at the Kings County penitentiary. He had an attack in four successive years. In none of these were the constitutional symx3toms very marked. He recovered under arsenicum. The following case, by Dr. S. D. Jones, is from Hoyne's Clinical Therapeutics, vol. I, page 356 : 5. A gentleman, thirty-five years of age, had typhoid fever for six weeks ; had been treated allopathically, and had been pronounced con- valescent, but relapsed and became delirious ; made vigorous efforts to get away, believing that those around him were enemies, and were endeavoring to take his life ; delirium contin- ued about three days. At this period small purple or bruised-like spots made their appear- ance upon his body, arms and legs. These spots turned almost black, and spread, many of them, to the size of the hand, and extended over bis body, ^especially his chest and abdo- men ; profuse haemorrhage set in from the nose and left eye ; after a few days both ears dis- charged small quantities of blood ; the haemor- rhage from the nose and left eye was so great that there were fears of bleeding to_death. This 112 ARSENICUM. bleeding was arrested after a few days, when the patient sank into a comatose state, and be- came entirely unconscious ; lay with his eyes rolled back, eyelids and mouth open ; pulse 120, small and corded ; surface hot and dry and a general ansemic condition of the entire body ; tongi^fe dry and covered with a dry, brown crust ; bowels constipated. Gave aconite 3d dilution, in water every hour, when the pulse was reduced to 98, and softer. Then gave ar- senicum, 3d trituration, in water, every four hours. Compressed the chest and abdomen with cloths wrung out of tepid water, in which tincture of arnica has been mixed, in the proportion of a teaspoonful to a pint of water ; extremities rubbed and kept warm by w T rapping them in flannels, and a jug of hot water to the feet ; enemas of tepid water to the bowels every day. Forty-eight hours after a perceptible change had taken place for the better ; pulse 97, fuller and more soft ; con- sciousness gradually returned. Continued the treatment, except the compress, which was con- tinued about one week. Patient gradually and steadily improved. Dr. C. Heinigke reported in the Alle. Horn. Zeituny, 81, page 27, as follows : 6. A case of red, infiltrated spots, which burn, cured by arsenicum 6. 113 SECALE. Skin. — 1. Petechia. Large eccliymoses. Gangrenous blisters. Blood-boils. [Ejchtek ; Spec. Therapia, Tome vi.] 2. Spots like flea-bites, on the feet, lasting eight weeks. [Ant. Scrinc ; in Satyr, med^ Sites. Spec, iv., Obs. v, page 35.] 3. Petechia. [Haase ; Handbucli der cliron. Kranklieiten, Tome ii.] 4. Petechial exanthema and furuncles on the lower limbs ; outer parts of the limbs, especial- ly the fingers, turn dark-blue, become gangre- nous and die altogether ; the gangrene rapidly extended over other parts of the body, was not confined to fleshy parts, but affected the bone, so that often the gangrenous parts fell off. [Dreysig ; Handbucli der med. Diagnostica, Band 2.] 5. An eruption of livid spots broke out over the body. [Account of the Ergot Epidemic in Germany, 1770 ; Prof. A. T. Thomson, Lec- turer on Medical Jurisprudence, London Lan- cet, Sept, 9, 1837.] 6. The skin livid on account of slow action of the capillaries. [Effects of 40 minims of the oil, in a young man, aged twenty ; Dr. 114 S E C A L E. Charles Hooker, Boston Medical and Surgi- cal Journal, 1834, page 300.] Concomitants. — Sensation as of something creeping on or under the skin. Coldness of the surface of the body. Cold, clammy condition of the skin. Extreme aversion to heat. Heat applied to any part of the body makes the patient worse. Anxiety and fear of death. All the senses benumbed ; sight, hearing, etc. Eyes sunken and surrounded with a blue margin. Dimness of vision ; everything looks black when moving the head ; when rising up in bed everything turns black before the eyes. Roaring in the ears with great difficulty of hearing. Constant nose-bleed. Face pale, sunken, hippocratic. Lips bluish. Speech slow and weak. Haemorrhages from the stomach, bowels, kidneys, uterus. Anxious respiration. Constant sighing. Pulse small, rapid, and intermittent. C O 31 31 E 1S T T S . 115 Restlessness : prostration ; extreme debility ; rapid sinking of strength. Comments. — The evidences of the purpura- producing power of secale are sufficient, but I have not been able to trace them satisfactorily to myself. The half dozen observations cited above prove how serviceable it is likely to be in those cases in which the well-know charac- teristics of the drug are present. Clinical — The following very interesting case was reported by me, in the American Homozop- athist, August, 1885 : 1. On June 17, 1881, I was called in to see a German woman, aged 55, living on 29th street, opposite the old Hudson River Railway sheds. I had known the family for some time, as a son, a jeweler by trade, had a peculiar trouble of the heart. The old lady had not been ill for many years, but had for months complained of a numbness of the left leg and foot, for which, however, she refused treatment, believing she could work it off. She was one of those dried- up little specimens, with a leathery skin, which we so often see among the poor class of Ger- man immigrants. The block on which they lived was notorious for its bad sanitary condition, and during the hot weather which was now prevailing funerals were a daily occurrence. 116 S E C A L E. She had been ill for several days, but refused to have medical attendance, as she had a great scorn for doctors. I was at the time attending that anomalous case of puerperal fever which I reported in the New York Medical Times for September, 1881, cured by calcarea carbonica 200, in the next house, and her daughter, see- ing me pass the door, called me in to see her mother. The old lady refused to look at me or speak to me, but by using my eyes and from the report of the family I gathered the follow- ing facts in the case : She had had for two or three weeks a sensation on various parts of the skin, but most pronounced on the lower ex- tremities, as of insects or vermin creeping about on her. She also complained of lack of sensation in her left foot and in both hands, which induced her to continually rub them with a piece of flannel. She had been taking some kind of German medicinal tea, the composition of which I did not learn. She evinced the greatest objection to lying in bed, and although very weak required constant supervision and persuasion to keep her there — and this when so exhausted that the attempt to get up only re- sulted in her sliding down upon the floor. Equally marked was her repugnance to being covered; and when I first saw her she lay in bed with nothing on but a short chemise and her CLINICAL CASES. 117 native modesty. What attracted my attention first was the shrunken and anxious expression of her face, and next the peculiar appearance of her feet and legs. Both feet and legs up to the knee were covered with bruises, or what ap- peared to be such. These were much worse on the left side, where the toes were actually black. That this was not a mere local trouble was shown by the presence of ecchymosesupon the forearms and upon the buttocks. More alarming, to the family at least, was the emeto- catharsis. The vomiting and purging occurred simultaneously and involuntarily, nearly hour- ly, but neither were very copious. The dejected matter was watery, nearly colorless, and pre- ceded by colic and rumbling in the abdomen. Her skin was cold and clammy. She had a great thirst and was clamorous (or at least had been until her voice became so husky and weak as scarcely to be heard) for iced water, lemon- ade, beer, anything that was cold. She had had bleeding from the nose, but its character and frequency I could not learn. The urine was suppressed. Of course, there was never a doubt about the remedy ; if in so desperate a case any drug could save it was secale. What- ever the remedy did do it was not a " faith- cure/' either on account of the doctor's mental attitude or the patient's; and I expected to 118 S E C AL E. find her dead on my return in the evening. Secale was given in the sixth trituration, dry- on the tongue, every ten minutes for an hour, and afterwards half-hourly ; a higher potency would have been given if I had had it with me. When I saw her four hours later, the vomiting had ceased, but the bowels remained about the same except in frequency. The medicine was commenced at 2:30 P. M., and the diarrhoea ceased at about midnight. The reaction was followed by a slight fever, for which I gave, the next day, aconite (this now I believe to have been a mistake), returning again to secale in the evening, on account of her having had a diarrhoeic stool. The purpura gradually faded, and quite disappeared in eight or nine days. 2. Prof. J. R. Kippax, M. D., writes me that the hypodermic injection of the fluid extract of ergot, in ten mimin doses, every six hours, did good service in a case in which the pur- puric spots were dark, confined mostly to the extremities, and attended with profuse uterine haemorrhage, after both erigeron 3 x and se- cale 3 x, internally, had failed to relieve. Dr. J. L Gage, of Vassar, Mich., published the following case in the American Homoeo- pathist, November, 1885, as showing the power of a proper remedy to cure : CLINICAL CASES. 119 3. A few years ago a man aged about fifty fell and broke the tibia above the ankle. He was helped up, and walked with help some rods, and being assisted into a wagon, rode home, got out, and walked into his house. The broken ends of the bones lacerated the soft parts, so in two or three days the leg was black all around the ankle, except a strip about an inch wide on the under side. It was a question whether the leg should come off, I determining to try and save the leg, and did. Secale 6, was the chief remedy given. There was slough- ing, some deep, some superficial ; but it healed readily, and he had a good leg again. In gan- grene and purpuric haemorrhages secale is most frequently our main reliance. CHINA. Skin. — Petechia. Purpura hemorrhagica. 1. A woman, 50 years of age, took, every six hours, 10 centigrammes of sulphate of quinine, for neuralgia. The next day the dose was in- creased to 15 centigrammes, and a blister was applied to the axilla. The next day, the part blistered was all black ; a sanguinolent serosity exuded from it ; more than that, the whole body was covered with spots of purpura. Quinine was suspended and the mineral acids substituted for it. At the end of nine days all 120 C H I ]N T A . the body was well ; the axilla was healed at the end of fifteen days. Quinine was subsequently prescribed for toothache, and the purpura reap- peared. In this case, and in those that followed, the quinine was chemically pure ; and hence must be regarded as the only cause of the phenomena observed. [Dr. Vepatt, in Bulletin Gen. cle Ther., Ixxii. page 140.] 2. A woman took quinine to relieve herself of a tertian fever. The second day she had nose-bleed ; the body was covered with spots of purpura ; the gums bleeding. The quinine was suspended, and mineral acids given for three days ; then, a laxative ; and at the end of eight days the spots had disappeared. [Ibid.] 3. A boy 12 years of age, presenting a gen- eral debility, took quinine. At the end of a few days purpura developed itself ; but the quinine was continued some time, to try its action. The purpura increased ; the gums bled. The quinine was stopped, saline purga- tives given, and in ten days the skin was well. [Ibid,'] 4. A man, who took quinine for a masked fever, presented no trace of a cutaneous affec- tion, even at the end of fifteen days. Attention being called to the subject, it was thought that he wo aid escape ; nevertheless, three days CONCOMITANTS. 121 after, he had twenty spots upon the shoulders. [Ibid.] Concomitants. — Excessive sensitiveness of the nervous system ; all the symptoms are ag- gravated by the slightest contact, by motion, or by mental or physical effort. The brain beats in waves against the skull. Ringing in the ears. No desire for eating or drinking. Body sore all over. Perspiration very profuse ai*d debilitating, especially at night. Profuse sweat during sleep, or on being cov- ered up. Perspiration on the side on which he lies. Jaundice. Periodical, or intermitting, symptoms. Prostration, with neither thirst nor hunger. Debility following the loss of blood or other fluids. Relationships. — Best suited to swarthy per- sons, u broken-down " constitutions and old women. Clinical. — The following case was reported by the writer, in the American Homoeopatlvist, for August, 1885 : 1. Mrs. L. M. B., a native of England, aged 37, resident in New York about nine years ; bru- 122 CHINA. nette ; large and fleshy ; originally of a ruddy complexion, bat now pale and anaemic ; the mother of four children, and in her last confine- ment, about one year previous to the date here mentioned, lost an enormous amount of blood, so much so as to endanger her life, since which time she has been feeble and dispirited ; her menses have always been rather free, and at times menorrhagic. The husband, who had formerly been a good workman, had for the past year and a half taken to drink, and the family had sunken into absolute poverty. The wife had endeavored to support herself and children by taking in coarse washing, and her system was much run down by over work, in- sufficiency of food, and constant anxiety. To these influences was probably due the severity of the haemorrhage at her last confinement. The child, unfortunately, lived until its tenth month, when it died of capillary bronchitis. The exhaustion caused by nursing this child, and her untoward surroundings, brought on a low fever, for which she received large doses of sulphate of quinine from a dispensary doctor. This was the condition of things when I first saw her, in March, 1881. Through a charitable organization I secured the removal of the fam- ily from the wretched room they occupied in a rear building on Eleventh avenue, near Twenty- CLINICAL CASES. 123 eighth street, to much healthier and cleaner quarters on Twenty-fourth street, near Ninth avenue. Work was found for the husband, who promised to reform, and who did main- tain tolerably decent habits for some months thereafter. A study of the patient's condition led me to give natrum muriaticum, both because she had been dosed heavily with quinine, and on ac- count of various symptoms which corresponded with its pathogensy ; but, although it was con- tinued for two weeks, in varying potency, with a milk and beef- tea diet, I saw no benefit from it. In some ways the patient was better, but these changes could well be ascribed to her improved surroundings and dietary. She had a fever every day, beginning late in the forenoon, without chill, continuing until evening, and passing off with a copious sweat which lasted until near morning. The fever would vary day by day as to the hour of com- mencement, sometimes as early as ten o clock, or as late as one o'clock, but never the same. During the fever she was stupid, and could not be depended upon to describe her sensa- tions. In the morning she had a bursting headache, and the congestion to the head ap- parently continued all day ; but as soon as the perspiration set in all the untoward symptoms 124 CHINA. disappeared, she became lively and bright, said she felt well and free from pain, and drank milk frequently and greedily. I stuck to na- trum longer chan I otherwise should on account of one symptom — fever blisters on the lips — but, finally, changed to mix vomica. This, ignatia, rhus tox., and lycopodium were given during the next (third) week of treatment. The symptoms varied considerably, and I was making a rather hopeless stern-chase after them, and felt very much discouraged, when a new phase presented itself and altered the en- tire outlook. Her menses came on the 16th day of treatment, and were profuse. The dis- charge was watery, and contained numerous dark coagula. On the 21st day, the menses continuing, and the patient being now very weak and apathetic, I was shocked to find that there had appeared spontaneously several ec- chymoses on the left thigh about the size of a silver dollar, and smaller ones on the leg, foot and along the lumbar region. Phosphorus 12 was given, bi-hourly. 22d day. The ecchymoses have spread con- siderably, the old ones enlarging and many new ones forming. Her face is shrunken and livid> with eyes surrounded by heavy blue lines ; sight dim and uncertain ; noises in the ear, like distant bells ; very apathetic, and CLINICAL CASES. 125 either does not reply at all to questions, or slowly, as if she did not fully comprehend ; de- sires continually cold lemonade, and refuses milk and the beef- tea, which disagree, causing eructations ; urine scanty, turbid, and with a red-brown sediment, diarrlioea of bloody mu- cus, scanty, infrequent, painless ; she wants to be bolstered up in bed on account of op- pression in the chest, when lying down ; skin cold, clammy and greasy ; temperature (axilla), 103. 4 Q F. In the presence of so grave a condition, I naturally hesitated as to the best course to pursue. Evidently phosphorus was doing no good. Various remedies, which had seemed indicated — at least, they were not given thought- lessly and without much study— had been given, nevertheless, without result. I had avoided china, which had several times been called to my mind by symptoms in the case, because she had been so recently deluged with it. * How- ever, I could not disguise from myself the many points of resemblance between this drug and the case before me, and on studying its pathogenesis carefully I became convinced that if any remedy was capable of saving my pa- tient it was china, and china only. China has the following : Indifference ; apathy ; ill humor. 126 CHINA. Dislike to all mental or physical exertion. Slow train of ideas. Intense throbbing headache — after loss of blood. Sight dim and faint. Fine ringing in ears. Hardness of hearing ; hamming in ears. Nose-bleed ; ringing in ears ; face pale. Face pale, hollow or livid ; blue around the eyes ; hippocratic. Longs for sour, cooling things. Violent thirst for cold drinks. Sour eructations after milk. Heartburn after milk. Haematemesis ; weak, pale, cold. Stools ; bloody, painless. Urine ; turbid, scanty; depositing brick-dust sediment. Uterine haemorrhages, ringing in ears, faint- ing, coldness, loss of sight ; discharge of dark clots. Menses dark, coagulated ; or pale and watery, with dark coagula. Can not breathe w T ith head low. Haemoptysis. Fever, long-lasting; and coming on at irregu- lar intervals. Sweat ; partial, cold, or profuse ; greasy. Haemorrhages from mouth, nose, or bowels ; wants sour things. CLINICAL CASES. 