•■■■<-■■ '^ ■:■■-■■ ■ Hi m »i ■HI ■HR H B|f||f «■ 1 ■B MP Hi ■ p— Hi pan .1 'Was ■i - nfflnHi ROBB & CO'S FAMILY PHYSICIAN. -A WORK ON- DOMESTIC MEDICINES. -DESIGNED TO SHOW TH] CAUSES, SYMPTOMS AND TREATMENT OF DISEASE, FOR THE USE OF THE PEOPLE. -BY- R. L. ROBB, M. D., J. V. BEAN, M. D., Homoeopathic, Regular, or Allopathic. S. LUCRETIA ROBB, M. D., Diseases of Women and Children. COMPLETE AND COMPREHENSIVE TREATISE ON DISEASES, AS THEY OCCUR IN EYERY DAY LIFE. SECOUD EDIT IO IST. CAREFULLY REVISED AND ENLARGED. — - SOLID ZBTT STJBSORIPTIOIT O^TX/Y". ROBB & CO., BOOK PUBLISHERS, Burlington, Iowa, and London, Canada. I88O- Entered according to Act of Congress, in the year 1879 By R. L. & S. L. EOBB, In the office of the Librarian of Congress at Washington. ALL RIGHTS RESERVED. Chas. I. Babkeb, Steam Book and Job Pbinteb, Burlington, Iowa. TO THE THINKING MASSES, And to all classes of our fellow men who love the light of plain truth, rather than the darkness and bigotry that results from one class holding all the most vital knowledge pertaining to our bodies, keeping it covered from the public eye by a cloud of words from the dead languages, and thereby aiding in making it a cloak under which ignorant or designing men can hide their wickedness, this work is most cheerfully dedicated by THE AUTHORS. AUTHORS' PREFACE TO SECOND EDITION. When, a few weeks ago, we saw this fruit of our labor issue from the press, we thought " Now all the long years of labor, study, care, and anx- iety — bestowed, and to be bestowed — upon its preparation, are ended"; but already our publishers ask of us a preface to the Second Edition. We take this opportunity to express our thanks for the very kind, and even unusually grateful manner in which the work has been received by people, press, and medical profession. In token of our thanks we have subjected every page to a careful revision, adding to every part matter likely to enhance its utility. The arrangement of the type is more con- densed and the book enlarged, so that there appears in this edition over one hundred pages of new matter, in addition-to what the first contained. Every article has been carefully compared and made to contain the very best of the thoughts, researches, and treatment appearing in the medical literature of the old and new Schools. Thus we have aimed, up to the hour of going to press, to make this the most complete Hand Book on Domestic Medicine ever issued from any press. While we thus pre- pared a work for the people, we have been both surprised and pleased to learn that it has been adopted by hundreds of Physicians as a daily com- panion in their professional labors, placing upon us a responsibility we had never intended thus to assume. Kealizing the extent of this added field, we have endeavored to make the work more worthy of the liberal patronage and generous praise it received in the first edition. While it has been our aim to produce a book giving in plain language the "Seed thoughts" of our best American and English physicians, we are not unaware that such is the wide range of our subjects, and such the abundance of the material, that a collection of this kind, large as it is, must be like a boquet picked from the fields in June, when hundreds of flowers will be left in unvisited spots, as beautiful as those which have been taken. THE AUTHOKS. Burlington, Iowa, January, 1880. PREFACE TO FIRST EDITION. In presenting this work, the publishers take a special pride, believing it is a book which will be the means of saving many valuable lives, and a vast amount of needless suffering from disease. There has never been published any work on domestic medicine which aimed to put in the hands of the people the vast amount of information as to disease, its causes, the circumstances modifying it, its course, its careful and systematic treatment, and all the signs of the pulse, tongue, breath- ing, digestive organs, evacuations, appetite, thirst, position, mental state, eyes, ears, nose, etc., and the indications of those signs, as used by physi- cians, in determining the nature of the disease and its probable termina- tion ; all this has been kept back from the masses, by physicians, as their individual stock in trade ; here it is all shown in plain language- While the authors do not claim this as a purely original work with them, we claim that they have brought together in this compact form, the gems of useful information gleaned from the whole field of medical art and litera- ture, and adapted in language to the comprehension of the common reader who is entirely unversed in the technical language of medical science. While it has been necessary to use a very few of those medical words, whenever they do appear, there and then appear their meaning, enclosed in parenthesis. Efforts have been heretofore made to produce a book giving the treatment of a few diseases, with their Allopathic and Homoe- opathic treatment, but both treatments written up by the same author; and, in the nature of the human mind, there would be some bias in favor of one or the other of the leading schools of medicine; and the treatment of the school of their choice would be fair, while that of the opposite would be more or less incomplete or unfair. Here we offer a work complete— covering the whole field of the art of medicine. The treatment includes only those remedies which have been proven by personal observations to be truly reliable, and are accompanied by practically verified curative indications in every case. The Allopathic Treatment, by Dr. J. V. Bean, must satisfy the friends of that school of medicine. As a staunch, rock-rooted, educated and experienced physician of that school, he stands in the front rank of his profession. While his education gives him command of the whole field of his art, his experience enables him to select his remedies from the very best, and present them to his readers in the manner they can most 6 PREFACE. safely use, and receive the most benefit from them. His language is plain, forcible, to the point, and very easily understood. The Homoeopathic Treatment, following each separate disease, is clear, concise, careful, full, and entirely reliable. The " Repertory " is one of the many valuable features of this work. By its help the remedy may be surely selected that will most certainly remove any disease, or symptom of disease, that can be cured at all. The Hydropathic treatment is recommended by all the authors whenever it may accomplish, or aid in accomplishing, the desired end. Dr. S. Lucretia Robb has added much valuable information on the treatment of the diseases of women and children, suggested by, and proven to be good, during years of experience. Being a thoroughly edu- cated physician, and herself a mother, she has been able to write upon the subjects connected with diseases peculiar to her sex fully, knowing, from personal experience and a large practice, just what would be most useful to mothers and daughters, in trying to understand and treat themselves, in all those cases in which a lady's natural and proper deli- cacy prevents her from going to a physician and telling him just what is the matter. Many and many a young lady, or young mother, has lost her life, for the reason that she could not bring herself to the determination to tell all to her physician. Mrs. Robb here removes that necessity, and we must say, she has done it successfully. Her work is a model of clear- ness in expression, and completeness in covering all this most delicate subject. This, alone, is worth many times the price of the complete work to any family. The Home Remedies. — A great many times, in cases of extreme emergency, there is some simple remedy in the house, which, if known, could be used, and thereby cure, or at least relieve, until something more could be done in the way of selecting a better remedy, or procuring the aid of a physician. These home remedies are pointed out and are always safe and at hand. The Index is very complete. If you have any name for your disease, you will find that in the index, and from the index will be guided to the description and treatment you are in search of. While we do not expect or desire this work to entirely do away with the good, faithful ptr^sician, we do expect to make a very great reduction in the number of his professional visits and office prescriptions to every one of our subscribers. And we do hope and desire to assist in educating the masses of the people in the art of medicine, until it will be altogether impossible for any of those designing or ignorant pretenders, now living off the ignorance of the people on this subject, to so live at all. We aim to encourage every competent and educated physician, and by helping our subscribers to know the true and good from the false, we know we are surely gaining that end ; and while greatly reducing the amount of his bill to any one family where our work enters, we increase greatly the number of families he will be called upon to treat. With the strong conviction that we are offering a work of no ordinary merit, we present this to a discerning and appreciative public, believing they will, on examination, fully confirm our convictions. THE PUBLISHERS. AUTHORS' PREFACE. In undertaking a work of this character, it is but natural to feel the great weight of the responsibility assumed. Taking the holding of the health and life of thousands upon thousands of fellow human beings, with all that life and health contains of usefulness, happiness, love and power, to individuals, families, communities, states and nations, upon ourselves, we cannot avoid a feeling of solemn responsibility. A desire and deliberate determination takes possession of our minds to write nothing without careful consideration— to hold nothing back from the people, that can give them a better understanding of themselves and their diseases. In this work, we have endeavored to bring together in a compact forni, all the information necessary to give the reader (without any ref- erence to other books,) all the information needed to fully understand the cause, nature, course and treatment of any disease they may feel called upon to treat, or may in any way come in contact with. Following the description of the peculiarities of each disease, we have arranged a care- fully prepared treatment. Those who prefer to employ the Hydro- pathic, or water treatment, will find a chapter giving full directions for the preparing and using the different baths ; and, in the treatment of separate diseases, you will find full and frequent directions for their use. We have omitted all treatment and reference to diseases of the sexual organs of a venereal nature. It is felt that their introduction into any work, save one intended strictly for physicians, is highly improper. They are of so grave a character, and so long-lasting and often terrible in their effects upon the organism, as to demand the highest professional skill in their treatment. We have included articles on the treatment of numerous complaints not heretofore included in any work on domestic medicine — especially of those which are peculiarly prevalent in certain climates — such as Tropical Diseases, etc.; directions for the discrimination between what is really a symptom of disease, and what is not, etc. The public is entitled to an explanation of the more cogent reasons we have for such a course, and for so enlarging the work over others heretofore offered to the public. 8 authors' preface. First of all, the common sense of every reader will admit, that we should write for the many, and not for individual cases — that we should attempt to embrace all contingencies as much as possible, and not con- fine ourselves to merely local circumstances ; and that it does not, there- fore, follow that persons whose situation and the like render any of these details unnecessary to them, should be compelled to adopt our suggestions, simply because we have published them ; whereas, it does necessarily follow, that those who are beyond the reach of any other resource — either by reason of distance or want of means— must wholly depend, either upon their own unaided judgment, or upon the directions afforded in works of this kind. Suppose, for instance, a family resident in the center of a highly cultivated country ; that family is not, therefore, within easy and imme- diate reach of the best professional advice, in which case, it is best that a work like this should be in the house to represent the physician, in so far as that is possible. And suppose another, and a very common case, as of the emigrant to distant states and territories ; to sparsely inhabited or desolate regions ; from whence, we would ask, are these to obtain the professional advice which would be so essential to them, unless it be from such directions as we are able to afford them in a work of this kind ? In this case, it must be admitted on all hands, that the work does good in comparison to its extent, amplitude, enlargement and comprehensiveness. Wherefore, then, should these essential conditions be withheld? Again, these are not all the questions involved ; there are yet mere vital points relating to the variations which may become necessary in the actual treatment of disease when once undertaken. In these cases, it is sufficiently obvious that those who prefer to exclude professional advice, should be so far removed from the chance of error as possible, which cannot be done without ample detail, because disease has scarcely ever, in two distinct cases, the same positive and exact characteristics. It is for this reason, also, that we have entered so largely into the consideration of the "Investigation of the Patient," and of "Disease." We are convinced that the great fault of domestic works in general is, that they do not give enough information, and, consequently, that they often mislead, instead of enlightening, the reader. It is, also, for these reasons, as well as for those already given, that we object to the extreme condensation of a domestic work, or to the lim- itation of its sphere to a particular class of diseases, and that we consider works founded upon this affected idea practically useless. We nowhere enjoin a person who has means and immediate access to educated and reliable professional advice, to undertake the treatment of dangerous diseases without it. We endeavor to provide for those who do not possess these advantages. Upon such grounds as these, we trust this work to the verdict of a liberal and discriminating people. We anticipate a hearty welcome to our evident endeavor, even if the product of our labor should fall short of its earnest purpose. R' L- &• LETTER TO MOTHERS. Dear Mothers: T really wish it could be my privilege to meet each one of you face to face, who may read that part of this work intended more particularly for you. In a brief manner I have endeavored to treat, with as much simplic- ity as possible, the more common disorders of women and children. You know how much and how often we, as females, suffer from dis- eases peculiar to our sex. First, On account of the dread we have of going to a man and telling him plainly just what is the matter with us, (if we know) — which is unfortunately not always the case. Second, From the inability of the average physician to understand our mental and physical diseases, on account of not knowing " how it is" himself. Third, From the harsh and often outrageous treatment we are subjected to by his harsh injections, burning with caustics, and deluging our systems with powerful drugs, which you and I know to be not only needless, but decidedly harm- ful. In this work, I believe you will find the needed information to ena- ble you to understand and treat all our ailments in a manner that is not only rational but really curative. And in the treatment of your daughters you will find what you long have needed — reliable help. I have long felt a deep interest in my own sex and have often felt the desire to warn mothers, more particularly in regard to daughters, as they attain the age of puberty ; tell them what they may expect in the way of "monthly changes." "Who can guide girls at such an age as well as a mother? Experience has shown how many women there are, whose happy girlhood days were blighted, with health, beauty, merriment, yes, and virtue too, gone forever, all through ignorance of themselves. It is false delicacy that would hide from girls that which, by all means it belongs to them to know. Mothers, teachers, it is with you this respon- sibility rests. The thousands of wretched wives who are thus suffering to a neglect of proper instruction at this turning point of their lives, warn you how serious this responsibility is. Every mother should carefully study all that is said in regard to in- fants in this work. There is a frightful waste of life caused from ignor- ance and neglect. Hence the need that mothers should understand and practice the means best adapted to preserve the health of their frail charges; and the importance of timely corrective measures in infantile affections. One of the fertile causes of disease and death in early life, is to be found in the ignorance displayed in regard to the dress of children. And it is not the poorly attired, but in many cases, the fashionably robed child which suffers the most. To parental vanity can be traced many of the causes which have resulted in death. SABAH L. ROBB. 9 INTRODUCTION. It is my purpose, in writing a description of the treatment of disease for popular use, to represent as fairly and plainly as I can, the principles and practice of the regular allopathic profession or school of medicine, in a manner which can be comprehended by all. It is not my intention to present an exhaustive treatise upon the practice of med- icine in all its departments. It is a matter of great importance how far it is proper to interfere in the management of diseases- Obvious is the fact, that in the great ma- jority of cases, diseases will, without special treatment, end in recovery. It is not to be supposed, therefore, that every instance of recovery is a cure. The prevalence of quackery depends largely upon the popular error, that the favorable termination of disease is always owing to the means employed. The greater the enlightenment of the public upon this subject, the less frequent will be imposition in medicine. The fact is, that disease, as a rule, tends to recovery and not to death, by the powers of nature alone. In all such diseases, the true course of treatment is indicated by a study of the way in which nature effects her cure, and in following that course. Much harm is often done by the unnecessary em- ployment of medicines. It is, therefore, a rule which should never be violated, that active treatment should not be employed, except in cases where it is certain to do good. It should not be inferred that proper treatment is useless. On the contrary, even in cases which would end favorably, if trusted to nature alone, much good may be done by shortening the duration of the disease, relieving the sufferings of the sick, and in preventing unpleasant and even dangerous consequences. In other instances, proper treatment is the means of saving life. The successful application of remedies, and the power of choosing between those of less or greater energy, depend upon experience and observation (or knowledge) not only, but a logical mind, judgment, common sense, and tact. The General Rules for Treatment of the sick may be sum- marized as follows : 1. The removal of the cause upon which the disease depends, is among the most important. In many instances this suffices. For exam- ple, nervous headaches may depend upon the continual use of coffee; dys- pepsia upon improper food and insufficient exercise in the open air; colic upon irritating matters in the bowels, etc., etc. Causes are also sure to interfere with a cure, as cholera infantum and the summer diarrhoea INTRODUCTION. 11 often resist treatment until the patient is removed from the air of a large city to the country. In other cases, the cause once operating ends its influence and adds nothing thereafter to the violence of the disease ; as in most of the contagious diseases. In other instances, the cause generally ceases when it has produced its effect, as is often the case in inflammation resulting from cold. Attention to the cause is important in the treat- ment, as far as it leads to a correct estimate of the nature of the disease. In endeavoring to remove the cause of disease, the attention must be directed to those within the system, as well as to the external agents One disease action is frequently the result of another, so that by removing the cause of the first, the latter trouble is cured. 2. The exact seat of the disease should be ascertained, and, as "the life is in the blood,'' it should be determined whether or not this is in the blood, and if so, its condition should be corrected and improved. Many cases are known to have continued for weeks and months, obstinately resisting treatment, or which only temporarily improve, quickly relapsing again, which have immediately and permanently yielded to treatment calculated to restore the blood to health. Even when the depraved con- dition of the blood is only secondary, measures to correct its condition are almost equally important, for the health cannot be regained while the blood remains impaired. Most diseases affect the solid tissues, and it is obviously necessary to restore the proper grade to the vital actions. 3. It may be stated, as a general law, that diseases are rarely station- ary. They tend to get better or to get worse. This fact affords valuable indications for treatment. It should be determined whether the disease intermits or not — i. e. t whether the pain, fever, or other disordered sensation or action returns at regular intervals of time, and going off again after a longer or shorter period of duration ; or whether the disease remits — i. e., becomes less vio- lent at regular intervals. Such diseases will yield to the treatment known as anti-periodic, which will be given in the article on the treatment of intermittent fever. Some diseases run a definite course and cannot be safely interrupted, such as the irruptive fevers. In such cases, when fully formed, proper management consists in preventing or removing injurious influences, mitigating their violence, correcting, as far as possible, any tendency to a fatal issue, and conducting them to a favorable termination. There are diseases which are indefinite in their course, and have a tendency, when not unusually severe, to get well sometime, and are often Jfcrested or shortened by treatment. The apparent danger should be then Jtept in view, and energetic measures never used, if moderate means will accomplish the end. Again, there are diseases which have a tendency to a fatal result, unless interrupted. These must be checked with mild means, if you can, but with the most energetic, if necessary. Then again, we find there are diseases which are necessarily fatal in their character, or at least are so in the present state of our knowledge. Here our endeavors should be to support the powers of life, and so prolong it, and to relieve the suffering of the patient and render him more com- fortable. 12 INTKODUCTION. In the diseases involving great danger to life, the way in which the affection will cause death, affords an important guide in treatment, by means of which a fatal termination may be averted. In many cases, the whole aim of treatment will be to obviate the tendency to death. For our purpose here, we can reduce ail modes of death to two, viz : by inter- ruption of respiration (called apnosa), and by failure of the circulation or exhaustion (called asthenia). These two modes of dying may be com- bined. The best illustration of the first mode named, {apncea), is furn- ished by cases of strangling. Other instances, are in diseases involving obstruction to the passage of air to the lungs, or which make them incom- petent to receive air, as croup and other inflammations of the air passages, catarrhal fever in children, extensive inflammation affecting both lungs, dropsy of the lung or pleural sac, and acute consumption. In all these cases, the obvious indication is, to supply oxygen to the blood. Obstruc- tion to the circulation may be caused by paralysis of the heart, by over- distension, by pressure upon the great vessels, by tumor, by dropsy of the sack covering the heart (pericardium), or coagulation. In these cases, the indication is to prevent or overcome, if possible, these obstructions. But in all diseases which prove fatal by exhaustion, the mode of dying is by asthenia, as in the continued fevers fatal of themselves. The indication is then to obviate this tendency by tonics, nourishment, and, perhaps, also by stimulants. 4. The use of remedies is also governed by the stage of the disease. In the commencement of a disease, experience shows that a measure may be effectual in arresting its progress, which would be harmful or useless at any later period in its course. A beginning cold is frequently cut short by a full dose of Opium or Dover's powder, but so favorable a result would not follow later in the case. Depletion is frequently useful in the commencement of diseases, but is harmful when advanced; on the other hand, stimulation is frequently of great importance in the latter stages of acute prostrating diseases, where, if employed at the commencement, it would have worked an injury. When one disease follows or appears in the course of another, or an accompanying symptom develops an undue importance, great watchfulness, and frequently new measures of treat- ment, are demanded. 5. The condition of the system, at the time of the attack., has the most important bearing upon the treatment. Measures which would be proper in a robust, hearty person, with an abundance of healthy blood, would be wholly unsuited in a feeble constitution, and those in whom the blood is impoverished or vitiated. The latter would necessarily require tonic and supporting treatment from the very first, while depletion might be beneficial in the former. The circumstances under which the patient is constantly placed, or those to which he was exposed previous to the occurrence of the disease, must be taken into account. The age of the patient has an important bearing upon treatment. Infancy is well known to be more than proportionately susceptible to many medicines, and while the restorative processes are rapid, the sys- tem is also easily depressed below the point of recovery. Supporting treatment is early called for in prolonged diseases of infants. In ad- INTRODUCTION. 13 vanced life, though less susceptible than middle life to the action of med- icines, excesses, of any kind whatever, are not well borne, caution is demanded and large doses should never be given. Supporting measures are demanded earlier in the course of disease in the old than in middle life, though excessive stimulation is not safe. Women are more susceptible than men, and should be treated more delicately. Particular care is required during menstruation, and unless treatment is demanded, it should be suspended during menstruation. In pregnancy, all purturbating treatment, such as emetics and cathartics, should be avoided. Individual peculiarities should be considered; any special suscepti- bility, or peculiar action of a remedy, dictates its avoidance in those per- sons. Hereditary influences must be considered ; the known constitutional habits of the parents should be weighed and govern the treatment of the child. For example, the child of scrofulous parents should, under some cir- cumstances, be treated differently from one in whom there is no heredi- tary morbid predisposition . The habits of the patient have an important bearing upon the treat- ment, and should be thoroughly investigated and known. Exhaustion from immoral excesses ; debility and impoverishment of the blood from insufficient food in quality, or variety, if not absolute starvation and bad air ; gluttonous indulgence of the appetite ; intemperance in the use of alcoholic drinks, and the effects of one's occupation or business, all have an important bearing upon the treatment. All these conditions call for supporting treatment at once, and often for stimulants. Previous disease often leaves a debility which calls promptly for sup- porting treatment. Peculiar tendencies to different diseases (diatheses) such as rheumatism, gout, consumption, etc., modify greatly different diseases, and may impress upon them more or less of their own character. The patient cannot be properly treated without giving these facts their proper bearing. 6. Co-existing influences often modify greatly the disease results of particular causes. The most prominent of these, are the epidemic (a widely prevailing disease,) or endemic (a locally prevalent disease) influ- ences and the miasmatic, especially marsh miasma, which causes ague and other periodical diseases. Without attending to these influences which modify disease, the treatment will be liable to be attended with fatal blunders. In all miasmatic districts, it is well known, that all diseases assume a character resembling more or less closely the periodical fevers with which these districts are infested. In all these localities, especially in autumn and winter, when other fevers, from whatever cause, and also inflammatory diseases, exhibit the remittent character of the proper miasmatic (or marsh) fever, we also see the best results follow the admin- istration of Quinine. Epidemics, (wide-spread prevalent diseases) it is well known, impart more or less of their own character to all coincident diseases. Sometimes, notwithstanding the epidemic influence, there is maintained a vigorous state of the system ; when this is the case, the type of disease is said to be ethenic. At other times, the tendency is to 14 INTRODUCTION. a feeble and weak, or typhoid, condition ; this is said to be asthenic. The latter condition calls at once for supporting and nutritious measures, and in the former, these measures are not as early called for, and even deplet- ing remedies may be useful. 7. The pointing of nature, as shown by the expression of wants by the patient, should not be disregarded, but should be watched for, and cautiously gratified, even though they are opposed by the dictates of our own reason, or even to the whole course of our experience. It is some- times noticed that the patient, during the progress of a severe disease, expresses a wish for some drink, or article of food, or some change in other respects, which would seem to be highly improper. As such wants are expressed, often as the mere result of restlessness, or whim of the patient, it should, of course, be properly denied. But, if the same wish is repeated from time to time, against the authority of physician, attend- ant, and the judgment of the patient himself, it may be looked upon as a real want of the system, and indication by nature, which ought to be com- plied with. At first, it should be gratified cautiously, and in a manner that little harm could result, if it should happen to be a mistake. If good should result from careful trial, a greater indulgence may be per- mitted. On this point, Prof. Geo. B. Wood forcibly says: "The prac- titioner will often be gratified at witnessing a rapid recovery, dating from the moment of his judicious surrender of his own judgment to the impe- rious call of the system.'' If error is committed on this point, let it be on the side of caution. 8. In the treatment of any disease, it is a good general rule to attend to the state of the functions, (secretions and excretions,) and to correct any disorder there, even though they are not directly connected with the disease. Especially should the bowels be kept regular, and constipation (fecal accumulations) carefully guarded against. The secretions of the skin and kidneys should be maintained, as nearly as possible, in a healthy state, and to this end, frequent examination of the urine is to be made. An irregular circulation, the temperature and nervous action should also receive attention. By these means alone, we occasionally cut off one of the chief sources of disease, and give great aid to recovery, for it is not always easy to determine how far diseases are mutually dependent. J. V. B. CONTENTS. Preface to Second Edition Page 3-4 Publisher's Preface to First Edition Page 5-6 Author's Preface Page 7-8 Mrs. Dr. Kobb's Letter to Mothers Page 9 Introduction to Allopathic Treatment Page 10-14 Table of Contents Page 15-22 Part First. DIAGNOSIS AND PK0GN0SIS; OR, WHAT IS THE DISEASE, AND HOW WILL IT END? HOW TO INVESTIGATE THE CONDITION OF THE PATIENT AND DISTINGUISH BETWEEN A STATE OF HEALTH AND DISEASE, AND DETERMINE THE PECU- LIAR NATURE OF THE DISEASE. CHAPTER I Page 23 THE GENERAL INVESTIGATION OF*THE PATIENT. The Constitution and its Varieties: Plethoric or Sanguine, Feeble, Bilious, Apoplectic, Nervous, Dry, Wiry, Lax, Lymphatic or Mucous, Catarrhal or Rheumatic, Scrofulous, and Consumptive. The Temperaments and their Varieties: The Sanguine, The Bil- ious, The Melancholic, and The Phlegmatic. The Antecedents of the Patient's Family. The Sexes and their Distinctions. The Age and the Conditions Which Qualify It : The earliest period of childhood. The second period of childhood. The third period of childhood. The first period of maturity. Full maturity. The first period of decline. The second period of decline, or old age. Individual Characteristics: Diseases to which (if any) the patient is liable. Manner of Living, General Habits, Occupation. 15 16 CONTENTS. CHAPTER II PageSO THE INVESTIGATION OF DISEASE. By Consideration of the Cause, General Character and Particular Symptoms. The. Causes of Diseases: First, Individual exposure, excesses, etc., Second, Endemic, or those peculiar to a certain locality. Third, Epi- demic causes, or those for the time being prevailing over a large extent of country. The Pulse, its Variations and Indications: The art of feeling the pulse, in order to determine its character accurately. What to do before you feel the pulse. How to place the fingers to get the most informa- tion, and what you learn from the fingers correctly placed, The average standard of health. General inferences deductible from the pulse. Var- ious names for alterations of the pulse, as frequent, slow, quick, slug- gish, or tardy, soft, strong, feeble, large, small, full, empty, unequal and intermittent pulse, Indications attributable to these varieties, respec- tively and jointly. The Condition of the Blood, its characteristics. Spontaneous dis- charges of blood generally. The Urine, its Varieties and Indications : The variations apparent in the urine, and their indications. The urine as a guide in fevers. Breathing, its Varieties and their Indications: The breath in health. The variations to which breathing is subject, and their indi- cations. The Digestive Functions, and the indications which they afford. The evacuations and their indications. Nausea and vomiting, and their meaning. Information derived from the appetite, and its variations. Absence of appetite. Natural appetite. Excess of appetite. Thirst, and the Indications it affords. The Tongue, and its indications and differences of appearance. The Nerves, Brain, Sensations and senses, and the information de- rived from their study. Loss of consciousness. Delirium. Fainting, etc. Motion, or muscular action, and rest or'sleep, including spasms, convul- sions and paralysis. $ The Sensations and their Indications : ^ain Discomfort, Anxiety. Heat, Chill. The Organs of Sense, eyes, ears, nose, taste, etc., and the knowledge derived from them. CHAPTER III Page67 INVESTIGATION OF THE DISEASE CONTINUED. Coughs, and their indications. The condition of the skin, hot, natural or sweaty, and the lesson it teaches. The complexion, its changes and varieties. Sounds given out by the chest, and the method of ex- amining and interpreting them. The voice and speech. Tearfulness and laughter, as signs of health or disease. Loss of, or unhealthy in- crease of flesh. Sneezing, yawning, groaning, etc. The saliva, defi- ciency and increase. The expectoration, and its valuable indica- tions. CONTENTS. 17 CHAPTER IV Page 73 DIET AND MANNER OF LIVING. CLOTHING AND HABITS. CHAPTER V Page 75 ADMINISTRATION AND REPETITION OF THE HOMCEOPATHIC ME- DICINES. External applications. Internal remedies and doses. Forms of medi- cines. Table of analogous remedies. THE BATH. Cold Salt Water Bath. Cold Fresh Water Bath. Hot Fresh Water Bath. Tepid, Shower, Vapor and Medicated Baths. Instructions, when and how to use the different baths. Acclimation. JPart Second, DISEASES OF THE BRAIN, THE SPINAL CORD, AND THE NERVOUS SYSTEM GENERALLY. CHAPTER VI Page 108 Spotted Fever — Cerebro-Spinal Meningitis. Hyperemia of the Brain, or Excess of Blood to the Brain. Anaemia, or Lack of Blood to the Brain. Apoplexy. Paralysis. Brain Fever. Acute Inflammation of the Brain. Hydrocephalus. — Dropsy of the Brain,or Water on the Brain. Lock Jaw — Tetanus — Trismus. Delirium Tremens. Epilepsy — Spasms. Spasms of Infants — Eclampsia Infantum. Chorea. — St. Vitus' Dance. Catalepsy— Trance. Hysteria— Hysterics. Part Third. DISEASES OF THE HEAD. CHAPTER VII Page 156 THE BRAIN AND NERVES. Headache — Cephalalgia — Hemicrania. Nerve Pain. Face Ache. Face Ague Neuralgia of the Face. CHAPTER VIII Page 168 DISEASES OF THE EYE. Inflammation of the Eye— Ophthalmia— Acute and Chronic. Cataract.— Specks on the Eye. Strabismus— Cross-Eye. Weeping, or Watery Eye. Bloodshot Eye. Stye. Blindness. Conjunctivitis. CHAPTER IX Page 182 DISEASES OF THE EAR. Inflammation of the Ear and Earache— Ostitis-Otalgia. Discharge from the Ears— Otorrhcea. Deafness. Humming or buzzing in the Ear. 2 18 CONTENTS. CHAPTER X.. , Page 190 DISEASES OF THE NOSE. Catarrh— Cold in the Head— Coryza— Acute and Chronic. Inflammation of the Nose. Bleeding at the Nose — Epistaxis. JPart Fourth. THE GATE. CHAPTER XI Page 201 DISEASES OF THE MOUTH AND THROAT. Inflammation of the Mouth. Canker of the Mouth — Stomatitis. Angina. Aphthous Sore Throat. Catarrhal Sore Throat. Quinsy. Diphtheria. Mumps— Parotitis. Scurvy of the Gums— Scorbutus. Toothache— Odontalgia. Part Fifth. DISEASES OF THE STOMACH AND INTESTINES. CHAPTER XII Page 225 DISEASES OF THE STOMACH. Dyspepsia — Acute and Chronic. Nausea. Eructations. Sick Headache. Bleeding from the Stomach — Hcematamesis. Spasm or Cramp of the Stomach — Cardialgia. Heartburn. — Waterbrash — Pyrosis. CHAPTER XIII Page 261 DISEASES OF THE INTESTINES. Diarrhoea — Intestinal Catarrh. Simple Diarrhoea, Chronic Diarrhoea. Cholera Morbus. Fevers. Bilious Fever. Gastric Fever. Inflamma- tion of the Bowels—Enteritis. Catarrhal Dysentery. Epidemic Dys- entery — Flux. Colic — Enteralgia. Flatulent, Bilious, Hysteric. Rheu- matic, Neuralgic, Printers' and Copper Colic. Constipation — Stenosis. Piles — Hemorrhoids. Worms — Helminthiasis. Prolapsus Ani. In- flammation of the Peritoneum — Peritonitis. Part Sixtlx. DISEASES OF THE LIVER AND SPLEEN. CHAPTER XIV Page 331 DISEASES OF THE LITER. Inflammation of the Liver— Acute— Chronic and Suppurative. Conges- tion of the Liver. Jaundice. Gravel in the Gall-bladder — Gall Stones, Cancer of the Liver. CONTENTS. 19 CHAPTER XV Page 333 DISEASES OF THE SPLEEN, Inflammation of the Spleen. Part Seventh.. DISEASES OF THE KIDNEYS AND BLADDEK. CHAPTER XVI.... Page 336 DISEASES OF THE KIDNEYS. Inflammation of the Kidneys— Nephritis. Bright's Disease of the Kid- neys — Morbus Brightii. Gravel — Renal Calculi. CHAPTER XVII Page 348 DISEASES OF THE BLADDER. Inflammation of the Bladder — Cystitis. Bloody Urine — Hematuria. Wet- ting the Bed — Enuresis Nociurna Spasm of the Bladder— Cystospas- mus. Paralysis of the Bladder. JPar-t Eiglitli. THE MALE SEXUAL ORGANS. CHAPTER XVIII , Page 357 Orchitis— Inflammation of the Testicles. Nightly Emissions— Sperma- torrhoea. Part Ninth. DISEASES OF THE RESPIRATORY ORGANS. CHAPTER XIX Page364 DISEASES OF THE LARYNX AND TRACHEA. Catarrh or Common Cold. Catarrhal Fever. Inflammation of the Lar- ynx or upper part of the windpipe. Cough. Croup — Laryngitis. Mem- branous Croup. Hoarseness. CHAPTER XX Page 384 DISEASES OF THE LUNGS. Congestion of the Lungs. Hemorrhage of the Lungs. Bronchitis — Acute and Chronic. Influenza. Whooping Cough — Pertussis. Pneu- monia — Inflammation of the Lungs. Asthma. Hiccup — Singultus. CHAPTER XXI Page 429 DISEASES OF THE PLEURA. Pleurisy — Inflammation of the Pleura. +, _ Part Tenth. DISEASES OF THE ORGANS OF CIRCULATION. CHAPTER XXII Page438 DISEASES OF THE HEART. Inflammation of the Heart— Carditis. Palpitation of the Heart. Fatty 20 CONTENTS. Degeneration of the Heart. Hypertrophy of the Heart— Enlarge- ment of the Heart. Angina Pectoris. CHAPTER XXIII Page453. DISEASES OF THE ARTERIES AND YEINS. Diseases of the Arteries. Inflammations of the Veins — Phlebitis. Vari- cose Veins or Dilation of the Veins. Part Eleventh.. DERANGEMENTS OF SINGLE SYSTEMS. CHAPTER XXIV Page 458 DISEASES OF THE BONES, MUSCLES, AND JOINTS. Ostitis — Inflammation of the Bones and the Membranes covering them. Rickets — Rachitis. Lumbago. Inflammation of the Joints. Hip Joint — Coxalgia. Knee Joint — White Swelling — Gonitis. Joints of the Foot. CHAPTER XXV Page 475. DISEASES OF THE LYMPHATIC VESSELS AND GLANDS. Acute Inflammation. Chronic Inflammation. CHAPTER XXVI Page 478 DISEASES OF THE SKIN. Erythema — Simple redness of the Skin — Erysipelas. Hives — Urticaria. Dandruff— Pityriasis. Scaly Tetter. Barbers' Itch. Bottle >.ose. Ring Worm. Tetter. Salt Rheum — Eczema. Shingles. Boils and Carbuncles. Scald Head — Favus. Itch — Scabies. Ulcers. Abscess. Whitlow— Felon. Chilblains. Corns. Part Twelfth. CONSTITUTIONAL DISEASES. CHAPTER XXVII Page 502 ACUTE CONTAGIOUS DISEASES. Measles. Scarlet Fever. Smallpox — Variola — Varioloid. Chicken Pox. CHAPTER XXVIII Page 525 EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. Fever and Ague— Intermittent Fever. Inflammatory Fexer—Synochia Typhoid Fever — Enteric Fever. Yellow Fever. Cholera. CHAPTER XXIX Page 575 CONSTITUTIONAL DISEASES WITHOUT DEFINITE INFECTION. Rheumatism of Joints and Muscles. Rheumatism of Sciatic Nerve. Con- sumption — Tuberculosis. Scrofula — Scrofulosis. CONTENTS. 21 Part Thirteenth.. DISEASES PECULIAR TO WOMEN. CHAPTER XXX Page 599 DISEASES OF THE FEMALE SEXUAL ORGANS. Menstruation; what it means. Its course in health. Derangements at- tendant on its appearance. Chlorosis — Green Sickness. Amenorrhoea —Suppression or Delay of the Menses. Menorrhagia — Profuse Men- struation. Leucorrhcea — Whites— Catarrh of the Sexual Mucous Lining. Prolapsus Uteri — Falling of the Womb. Menopause — The change of life. Mastitis— Inflammation of the Breasts. Carcinoma Uteri — Cancer of the Womb. Carcinoma Mammo3 — Cancer of the Breast. CHAPTER XXXI Page 630 CONDENSED SIGNS OF PREGNANCY. General Observations, Air and Exercise, Clothing, Diet Employment of the Mind, and habits during. Morning Sickness. Heartburn— Acidity— Waterbrash. Constipation. Diarrhoea. Toothache. Urinary Difficulties. Swelling of the lower limbs. MISCABRIAGE. General Symptoms. Exciting Causes. TREATMENT BEFORE CONFINEMENT. Preparation of the Breasts. Preparations for Labor. The Bowels. Diet. False Pains. Parturition or Labor. Treatment after Delivery. Gen- eral Management. After Pains. Flooding. Spasm of the Bladder- Retention of the Urine, Duration of Confinement. CHAPTER XXXII Page652 DISEASES FOLLOWING CONFINEMENT. Secretion of Milk. Excessive Secretion of Milk. Perspiration after De- livery. Milk Fever. Childbed Fever. Puerperal Fever. The Lochial Discharge. Diarrhoea of Lying-in Women. Abdominal Deformities. Weakness after Labor. Sore Nipples. Inflammation of the Breasts. Part Fourteenth. TREATMENT OF INFANTS. CHAPTER XXXIII.. Page 663 TREATMENT AFTER BIRTH. Stillborn children— Suspended Animation, treatment, mechanical mea- sures, etc. Swelling of the Head. Navel rupture in Infants ; mecha- nical treatment. Rupture in the Groin. Expulsion of the Meconium. Suckling of the Infant. The choice of the Nurse. Diet during Nur- sing. Additional Diet of Infants. Sleep— Sleeplessness. Exercise. Weaning. 22 CONTENTS. CHAPTER XXXIV Pageeis DISEASES OF INFANCY. Inflammation of the Eyes. Hiccup. Cold in the Head. Crying and Wakefulness of Infants— Colic. Regurgitation of Milk. Acidity. Flatulence, etc. Milk Crust— Milk Scab— Milk Blotches. Thrush— Aphthae. Constipation. Diarrhoea of Infants. Cholera Infantum — Summer Complaint. Chafing — Excoriations. Asthma of Infants. Swelling of the Breasts. Atrophy — Emaciation Dentition. Spasms. — Convulsions of Infants and Children. Vaccination. -~ ♦ Part Fifteenth.. SURGERY. CHAPTER XXXV Page 702 Accidents of various kinds. Apparent Death, from Hunger; from a Fall; from Suffocation; from Lightning; from Drowning; from being Frozen. Verification of Death. Concussion of the Brain. Concussion of the Chest. Sprains — Partial Dislocation. Hemorrhage — with. Means of Suppres- sing. Wounds, with their Divisions; Incised, Lacerated, Bruised, Punctured, and Gunshot Wounds. Bandages and how to apply them. Fractures — Broken Bones. Burns and Scalds. Sunstroke — Sun Fe- ver. Stings of Insects. Dropsy. CHAPTER XXXVI Page 720 FOOD FOR INFANTS AND INVALIDS. FOOD FOR INFANTS. Starchy Food. English "Pap." Cow's Milk. Infants Broth. Baby Pudding. Food for Young Children. Children's Pie. Brown Mush for Supper. Bread and Milk. Cranberries. FOOD FOB, INVALIDS. Gruel. Panada. Soft Toast. Egg Toast, Soft Boiled Eggs. Dry Toast. Milk Toast. Thickened Milk. Milk and Eggs. Beef Tea. Oyster Soup. Broiled Tenderloin. Arrowroot Gruel. Mutton Tea. Chicken Broth. Water Gruel. Rice Gruel. Sago Gruel. Tapioca Cup Pud- ding. Invalid Apple Pie. Roast Apples. Stewed Prunes. Lemon- ade. Apple Water. Toast Water. Flaxseed Tea, Barley Coffee. Oatmeal Coffee. Rice Water. Mucilage of Elm Bark. Alum Whey. Mustard Whey. Vinegar Whey. Rennet Whey. Orange Whey. Table of Remedies with abbreviation of Latin name. Full Latin (or technical) name. Common English name. Name of antidote to be used when the medicine has, from any reason, been taken in too large doses, and the names of a few diseases which are often cured by the rem- edy they follow. Part Sixteenth. THE REPERTORY. CHAPTER XXXVII Page 736 A list of all the symptoms developed by different diseases. Arranged with relation to the part of the body affected, and the symptoms of each part follow each other in alphabetical order. After each symptom is given the abbreviated name of a few remedies known to be excellent as a means of curing that particular condition. ROBB & CO.'S FAMILY PHYSICIAN. PART FIRST. DIAGNOSIS AND PROGNOSIS; OR, WHAT IS THE . DISEASE, AND HOW WILL IT END? CHAPTER I. HOW TO INVESTIGATE THE CONDITION OF THE PATIENT AND DIS- TINGUISH BETWEEN A STATE OF HEALTH AND DISEASE, AND DETERMINE THE PECULIAR NATURE OF THE DISEASE. The investigation of the condition of the Patient, and the deter- mining the particular nature of the Disease, are evidently essential to appropriate treatment. It is, therefore, imperative that a work of this kind should contain such simple instructions on this head as may lead unprofessional persons easily and simply to a clear and positive conclu- sion. Such an investigation may properly be divided into two distinct sections, namely: first, the general investigation of the patient, and secondly, the particular investigation of the disease . THE GENERAL, INVESTIGATION OF THE PATIENT. The general investigation of the patient should comprise a scrutiniz- ing inquiry into the particular constitution of the individual — the tem- perament — the antecedents of the patient's family, as of general health, habits, etc., of the parents, and of each of their families respectively — the sex, and the relative state of the secretions especially consistent with the state of health in such sex— the age of the patient, and the circumstances which qualify this condition — conditions, impressions, or habits, etc., which are individually peculiar to the patient — the toeak or particularly susceptible part, and what, if any, be the particular affections to which the patient has been subject — the general habits, occupation, method of living, diet, etc., — the relations between the climate and the individual, or any transitions of climate to which the patient may have been exposed. THE CONSTITUTION AND ITS VARIETIES. A plethoric {sanguine) constitution, or full habit of body, characterized by redundancy of animation and vital energy in health, and a prevailing and predominant activity in the circulative system ; the complexion being l!4 INVESTIGATION OF THE PATIENT. florid and glowing, the frame full and stalwart, the limbs generally active, the spirits and muscular apparatus buoyant and elastic, the generation of natural warmth abundant, and the pulse full and strong ; but consequently with susceptibility to inflammatory influences, and a predisposition to local, organic, or general congestions, suffusions, or emissions of blood. A feeble constitution, as opposed to the foregoing — in which fatigue is naturally a ready consequence of exertion; when the breath will easily be exhausted by sudden or rapid motion ; when the generation of heat will be naturally deficient, and the operation of the functions generally slow and easily impeded, or vexed, by being the least overtaxed, the mus- cles being readily wearied and incapacitated— the secretions varying from excess to deficiency or suspension— and the organs being either too readily provoked and stimulated, or very dull and insusceptible of external cir- cumstances—and the pulse being naturally feeble, soft, and yielding. The patient is consequently subject to diseases characterized by torpidity and utter inaction of the functions, or by excessive relaxation. A bilious constitution, characterized by dark and somewhat turgid skin, or even by superabundant yellowness of the skin, (an imperceptible proportion of yellow in the skin, observed on close examination, being indispensible to a really healthy complexion,) and by the readiness with which the liver sympathizes in, and becomes affected by, every external or internal contingency, with predisposition to derangements affecting the digestive functions and the stomach generally, and to irregularity of such functions ; as also to dark colored urine, costiveness (with dark motions,) and piles; the pulse is apt to be wiry. An apoplectic constitution, (a sub-division which is important here,) characterized by the short, thick-set, or close, full frame, with large head, apparently buried between the shoulders, the neck being very short and thick, and the pulse being more or less of the character of the plethoric habit, and the patient being predisposed to sudden rushes of blood to the brain. A nervous constitution, (a variety which is often found in combination with the bilious,) especially characterized by predominant excitability of body and of mind ; absence of fixity (or changeableness) of ideas, habits, inclinations, etc. ; irritability, and extreme sensitiveness and inequalities of temper — the pulse being accordingly also variable, easily subject to exceeding acceleration, but often subsiding, in sedate moments, to a move- ment slower than is customary. The patient is subject to the various affections so difficult of distinction and classification, which come under the head of nervous diseases ; sucli as spasmodic affections, fits, apparently traceable to no distinct cause; fugitive and inexplicable pains, particularly such as are aggravated by very slight touch, or by approximation, but which are relieved by pressure. A dry, zoiry constitution, (not uncommonly combined with the bilious or nervous,) characterized by swarthy complexion, sharp, deep-set fea- tures, searching glance, persistently dry condition of the the skin, firm, hard, wiry condition of the muscular and tendinous fibre; deficiency of flesh and angular frame ; generally, also, a rapid motion and quick per- ception ; the urine is dark, the motions are habitually hard and scanty, the secretions and sweat are usually deficient, and the pulse is generally INVESTIGATION OF THE PATIENT. 25 distinct and wiry, but commonly, also, quicker than that of the ner- vous habit (when unexcited). The patient is subject to inflammatory affections — to which the intestines are especially predisposed — as also to diseases generally, which occur (as it were) with superabundant animal power . A lax, lymphatic, or mucous constitution. — These three varieties, which are, indeed, susceptible of very nice distinctions, are, however, sufficiently analogous to be united in a work of this kind ; they are opposed to the fore- going. The complexion is generally fair, the flesh apparently full, but soft, flaccid, and puffy; the skin pallid, the frame rounded, the muscular and tendinous fibre unstrung, yielding, and relaxed ; sensations of chilli- ness prevail, and the individual is usually more sensitive of cold than of heat, but is also alive to immoderate elevation of the latter; the natural generation of heat is deficient, the circulation sluggish, the pulse being slow, (sometimes rather full, but always soft, easily compressed, yielding). The patient is subject to the transmutation of every disease into a sluggish, persistent, or chronic form, (the crisis and resolution being in general imperfect,) to superabundant secretions or accumulations of phlegm, to catarrhal affections, to abcesses, to excessive discharges of phlegm, etc., etc. ; to the accumulation of water (by decomposition, or imperfect compo- sition of the blood,) about particular organs, or throughout the body, (generally as the immediate consequence of inflammation,) and sometimes to the sudden suppression of discharges. The catarrhal or rheumatic constitution, (nearly analogous to the last, hut having one very distinctive feature in the susceptibility of the exter- nal surface,) characterized especially by want of sufficient activity and nervous tension and vitality in the skin, which, therefore, remains easily affected by every external circumstance, effects transpiration (throwing off moisture and unhealthy matter, through the pores of the skin,) very defec- tively and inadequately, and is apt, by being susceptible to the sudden suppression or repercussion of such transpiration, to re-convey the morbid humors which have been expelled by internal organs, upon those organs themselves, and thereby to generate diseases of the character indicated by the name here selected. A very decided feature of this habit of body consists of extreme susceptibility to derangement of digestion, which, if inherited, may be considered as the predisposing cause to such tendencies. A constitution in which the skin is especially liable to become diseased, (psoric) (more distinctly capable of individual classification than the scrofu- lous habit, but yet a mere modification of the latter)— distinguishable by the predominance, recurrence, or continuance of irregular and unhealthy secretions from the skin, and irregular action of the glands associated with it ; eruptions of various characters— ulcerative sores, general foul- ness— whicli seem to appear as the result of every affection, of whatever kind, and either to accompany or to follow every derangement. The consumptive constitution, (in the majority of instances, again, a modification of the scrofulous habit, but more subject to appropriate class- ification in a work of this nature,)— identified in general by a very clear, transparent skin, bright flush-spot on the cheeks, especially on the left cheek ; flatness ->f the chest, and hollowness on the breast-bone ; slender, attenuated, lengthened, fragile frame; elongation and spareness of the neck; prominent protrusion of the shoulder-blades; sudden and rapid lit) INVESTIGATION OF THE PATIENT. growth ; prevalence of heat of the hands after eating ; irritability of the circulative system, and consequently a,pulse characterized by smallness and quickness. The patient is particularly susceptible to complications affect- ing the lungs, resulting from every inflammatory or irritative process (which is also very frequent, and readily provoked;) to want of breath, and complete exhaustion after every unusual degree of exertion, especially after rapid motion, and often in consequence of mere mental excitement, or momentary irritability; to inflammatory affections of the lungs and adjacent membranes, (and expectoration of blood,) which will always be liable to result in decay of those organs. THE TEMPERAMENTS AND THEIR VARIETIES. The temperaments are subject to an infinity of individual peculiari- ties which might constitute separate divisions, but which, in our estima- tion, will be no more readily comprehended by the reader in his investi- gation into individual characteristics. We shall, therefore, confine the division of temperaments to the following distinctions, which, even then, are often compounded, and which should be held to modify the relations of morbid manifestations. A sanguine temperament, (usually associated with a plethoric constitu- tion,) — which is characterized by habitual animation and buoyancy of spirits, gaiety, good humor, etc.; the mind and body are alike quickly stimulated into excessive action, but every affection, or disturbance, is usually of as rapid a course, and brief duration, as it is severe while it lasts. The bodily health is, usually, good and strong, — and slow or last- ing diseases are of rare occurrence ; but the majority of affections, (which have a predisposition to assume a violent and inflammatory type,) are exceedingly severe, when they do occur, and run a very rapid course. A choleric temperament, (usually associated with the bilious constitu- tion,) characterized by the violence of the reaction occasioned by any irri- tation, or stimulus, or impulse, and, particularly, by its severe implica- tion of the biliary apparatus, which, with increased and altered secretion of bile, reacts upon the moral and mental faculties, and has a tendency to engender a liability to the provocation of ill-humor, and even venge- fulness, and malignity, or to rancor, and acrimony of temper, upon the revival of Causes of excitement. The complexion is usually swarthy, with a yellowish tinge ; the muscular and tendinous fibre hard, wiry, and tightly strung; the hair dark, and the features acute or deep-set. The patient is subject to bilious derangements, and to bilious complica- tions with every derangement, not uncommonly provoked by the violent fits of excitement to which he is constitutionally subject. The melancholic temperament is identified by the slow, meditative dis- position ; the gloomy, retiring, solitary, and hypochondriacal temper ; the tacit, latent, and unobservable progress of affections produced by external impressions, but silently harbored. Every impression is deep and lasting, and broods upon the mind and body; but the patient is not subject to violent impulses, nor very susceptible to sudden impressions, the organs being none the less alive to such impressions; the sensibility is apparently blunted or subjected to the reflective powers. The body is alike slowly, but progressively, affected by external circumstances. The INVESTIGATION OF THE PATIENT. 27 patient is subject to diseases affecting the intestinal apparatus, especially those which assume a chronic and continuous character. A Phlegmatic temperament (which is usually associated with the feeble and lax, or lymphatic constitution,) is distinguishable by the tardy ope- ration of all functions, mental as well as bodily; by the slowness with which irritation, or stimulation, is produced, and by the no less remark- able slowness, as well as by the inadequacy of the reactionary power. The predispositions are to be gathered from the remarks on the " feeble," and on the " lax," or »' lymphatic constitutions." THE ANTECEDENTS OF THE PATIENT'S FAMILY. We should pay especial attention to the general health, habits, or particular diseases (if they be known) of the parents of the patient, and of the paternal and maternal relations, which may serve to elucidate the origin of a bad habit of body, especially if such diseases as scrofula (in any of its multiplied forms,) cutaneous (skin) disorders, consumption, gout, piles, etc , be habitual with any member of the family, whose consti- tution could have been inherited by the patient. This is a most essential consideration, for it will, very frequently, be found that when a remedy in- distinctly indicated in the case, it fails to operate without previous prepar- atory treatment, and we are puzzled by the failure; whereas, after the previous administration of an opposite preparatory remedy, the medi- cine already selected as appropriate, but administered without effect, fre- quently becomes signally successful. This is generally owing to hereditary defects of constitution. THE SEXES AND THEIR DISTINCTIONS. In the male, we anticipate redundancy of animal strength, vigor, energy, and circulative power, and we must consider disease in a modified or aggravated aspect, according to the ascendency or deficiency of these characteristics. In the female, we may anticipate more acute sensibility, greater ten- derness and excitability, and a less vigorous and persistent reactionary power. We must not, moreover, omit to consider the conditions depend- ent peculiarly upon the organs of parturition, etc., and upon the func- tions associated with them ; the progress of pregnancy, and the genera- tion of milk; or, on the other hand, the presence of periodical changes should be duly considered, in relation to every simultaneous derange- ment. Relaxation of fibre, and lymphatic accumulations, are, also, (to a greater or less degree,) inseparably associated with the peculiarities of the sex; and the greater intensity and additional sphere of nervous sensibil- ity should lead us to corisider, with great caution, such nervous, spas- modic, or hysterical indispositions, as occur, associated with natural pre- disposing causes. THE AGE AND THE CONDITIONS WHICH QUALIFY IT. Age is not to be considered, without regard to conditions of previous health or disease — of habits, manner of living, climate, avocations, etc., especially in relation to persons who have attained maturity. It may, however, (subject to such modifications,) be considered under seven dis- tinct sections, viz: — childhood constituting three, maturity two, and decline two. 28 INVESTIGATION OF THE PATIENT. 1. Ill the earliest period of childhood (the first of infancy,) extend- ing to the period of the earliest teeth, the human being is extraordinarily susceptible to external influences ; sensitive, to a higher degree, and, con- sequently, alive to any sudden irritation from, apparently, slight causes; the brain, in particular, is liable to precipitation of blood, and the acute sensitiveness of the whole nervous structure renders spasmodic affections predominant. 2. In the second period of childhood — extending to the seventh year in our climate — we have to consider the natural irritability of the system, the want of firmness of fibre, the susceptibility to fatigue, readily obvi- ated by the provision of nature — a preponderance of tendency to rest ; and we have to anticipate the occurrence of organic inflammations, par- ticularly as connected with the respiratory or cerebral apparatus, and irregularities in the accumulation of flesh. 3. In the third period of childhood — extending to the beginning of manhood, or womanhood — the equilibrium between the functions, facul- ties, etc., being better established, and the tissues having become inured to external influences, we should consider the occurrence of such affec- tions, as already described more minutely, with reference to particular habit of body, circumstances, individual habits, avocations, etc. ; situation, and other local and general external causes. 4. In the period of approaching and progressive maturity — extend- ing to the twenty-fifth year, in our climate — the vigor of the circulative system should be developed ; it is then, also, that we may anticipate the serious development of latent, or declared bad habits of body, traceable to parentage, and particular care should then be taken — especially, if in infancy, or childhood, a course of constitutional treatment has been neg- lected — to neutralize, or modify such constitutional defects — affecting the Lungs, and the Brain especially — as in Epileptic or Consumptive affec- tions ; both being considered in due relation with the progress of sexual powers. 5. The period of maturi+y — extending, generally, from the twenty- fifth to forty-fifth year, in our climate, must, especially, be considered in relation with habits, mode of life, avocations, locality inhabited, trans- itions of climate, (if any,) etc., because any of these circumstances may tend, very materially, to lengthen or abbreviate the stage of vigorous maturity. In some cases, we may extend it to the fifty-fifth year ; in others, it may as reasonably be limited to the thirty-fifth year. In gen- eral, the period of maturity, properly so called (whether of long or short duration,) is characterized by continual, even, regular, and vigorous ope- ration of all the functions and faculties. 6. The first period of decline — which may, at present, be said to extend, in our climate, generally, from the forty-fifth to the fifty-fifth year — may be distinguished by diminished activity of mind and body, supervening irregularity of the functions, decreased powers of endurance and strength, returning susceptibility to external influences, and debili- tation of the attributive powers of either sex. This period, whether deferred or premature, is almost infallibly distinguishable by such char- acteristics. INVESTIGATION OF THE PATIENT. 29' 7. The second period of decline, or old age, which may set in from the fiftieth to the sixtieth year, in our climate— or sooner, or later, accord- ing to antecedent circumstances, is indelibly characterized by the decrease of .acuteiiess in the perceptive faculties, and in the organs which convey sensations— as of light, sound, smell, taste, and sensitiveness of touch- by growing obtuseness of moral and mental sensibilities; bj" decreasing retentive mental power; by general attenuation of frame, diminution of physical power, stiffness of joints, muscles, etc., aridity and puckering of the skin, the development of latent defects of circulation, and the like. INDIVIDUAL CHARACTERISTICS. The peculiarities of individual patients, and the particular effect of particular external influences, etc., upon them, both as to mind and body, should be very carefully considered ; and it is absolutely necessary, for the thorough appreciation of the distinctive points relating to the case of a patient, with whose habits, constitution, and susceptibilities, etc., we are not perfectly conversant, that we should most carefully gather the history of the particular and characteristic mannerism (if it may so be termed) which identifies him. Every person w hatsoever, must, in some point or other, be considered to constitute an exceptional case, and be so studied, for successful treatment. DISEASES TO WHICH (IF ANY) THE PATIENT IS ESPECIALLY LIABLE. It can hardly occur that a patient is not more subject to one class of disorders than to any other; and although this, to a certain extent, falls within the pale of the considerations suggest ed above, (see 6.,) yet there is one essential point to be considered here, namely, the issue, or final crisis, in which such disorders terminate, which is ever characteristic. METHOD OF LIVING, AND GENERAL HABITS. It is a most important comparison to institute, in the study of any case, to consider the relation between the habit of body in health or disease, and the method of living, occupation, etc. The habits may be especially considered in respect to the following distinctions: — (1) whether seden- tary or active ; (2) whether the chief exertion be of mind or body ; (3) whether the locality generally inhabited be of a close, artificial, (town) or of a free, natural atmosphere ; (4) whether the clothing, food, and other comforts, or even necessaries of life, have been sufficient, but moderate, or excessive, (both as to quantity, in proportion to actual requirement, or richness) or deficient in quantity simply; or, not only insufficient, but also unwholesome; (5) whether the domicile and person, or either, have been habitually cleanly, carefully attended to, or foul and neglected, (as to domicile, particularly as to cleanliness, drainage, and ventilation ; order and regularity are, however, also essential) ; (6) whether the habits as regards eating and fasting, labor and rest, etc., occupation or want of occupation, have been regular or irregular. With excessive confinement, close atmosphere, deficiency of exercise, etc., we may associate affections of the stomach and liver (especially,) of the digestive functions generally, and depression of spirits, as also (if the place of occupation be of a foul atmosphere,) affections of the lungs. With excess of mental labor we may associate nervous complaints, and habitual irritative fevers. With insufficiency or unhealthy kind of food, 30 INVESTIGATION OF DISEASE. deficient ventilation, drainage, and cleanliness, we associate low fevers, eruptive fevers, typhoid and putrid, or even intermittent complaints, and skin diseases. With excess of nutrition and indulgence (in comparison to physical exercise,) we may associate inflammatory complaints, and rushes of blood to particular organs. And in all cases, analogically, we may ally the nature of the complaint with the nature of the habits, occupation, food, etc. THE PART OR ORGAN USUALLY DISEASED. By investigation into the most frequent result of casual, accidental, external or internal causes, we may readily ascertain what part of the system is particularly liable to irregular or unhealthy action. And this research is always requisite, because every individual will be found to have one organ especially susceptible, and liable to become deranged by given causes, in some cases even, such as would seem to involve any other complication, rather than that which actually occurs. ATMOSPHERIC AND OTHER LOCAL INFLUENCES. The atmosphere, soil, etc., of particular localities, is known to be prone to engender particular derangements. It is also known that the water of particular springs and rivers, whether owing to the presence of mineral substances, to excessive hardness, or to other causes, has a ten- dency to generate particular diseases. It is, therefore, very important that these, and the like particulars, should be submitted to close investiga- tion. CHAPTER II. THE INVESTIGATION OF DISEASE. BY CONSIDERATION OF THE CAUSE, GENERAL CHARACTER, EXAMPLES, AND PARTICULAR SYMPTOMS. The investigation of disease may properly be confined to the consid- eration (1) of the various general, particular and local causes ; (2) of the general character of the disease; (3) of the general characteristics of the disease, as compared with existing or recorded examples; (4) of the symptoms— which last must again be divided into the consider- ation of the pulse, its varieties and indications; the discharges generally; the nature of the blood, if any be discharged ; the state of the digestive functions; the mouth and tongue; the eyes; the breathing, and its pecu- liarities; the peculiarities of complexion, motion, action, or inactivity; appearance, etc. ; the symptoms exhibited by the nervous system gener- ally, and especially by the brain. THE CAUSES OF DISEASE. These are either w hat may be termed constitutional causes, which consist in any unhealthy condition of the system, and for the distinction of which the reader should consult the part on " Constitution." or they are more immediate, as those hereafter described : CAUSES OF DISEASE. 31 This latter class of causes consists '.—First. Of such as may be traced to individual exposures, excesses, etc , or to particular conditions, either of locality, dwellings, atmosphere, circumstances, habits, particular suscep- tibility, constitutional predisposition, foregoing diseases, and consequent deterioration of constitutional strength, etc., all of which belong, more especially, to the " Investigation of the Patient," and have, already, been recited. Second. Causes, which are peculiar to a district, country, climate, or particular spot, and which are, then designated as endemic. Almost every district, especially such as are remarkable, for rapid evaporation, excessive and sultry heat, stagnant waters, and rapid decomposition of vegetable matter, or marshes with little or no drainage, or bleak, exposed situations, where dry, cold, and searching winds prevail, and the waters are hard, and, generally, impregnated with mineral substances; for sud- den and frequent changes of temperature ; for general flatness of country, or for elevated and irregular surface; for winds of a particular character, and from a particular quarter; whether inland, insular, or coasting; whether the prevalent occupation be that of factories or fields; and whether the habitations of the people are isolated, well ventilated, well drained, generally clean, or closely packed, squallid, small, dark, loath- some, ill-drained, and ill-ventilated. These, and many local distinctions of a similar character, will tend to render the generation and prevalence of particular diseases, properly speaking, indiginous, or endemic, and should, therefore, be duly considered. Third. Causes, which are of a general, indeterminate character, such as heat, cold, damp, draught, and particular electric relations, but which are prone to become associated with sudden transitions of atmospheric condition, and which will be the more surely developed by the presence, or precedence, of certain other diseases arising from similarly indeterm- inate causes, by the superabundance of particular natural products, (veg- etable or fruit,) or by the deficiency of food, as in cases of famine, or by calamities of various kinds. These are generally classed as Epidemic causes, and are properly divided into three sections, viz: those which occur regularly at certain seasons ; those which are of continuous dura- tion, and are, apparently, of incessant development, such as small-pox, measles, scarlet fever, etc.; and those more properly and exactly epi- demic, that is, which appear under particular electric, and other condi- tions, from time to time, scouring whole regions, and whole continents, wherever the like circumstances tend to engender them, but which, then, unaccountably subside. It is worthy of especial notice, that all three general classes of these causes engendering disease, are to be removed, modified, extenuated, or even eradicated, by judicious management, by the removal of the direct causes, (if any be apparent,) or by the preparation of the system, by means of specific remedies. THE GENERAL CHARACTER OF THE DISEASE. This is determinable by considering the various manifestations in conjunction with the state of the circulation, or action of the heart, as dis- tinguishable in the condition and peculiarities of the pulse, which, alone, can serve distinctly to characterize disease. Pain is, very generally, no 82 INVESTIGATION OF DISEASE. criterion, except as qualified by the pulse; the muscular and nervous action is usually no criterion, except as qualified by the pulse; the diges- tive functions, secretions, discharges, etc., will often leave the degree of progress, danger, or curability in disease undetermined, without refer- ence to the pulse; to the consideration of which we will, therefore, proceed. <► THE PULSE: ITS VARIATIONS AXD IXDICATIOXS. THE ART OF FEELING THE PULSE IN ORDER TO DETERMINE ITS CHAR- ACTER ACCURATELY. First. Avoid feeling the pulse abruptly, and until the patient has been beguiled (if possible) by irrelevant conversation. Second. Make such an investigation of the history of the case as to assure yourself that there may not be some immediate casual circumstance calculated to have fluttered, or otherwise affected the patient, and thereby to have disturbed the pulse more immediately. Third. Place three of the fingers upon the artery on the inner side of the left wrist of the patient, having the thumb so applied to the back of the wrist that the pressure which you apply to the artery can be modified, increased, etc., in any and every degree; and that thereby, and by so vary- ing the degrees of pressure,) having a considerable length of the artery under the three fingers,) you may be able, not only to distinguish the num- ber of beats which occur in the minute, but, also, the particular nature of such beats; as, for instance, whether by pressure, you can, apparently, suppress the gush of blood through the vessels ; or whether, when strongly pressed, the current seems to worm through, beneath the fingers, like a wire ; or whether the bound is so strong as apparently to force the fingers away in its impetuous passage; or whether the pulsations are very sud- den, distinct, abrupt, and, as it were, convulsive ; or whether, on the other hand, the pulsation appears to linger, and to pass languidly ; or whether, again, there is no distinct pulsation, but a rapid thrill, rather to be called a vibration than pulsation. In order to thoroughly distinguish these vari- ations, it is imperative that the attention should be absolutely centered in this one object, and not distracted by any other circumstance. THE AVERAGE STANDARD OF HEALTH. The healthy pulse of an adult (in the stage of maturity) male person of large and expansive frame, should (with the modifications before men- tioned, under the head of " Constitutions,") be firm, not compressible, but sensibly urged through the artery, notwithstanding pressure, yet neither hard, (conveying a shock to the touch,) sudden and twitching, nor like a thread, worming its way beneath the fingers; but moderately full, even, regular, and numbering from 70 to 75* beats in the minute. The healthy pulse of an adult (in the stage of maturity) male person, of smaller frame and proportions, should, in general, number from 72 to 78 beats, subject to the same general characteristics in other respects. * If, however, the pulse be habitually slower or quicker, we should assume this as an individual standard, because instances are upon record of the pulse of healthy adult males varying from 30 to 50 beats. Young infants are known to have a pulse numbering from 140 to 150 beats. If the skin be moist at a natural heat, and not flushed, this would be no sign of disease. The pulse also varies before aud after meals. Arteries of the front surface of Trunk, Arm, Fore-arm and Hand. INDICATIONS OF THE PULSE. 33 The healthy pulse of an adult female should, with the same general reservations, number from 80 to 85 beats in the minute; but we should not anticipate as strong or full a pulse in a woman as in a man ; nor, indeed, should we always attach much importance to the casual precipi- tation of the pulse, especially of highly nervous females. The healthy pulse of a young person in the second stage of childhood, viz. : from seven to fourteen years of age, should number from 80 to 86 beats in the minute. The healthy pulse of a child, under seven years old, from the period of teething, may be stated at from 86 to 96 beats in the minute. The healthy pulse of an infant, before teething, may be stated at from 100 to 120 beats in the minute, according as the child is robust or weakly; the robust infant generally exhibiting a less frequent but stronger pulsation. The healthy pulse of the first stage of declining life may be generally stated, for the male, at 70 beats ; and for the female at 75 beats in the minute. The healthy pulse of the second stage of declining life (that is, old age,) may be stated for the male, at from 55 to 65 beats ; and for the female, at from 65 to 70 beats in the minute. GENERAL INFERENCES DEDUCIBLE FROM THE PULSE. 1. Palpitation of the heart. — The palpitation or pulsation of the heart, when felt distinctly, and predominantly, or when even heard, or so severe as to reverberate, as it were, through the frame, and to shake the side, may be considered as characteristic, either of— Nervous irritation, the result of sympathetic disturbance, originating in the stomach, especially if worms be present; of hysterical and other spasmodic affections ; or severe bodily suffering, or of violent emotion, etc., and when the result of hysterical disposition, should occasion no apprehension ; or of— Excessive debilitation, resulting from loss of blood, or other severe, excessive and protracted discharges, in which case it generally termin- ates in a swoon, which, if only occasional, does not indicate organic disease of the heart ; or of — Sudden determination of blood to the heart, or other organs, which, in females, should apprize us of an approaching menstrual crisis, (if in due season ;) or of— Organic disease of the heart, when it will be characterized by con- tinuance, or very frequent recurrence, constantly terminating in loss of consciousness. 2. The pulse — will serve to determine the most essential questions respecting disease, such as (1) the degree of vital power possessed by the patient ; (2) the nature of the disease, that is, whether or not inflamma- tory action be present; (3) specific characteristics of the disease, that is, whether it be the result of superabundant strength of the blood and sys- tem, or whether it be occasioned by, or attended with, a depressed condi- tion of vital energy ; (4) the degree of progress made by disease upon the vital power, and consequently the greater or less degree of urgency; (5) especially in highly critical cases, when no other distinct index is affdorde, the selection of the appropriate reactionary remedy ; (6) according to the 34 INVESTIGATION OF DISEASE. greater or less degree of impression made upon the pulse by such admin- istration, whether or not we have properly selected, and how far we should be justified in changing the medicine. VARIOUS NAMES OF ALTERATIONS OF THE PULSE. 1. Frequent pulse — A term applied to the succession of the beats. By this we understand simply an increased rapidity of repetition. 2. Slow pulse — The designation of a pulse less rapid than in health. 3. Quick pulse — A term which designates the rapidity with which the current passes through the artery at each beat, qualifying the character of the beat ; whereas, frequency (as above) is a term denoting the rapidity with which one beat follows another. 4. Sluggish or Tardy pulse — Expressive of the languid, extended nature of the beats. 5. Hard pulse— Expressive of the sensation of firmness and positive- ness which it conveys to the touch. 6. Soft pulse— Expressive of the smooth flow (so to speak) of the blood beneath the pressure of the fingers. 7. Strong pulse— Is the name of a pulse, which seems to bound beneath the touch and repel compression.* 8. Feeble pulse — That which yields to compression, apparently defi- cient of vigor to force its way in spite of pressure. 9. Large pulse — Expressive of the dilation and expansion of the artery as evinced to the touch. 10. Small pulse— Expressive of the apparent retraction of the artery, and the minute channel through which the blood passes, as evinced to the touch. 11. Full pulse— A denomination applied to a pulsation which seems thoroughly to^ZZ the artery at each beat; whereas, the large pidse is only understood of a dilating current, without conveying the idea of solidity, as of a well-filled vessel. 12. Empty pidse— When the beats do not seem to convey a very dis- tinct elevation to the artery, and which appears as a combination of the characteristics of the soft and small pulse. 13. Unequal pidse — That which, without being suspended, does not beat at regular intervals of time, or in which the quality of the current (as hard, soft, feeble, full, etc.,) differs with different beats. 14. Intermittent pulse— Or that which is characterized by the occa- sional suspension of beats. INDICATIONS ATTRIBUTABLE TO THESE VARIETIES, SEPARATELY AND JOINTLY. 1. A very important distinction to be determined, namely: whether the disease is characterized or engendered by excess or deficiency of vital power; that is, by over-luxuriance, or poorness of blood, is to be evinced by the strong, hard (incompressible,) pulse, on the one hand, and by the soft feeble (compressible,) pulse, on the other hand ; the first being indicative of excess, and the second of deficiency of strength. 2. Another distinction, in determining the nature of the disease, con- sists in the explicit indications afforded by an unequal or changeable pulse, LESSONS FROM THE PULSE. 35 which, in acute cases, identifies the malady as nervous, not inflammatory ; and, in chronic cases, as irrespective of the circulation, and associated with the nervous system only. Thus, we should be most cautious not to mistake cutting, stitching, pricking, or shooting pains, in the chest, or violent fixed pains, (even with violent throbbing,) or pains in the chest, (as just described,) with suffocative oppression of breath, accompanied with such a state of pulse, for inflammation; for the pulse would distinctly identify a purely spasmodic or neuralgic suffering. 3. A healthy pulse, or a pulse of a purely nervous character, as just described, attending affections of the chest, and especially of the air-pas- sages, is precisely, in some cases, the unmistakable index of Asthma, in contra-distinetion to Consumptive affections, which are always character- ized by & feverish, feeble, irritative, accelerated pulse. 4. The accelerated pulse, if unqualified by any other feature, exhibits irritation, or fever, (properly so called,) or increased susceptibility to irrita- tion, which may result from mechanical causes, tending to lessen the action of the heart ; (as tight lacing, etc. ;) or from cold in particular, which has caused an irregular retrocession, or congestion of blood; or, again, from an increase in the richness, or quantity of the blood, which destroys the equilibrium between the motive action and the current of blood. Increas- ing acceleration is indicative of increasing inflammatory action; subsiding rapidity is indicative of the removal of the irritation, and analogously of its cause. If the frequency of the pulse continues or returns after a crisis, (resulting in perspiration, sleep, etc.,) we may judge that the effort of nature was incomplete, and that, therefore, a continued effort remains. Frequency of pulse may be associated with the over-strong or very feeble state of the circulation, and will be more continuous and difficult to subdue when qualified by feebleness, than by strength; it will, also, in many cases, be more excessive. Thus, in cases in which the pulse is very frequent, (as, for instance, 120 to 180, or even 200 beats to the minute,) it is also small, and then points out the lowest state of debility, or what is called a putrid condition. This is, indeed, an imperfect pulse, and sometimes proceeds to a mere thrill or vibration, when it is totally indistinct. An analogous sensation may, however, be conveyed in very severe cases of "inflammation of the substance of the lungs,'' as an inflammatory pulse; but then the artery will be dilated andfidl, if a long breath be drawn and held; whereas, the pulse of debility is qualified by a small, retracted artery. Again, if the pulse be accelerated, and also strong, or full, and hard, we may distinguish a decidedly inflammatory condition— inflammatory fever. 5. The small pulse, unqualified by any other condition, is indicative, either of weakness or of spasmodic condition, which may be easily deter- mined by the accompanying or antecedent circumstances, and by the following distinctions : — If associated with hardness (small and hard,) it is especially indicative of a convulsive state. If associated with softness (small and soft,) it is especially characteris- tic of debility. Further, we may study the following distinctions, either singly or in association : — The slow pulse (if not habitual — some adult subjects, especially males, having habitually a pulse varying from thirty to fifty beats in the minute, 36 INVESTIGATION OF DISEASE. without disease,) is indicative of insufficient quantity of blood— as after severe depletion— of advancing age, of the subsidence of fever, (which frequently leaves a reactionary pulse below the standard of health,) or of pressure on the brain, as in cases of congestion, water in the head, etc. Associated with the following variety, especially after concussion of the brain, etc., it is of a serious character. The sluggish or tardy pulse particularly distinguishes a torpid condition and a low typhoid character assumed by the disease, and pressure on the brain, when it is of more serious import than the slow pulse, and of stilL more serious consequence when associated with the last. The hard pulse (simply) indicates especially inflammation, (as in fever, etc.,) or a convulsive condition, when qualified by evidences resulting from the investigation of the nervous symptoms distinguishing this condition. In old age, again, the hard pulse (especially if large,) is of very frequent occurrence, or caused by the drying, contraction, or even ossification of the arteries, which convey this sensation to the touch, owing to a decrease of suppleness or elasticity. The soft pulse (simply) proves the absence, both of inflammation and convulsive condition. The strong pulse, which indicates superfluity of blood, a full habit. The feeble pulse, indicating deficiency of blood, an attenuated habit. The large pulse, (simply) indicates an unimpeded elasticity of action, and is the truest index of the absence of cramp, irritation, or excessive irritability; it is the distinctive feature, especially after acute inflamma- tions, of a vigorous operation of the heart, and proves that there is an ample sufficiency of blood in active circulation, (consequently no local or organic determination ;) the large pulse (when unqualified by other features,) is, therefore, to be considered as a proof of the effectual resolution of an irritative effort, (such as fever,) when it sets in at the crisis. The large pulse may, however, be associated with fullness (only) when it points out the insufficient liquefaction of blood (or thickness) in which case it is easily compressed, as often occurs in typhoid fevers, (with debil- ity,) and when it is a spurious fullness; or, again, the large pulse, may by associated with fullness andhardness, when it clearly indicates irritation of a peculiar kind. The full pulse distinguishes a plethoric or full condition of habit of body. The empty pulse offers indications analogous to the "small and soft," (as above stated.) The unequal or changeable pulse generally characterizes a universal nervous condition, and is one of the distinctive features of nervous fevers, or of fevers resulting from or accompanying deficient vital energy. It also indicates spasm at the heart, or even deeper and organic derange- ment of the heart, or deficiency of elasticity or energy in the action of the heart; and it may, also, in cases of inflammation of the substance of the lungs, be held to indicate such a state of congestive, or other obstruction, as impedes the progress of the current through those organs, when, conse- quently, it is a most serious symptom. The intermittent pulse. In this, we may, especially, distinguish a spas- modic condition of the heart, (sometimes organic disease.) particularly sympathetic as resulting from intestinal affections, such as congestive CONDITION OF THE BLOOD. 37 determination of blood, or such as excessive relaxation of the bowels, or predisposition to relaxation. THE CONDITION OF THE BLOOD. By this division of investigation, it must not be suspected that the inspection of blood abstracted by venesection is indicated, for the use of the lancet is the great and grievous error which has been effectually super- seded. The artificial abstraction of blood is, therefore, as an all but inva- riable rule, out of the question. But it will often occur, when the condi- tion of the blood affords very distinctive indications of the nature of the disease, or of the system generally, that spontaneous or casual discharges take place, which we may have an opportunity of investigating. We should, principally, notice a tendency to coagulate very quickly, or too firmly, or in too great a relative proportion to the fluid residue; or, on the other hand, an excessive predominance of the fluid proportion or absence of coagulation. 1. Coagulation, which is too rapid, firm, or too great in proportion to the fluid residue, especially if further qualified by the superficial floating of very little of the watery humor, (which is one of its constituents,) that, again, being coated over the surface with a very firm, white skim, is posi- tively indicative of inflammation, tendency of the disease to develop inflammation, or predisposition of the patient (if in health) to attacks of inflammatory disease. Coagulation, in general aspect, as just stated, but which throws up a superficial skim, of detached, unconnected, woolly, or yellowish, or, sometimes, greenish appearance, distinguishes an irritation of nervous rather than of a specifically inflammatory character. 2. Insufficiency of the watery constituent, that is, when all, or almost all, of the blood is dark and thick, indicates a highly bilious habit of the body. 3. Superabundance of the watery humor, as a constituent of the blood, that is, when the tendency to coagulate is slow, and affects only a small portion, (and that, often, of a paler color than is usual,) and when the greater part resolves itself into a watery superfluid, indicates a deficiency of power to appropriate and distribute the nourishing portion of the food for the sustenance and uses of the system ; and (if of menstrual blood) a ■constitutional disposition to debilitating disorders, such as "green sickness." 4. Absence of healthy coagulation, the blood being dark, but remain- ing entirely commingled in all its component parts, not separating the watery humor, and remaining in a thick, inadhesive condition, (not jelly- like,) indicates what is termed a putrid condition, or that stage of dissolu- tion in which the vital energy sinks from deficiency of power to expel what is mischievous (as in putrid typhus) ; and, in general, a scorbutic habit of body, which involves a predisposition in every disease to assume & putrescent character. 5. A dark, yet clear, red blood, indicates strength, and a sufficiency of reactionary power. 6. Black, or very dark purple blood — which is associated with such diseases as result in predominance of venous over arterial blood, and which may indicate organic defect of the structure of the heart, particu- larly if the complexion have a bluish or purplish hue ; and which may, 38 INVESTIGATION OF DISEASE- also, indicate a highly bilious complication of intestinal derangement in scorbutic subjects (particularly,) more especially if the blood be muddy, thick, and black. 7. Pale blood, from superabundance of watery fluid, also, character- ized by excessive liquidity, indicates constitutional weakness in the pre- dominance of the watery humor, as a constituent. Pale blood (from light redness of the coagulating portion) indicates a pernicious constitutional habit, such as the constitution heretofore des- cribed as " Rheumatic." 8. The watery humor (as a constituent of the blood) thoroughly and distinctly separated from the coagulating portion, which is deposited in a firm jelly (and without any of the unhealthy manifestations described under 1) above, may be assumed, as an index of a liealthy process of circu- lation. 9. The watery humor (as a constituent of the blood) appearing whit- ish, and thick, indicates deficiency of constitutional vigor, especially in the distribution of nutriment. ]0. The watery humor (as a constituent of the blood) appearing of a distinctly yellowish hue, indicates an admixture of bile with the blood. SPONTANEOUS DISCHARGES OF BLOOD GENERALLY. If the discharge be from the nose, in cases of inflammation of the brain, severe determination of the blood to the brain, or of inflammatory feA^er of any kind, the symptom is to be considered as a wholesome crisis. In general, discharges of blood may appear as the crisis of a disease, particularly of severe fever ; but they may occur as the result of local deter- minations of blood, or inflammations, of over-due fullness and distension of the vessels, of precipitation of blood upon a weak part, (or, generally, of comparative deficiency of firmness and strength in such part, as when a blood-vessel is broken ;) or again (as a most critical symptom) of a putrid condition. THE URINE, ITS VARIETIES AND THEIR INDICATIONS. From the consideration of the blood and its appearances, we cannot transfer our attention more appropriately than to the like variations in the urine, as the discharge, the processes attending the secretion of which are most intimately connected with the blood. THE HEALTHY APPEARANCE OF THE URINE. Unaffected by any of the subjoined or other particular circumstances of age, sex, method of living, active, or sedentary, particular articles of food or drink, the season of the year, and as a most important exceptional condition, the constitution of the patient — the urine should be of a pale, bright yellow, or straw-color, remaining clear after standing, precipitat- ing no sediment, and of the peculiar ammoniacal smell, but devoid of all loathsome odor. Exception 1. However, in old age, it is consistent with health that the urine should be offensive, lessened in quantity, and deepened in color. APPEARANCE, ETC., OF THE URINE. 39 Exception 2. Amongst females a degree of sediment is not always an unhealthy sign, and the urine is habitually of a paler hue. Exception 3. With respect to the habits of life, it may be expected that a person leading a very active life, with especial predominance of physical exertion, should emit darker and more scanty urine than the stated standard— and. that in an individual of very sedentary habits, it should be characterized by more copious, but paler discharge. Exception 4. As to eating and drinking, it may be stated as an excep- tion to the general rule above, that certain vegetables, (especially those of a diuretic nature,) such as asparagus, will usually cause the discharge to be offensive; other substances will give it a bright, gold yellow; excess of stimulating liquor will render the discharge pale and copious, etc. ; whereas, also, within about six hours after eating, it will commonly be cloudy. Exception 5. The increase of constitutional vigor, or perhaps more directly, the greater enjoyment of open-air exercise, which the summer affords, tends to render the urine darker and more scanty, whereas, in win- ter, (that is, under contrary circumstances,) it is usually less highly colored and more abundant. THE PROPER TIME AND METHOD OF INVESTIGATION. The urine should not be examined, or, at least, no reliance should be placed upon its manifestations, within less than six hours after a meal; and such of the urine as is reserved for investigation, should then be set aside in a place where the temperature is even and moderate, for at least two hours, not being at all exposed to sudden transitions of temperature in the interval, after which we may examine whether any of the subjoined evidences be present. THE VARIATIONS APPARENT IN THE URINE, AND THEIR INDICATIONS. 1. With respect to the progress of fevers, the urine affords the most valuable characteristics, varying with each stage, as the result of the febrile course is developed ; as, for instance: Before the fever has taken any turn towards issue, that is, so long as it continues to rage without any tendency to a crisis, the urine, of what- ever color, is emitted (and remains after standing) perfectly transparent and clear; or, in other cases, (especially nervous fevers, and fevers in which the digestive functions are predominantly implicated,) the urine will be emitted (and will continue the same, and without deposit after standing,) thick and cloudy. 2. As the crisis of any fever having critical days, approaches, the urine, which was previously clear, will become thick, and will form a small half-floating cloud, or sometimes a similar cloud completely buoyant, or which, should it sink for a time, will rise again to the surface. In other cases the cloud will sink to the bottom. If the cloud should float, the patient will die, even though they, may not appear very sick. If the cloud sinks for a time and then comes again to the surface, or, if it remains half- floating, there will be about an even chance between recovery and death. Jf, on the other hand, the cloud sinks to the bottom of the vessel, the patient will recover, no matter how sick they may apparently be. 3. The actual determination or crisis of the fever is distinguishable by the precipitation of a sediment (simply,) — in cases in which the urine had previously been clear— and by the like precipitation of a sediment, 40 INVESTIGATION OF DISEASE. ami the complete clearness and transparency (as if filtered) of the over- rating fluid, in cases in which the urine had previously been muddy and thick. But for this precipitation of a sediment to constitute a wholesome indi- cation, it should, also, be smooth, undisturbed, light— assuming an appar- rent, slight, rounded, elevation towards the center— white, or of a slightly gray color. It should not constitute more than one-fifth or one-fourth (at the most) of the whole volume discharged, and it should be deposited quickly after the emission. For, otherwise, it is a bad sign; as for in- stance: If black, or very dark, it indicates a putrid condition. If of the color of bile, or red, it characterizes an intermittent type of disease, or sometimes a rheumatic tendency. If white and gritty, or deposited from dark, turbid urine, there is depraved habit of body, or perhaps some concreting substance in the urin- ary canal. Or, generally, if disturbed, irregular, of a purple hue, muddy, heavy, and constituting from one-half to two-thirds of the whole volume dis- charged, it is a bad sign. In General: If the urine be red when the pulse is accelerated, there is a decisive, and positive indication whereby to distinguish constitutional fever, inflam- matory action, and increased development of internal beat— from a similar condition of pulse, which might otherwise characterize a purely spasmodic affection. If of a deep saffron color, it represents the admixture of bile in the blood, and if this hue be conveyed to white, absorbent surfaces, mois- tened with it, it decisively indicates jaundice. If it be thick and black, here is an indication of such a degree of inflammatory or putrid condition, as resolves itself into gangrene. If bloody, turbid, thick, and depositing an excessive proportion of sedi- ment, we have an evidence of approaching decomposition of the blood. If, other things being equal, it be characterized by the floating of an apparently oily substance on its surface, we have an evidence of what may be termed advanced constitutional decay. If matter be mingled with it, there must be internal suppuration. If the urine (of children) appear, as it were, milky, we have reason to suspect the presence of worms in the intestines. If it be thick, but pale, or still more, if it be very changeable in appear- ance, during the course of a fever, we have reason to look upon the disease as of a nervous kind. If it be clear, transparent, and watery, and there be continual urging to discharge it, the nature of the affection is distinctly spasmodic. If it be bloody, there is probably a degree of inflammation about the bladder or kidneys. If slimy, we look for a discharge of the character of phlegm from the bladder, or obstruction of the neck of the bladder by some concreting substance. Or, again, as regards the manner or sensations which characterize the discharge : VARIETIES OF BREATHING. 41 If the discharge be involuntary, the affection is of a paralytic char- acter; but it should, also, be noticed that in such cases of fever as evince this symptom, it is sometimes very difficult to ascertain whether it is really involuntary (in the true sense of the term). If really so, it is a serious manifestation. If, on the other hand, the discharge be either difficult, painful, or impeded, it variously represents disease of a locally inflammatory, or spas- modic nature. It should be noticed that sudden check of perspiration will often occasion an exceedingly copious and watery discharge of urine. Excessive relaxation of the bowels, the previous use of drastic purga- tives, or profuse sweating, will frequently cause a darker and more scanty discharge. Chemical and Microscopic Distinctions, and the distinctive fea- tures of other varieties of the urine, have been intentionally omitted, as calculated to lead unprofessional persons into erroneous experiments. BREATHING; ITS VARIETIES AND THEIR INDICATIONS. In many diseases, especially those whose seat is in the respiratory apparatus, the manner of breathing, the pains, etc., developed by the act of breathing, the sound emitted by the inward and outward passage of the breath, etc., are the only signs upon which we can rely for a thorough and distinctive appreciation of the nature of the affection, with the reservation, however, that the relations between the pulse and respiration are never to be overlooked. In all diseases, especially in those of an inflammatory or putrid character, there is much important insight into the direction, etc., of the malady, acquired by a careful consideration of the operation of this vital function. THE BREATH IN HEALTH. The frequency, and even the manner of breathing, in individual cases, is best determined by the habitual conditions of both. But, as there should be about four pulsations to every act of respiration, it may be expected that, in health, supposing the medium standard of the adult pulse to be 80 beats in the minute, there would be 20 inspirations and 20 respirations in the same time ; and in the like proportion. The breathing would also be easy, slow in repetition, and in inhaling and exhaling equal and full. It is not, however, to be inferred that the relative equality of proportion between the beating of the pulse and the expansion of the lungs, is, in itself, a sign of health although it may be assumed there- from that the blood is not deteriorated in quality, on the one hand, and that the operation of the lungs is not organically affected, on the other hand. THE VARIATIONS TO WHICH BREATHING IS SUBJECT, AND THEIR INDICATIONS. Frequent breathing — by which is understood a rapid and continuous suc- cession of inspirations and respirations— is an evidence either of acceler- ated circulation, or fever, and consequently of organic inflammatory affections of any kind, involving constitutional disturbance ; and also of 42 INVESTIGATION OF DISEASE. insufficient (elasticity) strength of the lungs. Frequency of breathing,. when associated with inadequate expansion, is an evidence of some obstruction which oppresses the operation of the lungs; as, for instance, created by congested blood (as in inflammation of the lungs,) by the pres- ence of water in the cavity of the chest, (or even, in severe cases, in the cavity of the belly,) by inflation with wind, (the oppression being communi- cated by the contiguity of the lungs to the inflated parts of the stomach,) or by the alteration of the substance of the lungs. This variety is opposed to the habitual degree of slowness, in the breathing of health. Slow (unfrequent) breathing, when less- frequent than in health, and further qualified, by deep breathing, at remote intervals, as if in a convul- sive effort, is frequently associated with spasmodic affections, swooning, etc., and is an evidence of want of strength. Quink breathing — a term by which is understood that the m-spiration is incomplete, and is quickly succeeded by the re-spiration — is occasioned by the presence of some oppression or obstruction, which renders the expansion of the chest so painful as to hurry the operation of decreasing the pressure, by expelling the air; it is almost invariably the result of any severe inflammatory affection of the intestines, or apparatus of respira- tion, and commonly occasions a more sudden and spasmodic effort' to expel the air, as manifested in cough. It is opposed to the healthy tar- diness of respiration ; that is, to the deep, slow , protracted inspiration and respiration, with power to hold tte breath (full) for a length of time. Tardiness— may, however, be excessive, as resulting from weakness. The deep or long breath — when even, protracted — as to the inhaling, and exhaling— noiseless, and evidently without effort, is one of the charac- teristic features of healthy respiration ; but, w T hen deep, long breath, is evi- dently the result of a severe effort, somewhat difficult, irregular, sonorous and, sometimes, abrupt, it becomes an evidence of spasmodic affection— especially involving the anterior (front) portion of the cavity of the chest and abdomen, or, sometimes, of great fullness of the vessels about those regions ; or, again, (as if there be a long pause between the explosion of one draught, and the re-inspiration of another,) of a condition of stupor and delirium. . The small or short breath (simply)— may be considered an evidence either of weakness, or of spasm. We have already noticed this variety, as associated with frequency. Difficult breathing—implies several distinct varieties, either of which may, appropriately, bear this name. In any degree, difficulty of breathing may be associated with coldness of the extremities, (especially the feet,) confusion and heat of the head, an empty, small and remittent pulse, owing to the obstructed and dilatory progress of the blood through the lungs. If rare, difficult breathing may be attributed to some accidental, or even mechanical, cause of oppression. As a symptom of disease, it would arise from the presence of any obstructing matter, (blood or w r ater, etc) impeding the action of the lungs and air passages; or, as a symptom, unat- tended with any evidence of inflammation, it would be occasioned by spas- modic affection of the respiratory apparatus. VARIETIES OF BREATHING. 43 Moaning or sighing breath is a variety of difficult breathing, and seems rather to identify the enveloping membranes of the lungs as the seat of the affection. Oppressed breath (simply) may arise either from impeded digestion, from particular conditions of atmosphere, or from affections of the air- passages. Panting breath rather identifies obstructions (such as thickening of the lining membrane,) in the windpipe and air-tubes. Suffocative breath — that is, when the breath is totally arrested by re- cumbency — may result from extravasation (pouring out) of blood on the lungs, etc., from the accumulation of water, from alteration of the sub- stance of the lungs, or from what is termed paralysis of those organs; in any case it is a most urgent symptom. In all respects, it is opposed to the easy breathing, or to the habitual degree of ease in breathing, which char- acterizes the healthy state of the patient. Warm breath (simply)— indicates a degree of fever ; if very hot, particu- larly if the extremities be cold, it is a positive index of general, internal inflammatory action, or more particularly of inflammation of the substance of the lungs, or of some of the adjacent intestinal parts. Cold breath — indicates a deficiency of vigor (superfluity of watery humor,) in the blood, and, consequently, sluggish, languid circulation. It may result, however, from obstruction which prevents the effectual pas- sage of the blood through the lungs. As a symptom appearing with the sudden suspension of pain, and with general dullness of sensation in severe organic inflammation, it indicates internal mortification; in any case, as attendant upon the last stage of a very critical disease, it is a fatal sign. Unequal breath — an expression which conveys its meaning — may, in >rery severe cases, result from obstructions impeding the inhalation or exhalation of the air, (chiefly in the windpipe and air-tubes,) or it may be occasioned by purely casual circumstances; as, for instance, spasmodic affection of the nerves connected with the respiratory apparatus. It is opposed to the equal breathing of health. Noisy respiration — or that which is attended with unnatural sounds, — is subject to several modifications; as, for instance, whistling breath, which, in the majority of cases, indicates the result of spasm, or of accu- mulation of phlegm, etc., in the windpipe. Rattling breath, which may result from the presence of matter, blood, or phlegm, partly obstructing the air-tubes ; or, as a fatal sign, it is the result of paralysis of the lungs. Flapping breath, or that which is accompanied with an occasional sound as of the sharp flapping to and fro of a dry valve, indicates the presence of very adhesive matter, or phlegm, in delicate cells connected with the air- passages. Crackling or crepitating breath, which, as associated with inflamma- tion of the lungs, would be qualified by the other distinctive symptoms of that disease, may (particularly in aged persons) indicate deficiency of moisture in the lining membrane of the air-passages. Oppressed breathing, or oppression of the chest, will be treated of under the head of anxiety, (see "Pain,'' etc). Offensive or fetid breath— & symptom which requires no further des- cription, but which must be considered in due relation to other circum- stances — as, for instance, going too long without food, will engender it.. 44 INVESTIGATION OF DISEASE. The menstrual periods are sometimes attended with it. Excessive use of mercury, under any treatment, is another ascertainable cause. A scorbutic habit of body (or that in which every affection has a disposition to resolve itself into a greater or less degree of putresence,) is unmistakably discernible from this symptom, when continual and habitual. Excess of animal food may occasion it. Decay of the teeth, and inattention to the proper cleans- ing of the mouth and teeth, will almost inevitably induce it. In typhus it characterizes the putrid degeneracy of the disease. In affections of the chest it usually characterizes suppurative processes in the lungs, etc. As a general rule, especially in the absence of any particular conditions, such as have been stated — foulness of the stomach, or the presence of worms, or other impure substances in the intestines, may be distinguishable by offensive breath. THE DIGESTIVE FUNCTIONS, AND THE INDICATIONS WHICH THEY AFFORD. The digestive functions, as is well known, afford some of the most palpable indications of derangement; and as the nutritive or tributary pro- cess is entirely centered in this portion of the system, one very important deduction is dependent upon its condition; namely, the sufficient or insufficient degree in which the subsistence of the whole constitution is provided for by the processes acting upon the food, and, in the habitual state of the digestive process. Persons of habitually strong digestive powers are more likely to resist the injurious effects of external circumstances; such as heat, cold, infection, sorrow, etc., etc.; but once attacked with disease (especially inflam- mation,) they are prone to be very seriously affected. At the same time disease will be more likely to run a rapid course with such subjects, and to terminate promptly, than to degenerate into chtonic disease. If the digestive process be habitually weak, we have a general indica- tion of precisely contrary conditions. THE EVACUATIONS AND THEIR INDICATIONS. Costiveness. — Suspended or deficient evacuations may be the effect of inflammatory tendency ; or of muscular debility; or of inaction of the lower intestines; or, again, of deficient or altered discharge of bile from the liver into the intestines ; or of general debility of the system, and poverty of blood. Suspended evacuations may, however, be occasioned by mechan- ical obstruction of the bowels, as the lodgment of improper substances, etc.; whereas, deficiency of discharge may result from excessive dis- charges or transpirations of another kind. Very dark evacuations may be either associated with costiveness or relaxation, and in both instances they usually, when not induced by the nature of the food, evince an excess of bile. Hard evacuations are of various kinds: — as hard and large; hard and small (detached) ; hard and knotty, etc.; in general they exhibit a deficient degree of natural irritability in the lining membranes, more or less excess of internal heat, and deficiency of moisture. Relaxation, as understood, not only of less consistent, but of more copious evacuations, is also subject to variations in the frequency. DIGESTIVE FUNCTIONS. 45 color, odor, etc., of the motion. In general, it may result from inflamma- tory or nervous irritability of the intestinal canal; or from the presence of obnoxious, irritating substances, impurities, etc., — such as undigested food, worms, — therein; or from suppression of other discharges; or emo- tions; or, again, from a debilitated condition of the bowels, or of the entire system. If the discharge be green (of an infant), acidity is commonly exhib- ited; if dark, predominance of bile; if pale, deficiency of bile. Spontaneous discharge should be distinguished from involuntary dis- charge, the former being of little importance, and being a common result of unconsciousness (when relaxation is present) and occurring, also, owing to the excremental matter being completely liquefied. Involuntary evacuations, properly so called, and attendant upon the last stage of severe fevers, especially fevers of a typhoid character, are indicative of paralysis, and are to be looked upon with great apprehension. Diminished evacuations are not necessarily opposed to the lessened consistency, and may occur either with highly consistent or very liquid motions; in the latter case, however, they generally exhibit an imperfect expulsion of the matter to be evacuated, and, in such instances, of the presence of some irritative substances in the canal. If unqualified by any other manifestation (such as hardness, or those already stated) and espe- cially, if there be a constriction of the passage, the decreased quantity of the evacuation may be attributed to spasm. Straining to evacuate, is sometimes of spasmodic character, especially if the motion be only partial, very scanty, or totally suppressed. But without spasm, or especially nervous character, such straining may result from a greater or less degree of inflammation and its sequels, or from the peculiar susceptibility of the canal to irritations. Of painful evacuation we shall have occasion to speak under the head 1 of " Pains." FLATULENCY— WIND IN THE STOMACH AND INTESTINES— AND ITS INDICATIONS. The generation of wind, either in the stomach or in the bowels, arises from the production of the elements, in the form of gases of the normal phlegm which is secreted from the blood. If habitual and excessive, it is clearly indicative of weakness or derangement (of nervous action or tone) in the stomach, if the wind be expelled upwards, — or in the bowels, if the intestines become inflated, or the wind be expelled downwards. Flatulent distention of the belly, occurring in children, often identifies an additional morbid state, characterized by the presence of worms in the intestinal canal. Flatulent, drum-like distention of the belly during the course of fever, betrays want of vigor which may occasion serious results. If, at the same time, the belly thus distended be very tender, and severe pain be caused by pressure, a tendency to local inflammation in clearly exhibited. NAUSEA AND VOMITING, AND THEIR INDICATIONS. 1. These symptoms especially point out either original, local, or sym- pathetic affections of the stomach or upper portion of the digestive apparatus, as opposed to the bowels or intestinal canal, which constitute the second division of this portion of the system. If, therefore, these symp- 46 INVESTIGATION OF DISEASE. toms be simultaneous with unhealthy evacuations, it is to be deduced that both the stomach and bowels are affected, either simultaneously or sympa- thetically, or by communication of the irritability from the one to the other. But they may be occasioned" by mere sympathy, without any actual local affection, as: 1, by sympathy with the womb in females, and indica- tive of the earliest stage of pregnancy ; or, 2, by sympathy with the liver, as evinced by the pain or other symptoms emanating from that organ ; or, 3, by sympathy with the brain, as the result of irritation, or of oppres- sion occasioned by determination of blood, concussion, or water; or, 4, by sympathy with the intestines, as particularly evinced by perverse and continued constipation. All these relations should be duly considered, and, in the absence of any such remote causes, we may trace the origin of these symptoms to the stomach itself, as: If habitual, 1, to an organic derangement of that and the neighboring portions of the system. 2. If both food and drink are thrown up as soon as swallowed, to inflammation. 3. If accompanied with foulness or enlargement of the tongue, as evinced in the state of the matter thrown up, especially if the suffering be immediately relieved after vomiting, to the presence of obnoxious and indigestible substances in the stomach. 4. If attended with sudden paroxysms of cramp-like pain, and abrupt suspension of breath, to increased irritability of a purely spasmodic char- acter. 5. If both symptoms occur habitually in the morning, and there be no further indication of irritation of the stomach itself, and if further exam- ination of the urine, and other symptoms lead to the same conclusion, they may be attributable to gravel or pregnancy. the appetite, and its indications. The appetite maybe equally great, or greater, in disease than in health, but there are very distinct indications which distinguish these opposite conditions. The appetite of health should be even, regular, (not capricious or fitful) varying in the frequency of its return only according to the habitual periods of meals ; but, if not governed by any habit calculated to modify the intervals between the returns of hunger, it should recur, in the adult, about every four to five hours, and in infants and children at intervals of from one to three hours ; and the meal should not be accompanied with flushing of heat, but rather with a sensation of chilliness. As an indica- tion of disease we find the appetite deficient, or absent, excessive and irregular— fitful— capricious— craving after particular substances, with absolute repugnance to others — characterized by a desire for unnatural things, as chalk — or by a particular longing for stimulants, etc., in the majority of which cases the stomach is the seat of derangement, but occa- sionally, also, the bowels, (as when worms are present in the intestinal canal;) except as regards suspension of appetite, which, in most cases, (particularly if supplanted by thirst,) indicates constitutional irritation, (fever), whatever be the original seat of the affection . In other instances we may remark an habitually excessive or craving hunger (not necessarily either capricious or fitful,) but particularly qualified if flushing of heat, or APPETITE AND THIRST. 47 peculiar heat of the hands follow a meal when we may have reason to apprehend a hectic or consumptive disposition. In some cases, however, in which excess of appetite occurs (unaccompanied with these qualifying conditions) especially in young persons, it may be attributed to worms alone — to over-rapid growth — to violent, exercise and excessive perspira- tion (sweat,) or to any other cause which would tend to absorb or to con- sume the substance and nutriment of the body. Absence of appetite may more particularly be attributed: 1. To organic derangement of the stomach, or simply to weakness of the first process of digestion. 2. And more frequently, to overloading the stomach, or the pressure of injurious and indigestible substances, even in moderate or small quan- tities. 3. To fever of any kind, otherwise determinable by the pulse, etc., except, indeed, to hectic or rheumatic fever, neither of which necessarily subdue the appetite. 4. To nervous, hysterical, and hypochondriacal conditions— or to nervous derangement resulting from emotions, as from excessive grief, alarm, etc. ; or to the like, resulting (without fever) from undue physical exertion (a rare case) when the nerves of the stomach are implicated ; or frequently from undue mental labor or anxiety. Natural appetite, that is, appetite neither increased nor decreased, may occur, associated with hectic or rheumatic fever; when, however, it is generally qualified by other circumstances — in both cases, it is more likely to be irregular or excessive. Excess of appetite, as a symptom of disease, is an evidence of poorness of blood, frequently attended with the secretion of an acrid, irritating phlegm ; but, without such conditions, it may result from purely nervous and sympathetic irritability — as during pregnancy, or in diseases of a purely hysterical character — or, again, from some habitual cause of irri- tation, such as worms. In hectic or consumptive complaints, it indicates the insufficient distribution of nutriment by the tributary apparatus, that is, a want of proper action in the digestive function to appropriate the nutritive constituents of the food. Excess of appetite will, also, often appear associated with habitual vomiting, or continued relaxation of the bowels, owing to the deficient distribution of nourishment. THIRST AND ITS INDICATIONS. In the majority of cases, continued thirst indicates fever or inflam- mation ; but, inasmuch as it will result from any dryness of the mouth and throat, and from lack of moisture in the stomach (without disease,) we must be careful to distinguish the thirst of health. The thirst of health may be the consequence of any condition calcu- lated to absorb the moisture of the mouth, throat, gullet, and stomach- such as: — severe physical exertion, greatly elevated temperature, particu- larly in a dry state of the atmosphere, or even when the temperature is much depressed by the deficiency of moisture in the air, particularly if strong exercise be taken during the prevalence of such atmospheric con- ditions,— or, again, eating salt food, or eating solid food, especially heating food (chiefly animal) in excess, or continuing too long without food (with- 4S INVESTIGATION OF DISEASE. out necessary abatement of appetite) after the return of hunger, whereby the saliva has been exhausted. When, however, there is no apparent cause for the thirst, especially if accompanied with increased heat, or dryness of the skin, etc., and if, upon investigation of other symptoms, further indications should warrant the conclusion, we may infer that the thirst arises from internal heat, and is, consequently a symptom of fever. If, in such a case, the thirst be intense and insatiable (the pulse being full, hard and frequent,) the character of the fever is distinctly indicated — it is inflammatory ; that is, there is a deficiency of the watery constituent in the blood. Thirst may, however, arise purely from acidity ; when it will be char- acterized by risings, and acrid sensations in the gullet, etc. It may, also, be associated with spasm ; when, however, it will be characterized by deficiency, not by excess of heat. THE TONGUE AND ITS INDICATIONS. The tongue affords many of the most important indications associated with derangement of the digestive functions. Tongue thickly furred, dirty white, or brownish white, without either unusual dryness, enlargement, or redness, indicates that the derangement involves rather the lining membranes than the nerves of the stomach, and that not to a serious extent. The derangement is then identified as com- paratively recent, and easily cured. Tongue furred with slimy matter, and with vivid red tip and mar- gins, indicates also an affection of the lining membrane of the stomach, but one of a more serious and continuous character. Yellow tongue, also qualified by one or more of the last-stated condi- tions, indicates the liver as implicated. Clean tongue, of bright redness, naturally moist, but with the papillae unnaturally prominent, indicates that the derangement affects the nerves of the stomach, and is of recent date. Dry, red, glazed tongue represents a similar affection to the last, but more severe, and of longer standing. Swollen, red tongue, but slightly charged with white fur, represents* such a degree of nervous derangement of the digestive organs as to react congestively upon the brain, and implicate that organ. Cracked, furrowed, fissured, swollen tongue, conveys to our apprehen- sion the most severe degree of derangement of the nerves of the stomach. Sioollen tongue, thinly coated white, but bright red at the tip and mar- gins, indicates a complication of both varieties of indigestion— viz., that of the lining membranes, and that of the nerves of the stomach, which is of old standing, and of an obstinate character. We may look for irregular operation of the brain, as associated with this symptom, as well as extreme despondency, nervous irritability, and depression of spirits and activity. Tongue indented on either side is a modification of the swollen tongue, already mentioned as associated with derangement of the nerves of the stomach, and consists of a very severe degree of tumefaction (transient swelling). SENSATIONS OF THE NERVES, ETC. 49 Tremulous tongue, or tongue trembling when protruded, is often noticed amongst habitual drunkards, and distinctly indicates a complex variety of the nervous form of indigestion, implicating the spinal marrow. Blackish, dry, furred and tremulous tongue, is a symptom in abdomi- nal or putrid typhus. THE NERVES, BRAIN, SENSATIONS AND SENSES. This section includes the consideration of suspension, or acuteness of sensation, perception, consciousness, volition, motion, rest, etc. LOSS OF CONSCIOUSNESS, DELIRIUM, FAINTING, ETC., AND THEIR INDI- CATIONS. Loss of consciousness may be of three kinds, (as we shall have occa- sion to consider it.) two of which are primarily referable to the brain, and one to the heart, namely : Apoplexy, (considered as a symptom,) which consists in total suspension of the activity of the brain, and conse- quently, also, of nervous irritability and vitality ; delirium, which con- sists in disturbance or irregularity in the activity of the brain ; and fainting, which consists of temporary suspension of the activity of the heart, but which, also, involves the like prostration of general nervous activity. Apoplexy, which is distinguishable by unaltered strength, or by increased strength of pulsation, accompanying total suspension or motion, or motive power, (which does not always return with consciousness,) indicates an organic affection of the substance of the brain more or less critical. Delirium, which is distinguishable by loss of consciousness, or more properly, perhaps, of connected ideas, (generally of the nature of sleep, without rest,) with or without frantic movements, but always with, increased or diminished activity of the brain of an irregular nature, affords various indications, according to the particular conditions and circumstances which precede, accompany, or follow it ; or to the particu- lar disposition of the patient, which may serve to qualify it. 1. When it becomes continuous, and is divested of any other symp- tom of derangement, and the functions of the system continue in regular operation, it ceases to be a symptom, assumes the individual character of an independent disease, and would seem to indicate a greater or less alter- ation of the substance of the brain. 2. When there is a continual predisposition to the return of attacks of delirium, without a permanent and continual duration, qualified, moreover, by other symptoms of hysterical or hypochondriacal suscepti- bility, it is of comparatively little importance as a symptom of diseases which exhibit that character (hysterical, etc.) 3. Persons of a habit of body and temperament, characterized by a peculiar activity, susceptibility, and excitement (easily provoked or aggravated) of the brain, so invariably exhibit this symptom with the least acceleration of circulation, and are so prone to become wholly abstracted by the continued activity of the brain, that we should weigh 50 INVESTIGATION OF DISEASE. well the accompanying indications, which further characterize disease, before attaching much importance to delirium alone, in patients of such a descripton. 4. If, however, there be active delirium — that is, raving, occasioned by suddenly increased flow of blood to the brain, with or without frantic action, with considerable derangement of the system, as shown by other symptoms, especially if this symptom occur in persons who are not sub- ject to a manifestation of the kind, we should first consider — whether there be continuous and active fever, in which case we have an indica- tion of the most inflammatory disposition of disease, and it remains to be considered whether the brain itself, or its membranes, be the primary seat of inflammation — or whether there has, previously, been some skin disease which has suddenly disappeared, or whether there are such symp- toms as forebode an eruption ; or whether, again, there have been evi- dences of inflammation, developed in some other organ, which suddenly subsided or disappeared. Or, if no such manifestations be present, we may consider the delirium as resulting from a sympathetic affection of the brain, of which the primary cause is seated in some other part, — such as the stomach or the bowels, or both, arising from the presence of irrita- tive matters, (as, for instance, worms, bile, etc.;) or, again, — if any such cause can be identified — the influence of narcotic and poisonous drugs. 5. There is, also, another kind of delirium which appears as a very important symptom, especially associated with any cause of pressure on the brain, generally the immediate or remote result of accident, or of— Inflammation : — Immediate, when it appears as an attendant symp- tom of the actual disease, — in which case, it distinctly indicates the pres- ence of blood disengaged, and accumulating in the substance of the brain, or suffusion of extravasated blood in the enveloping membrane; remote, when acute organic inflammation is not present, in which case, it identi- fies the presence of water. This is what is termed drowsy delirium. It is identified by a defi- ciency of activity of the nerves and brain, the absence, even, (in many cases,) of any motion of the body, a species of dull, inanimate sleep, total helplessness, and complete silence, or, at most, a low, internal murmur ; and it is characterized by prostration of nervous action. Drowsy delirium, may, also, appear in nervous and typhoid fevers, as an indication of general debility. In any case, it may be considered as a more critical symptom than active delirium. Fainting — swooning — should, also, be considered with due regard to the disposition of the patient, and to the circumstances which qualify it. 1. If it be habitual, especially as the termination of violent attacks of palpitation of the heart, which, generally, if not invariably, lead to this issue, there is reason to apprehend organic derangement of the heart. 2. If, on the other hand, it should occur casually, after violent emo- tion — as joy, fear, grief, etc., or after severe loss of blood, etc., or as the result of casual, but very excruciating pain, or as the consequence of an accidental injury of no great moment, it is not to be looked upon as a very important symptom. Arteries of the lower part of the Body and Lower Extremities MOTION OR MUSCULAR ACTION, REST. 51 3. If, again, it be the habitual result of mere nervous excitement, in persons of a highly susceptible hysterical, or hypochondriacal dispo- sition, — in which case, it is merely spasmodic, — it is not of great moment. v 4. If, however, one or more fainting fits should usher in an attack of fever, we have a positive indication of the subsequent nervous type of the disease. MOTION, OR MUSCULAR ACTION, REST— AND THEIR INDICATIONS. Although not in accordance with technical classification, we shall include under this head of" motion and rest," every circumstance, inter- nal as well as external, in which the motary power is called into play, or subdued. Wherefore, it must be premised, that motion and rest are either healthy and natural, or symptomatic of derangement, and, conse- quetly, unnatural. And. first, with respect to motion : — it is clear that to be healthy and natural, it must be subject to the will, and the consciousness ; that is, that until the resolution to effect a certain movement (as of the arm or leg) instinctively calls the proper muscle into play, that muscle should remain inactive (but ?zo£ incapable of action.) It is, also, clear that it should not exceed the limit prescribed by the will, (except in so far as the phys- ical impulse prevents an abrupt arrest— as, for instance, if running at great speed, the runner should be unable to stop himself suddenly, when at the top of his speed upon the sudden intervention of circumstances re- quiring it. It is, further, evidently clear that even if the will, excited by sensations, (which are painful,) does prompt motion — such as change of position — such motion is not to be considered as a healthy movement properly so called. An example of this occurs in any restlessness caused by suffering. With respect to motion, which occurs when nature, in health, would have prescribed rest — as in the case of restlessness at night, — this is, evidently, a case in which the motion is not subject to the will, and, therefore, unhealthy and unnatural; because sleep is totally independent of volition. The active and motary condition of health, as the general rule for an adult male, should not continue (in spite of the will) more than from sixteen to eighteen hours out of the twenty-four. In the earliest days of infancy, it should occur during little more than the time required for feeding. Young persons, under twelve or fourteen years of age, should have a natural tendency to activity during about fourteen to sixteen hours out of the twenty-four. Secondly, with respect to rest: — If understood purely in the sense of muscular inactivity, during the active and conscious operation of the will, it is also clear, that in order to be truly denominated as healthy and natural, it must, likewise, be subject to the will, which has the power of determining its duration, and of prescribing its recommencement at any moment. Even if prompted or disturbed by the sensations, the will is yet, to a certain extent, the mediating power. As sleep is not purely a degree of muscular inactivity (which it does not even necessarily induce,) it is totally exceptional. But, even here, if the will be retained in proper 52 INVESTIGATION OF DISEASE. ascendency, by being habitually exerted, it is well known that it his the* power of determining the duration of sleep ; for many persons can wake precisely at a given moment, after many hours' sleep, merely by having previously resolved to wake at such a moment. It is even admissible, that the will has an initiating power in inducing sleep, because sleep would not, in many cases, occur without a resolution to permit it; and, if it occurs in spite of the will, it is exceptional, because it must either be an unhealthy symptom in itself, or the absence of it must have been an excess of exertion, forced upon nature by the will. That sleep can be induced even with a disposition to rest — by a mere resolution of the will — has been asserted, but is far more problematical. If, however, it does not occur when the will composes the body for it, it is again exceptional, and the absence of it is a symptom of derangement (not healthy). It can not, nevertheless, be denied that the will cannot coerce it; and if the will,. which is refinement of nervous power, combat the irritation and irritability which repels sleep, it becomes a mere combat between one portion of the- nervous system and another, (resulting, perhaps, in fever,) both become more and more irritated, and each repels the other more violently. Thus,, the very thought that one cannot sleep, and the wish to do so, makes one more restless. The sleep of persons, of all ages, should be calm, neither interrupted, nor of too long duration, undisturbed, evincing a placid countenance and no evidence of pain, uneasiness, or fantastic dreams and visions. The only motion which does not identify irregularity during sleep, is the occasional turn from side to side. The more noiseless the breathing, the more per- fectly healthy the sleep. The skin during sleep should be warm, but neither very hot, dry, nor excessively moist. Restlessness, therefore — that is doubly, the inability to rest, in spite of the will, and the muscular motion prompted by the will (under such conditions,) may be considered as an unhealthy and unnatural condition of activity or motion (either internal or external). As a symptom of fever, it identifies an excessive susceptibility or irregularity, and irritative activity of sensation. It is a symptom rather of an inflammatory than of a debilitated state. Contraction of the extremities towards the belly, identifies pain in those parts (chiefly colicky pains). Continual starting up in bed, indicates great oppression and anxiety, or simply delirium. Continual sinking down towards the foot of the bed, denotes great prostration of vital energy. Throwing off the clothes — when the patient lays himself bare, denotes excessive oppression and anxiety, or simply active delirium, which may, likewise, be identified by evident inability on the part of the patient, to bear the bed clothes upon the body, or when they seem to oppress him like heavy weights. Grasping at imaginary objects, may be considered as one of the most severe indications of utter" failure of vital energy, if not of approaching^ dissolution. POSITION, SLEEP, SPASMS. 53 Position of the Patient— a question which is distinctly dependent upon the questions of motion and rest, and which evinces some very important manifestations — as, for instance : 1. Severe suffering, provoked by lying on one side, which constitutes inability to lie on that side, generally denotes internal derangement of organs, whose seat is in the opposite side. 2. Immovable retention of one position, identifies either excessive weakness or stupor, according to the associated symptoms, and the previ- ous duration or nature of the disease. 3. Repeated change of position — in some measure distinct from what has been more generally described as restlessness— if occurring on what are termed the " critical days " (as the seventh or fourteenth,) or anticipated periods of determinative issue in fevers, which run a regular course, (especially eruptive fevers,) may be assumed to indicate the approach of the crisis; or, if occurring early, in, or during the course of a fever, which has not been accompanied by an eruption, we may infer the necessity for such a development ; or, again, if unattended with the general indications of a forthcoming eruption, or unconnected with any period of crisis, and characterized either by determination of blood to important organs, or by deficiency or suspension of natural discharges or evacuations, this symp- tom may variously indicate the lodgment of oppressive matters in the stomach, or simply internal pain, or anxiety. 4. The favorable indications connected with the position, consist of such a position as is least inconsistent with that usually assumed by the patient when in health, and ability of the patient equally to lie on one side or the other, or upon the. back, which is decisive in determining the absence of disease of the organs of the chest (if the breath is not impeded or oppressed, when the head is bent backwards,) or of the intestines. Sleep, when unhealthy, is distinguishable by any circumstance con- trary to those above stated, or opposed to the habitual condition of the patient (in health). 1. Or, again, when it is characterized by delirium, under the head of which the particular indications afforded by this symptom will be found. 2. When it is impossible to rouse the patient, in which case fever being present, it is identified as of a typhoid character, or we may other- wise infer that there is an inflammation of the brain. This is especially an ill omen when it is manifested at the commencement of the fever. 3. When the sleep is disturbed by the least noise, but relapses imme- diately. 4. When it is interrupted by muscular twitches, convulsive move- ments, and repeated starting, or when there is grinding of the teeth dur- ing sleep, all of which occur associated with a high degree cf hysterical excitement in females, when they are not serious evidences of disease, but which may occur in consequence of sympathetic irritation, resulting from oppression or irritation of the stomach . Spasms and Convulsions should, according to our purpose, be classi- fied under the head of motion. Indeed they constitute muscular motion, both internal and external; but in order justly to discriminate their 64 INVESTIGATION OF DISEASE. symptomatic importance, we must have due regard to the general cir- cumstances, age, sex, disposition, etc., which may qualify them, for: 1. As occurring in females of a highly susceptible or hysterical dis- position, or in children, they are usually provoked by such trivial causes (often unattended with such constitutional disturbance,) that they are commonly not to be considered as of great moment, and may generally be traced to some source of irritation of the bowels. 2. If, however, they occur in consequence of wounds, by which important tendons have been seriously injured, spasms may be considered as highly momentous, and may result in lock-jaw, or, at all events, in permanent rigidity of the parts injured, or of other parts. 3. If again, they should occur (in persons of mature years, and of robust habit,) as resulting from severe loss of blood, etc., they are of por- tentous import. In this case they are the result of exhaustion of vital energy. 4. If, again, they appear as the effect produced by determination of blood to the brain, or to the spinal marrow, or are derived from the pres- ence of obnoxious matters or foreign bodies, they are not to be neglected. In the first of these cases, they are caused by super-abundance of blood, etc., in the second by nervous irritation. 5. If they occur at the point of issue in typhus fever, they may either be critical, (terminating in convalescence,) or fatal (when the vital energy sinks in this last effort). 6. If they appear associated with contagion, or the irregular develop- ment of eruptions or efflorescences, (as with purple rash, smallpox, etc.,) they are attributable to nervous irritation. 7. They may be attributed to the presence of worms in the intestines, or to any other obnoxious or irritating matter, either in the stomach or intestines, in which case, also, they are directly occasioned by nervous irritation. 8. Convulsions resulting from the pressure of extraneous matter (such as water) on the brain, or otherwise traceable to irritation of the brain primarily, may result in the highest degree of which they are sus- ceptible, namely epilepsy. Spasms, particularly if caused by tendinous injuries, may terminate in the highest degree of which they are susceptible, namely, permanent rigidity, (such as lock-jaw or the contraction of any limb, or part of a limb). 10. Spasms which affect the muscles of any limb, are commonly called "Cramp" The distinctive feature of a spasm is gathered therefrom, namely, an uninterrupted muscular contraction . 11. Convulsions consist in the alternate contraction and relaxation of one or more muscles. 12. Spasms and Convulsions, internally, include such affections as vomiting, already separately considered, (when they affect the stomach;) Colic, exemplified under the head of "Pain,'' (when they affect the bowels,) Palpitation, considered under the head of "Pulse,'' when they affect the heart;) Cough, separately considered hereafter, and also under the head of '• Breath," (when they affect the chest;) Retention of urine, PARALYSIS, HICCUP, TREMBLING. 55 considered under the head of "Urine," (when they affect the bladder;) Hiccup or Hiccough, separately considered, (when they affect the dia- phragm or midriff). Paralysis, which may be confined to muscular power, or which may extend to the superior faculties of the brain, and to all power of sensation and perception, must be considered with due regard to every circumstance connected with it, in order to form a just idea of its indications. In any case, the brain must be considered as the seat whence this symptom, either directly or indirectly, springs. But it may either appear as the result of some external oppression, or from internal and organic affection of the brain and spinal marrow. 1. If it be purely occasioned by external causes, or by causes which are external as regards the organic substance, as, for instance, if the oppression arise from congestion of an enveloping membrane, it will be easily distinguishable by being transitory, and consequently the more simply remediable. In the majority of such cases the paralysis will be local, leaving the superior faculties, and all other physical parts of the organism, unaffected. Very severe cases hold as an exception. 2. If it be the result of internal affection of the organic substance, as of disengaged accumulation of blood in the substance of the brain, it will be continuous, and will almost invariably impair, if not destroy, the memory, and permanently detract from the powers of perception and sensation. Hiccup or Hiccough, an internal development of muscular action, must, also, be considered with due regard to the conditions and circum- stances of age, and of the symptoms with which it is associated. Simply described it is a convulsion affecting the midriff or diaphragm. 1. If it occurs in children, and can be associated with cold, or with distension of the stomach, (that is, flatulency,) it is casual and of little moment. 2. If, however, it should be associated with nervous fever, it indi- cates a malignant type. 3. If associated with inflammatory fever, it identifies, to a certain degree, the tendency to inflammation of the bowels. Trembling is a symptom which is of various import, according to the circumstances and conditions under which it appears, and according to the disposition of the patient. 1. For, if the patient be of a highly nervous susceptibility, and it cannot be traced to any of the other causes metioned, it may be attribu- ted to a degree of nervous excitement or irritation, which may result from emotions of any kind — abuse of stimulants, whether medicinally administered (under foolish treatment) or not, or to excess of physical exertion, but more frequently of mental labor. 2. If the antecedent circumstances be characterized by loss of blood, or any animal fluid, it may, unquestionably, be attributed to debility, as, also, if it attend every attempt at exertion after severe acute disease. 3. If it be distinctly manifested, as unconnected with other direct causes, at the outset of a fever, here is an unquestionable premonition of the subsequent nervous character of the disease. 56 INVESTIGATION OF DISEASE. 4. If it should appear in a person of a full habit of body, or other- wise, with evident distention of the bowels, and unconnected with any- other apparent cause, it may, with propriety, be attributed to superabun- dance of blood in the vessels. THE SENSATIONS, AND THEIR INDICATIONS. The sensations need not necessarily be painful to afford a distinctive symptomatic indication, although it be true that, as an index of disease, every particular or characteristic sensation is generally painful, or, at all events, disagreeable. The most distinct sensation, as a symptom of dis- ease, however, is pain, or the painful operation of a function — or absence of pain when there is disease which should cause pain ; but we may also divide these sensations into two further distinctive subdivisions, namely, sensations of discomfort or unea-siness, and sensations of anxiety. PAIN, DISCOMFORT, AND ANXIETY, AND THEIR INDICATIONS. Pain, as a distinguishing symptom, in whatever part or organ it may have its seat, is to be divided into (1) that which continues uninterrupt- edly, which, if persistently in the same part or parts, and continues to become aggravated, (until resolution takes place,) and which is further qualified by being aggravated by the touch, and still more by severe pres- sure, and temporarily by the application of heat, is the general distinctive indication of inflammation of the part, or parts, whence the pain orig- inates: (2) Pain which is chiefly developed in a particular course, or direction, (the course or direction of a nerve,) or which is changeable, as to the part in which it occurs, but w T hich, in either case, is generally characterized by aggravation from apparent contact, or slight touch, and relieved, or not aggravated, by severe pressure, identifies pain of a nerv- ous character : and, (3), Pain which comes and goes in the same part, or parts, partakes of a contractive, or cramp-like character, is relieved by pressure, or warmth, or friction, is often intermittent, and always irregu- lar, and which is rarely continuous, and never persistently continuing to become aggravated, identifies pain of a spasmodic character, that is, spasm of the part, or parts, affected. 1. Pain in the chest, or painful breathing, may be the result of an overloaded stomach and impeded digestion, or may be occasioned either by a rheumatic, (2) a spasmodic, or an inflammatory affection ; or by occa- sional determination of blood to the part of the enveloping membrane of the lungs. If it communicate a sensation of being bruised, or of a stiffness, as if the muscles could not bear the expansion of the chest, (3), if the pain is of a shifting character, or if touching and pressing the chest causes pain, it may be identified as of a rheumatic character. If it be casual stitching, as, for instance, suddenly interrupting the respiration, without returning regularly, or being regularly provoked by a similar effort in breathing, it may be considered as of a neuralgic character. If there be persistent stitching pain whenever a certain degree of expan- sion takes place, with a dull, heavy pain, (without progressive aggrava- SENSATIONS AND THEIR INDICATIONS. 57 tion) in the intervals between such expansion, we may identify determin- ation of blood to the enveloping of membranes of the lungs. If, again, there be a continual acute pain, growing progressively worse and worse, and further qualified by a general and severe degree of fever, which has been preceded by chills, and is associated with more or less prostration of strength, inflammation of the membranes in question is clearly established. 2. Pain in the bowels, or painful evacuation, is either of (1) a nerv- ous character, when it will be fugitive, returning when the attention of the patient is directed to it, fugitive and aggravated by apparent contact or by slight touch, and relieved by severe pressure ; or, (2), spasmodic, (a modification of the nervous,) but relieved by contact and pressure of every kind, by lying on the belly, and by drawing the legs up, and oth- erwise contracting the body, may, by continuance, become inflam- matory ; or, (3) inflammatory, when it will be readily distinguished by persistency, accurate locality, progressive aggravation, and by excessive tenderness of touch, and still more of pressure. Colic, properly so called, is, strictly speaking, a spasmodic pain, but by long continuance may become inflammatory. 3. Painful discharge of urine may appear as the symptom, either of inflammation or irritability of the passage, or of the bladder, or neck of the bladder, distinguishable by the locality of the pain and nature of the discharge; for (1) if the pain arise from inflammation of the bladder, or neck of the bladder, it will be associated with fever and hard pulse, and the pain most severely felt at the bottom of the belly, and the discharge will, usually, be either mingled with blood, or blood will predominate •over the urine, or the discharge of urine will be followed by that of pure blood, with excruciating, twinging pain ; (2) if the pain be occasioned by inflammation, irritation, or irritability of the passage, it will be qualified by a scalding sensation, (when urinating,) towards the terminal part of the passage, with or without discharge of matter ; (3) if the pain be dependent upon inflammation, irritation, or irritability of the kidneys, the water evacuated will be hot, and the seat of pain will be chiefly in the loins and small of the back ; or, (4), if the pain be occasioned by spasm of the bladder, or neck of the bladder, there will be continual urging to pass water, but total inability to effect it ; that is suspension of urine, with cutting, cramp-like, agonizing pain in the part, relieved, however, by pressure ; that is, by doubling the body forward, and pressing the hands firmly upon the lower part of the belly. 4. Absence or sudden suspension of pain, in severe cases of organic inflammation, is, in all instances, a most ominous manifestation, but it may indicate two distinct conditions, namely: (1) the sudden transition of the inflammation to another organ, (in most cases to the brain,) when it requires the utmost care, but is, nevertheless, not so alarming as when such reappearance of the disease in another quarter does not quickly follow; for, in this case, the change, in the majority of cases, has been one from inflammation to mortification, (and consequent loss of sensa- tion). 5. Intermittent pain, which is also either periodical or irregular, or .that which is very severe for a certain period, often accompanied 58 INVESTIGATION OF DISEASE. by local heat or general flushes of heat, sometimes by the palpitation of the heart, and frequently by a degree of irritative fever during its contin- uance, and terminating with local or general sweat, (and that only,) and by an acute degree of nervous susceptibility and irritability, often aggra- vated by heat, or by slight contact, (the patient having, however, an inclination to press severely upon the part,) but which totally subsides during regular or irregular intervals, and which is of a nervous char- acter. 6. Remittent pain, or that which becomes modified from time to time for certain intervals, especially at certain periods of the day, or under particular conditions of heat, cold, access or exclusion of air, or owing to palliative measures, but which never totally subsides during the intervals, but dbntinues dull, heavy, and persistent, instead of being highly acute, pulsating, or shooting, and which is further qualified by severe feverish symptoms during the acute stages, which, however, also become modified, though never wholly subdued, during the intervals of comparative relief. This description of pain is generally associated with organic inflamma- tions, or with obstructive causes of irritation, with a strong tendency to organic inflammation, and identifies a tendency to chronic or continued inflammatory action in such parts or organs. 7. Inflammatory pain, in its genuine distinctive character, is very plainly distinguishable from pain of any other nature, as for instance: It is always accompanied with increased heat of the particular part affected, (if purely local,) and then even in some cases, especially, if it be of long continuance, by general increased heat of the body, or alternate heat and chills, frequent and hard pulse, and other signs of fever. And if it be internal, and affecting one or more of the important organs, the adjacent parts, as also the whole body, (except the lower extremities,) will manifest greatly increased heat, and the general symp- toms of fever will run high, the thirst being generally considerable, and often intense and insatiable, (in highly inflammatory subjects). It will be continuous, proceeding from bad to worse, until the crisis or other issue. It will be relieved by moisture of the skin, and general or even local perspiration. It will be greatly aggravated by pressure, or even by the least touch, as of the clothes or bedclothes, but still more so by severe pressure, which is usually insupportable. If local, there will be redness and often swelling of the parts ; if affect- ing the outer membranes, particularly of the intestines, again, redness will often be discernible externally. There will be sometimes more or less strong development of the adja- cent vessels, which will be observed to be swollen and dark, their course being palpable, where, in general, they are externally imperceptible. There will be often more or less throbbing or pulsation in the part with the pain, especially in the after or suppurative stage, (although this symptom may also accompany nervous pain). If local, it will usually be much aggravated immediately by warm applications, such as fomentations, but will afterwards decrease, and will be generally relieved at first by cold applications, but in such eases the SENSATIONS AND THEIR INDICATIONS. 59 pain will often return more severely, as soon as the cold application is removed. Whether local or affecting internal and important organs, it will be aggravated by stimulants, motion, exertion, mental or nervous excite- ment, fatigue, etc., and will have a tendency to grow worse towards night. If natural discharges have occasion to pass over the inflamed surfaces, as, for instance, of the bladder or bowels, the pain will usually become excruciating. If internal, the natural discharges will be qualified by the evacuation of blood, and either by being very liquid (of the excrements,) or very dry; in any case (of all discharges) they will be deficient in quantity, occur frequently, and there will be continued urging to discharge. The external surface, whether attending local or internal inflamma- tory pain, will invariably be dry until the crisis, when the pain will subside, with the development of moisture. The pain will, inseperably, prevent or disturb proper rest, (sleep; a condition which only applies to inflammatory pain, because pains, either of a nervous or spasmodic character, may be overcome by sleep, which frequently occurs in spite of them, especially the latter). Consequently extreme and inseperable restlessness, with such indications as above stated, identifies pain as inflammatory. The most perfect crisis, or resolution of inflammatory pains of any kind, consists in gentle, undisturbed, and placid sleep, with proper mois- ture of the skin. 8. Nervous pains are of a fugitive, irregular or periodical, pulsating, dragging, darting character, with or without local heat during the entire continuance of local suffering, but then often attended with local sweat, (simultaneously — which never occurs of inflammatory pain,) flushes of heat without fever, or with temporary irritative fever, (in modified degree,) restlessness, depression of spirits, hysterical disposition, or fantastic ideas; aggravated by thinking of them, and relieved when the attention is dis- tracted by objects of interest, or aggravated by apparent contact, or slight touch, and relieved by pressure, unattended with any variations of appe- tite or thirst; characterized by the occurrence of involuntary motions, as by jerking, or the sensation of twittering (vibrating) in particular parts, in the latter case, frequently without external perceptibility of such action— by extreme restlessness and uneasiness, with or without a degree of irritative fever, (and often with an extremely low pulse,) by intermittency or periodicity, by being usually dispelled during motion, or absorbing occu- pation, and by a peculiarly intractable persistency, continuing to recur, in spite of every resource, (when they cannot be traced to a precise point or cause,) without, however, affecting the general health, or detracting from the vigor of the functions. 9. Spasmodic pains are of a cramp-like, contractive, and very severe cutting character, but they are usually of brief duration, though they may be of frequent recurrence. In their distinctive and peculiar qualifications they are totally unassociated with heat, or any other inflammatory symp^ torn, and are, rather, except in highly excitable subjects, habitually attended with depressed than over-active circulation ; but by long continu- 60 INVESTIGATION OF DISEASE. once they will frequently engender a reactionary inflammation, and assume all the characteristic features of inflammatory pain, sometimes becoming, in such cases, very severe and intractable. As affecting important organs, they may first accelerate, then temporarily suspend the circulation and breath. In their distinctive character they are relieved by stimulants, heat, contraction of the parts, or of the whole body (doubling up,) pressure and especially friction. In their excess they render expansion of the parts impossible. They are either local, affecting particular motary mus- cles, or they are internal, affecting the muscles which are connected with or constitute important organs. A constant and severe degree of spas- modic pain, affecting important organs (as, for instance, the heart or stomach,) is indicative of organic derangement. A casual spasmodic pain, however severe, is attributable chiefly to the accidental presence of irrita- tive matters, especially in the stomach or bowels. 10. Pain in the back of the head usually denotes determination of blood to the head. 11. Pressing pain in the forehead, accompanied with giddiness, com- monly implies the presence of irritative or impure substances in the stomach; or, in some cases, excessive weakness: — that is, if it occur after a severe attack of illness, confinement to the bed, or more especially loss of blood, or other animal fluids. 12. Pains particularly and persistently, occurring in the back or loins, may (in females,) be associated with pregnancy, or, if at due time, with the monthly return ; but, in such cases, as in the more general definition, it may be held to intimate the presence of, or a tendency to piles. 13. Pain in the front part of the stomach or bowels, occasioned by "pressure, (although there be no actual or positive pain without pressure,) when occurring as associated with fever, or at the onset of fever, and further qualified by heat of the parts, and retching, (if of the stomach,) or straining (if of the bowels,)— denotes respectively inflammation of such part or organ as thereby typifies the fever. 14. Stitching, or prickling pain, may denote a spasm, but more fre- quently determination of blood to a part, or inflammation, especially of the enveloping membrane of an organic part. If it be occasioned by spasm — as of the stomach — it will be casual, generally severe, sometimes even to the degree of suspending the breath, but passing off without return, or with a similarly casual return, in the majority of cases,- upon the dislodgment of wind, especially belching; pressure and friction will relieve it. If it be the result of determination of blood, such as when it occurs on the right or left side, (about the liver or spleen,) provoked by rapid mo- tion, immediately after eating, or the like conditions — or when it occurs without such immediate causes, and continues to be perceptible upon drawing a deep breath for some time without striking constitu- tional derangement — pressure does not always aggravate it, unless severe motion does: relaxation of the parts, as by bending the body forward, relieves. If it be the decisive symptom of inflammation, as in pleurisy, we may thereby distinguish inflammation of the pleura, (the membrane which covers the lungs, etc., and lines the cavity of the chest,) from inflammation SENSATIONS AND THEIR INDICATIONS. 61 of the substance of the lungs, especially, if there be little, if any pain, until the parts are expanded, as by drawing breath deeply ; and its inflam- matory character will be distinguishable in the general derangement and high degree of fever, which accompanies it, with local and general increase of heat, (except sometimes of the extremities,) dryness of the skin, thirst, etc. Sensations of discomfort, such as the following: 1. Restlessness has been already mentioned under the head of Motion. 2. Giddiness, (simply) except in the cases mentioned as important, is a symptom of no great moment, but it often serves to determine the indi- viduality of disease. It may identify a nervous condition, generally speaking, occasioned by an irritation of the stomach, when we may identify the cause as an over- loaded stomach, with a tendency to expel the irritating substances, upward. In many cases, particularly as occurring in persons of a full habit of body, it denotes congestion of blood to the head. 3. In persons of advanced age, or of apoplectic tendency, it may be looked upon as one of the unpropitious indications of imminent apoplexy. Sensations of heat and cold are of two kinds — those (1) with which there is actual heat or coldness, and those (2) which merely convey these sensations, the part affected with such feeling being neither hotter nor colder (necessarily,) in a degree which should occasion such feeling. These are subject to many modifying conditions — of which we shall briefly notice the most important — and are generally to be held as of very great importance in the investigation of disease. Actual increase of heat, if unqualified by any particular local deter- mination, or by particular and local pains, denotes (1) increased activity of circulation, that is, fever (simply,) more or less inflammatory, as the degree of heat is greater or less; (2) local inflammation, whether of, par- ticular parts, if purely local, or attended with general inflammatory action throughout the system, if the heat be general, and simply charac- terized by local determination and other particular identifying symptoms. This heat, as regards a particular spot, may or may not be externally apparent to another person, it is sufficient that it is internally felt by the patient; (3) a determination of blood to particular parts or organs, with- out active inflammation, when the heat, whether internal or external, is confined to the spot, part, or organ affected, and to those which are con- tiguous; (4) when inflammatory and general heat is present, it is identi- fied by the simultaneous frequency, hardness and strength of the pulse, which increases with the increase of heat t and by its conveying no unpleas- ant sensation on contact to a healthy person ; and further, by the part of the healthy body thus brought into contact with it becoming so accus- tomed to it, after a short duration of contact, as to lose the distinct sensa- tion of greater heat in the sick body ; or (5) in the last stage of putrid fever, or as an indication that fever has assumed a portentous putrid character, it may signify incipient decomposition, in which case, however, it will increase as the pulse becomes more and more feeble, it will convey a most disagreeable sensation of a burning, stinging character to the part of a healthy body on contact, becoming more and more disagreeable the &2 INVESTIGATION OF DISEASE. longer the contact continues, and leaving the same unpleasant sensations for some time after the contact has ceased; this is a chemical, not an animal heat. Heat in the front portions of the stomach, bowels and chest, and especially, if conveying a burning sensation internally, to the patient, accompanying a high degree of fever, shows a general inflammatory con- dition of the tributary organs of life. Heat of the hands, after eating, denotes a disposition in the disease to become habitual, or if there be no distinct disease, a predisposition to hectic complaints. Fugitive heat is particularly associated with a nervous condition; it is, therefore, more common among females, (at certain periods especially,) but it may occur in either sex, associated with nervous debility, irritabil- ity, or susceptibility. Coldness of the extremities, associated with a severe degree of fever, denotes a high degree of inflammation in one or more of the important organs of life, such as may impede the thorough distribution of the blood throughout the system. Therefore, it is one of the distinctive features of inflammation of the lungs. But it may, also, denote deficient circulation or deficient strength of the blood, as associated with other symptoms of an enfeebled condition, and, as such, it identifies depression^ vital energy. Or, again, it may be the result of spasm, either of particular parts or of a superior organ, (as of the heart in particular,) if associated with other spasmodic symptoms. Numbness or deadness of particular parts may (1) be indicative of latent and insidious gout, and if from other symptoms there be such further analogy as to identify this condition, it may be of much conse- quence; or (2) it maybe purely nervous, and then quite superficial, in which case it will generally be palliated by cold applications ; or (3) it may, be occasioned by temporary arrest of circulation in the parts, in which case there will be no contraction or rigidity, and hot applications, friction, or rapid motion will palliate or remove it; or (4) it may be the result of spasm, in which case there will generally be contraction and rigidity, and heat or friction will likewise relieve, but motion will be, commonly, arrested. Itching, (without the presence of any eruption,) especially if preceded by chill, and accompanied by heat (as associated with fever,) usually announces the approach of a critical sweat; or, if unattended with fever, commonly denotes an acrid condition of the humors. Chill (or the sensation of coldness without actual coldness,) is a purely nervous indication of irregularity. It may consist of a spasm of the skin. The conditions which precede, accompany, and follow it, must indispensably be considered, in order to form a correct judgment of the various important indications which it affords, and which qualify every fever ; as for instance : 1. Acute fevers are characterized by the single and un repeated occurrence of the chill. Intermittent fevers by the more or less fre- quent repetition of this symptom, according as the repetition of the fever fits return. 2. If the fever be of an intermittent character, and the chill be slight, with great predominance of heat, there is reason to anticipate that SENSATIONS AND THEIR INDICATIONS. 63 the disease will run into a distinctly acute character; but if the chill be severe, of long duration, and very predominant, the occurrence of heat being imperfectly developed, the disease exhibits a tendency to become sluggish and of long duration, and to assume a chronic form. 3. Chill, which is very severe, and precedes the heat, may first be generally designated as identifying either violent, acute, or even inflam- matory fever, or, on the other hand, intermittent fever. 4. Chill, which is imperfect, or comparatively feebly developed, and which alternates with heat, (that is, is successively preceding and suc- ceeding it,) usually identifies fever of a nervous character, or of a rheu- matic, or catarrhal description. 5. Chill (rigor, coldness attended with shivering,) which occurs during the course of an acute fever, possesses many important significa- tions; as, for instance: If there be inflammation of any particular and important organ, especially of the lungs, we may anticipate suppuration or the still more urgent result of mortification, which will be further identified by subsidence of pain; or, in cases, particularly, in which no decided and local inflammation has existed, or in which the general symptoms are favorable, the approach of the crisis is identified, namely, the thorough development of an eruption, or, more frequently, the occur- rence of copious perspiration, followed by general abatement of the dis- ease ; or, when inflammation of one particular organ has existed, and any abrupt arrest has taken place, such as the irregular suppression of a discharge, we may anticipate a transition to other organs ; if no inflam- mation of any particular organ has existed, and there be evident suscep- tibility of any particular part, or evident tendency to determination of blood to such part, or obstruction to the operation of its functions, we may anticipate inflammation of such part; or, if none of these circum- stances be so combined as to warrant deductions, such as have been sug- gested, the chill may forebode the succession of intermittent fever. Sensations of anxiety : a name which is applied to a certain feel- ing of weight or pressure, with oppression of the breath, of which the seat appears to be the front part of the stomach and chest. No pains (or very few) are so distressing as these sensations, in which there almost appears to be a struggle for life, although, except in cases of organic dis- ease of the heart or lungs, or of inflammation of some important organ, or of general dropsy, they are not so immediately urgent as they appear. They may be the result of an accumulation of blood in the lungs, (con- gestion,) in which case, if the patient were of a consumptive habit, the symptom would be urgent. They may occur as a spasmodic affection of the lungs; or, again, from local derangement of the same organs, such as irregular reception and expulsion of the blood, owing, perhaps, to the obstruction occasioned by enlargements, (as of any important gland,) deposits of matter, etc.. in which last case, as distinguishable by the pulse, much importance should be attached to them. Such sensations may be the result of merely sympathetic nervous irri- tation of the lungs, most frequently when the stomach is affected, as by deleterious drugs, tobacco, coffee, excess of fermented liquor, or obstruc- 64 INVESTIGATION OF DISEASE. five and indigestible substances, in which case the affection must not be attributed to the lungs. They may be occasioned, as last indirectly stated, by overcharging or overtaxing the powers of digestion, especially, if the stomach be weak, a condition easily identified in those who have been treated with copious use of purgatives, emetics, or even tonics, or who have been addicted to excesses in eating or drinking, or in young persons affected with worms ; in such cases, if the patient has partaken of flatulent substances, or of very rich, heavy, or irritating food, or of mixed liquors, or has been affec- ted with bilious symptoms, the occasion of the anxiety is sufficiently apparent. They may be associated with inflammation of the heart, stomach, liver, lungs, or bowels ; or with dropsy of the belly, general dropsy of the system, or water on the chest; or, again, with permanent or organic dis- ease of the heart or lungs, or with determination of blood to any of these organs, in the majority of which cases they are of great consequence. They may be purely spasmodic, in which case the apparent suffering of the patient will be greater than in any other, and it is not uncommon, even without serious disturbance of pulse, to see the patient, as if in the last struggle of existence, either speechless and prostrate, or occasionally grasping at the bystanders, and feebly expressing an apprehension of immediate death. Such cases, especially, occur from comparatively slight causes of derangement (of the stomach, in particular,) in subjects of a highly nervous disposition, if males, or amongst females of excessive hysterical susceptibility, particularly if there be actually some affection of the womb. Women subject to frequent miscarriages are, particularly, subject to be affected in this manner. Under such circumstances, these symptoms are of comparatively slight importance. THE ORGANS OF SENSE * AND THEIR INDICATIONS. This section involves, to a certain extent, not only the investigation of the condition of the sense, which may be deranged without apparent derangement of its organ, but, also, of the external appearance of one organ itself (especially) — namely, of the eye, as well as of the sight. The other organs of sense — namely, the ears, nose, and palate, convey no such very distinct or important external manifestations, or none" which are not included under various heads in the course of this article ; and we shall, therefore, rest contented, in alluding to these, to treat of the senses which they convey — namely, hearing, smell and taste. The eye affords a multitude of external evidences of derangement — as, for instance : 1. A dilated pupil maybe engendered by sympathetic irritation of the brain, as associated with irritation of the stomach and bowels, partic- ularly from the presence of worms ; or it may indicate a local affection of the brain itself— as inflammation of the membranes — or water — and is then the result of direct pressure upon the brain ; or, again, it may result from total inaction, or suspended action of the bowels, in which case the * The sense of feeling is derived from the nerves, and is, elsewhere, separately considered. THE ORGANS OF SENSE. 65 symptom would identify a sympathetic affection of the brain ; or, it may be associated with insensibility of the nerve, which communicates the representations of the eye to the brain, in which case it need not be oth- erwise than a purely local symptom 2. A contracted pupil may be caused by great tenderness to Light, when it consists of a convulsive effort to exclude the light from acting too powerfully upon the eye. If attended with sensibility to light, it exhibits over-due irritability of the nerves connected with the sight, and, consequently, an irritative inflammatory tendency. If attended with insensibility to light, and associated with fever, it is an indication of the utter prostration of the vital energy. Languid expression of the eye, occurring as a distinct and appreciable symptom, may indicate (1) if associated with anxiety— overloaded stom- ach ; or, sometimes, the action of fermented liquor on the stomach; or of deleterious substances, or of heavy and indigestible food; in such cases it forebodes vomiting, especially if cold sweat bedews the forehead; (2) if associated with general debility, as the result of sudden and severe loss of animal fluids, or of very severe acute disease, it denotes the sinking of the vital energy, and often forebodes fainting. Squinting, or distorted sight, is always symptomatic, when it is not habitual, and constitutes a very important indication, in children especi- ally, affording a decisive index to the case, when other symptoms con- spire to evince the probability of acute water on the brain. Otherwise, it exhibits a sympathetic affection of the brain, originating in irritation of the stomach and bowels, especially if worms be the direct cause of such irritation. Staring expression of the eye, or fixed stare at one object, with or without raving, or muttering, if consciousness be absent, identifies delir- ium ; or even if consciousness be not absent, (in the usual acceptation of the phrase,) there is a degree of abstraction, amountingto momentary and accidental suspension of consciousness, absorbed by a fixed thought, or with vacancy of thought, in which case, also, it may be termed the indi- cation of a degree or species of delirium (in its strict sense). Sunken or retracted eyes denote debility. Protruding or prominent eyes, particularly if they be glittering, and characterized by suffusion of redness, combine to identify considerable congestion of blood in the head. The sight is attended with some variations of distinctive import- ance — as, for instance : 1. Double sight, or half-sight, either of which may exhibit a degree of spasm, and which may be simply associated with a hypochondriacal or hysterical disposition, but which may also arise from irritation of the stomach, especially, as the result of very stimulating food or drink ; in which case, however, it is usually characterized by giddiness, drowsiness, dread of motion, talkativeness, extreme taciturnity, or excessive rest- lessness and excitement ; or, again, as one of the premonitory symptoms of imminent apoplexy. 2. The appearance of a profusion of dark spots before the eyes, gen- erally conveying the idea of a slow descending movement aggregately, but sometimes, also, of irregular oscillation, which, even when the patient 66 INVESTIGATION OF DISEASE. wanders, is often to be distinguished in some fantastical expression ; of dread of insects, as, in health, he or she abhors, may (according to other symptoms present) identify or forebode :— depression of vital energ}' and fainting, if the patient has suffered from very debilitating affections, such as excessive loss of blood or other animal fluids, or from very rapid or severe acute disease, determination of blood to the head, or a deranged or over-loaded stomach ; and. perhaps, in the latter case, vomiting. 3. Obscuration of sight affords indications similar to those of dark spots before the eyes, as just stated. The taste affords very important indications in respect of its alter- ations — as, for instance: 1. Foul taste may originate either in local affections of the mouth, teeth, throat, etc., or in irregularities of the nervous system, as occurs particularly amongst women of a highly susceptible, hysterical disposi- tion ; or, sometimes, also, without such causes, during pregnancy ; ©r, again, as associated with fearer, in a tendency to putridity in the blood, which it, therefore, denotes to a certain extent ; or, again, if saltish and putrid, as occurring in persons of a consumptive constitution, or under circumstances likely to provoke consumption, it may originate in a sup- purative condition of the last-named disease. Furthermore, a sweetish, saline, bitter, slimy, or harsh and acrid taste, especially, if considerable phlegm be constantly in the throat, may be traced to the presence of an irritative condition of the stomach, occasioned by the presence of impure matters. 2. Loss, or absence of taste, may arise from some organic, nervous affection ; or, again, from cold, or derangements dependent upon cold. The hearing may constitute a characteristic symptom, either in its excessive or deficient sensibility. 1. If deficient, as associated with fevers, and, particularly, with typhus, this very irregularity constitutes a wholesome indication. 2. If excessive, associated with fever, we may identify either a degree of inflammatory action involving the brain, or, in general, too acute a susceptibility of the nervous system. 3. Buzzing or ringing in the ears, as associated with inflammatory action, or occurring without any apparent cause, or without either of the other conditions here mentioned, in persons of a full habit of body, may be attributed to congestion of the blood in the part; or, if associated with cold, to that, with or without increased secretion ; or, again, to determin- ation of humors to the ears, when more or less deafness usually qualifies the case. The sense of smell is also qualified by two chief conditions, namely: (1) deficiency or loss of smell, which is attributed to nervous dis- turbance, or to the effect of cold (when associated with cold,) or to indi- gestion ; and (2) unnatural conditions of smell; as, for instance: — the prevalence of putrid smell in the nose, which is attributable either to local disease of an ulcerative and putrid character in the nose or palate, or to tendency to putridity in the blood or developed as an early mani- festation of disposition to apoplexy— or peculiar smell (which is not putrid, but may be very disagreeable,) and which consists of an affection of the olfactory apparatus of a spasmodic character. COUGHS AND THEIR INDICATIONS. 67 CHAPTER III. INVESTIGATION OF THE DISEASE— Continued, COUGHS, AND THEIR INDICATION'S. Coughs are of various significance, and point to various derange- ments, or seats of derangement, according to the conditions which pre- cede, accompany, or follow them, or by which they are immediately pro- voked. They constitute a series of manifestations, which should never be overlooked in the investigation of disease, because it is clear that whether associated with direct or local inflammation of the respiratory apparatus, and of the lungs in particular, or with sympathetic affections of these organs, originating in other organic causes of irritation, whether in the stomach and digestive process generally, or particularly in the spleen, liver, etc.; the presence of cough indicates, for the time being, one of two conditions, respecting the respiratory apparatus, namely: — either (1) that there is in the system some cause of irritation oppressing these organs, directly, or reacting upon them from other parts. If the affection be merely sympathetic, caused, as is very frequently the case, by irregularity in the process of digestion, chronic derange- ment of the lining membrane of the stomach, etc., or by the presence of any impure substance in the stomach or bowels, either received from without, or spontaneously engendered from within, it does not indicate circumstances of much consequence as regards the organs of respiration, and should be dealt with purely as an affection of the stomach or bowels, etc.; with this reservation, however, that if the increased irritation of the lungs, etc., be allowed to continue too long, for want of the removal of such provoking cause in the digestive process, it may lead to congestion of blood to the lungs themselves. If the respiratory organs themselves be clearly the seat of the affec- tion, it may be the product of the congestion of blood, suppuration, tubercles, etc , or of a purely nervous affection; or, again, of inflamma- tory action in the lungs, or the ramifications of the wind-pipe, or pri- marily of common catarrh, etc. The condition of perfect health, as respects the respiratory organs, is, therefore, in any case, inconsistent with the presence of cough; for when no cause of irritation, either local or sympathetic, is present, there will be no cough, nor anything to impede the breath, and a deep inhalation may take place, the air being retained for many seconds in the lungs, without the slightest disposition to cough. If the habit of body be such as to lead to the suspicion that there is some latent taint in the system; or if, again, the taint be testified by morbid affections of the glands, skin, or bones, or by tendency, in every affection, to assume a sluggish, chronic character, or by continual inflam- matory or ulcerative affections of the eyelids or gums, every cough may be of momentous importance, and should lead us to investigate its cause, 68 INVESTIGATION OF DISEASE. and to treat the affection, of whatever character, without delay, lest, while we pause, it should run on to organic affection of the lungs, and degenerate into consumption. Sihort, dry cough, accompanied by watering of the eyes and frequent fits of sneezing, in the early stage of acute fever, usually prognosticates measles. It may, likewise, (without such particular accompaniments) announce an eruption of another character. Cough, (generally,) painful, hacking cough, associated with acute fevers (other than those originating in, or associated with, cold,) may often be the foreboding symptom of incipient inflammation of the lungs, when themianifestation of crepitating (crackling) breath will frequently be decisive. Predisposition to cough, as the result of every exertion of the lungs — such as the accelerated breathing caused by rapid motion, or speaking, or laughing; or, even as occasioned by mental or moral excitement — such as emotions, etc. ; or, again, as the result of every derangement of the sys- tem, usually identifies a tendency to organic affections of the lungs. Chronic, dry cough, especially if associated with more or less difficulty in breathing, and readily provoked by the slightest causes, and accom- panied from time to time with stitching sensations, or pains in the chest, would lead to the belief that tuberculous disease had set in. TRANSPIRATION FROM THE SKIN, AND SWEAT, AND THEIR INDICATIONS. The more distinctive method of dividing the consideration of this cutaneous process, would be to consider "transpiration," properly so called, as a healthy, natural operation — indicative of derangement only, wheu qualified by excess or deficiency. Excess of transpiration, under the name cf sweat, and deficiency of transpiration, under the name of dryness of the skin. 1. The transpiration of health is evinced by softness, with slight moisture of the whole surface of the skin, in an equal degree, and without any roughness, crackling, extreme tension, shriveling or withering, or flaccid, flabby looseness of the skin, but with natural fullness and elastic- ity; and it consists of a continual, imperceptible, gaseous exudation. 2. Siveat is a disturbed degree of transpiration, characterized by excessive discharge of humor of the skin ; it may be perfectly consistent with health, as the result of severe corporeal exertion; but, in relation to disease, sweat must be considered as of two distinct kinds: (1) that which accompanies the healthy determination or crisis of disease, or by which such healthy determination is effected, which is called critical, and (2) that which occurs before the critical period, which is followed by no relief, but rather by aggravation, or which is excessively profuse, which fore- bodes, or ushers in, or originates from, the peculiar operation of disease itself, especially characterized by the eruption of pimples (and not of a healthy reaction,) which is called symptomatic. Of the latter variety— symptomatic sweats — we may particularly notice (1) sweat occurring in the morning (without previous habit of the kind) and which, if associated with fever, identifies its hectic character; SWEATS, THE COMPLEXION. 69 (2) offensive sweats, which, as associated with fever, identify putrid typhus; (3) sweat emitting a sour smell, which commonly characterizes the fever as miliary; (4) local sweats, as, for instance, on the chest, or about the head, which are characteristic of determination' of blood to those parts ; (5) cold sweats, which denote a depression of vital energy, and which, in the last stage of prostration, forebode dissolution ; (6) tran- sitory sweats, as opposed to the continuous sweat of a wholesome crisis ; (7) symptomatic sweats may, however, be caused by a mere accessory mismanagement — such as want of ventilation, and excessive heat of the apartment — the use of feather-beds, which is much to be deprecated, especially in cases in which fever becomes developed — or the superfluous (and very mistaken) excess of covering; (8) otherwise we may generally attribute them either to great debility of the whole system, as associated with depressed pulse, etc., especially if occurring after long and debilitat- ing diseases, severe loss of blood or other animal fluids or other exhaust- ing causes, or to accumulation of noxious matters or substances in the stomach, when they will appear more particularly about the forehead and face, and will usually be cold and clammy ; or, again, to overdue activity of the circulation, accompanied with comparative deficiency of energy in the functional process of the skin. Critical Sweat, on the other hand, is to be distinguished (1) by affording general relief, and by the simultaneous modification of every source of suffering and the subsidence of the irregularities of the pulse; (2) by being warm and clammy ; (3) by being developed over the whole sur- face of the body simultaneously; (4) by the subsidence of all restlessness, nervous irritation, or mental uneasiness, and the occurrence of calm, even, undisturbed sleep; (5) by continuity; (6) by the period of its development, in relation to the duration and course of a fever — viz., on what is termed the critical day of those fevers which run a regular course and usually resolve themselves into an issue about a given period, as on the seventh or fourteenth day, etc. THE COMPLEXION AND ITS INDICATIONS. Red, florid complexion, commonly identifies determination of blood to the head, or a full habit of body in general. White (cold, dead white,) complexion of young females at the critical age, denotes a difficulty in the sexual transition — green sickness. Faint-yellow complexion, usually denotes intestinal disease — disease of the bowels. Deep-yellow complexion, on the other hand, identifies jaundice, or even organic disease of the liver. Pallid complexion, with (more usually) meagreness, want of fullness of the skin, commonly identifies the stomach and intestinal canal as the seat of disorder, and may be caused by any obnoxious or impure matters therein— such as worms, (in particular) or associated with acidity of the stomach, with a drawn, sunken appearance, (especially,) it denotes spasm; with (more usually) puffiness of the flesh, it is associated with constitu- tional weakness, qualified by sluggish circulation or congestion, or excess of watery humor (as a constituent) in the blood, or by deficiency of blood. 70 INVESTIGATION OF DISEASE. 6 Patchy redness of the complexion — that is, redness as of a flush- spot on the cheek, denotes a hectic disposition. 7. $nl leu and total change in the appearance of the complexion is often to be considered as a very serious manifestation. S. Livid spots, may, in advanced age, lead to an apprehension of apoplexy, as indicating inactive accumulations of blood upon important organs (with stagnant circulation); the general indication, however, afforded by this manifestation, is that of a putrescent condition of the blood (as associated with scorbutic habit of body). 9. Blue, or livid complexion (habitual) — organic affection of the heart. SOUNDS EVINCED BY THE CHEST, AND THEIR INDICATIONS. The only varieties which have been considered susceptible of general investigation, or which appear appropriate for the consideration of unpro- fessional persons, are such as are plainly manifested by what is termed percussion— that is, by tapping upon the chest, etc., with the tips of the first two fingers of the right hand, or upon the index finger of the left hand, being laid flat upon the surface— and which we shall confine to the clear and dull sounds. Auscultation, or the act of listening hy the application of the ear to the chest {immediate or by the unassisted ear — mediate, or by the stethoscope,) requires anatomical knowledge, and considerable experi- ence, to insure a correct interpretation. 1. The clear sound — or that which conveys the idea of an unoccupied cavity— is a sufficient evidence that the cavity of the chest and the lungs are free from any abnormal formations or accumulations of obnoxious matters, such as blood, matter, water, etc., and, therefore, indicates sound- ness. 2. The dull or muffled sound, or that which conveys the idea of a cavity, the resonance of which is impeded by repletion, indicates the presence of accumulations, whether of blood, matter, or water, etc., and consequently unsoundness. The sounds elicited anteriorly, posteriorly, and laterally, in one-half of the chest, ought to be carefully compared with those of the other; but, as the sound is naturally dull over the region of the liver, we must not expect to find it clear below the sixth rib anter- iorly, the eighth rib laterally, and immediately beneath the shoulder-blade posteriorly. THE VOICE AND SPEECH, AND THEIR INDICATIONS. 1. Loss of voice — which may be occasioned by paralysis, or by simple spasm in the organ of voice — generally, however, indicates inflammation of the upper part of the wind-pipe, and if this symptom becomes perma- nent, or chronic, it denotes organic disease of the part. 2. Hoarseness is likewise a symptom which originates in the upper part of the wind-pipe, and may consist of a temporary congestion or inflammation resulting from cold, or may denote organic disease of the part. 3. Stammering— as associated with fever— is a symptom of great moment, and which may sometimes be distinguished and foreshadowed in CRYING, LAUGHING, SNEEZING, ETC. 71 the early stage of disease, by the imperfect pronunciation of particular vowels or syllables— in which case it should be held to forebode severe affection of the brain. It is a frequent premonitory symptom of apoplexy. 4. Loss of speech is a very grave symptom when it occurs associated with concussion of the brain, apoplexy or typhus; or it may be associated with worms or other noxious matters in the intestines, or simply with hysterical disposition; or, again, it may be the result of spasm, in which case it may assume a periodicity. TEARFULNESS AND LAUGHTER, AND THEIR INDICATIONS. 1. Copious watering of the eyes in the early stage of fever, com- monly forbodes measles; or, if occurring in the course of acute fever, it usually denotes determination of blood to the head. 2. Tearfulness, or weeping— provoked by the most trivial causes, is one of the chief manifestations of hysterical disposition, the same being the cause of laughing; therefore, the two symptoms are generally combined, and the one succeeds, or runs on into, the other. In such cases, however, laughter is generally the first symptom, which, becoming prolonged and convulsive, is converted into weeping. An excessive susceptibility and tearfulness, or weeping upon the slightest vexation, or upon fantastical grounds of vexation, is similarly indicative of a hysterical disposition, and is one of its chief indications. 3. Laughter, in every case, denotes a great degree of nervous irrita- tion, both as regards the superior faculties and the animal functions ; if there be a predisposition to laughter, which is provoked by very trifling causes, a hysterical disposition is clearly identified, as already stated under the head of tearfulness ; if associated with fever, this symptom often forbodes convulsions or delirium. LOSS AND UNHEALTHY INCREASE OF FLESH, AND THEIR INDICATIONS. 1. Accumulation of flesh, (fat,)* .which is sudden, excessive, or other- wise irregular, is usually associated with organic disease of the liver, but may, at any rate, be very closely watched to detect the first manifestations of distinctive indications of disease. 2. Emaciation, or loss of flesh, when it does not occur as the result of fever, or of distressing affection of the mind — such as deep and gnawing grief, or continued mental excitement, etc.,— may be attributed (1) to undue and irregular discharges of blood, etc., evacuation of water, and the like; (2) to disease of the lungs, or of other organs connected with the respira- tory apparatus; (3) and most frequently, to derangements involving the digestive functions, and seated either in the stomach or bowels. SNEEZING, YAWNING, GROANING, ETC., AND THEIR INDICATIONS. 1. Sneezing is directly caused by irritation of the nerves connected with the lining membranes of the nose, and consists of a convulsive respi- * It is not unworthy of notice, that the same symptom has heen identified amongst the inferior animals, as accompanying the earliest stage of diseases resulting from obstruction of the biliary ducts. 72 INVESTIGATION OF DISEASE. ration : it may be the result of irritation in the bowels, and as such, when ir occurs very frequently, in children, without being associated with any more direct cause, (as here stated,) we may infer the presence of worms, as the provoking cause ; or it may occur as an incipient symptom of measles, if associated with fever which cannot be traced to cold ; or, again, it may- be the mere manifestation of cold in the head. 2. Yawning is the result of a sluggish passage of blood through the lungs, and, if associated with fever, whether acute or intermittent, in its incipient stage, it identifies one of two conditions; either a spasmodic, or a debilitated state. 8. Groaning may be attributable to purely mental causes, with which, indeed, this symptom is gener illy associated, otherwise it affords the same clue to the distinctive nature of the affection as the preceding symptom (yawning). THE SALIVA AND ITS INDICATIONS. The distinctive features respecting the saliva, as indicative of more or less derangement, are either an increased, or a deficient and diseased flow of this fluid, as compared with the habitual condition of health respect- ing it. 2. Deficiency of Saliva, or dryness of the mouth and throat, denotes either (1) a deficiency of the watery humor, as a constituent of the blood and consequently an inflammatory or feverish condition — in which case it will occur as a continuous symptom, associated with extreme thrist; or (2) may originate purely in spasm, in which case it will occur but casually, and, if attended with unnatural thirst, the latter symptom will disappear with the direct cause, and with the resumed action of the salivary glands. A diseased state of the saliva, which is so frequently associated with indi- gestion, may be manifested in the form of a thick and tenacious, or — though less often— a thin and acrid fluid. 2. Increased flow of Saliva may either be critical, as, for instance, in small-pox, or in sluggish nervous fevers, or in fevers generally, as occa- sioned by suppression of transpiration (through the skin) ; or it may be symptomatic, (in which case it may either identify a purely local affection of the salivary glands, or be associated with sympathetic disorders origina- ting in the stomach or intestines; such, for instance, as that deranged state which gives rise to the existence of worms) ; or, again, it may be associated with sore throat. THE EXPECTORATION AND ITS INDICATIONS. 1. Expectoration, which indicates a wholesome determination or crisis of disease, especially inflammatory diseases affecting the lungs, is technically termed "critical,'' and is identified by the facility with which it is detached and expelled, by the absence of pain associated with it, and, on the con- trary, by the relief which it affords, and by exhibiting a thick agglomera- tive consistency and yellowish color, occasionally modified by a few slight streaks of blood. 2. Expectoration, which is expelled by an effort, such as i epeated hawk- ing or coughing, or which causes more or less acute pain or soreness in the DIET AND MANNER OF LIVING. 73 effort to detach it, may either denote the presence of accumulations of obstructive and obstructed matters, in any of the air-cells or tubes, or in the windpipe, or whence the discharge of expectorated matter proceeds, as the result of a continued irritation. If jelly-like, or sticky and rusty-colored, it will usually indicate inflam- mation of the lungs. If transparent, stringy, or sticky, sometimes streaked with blood, and expectorated with much difficulty and without relief to the patient, it com- monly identifies acute inflammation of the tubes of the lungs, (bronchitis); in which affection a change in the expectoration to that of an opaque yellow, or greenish-white colored substance, which is easily coughed up, and is followed by considerable relief, gives evidence of subsiding inflam- mation. If it be of the character of matter, or if whitish streaks are seen, or small whitish-yellow, sometimes globular masses, connected together by, or floating amongst, sticky phlegm (continuously,) it is usually a symptom of suppurative (the second stage of) consumption ; again, if it consists of masses of substance of a brown or greenish-white color, and which flattens at the bottom of the vessel, into a shape resembling a piece of coin, it is an indication of an advanced stage of consumption. If it be of pure blood, it may be the result of inflammatory action, or of consumption; but it is, very frequently, the offspring of congestion, or an overcharged state of the vessels of the lungs. If a permanent symp- tom, (and not a critical expectoration,) it is, generally, of much import. If yellow, and particularly if also bitterish, affection of the liver is identified. CHAPTER IV. DIET AND MANNER OF LIVING. DIET. These excellent rules on diet have received the approbation of all classes; the self-denial imposed seems more stringent than it will prove on being carried into effect. Many individuals, in the authors' own experience, have pursued the same system of diet after they had no fur- ther occasion for medical assistance, thus continuing, from choice, what they had begun from necessity. These dietetic rules consist merely in the avoidance of medicinal and indigestible substances during treatment, both as calculated to interfere with the action of the medicines, and the proper functions of the alimen- tary system. Consequently, among liquids, the articles generally pro- scribed are green tea or strong black tea, coffee, malt liquors, wine, spir- its, and stimulants of every description ; lemonade, or other acid or alka- line drinks, and natural or artificial mineral waters. On the other hand cocoa, unspiced chocolate, toast, rice or barley-water, oatmeal gruel, sweet- ened with a little sugar, or raspberry or strawberry syrup, if desireol; 74 INVESTIGATION OF DISEASE. whey, milk and water, or pure milk not too recent from the cow, boiled milk, and, in some instances, butter-milk, or, in fact, any non-medicinal beverage is allowable. The diet should, however, be accommodated to the peculiarities of the constitution in individuals ; for instance, some persons cannot take the smallest quantity of milk without serious inconvenience; others throw out a rash after partaking offish; and, again, others loathe the very sight of animal food. These peculiarities should, also, be taken into account in the selection of the remedies. Of the varieties of animal food, pork, young or salted meats, and, amongst poultry ducks and geese, were better avoided, particularly when derangement of the digestive functions exist. Beef, mutton, venison, and most descriptions of game, if not too long kept, (high,) pigeons, larks, rabbits, etc., are allowable at discretion. (Refer to the Synopsis). Fish is a wholesome article of diet, and may, in most cases, be par- taken of occasionally, with the exception of the oleaginous species — such as eels, salmon, etc.; or shell-fish — as lobsters, etc.; and all kinds of salted, pickled, potted, or smoked fish. Eggs, when known to agree ; butter, if free from rancid, or unusual taste; cream, plain, unseasoned custards, and curds, are also admissible in moderation. Stimulating soups, and high-seasoned, or rich-made dishes, are directly opposed to this regimen. Beef tea, veal, and chicken broth, etc., thick- ened with rice, macaroni, or sago, and seasoned merely with a little salt, are, of course, allowable. Amongst vegetables, all of a pungent, aromatic, medicinal, or indi- gestible description, or greened with copper, are prohibited; such as onions, garlic, eschalots, asparagus, radishes, horse-radish, celery, parsley, mint, sage, mushrooms, etc.; but others, free from such qualities, such as potatoes, French beans, green peas or beans, cauliflower, spinach, seakale, mild turnips, carrots, etc., maybe used with the needful precaution of avoiding any particular article of diet, whether of the animal or vegetable kingdom, that may seem to disagree in the particular case in question. Lemon or orange-peel, laurel leaves, bitter almonds, peach leaves or kernels, fennel, anise seed, marjoram, etc., are objectionable ; acids, andthe ordinary condiments, such as pepper, mustard, pickles, etc., and salads, ought either to be sparingly partaken of, or entirely abstained from, par- ticularly, by persons predisposed to indigestion. Salt and sugar, in mod- eration, are admissible. All kinds of light bread and biscuit, free from soda or potash, and not newly baked; also, simple cakes, composed of flour or meal, eggs, sugar. and a little good butter; or light puddings, such as bread, rice, sago, sem- olino, without wines, spices, or rich sauces, are admissible; but colored confectionery, pastry, and, in some cases, also, honey, must be rejected. Regularity, in the hours of meals, should be observed, and too long fast ing, as well as too great quantity of food, at one time, should be avoided. It is not sufficiently considered that excess in eating, even wholesome and digestible food, is a most grievous error. The lightest diet will impede the operation of the digestive functions, if the stomach be over- loaded. It were alwa3's better to leave the table unsatisfied, than to CLOTHING AND HABITS. 75 indulge in any excess in this particular. Nor should it be forgotten, that a craving appetite, which induces an inclination to eat excessively, is, in itself, an unhealthy condition, which requires to be counteracted, rather than to be encouraged. During fevers and inflammatory affections, the patient must, of course, be kept upon a low regimen — gruel, barley-water, etc., and, at the commencement of convalescence, a light pudding, with a little weak beef tea, or mutton or chicken broth, should form the whole of the nour- ishment given. Nature, however, is our best guide; and whenever she takes away appetite, the necessity of not taxing the digestive functions must, with rare exceptions, be deemed imperative. (See Fever, and also Synopsis of the Rules of Diet). CLOTHING AND HABITS. Upon the first point, it were scarcely worth while entering into any observations, were it not simply to remark upon the impropriety of wearing garments impervious to air, and fitting closely to the shape, and the custom of exposing the extremities and chests of young children to the chilling atmosphere of our peculiarly variable climate, under the absurd idea of making them hardy. The evil consequences arising from the check given to perspiration, by the first-mentioned practice, are too well known to require any particular comment; but as the other is an error widely prevalent, I consider it my duty to mention it; and I feel assured, that, if mothers would only reform this custom, and clothe their chil- dren in a more rational manner, they would make no slight advance towards the prevention of serious affections, not only during childhood, but in after life. Cotton, linen, and even leather, worn next to the skin, are generally preferable to coarse woolens. As regards habits, it may be briefly observed, that a regular method of living, avoiding ill ventilated apartments, late hours, dissipation, over-study, anxiety, and other mental emotions, and taking sufficient air and exercise, are the best preservatives of health. The frequent use of hot-baths is injurious and liable to retard the cure under treatment. The idea that sea-bathing .is almost universally beneficial is exceedingly erroneous ; there are many constitutions on which it acts prejudicially. Medical baths, either natural or artificial, are strictly forbidden. Bathing the whole frame daily with a sponge or wet towel, with cold or scarcely tepid water, and the use of the flesh-brush are by no means objectionable, and, indeed, frequently strongly to be recommended. (See Notes on the Use of the Bath.) CHAPTER V. ADMINISTRATION AND REPETITION OF HOMEOPATHIC MEDI- CINES. The method, quantity, potency, and frequency of repetition, to be selected and observed in the administration of the remedies, will be stated more explicitly as regards particular cases, in the subsequent directions for the treatment of each separate disease. 76 ADMINISTRATION OF HOMOEOPATHIC MEDICINES. There will also be additional particulars in the remarks on internal and external remedies; and material assistance may be derived from the Repertory. Yet much will still be left to the discrimination and judgment of the administrator; because it is obvious, that a multiplicity of exceptional cases and conditions will arise, to which no general rule and few special regulations will apply. In instances of this description the particular character of each symptom distinguishable by the condi- tions under which it is manifested — or still more properly the assemblage of symptoms similarly qualified by conditions, will be the safest guide for the judicious selection of the remedy; and the continuance, return, sus- pension, aggravation, palliation, modification, or change of such particu- lar features of ailment, will serve to regulate the repetition, suspension, or change of the remedy. The same circumstances will also frequently guide the administrator to change the potency (strength,) when the remedy selected is evidently indicated, but has not been followed by adequate results; or, in other instances, to adopt a similar remedy, when both of the previous methods have equally failed. In pursuing such changes, great care should be taken in turning to the Table of Analogous Remedies, and from thence to the Repertory, and thereby selecting the remedy or potency whose operation assimilates most nearly to the aggregate features of symptoms and conditions in the case. The form of the medicine.— With respect to the form in which the medicines should be used, see under the head of " Remarks and Regu- lations respecting Internal Remedies and Doses." Repetition and selection.— The following are a few of the gen- eral rules to be observed in the domestic employment of the homoeopathic medicines: In diseases which are severe, and run their course rapidly, we must carefully watch the symptoms, and when we feel assured we have chosen the proper remedy, if no perceptible medicinal aggravation or improve- ment declare itself, but the disease seems to gain ground, repeat the medi- cine. In cases of high inflammatory action, Aconite or Belladonna, etc., should sometimes be repeated at intervals, varying from fifteen minutes to two, four, or six hours. If a medicinal aggravation take place, followed by improvement, we must let the medicine continue its action, until the improvement appears to cease, and the disease again makes head; if new symptoms set in, we must then have recourse to the medicine thereby indicated. Should, however, no perceptible medicinal aggravation take place, but improve- ment follow, we may safely await its approach to a termination, ere we again administer. If any symptoms remain, from the remedy first selected having afforded only partial relief, we must have recourse to some other medicine, which seems best fitted to meet them; but refrain from changing the remedy as long as benefit results from its employ- ment. In diseases whose symptoms are obstinate and long-continued, and in those which are virulent, but of short duration, as well as in those which partake somewhat of these features of violence, when a very striking improvement takes place, it will generally be found advantage- ADMINISTRATION OF HOMOEOPATHIC MEDICINES. 77 ous to cease to administer the medicine as long as the improvement continues and only to repeat as soon as the slightest symptoms of activity in the progress of the disease reappear. But when a sudden or marked improve- ment, of comparatively short duration, follows the first dose of a remedy, and on repeating the dose, the symptoms of the complaint increase instead of subsiding, as they did in the first instance, it maybe concluded that the medicine does not answer, and that another must accordingly be resorted to, in the selection of which it will be necessary to choose one related or analogous to the remedy first prescribed. The distinguishing of the medicinal aggravation from that of the dis- ease, being a point of material consequence, we shall here give the leading and most usual characteristics of each. The medicinal aggravation comes on suddenly and without previous improvement ; the aggravation of the disease more gradually, andfrequently/bZZoz#m(/ an amelioration. Lastly, the pulse is also a good guide, particularly in fevers and inflammations. Thus, when it becomes less frequent, or when, at all events, it does not increase in frequency, on an accession of aggravation, the aggravation is to be attributed to the medicinal influence; but when it does increase in frequency, the aggravation of symptoms must be considered as depending on the advance of the disease. We cannot attach too much importance to the necessity of carefully watching the effects of each dose, as, in addition to the temporary aggra- vation of the symptoms which sometimes set in, a development of collat- eral or medicinal signs occasionally takes place, particularly after fre- quent repetition of different remedies, in susceptible patients. By a want of attention, therefore, to this important point, we may incur confusion, and may be, unconsciously, treating a temporary medicinal disease of our own creation. We must, also, guard against falling into the opposite extreme — that of allowing the disease to gain head unchecked. Slight diseases are often removed by a single dose of a well-chosen medicine ; the more severe and deeply-seated disorders are, also, frequently removed by a single dose of a well-selected, or specific remedy; but, in general cases, and, particularly those which have been long and rudely treated by other means, a frequent repetition is usually required. As a general rule, however, a given number of repetitions, more or less, according to the severity of the case, will serve to place the patient thoroughly under the influence of the medicine, after which the pause maybe protracted, so long as the indications of progressive improvement are present. If, then, it becomes necessary to resume the administration, it will, generally, avail at remoter intervals than during the previous course. In complaints which are of a mild, though sluggish type, and which are unattended with any critical characteristics, the intervals, in the first period, may vary according to circumstances, from six to twelve hours. But in most complaints, in which constitutional or local inflammation is present, the intervals, in the first period, should not exceed four hours, and when important organs are involved, and constitutional fever runs high, these intervals should not, at first, exceed two hours. In severe acu.te affections, such as inflammations, fevers, etc., we may often repeat the same medicine in the same dose, at regular intervals, as long as it does good; but this rule has many exceptions, and the directions,. 78 ADMINISTRATION OF HOMOEOPATHIC MEDICINES. already given at the commencement of this article, should be borne in mind. In obstinate and lasting cases, by a long-continued administration of the same medicine, the patient often becomes less susceptible to its action ; in such instances, if the improvement remains stationary, or progresses slowly, we may gradually increase the dose, or still better, give, at suit- able intervals, some other remedy or remedies, of as nearly analogous medicinal properties, to that first administered, as possible, and then return to the original remedy, if needful ; if, on the other hand, decided amelior- ation follow each administration, we should allow a longer interval to elapse before repeating, by which means the system gradually recovers itself, and the susceptibility to medicinal influence remains unimpaired until the cure is completed. In rare cases, this susceptibility increase^ ; in such instances a higher potency should be selected — provided the remedy still appears to be appro- priate — and the intervals between the doses should be lengthened. This occasionally occurs when the medicine has been frequently repeated and given in solution. When the beneficial effect of a medicine is interrupted by any intermediary irregularity, such as attack of cold, looseness of the bowels, etc., some other medicine must be given for the new affection, on the removal of which, the medicine, which was previously acting favorably, must be again used. In the Selection of the Eemedy, it is not necessary that all the symptoms noted should be present; at the same time care must be taken that there are no important symptoms uncovered by the medicine, or which more strongly indicate another remedy. REMARKS RESPECTING INTERNAL REMEDIES AND DOSES. PRELIMINARY OBSERVATIONS AS TO THE FORM OF THE MEDICINES. The Form in which Homcepatkic Medicines are employed for internal administration, requires some particular notice, in order that the reader may have an additional opportunity of administering the medicine, with the medium or vehicle which may be most likely to promote its active operation in the case under consideration. It is well known, that the medicines are prepared in three distinct forms, namely : GLOBULES, (PILLS,) TINCTURES, AND TRITURATIONS OR POWDERS. 1. Globules, (or pellets of sugar of milk saturated with the tinc- ture), are, in a great majority of cases, the only form required for domestic treatment, and so greatly facilitate the explicitness of the directions for doses, that in the first instance, all the medicines comprised in the list of the remedies which are quoted in this work, must be understood to be recommended in globules, (at the potencies, (strength) also, stated in that list). Dose. — For adults eight globules, (pills), either dry or dissolved in a little water (a teaspoonful). For infants two globules in the same manner. 2. Tinctures might, as far as practical purposes are concerned, be coupled with Triturations, (powder) the latter being the form in which those remedies, which are insoluble, arefii'st made, and consequently which INTERNAL REMEDIES AND DOSES. 79 represents those lesser degrees of attenuation which are administered in a fluid form — of such remedies as do not require such pulverization to ren- der them soluble (or approximately so). It is this fluid form of soluble substance which is called the Tincture. Tinctures have, upon the whole, (like powders Triturations), been found better adapted to the treatment of acute diseases, and some forms of scrofula, ague, etc. Dose usually employed — For an adult, two drops to a spoonful of water ; or, in cases in which the substance medicating the tincture is precipitated (becomes thickened) by water — as, for instance, cam- phor, — then give two drops on a small piece of pure loaf sugar. For a child above two years and under twelve years old, one drop — constituting from two to three doses, according to the strength of the child. For an infant under two years old, one drop, similarly divided into six to eight doses. 3. Triturations, as has already been explained in speaking of Tinc- tures, represent the lower potencies (as administered in the latter) in powder, of substances which are not susceptible of immediate (approx- imate) solution, and which require previous and repeated pulverization, and extreme and minute distribution. The administration of Triturations is adapted to circumstances, such as those just mentioned in relation to the Tinctures of completely soluble substances. The objection to Triturations for unprofessional persons, is, that being in powder, we have no other means of naming a precise quantity for the dose, than by indicating the weight. Persons, therefore, who are in the habit of using them, should furnish themselves with appropriate and well- approved scales. Dose usually employed. For an adult, from half a grain to a grain (about what would lay on the point of a penknife blade of medium size). For a child between two and twelve years old, half a grain distributed as equally as possible into three portions— one of these third portions constituting a dose. For an infant under two years old, one-sixth part similarly. 1. Previous to undertaking the treatment of any affection, it is advis- able that the article on the administration and repetition of the medicine should be carefully studied. 2. Should the progress of the malady, notwithstanding treatment, without a distinct change in the nature of the symptoms, indicate a change of the remedies, it is advisable that the table of analogous remedies (see page 81) should be consulted in the selection of the new remedy. 3. In cases in which the distinctions between the indications for dif- ferent medicines prescribed are so slight as to leave the least doubt on the mind of the administrator, as to which he should select, the decision will be determined by. making out the list of symptoms, and referring to the " Repertory." This difficulty may frequently arise where two or more medicines are of closely analogous operation. 4. Of doses for infants and children.— Where no particular direction is given for the treatment of young children, or children under the age of twelve years, it is to be understood, that the dose, in general cases, should be in proportion of one-third of that directed to be taken SO ADMINISTRATION OF MEDICINES. generally \ or especially for an adult, as nearly as that proportion can be ascertained. The general dose for an infant, under six months of age, may be stated at the proportion of two globules (pills) to three teaspoonfuls of water, which solution should be administered by the teaspoonful at each dose. The general dose for an infant, between six and twenty-four months old, may be stated at two globules (pills) to the teaspoonful of water for each dose. Of Potencies.*— With respect to the potencies or dilutions to be employed, although it is by no means an essential point, still, as all the directions for treatment herein given, have been drawn in conformity with that scale, it is well that they should be in accordance with those quoted in the table of medicines and dilutions prescribed in this work. 6. Of the division of doses and solution.— The doses prescribed in this work, are all directed to be taken in solution, as that is doubtless the most efficacious method of administration. But when that is not con- venient, or is rendered impossible by the state of the patient, the globules (pills) may be administered dry, by being placed on the tongue. When the solution of any medicine in water has to be kept more than three days before the whole is consumed, it is necessary to preserve the water from decomposition, by adding six drops of jDroof spirit to the two tablespoonfuls of solution. In very hot weather, one day should be the limit beyond which no solution should be kept without such infusion of spirit. When it is not convenient to add the proof-spirit to the solution, the only way of obviating deterioration is to make a fresh solution at the expiration of every such stated period of time. The best medium of solution is distilled icater ; the next, filtered or 'pure rain water ; the next, water which has previously been boiled, or pure spring water . 7. Of the recurrence, suspension, etc., of doses.— It were impossible, as has been already stated, in laying down a general rule for treatment, always to assign a given recurrence of the dose of any remedy, without being as egregiously wrong in one case, as one might be positively right in another. The discretion of the person who uses the medicine, guided by a careful study of the article on the repetition of medicines, must indicate the frequency of the doses, the pause, the renewal, and the change, according to the conditions of each particular case. As far as the frequency, suspension, and resumption in the exhibition of medicine can be reduced to a systematic scale, this has been done in the subjoined table, from which the patient may occasionally derive assistance, but to which he must not trust in the least exceptional instances. Great care must be taken in distinguishing between the scale set forth for acute, and that designed to direct the treatment in chronic disease. The constitution, temperament, and habit of body must also modify all set regulations in respect to the recurrence, etc., of doses. Highly susceptible subjects require more sparing treatment, and must be closely watched, to observe the earliest indications in the cessation of effect, medicinal aggravation, or other exceptional conditions. * Potency is the term used to describe the strength of the medicine used. TABLE OF ANALOGOUS REMEDIES. Hi 8. Of consecutive treatment. — It is a manifest error, in treating of any malady, to direct a patient positively to begin by the administra- tion of this or that remedy. Every malady may develop itself in a variety of ways. The incipient stage of the same disease, even, is scarcely ever identical in two cases. In all instances, the development of complaint must depend upon constitutional tendencies, atmospheric influences, external circumstances especially relating to each case, condition of the system of previous treatment, etc. All the remedies which are applicable to the treatment of any com- plaint within the proper province of domestic management, together with the symptoms which indicate the exhibition being detailed, the only way which an unprofessional person will avoid error, is by invariably selecting the remedy indicated by the symptoms that are present, and the- circumstances which attend them, irrespective of any order of succession r except where (as next stated,) a particular course of medicine is directed to be taken in rotation. TABLE OF ANALOGOUS REMEDIES. As a general rule, however, when consecutive treatment is required, with medicines of analogous properties to those below stated, it will be found that such as are named, as operating beneficial after others, will be preferable for selection in such relation, to former treatment, viz: After Acidium-Nitricum — Calcarea, Petroleum, Pulsatilla, Sulphur. " Acid am-Bhosphori cum— China, Lachesis, Rhus, Yeratrum. " Acidt im- Sulphur icum— Pulsatill a. " Aconite— Arnica, Arsenicum, Belladonna, Bryonia, Cannabis, Ipecacuanha, Spongia, Sulphur. " Alumina— Bryonia. " Antimonium Crudum — Pulsatilla, Mercurius. " Antimonium Tartaricum — See Tartarus-emeticus. " Arnica — Aconite, Ipecacuanha, Rhus, Sulphuric-acid. " Arsenicum— China, Ipecacuanha, Nux Vomica, Sulphur, Veratrum. " Belladonna — China, Conium, Dulcamara, Hepar, Lachesis, Rhus, Stramonium. " Bryonia— Alumina, Rhus. " Calcarea-Carbonica — Acidum-nitr., Lycopodium, Phosphorus, Silicea. " Carbo- Vegetabilis — Arsenicum, Kali, Mercurius. " China— Arsenicum, Belladonna, Pulsatilla, Veratrum. " Cuprum- Acet—C-dlc&rea,, Veratrum. " Hepar-Sulphuris—Acidum, Nitr., Belladonna, Mercurius,Spongia, Silicea. " Ipecacuanha- Arnica* Arsenicum, China, Coculus, Ignatia, Nux Vomica. " Lachesis — Acidum-phosph., Alumina, Arsenicum, Belladonna, Carbo-veg., Causticum, Conium, Dulcamara, Mercurius, Nux Vomica. " lAjcopodium— Graphites, Ledum, Phosphorus, Pulsatilla, Silicea. " Mercurius — Acidum-nitr., Belladonna, China, Dulcamara, Hepar, Lachesis, Sepia, Sulphur. 82 ADMINISTRATION OF MEDICINES. After Nuoc Vomica— Bryonia, Pulsatilla, Sulphur. " Opium — Calcarea, Petroleum, Pulsatilla. " Phosphorus— Petroleum, Rhus. 11 Pulsatilla — Acid um-nitr., Bryonia, Sepia. " Jthus-Toocicodendron — Acidum-phos., Ammonium-c., Arsenicum, Bryonia, Calcarea, Conium, Phosphorus, Pulsatilla, Sulphur. " Sepia— Carbo-y., Causticum, Pulsatilla. 11 Silicea — Hepar, Lachesis. Lycopodium, Sepia. " Spongia — Hepar-sulphuris, Kali-Bi., (for instance, in croupj. " Stilphur— Acidum-nitr., Aconitum, Belladonna, Calcarea, Cuprum, Mercurius, Pulsatilla, Rhus, Sepia, Silicea. " Tartarus-Emeticus — Baryta-c, Ipecacuanha, Pulsatilla, Sepia. " Veratriun— Arsenicum, Arnica, China, Cuprum, Ipecacuanha. 9. Of Accessory or Palliative Treatment.— Id cases of obsti- nate constipation, the use of the injection, or lavement, is allowable. The injection should consist of cold water, or, if that disagree, of tepid water; in some cases it may, also, be requisite to add a tablespoonful of sweet or castor oil. The quantity of water necessary for the different ages may, under ordinary circumstances, be stated to be a pint for an adult; | of a pint for a youth of ten or fifteen ; & a pint for a child between one and five years of age; and about one ounce for an infant at birth, or soon after. In Cases of Acute, External and Local Inflammation, or, more particularly,with wounds in which there is a lodgment of foreign sub- stances, which cannot be extracted, or where suppuration is not sufficiently progressive, we may have recourse to an application of the nature of a poultice, such as that which is described in the ensuing page 87- All appliances and methods, such as bleeding, cupping, leeching, blis- tering, etc., are strictly prohibited. 10. Precaution to Insure a Proper Dose.— When the adminis- trator is not certain that the patient will adhere rigidly to the dose pre- scribed, or when given doses of medicines have to be sent to a distance, the simplest and safest expedient is to drop the globules into as much sugar of milk, as will envelop them securely, fold the contents together in a slip of clean, unglazed paper , and crush them from the outside, with the blade of a knife, or some other hard and even substance. 11. When Medicines Should be Taken, etc.— The medicines should invariably be taken fasting, (save the understated exceptions,) and abstinence from food or drink for about an hour after the administration, is equally important. It is, also, of great consequence, to abstain from excessive bodily or mental exertion during treatment, and to keep perfectly quiet, if possible, for about an hour after the administration of medicine. There are exceptional cases, such as modify this rule, which may arise out of accidents or sudden emergencies, but the rule should be followed as closely as possible, even in cases of this kind. INDISPENSABLE MULES FOB THE PEESEET ATION AND MANAGEMENT OF IIOMCEOPATHIC 3IEDICINES, ANTIDOTES, ETC. 1. Keep your chest closed, or your vials in a dark, dry, clean, and cool place, free from odor or scent of any kind, or, if in a hot climate, in as regular a temperature as possible. PRESERVATION OF IIOMCEOPATII1C MEDICINES, ETC. 83 2. Do not change the corks, or use the same vials to contain a differ- ent remedy, without having previously been assured that it has been thor- oughly cleansed, first with boiling and then with cold water. It is better, at all times, to rinse a vial, which has already contained medicine, with spirits of wine, and to expose it, uncorked, to the action of great heat, before it is filled with a different medicine. The cork, or stopper, should be submitted to the same process. The safest way of all is, to destroy empty bottles. 3. Let all the medicines be carefully marked and labeled, and abstain from handling two at one time. 4. In preparing your solution for administration, be assured that the glass, or spoon, or other vessel in which you are about to mix it, is per- fectly clean. 5. If it is necessary to prepare solutions of two or more medicines at one time, take care to keep them apart, and to mark them so that no mistake can occur. 6. Do not use the same spoon or other vessel to administer two dif- ferent remedies, without having previously ascertained that it has been scrupulously cleaned. Porcelain spoons are preferable to any metal, on this account, because you are more certain of the thorough removal of any former medicinal substances. 7. If you dissolve your medicines in open vessels, such as tumblers, take the precaution to have them well covered down during the intervals between the administration, and keep them in a dark, dry, clean, and cool place, totally free from odor or scent of any kind. 8. Do not resort to any other medicinal agency during homoeopathic treatment, and abstain from any external applications, except such as are described homoeopathically. 9. Avoid the use of all articles of perfumery, restoratives, cosmetics, and the like. Camphor, and other popular appliances for cleansing the mouth, etc., are strictly prohibited. The same may be said of smelling salts, etc. 10. The saturated tincture of camphor, as it is used homoeopathically, must be kept entirely apart from any other medicines, or from any vessels or vehicles, such as powders, in which it is proposed to convey or administer other medicines. 11. Do not change your course of treatment or your remedies, (when change becomes necessary,) too suddenly, or without allowing a sufficient pause to elapse, viz.: at least two hours, if possible, six hours, in general cases of a severe inflammatory nature, and in malignant fevers — and at least from two to three days (48 to 72 hours,) in diseases of a chronic kind. 12. If the symptoms be so violent as to compel you to resort to imme- diate change after any previous treatment, administer one drop of spirits of camphor on a lump of sugar, or a teaspoon ful of strong coffee, and then wait one hour, half an hour, or only a quarter of an hour, in urgent cases, before you proceed with further treatment. When, as occasionally happens with persons who are extremely suscep- tible to the effects of the homoeopathic remedies, an undue medicinal action is developed, giving rise to considerable local pain, or general con- stitutional disturbance, camphor is, generally speaking, the most effective S4 ADMINISTRATION OF MEDICINES. antidote, particularly to the vegetable medicines. (See Table of Medicines, etc.) It may simply be inhaled by the nostrils, or a drop of Tincture of Camphor may be taken on a piece of lump sugar. Coffee, without milk or sugar, is also a useful antidote, provided the patient has not been long accustomed to its use. The same may, in a measure, be said of wine. SYSTEMATIC TABLE, FORMING A SUMMARY OF THE RULES FOR THE ADMINISTRATION AND REPETITION OF THE MEDICINES. In summing up the general regulations for the administration and repetition of medicines, the following particulars may be mentioned : OF ACUTE DISEASE, NOT CRITICAL.— GENERAL INITIATORY REMARKS. In acute diseases, not critical, when, after the lapse of four, or at the most, six hours, no amendment results, another remedy should gener- ally be selected, or the general state of the patient and the nature of the disease should be re-investigated. When, on the other hand, in the course of an hour or two, symptoms of improvement ensue— such as moist skin, a clear state of the intellectual faculties, a happier frame of mind, or a gentle and undisturbed slumber, no repetition or change of medicine must be thought of until a cessation of the improved condition of the patient becomes manifest. In acute diseases of a severe and critical kind, however— such as severe inflammatory complaints, cholera, croup, nervous fevers, asthmatic affections, etc., the repetition of the dose sometimes becomes necessary every five, ten, or fifteen minutes— or, at all events, at intervals of from one to three hours, subject to the like conditions. 1. That there are two distinct periods in the course of treatment: — the first period, or that in which the medicine is more rapidly repeated to establish a medicinal ascendency over the disease; and the second jieriod, or that in which the treatment is resumed and continued to complete the cure, or, until change of treatment. That these two periods are advantageously divided by a pause, during which the medicine may be suffered to exhaust its action, and the varia- tion of symptoms, etc., be observed. That during the first period, in the treatment of acute disease, which is not of immediately critical character, the intervals between doses should extend over from two to four, or even six hours, according to the severity of the symptoms. That, as a general rule, a course of two, three, or four doses, according to the length of the intervals, will constitute the first period ; the greatest number of doses agreeing with the shortest intervals. That the pause, at the conclusion of the first period in the treatment of such diseases, should extend over from four to twelve hours, according as the progress of the disease has been checked by the previous treatment or not. 2. That the disease continuing to make head after the pause, whether modified or not, (if no suspension or change should appear desirable in conformity with the exceptions below stated), the same treatment should be resumed during the second period. CHRONIC DISEASE. 85 That during the second period in the treatment of acute disease, which is not of immediately critical character, the interval between doses should extend over from four to eight, or even twelve hours, according to the severity of the symptoms. That, as a general rule, one, two, or three doses, according to the length of the intervals, will constitute the second period; the greatest number of doses agreeing with the shortest intervals. 3. That, in the event of no alteration, or, at most, a merely tempo- rary mitigation of the smyptoms, by the remedy or remedies administered during the first period, another remedy must be selected as closely anal- ogous as possible to the symptoms present. 4. That, after the completion of the second period, in the event of the re-appearance of symptoms, which have yielded to the use of the remedy -or remedies previously administered, the same remedy or remedies shall be administered at still more extended intervals. That, in this after-treatment, the intervals between doses shall extend over from 12 to 48 hours. CRITICAL CASES OP ACUTE DISEASE. 1. That critical cases of acute disease— such, for instance, as of clxolera, •croup, or severe inflammatory disorders, which are excessively rapid in their issue, are not susceptible of the general rules applied to acute diseases. That the majority of these are individually exceptional. That, in their critical acceptation, they are only susceptible of one period of treatment. That, in cases of this nature, such remedies as Arsenicum, Caprmn, Digitalis, Lachesis, Sambucus, Hepar, Spongia, and Veratrum, may be administered at intervals, varying from five to thirty minutes, according to the urgency of the symptoms, until beneficial reaction takes place. That the evident (and progressive) decline of the vital principle, not- withstanding treatment, may, in such instances, warrant the change of the remedy, if there be any hope that the change may produce the desired reaction. That, otherwise, cases of this nature are susceptible of the same excep- tional conditions, as have been reserved for the previous class of com- plaints. OF CHRONIC DISEASE. — GENERAL INITIATORY REMARKS. In chronic diseases of a severe and obstinate kind, it is often very advisable to administer a dose of the remedy selected daily, the first thing in the morning (fasting) for a period of from four to eight days; or, in short, until such time as one or more symptoms become developed, which the patient had not experienced before commencing to take the remedy. When the remedy has been properly selected, the change in the patient's state will commonly occur within or shortly after the periods just named. Should no medicinal manifestations of any kind become apparent, another remedy may be selected, from two to four days after the last dose of the previous remedy has been taken. In chronic diseases, sulphur * is very often the most appropriate remedy to begin with, if no other is better indicated, and particularly if * See, also, the article on "Eradicative Treatment." 86 ADMINISTRATION OF MEDICINES. the patient has previously been affected with any skin disease. As soon as the symptoms developed by Sulphur have entirely subsided, a new medicine must be administered in accordance with the remaining symptoms (if any); but not for a longer period than from four to eight days. If improvement then sets in, the new remedy need not be repeated until the favorable change ceases to become progressively manifest. But, if no improvement ensues, although the remedy seems to be correctly chosen, Sulphur may again be resorted to, for from two to four days, and so on. It is frequently necessary to fall back upon Sul- phur several times in this manner during a protracted course of treat- ment. It should be remembered. 1. That there are two distinct periods in the course of treatment ; the first period in which the medicine is more rapidly repeated to establish a medicinal ascendency over the disease: "and the second period, or that in which the treatment is resumed and continued to complete the cure, or till change of treatment. These two periods are advantageously divided by a pause, during which the medicine may be suffered to exhaust its action and the varia- tion of symptoms, etc., be observed. During the first period in the treatment of chronic disease, the inter- vals between doses should extend to about twelve hours, and, as a gen- eral rule, a course of twelve doses will constitute the first period. The pause at the conclusion of the first period in the treatment of chronic diseases, should extend, for the vegetable remedies, generally, over from three to six days, according to the severity of the case, and the effect produced ; and for such remedies as Staphysagria, Conium, etc., over from four to eight days; for the mineral remedies, generally, over from six to ten days ; and for such remedies as Calcarea, Hepar-sulphuris, Graphites, Silicea, Stannum, Sulphur, Zinc, etc., from eight to twelve days. 2. That the disease continuing to make head after the pause, whether modified or not, (if no suspension or change should appear desirable, in conformity with the exceptions below stated,) the same treatment should be pursued during the second period. During the second period, in the treatment of chronic disease, the inter- vals between doses should extend over from twenty-four to seventy-two hours, according to the severity of the case. As a general rule, two, four, or six doses should constitute the second period, according to the length of intervals— the greatest number of doses agreeing with the shortest intervals between doses. 3. That in the event, or mere temporary mitigation of the symptoms, by the remedy or remedies administered during the first period, another remedy must be selected, as closely analogous in its properties as possible to the symptoms present, for further treatment. That, after the completion of the second period, in the event of the reappearance of symptoms, which have yielded to the use of the remedy or remedies previously employed, the same remedy or remedies shall be administered at still more extended intervals. EXTERNAL REMEDIES. 87 That, in this after-treatment, the intervals between doses shall extend over from two to six days. CONDITIONS CREATING EXCEPTION TO THE FOREGOING RULES, RESPECTING CHRONIC DISEASE. 1. That the repetition of any medicine be suspended. Upon the intermediate appearance of symptoms involving a complica- tion not covered by the previous treatment. Or, again, as soon as a i positive degree of improvement becomes appa- rent. To be renewed and recontinued upon the first indication that the natural and original disease is regaining its ascendency, from which we may judge that the medicine has exhausted its active agency. 2. That another remedy must be selected as closely analogous in its action as possible to the symptoms present. Upon the intermediate appearance of another symptom or symptoms, involving a complication not covered by the previous treatment. If no change takes place, and the disease continues to gain ground pro- gressively, notwithstanding the administration of ten or twelve doses. REMARKS AND REGULATIONS RESPECTING EXTER- NAL REMEDIES AND APPLICATIONS. Any remedy, which is prescribed for internal administration as Ho- moeopathic to a local affection, may be applied to the parts as a lotion, either by dissolving the globules in water, or by using the tincture to mingle with the water. External Amplication of the Nature of a Poultice.— The simplest and best application which can be used in cases requiring external treatment of this nature, to forward and encourage suppuration, or for any other reason, consists solely of a piece of lint saturated with cold water, applied to the parts, and kept constantly wet, the whole being care- fully covered with oiled silk, so as to exclude the air. All medicated poultices should be avoided. External Application of the Nature of Fomentation. — As a palliative application, pending the salutary action of internal treatment, in cases in which local irritation and tension are excessive, it is allowable to bathe the parts with water moderately hot, by means of a piece of flannel ; or to expose the parts to the action of the steam rising from boiling water poured into an open vessel. In cases of sore throat, in which the obstruc- tion and burning sensation in the nostrils is excessively distressing, the patient may similarly inhale the steam of boiling water. Hop poultices, and bread and milk poultices are good. Tincture of Arnica. — This useful medicine, when employed as a lotion to wounds, should always be discontinued upon the appearance of any eruption, etc. Individuals, of what is ordinarily designated as an inflammatory habit, or who have very irritable skins, and are liable to be affected with erysipelas, must be very cautious how they use it, and must modify their treatment accordingly, and abstain from the application upon the earliest appearance of medicinal irritation or erysipelatous swelling or redness. Such patients should invariably dilute the tincture with two- thirds more of water (in proportion) than is indicated in the directions, S8 ADMINISTRATION OF MEDICINES. which occur in various parts of this work, when they have occasion to employ it; and, should this precaution not suffice to exempt them from excessive medicinal aggravation, they should have recourse to calendula- officinalis as a substitute. General proportion of the lotion Tincture of Arnica 1 part, to water 6 parts. Or for very susceptible subjects Tincture of Arnica 1 part, to water 12 parts. For the eye, or as a gargle for the gums, after dental treatment . . Tincture of Arnica 1 part, to water 20 parts. For an infant under six months old Tincture of Arnica 1 part, to water 32 parts. For an infant over six months and under two years Tincture of Arnica 1 part, to water 20 parts. Tincture of Calendula- Officinalis may be employed in the treat- ment of wounds of every description, by those who, from constitutional causes, are unable to employ Arnica externally, without subjecting them- selves to the inconveniences generated by the character of that remedy. Calendula has, moreover, an important advantage over Arnica in very severe incised or lacerated wounds, where there are indications of a serious scar being otherwise left by the cut. It is also preferable in all severe wounds which cannot heal without previous suppuration. General proportions of the lotion — Tincture of Calendula one part, to water six parts. (For infants and children the same as Arnica.) Tincture of HJius-Toxicodendron is more especially adapted to the treatment of Sprains, for the milder forms of which it is a specific remedy General proportions of the lotion — Tincture of Rhus-tox., one part, to water six parts. (For infants and children the same as Arnica.) Tincture of Aconite. — Aconite has been used externally with great success for local inflammation arising from check of perspiration, (or from other causes,) in conformity with its well-known characteristic properties. Care must be taken to distinguish such cases of inflammation, usually extending to the membrane which invests the bone, and affecting joints in particular, from erysipelatous inflammation, to which it frequently bears a striking resemblance. The sudden appearance of symptoms of this nature in young persons, who are particularly liable to accidents arising out of carelessness, etc., and who, at the same time, have no pre- disposition to erysipelas, may be a strong ground of assurance in respect to the character of such inflammatory action, which may further be explained by a brief inquiry into the previous circumstances. In such cases, the external application of a lotion, composed of diluted Tincture of Aconite (simultaneously with the internal administration of the same remedy,) by means of a linen rag, saturated therewith, and applied to the parts, will speedily subdue the symptoms, and preclude more serious con- sequences. General proportions of the lotion — for a person of adult age, Tincture of Aconite, ten drops to a wineglassful of water. For a child under twelve years of age, Tincture of Aconite, six drops to a wineglassful of water. Tincture of Cantharis or Cantharides — The peculiar property which Cantharis, or Spanish Blistering Fty, possesses of creating a severe burning pain, followed by the effusion of watery fluid beneath the scarf skin, bears so close an analogy to the effects of a burn or scald, with the formation of vesication or blisters, that we can readily conceive it well adapted, according to the homoeopathic law, to be an admirable remedy for injuries of the like description, or attended with similar synip- EXTERNAL APPLICATIONS. 