127 Although the pathogenesis did not show ec- chym'oses on the skin, or elsewhere, and I did not at that time know of the recorded poison- ings in which purpura developed (Vepau), nevertheless, I determined, in view of the origin of the pathological state of the patient, resulting as it did from overlactation fol- lowing excessive parturient haemorrhage, and the remarkable coincidence in the concom- itants, to give china, and in a high po- tency. I gave half a dozen pellets of Car- roll Dunham's 200th, about noon, to be fol- lowed by a similar dose every four hours. Very little change was noted during the first twenty-fours, except an improvement in the condition of the bowels ; but on the 23d day the mental state was altered for the better in a marvelous degree, and the fever tempera- ture was only 100° F. All her apathy was gone, and she answered promptly and pleas- antly all interrogatories. She took nourish- ment freely, had no perspiration at night, and slept quietly and soundly. 24th day. No new ecchymoses have ap- peared since china was given, and many of the old ones are fading, changing to a mottled and greenish shade. She is now taking two quarts of milk daily ; beside beef-extract. Bowels and kidnej^s acting normally. Temperature at 128 c II I x a . noon, 99.4° F. ; but she is not conscious of any fever. She is very weak, but her mind is bright, and her spirits high. 27th day. She has continued to convalesce nicely. No fever to clay for the first time in two months. Appetite good and 'functions all normal. The ecchymoses are fading slowly. 32d day. She was up and moving about the room to-day. Has had an ounce of Speer's port wine, three times a clay, with her meals, since the 29th. Is in all respects well except extremely weak. Has had no medicine since the 28th, except five drops of dialyzed iron in half an ounce of water, at bedtime. KHUS VENENATA. Skin. — 1. There had appeared red spots, varying from a half to two inches in diameter, especially on the legs below the knee ; these pained her, and underwent all the changes as if caused by a fall or blow, namely, the red changed into a bluish, then greenish-yellow color, leaving finally spots of a little darker tint than the healthy skin. [Poisoning by using a branch for a fan ; Dr. Oeiime, in the JSew England Medical Gazette, vol i, page 121.] 2. There appear upon the skin small ecchy- PATHOGEXEST. 12S? moses ; the expectoration has a bloody tinge ; the stools rarely contain blood. [Dr. Wurmb.] 3. It affects the blood and the blood-making organs similarly to the ijoison of typhoid, scarlet fever, and erysipelas, producing ecchy- moses of the skin, etc. [Dr. W. H. Burt, Physiological Materia Meclica, page 787.] 4. Mr. C. H. B., aged forty-one years ; per- fectly healthy ; strictly temperate ; ha'd not a day's sickness for twenty-five years. He was poisoned by handling rhus vines. Two days after handling the vine the usual vesicular rash appeared upon the skin of both hands, particularly between the fingers, confirming the usual physiological action of this drug. The third day the gums commenced bleeding, ee* chymosed spots, of different sizes, appeared under the surface of the skin in the different parts of the body, particularly the legs, on the conjunctival membrane, on the Ver- million border of the lips, and upon the surface of the tongue. On the seventh day haemorrhage commenced from the bladder and continued seven days. Each passage of urine, which was free and easy, four or five each day, contained a good supply of blood. The haemorrhage from the gams was a continuous oozing, which lasted fourteen days. 130 RHUS. The amount of blood from the gums and blad- der was very great, giving the patient a marked anaemic appearance. The pulse and tempera- ture were not altered from the normal stand- ard until the fourteenth day, when he passed through a critical period ; the temperature rose to 108° Pahr., pulse 140, respiration rapid, which condition broke up by passing into a gentle sweat. After this critical period, the fourteenth day, the bleeding from the gums and bladder rapidly disappeared, and he quickly regained his usual strength and vigor. During the two weeks of bleeding his appetite was good, no headache, slept well, action of the skin normal,- and was even in good spirits. The treatment consisted in maintaining abso- lute rest in bed, a nourishing diet, and the ad- ministration, one remedy at a time, of bella- donna, terebinthina, hamamelis, sulphuric acid, china, and, on the fourteenth day, the free use of the tincture of aconite. Consulta- tions were had with Drs. C. Neidhard and M. Macfarlan, who each confirmed the diagnosis, and related similar cases from the action of rhus. [Dr. Richard C. Allejst, in Transac- tions of the Homoeopathic Medical Society of Pennsylvania, 1883, page 267.] The usual eruption of rhus varies in severity CONCOMITANTS. 131 from the blush of erythema to malignant phlegmonous erysipelas. Concomitants. — Great weakness and. para- lytic heaviness of the legs and feet. Great debility, paralytic weakness and. sore- ness, especially when at rest. Great restlessness and uneasiness ; must con- stantly change position ; especially at night. Burning and itching over the whole body. Crawling or prickling sensation over the sur- face of the fingers ; especially the tips. Tongue red, dry, and cracked ; or sore, with red tip. Great thirst for cold milk. Sensitiveness to the (cool) air. Sleeplessness with restlessness. Clinical. — The subjoined case, cured by rlius venenata, is an instructive illustration of how to find the true homoeopathic remedy. It was not until pathological lore was ignored, and the prescription based solely on the symptoms of the case, that a cure was found. I reported it in the American Homoeopatliist, August, 1885: James S.. aged 29 ; of the bilious type, lean and spare, but not emaciate ; by trade a carpen- ter, but at present employed on the elevated railway ; married ; had intermittent fever sev- 1 32 RHUS. eral years ago, and is somewhat subject to rheu- matic attacks ; applied at the Manhattan Hos- pital for treatment, October 10, 1879. He com- plained of an intense headache, describing the pain as throbbing. He felt dizzy when turn- ing or stooping, but had no nausea. The con- junctiva was reddened and dry. The face somewhat flushed, temp. 100.2; pulse 78, re- spirations 20. The pulse was rather hard, and the heart beat with a sharp click. He was given glonoine 12, every two hours. October 11. Headache no better. The face more deeply congested ; the conjunctiva about as yesterday, but the eyes look more staring. The brain seems to have a wavy, undulating motion whenever he stirs, but especially on stooping. He refuses to take his medicine, as he imagines it disagrees with him, and thinks he has been poisoned. Complains of pain in the left wrist and throbbing in the hand, which seemed to be synchronous with the throbbing in the head. Temp., 100.6 ; pulse, 82, and of about the same general character, respira- tions, 20. A study of the pathogenesy of glonoine con- firmed the impression that it was the remedy most homoeopathic to the case. Glonoine has — Throbbing ; in temples, in vertex, in occi- put, in whole head. CLINICAL CASES. 133 Severe pain in the forehead, throbbing in the temples, worse from walking. Head aches worse ; from shaking or jarring the head, stooping, bending it backwards, after lying down, when ascending steps, in damp weather, in the sun. Vertigo worse : from stooping, or moving the head. Fear: apprehensive of approaching death; fears she has been poisoned. Face flushed, hot, especially about the eyes and forehead, with headache ; livid, purple. Eyes injected, red, protuding, wild, staring. Pulse ; accelerated, increased during head- ache ; quick, small, irregular. Weakness of wrists after headache. Rheumatic pains in fingers of left hand. Feels pulse in fingers. Thus assurred of the homceopathicity of the remedy, although no improvement had taken place, I resolved to continue it, in a higher po- tency. Gave glonoine 200, every four hours. Oct. 12. Patient no worse ; remedy continued as before. Oct. 13. Headache very much improved, and the face and eyes less congested ; but the rheumatoid pains in the wrist had extended to the elbow, and were much complained of. Temp., 101.5 ; pulse, 86 ; respiration, 20. Small 134 RHUS. petechial spots, like flpa-bites, were noticed on the forearm and wrist, and this led to an exam- ination of the skin elsewhere. The patient now mentioned, for the first time, that he had had for some days similar spots upon the legs. The legs from the knee to the ankle were covered with numerous small ecchymoses of varying size, and in some places, where several had coalesced, as large as a silver dime. The knee of the left leg was tender and stiff, and the whole leg was perva- ded with a peculiar sense of weakness and numbness. The patient was very restless and apprehensive ; felt drowsy, but could not sleep ; the bowels, which previously had been regular, were now for three days constipated, with bitter taste, dry tongue, sore gums and inappetence. The petechia, the rheumatic pains in the wrist and knee-joint, the sense of weakness and prostration, the constipated bowels, the symptoms of the buccal cavity, the continued slow fever, and the insomnia with drowsiness, seemed to point clearly to phosphorus, which was given, bi-hourly, in the 6th trituration. Oct. 14. Most of the symptoms remain about the same, but the pulse is 92 and weak, and the temperature has risen to 102.28. The petechia} have increased in number and size, CLINICAL CASES. 135 and have spread to the thighs and back. A slight nose-bleed occurred during the night. He feels greatly prostrated, but is restless and anxious, and his sleep after midnight was disturbed by vivid dreams, in which he thought he was climbing a great mountain, carrying a heavy load. The urine was scanc and dark. Not seeing any clear indication for a change, phosphorus was continued until the 16th inst., in varying potency, third, twelfth, thirtieth, and two-hundreth ; but the patient grew slowly and manifestly worse, especially the pains and prostration. Oct. 16. Temp., 102.4; pulse, 90, weak and trembling ; respiration, 20, shallow, as if un- able to draw a full breath. The ecchymoses had extended over the entire body, and were accompanied by much itching. The pain in the joints very severe, making him extremely irritable and restless. During the night he had had a copious nose-bleed. The urine scanty, with coffee-ground sediment. An error in the remedy used being now ap- parent led to a further study of the case. The character of the pain so closely resembled that of rhus toxicodendron that its pathogenesy was examined, developing the following cor- respondences : Fear of death ; fears he will be poisoned 136 RHUS. Vertigo, worse from turning or stooping, or when rising from lying. Headache, rush of blood to the head, with throbbing ; restless ; face red. Eyes red and inflamed. Epistaxis of coagulated blood, worse at night. Face liery red ; dark-red ; with burning. Food, especially bread, tastes bitter. Tongue dry, red, cracked. Hunger without appetite. Urine diminished ; discharges a few drops of blood-red urine. Pulse accelerated, weak, faint and soft ; trembling or imperceptible. Tearing and burning in the shoulder and arm/ Pains felt mostly in the knee. Swelling and stiffness of the joints. Rheumatoid pains in the limbs, with numb- ness and tingling. Great debility, soreness and stiffness. Restlessness, must change position. Great sleepiness, with sleeplessness until midnight. Dreams of great exertion ; as rowing, swim- ming, etc, Intolerable itching of the skin, with a red rash all over. * C L I X I C A L CASES. 137 Rhus venenata was given, in the thirtieth potency. This was chosen in preference to rhus toxicodendron because of the profound depression of the nervous system, and for the reason that this rhus is said to exert a stronger influence upon the cuticle ; but I had no ex- pectation that it would do anything more than reduce the fever and relieve the rheumatoid pains. In this I was very happily mistaken, for while the pains and the fever abated at once, the ecchymoses also ceased to extend, began to change color like an old bruise, and disappeared within ten days. The nose-bleed did not recur after the rhus was taken, the fe- ver was all gone by the second day, and the wrist and knee supple and free from pain by the fourth. The patient was discharged on October 26, cured. Dr. J. L. Gage, of Vassar, Mich., reports the following case in the American Hbmaeopathist, November, 1885 : 2. I remember distinctly a peculiar case I had some thirty-five years ago. Was called to see a child about a y^ar old. One foot was swelled to the ankle and black, a purple or black spot as large as a dollar on the opposite thigh, and another on side of face. I gave rhus tox. 6 ; in three days it was well. 138 HAMAMELIS. Skin. — 1. An ulcer on inside of lower lip, which had been there for a few weeks before commencing the proving, assumed a more bloody appearance. [Dr. McGeorge ; Trans- actions, American Institute of Homoeopathy, 1874; Mary McC, aged 21 ; took 200th dilution once a week.] Hcemorrhages. — 1. Nose began to bleed be- tween 9 and 10 the next morning, and continued for an hour until I smelled camphor ; with the epistaxis was a feeling of tightness of the bridge of the nose, and considerable crowding pres- sure in the forehead between the eyes, with a benumbed sensation over the whole os frontis ; I was at first somewhat surprised, as in the whole course of my juvenile and adult experi- ence, I had never before been unfortunate enough to get a bloody nose, and epistaxis is something I never knew occur in my family. [Dr. H. C. Preston; Philadelphia Journal of Homoeopathy, vol. 1, page 460 ; from one drop doses of the third dilution.] 2. Profuse epistaxis, checked by smelling camphor ; ten hours after first dose. [Ibid. A young man took third dilution.] 3. Bleeding of the nose, which clears her head, and affords great relief. [Dr. McGeorge; PATHOGENESY. 139 Transactions American Institute of Homoe- opathy, 1874 ; from 200th dilution.] 4. Gums bleed easily. [Ibid.] 5. Active uterine haemorrhage, which alarmed her very much, but which ceased in a few hours after discontinuing the medicine. [A young lady took third dilation ; Philadelphia Journal of Homoeopathy, vol. 1, page 460.] 6. She had been flowing considerably for twenty-four hours and had lost over a quart of blood, bright and fresh, not coagulable, unlike her usual catamenial discharge, which was dark and coagulated generally ; this happened about midway between two menstrual periods ; gave sacch. lac, and the haemorrhage ceased in a few hours. [Mrs. W. ; proving with third dilution. Ibid.] 1. An alarming haemorrhage from the lungs set in suddenly. [A man took Pond's extract for several days, for acute rheumatism. [Pr. Thomas ; Monthly Homoeopathic Hevicw, vol. 1, page 251.] Concom Hants. — Varicose diathesis. Passive haemorrhages. Prickling and stinging in the veins, muscles and skin. Bruised and tired feeling, all over body. 140 HAMAMELIS. Relationship. — Pulsatilla relieved toothache, worse in warm room. In purpura. Comments. — Hamamelis does not appear to have caused purpura. Herpetic and pimply eruptions occurred during the provings, but no petechia or extravasations. Its curative power in this disorder is based entirely upon its action upon the capillaries. It is an irritant to these, and has caused inflammation in them, extend- ing up into the veins ; the result of this is ven- ous stasis, haemorrhages, often very severe and long lasting, and structural changes. Hama- melis does not alter the condition of the blood, and if ever useful in true purpura, the symp- toms will follow a very different sequence from those indicating phosphorus or crotalus. When the extravasations are due to disease in the vein-walls, and especially in persons inclined to varicoses, hamamelis may often prove a po- tent remedy. Clinical. — The following case was reported by Dr. Geo. E. Belcher, in the North Ameri- can Journal of Homoeopathy , vol. iii, page. 463: 1. A. R. S., a man with a hearty constitution, light but florid complexion, and dark auburn hair, after complaining some IS or 24 hours, was taken on Friday with violent fever. I CLINICAL CASES. 141 first saw him on Sunday, and found the symp- toms of a very aggravated type ; pains in the back and head very severe, the face deep red, and the eyes congested. He was restless, and had scarcely slept, and was at times delirious. Gave aconite 2, belladonna 2, alternately, every two hours.in solution. On Monday his symp- toms were generally worse. He had scarcely slept at all, and variolous papulae were abundant on the whole surface of the face, body and ex- tremities, and there was rash between the pim- ples resembling measles. Gave rhus 2x, tartar emetic, 1, alternately, every three hours. On Tuesday evening, about 7, I found that he had passed another restless night, but his mind was clear, except occasional short wanderings, and about noon had epistaxis, which lasted about an hour, and again about 5 o'clock P. M., which continued after my arrival until about 8 P. M. The blood was dark, discharging freely in drops, the pulse rapid, breathing hurried, lips and mouth dry, the face and body were covered (beside the papulae, which seemed to me not to have progressed, but to have shrunken), with a dusty red erythema, with purpuric spots, varying from the size of a pin to that of a three-cent piece, here and there, but over the abdomen, which I more particularly examined, occupying one-third of the surface. 142 HAMAMELIS. The vessels of the conjunctiva were so con- gested as at first sight to appear like chemo- sis. Gave hamamelis, 3 drops of 1st dilution in a tumbler of water, of w T hich a tablespoon- ful was given every 15 minutes. In 20 minutes the haemorrhage had ceased entirely, and re- turned no more. The hamamelis was then continued every hour. I found on Wednesday that he had had one dejection of a dark bloody character, but the purpura had not increased, and he had slept some. Gave rhus and hama- melis, alternately, every hour. On Wednesday night he appeared improved ; the mind and general feeling were better, the rash and pur- pura diminished, and the variola developed confluent. By Friday the petechia had dis- appeared, and afterwards, under the use of tartar emetic, the disease ran its usual course. Dr. Okie, of Providence, R. I., reports in the Philadelphia Journal of Homoeopathy, vol. i, page 538 : 2. A girl, aged 9, was said to be in a dying- state. She was sitting upright, supported with pillows, her breath greatly oppressed. She had been ill about two years, dating her first loss of health to a cough, which was said to have resulted from swallowing a small piece of straw ; since that period she had been tor- CLINICAL CASES. 