89 toms. Cantharis is, in fact, specific as an external remedy, in the treat- ment of burns or scalds, and is by far the most efficacious, if applied imme- diately after the injury has been inflicted (otherwise see Causticum,) and before the application of cold water, Acetate of Lead, or similar expedients have been adopted. Cantharis is, however, objectionable for persons whose constitutional peculiarity renders them susceptible of erysipelatous tumefaction of the skin, in the place of blisters, from the effect of a burn or scald. In these cases, Urtica-dioica is specific. In some instances, although very rarely, the external application of Cantharis may produce deranged action in the urinary organs, (exemplified by suppression of water) ; in such cases the mischief is readily counteracted by the internal administration of one drop of Tincture of Camphor on a lump of sugar. The lotion should gen- erally consist of the tincture at the second dilution and water, wherewith a linen rag is to be saturated, the linen being so wound around the parts as to exclude the air, and the moistening repeated as often as it becomes dry. General proportions— three drops of the Tincture of Cantharides, 2d, to every teaspoonful of water. Tincture of Urtica-Dioica, or Urtica-Urens, should be used in preference to tincture of Cantharides by those in whom a burn or scald is apt to produce erysipelatous swelling in the place of blistering. But this is the only case in which Cantharides is superseded by Urtica. General proportion of the lotion Tincture of Urtica-dioica I part, to water 10 parts. For an infant under six months old Tincture of Urtica-dioica 1 part, to water 20 parts. For an infant over six months and under two years Tincture of Urtica-dioica 1 part, to water 15 parts. Proof Spirits of Wine. — In mild cases of burns or scalds, if Spirits of Wine can be procured immediately, (otherwise, see Causticum,) speedy relief may often be obtained therefrom, and after-suffering avoided. Apply it warm to the parts (as hot as the patient can bear it,) the injured part having meanwhile been exposed to the heat of the fire. Causticum or Lime Water, as already intimated under the head of Cantharis and Spirits of Wine, is a preferable remedy to either of the foregoing, when an hour or two may chance to have elapsed before the use of any remedial application. The Causticum wash is, also, of much service in more serious burns, and in those of long standing. General proportions of the lotion — to every teaspoonful of water, add six drops of the Tincture of Causticum, and apply frequently to the parts by means of a piece of linen rag saturated therewith. Maw Cotton, (excepting when the suppuration is excessive, ancT the weather hot, for which case see Soap,) is highly useful as an external application to burns or scalds of a serious nature, and more especially when an injury extends over a large surface. The method' of use is as follows : Puncture any blister which may have arisen, bathe the sore well with tepid water, and then cover the parts with carded cotton or wadding in three layers — removing the outer layer only, and substituting a fresh one— when suppuration sets in. The Soap Plaster {Pure, white, hard Soap). This application is more particularly serviceable in cases of burns, where not only the outer 90 ADMINISTRATION OF MEDICINES or scarf skin, but also the inner, or true skin, has been destroyed. In serious eases, which have previously been treated with the lotion of Can- tharides, or Urtica-dioica, and in which the inflammation and pain have yielded to these remedies, but. which are too severe (owing to the injuries inflicted on the true skin and adjacent muscles) to heal without suppuration, the soap plaster is a very useful accessory. It should be made and applied as follows: Moisten the soap with tepid water, and make a thick lather or paste, and spread it upon linen; then puncture any blisters which may appear on the exposed surface, and remove all loose skin. After these precautions, apply the plaster to the parts, and secure it by means of a bandage, being careful that the whole of the injured surface is covered with the plaster. As a general rule, the plaster may remain undisturbed for twenty-four hours, when it should be gently removed and changed; but there are many exceptional cases, and the feelings of the patient should guide us in the removal and change of the plaster, whenever a return of pain is complained of. This course of application should be con- tinued until the injured parts are completely healed. The application of the plaster will always be attended with increased pain at first; but this must not deter us from the employment of it, as it will soon be followed by marked improvement. Flour — May be used as a substitute for cotton or the soap-plaster, when neither of the latter can be obtained at the moment. The method of application is simply to sprinkle flour copiously over the injured parts, after having taken the precautions directed to be observed under the heads of cotton and soap plaster. When it becomes necessary to remove the dry paste formed by the incrustation of the flour, this should be gently effected by first moistening and loosening it, by means of poultices (as directed under the head of external applications of the nature of a poultice.) Tincture of Arsenicum (considerably weakened with water) is a good application to bedsores, and as a local resource, in many cases, of malignant ulceration. General proportions of the lotion — to one wineglassful of water, ten drops of the Tincture. Tincture of Carbo-vegetabilis, in similar cases, as directed for the affection in question. General proportions of the lotion — to two tablespoonfuls of water, twenty drops of the Tincture. Tincture of Cinchona (concentrated). See "Bed-sores," after typhus, etc. General proportions of the lotion — to a wineglassful of water, fifty drops of the Tincture. EEMAKKS.AXB EEGZLATIOXS BESPECTIXG THE BATH The bath may be divided, according to modern appliances, into eight varieties, viz:— the hot and cold salt-water bath, the hot and cold fresh- water bath, the tepid, the shower, the vapor, and the medicated baths. Of these we shall here consider the two first-named only, viz ■ THE HOT FRESH WATER BATH. Except as respects new-born infants, for whom a third variety is necessary, namely: REMARKS RESPECTING THE BATH. 91 THE COLD SALT WATER, AND THE COLD FRESH WATER BATH. All the other varieties, especially medicated baths, are commonly prohibited, except for infants. The consideration of the bath is a matter of essential importance to health, and has been acknowledged as such, from the remotest antiquity, and in every climate. It is almost as much a necessity of existence as food and clothing. It involves what is a primary essential, cleanliness; but like all generalities, it is subject to exceptional modifications arising out of the condition of the system, or the temporary state of the body ; such, for instance, as the presence of an eruption, or rash, or the exuda- tion of perspiration after violent and prolonged exercise, both of which would render the bath obnoxious for the time. But for persons who are free from any morbid manifestation, which may render the free use of cold water objectionable, nothing, perhaps, will tend so much to brace the nervous and muscular construction of the frame, and to preserve the sturdy physical power of youth in advanced age, as the regular observ- ances of the bath. GENERAL EXCEPTIONAL CONDITIONS UNDER WHICH COLD BATHING SHOULD BE AVOIDED. When (as is sometimes the case) it is found to induce constitutional disturbance, or is invariably followed by headache, etc., of the same character. When it is followed by lasting chilliness, instead of the glow, which indicates its healthy action. There are comparatively few instances in which the cold fresh water bath disagrees with persons in good health ; in such instances, however, when they occur, the use of a sponge or wet towel must be substituted for the bath, and should be followed with brisk friction. When any inflammatory action is present, or when from exertion or from any other cause, the skin is moist and the pores are open, the Cold Bath should be avoided. During the presence of headache, other than headache arising from irregularities of digestion or nervous causes. Immediately, or within one hour after a meal. Before any meal has been partaken of, or, in other words, upon first getting up in the morning. Generally — with a declining temperature, as, for instance, late in the evening, when the temperature of the water will not have declined equally with that of the atmosphere. When the atmospheric temperature is not sufficiently high, as com- pared with that of the water ; or. in other words, when the water feels warm and the air cold. Generally — during the prevalence of cold east winds. GENERAL CONDITIONS UNDER WHICH COLD BATHING IS BENEFICIAL. When the temperature of the water, relatively to that of the atmos- phere, is as nearly as possible that which it would reach and maintain, by being constantly exposed to the action of the same atmospheric tem- perature. When it is always followed by a glow. 92 SEA BATHING. Ill affections of a purely nervous character. In the majority of affections resulting from debility of the digestive functions. During an ascending temperature, that is to say, in the earlier part of the day, generally, about two or three hours after the first meal, and at an equal distance from the second. When the water is cold compared with the air, but not so cold as to produce a shock or numbness. In this climate, from the end of June to the middle of September, may be stated as the best season for out-door bathing. In-door bathing may be continued throughout the year with great advantage, with the precaution that the thermometer in the apartment : stand at from 50° to 60° of Fahrenheit, and that the water be exposed to this atmospheric temperature at least six hours (when that is possible,) or be raised to from 45° to 55°, if below it. The sivimming bath, or bath in which (if not in open water) there is room to exercise the limbs, is preferable. GENERAL PRECAUTIONS TO BE OBSERVED IN BATHING. Do not bathe the lower extremities first. The immersion should be •complete at once. This need not be effected by plunging, when, as is not unfrequently the case, such a method is found to induce headache or temporary deaf- ness. Diving, which is a v^ery common amusement, is very often prejudicial without sufficient attention being paid to the fact. In general, you should abstain from diving. Never leap into deep water, feet foremost and in an erect position. The best method is to drop into it, the body and limbs being bent together. Do not stand still or remain motionless in the water. Do not remain too long in the water. Five minutes is quite long •enough to derive all the advantages of the bath. Never remain so long as to become thoroughly chilled. Leave the bath upon the first appearance of cramp. Apply a coarse towel briskly, all over the body, as soon as you leave the water, and take pains to dry yourself as thoroughly and as expeditiously as possible. Dress as soon as you are thoroughly dry. The bath should be followed by a brisk walk, but not sufficient to heat you. THE SALT WATER BATH, OR SEA BATHING. There has been a popular notion that sea-bathing is always preferable to fresh water bathing. Nothing can be a greater mistake, and there are a far greater number of exceptions to the proper use of the former than to that of the latter. It is indeed true, that the question of temperature is far less important in respect to sea-bathing, except, indeed, towards the fall of the year, when the temperature of the atmosphere, in our climate, becomes considerably depressed, and when, in conformity with one of the " general exceptional conditions'' above stated, it were advisable for those, even with whom sea-bathing generally agrees, to discontinue it. FRESH WATER BATHING. 93 But it is a matter of experience, that there are a great number of con- stitutional exceptions. And it is quite as important that all those with whom sea-bathing is found habitually to disagree, should abstain from what, at certain seasons and in certain places, may be a great indulgence. There are instances in which sea-bathing produces a species of nau- sea similar to that of sea-sickness, in persons who are totally exempt from this inconvenience on ship-board. This, then, is clearly a constitutional exception. In brief , however, it maybe laid down as a rule, that when sea-bathing habitually induces any kind of constitutional disturbance, it should be avoided. THE FRESH WATER BATH. The instances in which fresh water bathing disagrees, may almost be summed up under the head of the " General Exceptional Conditions '' above stated. The cases of constitutional exception are far less numerous than those which occur with respect to sea-bathing, and there are fewer cases still in which persons who cannot bear fresh water can tolerate the sea-bath. When, however, they occur, they should indicate the course of the patient. TEMPERATURE OF THE BATH FOR INFANTS. The warm bath, which is requisite for the treatment of newly-born or very young infants, should never exceed 98 degrees of Fahrenheit in heat. It should, in general, range from 92 to 98 degrees, according to the effect produced on the child. When the bath is used as a remedial agent, it is important to maintain the temperature at which the immersion had taken place; and it will, therefore, be desirable on all occasions to have a. thermometer within, so as to detect and regulate any variations. The cold bath should be, as nearly as possible, of the temperature at which the atmosphere would place or keep it. It is, therefore, desirable that cold spring water, which has not been exposed to the action of the air, for four hours at least, should be avoided in hot weather, when the atmospheric temperature would have materially increased the heat of it. Exceptions to the use of the cold bath. — In almost all cases the use of the cold bath, with new-born or very young infants, is reprehensible. PREVENTIVE AND ERADICATIVE TREATMENT. It is too true that the every-day practitioner suffers himself to be too completely engrossed by the actual condition of disease to investigate or to provide against its accessibility. The duty, however, of every man who deals with his profession, as a noble and humane science, is rather to point out the method of preventing the occurrence of active disease, and eradicating (if possible) the latent and slumbering defects of constitution, which may be described as dormant disease, than to confine his attention solely to the treatment of its active manifestation. This great and humane purpose should characterize the philosophy of every medical creed or denomination, and should ennoble, if it may not consecrate any system. 94 PREVENTIVE TREATMENT OF DISEASE. By the term "eradication," I wish to be understood to allude to the method of modifying or removing such unhealthy conditions of the system, as necessarily predispose the subject upon whom they operate to particular developments of active organic disease. I would first, however, be understood to confine myself, here, to such general hints as may, with due consideration of the regulations hereafter laid down for the treatment of each disease as it occurs, enable the non- professional reader to form some idea of the mode in which the rule is capable of being applied in the majority of individual cases, because it is obvious that this subject alone might require the whole space of more than one of such volumes as this, ere it was considered in detail. I would also hint that the rule is so distinct and positive, that the appropriate preventive treatment of any disease may be readily in- ferred from the distinction of the medicines which are specific (that is of positively analogous properties) in its treatment. preventive treatment generally. In respect to the prevention of disease, men, of all medical creeds, who have devoted their time and toil to the consideration of the subject, hold opinions which are necessarily in accordance to a certain point ; that is, as regards the modification or removal of the external land exciting causes of disease, such as local or general climate, and the substitution of clean- liness, pure air, drainage, etc. There is, however, a limit to the concur- rence of opinion, even on some of these points. We are further agreed as regards some of those causes which proceed from irregularities of living, from excesses, and, also, from improper or insufficient fooch Amongst these accessory measures, which are essential to the pre- vention of disease, I would, therefore, particularly, draw the reader's atten- tion to the following: — involving, first, those which concern the person immediately; and, secondly, those which concern the locality immediately, and the person indirectly. Those which concern the person, immediately, amongst others, are: 1. Exercise, in proper relation to the habits of the individual, to his strength and capabilities of physical exertion, the state of the weather, the method of taking exercise, whether active or passive (the latter being rather a modification of the accession of pure air than an application of exercise, properly so called,) and the circumstances of climate — involving the degree of altitude, or depression of temperature, the time of the day, (the evening being very adverse to health, especially, in districts in which thick vapor, lying close to the ground, is observable at and after sunset, marshes, etc.,) and the nature of the atmosphere at the time — whether unduly charged with, or deficient of, moisture ; or, again, whether any par- ticular wind prevail, which is known to be charged with noxious exhala- tions, as the Sirocco of Southern Europe, etc. 2. Cleanliness of person and habitation, which is subject to no excep- tional condition, but those of rare occurrence, which render it impossible. This action may, also, involve the free use of (cold) water in ablution, except in particular cases. 3. Ventilation, partly applicable to the person, and partly to the local- ity, by which I understand the admission, and free circulation of pure air, without the action of a direct current, or draught, and the avoidance of PREVENTIVE TREATMENT. 95 closely confined apartments, sedulously closed against the external atmos- phere. In ninety-nine cases out of a hundred, such exclusion would repulse, more probably, a restorative of health, than an aggravant of dis- ease. For nature is more surely in accordance with the requirements of human life, than any artificial means ; and science should be rendered not a repellant, but an assistant of nature. 4. Apparel, by which should be understood all coverings— which should be as light as possible, consistently with weather, climate, and par- ticular susceptibilities, or habits. The action of the skin is one of the most important functions of life, inasmuch as, if irregularly performed, it reacts upon all, or any of the organs most intimately connected with exist- ence. Over-clothing, or covering, on the one hand, therefore, may pro- mote an irregular excess of action, which will result in continued relaxation of the function, and consequent exhaustion; whereas, expos- ure, on the other hand, may occasion a repression and suspension of action which will, inevitably, recoil upon the superior organs. The strict consid- eration of this question is, more especially, imperative in climates in which the transitions of temperature are sudden or very considerable. 5. Aliments— by which is here understood both food and drink — should, in every case, be modified, in relative proportion, according to the climate, and to exceptional conditions arising out of the particular degree of strengthox weakness of digestion, which characterizes particular persons, or to any casual circumstances which may modify, alter, or deteriorate the digestive functions, and, consequently, operate upon the appetite. The American native, or the habitual inhabitant of a temperate climate, removing into a tropical zone, should decrease (if not totally eschew) the admixture of animal food; or. if removing into an arctic, or very cold cli- mate, might, with due regard to condition (especially whether salt or fresh) of such animal food, advantageously increase its proportion ; the habitual use of very salt, or otherwise highly seasoned food, is always uni- formly prejudicial; he should, also, diminish the proportion of stimulating ingredients, as the heat of the climate is increased ; under the same condi- tions he should strictly abstain from the use of stimulating liquor, or, if that has previously been habitual, he should decrease it gradually, until very moderate indulgence (if any) remains; and he should be very careful not to overload the stomach with either food or drink of any kind. It is very important that the American, removing into a tropical climate, should neither eat nor drink more than what is absolutely necessary — inas- much as every disease to which the inhabitants of temperate zones are subject, between the tropics, not only assumes complications, particularly, implicating the organs of digestion, but very frequently springs, either remotely (by predisposition thus occasioned,) or immediately, 'from impe- ded, or overtaxed digestion. The person of weak digestion should care- fully abstain from all indigestible or stimulating articles of food — should select the plainest diet— feed to supply the necessities alone, and not to gratify the palate— should eat but little at a time, and not at all, as the time of rest approaches— should avoid all stimulating food or drink, a d should never attempt to force an appetite. Regularity is indispensable to health. 6. The Habits of Living. — Regularity is a great preservative in this respect, including the just appropriation of the period of rest, as indi- 96 ADMINISTRATION OF MEDICINES, ETC. cated by the secession of light and the dormancy of nature, generally, and,, consequently, early hours, both in resting and rising, and a sufficient, but not excessive proportion of rest. The relations of night and day constitute the best directions for the equable adjustment of the due proportion of rest. The summer of temperate zones indicates a less proportion than the winter, as, also, the tropical night and day indicate a greater equality in the disposition of time. (See also "Rest," under '-Investigation of Disease.") Excessive disposition to rest, (indolence,) is as injurious, on the one hand, as excessive duration of mental or bodily activity is on the other, and the regular return of both conditions, at corresponding and stated hours, is important. Regularity of habits, also includes regularity in the period of eating, or the hours of meals, which is no less important than the former. The art of dividing time in every way is a powerful preservative. The preventive measures, which involve locality, amongst others, are: 1. Drainage.— If the locality be subject to periodical, irregular, or casual saturation, or flooding of water ; that is, if it be nearly on a level with some adjacent surface of water, such as lakes, rivers with sluggish current, or the sea ; the generally applicable methods of preventing the exhalation of noxious vapors, and the consequent impregnation of the atmosphere with miasma, injurious to life are (1) to create, artificially, where practicable, such channels as shall lower the general level of the water, or comparatively elevate the general surface of the soil, and which shall prevent the stagnation of waters; and (2) so to disturb the surface of the soil, as by furrowing, plowing, etc., that the exhalations shall be rapidly emitted, and thereby be subject to dilution and dispersion, as soon as they transpire. Or. again, and especially to towns and crowded districts, in which the accumulation of decomposing or decomposed animal and vegetable matter must necessarily be great, to create so free a vent, by means of proper sub- terraneous canals, and by the removal of all filth, etc., (exposed to the action of the atmosphere,) that any such matters shall be rapidly dis- charged, into such currents as shall remove impurities rapidly, or into such remote receptacles as shall secure the absorption, dilution, or dispersion of all noxious vapors, before they can impregnate the habitual atmosphere of the inhabitants. Therefore, every dwelling, to be wholesome, should be accessible to the free passage of natural currents of air, and should be provided with an ample and wholesome supply of water, and an easy dis- charge for all refuse deposits.* 2. Modifications of climate, by clearing, tillage, and every other result and accompaniment of industry, which thereby produces a doubly benefi- cial result, (1) by removing the susceptibility of the inhabitant to disease, and (2) by removing the cause which too frequently generates disease, viz : the unhealthy exhalation of the soil. 3. The choice of habitation, as to site, which should be removed as much as possible from particular geological influences ; from localities in * Vested interests, stolid indifference, and an indolent disinclination to listen to the voice of reason, too often oppose a formidable barrier to the removal of crying nuisances. If there were any one act of despotic government interference, more capable of defence than another, it would be one which was directed towards effectual sanitary improvement. PREVENTIVE RESOURCES. 97 which the water is impregnated with mineral substances, such as lead, iron, etc., from particular (local) and injurious currents of air, as in certain valleys ; from the midst of woodland (and a sufficient clearage should be effected) ; from the adjacency of stagnant waters, and, lastly, above the level of the mist or vapor, which consist doubly of the precipitated and continued exhalation from the soil, and which is readily distinguishable, in marshy districts, especially, by the dense white fog, which lies like a separate atmosphere, at an elevation of a few feet above the flat soil, after sunset. This subject has lately attracted much attention in the more populous countries, and is, therefore, of particular import to the colonist who may have to select the site of his own habitation. HOMCEOPATHIC MEDICINAL PREVENTIVE RESOURCES. No medicine, unless its action upon the human organs be analogous to disease, can be really, truly, and invariably preventive. The preventive measures, as regards the employment of medicinal agents, consist, in the repeated administration, usually in somewhat large doses, at intervals approximately of twelve hours, of one or more of such remedies, (for alter- nation is occasionally requisite,) as most closely assimilate in their specific action, and according to the indications stated for their selection in the case of each particular disease, or which, in combination, by alternate administration, most completely embrace the distinctive characteristic features of disease, when it assumes an epidemic, or even a local preva- lence. The first point is, therefore, to refer to the article hereinafter devoted to the treatment of such particular disease, whereby, to ascertain the principal remedies quoted, whether any, either singly or in combina- tion, (by alternate administration,) are described as direct specifics, and then compare that remedy with all the symptoms, by aid of the "Reper- tory." If, under the head of the particular disease, one or more remedies, under certain circumstances, and qualified by the presence of certain symptoms, are announced direct specifies, they will, doubtless, when early employed, be the unerring preventives or modifiers of the disease. Such, for instance, as vaccination against smallpox, which should be repeated, if many years had elapsed since the former operation, or which should not fail to be resorted to by those who have not been previously vaccinated: Belladonna against Scarlet Fever, China and Lobelia (chiefly) against Marsh Intermittent Fevers; Mercurius-Corrosivus against Dysentery, especially red Dysentery ; Bryonia and Rhus-Toxicodendron and Arsenicum, against some varieties of typhus; Cuprum- Aceticum, Camphor and Verat- rum, against Cholera and Diarrhoea, respectively, or against excessive and sudden relaxation, with spasmodic pains and cramps, when the diseases just named are prevalent; Aconitum and Pulsatilla, against measles; Aconitum, Belladonna and Hyoscyamus, in cases and particular localities, in which inflammatory fever, with prominent affection of the brain, becomes prevalent, and similarly occurs amongst numbers of persons at once- Bryonia, in cases and particular localities, in which inflammatory fever, with prominent derangement of the stomach, appears. Carbo- veg., etc., against scurvy, (see also "Eradicative Treatment.") Sabina and Secale, etc., against imminent miscarriage, (see also "Eradicative 7 98 ADMINISTRATION OF MEDICINES, ETC. Treatment," for cases in which this casualty becomes habitual). Camphor against severe colds, (influenza,) when they are what is termed going through the house. In fact, every remedy, as applied to the treatment of a particular disease, after it has set in under a particular aspect, is equally applicable to the preservation, when the current com- plaint bears a similar stamp. The Doses of preventive remedies should usually be repeated at inter- vals of about twelve hours, until a degree of medicinal action has set in, when the course may be considered complete ; but the action thus excited must be watched, lest it should occur that the prevailing disease (in a modified degree) has supervened. ERADICATIVE TREATMENT. No cure can be complete, where there is a latent constitutional taint, without proper eradicative treatment. Scrofula, in one shape or another, or complicated with other diseases, may be considered as the pre- disposing cause of susceptibility to the recurrence of every disease, that is, as the great parent of disease, and the most common source of the malig- nity and fatality of other diseases, when not itself the fell destroyer. Eradicative treatment is applicable to the removal or subjugation of defects in constitution, habit of body, or temperament, which operate con- tinually, not only as the predisposing causes of every prevalent disorder, but also as the complicating accompaniment of every disease; or, on the other hand, which resolve or threaten to resolve, themselves into organic decay, by attacking one or more of the important organs of life, especially. Eradicative treatment is also applicable to the extirpation of those slow, latent, or occasionally more active chronic diseases which are gradually sapping the constitution, and which would otherwise finally result in general disorganization, but which have not hitherto permanently destroyed the functions of any important organ of life. The space, which is necessarily confined in a work of this kind, will not admit of great detail, nor, indeed, could a whole volume, such as this, exhaust the subject, if compressed within the narrowest compass. AVe have the intention, therefore, of confining our remarks to such general relations, as may afford some idea of the mode in which the treatment is conducted, subject to the regulations severally laid down under the head of each disease (in the subsequent parts of this work,) or, as it would then appear, in the character of a symptom, development, or manifestation of a more deeply-seated diseased condition— in conformity with the nature of the parent disease. The reasons for suspecting, and the grounds for ascertaining the exis- tence of such parent disease, will be gathered from the article on " The Investigation of the Patient," particularly if due regard be paid to par- entage (including near relations — uncles or aunts) ; to the part or organ most susceptible to the action of morbid influences, transitions of climate, the nature of the locality generally inhabited, the diseases which most frequently affect the patient, and the inveterate or peculiar or dangerous form, which all maladies affecting the patient, assume. Of these, the question of parentage and near (blood) relations involve the most impor- tant and weighty considerations, as thence we may derive the origin of scrofulous habits of body, in all their varieties of combination, compli- cation, and development. ERADICATIVE TREATMENT. 99 Indeed, we may not improperly attribute every family defect of con- stitution, or every manifestation of a latent constitutional taint, which appears with greater or less intensity in several, or pre-eminently in one* of the members of a family, to an unwholesome or scrofulous inheritance. Thus to Scrofula we may attribute, amongst other derangements, Rickets, or enlargements and curvatures of the bones, and decay or exfoliation of the bones, resulting from comparatively trivial circumstances; chronic diseasaof the skin, or extreme susceptibility to the development of mor- bid appearances of the skin, of an endless variety, or especially to erup- tions of the nature of tetters, to ringworm, etc ; imperfect construction of the brain ; and imbecility, or prevalence of susceptibility to derange- ments of the mind, especially if complicated with glandular swellings or their cicatrices; torpid, or usually painless ulcerations, frequently char- acterized by a degree of putrescence, and commonly discharging a thin, watery, corrosive fluid; or which, if somewhat quickly dried up in one part, are usually developed in some other; affections of the lining mem- branes, in general (as of the stomach and bowels, air passage, etc.); habitual or long continued discharges of thin, watery fluid from any parts, as the result even of very slight causes of irritation, manifesting a deficiency of vigor in the membranes, to which may also be appended ^obstinate or continuous whites, and chronic discharges from the ears; chronic inflammatory affections of the eyes and eyelids, qualified by dis- charge of very adhesive gum, and continual adhesion of the lids in the morning, by excessive susceptibility to the action of currents of air, or to irritation by reading, by excessive or even continual flow of tears, -or susceptibility to watery eyes, by excessive sensibility of light; or, again, habitual susceptibility to styes; chronic inflammatory and sup- purative affections, or chronic enlargements or indurations, of gland- ular parts in general: as, for instance, of the neck and under the jaw, the groin, the armpits, etc.; or abscesses; chronic enlargement and habitual hardness of the belly; the prevalence of water on the brain, water on the chest, dropsy of the belly, or general dropsy in more than one member of any family; the like of what is called tubercular consumption, or of organic affection of the mesentery, or of unaccount- able emaciation and gradual decline ; worms, when they are evidently generated in consequence, not of casual circumstances, but of an inherited defect of constitution. The Accessory Means adapted to the eradication or modification of scrofula, are, amongst others: 1. Diet— the most important consideration of all — which should be always as nourishing, in relation to its bulk, as much compressed or reduced in bulk, as light and easy of digestion and as regularly administered as possible — sometimes frequently, but in small quantities at a time. An * Parents (or a parent) possessing the semblance of sound health, may yet carry the germs of scro- fula in the system, and consequently be capable of transmitting the disease to the offspring; hence the necessity for inquiry iDto the health of blood relations. Again, although there may not be any hered- itary taint in the family of either parent, the capability of giving a scrofulous constitution to the off- spring may be acquired by too early or too late a contraction of marriage, by disproportioned marriages, (as to relative ages,) by parental excesses, etc , and by any cause which may tend to injure the constitu- tion of one or both parents— as improper or insufficient food, impure air, etc. Lastly, the germ of scrofula may be transmitted to an infant by the milk of a scrofulous, or otherwise diseased nurse. 100 ADMINISTRATION OF MEDICINES, ETC. equal proportion of animal and vegetable food, or vegetable food pre- pared with a fair proportion of the pure gravy of sound and wholesome meat. Roasted meat in preference to any other — especially mutton and beef. Eggs, when found to agree, lightly boiled (soft), and eaten with a fair proportion of good, home-made, stale, wheaten bread, but not in com- bination with other ingredients. Sometimes milk (when it does not dis- agree, as is sometimes the case in particular instances.) Of beverages*. water is the only fluid which is universally safe. Stimulants, of all kinds, should usually be strictly avoided. 2. Air is second only to diet, in the treatment of scrofulous habits; pure country air, in a healthy, dry, rather elevated situation, not exposed, to the prevalence of bleak winds ; free access and circulation of air within doors, in all apartments inhabited, and, particularly in the sleeping room ; as great a proportion of the day time as possible, without severe fatigue, particularly in fine or favorable weather, should be spent in the open air. 3. Exercise should be as free and unrestrained as is consistentjwith the avoidance of excessive fatigue, or any of its consequences, and with due precaution that check of perspiration does not occur; no person should remain uncovered, or even still, for some time after strong exer cise ; proper protection of the skin from the arrest of transpiration and gentle motion are indispensable; nor should strong exercise in the open air be resorted to in extreme conditions of temperature, and especially when there is great moisture in the ground, and, consequently, much, exhalation. But when exercise cannot, owing to extremely unfavorable weather, be consistently obtained out of doors, it should, be sought in doors. With these, and other like precautions, active sports, appropriate- gymnastic or calisthenic exercises, and every such occupation as calls the muscles and sinews into play, will go far to promote a vigorous operation, of all the organic functions. 4. Water, used not only in the sense of ablution, or cleansing, but for the purpose of promoting a healthy action of the skim The cold fresh water bath should be used daily, (in the absence of particular reasons for abstaining) either in doors or out of doors, according to circumstances,, with due regard to the precautions mentioned under the head of the " bath,' 7 and to the habitual temperature of the body, (which at the time of bathing should, if possible, neither be above nor below the natural standard,) and with careful observance of the process of brisk friction afterwards, and of avoiding permanent chill. Washing and rubbing the body, especially, the chest, stomach, and neck, daily, first with a coarse, wet towel, and then with a coarse, dry one, will frequently form a good substitute for the bath. 5. Cleanliness of person, dwelling, clothing, bed clothes, etc.. is imperative. If it be possible, the clothes, both of the person and bedding, should be frequently changed ; the bed itself, even, should be frequently emptied, purified, and replaced, feather beds being wholly objectionable; and the greatest precaution should be observed against the use of damp apparel or bedding. 6. Harits of Regularity, mental, moral, and physical, should be strictly observed; excesses of all kinds are prejudicial; mental or moraL ERADICATIVE J RESOURCES. 101 excitement should be as much as possible avoided; the habitual observ- ance of duties, as tending to obviate irregular habits, on the one hand, and evil consequences, on the other, is not to be overlooked ; a proper degree of mental and physical occupation, without either undue physical exhaustion or excessive mental application, and, above all, in a method- ical and regular manner, is indispensable; a proper proportion, without excess, of rest, or without indulging an indolent disposition, is to be enforced. (See *' Investigation of the Disease,'' part "Rest.") Regular hours, and hours consistent with the natural division of night and day, should be observed, and the contrary strictly avoided; gloomy thoughts should, as much as possible, be dispelled by averting the attention to interesting occupations, but not by recourse to excite- ment; frequent change of scene is often very advantageous to those who have means to procure it, but this should be understood of changes which do not occasion great excitement. HOMOEOPATHIC MEDICINAL ERADICATIVE RESOURCES. In cases in which an inherent defect of constitution either provokes the development of particular diseases, or appears in complication with them, we not uncommonly find that remedies which, in every respect, correspond with the symptoms, and which would, under other circum- stances, operate as specifics, are repeatedly andministered without the least apparent effect. The reconsideration of the symptoms having more than once confirmed our selection, we should turn our attention to more deeply-seated causes which are present to thwart us. It is obvious, that the presence of inherent constitutional defects may occasion external appearances in disease, which are especially susceptible of erroneous infer- ences, and, therefore, without this very important clue, the special direc- tions for the treatment of any particular disease may frequently tend to discourage the unprofessional reader. In every case of disease, therefore, in which a remedy, after repeated reconsideration and ineffectual administration, is still apparently homoe- opathic, or analogous to the manifestations present, I would beg of the reader to investigate very closely all details of parentage, antecedent cir- cumstances, etc., (as above stated,) in order to ascertain the indication of inherent taint, whether strikingly apparent, or extremely remote and obscure, and, as far as in him lies, to make a judicious selection from eradicative remedies, such as Sulphur, which is, especially appro- priate when there are chronic affections of the skin; Calcarea-carb, when, the glands, in general, are particularly affected ; Mercurius, when the bones are prominently involved, unless this be traced, immediately, to abuse of mercury, in which case, Nitric-acid will be particularly useful, or, perhaps, Hepar-sulphuris may be required; or, again, Mercurius, when the salivary glands are, especially, involved, saving under the excep- tional condition just named ; Carbo-veg., against what are termed scorbutic complications; Sabina and Secale occasionally, generally, however, with an occasional course of Sulphur against predisposition to miscarriage. These are only to be considered as a few general suggestions ; but I would further add, with respect to Sulphur, that repeated occasions in which I, in common with imany other homoeopathic practitioners, have employed this medicament 102 ADMINISTRATION OF MEDICINES, ETC. under the circumstances above detailed, and when the remedies seemingly appropriate to the external evidences of disease had signally failed, have confirmed its pre-eminent utility. Very often, after the patient had been submitted to a few doses of Sulphur, the dormant susceptibility of the system becomes awakened, and a subsequent return to the particular and appropriate remedy which had hitherto failed, has been attended with the most decided benefit. In cases in which the constitutional taint is deeply seated, or very virulent, a long course of such alternations becomes necessary, continually returning to one or more doses of Sulphur, when the effect of other remedies becomes less apparent, and again employing the intermediary remedies, or those appropriate to special indications as before, if still required. In many cases, it is either highly beneficial or absolutely necessary, in treating chronic diseases of all kinds, to commence with a consecutive course of Sulphur in single daily doses, con- tinuing for a week or ten days, or until a more or less distinct degree of medical action has set in ; then pausing for about four days to watch the subsidence of such medicinal action, or to detect any particular symptoms requiring an intermediary remedy, or, sometimes suspending treatment for several days, or even weeks. These variations of treatment must be subject to the discretion and judgment of the administrator, because no two cases are strictly analogous, and, therefore, a rule would be merely one of many exceptions. So long, however, as greater activity of the skin, etc., is manifest after a course of Sulphur, it will be advisable to pause in the administration. If there be intermediary and distinct symptoms, not appertaining to Sulphur, but identifying a special remedy, it should be given till such particular symp- toms are subdued. Or, so long as general improvement makes steady progress, however slow, it will be advisable to abstain from repeating the doses of Sulphur, resuming the administration, however, immediately the malady becomes stationary or retrogressive. If acute or active disease has supervened, and yielded under the influence of intermediary or special treatment, we are not to consider the cure complete, but should return to extended courses of Sulphur at remote intervals. By persever- ing in such treatment, the most obstinate chronic diseases, short of actual organic decay, are overcome; and even if actual organic decay has set in, we have frequently found means to arrest its progress, and to prolong existence, and even comparative health, for a surprising length of time. The Doses. — As a general rule, the recurrence of the administration should take place once in twenty-four hours, namely: the first thing in the morning, fasting. The quantity should be sufficient to develop slight medicinal action, which is usually essential to the eradication of deeply- seated disease, but avoid the error of plunging into extremes. Eight pills daily. General conditions and injunctions respecting eradicative treatment. It is natural that the vigor of animal, as of vegetable life, is in the ascend- ant in the spring, and in the decline at the fall ; it, therefore, follows that the spring will be the season, in which eradicative resources, backed by the greater buoyancy of the vital energy, will be most successful. I would also strongly enjoin every person who has occasion to undertake the treatment of disease, characterized by conditions of the nature above RULES FOR DIET. 103 detailed, above all things not to be discouraged, but, so long as all circum- stances correspond to identify the accuracy of his treatment, to persevere steadfastly, assured that, especially if the patient does not lose ground, he is pursuing a course towards ultimate success. When a mother has given birth to one or more sickly children, she ought to undergo a course of constitutional treatment forthwith, even though she may again have fallen into the pregnant state. In the latter case, however, somewhat more than ordinary caution is required in watching the progress of treatment. SYNOPSIS OF THE RULES FOR DIET, UNDER TREAT- MENT. ALIMENTS ALLOWED. Soup or broth (in special cases of illness or indisposition) made from the lean of beef, veal, or mutton ; to which may be added well-boiled sago, tapioca, vermicelli, rice, semolina or macaroni, pearl-barley, and sometimes carrots, young peas, or cauliflower, seasoned merely with a little salt. Meats and animal products. Mutton, beef, lean pork of good quality* in a few exceptional cases, in which it is known not to disagree, (poultry rarely, except in particular cases,) pigeons, larks, rabbits, (venison, and game in general, may, if tender, in most cases, be partaken of in moder- ation, but never when high,) plainly cooked and roasted, stewed or steamed, in preference to boiled; further, soft-boiled eggs, good fresh but- ter and curds. Fish {occasionally). Soles, whiting, smelts, trout, cod, haddock, mul- let, perch, turbot, oysters and flounders, boiled, in preference to fried; when cooked in the latter manner, the white must alone be partaken of, and the outer, or fried portions rejected. Vegetables. Potatoes, brocoli, green peas, cauliflower, spinach, mild turnips, carrots, parsnips, French beans, beans, seakale, vegetable marrow stewed lettuce, well cooked, and prepared with the gravy of meat, where required, instead of butter. Condiments. Salt and sugar in moderation. Bread. All kinds of light bread, not newly-baked; and biscuit, free from soda, potash, and the like ingredients Light puddings, such as those made from vermicelli, semolina, corn starch, sago, arrow-root, rice; macaroni (without cheese,) simple cakes, composed of flour or meal, eggs, sugar, and a little good butter. Fruit. Baked, stewed, or preserved apples and pears ; also gooseber- ries, raspberries, grapes, or any other fruit not of an acid quality, fully ripe, preserved, or in the form of jelly, may occasionally be partaken of. Beverage. Water, toast-water, sometimes milk, milk and water, cocoa, chocolate (unspiced), arrow-root or gruel, made thin, barley-water, sugar and water, rice-water, and weak black tea, in cases where it has long been taken habitually, and has not been productive of injurious effects. Salt should be used in great moderation. 104 ADMINISTRATION OF MEDICINES, ETC. ALIMENTS PROHIBITED. Soups. Turtle, mock-turtle, ox-tail, giblet, mulligatawny, and all rich and seasoned soups. Meats. Pork, (except in instances named as allowable,) bacon, calf's head, veal, turkey, duck, goose, sausages, kidney, liver, tripe, and every kind of fat meat. Fish. Crab, lobster, and shellfish in general ; and almost all other fish not specified amongst the aliments allowed, as likewise all kinds of salted, smoked, potted or pickled fish. Vegetables. Cucumbers, celery, onions, radishes, parsley, horse-radish, leeks, thyme, garlic, asparagus, and every description of pickles, salads, and raw vegetables, or vegetables greened with copper. Rich or high seasoned made dishes. Pastry of all kinds, whether boiled, baked or fried. Spices, aromatics, and artificial sauces of all kinds, as also the ordinary condiments, mustard and vinegar, must be used in moderation. Cheese. Chestnuts, filberts, walnuts, almonds, raisins, and indeed the entire complement of a dessert, except what has been mentioned amongst the aliments allowed, under Fruit. The above regulations are subject to considerable modifications in par- ticular cases, both as regards the aliments allowed, and those which are prohibited. When it is necessary to make a very material alteration in the diet and habits of a patient, it ought, in general, to be done gradually and cautiously. Regularity in the hours of meals should be observed; and too long fasting, as well as too great a quantity of food at one time, should be avoided. ACCLIMATION, OR ACCLIMATIZATION. The process by which an individual or a species, on being removed to a different climate, becomes modified in constitution, and adapted to the changed conditions. The two words, however, are not strictly synonymous. Acclimation is generally used in speaking of particular individuals, and more especially of those belonging to the human species, and refers to the alterations which the system undergoes spontaneously in a foreign climate, by which it at last becomes no longer subject to the maladies peculiar to new comers. Acclimatization, on the contrary, expresses the artificial care by which man succeeds in naturalizing, under his own supervision, a species of animals or vegetables of exotic origin. Man inhabits all the zones, and nearly every region of the earth, and has been enabled, in repeated migrations, to change the place of his habitations, and to occupy new countries. The human species is, therefore, regarded as cosmopolitan ; and yet, two facts are important to notice, in this respect. First, most of the great migrations, historic or traditional, have been made in the direction of longitude, and not in that of latitude; the migrating tribes instinctively, or intentionally, keeping nearly within the same par- allels of latitude, and consequently not suffering very great alterations of temperature, nor meeting in their new homes with a flora and fauna very dissimilar to those of their native country. Secondly, at the present day, although an individual may migrate, either westward or eastward, as a ACCLIMATION, OR ACCLIMATIZATION. 105 general rule, without suffering from the change, a removal into a different latitude is almost always accompanied with peculiar dangers during the first few years of residence in the new locality. The most marked instance of this kind is, when a person from the temperate zone visits, for the first time to a tropical or subtropical region. The dangers that first beset him are fevers, which are so marked in type, and so ready to attack newly arrived immigrants, that they are sometimes called the "strangers" fever. The yellow fever of the West Indies and southern United States, and the coast fever of western Africa, are well known examples of these affections. They are not absolutely restricted to new comers, the natives being also subjected to them, but the recent immigrant is so much more likely to be affected, and is attacked by the disease in so much larger proportion, it is evident that his system has in it something which offers a peculiar attrac- tion for the febrile poison, and which does not exist, at least to the same extent, in that of the native or old resident. After passing through a period of general ill health and debility, extending over some years, and perhaps one or more severe attacks of illness, the immigrant approximates in his appearance and habit of body, to the older denizens of the place, and is no longer peculiarly liable to disorders, which affected him on his arrival. He is then said to be acclimated. No doubt, part of the immunity enjoyed by old settlers, in a tropical or sub-tropical climate, is due to the fact that they have learned prudence, in regard to exposure, and have come to regu- late, habitually, the mode of life to correspond with the climate of the country. Recent immigrants often neglect these essential precautions because they have not found them necessary in a temperate climate ; and it is only after repeated experience of their value, that they come to adopt them habitually, and as a constant protection. PART SECOND. DISEASES OF THE BRAIN, THE SPINAL CORD, AND THE NERVOUS SYSTEM, GENERALLY. CHAPTER VI. MENINGITIS CEREBRO-SPINALIS. SPOTTED FEVER— CEREBROSPINAL MENINGITIS. This disease has appeared in various parts of the United States and Europe, as an epidemic. It is of a most serious, and often, malignant character. The symptoms are not constant, but vary in each epidemic; indeed, the variation is so great, that of the reports of some thirty physi- cians, which we have consulted, we find no two alike. Our own experience in this disease, is confined to three cases of undoubted spotted fever, two of which recovered, the third coming into our hands after the disease had continued five days, and the patient was then dying. We will, therefore, in view of our own inexperience, transcribe the symptoms, as given by Professor Felix Niemeyer, of Berlin, in his exhaustive report of the epi- demic in the Grand Duchy of Baden, 1865, and. after that, the symptoms as given by Dr. Bushrod W. James, of Philadelphia, as he observed them with his very extensive opportunities in the United States. Symptoms, by ISTierneyer: "Without any other precursory symp- toms, the patient is at once attacked with a chill, attended with violent headache and vomiting. The headache speedily increases in intensity, the patient becomes exceedingly restless, tosses about, the pupils remain contracted, the sensual consciousness remains unembarrassed. The pulse rises to eighty or one hundred beats per minute., At the end of the first, or on the second day, much less frequently at a later period, we notice that the head is somewhat drawn backwards ; the patient continues to complain of violent headache, and the pain spreads from the head to the back of the neck, and to the back. The restlessness becomes excessive, the thoughts of the patient become confused, the pupils remain con- tracted, the abdomen caves in, the bowels are constipated. The frequency of the pulsations and respirations now increase to about one hundred and twenty, of the former, and upwards of seventy of the latter, per minute;. 106 SPOTTED FEVER. 107 the bodily temperature continues moderately low. In the course of the third and fourth day, the tetanic spasms of the posterior cervical and dor- sal muscles become more and more prominent, and patients are, some- times, attacked with lock-jaw. Opisthotonus (bending backward) super- venes with an extraordinary degree of intensity ; the consciousness is gone, but the patient still continues to toss about in bed, the pupils still continue contracted, the bowels constipated, the abdomen sunken; the urine is discharged involuntarily, or else the bladder remains distended, and the urine has to be drawn off with a catheter. The patient now lapses into a profound stupor, (unnatural sleep,) the moaning breathing is accompanied by a rahl (rattle,) and death takes place with the phenom- ena of an acute oedema of the lungs (collection of a liquid serum in the lungs, so as to fill them up)." (I dislike Niemeyer's use of the word oede- ma, here.) " This picture of the disease is, sometimes modified by the occurrence of a short preliminary stage, which is marked by slight pains in the head and back, or by the breaking out of herpatic vesicles (erup- tion of blisters,) or of scattered, dark-colored, roseola (red) spots on the first, second, or third day of the disease, or else the above described symp- toms develop themselves in a much shorter period, which circumstance constitutes one of the most important modifications of the disease; so that the consciousness vanishes, even on the first day of the attack, and a vio- lent tetanic spasm (spasm with unyielding stiffness) of the back of the neck, and back, begins; or, finally, may set in with such violence that a fatal termination of the disease is reached, even on the first or second day. This cursory picture of cerebro-spinal meningitis, and of the gen- eral course of the disease, applies, indeed, to most, but not by any means to all cases of the epidemic. This picture does not comprehend phenom- ena that occur in a variety of cases, such as: deafness in one or both ears, diplopia (double vision) from a diseased condition of the optic nerves, ptosis (palsy of the upper eyelid), softening and destruction of the cornea (front coating of the eye), and, finally, paralysis of the facial nerves and of the extremities, either on both or only one side of the body.'' Symptoms as quoted by B. W. James, M. D., from experience and a, careful study of the disease, as it has appeared in the American epidem- ics. In many of the epidemics, prostration appears to have been a very prominent symptom : " It sometimes sets in, with such a sudden violence, that persons who were afflicted with heart disease, dropped down dead in the street, in con- sequence of the sudden shock. This happened in a number of cases. Many persons died twenty-four or forty-eight hours after being seized with the chill. Persons overtasked with labor would very often die in four- teen to sixteen hours from the chill. The general features of the disease were: vertigo, with headache; diarrhoea, sometimes of a very prostrating character; in other cases, diarrhoea alternating with constipation; mod- erate fever; flashes of "heat, mingled with creeping chills, piercing pain through the head, soreness and stiffness of the upper portion of the spine, with aching pains in the spine, or tingling soreness and tenderness of the skin, severe muscular pains, numbness of the limbs, with partial paral- ysis; spasmodic twitchings of the muscular system, sometimes amounting to tetanic convulsions, with lock-jaw; the consciousness not much affec- 108 THE BRAIN AND NERVOUS SYSTEM. ted, except when the disease is at its hight, when a more or less active delirium, and, finally, coma and death set in. In most cases the eye looked injected and red, and the hearing was impaired; the pulse had a moderate frequency, generally, about one hundred per minute, the tongue remained moist, and in the course of the disease, became covered with a dark, brownish fur; the breathing was somewhat accelerated and inter- rupted by moaning inspirations; during the tetanic spasms, the expira- tions had a hissing sound, the air seeming to be forced out with an effort, the skin has a peculiar bluish pallor in this disease, owing to the general turgescence of the venous system; the spots which have given to this dis- ease its name, spotted fever, broke out on different parts of the body, generally however, on the chest, abdomen, and thighs ; sometimes the skin had a mottled appearance, or the spots looked like measle spots, or had a rose colored-tint. One hour the patient will seem quite well, and the next the most alarming symptoms may be present." Treatment. — Give, as soon as the nature of the attack is known, a good, full sweat; the hemlock sweats, of easy application, where hemlock branches are obtainable, are always efficacious. Two teaspoonfuls of best alcohol to four of water ; one teaspoonful of this solution every half hour, until there is a decided abatement of the symptoms. In cases threaten- ing immediate dissolution, the dose may be doubled for a short time. ALLOPATHIC TREATMENT This disease is an essential fever, attended with inflammation of the membranes of the brain and spinal cord; hence its name. It is popularly called spotted fever. The disease is* very fatal, in some epidemics reaching as high as four-fifths of all the cases, in other epidemics, not over one-fourth of the cases die. The bowels should at once be unloaded, but beyond that, purgation should not be practiced. Ice, in bladders, may be applied to the head and spine, if agreeable to the patient, otherwise they should not be used. The cold or warm wet pack, according to the degree of fever, should be used once a day. If the temperature is one hundred and four degrees, or over, the pack should be cold If not so high as this, cool sponging of the skin will suffice. When the pack is used, the patient is to be wrapped in a sheet wrung out of water, and then enveloped in blankets. In about an hour, free sweating occurs. The pack is then removed, the patient wiped dry and placed in bed. Opium should always be given to the extent of relieving pain. This is the most useful known remedy in this disease. The physician will obtain the best results by the hypodermic use of morphia. When effusion has taken place, and there is stupor and insensibility, the usefulness of Opium is at an end. Ergot is the remedy calculated to diminish the congestion of the cord, and should be given in large doses; a teaspoonful of the fluid extract, every six hours, is a good rule. In the beginning of the disease, Quinine is useful in controlling the fever and inflammation. If, however, a single large dose— twenty grains— is not followed by benefit, it should not be repeated, unless malarial diseases exist. In the cases having high fever, the Fluid Extract of Gelseminum, given in five-drop doses, two or three hours apart, will be found useful in moderating the action of the heart, and producing a general calm. Ice. acid drinks, cold tea, and lemonade, should be freely allowed to SPOTTED FEVER. 100 relieve thirst. Milk, eggs, and nourishing broths should be given in suffi- cient variety and quantity to maintain, as far as possible, the strength of the patient. In case food is not taken, from vomitingor other cause, nourishment should be given by injecting into the rectum; half a pint of strong beef tea with two or three tablespoonfuls of rich cream, or a half teacup each of beef essence and milk, can be given two or three times in the twenty- four hours. The injected nourishment should be caused to be retained by pressure upon the anus with a napkin or towel. Stimulants should be avoided until the symptoms denote that the vital forces are beginning to fail, and just in proportion to this failure, are they demanded. Their bene- ficial effect is shown by a fuller, stronger, and more regular pulse and reduced febrile and nervous excitement. A tablespoonful of whisky or brandy, from one to three hours apart, is a good rule, varied according to the judgment of your physician. In Spinal Meningitis (inflammation of the membrane of the spinal cord,) the principles of treatment are the same as is given for acute Men- ingitis-Cerebral. The disease generally proves fatal within a week. HOMCEOPATHIC TREATMENT — Gelseminnm, if indicated and used at the very beginning of the disease, will never disappoint us. It is indicated by the following symptoms : Severe chill, followed by conges- tion of the brain and spinal cord, dark red cheeks, dilated pupils, very little, if any thirst, perfect loss of strength, especially of the legs, with staggering gait, impeded speech, icy-cold hands and feet, pulse very weak, if perceptible, difficult and weak breathing, nausea and vomiting, eyelids close in spite of all the patient can do to prevent it ; sweating relieves inability to direct the movements of the limbs with accuracy, the men- tal powers remain active. Dose : Six pills dissolved in a tablespoonful of water, of which give two teaspoonfuls every fifteen to thirty minutes, until there is improvement and sweat, or the symptoms indicate some other of the remedies here mentioned, in preference to this. Belladonna is indicated by stupefying, stunning headache, from the neck into the head, with heat and pulsations in it ; inclined to bend the head backward, even before spasmodic aation is shown in any other part of the body; it relieves the pain; spasmodic bending the head back- ward ; convulsive shaking, distortion by spasm of the face and lips, grind- ing of the teeth, inclination to bite, the urine retained, or involuntary discharge, heat of the upper part of the body and coldness of the extrem- ities, hightened sensibility of all the senses, renewal of the spasm by touch or light. Dose: Six pills, as just directed for Qelseminum. Cicuta Vir. Vertigo, with reeling, moaning, and howling ; grind- ing of the teeth, double vision, pupils dilated or contracted ; dumb, deaf, great difficulty in breathing or swallowing, ashy paleness or bluish puffed face, cramp in the muscles of the back of the neck, with inability to move the head after it has been turned in any direction, trembling of the limbs, convulsions with cries, pressing together of the jaws, numbness and distortion of the limbs, forcible and involuntary bending of the body backward; violent, sudden jerks through the head, arms, and legs; after fits, insensibility and immobility ; pain in the stomach, with vom- iting, abdomen painfully puffed. 110 THE BRAIN AND NERVOUS SYSTEM. Dose : Eight pills or two drops of the medicine in a little water, every twenty minutes to one hour. Hyoscyamus. Head heavy and violent pains, alternating with pains in the nape of the neck; constricting, stupefying headache, sensa- tion as if the brain were shaken and loose ; dimness of eyes, fearful grinding of teeth, look-jaw, palsy of tongue, vomiting, involuntary stool, and urine; spasm of breast with arrest of breathing; sensation on bend- ing the neck as if the muscles were too short ; twisting of the neck to one side ; stiffness of arms and legs, jerking of hands and feet, spasms resembling epilepsy; great sensitiveness of the skin ; sores on the body, that have a tendency to gangrenous destruction ; pulse small, quick, intermitting. Dose : As directed for Cicuta Vir. Veratrum Viride, Opium, Nnx Vom,, Arsenicum and Digita- lis, are well approved remedies . HYPEREMIA OF THE BRAIN. EXCESS OF BLOOD IN THE BRAIN — CONGESTION OF THE BRAIN. By Hypersemia of the Brain is generally understood an excess of blood in the arteries and veins (blood vessels) of the brain; or, in other words, more blood in the brain than is natural in a condition of perfect health. This unhealthy increase of the volume of blood may be occasioned by three distinct causes. In the first place, the flow of the blood from the brain, being natural, a larger quantity of blood returns to the brain. In the next place, the flow of blood from the brain may be diminished by some disease of the blood vessels, or their surroundings, while the amount carried to the brain by other vessels, not so diseased, may be natural in amount. Finally, the cause may be located in the brain itself, the brain substance (cerebral parenchyma; may become hardened or wasted away {atrophied) or softened; or the capillaries (very small ends of the vessels) may become enlarged. This diseased condition of the brain is confined either to a limited locality, or extends throughout the whole brain. It is scarcely ever pos- sible to establish, during the life of the patient, a sure diagnosis regarding the exact seat and the extent of the hyperseinia, for the reason that conges- tions of very limited extent frequently excite much more striking symp- toms, than more extensive congestions. So far as treatment is concerned, such a diagnosis is scarcely ever of much importance. The most important terminations of this engorged condition of the brain, which impart to it a higher significance, in practice, are: sudden death from paralysis of the brain, in consequence of excessive pressure of the blood; dilation (widening) of the vessels, especially the capillaries, by which the tendency to congestion is increased, exudation and extravasation (or throwing out, and collection of blood in some of the cavities, or collec- tion beneath some of the covering membranes.) The Causes of cerebral hypersemia are various and important, in a practical point of view, since, in most cases, they determine the choice in the selection of the proper remedy. These causes are of two kinds : CONGESTION OF THE BRAIN. Ill Causes.— First, those which affect the brain directly, and second, indi- rect causes, by which, through the operation of influences that are partially unknown to us, the brain becomes involved in an affection more or less remote from itself. Among the direct causes affecting the brain, the most prominent are: concussions of the head by a fall, blow, or like accident; continued, persevering, and excessive mental exertions; emotional excite- ment, such as joy, grief, anger, disappointment, chagrin, etc.; exposure to excessive heat of the sun {sunstroke,) or to artificial heat; likewise to excessive cold ; more particularly, if the influence of cold is suddenly fol- lowed by the action of intense heat. In the second class of causes, we may range, according to circum- stances, almost all kinds of febrile (fever) affections, since almost all of them may be associated with this condition of the brain; in this place we must content ourselves with mentioning diseases where almost always congestions of the brain are present; they are: erysipelas of the face; diphtheria ; mumps ; inflammatory diseases of the eyes and ears ; difficul- ties during teething. Among the more or less chronic affections that may be mentioned in this connection, as casual circumstances, the most prominent in the list of those that impede the flow of blood from the brain, are : defects of the heart, right side, and tumors (morbid growths) on the neck. In the list of those that occasion a general increase in the impulse of the circulation, are: diseases of the heart, left side, suppres- sion of habitual losses of blood (such as menses or piles). In this last list, we likewise include those cases caused by the abuse of alcohol, in all its varied forms, or of other narcotic substances — such as opium. Without doubt there, also, exists a tendency to congestion of the brain ; in which case, they may be excited by any perceptible change from a condition of health. This tendency is identical with the so-called apoplectic habit, but cannot be recognized, with any certainty, before its occurrence, by definite diagnostic signs, but has to be determined, in most cases, by the occurrence of the actual fact ; it is a certain fact, that it is not alone indicated, as is popularly believed, by a thickset frame, and a short, thick neck. On the other hand, the idea of a probable occurrence of hyper- emia of the brain, suggests itself before it happens, in the case of indi- viduals, who, while consuming quantities of nourishing food, do not take bodily exercise in a corresponding ratio, and in whom this mode of living develops a condition that may justly be termed plethora, or excessive flesh. We have already stated, that the frequent repetition of attacks of this nature leads to a dilation (widening) of the blood vessels, which increases the disposition to renewed attacks. Generally speaking, you can safely predict a favorable termination in this disease, since a fatal result need not be apprehended, unless some other complicating disease should supervene. In one respect, it depends upon the age of the patient; while, in persons of middle age, the danger is not very serious; it is, on the contrary, much greater in the case of children and old people. In the case of children, death takes place very fre- quently in consequence of the paralysis of the brain, occasioned by the excess of blood in that organ; in old people, the vessels are generally so fragile that they easily tear, and their contents are discharged upon the brain. The apparent violence of the disease is no adequate guide by which 112 THE BRAIN AND NERVOUS SYSTEM. to judge of the danger likely to result from it, but the more frequently the trouble occurs, the more dangerous it becomes. When it depends upon pre-existing derangements, the prognosis depends almost exclusively upon the character of these derangements. The symptoms by which hyperemia manifests itself, vary according as one or another locality of the hrain is the seat of the affection, and according as the pressure upon the brain is more or less violent. The head feels heavy, confused, or as if encircled by a tight band ; the head- ache, which is scarcely ever wanting, is almost always throbbing, and is made worse by stooping, unusual exercise, and every mental effort ; buz- zing in the ears, sensitiveness of the eyes, even seeing sparks and obstruc- tion or obscuration of sight, are generally present. Vertigo (giddiness, dizziness,) is seldom wanting. If arising from hyperemia, a characteristic sign is to become aggravated by stooping, but more especially by looking up . Generally, the patient feels drowsy without being able to sleep, or else the sleep is anxious, disturbed, full of dreams. Feels very languid, and his gait is rendered insecure by want of firmness in the lower limbs. The pulse may continue natural, and there may be no fever present. This mildest form ma3 T be combined with constant restlessness and gloomy ideas ; sleep is disturbed by anxious dreams, which, in the more violent cases, do not altogether disappear while the patient is awake; they even assume the character of hallucinations, and if the trouble continues without being checked, a permanent mental derangement will not unfrequently result. Palpitation of the heart, ill humor, distrust, total indisposition to work, and fitful mood are almost always present. This form of hyperemia mostly befalls individuals, who, while enjoying good cheer, take but little bodily exercise, but per- form a large amount of mental labor. The foregoing symptoms are almost characteristic, also, of hyper- emia, consequent upon suppression of certain forms of loss of blood. The trouble is much more dangerous, if it sets in as an acute disease, and, although violent at first, continues to increase in intensity, until it terminates in death. In such cases, the face looks dark-red, the eyes are streaked with red, the blood vessels of the head and neck pulsate vio- lently ; the pupils of the eyes look smaller, all the senses are very sensi- tive, the headache is maddening, sometimes driving the patient to sui- cide. Delirium is apt to follow. This type of the disease is most common after sunstroke,, and not unfrequently is an accompaniment of mental derangement, of which, indeed, it may frequently be said to be the cause. Not unfrequently the above described symptoms are suddenly followed by all the signs' of apoplexy, regarding which the diagnosis cannot be established with any certainty, until the rapid course and sudden disap- pearance of the symptoms of paralysis have satisfied one that no pouring out of blood (extravasation) can have taken place, since the fluid could not have been reabsorbed so soon. In this category belong, most likely, all the cases that are said to have been cured so rapidly. This disease never exists during an epileptic attack, in which the course of the attack alone gives perfect certainty concerning its true nature. Among children, hyperemia is an almost habitual accompaniment of all fevers, and not unfrequently conceal the symptoms of the true dis-- CONGESTION OF THE BRAIN. 113 ease, for the reason that the course of the hyperemia is marked by tho- rn ore violent symptoms. In every considerable congestion of the brain convulsions of some kind almost always occur; they are accompanied by drowsiness, even to the extent of sopor (sound but unnatural sleep), delir- ium, excessive restlessness, and anxiety and vomiting, in nearly all cases. However threatening such a condition may seem at first sight, in most cases it passes off speedily, and without leaving a trace behind, so that the congestion seldom lasts longer than thirty-six hours, and generally abates after the lapse of twelve hours. Treatment. — In the acute form of the disease, applications of cold or ice water to the head, and keeping the extremities warm, is excellent. In the chronic form, resort to frequent bathing and rubbing, and plenty of healthy outdoor exercise. ALLOPATHIC TREATMENT.— Active congestion of the brain, not sufficient to produce apoplexy or sudden coma (insensibility), is denoted by the following symptoms: Pain in the head, sometimes intense, not limited to any special part, with a sense of fullness, bursting, or weight and throbbing. The head is hot, and the carotid, and other arteries of the neck and head, pulsating violently. The face is flushed, the eyesi injected; there is intolerance of light. The mind is confused, and con- sciousness may be suspended; there is dizziness, ringing in the ears, and. difficulty in speech. If paralysis and insensibility exists, the trouble is greater than simple congestion — there is apoplexy from extravasation of blood. These symptoms (signs) are, also, those of the beginning of inflamma- tion of the membranes of the brain, and a discrimination cannot, at once, be made. The treatment is the same. The intensity of the congestion determines the prominence of the symptoms. Intense congestion calls for blood-letting, promptly, at the hands of a surgeon, as necessary in preventing apoplexy and sudden death, hemorrh- age upon the brain, watery effusion, or inflammation. Blood-letting gives relief, by weakening the action of the heart, and diminishing the quantity of blood sent to the head. If the congestion is not sufficient to call for bleeding, either general or by wet cups, applied to the back of the neck, relief may be obtained by ice to the head, hot foot-baths, made stimulating by the addition of mustard or red pepper, and an active purgative ; one or two tablespoonfuls of Epsom Salts dissolved in water, is as good a physic as any for the purpose, in domestic practice. The after-treatment will have reference to the removal of the causes, if possible; they are, aside from enlargement of the heart and sunstroke, principally some form of using alcoholic stimulants, and over-stimulating food, excessive mental or emotional activity, and anger. If the patient is strong, or robust, the diet should be less hearty, and a cathartic of a smaller dose of salts, or a Seidlitz powder, taken occasionally. Let all the habits of life be governed by the word moderation. Passive Congestion of the Brain is caused by some obstruction to the return of the blood from the head, through the veins, except it may be caused by weakened arterial circulation. The trouble is distinguished by drowsiness, dullness of mind and perceptions, and sometimes by convul- sions, in children. Active delirium, throbbing arteries, and increased heat, 114 THE BRAIN AND NERVOUS SYSTEM. are wanting. Passive congestion may lead to watery effusion or extrava- sation of blood upon the brain. When caused by disease of the heart, or by tumors pressing upon the veins, and so producing the congestion, treat- ment lias reference to a removal of the obstruction. See treatment of diseases of the heart. For the treatment, or removal of tumors, the skill of a surgeon is necessary. To overcome enfeebled circulation, everything which produces exhaustion is to be avoided, and its force increased, and the blood enriched by nutritious food and tonics. Citrate of Iron and Quinine, one dram, dissolved in four ounces of simple syrup. Dose, a teaspoonf ul. Or the Soluble Citrate of Iron, dissolved in Sherry Wine, one dram to eight ounces. Dose, a teaspoonf ul, are good tonics taken before each meal. HOM(EOPATHIC TREATMENT — Belladonna. In plethoric persons, disposed to rush of blood to the head, red, almost purple face, dilated pupils, nervous agitation, sensitiveness to all unusual sounds and motions, especially any sudden jar, as of the bed or floor, delirium, constant or inter- mittent mutterings, and, if present a disposition to perspire, will be found reliable indications for Bell. Dose: Six or eight pills, or two drops of the remedy, in a little water, once in one to twenty-four hours, as the urgency of the case may demand. Study article on dose and repetition, in the previous pages. Aconite. If the trouble is the result of violent emotions, such as fright or mortified feelings. This remedy is also very useful in alternation with Bell., in cases of acute hypersemia among women and children, at times where the latter remedy is indicated, but the symptoms show, also, a high fever and excited condition of the heart. Dose: As for Bell., and also subject to the same considerations. Opium is a more useful remedy in this disease than either of the others already mentioned, provided the trouble has not been produced by this remedy in some of its forms. Its use is indicated by continued sopor, (sleep) with insensibility of all the senses, dark redness of the face, with paleness and coldness of the rest of the body, slow pulse, slow breathing. Dose : As for Bell. Tobacco is one of two drugs which frequently cause this disease. Do not take or give it in any form. If this so-called innocent habit is one of your failings, be firm, shake off the demon you see so surely destroying your life, and quit, forever, the habit which is costing you so dearly. Kux Vomica. When the disease is caused by a sedentary mode of life, or excessive mental labor, and more especially in the commencement, when caused by frequent use of spirituous liquors, attended with constipa- tion or irritation of the kidneys, Nux is a good remedy. Dose : Six pills every evening. Arnica. When the derangement is the result of a concussion, fall, or blow on the head, etc., use Arnica freely. Veratrum Viride. When Bell, is indicated apparently, but after being given for twenty-four hours, a dose every half hour, or hour, has produced no change for the better, you will find a change to Veratrum Viride a good one; it has been used extensively in this affection, both in general and hospital practice, with the best results. It is best given in a low potency. LACK OF BLOOD TO THE BRAIN. 115 Dose: Eight pills in three tablespoonfuls of water, to be given a teaspoonful every two to four hours. Sunstroke in hyperemia from the heat of the sun, applications of ice or cold water to the head, along the back, and to the extremities, is indis- pensable to re-awaken the paralyzed reaction of the organism, but this should not be an entirely constant application, but should have short inter- ruptions at intervals. ANMMIA OF THE BRAIN.— LACK OF BLOOD TO THE BRAIN. Anaemia of the Brain is not, as generally considered, a separate affec- tion, but rather a symptom of, or an affection caused by, some other disease. Anaemia of the brain either consists in a diminished volume of blood in the brain, or in a supply of blood to the. brain, destitute of red globules. In the former case, it is caused by constriction or compression of the arter- ies through which the blood courses towards the brain, or by any other circumstances, in consequence of which the space within the skull is nar- rowed. In the second case, all the causes of anaemia must be considered ; whereas, the deficiency of blood, consequent upon sanguinous losses, will have to be counted, since it is not only the decrease in the quantity of the blood, but, also, in the quality, that determines the anaemia. Then, again, there is no doubt but that changes of a spasmodic nature may induce a sudden decrease of the volume of blood to the brain ; a greater or less degree, we have observed, in consequence of powerful men- tal emotion or excitement. The symptoms of anaemia of the brain differ a good deal, according as it develops itself more or less rapidly. If it develops quite rapidly, we have a most pefect image of syncope (fainting or swooning,) unconscious ness, voluntary muscular movements are suspended, most generally, amid slight convulsions, and both the breathing and the pulse, are slower. This condition is most prominently seen, during metrorrhagia (hemor- rhage from the womb) in confinement; or from some other morbid dis- charge of blood. Evidently such accidents are attended with great danger to life. If the anaemia sets in more slowly, symptoms of stimula- tion always precede the sinking of the activity of the brain. Here, as well as in excess of blood in the brain, we have violent headache, great irritability of the organs of sense, buzzing in the ears, dimness of sight, vertigo (dizziness) ; and it is only from the course, and a careful study of the causes of disease, that we are able to obtain light regarding their cause. It is characteristic of most cases of anaemia of the brain, that the symptoms either abate or disappear in the horizontal position, and that the partaking of food or stimulating substances, cause an improvement. The course and duration of this disorder depends, of course, upon the aggravating causes. What is certain, is, that the appearance of anaemia of the brain is always a very bad symptom, especially in the case of chil- dren. ALLOPATHIC TREATMENT. When this condition exists in the whole of the brain, it is associated with, or depends upon, general anaemia or impoverishment of the blood of the whole system. There are also 116 THE BRAIN AND NERVOUS SYSTEM. present, as a rule, the headache, dizziness, and other symptoms of exhaustion and weakness. This anaemia of the brain, is that of a lack of the quality of blood, and not a lack of quantity. The essential element in which the blood is deficient, in these cases, and all cases of general anaemia, is iron, which enters so largely into the composition of the red. globules. The proper treatment, therefore, is to introduce into the blood, through the stomach, blood making materials. Nutritious food is most important, and should consist largely of fresh, rarely cooked, lean meat, as, beef and mutton, milk and eggs. The medicinal treatment should consist of Iron and vegetable tonics. The Citrate of Iron and Quinine fulfills the indication and may be given in doses of two to five grains, three times a day, before meals. It should be dissolved in water or syrup. This, with Cod Liver Oil and good food, will restore the health and the proper amount of blood to the brain. The Cod Liver Oil should be given, at first, in doses of a teaspoonful, increased to a tablespoon ml. If cream can be obtained it is equally as beneficial. If the nervous debility should be great, Strychnine and Phosphorus, in addition to the above, will be most useful. The pills of Phosphorus or Phosphide Zinc and Nux Vomica will answer very well, and, as they are sugar-coated will be preferred by many. Dose; One or two pills, three times a day. The Citrate of Iron and Strychnine is a pleasant preparation and can be given in three grain doses, dissolved in syrup, three times a day and will generally suffice alone. Quinine should also be given in one or two grain doses, in pill or powder, or some other bitter tonic, as Tincture of Bark, or Gentian. The Elixir of Quinine, Iron and Strychnine, also meets the needs of these cases, and can be used in doses of a teaspoonful at each meal. The electric current, known as Galvanism, is immediately useful. The poles of the battery should be applied to the mastoid processes (behind each ear) or upon the forehead and nape of the neck. In partial anaemia of the brain, caused by embolism, as occurs in that form of apoplexy, time is the necessary element in its removal, by the establishment of the collateral circulation. There can be no doubt, how- ever, in many cases, of the benefit of Strychnine in doses of about one- thirtieth of a grain, and the judicious employment of Galvanism, though much harm may also be done by their improper use. HOMCEOPATHIC TKEATxHENT. We must content ourselves with mentioning only a few remedies, known to be most prominent for anae- mia of the brain, when manifesting itself as an independent, and more particularly in the form of an acute disease. Ipecac, as a remedy, is particularly suitable for children, after rapid losses of animal fluids, if the symptoms of convulsions are present, together with more or less stupor. Dose : Eight pills, or "four drops of solution, in three tablespoonfuls of water. Give a teaspoonful every two or three hours. Secale Cornutnm is particularly useful in the hemorrhage from the womb of parturient females ; here it acts in a two-fold direction, against the hemorrhage itself, and against the symptoms arising from the brain Blood-vessels of side of Head, Neck, Trunk and Upper Extremities. APOPLEXY. 117 and spinal marrow; upon both of these organs it acts in a very marked manner. Dose : As for Ipec. Cuprum is only suitable where the whole process is developed slow- ly, and is more especially characterized where there is some spasmodic phenomena, such as some mental excitement. i)o.se : A small powder, or eight pills, in water, as directed for Ipec. HOME REMEDIES. Ammonia or Camphor applied to the nose, or even a little cold water applied to the face, will often arouse from syncope arising; from anaemia of the brain . APOPLEXY. Apoplexy is a sudden loss of consciousness, beginning at the brain, depending upon hemorrhage upon the brain, congestion or embolism (a small clot from the heart lodged in an artery of the brain). Characteristics.— Sudden or gradual loss of consciousness, sensa- tion, and motion, with greater or less disturbance of the pulse and res- piration. It is extremely difficult to distinguish clearly between the different varieties, the external symptoms not always bearing a uniform relation to the internal injury; thus all the indications of serous apoplexy may declare themselves from sanguinous extravasation ; and it is not always possible to decide, in apoplexy, whether effusion, or simple congestion of the vessels of the brain, has taken place. Premonitory Symptoms. — Continued inclination to somnolence; heavy, profound sleep, with snoring respiration; nightmare, grinding of the teeth, shocks or cramps, extreme drowsiness, or a general feeling of heaviness, or disinclination to the least exertion; frequent yawning and fatigue after the slightest exercise. A sense of weight and fullness, and pains in different parts of the head, sometimes very deep-seated. Head- ache and megrim, or giddiness and fainting; pulsation of the arteries of the temples and neck, with swelling of the veins of the head and fore- head ; disturbance of the functions of the brain, evinced by the loss of memory, irritability of temper, or mildness and indifference, despondency and weeping; irritation of the membranes covering the eye, dimness of vision, specks or motes before the eyes, or flashes of fire, or sparks, during darkness; aeuteness of vision, or double vision; sometimes, also, the words in a line appear to run into one another; difficulty of opening or closing the eyes ; noises, humming, singing, etc., in the ears; dullness of hearing; dryness of the nostrils, pinched appearance of the nose, with false perception of an unpleasant odor; sneezing, and slight bleeding of the nose ; stammering, and indistinct pronunciation; difficulty of swal- lowing ; numbness or torpor, or pricking sensation in the extremities, with inarticulate speech, and occasional partial attacks of paralysis in the face, (distorting the features,) or in some of the muscles of the limbs ; pains in the joints ; weak or unsteady mode of progression ; difficulty of passing water, etc. 118 THE BRAIN AND NERVOUS SYSTEM. Confirmed Attack. Symptoms.— The attack itself is commonly ushered in by either of the following groups of symptoms: The patient suddenly falls to the ground, and is instantaneously deprived of sense and motion. The limbs are relaxed and perfectly motionless, or the whole of one side is rigidly contracted, whilst the other is relaxed and powerless; in some instances one limb (such as an arm) is alone implicated. The speech is either entirely suppressed, or a few inarticulate sounds are all that can be uttered ; the countenance is flushed or livid and puffed, and there is foaming at the mouth, with contortion towards the affected side. The respiration is slow, impeded, and usually accompanied by a rough, harsh snoring. The pulse varies, but is usually weak at the commencement, and fuller and stronger, but slower, as reaction sets in. In other cases, again, the patient is suddenly seized with partial paralysis, comprising either an arm or leg, or the whole of one side of the body, attended with loss of the power of utterance, and pale, sallow, or livid and bloated countenance. In the course of a few hours, all, or the greater part of the symptoms mentioned under the first variety of apo- plexy, are prone to follow. Issue and Results.— When, in either form of the disease, recovery is about to take place, consciousness gradually dawns upon the patient; he begins to recognize persons and objects around him, answers when spoken to, or makes signs for writing materials, in order to express his wants on paper, when the power of speech is still denied him. But when a fatal termination is to be apprehended, the breathing becomes more and more oppressed, the face becomes pallid, and a cold, clammy sweat bedews the brow; the act of swallowing is rendered diffi- cult or impracticable, the teeth become clenched, the eyes dim and glazed, and the evacuations are passed involuntarily. Predisposing- Causes. — Chronic derangement of the primary organs of digestion, and, in some cases, disease of the heart, are the principal predisposing causes of apoplexy. The conformation of the frame is elso- considered to predispose persons to attacks of apoplexy. Old age is more subject to this disease than the robust or mature periods of life. Particu- lar seasons, such as the equinoxes, (the transition from winter to summer, and from autumn to winter,) increase the predisposition to attacks of apoplexy. Sudden changes of the barometric conditions of the atmosphere are, also, known to operate as predisponents. Exciting Causes. — The exciting causes of apoplexy are intemperance in eating and drinking ; mental emotions ; obstructed circulation, arising from tight articles of dress around the neck or waist, or from prolonged stooping, or keeping the head in a dependent position ; intense study ; blows on the head; the use of opiates ; baths at too high a temperature; violent vomiting, or strong muscular efforts; the suppression of habitual dis- charges; exposure to the rays of the sun; extremes of temperature; accidental loss of blood, or excessive bleeding. ALLOPATHIC TREATMENT of apoplexy will have reference to the period of the attack, and to its prevention. If an attack has occurred, the patient is to be placed in a cool, well aired room, with the head raised and cold applications made If the head is hot, and the arteries throbbing, and APOPLEXY. 119 the face flushed, ice should be applied to the head, and hot foot-baths, with mustard plasters, to the feet and legs. The dress about the chest and neck loosened to permit the free return of blood from the head. If the stomach is full, a vomit (emetic) should be given; but not other- wise. A tablespoonf ul of mustard, in water, is as good as any. An emetic which produces straining should not be given. There is, generally, an advantage in an active cathartic. For this purpose three drops of Cro ton Oil is the best cathartic, on account of the briskness and quicknees of its action: It can be given in a little syrup or glycerine. If free purgation does not occur in four hours, the dose should be repeated. The action of the physic can be hastened by injection of soap suds having a little salt added; one pint is the usual size for an injection. If the pulse is small or feeble, or the patient weak, a cathartic should not be given ; but if it is known that the bowels have been constipated, they should be moved by an injection. If the patient is below middle life, the condition is probably active congestion, particularly if the symptoms characteristic of this condition obtain, such as flushed face, congested eyes, throbbing of the carotids and other arteries of the head and neck, and a hard, resisting pulse, the life of the patient may depend on the immediate abstraction of blood. When paralysis exists, the apoplexy depends upon extravasation of blood from the rupture of an artery within the skull, or upon embolism (plugging of an artery in the brain, by a small clot from the heart,) bleed- ing should not be resorted to. In the latter case it can do no good, and in the former may do positive harm, by so weakening the patient that he cannot survive long enough for the clot of blood to be absorbed. If the patient regains consciousness, and paralysis of one side of the body (hemiplegia) remains, there is a clot. Cooling washes should be applied to the head, the bowels kept open, and the food nutritious, but unstimulating. Recovery will depend upon the absorption of the clot by the efforts of nature. Paralysis will be treated under that disease. HOMCEOPATHIC TREATMENT.— Homoeopathy possesses many reme- dies, by means of which it is frequently possible to ward off an impending attack of apoplexy. In order to better facilitate the selection of the appropriate medicines, inasmuch as the immediately exciting cause frequently serves to modify the course to be adopted, the subjoined table of medicines, especially appropriate for the treatment of cases distinctly traced to particular causes, has been pre-attached to the distinctive indications afforded for each medi- cine, separately, further on in this article. But it is, at the same time, necessary to caution the reader against holding the cause as paramount to the particular indications present, for the cause is ever the subordinate reason for selection. But when any one of the remedies named as appropriate for the treatment of cases traceable to particular causes, is, also, found upon reference to particular and dis- tinctive indications, +o correspond with the requirements of the case, we have thus ascertained a double reason for being assured that the selection is correct. 120 THE BRAIN AND NERVOUS SYSTEM. INDICATIONS AFFORDED BY PARTICULAR CAUSES, DURING THE PRES- ENCE OF PREMONITORY SYMPTOMS. When the attack is directly traced to a chill, select from: * Aconi- tum, Opium, Nux-vomica, and Mercurius. When the attack is traceable to a sudden fright, select either: *Aco- nitum, or Opium, or both, alternately. When concentrated grief is ascertained to be the exciting cause, select from : * Ignatia and Lachesis. When sedentary habits, or over-application to study, is distin- guished as the exciting cause, select: * Nux-vomica or Belladonna. When the attack is directly traced to a fit of passion, select from : * Aconitum, Bryonia and Nux-vomica. When excessive joy is distinguished as the exciting cause, select from : * Coffea and Opium. When the attack is directly traced to over-indulgence in vinous and spirituous liquors, select from : * Nux-vomica, Opium, Lachesis and Pulsatilla, When derangement, from overloading the stomach, is recognized as the exciting cause, select from : * Pulsatilla, Ipecacuanha and Nux-vomica. When exposure to the sun, or a hot bath (too hot), is distin- guished as the exciting cause, select from : * Belladonna and Aconite, or both, alternately. When the attack is directly traced to suppression of an habitual evacuation of blood, select from : * Nux-vomica and Pulsatilla. Aconitum is required in all cases where there are evident symptoms of fullness of the vessels, determination of blood to the head, character- ized by redness and fullness of the face, distention of the veins of the forehead, quick, full pulse, restlessness, and anxiety. Dose : Of a solution of six pills to two tablespoonfuls of water, give a teaspoonful every hour, until amelioration or change; but if. after three doses have been given, the improvement does not become speedily progressive, proceed with the next medicine. Belladonna is of essential service when the symptoms of congestion do not speedily or thoroughly yield to Aconite, or should only a partial degree of amelioration have taken place, in which case, this remedy should be administered four hours after the last dose of the foregoing — or, further, should the following symptoms present themselves: redness and bloatedness of the face, injection of the conjunctiva (the mucous membrane which lines the eyelids, and covers the front of the eyeball), violent beating of the arteries of the neck and temples, noises in the ears, darting pains in the head, with violent pressure at the forehead, increased by movement, the least noise or bright light, double vision, and almost all the symptoms relative to the eyes already mentioned ; dryness of the nose, with unpleasant smell and bleeding of the nose; fiery redness of the * The selection from one or more of the medicines thus enumerated, must, however, as already observed, depend upon the. correspondence between the symptoms of the case, and those hereinafter enumerated in connection with such of these medicines, separately. But if the indications for two or more medicines be so closely identical as not to be decisive between them — whereas both are not appli- cable to the treatment of cases arising from the same cause — then this discrepancy will be decisive between them, if the cause be clearly ascertained. APOPLEXY. 121 throat ; difficulty of swallowing ; slight attacks of paralytic weakness or heaviness in the limbs. Bo.se : Of a solution of six pills to two tablespoon fuls of water, give a teaspoonful (or two pills dry on the tongue) every three hours, until improvement or change. Nttx-vomica is particularly suited to cases in which the apoplexy threatens individuals of sedentary habits; or addicted to the use of ardent spirits, or too great an indulgence in the pleasures of the table, or in those Who have long been affected with indigestion, either bilious or nervous ; and have, consequently, more or less of the rheumatic or gouty constitutional tendency ; and, also, when the following symptoms present themselves: lieadaclie, deep-seated or frontal, but more especially at the right side, and giddiness, confusion, and humming in the ears ; nausea, and inclination to vomit; turgescence of the superficial vessels of the face or redness only of one cheek ; drowsiness; feeling of languor, with great disinclination to exertion, either mental or bodily ; cramps of the limbs, especially at night, and weakness in the joints; constipation and diffi- culty in passing water ; irritability of temper, aggravation of the symp- toms in the morning, or after a meal, and also in the open air ; bilious, sanguine, or nervous temperament. Dose : A solution of six pills, as directed for Belladonna. Opium is a most important remedy in almost all severe attacks, but particularly in old people, when we find the following symptoms : marked congestion to the head, indicated by stupor, giddiness, heaviness in the head, and violent pressure in the forehead ; singing in the ears and hardness of hearing ; sleeplessness, or agitating dreams, or frequent and almost overpowering drowsiness during the day ; redness of the face, and constipation ; pulse slow but full. J9o.se : Of a solution of six pills to two tablespoon fuls of water, give a teaspoonful (or two pills dry on the tongue) every two hours, until improvement or change. Ignatia is, also, indicated by many of the symptoms mentioned under the head of Nux-vomica, but it is chiefly called for when depress- ing emotions (particularly severe, and protracted grief) have been the exciting cause, and when the person affected is of a nervous tempera- ment. T)ose: Six pills in two tablespoon fuls of water, a teaspoonful every two hours, until improvement or change. HOME TREATMENT — As there is liability of apoplexy recurring, after recovery from an attack, all possible precautions should be observed. The individual should avoid violent bodily exertion, or strong mental labor, venereal excitement, the use of alcohol in any form, the stooping- posture, and tight neck cloths. The head should be well elevated at sleep, and every morning the head bathed in cold water. When dizziness, head- ache, with throbbing of the arteries occur, a brisk cathartic should be taken. The rule of life, as stated in the treatment of acute congestion, is moderation. Head symptoms are sufficiently common, without being followed by apoplexy, so that those who experience them need not become unhappy from fear of apoplexy, especially if they have never had the disease. 122 THE BRAIN AND NERVOUS SYSTEM. PARALYSIS. By paralysis, we understand a suspension of nervous action. It dif- fers in character according as one or another, or all the nerve trunks are attacked. And its symptoms must vary, just as the functions of the nerves vary . The name paralysis^ implies the complete cessation of the action, both of the nerves of sense of feeling, and of the nerves of motion. If only one set of nerves are affected, it is called incomplete paralysis, or paresis; one side of the body affected is called hemiplagia. If the upper extremities of one side, and the lower extremities of the other, are the seat of disease, we call it transverse paralysis. The causes of paralysis are various. Diseases of the brain and spinal cord, are the principal causes. Of these apoplexy, inflammation, and softening of the brain, are most prominent. There are many other influ- ences to which paralysis may be traced, as their result. The main causes of this class are : excessive exertions of the parts to which the paralyzed nerve is distributed, in which list must appear cases resulting from con- vulsions, continued and excessive pains, swellings, neuralgia, ligatures, a stroke of lightning, rheumatism, hysteria, gout, pregnancy, violent acute diseases, among which contagious and miasmatic diseases occupy a front rank, such as scarlatina, measles, variola, typhus, dysentery, and finally, poisoning by animal, vegetable, and more particularly, by mineral poi- sons. The Symptoms of paralysis may readily be understood. There can only be doubt, when the paralyzed part is not accessible to our vision. The prognosis depends on the nature of the exciting causes, and upon the possibility of removing them. If from disease of the brain, or spinal cord, a cure is not impossible, but doubtful. If from some acute disease, there is very little doubt of an ultimate cure. That the prognosis is ren- dered much more doubtful by an advanced age, an enfeebled constitution, and an extension of the paralytic phenomena over a large surface, is but natural to expect. ALLOPATHIC TREATMENT.— Paralysis. There are no diseases, the treatment of which ought more certainly to be directed by a judicious person, than the treatment of the several forms of paralysis. The treatment, as a matter of necessity, will have reference to the diseased conditions causing the paralysis, the state of the system, and any independent affections which may be co-existing. Treatment is not to be addressed to the inability to make muscular movements directly, but to the cause and associate affections. The nature of the causes must, therefore, when possible, be determined with positiveness. Among the questions to be settled before intelligent treatment can be begun, are: Is the cause of paralysis inflammatory, or is there a structural change of tissue (lesion,) and where is this lesion or inflammation situated? Is it in the course of a nerve within the skull or spinal canal? If it is a lesion, what is its nature and extent? Is it the result of poison, as lead or arsenic, copper or mercury? Or, are all these causes absent, and is the paralysis functional? What influence do co-existing diseases have on the paralysis? Is the system well nourished, or is there debility or anaemia? The treat- ment will vary according to the conclusions arrived at in answer to the above questions, and the result will, therefore, depend upon the correct- PARALYSIS. 123 ness of the conclusions, and the jn dgment with which the indications are carried out. There are cases in which the structural changes (lesions) are such as are beyond hope of repair ; in such cases the complete success of treatment cannot be hoped for. That part of the treatment having reference directly to the paralysis or to the paralyzed parts, and calculated to restore their function, promote the circulation in them and their healthy nutrition are chiefly Electricity, passive motion, (moving or exercising the paralyzed part by the hands of the patient or others,) active exercise under the direction of the will, rub- bing, shampooing, and stimulating applications. Strychnia is also given internally for this purpose. It must be borne in mind, that these measures cannot be effectual and may be injuries, so long as the paralysis is maintained by the conditions which caused it. The general treatment having reference to the causes of the paralysis is considered under their respective heads as apoplexy, as a cause of hemi- plegia (paralysis of one side of the body) and myeletis (inflammation of the spinal cord) as the cause of paraplegia, (paralysis of the lower half of the body.) The chief remedies are Strychnine and Electricity, but their use should be delayed until the acute stage of the causing disease has passed, though later on, both these agents are useful in restoring the circulation to the brain in cases of thrombosis (obstruction of the circulation in the brain by inflammation of an artery) or to embolism (obstruction of the circulation in the brain, caused by a plug lodging in an artery) and to promote the absorption of a clot in case of hemorrhage in the brain. For this end, very mild Galvanism (the direct electric current,) should be used. One pole should be placed upon the nape of the neck and the other upon the forehead, or upon each mastoid process. Strong currents may do serious mischief. But sufficient time having elapsed for the immedi- ate effects of the brain disease to subside, its judicious use will be beneficial. If there is headache or dizziness, the greatest care will be necessary, and in all probability, Electricity should be discontinued. It is also important to remember, that part of the paralyzing effects of these causing conditions is temporary, and may be the result of shock, contusion, or congestion, which are temporary. Even paralysis depend- ing upon no appreciable lesion (functional) is, foratime, stationary, before improvement begins. Besides, paralyzed parts do not, of themselves, resume their healthy action, even after the conditions causing the paraly- sis are removed, so that it will not do to trust to nature alone, but appro- priate efforts-must be made to restore healthy action. It is a serious error to begin treatment addressed directly to the paralysis, while that condition is maintained by the primary causes, fur- ther than to maintain the nutrition of the paralyzed muscles, by main- taining the circulation in them. It is a serious error to overlook the fact that after the paralysis has existed some time, that recovery will not take place spontaneously. After paralysis has existed so long that degenera^. tive changes have taken place in the muscles or nerves, recovery cannot take place. So long as contractions take place upon passing the electric current 124 THE BRAIN AND NEKVOUS SYSTEM. through the paralyzed muscles, they have not yet reached a condition that renders them hopeless. If pain is produced upon passing the elec- tric current through the paralyzed part, but no contractions are produced, the case is less hopeful than as if both contraction and pain were pro- duced. The former is called electro-muscular contractility, and the latter elec- tro-muscular sensibility. When both are lacking, the case may be said to be hopeless Electricity. — As before stated, the constant current may be applied to the brain for the purpose of improving the circulation and its nutrition (if the case is hemiplegia.) To the muscles, usually, the induced (or faradic) is used . This will prevent wasting and loss of function from disease; but, as a rule, that current should be used which produces the the greatest number of contractions and the least amount of pain. If the temperature of the paralyzed part is lowered and the muscles weak and flabby, great benefit, in all these particulars, will follow the use of the faradic current. Large, well-moistened electrodes should be used, one being placed over the motor nerve affected, and the other over the belly of the muscle. Every affected muscle should be faradized at each sit- ting. The same principle will govern the use of electricity in all forms of paralysis. In facial paralysis, one pole should be placed on the mastoid process, and with the other stroke the face. Pain is an evil, and the current should not be stronger than neces- sary to produce contractions. Nor should its application be made to one muscle long enough to tire it. From ten to twenty minutes is long enough for an electric sitting, nor should any muscle be subjected to the electric current for more than five minutes, nor oftener than every day or every other day. In infantile paralysis the most decidedly beneficial results are obtained from electricity. The electrical treatment should be begun early, but after all inflammation has subsided. So long as the electro-muscular contrac- tility continues, especially, if the joints have not become changed, the spinal cord and the nerve plexuses, as well as the paralyzed muscles, should be subject to faradization or galvanization. Strychnine. — Continuous with the use of electricity, Strychnine should be given. It is most useful in hemiplegia, when the muscles are completely relaxed; when they are rigid, it is not to be given. After the acute symptoms disappear, Strychnine is useful in promoting the nutri- tion of the affected nerves or nerve centers, as well as by kindling the contractile power of the muscles, whether the paratysis be herniplegic, paraplegic, or of a local character. The most effectual method of administering Strychnine in paralysis, is by hypodermic injection. One thirty-second of a grain a day, by hypo- dermic injection, has a better effect than the same or a greater quantity three times a day by the mouth. A good formula is : Take of Sulphate of Strychnine one and a half grains, Distilled Water one ounce. Mix. Apply heat to effect a solution ; ten drops contain one thirty-second of a grain, and can be given once a day, by hypodermic injection, to an adult. In infantile paralysis one drop of this solution, diluted by five drops of I>is- PARALYSIS. 125 tilled Water, and given once a day, is very beneficial, if the muscles have not lost their electro-contractility. It promotes the capillary circulation and the growth and power of the muscles. In making the injection, it is best to throw the solution into the muscle itself, taking the paralyzed muscles each in turn. To do this dex- trously requires the skill of a physician. Cases of paraplegia, in the early stages, should doubtless be treated with Ergot and Belladonna. A teaspoonful of the Fluid Extract of Ergot and ten drops of the Fluid Extract of Belladonna should be given three times a day, but after three or four weeks have passed, they should give place to electricity and Strychnine. In paralysis of the insane, there is scarcely any hope of permanent improvement from treatment, much less for a cure. These patients should be removed to insane hospitals. The treatment consists, for the most part, of palliative measures, and a regulation of the diet, with a view of retarding the progress of the disease, and contributing, as far as possible, to the comfort of the patient, during the continuance of the malady. HOM(EOPATHIC TREATMENT.— Paralytic attacks, being almost with- out any exception, secondary affections, are results following some other disease, or injury. It is evident that in treating them it is of the utmost importance to learn the first, or primary cause of the present affection. It is not always possible to do this, but when the cause is once known, the treatment should be directed to its removal. If it is the result of dis- ease, look for the treatment under the name of that disorder. If from some external cause, study and remove that. The treatment by Homoeopathic means always includes the searching out of the cause of the paralysis — which is always a symptom, or the result of a previous condition of disease or injury — and treating the malady from that point of observation, as far as it is practicable. Electricity is the sheet-anchor, in all schools of medicine, for the treatment of this disease, and it is for this reason that all Homoeopaths point to it with pride. As it is beyond successful contradiction that the cures it does so very frequently produce are in full accord with what they have demonstrated to be nature's law of cure. The use of this remedial agent is so fully and plainly given by my co-author, Dr. Bean, in the Allo- pathic Treatment of this disease, that I shall be content to refer my read- ers to that part of his work ; indeed, the whole of his treatment is so fully in accord with our experience and practice— except in the matter of dose, — that we will only add that the annexed are a few paralytic conditions and remedies, proven to be the best for that condition ; a further study may be made by means of the Repertory. Causticum, while not sup- posed to be able to produce a cure alone, is still one of the most substantial helps in almost all forms of paralysis. When caused by suppressed eruptions and ulcers, Canst., Ars. 9 Sul. After excessive bodily exertions, Rhiis-tox., Ars., Caust. After rheumatism, Canst., Fer., Bry., China, Am., RJius-t. After apoplexy, Bell., JYnx., Canst., Am. HOME REMEDIES. — Passive motion, in cases of complete paralysis is important, i. e., movements of the paralyzed limbs by the hands of the 126 THE BRAIN AND NERVOUS SYSTEM. attendants or the patient. It aids the circulation and nutrition, and maintains them in a state of preparation to respond to the force of the will. Friction of the surface of the paralyzed limbs, kneading the muscles, with a deep pressure, and shampooing, are useful in maintaining nutri- tion, and should be employed with perseverance. Persistent voluntary motion, in all cases of incomplete paralysis, is very important. There is reason to believe that, in some cases, paralysis continues at a certain point, until it becomes incurable, when persever- ing exercise, with other treatment, would have resulted in improvement or recovery. With this view, gymnastic exercises are to be enforced. The simplicity of this method does not prevent its being of great benefit. INFLAMMATION OF THE BRAIN. BRAIN FEVER, PHRENITIS, MENINGITIS, MENINGITIS CEREBRALE. The Causes are sometimes veiled in obscurity ; at others they are known to be the effect of excessive mental exertions, or the use of alco- holic drinks, or the effect of heat, or sometimes of cold, and other like causes, as mentioned under " Hypersemia of the Brain." Symptoms. — An attack of this disease may take place either gradu- ally, or very suddenly; generally the former. The premonitory symp- toms are, at first, depression of spirits, impaired appetite, mental uneasi- ness, and confusion of ideas, especially when in the recumbent posture, debility, and sometimes ringing in the ears, and blindness. These are succeeded, in most instances, by a more or less severe chill, and constant headache, which are soon followed by severe fever, hot and dry skin, flushed face, red eyes, or a haggard, anxious, fearful expression of them ; the pulse is quick, rapid, and forcible. The intensity of the headache increases, as also the ringing in the ears, sometimes changing to a humming or rumbling sound; the senses become morbidly acute, as known by the sensitiveness or restlessness as shown on exposure to either light or sound. The pupils of the eyes are constantly con- tracted, the patient is extremely restless or wakeful, with more or less delirium. They frequently imagine that some one designs to injure them and cannot bear restraint or contradiction, and the delirium is sometimes of a furious, raving nature. The head is remarkably hot, while the extremities are cold. The tongue is furred white, red at its edges, dry, pointed, and the papillae ele- vated; the bowels are obstinately constipated, and nausea and vomiting are common. Breathing is accelerated and laborious, seldom hurried, as in fevers, but irregular and with frequent sighs. Generally there will be spasmodic movements of the muscles and of the tendons The urine is scanty and of deep color. As the disease advances, a change occurs in the symptoms, the pre- vious delirium changes for a stupor which gradually passes into coma. The formerly contracted pupils are now dilated, and there is less sensi- bility to the light, the eye' loses its brightness; sometimes there is INFLAMMATION OF THE BRAIN. 127 squinting, and the countenance is vacant or idiotic; picking at the bedclothes or grasping in the air are almost always present at this stage. The hearing is much diminished, and, indeed, all the senses are very much blunted; the limbs become perfectly relaxed, the pulse is slow, sluggish, and irregular or intermittent, the respiration is deep, slow, and often stertorous (noisy, loud); the urine is very scanty, if passed at all, and the faeces are involuntarily discharged. Convulsions or paralytic attacks often ensue. Finally, the pulse becomes hurried, small, and unequal, the counte- nance pale and sunken, the skin has a cold and clammy perspiration upon it, the urine flows without any knowledge, the coma becomes more profound and death terminates the scene. It must be remembered, that these symptoms vary, being very mild with some, and extremely violent with others, depending upon the degree of strength of the system, the severity of the cause, and other attending circumstances. Some care is necessary in discriminating inflammation of the brain from fever of some other form; the headache of brain fever is more con- stant than that of fever, and appears to be confined to no particular spot. The sleep in this disease is disturbed with bad dreams and sudden starting or waking in fear, and with children a scream on awakening. The Prognosis is generally doubtful. Much depends upon the cause of the attack; if it be produced accidentally by blows, etc., it is more favorable than when owing to some constitutional disease or difficulty. The milder the symptoms the more certain is a favorable termination, but we should not be discouraged and despair, even in the worst cases, ALLOPATHIC TREATMENT of acute meningitis, cerebral, (inflamma- tion of the membranes of the brain). In the first stage of the disease, the object of treatment will be, to diminish the active congestion, and to limit the inflammation and its products. The hair is to be cut close to the head, and cold applied by means of a sack or bladder of pounded ice, or constant washing with cold water; the head should also be raised. An active cathartic is to be given: Ten drops of Croton Oil in Syrup or Glycerine, is appropriate, or twenty grains of Calomel, in a tablespoonful of Castor Oil, may be given. Owing to the urgency of the case, and the extreme danger to life, if the patient is robust, and the arteries of the head and neck beat- ing violently, in short, if the congestion is intense, blood-letting should be resorted to, preferably by wet cups to the nape of the neck, than general bleeding. The treatment, in this stage, is the same as in the condition called active congestion. These measures are only proper in the beginning of the disease, as exhaustion is one cause of death in cases of meningitis, which do not die quickly. Food should be of the blandest kind, and taken cold. The restlessness and excitement should be relieved by Chloral Hy- drate and Bromide of Potassium. Take of Chloral Hydrate eight scruples, Elixir of Bromide of Potassium four ounces, water four ounces. Mix. Do.se : One to two dessertspoonfuls, in syrup or sweetened water, from two to four hours apart, until relief is obtained. ' Opium is beneficial in relieving pain, and accomplishes as much as any other remedy, in controlling the inflammation. Dose : A grain to a grain and a half, in powder or pill, two or more hours apart, until pain is relieved. 128 THE BRAIN AND NERVOUS SYSTEM. After the stage of active congestion is over, the indications for treat- ment are to support the powers of life, and to promote the absorption of the products of inflammation (lymph and serum). The former indication is to be met, as far as possible, with nutritious, easily-digested food, of which meat essences and extracts, the preparations of milk, and milk beaten with eggs, form the principal pa.rt. Should the drowsiness and insensibility become so profound as to pre- vent sufficient food being given by the mouth to support life, as is fre- quently the case, half a pint of these strong liquid forms of food should be given, by injections into the rectum, two or three times a day, in addition to the amount taken by the mouth, and their retention effected by firm pressure upon the anus with a napkin. The absorption of the lymph will be aided by giving Iodide of Potassium. Take of the Saturated Solution of Iodide of Potassium one ounce, and give five, drops in sweetened water, flavored with Essence of Peppermint, two or three times a day. Strict attention should be given to the bowels, that they do not become consti- pated. If the bladder is not emptied by nature's efforts, the water should be regularly drawn, twice a day, with a catheter. For this the help of a physician is necessary. Vomiting, during any period of the disease, should be met by a fly blister to the nape of the neck, and a mustard plaster to the stomach. The following mixture is as commonly successful as any internal remedy: Take of Carbolic Acid ten grains, Simple Syrup one once. Mix, and give a teaspoonful each hour until relieved. Chronic Meningitis, Cerebral : In all probability, this affection is the result of a poison in the system, known as syphilis, either acquired or hereditary, and a history of the constitutional affection should always be sought for. Even when it is not clearly found, if the inflam-mation can- not be traced possitively to another cause, the existence of syphilis is to be suspected and govern the treatment. Iodide of Potassium should be given. Take of the Saturate Solution of Iodide of Potassium one ounce, and give at first five drops, in sweetened water flavored with Essence of Peppermint, three times a day. Increase the dose by one drop each day, until relief is obtained. Thirty or forty drops may be given at a dose, if relief is not sooner obtained. Give after meals. Quiet of mind and body is necessary. Nutritious food and warm clothing should be provided, and a warm bath be given two or three times a week. If the patient is pale and weak, Iron and bitter tonics should be given. The Citrate of Iron and Quinine is an eligible form in two-grain doses ; one dram of the drug dissolved in four ounces of syrup or water, is a convenient mixture. Dose : A teaspoonful, given before meals. Let us repeat. Iodide of Potassium appears to be the remedy for chronic meningitis not dependent upon tubercle or an injury. The writer is of the opinion that cauterization, blistering, etc, in this disease, are not, in the slightest degree, beneficial in arresting the disease. but add to the discomfort of the patient. They are not to be used, except in obstinate vomiting, when a fly blister should be applied to the nape of the neck. Treatment of Tuberclous Meningitis : This disease, depending upon the presence of tubercular deposit, offers very little encouragement for INFLAMMATION OF THE BRAIN. 129 treatment, if the diagnosis is clear. We are bound, however, to do what we can to give relief. The general principles of the treatment of acute and then of chronic meningitis obtain. Depletion should not be practiced. Cathartics should be limited to the relief of the constipation, which, as a rule, exists. For this purpose, Calomel, in one or two-grain doses to a child, and ten grains to an adult, followed, in six hours, by Castor Oil — a teaspoonful to a child ; a tablespoonful to an adult, if the bowels have not opened. In the main, measures to relieve pain and prolong life, are alone indicated. For the relief of pain, restlessness, etc., the use of Opium, Chloral and Bromide of Potassium, are indicated. The dose of Opium will vary from one-tenth of a grain to a child a year old, and a grain to an adult, repeated at intervals of two hours, until pain is relieved. Or Chloral Hydrate can be given in combination with Bromide of Potassium, as fol- lows: Take of Chloral Hydrate two scruples, Iodide of Potassium two scruples, Syrup of Tolu and water each one ounce. Mix. Dose: Give a teaspoonful, three or four hours apart, to a child one year old. The dose for an adult would be twenty grains of each drug. To prolong life, stimulants, in doses of a teaspoonful of whisky or brandy, may be given to a child, and one or two tablespoon fills to an adult, in addition to nourishing, easily-digested food — as milk and eggs, either alone or beaten together; cream, meat essences and extracts, and raw lean meat, minced fine. Preventive treatment is by far the most important and hopeful, especially for the consumptive predisposition, which is generally hereditary. If a baby, he (or she) should be brought up by a hearty wet nurse, and should not be weaned until he has cut all his teeth. Flannel should be worn next the skin, and the clothes should be warm. Over- exertion of mind and body should be avoided, but free exercise taken in the open air. The diet should be plain and nutritious. Milk should be freely taken. If the patient is reduced or decreasing in strength, Cod Liver Oil should be given. The Syrup of the Phosphates with Iron is, also, an appropriate remedy. Exposure to measles, and whooping cough, should be avoided, being especially liable to be followed by some form of tuberculous disease. HOMCEPATHIC TREATMENT.— With regard to the treatment of this disease, we may begin by stating that medical aid should always be pro- cured, if within reach; but when it is impossible or difficult to secure such assistance, the following remedies may be resorted to: Aconite is invariably required at the commencement of the attack, when the skin is hot and dry, and the pulse rapid, with the ordinary indi- cations of pure Inflammatory Fever, which is especially liable to be the case in young plethoric subjects. Dose: Dissolve six globules in three tablespoon fuls of water and give a teaspoonful of the solution every hour, until the pulse diminishes in force and frequency, and the skin becomes moist or covered with profuse perspiration ; after which, the intervals may be extended to two hours and the administration be proceeded with, if no other medicine appears to be indicated, until general and progressive im- provement becomes apparent. But if any of the subjoined symp- toms remain or supervene, consider the following medicines, and select that which is indicated by the symptoms present. 130 THE BRAIN AND NERVOUS SYSTEM. Belladonna seems to possess a certain specific influence over inflam- mation of the brain and its membranes, and is generally the remedy we should select, when the following, amongst other symptoms, present themselves : great heat of the head; redness and bloatedness of the face, with violent pulsations of the arteries of the neck; burying the head in the pillow, and increase of suffering from the slightest noise, with extreme sensibility to light; violent shooting and burning pains in the head; eyes red and sparkling, with protrusion or wild expression; contraction or dila- tion of the pupils ; violent and furious delirium; loss of conciousness ; some- times low muttering; convulsions; occasionally symptomatic hydropho- bia; vomiting ; involuntary evacuations of the fasces and urine. Dose: Of a solution of six globules to three tablespoonfuls of water, give a teaspoonful every two hours, until a change. But if distinct improvement supervene, (without intervening apparent aggravation,) the intervals should be extended to four hours, and, again, after tw r o more doses — if the amelioration be regularly progressive — to eight hours ; and so on, until permanent improvement or change. But, in very urgent cases, and when repeated doses of Belladonna have pro- duced inadequate results, consider the next medicine, and proceed accordingly. If in alternation with Zincum, a similar solution of each (separately) administered by teaspoonfuls, at intervals of half an hour (or even fifteen minutes,) in rotation, until the urgent symp- toms abate. Zincum may be had recourse to, after, or in alternation with Bella- donna, when that remedy effects only partial amendment. In those extreme cases, where symptoms of threatening paralysis of the brain are manifested by the following indications: Loss of consciousness; half- closed eyes ; dilated, insensible pupils; icy coldness of the extremities, or of the entire surface of the body; blueness of the hands and feet; impeded respiration; small, weak, scarcely perceptible pulse; Zincum has been found effectual in averting a fatal issue. Dose : If singly, dissolve six globules in three teaspoonfuls of water ; and give a teaspoonful of the solution, (or, otherwise, three globules dry on the tongue,) every hour, (or, in very urgent cases, even every quarter of an hour,) until the lividity and coldness, and the indica- tions of the pulse assume a more natural aspect — and then every three hours, until general improvement or change. If in alternation with Belladonna, as directed for that medicine. Bryonia. This remedy will frequently be found of great efficacy in children, when Aconite sand Belladonna have produced but trivial improve- ment, and the symptoms manifested resemble those enumerated in the article on "water on the brain." Dose : Dissolve six globules in four teaspoonfuls of water, and give a teaspoonful of the solution every two hours, until amelioration or change; but if partial improvement only should become apparent, within two hours after the third dose of Bryonia, pause two hours longer, and proceed with the next medicine. Helleborus-Nigev is required after Bryonia, in cases exhibiting the characteristic features of water on the brain, when the last named medi- cine has been inadequate to overcome the disease. In such cases, and when partial improvement only has resulted from the previous adminis- tration of Bryonia, Helleborus should be given four hours after the third dose of the last named medicine. Dose : As directed for Bryonia. WATER ON THE BKAIN. 131 Hyoscyamns is appropriate when there is drowsiness, loss of con- sciousness; delirium about one's own affairs; inarticulate speech ; tongue coated white, with frothy mucus about the lips; dilation of the pupils; fixedness of vision ; skin dry and parched; redness of the face, and picking of the bed clothes with the fingers. Dose: Of a solution of six globules to two tablespoonfuls of water, give a teaspoonful every one to three hours, until amelioration or change. Opium. When there is lethargic sleep, with snoring respiration ; half open eyes, and confusion or giddiness after waking; congestion of blood to the head ; complete apathy and absence of complaint. Dose: Of a solution of six globules to two tablespoonfuls of water, give a teaspoonful (or otherwise three globules dry on the tongue,) every hour, until amelioration or change. Stramonium. When there is starting or jerking in the limbs ; sleep almost natural, followed by absence of mind after waking, but sometimes attended with moaning and tossing about; vision fixed, and the patient frequently appears in a state of dread, and utters cries ; redness of the face ; feverish heat, with moisture of the skin. In many of the symptoms this remedy bears a close resemblance to Belladonna, with the exception of being indicated by signs of a more spasmodic character, and by less acute pain in the head. Dose : As directed for Hyoscyamus. HYDROCEPHALUS. DROPSY OF THE BRAIN. WATER ON THE BRAIN. In general, we understand by Hydrocephalus, every unhealthy accu- mulation of fluid in the cavity of the skull. It may be either acquired or exist from earliest life. Acquired Hydrocephalus is seldom an independent disease, but rather is generally symptomatic of some other constitutional disease. It becomes an important symptom when the disease sets in as a chief complication in meningitis ; or when it develops itself so rapidly that it acts like apoplexy, and speedily terminates fatally, (then it would be called serous apoplexy.) It is very hard, indeed always uncertain, to diagnose this disease. It scarcely ever calls for a special treatment, and had better be treated with- out medicines, by means of care and diet. Congenital hydrocephalus (that which exists from earliest life,) com- mences before the child is born, but may increase- after birth. The quantity of accumulated fluid may be very large, and hence the skull may acquire an extraordinary size. Its effects upon the child are sometimes imperceptible, but at other times very decided: the mental actions of the brain are mostly involved. It is only in very fully developed cases, that the motions of the muscles are interfered with, in which case a more or less complete paralysis sets in. The life of the patient is not absolutely threatened; it may be admitted that hydrocephalic children, who have got over the period of infancy, have pretty nearly escaped the most imminent danger of death, from this immediate cause. But they always remain weakly, irritable, and unusually disposed to frequent and malignant diseases. Hydrocephalus, or dropsy of the brain, is a curable 132 THE BRAIN AND NERVOUS SYSTEM. disease, but such a cure is mostly spontaneous, taking place in proportion! as the bodily development progresses, and if the body does not develop, the limbs remaining small, or paralyzed, the chances of cure are propor- tionately less. A cure may, indeed, be facilitated by artificial means, but not by medicines. A main point is to bring up such children with great care, to accustom them to light and nourishing food, and to active bodily exercise, and to excite their mental faculties until the body is well devel- oped. Such children should not be allowed to attend school until they are fourteen or fifteen years of age, and there need be no uneasiness about them falling behind their companions of the same age. If so held back they will, almost without exception, excel in study when permitted to apply themselves. HOMOEOPATHIC TREATMENT.— Among medicines, if we do use them at all, there are none which offer more hope than Carbonate of Lime (CalcariaCarb.,) and Arsenicum, but they must be given in small and very rarely repeated doses. Do not bandage the head of infants tightly for this disease. A very moderate bandage, in very early life, will likely be beneficial, while the tight bandage will be likely to cause inflammation and death. ALLOPATHIC TREATMENT.— This disease unfortunately gives very little hope of benefit from treatment. Physicing, bleeding, blisters, and salivation are to be avoided. Gentle laxatives or injections should be depended on to keep the bowels open. Plain nourishing food and Cod Liver Oil or Cream should be given. A child can take a teaspoonful of Cod Liver Oil two or three times a day, while a tablespoonful is enough for an adult. The active remedies which appear the most useful are Iodide of Potassium and Iron. A convenient prescription for a child is : Take of Iodide of Potassium thirty-two grains, Phosphate of Iron sixteen grains. Dissolve each salt in a little water separately, then mix and add simple syrup suffi- cient to make a two ounce mixture. Dose : A teaspoon half full four times a day, to a child one year old. One drop each of the Vinegar of Squills and Tincture of Digitalis can be given to a child three or four times a day to keep the kidneys active. As a last resort, the physician would be barely justified in resorting to- puncturing, to draw the water, and compressing the head by strapping. Preventive measures should be closely followed. The strength of the child having a tendency to hydrocephalus, should be increased as far as possible. Nourishing food with as much milk as can be digested, meats, and, if the child is reduced in strength, Cod Liver Oil should be given. Warm clothing, a daily bath, good sleep every night, in a well ventilated room, and exercise in the fresh air, are all helpful. Stimulants should be avoided. When the child has become of an age to commence its education (seven or eight years) only short and varied lessons should be given* and mental fatigue avoided. Congenital Hydrocephalus, or dropsy of the brain.— If the disease is congenital (from birth,) it may be questioned whether anything should be done to relieve the infant, except attending to its general health. There are medicines which, in many instances, diminish watery accumulations in internal cavities; the parents are very anxious for the recovery of the little one; some recoveries are reported. These facts, and the hopelessness of the disease, if left to nature alone, lead the physician to resort to medi- cinal treatment. LOCK-JAW. 133 Medicines which act on the kidneys (diuretics) are generally supposed to be called for, and with reason. The best of these is Iodide of Potassium, as an efficient diuretic, and, possibly having a direct influence over the dis- ease. The dose for a child, six months or a year old, is one or two grains three to six hours apart, dissolved in half a teaspoonful of Syrup of Pep- permint, or sweetened water flavored with Essence of Peppermint. Pressure of the head by a closely fitting cap, or very narrow strips of adhesive plaster, (one-third of an inch wide) and applied evenly over the skull, from side to side, and then from back of the neck to the orbit, may be of great use. Care in the use of pressure should be exercised, not to produce compression of the brain. If pressure is tolerated, and health good, the prospect is better. Generally the fluid accumulates so the straps must be loosened in two or three days. This process should be managed by .a physician. Tapping is sometimes resorted to, and, also, sometimes after the re- moval of the fluid, a solution of Iodine, one-third of a grain, and Iodide of Potassium one grain, to an ounce of distilled water, is injected into the cavity of the arachnoid membrane. This requires a physician. I can see no indication for irritating applications. Attention to the general health is necessary. Constipation of the bowels should be relieved by an occasional purgative, as a half teaspoonful of Rochelle Salts; three to five grains of Calomel, or a teaspoonful of Castor Oil. (The disagreeable taste of Castor Oil is removed by mixing it with an equal quantity of pure Glycerine and flavoring with a couple of drops of Oil of Cinnamon or Wintergreen, The diet should be of the breast milk, with Cream or Cod Live?" Oil, and raw meat minced fine. The treatment of acquired dropsy of the brain will be noticed in the •diseases leading to this affection. Generally there is but little encourage- ment for treatment. Diuretics are called for. Iodide of Potassium and Acetate of Potash, are the best; the dose of the former is one or two grains, and the latter three to six grains, four to six times a day. Blistering should be produced behind the ears with the Blistering Col- lodion. Active congestion will call for cold to the head, cathartics and Bromide of Potassium in doses of five to ten grains, three or four hours apart, for a child a year old. Constipation should be relieved. TETANUS. TRISMUS. LOCK-JAW. A painful disease, the leading symptom of which is persistent spasm of the voluntary muscles. When the muscles of the lower jaw are affected it is called trismus, or lock-jaw. The disorder is chiefly occasioned, either by exposure to cold or by some irritation of the nerves resulting from local injury, particularly of tendinous pa X (example in the hand or foot,) it is then called trumatic tetanus or trumatic trismus. The amputation of a limb, or the pulling on a nerve by some ligature used in tying some of the blood vessels, cut into either accidentally, or during some surgical operation. When it takes place in consequence of such a cause, or from any other external injury, the symptoms generally set in about the eighth day, sometimes later, 134 THE BRAIN AND NERVOUS SYSTEM. but when they follow exposure to cold, they usually set in much earlier. In some cases the attack comes on suddenly, and with extreme violence, but it more generally approaches gradually, a slight stiffness being first experienced in the back of the neck, with an uneasy sensation at the root of the tongue, and a difficulty in performing the act of swallowing, an oppressive tightness is complained of across the breast or in the chest, with a pain at the ldwer end of the breast bone, or in the pit of stomach, extending into the back, the breathing is hindered, the face pale, pulse small, bowels constipated and urine high-colored; a stiffness takes place in the lower jaw, which soon increases to such an extent, and presses the jaws so closely together that the smallest opening is unattainable, and now the patient has the lock-jaw. In some cases the spasmodic contractions proceed no further ; in others they return with great frequency and intense severity, and, also, extend to the arms, the abdominal muscles, the back and lower extremities, so as to bend the body forcibly backward (Opisthotonos), even to such a degree that the back of the head touches the heels, or forward (Emprosthotonos) until his nose touches his toes, or sideways (Pleurosthotonos). Finally, the arms, lower extremities, head and trunk become rigidly extended, caused by an equal contraction of all the muscles. The tongue is, also, seized with spasm, and is, not unfrequently, injured by the teeth becoming clenched together just as it is convulsively darted out. As the affection advances, the eyes become fixed and immovable, the whole countenance is fright- fully distorted and expressive of extreme anguish, the pulse irregular, the strength completely exhausted, and a termination is put to the suffer- ings, generally, about the fourth day, in acute cases, by one concentrated spasm. In some cases, the fatal termination is protracted considerably beyond the stated period. The spasmodic action does not continue unremittingly, the muscular contractions occasionally admitting of some abatement, but is generally renewed as soon as the patient makes an effort to speak, drink or move. Prognosis. — This disease is so intractable, that under any known treatment, the most stolid practitioner can but consider the attack as unfortunate in the extreme, and his prognosis must be unfavorable, although not always fatal. ALLOPATHIC TREATMENT.— "Lock-jaw" is so dangerous an affec- tion, that none would scarcely venture to assume the responsibility of the treatment, and, unless he be a physician, such a person would be fool- hardy. Most, if not all plans of treatment, prove unsuccessful in a large pro- portion of cases. The remedies, which appear to be most successful, are: Bromide of Potassium and Hydrate of Chloral. Forty grains of Bromide of Potassium, dissolved in water with syrup or sugar, should be given every two or three hours, or a dram (sixty grains) every three or four hours apart, during the day, until half an ounce (two hundred and forty grains) has been given ; double this amount maybe necessary. At bed time, a full dose of Chloral Hydrate, forty grains, dissolved in water with syrup or sugar, should be given for the purpose of securing sleep. In the morning, thirty grains of Chloral may be given, if the temperature reaches one hundred and one degrees Farenheit. LOCK-JAW. 135 Nitrite of Amyl has been used with success in a very limited num- ber of cases. It appears to control the spasms, and may be administered by inhalation, three to six drops on a handkerchief. A fullness of the head dictates the removal of the handkerchief. It should be repeated sufficiently often to relieve the spasms. I would recommend giving Chloral Hydrate at bed time, as directed above, even if the Nitrite is depended on. Calabar Bean.— Of late years this remedy has come largely into vogue in the treatment of tetanus. Out of fifty nine cases treated with this drug thirty-two recovered. Dr. Fraser recommends beginning with one-third of a grain of the extract by subcutaneous injection, and increase the dose continuously until the reflex excitability is sensibly diminished, then continue the injections at that dose. In milder cases, the medicine may be continued by the mouth in doses three times as large as the largest given by hypodermic injection. It is possible that if a good qual- ity of extract could be used every time, the result would be better. In all cases attention should be strictly paid to nourishing the patient and so support the powers of life. Four ounces (one-fourth of a pint) of good rich milk, with brandy, should be given every four hours, and a raw egg, beaten with milk and brandy, four times in the twenty-four hours. In cases of trumatic tetanus (caused by injury), all remaining sources of irritation, such as fragments of bone, bullets, pieces of cloth, or any- thing else, should be removed. Oftentimes the surgeon is justified in amputating the injured part, as a means of cure of the lock-jaw. This procedure is the more hopeful, if the spasm is confined to the jaw. Tetanus of infants is best prevented by cleanliness, warmth, fresh air and dry apartments. On southern plantations, where the disease appears endemic, it is arrested by having the cabins whitewashed with lime, both inside and out ; raising the floors up from the ground, that air may cir- culate freely under them ; removing all filth from and about the houses ,* particular attention to cleanliness of the bedding and clothing of the mother and child, and preventing any matter from the navel coming and remaining in contact with the skin. A dressing of one part Turpentine and two parts Sweet Oil or Lard, is highly recommended. A warm bath should be given the child daily. After the disease has become developed, the foregoing hygenic meas- ures should be carried out rigidly. The medicinal agents, which, in my judgment, are preferable to all others, are the Bromide of Potassium and Hydrate of Chloral, given after the same manner as directed for adults. The dose for an infant would be three grains given every two or three hours, which may be increased to five, or even ten grains, if the spasms are not relieved. When desirable to produce sleep, I would give two grains of Hydrate of Chloral with the Bromide of Potassium, every hour, until sleep takes place. After a couple of doses of the Hydrate of Chloral, if sleep has not taken place, the dose should be gradually increased until five or six grains are given, or until the desired effect is reached, namely, sleep. Eight scruples of the Bromide of Potassium, dissolved in two ounces of simple syrup, contains ten grains to a teaspoonf ul. Of this mixture, one-fourth 136 THE BItAIN AND NERVOUS SYSTEM. of a teaspoonf ul will be a dose to begin with. Six scruples of Hydrate of Chloral, dissolved in two ounces of syrup, gives eight grains to the tea- spoonful, and one-fourth of a teaspoonf ul the dose to begin with. If the spasms are so severe that the child cannot swallow, I would not hesitate to give at once, by injection into the bowel, a teaspoonf ul of the Bromide of Potassium mixture and a half teaspoonful of Hydrate of Chloral mix- ture. The disease is very dangerous, too dangerous to be treated without a physician. A blister, the size of a dollar, over the navel, is said to be useful when the disease does not yield to remedies by the mouth. The spine may also be thoroughly rubbed with some stimulating appli- cations, as turpentine, or hartshorn liniment. Brandy should be given in doses of ten drops to half a teaspoonful, with milk or beef essence, at short intervals, to prevent the rapid exhaus- tion of the patient. HOAKEOPATHIC TREATMENT.— Aconite is useful in lock-jaw, where there is frequent alternation of red and pale face, with distorted eyes, thumb turned into the palm of the hand, and the hand clenched, pulse full and bounding. Arnica. — In cases arising from an injury, such as bruise or cut of the flesh, or the puncture of a needle, pin, hay-fork, or like sharp pointed instru- ment, it should be given internally, ten drops in a quarter glass of water, two teaspoonfuls every hour, or half hour, if the case is urgent, at the same time it should be applied externally to the wound ; take one part Tincture Arnica to five parts water, moisten a soft cloth, and keep it on the parts injured. Opium is a useful remedy in some of the severest forms of tetanus, as well as lock-jaw, either from an injury or cold. The muscles of the whole body tremble, there is foam at the mouth, and finally the w T hole body is bent backward, in the form of an arch, when Opium is useful. Nux-vomica, or Strychnia. — When there are extremely severe spasms, followed by a short period of relaxation, then another spasm at periods of three to six minutes. Belladonna.— In attacks of trismus among children, when a jar of the bed will bring on a spasm. DELIRIUM TBEJIEXS. This is a disease frequently occurring in persons who are in the habit of using intoxicating liquors, even when they do not drink enough, at any one time, to become intoxicated. It is a dangerous disease, which frequently destroys life, or causes a state of insanity. Symptoms: It usually commences with some degree of nausea, vom- ting, and loss of appetite, especially for breakfast, which is, sooner or later, followed by constant wakefulness, incessant talking, walking about restlessly, and, sometimes, raving from the first. There is a constant trembling and unsteadiness of the limbs ; the hand is unsteady ; the tongue is tremulous when protruded ; the walk is staggering , the skin is cold, and the pulse is weak and rapid. As the disease progresses the symptoms become worse ; the patient is not silent for a moment; he is constantly talking, scolding or laughing ; DELIRIUM TREMENS. 137 changing from one thing to another, rapidly; arranging his clothes, room, bed, etc., with more or less agitation and mental suffering. He imagines the presence of things which he knows are mere illusions, or they may appear so real as, for a time, to make him actually believe that they truly exist; but, most generally, this deranged perception may be explained away, for the moment, by some kind friend. Among these imaginary objects, are: rats, mice, serpents, fiends, witches, guns, dragons, bugs, insects, etc., to free himself from which, he will have the most fearful struggles, with expressions of disgust, distress, and even fear and horror. It is impossible to name the various fancies which he creates ; at one time laughing, at another begging, with tears in his eyes, for life; then humbly asking pardon for some imaginary wrong. Again, pointing, with raving expressions, to the objects conjured up in his disordered mind; and, finally, raving almost like a maniac. His eyes are bloodshot and in constant motion, with a peculiar glare, glancing fearfully and suspiciously at every object around him; the coun- tenance is usually pale, haggard and distressed, the tongue coated with a thick, yellowish mucus, the head hot, and the bowels costive, with occa- sionally nausea and vomiting. If the patient is not relieved, he becomes worn out, and is compelled to lie down from sheer weakness, and may die suddenly, in an apoplectic or epileptic fit, or, he may gradually sink, the surface becoming cold, with clammy sweats, low, muttering delirium stupor, picking at the bedclothes, twitching of the tendons, and death. Sometimes the first symptom is an epileptic fit, or apoplexy, on recovery from which, well marked delirium tremens occur. The development of the disease most frequently follows a sudden abstinence from the use of liquors, among those who have become addicted to their excessive use, by which means the brain becomes excessively weakened and impaired. It likewise frequently happens, while the person is in the full tide of his "spree," and also, occasionally, after a continued but moderate use of alcoholic drinks. It usually comes on, in from one to five days, after the discontinuance of the inordinate alcoholic excitement. In the treatment of a patient with delirium tremens, opposition and the use of force should be avoided as much as possible, because they give rise to irritation, and increase the difficulty. Gentle and persuasive measures are the best, with a degree of firmness ; and at no time must you yield to the fancies of the patient, but rather reason or laugh him out of them. This course will accomplish much more than an opposite one. Take of the Sulphate of Quinine eight grains, Sulphate of Morphia one grain, mix and divide into four powders; one of these powders should be given every hour, for two or three doses; afterward, lengthening the time, so that too much Morphine be not given. Give the patient, shortly after the first powder, a tablespoonful of good brandy, in water and sugar, as a reward for a promise from him that he will lie still and try to go to sleep; repeat, if need be, until he does sleep; then let him rest three hours; after he awakes, give light food. ALLOPATHIC TREATMENT The success of treatment in this disease, attendedwith prostration, depends on nourishment,relieving the restlessness and inducing sleep. Milk, raw eggs, beef essence, or strong beef tea, should 13S THE BRAIN AND NERVOUS SYSTEM. be freely given. Both these ends are aided by the administration of Quin- ine, in two or three grain doses every three or four hours. The nervous- ness and restlessness, preceding the active delirium, is best relieved by the Bromide of Potassium, during the course of the disease ; it is, also, equally useful to relieve the same symptom ; but, to be effectual, it must be given in closes of forty to sixty grains, every four hours, dissolved in water or syrup- For the production of sleep, there is no remedy so uniformly suc- cessful as Hydrate of Chloral, given with the Bromide of Potassium, in doses of twenty to thirty grains. In old drunkards, it should be used with great caution. After a second dose of thirty grains of Chloral, if sleep is not induced, Morphine, in doses of one-third of a grain, may be given, and repeated, if necessary, in two or three hours. It is best given by hypoder- mic injection. However necessary sleep and quiet is, it is still more necessary to establish digestion, and support the powers of life, by suitable nutrition. In most cases, this, of itself, will quiet the delirium, induce sleep and carry the patient to recovery. Digitalis is found useful in this disease, in doses of a teaspoonful, of the tincture, or a tablespoonf ul of the infusion, made to two drams of the leaves to a pint of hot water. After four hours, the dose may be repeated. Pouring cold water on the head, and the free use of hop tea, are frequently of advantage in quieting the delirium. The patient should be treated kindly, and left in charge of an attend- ant in whom he has confidence. Visitors should be excluded from his room. Treatment of Alcoholism.— The chief point in the treatment of the mania for drink is to enforce at once total abstinence; this is more easy than to practice moderation. The sleeplessness may be guarded against by forty to sixty grain doses of Bromide of Potassium at bed time. If necessary, with this can be com- bined fifteen to twenty grains of Hydrate of Chloral, or two teaspoonf uls to a tablespoonful of Tincture of Hyoscyamus, gradually diminishing the dose as the symptoms disappear. Tonics should also be given. Of these the Citrate of Iron and Quinine, in doses of five grains, dissolved, in water or syrup, two drams and a half to eight ounces. Dose: A dessertspoonful three times a day. The Phosphate of Zinc, with extract of Nux Vomica in pill form, a quarter of a grain of the former, and a quarter to half of a grain of the latter, and one grain of Quinine, three or four times a day, will aid greatly in restoring the nervous system to a healthy state. The diet should be strong and nourishing, consisting largely of milk and eggs, beans, oatmeal, wheat and vegetables, with an absence of lean meat. This rule of diet should be observed after health is established. There is no more deplorable practice, both among physicians or in domestic practice, than the frequent giving or taking of alcoholic stimu- lants. It is not to be doubted that a habit of using liquors as a beverage not infrequently begins by "taking a little brandy and water occasionally," or " a glass or two of wine," for low spirits or a temporary indisposition. The practice is both harmful and useless. HOMOEOPATHIC TREATMENT.— Arsenicum. Pale, yellow com- plexion; bloated face, and cold, blue skin; fainting fits, particularly during vomiting. The patient imagines that vermin are crawling about the bed, EPILEPSY. 139 and ugly animals are staring him in the face. Great restlessness and fear of death. Extreme thirst; drinks little and often. Dose: Six pills to a tablespoonful of water, one teaspoonful every thirty minutes. Belladonna. Persons of a full, plethoric habit of body. Flushed face and red eyes, with dilated pupils. Boisterous delirium, with desire to escape. He tears the clothes, strikes, bites and shrieks, in his rage. Sud- den starting and jumping, while sleeping. Dose : As for Arsenicum. Camphor, Features distorted ; eyes sunken ; face, hands, and feet, icy cold. Confusion of ideas; maniacal delirium; convulsions, frothing at the mouth, and insensibility. Retention of urine, with constant desire to pass water. Dose : A drop or two, on a little lump of sugar, every hour. Hyoscyamus. Twitching and jerking of the muscles, especially of those about the face and eyes. Furious delirium, with wild, staring look ; dilated pupils, and throbbing of the carotid arteries. Grasping at imagin- ary objects; muttering. Dose : As directed for Arsenicum. Nux Vomica. Trembling of the limbs, and spasmodic twitching of different parts of the body. Incapable of thinking correctly. Makes fre- quent mistakes in talking. Delirium, with frightful visions, and efforts to escape. Very irritable, and wants to be alone. Constipation with large and difficult stools. Apprehensive of death. Dose : Double that recommended for Arsenicum. The best remedies for the inclination to drink, and the evil effects of drunkenness, are Ars., Nux.-v., SulpJi. EPILEPSY. MORBUS DIVINAS, MORBUS HERCULEUS. This is a disease marked by sudden and temporary seizures of un- consciousness, accompanied by convulsions, and is one of the most terrible diseases that afflict mankind. There are so many varieties of epilepsy that it is impossible to give a definition of the disease that will apply to them all. In most cases it is characterized by convulsions and loss of con- sciousness, occurring at longer, or shorter intervals, during which the patient is almost in good health. The absence of fever in epileptics serves to distinguish their affection from meningitis, and other inflammations accompanied by convulsions. The complete loss of conciousness, also, dis- tinguishes epilepsy from hysteria, as in most nervous diseases, a heredi- tary tendency is among the most frequent predisposing causes of epilepsy. Epilepsy often appears in the offspring of persons who have had various nervous complaints, such as epilepsy, insanity, paralysis, apoplexy, and hysteria. There is no doubt that women are much more frequently attacked with this disease than men. The most frequent periods at whicli epilepsy begins are: early infancy, and puberty, although no period of life is exempt from its first attacks. Various malformations of the body, and especially of the cranium, are certainly among the most frequent predis- posing causes. Weak constitutions are favorable to the production of 140 THE BRAIN AND NERVOUS SYSTEM. epilepsy. Among other predisposing causes, are dentition, the first appearance, and the cessation of menstruation, onanism, and the abuse of alcoholic drinks. Almost all kinds of diseases may produce epilepsy, but among the principal we must place those affections in which the blood becomes altered, or diminished, and organic affection of the eerebro-spinal axis, and of certain other parts of the nerve centers. Another powerful cause is excessive loss of blood. Pregnancy, parturition (confinement), menstruation, frequently cause epilepsy. A tumor, or a nerve, or any cause of irritation on the trunk, or the terminal part of any sensitive nerve, and especially, in the skin, or mucous membrane very often pro- duces it. A wound, a burn, worms in the bowels, or elsewhere, stone in the bladder, or in other places, foreign matter in the ear, etc., are known to have caused epilepsy. It is quite certain that great mental excitement has originated it in many cases, but it seems probable that the disease was not introduced by those causes, but was only brought on by them to man- ifest itself. When a fit is about to take place, it is usually preceded by some sensa- tion, or some change in the mind of the patient. If a sensation precedes the fit, it comes most frequently from some part of the skin, and especially from that of the fingers and toes. This sensation is well known under the name of aura epileptica. There is as much variation in the variety, and intensity of the sensation, as in its point of starting. Most frequently the aura is a sensation of cold, or burning, or that kind of sensation produced by a draft of cold air on limited parts of the body. Sometimes the aura starts from the eye or the ear, and then a flash of light, or some other sen- sation comes from some part of the eye, or peculiar sounds are heard. The stomach and bowels are also often the starting point of the aura. Some epileptics become gay, others mournful when they are about to have a fit ; in others, the attack is announced by some change in the digestive func- tion. A complete attack usually begins with an extreme paleness of the face, and at the same time, or nearly so, there are contractions of several muscles of the face, the eye, and the neck. Observers do not agree as regards the first manifestation of a fit, probably, because the seizure does not always begin with the same phenomena. Not only have we known the first symptom, not to be the same in different epileptics, but in the same one we have seen differences, in three different attacks. Many phy- sicians think the scream, the first symptom. It often is, but the pale- ness of the face usually precedes it. Some epileptics do not scream; as soon as these symptoms have appeared a rigid spasm takes place in the limbs, and the patient falls. Respiration is suspended, and the face becomes quite injected with black blood, and assumes a hideous aspect, both from the spasm of its muscles and its blackish or bluish hue. Some- times a momentary relaxation is then observed in the limbs, but all at once clonic (jerking), convulsions occur everywhere in the trunk, the limbs, the face, and often in the various internal organs, as the bladder, the bowels and the uterus. The mouth then ejects a frothy saliva, often reddened with blood from the bitten tongue. The respiratory muscles, after the first spasms which produce the scream, and suffocation, causing a gurgling or hissing sound, become relaxed, and then those employed in inspiration contract, EPILEPSY. 141 and almost as soon as air has reached the lungs, the convulsions cease or notably diminish. Ordinarily the fit is over in a few minutes, but it is not unfrequently the case, that after a general relaxation, another seizure comes on, and sometimes many occur with very short intermissions. During the whole time the fit lasts, the patient is deprived of conscious- ness, and when he recovers he remembers nothing that has taken place in the meantime. In some cases, the seizure is followed by prolonged coma, (insensibility) ending sometimes in death. When a patient recovers from a fit, even if it has not been very se- vere, he usually feels fatigue and suffers from headache. Fortunately he- soon falls asleep, and ordinarily is almost as well as usual, when he wakes up, except that the headache and fatigue still continue, though much diminished. When many fits have taken place, even at some- what long intervals, such as several weeks mental derangement often supervenes, and in this way epilepsy often leads to insanity. In some cases the fits recur at regular periods, in others they return with every return of the circumstances which seem to have caused the first, such as menstruation, pregnancy, the influence of certain seasons, etc. There is sometimes, although seldom, perfect regularity in the length of the inter- vals between the fits, and they come every day, every week, every month, etc., at irregular hours. Many patients have very different intervals between their successive fits. Some have many fits a day, others every six months or every year. The greater the number of fits, the less violent they generally are. In the complete fit of epilepsy, there are two distinct features. 1. The loss of consciousness. 2. The muscular convulsions. Each of these may exist alone. In the case of a seizure, consisting only in the loss of consciousness, without convulsions, we have the so-called epileptic vertigo, which is a form of epilepsy which frequently exists alone, and also co-exists often with the form of the disease in which the attack is complete. In this last case, the patient sometimes has a complete seiz- ure, sometimes only an attack of vertigo. Whether vertigo exist alone or co-exists with complete attacks, it is very dangerous, not for the life of the patient, but because fits of simple vertigo lead more frequently to insan- ity than complete fits of epilepsy. The cases of epileptiform convulsions, without loss of consciousness, are not so frequent as the cases of simple vertigo. They are particularly produced by injuries to the nerves or spinal- cord. The first thing to be done for an epileptic fit, is to find out, if possible, the cause which produced the attack, and, if it still exists, try to get rid of it. Very often epilepsy depends on some external cause of irritation, which may easily be removed. It is of the greatest importance to discover if there is anywhere such an irritation, and as the patient may not be aware of its existence, it is necessary to look for it everywhere. This is a proper place to point out the fact, not generally known among the masses of the people, that onanism or self-abuse, among children and young people of both sexes, is one of the most prolific causes of this truly terrible disease, and if the patient can be induced by any means to break away from the practice in any reasonable time, the epilepsy is virtually cured. Parents should not rest easy under the impression that their children would not be guilty of such a thing, but know to a certainty that such is not the case. My 142 THE BRAIN AND NERVOUS SYSTEM. young friend, troubled with epilepsy, you know whether this is one of your habits, contracted by the influence of companions in school or elsewhere, and if such is the case, you may rest assured, that if you continue in the habit, absolute and certain ruin of your body and mind are the inevitable consequences. Patients and their families should remember that the rules of hygiene must be followed much more closely by epileptics than by those afflicted by almost any other disease. ALLOPATHIC TREATMENT. The treatment of Epilepsy will have reference to the management of the paroxysms (fits,) and, also, to measures for effecting a cure, which are to be employed during the intervals between the fits. During the fit, the patient should be laid on a large bed, or even the floor, where the fresh air can freely circulate around him. No effort should be made to restrain the convulsive movements. The necktie and all tight clothing should be loosened. A cork, roll of linen, or piece of soft wool should be held between the teeth to prevent the patient biting the tongue. Cooling washes may be applied to the head. In those cases which have a brief warning of an approaching fit (which is called the aura epileptica) the paroxysm may be warded off by inhaling Nitrite of Amyl at the beginning of the warning. The patient should carry a small vial of Nitrate of Amyl and inhale from three to five drops upon a handkerchief, when this warning or aura is experienced. The handker- chief should be removed when fullness of the head is experienced. Also those cases characterized by frequent repetition of the fits the same remedy is very useful in stopping their recurrence. It is also recommended as a means of mitigating severe attacks, but in advanced stages of the parox- ysms, it should be used very cautiously. Of all the remedies which enjoy a reputation for preventing or mitigating a fit, this occupies the first rank. Among other remedies which are recommended for the purpose of preventing a fit, Chloric Ether, Hoffman's Anodyne and Fluid Extract of Valerian, are to be mentioned ; the dose of Ether is a teaspoonful. These same remedies are, also, used to prevent the frequent recurrence of parox- ysms before alluded to ; Tincture of Belladonna or Opium are said to be useful for this end, given in doses of from fifteen to thirty drops. The physician is often led to try the inhalation of Chloroform. But all these remedies are, in my opinion, inferior to Nitrite of Amyl. If other mea- sures fail, or are not at hand, compression of the carotid arteries may be tried, first upon one side of the neck, for ten or fifteen minutes, and then upon the other side. If the convulsions are very severe, both arteries may be compressed at once. The compression is produced by pressing the artery with the finger or thumb, firmly against the spinal column. The treatment of epilepsy, as far as a permanent cure is concerned, has not been very successful. Endeavor must be made to improve the patient's general health, and to this end all the vital functions must be carefully inquired into, with all the penetration of the most skillful physician. All advanced physicians are agreed that every thing which depresses the vital powers does harm. The habits of life must be regular and moderate ; daily exercise, early hours, and plenty of sleep, quiet occupation ; atten- tion must be given to regularity of the bowels, and urinary secretion. Mental excitement should be avoided, and if the patient is a child, be EPILEPSY. 143 kept from school. The diet should be simple, but generous and nutritious, including animal food, milk and eggs. Frequent bathing, two or three times a week, should be practiced. The habits of life which are pernicious, and may stand in a causative relation to epilepsy, and are to be prohibited, are: over-tasking of mind or body, either undue exposure or sedentary habits, the free use of alcoholic liquors, or tobacco, and sexual excesses, or self-pollution. There is no better established fact in the healing art, than the benefit of the Bromides (usually the Bromide of Potassium) in the treatment of epilepsy. It is not to be understood that the remedy is infallible, but it is true that it has been m-re useful than all other remedies combined. It is well determined that Bromide of Potassium is most valuable in those cases of epilepsy which are characterized by violent and frequent convul- sions. It is also noticed, that the beneficial effect of the remedy is more marked in attacks occurring in the day time than those occurring at night. The nice discrimination, in the use of remedies in epilepsy, requires the skill of an accomplished physician. But, roughly, it maybe said, that Bromide of Potassium should be given in all cases which have a con- gested, (flushed,) or full appearance of the face, rush of blood to the head, (or more accurately, to the brain, this is most accurately determined by the physician, by examination with the ophthalmoscope). The dose of Bromide of Potassium at the beginning, should be about fifteen or twenty grains, three times a day, increasing the dose by ten grains each week, until from forty to sixty grains are taken at a dose, three or four times a day. The medicine should be continued in these doses until the peculiar effects of the drug (called Bromism,) are produced, or the fits have ceased. Bromism is shown by mental weakness, heaviness of the intellect, failure of memory, partial loss of voice, drowsiness, depression of spirits, pallor, and an eruption of the skin, and sometimes by abscesses. The remedy, if it prevents the fits, should be continued for several weeks, or even months, at the dose which has proved effectual, and gradually decreasing the dose until twenty or thirty grains are reached three times a day. The drug should not be discontinued, until fifteen or eighteen months have passed without a paroxysm. It is better for the patient to take the bro- mides all his life, than to have fits. The addition of the Bromide of Iron from one-half a grain to a grain, to a dose of the bromides, will do much to prevent the impoverishment of the blood due to bromism. The follow- ing is a good formula: Take of Bromide of Potassium, six drams: Bromide of Ammonium, two drams: Bromide of Iron, six grains: water, six ounces. Mix and give a table- spoonful three times a day. It is a good rule, even after the case has been free from fits for fifteen or eighteen months, to give a dose of from two scruples (forty grains) to a dram (sixty grains) every night for a couple of years. Many of those cases of epilepsy which are not benefited by the bro- mides, are greatly benefited by Strychnine, especially in subjects which have the lighter seizures (petit mal) as well as the severe paroxysms (grand mal), and, also, in those cases having the attack at night, though in the latter cases, if severe, the bromide will be required, also. The dose of Strychnine is one-thirtieth of a grain. It had better be given in solu- U4 THE BRAIN AND NERVOUS SYSTEM. tion, though it is disagreeable to take, on account of its bitterness. The fol- lowing is a suitable formula: Take of Strychnine one grain, dissolve in two ounces of Dilute Phosphoric Acid, and two ounces ofzoater. The Strychnine dissolves slowly, and plenty of time should be given for solution to be effected before taking it. If the appetite is poor, thirty grains of Quinine should be added to this mixture. The dose is a teaspoonful three times a day. Should it be found impossible to take this mixture, the pills of Strychnine, of one-thirtieth of a grain each, may be given instead. I pre- fer the pills of Phosphorus, one-hundredth of a grain, with Strychnine, one-sixtieth of a grain. Dose: Two pills three times a day, for a grown person. The Phos- phorus is valuable in improving the nerve nutrition. The direct Galvanic (electric) current is, sometimes, of great service, and may be used in connection with either Strychnine or the Bromides, or both. It can only be of service in essential or idiopathic epilepsy (i. e.,. cases not dependent on structural changes, or other obvious cause). The current should include the whole brain, having the poles of the battery behind each ear; or on the forehead and nape of the neck; or one pole on the nape of the neck, and with the other follow the course of the sympathetic,and, also, the nerves along which the aura, or warning, is transmitted. Each method of application may be used for one-third of the time at each sitting. If beneficial, the use of the Galvanic current should be continued for several months or a year. In some cases, it is necessary to pass a seton quite deeply through the back of the neck, in addition to the internal remedies. This is par- ticularly serviceable in connection with the Bromide. Both it and the Bromide seem to relieve the so-called reflex irritation. Cases of epilepsy caused by injuries to the skull, which is not relieved by the Bromide of Potassium, may call for surgical operation. If the patient has had syphilis or has syphilitic parentage, the Iodide of Potassium should be given either alone or in conjunction with other treatment, until all syphilitic symptoms disappear, when, if the fits cease, the further treat- ment will be that appropriate to that diseased condition, syphilis. For this complaint, medical advice should be sought. Belladonna and Hyoscyamus, are recommended by high authority. They are applicable to these cases, in which Strychnine is most useful, viz.: in epilepsy occurring at night, in the lighter fits (petit mal), and in pale, delicate subjects, with cold hands and feet, a blue skin and feeble cir- culation. Belladonna, if used, should be given as follows: One fifth of a grain of the Solid Extract of Belladonna, or a hundred and twentieth (1-120) grain of Atrophine, its active principle, each night for a month, when the dose should be doubled for the second month, trippled for the third month, and so on until as large a dose as can be borne should be reached. Trouseau speaks very highly of this remedy, and recommends its continuance for from one to four years. Hyoscyamus may be used in the same way, beginning with one-half grain of the Solid Extract. These remedies can be had in pill ; for the first month, the dose is one pill; for the second, two pills; for the third, three pills, and so on, until the largest possible dose is reached. The existence of anaemia (impoverished condition of the blood) EPILEPSY. 145 demands the use of tonics of Iron and Quinine. The Citrate of Iron and Quinine, two to five grains in syrup, before each meal. The Pyrophos- phate of Iron will be found useful in one or two-grain doses, instead of the Citrate of Iron and Quinine, if the appetite is not deficient. Cod Liver Oil is always useful in improving nutrition of the body. It should be given in doses of a teaspoonful, gradually increased to a tablespoonful. H0M(E0PATH1C TREATMENT Belladonna has, among its patho- genetic symptoms, the whole series of the phenomena which characterize an epileptic fit. It is most useful where the disease has not continued long, and has the fits rather close together, and especially if an attack of vertigo is apt to supervene ; rush of blood to the head, red and bloated face, renewal of the attacks by contact, distention of the eyes with dilation of the pupils, full, hard, and hurried pulse, sudden starting from sleep with a cry and fear, obstinate, malicious temper, desire to tear everything, to bite, spectra which cause anxiety, fear; deep sleep with smiles and distortion of the features. Dose: Six pills every morning and evening, for a week, then every morning, for two weeks; then every third morning, for six weeks; then every week, as long as its beneficial effects are apparent. Fre- quently a dose of Sulphur occasionally helps materially. Cuprum is one of the few remedies which we know positively has cured many cases. In cases where epilepsy is a primary or original dis- ease, and not merely a symptom of some other disease, Cuprum is one of the first remedies to be thought of and used. It may not be any the less suitable in complicated cases. In this latter class of cases, the accessory symptoms will be found the best guide in the selection of the remedy; probably, in cases where the disease breaks out in the night, this medicine will be found the most beneficial, the aura commencing in the extremities and moving upward, until the speech is gone. In the treatment of epi- lepsy, use the higher potencies in less frequently repeated doses. We intend this last remark to apply to all the remedies in the Homoeopathic treatment. And we may further say, that a careful arrangement of the symptoms, and careful selection of the remedy, by the use of the Reper- tory, will be decidedly the most satisfactory mode of selecting the remedy. Dose : As for Bell. Plumbum is very nearly related to Copper. Plumbum is particularly adapted to epileptic attacks with a well defined aura, or to attacks where paralytic conditions are present ; entire or partial loss of consciousness remain for sometime after the attack. Plumbum acts very slowly, but, on the other hand, its action lasts long; it is very penetrating, so it, for this, if no other reason, is suited to cases of long duration. Dose : A small powder, or eight pills, at times as directed for Bell. Coni/um, in epilepsy, arising from self-abuse. Opium, in epilepsy, arising from a fright, or where it supervenes during insanity. Rana Bufo is undoubtedly a capital agent in the treatment of epilepsy, especially if the patient is the victim of onanism, and will dis- continue the practice. Bromide of Potassium.— Three grain doses, three times dally, and gradually increased, until the dose is ten grains for an adult; dissolve in a little water. 10 146 THE BRAIN AND NERVOUS SYSTEM. ECLAMPSIA. ECLAMPSIA INFANTUM. FITS OF LITTLE CHILDREN. Eclampsia occurs most frequently at an age when epilepsy is least fre- quent; that is, during the first months of infancy, until the fourth year. Symptoms and Course of the Disease.— Eclampsia sets in without any premonitory symptoms, only when it is the first symptom of the beginning of some other acute disease. As an independent disease, it is almost always preceded by preliminary symptoms. These are: ill humor, a whining mood, obstinacy, indisposition to play, sudden starting when touched ever so lightly, without expecting it, sleeplessness or restless sleep, during which the lids are not entirely closed; a peculiar twist of the mouth, gritting the teeth, change of color from the least cause, crying out without any apparent cause, sudden relinquishing of the nipple, uneasy, unequal breathing, sometimes a peculiar livid color around the mouth and eyes, and pointed appearance of the nose and chin. After these premoni- tory symptoms have lasted for a longer or shorter time, the actual paroxysm breaks out with the same suddenness as an epileptic attack, only with this difference: the patient utters no cry. Otherwise the attack has all the characteristic features of an epileptic fit. At the beginning the convul- sions are for some time tonic, (stiff and still,) after which they become clonic, (jerking,) and in less frequent cases they affect only one side. The features become distorted, the eyes stare, generally squinting upwards, the body is tossed to and fro, but the extremities are not as stiff or rigid as they are during an epileptic fit. The breathing is hindered, the abdomen distended. The face is either blue-red and bloated, with considerable full- ness of the blood vessels, ur else it is pale and sunken, the bodily tempera- ture is rather decreased than raised. During the aeight of the convulsion the consciousness and sensibility are completely extinct. Usually the paroxysm ends with a deep, moaning inspiration, after having lasted a few minutes, or even a number of hours, and the patients sink into a deep sleep, from which they awake in apparent health. The paroxysm does not always have such a fearful degree of intensity. Eclampsia, as well as epilepsy, has a series of gradations, the attack being sometimes marked only by partial convulsions, movements of the muscles, a staring look, with some squinting and drawing up of the mouth. The consciousness remains either entirely undisturbed, or is only partially interfered with, sometimes the attack consists in a comatose soper, (death like sleep,) which lasts for hours, with the characteristic half closing of the eyelids, and a few convulsive twitchings, taking the place of the convul- sions, even the face may retain its natural expression and color. A single fit is scarcely ever the end of the trouble. In the first place, there generally remains a disposition to relapse, and, in the second place, several fits usually follow, one after the other, the intervals between the fits being of uncertain duration, and the intensity varying in degree, sometimes increas- ing, at others decreasing in violence. Eclampsia may terminate in recovery, partial recovery, or death. Recovery may take place after any fit, sometimes quite unexpectedly, so that a child may be playing about one morning, which the day before was the victim of terrible fits. In partial recovery, some of the symptoms either remain permanently, or disappear only gradually. In such cases it is a question whether such remaining symptoms are not the result of FITS OF LITTLE CHILDREN. 147 disease of the brain, which may, also, have been the cause of the fits. Among such remaining symptoms, we mention paralysis of the eyes, less frequently the muscles of the back, idiocy, or only a certain degree of backwardness in the development of the mental faculties, and an unusual degree of nervous irritability. Death results, either during the attack, or else the death like sleep (coma,) terminates in death. The prognosis depends on many accessory circumstances, and is always doubtful. Age is an important consideration; the younger the child, the more likely they are to die, especially infants at the breast, but even they frequently recover, if the treatment is in careful hands. Where the disease is inherited, there is little probability of recovery. The more rapidly the fits follow each other, the more danger there is, especially if they contin- ually increase in violence. Convulsions, setting in at the commencement of some acute disease, are scarcely ever dangerous. If they set in during the course of the disease, they are more dangerous; they generally mean death. For Allopathic treatment, see convulsions of children, Chap. XXXIV. HOMCEOPATHIC TREATMENT.— Belladonna is, without doubt, the main remedy in eclampsia. It is particularly indicated in the case of robust, fleshy children, who show unmistakable signs of congestion of the l)rain, with very red face, the pupils expanded, the eyes stare, or constantly vibrate, the lower jaw firmly pressed against the upper, the head drawn backward, possibly the urine may be discharged involuntarily. Hyoscyamus acts very similarly to Bell. The sight of the eyes con- tracted, face dark red and bloated, the walls of the abdomen drawn firmly in, and the attack being caused by a fright, are indications for the use of Hyosc. Cuprum. See indications under Epilepsy. Ignatia. If the attack is sudden and violent, the fit being more free from jerking than common, if the spinal cord appears to be the seat of the disease, that is an additional indication for Ignatia. Chamomillais seldom useful for the fit, but may be needed to remove trouble with the bowels, before or between the fits. The child moans and worries, and wants to be carried. Cina, or Santonine, if the attack arises from worms. (See worms.) CATALEPSY.— TRANCE. We mention this disease, only because you expect us to, and can only say that it is one in which the consciousness and the voluntary motion of the muscles is suspended ; though they retain the faculty of passive motion. There are very few well established cases on record. It is very generally conceded, among physicians, that no treatment yet known amounts to anything. It may be necessary, in order to main- tain life, to inject food into the rectum, or, by means of the stomach pump, into the stomach. 148 THE BRAIN AND NERVOUS SYSTEM. HYSTERIA, OH HYSTERICS.* It is not only difficult, but almost impossible, to furnish a satisfactory and sufficiently comprehensive definition of hysterics. It is a nervous spasmodic affection common to females, but known by some other name, when it appears (as it rarely does) among males, usually as hypochondria. It attacks pregnant as well as non-pregnant females, and however alarming any single attack may appear, it is, in fact, seldom attended with any danger, unless it should pass into epilepsy. Symptoms : Usually the lady, from a calm or excited condition, but in which no symptoms of disease are shown, by an unwise word, and often from no apparent reason, commences crying and laughing at intervals, perhaps, also, venting reproaches ; peal upon peal of immoderate crying and laughter, sobs, floods of tears, stolid silence, wringing of hands, tearing of hair, stiff (tonic) convulsions, clonic (jerking) spasms, and smiles, are all irregularly combined and followed by a profound calm of the constitution, and a feeling of complacency. During these symptoms the female, at the commencement, is attacked with a sense of tightness about the throat, with throbbing, or repeated attempts at swallowing. Sometimes a sensa- tion as if a ball passed upward to the throat and lodged there, is experi- enced, and which is called the " globus hystericus.'' She may roll about from side to side, or she may lie perfectly still and motionless. She fre- quently presses her hands to her breasts or carries them to her throat, as if to remove some pressure or obstruction, the face is, usually, pale, though not always, and is not distorted ; no froth issues from the mouth, nor are there convulsive motions of the lower jaw, but the large muscles of the back are violently contracted, so as in many instances to cause the body to describe an arch backward. The trunk of the body is twisted forward and backward, the limbs are variously agitated, and the fists are firmly closed. Sometimes there is obstinate constipation and retention of urine; gener- ally, however, the urine is pale and copious. The paroxysm continues for a longer or shorter time, the sobbing becomes more violent, or the patient screams and sheds tears, and thus the fit ends. Sometimes they will lie apparently insensible and immovable for a longer or shorter time. The attack is often preceded by dejection of spirits, anxiety, yawning, shedding of tears, difficult breathing, nausea, palpitation of the heart, numbness of the extremities, etc. It is not uncommon for ladies affected by this terribly annoying dis- ease, to complain of dreadful and excruciating pains in the hips, knees, spine, etc., with great tenderness to the touch, and which is owing to the severe muscular contraction caused by the spasms, rather than by any dis- ease of these parts. Sometimes a species of paralysis accompanies hyste- ria, and, occasionally, ladies will imagine many strange things, and even practice more or less deception, speaking in a whisper, pretending to vomit blood, meat, etc. In some women, and especially during pregnancy, with a very slight warning, they may be attacked with a severe fit of hysterical convulsions * I believe that the common opinion, that hysterics amounts to nothing, has done a vast amount of mischief in the world, aside from all the actual suffering it has caused. I wish to say, once fur all, that hysteria is as much a disease, and as real in every sense as small-pox, but a little more under the control of the will, if the disease has not already overpowered that, too, which it does in many cases. HYSTERICS. 149 •which may occur daily, every other day, or at longer intervals, and which, if not removed, will induce miscarriage, which usually occurs at the time of a fit. Causes. Hysteria is a disease that attacks only women, after the beginning of menstruation, and may be produced by various causes, as: want of sleep, excessive fatigue, disordered digestion, sudden mental shocks-, as, joy, fear, grief, etc., excitement of the reproductive organs, onanism, excessive sexual intercourse, or, more frequently, abstemiousness among unmarried or widow ladies. Females of a nervous, irritable tem- perament, are most likely to be attacked. The paroxysms occur more fre- quently about the monthly period than at any other time. Excessive dis- charges, or debilitating diseases, frequently give rise to attacks of hysteria which occur during convalescence, and are renewed frequently, and from the slightest causes. Hysteria may be distinguished from epilepsy by observing that, in the former, there is no frothing at the mouth, no protrusion of the tongue, and after the paroxysm is over, the patient recovers her usual state, and does not fall into a sleep as in epilepsy. It may be distinguished from apoplexy by observing that in this the patient loses consciousness and voluntary motion first, and finally all motion ceases, and the breathing is stertorous. From puerperal convulsions, by observing that in these, the action of the muscles are violent and irregular, the head is strongly rotated to the right and left, and backward, with violent jerking convulsions of the mus- cles of the back, abdomen, and upper and lower extremities, spasmodic action of the muscles of the face is rapidly repeated, the lips and teeth are firmly closed, the breathing is loud and hissing, the tongue is very livid, protruded forward, and often bitten so that the blood and saliva is thrown to some distance through the compressed lips, the face becomes livid and the attack usually occurs in first labors, among females with short, thick necks. HOMOEOPATHIC TREATMENT.— The medicines which offer the closest similarity to the symptoms of the fits, when they occur, and which are most successful in restoring the patient during the paroxysms, may, in many cases, be administered in repeated doses, for the pur- pose of overcoming, or, at all events, of moderating the predis- position. It should, also, be borne in mind, that if this condition be associated with other derangements, the treatment which is particularly appropriate for such derangements is also the best preventive and eradicative resource. There are, however, a few medicines which are especially and particularly applicable to the removal or modification of this constitutional tendency ; these, however, we shall simply enumerate, with their chief and characteristic indications. Sepia is, in the great majority of cases, the medicine upon which the chief reliance can be placed, more particularly if the patient has been affected with green-sickness, whites, or with other chronic derangements, or diseases of the womb and its appendages ; or, again, when she is liable to be seized with sudden attacks of debility, approaching to general but temporary palsy, and attended with outbreak of profuse and often clammy perspiration. 150 THE BRAIN AND NERVOUS SYSTEM. Dose: Four globules in a teaspoon ful of water, every night at bed time, for ten days (unless change should sooner occur); then pause a fortnight, after which the course may, if necessary, be repeated as before, and so on, from time to time. Calcarea Carbonica, on the other hand, is more especially appro- priate for the treatment of persons of an attenuated, sickly-looking frame, and pale, wan, sunken countenance, with whom the general convulsion attending the attacks is very violent, and who are subject to fainting- fits, or to an habitually impaired and capricious appetite, the menstrual discharge occurring too frequently, and in excess. Dose: Four globules, as directed for Sepia. Natrum Muriaticum is to be preferred, also, in cases in which the countenance is sickly, pallid and sunken, but more particularly when there is an habitual dislike to society, and when constant gloom, sadness, or despondency is apt to affect the patient; whilst feeble powers of diges- tion, and prevailing chilliness, with occasional flushing of the face, and retarded menstrual discharge, further characterize the case. Dose: Four globules, as directed for Sepia. Veratrum is of much service in overcoming the constitutional ten- dency to hysterical attacks, as well as in modifying their immediate vio- lence, in cases in which they are attended with clenching of the jaws, or general spasm, coldness of the extremities, and clammy sweat, especially on the face and forehead. Dose: Three globules, as directed for Sepia. Treatment of the Attack. Belladonna is appropriate when the paroxysms are characterized by, and commence with, a sensation of chok- ing, with spasmodic closing or obstruction in the throat, and every sensa- tion as if suffocation would ensue; the face being hot, bloated, and of a dark-red hue, and there being other indications of determination of blood to the head ; or, when, as the paroxysm proceeds, the eyes become prom- inent, wild, and staring, and the pupils much dilated; or, when, again, during the intervals between attacks, the patient habitually sleeps in a disturbed and restless manner, suddenly tossing in, or even starting from, sleep. Dose: When the sensations of an approaching attack are apparent, give two globules in a teaspoon ful of water, repeating the dose after the lapse of a quarter of an hour, and again half an hour later, if the symptoms do not sooner subside ; or, again, after the subsidence of the attack, or during the momentary intervals of calmness, give similar doses from time to time. After the attack, the doses should be repeated every six hours, for twenty-four hours. Ignatia is of great value for the treatment of hysterical paroxysms affecting patients of a mild and very sensitive disposition, or those who are subject to extreme variations of spirits, and when the attacks are apt to be somewhat suddenly announced by convulsive laughter, provoked by some slight or imperceptible cause; the face, previously pale, becom- ing flushed, deep-red, or even livid, and the laughter terminating in screams ; or, more especially, when the attack is preceded by the sensation of a ball in the gullet, which gives rise to a feeling of suffocation, attended with spasmodic eructation ; further, when convulsive movements of the extremities, with clenching of the thumbs, occur during the paroxysm ; or when, again, there is alternation of flushing and pallor; or when the HYSTERICS. 151 patient is affected with frequent fits of yawning, or with drawing of a deep breath upon recovery. Dose; Two globules, as directed for Belladonna. Pulsatilla is appropriate for the treatment of patients of mild and sensitive or exceedingly timid disposition, or of phlegmatic or lymphatic constitution, and when there is an habitual or very frequent derangement of menstruation, or, more particularly, with predominant derangement of the organs and functions of digestion at the period of the menstrual dis- charges, and when the attacks are characterized by tearfulness or fits of crying without any ostensible cause. Dose : In all respects as directed for Belladonna. Gelseminum should be given when the hysterical paroxysms assume the proportions of convulsions ; there are : excessive irritability of body and mind ; a semi-stupid condition, with languor and prostration; nerv- ous headache, commencing in the back of the neck, and thence spread- ing over the head; vertigo and dimness of vision; difficult menstru- ation . Dose : As directed for Belladonna . Stramonium may be named as especially appropriate when the attacks are characterized by the predominance of hiccough and are at- tended with convulsive movements of the arms, and with an expression of extreme exhaustion or of vacancy, and difficult articulation ; or some- times with violent raving, sudden desire to remove, as if from the reach of some fancied danger, and with alternations of crying, or even discordant attempts to sing, and violent convulsive laughter ; or when, again, the violence of the attack is liable to be re-induced or aggravated by the sight of shining or glistening objects. Dose: As directed for Belladonna. Nux Vomica is preferred when the patient is habitually of an irritable disposition, or of nervous or bilious temperament, and of costive habit — or generally, of a meagre frame and pointed features ; the attacks being preceded or accompanied with twitchings of the limbs or of partic- ular muscles, and when a vexation or disappointment has been the excit- ing cause of the attack. Also when stimulants of various kinds have been too freely employed from time to time. Dose : In every particular as for Belladonna. Veratrum is generally to be recommended when the attacks are characterized by clenching of the jaws, or general spasmodic affection of the entire frame, coldness of the extremities, and clammy perspiration, especially on the face and forehead, and when a considerable quantity of pale urine is generally voided before or after the attack. Dose : As directed for Belladonna. Coniam should be administered when there is much vertigo, partic- ularly on lying down ; she cannot turn in bed, without exciting great dizziness. The breasts swell, and become painful and hard, as the men- strual period approaches, at which time the hysterical symptoms are usually developed. Choking sensation in throat, as though a ball were ascending from the stomach. Dose: In every particular as directed for Belladonna. Moschus. Violent, long-continued scolding, until she falls down in 152 THE BRAIN AND NERVOUS SYSTEM. an hysterical paroxysm. Great anguish ; she feels as if she must die, and insists that she will die. Feeling of constriction or tightness on the chest during the paroxysm. Dose: As directed for Belladonna. CaiilophylnmvriM prove of value in some cases, when the hysteria can be traced to disordered condition of the menstrual flow, or to some disease of the womb. Dose: As directed for Belladonna. HOME MEASURES. Above all things, it is necessary that any portion of the clothing which may fit tightly should be loosened as an attack ensues, or threatens to ensue ; all strings and fastenings should be undone. Whatever may tend to impede the circulation should be removed, and the patient should be stretched out in a recumbent position, (the floor being the safest and best place,) beyond the reach of any article which she might strike against in the convulsive movements. A free current of air should then be admitted, and the face of the patient should be sprinkled with cold water. Friction of the wrists, ankles, and palms of the hands, is often also of service. General Remarks. In order to overcome the constitutional ten- dency to hysteria, a long and judicious course of treatment is always required in inveterate cases. Persons who aresubject to hysterical attacks should avoid tight lacing, or any articles of clothing which fit too closely and firmly round the body. Elastic jackets are much to be preferred to corsets. They should also take regular exercise in the open air, without fatiguing themselves, avoid all depressing and exciting emotions, live regularly, keep early hours, abstain from rich, seasoned, or stimulating food or drinks, and partake only of plain but nourishing food. To these regulations may be added such others as have been enumerated under the head of " Green-Sickness." "Suppressed Menstruation," "Excessive Men- struation," "Difficult or Painful Menstruation,'' "Whites," and also the general rules prescribed in the article on " Eradicative Treatment." ALLOPATHIC TREATMENT. Hysteria. The name given to this dis- ease was because of a supposed connection between it and a diseased uterus (womb). In a certain proportion of cases there can be no doubt that this rela- tion exists. When the uterus is affected, with a decided alteration in shape, general treatment, while not without benefit, will quite frequently fail in removing the disease. If the patient is young and unmarried, without any irregularity in the catamenial flow, without pain in the back, or with- out pains' or undue frequency in micturition, such cause may be excluded, and the patient placed at once on general treatment alone. If the patient is married, but barren, there is a probable causative relation between the womb and the hysteria, or, in any case, if there is marked irregularity of thecatamenia (monthly sickness.) backache, and frequent passage of urine, in only small quantities, there is doubtless a displacement of the uterus, which should be restored to its proper position and maintained in a state of rest. The services of a competent physician will be required for this purpose. Regarding general treatment, one of the principal objects is to invig- orate the body by good nutritious food, exercise in the open air just short HYSTERICS. 153 of weariness, and regular habits regarding sleep. The mind should be strengthened by healthful occupation. Everything which excites the feelings, emotions, passions, or imagination, should be avoided. The patient should be urged to arouse the will against giving way to the paroxysms. The discreditable opinion commonly held of the disease may be urged as a motive for the patient to resist, to use the power of her own will, in warding off' the affection. This part of treatment is moral 'and its success rests on the tact of the attendant, but requires discretion and delicacy. Many times is the physician's patience sorely tried by patients prolonging the malady by their own desire to excite sympathy. If the patient is in reduced health, the Elixir of Quinine, Iron and Strychnine, in doses of a teaspoonful before each meal, will prove benefi- cial. Or the Elixir of Bark, Iron and Strychnine, may be given in the same doses, or doses of a dessertspoonful (two teaspoonfuls). If the patient is young, and in vigorous health, the Bromide of Potas- sium, in doses of twenty or thirty grains, three or four times a day, will often prove most beneficial, by allaying all forms of nervous excitement. Mono-Bromated Camphor is, also, beneficial, under the same conditions. It is best given in pills. The dose is four to ten grains, three or four hours apart. The distressing symptoms in hysteria demand attention and relief. In a hysterical convulsion, if it were not tha't the patient may inflict injury upon herself, as they would soon end of themselves, it would be well, gen- erally, to make no attempt to interfere, but let the paroxysm exhaust itself. Care should, however, be used to prevent the patient injuring her- self. Pouring cold water upon the head, from a little heigh, will, generally, bring the "hysterical fit" to an end. The insensibility (coma) of hysteria will generally yield to the same means. Some of the remedies which many times have a favorable effect upon the hysterical condition, are : Assafcetida and Valerian Mixture or milk of Assafcetida, (two drams of Assafcetida, dissolved in a pint of water,) may be given in doses of one or two tablespoonfuls, just before an expected attack. It may be repeated two or three times in the twenty-four hours. The Assafcetida may be given in pill. Valerian, in fluid extract, dose, a teaspoonful; tincture , dose, two tea- spoonfuls ; an infusion, (tea) made with a half ounce of the Valerian root to a pint of water. Dose: A wineglassf ul may be given to answer the same purpose as Assafcetida. The headache of hysteria is best relieved by Hyoscyamus and Camphor or the Bromides. The Tincture of Hyoscyamus and Spirits of Camphor may be given in doses of a teaspoonful. A pill containing a grain of the Extract of Valerian, a grain of Camphor, and half a grain of Extract of Hyoscyamus, may be given in doses of one or two pills, three hours apart The Bromides may be given according to the directions in a previous para- graph. In the absence of other means, the free use of hop tea will afford a good degree of tranquility to the nervousness of the patient. 154 THE BRAIN AND NERVOUS SYSTEM. CHOREA. ST. VITUS' DANCE. EPILEPSIA SALTATORIA. Chorea is a disease of the later years of childhood. It is seldom seen before the sixth year of age, and only occasionally after the fifteenth. Causes: Onanism, worms, fright, anger, second period of dentition, (teething,) and a continued effort to imitate some one afflicted with the disease. Symptoms: At first the patients show a certain uneasiness in their movements, and an unusual hurriedness, low spirits, ill temper. (The last two symptoms are often made much worse by the unkind rebukes the child receives, for what appears like hurried carelessness in handling things.) Gradually, or, in some cases, very soon, the involuntary movements begin, either confined to single parts, or affecting the whole muscular system ; the upper extremities are usually more affected than the lower ones. The face shows every possible contortion; even the eye balls are rolled about in every direction ; the arms and hands are, at times, flexed, (drawn up,) at others extended. The grip is no longer firm; the patients cannot eat alone, or if they do, have to bring their food to the mouth by a very circuitous route ;. the walk becomes unsteady, because the legs can no longer be put down with sufficient steadiness, and even the ability to keep them stiff enough to support the body firmly, is wanting. A striking feature of the disease is, that the more the patient tries to keep the part still, the more violent the involuntary motions become. It is peculiar to this disease, that even those excessive muscular movements do not fatigue the patient. After a gradual increase of the symptoms, the disease reaches its height, where it remains stationary for a time, lasting a few weeks, or even several months, and sometimes terminating in recovery, either quite suddenly, or only gradually. The cases where the convulsive movements become habitual, are very rare. Death is a very rare termination of the disease. So that the prognosis is favorable. ALLOPATHIC TREATMENT. CJiorea-SL Vitus' or St. Gay's Dance. This disease occurs, in a large proportion of cases, in persons whose vitaL forces are, more or less, reduced, and in a state of anaemia (impoverished blood). The diet should be plain, and unirritating, but nourishing. Fresh air, and out of door exercise, are to be insisted on. In proportion to the weakness, and anaemia, tonic treatment should be resorted to. Iron should be given, to restore the blood to its healthy state. I would use the Pyro- phosphate of Iron, in doses of a grain, three times a day. Take a drain of Pyrophosphate of Iron, dissolve in four ounces of simple Syrup, and give a teaspoon half full to a young child, and a teaspoonf ul to a nearly grown child, three times a day. Sweet cream, or Cod Liver Oil, will be useful in restoring health and strength ; of course, they are not to be given if the patient is full blooded, or over fat; but this is not likely. The bowels should be kept regular, and a daily bath should be given. If agreeable to the patient, and the reaction is good, a cool bath is prefera- ble, but if not, the bath should be warm. In some cases, the involuntary movements are so violent, that the patient should remain in bed. CHOREA. 155 The two remedies which certainly exert a curative influence over the disease, are Arsenic and Strychnine. Arsenjc is of undoubted value. It is conveniently given in the form of Fowler's Solution, in doses of five drops, three times a day, after eating. It can be given in water, or added to each dose of the Syrup of Iron, recommended above. It should be continued until swelling of the eyelids is produced. In obstinate cases, of general or local Chorea, this remedy has been found exceedingly useful, administered by hypodermic injection, in doses gradually increased to fourteen drops, diluted by an equal quantity of water. This treatment should be given and managed by a physician. The chief reliance of many physicians is upon Strychnine, but the most effectual manner of administering is such that it is unsuited to domestic practice. If the case is obstinate, and a physician cannot be obtained, I would recommend the following: Take one grain of Sulphate of Strychnine, water four ounces; after solution is effected, give a tea- spoonful three times a day, to a child ten years old. After a few days, it may be given four times a day. If rigidity of muscles is produced, the dose should then be diminished. In those severe cases in which the excessive choried movements pre- vent the proper amount of sleep, moderate doses of Hydrate of Chloral should be given to secure rest. Take of Hydrate of Chloral and Bromide of Potassium each two drams, simple syrup two ounces. Mix. * Dose : A dessertspoonful once or twice a day, to procure rest. HOMCEOPATHIC TREATMENT.— In view of the well recognized fact, that most cases of chorea get well themselves, although slowly, we would recommend the very limited use of medicine. The Homoeopathic remedies we will only mention the names of; they can be compared by the use of the Repertory : Cuprum, Stramonium, Belladonna, Hyoscyamus, Ignatia, Zincum, Cina, Gelseminum. If caused by onanism, Phosphoric Acid. PART THIRD. .+. DISEASES OF THE HEAD. +. CHAPTER VII THE BRAIN AND NERYES. HEADACHE. Headache is one of the most common symptoms of many forms of disease. Hence we might name a great many forms of headache arising from a variety of causes, without, however, helping the treatment in the least by so doing. The headache will disappear as soon as the affection upon, which it depends is cured. It is not always easy to find out the causes of headache — it is sometimes very violent, when the general disease seems very slight and on that account, to be more or less an independent condition of distress— but all attempts to point out remedies here, for all such cases, would be more than our space will allow. If the headache is simply an accompaniment of some other complaint, we must refer the reader to that complaint, and the Repertory, for treatment, and here only devote our attention to some particular forms of headache, which appear to be almost disconnected with other affections. 1. Hemicrania or Megrim. — A headache which usually affects one side of the head, and occurs paroxysmally at more or less regular inter- vals. This headache is a pure neuralgia, and while it does sometimes occur in company with other diseases, it occurs more frequently without such associations. The Causes: Where it occurs as a complication of other diseases, it may depend upon liver-complaint, derangement of the stomach or heart, but more frequently upon an unhealthy condition of the sexual organs. As an independent disease, it is only met with in the constitution and temperament which we term " nervous." Hence, it is more frequent among females, and occasionally among children. The Symptoms : In general, the symptoms of this form of headache are very constant and uniform, varying only in less important points, in most cases, without any precursory symptoms, much less frequently after 156 TIEADACIIE. 157 a previous feeling of fatigue, the patient awakes in the morning with a violent and constantly increasing headache. The pain is throbbing or tearing, or burning, or simply an ache, and is generally confined to a sharply circumscribed locality on one side of the head, usually the left. External pressure affords relief. Every mental and physical effort is pain- ful, while mental pleasure and attractive occupation afford some relief. As the pain increases, the eyes become sensitive to the light, and there is a copious flow of tears. When the pain is at its hight, the patient vomits a watery phlegm, after having experienced nausea for some time previous. After the vomiting the patients feel better, and want to sleep, and after a sound sleep they generally wake quite well, only a little weary. Such paroxysms sometimes recur again in a few days, sometimes not till months have elapsed; in the case of females, they are apt to come on about the monthly period. The general condition of the system is not always affected by the attacks; in the intervals between the attacks the patients may have the appearance of enjoying good health. Very rarely the pain lasts beyond twelve hours; if it lasts longer, it may continue thirty six hours. (See treatment at the end of this article). Neuralgic Headache. What this form of headache has in common with megrim is, that it likewise occurs periodically, most commonly affecting only one side of the head, and likewise tending in some cases to excite vomiting. But unlike megrim, this headache never ends with one paroxysm alone, but after the headache has once begun, the paroxysm generally returns at the same hour for several days in succession, some- times with as much regularity as intermittent fever. The remaining varieties of headache — Catarrhal, Congestive, Gastric, Rheumatic, Sick and Nervous — will be kept in mind in the treatment of this subject, without further reference here to each of their peculiarities, and patients will find the treatment very satisfactory. ALLOPATHIC TREATMENT. Recurring headache is one of the most difficult troubles to treat successfully, as far as permanent cure is con- cerned, yet many cases are much benefited by treatment. Hereditary predisposition, which is found in many cases, is beyond the reach of art, as far as removal is concerned, but their operation may be greatly less- ened by prudence and proper treatment. The disease, when- not a symptom of the numerous affections which it accompanies, as active congestion of the brain, inflammation of the membranes of the brain, inflammation of the brain, the essential fevers, etc., is, especially, neuralgic, and similar measures are called for in its treatment. When the pain is located in the face, or forehead, in the scalp, or back of the head and neck, and two or three tender points are found by pressing on the skin with the finger, the disease is a neuralgia of those parts, and should be treated as directed in the article on neu- ralgia. The treatment will embrace measures to be employed at the time of the attack, when immediate relief is urgently demanded and during the intervals, when the design will be to guard against a recurrence of the attacks, and moderate their severity. If the patient is a hearty, robust person, with an abundance of blood, and the headache dependent upon fullness of blood, and such symptoms of congestion occur, as a flushed 158 DISEASES OF THE HEAD. lace, throbbing of the head and ears, the congestion should be relieved. Probably a saline purgative, as a tablespoonful of Epsom Salts (Sulphate of Magnesia,) in water slightly acidulated with lemon juice, or in coffee, will prove effective against both the congestion and the headache. Such means as the application of cold to the head, by means of cold, wet cloths, or pounded ice in a sack or bladder, and hot foot-baths of simple warm water, or with the addition of mustard or red pepper, may be employed. In such persons the diet should be somewhat reduced, more exercise taken, and if constipation exists, it should be overcome by a daily dose of a teaspoon ful of Epsom or Rochelle Salts. Many cases occur where congestion is not so violent, following some error of diet, in which mild purgatives are useful ; two or three Compound Cathartic Pills, U. S. P., or the Improved Cathartic Pills, will answer a good purpose, though many others may be given. The salines act more quickly. If patients are not unpleasantly affected by Opium, an attack may frequently be warded off, shortened or lessened, by a full dose of Opium in some of its forms, as, one grain of powdered Opium, or one-sixth to one-third of a grain of Sulphate or Acetate Morphine, or a grain of Codia. Carbonate of Ammonia, in doses of from five to ten grains, is some- times successful in affording relief; also the Muriate of Ammonia (Sal. Ammoniac,) in doses of ten grains. The congestive form of sick headache is generally dispelled by one or more full doses, twenty to forty grains, of the Bromide of Potassium. The variety in which it acts, almost as a specific, is characterized by a flushed face, throbbing temples and intolerance to light. Ergot is also a valuable remedy in this variety of headache, and should be given in doses of a dram (teaspoonful) of the Fluid Extract. Some physicians extend its use to all forms of headache. The opposite form of sick-headache, manifested by paleness of the face, dizziness, and ringing of the ears, is quite certainly relieved by Bel- ladonna. The distress may be increased at first, but great relief follows afterward. The following is a useful formula : Take of Atropium (the active principle of Belladonna) one-fourth of a grain; Chinoidine, twenty grains. Mix and make into twenty pills. Take one pill two or three times a day. Five grains of Extract of Belladonna may be used instead of the Atropium. Relief is often obtained in this form of headache by the use of Elixir of Guaraua, in doses of a table- spoonful frequently repeated— from thirty minutes to an hour apart. If the face is pale and bloodless during the headache, three to six drops of Nitrite of Amyl inhaled from a handkerchief, will give relief. Some cases of nervous headache are quickly relieved by a teaspoon half full of Hoffman's Anodyne (Compound Spirits of Ether.) I have found cases in which the following relieved the pain with greater certainty than anything else used in their treatment: Take of C Moral Hydrate eight scruples; Bromide of Potassium one dram ; Simple £yrup two ounces. Mix. Dose : A dessertspoonful, and repeat in two or three hours, if the pain is not relieved. The physician often finds it necessary to let the patient inhale a little HEADACHE. 159 Chloroform. Evaporating lotions (washes,) as Alcohol, Spirits, Cologne, Vinegar, or Ether, often afford relief. Sometimes a towel, or other large cloth, wrung out of hot water and applied to the head, gives greater relief than cold applications. Strong coffee or tea may give great relief in some cases, though their constant use is often a cause of aggravating the malady. During the interval between the paroxysms, attention should be given to the general health, and to correct, as far as possible, any disorder which may be discovered. Indigestion and constipation are to be guarded against. The laws of health should be closely observed. Everything which is noticed to excite or increase the severity of the attacks, must be avoided. Sleep should be sufficiently long, and to this end the patient should habitually retire early. If the appetite is poor, and the patient weak and pale, or if he feels weary upon rising in the morning, he should have an Iron tonic, and plain but nourishing food. The Pyrophosphate of Iron one dram, dissolved in four ounces of water, or syrup, can be given in doses of a teaspoonful after each meal. Or the Citrate of Iron and Quinine can be given in the same way. In addition to Iron, I would recommend the pills of one-tenth grain of Phosphide of Zinc, and one-fourth grain of Extract of Nux-vomica, known as Hammonds' formula, of which one or two pills may be given three times a day; or the pills of Phosphorus, one-fiftieth of a grain, and Extract of Nux-vomica one-fourth of a grain, may be given in the same manner . Arsenic has been found useful, given between the attacks, and should be tried if the other means, after a faithful trial, do not benefit. It can be given in the form of Fowler's Solution, in doses of five drops in water, after eating. If swelling or watering of the eyes occurs, its use should be suspended until this symptom disappears, and then resumed again. Small doses of Quinine, two or three grains three times a day, may prove effective in guarding against a recurrence of the attack. It can be taken in powder or pill. Stimulants of all kinds are generally harmful, including beer and wine, and can be generally given up with advantage. Excesses of all kinds should be avoided. HOMCEOPATHIC TREATMENT. Arsenicum for intense frontal head- ache with vertigo, tearing in the head, with vomiting, when raising the head. Headache after meals, relieved by applying cold water, or by walking in the fresh air; sensation in the brain as if torn to pieces, with unquenchable thirst; all periodic headaches ; sometimes, when the head- ache is intense, a dose or two of Ars. gives as much ease as a dose of Opi- um ever does. Belladonna for headache from the heat of the sun. Nervous headache frequently on one side of the head, especially the right side, coming on from four P. m., to eight A. m., aggravated by the heat of the bed, and by lying down; better when sitting up, feeling in the brain like the swash- ing of water; cold sensation in the brain, in the middle of the forehead; pressive frontal headache, so severe when walking that the eyes are some- times drawn shut, frequently obliged to stand still, when walking, from the violence of the pain in the forehead ; at every step it seems as if the brain rose and fell in the forehead, relieved by strong pressure on the 160 DISEASES OF THE HEAD. forehead; violent throbbing in the brain, from behind forward, and towards both sides; finally, painful shootings, stabbing as if with a knife from temple to temple; boring, tearing, cutting, shooting pains in vari- ous parts of the head, worse on the right side and in the forehead, less in the back of the head ; headache is accompanied by dizziness, stupefaction, red and bloated face, red eyes ; excessive sensitiveness to noise, light shock, jar, or slight contact ; ill humor ; pains come on suddenly, last indefi- nitely, but cease suddenly; headache from catching cold in the head, as from having the hair cut. Dose : Of a solution of eight pills in four tablespoonfuls of water, give a teaspoonful every fifteen minutes to two hours, according as the severity of the case demands. Nux-vomica. Congestive headache, and headache from derangement of the stomach (gastric), w T ith nausea and vomiting, w T orse by coughing and stooping; pain as from a nail driven into the brain, or stitching pain with nausea and sour vomiting, stitches and pressure in one side of the head, worse in the morning, driving the patient out of his senses ; exces- sive sensitiveness of the brain to motion and walking ; heaviness of the head, especially when moving the eyes or thinking ; with sensation as if the skull would split ; whizzing in the head, with vertigo, or with shocks when walking; headache every morning on waking, after eating, and in the fresh air, when stooping or during motion, even when merely moving the eyes; the pains come again after drinking coffee; aversion to coffee, pale, worn-out look ; constipation, with tendency of blood to the head, irritable, vehement disposition, or lively, sanguine tempers ; persons who lead a sedentary life, or who drink. Dose : As for Belladonna. Calcarea Carb. for icy coldness in and on the head, also one-sided headache, with pale, puffed face, with empty belchings (eructations) and nausea, vertigo ; worse from mental exertion, stooping, or walking in the open air; better by closing the eyes or lying down; headache begins in the back part and spreads to the top of the head, so severe one thinks their head will burst and they will go crazy ; throbbing headache in the middle of the brain, every morning, lasts all day ; headache from over- lifting ; menstrual headache ; worse going up stairs, talking, or walking, or riding in the hot sun, or from taking cold ; better from tight bandag- ing, vomiting of mucus and bile, and pressure with cold hands, or some- thing cold. Dose : As for Belladonna. Ignatia is especially appropriate for one-sided headaches proceeding from irritation of the spinal nerves, or may be required in cases where Pulsatilla appeared to be indicated, but failed to relieve. It is, also, an excellent remedy, and should be preferably selected in cases in which the pain is confined to a small space, and causes a sensation as if a nail were being driven from within outward ; also, when the pain is of a pressive aching, or of a shooting description proceeding from within outward and chiefly confined to the forehead and root of the nose; and when there are nausea and dimness of sight, and sensibility of the eyes to light ; palene** of the face(Nux is red), and temporary alleviation from change of posi- tion ; aggravation from noise, strong odors, and drinking coffee. Ignatia is especially applicable to nervous females of a mild and sensitive dispo- HEADACHE. 161 sition, or to those in whom the attacks are prone to be excited by depress- ing emotions, or return at the menstrual period. Dose : As for Belladonna. Sepia is one of the most valuable remedies in the treatment of severe and inveterate sick headache or megrim. It is more particularly required in periodical headache, aggravated by mental emotions, in nervous females; the pain is either of a lancinating description, or it is a pressive aching, shooting, or a tearing, piercing or jerking pain, and affects the whole of the head, or it is only seated under the eye, or occupies one half of the head or forehead ; in the latter case, the pain is experienced chiefly in the morning, and is frequently attended with extreme sensibility of the eyes to the light. Sepia is, also, very efficacious in cases of obstinate megrim, with violent, piercing, or rending pain, intermingled with lan- cinations so excruciating that the patient is afraid to move, and can obtain only a very little relief by keeping perfectly still with the eyes closed; at other times, the pain is so severe as to cause the patient to scream out, and is accompanied with heat in the head, or faintness and giddiness, fol- lowed by nausea and vomiting. The source of the nervous headaches which call for the employment of Sepia, is to be found in derangement of the digestive organs, or in some derangement of the womb, in the case of females. The headache is, consequently, a secondary, and not a primary affection . We, accordingly, find that it is of the greatest efficacy in cases attended with green sickness, or with whites, in the intervals between periods, when a sensation of heat and fullness in the lower part of the belly, and, also, a peculiar offensive-smelling sweat, particularly in the armpits, and on the feet, prevail ; lastly, pale, dirty, or yellowish com- plexion, with a number of yellowish brown spots across the nose, a little resembling a saddle; shrunken features, or a countenance expressive of suffering; spare habit of body; constipation. Dose : As for Belladonna. Sanguinaria. This is one of the choice remedies for the sick head- ache to which Americans are subject; the attacks occur paroxysmally ; the pains begin in the morning, increase during the day, and last till eve- ning ; the head seems to feel as if it would burst, or as if the eyes would be pressed out, or the pains are digging, attended with sudden, piercing, throbbing lancinations through the whole brain, involving the forehead and top of the head more particularly, and being most severe on the right side, followed by chills, nausea, and vomiting of food and bile, forcing the patient to lie down and preserve the most perfect quiet, as every motion aggravates the suffering, which is only relieved by sleep ; the head is congested, and the veins on the forehead are distended like whip cords. Do.se : As for Belladonna. Pulsatilla is a remedy of great value in the treatment of megrim, characterized by rending or shooting pains, with heaviness of the head, giddiness, dimness of the sight, sensibility to light, or buzzing or singing in the ears, and earache; nausea, paleness of the face, lowness of spirits, headache with pain in the back of the neck ; aggravation of the head- ache, with chilliness towards evening, during repose, or particularly when sitting; amelioration in the open air; disposition mild; tempera- ment phlegmatic. In females with retarded periodical returns. Dose : As for Belladonna. 11 162 DISEASES OF THE HEAD. Bryonia for rheumatic headache, or headache with aching, piercing, or digging, tearing pain at a small fixed spot, or piercing, aching pain in the forehead, daily, after a meal, or coming on in the morning, disappear- ing in the afternoon and returning again in the evening with great vio- lence, when it is attended with a sensation as if the head were pressed together, particularly at the temple; burning, tearing pains over the entire head, or shootings in one side of the head. The pains are increased, by motion, and are attended with ill humor and disposition to chilliness or shivering; they are, sometimes, relieved or terminated by a fit of vom- iting. Dose: As for Belladonna. Sulphur is indicated in chronic headache, following the suppression or driving in of some eruption or disease of the skin; headaches occurring every day or every eight days, worse in the morning, or during the night, and attended with heaviness of the head, aching, or pressive pains in the forehead above the eyes, causing the patient to knit the brows or keep the eyes closed, or over the entire head ; incapability of mental exertion from the pains in the head ; pains as if the head would split, or rending, shoot- ing, dragging, jerking pains on one side of the head ; aggravation of the headache from meditation, the open air, or movement; extreme tender- ness of the scalp, cannot bear to touch or comb the hair ; falling off of the hair. If none of these remedies appear to be appropriate, study, with the aid of the Repertory, the following additional remedies: China, Veratrum, Gelseminum, Colocynth, Cimicifuga. In general cases, headaches which do not simply occur as the result of casual or accidental derangements involv- ing irregularities of digestion, the diet should be plain, but (in the absence of fever) nutritious, and the meals should be regular. Regularity of the general habits, and early resting and rising, with exercise in the open air (short of fatigue), are valuable aids in promoting and assisting a perma- nent cure. Everything which is known to provoke or aggravate an attack should be carefully avoided. Nineteen out of twenty cases can be cured, if this treatment is perseveringly adhered to. HOME REMEDIES.— Soda one-fourth teaspoonful, pulverized charcoal one-fourth teaspoonful, paregoric ten drops. Mix, to be taken as one dose, and repeated in one-half hour, if need be. This is splendid for sick head- ache, and should be given as soon as the indistinctness of vision comes on. Blood Root, or Sanguinaria (Red Percoon), which is so common in our country, is a most sovereign remedy for American sick headaches. Constant headaches may, frequently, be cured by snuffing certain arti- cles, such as Camphor, the juice of Blood Beets, or Ground Ivy, or freshly- grated Horse Radish Roots. A towel or night cap, wrung out of cold water and applied to the head, on retiring at night, is good for a headache which returns every morning. Applications of water, sometimes hot, at other times cold, will give relief in many cases.' -~~ ♦ NEURALGIA. NERVE-PAIN, FACE-ACHE, FACE-AGUE, AND NEURALGIA IX GENERAL. Symptoms. — Neuralgia is one of the most painful diseases, or rather symptoms of disease, to which the human family is subject. It commonly NEURALGIA. 163 occurs in the nerves of the face, although it is met with in different parts of the head, in the breast, side, hip-joints, and other parts of the body and limbs. Its attacks are usually sudden, and the paroxysm of pain varies in its duration. The pain is agonizing, lancinating, and shooting along the nerves like a shock of electricity, frequent feeling as if red-hot wires were thrust into the parts, and after the pain passes away, a numbness remains for some time. Sometimes, instead of attacking suddenly, it commences with aslight heat or sense of itching or numbness, which augments in severity more or less rapidly. The pain occurs, from time to time, at longer or shorter intervals, and is often produced by the most trifling causes, as a draught of air, a slight jar or noise, or even talking. The prognosis is favorable, as far as life is concerned, but the fearful, and frequently returning pain exhausts the body and wears on the mind to such an extent, that the patient is often driven to insanity, melancholy apoplexy, and even suicide Causes. — Exposure to miasmatic influences, injuries to the nerves by accident, heat or cold, derangements of the digestion, the growing of the bone through which the nerve passes, so as to close the very small open- ing through it; tumors growing in such a position as to make pressure on the nerve, and other causes, which are to this day not well understood by physicians. Neuralgia may be distinguished from rheumatism by the intensity of the pain, its short continuance and rapid return, and its liability to return on the slightest touch ; in acute rheumatism there is fever, redness, heat in the affected part, and some swelling, all of which are absent in neural- gia; in chronic rheumatism the pain is continuous, less severe and often worse at night. From toothache, by the short continuance of the parox- ysms, the rapidity with which it comes and goes, and the frequent con- vulsive twitchings of neuralgia. ALLOPATHIC TREATMENT.— The treatment of neuralgia has refer- ence, in the first place, to the removal of the cause, or morbid condition, upon which the neuralgia is ascertained to depend. These may be mala- ria (or miasmatic poisoning), poisoning by lead, an impoverished condi- tion of the blood (anaemia), syphilis, pressure by morbid growths upon a nerve, etc. In all these instances, while it is common to consider the neuralgia a disease, it is, really, but a symptom, and the cause behind is the disease. A rheumatic or gouty condition of the system frequently contributes to the production of the neuralgia, and treatment appropriate to these conditions is called for, if they exist. We nearly always find the health poor ; the bowels should be kept reg- ular by means of laxatives, but physicing should be avoided. Aloes and Pepsin answer very well. Take of Aloes eight grains, Pepsin thirty-two grains, Syrup of Own Arabic a sufficient quantity. Make a mass and divide into sixteen pills. Dose: One or two pills each day at dinner. A generous, nourishing diet should be given with plenty of milk and cream, raw eggs beaten with sugar and water, or milk and animal food, twice a day. Cod Liver Oil will be found beneficial in building up the 164 DISEASES OF THE HEAD. health. The clothing should be warm, and flannel worn next to the skin. Often, in intercostal neuralgia (in the nerves between the ribs), a chamois skin shirt will be exceedingly useful, and chamois skin drawers will be equally useful in sciatica (neuralgia of the great nerve of the thigh.) Iron is the great restorer of the health in these cases, by enriching the blood. The Citrate of Iron and Quinine, dissolved in Orange Flower Water, or syrup, can be given in five grain doses three or four times a day, or the Tincture of the Chloride of Iron can be given in thirty-drop doses, largely diluted in sweetened water, after each meal. Other prepa- rations of Iron may be given with equally good results. When the bene- fit expected does not follow the use of iron, it should be given with Man- ganese. An eligible formula is : Take of Sulphate of Quinine, Dried Sul- phate of Iron, Dried Sulphate of Manganese, each, thirty grains. Mix, and let them be made into thirty pills. Dose : One or two pills, to be taken three times a day. When the neuralgia is periodical, i. e., the pain recurs at regular inter- vals, quinine is a sovereign remedy, but its success is often remarkable when given in cases which are not periodical. It should be given in large doses— fifteen to thirty grains a day — for a week or more. This remedy is elevated to the first rank as an internal remedy for neuralgia. Arse- nous Acid (Arsenic) will rank next in value to Quinine, and will be ordered by the physician in cases in which Quinine is not tolerated, though it will not be likely to succeed, if Quinine has failed. Fowler's Solution is the most convenient form, and should be given in doses of five drops in water after each meal. But if the hygienic and tonic plan of treatment fails, a physician had better be consulted before resorting any farther to internal remedies. In rebellious cases, the other remedies usually given are Strych- nine, the preparations of Zinc, Carbonate of Iron in large doses, Phos- phorus, Oil of Turpentine and Iodide of Potassium. The latter is indica- ted when the neuralgia depends upon a rheumatic condition, and, also, with Mercury, when the neuralgia depends upon syphilis. The relief of pain occupies a large place in the treatment. During the severe paroxysm, large doses of Opium are generally required. Morphine in doses of one-fourth to one-half a grain can be given every hour, until relief is obtained, then stop giving it. The most effective method of giving Opium is by injection beneath the skin (hypodermic), over the seat of pain, at the hands of a physician. The relief given is complete, and cures are effected in numerous instances, especially, in sciatica. This ele- ment in the treatment should be guarded most carefully to avoid the mor- phia habit. If the pain is not severe, relief may be had from Belladonna, Hyoscyamus, Conium, Stramonium or Aconite, etc. Probably as good an internal anodyne as any, is Brown-Sequard's Neuralgia Pills, in which several of the pain-relieving substances are combined ; the dose is one pill, from two to four hours apart. When the patient cannot take a pill, a watery solution may be made, or a pill may be crushed and taken as a pow- der In the absence of these pills, the Tincture of Belladonna may be given in doses of ten to twenty drops; or the Tincture of Hyoscyamus, in doses of a teaspoonful to a tablespoonful, at the same intervals. The object to attain is relief from pain. NEURALGIA. 165 Much relief may be obtained by local applications. The best of these are liniments of Aconite, Chloroform, or Opium. A piece of flannel should be saturated with the liniment, laid on the painful part and cov- ered with oiled silk. A good liniment, applied in this way, is this : Take of Tincture of Aconite and Chloroform, each half an ounce, Soap Liniment one ounce. Mix. Of the forms of counter-irritation resorted to in neuralgia, the one most generally useful is the "flying blister.'' Small fly plasters, about half an inch in diameter, are placed over the painful points, for tow hours. The blistered points are to be dressed with simple ointment or tallow and allowed to heal as soon as possible. The blisters are to be repeated in a few days, if the neuralgia continues. Mustard plasters and dry cupping can also be resorted to. Severer counter-irritation will be resorted to by the physician in obstinate cases. In essential neuralgia, i. e., not dependent on an ascertained cause, there is no more useful agent than electricity in procuring relief from pain, and sometimes a cure results. Neuralgia of the face, neck and shoulder, and of the hip and thigh (sciatica,) are the forms of neuralgia most likely to be benefited by electricity. The positive pole of the gal- vanic battery should be placed at the point of emergence of the affected nerve, and the negative over the principal divisions of the expansion. From five to ten minutes should be occupied at each sitting. In old cases of a sciatica, a needle, isolated nearly to its point, should be passed down into the flesh, near the nerve, and attached to the positive pole, while the negative sponge, electrode, is passed over the course \)f the nerve. Gal- vanism frequently gives the best results in neuralgia of the uterus and ovaries. A permanent cure will generally depend upon a correct appreciation and management of the (diseased) constitutional condition upon which the neuralgia is dependent, or with which it is associated, with hygienic and tonic measures to strengthen the tone of the system and general health. These were alluded to in the beginning of our description of the treatment of this malady. HOMCEOPATHIC TREATMENT. Belladonna is indicated by darting pains in the cheek-bones, nose, jaws, or in the bones adjoining the ears; or cutting and tensive pains, with stiffness at the nape of the neck, and clenching of the jaws, twitching of the eyelid, or violent, shooting, tear- ing, and dragging pains in the ball of the eye; jerking pains in the facial muscles and mouth ; heat and redness of the face. The pain is, generally, preceded by itching and creeping in the affected side of the face, and at times becomes so severe as to be almost insupportable. The paroxysms are prone to be excited by rubbing the usual seat of the sufferings. Dose: Three globules in a teaspoonful of water, or dry on the tongue, repeated at intervals of four hours, for the first two days (should the pains continue, or recur without change of character during this period,) and, subsequently, at intervals of twelve hours, for two days (if yet required); after which (if necessary and still indicated) the course may be repeated as before, and so on, until decided and permanent amelioration or change. Platina is appropriate when the subjoined symptoms are predomi- nant. Feeling of coldness and torpor in the affected side of the face, with 166 DISEASES OF THE HEAD. severe spasmodic pain ; or tensive pressure in the bones adjoining the ears, with a sensation of creeping or crawling, and aggravation or renewal of the sufferings in the evening, and when in a state of rest; flow of tears ; redness of the face, etc. Dose : Three globules, as directed for Belladonna. Gelseminum should be given when the pain comes on in distinct paroxysms, and is very severe, accompanied with twitching and drawing in the muscles around the part affected ; the parts in and around the orbit of the eye are most commonly affected. Dose : Three globules, as directed for Belladonna. Colocynth. Violent rending and darting pains, which chiefly occupy the left side of the face, are aggravated by the slightest touch, and extend to all parts of the head, temples, nose, ears, teeth, etc.; mitigated by perfect rest, and by external warmth. Dose : Three globules, as directed for Belladonna. Arsenicum should be given when there is a tendency to periodicity in the attacks or paroxysms, and the pains partake more especially of a burning, pricking, and rending character, and are experienced chiefly around the eye, and occasionally in the temples ; the sufferings being occasionally of so severe a description as almost to drive the patient dis- tracted ; great anguish ; excessive prostration, with desire for the recum- bent posture ; sensation of coldness in the affected parts ; exacerbation during repose, from fatigue, in the evening, when in bed, or after a meal; temporary amelioration from external heat. Dose : Three globules, as directed for Belladonna. China should be selected when, as in the instance of the foregoing remedy, there is a tendency to periodicity in the attacks, and when the pains are excessive, attended with extreme sensibility of the skin, and consequent aggravation from the slightest touch ; the pains are located below the eye and in the cheek ; great prostration after the paroxysms. Dose : Three globules, as directed for Belladonna. Vevatnun is more especially indicated by insupportable pains, which almost drive the patient to distraction ; excessive weakness, even to faint- ing; general chilliness; exacerbation of suffering on getting warm in bed, or towards morning; temporary relief on moving about. Dose : Three globules, as directed for Belladonna. Spigelia is frequently a useful palliative remedy in all cases when the pain is excessive ; but it is more especially required when the pains are of a jerking, tearing character, exacerbated by the slightest touch, or by movement of the affected parts, or when they appear to shoot from the center of the brain to the sides of the head, or to the ears ; flow of water from the eyes and nose ; further, when the pains partake of a burning and pressive aching character, and have their seat in the zygomatic process ; glossy tumefaction of the affected side of the face ; excessive agitation and anguish ; rheumatic pains elsewhere. Dose : Three globules, as directed for Belladonna. Mezereum is more especially indicated for burning, pressive pains, coming very suddenly, and which leave the parts numb, attended with chilliness and shuddering; they are worse from eating warm food, or from entering a warm room; there is frequently redness and burning of the NEURALGIA. 167 throat, and a stiff feeling of the jaws. It is, especially, suitable after the abuse of Mercury, or in syphilitic persons. Dose: Three globules, as directed for Belladonna. Iris Versicolor is adapted to such cases as are associated with sick- headache, where there is a good deal of vomiting of a sweetish mucus, and sometimes of bile. Dose : Three globules, as directed for Belladonna. Nux-vomica should be administered when the pain is mostly below the eye, and the eye is inflamed and watery ; profuse watery discharge from the nostrils ; the affected side feels numb. The patient is morose, irritable, belches a great deal, and is constipated. It is, especially, suitable after abuse of coffee, liquors or drugs. Dose: Three globules, as directed for Belladonna. HJius Tox, will be found useful for drawing, burning, tearing pains in the face, and a feeling as though the teeth were too long ; very great restlessness, and tossing about; particularly adapted, if brought on by getting wet, or after wet weather. Dose : Three globules, as directed for Belladonna. Bryonia may be administered, particularly in cases of rheumatic face-ache, when the pains are of an aching, pulling, or tearing description, exacerbated by movement; irritability of temper, and general tendency to rheumatic attacks. Dose : Three globules, as directed for Belladonna. Hepar Sulphuris is also of much service against face-ache, resulting from excessive mercurial treatment, and is more particularly indicated when the pains are so much aggravated by the pressure of the teeth or by eating, that the patient is afraid to allow the crowns of the teeth to meet ; pains of a drawing or jerking character, often aggravated by entering a warm room, or by the warmth of the bed at night; also when there is great sensibility of the cheek and base of the temple, with extension of the pains into the ears, and up the side of the face. Dose : Three globules, as directed for Belladonna. Sulphur is frequently a medicine of considerable value, whether for the treatment of the immediate acute symptoms, or for the after-treatment, in cases in which abuse of mercury has developed a predisposition to face- ache. This remedy is especially indicated by throbbing, drawing and jerk- ing, or burning, aching pains in the bones of the face, and in the jaws, and all the teeth, whether sound or decayed ; or when the pains involve the whole face, and even head, and are accompanied with determination of the blood to the head, redness and swelling of the cheeks and nose, with suf- fused redness and inflamed appearance of the eyes; or when there are also aching, weary sensations in the limbs, or in the small of the back, or catch- ing, stitching, darting painsin theears; general chilliness and susceptibility to the least current of air, with sleeplessness during the whole or greater part of the night, and drowsiness towards morning or in the day; cold water or cold applications, and mastication, greatly aggravate or provoke a return of the pains, which are also renewed or aggravated, generally towards evening, at night, or by currents of air. Dose : If against the immediate acute symptoms, three globules, as directed for Belladonna. If for after treatment, four globules in a teaspoonful of water, the first thing in the morning, (fasting,) for ten 168 DISEASES OF THE EYE. days, (or until the earlier development of change,) then pause ten days, after which the course may be repeated, as before, if any ten- dency to a return of the attack should yet be perceptible, or dreaded. Phosphorus is indicated by tearing pains, which occur more especi- ally about the left side of the face, and which are further characterized by determination of blood to the head, and by a sensation of tightness in the skin of the face, by aggravation upon the slightest touch or movement of the parts, or by pains extending deep into the ear, and to the root of the nose, and often attended with a confused, shell-like roar in the ears. Dose : Three globules, as directed for Belladonna. Pulsatillas on the other hand, is to be preferred when the pains are usually aggravated towards evening, and at night, or in the morning, when seated, and when they are somewhat moderated in the open air; or further, when there is general chilliness with depression of spirits ; or, again, when the patient is of phlegmatic temperament. Dose : Three globules, as directed for Belladonna. CHAPTER VIII. DISEASES OF THE EYE. —~ ♦ OPHTHALMIA.— IXFLAJIJIATIOX OF THE EYES, ACUTE AND CHBOXIC. Ophthalmia is a term applied to inflammation of the eyes, whether of the acute or chronic form. All parts of the eye are subject to inflamma- tion, more especially its outer covering (conjunctiva) and the inner sur- face of the lids. At this place catarrhal ophthalmia, purulent ophthal- mia, and inflammation of the iris will be considered. CATARRHAL OPHTHALMIA. Symptoms. The conjunctiva, or white of the eye, becomes swelled, and of a scarlet color, being more or less covered with blood vessels, pre- senting the appearance of what is usually termed bloodshot, with this there is a sensation of heat, smarting, and pain, as if particles of sand were in the eye, and which pain is aggravated by rubbing the eye. There is much pain and uneasiness on exposing the eye to the light, and sometimes even on the least motion of the eyeball, so that the patient usually keeps the lids closed. A copious flow of hot or excoriating tears is also present. When the disease is very violent, or, in irritable habits, febrile symptoms are manifested. Causes. Catarrhal ophthalmia may be produced by exposure to cold, sudden changes of temperature, blows and other injuries to the eyeball, irritating vapors, foreign particles in the eye, improper exposure of the eye to strong light, overtasking the eyes by reading or writing late at night, intemperance, and other causes similar to those producing inflam- mation of other mucous surfaces. This disease may be distinguished from rheumatic ophthalmia, by the presence of headache, the greater intoler- ance of light, and the severe, throbbing pain common to the latter, besides INFLAMMATION OF THE EYES. 169 in catarrhal ophthalmia the blood vessels are apparently tortuous and of a scarlet red color, and in the rheumatic form, they are straight, hair-like radiated, and of a pink or violet hue; in rheumatic ophthalmia the sensa- tion of roughness or foreign bodies in the eye is never present. There is seldom any danger to be apprehended in catarrhal ophthalmia, when properly treated. PURULENT OPHTHALMIA. Symptoms. Usually a great itching is felt in the eye, or a sensation, as if a particle of dust were between the lids and the eyeball, and this usu- ally happens at night ; this is succeeded by a sticking together of the lids, generally in the morning, owing to a secretion of mucus. The lids are somewhat stiff, there is great and uniform redness of the eye, but without pain, tension, or intolerance of light, and a watery fluid is discharged. The disease soon extends to the globe of the eye, with high, vascular action and bright redness, great tumefaction of the membrane, and increased dis- charge. The conjunctiva suddenly swells, and becomes considerably elevated around the cornea. The cornea, appearing, as it were, at the bottom of a pit. This swelling is called chemosis, and is often so great as to overlap and nearly cover the cornea. The eyelids swell, and are almost immovable. The discharge is profuse and of a yellow color, and may con- tinue for ten or fifteen days without much change. Finally, the chemosis begins to shrink, the discharge diminishes and becomes thin and gleety, and the parts, which were the first attacked, are the last in which the dis- ease disappears. The inflammatory symptoms vary from a mild character to one of great violence, being accompanied with sharp, lancinating pain situated deep in the eye-ball, and which is usually worse at night. Some- times a deep-seated, throbbing pain in the eye comes on in paroxysms, or it may be violent and continuous, without any mitigation until the cornea bursts. The disease may terminate in bursting of the cornea, abscess of cornea, ulceration of the cornea, opacity of the cornea, thickening or granu- lation of the lids. Purulent ophthalmia may be discriminated from catarrhal by the che- mosis, the bright red membrane, and the profuse purulent discharge. The right eye more frequently suffers, and more severely than the left, though the discharge may attack either or both. Causes: The disease is propagated by contagion. It frequently occurs epidemically, and seems to depend upon some peculiar condition of the atmosphere And, under some circumstances, there is no doubt but it may be produced by exposure, injuries and other circumstances, that will occa- sion the catarrhal form. INFLAMMATION OF THE IRIS. Inflammation of the Iris, or Iritis, may be accompanied with rheuma- tism; sometimes with gout, and not unfrequently with syphilis; hence the names, rheumatic iritis, syphilitic iritis, etc., have been applied to these various forms. The disease is, however, in all instances, only a modifica- tion of one, and of the affection. Symptoms. Uneasy sensations are experienced in the neighborhood of the eye, with pains about the forehead, brow, and orbit, extending to the side of the head, There is, also, a redness of the sclerotica or white of 170 DISEASES OF THE EYE. the eye, with intolerance of light, and watery discharge, as these symptoms increase in severity. The iris, or that part of the eye which surrounds the pupil, and which we judge of the color of the eye — whether blue, black, etc., — becomes involved. Its color undergoes a change ; first in the lesser circle, which becomes of a darker hue, and afterwards in the greater, which becomes greenish, if it were originally blue or greyish; and reddish, if it were brown or black. The pupil is contracted, its opening being deprived of the bright, black color it naturally possesses, and the motions of the iris are impeded. Headache and feverish disturbance of the system are generally present. After a violent attack, with great diminution of sight, the symptoms subside, the eye recovers, and sight is restored. The iris is found to be connected to the capsule by adhesions of white color. The inflammation returns again, and again new adhesions take place ; the pupil becomes more and more contracted, and finally vision is lost. Occa- sionally the first attack may be so violent as to occasion loss of sight. Causes: It may be produced by cold, and frequently attended with rheumatism, syphilis, etc. Some rheumatic persons have one attack, or more, every year, in which the sight becomes gradually destroyed. ALLOPATHIC TREATMENT.— Simple Ophthalmia (Inflammation of the Conjunctiva). In a person who is robust, over-stimulated, or over-fed, a brisk cathartic of a tablespoonf ul of Epsom or Rochelle Salts, or a Sied- litz Powder, should be given, and repeated in four hours, if a free cathar- sis has not taken place. Such a patient should, also, have a low diet. A weakly patient, or one with impoverished blood, or one that habitu- ally feels tired and sleepy on rising in the morning, after a full night's sleep, should have hearty, blood-making, but plain, nutritious food ; also, tonics of Bark and Iron. One or two tablespoonf uls of the Infusion (tea) of Cinchonia Bark (one ounce of Bark to a pint of water) may be given in doses of one or two tablespoonf uls, before eating. Tincture Muriate of Iron may be given in doses of from ten to twenty drops, well diluted in sweetened water, after meals. The mouth should be rinsed with water, after taking the Iron. The Citrate of Iron and Quinine, in from two to five-grain doses, will fulfill all the indications. Rest, and temporary protection from light, will be required. Frequent application of water, either cold or warm, guided by the feel- ings of the patient, should be made. Quite warm applications are gener- ally preferred, and are more useful. One of the best stimulating washes is a solution of six grains of Alum or one grain of White Vitriol (Sulphate of Zinc,) and two to four grains of the Sulphate of Morphine, in two ounces of warm water. A few drops may be dropped in the eye, two to four times a day, with a quill or camel's hair brush. After using these stimulating applications for a jfew days, their use should be suspended for a day or two, and observe the result; for it does happen, sometimes, that the irritability of the congestion is kept up by their prolonged use. The extreme pain should be relieved, if necessary, by an occasional dose of Opium and Hyoscyamus. For an adult, a quarter of a grain of Morphine, or twenty drops of Laudanum, with one or two teaspoonfuls of Tincture of Hyoscyamus, are suitable doses. The Morphia, or Opium, may INFLAMMATION OF THE IRIS. 171 be given, with one grain of solid extract of Hyoscyamus, in pill. For a child, Paregoric (Camphorated Tincture of Opium) and Tincture of Hyos- cyamus, should be used in equal quantities. Dose: From fifteen drops to a teaspoonful, according to age. When the ophthalmia continues, and becomes catarrhal (mucus form- ing), the treatment above recommended for simple application will be appropriate. The tonics recommended will, generally, be more urgently needed. Frequent bathing of the eyes, with warm water, will be useful. The edges of the lids should be smeared with Brown Citrine Ointment, or, in its absence, with Castor Oil, or some simple ointment. The stimulating wash, which is followed most rapidly by benefit, is Nitrate of Silver — its use requires the direction of a physician. Two or three drops of a solution of Sulphate of Atropine (two grains to the ounce of water) should be dropped in the eye two or three times a day ; or a solution of half a dram of Extract of Belladonna to the ounce of water. Purulent Ophthalmia usually occurs in persons feeble in general health, and where such is the case, tonics ancknourishment are urgently called for. Citrate of Iron and Quinine should be given in doses of from two to five grains, dissolved in water or syrup, three times a day; or the following: Take of Citrate of Iron and Strychnine a dram and a half, Quinine half a dram, Citric Acid a dram, Simple Syrup four ounces. Mix. Dose: A teaspoonful, three times a day. Or the bitter infusions and Tincture of Iron, as recommended in sim- ple ophthalmia, may be given instead. The diet should be of nutritious, blood-making varieties, but plain. Fresh meat, milk, and eggs, may be allowed. A furred tongue and constipation will call for one or two Compound Cathartic Pills, once or twice a day, until the bowels move. Should the patient be robust and hearty, the tonic treatment should not be pursued, but an active cathartic should be given- Four Compound Cathartic Pills may be given ; or, doubtless, a full dose (one or two tablespoonf uls) of Salts will answer the purpose. In such cases, also, the diet should be reduced. Pure air is a necessity, and the patient must not be confined in bed, if it can be avoided. The greatest care should be exercised to avoid communicating the dis- ease to others. No other person should wipe on the towel or napkin used by the patient. If only one eye is affected, the well eye ought to be her- metically closed until all danger of contagion has passed. The great danger is, that the cornea may become ulcerated and slough, causing complete or partial blindness. I should strongly advise that no case should be treated without a phy- sician. The local treatment will consist of repeated cleansing of the eye by carefully injecting warm water with a syringe; a solution of Nitrate of Silver, three grains to the ounce of distilled water, should be dropped in the eye twice a day, or oftener; after a few days, a strong solution of Alum (ten grains to the ounce of water), should be substituted for the Nitrate of Silver, and vice versa. 172 DISEASES OF THE EYE. During the course of this disease, a solution of Sulphate of Atropine (two grains to the ounce of distilled water), should be dropped in the eye two or three, or more times a day, according to the urgency of the symp- toms. If the Atropine cannot be obtained, a solution of a half a dram of Extract of Belladonna, to the ounce of water, may be used instead. The pain may require relief by the administration of anodynes once a day, or oftener. Opium and Hyoscyamus, one grain each of the extract; or a quarter of a grain of Morphine, a grain of the Extract of Opium, or twenty or thirty drops of Laudanum, with two teaspoonf uls of Tincture of Hyoscyamus. AVet cups or blisters to the temple may be useful. Attendants often assisting the patient should immediately wash their hands to avoid carrying the disease to their own eyes. Granular Ophthalmia calls for the same general treatment as is recom- mended for the other forms of ophthalmia, and is appropriate under the same state of health. The form of iron I generally give is the Pyrophos- phate in solution with Iodide of Potassium, the latter having a favorable effect on the disease. Take of Iodide of Potassium five drams, Pyrophos- phate of Iron half a dram; dissolve&ach in two ounces of simple syrup with trituration in a mortar and mix. Dose : Give a teaspoonf ul after each meal. The bitter infusives recommended in simple ophthalmia maybe given, if the appetite is poor. The diet should be good and abundance of exercise should be taken in the fresh air. The edges of the eyes should be anointed each night with Brown Citrine ointment. The nice local treatment demands a skilled physician ; it con- sists principally in inverting the lid and applying the solid stick or crystal of Sulphate of Copper (blue stone) across the granulations. Before the lid is restored to its natural position, it should be bathed with a camel, hair brush, dipped in sweet oil. Another useful agent, applied in the same way is Nitrate of Silver; it should he fused with Xitrate of Potash, as the pure stick is too caustic. The lid should be washed with a camel, hair pencil dipped in water, after each application. Liquor Potasse, applied with a camel, hair pencil to the granulations is useful. These agents can be used in succession as the case continues. Once a day is frequent enough for their application. As a wash, a solution of Alum, three grains to the ounce of distilled (or rain) water is useful. If the edges of the lids are irritable or stick together at night, they should be anointed each night with Brown Citrine Ointment, Spermaceti Ointment, Castor Oil, or lard. Treatment of Chronic Ophthalmia.— The use of artificial light should be avoided, also ill-ventilated rooms and working upon small objects. If rt is impossible to do this, care should be taken to obviate the ill effects. Great relief may be had by having a pale, blue chimney, or shade to the lamp or gas jet. Free exercise in the open air should be taken and plenty of regular sleep. The diet should be wholesome, consisting largely of fresh beef, mutton, or chicken, milk, and eggs. Some of the tonics recommended in other forms of ophthalmia will be useful, if the patient is in feeble health. The bowels should be kept regular. The eyes should be frequently bathed with warm water, and a solution of alum or sugar of lead three grains to the ounce of pure rain water, or a solution of Tan- INFLAMMATION OF THE IRIS. 173 nin, ten grains to the ounce of water dropped in the eyes night and morning. It is sometimes well to bathe the closed lids after use of the eye water, with cold water. The edges of the lids should be anointed each night with Brown Citrine Ointment. Continual watering of the eyes in the wind should lead to the exam- ination of the lachrymal duct. In all tedious cases, which cannot be traced to a previous attack of catarrhal ophthalmia, or obstruction of the lachrymal duct, the edges of the lids should be examined to see whether an irregularly growing eyelash may not be the cause of the irritation. The irritability of the eyes of students is frequently relieved by bath- ing the eyes in very warm water, and the redness of the edges of the lids can be prevented by the use of Brown Citrine Ointment. The Opthalmia of Newly Born Children.— If the attack is a, severe one, recovery.may depend on the health and vigor of the child. The health of the mother, and her ability to nurse the child properly, will govern, in a measure, the chances of the child's recovery with a useful eye. The child may need feeding, but ought not to be weaned, for almost as surely as the cornea becomes ulcerated, the eye will be lost, if the attempt is made to raise the child " bfjthand.'' The preventive treatment will consist chiefly in the avoidance of the causes which may originate the disease, which are, besides contact with the unhealthy discharges of the mother during birth, etc., rude washing with soap and cloths by the nurse, cold, exposure to strong light, and contagion. The eyes should be thoroughly and frequently cleansed with warm water. Probably this can be best done by a small glass syringe, introdu- cing it at the outer corner of the eye and gently injecting. No harshness should be used, but firmness, for the eye must be thoroughly cleansed. After each cleansing, which should be as often as every hour, a solution of Sulphate of Zinc one grain to the ounce of distilled water or pure rain water, should be dropped in the eye. In severer cases, (which should be in the hands of a skillful physician,) a stronger solution should be used. Sulphate of Zinc three or four grains, and Alum six or eight grains to the ounce of water. In cases which are not too severe to be treated without a physician, a solution of one grain of Sulphate of Zinc in from two to four ounces of water, will be perfectly effectual. A soft piece of muslin, wet with water, folded several times, should be laid over the eyes and tied loosely, but firmly enough to be kept in place. A skillful physician should have charge of the case, if possible. Scrofulous Ophthalmia is characterized by small serous vesicles which arise on the conjunctiva. It is especially liable to invade the cornea. The affection is especially liable to occur in feeble persons whose nutrition is not good. Good diet of a plain but nutritious kind is espe- cially called for. Fresh meats, cream, milk, and raw eggs are suitable. The Syrup of Iodide of Iron in doses of twenty drops after meals, seems especially serviceable; or the Tincture Muriate of Iron may be given in similar doses, well diluted, with sweetened water. If the appetite is poor, an infusion of Peruvian Bark, Gentian or Quassia, made by macerating an ounce of the drug in a pint of hot water, may be given. Dose : Half a wineglass to a wineglassful. 174 DISEASES OF THE EYE- Or the bitter tonic and iron can be given together by using the Citrate of Iron and Quinine, in doses of two to five grains three times a day. A solution often grains of Tannin to an ounce of water, is a good ap- plication in this and all forms of conjunctivitis, or finely levigated Calomel may be dusted over the vesicles, by means of a camel, hair brush, once a day. The invasion of the cornea should be met with the solution of Sul- phate of Atrophine, four grains to the ounce of distilled water, dropped in the eye with a quill or clean camel's hair brush, two to six times a day, according to the intensity of the pain and inflammation. The edges of the lids should be kept annointed with Brown Citrine Ointment. If a skillful physician can be obtained, he ought to have charge of the case. ALLOPATHIC TREATMENT. In the treatment of Iritis, the first thing is to secure and maintain a full dilatation of the pupil, to prevent com- plete or partial obliteration of the pupils, by adhesion of the free edges of the iris, or by adhesion of the iris to the capsule of the crystalline lens, or possibly by adhesion of the muscular fibres of the iris. The required dilatation of the pupil is obtained by dropping into the eye, from two to four hours apart, a solution of two to four grains of Atropine in an ounce of distilled water. Pain should be relieved by Opium, in doses of one grain, or Morphine, in doses of one grain, or Laudanum, in doses of twenty-five drops, repeated at such intervals as may be necessary to relieve the pain — two to six hours apart. If the strength of the patient is reduced, the Citrate of Iron and Quinine, in three grain doses, dissolved in Syrup of Orange, may be given three times a day. In case the patient is rheumatic, or the disease is obsti- nate, the Iodide of Potassium should be given in Peppermint Water and Syrup, in doses of five to ten grains after meals. Besides the above treatment in syphilitic iritis, Iodide of Potassium should be given in large doses. Mercury will also be required in this form of disease. Iritis should be treated by a physician. HOMCEOPATHIC TREATMENT. To save space and needless repeti- tion, we will here mention all the remedies needed in the treatment of this affection, viz : Acute, Chronic, Simple, Scrofulous, Purulent, Granular, etc., and that arising from external injuries. The remedy which will be best suited to the treatment of any particular case, can be readily selected by comparing the symptoms of the case with those mentioned under each remedy. Of course, you will not find all the symptoms that may arise in any case, under the proper remed\ r , but the leading symptoms for which that remedy can be fully recommended as curative, will be found, and, on account of the great difference in different cases, there will be more symp- toms mentioned than are likely to be found in any one case. Aconite, in inflammation of the eyes, where there is a pus-like dis- charge. The inflammation runs high ; dry hot skin, and full quick pulse; intense redness and swelling of the affected parts, attended with acute pain. Great intolerance to light. Fear, anxiety, and great restlessness ; flushed face and throbbing in the arteries of the neck. Done: Six pills in three tablespoonfuls of water, of which give one teaspoonf ul every one to three or four hours, owing to the intensity of the symptoms, also as an external remedy. INFLAMMATION OF THE EYES. 175 Belladonna in acute Ophthalmia, with very great intolerence to light or noise. Vivid redness of the sclerotica (white of the eye,) with the discharge of hot salt tears, or great dryness of the eyes, with sensation as if there was dust or sand in the eye. Sharp pains in the eyeballs, extending to the brain. Pains which appear suddenly, and disappear just as suddenly. Dimness of vision. Throbbing headache, increased by motion. Dose : As for Aconite. Calcarea Carb., for scrofulous sore eyes, with inflammation, redness, and pus or pus-like secretion from the eyeballs, swelling and redness of the eyelids, which are aglutinated (stuck together). Stinging pains, worse at lamplight. Specks and ulcers on the eyeball, constant desire to keep the eyes in the darkness, swelling of the glands about the neck, and erup- tion on the hairy scalp, are additional symptoms calling for the use of Cal. Carb. Also chronic inflammation of the eyes. Dose: A powder of four pills every morning and evening. If the improvement is not satisfactory, give a single dose of Sulphur, and after three days, or in acute cases, sooner,return to Cal. Carb. Arsenicum. Inflammation of the lining membrane of the eyelids, and the outer covering of the eyeball, (conjunctiva) and even of the deeper coats of the eyeball, with dark redness and congestion of the blood vessels. Burning pains; the parts burn like fire. Inflammatory swelling of the lids. Specks or ulcers on the eye. Nightly aglutinations of the lids. Great anguish and restlessness. Intense thirst for small quantities of water very often. Dose: As directed for Aconite. Mercurius. — For scrofulous ophthalmia. Violent inflammation and redness of the eyes. Cutting, burning pains, or pressure in the eyes, as if from sand. Excessive sensitiveness of the eyes to the glare of fire, or the light. Little blisters and pimples on the eyeball. Little boils or styes, scurfs around the eyes and on the margins of the lids. In inflam- mation of the iris (colored parts of the eye), this medicine is of great ser- vice. It should never be given in large doses. Dose : As for Calcarea. Pulsatilla. — Aching, or burning and smarting irritation in the eyes, as if from copious secretion of mucus. Disordered stomach, foul tongue, with chilliness towards evening, followed by feverish heat. Piercing, shooting, pricking pains in the eyes with bright redness and flow of tears — especially on looking at the light or going into the open air ; or, on the other hand, excessive dryness of the eyelids, especially in the evening; sensitiveness, with disposition to weep. Dose : As for Aconite. Arnica is a very superior remedy when the inflammation is the result of an external injury. Use it simultaneously with its external use. (See external applications.) Dose: Internal, four pills every two to six hours. Application (exter- nal) five drops to two tablespoonfuls of water. Apply four times, daily. HOME REMEDIES. — Alum curd, made by stirring or rubbing a lump of Alum in the white of an egg, is frequently applied in domestic prac- tice, and with benefit. Some simple ointment, or oil, applied to the edges of the lids, will add to the comfort, particularly at night. 176 DISEASES OF THE EYE. SHORT-SIGHT, XEAR-SIGHTEDXESS. Pulsatilla and Sulphur according to indications, may be men- tioned as of the chief importance in the treatment of short-sightedness, when this affection remains as an after effect of acute inflammation of the eyes. Dose: Of either medicine, as selected, give three globules in a tea- spoonful of water, morning and evening, for a week (or until the earlier development of improvement or change), then pause four days, after which the course may, if necessary, be repeated as before, and so on from time to time, until amelioration or change. Acidum Phosphoricum is to be preferred in cases in which short- sightedness occurs as the consequence of a severe attack of typhus, or has been occasioned by debilitating loss of blood or other animal fluids. Dose: Three globules, as directed for Pulsatilla and Sulphur. Carbo vcg., Acidum nit., ox Sulphur, will be appropriate for the treatment of short-sightedness, when this condition can be traced to exces- sive use of Mercury. Dose : Of Carbo veg. or Acidum nit. give three globules in a teaspoon - ful of water, every morning,— or, of Suljihur, six globules in a table- spoonful of water, every morning, the first thing (fasting), for ten days (or until the earlier development of new symptoms, improve- ment, or change); then pause a week, after which the course may, if necessary, be repeated as before, and so on, from time to time, until manifest amelioration or change. BLIXDXESS. In common use, this name implies persons who are totally blind, or persons who possess some powers of vision, but not enough to enable them to distinguish the forms of objects. The causes of blindness are both ante-natal (before birth), and post-natal (after birth). It is contended by some, and likely with truth, that influences acting on the mother's mind(psycologically)may induce blindness in her offspring — as when the mother has received a powerful nervous impression from witnessing some horrible spectacle, or an extremely disgusting case of sore eyes, or malformation of the eyes. Many cases have been adduced which establish this as a truth in some cases, but not by any means with enough to establish the theory as a rule or law of psychological effect. The ante-natal causes wmich are now acknowledged to produce blindness, are the intermarriage of near relations, especially first cousins; scrofula and syphilis. In intermarriage, deafness follows more frequently than blind- ness ; in very many, indeed, in almost all of those cases where near rela- tives have married, the offspring shows a marked tendency to deficiency of the nerves of special sense; but in most cases, ante-natal, as well as post-natal, blindness is caused by imperfection or disease of the optical apparatus, which is accessory to the nerves of special sense, or, in other words, the defect generally exists in some part of the globe of the eye. Hereditary blindness is not frequent. Of seven hundred blind persons in the institutions of Philadelphia, whose parentage is known, only twelve had either parent blind. In Paris, of several hundred children born there, of whom one or both parents were blind, not one was blind at birth. BLINDNESS. 177 After birth, the principal causes of blindness are: 1. Special diseases of the eye, such as purulent ophthalmia, inflammation of the cornea and of the iris, cataract, or opacity of the crystalline lens, and amaurosis, or paral- ysis of the optic nerve. 2. General diseases, whose sequelae attack differ- ent parts of the eye, as small-pox, scarlet fever, measles, typhus fever, and other inflammatory fevers, and scrofula. 3. Injuries frcm blows or wounds, and from malpractice ; the latter being the most fruitful of all causes. Hence, we say, in any disease of the eye, avoid all ignorant persons and experiments of every kind and nature, and employ only the highly skilled ; if you cannot do that, better let nature alone, using only water to allay the inflammation. HOM(EOPATHIC TREATMENT.— For blindness caused by paralysis of the nerve of vision, from overtaxing the eyes, there is nothing that will excel the skilled and intelligent use of electricity. We are very far from meaning by skilled, those ignorant criminals, who go about the coun- try with their machines shocking every one they can persuade to take hold of the electrodes. Atropine, an alkaloid of Belladonna, is a prime remedy where blind- ness is the result of paralysis ; it should be used in small doses, not fre- quently repeated. Aconitum is the medicine of chief importance in cases of this kind, when characterized by a general fullness of the vessels, or by a full, hard pulse, and should be given, first, against the congestion, which is identified by the development of this symptom, as affecting the vessels of the head. It is the more appropriate when this symptom occurs associated with derangement of the stomach, and the congestion of the vessels of the head is recognized as of sympathetic origin. Dose: Three pills, in a teaspoonful of water, repeated at intervals of twelve hours, until general improvement or change. Causticum for sudden and frequent loss of sight, as from a pellicle drawn over the eyes, or as if looking through a mist. Dose: Three pills, as directed for Aconitum. Gelseminum, is indicated by sudden and total blindness, with giddi- ness ; the eyes look heavy and dim. Dose : Six pills, as directed for Aconitum. Mercurius will prove of service when there are momentary parox- ysms of blindness, the eyes being very sensitive to light or the glare of a fire. Dose : Three pills, as directed for Aconitum. Cicuta Virosa should be given when there is frequent vanishing of sight, as if from absence of mind, with great giddiness, particularly when walking ; when reading, the letters appear to move to and fro irregularly. Dose : Three pills, as directed for Aconitum. Phosphorus is most valuable when the obscuration of vision occurs at twilight, or at night; objects appear as if seen through a thick gray vail; blackness, or black points, or sparks before the eyes. Dose : Three pills, as directed for Aconitum. Pulsatilla should be selected in cases where there is a sensation, as if the dimness of sight could be removed by wiping the eyes; great dread of light; frequent and copious lachrymation ; the pupils are con- tracted. Dose: Six pills, as- directed for Aconitum. 12 178 DISEASES OF THE EYE. WEEPIXG-EYE.— FISTULA LACHHYMALIS- WATERY EYE. These names are applied to an ulcerated opening in the little sac, or bag, which is situated in the inner corner or angle of the eye, and which is technically named the lachrymal sac. Its office is to receive the tears and mucus of the eye, in order that they may be transmitted from thence to the nose. In the early stages, the affection consists of a thickened con- dition of the lining membrane of the sac, and the adjacent lachrymal parts, the result of inflammatory action, and, in consequence of which, the tears and mucus are obstructed in their passage to the nose, and hence escape by passing down over the cheek, giving rise to an habitually weep- ing eye, and an adhesion of the lids after sleeping. Children of a scrofu- lous habit, and adults who have suffered from rickets, or from swelling of the glands about the neck, groin, or other parts, in youth, and who are, more or less, troubled with derangement of digestion, are the most fre- quent subjects of the disease. When the disease is not checked, or in con- sequence of frequent returns of acute inflammation, sloughing ensues, the contents of the tumor escape through the break thus made in the skin. When the complaint has reached this stage, it presents a much more unsightly appearance, and if neglected or mismanaged, as it so frequently is by means of severe and irritating remedies, extensive inflammation and excoriation, are produced in all the surrounding parts ; in some rare cases a diseased state of the bones of the nose accompanies or precedes this malady. See treatment of Chronic Ophthalmia. HOMOEOPATHIC TREATMENT. In recent cases the cure is easily and speedily accomplished by homoeopathic treatment, without the aid of the painful, irritating, and disfiguring local means resorted to in some cases. In those of long standing, or of complicated character, occurring in scro- fulous, cancerous, or otherwise debilitated constitutions, the successful issue is necessarily of more difficult and tedious attainment. Aconituni is to be selected in all recent cases, but particularly when the inflammation and pain are considerable, when this remedy is of much efficacy. Dose : Of a solution of six globules to two tablespoonfuls of water give a teaspoonful every two hours, until the pain and redness are removed or diminished, or until other symptoms occur to indicate other treatment. Pulsatilla is more especially appropriate for the treatment of per- sons of phlegmatic temperament and of mild disposition, arid when the symptoms have a tendency to become aggravated in the evening or at night. In such cases Pulsatilla should be administered twelve hours after the last dose of Aconituni. Dose: Three globules in a teaspoonful of water, night and morning. Ntix-vomica is more especially appropriate for the treatment of per- sons of sanguine or bilious temperament and of irascible disposition, the symptoms, generally speaking, tending to become exacerbated in the morning. Dose : Three globules, as directed for Pulsatilla. Graphites, Calcarea c, Silicea, or Sulphur, are frequently required to complete the cure, or to overcome the .tendency to recurrence BLOODSHOT EYE. 179 •of the disease, after previous treatment, according to the instructions above afforded. In the severer forms of the complaint occurring in per- sons of bad constitutions, with or without implication of the nasal bones, or in uncomplicated cases of long standing, occurring either in children, with or without glandular enlargements, or in adults, they are still more frequently needed. Dose : Of either as for Pulsatilla, BLOODSHOT EYE. This derangement may arise from a blow or fall, the act of retching, vomiting, or violent coughing, crying, etc. It presents a bright, scarlet appearance in most instances at the commencement, but usually assumes a livid hue at a subsequent period. The affection generally disappears of itself; but as it is occasionally liable to prove exceedingly obstinate, the subjoined method of treatment may be required, or such other manage- ment as may be more particularly enjoined in the article on " External, Injuries,'' or also in that on " Inflammation of the Brain.'' ALLOPATHIC TREATMENT. The immediate application of cold is generally most serviceable. If the trouble is not rapidly removed its cure is hastened by hot appli- cations. In .case the congestion is greatly prolonged it is to be treated the same as is directed for conjunctivitis or simple ophthalmia, page 170. HOMCEOPATHIC TREATMENT. Arnica should be employed inter- nally and externally when this derangement has been caused by external injury, such as a blow or fall, and does not disappear spontaneously, in which case this remedy will quickly promote absorption, and remove the unsightly appearance. Dose (Internal) : Three globules in a teaspoonful of water, repeated after twelve hours, and subsequently, if necessary, at intervals of twenty-four hours, until the discoloration is removed. Application (External) : To two tablespoonf uls of water, add six drops of the concentrated Tincture of Arnica, and bathe the eye or eyes freely with this lotion, three times a day, until the discoloration disappears— only, however, during the internal administration of the same medicine as above directed. Belladonna is preferably indicated when the bloodshot eye is asso- ciated with symptoms of fullness and throbbing of the vessels of the neck, flushing of the face, oppressive pain in the head and the like, even in cases in which the direct cause of these symptoms is distinguished in a blow, fall, or other external injury ; or again, in cases in which the blood- shot eye appears as a symptom of cerebral derangement, as evinced by the associated symptoms, conditions, and circumstances. Do.se : Two globules in a teaspoonful of water, repeated at intervals of four hours, until manifest improvement occurs, or such change should ensue as to render other treatment necessary. CATARACT. By this name is understood a partial or general turning white (opac- ity) of the more vital parts of the eye. The formation of a cataract is generally slow, requiring weeks, months, or years for its complete devel- ISO DISEASES OF THE EYE. opment. It may appear in one eye or both ; but when the former is the case, the other eye is generally affected, either sooner or later. In cata- ract all objects, especially those that are white, appear to be encompassed with a cloud or mist. This disease is beyond the means that can be used at home, and must be treated by a good physician, who makes this his business. In his- hands a small operation on the eye will, usually, entirely remove the diffi- culty. CBOSS-EYES.—STBABIS3IUS,XEABSIGHTEB. This trouble is usually present from birth, (congenital.) and can then only be cured by a surgical operation, by which the small muscle which turns the eye towards the nose is entirely, or partially severed, when the eye will very soon, if not at once, return to its proper position. This- operation need only require two or three minutes, and give but little pain, and is a great help to any one so afflicted. There is another variety, which is the result of too constant and close application of the eyes, espe- cially by lamp light, as in children overtasked at school, sewing girls, etc. This can be cured by at once quitting the work that is the cause of the overstraining. As a rule, a little Bell, will help very materially in bet- tering this condition. Blindfolding the stronger eye— the one which is constantly used — for a long time will gradually strengthen the weaker eye by the use which the patient will be forced to make of it. In many cases, the axis of vision in both eyes will, by this means, becomethe same when the strabismus is spontane- ously cured. As a rule, if the patient can bring the eye which turns in (or out) to the front, or a direct line, an operation should not be resorted, to until the means above recommended have been faithfully tried. Other cases are relieved by glasses which will make the focus of vision of both eyes the same. The operation for strabismus should only be practiced as a last resorts — *> STYE. Symptoms. — This is a little hard tumor, appearing like a small, dark red boil, generally in the corner of the eyelid, attended with severe inflam- mation, and frequently causing fever; considerable pain and suffering. It suppurates slowly and imperfectly ; usually being from four to six days, and has no tendency to burst spontaneously. Presents a small yellow, or greenish yellow speck, in or near the center; when ready to be opened, touch lightly with a needle, or other sharp point, and apply a little pres- sure. ALLOPATHIC TREATMENT.— Styes may, sometimes, be aborted by the continuous application of hot fomentations. A large flannel cloth, wrung out of hot water, may be applied over the eye, and replaced by another as soon as it cools. I have known this procedure to cure a begin- ning stye in a day. Sometimes extracting the eye-lash, situated upon the stye, will be followed by a cure. Carefully brushing the surface of the lid with Tincture of Iodine will, sometimes, prove curative. If pus is formed and is spontaneously evacuated, the stye should be opened carefully. STYE. 181 The general health of a person subject to styes will require attention. H0MCE0PATH1C TREATMENT — Pulsatilla alone, will, in most 'cases, suffice to remove the stye, if given upon its earliest appearance. It is a sure cure. Dose: Give three globules in a tablespoonf ul of water, morning and evening, until the stye is removed, or such change takes place as to require other treatment. Hepar Sulphnris should be given when matter threatens to form, (indicated by increased swelling and heat, usually attended with throbbing) in order to expedite the ripening of the tumor. Dose : Two globules in a teaspoonf ul of water, repeated six times, at intervals of three hours. Staphysagria should be given two days after the last dose of any ^medicine previously administered, to complete the cure, particularly when the swelling degenerates into a hard white tumor. Dose: Three globules in a teaspoonf ul of water, night and morning, for a week, (or until the earlier manifestation of decided improve- ment or change); then pause four days, after which the course may, if necessary, be repeated as before, and so on, until the dispersion of the tumor, or the accidental occurrence of new symptoms. But if no effect be produced within four days after the second course, pro- ceed with the next medicine. Silicea should be employed after the foregoing medicine in some ^cases, in which, after a second course, the treatment just recomended has failed to produce any effect whatever, a condition which sometimes pre- vails in bad constitutions. Dose : In every respect, as directed for Staphysagria. Arsenicum, Tuycopodinm, Sulphur and Aurum, may be required in addition to those above prescribed, in cases of stye, which occur as asso- ciated with marked scrofulous taint of constitution. Aurum, it may be here observed, is particularly indicated when there is obstinate obstruc- tion and formation of scabs in the nose, with redness, and swelling in the •eyelids. Dose: Of Arsenicum, or Lycopodium, give three globules in a tea- spoonful of water, night and morning, or of Sulphur and Aurum, six globules in a tablespoonf ul of water, every morning, the first thing (fasting), for a week, (or until the earlier manifestation of new symptoms, or of general improvement or change,) then pause eight days, after which the course may, if necessary, be repeated as before, and so on, from time to time, until manifest improvement or change. Diet.— During the inflammatory stage the diet should be sparing, and the restrictions should be more or less rigid. 182 DISEASES OF THE EAR. CHAPTER IX DISEASES OF THE EAK. OTITIS INTERNA.— INTERNAL INFLAMMATION OF THE EAR. EARACHE. Inflammation of the inner ear is chiefly recognized by the extraordi- nary pain (earache) it causes. The pain is chiefly a tearing, throbbing or burning pain, is very much increased by motion, likewise by chewing, loud noise, contact of the outer parts. Inflammatory earache is one of the most distressing tortures that man can suffer. The excruciating character of this pain accounts for the cerebral irritation which is almost always present in this disease. The fever is very violent, and the pulse is hurried and small. The head glows, whereas the extremities are cold as ice ; delir- ium and fainting fits set in, before the brain can be said to sympathize with the distress. The outer ear usually shows signs of inflammation; the passage into the ear is sometimes entirely closed, red and very sensitive,, and the swelling spreads to the outer ear and the surrounding soft parts. Otitis is very apt to result in suppuration, and is still more inclined to spread to the brain. It is not certain whether the invasion of the brain takes place more easily when the inflammatory process has reached its night, or after the pus has begun to form. Suppuration supervenes but. too frequently during the course of a chronic affection of the bones; hence suppuration of a bone near the ear, may involve the brain, and lead to a fatal termination, even after all danger consequent upon inflammation, seems to be entirely removed. Otitis may be complicated with a menin- gitis, which runs a very rapid course, and is one of the most dangerous, diseases. Its treatment has already been indicated in a former chapter. Otitis may terminate, in favorable cases, in complete recovery ; this result, however, is rare ; generally a disturbance of the functions of the ear remain behind, sometimes assuming the form of perfect deafness. If pus forms, it is fortunate if it is discharged externally, even if the tympanum (ear- drum,) should be greatly injured, and chronic otorrhoea (discharge from the ear,) should be the result. The causes of otitis cannot be mentioned with positive certainty. A cold ; and suppressed or receding skin diseases, are among the prominent ones ; syphilis and scrofula are other causes. OTITIS EXTERNA. As we remarked above, an inflammation of the external meatus usually accompanies an inflammation of the internal ear, and, by its pres- ence, always reveals the existence of a higher grade of otitis interna. As an idiopathic affection, disposed, however, to extend to the inner parts of" the ear, it is either an inflammation of the cellular tissue, in the external passage, spreading uniformly all around, very painful, but not very dan- gerous, and of short duration, or else it consists in suppuration of one or more glands of the outer passage. In such a case, a small abscess is seen on one or the other side, more or less deeply in the inner ear. In this DEAFNESS. 183 form of the inflammation the pain is, likewise, comparatively very acute, but usually ceases all at once, when at its night, by the bursting of the abscess. This inflammation very frequently accompanies, as a compli- cating disorder, an inflammation of the parotid gland, or of other adjoin- ing parts. Erysipelas, likewise, does not unfrequently attack the outer ear, and, if it begins at the ear itself, may lead to errors in diagnosis. OTORRHCEA. Discharge from the Ear. — As a consequence of otitis, but some- times from other causes, we frequently meet with a discharge from the ears, which is, at times, slimy, at others purulent or ichorous, at others, again, watery or bloody. The slimy discharge is of a catarrhal nature, makes its appearance in the cases of many children, whenever they are attacked with a severe cold, and has no special significance. As a gen- eral rule, it very soon yields to a few doses of Pulsatilla. The other forms of otorrhcea are symptomatic manifestations of otitis, and require the same treatment as this disease. Injections of lukewarm water have always a good effect, and should never be omitted. DEAFNESS. Hardness of hearing may depend upon a variety of causes, by the peculiar nature of which, its curability is determined. If it proceeds directly from the auditory nerve, and is the commencement of complete deafness, it is not likely that much can be done for it by internal treat- ment. If the deafness is caused by a stoppage of the meatus externus, various obstacles may prevent the free entrance of sound, the most com- mon obstacle is the accumulation of indurated cerumen (ear wax) in front of the tympanum. This is most effectually removed by continued injec- tions of lukewarm water, until the plug is loosened, after which it can be readily grasped with a pair of pincers and drawn out. If an unopened abscess is the cause, which is not often the case, its reabsorption is easily accomplished by frequently dropping lukewarm water into the ear, which has to be retained in it for some time. A polypus in the passage may, if possible, be twisted or cut off; where this is not possible, the polypus can gradually be caused to shrink, by touching it frequently with the half- diluted tincture of of Thuya. If the tympanum (drum of the ear) is injured, a cure is, of course, impossible; in such case, the patients hear often much better by inserting a loose plug of cotton in the ear. This custom is so common, with many people, that they are never seen with- out cotton in their ears. It is a bad habit, which favors, more than any other proceeding, the formation of little plugs of earwax ; for the nuclei of most plugs, which we have removed in large numbers, were found to consist of cotton fibres. Still more hurtful is the habit of introducing medicinal substances into the ear. We are acquainted with a lady who has been using Camphor in this manner until her tympanum has become perforated in consequence. If little children are hard of hearing, we must ascertain, in everj T case, whether they have not inserted something like a bean, pea, millet seed, radish seed, or like articles into their ears. 184 DISEASES OF THE EAR. ALLOPATHIC TREATMENT.— The external canal (meatus) of the ear sometimes becomes obstructed by the natural secretion of the canal, owing to some accidental cause. Sometimes foreign particles add to the accu- mulation. These are best removed by thorough sj^ringing with an ear- syringe with a warm solution of Bicarbonate of Soda (baking). Before attempting to syringe the ear, the plug somtimes will require previous moistening with a few drops of glycerine. A preternatural dry- ness of the canal of the ear sometimes exists, which is easily relieved by a small quantity of glycerine carried into the canal, occasionally, by a camel's hair brush. It is not unfrequently necessary for the surgeon to have to resort to the use of the ear scoop and forceps for the removal of these obstructions. If, after their removal, there is intense and painful sensibility to sounds, a pledget of cotton, moistened with glycerine, may be laid in the exter- nal ear, and retained in place with a bandage or handkerchief. Chronic eczema (salt rheum) of the ear, generally depends upon some vice of the system, which may be removed by the use of the following tonic, viz. .' Takeof Citrate of Iron and Quinine a dram and a half; Fowlefs Solution a dram and a half ; Simple Syrup four ounces. Mix. Dose: Give a teaspoon ful three times a day. The ear should be syringed out, twice a day, with a warm solution of Bicarbonate of (baking) Soda, and, after each cleansing, the following application made by carrying it within the canal of the ear with a cam- el's hair brush : Take of Tannin a dram ; of Oxide of Zinc two drams ; of Glycerine one ounce. Mix. Shake the vial, and apply with a camel's hair brush or feather. Inflammation of the external canal (external otitis) occurs most fre- quently in childhood, from exposure to cold, or other causes. The inflammation extends from the outer covering of the drum to the bony lining of the auditory canal. The danger, aside from the imme- diate pain, is, that the disease may lead to perforation of the drum, and the possibility of necrosis (death of bone and exfoliation). In a few cases, the inflammation has been conveyed through the bony wall to the membranes of the brain, causing death. As a means of relieving pain, the canal may be filled with a solution of Morphine four grains, and Atropine two grains, in half an ounce of Glycerine, applying at the same time, over the ear, several thicknesses of flannel saturated with hot water. Laudanum may be used instead of Morphine, but it is not so effectual. If this does not pro- cure relief, the inflammation is deeply seated, and may eventuate in necrosis, if not relieved. Such cases should be in the hands of a surgeon. It is probable that the most, or only effectual treatment is, to cut down to the bone through the whole length of the auditory canal. Usually the inflammation subsides in two or three days, superseded by a more or less profuse discharge. This is called otorrhea. Otorrhcea (discharge from the ear) is a symptom, or consequent of many affections of the ear ; but from whatever cause, it requires in itself about the same treatment— the frequent use of the syringe. Warm water should be used, and should, generally, be rendered slightly alkaline with a little soda. If the dis- charge does not soon disappear, astringent washes should be used. A INTERNAL OTITIS. 185 dram of Tannin, in an ounce of Glycerine, will frequently prove effectual. The Tannin may be added in much larger quantity. It can be applied with a camel's hair brush, or a feather. A solution of Sulphate of Zinc, or Alum in water, may be used instead. After using one of these, time should be given for it to take effect, and then moisten the ear with a very little Glycerine. In all cases of discharge from the ear, not dependent on evident inflam- mation of the canal, or previous inflammation of the internal ear, examin- ation should be made for disease of the mastoid cells (in the eminence behind the ears called the mastoid process,) which may require incision, and, perhaps, trephining (boring into them). Internal Otitis. Inflammation of the middle and internal ear is very- serious, the pain is deep-seated and intolerable, attended with throbbing, con- fusion of the head, and fever. The inflammation is probably advancing to suppuration, possible disease of the internal ear, and permanent deafness.. The drum of the ear should be closely watched by frequent examination with the speculum, and as soon as matter has formed, shown by the altered color and form of the drum, the drum should be punctured by the surgeon, and the pus let out. In this way the patient is not only spared much pain, but more serious damage, from the drum breaking down beyond repair ; and the chances are also better for recovery without disruption of the internal ear. The throat is almost always inflamed. This should be met by appropriate treatment. Mustard plaster to the neck, or rubbing the neck with turpentine or harts- horn liniment, or the constant application of flannels wrung out of hot water, and astringent gargles of Sulphate of Zinc, a scruple to a teacup of water, or the application of Tannin in Glycerine (one dram to the ounce) with a linen mop, or such other suitable treatment as a physician would direct. The Eustachian tube should be inflated. This can be done, if a physician is not in attendance, by closing the mouth and nose, and making forciblejexpulsion of the breath simultaneous with the act of swallowing. External applications will be the same as directed for external otitis. Otalgia {or Neuralgia of the ear) uncomplicated with inflammation, is, I believe, very rare. It may be connected with some irritation of the mouth, as a decayed molar (double) tooth, or it may be due to some irrita- tion of the stomach, or some other organ supplied by the pneumo-gastric nerve. In these cases the trouble is reflex and its treatment consists in the removal of the offending cause. If no such cause is discoverable, and espe- cially if the pain is intermittent or periodical, such general treatment should be resorted to as is recommended in the article on neuralgia. Some relief may be given by applying over the ear, warm poultices of hops or poppy heads, or by pouring into the ear a few drops of Laudanum, Tincture of Aconite, or Belladonna, or the three may be mixed and diluted with a little glycerine. The local means for the relief of pain directed for exter- nal otitis are effectual here. Not unfrequently is the administration of an anodyne necessary. So often is earache caused by inflammation and the production of pus or mucus, that I believe the drum ought always to be thoroughly examined with the ear speculum, and, if indications of either are present, the drum ought to be punctured by the surgeon, and relief will follow the escape of the pus or mucus. 186 DISEASES OF THE EAR. Deafness. Some of the causes of deafness which may be removed by- domestic hand, are the following : A dried accumulation of the natural secretions of the canal of the ear, (meatus) may prevent the vibrations of sound reaching the tympanum (drum). This obstruction may be rendered still more complete, by wool or cotton with which the person negligently stops his ears, neglecting to prac- tice proper cleanliness. This obstruction is easily discovered. Its removal is best effected by thorough washing with warm water, or a weak solution of Bicarbonate of (baking) Soda, with a hard rubber ear syringe. A com- mon four ounce, hard rubber syringe, may be used, taking the precau- tions to wind the nozzle with muslin, until it is too large to penetrate the canal, except just at the point. A tin cup, with one side flattened, should be held under the ear, to catch the outflow of water. The injections should be continued at one or repeated sittings, until the canal is clean, and the passage to the drum is unobstructed. When the accumulation is unusually hard, it may be softened by moistening with Glycerine or bland oil, as Almond or Olive Oil. A deficiency of secretion in the canal may be partly overcome by mois- tening it with Glycerine, or Sweet, or Almond Oil, until the natural secre- tion returns. This may be hastened by very warm water injections and the application of essential oils, as Turpentine. They may require dilut- ing with Glycerine, or Sweet Oil to prevent too much irritation. Thickening of the lining membrane of the meatus may cause deafness, the result of chronic inflammation. It may be overcome by applying a mixture of Tincture of Iodine with Glycerine and Tannin. Take of Tannin one dram, dissolve in half an ounce of Glycerine, then add half an ounce of Tincture of Iodine, apply twice a day with a cameVs hair brush, or a feather. Attention to the general health is required, by the use of tonics as recommended in Eczema of the ear. Other causes of deafness require the attention of experts. HOMEOPATHIC TREATMENT. Inflammation of the Ears. Aconitum is required in commencing treatment when the affection is attended with considerable febrile disturbance, dry heat of the skin, with fullness and quickness of pulse. Dose: Of a solution of six globules to two tablespoonfuls of water, give a teaspoonful every two hours, until the indicative symptoms subside. Belladonna is indicated when there is determination of blood to the head, with redness of the face, by digging, boring, tearing or shooting pains extending to the throat ; fever and extreme sensibility to the slight- est noise ; when the pains are more severe internally ; also, when the brain partakes of the inflammation, and delirium is present. Also, in external inflammation of the ears, when the inflammation runs high, and threatens to extend to the face and scalp. Dose : Six globules, as directed for Aconitum. Hepar sulphuris should be administered twelve hours after the last dose of Belladonna, if, after the second day from the commencement RHEUMATIC EARACHE. 187 of treatment, the pain and inflammation be not completely reduced ; or, again, and more especially in cases in which suppuration and discharge have taken place. Dose: Three globules in a teaspoonful of water, repeated at intervals of twelve hours, until . decided and permanent improvement or change. Sulphur. This medicine should be administered twelve hours after the last dose of Hepar sulplmris, if the discharge of matter, in particular, should continue unarrested; or twelve hours after the fourth dose of Mercurius, if, in addition to the discharge of matter there should be hum- ming in the ears and pricking pains. Dose : Three globules as directed for Hepar sulphuris. Mercurius should be selected when the following symptoms and conditions characterize the case : — Shooting or tensive pains in the ear, extending to the cheeks and teeth ; sensation of coldness in the ear ; increase of suffering in the warmth of the bed ; inflammation and indura- tion of the ear, with soreness of the orifice, and discharge ; swelling of the glands. Also, in external inflammation, particularly when the adja- cent glands are involved. Dose : Six globules, as directed for Aconitum. Pulsatilla is a most valuable remedy in this affection. It is partic- ularly indicated when the external ear is simultaneously much affected, and appears inflamed and swollen; attended with heat, shooting and tensive excruciating pain internally ; moisture in the ear, or somewhat copious discharge. This medicine is particularly useful for females and individuals of chilly habit. Applicable, also, to most cases of external inflammation of the ears. Dose : Six globules, as directed for Aconitum. NERVOUS OR RHEUMATIC EARACHE. Pulsatilla is not unfrequently indicated for the treatment of cases of nervous or rheumatic earache, which ensue, from time to time, as the consequence of antecedent inflammation ; or more particularly, if there be a tendency to discharges from the ear, or if the ear be habitually moist. This is the best remedy for earache in most cases. Dose : Of a solution of six globules, to two tablespoonf uls of water, give a teaspoonful every half hour, (when the pain is very distress- ing,) or every three hours, (in less severe cases,) until a degree of improvement takes place; after which the intervals should be gradu- ally extended to twelve hours, and the administration thus continued, until the cessation of the pain, or the occurrence of other symptoms, requiring different treatment. Phytolacca should be administered when there is shooting pain in both ears, the right being worse, aggravated by swallowing ; feeling as if the ears were stopped up, with crackling sounds in them ; the sense of hearing seems dull, while it is really more acute. Dose : A solution of six globules, as directed for Aconitum. Nux-vomica is preferably indicated when the pains are of a tearing, shooting nature, extending to the forehead, temples, and bones of the face, worse towards morning ; dryness of the ear, particularly when the affection occurs in persons of a lively, choleric disposition. Dose : Of a solution of six globules, to two tablespoonfuls of water, give a teaspoonful every hour, (when the pain is unbearably severe,); 188 DISEASES OF THE EAR. or every three hours, (in less distressing cases.) until a degree of amelioration becomes apparent; after which the intervals should be gradually extended to twelve hours, and the administration thus continued until permanent and decided improvement or change. Dulcamara should be selected when the affection has arisen from a chill or wetting, and will, in many cases, prove sufficient for its removal; it is also indicated when the pains increase at night, and are attended with nausea. Dose : A solution of six globules, as directed for Nux-vomica. Jfcrcurius should be employed when the pain is attended with a sen- sation of coldness in the ears, and is characterized by exacerbation in the warmth of the bed; or, again, when there are shooting or tensive pains in the internal ear, extending to the cheeks and teeth. Dose: A solution of six globules, as directed for Nux-vomica. Chamomilla should be administered when there are stabbing pains in the ear, as if knives were driven into the head ; great sensitiveness of noise, and even of music ; extreme sensitiveness, susceptibility, and irrita- bility. Dose : A solution of six globules, as directed for Nux-vomica. Sanguinaria should be exhibited when there is burning of the ears, with bright redness of the cheeks, and headache accompanying the ear- ache; the neck feels stiff; painful sensitiveness to sudden sounds. Dose: A solution of six globules, as directed for Nux-vomica, Arnica is often of much service for the treatment of individuals of a nervous, excitable temperament, subject to attacks of earache, provoked by trivial causes, and is, moreover, characteristically indicated when there is an excessive sensibility to noise. Dose : A solution of six globules, as directed for Nux-vomica. China is frequently suitable after Arnica, in cases in which the last named medicine has been productive of partial relief only, and when, moreover, the pains are aggravated by lying on the ear, or by contact. Dose : A solution of six globules, as directed for Nux-vomica. Sulphur should be administered, if the excessive sensibility to noise should constitute a predominant indication ; it is, especially, suitable to persons subject to catarrh, or tendency of the blood to the head. Dose : Three globules, in a teaspoonf ul of water, night and morning, until permanent improvement or change. HOME TREATMENT.— Patients who are subject to attacks of nervous or rheumatic earache, should be very careful and moderate in the indul- gence of their appetite ; and the food should be simple but nourishing. Fermented and spirituous liquors, coffee and strong tea, etc., are capable of themselves of provoking an attack; and, inasmuch as a tendency to derangements of the digestive functions is very frequently to be distin- guished as characterizing the predisposition to earache, it is very essen- tial that those things should be avoided which are likely to engender irreg- ularities of digestion, however apparently trivial. Everything which is known to operate as an exciting cause, should, as much as possible, be avoided. Moist heat may relieve. Humming or Buzzing in the ~Ears.—Xux- vomica will be found of service in the treatment of recent cases of humming or buzzing in the ears, when this annoying affection is most predominant, or the symptoms are aggravated at night. DISCHARGE FROM THE EAR, 189 Dose: Six globules, in a teaspoonful of water, morning and evening, for a week; then pause a week, resuming the administration after the lapse of that time, if yet required. Pulsatilla is to be preferred when the evening is more especially the period of exacerbation, and for persons of a mild character, particularly females. Dose: Six globules, as directed f or Niix-vomica. Causticum. — Loud vibration of all sounds, and even of the patient's, own voice. Dose : Six globules, as directed for Nux-vomica. Mercurius is more distinctly indicated when the attacks are attended with sweating. Dose : Six globules, as directed for Nux-vomica. Discharge from the Ear.— Arsenicum should be given when the discharge is profuse, smells very badly, and makes the adjacent parts sore ; also when there is prostration and weakness. Dose: Give four globules, in a teaspoonful of water, night and morn- ing, for four days, (or until the earlier development of manifest im- provement or change,) then pause four days, after which the course may be repeated, as before, if necessary, and so on, until manifest improvement or change. Aurum will be found to be useful in chronic cases, particularly after the abuse of mercury, under old school treatment, where the discharge is fetid, and the bones of the ear are diseased. Dose : Four globules, as directed for Arsenicum. Calcaria Carb*, should be administered in chronic cases, when the discharge looks like matter, the glands of the neck are swollen, the abdo- men is large, and there are other evidences of a scrofulous constitution. Dose : Four globules, as directed for Arsenicum. Carbo Veg. is suitable after the suppression of itch, or itch-like erup- tions ; the discharge is offensive, the ear is inflamed, and sensitive to touch. Dose : Four globules, as directed for Arsenicum. Hepar Sulphuris may be administered when the discharge is very profuse and mild, particularly in scrofulous persons, or when it results from acute inflammation of the internal ear. Dose: Four globules, as directed for Arsenicum. Sulphur is indicated when the discharge consists of offensive matter, particularly if the left ear be affected ; eruptions behind the ears, which itch, and bleed after scratching. Dose : Four globules, as directed for Arsenicum. Mercurius is indicated, if the affection be of syphilitic origin ; the ears itch, the face is covered with little pimples which secrete pus. Dose: Four globules, as directed for Arsenicum. Pulsatilla will be found to be a very valuable remedy in the treat- ment of this troublesome affection. It is indicated when the discharge is the result of a cold, (catarrhal) or follows acute inflammation of the ear. The discharge is usually thick and yellow ; the ear is red and swollen, and there are stitch-like pains in it.. The left ear is commonly affected. Dose: Of a solution of six globules, in two tablespoonf uls of water, give every three hours, if required, a teaspoonful. 190 DISEASES OF THE NOSE, CHAPTER X. DISEASES OF THE NOSE. COBYZA 3 CATARRH.— COLD IN THE HEAD* Catarrh of the nasal mucous membrane is one of the most common and most frequently occurring affections. A simple catarrh arises from a cold. Individuals who watch them- selves somewhat, know very well, that if they feel chilly from exposing themselves to a current of air, after being heated, they will have a catarrh within twelve hours. Severe attacks always commence with a febrile sensation, lassitude, dull headache, especially above the root of the nose. At first the nose is drier than usual, sensitive to cool air, the smell is sometimes remarkably affected ; there is a tingling in the nose and a desire to sneeze. If a discharge takes place at the commencement, it is generally very tenacious, yellowish, or almost entirely watery. In most ose : As for Belladonna. Other remedies are Nux-v., Dulcamara and Xitric Acid. The latter, for that form of the disease which is the result of the use of Calomel, or Mercury, in too large doses. HOME REMEDIES. Precautions in diet, are particularly important in cases of children and infants. A frequent cleansing of the mouth, has a palliative and curative effect, not only in the case of children, but in that of adults. Warm water is the best means to cleanse the mouth. The use of fat food must be strictly forbidden ; after eating fat food, every symptom of the disease becomes aggravated. Cooling washes are usually to be recommended. Honey and Borax, a weak solution of Alum, or Sul- phate of Zinc used as a gargle or wash. ANGINA.— SOBE THBOAT.— APHTHOUS SOBE THBOAT. By this name we understand an inflammatory affection of the poster- ior (back) parts of the mouth and pharynx. According as it consists only in a catarrhal irritation of the mucous lining, or in actual inflammation of the parts, it is divided into catarrhal and tonsillary angina, which are two distinct forms of the disease. Catarrhal Angina is synonymous with acute catarrh of the pharynx and the posterior buccal cavity. The disease usually arises as independent of other affections, less frequently in the course of other catarrhal pro- cesses. Its most common cause is a cold; it likewise breaks out as a symptom of scarletina, less frequently as a symptom of typhus, and some- times it seems to spread even epidemically. Many individuals have from their youth a peculiar disposition to catarrhal angina, without showing in SORE THROAT. 205 their external appearance any signs of a peculiar irritability or weakness; on the contrary, they are persons of healthy-looking and vigorous consti- tutions. Symptoms. These vary according as children or adults are affected. In either case the disease usually breaks out suddenly without any pre- monitory symptoms. The children were quite cheerful the moment previous, and are suddenly attacked with all the symptoms of a very vio- lent fever and marked cerebral congestion. The temperature of the skin is very high, the pulse disproportionately accelerated, that is, in compar- ison with the trifling importance of the pathological process; the children want to lie down, and they sink into a soporous condition from which they are frequently roused by sudden exclamations or anxious fancies, which sometimes continue even after the patients are wide awake, so that they seem really delirious. All these symptoms are worse towards even- ing and attain their climax about midnight, after which they decrease in intensity. The cerebral symptoms are so intense, and, by their form and violence, cause so much anxiety, that it would seem at first sight as though the little patients were attacked with inflammation of the brain ; there is but one certain diagnostic sign, which is the copious sweat, that is scarcely ever wanting in this disease, and which always breaks out, if the patients are covered ever so little, sometimes even if they are not cov- ered at all, and which is never wanting, if the patients are sleeping. The appearance of the tongue maybe perfectly natural ; generally, however, it shows a thin, whitish coating at an early stage of the disease. The pupils are at times dilated, at times contracted. If the children are old enough to describe their morbid feeling, they complain much less fre- quently of pain in the throat than of pain in the pit of the stomach and in the ears. The pain in the latter may increase to a high degree of intensity, and may cause the patients to moan all the time. The appar- ently threatening intensity of these symptoms in the evening or at night bears no proportion to their striking decrease in the morning, when the children are seen playing about very cheerfully, only, perhaps, feeling a little more tired than usual. If left to itself, the disease does not termin- ate here, but soon after dinner a fever sets in, which, however, does not attain the same degree of intensity that the fever had at the first outbreak, and ceases on the third, sometimes not till the seventh day. The appetite is very bad, the bowels constipated, thirst moderate. There is very fre- quently a peculiar odor from the mouth, which is not so much a foul smell, as rather like that of Phosphorus ; and is always more marked in the more violent cases, perhaps, because in such cases the stomach is gen- erally very seriously involved. Catarrhal Angina is undoubtedly one of the most common causes of the cerebral congestions with which children are so often attacked, and is but too seldom recognized as their exciting cause. The above-mentioned diagnostic sign has never left us in the lurch, and we deem it so much more important as it is difficult, especially in the case of little children, to undertake an inspection of the throat. .In children of six or seven years, , marked cerebral congestions do not usually accompany this form of angina, which runs the same course, in their case, as in the case of adults. Among older individuals, catarrhal angina generally sets in without 206 DISEASES OF THE MOUTII AND THROAT. any decided fever symptoms; if they are present, they correspond to the febrile stage of every catarrhal fever; that is to say, they consist of alter- nate attacks of chills and heat, great lassitude, and rheumatic drawing and tearing in the extremities. At the same time they complain of disa- greeable dryness in the throat, and painful deglutition (swallowing), especially of the saliva, which is generally very tenacious, and secreted in small quantities. Drinking, or swallowing solid food, is generally much less painful. The fauces (back of the mouth), especially at the arch of the palate, appear uniformly red, less frequently dark than bright red, the uvula (palate) is involved in the attack, looks swollen and elongated, so that its tip touches the root of the tongue, by which many patients are obliged to swallow all the time, and even causes an inclination to vomit. The tonsils are, likewise, somewhat swollen. If the disease is neglected at this first stage, or if the patient takes, perhaps, a second cold, the difficulty of swallowing increases a good deal, even to such an extent that the liquid returns by the nose, and the attempt to swallow solids causes actual paroxysms of suffocation. In such higher grades of the disease, even adults are affected with a very foul breath, the fever assumes a more continuous type, and violent head- ache, nausea and vomiting, are seldom wanting. On inspecting the mouth, we find the whole of the back part of this organ dark red, some- times we notice a few superficial ulcers; the mucous lining is very much swollen, and the tongue thickly coated. In children, we have seldom an opportunity of watching these different degrees of the disease; on the contrary, they always feel sickest at the commencement of the attack. Amid a gradual decrease of all the symptoms, the patient generally recov- ers in seven to nine days, provided no untoward accident interferes with the cure. Only in the lighter forms of the disease recovery may take place in three, and even in two days. Catarrhal angina is a prevailing affection of young people; where there is a constitutional disposition to this disease, its attacks continue to a late age; decreasing, however, in intensity. Before the first year, it occurs less frequently; between the second and seventh, it is one of the most common diseases. Whereas, among young people, it is very com- monly an independent disease; among individuals between the ages of forty and fifty, on the contrary, it is, most generally, a mere symptom of some general disorder. The prognosis is always favorable, especially, if the catarrhal angina is the only morbid symptom. Some profess to have seen death result from the convulsions caused by the congestion of the brain ; in such cases, however, the cause of death has, most likely, been ascertained only super- ficially. ALLOPATHIC TREATMENT. Simple inflammation of the throat (angina) is most properly treated by a mild purgative. Gargles of a solu- tion of Chlorate or Nitrate of Potash (Saltpetre) may be used to relieve the dryness and irritation of the throat. A small quantity of Mucilage or Glycerine applied to the throat with a brush or mop will meet the same end. If the case should not end at once in recovery, Chlorate of Potash maybe given internally in doses of ten grains, three or four hours apart, and Quinine in doses of three grains three times a day. Should restlessness be SORE THROAT. 207 great, an anodyne of Opium and Hyoscyamus will be needed. One grain of each may be given at bed time to an adult. Should there be much secretion from the throat, five drops of the Tincture of Belladonna should be given every hour, until a slight dryness of the throat is felt, and every three or four hours thereafter. If there is much fever, Aconite should be given as directed for Quinsy. It can be given with the Belladonna. In sub-acute cases, the throat is frequently dry, and may be relieved by the frequent application of Glycerine, and by allowing lumps of sugar to dissolve in the mouth. If other measures are needed, they are the same as those just described for the acute form of the disease. For the chronic form of the disease, which is quite common among professional men and others who lead a sedantary life, the treatment is, I believe, mostly hygienic. More time should be spent in the open air. Indeed, it would be better if some calling " out of doors" could be followed until the throat wholly recovers. Then, such time should be spent out of doors, as will maintain the body at its greatest vigor. This and recreation for both body and mind are necessary, and treatment is useless without it. generally unnecessary with it. Regular sleep of eight hours every night is, also, an essential. Every working man (physical or mental) requires one day's rest in seven. The clergyman should rest every Monday, and all others on the Sabbath. The throat requires protection. For this there is nothing better than a full beard, which nature provides. Tonics may be necessary, if the body does not regain its vigor. The form of the tonics should be changed from time to time, and their use continued for a long time. Astringent applications are useful, especially, in the follicular variety. A gargle of Alum a dram to the pint of water, or Sulphate of Zinc a half a dram to the pint, or Tannin in Glycerine a dram to the ounce, applied with a camel's hair brush or mop are useful. If the secretion is great, ten drops of the Tincture of Belladonna may be given two or three times a day. HOMEOPATHIC TREATMENT.— In its ordinary form, there is no better remedy for this affection than Belladonna. When given every two or three hours, it hushes, in twelve to twenty-four hours, the most violent pains in the throat, removes the febrile and congestive symptoms, and leaves mostly only a little lassitude and an impaired appetite This effect of Belladonna is almost constant among children who are sometimes seen in the morning, after taking Belladonna, jumping about bright and cheerful, even if they seemed deathly sick the evening previous. Dose : Four pellets every two or three hours. Merciirius, when there is loss of strength, profuse sweats, bad breath, delirium, etc. Dose: Six pills, every two hours, in a little water. Aconite, if the fever is very high, with hot skin. Dose : As for Belladonna. QUINSY. Inflammation of the Tonsils, Ulcerated Sore Throat.— -This affection is usually met with only to the age of forty or fifty years, very seldom at a later period ; most frequently between the years of seven and 208 DISEASES OF THE MOUTH AND THROAT. fifteen. It is certain that persons who have to use their voice a good deal are more liable to an attack of angina, and are more generally affected with the chronic form. One attack of quinsy predisposes, in a striking manner, to relapses. Such diseases are more frequent in spring and fall, than in summer and winter; their frequent appearance in the same locality, at certain periods, justifies the inference that this disorder is sometimes epidemic. Damp, gloomy, and badly ventilated dwellings, are, undoubtedly, very frequent causes of amygdalitis ; we attend families in whom the children are, very frequently, attacked with this disease, and where, in the absence of any other unfavorable circumstances, the frequency of these attacks can only be accounted for by the unwholesome- ness of their habitations. The jDeculiar relation of syphilis and Mercury to the tonsils, although, as yet, beyond the bounds of comprehension, is well known. In scarlatina, we meet with amygdalitis as a characteristic symptom of the disease ; in less frequent cases, amygdalitis, likewise, accompanies other exanthema, least frequently measles. Symptoms : Acute amygdalitis (quinsy) generally commences, like all other acute affections, with a violent chill, which is speedily followed by an unusual rise of temperature, and increased frequency of the pulse, with violent headache, and sometimes violent symptoms of cerebral hype- remia; so that in the absence of local symptoms, which have not yet made their appearance, we are easily led, especially, in the case of children, to suspect the invasion of some acute disease. Generally, all the morbid symptoms, which occur in catarrhal angina, make their appear- ance in this disease, only they are more continuous, the fever, especially, is less remittent, on which account, acute tonsillitis is more readily than catarrhal angina confounded with some violent acute disease, such as men- ingitis, even in the case of adults. This is, particularly, owing to the fact that the local throat symptoms do not make their appearance at once, but not till the fever has lasted already a whole day ; in consequence of which, we neglect to examine the throat at the onset of the disease. The throat, generally, looks redder, more so on one side than on the other. The red- ness is very soon followed by a swelling of the tonsils; at first, only one tonsil being affected, the other tonsil remaining either unaffected or being attacked after the other. The more rapidly the inflammatory swelling increases in intensity, and the higher the grade to which the inflamma- tion is carried, the greater the danger of the inflammation terminating in suppuration. The swelling sometimes enlarges to such an enormous size, that it is no longer possible to see the back of the tonsils. As the local symptoms increase, the general condition of the patient becomes more and more unfavorable; the fever remains at its hight; swallowing is almost impossible, and yet there is a constant urging to swallow. Speech becomes guttural, sometimes quite impossible; the breathing is, more or less, impeded. During perfect rest, the pain is not so great, but is excited or aggravated by every motion. The lassitude is continually on the increase — partly owing to the violence of the fever, and partly to the deficient sup- ply of solid, and, more particularly, of liquid nourishment. The tongue is lined with a thick, tenacious phlegm, which is exceedingly trouble- some to the patient, and seems to cause the urging to swallow, which fre- quently results in an inclination to vomit. The bowels are constipated, QUINSY. 209 the urinary secretions diminished, and urine is very thick. In this man- ner, the disease continues about nine days, and sometimes increased to such degree in intensity that the patient, the day previous to the opening of the abscess, seems to be like one near death. Very seldom the general condition improves during the formation of the pus. As soon as the- abscess breaks, the threatening symptoms disappear almost immediately. That perfect recovery cannot take place at once, must be self evident to any one who considers how much strength the body has lost by sleepless- ness and deficient nourishment. Not in every case, and, as we shall show more particular when speak- ing of the treatment of this disease, is the course of tonsilitis as acute as we have described. From the most violent fever, with sopor and delir- ium, to a scarcely perceptible disturbance of the general health, all sorts of degrees of constitutional malaise can be noticed, even though the local affection should be the same. If the inflammation is dispersed, this result does not take place very rapidly ; on the contrary, in such a case, the inflammation is very apt to pass into the chronic form, which is much more rarely met with when the inflammatory process terminates in sup- puration. But even if the inflammation is dispersed, a febrile condition of the system, lassitude and loss of appetite, continue for some days; whereas, the decrease in the inflammatory symptoms ought to lead one to infer that the general well-being was much improved. The prognosis is almost always favorable. Only in children the disorder may terminate fatally, either in consequence of brain difficulties, or by suffocation, or even, under certain unfavorable circumstances, by mortification of the parts. Among adults, this danger need not be apprehended. Anginas, initiating or accompanying exanthematic affections (scarlet fever, etc..) have to be viewed from a different standpoint to that of independent angina. The chronic form of amygdalitis arises, in most cases, out of the acute form, in consequence of the reabsorption of the inflammatory exudation only taking place partially* and the swelling of the tonsil remaining. It seems as though, independently of all constitutional predisposition, such remaining infiltrations superinduced a tendency to relapses. Every new attack increases the swelling, so that an hypertrophy may ensue, by which access to the pharynx may be almost entirely prevented. After an abscess, hypertrophies of any size occur much less frequently. With- out any previous acute attack, chronic amygdalitis may develop itself almost imperceptibly, in persons who have to exert their vocal organs a good deal, such as ministers, singers, actors; but acute cases, arising from such causes are not near as violent or important as cases arising from the previously mentioned causes. It is only exceptionally that the enlargement of the tonsils causes trouble to the patients. It is seldom that they experience any pain ; nor is the pain ever very acute, unless an acute attack has just taken place. The most common derangement is an altered tone of the voice, as in an acute attack, and a weakness of the vocal organs, in consequence of which the sufferer is easily attacked with hoarseness. Jn spite of the swelling, which is sometimes very large, the difficulty of swallowing is either tri- lling, or else there is no difficulty at all. Only in rare cases, the patients 14 210 DISEASES OF THE MOUTH AND THROAT. complain of the swelling, as of a foreign body in the throat. It is a pecu- liar feature in such cases, that every cold brings on an acute attack of amygdalitis, which is generally, however, confined to some fever with pain in the throat, and some difficulty of swallowing, with moderate red- ness of the tonsils. By neglecting such attacks, they may recur so often, and in such rapid succession, that the patient's health may remain dis- turbed for weeks. The enlargement of the tonsils is always a very obstinate difficulty, which it is so much more troublesome to remove, as the patients who feel tolerable well otherwise, do not feel disposed to take medicine. In an advanced age the swelling generally disappears spontaneously. ALLOPATHIC TREATMENT.— Quinsy, (tonsilitis) is often relieved in robust persons promptly, especially if previous attacks have resulted in suppuration, by a brisk saline purge (Epsom Salts) given in doses of a table- spoonful and a half in water. Cold applications should be applied to the neck and lumps of ice taken into the mouth. As soon as the bowels have moved, a full dose of Quinine, ten or fifteen grains, and a third of a grain of Morphine, or its equivalent of Opium (a grain and a half,) or Laudanum, (forty drops) should be given. The attack is frequently cut short by this treatment. If the Opium cannot be well borne, Tincture of Aconite should be given in doses of a drop every hour until the fever is reduced, and then continued every two or three hours. In case the disease is not cut short, Belladonna or Stramonium (James- town weed) should be freely applied to the neck and covered with a warm poultice. Cooling or warm drinks may be given as is most grateful to the patient. Should the inflammation result in suppuration, as denoted by heavy throbbing pain, the abscess should be opened by a surgeon. Chronic enlargement of the tonsils generally comes on slowly in scrof- ulous children, weakly youths and young women. The enlargement is sometimes sc great that the fauces (throat) seems filled up, so that res- piration (breathing,) speech and hearing are interfered with. In these cases the enlarged organ ought to be excised by a surgeon. As much time as possible should be spent in the open air. The habits should be regular, and the diet good. Frequent bathing should be practiced. Every morning the throat should be bathed freely with cold water. Tonics may be indi- cated by the general health, and will require changing from time to time. Iodine seems, especially, useful. The syrup of the Iodide of Iron may be given. in doses of five to ten drops to a child, and twenty drops to an adult. Iodide of Potassium and Pyrophosphate of Iron, have a good effect. Ten grains of the former, and two grains of the latter, in syrup, is a dose for an adult. A suitable formula is the following: Take of Iodide of Potassium five drams, Pyrophosphate of Iron one dram, Simple Syrup four ounces, Essence of Peppermint half a dram. Mix. Take a teaspoonful in water after each meal. An additional tonic effect is sometimes obtained, by giving the Iodide of Potassium in Elixir of Bark and Pyrophosphate of Iron. Five drams of Iodide of Potassium may be dissolved in eight ounces of the Elixir, and from a teaspoonful to a dessertspoonful, taken three times a day. QUINSY. 211 This treatment will need to be continued for a longtime, to be of much benelit. Irritating the neck over the enlargement, with Tincture of Iodine, applied daily, or every other day, may aid in reducing the enlargement. The Compound Ointment of Iodine is often preferred to the Tincture, and it is doubtless best, when its use must be long continued. The best result from Iodine is obtained by injecting the tincture into the substance of the enlargement. HOMCEOPATHIC TREATMENT.— Belladonna should be given as soon as the patient complains of dryness with difficulty of swallowing, and a sense of constriction, or choking in the throat, which, on examination, is observed to be swollen, and to present a florid, red appearance. Belladonna is additionally indicated when the fever continues to run high, when the face is bloated, and the eyes are much inflamed, when there is considerable delirium and a disposition shown to leave the bed, or commit some act of violence, or when the rash, which sometimes attends this disorder, shows a scarlet hue. . Dose : Of a solution of eight globules in each two tablespoonf uls of water, give one teaspoonful every two hours, until improvement or change. Pulsatilla may be given with good effect, in cases in which the symptoms are mild, and an increased secretion of phlegm has taken the place of the dryness usually present in the early stages, while the patient is at the same time afflicted with nausea and bilious vomiting. Dose : As for Belladonna. Nux-v. is preferable to Pulsatilla when the phlegm is very viscid, and is secreted in such a quantity as to create a feeling of threatening suffoca- tion. Dose :■ As directed for Belladonna. The progress of matters in the throat must, however, be carefully watched, and Mercurius should be prescribed as soon as the presence of small ulcers, or, still better, their incipient formation can be detected. Dose: Three globules, in a teaspoonful of water, repeated in two hours, and again in two hours more, unless the pain and extent of the ulceration should continue to increase, when proceed at once with the next remedy. Acidum-nitricum should be administered two hours after the last dose of Mercurius, when, from the increasing size and painfulness of the ulcers, the latter remedy does not promise to arrest their progress or cause them to assume a healthy aspect. Dose: Three globules, as directed for Mercurius. In the milder forms of this disease, the two last named remedies will, frequently, be found sufficient to conduct it to a speedy and successful ter- mination. But in those much more dangerous forms, which the complaint so readily assumes, when it rages as an epidemic, and when the patient at the commencement is seized with vomiting and purging, attended with such prostration of strength as to render it impossible for him to leave the recumbent posture, without feeling faint and being compelled to fall back -exhausted by his efforts; where, moreover, the ulceration spreads with 212 DISEASES OF THE MOUTH AND THROAT. alarming rapidity, and early take on a sloughing character— in such cases the conducting of the disease to a happy issue becomes, obviously, a much more serious and difficult task. Arsenicum will, in the majority of such cases, be promptly required, although sometimes advantageously preceded by a single dose of Pulsatilla, (as before directed,) if called for by the predominance of bilious vomiting. Arsenicum is distinctly indicated by that marked prostration of strength, so characteristic of this disease, accompanied by nausea or vomiting; or when the ulcers present a livid hue. This important remedy is, also, indi- cated in a more advanced stage of the disease, when the ulcerations are covered with dark sloughs, surrounded by a livid margin ; the teeth and lips incrusted with a brownish, fetid discharge; the pulse small and irreg- ular, and there is delirium or constant muttering, with frequent hanging of the lower jaw ; laborious respiration; acrid discharge from the nostrils, causing excoriations ; the eyes dull and glassy ; the skin hot and dry, the thirst excessive, yet the patient drinks but little at a time, and appears to perform the act of deglutition with great pain and difficulty ; finally, when the prostration of strength is so extreme, that the patient seems rapidly sinking, and a rash of a livid color breaks out in blotches, here and there intermingled with purple spots. Dose: Of a solution of six globules, to two tablespoonfuls of water, give a teaspoonf ul every hour, until amelioration or change, contin- uing the administration at intervals of four hours, when the more urgent aspect of the disease has been overcome. In very serious cases the doses may be required similarly every ten, fifteen or twenty minutes. If in alternation with any other remedy, two closes of Arsenicum should be followed by a pause of two hours, and then by two doses of the other remedy in like manner. China will often be found of service when the tendency to gangrene continues, and the patient is still affected with considerable prostration of strength; accompanied with debilitating sweats. Dose: Pause at least two hours after the last dose of any other rem- edy, and then of a solution of six globules, to two tablespoonfuls of water, give a teaspoonful every two hours, until amelioration or change. Nux-vomica is frequently serviceable after Arsenicum, when the diarrhoea has been checked, but numerous small, foul, offensive ulcers, are seen in the mouth and throat. Dose : Three globules in a teaspoonful of water every hour, until ame- lioration or change, proceeding with the next remedy, if the sub- joined symptoms ensue. Carbo-veg. should be administered after a pause of six hours after the last dose of the foregoing remedy, should a copious, fetid, watery secretion be discharged from the ulcers, attended with extreme exhaustion and small, indistinct, or scarcely perceptible pulse. Do.se: Six pills every hour, until amelioration or change. Acidiiiii-iiitrictim maybe employed with great advantage when, from the beneficial effects of Arsenicum, or any of the other remedies above mentioned, the strength of the patient becomes invigorated, the countenance more animated, and the sloughs are thrown off in a satisfac- tory manner, yet the ulcers threaten to become indolent ; under the influ- ence of this remedy, these will, in most cases, very speedily acquire a clean and florid bottom, and begin to heal. Dose: As for Belladonna. DIPHTHERIA. 213 DIPHTHERIA. This disease generally commences with unimportant symptoms of fever, and most commonly without any local appearances. Only in a few cases may be observed symptoms of a not very intense inflammation of the tonsils. Hence, the case is usually neglected at this important point, because neither the patient nor the family are disturbed or uneasy about the matter. At first, there is a slight redness of the back of the mouth, {fauces,) the vessels in one or more places being full or injected. It is here that in a few hours you may first see traces of the patches of mucus (exu- dation). At the same time the redness increases considerably, without, how- ever, spreading to the front part of the mouth. One or more snow-white membranous patches seem to be laid loosely upon a deep-red or bluish-red or violet base ; they have exactly the appearance of a layer of cream spread upon the mucous membrane (skin of the mouth). But yet the general health is not very much disturbed ; the fever is slight, the pulse not very much increased in rapidity, the skin is not very dry, even a slight per- spiration breaks out from time to time, swallowing is not much hindered, the pains at the affected part of the throat are not very acute. Only a general feeling of lassitude shows that the local appearances have a deeper significance than one would suppose. The affection may, (if not prevented by remedies,) thus remain unchanged for the first seven days, only the exudation at most, invades a few other parts, in addition to the former. In the most fortunate cases the membranes become detached at the end of this period, leaving sores on the surface, (where they were at- tached,) with shaggy borders, which heal rapidly and leave the patient restored to perfect health. If the disease does not take this favorable turn, it assumes a much more serious form in the second week. The formation of the membranes keep spreading; they assume rather a dingy, blackish hue; the constitutional disturbance is more marked; the pulse remaining about the same. The prostration increases, yet the patients, even in violent cases, are not always compelled to lie down. Sleep is generally very much disturbed. The pains in the throat are intense, swallowing and speech are very much impeded ; the patients often complain of violent earache, which is not constant, but conies on by spells. This stage, also, lasts a week (if not prevented by remedies) and may be followed by re- covery ; the ulcerative process, however, is much sharper than at the end of the first week. The further progress of the disease in the third week, consists in an increase of the constitutional symptoms, but principally in gangrenous destruction of the affected parts in the fauces. There arise deep ulcers of various sizes, with a gray or blackish bottom, with shaggy borders and having a horrid smell. The loss of substance may be very considerable. The salivation is copious and very fetid ; the patients look very ill, although they may yet be capable of walking about. The termin- ation in recovery is a very slow process, in so far, at least, as recovery depends upon the healing of the ulcerated surface; for the constitutional symptoms show a marked improvement at a period when the ulcers still retain their malignant appearance. The return of the appetite is the most favorable symptom, likewise the decrease of the salivation and the fetor from the mouth. It takes several weejis before the ulcerated surfaces are completely healed. It is peculiar to this disease, that as the local 214 DISEASES OF THE MOUTH AND THROAT. symptoms disappear, a more or less universal paral3 T sis sets in ; this is not always the case, but very frequently. In the preceding description we give the picture of an attack of moder- ate violence, and running a favorable, but very protracted course. This case maybe regarded as a fair illustration of most cases of diphtheria. Under certain circumstances, the disease offers a very different group of symptoms, which the importance of the subject demands should be faith- fully portrayed by us. In the more violent cases, the preliminary stage is often very short. The disease sometimes enters the system so rapidly and with such extraordinary intensity, that the patient is at once attacked with excessive prostration, a small pulse, death-like pallor, and death takes place as soon as the membranes begin to form. In other cases, the disease begins quite suddenly with vomiting and an intensely sore throat, violent fever, heavy sleep, stiffness and external swelling of the neck and extraordinary frequency of the pulse. The speech is peculiarly altered, on account of the difficulty of moving the tongue. The vomiting consists of a thin, yellowish liquid, and is very often accompanied by a similar diarrhoea. The formation of the membranes takes place very rapidly, spreading almost simultaneously over the entire mouth and throat, even extending to the nose. The swel- ling of the adjoining parts and of the external neck becomes quite con- siderable, so that it extends like a thick pad around the lower jaw. At this time the fever symptoms are not very high, even if they had run ever so high at the commencement of the attack ; but the strength decreases very rapidly. When the attacks are so violent, the formation of the membrane extends towards the lungs, where it occasions all the symp- toms of true croup, induces, at an early period, suffocative paroxysms and stupor, and usually terminates fatally, death being preceded by very vio- lent vomiting. Very seldom consciousness remains undisturbed until the moment of death. After such violent attacks, death generally follows in two to four days. In certain conditions of the system, the affection runs a chronic course, the membranes being frequently detached and renewed again, and at the same time being confined within definite local- ities. In this way the strength of the patient vanishes by degrees, and' death is almost always the end of this chronic form of the disease. If the constitution of the patient is, at the outset, thoroughly tainted with scrofula, consumption or other diseases, the membranes evince, from the commencement, an extraordinary tendency to decomposition, and death results at an early period, although the extent and intensity of the disease may not yet seem very far advanced. Unfavorble external circumstances, such as damp dwellings, a crowd of persons living together in small rooms, insufficiency of fresh air, likewise exert a deleterious influence, on which account the worst forms of the disease are more frequently met with among the lower than among the higher classes. The prognosis of diphtheria is always doubtful, for the disease may terminate fatally, no matter what course it may take. If the disease sets in accompanied by symptoms of violent constitutional disturbance, the danger of a fatal termination is very great, since we may be almost *ure the more unfavorable the constitutional and domestic conditions of the patient, the more general the spread of the poison, the more rapid the DIPHTHERIA. 215 prostration, the less the chances of recovery. The extension of the diph- theritic process to the larynx and lungs, is almost always fatal. Nor should the protracted and mild course of the disease superinduce a feeling of security, for even then a malignant aspect may supervene. One of the most threatening symptoms is a deposit in the urine, that, when heated, changes like the white of an egg (albumen,) especially if there is a large amount of it. When the disease has subsided, it is found that paralysis, either gen- eral, or of special parts, or derangement of the special senses, such as hearing, smell, taste, etc., remain as sequelae of this formidable malady. ALLOPATHIC TREATMENT. We have to contend with a constitu- tional disease belonging to the same category as small-pox, scarlet fever, and other infectious diseases, and, like them, due to a special virus, or blood poison. This, of late years, has become more generally recognized. The trouble in the throat, and the development of a false membrane are regarded as special lesions (local disorders) characterizing the disease. The treatment will then be both general, or addressed to the condition of the system, and local or addressed to the local lesions, the former being regarded as supreme. In the great majority of cases which prove fatal, the mode of dying is by asthenia, (failure of the powers of life). This fact calls for remedies of a supporting kind. These, as almost every one who has witnessed much of diphtheria must feel, almost alone give any promise of being useful. There is no specific for the disease, and all we can reasonably hope from treatment is, to guide the patient safely to the end. It is true some practitioners report almost uniform success in treating this disease, but as the same plans of treatment have not proved more than usually successful in other hands, it is to be inferred that the cases reported were largely or wholly a disease less dangerous, probably follicular sore throat which have, by mistake, been called diphtheria. In local treatment, the great objects to be kept in view are, to favor the separation of the false membrane and prevent its extension, and give relief, as far as possible, from the suffering experienced from the affection in the throat. Of the external applications to the throat, they are all either injurious or useless. Blisters, leeches, and remedies of that class, are powerful for harm, while poultices and other mild applications fail to give relief, though it cannot be said that they are productive of harm. In selecting local remedies, it should be borne in mind that the pro- gressive extension of the false membrane and local inflammation is not a spreading of the same, properly considered, but the successive invasion of the different parts is due to the agency of an internal determining influ- ence, and that influence is the special morbid condition which consti- tutes the disease. If that is true, topical treatment will be likely to exert but little influence in controlling the extent of the local disease. In conformity with this view, many, if not the great majority of practition- ers, have abandoned the use of cauterizing and irritating local applica- tions to the throat (both inside and outside), and are content with the use of soothing and antiseptic (anti-putrid) local measures. Hence, the strong solution or solid stick of Nitrate of Silver, Sulphate of Copper, Alum, Hydrochloric Acid, and the astringent preparations of Iron are not to be 216 DISEASES OF THE MOUTH AND THROAT. used. So far as my own opportunities for observation enable me to decide, the milder measures are to be preferred. The remedies which enjoy a reputation for meeting the ends desired in local applications, are: Carbolic Acid, Sulphurous Acid, Lactic Acid, Chlorate of Potash, and Permanganate of Potash. I usually combine Carbolic Acid with a solution of Chlorate of Potash, as follows : Take of Chlorate of Potash four drams, dissolve in eight ounces of hot water, and when cold, add one dram of Carbolic Acid. This is a useful gar- gle, or it may be applied with a soft linen mop, or by a spray-producer, in cases not old enough to gargle. Sulphurous Acid, one or two drams to an ounce of water, is, also, use- ful, and may be applied by a mop, or in atomized spray; the usefulness of this remedy is attested by high authority, and is so grateful to the patient, that its use is frequently asked for every few hours. Lactic Acid enjoys a reputation of being an excellent solvent of the false membrane, used in the same way as before mentioned, in the strength of three and a half drams of the Acid to two ounces of distilled water; if the spray is used, the eyes should be protected by a bandage or napkin; if used as a gargle, /it should be diluted until the water is dis- tinctly sour. One or two grains of Permanganate of Potash to the ounce of water, is the proper strength for the use of that drug, and the methods of using it are the same as above mentioned. Bromine five grains, Bromide of Potassium two grains, water one ounce, is a mixture highly extolled by some practitioners. It should be applied by mop, camel's hair brush, or in spray. Probably, as useful an application as can be found at hand, in domes- tic practice, is common Lime Water. It may be used in any of the ways before named. Small pieces of ice, held in the mouth ; or, in young children, a teaspoonful of ice water, swallowed occasionally, give relief. When the false membrane is removed, and the local inflammation begins to decline, all local applications should cease. The greatest danger from the local affection, is from its invasion of the larynx (the organ at the top of the wind-pipe); it is accompanied by a croupy cough. As soon as respiration is interfered with, an emetic should be given, which produces but little prostration. The end is to expel the false membrane from the wind-pipe. For this purpose, the Yellow Sulphate of Mercury, in three to five-grain doses rubbed up with sugar, may be given ; Sulphate of Zinc in doses of five to ten grains, repeated every fifteen minutes, until vomiting is produced; or Powdered Alum in doses of a teaspoonful, mixed with syrup or honey, repeated every half hour, until the patient vomits, meets the end required. The patient should, also, breathe steam constantly, either from Rou- oheti's Croup Kettle, or by keeping the room filled with steam from boil- ing water. Quinine, given internally to the extent of reducing the pulse, is thought useful by most physicians. A grain may be given to a child from three to five years old, every two hours, or five grains to an adult. If the respirations become greatly embarrassed, and lividity of the face occurs, the case will, probably, prove fatal in spite of all efforts; but the DIPHTHERIA. 217 physician ought, at once, to perform tracheotomy (opening the wind- pipe, that the air may enter the lungs through the opening). Sometimes life is saved, and, at all events, the last hours are rendered more com- fortable. Regarding general treatment, there should be no prostrating remedies used. Emetics or cathartics are not to be given ; but if the bowels are constipated, they are to be moved by an injection of a dessertspoonful of Castor Oil, or a couple of Compound Cathartic Pills. The line of treat- ment should embrace tonics, nourishment and stimulants. Of remedies, the Sulphate of Quinine, the Tincture of the Chloride of Iron, Chlorate of Potash, and Brandy, are, especially, to be named as having been found useful. In my opinion, Quinine should be given from the beginning of the disease to the extent of tolerance, i. e., until the pulse is slowed and a slight ringing of the ears is produced — in doses of one grain, to a child, and five grains to an adult, from two to four hours apart, and then con- tinued in a dose just less than is necessary to produce this effect. In debilitated patients, there is no doubt of the benefit of Iron ; it should be given from the first, and is well combined with Chlorate of Potash. I con- sider this a useful mixture: Take of Tincture of Iron two drams, Chlorate of Potash two drams, Simple Syrup two ounces. Mix. Dose : A teaspoonful to an adult, or fifteen or twenty drops to a child, in water, every four hours. Nourishment forms an important point in the treatment. It should be concentrated, highly nutritious and varied. Milk, cream, eggs, and animal essences best meet these requirements. They may be used in the forms described in the article on the treatment of scarlet fever. A seri- ous difficulty in the treatment often arises from the refusal to take food, possibly from repugnance, and from vomiting. Owing to this difficulty, in some cases, and sometimes from a failure to appreciate the importance of feeding, death takes place from starvation. Food should be given from four to six hours apart, night as well as day. Should the fever run high, or prostration be noticeable, brandy should be given at once, without reference to other medicines, as a means of sup- porting the powers of life. There is, also, reason to believe that both brandy and Quinine protect the system against the action of the disease poison. A teaspoonful of the former, for a child, and a tablespoonful for an adult, properly diluted in sweetened water or milk, from two to four hours apart, is the usual method of administration, though double these quan- tities have been given hourly with good effect, and without producing excitement. Permanganate of Potash, two grains to the ounce of water, given in teaspoonful doses every three hours, is thought by many to be useful. Bisulphite of Soda is thought by some to have special powers over the disease, but probably its usefulness is overrated. It may be given as follows: Take of Bisulphite of Soda four drams, Tincture of Orange Flowers one ounce, Water four ounces. Mix. Give a child three years old one teaspoonful, and an adult one tablespoonful every two or three hours. The Sulpho Carbolate of Soda, in doses of two to five grains, according to the age of the child, four to six times a day, is highly recommended by some physicians, on account of its antiseptic action. Dr. Holiday, of -IS DISEASES OF THE MOUTH AND THROAT. Burlington, Iowa, speaks quite warmly in its favor. It is to be given instead of the Bisulphite of Soda. The fetid odor in the breath disappears rapidly under its use. Incidental symptoms demand attention. Vomiting is to be relieved by Bismuth, in five grain doses, Creosote in doses of a drop in water, or Hydrocyanic Acid in doses of three drops, repeated hourly. Diarrhoea calls for astringents, and, if severe, for opiates (see article on the treat- ment of Diarrhoea). Anodynes may be required to relieve restlessness; for this purpose equal parts of Paregoric and Tincture of Hyoscyamus is useful for children, and may be given in doses of from ten drops to a tea- spoonful, according to age. For adults ten to fifteen drops of Deodorized Tincture of Opium may be given with a teaspoonf ul of Tincture of Hyos- cyamus. Hemorrhage may be relieved by Persulphate of Iron, used in doses of ten to fifteen grains, locally, and Gallic Acid, or Fluid Extract of Ergot internally, in doses of a teaspoonful every two or three hours. Under all circumstances, the patient should be kept in bed, and in the recumbent posture. The disease is so weakening, that slight exertion has been known to cause fatal syncope (fainting). The room should be kept warm, and the air moist with steam. The room should, occasionally, be disinfected by burning Powdered Sulphur upon a shovel of coals, or by evaporating a few drops of Carbolic Acid on the surface of hot water. Ozone (active oxygen,) may be generated in the room, by pouring three parts strong Sulphuric Acid upon two parts of Permanganate of Potash,, in a deep glass dish, with benefit. Cleanliness is absolutely necessary, and the management should be similar to that for contagious diseases. See article on Scarlet Fever. Children not affected, being specially liable to the disease, should, if possible, be removed to a neighborhood free from the disease. In a disease so serious as diphtheria, where physicians are not content to trust their own judgment alone, in case of its occurring in a member of their family, without calling in the aid of a physician, I hardly presume that any intelligent person w r ili take the responsibility of managing the disease in his family, without the guidance of a skilled physician, even if the directions in this article are never so plain. HOMOEOPATHIC TREATMENT. Belladonna is frequently of great value in the early stage of mild cases, more particularly when the disease sets in with marked febrile symptoms, and there is marked redness and inflammation of the tonsils; the patient is uneasy and restless, and com- plains of the throat; is drowsy, and cannot sleep, or starts up suddenly out of every sleep. Dose: Of a solution of twelve globules to five teaspoonfuls of water, give a teaspoonful every two hours, until amelioration or change. Manv mild cases, with "the above characteristics, will be properly relieved and cured, by this remedy alone; and' should amelioration i>e noticed, the interval between the doses should be lengthened to three or four hours, according to circumstances. Should the symptoms recur with violence, however, after having been once mitigated under the action of Belladonna, do not resort to that remedy again, but select one of the subjoined. Acidum Muriaticum. This remedy has proved of great efficacy in a number of cases of simple diphtheria, and may very generally be admin- DIPHTHERIA. 219 istered as soon as the membranous deposit begins to appear, and particu- larly when there is not much glandular swelling, but considerable prostra- tion of strength and fetid breath, with little fever, but marked lassitude and weariness. Dose: Three drops of the second decimal dilution in a teaspoonful of water, every hour, until relief or change. In the event of improve- ment, lengthen the intervals to two hours, then to three hours, and so on, until the cure is complete; but if the exudation spreads to fresh surfaces, in spite of the employment of Acid Muriaticum for twenty-four to forty-eight hours, another remedy must be selected. Mercurius Protiodatus. One of the best remedies. Should the throat present a deep-red appearance, and the tonsils and surrounding parts be considerably swollen and studded with specks of exudation ; and if, moreover, there be cold in the head, accumulation of mucus in the throat, and excessive secretion and flow of saliva of a fetid odor, Mercurius is a useful, if not an indispensable remedy. It is an important remedy in all forms of the disease. Dose: One grain of the third trituration in six teaspoonfuls of water, a teaspoonful every two hours; or as much of the trituration as can be carried on the point of a penknife, administered dry (undissolved), at the same intervals, untiramelioration or change; but if, after the lapse of forty-eight hours, or even a shorter period, the exudation, fetor, and swelling increase, proceed to select another remedy. Kali Bichromicum. In the event of no improvement, from thirty- six to forty-eight hours after the employment. of Mercurius Protiodatus, and particularly when the disease extends into the posterior parts of the throat, and thence into the nostrils, Kali Bichromicum should be selected. It is, moreover, indicated by a tough and stringy discharge from the nose or mouth ; pain in the left ear; swelling of the glands under the ears; croupy cough; measle-like eruption, and red and shining tongue. Dose : As directed under Mercurius Protiodatus. Acidum Nitricum. When, notwithstanding the employment of Acidum Mur., or Mercurius, superficial patches of exudation continue to present themselves; and when the throat, in place of healing, becomes painful and of a vivid-red color ; also, when there is a tendency to ulcera- tive complication, and the gums are disposed to bleed, this remedy may be employed with advantage. It is further indicated by the presence of ulcers on the mucous membrane of the mouth, and by an acrid, corrosive dis- charge from the nose. Dose: Two drops of the third decimal dilution in a teaspoonful of water, every two hours, until relief or change. Kali Chloricum. When, after a period of not longer than forty- eight hours, the above described symptoms either remain stationary, or become aggravated ; or when the gums are more or less red and swollen, and the exudation is extensive, but confined to the mouth and palate, Kali Chlor., may be substituted with the best results. Dose : Same as directed for Acidum Nitricum. Phytolacca is a remedy which has been promptly curative in many cases of diphtheria, particularly in the mild, or non-malignant variety. It is indicated, more particularly, when there is considerable febrile mani- festations; headache: violent, aching pains in the back and limbs; great weakness, so that the patient cannot stand, and gets faint and dizzy, even,, when rising up in bed. Dose: As directed for Acidum Muriaticum. ±20 DISEASES OF THE MOUTH AND THROAT. La chests will prove useful when the inflammation and the diphthe- ritic deposit commence on the left side of the throat, and either remain there, or spread to the right side. It is further indicated, when the patient is always worse after sleeping, and cannot bear the slightest pressure on the throat. It is frequently useful after the previous employment of Belladonna, and in malignant forms of the disease, when mortification or sloughing of the parts threatens. Dose : As directed for Belladonna. Lycopodium should be given in mild cases, when the right side of the throat is first invaded, and the soreness is aggravated by warm drinks; the nostrils are stopped up, and the patient cannot breathe with his mouth closed; starting and jerking of the lower limbs; dread of being left alone. Dose: As directed for Belladonna. Apis Mellifica should be given when there is great debility from the commencement of the disease ; the false membrane presents a dirty- grayish hue; there is puffiness around the eyes, pain in the ears when swallowing; an itchy, stinging eruption on the skin; numbness of the feet and hands. Dose : As directed for Belladonna. Cantharides will prove very efficacious in many cases when the diphtheritic exudation appears in patches ; the adjoining surfaces of the mucous membrane being of a bright-scarlet redness, with intense burning and dryness of the throat, and great thirst, the burning resembling that produced by the application of a blister. It is further indicated by derangement of the urinary organs, manifested by burning and scalding on urinating; or by a suppression or increased discharge of urine; as well as by extreme prostration, and an irritable looking rash upon the skin. Dose: As directed for Acidum Nitricum. HOME REMEDIES.— Frequently gargle or wash the mouth and throat with a solution of Salt, Pepper, and Vinegar; or a solution of Saleratus in water; or Borax and Alum in a solution of water with a little Branch- added, if at hand. The patient should be removed to a clean bed, in a dry, well ventilated room, kept sweet and elean, and no one should be allowed to sleep in the room except the attendant. All visitors or callers should be positively kept out of the sick room. MUMPS— PAROTITIS. We comprehend under this designation two tolerably distinct condi- tions, which have, however, this in common: that the salivary glands are the seat, or rather the starting point of the disease. Consequently we shall first describe parotitis proper, or an inflammation of the parotid gland, together with the non-malignant inflammation of the other salivary glands, and afterwards the malignant form of the disease, attended with gangrene of the cellular tissue. Mumps is generally preceded for a few days by febrile symptoms. The patients feel languid, sleep is uneasy, the appetite is gone; headache, with a feeling of stiffness in the muscles of the back of the neck, is, scarcely ever absent; a slight catarrhal irritation of the digestive tract is, likewise, generally present. After these preliminary symptoms have MUMPS. 221 lasted for a short period, sometimes even for several days, the region below the ear on one side begins to swell, the swelling spreading very rapidly over the cheek and under the jaw ; in a short time the face looks very much disfigured by the swelling. The swelling is not very painful even to rather hard pressure ; the color of the swelling does not differ from that of the surrounding skin, except sometimes a slight redness ; the swelling is at times of a stony hardness, at times it is soft, and at other times has an uneven feel. The movements of the head, more especially of the jaws, are very much impeded. With the appearance of the swelling, the general symptoms usually improve, the fever abates rapidly, and the patients, in spite of their great disfigurement, feel tolerably well. In most cases the swelling spreads to the other side in one or two days, but here never attains the same size as on the former side. If the swelling runs a normal course, it generally reaches the climax on the fifth day, after which it gradually begins to disperse, so that between the tenth and four- teenth day no trace of the swelling remains visible. With a higher grade of inflammation, or under otherwise unfavorable circumstances, the red- ness assumes an inflammatory erythematous character, and suppuration may take place, which, in comparison to the size of the swelling, remains inconsiderable, but protracts the course of the disease very greatly. The swelling takes this course more frequently in the case of adults than in that of children ; in the case of the former, an inflammatory hardness of greater or less extent frequently remains for some time. Only in rare cases, or if the affection assumes a certain degree of malignancy, as it sometimes does in certain epidemics, the brain may become involved in the process. What is more frequently the case is, that the testicles, or the labia majora, swell suddenly, while the swelling about the neck disap- pears ; both swellings may, however, co-exist. Secondary parotitis occurs in the course of many acute diseases, par- ticularly typhus; in some typhus epidemics it is a constant sequelae of the disease, whereas, in other epidemics, it is entirely absent. The appear- ance of the swelling is not bound to any definite period of the disease; at times we see it break out at the commencement, at other times during the period of convalescence. It is generally preceded by local pains, in- creased congestions of the head, even delirium and chilly creepings ; its rapid development is seldom attended with abatement of the fever. The further course of the local process issimilarto that of the genuine mumps; the swelling either scatters or else it terminates in violent inflammation with suppuration, which, during a state of great constitutional prostra- tion, may assume a malignant form, with the discharge of pus. Whereas, in the former case, parotitis always indicates a favorable course of the general disease; the formation of pus, on the contrary, always portends danger, and is, at least, a disturbing complication. It is difficult to deter- •- peciallyfor hysterical subjects,) children, individuals with light hair, and a marked predisposition to purulent exudations at J.he edge of the eyelids, DYSPEPSIA. 239 or to styes, and for mild or phlegmatic dispositions. Under such condi- tions it is appropriate to the treatment of derangements of the stomach, occasioned hy excessive application to study, overloading the stomach, abuse of wine, spirits, beer, coffee, or rich chocolate, by excessive draughts of milk, or even of water, by new, slack-baked, or otherwise unwholesome bread, or butter, fat or greasy things, tainted or unwholesome meat (pork especially,) by eating oysters or tainted fish of any kind, by pastry, flatu- lent vegetables, fruits, or by ice cream ; or even when an external injury (as a strain) has been the exciting cause of the ailment. Amongst its characteristic indications, we more frequently find a want of thirst, than thirst; a repugnance to fat and rich meat, and suffering after taking pork or pastry; general chilliness, or great difficulty in keeping the hands and feet sufficiently warm; deficient sense of smell, sometimes accompanied by increased secretion from the nostrils; frequent and loose, or difficult and loose, or sluggish evacuations ; hypochondriasis, and convulsive fits of laughing and crying. Dose: Three globules as directed for Nux-v. Ignatia may, in some cases, be employed twelve hours after the fourth dose of Pulsatilla, if the latter has failed in affording permanent relief, and does not promise to complete the cure. It may, also, in some cases, be employed before or instead of Pulsatilla, when there is a tendency to alternations of exuberant and depressed spirits, or particularly, if grief be associated with the derangement. Ignatia is, also, appropriate for the treatment of derangements of digestion occurring amongst highly hys- terical females ; or of cases which result from abuse of coffee, beer, bran- dy (or even ardent spirits, in general,) milk, sweet things, or tobacco. Done : Three globules in a teaspoonful of water, three times a day. ^Bryonia is often appropriate to the treatment of derangements of the stomach, associated either with a hypochondriacal or hysterical dis- position, or with habitually sedentary habits; or when occasioned by depressing emotions, by chocolate, milk, new or slack-baked bread, tainted sausage meat, flatulent fruit or vegetables, or pastry; the indicative symptoms are as follows: Headache, burning or expansive, particularly after drinking, attended with bewilderment of the head and giddiness ; tongue glazed, dry, and red, or covered w T ith a whity- yellow fur ; sometimes the aversion to food is so strong, that the patient cannot bear the smell of it; loss of appetite, alternately with unnatural hunger; craving for acid drinks; great thirst; insipid, clammy, putrid, sweetish, or bitter taste in the mouth; acidity and flatulence, or bitter risings after every meal, or after partaking of milk. Hiccough, nausea, water-brash, vomiting of food or bile, par- ticularly at night ; tenderness in the region of the stomach to the touch, sensation of swelling in the pit of the stomach, especially after a meal, or. on walking; sensation of burning in the pit of the stomach, especially when moving. Constipation, temper, restlessness, irascible and obsti- nate ; also, when want of exercise or anger are frequently the exciting causes of the derangement, or the means of aggravating the indigestion. The indigestion is more apt to manifest itself in summer, or in damp weather, with a northerly or easterly wind, and is frequently accom- panied with chilliness. 240 DISEASES OF THE STOMACH AND INTESTINES. Dose: Three globules in a teaspoonful of water, every twelve hours, until amelioration or change. In cases in which the sufferings are very great, the like dose should be repeated every three hours during the attack, until the symptoms subside or change. Rhus-tox., which is particularly appropriate for the treatment of indigestion resulting from mechanical injuries (such as a strain), or when beer, spirits, coffee, milk, copious draughts of cold water when heated, new or slack-baked bread, tainted sausage-meat or fish (especially shell- fish, as muscles,) may directly have provoked the attack. The specific symptoms are as follows: Flat, sticky, sweetish, bitter, or foul taste in the mouth ; drowsiness, eructations, and sensation of fullness, languor or gid- diness, after eating ; a sensation of repugnance to food, especially, to meat, bread, etc., or sensation of satiety; or want of appetite, with hankering after dainties; continued, empty, painful and noisy eructations; offensive and very abundant flatulency ; the derangements of the digestive func- tions more apparent and troublesome at night; distention and pressure in the region of the stomach. Extreme depression of spirits, despondency, insuperable anxiety, and uneasiness respecting affairs. Dose: Three globules, in a teaspoonful of water, every four hours, until the symptoms are modified, and then every twelve hours, until positive change. Natrum-m, is particularly appropriate to the treatment of chronic cases occurriug amongst hypochondriacal subjects, or, sometimes, of preg- nant females; or when habitual excess in the use of fermented liquors has been the chief cause of derangement; or when milk diet, mineral waters of particular localities (unless brackish,) or the water of hard springs and mountain streams — or unwholesome bread, or fat and greasy food (especi- ally pork,) — or excess in the use of fruit or tobacco, may be distinguished as associated with the origin of the affection. Natrum-m. is generally useful in such obstinate chronic cases as have resisted the operation of Bryonia, Nux-vomica, etc., and which are characterized by frequent attacks of morning sickness, or by heartburn after every meal, water- brash, constant nausea, occasional sensations of faintness, pressure in the stomach, or intractable humor after eating, and obstinate costiveness, or when milk, and liquids in general, invariably disagree. Do.se : Six globules in a tablespoonful of water, every morning, the first thing (fasting,) ten days (unless earlier improvement ensues,) then pause four days, resuming the same course, if necessary, and soon. Kali-bich. is particularly applicable to the treatment of chronic cases in which milk, bread, fish, or pastry, constantly disagree with the patient. The distinctive symptoms are as follows : Indigestion, with aggravation of symptoms in the morning and dur- ing movement, relieved after eating (sometimes, however, a distressing feeling of weight is experienced after a meal ;) mouth and tongue dry ; thick yellow fur on the tongue; conflux of water in the mouth ; metallic, acid taste; want of appetite, nausea, flatulence, frequently accompanied by colic. Constipation or hard stools, attended with straining and burn- ing in the outlet; alterations of hard and relaxed motions, great sensibil- ity to cold air, complications with affections of the liver and spleen ; extreme depression of spirits, hysterics. Dose: As directed for Natrum-m. DYSPEPSIA. 241 Chamomilla is of great service in some derangements resulting from, or associated with, excess in the use of coffee or sweet things ; or more especially depressing emotions, such as vexation, disappointment, a fit of passion, and the like ; or again, if the derangement has been provoked by check of perspiration. The characterizing symptoms are as follows : Headache, with, sometimes, semi-lateral pulling, shooting, fullness, and beating in the head ; giddiness and staggering in the morning, when getting up ; oppressive heaviness, swimming in the head, and sensation of a bruise ; headache, felt sometimes during sleep, with obscuration of the eyes, and yellow color of the whites ; tongue dry and cracked, with a thick and yellowish coating; mouth dry, with occasional presence of frothy phlegm ; excessive thirst and desire for cold drink; bitter taste of the mouth and of food; want of appetite and dislike to food. Acidity or sour risings, regurgitation of food, nausea, vomiting of food, phlegm and bile; oppressive pain in theregion of the heart, distention at the pit of the stomach and upper part of the waist, chiefly after eating and at night, attended with disquietude and terror ; burning pain in the pit of the stomach ; uneasiness, and feeling of sinking in the stomach ; cramps in the stomach, especially when traceable to coffee ; sometimes constipation, but generally relaxation of the bowels. Dose: In casual cases, of a solution of six globules to three table- spoonfuls of water, give a teaspoonful every three hours, until ame- lioration or change. In chronic cases, three globules in a teaspoon- ful of water night and morning, until similar variation occurs. Ipecacuanha is available for the treatment of indigestion, occurring amongst children and pregnant females, or when occasioned by overload- ing the stomach, imperfect mastication of food, hurried and voracious feeding, or by irregularity of meals, or by abuse of tobacco, or even of coffee; or in cases in which veal or other young meat particularly disa- grees ; or when cold, nervous excitement, late hours, or over-application to study in particular, are to be traced as the exciting causes of derange- ment. The distinctive symptoms are: face pale and yellowish ; tongue sometimes clean, at others coated white or yellow ; aversion to food, and particularly to fat or rich indigestible food, such as pork, pastry, etc., or suffering from indigestion on partaking of such ; vomiting of drink, food, phlegm, or bile, sometimes after a meal ; retching, easy vomiting, gener- ally attended with coldness of the face and extremities, and sometimes alternation with watery looseness of the bowels, feeling of emptiness and flaccidity, and sensation of sinking at the stomach. Headaches attended with nausea and vomiting ; shooting pains, with heaviness and painful pressure on the forehead. Dose: Against the acute symptoms, when present, of a solution of eight globules to a wineglassful of water, give a teaspoonful every hour, until amelioration or change ; against the chronic aspect of the affection, that is, the recurrence of the acute symptoms, give three globules in a teaspoonful of water, night and morning until distinct change. China is appropriate to the treatment of derangements of thia. kind, according to the subjoined indications, when occurring in aged persons, or in patients of a hypochondriacal disposition, particularly if the loss of animal fluids, or mental affliction be distinguishable as the predisposing cause, or when the suffering can be attributed to overloading the stomach, 16 242 DISEASES OF THE STOMACH AND INTESTINES. to excessive indulgence in strong tea, or, in some cases, to abuse of spirit- uous liquors or coffee, to milk diet, or to unguarded or too copious draughts of water ; or again, when bread, butter, fat and greasy things generally disagree, or when tainted fish has been the immediate cause of derangement; or, again, if the symptoms can be traced to flatulent food, over-indulgence in fruit or spices and other seasoning, or, in some cases, to tobacco ; or, again, when every kind of food provokes an attack. This remedy is a valuable auxiliary in the treatment of this derangement, when there is impaired appetite with great weakness of digestion, which is more liable to be experienced on partaking of supper ; flatulence, bitter taste, languor, hypochondriacal disposition, and particularly when we can trace the affection to debilitating losses of fluids, such as the abstrac- tion or loss of blood, too great a drain upon the resources when nursing, prolonged use of aperient medicines, etc., also in disorders arising from the abuse of tea, or from a residence in impure atmospheres, especially such as are overloaded with the exhalations of decayed vegetable matter, where the drainage is insufficient, the cultivation imperfect, where stag- nant pools or ditches, charged with rank matters, abound, more particu- larly in the midst or vicinity of half-dried marshes, or on a level with them, or in such position in relation to them as exposes the habitation to the current of prevalent winds from them, or near the beds of periodical streams, when the water ceases to flow, and the bed appears to be dried up (especially in warm climates.) or when the rays of the sun have great power; or, again, in districts which are habitually dry and well drained, but which have been extraordinarily saturated by a wet season, and are beginning to dry up again. Dose: Six globules, night and morning, one week; wait four days, and if still indicated by the symptoms present, resume the admin- istration of the same remedy night and morning, every fourth day. DERANGEMENT OF THE STOMACH ARISING FROM CASUAL CAUSES— NOT HABITUAL. This should be understood to apply to those who are only casually affected, but whose digestion is habitually unimpaired. Causes.— The ordinary causes of this derangement are, hurried, im- perfect mastication ; overloading the stomach ; fac, greasy, indigestible or tainted food, flatulent vegetables, ices, stimulants, and others equally well known. HOJKEOPATHIC TREATMENT. When the symptoms of approach- ing derangement of the stomach declare themselves immediately, or a few hours after a repast, which has been too freely partaken of, a cupful of strong coffee, without milk or sugar, is frequently a sufficient restorative. Should, however, this fail to relieve, and sick headache and inclina- tion to vomit be present, we should assist nature by various artificial means— the milder, if sufficient, the better— such as tickling the ihroat with a feather, and by giving te.dd water to drink until the stomacli has completely evacuated its contents. DERANGEMENT OF THE STOMACH. 243 Bryonia is very serviceable, when the following symptoms are pres- ent: bitter eructations; fever, alternately with coldness and shivering, a redness of the face, heat in the head, and thirst with coldness and shiver- ing; also, when looseness of the bowels or constipation, and peevishness or excessive irritability are present. In derangement of the stomach, arising from succulent vegetables, and attended with excessive flatulence, this remedy is frequently productive of speedy relief. Dose : Of a solution of six globules, to two tablespoonfuls of water, give a teaspoonful every two hours. Arsenicum. When there are acrid and bitter eructations with nau- sea and vomiting; also dry tongue, excessive thirst, salt taste in the mouth, and burning or violent pressure in the stomach, with diarrhoea or colic, and griping in the lower part of the belly, particularly when arising from the effects of an ice which had been partaken of, the patient being warm, or from fruit, stale vegetables, or acids. Dose: Three globules, in a teaspoonful of water, every three hours, until amelioration or change. Carbo-vegetabilis is a very valuable remedy in this affection, either for the initiatory treatment, or after the previous administration of one or more of the other remedies, according to indications, for the purpose of removing any symptoms that may remain ; it is, moreover, particu- larly useful where great susceptibility to the influence of the atmosphere, particularly to cold, exists at the same time ; or in suffering arising from abuse of wine, ices, or salt; further, in derangement of the stomach, aris- ing from having partaken of game or fish which has been too long kept, or meat that has been re-cooked whilst in a state of fermentation, which is liable to occur in warm weather; in the latter instances, Carbo-v . is to be preferred to any other medicine, and will rarely fail to afford relief. 'Dose : Of a solution of twelve globules, to three tablespoonfuls of water, give a teaspoonful every four hours, until amelioration or change.* Nux-vomica is indicated by offensive or acrid eructations, constipa- tion, and confused headache, particularly, when arising from previous intoxication, or even slight over-indulgence in wine or other stimulants ; when possible, it should be taken the same night, as when taken in the morning, although eventually relieving, it frequently causes an aggrava- tion for a few hours. In derangement of the stomach, with heartburn, flatulence, more or less nausea and headache, etc., in consequence of a chill or of indulging in mental or corporeal exertion immediately after a meal, this remedy commonly affords speedy amelioration. Dose: Four globules, in a teaspoonful of water. Arnica is indicated incases of derangement of the stomach, charac- terized by eructations resembling rotten eggs. Dose : Of a solution of eight globules, to two tablespoonfuls of water, give a teaspoonful every three hours, until amelioration or change. Pulsatilla, in recent cases of deranged digestion, with rising of food, tongue foul, and covered with phlegm; chilliness, and lowness of spirits; and, also, when a rash has been thrown out, in consequence of the *A small quantity of finely powdered charcoal, in a little good French brandy, or water, will be found an equally efficacious mode of administering this remedy, as a corrective against derangement of the stomach, arising from having partaken of tainted meat or fish. 244 DISEASES OF THE STOMACH AND INTESTINES. derangement. This remedy is almost specific, when the disturbance has arisen from the effects of rich food, such aspork, or pastry, or even tainted meat, or from the effects of ices, cold fruits, or crude vegetables, acid or impure wine, etc. Dose: Four globules, in a teaspoonful of water. Obstinate Chronic Cases of Functional Derangement.— In cases of derangement of the functions of digestion, which, though modi- fied, are extremely difficult of removal, the remedies hereinbefore noticed will be required for initiatory treatment; but, in the majorty of instances,, the patient will have to be subjected to an appropriate course of such remedies as those hereto subjoined, in order to complete the cure. Sulphur is one of the most important remedies for administration after the previous exhibition of Nux-vomica or Pulsatilla, and in cases which would otherwise correspond with the indications for either of those medicines, but when either of them has been inadequate to effect a perfect cure. Dose : Six globules in a wineglassf ul of water, every morning the first thing (fasting) for ten days, (unless there be earlier improvement or change,) then pause four days, resuming the course similarly, if necessary, and so on, from time to time, until positive amelioration or change. Hepar Sulpharis is also of great value in cases in which the diges- tion is naturally weak, and sour vomiting, with burning sensation in the throat, colic and looseness of the bowels, are liable to be provoked by the slightest error in diet, and particularly when anything of an acid nature has been partaken of; or especially in cases in which the patient has previ- ously taken blue pills, or any other mercurial preparation, for a considera- ble time. Dose : If singly, three globules in a teaspoonful of water, night and morning, for a week, (unless earlier and decided improvement or change ensue,) pause four days, and resume the course, if necessary, and so on, from time to time, until amelioration or change ensues. Sepia is also indicated by a sensation of coldness, and is to be preferred to either of the preceding remedies, when this symptom is associated with a multiplicity of other equally characteristic indications, particularly if there be no appetite, or voracious appetite, and aversion to meat or milk, water-brash, especially after drinking; constant acidity of the stomach, aggravated by eating, and, if fat things, milk, etc., continually disagree. Dose : Four globules night and morning. Silicea is, especially, indicated when the patient entertains a repug- nance to cooked food, and is particularly averse to meat; when the patient is subject to severe pains in the stomach, attended with excessive thirst and water brash, bitter taste in the mouth in the morning, vomiting after drinking, and habitual nausea predominating after a meal, or upon rising in the morning. Dose : Six globules in a wineglassful of water, every morning the first thing (fasting,) until amelioration or change. Carbo-vefj. Here, again, this remedy is peculiarly valuable when annoyance or inconvenience is felt after every meal, amounting to nausea and vomiting, attended with excessive flatulency, and when the pit of the stomach is tender on pressure. Do.se : Three globules in a teaspoonful of water, until amelioration or change. DERANGEMENT OF THE STOMACH. 245 Obstinate Chronic Cases of Organic Derangement. In cases in which organic disease has been established, that is, in such cases as assume the critical aspect described in the general description of symptoms at the commencement of this article, it were desirable, if possible, that the interference of an experienced Homoeopathic practitioner should be invoked. General Derangement of the Stomach in Children. The fore- going particulars, applying to general cases, are equally to be kept in view in considering this affection, more particularly amongst children ; but as the causes and features of such derangements are necessarily far less com- plicated amongst children than amongst adults, it may save the adminis- trator much trouble to extract and render in a summary form, such details respecting the treatment of this affection amongst children, as will other- wise be gathered only in scattered portions of this article. Ipecacuanha, Pulsatilla or Carbo-veg. These medicines are of chief importance, either for independent, alternate, or successive adminis- tration, in cases in which hurried feeding (bolting the food,) imperfect mastication, and overloading the stomach, or rich, indigestible food, can oe distinctly traced as the exciting causes of derangement. The particular indications for each may be gathered from those details v/hich have already been afforded. Dose: If singly or successively of either remedy, two globules in a teaspoonf ul of water, every three hours, until amelioration or change. If in alternation, dissolveeight globules of each remedy, separately, in a wineglass of water, and give a teaspoonf ul, first of one solution, then of the other, so that an interval of four hours shall elapse between the doses, and so on, until amelioration or change. Pulsatilla, Arsenicum or Carbo-veg, These are in like manner appropriate in cases in which ices or cold fruits have been the exciting causes of derangement. In this instance, also, the particular indications foi each may be gathered from the foregoing part of this article. Dose : In every respect as directed in the forgoing prescription. Pulsatilla, China or Carbo-veg. These medicines selected accord- ing to the indications afforded in respect of each, in the former part of this article, are particularly appropriate to the treatment of derangements of digestion, occurring amongst children, in consequence of having eaten tainted meat or fish. Dose : In every respect as directed in the foregoing prescription. Carbo-veg., or Arsenicum. These medicines, respectively, accord- ing to the indications hereinbefore afforded, respecting each, are most appropriate, in the generality of cases, to the treatment of derangements of digestion occurring amongst children, as the result of excessive use of salted articles of diet, especially salt meat. Dose: Of either medicine, give two globules in a teaspoonf ul of water, every four hours, until amelioration or change. Aconitum, Arsenicum or Carbo-veg. These again occur as the most important remedies whence a selection should be made according to the special indications for each, which have already transpired in previous portions of this article, when acids (such as vinegar, etc.,) are identified as the exciting causes of derangement. Dose: Of the remedy selected as directed in the last prescription. 246 DISEASES OF THE STOMACH AND INTESTINES. SYMPATHETIC AFFECTION OF THE BRAIN AND NERVOUS SYSTEM. Depression of Spirits. — Hysterical and Hypochondriacal Affections. These most distressing results of long-continued or very severe derange- ment of the digestive functions, are almost invariably associated with what is termed "chronic indigestion," and not un frequently afford an important clue to the treatment of the primary seat of disease. But nothing can be a greater source of error in most cases, than to deal with them as primary diseases of the brain and nervous system. Depression of spirits may occur as the consequence of derangement, either of the nerves or lining membranes of the stomach, but with very different char- acteristic features ; for when the nerves are the seat of the disease, restless and uneasy anxiety, sudden fits of violent excitement, extreme irritabil- ity, impatience and despondency with violent impulses, are the result; when, however, the lining membrane is the seat of disease, extreme depres- sion of spirits occurs associated with languor, utter prostration, indolence, and listlessness. Sulphur is appropriate to the treatment of both varieties, but is more especially indicated by the indolence of mind and body, or t>y the vacancy of thought, or absence of mind and irresolution, which character- ize the latter ; it is, however, also appropriate when the depression of spirits is associated with painful anxiety of mind, extreme solicitude con- cerning the future and respecting one's health and affairs, erroneous or exaggerated notions on given subjects, general wretchedness without any ascertainable reason, sudden fits of violent excitement and periodical return of extreme impatience, restlessness, irritability and impatience, when the following symptoms are also present : — sensation of fullness and weight at the pit of the stomach; habitual constipation, headache, and particularly pain at the top of the head; dullness and heaviness of the head, the patient being unable to exert his mental faculties, or becoming exceedingly weary and exhausted after any application of this kind; disposition to piles ; or when chronic eruptions and affections of the skin are associated with the complaint. Dose: Repeated doses are generally required, administered thus : For adults six globules, or for young persons four globules in a wine- glassful of water, every morning the first thing (fasting,) for ten days (unless new symptoms or a change in the nature of the symp- toms be sooner developed) then pausing for a week, and resuming the like course, if necessary ; and so on until distinct amelioration or change ; if in alternation with Calcarea, commence with three doses of Sidphur, as just described ; pause four days and then administer three doses of Calcarea likewise, and so on until amelior- ation or change. Calcarea is indicated by depression of spirits, with disposition to tears ; flushing of blood to particular parts associated with attacks of inde- scribable anguish, and generally palpition of the heart, or painful sensa- tions in the region of the heart ; general uneasiness with aversion to mental or physical exertion ; despondency respecting one's health, and apprehension of death ; dread of mental aberration — or of contagion, or other causes of disease, or of imaginary misfortune ; and when there is intense acuteness of all the senses. Dose: In every respect as directed for SulpJiur, whether singly or in alternation. DERANGEMENT OF THE STOMACH. 247 Natrum-m. is indicated by depression of spirits accompanied with apprehensive foreboding, and with fretful, tearful disposition with des- ponding expression ; love of solitude, which, however, nourishes the disease, and dread of society, whereby, however, it is alleviated ; occasional bursts of violence; disgust of life; habitual moroseness and incapacity of mental labor ; weakness of digestion characterized by aggravation of the suffer- ings, mental as well as bodily, and by general and indescribable uneasi- ness after a meal, and until the proper maceration of the food is completed in the stomach and has been conveyed to the bowels, or by susceptibility to the recurrence of such symptoms provoked by the least excess or irre- gularity ; headache and want of appetite ; nausea occurring every morn- ing, etc. Dose : Six globules, or for young persons four globules, in a wineglass- ful of water every morning, the first thing (fasting,) until amelior- ation or change. Aunim-met, is indicated by incapability to concentrate the reflective faculties, and want of power of combination in the mind, characterized by crushing headache after the least exertion of the mind, or attention, and a sensation as if the brain were dashed to pieces; painful anxiety of mind and excruciating restlessness; whining, fretful disposition and dread of death. This remedy is often of great service against the hysterical attacks of females. Dose : As directed for Natrum-m. Lachesis is particularly indicated when the patient is haunted by the idea that he is the object of dislike, suspicion, or even hatred amongst his friends. Dose : Three globules in a teaspoonf ul of water, morning and evening, until amelioration or change. Nux-vomica is indicated by almost every variety of nervous,hysteri- cal or hypochondriacal derangement, either characterized by indolence, or excitability, but especially the latter; deep despondency with disgust of life, moroseness, and aversion to labor or exertion of any kind, character- ized by the following symptoms : excessive sensitiveness, and aversion to the open air ; fainting fits, after the least exertion, especially after motion in the open air, or giddiness, sensation of being stunned, and sparks or black spots before the eyes under the like circumstances; sensation of heaviness in the body, with weariness, languor, and great desire to assume or retain a recumbent position, by which the symptoms are alleviated; emaciation, and wiry condition of the flesh ; intense sensation of lassitude and fatigue, even in the morning after rest, and often excitability which renders the patient reluctant to retire to rest at night: drowsiness in the morning, after meals, or in the evening, followed by sleeplessness at night; sallow, pallor or yellowness of the skin ; heaviness, with pressive, tensive and expansive pain in the head ; intense headache seated in the fore part of the head along the brows; or pain — often acute and piercing, as if some sharp instrument were lodged there— deep in the brain; swelling and redness of the eyelids, and red suffusion of the eyes, particularly in the morning; cramp-like, contractive gnawing or pressive pains in the region of the stomach and below the ribs, and at the pit of the stomach ; extreme sensitiveness of the pit of the stomach to pressure; constipation, character- ized by slow and sluggish action of the bowels, with dark, hard, dry, and 248 DISEASES OF THE STOMACH AND INTESTINES. large but unfrequent evacuations— or by intermingled, loose, and lumpy evacuations; particularly appropriate, if there be disposition to piles ; frequent discharge of pale, watery urine — dragging and rheumatic aching pains in the back towards night; contused pains in the loins and back ; numbness of the arms at night. Dose : Three globules in a teaspoonful of water, night and morning, until a degree of good effect results, and then four globules in a tea- spoonful of water every 'night, until positive amelioration or change. After which a course of Sulphur, as above directed, will usually be beneficial. Phosphorus is particularly appropriate for the treatment of delicate and highly hysterical females, and fair subjects of a spare and slender frame, and is indicated by sadness, alternated with apparently good spirits (with mirth); attacks of indescribable anguish, affright — and even distres- sing hallucination, when left by one's self or during stormy weatjier; timid disposition, startled at every sound and apprehensive of thieves and acts of violence, etc., painful anxiety, or uneasiness respecting one's health. Dose: Four globules in a teaspoonful of water every night, until amelioration or change. Suspending treatment for four days after a a weeks course. China is indicated by distress, languor, or dullness of mind, the patient being easily disheartened and laboring under the impression that insuperable combinations are devised against him by adversaries to frus- trate every undertaking ; the patient gives way to despondency, and is overcome by a prevailing idea, that he is doomed to be unfortunate — symp- toms which are characterized by the following: weakness of digestion, with recurrence or aggravation of symptoms generally, and with indolent dis- position, ill-humor and distention of the belly, after eating; chronic relaxation of the bowels ; loose, yellowish, or slimy evacuations, or char- acterized by discharge of undigested food; or pale evacuations with dark urine; small, detached evacuations with slow and sluggish discharge, and w r ith deficiency of muscular vigor in the intestines ; sometimes the organs of sense are acutely sensitive ; sleeplessness occasioned by the crowding of ideas upon the mind, and by visionary projects, or sleep much disturbed by anxious, painftd dreams, which continue to haunt the patient when awake, and attended with frequent change of position and tossing. Dose: Three globules in a teaspoonful of water, night and morning, until amelioration or change. Sepia is of pre-eminent service in many confirmed and inveterate cases, particularly in females, and when complicated with severe hyster- ical affections ; the patient being wholly abandoned to despondency and weary of existence, anxious respecting her own health, but averse to the consideration of household or other affairs, and often indifferent to every one but herself. Dose : As directed for China. Silicea is of great service, generally, in obstinate cases of hypochon- driacal affection, resulting from stomach derangement, particularly, if noise easily frightens or startles the patient, or if there be constant anxiety and agitation, weakness of the memory, incapability of reflection, moroseness and taciturnity, intense irritability and tendency to be pro- voked to violence by contradiction, or excessive weariness of existence, further characterized by confusion of the head, or of ideas; pain ascend- NAUSEA. 249 ingfrom the nape of the neck to the top of the head; headache recurring every morning; heat in the head, particularly in the forehead; lacerating or darting pains in the head, or pulsating headache, with flushing of blood to the brain ; temporary defect or suspension of vision ; confusion and mistiness of sight when reading ; redness of the eyes and adhesion of the eyelids at night; the strong light of day is painful to the eye; bleeding at the nose; continued and watery discharge from the nose ; con- stant sneezing; hardness of hearing; scabby eruption on the lips, or swelling of the glands of the lower jaw ; toothache at night, aggravated or provoked by hot or cold things ; soreness of the tongue, or dryness of the mouth; deficiency of taste, or bitter taste; acid risings and water- brash, or pains in the stomach or bowels, or even vomiting after eating ; nausea every morning; colicky pains associated with constipation; pierc- ing or nipping pains in the bowels ; puffing of the belly, and difficult expulsion of very fetid flatulency ; hard stools with constant urging, or constipation characterized by hard, knotty, detached motions, evacuated slowly and with difficulty; wetting the bed; looseness; suffocating cough at night; aching pain in the chest, and impeded breath; numbness of the arms induced by lying upon them; trembling of the knee; offensive smell from the feet; cold feet, sweating of the feet, or lastly, cramps of the legs, particularly during rest and after exertion. Do.se : As directed for China. Accessory Treatment and Diet.— In no class of disorders is it more requisite to adhere strictly to dietetic regulations, than in those which consist of derangement in the digestive system, whether so-called functional or organic; the patient should, therefore, in such cases, regu- late his regimen as closely as possible, by the rules laid down at the com- mencement of this treatise (pp. 73, 74,) carefully avoiding, moreover, all such articles as he may find disagree with him, even if they be allowable as a general rule. NAUSEA. With respect to this affection, which must be considered purely as a symptom, the reader is referred to the foregoing portions of this article, wherein directions have been given for the treatment. In the majority of simple and casual cases, however, it might suffice to consider the indications afforded for Ipecacuanha, Cocculus, Nux-vomica, Bryonia, Chamomilla, Pulsatilla, and Aconitum, following the same regulations respecting the dose. In inveterate cases, however, in which this symptom occurs continu- ously, the accurate investigation of all symptoms associated with it, and of the whole of the foregoing details, becomes necessary, and one or more of the following remedies, according to the directions hereinbefore offered, may become necessary. Natrum-m., Arsenicum, Lycopodium, Lachesis, Carbo-veg., Rhus-tox., or Silicea. Five grain doses each of Oleate of Cerium and Sub-Nitrate of Bismuth every hour. One drop of Carbolic Acid or Creosote in water, every hour, or Five drops Prussic Acid in water, every hour, until the nausea ceases, are quite effectual remedies. 250 DISEASES OF THE STOMACH AND INTESTINES. Cold applications, or mustard plasters, may be applied over the stomach,, and are useful. If irritating substances are known to be in the stomach, an emetic should be given at once ; twenty grains of Ipecacuanha, with water, is most suitable. After free emesis has been produced, some of the above remedies should be given to quiet the stomach. A sixth or a fourth of a grain of Morphine should be given, if there is pain or cramp in the stomach. ERUCTATIONS. HOMEOPATHIC TREATMENT. With reference to eructations, as well as to nausea, as they must be considered purely as symptoms, the reader is referred to the foregoing portions of this article, wherein more distinct indications have been afforded, to facilitate the selection of the appropriate remedy. In most cases of a simple and uncomplicated char- acter, the consideration of such indications as are afforded for the admin- istration of the following remedies (chiefly) both as to selection and dose, will be sufficient to meet the requirements of the case : Arnica, Xux- vomica, Pulsatilla, Sulphur, Bryonia, Carbo-veg., Chamomilla, Cocculus, China, Antimonium-crudum, and Antimonium-tartaricum. In cases of an inveterate nature, and which are evidently associated with complica- tions involving the whole of the digestive and nutritive system in more or less continual derangement, it may be advantageous to consider the indi- cations afforded for Sepia, Acidum-sulph., etc. ALLOPATHIC TREATMENT. Pyrosis. Sour eructations after meals may generally be prevented by taking fifteen drops of Dilute Hydro- chloric or Lactic Acid, in sweetened water, before meals. Sulphurous Acid, in doses of twenty drops, in sweetened w^ater, before meals, will sometimes have a better effect. Either of these Acids often has a better effect when given in a teaspoonful of Glycerole of Pepsin. Alkalies, to be useful, should be taken when the sour eructation begins to appear in an amount sufficient to correct the symptom. Bicarbonate of Soda (Baking Soda) is best suited to this end. It is best given in milk or water. Alkalies are beneficial when the amount taken can be gradually diminished with relief of the symptoms. Bismuth is a very useful agent in most of these cases. It is best given with a little Carbolic Acid, as in this formula : Take of Sub-nitrate of Bis- muth three drams, Carbolic Acid four grains, Mucilage or Gum Arabic one ounce, Peppermint Water three ounces. Mix. Dose: Shake the vial and give a tablespoonful three or four times a day. When Bismuth is given alone it is best given in milk. The dose is from five to fifteen grains. BILIOUS OR SICK HEADACHE. In ordinary cases, in which sick headache is evidently the result of a casual cause, it will suffice to consider the indications afforded for Anti- monium-crudum, Ipecacuanha, Nux-vomica, Pulsatilla and Sulphur; or Bryonia, if this symptom be associated with costiveness. VOMITING OF BLOOD. 251 ALLOPATHIC TREATMENT. Bilious or sick headache is, generally, relieved by correcting the acidity of the stomach by the use of alkaline remedies. The use of the Aromatic Spirits of Ammonia, in doses of a teaspoon half full, well diluted in water, is the most generally effectual. In cases in which no stimulant is required, the ordinary domestic alkalies, as Soda or Saleratus, or a half teaspoon ful of Magnesia, may be used in doses of from five to ten grains. In some cases relief is only obtained after a free vomiting. In such cases the quickest relief is procured by giving an emetic of twenty grains of Ipecacuanha, or a tablespoonful of pulverized Mustard in a glass of water. Ergot has proved, in some hands, to be useful. The Fluid Extract may be given in doses of half a teaspoonful to two teaspoonfuls, three or four hours apart. H^JMATEMESIS, HEMORRHAGE FROM THE STOMACH. VOMITING OF BLOOD. This is scarcely ever an original affection, but almost always symp tomatic of some other disease. Vomiting of blood may depend on a variety of causes, and if it inclines to become profuse and threatening, it is of the utmost import- ance, in practice, to investigate, with accuracy and care, the precise cause in each attack. As a complicating symptom, bleeding occurs, more par- ticularly, in diseases characterized by a peculiar alteration of the whole mass of blood, such as typhus, scurvy, yellow fever, etc. The hemor- rhage may be very copious, although none of the larger vessels are rup- tured. A second cause of the bleeding is, a rupture of the walls of ves- sels. It may be caused by excessive accumulation of blood in the stomach, depending upon disturbances, engorgements, etc., of the vena porta, liver, spleen — hence, it is not of unfrequent occurrence in the case of individ- uals afflicted with piles ; or the hemorrhage may be caused by menstrual suppressions and stoppages, on which accountit occurs more frequently at the climateric age ; it sometimes seems as if the hemorrhage took place as a substitute for the menstrual discharge The vomiting during preg- nancy is very frequently stained with blood. The worst kind of bleeding arises from injuries of the stomach walls, consequent upon ulcerations of the mucous membrane. It is met with in chronic dyspepsia and cancer of the stomach. If there is a disposition to bleeding, it may be provoked by a blow upon the stomach, a fall, or violent emotion. The symptoms of haematemesis differ, according as the bleeding is more or less copious, and arises from different causes. If the bleeding is but slight, and the blood is not vomited up, the accident remains some- times entirely unnoticed. If the vomited substance only contains a few streaks of blood, it has no particular significance, at the time, but the patient has to be watched with more care, because we can never be sure whether a more dangerous hemorrhage is not threatening. The blood should likewise be examined, with a view to discovering disease changes that had remained latent heretofore; The bleeding likewise acquires importance from the circumstance, whether the blood is discharged ^252 DISEASES OF THE STOMACH AND INTESTINES. with violent straining, or is vomited up easily; in the latter case, the bleeding is much more significant, on account of its indicating ulceration of the mucous membrane, or some important change, dilatation, etc., of vessels, whereas a little blood may be discharged in consequence of vio- lent straining, even if the vessels are perfectly intact. As soon as a somewhat considerable quantity of blood is vomited, a series of characteristic symptoms appear. The morbid symptoms that already happen to be present, become associated with a constantly increas- ing dull pressure in the pit of the stomach, and a distressing feeling of distention of the stomach, generally attended with nausea. If the bleed- ing takes place slowly, the preliminary symptoms may be confined to these few; on the contrary, if the blood is expelled with rapidity and force, the patient experiences the usual symptoms of a considerable loss of blood, such as anxiety, paleness, cold sweat, cold skin, vertigo, and even fainting. A large quantity of blood is vomited up at once, and with great force. The action of the gastric juice imparts to it a blackish hue, and has the consistence of coagulated sour milk. The quantity dis- charged at one vomiting often exceeds one quart, so that it seems scarcely possible that the stomach could have contained such a large quantity at once. Immediately after the vomiting the patients feel faint and exhausted, and are tormented by an almost unquenchable thirst; at the same time a visible throbbing occurs in the pit of the stomach, of which the patient himself is conscious. After this paroxysm, a period of rest and comparative ease sets in, until another attack of bleeding occurs. The interval to the next bleeding, lasts from a few hours to several days ; in violent cases, four or five attacks may occur on the same day; of course, in such a case, severe symptoms of anaemia may set in, even unto convulsions, and death may be the immediate consequence. If so much blood is expelled from the stomach, the stools are likewise black as coal, and very thin; it may even happen that the blood is not vomited up first, but that the black stools may be the first sign of the bleeding. Regarding a return of the bleeding, we cannot speak with certainty ; it depends entirely upon the primary exciting cause. If there is a fre- quent return of the bleeding, anaemia and dropsy are unavoidable results. Recovery from a single attack usually takes place slowly, the patients being at the same time tormented by a variety of gastric dis- orders, such as a burning distress in the region of the stomach, foul taste, sweetish or foul eructations, horrid thirst, and by a long-continued abdominal pulsation. Under all circumstances, there is great danger lest the bleeding should return, hence the patient cannot be too careful in not overtaxing the stomach. Bleeding, resulting from ulceration, may not afford much relief, but in cases of haematemesis, of which we are unable to discover the exact cause, or which depend upon the sup- pression of other hemorrhages, the relief afforded by such bleedings may be quite considerable. As regards diagnosis, two circumstances may deceive us. In the first place a violent paroxysm of haemoptysis may be mistaken for vomiting of blood, and the deception may be kept up, if a physician does not himself examine the vomit, since patients often are so overwhelmed with anxiety VOMITING OF BLOOD. 253 that they lose all calmness and presence of mind. In other respects the black color of the vomit, and the absence of the bloody expectoration, which always follows a paroxysm of bloody cough, furnish the surest indi- cations regarding the true character of the attack. It likewise happens, that a person may have a violent attack of nose-bleed over night, and that the blood may be swallowed; if the quantity of the swallowed blood becomes excessive, it awakens the person, and the blood is then vomited up, and may look precisely as it does when true hsematemesis takes place. It is difficult to distinguish one from the other; our diagnosis has to be more particularly determined by the absence of all precursory symptoms, and subsequent gastric derangements. The use of whortleberries, and similarly colored fruit, may likewise occasion a momentary deception, more particularly, if the patients are very anxious. As a general rule, the prognosis, in all ordinary cases, is favorable, except where the hemorrhage is at once so excessive that death results from mere loss of blood. The prognosis, however, is always doubtful, in so far as a first bleeding leaves an inclination to a renewed attack, and the bleeding always indicates the presence of dangerous alterations in the stomach. Hence, a permanent cure is never absolutely certain. ALLOPATHIC TREATMENT. ELematemesis (vomiting of blood,) is a symptom of some other affection, the most serious of which are an ulcer or cancer of the stomach. It may be well to enumerate the symptoms of hemorrhage of the stomach and hemorrhage of the lungs, inasmuch, as by so doing, needless fears may be allayed by fully understanding the contrast between the symptoms accompanying each. The distinction may be more clear, if given in this table : In bleeding from the lungs Difficulty in breathing. Pain or heat in the chest. Blood coughed up by mouthfuls. Blood frothy. Blood of a bright red color. Blood mixed with spittle. Symptoms refer to lungs and bronchial tubes. The first efforts in treatment will be to arrest hemorrhage. The patient should be confined to the bed ; cold may be applied over the stomach ; small pieces of ice should be swallowed. If the bleeding is excessive, there should be entire rest of the stomach, and nourishment should be given by injection. Among the most suitable for this purpose is strong beef tea and milk. From foiir to six ounces may be used at each injection, four times a day. The addition of half a teaspoonf ul of Pepsin will aid its digestion. If the rectum should be especially sensiti\e, and does not retain the injection, twenty or thirty drops of laudanum should be added, and after the injec- tion firm pressure should be made upon the anus, with a napkin under the hand, until all efforts to expel it cease. It sometimes happens that vomit- ing of blood takes the place of the menstrual flow. If this is the case it should not be immediately arrested, but kept within proper limits. The swallowing of ice, cold over the stomach, and hot foot baths, are permissi- ble. Pain will require an anodyne; twenty drops of Laudanum, or a third of a grain of Morphine, every hour or two, until relief is obtained. In bleeding from the stomach. Sickness of the stomach. Fullness in vicinity of stomach. Blood vomited freely. Blood not frothy. Blood dark colored. Blood mixed with food. Symptoms refer to stomach. 254 DISEASES OF THE STOMACH AND INTESTINES. Remedies addressed directly to the flow of blood, may be called for. Those most likely to be in the house, ready for an emergency, are: Acetate (sugar) of Lead, Turpentine and Alum. Acetate of Lead may be given in powder, in doses of a sixth or eighth of a teaspoonful, and repeated in an hour, if necessary. The dose of Turpentine is ten to twenty, or thirty drops, given on sugar, or in mucilage or syrup. Alum may be given in powder, in doses of a quarter of a teaspoonful. Cathartics or emetics must not be given. Monsel's Solution of Subsulphate of Iron is the best remedy known to staunch hemorrhages. In these cases ten drops of the solution should be given in ice water, and, after the first two or three doses, can be given fre- quently, from ten to thirty minutes apart, if the bleeding does not cease. Tannin is a useful remedy; the dose in this disease is from ten to twenty grains. It should be given in powder. Excluding the existence of ulcer, cancer or other lesion of the stomach, treatment will have reference to the debilitated condition of the system, and the prevention of a recurrence of the hemorrhage. To this end, easily digested food, which is nutritious, as beef essence, milk, raw eggs, and broths. Ten drop doses of Aromatic Sulphuric Acid may be given before meals, in an ounce or two of some of the simple bitter infusions (teas,) as Colombo, Gentian, Quassia,Peruvian Bark, etc., made with an ounce of the drug to the pint of hot water. The Tincture Muriate of Iron may be given in doses of from ten to twenty drops, in sweetened water, after meals. The Citrate of Iron and Quinine frequently answers the purpose better than anything else. It should be given in solution, in water, or syrup of orange flowers, in doses of two to five grains. HOMCEOPATHIC TREATMENT. Aconitum should be given when the premonitory symptoms detailed declare themselves, and, particularly, when a considerable degree of fever precedes the attack. Dose: Dissolve six globules in two tablespoonfuls of water, and give a teaspoonful of the solution, repeating the dose in half an hour, and then every hour, till positive amelioration or change. In this mode, if taken in time, we may often, by calming the circulation, prevent an attack. Ipecacuanha. For a first attack we know of no better remedy than this ; unless some very peculiar symptoms should render some other medi- cine necessary, we would use this. Against following attacks it is not so good. The less the vomiting of blood, depends on some previously existing disease, the more this remedy is indicated. Dose : This must be large ; Ave or ten drops of the tinctm-e, and fre- quently repeated every thirty to sixty minutes, if the case is urgent. Nuoc-vomica. In a full habit of body, with a marked tendency to congestion of the stomach and bowels, particularly, when arising, from suppression of haemorrhoids, or of the menstrual discharge, or, from indul- gence in vinous, sprituous, or fermented liquors; this remedy is still further indicated by irritability of temper, and liability to constipation. Dose: Four globules in a teaspoonful of water, every four horns, until amelioration or change. Pulsatilla. The value of this remedy is noticed in the diseases of females above mentioned ; it is, also, in many cases, found more suitable VOMITING OF BLOOD. 255 than Nux-vomica for males, when of lymphatic temperament and mild dis- position. Distinctive derangement of the digestive or menstrual functions constitutes the general indication for this medicine. Dose : As directed for Nux-vomica. China, When a quantity of blood has been already vomited, this remedy, from its power of restoring the energy of the system after debili- tating losses, is clearly indicated; it should, also, be chosen when the patient has had a severe attack of vomiting of blood, which has ceased of itself, but still left great weakness. Dose; Six globules in a teaspoonf ul of water, every two hours, until improvement or change; if, however, there be very palpable ameli- oration after the first dose, the repetition may be suspended until the symptoms recur, or for twenty-four hours. Arnica, One of our most important remedies in severe cases, and especially when occurring in individuals of a robust constitution, of a san- guine temperament and choleric disposition. It is further indicated when the patient complains of pains, resembling the results of a contusion in all the extremities. Dose: Dissolve six globules in two tablespoonfuls of water, and give a teaspoonful of the solution every hour, until distinct improvement or change. Sulphur is useful in scrofulous habits, or when the affection has arisen from suppressed haemorrhoids ; its value, also, in cases of unhealthy menstruation will be pointed out in the proper place. Dose : Three globules in a teaspoonful of water, every four hours, for the first day, or until the violent symptoms subside. Then six glo- bules in a wineglassful of water, every morning the first thing, (fast- ing) for ten days ; pause four days, and resume the course, and so on, from time to time, when no acute symptoms are present. ACCESSORY MEASURES. The application of dry cupping-glasses to the stomach and under the ribs— or of a cloth, which has been dipped in moderately cold water, to the lower region of the belly— sometimes forms a useful auxiliary in arresting the discharge of blood. See also the article on " Discharge of blood from the Lungs." Diet and Regimen. The rules hereafter given under Spasm of the Stomach should be enforced, with the utmost rigor; solid food cannot be permitted, and all drinks should be cold; animal jellies, preparations of milk, light puddings and broths, merely tepid, may be allowed in cases where the patient may require such nourishment, but nothing more must be taken than is absolutely necessary for that purpose ; immediately after the attack, no food should be given for some hours, and then very cau- tiously, '^nd in small quantity. It is evident that, in such cases, absolute rest, both mental and bodily, is essentially requisite. CABDALGIA— SPASM OF THE STOMACH, Symptoms. Contractive and spasmodic, or gnawing pains about the region of the stomach, extending to the chest and back, attended with anxiety, nausea, eructation or vomiting, with faintness and coldness of the extremities: the patient is sometimes relieved by emission of ascend- ing wind, and when complicated with heartburn, by a discharge of a quan- 256 DISEASES OF THE STOMACH AND INTESTINES. tity of limpid fluid ; occasionally headache and constipation are present. In some cases the pain is very slight, (but there is always more or less,) and a degree of anxiety, with nausea, often increased by taking food. Complications. The disease is frequently accompanied by a disease of the liver, spleen, or of the pancreatic gla*nd, or even by cancerous degen- eration of the stomach, or first portion of the small intestines, in its advanced stages. It is a frequent attendant on gout. Age, Sex, etc. It is a more frequent affection in the female than the male sex, often occurring after the cessation of the usual monthly dis- charge, or from any interruption of its usual course; in such instances it is frequently accompanied with hysterics and fainting, and may pass on to vomiting of blood. It very rarely occurs before the age of puberty. The paroxysms last for a longer or shorter time, according to the vio- lence of the affection, and return in many instances periodically ; and may be brought on by partaking of improper articles of diet, or, in severe cases, by any solid food whatever. Origin. This disease originates in an unhealthy state of the nerves of the stomach. The Exciting Causes are: Long fasting between meals, very hot or cold drinks, an habitual use of ardent spirits, or of indigestible food, worms, and, in some instances, exposure to cold or damp weather. But coffee is the article to which most persons owe this pain. Precautions to be observed by those who are subject to spasm of the stomach. The chief articles to be avoided by an individual suffering from this malady, are: Crude, uncooked vegetable substances (such as salads,) cheese, new bread, sweet meats, cherries, nuts, olives, and roasted chest- nuts, and stimulants of all kinds, whether tea, coffee, alcoholic or fermented drinks. ALLOPATHIC TREATMENT. Spasm or Cramp in the Stomach. If the trouble occurs suddenly upon the ingestion of some article of food, which is plainly irritating the stomach, the organ should be relieved by an emetic of twenty grains of powdered Ipecacuanha in a glass of warm water. If the trouble is not plainly referable to such a cause, neither eme- tics nor cathartics should be given, but the pain must be relieved. This is done most quickly by giving thirty drops of Laudanum, and repeating the dose at intervals of half an hour to an hour, until the pain is relieved ; or a third of a grain of Morphine may be given at the same intervals. A laxative of a couple of Compound Cathartic Pills may be needed after the pain is relieved, to prevent constipation from the opiate. In cases subject to frequent returns of the pain, it is not advisable to give opiates, on account both of the liability of producing the "opium habit" and of the disturbance its frequent administration produces in digestion. Sometimes cold and sometimes hot applications, over the stomach, relieves the spasm and pain. Rubbing the skin over the stomach with a liniment made of an ounce each of Chloroform, Tincture of Aconite, and Soap Liniment, or laying a flannel, wet with equal parts of Turpentine and Laudanum, and covering it with oiled silk. Tincture of Belladonna in doses of ten drops, or Tincture of Hyoscyamus in doses of one or two teaspoonfuls, taken internally, is useful in relieving pain. SPASM OF THE STOMACH. 257 When pain occurs in the stomach, with spasms, the same procedures are useful, but some remedies seem to have especial benefit. If there is indigestion and irritation of the mucous membrane, Bismuth, in doses of a scruple three or four times a day, may be given. In these cases the fol- lowing is a good formula: Take of Sub-nitrate of Bismuth two drams, Pepsin one dram, Dilute Hydrocyanic Acid half a dram, Mucilage of Gum Arabic, and Peppermint- water each two ounces. Mix. Dose: A tablespoonful three times a day. The Purified Black Oxide of Manganese, in doses of ten to twenty grains, is also a beneficial remedy, and can be used in case of failure with the Bismuth. Cases accompanied with the formation of gas, should be treated with Nux-vomica, in doses of ten drops of the Tincture, or one-fourth of a grain of the Extract in pill, three times a day; or Strychnine, in doses of one- thirtieth of a grain, may be given instead. The Elixir of Bark, Iron and Strychnine, or Elixir of Quinine, Iron and Strychnine, in doses of one or two teaspoonfuls three times a day, are appropriate to these cases. In cases resisting other remedies, Fowler's Solution (Solution of the Arsenite of Potash,) in doses of one or two drops, in water, after eating, is almost always beneficial. Some change in the mode of life may be particularly important, as from inactive pursuits indoors to an active life in the open air; as, also, in some instances, change of scene and climate may be of the greatest value. In the use of stimulants, the advice of a conscientious physician should be rigidly followed. Harm will result from their use if taken at other times than with the meals, and in small quantities. The symptoms of dyspepsia should be met as is directed in that article. The tonics recommended to be of use should be taken for a long time. Each recurrence should be met as directed in the first part of this article. HOMEOPATHIC TREATMENT. Notwithstanding the usually intrac- table nature of this affection, it has been treated with marked success by the method about to be pointed out. Nux-vomica is one of the principal, and, in a large number of cases, the most appropriate of remedies against spasms of the stomach, and particularly in cases where this affection can be attributed to the long- continued use of strong coffee, or an excessive indulgence in spirituous liquors; it is of essential service in many cases of the same disorder, which have arisen after the suppression of chronic or hemorrhoidal dis- charges, or when the party affected is liable to fits of hysterics or nervous despondency. The following are the immediate symptoms which call for the administration of this medicine: Constriction, pressure, squeezing or spasm in the stomach, accompa- nied with a sensation as if the clothes were too tight at the waist, or as if wind were pent up in the sides, beneath the lower ribs. This sensation, as well as the pains before mentioned, become generally increased after a meal, or after partaking of coffee; in addition to which, a feeling of de- pression or constriction is experienced at the chest, which, in many cases, extends to between the shoulders and the lower part of the back. Fre- 17 258 DISEASES OF THE STOMACH AND INTESTINES. quently, also, we find nausea, accumulation of clear water in the mouth, or risings of sour bitter fluids, attended with a sensation of burning in the throat and gullet (heartburn) ; the tongue tremulous, cracked or fissured; clean, of a vivid red; coated yellow, or covered with a white mucus; lips and gums white, red and swollen ; blanched, yellowish, and somewhat indurated lips ; eyelids inflamed at the margins; sour or putrid taste in the mouth; vomiting of crude materials ; flatulent distention of the bow- els ; constipation ; aching in the forehead ; palpitation of the heart, and anxiety. When these symptoms are liable to be excited by a fit of pas- sion, or become aggravated in the morning, or when the patient is occa- sionally awakened out of his sleep by the spasmodic attack, this remedy is still more certainly indicated. Dose: In severe cases, of recent origin, three globules in a teaspoonful of water, every three hours, until amelioration or change. In chro- nic cases, with more or less acute pain after every meal, six globules every evening until positive amelioration or change. When the spasm of the stomach returns periodically, three globules should be taken in a teaspoonful of water, three hours before the expected recurrence of the symptoms. This rule applies in respect of any of the remedies herein prescribed, which have been administered with success against former attacks. If temporary relief only, followed by more intense suffering, has ensued, and continues three hours after a second dose of Nux-vomica, proceed with the next medicine. Carbo-vegitabilis should be given three hours after the second dose of Nux-vomica, if that remedy has produced only partial good effect, and will generally complete the cure, provided the affection be not one of long- standing, and, consequently, too deeply seated. Dose: Three globules in a teaspoonful of water, morning and even- ing, for four days. Chamomilla. For the employment of this remedy, the principal indications are: Pressure, as if from a stone in the pit of the stomach, or painful pressure and flatulent distention at the same part, as, also, of the region beneath the lower ribs and the belly itself, with shortness of breath, anxiety and throbbing headache ; mitigation of the above symptoms on partaking of coffee — a distinguishing mark between the indications of this remedy and those of jSTux-vomica ; on the other hand (as in the case of the latter,) it is also indicated when the symptoms as described are liable to be brought on by a fit of passion. Dose: Three globules in a teaspoonful of water, every four hours, until amelioration or change. Belladonna ought to be substituted for Chamomilla, or should be administered four hours after the third dose of the latter, when it has not been followed by relief, notwithstanding the apparent similarity of these symptoms ; farther indications for Belladonna consist of gnawing, pressure, or spasmodic tension in the pit of the stomach, relieved on bending backward and holding in the breath; or, further, spasm of the stomach, which recurs daily during dinner, or else pain of so violent a nature as to deprive the patient of consciousness ; tremulous, vivid-red and shming tongue, or redness of the tongue and elevation of the papillae; red and spongy lips. Dose : Three globules in a teaspoonful of water, every four hours, until the indicative symptoms are removed. If followed by more suffering after the third dose of Belladonna, proceed with Gelsemi- num, as directed for Belladonna . SPASM OF THE STOMACH. 259 Cocciilus, in many eases of this complaint, is particularly indicated, when, in addition to the usual symptoms, there are constipation and con- strictive pains over the entire stomach, with flatulency, and accumulation of water in the mouth, and alleviation of the sufferings on the recurrence of the latter symptoms. Dose: Of a solution of six globules to two tablespoonfuls of water, give a teaspoonful every three hours, until amelioration or change. Pulsatilla is useful in cases with shooting pains in the stomach, which are aggravated by movement, and particularly by making a false step. Pulsatilla is, also, one of the most appropriate remedies when the attacks are followed by vomiting, or accompanied by violent tension and squeez- ing, or throbbing and sensation of anxiety about the pit of the stomach, increase of pain after eating, or more particularly a feeling of pressure and pinching after dinner, with a relaxed state of the bowels, or a disposi- tion thereto. Disposition to hysterics or nervous despondency. This remedy is very serviceable in cases of this affection, arising from suppres- sed menstruation. Dose : Of a solution of twelve globules to four tablespoonfuls of water, give a tablespoonful every six hours, until amelioration or change. Sepia is an efficacious medicine in spasm of the stomach, arising from suppressed or difficult menstruation, and may, in general cases, advantageously follow Pulsatilla; it is indicated when most of the suffer- ings arise after a meal, by pressure in the stomach as from a stone, and by a burning pain in the pit of the stomach ; and by restoring singly, or in conjunction with Pulsatilla and Sulphur, the menstrual flux, it frequently removes the spasm at the stomach and hysterics consequent upon this derangement, or, at least, places the affection iri such a position that it is easily cured by some other medicine, closely corresponding to the remain- ing symptoms. Dose : In recent (not chronic) cases, of a solution of eight globules to two tablespoonfuls of water, give a teaspoonful every four hours until amelioration or change. In chronic cases, give three globules in a teaspoonful of water night and morning for a week, then pause four days, and resume the course, suspend treatment, or change the remedy according to circumstances, the thirtieth potency is best. China is of great service in most cases of spasms of the stomach with general weakness, arising from loss of humors, the result of blood-letting, or repeated loss of blood, abuse of emetics or aperients, too long continued suckling, etc.; and it is further indicated by great weakness of digestion, distention, and uncomfortable weight, pressure or pains in the stomach after eating, so that the patient feels much easier when fasting ; these latter symptomsare the more immediate indications for the employment of this medicine. Dose: Of a solution of six globules to two tablespoonfuls of water, night and morning for three days; and afterwards three globules in a teaspoonful of water every third night, until positive improve- ment or change. Bryonia. This medicine is more particularly adapted to the milder cases of spasm in the stomach, with painful pressure, or a feeling of disa- greeable fullness in the stomach after a meal, which occasionally becomes converted into a feeling of constriction, cutting or pinching, and is relieved by eructation and external pressure. This remedy is, moreover, still more 260 DISEASES OF THE STOMACH AND INTESTINES. clearly indicated when the symptoms are generally accompanied by severe headache or painful compression in various parts of the head, and particularly at the temples, which is liable to be excited whenever any article of diet disagrees in the slightest degree ; increase of the suffer- ings by movement; habitual costiveness. Dose: Three globules in a teaspoonful of water every two hours, until amelioration or change. Arnica- Montana, in spasms or pains in the stomach, which have originated in the effects of a strain, or from a blow, etc., will be found specific. It is, however, also an excellent remedy when there is a sense of fullness and constrictive pain in the stomach and in the fore part of the chest, shooting pain in the pit of the stomach, with painful pressure as from a stone, or aching, extending to the back, and tightness of the chest, increased by eating, drinking, and external pressure. Dose : Of a solution of four globules to two tablespoonfuls of water, or in the like proportion, give a teaspoonful night and morning, until amelioration or change. Arsenicum is required for periodic pains in the stomach, chiefly consisting of a burning character, and attended with acrid, sour eructa- tions, vomiting of crude materials, or of mucus, sometimes even of blood; tremulous, swollen, or glazed, red and fissured tongue; blanched, waxy, and somewhat indurated lips ; want of appetite; extreme debility; ema- ciation. Do.se : Two globules in a teaspoonful of water, every three hours, until amelioration or change ; or in very acute cases characterized by excessive prostration and livid aspect, give one globule in a tea- spoonful of water immediately, repeating the dose after half an hour, and again every two hours, until positive amelioration or change. But if little or no permanent relief ensue within two hours after the sixth dose, consider the various other remedies herein named. In chronic cases, give three globules in a teaspoonful of water, night and morning, until distinct amelioration or change. Calcarea. In obstinate cases, occurring in individuals who are, habitually addicted to the abuse of wine or ardent spirits, Calcarea will generally, be found of great service, especially, after the previous employ- ment of Nux-v. It is further a valuable remedy in the cases of females of full habit of body, subject to discharge of blood from the nose, or to exces- sively copious menstruation; and is, generally, indicated when the parox- ysm of pain comes on usually at night, or after a meal, in which latter instance vomiting sometimes results, or nausea and acidity, with painful sensibility on pressure at the region of the stomach. Constipation, hreni- orrhoids, or chronic looseness of the bowels are additional general indications for the employment of this remedy. Dose: Six globules in a wineglassful of water, every morning the first thing, for a week (unless earlier relief or change ensue); pause four days, and then, if necessary, resume the course as before, and so on, until positive amelioration or change. Diet and Regimen. These are subject to the same general rules as have already been afforded in the article on Indigestion. heartburn, blackwatee. water-brash. This is not an affection of the organ whose name it bears, but a painful or uneasy sensation of heat, or acrimony, about the pit of the stomach, sometimes extending upwards. It is frequently accompanied with anxi- DIARRHCEA. 261 ety, nausea, and vomiting; or a violent, gnawing, spasmodic pain in the region of the stomach, from which the patient experiences no relief, until he succeeds in ejecting a quantity of limpid fluid. Treatment. As heartburn is, strictly speaking, a mere symptom, emanating from derangement of the stomach, the general articles on u Indigestion, " and its subordinate affections, should be considered. CHAPTER XIII DISEASES OF THE INTESTINES. DIARRHCEA. Diarrhoea, or looseness of the bowels, is a disease of frequent occur- rence, manifesting itself, more especially, during the warm months of the year, though it may take place at any season. All persons are, alike, sub- ject to it when exposed to the causes. Symptoms. Diarrhoea consists in frequent evacuations from the bow- els, of a more fluid nature than usual, each discharge being, usually, accom- panied with, or preceded by a rumbling in the bowels, together with a sense of weight, or pressing down, and, commonly, relieved as soon as the evacuation takes place, but are renewed before the one, which is to suc- ceed, ensues. More or less griping is present, and not unfrequently nau- sea and vomiting. Fever is not, usually, present in diarrhoea. When the discharges are very frequent, or in large quantities, they rapidly reduce the strength of the system ; emaciation takes place ; the functions of the system become impaired ; the skin becomes pale, dry, rigid, and eventu- ally, sallow ; and if the disease continues, the feet and legs become drop- sical. The discharges become more and more offensive, a slow fever ensues from the exhaustion, and the patient dies. According to the character of the evacuations and the exciting causes, diarrhoea has been divided into several varieties, thus: 1. Lienteric Diarrhoea, in which the food is rapidly passed into the bowels, and appears in an undigested condition in the evacuations ; and is due to an impairment or suspension of the'functions of the stomach, with great irritation in the intestinal canal. 2. Chylous or Coeliac Diarrhoea, in which the discharges are of a milky white, or dirty white color, and is due either to a congested con- dition of the mucous membrane of the small intestines, or to tubercular (consumptive) disease of the mesenteric glands (small glands in the mem- brane uniting the bowels). 3. Mucus Diarrhoea, in which considerable mucus is found in the discharges, being, occasionally, streaked with blood ; due to colds and exposures. 4. Bilious Diarrhoea, in which the evacuations are mixed with much yellowish or greenish looking bile, and most generally accompanied by nausea and vomiting, due to cold, anger, chagrin, etc. 262 DISEASES OF THE INTESTINES. Causes. Diarrhoea may be caused by improper exposure to excessive heat or cold; by the use of acid, unripe fruit ; indigestible or other irrita- ting food; from the presence of worms; from overloading the stomach with food ; sudden frights ; fits of anger, grief, and other depressing emo- tions ; certain articles of diet occasion diarrhoea, in some persons, which are quite agreeable and salutary to others. A very frequent cause of diar- rhoea, among infants, is the use of spoon meats, and other gross articles of diet ; it may, also, arise from the bad quality of the mother's or nurse's milk; from the irritation caused by teething, etc., the going-in of cutane- ous eruptions ; fermented liquors, etc., are also among the exciting causes; changes in the atmosphere, rendering the disease epidemic in certain localities ; the unwise use of cathartics, is not an unfrequent cause. ALLOPATHIC TREATMENT. This disease is, frequently, transient, due to temporary indigestion, or following some dietetic error. In these instances, little or no treatment is necessary, except guarding indulgence of the appetite more carefully. If the contents of the large intestine (bowel) is not spontaneously expelled, a cathartic should be given. For this purpose, a tablespoonful of Epsom Salts, with ten drops of Deodor- ized or common Laudanum (Tincture of Opium,) to allay irritation, or a- Reidlitz Powder, answers a good purpose. A tablespoonful of Castor Oil,, or five or ten grains of Powdered Rhubarb will, also, meet the indications. If the evacuations have been copious, and of a feculant character, a cathartic is not required. After the bowels have been thoroughly emptied, if diarrhoea and pain, or uneasiness, still continue, it should be relieved by an anodyne, one or two teaspoonfuls of Paregoric, or ten or twenty drops of Laudanum, in a tablespoonful of Chalk Mixture, or Cinnamon Water, witb the addition of a little Prepared Chalk, or Soda, or five grains of Dover's Powder. Whatever the remedy chosen, it should be repeated every six or eight hours, if needed. The diet, for a few days, should be simple and restricted. A diet, largely composed of milk, is suitable. Care should be used that the bowels do not become over confined. If they do not move spontaneously, they should be started again by one or two Compound or Improved Cathar- tic Pills, twice a day, until an action is produced. It should, also, be stated that a free injection of warm water, followed by a small injection of warm water, or thin Starch, with half or two-thirds of a teaspoonf ul of Lauda- num, will, frequently, cure diarrhoea. Should the diarrhoea tend to continue, or frequently return, the prin- cipal treatment will refer to diet, and measures to render digestion com- plete. Tender meats, cooked rare; eggs, chicken, and milk, are, most gen- erally, found to meet the end required; but, in some cases, starchy articles, such as Rice, Corn Starch, Tapioca, Sago, Arrowroot, Wheat or Oatmeal, with milk, are found best suited. If the patient has been deprived of fresh vegetables, and ripe fruits, they should be supplied, in moderate quantities. A moderate quantity of food, frequently taken, is generally better than a full meal once or twice a day. In some instances, a change of climate is demanded. A removal from the city to the country, is, frequently, curative in the hot weather, partly from the tonic effect of the country air, and partly from the use of fresh DIARRHCEA. 263 milk, and ripe fruits, which the system required. In these cases, the use of Opium is only of limited and temporary value. It may be used as directed before, to relieve pain and irritation, but its continued use impairs digestion. It should be remembered, that diarrhoeas are, sometimes, prolonged by the presence of hardened feces; in these cases, Epsom Salts, or Castor Oil, should be given, in tablespoonful doses, every six hours, until a free motion is obtained; or injections of a quart of warm water, frequently repeated until hardened feces cease to be discharged. Large doses of Bismuth, from twenty to thirty grains, repeated two or three times a day, is a most valuable remedy in continued diarrhoea, and is not accompanied by any disagreeable effects. It can best be given in some milk. Chronic diarrhoea is frequently of malarial origin. In these cases, Quinine, in five-grain doses, two to four times a day, is curative without any "other remedy. Quinine is frequently required, as a tonic, in doses of two or three grains, three times a day. For the same purpose, the bitter infusion of Quassia.Gentian, or Colombo, alone, or combined, two ounces to the pint of boiling w r ater, dose : a tablespoonful, three times a day, are useful. One or two grains of Pyrophosphate of Iron may be combined with each dose of the bitters, or Quinine, if the patient is much reduced. The addition of Pepsin, in doses of five or ten grains, is, frequently, a great help to digestion. In chronic diarrhoea, Bismuth, given as before mentioned, occupies the first rank ; anodynes, before described, maybe given with it, but only as required to relieve pain or irritation. Sugar of Lead may, in rebellious cases, be combined with the Bismuth, with or without the anodyne, in doses of one to three grains. The vegetable astringents — Blackberry-root, Logwood, Catechu, Kino —have been, in their turn, found useful. As their efficacy depends on the presence of Tannin, I prefer to use it. It can be given in doses of ten to twenty grains, in syrup, and repeated every few hours, and may be com- bined with Bismuth, or an anodyne, or both. One of the most effective prescriptions in chronic diarrhoea is the fol- lowing: Take of Sulphate of Copper one grain, Sulphate of Morphine one grain, Sulphate of Quinine twenty-four grains. Make a mass and divide into twelve pills. Take one pill three times a day. In some rebellious cases the following is a highly useful combination: Take ofErgotine ( Watery Extract,) twenty grains, Extract ofNux-vomica five grains, Extract of Opium ten grains. Mix well, and divide into twenty pills. Take one pill every four or six hours. If the druggist is not known to be skillful and careful, probably the following had better be used instead : Take of Fluid Extract of Ergot two ounces, Tincture of Nux-vomica three drams, Deodorized Tincture of Opium three drams. Take a teaspoonful four or six hours apart. In the treatment of chronic diarrhoea, it becomes necessary to change the remedy occasionally, as in some instances the system becomes habitu- ated, in a measure, to its use. It is not, however, best to change a remedy as long as it is proving efficacious. 264 diseases of the intestines. The Diarrhoeas of Children Demand Separate Consideration. Those having the appearance of blood in the stools, will be treated under the head of dysentery. If the roundness of the figure, and the firmness of the flesh is maintained, it shows that nutrition is sufficient, and the diar- rhoea is not seriously harmful. On the other hand, if the child is beginning to waste, or the flesh becomes flabby, immediate treatment is required. Many of these cases are caused from poor food. If the child is at the breast, at may be the mother works too hard, and so impairs the quality of milk, or it is insufficient, and creamy cow's milk should be given in addi- tion. A little penetration, guided by common sense, will discover the cause and correct it by better hygiene. A green or irritating stool shows the need of an alkali, lime water by preference, or a little prepared Chalk or Soda, one to three grains, is a dose. When lumps or mucus pass in the stools a laxative is needed. For this purpose half a teaspoonful of Castor Oil, or Syrup of Rhubarb a tea- spoonful is suitable. Previous constipation also demands these laxatives, or the following may be given : Take of Epsom Salts one dram, Tincture of Rhubarb one" dram, Syrup of Ginger one dram, Cinnamon Water, or, Water nine drams. Mix. Dose: A teaspoonful three times a day for a child a year old. If there is no improvement from this treatment, we must rely on astringents and alkalies. If the evacuations are frequent, and the child weak, no laxatives should be given, but astringents should be used from the first. Often much precious time is lost by not following this rule. The physician finds, generally, when he is called, that opiates and astring- ents are needed exclusively, attention being also given to hygiene. The Compound Powder of Chalk and Opium answers the indications, and may be given in doses of three grains every other hour, to a child a year old. I often use the following: Take of Compound Powder of Chalk half a dram, Bismuth one dram. Mix and divide into ten poioders. Dose : One powder three hours apart until the diarrhoea is checked. Or the following may be used : Take of Paregoric two drams, Tincture of Catechu two drams, Chalk Mixture one ounce. Mix. Dose : One teaspoonful every three or four hours, to a child one year old. Often the diarrhoea is due to, or aggravated by imperfect digestion ; it is well to give Pepsin and Sub-Nitrate of Bismuth. Take of Pepsin one dram, Sub-Nitrate of Bismuth one dram. Mix, and divide into twelve powders. Give one immediately after the child has taken milk or food. They can be given in milk or syrup. Pepsin and Bismuth may be given in solution. In children over two or three years of age the treatment is similar to that for adults, making allowance for age. Take of Liquid Pepsin (Sheffer's formula) and Sohtiion of Bismuth, (U. S. P.) of each two ounces. Mix. Dose: Half a teaspoonful, to a teaspoonful, three or four times a day. Quinine, in doses of half a grain, to a grain, three times a day, is also beneficial. DIARRHCEA. 265 HOMCEOPATHIC TREATMENT. Dulcamara should be given in diarrhoea, occurring in summer, from cold. Particular indications for its use are, the relaxation of the bowels, being attended with colic, or, cutting pain in the region of the navel; the evacuations being liquid, slimy, and yellowish or greenish, generally coming on at night, and some- times being attended with nausea or vomiting; want of appetite, and great thirst; paleness of the countenance, and lassitude. This medicine may, also, be judiciously administered in many cases in which the relaxation of the bowels affords no ostensible specific or characteristic indications for any particular remedy. Dose : For adults, eight globules, to each two tablespoonf uls of water, give a teaspoonful after each evacuation, until distinct relief or change. But if only partial relief should ensue, in acute cases, in six hours after the second dose, or in. chronic cases in twelve hours after the sixth dose, proceed with the next, or, study other medi- cines. Bryonia should be given in cases of diarrhoea arising from the before- mentioned causes, and attended with many of the symptoms noted under Dulcamara, when that medicine has failed to afford the required relief, particularly if the looseness is liable to be aggravated after a meal, or after drinking, and the stools are passed almost involuntarily, and portions of undigested food are perceptible in the motions; also, when looseness is experienced after partaking of milk. In looseness of the bowels, occurring during hot weather, when we cannot trace the cause in any errors of diet, requiring other remedies, this medicine is further indicated, and especially so in the following instances ; diarrhoea, from checked perspiration, or being overheated— cold drinks— a chill from remaining in any cold, exposed situ- ation, or in draughts— or from exposure to an eastlerly wind. When this affection has been produced by passion, particularly in individuals of what is called a bilious temperament, Bryonia is, again, a most useful remedy. It may, also, be remarked that the relaxation of the bowels, arising from drinking impure water, or water strongly impregnated with vegetable substances, when heated, has frequently found relief in this medicine. Dose: In casual or chronic cases, and in all other respects, as more particularly directed for Dulcamara. China. Looseness in consequence of indigestion, particularly, if occasioned by partaking of fruit, or, flatulent food, such as vegetables ; evacuations very profuse and sometimes attended with but little pain ; and when the discharge comes on immediately after partaking of food, or espe- cially during the night; evacuations liquid and brownish, and sometimes containing portions of undigested food ; it is, in some instances, further indi- cated when considerable spasmodic, or, colic-like pain is present with flatulence, want of appetite, thirst and great weakness ; and is also valu- able after improper treatment of this affection, when considerable debil- ity remains. Dose : If singly, of a solution of eight globules to two tablespoonf uls of water, give a teaspoonful after every motion, until amelioration or change. In like cases, for children, a solution of three globules to two tablespoonfuls of water, similarly administered by teaspoon- fuls. If in alternation with Ferrum, a similar solution (separately) of each medicine (as distinctly stated for adults and for children,) of each of which the like dose should be given, the one four hours after 266 DISEASES OF THE INTESTINES. the other, in rotation, until amelioration or change. In chron ic cases, if singly, six globules, in a teaspoonful of water (for adults,) or two globules, in a teaspoonful of water (for children,) morning and eve- ning, every other day, until amelioration or change . Ferrum-m. may be advantageously given, in alternation with China, when the evacuations are partly composed of undigested food, and pass without pain. This remedy may, however, be administered alone, when the discharge from the bowels is unattended with pain, or there are pains in the back and posterior passage, paleness of the face, watery evacuations — or looseness, particularly, observable at night, or after eating or drinking — loss of flesh, alternate absence of appetite and voracious hunger, disten- tion of the belly without flatulency, spasm of the stomach, continued thirst, and weakness of the eyes, with great weakness of digestion. Dose: In all respects, whether for casual or chronic cases, and whether singly, or in alternation with China, as directed for the latter medicine. Chamomilla is a remedy, as already stated elsewhere, particularly useful in children, either at the time of teething, or at a more advanced period, when the affection has been excited by checked perspiration ; and it is further, particularly indicated when the evacuations are watery, bilious, green, yellow, or slimy, or of a fetor resembling rotten eggs; when there are fullness at the pit of the stomach, severe colic or spasm, pain, disten- tion and hardness of the belly, bitter taste in the mouth, foul tongue, thirst, want of appetite, bilious vomiting and flatulency (in infants,) attended with restlessness and screaming, and drawing up of the limbs towards the stomach. Do.se : Of a solution of eight globules to four tablespoonf uls of water, give a teaspoonful, after every motion, until positive amelioration or change ; or, in patients of a weakly habit of body, if this appears inad- equate to effect a cure (although the symptoms be analogous! and if, after repeated administration and temporary effect, the symptoms recur in all their former violence, consider Sulphur. Ipecacuanha is indicated by looseness, arising from indigestion, par- ticularly, if caused by imperfect mastication, and attended with nausea and vomiting, paleness of the face, weakness, and desire to retain the recumbent posture (in the case of children). Dose : As for Chamomilla. Pulsatilla should be administered six hours after the third dose of Ipecacuanha, if the latter affords only partial relief . It is, also, one of the best remedies for simple looseness of the bowels, arising from errors of diet, such as indulgence in acids, fruits, or rich, indigestible food, attended with foul tongue, and other symptoms of deranged digestion, as stated in the article on " Indigestion." Another remarkable indication for this rem- edy is, one evacuation differing from another in color. Dose: Six globules, in a teaspoonful of water, after every motion, until amelioration or change. Rheum is to be preferred to Pulsatilla, and should be employed after Ipecacuanha, or even before that medicine, when the sour smell of the evacuations is a predominant symptom. In general, however, it may be advantageously employed, especially, amongst children, when the symp- toms, in a great measure, resemble those of Chamomilla, but the pain is not so violent, and the evacuations have a sour smell; paleness of the face is, also, an indication for this medicine. DIARRHCEA. 267 Dose: Six globules, in a teaspoonf ul of water; or, for children, three globules in a teaspoonful of water, after every motion. Mercurius. When the diarrhoea arises from a chill, and the motions are copious, watery, slimy, frothy, bilious, or greenish, or streaked with blood, and cause a smarting or burning sensation on being evacuated ; also, when there is painful straining before, during, and after evacuation, fre- quently followed by protrusion of the lower intestine; severe, cutting pains; moreover, nausea and eructation, cold perspiration, trembling or shivering, great lassitude, and disposition to fainting ; evacuations con- taining undigested substances. Dose: Of a solution of six globules to three tablespoonfuls of water; give a teaspoonful after every motion, until distinct amelioration or change. Nux-vomica. Scanty evacuations or motions, consisting of slime and blood, attended with straining and great weakness; flatulency, and violent, cutting pains in the region of » the navel ; diarrhoea, alternating with constipation. For some of the accompanying symptoms, the reader is referred to the indications mentioned respecting this remedy, iathe arti- cle on ''Indigestion." Dose: Six globules, in a teaspoonful of water, every two hours, until amelioration or change. Arsenicum. Autumnal diarrhoea, or looseness, arising from errors in diet, acids, fruits, cold drinks, ices, or from a chill, etc., the characteristic symptoms for its employment are : watery, slimy, greenish, or brownish, corrosive, burning evacuations, with violent colic, excessive thirst, ema- ciation and great weakness, and when the affection is more liable to come on at night, or after eating or drinking. This is, also, a most important medicine for the treatment of the bowel complaint of children, as hereaf- ter, separately, considered. Dose: Of a solution of six globules, to two tablespoonfuls of water, give a teaspoonful every half hour (in very acute cases) ; or every hour (when the symptoms are modified by intervals of respite, until amelioration or change. If in alternation with Veratrum, of a sim- ilar solution (separately,) of each medicine, give first two doses (as just stated,) of the one, then pause an hour, and continue with two doses of the other, similarly. If singly, however, and only partial relief ensue within half an hour, or an hour after the third dose, pro- ceed with the next medicine. Veratrum, should be employed half an hour or an hour after the third dose of Arsenicum, when similar symptoms occur which have not yielded to the previous use of the latter. Veratrum is, moreover, especi- ally appropriate in cases in which the complaint is attributable to atmos- pheric causes. Veratrum and Arsenicum are important when excessive exhaustion accompanies the complaint. Dose : In all respects as directed for Arsenicum. DIARRHOEA ASSOCIATED WITH CONSTITUTIONAL DEBILITY. Sulphur is a most valuable remedy in diarrhoea, particularly occur- ring during the night, in persons of a scrofulous habit, or in very obstinate cases. In adults predisposed to piles, or in children, when the looseness of the bowels is attended with excoriation and with papular eruptions, it is particularly efficacious ; also, in cases where the slightest cold brings on a relapse or an attack ; or when milk disagrees and causes a looseness. 2GS DISEASES OF THE INTESTINES. Dose : Against the prevailing acute symptoms, of a solution of six globules to two tablespoonfuls of water, give a teaspoon ful every six hours, until the frequency of the motions are diminished. Sub- sequently give six globules, in a wineglassful of water, every morn- ing (fasting) the first thing, for ten days, unless collateral symptoms meanwhile occur, requiring other treatment; after which, pause four days, resuming the course, if necessary, as before. Sepia is to be preferred in obstinate cases of diarrhoea, occurring amongst females ; especially, when associated with predisposition to hys- terical attacks, headache, whites, sudden sweats, or flushes of heat and frequent attacks of shivering or shuddering, chiefly during stools. Dose: In every respect as directed for Sulphur, continuing the course in like manner, until permanent amelioration or change. HOME TALK. Acids, or acidulous wines, beer, coffee, strong tea and fruits, whether raw or cooked, should be carefully avoided. Solid food is likewise forbidden, during the prevalence of an acute attack, as tending to keep up the intestinal irritation ; and gruel, fresh milk, (unless it should be known to disagree with the patient,) broths, and light mucilag- inous foocl should be substituted. The majority of vegetables are objectionable, potatoes in particular. In every severe case, indeed, (during the prevalence of the attack) little more than thin arrowroot or gruel should be taken. In milder forms of the complaint, well-boiled rice, moistened with good gravy, may be rather serviceable than otherwise. Beef tea (with or without addition of a teaspoonful of isinglass to the half-pint) may, in some cases, serve materially to assist the operation of the medicines. When the attack is subsiding, and for some time after- wards, young meat (such as veal or lamb) should be avoided ; and sound, tender mutton, plainly roasted, will be found, generally speaking, most easy of digestion. Fish should be avoided. Above all, the patient should guard against indulging a craving appe- tite, and eating too freely, or overloading the stomach. In protracted cases, attended with debility, but no symptoms of inflam- mation or ulceration, generous, easily digestible food, and sometimes a little wine, or wine and water, must not be withheld. In such cases, a basin (half a pint) of beef-tea, with the addition of a teaspoonful of isin- glass, and a few slips of toast taken daily, about three hours after break- fast, will usually prove a useful accessory. The use of a flannel bandage round the stomach, is often of service, especially for delicate children. In every case, the clothing should be warm ; exposure to moisture, and espe- cially to having the feet wet, should be avoided ; fine woolen stockings or socks, and stout shoes, should be worn. Change of air will generally be of service to the convalescent. When diarrhoea prevails as an epidemic, as is not unfrequently the case towards the fall, all these precautions, which may or may not be essential under other circumstances, become indispensable. HOME REMEDIES. Take of Mayapple Root, pounded, one teaspoon- ful, White Oak Bark, pounded, or, if dry, powdered coarsely Ohe tea- spoonful, boiling water a pint; steep near fire for an hour or two, and sweeten with white sugar. Dose: A spoonful after each motion of the bowels. A little burned brandy, added, helps this. This is very valuable. CHOLERA MORBUS. 269 Take five or six clean corncobs, burn them on a clean fire, to a coal ; drop the cob-coals in two pints of boiling water; as soon as cool take a tablespoonful every three or four hour,s. This is specially valuable where there is much bloating, or the evacuations are very offensive, the eructa- tions tasting like what has been eaten. CHOLERA MOBBUS. Cholera Morbus is a disease common in warm seasons, and especi- ally in warm climates. The principal features of the disease are vomiting, purging, and severe griping pains in the abdomen. Symptoms. The attack is occasionally preceded by chills, headache, giddiness, and a numb sensation in the limbs, but more generally the attack is sudden, commencing with nausea and distress at the stomach, succeeded by violent gripings in the bowels; these are followed by fre- quent vomitings of a thin, dirty-yellowish, whitish, greenish, or even colorless fluid, with discharges from the bowels of a similar character to that vomited up, and which occur as frequently as the vomiting. During the intervals between the vomiting and purging there is much nausea and uneasiness at the stomach ; but in some cases a sensation of relief is afforded by the discharges and the patient lies in bed, much fatigued, but apparently free from pain and distress. These attacks of vomiting and purging usually take place every ten or twenty minutes, being either simultaneous, or the vomiting immedi- ately followed by the discharge from the bowels, or else the reverse. Sometimes the pain is so severe as to cause the legs to be drawn up, or even to cry out. Generally, there is great thirst, but as soon as any liquid is swallowed it is ejected; the tongue is dry, the urine high-colored, deficient or sup- pressed, the pulse rapid, soon becoming small and feeble. If the disease is allowed to progress unchecked the pulse sinks, the extremities become cold, the countenance pale and indicative of much suffering, the breathing hurried, cramps in the limbs, hiccough, a cold, clammy sweat breaks out, great prostration, and death. The disease frequently proves fatal in twen- ty-four hours, and, when malignant, even in a few hours; sometimes it subsides spontaneously. Sometimes patients with cholera morbus complain of a great burn- ing sensation internally, and in the more malignant forms of the disease, it is not uncommon for the last discharges to resemble the " rice water " evacuations of Asiatic Cholera. Cholera Morbus may be known from Diarrhoea and Dysentery by the character of the discharges from the bowels, which, in this, are of a purely bilious nature, not mixed with blood or mucus, and with scarcely any fecal matter. Causes. — Cholera Morbus is owing to an irritation of the stomach and bowels and a greater or less derangement of the liver, and is ordinarily caused by improper substances taken into the stomach, as unripe fruit, acids, much fat food, certain kinds of fish, lobsters, unfermented cider, improper use of alcoholic drinks, or any article that will irritate the mucous :270 DISEASES OF THE INTESTINES. membrane of the stomach and bowels, by undergoing an acid fermenta- tion. It is, also, produced by exposure to sudden changes, by sitting in a draught of cool air while in a state of perspiration ; by excessive heat ren- dering the bile more acid, or secreted in unnatural quantities, or by malarial influences. Persons of gross habits, or intemperate in eating and drinking, and those of sedentary habits, are the most subject to it. Prognosis. — When the symptoms gradually improve, vomiting ceas- ing, or becoming less frequent and distressing, with a gentle moisture upon the surface, succeeded by sleep, they are favorable. But frequent and severe vomiting, with great prostration of strength, swelling of the bowels, intermittent pulse, cold, clammy sweats, short, hurried breathing, constant hiccough, spasms of the extremities or convulsions are unfavor- able symptoms. ALLOPATHIC TREATMENT. Sporadic Cholera occurs independently of epidemic influences, and is commonly called Cholera Morbus. If the vomited matters have not contained undigested food, (the presence of which is probably causing the trouble,) a mild emetic should be given, if there is reason to suppose such irritating material still remains in the stomach. For this purpose, a teaspoonful of ground mustard in a glass of water is as appropriate as any other remedy, and has the advantage of being almost always on hand. Other mild emetics may be given. Almost always the contents of the stomach are expelled during the first acts of vomiting, and an emetic is almost always uncalled for, and, in that case will always do harm. The next indication is, to overcome the vomiting and purging. This is best effected by the hypodermic injection of one-eighth to one-fourth of a grain of Morphine, at the hands of your physician. This quickly effects the object. Other forms of Opium may be used by the mouth, if the phy- sician can not be procured. A third of a grain of Morphine, placed dry on the tongue, will generally prove efficient. Thirty drops of Laudanum is also an appropriate dose for the relief of the immediate symptoms. The dose ought to be repeated in an hour, if the vomiting and purging have not ceased. If the remedy is vomited as soon as taken, it should be immedi- ately repeated, in the absence of a physician, if administration of this by the mouth is not tolerated, a teaspoonful of Laudanum in a tablespoonful of thin starch or milk, should be given by injection into the bowels. It should be remembered, that this is a powerful remedy to handle, and if carried too far, there is danger of Opium poisoning. Another important point in the treatment of Cllolera Morbus is, to with- hold liquids as far as possible. The excessive thirst leads to an intense craving for drink. The presence of liquids in the stomach prolong the vomiting. The thirst may be relieved by letting small lumps of ice melt in the mouth, or ice water may be swallowed, but only a tablespoonful at a time. The immediate success of treatment depends largely on the strict compliance with this rule. The common practice is, to meet the prostration which follows the attack with small quantities of brandy or other spirits and water. They do not appear to be usually necessary. The appetite should be both carefully and moderately indulged after an attack. FEVERS.— GENERAL REMARKS. 271 Many other methods of treatment are in vogue, but are not given here, because this one is habitually successful, and the best suited of any for employment by those deprived of the attendance of a physician. In epidemic cholera (Asiatic,) the use of Opium is well suited for use during the preliminary diarrhoea, but is decidedly inappropriate when col- lapse has occurred. After this stage has passed, the best results have been produced by the use of Chloroform and Camphor, internally. During the cold stage, the hypodermic injection of Hydrate of Chloral is the best treatment discovered so far. HOMCEOPATHIC TREATMENT. Ipecacuanha corresponds to the less violent attacks, as long as the discharges have a bilious tinge, and the vomiting and retching are very severe. Dose: Six pills of the second or third decimal dilution, every fifteen to thirty minutes. Veratruni- Alburn is particularly adapted to a case where the evac- uations are colorless; these cases are always the most difficult to manage. This characteristic of the evacuations may be expected with tolerable cer- tainty, if the disease sets in at once, with violent, copious and frequent vomiting, and the accompanying diarrhoea is equally violent. Dose: As for Ipecacuanha. FEVERS.— GENERAL REMARKS. In all forms of acute disease, fever is present ; in fever, properly so- called, there is generally functional disturbance, accelerated action of the blood circulation with the participation of the nervous system, and a marked tendency to an increased development of heat. The symptoms common to most fevers are, at first, a feeling of coldness or shivering, then heat, accelerated pulse, thirst, restlessness, and languor. Fever, also, possesses the property of passing from one species (variety) into another. Thus inflammatory fever may pass into a low typhus, or, on the other hand, a simple fever, by injudicious treatment, may be changed into an inflammatory one; and that, again, assume the intermittent form; also, one attack may, if miserably mistreated, present all these different phases. Fevers terminating fortunately, and running a regular course, may be divided into five stages ; the accession, (or first appearance,) increase, crisis, decrease, and convalescence. When the result is fatal, it may arise from a metastasis, (changing from one part to another more vital part,) the exhaustion of the vital energy of the patient, or the disorganization of some important part of the body. The belief in critical days is of very ancient origin, though there is some difference in the calculation of physicians upon this point. Some counting from the day the shiverings declare the onset, others from the first hot fit ; except in cases where a marked periodicity exists, as in ague, such distinctions are of little value, because the treatment is directed to forwarding the crisis, and thereby materially shortens the duration of the disease, and changing its virulence, so the value of the counting for the critical day, is very materially lessened. The best course is to watch the 272 DISEASES OF THE INTESTINES. ease closely, take careful note of the symptoms, and select, with great care, the remedy pointed as the best to meet successfully that condition. By so doing, you will be most certain to have the pleasure of seeing your patient come safely through the attack, and arrive speedily at a state of perfect health. A Crisis may make itself known by diarrhoea, profuse perspiration hemorrhage, or increase or alteration of other secretions, or by the appear- ance of an eruption, after which, if the turn is favorable, the skin becomes moist and resumes its functions, and the pulse returns to its usual stan- dard. Fevers have been differently classified by different medical writers. The arrangement we shall adopt is as follows : simple irritative fever, inflammatory fever, typhus, putrid, gastric or bilious, intermittent, and eruptive fevers, such as scarlet fever, measles, etc. Although I have, for convenience in describing fevers and their remedies, so named them, I do hope no one will commit the error of treating the disease only by its name. Study carefully every case, and treat it according to its own indi- vidual peculiarities, as shown by its symptoms. Causes of Fever. It cannot be denied that there exists, in certain individuals, a peculiar predisposition t© acute diseases. The sanguine, nervous, and bilious temperaments (see "Temperaments,") possess this susceptibility in a more marked degree than the phlegmatic. The exciting causes are numerous ; miasms, epidemic influences, contagion, powerful mental emotion, derangement of some important organ, exter- nal lesions, excess or errors in diet, heat or cold, eruptions which have gone in— in fact, anything that causes derangement of the equilibrium of the system, may produce fever. FEVER.— GENERAL TREATMENT AND DIET. The great essentials in the treatment of fever, are : Perfect rest — mental and bodily. Pure air and a cool apartment; the temperature of the sick room should be kept as near sixty degrees as possible. Feather beds should be avoided, and matresses substituted when prac- ticable ; let the bedclothes be light but sufficient. Nature herself, generally, prescribes the diet, taking away the appetite, while the thirst present is undoubtedly her loud and well considered call for water or fluid of some kind. Water is the best diluent ; no solid food, broth or even gruel is permissible, where the inflammation runs very high, and very great caution is to be observed in allowing gruel and weak broths during the decrease of the fever. An error here, often causes mis- chief which cannot be repaired ; it is always better to err a little on the side of abstinence, than on that of indulgence. Toast water, or barley water, or rice water, sweetened with a little sugar, and flavored with raspberry, strawberry, orange, or, above all. lemon, may be allowed frequently, and only a little at a time. Avoid, until recovery is complete, any article of diet which might, in the least degree, over-tax the weakened digestive organs. Fruits fully ripe in almost any form are not at all likely to do any injury. BILIOUS FEVER. 27.'} GASTRIC OR BILIOUS FEVER. This is a form of fever in which, as its name implies, the digestive organs are chiefly affected. It somewhat resembles typhus, but it is dis- tinguished from the latter by the absence of nervous symptoms— although when it assumes a torpid character, these are occasionally developed — by the absence of the pressive aching pains in the back of the head ; and by the absence of disturbance or derangement in the senses of sight and hearing ; further, that the pain in. the right side of the belly, which is so constant a symptom in typhus, is not a feature of this disease. Fevers of this description have no definite course or duration. They not unfrequently fall short of the particular course to which the defini- tion is especially appropriate, as in such cases as result merely from indi- gestible substances, without actual increase in the discharge of (acrid) bile. In such cases, the successful effort of nature to expel the obnoxious substance (as by vomiting or purging, or both) is often sufficient to consti- tute a perfect resolution, and convalescence succeeds. In other cases nature is thus but partly relieved, the whole circulative system having become essentially involved, and the fever continues until some other crisis (as of sweat or urine) succeeds. Thus, gastric fever, if associated with mere foulness of the stomach, may run its course to perfect resolu- tion in a few days; or, if the lining membranes of the stomach or bowels be seriously affected, or the action of the liver be much deranged, and there be bilious fever, properly so-called, the fever may continue for weeks (if not properly or successfully treated,) or may assume a highly inflammatory character, or degenerate into nervous or even putrid or into chronic or hectic fever. On the other hand, again, it may result in transitions of various characters — the superficial membranes, either of the throat or external surface (the skin) may become affected, and eruptions of various kinds, abscesses, boils, etc., may ensue. Complications, and their treatment . In the case of any such compli- cations occurring, the treatment must be conducted according to the spe- cial directions afforded in the separate article, respectively, devoted to the complicating disease. Predisposing causes. The predisposing causes may be identified in continued exposure to great heat— whereby, the rapid sympathy existing between the skin and the liver and stomach, has conveyed, to those organs, an undue degree of irritability ; exposure to excessive moisture of the atmosphere, particularly, extreme accumulation of condensed vapors (heavy dews) over a reeking, heated soil, which continues to emit exhalations; exposure to great (especially sudden) transitions of temper- ature, particularly from great heat to comparative coldness, or to the alternation of heat and cold; whence, it follows, that, under such circum- stances, this disease may assume an endemic or epidemic character. The more particular and predisposing causes are: weakness of the stomach, that is, a morbid sensibility of the lining membrane, and overdue irrita- bility of the liver; habitual debauchery or excesses, sedentary habits, or anything, in fact, which may occasion derangement of the stomach, as considered in the article on " Indigestion.'' Exciting causes. The presence of obnoxious, indigestible, or irrita- ting matters in the stomach or bowels— which cannot be dislodged by the 18 274 DISEASES OF THE INTESTINES. ordinary action of those organs — either in the shape of excessive reception of food, whether or not in itself of an indigestible character, or simply the reception of indigestible substances in however small a quantity, or in the shape of altered or excessive internal secretions, such as bile. Other exciting causes are, taking cold, emotions, such as anger, grief, care, anxi- ety, etc , acute diseases; or, in fact, any cause of general irritation when acting upon persons already predisposed to this complaint, by such con- ditions as have been mentioned above. Symptoms— of which the following are the principal: sensation of fullness and weight in the region of the stomach, or flatulent distention, with inclination to vomit ; offensive, flatulent eructations, and, some- times, vomiting of food and tenacious phlegm mixed with bile; thickly furred, dirty-yellow tongue; belly soft; bowels costive; but in the advanced stage of the disease, the evacuations are often very offensive, and contain portions of undigested food ; frontal headache ; languor ; sickly and distressed expression of countenance, with yellow discolora- tion of the white of the eyes ; more or less chilliness, succeeded by heat and dryness of skin ; pulse quick but soft, sometimes intermitting or irreg- ular, particularly the latter; urine thick, cloudy, and dark colored. When bilious symptoms are markedly predominant, all the symp- toms commonly appear in an aggravated form ; the heat of the skin is very considerable, and the restlessness and thirst are excessive (the patient expressing a constant desire for acid drinks.) The region of the stomach is much distended with flatulency, but in addition to this symp- tom, the following are more or less marked ; the tongue is covered, at first, with a pale yellow fur, which gradually assumes a deeper or brownish color ; the taste and eructations are bitter, and the substance vomited con- sists of a greenish, bilious matter; the bowels are either confined or relaxed, the motions presenting, in the latter case, a yellow, green, or brown color ; the face exhibits an earthly, somewhat jaundiced aspect; sometimes there is, also, a greater or less degree of sensibility, hardness, tension and burning in the region of the liver ; the urine is dark-brown, bilious; the pulse full, accelerated, intermitting or double. ALLOPATHIC TREATMENT. Remittent fever (commonly called "bilious fever".) It is to be borne in mind that the exacerbations of fever, in this disease, are much longer than in intermittent fever or ague, and that the period of remission (diminishing) of the fever is of much shorter duration. It is not as convenient to get the physiological effect of anti-periodic remedies during the remission (while the fever is down,) as is the case in intermittent fevers. The one remedy which, par excellens, is a specific in this fever, is the Sulphate of Quinine, though the other preparations of Peruvian Bark hold a valuable place. As soon as it is discovered that the disease is remittent fever, b3~ the occurrence of a distinct diminution of the heat (the degree of fever,) the patient should at once be given Quinine until its specific effect is pro- duced, viz.: a slight deafness, a slight ringing in the ears, or roaring in the head. This is best produced by giving large doses, not very fre- quently repeated. Ten grains of the Sulphate of Quinine, in solution, repeated every six hours, until the characteristic effects of the Quinine BILIOUS FEVER. 275 are produced, is a good practice in this disease or in ague. If this dose is not sufficient to produce the effect or prevent the paroxysms of fever, the dose may be increased to fifteen or even twenty grains. An eminent authority advises the administration of twenty or thirty grains, at a single dose, once or twice a day, until the effects are produced. Other physicians give the remedy in doses of from three to six grains every two or three hours, which is by far the best practice. It requires about five hours after its administration for the maximum effect of Quinine to be reached, so that it seems to me unnecessary to repeat the dose any oftener than that. For the solution of Quinine, the following is a suitable formula: Take of Sulphate of Quinine four scruples {eighty grains), water five ounces, Aromatic Sulphuric Acid a dram and a half. Mix. A fair-sized table- spoonful will contain ten graiiis. The excessive bitter taste of the solution is very much obscured by chewing some Chocolate or Extract of Licorice, and taking the medicine while the mouth is still coated with the Chocolate or Licorice. The remedy may be taken in powder, easily, by enveloping it in a moistened medicine wafer, or enclosing it in jujuba-paste capsules. Quinine can be made into pills, for immediate use, by moistening the powder with Glycerole of Starch, or Aromatic Acid, rolling out the mass and dividing into pills. If the acid is used, the operator must be expedi- tious, as the mass soon hardens. Sugar, or Gelatine-coated pills of Quinine, may be used, and are an elegant form for the administration of Quinine, but slower in its action. They are liable to become hard with age, and so unfit for use. Before buy- ing these ready-made pills, one of them should be cut open; if the pill under the coating is hard, they are unfit for use ; if soft, they are good. This treatment is both curative and abortive. There is no complica- tion that can occur in this disease which will prevent the giving of Quinine. If the stomach can not be made to retain the remedy, it should be given by injection in the bowel. Once in twenty-four hours, is often enough to repeat the injection. The dose for this purpose is generally thirty to sixty grains. It may be mixed with Glycerine, Milk, or thin Starch. Thirty drops of Laudanum should be added to the mixture for the injection. If there is a disposition to expel the injection, firm pressure should be made on the anus (opening of the bowel) with a towel or napkin under the hand. A four or eight ounce hard-rubber syringe is preferable for the purpose of making the injection. Time need not be lost before the administration of Quinine for the action of cathartics, or any other preparatory treatment. Constipation should be relieved by the laxative effect of an Aloetic Pill, or one or two Compound Cathartic Pills, or by an injection of tepid water. This plan of treatment will, in a large proportion of cases, succeed in arresting the disease, but if the disease should continue, the treatment thereafter is essentially the same as in other continued fevers, which is more especially given in connection with typhoid fever. The anti-periodic remedies should be continued, but in more moderate doses. Five grains of Quinine two or three times a day, will, probably suffice, but if the fever should run high, the dose should be increased sufficiently to moderate the fever. 276 DISEASES OF THE INTESTINES. When the fever continues high, after the full effects of Quinine are produced, Fowler's Solution (Solution of the Arsenite of Potash,) may be given in doses of one drop, three or four times a day. It may be given in water, and is useful if the delirium lessens, the skin becomes moist, and the tongue clean. When this disease is associated with Typhoid Fever (known as Typho-Malarial Fever,) Fowler's Solution seems particularly serviceable. Headache and delirium are due to the intensity of the fever, and much good may be done by applying cold to the head, by frequent bathing with cold water, or if the heat of the head is very intense, with a sack or bladder of pounded ice. Immediate relief from the intensity of the fever may be derived by sponging the surface of the whole body, with tepid or cold water, according as the fever is moderate or high. The degree of cold should be governed by its agreeableness to the patient. The spongings may be repeated as often as the patient desires. If the fever rises as high as one hundred and four degrees F , or higher, as shown by a fever thermometer in the armpit, the application of the cold wet sheet (cold wet pack,) will prove servicea- ble- For its application a sheet or linen is wrung out of cold water, and laid smoothly on a hard mattress ; the patient then lies, or. is placed upon it, with his head upon a pillow. The sheet is then drawn over the body, one side at a time, and tucked under the opposite side. Some blankets or comforters are then closely applied over the body. The patient may be placed in the wet pack several times a day, and allowed to remain in it from five or ten minutes to an hour, according to the state of the tempera- ture. The effect of cold water is only temporary, and the treatment with Quinine, or other preparations of bark, must not be delayed or neglected. Water should not be applied to the body, if the patient is sweating. If any remedies, besides Quinine and cold, are needed to reduce the fever, the Tincture of Aconite is best suited. Half a drop to a drop may be given from half an hour to an hour apart, until an impression is made on the fever movement, after which it may be given one or two hours apart, until the fever is reduced. Then its regular administration is to be discontinued, to be resumed again as before, when the fever rises. Nausea, (sickness at the stomach) and vomiting may sometimes be relieved by laying a cloth, previously dipped in ice water, and folded over the stomach or by a mustard plaster. Doses of one drop of Creosote, or Carbolic Acid in water, frequently give relief. Bismuth and Oxalate of Cerium are generally successful. Take of Subnitrate of Bismuth a dram, Oxalate of Cerium half a dram. Mix, and divide into six yagers. Dose : One every hour or two. The powder can be taken dry on the tongue, and swallowed with a little water. Milk, with one-third part of lime water, can generally be taken by the stomach with benefit. Should the patient need nourishment and the stomach not tolerate food, nutritious injections should be given. Strong beef tea made with one pound of finely chopped lean Beef, to a pint of cold water, by heat (the temperature should be raised to 160°.) The temperature should be maintained at that for four hours, water being added from time to time to keep the quantity at one pint. One-fourth of this can be given by injection, or one-eighth by the mouth. Milk may also be BILIOUS FEVER. 277 .give by injection. To the beef tea fifteen drops of dilute Hydrochloric Acid, and two teaspoonfuls of Glycerole of Pepsin, or two-thirds of a tea- spoonful of powder of Pepsin should be added. If milk is used the acid should be omitted. Twenty or thirty drops of Laudanum should be added to the injection, if the' rectum is irritable, and the injection retained by firm pressure with the hand over a towel. Vigilance and restlessness will call for anodynes. For this purpose Tincture of Hyoscyamus in doses of one or two teaspoonfuls may suffice. If not, ten to twenty drops of Lau- danum may be added. A pill of one grain of Extract of Hyoscyamus and half a grain of Opium may be used. Protracted cases require the same treatment, with more attention given to feeding the patient. Fifteen drops of Dilute Hydrochloric Acid, in sweetened water, three or four times a day. It assists the digestion and relieves the dryness of the mouth and throat. During convalescence, tonic doses of Quinine, or Bark and Iron, should be taken. A dessertspoonful of the Elixir of Bark and Iron, is useful. Probably the Citrate of Iron and Quinine, or the Citrate of Iron and Cinchonidia in doses of two to five grains dissolved in Orange Flower Water, taken three times a day, answers the purpose the best. A tea (infusion) of Dogwood, Colombo, Gentian, Quassia, Boneset, and Wild Cherry, and Poplar, is useful, taken before meals. Two ounces of the dried drugs will make a pint of infusion (tea;) the dose is one or two tablespoonfuls. The Tincture of Iron, in doses of fifteen drops in sweetened water, may then be taken after meals. Should intermittent fever (ague) follow bilious fever, it should be treated as is directed for that disease. In Typho-Malarial fever the disease should be treated in the first place, as is directed in this article for remittent fever, aside from this the treat- ment will be as is directed for Typhoid fever. HOMCEOPATHIC TREATMENT. In simple cases, associated with uncomplicated derangement of the stomach, or simple foulness, especially, if the affection be casual, and can be traced directly to excess in eating or drinking, or to some particular indigestible substance, if all strikingly bilious symptoms be absent, such as those above enumerated, and if there be no bitterness of taste, or bitter eructations, the treatment should be regulated by the directions afforded in the article on " Indigestion." In the severer cases, characterized by predominant bilious symptoms, or if the disease assumes an inflammatory character, the ensuing indica- tions may advantageously be consulted. Aconitum is indicated, more especially, when everything received in the mouth, in the shape of food or drink, except water, has a bitter taste, or when there is continually a bitter taste in the mouth, the pulse being quick and frequent; when the tongue is covered with a yellow coating; when bitter eructations or violent urging to vomit, and retching occur, without discharge, or when there is vomiting of greenish, bitter, or slimy matters; also, by excessive nausea; suspended evacuations, or frequent, scanty, small motions, attended with much urging; swelling and tight- ness across the stomach, sensation of heaviness and fullness in the fore- head and temples ; and if fresh air appears to afford some relief. Do.se; Of a solution of ten globules to two tablespoonfuls of water, give a teaspoonful every two hours, until amelioration or change. 278 DISEASES OF THE INTESTINES. Belladonna is indicated when there is violent throbbing of the arter- ies of the temples, reeling giddiness, and intense and unbearable headache, chiefly seated in the forehead, as if the contents of the head would fall out at the forehead ; dryness of the mouth, and thirst; sometimes inces- sant nausea; tongue covered with a thick, whitish or yellowish coating; sour taste; repugnance to all kinds of food, and even to drink ; vomiting of food, or vomiting of sour, slimy or bitter matters ; suspension of evac- uations, or looseness of the bowels, with slimy evacuations; quick and full pulse; especially if the head symptoms be aggravated by moving the eyes, or by movement generally, or by shaking, or even by touch, and by the access of fresh air, or a draught, and if they be somewhat relieved when the head is supported or held backwards. Dose : In every respect as directed for Aconitum. Niwc-vomica is indicated in bilious fever by the following symptoms amongst others: absence of thirst, or ardent thirst attended with heart- burn ; constant nausea; bitter eructations; foul, or bitter taste in the mouth, the tongue dry and white, or covered with yellow coating towards the root ; painful sensation of weight and tightness across the stomach, constipation, with repeated urging to evacuate, without discharge, or looseness of the bowels, with scanty, insufficient, watery or slimy evacua- tion ; spasm of the stomach ; great inclination to vomit, sometimes even with empty retching, or vomiting of food ; full and frequent, or quick and intermittent pulse ; great prostration of strength in the first stage, and characterized by shivering, occurring with partial heat, or by heat following ; headache with heat of the head; dullness or confusion of the head, with reeling giddiness; buzzing, singing, or tingling in the ears; sallow appearance of the complexion, sensation of exhaustion and weari- ness; sometimes yellowish hue of the white of the eye, particularly of the lower part of the eyeball ; great sensibility of light, especially in the morning. Dose: Six pills dry, on the tongue, or in a teaspoonful of water, every two hours, until four doses have been given, and afterwards, if necessary, every six hours. Chamomilla is of eminent service after Nux-vomica, in very severe, cases, in which the last named remedy has failed to arrest the symptoms when the tongue is red and fissured, or when the tongue exibits yellow coating; or when further indicated by intense heat and redness of the face, (particularly at night,) restless and interrupted sleep, bruised pain in the head, with pressure, fullness, and heaviness; inflammatory redness and burning sensation in the eyes, bitter taste in the mouth ; every kind of food conveys a bitter taste; loss of appetite, nausea, or eructations ; vomiting of greenish, sour, or bitter matters; intense anxiety, and oppression of the chest; looseness of the bowels, with sour-smelling evacuations, having the appearence of stirred eggs; or greenish evacuations, or, on the other hand, constipation, with suspended evacuations. Dose: As directed for Nux-vomica. Bryonia is particularly appropriate to the treatment of this disease in the hot season. The indications which identifj" it are as follows: — in- sipid, foul, or bitter taste, particularly on waking ; continued thirst, tongue exhibiting a number of blisters, and covered with a white or yellow coat- BILIOUS FEVER. 