143 mented with incessant cough. She bled from the lungs pints at a time. She had raised large quantities of offensive matter ; at one time nearly a tumbler full. Examination elicited general anasarca, great swelling of lower extremities ; the abdomen swollen from the areolar infiltrations ; face much puffed, closing the eyelids ; a number of spots, resem- bling purpura, were found upon the lower ex- tremities ; she had been troubled with profuse epistaxis. Ausculatory examination elicited the presence of a very large cavitv, extending from the mammary region to near the base of the right side. The respiration in the left lung was puerile, with a mingling of rhonchi and mucous rales. The urinary secretion was almost nil, the urine itself of a deep, brandy color, depositing a heavy lateritious sediment. I feared a fatal result, and speedily. The scanty urinary secretion and pleuritic pains, the hydropic tendency, and the state of the thoracic organs led me to fear the supervention of anaemia and serous effusion into the pleural sac. Iodine was given ; for about a fortnight she improved ; the urine was much increased, the dropsy lessened, and the respiration easier ; petechiae did not appear ; cough about as usual. At this time she was seized with haem- orrhages, etc., which hamamelis checked 144 HAMAMELI8. promptly and there was no return. The strength, appetite and general health improved, so that she was up and about her usual avocations. She lived about 18 months, but finally died from pulmonary abscess. Dr. John C. Morgan published the subjoined case in the American Journal of Homoeopatltic Materia Medica, 1872, page 237. 3. A babe of nine months had capillary bron- chitis severely. When convalescing, it showed purplish, evidently hemorrhagic spots, on the face, limbs, etc. Regarding it as a capillary venous haemorrhage, I gave four doses of hama- melis 3, in twenty-four hours ; the first at 12 M., hoping to prevent the usual afternoon ad* dition to the number of spots. Not one ap- peared thereafter. The following case, reported by Dr. W. C. Doane, is from Hoyne's Clinical Therapeu- tics, vol. i, page 15 : 4. There w 7 as oozing of blood from the skin, as though it w T as coming from a sponge, and light- colored blood was discharged from the mouth, bladder, etc. The pulse was 35. Aconite and hamamelis w r ere given, and in about a week the patient was well. From such a report we cannot discover why either aconite or hamamelis should have been CLINICAL CASES. 145 given, whether they cured, or whether the case simply got well. That aconite may do good in purpura is not to be denied. In the febrile form of this disorder we may, says Dr. Rich- ard Hughes, gain a hint from the experience of the dominant school. " The late Dr. Parry, of Bath," writes Watson," was the first to point out the efficacy of abstinence, venesection, and purgations, in some instances, at least, of pur- pura. An example of this kind occurred in one of Dr. Latham's hospital patients. The whole tongue was livid, one-half of it pre- senting the appearance of a large, bleeding fungus, and on the inner surface of each cheek were several black, fungoid patches. The patient, also, was voiding unmixed blood from the bowels. In this case there was no evidence of the operation of any debilitating cause, and the pulse, though frequent, was hard. Bleed- ing from the arm always gave relief to his uneasy sensations ; he was purged also, and put upon a low diet. Under this plan he steadily improved, and in four or five days no vestige of the complaint remained, except the fading spots." As aconite so completely replaces phlebotomy here was its opportunity. That this is not an altogether unknown condition is further illus- 146 HAMAMELIS. trated by the subjoined case from the British Medical Journal, of October 1, 1859. Ellen O'B , set. 29, married, was admitted May 25th, 1859. * * * She was quite well three days before her admission, and went to bed feeling as well as usual. During the early part of the night she awoke with a painful sen- sation in her legs, as of needles running into them ; this continuing, prevented sleep ; and, on examining them in the morning, the legs were covered with blotches. She dressed, and continued at her work for some hours, by which time her knees and ankles had become red, swollen, and painful, so that she had to take to her bed. On the following day, her arms had become similarly affected. She suf- fered much from thirst and feverishness. On admission, her countenance was expres- sive of suffering. Pulse 120, full, hard, and incompressible. The tongue was coated and cracked, but moist. The skin, which was hot and dry, presented, on various parts of her body (but most of all on the extremities) numerous blotches or ecchymoses, varying in size from a pin's head to that of a florin. * * May 26th. — She did not sleep for pain, and was very restless. She had great pain in the wrists and ankles. There is a large increase in the number of spots, chiefly on the back and CLINICAL CASES. 147 nates. The dorsum of the left foot appears as if largely bruised. The tongue is foul ; the pulse 120, full, and hard. There is a slight tinge of blood in the saliva, streaking it. The skin is hot and dry ; chere is no acid smell. The countenance is anxious. Dr. L. Houghton Kimball, of Boston, fur- nishes the following case : 5. I was sent for on the morning of Tuesday ^ June 3, 1884, to see Miss Mabel O , a young lady of seventeen. She had retired in her usual health the night before, but awakened to find her body and the mucous membrane of her lips and mouth covered with numerous purple spots. She was very hoarse, with a feeling of pressure across her chest. There was a dry cough from irritation in the throat, and expec- toration of large quantities of blood. Put her on phosphorus 30. In the afternoon there seemed to be more hoarseness and pressure with an almost croupy cough for which a few T doses of kali bichronicum were given. Soon after she commenced passing large quan- tities of blood in her urine for which terebin- thina 3, was given every two hours. Wednesday she continued to cough and ex- pectorate large quantities of blood, and to pass an apparently enormous amount in her urine. Terebinthina was continued. 148 H A M AM E L I S . Thursday showed not much of any change in the symptoms, with the exception of a little less cough and more rest the night previous. Complained of pain in back and across the bowels. Terebinthina was continued. Friday morning — Vomited considerable blood in the night, cough and expectoration of blood considerably less. The spots in mouth and on lips are healing over. Faints on sitting up. Pulse small, weak and frequent. Tere- binthina continued. In the afternoon found her still passing much blood in urine, although the expectoration seemed much better. Bowels very sore and tender and distended with gas, much pain in back. Pulse 120. Gave hamam- elis 3 and terebinthina 3, in alternation every hour. Saturday morning — Slept very well, mouth looks much better, taste natural, no expectora- tion of blood. Bowels less tender and less tympanitic, pulse 100. Passed no urine from seven o'clock last evening till nine o'clock this morning. Then it was less in quantity and showed less blood. Hamamelis and terebin- thina continued, Sunday morning — Fainted yesterday when attempting to walk from the bed to the lounge. Slept well — pulse 100, no expectoration of CLINICAL CASES. 149 blood, a decided lack of urine in the secretions of the kidneys for the first time. Same medi- cines continued. Monday morning — Slept well, pulse 84 — very sleepy and weak. No blood in urine or expec- toration. My patient now showed a steady improvement under the administration of china 30, and soon regained her usual health. TEREBINTHINA. Skin.—l. Turpentine causes an eruption of the skin similar to that of scarlatina. [J. Wharton Begbie, M. D.; Edinburg Medical Journal, vol. 17, 1871, page 39.] 2. A scarlet eruption broke out upon the body (after five hours, second day). [Wilmer ; a man took the oil for tapeworm, one ounce in two doses, within an hour, in the morning, same dose in the evening (first day), one and a half ounce in emulsion in the space on an hoar (sec- ond day)]. 3. On the third day after some pain during the night, the skin of the elbow was found to be spotted with circumscribed dark redness of the bend of the elbow. On the fourth day, there were dark red spots, some of which were intensely red. The appearance in general was similar to extravasation of blood. [Prof. 150 TEEEBINTHOA. Hopper; N. Zeitung fur Horn. Kron., 7, 177, forming by dropping the oil on left elbow.] 4. In 1818, J. A., a young man set. 22 years, had taken, at the recommendation of a layman, one teaspoonful of oleum terebinth inse, for a so- called rheumatic affection of the hip, which was followed by a severe burning sensation in the epigastric region, and copious hematuria with considerable strangury, and small livid spots on the skin of the back and abdomen. [Quoted in the American Hornoeopatliist, vol. vii, page 44 ; original authority not stated. Blood. — 1. Turpentine increases the coagu- lability of the blood, and gives rise to numer- ous minute hepatic and pulmonic thrombi. [Leon Crucis ; De la Terebinthina, Paris, 1847.] 2. Violent nosebleed. [Hartland and Frink's Annals, 3, 118.] 3. Bloody urine. \_Huf eland) s Journal, 91, 100 ; effects on the crew of a ship laden with Turpentine.] 4. Expectoration streaked with blood. — Trousseau and Pidoux, vol. I, page 563 ; ef- fects of one drachm.] Concomitants. — Mind clear, then uncon- COMMENTS. 151 scious, followed by inability to concentrate the mind. Intense pressure and great fullness of the head. Pulse weak, thready, small, compressible. Distressing strangury with great loss of blood. The blood is thoroughly mixed with the urine. Urine scanty and turbid, with epithelial sed- iment. Copious hemorrhages from various organs. The blood is dark for want of oxygen. Tongue red, smooth, and glossy ; burning like fire. Bad effects from living in damp places. Comments. — The relations of turpentine to purpura are not obvious from its physiological effects, and I am not sure of its homoeopathic action. In the process of elimination through the skin it causes a rash, but this is scarlatin- ous rather than purpuric. Its powerful influ- ence on the blood, and its ability to induce multiple hemorrhages, \ may ally it to some forms of the disorder. Clinical. — Prof. T. Gr. Comstock, M. D., re- ports in the North American Journal of Ho- moeopathy, 1861, page 61, the following case 152 TEREBINTHOA. 1. On the 24th of November, I860, 1 was called to see Frank, aged three years, son of the United States Inspector of boilers. Child seemed to be covered over a greater portion of the body with dark reddish, ecchymosed, or purplish-looking spots, which assumed the ap- pearance of petechia in clusters. The peculiar petechial character of the eruption (if indeed purpura may fee called an eruption) was quite an anomaly, and the case struck me at once, before I had' learned its history, as being of unusual interest. The mother informed me that the peculiar spots upon the skin had been there for several days, and did not alarm her because the child was free from any fever ; but for the last two or three days he had passed a little blood while urinating, and during defe- cation, that his nose had bled ; and now blood seemed to be coming from the cavity of his ears, from his mouth, etc., and that the patient was constantly growing weaker. I examined the buccal cavity, and found its whole mucous membrane studded with spots of the purpura, which were well developed, and from which drops of blood oozed out. I regarded the case as purpura hemorrhagica, and prescribed accordingly arsenicum 5, every two hours. Nov. 25, 1860. — Patient to-day is worse— the haemorrhage having increased in quantity; his CLINICAL CASES. 153 urine seems to be almost pure blood, and forms a clot which looks like the substance of an enlarged liver. In addition to the haemorrhage from different parts of the body externally, as well as from the urethra, rectum, cavity of the ears, nose, and mouth, he actually bleeds from the eyes. Child has scarcely any fever, but his pulse is small, fine, and beats 1 20 ; his tongue looks dark — nearly black — and coated. On account of the delicate constitution of my patient, and the very grave character of the dis- ease, in addition to the haemorrhage from all the mucous membranes of the body, and as the quantity of blood passed when he made water, and per rectum was enormous, for he seemed literally to sweat blood ; 1 pronounced the prog- nosis as almost necessarily unfavorable. In this dilemma I concluded to try oleum terebin- thinae, and accordingly seven drops were ad- ministered to him upon a little sugar and repeated every three hours. The symptoms remained much the same for two days after the medicine w^as given ; the haemorrhage was not increased, and the second day I fancied that it had decreased. The child had very little appe- tite, but I gave beef tea and panada with Bor- deaux wine, and the same medicine was con- tinued until the 29th, when a marked improve- ment was manifest, as the haemorrhage had 154 TE REBOTHOA, almost entirely ceased. Without doubt, the oleum terebinthinae acted as a specific in arrest- ing the haemorrhage. I have met with several cases of purpura simplex within the last six years, and have treated them all successfully with arsenicum and secale ; I have also seen in the wards of Oppolzer in Vienna, some very interesting cases of purpura haemorrhagica, and they always made a great sensation, and were carefully observed by a great many medi- cal men, other than those attending regularly the clinic ; but in no case that I have ever seen, where the haemorrhage was so general as the above, terminated with a recovery. Dr. H. Detwiler, reported the following case, in the American Homoeopathist,, vol. VII, Feb- ruary, 1881, page 43. 2. A case of this disease, of a serious nature, occurred in the practice of Dr. A. Shough, in South Easton, in July last. Its history is as follows: Mrs. J. F. S., a widow, aet. 60 years, had complained for several days before the doctor was called, of lassitude, dimished appe- tite, and general malaise, followed by bleeding from the mouth and nostrils. The symptoms present at his first visit, were paleness of the skin; an anxious, alarmed, and confused ex- pression of countenance ; bleeding very freely CLOICAL CASES. 155 from the mouth and nose; tongue coated and covered with dark blood ; phlyctenae in the buccal cavity. Hamamelis 6th, in water, was given in teaspoonful doses, every half-hour for twelve hours, without effect. An alarming prostration of the patient, and an increase of the bleeding from the mouth and nose ensued, to which was added a discharge of dark, coag- ulable blood per anam, and hematuria. A consultation was proposed and the reporter of the case was sent for. Joint examination showed the pulse to be 67 to 70; skin dry, tongue thickly coated with sordes and dark blood ; blood oozing from its side and under surface, as well as \ from the gums and the whole epithelial or mucous lining of the mouth, palate, tonsils and fauces ; three isolated phlyctenae of the size of a large lima bean, resembling thrombi, on the right, and one on the left, inside of the cheek, which were very prominent and from which dark blood oozed freely. Blood was passed per anum without f cecal admixture ; and the urine con- tained black, rather ropy blood, which consti- tuted about three-fourths of its entire quantity; ecchymotic spots or petechise were very numer- ous on the upper and lower extremities, and were increasing in number. Phosphorus was given, but without effect, as we learned on 156 TEREBOTHOA. visiting her ilie next morning, and all the symp- toms had rather increased since our visit on the preceding evening. She now had no appetite ; extreme prostration ; fainting when raising the head ; the pulse was unchanged. Terebinthina 6th cent., six pellets in a tumbler full of water ; of which solution she was to receive a teaspoon- ful every half hour until visible improvement took place, then every hour or two hours. At our next visit we found the patient much better in every respect, and she made a speedy recovery. The bleeding preceded the appear- ance of the ecchymoses on the lower extremi- ties. On the hands and forearms they were observed on the first visit, and continued to increase. Prof. E. M. Hale, M. D., sends the following observation : 3. A case of purpura hemorrhagica, in which blood appeared in the urine was cured by tere- binthina 1 x ; five drops every two hours. Erigerok. Concomitants. — Epis taxis, and other haem- orrhages. Dysuria ; urine scanty. Comments. — Erigeron is an analogue of sul- phuric acid and arnica in extravasations CLIISTICAL CASES. 157 blood into the tissues. Country people use the bruised plant in the treatment of contusions and bruises ; but whether it is capable of set- ling up a condition analogous to purpura, is as yet unproven. Like other turpentines, it pro- foundly affects the blood, and is well known for its anti-hsemorrhagic virtues. Its influence upon the kidney will attract attention to this remedy when those viscera are involved in the hemorrhagic tendency. Clinical. — The following case was furnished by Prof. J. E. Kippax, M. D. : 1. Woman : middle-aged ; the principal symptoms were marked debility, anorexia, headache, sudden appearance of the purpuric spots, which first came out on the lower limbs, and then extended upward over the whole body. These spots were at first of a reddish color, but they subsequently became purple, and were accompanied by haemorrhage in con- siderable quantity from the bladder and uterus, often lasting as much as three weeks. This case was completely cured by erigeron 3 x. Akxica. Skin. — 1. Skin red, hot and (Edematous. [Dr. Black, British Journal of Homoeopathy, vol. ii, page 275.] 158 AEIICA. 2. Erysipelatous inflammation, the left hand also, the well- known anti-Ii*emorrliagic power of sulphuric acid ; and on reviewing all the symptoms, com- plexion and all, I fixed upon that drug. Four doses of the 1600th, (Jenichen), were given within twenty-four hours, followed by sac. lac. No new spots appeared thereafter, and a few days later, all the old ones were gone. Prof. E. M. Hale, M. D., furnishes the fol- lowing observation : 2. A mild case of purpura hemorrhagica was cured by sulphuric acid, first dilution, three drops every two hours, in one week. Dr. J. L. Gage, of Vassar, Mich., published 166 SULPHURIC ACID. the following case in the American Homceopa- thist, November, 1885 : 3. A boy about fourteen years old was terri- bly burned on his face and neck, hands and bare feet by the explosion of a gasoline stove. He made a good recovery, but when nearly well he had blisters all over his hands, inside and out, from the size of a pea to a nickle, filled with bloody water. I let out the blood, gave sulphuric acid 3, and he soon got well. The following case is from the pen of Dr. Hale, of Hastings, England : 4. A gentleman, set. 49, in fair health, with the exception of dyspepsia, began to ail in the middle of March, 1855. He first had a tender and painful swelling over the tibia, with much constitutional disturbance. As that got better an itching papular eruption appeared over the surface. This also disappeared ; but on May 1st bleeding of the gums, followed by epistaxis, occurred ; and Dr. Hale, being summoned, found his patient covered with petechia. ' fc The concomitant symptoms were of a very grave character, an anxious haggard expression of countenance, a hoarse voice, a shabby pulse, cold perspiration on forehead and extremities, and general prostration of the vital powers. * * * 'p} ie fi rs t s t e p i n the treatment was to CLINICAL CASES. 167 administer wine freely ; secondly, to give sul- phuric acid 2 ; and thirdly, to allow the patient to drink freely of orange- juice and water, and to support his strength with strong cool beef- tea and jelly. Improvement ensued, but the next day blood began to pass in the urine in large quantity. On the eighth day, however, all haemorrhage had ceased : and the patient made a rapid con- valescence. Besides the sulphuric acid, ledum 3, and arnica 3 were given. The next case is by Mr. Williams, of Liver- pool, and is so brief and instructive that I give it entire (vol. xvii, p. 288) : 5. On the 19 th of January, 1859, I was called to see a man of spare habit of body, aet. 50, complaining of pains in knees and elbows and wrists. Headache, shiverings, very thirsty, tongue very much coated, bowels were open. There was no swelling of the joints ; the pulse was 100, full. Ordered belladonna 2. On the 20th, the painful joints became swol- len, very much headache, pulse 130. eyes wat- ery and lids swollen, black patches about the size of a sixpence appeared on and over eyelids and on nose, tongue was much swollen, and a great quantity of saliva flowed from mouth. The shiverings continued, urine was scanty and 168 SULPHURIC ACID. high- colored. Ordered acid, sulph. 1, and ar- nica 1, alternately. Next day, purple patches appeared on thighs and legs, much larger than those on face. There was a greater discharge from the mouth. The tongue was covered with a black kind of mucus. The tonsils were much swol- len and ulcerated, gums exceedingly tender, and the fetor from the mouth was most offen- sive. Pulse 130 and weak. With difficulty he could speak, and was quite unable to swallow anything solid, even the medicine caused great pain in deglutition. During the night there was great restlessness and slight delirium. Continue the acid, sulph. and arnica. The day follow- ing the breath was so offensive that with diffi- culty I could stay in the room. His wife was quite unable to bear it ! The other symptoms remained the same and the pulse was if any- thing weaker. I ordered some chloride of lime to be placed in the room, otherwise no one would enter it to attend him. I also prescribed a lotion for the mouth, containing : j of tr. ar nica, to I viij of water, to be used frequently during the day ; and continued the acid, sulph. and arnica. Next day the fetor was decidedly less. No fresh patches appeared. He had rather a better night though the delirium con- tinued ; he complained of no pain anywhere, clinical cases. 169 only in swallowing. The knees and wrists were not much swollen, urine was more natural, pulse 120, weak. For three or four clays no fresh symptoms arose, but the patient was evi- dently sinking. Beef-tea and milk were ad- ministered when he could take it ; also he got wine daily, and continued the acid, sulph. and arnica. On the 29th the symptoms presented a more favorable character, the fetor had entirely gone from the mouth and the discharge was much less. He could swallow better, had some sleep during the night, ft.lt stronger ; pulse 100, not so weak ; the patches began to disappear from the nose and eyes and the swelling to leave the face ; he could speak better. Next day there was a still greater improvement. He felt hun- gry, and had no pain on deglutition ; all the patches were nearly gone from the face ; those on the arms and legs were much less : he con- tinued to improve daily. The patches left the legs and thighs, except one that sloughed, which healed under cold water dressing, and on the 24th February I pronounced him well. The acid, sulph. and arnica were stopped for the last few days. BRYONIA. Skin. — 1. Round, red spots, as large as peas and larger, in the skin of the arm, without sen- 1 70 BRYONIA. sation ; they do not disappear by pressing up- on them. [Hahnemann, from Materia Medica, symptom 411.] Concomitants. — Exceedingly irritable ; in- clined to be angry. Yery morose ; needlessly anxious. Vivid or frightful dreams ; about business or household affairs. Stitching or tearing pains ; in various parts of the body ; aggravated by the least motion ; the fear of pain keeps the patient from moving. Sitting up in bed causes nausea and fainting. Nosebleed and other haemorrhages. Clinical. — Dr. John L. Seward, of Orange, JN". J., published the following case in the American Hom&opatfiist, October, 1885. 1. This patient was an infant, at this time about ten months old, who had always been sickly. The mother's father was scrofulous and asthmatic, and all of his children were del- icate. When I saw this child it was covered with hsemorrhagic patches. Its entire left side and back was one solid mass of extravasation. The right thigh looked as if the child had been thrown on the floor and kicked. I gave arsenic, phosphorus, and china, successively, but with- CLINICAL CASES. 171 out result. One day I noticed that the child appeared to feel worse on being lifted up, and acting upon this hint I gave bryonia 200. The child improved greatly in every way. The pur- puric spots entirely disappeared. The child died the following summer of diarrhoea, but it at no time had a return of the purpura. Dr. Elias C. Price, of Baltimore, writes to me as follows : 2. During the early part of the year 1874, a lady came to see me from Prince Georges County, Maryland. She was about fifty years old, perhaps more. Her mouth and gums were bleeding very profusely ; and on looking into her mouth I found a number of purple blood- blisters on the gums and buccal cavity. I gave her bryonia. In a few hours the bleeding was arrested. I think she only remained in the city about twenty-four hours ; she took bryonia home with her, and in a few days reported her- self as quite well. In 1876, two years subse- quent to this attack, during the Centennial ex- hibition, she went to Philadelphia, and in part- nership with another lady opened a boarding house. I do not think it was more than six or eight months after going to Philadelphia to live, when she had another attack of purpura hemorrhagica, of which she died. 172 CHLORAL. 3. I have had several mild cases since which have yielded very readily to bryonia. CHLORAL. Chloral affects profoundly the nutrition of the skin, and produces various forms of lesion, accompanied by fever and tenderness, and suc- ceeded by desquamation. The chloral-rash, follows by preference the course of the larger nerve-trunks, and remains latent until aroused by some stimulus to the vascular system ; but then appears with an intensity and rapidity which are proportioned to the exciting current of the chloralization (Schule). Most usually the eruption is a smooth, bright scarlet erysipe- las, or a dark erythematous flush ; sometimes it resembles nettle-rash, and at others, measles ; and as a rule it is accompanied by severe itch- ing. This hypersemic condition is extraordi- nary intensified immediately after the inges- tion of the smallest quantity of wine, beer, or spirits (Murphy.) The drug has not often been pushed beyond the stage of intense erythema, with multiple cedemse, the minute cutaneous blood-vessels being visibly dilated ; but in a few cases conditions, evidently purpuric in nature, have been noted, and the ultimate action of the drug in this direction has thus been shown. PATHOGEXESI. 173 1. The pernicious effects which chloral may, under certain conditions, exert, do not seem to be limited to vaso-motor paralysis, or a tran- sient skin neurosis. Two cases which have oc- curred have seemed to demonstrate that they inay also involve the constitution of the blood and the nutrition of the tissues, and may thus imperil life. In these two cases, chloral ad- ministered in the presence of organic disease of the brain, induced what can only be desig- nated acute purpura — a condition in which, with marked constitutional disturbance, there was alteration in the capillaries of the cuta- neous and mucous surfaces, with sub-cuticular haemorrhage and ecchymoses. M. A., female, set. 69, who had been an in- mate of this asylum for many years, and who was subject to periodical attacks of mania, oc- curring every six months, and ushered in by convulsions and coma, entered upon one of her wonted paroxysms on the 1st of March, 1870, and was ordered twenty grains of chloral hy- drate three times a day. This produced sleep and cutaneous anaesthesia, and on the 4th of March a very unexpected result, in the form of a bright red blush, erythematous in aspect, but permanent under pressure, over the chest and shoulders. This blush, on March 6th, had pervaded the whole of the trunk and 174 CHLORAL. limbs, and had become mottled with livid patches and deep red spots. The lips and buccal mucous membrane had contempora- neously become red and raw-looking, the gums spongy, and the tongue blistered and ulcerated in several parts. The breath was foetid, the pulse 120, feeble and compressible, and the general condition that of great debility, with delirious excitement. On March 9 th no ma- terial change had taken place, except that the ulceration in the mouth had become more ex- tensive and distressing ; but onjihe 11th the petechial eruption showed signs of vanishing over the thorax and abdomen, where it had never been so severe as on the arms and legs, and where intervals of yellowish and white skin were now visible. The arms were of a red color, speckled with shreds of white, dead epidermis, partially separated from the sub- jacent cutis, and the lips were covered with sordes and dried blood. On March 15th a sort of general desquamation had set in, the cutis being raised in thick, round patches, like blisters from which the serum had been ab- sorbed, the skin beneath being of a dull purple color, and in some places yellow. After this a large bed-sore formed over the sacrum, and some superficial cracks and fissures presented themselves in the neighborhood of the joints. P A T H O G E X E S Y . 175 Convalescence was however, steadily main- tained, and the patient was soon restored to her usual health. During the progress of this case, from my narrative of which many interest- ing particulars have been necessarily omitted, I had an opportunity of showing it to my friend, Mr. Pridgin Teale, who, without any hint from me, at once pronounced it an example of pur- pura. 2. The second case to which I have referred was that of L. T., a female, aet. 46, laboring under heart disease, left hemiplegia, and de- mentia, with excitement ; who was ordered, as a calmative, on February 24th, 1870, fifteen grains of chloral thrice daily, and who seemed to derive benefit from the prescription until March 15th, when numerous reddish-purple blotches were observed around the left elbow, which, on the following day had enlarged and united with others of a similar kind which had come out on the shoulders and forearm. On March 17th, several livid marks had broken out on the face, while the left arm had become swollen and in- durated, and showed upon its red surface a mass of minute points, or stigmata, of a much deeper red, and not disappearing under press- ure. On the next day, dull-purple spots and discolorations — some small, round, and circum- scribed, others large and regular in shape— 176 CHLORAL. where seen on the leg, abdomen and back ; being restricted, in the latter situation, to a band two inches in breadth along each side of the vertebral column. Along with these pete- chia there was great prostration of strength, a tendency to somnolence, weakness and irrita- bility of the pulse, a raw state of the lips, which were entirely denuded of epithelium, and a fissured and thickly coated tongue. On the 19th of March, the spots and discolora- tions had spread in every direction, and had lost their vividness of hue, having assumed a deep purple tinge. Symptoms of pulmonary congestion also appeared. Strength gradually ebbed ; and after several slight attacks of syncope, death took place on the 22d of March. At the autopsy, thirty-one hours after death, the body was found covered with livid vibices and ecchymoses of various shapes and sizes, largest upon the limbs, smallest upon the abdomen. The ankles and feet were of a dif- fused purple color, and there was much sugilla- tion of dependent parts. Rigor mortis was present. The outer layer of the pericardium was adherent to the heart, which weighed seventeen ounces, had thin walls, dilated cavities filled with decolorized clots, and valves incompetent, and enormously thickened and puckered. There was a sort of cartilaginous deposit on the COMMENTS. 177 outside of the right auricle. The right lung was congested and oedernatous ; the liver was fatty; the capsule of the kidneys were thick- ened and adherent, with wasting of the cortical substance. In the head a large arachnoid cyst was found, coextensive with the right hemi- sphere, which was flattened beneath it. It presented a reddish-green appearance, and con- tained several ounces bilio-sanguiaous looking fluid. The whole brain weighed forty ounces ; the right half weighed eighteen ounces, the left half twenty-one and a half ounces. There were the rusty-brown traces of an old clot in the right corpus striatum. [Dr. Crichton Browne, in a paper entitled Chloral Hydrate : its Inconven- iences and Dangers, London Lancet, April, 1871.] Comments. — In case it might be said that such cases of purpura would not likely be pro- duced in persons who had no brain affection be- forehand, it is important to quote Dr. Browne's remarks on these interesting cases. He says : No question can, I conceive, arise that in the cases just described the purpuric affection was due to the use of chloral. The symptoms which they presented were of an unique kind, and almost unparalleled- in asylum practice at the present day. Purpura senilis is occasion- ally encountered in aged insane women, affect- 178 CHLORAL. ing chiefly the dorsal aspects of the hands and arms ; but purpura of the type exhibited in the above cases is, as far as I know, never met with. The modus operandi of chloral, in inducing this type of purpura, can only be conjectured. It may have been that a blood change was the first step in leading to the lesions observed. It Is not improbable, however, that some altera- . tions or withdrawal of nervous influence, inter- fering with the elasticity and calibre of the ves- sels, may also have been concerned. Whatever the action of chloral on the blood may be, it seems scarcely of a protective or salutary kind, as the two worst instances of typhoid fever in this asylum, during last year, occurred in women who had been taking chloral for some weeks before they w T ere struck down by that malady." Dr. Dyce Brown commenting on these cases in the Monthly Homoeopathic Review, June, 1871, says : These two cases are, to homoeopa- ttiists, extremely valuable, as no remedy we have has produced such unmistakable exam- ples of purpura. The medicines, hitherto known, producing the effects most resembling purpura, are mercurius, arsenicum, and phos- phorus ; but the latter, as Dr. Richard Hughes observes in his Manual of Therapeutics, does not seem to produce purpura symp_ CONCOMITANTS. 179 toms as a primary effect, but only in connection with the morbid state of the liver induced by phosphorus. Not so chloral. Its effects are, therefore, the closest simile possible to pur- pura, and point it out as likely to be of great service in the treatment of this disease. Concomitants — There has been no clinical experience with chloral in purpura as far as I am aware ; but cases with the following con- comitants seem tentatively to be indicative for its use : The mental phenomenon of delirium tremens, when not caused by alcohol. Confusion of thought,, cannot keep the mind to one idea. Eyes bloodshot and constantly watering. Dimness of sight ; transitory blindness ; dip- lopia ; or, photophobia. Eyelids droop. Face haggard ; or, intensely suffused with a deep redness. Gums spongy. Partial paralysis of the organs of deglutition and speech. Gelatinous diarrhoeic stools. Unconscious urination. Dyspnoea ; expiration easier than inspira- 011 . 180 IODU3I. Venous hum in the neck. Profound cutaneous anaesthesia. Indisposition and incapacity for muscular exertion. Utter prostration of muscular strength. . Lower limbs very weak, with sheer inability to put one leg before the other. Frightfully severe pains, particularly about the joints, worse in moist and cold weather ; the pains very strictly resemble the analogous sufferings which are (somewhat rarely) pro- duced by chronic alcoholism ; they do not run in the course of the nerves like neuralgia, nor are they exactly in the joints, like articular rheumatism ; they seem to encircle the limb, the finger, etc., immediately above or below a joint. [Observation by Anstie ; verified by G. W. W. in a case of chloral inebriism.