279 ing; desire for acids and stimulants, such as coffee, wine, etc., but repug- nance to solid or wholesome food; vomiting of bilious matters, particu- larly after drinking, or sometimes frequent, but ineffectual retching; oppressive headache; constipation of hard difficult stools, as if burnt. Dose : As for Nux-vomica. Pulsatilla is, also, a most important remedy in this, as in every other disease in which the digestive organs are particularly implicated — the tongue being covered with whitish coating; after swallowing food or drink, there is bitter, foul taste in the mouth ; all food conveys a bitter taste, especially bread; regurgitation of food; extreme nausea, or inclination to vomit, in the evening; excessive accumulation of phlegm in the stomach and gullet; vomiting of food or of phlegm, or of bitter or sour matters, more severe at night; acidity of the stomach ; flatulent dis- tention of the belly, with rumbling of wind in the bowels ; looseness of the bowels, with discharge of bilious or slimy matters in the evacuations, — or sluggish evacuations, and insufficient activity of the bowels; split- ting headache, with tightness and compression of the forehead ; slowness and fullness of the pulse (in general ;) fits of shuddering and coldness in the evening, or towards evening. Dose : In every respect as stated for Nux-vomica. Mercurius may frequently be employed with great advantage after Belladonna, when indicated by the following symptoms and conditions: Dryness, and burning heat of the lips ; drowsiness in the day time, but sleeplessness at night ; severe and painful sensitiveness of the belly and of the region of the stomach, to touch or to pressure, these symptoms being aggravated, or developed at night, the tongue covered with white or yellowish coating — or moist ; foul, or even offensive and loathsome, or bitter taste in the mouth ; nausea or inclination to vomit, or, at other times, actual vomiting of mingled phlegm and bilious matters ; the fever- symptoms are characterized by general coldness, shivering and shudder- ing all over the body, irregular, or quick and intermittent pulse ; heat of the head and face, with flushing, when all other parts of the body are affected with coldness, shivering, etc.; giddiness when the head is raised; intense headache, with desire to press the head between the hands; intense dejection, and listlessness. Dose: Of a solution of six globules, to two tablespoon fuls of water, give a teaspoonful every four hours until improvement or change. Ipecacuanha is indicated by inclination to vomit, with utter repug- nance to food; dryn ess of the mouth ; the tongue either clean, or covered with a thick, yellowish coating; violent retching, without discharge, and attended with great straining, or, easy, copious vomiting of slimy matters or of food, with a violent gush; looseness of the bowels, with discharge of yellowish and very offensive, or even putrid evacuations ; and accompa- nied with severe colicky pains; weight, and sensation of fullness, with very severe pains in the region of the stomach ; pale, yellowish hue of the skin; severe headache. Dose: Of a solution of ten pills to two tablespoonfuls of water, give (if violent vomiting occur,) one teaspoonful every hour, until the symptoms yield. China is applicable to such cases as evince the following symptoms: Frequent eructions; vomiting or regurgitation of food; loss of appetite. -SO DISEASES OF THE INTESTINES. and a sensation of thorough repugnance to all food, or as if one had eaten enough, or more than enough ; frequent emission of very offensive wind from the bowels; evacuations containing indigested food ; painful sensa- tion of tightness in the belly, and of weight in the region of the navel ; sensations of chilliness and shuddering after drinking; looseness of the bowels, with watery, slimy or yellowish evacuation ; heat, with full and quick pulse; headache (sometimes delirium,) burning sensation in the Zips, red face, and dry mouth. Dose: Of a solution of ten pills, to two iablespoonfuls of water, give a teaspoonful every two hours, until amelioration or change. Arsenicum is an invaluable remedy in the majority of very severe and urgent cases, either when one or more of the preceding have failed to arrest the symptoms, or when the disease has run on to an advanced stage before treatment has been resorted to. The chief indications for it are dryness of the tongue, accompanied with severe thirst, and with continual inclination to drink, with, however, inability to drink more than a small quantity at a time ; bitter, or very acrid, pungent eructa- tions ; saltish or bitter taste in the mouth ; nausea, vomiting of food or of greenish, brownish, or bilious matters ; extreme tenderness of the region of the stomach to contact; burning and cutting, cramp-like, or spas- modic pains in the stomach and bowels, accompanied with chil- liness and anguish— or very painful sensation of weight and burn- ing at one bpot in the stomach ; suspension of evacuations, excessive and continued relaxation of the bowels, attended with severe urging, and with brownish, yellowish, or greenish evacuations; scalding sensation in passing water; the evacuations (or vomiting,) are provoked by, or occur after every movement, or after drinking ; general heat of the body, usu- ally occurring at night, and accompanied with restlessness, anxiety, etc.; irregular, frequent, and quick pulse ; extreme prostration of strength, and desire to assume, or to retain a recumbent posture. Dose : As for Nux-vomica. ENTERITIS— INFLAMMATION OF THE BOWELS. The causes of enteritis are mostly the same as those of indigestion, dietetic transgressions ; the use of irritating, readily decomposed, sour substances; overloading the stomach ; abuse of spirits; a cold. In addi- tion, we have poisonous substances ; mechanical irritation by fecal matter, the progression of which, in the bowels, is arrested, in consequence of which, the vessels become compressed, or. finally, though rarely, the in- flammation may be caused by worms. Besides these causes, enteritis occurs as a continuation of other inflammatory processes, gastritis, peri- tonitis, and as a form of reaction against ulcerations of the intestinal mucous membrane. Symptoms.— If at first the inflammation is not spread over a large surface, and confined to the lining membrane, the symptoms are not very grave. There are few local pains, little fever, loss of appetite, constipa- tion, feeling of fullness in the umbilical region ; nausea occurs very sel- dom; there is never any vomiting. In this manner, the affection may exist a short time and disappear again almost imperceptibly, or it may INFLAMMATION OF THE BOWELS. 281 increase and continue to spread ; very rarely the disorder breaks out at once in all its violence. The pains now become intense, burning or tearing, or cutting like colic, until they sometimes grow intolerable; they spread over the whole abdomen ; are generally most violent in the umbilical region, where the least pressure causes an intense aggravation of the pain, which is increased, even by the act of breathing ; coughing causes extreme pain, which is likewise intensely aggravated every time the patient attempts to turn the upper part of his body, on which account he remains lying motionless on his back. At all times the pain has more or less prolonged aggravations like colic, evidently caused by the pro- gressive descension of the contents of the bowels. At the same time the abdomen is distended, but not to excess. Where the small intestine is alone affected, there is obstinate constipation ; where the large intestine is involved in the inflammation, we have sometimes, not always, diarrhoea, colored, frequently bloody stools, or alternate constipation and diarrhoea, or, finally obstinate constipation. In such cases, the colicky pains are more frequent and extensive, the distention of the abdomen more consid- erable. In violent attacks of this disease the constitutional symptoms are always very marked. A general chill only precedes a very sudden invasion of the disease. The patient feels the heat more preceptibly than others ; he is constantly complaining of an intolerable thirst ; the pulse is accelerated, even to one hundred and twenty beats, small and contracted, not often unequal and intermittent; the skin of the body is hot and dry; the extremities are frequently cool; the forehead is covered with a perspiration, as if from anguish; the appetite is entirely gone; the tongue has at times a light coating, at times it is clean and very soon becomes dry. If the affection increases in violence, the first symptom generally is nausea, which soon becomes associated with retching and vomiting. At first, bile and mucus are vomited up with the food ; but if the inflam- mation is extensive, even fecal matter may be thrown up; the vomited matter very soon acquires a smell like that of feces. The signs of col- lapse now become more apparent ; the face has a cadaverous appearance, expressive of deep suffering, with elongated features and sunken eyes. Under such circumstances, the patient often wanders, the skin becomes cool, and is covered with a cool perspiration. Convulsions and fainting fits occasionally complicate these symptoms, and death may ensue under such circumstances. A rapid and complete recovery only takes place exceptionally. The prognosis is always uncertain, because the disease is apt to pass into insiduous chronic complaints, even after the recovery seemed to be fairly under way; at all events, enteritis always constitutes one of the more important diseases. The diagnosis of enteritis, although somewhat difficult, yet, with proper care, can be made, in the majority of cases, with positive certainty. The disorder is most easily confounded with incarcerations, simple choler- ine, colic. The last two can become dangerous, if the trouble is esteemed too highly. Since it is not always possible to make a sure diagnosis until the disease has run along for a time, the employment of irritating remedies cannot be sufficiently guarded against in cases of colic and cholerine. ALLOPATHIC TREATMENT. Enteritis. The discrimination of acute enteritis (inflammation of the small intestines,] will be very unsat- 2S2 DISEASES OF THE INTESTINES. isfactory, if made by unprofessional hands. If the diagnosis is made out $ the treatment will be, essentially, as follows : The patient should remain in bed. Hot fomentations should be per- sistently applied to the abdomen, and some form of Opium given to the extent of relieving the pain and checking the diarrhoea. Opium, in doses of a grain, should be given two to four hours, or longer, apart; but suffi- ciently often to procure relief from pain. Hyoscyamus or Belladonna may be advantageously given with the Opium, rendering the action of the Opium more pleasant. The dose of the Extract of Hyoscyamus is one grain ; of the Tincture, one or two teaspoonfuls. The dose of Extract of Bella- donna is a quarter of a grain, and a dose of the Tincture is ten drops. Laudanum, in doses of twenty drops; or Morphine, in doses of a quar- ter of a grain, may be used instead of Opium. It is as well to administer the Opium by injection into the rectum. For this purpose, a teaspoonful of Laudanum should be used, mixed with one or two tablespoonf uls of thin starch or milk. An eight-ounce hard- rubber syringe is a suitable instrument for this purpose. After drawing the mixture into the syringe, the nozzle should be elevated, and the air can be expelled by slowly pressing the piston. After the injection, firm pressure on the anus (opening of the bowel) with a towel under the hand, for a time, will enable the patient to retain the injection. Both these methods of giving the medicine may be alternated. It is not best to give cathartics, unless there is good reason to believe irritating substances are contained within the intestinal canal, and then it is better to resort to injections of warm water, if the bowels require moving. The diet should be of a character which will not require intestinal digestion, nor cause irritation by their presence in the intestine. Beef- tea, beef-juice, raw eggs, and milk, answer this purpose as well as any- thing of which we have command. Rice and barley-water, or arrow-root, boiled in water, may be drank. It is common to recommend Cod Liver Oil and Iron. They are well suited to these cases. I believe tablespoon ful doses of pure Glycerine, having dissolved in it three to five grains of the Citrate of Iron, or the Citrate of Iron and Quinine, answer the purpose better. The patient will require systematic feeding, if the disease be pro- longed, to support the powers of life, as in fevers. Full directions for this will be given on the subject of typhoid fever. During convalescence, the usual diet should be returned to very cau- tiously. When the disease affects children, it is necessary to be very cautious in the use of Opium. The Camphorated Tincture of Opium should be used, with an equal quantity of Tincture of Hyoscyamus. The usual dose of each being fifteen or twenty drops for a child one year old. For a child of five years, three grains of Dover's Powder, equal to one-third of a grain of Opium, may be used. If the stools become charged with mucus, a teaspoonful or two of Castor Oil, with an equal quantity of Glycerine, flavored with one or two drops of Oil of Cinnamon, may be given. Rochelle Salts is, also, an INFLAMMATION OF THE BOWELS. 283 appropriate laxative, in doses of half a teaspoonful (in lemon syrup). Laxatives should, however, be given* with caution. The diarrhoea, which follows often upon the subsidence of the inflam- mation, may be checked by appropriate doses of Paregoric, Dover's Pow- der, or Opium, with ten grain doses of Sub-Nitrate of Bismuth, or Tinct- ure of Catechu, or Kino, in equal quantity with the Paregoric, in Chalk Mixture. Local, and other general treatment, will be the same as for adults. HOMCEOPATHIC TREATMENT. Aconite in the early stages, when the inflammation is just beginning, will cut the disease short. Dry, hot skin ; full, frequent pulse ; mouth and tongue dry, with intense thirst. Abdomen swollen and tender to the touch ; cutting, burning and tearing pains in the region of the navel. Great fear and anxiety of mind with nervous excitability ; bright-red and hot urine, are the leading symptoms calling for this remedy. Dose: Eight pills every one to three hours, dissolved in a little water, or dry on the tongue. Mercwrius. Abdomen swollen hard, and painful to contact. Cut- ting, stabbing pains in the bowels, accompanied with chilliness and shud- dering ; green or bloody mucous stools, with violent griping; profuse perspiration affording no relief; pale, wretched complexion ; foul smell from the mouth; vomiting of bitter mucus; restless sleep. Dose: A one-grain powder or six pills every two to four hours. Belladonna. Great heat and tenderness of the abdomen. Violent contraction or clutching pains in the bowels. Pains which appear sud- denly and disappear just as suddenly after continuing for a longer or shorter period. Congestion of blood to the head, with throbbing of the arteries of the neck (carotids.) Face flushed, eyes red and sparkling. Great intolerance to noise and light. Starting and jumping during sleep. Sleepiness, but cannot sleep. Partial or general spasms. Almost constant groaning or moaning. Dose : As for Aconite. Arsenicum, Even if the previous treatment fails, there is still hope that this remedy will succeed, if the following symptoms are present : — Very rapid and weak pulse. Sudden failure or sinking of strength. Cold, clammy sweat, and great restlessness. Intense thirst, drinking often but little at a time. Burning in the abdomen, worse after eating or drinking, usually followed by vomiting. Symptoms all worse after midnight. Dose : As for Mereurius. Arsenicum always gives the best satisfac- tion in potencies as high as thirty or upward. Bryonia and Cantharis are, also, good sometimes. See " Repertory." Make hot applications to the abdomen. Bathe with tepid or cold water. Drink Elm Bark Water, etc. CATARRHAL DYSENTERIA.—FLUX. Symptoms. The disease sets in without any definite precursory symp- toms, or suddenly with violent pinching, cutting pains, radiating from the umbilical region downwards, and which are speedily succeeded by a violent urging to stool, with discharge of fecal, soft or watery masses. -84 DISEASES OF THE INTESTINES After the evacuation, the pains abate for a shorter or longer period, after which they return with renewed violence, and more particularly with increased urging, attended with tenesmus, (pain and difficulty with frequent desire) and severe pressing pain, during which a small quantity of white, and subsequently blood-stained, mucus is discharged, without any admixture of fecal matter in most cases. At the same time, the patients experience an acute burning pain in the anus, and with every new dis- charge the tenesmus increases. In slighter cases the disease sometimes runs its course without any fever; the more acute cases may be attended with violent fever ; the stomach is at times involved in the affection, at times not at all ; there is loss of appetite, retching, nausea, vomiting; the tongue is usually quite clean. The duration of the disease usually depends upon its extent, which is pretty accurately measured by the extent of the pain. The slighter cases sometimes do not. last more than a day, the severe cases last weeks, and then are disposed to pass into the chronic form. In the case of children the non-admixture of fecal matter in the stools is an exception to the rule; blood, pus, and scrapings of intestinal membrane, shreds of mucous membrane, and false membrane, are met with the more frequently, of mixed green color. The dysentery of chil- dren assumes more easity a chronic form than in the case of adults, and almost always leaves a peculiar disposition to relapses. The so-called teething dysentery is just such a catarrhal affection, and arises less fre- quently in consequence of the process of dentition, than of other influ- ences acting upon the little patient, especially, an erroneous system of preparing and administering nourishment. In the case of children, even if there is no sign of fever, convulsive symptoms are apt to follow, imparting a higher degree of importance to the otherwise not very impor- tant disease. A fatal termination of catarrhal dysentery, in a person of an other- wise good constitution, is a rare occurrence. Even where the disease sets in as a complication of other diseases, the danger incident to its course is only of moderate importance. The treatment will be shown when we come to speak of dysentery proper. DYSENTERIA EPIDEMIC A, DYSEXTEBY PROPER, FLUX. However trifling catarrhal dysentery may seem, dysentery proper is an important and dangerous disease. History. Dysentery usually breaks out in an epidemic form; the few cases of sporadic dysentery that call for treatment, are either not dysentery, properly speaking, or else they are very rare occurrences. Dysentery is, more particularly, a disease of young persons and those of middle age, and very seldom attacks either the very young or very old. Epidemic dysentery almost always breaks out late in the summer, or in the beginning of fall, in very hot and dry seasons; it rarely lasts until winter is somewhat advanced; it seems to occur more frequently among the lower than the higher classes ; its spread is promoted by living in crowded rooms; nothing shows this clearer than the devastations which FLUX. 285 dysentery causes in the ranks of armies. Neither city nor country peo- ple are spared; it even seems as though the latter were more fearfully visited by this plague. If a disposition to dysentery prevails, errors in diet and catarrhal exposures excite the attack; the statement, however, that the use of fruit favors the breaking out of dysentery, is not yet proven. This assertion, at most, only applies to unripe fruit, or to such kinds as are apt to cause cholera morbus, diarrhoea, etc., such as the early cherries, plums, etc. There are, undoubtedly, individuals whose bowels are irritated by the use of any kind of fruit, and in whom it may cause an attack of dys- entery. These detached and well established historical data, cannot well be harmonized in one series, except by the supposition that there exists a peculiar virus, which has a special relation to the large intestine; for it is only in these parts that the phenomena of dysentery become localized. In this respect, dysentery is very near to Asiatic cholera, and, likewise, to other infectious epidemics. What the quality of the dysenteric virus is, has not yet been decided with any degree of certainty. That the virus is of a vegetable nature, might be accepted as true, where dysentery spreads over extensive districts ; but this theory does not apply where dysentery attacks whole armies. A discussion of this point is not as use- less as it might seem, since its proper solution is intimately connected with the preventive treatment of dysentery. This question may, per- haps be better elucidated by subsequent epidemics. It is certain that the virus is engendered in the patient, and is transmitted by him, like the poison of cholera. Contagion does not take place by contact, but the infection is propagated by water-closets, close stools, etc. This theory, which is now received as explanatory of the spread of cholera, explains the fact, why the disease decreases and disappears with the appearance of frost; the cold destroys the poison. This may be the reason, also, why dysentery sometimes continues as long as midwinter, provided the warm weather lasts, and there is no frost. The circumstance that during an epidemic all the inhabitants of one house, but not all the houses in the neighborhood, are attacked, and that epidemics spread more extensively, and more frequently in the country where the exhalations from excre- mentitious matter are more freely diffused through the air, speaks, like- wise, in favor of the theory, that infection is communicated in the man- ner above described. Among armies in the field, the epidemic is propa- gated in a like manner, whereas, the soldiers, lying in the barracks, are protected much more efficaciously, and the cases of dysentery occurring among them, are less numerous. Even if the views which we have here expressed, are not absolutely accepted as true, yet no reasonable physi- cian will neglect to arrest the spread of the disease, by effecting the remo- val of the various circumstances, which we have pointed out as exciting causes of the epidemic. Another important question regarding the his- tory of dysentery is, whether an alteration in the functions of the liver does not constitute the chief exciting cause of the disease. The origin of the epidemic, at a time when the action of the liver is known to be altered, and the affections of the liver which so often prevail, during and after epidemic dysentery, seem to confirm this opinion. Hence, individ- 2S6 DISEASES OF THE INTESTINES. uals in whom unhealthy changes in the functions of the liver, have developed a disposition to be attacked with dysentery, are most likely to be assailed by this plague ; this circumstance again shows why middle- aged persons should be most liable. Where the ulcers are not too extensive, they heal without much cica- trization. If the loss of mucous lining is considerable contracting cicatrices are the result, so that the bowels look as if twisted around by cords, or presenting valve-shaped contractions. It is upon the duration of this process that the length of the period of convalescence depends. Symptoms. The breaking out of the disease is almost always pre- ceded by precursory symptoms. The patient feels languid, prostrate, and out of humor; the appetite is, more or less, wanting; there is oppression of the stomach, deranged digestion, and an increased accumulation of flatulence. These symptoms soon increase to nausea and desire to vomit, with coated tongue and foul taste ; sleep is disturbed ; there is drawing in the extremities, sensitiveness to external cold, shiverings, and an accel- erated pulse. These symptoms show that the disease has invaded the organism. Above all, it is the diarrhoea which denotes the local sphere of the disease. Even if all the other precursory symptoms are wanting, diarrhoea generally precedes the attack, in company with slight, colicky pains, and without any further characteristic peculiarities. As these pains increase, the diarrhceic discharges occur more frequently, but are, at the same time more scanty, in the same proportion the tenesmus, which precedes every discharge, begins to distress the patient. At times, after a few fecal evacuations, and at others after a somewhat longer duration of the simple diarrhoea, fecal matter ceases to be dis- charged; this is the commencement of the real disease. The colicky pains, which are seldom wanting, increase in intensity, become more continuous, and are attended with a painful urging to stool; a sensa- tion as if the bowels would press out of the abdomen, or as though a heavy weight were suspended from the anus, or as if the sphincter ani (muscle that closes the anus, "puckering string") would tear. When these pains reach their hight, there occurs a scanty discharge, attended with an intense burning at the anus. At first a remission of the distress takes place after this discharge, but the more frequently it occurs, the more the tenesmus increases in violence, and the less it intermits after the evacuation has taken place. The evacuated substance, which, for some time, continues to show a little tinge, soon becomes a mere mucus, with a grayish admixture, or a more or less copious admixture of blood (red and white dysentery,) and of a peculiar insipid odor. In more violent cases, pure blood is evacuated. According as the disease is more or less intense the discharges occur every hour, sometimes every few minutes, so that the patient scarcely dares leave the chamber, however difficult it may be for him, owing to the con- tinned violent and colicky pains, to sit up The pains now become more tearing, cutting, radiating from the umbilicus (navel) downwards. The constitutional equilibrium is not much disturbed at the outset. In mild cases, the fever is scarcely perceptible, but there are frequent chilly creep- ings. The pulse is but a little accelerated, and temperature of the skin is not much increased. In proportion as the discharges increase in fre- flux. 287 quency, the pulse becomes correspondingly accelerated, hard and small, the skin hot and dry, the thirst distressing; the desire to vomit increases to real vomiting, although not regularly; the appetite is entirely gone. The patient soon loses his strength, and feels unable to sit up. The affec- tion may continue, at this stage, for a week, after which it may gradually terminate in recovery. If the local changes are more considerable, the disease increases in intensity. The pulse grows frequent, small, and feeble, the thirst becomes agonizing, the temperature unequal, the extrem- ities feel cool to the touch, the tongue can hardly be kept moist, the face has a cadaverous expression, and the prostration is complete. Usually the abdomen is much distended and sensitive. The discharges follow each other more rapidly, and the tenesmus continues uninterruptedly. The dis- charges, together with the blood, contain shreds of mucous membrane, and a number of membranous fragments. When the disease reaches this hight, delirium is not an unusual occurrence. If the disease approaches a fatal termination, the discharges either become fetid, or else they cease entirely, or take place involuntarily, as a sign that the bowel is paralyzed. It is always a bad symptom, if the discharges diminish in frequency without any corresponding improvement. Death supervenes amid symptoms of general prostration, meteorism (distention with gas), delirium, coma. The termination in recovery may be considered certain, if a general improve- ment is accompanied by a decreasing frequency of the stools, and the colic abates, although the tenesmus still continues. As soou as the discharges contain feces, and the fecal odor is restored, recovery may be considered under full headway. The pulse generally continues somewhat more rapid, yet becomes fuller and stronger, and the symptoms of fever disappear. After a severe attack of dysentery, recov- ery scarcely ever takes place very rapidly ; which, as we said before, is owing to the slowness, with which the ulcerated surfaces heal ; it may, also, be owing to the fact, that the condition of the digestive organs does not admit of a rapid reparation of the waste, by a copious supply of food. In armies, especially, the transition of acute into chronic dysentery is not a rare occurrence. The symptoms of chronic dysentery correspond with those of ulceration of the bowels, which, indeed, constitutes the basis of the chronic form. In such a case the fever disappears entirely, but the diarrhoea continues, consisting at one time of fecal masses, lined with pus and blood, and at other times of a sanguineo-purulent mucus, or changing about with obstinate constipation. At the same time, the appetite does not return, and the patients continue to lose flesh. Death is apt to termi- nate such sufferings, though, frequently, not until they have lasted a long time. The severest forms of dysentery, the septic, putrid or typhoid form, are of very rare occurrence in our latitude ; they are more frequently met with in hot climates. Such forms arise either because the milder form assumes a malignant type, with all the signs of gangrenous destruction of the bowel, or else they break out at once, with an extraordinary degree of intensity, characterized by the signs of a most acute typhus, and rapidly terminating in death. Strictly speaking, there is no transition jnto other affections; the abscesses of the liver, which do not occur unfrequently, even among us, 288 DISEASES OF THE INTESTINES. after a violent attack of dysentery, are most probably due to the absorp- tion of pus into the vessels; or possibly to a disease of the liver, running its course simultaneously with dysentery. The Prognosis, in the dysenteries of our climate, is emphatically favorable. ALLOPATHIC TREATMENT. Treatment of Acute Sporadic Dysen- tery or Flux (occurring independently of epidemic influences.) In this disease nature points unerringly toward a thorough emptying of the intes- tinal canal of its contents. This is shown by the copious diarrhoea which precedes the dysentery. The first object of treatment, therefore, is to effect this end as quickly and thoroughly as possible, assisting nature's efforts by an efficient cathar- tic. By far the most effective cathartic for this purpose is Sulphate of Magnesia (Epsom Salts). Take a sufficient quantity of Sulphate of Mag- nesia to saturate seven ounces of water: add one dram of Aromatic Sulphuric Acid. The dose of this mixture is a tablespoonful every hour or two, until it operates freely; or the Epsom Salts may be given in doses of a heaping tablespoonful steeped with one-third of its bulk of roasted coffee and repeated in four hours, if a free watery stool has not been before produced. Rochelle Salts, in doses of a tablespoonful in solution with water and lemon juice, or, Citrate of Magnesia, may be employed, but the acid solution of Epsom Salts is to be preferred. Castor Oil is only of less value as a purge in this disease than the cathartics before mentioned. If used, it should be given in doses of a tablespoonful or more, mixed with an equal quantity of Glycerine, and flavored with a couple of drops of Oil of Cinnamon. This should, also, be repeated in four hours, if it has not oper- ated. After thorough purgation has been produced, the cathartic is to be discontinued. This effect is followed by a period of rest, and sometimes recovery im- mediately takes place. This rest of nature should be aided, and prolonged by a full dose of Opium. The Opium benefits, also, by its direct effect on the inflammation (called antiphlogistic) as well as aiding recovery by prolonging the quiet of the intestine. It is preferable to give the Opium by injection into the rectum. For this purpose a teaspoonful to a tea- spoonful and a half of Laudanum should be mixed with one or two table- spoonfuls of thin starch or milk, and injected into the rectum with a hard rubber syringe. If it is thrown off it should be immediately repeated and caused to be retained, by firm pressure upon the anus (opening of the bowel,) with a towel under the hand, until the efforts to expel it cease. Generally speaking, once in twelve hours is often enough to repeat the injection of Laudanum, but it should be often enough to afford complete relief, and the dose increased until this effect is produced. Suppositories of Opium or Morphine can be purchased, which will answer the purpose. In some instances, neither the injections nor suppositories can be retained in the rectum. In such cases, it must be given by the mouth. Then the powder or pills of Laudanum or Morphine may be used. The usual dose is one grain of the powder, or one pill, or twenty-five drops of Laudanum, or a quarter of a grain of Morphine, but the dose must be increased until relief follows its administration, and repeated often enough to continue the relief. FLUX. 289 The patient should be quiet in bed, a large flax-seed poultice, containing two or three tablespoonfuls of mustard, placed over the stomach. About half an hour after the Opium or Laudanum injection is given, thirty grains of Ipecacuanha, wrapped in a medicine wafer, should be given, or it may be given in milk. The Ipecacuanha causes the stools to become natural, the griping and straining cease, the hot, dry skin becomes moist, and the patient becomes refreshingly calm. In a simple acute case, this may com- plete the cure. The Ipecacuanha may be repeated in from six to eight hours if required, and will be taken, if a disgusting sickness at the stomach is not caused. With every dose the hot poultice or a mustard plaster should be placed over the stomach. If a dose is vomited, it should be immediately repeated. Some patients find it impossible to continue the use of the remedy. In such instances, its use must be dispensed with. The treatment, then, will rest upon free cathartics and Opium. Whenever stools, with mucus or slime and blood, begin to pass, the cathartic should be at once resorted to, as in the first place, to be followed as before, with the Opium and Ipecacuanha, if it is tolerated. It is well to state here, that the treatment of dysentery, with Ipecacuanha, has reduced the fatality in acute dysentery to one-third of the mortality, previous to its introduction, as shown by reports from the East Indies. Persons who cannot take Opium or Morphine, can usually take the Watery Solution, or the Alkaloid of Opium, called Codia, in doses of one grain. The benefit from Opium is so great, that it is best for patients to suffer some inconvenience from the Opium. Its unpleasant effects may, sometimes, be obviated by giving with it a full dose of Hyoscyamus or Belladonna ; one or two grains of the Extract of Hyoscyamus, or one-fourth of a grain of Extract of Belladonna. Remedies which may, sometimes, be associated with the internal use of Opium, in this disease, are Bismuth, in doses of twenty to thirty grains (half a teaspoonful); Acetate of Lead, (Sugar of Lead,) in doses of three to five grains ; Sulphate of Copper in doses of a twelfth to a fourth of a grain ; Tannin in doses of ten to twenty grains, and the various vegetable astrin- gents, among which are Rhatany, Kino, Catechu, Logwood, White Oak Bark, Witch Hazel, White Pond Lilly Root, etc. Very seldom will it be necessary to resort to any of them, if the foregoing directions, regarding the use of Cathartics, Opium and Ipecacuanha, are strictly followed. When the disease is prolonged, and the stools become of a bloody, watery character, these astringents occupy quite an important place in the treatment. Ipecacuanha should be given, if tolerated, together with Opium, in some of its forms, to the extent of relieving pain, some of the foregoing astringents, which may be tried in succession, and tonics. Cathartics, as a rule, should not be given in such cases. Particular attention should be given to the diet, and nothing of a coarse character, which will make stools, should be allowed, but the food should be rich in nourishment. Milk, meat essences and broths, raw eggs beaten up with a little sugar and milk, or water, answers this purpose the best. Moderate quantities of arrow-root, sago, tapioca, and rice, may be given. The patient may drink, at will, of thin mucilage of Slippery Elm, or Gum Arabic, or Flaxseed Tea, Barley or Rice Water. 19 290 DISEASES OF THE INTESTINES. One of the best forms of tonic for prostrated cases, and when recovery is slow, is Elixir or Syrup of Quinine, or Cinchonidia, Strychnine and Iron. The dose is, usually, a teaspoonful three times a day, though a dessert- spoonful may be given. Whatever the form of tonic given, the dose of Quinine is one or two grains, Iron one grain, and of Strychnine not to exceed a thirtieth of a grain. In severe epidemics of dysentery, the treatment does not, materially, differ from the above, except, perhaps, in the quantities of medicines required to control the disease. The principles of treatment are the same. Cathartics are to be given more cautiously, and are to be omitted altogether, if the discharges become watery instead of mucus, or if the patient be notably prostrated. The rules for giving Opium and Ipecacuanha are to be observed. Much larger doses of Opium may be required to procure relief from the pain and griping, and to arrest the frequency of the discharges from the bowels. It should be given frequently enough, and in increasing quantities, until that result is reached. After a dose of Ipecacuanha has been retained, as a rule, less Opium will be required. While the Ipecacuanha should be repeated as before directed, no intermission must be permitted in giving the Opium, and should always be carried to the extent of checking the watery, bloody discharges, in increased doses, till this effect is produced. In increasing the doses in this way, the patient must be carefully watched that Opium poisoning (narcotism,) is not produced. Contraction of the pupils ("sight of the eye,") decreasing frequency of breathing, and profound sleep, indicate this condition. If, however, the patient breathes twelve times in a minute, the danger from narcotism is not great. In cases of great danger from exhaustion and prostration, stimulants are to be given with the nourishment. For this purpose, I believe Brandy to be the best. It should be given to a point short of excitement of the circulation or nervous system. Its beneficial effect will be shown by a general calm, and the pulse will become softer, fuller, more regular, and slower, and the tongue moistens. The dose should be begun at a table- spoonful for an adult, repeated at intervals of four hours, preferably with food, and may, if necessary, be increased in frequency and quantity to meet the requirements of the case. It does harm, if the frequency of the pulse is increased and the tongue becomes dry. Symptoms of malarial trouble will call for Quinine, the same as is directed in (bilious) remittent fever. In all cases of dysentery, patients should refrain as much as possible from efforts to stool, for the sensation is delusory, depending on the inflamed state of the bowel. Cold to the anus, as ice wrapped in a cloth, is useful. The Opium injections relieve this painful sensation the best of any tiling. Five grains of Sugar of Lead may be added to the injection with benefit, though for this combination a half a grain of the Acetate of Morphine, dissolved in a teaspoonful of Glycerine is better than the Lau- danum. Tannin, in quantities of a scruple, may be used in this way, instead of Sugar of Lead. In cases which, after thorough trial, cannot take Opium in any form, I would recommend an injection of one of the astringents named, dis- FLUX. 291 solved in a tablespoonful of Glycerine, with fifteen drops of the Fluid Extract of Belladonna or a teaspoonful of the Tincture. A teaspoonful or two of the Fluid Extract of Hyoscyamus, or two or three grains of the Solid Extract, may be rubbed up with Glycerine, and used instead of the Belladonna. In case none of these are procurable, a strong tea made with Stramo- nium, (Jimson Weed) may be used with benefit. During convalescence, the amount of doses and frequency of giving them, should be gradually diminished. Tonics, as recommended in simple acute dysentery, are applicable here. So dangerous a disease as epidemic dysentery, requiring such positive treatment, ought to be under the direction of a competent physician. HOM(EOPATHIC TREATMENT. According to our remarks on the causes of dysentery, it is evident that there must be a preventive treat- ment of dysentery, and that it must result in great good. From what we have said on the subject, the single points of this prophylactic treatment can easily be inferred. In this place, we desire to call attention to the absolute necessity of keeping the evacuations of dysenteric patients sepa- rate. It is, moreover, of the utmost importance to treat every diarrhoea that may occur during epidemic dysentery, with great care, and to arrest it as soon as possible, since it is an established fact, that a diarrhoea pro- duces an increased sensitiveness to the dysenteric virus. Mercurius occupies the first rank among the remedies for dysentery, and among the mercurial preparations it is the Corrosive Sublimate (Merc. Corr.) This remedy corresponds to the symptoms of ordinary dysentery so perfectly, that it may safely be regarded as a specific remedy for the whole process. The leading symptoms of dysentery, the bloody mucous evacuations without any fecal matter, attended with the most violent tenesmus and cutting colic, is a characteristic and constant symptom of Merc. Corr. All physicians agree that the lower attenuations of this rem- edy are preferable, and that it should not be given higher than the sixth ; they likewise agree that the dose should be frequently repeated. The best plan is to give a dose of the remedy after every discharge; as the dis- charges diminish in frequency, the medicine will likewise have to be repeated less frequently. The effect of the remedy is perceived very soon, in most cases within thirty-six hours. Of course, we cannot expect to perceive a striking improvement in twenty-four hours; nor would it be advisable to select another medicine, if no improvement takes place in that space of time. For this and all other remedies in this disease, the Dose is six pills after every second motion of the bowels, as long as is required by the symptoms. The Merc. Corr. almost always deserves a preference in epidemic dys- entery ; Mercurius sol. is preferable in the so-called white dysentery. In epidemic dysentery, the so-called white dysentery is of rare occurrence, and then only a very transitory condition. On the contrary, catarrhal dysentery, is, in every respect, adapted to Mercurius sol., and it is only in exceptional cases that this remedy will prove unavailing. As long as the evacuations contain feces, although in small quantity, it is well to give the solubilis the preference, no matter whether blood is discharged with the stools or not. On this account this remedy is especially appropriate 292 DISEASES OF THE INTESTINES. in the dysentery of children, especially during the period of dentition. The triturations of solubilis are preferable, whereas, the Sublimate acts better in solution. The Mercurius vivus is preferred in this disease by many physicians. Xext to Mercurius Belladonna is, without doubt, the most important remedy in dysentery, both the catarrhal and epidemic. As far as local symptoms are concerned, Belladonna is indicated by the violent urging to stool, with or without scanty discharge ; violent pains in the distended abdomen ; they are aggravated by pressure, or else evidently of an inflam- matory character ; liability of the rectum to protrude. Other prominent indications for Belladonna are : considerable urinary difficulties, even retention of urine; violent fever, also, with delirium, severe gastric derangement, nausea, vomiting. Belladonna is most frequently suitable for children ; less so for adults. The catarrhal form of dysentery being exceedingly varied, a number of other remedies might be recommended for this disease. Chamomilla, for instance, is a main remedy in the dysentery of teething children, if the local symptoms are accompanied by acute fever, restlessness, sleepless- ness, constant cries, vomiting of bile, nightly aggravation of the symp- toms, or the symptoms only show themselves during night-time. Ano- ther remedy is Ipecacuanha, when the tenesmus only sets in after the discharge, and there is frequent and distressing vomiting of bile, while the fever is not very considerable ; Dulcamara and Pulsatilla, when the discharges consist of mere mucus; they mostly take place at night. Baryta, for the dysentery of children, when it threatens to become chronic, provided there are no striking symptoms of ulceration of the intestines. Calcarea Carbonica is adapted to the same form of dysentery as Baryta, likewise applicable to ulceration of the bowel. Here it is even a chief remedy for children. A Dose of any of the preceding remedies should be given after each evacuation, provided they do not occur more frequently than every hour. We have already stated, that the above-mentioned remedies are suffi- cient in epidemic dysentery, unless it should pursue an entirely excep- tional, abnormal course, or be complicated with various accessory symp- toms. This statement, likewise, only applies to cases that have been treated homceopathically, from the commencement. But we are also called upon to treat dysentery in its more advanced stages, or after the system has been saturated with powerful medicines. For such abnormal forms of dysentery, the above-mentioned remedies are not sufficient, and one or more of the following list will have to be selected. Arsenicuni-album is never indicated at the commencement of dys- entery, only when evident signs of putrid decomposition become apparent, together with paralysis of the bowels and anus, in a slight degree. The evacuations have no longer a peculiarly insipid smell, but are fetid, of a blackish-brown color, mixed with numerous shreds of mucous membrane. The pains are uniformly severe, the fever is intense, attended with signs of rapid prostration and great thirst. Rhus-toxicodendron, Hartmann says: "It is particularly applica- ble in protracted cases, where the violence of the symptoms has been diminished by the previous treatment, but where all the symptoms that characterized the attack from the commencement, are still present : it is colic. 293 -prominently indicated by excessive prostration, the blood is greatly defi- cient in plasticity, the organic activity threatens to become extinct; typhoid symptoms supervene." In other words. Rhus is suitable in typhoid dysentery. A noteworthy symptom is the circumstance that the evacuations appear at night; there are, also, involuntary discharges. HOME REMEDIES. Of all treatments within the easy reach of all, there is nothing equals the complete and thorough washing out of the bowels, by large and frequent injections, of tepid or cool water. Many a case which appeared entirely hopeless, has been permanently cured by this simple means ; but be sure the washing out is thorough and frequent. COLIC— ENTERALG1A. A disease which appears under a great variety of aspects, and which is associated with various derangements, either casual, or permanent and organic. It should, therefore, especially be considered, with due regard to the general review of disorders affecting the stomach and intestines, as ■afforded in the article on " Indigestion." Colic may be spasmodic, particularly, as associated with hysterical complaints ; or may be associated with local determination (congestion) of blood, as occurring in conjunction with menstruation or piles; or, again, it may be developed as a transition of disease from other organs: as, for instance, when -some previous disease has been suddenly suppressed ; or, again, it may be associated with worms, or, may appear as a manifestation of flatulency ; or, again, purely from foulness or surfeit of the stomach, or result from indigestible food; in other instances, again, colic is associated with gravel, or other organic derangements of the kidneys, etc.; or it may become developed in consequence of the suppression of chronic eruption on the skin, or again, from excessive or acrid discharge of bile from the liver into the stomach and intestines. Symptoms. Griping, tearing, gnawing, or shooting pain in the bowels, chiefly confined to the region of the navel, generally attended with a painful distention of the belly, with spasmodic contraction, and some- times accompanied with vomiting and costiveness, or looseness of the bowels. One of the characteristic distinctions between this disorder and inflammation of the bowels, consists in the degree of alleviation to which the pain is subject upon pressure. The long continuance and intense severity of colic may, however, result in inflammation, for which reason it is ever advisable to arrest its progress in any severe case. Causes. The general exciting causes of this complaint are acid fruits, and indigestible substances, cold from wet feet, drinking cold beverages when heated, constipation, worms, etc. It is frequently, also, a concomit- .ant symptom of some other derangement, but occurs equally often as a primary disease. This disease is so well understood, that we are justified in proceeding at once to the treatment, giving in its course various symptoms, as devel- oped by different causes. ALLOPATHIC TREATMENT. Colic. In the treatment of colic, the .'first indication is to relieve pain, whatever may be the cause. This is done best by an injection of a teaspoonful of Laudanum with fifteen drops 294 DISEASES OF THE INTESTINES. of Tincture of Belladonna. If there is flatulence, a couple of ounces of Mixture of Asafcetida may be used as a vehicle for the Laudanum. The. injection should be made with a hard-rubber syringe. If no flatulence exists, the injection of Laudanum, with or without the Tincture of Belladonna, may be given with a couple of tablespoonf uls of Starch Water. The Asafcetida Mixture (or Milk) is made by rubbing two drams of the gum in a pint of water. A couple of teaspoonfuls or a tables poonful, of the Mixture (Milk) of Asafcetida given by injection, is an efficient remedy for the flatulent colic of infants. Three to five drops of Laudanum may be added, if the first injection does not relieve. A cathartic ought not to be given in colic, until after the pain is relieved, and then, if no inconvenience is experienced, twenty-four hours or a couple of days may pass before one is given. In the mean time, the bowels will generally move spontaneously. If they do not move, a large injection of warm water may be given. If this proves ineffectual, three Compound Cathartic Pills should be taken. If cathartics are given before relief from pain, the spasm of the intes- tine interferes with its action, and it aggravates the malady. Much relief is obtained by hot applications over the abdomen. In mild cases, some hot aromatic tea, as Ginger, Anise, Cloves, or Mint, may give relief. In severe cases, recourse should be had at once to the injection of Laudanum, or to a dose of twenty-five drops, and a teaspoonful of Spirits of Camphor, by the mouth. Morphine, in doses of a quarter of a grain, or an Opium and Camphor Pill may be given. If complete relief is not obtained in an hour, the dose should be repeated, either by injection or by the mouth. Hysterical colic is almost always relieved by an injection of a pint of the Mixture of Asafcetida; but if this does not succeed, the same remedy may be given by the mouth, in doses of a tablespoonf ul— Opium or Lauda- num may be added, in extreme cases, as directed above. The carminative teas, before mentioned, and hot applications, are useful. The treatment is given, in considering the disease (hysteria,) to which the reader is referred, if anything additional is needed. In rheumatic colic, immediate relief from pain is to be procured as before directed for "colic." The rheumatic trouble may, generally, be overcome by the continued use of Salycilic Acid, in doses of ten to twenty grains, four times a day, given in capsules or medicine wafers. For further consideration of the rheumatic condition, the reader is referred to the treatment of Rheumatism. The treatment of neuralgic colic is identical with that of neuralgia, to which, and to the treatment of neuralgia, the reader is referred. In Printers' and Painters' Colic (Saturnine or Lead Colic) the treat- ment consists, in the first place, in the relief of the extreme pain. This is accomplished precisely as is directed for simple colic. The use of opiates must be persisted in until relief is obtained. The obstinacy of the colic will require their continued administration at varying inter- vals of from one to six hours, for a much longer period than is required in simple colic. Together with the use of Opium, a liniment of one part each of'Chloro- colic. 295 form, Tincture of Aconite and Laudanum, and three parts of Soap Lini- ment, may be freely applied over the abdomen. Hot bathing is, also useful. As a means of relieving the pain of lead colic, used continuously with the use of Opium and hot bathing, Alum may be given by the mouth, in doses of fifteen grains every two hours. A good formula is this : Take of Alum two drams, Aromatic Sulphurvc Acid one dram, Syrup jof Lemon one ounce, Water three ounces. Mix. Dose: A tablespoon ful every two hours. A teaspoonful and a half of Alum may «be added to a pint of boiling milk, separate the acrid acid from the whey (Alum whey.) The patient may take a wineglassful every hour or two. After the pain is relieved, the elimination of the lead from the system may be greatly hastened by free purgation with the saline cathartics. The best one for this purpose is the Sulphate of Magnesia (Epsom Salts.) Take an ounce of Epsom Salts, Aromatic Sidphuric Acid a dram. Water four ounces. Mix. Dose : One-fourth part every three hours, until free purgation takes place. After first giving relief with Opium, the bowels should be briskly moved every day during the treatment, by the use.of Epsom Salts. The Iodide of Potassium is one of the best remedies to facilitate the elimination of lead from the system. Take of a saturated solution of Iodide of Potassium fifteen drops three times a day, and gradually increase the dose until the characteristic effects of Iodine are produced, viz : until the symptoms of an accute catarrh, with the presence of Iodine in the secretion from the nose. A drink of one dram (teaspoonful) of Aromatic Acid to the pint of water, sweetened as desired, is protective against lead poisoning. Thor- ough cleanliness, washing out the mouth and nose (with a douch) warm bathing each evening, and the occasional use of Epsom Salts as a purga- tive, should be practiced. In Colic from Copper, the relief of pain as directed for lead colic, with the use of Sulphate of Magnesia (Epsom Salts) for a purgation, are the principal points in treatment. Iodide of Potassium, given as directed for lead colic, assists in throwing the poison off from the system. The same precautions as to cleanliness are required as against lead. Milk is said to be a preventive. HOM(EOPATHIC TREATMENT. Nuoc Vomica is a valuable rem- edy in colic, either associated with flatulency or piles, or in colic arising from a chill, and is, particularly, indicated when there is a sensation of fullness and tightness at the upper part of the waist; deep-seated or cut- ting pains in the belly, with acute and hard, pressive, and forcing-down sensations, compelling the sufferer to bend double; confused headache, with occasional loss of conciousness ; flatulence, aggravation of the pains on the slightest motion, generally disappearing when at rest; constipa- tion, coldness and numbness in the hands and feet during the parox- ysm ; at the monthly period in females, when we find weight, or vio- lent, deep-seated, aching pain in the belly, dragging pains extending to '296 DISEASES OF THE INTESTINES. the thigh ; aching and creeping sensation in the same part when sitting; painful pressure towards the terminal bowel. Dose : Of a solution of six globules to six tablespoon fuls of water, give a teaspoonful every half hour (in very acute' cases,) or every hour, when the pain is not continuous or insupportable, until distinct amelioration or change. Pulsatilla is more useful in the affection occurring in females, either during the menstrual discharge or at other times, when corning on periodically in the evening during cold, damp weather ; also, when there are present a disagreeable tightness and distention of the belly and the upper part of the waist, pulsation in the pit of the stomach, aggravation of the suffering when at rest, or in the evening, attended toith shivering, which increases with the pains, and is mitigated by motion, when it has arisen from overloading the stomach, or from rich, greasy food, with inclination to vomit, flatulence, looseness of the bowels, paleness of the face, livid circle round the eyes, and headache ; also, hemorrhoidal colic, with fullness of the veins of the hands and forehead, restlessness, anxiety, and sleeplessness. Dose : A solution of six globules, or, otherwise, in all respects, as directed for Nux-vomica. Chamomilla is chiefly useful for bilious colic (with looseness of the bowels and bilious vomiting ;) or for colic in females during the menstrual discharge. The following are the principal indications ; sensation as if the intestines were gathered into a ball, and as if the belly were empty, with tearing and drawing pains, attended with excessive anxiety and restlessness; distention under the lower ribs, and in the pit of the stomach; incarcerated flatulency, sometimes nausea, bitter vomiting, fol- lowed by desire to relieve the bowels, and bilious diarrhoea ; livid circle round the eyes, alternate paleness and redness of the face ; the pains come on particularly at night, at times early in the morning, or after a meal . This remedy is particularly adapted for children of irritable tempera- ments, and is extremely serviceable in all cases in which a fit of passion has been the exciting cause of the sufferings. It is, also, useful when colic has arisen from cold in the feet, or checked perspiration. Dose : As for Nux. Colocynth, In the majority of violent and obstinate cases, we find this a most valuable remedy ; it is indicated when the pains are exces- sively violent, and of a constrictive or spasmodic character, or resemble stabbing and cutting, as if from knives ; sometimes there is a sensation of clawing and pinching, and tenderness of the belly, with a pain, as from a blow, or distention; at other times, a sense of emptiness is experienced, with cramps and shivering, or tearing pains in the legs ; during the con- tinuance of the attack, we find excessive restlessness, agitation, and toss- ing about, from the violence of the pain ; when the pains come on, they continue without any apparent intermission ; after their disappearance, a sensation of bruising remains, and the sufferer feels as if the intestines were held together by thin threads, likely to break from the slightest motion. This remedy, like Chamomilla, is, particularly, efficacious in the so-called bilious colic, being indicated by the loose discharge from the bowels, and bilious vomiting attending it; and, also, in cases where pas- sion has been the exciting cause. Colocynth is, more particularly, useful in the case of adults. Dose : As for Nux, colic. 297 Belladonna is useful against flatulent colic, when there is protru- sion of the transverse section of the great intestine, which becomes dis- tended, like a pad, above the navel, attended with colic-like pain, doubling up of the body, which is relieved by pressure on the part; also, severe bearing down of the whole intestines; also, in menstrual colic, with spas- modic constriction in the belly, and a burning pain lower down, or in the small of the back ; pain in the lower part of the bowels, as if a number of nails were holding the intestines. The symptoms are, also, attended with a liquid or matter-like discharge from the bowels, and swelling of the veins of the head; and the pains are sometimes so violent as almost to deprive the patient of reason. Dose : Of a solution of six globules to two tablespoonf uls of water, give a teaspoonful every half hour (in very acute cases,) or every hour (when the sufferings are not continuous or intolerable,) until distinct amelioration or change. Cocculits is indicated {especially, in menstrual or flatulent colic) when there are severe constrictive or spasmodic pains, and distention of the entire stomach, with nausea and fullness of the lower part of the belly, great flatulence, and difficulty of breathing; also, when there is a sensa- tion of emptiness, and tearing and burning pains in the intestines, some- times with squeezing, tearing and pulling pains, excessive anguish and nervous excitement ; constipation. Dose : As for Bell. Arsenicum is often appropriate in cases of colic (bilious,) arising from disordered stomach, with nausea, vomiting, great relaxation of the bowels, with green or yellow evacuations, violent gripings, headache, pale- ness of the face, and blue marks around the eyes. Again, in cases of bil- ious colic, which is prone to be preceded, followed or alternated with sick headache, Arsenicum is of great service. Dose : As for Nux-vomica. Coffea is valuable when we have to prescribe for colic with excessive pains, attended with great agitation, anxiety, and tossing about, grinding of the teeth, convulsions, suffocative attacks, oppressive despair, acidity of the stomach and coldness of the body and extremities. It is, also, useful in some kinds of menstrual colic, denoted by a sensation, as if the belly were being- rent asunder ; or by fullness and pressure in the stomach, and violent spasms which extend to the chest. It is, also, indicated by cutting pains in the intestines, as if divided by a knife, and, also, by the pains present being so violent as almost to drive the patient to distraction, causing him to bend double, and draw up his limbs. Do.se : As for Bell. lanatia is a most valuable remedy for colic, particularly as affecting female patients of delicate constitution, and is indicated by the following symptoms, amongst others: Fullness, tightness, and pressive sensation across the region which extends along the lower ribs; accumulation of wind in the bowels, which is expelled with much difficulty, a relief, how- ever, being obtained upon the expulsion of wind; stitching pains in the region of the spleen, etc.; more especially, however, if the colic occurs, or is worse at night. Dose : Of a solution of eight globules to three tablespoonfuls of water, give a teaspoonful every hour, (or in very mild cases, every three hours,) until distinct amelioration or change. 298 DISEASES OF THE INTESTINES. Iris- versicolor (Blue Flag,) Involuntary escape of fluid of an offensive, putrid and coppery odor. In cholera morbus, it arrests the vio- lent pain. Mercuriws is a medicine of great value, in cases of colic, character- ized by the following assemblage of symptoms: Nausea, with profuse flow of saliva; voracious appetite, with repugnance to sweet things; fre- quent and troublesome hiccough ; constant and painful urging to evacu- ate ; severe, pinching, drawing, nipping pains, with tightness and hard- ness of the belly, particularly, about the navel; or tensive, stinging, cut- ting, or burning pains ; aggravation of these sufferings at night, and, more particularly, in the latter part of the night; extreme tenderness of the belly upon contact or pressure (the clothes or bed-clothes appear to cause pain ;) sometimes looseness of the bowels with slimy evacuations ; considerable prostration of strength, and chill (or even shuddering,) accompanied with flushing of the cheeks. Mercurius is, also, a most important medicine in cases of colic, associated with worms. Dose: Of a solution of six globules to three tablespoonfuls of water, give a teaspoonful every half hour, until amelioration or change. Secale-comutuni is indicated for male patients affected with colic, attended with pain in the small of the back, eructations and vomiting, or dragging, tearing pain in the thighs ; or, amongst female patients, for colic, occurring at the menstrual periods, when tearing pains in the bow- els, paleness of the face, small, weak pulse, coldness of the extremities, and cold sweats, are predominant symptoms ; or when constipation, with cramp-like pains in the bowels, and burning pains on the right side of the belly prevail. Dose : Of a solution of eight globules to three tablespoonfuls of water, give a teaspoonful every hour until the suffering abates, and then every three hours until distinct amelioration or change. Carbo-veg. occurs, in many cases of somewhat serious aspect, as a medicine of great importance, and is particularly indicated by the follow T - ing symptoms : Violent pains in the bowels, provoked even by the light- est and most wholesome meal ; sensation of heat in the head and in the bowels ; determination of blood to the head, attended with heavy, aching pains; fullness and tightness of the belly, so severe as to convey the sen- sation that it would burst, and accompanied with flatulent risings, or accumulation of wind with difficulty and oppression of breathing, nipping pains and rumbling, and sluggish action of the bowels. Carbo-veg. may often be administered with striking success in cases of colic associated with piles or with flatulency. Dose: As for Bell. PREDISPOSITION TO COLIC. Sulphur is amongst the most valuable remedies in the generality of cases, in which a constitutional predisposition to affections of this * nature is evinced by the failure of other medicines to afford permanent relief. Therefore, in particular, if Nux-vomica, or Carbo-veg., or if both have been employed as above directed, in cases of colic associated with piles, but have failed in obviating the repeated recurrence of the attacks, the persevering administration of Sulphur becomes necessary. The same may, also, be said of bilious colic, in which Chamomilla or Colocynth, or both have been employed with similar results. The same remark is COLIC. 299 equally applicable to cases of flatulent colic, in which Nux-vomica, Carbo- veg., Chamomilla or Cocculus, or two or more of these medicines, have been previously employed in like manner. Dose: During the continuance of an acute attack, of a solution of six globules to two tablespooonfuls of water, give a teaspoonful every hour until relief is obtained. Subsequently, however, give six glo- bules in a wineglassfulof water every morning, the first thing (fast- ing,) for ten days, (unless collateral symptoms should appear in the meanwhile) — after which pause four days, and resume the course as before (if necessary,) and so on until the symptoms are permanently subdued or undergo a distinct change. WORM COLIC. As this is, in point of fact, a mere symptom dependent upon the pres- ence of worms in the intestinal canal, or upon the cases which promote the generation of these parasites, the subject will be more accurately con- sidered in the article devoted especially to that subject, to which, there- fore, the reader is referred. Home Measures in Casual Attacks. In cases of colic, arising from indigestible food, a cup of black coffee, without milk or sugar, will frequently afford relief, by causing the stomach to free itself from the cause of annoyance ; that is, in patients who have not used that article as an ordinary beverage. Diet and Regimen. In this, as in all other complaints arising out of derangements affecting the functions or organs of digestion, the diet and general habits, or the particular precautions in individual cases, should be regulated in conformity with the directions afforded under the head of "Indigestion." If particular food or drink, such as raw fruit, milk, or cold things, be apt to provoke an attack of colic, the particular food or drink in question, in every particular case, should be carefully avoided. Aconitum, Belladonna. One or both of these medicines may be advantageously administered, singly, in alternation, or in succession, and, in addition to such as have been mentioned with detailed indications (such as Opium, Nux-v., etc.,) when the constipation is associated with predom- inant fullness of the vessels of the head. Dose: Of either medicine, as selected, give three globules in a tea- spoonful of water, every six hours, until the predominant head symptoms are modified, and then every twelve hours, until positive amelioration or change. HOME MEASURES. In all cases of an inveterate or chronic nature, recourse may, occasionally, be had to an enema, or lavement of tepid or cold water, as a temporary mode of relief, until the medicine has effected the desired result. The drinking of a tumblerful, or more, of cold water, thrice a day, when fasting— dashing cold water against the belly, and then apply- ing brisk friction, by means of a coarse towel— combined with early rising, and daily exercise, (not violent or beyond the strength of the patient, so as to cause suffering,) will be found useful auxiliaries in promoting a regular action of the bowels. Electro-magnetism is another, and most useful, auxiliary, either in cases arising from culpable neglect, or indolence, or from inability, or impracticability, to relieve nature whilst traveling. In chronic cases, aris- 300 DISEASES OF THE INTESTINES ing from inertness of the bowels, or a sort of intestinal paralytic debility, the application of electro-magnetism is often superior to any other aux- iliary. Diet. The diet ought to be regulated according to the state of the primary digestive organs, and highly seasoned food, or that which con- tains much fibrous or ligneous matter, such as radishes, cabbages, tur- nips, green fruits, etc., should be avoided. HEMORRHOIDS— BILES. Symptoms. Enlargement of the veins, or effusion of blood in the cellular tissue of the terminal bowel, either within or without the fun- dament (internal or external piles;) or protrusion and distention of one or more of the inner foldings of the same intestine, with or without bleeding (ojDen or blind piles,) preceded or accompanied by pains in the back, the base of the spinal column, and belly ; sensation of itching, prick- ling, tickling, burning, or pressing at the terminal bow r el, sometimes extending to the adjacent parts, with, in general, constipation, and not unfrequently derangements of the urinary organs. Predisposing Causes. The predisposing causes of the disease are: 1. A constitutional taint. 2. Local debilitation of the vessels by con- tinued excesses, by abuse of warm drinks, purgings, or injections, etc. Exciting Causes. Among the exciting causes are, habitual costive- ness, severe exertion on horse-back, use of drastic medicines; of warm stimulating diet, or of vinous, alcoholic, and fermented drinks, tea or coffee, the excessive use of seasoned food and spices, the suppression of long-continued discharges, sedentary habits, sitting on a cold seat or on damp ground, the pressure of the gravid womb, tight-lacing, or any other cause of local pressure, morbid accumulation of blood in the liver, men- tal emotions, etc. The painful practice among surgeons of removing the hsemorrhoidal excrescences by means of the knife or ligature, is much to be deprecated ; for, independently of the danger not unfrequently attending the opera- tion, it may occasion serious consequences by a sudden transfer of the congestion to some of the noble organs ; in a great number of cases, more- over, it wholty fails, and the disease returns, sometimes even in an aggra- vated form. ALLOPATHIC TREATMENT. Treatment of Haemorrhoids (Piles) will consist, in the first place, in the avoidance of those causes, which pre- dispose to congestion of the veins of the rectum (lower bowels). Active out door life must take the place of sedentary occupation. Constipation must be completely remedied by the means directed for that disease. Attention to diet and the regular habit of emptying the bowels being all- important. Cathartics nor injections will not answer this purpose, though, as directed for constipation, a free cathartic will be necessary, when the bowels have been for a long time inactive, and the bowels filled with fecal accumulations. When this conditon of the bowels is attended with recurring attacks of bleeding the cathartic is especially useful. Straining at stool must be avoided, neither must the patient remain long sitting at stool. The inflammation which causes futile efforts at PILES. 301 straining, must be restrained by anodyne remedies. These efforts increase the congestion and contribute towards the formation of tumors. Diarrhoea must be treated as directed in that disease. The lax condition of the tissues in diarrhoea, aids in the development of piles. Immediately after the evacuation of the bowels has occurred, the anus (opening of the bowels) and the protruding piles should be bathed with cold water. The parts should be carefully dried and annointed with an ointment made by the following formula : Take of Tannin a dram, {sixty grains,) Pulverized Opium a scruple, {twenty grains.) and Stramonium Oint- ment an ounce. Mix. Five grains of Morphine may be used instead of the Opiun# In the absence of this ointment, before the piles are returned, they should be washed and dried as before, and lubricated with Cold Cream, Sweet (Olive) Oil, or Glycerine, before they are returned. "When the piles are protruding, they can be more readily pressed back when the patient is in a stooping position, w T ith the hips raised, or sup- ported on his knees, while the chest and head rest on the bed. If the piles become swollen and inflamed and cannot be returned, the patient should remain in bed and cold applications, as cold water, or a cloth wet in a solution of Sugar of Lead thirty grains, Acetate of Morphine ten grains, in a pint of soft water, or poultices, may be used. The above ointment may be made more curative by thoroughly mixing with it half a dram of Iodine. At night, the ointment should be applied again, and if the piles have not protruded, it should be introduced into the rectum with a suppository tube. Much suffering may be avoided, by establishing the habit of having the regular movement of the bowels occur just before bedtime, after which, if the piles are returned, as before directed, the sphincter muscle recovers its tone during the night, and the tumor of piles does not escape during the next day. By removing this much irritation, so much has been done toward a cure. The stools may be rendered soft and unirritating by taking one or two teaspoonf uls a day of the following mixture in water : Take of Magnesia, Sulphate of Magnesia, Precipitated Sulphur, and Sugar of Lead each an ounce, and Pidverized Anise Seed half an ounce. Mix well. The use of Ergot and Nux-vomica will often overcome the laxity of the tissues about the rectum, which predispose to piles, as: Take of Ergotine {Squibb' s Extract) a dram, Extract of Nux-vomica fifteen grains; make into thirty pills and give one night and morning ; or, take of Fluid Extract of Ergot one and a half ounces, Tincture of Nux-vomica half an ounce. Mix. Dose : Take a teaspoonf ul morning and evening. It is claimed a cure can be effected by the faithful application of a lotion of Iodine, Tannin and Stramonium, every night, to the part. Take of Iodine thirty grains, Iodide of Potassium six grains, water, eight drops is sufficient, Glycerine an ounce. Mix, and add to the mixture, two drams of Tannin, and afterward mix with it, in a mortar, two drams of Extract of Stramonium, moistened with sufficient water. Label Pile Lotion. This solution, to be beneficial, should be applied every night. A suppository of tallow may be formed/with the fingers)dipped in this mixture, and inserted into the rectum at night, and allowed to remain 302 DISEASES OF THE INTESTINES. until morning. If a greater anodyne effect is desired, five grains of Mor- phine may be added to the solution. The further treatment, if required, belongs to the practical surgeon. The most approved and most efficient treatment for the cure of piles, is the old, and well-tested operation of tying them off. The cure, by this means, is the most invariably complete of any method known. The plan is to thoroughly empty the bowel with Epsom Salts or Castor Oil, the evening before the operation. In the morning, the patient should, a couple of hours before the operation, take a large injection of a quart or more of warm water, and then take a half a grain of Opium, Then the anaesthetic can be given, the tumors exposed with a Thebault's anal speculuxp, and the tumors brought within reach with a Vulsellum. A large needle with a stout silk thread is passed through the base of the tumor, the needle re- moved and the thread tied tight on each side of the tumor, but not tight enough to sever the tumor. Two tumors, operated on in this way on each side of the gut, is sufficient to cause the cure of the others, if any exist. The patient will remain in bed, the pain relieved by Opium, in doses of a grain. The bowels should not be moved until the fourth day, when Castor Oil may be given, followed by an injection of warm water. After the op- eration, the urine (water) will generally require removing with a catheter. If the operation is to be done without an anaesthetic the cathartic should be given only about five hours before the expected operation, and, after they move, the warm water injection is given, and the patient brings down the tumors by straining over a vessel of warm water. When the tumors are down, they are tied as before directed. Small folds of membrane may protrude from the anus; when inflamed, they are troublesome and frequently bleed. They should be removed with the scissors, if not inflamed, and if bleeding follow, Sub-sulphate of Iron ought to be immediately applied to stop it. Other plans of treatment are by excision, the hot iron, Nitric Acid, the galvanic cautery or the ecraseur ; but the plan of tying them off is to be preferred. The object is. to obliterate the tumors. The plan of causing the obliteration of the tumors by injecting Carbolic Acid into each tumor, with a hypodermic syringe has come quite generally into vogue. The writer furnished the following description of this treat- ment for the Burlington Haiok-eye: Carbolic Acid, either concentrated or diluted with one to three parts of Glycerine or Olive Oil, is used. Four to six drops may be injected into each tumor. Only one tumor should be treated at a time, and from five to ten days should elapse between each operation. A coagulation is immediately formed in the tumor, which results in its ob- literation. Carbolic Acid, applied to the tissues, is an anaesthetic, so this operation is not painful, but the inflammation which sometimes results causes so much suffering, as to call for anodynes. For this purpose, Opium and Belladonna may be given by injection into the rectum— a tea- spoonful of Laudanum and ten to fifteen drops of the Fluid Extract of Belladonna, in a little Glycerine, will be quite effectual in controlling the inflammation and pain. The injection may be repeated in twelve hours, if necessary. Further means for relieving pain should be by Opium given by the mouth. For this plan of treatment, the same preparation is required as for the operation by the ligature (tieing off), and the after-treat- ment will be the same. PILES. 303 To prevent the return of piles, after a cure, attention to the general habit is necessary. The regular evacuation of the bowels, and keeping the fecal discharges in a soft state, by diet and laxatives, as is directed for constipation. HOMCEOPATHIC TREATMENT. Nux-vomica is a most valuable remedy, in this affection, and is very efficacious against both descriptions of piles, but especially against bleeding piles, particularly for individuals who lead a sedentary life, or who indulge in the use of coffee or stimulat- ing liquids, and also for females during pregnancy — when the haemorrhoids are attended with shooting, burning, or itching pains, colic, shooting and jerking pain, or pain as if from a bruise in the loins, rendering it difficult to rise or walk in an erect position ; and when they are accompanied by constipation, and sometimes painful and difficult passing of water, and the other symptoms described, as indicating this medicine, under the head of li Indigestion." Dose: Eight pilis in a teaspoonful of water, night and morning, until amelioration or change. Sulphur may follow the administration of Nux-vomica; and an al- ternation of these remedies, at intervals of a week or ten days, frequently effects a cure in cases of long-standing. Dose : If to follow Nux-vomica, to complete the cure, give six globules in a wine-glassful of water, every morning, the first thing (fasting) for ten days. Pulsatilla.— Discharge of blood and mucus during stool, and at other times, with painful smarting and sensation of excoriation in the piles, pains in the back, pallid countenance and disposition to fainting; difficulty in passing water. Dose: Of a solution of eight globules to six teaspoonfuls of water (to which add ten drops of alcohol), give a teaspoonful, morning and evening, until the whole is consumed. If further treatment then be requisite, pause four days, and recontinue the course in like manner. Ignatia is indicated by itching and creeping, and also, sensation of constriction and excoriation in the posterior passage, and prickings ex- tending deep into the lower intestine; discharge of blood or of bloody mucus, rumbling noise in the belly, and protrusion of the lower intestine, accompanied with acute pain. Dose ; Three globules in a teaspoonful of water, every twelve hours, until amelioration or change. Antimonium-crudum. — Discharge of mucus and of blood at every stool, followed by severe colic and pains in the piles, with throbbing, itching and burning at the fundament, and discharge of glutinous, acrid moisture, particula?*ly at night; frequent determination of blood to the head, with bleeding at the nose; stiffness in the back, shooting pains in the loins, burning and rheumatic pains in the limbs, flatulency and constipation. Dose: Of a solution of six globules to two tablespoonfuls of water, give a teaspoonful every six hours, until four doses have been given, and then every twelve hours, until positive change. HOME REMEDIES. Buckeyes. Take four or five ripe ones just after they come from the tree, remove the outer brownish shell from them; slice them up fine; put them in a tin cup with enough melted lard to cover them ; let them simmer or steep near a fire for an hour or two. Then strain and press out the lard, and when cold, it (the lard) is fit for 304 DISEASES OF THE INTESTINES. use. A little of this ointment must be applied to the tumors and within the bowel twice a day. Mullen. Take of the leaves a large handful, put in a quart of cold soft water, and place over the fire; let it simmer until reduced to a pint; then take out all the leaves, pressing them as dry as possible. Now put all the remaining liquor back over the fire and let it remain until reduced to one-fourth pint or less; put in three tablespoonfuls of good, clean lard, and a lump of beeswax as large as a hulled black walnut ; let it simmer until all the water has passed off in steam, then take off the Are and stir until almost cold, when you will have a nice smooth salve. To use. Apply a little of the salve to all the affected parts two or three times a day, rubbing it in well with the finger, reaching well up the bowel. This is reliable and gives permanent relief. The Surgical Operation for the Radical Cure of Piles,* which has, of very late years, been introduced among physicians, and also used to a great extent by specialists who have uniformly charged from fifty to five hundred dollars, and even more for the operation, is only this simple thing : Take of Carbolic Acid fifteen grains, of pure Glycei'ine sei>- enty-five grains. Mix Dose: Of this inject with a hypodermic syringe one to three drops (owing to the size of the tumor) into each tumor. This causes the formation of pus or matter, and the absolute destruc- tion of the piles, but the pain after the operation is very great and, also, needless. One hour before the operation an injection of one dram of the Tincture of Nux- vomica, one dram Tincture of Stramonium and one dram Laudanum to a quart of water should be used. After the operation, a salve made by adding one dram Arnica Flowers, one dram Stramoniuxii (Jimson Weed) leaves dry, one dram Tincture of Aconite, to a quart of water-, let it simmer slowly until it is reduced to one half pint, then add half a pound of good lard and an ounce of beeswax. Let this evaporate on the back of the stove, or near the fire, until all the water is gone, which will be when there is no more steam from it. It will burn very easy. Then pour off and press out all you can from the leaves, etc., and use to rub well on all the affected parts, two or three times a day, being careful to reach as far up the bowel as you can. With these precautions you will make a sure, safe, and almost painless cure. It will be best to go to some good, careful doctor, who knows his busi- ness, to get the hypodermic injections made. The rest you can do just as welL WORMS.-HELMINTHIASIS. IXYERMINATIOX. The number of worms that are found, more or less frequently in the human bowels, is very large. Here we will name and speak of three *It is a matter of surprise how many people suffer with piles. Naturally enough the number seeking relief is quite large, and it affords a tempting field for " specialists."' We do not know of any plausible objection to a physician making the treatment of any disease a specialty, but, of course, there are reasons. not only plausible, but just, why he should not play upon the credulity of patients to extort unreason- able fees for his services. In a communication from a well-known physician of Burlingtou, in regular standing, tbe attention of the public is called to the practice that sometimes obtains of charg- ing an extortionate price for the cure of a disease any family physician, of ordinary skill and experience, can treat by the method indicated, and for which he would make no more than the customary profes- sional charges. WORMS. 305 varieties as being the ones likely to produce any of the symptoms of dis- ease. First : Pin worms or thread worms. Second : Long round worms or Lumbricoid. Third : Tape worm or Taenia. First: The pin worm is the smallest of the three ; it is one-third to one-half an inch long, and as thick as common size thread. It has a very small swelling, which it uses for, and out of courtesy, we call it its head. Usually it is found only in the very last part of the intestine and some- times in the vagina, into which it crawls from the anus. At times, only a few are seen together ; sometimes, however, they occur crowded together in large masses, most generally among children. The symptoms occasioned by this worm, vary a great deal. One of the most common, is a violent, distressing itching of the anus, especially, in the evening and at night, and disturbing sleep a great deal. Some children are driven almost frantic by this itching, and are tormented by an almost unaccountable nervousness in consequence of it. Among adults, this itching is scarcely ever so painful and severe. The irritation caused by the worms, sometimes occasions a catarrhal affection of the- mucous membrane of the rectum, or a spasmodic contraction of the sphincter, with a constant urging to stool, which is not less distressing than the itching. If a large number of them penetrate into the vagina, they cause severe itching, whites, and the constant rubbing is apt to give rise to self-abuse. Beside these less important results, we sometimes meet, without any otherwise assignable cause, with more important disturb- ances, principally of the central nervous system, sometimes resulting in indefinite spasmodic movements, and at other times in eclampsia, epi- lepsy, chorea, etc. We cannot prove that these affections are caused by worms, but this seems the more probable, as a removal of the worms is sometimes succeeded by an entire disappearance of the nervous disease. ALLOPATHIC TREATMENT. Pix Worms. For practical purposes, it is sufficient to divide the treatment for worms into that for seat worms ascarides,) also called " pin worms " and thread worms. Bound worms lumbrici,) and tape worms (tenia?). Seat worms inhabit the lower bowel (rectum) and large intestine. In females, they sometimes invade the vagina. They deposit their eggs in the folds of the anus and vagina. Remedies, to be effective, must be applied to these parts. One of the best and simplest is a large injection of a solution of common salt, repeated every third or fourth day, until three or four injections are given. Some of thesame solution should be applied to the folds of the anus, and, with female children, to the folds of the external genitals. In cases of females, an injection may be required into the vagina. One injection will kill all the worms that it touches, but the eggs hatch in three or four days, so that the injection needs repeating. Tea (infusion) of Quassia is, also, effective as an injection. The strength of this tea is two ounces of Quassia chips to a quart of water. A weak decoction (tea) of Aloes may, also, be used for the same pur- pose, 20 306 DISEASES OF THE INTESTINES. In case the last two remedies are used, a solution of Carbolic Acid should be applied with a sponge to the folds of the anus and external genitals of female children. Should the worms continue to appear, it indicates that they lodge high up in the intestine, and a few doses of Santonine, of two to five grains to an adult, and half a grain to a grain to a child, should be given two or three times a day, for two or three days, followed by a purge of twenty grains of Calomel, for an adult, or five to ten grains for a child, or of Castor Oil. The Santonine may be given, powdered with a little sugar. After the purge, the injections will complete the cure. HOMCE9PATHIC TREATMENT. Of all three kinds of worms, the expulsion of the pin worm is by all odds, the most difficult. Internal rem- edies can do very little good, as these little pests have their home in the very lowest part of the bowels, where medicine, taken by the mouth, can- not reach them to do any good. But a solution of salt in water, about two teaspoonfuls to the pint, will reach them, if used as an injection, and repeated a few times. Or a decoction (tea) of common Garlic {Allium Sativum) used in full injections for a month; at intervals of three or four days, will make them seek a more pleasant place. A few doses of Cina, or Sulph. will remove any unpleasant constitu- tional symptoms remaining after the removal of the worms. Dose : Of either, six pills dissolved in a teaspoonf ul of water, every morning before eating. Long worm (himbricoides). The intestinal long worm is the most com- mon of all. It is, from six to twelve inches long, has a cylindrical body of the size of a goose-quill, tapering at both ends. Its common abode is the small intestine ; exceptionally, the worm wanders into the stomach. Very seldom, only one worm is present in the intestine, generally, there are several together, sometimes as many as twenty or thirty, and even many more. The symptoms caused by the presence of these worms, vary greatly. In the majority of cases, there are no very prominent symptoms present; it is only by accident, that the presence of worms is generally discovered; the only symptom, is perhaps, an increased longing for bread and pota- toes; and perhaps, a less fresh and healthy complexion, More deep-seated and more general derangements, may be caused by a number of worms together, or by the agglomeration of the worms into large balls, or by their entrance into some other organ; or else, the bowels may be exceed- ingly irritable, in consequence of which a small number of worms may cause intestinal catarrh or enteritis, together with their consequences. Among these latter, we number the nervous phenomena, caused by worms, which have already been mentioned in the paragraph on pin- worms. The ailments caused by lumbrici, often resemble greatly other more or less important processes, such as gastric fevers, typhus, dysentery, and likewise, the above mentioned nervous derangements; it is of no small importance to ascertain their origin, at an early period. These nervous derangements, manifest themselves by various phenomena, of more or less constant occurrence. The appetite becomes fitful, or the patient has WORMS. 307 a more or less exclusive, or, at any rate, decided hankering for farinaceous food,* the nose and anus, itch violently; the pupils are considerably dilated; the eyes are surrounded with dark margins; the patients are of a changeable and irritable mood ; bowels act irregularly, at times consti- pated, at other times, alternately constipated and loose, with frequent changes of this character. It sometimes happens, that their irritation occasions a real gastric fever, which does not always disappear immedi- ately after the removal of the worms ; large balls of these worms may even cause the same functional or structural changes, as hard masses of fecal matter. Properly speakings it is ortly in children, that lumbrici cause nervous derangements, and it is well, when these derangements manifest themselves, that you should direct your attention to the presence of worms. ALLOPATHIC TREATMENT. Round Worms. In giving medicines for worms, the bowels should be as empty as they conveniently can, so that the remedy may act on the worms as energetically as possible. For this reason, it is best to give remedies for worms in the morning, before break- fast, and if cases are rebellious, the patient should abstain from eating till noon, or through the day. Medicines ought not to be given to children, for worms, merely on sus- picion, but only when there is positive evidence of their presence. For round worms, one of the most efficient remedies is the Fluid Extract of Pink Root and Senna. The dose for an adult, is a tablespoon- ful, and half a teaspoonful to a teaspoonful for children, every four hours until it purges. This will probably end the round worm. Wormseed Oil, in doses of five to fifteen drops on sugar, three times a day for two or three days, followed by a purge of Castor Oil. is successful treatment. It may, also, be given with the Fluid Extract of Pink Root and Senna. Santonine is an efficient remedy against the round worm. It is tasteless, and may be given with sugar, or sprinkled on bread and but- ter. The dose is from half a grain to five grains, according to the age of the patient. It should be given three times a day, for a couple of days followed by a purge of Calomel or Castor Oil. After the purge, it should be given for a couple of days, to destroy any worm which may recently hatch. Another effectual plan is, to take a purge in the morning, fasting during the day, and take at night five grains of Santonine with twenty grains of Calomel, for an adult, or one or two grains of Santonine and five grains of Colomel for a child. The next morning a purge of Senna should be taken. An infusion (tea) of Senna for this purpose may be made by steeping an ounce of Senna leaves in a pint of water. One-fourth of this is a dose for an adult, and one or two tablespoonfuls for a child. It can be flavored and sweetened to suit the taste. The common remedy, Turpentine, ought not to be given, unless neces- sity compels it. It is not reliable against worms, unless given in doses of a tablespoonful, and then unpleasant effects may follow. If used, it should be given with twice the amount of Castor Oil. HOMOEOPATHIC TREATMENT. The long worm is most surely removed by Cina (worm seed,) and the form in which it is best, is the San- tonine (an alkaloid of worm seed, as Quinine is of Peruvian Bark.) This 308 DISEASES OF THE INTESTINES. can be given in doses of one or two grains, twice each evening for two- days; then omit for one week, and repeat until twelve doses are taken. This remedy can usually be obtained in the shape of candy, called San- ton ine Lozenges, containing one grain each, and are to be given as directed above. After the child has taken this remedy, the clothing or bedding which comes in contact with the urine, is almost always stained yellow or straw color, which is no cause for any alarm. It is best to keep the child from eating farinaceous food the day previous to taking the medicine. For conditions or symptoms remaining after the worms are removed, see Cina, Nux-vomica, Spigelia, Mercurius, Pulsatilla, at the close of this chapter. The tcenia or tape wo?*m is from three feet to twenty or more yards long, is smooth the best part of its length, and about a quarter to a half of an inch wide; towards the extremity representing the head, its shape is more rounded and thin, and the head itself is thin as a thread. The color is of a faintish white, with a yellowish tint. The worm consists of the very small head, which is sucked fast in the intestinal mucous mem- brane, and to which a neck of the thinness of a thread, and half an inch in length, is attached, from which neck, the single links of the worm afterwards proceed. At first, these links are narrow, but rather short than broad, so that the worm exhibits a series of closely-crowded trans- verse lines; the further removed from the head, the more the length of these links increase in proportion to their breadth, until the last links acquire a length of half an inch to one inch and more. The worm grows in length from head outward, until the last full- grown links become, sooner or later, detached, and are expelled with the stool. The taenia has its principal abode in the small intestines, and is only exceptionally met with in the large. Generally, there is only one taenia found in the same individual, although we are acquainted with one case where twenty-one worms were discharged by the same person. Such cases are, of course, very rare. As in the case of other worms, so are the disturbances caused by the taenia exceedingly various, both in kind and degree of intensity. It may be safely asserted, that in the majority of cases, the taenia causes very lit- tle trouble, and that the patients do not become aware of its existence, until a few links have been expelled with the stools, when a variety of ailments and distresses are forthwith traced to the taenia, which, in real- ity, are the work of the imagination, rather than of the taenia. The mildest disturbances which the taenia occasions, are winding, twisting, colicky pains around the navel, not very intense, setting in paroxysm- ally, more particularly after eating certain kinds of food, and in the morning, when the stomach is yet empty. Generally, these pains are associated with a little nausea, or even with a sensation of canine hunger. but these symptoms are so trifling, that they are only complained of when the patient has become perfectly certain that a taenia is growing in his bowels. Under circumstances which it is difficult to analyze, more intense disturbances may show themselves, a disconnected enumeration of which we here subjoin : violent colicky pains in the bowels, or a creep- ing or crawling sensation, as from a worm around the umbilicus, with WORMS. 309 increased secretion of saliva, nausea, even vomiting, especially after eat- ing fermented food, herring, sharp condiments, sour fruit. Increased appetite, canine hunger, in spite of which the patient emaciates ; itching of the nose and anus ; sickly complexion ; low spirits and irritable mood; irregular stool, alternately normal and diarrhoea; headache, disturbed sleep, vivid dreams; palpitation of the heart; changes in the sound of the voice. Finally, the above-mentioned more striking affections of the general nervous system, which can be traced with more certainty to the presence of taenia. The presence of taenia can only be diagnosed, with perfect certainty, if the patient has actually passed links of the worm. Many lay-persons are too anxious to attribute their ailments, gastric derangements, such as heartburn, water-brash, etc., to the presence of taenia ; especially, if they experience a sensation as if a worm were crawling about in the stomach, or up the oesophagus ; if, in such a case, no links are passed within a few weeks, it is pretty certain that there is no taenia. Most links are passed spontaneously at the time of the new moon. ALLOPATHIC TREATMENT. Tape Worms. In the treatment of tape worm the patient should fast for a day, taking a little milk or beef tea only. In the evening a purge should be taken of a tablespoonful of Castor Oil, a tablespoonful of Epsom Salts, or three drops of Croton Oil. After this purge operates, the worm is exposed to the full effect of the medicine which should then be taken. One of the most efficient remedies we have against tape worm, is Pumpkin Seed. Two ounces of fresh seeds are to be pounded in a mortar with half a pint of water, until the husks are separated, and the meats thoroughly incorporated with the water. The mixture is strained and taken, the fastings in the meantime continuing. The dose may be repeated in three hours, and in three hours more a purge of two teaspoon- fuls of Castor Oil should be taken. If the worm is not removed, head and all, the treatment is to be repeated the next day. The pressed Oil of Pumpkin Seed may be given instead of the above emulsion in doses of a tablespoonful two or three times, and followed by the Castor Oil purge, as before directed. After the preparatory treatment of fasting and a purge, a dram tea- spoonful of the Oleo-Resin of Male Fern (Felix Mas,) give a fourth part thirty minutes apart, on two successive days, followed by a purge of Castor Oil (two teaspoonfuls) ; or three drops of Croton Oil is an effectual remedy against tape or round worms in persons of any age. It can be given in syrup or mucilage. Should necessity compel the use of turpentine, one or two table- spoonfuls, with an equal quantity of Castor Oil, should be given after the preparatory treatment. As a preventive of intestinal worms of all kinds, only filtered water should be drunk. Meat should be thoroughly cooked, but it is not neces- sary to cook it until dry. Fruit and vegetables should be made clean before eating. Tonics following the treatment are useful. HOME TREATMENT. Tape worm is easily expelled by the use of either of the following: Take Kousso three to four drams, place in a common goblet or tum- bler, and pour cold water upon it until the glass is well filled, being care- 310 DISEASES OF THE INTESTINES. ful that none of the powder is left floating on the surface ; let it stand overnight, and in the morning, after taking nothing more than a small cup of black coffee, drink the medicine in two portions, half an hour apart. If there is a disposition to vomit, a little lemon juice may be swal- lowed. In from two to five hours after taking the medicine, the worm is expelled. No need of a cathartic. Pumpkin seeds two ounces, peel off the outer covering, bruise well r mix in a little water, and use as directed above for Kousso, except if the worm does not come away in six hours, use a cathartic or an injection of Oil. COSTIVE1TESS-CONSTIPATIOX— OBSTIPATION. This complaint is generally sympathetic with some other derangement of the organism, and consequently, in our treatment of different diseases, we have had frequent occasion to allude to it. One of the leading causes of aggravation and excessive obstinacy in the constipation, is the practice of flying to laxative medicines on the slight appearance of.costiveness, under the absurd idea, that keeping the bowels open is a species of panacea against disease of every description. Many mothers are so possessed with this idea, that they continually administer physic to their children, with- out the slightest apparent call for it,- and thus lay the foundation of dyspepsia and other visceral derangements in after life. Many a slight case of costiveness, which, if left to nature, would have disappeared of itself, leaving no ill consequences, has, by an ill-judged administration of aperients, been converted into obstinate and habitual constipation, embit- tering existence, and predisposing the constitution to a variety of diseases in after life. To prevent misconception upon this point, it should be clearly understood, that we by no means undervalue a regular state of the bowels, but, that when costiveness shows itself, we happily possess reme- dies calculated to restore the general balance of the system ; and in obstir.ate cases, do not content ourselves with simply alleviating the symptoms, but mainly direct our attention to the permanent removal of the affection. Many of the principal causes of this disorder, besides that mentioned, are the same as those particularized under Indigestion or Dyspepsia. ALLOPATHIC TREATMENT. Constipation is to be treated, always, with reference to the producing cause. In temporary constipation, as that of pregnancy, and in recovery from acute disease, is to be met, chiefly by attention to the diet ; but, if this fail, recourse should be had to laxa- tives, or, possibly, in the first place, to an active purge. If there is com- plete obstruction, the disease is too serious to be tampered with by any but the most skillful man. In habitual constipation, there should be a regular effort at stool, at a regular time, whether the desire exists or not. The preferable time for this is soon after breakfast. As a preventive of constipation, the natural desire to go to stool should never be voluntarily restrained. The constipation should be remedied, as far as possible, without medi- cines, but by laxative food. Vegetable diet tends toward a looseness of the bowels, and animal food, by being almost wholly absorbed, to consti- COSTIVENESS. 311 pation. The articles of diet to be preferred for this end are, cracked wheat, graham flour, indian meal or hominy, and oat meal, prepared according to the art of the kitchen, eaten with cream and sugar, or with butter and molasses. Almost all kinds of fruit, taken quite freely, are advantageous ia overcoming constipation. Molasses and brown sugar aid to make the bowels more lax. Milk is constipating, but only, I believe, because it is almost wholly absorbed. None of these articles of diet are to be used, if they disorder digestion or occasion other disturbance. Sometimes more harm is done by burden- ing the stomach and bowels with articles difficulty of digestion, or loading the intestines with unbolted flour, than could be done by the constipa- tion. In the use of medicines, the patient should not, as a rule, be physiced, but the least active medicines which will accomplish the result, are to be used. If, however, constipation has for a long time been present, and the bowels filled with fecal accumulations, a cathartic, which will thor- oughly empty them, is a necessity. For this purpose, a tablespoonful of Epsom Salts is a most efficient remedy. If boiled with a teaspoonful and a half of roasted coffee, for a couple of minutes in an earthen vessel, and after it is allowed to draw for a few minutes and strained, the taste will be covered. A tablespoonful of Castor Oil, mixed with an equal quantity of Gly- cerine, flavored with a couple of drops of Oil of Cinnamon or Wintergreen is appropriate under the same conditions. From three to five Compound Cathartic Pills, are also suitable for an immediate cathartic. Cathartics must not be frequently repeated, as this secondary effect is to render the bowels torpid; therefore, the smallest dose and the mildest means which will accomplish the result, should be resorted to, and prefer- ably those which have the peculiarity of not causing constipation after their action. One of the best of this class is Aloes. As a cathartic, the dose is from two to ten grains, but a fraction of a grain, with tonics, suffi- ces, generally. The remedy is well suited to all causes of debility in this disease, and to cases of hypochondria as with constipation. With sedentary persons, who cannot change their occupation to an active life, and women who suffer from a torpor of the intestines, and con- sequent constipation, the following pill will be found, in most cases, to overcome the trouble: Take of Extract of Nux-vomica, Extract of Belladonna, each ten grains ; Powdered Aloes fifteen grains, Extract of Dandelion thirty grains. Mix well, and divide into thirty pills. Take one pill at night. If the bowels do not move next morning, another pill should be taken, but, usually, one a day will be sufficient. If this proves too active, the Aloes should be omitted from the formula. The directions for taking will be the same. After the bowels have been moving regular for a long time, the pill should be omitted, ar.d only taken again if the regular opening of the bowel does not continue. For those who cannot take a pill, the same remedy may be given ia fluid. 312 DISEASES OF THE INTESTINES. Take of Tincture of Nux-vomica, and Tincture of Belladonna, each two and a half drams, and of Tincture of Aloes and Fluid Extract of Dandelion each five and a half drams. Mix. Dose: A teaspoonful, under the same conditions. The Dandelion is not necessary to the efficiency of the prescription. The Belladonna and Nux-vomica restore the tone and healthy action of the intestines, and seem, in my judgment, essential, particularly the latter, for the cure of many cases of constipation. There are many pills in the market for the relief of constipation, which have merit, as the Eccoprotic Pill of Wm. Warner & Co., and the Aperient Pills of other leading phar- maceutists. Before purchasing any of them, it should be ascertained that they contain Extracts of Nux-vomica and Belladonna, or Hyoscyamus. Palmer's Anti-constipation are a good remedy. Dose : One pill once or twice a day. From ten to twenty drops of the Tincture of Colchicum after each meal will often overcome constipation. Podophyllum is an appropriate laxative for constipation ; a quarter of a grain is an appropriate dose. It is often used with benefit with Belladonna and Nux-vomica, as may, also, be the Compound Extract of Colocynth, the dose of which for this purpose being two grains. One or two Compound Cathartic Pills, at night, relieve constipation, but do not produce a cure, as a rule, without the use of Nux- vomica or Strychnine. Senna is not inappropriate as a laxative. The Confection of Senna may be eaten, one or two teaspoonf uls at a time, or a tea of ten ounces of Senna leaves to a pint of water may be made, and one to four ounces taken at a time. Co-existing dyspepsia will require treatment as directed in that disease. A general debility will require tonics of Quinine and Iron. The Citrate of Iron and Quinine two drams and a half, dissolved in four ounces of Syi^up of Orange Flowers, is one of the best tonics. Dose: A teaspoonful three times a day. The Syrup of Elixir of Iron, Quinine and Strychnine, in doses of a tea- spoonful, three times a day, are appropriate. Many other tonics might be given, and are particularly suitable to cases afflicted with constipation. If a person is of a full habit, a teaspoonful of Epsom Salts daily, is an effectual remedy for his habitual constipation. The regular use of an injection of cold water, is a simple and often effectual temporary measure for relieving constipation. A piece of hard soap, about the size and shape of a pigeon's egg, will sometimes excite a movement of the bowels. These are only temporarily useful. An effectual cure almost always depends upon the will, establishing the habit of a regu- lar motion, with the tone restored to the intestine, by the use of Nux- vomica and Belladonna. If these are given for a time with Aloes or Podophyllum, the cathartic should then be omitted, and the Belladonna and Nux-vomica given alone. If the plan before suggested, of having a regular time for stool, and allowing nothing to interfere with it, were rigidly carried out, and taught by parents to their children, constipation would be a disease as seldom met with, as it is frequent now. HOMCEOPATHIC TREATMENT. In trivial cases it will be found suf- ficient to pay proper attention to diet, to avoid too dry or indigestible food, COSTIVENESS. 313 to masticate properly, to partake of meat only once a day, and to take sufficient exercise in the open air. Should this course not have the desired effect, we must choose one or more of the following remedies: Opium is chiefly to be selected in recent cases, when constipation is not habitual; but is, also, like Nux-v., and other remedies, serviceable in cases of a more chronic character, occurring in vigorous, plethoric, well- nourished subjects, and arising from inactivity in the intestinal canal, or from sedentary habits. In old people, it is generally more useful than Bryonia and Lachesis, when diarrhoea alternates with the constipation, although these, and other remedies, such as Antim., Phosph., and Ruta, must be borne in mind, and, administered when called for by the nature of the symptoms. The more immediate indications for Opium, are: want of power to relieve the bowels, with a feeling of constriction in ano ; pulsa- tion and sense of weight in the abdomen, dull, heavy pain in the stomach, parched mouth, and want of appetite, determination of blood to the head, with redness of the face, and headache. Dose : Six pills every twelve hours. Nux-vomica. This remedy is particularly useful when constipa- tion results from too heavy a meal, indigestible food, and stimulating liquids ; or when the confined state of the bowels has resulted from pro- longed diarrhoea, or frequent purgings. In the latter instances, Opium may often be advantageously alternated with Nux-v. In obstinate cases, arising from long-continued indulgence in vinous, fermented, or spirit- uous drinks, or coffee, or from sedentary habits or excessive study. Nux-v is one of the most effectual medicaments. It is peculiarly adapted to per- sons of irascible and lively temper, with determination of blood to the head, and headache, unfitness for exercise, disturbed sleep, and a feeling of gen- eral oppression, or heaviness; frequent and ineffectual efforts to relieve the bowels, attended with sensation of stricture, and sometimes frequent, painful and difficult emission of urine. It is, further, as remarked under the head of Indigestion (which see, for other indications for this rem- edy) particularly indicated for individuals subject to piles. Dose: Six pills, taken in a teaspoon ful of water every night, until amelioration or change. Pulsatilla. Has nearly the same indications as Nux-vomica, with the characteristic distinction of temperament before noted under the head of Indigestion, (which see). In recent cases, it is particularly indi- cated when the obstruction has arisen from indigestion brought about by rich or greasy food, and when it is accompanied with moroseness and shivering. Dose : Six pills, as directed for Nux-vomica. Alumina is useful against constipation, from inactivity of the bowels ; motions hard, dry, broken, evacuated with considerable exer- tion and forcing, and sometimes streaked with blood ; constipation from traveling. Dose : Six pills in a teaspoonful of water every evening, or every night at bedtime, until amelioration or change. Bryonia is especially useful in constipation occurring in ivarm weather, and in persons of dark complexion, and of irritable or obstinate disposition, with a tendency to be easily chilled, and subject to rheumatism ; it is further indicated, when constipation arises from dis- 314 DISEASES OF THE INTESTINES ordered *to/nach, and is attended with determination of blood to the Tiead, and headache. Dose: Six pills in a teaspoonful of water, repeated in twenty-four- honrs, even if partial relief ensue. In chronic cases, six pills may in like manner, be taken daily for ten days, or until positive ameli- oration or change. JPlatina is a useful remedy, when constipation has been brought about by traveling, when Opium has failed ; or especially when the act of expulsion is attended with straining, and when a feeling of weakness is experienced in the bowels after a stool, sometimes accompanied by shuddering. Dose : Eight pills in a teaspoonful of water, night and morning, until amelioration or change. Sulphur is one of the best remedies in the relief of habitual consti- pation, particularly, when haemorrhoids are present, or a disposition to them exists ; costiveness ; with hard, bullet-shaped stools ; or frequent inclination to go to stool, but without the desired result. Dose : For adults, six pills, for young persons, four pills every morn- ing the first thing (fasting,) until amelioration or change; or for ten days, then pausing four days ;— after which, if requisite, the same course may be resumed, and so on. Sepia may frequently be taken with advantage, in olironic consti- pation, after Nux-v. and Sulphur ; and is, moreover, particularly well adajDted for females, in whom there is an irregularity, or obstruction of the menstrual discharge ; it is also indicated by constipation in individuals subject to rheumatism, as well as by hard, conglomerate, bullet-shaped motions, and stoppage of the bowels. Dose : When the disorder is not of very old standing, give six pills in a teaspoonful of water, every twelve hours, until amelioration or change. In very inveterate cases, six globules, as directed for Sul- phur. Ivycopodium. Chronic constipation with ebullition and determina- tion of blood to the head ; colic, flatulence, sense of weight in the lower part of the bowels. Dose : For adults, four globules, or, for young persons, three globules in a teaspoonful of water, every twelve- hours, until amelioration or change. CONSTIPATION ALTERNATING WITH LOOSENESS. Rhus-tox., Antimon-crud., Ruta, Phosphorus. One or more of these four medicines may be advantageously administered singly, in alternation, or in succession, in addition to such of those already men- tioned, as correspond with the features of the case, when the costiveness or constipation occurs in alternation with looseness. Dose: Of the remedy selected, give four globules in a teaspoonful of water, every twelve hours, until amelioration or change, or for ten days, if requisite ; then pausing four days, and resuming the course, if yet required. JEsculus-hippocastanum {Horse-Chestnut). Dull headache. Dis- tress in the stomach. Desire for stool and pains in the abdomen. Con- gestion of the liver, which pains by walking; it acts when Nux-v. and Sul- phur fail to cure. Do.se: As directed for Baryta-c. (See next page.) COSTIVENESS. 315 Collinsonia-canadensis (Stone Root). Headache. Constipation with flatulence. Sluggish stool with distention of the abdomen. Intense heat and itching of the anus. Dose: As directed for Bar yta-c. Hydrastis-canadensis (Golden Seal). In chronic and obstinate con- stipation. Jtose : As directed for Baryta-c. Phytolacca-decandra (Poke-Weed). Long-standing constipation. Pains in the abdomen, when moving. Dose : As directed for Baryta-c. TodophyUum-peltatum (Mandrake). Pain in the forehead. Acute and chronic constipation of long standing. Dose: A small powder of the first trituration when rising and when going to bed, will make a permanent cure in ten days. CONSTIPATION OF AGED PERSONS. Baryta-c. will often be found of great service in cases of this kind, in addition to, before, or after, such of those medicines, named in the foregoing part of this article, as correspond most closely with the case in question. The particular indications may be gathered from the article upon the characteristic action of the medicines. Dose : Four pills in a teaspoonf ul of water the first thing in the morn- ing, (fasting) until amelioration or change, pausing, however, for four days, after a course of ten days, if the administration should require to be continued so long. CONSTIPATION OCCASIONED BY PURGING. China is particularly appropriate to the treatment of constipation, which occurs as the result of previous and violent purging, continued looseness, and the like. Do.se; Four pills in a teaspoonf ul of water every twelve hours, until distinct amelioration or change. PROLAPSUS AXI-FALLIXG DOWX OF THE LOWER PART OF THE INTESTIXES. A profusion of a portion of the rectum, or of its internal coat from the anus, is denominated a prolapsus or procidentia ani. In some cases, a con- siderable portion of the rectum comes out to the extent of three or four inches, in others only a little, it presents a circular dark red, pad-like lump, from the size of a small hulled black walnut to that of a goose-egg. Causes. Anything which tends to weaken the muscles which sup- port the intestine. Among these are the frequent use of cathartics (phy- sic,) especially, those containing Alces, Epsom Salts, etc. The presence of pin worms, (ascarides) in the lower portion of the intestinal canal, habitual costiveness, piles, straining at stool during diarrhoea, or dysentery (flux.) or w T hen straining to pass water. This is much more frequent among child- ren than grown people. In some cases, the intestine remains out a considerable time without any ill consequences, but more commonly it swells and inflames very speedily. TREATMENT. When this accident occurs, some person of strong and steady nerve, should at once attempt to replace the protruding parts, by 316 DISEASES OF THE INTESTINES. first oiling the parts well with fresh lard, Sweet Oil, Tallow, fresh butter not salted, or sweet cream; then second, make steady, not very hard, pres- sure in the center of the protruding parts, with the well oiled thumb or thumb and forefinger ; occasionally, if necessary, making light pressure on the outside of the tumor with the thumb and finger of the other hand, near the anus ; when it will slowly, or in some cases, quickly return to its proper place. If, after carefully and perseveringly trying for a reasonable time, ten or fifteen minutes, (which will appear to be a long time,) the parts do not return, send at once for a good and careful physician. This trouble having once occurred, is liable to occur again. The best means of preventing this, is a quiet position and careful attention to the diet, which should consist of the plainest aliment; rye mush and sugar is very good food in such cases. The Homoepathic remedies, which will usually permanently relieve the tendency to return, and, also, help in the moment of the accident, are in the order of their names, Nux-vomica, Ignatia, Jlercurius, Sulphur, Podo. Hydropathic in connection with careful diet, take a cold sitz bath every evening. This bath is, also, generally used by the homoeopath. ECLECTIC. Gently push the protruding part back into the body and inject into the bowels the following: Take of Crowfoot or Alum Eoot, White Oak bark, each in coarse powder, a tablespoonf ul ; make half a pint of strong decoction (tea,) to which add half a tablespoonf ul of powdered Alum. This should be injected cold two or three times a day ; when very severe, a bandage will have to be worn to keep the bowel from falling. Internally let the child drink freely of tea, or equal parts of Golden Seal and Solomon's Seal. The child should be taught not to strain during stool, and its diet must be similar to that recommended for costiveness. If while the bowel be firmly held in place by a tight bandage, the child be made to lift several times every day, a weight proportioned to its strength, it will aid materi- ally in overcoming the difficulty. FEFITOMTIS—IXFLA3I3IATIOX OF THE FEFITOXEFM. Causes. In the main, the origin of the disease is traceable to the following causes: After all injuries which bring the peritoneal cavity in contact with atmospheric air, peritonitis may be expected in the majority of cases. Although the inflammation very often remains confined to the injured locality, yet it will almost certainly spread over a larger j:>ortioii of the peritoneum, if blood, pus, or a quantity of atmotpheric air enters the peri- toneal cavity. This point deserves the utmost consideration in operations upon the abdominal cavity. The danger of inflammation is likewise greater, if the abdomen is very much distended before the operation, and collapses after it; hence, peritonitis is very apt to occur after tapping for dropsy, and after operations during confinement. An intense cold will sometimes cause peritonitis among persons, who are otherwise perfectly healthy. Among women, a cold may be a mat- ter of great importance. There is no question, that confinement and the menses are very apt to cause peritonitis : especially, if a cold super- PERITONITIS. 317 venes at such times. This observation is so common, even among lay- people, that women have become accustomed to be very careful at such times. The disappearance of the menses, or of lochia, at the commence- ment of the inflammation, has given rise to the theory, that it is this suppression which causes the inflammation ; it seems to us more simple, and more natural, to reverse this relation of cause and effect. During confinement, the collapse of the distended abdomen exerts a powerful influence; hence, peritonitis is more apt to occur in the case of women, who have borne several children, than among primiparae; By far the most violent forms of peritonitis, and which run the most rapid course, occur, if an organ becomes perforated, and its contents, or even the smallest portion thereof, escape into the peritoneal cavity. This occurs most frequently in the case of perforating ulcer, ulcerations of the intestines, and gangrenous destruction, consequent upon stricture of the intestine. Symptoms and Course. These, of course, not only differ in degree, according as the inflammation is confined to small portions of the perito- neum, or, as diffuse peritonitis invades the whole of the peritoneal expanse ; even the diffuse form differs, according as it develops itself sud- denly, or by degrees. Acute, diffuse peritonitis, either if caused by perforation, or when setting in as an idiopathic affection, almost always commences with a severe chill, attended with pain in the abdomen. This pain, which is the most characteristic symptom of the disease, is most intense from the very moment it is first felt. The pain is, as though a pointed knife were plunged through the abdomen, from above downwards, without the patient being always able to indicate the precise starting point of it. Immediately after, a feeling of illness overtakes the patient, he feels unable to remain up, and he is satisfied that a severe sickness is upon him. If peritonitis sets in, in consequence of the gradual spread of some other affection of the bowels, its own development is gradual ; the existing local pains increase in intensity, and gradually spread over the whole abdomen, at times rapidly and at others more slowly. In violent cases, the invasion of the pain is not at once followed by violent fever; on the contrary, the patients die in a state bordering on syncope, with cold extremities, and it is only the extremely hurried pulse that indicates the approach of a violent fever, which is scarcely ever more than twenty-four hours in coming. From its first beginning, the pain never abates one moment, except, that it some- times seems more like a colicky pain ] as the pain spreads the abdominal walls become so sensitive, that the patients cannot bear the least pressure, so that it is even a relief to them, if the blankets or sheets do not touch the abdomen. The least motion increases the intensity of the pains to such an extent, that the patients have to lie on their backs motionless, and dare not draw a deep breath, because the pain is aggravated by the pres- sure of the descending diaphragm; they even have to speak in a low whisper. The pains are at times tearing, at others stinging, lancinating, but most of the time fiercely burning, and with a soreness as from an open wound. Sometimes the disease sets in with violent vomiting, and diar- rhoea, almost like cholerine; in such a case, the act of vomiting causes intense suffering. The general symptoms betray, at first sight, the exist- ence of an intense disorder. At the first onset of the disease the face 318 DISEASES OF THE INTESTINES. looks pale, with a peculiar expression of distress and anxiety, and with pendulous features; afterwards the face looks flushed, or else the paleness remains throughout the whole disease, in spite of the fever. The eyes are dull and unsteady. The breathing is hurried, is carried on with the ribs only, the speech is short, a mere whisper. The tongue is usually quite clean ; there is a craving for cold water, yet only a small quantity can be drank at one time. Retching and vomiting, unless present. at the first, are very apt to supervene ; otherwise these phenomena and the diarrhoea dis- appear as the disease increases in intensity; as a general rule, the peritonitis is attended with complete retention of stool the first eight days of its existence. The urine is always less ; voiding it is often painful, or there is constant urging, yet no urine is voided. The pulse is hurried, from one hundred and twenty to one hundred and sixty beats, and soon becomes small, hard and tense. The skin is dry and constricted, although profuse and exhausting sweats sometimes break out ; the temperature varies from a burning heat to a disagreeable coolness. An examination of the abdomen is difficult, on account of the pain, which is aggravated by the least attempt at percussion. Soon after the pains are felt, the abdomen becomes more and more distended, so that the distended bowels can be felt through the abdominal walls. The sleep is very much disturbed ; if the patients sink momentarily into a sort of slumber, they at once become delirious. All such patients habitually lie on their backs, with the lower extremities slightly drawn up toward the abdomen. In the further course of the disease, the symptoms generally undergo the following changes: The distention of the abdomen increases more and more, although its painf ulness to contact generally decreases in proportion as the exudation becomes more copious ; it even happens, that the sensi- tiveness disappears entirely. This, however, is a bad symptom, if, at the same time, the whole condition of the patient seems to change for the worse. The difficulty of breathing corresponds to the degree of meteoristic distention- The anguish increases, the lips become bluish. The pulse is a little slower than at the commencement of the fever, but its quality remains the same; it does not indicate any remission of the fever, whose intensity continues unabated. If the disease terminates fatally, the general sensorium is overwhelmingly brought under its influence, the patients grow apathetic, do not feel any pain; the pulse becomes imper- ceptible, the face has a sunken, cadaverous appearance. Death may take place in thirty-six hours, and seems to be principally caused by paralysis of the bowels; the disease, however, seldom terminates in such a short period of time; it generally continues until the seventh day. ALLOPATHIC TREATMENT. The one remedy, without which acute peritonitis cannot be treated satisfactorily, is Opium, and it is invaluable. It should be given in doses of one grain, from two to four hours apart, until the pain is completely relieved, after which the dose should be repeated sufficiently often to maintain freedom from pain. This treat- ment, alone, will often save the patient's life. Right hot poultices, applied over the abdomen, will benefit,- if their weight does not cause distress; or the ointment of Extract of Belladonna and Extract of Opium may be smeared upon the skin of the abdomen and hot fomentations. The appli- cations should be kept hot. PERITONITIS. 319 Cathartics should, in no wise, be given, but if there are feces in the large intestine, an injection may be cautiously given. Nourishment should consist of milk, cream, raw eggs and beef essence. Upon the first indication of exhaustion, stimulants should be given in doses of a tablespoonf ul of brandy at intervals, varying from two to four hours apart. HOM(EOPATHIC TREATMENT. Aconitum. For many forms of peritonitis, Aconite is undoubtedly the most suitable and surest remedy. It is the specific remedy, if the inflammation either spreads further from a circumscribed spot, or increases where it sets in with more local symp- toms, without the accompaniment of the general disturbances, which are sometimes truly fearful, except, perhaps, the presence of an intense fever. It is in this manner, that inflammations, with an excess of plastic, exudation, generally announce themselves. Observation has shown, that in inflammation Aconite is only useful until the exudation is completed At this stage the pulse, in inflammations, for which Aconite is indicated, becomes somewhat slower and stronger, and the pain abates in a marked manner, which is seldom the case before the fifth day of the disease. All physicians agree, that one of the lower attenuations should be given in repeated doses. Dose: Six pills in a little water every hour or two, until the fever is somewhat under control. It is frequently well to alternate with Belladonna. Belladonna is suitable only at the commencement of peritonitis. It competes with Aconite, if the local symptoms are accompanied by severe congestions of the head and chest, with anguish, dyspnoea, restlessness, dark-red and bloated face; and continual and distressing vomiting of bile, which changes about with retching. The exudation is profuse, and the intestines are distended at an early stage of the disease, so that the single convolutions can be distinctly felt through the abdominal integuments. Intestinal catarrh, which may be present during the first days of the disease, is an additional recommendation for this drug, so is the development of this inflammation from enteritis. Belladonna is likewise an excellent remedy for the vomiting, which is apt to set in, in the subsequent stages of the disease; in this respect it is only surpassed by Arsenic in a few cases. The abatement of meteorism designates exactly the period when Belladonna is indicated. Dose : Six pills as directed for Aconitum. If in alternation with Acon- ite, give a dose of one, and in one or two hours a dose of the other, and so on. Veratrum, album is related to Belladonna in some respects. If the disease sets in in the form of chlorine; more particularly, if the vomiting is copious and frequent, at the same time the patients look pale and sunken, and feel cool to the hand ; the pulse is small at the onset, and the anguish, restlessness and thirst are exceedingly distressing, Veratrum is the appropriate remedy. As a general rule, the disease assumes this form in the first three days ; afterwards other remedies have to be employed. Dose: As for Aconite. Mercurius is less adapted to peritonitis than to enteritis. The ten- dency to suppuration is the best indication for this remedy. Hence, it is in the second and third week, that Mercurius must be given ; and the 820 DISEASES OF THE INTESTINES. more special indications are the above-mentioned phenomena, character- izing the process of purulent metamorphosis. It is the frequently exacer- bating fever, with creeping chills, and copious perspiration after the heat, which points to Mercury. In partial peritonitis, on the contrary, as soon as the inflammation is localized, Mercurius may be given at the onset. It is likewise appropriate, if the purulent exudation seeks to penetrate to the outside and form an abscess. These four remedies are the only ones that need be given in the first stage of the disease. In the further course of the disease we may have to administer : Bryonia alba. It comes into play at the most decisive period in the development of the disease, namely : when we desire to remove the effused fluid as soon as possible It is almost certain, that under the influence of Bryonia the exuded fluid will be reabsorbed without causing any further derangements ; hence, that no suppuration will take place. But the medi- cine should be used consistently ; we cannot expect to obtain results in a day, that can only be obtained in from ten days to a fortnight. As a gen- eral rule, Bryonia is not indicated, if a copious diarrhoea is present; this, however, is a rare occurrence in the second stage, and, if it does occur, it is a bad omen. Dose: Six pills in a little water every two to three hours. Sulphur is a second remedy we make use of in order to promote, or indeed, to excite the absorption of the exuded fluid. In cases where Bry- onia leaves us in the lurch, or effects the absorption of the exudation only to a certain point, Sulphur is entirely appropriate. It acts even when the remaining portion of the exuded fluid had been left for months without any alteration. Arsenicum album is very closely related to Veratrum album symp- tomatically ; in a present case, it is difficult to decide between the two remedies, especially at the commencement of the attack. In the further course of the disease, it is particularly the continued, violent, colicky pains, that point to Arsenicum; which is, likewise, sometimes indicated by the gradual development of the inflammation out of gastritis, the per- forating ulcer, or ulceration of the bow T els. We must not allow ourselves, by the peculiarities of the picture of the disease, more particularly by the extraordinary restlessness and anxiety, to be too readily induced to use Arsenic, as is so easily the case at the commenceinent of the disease. If Arsenic acts as a homoeopathic specific, the reaction must not be pros- trated, on the contrary it must be vehement ; hence the fever must be violent and continued. Dose: Three pills every three to four hours. It remains for us to mention several drugs, to which attention must be directed under certain circumstances. Opium, in small doses is some- times useful against the paralytic weakness of the intestinal canal, which often remains after the disappearance of the exudation ; the intestine is unusually distended, and the constipation is complete. JSux-vomica is still more preferable, under such circumstances, only the meteorism must not be too great. In general, it is an excellent remedy in equalizing the remaining trifling irregularities in the digestive functions, especially, the torpor of the bowels. The medicines we have indicated are most probably sufficient in every case of peritonitis without any unusual complications. PERITONITIS. 321 HOME REMEDIES. Although we have every reason to depend upon the efficacy of our means of treatment, yet the disease is so dangerous, its first invasion fills the patient with so much anxiety, and it is so exces- sively painful, that we are anxious to find out and apply such remedial agents, as will afford a momentary relief from the pains; and will, per- haps, exert a curative influence upon the morbid process generally. The chief palliatives are injections and fomentations. It is impossible to decide before hand, whether cold, or warm, moist, or dry applications deserve a preference. At first, when the pains are jiery violent, the patient usually prefers cold applications, ice-cloths, or even a bladder filled with ice. There are, however, exceptions to this rule, more particularly the cir- cumstance that patients cannot bear the least weight on their bowels, on account of the extraordinary sensitiveness of these parts. Warm and moist fomentations are generally best applied on the fifth day, in some cases, the patients prefer them at the very beginning of the disease; they are more especially useful, if the patients perspire very copiously. They should never be applied too hot, for too high a temperature is prejudicial. What had best be applied in a given case, will have to be decided by an actual trial, but such an experiment should be instituted with great care,, lest obstinacy in waiting for a result, should prove injurious. As a gen- eral rule, the fomentations that do not afford relief to the patient within a few hours, or are otherwise than pleasant to his feelings, are not adapted to his condition. As regards the wet sheet, it is one of the best means of reducing the inflammation. At first, these wet clothes should be applied to the abdomen alone. In view of the great sensitiveness of the abdom- inal walls, it is doubtful whether such an application can be frequently repeated. Simple injections of water, whether cold or tepid, are exceed- ingly beneficial. If used at the commencement of the disease, they will prove sufficient to remove the paralysis of the intestinal canal. During convalescence, injections of water often render excellent service. In scarcely any other disease, the diet deserves more careful attention than in peritonitis. There is no necessity of enjoying special rest, since the pain, which the patient suffers, renders movement almost impossible. The room should be kept at a uniform temperature of about fifty degrees, F., the air should be kept fresh, and the patient should only be lightly cov- ered. Feather beds should never be used as a covering. Very frequently, all kinds of covering should be kept from the abdomen by some suitable contrivance, such as barrel-hoops. At the commencement of the disease, the patients are tormented by an agonizing thirst, which can only be quenched by fresh water. Small lumps of ice in the mouth, likewise, ren- der good service, and are particularly suitable, if there is much retching and vomiting. Afterwards, if the appetite commences to return, such food should be used as will leave the smallest amount of fecal matter to be car- ried off by the bowels. Give beef broth early, and often enough to pre- vent exhaustion. 21 PART SIXTH. — ~ .+. ~_ DISEASES DF THE LIVER AND SPLEEN. CHAPTER XIV. «. ,- DISEASES OF THE LITEE. INFLAMMATION OF THE LIVEK. This disease is divided into the acute and chronic ; the latter gen erally goes by the name of Liver complaint, although, a careful con sideration of the symptoms, will frequently discover that the real dis- ease is in the stomach and intestines ; however, in many cases, the liver itself becomes much affected from this cause, and, in itself, deserves considerable attention. When the disease has been for a long time unchecked, and the inflam- mation becomes deeply seated in the substance of the liver, an abcess frequently forms, bursting either externally or internalry ; in the latter case often proving critical, inducing hectic fever. ACUTE INFLAMMATION OF THE LIVEB. This disease is much more common in tropical climates than with us. There, a high mode of living, exposure to heavy dews, or damps in the evening, and the powerful rays of the sun by day, are amongst its princi- pal exciting causes ; but it may, also, arise from violent mental emotions, the use of stimulating, or alcoholic drinks, suddenly suppressed evacu- ations, strong emetics, or purgatives, the abuse of mercury, gall-stones, external injuries, or injury of the brain. Symptoms. These differ according to the seat of the inflammation. When it occurs on the outer surface, or convex side, the symptoms closely resemble those of pleurisy ; there is, generally, a violent pain under the false ribs on the right side, sometimes resembling stitches, at others burning — shooting to the breast-bone, the right shoulder-blade, and point of the shoulder, and even affecting the right foot, — sensation of numbness, or tingling in the arm of the same side, the pain increased by inspiration ; a short, dry cough, and the symptoms of inflammatory fever; bowels irregular, generally constipated, and stools, in the majority of cases, of an unnatural color. 322 INFLAMMATION OF THE LIVER. 323 In this form, the patient can only lie on the left side. When the seat of inflammation is on the inner, or concave side of the liver, the pain is much less, and the patient complains rather of a sensa- tion of pressure, than actual pain, but the whole biliary system is much affected. The eyes and countenance become yellow, and sometimes com- plete jaundice declares itself; the urine is orange-colored, the evacuations mostly hard, and generally, of a whitish or gray color. We also find hitter taste in the mouth, vomiting, and considerable distress. The patient can only lie on the right side. Inflammatory fever is present in this form, likewise. In both forms, on examination, the region of the lower ribs, on the right side, will usually be found hot, tumefied and painful on pressure. Inflammation of the liver, unless properly treated, is apt to assume the chronic form ; it may, also, end in suppuration externally, or inter- nally by a communication, either with the lungs or intestinal canal, or by an abscess in the substance of the organ itself, or may terminate in indurations, or other alterations of structure, in gangrene, or in the form- ation of adhesions. The disease may terminate by resolution, critical transitions to other organs, piles, diarrhoea, bleeding at the nose, or eruptions in the skin generally, erysipelas. ALLOPATHIC TREATMENT. The treatment of congestion of the liver, will consist, as far as possible, in the removal of the causes of the disease. In some instances, there are sedentary life, and too generous living. Great heneflt will be derived in some of these cases, from horse- back riding, hunting, walking, etc., while saline laxatives, as Seidlitz Pow- ders, directly diminish the congestion. The use of beer, and spirits should be discontinued, and the diet made more simple and plain. If the congestion is of long continuance, benefit will result from the use of Dilute Nitro-Muriatic Acid. It may be given in doses of ten or fifteen drops. It should be given before meals, largely diluted in sweetened water, or preferably in a couple of ounces of some bitter infusion, as infusion of Columbo (one ounce simmered in a pint of water). Bathing the right side with a solution of Nitro-Muriatic Acid — three ounces to a gallon of water, is of advantage. DAnking the water from some of the sulphur springs, is sometimes useful. If the patient is debilitated, the use of Nitro-Muriatic Acid should be associated with the use of Citrate of Iron and Quinine, a dram and a half dissolved in four ounces of Lemon Syrup, or of Syrup of Orange Flowers, of which, a teaspoonful may be taken after each meal. If the congestion of the liver depend on disease of the lungs or heart, treatment, will of course, have reference to those affections, and remedies addressed directly to the congestion of the liver, will be only palliative. In inflammation of the liver, there is great danger to life. The intense pain should be relieved by the use of Opium, in doses of a grain, at such intervals as may be necessary to relieve the pain— one or two hours, or longer, apart. The pain must be relieved. Laudnum may be given by injection, in doses of a teaspoonful in a tablespoonful of thin Starch, and repeated once a day. The anodyne effects of this may be increased, if 324 DISEASES OF THE LIVER.. necessary, by giving Opium in doses of a grain, or Morphine in doses of a quarter of a grain, by the mouth . A liniment of equal parts of Laudanum, Tincture of Aconite, Chloroform, and Soap Liniment, may be continuously applied to the right side, over the liver, by means of a flannel, saturated in the liniment, and covered, with oiled silk. The bowels may need acting on mildly, preferably by an injection of warm water. In this disease there is especial danger from suppuration. Tonics and nutritious food are early called for. The best tonic remedy is Quinine and Nitro Muriatic Acid. Two or three grains of Quinine, every four hours, will be appropriate. The jSTitro-Muriatic Acid should be given in doses of ten to twenty drops, largely diluted in sweetened water, at about such intervals as food is given, as an aid to digestion. Such food as milk, eggs beaten up with sugar and water, or milk, given raw, strong beef tea, and animal essences, are appropriate. Should the inflammation, whether embracing the whole organ or limited to a portion, result in abscess, which can be distinguished through the abdominal wall by feeling with the hand (palpation,) it is proper to open it. If the surface of the liver is adherent to the inner surface of the wall of the abdomen, the opening may be made directly into the abscess. But if the adhesion has not plainly taken place, an incision should be made down to the peritoneum (lining membrane of the cavity of the abdomen) and the wound filled with Lint or Oakum. In three days the membrane will be adhered so the opening can be made with safety, which may be done either with the knife or trocar. Generous dfet, with the Quinine, will probably enable the patient to survive. Should the abscess open into the intestine or bronchial tubes, it may be necessary to give anodynes (as Opium) in small doses to relieve the irri- tation of those parts. HOM(EOPATHIC TREATMENT. Aconitum, Belladonna, Mercur- ius, Lachesis* Aconite is especially indicated in the commencement of the attack, and may always precede ^the other remedies, when there is vio- lent inflammatory fever, attended with insupportable shooting pains in the region of the liver, with tossing, restlessness, and great anxiety and anguish. Dose: Of a solution of eight globules to two tablespoonfuls of water, give a teaspoonful every three hours, until improvement or change. Belladonna may be advantageously administered, after Aconite has subdued the preceding symptoms, or from the commencement, when the following indications present themselves; oppressive pains in the region of the liver, which extend to the chest and shoulders, distention of the pit of the stomach, sometimes extending across the region of the stomach, producing a sensation of tension, with difficult and anxious res- piration ; determination of blood to the head, with cloudiness and giddiness, sometimes causing faintness ; great thirst, tossing about at night, and sleeplessness. Belladonna may be advantageously alternated with Xux-vomica in such cases as coincide with the joint indications afforded for both of these medicines, especially, if the patient has been ACUTE INFLAMMATION OF THE LIVER 325 addicted to excessive use of fermented liquors. Belladonna is, moreover, especially appropriate when the temperament of the j)atient exhibits a combination of the sanguine and lymphatic. Dose: If singly, dissolve eight globules in tw.o tablespoonfuls of water, and give a teaspoonful of the solution every two hours, until amelioration or change. If no positive and permanent improve- ment should ensue within four hours after the third dose, pause two hours more, and proceed with the next medicine. If in alternation with Nux-v., the like solution of each administered in rotation, by teaspoonfuls, at intervals of two hours. Merciwius will, in the majority of cases, prove effectual when Bella- donna has failed to produce a favorable impression on the disease, and should accordingly be administered six hours after the third dose of the foregoing remedy in such instances. The particular indications for Mer- ciwius are as follow : Considerable fullness or tumefaction in the region of the liver, with pricking, burning, or oppressive pains, not allowing the patient to lie long on the right side, and sometimes augmented by movement of the body or part affected; pain in the shoulders; bitter taste in the mouth, want of appetite, thirst, and continual shivering, sometimes followed by sweat- ing, but without relief, with pale yellow color of the skin and eyes ; also, in more advanced stages of the complaint, when there is induration of the liver. This medicine may, moreover, like Belladonna, be adminis- tered in alternation with Nux-vomica, under similar conditions. If the patient is of a lymphatic temperament, or is distinguished by softness of the muscular system, there will be additional reason for selecting Mer? curius. Dose : A solution of eight pills, in all respects, singly, or in alterna- tion, as directed for Belladonna. Bryonia, Chamomilla. Bryonia, when the pains in the region of the liver are mostly shooting, or consist of an obtuse pressure, with tension and burning, increased by touch, coughing or respiration, and, especially, during inspiration, or much exacerbated by movement ; also, when the symptoms are attended with violent spasmodic oppression of the chest ; rapid and anxious respiration; bitter taste in the mouth, tongue coated yellow, and constipation. Bryonia, like Chamomilla, is particularly useful in cases which have been excited by mental emotions, such as a violent paroxysm of anger, and is well adapted to persons of nervous or bilious temperament, and of choleric disposition. Dose : Of a solution of eight pills to two tablespoonsful of water, give a teaspoonful every three hours, until distinct amelioration or change. In cases in which the pain is very severe, the doses should be repeated every two, three and four hours, progressively, accord- ing as an improvement ensues, and, subsequently, every six hours. Chamomilla is more particularly required in the milder forms of the complaint, or, more correctly speaking, in simple irritation of the liver, when there are pressive pains, pressure in the stomach, oppression of the chest, and a sensation of tightness under the ribs ; yellow color of the skin, pains not aggravated by motion, etc.; tongue foul and yellow, bitter taste in the mouth; paroxysms of great anxiety. Chamomilla is, also, almost a specific, when the above symptoms have been brought on by a fit of passion. Dose: In all respects as directed for Bryonia. o^O DISEASES OF THE LIVER. Xu.r-rotnica is particularly indicated when the pains are shooting and pulsative, and attended with excessive tenderness in the region of the liver, to the touch, pressure in the region of the stomach and under the ribs, with shortness of breath and constipation ; also, when enlarge- ment and induration occur; and, in the chronic form, when there are marked symptoms of derangement of the stomach. This medicine is, especially, appropriate for the treatment of patients of a sanguine or bil- ious temperament or choleric disposition. Dose : In acute attacks, four globules in a teaspoonf ul of water every two hours, until a degree of effect is apparent, and then every six hours, until positive improvement results. In chronic cases, six globules in a tablespoonful of water, every night at bed-time, for a week, after which, a pause of four days should ensue, the adminis- tration being similarly resumed, if necessary, and so on. Pulsatilla. Sensation of tension in the region of the liver, and pres- sure or dull pain in the region of the stomach ; oppression at the chest, bitter taste, yellow tongue, nausea; loose, greenish, and slimy stools; excessive anxiety, especially, towards evening or during the night. (Tem- perament lymphatic ; disposition mild). Dose: Of a solution of six globules to two tablespoonfuls of water, give a teaspoonf ul every six hours, until amelioration or change. Sulphur is valuable to follow any one of the preceding medicines, which, although apparently indicated, does not speedily produce a decided action; or when the disease continues, although in a diminished degree; it is particularly efficacious, after Nux-vomica, to combat the bad conse- quences of the disease. In many instances, in which the distinct analogy between the symptoms of the disease, and those which characterize one or more of the other medicines enumerated herein, has led to the administra- tion of such other medicine or medicines, and when such treatment has failed to be followed by adequate benefit, the intermediate administration of a single dose of Sulphur, from time to time, has served to awaken the susceptibility of the system to the action of such other medicine (when evidently appropriate,) and the repetition of its administration after such dose of Sulphur has been followed by admirable results. Do.se; To assist the action of the other medicines, give four globules in a teaspoonful of water, following up the treatment with the rem- edy judged most appropriate to the case, after an interval of twelve hours. SUPPURATIVE IXFLAMMATIOX OB ABSCESS OF THE LIVEB. * Sulphur, Silicea, Eali-c*. Lycopodium. These four medicines may be numbered amongst those which have proved most useful in cases of suppuration of the liver. The selection from amongst them, must, of course, depend upon the particular features of each individual case, and must be regulated by instituting a comparison between the symptoms of the disease, and those which are recorded as characteristic of each of these medicines in the article on that subject, Dose: As for Nux. * See Treatment of Inflammation of the Liver. CHRONIC INFLAMMATION OF THE LIVER.— JAUNDICE. 327 Diet, The regulations for diet which are prescribed for the treat- ment of Fevers in general, and such other regulations as are detailed in the article on " Indigestion," are equally applicable to cases of Inflam- mation of the Liver. CHRONIC INFLAMMATION OF THE LIVER, OR CIRRHOSIS. In this form of the disease, we find many of the foregoing symptoms, but in a modified degree ; and in addition, a continued pain or uneasiness in the right side seldom leaves the patient, who gradually falls off in flesh and loses strength ; and there is, not unfrequently, present an occasional cough with expectoration ; sometimes, considerable perceptible enlarge- ment of the liver, either continual or returning periodically, with a num- ber of dyspeptic symptoms; high-colored or red urine, yellow tinge of the skin and eyes, occasional febrile symptoms ; the pulse, except during these attacks, generally quick but regular. ALLOPATHIC TREATMENT. Chronic Inflammation (Cirrhosis) of the Liver is, generally, caused by the use of alcoholic drinks. The patient, generally, pays no attention to this trouble, until it causes dropsy of the abdomen. It is then safely regarded as incurable. In the early stages of the disease, by the abandoning of the use of spirituous liquors, and by the use of Arsenious Acid, and the Iodides, as in the following formula, a recovery can doubtless be made. Take of the Iodide of Ammonium a dram, Fowlefs Solution, half a dram, Tincture of Columbo, an ounce, Water, four ounces. Mix. Dose : A teaspoonf ul three times a day, before meals. The use of Dilute Nitro-Muriatic Acid in doses of ten or fifteen drops in sweetened water, three or four times a day is beneficial. In the later stages, the treatment is the same as for Dropsy of the Peritoneum (Ascites) HOMOEOPATHIC TREATMENT. With proper modifications, as to the frequency of doses, the regulations prescribed in the foregoing article (pp. 324 to 326) are equally applicable to this variety of the disease. The med- icines enumerated should, accordingly, be selected in conformity with the indication therein set forth. The following, however, are especially appro- priate, in the majority of cases of Chronic Inflammation of the Liver, and >the undermentioned rule for the dose is generally, reliable, as regards other medicines. Nux-vomica, Rvyonia, Sulphur, Sejria. There are compara- tively few cases (if any) of Chronic Inflammation of the Liver, in which one or more of these medicines, either singly, successively, or alternately, will not be required ; for indications see pages 324 to 326. Dose: Of the medicine selected, give four globules in a teaspoonful of water, morning and evening, for a week (or until an earlier subsi- dence or change in the symptoms); after which, pause four days, resuming the course, as before, if necessary, and so on. JAUNDICE. Symptoms. Yellow color, varying in shade from a pale saffron to a dark-brown yellow, appearing first in the eyes, then extending over the 328 DISEASES OF THE LIVER. surface of the whole body; hard, whitish evacuations; orange-colored urine; symptoms of deranged digestion, and sometimes, tensive pain or pressure in the region of the liver. In severe cases, even, the perspiration will impart a yellow hue to the patient's linen. Exciting Causes. The disease frequently declares itself without being plainly referable to any exciting cause ; the principal causes, how- ever, are affections of the liver, indigestion, poisonous substances, taking cold, powerful mental emotions, emetics v drastic purgatives^ or internal obstructions, such as gall-stones, or even worms obstructing the biliary duct. Predisposing Causes. Amongst the predisposing causes may be enumerated, a too sedentary or irregular mode of life, indulgence in spirit- uous liquors, and the frequent use of aperients. It may be, also, remarked, that this disease frequently assumes the intermittent type. Jaundice is not, of itself, to be considered as a dangerous disorder, but rather as an indication of some internal derangement, which, if neglected, may entail serious consequences ; for example, dropsy, hectic fever, or gen- eral wasting away. ALLOPATHIC TREATMENT. Jaundice is a symptom which accom- panies (other) diseases of the liver, and, in such instances, its treatment is that of those affections. Generally, there is a catarrhal inflammation of the upper part of the intestine (duodenum) requiring that the food should be light and unirri- tating to this part of the digestive tube. Milk, eggs, animal broths, broiled beef steak, oysters, fresh fish, are suitable. Bread, arrow-root, rice, pota- toes, beans, pies, etc., may, by calling upon the functions of that part of the intestine, continue the disease, and should not be used. Laxatives may be called for, but must be mild. Injections are to be preferred, if there is constipation. A Seidlitz Powder may be taken. In this, as in other affections of the liver, the Nitro-Muriatic Acid is useful, in doses of ten drops in sweetened water, three times a day. Manganese has appeared useful, in catarrhal jaundice. Take of dried Sulphate of Manganese forty grains, Purified Ox Gall sixty grains, Resin of Podophyllum two and a half grains. Mix well, make a mass and divide into twenty pills. Dose : One three times a day. In Malarial Jaundice, after from ten to twenty grains of Quinine has been given, Manganese is, also, useful. Take of Dried Sulphate of Man- ganese forty grains, Chenoidine sixty grains. Mix and make into twenty pills. Dose : One three times a day. A small blister over the stomach has appeared useful. Pain should be relieved with half grain doses of Opium, or ten drops of Laudanum, or a grain of the Extract, or one or two teaspoonfuls of the Tincture of Hyoscyamus. When jaundice has continued for weeks or months,, there probably is an irremediable obstruction to the flow of bile. If it cannot be removed, remedies are directed to aid in the elimination of bile by the kidneys, and skin and to support the powers of life. JAUNDICE. 329 To increase the flow from the kidneys, the diuretic pill composed of one grain each of Extracts of Squill and Digitalis and Calomel, may be given, one pill every three hours, until it acts freely on the kidneys. Or the Fluid Extract of Broom may be given in doses of half a teaspoonf ul. Watermelon or Pumpkin Seed tea may be useful. The skin may be sufficiently acted on by hot bathing. If not, by the hot wet pack. Bile may be supplied to the aid of digestion by giving one or two cap- sules filled with ox-gall after each meal. It should be remembered, that the yellowness will exist in the skin for some time after the bile duct is open, so that the bile flows naturally into the intestine. HOMEOPATHIC TREATMENT. Mercurius, China. These are two of the best remedies in the treatment of the disorder. Mercurius may be denominated a specific remedy for jaundice in a great number of cases, when, indeed, the patient has not been subjected to drenching courses of Mercury or Calomel. Dose: Six globules in a teaspoonf ul of water, every six hours, until four doses have been given, and then' every twelve hours, until per- manent and positive amelioration or change. China is, however, to be preferred to Mercurius, in cases in which Mercury has been too copiously administered. China is, also, particularly appropriate when the attack has come on after violent corporeal exertion, or when it can be distinctly traced to indigestible substances ; also, when the disease assumes an intermittent character. In a great number of cases, indeed, in which jaundice recurs periodically, or in which patients, already predisposed to its attacks, have been unavoidably or inadvertently exposed to some directly exciting cause, (such as over-exertion, cold, etc.,) China will operate as a preventive resource, and will commonly ward off the develop- ment of an incipient attack. Dose: For the treatment of jaundice, in an advanced stage, give four globules in a tablespoonful of water, three times at intervals of four hours, and at intervals of eight hours, until amelioration or change. As a preventive resource, give six globules in a wineglassful of water, night and morning, for three days, then pause two days, sus- pending treatment, or resuming the course, similarly, according to the state of the patient. Nvx-vomica is preferable in the generality of cases, even in such as have been directly occasioned by violent emotion, when the bowels are confined, or alternately confined and relaxed. Nax-vomica is, also, espe- cially, appropriate when sedentary habits, or study, or indulgence in spirituous liquors, appear to have been the predisposing, or, partly, the exciting causes of the attack. Dose : Three globules in a teaspoonf ul of water, every four to eight hours. Digitalis. A most important remedy in many cases of this disease; the following are the principal indications for its employment: nausea, retching, or vomiting and purging of greenish fluid; or sluggish state of the bowels, with tohite, gray, or clay-colored evacuations; tongue clean, or coated white; pressure at the pit of the stomach, and region of the liver ; alternate heats and chills. 330 DISEASES OF THE LIVER. Dose : Of a solution of six globules to three tablespoonfuls of water, give a teaspoon ful every two hours, until the violence of the symp- toms become modified ; and then every four hours, until positive amelioration or change. INFLAMMATORY JAUNDICE. Cases in which jaundice is associated with symptoms of inflammation and pain on pressure in the region of the liver, are so closely analogous to inflammation of the liver, that the reader is referred, on this subject, to the foregoing articles, treating especially of that disease. GALL STOXJE.-CHOLELITH1ASIS, BILIARI CALCULI. The tendency inherent in the bile to form firm concretions, is quite considerable ; hence biliari calculi are a common occurrence. The causes of such concretions are very obscure; they occur in indi- viduals of the most varied constitutions, and pursuing the most diversified occupations, diet, and habits of life. Their formation seems to be most promoted by a copious supply of animal food, and by the use of lime-water. As a rule, such calculi are not met with until after the thirtieth year, but occasionally before; they occur more frequently among females, and their formation is promoted by every circumstance that causes an arrest of the flow of bile. Biliari calculi are chiefly found in the gall-bladder ; here they are met with in large numbers, seldom as solitary concretions. In the latter case their form is oval or rounded ; where several concretions are present, they assume an angular form with more or less curved surfaces, in conse- quence of the sides being rubbed off, and of the pressure and counter- pressure they exert upon each other. They mostly consist of a nucleus, rpund which a lighter-colored layer of lime has been deposited, which is again surrounded by an envelope composed principally of cholestrine and bile-pigment. Their color is at times light, at others white, yellow, dark-brown, dark-gray or black. They are not very firm ; in their recent state they are friable and can easily be crushed. Bilious concretions maybe present without any danger to the individual affected with them; they may be expelled without any pain ; on the other hand they may acquire importance from the pains which they cause and from the lesions to which they give rise. In this respect, the size of the concretions is of much less importance than their shape and the internal condition of the gall-bladder ; biliari calculi (gall stones) of the largest size sometimes cause the least distress. Symptoms. Hence the symptoms caused by these concretions vary a great deal according to their shape and intensity of pain. In slight eases, a short-lasting spasmodic pain, corresponding to the region of the gall- bladder, accompanies the expulsion of the calculi into the bowels. In other cases the pain is continuous but not violent, sometimes it is parox- ysmal. It is only in the smallest number of cases that the calculi cause regular attacks of colic. This colic commonly sets in all at once, the patient feeling otherwise perfectly well ; it is attended with a more or less violent pain in the region of the gall-bladder. Generally, this pain GALL STONE. 331 increases very rapidly in intensity; it is an intolerably burning, boring pain, and, while increasing in intensity, radiates over the chest and abdo- men to varying distances. At the same time the region of the liver becomes exceedingly painful to pressure, it is apt to bloat, and, in consequence of the contraction of the abdominal muscles, the abdo- men becomes hard as a board. The pain is generally so distres- sing and acute, and the patients find it so difficult to breathe, that they toss about in the greatest agony. The general constitutional condi- tion is, likewise, affected by the pain according to the sensitiveness of the patient and the duration of the pain. Although there is no fever, yet the pulse soon becomes small, filiform, almost unaccountable, disappears even entirely, although the heart is in tumultuous motion ; the skin becomes correspondingly cool, and is covered with a cold perspiration, the com- plexion is cadaverous. The pain is most commonly associated with distressing vomiting and retching which terminates in a painful hiccup- ing. The nervous system participates in the violent racking of the frame ; the patient is attacked by violent chills or local cramps, or else by violent convulsions at times tonic, at others clonic, which are apt to ter- minate in syncope. Such paroxysms sometimes last a few hours, at others a day and longer. The pains usually all cease as soon as the calculus enters the intestine; sometimes they disappear gradually or have complete remissions, according to the condition of the excretory ducts of the gall- bladder, or to the peculiar shape of the calculus, which at times adheres and at others moves on again. After the pain ceases, all the incidental ailments generally disappear very rapidly, and nothing remains but languor and weariness. About this time, icterus (jaundice) makes its appearance in different degrees of intensity. The appearance of icterus depends upon the length of time that the excretory ducts of the bile remain obstructed. If the obstruction only continues a short time, the icterus may not break out at all; on the contrary, if the obstruction lasts long, the jaundice may already set in during the pains. As regards fre- quency, the attacks vary, but the same individual is scarcely ever attacked once only; because, as we stated before, solitary concretions cause pain only exceptionally, whereas a multitude of smaller concretions that have become sharply angular by rubbing against each other, penetrate more easily into the excretory duct, and cause a more acute irritation. Prognosis. The terminations of colic from the presence of biliari calculi, or rather the consequences of gall stone, vary a great deal. Death scarcely ever takes place in consequence of an attack of such colic. If the calculus remains incarcerated for a long time, and fills, at the same time, the whole space of the excretory duct, we obtain a picture of a fully developed jaundice, with the various symptoms previously described. If the incarceration is not removed, suppurative hepatitis, inflammation of the gall bladder, and its excretory ducts, may be the consequence. In the last mentioned case, the patients succumb to peritonitis arising from perforation of the gall-bladder, or, if the gall-bladder should have become adherent to the surrounding parts, the patients fall away, gradually, until death ends their sufferings. The diagnosis of biliari calculi is, generally, very easy and sure. The seat of the pain, the sudden beginning and the equally sudden cessation of the pain, and, above all, the discharge of bilious concretions with the 332 DISEASES OF THE LIVER. feces, establish the diagnosis. If the concretions are soft, they may not appear in the feces, for the former may break up and scatter during their passage through the intestines. If the colic is not violent, it is difficult to recognize its true character, especially, if the symptoms of the stomach are not very prominent, and the attack runs a slow course. The swell- ing and painfulness of the region of the liver may remind one of hepa- titis, or else the symptoms may be those of acute hypersemia of the liver. The spasmodic symptoms do not, generally, follow immediately after the commencement of an attack, so that it is scarcely possible to confound it with eclampsia, epilepsy, etc. The treatment involves an abbreviation and mitigation of the attacks of colic, and prevention of all further mischief from it; at the same time we must try to prevent the return or reproduction of new concretions by proper treatment. ALLOPATHIC TREATMENT. In the treatment of the passage of gall stones, is in the first place, to relieve the pain, and for this purpose, the best remedies are Opium and Belladonna. If a physician is at hand, he will give a hypodermic injection of a quarter of a grain of Morphine with a sixtieth of a grain of Atropine. The effects of the anodyne should be maintained, until the pain, caused by the passage of the stone, ceases. An injection into the bowel of a teaspoonful of Laudanum, with half a tea- spoonful of Tincture of Belladonna, in a couple of tablespoon fuls of thin starch, maybe made, or the same remedies given by the mouth in half the quantities. The pain may be intense enough to induce the physician to resort to the inhalation of Chloroform or Ether. Belladonna Ointment may be applied over the seat of pain, and cov- ered with a hot flaxseed meal poultice. A hot bath is sometimes successful in mitigating pain . No rule can be given for giving Opium in this disease, but when larger doses have been given for a few days, Opium poisoning may occur unexpectedly. Expulsion of the calculus (stone) may be aided by cathartics. For this purpose salines are to be preferred, as Epsom Salts and Seidlitz Powders. No remedies are known which can be given in sufficient quantity to dissolve the stones. As a preventive measure, the Phosphate of Soda should be given in doses of from twenty to thirty grains, two or three times a day. The rem- edy should be persevered in for months. It has the property of rendering the bile more liquid, and so prevents the formation of new gall stones. A change from a sedentary life is desirable. A simple, wholesome diet, and attention to the general health are called for. CARCINOMA HEPATIS, CANCER OF THE LIVER. The disposition to cancerous growths in the liver is one of the most common accompaniments of what is generally designated as the carcino- matous diathesis. Cancer of the liver constitutes one of the most fre- quent forms of the carcinomatous disease. The symptoms caused by carcinoma of the liver, differ in intensity according to the size and localitv of the degeneration, so that the disease INFLAMMATION OF THE SPLEEN. 333 sometimes remains without any symptoms. Usually the disease com- mences with the vague symptoms of hyperemia or of fatty liver, with pressure and a feeling of fullness in the right side; the pain, as a rule, exceeds that of any other affection of the liver, and, on that account, is an important diagnostic sign. If the carcinoma is deep-seated, the pain may be entirely absent. An important item in the diagnosis of the carcinoma of the liver is the rapid enlargement of this organ, even to an enormous size, and the consequent bulging of the margin of the ribs. The constitutional symptoms vary a great deal. Sometimes the stom- ach and intestinal canal are much disturbed by the affection of the liver, and sometimes they remain perfectly free from all traces of trouble. As a rule, Carcinoma of the liver is an incurable affection, which must prove fatal sooner or later. The duration varies from a few months to a number of years, and depends upon the rapidity with which the cancer grows. Carcinomata that break out after operations, are generally more speedily fatal, than such as are restricted to the liver. A treatment pursued with a view of curing the disease, has very small chances of success. Reported cures should be received with a great deal of distrust. CHAPTER XV. INFLAMMATION OF THE SPLEEN. Symptoms. Sharp, pressing, or shooting pains in the region of the spleen, beneath the lower ribs on the left side, with, in most cases, a high degree of fever, with general derangement; and sometimes enlargement and tumefaction; when very severe, vomiting of blood. From our very imperfect knowledge, however, of the physiology of this organ and its relation to the others, this disease, except when it pre- sents itself in the tangible form above mentioned, is extremely difficult to discover. Its best characteristics are tenderness or sensibility on pres- sure in the region about the spleen, with general debility ; paleness of the complexion, bloodless appearance of the conjunctiva (the superficial membrane lining the eyelids, and extending over the fore part of the eyeballs,) languid circulation, and tendency of the extremities to become cold It is a rare disease in this country, but sometimes declares itself in hot seasons, w T hen it is not un frequently mistaken for other affections. It may, however, arise in individuals of delicate constitutions, or in children, when exposed to the influence of marshy miasms, particularly when, to that cause, has been added insufficient clothing, want of exercise or proper nutriment, and long-continued mental disquietude. ALLOPATHIC TREATMENT. Acute inflammation of the spleen is to be treated on the same general principles as inflammation of the liver. The same anodynes will be required, and they are to be administered in the same way. The constant apjjlication of cold by means of a bladder of 334 DISEASES OF THE LIVER. pounded ice over the region of the spleen, is particularly appropriate. Benefit will, also, result from the use of Ergot in large doses. A teaspoon- ful of the Fluid Extract of Ergot may be given three or four times a day. By far the most common affection of the spleen, is a chronic inflamma- tion, known as enlargement of the spleen, which occurs in malarial dis- tricts, or where intermittent fever prevails. It is also known as ague cake. This affection, occurring periodically, requires the use of Quinine in full doses — five or ten grains, given six hours apart, until a slight ringing of the ears is produced. For continued use for enlarged spleen, it should be continued with Sulphate of Iron. Take of Sulphate of Quinine sixty grains, Dried Sulphate of Iron, ninety grains. Make into thirty pills, according to the art of the apothecary. Dose : One pill, three, four or five times a day. Bromide of Potassium, given in doses of from ten to fifteen grains three times a day, sometimes reduces the enlargement of the spleen with wonderful rapidity. The Iodide of Ammonium and Arsenious Acid, in small doses, fre- quently repeated, are particularly efficacious in chronic enlargement of the spleen (ague cake) with chronic malarial poisoning. Take of Iodide of Ammonium Ujdo and a half drains, Iodide of Arsenic one and a half grains, Peppermint Water four ounces. Mix. Dose : Take a teaspoonful from three to five times a day. A dram of Fowler's Solution may be substituted for the Iodide of Arsenic. Brushing the skin over the spleen with Tincture of Iodine, or rub- bing it with the Red Iodide of Mercury Ointment, will be of benefit. Sometimes wearing a Belladonna Plaster, on the left side, will relieve the pain of enlarged spleen. HO.U(EOPATHlC TREATMENT. China should be administered at the onset of the treatment, if no fever of any moment existed from the commencement, particularly, if the disease owes its origin to marsh miasm, or if the accompanying fever present an intermittent type, in which case, it should be administered during the intervals, if impaired appetite and general derangement be present. Also, if the patients have been weakened by vomiting of blood, or diarrhoea. When the abuse of this medicine, or Quinine, has given rise to dis- ease of the spleen, benefit will often be derived from the employment of such of the subjoined remedies as may correspond most closely with the symptoms of the case. The alternation of China and Arsenicum is appro- priate, when the symptoms involve a combination of the indications afforded for each, respectively. Dose: If singly, when the disease presents no positive periodical character, and the symptoms are not violent, of a solution of eight globules, to two tablespoonfuls of water, give a teaspoonful every two hours, until positive amelioration or change. If the symptoms be very severe, the like dose should be repeated at intervals of one hour. If the disease assume a distinctly periodical character, the like dose should be administered, during the respite, an hour before the anticipated return of the attack. If in alternation with Arseni- cum, dissolve the like quantities of each, separately, and adminis- ter, first two doses of the one, at intervals of three hours, then pause nine hours, and proceed with two similar doses of the other, and INFLAMMATION OF THE SPLEEN. 335 Arsenicum is useful where the disease assumes the intermittent type, oris complicated with ague; and, further, when the patient complains of a violent, burniny pain in the region of the spleen, and a constant pul- sation at the pit of the stomach, attended with great anxiety ; also, vomit- ing of a dark, grumous fluid, watery, or bloody discharge from the bowels, and burning at the posterior passage; excessive weakness, and dropsical swelling at the feet. The alternate administration of this medicine, with China, is sometimes advantageously adopted as above stated. (See China). Dose: In all respects, whether singly, or in alternation with China, as directed for the last named medicine. Arnica is indicated by pressing pain in the left side, under the short ribs, causing difficulty of breathing, and when the vomiting of blood is very severe. When external violence has given rise to the disorder, Arnica is, especially, called for. Dose: In ordinary cases, of a solution of six globules to three table- spoonfuls of water, give a teaspoonful every three hours, until ame- lioration or change. But, if vomiting of blood occur, the like dose should be repeated every hour. Nnx-vomica is chiefly indicated by the symptoms of deranged diges- tion, constipation, etc, which remain after the more threatening symp- toms are removed, or after the use of Quinine. Dose : Six globules, in a, teaspoonful of water, at bed time, until ame- lioration or change. PART SEVEIVTH. — ♦ DISEASES OF THE KIDNEYS AND BLADDER. «► CHAPTER XVI. DISEASES OF THE KIDNEYS. NEPHRITIS— INFLAMMATION OF THE KIDNEYS. The history of the disease, in individual cases, is in many respects very obscure. It occurs chiefly among middle-aged persons, and among men more frequently than women. Some of the causes are: Bruises in the region of the kidneys ; sharp, or adhering gravel in the kidney; violent colds, employment of various drugs, such as Turpentine, Spanish Fly, Nitre and Savin, whether used internally or externally. Sometimes, violent, extensive burns. Exces- sive use of stimulants. Suppression of the "courses." Long lying on the back. Secondarily, the disease is caused by suppurative inflamma- tions in other organs ; also, by diseases of the brain and spinal marrow, heart disease, etc. Nephritis usually sets in, like other acute inflammatory diseases, with a violent chill, which is almost immediately succeeded by the local pains. After they have reached the acme of their intensity, they extend over the whole region of the kidneys, on both sides; they are continuous, of different degrees of acuteness, cannot easily be described according to their nature, they are considerably aggravated by pressure upon the renal region by taking a full breath, or by motion generally; also, by lying on the affected side, and by the warmth of the bed. They are scarcely ever restricted to the kidneys; on the contrary, following the course of the ureters (little tubes that carry the urine from the kidneys to the blad- der) they radiate into the bladder, testicles, and, in the case of females, into the round ligaments and thighs. Sometimes the testicles are found drawn up spasmodically. With the appearance of these pains, the urinary secretion diminishes in proportion as the inflammation involves a larger portion of the kid- neys, so that the secretion of urine may be entirely suspended. At first, the urine is only saturated, sometimes tinged like blood; but it may, like- wise, preserve its normal color, if one kidney is sound and the other does not secrete any urine at all. The general constitutional balance is very much disturbed. The fever is very violent, the pulse hurried and soon becomes small and contracted, the skin is hot and dry, the thirst 336 INFLAMMATION OF THE KIDNEYS. 3o7 agonizing. The patients feel sick to the core. Vomiting is a frequent occurrence without the stomach appearing much deranged, for the tongue may he quite clean. At first, the bowels are quite constipated, the appe- tite is gone. The further course of nephritis corresponds with the changes that have been indicated. Recovery may take place after the first onset of the disease, without any suppuration having taken place, or by arresting it, the completeness of the recovery being shown most conclusively by the urine resuming its normal quality. On the contrary, if suppuration sets in, the local pain decreases, becomes duller, and more like a painful pres- sure; the fever, however, increases, frequent chills or shiverings are experienced by the patient, the tongue becomes coated, the stomach is still more disturbed, pus is found in the urine at an early stage of the disease, and there is frequently an admixture of blood. The patient becomes anxious, restless, the pulse is more frequent and smaller. The subsequent phenomena depend upon how far the urinary secretion is suspended. If only one kidney is diseased, or only a small portion of both, there is no material diminution of the quantity of urine secreted ; an abscess forms, with the usual phenomena characterizing the suppurative process, the abscess either discharging, and recovery taking place, or else renal phthisis (consumption) setting in, with all the symptoms of marasmus (wasting away) gradually following. This last mentioned result may drag along for months, the urine containing pus all the time. Characteristic features of renal phthisis are, a great tendency to malignant affections of the skin, and a disposition to lie down. In some cases, serious symptoms set in most suddenly when the discharge of urine had been completely -sus- pended from the beginning, and the patients die in a few days. They may, likewise, set in gradually, so that the disease, by slow degrees, assumes a typhoid character. The patients sink into a sound sleep, are attacked with a more or less violent delirium, convulsions, and finally die. The diagnosis of nephritis cannot always be made with perfect certainty, because the symptoms are sometimes very trifling, and, moreover, very little characteristic. In nephritis the bowels are almost always obsti- nately constipated ; if the disease terminates in phthisis, the constipation changes to diarrhoea. The termination is unfavorable, only, if the symptoms of poisoning with uraemia become more and more manifest, until they reach the highest degree of intensity. In other respects, the disease becomes the more threatening, the more protracted a course it runs, until it finally terminates in phthisis. ALLOPATHIC TREATMENT. Treatment of inflammation of the kid- neys will consist in the use of hot applications to the loins, hot poultices, dry cupping, and other remedies to relieve pain. Mild purgatives, and medicines to act on the skin, and by these means relieve the kidneys, are indicated. If there is much pain, the medicines to act on the skin, should contain Opium, as the powder of Ipecacuanha and Opium with Chlorate of Potash, or Dover's Powders, the dose of which is ten grains. The popular objection to Opium in this disease, in sufficient doses to re- lieve the pain, on account of drying up the secretions, is groundless, because it acts freely on the skin, and so is protective against any ill which may result from a diminution of exertion from the kidneys; besides this sus- 22 33S DISEASES OF THE KIDNEYS. pension of the action of the kidneys will enable them to recover from the inflammation the more quickly, from simply the rest. The antiphlogistic effects of Opium, are, also, most important. Notwithstanding the consti- pating effects of the Opium, there is no difficulty in obtaining copious dis- charges from the bowels. Further effects on the skin may be secured by hot bathing, the hot wet pack, and the hot air bath. The hot air bath may be given by burning alcohol in a saucer, under the patient, sitting in a cane seated chair, well wrapped, (chair and patient), from the floor up to the neck with blankets. Jaborandi has especial power of causing the elimination of urea (a poisonous ingredient of the urine,) by the skin, and is, especially indicated in this disease. The dose of the tincture, or fluid extract is half a tea- spoonful to a teaspoonf ul. It may be repeated at such intervals as is required to excite a sufficient degree of sweating. The bowels may be freely moved with two or three grains of Jalap, and a half a grain of Podophyllum, or a saline cathartic may be given. The amount of purging and sweating required, will be proportioned to the decrease in the natural flow of urine. Nothing more than water should be given to increase its flow. Ice may be given in small lumps, and swal- lowed, or allowed to melt in the mouth, if there is sickness at the stomach. In the early stages, the diet should be light, but solid food is to be allowed as early and as freely as there is power to digest and assimilate it. If suppuration should occur, great attention must be given to sustaining the strength of the patient, and nourishment of milk, cream, raw eggs, beaten up with sugar and water, or milk, strong beef tea, juice of meats and aniseed essence, freely and regularly given. The difficulty of discriminating this disease and its various conditions, together with its serious nature, dictate that its control should be placed wholly in the hands of a skillful physician. ftOMCEPATHIC TREATMENT. Cantharides will be found most effica- cious in the treatment, and'may be taken, at the very commencement of the attack, even when the accompanying fever is considerable, particularly, when the urine passes off in drops, or is tinged with blood ; or when it is exceedingly painful to pass water, with burning pain in the urinary canal; and when there are the general symptoms of shooting, cutting, and tearing pains in the loins and regions of the kidneys ; or even in cases of complete suppression of urine. Dose : Of a solution of eight globules, to two tablespoonf uls of water, give a teaspoonf ul every three hours, until positive change. Nux-voniica is appropriate when the affection can be traced to excess of wine or stimulants, and sedentary habits; and where we find constipa- tion, feeling of faintness, nausea, vomiting, distention of the stomach, and drawing up of the testis, and of the spermatic cord. Dose : As for Cantharis. Belladonna. When shooting pains in the kidneys are present, extend- ing to the bladder— and further, when inflammation in the kidneys is accompanied with colic and spasms of the stomach, heat in the region of the kidneys, scanty flow of water of an orange-yellow, or sometimes of a bright-red color, depositing red or whitish thick sediment ; anxiety, restlessness, and periodical aggravation. Dose: As for Cantharides. i INFLAMMATION OF THE KIDNEYS— BKIGHT'S DISEASE. 339 Hepar-sulphtiris is useful when we have reason to apprehend the formation of an abscess, or the commencement of suppuration. The non- professional prescriber must be careful not to mistake the apparent alle- viation of suffering here for the subjugation of the disease, as the distinc- tion is difficult. The following symptoms may serve as a guide in these serious cases; cessation of the acute pain, a sensation of throbbing and a feeling of weight in the region of the kidneys, alternate chills and slight flushes of heat, and copious perspiration are sure signs of pus forming. Dose: A powder of eight pills dissolved, to be taken like Canth. INFLAMMATION OF THE KIDNEYS OCCASIONED BY MECHANICAL INJURIES. Arnica is appropriate for the treatment of Inflammation of the Kid- neys resulting from mechanical injuries (such as contusions or severe concussions,) and should be employed at the onset of treatment, whatever be the course afterwards indicated by the subsequent development of symptoms. ILL-EFFECTS FROM ABUSE OF CANTHARIDES. The mischievous use of Cantharides, in the application of blisters, whereby the kidneys often become considerably, and even seriously, affected, is promptly and effectively counteracted by the Homoeopathic antidote employed internally and externally. Camphor (Concentrated Tincture) should be administered without delay, when an affection of this kind is distinctly traced to the cause in question. Dose {internal) : One drop of the concentrated Tincture of Camphor, on a small lump of sugar, every hour, until three doses have been given ; and afterwards, every two hours, until the symptoms sub- side. Application {external) : Moisten the palm of the hand with a few drops of the concentrated tincture, and apply with friction on the inner side of each thigh. INFLAMMATION OF THE KIDNEYS ASSOCIATED WITH GRAVEL. This disease sometimes arises from the presence of stone in the kid- neys ; in which case the symptoms of fever do not occur, until a consid- erable time after acute pain has been experienced. Further, a numbness of the thigh, and a retraction of the testicle of the affected side, are con- sidered as distinguishing marks of the existence of a concretion in the kidney or urinary duct. BRIGHT' S DISEASE OF THE KIDNEYS-MORBUS BKIGHTII. Bright's disease mostly attacks persons of middle age, less frequently, children, and still less old people. Males appear more disposed to contrac- this disease, probably, because they use such noxious substances as predis- pose to it, more frequently than women. Feeble individuals are more frequently attacked than vigorous persons. Damp and cold weather it considered one of the most frequent causes of this disease. If we admit that colds, which are so common, may give rise to renal diseases in con- 340 DISEASES OF THE KIDNEYS. sequence of a suppression of the cutaneous exhalations, on the other hand',, we must not forget that the abuse of alcoholic beverages, which is such a prevalent vice, likewise, is a main cause of the nephritis, which is so frequently met with. But it is not only alcohol, but likewise, the above- mentioned drugs and poisons, that cause both nephritis and Bright's disease. Among general febrile diseases, it is, particularly, after cholera and scarlatina that nephritis occurs, although, it may, likewise, develop itself after other acute affections, but rather exceptionally. Among' chronic diseases, it is, such as rachitis, rheumatism and scrofulosis, which are often accompanied by this. disease. We are no more able to account for the connection between these dyscrasias and Bright's disease, than we are for the frequent occurrence of Bright's disease during extensive suppu- rations of bones, although we may know, that the quality of the urine, during such conditions of the system, undergoes considerable changes. A division of Bright's disease into acute and chronic, is a very difficult task. What can at most be asserted, is that the disease only passes through the first stage, or, goes on its course further into the other stages.. It is only the characteristic nephritis during scarlatina, very seldom dur- ing the course of other exan thematic fevers, to which the name of Bright's disease can properly be applied, for the reason, that in most cases, it passes. only through the first stage. The cause of it, in our opinion at least, is not. so much a difference in the causing influences, as the age of the patients- Nephritis after scarlatina is scarcely ever met with, except in children or young persons, in whom the reactive efforts of the organism differ greatly, especially, in regard to the kidneys, from those of middle-aged persons. This difference is, likewise, clearly manifested by the symptoms, as the following description sufficiently shows: The acute form of Bright's disease, after scarlatina, generally sets in with distinct febrile phenomena, sometimes with pain in the renal region, and almost always associated with vomiting at an early period, a circum- stance that deserves to be considered with great care in convalescents- from scarlet fever. Only in rare cases, the disease develops itself without the above-mentioned symptoms, in a more insidious manner, or is cov- ered up by the other morbid phenomena accompanying the exanthem. From the onset, the quantity of the urine is considerably lessened, but a day seldom passes that some urine is not voided. The urine has a very dark color, red, or brown, like beer, makes a very consistent foam, and,, after settling, deposits a dark sediment. The excretion of the urine is interrupted ; there is a good deal of urging, with scanty discharge. Theso symptoms of disturbance of the renal functions are very soon succeeded by a dropsical swelling over the whole body, which is first strikingly seen in the face, and attains a high degree of intensity. During this stage, the fever is, generally, not very violent, the patients may, even feel tolerably well, and have some appetite. The thirst is always great, they desire cold drinks; the. skin is entirely inactive, cool, feels dry, and has a pale, sickly color. The bowels are, generally, confined ; the pres- ence of diarrhoea is not a favorable symptom. If the disease has a favor- able termination, which may take several weeks, the urine is again secre- ted in larger quantity, the morbid products in the urine decrease, the skin resumes its functional activity, and, without any special signs of disor- dered functions, the disease soon yields to perfect recovery. Xot unfre- bright's disease. 341 •quently, however, sucli patients succumb to inflammations of other organs, or, which is less frequently the case, the second and third stage of the disease may appear. If the disease runs a rapid and favorable course, there is no great loss of strength, and the patients, generally, recover very rapidly. Where Bright's disease is not a sequela of acute diseases, it has an entirely different beginning. Under such circumstances, the first stage may, indeed, pass away ver3 r rapidly, with the more or less marked symp- toms of typhus, which, however, is, generally, associated with convul- sions, and where the accompanying oedema (puffy swelling) of the face, generally, shows the true character of the disease. If both kidneys are affected, an acute dropsy may, suddenly, cause death. But, almost always, the disease commences without any preliminary symptoms, without chilliness or heat, and without local pains; at any rate, these pains are not very prominent. Thus, it happens that the patients are unable to indicate the beginning of their trouble. Insensibly they begin to complain, their strength diminishes, they feel that some illness is about to overtake them, the appetite is less, symp- toms of stomach-catarrh become manifest, the intestines may, likewise, be similarly affected. The urine is voided as usual, seldom less, rather more, and, should the disease set in with much severity, the urine shows the above-mentioned darker color,' and diminishes in quantity. Usually, it is feebly turbid, even while being voided, of a pale color, of a bluish- green tint, foams very strongly, and the foam lasts a great while. Only at the commencement of the disease, blood is found mixed up with it. The test for albumen shows decisive results. Much less rapidly than with the acute form, sometimes even at a remarkably late period, but rarely before the termination of a few weeks, a symptom makes its appearance, together with the dropsical phenom- ena, which renders any error, in diagnosis, almost impossible. Here, too, one of the first symptoms is oedema of the skin, which has the peculiarity to be more prominent in one place or the other, and, at times, to disap- pear entirely. It is always most marked in the face and on the lower extremities. While the oedema of the skin is constantly increasing, water, finally, accumulates in the cavities, and the patient succumbs to the injury which the increasing pressure of the water inflicts upon the most important organs. In the more acute cases the disease hastens, with uniform rapidity, onward towards a fatal termination. If the disease runs a more chronic course, its intensity varies ; remissions that almost seem intermissions, and of various duration, are observed, during which, the strength of the patient not only increases, but the albumen disappears from the urine down to a scarcely perceptible trace. Accordingly, the disease at times lasts months, and at others, years; there are no positive landmarks by which the duration of the disease can be determined beforehand, even approximately. The prognosis is always very doubtful ; in cases of long standing, it is absolutely unfavorable. A complete cure is most easily affec- ted in recent cases that do not run too rapid a course. The danger is essen- tially increased, if there is a tendency to inflammation of other organs, or *by the presence of heart-disease. If the disease had been caused by exter- 342 DISEASES OF THE KIDNEYS. nal circumstances, a damp climate or dwelling, or frequent colds, the removal of these causes may be of great importance. ALLOPATHIC TREATMENT. Treatment of acute Bright's disease (acute inflammatory dropsy) will have reference, in the first place, to com- bating the inflammation of the kidneys. Upon the early recognition of this disease may depend largely the success of treatment. The patient should be kept warm in bed. Hot fomentations should be applied over the loins, by means of wet cloths covered with oiled mus- lin and several thicknesses of flannel. Dry cupping should be applied over the loins, as the best method of revulsion. If the patient is strong and robust, wet cupping (blood-letting by cupping) will be of the highest possible service. General bleeding is sometimes necessary in the very robust, but should never be employed, if the patient is in any way en- feebled, as when the disease occurs after scarlet fever, and in persons given to intemperance. Saline laxatives are valuable, both by way of revulsion and eliminating poisonous material from the blood, and so relieving the kidneys, as Epsom Salts, Seidlitz Powders, or ten grains of Jalap, or two or three grains of the extract, with a tablespoonful of Rochelle Salts, or Cream of Tartar. Opium, as a rule, ought not to be given in this disease : while it is appropriate in acute inflammation, it is not suitable in Bright's disease. It diminishes the secretion from the kidneys, while they ought to flow naturally. Belladonna, in doses often or fifteen drops of the Tincture, twice a day, or sufficiently often to produce a slight dryness of the throat, is said to be serviceable in this disease. The diet should be light. The drinks should be confined to water, barley-water, flaxseed tea, and other nourishing drinks, which may be given as freely as the patient desires. Nothing acts so satisfactorily on the kidnej-s in this disease as the free use of pure water. Medicines, to act on the kidneys, (diuretics) ought not to be given in the early stage of the disease, because their action may increase inflam- mation. The dropsy is not dangerous, unless it invades the pleural cavity (cavity of the sac lining the chest and covering the lung,) or the lung cells. This will be shown by the marked dyspnoea | difficulty of breath- ing, or short breath). As the danger is from uraemia (blood poisoning from urea, an ingredient of the urine remaining in the blood,) it is fortu- nate that remedies which will cause the elimination of urea from the blood, also, diminish the dropsy. This is done through the skin and bowels, the former by measures which produce sweating, (diaphoretics) and the latter by remedies which produce free, watery discharges from the bowels (hydrogogue cathartics). Hydrogogue cathartics are by far the most efficient. They are called for in proportion to the amount and location of the dropsy, and the dan- ger from blood-poisoning. When the dropsy invades the pleura or lungs, and the shortness of breath is marked, relief may be had in a few hours by giving Elaterium in doses of an eighth to a quarter of a grain, two or three hours apart, until free catharsis is produced. It may be given with a grain of Extract of Hyoscyamus, or a teaspoonful or two of the Tinet- bright's disease. 343 lire and a grain of Pulverized Capsicum. Elaterium must be used with caution, on account of its prostrating effects. It is scarcely safe for weak subjects, but may be a necessity. Croton Oil may be given in doses of a drop, repeated at the same intervals. The hot air bath may be used alternately with these active cathartics. The decrease of the amount of urine passed, and its low specific grav- ity shows that urea is not eliminated by the kidneys in sufficient quanti- ties, and measures should be at once resorted to, to compensate for that deficiency. The most reliable means at our hands for this purpose, are the watery stool-producing (hydrogogue) cathartics and copious sweating, by means of the hot air bath. In case of insensibility, or convulsions from blood-poisoning by urea, Elaterium should be given in doses of a quarter or half a grain mixed with butter, and placed well back on the tongue. The hot air bath should be used simultaneously. The hot air bath may be easily given by conveying hot air from an alcohol lamp, through a sheet iron pip*e under the bedclothes. The part of the pipe which rests under the clothes may be closed in a tin box for con- venience. Ronchette, of New York, devised a very simple apparatus for this purpose, called Ronchette's hot air bath. The elimination of urea by the skin, will be greatly facilitated by the use of Jaborandi. Half a teaspoonful to a teaspoonf ul of the tincture, or Fluid Extract may be given three or four times in the twenty-four hours. A very eligible remedy as a diaphoretic, is a solution of the Acetate of Ammonia, in doses of a tablespoonf ul three times a day. If the symptoms are not very urgent, the use of the saline cathartics, recommended in the first part of this article, are to be used instead of these most powerful ones just spoken of. The daily use of the hot air bath may be continued, during the disease as the most efficient means of producing elimination of urea by the skin. If the effect of the bath is agreeable, its ai (plication may be continued from half an hour to an hour each time, or if too depressing, it may be used for a shorter time, at more frequent intervals. When the flow of urine begins naturally to increase, the use of diure- tics (medicines which cause a flow of urine,) may be cautiously begun, and the other evacuates omitted, beginning with the cathartics. Among the eligible diuretics for this purpose, are Cream of Tartar (Bitartrate of Potash,) which may be drank at will in lemonade, made of a clear solution of an ounce of Cream of Tartar, dissolved in hot water, using a sufficient quantity of lemon and sugar. (See formula on next page.) Digitalis in doses of ten drops of the tincture three times a day, gradually increased until the desired effect is produced, or Broom (Scorporius,) in a tea, or half teaspoonful doses of the fluid extract three times a day. During convalescence, attention should be given to the diet, that the food is nourishing, and well digested containing tender meat, milk, and eggs. As the patient leaves the room, he should be clothed in flannel, and prop- erly protected against cold. Generally, the Tincture Muriate of Iron should be given in doses of from ten to twenty drops, largely diluted in sweet- ened water, after eating. Tonics of one or two grains Quinine, or a couple 344 DISEASES OF THE KIDNEYS. of ounces of some of the simple bitter teas as Columbo, Quassia, Gentian, etc., may be taken with benefit before meals. Chronic Bkight's Disease.— It is to be understood, in the first place, that this disease is incurable, but life is greatly prolonged by judicious management. The indications are related to the dropsy and the uraemia (poisoning by that ingredient of the urine known as urea, remaining in the blood.) General dropsy calls for the same treatment as is directed in the acute disease. It is better, however, to use the saline cathartics as Sulphate of Magnesia (Epsom Salts.) Citrate of Magnesia, Rochelle Salts or Seidlitz powder, if the dropsy be moderate, but if the dropsy be great, the more powerful hydrogogue (water-producing) cathartics may be used, as, Elaterium, Croton Oil, or Bitartrate of Potash (Cream of Tartar) and Jalap, as directed in the acute disease. One free watery stool may be produced daily. Care should be exercised not to weaken the patient by pushing cathartics too far. Remedies to act on the kidneys (diuretics) may be used in the chronic form of the disease, without risk of harm. Pure water may be drunk in large quantities. Of the diuretic medicines, the Cream of Tartar. Citrate or Acetate of Potash, are to be preferred. They may be used in connec- tion with the vegetable diuretics Digitalis, Squills, or Broom. The potash may be readily taken, prepared as follows: Take of Cream of Tartar an ounce, dissolve in hot water; when cold pour off the clear super- natant liquid, cut up some lemons into it, and sweeten to the taste. The whole of this Cream of Tarter lemonade is to be taken during the day, or: Take of the Citrate of Potash and Bicarbonate of Potash each four ounces, dissolve in a pint of soft water. Of this solution two tablespoonfuls may be put in a large tumbler half full of water, sweetened to the taste, add a large tablespoonful of lemon juice, and drink while effervescing, six times a day. In the absence of lemons, a tablespoonful of a solution of three drams of Citric Acid, in half a pint of water, may be used instead. Of the vegetable diuretics Digitalis is to be preferred, given in infu- sion, (tea) two drams of leaves to the pint of water, in doses of one or two tablespoonfuls. Broom in decoction (tea boiled,) one ounce of'broomtop to a pint, in the same doses. The tincture of Digitalis, Vinegar of Squill and the Fluid Extract of Broom may be used in doses of half a teaspoonf ul to a teaspoonful. Wheh the stomach or bowels w r ill not permit giving diuretics, cloths may be soaked in an infusion of Digitalis made, with an ounce of the leaves in a pint and a quarter of water, and laid over the abdomen. Or the body may be rubbed for a time with a liniment made with equal parts of the Tinctures of Digitalis, Squill, and Iodine. Medicines which produce sweating (diaphoretics) must be depended on, if hydrogogue cathartics are not well borne, and the kidneys do not act freely with the use of diuretics. Indeed, it seems preferable to use dia- phoretic measures alternately with the action of cathartics. Or rather use diaphoretic measures regularly, and resort to cathartics to cause a greater elimination of water and urea. The first and best means at our disposal for this purpose, is the hot air bath, as described in the treatment for inflammation of the kidneys, and in the treatment of acute Blight's dis- ease. In short, the benefit from the hot air bath is so great, and it acts so bright's disease. 345 nicely, that I am disposed to recommend its use to the exclusion of every other means. Jaborandi and Solution of the Acetate of Ammonia are appropriate, used as recommended in the treatment of acute Bright's dis- ease. The measures for the elimination of urea, are the same as given for that purpose in the acute form of the disease, namely : reliance, when the symptoms are urgent, on the use of the hot air bath, and the hydrogogue action of Elaterium, especially, when the urea has produced coma, insen- sibility, or convulsions. When this urgency does not exist, it is best to avoid the use of Elaterium, but recourse may be had to the milder cathar- tics, directed for the mitigation of the dropsy, in this and the acute disease. The tonic effect of Quinine and Iron, are markedly useful in this dis- ease. The former may be given in doses of two or three grains, three times a day. The form of Iron to be preferred is the Muriate Tincture of Iron. It should be given in doses of twenty or thirty drops, largely dilu- ted in sweetened water, three times a day . A change in the form of these tonics from time to time, is advantageous. Pills of a twentieth to a thir- tieth of a grain, given one three times a day, appears to be of great advan- tage in chronic Bright's disease. Food should be nutritious, and as abundant as the digestion will admit of. The clothing should be warm and the patient should lead an out door life to such a degree as his strength will warrant. For the relief of pain, Opium should be avoided, if possible, and Bel- ladonna, Hyoscyamus, Indian Hemp, Aconite, Conium, etc., used instead. When these fail to give relief, recourse may be had cautiously to Opium. It has acted admirably in some cases. Vomiting and purging are to be regarded as conservative, they only are nature's means for eliminating urea. They should be restrained only sufficiently to keep them within the bounds of safety. They may be relieved by aiding in throwing off the urea, by resorting to the hot air bath. Medicines calculated to relieve vomiting are Oxolate of Cerium in doses of five grains. Dilute Hydrocyanic Acid in doses of three to five drops, Creosote, in doses of one drop in water. Bismuth, in doses of ten to twenty grains, and lumps of ice swallowed whole, or allowed to dissolve in the mouth. If any remedies are necessary for diarrhoea, the remedies directed for the treatment of that trouble are appropriate. Upon the early recognition of the disease, and the promptness with which its effects are met, will depend the benefit of treatment. The disease may be stayed, and in some cases, life may continue with comfort- able health for years. Gallic Acid appears to have the power of preventing the waste of albumen. It should be given in doses of five to fifteen grains in solution with five or six drops of Aromatic Sulphuric Acid. The following is the formula of Dr. Aitken: Take of Gallic Acid, from one to two drains, Dilute Sulphuric Acid, one dram, Tincture of Lupuline (the yellow powder shaken from hops) a dram, Infusion of Hops six ounces. Mix. Dose: A tablespoonful three times a day. 346 DISEASES OF THE KIDNEYS. GRAVEL— REXAL CALCULI. The formation of gravel in the kidneys is a common occurrence, but frequently remains unnoticed, because no unpleasant symptoms* are caused by them. In most cases? the causes of this affection are obscure or very uncertain. While the gravel (calculi) are generally met with in rather fleshy per- sons who live mostly on animal food, yet they do, also, occur in weakly persons, who use a very spare diet. Without doubt, the mode of liviug is the cause of the concretions (gravel,) although a peculiar disposition of body must exist, which is as yet unknown to us. The urinary concre- tions in the kidneys vary ; at times they form a fine sandy deposit, gravel; at other times larger bodies, whose shapes vary according to their locality and their place of origin ; they may even be large enough to fill the cavity of the kidney. Their surface is at times smooth, at others rough ; the number of calculi contained in one kidney is very indefinite ; some- times their sides, where they had been in contact with other calculi, form regular facets. The symptoms, caused by renal calculi, are very important, because they frequently attain a great hight, and have the appearance of great danger, as though life itself were imperilled by them. * - Gravel may exist without any morbid symptoms; in other cases, the passage, and, perhaps, the formation of gravel are attended with marked derangements of the functions of the stomach, the main feature of which, generally, is an excess of acidity. We have pointed out this connection, when speaking of chronic catarrh of the stomach. Even larger calculi may exist, and be passed without any pain. This depends upon the size of the calculus, its smoothness, roughness, or the angularity of its form, upon the width of the ureters, upon the sensitiveness of the urinary pas- sages to the foreign body, whether and what severe disturbances the passage of the calculus occasions. These symptoms, together, are gener- ally designated by the name of renal colic. It should be observed, how- ever, that other obstacles to the excretion of urine, such as the presence of bloody coagula in renal hemorrhage, may cause renal colic, except that such colic is usually less persistent, violent, and distressing; for the reason that the obstruction is not fixed, and does not irritate or wound the mucous membrane. Renal colic generally breaks out suddenly, after a severe effort or con- cussion; its gradual development form indefinite pains in the renal region, whence they spread to adjoining parts, is of less frequent occur- rence; the former generally takes place, if the pains announce the entrance of a renal calculus into the ureter ; the latter, if the pain is occa- sioned by a gradual irritation of the renal pelvis, or by a change in the position of the concretion. The pains, generally, are very violent, are felt in the region of the affected kidney, whence they spread to the blad- der and the thigh, and, when excessive, generally, affect the whole side- The patients suffer a great deal, are tortured by an agonizing anxiety, and have no rest in any position or place. Their face is, at times, pale as death, at others bright-red ; the body is cool, the pulse small and fre- quent. If the parts are very sensitive, convulsive symptoms are apt to set in. The passage of urine is impeded and painful, sometimes the GRAVEL. 347 stranguary is complete. The pains, sometimes, continue gradually to increase, until the abdomen shrinks from the least touch, or else they remain unchanged, or they remit at intervals, until they finally cease en- tirely, and the patient again enjoys perfect health. In such cases, the concretions usually pass off, soon after, with the urine. If the calculus has not passed the pain may continue, and nephritis result in consequence. The passage through the ureter, which, after the intense pain has some- what abated, the patient is able to watch and point out as the calculus progresses, lasts from a few hours to several days. The diagnosis of renal colic is not always very easy. The most com- mon characteristic indications of the disease are: the fixed starting-point of the pain, together with the urinary difficulties. The prognosis is unfa- vorable only, if the concretions remain in the kidney, and cause a danger- ous irritation in this organ. An arrest of the calculus in the ureter is a rare exception. ALLOPATHIC TREATMENT. Gravel or Renal Calculus. The relief of pain in a "fit of gravel" (nephritic colic) is the first thing called for. The most reliable means of relief, is the hypodermic injection of a quarter of a grain of the Sulphate of Atrophine every fifteen or twenty minutes until relief is obtained, (by the hands of a physician.) In case relief is not soon given, recourse in severe cases, may be had to the inhala- tion of chloroform. The passage of the gravel may be hastened by freely drinking water, which increases the secretion of urine ; this will carry the gravel before it into the bladder. The most common variety of gravel is uric acid. This ingredient of the urine is very insoluble, and precipitates from the urine in the pelvis of the kidneys. The passage of this gravel causes pain. When gravel of this kind is passed in the urine into a vessel, it is known by its red color. The urine is, almost always, acid when voided. The preventive treat- ment of this condition consists in rendering the uric acid soluble, by the use of the vegetable salts of potash, as the citrate and Bitartrate of Potash. The Bicarbonate of Potash is, also, appropriate. The uric acid unites with the Potash and forms the Soluble Urate of Potash. Cream of Tartar lemonade may be made by the directions given in the treatment of chronic Bright's disease, and drank as freely as is agreeable to the patient. Or Citrate and Bicarbonate of Potash may be used, also, as there directed, as freely as is desired. Carbonate of Lithium should be given, two or three times a day, in doses of five grains. It may be taken in either of the Potash solutions, or, if disagreeable to the taste, in wafer or capsule Soda is inappropriate in this condition as with Uric Acid ; it forms a hard insoluble salt. Alcoholic drinks, wine and beer, ought to be omitted. The diet should be plain and simple, but nutritious. An active life in the open air is beneficial. Sometimes the gravel is composed of phosphate salts; then the gravel, if voided in the urine, is of a grayish or white color. The urine is, generally, alkaline. The use of Dilute Nitro-Muriatic Acid, in doses of ten to twenty drops 34S DISEASES OF THE BLADDER. diluted with sweetened water until pleasant, should be taken three times a day. Benzoate of Ammonia has the power of dissolving the. phosphate cal- culi. It may be given in doses of ten to twenty or thirty grains, two or three times a day. The diet should be generous, both in quality and quantity. There should be nervous and mental rest. Tonics of bark and iron are useful. The gravel may be composed of oxalate of lime. In that case, the color of the gravel, if voided, is dark brown or yellow. Its prevention will consist mainly in the use of Dilute Nitro-Muriatic Acid twenty or thirty drops in a glass of water, three times a day. The use of sweets, and espe- cially, the rhubarb or pie-plant ought to be disallowed in the diet. A calculus may be more easily discharged from the bladder, if the urine is retained for a long time, or the bladder may be washed out through an open mouthed catheter. Stone in the bladder nearly always begins with the presence of a cal- culus (gravel). CHAPTER XVII. DISEASES OF THE BLADDER. CYSTITIS— IXFLA3IJIATIOX OF THE BLADDEB. Inflammation of the bladder, in most cases, involves the mucous lin- ing of the bladder, and such is called Catarrhal Cystitis. The most frequent causes of cystitis are irritations affecting the mu- cous lining of the bladder, directly ; they are either mechanical, catheter- ism, injections into the bladder, stone, or medicinal; acrid diuretics, Can- tharides, Copaiba, Cubebs, or even the decomposing urine itself. In other cases, the disease may occur as a complication ; inflammatory dis- turbances of adjoining organs may spread to the bladder, or the cystitis may simply be symptomatic of some acute general affection. In rare cases, on ry, a cold alone will be sufficient to cause an inflammation of the bladder. The symptoms of acute cystitis vary. The local symptoms may amount to no more than a slight feeling of pressure in the region of the bladder, and are scarcely ever as intense as Hartmann describes them. Amid more or less febrile motions, the patient always experiences at first a pain when urinating. When the attack first sets in, a large quantity of urine is voided with painful urging; soon, however, the urine is voided only in drops, and amid the most agonizing pains, as though burning embers were passing through the urethra. This symptom is most strikingly witnessed in the most acute form of cystitis after the use of new beer : it is charac- teristic of this inflammation. Very soon the difficulty of urinating be- comes associated with a constant pain in the region of the bladder; it is INFLAMMATION OF THE BLADDER. 340 a cutting or stitching pain, and is aggravated by motion, urging to stool, coughing, sneezing, pressure from without; it spreads upwards and down- wards to the penis, periineum and thigh. At the outset of the disease, the urine is clear; after a while, it becomes slightly tinged with blood, and, in the further course of the disease, mixed with flocks of mucus and pus-corpuscles, turbid, inclined to decomposition. The general health is not always disturbed correspondingly to the abnormal sensations pro- ceeding from the bladder; at the commencement of the disease, the gen- eral health is not much impaired, and it is only at a later period that restlessness, chills, loss of appetite, and even vomiting, set in. The disease, very frequently, runs such a rapid course that an im- provement, and even complete recovery, may take place in a few days. If the disease increases in intensity, the tenesmus of the bladder may increase to complete retention, the bladder becomes extremely distended, and threatening symptoms of prostration set in, which may end in death. Usually, however, the disease, unless recovery takes place, assumes alen- tescent character, and becomes chronic. In the chronic form, the pains decrease considerably, only the con- stant urging remains. The mucus is secreted in considerable quantity, and along with it pus, so that the urine has a marked white-yellow appearance, sometimes like milk, and deposits a very tenacious mucous sediment. The tendency to decomposition is very great, the reaction decidedly alkaline, less frequently neutral. However, the urine is decom- posed, only, if it remains for a long time in the bladder. Unless pecu- liar circumstances hasten the loss of strength, it generally takes place very slowly, and the disease may continue for years before death takes place from exhaustion. Complete recovery is a rare event. Among the sequelae, we distinguish ulceration of the mucous membrane, hypertro- phy of the walls of the bladder, paralysis of the detrusor muscle; it is, particularly, the two first named sequelae that hasten the fatal termina- tion of the disorder, by causing hectic fever, and real phthisis of the bladder. What we have said, shows that the prognosis is quite uncertain. Even if we usually succeed in overcoming an acute catarrh of the blad- der, yet ailments sometimes remain for a long time after the slightest attacks, to which the careless or improper conduct of the patient may impart a high degree of gravity. Chronic catarrh of the bladder is always a dangerous disorder, whenever a great deal of the mucus and pus is secreted. HOMEOPATHIC TREATMENT. This malady, like the previous one, ought only to be treated by non-professional persons when medical aid is not at hand. Acoiiitum is ever requisite in the initiatory treatment of this disease, if there be a considerable degree of fever, with hot, dry skin, and quick, hard pulse. Dose: Dissolve ten pills in two tablespoon fuls of water, and give a teaspoonful of the solution every two hours, until the pulse becomes more healthy, and the skin moist, etc. After which, consult the indications for the following medicines, respectively, wherewith to • continue treatment. 350 DISEASES OF THE BLADDER. Cantharides* is as valuable a remedy in the treatment of Inflam- mation of the Bladder, as in that of the Kidneys, and will, in the greater number of cases, be required to follow the initiatory administration of Aconitum (or even to precede the latter, when the fever has not run so high). Dose: Dissolve eight pills in two tablespoonfuls of water, and give a teaspoonful of the solution every three hours, until change. Xux-vomica. When the affection is attributable to an indulgence in wine and spirituous liquors, this remedy, timely administered, will, in many instances, check its further progress; and, also, when it results from suppressed piles, or other habitual discharges, or from dyspeptic derangements. Dose : As for Canth. Pulsatilla is valuable in checking the development of the affection when arising from suppressed menstruation. It is, also, serviceable in all cases, from whatever cause arising, when occurring in individuals of phlegmatic temperament, with the following symptoms : frequent desire to urinate, painful and scanty emission of water, either slimy or tinged with blood, which deposits a purulent-looking sediment ; burning and cutting pains in the lower part of the belly, with external heat and tume- faction ; suppression of urine. Dose: Six pills in a teaspoonful of water, every six hours, until ame- lioration or change. Hellebor us-nig., Veratrum,. These medicines are of considerable service in cases of inflammation of the bladder, which come on gradu- ally, but, subsequently, become very severe, attended with frequent urg- ing to pass water, and spasmodic pains, during which only a small quan- tity of water is passed ; to these symptoms are added continual inclination to vomit, aversion to all kinds of food, excessive distention of the belly. Dose: Of either of these remedies as selected, give six pills in a tea- spoonful of water, every two hours, until three doses have been given, and then every six hours, until positive amelioration or change. HEMATURIA— BLOODY ZBIXE. Bloody urine, proceeding from the bladder, originates most com- monly in injuries of the mucous membrane of the bladder by foreign bodies, or by concretions. Moreover, hematuria, and malignant growths in the bladder, may arise from inflammation of the bladder and its conse- quences, ulcerations and dilation of the vessels. It is seldom the case that hemorrhage from the bladder occurs without any, evidently, mate- rial cause. As in the kidneys, so in the bladder, certain poisons may cause hemorrhage, though, in the latter, less frequently than in the former. Excepting the symptoms of the casual affection, the symptoms of hematuria are generally trifling, determined, for the most part, by the coagula that form very readily, and interfere with the easy flow of urine. * When an affection of the bladder has been induced by the local application of Cantharides, in the form of a plaster, the Tincture of Camphor should be employed as an antidote, in the manner described at page 89. BLOODY URINE 351 Hence, we have urging, tenesmus, spasm of the bladder, burning or cut- ting pains, and, very frequently, a perfect ^absence of pain. The symp- toms are always restricted to the bladder, and do not involve the kidneys in any way. As a rule, the blood is not intimately mixed with the urine, is not decomposed, and, if the hemorrhage is at all considerable, the blood coagulates in such quantity, that the catheter is often required in order to effect a passage for the urine. The flow of blood from the bladder very easily exceeds the quantity flowing from the kidneys, and hence super- induces, more readily, the phenomena entailed by loss of blood. On the other hand, an hemorrhage from the bladder usually has a shorter dura- tion than hemorrhage from the kidneys, and scarcely ever lasts uninter- ruptedly for weeks. Of itself, it is scarcely ever an accident of any great importance. ALLOPATHIC TREATMENT. In the treatment of bloody urine, we ought to discriminate between hemorrhage from the bladder and from the kidneys. In hemorrhage from the kidney the blood is more evenly mixed through the urine, and flbrine is apt to be discharged in long strings, which have been moulded in the ureter (the tubes leading from the kidneys to the bladder). In hemorrhage from the bladder, the blood is apt to be passed with the very last of the urine voided. Internally, the remedies to be resorted to are the following: The Tincture Muriate of Iron, which should be given in doses of twenty or thirty drops largely diluted in sweetened water ; Gallic Acid may be given with Ergot, the former in doses of ten to fifteen grains, with five or six drops of Aromatic Sulphuric Acid, in water, and the latter in doses of ateaspoonful of the Fluid Extract, four times a day, or oftener. In this, as in other forms of hemorrhagic disease, a useful formula is : Take of Gallic Acid a dram, Ergotine and Digitalis, each, a scruple. Make into twenty pills. Dose: One every four hours. Turpentine is also a useful and available remedy. It may be given in the following mixture: Take of Oil of Turpentine three drams, Fluid Extract of Digitalis a dram, Mucilage of Gum Arabic half an ounce, Gly- cerine two ounces, Water an ounce, Oil of Gaultheria half a dram. Mix. Dose : A dessertspoonful every three hours. Should the disease be periodical, ten grains of Quinine once or twice a day, will prove the best remedy. The Tincture Muriate should be given alternately with any of the other plans of treatment given. In case the hemorrhage is from the bladder, it is best to wash out that organ by injecting into it a solution of Tannin, or Alum, or both, strong enough to have a styptic taste. When the hemorrhage is from the kidneys, hot air baths and purga- tives are called for, as directed in the chapter on Diseases of the Kidneys. Drink should be simple, as plain water, barley-water, etc., which may be taken freely. HOJKEOPATHIC TREATMENT. The best remedies for hemorrhage from the urinary organs are : Arnica. When caused by gravel in the bladder, injury from exter- nal causes, like a fall or blow. Especially, if caused by the awkward or ignorant use of the catheter. 352 DISEASES OF THE BLADDER. Dose: Six pills every two to four hours. Cannabis. The flow of blood is accompanied by retention of urine, or at least, by painful urination, burning, lancinating, sharp pains during the emission of urine, fine where the blood comes from the urethra also. Dose : As for Arnica. Cantharis is only good where there is much pain of a violent cut- ting, pressing, and crampy character, extending into the urethra, and, also, into the kidneys. Pain increased by drinking water. Dose : As for Arnica . Xux Vomica. If the difficulty is caused by the abuse of spirits, by suppressed menses, etc. Dose : As for Arnica . Sassafras tea, or a few drops of Oil of Sassafras on a lump of sugar, taken three times a day, is a sovereign remedy. The Oil is best. Take it for two days only. Witch Hazel. In any form, as a tea (home-made,) Pond's Extract, Humphrey's Extract, or any of the standard extracts of this remedy may be relied on as very good indeed, in all cases of this kind, as well as in many other forms of excessive bleeding. Ipecacuanha. Is reliable where there is profuse loss of blood, with cutting in the abdomen and urethra, faintness, deadly paleness, sickness at the stomach, oppression of the chest, and a feeling of warmth in the lower abdomen. Dose : As for Arnica. ENURESIS NOCTURNA— WETTING THE BED. This inconvenience would be of little consequence, except for the cry- ing abuses to which the endeavor to remove, it has led. Physicians, as well as parents, have supposed that this weakness could be done away with by purely educational means, which were, moreover, suggested by the most insane views regarding its causes. Latterly, physicians have im- proved their methods of meeting this accident; lay-persons, however, are still true to their absurd prejudices in this respect. Wetting the bed is an accident to which children are liable ; it seldom lasts beyond the age of pubescence, still less beyond the age of twenty years. Healthy individuals scarcely ever wet their beds more than once. This trouble, generally, dates from the earliest infancy, and rarely makes its appearance at a later period. Various causes have been assigned for it, and corresponding methods of treatment devised for its cure, however, with varied results. Laziness may give rise to it in many cases, but more frequently it is the fear of getting up in the dark. A common cause of the trouble is, that children sleep too soundly to be roused from their sleep by the irritating action of the urine upon the bladder. Yet the bladder need not be weak or paralyzed ; if so, the accident may take place even during a light sleep. The children, generally, say that they dreamed of wetting the bed, showing that the irritation was not sufficiently powerful to wake them. The quality of the urine may cause a passing attack of enuresis : we see this in children who are liable to catarrhal attacks, and, under such circumstances, immediately void a saturated urine. The irritation caused by pin-worms may, likewise, induce enuresis. WETTING THE BED. 353 Corporeal punishment should never be resorted to as a means of curing this weakness, which is rather made worse by it than otherwise ; older children are made so nervous by this treatment, that they sometimes remain wide awake half the night. On the contrary, their sense of honor and will should be appealed to. It is of no use to keep the ordinary bever- age from them in the evening; this may cover up the weakness for a time, which returns again as soon as a little more liquid is again partaken of. Nor is it of any more use to frequently rouse children from their sleep at night. If no abnormal conditions forbid, the best plan is, to gradually accustom the bladder to hold larger quantities of liquid. Children should be accustomed during the day to retain the urine as long as may seem proper, and not to yield to the least desire to urinate, as is their usual cus- tom. This system, if carried out consistently and vigorously, is often alone sufficient, in otherwise normal cases, to effect a cure, of course not in a few days. By measuring the quantity of urine at every discharge, we can determine a priori the time when the enuresis will cease. The more the quantity increases the nearer we are to a cure. This method has the advantage of being readily adopted by the children, provided they are promised a speedy delivery from their trouble. ALLOPATHIC TREATMENT. The involuntary flow of urine during sleep, so frequently met with in young children, may result from any of the causes of incontinence. The character of the urine is to be examined in all cases. If it is alkaline when first voided Dilute Nitro-Muriatic Acid should be given in doses of from five to twenty drops, in from a quarter to half a glass of sweetened water, three or more times a day, to cause an acid reaction of the urine. If the patient is weakly, ten drops of the Tinc- ture Muriate of Iron should be given in the same way as the acid, after each meal. Should the urine be exceedingly acid when first voided, alkalies ought to be given. A drink of Cream of Tartar Lemonade may be used: Take from two to four teaspoonfuls of Cream of Tartar, dissolve in hot water; when cold pour of the clear liquid, cut some lemons into it and sweeten. Drink as desired. The patient ought to be made to drink spar- ingly of water, or other fluids, during the latter part of the day. During the night he should sleep on the side. He ought to be wakened if he turn on his back. The next indication, is to overcome the irritability of the bladder. There is no remedy, which so positively accomplishes this as Belladonna. Take of Sulphate of Atropine one grain, dissolve in one ounce of distilled water. Give five drops at bed-time, and increase the dose by two drops each night, until the incontinence ceases, or marked dryness of the throat, or dila- tion of the pupil is produced. The Tincture of Belladonna may be used for the same purpose, in doses of five drops. The ratio of increase of the Tincture may be five drops, until the same results are produced. If the trouble does not cease under the use of the Belladonna alone, the Tincture of Nux-vomica may be given, in doses of three drops three times a day, to a child of three to five years old. If the child is five years old or over, five drops may be given. Ergot is often efficacious in this disease, twenty to thirty drops of the fluid Extract may be given in water, two or three times a day. 23 354 DISEASES OF THE BLADDER. Iodide of Iron is often, especially serviceable in this trouble. It seems adapted to cases of weak, pale, scrofulous children. The Syrup of the Iodide of Iron may be given in doses of twenty drops, largely diluted in water, three times a day. If it is used, it is not necessary to use the Muri- atic Tincture. If these means fail, it is best to awaken the patient once or twice in the night to empty the bladder. A large ball, roll of cloth, or something of the kind may be tied to the back of the patient, which will awaken him if he turns upon his back, when he may arise and empty his bladder. It is claimed, that the trouble is caused in some boys by a long prepuce having a very small opening, giving rise to irritability of the bladder: That, in that case, drugs are useless, but circumcision removes the diffi- culty. HOMCEOPATHIC TREATMENT. Where, in spite of every precaution on the part of the nurse, children wet the bed every night, and no other symptom of derangement can be detected, the following remedies are often effectual in surmounting the weakness. Sepia is to be preferred, when the mishap generally occurs during the first sleep. Dose; Six pills in a teaspoonful of water at bed time, for four nights in succession; then pause four days, and resume the administration, if necessary, on alternate days, four times and so on. Aciditm-phosphoricum will prove useful in some cases when large quantities of urine are emitted, so that the child's bed is "flooded" nightly. Dose : As for Sepia. Belladonna is appropriate in cases in which the weakness is evi- dently incidental to a relaxed condition of the bladder, or, to cerebral irri- tation. Dose: Four pills in a teaspoonful of water, repeated, if necessary, every day. Sulphur should be perseveringly employed in almost all chronic cases occurring in delicate children, but particularly in those who are, or have been subject to eruptions on the skin. Dose : As directed for Sepia. Ciiia is a useful remedy when the existence of worms appears to be the irritating cause. Dose : Eight pills, as directed for Sepia. CYSTOSBASMUS-SBASM OF THE BLADDER. This spasm is a symptom in many affections of the urinary organs, and, as such, is not referred to in this place. There is no doubt, that it may, likewise, present a pure nervous condition of the bladder, although its occurrence, as such, is comparatively rare. The disease may break out at any age, but is most frequent in middle- aged individuals of the male sex. All persons with weak and irritable nerves are predisposed to this affection, hence it is most frequently met with among hypochondriac and hysteric individuals. Hence, a sudden emotion, an outburst of passion, great depression of strength, violent exertions during sexual intercourse, onanism, may be proximate causes of i SPASM OF THE BLADDER. 355 the disease. Whether a simple spasm of the bladder may be caused by a cold, is questionable. A spasm of the bladder commonly sets in quite suddenly, (the patient being otherwise in the enjoyment of good health,) as a violent, constrictive pain, proceeding from the neck of the bladder, and extending along the under side of the penis towards the glans, and attended with partial or complete erection ; sometimes radiating to the groin, testes, thighs, and very often, at the same time, along the perinseum towards the anus, accom- panied by a pain resembling tenesmus. If the spasm affects the detrusor muscle (the muscle that forces the urine from the bladder) alone, the least accumulation of urine excites a violent desire to void it, so that the patients are sometimes unable to prevent the flow of urine ; if the sphincter (the muscle that retains the urine in the bladder) is affected, the urine is either voided drop by drop, or cannot be voided at all ; if the detrusor and sphincter are affected at the same time, we have the most violent urging to urinate, attended with a more or less complete inability to void the urine : this last-mentioned case is most apt to cause nervous phenom- ena of a different kind, such as anguish, restlessness, trembling, convul- sions, violent tenesmus. An attack of spasm may last from one or more minutes to half an hour. After the pains begin to abate, the urine some- times passes off in a full stream, clearer and paler than usual. The return of the paroxysm is not governed by any rule, since the spasm sometimes ■ only takes pla.ce once, sometimes a number of times, even on the same day. ALLOPATHIC TREATMENT. Spasm of the bladder is best and most quickly relieved by an injection into the bowel, of a teaspoonful of Laud- anum, and thirty drops of the Tincture of Belladonna, in one or two table- spoonfuls of thin starch. The injection should be made with a hard- rubber syringe. Hot applications may be made over the bladder and between the legs. This may be well done with a hop poultice. The removal of the cause is more difficult. A gouty condition and a highly acid urine, is to be met by the use of alkalies, as the Cream of Tar- tar Lemonade, made by dissolving an ounce of Cream of Tartar in hot water ; after cooling, the clear, supernatant liquid is to be poured off and drank during the day, with the addition of lemons and sugar. Or Citrate of Potash maybe taken as follows: ]>issolve four ounces, each, of Citrate and Bicarbonate of Potash in a pint of water. Two tablespoonfuls of this may be drank in half a glass of sweetened water, after mixing with it a tablespoonful of Lemon Juice, or a solution of Citric Acid two ounces to the pint of water. The dose may be repeated four to six times a day. This makes the urine bland and unirritating. Wine of Colchium may be given in doses of ten to thirty drops, three or four times a day, omitting its use when the bowels move too freely. Should the trouble be caused by an inflamed (or abscess of) kidney, anodynes should be given as needed, and the person treated as directed in that disease. If caused by a stone in the bladder, as denoted by severe pain after voiding urine, the removal of the stone by a surgeon, is the only certain treatment. Opium and Belladonna can only temporarily relieve pain. Excessive venery is one cause which is removed only by continence. The diet should be plain and nutritious. All stimulants should be 356 DISEASES OF THE BLADDER. avoided. Milk may be allowed freely. Barley-water and Flaxseed tea are appropriate as drinks. In Paralysis of the Bladder, if there is an overflow of urine (con- stant passing water.) the catheter ought immediately to be used, the bladder emptied, and then washed out with warm water. The use of the catheter twice a day, or oftener, is necessary, as long as the paralysis continues. The catheter used should be large, and the bladder completely emptied each time. The bladder ought frequently to be washed out with warm water. Remedies calculated to restore the muscular power, are: Strychnine, Electricity and Ergot. The dose of Strychnine is one-thirtieth of a grain three times a day. It may be given in solution with Dilute Phosphoric Acid. Take of the Sulphate of Strychnine one grain, Dilute Phosphoric- Acid half an ounce. After solution is effected, add Syrup of Ginger three and a half ounces. Mix. Dose : A teaspoonf ul three times a day. If the patient is feeble, half a dram of the Pyro-phosphate of Iron may be added to the mixture, and also half a dram of Sulphate of Quinine, if its tonic effect is needed. Ergot is also valuable in this trouble. The dose of the Fluid Extract is half a teaspoonf ul to a teaspoonf ul, in water, three or four times a day. The form of Electricity most appropriate, is the direct current. Hot hip baths, the cold douche, blisters over the lo,wer part of the spine, are said to be serviceable. Aloes is the most suitable purge. HOME REMEDIES. Acid, or alkaline drinks, in any of the various forms usually present in the house. Hot poultices, hot bricks, or other hot applications to the region of the bladder. Camphor, freely inhaled,, sometimes relieves ; a very weak tea made from a few sprigs of Deadly Nightshade, will be good, but must be used very carefully. PART EIGHTH. DISEASES OF THE MALE SEXUAL ORGANS. CHAPTER XVIII. OKCHITIS-INFLAMMATION OF THE TESTES. Now and then, this affection is met with, as the result of mechanical injuries, but most frequently originates in gonorrhoea. It not only super- venes during the course of acute urethritis, but it may, likewise, set in suddenly during gleet, generally, without any apparent exciting cause. Severe exertion, or the discontinuance of the use of suspensories, are said sometimes to cause the disease, but this is not an established fact. The excessive use of beer or wine is a much more active cause of the disease, probably because the inflammation is very much increased by such stim- ulants. Both Cubebs and Copaiba hold the same relation to gonorrhoea. They have a specific effect upon the urethra, and it is easily conceivable that, instead of effecting a cure when given in large quantities, they aggravate the inflammatory symptoms, and, owing to the specific action which they likewise exert upon the testicles, communicate the inflam- mation to these organs. Symptoms. Orchitis seldom sets in suddenly. Ordinarily, it com- mences with slight drawing pains in the spermatic cord, which is sensi- tive to contact. At the same time, the patient experiences violent tearing pains in the thigh of the affected side. The weight of the testicles at first is troublesome, then becomes painful, and, finally, intolerable. In one or two days the epididymis becomes painful to pressure, swells with more or less rapidity, and shortly after is succeeded by an inflammatory effusion into the tunica propria, in consequence of which the testicle very soon enlarges to the size of a fist. The pains now become agonizing; the patient has to confine himself to a horizontal posture, with the testicle properly supported. The pain is a burning, tearing. pain, most frequently, with remissions after the fashion of rheumatic pains. The general con- dition of the patient does not suffer much, only in violent cases, there is fever or even vomiting. The discharge usually disappears after the orchitis is fully developed, and does not re-appear until the inflamma- tion has run its course; only in a few cases, it does not re-appear after the subsidence of orchitis. The inflammation, in its acute form, does not often last beyond the tenth day, sometimes the improvement commences on the fourth day. 357 358 DISEASES OF THE MALE SEXUAL ORGANS. This, however, is not very rapid, since it sometimes takes weeks before the testicle resumes its former size ; very fequently an obstinate swelling of the testicles remains. ALLOPATHIC TREATMENT. Inflammation of the testicle is to be treated, first, by absolute rest. The patient should be confined to his bed, and should not be permitted to rise for anything. The bowels should move into a bed pan, and the urine be voided while lying down ; above all, he must not walk about, nor even sit in a chair. The testicles must be supported by a roll of soft cloth between the thighs, while the patient lies upon his back. The support must be sufficient to relieve the pain as much as possible. Such applications should be made as will give the greatest relief to the pain. This is, generally, best done by hot applications, as flannels wrung out in hot water, covered with oiled silk to retain their moisture, and heat or warm poultices. Sometimes cold applications are more grate- ful; they should then be resorted to, and even ice applied, if it relieves the pain more than other means. I have often found cloths, dipped in a solution of ten grains of the Acetate of Morphine, and two scruples of Sugar of Lead, in a quart of soft water, a grateful application. A brisk purge may be given at the beginning of the trouble. For this purpose, nothing is better than a couple of tablespoonfuls of Epsom Salts. (If this amount is boiled a couple of minutes with two and a half teaspoonfuls of roasted coffee in an earthen vessel, and allowed to draw for a few minutes, then strained, it can be taken without trouble) or the same amount of Citrate of Magnesia, or Rochelle Salts taken in lemonade or a couple of Seidlitz Powders may be used. During the hight of the inflammation, a quarter of a grain of Mor- phine, or twenty-five drops of Laudanum, with ten or fifteen drops of Tincture of Belladonna may be given sufficiently often to relieve the pain. Or a teaspoonful of Laudanum, and thirty drops of Tincture of Belladonna, with a couple of tablespoonfuls of thin starch may be given by injection into the bowel, once or twice a day, and any additional ano- dyne, if needed, given by the mouth. If the inflammation leaves the testicle in a hardened condition, which does not disappear, it may be removed by applying Tincture of Iodine once a day, or every other day. HOMCEOPATHIC TREATMENT. Orchitis, or inflammation of the testicles, when depending on an injury can be relieved by Arnica. A dose every four to eight hours ; also, apply exterally. If the result of gonorrhoea, by Clematis or Aururn if a dose is taken every evening. Pulsatilla is, also, a reliable remedy, if the swelling is considerable, without fever or thirst. Aconite, if there is much fever and thirst, and, especially, if this should occur at the beginning of the attack, which it should, usually, be expected will be the case. .+. SPERMATORRHOEA. By this heading, we. strictly speaking, comprehend a flow of semen without any sexual excitement. However, in order to avoid the necessity SPERMATORRHOEA. 359 of resorting to a number of sub-divisions, we have classed together in this chapter abnormal nocturnal emissions, as well as various other morbid derangements of the male sexual organs; an additional motive for this arrangement, is the circumstance that the treatment of most of these con- ditions is the same. The functions of the male sexual organs, vary in accordance with tem- perament, mode of life, constitution, etc., to such an extent, that it is often difficult to decide, whether, these differences are of a morbid nature, or belong to the normal standard. This can only be determined by the man- ner in which the male sexual sphere is, generally, affected by the local phenomena; whether the organs are not abnormally disturbed, or whether the procreative powers are impared or even suspended. The history of these various abnormal conditions of the sexual sphere is pretty much the same. Debilitating constitutional diseases, or acute diseases during the period of convalescence, are apt to cause a so-called irritable weakness in the sexual sphere, which, in the former case, is per- manent, and in the latter case only temporary. This fact is most strikingly witnessed in diabetes and tuberculosis. In the last-named condition, the excessive irritability of the sexual organs contribute to hasten the gen- eral decay. A second cause are cardiac and nervous diseases, which may, however, likewise, result from the sexual weakness. Hypochondria is a frequent cause, and still a more frequent consequence of sexual weakness. The most common cause of sexual weakness is the vice of onanism, which is too much overlooked by physicians. Yet it is certain, that thousands might, by a timely warning, be saved from unspeakable mental and physi- cal disease. Excessive nocturnal emissions, generally, take place between the years of twenty and twenty-five, and, exceptionally, at an earlier age, even six- teen. They are of a morbid nature, if they occur almost regularly without rousing one from sleep, and if they do not occur often, yet leave for days a sensation of languor and debility, and of mental depression. They are, likewise, abnormal if they occur several times in one night or week. More- over, every emission that takes place in the waking state, with or without any special cause, at stool for instance, is to be regarded as abnormal. The consequences of such abnormal losses very soon show themselves : Paleness of the face, with dark margins around the eyes ; insufficient sleep ; drowsiness, with inability to sleep ; dullness of the head ; aching, pressing pain in the head ; vertigo ; irritable, sensitive temper ; aversion to society, to work, and, after a while, a deranged appetite and digestion ; deficient assimilation. Spermatorrhoea, properly speaking, consists of a loss of semen at every emission of urine, at stool, without any cause, or after the most tri- fling erections. The pernicious consequences of this sort of spermator- rhoea, manifest themselves much more speedily than after nocturnal emissions, most probably because spermatorrhoea never occurs in organ- isms, whose physiological functions had been carried on in a normal manner. Irritable weakness of the sexual organs is sometimes the cause, but more frequently the consequence of both the previously-mentioned anomalies. The sexual excitement occurs too easily and too vehemently without possessing sufficient energy and consistence, for the act of coition. 