~] Aggravation of the symptoms from even the smallest quantity of alcoholic beverages. IODUM. Skin. — 1. Various species of eruptions, from simple erythema to morbus maculosus (pur- pura). [Rilliet; Memoir Sur VIodisme, Paris, I860, General Effects.] 2. Ecchymosis or purpura on the lower ex- tremities. [Stille ; Therapeutics, I, 731.] COMMENTS. 181 Concomitants. — Emaciation. Ravenous hunger. Hoarseness. Comments. — Iodine has 'a -powerful influence upon the blood, and when its use is long-contin- ued the blood and all the secretions become thin and watery. KALI HYDRIODICU3I. Skin. — 1. Purpura. [Dr. Flagg, Charles- ton Medical Journal, 1848 ; Effects.] 2. Purpura, in a predisposed subject, and of course erythema and other symptoms of iodism. [Tilbury Pox ; Lancet, 1867, vol. I, page 455 ; General Effects.] 3. I have seen it produce on three several oc- casions, after a fortnight's use, a genuine spot- ted disease on the legs of a gentleman ; in the oase of a lady, I ordered it for removal of a very serious tertiary symptoms of syphilis ; it caused toward the termination of the cure a petechial eruption on the lower limbs. [Ric- ord, Bulletin cle Therapie, Sept., 1843 ; Char- acteristic effects in Syphilitic patients.] 4. Phlegmonous swellings, as from bruises. [Houat ; Pathogenesis nouvelles Donniees de Materia Medica.~\ 182 KALI II Y D It I O D I C U M . 5. Eruption on the face (alter some days) ; sub- sequently all over the body ; maculae first of a dark-red color came out, which gradually got darker, until the spots resembled purpura ; the cuticle next became raised over some of the spots, and was filled with a fluid of a purple color, constituting large bullae an inch in diam- eter. [Dr. O'Reilly; New York Medical Ga- zette, quoted in New York Journal of Medi- cine, 1854, page 297.] 6. He presented a most grotesque appear- ance, looking more like a leopard than a man ; he was mottled all over with spots ; those on his face were purple, whilst those on the lower extremities were of a dark-red color ; the spots on the legs came out last ; there were two large bullae on the forehead, one on the lip, two under the left clavicle, two on the inside of the right thigh, one on the side of the prepuce. Mortification seized on the lip ; the patient emitted a most vile smell; his mind was inco- herent ; and vital powers were prostrated to the lowest degree. The patient rallied, the eruption disappeared, and the patient recovered excellent health, but with the loss of the entire penis. [Ibid; another case ] 7. N. F., age 28, Irish, entered Ward 10, PAT II OGENESY, 183 Charity Hospital, December 21, 1870. His venereal history, as given by himself was im- perfect. He acknowledged ; having had gonor- rhoea eight years ago, and again six years ago,, but denied having had any sores upon the genitals, or any of the ordinary early secondary symptoms of syphilis. Last February, eefchy- matous ulcerations made their appearance upon the legs, and it was for these that he sought admission to the hospital. On December 23, a mixture containing twenty grains of iodide of potassium was given him. On the evening of the following day, after having taken only three doses, the patient complained of heat, and a burning sensation in his face and hands, which were observed to be reddened, and the medicine was at once discontinued. On the next day, he had small purpuric spots thickly covering his feet and the lower portion of the legs ; with this were bullae, tilled with purplish fluid, situated on the back of the neck, the face, and upon the hands. In evidence of the fact that this eruption was produced by the iodide of potassium, the patient reported that on three previous occasions he had taken iodide, and always with the same unpleasant results. Prof. B. W. McOeedy, has since told me of a similar case in his practice; and Boinet. (Iodotherapie, 1865, page 68), states that 184 KALI HYDEIODICUM. Cazenave has seen "eruptions of bullae filled with sero-sanguinolent fluid" under similar circumstances. [Prof. Freeman J. Bumstead, M. D.; American Journal of the Medical Sciences, vol. lxii, 1871, page 99.] 8. Virchow has observed the iodide of pot- assium cause purpura hemorrhagica, when administered to a patient with cancer. Concomitants. — Scrofulous and syphilitic affections. Enlarged or atrophied glands. (Edematous infiltration of tissues. Coryza, with pain in the frontal sinuses. Swelling and sponginess of the gums, with ptyalism and fetor of the breath. Comments. — The influence of the iodide of potassium upon the blood cannot be said to be definitely determined ; but it is known to re- duce the vital constituents of that fluid, and its power to produce petechia and ecchymoses is now conceded by all authorities. Iodine and the iodide of potassium are very similar in their effects upon the blood and skin ; and in- deed so nearly are they identical that many excellent practitioners fail to differentiate between them. 185 MERCTJRIUS. Alley, of Dublin, has described a spotted dis- ease of the skin, caused by the use of mercurials, consisting of purplish blotches, and resemb- ling purpura. Dr. Richard Hughes says that mercurius unquestionably causes ecchymoses and haemorrhage, through its action upon the blood, and in the asthenic febrile form of purpura, when the consecutive symptoms indicate that the blood is at fault, he prefers it to any other medicine. Its destructive in- fluence upon the blood is fully recognized by all observers ; its effects are thus stated by Dr. Headland: "By some inscrutable chemical power, of whose agency we know nothing, it is able to decompose the blood: by some destructive agency, it deprives it of one- third of its fibrin, one-seventh of its albumin, one third or more of its globules ; and at the same time loads it with a fatty, fetid matter, the product of decomposition." In the same strain Bartholow observes : " It remains true that any considerable quantity of mercury, ad- ministered a sufficient time, will affect the quality and composition of the blood ; the red globules are diminished in number ; the fibrine loses its plasticity ; the proportion of water is increased, and various effete materials, whose nature is unknown, accumulate/' Stille re- 186 MEKCURIUS. cites the elements of an artificial land-scurvy set up pathogenetically by a profuse and prolonged use of mercurials: "The muscles lose their firmness, fullness, and power ; the complexion assumes a pallid or an earthy hue ; the breath becomes fetid ; the urine is readily decomposed ; and diarrhoea is usually present. The gums grow spongy; the hair falls out; dull pains in the bones and joints are felt ; oedema of the ankles, or even general dropsy, may form ; haemorrhage from the nose, bowels, kid- neys, or reopened wounds, takes place ; and hectic fever, with tubercular consumption, may terminate life." All this reads much more like scurvy than purpura, and I very much doubt if mercury ever takes high rank in the ordi- nary forms of this disease. In anomalous cases, however, it may prove the true siviilia ) and become the only drug capable of saving the life of the patient. Whether the subjoined case, furnished by Dr. Buchmann, of Alvensleben^roves anything as to the purpura producing power of corrosive sublimate, or whether the ecchymoses were due to iodoform, I will not venture an opinion ; but give the case a place here as an interesting study in pathognomonic effects, as reported by a capable and discriminating practitioner. PATHOGEIESY. 187 March 4, 1885. A. Fr., 4f years, girl, com- plained of pains in the left meatus and externus which increased to the 7th, and resulted in loss of consciousness. The physician called diag- nosticated scarlatina, and ordered wrapping the child in cold sheets. Besides R. Acid muriat. 1:160 internally. March 9. Ill-smelling, purulent discharge from both ears. March 16. The abcess was opened above the left mastoid process. Deafness. R. Solut, sublim. 5,0 in alcohol 40,0 D. S. poison, to use with 5 liters of water. One liter daily was used for injection into the opening of the abcess, and into the ears. % A part of the solution went through the Eustachian tube into the throat and was swallowed. After each injection iodoform was blown in by a rubber tube, though an allopathic journal had warned against the simultaneous application of iodo- form and corrosive sublimate. March 25. R. Chinin. mur. 0,1 with one drop of acid mur. in a wafer, for the bleeding from the abcess opening, was vomited up again, and no more given. March 26. Ecchymoses and petechia first on the legs, then all over the skin of the body, except in the face. Sponginess of the gums, bloodv mucus in the mouth. 188 MERCURIUS. March 27. Blood urine. An allopathic physician, called in on the 28th, in the morn- ing declared the case incurable, but neverthe- less, ordered liq. ferr. sesquichlor; which was not given, however, as the child would not take it, March 28. Afternoon. I was called in. The smell of iodoform, which to me is intolerable, caused me to remove the child from the sick- chamber into another room. Status prsesens: frightful, pale, gray face, lusterless eyes, dys- pnoea, pulse hardly perceptible and uncountable. Deafness. Sleeplessness. Stinking, black, tough mucus in the ears ; black, tough mucus in the mouth ;. black, coagulated blood evacu- ated from the bladder. (Edema of the lower extremities. Skin like as if it were sown over with ecchymoses and petechia, except on the face. The child moves no limb, not even the eyes, and has taken no food, but water to-day. No sleep at night, and constant moaning. Gave arsenicum 30, every three hours. March 29, A. M. The child is reported to have slept some, to have taken milk, to have less dyspnoea. From the beginning I was of the opinion that a cure might be possible only in oneway, viz., if it would succeed, by the greater affinity of a high potency of similar action to the morbific cause, to drive this out, and I PATHOG.ENESY-. 189 thought mercurius viv. to be adequate for that purpose, but I did not have it at hand when needed. I, therefore, now sent three globules of mercurius vivus cm. Fincke, in a paper with sugar of milk, to be diluted in a cup of water, and one teaspoonful to be taken every two hours. March 30, 2 P. M. When I called they told me that last night, at 8 o'clock, such a strong odor of iodoform Issued from the mouth, nose and ears of patient, that the whole room was filled with it, and they had to open the windows in order to enable me to stay in the room. This odor disappeared as suddenly as it came at 5 o'clock this morning, after it had lasted all night. The child has taken more milk. Pulse 120. Dyspnoea gone. Stinking, blackish, brown secretion from the ear. No blood in the mouth. Gave nitric acid 200 (Lehrmann) every third hour. April 1. — Mouth without blood. Urine straw-colored, perfectly transparent. Petechise and ecchymoses pale. The child can speak again, and looks much better. Desire for beer. Continued the nitric acid, as before. April 3. — Profuse epistaxis. Tamponaded with cotton, moistened with liq. ferr. sesqui- chlor., and gave china 30, every third hour. April 4. — Great debility ; continued china as before. 190 MEECtJRITJS. Aprils. — Petechia and eccliymoses and oedema have all disappeared. Increased suppuration from the ears : ill-smelling, but not bloody. Gave one dose of silicea, in the evening. April 12 — She can stand on her feet. At noon she eat soup, for breakfast took white bread, and for supper the same with milk. April 15. — Suppuration from the right ear only. The abcess-opening not quite cicatrized. Patient can walk again. Gave Pulsatilla 6, three times a day. April 22. — Abcess forming behind right ear ; on opening it a profuse purulent discharge. Gave one dose of aurum 30, in the evening. May 2 — The discharge from the abcess be- hind the right ear has ceased ; hearing pretty good. Otherwise perfectly well. [Translated from the AllgemeineHom.Zeltung^vol.llO^age 180, by Bernhardt Fincke, M. D. ? Brooklyn, New York, and reproduced here from the American HomoeopatMst, vol. XI, page 285.] erPRinr acetioum. Skin.— Petechial spots on neck and arms. [Journ. de Councils, 1843 ; a woman poisoned by verdigris.] Concomitants. — Irritability with indifference; weeps much ; constant restlessness, as if some misfortune was impending. CONCOMITANTS. 191 Nervous trembling, with restlessness. Cramps in the legs and feet, with great rest- lessness ; extensor muscles most prominently effected. Chilliness over the entire body ; most severe in the extremities. Great muscular weakness. Gums ulcerated ; mouth dry. Thirst for cooling drinks, which relieve the gastro-intestinal symptoms. Menses suppressed, with violent, unbearable cramps. Dyspnoea, as from inhaling acrid vapors. Paralysis of muscles of the back ; of the limbs ; without loss of sensibility. Comments. — Copper produces vaso -motor paralysis, and, therefore, moves in the same plane as does the influence, whatever it may be, that causes purpura abruptly in persons apparently in the enjoyment of perfect physi- cal health. It has, as far as I am aware, no in- fluence upon the blood, and cannot, therefore, benefit cases that depend upon, or are compli- cated with, changes in that vital fluid ; but there are doubtless many cases which are pure- ly neurotic in origin — and neuroses as a cause of skin diseases are assuming more and more importance in dermatology as the pathology of these disorders is more accurately evolved from 192 C U P R II M . the obscurity which has always enveloped it — and in such, cuprum, when indicated by the concomitant conditions, may yet achieve dis- tinction, and prove indeed a friend in need. Clinical. — The following case, reported by Dr. Kissel, is from Hoyne's Clinical Thera- peutics, vol. ii, page 237 : 1. A girl, seven and a half years old, blonde complexion. She had been for eight days sown ''broadcast" with dark red spots, from the size of a millet-seed to a shilling. These spots Occupied the upper half of the body, the chest, upper arms, face, and mucous mem- brane of the mouth. Otherwise her health seemed undisturbed. Urine normal. The number of spots increased ; on the fore- head, both eyelids, and elbows, bluish ecchy- moses of the circumference and height of a half walnut arose. From one alveolar process from which the child had herself extracted an incisor tooth two days before, blood con- tinually flowed ; her cheeks and lips were pale ; strength gone. Staller's acid stopped the tri- fling alveolar haemorrhage, but by no means proved a true remedy for the disease. For, after eight days, a boil of the size of half a moderate apple developed itself on each shin- bone. The cuprum aceticum at once arrested the progress of the disease and cured her. 193 SAXGUIXAEIA. If there was anything in the doctrine of sig- natures, and who will venture to say that there is not the basis of a genuine therapeutic idea, blood-root should certainly be a precious rem- edy in purpura. In the slow evolution of therapeutic knowledge, sanguinaria has not yet achieved any special distinction in this line ; but, there are several reasons for suspecting that it will yet be acknowledged as a valuable remedy in ecchymoses, the most important of which is that, in one well-attested case, it has caused them. Beside this, sanguinaria has a well-known influence in causing paralysis of the entire vaso-motor system : and as has been pointed out. on previous pages, vaso-motor de- bility is the inciting, if not the veritable, cause of some of the cases of purpura. Again, sanguinaria affects all the mucous tissues pro- foundly, and while a more thorough study of the drug may not show the same degree of le- sion produced on the cutaneous as on mucous surfaces, yet we know that all remedies that effect one influence the other. It may, there- fore, be safely stated that sanguinaria is a drug which we cannot afford to lose sight of in the discussion of the therapeutics of this disorder. The following very instructive case was re- ported by Dr. William M. Decker, of Kings. 194 SANGUINARIA. ton, New York, at the semi-annual meeting of the New York State Homoeopathic Medical Society, at Ithaca, in September, 1883, and is published in volume xix of the Transactions, from which it is quoted : The subject of this disease was the second child of good parentage ; a male, aged three years. Temperament, leuco-phlegmatic. Head and frame large and well-proportioned. Tissue largely adipose ; muscles flabby. Complexion blonde. Mentally bright, with a jolly, good- natured, playful disposition. The child has an asthmatic or catarrhal diathesis, and easily catches cold; but, excepting an occasional attack of asthma, and repeated coryza and mild laryn- gitis, had been usually well up to the time of this sickness. His appetite was good, and he was very fond of cow's milk, upon which he mainly subsisted. He drank the milk cold ; and soon after drinking it, the surface of his body would be cool, his face, and especially hi§ ears, pale, cold, and anaemic. This condition, and his susceptibility to catching cold, are sug- gestive of a lack of vital force. For a short time previous to the manifestations of the dis- ease he drank milk from cows, which were fed cotton-seed meal for the purpose of increasing the quantity of their milk ; but this, I believe, had no influence upon the disease. Just pre- PATHOGENESY. 195 ceding the disease he either had catarrhal laryngitis or asthma, for which an old school physician administered sanguinaria canadensis, and by mistake gave an overdose, which produced intense nausea, emesis, and consider- able prostration. The following day there ap- peared, just under the skin, blotches of ecchy- moses, first on the lower extremities and but tocks, and, a few days later, *m the arms. In Appearance these blotches were first a mottled scarlet ; and after twenty-four hours they would become darker, then dark purple, and later green, and finally yellow — thus under- going the same changes in color as ecchymoses from a bruise. These subcutaneous haemor- rhages became multiple. The effusions fre- quently coalescing ; but each blotch, or collec- tion of effusions, was usually separated from its neighboring blotch by a clear but short in- terval. The effusions were larger on the lower than on the upper extremities, and largest of all on the buttocks, where there were discolorations as large as the palm of a hand. As one set of blotches were disappear- ing, fresh ones would form, so that it was not uncommon to find effusions in all the various stages of change on the body at the same time. These haemorrhages, however, did not come and go periodically, or with any regularity ; 196 SAISTGUIISTARIA. but when they did appear it was usually in the night, and would be first noticed the next morning. Effusions did not occur on the trunk above the waist, nor on the head, excepting a very few miliary effusions in the external ears. The effusions were, therefore, limited to the ex tremities, with the exception of the buttocks and ears ; and were generally larger posterior- ly than anteriorly. Accompanying these ec- chymoses there was intermittent fever, aro- rexia, partial insomnia, and anasarca confined to the extremities — more in the legs than in the arms. There was no fever in the forenoon ; and then the child was somewhat playf ul ; and could use his legs freely, and made no com- plaints. But every afternoon about 2 P. M.. a slight fever would come on and disappear again before the next morning. During the fever the child was cross and fretful and de- sired his mother to hold him. He also com- plained of his legs hurting him, and would not stand on them, nor walk, unless made to do so. When forced to w r alk he did so with difficulty and complaining ; and his walk was stiff and clumsy. The anasarca was worse in the after- noon, as were all his symptoms, inconsequence of the fever. There were no internal haemor- rhages ; and the gums were not soft and spongy, as in scurvy. His bowels were regular ; and he PATHOGEXESY. 197 had no headache, chill, or sweat. None of the purpuric blotches were elevated above the sur- face of the skin, and none suppurated. After- noons, when the disease was at its worst, his flesh was sensitive to pressure. The old-school physician, on the appearance of rhe purpura, administered calomel ; but when I first saw the child, a few days later (and by the way, I only saw him once, and then was in the house with him for twenty- four hours), I substituted lachesis, sixth cen- tesimal trituration, a powder every two hours. The next morning a fresh lot of effusions were visible ; and his general condition was no bet- ter. I then decided that arsenicum was a more appropriate remedy, as h covered the anasarca, the fever, and general condition ; and pre- scribed the sixth centesimal trituration, at first every hour for a short time, and then every two hours. The following day the child was very much better. The anasarca of the legs had di- minished considerably, the afternoon fever did not come on until two hours later than usual, and then with less severity. Arsenicum was just the remedy ; the convalescence began with its administration. The anasarca quickly dis- appeared ; the afternoon fever was vanquished in two days, and in two days more the cure was completed. On the night of the second 198 S A 1ST G U I 1ST A R I A, day after beginning arsenicum, there appeared a slight crop of purpura ; but, with this excep- tion, nothing marred a very speedy recovery. The whole duration of the disease was not more than two weeks ; and had arsenicum been administered at the outset instead of calomel, and afterwards lachesis, I verily believe the disease would have yielded almost immedi- ately. It is interesting and instructive to notice the parallel between Dr. Decker's case and the well-known symptoms of purpura rheumatica (the jjeliosa rheumatica of Schonlein). Dr. Decker's Case. Subject young, aged three years, but had suffered from no previous attack of rheu- matism. Purpuric blotches varying in size from a ten-cent piece to the palm of a hand. The purpuric blotches oc- curred on the lower and up- per extremities, but not on the trunk above the waist. On first appearing the blotches were bright red (scarlet), and did not disap- pear under pressure ; that is they were true extravasa- tions from the first. Purpura Rheumatica . Usually attacks young subject with delicate skin, who have already suffered from rheumatism. The purpuric spots vary in size, but are mainly small and round — from pin-head size to that of a split pea. The purpuric spots occur mainly on the legs, and about the affected joints. The spots at first may be due to simple hyperemia, and in that case disappear under pressure ; but even so they quickly become hemor- rhagic, and darken in color. PATHOGEN 32 SY 199 Dr. Decker's Case. The extravasations oc- curred in the sub-cutaneous ceJlular tissue — rarely in the skin. No elevations, from ex- travasations, above the gen- eral surface of the skin. The ecchymoses appeared in successive crops, without regularity or periodicity. The purpuric blotches un- derwent the same changes in color as a bruise. Complained of pain in the legs only in the afternoon. Purpura Rheumatica. The extravasations are in- to the tissues of the skin, and except in very grave cases do not, to any consid- erable extent involve sub- cutaneous tissue. When the patches are large and discreet they are often perceptibly elevated ; apparently from local cede- mae of the cutaneous, and perhaps likewise of the sub- cutaneous tissues. The purpuric spots fre- quently alternate with at- tacks of rheumatoid pain in the joints, as one becomes more pronounced the other lessens, or disappears. This alternation may go on for weeks. The striking resemblance of the ecchymoses of traum- atism and of purpura, has been dwelt upon by number- less observers ; but the pur- puric spot is apt to ripen and fade at a quicker rate then an ordinary bruise. Pain in the legs, more par- ticularly in the neighbor- 200 SANGUINAEIA Dr. Decker's Case. Legs swollen and slightly cedematous — no pitting on pressure. Fever intermittent, came on about 2 P. M. and Purpura Eheumatica. hood of the joints, is often the preliminary of an attack of the rheumatic form of purpura. , Legs swollen and oedema- tous. Fever generally accom- panies the attack. The disease usually lasts several weeks, with repeated relapses. The disease did not last but about two weeks. It, however, gave every evi- dence of persistence, and if it had not been brought to an end by the administra- tion of the appropriate rem- edy, would probably dragged along for a considerable per- iod before the toxic influ- ence of the sanguinaria was completely exhausted. The question naturally arises, was the appearance of the ecchymoses, within twenty- four hours after an overdose of sanguinaria, a pathogenetic effect of that drug, or a mere coincidence ? Dr. Decker is of the opinion that sanguinaria induced the disease, and I think the inference is well taken. The follow- ing correspondences are worth noting. PATHOGEKESY 201 Dr. Decker's Case. Afternoon fever about 2 P. M., daily. Rheumatoid pains in the legs which came on every afternoon and disappeared before the next morning — worse in the evening and at night. Sanguinaria Pathogenesy. Afternoon fever, with cir- cumscribed red cheeks. Fev- er 2 to 3 P. M., daily.— Her- ing. Febrile condition came on at 2:30 P. M., not as severe as the day previous, and passed off between 8 and 9 P. M. (fourth day); the fever recurred four or five days, gradually subsiding, yet very regularly between 2 and 3 P. M. [Dr. Tinker, Trans. Arner. Inst, of Horn., 1870 ; proving, with tincture of dried root, 10 drops first and second days.] In the evening the leg and foot swelled, with terrible burning pain ; she did not know where to lay the limb; the pain lasted until mid- night : she had to nurse the limb continually ; after mid- night the pain became eas- ier, but continued until the next day [Compilation by Dr. A. K. Hills, North Arner. Jour, of Horn., N. S., 3, 359. Arranged by Dr. B. Fincke]. Most of the symptoms seem to be aggravated in the evening. [C. Herixg, 202 SANGUINARIA Dr. Decker's Case. On walking in the after- noon all the joints seemed to be stiff. Both legs swoll- en, and slight anasarca, most marked at night. Com- plaining of pain in the legs. Sanguinaria Pathogenesy. New Archiv. fur Horn., 2, 2 y 114]. Rheumatic pain in left, also inside of right thigh. Bruise-like pain in thigh. Wandering pains worse at night [Ibid.] Stiffness and tension in the hollows and sides of the knees. [Dr. Huseman, prov- ing with sixth dilution]. Extremely weak in the knees and lower extremities in the evening. Bruised pain in the left hip-joint, when walking. Stiffness in the limbs. Pain in the left foot. Burning in the soles of the feet, worse at night. [Dr. Bute, effects of first di- lution]. Muscles apparently lame in the afternoon, and sensi- tive to moderate pressure. Severe rheumatic pain in lower extremities, so severe as to cause serious lameness in walking. [Dr. Tinker, loc. cit.\ Left leg aad foot swell, at 4 P. M. [Dr. A. K. Hills, loc. cit.] Stiffness of the nape of the neck. Rheumatic pains in the nape of the neck, shoul- PATHOGENESY. 203^ Dr. Decker's Case. Restless and wakeful. Loss of appetite. Numerous hemorrhagic effusions just under the skin, and in the cellular tissue, of various sizes, the most of them as large as a fifty cent piece, and some of them as large as the palm of the hand. They came in suc- cessive crops on the legs, buttocks and arms, and al- ways in the night. Sanguinaria Pathogenesy. ders and arms when touched. [Dr. Bute ; effects of first dilution.] Restless tossing all night, with troublesome dreams. [Dr. Tinker, loc. cit.] Passed, a very restless night till toward morning perspiration broke forth freely, when most of the se- vere pains abated. [Ibid.] Little sleep, many busy unpleasant dreams. [Dr. B. Fincke, loc. cit.] Almost a total loss of ap- petite. No desire for food. [Dr. Tinker, loc. cit.] Longing for indefinite things with loss of appetite. Loss of appetite with uncer- tain cravings. [Dr. Bute,. loc. cit.] Loss of appetite. [Case of poisoning ; Amer. Jour, of Med. Sciences, 1841, 2,506.] Although the pathogenesy of sanguinaria shows, as far as I am aware, no other case, beyond Dr. Decker's, of purpura, yet in the judg- ment of many excellent practitioners it has a positive action upon the blood and blood-vessels. The Eclectic physicians rely upon it in the treatment of hasmor- 204 SANOUINARIA Sanguinaria Pathogenesis. rhages, particularly epistax- is, menorrhagia, and haem- optysis. E. M. Hale sug- gests it in sanguinous apo- plexia, and when the gums are spongy and bleeding ; while Burt asserts its cura- tive power in haemorrhoids. It certainly has a very im- portant and characteristic action upon the pulse-rate and tension as is shown in the experiments of Tully Downey, Bird, and others. Clinical. — The following case has been only quite recently under observation, and amply illustrates the power of sanguinaria in the cases for which it is adapted : Mrs. E. F. H., a widow, aged sixty-three, a former patient of my father's, but whom I had not seen for some years, applied for treatment on July 17th of this year, for a peculiar form of rheumatoid pain in the hands and forearm. She had been a rheumatic subject for a score or more of years, but the pains had formerly been in the shoulders and in the "neighborhood -of other large joints. She had, at this time, no pain above the elbow, the rheumatism hav- ing confined itself to the parts below that CLINICAL CASES. 205 point, and to the feet, for about eight or nine months ; but the right shoulder was per- manently crippled by the former attacks, and so stiffened that she could not bring the hand on that side to her head, and all backward movement was greatly abridged. Digestion was, and had been for years, enfeebled ; still she could with care prevent any serious attack of dyspepsia. The bowels were, naturally enough, torpid ; but she had two or three fair- ly good stools each week, unless she permitted her stomach to be overloaded with food diffi- cult (for her) of digestion ; which indiscretion was usually followed by a sharp attack of diarrhoea. For some time the pains in the hands had been growing more and more severe, until at last, after having passed a restless and , distressed night, she applied for relief very early in the morning of the day already men. tioned. Seven of the joints of the right hand, and three on the left, were swollen,' hot and painful. She described the sensation, u As if they were on fire." The actual local temper- ature was not much increased, as far as I could judge by contact, and the bodily temperature was even slightly sub-normal, but the subject- ive sensation was one of violent heat in the painful parts. With this was a tired feeling, and a sense of weakness, which may have been "306 SMJGUINARIA. mainly due to the loss of sleep. There was a noticeable exacerbation of the pain about sun- down, which continued until midforenoon, when there would be considerable relief until again in the afternoon. A study of the stomach symptoms showed a rather indifferent appetite, chough a sufficiency of food was in- gested. An excess of fatty or richly nitroge- nous foods caused burning pains in the stomach, slight nausea, never going on to vomiting, re- gurgitations and eructations ; this being fol- lowed, as I have already said, by papescent or liquid stools. She was naturally of a very bright and sunny disposition, but it seemed to me, from the remarks she let fall about her surroundings, the people she lived with, and other matters, that she was in a rather querel- lous mood. The whole case reminded me so forcibly of sanguinaria, that I decided to give that remedy in the sixth decimal trituration. Sanguinaria has the following symptoms: Very irritable and morose, and impatient at the least trifle. Irritability ; she could break things to pieces without any cause. Appetite much impaired. Loss of appetite, with uncertain cravings. Aversion to butter. Violent, though transient, gastrodynia. CLINICAL CASES. 207 Spasmodic eructations ; frequent eructations of a bad odor ; eructations of wind from the stomach. Regurgitation and disposition to vomit. Bitter vomiting ; it sometimes occasions vomiting, but more especially burning at the stomach. Slight nausea, with a burning at the stomach. Disagreeable sensation at the stomach ; sen- sation as of indigestion ; heavy, dull sensation, with qualmishness, eructations, and very dis- agreeable feelings in the stomach. Burning sensation in the stomach. Stools soft (first days) ; hard (latter days). Five natural evacuations in one day. Rheumatic pain in the right shoulder. Violent pain in the shoulder joint. Rheumatic pain in the right forearm. Redness of the hands with violent burning. Violent pain in the right hand close to the index linger. Ulcerative pain in the right thumb, after- wards in the left, then extending to all the fingers, one after another. Cutting pain in the joints of the finger. Burning pains in the feet, worse at night. Sensation of weariness and lassitude through- out the system. Great weakness ; very great prostration of strength. 208 sanguinaeia. Most of the conditions aggravated in the evening or at night. As I was preparing the medicine we con- versed on various topics, in the midst of which she incidentally called my attention to a pecu- liar condition of her skin. About the wrist, and extending upward to the elbow, in the region of the clavicle, upon the thighs, and on the dorsum of the feet and balls of the toes, were little round, and roundish, purpuric spots, varying in diameter from the six- teenth to half an inch, but mostly quite small. They were painless, were unaffected by pressure, each lasted several days, gradual- ly fading like a bruise, and were most profuse on the right side of the body, and on the posterior portion of the limb. This had been going on for several years, now better, now worse, but never quite disappearing, and on the whole being more definitely pronounced, and larger in size, season by season. There was no history of haemorrhages. I remembered Dr. Decker's case, as it very much interested me at the time it was read, at the Ithaca meeting, and wondered whether sanguinaria would show any effect here, but as I did not know of the purpuric spots at the time of deciding upon the remedy, these had no influence in the selection on sanguinaria. I CLINICAL CASES. 209 saw nothing further of this patient for five or six weeks, when she called to report that the medicine had helped her very much, and to say that she had had during the past month less rheumatism than for any like period for years. The purpuric spots had completely vanished, and have not up to this date (four months) returned. She has now only transient rheumatic pains, rarely severe enough to cause actual suffering, but the affected joints remained enlarged and stiff. She still takes a dose of sanguinaria whenever she has a paroxysm, and it seems to quickly lull the pain ; she has taken no other remedy whatever since the middle of July last. HYDROCYANIC ACID. Prussic acid disorganizes the blood, rendering it bluish-black and noncoagulable. From its fugaciousness it does not seem probable that its influence is permanent enough to produce purpura, and it is introduced here merely on account of its apparent usefulness in the subjoined case. Clinical. — Prof. Reuben Ludlam, M. D., published the following case of purpura haem- orrhagica at the climateric, in the Chicago Clinique, January 15, 1885. (Volume VI, page 31). A number of remedies had been used, but the patient finally recovered under hydrocyanic acid. 210 HYDROCYANIC ACID. 1. Mrs. B., aged forty-eight years, has .been married thirty-one years. She has had five children and three miscarriages, the last being a miscarriage at four months, which occurred about seven years ago. The menses appeared soon after her twelfth birthday, at which time she contracted a severe cold by washing her underclothing and putting it on again while it was still wet. Her menstrual history from that time is one of great irregularity, the menses usually being too frequent, too profuse and lasting for a long time. Sometimes, however, six weeks would pass without their appearance, but the flow was always profuse and long-last- ing. The menses were usually preceded by an intense headache, with a flushed face and intolerance of light or sound. Epistaxis was frequent, and it often occurred several times a day. Four years since she was treated for some displacement of the uterus, and wore pessaries of various sizes, shapes and material. These manipulations and instruments produced intense pain and inflammation, which finally resulted in a pelvic abscess. For the last two years her menses have been absent at times for three months ; then again there would be an interval of two to six weeks. They were always profuse, continuing from ten to fourteen days. In the CLINICAL CASES. 