360 DISEASES OF THE MALE SEXUAL ORGANS. The ejaculation of the semen takes place too soon, or even not at all, or the introduction of the penis into the the vagina is prevented, by a prema- ture cessation of the erection. The sexual weakness may be characterized by all sorts of abnormal manifestations in the sexual sphere. The mental disposition exerts a powerful influence in this direction. Hypochondriacs are particularly disposed to irritable weakness, which, under abnormal mental influences, sometimes attains to such a degree of intensity, that it seems to amount to complete impotence. Complete impotence, by which is meant an entire suspension of the ability to perform the sexual act, is, upon the whole, a very rare and, fre- quently, only temporary disorder, except when depending upon debilitat- ing incurable constitutional diseases, such as diabetes or tuberculosis, or when depending upon the loss of one testicle. An excess of sexual excitement (satyriasis) besides taking place at the commencement of gonorrhoea, as we have already stated, may, likewise, occur in consequence of debilitating conditions, first as a passing increase, and subsequently, to be succeeded by a decrease of excitability. It is fre- quently met with, in the case of persons who have been addicted to the vice of onanism, or among worn-out roues; very rarely without such a cause, and then, mostly as a symptom of some deep-seated disease of the brain. In treating most of these forms of sexual weakness, the diet, mode of life and psychical (mental) agencies exert an important influence; hence we place them in the front rank. We cannot lay it down, as a rule, that these morbid conditions require either a lean or strengthening diet. Some are afflicted with weakness of the sexual organs, more especially with excessive pollu- tions, because they live too well; it is a mistake to suppose that this waste is repaired by a nourishing diet, since it is well known that some persons are living in circumstances which preclude the possibility of indulging in good living. Hence, it becomes a matter of interest to inquire whether a lean or rich diet is the more suitable. All such patients must be cautioned against going to sleep with a full bladder or a full stomach, either in the daytime or at night. Certain beverages, such as spirits and hop beer, must be strictly avoided. Beer-drinkers are very apt to deny the debilitating influence of hop beer on the genital organs ; that this influence exists, must be evident to all who are acquainted with the effects of Lupulin. It is well known that drunkenness, either partial or total, causes an irritable weakness of the sexual organs. Coffee, and, in some, even tobacco, have to be interdicted ; among the secondary effects of coffee, we notice a depressing excitability and irritability of the nervous system. In general, all strongly spiced and stimulating food is hurtful. As regards bodily exercise, it is certain that bodily fatigue diminishes sexual excitement, and brings it back again to a normal standard; muscular exercise has also the advantage of preventing the mind from dwelling upon erotic subjects. Viewed from this point, walking is not the best kind of exercise, for the reason that it leaves the mind free to revel in all kinds of fancies; onanists are very apt to be fond of walking. Severe mental labor is sometimes preferable to bodily exercise, especially in the SPERMATORRHOEA. 361 case of hypocondriacs and onanists. This leads us to a consideration of psychical influences, as a means of cure. Every physician knows, that the evil consequences of nocturnal emis- sions, and even, to some extent, of self-abuse, are more imaginary than real. Numbers are made hypocondriacs by reading books that fill them with fear and trembling at the excess they may have been guilty of in former days. Encouraging advice does more good than medicine. Self- abuse is prevented much more certainly by comforting encouragement than by picturing the consequences of such a crime in the most frightful colors. In dealing with sexual weakness, it is, in the first place, necessary to depress the fancy,' and in the second place, to strengthen the will. On this account, reading novels is so hurtful, and cold-water treatment has such an excellent effect. Prof. O. S. Fowler, the world-renowned Phrenologist, and keen observer, makes these truthful remarks about the prevention of this fear- ful vice, self-abuse, by knowledge*: " What Salvation remains for those yet guiltless ? To forestall is infinitely better than to cure. Must all our noble boys, all our pure, lovely girls, be defiled by this moral leprosy, and lost if not redeemed ?" "Is there no prevention ? Can they not, somehow, be kept from this fell destroyer? Must all fall over this moral precipice, only to be marred and defiled for life ? What a pity, this offering up of human life on this vile alter ! We cannot spare our sons, we must not lose our daughters thus! They are too infinitely precious. Think what a darling child is worth ! Its entire future, and all its decendants are at stake. The risk is too awful. No parents should sleep until they have first so hedged their children around that they cannot sin. How can this plague be stayed? Not by Ignorance. That has been tried, only to fail, quite too long already. All who fail, sin for want of knowledge. Nothing can be clearer. Say, ye who have sinned, did you not err through ignorance ? Would not one seasonable word have prevented all the suffering it has caused you? Let universal experience decide. Parental warning and counseling are its great forestallers and preventers, Parents are bound to feed, clothe and educate their children, and guard them against lying, stealing, etc., then why not against this secret sin, as well, as much the most, as it is ruinous to soul and body. God in nature puts on parents the sacred duty of guarding their children against all sinful and self- ruining practices ; and their first duty is to guard them against this vice. And the guilt of those who do fall, rests not on the poor, life-long suffering victims, but on their parents." "An eighteen-year old liliputian, in Portland, Me., when told that this had made him small and weak, clinched his fist, gritted his teeth, and muttered curses upon his father and elder brother who lately deceased, who died by this sin, because they allowed him to fall by not warning him, and he was right. So has any other child, whose parents let him or her contract this vice. Parents are their children's keepers, not the children their own. Choose your own means, but use some effectual end I Give them no occasion to curse your neglect. The mother is more especially adapted and required to teach this class of truths. In ordaining that she- nurse them, nature commands that she supply their other physical wants, and also mould their morals ! Those who defile themselves, may justly 362 DISEASES OF THE MALE SEXUAL ORGANS- blame her most; yet blame is too weak a term. She should teach them the sacredness of this structure, and to guard it as the apple of their eye. n "All communities contain sufferers from sexual abuses ; let her make such her walking examples of breaking this law of chastity. Parents should teach sexual truths, aided by good books, as early as they can be understood. You must plant knowledge before the sin has taken root; much best — before the seeds of sin have been sown." " To the Sexual Education of Girls, these principles apply with, redoubled force. Young America learns such things early and easily." Stop the act, and that and cold water will complete the cure. ALLOPATHIC TREATMENT. In Spermatorrhoea, if the discharges are only occasional, and the. general health is not affected, no special treat- ment is required if the patient is unmarried ; as soon after marriage the annoyance will cease without treatment. It is best, however, that he should not eat a hearty meal for four* or five hours before retiring; he should empty the bladder before retiring ; the bed should be hard and the coverings rather light ; he must lie on his side, never on his back, and rise about the middle of his night's rest, and stepping on the cold floor,, empty his bladder again. In instances in which the health has become debilitated, and the functions of the mind impaired.it will be necessary to institute medical, treatment. In these cases, the whole nervous system has lost tone. The diet should be nutritious but plain; cold bathing and tonics should be resorted to. If the patient is unmarried, I would put him upon the use of Strychnine and Quinine dissolved in Dilute Phosphoric Acid, as : Take of Sulphate of strychnine a grain, Dilute Phosphoric Acid one ounce; after the Strychnine is dissolved, add half a dram of the Sulphate of Quinine, and three ounces of Syrup of Orange Flowers, or Simple Syrup. Dose : A teaspoonf ul three times a day. If the patient is married, I would give two or three grains of Pyro- phosphate of Iron in syrup, after eating, giving the former mixture before eating; or, instead of the first mixture, Phosphide of Zinc and Nux-vomica, a quarter of a grain each, may be taken in pill three times a day ; or the pills of Phosphorous, Nux-vomica and Quinine may be used. In addition* teaspoonf ul doses of Fluid Extract of Ergot may be taken one, two or three times a day; from two to twenty drops of Tincture of Belladonna may be given with the Ergot, at night, with benefit. The dose should be increased until benefit or dryness of the throat is produced. In cases more extreme, with greatly reduced health, it may be neces- sary to resort to Cod Liver Oil, in addition to other tonic treatment. In rebellious cases, Mr. Erichsen's method of applying a solution of Nitrate of Silver to the neck of the bladder, through a silver catheter hav- ing several fenestrations (openings) should be resorted to. The strength of the solution should be five grains to the ounce, at first; but, after two or three weeks, if no improvement result, the strength may be increased. The solution is driven out of the openings by a. sponge fastened to the end of a wire stylet, being pushed through the catheter to the end next the bladder. Occasionally, the daily introduction of cold steel sounds, will answer the same purpose. SPERMATORRHOEA. 363 The measure, which succeeds in the end, without fail, is life in wed- lock. In some extreme cases, the cure is not attained for a year, or, per- haps, more. Only a temporary lack of capacity exists, and, eventually, a complete cure results, if the patient lives a married life, and the general health is good, or restored with the use of appropriate tonics. If the person is unmarried, and in robust health, it is best to use the following prescription : Take of Bromide of Potassium an ounce, Infu- sion of Digitalis eight ounces. Mix. Dose : A tablespoonful twice a day, and, after the emissions cease ; give at night only. In this class of persons, from two to five two-grain pills of Monobro- mated Camphor, taken twice a day, is appropriate treatment. As with the Bromide of Potassium, after the involuntary emissions cease, the medicine need only be taken. at night. When the Bromides of Camphor or Potassium are used, and the discharge is not stopped, a pill of a third of a grain of Extract of Belladonna, and one or two grains of Extract, of Hyoscyamus should be taken, at bed time, in addition. JPAIfcT NINTH. — ♦ DISEASES OF THE RESPIRATORY ORGANS. CHAPTER X IX. DISEASES OF THE LARYNX AND TRACHEA— WINDPIPE. CATARRH OR COMMON COLD— CATARRHAL FEVER. This term is given to an affection, which consists of a mild degree of inflammation of the lining membrane of the nostrils and windpipe, and occasionally, also, of the ramifications of the latter, induced by exposure to sudden changes of temperature, or to a damp or chilly atmosphere with insufficient clothing, particularly as regards children. Symptoms. This complaint is characterized by slight fever, impaired appetite, obstruction of the nose, sneezing, unusual languor, pains in the head, or in the back and extremities, and subsequently hoarseness or cough, generally preceded by transitory chills or shiverings ; there is, also, a slight degree of wheezing and difficulty of breathing. When the disease is confined to the nose and sinuses, it is termed a cold in the head. ALLOPATHIC TREATMENT. The treatment of catarrh, or common cold, is given in Chapter X, under the head of catarrh, and under the head of acute bronchitis. Sub-acute laryngitis often occurs in colds, either alone, or with coryza (acute catarrh of the nose,) or with acute bronchitis, but may occur alone. The inflammation is of a low grade. There is either hoarseness, or loss of voice (aphonia,) and a hoarse cough. In children, spasm of the larynx is apt to be excited, known as false croup, but this is rarely the case in the adult. Besides the treatment, as recommended for acute bronchitis, strong irritations over the larynx (Adam's apple) is use- ful. This is best made by the frequent application of Tincture of Iodine. "When the coloring of the skin is an objection, the Decolorized Tincture of Iodine may be used, or a blister can be applied over the larynx. The inhalations of warm vapor is, especially, useful in all inflamma- tions of the larynx. The steam from a solution of Chloride of Ammo- nium from a croup kettle, or a spray producer may be inhaled with ben- efit. Glycerine may be applied freely to the epiglotis, and orifice of the larynx, with benefit, in some cases. It should run into the larynx. A large camel's hair brush should be used. 364 COMMON COLD. 365 Should the fever run high, and the pulse rapid, great benefit will be derived in this, as in other catarrhal inflammations, by giving Tincture of Aconite, in doses of half a drop to a drop, every half hour, until an impression is made on the fever, and then given one or two hours apart. It may be used without interfering with other treatment. A couple of drops of Tincture of Belladonna may be advantageously given with each dose of Tincture of Aconite, especially, when the secre- tion of phlegm is profuse. Tincture of Iodine, dropped in hot water, will yield a vapor which may be inhaled frequently, during the day. The vapor may be made to ascend through a funnel made of stiff paper, and so conveyed to the mouth. Chronic hoarseness of the throat occurs, most frequently, in persons of sedentary habits, in a somewhat debilitated state of health. The indi- cations are, in the first place, for life in the open air, and less at the desk. These persons, also, need tonics, and, possibly, an alterative. Such a med- icine we have in the Syrup of the Iodide of Iron, which may be given in doses of thirty drops, in water, three, times a day. An equally serviceable, and more elegant preparation, is the follow- ing : Take of the Iodide of Potassium five drams, Pyropliosphite of Iron one dram, Water one ounce, Simple Syrup three ounces, Spirits Peppermint half a dram. Dissolve the Iron in half the Water, and add the Syrup; dis- solve the Iodide of Potassium in the remainder of the Water, mix and add the Spirits of Peppermint. Dose : A teaspoon ml three times a^day. In robust persons, the Iron maybe omitted. Other tonics, which may be useful, are Citrate of Iron and Quinine, in doses of from three to five grains, three times a day, dissolved in water or syrup of Orange. Two or three grain doses of Citrate of Iron and Strychnine, given in the same way, may be found useful, in restoring the general health. Three to five drops of Fowler's Solution may be given, often with advantage, with the above remedies. A dram and a half, to two and a half, is proper for a four-ounce mixture. Pills of the Phosphide of Zinc, and Extract of Nux-vomica, will often prove serviceable. The following mixture of Iron may be given in connection, if Iron seems required : Take of Pyrophosphate of Iron a dram, Water sufficient to dissolve, Syrup of Ginger sufficient to ?nakefour ounces. Mix. Dose: A teaspoonful three times a day. Nervous hoarseness is often relieved by from five to ten grains each of the Bromide of Ammonia and Bromide of Potassium, in water, three times a day. Atrophine, in doses of a hundred and twentieth to an eighti- eth of a grain, twice a day, will often prove effectual in relieving this form of hoarseness. Counter-irritation, by means of Tincture of Iodine, or Decolorized Tincture of Iodine, applied by a camel's hairbrush; or a liniment of equal parts of Croton Oil, Turpentine and Sweet Oil ; or by the use of Ointment of Tartar Emetic (made by mixing two drams of Tartar Emetic with an ounce of Lard,) rubbing it well into the skin twice a day. Applications to the diseased surface, the vocal cords, and interior of the larnyx, can best be made by inhalation. Iodine may be inhaled by 366 DISEASES OF THE RESPIRATORY ORGANS. dropping the Tincture into hot water. Carbolic Acid may be combined with Tincture of Iodine in the proportion of half a dram to a dram, to half an ounce ; a sufficient quantity of Iodide of Potassium should be added, to prevent the Iodine from precipitating. Iodoform vapor may be inhaled with benefit often. The vapor may be generated by heating a plate or saucer with some of the powder upon it, and may be conducted to the mouth by a stiff paper funnel. Bromine vapor may be inhaled by warming a vial having a few drops of the liquid, and holding to the mouth. A solution of Nitrate of Silver, containing ten to twenty grains to the ounce, is, perhaps, the most useful of all the local applications. It should be applied with a brush or probang, with the aid of a laryngo- scopy mirror. Various substances, besides the above, may be used by means of the steam atomizer, or the air spray producer, but they have no special advantage over the methods given. Persistent cases of excessive hoarseness (chronic laryngitis) depend, generally, upon tuberculosis or syphilis. If ulceration has gone on to any extent, the hoarseness, or loss of voice is incurable. The former dis- ease is treated in the article on consumption. The latter disease does not come within the scope of this work. This trouble must not be confounded with the hoarseness which exists in chronic pharyngitis (inflammation of throat) frequently called clergy- man's sore throat, which is treated of in chapter XI. The treatment of this form ofgpatarrh (sub-acute laryngitis) in chil- dren does not differ materially from its treatment in adults. The child, in the majority of cases, should be kept within doors until the inflammation — cough and hoarseness— disappear. Then he may be gradually accus- tomed to his out door play, by beginning first at mid-day. In fact, some children may be permitted to go out for a little while in the middle of the day, during the course of the attack. The clothing should be warm enough to keep the skin warm and moist. Flannel should be next to the skin. A stimulating application should be made to the neck, as rubbing the skin thoroughly and often with Turpentine, or Turpentine and Spirits of Cam- phor and a flannel saturated with Camphorated Oil, (Camphor one scruple, Olive Oil one ounce,) may be worn around the neck. Cough should be relieved by the use of Paregoric, in doses suited to the age of the child, with an equal quantity of Tincture of Hyoscyamus, from ten to thirty drops each, can be given to children two to six years old in Syrup, or Syrup of Squills or Ipecacuanha. A hot foot bath at night will be useful. The cough mixture, or ten to thirty drops of Paregoric, or three grains of Dover's Powders (to a child three to five years old.) should be given upon going to bed. If the disease becomes chronic, as in the adult, it probably depends upon tuberculosis or syphilis, and is amenable to treatment proper for these diseases. Should the chronic affection be of scrofulous origin, benefit will result from the internal use of the following mixture: Take of Iodide of Potassium a dram and a half Pyrophosphite of Iron half a dram, Simp7e Syrup four ounces, Spirits Peppermint half a dram. COMMON COLD. 367 Dose: A teaspoonful may be given three times a day. Cod Liver Oil will be useful. The diet should be good, the clothing flannel, and warm. The Tincture of Iodine should be applied upon the neck, over the larynx, every day, or if the neck becomes very sore, every other dav. HOMCEOPATHIC TREATMENT. Premonitory Stage. Camphor (concentrated tincture) is frequently effective in arresting the develop- ment of incipient cold or influenza, particularly if the exciting cause, to which it is immediately traced, has been wet feet. The symptoms which, usually, identify the propriety of resorting to Camphor under these circumstances are as follow: unusual weariness, heaviness, and general uneasiness, attended with shivering and dryness or coldness of the skin, and symptoms of approaching fever. Dose : One drop of the concentrated tincture on a small lump of pure loaf sugar every three hours, until three doses have been given. Nux-vomica is the most generally useful, particularly when the symptoms have accrued after exposure to a draught, or prolonged expo- sure, in winter, to a cold, dry, frosty atmosphere. Dose: Six pills in a teaspoonful of water at night, repeated, if neces- sary, after an interval of six hours. Chamomilla is preferable when a copious outbreak of perspiration has been suddenly checked by a current of dry, cold air, or by asudden tran- sition from heat to cold. In the case of children, and highly sensitive females, this remedy is more especially useful. Dose: Six globules in a teaspoonful of water, as is directed for Nux- vomica. Bryonia should be employed when the symptoms of incipient catarrh have been excited by prolonged exposure to a cold easterly wind ; or when in adults, who are subject to liver complaints or to rheumatism, the natural sweat has been suddenly suppressed, whilst they were somewhat heated. Dose : Six pills in a teaspoonful of water, repeated, if requisite, after the lapse of twelve hours. Dulcamara is the most appropriate remedy to be taken by those who are subject to severe coughs, or to sore throat, whenever they are exposed to a close, damp atmosphere (either during the day or late in the evening,) or after getting the feet wet. Its alternate administration with Mercurius is sometimes of great advantage. In other cases, when Dulca- mara fails to arrest the symptoms, it should be promptly followed by Mer- curius. Dose: As for Nux. If in alternation with Mercurius, six pills, first of the one then of the other, in a teaspoonful of water, at intervals of four hours between them. , Arsenicum is, especially, appropriate for the treatment of ill- effects resulting from a chill whilst bathing, or from long-continued immersion in the water, either voluntary or otherwise. Chills in the stomach, produced by partaking of raw, cold fruits, or by eating ices, or drinking very cold water when heated, are also most readily counteracted by this medicine. Dose: Four pills in a teaspoonful of water, repeated, if necessary, every three hours. 368 DISEASES OF THE RESPIRATORY ORGANS. Pulsatilla should, however, be preferred under similar antecedent circumstances, if drinking whilst heated, or eating cold fruit, ices, etc., has caused the indisposition. Dose : Six pills, as directed for Nux. Fever Stage. Aconitum is one of the principal remedies in fever- ish attacks, provoked by cold, and particularly from exposure to a dry, cold wind, or to a draught, when hot, dry skin is present, or general shiv- ering chills, alternating with burning heat of the surface ; great thirst, especially towards evening, with a sensation of dryness, and roughness or scraping, slight burning, and sensation of excoriation in the upper part of the windpipe, or even throughout the whole of the chest, which gives rise to an incessant short, dry, hollow cough (more of a hoarse or rough des- cription at night ;) restless sleep. t Do.se : Six pills every two hours in a teaspoonful of water. Bryonia when there is an excessively dry, hollow cough, accompanied by tenderness of the upper part of the windpipe, on pressure ; inclination to vomit, and pain in the chest, as if it would be torn asunder ; severe headache, aching pains in the limbs, increased by the slightest movement, violent cold in the head. Dose: Four pills i*n a teaspoonful of water, every two hours. Nnx-vomica. Dry cough, particularly in the morning, and some- times during the day, rarely during the night ; occasionally a small quantity of adhesive phlegm is with difficulty expectorated after a fit of cough- ing; and the paroxysms are frequently attended with a painful sensation in the region about the navel, as if arising from the effects of a bruise or blow. This remedy is, further, of great utility in catarrhal fever, with dis- position to chilliness or wandering fever-chills, worse during movement, coming on and gradually increasing in the after part of the day, and alter- nating with flushes of heat. Warmth and absolute rest mitigate these symptoms. Dose : As for Bryonia. Chamomilla. In the treatment of children, this medicine is gene- rally preferable to Nux-vomica, in arresting the attack. It is extremely valuable in restoring the suppressed, perspiration, and removing the fol- lowing symptoms: colic, with pains in the head, ears, and teeth, thirsty and ill hranor, and impatience ; dry heat of the skin, or chilliness in any part of the body which may happen to be uncovered for a short time, or on lifting up the bed-clothes ; burning heat in one part (as for instance one cheek) and chilliness in another; severe, dry cough, especially, at night, excited by tickling in the upper part of the windpipe. Dose : As for Aconite. Belladonna is indicated when there is a throbbing, bursting head ache, attended with tendency of blood to the head, and increase of the pain from movement, or exposure to cold air, pain and heat in the head, eyes. and nose; cough at night. Dose : As for Bryonia. Mercurins, when the lining membrane of the eyelids, nostrils and air-tubes is highly irritated, and gives rise to copious shedding of tears, cold in the head, and cough with profuse expectoration ; headache, or feel- ing of tightness and fullness in the head, with pulsation extending to the INFLAMMATION OF THE LARYNX. 369 nose; pains in the limbs and joints, accompanied with profuse sweating, which affords no relief. Dose : As for Bryonia. Sepia is indicated in cases of catarrhal fever, with shivering chills on every movement in a warm room, rarely alternating- with heat; nocturnal spasmodic cough, with shortness of breath and inclination to vomit; cold in the head, pain at the back of the head. Predisposition to Cold. Precautionary Management. Some individuals, particularly among those of the fair sex, are tormented with an extreme degree of susceptibility to cold, the best corrective of which is, to rub the throat, chest, and indeed, the whole body, every morning with a wet towel, until a glow of heat is produced, drying one part before another is commenced; also, to acquire a habit of going out every day, pro- vided there is no inherent predisposition to pulmonary consumption; extremes, either of heat or cold, should at the same time be avoided, and care taken, when the body is heated, to let it cool gradually. The shower- bath is another useful means of overcoming an unusual susceptibility to cold. It should, generally speaking, be begun in summer and used tepid at first. ACCESSORY MEASURES. In many instances catarrh is carried off, or runs to a salutary termination, in a day or two; and this desirable result is frequently obtained by having timely recourse to the simple expedient of remaining a little longer in bed, and encouraging a gentle sweat by drinking a warm demulcent fluid, such as gruel; bathing the feet and legs in warm water, at the temperature of about 9S to 100 degrees Fahrenheit, is, also, a useful auxiliary mode of restoring perspiration, but the patient should go to bed immediately afterwards. Yery robust persons who are accustomed to be in the open air in all weathers, but who have caught cold after having overheated themselves, will frequently prevent any bad effects by drinking one or two glasses of cold water on going to bed. Others again, recover quickly, especially, when the cold is confined to the head, by totally abstaining from all fluids for forty-eight hours, or by tak- ing a tablespoon f ul of fluid, thrice a day only (at breakfast, dinner, and tea,) for seventy-two hours. INFLAMMATION OF THE LARYNX, OR UPPER FART OF THE WINDPIPE. The disease consists in a suppurative inflammation, having its seat in the lining membrane of the upper part of the windpipe, or the connecting cellular tissue between it and the subjacent parts. The disease bears a considerable resemblance to croup, of which it very generally, forms a part; but occasionally the inflammation is exclusively restricted to the upper part of the windpipe ; and it is a frequent cause of a fatal termina- tion in scarlet fever and smallpox. It is distinguished from croup by a constant hawking (which the patient voluntarily exercises irt order to clear the air-passage) rather than a violent and involuntary cough, and by the character of the expectoration, which consists of a thick, tenacious phlegm, rather than of a coaguable and membranaceous looking exuda- tion. 24 370 DISEASES OF THE RESPIRATORY ORGANS. Symptoms. The invasion of the disorder is announced by the usual signs of inflammatory fever; the voice soon becomes hoarse and inarticu- late, whilst a painful sense of constriction is experienced in the throat; the breathing is laborious and shrill during inspiration ; the upper part of the windpipe is extremely sensitive to the touch, so that the slightest pressure against it, either externally, by the hand, or internally, from the perform- ance of the act of deglutition is productive of the most distressing spasms, which threaten death from suffocation. The heat of the skin is great, the pulse rapid and hard, the thirst considerable, but incapable of being satis- fied from the suffering that is occasioned by the attempt. On examining the throat, it is often found to present a red, inflamed, and turgid appear- ance ; in some cases the epiglottis (the small, oblong body, attached to the root of the tongue, which protects the opening of the windpipe) is involved, and the motions of the tongue are thereby rendered painful and difficult. As the disease gains ground, the face becomes swollen, and sometimes livid, the eyes protruded as in threatened strangulation, and life is speedily cut short by suffocation. Results. The disease, if not arrested, occasionally terminates fatally within a few hours, or in a day or two, at the farthest. It ought not to be treated by the non-professional reader. HOM PERIOSTEUM. Inflammations of the bones occur in every age, less frequently, how- ever, before the second, and after the fiftieth or sixtieth year. In most cases, they originate in mechanical injuries, or mechanically-acting influ- ences ; they are less frequently owing to the extension of inflammation from the soft parts. In the great majority of cases, the mechanical is associated with a constitutional cause, very frequently the latter existing alone. Among the constitutional diseases, it is, more particularly, scrof- ula, consumption, syphilis, and calomel, that give rise to ostitis. Very often, it is very difficult to trace the cause with anything like certainty, especially, so far as the inflammation of the substance of the bones is con- cerned, because it generally developes itself with scarcely "perceptible symptoms, and in a very insidious manner, hence too long a period of time may have elapsed since the cause first began to act, to permit of the disease being traced to a definite origin. Bones that are but thinly covered by soft parts, are particularly exposed to inflammation from mechanical causes; inflammation arising from more dynamic or constitutional causes, may attack any bone ; nev- ertheless, inflammations of the lower jaw, of the vertebrae (backbone,) the bones of the hands and feet, and of the ribs, occur most frequently, and are of particular importance. Periostitis (inflammation of the membrane covering the bones) occurs more particularly on the fingers, on the bones of the lower extremities, and on the skull-bones. The symptoms and course of ostitis differ very remarkably in extent as well as intensity. It is very often found that at the outset the disease is entirely without any symptoms, until the disease is finally revealed by the process of suppuration . It very seldom runs an acute and rapid course; this is, generally, the case, if the inflammation attacks the outer surface of the bone. In such a case, the intensity of the pain depends upon the extent of the inflammation ; the fever is high, delirium sonie- 458 INFLAMMATION OF THE BONES. 459 times sets in, slight chills are common, and the patient very soon begins to lose his strength. Cases of this kind, which run a rapid course, always terminate in suppuration, and the artificial removal of pus is, in most cases, a matter of absolute necessity. After the pus is evacuated, a cure does not always take place immediately; the bone, divested of its perios- teum, becomes more or less careous before a cicatrix has time to form. If the periostitis runs a slow and somewhat chronic course, the inflam- mation, of itself, is not very painful ; but very violent pains can be excited by contact ; here, too, the exudation may be transformed into pus, but is, likewise, apt to result in bony growths, and to form extensive flat, or tuberous, bony indurations. If the inflammation is located in the interior of the bone, the latter is generally distended in its whole length, is not very sensitive to pressure, but the patient is tormented by paroxysms of peculiar, dull, boring pains, which, even in the absence of any specific cause, are, particularly, apt to set in, and to become aggravated at night. These pains are usually felt for some time before the bone commences to swe. I ; they interfere with the mobility of the limb more or less, generally the less, the more remotely they are felt from the joint. Ostitis of this central character always runs a chronic course. Its terminations are suppuration or ossification of the exudation. If one of the large bones is invaded by the suppurative process, death almost always results, although in some cases, not till the patient has lived through years of suffering. An important diagnostic symptom is the presence of albumen in the urine ; it almost always occurs, if the suppur- ation is extensive, and augurs very badly for the final result. The importance of inflammations of bones varies a good deal. Age exerts a characteristic influence; children and young people generally recover from such inflammations, even if these should last a long while, unless they originate in inveterate, constitutional maladies ; older per- sons, especially, when on the other side of forty, generally fall victims to such inflammations. Children very often recover when the second period of dentition sets in, or when they enter upon the period of pubescence. The seat of ostitis is of no small importance ; inflammation of the bones in the upper part of the body is less dangerous than inflammation of the pelvic bones, or the bones of the lower extremities. It is, likewise, impor- tant to determine whether the inflammation is so located that vital organs may become involved; on this account, inflammations of the skull bones and ribs are more threatening on account of the danger to important organs resulting from them. Sometimes the inflammatory symptoms disappear entirely for a time, and then suddenly reappear again from some cause or other, or without any cause; or else, in one portion of the bone, the inflammation runs a favorable course, and then all at once takes a new start, either continu- ously in the tissue of the bone, or in separate portions. Every inflamma- tion involving more than one bone, renders the prognosis so much more unfavorable. ALLOPATHIC TREATMENT. Inflammation of bone can scarcely, in any case, be treated intelligently, except by a skillful surgeon. Rest and cold or cooling applications are the most important means of local 460 DISEASES OF THE BONES, MUSCLES AND JOINTS, treatment. If cold is not aggreeable, it should be replaced by hot fomen- tations—a flannel, wrung out of hot water, and applied to the part, then covered well to retain the heat. In Chronic Ostitis (inflammation of bone,) counter-irritation by means of blisters, or the frequent (daily) application of Tincture of Iodine should be resorted to. Sometimes deep incisions into the periosteum (the mem- brane covering the bone) afford relief in both the acute and chronic forms of the disease. Pus should be evacuated by the trephine (an instrument for taking out a disc of bone.) If the inflammation has continued long, especially, at the end of a bone, it is, probable, pus has formed and the trephine should be used. When the Medullary Tissue (Marrow) of the bone is inflamed (myelitis) the bone as well as its medulla is, generally, involved, in which case the condition is called osteo-myelitis. When the disease is the result of wounds, the dressings must often be changed, and the wound disinfected with a solution of Carbolic Acid in water, one dram to the pint, or Chlor- ine water, or the solution of Chlorinated Soda (Labarrague's Solution) diluted until they are unirritating. Absolute cleanliness and fresh air must be secured. The diet should be good. Tonics may be necessary, two or three grains of Quinine three times a day seems the most suitable. Both tonics and stimulants may be employed. Cold is often the most useful, and may be applied by means of bags of ice. If cold causes pain or chills, hot applications should be used instead, as directed for ostitis. Free incisions through the periosteum (membrane covering the bone) and superficial tissues give some relief. If there is no opening into the cavity of the bone, and from the amount of inflammation and the length ol time which has elapsed, there is reason to suspect pus has formed, the trephine should be used, and the pus let out. As a rule, amputation is inadmissible, but if resorted to, it must be at the nearest joint towards the direction of the body or above it. In chronic osteo-myelitis counter-irritation with Tincture of Iodine or blisters and the internal use of Iodide* of Potassium in doses of ten grains or more, three times a day, should be resorted to. Where matter forms, it should be let out with the trephine. Excision (taking out a piece) may be resorted to in the chronic affection, but not in the acute. When amputa- tion is called for, it may often be performed through the shaft of the affected bone, if the point of amputation is well above the diseased por- tion. Periostitis (Inflammation of the Periosteum-Membrane Cov- ering- the Bone,) in acute cases, requires perfect rest. Cold should be applied, either of cold water or bags of ice. If these cause pain, hot fomentations should be applied, or hot poultices used. Pain must be re- lieved by Opium in doses of a grain, a quarter of a grain of Morphine, or thirty drops of Laudanum given one, two, or more hours apart, as may be required. If these means do not succeed, free incisions must be made through the periosteum. If the disease is primary, and necrosis (death of bone) follow, it is generally confined to the outer lamina (layer). If the dis- ease is secondary, resulting from ostitis or osteo-myelitis, and necrosis occurs, it is much more extensive, which will be considered under necrosis. INFLAMMATION OF THE BONES. 46! Specific forms of this disease (periostitis) from syphilis, scrofula, etc., gen- erally yield to appropriate constitutional treatment. One of the results of inflammed bone is caries— a kind of surface soft- ening and disintegration of the bone tissue. The constitutional treatment relates to the cause of the inflammation, whether specific or scrofulous, and the appropriate constitutional remedies should be taken. In the for- mer case Iodide of Potassium, or Mercury, or both and Iron. In the latter, Iodide of Potassium, Iron and other Tonics. The local treatment consists in the complete removal of all the dis- eased portion. First, by excision with instruments; second, by the appli- cation of Acids. When a joint is carious, amputation is, generally required, though sometimes excision may be practiced. Another of the results of inflammation of bone, and its membranes is necrosis (death of bone). The treatment required is its removal. While it remains, it is only a source of irritation; but its removal must not be attempted before complete separation has taken place. The suppuration which has gone on during the process of separation, generally requires supporting treatment — Tonics of Iron, Quinine, nutritious food, and in some instances, Cod Liver Oil. HOMCEOPaTHIC TREATMENT. The frequent occurrence of ostitis in individuals whose constitutions are tainted with some constitutional disease, invites a careful inquiry into the presence of such a constitutional taint, even though not manifested by any outward signs; and, in the second place, to employ such remedies as not only correspond with the constitutional affection, but likewise, aim at remedying the local disease. A mere comparison of symptoms will scarcely ever answer the purpose, for the reason that the localities may differ too much; it is only for a few definite localizations of ostitis, that we possess real remedies. In general, we advise, therefore, that the general, not the local symptoms, be taken as our guide; on this account we mention the following remedies, with a few short comments: Mercurius is a medicine of whose specific and almost constantly defi- nite relation to the osseous tissue we may always rest satisfied. It is indeed suitable in most cases of ostitis and periostitis, provided they do not originate in calomel poisoning. It is particularly indicated by : Vio- lent bone-pains, distention, swelling, redness of the skin, and, in general, by the more acute symptoms of the disease. The infantile organism is more rapidly and certainly affected by Mercurius. The dose had better be as small as possible ; the slow course of the disease would seem to point to small doses, and given at comparatively long intervals, as preferable to large doses of this agent. Dose : Four pills daily. Merzereum antidotes Calomel in the bone-range. Merzereum is par- ticularly adapted to periostitis ; less to ostitis, and is particularly appro- priate at a period of the disease when no complete suppuration has yet set in. Dose: Four pills daily. Phosphoric Acid is generally preferred to Nitric Acid in non- mercurial ostitis ; it is indicated in the inflammatory bone-affections of children, especially, in inflammations of the vertebrae, (back-bone) if there is an evident disposition to caries. In fully developed caries, with symp- 462 DISEASES OF THE BONES, MUSCLES AND JOINTS. toms of slow hectic fever, Phosphoric Acid is one of the most important remedies. Dose : Four pills daily. Phosphorus is inferior to Phosphoric Acid, for the reason that the latter acts more specifically and more penetratingly in chrome affections. In other respects, the curative action of both remedies is very similar ; we would accord the preference to Phosphorus, if consumption, with unceas- ing diarrhoea, has set in. Dose : As for Mercurius. Staphysagria is indicated, if the ostitis runs its course with severe pains, and the bone and its coverings are affected at the same time ; in the case of scrofulous individuals ; if the facial bones, or those of the legs and feet are involved. Dose : Same as for Mercurius. Baryta-carbonica is eminently adapted to a slow and almost pain- less scrofulous inflammation of the bones of the extremities, after suppu- ration has begun to set in. Dose: As for Mercurius. Aurum is, like Nitric Acid, an exquisitely anti-Calomel medicine, and hence, deserves special attention in cases of mercurial ostitis. It has, like- wise, an excellent effect in. non-mercurial ostitis with caries, and violent pains, especially at night. Aurum is a specific remedy for inflammatory •ulceration of the nasal bones, and facial bones generally. In affection of this kind, we prefer Aurum muriaticum to the common gold. Do.se : As for Mercurius. Silicea is one of the most important remedies in caries from any cause, and at my age, as soon as the inflammatory stage has run its course: it is adapted to every constitution, but may not have a very favorable effect in acute ichorous suppuration. We must not forget that Silicea acts very slowly; we recommend small doses at long intervals. Dose : Same as above. Calcarea. This agent is not so much indicated in uncomplicated ostitis, as in ostitis depending upon scrofula: it does not act directly as a curative, but by virtue of the favorable change it effects in the scrofulous disease. On this account, its use should be deferred until the suppurative process is fully established. Dose : Same as for Mercurius. RICKETS. Early Signs. This distressing disease commonly begins to show itself about the tender age of from one to two years. It is, generally, pre- ceded, for a longer or a shorter period, by derangement of the general health, before any of its well-known characteristic features become developed. Pale and sickly countenance ; dry, harsh skin ; soft and flabby flesh ; irregular appetite, sometimes with desire for indigestible or unnatural food ; constipation or diarrhoea ; general febrile excitement, fretf ulness. and languor. General Symptoms. After which, the head is observed to become RICKETS. 463 preternaturally enlarged, and the forehead unusually prominent. The breast-bone projects; the ribs appear flattened; the belly is much dis- tended; while the rest of the body, and the limbs in particular, are greatly emaciated, and the debility is extreme. As the disease advances, the muscles become more flaccid, the wrists and ankles become swollen, the legs, thighs, and arms distorted, and the spine partakes in the general deformity, by becoming shorter, and curved in various directions. When the disease is early attended to, and the more general exciting causes, — such as defective nursing, damp or wet, ill-ventilated dwellings, insufficient exercise out of doors, improper food, and uncleanliness — are capable of being removed — the chances of recovery are much increased, and the deformity is frequently materially, if not wholly diminished as the patient grows up. Otherwise, if life be spared, it is liable to be ren- dered miserable by a state of almost continuous suffering. HOME AND MECHANICAL MEASURES. At the head of the arti- ficial contrivances for counteracting deformity, may be placed the gentle and cautious use of gymnastic exercises, as soon as the child is old enough to undergo them ; and it is surprising how early they may be advanta- geously resorted to. Without these, all instruments are often futile, not to say hurtful. But in combination zvith them, the objection to the tempo- rary employment of an appropriate apparatus for the purpose of exercising compression, is, I believe, in certain cases, removed. I allude, more espe- cially, to the instance in which the legs have become very much bent, either in consequence of neglect, or from its having been found imprac- ticable to prevent a high-spirited child from constantly getting on his feet, before his delicate frame had become sufficiently invigorated by suitable treatment. I am free to admit, however, that instruments should always be rejected whenever and wherever they can possibly be dispensed with. ALLOPATHIC TREATMENT. This is a disease which almost, with- out exception, depends on poor feeding and hygiene, during the first year of the child's life. Children of unhealthy parents are more liable to the disease, but if the child is well fed, has plenty of fresh air, is kept clean, and is warmly clad it will not have rickets. If the child is not thriv- ing on its mother's milk, it ought to be fed artificially, or, what is bet- ter, a vigorous wet nurse procured. In the absence of a wet-nurse, rich, fresh cow's or goat's milk may be given. For the first month the milk should be half water, enriched a little with cream, and sweetened with su- gar of milk or loaf sugar. At two months old only a quarter part of water need be added; after three or four months genuine milk may be given pure. Eggs beaten up raw, with a little sugar, and diluted with water, may be given if the child likes it. The juice of lean meat may, also, be given. Strong beef tea, made from finely chopped lean meat and cold water, grad- ually raised to the temperature of one hundred and sixty degrees, and main- taining it at that temperature for four hours, may be employed for nour- ishment. Underdone lean beef, finely ground in a mortar, a teaspoonful at a time may be given. A pound of finely chopped lean meat, with eight ounces of distilled water and eight to ten drops of Hydrochloric Acid, and a third to half a teaspoonful of common salt, allowed to macerate for three hours, and then strained through a hair sieve, then pour on the meat a couple of ounces more of distilled water, and squeeze it through. The res- 464 DISEASES OF THE BONES, MUSCLES AND JOINTS. idue makes a nourishing and valuable food in cases of debility. Milk, how- ever, is the food for babies, and the other articles of food may be resorted to only when the baby does not thrive sufficiently on the milk. From the age of six months to a year, farinaceous food may be given, in restricted quantities. One of the best forms is Liebig's food. Take a heaping tablespoonful of wheat flour (middlings is better,) a heaping des- sertspoonful of malt flour, seven and a quarter grains of Carbonate of Potash, and an ounce- of water. Mix well. Add five ounces of cow's milk and heat gently. When the mixture begins to thicken, remove from the fire and stir for five minutes, heat, and stir again until it becomes quite fluid, then boil and strain through a sieve, when it is ready for use. In the absence of malt flour, barley may be ground in a coffee mill and sifted to remove the husk. This food is a little laxative, so it cannot be given more than three times a day. If there is diarrhoea, twenty or thirty grains of prepared chalk may be used instead of the Bicarbonate of Potash. For older children the diet must be good, containing such articles as meat, eggs, and milk. Nothing must be done to weaken, but everything to strengthen the patient. The child should have such exercise as is consistent with the weakened condition of the bones, such as rolling and tumbling on a hard matress. Older children may walk about some, if provided with proper artificial support, such as a wheel crutch. They should be taken out into the open air every day, or two or three times a day for a ride, or carried out. Bending of the limbs may be overcome by applying a light splint of paste- board or leather, but the limbs must not be so encumbered as to prevent their pretty free use. A light apparatus may be worn when the child walks, to prevent the curvature of the spine. The child should lie upon a flat matress without a pillow. The principal treatment is dietary and hygienic, as given above. For medicinal treatment the Compound Syrup of the Lacto-Phosphates gives the most promise of all medicines of being useful, excepting Cod Liver Oil. It may be given in closes of from ten or fifteen drops to a teaspoonful according to the age of the child, three or four times a day. The dose of Cod Liver Oil may be begun at fifteen to twenty drops and increased to a teaspoonful or a dessertspoonful, according to the age of the child and given four times a day. If the oil deranges the digestion, it should not be given, otherwise it should be given continuously. Other tonics may be given instead of the Lacto-Phosphates, as the Syrups of the Phosphates or H jpophosphites, in the same doses as the Lacto-Phosphates. The Citrate of Quinine and Iron, in doses of half a grain to two grains, three times a day. Complications (other diseases) which may occur will require the appro- priate treatment, keeping this in view, that all treatment must be sus- taining. HOMOEOPATHIC TREATMENT. Calcarea is a medicine of the most essential importance in all cases of rickety disease, and is more particu- larly required when the fontanels remain open too long, and when the process of teething is unduly protracted, or the teeth that are protruding have a tendency to premature decay; or, again, when there is curvature of the spine and of the limbs, with enlargement of the joints, and very undue dimensions of the skull. Calcarea, again, is yet more especially indicated, RICKETS. 4G5 if, in addition to these manifestations, there be incrustations on the face, or if the belly be enlarged and hard, and whilst rapid or gradual loss of flesh takes place, the appetite is morbidly voracious ; the skin is commonly dry and flaccid, and the child wears the appearance of being much older than it really is, although it be commonly diminutive and fragile; the bowels are habitually costive, or are frequently affected with excessive and protracted relaxation. Dose: Four pills in a teaspoonful of water, the first thing every morn- ing, for a week (unless decided change should sooner occur;) then pause ten days ; after which the course should be repeated as before, and so on, until some distinct signs of general improvement follow. Baryta Carbonica will be found adapted to some cases, particu- larly of dwarfish children, where there appears to be a general arrest and suspension of development, particularly if there be a tendency to gland- ular enlargements in the neck and elsewhere. Dose : As directed for Calcarea. Mercurius should be employed if the following symptoms should en- sue: — Pains in the bones, as if from soreness, or as if bruised, with extreme tenderness of the shin bone and knee-joints to pressure, with or without pressure of the limbs; dandruff, and other obstinate affections of the scalp and face; incrustations on the face; extreme susceptibility to take cold, with constant or very frequent prevalence of cold in the head or on the chest, and tendency to excessive perspiration, whether offensive or not; and often a chronic, slimy, or clay-colored diarrhoea. Do.se : As directed for Calcarea. Silicea is appropriate to the treatment of almost all cases of disease of the bones ; and is more particularly and decisively indicated by a pecu- liar tendency to ulceration manifested by the skin upon the least abrasion, — that is, when it " heals badly" as it is popularly termed ; or when there are scabby eruptions on the scalp, the glands being disposed to suppurate, the complexion pallid but puffy, and the ears being constantly or fre- quently affected with discharges of matter. Silicea may be required after Calcarea, to complete the cure. Dose : As directed for Calcarea. Sulphur should be employed after Calcarea or Silicea, if these medi- cines, having previously been productive of decided good effect, should cease to operate so beneficially, or if the following symptoms should pre- vail (which, if predominant, however, might more distinctly indicate the employment of Sulphur at the onset:) — Extreme susceptibility to take cold, and to protracted discharges from the nose or from the wind-pipe, or to excessive or continued relaxation of the bowels ; but still more espe- cially by obstinate and intractable constipation, with flabbiness of the flesh or skin, pallor or pufflness of the face ; protracted inability to use the legs or to maintain the erect position ; tendency to be easily thrown into a vio- lent perspiration by any exertion; the skin being otherwise dry, and even harsh, and the eyes and eyelids appearing to be habitually more or less inflamed, and both mind and body languid, and unfit for exertion of any kind. Do.se: The same, and at same intervals, as directed for Calcarea. When there is an hereditary predisposition to this disease, too great attention cannot be paid to the first manifestations of ill-health. Great 30 466 DISEASES OF THE BONES, MUSCLES AND JOINTS. care should, at the same time, be taken to avoid undue pressure upon the chest and other parts. The bones of a rickety child are wanting in the natural and requisite strength, or firmness, to support the weight of the frame. Consequently, when every precaution is not adopted, and the child is allowed, or rather compelled, by its heedless or culpable parents, or oth- ers, to use muscular exertion, deformity invariably results. It will, there- fore, be necessary to deal gently and cautiously with the child, from the first day of its early existence. And while every care is observed, to escape the mischief alluded to, other means, having for their object the improve- ment of health, must be strictly followed. The child should be regularly in the open air, when the weather permits ; its apartments ought to be well ventilated ; its personal cleanliness should be constantly ensured; and wholesome and appropriate nourishment provided. When the health and strength are improving, but the limbs and other parts have become deformed, to a greater or less extent, in defiance of every solicitude — or, as more frequently happens, from oft-repeated infractions of the rules laid down— considerable benefit may yet be accomplished by judiciously applied mechanical aid. LUMBAGO— CRICK IN THE BACK. Diagnosis. Violent pain, of a rheumatic character, in the lumbar region, either periodical or permanent, frequently accompanied with a considerable degree of fever. ALLOPATHIC TREATMENT. In acute lumbago, the employment of strong mustard plasters or repeated hot wet packs, with a hypodermic injection of a quarter of a grain of Morphine over the seat of pain, repeated sufficiently often to subdue the pains, is generally effectual treat- ment. A cathartic should be given to move the bowels. If the disease does not subside after the pain is relieved and the bow- els moved, the treatment by mustard plasters or hot wet packs and Opium should be tried to relieve pain (a quarter of a grain of Morphine, a grain of Opium, or twenty-five drops of Laudanum, may be given by the mouth.) and should be continued. The effect of Salicylic Acid, given in doses of ten grains every four hours, should be tried. It can be given in capsules, or mixed with Starch. Chronic lumbago is most frequently cured by Iodide of Potassium, given in doses of from ten to twenty grains, three times a day. It may be given in Peppermint Water, after meals. Much relief may be obtained by wearing a Belladonna plaster across the loin. Other remedies are the same as those recommended for chronic mus- cular rheumatism. HOMOEOPATHIC TREATMENT. Aconite may be given at the com- mencement, if much fever declare itself. Bryonia when the pains in the back are of a severe aching or lancin- ating description, constraining the individual to walk in a stooping pos- ture; aggravated by the slightest motion, or draught of cold air, and attended with a general sensation of chilliness. I INFLAMMATION OF THE JOINTS. 467 Nux-vomica is particularly indicated when the pains resemble those produced by a bruise, or by excessive fatigue; also when they are much increased by motion and by turning in bed at night, and are attended with considerable weakness; and moreover, when irritability of temper and constipation are present. Nux-vomica is often of great service after Bryonia in acute lumbago. In chronic cases it is a remedy of no mean importance. Wilis-toxicodendron is almost specific. It should be preferred to any remedy when the symptoms are as follows : Dragging or shooting pains in the back and small of back; severe aching or pain, as if from the effects of a bruise or a sprain in the loins; a feeling of stiffness or ten- sion in the affected parts on attempting to move, but aggravation of the pains when in a state of rest, or when pressure is made on the seat of the sufferings. It is also a useful remedy in chronic cases. Belladonna, where the pains are deeply seated, causing a sensation of heaviness, gnawing, or stiffness; it may follow Aconite with consider- able benefit, when slight inflammatory symptoms are present. Pulsatilla, when the pains, resembling those mentioned under Nux- vomica, are moreover attended with a sensation of tension or constriction at the affected part ; it is particularly indicated for females, or individuals of mild, sensitive, or phlegmatic temperaments. Mercuvius, when the pains are much of the same description as those given under Nux-vomica, but considerably aggravated at night, incapaci- tating the sufferer from taking rest. (See Rheumatism). INFLAMMATION OF THE JOINTS. ALLOPATHIC TREATMENT. Acute inflammation of a joint (syno- vitis,) demands, in the first place, absolute rest. This is imperative and invariable. This object may be aided by properly adjusted splints. The limb should be in a position which will relieve the articular surfaces from pressure. If the affected joint is in the lower extremity, the limb should be in the straight position. If the affection is in the knee, or hip joint, a degree of extension may be secured by the weight and pulley, as used for fractured thigh (described in the treatment for hip joint disease,) and relief from pain secured in this way. Rest and extension, which will seoarate the joint surfaces, and keep them apart, is, in most cases, all the treatment needed to ensure recovery. Counter-irritation, by applying Tincture of Iodine, or blisters, the use of cold by ice bags, compression with bandages, and a wet sponge, etc., have all, in some cases, been useful, and are sometimes hurtful, and do not compare with the means just described in efficacy. When the inflamma- tion and heat in the joint is great, a solution of Sugar of Lead and Opium will benefit : Take of Sugar of Lead thirty grains, Acetate of Morphine five to ten grains, (or two ounces of Laudanum,) and rain water a quart. Mix, and it is ready for use. The internal use of Opium may be called for by the severe pain. In chronic synovitis, rest and extension, as in the acute, are appropri- ate means of treatment. The use of blisters and other forms of counter- irritation are more useful and less often hurtful. The constitutional state 468 DISEASES OF THE BONES, MUSCLES AND JOINTS. is generally faulty. This is to be corrected by good, nutritious food, fresh air, exercise and, sometimes, tonics. The Citrate of Iron and Quinine is as frequently useful as any, and may be given in doses of three grains, three times a day, if the patient is feeble. If absolute rest is enforced in this trouble, the joint lacks its natural stimulus— that of motion. At the proper time (which is difficult to deter- mine often,) passive motion (moving the joint by the hands of others;) must be resorted to, and after a time (which individual judgment only can determine,) active motion (by the patient) may be tried. After several weeks have passed it is best to try passive and then active motion. Passive, then active motion, good food, air, and good hygiene, gener- ally, have often restored swollen, painful, and stiff joints^ in a few weeks, to their natural activity. It is often desirable to keep the surfaces of the joint apart by traction even when motion, both active and passive, is practiced. The weight of the limb may be sufficient, in case of the upper extremity. In the lower extremities, which must sustain the weight of the body, the end is met by- very ingenious splints, invented by Dr. Sayre, of New York. Varieties are made for use of the different joints, hip, knee r and ankle. When these splints are properly adapted, the patient can go about without pain. In this way the functions of the joint are maintained, while all irritation is obviated, and the most favorable condition is maintained for recovery. COX ALGI A— INFLAMMATION OF THE HIP JOINT. This inflammation, the chronic form of which is called "voluntary limping," cannot be traced to any definite cause. It affects, principally, children and young people, during the first years of pubescence. Its extremely frequent occurrence during the years fourteen to seventeen, and in persons of rapid growth, leads us to infer that a rapid growth of the bones constitutes a disposition to this inflammation, and that an exertion, a cold, or other scarcely apparent circumstances, simply act as exciting causes. Acute inflammation of the hip joint sets in suddenly, even with a violent chill, like all other acute inflammations, with which severe pains are associated. The patient locates these pains, at times, in the small of the back, at other times, more in front, very seldom in the hip joint ; they are extremely acute, tearing, burning, stitching, shooting, aggravated by every motion of the lower extremities, not altogether, and sometimes not at all, relieved by horizontal posture. At the same time, a high fever accompanies the pains, the pulse being not unfrequently upwards of one hundred and twenty; this circumstance distinguishes the disease from lumbago, with which it is easily confounded. Amid symptoms of this kind, which may become sufficiently intense to simulate typhus, the following objective changes become manifest in one, two or more weeks: The affected hip, and the buttock of the same side swell, so that the fold between the buttocks is much deeper ; the thigh is somewhat turned out- wards, and slightly drawn up towards the abdomen ; the knee is half bent; extension and rotation of the thigh are very painful; nor can these INFLAMMATION OF THE HIP JOINT. 469 movements be executed completely. Walking is not entirely impossi- ble, but can only be performed with the greatest pain. It is very seldom that an improvement begins at this point; as a rule, an extensive suppuration sets in, amid frequent chills and burning heat •of the skin. After this, a short intermission seems to take place in the further development of the disease, until the abscess reaches the skin and bursts. This may take place backwards, to one side, or in front. After the pus is discharged, the patient feels much better, and then worse .again, provided the suppuration becomes very profuse and continuous. As a rule, the prospect of a speedy closure of the cavity is very slim. The terminations of the disease are: Very rarely a complete and rapid restoration ; long-lasting suppuration, with final recovery, and a total or partial destruction of the joint. The chronic or subacute disease presents a very different group of symptoms. The disease commences with vague symptoms in the hip- joint, resembling rheumatic pains and alternately exacerbating, remit- ting, or even intermitting for some time. These pains may be absent .and in their stead the patient may only complain of astiffjoint which is, more especially, felt during motion. Sensible pressure on the hip-joint generally causes more or less pain, and the thigh is usually rotated out- wards to some extent as soon as the disease commences. With such tri- fling symptoms it may go on for some time, before more serious changes become manifest. The pains increase in intensity, and cause the patient to limp, the thigh is slightly flexed and turned inwards. Almost with- out an exception, a more or less violent pain is at the same time felt in the knee, very generally surpassing the pain in the hip joint in intensity. The affected limb becomes lengthened, its muscles become relaxed and flabby. In the further course of the disease, suppuration sets in, the pus escaping on the outside, and destroying life by caries and hectic fever. A cure at this stage is a rare occurrence, or else the parts grow together, and the joint is permanently stiff. ALLOPATHIC TREATMENT. Hip joint disease is simply an inflam- mation of that joint, and is to be treated as already described for inflam- mation of the joints. In incipient hip joint disease, rest in bed and the straight position, with extension with the weight and pulley, is to be maintained, the weight being sufficient to relieve pain. This will vary from three or four to ten pounds. The mode of its application is by long adhesive plasters applied to the sides of the leg, and well secured by a bandage above the ankle. The foot and ankle should be bandaged, but the plasters must not be included within this part of the bandage. The lower end of the plasters are then fastened to a narrow board with a hole in the center, which is long enough to separate the plasters from the ankle, and so prevent irritation, a rope is knotted and passed through the hole in the board which is attached to the plasters. The rope is then passed over a pulley fastened to the foot of the bed, and the weight then fastened to the rope. The rope must draw in the line of the limb. In addition to this treatment, good hygiene, which consists in plenty of fresh air, comfortable temperature of the room, sponging of the ibody every other day, with water at an agreeable temperature; good, 470 DISEASES OF THE BONES, MUSCLES AND JOINTS. nutritious food and cheerful surroundings, will be sufficient to carry the patient through the acute inflammation to recovery. It is best to bring the limb at once to a straight line, and the weight applied. It ought not to cause pain, or at least after a few hours. This treatment should continue six weeks or longer. The time comes when exercise must be secured, and at the same time extension contin- ued. This is best secured by a suitable splint for hip joint disease. There are several varieties of apparatus adapted to this end ; one of the best is Dr. Sayre's. The splints of Davis or Bauer meet the required end. Many cases have been successfully treated by the use of the wire- gauze splint of Hamilton or Barwell. If these are used, the body is to be supported by crutches. A sole-leather, felt, or guttapercha splint, similarly constructed, will meet the end. It should extend from the top of the illium (hip bone) to above the knee, and broad enough to cover the thigh one-half in. A pro- jection from the top of the splint behind, three or four inches wide, should extend nearly around the body, and fastened in front with a strong piece of elastic band. Leather should be softened with cold water, and guttapercha with hot water, and moulded to the limb and pelvis, and retained with a ban- dage, until it hardens. The inside of the thigh should be covered with a suitable short splint. After the splint hardens, permanent fastenings can be attached. This method of treatment, faithfully and intelligently carried out, as a rule, will obviate the necessity of an operation, and secure a satisfactory result. When the disease progresses until the bone becomes extensively diseased, an operation for its removal is demanded. HOMCEOPATHIC TREATMENT. Although the number of homoeo- pathic remedies for hip joint disease is but small, yet the success with which they are used in this disease, is a source of pride to our practice. In view of the almost positive certainty of a correct diagnosis, in most cases of hip disease, the clinical results that have been obtained in the treatment of this disorder, may be regarded as absolutely reliable testi- mony. Rhus Tox. At the outset of the disease, when violent fever, hur- ried pulse, rheumatic pain from the hip to the foot, and constant desire to gain relief by a change of position, but before pus has actually formed, will be found an excellent remedy. Dose: Six pills in a teaspoonful of water, every five to twenty- four hours. Belladonna. Under almost the same indications as Rhus Tox., except the restlessness is not so marked, and there is more of a tendency to a dark-red appearance of the skin over the affected parts ; showing a deep inflammation. Do.se ; As for Rhus Tox. Mercurius. If the formation of pus has really commenced, no rem- edy will compare with this, being frequently able to arrest the disease and restore the patient to health, as far as the nature of the attack will permit any remedy to do so. Dose: Six pills, or a small powder, three or four times a day. INFLAMMATION OF THE KNEE JOINT. 471 Calcarea-carb., after the disease has turned, or shows marked signs of turning for the better, helps very much by aiding in the nutri- tion of the parts affected, as well as the system in general. Dose: kSix pills twice each day. The rest of the treatment may be condensed in the following points : The patients should not remain in a state of absolute rest, on the con- trary, they had better move about by means of crutches. If pus forms, warm poultices may be applied; they not only promote the formation of pus, but very often favor its absorption. Only if carious destruction of the joint has taken place, the patients will have to remain quiet, lest spon- taneous luxation should result ; in such circumstances, a suitable exten- sion apparatus may be resorted to, which will have to be applied, how- ever, with a great deal of caution. The diet should be, at all times, plain and strengthening; the use of fat is to be rigidly prohibited. GONITIS— INFLAMMATION OF THE KNEE JOINT- WHITE SWELLING. This is one of the most frequently occurring inflammations of joints ; owing to the exposed situation of the knees, this might, indeed, be ex- pected. A simple inflammation of the knee, is generally the result of some mechanical injury or of excessive use, and is an unimportant affection, as long as the inflammation is confined to the integuments. It is scarcely ever attended with fever, is never ushered in by a chill, and runs its course within a few weeks. However, as we can never be sure whether such an unimportant disease may not result in the more dangerous white swelling, it ought to be managed with all due precaution. Symptoms. While using the joint, the patient complains of pain and impaired mobility; in more rapidly progressing cases the temperature of the joint is higher than usual. If the inflammation emanates from the soft parts, the pains are generally less than when the bones constitute the starting-point. Sometimes the knee swells rapidly, at other times more slowly, and most slowly if the bones receive the first shock of the disease. In the latter case, the knee preserves its form for a long time, in the other cases the swelling soon modifies any former shape of the knee. As the swel- ling increases, which generally has a very white appearance, it grows pro- gressively softer, elastic, and finally shows symptoms of fluctuation. The cutaneous veins become very much enlarged. The pains generally increase with an increase of the swelling. Sometimes not till after the lapse of years, and, in a few cases, after that of weeks, distinct fluctuation is per- ceived in one or more places; here the skin reddens, breaks, and a pus, which is mostly thin and mixed, is discharged. In spite of the evacuation of pus, the swelling remains almost unchanged. The suppuration in a case of white swelling is generally very tardy. The openings may close for a short time, after which they generally open again, ,so that, in a fortunate case, suppuration may cease after many months, and the swelling may grow smaller, but the joint remains stiff and thick, and the leg somewhat bent. A cure of this disease is witnessed only in the case of young people. If the case terminates less favorably, 472 DISEASES OF THE BONES, MUSCLES AND JOINTS. the suppuration gradually superinduces hectic fever, and finally ends in death. The prognosis is always bad, for no one escapes from such an attack without some permanent injury; the difference in favor of young and robust individuals is, that death needs not be apprehended in their case, which is generally sure to occur in individuals of upwards of thirty years of age. ALLOPATHIC TREATMENT. The treatment of inflammatory dis- ease of the knee does not differ materially from that given for inflamma- tion of the hip joint, and joints in general. Rest is the first essential; this may be secured, first, by applying a splint to the posterior of the limb, including both the thigh and leg, to keep the joint perfectly still. Cold applications, or warm, as give the most relief, may be employed. The hot wet pack applied to the knee will be useful, if cold causes pain. The evaporating solution of Lead and Opium, given in the treatment of synovitis may be used. If the joint continues painful, pull moderately on the ankle to separate the ends of the bones in the joint, and if this gives relief, the weight and pulley should be employed to produce exten- sion, as directed for disease of the hip. A large amount of water in the joint, producing enlargement, should be met by pressure, either an elastic band or bandage and wet sponge. Pressure would be painful and harmful without extension. After six weeks or more have passed, exercise of the joint becomes necessary, but extension must be continued. This can be done by the proper application of a Sayre's splint for the knee joint. If the limb is distorted, the tendons necessary must be divided to bring it into shape. When the fluid in the joint is not removed by absorption from pressure and friction, (rubbing with a simple liniment,) aiding nature, it is neces- sary to remove the liquid with an aspirator, or possibly by incision, but the wound must be hermetically sealed immediately, and the joint kept motionless by a well-secured splint until the wound heals. Nearly, if not all cases, can be cured by absolute and permanent rest, and extension, as has been indicated, and, in some cases, compression. When the inflammatory disease in a joint has advanced to suppuration and decay of tissues, it is commonly spoken of as a " white swelling." If it is the knee joint that is affected, it is then known as " white swelling of the knee joint." The treatment described for inflammation of the knee or joints, if properly carried out, will prevent this undesirable state of affairs. If it occurs there is pain, irritation, fever, loss of appetite and debility. Extension by means of Sayre's splint for the knee (or for such other joint as is affected) must be made. This will relieve the pain. The services of a surgeon are necessary in the management of these cases. If it is impossible to procure a splint, extension should be made with a weight and pulley. There is the disadvantage of confinement with this manner of extension at a time when it is very important for the patient to be much in the open air. The patient should have the benefit of fresh air, sunlight, and good food. Tonics may be required. There is no better one than the Citrate of Iron and Quinine, given in doses of one to four grains, three times a day. The Compound Syrup of Hypophosphites is another useful one, especially INFLAMMATION OF THE KNEE JOINT. 473 if there is much discharge, as also is the Compound Syrup of the Lacto- Phosphates. The dose of each is a teaspoonful. The former syrup may be combined with a fourth Dilute Phosphoric Acid. The dose then will be the same. When an inflamed joint, acute or chronic, will permit the two surfaces of the joint to come together by ajar, without pain, and when there is no pain on pressure, the instruments may be removed. A condition of irri- tability remains and the joint cannot be used without pain. The case requires passive motion and rubbing. Gentle but thorough friction to restore the functions of the joint, remove the congestion and irritability. The pretense that the hands of some persons have especial power in this direction is simply pretense. In the successful cases under their hands, they have only by accident stumbled upon the case at a stage when the rubbing was the element necessary to restore the use of the joint. One so-called cure of this kind, at the hands of a pretender, is the source of a wonderful amount of fame to the injury of society, and an unfavor- able reflection is made on the medical profession, which is unjust. HOM(EOPATIC TREATMENT. Silicea is the medicine of chief im- portance in the treatment of the inflammation of the lining or covering membrane of the knee-joints, or for the treatment of the enlargements, and other mischiefs resulting from such inflammation. Dose : Six pills in a teaspoonful of water, three times a day. Sulphur and Calcarea are indicated at the onset, or after the pre- vious administration of some other medicine, to complete the cure. They are of chief importance in scrofulous enlargements of the knee, and may also be required as intermediary remedies, when other medicines, apparently indicated, cease to produce any decided effect. Dose : Give six pills in a tablespoonf ul of water, every morning and evening. Bryonia may be given, if the trouble results after rheumatism, with red and very painful swelling of the knee, particularly, if the slightest motion aggravates the pain. Dose: S'ime as Silicea. Pulsatilla is an excellent remedy for the treatment of glazed or shining, white, soft, or doughy swellings of the knee, and is, indeed, more or less especially appropriate for the treatment of soft, colorless swellings of the knee, in general, whether painful or otherwise. Dose : In every particular as directed for Bryonia and Silicea. External applications are not always appropriate in this disease. Poul- tices are injurious if they increase the pains; in most cases, they not only relieve the pam, but likewise exert a favorable effect upon the reabsorp- tion of the pus in the diseased joint. An uninterrupted recumbent post- ure is to be avoided, as long as the patients remain capable of moving about; only the diseased limb must not be used for a walk. A moderate and constant pressure by a starched bandage is only borne, if the bones are not too much diseased; it has the double advantage of antagonizing the swelling, and protecting the limb during motion. It has the best effect, if the abscess has already broke, for, in such a case, the bandage most decid- edly promotes the course of the suppurative process. Amputation is only advisable if the joint is utterly disorganized, and the constitution begins to show signs of failing under the constant pain and loss of fluids. 471 DISEASES OF THE BONES, MUSCLES AND JOINTS. INFLAMMATION OF THE JOINTS OF THE FOOT- TARSUS. The inflammation is either seated in the bones, or where they articu- late with those of the metatarsus (between the ankle and toes ;) or else in the articulation of the tarsus (ankle) and tibia (large bone of the leg,) or in both localities at the same time. Here, too, mechanical injuries are rarely the cause of the inflammation. An inflammation of the metatarsus is particularly met with among children, and during the age of pubes- cence; an inflammation of the tibia-tarsal articulation occurs more fre- quently among adults. The Symptoms are most commonly the following: At first a pain is felt in walking, particularly during certain positions of the foot ; in a state of rest the pain subsides almost entirely. Gradually the joint begins to swell, the swelling increasing more and more, and gradually extending over the whole foot ; at the same time the pains increase, become continuous, and walking is entirely out of the question. At last, the pus finds an outlet in one or more places. In favorable cases, the suppuration now decreases, the strength keeps up, the fistulous openings close, although sometimes not till years have elapsed. Or else the swelling continues to increase, even after the abscess, the foot becomes completely distorted, and hectic fever is the unavoidable consequence. The course of the disease always exceeds one, and even more years, until the pus escapes outwardly. At all times life is in danger, even in the case of children; adults succumb almost always with scarce an exception. A peculiar form of tarsal inflammation is a flat foot. Sometimes it affects small children, although it is only slightly developed at that age ; it mostly shows itself after pubescence, most generally among males if they suddenly grow up in hight. Every time after the foot is perseveringly used, violent pains are experienced in the joint, which becomes stiff after walking, with inability to stand upon the affected limb. Little by little the foot loses its arched shape, and the patients generally walk on the inner edge of the foot. The malformation of the foot may become very considerable, and may, materially, interfere with its use. Sometimes the trouble does not cease spontaneously, until after the patient is thirty years old. This form of inflammation, which, under similar circumstances, may likewise occur at the knee, never results in suppuration. Treat only by a physician. ALLOPATHIC TREATMENT. The principles of treatment of inflam- matory disease of the ankle joint, are essentially the same as is laid down for the treatment of synovitis in general, and of the hip and knee joints. Absolute rest is the first essential. Of all the plans of local applications, I believe heat to be the best. It can be applied by the hot wet pack, or by immersing the ankle in water as hot as can be borne, when the pain is relieved by repeated hot packs, or by the hot foot bath; the limb should be elevated, and kept in that position until there is no tenderness on pressure, and until the limb can hang down without causing pain. If there is effu- sion in the tissues about the joint, compression should be made by firmly bandaging a large sponge around the joint, which has been previoufly satu- rated with warm water and squeezed as dry as possible. (The foot, ankle and leg should be bandaged). The sponge and bandage about the joint ULCERS. 475 should be kept wet with warm water. By the swelling of the sponge, and the shrinking of the bandage, considerable compression is produced. Com- pression can be made more conveniently by the double India-rubber bag which is inflated with air. After a few days, rubbing the joints with the hand, will be useful. In more advanced cases, extension should be made by the use of Sayre's splint for the ankle joint, and the patient permitted to go aboufon crutches, while the surfaces of the joint are kept apart by the extension. The excessive secretion of fluid in the joint may be caused to be absorbed by pressure and rubbing. If pus is formed in the joint, or a thickened fluid which cannot be absorbed, as determined by the exploring-needle, or trocar — it should be withdrawn by the aspirator, or incision as de- scribed in the treatment of the knee joint. Extension by means of Sayre's splint, should be continued. When the disease has advanced to destruction of the tissues of the joint (cartilage or bone,) the treatment is too complex to be described here. The reader is referred to some recent complete work on surgery, or diseases of the joints. If, however, the treatment described here is thor- oughly carried out in the beginning of the disease, recovery will be reached without serious consequences. CHAPTER XXV ULCERS. LYMPHATIC TUMORS. DISEASE OF THE CINGLOBATE GLANDS. Abscess— by this term is meant a collection of purulent matter, result- ing from morbid action, contained in a sac or cyst of organized coagula- ting lymph furnished with absorbent and secreting vessels. Abscesses are divided into acute and chronic. The acute variety is preceded by sensible inflammation in the affected part, which is soon fol- lowed by suppuration. The commencement of the suppurative process is known by a change in the description of pain, which becomes more obtuse and throbbing, by an increase of the swelling, and when matter is formed, by the perceptible fluctuation of the part, when the abscess is not too deeply seated; lastly, particularly in idiopathic (primary) cases, when the formation of pus is considerable, the fever, which had attended the earlier stages, is materially lessened, and irregular chills, or rigors, super- vene, succeeded again by heat and increase of fever. When the abscess is mature, the tumor becomes pointed, or presents a conical shape, generally near the center of the inflamed cutaneous sur- face ; over this spot the skin assumes a reddish hue, becomes thin, and, ere long, gives way and allows the contents of the cavity to escape. The signs of the formation, or existence of a chronic abscess, on the other hand, are, in the generality of cases, devoid of any apparent disor- der, either local or constitutional, until it begins to approach the surface and form an external swelling. The secreted matter is unhealthy, thin, and contains substances resembling curds or flakes. 476 DISEASES OF THE BONES. MUSCLES AND JOINTS. When the pus is let out (evacuated,) and the air admitted into the cav- ity, inflammation of the cyst arises, and is beneficial, if the cavity of the abscess is small, but if it be large, great constitutional disturbance ensues, the cavity, instead of contracting and filling up by healthy granulation, goes on discharging copiously until, in the end, hectic fever is produced. ALLOPATHIC TREATMENT. Acute inflammation of the lymphatic vessels (angeiolencitis) requires the application of heat promptly and con- stantly. Flannels wrung out of hot water, and the limb, or other part affected, covered with them, and the whole well covered in, to retain the heat, is a form of hot wet pack which is most serviceable. They should be renewed as often as they become cool. The hardened inflamed lines may be covered with Belladonna Ointment. Any wound or ulcer causing the inflammation is to receive its appropriate treatment. Pain is to be relieved, if necessary, with Opium in grain doses, Mor- phine in doses of a quarter of a grain, or Laudanum in doses of twenty- five drops, repeated just often enough to give relief. Free incisions through the inflamed part relieve the tissues strangu- lated by the inflammation, and evacuates the pus. Early incisions are very important. Pus has often formed in the subcutaneous tissue, which is not detected by fluctuation. Too great delay in making these incisions may be attended by serious consequnces. The patient must be nourished with milk, strong beef tea, and eggs. If much depression occurs, Quinine and Brandy, or Whisky, should be freely administered. The former in doses of five to ten grains, from four to six hours apart, according to the urgency of the symptoms. The latter may be given, according to the degree of urgency of the symptoms, in doses of a tablespoonful (half an ounce) to one or two ounces, from half an hour to four hours apart, but always short of producing symptoms of intoxication. The bowels should be moved by Citrate of Magnesia, or an injection of warm water. Should the disease become chronic, the strength of the patient should be supported by good food and tonics. Poor digestion may be improved by teaspoonful or dessertspoonful doses of Sheffer's Liquid Pepsin, * and the blood enriched by the Tincture Muriate of Iron in doses of ten to twenty drops, largely diluted in sweetened water, three times a day. The best local application is the application of the Biniodide of Mer- cury Ointment in one-half to a full strength, applied sufficiently often to produce slight irritation. Inflammation of the lymphatic glands (adenitis.) in the acute variety, is to be treated precisely as directed for inflammation of the lymphatic vessels. As the inflammation is more localized, hot linseed poultices, hav- ing the surface strongly impregnated with Laudanum, may be used with great advantage. Tiie surface over the inflamed gland may be covered with Belladonna Ointment. Other hot applications are equally appropri- ate, as in inflammation of the lymphatics. When the general health is poor or the patient scrofulous, such reme- dies as the Citrate of Iron and Quinine, in doses of two to five grains should be given. Iodide of Potassium with Iron is often an appropriate remedy. * The formula for making Liquid Pepsia is, take of Saccharated Pepsin (Sheffer's) two drams, Hy- drochloric Acid a dram, Water five ounces. When solution is effected, add Glycerine three ounces. ULCERS. 477 Take of Iodide of Potassium five drams. Pyrophosphate of Iron a dram, Peppermint water eight ounces. Mix. Dose : A dessertspoonful three times a day. It can be sweetened or not, according to the taste of the patient. The Compound Syrup of the Phosphates or Hypophosphates in doses of a teaspoonful to a dessertspoonful three times a day is suitable. Cod Liver Oil is often required. After the disappearance of the acute inflammation, if the glands remain, hard rubbing with Iodide of Mercury Ointment will generally produce absorption. This ointment may often be reduced one half with lard. HOM(EOPATHIC TREATMENT. In acute abscesses, apply poultices and warm, unmedicated fomentations, and forward the suppurative pro- cess. The lancet is never necessary, except when the pus, by its exten- sive diffusion or pressure, especially when deep-seated, is liable to injure important parts ; or when, from its situation, there is reason to apprehend its discharge into any of the cavities of the body. When it is necessary to make an opening with the lancet, the incis- ion ought to be made at the lowest or most dependent point, where this can be safely and readily accomplished ; but when this is impracticable, in consequence of the great thickness of the parts between the pus and the skin, the most prominent or pointed part should be selected. When, on the other hand, this latter point happens to be at the upper part of the abscess, the lancet had better not be used at all, but trust rather to the use of remedies. Hepar Sul., Silicea, Arsenicum, and Lachesis. In chronic abscesses, it has usually been found most beneficial^ to make an outlet for the matter (pus) as early as possible, so as to prevent its large accumulation, and thereby avoid the consequent frightful consti- tutional disturbance so liable to occur in such cases from the extent of the inflammation. After the bursting of the abscess, make the opening merely large enough to admit of the exit of the matter. When the col- lection of pus is very extensive, it frequently accumulates again after having been evacuated, hence it has been recommended to heal up the opening immediately, and to make a new one when necessary, but before the pus has accumulated in anything near like the first quantity evacu- ated. HOME TREATMENT. An excellent remedy for all open sores upon an inflamed base, milk leg, and inflamed breasts, is tobacco salve. To be made as follows: Take one-half pound of Navy plug tobacco, two pints of good Vinegar, three-fourths of a pound of Tallow, one-fourth of a pound of Lard or Sweet Oil, half a pound of Rosin, half a pound of Bees- wax, one ounce of Balsam Fir, one-fourth pound of Burgundy Pitch. Cut up the tobacco fine and soak in half an ounce of water till soft. Add one-half of vinegar, boil and strain, then add balance of vinegar, steep, rinse the dregs and strain ; then boil down one-half and add wax, rosin, lard, and Burgundy pitch ; then boil down till water is all evaporated, add balance of fir and stir till cold. If too stiff, add lard or oil to the con- sistency required. 478 SIMPLE REDNESS OF THE SKIN. CHAPTER XXVI. DISEASES OF THE SKIN. ERYTHEMA-SIMPLE REDNESS OF THE SKIN. Erythema occupies a middle rank between congestion and inflam- mation of the skin ; it is easily confounded with a benign form of ery- sipelas. Its causes are : Mechanical injuries of the skin; the influence of a high temperature, of various medicinal agents; continual moistening of one part of the skin by urine, liquid stool, perspiration, tears, and even the constant use of moist compresses ; constant irritation of the skin by rough clothes. In the case of children, erythema seems to be, likewise, caused by hearty and fat food. Erythema seldom occurs as a wide-spread affec- tion, to which the designation of " epidemic " might be applied. Chronic erythema breaks out chiefly in the face, and, more especially, on the nose; its causes sometimes seem to be purely local, and, at other times, constitutional. Erythema is characterized by a more or less diffuse redness of the skin, not separated from the normal redness by sharply-drawn outlines, assuming a yellowish, not a white tint under the pressure of the finger, and continuing for some time, and, finally, terminating in desquamation (peeling off). These characteristics belong to all forms of erythema. Ery- thema caused by external irritants, most generally breaks out on the scrotum, at the anus, between the thighs, in the axillae (arm pits,) face, and in the deep integumentous folds of fleshy persons, or at the place where the irritating cause exerts its influence. After the cause ceases to act, the erythema generally disappears of itself in a .few days. If the irritation continues, the skin may become detached (intertrigo,) and ulcers may form, or the skin may even become gangrenous. Erythema arising from internal causes is almost exclusively located on the dorsal surface of the hands and feet, where it is never absent, even if other parts are, likewise, affected. At first the place exhib- its a redness, and in a few days darker-colored papules of various sizes spring up, which remain even for some time after the diffuse redness has disappeared ; the affected spot, likewise, retains a yellowish tint for some time after. In particular circumstances, subsequent crops of this eruption break out on its borders, by which means the affection runs a very pro- tracted course. This form of erythema is generally attended with a little fever, and at the diseased spot a darting-burning pain is generally expe- rienced. The former variety, on the contrary, has no fever as long as the erythema is of the simple kind ; whereas, the intertrigo of sensitive children may be attended with fever. The second variety, without any subsequent crops, lasts from one to two weeks. In treating the first variety, all that it may be necessary for us to do, is to remove the exciting cause. In some individuals, the disposition to erythema is so great, and it leads so easily to more serious consequences, that we are led to suspect behind the local irritation the existence of some ERYSIPELAS. 479 constitutional disposition. This is particularly the case with the inter- trigo, 'or soreness of children. Since this soreness is often caused by impro- per diet, the first thing to be done is to regulate it with care; if the sore- ness continues in spite of this change, a few doses of Mercurius vivus or solubilis will cure the trouble very speedily. ERYSIPELAS. Erysipelas proper is altogether a primary affection, the cause of which it is difficult to trace in every case. The disease occurs almost exclusively between the age of pubescence and that of sixty, and is of less frequent occurrence among old people than among children. Atmospheric influ- ences are generally regarded as the cause of erysipelas, but this theory is not justified by the evidence of fact. All we know positively is, that ery- sipelas often sets in as a sporadic disease, and that sometimes it breaks out in the form of a limited epidemic, which never assumes a very exten- sive range, and has given rise to the erroneous view that erysipelas is a contagious disease. It is a characteristic feature of this disease that every new attack of erysipelas increases the patient's liability to other attacks, which only becomes extinct at an advanced age. The cause of successive attacks of erysipelas is very often to be found in violent emotions, gross errors in diet, and in colds, more especially in the action of severe cold upon a heated skin. The origin of wandering erysipelas is involved in complete mystery; it is to be observed that it inclines to set in previous to the age of pubes- cence. Traumatic erysipelas arises in consequence of injuries, if suppuration ensues, or even at the start, soon after the infliction of the injury ; or it accompanies suppurating inflammatory processes, such as gum boils. It may be looked upon as an excess of reaction against the inflammation from which it proceeds. This circumstance likewise accounts for those cases of erysipelas that supervene during typhus and other constitutional diseases as a malignant complication or as a terminal disease. Symptoms and Course. True, or the so-called exanthematic erysip- elas really only breaks out in the face, whereas erysipelas on other parts of the body is, properly speaking, erythema. The appearance of the exanthem upon the skin is generally preceded for a few hours or even days by a preliminary stage, consisting of a severe fever with marked gas- tric symptoms, with which symptoms of cerebral hypersemia, and more especially a violent headache, sometimes become associated at an early period. During a first attack these precursory symptoms are scarcely ever absent ; but they do not occur with a return of the disease. While the fever is on the increase, the face feels hot and tense, and sometimes rheu- matic pains in the nape of the neck are complained of, a vivid redness breaks out at a certain circumscribed spot in the face, which spreads rapidly and causes a burning pain. In proportion as the redness becomes more intense, the swelling likewise increases and the skin assumes a glis- tening appearance. Erysipelas generally breaks out on one cheek, whence it spreads to the nose, the eyelids, forehead, ears, less frequently to the lips and scarcely ever to the chin. AVithin two or three days, and some- 480 DISEASES OF THE SKIN. times in thirty-six hours, the erysipelas reaches its acme at the spot where it first appeared, amid febrile symptoms, which are sometimes exceedingly severe, attended with a foul-smelling catarrh of the mouth, vomiting, and most generally delirium ; these symptoms, however, are not constant, whereas the headache and soporous stupefaction are exceedingly annoy- ing. The face is now very much swollen, the features are disfigured to such an extent that they are no longer recognizable, the redness has a bluish and even brown-red tint, and vesicles of various sizes sometimes spring up upon the inflamed surface, which always indicate an intense degree of illness. The inflammation decreases very rapidly ; the redness disappears after the existing vesicles had dried up previously, and had become trans- formed into thin and flat crusts, and very soon desquamation commences, first in large patches, and afterwards in very small scales. But inasmuch as the disease never terminates with its first appearance, and usually spreads over the whole head, we find erysipelas in full bloom close to the original spot in process of healing, and find the redness gradually diffus- ing itself into this spot, whereas it forms a sharp contrast with the sur- rounding normal parts of the face. In this manner erysipelas gradually wanders over the whole face, even beyond the ears, invading a portion of the nape of the neck, and spreading over the forehead and the hairy scalp. In this latter case, the patients suffer severe local pains, even after the fever abates. The intensity of the fever, as it first breaks out at the commencement of the disease, does not keep pace with its gradual pro- gression. Whereas, at one spot, the inflammation runs its full course in five to six days, yet, on account of its progressive appearance in different localities, the whole course of the disease lasts from ten days to a fortnight. The process of desquamation may last much longer, and the most severely affected parts often exhibit, for a long time, a yellowish tint with signs of serous infiltration. Deviations from this course are not unfrequent. The whole face may be covered so rapidly, that it would seem as though the exanthem had broke out all over at once. These are cases of intense virulence, where one ear, however, commonly remains uninvaded. Moreover, the inflam- mation may communicate itself to the cerebral meningse ; generally, how- ever, this does not take place until the local process has reached its hight. In such a case, the redness very soon assumes a dingy and livid look ; the skin becomes lax and wrinkled, a most violent delirium sets in, and coma and death speedily supervene. This course has been mistaken for a metastasis of erysipelas : whereas, in such a case, the same changes take place as in other similar cases, namely : that, with the appearance of a violent disorder, the previously-existing lesser disease abates and disap- pears. Erysipelas seldom becomes associated with diseases of other impor" tant organs. Attacks of erysipelas succeeding the first attack are very apt to show deviations from the normal course. These attacks are very seldom preceded by precursory symptoms, the less so the more frequently the attacks have occurred. Nor is the fever as severe, the swelling is less, and the spread of the disease over the face takes place more slowly. It not unfrequently happens that in subsequent attacks the patients are not obliged to lie down, and that their appetite remains the ERYSIPELAS. 481 same as in their normal condition. Subsequent attacks are more like erythema than erysipelas. The frequency of the attacks differs greatly in different individuals; sometimes there are several attacks in a few weeks, and, after a short time, cease entirely; or months, and even years, intervene between the attacks; in such cases a spontaneous cessation is much less frequent. Among the consequences of true erysipelas, the following deserve particular mention: Swelling of the skin, especially, that of the eyelids, nose and lips; the swelling is mostly puffy, the skin having a pale look, and being disposed to the formation of comedones; if the attacks are very frequent, the swelling may reach a considerable degree of thickness, and is very obstinate. Loss of the hair, which almost always falls out if the scalp had been intensely affected by the disease; in most cases, the hair grows again, but there are exceptions to this rule. Severe catarrh of the ear, with obstinate hardness of hearing. Disposition to neuralgia. Wandering erysipelas, or erysipelas ambulans or erraticum, attacks the face less frequently than the extremities. On one of the extremities, an erysipelatous sjoot appears which heals exactly like the above described spots, only there is very little tension and pain, and the general organ- ism is not so much involved. From this spot, the erysipelas spreads toward the trunk ; the spot which is attacked next, being either in close contact with the first, or else all subsequent spots being more or less remote from each other. Symptomatic erysipelas, as an accompaniment of inflammatory pro- cesses, is of no great importance, except when it covers a large extent of surface and depends upon septic causes. Generally, it disappears of itself as soon as the cause that occasions it, is removed. If it is very intense, it may result in suppuration or gangrenous destruction of the skin. If the erysipelas sets in, in the course of serious, constitutional diseases, with fever, it is always a bad omen. In such cases, the redness is never very vivid — rather dingy, having a bluish tint ; the swelling is not excessive, and yet the disposition to form blisters is very great ; these blisters do not always dry up, but often become transformed into badly-looking ulcers, which are apt to become gangrenous. The fever accompanying this form of erysipelas, always increases to a high degree, but speedily assumes the character of an adynamic fever, the pulse becomes very small and frequent, the temperature increases considerably, the cerebral phe- nomena become very marked, and sopor and coma set in at an early period, and death sometimes takes place so rapidly that life becomes extinct already on the third day after the appearance of the inflam- mation. Erysipelas of babes generally sets in in the first week after the birth of the infant, very seldom after the first month. It almost always pro- ceeds from the umbilicus, on which account it has been traced with great probability to the consequences of an improper management of this organ, more especially to a purulent inflammation of this organ, which can eas- ily be accounted for by bad management. As a rule, the erysipelas spreads from the umbilicus over the abdomen, the sexual organs, thighs, less frequently over the thorax and back. The redness is not very vivid, the swelling, on the contrary, is very considerable. The children are 31 482 DISEASES OF THE SKIN. exceedingly restless, feverish, and incline greatly to spasmodic affections and sopor. ALLOPATHIC TREATMENT. A patient with erysipelas (erysipela- tous fever) should be confined to bed in a well-ventilated room. The diet should be light, but consisting largely of milk. Cold drinks may be given as desired. If the bowels are constipated, they should be moved by a saline cathartic, as the Citrate of Magnesia, aided, if necessary, by an injection of warm water. If the case be a mild one, and the fever not high, it is not generally necessary to resort to the use of drugs. In severe cases, the remedies most useful are Quinine and the Muriate Tincture of Iron. Quinine, in these cases, should be given in doses of five to ten or more grains every four hours. If a slight ringing in the ears is produced, the doses are sufficiently large. It is best given in powder enveloped in medicine wafers. The Tincture Muriate (Chloride) of Iron is very gen- erally given by physicians in doses of ten to thirty drops every four hours. It should be largely diluted with sweetened water, and may be given immediately after the Quinine. Beyond the support it gives to the system laboring under so debilitating a disease, the (direct) benefits from the Iron are questionable, but as it is beneficial in this way, it ought not to be omitted in any severe case. Belladonna is especially antagonistic to this disease. The Extract may be given in doses of a quarter of a grain in pill, three or four hours apart, or the Tincture may be given in doses of from five to ten drops at the same intervals. The Belladonna may be given with the Quinine. In cases with high fever, the pulse strong, and there is no depression of the system, the Tincture of Aconite should be given in doses of half a drop to a drop every hour until an impression is made on the fever move- ment, and then continued two or three hours apart, or just sufficiently often to continue the effect of moderating the fever. This remedy does not require the suspension of any of the others mentioned, but it should not be given when there is prostration. There is no treatment which will limit the inflammation. The sooth- ing effect of the Lead and Opium wash, is often extremely grateful to the patient. A half a dram of Sugar of Lead and ten grains of the Acetate of Morphine are dissolved in a quart of rain water. A soft mus- lin cloth is dipped in this solution and spread over the inflamed sur- face. The cloth should be kept wet. If this does not relieve the pain markedly, it is well to try anointing the surface well with Olive Oil. Two drams of the Fluid Extract of Belladonna to six drams of oil will give the oil a decided anodyne property. Glycerine, with ten to twenty drops of Carbolic Acid to the ounce, is another good application. Prostration or debility, occurring in the course of the disease, should be treated in the same manner as when it occurs with continued, or other fevers, with nutritious food, milk, beef essence, raw eggs beaten up with sugar and water or milk. Nourishment should be given in these cases four hours apart. If the pulse should be very rapid and feeble, brandy, or whisky in doses of one or two tablespoonfuls may be given with the nourishment. The stimulant is beneficial, if the pulse becomes fuller, slower, and more regular. Sago, Rice, and other farinaceous articles are not to be excluded, if agreeable to the patient. ERYSIPELAS. 483 HOMCEOPATHIC TREATMENT. Aconite may be required at the onset, only in case there be much/ever, or hot, dry skin at the commence- ment; or even during the course of the disease, if required. Dose: Dissolve six pills in three tablespoon fuls of water, and give a teaspoonful of the solution every three hours, until the pulse becomes diminished in force and frequency, and the skin moist. Belladonna,, when the redness expands in rays, and an acute shoot- ing pain with heat and tingling is experienced in the affected part, which is aggravated by movement. Erysipelas of the face, with burning heat, excessive swelling, so that the eyes are almost closed, violent head- ache, thirst, dry, hot, skin, restlessness, disturbed sleep, delirium. In such instances, Belladonna, is, generally, alone sufficient to effect a cure. There are cases, however, in which it will be found necessary to have recourse to Rhus-toxicodendron, in alternation with Belladonna, according to the particular symptoms, or group of symptoms present. Done: If singly, of a solution of eight pills to two tablespoonfuls of water, give a teaspoonful every two hours, until change, when the intervals should be extended to six hours, until the symptoms are wholly overcome, or assume distinctive features indicative of another remedy. But in those cases, of occasional occurrence, in which the symptoms, being severe, are but little moderated, within three hours after the fourth dose of Belladonna, Rhus., a similar solution of each medicine, administered by teaspoonfuls, at intervals of two hours, until change. Rhus-toxicodendron is to be preferred, particularly when the dis- ease manifests a tendency to extend itself to the brain and its membranes and the symptoms closely resemble those which characterize brain fever. Rhus is especially suitable for the treatment of erysipelas arising from particular kinds of food, operating upon certain individual peculiarities of constitution which predispose the patient to such attacks. Dose: As directed for, and under Bell. Arsenicum is required, either after the previous administration of one or more of the foregoing medicines alone, or in alternation with Rhus when vesicles of a blackish hue, with a tendency to degenerate into gan- grene, present themselves; or, still more essentially, if great (and rapid) prostration of strength occurs. Dose: In all respects, whether singly or in alternation, as directed under the head of Belladonna. Pulsatilla is more especially indicated when the hue of the skin is less intense, or of a bluish-red, and the morbid spots frequently disappear from one place to reappear in another (fugitive erysipelas). It is further- more appropriate when the disease affects the internal and external ear, especially in the vescular variety of erysipelas, and after the employment of Rhus-toxicodendron. Dose: Six pills, in a teaspoonful of water, every three hours. Xux-vontica is often of service in cases of erysipelas developed in the knee or foot, and characterized by extremely painful, bright-red swel- ling. It is more especially advantageous in cases of spurious erysipelas occurring in irritable subjects, particularly females, and when mortifica- tion of the subcutaneous cellular tissue has ensued. Dose: As for Pulsatilla . ERYSIPELAS TERMINATING IN ULCERATION. Sulphur, Arsenicum* See article on " Ulcers." 484 DISEASES OF THE SKIN. SUSCEPTIBILITY TO ERYSIPELAS IN THE FACE. Belladonna, Rhus, When this disease is repeatedly developed in the face, and there is, in fact, an habitual tendency to attacks of this na- ture, Belladonna and Rhus (in particular,) either singly, alternately, or successively, according to circumstances, are frequently capable of per- manently removing the complaint, and of obviating the return of the attacks. Dose: If singly, of either remedy, give six pills, night and morning for a week, (as soon as the acute symptoms of an attack have been subdued;) then pause four days, after which the course may be- repeated, as before, and so on from time to time. If in alternation — give first the one (as just directed,) and then after an interval of twenty-four hours or longer, proceed with the other, in like manner, and so on, occasionally, until the predisposition seems conquered. HOME REMEDIES. To relieve the burning and pricking sensation,. the face or parts attacked may be bathed frequently with Ammonia Water. Or, clean, fine wood-soot from the chimney may be made into an ointment with lard spread on cotton batting, and applied upon the affected parts. Rye flour boiled in water, and mixed with soft soap is a good applica- tion to lay on the affected parts, changing it twice a day. Sometimes the burning sensation will be allayed by washing with a solution of copperas, half an ounce to a pint of water. NETTLE-RASH. HIVES— URTICARIA. Diagnosis. Spots or wheals, flat or prominent, and of a dull white color, like the sting of a nettle, or redder than the surrounding skin, generally encircled with a rosy areola, disappearing in warmth, and reappearing when exposed to cold, evolved suddenly, and continually changing their situation. This eruption is brought to the surface by various causes, not unfre- quently arising from indigestion, caused by the use of improper articles of food. Before the eruption discloses itself, the patient is affected with rest- lessness, languor, oppression and want of appetite, derangement of the digestive functions, and fever. When the eruption breaks out, the above symptoms become relieved, but considerable suffering arises from heat and itching, sometimes accompanied with swelling of the parts affected. This disease, in almost all cases arising from a constitutional cause, requires for its total eradication a regular course of treatment. ALLOPATHIC TREATMENT. Acute Urticaria, depending on irrita- tion of the stomach, especially if caused by some food which has been eaten, an emetic of twenty grains of Ipecacuanha in half a glass of water should be given. After the vomit a simple laxative should be given. A Seidlitz Powder or Citrate of Magnesia in a dose of a tablespoonf ul in half a glass of water and drunk during effervescence. The diet should be simple for several days, consisting of rare lean beef or mutton, milk, eggs, bread, and farinaceous food. Bismuth in doses of ten or fifteen grains should be given (in milk) before each meal. Alkaline drinks should be taken to overcome acidity or irritation of the bowel. Ten to twenty grains of the Citrate of Potash in lemonade every four hours will be sufficient. NETTLE RASH. 485 In the chronic disease the cause must be carefully sought out and Temoved. Articles of food which are found to disagree must be avoided. .Sometimes it is necessary to omit one article after another until the offend- ing one is found. A pure milk diet is sometimes necessary. Bismuth and Citrate of Potash recommended above are often useful. In many instances the Solution of Pepsin and Bismuth (Sheffer's formula,) in~doses of a dessertspoonful before eating, should be tried. If the patient is rheu- matic or gouty Wine of Colchium should be tried in doses of a teaspoon- ful one or more times a day, to produce a slight action on the bowels. "When causes in the stomach or bowels are excluded, Fowler's solution in doses of three to five drops after meals should be tried ; the remedy should be omitted for a time if it causes puffy lids, watery eyes, or abdominal jpains. If the disease occurs periodically Quinine should be given in doses of five grains three to six times a day. The presence of fleas and insects as causes should be sought for. A solution of Corrosive Sublimate in half a pint of water, is a useful appli- cation where the disease depends on the bite of insects. Bathing with vinegar and water is often beneficial, or sponging with a tablespoonful of Dilute Nitric Acid in a quart of water. H03KE0PATHIC TREATMENT. In acute cases, the remedies found most useful are Dulcamara. Aconite, Nux-vomica, Pulsatilla, Antimonium- crudum, Belladonna, Hepar-sulphuris, Rhus-toxicodendron and Bryonia. Dulcamara, when the exciting cause has been cold or damp; when the affection occurs in wet weather, or when we find considerable fever, with bitter taste in the mouth, foul tongue, diarrhoea, pains in the limbs, and extreme itching, with a burning sensation after scratching. Aconite when the febrile symptoms are more intense, the pulse high, the skin hot and dry, and great restlessness and anxiety are present. Nux-vomica when there is considerable gastric derangement, with constipation, more especially when arising from wine, stimulants, or indi- gestible substances ; it may, if necessary, follow Aconite in eight or twelve hours after the febrile symptoms are somewhat modified. Pulsatilla deserves a preference, under similar circumstances, when the bowels are relaxed, and the patient is of a quiet disposition, and lym- phatic temperament, and the attack has apparently been excited by indi- gestible food. Antimonium-crudum may follow Pulsatilla should the latter have failed to relieve the affection. Belladonnais indicated when the affection is attended with a severe "throbbing headache, with redness of the face. Hepar-sulphuris has frequently been found useful in urticaria accompanied by cold in the head, and particularly when the coryza (dis- charge from the nose,) was confined to one nostril. Hhus-foxicodendron is one of the most useful remedies in a great majority of cases of this eruption, and especially when the affection has apparently arisen from some idiosyncrasy of constitution, in which the eruption has been thrown out by the use of some particular article of food. Prescription. In ordinary cases, we may prescribe 6-12 globules, of 4S6 DISEASES OF THE SKI^. the sixth dilution in six dessertspoonfuls of water, and order one to be taken morning and evening, except in the case of Aconite, which may be more frequently repeated, when the febrile symptoms seem to demand it. In this, as in every other cutaneous eruption, great care ought to be taken against driving it inward, by external application or lotions; a sudden retrocession, as noted under Scarlatina and Small-pox, being fre- quently attended with fatal consequences. When, however, from improper treatment, we have reason to dread this having taken place, we may generally succeed in re-establishing the eruption, and thereby avert- ing any dangerous consequences, by the employment of Bryonia in repeated doses. Should, however, marked cerebral symptoms declare themselves, the complaint should be treated as described under Scarla- tina. Urtica TTrens has been found useful in some cases; and in those of a chronic or extremely obstinate character, Calcarea, Lycopodium. Sul- phur, Carb.veg., Causticam, Acid, nitric, Conium, Natr. mur.,etc, the last two, particularly, when the eruption is liable to reappear after violent exercise or exertion of any kind ; Calcarea, when exposure to cold fresh air produces it ; and Acid, nitricum when it arises from the patient going into the open air, after having kept within doors for a day or two. HOME REMEDIES. Whenever the eruption appears, rub the body with wheat flour, and let the patient drink freely of hot teas (Sage, Sassa- fras, or something similar). Warm saleratus water is a good application for the skin. DAJSDR UFF— PITYRIASIS. Pityriasis is a throwing off of the skin, either in thin scales, or in larger patches ; it may or may not be accompanied by some other affection of the skin, and the skin thrown off may, to all appearance, be perfectly sound ; or else the process may be accompanied by trifling local or more extensive symptoms of thickening of the skin. According as the skin is un- changed, or looks red under the scales, the affection is designated as pity- riasis simplex or rubra (red). The causes of this affection are very obscure ; in some cases the disease can be traced, with some certainty, to a derangement of the functions of the liver, and of the female sexual organs. Pityriasis rubra, when spread over more extensive portions of the skin, not unfrequently sets in with slight febrile motions, which may break out at every renewed appearance of the exanthem. On portions of the skin, which itch and burn very fiercely, large red spots of indefinite and irregular shapes make their appearance. Accompanied by a pecu- liar feeling of tension, the skin on these spots very soon begins to exfo- liate. The eruption first manifests itself on the trunk, and only invades the face, if exceedingly severe. The almost inevitable itching may cause a moisture to ooze from the otherwise dry spots on the skin. This itch- ing, which is absolutely agonizing, very commonly interferes with the sleep. The affection is very obstinate, but at the same time one of the rarer forms of cutaneous diseases. Pityriasis, confined to isolated spots, is much less frequently of the DANDRUFF, 487 character rubra than a general pityriasis ; it is most commonly met with on the hairy scalp, in the palms of the hands, on the soles of the feet and in the face. The itching is much less distressing, but is still very violent on the hairy scalp. By scratching the skin till it tears, a moisture is secreted from the irritated spot, resulting in the formation of superficial scurfs and crusts, and agglutination of the hair. In treating a case of general pityriasis, we must not forget that we are dealing with a very chronic affection which never promises rapid success, and where it would be, consequently, improper to make a fre- quent change of medicines, or to repeat the dose too often. The most important remedies are Graphites and Arsenicum, with which it is most likely that a cure can best be affected. The attack may be modified in any and every degree, from that just described to that resulting only in the throwing off of small, dry scales from the hairy scalp. The treatment is one of the most difficult known to the profession of medicine only on account of its tediousness and the absolute carelessness of patients who more than half the time neglect to use the means which would cure, if used as directed. Sepia is, particularly, indicated in the case of females, if the spots break out in consequence of menstrual irregularities, or at definite periods of the year. ALLOPATHIC TREATMENT. For dandruff, there is no more effect- ual application than keeping the scalp clean with a strong solution of Borax. Frequent daily (or often enough to keep off the scales) shampoo- ing with a mixture of equal parts of Soft Soap (Sapo Veridis, made of Olive Oil and Caustic Potash) and Alcohol, is most useful. Washing the head with weak alkaline solutions is, also, useful. After each washing of the head, the hair should be well oiled to pre- vent the skin becoming too dry. Olive or Almond Oil, scented to suit, are appropriate for this. If the scales are thick, the use of a five per cent solution of Oleate of Mercury is very beneficial. An ointment of fifteen grains of Red Oxide of Mercury, or thirty grains of the White Precipitate, with an ounce of Lard and half an ounce of Sweet Oil, is beneficial. In old cases, with no derangement of the stomach or bowels, three drops of Fowler's Solution should be given after each meal. Derangement of digestion, or other indisposition, demands suitable treatmento HOME REMEDIES. Dissolve Salts of Tartar two drams, in one pint of clean rain water. liub some of this upon the head until a lather is formed, and thoroughly cleanse the scalp from all particles of dandruff by continued rubbing. Then wash in clean water, and dry the head and hair as thoroughly as possible. Continue this for a few times, as often as an accumulation of dandruff is noticed PSORIASIS— SCALEY TETTER. This is pre-eminently an affection of the male sex; in the case of fe- males, it is never attended with sexual disorders. It attacks individuals between the seventh and fiftieth year, and occurs most frequently in the 488 DISEASES OF THE SKIN. cold season. It cannot be traced to constitutional derangements, since persons who are afflicted with this disease, otherwise, enjoy the most per- fect health. With the appearance of some constitutional disease, the pso- riasis disappears at once, but returns again as soon as the disease is removed. Psoriasis begins thus : At various, more or less numerous scattered spots, the detached epidermis (skin) forms a small, white rising (psoriasis punctata). These spots gradually spread until they reach the size of drops (psoriasis guttata;) on removing the scales, we find the skin underneath slightly red and bleeding. In proportion as the circumference continues to expand, the original spot becomes cleansed of its scales, and a ring forms surrounding a healthy-looking skin (psoriasis annularis ;) in the fur- ther progress of the exanthem, this ring opens, loosing its roundness (pso- riasis gyrata) and finally disappearing altogether. All these stages, or most of them, co-exist side by side in almost every case of this disease. Psoriasis is not attended with itching, or, at most, only at the com- mencement, but in no case if it has become an inveterate disease. It may remain stationary, though breaking out in new places, or it may intermit on its manifestations for months and even years. Among external remedies which are never hurtful, and usually effi- cient, is the vapor bath, accompanied by frictions with castile soap, or brown soap ; cold bathing is of decided benefit, but its effects are not at nee perceptible. ALLOPATHIC TREATMENT. The treatment^ psoriasis ought to be under the direction of a physician. The principal remedies which are use- ful, and sometimes curative, given internally, are Arsenic and Cod Liver Oil. The dose of Arsenic should be small— generally three drops of Fow- ler's Solution is sufficient — given three times a day. after meals. If the eyes become watery, or the lids puffy, or a silvery coat upon the tongue occurs, the dose of the Solution should be diminished to two drops or even one drop, if necessary. The other remedies which are often useful are Quinine, Iron, Phosphorus, Iodide of Potassium, and Colchicum. The two remedies first named are, generally, applicable. The Quinine, in doses of one or two grains, and the Iron, in doses of a grain, three times a day. When other remedies are needed, will be determined by the physician, who should see the case once or twice a week. Bathing with Juniper Tar Soap, and, also, the use of Ointment] of Liquid Pitch, are useful external applications. SYCOSIS MENT AGRA— BARBER'S ITCH. This is, exclusively, a disease of the male sex. If persons who not shave are attacked by it, which is a very rare occurrence, its causes are very obscure. In cases where the beard is shaved, the eruption may be caused by bad or irritating soap, or by a dull razor, but is almost always the result of shaving by a careless and uncleanly barber, who does not properly clean and scald his razor, and, although generally so frightfully obstinate, yet may heal spontaneously, even without much loss of time ; all that need be done is to omit shaving the affected parts. Dirt and snuff likewise seem to occasion sycosis (barber's itch). COPPER-NOSE, BOTTLE-NOSE. 489 The disease generally sets in, like herpes labialis (cold blisters,) with a sensation of burning, heat and tension; most commonly, we first notice on the chin a small cluster of isolated, red knobs or pimples (tubercles) of a pretty large size, each of which is perforated by a hair. Some of these tubercles, in a few days, change to pustules, break and form dark crusts, without the infiltration, which forms the little tubercle, disappearing on that account. In spite of all care, and, generally, in consequence of con- tinued irritation, the number of tubercles increases slowly, but uninterrup- tedly, the former ones growing larger ; the skin upon which they are seated, becomes more and more infiltrated ; after breaking, the pustules change to ulcers. The patients do not complain of much pain, but their ugly appearance fills them with anxiety. The disease is extremely obstinate, and may last for years. It is true that it not unfrequently abates in sever- ity, and, at times, even disappears altogether ; but it breaks out again with renewed fierceness, and in such a case, in more than one spot simultane- ously. Its first appearance is almost always on the chin ; it is here that the disorder exists most commonly in its fiercest intensity, but it likewise invades every other bearded portion of the face, and, in severe cases, even the eyebrows. Fifteen grains of Carbolic Acid to one ounce of Glycerine, applied in small quantity after pulling the hair out of the centre of each tubercle, every day twice, after thorough washing with good soap, is a very certain cure. ALLOPATHIC TREATMENT. Removal of the diseased hair, by ex- traction with a pair of forceps, a few at a time, is the first requisite after subduing the inflammation with warm poultices. Then the application of an ointment of Carbonate of Copper two drams to an ounce of Lard, will complete the cure. The Oleate of Mercury; or a solution of Corrosive Sublimate fifteen grains with Muriate of Ammonia thirty grains in eight ounces of Distilled Water; or a dram of Sulphate of Copper and four drams of Sulphate of Zinc dissolved in a pint of water, are effectual applications. The general health and state of the bowels require attention„ ACNA ROSACEA, GUTTA ROSACEA— COPPER-NOSE, BOT- TLE-NOSE. Acna Rosacea is an exanthem consisting of tubercles with some dis- position to suppurate; suppurating tubercles; and, moreover, of contin- ual venous congestion. It almost always commences at the tip of the nose, whence it spreads over the nose and over both cheeks, finally, over the forehead and rest of the face. First, we notice a spot of small extent, painless, and distinctly traversed by dilated cutaneous veins. Upon this base single tubercles start up, which sometimes suppurate at an early period, but likewise spread in size after the pus is discharged. New tubercles keep constantly forming, new spots keep constantly breaking out, the skin becomes more and more thickened, the veins become more and more varicose, the iso- lated little blotches change to large tubercles, cracks and deep rhagades, and even ulcers make their appearance, and the face looks very much 490 DISEASES OF THE SKIN. disfigured in consequence of this extreme development of nasal exan- them. At first, the affection has remissions, but the dark redness never disappears entirely ; at a later period the disorder keeps growing all the time. Abuse of wine and spirits is the cause of the disease in by far the larger number of cases ; but it likewise breaks out on individuals of very moderate habits, as drinkers. Among women the disease is of rare occurrence, and only among drinkers of spirits, as a rule, and associated with menstrual anomalies. The disease is not often seen previous to the twenty-fifth year; its most frequent occurrence is after the fortieth. Overheating the system and immoderate drinking are very apt to cause a renewed outbreak of the disease. It is exceedingly obstinate, and, in its higher grades, is considered incurable. HERPES— TETTEK. All forms of herpes (and they are many), are characterized by the for- mation of little blisters, clusters of which are seated upon the inflamed, red epidermis ; the vesicles of one cluster breaking out simultaneously and running an acute course. HERPES FACIALIS, FACIAL HERPES. This form of herpes accompanies a large number of fevers and chronic diseases, without exerting any specially modifying influences over their course ; except in pneumonia, w T here this form of herpes is said to con- stitute a decidedly favorable omen. As an independent exanthem, it seems to manifest itself when indicating the commencement of a catarrhal affection, provided the catarrhal irritation is not very intense. A first appearance predisposes, most decidedly, to relapses. Herpes facialis (cold blisters) most generally breaks out on the lips, less frequently on the cheeks, forehead, ears, eyelids. A tension, burn- ing, and a marked sensation of swelling, are experienced at a certain infiltrated spot, where the blisters start up amid slight febrile motions, and an unusual feeling of lassitude. In the face, they are always of a tolerably large size, but there are not many of them clustered together, they incline to run into one another ; the skin of the spot where they are located does not show a very vivid redness; sometimes they are pitted or cleft. They contain a clear liquid which soon becomes dim and changes to a rather dark scurf that soon falls off, leaving for some time, a red, some- what infiltrated spot ; burning pains, likewise, remain for some time. A few doses of Rhus-tox. will cure this form. ALLOPATHIC TREATMENT. The bowels should be kept open by the use of Rochelle Salts, Citrate of Magnesia, or Seidlitz Powders. If the health of the patient is not vigorous, two grain doses of Quinine (or some other preparation of Peruvian Bark,) should be given three times a day. The Ointment of Subacetate of Lead is a useful local application, or the Oxide of Zinc Ointment may be used. If the disease becomes chronic, Fowler's Solution, in doses of three to five drops, may be given after each meal. If the eyes become watery, or the lids swell, or the tongue has a silvered coating, the dose of Fow- ler's Solution should be diminished. KINGWOItM. 491 SHINGLES-HERPES ZOSTER, ZONA. This form is characterized by the development of clusters of blisters (vesicles) of which there are, generally, several, along the tract of one or more spinal nerves, assuming, on the trunk, the shape of a zone or belt, but, on the extremities, breaking out in a more irregular form. Shingles commence almost without an exception with rheumatic pains in the parts where it is to break out, and is often attended with great las- situde and fever. The preliminary pains are not unfrequently like inflam- matory pains. With violent and painful burning, an efflorescence breaks out, after which pimples without pus arise, next clusters of vesicles (blis- ters) with a tendency to run into one another. These vesicles remain out for four to six days, after which they change to flat scurfs. But as a new clus- ter may arise after the first, and these successive crops may continue, even after the first vesicles are entirely healed, the whole process may last even three weeks. It is very seldom the case that scratchingjor the friction of the clothes will cause a superficial ulceration. There may be no pain during the continuance, except the slight burning attending the successive break- ing out of new crops of vesicles; but the greatest distress to the patient is the burning itching which is especially severe in bed. After the falling off of the crusts all pain is gone, or the peculiar itching may perhaps continue for some time, or finally — and this is not by any means a rare occurrence- intercostal neuralgia of a very obstinate type may set in, apparently the more readily the less scantily the herpes was out on the skin. HOMCEOPATHIC TREATMENT. Merzereum is to be relied on, giving four doses daily, six pills at a dose. HOME TREATMENT. Take green rye when about six or eight inches high and stew it into a salve with fresh cream. Apply this to the part every morning and evening till cured. Always wash the part with castile soap suds and dry it each time before using the salve. RINGWORM. HERPES IRIS AND CIRCINNATUS. Herpes iris consists of a larger blister, which is not unfrequently filled with a blood-tinged liquid, and is surrounded by a wreath -of smaller vesi- cles, around whose external border another and larger wreath may form. The course is the same as that of other herpetic vesicles. The affection first appears on the dorsa of the feet or hands, spreading on the extensor- surfaces from below upwards, and the new clusters of vesicles appearing either in the same relative position as the vesicles of herpes generally, or else again assuming the form of herpes iris. This form of herpes most fre- quently occurs among women and children. Herpes circinnatus, which comes out in the same manner as herpes iris, is distinguished from the latter by the circumstance that the central blister is missing, and that only the wreath of vesicles is present. ALLOPATHIC TREATMENT. In the treatment of " ringworm " (her- pes circinnatus) simple measures generally succeed at once, as the applica- tion of a strong solution of Nitrate of Silver, from ten grains to a dram to the ounce; an ointment of ten grains Acetate of Copper to the ounce of Lard; a five-percent Solution of Oleate of Mercury in Oleic Acid, containing a dram of Ether to the ounce ; a solution of Corrosive Sublimate two grains- 192 DISEASES OF THE SKIN, and upward to the ounce of water, or the Corrosive Sublimate Ointment with from ten to twenty grains of Corrosive Sublimate to the ounce; or Tincture of Iodine, will suffice. These applications destroy the parasitic plant which causes the disease. In ringworm of the scalp (tinea tonsuraus) the first indication, as in ringworm or scald head, is the same. To destroy the parasitic plant is best done by applying a blistering fluid (Blistering Collodion,) remove the loos- ened epidermis, and then apply an ointment made by mixing twenty grains of Corrosive Sublimate, or forty grains of White Precipitate with an ounce of Sulphur Ointment, or some of the mixture given for ringworm. The scalp should be carefully cleansed every day to remove any loosened scarf- skin which may interfere with the ointment (or other application) reaching the parasite and the application made twice a day. Scrofulous or poorly nourished children will need tonic treatment, as a teaspoonf ul or more of Cod Liver Oil and a teaspoonf ul of the Compound Syrup of Hypo-phosphites daily. It is claimed that the continuous use of Soft Soap (Sapo Veridis) made with Olive Oil and Potash, will cure the disease in two weeks ECZEMA— SALT RHETJMo The causes of eczema are either external irritants acting directly upon the skin, or else substances that affect this organ through the general circu= lation, into which they had been absorbed, or finally constitutional influ- ences. Heat, for instance, causes the so-called baker's itch ; and heat, intense cold, salt-baths, mercurial frictions, Croton Oil, etc., a number of medicinal agents taken internally, fat food or food giving rise to an unu- sual deposition of fat, scrof ulosis, affections of the female organs of gener- ation, varicose veins, and in general, all kinds of stoppage in the venous system, and a number of other similar circumstances and influences uni- formly occasion eczema. Among the direct cutaneous irritants we distinguish: Neglect in attending to the skin, vermin, friction by clothes, continued rubbing of a part, for instance, between the thighs when riding on horseback, and by continued walking. A good example of eczema is obtained by rubbing Croton Oil upon the skin. Upon a red surface a number of vesicles (blisters) or pimples shoot up, which, if carefully guarded, heal in a few days, leaving the affected portion of the skin injected. If the vesicles are not protected, if they are scratched or rubbed against by the clothes, they break and crusts form, beneath which, if the irritation continues, the exudation continues like- wise, or else may be so copious that no crusts can form, in which case the affected part always looks red and moist. If the irritation continues, the eczema spreads to the adjoining parts; scratching even communicates it to remote parts; besides the vesicles, pustules form likewise. Eczema of the legs (salt rheum) really depends almost exclusively upon varicose veins, more especially upon dilation of the small cutaneous veins, whereas the larger vessels may continue in a perfectly normal con- dition. This eczema is extremely obstinate, itches most horribly, gener- ally exacerbates in the spring and fall, and is a species of eczema rubrum SALT RHEUM. 493 with occasional formation of pustules and an infiltration of the skin that makes it look very badly. Eczema seldom runs an acute course ; the extremely acute form of "eczema universale" is very rare; on the other hand, it not unfrequently commences as an acute exanthem, slight fever, but very soon assumes a chronic character. All the different forms of eczema itch more or less; scratching, which it is impossible to avoid, is a main cause of the onward spread, and the protracted course of the disease. Every kind of eczema may heal and does heal spontaneously, provided the chief requi- site towards a cure, namely, rest in a lying position, and absolute cleanli- ness is attended to. Eczema of the leg and scrotum give the least hope of a cure. ALLOPATHIC TREATMENT. In an acute attack of Eczema in a person of robust constitution, the bowels ought to be briskly moved. Ten grains of Calomel, followed after six hours, by a dessert to a tablespoonf ul of Epsom Salts, or Citrate of Magnesia, or a double Seidlitz Powder.. This should be followed by ten to fifteen grain doses of Citrate of Potash or Cream of Tartar in Lemonade, a sixth of a grain of Tartar Emetic should be added to each dose, and given from two to four hours apart. If 'the patient is not strong, Calomel should not be given, but a saline laxative of a dessert to a tablespoonf ul of Epsom Salts or Citrate of Mag- nesia, or a Seidlitz Powder. This should be followed by Cream of Tartar in doses of ten to twenty grains, in Lemonade, from two to four hours apart. The eruption should be poulticed with Flaxseed Meal or Slippery Elm spread thin between very thin layers of muslin or soft linen dipped in warm water, spread over the eruption, and covered with oiled muslin. When there is much burning, the following powder, sprinkled on the eruption, before the poultice is put on, is useful : Take Camphor half a dram, Ether a sufficient quantity to powder the Camphor, four drams each of Oxide of Zinc and Starch. Mix. Old chronic cases of this disease are known as Salt Rheum. The crusts should be softened by poulticing with Flaxseed meal or Powdered Slippery Elm, until they can be easily removed. After the crusts are removed and the surface carefully dried, the Ben- zoated Oxide of Zinc Ointment should be applied constantly, and all irri- tating applications cease, though an occasional cleansing may be necces- sary. If the secretion does not disappear, or. greatly diminish, one of the best applications which can be made is a dram of Tannin dissolved in an ounce of Glycerine. The ointment may be used again in a short time after the Tannin and Glycerine are used. Tonics will be needed, and the principal ones are Quinine, Iron, Arsenic and Cod Liver Oil. The Cod Liver Oil may be given in doses of a teaspoonf ul three or four times a day. The Citrate of Iron and Quinine in two to five grain doses, three times a day; it should be dissolved in Syrup of Ginger or Orange Flower Water. These are particularly indica- ted, if the patient is in poor health with impoverished blood. All chronic cases are benefited by Arsenic. It should be given as Fowler's Solution, in doses of three to six drops, after meals. It can be combined with the Citrate of Iron and Quinine, as in the following formula- Take of Citrate- 494 DISEASES OF THE SKIN. ■of Iron and Quinine a dram and a half, Syrup of Ginger or Orange Flower Water four ounces, add Fowler'' s Solution a dram, and a half Dose : A teaspoonf ul, three times a day. In the use of Fowler's Solution, if the eyes become watery or the lids swelled, or the tongue has a silvered coating the dose should be diminished. HOME TREATMENT. Take Beef Marrow, Sulphur, Black Pepper, White Turpentine, of each equal parts, mix together and make an oint- ment to apply to the tetter. Another beneficial ointment can be made as follows : Take of fresh Sheep's-Sorrel leaves, fresh Calendine leaves, and Red Clover leaves and flowers, each a handful ; beat them up well in good cream or fresh butter that has not been salted. Then squeeze off* the cream or butter, and use it as an ointment, applying it over the tetter two or three times a day. Bathing the affected parts in strong Saleratus water has been known to cure effectually a number of cases. BOIL—FERVNCULUS-ABSCESSUS JSUCLEATUS. Diagnosis. Round or rather cone-shaped hard elevations of different sizes slowly inflaming and suppurating, discharging matter generally at first, tinged with blood, but still retaining a portion of morbidly-altered cellular tissue, which may form the nucleus of other elevations after those which appeared first have healed. ALLOPATHIC TREATMENT. The maturity of a boil may be hast- ened by poulticing with Flaxseed meal, or powdered Slippery Elm, when it may be allowed to break, and run out into a poultice. Water dressings covered with oiled muslin may be used instead. Boils which contain pus, and do not come to ahead, should be opened. Boils occurring singly, or in crops which do not soon suppurate, but remain hard, may be made to disappear by brushing them over with Tincture of Iodine ; sometimes crops of them may be suppressed by early resorting to this application. When boils occur in successive crops, it is probable poultices will induce their farther development, and should not be used if this appears to be the case. But if they are painful, a poultice, having incorporated in it Stramonium (Jamestown Weed,) or Tobacco, or that has Lauda- num, or Fluid Extract of Belladonna should be poured upon its surface. A plegget of cotton, saturated with equal parts of Carbolic Acid and Gly- cerine, with, or without one-half part of Fluid Extract of Belladonna, placed over a group of boils, is often effectual in relieving the pain. Soap plaster is a good application for these groups of boils, but after they open, Resin plaster should be used. The diet should be plain and nutritious. Occasionally a boil can be aborted by touching the inflamed pimple with the Acid Nitrate of Mercury, or the solid stick of Nitrate of Silver. The system of persons having boils requires supporting. For this purpose, Quinine and Iron should be given. The former may be given in sugar coated pills (Warner's,) in doses of from two to six grains three CARBUNCLES 495 times a day. When ringing of the ears is produced, the dose should be decreased. The latter may be given with Chlorate of Potash. Dissolve four drams of Chlorate of Potash in four ounces of boiling water, add three and a half ounces of simple syrup, and half an ounce of Tincture of Chloride of Iron. Dose : A tablespoonful three times a day. If the case does not improve, Iron and Arsenic may be given instead of Iron and Chlorate of Potash. Take of Citrate of Iron and Ammonia two drams, Fowler's Solution eighty minims, simple syrup one ounce, Anise water sufficient to make eight ounces. Dose : A dessertspoonful three times a day. A tenth of a grain of the Sulphide of Calcicum given hourly, is claimed to prevent the recurring crops of boils. Sometimes a trip into the country is necessary for their cure. HOMCEOPATHIC TREATMENT. These sores yield readily to internal treatment and without pain, while the treatment with drawing salves is often distressingly painful. No external application need be used, but as soon as the parts begin to look red and cause pain, we give Arnica every two to four hours. If the swelling still increases and a small spot of pus has already made its appearance, give Arnica and Hepar Sul. in alternation every two to four hours. If the tumor has been allowed to go on so long that pus has formed deep in, the sore has become very painful and still does not discharge, but fluctuates on sudden pressure, an incision may be made with a lancet, after which the pain will cease and the pus run out. Poultices of bread and milk or kindred substances should not be applied too soon, lest the natural development of the tumor should be interfered with. This is the reason why many persons are afflicted with fresh boils, every six to eight weeks ; the acrid matter is not permitted to be fully expelled from the organism. Pork and fat food must be avoided by those who are the subjects of such sores. A single small dose of Sulphur, allowed to act for months, will entirely eradicate the tendency to boils. CARBUNCLE. ANTHRAX— FERUNCULUS MALIGNANS— PUSTULA NIGRA. Diagnosis. A livid, bluish, or black spot upon an extended surface, extremely painful, readily running to gangrene, and proving fatal, occa- sionally from the extension of mortification. The disease is attended by headache, thirst, foul tongue, sickness, loathing of food, languor, jactita- tion, (trembling) and sleeplessness. ALLOPATHIC TREATMENT. Carbuncles should be early cut through to their base by a crucical (+) incision and dressed with a Flaxseed Meal poultice or the mixture of Carbolic Acid one part, and Glycerine two parts. After the slough comes away, the ulcer may be washed with a solution of Carbolic Acid one dram in five ounces of water, or oiled with Olive Oil or Glycerine, containing tw*elve drops of Carbolic Acid to the ounce. The internal treatment is the same as recommended for boils. The diet should be plain and nutritious, as lean meat, milk, eggs, and simple starchy articles of food. 496 DISEASES OF THE SKIN. HOMCEOPATHIC TREATMENT. The best remedies in this affection* are in the order of their names : Ars., Silicea, Mercurius. Arsenicum is, by all means, the most efficacious remedy, and the more especially so if gangrene is approaching or has appeared. Silicea, When administered in the beginning, in simple carbuncle is frequently found sufficient to effect a perfect cure. Mercurius. Pain, worse at night, attended with copious sweats which give no relief. If the strength is greatly reduced by the loss of blood, etc., China, three doses a day for a week, will greatly assist nature. FAVUS. HOXEY-COMB TETTER, SCALD-HEAD. This cutaneous affection is characterized by the accumulation of mul- titudes of fungi around the roots of the hairs, hence their exclusive appear- ance on the hairy portions of the skin. Favus is a disease of the lower classes. It only attacks individuals who pay no sort of attention to cleanliness. In other respects such indi- viduals may enjoy either the most perfect health, or else be of sickly and cachectic constitutions ; favus may attack either sex. This exanthem can be transferred to other persons by hats, caps and other head gear, likewise by sleeping in the same bed ; it has likewise been transmitted purposely from one individual to another. A single favus-efflorescence has its origin in the orifice of a small gland in the form of a small, imbedded, not painful papule, which is per- forated by the hair, and keeps constantly increasing in breadth and hight, until the characteristic crust finally arises from it. This crust has the shape of a dish, with a rounded central depression and round elevated borders ; it has a yellowish or. gray tint, without any exudation under- neath, and has a peculiar odor. The consequences of favus are partial atrophy of the skin in consequence of the crusts being imbedded in it ; eczema occasioned by the scratching ; destruction of the hair on the affected parts ; on the other hand, this dis- order has no influence upon the general state of the constitution. The disease runs a very chronic course, yet spontaneous cures occur, although very tardily and not without corresponding modifications in the hygienic circumstances of the patients. According to what we have stated concerning the history of the dis- ease, we deem an internal treatment of it useless and ineffectual. This can only be cured by removing the crusts in which the fungi are imbed- ded, and by preventing their return. The surests means of accomplish- ing this result, is care and cleanliness. The removal of the crusts is secured by softening them with oil, and afterwards removing them, together with the perforating hair. This is a very tedious but sure under- taking. Every sickly-looking hair has to be pulled out singly, for the reason that the disease has already invaded the soil in which it grows. Dr. Hole, of Chicago, says this ^eruption is treated with success in some cases by means of Iris-versicolor ; a cerate is applied to the scalp, and a few drops of the Tincture, even as many as twenty, in half a tum- blerful of water, given internally, in teaspoonful doses, three or four times, a day. HONEY-TETTER— SCALD HEAD. 497 ALLOPATHIC TREATMENT. In this disease (scald-head— favus) as in ringworm and tinea-tonsurans and barber's itch, the object of treat- ment is to destroy the parasitic plant occasioning the disease. The crusts may be got rid of by poultices or preferably, by constantly applying a mixture of equal parts of Sulphurous Acid and Glycerine. A piece of lint may be saturated with the mixture, laid over the part and then covered with oiled muslin. This same mixture may complete the cure, or a solu- tion of Corrosive Sublimate, five to ten grains to the ounce may be used. The hair must be pulled out in the affected part and for a little space around it. The cure is now easy, but without which is almost impossible. The food should be good. Two to five grains of the Soluble Citrate of Iron or the Citrate of Iron and Quinine may be given three times a day. After the cure is complete the occasional application of the Oleate of Mer- cury should be made or a hair pomade used, with which has been mixed five grains of Corrosive Sublimate to the ounce: Take of Corrosive Subli- mate, five grains, Simple Ointment an ounce, Otto of Roses three or four drops. Mix, and use as a hair pomade. HOME TREATMENT. Take of good wood Soot, Saltpetre, and Sul- phur, each one teaspoonful, Lard two tablespoonfuls ; mix together and form an ointment. Apply to the head every night and morning, first washing with Castile Soapsuds. Another ointment to be made in the following manner is, also, bene- ficial: Take a handful each of Jimson Weed leaves, Yellow Dockroot, and Mullen leaves, Lard half a pound, boil together until the leaves are crisp; squeeze, strain out the Lard, and then add six ounces of Tar. To be applied as an ointment to the head. ITCH— SCABIES. This contagious, inflammatory affection of the skin is characterized by an eruption of pointed vesicles, transparent at the summit, and filled with a viscid and serous fluid, in which lives a very small insect. These are subsequently mixed with, or terminate in, pustules. With the excep- tion of the face, they appear in every part of the body, but much more frequently and abundantly about the wrists, between the fingers, and at the bend of the joints, etc., and are accompanied by incessant and almost insuperable itching, without fever. There are several varieties of the disorder, but it is often very difficult to distinguish their characteristic differences. External Treatment. The local application of Sulphur, either in the form of lotion or ointment, should be used. The above method of treatment, combined with the free and frequent use of soap and water, undoubtedly suffices, in mild and recent cases, to remove this troublesome affection ; but as in those of longer standing, it may be found inadequate to destroy the mites which have now been clearly demonstrated to be the cause (not the result) of the disease, the following course of treatment should be adopted, and will usually succeed in accomplishing a speedy and permanent cure: Let the patient be placed in a hot bath, and the hands, wrists, and other affected parts be well rubbed with fine sand (or a sand ball,) for the purpose of tearing open the 32 498 DISEASES OF THE SKIN, passages and cells where the vermin have burrowed and located them- selves. In persons of tender or delicate skins, brisk rubbing with a coarse towel, after the bath, may be sufficient to effect the required object; but the use of fine sand, or pounded chalk, is to be preferred. When the patient has been dried, all affected parts should then be well rubbed with a lotion made of Olive or Almond Oil and a few drops of some essential oil, thus: To two tablespoonf uls of Almond Oil add twenty drops of the Oil of Sassafras. The rubbing in, and, if needful, in inveterate cases, the hot bath and frictions, should be repeated every three days for a fortnight or so, or until the cure is complete. When, as is sometimes the case in certain habits, boils are associated with itch, and continue to break out for some time after the removal of the latter, the remedies prescribed in the article on Boils should be had recourse to. The sudden suppression, by external means, of some of the eruptions which have been mistaken for, or occasionally follow, or have been devel- oped during the existence of inveterate itch, has, undoubtedly, as not unfre- quently happens in other chronic eruptions, been repeatedly attended with serious consequences. ALLOPATHIC TREATMENT. The remedy for scabies, itch, is Sul- phur, upon going to bed. The body should be rubbed well with Soft Soap and a little warm water, for fifteen or twenty minutes, then a warm bath for thirty minutes or more, then an Ointment Compound of two parts Sul- phur, one part Carbonate of Potash, and twelve parts Lard, should be thor oughly rubbed over the whole body, especially to the affected parts. The patient may bathe the next morning. This treatment should be repeated for three separate nights. A solution of Sulphate of Copper— one ounce to the pint — may be used after the bathing, instead of the Sulphur Ointment. Clothes should be exposed to the fumes of burning Sulphur (Sulphurous Acid Gas). ABSCESS-PSO US-PSOITIS. (Lat. Abscedere, to separate,) a collection of pus in a circumscribed cavity. The causes of abscess are often involved in obscurity, excessive exer- tions, a cold, rheumatism, mechanical injuries, caries of the bones, may be mentioned as probable causes. The name is given to collections of pus in some of the naturally existing cavities of the body. Of these we do not propose to treat in this article. An abscess may be acute or chronic, according to the character of the inflammation which produces it. The formation of an acute abscess is ushered in by a sudden, or else rapidly-increasing violent pain, which it is difficult to define. It often radiates upwards or downwards, and soon produces a stiffness which materially interferes with the natural motions of the adjacent parts, the pain is generally, not always, of a throbbing character, and soon shows redness of the surface, if not too deeply seated; swelling and violent fever is mostly present, attended with increase in the pulse very marked. Pus forms rapidly, and is often so profuse in quantity ABSCESS. 499 as to indicate its first appearance by a succession of chills, distinct or sud- denly following each other, called creeping chills, known by the sensation of " little chills playing tag up the patient's back." The f ully-formed abscess can be reabsorbed, which is, however, rarely the case. When the pus has formed in considerable quantity near the surface, its presence may be readily discovered by the feeling of "fluctuation" produced by placing the fingers of one hand on one side of the swelling, and with those of the other, giving a smart tap on the opposite side. If the cavity formed, and contaning the pus is very deeply seated, it often baffles the skilly of the most experienced surgeon to determine its presence and exact location. The pus usually tends towards the surface, which it reaches by a gradual thinning of the intervening tissues; but if these be very resisting, it may travel in other directions, possibly to break into some of the natural cav- ities, lungs, or abdominal cavity, when it will be likely to result in death. It is in these cases that an early incision by the surgeon is especially called for before "pointing" has taken place. In chronic abscess the pain, redness, fever, and increased temperatures of the parts may be absent, and for this reason, it is also commonly known as cold abscess. In most cases, its progress is slow, and it may remain for a long time without any increase in size, or any tendency to open through the skin. Usually it is necessary to open it ; this may be done by simply cutting directly Into the cavity. Treatment is not surgical, except so far as the necessary slight amount of cutting into the cavity. In the first place, we have to try to scatter the inflammation before the suppuration sets in, even if this can- not be accomplished in all cases, it is at all events certain that the spread of the inflammation may be prevented by appropriate treatment. The following is the best : ALLOPATHIC TREATMENT. Ulcers will be benefited by some of the following applications : Ten or twenty drops of Carbolic Acid in an ounce of Glycerine, sometimes half a dram to a dram of Tannin should be added ; a strong solution of Nitrate of Silver— forty grains to the ounce— or the solid Stick ; a solution of Sulphate of Copper, three to ten grains to the ounce ; Powdered Iodoform dusted over the ulcer, is an excellent appli- cation, as is pure Salicylic Acid. An Alum Curd (Alum dissolved in white of an egg) may be used, or if it prove ineffectual, the surface may be dusted with powdered burnt Alum. HOMCEOPATHIC TREATMENT. Bell., especially if the fever is accompanied by copious perspiration, and every motion aggravates the pain extremely. ItJius., should be given if the fever consists of a burning, dry heat with intense thirst, if the trouble seems to have originated in a cold, and the pains are worse at night, and when the patient is lying down, or at xest. If these two remedies do not effect an improvement, and the fever is mingled with chilly creepings, the pulse becomes very much accelerated- and the skin is at times very hot, and at other times drenched with perspir, ation, we should at once give Mercurius, which is the only remedy that •can at this stage arrest suppuration, if such a result can be accomplished at all. 500 DISEASES OF THE SKIN. If an abscess forms, we give Hepar Sulph., in order to promote the suppuration, for the main point now is to evacuate the pus as rapidly as pos- sible and by this means to heal the sore as soon as the pus is discharged. If the opening becomes fistulous, we must be prepared for a very tardy recovery. Sulphur is espcially suited for chronic abscess, and for a tendency to suppuration, depending on a scrofulous constitution, when the pains are stinging in their character, and the pus of a healthy color. WHITLOW OH FELONo Is so well known that no description is needed. As soon as it is sus- pected that one is beginning to appear on the finger, remove the kind of skin lining from the inside of an egg shell in as long a strip as you can and wrap tightly around the affected finger. This will, if used in time, stop the further progress of the disease, but is painful. If it has gone on until pus is already formed, the lance must be applied clear to, and a little way along the bone at the seat of pain, being careful that the knife does not cut across any muscle. After it is lanced apply poultices. Among the best of which is a linen pad, saturated with cold water, frequently removed and covered closely with a piece of oiled silk, bladder or similar substance. ALLOPATHIC TREATMENT. The earlier the periosteum (membrane covering the affected bone) is divided with the knife, the sooner will the patient have relief. Saving the bone depends on the promptness of this measure, and serious difficulty is prevented by early resorting to it. Subse- quently dressings are the same as for Carbuncles or Boils. CHILBLAINS, External Treatment Tincture of Arnica may, in many cases, be advantageously applied externally to the parts affected simultaneously with the internal exhibition of the same medicine, in repeated doses. Application: To five parts of water add one of'the concentrated Tinc- ture of Arnica, andbathethe parts freely with this lotion, three times a day. Tincture of Cantharides. In recent chilblains, induced by expo- sure to intense cold, this remedy may be applied externally with great success. It operates against the formation of vesicles or blisters, and aids in subduing the congestive action. Application : Add four drops of the tincture, to two tablespoonf uls of water, and bathe the parts with the lotion three times a day. Tincture of Causticum is to be preferred to either of the foregoing for broken chilblains of old standing, and for those cases in which the ulceration has eaten deeply into the flesh. Application : Add four drops of the Tincture to two tablespoonf uls of water, and apply the lotion as directed for Cantharides. ALLOPATHIC TREATMENT. Useful applications for chilblains are: Take of Carbolic Acid a dram, Simple Ointment (or Lard) two ounces. Mix for an ointment ; the surface may be painted with Tincture of Iodine. Equal parts of Turpentine and Chloroform will give relief. FROZEN LIMBS. CORNS. 501 FROZEN LIMBSo Application of Snow. In slight cases 01 "frozen fingers," or other limbs, or portions of the body, the well-known practice of applying snow to the affected parts, is beneficial. Camphor (Saturated Tincture). When Snow cannot be procured, this is a valuable substitute. For young children this is more particularly applicable, especially when the face is the seat of the injury. Application : To five parts of Spirits of Wine add one of the Tincture of Camphor, and bathe the parts with this lotion freely twice a day. Acidnm-nitricum is a most efficient remedy in severer cases, both for internal and external exhibition. Dose: Of a solution of six pills to the wine-glassful of water, give a teaspoonf ul every three hours. Acidum-niiricum (externally — second dilution). This remedy may simultaneously with its internal administration be applied externally. Application : Add four drops of the Tincture, at the second dilution, to two tablespoonf uls of water, and bathe the parts with this lotion three times a day. If convenient, it were preferable to saturate a piece of linen rag with the lotion, and to apply it to the frost-bitten part, covering the whole over with oiled silk. Diet and Regimen, Plain, wholesome, nutritious, but unstimulat- ing diet; a sufficiency of active exercise in the open air; free ventilation; frequent change of linen; the free use of cold water COR^So That these troublesome excresences not unfrequently arise from an inherent vice of constitution, is evident, from the fact of many individu- als who wear tight boots and shoes (unquestionably the principal exciting cause) escaping them, while others, with every precaution, suffer severely; such being the case, the main object must be, by a course of properly-se- lected internal remedies, to eradicate the predisposing cause or condition. After removing the corn, which has been destroyed by the application of Acetic Acid, the place where it was situated, must be relieved from pressure. For this purpose corn plasters of variows sizes, having holes in the center, may be obtained or made from the soft felt of an old hat Palliative Treatment. Great alleviation of suffering has been found to result from bathing the feet in warm water, and from subse- quently resorting to the following application; Tincture of Arnica. A lotion composed of a weak solution should be applied to the corn, after it has been previously soaked in warm water, after being pared down with great care. The skillful reduction of the corn by an experienced operator, may likewise be mentioned as a ready and prompt palliative treatment- Equal parts of Spirits of Ammonia and lemon juice applied twice daily, after thoroughly soaking the feet in warm water, is excellent P A. R, T T W E L, F T H. CONSTITUTIONAL DISEASES. CHAPTER XXVII. ACUTE CONTAGIOUS DISEASES. MEASLES— MORB ILL Measles attack individuals of every age and sex, but least frequently very old people and infants. Inasmuch as almost everybody has an attack of measles in his early youth, they are on this account seldom met witlr among old people. One attack of measles generally protects persons against a second one ; exceptions, however, are not very rare, although it behooves us to guard against mistaking roseola for measles. The ordinary season for measles are the months when catarrhs are common, from October till April. Symptoms and Course. The incubation- period of the measle-con~ tagium, until the efflorescences break out upon the skin, is eleven or at most twelve days. The general health does not seem in the least dis- turbed in the first eight to nine days of this period ; definite preliminary symptoms show themselves in the last two or three days- These prelimi- nary signs are falsely said to have been noticed at an earlier period ; but as catarrhal affections are very prevalent during epidemic measles, it is very likely that purely catarrhal symptoms have been mistaken for the prodromi (premonitory symptoms) of measles. The prodromi proper begin with a slight catarrh of the nose, lassitude and some fever. This fever increases considerably on the second day, frontal headache super- venes, the eyes look red, are sensitive to the light, but the conjunctiva is seldom puffed up. On the third day there is another increase of fever,, the patients feel unable to sit up, the tongue is thickly coated, the appe- tite gone, and in the night from the third to fourth day, immediately previous to the appearance of the exanthem, a hoarse, barking cough sets in resembling croup, which, however, is scarcely ever attended with the danger that generally characterizes croup and never changes to true croup. These symptoms may increase to a considerable degree of intensity, may be associated with vomiting, delirium, sopor; at times however, they are entirely wanting, or so slight that it is not deemed 502 MEASLES. 503 necessary to confine children to the room. This is the reason why the measles spread so rapidly through the schools, for it is on the day previ- ous to the breaking out of the measles that the infectious principle is most active, and that the measles are most easily communicated. We account for this circumstance by the fact that in the last twenty- four to twelve hours previous to the appearance of the exanthem upon the skin, distinct, lentil-sized measle-spots are perceived, in almost every case, on i;he sides of the fauces. Without doubt, it is the extension of these spots to the larynx and trachea that causes the peculiar croupy cough, and we have always considered it an excellent diagnostic sign to find this cough associated with red spots on the palate, in which case we were able to positively predict the appearance of the eruption within twenty-four hours. In other respects, the prodromi have no distinctive peculiarity from which the character of the exanthem might be inferred; it can, at most, only be suspected after several cases had already occurred in the place, or in its immediate vicinity. The measle-exanthem breaks out gradually, in one case more rapidly than another. The first spots always show themselves in the face, most commonly on the cheeks and temples. They are of the same size, of a bright redness and with rather sharp outlines ; after being out for a short time, they become somewhat raised above the skin and harder. With more or less speed, generally within twenty-four to thirty-six hours, the exan- them comes out over the whole body from above downwards, and is fully out in forty-eight to sixty hours, so that no new spots appear; up to that time, new spots had continued to break out in addition to the first spots that were more or less scattered and isolated. The spots keep growing in size to such an extent that some of them run together, and the nor- mal skin, in the place of spots, exhibits here and there irregular red patches. In proportion as the exanthem comes out more profusely, its color gen- erally grows darker, sometimes with a bluish tint. With the fuller devel- opment of the eruption the constitutional symptoms most commonly increase in intensity. The catarrh of the conjunctiva and the cough, espe- cially, grow much worse. The pulse sometimes increases to one hundred and forty beats. Sometimes the skin is dry, but at other times covered with perspiration. In very rare cases the constitutional equilibrium remains undisturbed, even during the eruptive stage; however, in every considerable epidemic a child with measles is occasionally seen running about the streets. If the exanthem runs a mild course, its decrease commences at the end of the third day, seldom before this time, and continues with great rapidity until the eruption has entirely disappeared. The spots grow smaller, assume a distinctly yellowish tint, which is especially marked on pressure with the finger, and within twelve to twenty-four hours the spots have completed their disappearance without leaving a vestige of their existence. Very frequently, however, the yellowish tint remains for several days. The fever declines very speedily, but the bronchial catarrh most generally con- tinues for a few days longer, and resolution sometimes does not take place until a considerable quantity of mucus has formed. Not unfrequently the patient is at this period attacked with diarrhoea for one or two days. Pro- 504 ACUTE CONTAGIOUS DISEASES. fuse perspiration is not the rule, but is not by any means an unusual occurence. Desquamation (peeling off) commonly commences on the seventh day, but may delay until the fourteenth. The skin comes off in bran-shaped scales, very seldom in larger patches; in the face and on the extremities the desquamation is most distinct. During this period, the general health is generally good ; except that the bronchial catarrh and still less frequently the diarrhoea may continue to some extent. Among the malignant deviations we name the following: The spots when first coming out, are of a pale-red color, which do not increase in intensity, nor do they acquire the yellowish tint. Within the spots hemorrhagic appearances are manifested, and between the spots ecchymoses are noticed . The spots fade away soon after their appearance, or else they fade very suddenly at the regular period or before. In the case of children the pulse exceeds one hundred and forty beats, and in the case of adults one hundred and twenty beats; moreover it is a small pulse. The tongue is dry. Angina tonsillaris. Diaphoretic mem- branes form in the buccal cavity. The respiration becomes hurried and superficial. Sopor and delirium after the second day of the eruption. Of great importance are certain complications of measles, that are very apt to occur and which were formerly regarded as metastases, because the exanthem disappears with the appearance of these complications. Laryngitis with croupous exudation is of rare occurrence while the exan- them is still out; it is more commonly met with after the exanthem has left the skin. A slight bronchitis is an accompaniment of every case of measles ; it only assumes a dangerous character, if it continues beyond the stage of decline, or reappears again during the stage of desquamation, or otherwise assumes a very acute form. It is very apt to run into an exceedingly obstinate chronic catarrh. Enteritis (inflammation of the bowels) is a rather frequent complica- tion in some epidemics; it excites legitimate apprehensions, for the reason that other consecutive diseases, more particularly scrofulosis, are apt to follow in its train. Affections of the brain are rare; their intensity is rarely such as to excite apprehensions ; the supervention of sopor is a bad sign, because it may usher in a fatal general paralysis. Of the highest importance are likewise the numerous and always obstinate sequelae (results of the disease) of the measles, which make this exanthem one of the most malignant, whereas, its ordinary normal course and character entitle it to be regarded as one of the most harmless. Among these sequelae we distinguish : Chronic conjunctivitis (inflammation of the eyes,) with impaired vis- ion; chronic ostitis, with deafness ; chronic ozsena; chronic inflammation of the lymphatic glands, mostly without suppuration ; chronic inflam- mation of the parotid and submaxillary glands. Chronic bronchial catarrh, which gives rise to a peculiar spasmodic cough; or real whooping-cough, which is much more severe as a sequela? of measles than when setting in at other periods, and which very often developes a most dangerous pneumonia. After measles, children are very frequently attacked with scrofulous symptoms. It is very likely that, in the case of little children, the mea- MEASLES. 505 sles simply act as an exciting cause of scrofulosis ; but it is likewise among larger children that, after an attack of measles, all sorts of phenomena make their appearance, which we are in the habit of designating as scrof- ulous, and wmich go to show that a morbid change has been impressed upon the whole activity of the organism. Tuberculosis (consumption,) likewise, frequently breaks out after measles. ALLOPATHIC TREATMENT. In mild cases of uncomplicated measles the treatment will consist of good hygiene, and the relief of such symp- toms as annoy or give trouble. The patient should be in a large, well-ventilated, but somewhat dark- ened room, with a temperature which will be comfortable for attendants to sit in— sixty-eight or seventy degrees— and should be uniform day and night. Such a temperature is comfortable, and in it there is no danger of taking cold from temporary or accidental uncovering of the patient. The diet should be light and simple, consisting of milk, or milk and water, raw eggs beaten up with sugar and water, gruel, toast, and such other farinaceous articles as the patient desires. Any simple drinks, cold water, lemon, or orangeade, gum, barley, or ricewater, flaxseed tea, etc., may be allowed as freely as desired. Emetics and cathartics are not to be given, but if the bowels have not moved for a couple of days, an injection of warm water or a laxative dose of Castor Oil (a dessertspoonful,) or Citrate of Magnesia (a teaspoonful to a dessertspoonful for older children,) should be given. The injection is to be preferred, on account of the irritable state of the bowels. Remedies are indicated for the relief of the bronchitis and cough, or restlessness. Opium and Hyoscyamus are best suited for this. From five to ten grains of Dover's Powder, w r ith half a grain of the solid Extract of Hyoscyamus, or fifteen to twenty drops of Laudanum, with an equal quantity of Fluid Extract of Hyoscyamus, may be given from two to six times in the twenty- four hours. For children, opiates may be given as directed for Bronchitis or Pneumonia. Owing to the danger from severe bronchitis or pneumonia, it is best, in severe cases, to have an oiled mus- lin jacket worn over a flannel shirt. A malignant form of the disease will require tonics and stimulants. Of these, Quinine may be given in doses of half a grain to three grains, three to six .times a day. If the pulse is weak, Carbonate of Ammonia in doses of one to ten grains, in half a teaspoonful to a tablespoonful of Spir- its Menderus, two to six hours apart. Brandy is similarly indicated, and should be given in liquid food, in doses of half a teaspoonful to a table- spoonful, or more, according to the age of the patient and severity of the symptoms of prostration, and maybe given from three or four times a day to hourly. For high fever, with a strong, bounding pulse, no remedy acts better than Aconite. A drop of the Tincture can be given, to an adult, every hour until an impression is made on the fever, and then at longer inter- vals, to maintain the effect. When the eruption is especially irritating, much relief will be afforded by oiling the skin as in scarlet fever. Complications of any kind should be treated as directed for the special diseases, bearing in mind that supporting treatment only is appropriate 506 ACUTE CONTAGIOUS DISEASES. for serious complications. The precautions directed by the New York Board of Health, against the spread of scarlet fever and measles, should be observed. An unusually high fever, when there is no sweating, will be benefited by a cool sponge bath or wet pack. Sleeplessness, which is not relieved by the Opium or Opium and Hyoscyamus given for cough, may be relieved by giving to an adult twenty grains each of Chloral Hydrate and Bromide of Potassium in syrup and water in one dose at bed time. A prostrated condition of the system follows some cases of measles, particularly in adults, which favors the development of any diathesis (tendency to disease) which may exist in the patient. Consumption is the most frequent exposure, and exertion should be avoided for some time after recovery from measles. The debilitated system should be built up by tonics of Quinine and Iron, with such hearty food as the patient will take. The Citrate of Iron and Quinine, given in doses of half a grain to a grain to a child, or three grains to an adult, dissolved in Syrup of Orange or Orange Flower Water, three times a day, is as suit- able as any tonic. Other tonics, embracing the same principles, may be given. The Health Board of New York enforce the following Sanitary Regu- lations against Scarlet Fever and Measles : "Cake of Patients. The patient should be placed in a separate room, and no person except the physician, nurse, or mother, allowed to enter the room, or to touch the bedding or clothing used in the sick room, until they have been thoroughly disinfected. "Infected Articles. All clothing, bedding, or other articles not absolutely necessary for the use of the patient, should be removed from the sick room. Articles used about the patient, such as sheets, pillow cases, blankets, or clothes, must not be removed from the sick room until they have been disinfected, by placing them in a tub with the following disinfecting fluid : eight ounces of Sulphate of Zinc, one ounce of Carbolic Acid, three gallons of water. "They should be soaked in this fluid for at least one hour, and then placed in boiling water for washing. "A piece of muslin one foot square, should be dipped in the same solution and suspended in the sick room constantly, and the same should be done in the hall way adjoining the sick room. "Feather beds and pillows, hair pillows and mattresses, and flannels or woolen goods, requiring fumigation, should not be removed from the sick room until this has been done. Whenever the patient is removed from the sick room, inform the Bureau of Sanitary Inspection, when the disinfecting corps will, as soon as possible thereafter, perform the work of fumigation. "All vessels used for receiving the discharges of patients, should have some of the same disinfecting fluid constantly therein, and : ; mined iately after use by the patient, be emptied and cleansed with boiling water. Water closets and privies should, also, be disinfected, daily, with the same fluid, or a solution of Chloride of Iron, one pound to the gallon of water, adding one or two ounces of Carbolic Acid. MEASLES. 507 "All straw beds should be burned, but must not be removed from the sick room without a permit from this department. They will be removed by the disinfecting corps. 11 It is advised not to use handkerchiefs about the patient, but rather soft rags for cleansing the nostrils and mouth, which should be immedi- ately thereafter burned. "The ceilings and sidewalls of the sick room, after removal of the patient, should be thoroughly cleansed, and lime-washed, and the wood- work and floor thoroughly scrubbed with soap and water. "As a fumigating, antiseptic, and disinfectant, Chlorine Gas stands, unrivaled. The ingredients used in its production should be in glass or earthen deep dishes or saucers placed in the higher parts of the room. The Gas will descend, being heavier than the air, and become mixed with surrounding air. The following articles are used for its production: One part of common Salt mixed with one part Black Oxide of Manganese, and placed in shallow earthen vessles ; two parts Sulphuric Acid previ- ous y diluted with two parts by measure of water, is then to be poured over it and the whole stirred with a stick. The room with the infected articles should be then shut up tightly, and remain closed for several days. The cleaning, scrubbing, and white washing can then follow/' HOMXEOPATHIC TREATMENT. Aconite, which is particularly indi- cated when the fever assumes an inflammatory form, attended with dry heat of the skin, heat in the head, with confusion and giddiness, redness of the eyes, intolerance of light, general weakness or prostration; when- ever marked febrile or inflammatory action becomes prominent. Dose: Six pills every two to four hours, in water. Pulsatilla is also very efficacious in this affection, and is frequently indicated in the commencement, by the striking predominance of the characteristic catarrhal symptoms attendant upon measles, further quali- fied by aggravation towards evening. This remedy is of great utility in bringing out the eruption, when it is longer than the average period in making its appearance. Pulsatilla is also valuable when any derangment of the stomach is present, or when the cough, which so generally accom- panies the disease, is worse towards evening or in the night, and is atten- ded with considerable rattling of phlegm in the chest, or copious, thick, yel- lowish or whitish expectoration, sometimes followed by vomiting or symptoms of approaching suffocation; further, when there is cold in the head with a thick, yellowish or greenish nasal discharge. Dose : Six pills every four hours, in water. Bryonia is an excellent remedy, when the eruption is faint, retarded or imperfectly developed, and the respiration much repressed and laborious attended with achings in the limbs; also, when there is a dry cough and the patient complains of shooting pains in the chest, increased by a full inspiration. Dose : As for Pulsatilla. Sulphur is, in general, highly beneficial after the active symptoms of the disease have yielded to the action of immediate treatment, and espe- cially after the previous administration of Pulsatilla, particularly when we have reason to suspect a scrofulous or other constitutional taint. Sul- •508 ACUTE CONTAGIOUS DISEASES. phur will, frequently, in such cases, be most effective m eradicating the predisposition to chronic affections engendered by measles. Dose ■ Six pills in a tablespoonful of water, every morning (fasting) for ten days. Check of the Eruption. The disease has frequently terminated fatally, from the eruption being driven in by sudden exposure to cold or change of temperature. Bryonia is generally found efficacious in re-evolving the eruption, and preventing disastrous consequences. Dose : As directed above. Pulsatilla is indicated, if looseness of the bowels, with mucous dis- charge, follow the supression. Dose: As directed for Bryonia. AFTER EFFECTS OF MEASLES — COUGHS. In general, the treatment of such affections will be most effectually conducted by following the instructions furnished separately in the arti- cle on "Coughs." Looseness of the Bowels. Explicit directions on this subject will be found in the article on "Diarrhoea." Inflammation of or Discharge from the Ears. (See page 182.) Tenderness of the Skin. Mercurius. This remedy, administered for a brief time, is generally sufficient to remove the tenderness which is so peculiarly apt to result from measles. Eruptions on the Skin. Niwc-vomica is indicated, in cases of this kind resulting from measles, by the presence of an eruption of minute white grain-like elevations. Dose : Six pills every evening for a week. HOME TREATMENT. Measles in their uncomplicated form gener- ally require but little, if any. medical treatment. The patient should be placed in a large well ventilated room, and it is better that he should remain in bed, and should have all the cold water which he desires. The diet should be light, such as wheat or rice flour gruel, toast water, milk and water, tapioca, sago, or other light food. He may be allowed a more liberal diet, as the fever subsides. The eyes should be excluded from the light. If the eruption be long in coming out, or recedes after it has appeared, apply mustard poultices over the abdo- men, to the feet, ankles and wrists: and if there are symptoms of inflam- mation of the lungs, apply a mustard poultice over the whole chest, which may be removed as soon as decided redness bas been produced. SCARLET FEVER— SCARLATIXA. This is distinguished from other eruptive fevers by the fact of the eruption being an exanthema, an efflorescence, or a rash; these terms not being strictly applicable to vesicles and pustules. Scarlet fever is highly contagious, and it may be communicated by means of fomites (producers of contagious disease). The infectious material remains for a long time in garments, bedding, carpets, wall-paper, etc , preserving its power of producing the disease. It is, doubtless, occasionally transmitted SCARLET FEVER. 509' through the air at great distances: and, hence, sometimes breaks out spontaneously without any agency of affected individuals, or clothes of any kind. It is difficult to determine the duration of the period from the time of exposure to the contagious principle to the full development of the first well-marked symptoms. Austin Flint, and other recognized authorities, argue that twenty-four hours, often, is the extent; but eight days is generally allowed to be the period in a vast majority of cases. As a rule, the disease is experienced but once; but exceptions are not very rare ; the author has known of a case where the same individual has been attacked four times. The contagion is most freely active soon after the appearance of the exanthem. As soon as the fever has subsided, the con- tagious nature of the disease has, most probably, become extinct. Chil- dren are much more susceptible to the special cause than adults. After forty years, very few persons are attacked; also children, under two years, rarely contract the disease, and many persons appear to be entirely free through life, notwithstanding numerous exposures. The largest number, and most malignant cases occur between the second and seventh year ; a much smaller number between the eighth and twenty-fifth year; from twenty-five to forty it is very rare. Scarlatina very often occurs in a neighborhood, either in company with or immediately after, epidemic measles. It also, not unfrequently occurs in company with small-pox. Symptoms and Course. The disease is variable, both in its symp- toms and course, and we will now endeavor to point out the fixed types of scarlet fever: The patients exhibit the symptoms of a severe cold (catarrhal fever,) which unlike measles, is not often attended with a cough, but with inflammation of the throat, and loss of appetite and generally, occasional vomiting; the pulse is very rapid; the skin seldom moist. After the preliminary stage has lasted two days, the exanthem makes its appearance, generally with a marked increase of the fever, and other preliminary symptoms. Children are attacked with convulsions at this stage more frequently than at any other. The eruption is first visi- ble in the throat, on the tonsils, etc.; externally, on the neck, whence it spreads downwards over the rest of the body. First, we notice closely- crowded red spots (stigmata,) these very speedily run into each other, causing a homogenous, faintly-dotted redness, or else they grow in size, and running together form single spots of a darker color, seated upon a faintly-red skin ; or, finally, small vesicles spring up upon the red surface most generally in consequence of the intense character of the skin affec- tion. The exanthem is, in cases running a natural course, generally fully out in twenty-four hours after the first external appearance; during all this time the fever has continued as high, or even more intense, than before ; the thirst great, the tongue coated, or, cleared of its coat, showing a dark strawberry appearance. One of the most constant of the symptoms of this fever is this strawberry tongue. The urinary secretion is much less; sometimes a little cough makes its appearance now, but rarely assumes a violent form. The throat is very sore, dark red, and swollen ; the surface of the body is also swollen. On the fifth or sixth day after the appearance of the eruption, it begins to pale off, with lessening, of the fever and much more so the sore throat {angina). 510 ACUTE CONTAGIOUS DISEASES. Soon after this, the process of desquamation (peeling off,) begins. It always begins on the neck with small scales; on the body, and more par- ticularly on the hands, the skin peels off in large patches ; the itching is now severe, and may be allayed by rubbing the itching parts with some pure clean oil ; the appetite now speedily returns and the patient feels quite well ; in fourteen days at the latest the desquamation is completed. Such is a plain case, and unless some important variation takes place frequent sponging of the whole body, cooling drinks and pure air, are all the remedies needed. But variations are so frequent that too much watch- fulness is impossible. As soon as a change takes place in any symptom, study, at once, its meaning, and if not fully satisfied as to the result being favorable, call aid without delay. ALLOPATHIC TREATMENT. Kigid isolation should be provided in all cases of scarlet fever, as a precaution against its spreading. They must be watched most carefully in every instance, for some of the most danger- ous complications (co-existing diseases) and sequelae (resulting diseases) occur in those cases, which, from their very mild character, have been left almost, if not entirely to themselves. Competent medical aid should in all cases be called upon the first appearance of a serious symptom, or one that is not well understood or certain to result favorably. Mild cases of scarlet fever do not call for active measures of treatment, but whether the disease is mild or severe, the strictest attention should be paid to hygiene (health rules). To this alone mild cases can be safely trusted. The room ought to be large and freely ventilated. The temper- ature of the room should be carefully kept at seventy degrees, except when the fever is extremely high, it may be as low as sixty-five degrees. The clothing on the bed should not be heavy enough to increase the heat of the body or to be disagreeable to the patient, nor light enough to cause chil- liness. The body linen and the bed linen must be changed every day. After the fever has begun to decline and the heat of the skin greatly diminished during the latter part of the disease, the heat of the room should not fall below seventy degrees day or night. If the child is pale, weak, and chilly the temperature of the room should be kept as high as seventy-two degrees. Chilliness and taking cold must, in all cases, be avoided after the fever has begun to decline and the scarf-skin shed off (desquamation) on account of the liability of causing inflammation of the kidneys and dropsy, the most dangerous complications and sequelae we have to contend with. The patient should be kept in bed until the desquamation entirely ceases, nor should he be allowed to leave the house within four weeks. At first light food only should be given, such as milk and its prepar- ations, meat broths, egg beaten up with sugar and water, given raw. arrowroot prepared with milk and water, and gruels, but nothing more substantial should be given during the earlier stages of the disease. Cold water, lemonade, and juice of fruits may be freely allowed. As the fever declines and the patient recovers, the regular diet should be gradually resumed. If, however, there is great weakness or the case has run some time beef essence, juice of meats, egg beat up with sugar and milk should be given frequently and in such quantities as the child can be induced to take. Small quantities of wine, wine whey, milk punch or egg-nog SCARLET FEVER. 511 should also be given. A teaspoonful of whisky or brandy and two or three tablespoon fills of sherry wine, is a dose for a child one to three years old. One or two tablespoonfuls of whisky or brandy and a wineglassful of wine is a dose for an adult (grown person). In general a tepid bath should be given twice a day, the temperature of which should be ninety degrees, if the fever is moderate, or eighty degrees if very high. The patient is undressed and immersed in the water for fifteen minutes or half an hour, until the heat of the body is reduced and the patient quieted. If the bath is not practicable, frequent sponging of the whole body, with tepid or cool water, as the fever is mod- erate or high, every two, three or four hours, or the application of the wet sheet — wet pack — once a day, should be practiced. In the applications of the wet sheet, the sheet should be wrung out of cool water of sixty or seventy degrees, according to the degree of fever, and the patient, stripped of all clothing, is enveloped in the sheet and then surrounded with several blankets. Usually after remaining in the pack for about an hour, free sweating takes place. The pack is then removed, the patient wiped dry and placed in bed. When the heat of the body is one hundred and four degrees, or higher, the cold tost pack should always be used, and will render most signal service. If not as high, frequent sponging is pre- ferable in domestic practice. In no case should the bath with water, in any form, be given when the patient is sweating, or the skin moist. When the body is wiped dry, after each bath, sponging, or pack, it should be well rubbed with oil, from head to foot, except the face and scalp. One of the best ointments for this purpose is the following: Take of Glycerine one dram, Rosewater Ointment one ounce. Mix. Only that part of the body which is being rubbed should be uncovered at a time, or the whole can be done under the bedclothes. Glycerine one part and Sweet Oil four parts is a good application, or pure Lard may be used alone for the purpose. This oiling of the body relieves the itching and burning of the skin, keeps it moist and soft, and is in a general way, ben- eficial, as is shown by the lowered temperature and pulse. It should be applied at least twice a day, even if a bath is not given as often, and con- tinued during the stage of disquamation. As a rule, cathartics should not be given, but constipation should be relieved by injections of warm water. For the sore throat, a solution of Chlorate of Potash one dram to the pint of water, of which the patient can drink at will, is probably all that is needed to be done in mild cases. This remedy is beneficial in a general way, as well as giving relief to the throat. If the glands are enlarged (hard lumps about the neck,) Tincture of Iodine may be applied with a camel's hair brush or feather. When the throat is severely inflamed, compresses wet with cold water should be applied to the sides of the neck. They should be changed often, to maintain a uniform degree of cold. Pounded ice may be applied to the sides of the neck, in little bags, if the inflammation of the throat is so violent and the fever high. The solution of Chlorate of Potash, kept cold, should be given often as a drink and a gargle, if the patient is old enough. Small lumps of ice may be held in the mouth, or icewater frequently swallowed. When the violence 512 ACUTE CONTAGIOUS DISEASES. of the inflammation has begun to decline, or the cold becomes disagree- able to the patient, or if suppuration (forming of pus or matter) begins, the cold should be displaced by warm applications; warm poultices kept on the neck by a light kerchief, or a flannel cloth wrung out of hot water and applied to the neck, well covered with cloths, to retain the heat. If the discharge accumulates in the throat and nose, it should be removed by a soft cloth swab or feather wetted in a solution of Alum, in green tea or sage tea, or Borax mixed with honey and water. When the discharge is of a fetid or suppurative (pus-like) character, the following application should be made to the throat, with a soft swab, three or four times a day : Take of Carbolic Acid twelve drops, Glycerine one ounce. Mix. If the nose is invaded with the inflammation, it should be carefully cleansed, and the same mixture carefully and thoroughly applied with a feather or camel's hair brush. When the secretion from the throat is profuse, Belladonna is indica- ted until the throat becomes dryer, the pupils dilated or the secretion diminishes. The Tincture of Belladonna is an appropriate form, and may be given in doses of one to five drops to a child, or fifteen to twenty drops to an adult, four to six hours apart. The medicine may be continued just sufficiently often to maintain a slight dryness of the throat. Quinine should be given through the whole course of the disease, from the beginning of high fever until recovery is well established, and the appetite good. The dose is from one to two grains for a child, three or four times in the twenty-four hours; and three to five grains for a grown person, at the same intervals. As soon as the desquamation (shedding off of scarf skin) begins, the Tincture of the Chloride of Iron should be given in five-drop doses to a child, and from fifteen to twenty drops to an adult, three times a day. It should be given well diluted in water. In malignant cases, in which the system is overspread by the disease, denoted by excessive frequency of the pulse, the chief reliance is on alco- holic stimulants, in the forms before mentioned, and they should be freely given. JJremia (urea, constituent of urine remaining in the blood) is the most serious result of diseased kidneys, and is indicated by prolonged convulsions, headache, disturbance of the sight, or insensibility, and should be promptly met by a cathartic dose of Epsom Salts — two table- spoonfuls for a grown person, and one to two tablespoonfuls for a child. Free sweating should be produced quickly, by the use of the warm wet pack, or better, by the hot-air bath, once or twice a day. The hot air-bath can be given by putting the patient, stripped of clothing, in a cane-seated chair, then wrap a large blanket around both the patient and the chair, from his neck to the floor, covering the whole in tightly, except the pa- tient's head ; then burn alcohol in a saucer under the chair until free sweating is produced. Hot flannels should be applied constantly to the loins. The physician should be promptly sent for upon the first appear- ance of any of these symptoms. He will probably give Elaterium for a cathartic. Dropsy will be treated by hot-air baths, or the hot w r et pack, once or twice a day. The bowels should be kept open by Rochelle Salts or Castor SCARLET FEVER. 513 Oil, in doses of a teaspoonful for a child, or a tablespoonful for an adult, repeated every six hours until the bowels open. The Quinine and Iron, before mentioned, should be given through this complication. The fol- lowing mixture, to act on the kidneys, is useful : Take of Acetate of Potash one dram {or half an ounce;) Tincture of Digi- talis one dram (or half an ounce ;) Syrup of Squills three drams (or an ounce and a half;) Water two ounces (or eight ounces). Mix. Dose : A teaspoonful every four hours to a child, or a tablespoonful to an adult. Use the smaller quantities in filling the formula for a child, and the larger for a grown person. In the absence of this mixture, the patient may drink quite freely of a decoction (tea) of Juniper Berries, or Water- melon Seeds. If discharge from the ear occurs, it should be frequently syringed with warm castile soapsuds, and the Carbolic Acid and Glycerine, before mentioned, applied. As a preventive of scarlet fever, Belladonna has some reputation. Take of Extract of Belladonna three grains, Alcohol one dram, Water half ounce. Mix. Dose: A drop morning and evening, for each year of the child's age. Clothing, and other articles, which have been exposed to the poison of scarlet fever can be cleansed by immersing them in boiling hot water, or exposing them to a heat of over two hundred degrees. All unnecessary articles of furniture or clothing should be removed from the room, before the scarlet fever patient occupies it. See also the sanitary rules of the New York, Board of Health, printed on pages 506 and 507. HOMEOPATHIC TREATMENT. In those cases in which the disease appears in its simple form, the skin presenting the characteristic hue t with a smooth and glossy surface, Belladonna is a specific remedy. Even in the severer forms of scarlet fever, when the throat is con- siderably affected, and high fever or congestive symptoms set in and which if not properly treated: or if they occur iii a bad habit of body, may assume the malignant type, attended with ulcerated sore throat, extension of the inflammation to the air-passages, delirium, spasm, etc., Bell, is a very valuable remedy. It should be given as soon as the throat and tongue become affected with dryness and burning, and there is a desire, but com- plete inability to swallow even drinks or saliva; with sense of suffocation; further, when the throat is of a bright-red color, having its surface excor- iated, or covered with white specks, or stringy mucus, or presenting the appearance of thrush ; the tonsils swollen, and the tongue of a bright fiery- red hue, sometimes interspersed with dark-red patches at a later period of the disease; also when delirium exists. If the disease has taken a favor- able turn, we may allow Bell, to continue its action ; but if, after twenty- four to thirty-six hours, the swelling and inflammation increase rather than diminish, as in the case sometimes in strumous constitutions, or if we already perceive an appearance of ulceration commencing, with increase of mucus, give at once Mercurius. If, on the other hand, the ulcers pre- sent a livid appearance about the edges, and emit an offensive odor, or, when there is an excessive thirst for small quantities of water, and an extreme prostration of strength, Arsenicum is to be preferred to Mercurius, 33 514 ACUTE CONTAGIOUS DISEASES. and if this medicine prove inadequate to a complete cure, it should be fol- lowed by Nux-v., (see Ulcerated Sore Throat). Nux-v., is moreover of consid- erable efficacy, when a large quantity of viscid mucus is secreted from the inflamed and tumefied lining of the fauces, which adheres so tena- ciously, that it is with difficulty expelled, and sometimes even threatens suffocation. Pulsatilla is, also, useful in such cases. When the fever assumes a clearly inflammatory type, and the pulse runs high, we may administer Aconite in the same manner as given under Inflammatory Fever, which see. When the quickness of the pulse, and other febrile inflammatory symptoms are subdued, and the affection of the throat again appears most prominent, we may return to Bell., especially if the skin retain the pecu- liar. scarlet hue. Opium may follow the Bell, when there is burning heat of the skin, drowsiness, stupor, heavy breathing, open mouth, eyes half closed, rest- lessness with vomiting, or convulsions. Pulsatilla is indicated when derangement of the stomach and diges- tive organs is a prominent symptom, the face pale, red, or bloated; dispo- sition fretful and sensitive, or melancholy, with crying or tears, without sufficient cause. COMPLICATED FORMS OF SCARLET FEVER. Varieties of scarlatina not unfrequently occur in which the charac- teristic peculiarities of the efflorescence are wanting, namely, the color, which is not a bright scarlet, but of darker hue, and the effect of pressure which does not leave the white impression after it. There are, also, cases in which small granular elevations appear upon the surface of the red patches. These variations from the foregoing description of the manifes- tations afforded by scarlet fever, are not to be mistaken for indications of a different disease, but should be accepted as signs of a different type of the same disease. There are, also, instances in which the eruption is con- fined to internal parts, when, with the characteristic acceleration of pulse, there is sore throat, and the mouth and throat are bright red, hot, swol- len, and often very dry. This variety will be subject to treatment, such as that already detailed, according to the special indications present. Other instances, again, oceur of a yet more insidious character, which are not distinguished until the dropsical swellings supervene, and which either evince no eruption at all, or so slightly as to escape notice. This variety must, in all instances, be treated as directed for the like symptoms supervening as the after-effects of the disease when the erup- tion has been struck in or imperfectly developed. Another very danger- ous complication, which is frequently associated with scarlet fever, con- sists of inflammation of the upper part of the windpipe. This variety should be subjected to the treatment prescribed in the article devoted to the consideration of that particular disease, so long as symptoms of this nature continue— returning, however, to the specific treatment of the primary disease (scarlet fever) as already directed in this chapter, as soon as the complication is subdued. Another variety is characterized by degenerating into a low typhoid type, in which case, the following treatment becomes requisite. Ammonium-carb,, Arsenicum, Acidum-phosph., Secale-covn. SCARLET FEVER. 515 Prom amongst these remedies, a selection should be made by accur .ately studying the symptoms of the case, and by comparing them with the indications afforded under the head of each symptom respectively. Cases in which the throat becomes the chief seat of danger, require the following treatment: Arsenicum, is indicated in the majority of cases in which severe and dangerous sore throat accompanies scarlatina, the tonsils being swollen into hard tumors, often as large as apples, attended with snorting and dif- iicult breathing, enlargement of the adjacent glands, and remittent pulse. Dose : Six pills every two to four hours. Acidum-nitric., Aconitum, Lycopodium, Belladonna, If little or no improvement should have followed the administration of Arsenicum within the time just stated, proceed with these remedies in succession in the order in which they are placed. Dose as for Arsenicum. AFTER-EFFECTS OF SCARLET FEVER. Scrofulous subjects in particular are subject to a multitude of consecu- tive ailments of scarlet fever, which are often of an obstinate character, and require careful treatment and great precaution. Excessive Susceptibility to Take Cold. In general, also, we may number amongst these after-effects, when the skin has been cast, an exceeding susceptibility to take cold, which, if not obviated, may entail serious consequences. Treatment. As accessory precaution we may mention great care as to diet, sufficient exercise out of doors f if possible, but only in very dry weather, warm clothing, and avoidance of drafts, without, however, resorting to the extreme of coddling or the exclusion of free ventilation, which is as essential to thorough recovery as medicine. Calc'area should, in the majority ofcases.be administered, unless there be symptoms which distinctly point to other remedies, in repeated doses. Rawness of the Face. Chamomilla, Belladonna, Aurum- trip. Chamomilla may, in most cases, be employed singly with perfect success against this troublesome consequence. When, however, an inflam- matory tendency continues, and the affected parts are much swollen and painful, etc., it will be desirable to resort to alternate administration of Chamomilla and Belladonna as follows; and if no relief follows take Aurum-trip. Four doses daily. Offensive Discharge from the Nose. Aurum is indicated by offensive discharge of matter, from the nose, with soreness and swel- ling of the interior, following scarlet fever. Soreness of the Nose, etc., with Swelling of the Glands. Mer- curius and Hepar-s. Silicea, Sulphur, Calcarea. Mercurius is required when there is soreness of the nose and face, with swelling of the glands on the inner side of the lower jaw, followed, if necessary, by one or more of the other remedies named. Puffiness and Swelling of the Face and Extremities, etc. Belladonna is in most cases sufficient to overcome the following ■symptoms, occurring as the after-effects of scarlet fever, namely:— Puffi- ness of the face, swelling of the hands and feet, lingering fever in the evening,glandular enlargements, chaps aboutthemouth, severe headaches, stammering, etc 516 ACUTE CONTAGIOUS DISEASES. Dropsical Swellings, etc. Arnica, Belladonna, Helleboras, Acid u m-P7iosph., Gelseminutn. One or more of these remedies respectively according to the detailed indications afforded respecting them in the Repertory should be administered, when symptoms- of water on the brain supervene, such as dullness of the mental faculties, with evident painful effort to think clearly ; excessive drowsiness; weakness of the feet and repeated falling down ; squinting dilation of the pupils, etc. Arsenicum, Helleborus, Digitalis, Selection should be made from these remedies, particularly when symptoms of water on the chest super- vene, such asf painful oppression of respiration, aggravated by motion or by lying on the back; the patient is suddenly disturbed in sleep by a suf- focative sensation, which compels him to sit up, or even to get up, and seek for air; or even inability to lie down, necessitating a sitting or even a perfectly erect posture; short, dry, and even spasmodic cough, and stitching, crampy pains between the shoulders ; excessive anxiety, etc. Mumps. Mercurius, Carbo-veg. Mercurius is specific in the ma- jority of cases of mumps under these circumstances. Dose: Four globules in a teaspoonful of water every six hours, until amelioration or change; but if no improvement whatever should ensue within four hours after the second dose, or especially if there be reason to believe that the patient has been treated with* Mercury, proceed with the next remedy. Carbo-veg. This remedy is required in cases in which a few doses of Mercurius produce no effect whatever, and more particularly when the patient has been subjected to doses of Mercury, or if induration begins to be developed. Do.se : In every respect as stated above for Mercurius. Calcarea, Kali-carb. These remedies are invaluable in very obsti- nate and continuous cases, and should be selected, if the symptoms be conformable to those recorded of these medicines in referring to the "Re- pertory." Dose: Of either remedy, as selected, give six globules in a tablespoon- ful of water, morning and .evening for ten days, if the malady does not sooner yield. HOME REMEDIES. The milder forms of the disease require but little treatment. Keep the patient in a well ventilated room, place him upon spare diet, and sponge the surface of the body occasionally with tepid water, if the heat of the skin is great. Instead of sponging with tepid water, take a lump of suet and rub the body with it, except the face and scalp, morning and evening. It has the effect to remove that pungent heat much more effectually than water. The greasing should be com- menced as soon as the disease is recognized, and continued during the whole course of it. During the stage of convalescence or when the skin is peeling off apply it in the morning and give the child a warm bath in the evening, rubbing it well with a soft towel. SMALLPOX. This disease is by medical practitioners of the present day, divided into two varieties: — the distinct, when the pustules on the face are clearly defined, and do not run into each other— and the confluent, when they coalesce and form one continuous whole. I SMALLPOX. 517 When the symptoms are less severe than those properly characteristic of the disease, and eruption on the face slight, it is called the modified smallpox. We generally find this description in such persons as have been properly vaccinated, — a precaution, which, although not always a preserva- tive against the attacks of smallpox, greatly lessens its virulence, and gives a milder character to the complaint, when taken. Symptoms. The disease is frequently very sudden in its attacks, com- mencing with chilliness and shivering, followed by symptoms of fever, headache, severe pains in the small of the back and loins, languor, weari- ness and f aintness ; the patient, also, complains of oppression of the chest, and acute pains in the pit of the stomach, increased by pressure. The eruption makes its appearance at the close of the third day, first on the face and hairy scalp, then on the neck, and afterwards spreads over the whole body. Symptoms of cold— as sneezing, coughing, wheezing, and fre- quently difficulty of breathing, often accompany this disease. The eruption first displays itself in the shape of small, hard-pointed, red elevations, which can be felt under the skin of the forehead, before it is possible to discover any eruption with the eye which, in about three days, present a bladder-like appearance, surrounded by an inflamed cir- cular margin, and become depressed in the center as they enlarge. About the sixth or eight day, the watery secretion in the pustule becomes con- verted into matter, and the depression in the center disappears. When the pustules are very numerous on the face, it generally becemes much swolen, and the eyelids are frequently closed up. On the first day, a small lump, like a millet-seed, may be felt on each of the eleva- tions above noticed, distinguishing this eruption from all others. The pocks continue coming on during the first three eruptive days, and each pock runs its regular course; thus, those which first appeared are forming into scabs or drying off, whilst the others are suppurating. The drying off commonly takes place on or about the eighth or fourteenth day, accord- ing as the pustules may happen to be distinct or confluent. When the pustules have obtained their full development, they gener- ally burst, in mild cases emitting an opaque, watery discharge, which dries into a crust and falls off; whilst, in severe ones, we find a discharge of thick, yellowish matter, forming scabs and sores, which leave, on their healing, permanent marks or pits. Red stains, caused by increased vascu- lar action, always remain for a while after the eruption; but if no ulcera- tion has taken place, they disappear in process of time. In confluent smallpox, all the precursory symptoms are more severe, the fever runs high, and frequently continues so throughout the course of the disease; the pain in the pit of the stomach and difficulty of breath- ing are more complained of, and in children, the eruption is frequently preceeded by convulsions and delirium; the latter symptom, indeed is fre- quently present with adults, during the suppurative or secondary fever, which not uncommonly assumes a character akin to typhus, and sometimes •carries off the patient on the eleventh day. All cases in which we have generally a deeply-rooted morbid constitutional taint to contend against, require the utmost skill of the experienced practitioner to ward off a fatal result. An extensive inflammatory blush of the face or trunk almost invariably precedes the eruption in the confluent variety of smallpox. Salivation, with soreness of the throat and small white ulcers or pus- 518 ACUTE CONTAGIOUS DISEASES. tules on the tongue and in the upper part of the gullet, frequently declares- itself in both forms of this disease, but particularly in the confluent. Before we come to the medicines to be administered in the different stages of the disease, we may say a few words upon the general treatment of the patient. Cool and fresh air are our best auxiliaries, the emanations from the patient in this complaint being of a nature to react upon the organism, and warmth being calculated to increase it3 activity. So beneficial is cool air found in this malady, that taking a child to an open window when attacked with the convulsions, frequently present, will generally be found to afford immediate relief. . Great cleanliness must also be observed, and the linen frequently changed. When the vesicles declare themselves, and begin to form into pustules, the room ought to be kept as dark as possible, to aid in preventing" the risk of disfigurement, a precaution deducible from common experience,, since we find that the parts of the frame exposed to the action of light are always those most strongly marked by the ravages of the disease. To avoid the pits, and consequent disfigurement left by this disease,, many physicians have adopted a mask or plaster for the face, of different substances, such as gum, mucilage, calamine, etc. The application of collodion to the face, or of oil when the collodion can not be tolerated — has been found of service in preventing disfiguration from pock-marks^ but the most successful of all means, so far employed, is that followed by physicians of the Eegular Homoeopathic school. ALLOPATHIC TREATMENT. As there are no specific remedies for smallpox, its treatment will be palliative and supporting. If the person has not been vaccinated, this is the first thing to be done after exposure. Five or six points should be inserted in each arm. It is a good practice to resort to this in any one whether vaccinated or not, at any time before the appearance of the eruption. It will mitigate, if not prevent the dis- ease. Aside from this, the treatment is the same as in other continued fevers. The room should be large and well ventilated, and all unneces- sary articles removed from it, carpets, curtains, etc., that they may not be infected and act as conductors of the disease (fomites). The best dis- infectant in this disease is Iodine. A couple of drams of the Tincture should be placed in the vessels which receive the sputa or other excre- tions, and three drams of the scales may be put in a chip basket and hung over the patient's bed. If the room is not kept free from smell, the number of vessels containing Iodine may be increased, or a few scales may be vaporized by sprinkling them on a hot shovel. Carbolic Acid may be used with the Iodine by moistening one or two cloths, a little over a foot square, with a solution of Carbolic Acid in water, and hanging them up in the room, and adding a quarter part of Carbolic Acid to the Tincture of Iodine in the vessels receiving the excre- tions. Chlorinated Lime and Labarraque's Solution r Quick Lime and Per- manganate of Potash in solution, are also, useful disinfectants, and may be employed on account of cheapness. The nurse should, after waiting on the patient, wash his hands in clear water with soap, and then wash them in a disinfectant fluid. SMALLPOX. 519 Complete isolation is the only real safegard against a spread of the disease. Destruction of clothing used about the patient, and in the sick room, is necessary. During the invasion of the disease, the febrile movement may be less- ened by frequent tepid sponging, cool drinks, such as cold water, lem- onade or orangeade, or cold barley or rice water. The writer favors full doses of Quinine, five to ten grains every four hours, until the fever is lessened, and if the pulse be bounding, strong, and frequent, Tincture of Aconite may be given in doses of one drop every hour, to an adult, until the fever and pulse are comfortably reduced. Emetics and cathartics are not to be given, but constipation is to be relieved by injections of warm water, or the mildest laxatives, as directed in measles. During the eruption, and before suppuration, the measures before mentioned are to be continued or not, according to the severity of the symptoms. Nausea and vomiting will be relieved by five to ten-grain doses of Bismuth, with five grains of Oxalate of Cerium, or five-drop doses of Dilute Hydrocyanic Acid, or one-drop doses of Carbolic Acid or Creosote in water every hour, until relief follows. Cold, or possibly heat, applied over the stomach will aid. Diarrhoea is to be relieved by Bismuth in ten to fifteen-grain doses in milk, with, if neccessary, an opiate, as a dessertspoonful of Paregoric or ten to fifteen drops of Laudanum. Restlessness and watchfulness will be relieved by a grain of Opium, and one or two grains of Extract of Hyoscyamus Acid, or twenty grains each of Hydrate of Chloral and Bromide of Potassium, given in solu- tion with sugar, given at bed time. This will insure a nights sleep. It is to be expected that Dilute Hydrochloric Acid in doses of ten to twenty drops, or Dilute Phosphoric Acid in doses of half a teaspoonful largely diluted in sweetened water, and taken three or four times in course of the day, as a drink, will prove beneficial, as it has done in other continued fevers. Systematic feeding should be begun in this stage, and should consist largely of milk, eggs beat up with sugar and milk, or water, (as directed in scarlet fever) strong beef tea or essence, poached eggs or cooked in the shell in hot (not boiling) water, toast, rice and water; simple farinaceous food may be given. The patient should be fed during this stage four times a day, and oftener if there is any appearance of the strength fail- ing, when food, such as milk or eggs should be given at not longer inter- vals than four hours. Feeding is most important during the suppurative stage. Upon any appearance of exhaustion alcoholic stimulants should be given ; from one to three teaspoonfuls of brandy or whisky may be given with three to four ounces of milk or egg and water, a couple of hours apart. If the symptoms of prostration increase the stimulant may need to be increased. It is beneficial when it renders the pulse fuller, slower, softer and regular. Complications require trea£ment appropriate to those particular dis- eases. Local treatment consists of measures to prevent the pitting and to relieve itching, which becomes intolerable. 520 ACUTE CONTAGIOUS DISEASES. For the former purpose the following have been found, in a degree useful : Careful evacuation of the vesicles with a fine needle; it is a tedi- ous thing to do. Second, after rupture inserting into each vesicle a fine point of Nitrate of Silver. It is claimed to be most successful if done on the second day of the eruption. Third, the application of the Tincture of Iodine twice a day during the papular stage of the eruption. Fourth, exclusion of the light and air by means of a plaster. A mixture of Tan- nin and Iron is employed in cases in the N. Y. Hospitals. It produces a black mask. Coating the face with Olive Oil and dusting upon the oiled, surface twice a day with equal parts of the Sub-Nitrate of Bismuth and prepared chalk. Pulverized Charcoal made into a paste with Olive Oil or Glycerine is a simple application and as effectual as any. Calamine is used in the same way as the pulverized charcoal. The application of Collodion once or twice daily with a camel's hair brush while the eruption is papular, is said to be successful. It should be begun when the eruption first appears, and acts by excluding the air and compressing the papule. The application of guttapercha, dissolved in Chloroform, acts in the same way. These applications are made usu- ally to the face only . The terrible itching is thought to be greatly relieved by smearing the pustules with cold cream, a mixture of equal parts, by bulk, of Lime-water and Linseed or Olive Oil, or a mixture of one part of the solution of the Subacetate of Lead to seven parts of Almond Oil. When the pustules burst, they should be dusted and kept coated with Oxide of Zinc in powder, or mixed with pulverized Starch. If fissures (cracks in the skin) and excoriations occur, a mixture of Oxide of Zinc, in Glycerine or Olive Oil, two drams to the ounce, should be made. Thorough vaccination, at four or five points, is an almost sure protec- tion against small-pox, and a certain protection against the disease proving fatal. Children should be vaccinated in infancy, and re-vaccinated not later than six or eight years, and still again before childhood passes. "When epidemics of small-pox occur, all persons who have not been vaccinated within three or four years, should be re-vaccinated. HOMOEOPATHIC TREATMENT. Aconitinn may be required in the first, and early in the second stage; if the fever runs high, the thirst is excessive, the skin very hot and dry, the pulse quick, hard and full, and the breathing laborious and rapid. Aconite should, also, be resorted to as an intermediary remedy, at any stage of the disease, when distinctly indicated by symptoms of this description. Dose : Six pills every two to four hours. Antimonium-tart., (Tartar Emetic) is well indicated in this disease, from the close analogy which the eruption it is capable of producing bears to that of small-pox, and may, therefore, be, also, administered with advan- tage during all stages of the disease, unless some other remedies should be more urgently called for by the nature of the symptoms; this should be a constant remedy, tightness across the chest, perhaps attended with nausea and vomiting, or diarrhoea, before the eruption is fully out, and the exist- ence of a hollow, sounding cough, with loud,mucus rattling, is an addi- tional index for the employment of Antimonium-tartaricum. SMALLPOX. 521 Dose: Dissolve ten pills in two tablespoonfuls of water, and give a teaspoonful of the solution every three hours, until amelioration or change. Chamomilla is sometimes of great service during the course of the •disease in children, when the following distinctive symptoms appear: — difficulty of breathing, with predominant looseness of the bowels, deep green stools, severe colic, tenderness of the belly, and vomiting; it is like- wise calculated to be useful during the maturative stage, when much restlessness and whining prevail, and the rest is much disturbed by a troublesome cough at night. Dose: Four pills in a teaspoonful of water, every two hours. Belladonna. This remedy may follow Aconite or Chamomilla, when either of the latter have been indicated, should symptoms of disturbance of the brain have set in, characterized by flushed countenance, intoler- ance of the eyes for light, headache and delirium, great thirst, nausea and vomiting, or, when there is redness of the tongue at the tip and margins ; belly tumid and painful, particularly about the region of the stomach, with sensibility on pressure; prostration of strength and stupor. Dose: Of a solution of four pills to two tablespoonfuls of water, give a teaspoonful every two hours. Opium is useful, when there are symptoms of stupor or strong incli- nation to sleep ; it may be employed after Belladonna, or even preferred to the latter remedy, in cases in which there is continuous lethargy, with open mouth, half-closed eyes, and snoring breath ; or, again, when there is violent delirium, with incessant tossing about of the hands. Do.se: Six pills carefully placed upon the back part of the tongue, every three hours until change. CONFLUENT SMALLPOX. Aconite is indispensable when the fever runs high, and threatens to continue, as it usually does in this more malignant form of the disease; and it will be necessary to diverge even from other important considera- tions, from time to time, (having commenced with the administration of this remedy.) to return to it for the purpose of effectually acquiring an ascendency over the fever. The alternate administration of Sulphur is often necessary when the fever does not appear to be the least modified, within two hours after the second dose of Aconite. Dose: Six pills in a little water to be given every two hours. Mercurius is highly serviceable in confluent smallpox, after the pre- vious administration of two doses of Aconite, as above directed, when the following symptoms predominate: — Inflammation of the e3 T es, soreness of the throat and nose, offensive breath (salivation,) cough, hoarseness, tenderness of the stomach, excessive looseness of the bowels, particularly characterized by incessant straining, and, sometimes, bloodj- evacuations. Dose : Six pills in water every two hours. Pulsatilla is highly useful in confluent smallpox, characterized by the presence of an efflorescence analogous to that of measles, before or du- ring the development of the eruption, especially when nausea or vomit- ing and marked aggravation towards night, additionally qualify the general symptoms. Dose: Six pills every two hours. Arsenicum should be administered after the second dose of Pulsa- 522 ACUTE CONTAGIOUS DISEASES. tilla, (or even of An timonium-tart, or Ipecacuanha, in the event of nei- ther of the others having proved efficacious.) when the nausea and vom- iting continue unallayed, especially if the patient complains of excessive thirst and dryness of the mouth, the tongue being foul and dark, and the prostration of strength severe. Arsenicum is also of great value in cases of a hard type, and when livid spots are observed on the skin before the eruption is out, or when— other symptoms corresponding— the scabs are of a dark brown color and very offensive, more particularly if this man- ifestation be further characterized by intense weakness and languor, thirst, nausea, or vomiting, with more or less severe pain in the region of the stomach,— or, again, when the fever assumes a putrid typhoid character. Dose : Six pills every two hours, in water. Curbo-veg. should be admistered when the eruption assumes a gangrenous appearance; or when the pustules are thin and unhealthy, and the scabs and incrustations are of a dark brown color, and emit a very offensive smell. Dose: As directed for Arsenicum. Acidum-muriaticum may be employed with great advantage in cases of a bad type, in which the fever assumes a typhoid character, and when the patient exhibits a continual tendeney to sink downwards (towards the foot) of the bed. Dose: As for Arsenicum. China may be advantageously administered against the debility resulting from profuse diarrhoea or discharge from the pustules. Dose : Six pills every four hours. Sulphur is a useful remedy at the maturity of the eruption, and as the drying process is about to set in ; it will often tend materially to forward the total disappearance of lingering traces of the disease, as well as to overcome any latent mischief which has been left to rankle in the system by this virulent disorder. The alternate administration of Rhus at this period will be required, if there be aching pains in the back and extremities, aggravated towards night, but somewhat relieved by motion. Dose: Of Sulphur, singly, six pills (for adults,) or for young per- sons four pills in a wineglassful of water every morning the first thing (fasting,) continuing this course for a week; if in alter- nation with Rhus., give three globules of either medicine in rota- tion, the one six hours after the other, until amelioration or change. Check of the Eruption. Bryonia, Antimonium-tart. The administration of either of these, remedies, according to special indica- tions, will become requisite when the eruption is checked, and the chest is more prominently affected. Dose : Of either remedy, six pills every two hours. MODIFIED SMALLPOX— VARIOLOID. This is merely a mild description of smallpox, and, as we have before- said, is the form which the disease generally assumes when it attacks those who have been properly vaccinated. We must regulate our treat- VARIOLOID. 523 ment according to the symptoms, being guided in the selection of the remedies by the indications before given. Complications and After-effects of Smallpox. We should watch closely, during the progress of the disease, or symptoms of " Inflam- mation of the Lungs," or of tbeir enveloping membranes (pleurisy,) and the treatment, in cases in which such complications occur, should be regulated according to the directions especially afforded under the head of those particular maladies respectively. Boils, Glandular Swellings, etc. Amongst the many severe after-effects of smallpox, we may number glandular swellings and other scrofulous affections, developed by the malignancy of the disease, inflam- mation of the eyes, boils, etc.. which will be most effectually treated by reference to the separate articles devoted to these subjects respectively. Cough. In this respect, the reader is recommended to refer to the separate article on this subject. Asthmatic Affections. Antimonium (Tartar Emetic) is, in the generality of t cases, the most available remedy in cases of this kind, result- ing from the smallpox. Dose: Four pills night and morning, until amelioration or change. Looseness of the Bowels. China, Phosphorous. China is, in the majority of cases, more available when there has previously been excessive loss of animal fluids, especially, if the symptoms assume an intermittent character. Dose: Six pills in a wineglassful of water daily, the first thing in the morning, until change. Phosphorus is, especially, adapted for the treatment of blond sub- jects, or of a spare, slender habit of body, and fragile frame, when this relaxation continues any length of time. Dose : As directed for China. Diet and Mode of Life. In these particulars, we should be guided by the virulence of the attack ; but, in all instances, the beverages should be cold, as a warm diet, and neglect of the precautions before mentioned, may convert the mild into the malignant form. Whilst the fever runs high, water, or toast and water should alone be allowed; but when the affection is going off, mildly nutritious food, such as lean meat, farinace- ous food, cocoa, and plain broths, or beef tea, are allowable. In mild cases, thin gruel, or farinaceous food, in small quantities, may be allowed throughout. Even after recovery, in some cases, it is necessary that the patient abstain, for a considerable time, from animal food in a large quantity. It should not be. omitted, that a plain, nutritious, and even generous diet, taken in small quantities at a time, and at regular periods (when there are no lingering 1 after-effects.) combined with regular habits in other respects, and with the bracing effects of the open air, tend greatly to per- fect the cure. The general regulations in respect of diet and regimen, which apply to other eruptive fevers, or to fevers in general, hold good with regard to smallpox. It may be remarked that, after recovery from an attack of malignant smallpox, the patient's constitution often requires a thorough renovation, and that he should, therefore, be put under a course of medicine best cal- culated to attain that result. 524 ACUTE CONTAGIOUS DISEASES. HOME MEASURES. In severe cases, when the pustules are very troublesome, they may be anointed with Oil of Almonds, or gently sponged with tepid water, when they become hard, — or dusted with pure starch, when a thin, acrid, or otherwise unhealthy discharge runs from them. The hair of the head should be clipped, for the sake of the cleanliness and comfort of the patient; and the hands should be muffled, to prevent injury to the pustules from scratching. " I am willing to risk my reputation as a public man," wrote Edward Hine to the Liverpool Mercury, "if the worst case of smallpox cannot be cured in three days, simply by the use of Cream of Tartar. One ounce of Cream of Tartar dissolved in a pint of water, drank at in tervals,when cold, is a certain, never-failing remedy. It has cured thousands, never leaves a mark, never causes blindness, and avoids tedious lingering.'' CHICKEN-POX. Symptoms. A disease, bearing considerable resemblance, in its exter- nal character, to smallpox, but differing in its duration, and symptom - atically, being considerably milder, generally requiring no medical assis- tance, but merely attention to diet, and but rarely becoming dangerous, except when it extends itself to the lungs or brain. The fever, however, occasionally runs high. When this affection attacks an individual, and smallpox is epidemic, which is not unf requently the case, it is often mistaken for that disorder, but it soon discovers its real character, by the rapidity with which the eruption declared itself, the vesicles (in many instances, closely resembling the pustules of the smallpox) being generally, fully matured by the third -day, and the whole eruption disappearing at the end of the fourth or fifth without leaving any mark. HOMOEOPATHIC TREATMENT. Aconite is required when much -fever is present. Dose: Of a solution of four pills to two tablespoonfuls of water, give a teaspoonf ul every six hours, until amelioration or change. Coffea is to be preferred when extreme restlessness and anxiety are present without a great degree or fever. Dose : A solution of four pills, as directed for Aconite. Belladonna should be given if the brain become evidently affected. Dose : A solution of four pills, as directed for Aconite. Antimoniiim-tavtaricuni may be given to accelerate the develop- ment of the eruption, when it is slow in making its appearance. Dose: Dissolve six pills in two tablespoonfuls of water, and give a teaspoonful of the solution every four hours, until the eruption is thoroughly evolved, and the fever subsides. Mercurius may be given when the watery secretion of the \esicles becomes converted into thick, yellowish matter, as in the small-pox, and is, also, beneficial if strangury be present. Dose: Two pills in a teaspoonful of water, every four hours, until amelioration or change. Check of the Eruption. This should be treated as directed for Small-Pox under similar circumstances, (see page 52) Cases, in which this disorder appears with manifestations closely resembling many of those which characterize small-pox, may be similarly treated, according to the particular indications present. FEVER AND AGUE. 525- CHAPTER XXVIII. EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES, FEVER AND AGUE— INTERMITTENT FEVER. We have now to enter upon a class of fevers differing essentially from those already considered, in possessing a marked character of their own r in the simplicity of their form, the periodicity of the different stages, (al- though the periods of fever-fits are not necessarily regular,) and the uncer- tainty of their duration; at the same time it may be noticed that one of the distinctive features of intermittent fever consists in the fact that the febrile action does not individually constitute the disease, but appears rather as an occasional development of other morbid processes. Intermittent fevers cannot be better described than as a compound of acute and chronic disease; acute during the continuance of each attack, and chronic in the continuance of liability to the attacks. Symptoms. These must be classified in three distinctive stages ; (1) a chill or cold fit, (2) followed by heat, and terminating (3) in perspiration more or less profuse; these three stages constitute a paroxysm ; after which for a certain period, called the interval or respite, the patient is, generally, free from suffering. The fever-fits are characterized by the red deposit in the urine. These periods are, generally, of definite duration; but occasionally indefinite and irregular. If the paroxysms return at regular intervals of twenty-four hours, the fever is termed a Quotidian,— of forty-eight, a Ter- tian,— of seventy-two, a Quartan ; even longer intervals have been observed between the attacks, as that of seven days, which is somewhat inappropri- ately termed an eight-day intermittent fever. If two fever-fits take place within each period, the ague is said to be doubled ; as a double Quotidian,, or Tertian, etc. These fevers are sometimes found existing in the simple form above noted ; that is, that each fever-fit (as it occurs) assumes the character of simple fever; in other instances, however, the fever-fits (as they occur) assume the characteristic features of inflammatory or typhoid fever, or of complications involving the respiratory or digestive functions respectively, etc. The absence of continuity, or regular process to a crisis will then iden- tify the febrile symptoms as appertaining to this class in general, whereas, the peculiar implication of particular organs will qualify the specific char- acter of any particular variety. They are exceedingly indefinite in duration, and frequently assume a tediously chronic form. An individual once attacked with ague, is fre- quently liable to a return of it in after life, if the disease has not been rad- ically extirpated in the first instance; nay, more, any attacks of disease to which he may afterwards be subjected, are peculiarly apt to assume the intermittent form. Ague is rarely dangerous in this country, except when of long contin- uance, and then, owing to the weakness which it occasions, and the injury 526 EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. which it inflicts upon the constitution; it may, however, lead to obstruc- tions and indurations of the more important organs, particularly of the liver and spleen, or may induce dropsical affections. It should not be omitted, however, that the sudden development of eouliar symptoms in connection with the fever-fits, may be more or less ominous, and should be watched and treated with especial care. Some- times, however, intermittent fevers appear (as a wholesome crisis) in the last effort of the constitution to expel morbid humors, whieh have long preyed upon the system; and in such case, if treated with due care (which will assist in their development,) they will serve to carry off the causes of tedious chronic disorders. But in hot climates, or in low, marshy countries, this disease is exceed- ingly fatal, in consequence of the brain and its tissues, the lining mem- brane of the stomach and bowels, the lungs, and the investing membrane of the stomach and bowels becoming affected; in such instances, whe i the disease gains ground, the patient loses strength and becomes emaciated ; every fresh paroxysm entails an increase of suffering, and the perspiration fails to relieve; he complains of a sensation of w r eight in the region under the false ribs, particularly the right, with griping pain in the bowels, flatu- lent distention of the belly, looseness of the bow r els or constipation, and constant thirst ; or of headache, cough, and shortness of breath ; the tongue is furred, and dry at the tip ; the skin hot, harsh, and dry : the urine scanty, the belly tumid, the extremities become dropsical, and sleep is restless or broken. Death may ensue from collapse in the cold stage, from the absence of perspiration, and from the disease passing into continued or remittent fever, or from disorganization of some important part, such as the brain, lungs, spleen, or liver. We shall now proceed to a general consideration of the three stages of the disease, premising that the various modifications of the symptoms will be found more in detail, under the medicines when we enter upon the consideration of the remedial treatment. The symptoms which precede the chill are a sense of languor, or general uneasiness; yawming, headache, stupor, pains in the limbs or back ; the toes and fingers becoming numb, and the nails blue. These are followed by the following, which belong to the fever stage. Coldness of the extremities, with a feeling as of a stream of cold water running down the back, and extending itself to the chest and belly; general prostration of strength, insupportable coldness, exter- nal and internal tremors, chattering of the teeth, respiration labored and hurried, with inability to draw a full inspiration, and oppression at the chest. The head is variously affected, sometimes with headache, at others with drowsiness, stupor, or delirium; the pains noticed in the premoni- tory symptoms are generally present, and, in some instances, the patient complains of pain all over ; the tongue is moist, the eyes are heavy and sunken, the features pinched, and the lips and cheeks livid ; the rigors sometimes run on to convulsions. The pulse is weak and oppressed, sometimes slow, at others quick and frequently intermitting, and often, from the severity of the rigors, scarcely perceptible. The heat of the body, except at the extremities, is generally above the natural standard, w T hile the patient complains of cold. FEVER AND AGUE. 527 Sometimes the patient feels only a slight degree of cold, without tre mors, but accompanied with symptoms of functional derangement, and in a few hours the hot fit declares itself. The duration of the cold stage is from an hour to four hours; and it runs without any marked interval, into the hot stage, which presents all the characteristics of a modified inflammatory attack, with hot dry skin, and thirst, oppression at the chest, hurried and anxious breathing, and acute pains in the head, regions of the spleen, liver, etc.; there is also occasionally a degree of disturbance about the brain, or even delirium. The general duration of the hot fit is from four to twelve hours, when it terminates in the sweating stage; when this does not take place, it is apt to run on to continuous fever, or take the form of a remittent, a not uncommon issue of this disease in warm climates. After the hot fit has continued a longer or shorter period, profuse per- spiration sets in, commencing in the forehead and extremities, and quickly diffusing itself over the whole body ; as soon as it makes its appearance, the uneasiness and other symptoms begin to disappear, and the patient, in simple ague, continues free from suffering until the next paroxysm. Causes. Marshy districts are noted as being the hotbeds of this mal- ady ; the presence of stagnant water in the immediate vicinity of dwel- lings will provoke it; as occasion alty, also, conditions which will engen- der low typhus ; the continued prevalence of epidemic disorders may also be cited amongst the causes of intermittent fever ; a continuance of fish or farinaceous diet is also apt to produce it; it may, moreover, arise from taking cold, indigestion, internal obstructions, the presence of inactive humors which oppress particular organs, from peculiar constitutional ten- dency or the like, occasioned by acute diseases, or by difficult chronic affections, or even from purely local irritation. Nervous or inflammatory fever may change into an intermittent, or the latter take upon itself, if it continue, the character of either of the two former, or become remittent ; this frequently happens in hot cli- mates The medicines should generally be administered in the interval between the paroxysms but when these are extremely short, or when they are attended with after-pains of the preceding paroxysms, they should be administered when the sweats, or other concluding features of the attacks, begin to subside. ALLOPATHIC TREATMENT. The principles of treatment of inter- mittent fever may be briefly given as follows : When there is violent derangement of the functions of the bowels, or in cases of long standing intermittents, it is well to begin treatment with a cathartic. In the for- mer condition a healthy action of the bowels is to restore, and, in the latter case, a cathartic unloads from the intestines and intestinal glands the accumulated diseased secretions, and leave the intestinal tract free and active to absorb the anti-malarial remedies. If, however, there is not time to move the bowels, and get the system under the effect of the antimalarial remedies, time ought not to be lost by waiting for the action of a cathartic, but the specific treatment should be begun at once. Two to four Compound Cathartic Pills, or such other lax- atives as will move the bowels thoroughly without being severe, may be 528 EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. used equally as well. The Calomel has no special application beyond its action upon the upper part of the intestine as a cathartic. An efficient cathartic for this purpose is five grains of Calomel with half a grain of Resin of Podophyllum, followed in six hours by a Seidlitz Powder or a tablespoonful of Citrate of Magnesia or Castor Oil (the oil mixed with an equal part of Glycerine and flavored with Oil of Cinnamon or Winter- green). The remedies which act with complete certainty against this disease are the preparations of Peruvian Bark, preferably the Sulphate of Quin- ine. The system comes fully under the effect of Quinine in five or six hours after it is taken. It is a point in the proper treatment that a suffi- cient quantity of the remedy be given before six hours of the time of the next expected paroxysm, to thoroughly affect the system. To do this, a safe and effectual plan is to give ten (10) grains of the Sulphate of Quin- ine as soon as the fever of a paroxysm has passed, and another dose of ten (10) grains six hours before the time of the next expected paroxysm. A better effect is obtained by giving with the Quinine on this plan an eighth to a quarter of a grain of Morphine. The Quinine may be given in black coffee, with chocolate and sugar, or licorice and sugar. One of the nicest ways of giving Quinine is to envelop the powder in a moist- ened medicine wafer when it is easily swallowed. It may be, also, given in capsule or in Gelatine or Sugar Coated Pills. These pills should always be examined before purchasing, by cutting one of them open with a knife to see that the interior is fresh and soft. Quinine is most active when given in solution. This is effected by adding to a mixture of Quinine and water a minim (drop) of Aromatic Sulphuric Acid for each grain of Quinine. Generally, have the acid in excess as in the following prescription: Take of Sulphate of Quinine ■forty grains, Aromatic Sulphuric Acid one dram, Water a sufficient quan- tity to make four ounces. Mix. Each tablespoonful contains five grains of Quinine. If this mixture is used chewing a little licorice or choco- late until the mouth is well coated just before taking the mixture, will mask the taste of the Quinine. If taken in some of the previous ways the efficacy of the Quinine will be increased by a dose of Aromatic Sul- phuric Acid (two or three times as many drops as there were grains of Quinine) taken diluted in sufficient sweetened water to make a pleasant drink. If sufficient Quinine is taken to produce a ringing of the ears before an expected paroxysm, that paroxysm will, in all probability, be pre- vented. Other plans of administering this drug are : in doses of three to five grains, from two to four hours apart, until the ringing of the ears, deaf- ness or roaring in the head (called cinchonism) is produced. It is, also v an effectual plan. The tendency of the disease is to recur at its regular periodical periods —the third, fifth, and seventh days. After a week has passed, the tendency of the disease, generally, is to return every seventh day until three or four septenary (seventh day) periods have passed. It is advisable, therefore, to continue the use of the Quinine in daily quantities of three to five grains, until ten days have passed ; but on the seventh day, or late in the sixth day a full dose of ten or fifteen grains should be taken, and every seventh day FEVER AND AGUE. 529 thereafter, until four septenary periods have passed. Even then it is not safe to abandon the use of the remedy unless the patient has become strong and hearty. It should be remembered, that the remedy is just as effective against the next seizure, if given during a paroxysm, as if given during the inter- val, so that if paroxysms occur with great frequency, no delay ought to be allowed before giving the remedy, but it should be given at once. If only six to twelve hours can elapse before an expected seizure, twenty grains of Quinine ought to be given in two doses in the latter case, and fifteen or twenty grains in one dose in the former. Ten grains of Quinine possess a greater anti-periodie effect, if given at one dose than twenty grains given in small doses at short intervals dur- ing the intervals between paroxysms. Other preparations of Peruvian Bark are effective, given in the same way, but less so than Quinine. Quinidia, Cinchonidia, Cinchonia, the two latter have the advantage of being cheaper than Quinine. The Precipi- tated Extract of Bark (Chenoidine) given in double the quantities of Qui- nine is, also, efficient, and very cheap. The Cincho-Quinine is, also, an effectual remedy, is less bitter than Quinine, and costs about one-third less. The impure alkaloid of Quinine is comparatively tasteless, especially when mixed in three-fifths its quantity of Tannin — sugar may be added — and taken in powder, dry on the tongue, and swallowed with a drink of water: or the Tannate of Quinine may be given in a similar way, and is compara- tively tasteless. The dose is one-third-more than the Sulphate of Quinine. All these preparations, not taken in solution, should be followed by a dose of Aromatic Sulphuric Acid, as directed above under the directions for Quinine, as soon as the mouth is fully freed of the medicine. When a tonic effect of Bark is needed, the other preparations are generally to be preferred to Quinine. The dose for this purpose is gen- erally two or three grains three times a day. In case they are used in this way, it is generally advisable to give an anti-periodic dose of Quinine at the weekly periods, as before mentioned. In all cases where ague has existed for some time, the blood has be- come impoverished, — of poor quality — the patient is anaemic, and requires the use of Iron. It is advisable to give it in connection with tonic doses of some of the preparations of Bark. The Citrate of Iron and Quinine or Cinchonidia in doses of from three to five grains, generally meets the required indication. The Sulphate of Cinchonia may be given in pills with Iron as follows : Take of Sulphate of Chinchonia a dram, Reduced Iron half a dram. Make into thirty pills. Dose: Take one three times a day. The other Alkaloids of Bark, and the Precipitated Extract of Bark may be used instead of the Sulphate of Cinchonia. Other Salts of Iron, as the Dried Sulphate of Iron, may be used instead of the Reduced Iron. The Muriate Tincture of Iron, is one of the best preparations of Iron in these cases in doses of fifteen or twenty drops given in sweetened water three times a day, or other preparations of Iron may be used alone, in which case the tonic doses of the preparations of Bark should be given separately. In some cases I have found the Citrate of Iron and Strychnine in doses of two or three grains three times a day, a most useful tonic. 