211 latter part of October, 1884, she observed numerous dark purple spots on the lower extremities. Their appearance was preceded by aching and weariness of the limbs, with profuse menorrhagia and frequent haemorrhage from the nose. The night of November 4 she was attacked with vomiting and diarrhoea, the stools and ejecta consisting mostly of blood. The physician who was called prescribed the inevitable Ergot, gave a guarded prognosis, and was altogether so indifferent that they for the first time resolved to try homoeopathy, and November 8 I was called to attend her. I found her frightened, anxious, with a weak, almost imperceptible pulse, the lower extremities cold and oedematous, and covered with a purplish eruption to the hips, the spots varying in size from that of a pin head to a ten-cent piece, and they would not disappear from pressure. There was constant nausea and occasional vomiting. The conjunctiva was injected, but no haemor- rhage had appeared from the eyelids, the ears or the mouth. There was no fever present, and the general health seemed unaffected, with the exception of the extreme weakness and tendency to faint. These symptoms were relieved by appropriate remedies. The eruption still at times makes 212 HYDROCYANIC ACID. its appearance, and is at first of a bluish-purple, changing successively to greenish, blue-brown and yellow. The haemorrhages have not been repeated since she came under my care, although the menses appeared after being delayed two weeks. Previous to the petechia making its fresh appearance there will be fugitive rheu- matic pains in the limbs, then in the back and chest or head. When the head was affected the pain was agonizing, compelling screams from the patient, and was accompanied with a cold perspiration upon face and hands, and a sensation of coldness in head. For this condi- tion wratrum alb. did good service. The next morning the petechial spots covered the scalp. When first called ipecac, was indicated and given ; but lachesis 6 and 30, phosphorus 3, ledum 3, arnica 3, and arsenicum have been the remedies prescribed as the symptoms called for them. Mental and physical rest was strictly enjoined. Tea, coffee, and stimulating food or drinks were rigidly prohibited, and all food and drink were taken cold, and as little of the latter as was prac- ticable. Lemonade was allowed in moderate quantities. She had always been accustomed to a stimulating diet, with an occasional glass of wine or beer, which was of course denied her. This case, which I am privileged to show you CLINICAL CASES, 213 through the kindness of our friend, Dr. C. T. Canfield, is a rare and a very interesting one. Its whole clinical history, the epistaxis, the irregular and copious menstruation, the cerebral congestion in advance of the monthly cycle, and the appearance of the peculiar spots which you have seen upon the legs of this patient, are so many points for study. The derangement of the menses through chill from wearing wet clothing at their first appearance was a mis- chievous factor of the subsequent ill-health ; and the approach of the climateric undoubtedly has to do with the development of purpura at this time of life. The treatment that she has received from Dr. C. was skillful and appropriate. Under it her last two periods have been only six weeks apart, and the flow has continued but four days instead of ten. Her general condition and spirits are greatly improved. The case has been well managed and the only suggestion that I have to offer is to put her upon a medium attenuation of hydrocyanic acid, which I have found to be a very useful remedy in other forms of purpura hsemorrhagica. The patient was given hydrocyanic acid 6 and 30 in alternation, and recovered rapidly. LEDUM. Skin. — Bluish spots, like petechia, over the 214 LEDUM. whole body. [Hahnemann ; Materia Medica Pur a. Vol. iii, page 20.] Concomitants.— -The limbs and whole body are painful, as if bruised and beaten. The eruption burns and stings like insect- bites. Sensation of coldness, all over. Comments.— Hahnemann, as early as 1796, in Huf eland's Journal, called attention to the value of ledum in cutaneous diseases ; and Teste, in his Materia Medica, affirms the value of ledum in insect-bites, which are a sort of traumatic petechise. Ledum will probably never achieve a considerable reputation in the cure of purpura ; but in the gouty diathesis, and in that form of purpura which has been denominated peliosis rheumatica, it may prove of real service. In the subjoined case the ap~ pearance and location of the purpuric spots are such as we might reasonably expect in the le- dum case, but the profuse nose-bleed is not a characteristic symptom of this remedy. Clinical.— The following is reported to me by Prof. J. R. Kippax, M. D., of Chicago: 1. The purpuric spots were small, and ap- peared mostly on the lower extremities near the joints. The patient suffered from profuse and long lasting epistaxis. Cured promptly by ledum 6x. 215 BERBERIS VULGARIS. Skin. — Two small red spots on each side of the forehead. On the forepart of the left shoulder three small, mottled, dusky-red spots. On the forepart of the right shoulder, two dusky-red mottled spots nearly confluent, one about a quarter of an inch, the other about five-fourths of an inch long, somewhat painful upon grasping it, as after a bruise of the skin. A pale dusky-red mottled spot as large as a half-dollar near the external condyle of the left humerus, at times burning and itching as if congested, in the middle of an elevated nettle- rash-like welt. Small dusky-red, petechial- like, at times slightly itching or burning spots on the forearm, also at times on the back of the hand, chiefly near the wrist and a few inches from it. [Hesse ; Journal fur Horn. Arzneien, 1, 1834 ; effects on Ave persons, of an infusion of the root.] Concomitants. — Bruised pain, with stiffness, lameness, and numbness in the lumbar and sacral regions ; worse while sitting or lying. Dryness of the mucous membranes. Comments. — Berberis cause engorgement of the venous capillaries, and may in this way sometimes be responsible for interstitial effu- sions ; but it is doubtful whether it ever proves 216 LYCOPODITTM. of much service in the cure of purpura, except perhaps iu those rare cases in which this is consecutive to kidney disease. FEERUM PHOSPHORICUM. The phosphate of iron is such a capable rem- edy, in debilitated states of the system, that it ought to make a place for itself in the treat- ment of purpura. This it will probably do, but as yet its influence in this disorder remains undefined. Clinical. — The following case was reported to me by Prof. J. R. Kippax, M. D., of Chicago : 1. This little child suffered for several days from loss of appetite, with great lassitude and general uneasiness. Suddenly petechial spots appeared in great numbers on the limbs and extended to the trunk and arms. Subsequently there was passive haemorrhages from the mouth and bowels, large quantities of black blood being passed. Hamamelis 3 x afforded some relief. The case was afterwards cured under ferrum phos. 6 x. LYCOPODIUM. Sluggishness of the peripheral circulation, and various forms of skin disorder, are charac- teristic of lycopodium ; but " spots like flea- bites," on the lower extremities, and u large CLINICAL CASES. 217 red spots on the legs, which neither pain nor itch," are the only evidence in its pathogenesy of itspetechi^e-producing power. Clinical. — The following case, by Dr. Jno. C. Morgan, is from Hoyne's Clinical Thera- peutics, vol. i, page 275. 1. C, aged ten, has been troubled for four months with cracked skin, especially on the feet, with purpura over the whole cutaneous surface ; unaffected by bathing. Family scrof- ulous. One dose of lycopodium 200 cured. In addition to the above the following reme- dies have been suggested by various authori- ties : Apis, Belladonna, Bovista, Cocci onella, Hyosciamus, Kali chloricum, Magnesium mur., Magnesium sulph., Nitric Acid, Nux Vomica, Phosphoric Acid, Ruta,, Silicea, Stramonium and Sulphur. REPERTORY. SKIN. Anaesthesia, profound cutaneous : Chloral Black, mottled, like a snake : Crotalus. Blisters, blood : Arsenicum, Lachesis, Lycopodium, Phosphorus, Secede. black : Lachesis blue : Lachesis. brown : Lycopodium, Phosphorus. — gangrenous : Secale. Blood oozing from skin : Crotalus, Lachesis. — boils : Arnica, Lachesis, Ledum, Lycopodium, Phosphorus, Secale. Bloodvessels, small, look like the foliage on the branches of a tree : Crotalus. much dilated : Chloral. Blotches (ecchymoses) of varying size, from ten-cent piece to palm : Sanguinaria. Braises very easily : Lachesis, Phosphorus. Bullae, with, containing purple fluid : Kall-hydriodivum. Burning sensation in the skin : Arsenicum, Lachesis, Lycopo- dium, Phosphorus, Rhus. at night : Arsenicum. in spots where ecchymoses are about to occur : Lachesis* Clammy skin : Lachesis, Secale. Coldness of the surface of the body, with : Crotalus, Lachesis, Secale. — and moist : Lachesis. — — dry : Crotalus. Creeping under skin, sensation of something : Secale. Dry and cold skin : Crotalus. Hyperaesthesia in the patches : Phosphorus. 220 REPERTORY. Insensibility of skin : Crotalus. Itching : Berberis, Bryonia, China, Chloral, Lachesis, Ledum, Lycopodium, Mercurius, Phosphorus, Rhus, Sulphuric- acid. — intolerable : Mercurius, Rhus. — over whole body : Rhus. — spots in, where ecchymoses are about to occur : Lachesis. Jaundice, with : China, Patches, livid : Phosphorus. Leaden appearance of skin : Crotalus. Mottled all over like a leopard : Kali-hydriodicum. CEdema with redness and heat : Arnica. Oozing of blood from the pores of the skin : Crotalus, Lachesis. Paleness, remarkable, of skin : Phosphorus. Pallid skin : Crotalus. Parchment-like skin : Crotalus. Pressure causes black and blue mark, which spreads indefin- itely : Lachesis. — slight, leaves marks of fingers : Phosphorus. Prickling in the skin : Berberis, Hamamelis, Lycopodium. — subcutaneous : Hamamelis. in the veins : Hamamelis, Rash follows the course of the large nerve trunks : Chloral Specks like pin-heads, red, on hands : Phosphorus. Splotches, irregular : Lachesis. Spots, purpuric : Arsenicum, Berberis, Bryonia, Crotalus, Lach- esis, Ledum, Lycopodium, Phosphorus, Sangulnaria, Terebinthina. ~ black : Arsenicum, Crotalus, Lachesis, Rhus. - blue : Arsenicum, Bryonia, Crotalus, Lachesis, Ledum, San- guinaria, Sulphuric-acid. ~ — on abdomen : Arsenicum. - bluish-black : Lachesis. red '.'Lachesis, Phosphorus. — burning : Arsenicum, Berberis, Lachesis, Ledum, Mercurius, Rhus, bulphuric-acid. — circular : Lachesis. REPERTORY. 221 Spots circumscribed, sharply : Arsenicum. — dark colored : Crotalus, Phosphorus. purple : Crotalus. red : Terebinthina. — dusky-red : Berber is, Terebinthina. — extend indefinitely, inclined to : Pltosphorus. — flea-bites, like : Arsenicum, Lycopodium, Secale. — gangrenous, inclined to become : Lachesis, Secale. — insect bites, burning and sting like : Ledum. — intense red : Terebinth but. — itching: Berberis, Iodum, Lachesis, Ledum, Lycopodium, Mercurius, Sulphuric-acid. — irregular-shaped : Luchesis — large : Crotalus, Lachesis, Lycopodium, Phosphorus. — as the hand : Ladies is. — livid : Crotalus, Tj(ichesis 3 Phosphorus. — marbled : Berberis. — painless : Ledum. — pin-head like : Pliosphorus. on the hands : Phosphorus. — purple : Arsenicum, Leichesis. on chest : Arsenicum. neck : Arsenicum. — red : Arsenicum, Berberis, Bryonia, Crotalus, lodum, Lachesis, Lycopodium, Mercurius, Phosphoi us, Sulphuric-acid. neither pain nor itch : Lycopodium. — round : Bryonia, Mercurius. — scarlet : Arsenicum, Bryonia, Lachesis, Mercurius, Phospho- rus. Terebinthina. — small : Bryonia, Lachesis, Lycopodium, Mercurius, Sulphuric- acid. near joints : Ledum. — stinging : Ledum, Lachesis, Mercurius. — violet : Phosphorus. — yellow : Crotalus. — and Stripes, : Phosphorus. Spotted like a snake : Crotalus. 222 REPERTORY. Stinging sensation in the skin : Bryonia, Hamamelis, Rhus. — subcutaneous : Hamamelis, in the veins : Hamamelis. Stripes (vibices) : Phosphorus. Sweat, bloody : Crotaius, Lachesis; Lycopodium. — cold : Arsenicum, China, Mercurius, Secale, Sulphuric-acid. — covered, when : China. — debilitating : China, Mercurius. — greasy : Bryonia, China, Mercurius. — nightly : China, Mercurius, Phosphoric-acid. — partial : China, Phosphorus. side on which he lies : China. — profuse : China. — sleep, during : China. — wine, like putrescent : Lachesis. Tenderness of the skin : Chloral. Varicose veins, with : Hamamelis. Yellowness of skin : Phosphorus. BLOOD. Acrid : Blius, Sulphuric-acid. Black : China, Lachesis. Bluish-black : Hydrocyanic-acid. Bright : Arnica, Ledum, Mercurius, PhospJiorus, Rhus. Brown : Bryonia, Rhus. Coagulated : Arnica, China, Mercurius, Phosphorus, Rhus, Secale, Terebinthina. Dark : Crotaius, Hamamelis, Nux vomica, Phosphorus, Terebin- thina. Dark-red : Lachesis. Fluid : Crotaius. Non-coagulable : Crotaius, Hydrocyanic-acid, Lachesis, Phos- pJiorus. Offensive : Bryonia. Thin : lodum. Watery : lodum, Lycopodium. REPERTORY. 223 Diseased vein-walls : Hamamelis. Inflammation of veins : Hamamelis. Peripheral circulation sluggish : Lycopodium. Venous capillaries engorged : Berberis. — stasis : Hamamelis. Extravasation of blood from all the tissues : Phosphorus. Haemorrhages : Arnica, Arsenicum, China, Crotalus, Ftrrum- phosphoricum, Hamamelis, Iodum, Lachesis, Phosphorus, Ledum, Lycopodium, Mercurius, Rhus, Secale, Sulphuric- acid, Terebinth ina. — black : China, Mercurius, Nux vomica, Sulphuric-acid. — bright : Arnica, Ledum, Phosphorus, — brown : 'Bryonia, Bhus. — dark red : Lacliesis, Nux vomica. — offensive : Bryonia. — thick : Arnica. — pale : Lycopodium. — passive : Hamamelis, Ferrum-phosphoricum. — every orifice, from, of the body : Crotalus, Sulphuric-acid. more pronounced than the skin symptoms : Phospltorus. — multiple ; nose, lungs, etc. : Arnica. — vicarious : Pliospltorus. — bowels, from : China, Secale. — kidnej 7 s : Secale, Terebinthina, — lungs : Arnica, Hamamelis. — mouth : China, Tereb'tntldna. — nose : Arnica, China. — uterus : Hamamelis, Secale, Terebinthina. bright and fresh blood : Hamamelis. midway between the menses : Hamamelis. Secretions, all, bloody : Phosphorus. Wounds, slight, bleed easily : Phosi)horiis. — pin-scratch bleeds for hours : Phosphorus. — slight pinching of skin causes bleeding : Lachesis. — scratching the skin causes bleeding '.^Lachesis. 224 REPERTOBY. GENERAL CONDITIONS. Asthenia : Mercury. Benumbed, all the senses : Secede. Bruised, as if : Arnica, China, Crotalus, Hamamelis, Ledum. — body sore all over ; Arnica, China, Crotalus, Hamamelis, Le- eluin. — keeps changing from place to place, he feels so tired, sore and bruised : Arnica. Burning pains everywhere : Arsenicum, Phosphorus, Bhus. — increased by friction : Berberis. ■ — interior parts : Bryonia, Mercurius, Phosphorus, Bhus, Se- cale. Coldness all over : Arsenicum, Cuprum, Ledum. — of affected parts : Mercurius; Bhus, Secale. Contact and motion aggravate his physical suffering : China. Debility: China, Crotalus, Ferrum-phof-phoiicum, Bh us, Secale. — following the loss of blood, or other fluids : China. — rapid sinking of strength : Secale. — soreness and stiffness, especially when at rest : Bhus. — with paralytic weakness : Bhus. Emaciation : Arsenicum, China, ierrum, lodum, Lycopodium, Secale. — of affected parts : Ledum. — with good appetite : lodum. Exertion, dislike for : China. — easily tired by slight : Crotalus, — indisposition and incapacity for : Chloral. Exhaustion : Lachesis, Sulphuric-acid. — with sense of tremor all over the body without trembling : Sulphuric-acid. Faintness : Crotalus. Gangrene : Lachesis, Secale. — of viscera : Lachesis. Glands, enlarged or atrophied : lodum, Kali hydriodicum. — pain in : Arnica, Lycopodium, Mercurius, Phosphorus. burning : Arsenicum, Phosphorus. REPERTORY. 225 Heat, aversion to : Secale. — applied to any part of the body makes the patient worse : Secale. Heated, aggravation from getting : Bryonia. Intermitting or periodical symptoms : China. Jaundice : China, Lachesis, Mercurius, Rhus, Secale, Sulphuric- acid. Lassitude : China, Ferrum-phosphoricum, Lachesis, Sanguinaria. — with sensation of weariness : Sanguinaria. Malignancy, peculiar, of attack : Grotalus, Lachesis, Phosphor- us. Melanosis : Lachesis. Motion and contact aggravate sufferings : China. — fear of pain keeps niiri quiet : Bryonia. Mucous membranes, remarkable paleness of the : Phosphorus. Oedematous infiltration of tissues : Kali hydrhdicum. — tendencies : Arsenicum. Paleness, remarkable, of mucous membranes : Phosphorus. Paralytic weakness : Bhus. Periodical, or intermitting symptoms : Arsenicum, China. Prostiation : China, Chloral, Lachesis, Sanguinaria. — after slight exertion : Lachesis. — intense : Lachesis. — muscular strength utterly gone : Chloral. — profound : Sanguinaria. — with neither thirst nor hunger : China. Restlessness : Arnica, Arsenicum, Cuprum, Mercurius, Bhus. — constantly changes position : Arnica, Bhus. especially at night : Rhus. the bed on which he lies feels so hard it makes him tired : Arnica. — nervous trembling, with : Cuprum, — sleeplessness, with : Bhus. — and uneasiness : Bhus. Sensitiveness, excessive, of the nervous system : China. — to the (cool) air : Phosphorus, Bhus. 226 EEPERTORY. Sighing, constant : Secale. Soreness : Arnica, Bryony t, Rhus. — with great debility : Rhus, — tired and bruised : Arnica. Stiffness and debility : Rhus. Stitching pains in various parts of the body, aggravated by least motion : Bryonia. Syncope : Lachesis. Tearing "pains, worse from movement, therefore keeps very still : Bryonia. Vaso-motor paralysis : Chloral, Sanguinaria. Weakness : Arsenicum* Cuprum, Phosphorus, Rhus, Sanguin- aria, Secale, Su 1 phuric-acid. — muscular : Chloral, Cuprum, lihus, Sanguinaria. — with sensation of tremor all over the body, without trem- bling : Sulphuric-acid. — with paralytic heaviness of the legs and feet : Rhus. MIJSTD AND DISPOSITION. Angry, inclined to be, and exceedingly irritable : Bryonia. — at trifles : Arsenicum. Alone, when, feels worse : Phosphorus. Anxiety and fear of death : Secale. — of conscience : Ferrum. — when alone : Phosphorus. ' Apathy : China. Arrogance : Lachesis. — thinks himself important : Cuprum, Ferrum, Lycopodium. Benumbed, all the special senses : Secale. Brain beats in waves against the skull : China. Confusion of thought, cannot keep the mind to one idea : Chloral. Death, fear of : Rhus, Secale. with great anxiety : Secale. fears he will be poisoned : Rhus. Defiant mood : Arnica, Lycopodium. REPERTORY. 