34 530 EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. Other medicines sometimes have to be resorted to in the cure of ague, from force of circumstances, or other causes. The one most useful after the preparations of bark is Arsenic. The most eligible form for giving this remedy, is in Fowler's Solution, (taste- less Ague Drops). It is not very suitable as a sole remedy against ague, but if given for this purpose, the dose is ten or fifteen drops in water, three times a day after meals, when given as the sole cure for ague. Puffi- ness of the eyelids and watering of the eyes may be disregarded, if the stomach or bowels do not become disordered, after a few days — three to five, according to the susceptibility of the patient — the dose should be decreased by two drops each day, until a dose of two drops is reached. The most important part which Arsenic plays in the cure of intermit- tents, is in the care of chronic malarial infections, and to prevent relapses, when the paroxysms are broken up by the preparations of bark. For this purpose it is often combined with tonic doses of bark and Iron, as in the following: Take of Quinine a dram, Vallet's Mass of the Carbonate of Iron a dram, Arsenious Acid one grain. Make into thirty pills according to art. It is advised, however, that the Arsenic be always given sepa- rately in the form of Fowler's Solution, (because it may be necessary to suspend its use for a time, when the other tonics ought to be continued; another reason, the Arsenious Acid may not be properly mixed in the mass on account of unskillful druggists, and, serious consequences might fol- low,) and Iron and tonic doses of Bark given, also, separately. The dose of Fowler's Solution for this purpose, is three to six drops after meals, upon pumness, or watering of the eyes, or derangement of the stomach or bowels occurring, its use ought to be suspended for two or three days, until these symptoms disappear,) and then begun again. Full doses of Qui- nine should be given at the septenary periods, as before directed. The Sulphate, or Muriate of Berberina and Hydrastia, probably rank next to the preparations of Bark, in the cure of intermittents. The dose of Berberina is fifteen to twenty grains given in capsules, medicine wafers or pills, on the same plan as directed for Quinine, or in five-grain doses every three hours, until twenty grains are taken. Hydrastia, which is really a Muriate of Berberia, may be given in the same way. It may be combined with Iron in pill. Salacin (Alkaloid of Willow Bark,) is some- times successful in arresting the paroxysms. Thirty to forty grains should be given in the intervals. Eight or ten teaspoonfuls (even,) of common salt, taken with intermission, will often arrest the disease. Ten drops of Nitric Acid in a glass of sugar and water taken every six hours will sometimes succeed. The Hydrochlorate of Ammonia a dram between paroxysms, will often arrest the disease. The Carbazolate (Picrate) of Ammonia in doses of a quarter to half a grain in pill three times a day, is an old remedy which often succeeds. It can be given in pill. Just previous to an expected paroxysm, a hypodermic injection of a quarter of a grain of Morphine will often arrest or mitigate it. A full oose of Opium by the mouth is in a less degree efficacious. During the hot stage cold drinks and cold bathing maybe freely in- dulged in. If any medicines are needed in this stage a half a drop to a drop of Tincture of Aconite may be given every half hour until the pulse and fever is reduced, when its administration should be stopped. Taking FEVER AND AGUE. 531 the bed before the expected chill, covering the body and keeping it warm with hot bottles has warded off " the chill." A teaspoonful of Chloroform swallowed with mucilage or syrup has prevented the paroxysm. The difficulty of effecting a cure, especially in chronic cases, is experi- enced by the patient remaining in the malarious district where he is con- stantly receiving additional doses of the poison. So that sometimes it is necessary for the patient to remove to a locality where malaria is un- known. The best preventive of ague, aside from removal from the malarious district, is frequent doses of Quinine from daily to twice a week of two to five grains each, and the use of Iron to overcome the anaemia. The pre- judice against taking Quinine for a long time, for fear of injury, is wholly without foundation. Poisoning by malaria is most apt to occur in the evening, night, and early morning. It is obvious, then, that remaining in the house during these parts of the day is advisable, preferably in an upper room (it is pro- bable that the poison does not rise as high as the second story of a house which is high — 10 or 12 feet between joists). It is also claimed that if the open doors and windows are closed with fine muslin screens from sunset until the dew is off in the morning, the occupants of the house are in no danger — the poison cannot pass through these screens. The enlarged spleen from ague, will generally yield to the remedies which cure the ague. This difficulty is treated of in diseases of the spleen (Chap. XV). The ointment of the Red Iodide of Mercury seems particu- larly applicable in cases of chronic enlargement. A Belladonna plaster worn over the side generally relieves the pain materially. The anaemia and dropsy occasioned by chronic ague will be relieved by the tonic treatment recommended to prevent relapses. In pernicious (congestive or sinking chills) intermittents, no time should be lost in giving an anti-periodic, and nothing but Quinine is to be relied on. Twenty grains should be given at once, by the mouth, or forty grains by injection into the rectum. The dose should be repeated every five hours during the intervals, unless marked Cinchonism (ringing of the ears) is produced. The patient has, in some instances been kept under this effect of the remedy for a long time after the paroxysm has passed; subsequent doses after the patient merges from the paroxysm, will vary from ten to twenty grains. The hypodermic injection of Quinine is sometimes necessary here, and is, in the opinion of the writer, to be always preferred. From five to ten grains may be given at a dose : Take of Sul- phate of Quinine a dram, Sulphate of Morphine a grain, Dilute Sulphuric Acid forty minims, Water one ounce. Mix and filter. A dram contains seven and a half grains. The dose may be repeated, given in this way, in half the time given by the mouth or bowel. Excessive Cinchonism is not necessary, but promptness and intelli- gent boldness are necessary for success. Large doses must be given for a longer period than for the milder disease, but the treatment is governed by the same principles. HOMCEOPATHIC TREATMENT. In the treatment of ague, the type, although by no means to be held as unimportant, is yet of very secondary consideration to the other features of the malady. 532 EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. China or Quinine. This well-known, but too frequently abused remedy, is of great efficacy in those fevers which owe their origin to the influence of marsh miasm, and are peculiarly prevalent at particular seasons of the year. It may be given when the fever commences with a sense of languor, or general uneasiness of the heart, anxiety, headache sneezing, great thirst, craving hunger or nausea, and pain in the bowels. It is, also, indicated when the fever has set in with absense of natural thirst — during the cold stage — but thirst is experienced after the heat and during the sweating, or thirst between the hot and the cold stage, and when the chill and fever are followed by a copious sweat. It is contra- indicated when thirst exists during the hot stage. Turgidity of the veins, with heat in the head, and natural warmth, or increased heat of the body, with or without increased heat of the surface. Or, again, determination of blood to the head, commonly with redness and heat in the face, with chilliness of all the other parts of the body, and even external coldness or only a feeling of internal heat in the face, with coldness of the cheeks to the touch, and cold sweat on the forehead, are further indications for the employment of this remedy. In many cases, China, although not capa- ble of effecting a radical cure, is yet of great utility as a palliative ; it should, under such circumstances, be exhibited immediately before the cold stage. In such instances, the consecutive treatment should be adapted to the remaining or supervening symptoms. Dose : Of China, four drops in a teaspoonf ul of water every hour in the interval between the fever-fits — the same dose being repeated as the symptoms occur in like manner. When directly specific, how- ever, a single dose of this medicine will generally remove the fever. Of Quinine, one grain in the same intervals. Lobelia. This remedy promises to be of equal efficiency with China in the treatment of ague, and may be particularly selected, in many instances, even in preference to China; but in the majority of cases which appear to indicate the latter remedy, when that, however, has been pro- ductive of only temporary relief, and particularly when derangement or foulness of the stomach is present. Dose : Of a solution of ten pills to four tablespoonf uls of water, give a teaspoonf ul every three hours, until amelioration or change ; or a dose in the like proportions, two hours before the anticipated return the attack. Arsenicum is one of the most important remedies in intermittent fevers. It is indicated when the different stages are not definitely marked, but the fever and heat and shivering appear simultaneously— or when we find cold shuddering alternately with heat, or a sensation of cold internally, with heat, or an imperfect development of the paroxysms; or burning heat as if molten lead were coursing through the veins, communicating an unpleasant sensation of heat to the hand, when placed upon the body of the patient ; great restlessness ; excessive, almost insatiable thirst, oblig- ing the sufferer to drink constantly, although but little at a time : depres- sion, marked prostration of strength, and anxiety: nausea, desire to vomit, retching, and even vomiting ; severe and burning pains m the stomach, and insupportable pains all over the body, especially, in the limbs. One marked characteristic of Arsenicum is, that all the sufferings of the patient, pains in the limbs, etc., increase in intensity during the parox- ysm, and others develop themselves; another is, its marked periodicity. I FEVER AND AGUE. 533 generally, either Tertian or Quartan, and the rigors generally setting in towards evening. It, is, therefore called for in these cases, where we meet with a well-marked periodicity of imperfectly developed paroxysms, with some, or any of the symptoms above mentioned. It is the remedy when large doses of Quinine have been used with no good result. Dose: Six pillsinatablespoonfulof water; administer during the inter- val between the fever-fits, three doses, as often as they continue to recur. Or in cases of the continuance of the cold fit, or exhaustion so severe that the patient is unable to rally, even during the inter- vals,— of a solution of twelve globules to three tablespoonfuls of water, give a teaspoonful at intervals varying from a quarter of an hour to two hours, according to the severity of the case, doubling the intervals, or suspending treatment as soon as reaction sets in. The thirtieth potency is best. Ipecacuanha is usefully employed in the majority of cases of marsh fever, at some stages of the disorder, especially, in the earlier periods. Some instances occur in which it is sufficient of itself to effect a cure ; in other instances, it is most successfully followed by other and appropriate remedies, or coupled with Nux-v. in particular. It is indicated by the following symptoms: much shivering, with but little heat, or vice versa ; increase of the shivering by external warmth ; oppression at the fore part of the chest ; want of natural thirst, or at least, little thirst ; dryness of the mouth, nausea, vomiting, and other symptoms of deranged digestion. Dose: As directed for Lobelia. Nux-vomica is, especially, indicated by excessive weakness at the commencement of the fever; the shuddering mixed with or immediately followed by heat ; warmth of the cheeks, with internal chilliness; feel- ing of heat in the face, with shuddering in the remaining parts of the body; heat in the head, with coldness of the body; burning pain in the eyes; or giddiness, with feeling in the head as if from intoxication, desire to lie down, with trembling of the limbs; fainting, or a sensation of paralytic weakness and prostration, with cramps in the different extremities, particularly the calves of the legs and feet; difficulty of breathing, palpitation of the heart, anxiety, irascibility, fear of death and even violent delirium ; derangements of the alimentary organs, such as want of appetite; dislike to bread ; bitter and sour eructations, tension of the belly, or spasms of the muscles in that region, and constipation ; burn- ing, itching miliary eruption, and burning itching sensation over the whole body. During the fever: coldness and blueness of the skin, desire to be constantly covered, even during the access of heat and perspiration; occasionally stitches in the side, shooting pains in the belly, aching in the back and limbs, and dragging pain in the belly during the rigors. During the hot jit particularly: headache, buzzing in the ears, heat in the head or face, with redness of the cheeks, and thirst. Dose : As for Lobelia. Pulsatilla, like the two medicines last mentioned, is an excellent remedy in agues complicated with the stomach or bilious symptoms, whenever the slightest attack of indigestion brings on a relapse. Its more peculiar indications are vomiting of phlegm at the commence- ment of the cold stage; want of natural thirst, all through the fever, or thirst, only during the hot fit; simultaneous heat and shivering, aggra- vated in the afternoon or towards evening; shivering when uncovered; 534 EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. anxiety and oppression of the chest during the shivering. During the hot stage, redne'ss and swelling of the face, or redness of the cheeks only, and perspiration on the face. The presence of diarrhoea, and the patient being of a mild disposition, are corroborative indications for its employment. Dose: Six pills every four hours. Antimonium-crudum. The indications for this remedy closely resemble those of Pulsatilla, but it is particularly called for when the per_ spiration breaks out simultaneously with the access of heat and then suddenly disappears, leaving the skin dry and hot. Dose: Four pills in a teaspoonful of water, as directed for Pulsa- tilla. Belladonna. Severe headache, with giddiness, or heat and redness of the face, pulsation of the large blood-vessels of the neck, and excessive aggravation of pain from meditation; partial shivering and shuddering, with heat in other parts; great heat with slight shivering; or violent shivering with moderate heat ; absence of natural thirst, or, on the con- trary, intense thirst ; extreme susceptibility, tearfulness, or depression of spirits, and desire for death, particularly when the sufferings are at their night. Dose: Four pills in a teaspoonful of water every three hours, during the first interval which occurs after treatment has been undertaken and afterwards at lengthening intervals. Ignatia is indicated, when, with heat of some parts of the body, there is coldness, chill, and shuddering of others; also where the heat is only external. Its best characteristic is, when the chills are easily relieved by external warmth, and attended with thirst. Dose : As for Bryonia. Ajjis. Violent headache, amounting almost to unconsciousness ; pain in the limbs and all over the body, thirst more during the heat; sensitive- ness at the pit of the stomach; scanty urine and swollen feet. Chill about four p. m. Dose : As directed for Ignatia. Natrum-m. is especially advantageous, for cases which have been mismanaged with excessive doses of Bark or Quinine, particularly as fol- lows: Ague-fits, commencing with headache, general aching pains, predo- minant or prolonged shivering, great thirst during the hot fit, and nearly to the same extent during the cold stage; also, dryness of the mouth and tongue; tenderness of the pit of the stomach to the touch ; bitter taste and loss of appetite ; debility ; sallow complexion ; soreness of the corners of the mouth. Dose: Six pills in a teaspoonful of water every four hours, the first interval after treatment is undertaken, and three hours before the return of every attack, until amelioration or change ; and afterward at longer and longer intervals. Carbo-vegetabilis is particularly indicated, when throbbing at the temples, aching in the teeth, and in the bones of the extremities, and the coldness of the feet precede the paroxysm ; when thirst is present only dur- ing the shiverings, and there are rheumatic pains in the teeth or limbs before or during the attack; or nausea, giddiness, and redness of the face during the hot fit; further, when an intense, burning pain, occupying the i INFLAMMTORY FEVER. 535 prominent part of the forehead and the eye on the right side accompanies the fever. Where Quinine has failed, this is another excellent remedy Dose : ■ As for Natrum. INFLAMMATORY FEVER-SYNOCHIA. Diagnosis. Rigors (chills) — generally considerable — followed by burning heat; pulse strong, hard, and greatly accelerated ; dryness of the skin, mouth, lips and tongue; the latter generally of a bright red, in some cases slightly coated with white ; thirst; urine red and scanty; con- stipation ; respiration hurried in accordance with the pulse; amelioration of symptoms as the pulse assumes a more normal state. It runs its course with rapidity, rarely exceeding fourteen days, and progressing with regu- larity to a crisis, which shows itself in profuse perspirations, diarrhoea or hemorrhage, principally epistaxis (nose bleeding). The period mentioned is its ordinary period of duration, but under careful treatment the perfect crisis is considerably hastened and without the long convalescence entailed by the usual heroic antiphlogistic treatment. It is peculiarly apt, if not carefully treated, to change to typhus, or, by mestastasis, to fix upon some important organ. Causes. Sudden chill, or check of perspiration, exposure to wet or damp winds, or dry, easterly winds, violent emotions, such as grief, joy, anger, etc., high living, external injury, local inflammations, and from slight attacks of fever mismanaged. Individuals of what is termed a plethoric habit are particularly sub- ject to this disease ; it mostly attacks between the ages of fifteen and thirty years . Under diagnosis we have just now given the symptoms usually present in synochia; we, however, find it complicated, in many cases, with cere- bral (brain) disturbance which you will find more fully considered under Inflammation of the Brain. HOM(EOPATHIC TREATMENT. When the symptoms above described are present, give at once a dose of Aconite, every two to six hours, according to the intensity of the fever. The pulse should be carefully watched and also the appearance, first, of simple moisture of the skin, and afterward, of copious sweating, which generally takes place after a few doses of Aco- nite. The intervals between the doses must be lengthened as soon as this favorable change takes place. A slight degree of delirium is frequently present in this affection, chiefly at night, which — unless it threatens to run on to inflammation of the brain, in which case Belladonna must be given — Aconite of itself is sufficient to subdue. When, however, during the course of the disease, other important symptoms besides those mentioned develop themselves, different remedies, such as Bell., Bry., etc., must be given. Belladonna is, especially, useful after the previous employment of Aconite ; but it may, also, be employed at the commencement of the attack in all cases where the cerebral (brain) system seems most prominently affected, and there is great heat in the head, with violent headache, par- ticularly in the forehead, and redness of the face; distention of the arteries 536 EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. of the temples; nocturnal sleeplessness, with furious delirium; eyes red, shining and fiery; general internal and external heat; burning thirst and agonizing restlessness. Bryonia. When the state of excitement is chiefly confined to the organs of the chest (thoracic viscera) or when there is gastric complica- tion, and the fever inclines to degenerate into typhus. This medicine is accordingly indicated when, in addition to the usual symptoms of inflammatory fever already given, we find a heavy stupefy- ing headache, with a sensation as if the head would burst at the temples, much aggravated by movement, vertigo and giddiness on rising up or moving, burning heat of the head and face, with redness and swelling of the latter; delirium; oppression at the pit of the stomach; excessive thirst, sometimes followed by vomiting ; constipation ; aching or shooting pains in the limbs, short cough; oppression of the chest, and laborious breathing. A dose every three to six hours, according to the urgency of the symp- toms. Cantharis is good in irritative fever, especially when the following symptoms are developed: the fever is very intense during the night, and is accompanied by burning of the skin, strong accelerated pulse, general redness of the surface, dryness of the mouth, and violent thirst. Fur- ther, when pains are complained of in the right side of the body, attended with great anxiety and raving. Chaniomilla is best when the attack is brought on by a fit of anger or vexation; present burning heat and bright redness of the cheeks, tremulous, anxious, palpitation of the heart, extreme irritability of tem- per, and over sensibility of the senses, alternate chill and heat and some- times spasmodic attacks. A dose or two of Aconite is generally needed in the beginning. When inflammatory fever seems to arise from a primary inflamma- tion of some important, organ, such as head, lungs, liver, stomach or bow- els, the appropriate treatment will be found under the title ''Inflamma- tion of Head, Lungs, Liver," etc. Bryonia is indicated by headache and giddiness, with dry heat pre- ceding the attacks of shivering; by the predominance of cold or shiver- ing, with redness of the cheeks, heat in the head, and headache; or marked heat, followed by shivering; by stitches in the side, excessive thirst, thickly coated tongue, bitter taste in the mouth, disgust at the sight of food, nausea or vomiting, and constipation, especially in the cases occurring in the spring. Dose ; Six pills in a tablespoonful of water every morning, or as nearly at that period as possible, during the interval between the attacks. TYPHOID FE VER—TYPHU S—FE VEB—EXTEBIC FE VEB. Typhus occurs in two forms that do not differ much from each other, namely: abdominal typhus and exanthematic typhus. More recently, this last-named form has become much less frequent than the former. In spite of these differences, the description of both forms is pretty much the TYPHOID FEVER. 537 same; up to this period, we have not succeeded in discovering the reason for the appearance of either one or the other form. Typhus originates in some infectious agent ; all that is known of this agent is: that it is caused by the decomposition of animal substances. Hence, typhus occurs most frequently where the decomposition of ani- mal matter is most favored by circumstances, namely : in large cities and hospitals; likewise, in localities which are least favorably situated for carrying away the products of decomposition, such as cities built in a flat country and with imperfect drainage. The infectious principle at times seems to act with great intensity; at other times very mildly, so that typhus in crowded localities sometimes breaks out with an extraordinary virulence; and other times with comparative mildness. According to all probability, a graduated difference of this kind is chiefly owing to the quantity of the infectious agent that acts upon the organism, not to its quality. The contagion is reproduced by the patient. We cannot share the views which prevail concerning the formation of a contagion. We do not consider any form of typhus contagious. An apparently conta- gious transmission of typhus only takes place among those who have been for some time exposed to the emanations from the infected individ- ual, not among those who have only been in contact with the patient for a short period of time These remarks apply to exanthematic typhus, which is considered as decidedly contagious, but which only appears so for the reason that it produces a larger quantity and a more infectious quality of contagious matier. Physicians in private practice are seldom attacked, notwithstanding they are brought in closest contact with the patients when exploring their chests ; hospital-physicians and nurses, on the contrary are taken down very often. More recently the level of the surface-water has been more particularly examined with reference to typhus and cholera ; a high level is supposed to favor the breaking out of these plagues. We are still without any reliable data in this respect. In large cities the construction of wells and water-closets deserves great at- tention; where both are so close together that the well-water can" be con- taminated by the contents of the closets, typhus is very likely to occur. This subject is, without doubt, worthy the most serious attention of the board of health, for typhus is not only one of the most dangerous, but likewise, one of the most frequent diseases. A few points can easily be inferred from what we have said, such as : epidemic and endemic, slightly endemic and sporadic type of typhus; breaking out of typhus in very damp and hot years, during the hot months of the summer and in the fall; likewise, in crowded hospitals, more par- ticularly, if they are full of wounded soldiers ; or in densely populated streets, tenement-houses, on ship-board, etc. Typhus occasioned by an insufficient supply of food, or by unwholesome and deteriorated food, is less easily accounted for. One attack of typhus does not always, but very generally, protect against a second attack. There are certain other circumstances that almost positively preclude the possibility of typhus, especially, abdominal typhus; these are: Intermittent fever, consumption, cancer, heart-disease of the higher grade. Age does not establish any positive lines of demar- cation; except infants, persons of any age may be attacked, but more par- 538 EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. ticulaiiy young 1 people and individuals up to the age of fifty. Vigorous constitutions are more easily attacked, and likewise more severely. Exciting causes are: Fear and anxiety; a sudden change of diet when persons settle in a locality where typhus is endemic; catarrh of the intestines ; mental depression, both by excessive mental labor as well as by care and grief. Symptoms and Course. In abdominal typhus, the ulcers in the intes- tines act the most important part; they have even given rise to the name of this form of the disease. However, it behooves us to premise the statement that in their various phases, these ulcers do not correspond with definite phases in the total course of the disease. Except these two almost constant phenomena, typhus does not offer any permanent, characteristic signs. The brain, especially, remains unal- tered; the lungs, on the contrary, show at first, symptoms of irritation; afterwards pneumonia. During the first weeks of the disease, the mus- cles have a somewhat characteristically dark color, and the internal sur- face of the arteries has, likewise, a dark-red appearance. In exanthem- atic typhus, the intestinal ulceration does not exist, whereas, in this form, likewise, the spleen is considerably hypertrophied and softened, and the vessels, also, have a bright appearance as if injected. Abdominal typhus very rarely breaks out suddenly ; it is, generally, preceded, for a few days,- or even a week by indefinite symptoms, such as lassitude, indisposition to work, loss of spirits, impaired appetite, very seldom hunger, almost bordering upon a voracious desire for food; wander- ing rheumatoid pains in the limbs, especially in the back, headache of the indeterminate type, sleep full of dreams. The disease is generally ushered in by a chill of moderate violence, or by a marked fainting sensation, which is soon followed by the character- istic feeling of illness, namely : an inability to stand erect or move about, and a desire to lie down. Very seldom one of these conditions is entirely wanting, so that it is difficult to point out the real beginning of the disease; instead of one severe chill, we often meet with a succession of very feeble chills. The disease now developes itself in the following manner: The patients feel weak, have neither the strength nor the desire to rise from their beds; headache, at times more frontal; and at other times, in the more violent cases, in the occiput, throbbing and very distressing ; com- plete loss of appetite ; altered, generally pasty taste ; vomiting not very frequent; bowels quite torpid in the first w T eek ; restless sleep ; when waking early in the morning, the patients commence very soon to com- plain of phantasms which they cannot avoid; yet they talk very ration- ally and are perfectly conscious of seeing phantasms. The pulse is gener- ally full, very seldom exceeding one hundred beats, very often dicrotic (double or rebounding,) the temperature is high, the skin feels burning hot. The breathing is almost constantly hurried, anxious, the patient talks hurriedly, yet is able to take a long breath. The spleen is generally swollen, the swelling increasing rapidly in size, and is not unfrequently painful. The abdomen does not show any constant alterations, but when pressed upon, the patients complain of pain in this region, and a gurgling sensation is communicated to the finger, with which the pressure is made. The tongue is at times coated very thickly, at other times it only has a TYPHOID FEVER. 539' whitish coating, and again it looks quite clean, but the coating changes as the disease progresses. Sometimes the patients complain of a little hack- ing cough, and exhibit symptoms of a slight bronchial catarrh. The urine is less in quantity, saturated, notwithstanding that the patients often experience a very violent thirst. All these symptoms remain in force only in very violent cases ; most generally a sensible remission of these symptoms takes place towards the end of the first week. Second Week. In the second week the symptoms of the disease undergo a marked change, unless the morbid process takes a turn towards recovery, which is very seldom the case. For the present, we only speak of typhus of a moderately severe type. In this stage, the patients lose their consciousness more and more; they are either lying in a state of lethargic apathy, or else it is only with great difficulty that they are able to reply to questions, or to give utterance to their own ideas. In the even- ing and during the night, this soporous prostration is generally interrupted by a state of nervous exaltation, during which the patients manifest their internal nervousness by animated talking, or by constant endeavor to escape from their beds. Sensations of pain now cease entirely-; when asked how they feel, they answer: " Quite well." They express no desire for drink, but they swallow the offered beverage hurriedly and greedily ; when repeatedly asked to do so, they put out their tongues slowly and tremulously, and forget to draw them in again. Another evidence that the influence of the brain is almost entirely suspended, is, that the patients persevere for a long time in an uncom- fortable position, and that they allow the urine and feces to escape into their beds. At the beginning of the second, and very frequently already at the end of the first week, the patients complain of a violent buzzing in the ears, afterwards they are evidently hard of hearing. Corresponding with these changes, the countenances of the patients become altered. Although the complexion seems to shine, yet it has a livid hue ; the eyes stare, or they have a vague and unsteady expression ; when raised in their beds the patients at once turn pale and look as if they would faint. The vari- ous functions show the following deviations from their normal condition: The pulse is seldom below one hundred, nor is it often above one hundred and twenty, it is weaker than usual and sometimes dicrotic. The tongue, which already showed a good deal of dryness in the first week, now is constantly dry; the streaked coating, which had marked it hitherto, now vanishes; it shows a peculiarly red color, and the papillse seem to have become effaced ; towards the end of the second week the tongue appears covered with a brownish incrustation. The appetite is entirely wanting, yet the patients will taste of what they are offered to eat. They do not seem thirsty, yet they drink greedily the proffered beverage. At this stage the abdomen begins to bloat quite considerably ; when the iliocoecal region is pressed upon very hard, the patients distort the corners of their mouths. Diarrhoea now usually sets in, from four to eight passages tak- ing place involuntarily every day. They have a yellowish color, deposit a sediment of thick consistence over which floats a watery, opalescent sub- stance. The urine is secreted in smaller quantities, it is dark and is fre- quently voided involuntarily; sometimes it is retained altogether, so that 540 EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. the b.adder becomes very much distended. The respiration is still accel- erated, yet the peculiar hurried breathing of the first week is scarcely yet perceived; catarrhal symptoms are likewise discovered, although the patients scarcely ever cough and only rarely bring up a tenacious, yel- lowish mucus. The spleen continues to enlarge, although owing to dis- tention of the bowels, and the consequent displacement of the spleen upwards, the enlargement cannot well be discovered by examination. Upon the abdomen, thorax and back, roseola-spots break out in greater or less number, some of which are usually present at the end of the first week. About the middle of the second week all these symptoms generally show an increase, less frequently a remission ; both the increase and the remission are, however, of short duration. Third Week. In the third week, especially at the commencement, the symptoms continue to increase in intensity. The patients are now lying in a state of complete apathy ; in the day-time they are only slight- ly delirious, but during the night the nervous exaltation is much worse, attended with grasping at (lochs. The prostration is so great that the patients are no longer able to sit erect ; they are constantly lying on their backs, and the body, yielding to the law of gravitation, settles from the pillow downwards towards the middle of the bed. The tongue is only slowly protruded after loud and repeated requests ; it is quite dry, with a brownish coating, which is likewise exhibited on the teeth and at the nostrils. Deglutition is very difficult, and it is only with a great effort that the patient is able to swallow very small quantities of liquid at one time. The diarrhoea continues, but the passages are generally less copi- ous, and not unfrequently tinged with blood. The urinary secretions continue to decrease and paralysis of the bladder is not an unfrequent occurrence. The abdomen is greatly distended and is no longer sensitive to pressure. The other symptoms continue unchanged, except that the roseola-spots pale off and become complicated with miliaria (measle-like) and sometimes with ecchymoses (black-like bruised place). Bedsores are now very apt to torment the patient. Emaciation proceeds very rapidly, and the whole appearance is that of a general collapse. Up to the middle of the third week, the fever maintains its intensity. In cases where the disease continues during the fourth week no remission of the fever is per- ceptible. In most cases, however, the seventeenth day is characterized by a sudden abatement of the fever and of most of the other derangement of the functions. This improvement at times is only apparent, as in a few hours the symptoms again exacerbate; but at other times it is a real improvement marking the beginning of recovery- If the patients die, it is most generally at this period ; the remission just alluded to, when followed by exacerbation of the symptoms, is generally looked upon as a fatal change. Death takes place with symptoms of paralysis of the heart and lungs. In favorable cases the fever remits every morning on the last days of the third week, whereas the evening exacerbations decrease in violence, the consciousness returns gradually and with it a desire for food and drink. At this stage the fever scarcely shows a sudden and considerable decrease. with a correspondingly sudden beginning of convalescence. With the third week typhus of a medium grade has reached its inten- TYPHOID FEVER. o41 si ty in so far as signs of convalescence now begin to show themselves, although very slowly. Every case of tyhus out-lasting the third week, may be safely regarded as very severe. Except complications take place, no new symptoms develop themselves during the fourth and fifth weeks. The remissions of the fever are very distinct and grow more decided in character; the pulse, on the contrary, increases in weakness and frequency. The patient looks as if he were in a state of terrible collapse; occa- sionally threatening paroxysms of collapse really take place, more partic- ulary in the night; in the latter course of the disease, such paroxysms are, however, not as dangerous as they seem. In the case of adults the consciousness usually returns towards the end of the fourth week ; but. if the fever continues, delirium is still very frequent towards evening. The diarrhoea is at times less than it was, and at other times more profuse ; in some cases it now ceases altogether. The skin looks clean, with the exception of miliaria here and there. The bed-sores which are never wanting during such a protracted course of the disease, grow rapidly in extent and malignancy. If the fever runs a course of four weeks, recovery takes place very slowly. In very fortunate cases recovery goes on uninterruptedly, bu: most frequently its course is disturbed by all sorts of accidental inconve- niences, such as vomiting after certain kinds of food, or even after any kind ; sudden disappearance of the appetite that had just begun to return; return or protracted continuance of the diarrhoea; exacerbations of the fever. The decubitus, the nature and conduct of which afford an excel- lent criterion by which the amount of progress in the recovery of the patient can be measured, sometimes causes a great deal of serious trouble, provided the final cure of the fever is very much delayed. Death either takes place in consequence of the utter prostration of the patient, from exhaustion, or from sudden and complete overpowering of the whole of the vital powers of the system. ALLOPATHIC TREATMENT. The first requisite for the proper treatment of typhoid fever is, that the patient shall be in a large room, ventilated by means of several windows, that the air may be constantly changed by the free entrance of pure fresh air. Disinfection should also be constantly practiced. The generation of Ozone (active oxygen) constantly in the sick room, is very beneficial. This is best done by a mixture of two parts of Per- manganate of Potash and three parts strong Sulphuric Acid in a broad, open vessel. An invigorating quality is imparted to the atmosphere of the room, and is especially beneficial, when, for any reason, the room cannot be freely open. Dry scales of Iodine, in a chip-basket, hung over the bed, and placed in saucers in different parts of the room, are valuable in removing any unpleasant odor in the atmosphere. A few of the scales maybe vaporized, occasionly, by sprinkling on a hot shovel. Another available disinfectant is Carbolic Acid; a few drops may be put on wetted cloths which are hung up in the room. The floor may be occasionally sprinkled with Labarraque's Solution (Chlorinated Soda). The vessels which are to receive the excretions should always contain a little of the Solution of Chlorinated Soda. Permanganate of Potash, or Carbolic Acid, five or ten drops in water. 542 EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. It is needless to remark that carpets, curtains, and all unnecessary articles, ought to be removed from the room. The proper temperature of the room is sixty degrees. The bed linen should be changed daily. As soon as it is determined that the patient has typhoid fever, the hair should be shingled. The most effectual plan for controlling the temperature is, by the use of water. Where there are proper facilities for it, the bath is the surest and most efficient method for reducing a high fever. The patient should be placed in the bath at a temperature of ninety-eight degrees F., and the temperature of the water lowered to eighty degrees, or to sixty degrees, by the addition ice or of ice water. After a time varying from five minutes to half an hour, a marked reduction of the temperature is produced, as shown by a thermometer placed in the rectum (bowel,) when the patient is removed from the bath, wiped dry and placed in bed. For this, a bath-tub is necessary, large •enough to receive the body, provided with a discharge pipe to convey off the extra water, a strong sheet to lift the patient, a thermometer to test the temperature of the bath, and a fever thermometer to ascertain the amount of reduction in the heat of the patient. The most suitable method of applying water in private practice, and in families, is, by the use of the cold wet pack. A sheet is wrung out of cold water and placed on the bed. The patient is then laid on the sheet, with a proper support for his head. Each side of the sheet is then brought over the patient and tucked under the opposite side. The legs are well wrapped in, and the patient is well covered with blankets. He may remain in the pack from ten minutes to an hour. The pack may be repeated several times a day, the frequency being determined by the rise ■of temperature. When taken from the pack, the patient is to be wiped -dry. An agreeable, but less effectual plan, is, cool sponging and having the cloths dipped in cold water and laid upon portions of the body. When there is any tendency to collapse, wet baths should not be given. There can be no doubt of a greatly diminished mortality by the use of cold baths, the disease pursuing a milder course under their use. If, in the use of water, the circulation becomes feeble, the skin blue or the extremities cold, stimulants should be given, and bottles of hot water placed at the feet. The use of the mineral acids is of marked benefit in this disease by aiding the gastric secretion and improving digestion and in increasing the mucus secretions, and relieves somewhat the dryness of the tongue. The Dilute Hydrochloric (Muriatic) Acid is as applicable as any, given in doses of ten drops diluted in water, sweetened with simple Syrup or Syrup of Orange Peel. It seems better suited to aid digestion, than any other acid. If the teeth become set on edge, it is well to wipe them off after each dose of the Acid with a cloth wet with a solution of Bicarbonate of Soda. This will do much towards preserving the teeth from the injurious effects of the Acid. In case of apparent exhaustion of the nervous system the Dilute Phosphoric Acid may be given in doses of ten or fifteen drops every hour or tw T o, properly diluted and sweetened. It is given habitually TYPHOID FEVER. 543 by some physicians in this disease. It is conclusive that the use of the Acids diminish the mortality of the disease very greatly, besides being very grateful to the patient. The patient may also drink freely of cold water or iced water, barley or rice water acidulated with lemon or orange juice; the only limit neces- sary to be observed is, that the amount taken does not derange the stomach. In view of the fact that typhoid fever is a self-limited disease, the essential element in the treatment is to support the powers of life and keep the patient alive until the disease shall disappear. The means for this purpose are food, (nourishment) alcoholic stimulants and tonic doses of Quinine. Regarding the nourishment of the patient, it is important that system- atic feeding be begun early in the course of the disease and continued throughout. In the beginning of the disease, but very little food will pro- bably be taken, owing to a repugnance to it, but if liquid food is given cold the patient will often take it to relieve his thirst, and in this way enough nourishment will be taken to maintain the strength. It should not be given to the extent of producing vomiting or a feeling of discomfort from over-fullness or indigestion. The forms of food best suited for fever patients are milk, strong beef tea or essence, and fresh raw eggs beaten with a teaspoonful of sugar and half a cup (four ounces) of water or milk. Further on in the disease, there is an indifference to food, but if it is given it is digested; it should be regularly given. If only about four ounces of milk, beef tea, or egg and water or milk are taken at a time, it should be given every two hours. If an ordinary drinking glass full (eight ounces) is taken at a time, four hours should be the intervals of taking food. If the patient expresses a desire for any particular kinds of food, the wish should be complied with, as far as possible. It is a good rule, however, not to give solid food when there is diar- rhoea. With the three articles mentioned, sufficient nourishment may be given. In making beef tea, a pound of finely chopped lean beef will make a pint of strong tea. A pint of cold water is poured upon the beef and brought to a temperature not above one hundred and sixty degrees Fah- renheit, and kept at that point for four hours, a little water being added from time to time to supply the loss from evaporation. (The Hydro- chloric Acid, previously directed, can be given in the beef tea.) Mutton or chicken can be used instead of beef. Finely divided lean beef pounded in a mortar, until the nutritious elements are separated from the fibre, may be given. Nothing excels a milk diet. Everything else should, asa # rule, be supplementary. By early and continuous feeding, the severer symptoms of the disease are generally obviated, as they generally depend on the exhaustion and prostration, which is prevented by nourishment. In the course of the disease, if severe, alcoholic stimulants are almost always required. They should be given from an early period in the attack, as aid to digestion, a teaspoonful to a dessertspoonful of Whisky or Brandy with each half glass (four ounces) of milk or other liquid food, but not oftener than two hours, greatly aids in the feeding of the patient, and so prevents, in many cases, the innutrition and its results, which is shown by delirium, a rapid feeble nulse, twitching of the muscles, pick- 544 EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. ing at the bedclothes, coma, with watchfulness, restlessness, etc. In a stage of this fever where there is marked exhaustion, Brandy or Whisky should be given freely and to the extent of relieving the symptoms above enumerated. I believe life is saved by the free but judicious administra- tion of Alcohol in the advanced stage of prostrating diseases in obedience to the scriptural injunction, " Give strong drink unto him that is ready to perish." The appropriate dose will be from one to two tablespoon fuls of Brandy or Whisky, given from one to four hours apart. The stimulant is doing good when the weak, rapid pulse becomes stronger, slower, fuller (a pulse of one hundred and twenty is generally a weak pulse; one of one hundred and thirty, or more, always so,) when the dry tongue becomes more moist, the delirium, vigil, restlessness, etc., lessened, and the sleep becomes more refreshing, It does harm, if the pulse is quickened, the tongue dryer, the delirium greater, the restlessness increased and is being given too freely. The tonic effect of Quinine is best produced by doses of two or three grains four times in the twenty-four hours. In the early part, headache may be relieved by cold water, either by keeping a thin cloth on the head, which will keep cool by evaporation, or by the use of ice-water, vinegar and water, pouring water upon the head (douche) or by bladders of ice. Vigil (or wakefulness,) sleeplessness, or delirium, should be relieved. For this purpose, there is nothing better than ten grains of Dover's Pow- der, or a grain of Opium with a grain of the Extract of Hyoscyamus, at night, which will produce a refreshing sleep. A condition of semi-coma (insensibility) with watchfulness, does not prevent the use of Opium to produce sleep. It is, sometimes, better to give at night, especially when there is delirium, twenty grains of Hydrate of Chloral with an equal quantity of Bromide of Potassium, dissolved in water with syrup. Nausea and vomiting are generally relieved by greater care in giving food and drink, especially, a more limited amount of the latter. Cold or Mustard may be applied over the stomach. Ten grains of Bismuth, Sub- Nitrate, with five grains of Oxalate of Cerium, or a drop of Carbolic Acid in water, or three to five drops of Dilute Prussic Acid, may be given hourly, if needed. Diarrhoea is generally present, and may require to be restrained bj T opiates and astringents, directed in the treatment of that disease. Some- times a large injection of thin Starch will suffice. Merely a looseness of the bowels does not need treatment. Cathartics are not to be given ; but if constipation exists, it is to be relieved by injections or mild laxatives, as a dessertspoonful of Castor Oil in emulsion with Glycerine, flavored with Oil of "Wintergreen (Gaulthe- ria) or Cinnamon. Should ulceration of the intestines occur, a peritonitis or a hemor- rhage is almost sure to result. The former result is to be treated by full doses of Opium, to relieve the pain, and every means should be used to support life. Large, warm poultices should be kept on the abdomen. Peritonitis not caused by ulceration, is not so fatal, but is to be met by the same means. Hemorrhage into the intestines will call for Opium in doses of a grain TYPHOID FEVER. 545 with ten grains of Gallic Acid, in solution, with ten drops of Aromatic Sulphuric Acid. Nose-bleeding, if excessive, will call for the treatment directed in the article on that trouble. The distention of the abdomen from gas in the intestines (called tym- panites) occasions great discomfort. It may be relieved by a large injec- tion of warm water, containing a tablespoonful of Turpentine previously mixed with Glycerine. A flannel cloth wrung out of hot water and then wet with Turpentine, laid over the abdomen, will afford relief. The urine should be examined frequently, to ascertain whether adefi- ciency in the amount of urea may not warn of Uraemia (poisoning by this ingredient of the urine remaining in the blood). The smell of Ammonia in the expired breath, also, indicates Uraemia. Diuretics (medicines to act on the kidneys) are required, as, a half a teaspoonful of Vinegar of Squill in a tablespoonful of infusion of Digitalis every four hours until urine is passed freely, and if the symptoms are urgent, hot-air baths should be given. Profound sleep (coma) wil'l call for these measures for relieving the blood of urea, and blisters to the back of the neck, by means of Blistering Collodion. •During convalescence, care is to be exercised against overloading the stomach, but, at the same time, the diet should consist largely of well- cooked meats, eggs, milk and simple farinaceous articles. Iron should be given as a means of enriching the blood. The Tincture of the Chloride of Iron, in doses often drops, largely diluted in sweetened water, and given after meals, is as appropriate as any. The Pyrophosphate or Soluble Cit- rate of Iron, are efficient and pleasant to the taste. A dram may bedis- solved in Syrup of Orange and given, in doses of a teaspoonful, after meals. The Citrate of Iron and Quinine, given in the same way, and in the same doses, is a useful tonic during this stage of the disease. Derangements of the stomach will call for the Liquid Pepsin and Bismuth, or such other treatment as is directed in the treatment of Dys- pepsia. HOMOEOPATHIC DIVISION AND TREATMENT. It were of no service, as it would, also, be a difficult task, to define, exactly, the varieties of complication which may attend disorders of this kind. The broad distinction consists in the organs which are, espe- cially, affected. But, in order to facilitate the discrimination of unprofessional per- sons in the treatment of this most difficult species of disorders, we will divide their indication, progress, and issue, into three distinct stages, the premonitory and incipient, the acute, and the debilitated and convales- cent stages. It is not, however, to be assumed that these gradations are always clearly defined. They may merge imperceptibly, may be arrested by treatment, or may be suspended by fatal results. The incipient stages are, however, naturally distinguishable until the positive development of the fever becomes evident, and the stage of debility, which isaconsequence of the ravages of the fever, differs from the two former in the substance of active symptoms, and the accompanying prostration of animal power. In the treatment of all alike we must be guided by the symptoms, and select 35 546 EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. the most appropriate remedy according to the characteristic indications afforded. H03KE0PATHIC TREATMENT— During the Premonitory and Incipient Stages. Bryonia-alba, RJius-toxicodendron. These rem- edies, either singly (according to the subjoined symptomatic indications of each,) or in alternation (where the symptoms of the disease embrace the characteristics of both,) have, when seasonably administered in the incipient stages of many varieties of these fevers, been found sufficient to arrest the progress and development of the malady, altogether, or at all events so far as to modify its future course, as to deprive it of much malig- nancy . Bryonia and Khus are, in fact, the medicines whose ascertained operation is most closely akin to that of this class of disorders. Bryonia. This remedy is especially applicable to cases which mani- fest an inflammatory tendency. It should be selected in the incipient stage, when the following symptoms are present: — After a slight cold the patient complains of aching pains over the whole body, which admit of no relief from a change of posture; severe, throbbing, bursting, frontal headache (aggravated by opening or turning the eyes) prevails ; the scalp is tender to the touch, and the head burning hot, yet the forehead is, nevertheless, frequently bathed with cold sweat ; the sitting or even the recumbent posture is rendered compulsory by the prevalence of debility, languor and heaviness of the limbs, and there is an aversion to cold air ; the nights are disturbed, more especially the fore part of the night, by ebullition or congestion of blood, heat, and anxiety ; the patient sighs and groans during sleep, and is often aroused by agonizing or frightful dreams, which continue to haunt him even whilst awake. The digestive functions are considerably deranged, as exemplified by the presence of bitter taste, loathing'of food, nausea, and inclination to vomit, a yellow, furred and dry tongue, pressure or weight and pricking in the pit of the stomach, with sensation of distention about the lower ribs on both sides, and costiveness. Dose: If singly, dissolve eight pills in two tablespoonfuls of water, and give a teaspoonful of the solution every two hours; if in alter- nation with Rhus., dissolve six pills of each remedy separately in two tablespoonfuls of water, and give a teaspoonful of the one solution four hours after the other, in rotation, until amelioration or change. Rhus-toxicodendron is especially applicable to the low, nervous variety in the premonitory stage of typhus. It should be employed when, either after exposure to a thorough wetting, or without any assignable reason, the patient is seized with violent relaxation of the bowels, accom- panied by colic, and complains of chilliness, even when seated close to the fire; further, when aching pains (or pains as if arising from the effects of contusions) are experienced in particular parts of the body, or when a painful sensation is experienced, as if the flesh had been torn from the bones; the tongue is furred white, and giddiness, inclination to vomit, or actual vomiting of phlegm, is present ; the patient is tormented by numb- ness, creeping and tingling in the parts of the body on which he lies, together with lancinations, drawing pains, and stiffness in the nape of the neck and in the back, rigidity and feeling of paralysis in the extrem- ities, with trembling on holding out the arms; the chief qualifying con- TYPHOID FEVER. 547 -dition is, that all the symptoms are, generally speaking, exacerbated dur- ing rest and at night. Dose: If singly: Of a solution of ten pills to two tablespoonfuls of water, give a teaspoon ful every two hours, until amelioration or change. If in alternation with Bryonia, dissolve ten pills of each remedy separately in two tablespoonfuls of water, and give a tea- spoonful of the one solution four hours alter the other, in rotation, until amelioration or change. Ipecacuanha may be selected in the early stage of typhus, when it is ushered in by prominent symptoms of derangement in the digestive organs, such as headache, giddiness, nausea, vomiting, watery, yellow or greenish, slimy evacuations; particularly when these are associated with slight chills alternating with heat, or considerable shivering with slight heat or marked heat with but little shivering. Dose: Eight pills in a teaspoonful of water every three hours until amelioration or change. Pulsatilla may also be selected in this stage of the disorder, when frequent shivering, bitter taste, whitish tongue, loss of appetite, nausea, vomiting of phlegm, slimy evacuations, and febrile heat, intermingled with chills, prevail; and more particularly when these symptoms become exacerbated towards evening, and occur in mild, temperate, or phlegma- tic subjects, or in females, with extreme depression of spirits and tearful- ness. Dose: Eight pills in a teaspoonful of water every three hours, until amelioration or change. Digitalis is indicated when nervous fever, or rather typhus, accom- panied by bilious derangement, is ushered in by yellow jaundiced hue of the skin ; violent, bilious, spasmodic pains in the stomach ; sensibility of the upper part of the stomach on the left side, on pressure; frequent urging to make water, particularly at night, with scanty urine ; burning heat of the head and face ; anxiety of mind and dread of some imaginary impending misfortune ; urination painful and difficult, or entirely sup- pressed. Dose: Six pills in a tablespoonful of water every three hours, until amelioration or change. Nux-vomica.— Symptoms of stomacha derangement, constipation, with frequent inclination and ineffectual efforts to evacuate. Nux-vomica is further indicated when the spasms, which not unfrequently accompany this disease, are confined to the stomach and intestines, particularly the inferior bowel— a frequent cause of the above-mentioned constipation; painful and difficult emission of urine; painful pressure and tension in the regions about the stomach and the lower ribs; sensation as if the limbs were bruised; general nervous excitability, with great nocturnal restlessness and slight delirium; weakness and aggravation of the symp- toms in the morning. Temperament, sanguine or billious; disposition, irritable and impatient. ose: Six pills in a tablespoonful of water every four hours until amelioration or change. China.— This remedy is frequently of service in the first stage, or when paleness of the face, lancinating, rending, aching, or pressive head- ache, cloudiness of vision, buzzing or roaring in the ears, dullness of hear- ing are present ; yellow or white coating on the tongue, dryness of the 548 EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. mouth, insipid, clammy, or bitter taste ; inclination to vomit; sensibility and distention of the belly ; thin, yellow, watery motions, occasionally intermixed with undigested substance; urine scanty, pale or dark colored and cloudy; oppression at the chest; dragging, shooting pains in the limbs ; anxiety, sleeplessness, and general coldness and shivering. Dose: Six pills in a tablespoonful of water every six hours, until amelioration or change. Aconitum. Belladonna. These are the best remedies in the incipient stage of the disorder, when inflammatory symptoms declare themselves from the commencement. The selection between Aconite and Belladonna will be gathered from the subjoined symptomatic indi- cations, and ' from the article on the "characteristic symptoms," under the head of these remedies respectively. It should be added here, that when the disease becomes further developed, and still retains the inflammatory character— Bryonia and Rhus respectively, according to the symptoms, are generally preferable. Aconitum is indicated in the incipient stage by the presence of the following symptoms:— Chill fol- lowed by the burning heat, strong, hard, and quick pulse; dry skin, mouth, lips, and tongue ; the latter* being generally, of a bright red, but some- times also coated with white; excessive thirst; red and scanty urine; hurried breathing; the symptoms being aggravated or modified, according to the greater or less irregularity of the pulse. The condition which distinctly points to Aconite, as the remedy (when other complications are not present,) consists in the aggravation of the above symptoms at night, often attended with slight delirium. Should the delirium become violent, and considerable cerebral disturbance be otherwise manifested, or should this particular symptom not yield rapidly to the action of Acon- ite; — when, moreover, the skin continues hot and dry, and the bowels relaxed, or the motions are even passed involuntarily, or when there is in- flammation of the glands of the throat (tonsils), or red, parched tongue, great thirst with disinclination or dread to satisfy it, it will be preferable to administer Belladonna until the indicative symptoms yield. Dose : Of a solution of six pills to two tablespoonf uls of w T ater. give a teaspoonful every three hours, until amelioration or change. In mild cases in which the symptoms yield readily to the action of the medicine, the repetition may be deferred to intervals extending to tw 7 elve hours. Belladonna is particularly indicated by the following symptoms. in addition to those above enumerated: alternate heat and chills, or gen- eral heat externally and internally, w T ith redness, burning heat, and bloated appearance of the face, or alternations of coldness and palenes.-. and heat and redness of the face, violent throbbing of the large arteries of the neck ; redness, sparkling, and protrusion of the eyes, with dilation of the pupils, extreme sensibility to light, and distortion of the eyes; singing or noise in the ears to a greater or less degree ; wild expression of the countenance, with uneasy glancing around, as if from fear, sometimes attended with a marked inclination to run aw r ay; violent shooting pains in the forehead; or dull heavy pain, causing the patient to put his hand frequently to his head; sopor; furious delirium or loss of consciousness: delirium and snatching at the bedclothes, or spasmodic or convulsive at- tacks; parched lips, soreness of the corners of the mouth, redness and TYPHOID FEVER. 549 dryness of the tongue, which is also sometimes foul, and covered with a yellow coating; skin hot and dry; bitter taste in the mouth, intense thirst, difficulty of deglutition, especially of liquids; nausea; pressure at the pit of the stomach; excessive distention of the bowels, and constipation or watery motions; scanty and red or amber-colored urine; rapid respiration; pulse full and accelerated, or quick, hard and wiry; inflammation and swelling of the glands before and beneath the ears. Dose: Dissolve eight pills in three tablespoonfuls of water, and give a teaspoonful of the solution every four hours, until amelioration 01 change. In mild cases, or when the symptoms yield readily to the action of the medicine, the repetition may be deferred to a period of twelve hours, and repeated at such intervals,, until amelioration or change. Stramonium is indicated by symptoms of the same nature as those which indicate Belladonna, with the addition of the following: — twitching of the muscles of the face, starting of the tendons, squinting, trembling of the extremities, tremulous motion of tongue on protrusion, burning heat of the body, suppression of the urine, fantastic gesticulations, and in- voluntary spasmodic smiling. Dose: Eight pills in a teaspoonful of w T ater every three hours, until amelioration or change. Hyoscyamus is indicated by the same symptoms as have been stated at length under the head of Belladonna, with addition of the following: twitching of the tendons, strong, full pulse, fullness of the veins, burning heat of the skin, sensation of pricking all over the body, and constant delirium; frequent but ineffectual urging to urinate. Dose: Three globules in a teaspoonful of w r ater every three hours, until the symptoms are distinctly modified or changed. Baptisia (Wild Indigo) is especially required when the w r eak and tremulous feeling; the quick (90,) full, and soft pulse; the internal and external heat, w T ith thirst ; the headache and tendency to delirium ; the tongue yellowish-brown in the center, and red at the edges ; the consti- pation alternating with diarrhoea; all contribute to make up the morbid picture ;— hot, dry skin, and a quick, full pulse: the tongue is thickly coated with a whitey-brown fur; the head aches, and t here is at least, nocturnal delirium; no appetite and great thirst; the urine is high colored, and generally with constipation. Dose: The same as directed for Stramonium. Treatment of Abdominal Typhus ; that is, Typhus with tenderness and distention of the belly, griping, or sometimes dull, continuous pain, diarrhoza, etc. Mercurius will be found a most efficient medicine, if immediately employed when the disorder assumes the low form of abdominal typhus, or occurs in persons of sluggish constitution and slow circulation, and is attended with pale, yellowish appearance of the face, severe headache, or sensation as if a tight band were across the forehead; thickly coated tongue; bitter or foul taste; little thirst; sensitiveness of the region about the navel and the pit of the stomach, to the touch, and distention of the belly ; evacuations, copious, watery, floculent, or slimy and even bloody, sometimes qualified by straining without evacuation; at first, dry burning skin followed by profuse, debilitating sweats; depressed pulse, and great 550 EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. prostration ; extreme restlessness and anxiety, with constant tossing- about in bed; and disturbed and unrefreshing sleep with anxious dreams. Dose : Six pills in a teaspoonf ul of water, every two hours, until the evacuations become diminished in number, and improved in appear- ance, and the tenderness and pain in the lower part of the stomach, etc., are relieved. After which, some other remedy^ must be selected, in accordance with the remaining symptoms ; consider Aci- dum Nitricum, amongst others. Rhus-toxicodendron is especially indicated in abdominal typhus characterized by continued heat and dryness of the skin ; violent delirium \ oppression of the heart, with sighing and moaning; pains in the limbs ; extreme debility ; tongue and lips dry and red, or covered with a brown or blackish, tenacious fur; red, burning cheeks; convulsive twitching of the tendons, snatching at the bedclothes, drowsiness or stupor, with mut- tering, and loud nasal breathing ; weak, accelerated pulse ; anxious expression of countenance ; sleep disturbed, or prevented by the frequent recurrence of sudden starts ; eyes inflamed, watery and insensible ; features collapsed; breath exceedingly offensive; involuntary evacuation of the excrement and urine ; coldness of the extremities; sinking energies ; livid spots and miliary eruption. Dose: Dissolve twelve pills in three tablespoonfuls of water, and give a teaspoonful of the solution every two hours, until three doses have been given ; then extend the intervals (or sooner, if distinct improvement takes place) to four hours, and continue the adminis- tration until the symptoms particularly indicative subside or become altered. If no alteration follow the fourth dose, or the aspect of the symptoms be as follows, proceed with the next remedy. Camphor frequently proves useful after Rhus., particularly when the following symptoms prevail; heat of the head, with confusion of ideas, or violent delirium ; giddiness ; throbbing headache ; burning heat in the forehead; cold and clammy skin ; continuous coldness of the hands and feet; debilitating and clammy sweat; tendency to violent relaxation of the bowels ; scanty, cloudy urine, which deposits a thick sediment; great weakness, and feeble, scarcely perceptible pulse. Dose : One drop of the saturated tincture on a small lump of loaf sugar every quarter of an hour, until distinct amelioration or change ; or, if themore urgent symptoms have yielded, and the following remain, proceed with the next remedy. Cocculus may often follow either Rhus, or Camphor (after the previ- ous employment of Rhus.,) especially when the great debility continues, and the patient complains of giddiness and headache ; or wmen there is a tendency to swooning or paralysis of the limbs, and when there are prominent symptoms of derangement of the digestive functions. Dose: Of a solution of six pills to three tablespoonfuls of water, give a teaspoonful every two hours, until amelioration or change. These remedies, either singly or in alternation, are amongst the most important, in cases of a desperate character, and when the most alarming symptoms occur. Arsenicum. This is decidedly one of the most important remedies in abdominal typhus, especially in the second and third stages, sometimes restoring the patient when almost beyond the reach of hope, and renova- ting the vital spark. The chief indications for its employment are:— extreme prostration of strength — falling of the low r er jaw, open mouth, dull TYPHOID FEVER. 551 and glassy eyes, bitter taste, inclination to vomit, pressure and aching at the pit of the stomach, pain in the right side of the inferior region of the belly, bursting headache, giddiness, violent or low delirium, drowsiness, flatulent distention of the bowels, burning thirst, dry. hot skin, parched, cracked, sometimes blackish-looking clammy tongue, and violent and continuous relaxation of the bowels; pulse scarcely perceptible, and inter- mittent. Dose: If singly, of a solution of six pills to three tablespoonfuls of water, give a teaspoonful every quarter of an hour (in very critical cases,) or every hour (in less urgent instances) until amelioration or change, doubling the length of the intervals as soon as distinct improvement occurs. If in alternation with Yeratrum, dissolve separately six globules of each remedy in three tablespoonfuls of water, and give one teaspoonful of the one, half an hour after a similar dose of the other (in very critical cases.) in rotation — or at intervals of one hour (in less urgent instances,; until amelioration or change. Veratrum is occasionally useful after or in alternation with Arseni- cum, when the inferior extremities become cold and covered with cold sweat. Dose: In every respect, singly or in alternation with Arsenicum, as directed for the latter remedy. Carbo-vegetabilis may also prove serviceable in very critical cases. It is indicated where we find drowsiness with rattling respiration, face pinched, sunken, and deathlike ; pupils insensible to light, pulse scarcely perceptible, and the vital power rapidly sinking; cold perspirations on the face and extremities; involuntary and offensive evacuations; deep-red urine, with a cloud floating in it, or rising towards the surface. In abdom- inal typhus, however, the more particular indication consists in symptoms of incipient ulceration, or in signs of so-called putrescency. The following symptoms are, also distinctly indicative of this remedy: burning, lancinating pains about the region of the stomach, and deep in the bowels, which become renewed after partaking of food of any kind, and are accompanied by great anxiety, excessive flatulency, and the evac- uation of burning, light-colored, fetid, watery, bloody stools, attended with painful urging; desire for salt food, and for coffee, with aversion to meat, generally, and dread of indulging the craving, lest the sufferings be aggra- vated. Dose : In every respect, singly or in alternation with Arsenicum, as directed for that remedy, above. Treatment of the Second or Active Stage in Typhus.— Whether of the inflammatory or low variety. Bryonia is more particularly indi- cated when the disorder assumes the character of inflammatory nervous fever, or typhus especially affecting the brain, w T ith violent, stupefying headache, as from a blow, and pain across the forehead and at the temples, as if the head would burst ; frequent raising of the hands to the head. Aggravation of these sensations by movement; continued, violent delir- ium, with excessive febrile heats; foul, thickly-coated, yellow tongue, or dry, cracked tongue, with pinched mouth and great thirst, and vesicles in the mouth or on the tongue; furred lips; nausea, inclination to vomit, or vomiting of mucous and bilious matter; tenderness of the pit of the stomach, when touched ; general heat of the whole body, dryness of the OOZ EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. skin, redness of the face, and profuse perspiration during the fever; sensi- bility about the region of the stomach ; distention of the belly, oppression at the chest, and frequent sighing and moaning, indicative of threatening miliary eruption; constipation, or relaxed stools; urine of a deep orange color or bright yellow, with yellow sediment ; sensation as of a plug in the throat, with difficulty of hearing; stitches in the side ; drowsiness or dispo- sition to sleep during the day ; sleeplessness, fugitive heat, and excessive restlessness, or continued drowsiness or stupor, with starlings and unpleasant dreams; painful shootings and soreness of the limbs, aggra- vated by movement; trembling of the hands; pulse quick, soft, frequent, or irregular, small and intermitting; miliary irruption, livid spots ; irrita- bility, irascibility, despair of recovery. Dose: If singly. Under very favorable circumstances, of a solution of six globules to three tablespoonfuls of water, give a teaspoonful every twelve hours. In cases which assume the more serious features, a similar dose should be repeated every three hours, until amelioration or change. If in alternation with Rhus, dissolve separately, six globules of each remedy in three tablespoonfuls of water, and give a teaspoonful of one solution four hours after the like dose of the other, in rotation, until amelioration or change. Eupatorium-perfoliatum. Pain in the bones, attended with hot, dry skin. This remedy has been highly recommended by the most success- ful practitioners, as Drs. Williamson, ISTeidhard, and others. Dose : The same as directed for Bryonia. Hhiis-toxicodendron. This medicine is more peculiarly suitable to the low form or stage, Bryonia being more applicable to the inflammatory, but will frequently be found servicable in all the stages of the disease, particularly when there is undue relaxation of the bowels, congestion to the head, oppression at the chest, and great weakness. The headache is generally of a stupefying nature, with a feeling as if from a bruise, but not so severe as that indicating Bryonia ; the tongue presents nearly the same character, less nausea and inclination to vomit exist; violent pain is present about the region of the stomach, especially when touched. Consti- pation as named of Bryonia, but more frequently copious, yellowish, or loose, bloody evacuations, with severe cutting pains in the belly; the symptoms are general heat, and those of the face resemble those mentioned under Bryonia, but without the perspiration, or at most, a clammy feeling of the skin. The urine is hot, dark colored, or at first clear, and afterwards turbid ; the symptoms of the ears the same ; sleep also the same ; difficult deglutition of solids, as if from contraction of the throat and the gullet ; general trembling, debility, and prostration, almost amounting to paralytic weakness of the different limbs ; shooting pains in various parts of the body, aggravated when at rest or at night, and momentarily relieved by moving the part affected ; pulse quick and small or weak and slow ; as mental or moral symptoms, we may notice, excessive anguish, anxiety, extreme lowness of spirits, and disposition to weep. Dose: Whether singly or in alternation w r ith Bryonia, in all respects as directed for the latter remedy above. Arnica is also of some importance in low or sluggish nervous fever, with lethargy, or delirium, and snatching at the bedclothes ; or when the patient lies in a state of unconciousness, as if he had been stunned by a concussion of the brain. TYPHOID FEVER. 553 Dose: Three globules in a teaspoonful of water every four hours, until amelioration or change. Pulsatilla is often of considerable service in the second stage of typhus, when slight delirium, tears and lamentations, alternating with drowsiness, prevail. Dose: Three globules in a teaspoonful of water, repeated, if necessary at the expiration of four hours, and so on until amelioration or change. But if any of the undermentioned symptoms declare them- selves, proceed with the next remedy. Acidum-phosphoricum is frequently required, either when, at the commencement of the disease we find great exhaustion and prostration, with wandering even while awake ; or in almost hopeless cases (alone or still better in alternation with Rhus.) when the patient is always found lying on th^back in a drowsy state, and either makes no reply when spoken to, or •; una wers incoherently ; or in other instances, and especially after the previous employment of Pulsatilla, when the following symptoms prevail: Constant loquacious delirium or low muttering ; snatching at the bedclothes ; fixed looks ; seeming efforts to escape from some alarming object; black incrustations on the lips ; dry, hot skin ; continual, copious, watery discharges from the bowels, the motions, being in general invol- untary ; bloody evacuations ; frequent, weak, and occasionally an inter- mitting pulse. Dose: Three globules in a teaspoonful of water, at first every hour, extending the intervals to three hours as soon as the symptoms are modified, and continuing the administration until positive amelior- ation or change. Or if the under-mentioned symptoms should, in particular, continue unmodified, proceed with the next remedy after a lapse of three hours from the last dose. Acidum-nitricum should be administered after or during the course of Acidum-phosphoricum, but not within less than three hours of a previ- ous dose of the latter, if the bloody evacuations fail to yield readily to the previous treatment. Acidum-nitricum is, moreover, particularly useful when there are white specks in the mouth and throat ; sensibility of the belly on pressure ; relaxation of the bowels, and slimy, acrid, greenish- colored stools; straining; intestinal ulcerations ; shooting pains in the lower bowel ; scalding when passing water ; and tendency to collapse In some cases it is necessary to administer this remedy by injec ion or enema, as below stated. Dose : Three globules in a teaspoonful of water, repeated, if necessary, after four hours (or every four hours till the symptoms yield.) return- ing to Acidum-phosphoricum, if requisite or proceeding with the next remedy, after a pause of three hours, if the under-mentioned symptoms, in particular, supervene. The enema should consist of six drops of the tincture at the third dilution to every two table- spoonfuls of water. Cawtharides should be administered after or during the course of either of the three foregoing remedies, but not within less than three hours of a dose of any other medicine, if painful evacuation of water be distinctly manifested. Dose: Three globules in a teaspoonful of water, repeated, if neces- sary, after an interval of three hours (or continuing at such intervals until the indicative symptom is positively subdued,) returning to either of the foregoing, or proceeding with other treatment, or sus- pending treatment, according to the prevalence of particular symp- toms or general improvement be manifested. 554 EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. China is sometimes of considerable valwe in the second stage of this disease, especially when the attack has become protracted and tedious: — nocturnal sweats, obstinate relaxation of the bowels, but unattended with pain in the bowels, the tongue at the same time being clean. Dose: Three globules in a teaspoonful of water, every four hours, until amelioration or change, unless, after the third dose, the sweats remain unmodified, when proceed with the next remedy, after a pause of four hours. Sulphur should follow the third dose of China, in the event of the continuance of the sweating, notwithstanding the previous administra- tion of the latter remedy. Sulphur has always been found of considerable service — Bryonia, Rhus., or Acidum-phosphoricum having been fruitlessly administered, but particularly when the following symptoms were encoun- tered : Pale and collapsed countenance, burning, itching eruptions on the lips, dryness of the mouth, foul, dry tongue; bitter taste; slimy or bilious vomiting ; tenderness of the region about the stomach, and pain as from excoriation of the parts above the navel, increased on pressure; flat- ulent rumbling in the bowels ; frequent, watery, flocculent, or yellow evacuations ; cloudy urine, depositing a reddish sediment ; miliary erup- tion ; eruption with a discharge of matter; bleeding at the nose ; stitches in the chest, oppressed breathing; dry cough, worse towards evening and at night ; sleeplessness, or whining during sleep ; dry heat during the day with moderately quick pulse, and profuse sweating at night. Dose: Dissolve six globules in three tablespoon fuls of water, and give a teaspoonful of the solution every six hours, unless, after the second dose, the following symptoms be present, when proceed with the next remedy. Acidum-sulphuricuni should follow the second dose of Sulphur after an interval of six hours, if the sweating be yet very profuse, particularly if so when lying still and modified by movement ; or it should even pre- cede either or both of the preceding remedies, if the sweating be very pro- fuse when lying still and diminished by movement. Dose: Three globules in a teaspoonful of water, every four hours until amelioration or change. Calcarea, J Calcarea-c, may sometimes be adminis- Hepar-sulphuris. > tered advantageously, alternately with Bella- Lycopodium. ) donna, Arsenicum, or Rhus., according to the symptoms ; it is further, occasionally, a most efficient remedy in cases in which debilitating relaxations of the bowels, or bleeding of the nose, will not yield to such remedies as Acidum-phosph., Rhus., China, etc.; lastly, Calcarea-c, maybe exhibited with advantage where there are symptoms of impending miliary eruption, jerking or twitchings in the limbs, particularly in children, tendency to inflammation of the mem- branes of the brain, delirium, etc. Dose: Of a solution of six globules to three tablespoon fuls of water, give a teaspoonful every three hours until amelioration or change. Or if the undermentioned symptom should declare itself, or having been previously present, should continue unmodified after the third dose of Calcarea, proceed with the next remedy, after a pause of four hours. Hepar-sulphuris should follow the third dose of Calcarea after an interval of four hours, if discharge of blood from the nose should supervene TYPHOID FEVER. 555 or, having been previously present, should continue without material improvement ; except, indeed, the presence of other symptoms of a more urgent character, should require t*he administration of other remedies, such as Pulsatilla, Belladonna, Rhus , or Sulphur. Dose : Three globules in a teaspoonful of water, repeated, if necessary, after an interval of four hours— or continued, at such intervals, if requisite, until the distinct modification of the indicative symptom. Lycopodium is often a valuable remedy after Calcarea, with or (with- out the intermediate administration of Hepar-s. according to the circum- stances. ! in the second stage of typhus, when miliary eruption is slowly and scantily developed, and the following symptoms occur; drowsiness with muttering delirium ; confounding of words ; stammering; twitching of the tendons, snatching at the bedclothes, flatulent distention of the bowels, with constipation; affections of the bladder; or when there are shiverings alternating with heat; circumscribed redness of the cheeks; debilitating sweats; excessive debility; complete hanging of the lower jaw; half-closed eyes ; slow respiration ; or, state of excitement, without heat or congestion in the head or face; redness of the tongue ; constipation ; burning urine ; tranquil and resigned state of mind, or surliness and malevolence, especially on waking. Dose: Three globules, in a teaspoonful of water, every three hours, until amelioration or change. In case of amelioration, pause until the symptoms evidently retrograde, when resume, at intervals of six- hours, as long as necessary. In the case of change, suspend treat- ment for four hours, and continue with the remedy newly indicated. Lachesis may prove serviceable in fever analogous to typhus, attended with giddiness on rising or sitting up ; muttering ; bitter taste ; delirium; hanging of the lower jaw; vacant expression of countenance ; sunken features ; yellowish tongue, with bright-red margins ; cracked tongue ; smooth, dry tongue, with diffiadty of protruding it, and inarticulate speech ; seeming paralysis of the eyelids; lethargic sleep, and tendency to lie in the prone position; thirst, with disinclination to drink; brownish-red copious urine. Dose: Three globules, in a teaspoonful of water, as directed for Lyco- podium — or if the symptoms be very urgent, begin by administering at intervals of two hours — extending the intervals to four hours after two doses have been given. Phosphorus is of great service where we find great dryness of the tongue, heat of the skin, small, hard, quick pulse, painless relaxation of the bowels, with excessive flatulent rumblings ; or when the disease becomes, as it were, concentrated in the lungs, and there is consequently congestion, with extremely laborious breathing, and excessive anxiety, dullness on percussion, mucus rattling, stitching during respiration, cough, with copious expectoration of phlegm, mixed w r ith blood or even offensive matter, more benefit may be looked for from this than from ally other remedy. Phosphorus, is also, serviceable when, notwithstanding the pneu- monic concentration, there is, moreover, sensibility and rumbling on the right side of the lower part of the belly, or when there is continued heat of skin, with small, hard, accelerated pulse, throbbing of the great arteries of the neck, and nocturnal sweats; sleep disturbed by crowding of ideas, weeping, whimpering, sudden cries, and restlessness. The patient awakes from sleep complaining of great thirst and dryness of the mouth, excessive ■556 EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. heat, and aching of the whole body. In addition to these symptoms, there is a burning- sensation in the belly and fundament, with frequent semi-fluid stools, streaked with blood; giddiness,' confusion, and throbbing pains in the head ; deafness ; frequent discharge of blood on blowing the nose, and heat in the face ; tongue and lips dry and cracked; bitter taste; copious evacuations of urine, which deposits a whitish or reddish sediment; delirium; stupefaction. Dose : Dissolve six globules in three tablespoonf uls of water, and give ateaspoonful of the solution every four hours, until amelioration or change. Acidum-muriaticiim. Weakness, with a constant tendency to sink down in the bed, with groaning during sleep, almost paralytic state of the tongue, rendering it nearly impossible for the patient to speak, even when in a collected state, and great dryness of the mouth. Dose: Of a solution of six globules to three tablespoonf uls of water, give a teaspoonful every three hours, until amelioration or change. Natrum-ninriaticum is recommended in nervous fevers with great debility, insatiable thirst, dryness of the tongue, and loss of conciousness, and particularly, when they follow in the course of antecedent debilitating diseases. Dose : Of a solution of six globules to three tablespoonf uls of water, give a teaspoonful every three hours, until amelioration or change. Helleborus has, also, been found of great utility in nervous fever, occurring after other febrile affections, such as scarlatina, measles, stom- achal fever, worm fever, and cholera, with pain as from contusion, com- bined with tumefaction in the integuments of the head; disposition to somnolency, with confusion of ideas, and extreme restlessness ; dark, cloudy urine; heaviness, or feeling of stiffness and powerlessness in the limbs; depression of spirits, and obtuseness of the faculties. Dose: A solution of six globules, as directed for Natrum-muriaticum. Secale-cormitum is, in like manner, with Natrum-m. and Helle- borus, recommended by many homoeopathists who have had frequent opportunities of treating nervous fevers, particularly, in cases occurring in the wake of other diseases; but is more especially, appropriate where the symptoms developed clearly proceed from irritation of spinal nerves with wandering, fugitive, spasmodic .pains, extending from the base and column of the spine into different parts of the body; the spasms which affect the face become subsequently of an intermittent nature ; whilst those that have their seat in the hands and feet partake of a continued character. This remedy is, further indicated by dry heat of the skin, insatiable thirst, accelerated pulse, great restlessness and sleeplessness; excessive languor, and aversion to food. Should the spasmodic affections readily yield to the employment of this remedy, but if the febrile symp- toms continue, some other remedy appropriate thereto must be pre- scribed. Dose : Dissolve six globules in three tablespoonf uls of water, and give a teaspoonful of the solution every three hours, until amelioration or change. Arsenicum. ) These remedies are of signal importance, either Veratmnn, v singly, in succession, or in alternation according to the Carbo-veg. ) individuality, succession, or com b ina tion, of the symp- toms present, in the second stage of typhus, in all desperate cases in which TYPHOID FEVER. 557 vitality becomes nearly extinct. For distinctive indications, the reader is referred to the foregoing prescription of these remedies, under the head of Abdominal Typhus. Dose: If singly, of either remedy: Dissolve six globules in three tablespoonf uls of water, and give one teaspoonful of the solution every quarter of an hour (in ver\ critical cases,) or every hour (in less urgent instances,) until amelioration or change, doubling the length of the intervals as soon as distinct improvement ensues If in alternation, dissolve, separately, six globules of the remedies to be used alternately in three tablespoonfuls of water, and give a tea- spoonful of one, half an hour after a similar dose of the other (in very critical cases),, in rotation, or at intervals of an hour (in less urgent instances) , until positive amelioration or change, doubling the length of the intervals as soon as a degree of improvement is evident. Carbo-veg. In addition to the indications given for this remedy, under the head of Abdominal Tyhfus, the following symptoms are characteristic of its employment in the second stage: excessive anxiety, and burning heat of the skin, arising from congestions to the head and chest; the eyelids agglutinated during the night; deafness and ringing in the ears; bleeding from the nose, and obstruction of the nose from incrusta- tions, eruption around the nose, and brown or blackish, cracked lips; the legs drawn up during sleep, and the sleep restless, and disturbed by frequent waking. Dose: Three globules in a teaspoonful of water, every three hours, until amelioration or change, when thus specially indicated; when, as above, singly, or in alternation, the dose should be as directed under the last head. Treatment of Typhus Characterized by Stupor. In treating of this variety of the malady, it will be unnecessary to recapitulate the remedies already enumerated, in relation to the various stages and vari- eties hereinbefore described. Suffice it to say, that -the same featwes and conditions would indicate their employment in this variety, and that the method of administration should be, in every respect, similar. But the symptoms which more particularly distinguish this species of typhus, especially indicate, by assimilating most closely to the specific opera- tion of. Opium. This remedy should accordingly be given when the follow- ing group of symptoms prevail: great drowsiness or lethargy, with stertorous breathing;, open mouth, half-closed. eyes or fixed look; slight delirium or muttering, snatching at the bedclothes; the patient being in a continual state of stupor, from which it is extremely difficult to rouse him, and from which he is scarcely aroused before he relapses into his former state; furious delirium, and incessant restlessness; dry, offensive stools, with involuntary evacuations of excrement and urine. Dose: Of a solution of six globules to three teaspoonfuls of water, give a teaspoonful every three hours, until amelioration or change. Treatment of the Stages of Debitity and Convalescence After Typhus. Hhus-toxicodendron. This remedy retains its importance in the treatment of typhus throughout all the stages of the malady, and is amongst the best appliances during the period of debility, which generally supervenes after the issue of this fever. Rhus, is more •558 EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. especially indicated in this stage, when the progress towards recovery is sluggish, the pulse retaining a febrile character, the appetite, although improved, being capricious, the bowels predisposed to relaxation, and the chest not yet exempt from feelings of oppression. Dose: Three globules, in a teaspoonful of water, night and morning, until distinct amelioration or change. Upon evident improvement taking place under this treatment, it will be sufficient to repeat the dose every night. China is frequently of great use in this stage, against the debility resulting from the effects of the malady, more especially when the patient has suffered much from violent relaxation of the bowels during the previous course of the disease ; or if there be a tendency to continuance in this symptom. China is, also, particularly useful when debilitating sweats supervene. In this case it should be followed by Sulphur, if that symptom has not yielded distinctly, after the second dose. Dose: In the case first described, three globules, in a teaspoonful of water, repeated, at intervals of twelve hours, until three doses have been taken. Under the last-stated circumstances, a similar dose, night and morning, and if the symptom does not distinctly yield within twelve hours after the second dose, proceed with the next remedy. Sulphur should follow, twelve hours after the second dose of China, in case of the obstinate continuance of the sweats, or of the presence of dry cough at night. Dose: Three globules, in a teaspoonful of water, every twelve hours, until amelioration or change. Ferrum-metallicum is a preferable remedy when the pulse contin- ues weak or frequent, after a profuse discharge of blood, particularly in the case of females affected with green sickness, or who have previously suffered from it. Dose: Three globules, in a teaspoonful of water morning and evening, for a week. ACCESSORY MEASURES DURING THE PERIOD OF DEBILITY. The fever having subsided, and the patient being able to sit up, should first be removed to another apartment, free ventilation and a moderate degree of warmness being simultaneously secured. By degrees. and as soon as possible, passive motion, and from thence, if possible, walking exercise (not sufficient to exhaust the patient), should be daily sought in the open air, in fine weather, with, however, particular precautions against damp or chill. Nothing will conduce to restore the patient to health and strength more rapidly and thoroughly than such accessory treatment, with proper precautions in respect of diet, as stated below. AFTER EFFECTS OF TYPHUS. Bed-sores, Abscesses, Boils, Swelling of the Feet, Weakness of Digestion, and General Derangements. These are more or less frequently the results of very severe or protracted cases, especially when the reactionary process is sluggish, and require simultaneous local and constitutional treatment, with this reservation : that when the local application is untneclicated, (such as pure spirits), we may select the constitutional remedy, irrespec- tive of such application, according to the particular features of the ease. YELLOW FEVER. 559 by consulting the symptoms present, and the article on "Boils" and "Abscesses,'' as regards those particular affections. External Treatment of Bed-sores. Spirits of Wine, Col- lodion or Glycerine will, in general, suffice to remove this trouble- some affection. Application: To one part of the Spirit, add two parts of pure water, and saturate with this solution a linen pad, which must be applied to the parts and kept moist. Arnica (tincture) should be employed, if the diluted Spirit has proved insufficient and inflammation has not supervened. Application: To one part of the Tincture, add twenty parts of water, and proceed as directed for Spirits of Wine. Tincture of Carbo-veg., ) When mortification Tincture of Arsenicum, \ supervenes we may suc- Tincture of Cinchona (concentrated., ) cessfully employ either of these remedies (according to symptomatic indications,) simultaneously with the internal administration of the same medicine, as stated below. Application: To a wine-glassful of water, add five drops (of the Tinct- ure of Arsenicum,) or ten drops (of either of the others,) and saturate with this solution a linen pad, which apply to the parts and keep moist. YELLOW FEVER. In this article we have quoted freely from the report of that commis- sion of eminent physicians, appointed in 1878 by the oldest National Medical Association in America. This commission was composed of eleven of the most thoroughly educated physicians in the United States, seven of whom were experts in this disease in all its phases. Causes and Prevention. Yellow fever is a specific disease, entirely independent of malaria, occurring rarely a second time in the same person. It is infectious and capable of transmission to any distance by means of fomites or infected material. The yellow fever germs, for we accept provisionally the germ theory of the disease, are indigenous to the West Indies, and, perhaps, to the west coast of Africa, and have been thoroughly naturalized in many localities in the southern portion of the United States. They were imported into New Orleans during the last quarter of the eighteenth century, and have existed in the soil or atmosphere of that place ever since, either in a latent or an active condition. They may lie dormant for many years consecu- tively, and they require a concurrence of causes to develop them into a state of disease-producing activity. Some of the factors which seem to be favorable to the excitation of the yellow fever germ, are the following: Low, swampy ground, near the level of a tropical sea. Long continuance of very high temperature, following heavy rains. Long continuance of south and east winds. Aggregations of human beings, with the excreta of their bodies in a small space. A crowded and dirty ship may be a nidus for yellow fever, as well as a crowded and dirty city. Long continuance of calm weather, unbroken by thunder-storms. 560 EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. Exposure of decaying vegetable and animal matter to a burning sun. Inefficient drainage and the general accumulation of filth, especially the city garbage. Deficiency of ozone in the atmosphere. Pestilential exhalations from an upturned soil. When the yellow fever germ has been waked into activity by these causes, it may be transported to places where none of them exist. It seems that a certain concurrence of several of the above factors is neces- sary to the generation of yellow fever. There is probably one combina- tion in one epidemic, and a somewhat different combination in the next epidemic. An epidemic may be mild or severe according to the number and force of the concurring causes. There may, also, be other unknown but discoverable factors, which may be necessary at one time to produce an epidemic, and not necessary another. No one of the above suggested causes could excite an epidemic by itself, and it is not probable that they all ever concurred equally to the formation of the disease. The most extensive collections and comparison of facts are necessary to illumine the very great darkness which lies upon these complex questions. The naturalized yellow fever germs may receive 'so slight a stimulus as to produce only a few sporadic cases. Or they may be vitalized in certain localities to such a degree as to occasion quite an outbreak in those localities, not easily communicated to other quarters. Or thirdly, the disseminated germs may be vivified in all directions, and a general epidemic excited. Or lastly, the naturalized germs may lie entirely quiescent, until fresh and active germs are brought in from foreign ports, which then act as sparks to ignite the inflammable material already existing. We thus have four shades or degrees of yellow fever visitation : sporadic cases ; local and limited outbursts; epidemics from naturalized germs ; and epidemics from importation. In sporadic cases and limited outbreaks the specific nature of the fever is not clearly brought to light, and it is sometimes difficult to diag- nose it from the dominant malarial or bilious diseases. The imported epidemic, whether from Havana to New Orleans or from New Orleans to Memphis, etc., etc., is always a more quick-spreading and malignant disease than that arising from our naturalized germs The comparative mildness of the late epidemic in New Orleans, is one out of several reasons for believing that the disease was of local origin. The yellow fever of domestic origin can only be prevented by local sanitary measures. So long as the public authorities ignore the crying- evils at home, and watch only for the enemy at the seaside, we shall continue to be scourged with repeated epidemics of yellow fever. Quar- antine may or may not keep out the tropical foe, but our utmost energies should be concentrated against the enemy which has been domiciliated in our households for nearly a century. Is there any personal prophylatic against yellow fever? None which has the least scientific value. Quinine is probably serviceable when malarial fevers are simultaneously prevailing, not because it has any power against yellow fever, but because an attack of malarial fever, pre- ventable by Quinine, might, if allowed to occur, precipitate an attack of yellow fever. YELLOW FEVER. 561 Quinine for intermittents, Belladonna for scarlet fever, and vaccina- tion for smallpox, are the only prophylactics which have commanded even the partial belief of the profession. They are all confessedly homoe- opathic in their actions, and we confidently believe, if prophylactics for yellow fever or any other disease exist, that they will be found only by study and experiment in that direction. 11 To prevent the development of yellow fever we recommend: 1st. The thorough drainage of the city. This mighty work can only be efficiently achieved by the general government. Whether that would be constitutional or not we need not pause to inquire. An intelligent people will some time or other so modify their government, that it shall recognize the superior claims of the health and lives of its population over those of railroad companies and harbor improvements. As is well known the topography of New Orleans presents very considerable difficulties in the way of a perfect system of drainage, but not such as to be insuperable to engineering skill. 2d. The constant irrigation or flushing of the street gutters and canals by fresh water pumped in daily by steam apparatus. Allied to this meas- ure is a perfect system of water works, which shall give an abundant supply of river water for drinking, bathing and cleansing purposes, so as to supersede the use of cistern water almost altogether. In this connec- tion we may mention a curious fact communicated to the Commission by Mr. Harry Hammersly, who keeps a floating bathing establishment in the Mississippi river. One hundred and fifty boys under twelve years of age took one, and some of them two baths a day during the whole sea- son, and not one of them had the yellow fever, although it prevailed ex- tensively among their families, and children of that age were peculiarly liable to it. 3d. The consumption of all the city garbage by cremation. This new process has been extensively experimented upon during the last six months in the city of Xew York, and with extraordinary success. The plan has been described to us by Dr. George F. Foote, of Stamford, Con- necticut, a brother of the inventor. A single large furnace has been so constructed as to consume 1,000 loads in twenty-four hours. The garbage is not handled, but dumped immediately from the carts into the furnace. The combustible material mingled with it — old rags, paper, straw, vege- table debris, unburnt coal in ashes, the sweepings of stores, factories, streets, etc., is about a sufficient supply of fuel for the whole work, when the fire is once started under a full blast. The gases from the combustion — carbonic oxide and carburetted hydrogen — are brought under the boiler and again burned to generate steam to drive the blowing engine. The expense for fuel is light ; there is no escaping odor, and the residue or slag, about eight per cent, by weight, can be made available for useful purposes. One such furnace in each district of Xew Orleans would consume daily every atom of its garbage, deliver it from every pestilential emana- tion and odor, and give its atmosphere something like the sweetness and purity of mountain air. Xor will it be many years, in our opinion, before the people of Xew Orleans, who are compelled by the nature of the soil to bury their dead above ground, will discover that in their case, at least, 36 562 EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. cremation is the very best disposition to make of the human body, when the principle of life has abandoned its tissues. 4th. The generation of ozone to supply its deficiency in the atmos- phere when detected by the proper instruments. This should be made one of the most special and important duties of the Sanitary Commission. Ozone is a peculiar gas, a modified form of oxygen, generated by electri- cal storms and violent concussions of the atmosphere. It is so powerful as a disinfectant, that one part of it will purify three million parts of at- mospheric air. Ozone is thus nature's great disinfector and purifier, more subtle, powerful and ubiquitous than all others, and we must learn to utilize this splendid gift of the Creator for our own sanitary blessing. When it is deficient, deleterious gases accumulate and produce diseases of various kiuds, and when the other factors of yellow fever productions are present, the deficiency of ozone may be t*he determining element for the manifestation of the disease. The scientists of the Sanitary Commission will be provided with the instruments and chemical means for detecting its slightest variation, and for restoring it in suitable quantity to the air, where, by the law of the equitable diffusion of gases, it will be almost in- stantly distributed many miles around. There are many measures of great sanitary importance over which the Commission would exercise a strict supervision. It would enforce the frequent emptying and disinfection of water-closets, sewers and all places containing putrescent matters, vegetable or animal. It would see that no sacks of decaying coffee, or chaff in rice pits, or dead animals, or any offensive matter was left exposed so as to poison the atmosphere. It would prevent, so far as possible, the destruction of trees, and in every way encourage their planting and growth. Above all, it would forbid the upturning of the soil during the spring and summer months, as epi- demics of yellow fever have followed such upturning at Xew Orleans, Xatchez and Vicksburg, in such a manner as very strongly to suggest that the relation of cause and effect existed between this exposure of the earth :and the development of the disease. YELLOW FEVER ITS SYMPTOMS. This fever is a disease of warm climates, and has obtained the name of yellow fever from the hue which the skin of those affected by it very frequently acquires. The more constant symptoms of the disease are : violent vomiting, first of bilious and subsequently of brownish-black matter, which is also passed by stool; great anxiety and prostration, intense fever. Remarkable remissions take place in the course of the fever, succeeded in a few hours by exacerbations. The outbreak of the malady is generally preceded by sudden debility and restlessness, which are soon followed by headache, giddiness, faintness, and slight chilliness, to which are added precordial oppression, want of appetite and deranged digestion. In other cases, the seizure is sudden and unattended with premoni- tory symptoms; and the course of the disease exceedingly rapid, and a fatal termination not unfrequent within thirty-six hours from the acces- sion of the attack. The more usual form which the disease takes is, however, as follows ; Immediately after the fit of chilliness and horror, violent reaction sets in, announced by a high degree of fever, with YELLOW FEVER. 563 great heat of skin, strong throbbing of all the arteries of the body, and determination of blood to the head. The respiration is hurried and often laborious, attended with deep sighing and gasping for air. The face is flushed, the eyes heavy, sensitive to light, and affected with burning pain, the tongue white, furred, and sometimes red, but soon becomes parched and dark-colored, and tinged with yellow after the vomitings come on ; the thirst is excessive. A burning pain is sometimes experi- enced in the pit of the stomach ; an excessive sensibility to the touch in the right side; and the stomach, irritabie from the first, is rendered so much so as the disease advances, that everything which is taken into it is almost immediately rejected, along with a quantity of bilious matter. Severe darting pains traverse the head, the small of the back, and even extend down the thighs. The pulse is subject to variations, being in some cases quick and strong, in others quick, low and irregular ; in pleth- oric individuals, who have not been long exposed to the relaxing effects of the warm climate, it is accelerated, full and bounding, for some hours after the development of the reaction ; the urine is suppressed, or scanty and offensive; the stools, likewise, have a most disagreeable fetor; the patient is excessively restless, tormented with spasms in the abdomen and legs, and tosses about with anguish. These symptoms constitute the first or inflammatory stage of the fever, and may continue from twenty- four to sixty hours, and upwards, according to the severity or mildness of the attack. The second stage commences with the abatement of several of the preceding symptoms, and the increase or substitution of others. The skin and eyes present a yellow tinge; the head is confused, or delirium super- venes, and the eyes look glassy. The fits of vomiting are more violent, and the matter ejected becomes thicker and darker; the patient occasion- ally drops asleep, but instantly awakes in a fright, and sometimes he springs out of bed in a state of furious delirium, but instantly sinks to the ground in a state' of tremor and exhaustion; the pulse flags, but is some- times soft, at others high ; the tongue is generally parched, harsh, and discolored, but sometimes moist, and covered with a dark fur ; there is frequent hiccup, and the skin is soft and clammy. The duration of this stage is also variable ; rarely, if ever, longer than forty-eight hours, some- times only twelve. The first and second stages terminate by a remission of the more alarming symptoms, and a hope of recovery is entertained, but it is too often doomed to disappointment by insidious degeneration of the disease into the third stage, in which the pulse sinks, becomes irregular and intermittent, yet sometimes increases in frequency; the vomiting becomes incessant, and is attended with great straining and noise, from the violent belching of flatus ; the matter vomited is grumous, resembling coffee grounds, and is named the black vomit. The breathing becomes more labored; the tongue black, or shrunk, dry, and red; the eyes hollow and sunk, and the features shortened. A gradual aggravation of the symp- toms then ensues, attended with startings or twitchings of the tendons, the limbs become deadly cold, and the hiccup distressingly constant. Hemorrhage, or oozing of the blood takes place from different parts of the body; the urine is deep-colored, the stools black or sanguineous; theabdo- 564 EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. men often tense and tympanitic; varices make their appearance, and death slowly or suddenly terminates the scene. ALLOPATHIC TREATMENT. This disease is one in which the treatment must be directed to guiding the patient through it, as in typhoid fever. The fever is self-limited, and will run its course. The room should be managed as directed for typhoid fever. Disin- fectants should be used as directed for that disease. A very essential point in all cases, whether mild or not, is to keep the patient in bed. This cannot be too strongly insisted on, from the first slightest indisposition. During the first stage, the use of water should be resorted to, tc moderate the intensity of the fever. Preference should be given to the wet sheet or cold sponging. They should be managed in the same way as directed for typhoid fever. If there is perspiration, (sweating,) bathing is not to be followed at all. It is recommended by good authority to give three grains of Quinine, three grains of Dover's Powder, and three grains of Calomel, every two or three hours, while this stage of the fever lasts. (The writer would omit the Calomel.) It is also recommended, if the skin continues hot and the fever high, to produce its reduction with Aconite. Sixteen drops of the Tincture in four ounces of water in doses of a teaspoonful, every half-hour, may be given until a reduction in the fever is produced. It may then be given every hour or two to maintain its effect. It certainly is appropriate, if the treatment with water is not satisfactory. Purgatives are generally given in the beginning of the disease, but they seem uncalled for, except for the relief of constipation, for which Castor Oil is to be preferred, in doses of a desertspoonful to a tablespoonful, mixed well with an equal quantity of Glycerine and flavored with Oil of Cinnamon (or Gaultheria,) or recourse should be had to injections. Regarding the use of Calomel or other mercurials, it is difficult to see what benefit can accrue from them, further than their action as cathar- tics, the use of which has just been discussed. Emetics are not to be given, but all stomach troubles should be met by proper palliatives. The nausea and vomiting, by the use of Opium to the extent of relieving the pain, when, if the vomiting continue, the addition of Carbolic Acid, or Creosote, in doses of one drop, or ten to twenty grains of Sub-Nitrate of Bismuth, or five-drop doses of Dilute Hydrocyanic Acid may be given every hour or two, until the vomiting is relieved. Small lumps of ice may be swallowed. Mustard plasters, dry cups, or small blisters, two inches square, may be applied over the stomach. "Warm poultices over the stomach often relieve the nausea and pain. Probably as appropriate a way to administer Opium as any, is by the hypodermic injection of a sixth of a grain doses of Morphine, or injec- tion of a teaspoonful (dram) of Laudanum in an ounce of thin starch, in- to the bowel. The drug should be given at any time when necessary to relieve suffering. The ordinary dose may be given by the mouth, as one- fourth of a grain of Morphine. Any coldness of the extremities should be met by the application of heat by the hot foot-bath, made stimulating by adding Mustard or Cay- YELLOW FEVER. 565 -enne pepper, and Mustard plasters. The bath should be given under the bedclothes. In this way the tendency to internal congestion, upon which may depend the tendency to hemorrhage, is relieved. Cold to the head, by means of cold water, the ice cap, or bladders of pounded ice, may be used to relieve headache. As soon as the amelioration of the symptoms (usually temporary) occur at the close of the second or third day, particular attention must be given to nourishing the patient and keeping him quiet in bed — perfectly quiet, and carefully covered with blankets. Bathing and all other means of reducing the fever should cease. Food and alcoholic stimulants must be given, as directed in the treat- ment of typhoid fever throughout the course of the disease. By this means alone life may be saved. Beginning at the period of amelioration in the symjrtoms, tonic doses of Quinine, from two to three grains four times a day, should be given. The mineral acids are indicated the same as in typhoid fever, prefer- ence being for the Aromatic Sulphuric Acid, on account of the tendency to black (hemorrhagic) vomit. The dose is ten drops largely diluted with water. It can be given at intervals of two hours or more. The teeth should be wiped with a cloth dipped in a solution of Bicarbonate of Soda .after giving the acid to prevent injury to them from the Acid. To prevent hemorrhage into the stomach, and consequent black vomit ten or fifteen-drop doses of the tincture of the Chloride of Iron should be given four to six times a day, largely diluted in sweetened water. If hemorrhage occurs ten-grain doses of Gallic Acid should be given in the Acid mixture, until that symptom disappears. Difficulty in the secretion of urine should be met by diuretics, as the infusion of Digitalis in doses of a tablespoonful, or the Tincture in doses of half a teaspoonful with half a teaspoonful of the Vinegar of Squill, given four to eight times a day. If diuretics are inoperative, and especially if there are symptoms of uremia, (poisoning by retention of urea, an ingredient of the urine, in the blood,) the smell of Ammonia in the breath, or insensibility, the hot air bath should be used to produce copious sweating. If this does not relieve, a cathartic of one or two drops of Croton Oil or a quarter of a grain of Elaterium in Glycerine may be given. When the symptoms of remittent or intermittent fever are associated with yellow fever the first remission or intermission should be seized upon for giving thirty grains of Quinine at a dose. Subsequent treatment of these complications should be as directed for these diseases. Salycilic Acid has been used by Dr. Buenz, of Savannah, in the epi- demic of 1876, in a single dose of a dram and a half in capsules, or rubbed up with sugar ; if the stomach rejected it, twice the quantity (three drams) was given by the rectum (injections into the bowel.) Out of one hundred and seventy-nine patients only four died. The disease during that epi- demic was of intermittent and remittent type. Whether this treatment is generally applicable is a question as yet undecided. During the severe epidemic of 1878, in the Southern states, Dr. Mar- shall of Burlington, Iowa, who was then at Jackson, Miss., states while the disease was almost universally fatal, wonderful results were obtained 566 EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. by treating patients on the general principles appropriate to fevers which must run their course, which we have just sketched. The bowels were* kept open and the kidneys active by the use, from the beginning to the- end, of the Hyposulphate of Soda. An ounce of this salt was dissolved in eight ounces of water and a tablespoonful given every four hours. The patient was kept well covered with blankets and a gentle sweating encour- aged by the use of Orange Leaf or Horse-mint tea. Besides this, keeping the patient in bed during the stage of calm, and giving liquid nourishment and stimulants and tonic doses of Quinine, constitute the treatment. An almost universal fatality was reduced to a fatality of one in ten in whites, two in fifteen in mulattoes, and one in thirty-six in negroes. Getting up, or eating solid food of any kind during the disease, which patients desire to do during the stage of calm, is almost always fatal. HOMOEOPATHIC TREATMENT. All through this work numerical comparisons have been steadily avoided, but on account of the thorough reliability and the broad extent of country covered, we think we may be excused for thus presenting these statistics, when it is so evident that it will be the means of saving very many valuable lives. The treatment here fol- lowing has been thus proven, and if these remedies are given in time (as they will be where this work is owned) and the full directions followed the deaths from this terrible destroyer and foul plague of all hot climates will, we confidently believe, be reduced below three per cent of all persons attacked with the disease. We quote again from the before-mentioned report : On analyzing the reports handed to us, we ascertained the following facts : We have here 1,945 cases of yellow fever treated homceopathically in the city of New Orleans, with a loss of 110 patients, a mortality of 5 6-10 per cent. We have 1,969 cases of yellow fever treated in cities and towns outside of New Orleans, with a loss of 151 patients, a mortality of 7 7-10 per cent. This makes a total of 8,914 cases of yellow fever, treated homoeopath- ically, during the epidemic of 1878, with a loss of 261 patients, a mortality of 6 6-10 per cent. We have, moreover, reports of 555 cases treated homceopathically in the great epidemic of 1853, with a loss of 33 patients, a mortality of 6 per cent. Also, reports of 2,100 cases treated during the several minor and much milder epidemics which occurred between 1853 and 187S, with a loss of 66 patients, a mortality of 3 7-10 per cent. Making a grand total of 6,569 treated by homoeopathic physicians, with a loss of 360 patients, a mortality of 5 4-10 per cent. The number of cases reported as occurring in 1878, among negroes, including mulattoes, was exactly 900— with a loss of 27 patients, a mor- tality of 3 per cent. Some physicians did not distinguish between their patients as to race- or color. The number distinctly reported as white, was 2,299, of whom 194 died, a mortality of 8 4-10 per cent. This includes the returns from points like Memphis or Chattanooga, where the fever was very malignant,. YELLOW FEVER. 567 and the mortality very great. In four of the New Orleans reports, 1,076 patients are described as being white, of whom 66 died, a mortality of 6 1-10 per cent. The number of cases distinctly reported as colored in the city of New Orleans, was 107, of whom 3 died, a mortality of a little less than 3 per cent. The total number of cases reported as being under 15 years of age, is 1,089, of whom 4S died, a mortality of 4 4-10 per cent. The total number of recoveries after black vomit, was 125. This dreaded symptom, formerly considered so fatal, has been growing less and less so since the epidemic of 1853, and a great many recoveries have been recorded during the great visitation by gentlemen of both Schools. Chil- dren seemed to have it more frequently in proportion to numbers, and to recover from it more readily than adults. We must not forget that there are various shades and degrees of black vomit. Blood more or less black- ened by the acids in the stomach, may have been quite healthy when exuded from the mucous membrane of that organ, and be far less prog- nostic of danger than that sooty, coffee-ground substance, the genuine black vomit, which shows under the microscope a chemical destruction and disintegration of the blood-globules. Among these returns are nine papers to which we attach especial value These comply fully with the request of the circular letter, to give not only cases and deaths, but the name, age and address of every patient attended, so that with these documents in our hands, we can verify every statement, and challenge comparison with any member of the Allopathic School who can furnish us with similar acurate data. These returns exhibit an attendance upon 2,010 cases of yellow fever, with a loss of 129 patients, a mortality of 6 4-10 per cent. There were 64 recoveries after black vomit. The number of children under 15 years of age amounted to 828, of whom, only 40 died, a mortality of 4 6-19 per cent. HOMOEOPATHIC TKEATMENT. Aconitum has been named as the most direct and positive remedial agent in the early stage of yellow fever; and, indeed, its specific effect upon the human economy in a healthy state, especially under conditions of temperature provocative of the generation of fevers of this kind, tends greatly to confirm this opinion. In case of an attack of fever of an inflammatory character, whether it be apprehended that it may resolve itself into this form or not, the prompt administration of Aconitum can only have been productive of benefit. Dose: Six pills in a teaspoonful of water, or dry on the tongue, repeated, after the lapse of one or two hours, and subsequently, at intervals of one, two, three and four hours, until the fever symp- toms abate, the breathing becomes less laborious, and the pulse more regular, or less quick and frequent. But if symptoms of severe exacerbation should threaten to succeed, notwithstanding the admin- istration of Aconitum, proceed promptly with such of the following medicines as may offer the closest analogy to the case. Belladonna may prove of much service after the previous adminis- tration of one or tw r o doses of Aconitum, for the treatment of those cases (during the first stage) which attack young, full-habited subjects, with very marked and predominant brain-symptoms. It is useful'in the first or second stages. Dose : As directed for Aconitum. 568 EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. Bryonia may be called for in the first, or even in the second stages, where Aconite or Belladonna have not sufficed to allay the symptoms. It is more particularly indicated when the pains assume a rheumatic charac- ter, and all the symptoms are aggravated by motion. Dose : As directed for Aconitum. Arsenicum* Faintness, depression, nausea with intense burning in the region of the stomach, increased by pressure ; violent vomiting of brown turbid matter, mixed with mucus, and sometimes stained with blood. Pulse small, frequent and irregular ; skin cold and clammy in the stage of collapse, at other times it is very hot; breathing feeble and accom- panied with sighing; great nervous irritability ; intolerable pain in the bowels, with dark, or bloody stools; great emaciation; want of sleep, urine scanty, high-colored, and passed with an effort; delirium; jerking; coma; convulsions; thirst frequent, but usually for the moment satisfied with a small quantity of water. Dose: Six pills in a little water, or dry, every one to three hours, or in severe cases, every ten or fifteen minutes. Crotalus has been employed in some cases with very marked success, all danger having been subdued after a few hours, even in cases which had reached the fully developed third stage. It is more especially indicated by the hemorrhages occurring from the oyes, nose, mouth, ears, stomach and bowels. Dose : As directed for Arsenicum. Agentuni Nitricum, has been employed in some cases, with good effect, where the patient is sinking, the vomiting becomes worse, with brownish stains in the matter ejected, or other evidence is given of effu- sion of blood upon the mucous lining of the stomach. Dose: As directed for Arsenicum. Pulsatilla. Mercurius, Nux-vomica, Acid-nitricum, and China may prove of service in the first or second stages, more particularly, and Cantharis, Digitalis, Carbo-veg.,Croton-tiglum, Rhus-tox., and Veratrum- album, in the second and third stages, more particularly. The selection should be guided, in each case, by the analogy existing between the symptoms of the disease, and those which are specific to each of these medicines, as found by the appended " Repertory." ASIATIC CHOLEBA— MALIGNANT CHOLEBA— EPI- DEMIC CHOLEBA. This virulent disease generally commences with giddiness, headache, singing in the ears, and uneasiness, a sensation of flatulence in the stomach, (rumbling of wind), or griping pains, rapid loss of strength, and a feeling of weight and oppression in the region of the heart. In the severest forms of the malady, the patient suddenly falls senseless to the ground, as if struck by electric fluid. But in many instances, diarrhoea is the first symptom, which, if neglected, soon becomes associated with vomiting, severe colic, cramps, or convulsions, anxiety, and dread of disso- lution, which appears to be inevitable. In some, though not all, cases of Asiatic Cholera, we find the lips, nails, and sometimes the whole skin, of a blue color, but, in almost every EPIDEMIC CHOLERA. 569 instance, the frame loses its power of generating heat, the pulse and pulsa- tion of the heart are almost unfelt, and the circulation of the blood becomes stagnant. Patients who have outlived the second stage sometimes fall victims to a secondary typhoid fever in the third. Predisposing Causes. — The predisposing influences are: intemper- ance in eating and drinking, insufficient of or cold, indigestible fruit and crude vegetables, cold drinks, when the body is overheated; exposure to exhalations from decayed vegetable or animal matter, residence in low, damp, dark, ill-ventilated dwellings; excessive fatigue, suddenly suppressed perspiration, sudden mental shocks, or moral emotions, as fright, fear, grief, and especially passion ; neglect of cleanliness, both personal and domestic ; constitutional debility, serious derangement of the digestive organs, weakness of the bowels, etc. As any, or, at all events, several of these in conjunction, tend to favor the invasion of the disease, they ought, when practicable, to be carefully guarded against or removed. Exciting Causes.— These are generally said to depend upon some peculiar atmospheric conditions. But it is to be remarked, that such atmospheric conditions, (properly so called, in contra-distinction to the many other immediate causes of disease, with which the atmosphere may be impregnated), do not appear, necessarily, to involve whole regions, or even extensive tracts of country. Cases are not wanting, especially in tropical climates, in which this disease, in all its distinctive features, has occurred, almost in isolated instances, or has been confined to particular spots. ALLOPATHIC TREATMENT. In the treatment of epidemic, or Asiatic cholera, this much appears to be settled, that upon the appearance of the diarrhoea, (cholerine,) which is preliminary to the disease, the patient should take to his bed, and remain there; this is essential to success. The remedy which is best suited to control the preliminary diarrhoea, is Opium. Strychnine, Sulphuric Acid, Chloroform, and Camphor, have been found useful. The following formula is found useful during this stage: Take a fourth of a grain of the Sulphate of Strychnine, Aromatic Sulphuric Acid half an ounce, Sulphate of Morphine two grains, Camphor Water three and a half ounces. Mix; a teaspoonful, icell diluted, may be given every one, two or three hours', according to the severity of the diarrhwa. The plan of checking the diarrhoea by a full dose of Opium, varying from a quarter of a grain, to one grain of Morphine, according to the severity of the diarrhoea, is a good one. The continued use of the above mixture would then be appropriate. But a return or increase of this symptom, (diarrhoea,) should be met with another full dose of Opium after an interval of not less than an hour. The bowels should move in a bed-pan, the patient not being allowed to rise to stool. The stools should be buried, and the vessels thoroughly washed and disinfected by keeping a solution of Permanganate of Potash, or Carbolic Acid, in them. The floor may be sprinkled with Labarraque's Solution, or a solution of Carbolic Acid, one part to forty of water. 570 EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. The food, when there is diarrhoea, should be composed of farinaceous articles, milk, and beef tea. The drink may be Sulphuric Acid Lemonade, using for a change, and to gratify the taste, plain water, cold tea, or milk and water. Hot poultices, or mustard plasters, may be applied to the abdomen to relieve pain. When vomiting and purging occur, there appears to be no remedy more generally useful than Chloroform, given in doses of five to ten drops every half hour, or hour. It relieves the vomiting, pain, and spasms. Lint, saturated with Chloroform, laid over the stomach, and covered with oiled muslin, will aid in controlling the vomiting. The use of Chloroform may be continued in five to ten drop doses, or teaspoonful doses, of Spirits of Chloroform, (Chloroform one part to Alco- hol twelve parts,) every half hour, or hour, may be continued, either of which may be given in teaspoonful doses of Camphor Water, which will give the beneficial effect of the Camphor. The benefit of that variable mixture called Chlorodyne depends largely upon the Chloroform it contains. Brandy, or Whisky and water, should be given as freely as the stomach will retain them, in small quantities at a time. The thirst may be relieved by water, rendered slightly sour by the addition of ten to thirty drops of Aromatic Sulphuric Acid to a glass of water. Ice water may be taken in small quantities, or simple water may be used. Water is not harmful, if it does not provoke vomiting. Small lumps of ice may be given. Concentrated nourishment as milk and meat essences should be fre- quently given in small amounts (with whisky or brandy, or without) if the stomach does not reject it. When collapse occurs the Opium and Strychnine before appropriate are not to be given, because they may not be absorbed, and when the pa- tient rallies from the collapse (if he does,) there is danger from an over dose by accumulation in the stomach. The remedy which has yielded the best results in the stage of collapse, or when it was approaching, is the Hydrate of Chloral given by hypoder- mic injection, from five to ten grains in solution in water being the dose given at intervals of half an hour to an hour or two. It is often advan- tageously given with Morphine in doses of from an eighth to a quarter of a grain. The surface of the body should be kept warm, if possible, by dry heat, such as hot flannels, bottles of hot water, etc. It is not desired to occasion sweating, but perspiration should be wiped off with warm dry cloths. Injections of warm water or injections of whisky with warm beef tea are permissible. The latter has been known to avert an approaching col- lapse and arrest the diarrhoea. If the patient rally from the collapse the cautious use of nourishment and stimulants as directed for typhoid fever are indicated. If the kidneys do not act freely they should bestimulated by the use of half teaspoonful doses of the Vinegar of Squills in a dessert or tablespoonful of Infusion of Digitalis four times a day, and bland drinks such as flaxseed tea or barley water. If coma (insensibility) occurs, the hot air bath should be resorted EPIDEMIC CHOLERA. 571 to, to throw off the urea by sweating. The danger of ursemic poisoning is averted by getting the kidneys to acting freely. Tonics should be given For this purpose there is none better than two or three grains of Quinine given four times a day. Thorough cleansing and disinfection of buildings and surroundings, having privy vaults, drains, and vessels which receive excretions, house waste, etc., contain disinfectants, no filth of any kind being allowed to accumulate, the severe ravages of the disease may be prevented. HOM(EOPATHIC TREATMENT. The success of treatment much depends upon the promptness with which remedial resources are exhib- ited, upon the earliest recognition of the attack. Tincture of Camphor, if administered upon the earliest premoni- tory indications of the attack, will often avail to prevent the further development of the disease, and will, at all events, in the great majority of cases, avert fatal consequences. The following are the particular indi- cations in the early stage — chilliness, shivering, giddiness, headache, singing in the ears, pain, weight, pressure, or a. distressing sensation in the pit of the stomach, cramps with protracted rigidity in the calves of the legs, sensation of general uneasiness, sudden loss of strength ; sunken, blue-encircled eyes ; diminution of the senses; slow, or scarcely percep- tible pulse; blueness and icy coldness of the face and hands, and greatly diminished temperature of the whole body ; burning heat in the throat and region of the stomach ; distended bowels ; much flatulent rumbling; nausea and even vomiting, and diarrhoea; diminished or suppressed urine (an almost constant symptom in cholera;) hoarse voice; countenance expressive of excessive anguish ; suffocating oppression. After taking Camphor, sweat soon breaks out as a sure sign that an improvement has commenced. Then the remedy must be given less frequently and in smaller doses, or it may give rise to congestion of the brain. Dose : Take of the purest loar sugar, or of Sugar of Milk finely powdered just a sufficiency, upon which deposit a drop of the tincture, thus administering the dose, and repeating such dose, at first every five minutes, extending the intervals according to the duration of the intermissions between the spasmodic attacks, only repeating the administration as the attack returns, and continuing this course until positive amelioration or change. Decided improvement is readily distinguishable: first, by increased warmth, and, shortly, by diminution of anxiety, by comparatively healthy perspiration, and by an inclination to sleep. After sleeping an hour or two the patient awakes with a sensation of ease, which he can scarcely believe. Veratrum (especially under the particular circumstances just enu- merated) should be employed without a moment's delay, when cholera sets in, in its worst and characteristic form, with sudden and violent fits of vomiting and purging, the evacuations resembling starch or rice-water, after several paroxysms ; flatulent rumblings, excruciating gripes, severe cramps (either with protracted rigidity, or with rapid alternations of con- traction — particularly the letter) in the calves of the legs, etc., (second stage,) ice-like coldness of the entire body, even of the tongue, cold, clam- my sweat, suppressed respiration, feeble pulse, great thirst — the patient, if permitted, drinking large quantities of water — excessive weakness, terrified look, weak, hollow voice, groaning and yawning. 572 EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. Dose: Six globules in a teaspoonful of water, every quarter of an hour, (in extreme cases) or every half hour (in less urgent circum- stances,) or even in some very desperate cases, and when a fatal issue seems imminent, every five minutes, until the extreme severity of the symptoms becomes somewhat abated ; and, subsequently, every time the paroxysms return, and so on until the symptoms yield or change. Arsenicum-album displays its curative action in those terribly rapid cases where cholera algida at once sets in without any premonitory symptoms. The most essential indications for Arsenicum are : Sudden and complete exhaustion, vanishing of the pulse, together with violent palpitations of the heart, great dyspnoea, inexpressible anguish, constant tossing about, horrid thirst, yet the least quantity of liquid is vomited up again immediately ; burning distress in the region of the stomach and upper portion of the bowels ; complete suppression of urine. In such cases Arsenicum should be given at once, without any other medicine being resorted to in the first place. After the exhibition of Arsenic the urine is often secreted in large quantity, a very favorable change. Dose: Six pills in a teaspoonful of water, every quarter of an hour (in urgent cases,) or even every five minutes (when a fatal issue appears imminent.) or only every half hour (in cases of a less desper- ate character,) until the symptoms are modified, and the sufferings are not so incessant; then extending the intervals according to the duration of the periods of remission between the paroxysms and so on, until positive change. Aconite is a splendid remedy if, in the beginning, or after the blue cold stage, there is heat of the skin, quickness of the pulse, headache, noise in the ears, dryness of the tongue with craving thirst, this remedy should be given in small doses — six pills every ten to thirty minutes. On the other hand, when the skin is cold, clammy and livid, the pulse not perceptible at the wrist, the action of the heart quite feeble and irregular, the head cold, the pupils of the eyes dilated very much, and not sensitive to the effects of light, involuntary discharge from the bowels of a thin stool resembling rice-water, vomiting of a similar substance, the dose should be large— twenty drops of the Tincture of Aconite, in a glass- ful of water, to be given one teaspoonful every fifteen to sixty minutes. Carbo-veg may often be advantageously employed after the previous administration of one or more of the preceding medicines, or even in alternation with Arsenicum (in some cases) when the patient is reduced to the last extremity, animation being all but completely suspended, and the pulse scarcely perceptible; or when, on the cessation of vomiting, purging, and cramps or convulsions, determination of blood to the head and chest ensues, attended with oppressed breathing, coldness of the breath, redness or livid hue of the face (which is covered with clammy sweat) and lethargy — the patient seeming as if seized with an appoplectic fit. Also, when every sign of reaction has been extinct from the beginning. Dose : Six pills in a teaspoonful of water (or, — if there be difficulty in ensuring its being swallowed thus— dry on the tongue,) at intervals of five, ten, and fifteen minutes successively, and then (if the pulse become stronger) every half hour until positive change. But if, upon the development of stronger pulse, and the subsidence of the lethargic symptoms, the pain, vomiting, cramps, etc., should return, at once, resume the administration of Veratrum, as before. Additional Partictlars. Ipecacuanha, Nux-vomica. These EPIDEMIC CHOLERA. 573 remedies (the first either singly or followed by Nux-v.) have been found efficacious either before or after the previous administration of the other medicines, (generally when more urgent symptoms had been overcome,) or at the onset of the attack (in milder cases,) when such indications as the following could positively be identified. Ipecacuanha may be administered under circumstances such as those just stated, either after previous treatment, when the vomiting becomes a prominent symptom, and the discharge attending it is more copious, or at the onset of the attack, when the vomiting (being copious, and attended with much nausea) predominates, so as to characterize the case distinctly. Further indications for this remedy, are such as the fol- lowing:— sensation of weakness (or of internal sinking,) coldness of the face and limbs, sensation of shivering in the belly, slight cramps in the calves of the legs, and in the fingers and toes; or sometimes, again, vomiting, alter- nated with watery diarrhoea, accompanied with, or preceded by griping, colicky pains ; or even yellowish diarrhoea in some cases in which the vomiting does not occur ; or loose evacuations of excremental matter, mingled with slime (at the commencement of the attack,) or evacuations of a greenish or brownish character. Dose: Of a solution of twelve pills to four tablespoonfuls of water, give a teaspoonful every hour, until change. But if, after the more violent symptoms (the vomiting especially) have yielded in a degree to the action of Ipecacuanha, pause three hours, and proceed with the next medicine, if the subjoined symptoms remain. Nux-vomica may be employed with great advantage three hours after the last dose of Ipecacuanha, when the vomiting has subsided under the influence of the last-named medicine, but symptoms of spasm of the stomach remain, such as weight and constriction in the region of the stomach; or again, w r hen anxiety, great debility, griping, frequent, small evacuations with much straining, frontal headache, or aching pain at the back of the head, and shuddering, with predominant internal chill, con- tinue to prevail. Dose: Of a solution of six pills to two tablespoonfuls of water, give a teaspoonful every hour, until the symptoms abate; and then every three hours, until positive change. Cicuta-virosa has proved an appropriate remedy, when there are spasms in the muscles of the chest, continuous vomiting, and a little diar- rhoea, when the eyes are turned upwards, and the patient is in a drowsy state. Dose: Six pills in a teaspoonful of water, (or, if there be difficulty in this method, dry on the tongue,) every ten minutes, until the symp- toms abate, and then every half hour, until positive amelioration or change. Treatment of the After-effects of Cholera. Carbo-veg. is of much service in the stage of convalescence, when flatulent rumblings, and colic with diarrhoea and excessive flatulence during stool remain. Dose: Four pills in a teaspoonful of water every hour, or after every intestinal evacuation, until a degree of improvement becomes appar- ent, and then every twelve hours. Bhosjyhorus is very useful when debilitating diarrhoea remains after the removal of the more urgent symptoms, and particularly when the stools are watery, and sometimes productive of an acrid, pungent sensa- tion in the last intestine, and attended with belching, weight or oppression 574 EPIDEMIC AND ENDEMIC INFECTIOUS DISEASES. at the pit of the stomach, and lateral regions (without the heat or burning which accompanies this symptom in the cases that call for the employ- ment of Arsenicum,) and pain in the region of the navel, rumbling noise in the bowels, either at other times or on pressing the hand against the belly, pricking or shooting pains in the left side of the chest, etc. Phos- phorus is also useful when a tendency to vomit remains, but with the distinctive indication that it only occurs about a quarter of an hour or so after drinking, or when the cold fluid drank has become warm in the stomach. Again, it is a remedy of much importance in the event of con- gestion in the chest, with oppressed and laborious breathing, in addition to the before-mentioned symptoms during the course of the disease. Dose: Four pills in a teaspoonful or water, every three hours (or every hour in more urgent cases) until the symptoms abate, and then every six hours. Acidum- phosphor icum should be administered, either after the previous use of Phosphorus, or even before it, in the event of the tongue becoming exceedingly clammy, or slimy ; or, again, if colliquative diar- rhoea should ensue, with or without the typhoid or congestive symptoms, hereafter described; or when the dullness of the head, and pallor of the face, occur ; or the evacuations are watery or slimy, or exhibit a greenish- white hue, and there is inadequate discharge of urine. Dose : Of a solution of six pills to two tablespoonfuls of water, give a teaspoonful every two hours. Accessory Treatment. The patient should be kept in a room of a warm temperature, the bed should be heated by artificial means, bottles of hot water applied to the feet, if necessary, and hot flannels to other parts of the body. The observance of this rule greatly facilitates the action of the medicine employed. Enveloping the patient in a damp sheet, (one which has previously been soaked in warm water.) and then wrapping him in blankets, is another useful auxiliary mode of treatment. Frictions with woolen cloths, and the act of rubbing and pinching, under the bedclothes, the parts affected with spasms, have also been recommend- ed; but if these auxiliary measures prove distressing to the patient, he should be left quietly under the action of the medicine. Anything which might disturb the equanimity of the sufferer, such as noise or contra- diction, should be carefully avoided, and his spirits should be sustained as much as possible. Food and Drink. Cold water is the best 'drink, but the patient should not be allowed to take too much at a time ; the occasional adminis- tration of a small piece of ice, if possible, or of iced water in teaspoonfuls is often attended with benefit; and injections of iced water are sometimes serviceable in relieving the colic and cramps in the intestines, or of starch- water in the case of straining. When cold water, in lieu of diminishing, increases the vomiting or other sufferings, and the patient expresses a wish for a little nourishment, tepid emulsion of sweet almonds, thin gruel, barley water, toast water, milk and water, (all warm and given a teaspoonful at a time,) may be administered. During the convalescence following this disease, we must be careful not to indulge the patient to the full extent of his desires. It is, there- fore, advisable, when the appetite returns, to commence with Semolina, Sago, Arrowroot, and such like, as also Cocoa, chicken broth, or beef tea; RHEUMATISM OF THE JOINTS. 575 but great caution must be observed, in order to avoid the risk of a relapse from an undue amount of nutriment. This is best accomplished by the administration of a tablespoonful every hour, or only every two or three hours, diminishing, or gradually augmenting, and varying the quantity and quality of the food, according to the effects produced. General Accessory Precautions. — Care ought to be taken to avoid excesses of all kinds, late hours, exposure to night air, melancholy thoughts, or fear, which are all predisposing causes to the attacks of this malady. Pure air, and thorough ventilation, are indispensable, and the precaution of providing a free current of water through all drains, etc., is not to be neglected. If it be known that stagnant, or obstructed drains, cesspools, and the like, are distributing noxious exhalations about a dwelling, the safest course is, (if possible,) to remove to another locality; the next, to endeavor to neutralize the poison which is given out by these decomposed deposits, by means of chloride of lime, or peat, charcoal, etc. It is, however, very hazardous to set about removing such nuisances during the prevalence of the epidemic; this should have been done before, or should generally be left until afterwards, when there is no longer reason to apprehend the distribution of additional causes of disease; a keen frost may render the cleansing of foul places comparatively safe . Regular exercise should be taken during the best part of the day (in fine weather) in the open air, but excessive fatigue should be avoided. PRESERVATIVE MEASURES DURING THE PREVALENCE OF CHOLERA. Accurate observance of the Homoeopathic Preventive Regulations will, in a very great number of cases, avert the attack altogether. But, even if this should not be the case, the disease will, in general, be developed in a very modified form, and such as will usually be readily subdued by the employment of Camphor, (as heretofore directed at page 571.) In some few cases, further treatment may become neces- sary, according to the directions stated in the foregoing portions of this article, but there will rarely be reason to apprehend a serious issue. See, also, Veratrum. CHAPTERXXIX. CONSTITUTIONAL DISEASES WITHOUT DEFINITE INFECTION. ACUTE ARTICULAR RHEUMATISM.— RHEUMATISM OF THE JOINTS. This form of rheumatism often arises from a cold, and from expos- ure to the atmospheric influences; it not unfrequently assumes an epidemic type, and, in such a case, breaks out most commonly in the fall and winter. 576 CONSTITUTIONAL DISEASES WITHOUT INFECTION. The disease commences very gradually, with a vague feeling of fatigue, accompanied with slight catarrhal symptoms; it may break out after severe attacks of angina, very seldom suddenly, and scarcely ever with a chill, but with alternate chills and heat. Simultaneously with the fever, very seldom after, and still less seldom before, one or more joints become painful; the pain rapidly increases, and the joint swells, sometimes with, and at other times without, redness ; at this period, the least motion, and the least pressure, cause pain, so that the patients remain perfectly quiet, for fear of hurting themselves. Generally, several joints are attacked at once, very seldom only one at a. time, never all the joints at once from the start. The disease progresses in a .very characteristic manner. While the joint that was first attacked, is getting better in three to five days, sometimes with a complete cessation of the pain, as well as the swelling, other joints are attacked in the same manner ; in this manner most of the other joints are invaded, after which the rheumatism frequently breaks out again in the joint whence it had originally proceeded. At times the swelling is quite considerable, at other times scarcely perceptible ; some- times it is confined to the joint alone, at other times the surrounding parts are very extensively involved ; not unfrequently the articular extremities feel enlarged. The constitutional symptoms are at times very violent, at other times very slight ; this depends a good deal upon the number of joints involved. The fever runs pretty high, remitting very irregularly ; the temperature is not much raised above the normal level ; pulse about one hundred, in very acute cases increasing very sel- dom to one hundred and twenty and upwards, small and changeable ; a copious perspiration, having a musty, sour smell, continues during the whole course of the disease, corresponding with which the patients are tormented by a distressing thirst. The urine is very scanty, saturated, and, on cooling, deposits a copious sediment. The digestion is slow, the appetite impaired, but very seldom entirely suspended. The course of uncomplicated rheumatism is never very rapid, gener- ally more or less wavering; recovery takes place gradually; single joints may remain painful and swollen for a long time, the pulse remains obsti- nately accelerated, the perspiration continues, the weakness abates very slowly. A favorable change takes place very seldom after the first week, a little more frequently after the second, but most commonly only after the third and fourth week. Very often we have noticed that, before the disease terminates, every joint is attacked twice, and that the second attack only lasts half as long as the first. In violent cases all the joints are affected together at the termination of the attack, some, however, are more acutely inflamed than others. With proper management and care this form of rheumatism ends in recovery in one week at the latest. However, by neglecting to guard against relapses, an acute attack may very easily terminate in a chronic form, and contractions and paralytic conditions may arise which can only be removed with great difficulty. CHRONIC ARTICULAR RHEUMATISM. It most frequently develops itself out of the acute form, of which it constitutes a rest, as it were; it likewise arises from the continued action of damp and cold places. RHEUMATISM OF THE JOINTS. 577 Chronic rheumatism is less frequently located in the external integu- ments of the joints where acute articular rheumatism is generally seated than in the synovial (inner) membrane lining, the ligaments and articular cartilages. Little by little these grow thicker and rough. The disease sel- dom involves a number of joints ; generally it is limited to one or a few only. Neither the swelling nor the pain is very considerable ; to some ex- tent the power of motion remains, yet the patients may be entirely de- prived of the use of the affected limb, while the rest of the body is per- fectly sound. The rheumatism has remissions followed by exacerbations, each of which leaves the joints somewhat worse. These exacerbations often look like an attack of acute rheumatism, with fever and slight in- flammation of the affected part; sometimes, however, they are without fever and distinguished only by pain and loss of mobility. Chronic rheumatism sometimes remains after repeated attacks of acute rheu- matism, of which it seems to constitute the ultimate stage. The joint is not greatly distorted by the disease. A complete cure is very much impeded by the extreme obstinacy of the trouble, and likewise by the impossibility of preventing the joint from being acted upon by influences that never cease, by their presence, to perpetuate the dis- ease. DEFORMING RHEUMATISM. ARTHRITIC RHEUMATISM. This form of articular rheumatism always runs an exceedingly chro- nic course; it does not develop itself out of the acute form, occurs very rarely previous to the thirty-fifth year of age, and is most frequent after the fortieth year. It breaks out among all classes, especially, however, the lower; on this account it is very difficult to determine the degree of influence exerted by bad food or damp dwellings over this disease. Ar- thritic rheumatism affects more particularly the female sex; the critical age undoubtedly favors an outbreak of this disease, for we meet with it most frequently about this time. This may attack any joint in the body, but it is mostly limited to the joints of the hand and feet, affecting both sides of the body at the same time. It generally commences in the hand, whose joints become more or less painful, especially when they are moved or pressed upon laterally. Sometimes the pain is principally felt in bed. The joint swells very slowly ; at times long intervals occur in the further continuance of the swelling, after which the arthritic process resumes its course amid renewed paroxysms of pain. Towards the end the shape of the joints is very much altered, especially the shape of the finger joints. They look bulbous and are especially enlarged in breadth ; they feel hard ; their integumen- tous covering has a natural color. The power of motion is not entirely suspended, but motion is very painful ; in the very highest grades of the disease the joints are entirely immovable. Life is not endangered by this condition, but its curability is very doubtful. The swelling never disap- pears entirely ; all that can be properly aimed at by treatment, is to arrest the further progress of the disease. ALLOPATHIC TREATMENT. In the treatment of inflammatory rheu- matism or rheumatic fever, no active single remedy has afforded such good results as Salicylic Acid. Its effectiveness in this disease, above all others has caused' the repute of the drug. The fever is not unfrequently 37 57S CONSTITUTIONAL DISEASES WITHOUT INFECTION. corrected in forty eight hours. While not every case is so favorably influenced, yet it exerts a remarkable power in greatly modifying the dis- ease, lessening the fever, pain, and swelling. Fifteen to thirty grains may be given in medicine wafers or capsules every hour until the fever and pain abate, when the medicine may be continued in doses of ten to fifteen grains every three or four hours for several days. It is claimed, that in some instances, these large doses cause sickness of the stomach, and prostration like collapse, which may be avoided by combining the acid with one-fourth its quantity, each of Bicarbonate of Soda and Carbonate of Ammonia. The formula of Brideaux is; Take of Bicarbonate of Soda, Carbonate of Ammonia, each five grains i Salicylic Acid twenty grains, Water one ounce. Mix. For one dose. Much the pleasanter way to take the Acid, is in capsule, or wrapped in medicine wafers. Fifteen grains of Salicine (active principle of Willow Bark) every three hours, will often give relief within forty-eight hours. It can be given in capsule or wafer, or mixed in water. It should be used, provided Salicylic Acid is not given. A well tested, and beneficial plan of treatment, is known as the alka- line treatment. A solution of a teaspoonful of Bicarbonate of Potash should be made in a quarter of a glass of water ; to this is added a table- spoonful of a solution of half an ounce of Citric Acid, in four ounces of water, and drank during effervescence. More water may be used if •desired. This should, be repeated every three hours, until the urine has become alkaline, (as ascertained by testing freshly voided urine with lit- mus paper) or the fever has abated, then once in six hours, and after three or four days, twice a day will be sufficiently often to keep the urine alka- line. After the violence of the symptoms has subsided, if anaemia (impov- erished blood and feebleness) exist, the Bicarbonate of Potash should be discontinued, and twenty to thirty drops of Muriatic Tincture of Iron, largely diluted in water, and ten grains of Iodide of Potash, at different times, should be given six hours apart. It is only fair to add, that the benefit of the alkaline treatment, which has such earnest advocates, is, also, seriously questioned by some who claim better results by some of the other methods of treatment, such as blisters, cold baths, and Quinine. The Chloride of Trimethylamine in doses of two grains every three hours, is claimed to moderate the fever and pain immediately, and moder- ate and shorten the disease. Take of Chloride of Trimethylamine sixty- four grains, Peppermint Watei* thirty two drams. Mix. Dose: A teaspoonful. This drug, if used, should be given alone. Prof. Da Costa recommends ten grains of the Bromide of Ammonium every three hours. It can be given in water flavored with Tincture of Orange peel. Quinine is useful in maintaining the reduction of heat produced by a cold bath, if given in a dose of twenty grains upon taking the patient from the bath, but it seems to the writer, that a more effectual plan, is the repeated application of the wet sheet and the use of Aconite. There is no doubt of the benefit of Quinine, or some other preparation of bark as a tonic in doses of two or three grains four times a day, after a few days RHEUMATISM OF THE JOINTS. 579 'have passed. Large closes of Quinine have been thought to be curative. It has not proved so in the common experience of the profession. In patients having a high fever and a strong pulse, the Tincture of Aconite may be given in doses of half a drop every hour or two to main- tain an impression on the fever, and to moderate the pulse, until such a time as the fever spontaneously subsides, or is prevented raising by the effect of one of the curative remedies before mentioned, viz : Salicylic Acid, Salicine, or Alkalies, etc. In those cases having a sudden rise of temperature, to one hundred and five degrees or one hundred and seven degrees or more, (above which a fatal result is to be expected,) the most effectual and speedy method of reducing the fever, is by the cold bath, as directed in typhoid fever. By promptly reducing the fever in these extreme cases life may be saved. While this danger seldom occurs in this disease, it should promptly be resorted to, if required. Blisters are often applied around the affected joints, followed by poul- tices to keep up the discharge, or a small blister one or two inches square, which is allowed to heal, and another one immediately applied. This is called the flying blister. The preferable local application seems to the writer, and used in his practice, is hot packing of the affected joints, wrap- ping them with flannels wrung out of hot water, and thickly covered in. Cloths saturated with an Alkaline and Opium Solution, similar to that recommended by Fuller, may be wrapped about the joint with benefit. Take of Carbonate of Potash six drams, Laudanum one ounce, Glycerine two ounces, Water nine ounces. Kubbing the affected joints carefully with a liniment of one part each, of Chloroform and Tincture of Aconite, and two parts Soap Liniment, will afford relief. Through the whole course of the disease, Opium given to the extent of relieving pain, is most happy in its effects. Two grains of the solid Extract, with a third of a grain of the Extract of Belladonna in pills may be given at night, if the pain is 1 very severe, and repeated during the day in doses of half this amount, at such intervals (three to six hours) as will make the pain tolerable, until it disappears in the course of the disease, or under the effect of one of the three curative remedies mentioned above. Constipation should be relieved by half teaspoonf ul doses of Wine of Colchicum six hours apart, until the bowels are moved; Cathartics are not needed. The appetite should be gratified, and encouraged by nutritious diet. The patient ought to lie between blankets, and wear flannel garments, if any, next to the skin, during the whole course of the disease. During the latter part of the disease, tonic doses of Quinine, three grains four times a day, or equivalent doses of some other preparation of Cinchona bark are advantageous. The Salicylic Acid, Saline, and Alkaline treatments, are said to pre- vent heart complications, hence, in part, is the prompt and bold manner with which they are recommended to be given. Should violent and irregular action of the heart, friction sounds, pain in the region of the heart, enlargement of the area of dullness on percus- sion, difficulty of breathing, and increase of fever occur in the course of the disease, the dangerous complication, pericarditis, has occurred. Full ■doses of Opium are to be given. 580 CONSTITUTIONAL. DISEASES WITHOUT INFECTION. The treatment before recommended for the rheumatism should be continued. Large, hot poultices of flaxseed meal and mustard, should be kept over the region of the heart. If the action of the skin and kidneys is not sufficient, the hot air bath should be given. Particular attention should be given to nourishing the patient. Milk, raw eggs, beaten with milk or water, and strong beef tea, or essence, should be freely given. When symptoms of weakness occur, stimulants should be given as are directed in the treatment of typhoid fever. The treatment of pericarditis has been more fully considered else- where. CHRONIC RHEUMATISM OF THE JOINTS. In chronic rheumatism of the joints, attention should be given to the general health, and measures employed to restore it to its fullest vigor. To this end, good food should be taken, avoiding sugar and starchy food, while milk, cream, eggs, and fruits, may be freely taken. The Citrate of Iron and Quinine, in solution, in doses of three to five grains, will be serviceable. It is claimed by good authority that the Tincture of Chloride of Iron is curative in acute rheumatism, and other equally high authority claims it to be a preventive of rheumatism. It is equally worthy of a trial in the sub-acute, or chronic form. The dose is twenty to thirty drops,* largely diluted in water, every six hours, (four times a day.) It will be especially serviceable if the svstem is debilitated. Iodide of Potassium, in doses of ten grains, dissolved in water, (Peppermint or Sarsaparilla, covers the taste,) three times a day, frequently is very beneficial. A better effect is sometimes produced by giving five drops of Fowler's Solution, with the Iodide of Potassium. The remedies so useful in acute rheumatism, are not so appropriate in this, though they may be tried. Alkalies are required, if the urine is acid, but they should be given more moderately. While Salicylic Acid has succeeded in my hands, it has often failed. The Hydrochlorate of Ammonia often succeeds admirably in doses of fifteen to twenty grains. It is best given in Elixir of Cinchonia, and given four times a day. Tincture of Guaiac, or the Ammoniated Tincture, in doses of one or two teaspoonfuls, three times a day, is one of the most successful remedies. It may be given in milk, or the gum prescribed in other mixtures. Prickly Ash, (Xanthoxylum,) has a deserved reputation in this disease ; the dose of the Tincture is one or two teaspoonfuls. In domestic use, a tea is generally made, (an ounce of bark to a pint of tea.) and two to four tablespoonfuls taken at a time. Poke root, (Phytolacca Decandra,) cures some cases of chronic rheu- matism. The dose is ten or twenty drops of the Tincture. A tea made, in domestic practice, from half an ounce of the root to a pint of tea,) could be given in doses of a tablespoonful. The waters from Sulphur springs are helpful in very old cases. Warm bathing, alkaline bathings, vapor baths, Turkish baths, and RHEUMATISM OF THE JOINTS. 581 the wet pack, are each in their turn useful means of treatment, and should he given a thorough trial in obstinate cases. The relief of pain is called for in some instances, and should be met, when not afforded by local applications, with Opium, given in half the doses recommended in the acute varietj-. Local applications are highly useful. Flying blisters, from one to two inches square, and allowed to heal at once, following each other over different parts of the joint, so that a fresh blister always exists on some part of the surface, is one of the best plans of local treatment. Stimulating liniments are frequently beneficial, as the following: Take of Ammonia Liniment an ounce and a half, Chloroform half an ounce, Soap Liniment two ounces; rubbing the joint well with it. If the pain is very great : Take of Chloroform, and Tincture of Aconite, each an ounce, Soap Liniment two ounces; mix. Wet a flannel with the Liniment, apply it round the joint, and cover with oiled muslin. Turpentine, or Petroleum, well rubbed into the part, or a flannel, saturated with them, and wrapped round the part, are sometimes useful. Other useful Liniments: Take of Oil of Cajuput and Laudanum each two drams, Turpentine four drams, Ammonia Liniment an ounce ; mix. Or Aqua Ammonia a dram, Laudanum four drams, Tincture of Cantharides three drams, Soap Liniment ten drams; mix. Iodine is one of the best local agents in overcoming inflammation, and removing its products. The Tincture may be used, but the following ointment is believed to be preferable, because, after a few applications of the Tincture, a dead scarf skin prevents the penetration of the remedy : Take of Iodine thirty grains, Iodide of Potassium a dram, Water a dram, Lard an ounce ; mix. If this irritates too much, it can be made weaker with Lard. A certain amount of stiffness, tenderness, and inability to use the joints, or limbs, is met with, in many cases, after the inflammation has subsided. This is removed by regular passive motion, i. e., motion by the hands of others, systematic shampooing, kneading and slapping with the hands, (called massage.) So-called cures of rheumatism are effected at this stage by "rubbing," "slapping," and "mesmeric" quacks. Liniments are largely useful in this stage, partly because they neces- sitate a certain amount of rubbing. Flannel ought always to be worn by those who surfer from chronic rheumatism. The general treatment of muscular rheumatism is not essentially different from that of chronic rheumatism affecting the joints, and it is unnecessary to describe it here. Absolute rest of the affected muscles is necessary. Tain should be relieved by the hypodermic injection, over the affected muscle, of a quarter of a grain of Sulphate of Morphine, with a fiftieth of a grain of Sulphate of Atrophine, in the acute stage, or of Atro- pine alone, in the chronic disease. Strong mustard plasters should be applied over the painful muscles, and immediately upon their removal, a hot poultice of Flaxseed meal, with Laudanum poured over the surface, or hot fomentations of flannel wrung out of hot water and well covered, to retain the heat. Rubbing the part and the use of liniments as in chronic rheumatism 5S2 CONSTITUTIONAL DISEASES WITHOUT INFECTION. of the joints, is useful. Sometimes the daily use of the wet pack has; proved curative. Aside from tonic remedies probably Iodide of Potassium and Guiaeum, as recommended for chronic rheumatism of the joints, and five grain doses of Quinine three or four times a day, are the most fre- quently curative, especially if the pain is periodical. Persons subject to this affection should wear flannel the year round.. The daily use of the cold sponge bath will invigorate the system against liability to cold, while an over quantity of clothing, night or day, is to be avoided. Invigoration of the system, especially by an out of door life,i s to be sought for. HOMEOPATHIC TREATMENT. Aconitum is the main remedy in acute articular rheumatism, if the pulse is not only frequent, but likewise full and hard, the temperature is considerably higher, the joint is red and exceedingly sensitive to contact ; it is suitable for nervous, irritable, ple- thoric individuals; or when heart troubles have set in. Further indica^ tions may be gathered from the Repertory. Aconite has been less fre- quently used in chronic cases, where it sometimes acts with great efficacy. Aconite is less adajDted to chronic articular, than to muscular rheumatism, especially when the disease is located in the upper extremities. Bryonia u lb a is a leading remedy for acute and chronic rheuma- tism, except the arthritic form. It is most suitable for rheumatism caused by exposure to cold and dampness after a severe muscular effort ; the vio- lent fever soon weakens the patient; the swelling of the joint is dark-red and exceedingly painful ; the respiratory organsshow symptoms of inflam- mation ; the perspiration has a sour smell. In muscular rheumatism, Bryonia is indicated by the following symptoms: The muscles of the trunk are the seat of the disease, especially the muscles belonging to the chest; the patient feels much better during rest; the pains are severe tear- ing pains, and incline to shift from one place to another. Mercurius. Mercurius is not so much adapted to chronic as to most forms of acute and sub-acute rheumatism, with the following general indi- cations: The fever runs high ; the pulse is remarkably quick and hard,. the perspiration very copious and having a musty smell, the thirst is exceedingly tormenting. The local swelling is not very great, but painful, intensely red, giving rise to the apprehension of pus forming in the joints it is not apt to shift about; even if other joints are affected, yet the origi- nal joint remains swollen and painful ; the breath is foul, the tongue has a thick, yellow coating, the appetite is gone, every kind of food causes nausea. The pains are worse every night, towards midnight, aggravated by severe cold and ameliorated by external warmth. The more frequently relapses set in, the more specially Mercurius is indicated. In muscular rheumatism, Mercurius is indicated by the following circumstances ; the pains exacerbate at night, they are deep-seated as if the bone were attacked with great sensitiveness to gentle as well as firm pressure. Rhus-toxicodendron is adapted to every kind of rheumatism, except arthritic. In acute articular rheumatism, it is indicated by the following symptoms: Violent fever, with tendency to the adynamic type, delirium and excessive restlessness; the swelling is inconsiderable, admits of some motion, is instantly red and somewhat sensitive to contact. The perspiration is not considerable. The patients are constantly changing RHEUMATISM OF THE JOINTS. 583 their position, for even after lying for a short time in the same position, the pains are very much increased. Feather beds are intolerable, so is external artificial warmth. For muscular rheumatism, Rhus-tox. is the best remedy, if the attack is caused by exposure to wet; if the above men- tioned circumstances either improve or aggravate the symptoms; if the pains at once become associated with paralysis and contraction ; if the muscles of the lower extremities are the seat of the disease. Rheumatic paralysis particularly points to Rhus. In chronic articular rheumatism, Rhus, is of little, if any use. Pulsatilla is indicated in mild, sub-acute rheumatism of the joints and muscles; the affection shifts about frequently and speedily ; the pain exacerbates in the evening and at night; they are violent, tearing, draw- ing and jerking pains, increased by warmth, improved by cold, at least for a short time. Pulsatilla is seldom appropriate in chronic rheumatism, but more so in the rheumatism of muscles and of joints. Tartar-emetc. deserves to be used more than it has so far been — it is one of those remedies that have a good effect in exceedingly painful local muscular rheumatism, for instance, rheumatism of the muscles of the back, contracted after a cold, during the performance of a fatiguing muscular effort. In such a case, Tartar emetic very soon brings relief. In acute articular rheumatism, Tartar emetic is indicated by the follow- ing symptoms: marked swelling of a number of joints, the pains are not very great during rest, but this rest is frequently interrupted by sponta- neous spasmodic, very painful contractions of single bundles of muscles There is not much fever; the symptoms of digestive derangement, on the contrary, are very prominent. A condition marked by such symptoms, sometimes occurs during the subsequent course of articular rheumatism, scarcely ever at the commencement. Digitalis-purpurea is, in our opinion, a most important remedy in acute articular rheumatism; in the last few years we have often seen this remedy produce a striking effect, and shorten the course of the disease. Hurried, small pulse, easily affected by motion; increased strength of the beating of the heart, but the sounds are muffled and indistinct, mingled with arterial murmurs ; hurried respiration, with ability to draw a long breath; hurried, abrupt speech; almost complete suspension of the urin- ary secretion; shining-white swelling of the joints, not very sensitive to pressure; a number of joints are attacked at once; the whole body is very pale. During the whole course of the disease we have given this medicine without any other drug, and in spite of the violence of the symptoms, we have never been able to discover any but the best results. In conclusion, we desire to state that Digitalis holds a high rank as a remedy for rheumatism among the rational physicians ; there is, undoubt- edly, a reason for this. Sulphur bears almost a specific relation to the rheumatic process. In an acute attack, we would not think of giving Sulphur; on the other hand, Sulphur is indispensable to remove the remaining traces of acute rheu- matism, upon which the. extraordinary disposition to relapse generally depends. What this remedy is capable of accomplishing in chronic rheu- matism, is shown by the numerous cures which are every year wrought by the use of Sulphur-springs, and which it is impossible to doubt. 584 CONSTITUTIONAL DISEASES WITHOUT INFECTION. Sulphur exerts a curative power over arthritic rheumatism ; it arrests the progress of the disease, and materially reduces the swelling of the joints, but must be given in large doses. Although Sulphur-springs are the most effective remedy for constitu- tional rheumatism, yet there are other means calculated either to heal or prevent new attacks; some of these means are often sufficient to perform a cure. In this class we rank the cold-water treatment, sea-bathing, the Turkish and Russian baths. The two last-mentioned have to be employed with great care ; if they help at all, the favorable effect is seen after a few baths. It is a matter of course that the cause should be removed as much as may be. The diet in acute rheumatism is easily managed ; the patients either do not crave any nourishment, or their appetite is very much impaired. Fat and greasy articles of diet are decidedly injurious; acid substances, espe- cially stewed fruit, have a very good effect; raw fruit may be partaken of, but moderately. HOME TREATMENT. In the treatment of acute rheumatism, the first thing to be affected, is the production of a copious perspiration ; for this purpose, a warm vapor bath may be used, or the patient may be placed in a well warmed bed, with bottles of hot water, or ears of boiled corn placed around him. Warm drinks, such as Pennyroyal, Catnip, Sage, and Flaxseed tea should be freely administered over the painful and swol- len joints; apply warm or cold fomentation of Hops, or Hops and Stra- monium (Jimson) leaves, or poultices of Flaxseed meal, or bran or rye meal may be used. Equal parts of vinegar and whisky made warm and rubbed on the principal joints, will sometimes relieve the pain. One of the best applica- tions, however, is fresh leaves of Stramonium, (Jimson Weed) which should be bruised, and moistened with a little water, and applied over the parts, and renewed three or four times a day. After the hot applications have been used, the parts should be covered with cotton batting, about a quarter of an inch thick, and a piece of flannel spread over it so as to retain the heat and moisture. Lemon juice, a tablespoonful every two or three hours, or warm lem- onade will be found beneficial. A free use of lemons in any form, is bene- ficial. Celery is a cure for rheumatism ; indeed, the disease seems almost impossible, if the vegetable be cooked and freely eaten. The celery should be cut into bits, and boiled in water until soft, and the water drank by the patient. Put new milk, with a little flour and nutmeg into a saucepan with the boiled celery, serve it warm with pieces of toast, and the painful ailment will soon yield. RHEUMATISM OF THE SCIATIC NERVE. This constitutes one of the most frequent, and, at the same time, one of the most painful forms of rheumatism. Its causes are generally involved in uncertainty ; a cold, excessive exertions, abdominal affections, stagnation of habitual hemorrhages, etc., are mentioned as such causes, RHEUMATISM OF THE SCIATIC NERVE. 585 but it is difficult to trace a distinct connection between these two orders of phenomena as cause and effect. At times the affection commences very suddenly, at other times the pain arises gradually from sensations that resemble a slight attack of ordi- nary rheumatism. The pain is generally located between the hip and knee, so that the course of the nerve can be determined very exactly by the pain. It is very seldom that the pain runs upwards, but more generally down- wards below the knee, and as far as the foot, on the internal or external surface of the leg. We distinguish two kinds of pain; either the pain is constant, somewhat remittent, but never entirely intermittent, and usually following very exactly the tract of the nerve without the patient being able to define the quality of the pain; or else peculiar tearing-darting pains may supervene, resembling electric shocks, setting in paroxysmally and being excited by motion or making a wrong step, sneezing or coughing. At the same time one or more places in the course of the nerve are gener- ally sensitive to pressure. Although the pain does not seem to be worse at definite periods, yet all patients complain that it is worse in bed, and that this exacerbation is sometimes so great, that they dare not go to bed. Inas- much as the pains are very much increased by an extension of the leg, by pressure or by the nerve being put on the stretch, the patients generally keep the limb slightly flexed, using it as little as possible during a w«.lk or for the performance of any other motion . This is generally the cause why the diseased limb, after the rheumatism has lasted for some time, grows thin, although the emaciation may likewise be caused by a gradually devel- oping paralysis. The diagnosis being sometimes extremely difficult, it is important to know that it always attacks only one limb. This disorder runs a chronic course. A spontaneous cure only takes plaee with a gradual abatement of the pains, but not till months have elapsed. The general health is very much disturbed by the constancy of the severe pains and by the sleeplessness ; the appetite becomes impaired and the bowels are inactive. ALLOPATHIC TREATMENT. This affection is a form of neuralgia, but not unfrequentl.y of a rheumatic origin. The remedy which gives the most speedy relief is Morphine, by hypodermic injection. A prompt and complete relief of the pain by this means is not unfrequently curative. The injection should be made in the neighborhood of the nerve. The dose to be preferred is a quarter of a grain, which can be repeated in twenty or thirty minutes, if the pain is not relieved. If the Morphine should not succeed, the hypodermic injection of a fiftieth of a grain of Atropine should be made. Relief from it is more apt to be permanent than the same degree of relief from Morphine, but this injection cannot generally soon be repeated, but if the pain is not relieved nor excessive dryness of the throat, nor other inconvenience experienced; a second injection will be made, but generally, if the pain is not relieved by the first injection of Atropine, it is best, as a rule, to resort to Morphine. The injection, under the skin, of fifteen or twenty drops of Ether behind the great trochanter is often followed by quick relief. Electricity is often beneficial. The direct current should be passed down the nerve. In old cases, a needle, such as is used in acupuncture, insulated to near its point, should be introduced to near the nerve, and 580 CONSTITUTIONAL DISEASES WITHOUT INFECTION, attached to the positive pole. The negative pole is then passed down the course of the nerve. A daily sitting of five to ten minutes is appropriate. The neuralgic form of the disease is more often benefited by Electricity than the rheumatic. Acupuncture, in old cases, especially in the form originated by Baudenscheid, is sometimes particularly beneficial. The general treatment is that given for chronic rheumatism or neuralgia, as the affection is of a neuralgic or rheumatic origin. It is not necessary to repeat these directions here. Iodide of Potassium, in doses often to thirty grains, three times a day; Alkalies; Salicine, in doses of fifteen grains, four times a day; Quinine five grains, and tincture ofNux Vomica five drops, three or four times a day ; or ten to twenty drops of Turpentine, with Honey, three or four times a day, are particularly recommended in rheumatic sciatica. The same local measures given for neuralgic and chronic rheumatism are appropriate. In addition may be mentioned as especially applicable: A strip of flannel wet with Chloroform, laid over the course of the nerve, and covered with oiled silk, (or muslin,) or the whole limb covered with new flannel, which has been thickly sprinkled with sulphur and covered with oiled muslin, are recommended by Fuller. Enveloping the limb is claimed by Trosseau to have cured after blister and Morphine failed. Great relief is sometimes given by blistering the head. Flying blisters, as directed in neuralgia, are generally beneficial. The actual cautery is recommended. t CONS UMPTION—TUBERC ULOSIS— PHTHISIS. Tuberculosis is not only the most frequent of all constitutional diseases, but likewise the most common of all diseases. It is character- ized by deposits into all sorts of tissues and organs, of a small lump or granule, the size of a millet seed ; of a pale yellowish, or gray color ; of a soft, cheesy consistency. The formation of these deposits or tubercles, depends, in most cases, upon the peculiar conditions of the organism. In almost every case, tuberculosis can be demonstrated as developing itself under the following circumstances : It may result from a deficient supply, or the bad quality of the food, in the same manner as scrofula; in this manner consumption, tuberculosis,) often succeeds the latter, so that when, at the age of pubescence, twelve to sixteen years, scrofula disappears, tubercles take the place. It may likewise be occasioned by a deficient activity of the respiratory (breathing) organs, as may occur during certain trades, which will be named by and by, or as may result from tight dressing, or from a sedentary mode of life. Whether a pre-existing germ is excited or created by such causes, is uncertain ; the former, however, seems to us more probable. It may, likewise, be inherited like scrofula. The consumptive constitution does not manifest itself by any positive symptoms, and the so-called consumptive habitconsists of nothing else than the symptoms of general debility and imperfect digestion or nutrition. There die as many persons without as with this habit. The only point that CONSUMPTION 587 enables us to be tolerably sure of its existence, is the fact that the person was affected with scrofula when young. Consumption is found equally distributed in both sexes, perhaps a little more among women. It breaks out chiefly between the ages of eighteen and thirty years. The deposit of tubercles, and hence the tubercular disease generally; perhaps, likewise, in many cases, the origin of the peculiar consumptive habit, are founded in the following circumstances : A scanty supply and a bad quality of food, damp dwellings, deficient exercise in the open air— on this account the disease is chiefly met with in the lower walks of life, and likewise occurs more frequently in cities than in the country ; among individuals whose business confines them to a room ; and among prisoners. Too rapid growth, more particularly if the growing persons are fed on improper nourishment, for this will occasion a condition of great debility Continued depressing emotions, especially sorrow and grief, home- sickness. The connection of cause and effect between these influences and the disease is not clearly made out; but that this connection exists, can be shown by a number of cases ; tubercles are often very properly desig- nated as tears shed inwardly. Circumstances incident to pregnancy, confinement, nursing, the more certainly, the more rapidly one confinement follows another, and the longer the infant is nursejd at the breast. Women with consumptive dispositions generally pass very well through their first confinement ; they keep up nurs- ing for a year, without losing much strength, but after that, they complain of feeling exhausted. During the next pregnancy they apparently feel better in every respect, but immediately after confinement the symptoms of an approaching consumption multiply; while nursing her child, the mother experiences all sorts of inconveniences ; the next pregnancy again brings an improvement, until phthisis suddenly breaks out in all its might, usually during the first weeks after a new confinement, and very often runs a very rapid course to a fatal termination. A sudden change in the mode of living; if an occupation requiring constant exercise in the open air, is exchanged for a sedentary business ; a luxurious mode of living is suddenly replaced by a mode of living full of privations ; if the climate is suddenly changed, if persons move all at once from a warm into a cold climate. Circumstances and conditions that permanently interfere with the breathing; tight dresses preventing a free expansion of the chest ; occupa- tions that render constant stooping necessary, as in the carpenters' and tailors' trade, etc. ; or trades in consequence of which the lungs become filled with fine dust. Diseases of the respiratory organs. Frequent attacks of acute bronchial catarrh, pneumonia, pleuritis; above all, measles, whooping cough and influenza are very common exciting causes of tubercular deposits. Most diseases that cause a rapid decline in the assimilative functions such as: Typhus, dysentery, cholera, chlorosis, diabetes, inveterate syph- ilis, chronic eruptions. Influences which greatly debilitate the nervous system, such as long- continued mental labor, venereal excess, self-abuse. What causes are chiefly instrumental in exciting the first outbreak of 5S8 CONSTITUTIONAL DISEASES WITHOUT INFECTION, the disease, is hard to decide. If the germ is present, the most trivial event may kindle the spark into a flame. Certain conditions of system afford a certain immunity from tubercu- losis. It is certain that mid-mountain air diminishes the chances of tuber- culoses becoming a fully developed disease. Symptoms and Course. In describing this disease, we shall adhere to the most common form, namely: chronic miliary tuberculosis, (consumption.) It is very difficult to say, with anything like certainty, when the disease really commences. The deposit of the first tubercles, especially if not very numerous, is accompanied by symptoms that seem too insignifi- cant to a patient to complain of to a physician. When a physician is consulted, the disease is already sufficiently advanced to be discoverable by the usual means of exploration ; at its first beginning, no such result can be obtained. Tliat the disease is beginning to set in, can almost positively be inferred if individuals who were afflicted with scrofula when young, or persons with a tubercular, (consumptive,) habit, show the following symptoms : disposition to pulmonary hypersemia, with palpi- tation of the heart ; disposition to catarrh of the air passages, the attacks being veiy obstinate, with bloody sputa, long-lasting hoarseness ; general nervous irritability, irritability and increased frequency of the pulse. Repeated attacks of catarrh ought especially to exejte suspicion, for they evidently indicate the period when the. first tubercles are deposited. Very often, however, the deposition may be going on for a long time without any apparent symptoms, in which case the supervention of a severe -bronchial catarrh, which gets worse all the time, shows the sudden outbreak of phthisis, or, in other words, of the purulent dissolution of the tubercles. In young women the disease not unfrequently sets in with all the symptoms of chlorosis, (green sickness) which may lead to very injurious mistakes. The older the patients, the less distinctly is the beginning of the disease recognizable. Very seldom, however, the disease breaks out suddenly in»such a manner that an apparent ful- ness of health is suddenly followed by a state of illness, with all the characteristics of consumption; a more or less sickly condition almost always precedes the outbreak. It would be of great importance if the first deposit of tubercles could be clearly made out by a physical explor- ation of the lungs. We only know of two tolerably reliable indications, early attention to which maybe of the most decided importance to the treatment. One is a prolonged, although not very much louder expira- tory murmur, which is particularly important if it is heard during- a slow expiration with closed mouth. The second is the so-called "respiration saccadee," jerking, wavy, cogged-wheeled respiration, which is most dis- tinctly perceived during an inspiration. These sounds can be easily heard when present by placing the ear close against the patient's naked breast or back. In the place of an uniform blowing murmur, we hear an inspira- tory murmur at intervals, but not otherwise altered in any respect. Another reliable sign is if, during a slight catarrhal attack, the apices of the lungs exhibit symptoms of catarrhal irritation. Another sign is, when the expectoration looks like soaked sago, or is transparent, having the shape of fine, firm threads; this is a symptom of chronic catarrh of the finest bronchial ramifications, CONSUMPTION 589 The existence of a tolerably severe, protracted, acute bronchial catarrh, or a more or less violent spitting of blood, (hsemoytisis) generally, is an evident, and very seldom doubtful sign, that the phthisis has set in. At the same time, the patients complain of unusual debility, stitches, or a peculiar drawing pain in the upper lobes of the lungs, peculiar rheu- matic pains in the arm of the affected side ; the respiration is accelerated the pulse very frequent ; this acceleration is very much increased by the least motion ; the existing fever very soon shows typical increase, setting in in the morning between nine and eleven, or in the evening between five and seven o'clock, or at both these periods, and sometimes attended with such complete remissions, that the fever has very much the appear- ance of an intermittent disease. From this beginning, the symptoms can be easily observed further in their character of tubercular phthisis, with various modifications during their course, to which we will first call attention before describing the various local symptoms. The course of the disease, especially among individuals of a more advanced age, is marked by stages. After the first evidently tubercular catarrh has slowly disappeared, a feeling of almost perfect health is again enjoyed by the patient, who is at most reminded of the slumbering danger by a dry cough, or a disposition to shortness of breath after an unusual bodily exertion, or after talking. In the course of months, and sometimes not till years have elapsed, another catarrh breaks out, which likewise, ends without any untoward symptoms, and these changes continue until finally an acute attack of marked intensity terminates in fully developed phthisis. At the same time, nutrition may remain perfect for years, the patient may retain his flesh and healthy complexion, or else he may lose his flesh gradually, and acquire a more or less anaemic (bloodless) appear- ance. A chronic, uniform course of phthisis occurs much less frequently after an acute catarrh. On the contrary, it sets in with very trifling symptoms, a slight, hacking cough, loss of flesh, palpitation of the heart, shortness of breath, etc., and the patient already presents a complete pic- ture of phthisis, w T hen all at once an acute catarrh sets in, which is sud- denly transformed into the actual disease, or else no acute catarrh ever takes place. The patients continue to fail almost imperceptibly, hectic fever supervenes, a tuberculous diarrhoea and oedema (swelling of the extremities) make their appearance, and death takes place amid symp- toms of complete exhaustion. A subacute course of the disease, quick consumption (phthisis florada) succeeds the initial catarrh sometimes immediately, especially in the case of young individuals, and after confinement, likewise, after severe acute diseases ; very frequently it forms the conclusion of the more chronic forms of phthisis. This subacute course is particularly distinguished by intense hectic fever, tuberculous diarrhoea, disposition to pulmonary hemorrhage. The most vigorous patients fail within eight or ten weeks, nor is it at all possible to arrest the course of the disease in the least degreeo The cough of consumptive persons varies exceedingly. At the begin- ning, a constant short and hacking cough is very usually present, some- 590 CONSTITUTIONAL DISEASES WITHOUT INFECTION. times interrupted by severe paroxysms, resulting in the expectoration of a light-colored, scanty mucus; or else, the cough sets in in irregular paroxysms, which are generally excited by marked changes in the temperature, and by pulmonary efforts ; these paroxysms often last for several hours, and end with retching; the sago-like expectoration follows in a few hours. A cough that at once sets in, with a copious expectora- tion, is a rare occurrence. After suppuration has taken place, the cough becomes much less wearing and spasmodic; the coughing fit readily results in copious expectoration. Between the more violent paroxysms, a constant hacking takes place, during which the mucus rale (rattle) is distinctly heard. In very rare cases there is no cough during the whole course of the disease. Previous to the deposition of numerous tubercles and their purulent dissolution, the expectoration is without any characteristic features. Nevertheless, a continual expectoration of clear mucus is always a suspi- cious symptom ; but such an expectoration acquires significance when it is traversed by fine streaks of a yellowish color, and when, moreover, it frequently appears streaked with blood. Still more characteristic is the presence of sago-like, firm little lumps and fibres. Much less frequently hard, yellowish or greenish, cheesy little lumps are coughed up at an early period; they generally taste very badly, and frequently have an offensive odor. Sometimes the expectoration contains small lumps of calcareous matter, (chalk-like) tubercles, seldom however, previous to suppuration having fully set in ; usually after caverns have formed. The cavernous expectoration has a yellow-gray color, less frequently a greenish color, is firmly coherent ; in the water it forms irregular, shaggy balls, which slowly sink to the bottom ; it is surrounded by a quantity of clear bronchial mucus, with whieh, however it does not mix. The larynx and trachea seldom remain intact during the whole course of the disease ; they show more or less marked symptoms of catarrhal irritation. At an early period of the disease, the voice becomes husky, or loses its clearness and firmness of tone; at a later period, these organs become painful, according as the above described ulcers are located, and not unfrequently complete loss of voice sets in. The tendency to sudden changes of color is a striking phenomenon only at the commencement of the disease. Very soon the pulse becomes frequent, and feebler than usual, it is accelerated by every movement. In the last stage it almost always exceeds one hundred, sometimes rising- to one hundred and forty. It is only exceptionally that the pulse of consumptive patients is retarded, and then only occasionally, alternat- ing with a frequent pulse. As a rule, the pulse affords the best means of Hidging how far the patient's strength has already been consumed by the disease. The digestive functions are generally very much impaired. Usually at an early period of the disease the appetite grows poorly, or cardialgic pains are experienced after eating, which are not unfrequently followed by distressing vomiting. The appetite seldom remains natural; some- times, generally shortly previous to the patient's death, he experiences a morbidly increased hunger. Except in quick consumption, the stools generally remain natural for a long time; diarrhoea only sets in after the CONSUMPTION. ~>!U symptoms of extensive suppuration of the intestinal tubercles have become manifest. These diarrhceic stools are peculiar, partly papescent and part- ly watery, resembling mustard in color, and appearance ; most commonly the passages are accompanied by a quantity of gas, they frequently contain blood and pus, and are seldom colorless. They are not frequent, from three to six a day, generally two in the morning in quick succession ; in the daytime they occur after the patient has partaken of nourishment. Sometimes they are preceded by slight colicky pains, at other times they are quite painless. They are always a bad symptom, for the longer the diarrhoea postpones, the longer is the patient's strength preserved. In the first period of the disease, the patient is sometimes troubled with diarrhceic stools, but they generally abate in proportion as the pulmonary symptoms decrease in intensity; if the tendency to diarrhoea has once become established, the course of the disease is generally very rapid. The skin does not show any special symptoms ; it is pale and some- times exhibits a yellowish tint. At an early period of the disease the muscles begin to show symptoms of wasting away. A characteristic sign of phthisis is the bulbous thickening of the ends of the ringers ; most like- ly this change takes place because the ends of the fingers do not partici- pate in the general emaciation. What is peculiar, is, that in most consumptives the sexual passion is very much excited, especially in the case of men, and that the virile power continues so long unimpaired, in spite of the general emaciation. The menses remain natural for a long time ; if they cease, death mayposi- tively be expected within a few months. The urinary secretions do not undergo any abnormal changes ; if sweats break out, the urine is of course diminished. Home and General Treatment and Prognosis. Although the prognosis in consumption is absolutely unfavorable, although the pros- pect of a case that had been diagnosed with positive certainty, is very slim, yet the labor of a family or physician in this direction is not without reward, since it may be in our power to postpone the fatal termination. Professional aid becomes still more important, if it is tendered at a period when the tubercular disease was still hidden, or had emerged into light with sufficient distinctness to be recognized in its true character with a tolerably reliable degree of certainty. Although success cannot be posi- tively promised at this period, yet it is our opinion that the formation of tubercles can either be prevented, or that their further development can be stayed. After all, the case may perhaps be the same as that of other acute or chronic diseases, which only become incurable after they are too far advanced. Unfortunately the aid of the physician or proper means is not sought until the suppurative process has already set in, in other words, in the stage of phthisis, when help is exceedingly doubtful. It cannot be denied that consumption is curable at any period during its course, although such a result happens very seldom after hectic fever hassetin, and more particularly after the consumptive process has invaded the intestines and the larynx. For this reason no case should at once be abandoned as beyond the reach of successful treatment. A complete cure, that is, a complete reabsorption of the tubercular deposits, indeed, 592 CONSTITUTIONAL DISEASES WITHOUT INFECTION. cannot be expected; remnants of the disease will remain, and a new outbreak may take place at any time. What we have said, shows that the treatment must aim at three objects: preventive treatment, the treatment of consumption as a consti- tutional disease, and the treatment oftheacute intercurrent exacerbations and their most prominent symptoms. The preventive treatment has to embrace a vast range, if it is to be of any use. As mistakes in the first education and care of children may promote, if not originate, scrofula, and as scrofula may easily terminate in consumption, the means of prevention must necessarily go back to the first years of childhood. A correct mode of living from the earliest infancy is an excellent preventive against this dreaded disease, every parent should see to it that physical laws are properly obe3 T ed in the rearing of children, for this will at the same time prevent a legion of other diseases. A parent's duties in this respect are so much more sacred as so many false customs and wrong maxims have been grafted upon the education of the young by the present age. Unfortunately it cannot be denied that parents and physicians pay too little attention to the first ■development of childhood, and that they confine their solicitude much more to the treatment of existing diseases than to their prevention. Of course, preventing diseases does not pay the physician. TTe have not space to exhaust the whole subject of prevention ; hence we have to limit ourselves to a statement of the most essential points. The diet should be regulated in accordance with the principles which are more and more universally recognized as correct. Above all, during the first two years the nourishmentshould principally be milk; afterwards, other easily digested articles of diet may be added in suitable quantity and order. Potatoes should not by any means constitute the chief nour- ishment of children. But not only the quality, also the quantity of the food, which should be supplied at regular intervals, should have our care- ful attention. It may seem a small matter to bother about such trifles w.hen the children are robust and healthy, but it is not a small matter ; on the contrary, it is a subject of great importance. Besides proper diet, a salubrious home, fresh air, exercise, and cleanliness must likewise be provided for the little ones. The mental culture is likewise of the utmost importance. Daily experience shows that precocious development and continued mental exertions render children irritable, make them look pale, deprive them of their appetite, and predispose them for all sorts of bodily sufferings. These symptoms show themselves already, in the seventh year, but still more at the age of pubescence, particularly among females. How many individuals fall victims at an early age to an unreasonable and precocious mania for acquiring knowledge! The only means of counteracting the absurd claims of our schools is gymnastics in all its forms, especially if it lays particular stress upon the cultivation of the respiratory muscles, but not by imitating the modern plan of practising neck-breaking tours de force, and straining the muscles to their utmost limits. A proper system of hardening children should likewise be pursued, with a view of rendering them capable, at an early period, of bearing abrupt changes of temperature, without being made sick by the exposure. If it is proper that all these rules should be enforced in the education CONSUMPTION. 593 of every child, it is still more important that they should be strictly carried out in the case of scrofulous children, or children born of consumptive parents. At the age of pubescence all the signs denoting the accession of tuber- culosis, become more apparent, and the tuberculous habit frequently shows its peculiar characteristics at an early age. To the above-stated rules a few other important rules may be added. In the first place, the young people must be taught to breathe properly, not merely with one portion of the respiratory muscles. Nothing is more conducive to this end than early singing lessons, taking care to pay particular attention to a correct practice of the middle notes. It is during this period of development that gymnastics perform real miracles ; chamber-gymnastics in particular becomes an invaluable aid in the harmonious development of the muscles. However, in practising with the arms, heavy weights must not be used. The dress, likewise, deserves our attention ; it should be of such a style as not to interfere with the freedom of respiration. If a catarrh occurs, it must not be neglected; chlorosis (green-sickness) should likewise be carefully attended to. In selecting a trade or profession, male individuals should avoid such as are known to favor the development of consumption. Women should be cautioned against reckless dancing and the continued application to work that requires constant sitting. A rigid preventive treatment is likewise necessary, if symptoms of tubercles have broken out, and if the tendency to catarrh has at the same time become very prominent. Whatever involves an increased activity on the part of the lungs, such as running, dancing, continued talking in large crowds, hurried going upstairs or ascending an eminence, should be strictly avoided at this stage; so should anything that interferes with the action of the lungs, such as continued stooping in a sitting posture, tight clothing, etc. The patient now ought to practice deep inspirations ; a substantial, but simple diet, without any artificial stimulants, is likewise indispensable. It being of essential importance that the patient should avoid all opportunities of being attacked with acute catarrh, he will have to avoid keen and cold winds, and provide himself with a respirator, (a piece of sponge fastened over the mouth when out on cold days will do) the usefulness of which has not yet been sufficiently recognized. The damper the atmosphere of the place where the patient resides, the more important it is that he should wear flannel undershirts ; this rule applies more particularly to the female sex. A sojourn in crowded rooms that are lighted with gas, and in damp and musty churches is exceedingly prejudicial. Proper ventilation and a moderate heating of the rooms should not escape our attention. At this period the food should be more simple and of a more digestible quality than ever; animal food deserves a decided preference. Milk now commends itself as an excellent nourish- ment, provided the patients are able to bear it, which is unfortunately not always the case. We must insist, that a woman suspected of consumption should never nurse her children at the breast. It behooves us likewise to direct attention to the circumstance that the mental labor and the mood and disposition of the patient are of the utmost importance to the course of the disease. We doubt whether grief and care can cause tubercles, but 38 594 CONSTITUTIONAL DISEASES WITHOUT INFECTION. what is absolutely certain is, that depression of spirits, sorrow and care, and continued chagrin accelerate the course of tuberculosis, and that a good deal of mental excitement likewise exerts a pernicious influence. Even a change for a few weeks only from their usual surroundings to a quiet and pleasant retreat, affects the patients beneficially. What we have said shows how much importance we attach to a cor- rectly-understood preventive treatment. Various medicines are likewise of importance during the course of consumption. HOMEOPATHIC TREATMENT. In the first stage of the malady, when the tubercles are in a crude, unsoftened state, or when they are inflamed, and commencing to soften, the remedies by means of which the malady may be retarded, if not arrested, and, with due collateral precau- tions, kept harmless for years, are, chiefly, Aconitum, Bryonia, Belladonna, Lachesi? , Hepar, Spongia, Phosphorus, Dulcamara, Pulsatilla, Arsenicum, Nux-v., Hyoscyamus, Silicea, Calcarea c, Carbo v., Acidum nitricum, and Sulphur. These must be selected according to the aggravated symptoms of the case under treatment. Their leading indications may be gleaned from the chapters on "Cough." "Pleuritis," "Pneumonia," "Hemoptysis," and " Repertory." In the second stage, with more free, copious, and somewhat purulent expectoration, the most important remedies are: Acidum nitricum, Silicea, Xali-c, Sulphur, Calcarea, Natrum-m., Mercurius, Lachesis, Phosphorus, Xycopodium, Carbo-v., Sambucus, Hepar sulphuris, Spongia, Cinchona, Ferrum, Conium, Zincum, Ammon-c, Laurocerasus, Graphites, Xitrum, Iodium, Drosera, Plumbum, etc. In the third, or ulcerative stage, the same remedies as the foregoing, together with Guaiacum, Sepia, Stannum, Staphysagria, Acidum phos- phoricum, Sanguinaria canadensis, are those by means of which the symptoms may be materially mitigated, and the fatal issue of the disease postponed. A few general indications for most of these will be found in the chapter on "Cough." When the colliquative sweats are particularly distressing, Sambucus, Stannum, Cinchona, Phosphorus, Arsenicum. Carbo v. et al., Silicea, Mercurius, Nltrum, Lachesis, Sulphur, and Ly co- podium, are the medicines which are of the greatest service. The remaining morbid symptoms must regulate their selection. When colli- quative diarrhoea predominates: China, Ferrum, Arsenicum, Phos- phorus, Acid, Phosphoricum, and Sepia, are the most useful. (See "Diarrhoea.") While conducting the treatment of consumption, the state of the digestive functions, and in females the condition of the uterine system, likewise, must be strictly attended to. This is, however, a superfluous precaution to the homoeopathic practitioner, as he is ever careful to pay due regard to every symptom, not only in this, but in every other disease. Should none of the remedies, above quoted, correspond to the derangements alluded to in particular cases, although they may be other- wise indicated, an intercurrent remedy may be selected from amongst those we have mentioned in the articles on "Dyspepsia," "Chlorosis." etc. The temperament and constitution of the patient ought also to claim attention in the selection of the remedies. SCROFULA. 595 In conclusion, it must be remarked, that as the irritation which is so repeatedly created in the lungs by the vicisitudes of climate, so constantly occurring in most parts of this country, forms a great drawback to the more or less successful treatment of pulmonary consumption, it is of great moment that every possible means be taken to avoid that pernicious influence. It has been much in vogue with many medical men to recommend warm climates, or well-sheltered situations,' even although the atmosphere might be of humid and relaxing nature. But we confess that we are inclined to side with those who do not object to a somewhat bracing and cold atmosphere, provided it be dry, and not of variable temperature. Much, however, depends upon the peculiarity of the case — the air, as well as the food, which may be adapted to one patient, being often perfectly inappropriate, and, therefore, injurious to another. SCMOFULA—SCBOFULOSIS. This is a constitutional anomaly which it is as difficult to define as rheumatism, perhaps more so. Scrofula may be inherited from scrofulous parents, whose disease is not necessarily, but in a majority of cases, reproduced in the children. It may likewise be regarded as an inherited disease, if the parents were affected with some chronic disorder, (more especially the mother during pregnancy,) such as consumption, constitutional syphilis, fever and ague, mercurialism. Finally, there is every reason why scrofula should be regarded as inherited, when the disease breaks out among the offspring of marriages between near relatives, and after such marriages had been continued for several generations. Scrofula may likewise be acquired by exposure to influences that con- tinually impair the process of nutrition. Above all, it is a deficient sup- ply of food, or improper food generally, that develops scrofula in children, the more certainly the sooner the child was exposed to such an influence. This is the reason why children that are chiefly fed on farinaceous soups, bread, potatoes, easily become scrofulous, the more certainly the smaller the quantity of milk they were allowed at the same time. Potatoes, and next to them, farinaceous food, are the articles of diet to which scrofula is chiefly attributed. Children who are nursed by healthy mothers, can likewise become scrofulous if they are fed too often, or if they are kept too long at the breast, which is so often done in the country by women who are anxious to prevent another conception. Scrofula is not perhaps directly caused, but decidedly promoted, not only by improper food, but likewise by an insufficient supply of fresh air, want of exercise, living in damp dwellings, inattention to the skin. If hereditary scrofula "and the last-mentioned circumstances meet, scrofula reaches the acme of its development. In our opinion, improper nutrition is a much more frequent cause of scrofulosis than hereditary descent. Parents generally bring up their children as they had been brought up themselves ; the absurdities of their own parents have become engrafted upon them with the mother's milk, and the grandmother gener- 596 CONSTITUTIONAL DISEASES WITHOUT INFECTION. ally stands by the cradle as a faithful watch-dog to prevent the old yom~ tine from being departed from in the least particular. In this point of view it is often proper to say, not that scrofula has been inherited, but that absurd views concerning the bringing up of children have been transmitted from one generation to another. As an evidence of the truth of this statement, we mention the circumstance that the first-born in a family is apt to have a feeble and sickly constitution, whereas children born at a subsequent period, are healthy ; or that some children who were brought up on improper food, become scrofulous, whereas no sign of scro- fula is manifested in children with whom more rational maxims are pursued. Scrofulosis always breaks out in childhood. It seldom manifests itself before the second year. Children that are very large and bloated in the first two years, almost always become scrofulous at a later period ; children with firm muscles and slender forms are scarcely ever attacked with the disease. Scrofulosis scarcely ever breaks out after the second dentition, still less frequently after the age of pubescence. Symptoms and Course. It is very difficult to furnish a complete picture of the scrofulous disease, for the reason that it manifests itself in so many different localities and diversified forms; hence a few general statements will have to suffice. Scrofula chiefly locates itself in the Lymphatic Glandular System. Either we find a more or less exten- sive hardened and thickened degeneration, or else a swelling tending to> suppuration, the surrounding soft parts being more or less involved in this process. In the former case, the swollen glands may remain un- changed for many years, until they gradually disappear, most commonly at the age of pubescence, leaving only a few trifling remnants of diseased structure. The inflammatory exudation is seldom deposited in an acute form; generally the glands swell slowly and without pain, the swelling sometimes even remains stationary, or else retrogrades, until gradually one portion of the gland becomes injected, fluctuates and breaks. The suppuration generally takes place very slowly, because the decomposition of the pus goes forward step by step. In other cases, especially in indi- viduals with sickly constitutions, a complete decomposition of the exuda- tion takes place before the swelling discharges ; in such a case the discharge indeed takes place very rapidly, but other glands are attacked so much more speedily, one after the other, and the patient's strength is under- mined by hectic fever. The cervical and posterior cervical glands are generally attacked first and most extensively : but the morbid process may likewise be transmitted to every other part of the body. It beconies- most threatening, if the glands in contact with the bowels (mesenteric) or bronchial glands are invaded ; in such a case obstinate and severe catarrhal irritations may set in, which are often followed by hectic fever and death. If scrofula can be suspected, every chronic intestinal catarrh, or every chronic bronchitis, is not necessarily traceable to a scrofulous origin. The skin is very often the first organ that shows symptoms of the scrofulous taint. It is but too often the case that children who, up to the time when they were weaned, look fleshy and solid, after they are weaned are attacked by skin diseases; the scabs are generally accompanied by SCROFULA. 597 •obstinate ulcers, which constitute characteristic symptoms of scrofula. While the exanthem, which is most commonly confined to the head, is •still out, or soon after its disappearance, the glands become affected. The localization in the bones and joints is one of the most dangerous signs of scrofulosis . The inflammatory forms run a very protracted course, and it is only when the patient's constitution is in a very bad state, that those forms terminate in hectic fever and death, but, on the other hand, leave the affected joints with an impaired mobility, stiffened and de- formed. Scrofulous inflammation of the vertebrae is the most threatening, for it either leads to curvature of the spine, or develops hectic fever by the •origination of congestive abscesses. Another symptom of scrofula is the sore eyes (ophthalmia) which we riave already described in a previous chapter. It is either confined to the margins of the lids, or involves the whole conjunctiva. The ears of scro- fulous children have a peculiar inclination to discharge, with small sores (eczema) breaking out at the same time round the ears. The mucous membranes do not show any particular morbid symp- toms, but an extraordinary susceptibility to catarrhs, especially the mucous membrane of the nose and throat. In the nose, the copious secre- tion is associated with soreness and ulceration, and a swelling of the whole nose, in which the upper lip generally participates in a manner that is exclusively peculiar to scrofula. In the mouth we notice frequent attacks of sore throat, with disposition to swelling of the tonsils. These various localizations manifest themselves in most diversified combinations and successions, sometimes one at a time, and at other times all together. Their course is always slow and dragging, subject to many oscillations between remissions and exacerbations, but generally termin- ates in recovery, as long as the vital organs remain unaffected by the disease, always, however, leaving some remnants of the disease behind. Even suppuration of the bones of the back (vertebree) sometimes termin- ates in recovery with surprising rapidity. The general state of the organism is of importance, both to the course of the disease, as well as to the treatment. There are two kinds of scrof- ulous constitutions. The one active is distinguished by a lively circula- tion arid a marked tendency to febrile affections. Such children have a fine, transparent skin, flushed cheeks, with great tendency to sudden changes of color in the face, an extreme nervous irritability, increased mental activity, melting, languishing eyes, delicate bones, and slightly- developed muscles. The torpid scrofulous constitution, on the contrary, is characterized by a diminished activity of the circulation and repro- duction, and great tendency to fat. The whole body of such a person looks bloated, especially the face, the features are coarse, the nose and upper lip are swollen, the bones, especially the skull, are large, and the limbs coarsely-shaped ; other characteristics are : a distended abdomen flabby muscles, mental and bodily indolence, a dingy-looking, yellowish- gray skin, disposition to canine voracity. From such general symptoms 1:he speedy outbreak of local scrofulous affections can be predicted with tolerable certainty ; frequently, however, especially if a proper mode of living is pursued from an early period, the scrofulous habit disappears 598 CONSTITUTIONAL DISEASES WITHOUT INFECTION. entirely, sometimes at the age of seven years, without having occasioned any local diseases. The treatment of the various local scrofulous diseases has been discussed in other articles, and all that remains for us to do here, is to consider the disease in its totality. According to what we have said when treating of the causes of the disease, it is evident the casual indica- tion in scrofulosis occupies the first rank. Before any medical treatment can be thought of, the mode of living has to be thoroughly changed. This change refers mostly to diet, habitation, exercise in the open air, atten- tion to the skin, etc.; in cases of scorfulosis of active persons, it has likewise to take into special account the mental development of the patient, which should never be forced, and premature, and should always go hand in hand with an abundance of bodily exercise. In this respect it is difficult to lay down specific rules which might be adapted to one child, and decid- edly contrary to the constitution of another. The physician should care- fully investigate, and afterwards remedy the defects of education, but definite laws cannot be laid down to such a result. The casual indication likewiseincludes measures having reference to a true and useful preventive treatment ; hence, a parent or physician should make it his duty to watch over the education of his children, in every possible direction and aspect of the case. How much trouble will a parent save himself by such a course, and how much care, anxiety, and suffering to others. For TREATMENT see: Ophthalmia, Otorrhcea, Nasal Catarrh, Dis- eases of the Liver, Diarrhoea, Tardiness in Learning to Walk, Cough, Teething, Diseases of the Glands and Bones, Rickets, and the general article on Preventive Treatment, which has been prepared to meet the wants of such cases. PART THIRTEENTH DISEASES PECULIAR TO WOMEN, CHAPTER XXX. DISEASES OF THE FEMALE SEXUAL ORGANS. MEXSTR UATION. By menstruation we understand a flow of blood from the female sex- ual organs recurring at regular intervals. It is a sign that the female organism has attained the faculty of conceiving, and depends upon the fol- lowing processes : The gradual maturing of an ovum (egg) in the ova- ries determines an increased afflux of blood to those organs. If this congestion has reached its acme, the other organs of the sexual system participate in this hyperemia (congestion; to such an extent that the blood-vessels become ruptured and a more or less considerable, discharge of blood takes place, accompanied by a sometimes more extensive and at other times more local detachment of the epithelial lining of the sexual organs. While the discharge of blood lasts, the matured ovum (egg) enters the fallopian tubes, which renders its fecundation possible. A discharge of blood need not necessarily accompany the passage of the ovule into the tubes; otherwise how could a woman who is nursing her baby and does not see the least sign of a menstrual show, conceive again at such a time? That this has happened, is a fact established beyond the possibility of a doubt. According to circumstances the menses appear at times sooner, and at other times later. They are influenced by climate ; the nearer to the equa- tor, the sooner the menstrual period appears; they are likewise influenced by the mode of living ; in cities the menses appear sooner than among country-girls; by the mental capacities; the more advanced the mental development, the earlier the menstrual functions make their appearance. The constitution exerts no particular influence; very robust girls some- times menstruate very late, whereas feeble ones often menstruate prema- turely. According to the circumstance the menses may set in between the ages of ten and twenty years; in our climate they appear in cities between the ages of fourteen and sixteen, and in the country between the ages of sixteen and twenty years. The quantity of the menstrual blood is likewise variable and cannot be determined a priori ; stout women sometimes lose a small quantity of 509 600 DISEASES OF THE FEMALE SEXUAL ORGANS. blood, whereas feeble and spare-built women lose a great deal. The quan- tity is from two to eight ounces. ]STor is the duration of the menstrual flow the same in all cases. It generally averages five days, but, without being considered abnormal, may last only two, or may be extended to eight or nine days. Sometimes the bleeding stops for a short time and then reappears again. The periodicity of the bleeding likewise varies. By far in the majority of cases it returns again every twenty-eighth day. In many cases there is an interval of four weeks between the periods ; in a few cases we notice an interval of twenty-one to thirty days. Four weeks may be considered the normal length of the interval between each two successive turns. The influence of the menses upon the general health is sometimes considerable, and at other times none at all. We notice hyperemia of the vagina and of the external pudendum, sometimes with increased secretion of mucus ; tumefaction of the breasts with painful, knotty swelling of single milk ducts. During the menstrual flow the ner- vous system is much more sensitive and excitable, whence the follow- ing phenomena ; chilliness alternating with flashes of heat: headache; hemicrania, vertigo, languor, drowsiness without any ability to sleep; irritated, whining mood; loss of appetite, palpitation of the heart. In addition to these derangements, we often see a sickly-, gray complexion, efflorescences in the face, margins around the eyes; vomiting or nausea; altered voice. These phenomena usually occur only during the first twenty-four hours of the flow, after which they cease either suddenly or gradually. The total cessation of the menses take place indefinitely, some women mensturating regularly until the age of fifty-five, whereas others cease to menstruate when they are thirty years old. These differences do not depend upon the time of the first appearance of menses, or upon the vigor of the individual, upon the number of times a woman has conceived, nor even upon other morbid conditions. The final cessation is not bound by any rule, and may take place quite normally, betwen the ages of forty and fifty years. It may occur suddenly and completely, or in paroxysms ; some periods, even to the number of ten or twelve, being skipped, after which the menses may occur again regularly for months, or a sort of hemorrhage may set in, which is again followed by a stoppage of the menses. As a rule the quan- tity of the menstrual flow is larger, as the period of a final cessation draws near, than in the preceding years. In the previous paragraphs we have only briefly alluded to the most important points. But they show satisfactorily the importance of the menstrual function to the female organism. Hence, it is that menstrual irregularities have, at all times, excited a lively interest among physi- cians, as well as lay-persons, to such an extent that they have been class- ified under special heads, although, in reality, they constitute a symp- tomatic manifestation of one and the same general or local disease. The question now is, when, in a general sense, menstruation may be said to be abnormal. The menses are abnormal in the first place, if they do not harmonize with one of the previously indicated periods; they are likewise abnormal, if, for some cause or other, the usual duration of the menstrual MENSTRUATION. 601 flow in a given case is either shortened or lengthened. A woman who menstruates every twenty-first day, is not considered sick; but we consider a return of the menses every twenty-first day abnormal, if here- tofore they had occurred every twenty-eighth day. Finally, whether the menstrual flow is to be considered abnormal, may depend upon the influence which it exerts upon the general organism. A supension of the menses in the case of a young girl who, after being relieved from the prejudicial influences of school and city home, goes into the country, and there regains her blooming health, cannot be regarded as a morbid condition. Every attention should be given to the mind and feelings of the young woman ; her excited fancy should be controlled, and her nervous sensitiveness, and excitable temperament, which are so apt to cause disease, should be quieted. For this reason, a woman should be treated with kindness and attention, especially during pregnancy and the menstrual period. Every depressing emotion, chagrin, fright, anger, acts prejudicially upon persons in health, much more upon those who are diseased. We refer the reader to our article on hysteria, and to our subsequent article on chlorosis, where we shall show that a premature development of the mental faculties, and more particularly of the fancy, exerts a pernicious influence upon the constitution of the growing woman generally, and upon the normal functions of the sexual system in partic- ular. Woman's material mode of living deserves a closer attention. A wrong system has, in this respect, become a second nature to such an extent, that a physician is expected to allow his patients to indulge in their accustomed violations of a proper diet, on which account we invite him to pay particular attention to the following points in the treatment of female diseases. 1 . Women who lead a sedentary life, should be induced to take more exercise than usual, and to rouse themselves from their phlegmatic torpor. This is one of the first requisites of health; frequent exercise in the open air, cleanliness, frequent bathing and washing, and frequent changes of linen. During the menses, every heating exercise, and every exposure to a cold should be avoided; likewise heavy farinaceous food, freshly baked bread; violent emotions, sexual intercourse, emetics, purga- tives, baths. This caution need not be carried so far as to compel healthy and robust women to lie down the first two days, and even to give up their accustomed walk. 2. A bad habit, that is indulged in by many ladies, is eating at any hour of the day. This practice is decidedly injurious to the success of any good treatment, and should be abolished. Order is useful in all things, and likewise in our meals, and patients should be given to under- stand that they must partake every day of a warm dinner, at a fixed hour; breakfast and supper may consist of cold articles of food. 3. Too much sleep, and sleeping too often within twenty-four hours, can only be approved of if the patients are very weak and anaemic ; during sleep the body has to be kept perfectly unrestrained and easy, without the least inconvenience from the pressure of the ordinary clothing; •otherwise, sleep will not exert the quickening influence that is expected 602 DISEASES OF THE FEMALE SEXUAL ORGANS. from it. Females, especially, have the bad habit of lying down with a mass of clothing on. This practice not only prevents the body from getting warm, but interferes with the free circulation of the blood, and thus gives rise to other troubles, in addition to those already existing. Tight lacing is another censurable practice, which is often the sole cause of menstrual irregularities. By going without corsets for a time, the woman will soon learn to keep her back straight, without any articial support. If corsets are worn too tightly, they compel the wearer tobreathe with the upper portion of the thorax, the lower ribs not being allowed freely to expand, on account of the compression exerted upon them. This gives rise to an incomplete respiration, an imperfect introduction of oxygen, and a diminution of the elasticity of the plumonary vessels. Thus it is that corsets become a co-operating cause of many of the blood diseases of females. When speaking of chlorosis and tuberculosis, we shall revert to this subject. 4. Regarding the function of the bowels, it is of importance that our female patients should never suppress an urging to stool, and that they should at least have one evacuation from the bowels every day. Women are much more afflicted with constipation than men ; in most cases they are the authors of this exceedingly prejudicial state of the bowels, some- times on account of neglect, at other times from sheer laziness, again on account of sedentary habits, and finally, because they are ashamed of satisfying the call of nature. 5. Women should make it a rule to wash their parts, especially if affected with leucorrhcea, or other diseases, several times a day with cold water, and during the menstrual flow, with tepid water. More recently the Sitz-baths and the vaginal syringe are now in almost general use.. These are not only excellent means of relief in many morbid conditions, but likewise, excellent means of prevention, and should be found in every lady's bed-chamber. Cold water is indeed the most reliable nervine at our disposal. DERANGEMENTS ATTENDANT UPON THE APPEARANCE OF THE MENSES. It must be self-evident, that the awakening of the sexual life, which is< the greatest revolution which the female organism can undergo, is accom- panied by phenomena which very often partake of the nature of a morbid process. The normal conditions under which the menses should first appear have been explained in a previous paragraph. A premature appearance of the menses always implies a feeble constitution and powerful sexual instinct. Hence, it is of the utmost importance not to accelerate this period because all the ailments which sometf^ies befall young girls at this age, are supposed to originate in the tardy appearance of the catamenial discharge. Of course, where the delay is evidently of a morbid character, nature should be assisted by such remedial means as will promote the men- strual flow. Such morbid phenomena are the more striking, the more sensitive and delicate the young woman who had been reared in the bosom of luxury and ease. Although these ailments may not be very considerable, yet their removal often requires the interference of art. Sometimes a judicious diet is sufficient for this purpose, but in many cases medical agents have to be used. Such cases are characterized by the following symptoms : Conges tion of blood to the head, as indicated by heaviness of the head ; rush of MENSTRUATION. 603 blood to the chest, with palpitation of the heart, and sometimes attended with oppression of breathing; sensation of warmth and repletion in the abdomen; feeling of indolence through the whole body; occasional flashes of heat and red flushes in the face; languid feeling in the legs and feet; pain in the small of the back and pelvic region ; drawing in the thighs, frequent urging to urinate. These symptoms may be regarded as menstrual distresses, which are very speedily succeeded by an actual appearance of the menses and disappear with them. If these symptoms continue for a longer time without any menstrual show taking place, the patient will have to take a good deal of exercise in the open air, use more vegetable than animal diet, more liquids than usual, and spend her time as much as possible in cheerful company. If the above mentioned symptoms become more severe and continuous;, if the rush of blood is more violent, causing anxiety, palpitation of the heart, constant heat, a restless sleep full of dreams and interrupted by sudden starts ; if the face looks bright-red, and the signs of cerebral hyper- emia and congestion of the organs of the chest becomes manifest; we resort to remedies that have been indicated for such conditions in their respect- ive chapters. One of the leading remedies is undoubtedly Pulsatilla, especially if the congestive symptoms of the head and chest are accompa- nied by signs of abdominal and uterine congestion, as if a stone were oppressing the uterus, and the patient complains of chilliness, stretching of the extremities; yawning and other febrile symptoms may likewise be indicated by a certain train of symptoms. The above-mentioned dietetic rules should not be neglected while this medicine is used. Belladonna may be added to this group of remedies as one of its most prominent members, whereas Chamomilla is very seldom indicated, Veratrum and Belladonna will often be required, the former, if the functional activity of the heart is very much impaired, as indicated by paleness of the countenance, great chilliness or constant alternation of chilliness and heat, anxious feelings ; the latter if symptoms of cerebral congestion prevail, with bright redness of the face. If the young woman has reached the age of pubescence and feels other- wise quite well, although the menses do not show the least sign of making their appearance, you would commit a great wrong to drench the organism with medicines; your duty will be to leave nature alone in determining the period for the appearance of the menses, more particularly if the organ- ism shows signs of being backward in its development. It is only if the organism is sufficiently developed and the young woman's age justifies the expectation that the menses ought to appear, that it is proper to hasten this process by the employment of suitable remedies. We give Pulsatilla, and if the indications are satisfactory, repeat the dose rather frequently, more particularly in cases where the non-appearance of the menses causes, without any other bodily ailments, an excessive nervous irritability, whin- ing, peevish, timorous disposition, paleness of the face and great flabbiness of the muscular tissue. ISTux-vomica, on the contrary, will be found appro- priate in persons of an opposite temperament, an irascible, choleric dispo- sition, a full habit without any decided congestions, redness of the cheeks and turgescence of the body. Dose : For any of the remedies, (homoeopathic) six pills, once in each, day, dissolved in a teaspoonful of water. '604 DISEASES OF THE FEMALE SEXUAL ORGANS. CHLOROSIS OB GUEEN SICKNESS— EMANSIO MENSIUM. Chlorosis is a disease which occurs exclusively among females, chiefly between the ages of thirteeu and twenty-four, seldom at a later period; if it does, it can be traced to secondary disturbances, such as confinements of young women, coming rapidly one after another, more epecially if the women nurse their own children. The disease sometimes breaks out previous to the first appearance of the menses, more frequently after several menstrual periods ; as an entirely primary disease, it only breaks out among unmarried women. It is, in some degree, hereditary; females of a pale complexion are more liable to be attacked with it ; though no constitution is exempt from the disease, although delicate individuals with irritable nerves are more susceptible to it. Among other causes, we may mention : insufficient ex- ercise, mental exertions, without corresponding muscular activity ; excite- ment of the fancy, especially when caused by novel-reading ; excitement of the sexual instinct by onanism, improper converse with the other sex ; deprivation of the open air, and interference with the free expansion of the chest by tight dresses. Chlorosis is very commonly met with among daughters of a tuberculous mother. Symptoms and Course. — This disease generally comes on very slowly, the patients become more irritable, they are apt to get tired after every little effort, they are liable to changes of color, the skin soon loses its bright lustre, and the patient complains of feeling chilly at an early period of the disease. Inasmuch as the disease may be characterized by a variety of symptoms, we will describe the derangement* as they appear in each special organ and system. The skin at times has the color of wax ; at other times it is rather yellowish, or of a dingy white, the veins being either not at all percept- ible, or but indistinctly so, the color of the cheeks may change quite often, within a very brief period of time. The visible mucous membranes are more or less without color. Swelling of the feet and limbs sometimes occur, but only in the highest grades of the disease. The following symptoms occur in the digestive range : impaired appetite, aversion to meat, longing for strange articles of diet, such as vinegar, chalk, coffee, beans ; bloating of the stomach after every meal, sourness of the stomach, and generally the bowels are very torpid. In the nervous system we discover excessive irritability, neuralgia, hysteric symptoms, fitful mood. The breathing is accelerated, the least physical exertion causes dyspnoea (shortness of breath,) sometimes to a very high degree. The circulation is accelerated, very seldom retarded ; disposition to palpitations of the heart, which are easily excited by a physical effort. The menses are irregular, sometimes entirely suppressed, or very tardy, sometimes more profuse than usual, but alwaj'S of a lighter color, or even quite colorless. Accompanying these symptoms, are pains of the most diversified kind, very generally uterine catarrh. The urine has a strikingly pale color. The patients generally sleep very soundly, and have to sleep a long time, though sleep never refreshes them. One or the other of these derangements is generally wanting. GREEN SICKNESS. 605 The one characteristic symptom is never absent : dyspnoea and palpi- tation of the heart from the least unusual effort, especially after going up stairs. The course of chlorosis is always more or less protracted, sometimes very chronic. If no particular disturbances take place, the affection can sometimes be cured in a few weeks; whereas, if the mode of living which had acted as the exciting cause is persevered in, the trouble may continue for years. The disease is most commonly more violent in summer than in the winter season. Uncomplicated chlorosis always terminates in recovery. Among the complications, the simultaneous presence of consumption and scrofula are most threatening. We generally find that scrofulous girls who are attacked with chlorosis recover their health to some extent for a year or two, after which they die of consumption, or phthisis may set in as a direct development of a protracted chlorosis. HOMOEOPATHIC TREATMENT. The leading remedies which have been found most useful in this affection are Pulsatilla, Sepia, Bryonia, Sulphur, Calcarea carb., Ferrum, Lycopodium, and Plumbum. Pulsatilla is peculiarly useful in chlorosis, when the derangement seems to have been excited by, or is connected with, indigestion ; and it is accompanied with headache, particularly in the side of the head, with shooting pains extending to the head and teeth, sometimes shifting suddenly to tlie other side ; sallow complexion, difficulty of breathing, and sense of suffocation after the slightest movement; palpitation of the heart , coldness of the hands and feet, often changing to sudden heat; disposition to diarrhoea and leucorrhcea, pains in the loins, sensation of weight in the abdomen, almost contant chilliness and shivering, spasms in the stomach, with nausea; inclination to vomit, and vomiting; hunger, with repug- nance to food ; swelling of the feet and ankles, great fatigue, especially in the legs. This medicine is particularly adapted to females of mild disposition, disposed to be sad and tearful. Dose : Six pills every evening. Sepia is a remedy of very great value in this disease when there is a good deal of headache, sallow complexion, with dark colored spots ; frequent colic and pain, as if arising from bruises in the limbs, with a drawing, tearing pain in the thick muscles of the back part of the legs. It may follow Pulsatilla, with great advantage, or be given in alternation with that remedy. Do.se : Six pills or a powder every morning. Bryonia. Frequent congestion of the head and chest, bleeding at the nose, dry cough, coldness and frequent shivering, sometimes alternating with dry and burning heat, constipation or colic, bitter taste in the mouth, tongue coated yellow, sense of pressure in the stomach, as if from a stone. Sulphur is more particularly indicated when there is pressive and tensive pain in the back of the head, extending to the nape of the neck; humming in the head, pimples on the forehead and round the mouth ; pale and sickly complexion, with red spots on the cheeks; changeable appetite, with general emaciation; heaviness in the stomach, under the lower ribs and in the abdomen; bowels irregular, great tendency to 606 DISEASES OF THE FEMALE SEXUAL ORGANS. take cold, irritability and inclination to be angry, redness and melancholy, with frequent weeping. Dose : Six pills every other day. Calcaria Carb. is often of the most striking benefit in chlorosis. Sometimes a complete cure is effected by it alone, even in the worst cases, with (oedema) swelling of the extremities, and extreme dyspnoea. When there is complication with tubercular diathesis, accompanied by cough, Sulphur and Calcarea Carb., often prove highly beneficial in alternation, or if oppressive headache is complained of, Sepia may be given in alterna- tion. Sometimes menstruation does not take place for some time after- wards, though the general health is very much improved under the em- ployment of the remedies prescribed. Dose: Six pills every morning. SUFFRESSIOX OR DELAY OF THE MENSES. AMEX- ORRHCEA. This suppression either takes place during the flow, or in consequence of causes acting previous to the actual appearance. In the former case a cold may have operated; or cold washing may be the cause ; or the feet may have got chilled ; or the patient may not have been sufficiently pro- tected by her clothes; mental or moral emotions, vexations, chagrin, anger, fright, or dancing, sexual intercourse, dietetic transgressions may have led to the suppression. Most of these causes, if operating shortly before the time when the menses were to come on, may cause their retention. A gradual suppression of the catamenia may take place in consequence of deficient nutrition, as well as of the abuse of warm beverages, and the con- tinued influence of depressing emotions, ^\e have already shown that a change in the mode of living may superinduce a suspension of the menses, in the case of young women, without leading to derangements of the gen- eral health, The more sudden the suppression of the menses, the more violent the changes arising from such an occurrence. Some of the most prominent symptoms are: Violent headache, great anxiety and oppression of breathing, nose-bleed, spitting of blood, congestions of the head, heart, and lungs, and the like. In some cases, a suppression of this kind gives rise to acute uterine catarrh. If a physician is called in time, he will, of course, inquire what gave rise to the trouble, and will seek to remove the consequences of fright, mortification, anger, etc., by appropriately specific remedies. If the physician is not called until some time after the morbid symptoms have existed, the aforesaid remedies will no longer be appli- cable, and the constitutional condition generally will have to be acted upon by corresponding remedies, and 3 T ou should follow the same course as a physician. ALLOPATHIC TREATMENT. Amenorrhea. If the menstrual flow (menses) never has appeared, and the patient is strong and healthy, and there is no menstrual molimen (symptoms or sensations of menstruation) it is not prudent to resort to any interference. Every means should be employed to strengthen and invigorate the system. The body, rather SUPPRESSION OF THE MENSES. 