227 Delirium tremens, the mental phenomena of, when not caused by alcohol : Chloral. Discontented : Rhus. Dreams of great exertion, as rowing, swimming, etc. : Bhus. — about business or household affairs : Bryonia. — vivid or frightful : Bryonia. Efforts, mental, aggravate all the symptoms : China. Exhaustion, mental : Lachesis. Fatigue, mental : Ledum. Fear of death : Arsenicum, Lachesis. Forgetfulness : Lachesis. Fretfulness : Arsenicum, Bryonia, Phosphorus. Haughtiness : Lycopodinm. Headache : — intense : Cltina. — red face, with : Bhus. — rush of blood to head : Rhus. — throbbing : China, Bhus. after loss of blood : Clan a. Hurry, wants to do everything in a : Sulphuric-acid. Ideas, slow train of : China. Ill-humor : Bryonia, China, Phosphorus. Impatient at the least trine : Sanguinaria. Inability for mental labor : Lycopodium. Indifference : Arsenicum, China, Cuprum. — says he is well : Arnica. — apathetic : China, Phosphorus. Irritable : Cuprum, Iodum, Lycopodium, Mercurius, Phosphorus, Sulphuric-acid. — at the least trifle : Sanguinaria. — she could break things to pieces without any cause : San- guinaria. loquaciousness : Lachesis. — talks to himself : Rhus. Melancholy: Arsenicum, Crotalus, Lachesis, Lycopodium, Bhus. Mind clear, then unconscious, followed by inability to con- centrate the mind : Terebinthina. 228 REPERTORY. Morose, very, and needlessly anxious : Bryonia, Ledum. Oversensitive to external impressions : light, odors, noises, contact : Phosphorus. Quick-witted : Phosphorus. Restlessness : Arsenicum, Cuprum. — as if some misfortune was impending : Cuprum. Sadness : Crotalus. — recurring regularly at twilight : Phosphorus. Sensitive disposition : Phosphorus. Sighing, constant : Bryonia^ Secale. Sleepiness : China, Ledum, Lycopodium, Phosphorus. — witri sleeplessness until midnight : Rhus. Speech slow and weak : Secede. Timidity : Bryonia, Lycopodium, Sulphuric-acid. — associated with a sense of extreme fatigue : Phosphorus. Tremulous weakness, as from impending evil : Crotalus. Uneasiness, constant, cannot lie still, must change position : Arsenicum. Vertigo, worse from turning or stooping, or when rising from lying : Iihus. Weakness, tremulous, as from impending evil : Crotalus. Weeps much : Cuprum. EYES. Black flickering before eyes : Lachesis. Blindness, transitory : Chloral, Mercurius, Phosphorus. Bloodshot : Chloral, Phosphorus, lihus. — and constantly watering : Chloral. — a slight knock near the eye involved the whole eye : Phos- phorus. Blua margin around : China, Secale. Blue wpots on conjunctiva : Arsenicum. Diplopia : Chloral, Joduni, Lycopodium, Rhus, Secale. Distorted : ' Cuprum, Lachesis, Secale. Escori.iting discharges : Arsenicum. Eyelids droop : Chloral, Mercurius. — cedematous : Phosphorus. REPERTORY. 229 Fire, glare of, intolerable : Jlercurius. Glassy : Bryonia. Haggard : Aseracum, Cuprum, Secede. Haemorrhage from eyes : Crotalus, Phosphorus. Hemiopia : Lycopodium. Herpes on lids : Bryonia. Inflamed : Arsenicum, Bryonia, Ledum, Lycopodium, Rhus, Sulph uric-acid, Mercurius, Phosphorus. Lachrymation : Ferrum, Ledum, Lycopodium, Mercurius. Phos- phorus, Rhus, Sulphuric- acid. Motionless : Arnica. Pale, everything looks : Rhus. Petechiae on conjunctiva : Crotalus. Photophobia : Bryonia, Chloral, Mercurius, Phosphorus. Sight, dimness of : China, Chloral, Secale. everything looks black : Phosphorus. when moving the head : Secale. when rising up in bed everything turns black before the eyes : Secale. everything looks blue : Lachesis. Scabs on lids : Mercurius. Sunken : Arsenicum, Secale. Swollen : Rhus. — lids : Arsenicum. Tingling, crawling, around eyes : Arnica. Tremor of lids : Iodum. Veil, gray, before eyes : Phosphorus. Veins distended and red : Jlercurius. EARS. Bruising pain in ears : Arnica, Ruta. Dryness, sensation of : Phosphorus. Hardness of hearing : Arnica, China, Lodum, Ledum, Lycopo- dium, Mercurius, Phosphorus, Secale, Sulphuric-acid. Haemorrhage fr^m ears : Crotalus, Phosphorus. Humming in ears : China. Otalgia : Mercurius. 230 REPERTORY. Rending, tearing, in ears : Mercurius, Phosphorus. Ringing in the ears : China. Roaring in the ears, with great difficulty of hearing : Secale. Stinging, stitches, in ears : Arnica, Mercurius, Phosphorus. NOSE. Bleeding : China, Crotalus, Erigeron, Hamamelis, Lachesis, Phos- phorus, Rhus, Secale, Terebinthina. — affords great relief : Hamamelis. — black : Lachesis, Secale. — blows much blood from nose : Phosphorus. — bright : Ledum. — clotted : China, Ferrum, Secale. — coagulated, worse at night : Rhus. — constant : Secale. — exertion, slight, causes : Phosphorus. — nose continually full of coagulated blood : Ferrum. — straining at stool causes : Phosphorus. — thin but soon coagulates : China. — trickling of blood from nose : Lachesis. — pale : Arnica, Ledum, Phosphorus, Rhus, Secale. — violet : Terebinthina. — with pale face and ringing in ears : China. Coryza with pain in the frontal sinuses : Kali-hydriodicum. Smell, sense of, benumbed : Secale. Tightness, feeling of, across the bridge of the nose : Hamamelis. FACE. Anxious : Cuprum. Benumbed sensation over whole forehead : Hamamelis. Blackish : China. — lips : Arse)dcum, China. Bloated : Arsodcum, Bryonia, China, Phosphorus. Blue : Arsenicum. — circles around eyes : China, Phosphorus, Secale. — lips : Cuprum. Brown : lodum. Burning sensation : Arsenicum, Kali-hydriodicum. REPERTORY. 231 Cracked lips : Arnica, Arsenicum, Bryonia, Mercurius. Crowding pressure in the forehead between the eyes: Hamamelis- Dark red : Secale. — with burning : Bhus. Discolored : Crotalus, Secale. Disfigured . Arsenicum, lodum. Distorted : Cuprum. Dry lips : Bryonia, China. — and black : Phosphorus. Earthy : Arsenicum, China, Ferrum, Lycopodium, Mercurius. Fiery red : Rhus. Haggard : Chloral. Heat, sensation of : Arnica, Bryonia, Ferrum, Bhus. Hippocratic : Arsenicum, China, Phosphorus, Secale. Hollow : China. Leaden : Arsenicum, Lachesis, Mercurius. Livid : China. Lumps, indurations : Ledum. Pale : Arnica, China, Cuprum, lodum, Lycopodium, Mercurius, Phosphorus, Secede. Red cheeks, circumscribed : Sanguinaria. Redness, intensely suffused with a deep : Chloral. Sunken : Arnica, Arsenicum, China, Forum, Phosphorus, Secale. White of egg, as if, had dried on it : Sulphuric-acid. MOUTH. Bleeding, excessive and prolonged : Phosphorus. from a tooth cavity : Phosphorus. Breath fetid : Chloral, Kali-hydriodicum. — offensive : Lachesis, Phosphorus. Blood blisters : Arsenicum. Dry : Berber is, Cuprum, China, Lachesis, Lycopodium, Bhus. Expectoration streaked with blood : Terebinthina. Gums, bleeding : Phosphorus, Sanguinaria. from slight causes : Phosphorus. — spongy : Chloral, Sanguinaria. and swollen : Kali-hydriodicum. 232 REPERTORY. Gums ulcerated : Cuprum. Petechiae : Crotalus, Phosphorus. Raw, mucous membrane : Chloral. Saliva, bloody : Arsenicum, Phosphorus, Rhus. — profuse : Kali-hydriodicum. — gummy : Lachesis. Thirst : Arsenicum, China, Mercurius, Phosphorus, Secale. — burning : Arsenicum. — intense : Lachesis. Tongue blistered and ulcerated : Chloral. — burning like fire : Terebinthina. — red, smooth and glossy : Terebinthina. STOMACH. Acids, longing for : Phosphorus. Anorexia : China, Ferrum-phosphoricum, Lycopodium, Rhus, Sanyuinaria. — aversion to butter : Sanyuinaria. — longing for indefinite things, with : Sanyuinaria. — no desire for food : China, Sanyuinaria. — with uncertain cravings : Sanyuinaria. Bitter, food especially bread tastes : RJats. Burning pain : Arsenicum, Bryonia, Phosphorus, Sanyuinaria. Disagreeable sensation : Sanyuinaria. Eructations : Arnica, Bryonia, China, Sulphuric-acid. — bad odor, of : Sanyuinaria. • — frequent : Sanyuinaria. — spasmodic : Sanyuinaria. — sour, after milk : China. Gastrodynia : Bryonia, Phosphorus. — violent but transient : Sanyuinaria. Heartburn : lodum, Sulphuric-acid. — after milk : China. Haematemesis : China, Crotalus, Lachesis, Phosphorus. Hunger : lodum, Rhus, Secale. — ravenous : lodum. — without appetite : Rhus. REPERTORY. 233 Indigestion : Mercurius. — sensation as of : Sanguinaria. Nausea : Arsenicum, Bryonia, Cuprum, lodum, Lachesis, Lyco- podium, Mercurius, Phosphorus, Rhus, Secede. — with burning at stomach : Sanguinaria. — regurgitation and disposition to vomit : Sanguinaria. Paralysis, partial, of deglutition : Chloral. Qualmishness : Sanguinaria. Regurgitation of food, and disposition to vomit : Sanguinaria. Spicy things, longing for : Phosphorus. Thirst : Arsenicum, Bryonia, China, lodum, Mercurius. — for cooling drinks, which relieve the gastro-intestinal symptoms : Cuprum. — cold milk, for : Rhus. — sour drinks, for : China. Vomiting : Arsenicum, Cuprum, Lycopodium, Phosphorus. — bitter : Arnica, Bryonia, Sanguinaria. — blood : Arnica, Phosphorus: ABDOMEN. Ascites : Arsenicum, China, Ledum, Mercurius. Atrophy of liver, acute : Phosphorus. Bleeding from anus : Crotalus, Mercurius, Phosphorus. — and other openings of the body : Crotalus. Blood, discharged from rectum during stool : Phosphorus. Bloody stools : China, Ritas. — painless : China. Burning pain in : Arsenicum. — in rectum : Arsenicum. Coldness, sensation of : Terebinthina. Colic : Cuprum, Ferrum, Secale. Constipation : Bryonia, Lachesis, Lycopodium, Phosphorus, Sanguinaria, Sulphuric-acid. ' ' — alternating with diarrhoea : lodum, — the foeces being slender, long, narrow, dry, tough, and hard like a dog's ; voided with great difficulty : Phosphorus. Cramps : Bryonia, Cuprum, Bhus. 234 REPERTORY. Cramps, with convulsions : Cuprum. Cutting pain in : Arsenicum, Bryonia, Lycopodium, Mercurius, Sulphuric-acid. Diarrhoea : Arnica, Arsenicum, Bryonia, China, Cuprum, Mer- curius, Phosphorus, lihus. — gelatinous : Chloral. Flatulenca : China, Phosphorus. — obstructed : lodum, Lycopodium, Phosphorus. Glands inflamed : Mercurius. — painful : Mercurius, Terebinthbta. — swollen : lodum, Mercurius. mesenteric : Arsenicum. Griping, pinching, pain in : Lycopodium, Mercurius, Sulphuric- acid. Hardness of : Arsenicum. Haemorrhoids : Arsenicum, Lerrum, Phosphorus, Sanguinaria. — burn like fire, and bleed profusely : Phosphorus. Itching at anus : Lycopodium. Melaena : Crotalus. Mucus discharged from anus : Mercurius, Phosphorus. — serous : Kali-hydriodicum. Paralysis of intestinal canal : Phosphorus. Pressing pain in : China, Cuprum, Terebinthina. Prolapsus of rectum : Lachesis, Lycopodium, Mercurius. Rending, tearing, pain in : Phosphorus. Spleen enlarged : Arnica, Phosphorus. Stinging, stitches, in : Bryonia. Stools, frequent but natural : Sanguinaria. — soft : Sanguinaria. Swollen : Lodum. Tenesmus : Mercurius. Throbbing : Sanguinaria. Twitching in : Rhus, Sulphuric- acid. Varices al>out inguinal : Berberis. Weakness and emptiness, sensation of, in abdomen : Phos- phorus. REPERTORY. 235 URINARY ORGANS. Albuminuria : Phosphorus. Blood discharged from urethra : Cantharis, Lycopodium, Secale. Bloody urine : Phosphorus, Terebinthina. — the blood is thoroughly mixed with the urine : Terebinthina. Blood-red urine, discharge of a few drops ol : Rhus. Dysuria : Arsenicum, Cantharis. — urine scanty : Erigeron. Glycosuria : Phosphorus. Scanty urine : China, Erigeron, Terebinthina — depositing brick-dust sediment : China. epithelial sediment : Terebinthina. Strangury : Cantharis. — with great loss of blood : Terebinthina. Turbid : Mercurius. — brick-dust sediment : China. — epithelial sediment : Terebinthina. Unconscious urination : Chloral. MALE GENITALS. Aversion to coition, or irrisistible desire : Phosphorus. Scrotum, blue spots on : Arsenicum, PJtosphorus. FEMALE GENITALS. Menses coagulated : Arnica, China, Ferrum, Rhus. — dark : China, Lachesis. — pale : Berberis, China. — — with dark coagula : China. — profuse : Lachesis. dark, coagulated : Lachesis. with pressing downward : Lachesis. — suppressed : Bryonia, Cuprum, Lycopodium. with violent, unbearable cramps : Cuprum. — watery, Berberis, China, Phosphorus. THROAT AND CHEST, Anxious respiration : Secale. 236 REPERTORY. Bloody expectoration : Arnica, Bryonia, Ferrum, Ledum, Ly co- podium, Rhus, Phosphorus, SidpJturic-acid. — spitting, from throat : Crotalus. Cold air, longing for : Laches is. Dryness in throat, without thirst : Lachesis. Dyspnoea : Arsenicum, Iodum, Lachesis, Phosphorus. — cannot breathe with head low : China. — expiration easier than inspiration : Chloral. — as from inhaling acrid vapors : Cuprum. — shortness of breath : Lachesis. Haemorrhage : Arnica, China, Ferrum, Phosphorus, Rhus. — clearing throat causes : Phosphorus. — coughing causes : Phosphorus. during : Lachesis. Hoarseness : Iodum, Mer curias, Phosphorus, JRhus, Sulphuric- acid. Suffocative sensation on awaking : Lachesis. when lying, must sit up : Arsenicum. HEART AND CIRCULATION. Cardiac derangements caused : Phosphorus. Debility of the heart : Crotalus. Fever : Arnica, Arsenicum, Bryonia, China, Lycopodium, Mer- curius, Phosphorus* Bhus. — begins at 2 P. M., and lasts until morning : Sanguinarva-. — intense paroxysms : Lachesis. — intermitting : Arsenicum, China, L'hus, Sanguinaria. — long-lasting, and coming on at irregular intervals : China. Palpitations : Arsenicum, Bryonia, Iodum, Lycopodium, Mercur- ius, Phosphorus, Secale, Sulphuric-acbd. — even while sitting : Phosphorus. Pulse accelerated : Lachesis, Bhus. — faint : Bhus. — feeble '.'Crotalus. — imperceptible : Cuprum, Rhus. almost : Crotalus. — intermittent : China, Secale. REPERTORY. 237 Pulse, irritable : Chloral. — languid : Crotalus. — rapid : Bryonia, lodum, Lachesis, Mercurius, Phosphorus. — sluggish : Crotalus. — small : Cuprum, Secale. — soft : Ferrum, Rhus. — thread-like : Crotalus. — trembling : Crotalus, Rhus. — weak : Chloral, Crotalus, Rhus. Tumbled over, a feeling as if the heart : Crotalus. EXTREMITIES AND BACK. Aching in extremities, constant, exhausting : Lachesis. Anasarca in arms : Sanguinaria. worse afternoons : Sanguinaria, Beaten, arms as if they had been : Ledum. Bruised, arms as if : Ledum: Burning pain in hands : Sanguinaria. — spot on thumb : Lachesis. Chilliness in the extremities : Cuprum. Crawling or prickling sensation of the surface of the fingers especially the tips : Rhus. Cutting pain in joints of fingers : Sanguinaria. Hands swollen : Crotalus. Paralysis of limbs, without loss of sensibility : Cuprum. Purpura begins on shoulders and forearm : Chloral. — begins arms and legs : Lachesis. Redness of hands, with violent burning : Sanguinaria. Rheumatoid pain in right forearm : Sanguinaria. Severe pain about the joints, worse in moist and cold weather: Chloral. Tearing and burning in the shoulder and arm : Rhus. Ulcerative pain in right thumb : Sanguinaria. — extending to other fingers, one after another : Sanguinaria. Violent pain in right hand, close to index finger : Sanguinaria. Lumbar and sacral region, bruised pain, with stiffness, lame- 238 REPERTORY. ness, and numbness, worse while sitting or lying : Berber is. Paralysis of muscles of back, without loss of sensibility : Cuprum. Purpura most pronounced on buttocks : Sanguinaria. Purpuric spots larger posteriorly than anteriorly : Sanguinaria. — larger on the lower than upper extremities : Sanguinaria. Rheumatoid pain in shoulders and arms (when touched) : Sanguinaria. Stiffness of the nape of the neck ; Sanguinaria. Violent pain in shoulder-joint : Sanguinaria. Anasarca, lower extremities : Sanguinaria. — worse afternoons : Sanguinaria. Beaten, legs feel as though they had been : Ledum. Bruised, legs as if : Ledum. Bruise-like pain in thighs, worse at night : Sanguinaria. Burned, legs pain as if : Lachesis. Burning pains in the legs (every night till midnight) : San- guinaria. — in feet, worse at night : Sanguinaria. Clumsy in walking : Sanguinaria. Cramps in the legs and feet, with great restlessness : extensor muscles most prominently affected : Cuprum. Icy-ooldness of feet : Lachesis. Purpura on lower extremities especially : Crotalus, Iodum. Rheumatoid pains in the limbs, with numbness and tingling: Bhus, Stiffness in walking : Sanguinaria. Stifmess and tension in hollow and sides of the knee : San- guinaria. — and swelling of the joints : Bhus. Swollen feet : Crotalus. Veins of the abdomen and thighs, protuberent and arbores- cent : Phosphorus. Weak knees : Sanguinaria. REPERTOEY. 239 SLEEP AND DREAMS. Drowsy but unable to sleep : Bryonia, Crotalus, Ferrurn, Lach- es is, Secale. — afraid to sleep, so much worse after : Lachesis. Insomnia : Asenicum, Bryonia, Iodum, Phosphorus, Lachesis, Ledum, Sanguinaria. Restless sleep : Arsenicum, Lachesis, Phosphorus, Rhus, San- guinaria. — tossing all night, with troublesome dreams : Sanguinaria. — many busy, unpleasant dreams : Rhus, Sanguinaria. — difficulty of falling asleep, followed by frightful dreams : Phosphorus. Somnolence, tendency to : Chloral. Starting, frequent, during sleep : Arsenicum. Worse after sleep : Crotalus, Lachesis. STAGES AXD STATES. Afternoon aggravations : Cantharis, Iodum, Lycopodium, San- guinaria. — every other : Lycopodium. Alone, aggravation when : Arsenicum, Lachesis, Lycopodium. Arthritic pains, with : Bryonia, Ledum, Lycopodium, Mercurius- Rhus. Awaking on, worse : Arsenicum, Lachesis. — better : Phosphorus. Caused by alcoholism, chronic : Crotalus, Lachesis. — debility from fevers : Arsenicum, Cldna, Lachesis. — lack of nourishment : Arsenicum. — living in damp places : Terebinthina. — vaso-motor paralysis : Chloral. Constant change of symptoms : Sanguinaria. Crops, the purpuric spots come in : Crotalus, Lachesis, San- guinaria. Evening aggravation : Arnica, Lachesis, Lycopodium, Secale. Exertion of body aggravates : Arnica, Arsenicum, Bryonia, Lycopodium, Rhus. 240 REPEETOEY. Forenoon aggravation : Sulphuric-acid. Midnight aggravation, about : Arsenicum, Ferrum, Rhus. Morning aggravation : Phosphorus. Relieved, pains, by perspiration : Sancjuinaria. by warmth : Arseyilcum. Worse from changes in the weather : Phosphorus. — emotional excitement : Phosphorus. — heat applied to any part of the body : Secale. — at night : Arsenicum, Rhus, Sanguinaria. — stimulants, from : Chloral. Winter, aggravation during : Rhus. Anaemic persons : Arsenicum. Animal fluids, loss of, caused : China, Ferrum, lodum, Lycopo- dium. Broken-down constitutions : China, Crotalus. Children who have grown rapidly : Phosphorus. Chlorotic girls : Ferrum, Lycopodium. Elderly persons, particularly women : China, Phosphorus, Sulphuric-acid. Dropsy, with : Arsenicum, China, Lycopodium. — after purpura : Helleborus. Emaciation, with : Arsenicum, China, Ferrum, lodum, Lycopo- dium. Fair complexioned persons : Phosphorus. Gouty diathesis : Ledum. Hysterical women : Bryonia, Phosphorus. Plethoric persons : Ferrum, Lycopodium. Rheumatic persons : Arnica, Bryonia, China, Ledum t Mercu. rius, Rhus. — disposition : Phosphorus. Scrofulous and syphilitic persons : Kali-hydriodicum. Stout persons,: Crotalus. Swarthy persons '.China. Tuberlosis : Arsenicum. Varicose diathesis : Hamarr.elis.