607 than. the mental faculties, should be exercised. Life in the open air, and tonics containing iron, should be given, if the patient is anaemic (having thin blood.) Constipation should be corrected as directed in the treatment of that disease. The preparations containing Aloes are espec- ially appropriate. Scarcely ever is menstruation, (and menstrual sensations,) absent after nineteen or twenty years, unless there is a lack of development in some of the organs of generation. This is to be inferred, if invigorating measures after employment for some time, have proved ineffectual. The advice of a skillful physician should be always procured. Develop- ment of the womb to a proper size has, in some cases, been induced by treatment. Retention of the menses is probable when regular symptoms of menstruation occur without the flow, and the abdomen of the patient gradually enlarges. The cause of retention may be absence of the vagina, an imperforate hymen or closure of the mouth of the womb. These may be overcome by the skill of the surgeon. If the general health is good, and the generative organs, vagina, uterus, and ovaries, are well, or reasonably developed, Iron may be effica- cious in establishing the menstrual flow. Persons who have amenorrhoea (suppression of menstruation,) are generally suffering from an indisposition of some kind, with which the amenorrhoea is associated, or dependent upon. In some cases, the patient has fallen into ill health before the menses have ever appeared, and as a consequence, there is no attempt at menstruation. It is, therefore, perfect nonsense to attempt to bring on the monthly flow, or cure the amenorrhoea, while the general health remains impaired. In a patient suffering from consumption, treatment ought not to be directed to menstruation at all, until the patient can be brought up to a good degree of general health, and then nature will establish the menses, if the system is able to sustain the discharge. It is a popular error that stoppage of the monthly courses is the cause of the ill-health which accompanies it, whereas, exactly the opposite is the truth ; the general indisposition has caused the suppression of the menses. In the treat- ment of these cases, the return of the monthly sickness is the final result to be attained. Improvement in other respects must be first attained, and, almost always, the rest will follow as a necessity under nature's order alone. If the patient is not surrounded by good hygiene, this is the first point to attain. She should have pure air, and exercise out of doors should be taken. This exercise, if taken for exercise, is apt to be neglected, and not be of a character which will make her of cheerful spirits ; recreations, such as buggy riding, and walking with cheerful companions, or rambles in the fields or woods, will accomplish this, if not carried to a point which is fatiguing. When the patient becomes exhausted at her exercise, she is going a little too far. A sedentary occupation may sometimes need to be changed for a more active one. With persons who are unaccus- tomed to physical exercise, this habit must be cautioilsly and gradually begun. 608 DISEASES OF THE FEMALE SEXUAL ORGANS. With shop and factory girls, poor hygiene is most likely to be the cause of such a poor state of health as will produce amenorrhea. In these cases, while the use of medicines follow the same rules as in other debili- tated patients, it is quite secondary to the improvement of their hygenic circumstances. In schools, too little time is given to unrestrained life (exercise) in the open air, and too much time to quiet mental work, and the anxiety of parents as to the intellectual development of their children, leading them to send them to school at too early an age, and crowding them too rapidly, is a prolific source of ill-health, and consequent amenorrhoea. If parents would not send their children to school until they were eight year sold, and then, if a large portion of the day was appropriated by every student, to take such recreations as her inclinations lead her to, the breaking down and ill health in schools for girls, would be as rare as it is now common, provided eight full hours of the twenty -four were regularly spent in sleep. The importance of exercise is admitted, in theory, in these schools, but the amount is not regulated to the wants of each particular case. The long walk may be beneficial to the strong and well-nourished, if they are accustomed to such exercise. The girls not so strong and well-fed, may, in these very walks, lay the foundation for a serious disease. To make exercise most useful it must be pleasurable, and for that end restraint must be thrown off. Again, exercise ought not to be violent. The gymnasium is productive of good if not carried to an extreme. It may do much harm. Such exercises as jumping are not to be indulged; occasional and moderate horseback riding is good, but carried to an extreme, it may do harm. Early hours, good nourishing food, of which animal food forms a large part, plenty of fresh air, and warm clothing are necessary to ensure good health, both before and after menstruation. The constipation and derangement of the digestive organs is generally an effect of the state of ill-health, which is to be corrected in the first place, before the patient can take such an amount of nourishment as will bring her body to a vigorous state, and maintain it there. Two or three Compound Rhubarb pills at night, followed by a Seidlitz Powder, or a dessertspoonful of Rochelle Salts, in Lemonade, in the morning, may be given once or twice a week, for a time; or, after the bowels have moved freely, from the use of three or four Compound Cathartic Pills, remedies may be used as are directed for constipation. The pills containing Aloes and Extract of Nux Vomica, are to be preferred. The circulation should be maintained by free, pleasurable exercise in the open air, sponging the skin with tepid or cool water, and rubbing briskly with a coarse or rough towel, until the skin is aglow, and warm clothing. It is very important to keep the feet, legs, and arms so well clothed that they will keep warm. The two remedies which are especially serviceable in building up the health to a point at which menstruation will occur in obedience to nature alone, are Iron and Quinine. One of the best forms for its efficacious administration is the Citrate of Iron and Quinine in doses of from two to five grains three times a day. It may be dissolved in Syrup of Ginger or SUPPRESSION OF THE MENSES. 609 Orange Flower water. Take of Citrate of Iron and Quinine from one and a half to three drams, Syrup of Ginger six ounces. Mix. Dose: A teaspoonful, or a teaspoonful and a half, three times a day. If the bitter taste is seriously objected to, one or two grain pills of the Sulphate of Quinine may be given two or three times a day, and the same quantity of the Soluble Citrate of Iron may be given in solution with Cinnamon or Orange Flower water in the same proportions as directed for the Citrate of Iron and Quinine. Before buying the sugar or gelatine coated pills of Quinine one of these should be cut open with a knife, if they are good they will be soft under the coating. The Pyrophosphate of Iron answers the purpose very well. It can be given as follows: Take of Pyrophosphate of Iron two and a half drams, water sufficient to dissolve, Syrup of Orange sufficient to make six ounces. Mix. Dose : A teaspoonful three times a day. The Tincture Muriate of Iron has long deservedly enjoyed a reputa- tion in the cure of amenorrhoea, and is one of the most effectual. The dose is fifteen or twenty drops three times a day, largely diluted in sweetened water . After the use of Iron and Quinine for a time, if health is not restored it is well to change to the use of Iron with Strychnine. Take of the Ci- trate of Iron and Strychnine seven scruples, water sufficient to dissolve, Syrup of Ginger or Orange a sufficient quantity to make six ounces. Mix. Dose : A teaspoonful three times a day. Each teaspoonful contains a fraction less than a thirtieth of a grain of Strychnine. If the patient does not suffer from impoverishment of the blood, or if they have recovered from the anaemia, from three to five drops of Fowler's Solution, three times a day, may be given with benefit. It seems to restore the activity of the ovaries. The Chloride of Gold and Soda in pill, one twentieth of a grain each, three times a day, is also thought to be benefi- cial, in the same way. Dyspepsia must be treated as is directed in that disease. It may some- times be advisable to keep the patient for a time on a milk diet. Only such food should be given as is found by experiment to be readily diges- ted. Milk, beef tea, eggs beat up with sugar and water or milk, are some of the easiest digested and most nutritious articles of food. The object in treatment is first, to put the body in good health as the amenorrhoea is only a symptom of the state of ill health. If menstruation has been suddenly suppressed, it is best to give a hot sitz (hip) bath, a copious drink of Ginger tea, place her in bed and give her a full dose of Dover's Powder's (ten or fifteen grains,) especially if she has had a child. A mustard plaster may be put over the lower part of her abdomen, and bottles of hot water about her hips and loins. The use of electricity has, in some instances, caused a return of the flow. A hot water injection into the rectum may be made. When the time for menstruation has passed, we must wait until just before the next period, when for three or four days a warm hip bath should be given night and morning. If there is no pregnancy some of those 39 610 DISEASES OF THE FEMALE SEXUAL ORGANS. remedies called emenagogue (calculated to promote the flow of menses,) may be given, if the physician desires, but as so much harm may be done with these, it is deemed proper not to give directions for their use in a popular book. When the mental emotions have been the cause of the sudden sup- pression, Opium to the extent of producing quiet in doses of half a grain to a grain, is the best remedy. Laudanum in doses of ten to twenty drops, or Paregoric in doses of two teaspoonfuls may be given. Chronic suppression should be treated on the principles before given, viz : Correction of the general health, and from month to month encour- age the menstrual flow by the gentle measures just enumerated HOMOEOPATHIC TREATMENT. Pulsatilla should be employed when a suppression takes place from the sudden effects of a chill, when the symptoms generally correspond with those described under the head of that remedy, in the article on Chlorosis. Dose: Six pills in a teaspoonful of water, night and morning, for a w T eek (unless a change should sooner occur;) then pause eight days, after which the course may, if necessary, be repeated as before, and so on. Cocculus in cases in which there are habitually attacks of colic-like pains in the bowels at the periods at which the menstrual discharge should occur if it were regular, more especially if the patient complains of great weakness of the lower extremities languor and lassitude, precar- ious appetite, and generally also nausea, with much oppression at the chest and in the region of the stomach, etc.; especially when this functional derangement occurs in full-habited and apparently healthy persons, par- ticularly if the suppression be traced to mental emotions. Dose : As for Pulsatilla. Nnx-nioschata when the suppression is accompanied by spasms and other hysteric affections ; disposition to sleep and faint away ; great nervousness ; complete exhaustion after slight exertion ; pains in the loins, etc. Dose : As directed for Pulsatilla. Canlophyllum should be given when there are spasmodic, bearing- down pains ; and sympathetic, crampy, spasmodic pains in the bladder, rectum, or bowels. Dose : As directed for Pulsatilla. Veratrum should be administered in cases in which the convulsive and other symptoms incidental to the suppression, when caused by fright, have failed to yield to the last-named medicine ; and when there are pale, livid face ; frequent nausea and vomiting ; cold hands, feet, and nose ; great weakness, with fainting turns. Dose : As directed for Pulsatilla. Lycojioclium has proved of service in cases in which the patient complains of headache and giddiness; flatulent distention of the bowels before each period at which the secretion ought to have returned ; and habitual costiveness. Dose: As directed for Pulsatilla. Belladonna should be employed in cases which are associated with fullness of blood, determination of blood to the head, violent throbbing of the arteries of the head and neck, and nose-bleed. MENORRHAGIA. 611 Dose : As directed for Pulsatilla. Sulphur is one of the most important remedies for the treatment of ■cases which assume a chronic and obstinate character, more particularly if such cases occur in persons of a feeble or exhausted constitution, or who bear about tbem, in a marked degree, the traces of a scrofulous habit of body, or who are affected with the piles; or, again, when the prevailing symptoms are such as have been described in detail under the head of this medicine, in the article on "Chlorosis or Green-Sickness." Dose: Six pills in a teaspoonful of water, the first thing in the morn- ing, for six days, (unless change should sooner occur;) then pause ten days, after which the course may, if necessary, be repeated as before, and so on. Sepia is also of great value, whether at the onset, or after the previous administration of Sulphur, for the treatment of chronic and difficult cases, and for such as are complicated with scrofulous taint of constitu- tion, or which occur in otherwise feeble and exhausted subjects. Sepia is more especially appropriate when the prevailing symptoms are such as have been described in detail under the head of this medicine, in the article on " Green-Sickness." Dose: Four pills, in other respects as directed for Sulphur. MENORRHAGIA— PROFUSE MENSTRUATION. The quantity of the menstrual discharge varies a great deal in differ- ent individuals. The climate, constitution, and manner of living, have considerable influence. The duration of the discharge, and the periods of return, are also varied. In some women, it continues from four to ten days, while in others it lasts only a few hours ; from three to six days is, however, the most usual period. The regularity is, in many cases exact, to a day, or even an hour ; while in others, a variation of several days is a usual occurrence, without the slightest disturbance in the usual health resulting therefrom. An excess of loss of menstrual blood, a true menorrhagia, does not occur as often as it may seem to those who complain of it. To constitute menorrhagia, several circumstances have to occur that require to be carefully discriminated. The average of discharged blood has to exceed the ordinary loss quite considerably ; and then, again, we have to inquire whether the scantiness of the ordinary menstrual flow is not an abnor- mal diminution in the present case. The menstrual flow is likewise considered too copious if it continues beyond the ordinary period, although this need not necessarily imply that the menses are profuse. It is therefore, the morbid character of the menses that is necessary to deter- mine the disorder, for a copious flow of the menses cannot be considered abnormal as long as the constitutional harmony is in no respect disturbed by it. The causes of menorrhagia are quite numerous, of which it may be best to make mention of a few : Excess is occasioned by onanism, novel- reading, a constant dwelling of the fancy upon sexual things, and the habitual use of heating beverages. A few other important points have to Toe added: Under certain circumstances, a profuse flow of the menstrual 612 DISEASES OF THE FEMALE SEXUAL ORGANS. blood becomes a real physiological necessity to the body ; for instance, if a larger supply of nourishment than the body requires for its normal support, causes a real plethora. This can hardly be regarded as a morbid condition. A profuse flow is sometimes occasioned by changes in the uterus, such as acute or chronic inflammation of the womb, or some foreign growth in the uterine cavity. Nursing exerts- a very particular influence. As a rule, nursing women do not menstruate; yet it may happen, even in the case of quite healthy mothers, that the menses reappear again permanently, in which case the flow is often very profuse. This is not a normal condition, although it does not inconvenience all women. Menorrhagias that set in when the process of nursing is continued too long, are of an exceedingly threatening character. This accident occurs quite often where the women nurse their children for several years for the purpose of preventing conception, not thinking that by so doing they inflict permanent injury upon their health. We must not forget to record the fact that diseases of other organs, or of the general constitution, exert an influence upon the menses. Diseases such as typhus or scurvy, etc., the influence of heart disease or consumption, and all such diseases which alter the quality of the blood, must be considered. It is more especially heart disease that causes menorrhagia, so that the heart had better be carefully examined in every case of menorrhagia. Finally, the cessation of the menses, at the critical age, is almost always ushered in by profuse loss of blood. HOM(EOPATHIC TREATMENT. Ipecacuanlia is one of the more generally useful medicines in severe cases of this derangement, as well as in flooding after labor, and may, in most instances, be administered first, unless there are strong indications for a preference being given to any of the others. Dose: Six globules in a teaspoonful of water, repeated at intervals of six hours, until amelioration or change. Sabina is indicated when the discharge is excessive, of a bright color,, and occurs in full-habited females who are prone to miscarry ; or when the subjoined symptoms prevail ; rheumatic pains in the head and linibs, great weakness ; pains in the loins similar to those of labor. Dose: Six globules, as directed for Ipecacuanlia. China is of considerable utility where there is great debility in con- sequence of a more copious menstrual discharge than is natural. Dose : Six globules in a tablespoonful of water, repeated at intervals of six hours, if necessary. Niioc-vomica is especially appropriate for the following symptoms: — The discharge being of too frequent occurrence, too profuse, and of too long duration; and when it commonly stops for a day or so and then returns, attended with spasms in the belly; sometimes nausea and faint- ing, especially in the morning; pains in the limbs ; restlessness; irascibil- ity. Nux- vomica is especially serviceable when the above symptoms occur in females who are addicted to the daily or frequent use of coffee, liquors and other stimulants, or have been extensively drugged by old-school practitioners. Dose : Six globules in a teaspoonful of water, repeated at intervals of four hours. PROFUSE MENSTRUATION 613 Chamomilla is frequently useful when there is [ a discharge of dark, ■clotted blood, with severe colic, or pains like those of labor; great thirst; paleness of the face, and coldness of the limbs. Dose : Six globules in a teaspoonf ul of water, repeated at intervals of six hours, until improvement or change. Ignatia is of considerable service in cases resembling the above, when the derangement happens in hysterical or sensitive females of mild and uncomplaining disposition ; or who have had a great deal of trouble. Dose : As for Chamomilla. Veratrum is more particularly required for too early or too copious menstrul discharge, always attended with diarrhoea. Dose : Three globules, as directed for Chamomilla. Gelseminiim is indicated in cases in which there is scarcely an inter- val between the periods ; which are not, however, attended with much suffering; or, the flow having ceased, is brought on again by fright or other mental emotion. Dose; Three globules, as for Chamomilla, Kreosote will be found useful when the menstrual blood has a deci- dedly offensive odor, is too profuse, and lasts too long; the abdomen becomes distended before the periods ; leucorrhoea, which excoriates the parts, between the periods. Dose : Three globules, as directed for Chamomilla. Diet and Regimen. Patients who are habitually affected with exces- sive menstrual discharge should live with great regularity, keeping early hours, taking regular, but moderate daily exercise in the open air (during the intervals) in favorable weather, and partaking of nothing but the most digestible, simple, and unstimulating diet, which, at the same time, should be of a nourishing and strengthening description. Emotions of all kinds should be avoided as much as possible ; and during the continuance of the discharge the semi-recumbent posture should be retained, and the body kept cool. Neither food nor drink should be taken hot ; the food should be as cool as it can be relished, or chiefly cold, and the beveiage quite cold. In addition to these directions, more explicit particulars may be derived from the article on "Eradicative Treatment,'' at p. 93. ALLOPATHIC TREATMENT. The successful treatment of menorr- hagia will depend on the exact recognition of the profuse menstruation, and the use of appropriate means for effecting their removal. For this reason, if for no other, the skill of a physician is required to secure such a knowledge of the causes of the trouble, as will lead to intelligent and proper treatment. The general condition of the patient is to be looked after. If the blood is impoverished, the patient must be invigorated, and the general health improved by good hygiene, good food, pure air, and exercise, carried to the point of making the patient feel vigorous, never fatigued, etc. The directions given for the management of the condition known as "anaemia," are appropriate here. If the patient resides in a malarious, locality, anti-malarial treatment will be required, as two or three grains of Quinine three or four times a day, or a larger dose once or twice a day for a few days or a week, followed by such directions as are given in the treatment of ague. The use of iron, as directed in the treatment of anaemia and ague, is generally necessary. If the bowels are torpid and 614 DISEASES OF THE FEMALE SEXUAL ORGANS. inactive, they should be moved by a brisk cathartic, and during the day of the menstrual flow, a mixture of Epsom Salts and Aromatic Sulphuric Acid should be given, as: Take of Epsom Salts an ounce, Aromatic Sulphuric Acid half an ounce,. Syrup three and a half ounces. Mix. Dose: A teaspoonful to a dessertspoonful, in water, four times a day. In cases due chiefly to debility, a half a dram of Sulphate of Iron may be added to the above formula. The dose will be the same, given three times a day. Two or three times a week a laxative pill may be taken, such as are directed for constipation, if the bowels are not suffi- ciently active. The chronic congestion of the uterus requires attention when this exists, which is always the case in those instances not dependant on organic disease. The warm vaginal douche, as directed for leucorrhcea, is useful. Tonics are also required which contain Quinine, Iron, and Strychnine, as: . Take of Citrate of Iron and Quinine, and of the Citrate of Iron and Strychnine, each a dram and a half ; Water of Orange Floioers four ounces. Mix. Dose : A teaspoonful three times a day. This medicine may be sweetened with the addition of sugar or substi- tuting Syrup of Orange. The coexisting leucorrhcea must be treated as directed for that disease. Many a case of menorrhagia depends upon a flexion of the womb. It is astonishing sometimes, how quickly the excessive flow will cease when this displacement is corrected. A chronic inflammation of the womb, resulting from sub-involution of the womb, (its failure to regain its natural size after confinement or miscarriage,) may cause this trouble. The most suitable constitutional treatment appears to be the daily use of the hot douche, and hot hip bath, and rest much of the time in the reclining posture. The tonic recom- mended for chronic congestion is suitable, with three or four doses a day of half a teaspoonful of Fluid Extract of Ergot. If, after this treatment has been continued through a whole interval, between times of menstru- ation, without benefit, it will be well to try Iodide of Potassium, instead of Strychnine, as in this formula: Take of Elixir of Cinchona and Pyrophosphate of Iron eight ounces, and add Iodide of Potassium five drams. Mix. Dose: A teaspoonful to a desertspoonful three times a day. During the time of menstruation the use of Ergot as hereafter men- tioned, will be very serviceable. The daily use of the sponge bath is a most serviceable tonic, and should be always resorted to. After the bath, the body should be rubbed with a coarse towel until the skin is aglow. In the Menorrhagia of the Climacteric Period (change of life) in addition to such treatment, sketched above, as the case may require; cold hip baths should be resorted to ; its good effects are marked. The internal remedies may be given the same as for other causes. Applications of styptic medicines to the interior of the body of the womb, are called for in case of excessive hemorrhage. These will be made by a physician by PROFUSE MENSTRUATION. 615 means of an intra uterine syringe, a probe wrapped with cotton, or other instrument for the purpose, after dilating the neck with sponge tents. The best applications are the Liquid Sub-Sulphate of Iron, a mixture of five drams of Sulphate of Zinc in three drams of Glycerine. It is necessary to have the manner of living strictly regulated during the time of the menstrual flow. For two or three days before the expected period, and during the time, the patient ought to remain quiet in the recumbent position. The room should be cool and clothing light. The bowels kept open; the diet should be simple and plain, and the appe- tite for food or drink only moderately indulged, and the patient must refrain from the relations of the bed. These rules closely followed, will greatly diminish the flow. The internal remedies to be given during the excessive flow, are those which produce a contraction of the womb, and so closing the vessels and stopping the hemorrhage; and those having the power of arresting hemorrhage called styptics. It is unnecessary, in my opinion, to mention any other remedy than Ergot for the purpose of controlling an excessive menstrual flow; a teaspoonful of the fresh powder in ginger tea,- or a tea- spoonful of the Fluid Extract in water, may be given four times in the twenty-four hours. Of styptics, ten grain doses of Gallic Acid with ten drops of Aromatic Sulphuric Acid in a wine glass of water, well sweet- ened, is useful, given three or four hours apart. Rue and Savin in doses of a grain, are highly recommended. They act, however, in a similar way to Ergot. Other styptics as directed for hemorrhage from the lungs or kidneys. In some cases, the flow may be so severe as to require arresting imme- diately, so that while the foregoing treatment is required, it is necessary to stop the flow by mechanical means, that is, the vagina must be plugged up tightly, so that no more blood can flow. A bivalve speculum is intro- duced into the vagina, and a piece of lint slightly moistened with Glycer- ine, and then saturated with Liquid Sub-Sulphate of Iron is placed over the mouth of the womb, and two or three yards of bandage (previously wet with cold water and wrung out) packed into the vagina. It is all then held in place by a T bandage. Cloths wet with cold water, are laid over the pelvis occasionally. Cold water may be injected into the rectum. It is often necessary to support the woman under the exhaustion of the loss of blood, by giving stimulants of brandy, and nourishment of strong beef tea or milk, quite frequently, but in small quantities. Organic diseases causing menorrhagia demand their appropriate treatment, but as nothing can be done without the aid of a surgeon the description is not given here. LEUCORRHCEA— WHITES. CATARRH OF THE SEXUAL MUCOUS LINING. Simple catarrh is one of the most common derangements of the female sex. It originates in a variety of causes. In the first place, we have to mention as exciting causes, such as act directly upon the sexual organs— excesssive coition, and self-abuse, miscarriage, and to some extent confine- ments, which, if occurring in too rapid succession, almost always causes 616 DISEASES OF THE FEMALE SEXUAL ORGANS. leucorrhcea, especially when after the last named causes, the patients per- sist in getting about too soon. Sudden and violent attacks of vaginitis and leucorrhoea have been observed to arise from causes such as those which follow sudden suppres- sions of perspiration; of diarrhoeas, or of sudden suppression of milk, or in other instances, suppression of some eruption on the skin. The influence of cold, damp weather, or exposure to cold and damp from the location of the residence in a marshy district, or perhaps the nature of the house itself, (stone, with walls constantly moist on their inner surface) and from water standing in the cellar, especially when long con- tinued, is a powerful promoter of leucorrhcea. An entirely opposite, but not less numerous class of causes of this dis- ease, may be found in the high living, stimulating spices, condiments, and drinks in which many women indulge. Symptoms. At the first appearance of leucorrhoea, there are usually the indications of acute inflammation, pain, heat, and redness of the parts involved which may subside as the discharge becomes more and more fully developed. With this discharge, whether acute or chronic, there will usually be more or less pain in the groins and hypogastrum (lower part of the abdomen) and in the lower part and small of the back. The urethra will often become implicated; causing painful micturation (passing water) and sometimes causing almost inability to urinate, in the acute form. ALLOPATHIC TREATMENT. The treatment of Lecuhorrhoea or Whites must necessarily be directed first to the cause, as failure of the general health, as from consumption, or anaemia, (impoverishment of the blood.) The treatment will relate primarily to the treatment of consumption, for which directions will be given in the article on consumption ; or if the patient is anaemic, (pale, weak, and tired, espec- ially tired upon rising after full a night's rest,) the treatment will first be directed to the removal of the anaemic condition, by the use of tonic remedies, especially Iron. When the discharge is very profuse, and exhausting, the Phosphate or Hypophosphite of Lime, may be given with great advantage. During the general improvement of the body, the discharge diminishes. In Parrish's chemical food (Compound Syrup of the Phosphates,) we have both the Iron and Lime. The dose is a teaspoonful. It may be mixed with an equal part of Syrup of the Lacto- Phosphate of Lime, and a dessertspoonful given three times a day. The Compound Syrup of the Hypophosphites (Lime, Soda, Potash, and Iron,) meets the indications, and is agreeable to take. The dose is from a teaspoonful to a dessertspoonful, three times a day. If there is coilcky pains, or symptoms of dysentery, the Hypophosphites should be combined with Dilute Phosphoric Acid. Take of the Compound Syrup of Hypophosphites seven ounces, Dilute Phosphoric Acid one ounce. Mix Dose : One or two teaspoonfuls three times a day. It is a good rule to add the Dilute Phosphoric Acid to the Hypophos phites whenever they are given. In marshy districts, or when ague is prevalent, Quinine should be given for a week, alternated with Cinchonidias for a week, in doses of two or three grains, three times a day; or such other treatment as is suitable for Ague poisoning, given in the treatment of intermittent fever. Some- LEUCORRHCEA. 617 times a change of residence is necessary to retain better hygiene. Exalted activity of the sexual organs will demand an omission of the relations of the bed. There are few cases of Leucorrhcea in which the uterus is sound. The organ is relaxed, and probably enlarged, and the secretion of the mucus membrane increased, showing a chronic inflammation, or congestion. Flexions (the womb bending on itself,) or other displace- ments of the organ, must be corrected by mechanical means. The skill of a physician is required, but if unavailable, it may be said here that the common ring pessory relieves more cases of displacement than any other instrument that can be used by the unskilled hand. The neck of the womb should rest within the ring after its introduction. The concave pessory ought not to be used as a rule; it makes a flexion worse, as do the stem pessories with a cup. Adjusted by a skilled person, some form of Dr. Hodge's bow pessory is suited to most displacements. Correction of the malposition of the womb relieves the congestion, and so does much towards curing the discharge. This caution must be added: an unsuit- able, or illy fitted supporter, is a positive injury. The enlargement and chronic inflammation is generally caused by rising too soon from child- bed, or after an abortion. A long period of rest in bed is required after these events; four weeks will do, but sometimes a longer time is required. The binder, wide enough to reach from the ribs to the middle of the thighs, should be kept tightly pinned after delivery. After the lochia (flow,) ceases, the warm vaginal douche should be commenced. Consti- pation must be obviated, as directed for that trouble. The preparations containing Aloes are to be preferred. Diet should be nourishing, and the exercise at first moderate. Too frequent pregnancies in women, liable to abortion, is another cause of chronic enlargement, and of a condition causing Whites. The womb must have rest after an abortion, as well as after confinement ; this is necessary for months, sometimes. Too frequent menstruation is another cause to be obviated, if possible. In this chronic enlarged condition, a teaspoonful of the Fluid Extract of Ergot, wath ten or fifteen drops of Tincture of Xux-vomica may be taken two or three times a day. Ten grains of the Iodide of Potassium in sweetened Pepper- mint water, three times a day, is a beneficial remedy for this enlargement and for the chronic discharge. Iron may be indicated in the form mentioned above. Change of climate, and the use of mineral waters may sometimes be called for, but generally the indication is met by the Hypophosphites recommended above. The kind and quantity of food should be regulated to meet the wants of the system. Sleep should be long and undisturbed. The skin must be kept warm with flannels, bathing, rubbing, and out-door exercise. The bath should, as a rule, be warm and tepid, taken daily, and followed immediately by cool bathing. The combined sitz and sponge bath is most generally applicable; after the bath the skin should be rubbed until it is aglow. If there is a poor reaction, or no reaction, the ■cool bath should not be used. Some are most benefited by the warm baths exclusively. While many cases of leucorrhcea can be cured without them, injections are very valuable in treating this trouble, and sometimes they are a necessity. A long, flexible syringe, having a long vaginal tube, should be 618 DISEASES OF THE FEMALE SEXUAL. ORGANS. selected, and used after the form called the "douche.'' Thesyringeshould be- filled and one end of the tube introduced into the vagina, and the other in the bucket containing the fluid, which is raised considerably higher than the patient. The tube acts as a siphon. The hight of the bucket and the length of this column of fluid governs the force of the current. The flex- ible tube should therefore be long. In this way, any quantity of fluid, can be used at an injection without wearying the patient. She should lie upon her back, with her hips raised with a pillow, and a rubber cloth so arranged thab the fluid may be conducted into a bucket. In the use of water injections, I have found warm water (as hot as can be borne) the best. The quantity allowed to flow through the vagina should be large ; one or two gallons frequently repeated. Sometimes the cold douche alter- nated with the hot douche, and less often the cold douche alone, gives better results. The diseased surface is not generally the vagina, but the interior of the womb, which medicated injections do not reach. They are often, however, useful. The simple water injection should be used first, followed by a quart of the medicated injection. A strong tea, of "White Oak Bark, with or without the addition of one or two teaspoonfuls of Alum in the quart may be used. One or two drams of Tannin and four drams of Alum to a quart of water, is often serviceable. One or two even teaspoonfuls (drams) of Sulphate of Zinc in a quart of water, may be used. It is often better to change the injection from time to time. If the flow is offensive, the Permanganate of Potash, two drams to the quart, or one dram of Carbolic Acid to the quart of water, may be used for an injection. If the discharge is irritating, Dathing the external genitals with a solution of Soda or Borax will be useful. Many times the physician has to resort to topical applications to the neck of the womb and its cavity, for which the following preparations of Iodine and Tannin are highly useful : Take of Iodine half a dram, Iodideof Potas- sium and Water, of each a sufficient quantity to dissolve the Iodine, Glycerine sufficient to make an ounce, then add two drams of Tannin, or such quantity as is desired. The Tincture of Iodine saturated with Tannin, is a very efficient application in chronic inflammation of the neck and interior of the womb, and in enlargement of the organ, so prolific of leucorrhoeal dis- charge. Also an excellent plan of local treatment, which must also be made by the physician, is, Idoform one dram, Tannin one ounce. Mix well. A sufficient quantity of this powder is to be packed dry around the neck. One of the most effectual applications in these same affections with ulceration, and consequently, for the leucorrhcea, is the undiluted Car- bolic Acid, which may be applied to the neck and cavity of the womb with a probe wrapped with cotton, but by a physician only. Before mak- ing this internal application, the uterine (womb) cavity should be dilated with a sponge tent. HOM(EOPATHIC TREATMENT. The radical cure of this disorder is attended with much difficulty, and can only be affected by long patient, and careful treatment in those cases in which it is incidental to serious derangements of the womb, or of its appendages. Pulsatilla is indicated when the discharge is thick like cream, or milky, and sometimes gives rise to a burning sensation ; when, moreover, it is associated with indigestion, and occurs in females of relaxed fibre and LEUCORRHCEA. 619 lymphatic temperament, or in whom the monthly flow is irregular and scanty; the discharge is often worse when lying down. Dose: Six globules in a teaspoonful of water, morning and evening, for four days, (unless a decided change should sooner occur ;) then pause four days, after which the course may, if necessary, be repeated as before, and so on. Sepia should be selected when the affection occurs in delicate and exhausted females, the discharge being yellow or green, generally watery, and more or less acrid or corrosive; and when it is accompanied by a ten- dency to profuse perspiration, particularly on sitting down, after walking. Sepia is, also, additionally indicated, if the monthly discharges are irregu- lar; and, further, when bearing-down is often experienced. Dose : Four globules, in other respects as directed for Calcarea. China should be given when the discharge is very profuse, and gives rise to great debility; the menses seem to be suspended, or the leucorrhoeal discharge occurs instead ; painful pressing towards the groins and anus. Dose: Four globules, as directed for Pulsatilla. jEsculus-hip (Buckeye,) is indicated where the whites are accom- panied by intense pain and lameness in the back and hips, so that it is almost impossible to rise after sitting, or to walk a long distance ; consti- pation, and piles. Dose: Three globules, as directed for Pulsatilla. Kreosotum. The discharge precedes and follows the menses, and is greatest when standing or w r alking; it is yellow, offensive, acrid, and cor- rosive, causing soreness of the parts, and violent itching. Dose: Three globules, as directed for Pulsatilla. Podophyllum should be administered in cases in which the discharge is thick and transparent, and there is constipation, and a feeling of bearing, or pressing downwards on the genitals; falling of the womb, and protrusion of the intestine during stool. Dose : Three globules, as directed for Pulsatilla. Collinsonia is indicated by cases in which the discharge, which may be thick or thin, is accompanied by great itching of the parts; and there are obstinate constipation, and disordered and painful menstruation. Dose: Three globules, as directed for Pulsatilla. Iodinm may be found very useful in cases of long standing ; particu- larly in scrofulous subjects ; the whites are most abundant at or near the time for the menstrual flow ; and the discharge is so very acrid and corro- sive that not only are the adjacent parts made sore, but the underclothing is made rotten and destroyed. Dose : Six globules, as directed for Calcarea. Diet and Regimen. The diet ought to be simple, but generally very nutritive. Coffee and tea ought to be avoided, and cocoa or arrow- root substituted. Regular exposure to the benign influence of the fresh air is commendable, but over-fatigue and prolonged standing should be sedulously avoided. PROLAPSUS UTERI— FALLING OF THE WOMB. This is one of the most common forms of uterine displacement. It occurs in three distinct, different degrees, to each of which some writers 620 DISEASES OF THE FEMALE SEXUAL ORGANS. on the subject have affixed a different name. Thus, relaxation,or simple descent of the womb, is understood to indicate the first and least displace- ment downward, and to consist only in a simple bearing-down of the womb upon the upper portion of the vagina. In prolapsus uteri, the organ comes still lower down, and may present at the orifice of the vagina. In procerdentia uteri, there is actual protrusion of the organ, even the entire body of the womb being, in some cases, extended from the vulva. These are but different degrees of descent of the uterus in the line of the vagina. Upon examination of the same displaced uterus, at different times of the day, it may be found to be more or less prolapsed, according to the condition of active exercise, or quiet, in which the parts may have been for some hours previous. Symptoms. The principal and primary symptoms of the descent of the womb are: dragging and aching pains in the small of theback, pulling and bearing-down pains in the lower part of the abdomen, sensation as if some- thing would issue from the vagina; sufferings much worse from walking, or other exercise ; the pains are often noticed to have come immediately after some exertion of an unusual kind, and after some more than ordi- nary muscular effort; frequent calls to urinate, dysuria (painful urina- tion,) or even retention of urine. In the more fully developed forms of prolapsus, the history of the case, the attendant circumstances, and the external appearance of the mouth of the womb, and even of the entire body of the uterus itself, can hardly fail to render the diagnosis at once easy and certain. And if the falling of the womb is not so far developed as to give any such external signs, the severe aggravation from walking and from lifting, together with the relief experienced from lying down, render the case sufficiently clear. Should there be any doubt, however, the vaginal touch will verify the diagnosis. The Causes. Prolapsus of the womb may arise from various causes, such as over lifting or some other muscular exertion, or from an improper manner of dress, such as tight lacing, or the weight of heavy clothing drag-, ging on the abdomen. Incase of married women who have borne chil- dren, many cases of falling of the womb are caused by mismanagement. Perhaps the bandage worn has been too tight, or has slipped up and the pressure has forced the bowels to press down upon the womb while in a relaxed condition, or perhaps, the patient has gotten up from the bed too soon after confinement ; the whole system being weak, it is very easy to do a little too much, and bring on injuries which are very often hard to relieve one's self of. In cases of displacement of the womb, the recumbent pos- ture is a necessary requirement, together with the properly selected remedy; a cure can very frequently be obtained. HOMCEOPATHIC TREATMENT. There is scarcely any remedy in the whole Materia Medica that may not be found useful in these displacements but for fear of confusing the common reader, will mention only a few of the remedies which have proven, during several years of practice, to be the most reliable. Bell., Chamomilla, Nux-vom., Platina, Puis., Sepia, Cantharis, Con, Aeon., China and Arnica. belladonna. Pressure, as though all the contents of the abdomen would issue through the genital organs. This is particularly felt early in FALLING OF THE WOMB. 621 the morning ; sensation of heat and dryness in the vagina. Pains in the pelvic region, which come on suddenly and cease suddenly, or feeling in the back as if it would break, hindering motion, suppression of the stool and of urine. Chamomilla. Frequent pressure toward the uterus, like labor pains, with frequent desire to urinate, often passing large quantities of colorless urine. Frequent discharge of clotted blood, with tearing pain in the veins of the legs, and violent labor-like pains in the uterus. Contrary to her condition in health, she is always out of humor, particu- larly at her menstrual periods, when she is headstrong, even unto quarreling. She can hardly speak a pleasant word, and has to restrain herself in order to do so. China. In cases where the prolapsus and attendant symptoms were superinduced by losses of fluids, particularly of blood. She has much ringing in the ears, a sense of distention in the abdomen, which is not relieved by eructations. Nux Vom. Prolapsus uteri, from straining by lifting. Pressure toward the genital organs, early in the morning, in bed, or during a walk, with a sensation of drawing in the abdomen. Constipation of large hard, difficult stools, or small stools, with frequent urging. Pain in the small of the back, preventing her from turning over in bed. Frequent urination ; she passes little, and often, with much burning pain. The prolapsus of long standing is often accompanied with dry cough, and a sense of constriction around the lower part of the abdomen. Pulsatilla. Pressure in the abdomen and small of the back, as from a stone, with disposition of the lower limbs to go to sleep, when sitting, and attended with ineffectual desire for stool. Menstrual colic, with great restlessness, tossing in every possible direction. Mild, tearful, yielding, disposition. She cries at everything, is sad and desponding. Very bad taste in the mouth in the morning, nothing tastes good. She is pale and feeble. Cantharis. Burning in the vulva, and violent itching in the vagina. Almost constant desire to urinate, with cutting, burning, and passing of a few drops of urine, sometimes bloody, sometimes followed by a discharge of bloody mucus. Conium. Induration and prolapsus at the same time. Much nausea and vomiting. Vertigo, particularly when in a recumbent posi- tion, and in turning over. Intermittent flow at every emission of urine. The breasts become sore, enlarged, and painful at every menstrual period. This remedy alone, in many cases where the above symptoms are present, is sufficient to produce a cure. Aconite. If the prolapsus has occurred suddenly, and there is in con- sequence, great inflammation of the parts, with burning pain as if from hot coals ; excessive sensibility to the least touch ; bitter, bilious vomiting, anguish, and cold perspiration, or hot and dry skin. Arnica. When the prolapsus has been caused by a concussion, and a bruised, sore feeling remains. She cannot walk erect on account of a bruised sore feeling in the uterine region. Dose : Each of the foregoing remedies may be given, six or eight pills every four hours. 622 DISEASES OF THE FEMALE SEXUAL ORGANS. Platina. Painful sensitiveness and continual pressure and dragging sensation in the lower part of the abdomen, and the mons veneris and inter- nal organs, with internal chills and coldness. This, as proved by experi- ence, is one of the most effectual remedies for prolapsis uteri, and taken singly, or in alternation with some other remedy, will give good satisfac- tion. Dose: A small powder three times each dav. Sepia. Painful stiffness, apparently in the uterus. Pressing in the uterus, oppressing the breathing ; sensation as if everything would come out of the vagina and uterus. Sensation of weight in the arms, not relieved by an evacuation. Great sense of emptiness at the pit of the stomach. The urine deposits a clay-like sediment, which it is hard to remove from the chamber. Dose: To be administered the same as Platina. Platina in alternation with Conium or Belladonna is very beneficial. Dose: If given in alternation, every six hours. THE CHANGE OF LIFE-MENOPAUSE. After a certain number of years, woman lays aside those functions with which she has been endowed for the perpetuation of the species, and resumes once more, that exclusively individual life which had been her's when a child. The evening of her days approaches, and if she has observed the precepts of wisdom, she may look forward to a long and placid period of rest, blessed with health, honored, yes, loved with a purer name than any which she inspired in the bloom of youth and beauty. But ere this haven of rest is reached, there is a crisis to pass, which is ever the subject of anxious solicitude. The more common, and less scien- tific name for it is the change of life; physicians know it as the menopause — the period of the cessation of the monthly flow. It is the epoch when the ovaries cease producing any more ova, and the woman, becomes there- fore, incapable of bearing any more children. The age at which this occurs is variable. In this country, from forty to forty-six years is the most common, though instances are not at all unusual, where it does not take place until the half century has been turned, and we have known instances where women .past sixty have con- tinued to have their periodical returns. Examples of early cessation are more rare. We rarely meet them earlier than thirty years, but healthy women have been observed in whom the flow had ceased as early as twenty eight. The physical change which is most apparent at this time, is the ten- dency to grow stout. The fat increases as the power of reproduction decreases. And here a curious observation comes in. We have said that when a girl changes to a woman a similar deposit of fat takes place, (though less in amount) which commences at the loins. This is the first sign of puberty. In the change of life, the first sign is visible at the lower part of the back of the neck, on a level with the bones known as the cerv- ical vertebra. There commences an accumulation of fat, which often grows to form two distinct prominences, and is an infallible index of the period of a woman's life. THE CHANGE OF LIFE. 623 The breasts do not usually partake of this increase, but become flat and hard; the substance of the gland losing its spongy texture. The legs and arms loose their roundness of outline, and where they do not grow fat, they wither up and resemble those of the other sex. The abdo- men enlarges, even to the extent, occasionally, of leading the wife to believe that she is to be a mother— a delusion sometimes strengthened by the absence of the monthly sickness. Finally, a perceptible tendency to a beard often manifests itself, the voice grows harder, and the characteris- tics of the female sex become less and less distinct. In proportion as women enjoy good health, and especially, in propor- tion as the menses are normal in quantity, and regular in their return, may we expect to pass through the trying season of the change of lite at about the usual age, or a little later, and with comparatively little suffer- ing; while in proportion as the health has been poor, and especially, at the time of puberty, and the menses has been imperfect and irregular, shall we have reason to apprehend that the change of life will be, indeed, a critical period, and that it will require all the care and skill that can be employed to go through it in safety, and with health improved, instead of being rendered much worse. For the change of life, once well passed, the woman settles down with a new form of life, and it may be with a new lease of life, and has a right to look forward to a happy old age. It is gratifying to know, that nearly all the threatening affections of the change of life can be avoided by such hygienic care, as one can render themselves, as they depend upon causes under the control of the individual. Symptoms of the Change of Life— vary in different individuals according to their respective temperament; for in this, as well as in otuer conditions, women present the plethoric, ( full of blood) the chlorotic, or nervous type. Thus, in those of the plethoric type, the symptoms will resemble those of congestion ; there may be flushes of heat, rush of blood to the face and head, uterine and other hemorrhages, leucorrhoea, and even diarrhoea. In those of the chlorotic type, the symptoms, which at or near the proper age, would indicate the approach of the change of life, are the sallow complexion, weak pulse, and various other indications of debility. In those of a nervous type is, as the change of life approaches, an evident disturbance of the equilibrium, not unlike that which, in similar cases, pre- cedes the monthly flow. Hence, the over-anxious look, the brimful eye, the terror struck expression, as if apprehensive of seeing some frightful objects, the face bedewed with perspiration, and the remarkable tendency to hysteria, which are sometimes to be met with. In many cases, the change of life comes on so gradually, that the sys- tem accommodates itself to the new order of things with no shock to the nervous system, and without disturbing the accustomed harmony of the general circulation. In such cases, the intervals between the menstrual periods become more and more prolonged, and even the menstrual dis- charge itself, may gradually diminish in quantity. The most frequent, and least dangerous symptom, is an irregular return of the menstrual flow every week, or every two or three weeks, or every two, three or four or six months, and being more or less irregular as regards quality or quantity of menstrual blood. Serious and alarming hemorrhages frequently set in, especially among plethoric and nervous women, or such as have indulged in sexual excesses. Sometimes these hemorrhages alternate with whitish 624 DISEASES OF THE FEMALE SEXUA.L ORGANS. or yellowish leucorrhoea, which often has a fetid smell, is acrid and extremely copious. This leucorrhoea may continue long after the men- strual discharge has entirely ceased to appear. At this period, we not unfrequently meet with colic, uterine cramps, pains in the sides, weight in the loins, or distressing itching in the parts. The most distressing diseases with which the change of life is attended, and often terminate fatally, are ulcers, and polypi of the uterus, and cancers of this organ and of the breast, also, pulmonary phthisis, (or consumption) likewise, takes a fresh development and frequently terminates fatally. TREATMENT. In this place, it will be sufficient to refer to the different disorders already described, such as hemorrhage, flooding, diarrhoea, cancer, etc., and to their corresponding medicines, for the treat- ment of the various forms of disease that arise at the change of life, The remedies most frequently useful in disorders of the critical age, will be found under the head of Menstrual Disorders, and other affections which may be the most prominent of those which attend the change of life. MASTITIS— INFLAMMATION OF THE BREASTS. The mammse constituting exclusively a part of the female organism, we prefer treating of inflammation of the mammse in this place, instead of ranging this disease among the diseases of the thoracic organs. Mastitis proper, only occurs during or immediately after nursing. The painful, sometimes rather extensive, hardened swellings of single por- tions of the breasts, which sometimes occur among unmarried females or married women who are not nursing, especially about the time of the menses, are evidently transitory states of congestion which never termin- ate in suppuration. The cause of mastitis is always traceable to the impeded discharge of milk. By some cause or other, soreness, or a bad shape of the nipples, too feeble drawing of the child, one or more milk ducts become closed, the milk in the corresponding mammary lobule becomes stagnant, and an inflammatory process is the result. Another cause of obstruction of the milk-ducts, is the improper manner in which some women wear their clothes, owing to which, the breasts either hang too loosely, or a direct pressure is exerted upon them. The doctrine that mastitis can originate in dietetic transgressions or cold, is a convenient supposition rather than a scientific fact. What happens with other abscesses, is likewise, true in regard to abscesses of the mammse ; in some cases they heal rapidly, in other cases they cause vast destructions of tissue. Mastitis is most apt to occur soon after confinement, or shortly after weaning the child; mastitis occurring at the latter period, is less apt to lead to the formation of abscesses. Symptoms. The disease never breaks out all at once. Generally, women experience, some time previous, a gradually increasing pain both spontaneously or while the child is nursing; and a swelling soon develops itself soon after. As a rule, the lower or lateral lobes are inflamed, very seldom the upper ones, and still less frequently both breasts. Sooner or later, sometimes in a few days, and at other times in some weeks, the painful spot becomes red and more sensitive, and the inflammation is INFLAMMATION OF THE BREASTS. 625 intense, the whole organism feels the effect of the inflammatory process, and shows its sympathy by febrile phenomena. Soon the infiltrated tissue shows the signs of suppuration, the pus being discharged through a small opening. As soon as the discharge, which is never complete, commences, the pain suddenly ceases and the febrile symptoms abate. The course of the inflammation depends upon a variety of circum- stances. If the inflammation is confined to one lobe, the abscess most commonly discharges close to the nipple, empties itself very rapidly and heals. If several lobes are inflamed, or the inflamed lobe is situated near the base, the suppuration, swelling, and pain continue for a long time; months and even years may elapse before the abscess heals, which discharges through several openings near the nipple. This disorder never lasts less than two weeks, and, under corresponding circumstances may continue for months even, in its acute form. The treatment of mastitis includes, above everything else, a prophy- lactic treatment which has to be commenced long before confinement, especially in the case of primiparae (a woman with her first child.) The preservation and proper management of the nipples and of the mammae generally, should be a constant subject of our attention. After confine- ment, if women do not intend to nurse their children, they will have to dispense with liquids as much as possible. Nursing women have to keep the following points constantly in view : the breasts must not be kept too warm, must not be enclosed in tight clothing, and must, by some suitable support, be prevented from dragging down ; every time after the baby has nursed, the nipple must be washed, but not be kept moist between the acts of nursing; the excessive use of liquids which women fancy favor the secretion of milk, must be avoided; the child should be put to the breast as seldom as possible, for the more hungry it fe the more vigorously it will draw and the more completely the breast will be emptied. At the same time the nipples will not be held so long in the child's mouth, and they will not be exposed so much to the risk of being made sore by the constant nursing. By following these instructions, and more particularly, by putting the child to the breast every two hours in the early period after confinement, mastitis will generally be prevented. You must do it. If the breasts have become hard and painful, the best remedy in the case of lying-in-women is Bryonia, less frequently Belladonna, whereas, the latter medicine is better adapted to women who are weaning their infants. We sometimes succeed in dispersing the stagnation of the milk by gently rubbing the indurated portion while the child is nursing. The same good effect is sometimes obtained by causing the milk to be drawn by an older, more vigorous child. In no event should the infant be all at once kept from the breast, even if nursing causes pain. It is only if the pain is very acute, and the hardness considerable, that the infant should no longer be put to the diseased breast. Belladonna will now have to be administered. As soon as redness has set in, the chances of scattering the inflammation are very slim; in some exceptional cases we may sometimes succeed in effecting this result by a few doses of Mercurius. Warm poul- tices should never be omitted ; they sometimes favor the dispersion of the abscess as much as in other cases, they hasten the process of suppuration. Hepar sulphuris will promote the discharge of the pus. A great many 40 C26 DISEASES OF THE FEMALE SEXUAL. ORGANS. authorities teach to open the abscess at an early period in order to prevent the further spread of the inflammation. We doubt whether such a pro- ceeding is justified by corresponding results; after opening the abscess, we have often seen the inflammation spread much more rapidly; in the most tedious cases of mastitis, the abscess had been opened in accordance with this suggestion. In a fortnight at least, the discharge of pus ceases under the use of a few doses of Mercurius, aud the sore heals. HOMOEOPATHIC TREATMENT. Bryonia is the principal remedy in this affection, before the inflammation becomes fully developed, espe- cially, when the breasts are hard, red, tense, and tumefied, and feel heavy; and when there is some degree of fever. Dose : Of a solution of six globules to four teaspoonf uls of water, give a teaspoonf ul every four hours. Belladonna is, however, required when the inflammation is more intense, and the erysipelatous appearance of ^ the skin is clearly defined, usually running in radi; and is, in such instances, usually sufficient to subdue all such inflammatory symptoms. Dose : As directed for Bryonia. Sulphur may be required, more especially for the treatment of scro- fulous subjects, and when the previous administration of Belladonna has bee?i productive of partial or limited improvement, and evident suscepti- bility remaining, even if the active, inflammatory symptoms have been allayed. It is also useful when, after the bursting of an abscess in the breast, the cavity is slow in healing up, and the discharge excessive. Dose : As for Bryonia. Graphites should be employed, particularly in scrofulous subjects where the breasts are in such bad condition from previous inflammations and abscesses, that the milk cannot flow, and its retention threatens inflammation and abscess. Graphites will, in most cases, ward off this diffi- culty. Should Graphites fail, Phytolacca should be tried, no other remedy being more prominently indicated. Dose : As directed for Sulphur. Phytolacca- decandria will be found to be a most valuable remedy in many cases ; more particularly where the breasts are hard from the commencement of the disorder, sensitive to touch, and more or less pain- ful. It will also prove useful for Humps" in the breasts. Dose : * As directed for Bryonia, use also, as an external application. Mercurius may be required after any of the foregoing medicines, when, notwithstanding the previous treatment, and the reduction of the inflammatory symptoms, a degree of induration still remains. Dose: As directed for Sulphur. I*hosi)horus is indicated when symptoms of threatening formation -of matter (abscess.) such as increase in pain, with transitory chills, and throbbing in the breast ensue. Its immediate employment, under such -circumstances, will often succeed in speedily relieving pain, and prevent- ing the ripening and bursting of the abscess. It is also indicated in severe cases where there are already fistulous ulcers formed, of blue appearance, and having callous edges; and the patient has hectic fever and night sweats. Dose: Three globules every six hours, until relief is obtained. CANCER OF THE UTERUS. 627 CARCINOMA UTERI— CANCER OF THE UTERUS. In, by far, the majority of cases, this disease occurs beyond the age of forty, and is very seldom met with in women of a less advanced age. Feeble as well as robust, married as well as unmarried women are attacked by this terrible destroyer. Cancer of the uterus is one of the most fre- quently occurring forms of carcinoma, and not unfrequently runs its course as a solitary cancer. It is only in rare cases, that it breaks out in addition to cancerous degenerations of other organs. Cancer of the uterus is frequently mistaken, at the commencement, for menstrual disorder, leucorrhoea or chronic inflammation of the womb. The first symptoms usually menstrual derangements, cessation or a more frequent return of the menses, or in place of the menses we have irregu- lar hemorrhages and leucorrhoea. The mistake is made the more easily, if the patient has not yet reached the critical period, so that these changes may be set down as results of a natural cessation of the monthly secretion. If the patient has passed through the critical period, a sudde nflow of blood takes place, at first resembling the menstrual flow, but soon increasing to a true hemorrhage. In the beginning, the patient often complains only of a feeling of weight, drawing in the pelvis, a pressing towards the sexual organs, or the pains are excited by bodily motion, a concussion, sexual intercourse, touch. An examination shows the vaginal portion harder t'han in the nor- mal condition, of unusual resistance, swollen, misshapen, rugged and knotty, sensitive to pressure and readily bleeding. In the course of the disease, pains set in, which are, at first, only vague, and occur only now and then, but afterwards become more severe, and finally, especially at night, exceedingly violent, pressing, stinging, lancinating, burning, not con- fined to the region of the uterus, but spreading to the small of the back and thighs. Characteristic are the more or less violent, burning, and stinging-boring pains over the pubic bones, and in the small of the back, along the hips and thighs, interfering with walking, and even sitting; very often a burning pain is continually felt deep in the pelvis, accompa- nied by fugitive stitches darting through the uterus. The neighboring lymphatic glands are generally larger and painful. At the beginning of the trouble, a serous, orslimy secretion flows from the vagina, having but little smell ; more usually the discharge is copious, of a brownish-red, suspicious-looking color, having a horrid smell, and excoriating the skin. The bleeding becomes more and more frequent and copious, the blood being mixed with detached portions of tissue. These hemorrhages con- sume the strength of the patient in a very short time. At this stage of the disease, the ichorous dissolution of the cancer progresses very rapidly. The disease generally lasts for years, calculating from the first mani- festation of distinct symptoms, and without allowing for the influence of special circumstances, such as confinement, which is one of the most per- nicious occurrences that can happen to a woman afflicted with cancer of the womb. It is inconceivable how it is possible for the organism to bear up for so long a time under a destructive malady, like cancer, without perishing. TREATMENT. No more than we reject the possibility of a cure of can- cer generally, do we believe that cancer of the uterus is an incurable dis- ease, although it is difficult to obtain certainty in this respect. 628 DISEASES OF THE FEMALE SEXUAL ORGANS. Kreosotum. When the following symptoms are present: Obstinate leucorrhoea during frequents recurring losses of blood, with aching or pressing pains, and gradual'! y appearing fetid discharge of a serous fluid or a bloody ichor. This is attended with burning or lancinating pains in the small of the back, and loins. "When standing, she experiences a sensation as of a weight in the pelvis; coition is painful; all the symptoms are worse at the time of the menses. Electrical stitches in the vagina, as if proceed- ing from the abdomen, causing the patient to start; voluptuous itching- in the vagina, with burning and swelling of the external and internal labia ; ulcerative pain during coition ; the menses appear from four to ten days too soon, and continue for days, with a discharge of dark, coagulated blood, pains in the small of the back, and subsequent discharge of a pungent ami bloody ichor; gnawing, itching and smarting in the parts; the menses stop for hours and days, but afterwards return again in a more fluid form and attended with violent, colicky pains. The pressing downwards, and the abdominal spasms continue after the menses, more especially in the groin and pelvic region ; bleeding from the uterus, and a continual cor- rosive leucorrhoea are not wanting. The pains are worse at night. Sen- sation of fainting on rising, with a peevish and desponding mood, and livid complexion. Arsencinm-album has been given with excellent success in car- cinoma uteri. Arsenic can only be resorted to after the whole organism reflects the picture of a cancerous disease. However, it only palliates the severe pains and the sleeplessness, and perhaps modifies the profuse Menorrhagia, which occurs every now and then in the course of the disease. Nitri-acidum is indicated in carcinoma uteri, as it is in many other inveterate dyscrasic conditions of the organism. The most important symptoms are: Irregular menses, they sometimes remain suspended for weeks and then appear again at short intervals; between the menses. copious leucorrhoea of a badly-colored, brownish appearance and offensive odor. The patient looks worn, feels nervous and is depressed in spirits. Obstructions in the portal circulation, such as hemorrhoids, indicate this drug. Acidum nitricum can, however, only be used as an intercurrent remedy at the commencement of the disease; if ichorous dissolution has commenced, this drug is no longer of any use. CARCINOMA MAM3I2E— CANCER OF THE BREAST. Next to the uterus, (womb) the breasts are the most frequently- attacked by cancer. The causes of this disease can scarcely ever be deter- mined with certainty. The influence of depressing emotions, which are so easily and so commonly succeeded by cancerous degenerations, or dis- eases, is a much more evident source of the difficulty than the belief of some, that it is the result of a bruise, from a blow or contusion. Cancer of the breast most commonly occurs between the ages of forty and fifty, about the period which is generally designated as a change of life. Unmarried women or women who have not had children, seem to CANCER OF THE BREASTS. 629 ibe more liable to it than married women with children. Before and after this period, it is proportionally a rare occurrence. The commencement of the disease is scarcely ever marked by pecu- liar morbid phenomena ; the patients generally do not notice anything out of the way, until a tolerably large tumor is perceived in the breast. It is at first round, smooth, movable, grows with more or less rapidity, and loses its mobility in proportion as it increases in size, and its surface becomes more uneven* At first, it is most commonly deep seated, and gradually grows towards the surface, is sometimes entirely painless, or becomes painful only at the time of the menses, and when receiving some mechanical injury. If the cancer reaches the skin, it coalesces with it, after which, the pains are almost constantly felt. At the same time, the disorganizing process extends to the deeper tissues, and at an early stage, the axillary (arm pit) and other neighboring glands become involved. The patients now commence to feel constantly or at intervals, and par- ticularly at night, lancinating, boring pains in the affected part, which very soon become unbearable. The assimilative functions begin to suffer ; the patients have a pale yellowish-gray appearance, the spirits are very much depressed. A characteristic sign, is the gradual effacement, and finally the complete retraction of the nipple, which discharges either spon- taneously or on pressure,^ turbid, serous fluid. At the place where the cancerous growth first became interwoven with the skin, the latter, by* slow degrees, loses its healthy color, and finally breaks. An irregular- shaped ulcer forms, showing a disposition to penetrate to the subjacent tissues; the edges of the ulcer are infiltrated, have a sickly color and an uneven base, and secrete at first, a thin, serous, and afterwards an ichorus, purulent, bloody, and most commonly very fetid fluid. If the disease runs a slow course, the incipient ulcer often heals for a time, but again breaks open at a later period ; if the disease runs a rap^id course, spongy and readily-bleeding excrescences are apt to shoot up from the bottom of the sore. If larger vessels become necrosed, hemorrhages take place, which are sometimes very profuse, at other times trifling. The further course of the disease, which, having arrived at this stage, always terminates fatally, depends upon the extension of the cancer, upon the invasion, by the carcinomatous process, of internal organs, upon the importance or the hemorrhage, and upon the loss of fluids in consequence of the ichorous discharge. The duration of the whole disease varies considerably, ranging from two to twelve, and even more years. The younger the patient, the sooner she will succumb to the disease, and the more sudden the cancerous growth, the sooner it will destroy life. The prognosis is very bad, with scarcely an exception. In many respects, the diagnosis is liable to difficulties, because vari- ous kinds of benign tumors may occur in the breast. An incipient can- cer cannot always be recognized as such, though it may grow rapidly and be painful ; these two conditions never occur in the case of benign tumors. At a late period, the diagnosis is determined by the retraction of the nipple, the fluid which it discharges, the rugged unevenness and immobility of the swelling, the participation of the neighboring glands in the disease, the failing of the whole organism without any increase of the 630 DISEASES OF THE FEMALE SEXUAL ORGANS. secretory products. Nevertheless, there occur many cases of cancer, the trie nature of which remains for a long time undetermined, and is clearly revealed only after the disease has run a long course. Cancer of the breast is generally considered a surgical disease ; it is supposed by most authors that internal treatment cannot reach it. The disease, at least in its incipiency, is considered purely local, and an opera- tion the only cure. For these and other reasons, having given you the means of selecting an intelligent and honest p'hysician. and surgeon, we unhesitatingly commend you to his care and here offer no treatment. HOME REMEDIES. Take the juice of Sheep Sorrel, let it evaporate on a pewter plate to the consistence of a thick extract ; apply this over the cancer. It is very painful but good. Another. Take equal parts of Sheep Sorrel, Poke Leaves and Yel- low Dock Root, beat them up in a mortar with a little water ; squeeze out all the fluid ; place it on a lead or pewter plate, and let it evaporate until it forms a thick extract. Apply to the cancer. This is a noted can- cer cure. Again : Make a ley of the ashes of Red Oak Bark ; boil down until it is as thick as molasses, and cover the cancer with it, In about an hour afterward cover it with a coat of Tar. Remove this in a few days, and if any protuberances remain in the womb, apply more of the Oak Bark • Potash and the Tar plaster, and so on until the cancer is cured. HeaL the ulcer with some common salve. CHAPTERXXXI, PREGNANCY. CONDENSED SIGNS OF PBEGNANCT. The determination of pregnancy, at the earliest possible period, forms a most difficult problem, on account of the same symptoms having been known to exist through the influences of other derangements. Suspension of the menses is generally the first indication which leads the woman, in whom impregnation has been possible, to consider her- self enceinte. But the importance of this symptom will very greatly depend upon the attendant circumstances : if the woman has been very regular, and if the cessation of the menses promptly occur after some par- ticular sexual intercourse, the presumption of pregnancy will be very strong indeed. But if she has always been very irregular, the mere fact of the menses failing to make their appearance at a particular monthly period, will carry with it but little weight. Where the entire absence of the menses for two or three months occurs, from no other assignable cause, and where this suspension is attended with good health and appe- tite, and some perceptible increase in the size, or, on the other hand, per- ceptible sinking away of the abdomen, the conclusion of pregnancy may be considered to be well founded. SIGNS OF PREGNANCY. 631 Changes in the breasts very frequently occur; they sometimes feel heavy, are inclined to itch, and the areola around the nipple becomes dark- colored, and sometimes presents an oily appearance. And yet, even these circumstances are far from affording unmistakable evidences of pregnancy, since they have been known to arise in this combination from other causes. Another symptom which may, and does often occur in the early months of pregnancy, is an itching and irritation of the sexual parts ; though in newly-married women, the menses are sometimes suspended from irritation of the sexual organs when no conception has taken place, and at the same time, there may be an increase in the size of the abdo- men, and in the sensibility of the breasts ; so that even this very strong combination of symptoms cannot be relied upon. Morning sickness forms, in very many women, the next sign of preg- nancy. As its name indicates, it is a morbid symptom, but on that account none the less valuable as a diagnostic sign. It arises from sympathy of the coeliac, or solar plexus, with the organic nervous system of the uterus. This morbid irritability may commence immediately after conception, but it generally sets in about the fifth or sixth week after conception, and ceases soon after the third month. It may become, in individuals, a positive indication of their being pregnant, since these persons learn by experience that these symptoms occur with certainty and regularity at a particular time after conception. Thus, in different persons, the presence or absence of morning sickness will have a very different diagnostic value. Still, where morning sickness makes its appearance persistantly attended with suppression of the menses, and in circumstances where there is a liability to impregnation, it can scarcely be attributed to any other more probable cause than pregnancy, and this indication will be strengthened by the character of the sickness itself. The appetite improves and is good through the day, in spite of the nausea, vomiting of a peculiar watery fluid, and sinking at the pit of the sto- mach, which occur and continue for a short time, only on first rising in the morning. The sickness and the fluids vomited up are different from those accompanying any other disorder, such as gastric or bilious fevers, for example. While morning sickness, from its peculiar character, brief daily appearance, usual temporary continuance, and final, sudden and perhaps unexpected disappearance, becomes, where it occurs, a valuable indication of pregnancy, its absence is hardly to be regarded as an opposite sign, as disturbances of the uterus, apart from pregnancy, may occasion it, and it sometimes follows suppression of the monthly flow from other causes than conception. Certain other derangements of the digestive organs, such as eructa- tions, heartburn, remarkable longings for some particlar article of food, or other substance not used as food; and, on the other hand, aversion to some one or more of the common varieties of food, which may occur separately, or in connection with morning sickness, or even subsequently to it. The same may be said of salivation, which occurs, in some women about the fourth or sixth week: in such cases, the frequent spitting will be equally diagnostic, whether the quantity be large or small. Thissali- (332 PREGNANCY. van on. differing from that which is produced by mercury by the absence of foul breath, sore gums and great prostration ; it becomes characteristic of pregnancy, just as the morning sickness, above described, does by reason of its being a sympathetic affection. OBSERVATIONS ON PREGNANCY. This period may be regarded as one of the most interesting eras of a woman's life. She is now no longer acting for herself alone, but becomes invested with a new and serious responsibility, and upon some of the most apparently trifling of her actions, may depend the future health and happiness of a being bound to her by the fondest ties. » From the mass of evidence collected by careful observers of the oper- ations of nature, we are warranted in drawing the conclusion, that thj actions of the' mother exercise a great influence over not only ti.e constitutional and physical, but also, the mental organization of her offspring. Keeping this fact in view, we shall endeavor to point out the course that mothers, who prefer the welfare of their future offspring to their own indulgence, should pursue, and from which they will derive a double benefit, an improvement in their own health, with exemption from suffering, and the delight of seeing their children pass safely through the anxious period of infancy. The leading causes of a weak and sickly child, are ill-health, or con- stitutional taint of both or either of the parents; very early, or late mar- riages; great inequality between the ages of the parents; errors in dress, diet, and general habits of life, and lastly, powerful mental emotions. Females should seldom, at least in this country, enter into the mar- riage bond before their twenty-first or twenty-second year ; prior to that period their organization is scarcely ever fully developed; those who marry at sixteen or eighteen years of age incur the risk of a severe after- suffering themselves, and also, of giving birth to weak and delicate children. How very often we see the first children of such marriages perish in infancy, or after contending through a childhood of continued delicacy, sink into a premature grave. Women who marry late in life incur considerable personal risk, and severe suffering in giving birth to children, and the offspring is seldom healthy. The children of old men. although by a young wife, are very often extremely delicate and suscepti- ble to illness; they do not unfrequently precede their father to the grave or linger but to drag on a miserable and wearisome existence. In concluding these observations, we may remark, that so far is the period of pregnancy from being destined for one of suffering or danger, that nature has taken every precaution for the protection of the female and her future offspring. While pregnancy runs its equable and uniform course, the expectant mother enjoys an almost complete exemption from the power of epidemic or infectious diseases, and even chronic complaints are frequently suspended ; in fact, with the exception of some slight mor- ning sickness, and occasional trifling uneasiness, a well-constituted organism should enjoy as good health during pregnancy as at any other time; and many women pass through this period and give birth to vigor- ous children without even the most trifling inconvenience. Though, as we have said, nature seems during this period to adopt every possible precaution for health and preservation of the parent and HYGIENE OF PREGNANCY. 633 her future offspring, yet are her wise arrangements too often rendered void by direct violation of her laws. The expectant mother should therefore bear in mind, that the duty of leading a regular and systematic course, so essential to every individual, devolves upon her with double force, since every neglect or breach of these ordinances of nature upon her part is frequently visited with fearful energy upon her yet unborn infant. HYGIENE OF PREGNANCY. A few words on this subject, which is quite as important as the med- ical treatment of [he disorders of pregnancy, inasmuch as it is intended to prevent such disorders from occurring. In order that this period may be passed with as much comfort and its end accomplished as easily and safely as possible, all irregular and, I might say, intemperate habits, should be laid aside, and all pernicious practice abandoned. The pregnant woman should strive to cultivate for herself the utmost cheerfulness and tranquility of mind ; she should strive to be at peace with all the world, and at peace with herself, for her mental and moral state will surely be engrafted upon her offspring, the education of the future being commenced while yet in utero. And in this effort she should be seconded by her husband, whose responsibility is very great at this period — whose conduct toward the wife of his bosom, at this period, acting upon her mental organization, will be transmitted to their joint offspring for weal or for woe. A pregnant woman, during the whole course of her pregnancy, will require more sleep than at other periods, and an ample allowance of the same should always be indulged in. And yet, at the same time, habits of slothfulness should be avoided. >" Early to bed, and early to rise," applies with additional force at this juncture, and nine, or, at least, ten o'clock at night, should find her in bed, and six, or, at the least, seven o'clock in the morning, should find her up. Habits of regularity, in all things should be cultivated — regularity as to hours for sleeping and wak- ing — and regularity as to meals, exercise, stool, etc. Air and Exercise. Nothing tends more to the preservation of health, than a proper attention to these two important points, and yet, unfortunately, there are, perhaps, few more completely lost sight of. During this epoch, carriage riding, alone, is not sufficient ; walking brings, not only the physical, but the whole of the organic muscles, into play, and communicates the increasing vigor of the mother to her off- spring ; therefore, walking is indispensable, and every day should find the expectant mother taking a walk, leisurely, and with the mind at ease; and this rule should be observed, even in cold and unpleasant weather, excepting when the walking is rendered dangerous from snow and ice. A walk is often an excellent remedy for the feeling of drowsi- ness and heaviness, which often creeps over a woman in this condition — a much better remedy than taking a nap or a prescription from the doctor. Some women take a great deal of exercise, yet, without corresponding benefit, from their work occupying them wholly indoors, showing the inutility of exercise in itself, unless combined with pure air. Others, again, injure their health, and frequently induce miscarriage, through (i34 . PUEGNANCY. their excessive levity and thoughtlessness, by unrestrained indulgence in active exercise, riding on horseback, dancing, etc. A woman ought to- recollect, that, if through her own folly, she has brought on miscarriage, the greatest possible care should be taken to prevent its recurrence ; that a second attack increases her liability in future ; and that she who has suffered twice or thrice from this misfortune, even when she escapes it, rarely attains her full time. Moreover, continued casualties of this nature frequently terminate in premature death. Employment of the Mind, etc. Useful employment, reading, or use- ful and agreeable conversation, should engage the waking hours, not otherwise employed. In fact, I should like to impress upon the interested portion of my readers, the importance of cultivating a proper condition of mental vitality, as well as physical. How important it is that the expecting mother, as a new thread of life is being spun within her, should think and do that alone which is good and right, for of a cer- tainty, her offspring will have woven into the tissues of its existence the resultant of what she is and does during her pregnancy. Experience has presented us with many instances in which the pre- dominant feeling in the mind of the mother, during pregnancy, has influence on the future mental organization of the child. The effect of any unpleasant or unsightly object upon the imagination of the mother, and the transmission of that effect to the offspring, evidenced in various mental or physical peculiarities, after birth, is a theory as old as tradition. Clothing During Pregnancy. The dress of the female should, of course, be suited to the season, and if she pass from a warm into a cold atmosphere, she ought to keep herself well protected to prevent the risk of taking cold. But, a point of far greater importance, is the adaptation of the clothing to the form, so as to preclude all unnecessary pressure upon any part of the body, that might interfere with the functions of those important organs which are destined for the birth and nourishment of the infant ; tight lacing (at all times most objectionable) is particu- larly injurious during this period, inasmuch as it interferes with the natural action of the body, and bearing directly upon the abdominal muscles, the blood-vessels, lymphatic, and the bowels, produces narrow- ness of the chest, disturbes the circulation, and causes derangements of the liver, and exercises a most distressing effect upon the breasts and uterus. Females, in their efforts to preserve the elegance of their form during pregnancy, are little aware that the constricting efforts thus exer- cised upon the abdominal muscles, destroy their elasticity, prevents a proper retraction after parturition, and thus proves one of the most com- mon causes of abdominal deformitj^. Moreover, to the vanity of their mothers in this and other respects, many, it is probable, owe their club- feet and other deformities ; and in addition to these evils, this practice not unfrequently deranges the position of the foetus— a displacement which, together with the consequent want of energy in the muscles, and the parts concerned, generally brings on protracted and dangerous labors. Besides, this continued pressure on the uterus is liable to bring on prema- ture labors. To tight lacing may be attributed the difficulty which so many mothers of the present day experience in suckling their infant, by the unnatural pressure deranging the process required for the subsequent MORNING SICKNESS. 635 secretion of milk; from this, also, arise sometimes, those dangerous indur- ations, cancers and other affections of the breasts and, also, retraction of the nipple, from which the act of suckling is rendered difficult, and in some instances, impossible. Care also should betaken not to wear anything tight about the limbs, such as wrist-bands or garters, even elastic garters spanning the leg may be injurious, as they impede circulation, and encourage the development of various veins, to which the system is already predisposed, and which, in many instances, become very painful and troublesome. One fact in connection with this question of dress, is here noteworthy, viz: that women in the latter months of pregnancy, complain of, and really suffer from coldness of the abdomen, the protruding abdomen causing the cloth- ing to set off to the extent of almost completely exposing that part of the body to direct contact with the air. In view of this, the clothing should be so adjusted, or an extra garment worn to obviate the difficulty. Notice of these matters are greatly beneficial, and are so apt to be considered of minor' or insignificant importance. Diet. The diet during pregnancy should be generous in meats, vegetables, and fruits, and at the same time plain. Excessive coffee and tea drinking should be laid aside. Sugar, salt, and spices should be taken in moderation ; stimulants of all kinds, especially such as wines, liquors, beer, etc., should be most strictly avoided. If, however, the female has been long habituated to wine it may be taken in extreme moderation, and diluted with water. GASTRIC DERANGEMENTS DURING PREGNANCY. Nausea and Vomiting— Morning Sickness. In many women, nausea and vomiting set in at an early period of pregnancy, and are simply the result of a peculiar reflex irritation of the stomach; in these cases this affection usually continues but a short time. Next to the ces- sation of the catamenia, and especially in conjunction with it, morning sickness becomes one of the earliest, as well as one of the most reliable, early signs of pregnancy ; while for all those who have ever before experienced it, there is little room for mistake in regard to its nature ; for, in each individual in whom it occurs, it has a uniform type and well remembered character. The nausea may occur at an early period in the morning, with unvarying regularity ; or in the evening, or at any period of the day, or even of the night. For each individual, it maintains, also, its uniformity as to the date of its first appearance ; in some, it appears very soon after conception; in others it begins toward the third or fourth month, and, in others again, it comes on only toward the close of gestation ; in these latter cases, it might have appeared, also, for a short time after concep- tion. In the duration there is, also, the same general variety and indi- vidual uniformity. Thus, in some women, it lasts but a few weeks — from six to eight at most ; in others it continues for four or five months; while in some few most distressingly severe cases, this difficulty persists through the whole period of utero-gestation, unless relieved by art. The nausea and vomiting of pregnancy, as already stated, are most apt to occur on first rising in the morning; sometimes these symptoms disappear in a few minutes, sometimes they last through the greater por- <336 PREGNANCY tion of the day. In some, the vomiting is very easy ; in others it is attended with very severe retching, and even with other painful symp- toms. Those who vomit upon waking or rising in the morning, usually throw up some viscid, glairy matters, which are generally colored with a little bile, especially if the retching has been very severe. Others vomit only after eating, occasionally after only one of the daily meals, but some times after all of them. Again, in some unfortunate cases, the vomitings continue, even in the intervals of the repeats, everything taken into the stomach, whether liquid or solid, being immediately rejected. There are cases, finally, in which the mere thought of food, or the sight or smell of it, is sufficient to induce the vomiting. In some cases, nearly all of the food taken seems to have been thrown up, even for months insuccession, and yet a good delivery succeeds at full term ; the repeated and severe vomitings seeming to exert compara- tively little influence upon the general health. In like manner, preg- nant women may rise from the breakfast table, vomit, and return to their food as if nothing had happened. Such characteristics, so different from vomiting, arising from any other cause, almost conclusively indicates the presence of pregnancy. The diet and regimen of the pregnant woman should be carefully attended to ; such articles as best agree should be taken in each case, and equal care taken to avoid every unwholesome or irritating influence. It has sometimes been found that the excessive irritability of the stomach, in pregnancy, is due to the presence of fumes from some neighboring manufactory, which, although insufficient to induce any unpleasant symptoms in the ordinary condition of the woman, very powerfully affect her when pregnant. TREATMENT. The following remedies will be found to cover the principal forms of gastric derangements of pregnancy. For particular indications, see "Heartburn." Antimoniiim crud. Nausea and vomiting, or only nausea with white-coated tongue. Watery stools, with occasional hard lumps; fright- ful vomiting with convulsions ; belching, with taste of what has been eaten ; painful sense of fullness of the stomach, which is sore on pres- sure. Dose : Six pills night and morning. Arsenicum. Very great debility and exhaustion ; the least effort causes exhaustion. Very pale white look. Bittern-ess in the mouth, particularly after eating or drinking. Cold water seems to lie in the stomach until it gets warm, after which she vomits it, therefore she can- not drink it although she desires' it. Feels cold, and wants to be in a warm room, or to be covered up warmly ; very uneasy and restless ; vomiting of blackish or greenish matter. Dose : As for Anti. Crud. Bryonia. Nausea on waking in the morning. Nausea is usually relieved by keeping quiet; dry, parched lips, dry mouth and tongue: head aches as if it woivld split; stool of hard, dry feces as if burnt. All the symptoms worse from motion, better when still. Dose As for Anti. Crud. MORNING SICKNESS— HEARTBURN. 637 Calcarea Curb. She cannot sleep after three in the morning; heartburn and food eructations ; soreness of the tongue, either on the tip or sides, so that she can scarcely eat or talk. Sensation as if the feet were cold or damp. Feels better from warmth, and cannot bear cold air. Vomiting of sour matter. Dose: As for Anti. Crud. Conium. Vertigo, particularly on turning over in bed. ^Vhere the history of the case of vomiting reveals the fact of swelling and soreness of the breasts with each menstrual period, and the patient always feels worse after going to bed, so much so, that she is obliged to sit up or walk about to get relief. The urine intermits at every flow. Done : Six pills three times a day. Ipec (€. One continual sense of nausea all the time— not a moment's relief. Vomiting of large quantities of mucus. Diarrhoea and colic, dis- gust for food ; empty retching; vomiting of food, slime, or blood; sour vomiting, cutting pains about the umbilicus (navel). Dose : As for Conium. Nuopvom. Nausea and vomiting every morning with constipation ; large difficult feces. Food and drinks have a fetid smell to her. Not much appetite, or canine hunger ; aversion to water and bread. Longing for brandy, beer, etc. Bitter or sour taste. Vomiting of food, bile, of black or sour matter. Dose: As for Conium. Pulsatilla. Pulsations in the pit of the stomach. Vomiting of mucus. Bad tase in the mouth every morning on waking; she has to wash it out, soon it is so bad she cannot bear it. Nothing tastes good to her. Absence of thirst; she does not relish as much water as usual. Nightly diarrhoea; stools very changeable, loss of taste or bitter, fatty, saltish, sour, or sweetish taste. Dose : As for Conium. Sepia. Vomiting of milky water or milky mucus. Sense of empti- ness at the pit of the stomach ; the thought of food sickens her ; a sense of weight in the anus Eructations tasting like spoiled eggs. Taste as of manure. Aversion to meat. In the morning, nausea as if all the viscera were turning inside out. Taste bitter or saltish. Disgust for all kinds of food. Constipation. Dose: Six pills night and morning. HEARTS LUX— ACIDITY— WATERBRASH. These distressing forms of gastric disturbance sometimes make their appearance soon after conception, while in other cases they may not make their appearance until after the fourth month. Some women are remarkably subject to these symptoms when pregnant; in others they are manifested with less violence; in others not at all. There may be merely a burning sensation— heartburn in the throat— which indicates sympathetic irritation ; or the severe forms of waterbrash with acidity which arise from more fully developed irritation. As in the nausea and vomiting of pregnancy, so in waterbrash, acidity, and heartburn, every degree of intensity and variety of manifestation and complication may be 638 PREGNANCY. seen in different individual cases. Sometimes these disturbances are found accompanied with, and greatly aggravating the nausea and vomit- ing, while at other times they seem to appear instead of the vomiting. As in the cases of ordinary dyspepsia, these sufferings are worse after certain articles of food or drink, such as meats, fat meats or gravies, milk, or fruit. In the more severe cases, nearly everything that is eaten becomes but an added fuel to the burning fire. Still, a careful avoidance of all those articles which, whether solid or liquid, are found to disagree most, and a careful selection from the remedies given, will, as in cases of nau- sea and vomiting, go very far to remove the most distressing symptoms, and eventually to secure a great improvement in the general health. TREATMENT. Antinionium Crudum. Nausea alone or nausea and frightful vomiting with convulsion. Belching, with a taste of what has been eaten. Thirst at night. Painful sense of fullness of the sto- mach, which is sore on pressure. Dose : Eight pills every four hours. Arsenicum, is very useful when there is very great debility and exhaustion. Very pale, white look. Sensation as of a stone ifl the sto- mach. Vomiting of fluids as soon as she takes them. Exhausting diar- rhoea. Feels cold and wants to be in a warm room. Very uneasy and restless. Dose : As for Anti. Crud. Bryonia is particularly indicated when there is distressing heart- burn, dry, parched, lips, splitting headache. Stool of dry, hard feces, as if burnt. All the symptoms aggravated by motion. Dose : Six pills every three hours. Calcarea Carb. Heartburn and food eructations. Sensation as if the feet were damp and cold. Dose: As for Anti. Crud. Conium. Vertigo on turning in bed. Eructations with heartburn. Terrible nausea and vomiting. Where the history of the case reveals the fact of swelling and soreness of the breasts with each menstrual period, and the patient always feels worse after going to bed, and has to walk about to get relief. Dose: As for Bryonia, Sepia. The thought of food sickens her. Eructations tasting like bad eggs. Want of appetite. Taste bitter or saltish. Disgust for all kinds of food. Vomiting of food and bile. Constipation^ Dose: Six pills every night and morning. CONSTIPATION OF PREGNANCY. Constipation is a very common attendant upon pregnancy, so fre- quent that by some it is deemed almost a natural consequence. But it is much more apt to occur, and at the same time be more troublesome and obstinate, in pregnant women, whose habits of life are confining, and those who are naturally of a more costive habit. When it does not arise from mechanical pressure exerted by the uterus upon the rectum, by which its dimension is lessened, and its action paralyzed, active exercise in the open air (avoiding indigestible food, strong coffee, and other stimu- TOOTHACHE DURING PREGNANCY. 639 lating liquids,) is sufficient to remove the complaint, or, at all events, render it less troublesome. When nature requires further assistance, the following remedies have given the best satisfaction in the numerous cases which I have treated. TREATMENT. Nux v. In women of sedentary habits, accustomed to the use of much coffee, wine, and rich and highly-seasoned food, gener- ally. Stools large and difficult ; colicky pains, or loud rumbling or rol- ling in the bowels. Constipation in persons who have been in the habit of using purgatives. Rush of blood to the head during stool. Dose : Four pills every evening, dry on the tongue. Ignatia can be made use of when the same symptoms as given after Nux., with the addition of an empty feeling at the pit of the stomach; sighing and full of grief. Dose: Four pills every morning, dry on the tongue. Bryonia. The stool is mostly dark, dry and hard, as if burnt, and is evacuated with much difficulty. The lips are parched and cracked. Much thirst. Stinking flatulency. Obstruction of the bowels from hard- ened stool. Stool too large to be evacuated without pain. Dose : The same as directed for N'ux. Sepia. Sensation of weight or heavy lump in the anus ; this is a very characteristic indication. The stool is very difficult to pass, even with the most terrible and involuntary strainings. Knotty and insufficient stool. Sepia has given very marked benefits. Dose : A powder each second night. TOOTHACHE DURING PREGNANCY. Toothache is a common and very distressing accompaniment of preg- nancy, being in fact, only a particular form of neuralgia. If toothache occurs in sound teeth, as is quite frequent, thev should never be extracted, and only the greatest care should be used in extract- ing decayed ones, especially, if the patient be of a very nervous tempera- ment. The female should, as soon as she is in proper state, put herself under proper treatment, for this is a valuable indication of some consti- tutional taint lurking in the system, and no remedies can be otherwise than palliative, until this tendency is eradicated. TREATMENT. Alumina. (Alum) when the pains are excited by mastication, (chewing of the food,) and when they are of a tearing nature, extending to the cheek bone, temple and forehead. Calcarea. When the toothache is excited or aggravated by cold air, or anything hot or cold, and attended with painful sensation of the gums, and pulsative, gnawing, or throbbing pains which are aggravated by noise. Sepia. Is particularly indicated when there is pulsative, shooting, drawing toothache, with pain extending to the ears, or to the arms and fingers, excited by compressing the teeth or by cold air, and attended with swelling of the cheek, and enlargement of the glands under the lower jaw. 640 PREGNANCY. Magnesia Carbonica. Nocturnal pains in the teeth, insupportable when lying clown, and compelling the patient to get up and walk ; pains generally boring, burning, drawing, tearing, and resembling those of ulceration, attended with swelling of the cheek on the affected side. Dose: These remedies may be given every three hours, six pills at a dose, until relief, and then the time may be lengthened. The above are the four leading medicines, for this peculiar condition, though there are others which may be called for by particular symptoms, of which I will mention a few. Arsenicum, Belladonna, Chamomilla, Gelseminum, Hyoscyamus, Merc. Sol., Nux-vom., Pulsatilla. SWELLING OF THE LOWER LIMBS— VARICOSE VEINS. This a very common attendant of pregnancy; it often occasions no little inconvenience, and is usually confined to the seventh, eighth and ninth months. It is supposed to arise, in most instances, from mechanical pressure alone, and to be free from constitutional disease. This is true in those cases where it is not accompanied by dropsical affetions. Standing and walking serve to aggravate this condition ; it becomes worse toward evening, gradually increases as pregnancy advances, and is often combined with a varicose state of veins. Many females suffer much during pregnancy from distention of veins in the thigh and other parts, which, becoming violent, eventually cause great pain and inconvenience . These varicose veins generally arise from obstructed circulation, caused by the pressure of the uterus upon the blood-vessels. Considerable alleviation is experienced by constant bathing with water or with diluted alcohol or brandy. Also, by bandaging from the foot upwards with a gentle and equal pressure, and by preserving a recumbent posture, which is required in severe forms of the complaint, accompanied with considerable swelling of the feet, ankles, etc. In order to afford relief we would recommend the following remedies. TREATMENT. Pulsatilla may be given, particularly when there is excessive pain and swelling, with a good deal of inflammation, or when the veins are of a livid color which is imparted to the whole limb. Arnica is of great service when the occupations of the patient render it impossible for her to lay herself up, and avoid much standing and mov- ing about in discharge of her domestic duties. Pulsatilla and Arnica given in alternation, a dose every day, will prove very beneficial in such cases. Nnx-vomica when the affection is attended with constipation ancj piles, and irritability of temper. Dose: Six pills every evening. Arsenicum when the veins are attended with severe burning pain, with a sensation as if scalding water was running over them. Dose : Eight pills every second evening. Carbo-veg., when Arsenicum is not sufficient to subdue the scalding burning sensation. Dose: As for Arsenicum. Belladonna. Varices with considerable erysipelatous inflammation. Dose : Six pills every four hours. ITCHING OF THE GENITALS— URINARY DIFFICULTIES. 641 ITCHING OF THE GENITALS.— (PRURITIS). Itching of the genitals, which is a frequent attendant upon pregnancy is caused by congestion of blood to the parts, and may often be relieved by bathing the parts with water in which borax has been dissolved, or with common soda and water. URINARY DIFFICULTIES AND DERANGEMENTS DUR- ING PREGNANCY. As gestation advances, the increasing size of the uterus causes it to press more and more against the bladder. Thus the capacity of that organ is diminished by the pressure which necessitates a much more frequent discharge of urine. The same frequent micturation results, too, from direct irritation of the neck of the bladder; causing hourly calls to pass water, which are sometimes but partially relieved by the flow of a few drops, only, at a time, or the irritation may amount to dysury, (painful urina- tion,) or even to a complete retention of urine. Where some displacement seems to be the cause, which may some- times be known by the suddeness of the onset of the difficulty, especially if it follows some accident or over-exertion, the case should receive treat- ment for the difficulty, different than which arises from other causes, of which I will mention at the end of this article. Incontinence of urine sometimes appears, especially in the latter stages of pregnancy. When it appears in the early months, it may result from the pressure of the womb upon the neck of the bladder before it rises out of the pelvic cavity, causing the loss of tone of the part. This difficulty will often yield to the proper remedy, but if not, when it comes on in the early stage of pregnancy, it may be expected to disappear when quickening takes place, and the uterus emerges from the cavity of the pelvis. For the medical treatment of these difficulties, the following reme- dies should be studied. It is to be noted, likewise, that these remedies should be consulted and may be required for urinary difficulties occur- ring, not only during pregnancy, but before, during, and after parturition as well. TREATMENT. Aconite. Retention of urine, with stitches in the region of the kidneys. Difficult and scanty emission, with pinching around the umbilicus (navel). Bright-red, hot urine. Desire to urinate, accompanied with great distress, fear and anxiety. Worse from exposure to dry, cold air. Dose : Six pills every half hour or hour owing to the severity of the case. Arnica. After passing a little urine she wishes to pass more, but is unable to do so at that time. Brown urine with brick-red sediment. A bruised and sore feeling exists across the lower part of the abdomen. Do.se: Four or six pills every two or three hours. Cantharis. Very frequent urination, even sixty times an hour, with violent cutting pain, causing her to scream. The urine is often bloody. The urine does not flow in a stream, but dribbles away, or passes drop by drop, with cutting and burning pains, and tenesmus of the bladder, which is agonizing in severity. Dose : Same as for Aconite. 642 PREGNANCY. Causticuni. Frequent desire to urinate, a small portion passing away involuntarily. Involuntary passing of urine at night. Dose : As for Arnica. Conium. The urine flows and stops, and flows and stops again, and so on. There are cutting pains during the flow, and burning or smarting afterward. Vertigo, particularly on lying down. Dose : As for Arnica. When the cause can be traced to displacement from accident or over- exertion, Belladonna and Platina have given me the best results. They are to b'e taken in alternation, every four hours. Complete rest w r ill be necessary for a few days, in a case of that kind. MISCARRIAGE. Women who have suffered once from this affection are exceedingly subject to its recurrence, and this liability is still further increased after a second or a third attack. When it occurs before or about the third or fourth month it is attended with much less pain or danger, although fre- quent miscarriages, owing to the abundant discharge that is generally j)resent, break down the constitution, and frequently develop severe chro- nic diseases. When a miscarriage takes place at a later period it assumes a very serious outlook, and is accompanied with a considerable degree of peril to the patient. Exciting Causes — Are sudden mental emotions, such as fright, grief or excessive joy, mechanical injuries, or excessive physical exertion, such as lifting too great a weight, reaching up high, going up or down stairs, long walks, riding on horseback or in carriage over rough roads, railway traveling at too great a speed, etc. Other causes are, a luxurious mode of life, fashionable habits, neglecting to take air and exercise, while an unhealthy state of the constitution, giving rise to numerous local and gene- ral derangements, is undoubtedly the predisposing cause. The Symptoms vary so much in particular cases, that it is almost impossible to give any particular train of symptoms— though most cases of miscarriage are preceded and attended by the following symptoms: A chilly sensation followed by fever with more or less bearing-down, par- ticularly when occurring late in pregnancy ; also, severe pains in the belly; drawing and cutting pains in the groins; or pains frequently bearing resemblance to those of labor; discharge of viscid mucus and blood some- times bright red frequently mixed with clots; at other times dark and clotted followed by the emission of a thin, colorless fluid. The miscarriage generally takes place during this discharge, which occasionally continues, if not properly checked, to flow for hours, therefore placing the sufferer in considerable jeopardy. After the child has been expelled, the flooding and pains generally disappear gradually; but if a portion of the placenta (after- birth) be left within the womb', the pains may continue with more or less severity and irregularity, the flooding will frequently become excessive and alarming, and offensive, putrid discharges will take place from the vagina. When miscarriage is threatened, the individual must assume the recumbent posture, and in some cases, indeed, should be strictly confined to the bed, sleeping with few bedclothes ; the apartment should be kept MISCARRIAGE. 643 'cool, and every means should be employed to ensure perfect repose to the mind. In all cases of miscarriage, medical assistance should be summoned as promptly as possible ; but as life may be lost in urgent cases before a phy- sician can be obtained, the following additional particulars should be observed: — When the misfortune gives evidence of being unavoidable and the hemorrhage is excessive and is not promptly arrested, by properly selected medicines, the following directions should be observed: Apply cold to the abdomen in the form of cold cloths or sacks of ice or cloths wrung out of ice water, etc., which will frequently have the desired effect, by causing the womb to contract and discharge its contents. As perma- nent cessation of the flow cannot be expected until this is accomplished, and as it is frequently slow to dilate sufficiently for that purpose, the pas- sage should be plugged to prevent the flow until the womb is sufficiently dilated. A piece of sponge of sufficient size, or a plug made of old muslin or linen rags with a string attached of sufficient length to disengage it when necessary, (called a tampon) may be used for the purpose, and should be cautiously inserted. The tampon should be large enough to entirely fill the passage, so as to obstruct the flow of blood. At the same time the indicated remedy should be given, and frequently upon removing the plugs, the womb will be found dilated and will expel its contents. The tampon, (plug) however, is only to be used in miscarriages occurring before the period of quickening, never afterwards. Another, and perhaps the best and safest plan to adopt for dilating the mouth of the womb is this: The patient should be placed upon the bed in the same position as for labor. The bed should first be protected with oil cloths or india rubber cloth so arranged as to guide a stream of water from the vulva into a pail or tub placed near the bed. Another pail must be provided containing tepid water; with a common syringe, the warm water should be thrown directly upon the mouth of the womb. This operation irritates and softens the neck of the uterus, so that contractions set in in the course of an hour or two, and thus labor is provoked and takes place in the most natural manner possible, except when it occurs in nature's own way at full term. This operation should be repeated in the course of two hours, if the first experiment should not prove sufficient. This will fail unless the stream is directed upon the mouth of the womb. The following are remedies. TO PREVENT AND ERADICATE A TENDENCY TO MISCARRIAGE, Sabina is particularly applicable to women who habitually miscarry about the third month. Feeling of sinking or faintness in the abdomen. Violent forcing or dragging pains extending from the back through to the pubis. Dose: Six pills in a teaspoonful of water, repeated after the lapse of twelve hours, and again after the lapse of twenty-four hours, grad- ually lengthening the interval for each successive dose, until the period of danger is past,— being careful, however, to watch the effect of each administration to discontinue or lengthen the intervals as the case may require. Secale. Especially after miscarriage has already occurred more than once, and is generally more suitable to thin, scrawny, exhausted women ; 644 PREGEANCY. passive hemorrhage with little or no pain. Great debPity, feeble almost extinct pulse. Dose: Six globules, as directed for Sabina. Sepia. Painful sensation of emptiness at the pit of the stomach Sense of weight in the anus like a heavy ball. Yellow saddle across the nose. Pressing in the womb, with oppressed breathing. Very fetid urine depositing a clay-colored sediment which adheres to the vessel with great tenacity. Dose : As directed for Sabin. Viburnum Prim. Spasmodic pains shooting from the abdomen into the legs. Frequent and very early miscarriages, thus causing sterility. This remedy is almost specific as a preventive for miscarriages. Dose: Six drops of the tincture to be taken every evening, in mild cases, in urgent ones, every morning, noon and evening. THE ACTUAL ATTACK. Arnica. When the symptoms have been excited by an accident — such as a fall, blow or concussion, and there is a sore, bruised feeling, this remedy will prove effectual, if administered as follows; Dose: Take six pills every ten, fifteen or twenty minutes, (in very urgent cases,) and subsequently every half hour, gradually extend- ing the intervals to three hours, and continuing the administration until decided improvement or change, Rhus. If the symptoms have originated in a strain from lifting,, pulling, or dragging a heavy weight. Pains worse in the latter part of the night. Dose: As for Arnica. Belladonna. Flushed face, red eyes, throbbing and heat in the head. Pain in the back, as if it would break. Severe bearing down, as if every- thing would fall out. Profuse discharge of blood, neither very bright nor very dark colored. Pains which come on suddenly and ceases just as sud- denly. Great intolerence to light and noise. Dose: As for Arnica. Chamoniilla. Periodical pains resembling those of labor with dis- charge of dark colored or coagulated blood. Violent pains in the bowels- extending to the sides, with frequent urination. Becomes almost furious about the pains. Hot perspiration about the head. Dose: In every respect as for Arnica. Nux-vom. Every pain produces a desire to evacuate the bowels, or to urinate. Much pain in small of the back, which is made worse by turn- ing in bed, writhing pains in the abdomen, accompanied by nausea or pains in the back or loins as if dislocated, constipation of large difficult stools. Persons of sedentary habits. Dose: As for Arnica. Pulsatilla. Labor-like pains, attended with hemorrhage ; restless- ness. The discharge is arrested for a little while, then returns with redoubled violence. Suffocative spells. She craves fresh air, and is worse in a warm, close room. Inclination to be chilly, even in a warm room. Mild, tearful women, Dose : As for Arnica. Ipecac. Profuse and continuous discharge of bright red blood, accompanied with a pressure downward. Cutting pains around the naval. TREATMENT BEFORE CONFINEMENT. 645 Continual sense of nausea, without a moment's relief, disposition to faint. Dose: As for Arnica. China. In weak and exhausted persons, when there is loss of fluids. After miscarriage, when there has been loss of blood unto fainting, gid- diness, drowsiness and loss of conciousness. Heaviness of the head, ring- ing of the ears, and coldness of the extremities. Twitching and jerking of single muscles. Dose : As for Arnica. HOME REMEDIES. Something simple, and in almost every house, is Nutmeg, of which take one and grate into a bowl or cup, and pour boil- ing water on. Drink the tea. This often arrests very severe cases of hemorhages. ♦ — TREATMENT BEFORE CONFINEMENT— PREPARATION OF THE BREASTS. Young mothers frequently find much difficulty in nursing their infants in consquence of some defect or incapacity of the nipple. In many instances, the structure of the breasts is disorganized by an ignorant nurse having compressed them in childhood, under the idea that such barbarous management w&s necessary to expel some of the contents of the breast ; mothers should be particularly watchful against this practice. The use of improper stays in after life, by which the skin is rendered so tender as to preclude suckling, often occurs. The first two cases are beyond the power of art, and if suckling be attempted, hardening of the nipple and breast ensues, attended with severe suffering. Another difficulty frequently occurring, is a shortness or retraction of the nipple, so that it is impossble for the infant to take hold of it. I have frequently had charge of young mothers whose nip- ples were so small that they were unable to nurse their babe. If this should be the case— if the nipple should be sunken instead of protruding- it has to be drawn out by means of some suitable instrument in the shape of shields, or an exhausting pump; a convenient one, in many instances, can be made in this way. Take a bottle with rather a large neck, pour hot water into it, then empty and quickly place the neck of the bottle over the nipple; the air cooling in the bottle will cause the nipple to draw down, and thus lengthen it. After the nipples have been drawn out, they have to be gently pressed and worked with the fingers in order to harden th^m, lest the delicate skiu should be injured by the sucking of the infant. During the two months previous to th e expected confinement,the nipples should be washed every day with cold water, borax and water, alum and water, or with rum or brandy. The whole breast should be washed quite frequently, more especially during pregnancy. It may, also, be here remarked, that when any ten- derness exists during the period of nursing, the shield should be resumed between the intervals of the infant being applied to the breast, and the bathing continued— due care being always taken to lave the nipple care- fully with tepid water before it is again offered to the child. Sulphur will frequently be found useful if an eruption breaks out on the nipples, six pills the first thing in the morning, after which the erup- tion generally disappears . 646 PREGNANCY. PRECURSORY SIGNS OF PARTURITION. A few days, or even two weeks, before confinement, the uterus begins to descend. Until the thirty-eighth to the thirty-ninth week of preg- nancy the uterus keeps rising in the abdominal cavity, and the breathing is very much interfered with. As soon as the uterus begins to descend, the breathing becomes freer, and the pit of the stomach again becomes vis- ible ; but now the uterus presses upon the pelvis like a heavy burden, and the female feels as if her hips would come apart. The small of the back is par- ticularly affected by the presence of the child's head agaiost the internal surface of the sacrum, which sometimes feels bruised and numb, in con- sequence. Another sign of impending parturition is the frequent and anxious urging to urinate, caused by the increasing pressure upon the bladder by the descending uterus. The last and most reliable sign of parturition is the appearance of the first labor pains, which may set in a few days pre- vious to the act of parturition, but which, generally, are Lot felt until a few hours before the event. THE BOWELS. If the bowels have been constipated, an artificial evacuation previous to delivery, may be obtained bv a lavement of lukewarm water, repeated with a small quantity of linseed or sweet oil when necessary from a fail- ure in the first attempt to obtain the desired effect. Injection. If of lukewarm water simply, inject about a pint; if the addition of oil be necessary, to a pint of water add two tablespoon fuls of" the oil ; shake them well together in a bottle, or other closed vessel, and inject the mixture. PREPARATION OF THE BED FOR LABOR. If the means allow, the confinement bed had better be arranged a few days previous to confinement, since at the last moment something might be forgotten, or a needful article might be wanting, because the hurry and anxiety of finding things are both unpleasant and injurious to the patient. The best thing for a patient to lie upon, is a simple matress, which should be slightly raised toward the head. The nates (hips) should be raised upon a cushion about a hand high, which may be covered with oil cloth or rubber cloth, or any common cushion may be used for the purpose, the object of which is to raise the body so as to procure the necessary space for an examination, and for the reception of the infant. The bed should be arranged so that every part of the body, from the nates to the head, is supported. The body being thus supported, the following rules may be observed in regard to the thighs and legs: It is better to have the space between the thighs and the foot-board of the bed just long enough so that the feet of the patient may press firmly against the foot-board; but if the space should prove too much, a foot-bench may be placed between the bed and the feet, so that she can press against it without drawing up the knees. It is sometimes necessary to have a cord or sheet attached to the foot of the bed, which the female may hold in her hands during the pains, for the hands are often spasmodically contracted during the pains, and it PARTURITION OR LABOR. 647 affords the patient great relief to hold something firmly in the hands at such a time. Holding another person's hands, likewise, affords relief to the patient. Persons frequently arrange the confinement bed by the side of the regular bed, into which they are lifted soon after the act of parturition is accomplished. However, those who do not find it convenient to prepare a separate couch, must protect the matress by some old cloths, or oil or rubber cloths may be placed under them, to prevent the fluids lost by the mother and child from soaking the matress. Even after parturition, it is best to leave the oil cloth under the patient, for the flow of blood con- tinues quite freely for a few hours after labor. After preparing the bed for confinement, we will now consider — FALSE PAINS. False pains sometimes precede labor but a few hours — but in many cases come on some days, or even weeks, before delivery, and chiefly differ from labor pains in these respects : they usually begin at the upper part of the womb, are seldom felt in the back, do not extend so greatly around the lower part of the body as the true pains, are either on all the time or appear with great regularity, and do not cause the womb to become firm and hard, while the true pains do. They are chiefly confined to the belly with sensibility to touch and movement, and in fact are very annoying. False pains can sometimes be distinguished from true ones by sitting over a vessel of warm water after which, if false, they will frequently abate, and if labor, they will continue with more regularity or strength . TREATMENT. Bryonia is indicated when there are pains in the loins resembling a dragging weight, much increased by motion, with pains in the abdomen, preceding those in the back. This remedy is more par- ticularly indicated when the above symptoms have been excited by a fit of passion, or by taking cold. Dose : Of a solution of six globules to four teaspoonf uls of water give a teaspoonf ul. If soon after the administration of the first dose an aggravation of the pain ensues, pause until two or three more parox- ysms have occurred ; and if these succeeding pains prove to be of diminishing intensity or frequency, do not repeat the dose until re- lapse threatens. On the other hand, if no improvement is the result, repeat the dose after an interval of three hours, and so on, if the proper time for the expected time for labor is not nearly due — dis- continuing immediately on relief or change. Nux-vomica. When the exciting cause seems to be constipation or mental irritation, or too luxurious mode of living, stimulants or spirituous liquors, etc. Dose : As directed for Bryonia. Pulsatilla. Abdominal pains and pains in the loins resembling those from continued stooping, or pressure of a tight bandage, attended with painful dragging and aching in the thighs, constipation or relaxation, mildness of temper or great sensibility ; particularly when these pains seem to have arisen from indigestion brought on by rich indigestible food. Dose : As directed for Bryonia. PARTURITION OR LABOR. During the first pains of the female, she may remain dressed and out of bed, because a certain unrest drives her from place to place, and it 648 PREGNANCY. would not be best to confine her to her bed. But all things should be made ready; the attending physician should be sent for; warm water should be at hand ; and in some convenient place in the sick room (all in one place,) the infant's linen bandages, and little strips of linen, should be kept all ready ; also, a pair of scissors and two pieces of string, each about one-half a yard long; the strings may either be tape, about a quar- ter of an inch wide, or cord of sufficient size and strength suitable for tying the cord attached to the infant ; a little fresh lard, or oil, some soap and pins, should also be at hand. Besides the attending physician and nurse, a friend may, likewise, be present in the sick room (if requested by the patient,) in order to comfort and quiet the sufferer. But all superfluous, persons, such as callers and children, must be kept away. If the pains become stronger, the female should lie down. Perhaps by this time the water may break, which may take place with a feeble report. A young woman who has never borne any children, should be warned of this event, so as not to get frightened by the suddenness of the occurrence. Nothing should be done, by irritating the neck of the womb, dilating the mouth of it, or by any other artificial means, to hasten the moment of delivery. This is the business of nature, who knows best when the right time has come for ushering the child into the world. Every arti- ficial interference is contrary to law, and is more hurtful than useful. Of course, these remarks apply o ly to natural labor. In preternatural labor, or those requiring mechanical means, the conduct of the attending physi- cian depends entirely upon his or her own tact and knowledge. The parturient female niay adopt any position that is most comfortable to her — on the side or back, with her limbs stretched out or raised ; but she must not bear down during a pain, until the right time for it has come. Premature bearing down may result in distressing weakness of the womb ; for not only the child, but the whole organ, is pressed by such untimely efforts. Xo bearing-down should be resorted to until the mouth of the womb is dilated so that the infant's head is protruded at least half its length. At this period, the patient may assist nature by holding the breath and bearing-down during a pain, with her head bent forward, (never backward, lest she should give rise to the formation of Goitre). During the passage of the head through the soft parts, the perineum (bridge between the front and back passage) must be properly supported, lest rupture might take place; at each pain, the attendant should place the palm of the hand against the perineum, without, however, making any pressure against it, until the perineum remains hard and globular, even between pains. At this season, the patient may contribute a great deal to a rapid and successful delivery by a suitable position of the body. As soon as the head shows a tendency to pass through the vulva, the patient should remain quietly on her back, with her feet firmly pressed against the foot-board, air' legs extended and stretched apart a comfort- able distance. At this stage, all bearing-down may cease, lest a too rapid delivery of the head should rupture the perineum. After the head is born, and the shoulders are still within the vagina, a short pause generally takes place, which must not be broken by any PARTURITION OR LABOR. 649 improper pulling on the head which may give rise to fatal dislocation of the vertebrae. Supporting the head with one hand, the abdomen may be gently rubbed with the other, in case the pains should not come on again with sufficient speed. The patient may now rest assured that, by assisting the remaining efforts of nature, delivery will soon take place. Occasionally it has happened that parturient females, while com- pressing the teeth during a hard pain, have broken off a portion of the tooth, or have lost the whole of it ; therefore, it is always best to have a handkerchief or napkin placed near her, which she may crowd into her mouth as soon as the pain is approaching, or if she should be surprised too suddenly, one of her attendants must do this office for her. THE PLACE OF THE ACCOUCHEUR (PHYSICIAN) AT THE BEDSIDE. As soon as the labor pains assume an expulsive character, the attend- ant should place himself or herself by the side of the bed where they can use the right hand most convenient, and should not leave the bed-side of the patient. "We may assist the female, either sitting or standing, according as is most convenient. The patient should not be uncovered, as it is entirely unnecessary to expose the patient's person, and is also, risking the chance t3 take cold, which, at this time, would be very injur ious. As soon as the little one makes its appearance into the world, it may be uncovered enough so that it may be wiped off with a soft cloth, which may be placed convenient for the purpose, but the mother need not be exposed, even at this time. THE CARE OF THE CHILD DURING LABOR. Immediately after the expulsion of the head, we should feel with one finger about the child's neck to see if the cord is around it ; in case it should be, a slight traction on the cord may loosen it from the placental end, so that it will slip over the child's head, leastwise will keep it from choking or strangling it. "When the head is born, it should be carefully supported from the clots and other discharges from the uterus, patiently waiting for the work of nature to complete the delivery. After the expulsion of the child, it is better to turn its back to the mother, and let her covering fall between the child and herself, thus, at the same time bringing the child to our full view and completely protect- ing the mother from cold and exposure. A soft cloth should now be used to wipe the child's face, eyes, and mouth. It usually cries lustily as soon as it is born, but it should be permitted to lie undisturbed for.some four or five minutes, or until breathing is established. The cord should then be tied about three inches from the child and again about an inch further along the cord, and then cut betweeen the two places. The child should then be wrapped in a blanket and handed to a nurse to wash. After it has been properly washed and thoroughly dried, a piece of raw cotton, or cotton batting the size of the palm of the hand, should be laid on the abdomen just above the naval, the remnant of the cord laid on it with its cut end pointing upward— the cotton being arranged so as to embrace the base of the cord— and another piece of cotton of the same size placed over the cord, the whole being kept in place by the usual belly band. 650 PREGNANCY THE ATTENTIONS TO THE WOMAN AFTER LABOR. After the child has been handed to the nurse, the next care of the attendant is to look after the delivery of the placenta (after-birth) ; until it is removed, and the uterus is firmly contracted there is more or less danger of flooding. In most cases, there is a short suppression of the pains immediately after the expulsion of the child, after which the pains return in a diminished degree, and the after-birth usually becomes detached, and either lies free in the vagina or is expelled without the vulva. If it should not be outside the vulva a very slight traction of the cord a little upward and outward, taking hold close up to the person, will be all that is necessary to disengage it, after which it should be care- fully scooped up and placed in a vessel ready for its reception. The woman should then be made comfortably dry, and a soft dry cloth should be applied to the vulva. She should then be straightened out a little in bed, and in all respects made as comfortable as possible, both mind and body must be kept in a state of perfect repose; every- thing which may tend to arouse the excitability of the patient, such as talking, noise, strong light, and odor must be carefully avoided, and the room kept at a moderate temperature. GENERAL MANAGEMENT, DIET, ETC. In the first place, we would most severely disapprove of administering stimulating, and even spirituous beverages after delivery, which, far from possessing a strengthening property, tend only to excite the whole nerv- ous system. As a usual thing, for some time after parturition, nature calls for but little nourishment; it should be given only, and when the woman herself, expressly feels the need of it, and then let her partake of such nourishment as she particularly craves, (unless it should consist of rich meats, pastries, and vegetables which create gasses in the stomach and bowels ;) however, we must allow nature to pursue her own course, which, as a general thing, prescribes but little nourishment for the first five or six days after delivery, and thereby avoids the necessary call- ing of the bowels into action, which state of constipation (if it niay be so called) is ordained for the wisest purpose, and attended with the most beneficial results ; the balance of the system is kept up by the passing off of effete matter in the shape of increased perspiration, etc. Then we cannot sufficiently condemn the use of physics, which only tend to promote irritation, and occasionally aid in bringing on puerperal fever and other evil consequences. In many cases, this artificial relax- ation, also, interferes with the proper secretion of milk. After the fourth or sixth day, nature generally acts spontaneously. When it appears neces- sary to afford mechanical assistance, we may do so by application of warm friction to the abdomen, or the employment of a lavement as directed to evacuate the bowels before confinement. When a costive state of the bowels continues so long as to cause inconvenience, the appropriate medicine may be selected and administered according to the directions for constipation of pregnant females. AFTER PAINS. These pains, which frequently annoy the patient so much, especially if she be of highly nervous sensibility, and deprive her of the necessary AFTER PAINS— FLOODING— RETENTION OF URINE. 651 rest, ought, under such circumstances, to be subdued as soon as possible ; by means of the following remedies, good results will certainly follow. TREATMENT. Arnica employed internally, and also externally as a lotion, when there is a sore feeling all through the patient, as if from a bruise. The pains are not very severe, but there is a bruised, sore feeling, with pressure on the bladder, and retention of urine. Done: Internal. Six pills every two hours, commencing immedi- ately after the delivery. Application— externally. To four table- spoonfuls of tepid water add fifteen drops of the concentrated Tinc- ture of Arnica, and apply to the parts. Chamomilla should be administered an hour after the second dose of Arnica when the after pains still continue to a severe extent, and the patient is highly excitable and sensitive. It is sometimes beneficial to alternate the two. Dose : Six pills repeated if necessary after the lapse of an hour from the first dose, then pause three hours and so on. Nux-vomica should be employed when the after pains are very severe and there is a continual inclination to relieve the bowels when lying down, but passing away when rising, accompanied by inclination to cramp in different parts of the body. Dose: As directed for Chamomilla. Pulsatilla is to be preferred when the pains are protracted and the patient is of a mild, tearful disposition, but sensitive and easily alarmed about herself; the pains become worse towards evening. Dose: Six pills as directed for Chamomilla. Secale is indicated in feeble, thin and delicate women when the pains are more particularly of a pressing or forcing nature, similar to labor pains. Dose : As directed for Chamomilla. FLOODING. With respect to the treatment of flooding or excessive oischarge of blood as incidental to delivery, it will require exactly the same medical and general treatment as is given in the article on miscarriage, page 642. It is to be remembered, however, that while in flooding after labor at full term, the application of cold to the abdomen is allowable in severe cases, while the tampon or plug is not to be resorted to. It may be mentioned, in addi tion, that pressure made upon the womb through the relaxed walls by clasping it with one or both hands equally and forcibly, but yet gently and without roughness, very frequently arrests the hemorrhage with great promptness. Injections of water as hot as can be borne, continued for some time, will produce the same good results. RETENTION OF URINE— SPASM OF THE BLADDER. During the passage of the child's head out of the womb, it is sometimes pressed against the bladder with so much force, that it causes an inflam- mation and irritation of this organ. The best remedy is Arnica. Next to Arnica, Cantharis, or Nux. Yom. 652 PREGNANCY. \Dose : Four pills every half hour, especially if the urine passes off drop by drop, and the discharge causes pain. It may be well to apply warm cloths or other warm applications to the parts, for the warmth will have a relaxing tendency. INCONTINENCE OF URINE. An incapability of retaining the urine is ; on the other hand, another not unusual sequel of protracted or severe labor. TREATMENT. The employment of Arnica, internally and exter- nally, as advised under the head of "After Pains" at page 650, is in the majority of cases, sufficient to overcome this weakness. When it fails to accomplish this object, the following remedies should be had recourse to: Pulsatilla is frequently successful in remedying the defect in from two to four days. Dose: Six globules three times a day, for two days. Belladonna may be given, if, in one or two days after the last dose of the foregoing medicine has been given, only partial relief has ensued. Dose : As directed for Pulsatilla. DURATION OF COXFIXEMEXT. Strict attention should be paid to cleanliness and ventilation of the lying-in chamber. Everything that produces an offensive odor should be promptly removed from the room, and a draught of air should be allowed to pass through the room (not, however, across the patient's bed). The parts should be bathed daily with lukewarm water so long as the dis- charge continues; this should be performed under the bed-clothes . The patient should make no exertion during the first three or four days, or at least until the proper secretion of milk ; after that time, she may be carefully moved from the bed to a couch, long enough for the bed to be aired a little. After the tenth day she may sit up out of bed, for a short time if she is able, which may be lengthened gradually from day to day, as she gains strength. Thus, too. she may begin to walk, little by little until she gradually grows stronger and more accustomed to exer- cise. In summer, she may ride out during the third week ; and in win- ter, during the fourth week, all things being favorable. CHAPTER XXXII. +. DISEASES FOLLOTYISG COXFIXEMEXT. SECBETIOX OF 3IILK. This is one of the most interesting and remarkable changes occurring during the lying-in period. While the child is still in the uterus, all that pertains to the mother unites to effect its nourishment, growth and development there. Suddenly all this is interrupted, the child is expelled from the little world within, and has to find nourishment else- SECRETION OF MILK. 653 where. Nature intends it to be supplied, as before ,from'the maternal blood, though through the medium of mammary glands. The reaction upon the organism, from this change from the uterus to the breast, causes what is called milk fever, in consequence of which there results a disturbance in the system, more or less well marked, according to the obstacles to be overcome. In some cases appears chills, fevers, headaches, and a great variety of pains and suffering; while in others this period is passed without any of the above mentioned disturbances. As a general thing, all the disturb- ances incident to the coming of the milk, are less when* the child is applied to the breast as soon after delivery as is practicable. Much advan- tage is gained both to the mother and child, by this method, since it serves to lessen the suffering of one from hunger, and the danger of the other from fever. SUPPRESSION OR SCANTY SECRETION OF THE MILK. It is of vast importance that the natural operations of the organism peculiar to this condition proceed with regularity. Among these, the secretion of milk takes a prominent position, and its sudden suppression is apt to be followed by internal and local inflammation, flow of blood to the head, hot and cold flashes, etc. The use of the following remedies should be employed according to their indications. TREATMENT. Pulsatill t should be promptly employed in cases of sudden suppression of the secretion of milk, whatever cause has occa- sioned it ; and this medicine will frequently be found sufficient to restore the natural flow of milk. Dose: Four pills repeated. every four hours (or every eight, in very mild cases) until change. Bryonia is to be preferred when there is oppression at the chest or stitching pains in the chest or side, or more particularly if the suppres- sion can be traced to some sudden mental emotion, or to catching cold. Dose : As for Pulsatilla. Chamomilla should be selected, if the patient be particularly irri- table and excitable, and the suppression be followed by intense flushing of heat or burning heat of the hands and face, either with crimson flush or alternate flushing and paleness, or one cheek red and the other pale. Dose : As for Pulsatilla. Belladonna should be given in cases in which the suppression is characterized by redness of the face, and general symptoms of congestion of*the head, breasts feel heavy and appear red, and the redness running in streaks over them ; sensitiveness to noise, light, or touch. Dose : As for Pulsatilla. Aconite should be given if active feverish symptoms, such as hot, dry skin set in, and, under such circumstances, will remove the whole disordered condition with promptitude. Dose: Four pills every two hours. EXCESSIVE SECBETIOX OF THE MILK— GAL AC TOB- BIKEA. Occasionally, on the other hand, it happens that too abundant a secre- tion takes place, causing distention of the breasts with spontaneous flow 654 DISEASES FOLLOWING CONFINEMENT. of milk, keeping the breasts constantly wet. Relief from such an uncom- fortable state may be obtained by the appropriate remedy according to the indications below. The function of lactation being one purely physi- ological, and provided for in the economy of suitable forces. Under the stim- ulus of maternal instinct and affection most women enjoy perfect health during its continuance. Many, indeed, are never so well as when giving suck to their children. Under the influence of this process, there arises a greater activity of all the functions at the same time, and, also, a greater strength of appetite, and corresponding energy of the digestive powers. The process of conversion of food is unusually rapid, the excess going to form milk. Where a greater amount is thus formed than is required, the system becomes gradually exhausted, even in health. This over-pro- duction may be due simply to excess of vitality, while it may result from the efforts of nature to supply the required material support, even under diffculties. The following remedies will be found beneficial, as the indi- cations appear: TREATMENT. Aconite may be taken as a precautionary measure when there is high febrile action of the whole system, and we are igno- rant of the exciting cause. Dose: Take four globules repeated at intervals of four hours, until the frequency of the pulse is diminished and the skin becomes moist. Phus-tox. frequently proves of much service where febrile symp- toms arise from distention of the breasts, induced by an excessive secre- tion, and indications of what is generally termed milk fever (which, how- ever, frequently arises from other causes). Dose : Three globules every six hours until amelioration or change. Calcarea Carb. should be employed in cases in which excessive distention of the breasts, spontaneous emission of milk and loss of flesh occur without any marked and active fever symptoms— or after the pre- vious employment of Aconite or Rhus, when the fever symptoms have been allayed. Dose: Six pills as directed for Rhus. Phosphorus is of especial value in cases of this kind, when there are marked signs of a tendency to consumption, and emaciation takes place rapidly. Phosphorus is yet further indicated when there are sensations as of a rush of blood, with oppression at the chest, and sometimes even short, dry, hacking cough. Dose : Three pills as directed for Rhus. * PEPSPIBATIOX AFTER DELIVERY. The increased perspiration which takes place after child-birth, is as before mentioned, a substitute for the suspended action of the alimentary canal, consequently its sudden suppression is unavoidably followed by an injurious result, and not unfrequently followed by fever. Exciting Causes. Exposure to cold, or a sudden chill, or applying damp linen or clothing not well aired, are the most frequent causes. TREATMENT. Dulcamara should be promptly administered when the perspiration has been checked by a chill, and in such cases a single EXCESSIVE PERSPIRATION — MILK FEVER. 655 dose will often restore the action of the skin, and prevent further injuri- ous consequences. Dose : Four pills repeated, if there be a degree of effect after the lapse of three hours, but if no evident reaction should have occurred, pro- ceed with the next remedy. Bryonia is to be administered when extreme oppression at the chest is present, or when there is a feeling of soreness and aching in all the limbs aggravated by movement. Dose: As directed for Dulcamara. Sulphur should be employed after the foregoing medicines, in cases in which such treatment is insufficient, and there is more especially intense heat of the skin and distress. Dose : As directed for Dulcamara. EXCESSIVE PERSPIRATION. On the other hand, an excessive perspiration is equally as harmful ; it is chiefly injurious from the extreme debility and high susceptibility of taking cold which it occasions. It is generally brought about by keep- ing the room at too high a temperature, the use of too many bed-clothes, or by stimulating beverages. TREATMENT. Our first care should be the removal of the exciting causes, after which, if it still continues excessive, the following remedies may be employed. China should be employed if the perspiration be of an exhausting character and attended with great debility. Dose : Six globules every three hours. Acidum Sulphuricum is to be preferred when the perspiration is excessively profuse when lying still, but is diminished when moving about. Dose : As directed for China. MILK FEVER. The secretion of milk is considered an operation of nature and not one that requires medical aid for its regulation ; but occasionally suffer some slight uneasiness for a few days following confinement; and when any of the below mentioned group of symptoms present them- selves, the affection is known by the name of Milk Fever. Symptoms. Shiverings and heat terminating in perspiration; the pulse is at first weak, changing to various phases, (sometimes quick and frequent,) at others soft and regular ; and in some instances the symp- toms are attended with a drawing pain in the back, extending to the breast, a disagreeable taste in the mouth, thirst, oppressive breathing, anxiety, headache, etc. Exciting Causes— are neglecting to put the infant to the breast sufficiently early, which allows the absorption of the milk into the cir- culation, mental emotions, fright or anger, and excessive talking. TREATMENT. Nature herself, if not disturbed by improper treat- ment, will, in most cases, suffice to restore the equilibrium of the system ; 656 DISEASES FOLLOWING CONFINEMENT. should the affection become aggravated we may dread the setting in of puerperal fever. Aconite must be employed in all instances where considerable fever is present, and will usually remove all the symptoms. Dose: Give four globules repeated after the lapse of three hours if necessary. Pulsatilla will be found particularly useful in severe cases, espe- cially when caused by taking cold, and appearing more like a rheumatic affection and have the general symptoms of milk fever. Dose: As directed for Aconite. Belladonna is very useful in particular cases in which complications with very severe disturbance of the brain, or when inflammatory action in the breast may supervene. Dose: Three globules repeated at intervals of four hours, until a degree of improvement sets in, and then at intervals of six hours. Rhus, is also of considerable service when extreme fullness, tension and painfulness of the breasts, with excessive secretion of milk, attend the case. Dose: As directed for Belladonna. CHILD-BED FEVER— PUERPERAL FEVER. This trouble is of so grave a nature that it is with reluctance that we approach the subject. Where it is at all possible, we would ad vise a skilled physician to be employed. As this work, however, will enter some home where no physician can be procured, it has been thought judicious to treat the disease at sufficient length to be available in cases of emergency. Symptoms. This disease assumes various types and degrees, and has received various names. Usually the disease begins on the second, third, or fourth day, although in some cases it even appears later, as late even as the eighth or ninth. It sometimes begins with a distinct chill, and again, there may be only slight chilliness, imperfect and merely noticed. The pulse is very rapid, full and soft. In some cases there is neither pain, distention nor tenderness of the abdomen ; while in others, the pain is very acute, the distention enormous, and the tenderness exquisite. Profuse sweating is a very common and distressing accompaniment of this disorder; the sweating of puerperal fever does not diminish the amount of urine, nor abate the quickness of the pulse. An intolerable thirst prevails, and the patient drinks immense quantities of whatever fluid she may be allowed. Dark spots appear on the wrists or other parts of the body. At first, the lochia may be unaffected; they may be even increased in quantity, but more commonly they are entirely suppressed. As the disease advances, usually about the third day, diarrhoea and vomiting may supervene. The patient becomes listless and languid, losing all interest in surrounding circumstances, and even in her child, and the expression of her face indicates anxiety and great prostration ; or, on the other hand, she may be unduly excited, nervous and tremulous. If the disease progresses in spite of treatment, delirium commonly supervenes. Rattling of the breathing, with enormous distention of the abdomen, are usually regarded as fatal symptoms. CHILD-BED FEVER. 657 As the disease advances, the womb, theperitonium and other organs, and tissues of the abdomen become involved in the prevailing inflamma- tion. The first symptoms of this disease are similar to those of "milk fever," but the distinction is to be made by the fact of absence of pain r and, more particularly by absence of tenderness in the abdomen. Causes. This disease may result in consequence of a chill occasioned by a draught of air, or other cause, or from the use of damp or wet linens, or it may be occasioned by violence; or again, it may be impossible to assign any reason for its occurrence ; in which case we are led to believe that it is due to infection, or arises in consequence of some lurking taint or predisposition of the system. TREATMENT. Aconite should be employed, at first being indicated by the feeble condition, and by other circumstances; and will in very many instances, when promptly administered, particularly in those cases of a more simple form, serve to dissipate the entire disordered condition^ and restore harmony to the system in an almost magical manner. Dose: Give four globules every hour, 01 half hour, according to the- severity of the symptoms. If, at the end of twelve hours, the symp- toms have abated, the intervals may be extended two or three hours. Belladonna should be administered when the pain is violent and cramp-like, coming on suddenly and ceasing as suddenly, with swelling of the abdomen ; or the pains are forcing, as if the contents of the abdo- men would be forced out ; sensitiveness of the belly to the touch, she cannot even bear the jar of the bed ; redness of the face and eyes; headache; dry mouth with red tongue; sleeplessness and restiveness ; delirious; suppress- sion of the lochia or escape of red and fetid blood ; the breasts are red and inflamed, or swollen and empty. Dose: As directed for Aconitum. Hyoscyamus may be used in some cases of a similar nature to that indicative of Belladonna, but where the disease has been developed, by mental emotions, and is characterized by spasmodic symptoms, jerks and twitches, delirium, throwing off of the bed-clothes, and desire to be uncov- ered, etc., it is more particularly indicated. Dose : As for Aconite. Bryonia will be found useful in cases in which the abdomen is swollen equally and is sensitive to the touch ; violent splitting headache the pains are aggravated by the slightest motion; sitting up, or even rais- ing the head, causes nausea and fainting; great thirst with desire for cold drinks ; the patient is irritable or restless, and apprehensive as to the results of her sickness. Dose : As for Aconite. Bhus-tooc, is suitable when the fever is of a low typhus grade ; the patient is very restless, constantly tossing about. The lochia is again tinged with blood, or clots of blood are discharged ; aching soreness and stiffness of the limbs; the tongue is red. Dose : As for Aconite. Mercurius is indicated by dejected expression of countenance ; great 1 hirst; constant flow of saliva; lancinating, boring or pressive pains in the belly ; profuse sweat which does no relieve; mucous or bloody diarrhoea or 658 DISEASES FOLLOWING CONFINEMENT. ineffectual desire for stool ; very offensive wind; the symptoms are usually aggravated at night. Dose: Give six pills every two hours until improvement or change. Niix-vomica is suitable at the commencement, when the lochia has been suddenly arrested by some mental emotion, such as vexation; fre- quent desire to urinate, with pain, scalding, and burning; heaviness and burning in the abdomen ; pain in the small of the back, worse in the morn- ing; frequent and effectual in urging to stool ; despondency ; sleeplessness or else dreaming frightful dreams ; the symptoms are usually aggravated early in the morning. Dbse : As directed for Mercurius. Colocynth will be found valuable when the abdomen is greatly dis- tended, and the pains are unbearable, being of a sharp, cutting or lancin- ating character, which cause the patient to draw the thighs up as close to the belly as possible ; diarrhoea with colicky pains aggravated«or excited by eating or drinking. Dose : As for Aconite. Chamomilla is useful for cases in which the breasts are flaccid and without milk: diarrhoea, "pains in the abdomen like pains of labor; general heat with redness of the face, or one cheek is red, and the other is not ; great agitation, impatience and nervous irritability. Dose: As for Mercurius. Arsenicum will prove valuable when there are great anguish; sudden prostration; sunken countenance, with a sallow complexion; extreme restlessness, and anguish with fear of death ; sleeplessness ; dry and par- ched lips; great thirst with desire to drink but little at a time; burning heat in the abdomen ; feeble and intermittent pulse, 'with coldness and desire to be covered. Dose : As for Aconite. Secale is good where there is strong tendency to putrify ; the dis- charge is pus-like and offensive. Dose : As directed for Mercurius. Diet and Regimen. The most absolute repose of mind and body should be secured ; all noise should be shut out, the room darkened and a moderate temperature maintained ; the room should be well ventilated, so as to have the air changed without admitting a cold draught. Purification of all aliment must be enforced, and the thirst allayed by small quantities of cold water, which should be iced in summer, or when vomiting is pres- ent. If the lochia is suppressed, flannels wrung out of warm water may be applied to the external genitals, or a tepid injection may be thrown into the rectum, if there be great constipation ; but it must be a small quantity, that the bowels may not be much disturbed. The infant should be removed and fed on cow's milk and water until the patient is out of danger. LOCHIAL DISCHARGE AND IRREGULARITIES. By the detachment of the placenta from the inner sides of the womb, the blood vessels are left open, and for some days after confinement, discharge blood; in six to eight days this changes to serum, and finally to a white purulent mucus. This is the lochial discharge. In most cases it lasts from two to three, while in others, it continues several weeks. In LOCIIIAL DISCHARGE— DIARRHCEA. 659 •cases where it becomes suppressed suddenly, it needs medical attention, .also when profuse and long continued. Causes. Profuse and protracted lochial discharge may be frequently traced to sitting up too soon after confinement, or to keeping the room too warm, or to mental emotions. TREATMENT. If, after nine days, the discharge continues profuse, containing pure blood, whereby an unnatural state is indicated, one or more of the following medicines may be required: FOR EXCESSIVE DISCHARGE. Bryonia is to be preferred when the discharge is of a deep red color, and is attended with internal burning pain, in the region of the womb. Dose : Six globules, three times a day. Nuoc Vomica is usually required when a chill or the use of stimulants has produced the mischief, and the patient is affected with severe pains in the back, and a constant and fruitless urging to stool, Dose : As for Bryonia, Calcarea is most particularly indicated when troublesome itching of the parts is experienced ; or when the discharge is protracted, and occurs in women of full habit. Dose : As directed for Bryonia. Silicea should be employed when pure blood flows with the lochial discharge every time the infant is placed at the breast. Dose : As directed for Bryonia. SUPPRESSED DISCHARGE. Pulsatilla, When the lochial discharge is suddenly suppressed— which it sometimes is from a variety of causes— and from this cause puer- peral fever threatens to ensue, the danger may frequently be warded off by the administration of this medicine. Dose: Four pills every four hours. Aconite will generally suffice if promptly administered when the sudden suppression is caused by fright, and is attended with febrile symp- toms. Dose: Four globules every hour until relief. Dulcamara will be found beneficial when the suppression is caused by exposure to damp or cold. Dose: As for Pulsatilla. Belladonna, Where sudden suppression is followed by congestion -of the brain, with flushed face, delirium, etc. Dose : As for Aconite. OFFENSIVE DISCHARGE. Carbo-veg, should be administered, if the discharge becomes thin, and offensive. Dose : Six pills four times a day. Kreosote or Secale should be given twelve hours after the sixth dose of Carbo-veg., if the discharge should still continue offensive. Dose : As for Carbo-veg. — «♦— — ~~ DIABRHCEA OF LYING-IN WOMEN. Diarrhoea at this time is to be looked upon as a serious occurrence and immediate means must be employed for its correction by proper remedies. 660 DISEASES FOL-LOWING CONFINEMENT, Dulcamara is generally indicated by the cause of the trouble being a check of the naturally increased perspiration from a chill. Dose: Four globules administered every three hours. Phos. Acid is most effectual for the treatment of painless and almost involuntary evacuation . Do.se; As directed for Dulcamara. Antimoniiun-crud., is generally sufficient when the evacuations are thin, watery and offensive. The tongue is coated white. Dose : As for Dulcamara. Rheum is to be preferred in cases which, in addition to the indica- tions afforded for the last-named remedy. The evacuations and the body emit a sour smell. Dose: As for Dulcamara. Phosphorus should be employed in very obstinate cases, when the discharge is watery and almost painless. Dose : As for Dulcamara. Veratrum should be given if the discharges are very profuse and watery, attended with much pain, chilliness, coldness of the surface and cold sweat on the face. Dose : As for Dulcamara. For cases in which neither of the medicines above mentioned have 1 the desired effect, consult the article on " Diarrhoea " page 261. WEAKNESS AFTER DELIVERY. We frequently find our patient very weak after delivery, especially if there has been considerable loss of blood, for which the following remedies will prove effectual. TREATMENT. China ranks first of all and will generally be found efficient in restoring the vital energies; especially when there has been considerable loss of blood, or very profuse sweating. Dose: Give six pills every three hours for the first two days, after that give twice daily. Aconite should generally be given at first when there is nervous weakness, attended with great restlessness and want of sleep. Dose: As for China. Sepia. This remedy is indicated when there is a painful sensation of emptiness at the pit of the stomach. Icy coldness of the feet and hands; the urine deposits a very hard crusty sediment; flushes of heat and loss of appetite. Dose : Six pills once in six hours. Sulphur. Weak fainting spells coming frequently during the day; feels very faint and weak from eleven to twelve every morning ; flushes of heat ; cold feet ; heat on top of the head. ABDOMINAL DEFORMITY. PENDULOUS ABDOMEX. Abdominal deformity is more common to those women who have borne many children, or to those who present a disposition to corpulency. It may be caused by wearing tight stays, which have a tendency to relax: SORE NIPPLES— INFLAMMATION OF THE BREASTS. 661 the abdominal muscles, and increase the existing disposition to this affec- tion ; or it may take place in consequence of a strain upon the muscles of the belly during pregnancy. ACCESSORY MEASURES. An elastic bandage laced at the back, and exerting an equal pressure over the whole of the abdomen may be worn with advantage. In some cases where there is a tendency to this affection, particularly in corpulent persons, we may, soon after delivery, have recourse to mechanical aid by transferring the support of the abdominal muscles to the shoulder, by the aid of properly constructed apparatus ; but we must, in the strongest man- ner, object to this, or any other pressure being exercised upon the abdom- inal region during pregnancy, as such a measure is obviously calculated to entail injurious consequences upon the offspring. Diet and Regimen. Spare diet and regular exercise must, in all cases, be observed. SOME NIFFLES. In a previous chapter I have shown the necessity of preparing the nip- ples for their new function. In spite of all care however, the nipples sometimes become sore three, four or six days after confinement, especially if the skin is very fine and delicate. This is a most distressing affection, because of the cracks opening whenever the child takes hold to suck. If the nipples are too short, the shield before mentioned should be worn between the interval of nursing. In case, however, the nipples should be insufficient, or their tenderness remain, in spite of treatment, nursing may yet be accomplished by using a proper shield, or artificial teat, numerous and excellent varieties of which may be procured. It is well to bathe the nipples with warm water and milk, or with borax water, as soon as the babe is done nursing, being sure to wash the breasts as soon as it is ready to nurse again. Arnica employed internal and externally. This remedy will very often obviate all further inconvenience, if used at the onset. Dose. (Internal). Four pills three times daily. Application (exter- nal). To a half teacupful of water add fifteen drops of concen- trated Tincture of Arnica with which a small strip of linen may be wet and applied to the nipple, this may be repeated three times aday. Chamomilla. The nipples are much inflamed, and are very tender, she can hardly endure the pain of nursing; she feels irritable and cross with impatience. Dose: Four pills three times daily. Sulphur should be given, if after nursing the nipples smart and burn badly ; they chap badly about the base and bleed. Dose: Six pills night and morning. INFLAMMATION OF THE BREASTS. One of the greatest obstacles to nursing an infant is inflammation of the breasts. The breasts become red and inflamed, occasionally suppur- ating in some parts which open, and discharge, while others still remain hard, and inflamed, which either end in suppuration, or in the formation of hard lumps. 662 DISEASES FOLLOWING CONFINEMENT. Causes which produce this disorder are numerous. Anything which- may operate as an exciting cause to disturb the local secretion, such as fright, passion, cold, etc; though it not unfrequently arises without being able to trace it to any particular origin. Inflammation of the breasts fre- quently arises from not applying the infant to the breast soon enough after its birth; and occasionally from a sudden cessation of suckling, caused by the death of the infant, or from disinclination of the child to suck, or from other reasons. When the milk is copiously secreted, and either from inability on the part of the child, or from the obstruction of the milk tubes, or from deficiency of the nipple, the milk cannot be freely drawn in the natural way, every effort should be made, without loss of time, to secure this end by such other means as may be possible. Sometimes the breast may be drawn by another child, or by a friend, or by young puppies. The proper remedy should be selected, and faithfully administered in order, as rapidly as possible, to remove all difficulty. In cold weather the breast should be warmly protected. If the inflammation is caused and kept up by a tender and ulcerated state of the nipples, let these be particularly atten- ded to, in accordance with the directions already given. (For particulars see Mastitis, pages 624-626). TREATMENT. Aconite. When a chill in dry cold air has been the exciting cause, and there is high fever prevailing. There is fear, anxiety, and restlessness, thirst for cold water, etc. Dose : Six pills every hour until the fever moderates. Belladonna. When the breasts feel heavy ; there are red streaks running like radii from a central point; she is occasionally chilly, a dull and stupid feeling prevails. It is well to alternate Aconite with this remedy. Dose: Four pills every two* hours. Bryonia. Her breasts have a stony heaviness in them, they are hot, hard and painful, but not very red. She feels sick when first sitting up in a chair, and still more sick on standing up, rough dry lips, thirst, and constipation, stools dry looking as if burnt, she feels worse when moving, and wishes to keep still. Dose • As for Belladonna. Phos2)horus. Inflammation of the breasts, threatening ulceration with cutting or stitching pain. Hectic fever and night sweats, deep ulcers with blue appearance. Dose: Six pills every six hours.. Sulphur. The inflammation runs in streaks from the nipple, suppu- ration profuse, with chilliness in the fore part of the day, and heat in the after part. Sometimes piles in complication. The breasts feel hot. She has night sweats, flushes, or heat, weak and faint spells, irresistible hunger at 11 A. M. Dose : Six pills every twelve hours. Another treatment of gathered breasts, which has never been known to fail, if employed as soon as threatened, is this: take of Chloroform and Glycerine equal parts. As the substances are of unequal weight, the vial containing them should be thoroughly shaken, the mixture quickly applied, and the part covered with oiled silk, or something equally impermeable, to prevent too rapid evaporation. PART F'OXJR.TEEIVTH. TREATMENT OF INFANTS. CHAPTER XXXIII, TREATMENT AFTER BIRTH. As soon as the child is born, it should be wrapped in a soft woolen cloth, it first being warmed, as care should be taken to gradually inure the infant to the temperature of the surrounding atmosphere. The skin should then be gently washed with a little warm water; or it may be annoiuted with lard, using a little fine toilet or castile soap in the water with which it is washed, but care must be used in the first washing, less it should get chilled. It is best only to wash part of the body at a time, keeping the other parts protected. After washing, the skin ought to be dried immedi- ately to avoid the risk of taking cold. The child should be bathed every day, gradually lowering the temperature of the water after weaning. The best time for bathing is in the morning, soon after being taken out of the bed. I wish I could impress every mother with the importance of dressing their infants in a more suitable manner. The practice of bandaging and swathing the tender bodies of their infants, and loading them with a superfluity of clothing, which, by its weight and length, presses upon the lower extremities, and is frequently the cause of deformity and weakness in after life, and moreover causes rupture of both navel and groin. STILL-BORN CHILDREN— S USPENBED ANIMATION Causes. In many cases this arises from difficult parturition, pressure of the cord around the child's neck, natural debility arising from some scrofu- lous or syphilitic taint of either or both of the parents; or from accumula- tion of mucus in the nose and throat; or, if delivered with forceps, it might be caused by an injury from them; or again, it is caused by too sudden alteration of temperature, the action of the lungs not having commenced. TREATMENT. From whatever cause the apparent death or suspen- ded animation of the child should result, no time should be lost in making proper efforts to establish respiration. Mechanical Means to be employed, is to immerse the child sud- denly into cold water, or better still, cold or even iced water should be poured over it. In some, apparently lifeless children, pouring cold water on the head and letting it run down over the body, establishes the circula- 663 664 TREATMENT OF INFANTS. tion and respiration; the child should then be wrapped in woolen blankets ui:i.il quite restored. Of course, in all those cases where the breathing is prevented by an accumulation of mucus in the throat and nose, such measures should be employed as to remove such obstructions. Should these methods fail, the one of which a description may be found in the article on "Apparent Death from Suffocation," will have to be resorted to. Should this method fail, the lungs may be directly filled and respira- tion may be excited by an adult placing his or her mouth directly ovpr the mouth of the child, closing the child's nostrils between the thumb and forefinger of his hand and blowing air into the child's lungs, and, when filled, by gradually and carefully compressing the walls of the chest, emptying the lungs again. This should be repeated again not oftener than from ten to fifteen times a minute. This artificial respiration, and all other methods employed to restore suspended animation, should be persevered in for some time, life having returned after the lapse of an hour from judicious and careful treatment. Medicinal Treatment. If the child should still continue to' breathe feebly and imperfectly after animation has been restored, the fol- lowing remedies may be resorted to. Aconite if the child is warm, purple-hued, pulseless, and breathless or nearly so. Dose: Two pills on the infant's tongue. Belladonna. The face is very red and the eyeballs are greatly in- jected. Dose : As for Aconite. China if the face is pale, the infant small and of a delicate frame and incases where the mother has had profuse hemorrhage. Dose . As for Aconite. Opiumis good if improvement takes place slowly and the face is livid and bluish. Dose : As for Aconite. SWELLING OF THE HEAD. Immediately after birth the head of the infant appears more or less swollen ; this in most cases is but a trifling affection, and will disappear of itself; medicinal treatment may sometimes be required. Arnica or Rhus, will usually be sufficient to hasten the swelling to subside; when it is very extensive, it is necessary to resort to external application of the same remedies. Dose: Two pills repeated again in twelve hours. Application, (external) : To four tablespoonf uls of water add six drops of the tincture, and apply this lotion to the part, repeating the oper- ation after the lapse of twelve hours. If there should result an ichorous discharge and caries of the bone and prostration. Calcarea will in many cases produce a cure. Dose: Two pills every second day. Silicea is useful, if the trouble yields slowly to Calcarea, to finish the cure. Dose: Two pills as for Calcarea. RUPTURE IN INFANTS— PROPER TIME FOR SUCKLING. 665 RUPTURE IN INFANTS. NAVAL RUPTURE. Hernia or rupture may be developed before birth and a predisposition to this affection may be observed in children whose parents are similarly affected. The mechanical treatment of naval rupture is as follows: — Take a piece of lint or soft cloth just large enough, when folded five or six times, to cover the rupture effectually, then press in the protrusion and keep it reduced with the hand, until the compress is rightly adjusted and secured in its position by means of two strips of adhesive plaster placed over the compress in the form of a cross. Another compress may be made by taking a button-mould about an inch or an inch and a quarter in diameter and cover it with a piece of soft linen ; apply and secure it the same as the before mentioned compress, or. by a bandage made of suitable form to secure it properly. This disease being frequently brought on by violent fits of crying, to which delicate children are subject, the bandage may be worn for some time after the cure, as a precautionary measure against its return. It is best to administer a remedy or remedies in order to assist the mechanical measure, and in nearly every case whether subsequent treat- ment be required or not. Xuoc-vomica may be looked upon as a medicine of primary import- ance. Dose: Two pills every morning and evening. Aconite. This remedy is suitable when the infant feels hot and is restless; in that case it is best to give it in alternation with the Nux. Dose; Two pills in alternation with the Nux every six hours. Cha momilla is sometimes of service; more particularly when the infant is very fretful and the motions of the bowels be too relaxed and of an unhealthy color, or if there be evidence of griping in the bowels. Dose : As for Nux. Sulphur is also of great service after any of the previous remedies in obstinate cases when there has been partial improvement, but the treatment prescribed has been insufficient to complete the cure. It is also good for the treatment of soreness of the navel, remaining after the liga- ture has fallen off, or even before this takes place. Dose : As for Nux. Silicea should be given four days after the fourth dose of Sulphur, in cases of soreness of the navel in which no decided improvement has been effected by the last namedanedicine. Dose : As for Nux. RUPTURE IN THE GROIN. All the remedies just enumerated are just as good in those cases of rupture in the groin, which are occasionally met with. WHEN MAY THE CHILD BE PUT TO THE BREAST. Even before delivery the breasts secrete a milky fluid; the genuine milk is only secreted after delivery. In some instances it has been the custom to draw off this first milk and feed the child in the meantime on catnip tea. or chamomile tea, cracker water, or thin soup, etc. Nothing 660 TREATMENT OF INFANTS. can be more irrational or inhuman. Nothing is more calculated to expel the meconium (the excrementitious matter discharged from the bowels of a new born infant), than the first milk, which has a slightly loosening effect upon the child's bowels. It is evident that nature has designed it so, else, why should the milk be secreted and the child created with a desire to suck as soon as born ? After having a few hours rest, the mother may take a little nourish- ment, if she should desire it. After this, the child may be put to the breast; if the mother should feel rested before, and the child should desire, it can nurse before, and at all events do not let more than twelve hours elapse before letting the child nurse. If the child was born in the evening or night, it need not be put to the breast before morning, espec- ially if the mother sleeps; often both mother and child sleep till morning, but if it should wake and become restless, it may be fed on a few tea- spoonfuls of water and milk, of equal parts, sweetened. OBSERVATIONS ON THE SUCKLING OF THE INFANT. Conquist, whose opinion in this respect we perfectly indorse, in his "Outlines of Midwifery," remarks: "Unless very peculiar urgent reasons prohibit, a mother should sup- port her infant upon the milk she herself secretes. It is the dictate of reason, of nature, and of common sense. Were it otherwise, it is not probable that so abundant a supply of suitable food would be provided to meet the wants of an infant when it enters upon a new course of existence. It is difficult to estimate the mischief resulting from infants being deprived of their natural nourishment; for, however near the resem- blance may be between food artificially prepared and breast milk, still reason and observation demonstrate the superiority of the latter to the former. As a further inducement it should be remembered that medical men concur in the opinion, that very rarely does a constitution suffer from secreting milk ; whilst the health of many a woman is most materially improved by the performance of the duties of a nurse. Presuming that the laudable determination is formed to indulge the child with that nutriment which is designed for its support, it becomes necessary to state that unless very strong objections should exist, twelve hours should never elapse before the infant has been put to the breast. Instinct directs it what to do, and the advantages of allowing it to suck soon after birth are many and important, both to the mother and the child. By this commendable practice, the patient is generally .preserved from fever, from inflamed and broken breasts, and from the distressing and alarming consequences resulting from those complaints. If the breasts should not have secreted milk previous to delivery, the act of suckling will encourage and expedite the secretion. Thus the mother will be saved from much of the pain connected with distended breasts, besides which, if the infant be not put to the nipple until the breasts become full and tense, the nipple itself will sometimes almost dis- appear on account of its being stretched, and without much and effectual THE CHOICE OF A NURSE— DIET DURING NURSING. 667 labor on the part of the child, it cannot be laid hold of; and even then the pain endured by the mother 's exquisitely severe, and not unfrequently the cause of sore nipples." THE CHOICE OF A NURSE. For those who cannot give suck to their own children, the selection of a nurse is of great importance, and the medical attendant ought generally to be consulted, and the following points merit particular attention: She should be of sound constitution and of good health, of full and moderate plumpness, with a fresh complexion, and clear eyelids, free from any appearance of redness, scurfiness or thickening. She should be thor- oughly exempt from glandular enlargements, and possess deep red lips without cracks, sound white teeth, and well formed, moderately firm breasts, with nipples free from excoriation or appearance of eruptions; the child of the nurse is one of the best criterions to judge by— its being plump and healthy is a great point in her favor. We should also endeavor to discover if she is free from any hereditary taint; she should, moreover, be of a mild, patient and equable temper, not irritable, or disposed to fits of passion, or nervous ; .of regular and temperate habits, and fond of children. She ought also to be about the same-age, and to have been delivered about the same time, or, at least, within three months of the same period as the mother; with respect to age, we must, of course, avoid extremes. A woman, hav- ing given birth to a child very late in life, should choose a nurse several years her junior, and fully qualified for her duties; the reverse of the rule applies to extremely young mothers. DIET DURING NURSING. As regards the nurse's diet, it should be simple and easily digested, and she ought to live upon a proper proportion of animal and vegetable food. Nature generally provides for the increased call upon her powers by suppression of the menstrual discharge, and a moderate increase of appetite, which may be safely indulged ; but all food of a highly concentrated, heavy description, is injurious, causing the milk to become unsuited to the delicate digestion of the infant ; the best guide, in the majority of cases, is the regular Homcepathic regimen, which may be consulted with advan- tage. Reference' must, however, be had to constitution; thus, a strong woman of full habit will not require much animal food, and will have, generally speaking, a plentiful supply of good milk, if she drink nothing but gruel, barley water, toast water, cocoa, tea, etc,; whilst, on the other hand, a woman of somewhat delicate constitution and languid circulation, will want more nourishing food, milk, etc. But we cannot too strongly repudiate that too prevalent but deeply erroneous idea that women, during the period of sucking, necessarily require stimulants to keep up their strength ; under these impressions, both wine and malt liquors— and, among the latter, more particularly porter —are frequently resorted to. Porter is not only injurious, from its stimu- lating properties, but the deleterious effect which the different ingredients composing it produce upon the milk, forms one of the most prolific causes of 668 TREATMENT OF INFANTS. the many evils that attack infancy. We shall conclude this part of the sub- ject with a single quotation from a well-known medical writer: " There is an evil too generally prevalent, and most pernicious in its consequences on individuals and society, and by no means confined to mothers in the lowest classes of the community, which cannot be too severely reprobated; it is the wretched habit of taking wine or spirits to remove the languor present during pregnancy and suckling. It is a practice fraught with double mischief, being detrimental both to mother and child. The relief afforded is temporary, and is invariably followed by a degree of languor which demands a powerful stimulus, which at length weakens, and eventually destroy es the tone of the stomach, deteriorates the milk, and renders it altogether unfit to supply that nutriment which is essential to the existence and welfare of the child." SUPPLEMENTARY DIET OF INFANTS. Unfortunately, some mothers do not possess sufficient milk for the proper nourishment of their offspring ; if this arises merely from a defi- ciency in the secretion, and the woman is in other respects healthy, we must have recourse to supplementary diet to make up for the diminished quan- tity of the natural nutriment. Goat's, ass's, and cow's milk are excellent substitutes, especially the latter, diluted with one-third of water ; goat's milk being apparently objectionable from its peculiar aroma. The milk, therefore, of the cow ought, when possible, to be obtained, and, if given undiluted, to be boiled, — cow's milk being generally considered too heavy, which boiling in a great measure obviates ; it ought also to be slightly :sweetened, so as to resemble as closely as possible that of the nurse, and should, moreover, be about the same temperature, say from ninety-six to ninety-eight degrees,— a point less regarded than it should be, and easily determinable by the thermometer. If any constitutional taint exists in the mother, the sooner the child is transferred to another breast, the bet- ter for both parties ; and if a nurse be not procurable, the above will gen- erallv prove sufficient nourishment until the front teeth appear, which is a clear indication that the digestive organs are prepared for more solid food; if, however, the milk diet appears to disagree with the infant, wemay give thin water gruel, or mix a little thin arrow-root, rusk, or well tosted bread in water, to which the milk may be afterwards added ; such alterations in diet are, however, but rarely required. We may here observe, that no portion of the milk ought to be retained for a subsequent meal, from the quickness with which it becomes sour; the same remark applies to any of the above preparations, in which milk forms the principal ingredient. In the cow's milk, at first diluted as above described, we may, after two or three weeks, gradually diminish the quantity of the water, as the digestive organs become stronger; but we cannot too stringently press the point, that, where it is at all practicable, the child ought to derive as great a portion of its nutriment as possible from the breast, no food being able efficiently to supply the place of that which nature intended for it at its birth. When it is necessary to give supplementary nourishment, a sucking- bottle ought to be used, as the best imitation of nature, in giving the DURATION OF SUCKLING— WEANING. 669 food slowly ; particular care being taken to observe the utmost cleanli- ness. The child ought, in feeding, to be kept in a reclining, not supine position, as the latter frequently causes it to incur the risk of suffocation ; and when it evinces disinclination to its food, no more should be offered. The child should be accustomed to take its nourishment from each breast alternately ; as, if this precaution be not adopted, inflammation is likely to arise in the breast not used, and the child is apt to become crooked from being always retained in the same position. The physician is frequently asked how often the child ought to be applied to the breast; the best rule on this point, is, to give the breast when the infant desires it, and to withdraw it when the child appears satisfied. As the infant increases in strength, it may be easily accustomed to regular hours. It should not be permitted to " lie at the breasts " dur- ing the night ; which is a most pernicious practice for both mother and child. DURATION OF SUCKLING— WEANING. The period of suckling ought seldom to last longer than forty weeks ; but in this we must be guided, in a great measure, by the constitution of the infant; weak, ill-conditioned children, in whom teeth are long in making their appearance, it has been recommended to continue at the breasts for eighteen months or even a longer period. Weaning ought, in fact, to be regulated by the constitution both of mother and child. The full development of the front teeth, which in healthy children is from nine to ten months, but in delicate and scrofulous constitutions, is delayed for several months later, has been considered the best indi- cation of weaning; but this is by no means an unexceptionable rule. If the strength of the mother appears unequal to the task, and the supply of milk begins to fall off, the child may be gradually weaned, even before the teeth appear ; still, even when the supply is ample, and the mother and child are apparently strong, a continuance of suckling beyond the tenth month is generally injurious alike to parent and child. Weaning should not take place suddenly, but the infant should be gradually accustomed to other food, and a less frequent administration of the breast, until entirely weaned; the time to commence this grad- ual course, is upon the first appearance of the front teeth, so that the weaning may terminate with their full development; thereby the secretion lessens by degrees, preventing all evil consequences of swollen or inflamed breasts, and the child, also becomes quietly reconciled to the deprivation. Weaning ought not, however, to take place, if the child suffers con- siderably from the irritation of teething, or any acute infantile disease. When, however, it is found absolutely necessary to wean, the above precautionary measures should be observed, both with respect to the mother and child. FOOD OF THE INFANT. After the child has been weaned, its nourishment should generally consist of the same simple food as before mentioned. The transition to a more substantial diet ought to be extremely gradual and guarded, and no material alteration made until after the appearance of the eye-teeth. 670 TREATMENT OF INFANTS. SLEEP— SLEEPLESSNESS. From the inability of the infant itself to maintain a proper degree of warmth, it should sleep by its mother's or nurse's side, for at least the first six weeks, particularly during winter or early spring. Care must be taken not to overburden it with bedclothes, and to place it in such a posi- tion as to prevent it slipping under them, and thereby becoming exposed to the risk of breathing a vitiated atmosphere, or even of suffocation; after six or eight weeks, when the organism becomes stronger, and able to preserve a proper degree of natural warmth, a separate bed or cradle will be more conducive to the health of the infant ; this change of arrangement will be found beneficial to both parties— to the child, from its breathing a purer air; and the mother, being freed from the necessary watchfulness and restlessness consequent upon the child sleeping with her, will enjoy better health, and be more likely to secrete good and nutritious milk. Moreover, sleeping in the same bed with an adult, and particularly with an old person, is somewhat detrimental to the health, not only of infants, but even of children. As to the length of sleep allowed to the infants, the chief business of the first months of its existance being sleep and nourishment, we may safely leave the point to nature, and not attempt to coerce the inclinations of the child; if the infant is lively on waking, we may conclude it has not slept too much ; and as it increases in vigor, and is able to endure longer intervals of wakefullness, we may proceed (recollecting that night is the proper period for sleep,) so to regulate its habits of taking its food and rest, as to accustom it to an uniform system, and particular hours. Chil- dren, up to two years of age, require rest during the day, and the nurse ought to endeavor to get them into the habit of taking it in the forenoon ; for, if it be taken in the afternoon, it generally interferes with the night's sleep. Whether by night or day, we must carefully exclude both light and noise from the nursery ;- for although they may be insufficient to arouse the infant, still they cause its sleep to be disturbed and unrefresh- ing, and, by acting upon the nervous sensibility, predispose the child to convulsions or spasmodic attacks from slight accidental causes. It is true that, during the first month, the infant sleeps immediately on leaving the breast, and no evil consequences ensue; but it must be borne in mind, that it takes but a little at a time, and milk is at that time wisely adapted to its delicate digestion ; but as the secretion becomes richer, and suited to the increasing power of those organs, it is injurious to put the child asleep immediately after a full meal, for its rest is then unquiet and disturbed, from the process of digestion being interfered with, more particularly when the nurse foolishly endeavors to force nature, by| resorting to the baneful practice of rocking. Nothing causes greater annoyance and even anxiety to the mother,l than a disposition to wakefulness on the part of her infant. A healthyl child should always be prepared for its rest at the usual hours; if, insteadf of going to sleep, it appears restless, fretful, and disinclined for its accus-| tomed rest, it is an evident indication of some derangement of the child'; general health; frequently, through ignorance, nurses, instead of attend- ing to this warning voice of nature, which, by the sleeplessness of the infant demands appropriate relief, endeavor to stifle it, and sometimes, u EXERCISE. 671 free themselves from a little temporary annoyance, administer opiates, often in the form of "carminatives,'' " soothing syrups," which induce an unrefreshing slumber, and not unfrequently a deep stupor, mistaken for sleep, while the original evil still continues to make head against the vital power. This baneful practice has not only been the ruin of many constitutions in after life, but to it, conjoined with improper diet, stimu- lating or unwholesome drinks, quack medicines, together with the highly erroneous practice of a frequent administration of laxatives, in infant maladies, a considerable number of diseases and even deaths are annually attributable. Every mother should not only caution her nurse against the use of opiates, but use her utmost vigilance to detect any breach of her injunctions, which should be visited with the immediate discharge of the person so offending ; for she must be truly unfitted for such an impor- tant trust, who, after being'warned of its injurious tendency, will perse- vere in a practice placing in jeopardy the life of her infant charge. TREATMENT. Amongst the homoeopathic remedies which have been found the more generally useful in removing restlessness and sleep- lessness in children, the subjoined deserve especial notice. Coffea is very efficacious when the child seems unusually lively, restless and wakeful; but will commonly fail to answer its purpose when the nurse is in the daily habit of taking coffee as a beverage. Dose : Two globules, dry, at night and morning. Opium may be substituted for Coffea when the nurse is in the daily habit of taking coffee, and is especially indicated if the face of the child looks red. Dose : As for Coffea. Chamomilla will do good when the child is tormented with flatu- lence, and distention of the bowels, and appears to suffer from colic, indi- cated by drawing up the legs, screaming, etc. Dose : As for Coffea. Aconitwm is preferable to any of the preceding, when there is gene- ral febrile heat and great restlessness. Dose: Two globules, dry, on the tongue, three times each day. ADDITIONAL PARTICULARS. The reader should further consult, if necessary, the general article on " Sleeplessness," and that on " Crying, Wakefulness, and Colic of Infants," in the subsequent pages. EXERCISE, For the first six or seven niDnths the great business of natureseems to be the proper development of the infant frame, and particularly of the respiratory and digestive organs. During this period, also, the cartilage is gradually forming into bone, and the infant's delicate muscles are acquiring power and strength. We find, however, that consciousness is yet indistinct, and the infant evinces no anxiety to indulge in voluntary motion, the muscles of the neck and back not possessing sufficient power to support the head, or to keep the body in an erect position ; fortius reason, children during this period, should, when carried in the arms, be kept in a reclining position, so as to avoid an undue pressure upon the 672 TREATMENT OF INFANTS. spinal column ; a neglect of this precaution, and a premature carrying of the infant in an upright position, is a too frequent cause of deformities of the spine, and derangement of the functions in after life. As its powers gradually develop, the infant seems inclined to exercise them, and evinces a desire to sit upright, which we may safely indulge, taking care not to overtask its strength by keeping it sitting up during the greater part of the time it is awake. A careful attention to nature in this, as in all other cases is the best guide. The practice of dandling the child in an upright position, seems rather to proceed from the pleasure of indulging the feeling of parental affection, than from any benefit the child can, by any possibility, be expected to derive from it; in fact, it is highly injurious, even at a rather more advanced period, as exciting a premature involuntary exercise of the mus- cles, and consequent deformity. The act of respiration bringing into play a great variety of muscles, occasional crying seems sufficiently active exer- cise during this period. In mild spring and summer weather, the child may, under favoring circumstances, after the first fortnight has elapsed, be carried out into the air for a quarter of an hour at a time, and the period of exercise grad- ually increased ; in fact, if the weather be fine, it can scarcely be too much in the open air. Should its birth occur in winter, advantage may be taken of a fine day, after it is amonth or five weeks old, as the frame is grad- ually acquiring the power of generating heat; but, at the same time, great care must be taken to prevent its catching cold; and should the child exhibit the slightest sign of being affected by the atmosphere, the practice of carrying it out of doors should be immediately discontinued, and it should be carried up and down in a well ventilated room, the nurse mov- ing it quietly in her arms from side to side. Many children are lost through a foolish idea of making them hardy, by acustoming them to endure cold ; this can occur only through ignorance ; for nature, in very early infancy, does not possess sufficient energy of reaction to overcome the power of a sudden or long-continued chill. We may recommend an occasional gen- tle friction of the hand over the body and limbs, which materially assists in the promotion of the circulation of the blood, and will, in unfavorable weather, serve, in some measure, as a substitute for exercising the infant out of doors. The practice of assisting children to walk, or of exciting them to a premature exercise of their powers, is highly reprehensible, causing, in many cases, curvature of the limbs, the bones not yet being sufficiently formed to bear the burden imposed upon them. By allowing nature to act, the infant's power will become more gradually, but at the same time more fully developed; its carriage will be more firm and erect, and its limbs straight and well formed; moreover, it will walk with greater con- fidence and independence, by the expiration of the first year, than those who have been taught to walk by the assistance of the nurse, leading strings, or mechanical inventions. RETARDED STREXGTH OF THE LIJIBS. TREATMENT. Calcarea carb. is. in the majority of cases, the appropriate medicine when the child continues to be feeble, and any INFLAMMATION OF THE EYES. 673 attempt to walk, or the capability of sustaining an erect position, is unduly procrastinated. Dose: Two globules every morning, the first thing, for four days (unless some condition requiring other treatment should sooner arise); then pause eight days, after which repeat the course as before; then pause again for three weeks, and repeat the course once more. But if within three weeks after completion of the third course, no very apparent change should have taken place, consider the following medicines. Silicea or Sulphur* may be required after the previous employment of Calcarea, when the last named medicine has been productive of no very apparent improvement, more particularly if the child manifests a gener- ally feeble or scrofulous habit, and is affected with enlargement of joints or tendency to curvature of the bones, or rickety affections. Dose : Of the remedy selected, give two globules, as directed for Cal- carea, CHAPTER XXXIV DISEASES OF INFANCY. IXFLAJIMATIOX OF THE EYES— OPHTHALMIA. Xew born infants and older children are subject to purulent ophthal- mia, or inflammation of the eyes. This disorder is always more or less serious, for, unless speedily cured, the inflammation may result in ulcera- tion, and the contents of the eye-balls be discharged, causing permanent deformity as well as hopeless blindness. The first indication of the disease is, generally, the eyelids becoming- glued together during sleep, with redness and swelling externally. The Causes are sudden exposure to the light of day, to cold, or the glare of a lamp or fires. Many cases of inflammation of the eyes occur in babes whose mothers are affected with leucorrhcea, therefore we must conclude a discharge from the genitals of the mother is a very frequent cause of opthalmia in newborn infants; or it is sometimes epidemic; and no doubt many children who are what is commonly called " born blind," owe their misfortune to the neglect of proper precaution, in many cases the exter- nal indications of this affection being so slight as to escape observation. For additional particulars see page 168. TREATMENT. Aconite should be administered as soon as we become aware of the existence of this evil; a few doses will generally be found sufficient to subdue this a'ffection in all mild cases. Dose: Two pills every four hours. Belladonna. The eyes look very red ; cannot bear the light ; open- ing the eyes only when in a dark place. This remedy is good to alternate with Aconite. Dose : As for Aconite. 43 674 DISEASES OF INFANCY. Sulphw\ There are pimples, more or less over the body; the eyes seem to itch very much. This remedy should be selected when we have reason to suppose the constitution of one or both of the parents is affected. A little breast milk applied to the affected eyes of an infant often affords speedy relief. Dose : Two pills repeated every twelve hours. HICCUP. This affection, though in itself of slight importance, frequently causes a considerable degree of uneasiness to the young mother. It generally arises from exposure of the body, even in a warm room, to the atmo- spheric air, even during the operation of dressing and undressing the new born child. Wrapping the infant warm in bed, or better still, applying it to the breast will generally lead to a cessation of the affection ; should it, how- ever, continue, the administration of a small quantity of white sugar, as much as will cover the end of a teaspoon, dissolved in a teaspoonful of water will frequently effectually remove the evil. Nuoc-vomica. Two pills placed in the mouth of the infant will arrest the trouble, if the other advice should fail. ALLOPATHIC TREATMENT. Hiccup is generally relieved by a sudden arrest of the attention, as by a reproof or a sudden expression of great surprise. Hot cloths wrung out of warm or hot water may be con- tinually applied, or a mustard and flaxseed poultice laid over the region of the diaphragm. The common internal remedies are cold water, snow, pounded ice, or ice cream. Anodyne and antispasmodic drugs are useful in this, as in other coughs. A combination of Chloral, Bromide of Potas- sium with or without an opiate, is generally effectual. Take of Hydrate of Chloral and Bromide of Potassium and Bicarbonate of Potash one scruple, Paregoric two drams. Peppermint Water sufficiejit to make two ounces. Mix. Dose: A teaspoon half full, to a dessertspoonful' every two or three hours. Obstinate cases will require professional advice. SNUFFLES, OB COLD IN THE HEAD— CORY Z A. Snuffles, or cold in the head is one of the earliest and most common affections of the young infant. It consists of an inflammation of the mucous lining of the nose. The first that is known of it is, that the infant's nose is stopped up so as to hinder its breathing, hindering it in the action of sucking, by not allowing the breath to pass through the nos- trils, obliging the infant to release the nipple in order to breathe, causing it to become fretful and irritable While this state continues, it has its influence against the infant's thriving, both by hindering it from taking a sufficient amount of nour- ishment, and by annoying the breathing of the child so as to disturb its sleep. When the nose is dry while administering a remedy, to remove the evil, relief may be obtained by oiling the nose on the outside and by COLIC OF INFANTS. 675 using a feather or camel's hair pencil on the inside. Fresh lard, goose grease, cream, or a little breast milk will often afford grateful relief. TREATMENT. Aconite. This remedy, if administered at first when there are febrile indications, will often cut short an attack of coryza. Dose: Two globules every two hours. Nux. The trouble is worse at night, particularly toward morning or in the morning. Through the night the nose is very dry. Dose: As for A conite. Euphrasia. Profuse, fluent discharge and acrid discharge from the eyes ; the eyes are much involved. Dose : As for Aconite. Chamomilla. Where there is watery or mucus discharge; the child is quieted by carrying it up and down the room. One cheek red, the other pale. Dose : As for Aconite. Pulsatilla is indicated by thick, green or yellow bloody matter, like discharge from the nose attended with frequent sneezing. Worse towards ^evening. Dose : As for Aconite. ALLOPATHIC TREATMENT. Cold in the head generally requires but little more than maintaining an equal temperature for a few days, when it naturally subsides. It is necessary to keep the nostrils open that the child may nurse. For this purpose, the nostrils may be moistened with Glycerine applied with a camel's hair pencil. Nurses are in the habit of provoking sneez- ing by dropping milk into the nostril, so clearing it out. and smearing the nose with Olive or Almond Oil. A very useful application when the discharge tends to continue, is Tannin fifteen grains, Fluid Extract of Belladonna twenty drops, Glycerine two drains. Mix, and apply with a camel's hair pencil two to four times a day after first cleansing the nos- tril with a camel's hair brush and warm water. If the discharge is offen- sive, a solution of one or two grains of Permanganate of Potash to the ounce should be used to cleanse the nostril. In chronic cases, the above mixture of Tannin may be used alternately with the dry powder or a solution of Alum, five grains to the ounce, may be employed. If the disease depends on scrofula, the following mixture may be given : Take of Iodide of Potassium sixteen grains, Pyrophosphate of Iron ten grains, water sufficient to make a solution, Syrup of Peppermint sufficient to make two ounces. Mix. Dose: A teaspoon half full, to a teaspoonful, three times a day. Or three to five drops of the syrup of the Iodide of Iron may be given. CRYING AND WAKEFULNESS OF NEW BOBN INFANTS- COLIC. Occasional crying of new born children is a wise provision to bring the respiratory organs into play, and to expand the chest. When, how- ever, the crying becomes excessive and threatens to prove injurious, we must, in the first place, endeavor to discover its origin, which will fre- quently be found in some derangement in the infant's dress, a wet diaper 676 DISEASES OF INFANCY. or tight bandage, or perhaps it may feel thirsty and would like to be refreshed by a little cold water. Care and love will easily detect the cause of the child's cries, and a good, true mother will scarce ever lose her patience at such times. Sleeplessness is often caused by similar circum- stances; the children sometimes lie with their heads too high, or they are too warm, or they are sometimes affected by nursing their mother when she is in a nervous and excited condition ; all these things must be considered. TREATMENT. Belladonna will frequently be found sufficient to remove the evil, when no exciting cause or guiding symptoms of disease present themselves, and the infant is peevish and irritable, affected with incessant whimpering and wakefulness, or prolonged fits of crying. The infant's face looks somewhat flushed. Dose : Two pills every three hours until relief or change. Cliamomilla is of very great service, when the child appears to have griping pain (colic,) indicated by drawing up the limbs, contortions of the body and face; or when there is a yellowish, greenish watery discharge from the bowels, the child wants to be carried all the time. Dose : As for Belladonna. Coffe i cruda will generally prove beneficial, when the child is exceedingly wakeful and bright, may be somewhat fretful or not. Dose : As for Belladonna . Aconite should be employed when there is, in addition to the above mentioned symptoms, considerable dry heat of the skin, with extreme restlessness. Dose : As for Belladonna. JTax-vomica will usually succeed in restoring ease, when flatulent colic, accompanied with violent fits of crying, drawing up of the legs and a costive state of the bowels, appears to be the cause of the disturb- ance. Dose : As directed for Belladonna. Pulsatilla is very suitable when the derangement arises from over- loading the stomach, or improper food, and the crying, or wakefulness, is accompanied with colic, wind and diarrhoea of stools, with no two that look alike. Dose : As for Belladonna. ALLOPATHIC TREATMENT. Crying, when not dependant on hun- ger, fright, willfulness, or peevishness, is generally dependent on dyspeptic colic. These are loud and may be long. Whimpering, moaning, painful cries, depend on inflammatory or exhausting diseases. The smothered cry depends on true or false croup. The treatment, therefore, will have reference to the causitive conditions. The use of soothing syrups is not free from danger, as they contain a secret amount of Morphine, which is an unsafe drug to give to children. Simple restlessness may be relieved by two to five-grain doses of Bromide of Potassium dissolved in syrup. When necessary to give an anodyne, it is best to give Paregoric ; the doses of which is on the printed label, suited to the age. It can be given with the Bromide of Potassium, or an equal amount of Tincture of Hyos- VOMITING OF MILK. 677 -cyamus. But rather than by any drugs, should relief be obtained by correcting whatever derangement causes the crying. Colic may be temporarily relieved by a dose of Paregoric suited to the age, given at suitable intervals of from half an hour to longer intervals, until the pain is relieved. Warm cloths or poultices, over the abdomen are useful. The principal treatment consists in correcting the derange- ment of the stomach and bowels. Irritation from unsuitable milk is a frequent cause, as is noticed at the period of menstruation during lacta- tion; the occurrence of another pregnancy, violent mental emotions, hard exhausting labor, errors of diet, or some other causes which render the breast milk unsuitable. These causes suggest their own change. If the amount or quality of the breast milk is insufficient, the trouble will be relieved by proper artificial feeding. An excess of acidity in the stomach, as shown by sour eructations (belchings) sour and greenish stools, scat- tered, sometimes, with lumps of undigested material, call for alkalies sufficient to correct these symptoms. The best is Bicarbonate of Soda in doses of one or two grains, or teaspoonful doses of Lime Water, given often enough to correct the sourness (acidity). Two to five grain doses of Pepsin, with an equal quantity of Bismuth may be given three or four times a day. The regulation of the diet to the exact wants of the system is the most important part of the treatment. This will have to be accomplished somewhat by experiment. The milk for artificial, as tested by litmus paper, should be alkaline, and not used until sufficient Lime Water or Soda is added to make it so. It should be perfectly fresh, and kept on ice to prevent any decomposition (souring,) or if this is impossible, and it can- not be freshly milked each time it is used, scalding will help to keep it, and is in this case, permissible. The juice of lean meat may frequently be given, instead of milk, with .advantage, or raw lean beef, chopped fine and ground in a mortar, and strained through a sieve, may be salted or sweetened and fed a teaspoonful :at a meal. It will frequently be digested when milk will not. In older children, the treatment will be the same for the relief of pain. If the irritating matter is not removed by a free, loose stool, a tea- spoonful or a dessertspoonful of Castor Oil (mixed with an equal quantity of inodorous Glycerine, and flavored with a couple of drops of Oil of Win- tergreen or Cinnamon, to make it palatable,) should be given. VOMITING OF MILK—SOUR STOMACH— FLATULENCE. The infant, the same as the adult, is subject to attacks of indigestion, and the disorder in the one case bears a certain similarity to that in the other. Though vomiting in every case is by no means the result of indi- gestion, for when the stomach is simply overloaded or rather overfilled, it relieves itself of the excess by vomiting, and this act takes place with little effort and no suffering, the process of digestion still going on undis- turbed. When indigestion, colic, constipation or diarrhoea arises from impro- per food, in babies raised by hand— that is, from food which evidently 67S DISEASES OF INFANCY. does not agree with the child's stomach — or even from unwholesome ma- ternal milk, we will frequently have to encounter many difficulties before we can select a suitable article of food that will agree with the delicate digestive apparatus of the babe. We should endeavor to make a good choice of food; and if, having done so, we find that the choice has been a mistake, we should try again, not desparingly, but remembering always that what is one baby's food is another baby's poison. TREATMENT. Ipecac, There is much sickness of the stomach ; the more constant the nausea, the more certain will Ipecac relieve; the stools look fermented. Dose : Two pills, repeated after a lapse of four hours. CJiamomilla* The child is very irritable and fretful, must be carried all the time; distress after nursing; sleepless starting and jerking while asleep ; stools smell like rotten eggs and are green, chopped, or consist of white and yellow mucus. Dose : As for Ipecac. Arsenicum. The food is thrown up as soon as taken into the sto- mach, and passes off through the bowels undigested; the stools are offen- sive; much crying during and after nursing, or as soon as the child begins otake food. Emaciation and restlessness. Dose : As for Ipecac. Nux v n m. is indicated when vomiting of milk is attended with flatu- lence, constipation, uneasiness or irritability of temper. Do.' e : As for Ipecac. Bryonia. Should be given the second dose of Nux after the lapse of four hours, if the symptoms mentioned in the last remedy have not entirely yielded to its action. Dose : As for Ipecac. ALLOPATHIC TREATMENT. Flatus will be relieved by alkalies, given as above, and care regarding food. Vomiting, except as a symptom of serious disease, and not simply a regurgitation from over-distention, of the stomach, will be relieved by the ame means occurring from over-distention; the infant should be given a little less of that article of food at a time. With infants at the breast, it is generally of no consequence. FLATULENT DISTENTION OF THE STOMACH AND BOWELS. Gentle friction with the palm of the hand, which has been previously warmed, will often give grateful relief. It is best to begin at the lower right side of the bowels, passing the hand gently up the right side as high as the stomach, then across and down the left side and so on. At the same time the following remedies should be employed. Nux vom. should be employed at the onset for children of a spare, meagre habit, or who are more subject to a costive condition. Dose : One pill every two hours. Pulsatilla is to be preferred, if the children are of a relaxed habit or who are subject to discharge from the eyes and eyelids; or particularly when diarrhoea is present. MILK CRUST.— MILK SCAB. 679 Dose : As directed for Nux, Chamomilla should be administered four hours after the third dose of Nux or Pulsatilla, if no permanent relief should have resulted; and more especially if convulsions or diarrhoea be developed as attendant symptoms. Dose : As directed for Nux. Diet. The diet must, at the same, time be attended to and altered if of an indigestible nature and the suspected cause of the mischief. MILK CRUST.— CRUST A LACTEA.—MILK SCAB. Description and Symptoms. This eruption occurs in children while nursing, and more commonly while teething, and appears to be very closely connected with that process. It commonly commences on the cheeks, and forehead, by the breaking out of a number of small yellowish pustules, (pimples) crowded together on a red surface. These pustules excite great itching, and are quickly broken, discharging a viscid fluid that dries, forming greenish-yellow scabs; the scabs are frequently rubbed off but form again; fresh crops of pustules appear around the scabs which quickly extend to the scalp, and even the face. The eruption appears behind the ears, and patches will sometimes appear also, upon the neck and breast. The discharge from the pustules is caught by the hair upon the head, and forms into small irregular friable masses, which may resemble the bruised yolk of a hard boiled egg. The pustules or achores, as the small superficial ulcers which they form upon the skin are sometimes called, have an irregular form, contain a straw-colored fluid, rest upon an inflamed base, and are succeeded by a thin brown or yellowish scab. There is much irritation, heat and itching; the discharge is very profuse, and with so much itching that it is easily rubbed off, leaving the surface raw and excoriated. Whenever this discharge is brought in contact with the skin — in the face, where it trickles down on the breast, where it falls, and upon the backs of the hands, violently used by the child to rub' with— it proves so acrid as to produce there a fresh eruption. The same is true even of the arms of the nurse upon which the child rests its head at night. The itch- ing and burning acridity of the eruption, and discharge are much worse at night. All external application should be avoided, with the exception of a little sweet cream or olive oil, which has sometimes proved very grateful. Everything should be carefully avoided which would have a tendency to drive this eruption in, since it might result in some more serious trouble. TREATMENT. Aconite should always commence our treatment, when we find excessive restlessness and excitability produced by this affec- tion, and when the skin around the parts is red, inflamed and itching. Dose : Two pills repeated every two hours. Viola Tricolor: As soon as the benficial effect has resulted from the administration of Aconite; and six hours after the last dose of that medicine, it will be well to proceed with the remedy under consideration, which, in the simple and uncomplicated form of the disease, is often suf- ficient to effect a cure. Dose: Two globules every night and morning. Calcarea. Eruptions, with thick scabs, and yellow pus underneath. 6S0 DISEASES OF INFANCY. Stools having a chalky appearance. Sometimes the eruption appears in the form of a ring-worm. Dose: Two globules every morning. Graphites should be given when a transparent, glutinous fluid exudes, which causes the crusts to fall off; the eruption appears more particularly on the chin and behind the ears ; emits a fetid odor, and itches intolerably. Dose : As directed for Viola Tricolor. Arsenicum is indicated when the eruption is very dry and scaly and causes destruction of the hair. Dose : As directed for Viola Tricolor. Rhus Tox. when the scalp is considerably affected ; thick scales ; a bright edge of inflammation surrounds every portion of the eruption, and there is much itching, particularly at night. Dose : As for Viola Tricolor. Sulphur when the eruption extends more or less over the whole body, with much itching ; although the main affection appears on the head. Dose : As directed for Calcarea. Sepia. Eruption very moist; almost constantly discharging pus- like matter. The child often jerks its head to and fro, seemingly from the itching. Dose: Two pills every evening. APHTHM— THM USH. The thrush often attacks the infant in the second week, and is char- acterized by the mouth and tongue being covered with minute whitish blisters, which are rubbed off by the action of sucking. A succession of these vesicles is constantly taking place as long as the disease lasts, and if not checked, becomes confluent and sometimes present an ulcerated appearance, or form a thin, white crust, which generally lines the whole cavity of the mouth, and in severe cases, extends to the throat, and even throughout the stomach and bowels. The affection, although of itself neither malignant nor dangerous frequently causes, not only considerable suffering to the child by prevent- ing it from suckling, but great pain and inconvenience to the mother by being communicated to the nipples and causing excoriations, etc. TREATMENT. Chamomilla. When the child exhibits much uneasiness, and must be carried all the time, this remedy will prove more beneficial. Dose : Two pills every three hours. Mercurius is to be recommended when there is more than usual moisture in the mouth. There is inflammation in the whole cavity of the mouth ; the gums have ulcers on them. Dose : Two pills to be taken every four hours. Carbo veg. The mouth is very hot, the tongue almost immovable, and a sort of bloody saliva escapes occasionally. Dose : The same as for Mercurius. Sulphur. The child does not take its usually long sleep; it awakens CONSTIPATION. 081 often and the same symptoms prevail, even after taking the other reme- dies. Dose : As for Mercurius. Bryonia. The mouth seems unusually dry with thirst; dry lips, rough and cracked; the child does not like to take hold of the breast, but when once in its mouth and moistened, and it is fairly at work, it nurses well. Dose: The same as for Clwmomilla. External Application.— The mouth should be carefully washed after nursing, with a soft old linen rag dipped in tepid water, or in water containing a small quantity of Borax and Honey in solution. Pure molas- ses, applied by means of a piece of old linen or muslin, or by the finger, constitutes one of the best healing washes, where one seems to be needed. ALLOPATHIC TREATMENT. Thrush: A good digestion and regu- larity of the bowels, should be secured. The nourishment of the child is generally insufficient, so that in cases of weakly infants, additional feeding is necessary. A little new creamy milk, the juice of lean meat, or freely ground lean beef may be given. For local use, a wash of Lime Water, a solution of Chlorate of Potash or Borax is appropriate. If ulceration occurs, the popular Golden Thread tea and Borax maybe used. Sulphurous Acid two drains in an ounce of water, may be applied with a linen mop. Other remedies are given on page 201, in the'treatment Stomatitis. CONSTIPATION. Even very young infants are sometimes affected with constipation; in fact, during the first two months of infantile life, constipation is frequent, while diarrhoea is comparatively rare. This may be occasioned by some hereditary predisposition, and be maintained by the constantly imparted influence of a costive habit on the part of the nursing mother. In the medical treatment of the constipation of infants, recourse must always be had to the cause. If this be found in the nursing mother, the proper remedies should first be administered to her. Should there be any- thing in her diet which may be capable of rendering either her or her child constipated, this should also be attended to. With scarcely a single exception, cases of costiveness in nursing infants will be found dependent upon the influence of diet, hereditary and constitutional weakness and inaction of the bowels or actual derangement of the liver. MECHANICAL MEASURES. Before proceeding to enumerate the remedies, we may observe that an injection (lavement) of tepid water, or of some milk and water, may occa- sionally be used, if necessary, to remove the obstruction of feces; or, a suppository consisting of a small strip of paper or linen, spirally twisted and lubricated with oil, may be introduced by a gentle rotary movement. If these means should fail at first, they should be repeated after the lapse of a few hours. Rubbing the stomach and bowels frequently in the course of the day with a warm hand sometimes assists the means employed. In order to overcome the constitutional tendency, it will be well to use the ^appropriate remedies. 682 DISEASES OF INFANCY. MEDICINAL MEANS. Nux vom., when the stools are large and difficult, or small, frequent and painful, with disturbed or restless sleep, frequent efforts to evacuate the stool without effect. Dose : In ordinary cases give two pills morning and evening for two days, then pause two days. Bryonia is suitable, if the stools are very dry, as if burnt, and of a dark color ; dry lips and mouth, and there is alternation of constipation and diarrhoea. This is a good remedy to alternate with Nux vom. Dose: As for Nux vom., or when alternate with Nux vom , give Bryo- nia in the morning and Nux vom., in the evening. Calcarea carb., is to be preferred when the stools are of a whitish or a clay color. Dose : As for Nux vom. ALLOPATHIC TREATMENT. Constipation is best relieved by injec- tions of soap and water or cold water. I have known teaspoonful doses of Olive Oil to relieve constipation in infants without being followed again by constipation. Syrup of Rhubarb in doses of half a teaspoonful to a teaspoonful and a half may be used. Fluid Extract of Senna in doses of ten to thirty drops in syrup is generally an effectual remedy in constipa- tion. Change in the diet which will overcome costiveness is called for. To this end fruit is indicated. It may be raw or cooked. If hard feces have lodged in the rectum (lower bowel) which the injec- tions do notremove, they should be broken down by the finger or removed with the handle of a spoon. In older children free exercise should be taken ; in cities the systema- tic use of gymnastics may be useful. Cold wet packing of the abdomen often succeeds. Exercise and bathing and a diet with plenty of fruit will probably relieve. The Fluid Extract of Senna may be given, and for continued use Tincture of Nux Vomica and Belladonna will establish the habit of a regular stool. Take of Tincture of Nux Vomica and Tincture of Belladonna each two drams, Syrup of Orange Peel four drams. Mix. Dose: One to twenty drops once a day according to the age of the child. ZHARRHCEA OF INFANTS. Infantile diarrhoea constitutes one of the most frequent and serious of all diseases that occur in infancy and childhood. Of itself alone diarrhoea does not often prove directly fatal, but its long continuance seriously weakens the patient, and endangers the health, and it constitutes more- over a very grave complication of other forms of disease. Causes of diarrhoea are various ; the introduction into the stomach of in- appropriate indigestible food ; the deranged condition of the mother's milk induced by mental emotions, improper diet, or other causes on the part of the mother ; fright and exposure of the infant to cold ; and the improper use of laxatives, etc., may be enumerated as being the most frequent exciting causes of this disorder. It is well to notice closely as to the symptoms. A healthy infant at the breast, passes on an average from three to six motions in twenty-four hours ; but in some instances the evacuations are more frequent, yet with- out in any degree affecting the health of the child: in such cases then, DIARRHCEA OF INFANTS. 683 there ought to be little or no interference, so long as the stools remain free from fetor, possessing merely the slightly acid smell, peculiar to unnatural indication. When, however, the stools become green, and watery, or yellow and watery, brown and frothy, as if fermented, mixed with phlegm or mucus, or consisting entirely of mucus, emit an offensive odor, and are generally preceded or accompanied by signs of suffering, it becomes neces- sary to have recourse to remedial aid. TREATMENT. Aconite should be employed when the skin is hot and dry ; and the child is restless ; stools watery and often of a dark color; after the fever has subsided the diarrhoea will usually disappear also. Dose: Give two pills every hour, until the fever abates, then gradu- ally lengthen the time. Antimoniwni cruel. When the tongue is coated white, and there is some nausea and watery discharges ; sometimes there are hard lumps of feces' with the water. Dose: Four pills every four hours. Chamomilla is almost indispensable in bowel complaints, when the following symptoms are present; redness of the face or of one cheek, hardness and fulness of the belly, attended by severe colic : constant cry- ing and drawing up of its legs, wants to be carried. Its discharges smell like rotten eggs. Dose : Two pills every two hours. Arsenicum is suitable when there is much exhaustion and rapid emaciation ; stools undigested, offensive, and painful immediately after taking nourishment; stools and vomiting at the same time. Dose : The same as for Chamomilla. Bryonia. Diarrhoea from hot weather, or is aggravated by the return of every hot spell of weather. Dose : The same as for Chamomilla. Calcarea Carb., is particularly suitable for children who have large heads and open fontanelles; the head perspires so much as to wet the pil- low far around. Muscles soft and flabby. Dose : As for Antimonium Crud. Carbo-veg. should be administered when Bryonia fails. Dose : As for Bryonia. Pulsatilla is suitable for diarrhoea arising from indigestion, or from a chill. The stools are very changeable, no two alike, and are usually worse at night. Dose : As for Chamomilla. Ipecac is particularly good when there is much nausea and vomiting, or almost constant nausea ; the stools are frequent. This remedy is par- ticularly indicated at the time of weaning, or when food disagrees. Dose: As for Chamomilla. Mercnrius is characterized by the following symptoms; much pain before the stool, great relief afterwards ; stools frothy, slimy, bloody or dark green, with much straining. The child's legs and thighs are cold and clammy, particularly at night. Dose: As for Anti. Crud. Belladonna. When the child is very drowsy, half asleep and half awake, much moaning. Dose : As for Anti. Crud. 6S4 DISEASES OF INFANCY. Podophyllum should be employed when the diarrhoea is worse in the morning, stools green or watery, or which may be quite natural, only too frequent. This is particularly good when there is falling of the bowel. Dose : As for Anti. Crud. Sulphur is particularly good for children who have delicate parents. Much redness around the anus, eruption of pimples upon the skin ; or, if the child, after getting better, under other remedies, always gets worse. Dose : As for Anti. Crud. Veratrum, alb. Much exhaustion after every passage, with cold sweats upon the forehead, or upon the skin in general. Dose : As for Chamomilla. ALLOPATHIC TREATMENT. For treatment of the diarrhoeas of chil- dren, see Chapter XIII., p. 262. CHOLERA INFANTUM-SVMMEB COMPLAINT. This is a special form of bowel complaint, which requires special notice. This disease very often proves fatal, even under the best of treat- ment, since it appears usually in the latter part of the summer, when the young infant's system is already somewhat exhausted by the previous heat ; when the air is impure and the weather sultry, or warm and damp, .and seems to spring up as an epidemic from some atmospheric miasm which is little less than malignant. In this, the worst form of infantile diarrhoea, all the symptoms seem equal in intensity and the disease runs a very rapid course. Children under two years are most liable to attack. Vomiting and diarrhoea form the most noticeable symptoms. The stomach is so irritable that it rejects immediately and sometimes with great violence, everything that it receives. At first, the matter vomited consists of the ordinary contents of the stomach, but this does not con- tinue long ; as the malady advances the matter vomited is tinged with bile and presents a greenish hue. The discharge from the bowels usually consists of a colorless or some- times greenish, inodorous and watery fluid ; occasionally with shreds of mucus mixed with it. The stools are usually discharged without effort — sometimes Unconsciously — or are squirted out as though thrown from a syringe. Frequently there is considerable pain with straining, the infant manifesting its sufferings by a whining, plaintive cry, by restlessness and by drawing up and extending its limbs. As the disease advances vomit- ing becomes spontaneous and the matter ejected resembles that passing from the bowels, while the number of stools increase. Sometimes there is a sudden lull in the whole force of the disease, or the diarrhoea may abate and the vomiting continue, or the opposite. There is extreme lan- guor and prostration and generally very rapid emaciation ; which condi- tions, together with the vomiting and the diarrhoea as above described clearly and unmistakably point to cholera infantum. As the disease progresses, the discharges from the bowels become still more frequent, are passed involuntarily, and are usually more profuse, resembling dark-colored dirty water, or "washings of meat," and are very offensive ; emaciation becomes extreme ; the eyes are languid and CHOLERA INFANTUM. 685 ■ dull, or hollow and. glassy, and the child takes no notice of surrounding objects or persons ; the lips are dry and shrivelled. In many cases, the child lies in an imperfect doze, with half-closed eyes, and entirely insen- sible to external impressions. The abdomen frequently becomes disten- ded and hard, or is sunken or flaccid. Frequently, in fatal cases, the child falls into a complete state of stu- por, and convulsions ensue. It not unfrequently happens, particularly in children predisposed to affection of the brain, that in an early stage of the disease, the brain becomes involved, and the child dies with all the symptoms of inflammation of the brain. Favorable Symptoms are: An abatement of the fever, and the gradual restoration of an even temperature, with decreased frequency of the pulse; cessation of vomiting, and decrease in the number of evacua- tions, with a gradual return of the stool to a more natural condition and appearance; natural and peaceful sleep; desire for food; and a general im- provement in the appearance of the child, together with a return of playfulness. TREATMENT. Much of what has been said under the head of Treat- ment, in the preceding article on " Diarrhoea of Infants " (page 682,) may be made available in selecting the remedy suited to a case of cholera infantum, and that article should therefore be carefully consulted. The subjoined medicines, however, are those most frequently called for in the treatment of the disease under consideration, and are approved as of the utmost efficacy when carefully selected for the individual case. Aconitum is very frequently indicated, and should be given, in cases in which there is febrile excitation, manifested by acceleration of the pulse, heat and dryness of the skin, and thirst. Under such circumstances it often happens that Aconitum, when promptly administered, not only removes the febrile indication, but, as well, cuts short the entire disease, and very promptly aids in restoring the babe to health. Dose : Two globules dry, on the tongue, every one or two hours, accor- ding to the severity of the symptoms, until manifest improvement or change. If a favorable change should result, however slight, at once lengthen the intervals between the doses to two, three, or four hours, as the case may be according to the existing condition, and finally cease giving medicine upon the exhibition of marked and decided amelioration and improvement. Should, however, no evidence of improvement be manifested after the sixth dose, or should symptoms indicative of some other remedy sooner occur, proceed at once to the administration of another and better indicated remedy. Arsenicum is suited particularly to cases in which there is great weakness from the first, so that the child does not care to hold its head up; there is much thirst, while drinking induces vomiting and stool; vomiting and purging occur at the same time, and greatly exhaust the child; the child has a pinched and distressed look, and is very restless, which restlessness, together with the other symptoms, grow worse after midnight ; coldness of the hands, feet, etc. Dose : In every particular as directed for Aconitum. Ipecacuanha should be given when the stools, which are very fre- quent, have a fermented appearance, or resemble greenish water; and 6SC DISEASES OF INFANCY. when, more particularly, nausea and vomiting predominate, the child seeming to be sick at its stomach, almost constantly. Dose : In every particular as directed for Aconitum. Chamomilla will frequently prove useful in the early stages of some cases, particularly if the child be suffering from the irritation incident to dentition; it is more particularly indicated by the presence of griping, colicky pains, with greenish stools; fretfulness and crossness, with desire to be carried. Dose. Two globules dry, on the tongue, every three hours, until manifest improvement or change. Veratrum is required in cases in which the purging and vomiting are almost constant and simultaneous, and are excited by even the small- est quantity of nourishment or drink; motion even excites nausea; there is very great prostration, with coldness of the face and extremities, and cold sweat forming on the forehead, and an almost imperceptible pulse. Dose: As directed for Aconitum. Secale is indicated by a chain of symptoms very similar to those pointing to Veratrum, but is more particularly indicated by paleness of the face, with sunken eyes, dry "heat of the body, restlessness, and sleeplessness. Dose : As directed for Aconitum. Podophyllum should be given in cases in which the dejections have an exceedingly offensive odor, and are passed most frequently in the morning; the child moans during sleep, tying with half-closed eyes, and rolls its head from side to side. Dose : In all respects as directed for Aconitum. Mercurius should be given, particularly at the commencement, if there be much colicky pains, which are relieved by the purging, the stools being slimy or bloody; or, when there is a great deal of perspiration, par- ticularly on the thighs. Dose : As directed for Aconitum. Croton tig. should be administered in cases in which the stool is forcibly expelled, as though forced from a syringe, one gush and it ceases. Dose : As for Aconitum. Belladonna is required in some cases, particularly if there be great heat of surface, with flushed face, and evidences of a tendency to conges- tion of blood to the head ; the child is very thirsty, drinks hurriedly, and thrusts its hands constantly into its mouth. Dose : As for Aconitum. Calcarea Carb. will prove valuable in cases in which the stools are whitish and watery; and have a sour smell, as does the matter vomited ; there is great emaciation, while the abdomen is bloated ; the face has an old, wrinkled look ; the extremities are cold. It is especially adapted to scrofulous children, with retarded dentition, or where the case has become chronic. Dose. Two globules, dry on the tongue, repeated every four hours, until manifest improvement or change. Sulphur may be called for, in cases similar to those indicative of Cal- carea, It should be given, likewise, in cases where the patient, having got better, relapses, and this process is again repeated, so that the ease seems to linger, and has a tendency to become chronic. CHOLERA INFANTUM. 687 Pose: As directed for Calcarea. Bryonia, Nux vomica may be called for in the treatment of this malady, in its earlier and later stages. For discriminative indications for their use, consult, under the heading of each medicine, respectively, the article on " Diarrhoea of Infants. " Diet and Regimen. Very little nourishment will be taken by an infant suffering from cholera infantum. Breast-milk should constitute its chief source of food and drink, in cases in which the child suckles ; but in other cases, however, great care must be taken to avoid giving anything that can add to the irritation already existing in the stomach and bowels. Pure dilute milk, boiled and sweetened, or thin, well boiled oat-meal gruel, will afford sufficient food and drink. Water may be given in small quantities, if it does not excite vomiting ; in which latter case, the infant may be per- mitted to suck small pieces of ice from time to time, if its lips be parched and dry, or a small piece of ice may be enclosed in a linen rag, and the child allowed to suck at it. Every effort should be made to sustain the nat- ural warmth of the body, particularly of the abdomen and lower extremi- ties, by the application of warmed woolen cloths , but the resort to the application of cloths wrung out of hot spirits, or claret wine, or other poul- tices, is highly objectionable, and should not be resorted to. ALLOPATHIC TREATMENT. In the cholera of infants, if vomiting and purging have not emptied the stomach and bowels of their irritating contents, as shown by undigested substances in the stools or vomited mat- ter, an emetic of three or five grains of Ipecac should be given in water, or a purge of three grains of Calomel should be given. The latter should be assisted in its operation by an injection of warm water. If no indigestible matter is noticed, neither a purge nor an emetic should be given, but no time should be lost in stopping the discharges. This is best and soonest done with Opium. One drop of Laudanum maybe given with a teaspoon- ful of Chalk Mixture, or three grains of Sub-Carbonate (or Nitrate) of Bismuth in a teaspoonful of Lime Water. This may be given every hour to a child a year old. To those younger Paregoric should be given instead of Laudanum. If neither Bismuth and Lime Water nor Chalk Mixture are at hand, the Opiate should be given with a grain or two of Bicarbonate (baking) Soda. The object is to diminish the discharges from the stomach and bowels and improve their character. When the discharges are checked or the child begins to be stupid, the opiate should be discontinued or given less fre- quently. When the vomiting has ceased, if the bowels continue moving, if the child is not inclined to be stupid an injection of two to five drops of Laudanum may be given, with half a teaspoonful of milk in a small hard rubber syringe. If the child is nursing it should be confined wholly to the breast, and then only allowed to draw small quantities at a time. If the breast milk is rejected, it can be allowed lean meat finely minced, pounded in a mortar and strained, which may be seasoned with salt. The white of eggs mixed with water, and rendered alkaline with Bicarbonate of (baking) Soda, five to ten grains, is frequently well digested. The raw meat juice and white •of egg are of great use when there is great prostration or emaciation. If the pulse weakens or collapse threatens, stimulants should be freely 6S8 DISEASES OF INFANCY. given. Brandy or Bourbon Whisky is best suited. The dose is fifteen or twenty drops to a teaspoonful given with the milk, meat, or egg, and can be repeated at intervals varying from one to four hours, Stimulants are generally indicated early. Rice or barley water can be drunk ; small lumps of ice may be allowed. A warm poultice over the stomach will be beneficial. Great heat of the skin will require cool sponging. If the skin is cool, or cold, a warm bath of one hundred to one hundred and four degrees, will be beneficial. Sometimes cholera infantum is caused from ill nourishment. In these cases the acute symptoms are relieved by Opium as above directed, and better nourishment completes the cure. When the disease occurs from the effects of heat, Bromide of Potassium is highly serviceable, and is thought by some to be generally applicable. Take of Bromide of Potash two scru- ples, Mucilage of Gum Arabic two ounces. Mix. Dose : From fifteen drops to a teaspoonful. Five grain doses of Cerium, an eighth of a drop of Creosote, or Carbolic Acid in water, are useful in relieving the vomiting. Continued diarrhoea will call for astringents as directed for that disease. Anaemia (thin blood,) will require tonics, such as : Take of Citrate of Iron and Quinine ten to fifteen grains. Orange Water ani Peppermint Water each an ounce. Mix. Dose : Give a teaspoon half full three or four times a day. If the cause of the disens a is malarial, one or two grains of Quinine ought to be given at the first intermission. CHAFING- EXCORIATIONS. Excoriations, soreness, or chafing, frequently occurs in those parts of the skin of infants which are either rubbed together in the natural move- ment of the limbs, or liable to be fretted by friction of the diaper or other article of clothing. Thus the groins, the surface between the genitals and the thighs, behind the ears, under the arms, and even the folds in the neck of fleshy children, may become the seat of these excoriations. Such tenderness of the skin is due, in the first place, iu a great part, at least, to taint in the constitution; and for its complete removal will re- quire, therefore, a suitable remedy. Against this affection, cleanliness is the best preventive. TREATMENT. Chamomilla will be found speedily effective if the child cries much, and requires to be carried continually up and down the room. Dose : Four globules night and morning, Mercurius. The excoriation is much worseat night; it is very raw and bloody; the child does not sleep much. Dose : As for Chamomilla. Calcarea carb. will be suitable for very fat and flabby children. Dose: Two pills in the evening. Graphites will be found useful when the affected parts discharge a quantity of transparent glutinous fluid, especially behind the ears and between the thighs. Dose : As for Calcarea carb. ASTHMA MILLARIS. 689 Sepia. The skin is very delicate; the least injury tends to ulcera- tion. Dose : As for Calcarea carb. Sulphur. There is much itching of the skin in general'andof the parts affected. Dose: As for Calcarea carb. A most valuable application to the excoriated parts of infants is to take green tea and pulverize it to a fine powder and apply the same as any powder. ALLOPATHIC TREATMENT. Protecting the chafed or excoriated skin from irritation, will provide for its cur©. If the trouble is caused by the discharges from the bowels or bladder, the napkin should be immediately removed and the child cleaned. These discharges must be rendered un- irritating by giving Bicarbonate of Soda, in doses of one or two grains, sufficiently often to accomplish the result. The raw surface on the skin may be dusted by starch, flour, Oxide of Zinc or Calomel, or the Benzoated Oxide of Zinc Ointment may be ap- plied. ASTHMA OF INFANTS— ASTHMA MILLARIS. Attacks children between two and eight (seldom infants at the breast or full grown persons,) is very similar to croup. The attack almost al- ways sets in in winter, in consequence of a cold; first at night, suddenly without any distinct premonitory symptoms, and sets in at once with the most violent symptoms of suffocation without any rattling or wheez- ing. The pulse is hurried and small. If cough sets in it is short, rough, without gagging or expectoration ; the voice is hoarse, deglutition diffi- cult. However, the child does not complain of a local obstacle in swal- lowing or breathing or of pain in the larynx or trachea, but of a dull pain or spasmodic drawing throughout the chest, as if caused by suffocating vapors. Slight spasms and change of color are noticed. A general ere- thism of the circulation and nervous system, scanty and pale urine hav- ing a sweetish odor. The patient is suddenly roused with a fearful look and an expression of anxiety in the altered features. The voice is deep, barking, hollow sounding, husky, very seldom wheezing or crowing. During the convulsive movements of the chest the labored inspirations of the chest are suddenly followed by a noisy expulsion of the air. The face becomes dark-colored, the eye becomes staring and protruded, the veins of the neck and temples swell. If the attack does not destroy life it ends in a few hours with sneezing, eructations and vomiting. The breathing becomes easier, the peculiar sound disappears and, amid a general subsi- dence of the symptoms, the child falls into a quiet slumber from which it awakes exhausted and desponding. Generally a second attack sets in the following night, more violent than the former with increasing fever. The danger of suffocation is greater, the face and lips become mottled blue, the shoulders are raised, and all the muscles of the thorax are violently worked. The face becomes more and more distorted, the nostrils dilate, the pulse becomes very rapid and intermits; the patient tosses about, is 44 690 DISEASES OF INFANCY. covered with cold or lukewarm perspiration, feces and urine are passed involuntarily, but the consciousness is undisturbed ; finally, the patient dies of suffocation amid convulsions. Only a few children survive more than one attack, and death almost always sets in during the third or fourth attack. The attacks never terminate with expectoration. Asthma Millaris cannot well be confounded with croup, if we remem- ber that in croup the larynx is always tender to pressure, and that the patients bore their heads into the pillow, whereas in this disease the child sits erect and does not complain of pain in the larynx, but of spasmodic constriction of the chest. In croup the breathing is fine and crowing ; in asthma millaris it is deep and hollow. If the disease is speedily recognized subsequent attacks may be aver- ted and the present attack modified and alleviated by one of the following remedies. TREATMENT. Ipecacuanha. Sudden paroxysms of suffocation at night with a sensation of violent constriction in the chest, short and anx- ious inspirations and sudden and jerking expirations, pale, bloated face with blue margins around the eyes ; peevish mood. Sanbucus nigra. Sudden starting up from sleep with a shriek, anxiety and trembling, sudden, wheezing inspirations which sometimes intermit, deep, hollow rough voice, bluish pumness of the face and hands, protruded eyeballs with the mouth half open. Anxious tossing about; heat without thirst, hurried and tremulous pulse, torpor and copious, mostly cold sweat. On comparing these indications with the symptoms of the disease, it is readily seen that Ipecac is only given to advantage in the beginning of the attack, and if the attack attains to its full development Sambucus has to be given. If the attack should set in again during the night following nothing can be expected of this agent, and it will be advisable to give Arsenicum. All these remedies have to be given in the form of a watery solution— a dose every five or ten minutes. Other varieties of asthma can be most frequently controlled by Arsen- icum. For asthma, caused by the inhalation of sulphur, we give Pulsatilla. Asthma, caused by a fit of anger, or a cold, can be best relieved by Chamomilla or Nux-vom., the latter being more particularly indicated by a vehement disposition. For asthma, caused by the inhalation of stone dust, in the case of stone cutters, sculptors, etc., we give Calc. Carb., Silic. or Sulphur. Calcarea Carb. is a main remedy for chronic asthmatic complaints, with disposition to draw a long breath, and sensation as if the breath were arrested between the shoulder blades. The distress is relieved by raising the shoulders. Mere stooping causes the breath to give out frequent par- oxysms of dry cough, at night especially. SWELLING OF THE BREASTS. These organs in infants— more especially female infants— sometimes become swollen and hard, which is often the result of the absurd and -wicked practice on the part of nurses, of squeezing them, under the erro- ATROPHY— EMACIATION— MARASMUS. 691 neons opinion that if the milk is not squeezed out of them, they will not perform their proper functions in after life. This practice is a cruel one, and very often brings about the state of affairs it is intended to prevent, for by squeezing the gland, inflammation, swelling, and perhaps suppuration and destruction follow, and the breast is rendered useless, and the source of a great deal of trouble and suffering in after life. TREATMENT. Aconite should be given ; if there be much fever at, the onset this remedy may dispel the whole difficulty. Dose : Two pills every six hours. Arnica, The breasts are merely hard, with no apparent inflammation or if the redness has not appeared. Dose : The same as Aconite. Belladonna. If the breasts are very red and run in streaks to the adjoining parts. Dose : As for Aconite. Bryonia when the breasts are quite hard and of a pale red color. Dose : As for Aconite. Chamomilla. The child is very fretful ; the breasts are very tender to the touch. Dose : As for Aconite. Hepar Sul. will be useful if the matter or pus has already formed. Dose : As for Aconite. ATROPHY— EMACIATION— MARASMUS. General Causes. Emaciation of infants and children usually arises from a predisposing constitutional cause, which frequently becomes de- veloped during the irritation of teething, or is called into activity by inap- propriate or unhealthy nourishment, either from the breast, or in the form of supplementary diet, at an earlier period ; or again, and, unfortunately, not unusually, it is engendered or developed, and rendered more compli- cated, and almost incurable, at a somewhat more advanced age, by the per- nicious habit of a free and reiterated use of mercurial preparations, in the vain hope of bringing about a healthy state of the primary organs of diges- tion, when these have become deranged by repeated infractions of appro- priate rules, as to diet and general habits. The manifestation of worms, and the usual attendant symptoms of mvermination, and the enlargement and induration of the mesenteric glands, are frequent, antecedent, occa- sional causes of the disease. TREATMENT. Sulphur is appropriate in almost all cases at the commencement of the treatment, when the disease has become fairly developed, or occurs in scrofulous children, but is more especially indica- ted by the following symptoms : Craving appetite for food and drink, watches eagerly for the cup or spoon, and clutches at them, thrusting everything into its mouth ; enlargement of the glands in the groin or arm- pits; slimy, excoriating diarrhoea, or obstinate constipation; pale com- plexion, sunken eyes ; jumping, starting, and screaming; restless sleep. Dose: Three globules every morning, the first thing, for ten days, unless decided change or new symptoms should sooner occur ; then pause five days, after which the course may, if still indicated, be repeated as before, and so on, until decided amelioration or change. Calcarea should either be employed at the onset, or after the pre- 692 DISEASES OF INFANCY. vious administration of Sulphur (as just directed), if the following symp- toms be more especially predominant, or should supervene ; or if, again, Sulphur should not have been productive of apparent improvement within eight days after the completion of the second course. The indicative symptoms are : great emaciation, with craving appetite ; enlargement and induration of the mesenteric glands and of the belly; great weakness, clayey evacuatious, a dry and flabby skin ; too great a susceptibility of the nervous system ; large, open fontanelles; profuse sweat about the head; cough with rattling of mucus. Dose : Three globules, as directed for Sulphur. Cliamomilla is chiefly required when the following symptoms occur: Frequent screaming, with drawing of the legs towards the stomach ; hard- ness and fullness of the belly ; great restlessness andfeverishness ; acidity ; flatulence, frequent purging, the stools being of a deep grass-green, or very yellow color, or whitish, yellow and frothy, sometimes resembling beaten eggs, and of an offensive odor, often like that of rotten eggs ; occasional sickness, the matter vomited being more or less of a bilious description ; thirst ; want of appetite ; frequent change of complexion. Dose : Three globules thrice a day. Pulsatilla is indicated when less restlessness and peevishness pre- vail than under Chamomilla, and little or no thirst, with complete loss of appetite; or, on the contrary, voracious and inappeasable hunger, with acid or other disagreeable risings; or disposition to vomiting the contents of the stomach ; frequent papescent stools of a greenish, bilious description ; or watery, slimy evacuations, at times of a light or whitish color; the child is always better in the open air. Dose : As directed for Chamomilla. AntimoniiiiH c. may be had recourse to, twelve hours after the last dose of the preceding remedy, if no improvement has resulted; or this remedy may be preferred, from the commencement, if the child cannot bear to be looked at, or touched by any one ; or if its tongue be covered with a thick white coating. Dose: As directed for Chamomilla. Ipecacuanha is usually a most useful medicine, when nausea or copious and frequent vomiting form more prominent features in the case than purging ; or, when there is both vomiting and purging ; the substance ejected from the bowels being chiefly of a greenish-yellow color, and often bearing resemblance to matter in a state of fermentation. Dose: As directed for Chamomilla. Merciirius is required when the evacuations from the bowels are very frequent, but generally scanty and slimy, and usually attended with distressing straining; or greenish, sour-smelling, or fetid; also when small white ulcers make their appearance on the inner surface of the lips and cheeks, or on the tongue, etc.; when, with less flatulency, most of the symptoms mentioned under the head of Chamomilla are present; or, and more particularly, when the patient is affected with enlarged joints and glands, and distorted limbs— provided always these latter symptoms have not been induced, or at least materially aggravated by the abuse of Calo- mel, or other mercurial preparations, under allopathic treatment — this medicine is also of much efficacy. Dose : As directed for Sulphur. ATROPHY— EMACIATION— MARASMUS. 693 Xux- vomica. The interposition of constipation, or alternate states of costiveness and relaxation, with fickle, variable, or entire loss of appe- tite; regurgitations or vomiting, flatulency, acidity, excessive irritability of temper, great feebleness, soreness of the mouth, or formation of small white, ulcerative specks or spots, are all indicative symptoms for the em- ployment of this remedy. Dose : As directed for Chamomilla. Bryonia. Vomiting occurs almost immediately after eating ; consti- pation ; the child always feels cold ; the lips are dry and parched, and the mouth is dry. Dose : As directed for Chamomilla. Arsenicum is one of the most important remedies ; it is indicated by dryness of skin, which resembles parchment ; hollow eyes ; desire to drink often, but little at a time; excessive agitation and tossing, especially at night; short sleep, interrupted by jerks ; colic, with relaxed stools of greenish, brownish, or blackish color, or evacuations containing undiges- ted food ; night sweats ; extreme prostration ; pale, waxy appearance. Dose : As directed for Sulphur. Baryta carb. is indicated by enlargement of the glands; of the nape of the neck ; tenderness of the belly, with tumefaction and induration of the abdominal glands ; continual desire to sleep ; great indolence, and aversion to exertion and amusement ; dysenteric or loose stools, sometimes containing thread worms. Dose : As directed for Sulphur. Aciduni nitricum is chiefly required in cases which have been devel- oped or exacerbated by the abuse of mercurial preparations ; the bones and joints being swollen and tender, the mouth and gums more or less inflamed and sore, the mesenteric and other glands much enlarged ; the bowels confined or much relaxed, and attended with straining. Dose : As directed for Sulphur. jPhos%>hovus is more or less useful, in cases with protracted and debil- itating watery diarrhoea, and when the mesenteric glands are diseased. Dose: As directed for Sulphur. Belladonna is to be preferred when the prevailing symptoms and conditions are as follows: capriciousness and obstinacy ; nocturnal cough with rattling of phlegm ; enlargement of the glands of the neck ; unquiet sleep ; precocity of intellect ; (blue eyes and fair hair). Do.se; As directed for Chamomilla. China is required for excessive emaciation ; voracity ; diarrhoea at night, or frequent, white, papescent motions, or evacuations of undigested matter; frequent perspirations, especially at night; great debility and languor; unrefreshing sleep. Do.se : As directed for Chamomilla. China is more particularly required when the patient suffers from worms ; or for wetting of the bed, insatiable appetite, etc. Dose : As directed for Chamomilla. Rhus should be selected, when there is slimy or sanguinous diarrhoea ; debility, and excessive languor, with constant desire for the recumbent posture; great restlessness; the symptoms are all aggravated after mid- Jiight. Dose: As directed for Chamomilla. 694 DISEASES OF INFANCY. Diet and Regimen When the disease is manifested in infants at the breast, recovery will, in many cases take place on the substitution of a good nurse of sound constitution, or of appropriate artificial feeding — such as goat's milk, or, sometimes, weak broths — for the faulty nutriment which has originated the disease. But when the child is of scrofulous constitution, and glandular enlargements, etc., have become developed, the addition of regular and appropriate medicinal treatment is required. Again, when the affection has been engendered by improper food, in children who are being reared by the hand, or who are past the age of infancy, if the progress of decay is not too far advanced, and no organic disease be developed, a cure may, as in the former case, be accomplished by the correction of the main source of all the mischief. The improper food ought, therefore, to be at once withdrawn, or the quantity reduced, if that has been too great. Goat's milk or cow's milk, wLich has previ- ously been boiled and diluted (one part of water to about three of good milk,) and, occasionally, chicken broth, or, to children of more advanced age, farinaceous food, generous beef tea, or mutton broth, free of fat, may be substituted for food of a more solid or indigestible nature, with which the child has been dieted. Pure air and regulated exercise, are also of great importance. ALLOPATHIC TREATMENT. Atrophy. A full discussion of the treatment of infantile atrophy (wasting away) would require considerable space. It may briefly be said to be caused by lack of proper nourishment. If the child is at the breast, the amount of breast milk is insufficient or its quality poor, or, from accidental causes, it is absolutely harmful. In the latter case, the child should be raised by a wet nurse, which is preferable, or weaned ; in the two former cases, it ought to be raised by a wet nurse, or artificially fed, in addition to the food it gets from the breast. For artificial feeding, milk is most suitable. The milk should be daily tested with litmus paper, and if it is alkaline, i. e. turns red litmus paper slightly blue, it may be sweetened a little, and diluted as further directed and given to the baby, without further preparation. If it is not alkaline, sufficient Lime Water or Bicarbonate of Soda should be added to render it so. Previous to a month old, one-half water should be added to the milk; at a month old, only a quarter part water should be added. A little cream should be, also, added to make up for the water. After four months, milk may be given plain, except that it should be rendered alkaline, if not naturally so, with Lime Water or Soda. Milk is the food for children. A child a month old should take a quart of milk a day prepared as above ; but not over a quarter of a pint at a time. Cow's or goat's milk should be treated as above. If possible, the animal should be fed on grass and should have only pure water to drink and subject to no confinement. If the child should continue to waste after being suitably fed as above directed, other foods may be given as directed in the dyspepsia of infants treated with colic. Cod Liver Oil may also be given in doses of ten drops in the first place, gradually increased to a teaspoonful. The tonic effect of Iron and Quinine is of service. Take of Citrate of Iron and Quinine fifteen grains, Syrup of Orange Peel and Peppermint Wa- ter each an ounce. Mix. DENTITION. 695 Dose: From fifteen to thirty drops three times a day. Pepsin or Lactated Pepsin in doses of two to five grains, after feeding or nursing, may be advantageous, or Liquid Pepsin (Sheffer's formula) may be tried as an aid to digestion. DENTITION. The development of teeth in their regular order, although a perfectly natural process, is often attended with much suffering. When dentition is slow, retarded and difficult, it not only becomes of itself a serious disorder, but it involves also a Ions: train of morbid symptoms and actual diseases wJiich may exhaust the patient's strength, and finally destroy its life. The primary difficulty in such cases is in the nutrition, and as w T e often see in older children a remarkable backwardness in the development of the osse- ous (bone) system in general, so we often find in earlier periods of infantile life a corresponding slowness in the development of the teeth. And both these forms of imperfect development occurring, as they often do, succes- sively in the same children, are to be attributed to some profound consti- tutional taint which affects the nutrition. In order that our reader may judge of the deviation from the normal standard of dentition in any given instance, we propose to state here the mode and order of the appearance of the teeth in health. It should first be observed, however, that there are anomalous cases of dentition in which the non-appearance of the teeth should not be regarded as requiring active interference, unless other morbid symptoms are present. The non-appear- ance of the teeth at the usual time, unless accompanied by symptoms indi- cative of constitutional disturbance, really furnishes less occasion for apprehension than their premature appearance would. Even in the con- dition of apparently perfect health, some infants begin to cut their teeth very early, even by the third month, while in others this process com- mences at a very much later period. In the early months the infant's mouth is naturally dry ; this dryness is relieved by frequent nursing. But usually about the fourth or fifth month a very considerable change takes place in this respect ; the mouth is now found constantly full of saliva, and the child is constantly drivel- ing — or drooling, as it is sometimes called — but no other indication appears of tne approach of the teeth to the surface, except that the edge of the gums becomes broader than it was before. No further change may take place for many weeks, and it is generally near the end of the seventh month, oftener later than earlier, before the first teeth make their appearance. The middle incisors of the lower jaw are generally the first to pierce the gum; next in order appear the middle incisors of the upper jaw ; then the lateral incisors of the lower. The first molars next succeed, and often without any very definite order as to whether those of the upper or of the lower jaw are first visible, though in the majority of cases the lower molars are first to appear. The four canine (stomach and eye teeth com- monly called) teeth succeed, and lastly the four posterior molars, making in all the number of twenty deciduous teeth. There are, however, inter- vals of rest between the successive irruptions of teeth ; thus a period of six or eight weeks generally intervenes between the lower and the upper 696 DISEASES OF INFANCY. middle incisors; the lower lateral incisors come very soon after. But a pause of three or four mouths ruay occur before the first molar teeth make their appearance; another of equal length may occur previous to the appearance of the canine teeth ; and still another before the first dentition is completed by the irruption of the last molars. In some few cases the teeth come through so readily as to scarcely disturb the infant; but more frequently indeed the mouth becomes hot and the gums look tumid, tense and shining, white the exact position of the tooth is marked sometimes before its appearance, by the prominence of the gum; or the irruption of the teeth is preceded or accompanied by a somewhat different condition of the mouth, in which there is much heat and intense redness of the mucous membrane, an extremely copious flow of saliva, and a disposition to the formation of small aphthous ulcers on the tongue and on the inside of the lips, though the gums themselves may not be particularly swollen and painful. Either of these states is usually attended with some degree of febrile disturbance, and apparently with considerable suffering to the infant, who is constantly fretful and peevish, or cries out occasionally as if in pain. A third morbid condition of the mouth is sometimes seen, which is usually ushered in or attended by very considerable fever. The gums then become extremely hot and swollen, and unusually tender, especially over some tooth or other in particular : and in that situation we find the gum swollen up into a kind of little tumor. Small unhealthy ulcerations with a sloughy appearance often form upon the summit of the gum, and especially around any tooth which has partially pierced through it. To this affection, which is often very painful and difficult of cure, the name of odontitis infantum has been applied. A single word with reference to lancing the gums. This operation is in almost all cases unnecessarily performed, and in many cases it proves positively injurious. And yet it sometimes affords the most important and immediate relief. "Where the gums are red and inflamed, in our opinion they never need to be lanced, but only when in their very slow growth they have changed to a dense, firm and unyielding, cartilaginous formation, thick and of a whitish color, through which the teeth vainly attempt to make their way, and the irritation of the child's system threatens to destroy its life 03- sheer exhaustion, or by inducing fatal con- vulsions. Before proceeding to indicate the remedies to be employed in disor- ders of dentition, we remark that the tooth does not mechanically cut its way out of the gum. but its growth causes slight pressure by the crown of the tooth, a pressure which excites the absorbents to remove the impedi- ment. In this manner the absorbents do absolutely, when the infant is in a perfectly healthy condition, open up the way for the tooth to escape without pain or suffering. Now the duty of the physician, or the one act- ing as such, is so to direct the course of events, that the evolution of the teeth shall become as painless as any other process of development. All the laws of health should be rigidly enforced, and every prescription care- fully made and finally, when the period of dentition fairly commences, if suffering is experienced, or difficulty arises, the following remedies should be carefully and particularly studied and administered. DENTITION. 697 Aconite, Constant restlessness as from distress, which no change of posture or circumstance seems to relieve. The child gnaws at its lingers or something else, cries, whines or frets much of the time. Its sleep is very much broken, and there are usually much heat about the head, and a dry skin, sometimes with cold hands and feet. Soon after or whilst waking from sleep its cries of discomfort recommence. Accompanying this state of things sometimes there is constipation, when the stools are watery and dark-colored, or bloody and slimy. The child is usually very thirsty and seems to be relieved very much by holding on to the cup con- taining cold water with its mouth, apparently for the purpose of cooling its gums. Dose : Two pills every three hours. Antimonium crud. When the stomach so sympathizes as to pre- sent prominent symptoms. Tongue white ; much vomiting ; no thirst; stools composed of hard lumps and watery secretions passing together. Dose : Give two pills three times daily Arsenicum, alb. The child has undigested, foetid stools, and is emaciated ; dry and shriveled skin ; particularly restless after twelve at night. It has paroxysms of anguish day and night, during which it often strikes its face or head with its little hand, as though that afforded relief. It often vomits all fluids soon after swallowing them, particularly water. It will only take a sip or two at a time, but very often. The child often has a pale, waxy look. Dose : Two pills every four hours. Belladonna. The child moans a great deal ; violent starting or jumping of parts, or of the whole of the body whilst sleeping or waking; convulsions, followed by very profound sleep ; agravation every afternoon ; very hot fever at night, often lasting all night, with delirium ; face and eyes red, and often with heat of the head. Dose: Two pills, to be repeated every two hours. Bryonia alb. Dry, parched lips ; dry mouth and constipation, the stools being dark and dry, as if burnt. The child wishes to be kept very quiet ; seems to dread to be moved. If it be raised to the perpendicular it often vomits ; seems faint, and wishes to lie back again ; vomits its nourishment soon after taking it ; the gums look swollen, are hot and dry, though pale or light red. Dose: Two pills every four hours. Calcarea Carb. The child has large open fontanelles. The head perspires during sleep so as to wet the pillow far around. Stools large, hard, and of a chalky appearance, or thin and whitish. The child's feet are often cold and damp ; the abdomen is in some cases large, and little lumps are sometimes found about the neck • sometimes a loose rattling cough is present ; soft and flabby muscles. Dose: Two pills morning and evening. Cina. The child rubs its nose much, and is unusually hungry ; very restless in its sleep ; must be kept in motion nearly all the time by walking, or otherwise ; diarrhoea ; stools occurring immediately or very soon after drinking ; child very peevish, does not like £o be looked at, spoken to, or even touched ; its urine, when it can be preserved in a ves- sel, or when seen in a puddle on the floor, soon turns white like milk ; 698 DISEASES OF INFANCY. restless at night ; frequent crying out, as from colicky pains, and calling for water. Dose : As for Aconite. Chamomilla. The child starts and jumps during sleep ; when awake it must be carried all the time, in order to soothe its sufferings ; some- times it will only sleep whilst being carried in the arms ; one red cheek, the other pale ; diarrhoea watery and slimy, or like chopped eggs and spinach, having the odor of rotten eggs ; very thirsty ; likes to hold its mouth in cold water a long time when drinking ; the appetite is not as good as usual, and there is frequent vomiting of thin, sour milk. Dose : As for Aconite. Hyoscyamus. Pressing of the gums together, with putting the hands to the jaws, putting the fingers to the mouth, and other indications of pain in the jaws ; difficulty in swallowing ; convulsions, beginning with twitching of the muscles of the face, especially about the eyes ; dilation of the pupils ; deep sleep after the spasm goes off. Dose : Two pills to be given every two hours. Ipecac. Continual nausea, with occasional vomiting; diarrhoea ;- stools fermented and of many colors, as green as grass ; face pale, with blueness about the eyes. Dose : As for Hyoscyamus. Merc. Sol. Copious flow of saliva, and sometimes little blisters are seen on the tongue, gums and cheeks ; quite large ulcers are seen on the protruding gum. With the above conditions the nights are very trouble- some ; stools usually slimy, bloody, green, and accompanied with strain- ing. A single dose of Merc, is often sufficient. N~U9C vom. For teething children, being raised by artificial food, or whose mothers indulge in highly seasoned food, wines, etc. ; worse about four in the morning; constipation, with large difficult stools or they become small, frequent, lumpy or fluid ; bloody saliva often stains the pil- low when sleeping. Dose: Two pills four times each day. Podophyllum.. Grinding of such teeth as are already cut, with wor- rying and crying, often with painful diarrhoea ; rolling of the head from side to side, with green stools, or frothy, undigested stools ; falling of the bowel with every stool ; voracious appetite ; food soon sours after eating ; much gagging as if it would vomit ; dicharge of carrion-like smelling stools. Dose: Give two pills every four hours. Stramonium. When the child's brain seems so affected as to cause it to cease making its wants known except by motions ; it seems to shrink from the sight of objects when first presented, as if afraid; convulsions with cries as if from being frightened by the sight of some hideous ob- ject, Dose: Give two pills every two hours. Sulphur. White sour diarrhoea with redness about the anus ; papu- lous eruptions on the skin, with much itching ; the child takes no niore- long naps, as is its custom ; jumps in its sleep. Dose: Two pills each night and morning. SPASMS— CONVULSIONS. 699 SF ASMS— CONVULSIONS. Even in very young infants, spasms, or general convulsions, are of frequent occurrence. They are present at the commencement of many diseases of children, and they attend the fatal termination of nearly all. Convulsions may be occasioned by morbid conditions of the nervous sys- tem— idiopathic convulsions— or they may be merely sympathetic, symp- tomatic of disorders in other organs, especially in those of the alimen- tary canal (the whole canal through which the food passes). Among those of the nervous system, may be enumerated those which arise from pri- mary disease of the brain or other large nervous centers, and those which result from general exhaustion of the vital force, as in cases of difficult dentition and in the advanced stages of Whooping Cough ; among the lat- ter class of sympathetic convulsions may be enumerated those cases which arise from the irritation of intestinal worms, from the presence of un- wholesome food, such as curdled milk, and from the influences which are about to develop eruptive disorders or typhoid fevers. Convulsions which appear immediately after nursing, and especially if there is vomiting of curdled milk, it is then evident that the character of the milk is unsuitable. Such cases occur in the children, even of mothers perfectly healthy, if they give suck while in a state of high phy- sical excitement or mental distress. In cases which come on suddenly and without apparent cause, especially if the convulsions are associated with fever, stupefaction, and vomiting, there may be reason to apprehend the beginning of some eruptive disorder, such as scarlatina, measles, chickenpox, etc., and this opinion will be strengthened by the prevalence of one or the other of these epidemics at the time. Many cases of the brain disorders commence with vomiting and convulsions. In such instances, upon minute inquiry, it will always be found that some indications of cerebral disorder have been present for several days, and there is usually severe pain in the bead immediately before the attack. In most cases, it will not be difficult to find out the exciting cause of the spasms, which may be suppression of some cutaneous eruption, or its too tardy appearance, direct injury of the head or some portion of the nervous substance, fright of the child, or even of the nurse, a feverish con- dition of the mother's milk, the influence of some epidemic miasm, the beginning of some brain difficulty, etc., etc. TREATMENT. Remove as far as possible the exciting cause, whether it exists in the nurse or the child itself, avoid every excitement and keep the child perfectly quiet and free from every disturbing influence, of noise light, etc., and very carefully administer the remedy which appears to be indicated by the nature of the case, and by the attendant conditions. Aconite. High fever with dry, hot skin, anxiety and restlessness during dentition, grinding of the teeth, and convulsive hiccough. Dose: Four pills every half hour until the fever subsides, then every two, three, or four hours. Arnica. Where the spasms arise from some mechanical blow or in- jury; from concussion of the brain, a blow or fall. Dose : Four pills every hour or two. Arsenicum. Spasms preceded by great restlessness and burning heat over the whole body. Extreme thirst, drinking little and often. Patient 700 DISEASES OF INFANCY. lies motionless as if dead ; finally, the mouth is drawn first to one side and then to the other ; a violent jerk appears to pass through the whole body and consciousness gradually returns. Dose : The same as for Arnica. Belladonna. Heat of the head with flushed face, red eyes and dilated pupils. Starting and jumping during sleep. Drowsiness with inability to sleep; convulsive motion of the mouth, facial muscles and eyes ; foam at the mouth and grating of the teeth ; drowsiness after the spasm. Dose : As for Aconite. Chamomilla. Stretching of the limbs with convulsions of the ex^ tremities, eyes, eyelids, and tongue. Jerking and twitching during sleep. Redness of the face or one cheek red and the other pale. The child is very cross and fretful, must be carried all the time to be quieted. Hot sweat on the forehead and hairy scalp. Constant moaning and craving for drink. Dose: Four pills every one, two, or three hours. Cina. Spasms of the chest followed by rigidity of the limbs or the whole body. Especially suited to children troubled with worms. Con- stantly picking and boring at the nose. Frequent swallowing, as if some- thing were in the throat. Dry hacking cough. Urine turns milky after standing. Dose: Four pills every three hours. Cuprum. Shrill cries during the attack. Drowsy and stupid during the intervals with nausea and vomiting of phlegm. After the convulsion the child screams, turns and twists in all directions. If caused from sup- pression of scarlatina, measles, or like eruptions Dose : Four pills or a small powder every two or three hours. Gelseminum. Spasms during dentition with sudden loud outcries. Nervous excitable persons who are very sensitive. Dose: The same as for Cuprum. Hyoscyamus. Convulsions with twitching and jerking of all the muscles, especially those about the face and eyes. Convulsive trembling and foam at the mouth. After sudden fright. Cough worse when lying down, relieved by sitting up. Dose: As for Cuprum. Ignatia. Sudden starting from a light sleep with loud screaming and trembling all over. Single parts seem to be convulsed, or single muscles here and there. The spasms return every day or every other day about the same hour. Dose: Four pills every two hours. Ipecac. Much nausea and vomiting accompanies the spasms. Espe- cially if caused by eating indigestible food, or when, during an eruptive fever, the eruption strikes in. Green, diarrhceic stools. Dose : Four pills every hour or two. Opium. Trembling over the w r hole body and tossing about of the limbs. Loud screaming before or during the spasm. The child lies unconscious as if stunned, with heavy difficult breathing. Convulsions caused by fright. Dose : As for Ipecac. SPASMS— CONVULSIONS. 701 Secale. Twitching of single muscles. Twisting of the head to and fro. Contortions of the hands and feet. Labored and anxious breathing. Thin scrawny children with shriveled skin. Dose : As for Ipecac. Stramonium. Convulsions from fright with tossing of the limbs and involuntary passages from the bowels and bladder. Awakens with a shrinking look as if afraid of the first object seen. Spasms caused by some suppressed eruption, or if the eruption does not come out freely". Dose : As for Ipecac. VACCINATION. The customary place for vaccination to be performed, is on the outer side of the upper part of the left arm. Three to six points should be in- serted. In two or three days the swelling is noticed, and the fifth or sixth day the vesicles are formed, which reach their greatest size from the seventh to the ninth day. Tnis is the time to vaccinate from arm to arm. The crusts mature and are ready to drop off on about the twentieth day. The itching, burning, and pain occasioned by the vesicles, may be greatly relieved by brushing over them a mixture of one dram of Fluid Extract of Belladonna, with four drams of Olive Oil, or, if the inflammation is very intense, a cloth wet continually with a solution of fifteen grains of Sugar of Lead, and five to ten grains of the Acetate of Morphine in a pint of rain water, can be constantly applied if the patient remains in bed. The feverishness and discomfort does not require any treatment. A child should be healthy when vaccinated. The vile disease, Syphilis, is the only constitutional affection which can be transmitted by vaccination, so that if it cannot be practiced from the arm of a healthy infant, having healthy parents, the lymph, or crust, from the heifer, (cow pox), should be used. A vaccination which is perfectly pure may arouse up a constitutional vice existing in the patient, and give rise to eruptions or troublesome sores. Vaccination should be performed in infancy. Revaccinations should be made when the child is from five to eight years old, and again before reaching adult life, and also through life when especial danger from small pox exists. SURGERY. -~- ■ ♦ CHAPTER XXXV. ACCIDENTS OF VARIOUS KINDS. ArPAREJVT DEATH. Asphyxia. In every instance where an individual has, to all appear- ance, suddenly expired from external causes, animation may only be sus- pended. There are many cases, of course, where sudden death is no mere suspension of animation ; but there are others where apparent death is far from uncommon ; in all cases, therefore, where there is the least uncertainty, care should be taken to do nothing that may cause death, and interment should be avoided until certain signs of putrefaction set in. Apparent Death from Hunger. Give small injections of warm milk, repeatedly; great care should be taken to give the food when the patient begins to rally, in the smallest possible quantity at a time. Milk may be given, drop by drop, and gradually be increased to a teaspoonful, and after some interval, a small quantity of beef tea, and a few drops of wine. After a sound sleep has succeeded, but not till then, a small meal may be given ; but it is best that the patient should eat little at a time, but often. It must be borne in mind that for all persons suffering from starvation, eating too much and too hurriedly, is in the highest degree dangerous. Apparent Death from a Fall. Place the patient cautiously on a bed, with his head high, in a place where he can remain quiet. Put a little Arnica on his tongue, and wait till a medical man visits him to see if there is any fracture, or whether there are still signs of life; bleeding may be here sometimes of benefit, but it requires great caution. Arnica may be repeated, and also administered in injections. If the patient has been bled, give China or Quinine ; but it is obvious that if much blood has been lost by the fall or wound, venesection would be injurious. Apparent Death from Suffocation, (hanging, pressure, choking 1 ). Remove all tight clothing. Put the patient in a proper position, the head and neck rather high, the neck quite easy, not bent forward. Begin by rubbing gently, but constantly, with cloths ; give an injection of a dozen or two globules, or a few drops of Opium, dissolved in a half pint of water 702 APPARENT DEATH. 703 and injected slowly. This may be repeated every quarter of an hour whilst the ribs are being rubbed gently. Hold, from time to time, a mirror before the mouth, to see if the breath dims it; open the eyelids and see if the eyes contract; put warm cloths on; hot stones, wrapped in blankets, to the feet, between the thighs, to the sides, neck, and shoulders. If, in an hour, no change is produced, take a bitter almond, pound it fine, mix it in a pint of water, put a few spoonfuls into the mouth, or into the nose, and give the rest in injections. Apparent Death from Lightning. The body should be immedi- ately removed into a current of fresh air; and cold water dashed frequent- ly on the neck, face and breast. If the body be cold, warmth, by friction, must be employed in the same manner as recommended for the drowned, in the next article; as well as the means therein prescribed for inflating the lungs. A few globules of Nux Vomica may be put upon the tongue, and repeated in half an hour, when, if no effect is produced, a little Nux Vomica in water, rubbed on the neck, and some injected, may be of ser- vice. Or, better still, place the patient in a half-sitting, half-recumbent posture, in a cavity freshly dug in the earth, cover him over with newly excavated earth (leaving the face alone exposed, which should be turned towards the sun, until the first signs of returning animation become appa- rent,) after which Nux-v. is to be had recourse to, as above directed. There is no doubt but that in many cases of apparent death from lightning, both in the case of man and animals, careful and persistent use of this simplest of nature's means will restore the apparently departed life. The writer hereof has succeeded in the case of a person who«had been supposed to be dead for three hours. If the fresh earth is not moist it should be slightly moistened. Apparent Death from Drowning. Dr. Marshall Hall's so-called * 'ready method " of recovering persons from apparent death by drowning, has proved so successful in some cases, when zealously and indefatigably employed, even after a submersion of half an hour's duration, that it ought always to be tried in the first instance. The following is a summary of his directions: RULES. 1. Treat the patient instantly, on the spot, in the open air, freely expos- ing the face, neck, and chest to the breeze, except in severe weather. 2. . Send with all speed for medical aid, and for articles of clothing, blankets, etc. I. TO CLEAR THE THROAT. 3. Place the patient gently on the face, with one wrist under the forehead. (All fluids and the tongue itself then fall forwards, and leave the entrance into the windpipe free.) II. TO EXCITE RESPIRATION. 4. Turn the patient slightly on his side and apply snuff, or other irritant, to the nostrils; and dash cold water on the face, previously rubbed briskly until it is warm. If there be no success, lose no time; but III. TO IMITATE RESPIRATION. 5. Replace the patient on the face. 6. Turn the body gently, but completely, on the side and a little be- 704 ACCIDENTS OF VARIOUS KINDS. pond, and then on the face alternately; repeating these measures deliber- ately, efficiently, and perseveringly fifteen times in the minute only. (When the patient reposes on the chest, this cavity is compressed by the weight of the body, and expiration takes place; when it is turned on the side, this pressure is removed and z/ispiration occurs). 7. When the prone position is resumed, make equable but efficient pressure along the spine; removing it immediately before rotation on the side. (The first measure augments the expiration, and the second com- mences mspiration). IV. TO INDUCE CIRCULATION AND WARMTH, CONTINUE THESE MEASURES. 8. Rub the limbs upwards, with firm pressure and energy, using handkerchiefs, etc. 9. Replace the patient's wet clothing by such other covering as can be instantly procured, each bystander supplying a coat or a waistcoat. Meantime, and from time to time, Y. AGAIN TO EXCITE INSPIRATION. 10. Let the surface of the body be slapped briskly with the hand, or 11. Let cold water be dashed briskly on the surface, previously rubbed dry and warm. The measures formerly recommended, and now rejected by Dr. Hall, are "Removal of the patient, as involving dangerous loss of time; the bellows or any forcing instruments, and the warm bath, as positively injurious; and galvanism and the inhalation of oxygen as useless. The inhalation of diluted pure ammonia has in it more of promise." Avoid all rough usage. Never hold up the body by the feet Do not roll the body on casks. Do not rub the body with salts or spirits. Do not inject smoke or infusion of tobacco, though injections of spirits and water may be used Another Method (Sylvester's) is : Lay the patient on his back, and, having pulled the tongue forward, draw the arms up slowly over the head, by which means the ribs are elevated by the large fleshy muscles of the chest, which are attached to the arms, and mspiration is produced; the arms are then to be brought down to the side of the chest, which they are to compress in a slight degree thereby inducing expiration. These movements are to be repeated as slowly as in the Marshall Hall method, and it is said that they give a more complete change of air to the lungs. The means employed should be persisted in for several hours, till there are signs of death. When symptoms of recovery begin to show themselves, stimulating injections of wine or brandy may be useful; but be careful not to admin- ister any liquids by the mouth until animation is fully restored, lest they pass into the lungs, and so suffocate the patient. At this period the patient should never be left alone, as some have been lost from want of care, who otherwise might have been saved. Apparent Death from Being Frozen. — When a patient is found in a state of frost-bitten asphyxea, arising from exposure to intense cold, he should be moved with great gentleness and caution, to guard against any VERIFICATION OF DEATH. 705 injury, as fracture, etc., to a place of shelter, such as a barn, or unheated apartment, since only a moderate degree of heat might annihilate all hope of restoring animation ; at the same time, the patient ought to be protected from the slightest draught. He should then, especially if the limbs have become stiffened by the frost, be covered over with snow to the night of several inches— the mouth and nostrils, alone, being left free. The patient ought to be put into such a position that the melted snow may run off readily, and its place be supplied by fresh. When there is no snow, a cold bath, the temperature of which has been reduced by ice (or a bath of cold sea or salted water,) may be substituted, and the body im- mersed therein for a few minutes. The process of thawing is, by these means, to be affected, and when every part has lost its rigidity, the patient should be undressed by degrees,. or the clothes cut from the body, if requisite. As the muscular, or soft parts become pliable, they may be rubbed with snow until they become red ; or the body should be wiped perfectly dry; if snow is not to be had placed in flannel, in a moderately warm room, and rubbed with warm hands of several parties, simultaneously. In the event of no signs of returning animation declaring themselves soon after the forgoing treatment, small injections containing Camphor may be administered every quarter of an hour. As soon as any symptoms of approaching restoration become perceptible, small injections of luke- warm black coffee (coffee without milk) may be thrown up the bowels, and as soon as the patient is able to swallow, a little coffee may be given in the quantity of a teaspoonful at a time. The measures above detailed ought to be persevered in for several hours, against the excessive pain which is generally experienced when life is restored, Carboveg. should be prescribed in repeated doses, and if it fails to relieve the suffering, Arsenicum may be given. The party rescued must avoid subjecting himself to the heat of fire or stove for a consider- able length of time after his recovery, as serious consecutive ailment, and particularly disease of the bones, is likely to follow. Apparent Death from Noxious Vapors.— The treatment consists in removing the body into a cool, fresh current of air; frequently dashing cold water on the neck, face and breast ; if the body be cold, applying warmth, etc., as above recommended in the case of drowning; infla- tion of the lungs, early and judicious application of galvanism or electric- ity — after life has been restored, Op., or Aeon., may be given with advan- tage. — ~~™. — _«. VERIFICATION OF DEATH. The prize of five thousand francs given by the Acadamy of Medicine, France, to be awarded to the discoverer of a simple and easy process by which any illiterate person might be able to ascertain, without a doubt, whether death had really and irrevocably taken place, was divided among four competitors. 1. If a portion of the body be rubbed with a coarse wet towel, or with the back of a knife, and then be left exposed to the air. in the course of a few hours the skin will have become transparent and like parchment, if death has reallv occurred. 706 ACCIDENTS OF VARIOUS KINDS. 2. If a light be held to the back of a finger at a moderate distance a blister will be formed ; if this contain serosity, there is still life in the body. If the skin be touched with a piece of burning charcoal, if death is com- plete, it will become livid, a blister will be raised filled with vapor and having no serosity nor appearance of reaction. Putrefaction is also satisfac- tory evidence of death, but this can not be waited for. <> COXCLSSIOX OF THE BRAIX. In concussion of the brain, which may arise from a violent shaking of the brain or of the whole body, without any direct violence having been offered, or with such as a severe blow or fall on the head, the symp- toms vary, according to the degree of injury which the brain has sus- tained. Symptoms. When the concussion is very severe, there is immediate deprivation of sense and power of motion, and death is the general result; but when slight, a temporary stunning or confusion, with more or less headache is produced, followed by increased action of the pulse, giddiness, and sickness. When, on the other hand, the violence done is greater than in the latter instance, though not so severe as to cause the fatal termina- tion alluded to above, we may divide the progress of the results of such accident into three distinct stages, as follows: The first stage, in which the patient is rendered insensible and inca- pable of movement; his limbs become cold; the pulse weak, slow and intermittent : the respiration laborious, but usually without snoring. The second stage, in which, as the patient begins to recover from this condition, the pulse and respiration improve, and w r armth begins to be felt in the extremities; the sensibility to touch then returns, and the con- tents of the stomach are, in most cases, ejected; still, he continues to remain in a dull, confused state, and inattentive to, or almost unconscious of, slight external impressions. On the gradual subsidence of the first effects of the concussion, the patient becomes enabled to respond to ques- tions spoken'in a loud tone. The third stage. When the stupor has considerably or entirely abated inflammation of the brain, of an active character, will, in many cases then begin to develop itself, with all its symptoms, and if not checked, suppuration or effusion of blood within the head, preceded by sudden coldness and shivering, will result. This stage needs very close watching and care, as it may terminate fatally. TREATMENT- Arnica is the specific remedy in all cases of injury arising from external violence, and its timely administration internally, simultaneously with its externa] application (if there be a wound,) in cases of concussion of the brain, will, in most instances, if the injury be not very severe, suffice to remove all traces and evil consequences of such misfortunes. . Application (external) : Add twenty drops of concentrated Tincture of Arnica to two tablespoon fu Is of water, and bathe the parts with this lotion three times a day until the dispersion of the bruise, swelling, etc. Should the swelling pains, and other symptoms increase, after one or two applications, the lotion should be discontinued, until these symptoms of aggravation have subsided. Dose (internally) : A few drops in a little water every two or three hours, varying the time as the urgency of thecase appears to demand. CONTUSION OF THE CHEST — SPRAINS. 707 When the contusion has been serious, the following symptoms usu- ally characterize the case: — Extreme restlessness or jactitation and irri- tability of temper, with sensibility of the eyestolight; small, quick pulse; delirium ; or coldness and shivering. The treatment which is called for in cases of this nature, is identical with that which has already been detailed in the article on Inflammation of the Brain, to which the reader is referred for particulars. After an injury to the head, particularly if it has been of a somewhat severe character, the patient ought not to be allowed to partake of any stimulating liquids, such as wine, spirits, until at least three or four weeks have elapsed, even though he may appear to have entirely recov- ered from the effects of the accident. He ought, likewise, to be kept quiet, and not be permitted to expose himself to excitement of any kind, other- wise the most serious consequences may result. CONCUSSION OB CONTUSION OF THE CHEST. TREATMENT. Arnica should be promptly employed, in those instances in which the chest has been injured by a contusion, or violent concussion, and when the following symptoms are the result: Soreness, or a sensation as if from incipient suppuration, with heat and throbbing, is experienced in some particular spot; fever, or alternate chilliness and heat followed by fever, which becomes aggravated in the evening ; sleep- lessness or disturbed sleep, with general heat, and sometimes perspiration towards morning; short, dry cough which increases the pain, or cough with spitting of blood ; further, when the pain in the chest is rendered more acute by taking a full breath, laughing or sneezing, or when prick- ing pains or a sensation of fullness or pressure, as if caused by extrava- sated blood, is experienced, together with a feeling of constriction that obstructs the freedom of breathing. If the fever symptoms should be very intense, a dose of Aconitum should be given, either at the commence- ment or as an intercurrent. Dose : To be used as just directed for Concussion of the Brain. Quinine is not unfrequently of much service in completing the cure when a degree of delicacy of the chest remains behind, with tendency to suffer from shortness of breath, and a short dry cough, combined with paleness of the face, impaired appetite, and restless, unrefreshing sleep. Dose: A small powder or one half grain, night and morning, for six days (or until earlier change;) then pause four days, after which the course may, if necessary, be repeated as before, and so on. SPRAINS— PARTIAL DISLOCATION A sprain is sometimes very painful. Very often they are the result of momentary displacement of the bones, which strain or partially tear the ligaments which surround and hold the joint in its proper position. They are accompanied frequently with some constitutional disturbance. The injured part swells and the membrane covering ends of the bones within the joint is usually involved. TREATMENT. The treatment of sprains consists in restoring the bones to their natural position, (if necessary,) by extension and direct pressure, and applying a solution of Arnica to the part, which must also be bandaged to support the limb and prevent recurrence of the accident 708 ACCIDENTS OF VARIOUS KIIS'DS. A few drops (two or three) of the same remedy, taken internally, will greatly assist in making a speedy recovery. Or if the sprain is attended with swelling and great pain Rhus-tox. may be taken alone or in alter- nation with Arnica, to great advantage. If a sprain originated by lifting heavy weights Rhus, will greatly assist. Use as directed for Arn. Petro- leum (coal oil) is a good remedy in many cases; apply externally. Aconite must interpose within not less than one hour after the pre- vious internal use of either of the other remedies here mentioned, when- ever the local pain, heat, and redness resulting from a severe sprain are attended with fever and restlessness. A small dose repeated every thirty minutes to two hours. In sprains and strains the recovery is usually very tedious, indeed, in many cases it is more so than even a broken bone, especially when by some unusual effort or sudden motion some of the fibers of a muscle have been ruptured. In this last named case, position and rest is all important The position should be such as will relax the injured muscle and allow the ends of the ruptured fibers to come in contact with each other, when that must be maintained until the ends so brought in contact shall unite. HEMORRHAGE— MEANS OF SUPPRESSING. The word hemorrhage, of course, means the escape of blood from any vessel in any part of the body, but here we only propose to speak of those bleedings which occur as a consequence of some accidental cutting or rupture from some external cause, of a blood vessel, in other w r ords, those cases which occur in " minor surgery." Hemorrhageis of frequentoccurrenceandasarule requiresprompt action and presence of mind in those present, to prevent it from becoming seri- ous, and even imperiling life itself. The means of preventing and sup- pressing the flow of blood from an artery that has been cut or broken in any way are few and simple. For temporary means to stop bleeding from any artery in the arms or legs, a handkerchief or something of the kind passed around the limb (above the point of injury, through beneath which a small stick, nail or wire is passed and then twisted around until it produces a good degree of pressure, will stop almost any case. This is an always present substitute for the tourniquet used by surgeons in like cases. Another means, always present, is direct pressure by means of the hands. On the upper extremities the circulation may be readily arrested with the fingers, by grasping the arm as shown in this cut. If their points are so ap- plied over the artery, a very slight force is sufficient, and any part of the arm above the elbow may be selected, although that shown in the cut is usually most conven- ient. This fact should be impressed on the mind of all, especially the young of both sexes, as it will perhaps be the means of saving life in case of serious hemorrhag HEMORRHAGE— WOUNDS. 709 If the accident should occur in the lower extremity, resort to the hand- kerchief and stick may be had recourse to, or the flow may be effectually stopped by making pressure on the artery near its passage from the body by means of the thumbs, applied as shown in this cut. If the pressure is made much lower down on the leg, much additional force is necessary, and even then, if the thigh be fat and muscular, it may not always be entirely successful; but if this force is used as here directed and illustrated, there need be no fear of fatal hemor- rhage, even if all the arteries of the leg should be severed. As soon as possible, the end of the bleeding vessels should be secured by tying by means of any small, strong cord, as a thread of silk or strong spool cotton. We wish it to be distinctly un- derstood, that we do not mention these means as being superior to the means within the reach of the well prepared surgeon, but only as effectual means which will be present in any sudden emergency and so simple that any one may understand and apply them readily. WOUNDS. Wounds are generally divided into, or classified as (1) incised, (2) lacer- ated, (3) contused, (4) punctured, (5) gunshot, and ^6) poisoned wounds. (1.) By an incised wound is meant one which has been produced by a sharp instrument, as a sword, knife, etc., and is not accompanied with any con- tusion or laceration. Incised wounds, although more liable to be attended with a greater loss of blood, are, generally speaking, the least dangerous and the most easily healed. (2.) Lacerated wounds are those in which the muscular fibers, instead of being divided by a sharp-cutting instrument have been torn asunder with some violence ; the edges, in place of being even and regular, are jagged and unequal. They are commonly attended with little or no bleeding, rarely lieal without suppurating, and are frequently succeeded by violent inflam- mation. (3.) The terms contused wounds or bruises, are applied to those injuries which are occasioned by some blunt instrument, or hard, blunt surface being brought in violent collision with a part of the body. When severe, they are dangerous, from being prone to terminate in mortification and sloughing. (4.) Punctured wounds are those which have been caused by pointed instruments; they partake more of the nature of lacerated than of incised wounds, and are dangerous from the great depth to which they frequently penetrate, and the serious consequences they often entail. 710 ACCIDENTS OF VARIOUS KINDS. (5.) Gunshot wounds partake of the character of lacerated and contused wounds. Degree of the Injury. Wounds of the arteries are, for the most part, the most serious: they are to be distinguished by the bright color of the blood, which, moreover, issues very rapidly and in jets; while that from a vein flows in a smooth, uninterrupted stream, and has a darker hue. IXCISED WO VXDS. TREATMENT. (External . ) In the treatment of wounds of a severe description, our first object is to arrest the flow of blood. By the tourniquet (an instrument used for this purpose), the ligacure, compression, cold water or ice, and astringents, are all appliances to this end, variously ap- propriate according to the degree or source of the hemorrhage. When the iujured vessels are of a small size, they spontaneously cease to bleed, or do so, at all events, as soon as the wound is dressed ; but when the discharge of blood is considerable, one or more of the subjoined measures must be immediately resorted to for the purpose of arresting it. MECHANIC AD MEANS— DRESSING. Wounds of Arteries and Veins. When, therefore, there is reason to conclude that an artery has been wounded, a tourniquet should be applied around the limb to check the flow of blood ; the external wound must then be closed, covered with a graduated compress, and firmly secured with a bandage When a proper tourniquet is not at hand, its place may be toler- ably well supplied by a handkerchief secured around the limb, and tight- ened by two or three turns ot a stick passed under the handkerchief, until the discharge of blood ceases ; or the substitute may consist of a cork cut longitudinally, and firmly fixed over the artery, the site of which is readily to be found at the inner surface of the limb, in spare or emaciated sub- jects, by its pulsation ; but as, in robust and muscular patients it is more difficult to find the artery, it will, in such cases, be advisable first to tie a handkerchief or non-elastic garter tightly around the limb, above the wound, which w T ill have the effect of rendering the artery more prominent. In order to make the compression of the cork more effectual, several plies of lint or linen, or a piece sufficiently large to form a few inches square and one in thickness, should be placed over the cork, (which should beheld firmly in the required position during the preparation of the compress,) and the whole then tightened, and retained as long as may be requisite. The application of ice to the wound is, also, of unequivocal service. Bleeding may. also, be arrested by twisting the divided ends of the artery firmly by a pair of forceps, if the vessel be of small size; or by the application of lint saturated with "Monsell's Solution" (Persulphate of Iron) to the wound secured with a compress and bandage. This latter method is also well adapted to the arrest of bleeding from w T ounded veins. When the discharge of blood comes from a large artery, it must sooner or later be stopped by ligature. It is to be remembered that when an artery is wounded, compression is to be made between the wound and the heart ; and v ice versa when a. INCISED WOUNDS. 711 wounded vein needs compression, as the blood flows through the arteries from the heart, and through the veins, to the heart. It is sometimes neces- sary, in cases of wounded arteries, to make compression both above and below the wound. Wounds in the Mouth. Bleeding from wound, etc., in the mouth, sometimes requires the application of styptics, such as alcohol, kreosote water, "Monsell's Solution," etc. The same may be said of slight superficial wounds, as also of fungous tumors, and other diseased surfaces, when cold water fails to answer the purpose. Copious discharge of blood after the extraction ~of a tooth is, usually readily suppressed by pushing a compress of lint into the hollow space left ; or by the aid of styptics, when requisite. A simple, and sometimes extreme- ly efficacious mode of checking the flow of blood, is by replacing the extract- ed tooth, and keeping it in its former position, until the risk of further dis- charge of blood is obviated. The next step to be taken in wounds of every description, after the hem- orrhage is stopped, is to remove all extranous matter, such as sand, frag- ments of glass, splinters, etc. ; then to relax the muscles by placing the injur- ed limb or part, in such a position that the wound may not be made to gape ; finally, to bring the lips or sides of the wound in accurate contact, and ke^p them so by bandages, plasters, stitches, etc. Bandages are usually indis- pensable in deep, and even in small, superficial incised wounds ; but care must be taken not to apply them too tightly nor when there is excessive inflammation. Stitches are commonly found necessary in wounds of the face or belly, and sometimes of the hands, and in old people generally. In the young and vigorous they are seldom called for, and may be even improper and hurtful when the patient is of an irritable habit of body. Strips of adhe- sive plaster — cut narrow and sufficiently long to retain their hold as firmly as possible, and act with the required compressive power — form, in the majority of incised wounds, the most frequently useful means of bringing the sides into close approximation, and effecting adhesion. It sometimes happens, however, that even incised wounds, particularly when deep and of considerable magnitude, terminate in suppuration. It is consequently necessary to leave intervening spaces between the slips of plaster, to admit of the exit of the matter in such an event. Again, when it is found impracticable to cleanse the wound of all foreign substances, it ought to be only lightly, and so to speak, incompletely dressed, as it will be neces- sary to renew the dressings repeatedly. In some cases it is necessary to dilate the wound, to facilitate the abstraction of a splinter, etc. When it is necessary to dress the wound, and the compress is found adherent, it is advisable to remove it with caution and gentleness, in order to avoid tear- ing asunder the closing wound; the employment of tepid water will facilitate the separation of the linen. It is best to keep all wounds as much secluded from the external atmosphere as possible. TREATMENT (Internal or Constitutional.) Arnica is the first remedy in the constitutional treatment of wounds of all kinds, and its internal administration should commence as soon as the patient has been rendered as comfortable as circumstances will admit. Done : Eight pills in a teaspoonf ul of water, to be repearted every two to six hours, if necessary. 712 ACCIDENTS OF VARIOUS KINDS. Aeon it um is found necessary, if the patient be robust and strong, and sympathetic fever runs high. Dose: Six pills in a teaspoonful of water, every one to three hours, until the fever indications have abated. China is required for the treatmentof those serious injuries by which very severe loss of blood is occasioned, resulting in all the signs of extreme exhaustion, characterized by severe and repeated faintingfits, with deadly paleness of the face or livid appearance of the countenance, twitching of the tendons, etc. In cases in which reaction does not speedily follow the first dose of this medicine, two or three teaspoonfuls of good wine should be administered, after which, if a general improvement takes place, the next medicine should be subsequently employed. But if, on the other hand, the wine only acts as a temporary stimulant, the dose of China must be repeated before proceeding with further treatment. Dose. Six pills in a teaspoonful of water, followed in half an hour, if the patient does not rally, by the administration of a teaspoonful of wine (repeated three times, at intervals of five minutes). After which, if the patient sinks again, repeat the dose of China as before. But if the worst symptoms have subsided, proceed with the admin- istration of Arnica. When matter (pus) forms in incised wounds, the same treatment must be pursued as is described under the head of Lacerated Wounds. LACERATED WOUNDS. TREATMENT. (External or Local.) In the treatment of lacer- ated wounds, we must, after having carefulty cleansed them, closely ap- proximate all the parts that will admit of the process, and retain them in their places by means of plasters and an appropriate position of the body or limb, for the purpose of endeavoring to unite them by the first intention. If the laceration be extensive, and arteries of any considerable magnitude have been divided, they must be secured by ligature. During the process of sloughing, which commonly ensues, the wound must be closely watched as secondary bleeding is liable to ensue. Arnica and Calendula {Concentrated Tincture) are of great impor- tance in the treatment of Lacerated, Contused, and other wounds. When the discharge of blood is profuse, and the wound is of such a character as threatens to leave a severe scar, or to terminate in extensive suppuration before healing, Calendula is found most efficacious, and will frequently greatly modify the severity of the symptoms. When, on the other hand. the parts are severely bruised, and show a disposition to turn black in the neighborhood of the wound, or when the wound is slight, Arnica is to be preferred, except in persons in whom it produces inflammation of the skin or is apt to develop a rash. Calendula has likewise been found to be a useful application, during the healing process, when the granulations are excessive or redundant. Application: To sixteen parts of water, add one of the concentrated Tincture of Arnica or Calendula (as the case may be.) and saturate therewith a pad made of linen rag, which place carefully over the wound, remoistening and reapplying the same as often as maybe necessary. CONTUSED WOUNDS OK BRUISES. 713 CONTUSED WOUNDS OH BRUISES. TREATMENT. External . In eases in which gangrene ensues from very .-evert- injuries, by contusion, notwithstanding the appropriate treat- ment as below directed, the question of amputation is at once presented, and the services of a surgeon should be had without delay. In cases in which the membrane investing the bone (the periosteum) has been injured by a contusion, if effused blood or matter is evidently pent up beneath it, and the suffering attendant upon the injury is very intense, an incision may be necessary, whereby the effused fluid may be allowed to escape, the constitutional treatment being, at the same time, pursued as appropriate to the symptoms and conditions of the case. Hot Water.* In the first instance, the only external application in cases of contusion should consist of hot water. In those very severe cases in which the injured part has been squeezed out of shape, or otherwise absolutely disfigured, the application of the hot water should be continued simultaneously with the appropriate constitutional treatment, a remark which also applies to such cases as have demanded recourse to a surgical operation. Application ; Bathe the part freely with hot water for five minutes. repeating the operation in the course of three hours : or otherwise saturate a linen rag with hot water, place it over the part, covering the whole with oiled silk, and remoistening the rag as fast as it becomes dry. Arnica {Concentrated Tincture) should be applied, when there is con- siderable extravasation of blood, to promote absorption and otherwise forward the cure. Application : To ten parts of water add one of the concentrated Tinc- ture of Arnica, and bathe the parts well with this lotion every three hours, until evident indications oi amelioration. Bhus-tox., Concentrated Tincture is to be preferred in cases in which the joints, synovial membranes, or tendons are injured by a contusion, and this remedy should be employed, simultaneously with its internal administration, at the onset in such instances. Application: To sixteen parts oi water add one of the Concentrated Tincture of Rhus-tox., saturating a piece of linen rag with this lotion and applying it to the parts injured, covered with oiled silk, and remoistening this dressing as often as it becomes dry. until the pain and other symptoms abate suspending the application, however, and substituting hot water, as above directed, if an eruption should be developed in the parts . TREATMENT. | Constitutional.^ Arnica. This medicine must be administered internally, during the first period, and whilst hot water or the Tincture of Arnica, only, is being applied externally to the parts. In very severe cases even, in which the contusion has been so violent as to squeeze the limb nearly flat, or otherwise to disfigure it. this medicine should be employed at the onset. When amputation has become neces- sary and has been performed. Arnica is generally to be recommended as the appropriate medicine for constitutional treatment. Dose : Six globules in a teaspoonful of water, repeated after two to four hours. *If water is applied as hot as can be borne to any injury that is likely to caure a black, eye, it will prevent it from becoming black. 714 ACCIDENTS OF VARIOUS KINDS. Rlufs-to.xicodendron is to be preferred simultaneously with the external administration of the same medicine, for the treatment of cases in which the joints, synovial membranes, or tendons have been especially injured by the contusion. Dose: Six globules, as directed for Arnica. Arsenicum may be employed in those very severe cases in which gangrene threatens to ensue, and the skin has assumed a livid and black appearance, if indeed, amputation be not absolutely necessary. So long as there is a prospect of avoiding the loss of the limb, the employment of this and the successive medicines should not be neglected. Dose: Six globules in a teaspoonful of water, repeated at intervals of three hours until some degree of improvement or change becomes apparent. PUNCTURED WOUNDS. The external treatment of punctured wounds is the same as directed for wounds in general, but unless compression can be made by means of a bandage or adhesive plaster through the whole extent of the wounds, the effort should notbe made to obtain healing by first intention, (without the formation of pus). If the wound is deep or so situated as to be in danger of producing lock-jaw, it will be necessary to resort to such constitutional treatment as is recorded under the head of Lock Jaw, in this work. Ap- plications of cold water are always useful in cases where there is much fever in the wound. GUNSHOT WOUNDS— SPLINTERS, ETC. When splinters of bone, a ball or other foreign substances are lodged in the wound, they should be extracted with as little irritation as possi- ble, if they press upon some important organ or part. If they do not so rest as to endanger some important part, they may be allowed to remain (if deep seated and so difficult to reach as to necessarily occasion a high degree of irritation in the effort to extract them,) until loosened by suppur- ation, which will be hastened by appropriate treatment. Cold water constitutes one of the most generally useful of local appli- cations, in cases of gunshot or similar wounds. Saturate a linen or old cotton rag, or lint pad with cold water and apply it to the part, constant- ly remoistening the pad as it becomes dry or hot. If there is added a little Arnica Tincture to the water, the benefit will be marked. About twenty drops of tincture to each three tablespoonfuls of water. Calendula used in the same way is good, in many cases even better than Arnica, especially where the latter is known to irritate the skin of the patient. BANDAGES. Bandages are always necessary in fractures of bones, and often in sprains and in varicose veins and sores on the extremities, usually, although BANDAGES 715 very improperly called " fever sores." Of all the different bandages none excel the " roller," and to make and apply it neatly is an accomplishment that all should have. It is to be prepared from a piece of muslin of the requisite length and width by tearing it from the piece, and then winding it into a neat cylindrical form by band; this is accomplished by folding one end of the band five or six times on itself, so that it may form a sort of axis, then roll it a few turns on the thigh to give it size, then place the cylinder between the thumb and fore-finger of the left hand, allow the band to run over the right forefinger, holding firmly. bet ween the thumb and finger of that hand so as to make traction, and tighten the cylinder. Having thus arranged it, give a rotary motion to the hand, and cause the cylinder to revolve upon its axis by means of the fingers and thumb of the left hand, while at the same time the right thumb and forefinger are moved partially around the cylinder itself, which, by this movement, is soon formed of the required size. The spiral bandage is that which is most frequently used in the treat- ment of all affections, either of the extremities or trunk. In applying this bandage, each turn is made to cover about one-third of the one which preceded it, and as most parts to which it is applied are conical in shape, especially in the extremities, it is obvious that in ascending from the lower to the upper portion of them .and in applying the spiral bandage it must be done so as to cause the pressure to be uniform through its whole extent; to accomplish this we make what we call reverse turns, which is done as follows : Apply the end of the band to the limb at the smallest part to w r hich you wish to apply it, and continue to make simple spiral turns, until you approach the enlarged portion of the limb. Then apply two fingers of the free hand to that portion of the bandage which is alrea- dy in contact with the limb, not to assist in forming the reverse or to fold it down, but, to prevent the turns already applied from slipping or becom- ing relaxed while the reverse is being made. See that no more of the bandage is unrolled than will enable you to separate the cylinder a short distance (four or six inches) from the limb; let that portion of the band- age be loose which is between the fingers, holding the band to the limb and the body of the cylinder; turn the hand holding the roller from being squarely back down, to a point where the palm is down, by motion of the wrist alone without moving the fingers from the cylinder at all; as shown in this cut. Take especial care to make no traction nor to sink the cylinder below the level of the limb, till the fold or reverse is made, when it may again proceed up the limb. It should always ascend spirally and only cover in about one third of the preced- ing turn. Keep each turn and each reverse parallel with its fellow. 716 ACCIDENTS OF VARIOUS KINDS. FRACTURES— BROKEN BOXES. As soon as a limb or other bones are discovered to be fractured, the patient ought to be placed on a litter of any kind which happens to be at hand, such as a shutter or board, and removed to some neighboring place of shelter, or to his own abode, if it be not too far distant, and a surgeon sent for at once. Great care and gentleness ought to be exercised in lifting and handling the patient, and in transporting him from one place to another; otherwise a fracture originally of the simple kind is liable to be converted into a compound, or at least into a complicated one; for laceration of the soft parts is likely to occur from the action of the sharp and jagged edges and ends of the broken bone or bones, whereby the probabilities of recovery will be made more doubtful and perhaps unfavorable, especially if the accident has happened to a debilitated or aged person. MECHANICAL MEASURES. For Simple Fractures. In the case of a simple fracture, the adjust- ment of the ends of the bones to their natural position should be effected by placing the limb in the position best calculated to relax the principal muscles attached to the broken bone; it should then be gradually exten- ded until the upper and lower fragments are brought into their proper position. After that is accomplished, splints of pasteboard or light wood held in position by means of carefully applied bandages, (see cut on page 715) to remain until the union of the broken bone is well secured. For Compound Fracture. The ends of the bones have been forced through the flesh and must be carefully cleaned and returned to their natural position. The parts of bone should be held in their position by means of splints and bandages as directed above for simple fracture. In fracture complicated with a wounded artery or dislocated joint, the artery should be tied, to stop the hemorrhage, and the dislocation reduced before the bone is set. This variety requires more care and cool- ness than the other varieties do. It is always desirable that a good sur- geon should be secured in the case of any fracture. After fracture of the bones of the arms and legs, which is so readily known by anyone, by means of the changed length and position of the affected extremity, as compared with the other, and by the hearing or feeling of the snap at the moment of accident, also by the grating sound and sensation produced by moving the one part of the bone against the other — fracture of the clavicle (collar bone) is the most frequent, or at any rate a very common occurrence. It usually takes place near its middle, and is the result of force applied either directly or indirectly. The fracture is easily discovered by passing the finger along the collar bone: the natural line ^J iJL 1 ■ j/M^\ of the bone is observed to be interrup- ted, and the broken ends are percep- tible; the shoulder falls forwards and inwards. The outer fragment is drawn downwards by the action of the muscles; by pressing the shoulder BURNS AND SCALDS. 71 T upwards and outwards a grating (crepitus) can be felt tiire. Treatment of this fracture consists in adjusting the broken extremities of the bone, by forcing the shoulder upwards, outwards, and backwards, and retaining it in this position. The following mechanical appliance is a good and simple one for accomplishing this object. A padded belt is placed around each shoulder and drawn together on the back by a strap, and the arm below the elbow placed in a sling. Or, a folded towel is placed in the arm-pit and a bandage passed from shoulder to shoulder, forming a figure oo (see adjoining cut) across the shoulders. at the point of frac- BUBWS AXD SCALDS. There are several varieties. The first variety causes a mere redness of the skin and soon passes away without causing the skin to come off at all. The second variety causes the skin to rise in blisters, which are filled with serum ; if slight these soon dry up and heal, but if the skin is much injured, may be followed by obstinate ulcers. The third variety causes the destruction of the parts and although perhaps not causing as much, if any, pain, is by far the most dangerous, and serious consequences may follow. The constitutional disturbances and the period of danger following deep burns or scalds have been divided into three stages. 1. Depression and Congestion, during the first four or five days; 2. Keaction and Inflam- mation, in which the patient may sink with an affection of the head, chest or abdomen; and, 3. Suppuration and Exhaustion which may continue from the second week to the close, and is often associated with hectic fever or pleurisy. The danger of burns and scalds often depend more on the extent of surface involved, than upon the depth of the injury. Burns or scalds in the trunk, neck, or head are far more dangerous than those of an equal extent in the extremities. Children suffer more severely from these acci- dents than adults. TREATMENT. A most important object to be kept in view and attained as nearly as possible, is to cover the injured part with some suit- able material that will exclude the atmospheric air, which covering should not be removed until the cure is complete. The following local applica- tions are recommended. A thin sheet of smooth (not glazed) cotton bat- ting should be applied to the denuded parts and not removed ; this may be saturated from time to time with a mixture of Carbolic Acid one part, to Olive Oil six parts; then cover this with several thicknesses of the same cotton batting. As a domestic remedy these should be kept on hand, always ready for burns and scalds. Another and a very excellent remedy is Extract of Witch Hazel (Ham- msemillas), Pond's Extract, which should be applied in the same manner as just directed for the Carbolic Acid and Olive Oil. 718 ACCIDENTS OF VARIOUS KINDS. Tincture of Cantharides (Spanish Fly) ten drops to an ounce of water applied also by means of the cotton wool, is especially useful when blisters are forming or have just formed. See under the head of " Tincture of Cantharis " page 88. Also " Causticum or Lime Water," page 89 ; "Raw Cotton," page 89; " The Soap Plaster," page 89; "Flour," page 90. SUNSTROKE- SUN FEVER— COUP DE SOLEIL. This is a paralysis of all the functions of the brain, occurring either gradually or suddenly, excited by heat, generally following exposure to the direct rays of the sun, particularly when to this exposure is added the pressure of tight and unsuitable clothing. Symptoms. The affection is generally preceded by premonitory symp- toms, such as thirst, heat, and dryness of the skin, vertigo, congestion of the eyes, frequent desire to pass water; fainting follows and is often instantly fatal, or insensibility and loud (stertorous) breathing occur either with or without convulsions. In both varieties the number of deaths is proportionately great and a very unusual congestion of the lungs is the most common morbid condition found after death. TREATMENT. For medical treatment see "Congestion of the Brain'' pages 110 to 115. HOME TREATMENT. It is now agreed that sunstroke results from a depressed, and not, as formerly supposed, from an excited or stimulated condition of the nervous system and its center. The treatment therefore is to apply cold water by pouring, or cold compresses constantly applied over the head, neck and chest, or by pounded ice applied to the same localities. Prevention. Clothes should be light and loose, especially about the neck. Green leaves in the hat or cool cloths applied to the head are good, and simple preventives. Another and very important means is to abstain from drinking any kind X)f spirits ,s& it undoubtedly predisposes to attacks of sunstroke by the depression which must and does always follow the first effects (i. e. stimulation). Seven tenths of all who die from sun- stroke are habitual drinkers and a much smaller percentage recover than among non-drinkers. STINGS OF INSECTS, Such as the Bee, Wasp, and Hornet, are sometimes very painful, but rarely dangerous, except when the part attacked is very sensitive, as the eye, or else a very important organ, or the number of insects attacking the person is so great as to produce general poisonous symptoms. TREATMENT. First, extract the sting, if it has been left in the wound. Second, apply slices of the common onion, each slice being removed as soon as it becomes saturated with the poison, and another applied in its place. Musquitoes may be prevented troubling in the night, by rubbing a little good soap on the hands and face before going to bed. A little Oil of Pennyroyal or Cedar so applied is also efficient. DROPSY. 719 DROPSY. We have assigned this place to this class of diseases, because the treat- ment of dropsy is so uniformly the same that a separate description of the disease, as developed in special organs or systems would have led to many useless repetitions. Dropsy is never an independent or primary disease, but always follows or is properly a symptom or result of other diseases, although it sometimes appears to be of a primary character. In general, all conditions which, in the long run, interfere with the circulation, or retain the water in the blood, lead to dropsy; likewise any other conditions that result in a con- dition of surplus or want of blood. In most cases, however, something else has to become associated with these conditions, otherwise it would be difficult to comprehend why many conditions which we meet in practice should be able to continue so long before resulting in the development of dropsy. We are unacquainted with the nature of this something ; whether it is a relaxation of the coats of the vessels, or a more copious supply of water in the blood, or whatever else, we have not yet been able to find out. Most likely it is from this unknown cause that dropsy, which is the result of a general wasting away of the flesh, without any special cause, takes place so frequently as seen in many cases. In accordance with the above-mentioned three classes of causes dropsy sets in, if the flow of the venous blood into the heart is interfered with; if the circulation is obstructed by a clot in the larger trunks of the veins (as for instance in consequence of inflammation of the veins in the lower extremity, in the case of lying-in women; dropsy arising from inflamma- tion of the great portal vein ;) in the case of pulmonary affections imped- ing the circulation of the blood through the lungs; in consequence of affections of the liver resulting from obstructions of the circulation of the blood into the liver. In the case of kidney affections, if the function of the kidneys is very much interfered with; in chlorosis (green sickness) affections of the spleen, like fever and ague, after copious losses of blood, or after severe, debilitating diseases, in general in conditions of debility of a high order. Symptoms. At the onset dropsy is more or less local ; as a rule, it commences with a swelling around the the ankles, less frequently in the face ; dropsy of the abdomen takes place only when the liver is diseased. In this case, it may remain localized as such ; in the former case it gradu- ally spreads over the whole body just beneath the skin, then unites with dropsy of the abdomen, and finally with oedema (dropsy) of the lungs or brain, in which case death soon results. Dropsical effusions are generally accompanied, and sometimes pre- ceded by prostration, and by decrease of the urinary secretions. The urine is dark, thick, becoming cloudy in a short time; the quantity is sometimes very scanty. All the other watery secretions are likewise less, or they are entirely suspended ; the stools are very dry, the skin is dry and cracks easily, appears incapable of perspiration ; the mucous mem- branes are likewise dry, on which account the patient is often tormented by a distressing thirst. Dropsy at times develops itself very speedily and universally, some- times slowly and progressing very gradually. It is especially after nephri- <-0 FOOD FOR INFANTS AND INVALIDS. tis (inflammation of the kidneys) that water accumulates very rapidly ; it collects most slowly in company with affections of the lungs. The course of the disease is at times uninterrupted, leading speedily to death, or else it makes pauses, a portion of the serum that had been poured out into the cavities, or beneath the skin being reabsorbed. This may result from a transitory cessation or diminution of the obstruction in the circulation, or from copious discharges of urine, watery discharges from the bowels, oozing through cracks in the skin, or from a general invigor- ation of the whole organism. Death generally takes place by oedema (dropsy) of the lungs or brain. Recovery is attended with copious discharges of urine, very rarely with diarrhoea alone. (See Index.) CHAPTER XXXVI. FOOD FOR INFANTS AXD INVALIDS. FOOD FOB IXFAXTS. In is a sad fact, true nevertheless, that at least half the children at the present time are deprived of their proper sustenance and left to the tender mercies of wet nurses or the bottle. Between the two evils it is difficult to say which is the least, but unless a superior nurse can be found— one intel- ligent and thoroughly clean in her personal habits — we should say choose the last, and bring the child up by hand. It is our opinion, and the conviction is borne out by every mother's experience, that the moral, mental, and spiritual, as well as physical con- dition of a child is greatly influenced during its nursing period. Mothers who nurse their own children know that it is of the greatest importance to the quiet and healthful condition of the child, that they should be free from all sources of agitation, anxiety and irritability. Overwork, giving way to fretfulness, or being subjected to the unrea- sonable temper and caprices of others, frequently induces a state of mind that shows itself plainly in the uneasiness and disquiet it produces in the infant, and would be seen with still greater distinctness were women accustomed to trace results more strictly to their causes. If this is the case with the mother, if her mental and spiritual condi- tion finds itself reflected so minutely in the lights and shadows of the little life which is dependent upon her, why should it not receive a color- ing from the milk which it derives from a dull, coarse, appetite-loving wet nurse of the ordinary stamp? Two thirds of these nurses make a necessity of strong tea and coffee, and malt liquors two or three times a day: they are often anything but scrupulous in their personal habits, and so accustomed to the exercise of a violent will, by virtue of their office, as to be unwilling to bear the slightest control or contradiction. These are not the influences which a thoughtful mother would like to have her child drink in with its milk, and for reasons here mentioned, we would FOOD FOR INFANTS. 721 all the more earnestly advise you to use the directions for the " Choice of a Nurse," on page 667. We believe it to be a misfortune, the extent of which is not at all rea- lized, when the mother cannot nurse her own child. The mother's milk contains all the elements necessary for its proper growth in every direc- tion, and no substitute can be found for it ; but where this is impossible, unless, as before remarked, a very superior nurse can be obtained, it is safer to trust to the simple food which at least sustains life and does no hurt if given at right times and in proper quantities, leaving the mental and spiritual activities unimpeded, though probably subject to a slower growth than if aided by the sympathetic magnetism of the mother's nature. STARCHY FOOD. Such as arrowroot, sago, corn starch and the like is commonly held to be very healthy and nutritious for infants, yet the experience of every physician, furnishes numerous instances of feeble sickly children that are so fed, while the number is small that survive it. The reason of this is r that the digestive organs of infants are not sufficiently powerful to con- vert the starchy matter into nourishment; it therefore only serves to clog and impede the action of the system, while the little victim is gradually being starved on the trifle of sustenance which it can obtain from what- ever sugar and milk is given with the other food. ENGLISH "PAP." English and French babies, when brought up by hand, are fed almost altogether on " pap," which is made in England in the following way: Boiling water is poured on a small piece of the crumby part of white light bread. This is covered up for a moment, and then the water poured off. The softened bread is then put in a little porcelain stewpan, with a trifle more of water and allowed to boil up, and it is then a pulp. A lump of white sugar and a little cold milk added, brings it precisely up to the ideas of most young Britishers, who grow very stout and healthy upon it. This is excellent food where the mother is capable of partly nursing her child. French pap is made of flour instead of bread, which is decidedly objectionable, as it is not only less agreeable but much less easily digested. COW'S MILK. A diet of cow's milk exclusively, is not good; it is too rich and very apt to provoke eruptive diseases. But if the bottle is preferred to spoon feeding, good cow's milk may be given, diluted with one half to one third of boiling water and sweetened slightly with white sugar. Use only of one good cow's milk. An excellent change from this consists of a thin strained gruel from the best prepared barley, with a little milk and sugar added. A little sugar is necessary in infants' food, but be particularly careful not to make it sweet, as this causes continual thirst as well as disorders of the child's stomach. infant's broth. After the baby is three months old, it may occasionally be treated to a little clear chicken or mutton broth, made in the following manner; Cut 46 . 722 FOOD FOR INFANTS AND INVALIDS. up a pound of lean mutton into small pieces, and put them into a small jar, cover them with cold water, set the jar into a kettle of warm water and let it come to a boiling point, and simmer the mutton until the strength is extracted. One pound of meat should make a quart of broth. Simmer at least six hours, strain and put in a little salt, but no other spice. Treat part of a chicken in the same way for chicken broth. BABY PUDDING. Grate a little stale bread, pour some boiling milk upon it, cover, and when it becomes a pulp, stir into it the yolk of an egg and a grain of salt. The quantity should fill a teacup in which boil it fifteen minutes. ESSENTIALS FOR A BABY. Warm, sensible clothing, quiet, with food and sleep at regular inter- vals, are the essentials to health and comfort of babies. FOOD FOR YOUNG CHILDREN. The great danger in feeding young children does not lie so much in the food as in the preparation or want of preparation. A hard indigestible potato is bad for them, and a little tender stewed meat is good, but if the potato were mashed and mealy, and the meat hard and tough the case would be just the reverse. The principal danger is in their swallowing indigestible substances, and whether these are hard apples or lumpy potatoes, tough meat or sad bread, rich cakes or nuts, makes very little difference, the irritation and derangement produced is the same. Meat for children under the age of ten years, should be cooked very tender and cut up very small or given in the form of soup. Potatoes should be mashed, apples roasted or stewed, and, if very ripe and mellow, may be eaten raw, and if bread and milk could form their break- fast and some kind of mush with milk their supper, they would be all the better for it, for the rest of their lives. children's pie. Cover the bottom of a pie dish with slices of bread and butter, cover that with fresh berries sprinkled with sugar or with stewed fruit, fresh or dried. Set it in the oven fifteen or twenty minutes. Sift a little sugar over it when it comes out. BROWN MUSH FOR SUPPER. Stir into a quart of boiling water, a teaspoonf ul of salt, and Graham flour enough to make it as thick as corn meal mush. Let it boil gently half an hour, keeping it covered. Eat with cream, or milk and sugar. BREAD AND MILK. Cut or break up stale bread into small pieces and let them come to a boil in milk. It makes an excellent breakfast for children, with a slice of toast or without. CRANBERRIES. Should be stewed soft, strained through a colander which will pass everything but the skin ; boil up a second time with the sugar and set away to cool. They may then be eaten with impunity by the most delicate children. FOOD FOR INVALIDS. 723 FOOD FOR INVALIDS. The diet for invalids depends so much upon the condition of the patient, that only the most general directions can be given; the special application must be left in every case to the judgment of the nurse, provided she have good natural sense. Neatness, cleanliness, and promptitude, are the great requisites in a sick chamber. The best prepared food is spoiled by want of care and punctu- ality in placing it before the patient. Where persons are ill their senses are often preternaturally acute; slight marks of neglect which would not be noticed at another time, become extremely offensive; and a few minutes delay, not only seems unpardonable, but is sometimes really injurious. Patience, tact, and nat- ural kindness of disposition are essential qualities in a good nurse, and when to these are added firmness and good judgment, the sum total in this line has been reached. As a general rule, however, one half of the nurses injure their patients by absurd restrictions, and the other half by foolish indulgences. GRUEL. This simple refreshment is invaluable in sickness, and is made with little trouble and less expense, yet is very seldom prepared exactly right. One tablespoonf ul of fine Indian or oat meal, mixed smooth with cold water and a little salt; pour upon this a pint of boiling water, and turn into a sauce-pan to boil gently for half an hour; thin it with boiling water if it thickens too much, and stir frequently; when it is done a tablespoonf ul of cream or a little new milk may be put in to cool it after straining, but if the patient's stomach is weak, it is best without either. Some persons like it sweetened and a little nutmeg added, but to many it is more palatable plain. * PANADA. Break into a bowl three good sized crackers (arrow root or oat meal are nice) broken into small pieces; pour upon them boiling water and cover close for a minute, then add a teaspoonf ul of white sugar and a little pure milk. It is an excellent breakfast or supper for a child or an invalid. Instead of the milk the juice of a lemon may be squeezed in and another teaspoonful of sugar added, if there is fever. " SOFT " TOAST. Some invalids like this very much indeed, and nearly all do when it is nicely made. Toast well but not too brown, a couple of thin slices of bread; put them on a warm plate and pour over boiling water ; cover quickly with another plate of the same size and drain the water off; remove the upper plate, butter the toast, put it in the oven one minute and then cover again with a hot plate and serve at once. EGG TOAST. Make a soft toast and have ready one or more fresh eggs, which have been boiled twenty minutes ; remove the shells, cut them in slices and place upon the toast, with a little butter, pepper and salt; without the butter they may be eaten with impunity by the most delicate invalid, as an egg cooked for twenty minutes is really more easy of digestion than one that is termed "boiled soft." 724 FOOD FOR INFANTS AND INVALIDS. SOFT BOILED EGGS. Fresh eggs for invalids who like them cooked soft, should be put in a pan of boiling water, and set on a part of the stove where they will not boil for several minutes. At the end of that time they will be like jelly, perfectly soft, but beautifully done and quite digestible by even weak stomachs. DRY TOAST. Cut your slices of bread even, and not too thick. Toast before a clear fire, a nice light brown. Cover with a napkin and serve quickly while it is hot. Dry toast is not always good for invalids, especially when the bowels are confined and it is desirable to keep them open. In this case Graham bread not toasted is much better. MILK TOAST. This is a favorite dish with nearly all sick people, when they are get- ting well. Cut stale bread in rather thin slices, toast a fine brown and lay them in a deep dish. Meanwhile boil a quart of new milk in a lined sauce- pan in which you have first put a very little cold water, to prevent burn- ing. As soon as it boils pour it over the toast, cover, and serve quick. For an invalid no butter should be put in the milk. Some people put in a thickening of flour, but this spoils it for many. THICKENED MILK With a little milk, mix smooth a tablespoonful of flour and a pinch of salt. Pour upon it a quart of boiling milk, and when it is thoroughly mixed put all back into the saucepan and boil up at once, being careful not to burn, and stirring all the time, to keep it perfectly smooth and free from lumps. Serve with slices of dry toast. It is excellent for diarrheal ; this alone will often cure it by scorching the flour before mixing with the milk which makes it into (Carb. V). MILK AND EGGS. Beat up a fresh egg with a grain of salt, pour upon it a pint of boiling milk, stirring it all the time. Serve hot with or without toast. It is good in case of weakness for an early breakfast, or for a traveler before starting on a journey. BEEF TEA. Cut up a pound of rump steak into small pieces, and put it into a bottle (wide mouthed fruit jar) putting a very small quantity of lukewarm water into the bottle with it, cork tightly and put the bottle into a kettle of warm water ; the water should be allowed to boil for a considerable time ; the bottle should then be removed and the juice drained off. The tea maybe salted a little and a teaspoonful given at a time. OYSTER SOUP. Make a little broth of lean veal or mutton, simmer with it some root or essence of celery. Strain it, put on the fire and when it boils throw in the oysters with their liquor, and a trifle of pepper and salt. Serve it as soon as it comes to a boil, on little squares of toast. BROILED TENDERLOIN. This is a choice piece from a sirloin steak, and is highly enjoyed when FOOD FOR INVALIDS. 725 the patient is becoming convalescent. Cut out the round piece from the inside of a sirloin steak, broil it quick over a bright fire, upon a small, heated gridiron, turn it, with its gravy, upon a piece of freshly made toast sprinkle with salt and pepper, but no butter, place between two hot plates, and serve directly. A tender mutton chop or half the breast of a chicken may be served the same way, only the chicken will require longer, and somewhat slower cooking. ARROW ROOT GRUEL. Add a teaspoonf ul of arrow root to half a pint of boiling water ; mix well, add half a pint of milk and boil together for two or three minutes; sweeten to the taste. A little lemon juice or wine may be added. MUTTON TEA. Take one pound of mutton, remove the fat and cut the meat in small pieces ; pour half a pint of boiling water over it, and let it stand near a fire for half an hour, and then boil for one hour, strain through a sieve or cloth, add salt to suit the taste. A very nourishing diet. CHICKEN BROTH. Take half a chicken, remove all the fat, cut the meat up into small pieces, and break the bones ; put into a vessel with three pints of boiling water; boil for one hour, season with salt and strain. WATER GRUEL. Corn or oat meal two tablespoonfuls, water one quart; boil for ten or fifteen minutes, and add sugar, or salt, if desired by the patient. RICE GRUEL. Ground rice one heaping tablespoonful, ground cinnamon half a tea- spoonful, water one quart; boil slowly for fifteen or twenty minutes, add the cinnamon when it is nearly done boiling, strain and sweeten. SAGO GRUEL. Sago, two tablespoonfuls, water one pint, boil until it thickens, fre- quently stirring. Wine, sugar, and nutmeg may be used, if desirable. TAPIOCA CUP PUDDING. This is very light and delicate for invalids. An even tablespoonful of tapioca soaked for two hours in nearly a cup of new milk. Stir into this the yolk of a fresh egg, a little sugar, a grain of salt and bake in a cup for fifteen minutes. A little jelly may be eaten with it or a few fresh straw- berries. INVALID CUP PUDDING. One tablespoonful of flour, one egg; mix with cold milk and a pinch of salt to a batter. Boil fifteen minutes in a buttered cup. Eat with sauce, fruits, or plain sugar. INVALID APPLE PIE. Slice up one or more nice, tart apples in a saucer, sweeten with white sugar and cover with a moderately thick slice of bread, buttered slightly on the under side. When the bread is nicely browned, the apples, if of a tender kind and thinly sliced, will be done. 726 FOOD FOR INFANTS AND INVALIDS. ROAST APPLES. These can nearly always be eaten with safety, when they are eaten with relish. Choose good sized, fair apples of a tart and juicy, but not of a. sour kind. Rub them off clean, and put them in rather a slow oven, which may increase in warmth, so that they shall be thoroughly done in an hour. When so soft that the savory pulp breaks through the browned skin in every direction, take them out, sift white sugar over them, and carry one at a time on a saucer to the patient. STEWED PRUNES. These are extremely good in small pox, measles, scarlet fever, and the like, both as food and medicine. Get the box prunes, as they will not need washing, and because they are generally of a much better quality than the open sort. Soak them for an hour in cold water, then put them in a porce- lain lined saucepan with a little more water if necessary and a little coffee or crushed sugar. Cover and let them stew .slowly an hour, or until they are swollen large and quite soft. They are excellent as an accompaniment to breakfast for a sick woman. LEMONADE. This is invaluable in fevers and also in rheumatic affections. Rub the lemons soft, cut them half through the center and squeeze out the juice. Take out the seeds with a teaspoon. Put two tablespoonfuls of white sugar to each lemon and fill up with cold or boiling water according as you desire the lemonade hot or cold. Two medium sized lemons will make a pint or more. APPLE WATER. Roast two tart apples until they are soft, put them in a pitcher, pour upon them a pint of cold water and let it stand in a cool place an hour. It is used in fevers and eruptive diseases and does not require sweetening. TOAST WATER. Toast slightly a piece of bread and add to it boiling water ; it may be sweetened, if preferred, and flavored with a little lemon or orange peel. FLAX SEED TEA. Take an ounce of flaxseed and a little pounded licorice root and pour on a pint of boiling water ; place the vessel near a fire for four hours ; strain through a linen or cotton cloth. BARLEY COFFEE. Roast barley until well brown, and boil a tablespoonf ul of it in a pint of water for five minutes ; strain and add a little sugar if desired. This is a nourishing drink toward the close of fever and during convalescence. OAT MEAL COFFEE. Mix common oat meal and water to form cake. Bake it until it is brown, then grind it in a coffee mill ; take about a tablespoonful for one pint of water and boil it five minutes. This is good for checking obstinate vomiting or distress in the stomach, when caused by drinking too much ice water. FOOD FOR INVALIDS. 727 RICE WATER. Take two ounces of rice and two quarts of water ; boil an hour or so and add a little sugar; a little nutmeg or lemon may be used to flavor, if the patient likes it. MUCILAGE OF ELM BARK. Place about a teaspoonful of ground elm bark in a pint of cold water ; this may be drank after an hour or two. If more agreeable to the patient, it may be flavored with lemon juice or essence of lemon. Is very beneficial in cases of inflammation of the stomach or bladder, etc. ALUM WHEY. Take a pint of sweet milk and add a teaspoonful of powdered alum, then boil and strain; this is useful in diarrhoea, dysentery, and inflamma- tion of the stomach. The curd forms an excellent poultice for inflamma- tion of the eyes. MUSTARD WHEY. Take a tablespoonful of mustard seed, and one pint of sweet milk, boil together for a few minutes and separate the curd. This is a very useful drink in dropsy. VINEGAR WHEY. Take a pint of milk and one teaspoonful of good vinegar ; boil them together for a few minutes and separate the curd. RENNET WHEY. Take one quart of new milk and a large spoonful of rennet ; heat the milk and then add the rennet, after which boil until the curd separates, which is to be skimmed. ORANGE WHEY. Take a pint of milk, the juice of one orange with a portion of the peel, boil the milk then add the orange to it and let it stand until coagulation takes place, then strain. TABLE OF REMEDIES. With the abbreviations used in writing prescriptions, the full Latin (Technical) names, and one or more of the common English names, with their antidotes on the opposite pages. Read ac?°oss this and the next page after each number. ABBREVIATION. 1 Abies Can 2 Ac 3 ^Escul G 4 Agar M 5 Agnus C 6 Al Rub 7 Alum 8 Ambra G 9 Amm C 10 Amm Mur 11 Anac 12 Ant C 13 Apis Mell 14 Aralia R 15 Arg Fol 16 Arg Nit 17 Arn Mont 18 Ars Alb 19 ArisVirg 20 Arum T 21 Asa 22 Asarum 23 Asclep I 24 Asclep S 25 Atrop 26 AurumF 27 Aur Mur 28 Bap Tinct 29 Baryta 30 Bell 31 Borax 32 Bov 33 Brom 34 Broom .35 BryAlb 36 Chinca 37 Cal Carb 38 Cal Caus 39 Cal Phos 40 Calen Off 41 Cac Grand 42 Camph 43 Cann Sat 44 Canth LATIN. Abies Canadensis Aconitum Napellus iEsculus Glabra Agricus Muscarius Agnus Castus Alnus Rubra Alumina Ambra Grisea Ammoninm Carbonicum Ammonium Muriaticum Anacardium Antimonium Crudum Apis Mellifica Aralia Racemosa Argentum Foliatum Argentum Nitricum Arnica Montana Arsenicum Album Aristolochia Virginia Arum Triphylum Asafoetida Asarum Europaeum Asclepias Incarnata Asclepias Syriaca Atropin Aurum Foliatum Aurum Muriaticum Baptisia Tinctora Baryta Carbonica Belladonna Borax Bo vista Bromium Spartium Scoparium Bryonia Alba Chinca Calcarea Carbonica Calcarea Caustica Calcarea Phosphorica Calendula Officinalis Cactus Grandiflorus Camphora Cannabis Sativa Cantharides 728 ENGLISH NAME. Hemlock Pine Monk's Hood, Wolf's Bane Ohio Buckeye Bug agaric, Amanita Chaste-tree Tag Alder Argilla, Clay, Ox. of Alumen Ambergris Carbonate of Ammonia Muriate of Ammonia Malacca Bean Crude Antimony Honey Bee Spikenard Silver Foil Nitrate of Silver t Leopard's Bane Arsenic Virginia Snakeroot Indian Turnip Asafoetida Common Asarabacca Swamp Milkweed Common Milkweed Alkaloid of Belladonna Gold Muriate of Gold "Wild Indigo Carbonate of Baryta Deadly Nightshade Biborate of Soda Puff-ball Bromine Broom White Bryony Chinca-root Carbonate of Lime Caustic Lime Phosphate of Lime Marsh Marigold Night-blooming Cereus Camphor Hemp Spanish Fly TABLE OF ANTIDOTES AND DISEASES. Before the appear the names of antidotes to the medicines named on the opposite page and after the in each line the name of a few of the diseases, diseased parts, or conditions, which the remedy named after the corresponding number on the opposite page is known to cure. Of course the few diseases named here does not, by any means, com- prise all which the remedy named will cure. ANTIDOTES. DISEASES. 1 Coffee. — Dyspepsia, Palpitation of the heart. 2 Vinegar, Coffee.— Fevers, Lungs, Croup, Heart Disease, Neuralgia. 3 Xux Vom. — Piles, Lame Back, Constipation, Spasms. 4 Salt, Ether. — Apoplexy, Chorea, Delirium Tremens. 5 Wine, Coffee.— Impotence, Scanty Secretion of Milk 6 Sulphur. — Skin Diseases. 7 Ipecac, Soda. — Leucorrhcea, Lead Colic, Constipation. 8 Camphor. — Hysterics, Hard hearing, Dry Cough. 9 Camphor, Lemon-juice. — Syphilis. Dysmenorrhea, Spasms, Epilepsy. 10 Oil, Elm Bark.— Catarrh, Consumption, Diarrhoea. 11 Camphor. — Weakness of Mind, Heart Disease. 12 Mercurius, Puis. — Weakness of Digestion, Scald Head. 13 Arnica, Onion. — Diseases of the Kidneys. Dropsy. 14 Cimicifuga. Xux. — Gravel, Leucorrhcea", Dry Cough. 15 Pulsatilla, Merc. — Melancholy, Rheumatism of Joints. 16 Common Salt. — Gonorrhoea, Cracked Nipples, Epilepsy, Diarrhoea. 17 Vinegar, Camphor. — Bruises, Swelling of the Glands, Lungs. 18 Iron, Ipecac— Diarrhoea, Fever and Ague, Obstinate Skin Diseases. 19 Camphor. — Sick Headache, Piles, Dyspepsia. 20 Onion. — Salivation, Inflammation of Mouth and Throat, Asthma. 21 Camphor. — Hysterics, Dyspepsia, Premature Menses. 22 Vinegar. Camphor. — Colic, Vomiting. 23 Pulsatilla. — Asthma, Pleurisy, Diarrhoea, Cough, Catarrh. 24 Bryonia. — Headache, Dropsy, Influenza, Rheumatism. 25 Coffee. — Xeuralgia, Spasms, "Paralysis, Whooping Cough. 26 Merc, White of Eggs. — Diseases of the bones, Sexual Organs, Glands. 27 Xitric Acid. — Chronic Catarrh, Dropsy, Syphilis. 28 Bryonia. — Typhoid Fever, Diphtheria, Dysentery. 29 Soda or Magnesia in Vinegar. — Scrofulous swellings, Rickets. 30 Vomit, Coffee — Diseases of Brain, Xerves, Glands, Lungs, Skin. 31 Mercurius. — Sore Mouth, Menses during Nursing, Liver Spots. 32 Camphor. — Externally to stop bleeding^ Headache. 33 White of Egg.— Consumption. Croup, Dysentery. 34 Rhus toXs—Xursing Sore Mouth, Mercurial Salivation, Childbed Fever. 35 Coffee, Camphor.— Rheumatism. Pneumonia, Constipation, Typhus. 36 Cantharis. — Eructations, Vomiting, Burning Urine. 37 Camphor.— Scrofula. Slow Teething of Infants. Profuse Menses. 38 Bryonia,— Coughs, Croup, Ulcers, Curvature of the Spine. 39 Xitric Acid. — Herpes, Discharge from Ear, Chronic Bronchitis. 40 — Wovxds, Colic, Cancer. 41 Verat Viride. — Heart Disease, Pneumonia, Fever and Ague. 42 Opium, Vinegar.— Cholera. Influenza. Hysterics. Headache. 43 Lemonade. — Gall Stones, Burning Urine*. Xose Bleed. 44 Camphor. — Bloody Urine, Dysentery, Kidney Diseases. 729 '30 TABLE OF REMEDIES. ABBREVIATION. LATIN. 45 Cap Ann Capsicum Annum Carbo Animals Carbo Vegetabilis ENGLISH. Cayenne Pepper Animal Charcoal Vegetable Charcoal 48 Cardu Mar Carduus Marise Common Thistle 49 Caul Thai CaulophyllumThalictroidesBlue Berry Boot 46 Carbo A 47 Carbo V 50 Caus 51 Cepa 52 Cera Virg 53 Cham 54 Chel Maj 55 Chim Um 56 Chi 57 Chi Hy 58 Cic Vir 59 Cim Rac 60 Cin 61 Cist C 62 Clem 63 Cocc 64 Coc Cac 65 CofT 66 ColchiAu 67 Col 71 Cro 72 Crotal 73 Crot Ole 74 Cup Met 75 Cupr Ac 76 Cupr Sul 77 Cyp Pub 78 Daph 79 Digi Causticum Cepa Cerasus Virginica Ohamomilla Vulgaris Cheladonim Majus Chimaphila Umbellata China Chloral Hydrate Cicuta virosa Cimicifuga Racemosa Cin a Cistus Canadensis Clematis Erecta Cocculus Indicus Coccus Cacti CofFea Cruda Colchicum Autumnale Colocynthis 68 Collin Can Collinsonia Canadensis 69 Con Conium Maculatum 70 Corn Flor Cornus Florida Crocus Crotalus Horridus Crotonius Oleum Cuprum Metallicum Cuprum Aceticum Cuprum Sulph Cypripedium Pubescens Daphne Indica Digitalis Purpurea 80 Dor T. Lin Doryphora Ten Linse 81 Dros 82 Dulc 83 Euc Glob 84 Eup 85 Euphor 86 Euphra 87 Ferr 88 Ferr Ace 89 Ferr Mur 90 Fil M 91 Gel Semp 92 Graph 93 Glo 94 Hama 95 Hede Pul 96 Helleb 97 Hep Sul 98 Hy Acid Drosera Dulcamara Eucalyptus Globulus Eupatorium Euphorbium Euphrasia Ferrum Metallicum Ferrum Aceticum Ferrum Muriaticum Filix Mas Caustic Tincture Common Onion Wild Cherry (red) Common Chamomile Garden Celandine Prince's Pine, Wintergreen Peruvian Bark Chloral Water Hemlock Black Snakeroot Worm-seed Rock Rose Virgin's Bower Seeds of Cocculus Cochineal Raw Coffee Meadow Saffron Bitter Cucumber Cure All, Rich weed Spotted Hemlock Dogwood, Box Tree Saffron Rattlesnake Poison Croton Oil Copper Acetate of Copper Sulphate of Copper Bleeding Heart Indian Daphne Fox-glove Colorado Potato Bug- Sun-dew Bitter-sweet Blue Gum Tree Boneset, Ague Weed Spurge Eye-bright Iron Acetate of Iron Muriate of Iron Male Fern Gelseminum Sempervirens Yellow Jessamine Graphites Glonoine Hamamelis Virginiana Hedeoma Pulegioides Helleborus Niger Hepar Sulphuris Hydrocyani Acidum Hydras Can Hydrastis Canadensis 100 Hvos 101 Hyp Perf 102 Ign 103 Indigo 104 Iod 105 Id 106 Iris Ver Hyoscyamus Niger Hypericum Perforatum Ignatia Amara Indigo Iodium Ipecacuanha Iris Versicolor Black Lead Nitro-Glvcerine Witch Hazel Penny Royal Christmas Rose Sulphuret of Lime Prussic Acid Golden Seal, Yellow Puccoon Black Henbane St. John's Wort St. Ignatius' Bean Indigo Iodine Ipecac Blue Flag TABLE OF ANTIDOTES AND DISEASES. 731 ANTIDOTES. DISEASES. 45 Camphor. — Chronic Dysentery, Fever and Ague, Dyspepsia. 46 Arsenic. — Cancer, Goitre. Offensive breath or discharges. 47 Arsenic. — Cardialgia, Ulcers, Burns, Flatulence, Dyspepsia. 48 Nux V. — Jaundice, Gall Stones, Cough, Pleurisy. 49 Pulsatilla. — False Pains, Tedious Labor, Dysmenorrhoea, Colic. 50 Coffee. — Chronic Hoarseness, Cold Feet, Insanity. 51 Coffee. — Stings of Insects, Poisoned Wounds, Frozen Parts. 52 Ammonium. — Slow Fevers, Dyspepsia, Ulcers, Whooping Cough. 53 Aconite, Coffee. — Children's Diseases, Spasmodic Pains, Neuralgia. 54 Sulphur. — Headache, Warts, Eruptions, Jaundice. 55 Cantharis. — Dropsy from Disease of the Kidneys, Constipation. 56 Arsenic, Verat Alb. — For all diseases of Periodic Recurrence. Weakness.. 57 Ammonia. — Insanity, Sleeplessness, Neuralgia, Lock Jaw. 58 Tobacco. — Epilepsy, Mania, Defective Eyesight. 59 Coffee. — Menses too Profuse, Chorea, Rheumatism. 60 Ipecac. — Worms, Whooping Cough, Spasms, Catarrh. 61 Belladonna.— Foul Breath, Chronic Diarrhoea, W T hite Swelling 62 Mercurius. — Orchitis, Old Foul Ulcers, Syphilis. 63 Camphor. — Menstrual Colic, Sea Sickness. Nausea, Asthma. 64 Tea, Wine, Ipic. — Vomiting, Cough, Palpitation of the Heart. 65 Aconite. — Nervous Diseases, Cardialgia, Dyspepsia. 66 Vinegar, Honey. — Gout, Burning Urine, Cramps of Calves of Legs. 67 Camphor, Coffee. — Colic, Dysentery, Costiveness, Neuralgia. 68 Nux Vom. — Piles, Diarrhoea, Chronic Constipation. 69 Coffee. — Apoplexy, Amenorrhoea, Catarrh. 70 Quinine.— Sour Stomach, Intermittent Fever. 71 Aconite. — Hysteria, Uterine Hemorrhage. 72 Arsenic. Ammonia, Spirits. — Headache, Skin Diseases. 73 Opium, Mucilaginous drinks.— Constipation, Eczema. 74 Emetics, White of Eggs.— Epilepsy, Insanity, Vomiting, Asthma. 75 Milk, Iron Filings. — Jaundice, Colic, Croup. 76 Ipecac. —Emaciation, Rage, Vertigo. 77 Tea.— Excessive Mental Labor, St. Vitus' Dance. 78 Vinegar, Camphor.— Itching Eruptions, Pains in Bones. 79 Emetics, Wine, Ammonia.— Heart Disease, Bloody Cough, Dropsy. 80 Jimson Weed.— Vomiting, Dysentery, Night-Mare. 81 Camphor. — Whooping Cough, Consumption, Cough. 82 Camphor.— Salivation, Hives, Bright's Disease, Hoarseness. 83 Quinine.— Intermittent Fevers, Asthma from Heart Disease. 84 Ipecac, Nux.— Fevers: Intermittent, Spotted, Remittent. Influenza, 85 Lobelia.— Spasms, Diarrhoea, Cholera Morbus. 86 Belladonna— Chronic Sore Eyes, Ophthalmia, Sneezing. 87 Arsenic, China.— Nursing Sore Mouth, Diarrhoea, Chlorosis. 88 Kreasote.— Consumption, Dropsy, Excessive Menstruation. 89 Pulsatilla. Arsenicum.— Catarrh of the Bladder, W 7 etting the Bed. 90 Lemon. — Tape Worms. 91 Belladonna.— Headache, Dumb Ague, Convulsions, After Pains. 92 Nux, Wine.— Chronic Eruptions, Catarrh of the Ear, Salt Rheum. 93 C«ffee— Sunstroke, Congestive Headache, Nervous Diseases 94 Arnica. — Burns, Scalds, Bleedings, Varicose Veins. 95 Turpentine. — Nausea, Whites, Amenorrhoea from a Cold. 96 Camphor.— Dropsy of the Brain. Scanty Menses. 97 Vinegar.— Typhus„Scrofula, Skin, Glands, Profuse Menses. 98 Ammonia, Cold Affusion.— Epilepsy, Apoplexy, Cholera, Phthisis. 99 Ammonia.— Headache, Catarrh, Constipation, Leucorrhcea. 100 Coffee, Bell.— Hysterics, Hydrophobia, Brain Fever. 101 Pulsatilla.— Congestion of "the Blood to the Head, Painful Menses. 102 Camphor, Lemon.— Hemicrania, Spinal Irritation, Convulsions. 103 Belladonna. — Epilepsy, Chorea, Vomiting, Colic. 104 Coffee, Starch.— Goitre, Enlarged Glands, Liver Complaints. 105 Coffee.— Vomiting, Asthma. Diarrhoea, Fever and Ague. 106 Veratrum Alb.— Summer Complaint, Morning Sickness. 732 TABLE OF REMEDIES. ABBREVIATION. 107 Jalap 108 Jug Cin 109 Kali Bi 110 Kali Car 111 Kali Hi 112 Kreaso 113 Kousso 114 Lach 115 Laur 116 Led Pal 117 Lil Tig 118 Lye 119 Lob 120 Mag Car 121 Mag Mur 122 Mangan J 23 Menis Can 124 Meny 125 Meph 126 Mer Viv 127 Mer Sol 128 Mer Dul 129 Mer lod 130 Mer Corr 131 Mez 132 Morph 133 Mosch 134 Mur Ac 135 Nat Car 136 Nat Mur 137 Nit Acid 138 Nux Jug 139 Nit 140 Nux Mosch 141 Nux Vom 142 Olean 143 Ol Jec 144 Ol Kic 145 Op 146 Petro 147 Phos Ac 148 Phos 149 Phy 150 Plat 151 Plumb 152 Plumb Act 153 Pod Pel 154 Poly Punc 155 Pals 156 Ran B 157 Ran S 158 Rhod 159 Rhus Tox 160 Rhus Glab 161 Rum Cris 162 Ruta G 163 Sabad 164 Sabin 165 Sarnb 166 Sang 167 Scut Lat 163 Sec LATIN. Jalapa Juglans Cinerea Kali Bichromicum Kali Carbonicum Kali Hidiodicum Kreasotum Kousso Lachesis Laurocerasus Ledum Palustre Lilium Tigrinum Lycopodium Clavatum Lobelia Magnesia Carbonica Magnesia Muriatica Manganum Menispermum Canadense Menyanthes Trifoliata Mephitis Putorius Mercurius Vivus Mercurius Solubilis Mercurius Dulcis Mercurius Iodide Mercurius Corrosivus Mezereum Morphium Moschus Muriatis Acidum Natrum Carbonicum Natrum Muriaticum Nitri Acidum Nux Juglans Nitrum Nux Moschata Nux Vomica Oleander Oleum Jecoris Oleum Ricini Opium Petroleum Phosphori Acidum Phosphorus Phytolacca Decandra Platina Plumbum Plumbum Aceticum Podophyllum Pelltaum Polygonum Punctatum Pulsatilla Ranunculus Bulbosus Ranunculus Scelaratus Rhododendron Chrysanth'm Rhus Toxicodendron Rhus Glabrum Rumex Crispus Ruta Graveolens Sabadilla Sabina Sambucus Nigra Sanguinaria Canadensis Scuttellaria Laterflora Secale Cornutum ENGLISH. Jalap Butternut. White Walnut. Bichromate of Potash Carbonate of Potash Iodide of Potassium Creasote Kousso Snake Poison Cherry Laurel Marsh-tea Tiger-spotted Lily Club Moss Indian Tobacco, Asthma-weed Carbonate of Magnesia Muriate of Magnesia Manganese Sarsaparilla Buck Bean Skunk Mercury, Quicksilver Soluble Mercury Calomel Iodide of Mercury Corrosive Sublimate Mezereon Morphia Musk Muriatic Acid Carbonate of Soda Kitchen Salt Nitric Acid Walnut Shell Nitre, Saltpetre Nutmeg Vomic Nut Oleander Cod Liver Oil Castor Oil Opium Rock Oil Phosphoric Acid Phosphorus 4 Poke Root, Poke Berry Platina Lead Acetate of Lead May Apple Smartweed, Water Pepper Wind Flower Buttercup Malignant Crowfoot Siberian Rose Poison Sumach Common Sumach Yellow Dock Rue Mexican Barley Savin Elder Blood Root Skull Cap Ergot TABLE OF ANTIDOTES AND DISEASES. 733 ANTIDOTES. DISEASES. 107 Rhubarb.— Constipation, Small Doses for Diarrhoea of Infants. 108 Mayapple Root. — Quinsy, Camp, Diarrhoea, Salt Rheum. 109 Iodine.— Croup, Cough, Bloody Catarrh. 110 Vinegar, Wine. — Consumption, Whooping Cough, Dyspepsia. 111 Tobacco. — Brain Fever, Sore Throat, Goitre, Cancer. 112 Milk, Mucilage.— Diabetes, Foul Smelling Discharges, Burns. 1 13 Coffee. — Tape Worms. 114 Ammonia, Arsenic. — Fevers and Convulsions. 115 Ammonia, Cold Affusions. — Pneumonia, Gangrene, Apoplexy. 110 Camphor. — Insect Bites and Stings, Whooping Cough, Ague. 117 Sepia. — Menses too profuse and too often. Sterility. 118 Camphor.— Excoriations of Infants, Gravel, Bloating, Ulcers. 119 Ipecac— Croup, Asthma. Vomiting, Sick Headache. 120 Table Salt. — Menstrual Difficulties, Diarrhoea of Pregnancy. 121 Calcarea. — Worms, Leucorrhcea, Uterine Spasms. 122 Coffee, Ipecac— Excoriating Leucorrhcea, Fall of the Womb. 123 Bryonia. — Liver Complaint, Skin Diseases, Dropsy. 121 Camphor. — Malarial Diseases, Rheumatism. 12-5 Camphor. — Sick Headache, Hysterics. 126 Gold, Iodine. — Glands, Ulcers, Diarrhoea, Flux, Liver. 1-7 Xitric Acid. — Diseases of Females, Sore Mouth and Throat. 128 Chloride of Potash. — Putrid Sore Throat, Biliousness, Diseased Bones.. 129 Hepar Sul. — Diphtheria, Goitre, Hardened Glands. 130 White of Eggs. — Bloody Flux, Ophthalmia, Syphilis, Bowel Compl'ts 131 Mercurius, Milk — Bones, Skin, Bowels, Hectic Fever. 132 Quick Emetics. — Used to produce sleep and relieve pain. 133 Camphor.— Hysterics, Nervous Headache, Asthma. 134 .Sulphur. — Scrofula, Diphtheria, Typhus, Ulcers. 135 Vinegar. — Glandular Swellings, Scrofulous Sores. 136 Xitrate of Silver. — Fever and Ague, Constipation, Hemorrhage. 137 Camphor, Conium. — Syphilis, Fistula, Liver Complaint, Diabetes 138 Arnica. — Boils, Fever and Ague, Leucorrhcea. 139 Hepar Bui., Sulphur. — Dyspepsia, Cardialgia, Diarrhoeas, Gravel. 140 Caraway Seed. — Hysterics, Dysmenorrhoea. 141 Emetics, Coffee. — Cramps, Convulsions, Xeuralgia, Diabetes, Ague. 142 Camphor.— Paralysis, Vertigo, Insanity. 143 — Wasting Diseases. 114 — Is a mild Cathartic. 145 Coffee. — Apoplexy, Mania, Lead Colic, Hernia, Sleeplessness. 146 Xux. — Weakness^of the Bladder, Chilblains, Herpes, Sore Throat. 147 Camphor, Coff. — Onanism, Epilepsy, Diabetes, Consumption, Scurvy. 148 Milk, Magnesia. — One of the most generally useful remedies. 149 Bloodroot. — Salt Rheum, Diphtheria, Piles. Rheumatism. 150 Pulsatilla. — Excessive Menses, Catalepsy, Falling of the Womb. 151 Opium, Alum. — Paralysis, Colic, Dysentery. Sterility. 152 Vinegar and Magnesia. — Headache, Convulsions, Loss of Sight. 153 Arnica. — Bilious Headache, Dyspepsia, Colic, Diarrhoea, Piles, 151 Pulsatilla. — Dysentery, Amenorrhoea, Sprains, Bruises. 155 Coffee. — This remedv'is the woman's friend. 156 — External applications to old sores. 157 Camphor. — Gangrene, Cancer of the Stomach, Dandruff. 158 Lobelia. — Chronic Rheumatism, Asthma, Ophthalmia. 159 Lobelia; internal and external. — Erysipelas, Pneumonia, Typhus. 160 Borax. — Rheumatism, Xight Sweats, Scurvy, Bleeding, Piles. 161 Belladonna. — Epistaxis, Diarrhoea, Colic, Itch. 162 Camphor. — Worms, Uterine Irregularities, Weak Eyes from Reading. 163 Cina. — Tape Worm, Neuralgic Rheumatism, Fever. 164 Elm Bark. — Miscarriage, Uterine Hemorrhage, Dysuria. 165 —Cold in the Head, of Infants; Externally for Burns. 166 Bryonia.— Sick Headache. Vomiting, Jaundice, Croup, Pneumonia. 167 Coffee. — Delirium Tremens, Chorea, Sunstroke. 168 Camphor. — Tedious Labor, Blood Diseases Generally. 734 TABLE OF REMEDIES. .ABBREVIATION. 169 Sen 170 Sen Aur 171 Sep 172 Sil 173 Spig 174 Spong 175 Squi 176 Stan 177 Staph 178 Stram 179 Sul 180 Sul Ac 181 Symp 182 Tabac 183 Tarax 184 Tar Em 185 Tereb Ol 186 TeuMV 187 Thu 188 Trios Perfo 189 Urt U 190 Val Off 191 Yari 192 Verba 193 Yer Alb 194 Yer Vir 195 ViburnPru 196 Vine 197 Yio Tri 198 Xanthoxl 199 Zin Sul ;200 Zinc LATIN. Senega Senecio Aurans Sepia Silicea Spigelia Spongia Tosta Squilla Maritima Stannum Staphysagria Stramonium Sulphur Sulphuris Acidum Symphitum Officinale Tobacum Taraxicum Tartarus Erneticus Terebinthina Oleum Teucrium Marum Verum Thuya Occidentalis Triosteum Perfoliatum Urtica Urens Valeriana Officinalis Variolin Yerbascum Thapsus Veratrum Album Yeratrum Viride Viburnum Prunifolium Vinca Minor V^iola Tricolor Xanthoxylum Fraxincum Zincum Sulphas Zincum ENGLISH. Rattlesnake Root Ragweed Cuttle Fish Juice Silica Pink Root Burnt Sponge Squills Tin Stave's Acre Jimstown Weed Sulphur Sulphuric Acid Common Comirey Tobacco Dandelion Tartar Emetic Spirits of Turpentine Cat Mint Tree of Life, Arbor Vitse White Ginseng Nettle Valerian Cowpox Virus Mullein White Hellebore Black Haw American Hellebore Periwinkle Pansy Prickly Ash Sulphate of Zinc Zinc TABLE OF ANTIDOTES AND DISEASES. 735 ANTIDOTES. DISEASES. 169 Arn., Bell. — Diabetes, Chronic Cough. 170 Pulsatilla. — Hay Asthma, Coryza, Bright's Disease, Dropsy. 171 Lemon Juice. — Menstrual Difficulties, Sick Headache, Ozena. 172 Camphor.— Old Ulcers, Diseased Bones. 173 Coffee.— Nervous Sick Headache, Neuralgia, Worms, Toothache. 174 Camphor. — Croup, Hoarseness, Spitting Blood. 175 Camphor. — Hemopthysis, Bronchitis, Diabetes, Cough. 176 Pulsatilla. — Cardialgia, Mucous Consumption. 177 Camphor. — Toothache, Rheumatism of Joints and Muscles. 178 Lobelia. — Brain Fever, Spasms, Hydrophobia, Asthma. 179 Aconite, Puis. — Useful in Scrofulous and Skin Diseases. 180 Magnesia, Lemon Juice. — Night Sweats, Bed Sores, Mercurial Salivat'n 181 — Applied Externally for old Ulcers. 182 Lobelia, Coffee.— Hernia, Sea Sickness, Renal Colic. 183 Vinegar. — Torpid Liver, Flatulence, Hives. 184 Tannin, Ipecac— Croup, Smallpox, Cough, Pneumonia, Yellow Fever. 185 Coffee. — Bloody Urine, Rheumatism, Typhus, Worms. 186 Camphor.— Coiic and Wakefulness of Infants. 187 Sassafras. — Cancer of the Womb, Syphilis, Gonorrhoea. 188 Ipecac. — Bilious Colic, Asthma, Rheumatism, Bilious Fever. 189 Belladonna. — Hives, Burns, Gravel, Dysentery. 190 Coffee. — Nervous Pains, Epilepsy, Rheumatism. 191 Smallpox. — This is the only reliable article for Vaccination. 192 — Piles, Varicose Veins, Fever Sores. 193 Camphor. — Cholera, Cramps, Vomiting, Colic. 194 Coffee. — Female Diseases, Fevers, Use instead of Aconite. 195 Pulsatilla.— Hysteria, Cancer, After Pains, Prevents Miscarriage. 196 Sulphur.— Eruptions and Skin Diseases 197 —Scald Head, Fetid Urine. 198 Ammonia. — Salivation, Amenorrhea, Catarrh. 199 Hepar Sul., Ignatia. — Somnambulism. Nervous Diseases. 200 Hepar Sul., Ignatia.— Red Eyelids, Spasms, Paralysis, Pimples. PAH.T SIXTEENTH, CHAPTER XXXVII. A LIST OF ALL THE SYMPTOMS DEVELOPED BY DIFFERENT DIS- EASES; ARRANGED IN RELATION TO THE PART OF THE BODY AFFECTED AND THE SYMPTOMS OF EACH PART FOLLOW EACH OTHER IN ALPHABETICAL ORDER. THE REPERTORY. This Kepertory is to be used in selecting a remedy to cure some disease or symptom of disease. It can be almost as well used when you do not know any name for the trouble, as when you do, having only to learn all of the symptoms you can, both those that can be seen and those which can only be felt, and writing each symptom on a line by itself, you proceed to find each symptom in the Repertory, and then note on the slip of paper you have your symptom down on, on the same line with each symptom the abbreviated names of the remedies that appear in this Full Faced Black Type. If you do not find any of that type following your symptom, take the remedies appearing in Italics, and if none of them, then the Roman or com- mon type. {For dose, etc., of remedy selected, see Page 78-79 and Index). Full Faced Type indicates remedies which are known to be the most certain to cure the symptom they follow. Italic type indicates remedies that are good, but not so good as those in full faced type. Roman, or common type, are used for remedies having a very general reference to the symptoms which they follow. Here is an example of a case of scarlet fever arranged and the remedy selected; by reference to the pages of the Repertory named you will be able to understand it easily : 1. Throat (Pharynx) Redness of , page 26. 2. Throat Swelling, page 26 3. Urine Red (Scanty) page 81 4. Palate, Redness of, page 25 5. Headache as if head would burst, p. 6. 6. Delirium, page 2 7. Skin Red, Burning, page 122 Aeon . Bell.. Can.. . Ars... Bell.. Ars... Br v.. . Apis. Bry. Bell. Bell. Calc Bell. Aeon. Bell.. Chi.. Bry.. Sil.. Bry. Bell. Merc- ian.. Carbv Spig, Op... Sil.. Dulc. Merc 8. Scarlet Rash, page 124 Aeon . Bry . . Bell In the above case you will readily see that Belladonna is the only remedy that appears in full faced type after every symptom, and it may be relied on to cure the case, withoutfail. Sometimes there will be no remedy in the full faced type after every symptom, then take the one that approaches most nearly to it, being careful to get all the symptoms down. 736 I. MIND AND DISPOSITION. CONDITION OF THE MIND General Symptoms. AMOROUS : Ant. crud. Canth. Graph. Hyosc. Ign. Lye. Nux vom. Phosph. Plat. Puis. Sil. Stram. Ye- ratr. ANXIETY, FEAR: Aco. Arn. Ars. Aur. Bell. Bry. Calc. Carb. veget. Cham. Cocc. Graph. Hell. Tgn. Lye. Nux vorn. Puis. Rhus. Sep. Stram. Sulph. Yeratr. BOLDNESS : Ign. Op. Puis. DISTRUSTFUL : Bar. BeU. Caust. Cic. Dros. Hell. Hyosc. Lye. Ph. ac. Puis. Sulph. ac. FITFUL MOOD: Aur. Carb. an. Ferr. Graph. Ign. Kali. Plat. Stram. Sulph. ae. Zinc. GENTLE : Cocc. Croc. Ign. Lycop. Puis. Sil. Sulph. GREEDY: Ars. Lye. Natr. c. Puis. Sep. HAUGHTY: Lycop. Plat. Stram. Yeratr. HOPELESS : Ars. Aur. Calc. Caust. Cham. Con. Graph. Ign. Lye. Puis. Rhus. Sulph. INDIFFERENT : Chin. Cocc. Con. Ign. Natr. mur. Phos. Ph. ac. Puis. Sep. IRRITABLE MOOD: Aeon. Aur. Bell. Bry. Cham. Coff. Ign. N. mur. N. vom. Phosph. Puis. Sep. Sulph. Yeratr. JOCOSE MOOD: Aur. BeU. Cann. Carb. an. Coff. Croc. Hyosc. Natr. c. Op. Phosph. Plat. Puis. Stram. Yeratr. Zinc. PEEYISH : Alum. Aur. Calc. Caust. Cham. Con. Ign. Lye. Merc. Natr. c. Nitr. ac. Phosph. Plat. Puis. Sil. Sulph. SAD: Aeon. Bellad. Cham. Graph. Ign. Lye. Natr. m. Plat. Puis. Rhus. AS CAUSED BY DISEASE. SERIOUS MOOD: Cocc. Led. Sulph. ac. Thuj. Cloudiness. CLOUDINESS: Bell. Bry. Cann. Canth. Caps. Chin. Cocc. Carb. veg. Caust. Hyosc. Ign. Lpec. Kali. N. vom. Op. Yeratr. CONFUSION: Ant. cr. Ars. Bell. Bry on. Canth. China. Euphr. Ferr. Ign. Kali. Natr. carb. Nux vom. Phosph. Ph. ac. Puis. Rhus. Sec. corn. Spig. Staph. Zinc. DIZZINESS : Aeon. Alum. Anac. Ars. Aur. Bell. Bry. Calc. Carb. veg. Caust. China. Coloc. Con. Graph. Lye. Natr. mur. Nitr. ac. N. vom. Op. Phosph. Phos. ac. Puis. Sep. Sil. Sulph. Veratr. DULLNESS: Aeon. Calc. Canth. Hyosc. Petr. Sep. Stram. Sulph. Zinc. INTOXICATION: Agaric. Antim. crud. Arg. Ars. Asar. Aur. Bell. Bry. Camph. Caps. Caust. Cham. Cic. Cocc. Coff. Con. Croc. Ferr. Graph. Hyosc. Ign. Ipec. Led. N. vom. Ph. ac. Op. Puis. Rhus. Sec. corn. Sil. Stram. Veratr. LOSS OF CONSCIOUSNESS: Ars. Bell. Calc. Canth. Hyosc. Nitr. ac. N. vom. Ph. ac. Rhus. Stram. Veratr. STUPEFACTION: Aeon. Ars. Asa Bell. Bry. Calc. Camph. Caps. Caust. Cham. Coff. Con. Cupr. Dulc. Ferr. Graph. Lye. Hell. Hy- osc. Lpec. K. vom. Opium. Phosph. Ph. ac. Rhus. Sepia. Stram. Sulph. VANISHING OF SENSES: Ars. Bell. Calc. Camph. Cic. Cupr. Graph. Hyosc. N. vom. Stram. YERTIGO : Ars. Bell. Bry. Camph. Cann. Caps. Cham. Chin. Op. Ph. MIND AND DISPOSITION. ac. Puis. Rhus. Sep. Sec. corn. Sil. Spong. Sulph. Yeratr. Mental Weaknesses. ABSENCE OF MIND : Anew. Am. Bell. Canst. Cupr. Hell. Hep. Hy- osc. Ign. Lye. Merc. Natr. mur. Op. Ph. ac. Rhus. Sep. AVARICE: Puis. COMPREHENSION, ready: Coff. Op. Valer. — heavy: Ambra. Camph. Cham. Con. Lye. Nitr. ac. Op. Ph. ac. Zinc. DELIRIUM: Ars. Aur. Bell. Bry. Camphora. Canth. Cham. Cina. Con. Cupr. Dulc. Hyosc. Op. Phosph. Pliosph. ac. Plat. Rhus. Sec. cor. Strani. Sulph. Yeratr. — with frightful specters : Bell. — nocturnal, raving about the day's business: Bry. — without consciousness : Hyosc. Puis. — loquacious, with open eyes : Coloc. Op. Veratr. — quiet, with stupefaction : Ph. ac. — with anxiety, fear of death, over- estimation of one's self : Plat. — bland, with loss of recollection : Rhus. — without consciousness, often ter- minating in rage : Sec. corn. — various, shameless, haughty : Strani. — religious, haughty : Yeratr. — with disposition to escape: Bry. Cocc. Strain. DERANGEMENT, mental: Bell. Canth. Cupr. Hyosc. Op. Plumb. Strani. Yeratr. EXCITEMENT of the fancy: Aeon. Ambr. Anac. Ant. Crud. Am. Bell. Chin. Coff. Hyosc. Lachesis. Op. Phosph. Phosph. ac Pulsat. Strani. EXHAUSTION from mental labor: Aurum. Cham. Colch. Natr. Nux vom. Phosph. Puis. Sil. Spig. Spong. Staph. — nervous : Aur. Bell. Calc. Dig. Iod. Natr. c. N. yoni. Phosph. Sep. Staph. Sulph. Zinc. FOREBODINGS: Aeon. Spig. FOREBODING of death: Stram. Veratr. ILLUSIONS OF THE FANCY: Bell. Bryon. Caust. Hell. Op. Phosph. Rhus. Staph. Stram. ILLUSIONS OF SENSE: BeU. Op. Phosph. Ph. ac. Plat. Sec, Stann. Stram. — slow flow of : Cann. Chin. Ipec. N. vom. Op. Rhus. Buta. Spig. Veratr. INSENSIBILITY : Hell. Hyosc. Op. Ph. ac. Sec. Corn. Stram. INSANITY: Aeon. Agar. Ant. crud. Ars. Bell. Cann. Canth. Coccul. Con. Cupr. Dulc. Hyosc. OpAum. Sec. corn. Strani. Sulph. Yeratr. Zinc. — with haughtiness : Hyoscyam. Stram. Yeratr. — mirthful : Crocus. Ign. Stram. — mild: Croc. Yeratr. — religious : Yeratr. — talkative: Stram. — furious : Hyosc. Stram. LAUGHTER: Bellad. Crocus. Hy- osc. Strain. Yeratr. LOSS OF RECOLLECTION: Aeon. Alum. Anac. Arg. Arn. Bar. Bell. Bry. Calc. Camph. Cannab. Cham. China. Con. Cupr. Dig. Hell. Hyosc. Ign. Natr. mur. N. vom. Opium. Phosph. Plat. Rhus. But a. Sep. Silicea. Stann. Staph. Stram. LOSS OF CONSCIOUSNESS: Agar. Bell. Bryon. Canth. Cham. Cocc. Cupr. Hyosc. Ipec. Nux vom. Op. Rhus. Stram. Yerat. MISTAKES IN TALKING: Cham. Chin. Con. Croc. Ign. Lach. Lye. MIND AND DISPOSITION. 3 Natr. mur. N. vom. Puis. Sep. Sil. EAGE: Aeon. ^grar. Ars. Bell. Caraph. Cann. Canth. Cham. Coc- cul. Croc. Cupr. Drosera. Hyosc. Opium. Petr. Plumb. Euta. Sec. corn. Strain. Yeratr. SHAMELESSNESS: Hyosc. N. vom. Op. Strain. Verat. WANDERING OF THE MIND: Aeon. Am. Aur. Bell. Caust. Cham. Cocc. Croc. Hell. Ign. Kali. Natrum mur. Phosph. Ph. ac. Plat. Sep. Stann. Sulphur. Verat. WEAKNESS OF MIND : Bar. Bell. Defects of Memory. .FORGETFUL : Aeon. Alum. Anac. Arn. Ars. Bar. Bell. Colchic. Coccul. Digit. Hell. Hyosc. Ign. Laches. Lye. Natr. mur. Petr. Phosph. Plat. Rhus. Rhododend. Sec. com. Silic. Spig. Staph. Strain. Sulph. Yeratr. Viol. odor. MEMORY, involuntary : Hyosc. — quick: Aeon. Coff. Hyoscyam. Lach. Op. Viol. odor. — defective : Aeon. Anac. Arn. Bell. Bryon. Calc. Camph. Cocc. Graph. Hyosc. Puis. Sep. Spigel. Strain. Sulph. Yeratr. — feeble : Aeon. Alum. Ambr. Anac. Ars. Aur. Bell. Bryon. Calc. Caust. Colch. Cupr. Dig. Graph. Hep. Hyosc. Ign. Lye. Natr. mur. Op. Tlat. Pulsat. Rhus. Sep. Spigel. Staph. Strom. Sulph. Yeratr. — loss of : Bell. Camph. Con. Hyosc. Nat. mur. Op. Stram. Yeratr. MEMORY, decrease of: Anac. Ars. Aur. BeU. Hell. Hyosc. Op. Stram. Yeratr. Mental Derangements. ANGER, also with vehemence : Cham. — with fright. Aeon. — with f eeling of coldness : Ars. — with subsequent ill-humor : Bry. — with silent grief : Ign. — with irascible mind : N. vom. — with pushing away that which one holds in one's hand : Staphis. — with mental derangement: Yera- trum. ANXIETY AND FRIGHT. — with joyful surprise : Coff. — with subsequent starting during sleep : Hyosc. — followed by grief or spasms : Ign. — followed by anxiety or nocturnal pains : Merc. — with fear, heat of the head, and spasms: Op. — followed by mental confusion: Plat. — followed by diarrhoea : Puis. — with suffocative fits and blueish face : Samb. — with involuntary stool and icy coldness : Yeratr. GRIEF. — caused by mortification and fol- lowed by mental confusion : Bell. — with shame and suppressed anger : Ign. — with nocturnal anxiety and com- plaints : Merc. — followed by spasms : Op. — with emaciation, drowsiness, and morning-sweats : Ph. ac. GRIEF, with apprehensions for the future and day-drowsiness : Staph. HOMESICKNESS. — with flushed face and sleepless- ness: Caps. — with noctural anxiety and sweat: Merc. — with emaciation and morning- sweat, drowsiness : Ph. ac. JEALOUSY. — with vehemence and dehrium : Hy- osc. — insane, with distrust : Lach. MIND AND DISPOSITION. UNFORTUNATE LOVE. — with thoughts of suicide : Aur. — with jealousy and loquacity: Hy- ose. — with silent grief : Ign. — with desponding mood : Lack. — with emaciation and morning- sweat : Ph. ac. — with unmerited mortification : Staph. "WRATH. — with cries, hsemoptisis, palpitation : Arn. — with loss of consciousness or delir- ium : Bell. — with flushed cheeks, thirst : Bry. — hot sweat about the head, spasms : Cham. — thirst, vomiting of bile, chilliness heat : Nux voni. — laughter, weeping, anxiety: Plat. — with internal chilliness, no thirst, but dizziness : Puis. — on account of unmerited humilia- tion, whole body sore : Staphis. Mental Derangement. FOREBODINGS OF DEATH. — with foretelling of the day of death : Acoii. FOREBODINGS OF DEATH, with anxiety and restlessness : Bell. — alternating with fits of rage : Strain. HYSTERIA AND HYPOCHON- DRIA, — with anxiety, disposition to sui- cide: Aur. — caused by suppression of the sexu- , al instinct : Cou. — with fitful mood, sleeplessness: Ign. — of those who lead a sedentary life and revel at night, with consti- pation: N. vom. — after unmerited insults, with flatu- lency: Staph. — with tremulous and excessive sensi- tiveness : Yaler. RAGE, — timorous, with frightful spectra: Bell. — amorous, with shameless gestures : Cauth. — with haughty manners and spasms : Cupr. —with furious jealousy : Hyosc. — with amorous tenderness and jeal- ousy: Lach. — silent, with religious melancholv: Lye. — with frightful visions, alternating with stupor : Op. — censorious, with trembling and spasms: Plat. — raving, with frightful spectra: Strain. — w. wicked imprecations : Yeratr. SUICIDE, DISPOSITION TO, — with amorous fancies : Ant. crud. — with nocturnal anguish and despair : Ars. — w. religious melancholy: Aur. — w. anxiety, restlessness, frightful spectra: Bell. SUICIDE, DISPOSITION TO, with silent anguish, fear of death : Puis. — with stupefaction of the head, rest- lessness: Rhus. SOMNAMBULISM, — with 23rediction of the day of death : Aeon. — with intense fancy, and dullness of feeling: Op. — with clairvoyance, increased sensi- bility: Phosph. Vertigo. According to its nature. GENERALLY: Aeo. Ambr. Arn. Bell. Bry. Calc. Camph. Cann. Garb : veg. Gic. Cocc. Coff. Cupr. Dig. Graph. Hell. Hep. Ipec. JKerc Mosch. Lye. Natr. Natr. mur. Nitr. Nitr. etc. N. vom. Op. Petr. Phosph. Ph. ac. Plat. Puis. Rhus. £ec. Corn. Spic. Staph. Stram. Stann. Sulph. Tliuj. Verat. Zinc. AS IF FALLING: Aeon. Am. Ars. Canu. Cham. Cic. Con. Croc. Hep. Ign. Ipec. Nitr. ac. N. vom. Op. Puis. Sec. cor. Sil. Spig. Sulph. Staph. Stram. AS IF FALLING BACKWARD: Bry. Campli. Chin. N. vom. Ph. ac. Rhus. Spig. Stram. AS IF FALLING SIDEWISE: Arsen. Cann. Caust. Con. Euphr. N. vom. Puis. Staph. Sulph. AS IF FALLING TO RIGHT SIDE: Aeon. Ars. Calc. Rhus. Ruta. AS IF FALLING TO LEFT SIDE : Aur. Bell. Spig. Zinc. AS IF FALLING FORWARD: Arn. Caus. Cic. Cupr. Ferr. Graph. Natr. mur. Petr. Ph. ac. Puis. Rhus. Sil. Spig. Sulph. TURNING: Aeon. Arn. Bell. Bry. Calc. Carb. veg. Caust. Chel. Cic. Cocc. Croc. Cupjr. Ferr. Merc. Mur. ac. Natr. mur. N. vom. Ph. acid. Puis. Rhod. Rhus. Sep. Sil. TURNING IN A CIRCLE : Aconit. Bell. Bry. Calc. Caustic. Cic. Con. Ferr. Hell. Kali. Merc. Nux. vom. Op. Puis. Rhus. Sep. Staph Yeratr. Vertigo. With accompanying ailments. ANXIETY: Ignat. Op. Rhus. Rho- dod. ERUCTATIONS : N. vom. EYES, gauzy before : Laur. Sabin. COLIC : Coloc. Petr. Spig. Stram. DEAFNESS : N. vom. Puis. DIM SIGHT : Stram. DIARRHOEA : Cham. Stram. CHILLINESS : Cocc. Plumb. Rhus. Yeratr. FAINTING: Bar. Bryon. Canth. Chamom. Croc. Hep. Ign. Laur. N. vom. Plat. Sabad. HEAT: Aeon. Arg. Bry. Croc. Ign. Laur. Led. Merc. Nux vom. Puis. Stram. HEADACHE : Aur. Bar. Calc. Con. Canth. Cupr. Ferr. Graph. Hep. Ign. Lach. N. vom. Puis. Strain. NAUSEA: Aeon. Ant. crud. Arg. Arn. Bar. Bell Bry. Chin. Coff. Calc. Coccul. Ferr. Hyosc. N. vom. Puis. Petr. Phosph. Sil. Spig. NOSE, BLEEDING: Aeon. Ant. crud. SuIjjIi. OBSCURED VISION: Aeon. Arg. Bell. Canth. Cham. Cic. Croc. Dulc. Ferr. Hyosc. N. vom. Natr. mm*. Nit. ac. Op. Puis. Phosphor. Merc. Sec. cornut. Stram. Sulph. PALE FACE: Puis. SWEAT: Rhus. — cold: Ign. Yeratr. VOMITING : Calc. Graph. Hyosc. YAWNING: Agar. Petr. II. HEAD. Internal. MENINGITIS: Aeon. Arn. Bell. Bry. Camph. Canth. Crotal. Cupr. Glonoin. Hell. Hyos. Laches. Mercur. Op. Phosph. Stram. (See general Index). CONCUSSION OF BRAIN: Am. Bell. Cic. Merc. Ph. ac. Sep. e HiiiAlk HYDROCEPHALUS. — acute : Aeon. Bell. Bry. Hell. Merc. Op. Sulph. — chronic: Ars Hell. Sulph. HEADACHE. Sensations as if the brain were distended: Bell. Caps. — like a band around the head : Aeon. Carb. veg. Mercur. Nitr. ac. Plat. Si3ig. Sulph. BEATING: Aco. Ars. Asar. Aur. ' Bell. Bryon. Calc. €aps. Carb. veg- et. Caust. Cham. Cocc. Hjosc. Ign. Ipec. Lycopod. Nitr. ac. Phosph. Puis. Rhus. Sep. Silic. Sulph. Ye- ratr. — as if the brain were moved : Aeon. Ars. Bell. Bry. Croc. Kali. Bheura. Spig. -—rush of blood: Aeon. Ambr. Ant. crud. Arn. Asa f. Bar. Bell. Bry. Campli. Cann. Canth. Chin. Coff. Calc. Carb. veg. Caust. Coloc. Dig. Ferr. Graph. Hell. Hyosc. Ign. Iod. Kali. Lack. Lye. Merc. Natr. Nitr. ac. Nux vom. Op. Plumb. Pulsat. Phosph. Rhus. Sep. Sil. Sulph. Spong. Staph. Stram. Thuj. Valer. Veratr. — boring: Ant. crud. Bell. Arg. Calc. Cocc. Chin. Dulc. Hepar. Ipec. Ign. Plat. Staph. Phosph. ac. Bhodod. Sep. Sil. Spig. Stram. Sulph. • — as if bruised: Aeon. Ars. Aur. Camph. Cham. Chin. Coff. Euphr. Hell. Ignat. Ipec. Phosph. Nux vom. Puis. Rhus. Sep. Veratr. — as if it would burst: Ant. crud. Asar. Bar. Bellad. Calc. Caps. Cham. Chin. Coff. Con. Ign. Natr. mur. Nux vom. Phosphor. Rhus. Sep. Sil. Spig. Spong. Sulph. — burning: Aeon. Arn. Bell. Bry. Cupr. Hell. Ipec. Merc. Natr. N. vom. Phosph. Ph. ac. Rhus. Sec. corn. Spig. Staph. Stann. Veratr. i — buzzing : Caust. Cocc. Phos. Sulph. Veratr. ! — crawling : Aconit. Arn. Bar. Cocc. Hyosc. Puis. Rhus. Sulph. Thuj. ! — digging: Agar. Aur. Bar. Brij. Dulc. Ign. N. vom. Spig. ! — drawing: Aeon. Aur. Bell. Calc. Carb. veg. Cham. Cina. Coloc. Cupr. Dulc. Graph. Hell. Lye. Ipec. N. Tom. Nitr. ac. Petr. Plat. Puis. Rhus. Sep. Sil. Sulph. Veratr. DULL HEADACHE : Antimon. crud. Bry. Calc. Carb. veg. Chin. Camph. Cocc. Coff. Dulc. Hell. Ign. Natr. mur. Ph. ac. Plat. Puis. Veratr. Zinc. HEAVINESS OF HEAD: Aeon. Arn. Asa f. Agar. Alum. Ars. Bell. Bry. Camph. Cann. Cham. Chin. Cic. Coccul. Coff. Croc. Cupr. Calc. Carb. veg. Caust. Con. Digit. Dulc. Bros. Euphr. Ferr. Hell. Hyosc. Ign. Ipec. Kali. Lye. Merc. Natr. mur. Nitr. acid. N. voin» Opium. Petr. Plumb. Puls- at. Phosph. Ph. ac. Plat. Sabin. Spig. Spong. Staph. Stram. Silic. Stann. Sulph. Thuj. Veratr. HAMMERING: Calc. Chin. Coff. Lach. Natr. mur. Phosph. Sil. Sulph. HEAT : Aconit. Alum. Arn. Bell. Bry. Calc. Canth. Caustic. China. Coff. Dig. Dros. Dulc. Euphr. Hell. Hyosc. Ign. Ipec. Lycop. Merc. Natr. mur. Nitr. ac. N. vom. Petr. Phosphor. Plumb. Puis. Rhus. Sep. Sil. Stann. Stram. Sulph. HEMICRANIA : Asar. BRY. Chin. Coloc. Ign. Ipec. N. vom. Rhus. Sep. AS AFTER INTOXICATION: • Bryon. Merc. Natr. mur. Puis. JERKS: Ambr. Bell. Bry. Calc. HEAD. Dig. Mur. ac. Natr. mur. N. vom. Puis. Petr. Phos. Spic. Spong. Sep. Stann. Thuj. Voter. SIMPLE PAIN: Aeon. Ars. Bar. Bell. Calc. Canth. Carb. veg. Chin. Cocc. Croc. Cupr. Hell. Hyosc. Iod. Lach. Lyeojj. Merc. Mur. ac. Natr. < ■. Natr. mur. Nitr. Nux vom. Op. Ph. acid. Plumb. Pills. Ehus. Sep. Sil. Spig. Strain. Sulph. Yaler. AS FROM A NAIL (clavus :) Aeon. Agar. Coff. Hep. Ign. X. vom. Ruta. Thuj. PRESSING ASUNDER: Aeon. Bar. Bell. Bry. Calc. Ign. Lye. Merc. Natr. mur. Nitr. Nux vom. Sep. Sil. Spig. Stann. Staph. PRESSING TOGETHER: Alum. Asa foet. Bry. Calc. Cina. Cocc. Graph. Hell. Phosph. ac. Sil. Staph. PULSATING: Bell. Bryon. Chin. Petr. Phosph. Puis. Rhus. Sulph. PRESSURE : Aeon. Ambr. Arg. Arn. Asaf. Asar. Anac. Ars. Aur. Bell. Bryon. Calc. Caps. Cham. Chin. Cic. Cina. Cocc. Coff. Croc. Dig. Hell. Hyosc. Iod. Ign. Ipec. Lach. Merc. Mur. ac. N. vom. Natr. carb. Natr. mur. Nitr. ac. Petr. Pulsat. Phosphor. Phosph. ac. Plat. Spig. Sep. Sil. Stann. Staph. Sulph. Voter. Zinc. ROARING: Aur. Ferr. Graph. Phosph. Sulph. STINGING : Aeon. Ambr. Arg. Arn. Asa f. Alum. Ars. Bar. Bell. Bov. Bry. Canth. Caps. Chamom. Chin. Cic. Calc. Caust. Con. Dulc. Ferr. Hep. Ign. Ipec. Natr. mur. N. vom. Petros. Phosph. Plumb. Puis. Ph. ac. Rhus. Sabacl. Selen. Staph. Sep. Sil. Sulph. Thuj. STUPEFYING: Anac. Ars. Ant. crud. Arn. Bell. Bov. Cann. Cic. Cina. Calcar. Hyosc. Ign. Mur. ac. Phosph. Natr. carb. Nitr. Ph. ac. Plat. Ruta. Sabad. Sepia. Stann. Staph. Verb. Zinc. TEARING: Alum. Ambr. Anac. Ant. cruel. Arg. Arn. Asar. Bell. Bry. Calc. Camph. Canthar. Caps. Carb. veget. Caust. Cham. Chin. Cocc. Coff. Coloc. Con. Ign. Ipec. Lycop. Mur. ac. Natr. mur. N. vom. Ph. ac. Puis. Rhus. Sil. Spig. Sulph. TWITCHING : Arn. Bell. Bry. Carb. veg. Caust. CJiin. Ign. N. vom. Ph. ac. Staph. Sulph. VIBRATING: Lye. Nitr. ac. Nux vom. Sil. Stann. According to the Part of the Head FRONT PART OF THE HEAD: Aeon. Alum. Ambr. Anac. Antini. cruii.Arg. Arn. Arsen. Asa foet. Asar. Aur. Bar. Bell. Bry. Camph. Calc. Cann. Canth. Caps. Carb. veg. Caustic Cham. Chin. Cicc. Cina. Cocc. Coff. Colch. Coloc. Con. Croc. Cupr. Dig. Dros. Dulc. Euphr. Ferr. Graph. Hell. Hyosc. Ign. Iod. Ipec. Kali. Lye. Merc. Natr. mur. Nux vom. Op. Phosph. Plat. Plumb. Puis. Rhodod. Ilhus. Sabin. Samb. Sep. Sil. Spig. Spong. Staph. Stann. Sulph. Veratr. Zinc. TEMPLES : Aeon. Agar. Alum. Ant. crud. Arg. Arn. Asaf. Asar. Bell. Bry. Calc. Camph. Cann. Canth. Caps. Chamom. Chin. Cina. Cocc. Con. Cupr. Dig. Euphr. Hell. Hep. Ign. Lach. Nitr. ac. Op. Phosph. Phos. ac. Eheum. Rhus. Pdioclod. Sabin. Spig. Spong. Stann. Staph. VERTEX: Aeon. Ambr. Ant. crud. Arg. Arn. Asaf. Aur. Bell. Bry. Cann. Canth. Caps. Caust. Chin. Cina. Cocc. Coff. Coloc. Con. Croc. 8 HEAD. Cupr. Ferr. Graph. Hell. Ign. Loci. Ipec. Laeh. N. voni. Phosph. Ph- at: Plat, Sabin. Samb. Sep. Sil. Spig. Spong. Stann. Staph. Stram. Sulph. Tlmj. Teratrum. OCCIPUT : Aeon. Anibr. Arg. Am. Asa f. Asar. Aur. Bar. Bell. Bry. Calc. Camph. Cann. Canth. Caps. Carb. veg. Chin. Clc. CorT. Colchic. Croc. Cupr. Dig. Dros. Hell. Hy- osc. Ign. Ipec. Lye. Her cur. Mosch. Nitr. Nnx Yoni. Op. Petr. Plat. Puis. Elms. Sabin. Samb. Spig". Spong-. Staph. Stann. Sulph. Thuj. EIGHT SIDE: Aeon. Alum. Ant. rand. Arg. Arn. Asa f. Bell. Bry. Camph. Canth. Canst. Chin. Cin. Coccid. Colchic. Croc. Dig. Dros. Graph. Hep. Ign. Kali. Lach. Lye. Nux voni. Phosph. Ph. ac. Plumb. Puis. Rhus. Sabacl. Sabin. Sil. Spig. Spong. Sulph. Thuj. LEFT SIDE: Aeon. Anibr. Ant. crud. Argent. Arn. Asa f. Asar. Aur. Bell. Bry. Calc. Camph. Cann. Caps. Carb. Yeg. Chin. Clc. Cin. Coec. Coloc. Croc. Cupr. Dig. Dulc. Dros. Euphorb. Ferr. Hell. Hyosc. Iod. Lach. Merc. Nitr. Nitr. ac. Nux voni. Plumb. Puis. Petr. Plat. Rhodod. Bhus. Sabin. Samb. Sec. cor. Sep. Spigel. Spong. Staph. Stann. Sulph. Yeratr. External. BLOTCHES : Ant. crud. Ars. Aur. Hep. Natr. mur. Nux vom. Phosph. Sil. Thuj. BLOATING: Ars. Sulph. BOILS : Bell. Bhus. Arn. BURNING: Am. Ars. Bar. BeU. Bry. Caps. Carb. veg. Coloc. Dulc. Bros. Graph. Phosph. Plat. Sabacl. Sil. Spig. Spong. Staph. Stann. Sulph. Yeratr. CHILLINESS: Bar. Calcar. Carb. veg. Dulc. Kali. N. vom. Ph. acid. Spig. Staph. Yeratr. COLDNESS:- Agaric. Alum. Bar. Calc. Phosph. Ph. ac. Khod. Ye- ratr. — f eeling of : Asar. Cann. Lach. Ye- ratr. DRAWING: Agar. Bar. BeU. Calc. Canth. Chin. Ignat. N. vom. Ph. ac. Puis. Bhus. Staph. ERUPTION : Anac. Ars. Aur. Bar. Calc. Carb. veg. Clc. Con. Graph. Hep. Kali. Merc. Xatr. mur. Petr. Bhus. GNAWING: Caps. Dros. Thuj. HAIR FALLING OUT: Anibr. Ant. crud. Ars. Aur. Bar. Bell. Calcar. Canth. Carb. Yeg. Caust. Con. Ferr. Graph. Hep. Ign." Iod. Kali. Lye. Merc. Natr. mur. Nitr. ac. Petr. Phosph. Plumb. Sec. cor. Sep. Sil. Staph. Sulph. HAIB AS IF PULLED: Aeon. AJum. Arn. Bar. Bry. Canth. Kali. Lye. Mur. ac. Nitr. Phosph. Ph. ac. Rhus. HEBPES: Alumina. Graph. Petr. Rhus. ITCHING: Agar. Alum. Arg. Am Ars. Asar. Aur. Bar. Bell. Bry. Calc. Caps. Carb. Yeg. Caustic. Chin. Conium. Bros. Graph. Hep. Kali. Merc. Lye. Mur. ac. Natr. mur. Petr. Phosphor. Puis. Rhod. Rhus. Buta. Sabacl Sep. Sil. Spig. Staph. Sulph. Thuj. Yeratr. Zinc. LICE: Oleand. Sabad. Staph. Fine Comb. PAIN AS IF CONTUSED: Arn. Ipec. Bhus. Buta. PAINFULNESS : Arsen. BeU. Calc. Caust. HeU. Merc. N. vom. Bhod. Bhus. Thuj. PIMPLES: Ars. Bar. BeU. Kali. Mm-, ac. Natr. c. Petr. Bhus. SU. Zinc. i EYES. 9 SCALES ON THE SCALP: Cal- car. Phosph. Elms. Staph. SCURFS: Ars. Bit. talc. Ferr. Graph. Hep. Lye. Mer& Natr. mur. Petr. Rhus. Ruta. Sil. Staph. Sulph. AS IF THE 3KEN ADHERED: Am. SWEAT : Bar. Bell. Bit. Calc. Chain. Chin. Coloc. Ipec. Graph. Hepar. Nux vom. Mere. Natr. nrar. Nitr. ac. Op. Petr. Phosph. Phosph. ac. Plumb. Puis. Rheum. Rhus. Ruta. Sec. corn. Sep. Silic. Spig. Sulph. Yaler. STINGING: Agar. Alum. Ant. cr. Arn. Asa f. Aur. Bar. Bell. Canth. Caust. Chin. Digit. Hep. Iod. Kali. Natr. mur. Nitr. ac. Phosph. Phos. ac. Sabad. Spigel. Staph. Snlph. Thuj. Yeratr. SWELLING: Ars. Bell. Chain. Caust. Cup. Dig. Euphorb. Op. Phosph. Puis. Rhus. Sep. Strain. Sulph. TEARING : Agar. Alum. Ambr. Bar. Bell. Calc. Digit. Graph. Lyeop. Merc. Natr. Rhus. Ruta. Sabin. Sep. Staph. TENDENCY TO COLD: Kali. Natruin mur. TINGLING: Aeon. Arn. Arsen. Carb. veg. Ferr. N. vom. Rhod. Sabad. Spig. TREMBLING OF HEAD- Cic. Coe. Isrn. III. EYES. Visual Power. AMAUROSIS: Bellad. Calc. Cann. Chin. Cocc. (Con.) Dig. Dulc. Hy- osc. (N. vom.) Mercur. Nitr. ac, Phos. Plumb. Puis. Rhus. Ruta. Sec. corn. Sil. Spig. Strain. Sulph. — incipient: Aurnm. China. Caust. Dulc. Hyosc. Natr. mur. Puis. Sulph. BLINDNESS: Ant. crud. Phosph. Sil. Yeratr. BLURRED : Bell. Bry. China. Dros. Graph. Hyoscyam. Lycopod. Natr. mur. Sil. Stram. CATARACT: Baryta. Cann. Caust. Conium. Euphr. Hyosc. Nitr. acid. Op. Puis. Ruta. Sil. Sulph. DAZZLING: Con. Dig. Dros. Ign. Kali. Lye. Merc. Nitr. ac. Ph. ac. Sil. Stram. Sulph. GLAUCOMA: Phosph. HEMERALOPIA: Bellad. Dig. Hy- osc. Merc. Yeratr. ILLUSIONS OF COLOR: — pale: Dig. — blue: Bellad. Stram. Sulph. Zinc. — checkered : Euphorbium. Kali. Nitr. Sulph. — colored streaks : Con. — fiery yellow : Ph. ac. — yellow: Ars. Canth. Dig. Kali. Sulph. Santon. — gold-colored: Bell. Hyosc. — green: Dig. Mere. — red: Bell. Cann. Con. Croc. Dig. Hep. Hyosc. Spig. Stram. Sulph. — black : Caps. Chin. Cic. Cocc. Merc. Phosph. Staph. — white : Cann. Dig. Kali. Ph. ac. — halo around the light, many-col- ored: Bell. — gray : Phosph. Sep. — green : Phosph. Sep. Zinc. — bright : Calc. — ruin-bold : Nitr. —red: Bell. — black : Phosjm. 10 EYES. ILLUSIONS OF SIZE, SHAPE, DISTANCE. — seeing double: Agar. Aur. Bell. Cic. Digitalis. Euphorb. Graph. Hyosc. Nitr. acid. Merc. Petr. Puis. Secale corn. Sulph. Veratr. — seeing things half : Aur. Calc. Lye. Mur. ac. Natr. mur. VISION, false: Hyosc. — larger: Hyosc. Staph. — brighter: Camph. Hyosc. N. vom. — smaller: Hyosc. — slanting: Stram. — confused: Stram. OPTICAL ILLUSIONS OF THINGS NOT PKESENT: — flashes : Croc. Natr. Spig. — flashes, black : Staph. — gray covering : Phosphor. Sil. — threads: Con. — feathers: Calc. Lye. Natr. Natr. mur. Spig. — fire : Bar. Bell. Bnj. Dig. Dulcam. Natr. mur. Ph. ac. Spig. Staph. Stram. Veratr. — spots, dark: Calcar. Carb. veg. Caust. Con. Dig. Kali. Lye. Natr. mur. Nitr. ac. Petr. Phosph. Sec. corn. Sep. Sil. Sulph. — gauze: Asa f. Alum. Ars. Aur. Bryonia. Caust. Cina. Croc. Drosera Euphorbium. Euphr. Hyosc. Ign. Lye. Natr. mur. Opium. Petr. Phosph. Plat. Bhod. Bhus. Sabin. Sec. corn. Sep. Stram. Sulphur. Thuj. — sparks: Arsenic. Aur. Bar. Bell. Bry. Calcarea. Caust. Coloc. Croc. Dig. Dulc. Kali. N. vom. Op. Petr. Sil. Spig. Veratr. — cobwebs : Agar. Caust. — figures: Camph. Samb. — mist : Aeon. Agar. Alumina. Ambr. Arg. Bell. Bry. Cann. Caust. Croc. Dig. Graph. Kali. Merc. Natr. mur. Ph. ac. Plat. Plumbum. Puis. Ruta. Sec. corn. Spig. Staph. Stram. Sulph. — point : Calc. Con. Dig. Kali. Merc Natr. mur. Nitr. ac. N. vom. Petr. Phosphor. Sulph. — halo around light : Staph. LONG-SIGHTED: Alum. Bell. Bry. Calc. Caustic. Con. Bros. Hyosc. Lye. Natr. mur. N. vom. Petr. Sil. Spigelia. Sulph. AS IF THINGS WEBE MOVING: Bell. Con. Cic. Euphr. Hyosc. Ign. Merc. Sabad. Stram. PHOTOPHOBIA : Aeon. Alum. Arm Ars. Bellad. Bry. Camph. Cham. China. Cic. Cina. Coff. Con. Croc. Euphras. Graph. Hell. Hep. Ign. Kali. Lycopod. Merc. Mur. ac. Nitr. ac. N. vom. Ph. ac. Puis. Sep. Sil. Sulph. SQUINTING : Alumina, Bellad. Hy- osc. Puis. Sec. corn. SENSITIVENESS: Aeon. Antim. crud. Bell. Chin. Coff. Hell. Ign. N. vom. Spig. SHOBT-SIGHTEDNESS : Agar. Anac. Calcar. Carb veg. Chin. Con. Euphr. Graphites. Hyosc. Natr. mur. Nitr. ac. Phos. Ph. ac. Plumb. Puis. Ruta. Stramon. Valer. Thuj. STABING AT ONE POINT: Cicu- ta. Cocc. Buta. Stram. VIBBATIONS : Arsen. BeU. Calc. Carb. veg. Caust. Cham. Con. Dig. Graph. Hell. Ign. Lye. Mur. ac. N. vom. Petr. Phosph. Ph. ac. Pulsat. Sec. corn. Sep. Staph. Sulph. VISION, sudden blackness of : Aeon. Alum. Arg. Ars. Asa feet. Atrc Aur. Bell. Bry. Calc. Carb. veg. Caust. Canth. Caps. Cham. Cic. Cina. Croc, Dros. Dulcam. Ferr. Graph. Hepar. Hyosc. Lye. Merc. Natr. mur. Nitr. Nitr. ac. N. vom. Op. Phosph. Plumb. Puis. Sabin. EYES. 11 Sec. cor. Staph. Stram. Sep. Sulph. VISION, dim : Alum. BeUad. Cham- om. Chel. Rheum. Ruta. Sabad. — pale : China. Croc. Dros. Petr. Puis. Rhus. Sil. — obscured: Aeon. Agar. Arm Ars. Asar. Aur. Bar. Bell. Bry on. Calc. Camph. Caps. Caustic. Cham. Cic. Con. Cupr. Dig. Bros. Euphr. Ferr. Hyosc. Iod. Kali. Lye. Natr. mur. Nitr..ac. Nux vom. Op. Phosphor. Plat. Pulsat. Ruta. Sil. Spig. Stram. Sulph. Thuj. — vanishing of : Agar. Bell. Calc. Cic. Con. Hep. Hyosc. Merc. Natr. m. Nitr. N. vom. Op. Phosph. Puis. Sec. corn. Spig. Staph. Stram. Veratr. — weak: Asar. Agaric. Alum. Ars. Bar. Bell. Calc. Can. Caps. Carb. veg. Chin. Con. Croc. Dros. Graph. Hep. Iod. Lye. Hyos. Ign. Natr. mur. Nitr. ac. Petr. Phosph. Ph. ac. Plumb. Rhus. Ruta. Sec. corn. Sep. Sil. Staph. Sensations. In the eye-balls and eye generally. AGGLUTINATION : Alumina. Bell. Bry. Calcar. Carb. veg. Caustic. Croc. Euphorb. Hep. Ign. Kali. Lye. Nat. mur. Nitr. ac. Nux vom. Phosph. Plumb. Pulsat. Rhus. Ru- ta. Sep. Silic. Stann. Staph. Sulph. Thuj. BURNING : Aeon. Agar. Alum. Ars. Arn. Aur. Asa f. Bar. Bell. Bry. Calc. Canth. Col. Con. Caps. Cham. Chin. Cic. Croc. Dig. Dros. Ferr. Graph. Hell. Ign. Kali. Lye. Mur. ac. Xitr. ac. Nux vom. Phosph. Plumb. Pulsat. Rhod. Rhus. Ruta. Sep. Sil. Spigel. Spong. Staph. Stram. Sulph. Thuj. CORNEA, spots on : Apis. Ars. Aur. Calc. Can. Chel. Con. Euphr. Hep. Lye. N. vom. Sep. Sil. — obscuration of : Ang. Cann. Caps. Chel. Chin. Nitr. ac. Op. Plumb. Puis. Sulph. — ulcers on : Euphr. Ruta. DRYNESS : Agar. Asa f. Asar. Bar. Bell. Bry. Caust. Croc. Euph. Kali. Lye. Natr. mur. Nux vom. Phosph. Puis. Spig. Staph. Sulph. Veratr. DISTORTION: Aeon. Arnic. Ars. Bell. Bry. Camph. Canth. Cham. Cic. Cocc. Cupr. Hell. Hyosc. Opium. Petr. Plat. Plumb. Pulsat. Sec. corn. Spig. Stan. Stram. Sulph. Veratr. ECCHYMOSIS: Arn. Cham. Nux vom. Plumb. EYE-GUM. Agar. Alum. Calcar. Caust. Cham. Chin. Con. Dros. Euphorb. Graph. Hep. Lye. Nitr. ac. Phosph. ac. Sil. Spig. Sulph. EYES, blood flows from: Cham. Euphr. N. vom. Ruta. — gum: Euphr. Ign. Puis. FUNGUS HJEMAT: Apis. Bell. Calc. Lye. Sep. Sil. GLAZED: Bell. Cocc. Croc. Op. Ph. ac. Spig. HEMORRHAGE : Bell. Cham. Euphr. N. vom. INFLAMMATION : Aeon. Arnbr. Apis. Arn. Ars. Bar. Bell. Bry. Calc. Camph. Canth. Carb. veg. Cham. Chin. Coloc. Con. Cupr. Dig. Dulc. Euphras. Euphorb. Ferr. Graph. Hep. Hyosc. Ignat. IpeG. Kali. lye. Merc. Natr. mur. Nitr. ac. N. vom. Opium. Phosph. Ph. ac. Plumb. Puis. Rhus. Sep. Sil. Spig. Staph. Sulph. Veratr. LACHRYMATION : Aeon. Agar. Alum. Ambr. Anac. Arn. Ars. Asar. Bar. Bell. Bry. Calc. Camph. Canth. Caps. Carb. veget. Canst. Chelid, Chin. Cina. Coff. Coloc. Con. Croc. Digit. Euphr. Fer. Graph. Hell. Hep. Ign. Kali. c. Lach. Lvc. Merc. Natr. mur. Nux 12 vom. Op. Petr. Phosph. Ph. ac. Plat. Puis. Bhodod. Rhus. Ruta. Sabadilla. Seneg. Sep. Sil. Spig. Spong. Stan. Staph. Strain. Sulph. Valer. Teratr. Zinc. L ACHRYMATION, smarting : Aeon. Bell. Calc. Carb. veg. Con. Dig. Euphr. Graph. Lycop. Natr. mur. Phosph. ac. Rhus. Sabin. Sing". Staph. Sulph. LOOKS, anxious: Strain. — staring : Aeon. Am. Bryon. Camph. Canth. Cic. Cina. Cocc. Cupr. Hell. Hyosc. Nux vom. Op. Sec. corn. Spig. Strain. Teratr. — disturbed: Canrphor. Cupr. Op. Sec. corn. Strain. Verat. — wild: Cupr. Hyosc. Opium. Sec. corn. MOTIONS, convulsive : Canthar. Cham. Cupr. Hyosc. — involuntary: Spig*. Stram. PAIN, simple: Aeon. Arnic. Bar. Bell. Bry. Calc. Canth. Carb. veg. Cin. Croc. Dig. Euphr. Petr. Phosph. Plat. Plumb. Fulsat. Rhus. Ruta. Sabin. Sep. Sil. Spig. Stann. Staph. Teratr. PELLICLE ON EYES : Cann. Eu- phras. Puis. Ruta. PRESSURE, outward: Jicon. Asa foet. Asar. Aur. Calc. Canrph. Cann. Canth. Con. Hell. Ign. N. vom. Rhus. Spig. Staph. — inward: Agaric. Anac. Aur. Bry. Calc. Caust. Kali. Ph. acid. Spig. —as from a foreign body: Ambr. Anac. Arn. Ars. Asa f. Aur. Bar. Bell. Calc. Caps. Carb. veg. Caust. China. Cina. Cocc. Con. Croc. Ferr. Hyosc. Ign. Merc. Natr. mur. Nitr. ac. Petr. Phosph. Ph. ac. Plat. Plumb. Puis. Rhus. Sep. Sil. Spig. Stann. — together: Arg. Sabin. Yerat. PROTRUDED: Aeon. Am. Ars. Aur. Bell. Canth. Caps. Cin. Cocc. Con. Cupr. Hep. Hyoscyam. Op. Rhus. Spigel. Spong. Staph. Stram. Verat. PUPILS, dilated: Aeon. Agar. Anac. Arn. Ars. Asa f. Aur. Bell. Calc. Camph. Canth. Caps. Caust. Chin. Cina. Con. Croc. Cupr. Dig. Dros. Hell. Hep. Hyosc. Ign. Ipec. Mur. ac. Nitr. ac. Nux vom. Petr. Ph. ac. Plumb. Pulsat, Sec. corn. Spig. Stann. Staphys. Stram. Teratr. Zinc. — contracted: Aeon. Agar. Anac. Arn. Ars. Aur. Bell. Calcar. Camph. Canthar. Capsic. Cham. Chin. Cic. Cina. Cocc. Croc. Dig. Dros. Hell. Hyosc. Ign. Mur. ac. Natr. carb. Ph. ac. Plumb. Puis. Sec. com. Staph. Stram. Stann. Sulph. Thuj. Teratr. — immovable : Aeon. Baryt. Bell. Cham. Chin. Cupr. Dig. Ferr. Hyosc. Op. Plumb. Seneg. Spig. Strain. —suddenly dilating and contracting : Bar. PUS: Ars. Bry. Euphorb. Hep. X. vom. Ruta. RUSH OF BLOOD TO EYES: Aur. Bell. Plumb. Sep. Spig. SMARTING: Ambr. Agar. Alum. Ars. Bell. Bry. Calc. Canth. Carb. veg. Caust. Chin. Con. Croc. Droser. Euphr. Graph. Hell. Hep. Kali. Lye. Merc. Mur. ac. Nitr. ac. >'ux vom. Phosph. Ph. ac. Rhus. Sept. Sil. Staph. Sulph. Thuj. Tal. SPARKLING: Aeon. Bell. Briton. Hyosc. Op. Stram. SPOTS ON EYES: Euphr. Nux vom. Puis. Ruta. SQUINTING: Alum. Bell. Hyosc. Puis. See. com. SUNKEN: Ambra. Camph. Chin. Cic. Cupr. Dros. Ferr. Hyosc. Op. Sec. corn. Spong. Staph. Teratr. SWELLING: Ars. Bry. Carb. veg. EYES. 13 Hep. N. vom. Phosph. Plumb. Elms. Ruta. Strain. Sulphur. ULCERATION: Ambr. Am. Calc. Caps. Cham. Lyc. Phosphor. Sil. Spang. Staph. Sulph. VEINS ENGORGED : Aeon. Ambr. Spig. VEINS, red : Enphr. "WHITES, blueuess of : Veratr. "WHITES, yellowness of: Aeon. Ambr. Ant. crud. Arsenic. Bell. Bry. Canth. Cham. Chin. Cocc. Con. Ferr. Ign. >\ Yom. Op. Phosph. Ph. ac. Plumb. Puis. Rhus. Sep. Sulph. — without lustre : Asa f . Asar. China. Ferr. Hyosc. Merc. Ph. ac. Sabin. Veratr. In the eye-brows. DRAWING : Bell. Caust, Dros. Hell. Rhus. ERUPTION: Cuprum. Kali. Selen. Sil. Spong. Stann. Thuj. FALLING OF LASHES : Agaricus. Plumb. Selen. ITCHING: Agar. Alum. Caust. Chhi&.\Selen. Silic. Spigelia. Sulph. SWELLING: Kali. TWITCHING: Caustic. Kali. Zinc. WARTS: Caust. At the eye-lids. (u. signifies upper, 1. lower lid ; r. right, 1. left ; where these signs are wanting, both lids are meant.) EYE-GUM: Dros. Ferr. Rheum. Rhus. Staph. AGGLUTINATION: Aeon. Agar. Bell. Bry. Calc. Causticum. Cham. Con. Big". Drosera, Euplir. Ferr. Graph. Ign. Kali. Mur. ac. Natrum. mur. Nux yom. Phosphor. Plat. Puis. Rhus. Sep. Silicea. Spigel. Staph. Stramonium. Sulph. Veratr. BLUENESS : Dig. BURNING : Ambr. Asar. Ars. Bell. Bry. Caps. Con. Graphit. Kali. Nux vom. Ph. ac. Rhus. Seneg. Spig. St ami. ECCHYMOSIS : Apis. Arn. INFLAMMATION : Aco. Apis. Ars. Bell. Bryonia. Calc. Carb. veg. Caust. Cham. Dig. JEuphr. Hep. Hyosc. Ign. Lyc. N. vom. Pulsat. Rhus. Sep. Spig. Spong. Staph. Stramonium. Sulph. Thuj. Veratr. ITCHING: Ambr. Ars. Bellad. Bry. Calc. Camph. Carb. veg. Caustic. Cocc. Drosera. Euphorb. Euphrasia. Lyc. Nnx vom. Phosph. Rhus. Spong. Staph. Sulph. Veratr. — u. : Bar. Carb. an. Cin. Croc. Sil. Staph. — 1. : Caust. Lach. Petr. Ruta. PARALYSIS: Bellad. Cocc. Mtr. ac. Rhus. Sepiae. Spig. Stram. Ve- ratr. PIMPLES : Hep. Lyc. Petr. Rhus. Sulph. — u. : Hep. — u. r. : Canth. Lyc. — u. 1. : Chel. — 1. : Natr. mur. Seneg. — 1. 1. : Alum. SMARTING: Camph. Carb. veg. Caust. Ign. Rhus. Spig. — u. r. : Rhus. — u. 1. : Aur. SPASMS. Alum. Ambr. Bell. Croc. Hyosc. Rhododendr. Sep. Sil. STYES: Ambr. Apis. Digit. Ferr. Lyc. Puis. Rhus. Sep. Stann. Staph. SWELLING: Aco. Arn. Ars. Bar. Bell. Bry. Calcarea. Caust. Cham. Euphr. Ferr. Hyosc. Ign. N. vom. Phosphor. Pulsatilla. Rhus. Ruta. Sen. Spong. Stram. Sulph. Valer. — u. : Aco. Asar. Natr. c. Sep. Sil. Sulph. — 1. : Ars. Aur. Bell. Bry. Croc. Dig. Lach. Op. Ph. ac. Rhus. Sep. AS IF SWOLLEN: Aconitum. Croc. Rhus. Valer. 14 EARS. TETTEK: Bry. Ehus. Sep. ULCEEATION: Colch. Croc. Ign. Lye. Nux vom. Phosph. Puis. Elms. Silicea. Spig". Staph. Stram. — 1. : Colch. Natr. nmr. In the canthi, (Corners of the eye ABSCESS, int.: Bry. AGGLUTINATION : Phosph. Staph BLUEISH, int. : Aur. Sassap. BUBNING : Alum. Stann. Staph. — int. : Agar. Asar. Aur. Bar. Bell. Calc. Graph. Hell. Natr. nmr. Phosph. Ph. ac. Ehodod. — ext. : Carbo anim. Cina. Kali. Sep. Spig. Stront. Sulph. EYE-GUM: Agar. Ant. crud. Calc. Caust. Coff. Dig. Euphr. Graph. Ipec. N. vom. Staph. Thuj. — ext. : Chin. Puphorbium. Ipec. Sabad. Staph. — int. : Agar. Enphras. Helleb. Ehus. Sil. Staph. EISTULA LACHEYM: Calc. Chel. Petr. Pulsatilla. Euta. Stann. Staph. GUM: Natr. nmr. INFLAMMATION : Aco. Alum. Ars. Cham. Euphr. Ign. N. vom. Phosph. Puis. — int. : Agar. Merc. — ext. : Calc. STYE : Puis. Sep — int. r. : Natr. mur. ITCHING: Arg. Arn. Calc. Caust. Cina. Hell. Hyosc. Natr. mur. Plat. Puis. — int: Bellad. Caust. Con. lye. Nitr. ac. Nux vom. Pulsatilla. Ruta. Sep. Staph. LACHEYMATION: Petr. Silicea. Thuj. PBESSUBE, as from a foreign body, 1. : Agar. Bar. Con. Ignat. Nitr. ac. PUS: Cham. Cina. Graph. X. vom. Puis. Staph. SMAETING: Garb. veg. Mur. ac. N. vom. Sep. Sil. — int.: Con. Graph. Hell. Kali. N. vom. Puis. Staph. — ext..: Camphora. Ign. N. vom. Sulph. IV. EARS. On the Ears. BOEING: Alum. Am*. Baryta. Bell. Caust. Euphr. Helleb. Plat. Plum- bum. Sil. Spig el. Stann. DISCHABGE, of blood: Bryonia. Cic. Graph. Mercurius. Petr. Phosph. — of pus: Alum. Aur. Bellad. Boy. Calc. Caustic. Kali. Lye. Merc. Petr. Pulsat. Sep. Sulph. — humor: Asa foet. Caust. Mercur. Natr. mur. Phosph. Sep. EEUPTION : Agar. Bar. Cic. Chin. Kali. Petr. Phosphor. Pulsatilla. Sep. Sil. Spongia. Su'ph. — behind the ears : Antim. crud. Canth. Chin. Puis. Sabad. Staph. EAB-WAX, liquid : Merc. — blood-red: Con. — hard: Selen. Soft water. — pappy: Lach. — deficient : Calcar. Carl), veg-. — increased: Agar. Calc. Con. Selen. Sep. Sil. HEAT: Aco. Alum. Ars. Asar. Bel- lad. Bry. Calc. Cantharis. Capsic. Carb. veg. Chin. Hep. Ignat. Kali. Merc. Natr. mur, Petr. Ph. ac. Puis. Sab in, Sep. Sil. ITCHING: Agar. Alum. Ambr. EARS. 15 Ant. cr. Arg. Bar. Bell. Calc. Carb. veg. Caust. Coloc. Con. Caps. Graph. Hep. Ign. Kali. Lxjcop. Mur. ac. Natruru mur. Nitr. ac. Nux vomica. Petr. Phosphor. Phosphor, ac. Plat. Pulsat. Rhod- od. Rhus. Sambuc. Selen. Sep. Sil. Spig el. Stann. Sulph. ITCHING of external ear: Arg. Spig. — of lobule: Argent. Sabadilla. Ve- ratr. INFLAMMATION: Aeon. Bryon. Kali. Lye. Merc. N. vom. Ph. ac. Puis. Sil. Spong. PABOTID GLANDS, pains on: Arg. Bry. Cham. Chin. Cocc. Hyosc. Ign. Merc. Phosphor. Puis. Rhus. Sabacl. — pressure: Merc. — inflammation : Chamom. Rhus. — swelling: Bar. Bell. Bry. Carb. veg. Chamom. Chin. Cocc. Con. Dulc. Hyosc. Ign. Merc. Nitr. ac. Phosph. Puis. Rhus. Sepiae. Sil. Sulph. — hardness : Rhus. — painfulness: Puis. — stitches: Bell. China. Con. Ign. Nitr. ac. Pulsat. Sep. Sulph. STITCHES: Alum. Ant. cr. Arn. Ars. Bar. Bell. Bry. Calc. Cann. Canth. Capsic. Carbo. veg. Caust Chamom. China. Colch. Coloc. Con. Dros. Dulc. Ferr. Graph. Hell. Hep. Ign. Ipec. Kali. Lycopod. Merc. Ratr. mur. Nux vom. Petr. Platin. Plumb. Ph. ac. Puis. Bhodod. Sep. Sil. Spigel. Spong. Stann. Staph. Sulphur. Veratr. Zinc. SWELLING : Ant. cruel. Calcarea. Caust. Kali. Lycop. Merc. Natr. mur. Nitr. ac. Ph. ac. Puis. Rhus. Sep. Silic. Spong. Zinc. TEARING: Aconit. Agar. Alum. Ambr. Anac. Arn. Aur. Bar. Bel- lad. Camph. Cantharis. Capsic. Cham. Chin. Carbo. veg. Caust. Con. Cupjr. Dros. Dulcam. Graph. Hyosc. Kali. Lye. Merc. Mur. ac. Nitr. ac. N. vom. Plat. Plumb. Ph. ac. Pulsat. Stann. Spigelia. Sulph. Zinc. — behind the ears: Alumina. Ambr. Arg. Bar. Belladonna. Canth. Caps. Plumb. Rhus. Sep. Sil. TENESMUS : Ambr. Anacard. Arn. Ars. Asar. Bell. Carb. veg. Caustic. Coloc. Conium. Cham. Cina. Colch. Croc. Dros. Dulc. Hell. Kali. Lye. Merc. Mur. ac. Nitr. ac. N. vom. Phosph. Plat. Puis. Rhodod. Rhus. Sabad. Sep. Spig. Spong. Stann. Sulph. Thuj. ULCERS: Alum. Camph. Kali. Merc. Puis. Ruta. Spongia. Stann. Hearing. DEAFNESS: Ambr. Ant. crud. Am. Plumb. Puis. Sec. corn. Yeratr. FLUTTERING: Bell. Cupr. Merc. Plat. Spig. GROANING: Puis. Sabad. HAEMORRHAGE: Bell. HAMMERING: Spig. HARD HEARING: Ambr. Anac. Ant. cruel. Arn. Arsen. Asar. Aur. Bar. Bell. Bry. Calc. Caust. Cham- om. Chin. Cic. Coccul. Croc. Dulc. Dros. Graph. Hyosc. Ign. Iod. Kali. Lye. Merc. Natr. m. Nitr. ac. Petr. Phosph. Ph. ac. Puis. Ruta. Sabad. Sec. cor. Sep. Sil. Spig. Sp>ong. Stram. Stann. Sulph. Yeratr. — to human speech : Ars. Phosph. HUMMING: Aur. Bell. Bryon. Caust. Con. Laches. Lycop. >atr. mur. N. vom. Puis. Sabad. Sep. Spig. Sulph. 16 NOSE. Illusions of Hearing. ROARING : Aeon. Ambr. Ant. crud. Arn. Ars. Asar. Aur. Bell. Bryon. C'alc. Cann. Carb. veg. Canst. Cic. Cocc. Colchic. Con. Graph. Ignat. Kali. Lye. Merc. Nitr. ac. N. vom. Op. Phosph. Ph. ac. Plat. Puis. Rhus. Sec. corn. Sep. Sil. Staph. Sulph. Thuj. Veratr. INTOLERANCE OF MUSIC : Aeon. Cham. Coff. Ign. Viol. oil. REPORTS: Graph. Kali. Natr. c. Rhus. Sabad. Sil. Staph. Zinc. RINGING: Alum. Arsen. Calc. Clemat. Kali. Lycop. Phosph. Rhod. Sil. Sulph. Valer. Zinc. RUSHING: Aur. Bar. Bell. Cocc. Con. Cham. Dulc. Kali. Natr. mur. Nux vom. Puis. Rhodod. Stann. RINGING : Aeon. Agaric. Anac. Arn. Ars. Asa f. Aur. Bar. Bell. Bry. Calc. Camp. Cann. Canthar. Carb. veg. Caustic. Cham. Chin. Cic. Con. Dulc. Graph. Kali. Ignat. Lye. Mercur. Natr. mur. N. vom. Op. Petr. Plat. Ph. ac. Puis. Rhus. Sep. Silic. Stann. Staph. Sulph. Veratr. SENSITIVE HEARING, excessive: Anac. Bell. Carb. veg. Coff. Graph. Ign. Lye. Nux vom. Phos. Ph. ac. Sep. Sulph. SENSITIVENESS TO SOUND: Aco. Bell. Chin. Coff. Colch. Con. Ign. Iod. Merc. Natr. carb. Nitr. ac. N. vom. Ph. ac. Puis. Sil. Spig. Zinc. SENSITIVENESS TO MUSIC: Aeon. Cham. Coff. Ign. WHIZZING: Aeon. Agar. Alum. Anac. Arn. Ars. Asar. Aur. Bar. Bell. Bry. Calc, Canth. Carb. veg. Caust. Chamom. Chin. Cupr. Eerr. Hep. Kali. Lye. Merc. Natr. mur. Nux vom. Op. Petr. Phosph. Puis. Rhod. Ruta. Sec. corn. Sep. Spig. Sulph. Terat. Zinc. V. NOSE. On the Nose. BLACK PORES : Nit. ac. Sulph. BLOOD BLOWN FROM THE NOSE : Agar. Alum. Ambr. Ars. Asar. Bar. Canth. Caps. Caust. Dros. Graph. Hep. Kali. Lach. Lye. Natrum mur. Nux vom. Petr. Phosph. Phos. ac. Puis. Sep. Silic. Sulph. BOILS : Alum. Carb. an. Arnica. BONE-PAIN: Aur. Hyosc. Lach. Merc. CANCER: Aur. Calcar. Sep. Sulph. COLDNESS: Arn. BeUad. China. Dros. Ign. N. vom. Plumb. Veratr. DISCHARGE OF PUS : Aur. Cina. Lach. Phosph. ac. Puis. DULL : Anac. Calc. Caps. Carb. an. Ipec. Kali. Nux vom. Puis. Rhodod. HEMORRHAGE: Aeon. Cann. Conium. Croc. Led. Rhus. Sabin. INFLAMMATION: Agar. Arnica. Ars. Aur. BeUad. Cann. Canth. Lach. Merc. Natr. mur. Plumb. Rhus. Sulph. ITCHING: Agar. Alumina. Arn. Bell. Bov. Calc. Carbo veg. Caust. Cannab. Caps. Coloc. Con. Chel. Chin. Cina. Kali. Lye. Hell. Ign. Laches. Merc. Mur. ac. Nux vom. Platina. Plumb. Phosph. Phosphor. ac. Santon. Sambuc. Selen. Seneg. Sep. Silic. Spig'. Staph. Zinc. NOSE BLEED: Aconit. Agaric. FACE. 17 Alum. Ambr. Ant. crud. Arg. Arn. Ars. Bar. Bell. Bry. Calc. Cann. Canth. Caps. Garb. veg. Causli- cum. Cham. Chin. Cina. Coff. Colch. Con. Croc. Cupr. Dig. Bros. Dulcamara. Ferr. Graphit. Hep. Hyosc. Ipec. Kali. Lach. Lycop. Merc. Mosch. Natr. niur. Nitr. ac. > T . Yom. Petr. Phos. Ph. ac. Pulsat. Bhod. Rhus. Ruta. Sabad. Sabin. Sambuc. Sassap. Secale corn. Seneg. Sep. Silicea. Spong. Stan- ?ium. Sulphur. Thuj. Veratr. POLYPI: Teucr. mar. SCURFS IN NOSE : Alumina. Ant. cruel. Arn. Aur. Bry. Canth. Cham. Cic. Cocc. Hepar. Hyosc. Ignat. Kali. Lachesis. Merc. Nux vom. Ph. acid. Puis. Selen. Sil. Spigelia. Staph. Thuj. — under the nose : Bar. Kali. Smell. SMELL, of blood : Sil. — sensitive: Aeon. Aur. Bar. Bell. Cham. Chin. Cocc. Colch. Graph. Kali. Lycop. A 7 , vom. Phosph. Plumb. — putrid: Aur. Bellad. Calc. Merc. Sulph. — fine, extremely : Aeon. Agar. Aur. Bell. Chin. Cocculus. Coff. Con. N. vom. — of lime : Sulph. — of foul cheese : N. vom. — deficient : Anac. Bell. Hep. Hyosc. Nat. mur. Op. Plumb. Pulsat. Ruta Sec. corn. Sep. Sil. Zinc. — catarrhal: Graph. Merc. Puis. Sulph. — fetid: Belladonna. Phosph. Sep. SWELLING: Arn. Ars. Aur. Bell. Bry. Calc. Cann. Canth. Caust. Cham. Chel. Cocc. Lye. Merc. Natr. mur. Nitr. ac. Phosphor. Ph. acid. Puis. Rhus. Sep. Spig'elia. Stann. Stram. Zinc. SWELLING OE BONES : Aur. TETTER: Rhus. Spig. TWITCHING: Agar. Arnica. Aur. Caps. Con. Hyoscyam. Plat. Puis. ULCERATED NOSTRILS: Anac. Ant. crud. Arn. Aur. Bell. Bryon. Calc. Cham. Cocc. Graph. Hep. Hyosc. Ign. Lach. Lye. Merc. Natr. mur. Nitric acid. N. vom. Phosph. Phosph. ac. Puis. Sep. Spig. Stann. Staph. Zinc. — exter. nose: Puis. WARTS: Caust. YL FACE. Color and External Ap- pearance. ACNE ROSACEA (red pimples): Arsenic. Cann. C. an. Veratr. — blue: Aco. Ars. Asar. Bryon. Camph. Cham. Cic. Cina. Con. Cupr. Dros. Hyosc. Ign. Ipecac. Mercurius. Op. Samh. Spongia. Stramon. Veratr. — margins around eyes : Anac. Arsen. Calcar. Cham. China. Cina. Cocc. Cupr. Graph. Hep. Ignat. Ipecac. Kali. Lach. Lycop. Merc. Phosph. Phosph. acid. Rhus. Sabad. Sabin. Sec. corn. Staph. Stram. Sulphur. Veratr. -brown, changing to : Bryon. Hyosc. Iod. Op. Sec. corn. Stram. -bloated: Aco. Arnic. Aur. Bar. Bell. Bry. Cham. China. Cina. Cocc. Cupr. Dig. Dros. Dulcamara. 18 FACE. Ferr. Hyosc. Ipec. Kali. Led. Lye. Merc. Natr. c. Nux vom. Op. Phospli. Plumbum. Rhus. Sep. Spig. Spongia. Staph. Strain. COMPLEXION, changing: Aco. Bell. Boy. Capsic. Cham. Chin. Cilia. Crocus. Hyosc. Ign. Led. Opium. Natr. c. Phosph. Ph. ac. Veratr. Zinc. — jaundiced : Aeon. Ainbra. Ant. crud. Am. Ars. Bry. Calc. Causticum. Canth. Cham. Chel. Chili. Cina. Con. Croc. Ferr. Graph. Hell. Hep. Ign. Jod. Kali. Lye. Merc. Natrum. mm. Nitr. ac. Jf. yom. Op. Petr. Plumb. Puis. Rhus. Secale com. Sep. Spigelia. Veratr. --shining: Aurum. Plumbum. Rhus. Selen. — sallow: Bryon. Carb. veg. Ferr. Merc. Phosphor. Sec. corn, —sickly: Anac. Bryon. Calc. Canth. Caust. Chin. Cina. Colch. Cupr. Kali. N. vom. Plumb. Phosph. Ph. ac. Puis. Rhus. Sec. corn. Silicea. Spigel. Stann. Staph. Sulph. Ve- ratr.. Zinc, ^-red: Aeon. Arg. Arnica. Ars. Bar. Bell, Bryon. Calcar. Camph. Cann. Canth. Capsic. Caustic. Cham. China. Clc. Cina. Cocc. Coff. Croc. Cupr. Drosera. Euphr. Dig. Dulc. Ferr. Hyosc. Hep. Ign. Ipec. Laur. Lye. Merc. Mur. ac. Natr. c. N. yom. Op. Petr. Phosph. Plat. Plumb. Puis. Rhus. Ruta. Sabad. Sabina. Sep. Sil. Secale cornut. Spigel. Spong. Stannum. Stramon. Sulphur. Thuj. Veratr. Zinc. red and bluish: Aco. Bell. Bry. Hep. Merc. Opium. Phosphor, —red, burning cheeks: Aeon. Am. Bellad. Bry. Cannab. Caps. C. an. Cham. China. Cina. Cocc. Coffea. Dulc. Hell. Ign. Kali. Lycop. Merc. N. vom. Op. Plat. Sabad. Scxi^. Stann. Straw.. Valer. — red on one side : Aeon. Am. Cann. Canth. Cham. Chin. Ign. Ipec. N. vom. Pulsat. Rheum. — red, erysipelatous: Bellad. (Cal- car.) Camphor. Cham. Lach. Rhus. Ruta. Stram. — sallow: Arsen. Bry. Canth. Chin. Cic. Euph. Ferr. Hyosc. Ignat. Ipec. Merc. Natr. mur. Nnx vom. Op. Plumb. Phosph. Sec. corn. Sil. EYES, sunken: Ambr. Arsen. Cal- car. Camph. China. Cic. Cupr. Coloc. Dros. Ferr. Hyosc. Jod. Lye. Nitr. ac. Op. Phosphor. Ph. acid. Sec. corn. Spongia. Stannum. Staphys. Sulph. Verat. FEATURES, altered: Ars. Bellad. Camph. Canth. Chamom. Colch. Rhus. Spig. Veratrum. FRECKLES: Calc. Kali. Lye. Natr. c. Phosph. PALE: Aconitum. Ambr. Anac. Am. Ars. Bell. Bry. Calc. Camph. Cann. Canth. Caps. Carb. Yeg. Cham. China. Cic. Cina. Coloc. Con. Cocc. Cupr. Dig. Euphorb. Euphr. Ferrum. Graphit. Helleb. Hyosc. Ign. Jod. Ipec. Kali. Laches. Led. Lye. Merc. Nnx vom. Op. Plum- bum. Petr. Phos. Ph. ac. Puis. Rhus. Sabin. Sec. corn. Sej). Sil- icea. Spigelia. Spong. Stann. Stram. Sulph. Teacr. mar. Veratr. Zinc. SPOTS, yellow: Calc. Hell. Lye. Natr. c. Phosph. Sepia. — red: Alumina. Ambr. Bellad. Canth. Croc. Lye. Merc. Nux vom. Op. Phosph. Sabadilla. Samb. Sil. Sulph. Zinc. — white : Ars. Merc. Natr. c. SWELLING : Alum. Ars. Bell. Bry. Calc. Canth. Carb. veg. Chamom. Dulc Graph. Hell. Hyosc. Kali. Lycop. Natr. mur. Nitr. ac. Op. Petr. Phosph. Rhus. Samb. Sep. Stram. FACE. 19 Sensations. In the face generally. BLOTCHES: Antrim, crud. Canth. Cic. Hell. Lach. Led. N. vom. Op. Puis. Viol. tr. BOILS: Alum. Am. BeU. Bry. Chin. Laur. Led. BONES, inflammation of: Staph. — swelling of : Sil. Spig. — pains of : Asa f . Caps. Chel. COLDNESS : Asar. Camphor. Canth. Cham. Cilia. Dros. Hyosc. Ign. Ipecac. Khus. Yeratr. CONVULSIONS: BeU. Calcarea. Camphor a. Canth. Cham. Cupr. Dig. Ipec. Phosphor. Rheum. Strain. Sulph. CRAMPY FEELING: Bellad. Cina. Cocc. Big. Dulc. Hyosc. Kah. Nitric acid. Platina. Rhus. Spongia. Stannum. Thuj. Va- leriana. CRUSTA LACTEA: Ambr. Arsen. Bar. Bellad. Bry. Hep. Ledum. Mercur. Rhus. Sassap. Staph. Viol. tr. ERUPTION : Alum. Anac. Ars. Aur. Bar. Calcar. Carb. veg. Caust. Chamom. Cic. Colch. Coloc. Con- ium. Dulc. Graph. Kah. Lachesis. Led. Lye. Merc. Natr. mur. Petr. Plumb. Ph. ac. Rhus. Sep. Silic. Stann. Staph. Veratr. Viola, tr. — on the lips: Aco. Ant. cr. Arn. Bar. Bell. Bov. Bry. Cann. Canth. Caps. Caustic. Chin. Coloc. Con. Dulc. Hep. Hyosc. Ignat. Ipec. Kali. Led. Mur. acid. Nux vom. Rhus. Samb. Scill. Spigelia. Spong. Staphys. Sulphur. Veratrum. Zinc. — around the mouth : Ant. crud. Bar. Bov. Calc. Carbo veget. Cocc. Graph. Petr. Phosphor. Ph. ac. Rhod. Rhus. Sep. Sil. Staph. Veratr. Zinc. — around tMe ears: Ant. crud. Mur. ac. Petrol. Phosphor. Sulph. — on the forehead : Agar. Ambr. Ant. crud. Arn. Baryta. Bov. Calc. Canthar. Carbo veget. Chamom. Clem. Coccul. Euphorb. Hell. Hep. Led. Mur. ac. Natram mur. Rheum. Rhod. Rhus. Sep. Sil. Staph. Sulph. ERYSIPELAS : Rhus. Bell. FEELING OF COLDNESS: Am. Bar. Merc. Mosch. Phosph. Plat. Rhod. Ran. seel. FLASHES OF HEAT: Ambr. Arnica. Asa feet. C. an. Cocc. Graph. Lye. Nitr. acid. Petr. Sulph. Teucr. mar. Thuj. Valer. HEAT : Aeon. Agar. Alumina. Ambr. Anac. Arn. Ars. Asaf. Asar. Bar Bellad. Bov. Bry. Calc. Camph. Cann. Canthar. Caps. Carbo veget. Caust. Cham. Chin. Cina. Cocc. Coffea. Coloc. Con. Croc. Cupr. Digital. Drosera. Dulcam. Euphr. Ferr. Graphit. HeW.Hepjar. Hyosc. Ign. Ipec. Kali. Led. Lye. Merc. Mur. ac. Natrum mur. Nitr. ac. Nux vom. Op. Petr. Platina. Plumb. Phos. Ph. ac. Puis. Rheum. Rhod. Rhus. Ruta. Sabad. Sabina. Samb Sassap. Senega. Sep. Scill. Sil. Spig. Spong. Stann. Staph. Stram- on. Tar. Thuj. Yeratr. Viol. tr. HERPES: Bar. Bov. Calc. Carbo veg. Caustic. Chel. Graph. Led. Natr. c. Nitr. ac. Pet. Phosph. Rhus. Sabad. Sep. Sil. — on the cheek : Ambra. Anac. Bar. Bov. Bryon. Caustic. Merc. — on the chin : Bov. Chel. N. vom. — on the lips (cold blisters) : Rhus. — on the temples : Alum. ITCHING: Agar. Alumin. Ambr. Arg. Arnic. Asa f. Aur. Bry. Bov. Calc Caps. Carbo veg. Caustic. Clem, Coloc. Con. Dulc. Graph. 20 Kali. Lach. Lye. IS", vom. Opium. Petr. Phosph. Ph. ac. Plat. Plumb. Rhus. Kuta. Sabadilla. Sabin. Sas- sap. Sep. Sil. Sulph. Yeratrum. Ziuc. MUSCLES, twitching of: Bell. PKOSOPALGIA: Aconit. Alumina. Asa f. Aur. Bar. Bell. Bry. Cale. Caps. Chin. Cilia. Colch. Coloe. Con. Daph. Graph. Kali. Lye. Mur. ac. Mtr. ac. Nux vomica. Phosph. Sep. Spigelia. Stann. Staph. Valer. Veratr. Yerb. PULSATIONS : Agar. Cann. Cham. Clem. Croc. Hell. TEARING: Agar. Alum. Ambr. Arg. Aur. Bell. Bry. Calc. Carb. veg. Chel. Cina. Colch. Con. Daph. Dig. Dulcam. Euphorbium. Graph. Kali. Led. Lye. Merc. Mur. ac. Natr. c. Mtr. ac. Phosph. Plumb. Rhus. Sassap. Senega. Sepise.Stilig . Spigelia. Spong. Staph. Sulphur. Thuj. Teucrium mar. Zinc. PIMPLES : Agar. Ambra. Ang. Ant. cruel. Arsen. Bar. Bellacl. Bov. Calc. Caps. Carbo veg. Caust. Cocc. Con. Drosera. Graph. Kali. Lijc. Natrum mur. Nux vom. Mtr. ac. Petr. Phos. Ph. ac. Rhus. Sassap. Sep. Sil. Sulph. Stann. Staph. Ve- ratr. Zinc. — around the eyes : Calc. Hep. Ign. Merc. Petr. Sil. Staph. Sulph. — on the cheeks : Ant. crudum. Arn. Calc. Canth. Carbo veg. Caust. Cham. Cina. Dulcam. Hyosc. Nux vom. Phosphor. Sassap. Sabina. Sep. Staph. Yaler. Veratr. — on the chin : Ambr. Antimon. crudum. Bellad. Calc. Canth. Caust. Cic. Clem. Con. Dros. Dulc. Hep. Hyosc. Lye. Nitr. ac. Nux vom. Rhus. Sabina. Sil. Spigelia. S-pong. Sulphur. Thuj. Yera/tr. SENSATION OF HEAT: Arn. Asa f. Bar. Bell. Bry. Camph. Croc. Dros. Euphr. Ipec. Merc. Nux vom. Petr. Platina. Rheum. Rhus. Ruta. Sabadilla. Spo?ig. Stramom. Thuj. SPASMS: Ambr. Carbo vegetab. Camph. Cann. Cham. Cocc. Cupr. Dig. Hep. Op. Sepise. Stram. STITCHES : Agar. Arg. Asa f. Asar. Aur. Bar. Bry. Calad. Canth. China. Cocc. Con. Dig. Graph. Ign. Kali. Lye. Merc. Natr. mur. Nitr. ac. Petr. Phosph. Plat. Plumbum. Rhod. Rhus. Sabad. Sabin. Sep. Sil. Spigelia. Spongia. Staph. Stann. Sidph. Thuj. Yeratr. Verb. SWEAT: Aeon. Ambra. Arg. Arn. Ars. Asa f. Bell. Bry. Calc. Camph. Cann. Capjsic. Carb. veg. Cham. China. Cina. Coccul. Coff. Con. Croc. Cupr. Dulc. Drosera. Hell. Hep. Hyosc. Ignatia. Ipic. Laur. Led. Lycop. Merc. Natr. mur. N. vom. Op. Petrol. Plat. Pulsat. Rheum. Rhus. Samhucus. Sassap. Sep. Spong. Staph. Stram. Stann. Sulphur. Thuj. Yaler. Yeratr. — cold, on the forehead: Bry, Cin, Cupr. Ipec. Rheum. Yeratr. TENSION: Aconit. Alum. Am. Asa f. Aur. Bar. Bry. Calc. Canth- • aris. Chel. Colch. Con. Euphort). Laurocer. Led. Lye. N. vom. Petr. Platina. Phosjjh. Ph. ac. Pulsatilla. Rheum. Rhus. Sabad. Samb. Sep. Spong. Veratr. Yerb. Yiol. od. THROBBING: Am. Bellad. Calc. Sabad. Staph. TITILLATION : Bell. Cann. Coloc. Laur. Phosph. ULCERS : Ars. Bry. Merc. YESICLES: Alum. Ant. or. Bar. Cantharis. C. an. Caust. Euphorl). Graph. Nitric acid. Petr. Plumb. Phosph. Rhus. Sepias. Silicea. Sulph. Valer. Zinc. FACE. 21 WARMTH, feeling of: Asa feet. Asar. Cann. Cantharicl. Chin. Cocc. CofF. Croc. Laur. Phos. ac. Puis. Samb. Seneg. Yaler. On the lips. fu. signifies upper lip ; 1. lower lip, and c. cor- ner of the mouth.) BLACK : Aconit. Bryon. Chin. Mer- cur. Phosph. acid. Yeratr. BLUE : Agar. Ars. Caust. Cina. Con. Cupr. Dig. Op. Phosph. Stramon. Yeratr. BLISTERS, bloody: Natr. mur. Bry. Ign. Ph. ac. Plat. — u. : Kali. Rhus. —1. : Ars. Bry. Rhus. J3URNING: Agar. Anac. Arnica. Ars. Bry. Caps. C. an. Chin. Hyosc. Kali. Merc. Muriatic ac. N. yom. Phosph. Rhod. Ehus. Sabacl. Sulph. Thuj. — u. : Ant. crud. Bar. Caustic. Daph. Graph. Merc. Natr. c. Rhus. Sa- bad. Sep. Spigel. Staph. Yeratr. — 1. : Asa f. Bar. Bellad. Boy. Bry. Clem. Daph. Graphit. Kali. Phosph. Phosphor, acid. Sabad. — c. : Am. Coloc. Daph. Dros. Natr. c. Zinc. CANCER : Ars. (Bryon.) Clem. Con. Sil. CHAPPING : Alum. Arn. Bry. Calc. Caps. Carbo veg. Cham. Chin. Colch. Croc. Ign. Nux vom. Phos. Pulsatilla. Staph. Yeratr. Zinc. — u. : Caust. Natr. mur. Sab. Selen. — 1. : Cham. Chin. Daph. Dros. Graph. Natr. mur. Nux vom. Phosph. Ph. ac. Puis. CONTRACTION: Calc. Sec. corn. DEADNESS, u. : Calc. DISTORTION : Bellad. Graphit. Nux vom. Sec. corn. DRY : Aco. Agar. Alum. Ambr. Anac. Am. Ars. Bar. Bell. Bry. Calad. Cann. Canth. C. an. Cham. China. Con. Croc. Cycl. Dros. Graphites. Hyosc. Ign. Merc. Mur. ac Nux vom. Phosjjh. Plat. Puis. Rhodod. llh lis. Strain. Tlmj. Yeratr. Zinc. — u. : Annn. Plat. Sulph. — 1. : Daph. Merc. Sabin. ERUPTION, vesicular: Alum hi a. Canth. Laur. Natrum mur. Rhus. — u. : Amm. mur. Ars. Carbo veg. Cic. Con. Graph. Hell. Laur. Mur. ac. Plat. Seneg. Sil Stront. Yaler. — 1. : Aur. Bell. Bry. Carbo veg. Clem. Kali. Laur. Mur. ac. Natr. mur. Phos. Plat. Rhodod. Sassap. Sepia. Staph. Sulph. — c : Caust. Daph. Laurocer. Seneg. GLANDS, indurated: Con. Sulph. Zinc. — ulcerated: Ign. HEAT: Ambr. Arn. Bell. Canth. Carbo an. Daph. Hep. Sep. HERPES : Anac. Ars. Rhus. Sep. — u. : PhosjDh. Sep. — 1.: Sep. — c. : Carbo veg. Phosph. Sep. PALE : Ferr. Kali. Lye. Yaler. PEELING OFF : Alum: Bell. Canth. Caps. Cham. Con. Daphne. Nux vom. Platina. Plumb. Puis. — u. : Sulph. — 1. : Daph. Kali. Natrum mur. PIMPLES: Cann. Caps. China. Dulc. Hyosc. Ipec. Kali. Mur. ac. Nux vom. Rhus. Spong. — u. : Aco. Ant. crud. Arn. Bell. Calc. Carbo veg. Capsicum. Caust. Dig. Kali. Led. Lycop. Nux vom. Rhus. Sassap. Sej3. Scill. Silicea. Staphys. Thuj. Zinc. — 1. : Bell. Bry. Calc. Capsic. Caust. Ign. Merc. Mur. acid. Natrum c. Rhus Samb. Sil. Spig. — c. : Antim. crud. Bar. Bellad. Calc. Cann. Canth. Caustic. Coloc. Phosph. Rhod. Rhus. Yeratr. PRESSURE, u.: Sulph. ac, — 1.: Yaler. 22 RHAGADES: Arn. Bryonia. Cann. Cgjjs. Croc. Ign. Plat. Puis. — u. : Agar. Kali. Natr. mm*. Ph. ac- Sabad. — 1. : Bry. Cham. Kux' vomica. Puis. Plat. Sulph. — c. : Ant. crud. Merc BOUGH: Anac. Calc. Mur. acid. Plat. — u. : Calc. Sulpn. — 1. : Merc. Natr. mm. SCUKFS: Ars. Bar. Bryon. Cami. Cham. Ign. Mur. ac. N. vom. Staph. Sulph. — u. : Ars. Cic. Kali. Mercur. Petr. Sil. Stajyli. Sulph. — 1. : Alum. Calc. Natrum mur. Ph. ac. Sulph. — c. : Calc. Graph. Ig-n. Sil. SPASM : Ambr. BeUad. Caust. Kali. Merc. Plat. SWELLING : Arm Alum. Aur. Bell. Bry. Carbo veg. Caps. Chin. Dig. Natr. mur. Opium. Bhus. Strain. — u. : Argent. Bar. Bell. Bov. Canth. Carbo veg. Con. Daph. Graph. Hep. Kali. Lye. Merc. Natr. mur. Nitr. ac. Petr. I hosph. Rhus. Staphys. Sil. Sulph. Thuj. Zinc — 1. : Alum. Asa f . Calc. Caust. Daph. Lye. Mur. ac. Natrum mur. Puis. Sep. Sil. TBEMBLING : Strain. Sulph. -1. : Arn. Con. TWITCHING : Arsenic. Cham. Dulc. — u. : Carbo veg. Natr. c. Plat. Sabad. Thuj. Zinc, — L: Bry. TUBEBCLES: Bell. Caust. Con. Sep. Sil. Sulph. — u. : Arsenicum. Bar. Graphit. Magnes. c. — 1. : Ign. Sep. — c. : Bry. Stront. ULCERATION, c. : Calc. ULCEBS: Ars. Bellad. Capsic. Cham. Chin. Cic. Con. Dulc. Graph. Natr. mur. Nitr. ac. N. vom. Staph- Sulph. — u. : Caps. Caust. Daph. Kali. Merc. Staph. — 1. : Bry. Caps. Ign. Lye. Merc. Nux vom. Pliosphor. Phos. ac. Puis. Sep. Sil. Staph. Zinc. — c. : Arn. Bell. Graph. Hep. Ign. Merc. Nux vom. Natr. mur. Phosph. Sil. Zinc. Lower jaw and articulation of the jaw. BONE, swelling of: Sil. CONTBACTION: Nux vom. Puis Stann. CRAMP : Alum. Asa feet. Asar. Bell. Chamom. Cocc. Colch. Ignat. Kali Merc. Mur. ac. N. vom. Plat. Rhus. Spig. Spong. Stann. Sulph. — in the joint: Aeon. Arnica. Bell. Bry. Calc. Camph. Canthar. Cic. Colchic. Con. Hyosc. Ign. Laur. Merc. N. vom. Op. Phosph. Plat. Plumb. Rhus. Sec. corn. Spig Strain. Sulph. Verat. CRACKING: Nitr. acid. Rhus. Sa- bad. DEPBESSION: Op. DISLOCATION: Ign. Petr. Ph. ac. Bhus. Staph. j PAIN, arthritic : Caust — crampy : Digit. Plat. Sassap. Spong. Stann. PBESSUBE: Ambr. Am. Asar. Aur. Bry. Chin. Coff. Cupr. Bros. Ign. Led. Phosph. Sabin. Sassap. Spig. Vera.tr. BIGIDITY: Bellad. Caust Cocc. Euphr. Graph. Hyosc. Merc. Nux vom. Petr. Sassap. Sep. Thuj SWELLING : Aeon. Arn. Ars. Staph. Yeratr. TEARING : Agar. Anac. Arn. Aur. Bar. Bell. Bov. Bry. Canth. Carb. anim. Chin. Cocc. Coff. Colch. Droser. Graph. Laur. Mercur. Nux TEETH AND GUMS. 23 vom. Phosphor. Plumb. Puis. Sas- sap. Spig. Stann. Sulph. TWITCHING: Am. Bell. Bryon. Canth. Chin. Cina. Con. Ign. Rhus. Sabin. Yaler. Chin. BURNING : Anac. Ant. crud. Bov. Canth. Caust. Rhus. Spong. COLDNESS : Teratr. CRAMP : Bell. DRAWING : Caust. Cupr. HERPES : Boy. Chelid. Natr. mur. Nux vom. Sil. ITCHING: Alum. Con. Dig. Kali. Lyc. Natr. mur. Op. Phosph. Plat. Puis. Sassap. Scill. Spig. Stront. Sulph. Zinc. NUMB FEELING: Asa f . Plat. PIMPLES: Ambr. Anac. Ant. cr. Bell. Calc. Canth. Caust. Cic. Clem. Con. Dros. Dulc. Graph. Hyosc. Lyc. 3Iere. N. vom. Nitr. ac. Rhus. Sabin. Sassap. Sil. Spig. Spong. Sulph. Thuj. Veratr. Zinc. PUSTULES : Merc. Oleand. Sabin. Zinc. SWELLING : Carb. veg. TEARING- Aur. Caust. Plat. ULCERS: Hep. VESICLES: Hep. VI. TEETH AND GUMS. Teeth. BLACK: Ignat. Merc. Plumb. Sep. Staph. BLEEDING: Ambr. Bar. Graph. Phosph. Ph. ac. Sulph. Zinc. BRITTLE: Lach. Plumb. Sabad. Staph. DECAY : Amm. Carb. an. Sil. DULL : Agar. Caps. Nitr. acid. Puis. Spong. Staph. FALLING OUT: Ars. Bry. Merc. N. vom. Plumb. Sec. corn. FETID: Calc. Carb. veg. Daph. Graph. Kali. GRITTING : Aeon. Ant, crud. Ars. Bar. Bellad. Canth. Caust. Chamom. Cic. Coff. Con. Hyosc. Ign. Merc. Plumb. Sec. corn. Sep. Stram. Teratr. HOLLOW: Asar. Calcar. Daph. Hyosc. Plumb. Phosph. Sabad. Selen. Sep. Sil. Staph. LOOSE: Aeon. Arn. Bry. Camph. Cham. Chin. Cocc. Hyoscyam. N. vom. Op. Puis. Rheum. Rhus. Staph. Veratr. MUCUS ON TEETH: Alum. Arn. Bov. Bry. Cham. Daph. Iod. Plumb. Selen. SMOOTH: Phosph. Selen. TEETHING: Aeon. Arn. Bryon. Chamom. Cic. Cina. Coff. Cupr, Hyosc. Ign. Ipec. N vom. Op. Puis. Rhus. Stram. TOOTHACHE, see Index. YELLOW: Iod. Lyc. Nitr. ac. Gums. BLUE: Sabad. BLEEDING: Agar. Alum. Ambr. Ang. Bar. Bellad. Bov. Calc. Carb. veget. Caustic. Con. Eujmr. Graph. Iod. Kali. Lycop. Merc. Natr. mur. Nitr. ac. N. vom. Phosph. Ph. ac. Ruta. Sep. Staph. Sulpjh. Zinc. BURNING: Bell. Chamom. Merc Mur. ac. X. vom. Petr. Puis. Rhus. Sej). CORRODED : Merc. Staph. FISTULA : Calc. Canth. Caust. Natr. mur. Petr. Puis. Sil. 24 MOUTH. GBOWTHS: Staph. HEAT : Bell. Lye. INDENTED: Merc. INFLAMED : Bov. loci. Natr. nmr. N. Yom. Petr. Phospli. Sil. PALE: Carb. an. Merc. Nitr. acid. Plumb. Sabin. Staph. PTJTBID: Ambr. Nux. vom. Staph. BECEDING : Bov. Carb. veg. Graph. Merc. Natr. carb. Phospli. Ph. ac. Elms. Sep. Staph. BEDNESS: Carbo an. Iodine. Merc. Nitr. Sep. SENSITIVE: Anini. Ang. Arsen. Carbo veg. Caust. Natr. mur. Phosph. Puis. SPONGY: Ang. Bry. Graph. Merc. N. yom. Staph. SCUBVY: Cic. N. vom. Staphys. (See Index.) SUPPUBATION : Canth. Caust. Lach. Merc. Petr. SWOLLEN: Alum. Ambr. Ang. Bar. Bellad. Bism. Bov. Calc. Carbo an. Carbo veg. Caps. Caust. Cham. Chin. Cocc. Graphites. Hep. Hyosc. Joel. Kallc. Lach. Lye. Merc. Mur. ac. Natr. mur. N. vom. Nitr. ac. Petr. Phosph. Plumb. Puis. Sabin. Sep. Sil. Spig. Spong. Staph. Sulph. TUBEBCLES: Caust. Phosph. ac. Plumb. Staph. ULCEBATED : Alum. Auruni. Bov. Calcar. Kali. Kali bichr. Lye. Merc. Millef. N. vom. Phosph. Sabin. Stann. Staph. Zinc. VESICLES: Bellad. Calc. Canth. Daph. Nux vom. Petr. Sep. Staph. WHITE : Merc. Staph. Till. MOUTH. Buccal Cavity. APHTHAE : Bry. Caust. Cham. Chin. Ipec. Merc. Nitr. ac. Nux vom. Sulphur. Sulph. ac. BLISTEBS: Ambr. Anac. Canth. Calc. Caps. Jod. Merc. Nitr. acid. Phosph. Spong. Staph. Thuj. BLUE : Cic. Merc. BLEEDING : Bell. Canth. Mancin- nella. Millefoi. BURNING: Asa f. Asar. Bellad. Bov. Carbo veget. Cantharis. Cham. Cupr. Merc. Petr. Phos. Plumb. Spong. Sulph. Veratr. BBEATH, sour : Nux vom. — bad. Aeon. Ambr. Arn. Agar. Aur. Bar. Bell. Bry. Camph. Canth. Capsic. Calc. Carbo anim. Carbo veget. Cham. Chin. Croc. Digital. Eerr. Graphit. Kali. c. Hyosc. Ign. Ipec. Merc. X. vom. Petr. Plumb. Puis. Sepise. Spigel. Stram. Sulph- ur. Zinc. DBYNESS : Aco. Ambr. Amm. Ars. Aur. Antim. crud. Ami. Asa 1. Asar. Bar. Bell. Bry. Cah: Carbo veg. Cann. Canth. Capsic. Cham. China. Cina. Cocc. Coffea. Colch. Croc. Eerr. Hyosc. Ign. Ipec. Kali c. Kali bichr. Lye. Mur. ac. Merc. Natrmn c. Nitr. Nitr. ac. N. vomica. Petr. Phosph. Phosph. ac. Pihod. Plumb. Puis. Sabad. Sassap. Seneg. Sep. Sil. Sj)ig. Stram. Sulph. Thuj. Veratr. Zinc. FOULNESS: Arn. Ars. Aur. BeU. Bov. Bryon. Capsic. Carb. veg-. Cham. Chin. Crotal. GrajDh. Hyosc. Iod. 3Ierc. N. vom. Nitr. ac. Puis. Buta. Sabin. Spigelia. Staph. GBOWTHS: Staph. MOUTH. HEAT : Anmi. Calc. C amphora. Carbo veg. Cliam. Mercur. Natr. c. Phosph. Plumb. Sil. Sulph. INFLAMED : Aeon. Bisinuthmn. Broni. Calad. Canth. Coleh. Ig*n. X. Yoni. Veratr. ROUGH : Carbo veg'. Caustic. Cina. Cocc. Dig. Ipec. Millefol. Ph. ac. SKIN DETACHED : Merc. SWELLING : Amni. Causticum. Cauth. MerCc Sep. Zinc. TRISMUS: Calc. Con. Phosphor. Sulph. ULCERS: Arg. Graphites. Kali bichr. Merc. Xatr. mur. Xitr. ae. X. vom. Opium. Petr. Phosph. Plumb. Sepise. Sil. Staph. Zinc. Palate. BLISTERS: loci. Xux vom. Xitr. ac. Phosj3h. Spig. BURNING: Carbo veget. Camph. Cann. Canth. Caustic. Cocc. Mur. ac. Phosph. Phosph. ac. Rhodod. Seneg. Spig. Staph. Thuj. DRYNESS: Camph. Cann. Cina. Cocc. Hell. Merc. Nux vom. Op. Plumbum. Samb. Sepia?. Staph. Strain. Sulph. Veratr. INFLAMMATION : X. yom. PEELING OFF : Amm. Euphorb. REDNESS : Ars. Bell. Canth. SMARTING: Carbo veget. Coloc, Canth. Cham. China. Kali c. Merc. Seneg. Zinc. SORE: Daph. Nitr. ac. Phosph. acid. STINGING: Bar. Camph. Caust, Coloc. Ign. Kali c. Phosphor. Staph. Zinc. . SWELLING: Apis. Ars. Bell. Caps. Chin. Merc. Natr. mur. X. yom. Seneg. Stram. ULCERS: Apis. Aur. Kali bichr. Merc. Natr. mur. Xitr. ac. Ph. «*?. Sil. WHITE: Merc. Pharynx. (Compare Larynx.) APHTHAE : Spong. Staph. BALL, hysteric: Calc. Causticum. Graph. Ign. Kali c. Natruni mur. Plumb. Sep. Sil. Sulph. Valer. BURNING: Aco. Alum. Amm. Ars. Arn. Asa feet. Bellad. Calc. Camph. C 'a nnabi s . Canth. C arbo veg. C aus- ticum. Cham. Cocc. Con. Digital. Dros. Euphorb. Graphites. Hyosc. Iod. Merc. Xitr. ac. N. vom. Petr. Phosphor. Puis. Pihod. Sabad. Seneg-. Strain. Sec. corn. Spongia. Sulph. Veratr. CONTRACTION: Aco. Alum. Arg. Ars. Asa feet. Bellad Calc. Caus- ticum. Chin. Cic. Daph. Hyosc. Merc. Natrmn muriat. Phos. Sabad. Stram. Sulph. Veratr. CROUP, gangrenous : Ars. Chin. — membraneous: Aco. Brom. Cham. Dros. Hep. Iodine. Phosph. Samb. Spon g. — disposition to : Lycopod. Phosph. DEGLUTITION DIFFICULT: Aconit. Arg. Arn. Asar. Bell. Bry. Calc. Canth. Carbo vegetab. Cham. Chin. Hyosc. Ign. Ipec. Kali bichr. Merc Natr. mur. Nitr. Xux vom. Op. Phosph. Ph. ac. Puis. Pyro c. Sabad. Spong. Stramon. Sulph. Thuj. — desire for: Bell. Caust. Con. Ipec. Merc. Seneg. Sabad. Thuj. — painful: Aeon. Alum. Arg-. Ars. Asa f. Bar. Bell. Bry. Calc. Camph. Canthar. Caps. Carbo veg. Causti- cum. Cham. China. Cocc. Coffea. Croc. Terr. Graph. Hell. Hep. Ign. Ipec. Kali c. Lycopod. Merc. Natr. mur. X. vom. Petr. Pliospjh. Ph. ac. Puis. Rhus. Ruta. Sabad. Sabin. 26 MOUTH. Sep. Seneg. Sil. Spig. Staph. St ram. Sulph. Zinc. DRYNESS: Agaric. Alumina. Ambr. Anac. Ant. crad. Ars. Asa f. Bar. Bell. Bry. Calad. Calc. Canth. Caust. Cham. Cocc. Colch. Cupr. Hyosc. Ign. Ipec. Kali c. Lye. Merc. Mur. ac. Natr. mur. Nitr. ac. N. vom. Op. Petr. Phosph. Ph. ac. Plat. Plumb. Puis. Khus. Sabad. Sabina. Sec. corn. Sepise. Sil. Spongia. Stann. Staph. Stram. Thuj. Sulph. INFLAMMATION: Aeon. Agar. Apis. Alum. Arg. Ars. Bar. Bell. Bry. Canth. Caps. Chain. Con. Euphorb. Iod. Lach. Lye. Mercur. Petr. Phosph. Ph. ac. Puis. Euta. Seneg. Sep. LUMP IN THEOAT: Ambr. Ant. crud. Arn. Ars. Bell. Calc. Caust. Croc. Hep. Mercur. Natr. m. Plumb. Sabad. Sab. Sep. PARALYSIS : Aco. Bell. Cocc. Ipec. Plumb. Sep. AS IF A PLUG IN THROAT: Amm. Bar. Chamom. Crocc. Ferr. Hep. Ign. Merc. Mur. ac. Natr. mur. Nux vom. Sep. Sulph. REDNESS : Aco. Alum. Apis. Bell. Canth. Merc. Nitr. ac. Spong. ROLLING OF DRINKS, audible: Cuprum. Lam-. EOUGH: Aeon. Ambr. Antim. crud. Arg. Ars. Bar. Bryon. Carboveget. Caustic. China. Coccul. Dros. Euphr. Graph. Hep. Hell. Hyosc. Ign. Ipec. Mur. acid. Natr. c. N. vom. Phosph. Ph. ac. Plat. Plumb. Rhod. Elms. Sabad. Sassapj. Sen- ega. Spong. Stann. Staph. Sulph. Thuj. Veratr. SCRAPING : Alum. Anac. Arg. Ars. Bry. Carbo an. Cocc. Croc. Dros. Dulcam. Kali c. Hyosc. N. vom. Puis. Rhus. Sabad. Stann. Thuj. Veratr. SMAETING: Ambr. Carbo veget. Dros. Hyosc. N. vom. Ph. ac. Sep. SOEE THEOAT, chronic: Ammon. Arg. Bar. Bov. Dulc. Lach. Lye Nitr. Pulsatilla. Ehus. Zinc — in measles : Carbo veg. HEAT: Bellad. Cham. Duicam. Euphr. Ferr. Hyosc. Iodine. Mer- cur. Natrumc. Nitric ac. Phosphor. Ehododend. Sepise. Stram. SPASM: Alumina. Carbo veget. Caps. Con. Dig. Graph. Ipec. Phosphor. Sassap. Sepise. Stram. Sulph. Veratr. SWELLING: Aco. Arg. Bellad. Bry. Carbo animalis. Cham. Chin. Hep. Hyosc. Iodine. Ign. Lye. Merc. Petr. Spig. Stann. Sulph. AS IF SWOLLEN: Veratr. ULCERS : Arg. Calc. Iod. Ign. Merc. Nitr. ac. UVULA INFLAMED : Apis. Bell. Broin. Millefol. Mercur. Ruta. Zinc. — elongated: Caps. Chel. Croc. Plat. Sabad. Sulph. —swollen: Bell. Calc. China. Coff. Dulc. Kali bichr. Lycop. Merc. 8. vom. Pulsatilla. Sabad. Seneg. Sil. Sulphur. Zinc. Saliva. FRONT OF MOUTH: Bell. Calc. Camph. Canth. Chamom. Cic. Cocc. Cupr. Hyosc. Ign. Laur. Op. Plumb. Sec. corn. Stram. Veratr. — bloody: Cantharis. Hyosc. Pyro- carb. Sec. cornut. Stram. MUCUS, bitter: Arn. - -bloody : Alum. Amm. Bism. Iod. Lye. Mercur. Phosphor. Sec. corn. Selen. Sulphur. Stram. Thuj. Zinc. — foul: Bellad. Bov. Calcarea. Carbo veg. Cham. China. Sep. Zinc. — yellow: Bry. Spig. — gray: Arg. — green: Carbo vegetab. Colch. Natr. mur. Plumb. Zinc. MOUTH. 27 — salt: Alum. Amm. Bovista. Graph. N. vom. Plios. Rhus. Sulph. — sour : Plumb. — sweetish : Asar. — tasting badly : Merc. — smelling badly : Chin. Ignat. Puis. Rheum. — viscid: Alum. Ambr. Anac. Ant. crud. Arg. Asar. Bell. Bry. Camph. Caps. Chamom. Coff. Dule. Euphr. Iod. Ign. Merc. Nux vom. Phosph. Ph. ac. Plumb. Pulsat. Rhus. Samb. SALIVATION: Ant. crud. Agar. Alum. Apis. Bellad. Brom. Bry. Camph. Canth. Cham. Chin. Cocc. Colchic. Con. Cyc. Dros. Dale. Euphr. Ferr. Hell. Hyosc. Ign. Iod. Kali c. Ipec. Merc. JNitruin ac. Nux vom. Op. Phosph. Plumb. Puis. Rhus. Stram. Veratr. SALIVA, bitter: Arn. Ars. Merc. Thuj. — frothy: Ant. crud. Bell. Bry. Cam- phora. Canth. Cic. Cocc. Ign. Ipec. Phosph. Plumbum. Sil. Sabin. Sec. corn. Spigelia. Sir am. — watery : Asarum. Camphora. Colch. Dig. Dros. Hell. Iod. Ipec. Lach. Nux vom. Phosph. Plumb. Staph. — increased flow: Aeon. Alum. Arg. Asar. Bar. Bell. Bov. Brom. Bry. Calc. Camph. Canth. Carb. veget. Caustic.'Cham. Chin. Cocc. Colchic. Dros. Dulc. Graph. Hell. Hep. Hyosc. Ign. Ipec. Merc. Natr. mur. N. vom. Phosph. Pulsat. Rhus. Sep. Spig. Spong. Staph. Stram. Sulph. Yeratr. Tongue. BLACK : Ars. Chin. Op. Sec. corn. BLOTCHES: Apis. Dros. Lycop. Phosph. BLISTERS: Amm. Arg. Ars. Apis. Bar. Bell. Brom. Bry. Calc. Canth. C. an. Canst. Cham. Chin. Croc. Graj3h. Hell. Kali carb. Mur. ac. Natl*, mur. Nitr. ac. X. vom. Phosph. Puis. Sabad. Sep. Spig. Spong. Staph. BLUE: Ars. Dig. Lach. Mur. acid. Saltad. BURNING: Aeon. Alum. Ardent. Ars. Asar. Bar. Bell. Bry. Calc. Canth. Carb. an. Caust. Chin. Coff. Coloc. Croc. Graph. Hyosc. Ign. Kali carb. Merc. Natr. mur. . Op. Phosxih: Ph. ac. Flat. Plumb. li/todod. Sabad. Spig. Spong. Sulph. Veratr. CANCER: Apis. Ars. COATED, brown : Arsen. Bell. Bry. Carb. veg. Crotal. Mancin. Plumb. Sabin. Sec. cor. Su!ph. — yellow: Aeon. Alum. Arn. Ars. Bellad. Bry. Cann. Chamom. Chin. Cocc. Kali bichr. Lach. Merc. Nitr. acid. Sabad. Sabina. Senec. Stann. Zinc. — like a crust : Chin. — like fur : Merc. Puis. — frothy: Plumb, —slimy: Aeon. Agar. Beil. Canth. Chamom. Chin. Cina. Ignat. Merc. Nitr. Nux vom. Phosph. Plumb. Puis. Sec. corn. Sep. Sil. Stann. — dirty: Aeon. Ant. crud. Arn. Chin, —blackish: Ars. Bry. Merc. Sec. corn. — white: Aeon. Agar. Alum. Anac. Ant. crud. Ars. Asar. Arn. Bell. Bryon. Calcar. Canth. Cann. Carb. veg. Cham. Chin. Cina. Croc. Dig. Euphr. Ign. Ipec. Merc. Mur. ac. Xat. mur. Petr. Phosph: Plumb. Puis. Rheum. Rut. Sabad. Sabin. Sassap. Selen. Seneg. Spigel. Staph. Sulphur. Yeratr. Zinc. CRACKS : Bar. Calc. Ign. Merc. CRACKED : Bar. Bell. Bryon. Calc. Cham. Chin. Plum 1 - Ph. ac. Sec. corn. Spig. 28 MOUTH. PRY : Aeon. Ambr. Aril. Ars. Bell. Bry. Calc. Canth. Carb. veg. Caust. Cham. Cocc. Coff. Con. I)ulc. Kali carb. Lye. Hell. Hyosc. Ipec. Lack. Merc. N. vom. Op. Phospli. Ph. ac. Plumb. Puis. Elms. Sep. Staph. Strain. Sulph. Yeratr. Zinc. HEAT : Aeon. Bellad. Canth. Carbo veget. Plumb. Pulsat. Stram. Sulph. HEAVY: Anac. Bell. Calc. Carb. veget. Merc. Mur. ac. Natr. mur. Plumb. N. vom. Ruta. INDENTED: Merc. INFLAMMATION: Aconit, Arn. Canthar. Cham. Nux vom. Plumb. PAPILLAE, erect : Croc. Oleand. — inflamed: Bell. PARALYSIS: Aeon. Bar. Cocc. Crotal. Dulcam. Ipec. Hyosc. Laur. Mur. ac. N. vom. Op. Rhus. Rut. Sec. cor. Stram. PEELING OFF: Spig. RANULA: Ambr. Calc. Natr. mur. Nitr. ac. Staph. RED : Cham. Yeratr. ROUGHNESS: Aeon. Alum. Bar. Calc. Carb. veg'. Cocc. Dulc. Graph. Hyosc. Merc. Phosph. Sep. Stram. Sulph. SMARTING: Aeon. Am. Arsen. Asar. Bell. Cham. Chin. Coloc. Croc. Dros. Ign. Ipec. Natr. mur. Op. Sep. Sulph. Zinc. SORE: Agar. Ars. Canth. Cic. Dig. Kali c. Lye. Merc. Mur. acid. Natr. mur. Nitr. ac. Op. Sen. Sii. SUPPURATION: Canth. Mancin. SWELLING : Anac. Apis. Ars. Bell. Bryon. Calad. Chin. Cic. Dig. Dros. Glonoin. Hell. Merc. Natr. mur. Plumb. Pyrocarb. Ruta. Sabad. Sec. Sil. Stram. Yeratr. TONGUE PROTRUDED : Aco. Plumb. TREMBLING: Bell. Phos. ac. Stram. TWITCHES : Sec. corn. ULCERS: Amm. Apis. Arsen. Canth. Chin. Cic. Dros. Kali bichr. Lye. Mur. ac. Merc Natr. mur. Nitr. ac. Op. — at the edge of tongue : Caust. Merc. Nitr. ac. Thuj. — under the tongue : Lye. WHITE : Arsen. Canth. Coloc. Hell. Kali carb. Nitr. ac. Nux vom. Op. Petr. Phosphor. Puis. Sep. Sulph. Yeratr. WITHERING: Yeratr. Speech. DUMB: Cicuta. Pyrocarb. Stram. SPEECH, impeded: Aeon. Anac. Arg. Arn. Ars. Bell. Bry. Calc. Cann. Canth. Carb. veg. Caust. Cocc. Conium. Dulc. Hyosc. Ign. Lye. Merc. Mur. ac. Natr. mur. N. vom. Op. Plumb. Petr. Phos- phor. Sec. cor. Spong. Stann. Stram. Sulph. Yeratr. Zinc. — hurried : Aeon. Bry. Hep. Merc. — stuttering: Cocc. Stram. — slow: Thuj. —low tone: Bell. Canth. Chamoin. Chin. Hep. N. vom. Op. Sec. com. Staph. — nasal: Bry. SPEECHLESS: Arn. Ars Bar. Bell. Bryon. China. Con. Crotal. Cupr. Hyosc. Lye. Merc. Mur. ac. X. vom. Op. Phosph. Plumb. Puis. Ruta. Sec. corn. Strain. Veratr. STUTTERING: Aco. Arn. Bell. Cham. Euphr. Hell. Opium. Sec. corn. Strain. Verat. STAMMERING: Euphr. VOICE, clear: Chin. Secale corn Spong. Stram. Yeratr. — low: Ant. erud. Canth. Ign. Nux vom. Op. Puis. Secale corn. Spong. Yeratr. APPETITE; 29 — indistinct : Bry. Cann. Cocc. Hyosc. Sec. corn. Strain. Yeratr. — loss of: Antimon. crud. Cann. Dros. Hyosc. Lach. Plumb. Ruta. Spong. Yeratr. IX. APPETITE. LOSS OF APPETITE: Aco. Agar. Alumina. Ant. crud. Arg. Arn. Ars. Bar. Bell. Bry. Calc. Canth. Carbo vegetabil. Caustic. Cham. China. Cic. Cocc. Coff. Colch. Con. Croc. Cujor. Cycl. Dig. Dros. Dulc. Ferr. Graphites. Hell. Hep. Hyosc. Ign. Ipec. Lach. Lye Merc. Natr. niur. Nux vom. Op. Phosphor. Plat. Puis. Ehodod. Rhus. Ruta. Sabad. Sec. • corn. Sep. Sil. Spigel. Spong. Stann. Staph. Sulph. Tliuj. Yeratr. Zinc. AVERSION TO BEER: Bell. Cham. China. Cocc. N. vomica. Phosph. Spig. Spong. Stann. Sulph. — to brandy : Ign. Merc. — to bread: Con. Ign. Lycopod. Natr. niur. Nitr. ac. Nux vom. Phosph. Ph. ac. Puis. Rhus. Sep. Sulph. — to brown bread: Kali c. Lye. N. vom. Puis. Sulph. — to solid food : Ferr. Mercur. Staph. — to fat food : Ars. Bell. Bry. Calc. Carbo veg. Drosera. Hell. Hep. Merc. Natrum mur. Petr. Pulsatilla. Psorin. Rhus. Sep. Sulph. — fish: Graph. Zinc. • — meat: Alum. Arn. Ars. Aur. Bry. Calc. Carbo veget. Causticum. Ferr. Graph. Ign. Kali bicher. Lye. Mercur. Mur. ae. Natr. mur. Nitr. ac. N. vom. Op. Petr. Plat. Puis. Rhus. Sabad. Sepiae. Sil. Sulph. Zinc. — broth: Arn. Ars. Belladonna. Graph. Rhus. — vegetables : Hell. — coffee : Bellad. Bry. Calc. Carbo veget. Cham. China. Coff. Dulc. Lye. Merc. Natr. mur. N. vom. Phosphor. Rhus. Sabad. Spig. — to milk: Arn. Bell. Bryon. Calc. Carbo veg. Cina. Ign. Xatr. c. Nux vom. Phosphor. Pulsat. Sep. Sil. Stann. Sulph. — sour things : Bellad. Cocc. Ferr. Ign. Nux vom. Ph. ac. Sabad. Sulph. — salt things : Carbo veg. Graph. Selen. — sweet things: Ars. Caust. Graph. Merc. Nitr. ac. Phos. Sulph. Zine. — to water: Bellad. Brom. Bryon. Canth. Caust. China. Lye. Natrum mur. N. vom. Strain. — to wine: Ign. Lach. Merc. Rhus. Sabad. Sulphur. DESIRE FOR BEER: Aeon. Bry. Calc. Causticum. China. Cocc. Graph. Lach. Merc. Xatr. e. N. vom. Op. Petr. Ih. ac. Pulsat. Rhus. Sabad. Spig. Spong. Sulph, Zinc. — bitter things : Dig. Natrum mur. — brandy : Aco. Arg. Ars. Bov. Bry. Calc. China. Cic. Hep. Mur. ac. X. vom. Op. Puis. Selen. Sep. Spigel. Stapjh. Sulph. Sulph. ac —bread : Ars. Bell. Bov. Ferr. Hell. Ign. Natr. m. Plumb. Puis. Staph. — bread and butter : Ferr. Ign. Merc. — something refreshing: Carbo an. Caust. Cocc. Phosph. Ph. ac. Pulsat. Rheum. Yaler. 30 — for fat food : Nitr. ac. Nux yoiu. — for meat : Hell. Sulpli. — liquids : Ferr. Merc. Staph. Sulph. — pastry: Plumb. — smoked things : Caust. — vegetables : Alum. Mag-nes. carl). — cucumbers : Ant. crud. Yeratr. — herrings : Nitric ac. Yeratr. — cheese: Ign. — coffee : Ars. Aur. Bryon. Capsicum. China. Colch. Con. Mosch. Selen. — chalk : Mix. ac. N. vom. — sweet things : Amm. Calcar. Carbo veg. Chin. Ipec. Kali c. Lye. Natr. c. Nux vom. Petr. Rheum. Rhus. Sabad. Sulph. — farinaceous : Sabad. — milk: Anac. Ars. Aur. Bov. Bry. Calc. Chel. Mercur. Natr. mur. Nux vom. Ph. ac. Ehus. Sabad. Sabina. Sil. Staph. — fruit: Alum. China. Ignat. Puis. Sulpli. ac. Yeratr. — juicy: Ph. ac. — salt: Calc. Carbo veg. Caust. Conium. Nitric acid. Phosph. Ye- ratr. — sour: Antim. crud. Arn. Ars. Bry. C. an. Cham. China. Con. Big. Hep. Ign. Kali c. Lach. Phosph. Puis. Sabin. Sec. corn. Sep. Stram. Sulph. Yeratr. — wheat bread : Aur. — warm food : Cycl. Ferrum. Lye. — wine: Aco. Arg. Bov. Bryon. Calc. Chin. Cic. Hep. Lach. Pulsat. Sep. Spigelia. Staph. Sulph. BAD EFFECTS OF FOOD OB DKINK: see Index. HUN GEE : Agar. Alum. Antim. crud. Arg. Ars. Aur. Bellad. Bryon. Calc. Canth. Carbo veg. Cham. China. Cina. Cocc. Coff. Graph. Hell. Hyosc. Ign. Lye. Merc Mur. ac. Natr. mur. Nux vom. Op. Petr. Phosphor. Plat. Plumb. Puis. Ehus. Sabad. Secale corn. Sep. Sil. Spong. Stapjh. Yeratr. — without appetite : Ars. Bellad. Bry. Calc. Chin. Dulc. Hell. Ign. Lye. Natr. mur. Nux vom. Op. Puis. Rhus. Sil. Sulph. Yeratr. — canine : Ars. Bryon. Calc. Cham. Chin. Cina. Cocc. Graph. Hell. Hy- osc. Iodine. Lye. Natr. mur. N. vom. Op. Phosph. Puis. Rhus. Sep. Sil. Spig. Sulph. Yeratr. THIEST: Aeon. Ant. crud. Am. Ars. Bell. Bryon. Calc. Canth. Carb. veg. Caust. Cham. Chin. Cina. Coffea. Crocus. Crotal. Cupr. Dros. Dulc. Ferr. Hep. Hyosc. Ign. Kali bichr. Merc. Natr. mur. Nux vom. Plumb. Rhus. Sec. cornut. Silic. Strain. Sulph. Veratr. — loss of : Ambr. Apis. Arsen. Bellad. Camph. Canth. Chin. Con. Hell. Hep. Lycop. N. mosch. Oleand. Op. Ph. ac. Puis. Ehus. Sep, Spig. Spong. Stajih. — with aversion to drinks : Arn. Bell. Canth. Caust. Hyos. Lach. Lye. Natr. mur. Nux vom. Ehus. Samb. Stram. — none, but desire to drink : Ars. Camph. Cocc. Coloc. Graph. Man- cin. Phosph. X. TASTE. TASTE, bitter: Aconit. Alum. Ant. crud. Arg. Arn. Ars. Aur. Bar. Bel 1 . Bov. Bry. Calcar. Cant!,. Carb. veg-. Cham. Chin. Cocc. Coff. Croc. Cupr. Dig 1 . Glonoin. Hyosc. Igrn. Ipec. KaM c. Lye. Mere. Mur. ERUCTATIONS. 31 ac. Natr. inur. Nitr. ac. Nux vom. Op. Petr. Phosph. Pulsat. Khod- odend. Rhus. Sabad. Sabin. Sec. corn. Sepice. Silic. Spong. Staph. Straw,. Sulph. Veratr. — of food:Ars. Bryon. Camph. Chin. Ferr. Hell. Hep. Ign. Ph. ac. Puis. Sabin. Staph. Strain. — of blood : Alum. Ars. Canth. Ferr. Ipec. Kali carb. Rhus. Sabin. Zinc. — burnt : Bryon. Cyclam. Laur. Puis. Scill. Sulph. — of pus: Dros. Merc. Natr. carb. Puis. — nauseous : Bry. Chel. N. vom. Puis. Valer. — earth: Caps. Ferr. Hep. Merc. Puis. — flat: Agar. Alum. Ant. crud. Ars. Asaf. Aur. Bell. Bry. Caps. Chin. Coloc. Dig. Dulc. Euphorb. Ign. Ipec, Natr. mui*. Op. Ph. ac. Puis. Bhus. Sec. corn. Stann. Staph. — foul : Aeon. Arn. Ars. Aur. Bellad. Bry. Cham. Con. Cupr. Ign. Kali carb. Lycop. Merc. Mur. ac. N. vom. Ph. ac. Puis. Rhus. Spig. Staph. Veratr. — of foul eggs: Aeon. Arn. — bilious: Aeon. Bry. Cham. Puis. Veratr. — of cheese : Chin. — chalky : Ign. Nux niosch. — insipi' . Aeon. Alum. Ars. Bell. Bry. Caps. Chin. Euphras. Ign. Kali c. Op. Petr. Phosph. Sabin. Spig. Stann. Staph. Yaler. — salt : Alum. Ars. Bar. Bell. Calc. Carb. veg*. Chin. Coff. Croc. Iod. Merc. Puis. Rhodod. Sulph. — sour: Aeon. Alum. Ars. Aur. Bar. Bell. Calc. Canth. Caps. C. an. Con. Chamom. Chin. Cocc. Crotal. Graph. Ignat. Kali c. Kali bichr. Lye. Merc. Nitr. ac. Nux vom. Pyrocarb. Phosph. Puis. Bhus. Sep. Sil. Sulph. — slimy: Alum. Arn. Arsen. Bell. Cham. Chin. Cocc. Dig. Hell. Hep. Lye. Merc. Nux vom. Petr. Phosph. Ph. ac. Rhus. Sep. Sulph. — sweetish: Alum. Aur. Bell. Bry. Canth. Chin. Coff. Croc. Cupr. Ferr. Kali c. Lye. Merc. X. vom. Phosph. Plat. Plumb. Puis. Sabad. Spong. Sulph. Zinc. — offensive: Ars. Broni. Bry. Calc. Canth. Chin. Cocc. Dros. Ign. Merc. Natr. mur. Nux vom. Phosph. Pulsat. Sep. Spig. Stann. Sulph. Zinc. — lost: Alum. Anac. Ant. cr. Bell. Bry. Calc. Hyosc. Ipec. Kali c Lye Merc. Natr. mur. Rhodod. Sec. corn. Sep. Silic. Stram. Sulph. Ve- ratr. XL ERUCTATIONS. ERUCTATIONS, bitter: Alum. Ar- nica. Ars. Bar. Bell. Bry. Cham. Chin. . Calc. Carb. veg. Cocc. Droser. Hyosc. Ign. Kali carb. Lye. Merc. Mur. ac. N. vom. Phosph. Pulsat. Sil. Spong. Stann. Sulph. Veratr. — foul: Aeon. Arn. Bellad. Broni. C. an. Cocc. Merc. Mur. ac. N. vom. Phosph. Puis. Sep. Sulph. — after eating: Antim. crud. Bellad. Bry. Camph. Canth. Chin. Cina. Cocc, Coff. Crotal. Euphr. Ferr. Graph. Ign. Natr. mur. Phosph. Pulsat. Rhus. Sil. Sulph. Thuj. — bilious: A rn. Bryon. Cocc. Dros. 32 HEARTBUKN AND REGURGITATION. X. voni. Puis. Spong. Yeratr. -hot : Mancin. -spasmodic: Ferr. Nux vom. Phosph. Ruta. -loud : Ant. crud. Caust. Con. Kali c. Petr. Phosph. Plat. Puis. -empty: Aeon. Agar. Alum. Anibr. Ant. crud. Arn. Ars. Bar. Bell. Bryon. Cale. Cann. Canthar. Carb. Teg. Caust. Coloc. Con. Chamom. China. Cocc. Coff. Colchic. Croc. Dulc. Euphorb. Graphit. Hell. Iod. Ign. Ipec. Kali c Lye. Merc. Millefol. Natr. mur. X. vom. Phosphor. Plumb. Plat. Rhus. Ruta. Sabad, Sabin. Sep. Sil. Spig. Spong. Staphis. Teratr. -sour: Anibr. Arsen. Bar. Bell. Bry. Calcar. Carb. veg. Cham. Chin. Con. Dros. Dig. Graph. Ignat. Kali c. Kali bichr. Lye. Mercur. Natr. mur. N. vom. Op. Posph. Pu's. Sabin. Sil. Staim. Sulph. Sulph. CtC. Zinc. -fetid: Bism. Cocc. Merc. X. vom. Sulph. Thuj. -incomplete : Arn. Bell. Canth. Cina. Cocc. Con. Hyosc. Millefol. Xatr. mur. Ph. ac. Rhus. Sabad. -suppressed: Aconit. Alum. Ambr. Bar. Bell. Calc. Canthar. Caustic. C. an. Cocc. Cou. Hyosc. Ign. Kali carb. X. vom. Phosph. Plat. Plumb. Puis. Sulph. -repulsive : Asa f . Cina. Nat. mur. Ph. ac. Plumb. XII. HEARTBURN, REGURGITATION. HEABTBUBX : Agaricus. Alumina. Ambr. Ant. crud. Arg'. Arn. Bar. Bell. Calc. Capsic. Carbo veg. Caust. Cham. Chin. Croc. Crotal. Con. Dig. Dulc, Ferr. Graph. Iod. Ign. Lye. Merc. Natrum mur. N. vom. Petr. BEGUBGITATIOX, bitter : Arnica, Bar. Bry. Dros. Ign. Nux vom. Phosph. Puis. Rhod. —of blood : Canth. Chin. Merc. N. vom. — salt : Arn. Lye. Yeratr. ■ — sour : Alum. Calc. Con. Dros. Nux vom. Petr. Plumb. Puis. Bhus. Sabin. Spong. Zinc. ■ — of food : Antim. crud. Arnica. Bell. Bry. Carnpli. Canth. Carbo veget. Cham. Dulc. Ferr. Ign. Lye. Merc. Nux vom. Phosph. Plumb. Puis. Sep. Sulph. —of water : Aco. Arg. Arn. Bar. Bryon. Cann. Caust. Cina. Hep. Kali c. Merc. Xux vom. Petr. Phosph. Phunb. Puis. Sulph. ac. BISIXG: Alumina. Bellad. Calc, Chin. Phosph. Pulsat. Bhus. Sabad. Stann. — hot : Asa f . Canth. Carbo veg. Cic. Coffea. Croc. Dulc. Hell. Here. Nux vom. Plat. — cold: Yeratr. — sweet : Aco. Chin. Plat. Merc. Stann. — burning: Arsenic. Bov. Calc. Carbo veget. Croc. Hep. Hell. Lye. Xux vom. Phosph. Sabina. Secale com. Sep. Sil. Staph. Sulph. Thuj. Yerat. Zinc. \YATEB-BBASH, bitter : Chelidon. Graph. Xuxmosch. Sulph. — sour: Bell. Calc. C. an. Con. Natruni c. Sulph. — general: Ant. crud. Arsenic. Bry. Carbo ves\ Chin. Cina. Cocc. I NAUSEA AND VOMITING. 33 'i.yrraph. Hell. Ign. Kali c. Lye. Merc. Nux vom. Staph. Sulph. -more fully : Aco. Alum. Ars. Bar. Bryo. Calc. Cantli. Carbo veg. Caustic. Cic. Cina. Cocc. Bros. Ferr. Hep. Ign. Kali c. Lye. Natl'. mur. Nitr. ac. Nux vom. Petr. Phos. Puis. Sabad. Sep. Sil. Spig. Staph. Sulphur. Yeratr. -with shuddering: Sil. — with hiccup : Aconit. Agar. Alum. Ant. crud. Arg. Ars. Asar, Bar. Bell. Bov. Bry. Calc. Cann. Canth. Carbo veg. Causticum. Cham. Cic. Cina. Cocc. Coff. Colchicum. Con. Cupr. Dig. Dros. Dulcam. Euphr. Euphorb. Graph. Iod. Kali c. Merc. Natr. mur. BL voni. Op. Phosph. Pulsat. Samb. Sep. Spong. Staph. Stram. Sulph. Yeratr. XE NAUSEA, TOUTING. LOATHING: Aco. Ant. crud. Arg. Arn. Asar. Bar. Bell. Bry. Canth. Cham. Chin. Cocc. Colch. Cupr. Digit. Dulc. Ferr. Hep. Ign. Ipec. Kali c. Merc. Nux vom. Op. Phosph. Plumb. Puis. Bhod. Se- cale corn. Sep. Sil. Spigel. Stram. Sulph. ac. TAUSLA, generally: Aco. Alum. Ant. crud. Arg. Arn. Ars. Bell. Bry. Calc. Cann. Carbo veg. Caus- tic. Cham. China. Cocc. Coff. Con. Croc. Cupr. Dig. Dros. Dulc. Glonoin. Hep. Ign. Ipec. Kali c. Lye. Mosch. Mercur. Mancin. Natr. mur. Nux vom. Petr. Phosph. Ph. ac. Puis. Bhus. Buta. Sabad. Sep. Sil. Staph. Sulph. Yeratr. — in the chest: Aco. Bry. C Ac. Merc. Nux vom. Rhus. Sec. corn. Staph. — in the throat: Aco. Ars. Bell. China. Cocc. Coffea. Cupr. Cycl. Ferr. Merc. Ph. ac. Puis. Bhus. Spig. Stann. Staph. Sulph. Taler. — in the stomach : Aconit. Arn. Asar. Calc/Cann. Cantharis. Cham. Chin. Cic. Cocc. Croc. Cupr. Hell. Ipec. Kali carb. Lye. Merc. Natr. mur. Nux vom. Phosphor. Puis. Bhus. Sil. Sulph. Yeratr. — in the abdomen: Bell. Bry. Cocc. Cupr. Hell. Hep. Puis. Bheum. Samb. Sil. Staph. QUALMISHNESS: Aco. Arnica. Ars. Bar. Bellad. Bry. Calc. Caps. Carbo veg. Caustic. Cham. China. Cina. Coffea. Croc. Digit. Euphr. Hep. Ign. Ipec. Kalic. Lye. Natr. c. Nitr. ac. Nux vom. Petrol. Phos- phor. Plat. Pulsat. Bhus. Sabad. Sil. Staph. Sulph. Thuj. Yeratr. Zinc. BETCHING : Aco. Ant. crud. Arg. Arn. Ars. Asar. Bell. Bryon. Canth. Chin. Cocc. Cupr. Dig. Dulc. (xlonoin. Hyosc. Ipec. Lyc.Natrum. mur. Plumb. Pulsat. Sabin. Secale corn. Sulph. Yeratr. YOMIT, inclination to: Aeon. Ant. crud. Arg. Arn. Ars. Am*. Asar. Bell. Bryon. Cann. Canth. C. veg. Cham. China. Cocc. Coffea. Croc. Cupr. Dig. Ferr. Graph. Hep. Hyosc. Hell. Ign. Iod. Ipec. Kali bichr. Lye. Merc. Mur. ac. N. vom. Op. Plat. Plumb. Puis. Pyro carb. Rhus. Sabina. Secale corn. Sep. 34 NAUSEA AND VOMITING. Sil. Spig. Spong. Staph. Strain. Snlph. Thuj. Yeratrum. — anxious : xico. Calc. Caustic. Kali c. Lack. Lye. Nitrum ac. Plumb. Sabad. VOMITING, generally : Anthn. crud. Arg. Am. Arsen. Asar. Bar. Bell. Bryoii. Calc. Campk. Cann. Can- thar. Caps. Cham. Chin. Cilia. Cocc. Coffea. Colch. Con. Cupr. Dig-. Dros. Dulc. Euphorb. Fen*. Grapk. Hell. Hep. Hyosc. Ipec. Iockne. Kak c. Lack. Lye. Mer- cur. N. voin. Phosph. Pk. ac. Op. Plumb. Puis. Euta. Sabin. Sec. corn. Sep. Sil. Sulpk. Yeratr. Zinc. — bitter: Bryo. Cann. Cantk. Cham. Ckin. Cocc. Cupr. Ipec. Sec. corn. Sep. Sil. Sulph. Tkuj. Yeratr. — bloody: Aco. Arn. Arsenic. Bry. Campk. Cann. Canth. Chin. Cupr. Dros. Ferr. Hyosc. Ipec. Lye. Nnx vom. Op. Plumb. Pulsat. Bkus. Sepise. Stann. Yeratr. Zinc. — of brown substance : Arsenic. Bism. — bikous: Aeon. Ant. crudum. Ars. Bell. Bism. Bryo. Campk. Cann. Cantk. Cham. Colch. Con. Cupr. Dig. Dros. Dulc. Hyosc. Ipec. Iodine. Kali bichr. Lye. Merc. Natr. mur. N. toui. Phosph. Puis. Sab. Sec. corn. Sep. Sil. Stann. Strain. Yeratr. Zinc. — yellow: Arsen. Bryon. Cann. Colckic. Iod. Ipec. Plumbum. Veratr. — yellow-green : Arsen. Bryon. Dulc. Ipec. Yeratr. — of drinks: Ant. crud. Dulc. Ipec. — green : Aco. Ars. Asar. Bry. Cann. Chainom. Crotal. Cupr. Digitalis. Hell. Hep. Hyosc. Ign. Ipec. N. vom. Op. Plumb. Pulsat. Stram. Yeratr. — violent : Cupr. Ipec. Yeratr. — green-blackisk : Plumb. Petr. Pkospk. — of urine : Op. — of faeces : Bry. N. vom. Op. Plumb. — sour: Ars. Asar. Bellad. Calc. Caust. Cham. Ckin. Cocc. Ferr. Graphites. Hep. Ipec. Lye. Nux vom. Op. Phosph. Psorin. Pulsat. Sabin. Secale cornut. Stann. Stram. Sulph. Yeratr. — frotky: Yeratr. — of mucus: Aeon. Ant. crud. Ars. Bar. Bell. Bry. Cann. Cham. Chin. Cocc. Cupr. Dig-. Dulc. Ferr. Grapkit. Hep. Hyosc. Ign. Ipec. Lye. Merc. S. vom. Pulsat. Pkospk. Sec. cornut. Sil. Stram. Sulph. Yeratr. — of food: Antim. crud. Arn. Ars. Bell. Bryon. Calc. Canth. Chamom. Chin. Cina. Cocc. Coffea. Coloc. Dig. Dros. Ferr. Grapkites. Hyosc. Ign. Ipec. Kali bichr. Kak c. Lack. Lycop. Merc. N. vom. Op. Pkos. ac. Plumb. Puis. Pyro carb. Sabin. Sep. Sil. Stan. Sulph. Yeratr. — fetid: Cupr. Ipec. Plumb. Sec. corn. Yeratr. — watery: Asar. Bry. Cannab. China. Cupr. Dros. Ferr. Hyosc. Ipec. Pulsat. Stram. Veratr. —black : Ars. Calc. Campkora. Chin. Hep. Ipec. Lye. Manciu. Nux vom. Op. Petr. Phosph. Plumb. Secale corn. Stram. Sulpk. Sulpk. ac. Yeratr. — of worms: Aco. Anac. Ars. Cina. Coff. Ferr. Hyoscyam. Merc. Na- trum mur. Sabad. Secale corn. Sil. Spigelia. Veratr. 35 XIV. STOMACH AND PIT OF STOMACH. 1. Stomach. ACIDITY : Con. Graph. Sil. Sulph. acid. Zinc. AS IF BLOATED : Alum. Bellacl. Bov. Chin. Con. Croc. Dulc. Ferr. Hell. Iod. Kali bich. Lye. Nitr. ac. Nux mosch. Op. Petr. Phosph. Sab. Stann. Zinc. BURNING: Aeon. Ambr. Arg. Ars. Asa f. Bar. Bell. Bry. Calad. Cal- car. Camph. Caiith. Caps. Carb. veg. Chin. Cic. Colch. Con. Croc. Digit. Euphorb. Graphit. Ignat. Iod. Nux vom. Petr. Phosph. Phosph. ac. Sabad. Sec. cornut. Sep. Sil. Sulph. — at the j) ylorus : N. vom. CANCER : Ars. Lye. N. vom. — as if something alive in it: Croc. COLD : Ars. ». vom. Puis. Veratr. COLDNESS: Alum- Arseu. Bar. Caps. Con. Graph. Ign. Natr. mur. Phosph. Sabad. Sulph. Sulph. ac. CONSTRICTION: Aco. Alum. Bry. Bellacl. Calc. Carb. veg. Chin. Con. Cocc. Euphorb. Lycop. Nux vom. Phosph. Plumb. Sil. Sulph. CONTRACTION OF PYLORUS: Ars. Euphorb. Ign. Nitr. ac. Nux vom. Phosph. Zinc. CRAMP : Ars. Ambr. Ant. cruel. Am. Asa feet. Bar. Bellacl. Brom. Bry. Calc Carb. veg-. Caust. Cha- mom. Chin. Cocc. Con. Cupr. Dig. Euphorb. Ferr. Hyosc. Iod. Ign. Ipec. Kali carb. Lye. Merc. Natr. c. Natr. mur. N. vom. Petr. Phosphor. Plumb. Puis. Psorin. Sabad. Sec. corn. Seneg. Sep. Sil. Stann. Staph. Sulph. Sulphur, acid. Thuj. Valer. Veratr. CRAMPY PAINS : Arn. Caust. Eu- phorb. Ign. Kali carb. Nux vom. Puis. CUTTING: Alum. Antim. cr. Ars. Asa f. Calc. Cann. Canth. Chel. Digit. Kali carb. Petr. Phosph. Stann. Sulph. EMPTY FEELING: Alum. Bar. Bry. Carbo veg. Caust. Chin. Dig. Graph. Ign. Ipec. Iod. Kali c. Kali blchr. Lye. Mur. ac. Natr. mur. N. vom. Petr. Phosph. Platin. Plumb. Rhus. Sep. Veratr. FLATULENCE, feeling of : Arnica. Ars. Croc. N. mosch. FULLNESS, feeling of: Aco. Alum. Arn. Asa f. Asar. Bar. Bov. Calc. Canth. Carb. veg. Cham. Chin. Cocc. Ferr. Hell. Iod. Kali c. Ign. Lach. Lye. Merc. N. vom. Opium. Petr. Phosphor. Puis. Rhus. Sa- bina. Sepise. Silicea. Stann. Sulph. Sulph. ac. Yaler. GRIPING : Caustic. Euphorb. Graph. -Natr. carb. Phosph. Sil. Stanu. HEAT: Aco. Ars. Camph. Canth. Cocc. Con. Digit. Eupliorb. Mur. ac. Plumb. Phos. Sulph. INFLAMMATION: Aco. Ant. cr. Arsen. Bell. Bry. Canth. Chin. Cic. Colchic. Hyosc. Ipec. Nux vom. Phosph. Plumb. Puis. Sabad. Sec. cor. Stram. Veratr. MOVEMENTS : Cocc. Cupr. Iod. PINCHING: Argent. Arn. Asar. Bry. Canthar. Con. Croc. Dulcam. Hell. Nitr. ac. Rhus. Sep. Stann. Sulph. PRESSURE: Aeon. Agar. Ambr. Ant. crud. Arn. Anac. Asa foet. Asar. Ars. Bar. Bell. Bov. Bryon. Calc. Canth. Carb. v. Caust. Cham. Chin. Cic. Cocc. Coloc. Con. Crotal. Cupr. Dig. Ferr. Hell. Hep. Ign. Ipec. Iod. Kali c. Lye. Mercu*. 36 STOMACH AND PIT OF STOMACH. Mur. ac. Natr. mur. Niix vom. Op. Petr. Phosph. Ph. ac. Plat. Plumb. Puis. Rhus. Sabin. Sec. corn. Sep. Spigel. Spong. Staph. Stram. Sil. Staim. Sulph. Veratr. PRESSURE AS FKOM A STONE : Aco. Alum. Arn. Ars. Bar. Bry. Calc. Carbo veget. Cham. Dig. Ferr. Kali c. Merc. N. vom. Op. Puis. Sepias. Sil. Staph. Sulpli. RUM3LING: Arn. Arsen. Croc. Graph. Kali c. Natr. c. Phos. Ph. ac. Sep. Stann. Zinc. TEARING : Arn. Ars. Puis. WEAK DIGESTION: Bar. Bryon. Calc. Canth. Carbo an. Caust. Ccn. Chin. Cuprum. Dig. Graph. Hyosc. Ign. Lye. Mere. Natr. c. N T . vom. Op. Petr. Phosph. Pulsat. Ruta. Yaler. Yeratr. Zinc. WRENCHING: Arn. Calc. Carbo veg. Caust. Chin. Cocc. Lye. N. vom. Petr. Phosph. Puis. Sulph. Sulph. ac. 2. Pit of Stomach. ANXIETY: Ars. Bry. Calcarea. Cann. Canth. Cham. Chin. Cic. Con. Ferr. Ign. Mercur. N. vom. Pulsat. Sab ad. Sabina. Sec. corn. Stram. Stann. Sulph. BURNING: Ambr. Ant. crudum. Arg. Ars. Bry. Caps. Cham. Kali bichro. Mancin. Merc. Natr. mur. Nux vom. Phosphor. Pyro carb. Sec. corn. Sep. Sil. Veratrum. Zinc. CONSTRICTION: Agar. Alumina. Asar. Calc. Carbo veg. Digit. Dros. Kali c. Merc. Natrum mur. Plat. Rhus. Sulph. Zinc. CRAMP: Hyosc. Kali c. Nitric ac. Phosph. CUTTING: Anac. Bellad. Bryon. Cann. Digit. Kali c. Mercur. Nitr. Phosphor. Sulphur. Yaler. DIGGING: Arn. Chin. Cina. Kalic. Natr. mur. Phos. Sabad. Sulph. GNAWING: Glonoin. OPPRESSION: Ars. Ant. crudum. Bell. Bry. China. Cocc. Hyosc. Platina. Plumb. Rhus. Sec. corn. Staph. PRESSURE : Aeon. Anac. Arn. Are. Asar. Aur. Bar. Bellad. Bry. Caps. Carbo veget. Caust. Cham. China. Cocc. Cupr. Dig. Graphites. Hell. Hyosc. Ign. Ipec. Kali c. Lye. Merc. N. vom. Natrum mur. Petr. Phosph. Plat. Puis. Bhod. Bhus. Sec. corn. Sep. SjAg .[Stanji. Staph. Sulphur. Yaler. Yeratr. PULSATIONS : Asa f. Cann. Cic Iod. Merc. Puis. Rhus. Thuj. SENSITIYENESS; Alumina. Arn. Bry. Camph. Canth. Carbo vege- tabilis. Cupr. Ferr. Hell. Hyosc. Kali c. Natrum c. Nux vom. Sec. cornut. Spong. Stann. Yeratr. STITCHES: Aconit. Anac. Am. Bar. Bell. Bryon. Calad. Canth. Caps. Chel. China. Cocc. CofL Cupr. Dig. Dulc. Euphr. Graphit. Ign. Iodine. Ipec. Kali c. Natrum mur. Phosph. Plat. Plumb. Puis. Bhus. Sabin.Sey. Sil. Spig 1 . Staph. Stann. Sulpli. Zinc. SWEAT: Bell Nux vom. Secale corn. SWELLING-. Ars. Aur. Beilad. Bryon. Calc. Cham. Cic. Coff. Ferr. Hell. Kali c. Lye. X. vom. Natr. mur. Op. Sabina. THROBBING : Arn. Ars. Asa f. Bell. Cann. Carbo veg. Cham. Cic Dros. Ferr. Ipec. Phos. Puis. Rhus. Sep. Sulph. TENSION : Aeon. Anac. Arsenic. Bry. Cham. Cocc. Dros. Dulc. Hep Kali c. Lycop. Mercur. Pulsat. Phosphor. Rheum. Sabin. Staphy- sag. Stann. Sulph. Yeratr. XV. HYPOCHONDRIA. 37 (L. Signifies region of the liver ; S. region of spleen ; B. both sides.,) BURNING : Aco. Alum. Bryon. Crotal. Ign. Mur. ac. Phosph. Pliosph. ac. Plat. Secale corn. Sulpli. — S.: Cami. Chel. Graph. Ign. Seneg. Spig. — B.: Laur. Kali carb. Mercur. Sulph. CONSTRICTION, L: Aco. Asa f. Asar. Dros. Ign. DISTENTION, L: Am. Bryon. Lye. Merc. Sep. — 8.: Merc. Natr. c. Nitr. ac. — B.: Calc. Cham. Ign. FLATULENCE : Cham. Chin. Colch. Ign. Nuxvom. Puis. Veratr. HARDNESS, L. : Am. Bryon. Calc. Cann. Graph. Merc. Mar. magn. —S.: Iod. INFLAMMATION, L.: Aco. Bell. Bry. Canth. Cham. Cocc. Ignat. Merc. JViix vom. Puis. Sec. corn. — 8.: Aeon. Ars. Dros. Ferr. Jf. vom. Plumb. — B.: Aco. Canth. Nux vom. PRESSURE, L.: Aco. Ambr. Arn. Ars. Asa f. Bar. Calc. Carbo veg. Camphor. Chamom. Chin. Cocc. Con. Graph. Ign. Iodine. Kali c. Lycop. Merc. Mur. mag-n. Natr. mur. X. vom. Petr. Phosph. Ruta. Sabad. Sabina. Sefiue. Stann. Staph. Suljjh. Veratr. Zinc. —S.: Alum. Arn. Asa f. Bell. Camph. Cann. Chin. Con. Ign. Lycop. Mur. ac. Natrum mur. Petr. Plat. Rheum. Rhodod. Rhus. Sassap. Sephe. Stann. Zinc. — B.: Aco. Alum. Arn. Asa f. Camph. Caps. Cham. Chin. Cocc. Cort. tgri t N. vom. Ph. ac. Rhodod. Sec. corn. Spong. Staph. Veratr. Zinc. STITCHES, L.: Aco. Agar. Alum. Arn. Asa f. Bell. Bov. Bry. Calc. Caniph. Canth. Carbo veget. Caust. Chin. Cocc. Con. Dulc. Graphites. Hyosc. Ipec. Iod. Kali c. Laur. Lye. Merc. Mosch. Mur. ac. Natr. c. N. vom. Phosphor. Platina. Plumb. Psorin. BJius. Sep. Sll. Sabad. Spig. Spong. Sulph. Zinc. — S.: Aco. Agar. Arn. Arsen. Aur. Bar. Bry. Caust. Chin. Glonoin. Hep. Ignat. Ipec. Mur. ac. Na- trum mur. Ph. ac. Plumb. Rhodod. Selen. Spig. Sil. Sulph. SWELLING, L.: Cann. China. N. mosch. — S.: Ign. N. mosch. Ruta. — B.: Aco. Alum. Arn. Arsenic. Bry. Canth. Chin. Ferr. Ipec. Phosph. Plumb. Pulsat. Sil. Spig. TENSION, L.: Ars. Brom. Bry. Calc. Carbo veg. Causticum. Ferr. Lye. X. vom. Sulph. Veratr. — S.: Camph. Con. Merc. Rhus. Zinc. — B.: Aco. Ant. crud. Asa f. Calc. Cham. Chin. Conium. Ferr. Hell. Lye. X. Tom. Op. Puis. Slaph. Veratr. WARMTH, feeling of: Sabad. XVI. ABDOMEN. Sensations. ALIVE, as of something: Cann. Croc. Hyosc. Ign. Merc. Plumb. Spong. Tliuj. BALL, ascending: Aeon. Ignatia. Plumb. BLOATING: Aeon. Alum. Am- br a. Antim. crud. Arg. Arn. Ars. Asa f. Aur. Bar. Bell. Bry. Calc. Canth. Capsicum. Carbo a?i. Carbo vegetab. Caust. Cham. Chin. Cic. Cina. Cocc. Coloc. Con. Croc. Cupr. 38 ABDOMEN. Dulc. Euphorbium. Euphr. Ferr. Graphit. Hell. Hep. Hyosc. Iod. Ign. Ipec. Kali c. Lachesis. Lye. Merc. Mur. ac. Natr. mar. N. vom. Op. Petr. Phosph. Phos. ac. Plati- na. Plumb. Pulsat. Rheum. RJiod. Rhus. Rata. Sabina. Sec. cornut. Sep. Sil. Spigel. Spong. Stannum. Staph. Strain. Sulphur. Thuj. Valer. Veratrum. Zinc. BOUNDING, as of something: Croc. BRUISING PAIN: Asa feet. Am*. Camph. Cann. Cina. Coccul. Ooloc. Con. (Ferr.) Hell. Hep. s. c. Ign. Nux vom. Op. Phos. Pulsa- tilla. Samb. Sep. Staph. Strain. Snlpli. Valer. Yerat. BURNING: Aco. Alum. (Ambr.) Arg. Arn. Ars. Asa f. Bell. Bry. Camph. Canth. Caps. Carbo vegetab. Caust. Cham. Coccul. Coloc. Cuprum. Euphorb. Euphr. Graphites. Ipec. Kali c. Laches. Merc. N. vom. Phosph. acid. Plat. Plumb. (Puis.) Rhus. Sabad. Sabin. Sec. cornut. Sep. Sil. Spigelia. Spong. Stann. (Thuj.) Veratr. COLDNESS: Alum. Ambr. Ars. Kali c. Merc. Phos. Plumb. Ruta. Secale cornut. Sulphur. Zinc. CLOTHES TOO TIGHT, as if the: Nux vom. CRAMPY FEELING: Ambr. Arsen. Carbo veget. Coccul. Coloc. Con. Graph. Phosph. Ph. ac. COLIC : Aco. Alum. Am. isuasaa. Asa f. Aur. Bar. Bry. Camphora. Cann. Canth. Cham. Chin. Cocc. Coff. Coloc. Con. Cupr. Digit. Euphorb. Ferr. Hell. Hep. sulph. Hyosc. Ign. Iod. Kali c. Mur. ac. N. vom. Op. Plumbum. Puis. Ruta. Secale corn. Staph. Strain. Veratr. CONTRACTION: Arg. Aur. Bell. Calc. Carbo an. Carbo veget. China. Coccul. Coloc. Con. Dig. Euphorbium. Ferr. Graph. Hep. sulph. Ignatia. Jpec. Kali c. Lach. Lycop. Nitric acid. K. vom. Petr. Phosphor. Ph. ac. Platina. Plumb. Rheum. Rhus. Sabad. Sabin. Sec. corn. Sep. Spig. Sulph. Thuj. CRAMPS: Alum. Ambr. Arsen. Aur. Bell. Bry on. Caustic. Chauiom. Chin. Coccul. Coff. Con. Cupr. Digitalis. Euphorb. Ferr. Hep. sulph. Hyosc. Igu. Ipec. Iodine. Kali c. Moscli. Mur. ac. N. vom. Plumb. Pulsat. Rhus. Sec. corn. Spong. Staiin. Staph. Stramon. Thuj. Valer. Veratr. CREEPING: Asa f. Carbo veget. Caust. Chin. Plat. Stann. Zinc. CUTTING: Alum. Ambr a. Ant. crud. Arg. Am. Ars. Asa f. Bar. (Bell.) Bry on. Calc. Campjh. Canth. Carbo an. Carbo veg. Caust. Cham. Chin. Cina. Coccul. Coff. Coloc. Con. Croc. Cupr. Dig. Dros. Dulc. Graph. Hep. sulph. Hyosc. Ignat. Ipec. Iod. Lach. Lye. Merc. Mur. ac. Natr. mur. Nitr. ac. N. vom. Op. Petr. Phosph. Ph. ac. Plat. Plumb. Puis. Rheum. Rhus. Sabad. Sabin. Selen. Sepiae. Sil. Spig. Spong- Staph. Sulphur. Valer. Verat. Zinc. DIGGING: Alum. Arn. Ars. Asa f. Bell. Calc. Cina. Coloc. Con. Dig. Dulc. Graph. Kali c. Phosph. Phosph. ac. Rheum. Rhod. Rhus. Sabadilla. Sep. Spig. Spong. Stann. Valer. DRAWING: Aco. Ars. Asa feet. Bar. Bry. Calc. Camph. Cann. Caps. Carbo veget. Chamom. Chin. Cic. Coccul. Conium. Cupr. Dros. Graph. Hep. s. c. Hyosc. Ign. Iod. Lye. Nitrum ac. N. vom. Op. Plat. Plumb. Puis. Rheum. Rho- dod. Rhus. Ruta. Sabin. Sep. I ABDOMEN. 39 Spig. Stann. Staph. Stramon. | Thuj. Valer. Veratr. DROPSY: Aeon. Ambr. Arn. Ars. Bry. Camph. Canth. Cliina. Dule. Ferr. Hell. Kali c. Lye. Merc. Nuxvom. Spong. DYSENTERIC PAIN : Arn. Bryon. Rhus. EMPTY FEELING : Ant. crudum. Arn. Carbo veg. Caust. Cham. Cina. Cocc. Coloc. Croc. Dulc. Euphorb. Kali c. LacbJMerc. Mur. ac. N. vom. Phosphor. Pulsat. Rhus. Sabad. Sep. Stann. Zinc. FLATULENCE, moving about : Ant. crud. Bell. Bry. Cann. Canth. Caps. Carbo an. Caust. Chin. Cina. Coff. Croc. Dig. Euphorb. Hell. Hep sulph. N. Tom. Plat. Plumb. Pulsat. Sabad. Stann. Staph. Sulph. FULLNESS: Alum. Ant. crudum. Arn. Ars. Asa /. Aur. Bar. Calc. Camph. Cann. Canth. Cham. Cliina. Cic. Coffea. Coloc. Con. Croc. Dig. Ferr. Graph. Hell. Hyosc. Ignatia. Kali c. Lye. Mur. ac, Natrum mur. N. vom. Phosph. Phos. ac. Plat. Plumbum. Pulsat. Rheum. Rhod. Rhus. Sil. Spig. Spong. Stann. Sulphur. Thuj. Yaler. Zinc. GURGLING: Alum. Ambr. Asa f Carbo veg. Cham. Croc. Dig. Graph. Hell. Lye. Merc. Nux vom. Ph. ac. Plat. Plumbum. Sep. Stann. Valer. Zinc. GRIPING: Aconit. Bell. Cham. Coloc. Con. Hep. s. Ipec. N. vom. Phosph. Pulsat. Sil. Stann. — colicky: Bry. Canth. Euphorb. Plumb, Rutn. Sil. HARDNESS: Alum. Ars. BeVad. Cale. Caps. Caustic. Cham. China. Coloc. Con. Cupr. Ferr. Graphit. Hep. sulph. Hyosc. Kali c. Merc. Phosph. flumb. Puis. Sec. corn. Sep. Sil. Sulphur. Yaler. Veratr. HEAT: Bellad. Bryan. Culcarea. Camph. Canth. Carb. an. Carbo veg. Cic. Cina. Digit. Euphorb. Graph. Ipec. Lye. Phosphor. Plumb. Ruta. Sil. Spong. Stann. Sulph. Zinc. HEAVINESS : Ambr. Asa f. Aur. Bell. Camph. Ferr. Graph. Hell. (Ipec.) Merc. N. vom. Op. Puis. Rhod. Rhus. Sec. corn. Sep. Staph. INACTIVITY: Champhor. Cham- om. Kali c. Nux vom. Op. Staph. INDURATIONS: China. Lycop. Plumb. INFLAMMATION: Aeon. Arsen. Bellad. Bryon. Canth. Cham. Chin. Cic. Ipec. N. vom. Phosph. Plumb. Puis. Rhus. Sabina. Spongia. Strain. Veratr. LABORLIKE-PAIN: Aco. Asa. feet. Aur. Camph. Carbo vegetab. Cham. Cina. Coff. Cupr. Ferr. Hyoscyam. Ign. Ipec. Kali c. Nux vom. Op. Puis. Rhus. Sabina. Sec. corn. LARGE : Antim. crud. Calc. Caust. Coloc. Hep. sulph. Kali c. Sep. Staph. Thuj. LEAD-COLIC : Hyoscyamus. Op. Stram. MOVEMENTS, internal: Coloc. Croc. Cupr. Dig. Iod. Nux vom. Thuj. Valer. Veratr. NAUSEA : Bryon. Cic. Coccul. Croc. Cupr. Hell. Ipec. Rheum. Ruta. Samb. Silic. Stannum. Staph. PAIN, diarrhoeic: Ambr. Antim. crud. Arg. Asaf. Bar. Bellad. Bry. Calc. Canth. Carbo an. Carbo veg. Cham. Chin. Coff. Dig. Graph. Hell. Ign. Kali c. Merc. N. vom. Nitr. ac. Op. Petr. Phosph. Plat. Pulsat. Rhod. Rhus. Sabin. Sec. corn. Sep. Spigel. Staph. Vera- tr um. Zinc. 40 ABDOMEN. —simple : Aco. Ant. crua. Arg. Ars. Bar. Bell. Bryon. Calc. Cantli. Carbo veg. Causticum. Cham. China. Cic. Coloc. Con. Cupr. Dros. Euphorb. Euphr. Graphit. Hell. Hyosc. Ign. Ipec. Iod. Kali c. Lye. Merc. Nitr. ac. Nhx vom. Op. Petr. Phosph. Plat. Plumb. Puis. Rheum. Rhus. Ruta. Samb. Sec. corn. Sep. Sil. Spig. Stann. Sul- phur. Yeratr. Zinc. PINCHING: Alum. Ant. cr. Ars. Asa f. Aur. Bar. Bell. Bry. Calc. Cann. Cantli. Carb. v. Caust. Chamom. Chin. Cic. Cina. Cocc. Coloc. (Coif.) Croc. Cupr. Dig. Dros. Dulc. Euphr. Graph. Hell. Hep. Hyos. Ign. Ipec. Kali -c. Lye. Merc. Mur. ac. Natr. mur. Nitr. ac. N. vom. Petr. Phosph. Ph. ac. Plat. Plumb. Puis. Rheum. Rhus. Rut. Sabacl. Samb. Sep. Silic. Spigel. Spong. Stann. Staph. Sulph. Valer. Yeratr. Zinc. PRESSURE: Aeon. Alum. Ambr. Antim. cruel. Arg. Am. Ars. Asa f . Aur. Bell. Bry. Calc. Camph. Caps. Carb. v. Chin. Cina. Cocc. Coff. Coloc. Con. Croc. Cupr. Dig. Ferr. Hep. Ign. Iod. Kali c. Lye. Merc. Mosch. Mur. ac. Nitr. ac. N. Tom. Opium. Petr. Phosph. Plumb. Pulsatilla. Rheum. Rhus. Ruta. Sabad. Sabin. Samb. Sep. Sil. Spig. Staph. Valer. Yeratr. Zinc. — outwards: Aeon. Asaf. Bell. Cann. Dulc. Kali carb. Lye. Mercur. Nitr. acid. Nux vom. Rheum. Thuj. — inwards: Bry. Bell. Rheum. Zinc. — as from a stone : Cupr. Hyosc. X. vom. Op. Puis. Sabad. PRESSING: Alum. Argent. Chin. Coff. Coloc. Euphr. Ign. Iod. Plat. Pulsat, Ruta. Sulph. Thuj. Valer. Zinc. PULSATION: Alum. Calc. Lycop. Merc. Zinc. QUALMISHNESS : Bar. Calc. Carb. veg. Ipec. Phosph. Plat. Rho- dodend. Spong. Yeratr. RING AROUND NAVEL, as if: Puis. SENSITIVENESS: Aconit. Arn. Bry. Canth. Cham. Cic. Coff. Dulc. Mosch. Pulsat. Secale cornut. Stram. Valer. Yeratr. SHOCKS: Arn. Cannab. Platina, Stann. SORE PAIN: Aeon. Alum. Ars. Bar. Bellad. Calc. Carb. veg. China. Cic. Coloc. Con. Croc. Euphorb. Kali c. Natr. mur. Nux vom. Phosph. Sep. Stann. Sulph. Zinc. STITCHES : Alum. Ars. Asa f. Bell. Bryon. Calc. Cann. Canthar. Caps. Caust. Cham. China. Cina. Coccul. Con. Croc. Cupr. Dig. Ferr. Graph. Hell. Ign. (Ipec.) Kali carb. Merc. Nitr. ac. Nux vom. Phosph. Phosph. ac. Plumb. Puis. Rhodod. Ruta. Sabad. Sep. Spig. Stann. Staph. Sulphur. Thuj. Veratr. Zinc. SWELLING: Aeon. Ant. cruel. Ars. Bryon. Cann. Canth. Cham. Chin. Colo** Con. Kali carb. Op. Plumb. Sv . 3orn. Sulph. TEARING: Alum. Arn. Ars. Aur. Bry. Calc. Canth. Carb. an. Carb. veg. Caustic. :Cham. Chin. Coccul. Coloc. Con. Dig. Hell. (Ign.) Ipec. Iod. Kali carb. Lye. Merc. N. vom. Phosph. Plumb. Pulsat. Rhus. Ruta. Samb. Sil. Spig. Stram. Thuj. Veratr. Zirib. TENSION : Aeon. Alum. Ambr. Ant. crud. Arn. Ars. Isa f. Bar. Bell. Calc. Caps. Carb. an. Carb. veg. Chin. Coloc. Graph. Hyosc. Ign. Iod. Lye, Nitr. ac. N. vom. Opium. Petr. Plat. Plumb. Pulsat. Rheum. Rhododend. Sec. corn. Sep. Sil. Spong. Stann. Staph. Stram. Sulph. Thuj. ABDOMKN. 41 TWITCHING: Aur. Canth. Canst. Chin. Coff. Con. Dig. Graph. Ign. Kali e. Phosph. Rhus. THROBBING: Am. Cairn. Canth. Chin. Dulc. Ign. Kali c. Op. Plat. Selen. ULCERS: Cupr. Plumb. ULCERATIVE PAINS : Cann. Chin. Coccul. Cupr. Dig. Hell. Merc. Nitr. ac. Rhus. Sabacl. Sep. St ami. UNEASINESS: Calcar. Dulc. Eu- phorb. Ipec. Kali c. Nitr. ac, Phosph. Plat. Sabin. Sep. URGING : Asa f . Bell. Calc. Carb. veg. Coloc. Dig. Dulc. Graph. Ign. Iod. Kali carb. Phosph. Puis. Sep. Thuj. WARMTH: Canth. Caps. Cina. Coff. Iod. Ipec. N. vom. Phos. Sabin. Sec. corn. WEAK FEELING: Aeon. Carb. an. (Ferr.) Ign. Phosph. Platina. Rhodod. Sen. Stann. Zinc. WRITHING : Alum. Ars. Asa f. Bry on. Calc. Caps. Cina. Con. Dros. Dulc. Merc. Plat. Plumb. Rhus. Ruta. Sabad. Sabin. Silic. Stajyhys. Valer. V ' frtr. Region of the Abdomen. ABDOMEN, lower Alum. Ambra. Ant. crud. Arg. Arn. Arsen. Asa f. Aur. Bar. Bell. Bry. Calc. Campli. Cann. Canth. Caps. Carbo an. Carb. veg. Caust. Cham. Chin. Cic. Cina. Coccul. Coff. Coloc. Con. Croc. Cupr. Dig. Dulc. Ferr. Hell. Hepar. Hyosc. Ign. Iod. Kali c. Lye. Merc. Natr. mur. Nitr. ac. N. vom. Phosph. Pit. ac. Plat. Plumb. Puis. Rheum. Rhod. Rhus. Ruta. Sabad. Sabiu. Sanibuc. Sep. Silic. Spigel. Spoug'. Staun. Staph. Sulph. Thuj. Valer. Veratr. Zinc. — sides of: Aconitum. Alum. Ambr. Antim. crud. Arg. Arn. Ars. Asaf. Aur. Bar. Bell. Bry. Calc. Cam- phor. Cann. Canth. Capjs. Garb. an. Carb. v. Caust. Cham. Chin. Cina. Coccul. Coff. Croc. Dig. Bros. Dulc. Euphorb. Ferr. Graphit. Hell. Hep. s. c. Hyosc. Igu. Ipec. Iod. Kali c. Lye. Mercur. Moschus. Natr. mur. Nitr. ac. N. vom. Opium. Petr. Phosph. Plat. Plumb. Puis. Rheum. Rhodod. Rhus. Ruta. Sabad. Samb. Sep. Sil. Spig. Spong. Stann. Staph. Sulph. Thuj. Valer. Zinc. EPIGASTRIUM: Aco. Ambr. Ant. crud. Arn. Ars. Asa f. Aur. Bar. Bell. Bry. Calc. Camph. Cann. Canth. Caps. Carbo veg*. Caust. Chamom. China. Cina. Coccul. Coloc. Con. Croc. Cuprum. Dig. Di^os. Dulc. Euphr. Hell. Hep. sulph. Hyosc. Ignat. Ipec. Iod. Kali c. Lycop. Mercur. Mosch. Mur. acid. Natr. mur. N. vom. Op. Petr. Phosph. Ph. ac. Plat. Plumb. Puis. Rhodod. Rhus. Sabad. Samb. Sep. Sil. Spig. Spong-. Stannum. Staph. Sulph. Thuj. Valer. Veratr. Zinc. LUMBAR REGION: Aeon. Ambr. Ant. crud. Arg. Arn. Aurum. Asa f. Calc. Cann. Cauth. Carbo an. Carbo veg. Cham. China. Cina. Coccul. Coloc. Dig. Euphorb. Ign. Iod. Kali c. Lye. Merc. Nitr. ac. Nux vom. Plumb. Pulsatilla. Rheum. Rhus. Ruta. Sab. Sec. corn. Sep. Spig. Spongia. Staph. Sulph. Thuj. Valer. Zinc. UMBILICAL REGION : Aco. Alum. Ambr. Ant. crud. Arn. Asa f. Bar. Bell. Bry. Calc. Cann. Canth. Caps. Carbo an. Carbo veg. Causticum. Cham. Chin. Cina. Coccul. Coloc. Con. Dig. Dulcam. Graph. Hep. sulph. Hyosc. Ignat. 42 CATARRH. Ipec. Tod. Kali carb. Merc. Mosch. Mur. acid. Nux vom. Op. Phosph. Ph. ac. Platina. Plumb. Pulsat. Rheum. Rhod. Rhus. Buta. Sabina. Sep. Sil. Spigel. Spongia Stann. Staph. Sulph. Thuj. Valei\ Veratr. Zinc. XYIL CATARRH. Sensations. CATARRH: Alum. Ambr. Antim. crud. Arg-. Asa f. Ars. Bar. Bell. Bry. Calc. Camphor. Canth. Caps. Carbo vegetab. Caust. Chin. Cina. Coccul. Coloc. Cupr. Dros. Euphorb. Euphr. Graphit. Hell. Ign. Iod. Kali c Lach. Lye. Merc. N. vom. Natrum mur. Nitric acid. Petr. Phosphor. Ph. ac. Plat. Plumb. Puis. Rhod. Rhus. Selen. Sep. Sil. Spig. Spong. Stannum. Staph. Sulph. Thuj. Veratrum. Zinc. — on one side : N. vom Puis. — alternately fluent and stopped : Nux vom. Puis. — in the day time : N. vom. CATARRH, generally : Aeon. Am. Camph. Coccul. N. vom. Puis- Sabad. •CATARRHAL FEVER: Aeon. Bellad. Bryon. Camph. Cham. Coff, Graph. Hep. s. Mercur. Nitric ac. N. vom. Rhus. Sabad. Sep. Spig. CATARRHAL DISCHARGE DE- LAYED: Calc. CATARRHAL PEELING: Ambr. Ant. crud. Arg. Bry. Cann. Carbo an. Carbo veg. Cic. Com Ign. Ipec: Merc. Mur. ac. Nitr. ac. Phosph. Sabin. Thuj. CORYZA: Acou. Alum. Ambr. Ars. Bar. Bellad. Bry. Calc. Cainphor. Caun. Capsicum. Carb. an. Carb. veg. Caust. Cham. China. Coff. Con. Cupr. Dig. Dulc. Graphites. Hep. sulph. Ign. Ipec Kali c. Lye. Mosch. Mur. ac. Natr. mur. Nitr. ac. N. vom. Op. Petr. Phosph. Plat. Pulsat. Rhod. Sabin. Samb. Sep. Sil. Spig 1 . Spong. Stannum. Sulph. Thuj. Zinc. — on side : Nux vom. — of infants : Samb. — evening and morning : Nux vom. DRY NOSE: Ambr. Bar. Bellad. Bry. Calc. Canth. Cic. Con. Dulc. Graph. Hyosc. Ignat. Ipec. Lye. Merc. Mur. acid. Natr. mur. Nitr. ac. (Nux vom.) Petr. Phosph. Rhod. Sep. Sil. Spig. Sulphur. Veratr Zinc. DRY NOSE, without being stopped: Sep. — upper nostrils : Sabad. — front nostrils : Spig". MUCUS FROM THE NOSE, dis- charge of: Cham. Euphorb. Phos. Rhod. — arrest of discharge : Euphorb. Ph. ac Bhod. NASAL MUCUS FROM THE POSTER. NARES, corrosive. Ars. Nux vom. Nitr. ac. Sil — smarting: Ars. Sulph.. without catarrh : Rhus Sabad Selen. Spig. involuntary : Bhus. — bloody: Ambra. Bar. Canth. Caps. Caust. (Coccul.) Cupr. Graph. Kali c. Lach. Lyeop. Merc. Natr. mur. Nitrum ac. N. vom. Petr. Phosph. Ph. ac. Puis. Sabad. Sep. Sil. Spig. Sulph. Tiiuj. CATARItH. 43 -burning: Arsen. Pulsat. Sulph. -thick : Alum. Ant. crud. Bar. Calc. Graph. Mur. ac. Natr. raur. Nitr. ac. Puis. Sabad. Selen. Staph. Sulph. -thin : Camph. Capsic. Rhus. Staph. -transparent : Sabad. -purulent: Calc. Cina. Con. Graph. Lach. Merc. Puis. and yellow : Calc. Cicuta. Con. Sulph. -gelatinous : Selen. -yellow: Cic. Puis. Selen. -yellow-green : Natr. Phosph. Puis. Sabad. and bloody : Sep. -yellowish: Alum. Ant. crud. Bar. Bell. Graph. Nitr. ac. Puis. Spig. and watery: Sep. -greenish : Puis. Spig. -clear: Sabad. -in little lumps : Selen. -acrid : N. vom. Spig. pus : Merc. water : Ars. Lach. Lycop. Mur. ac. N. vom. Sil. -odor of catarrh : Puis. -suppressed: Spong. -fetid : Bellad. Calc. Caustic. Graphit. Hep. s. Lye. Mercur. Nitr. ac. Puis. Sep. -indurated: Bryon. Lach. Sep. Staph, -increased: Arg. Bar. Calcar. Canth. Carbo veg. Cic. Cina. Coff. Con. Euphr. Graph. Lod. Lach. Mur. ac. Nux vom. Petr. Phosph. Plat. Rhod, Rhus. Sabad. Scill. Selen. Sil. Zinc, -watery: Alum. Bellad. Carbo an. China. Coff. Con. Graphit. Ign. Iod. Lach. Mercur. Mur. ac. JV. vom. Phosphor. Plumb. Rhus. Staph. Sulph. -white: Spig. -tenacious: Alumina. Canthar. Graph. Sabad. Sep. Spig. SNEEZING: Alum. Ambr. Ant. crud. Arg. Arn. Ars. Asa f. Bar. Bellad. Bov. Bry. Calc. Cann. Canth. Carbo animalis. Carbo veg. Caust. Chin. Cina, Coccul. Con. Croc. Dros. Dulc. Eujjhorb. Euphr. Graph. Hell. Hep. sulph. Iod. Ipec. Kali c. Lach. Lye. Merc. Mosch. Mur. ac. Natr. mur. Nitric acid. N. vom. Petr. Phosph. Rhod. Rhus. Ruta. Sabad. Sepiae. Sil.. Spig el. Spong. Stannum. Staph. Sulph. Thuj. Yeratr. Zinc. — troublesome: Phosph. Sulph. — racking: Sabad. — violent : Aconit. Bar. Capsic. Chin. Merc. Rhus. Sabad. — vehement: Cina. Puis. Rhus. Sabad. Valer. Veratr. — spasmodic : Rhus. — after tingling in nose : Ambr. Car- bo veget. Dros. Mur. acid. Nitr. ac. Puis. Spig. Zinc. — painful : Aeon. Dros. — without catarrh: Alum. Ars. Calc. Carbo veg. Caust. Cic. Con. Dros. Euphorb. Hyosc. Iod. Lye. Mer- cur. Nitric acid. Phosph. Stann. Sir. ' . Zinc. — dry: Chin. — excessive : Bry. Merc. Sil. — suppressed : Aconitum. Alum. Carbo veg. Caust. Cocc. Natr. mur. Plumb. Sil. Zinc. — desire for : Ambr a. Carbo veg. Mm*. ac. Phos. Sil. Sulph. Zinc. ineffectual: Canth. Carbo veg. Caust. Euphorb. Hell. Lye. Phosph. Plat. Plumb. Sil. SNIFFLING: Sep. STOPPAGE OF NOSE: Alum. Ambra. Ant. crud. Arg. Aur. Bar. Bell. Bry. Calcarea. Carbo veg. Caustic. Cham. Chin. Cic. Cina. Con. Digit. Graph. (Ign.) Iod. Kali e. Lach. Lye. Merc. Mosch. Natr. mur. Nitr. ac. N. vom. Op. i4 CATAKRH. Petr. Phosph. Plumbum. Puis. Rltotl. (Rhus.)Samb. Sep. Sil. Spig. Stann. (Staph.) Stram. Sulph. Thuj. Zinc. — behind: Staph. — in front : Arg. Spig*. — m one nostril: Ignat. Sabacl. Staph. — as from a leaf high u/p : Ignat. Mur. ac. — feeling of: Plumb. Strain. — by ulceration every night: Lycop. Accompanying Ailments. ABDOMEN, burning on: Carb. v. — rumbling in : Phosph. —stitches in : Carb. veg. BACK-ACHE : Kali carb. CHEEKS, redness of one half: Cham. N. vom. STUPEFACTION: Hell. CHEST, simple pain in: Aconit. Bry. Caust. — roughness : Carb. veg. Sulph. — stitches: Merc. — pain, as if flying to pieces: Cina. Sil. — constriction of : Phosph. CHILLINESS : Caust. Graph. Sulph. — and heat altern. : Graph. COLIC: Calc. — aching: Aeon. Canth. COUGH: Bell. Cupr. Nitr. ac. N. vom. Sulph. — desire to, in throat: Petr. Sep. Sulph. DIABKHCEA: Sep. DRAWING IN THE ARMS : Sep. DRY LARYNX : N. vom. DRY MOUTH : N. vom. DROWSINESS: Cham. N. vom. Petr. DULL FEELING IN HEAD: Cham : Hell DYSPNCEA: Sep. EARS, buzzing in the : Rhodod. Sep. — pains in the : Am. Lach. Puis. EYES, pain in the: Sep. — red: Yeratr. — weeping : Alum. Carbo veget. Chin. Euphr. N. vom. Staphys. Veratr. — lids, red : Sabad. — closed by gum : Caust. — smarting in the corners of : Carb. veg. FACE, bloated : N. vom. Staph. — hot : N. vom. Rhodod. FEVER CHILL: Bry. Caps. Clia- mom. N. vom. Puis. Spong. — heat: Spig. HEAD, burning in: Calc. Hell. Lye. N. vom. Phosph. — simple pain in: Aeon. Byron. Calc. Caust. Chin. Cic. Cina. Euphr. Graph. Hell. Kalic. Lach. Lye. Nitr. ac. N. vom. Phosph. Puis. Rhodod. Sep. Spig. Thuj. — stitches: Sabad. — cloudiness : Staph. — contraction: Sabad. —dull: Chin. Dulc. Euphr. Hell. Lye. Phosph. Rhodod. HOARSENESS: Ars. Caust. Kali carb. Nitr. ac. N. vom. Puis. Spig. HOT HANDS AND FEET : N. vom. — at night : Lye. LANGUOR : Graph. Sep. LIMBS, pains in the: Calc. Caust. Ipec. — distortion of : Phosph. LIPS, corrosive: Cann. — chapped: Chamom. Hell. Staph. — itching: Hell. LOSS, of appetite: Phosph. — of smell: Arn. Cina. Coccul. Hell. BL vom. Puis. Rhod. Sabad. Spig. Staph. — of taste: Puis. Sabad. NAUSEA: Graph. NOSE, sensitive: Calcar. China. N. vom. — burning: (Arn.) Puis. — inflammation : Lycop. Merc. Stann. BREATHING, RESPIRATION. 45 — biting in the : Carb. veg. Euphorb. — ulceration : Cham. — swelling: Bry. Cham. Puis. Rhus. Spig. — heat : N. vom. — itching : Nux vom. Sabacl. Spig. under the nose : Hell. • — titillation : Capsic. Carb. veg. Nux vom. Puis. Sabad. Sep. Staph. — scraping: N. vom. — soreness: Lack. Nux vom. Puis. Spig. — sore pain: China. Xitr. acid. X. vom. Staph. NOSTRILS, ulcerated: Bry. Calc. Coccul. Ign. Lye. Merc. Petr. Puis. PHOTOPHOBIA: Puis. SICK FEELIXG ALL OYER: Phosph. SLEEPLESSNESS: Ars. SUBMAXILLARY GLAND, pains in the : Graph. THIGHS, drawing in the : Sep. THIRST : Cham. Graph. Lye. THROAT, inflamed : Phosph. — creeping in : Kali c. — simple pain in : Xux vom. — f eeling of roughness : X. vom. Nitr. ac. Phosph. Rliodod. THROAT, stitches in : Nitr. ac. — scraping in : N. vom. — mucus in : X. vom. TOOTH-ACHE: Chin. Lach. UPPER LIP, inflamed : Lye. URINE, flow of : Yeratr. YERTIGO : Chin. N. vom. WHINING MOOD : Puis. Spig. YAWNING: Bry. Cupr. Hell. XVIII. BREATHING, RESPIRATION. Sensations. ASTHMA: Aco. Ant. cruel. Am. Ars. Asa f. Aur. Bell. Bry. Calc. Capsic. Carb. anim. Carb. veg. Cham. Chin. Cic. Cina. Coccul. Coloc. Con. Cupr. Dig 1 . Dros. Euphorb. Euphras. Ferr. Graphit. Hyosc. Ignat. Ipec. Iod. Kali c. Lye. Merc. Mux. ac. Natr. mur. Xitr. ac. Nux vom. Op. Petr. Phosph. Plat. Plumb. Puis. Rheum. Rhod. Pacta. Sabin. Sec. cor. Sep. Sil. Spic."( Spong.) Stann. StapJu Sulph. Thuj. Yeratr. Zinc. — spasmodic : Aconitum. Ambr. Caust. Cham. Chin. Coffea. Cupr. Ferr. Ipec. Kali c. Mosch. X vom. Op. Puis. Samb. Yeratr. BREATHING, moaning: Ipecac. (See also : groaning.) — Anxious: Aeon. Am. Ars. Bellad. Bryo. Camph. Cham. Coff. Ferr. Hep. s. Ign. Ipec. X. vom. Op. Phosph. Plat. Plumb. Puis. Rhus. Samb. Secale corn. Spig. Spong. Staph. Stram. Thuj. —intermittent : Camph. Op. — wheezing: Cham. China. Nitr. ac. — noisy: Aeon. Chin. — hurried: Ipec. Samb. — labored : Aco. Ign. Spong. — hot: Aco. Ant. crud. Bry. Brom. Cham. Coffea. Ferr. Natrum mur. Platina. Rhus. Sabad. Sulph. —cold : (Carbo vegetab.) Chin. Rhus. — cooling in trachea : Arn. —panting : Arn. Camph. Cupr. Ipec. Nitr. ac. Op. Phosph. Sil. Spjong. Stann. — small: Bell. — spasmodic : Puis. — slow: Aconit. Camph. China. Cic. Hyose. Ign. Xux vom. O-p. Spong. Staph. 46 BREATHING, RESPIRATION. — loud: Aco. Cina, Op. Yeratr, — low : Ign. — deficient: Bell. Camph. Can- tharis. Caustic. Cic. Coccul. Dig. Ferr. Hell. Ign. Ipec. Iod. Merc. Nux voiri. Platina. Puis. Ehus. Spig. Spong. Staun. Staph. Yeratr. — faint: Chin. Nitr. ac. Opium. Phosph. Yeratr. — wheezing: Calc. — piping: Alum. Ambra. Cann. Cham. China. Cina. Cocc. Coloc. Hep. sulph. Iod. Kalic. Lye. Natr. mur. Nux vom. Phosph. Plumbum. Sabad. Samb. Sep. Spong. Sulph. — having an odor: Ai'S. Aur. Natrum mur. Nitr. acid. Petr. pungent : Dros. foul: Am. Arsen. Aur. Bry. Cham. Chin. Graph. Iod. >*itr. ac. Puis. Buta. Sabin. Sep. Spig. like milk : Spong. sour : (Cham.) Nux vom. like sulphur : Nux vom. fetid: Aco. Ambr. Am. Aur. Bar. Bellad. Bryo. Camph. Canth. Caps. Carbo animal. Carbo vegetab. Cham. Chin. Croc. Ferr. Graph. Hyosc. Ign. Ipec. Kali c. Merc. N. vom. Petr. Plumb. Puis. Bheum. Sep. Spig. Stann. Stram. Sulph. Zinc. BKEATHING, short : Aeon. Alum. Am. Ars. Asa f. Aur. Bar. Bell. Bry. Calc. Camph. Cann. Canth. Carbo veg. Caust. Cham. Chin. Cic. Cina. Coccul. Coffea. Coloc. Con. Cupr. Digit. Euphorb. Eu- phrasia. Ferr. Hepar. sulph. Hyosc. Ign. Ipec. Kali carb. Lycop. Merc. Natr. mur. Nitr. ac N. voni. Op. Petr. Phosph. Plat. Plumbum. Puis. Bhod. Rhus. Ruta. Sabad. Sabina. Samb. Sec. corn. Sep. Sil. Spig. Spong. Stann. Stram. Sulph. Yeratr. Zinc. — heavy: Aco. Alumina. Arg. Am. Ars. Asa f. Aur. Bar. Bell. Bry. Calc. Camph. Cann. Canth. Caps. Carb. veg. Caust. Chin. Cic. Cina. Coccul. Con. Croc. Cupr. Dig. Dros. Euphr. Terr. Graph. Hell. Hep. s. Hyosc. Iodine. Kali c. Lye. Merc. Xux vom. Op. Phosph. Ph. ac. Plat. Plumb. Pulsat. Bhod. Rhus. Sabad. Sec. com. Selen. Sep. Sil. Spig. Spong. Stann. Staphysag. Strain. Sulph. Thuj. Yaler. Yeratr. — deep : Ant. crud. Arn. Aurum. Bell. Bry. Camph. Cann. Caps. Cham. Chin. Cic. Dig. Dros. Hell. Hep. sulph. Ign. Ipec. Kali c. Merc. Mosch. Mur. ac. N. vom. Op. Phos. Plat. Plumbum. Bhus. Selen. (Sil.) Spong. Stann. — disposed to draw along: Croc. Cupr. Hell. Lach. Mosch. Bhus. Sabin. Selen. Stram. BBEATH, stojDpage of: Asa feet. Bell. China. Cic. Coff. Pros. Mosch. Opium. Pulsat. Buta. Zinc. — incarceration of: Aco. Am. Bar. Bellad. Bry on. Calc. Canrph. Cann. Canth. Capsic. Carbo an. Cina. Cocc. Croc. Cupr. Dros. Euphr. Ipec. Kali carb. Mosch. Natr. mur. Nitric ac. Op. Phosph. Plat. Plumb. Puis. Bhus. Ruta. Sabin. Sep. Sil. Spig. Spong. Staphys. Stram. Sulphur. Yeratr. BBEATHING, oppressed: Aconit. Alum. Ambr. Ant. crudum. Arg. Am. Ars. Asaf. Aur. Bar. Bellad. Bryon. Gale. Camph. Cann. Canth. Caps. Carbo an. Carb. veg. Caust. Cham. Chin. Cina. Coccul. Con. Coloc. Con. Croc. Cupr. Digitalis. Bros. Bulc. Fern. Graph. Hell. Hep. sulph. Hyosc. Ignatia. Ipec. Iod. Kali c. Lycop. Merc. Mosch. Mur. ac. Natr. mur. Nitric ac. H. vom. Op. Petr. Phosph. Phos. ac. BREATHING, RESPIRATION. 47 Plat. Plumo. Puis. (Rheum.) Rhocl. Rhus. Ruta. Sabad. Sabina. Samb. Sec. corn. Sepiae Sil. Spig. Stann. Staph. Stram. Sulph. Thuj. Valer. Veratr. Zinc. EXPIRATION, blowing: Chin. — slow: (Arnica.) Camphora. Cham. Chin. Hell. Ign. — quick: Chin. Ign. Stram. . — sniffling: Rhus. — difficult: Ipec. —strong: Caps. Chin. INSPIRATION, slow: Ferr. Ignat. Op. Staph. Stram. — stertorous : • Nux vomica. Op. Puis. Rheum. — quick: (Arnica.) (Camphora.) Cham. Ign. — difficult : Chin. Cina. Coccul. Ferr. Ign. Staph. Veratr. — like urine : Graph. — rattling: Aeon. Ani. Bell. Bry. Calc Cann. Carbo an. Caust. Cham. Chin. Cina. Croc. Cupr. Ferr. Hyosc. Ipec. Lye. Op. Petr. 8 a ml). Sepiae. Spong. St annum. Strain. — hiccuping : Asa f . Op. Sec. com. —stertorous: Bellad. Cham. Chin. Coccul. Cupr. Hep. sulph. Ign. Kali c. Natr. mur. Nitric acid. Nux vom. Op. Petr. Sep. Stannum. Stram. Sulph. — painful: Aeon. Arn. Arsenic. Bry. Chin. — quick: Aeon. Asa f. Bell. Bryon. Cupr. Dig. Hell. Hep. s. Ign. Ipec. N. vom. Op. Samb. Secale cornut. Spong. Stram. Veratr. — sniffling: Arn. China. Nux vom. Rltus. Sabin. — sighing: Ant. crud. Capsicum. Chin. Coccul. Op. Secale corn. Selen. Stram. EXPIRATION, groaning: Bell. Bry. Cham. Cina. Coccul. Cupr. Ign. Kali c. Mur. ac. Nux vom. Op. Sec. corn. Stram. — inequal: Coccul. Ignat. Ipec. Op. Sec. corn. — imperceptible : Veratr. — irregular: Bell. — interrupted: Aeon. Cham. Cic. Cina. Cupr. Ignat. Op. Puis. Phosph. — suppressed: Cupr. SUFFOCATING FITS: Aeon. Ant. crud. Ars. Bell. Bryon. Camph. Cann. Causticum. Cham. Chin. Coccul. Coff. Con. Cupr. Digit. Hep. sulph. Hyosc. Ignat. Ipec. Lach. Mosch. Nux vom. Op. Plat. Plumb. Puis. Rhus. Sabad. Samb. Sec. corn. Spong. Staph. Sulph. Veratr. Causes of the Impeded Respiration. ABDOMEN, flatulence: Capsic. Cham. Ign. — unpleasant feel : Ars. — simple pain : Arn. Bry. Ign. Ruta. — swelling : Bry. — pinching: Rhus. Spig. — cutting: Puis. — weight like a stone : N. vom. — stitches: Croc. Dros. Mosch. Nux vom. Puis. Ruta. — fullness: Cann. Caps. Cham, Chin. Phosph. — compression: Staph. — crying: Cupr. Rhus. Samb. — simple pain in : Stannum. — jerks in : Calc. ANXIETY: Aco. Arnica. Croc. N. vom. Puis. Rhus. Ruta. Valer. Veratr. — fits of : Ars. Lye. Stann. ARMS ABOVE THE HEAD, rais- ing the: Cupr. BACK-ACHE: Arg. Cann. Lach. Ruta. Sep. (Staph.) — dislocation-pain in : Petr. 48 BREATHING, RESPIRATION. — simple pain in : Puis. Selen. ■ — stitches in : Nux vom. Puis BLADDER, stitches in : Aur. BREATHING, nasal: Puis. CHAGRIN: Ars. Cham. CHEST, oppression in : Aconit. Arn. Cann. Cic. Chi. Coccul. Coff. Dros. Ign. Merc. N. vom. Puis. Rhus. Sabad. Spigel. Veratr. -pressure in the : Argent. Arn. Asaf. Bellad. Camph. Cann. Caust. Cham. Chin. Cic. Ign. N. vom. Rheum. Ruta. Sabad. Samb. Spig. Staph. Stram. Valer. — spasm in the : Petr. — empty feeling : Stann. — faintness in the : Stann. — heaviness in the: Plat. — tension in the : Merc. Mur. ac. — stitches in the: Aur. Carbo veg. Merc. Stann. — fullness in the : Sep. — contraction in the : Sep. — as if oppressed by a load : Rheum. Sabad. Spig. — ulcerative pain : Staph. — throbbing in : Asa f. — spasms in : Asa f oet. Cupr. Plumb. — pressing in : Ign. Veratr. ■ — mucus in : Cina. —pain generally : Selen. — weight in : Cann. Ign. Rhus. ■ — tension in : Cann. Cic. Coccul. Puis. Rhus. Staph. — stitches in : Aeon. Arg. Asa f. Bry- 011. Canth. Caps. Chin. Dros. Plumb. Ruta. Spig. Staph. Yeratr. — shocks in : Cann. — fullness in : Aeon. Ant. cr. Cans. Puis. Ruta. Veratr. — as if bruised: N. vom. — drawing in : N. vom. — contraction in : Arn. Asa f . Can- thar. Capsic. Chin. Coccul. Cupr. Hell. Ipec^ Moschus. N. vom. Op. Spig. Staph. Veratr. COUGH: Ars. Brv. Coccul. Cuprum. Dros. N. vom. Petr. Rhus. Sil. Spig. Veratr. —dry: Cupr. Ipec. N. vom. Rhus. Sep.. CRAMP, in left side : Merc. DREAMS, anxious; Graph. — as from dust : Ipec. EPIGASTRIUM, pain in: Arsenic. Coccul. Hell. Pulsat. Sep. Staph. FLATULENCE: Cham. Nux vom. Puis. HEAD, dull: Sep. — ache: Arn. HEART, stitches in the : Cham. Petr. (Puis.) — region of, pain in the: N. vom. (Puis.) HYPOCHONDRIA, swelling in: Cham. Ign. — pain in: Chin. Puis. Staph. LARYNX, mucus in : Chin. Cupr. — contraction: Sabad. Spong. LIVER, pain in : Sep. LUNGS, weak: Stann. MORTIFICATION: Ign. Staph. NAPE OF NECK, drawing and stinging in : Sep. NAUSEA : Rhus. Samb. NOSE, dry: Canth. ODORS, strong: Phosph. PALPITATION OF HEART : Spig. RECTUM, stitches in : Sulph. RIBS, -pains under the : Sep. RISING, from abdomen : Valer. SCAPULiE, pressure in: Rhus. — pressure when leaning against : Sep. — stitches: Pals. Sep. — dislocation-pain : Petr. — drawing: Rhus. Ruta. STITCHES IN RIGHT SIDE: Graph. SPLEEN, pain in : Ruta, — stitches in: Arn. STOMACH, anxiety in pit of : Can- nab. Ferr. Sabatl. Stram. — pressure in pit of: Am. Bry. Camph. Chamom. Chin. Cic. Coc- COUGH. 49 cul. Helleb. Hyosc. Ignat. Mosch. Nux vom. Rhus. Samb. — cramp in pit of : Sulpli. — simple pain in pit of : Arnic, Cina. Helleb N. vom. Pulsat. Ruta. Sabad. — feeling as if swollen in pit of : Rhus. — stitches in pit of: Chin. Phosph. Spig. — warmth in ditto • Bry. — digging in ditto : Chin. — griping: Phosph. — pain in : Caps. Cham. Rhus. — fullness in : Chin. Coccul. LIKE VAPORS OF SULPHUR: Croc. Mosch. TRACHEA, obstacle in: Cannab. Spong. — tickling: Rhus. — mucus in : Cupr. Ruta. Yeratrum. — contraction of: Canth. Ipec. Puis* THROAT, as if larger : Yeratr. — scraping in : Sabad. — like a plug : Spong. — constriction : Canth. N. vom. Puis. Veratr. — rising in: Cann. Stann. — like a foreign body in : Cic. — mucus in : Aur. —dryness: Petr. — constriction : Cham. Coccul. THROAT-PIT, constriction in : Rhus. XIX. COUGH. Character of the Cough. COUGH, in general: Aco. Ambr. Bell. Calc. Cann. Cantharis. Caps. Carbo an. Carbo veget. Causticum. Cham. Chin. Cina. Coccul. Coloc. Con. Digital. Dros. Fer?\ Euphorb. Graphites. Hep. s. Ignat. Iod. Ipec. Kali c. Lye. Mercur. Mur. ac. Xatr. mur. Xitric ac. Op. Petr. Phosph. Phos. ac. Plumb. Puis. Rhus. Ruta. Sabin. Sep. Sil. Spig. Spong. Staph. Sulph. — with expectoration: Ambr. Ant. crud. Arg. (Am.) Ars. Asa f. Bell. Bry. Calc. Carbo veg. Caust. Cham. China. Cic. Cina. Con. (Croc.) Dros. Euphorbium. Euphr. Ferr. Graph. Hepar s. Ipec. Kali c. Lye. Merc. N. vom. Natrum mur. Petr. Phosph. Ph. ae. Plumbum. Puis. Rheum. Rhus. Ruta. Sabad. Sabin. Secale cornut. Selen. Sep. Sil. Spigelia. Spong. Staph. Stront. Sulph. Ye- ratr. — with easy expectoration: Argent. Euphr. Plumb. Puis. Staph. — with difficult expectoration : Ambr. Ars. Aur. Bry. Camph. Cann. Canth. Caust. Cham. Cina. Dros. Euphr, Hyose. Ign. Iod. Kali c. >~ux vom. Phosph. Plumb. Puis. Sep. Stann. Staph. Sulph. Zinc. — without expectoration : Aconit. Alum. Ambr. Antim. crud. Arn. Ars. Asa fset. Bar. Bellad. Bry. Calc. Cann. Canth. Caps. Carbo an. Carbo veg. Caust. Cham. China. Coff. Coloc. Con. Croc. Cupr. Digit. Dros. Euphorb. Ferr. Graphit. Hell. Hep. s. Hyosc. Ignat. Iod. Ipec. Kali c. Lycop. Mur. ac. Merc. N. vom. Op. Petr. Phosph. Phos. ac. Plat. Plumb. Pulsat. Rheum. Bhod. Rhus. Sabad. Sep. Sil. Spi- gel. Spong. Stann. Sulphur. Yeratr. Zinc. — anxious : Aeon. Cina. Coff. Rhus. — fatiguing : Cocculus. Crocus. Ipec. N. vom. Rhus, —barking : Dros. Spong. -dull: Arsen. Bar. Bell. Carbo veg. 50 COUGH. Euphorb. Hep. s. Kali c. Lye. Petr. Phosph. Sep. -close: Asaf.Bry. Chamom. Coc- cul. Sabad. -rocking: Antiin. crud. Ipec. Puis. Rhus. -suffocative : Aco. Bry. Cham. Cupr. Ipec. Op. Spigilia. Spong. -violent : Ambra. Cina. Con. Hep. s. Ign. Ipec. Merc. N. vom. Phosph. Euta. Sabad. Spig. Spong. Staiin. -hoarse: Aco. Ambr. Asa f. Brom. Chin. Cina. Drosera. Samb. Spong*. Veratr, -hollow: Aco. (Bell.) Caust. Cina. Euphorb. Hepar sulph. Ign. Ipec. Opium. Fliosph. Sambucus. Spig. Spong. Veratr. -hacking: Aeon. Alum. Ars. Cann. Canth. China. Coffea. Coloc. Cupr. Dros. Euphorb. Hell. Hyosc. Kali c. Natrum mur. Op. Phosph. Plumb. Rhus. Stann. Sulph. Thuj. and dry : Alum. Arg. Am. Ars. Bell. Canth. Capsic. Carbo an. Caust. Cina. Con. Graph. Ign. Phosph. Sabad. Sabin. Sulph. Veratr. Zinc, -irritating : Coff. Ign.. -spasmodic: Aconit. Ambr. Bell. Bry. Carbo veg. Chin. Cina. Con. Ferr. Hyosc. Ignatia. Ipee. N. vom. Phosph. Plumbum. Puis. Sep. Sil. Staph. -short: Aco. Alumina. Arg. Arn. Ars. Aur. Bell. Canth. Carbo vege- tabilis. Caust. Coff. Euphorb. Ign. Ipec. Merc. Mur. acid. Nux vom. Natr. mur. Phosph. Platina. Puis. Rhus. Sabad. Spigel. Spong. -scraping: Nux vomica. Puis. Sabad. -deep : Ambra. Ars. Drosera. Hep. s. Petr. Phos. Samb. Spong. Stann. Veratr. -unceasing: Cupr. Droser. Hyosc. Ipec. -titillating : Alum. Arn. Asa f. Calc, Canth. Caust. Chamom. Chin. Con. Hyosc. Iod. Kali. Merc. Nux vom. Natrum mur. Nitric ac. Phosph. Rhus. Stann. Staph. — with vomiting: Alumin. Arg. Ar- sen. Asa f. Aur. Bry. Calc. Carbo an. Carbo veget. Cina. Coccul. Com Dig. Dulc. Iod. Nitric ac. Phosph. Plat. Puis. Rhus. Spong. Stann. Staphys. Zinc. — whooping : Aeon. Ambra. Arn. Ars. Bell. Byron. Cham. China. Cina. Con. Cupr. Dros. Euphr. Hep. s. Hyosc. Ign. Ipecac. Kali c. Mosch. Mur. ac. N. vom. Opium. Phosph. Puis. Rhus. Ruta. Sep. Spong. Sulph. Veratr. Expectoration. ACRID : Puis. BITTER: Ars. Cham. Drosera. Ni- tric ac. Puis. BLOODY: Aeon. Alum. Arn. Ars. Bell. Bry. Calc. Canth. China. Cina. Con. Croc. Cupr. Daph. Dig. Dros- era. Dulc. Ferr. Hepar sulph. Hy- osc. Iod. Ipec. (Kali c.) Lye. Merc. Mur. ac. Nitric ac. Op. Phos. Plumb. Puis. Rhus. Sabad. Sab in a. Sec. corn. Selen. Sep. Sil. Staphys. Stram. Sulphur. Zinc. BLOOD, brown: Bry. Rhus. — thick: Cupr. — thin: Eerr. Sabin. — coagulated: Arn. Bryonia. Canth. Nux vom. Nitric acid. Puis. Sep. — bright-red: Arn. Cantharis. Chin. Dros. Hyoscyam. Rhus. Sabad. Sa- biua. Sep. Sil. — frothy: Arn. Dros. Ferr. — black: Arn. Canthar. China. Croc. Nux vom. Nitric acid. Puis. BILIOUS- Puis. TASTING OE OLD CATARRH: Ignat. Puis. Sulph. Zinc. COOL : Cann. Phosph. (Sulph.) COPIOUS: Alum. Bry. Caust. Cic COUGH. 51 Cina. Dros. Euphr. Ferr. Graph. Kali c. Lye. Puis. Sep. Sil. Stan- num. Sulph. HAVING A FOUL TASTE: Cal- carea. Carbo veg;. Cham. Cupr. Ferr. Pliospli. Pulsat. Sepise. Stann. Zinc. FEOTHY: Op. Phosphor. Plumb. Sil. GRANULAR: Chin. Phosphor. Sep. GLOBULAR: Thuj. GRAY : Ambra. Lycop. Sepise. Thuj. GREEN : Ars. Cann. Carb. veg. Ferr. Hyosc. Lycop. Puis. Sep. Stann. Thuj. INDURATED: Iod. INODOROUS: Arg. LIVER-COLORED: Puis. HAVING A METALLIC TASTE : Ipec. MUCUS, bloody: Alum. Arn. Ars. Bry. Chin. Con. Dros. Ferr. Iod. Ipecac. Opium. Phosph. Sabin. Sec. corn. Selen. Sil. Spong. Zinc. —transparent: Ars. China. Sil. — yellow : Bry. Dros. Puis. — gray: Ambr. — blackish: Lye. — dry: Bry. Plumb. — white : Ambr. Argent. Cina. Phosph. Rhus. Sep. Spong. — tenacious: Antim. cruel. Ars. Bell. Bryon. Cann. Canth. Carbo veget. Canst. Cham. Coccul. Euphr. Iod. N. vom. Phosph. Puis. Ruta. Samb. Sep. Staph. Veratr. Zinc. HAWKING UP OF MUCUS: (See Larynx.) NAUSEOUS : Dros. (Puis.) PURULENT : Bell. Calc. Chin. Con. Dros. Ferr. Lycop. Kali c. Natr. mur. Phos. Ph. ac. (Puis.) Ruta. Sep. Sil. Staph. Zinc. SALT : Alum. Ambr. Ars. Bar. Cann. Carbo veg. (Drosera.) Graph. Lye. Phos. Puis. Sep. Stann. Sulph. SOUR: Calc. Phosph. Ph. ac. SLIMY: Alumina. Ambr. Arg. Ars. Aur. Bar. Bell. Bryo. Calc. Caps. Caust. Chamom. Chin. Cina. (Croc.) Digit. Eivphr. Ferr. Hep. s. Hyosc. Iod. Ipec. Merc. Mur. acid. A Xr. mur. Op. Phosphor. Plumb. Pr's. Rheum. Rhod. Rhus. Sabin. Sec. corn. Selen. Sep. Sil. Spigeiia, Spongia. Stann. Staph. Sulph. Z.^c*. HAVING A BAD SMELL: Arsen. Calc. Stanu. — — taste: Ars. Stann. LIKE STARCH: Arg. Bar. SWEETISH: Calc. Ferr. Nux voul Phosph. Stann. TASTELESS: Arg. TENACIOUS: Alum. Ars. Carbo veg.Caust.Dulc. Iod. Kali c. PhospL*.. Sep. Stann. Zinc. THICK : Arg. Ipec. Lye. Phos. Stani:. Sulph. Zinc. TITILLATING: Caust. LIKE TOBACCO: Puis. TUBERCLES, brownish : Phos. VISCID: (Rhus.) WATERY: Arg. WHITISH-YELLOW : Lyc.Phosph, ac. YELLOW: Ars. Bryo. Calc. Dros Ign. Lye. Phosphor. Puis. Sep Spong. Stann. Stapjh. Thuj. Elxciting Causes. AS FROM THE ABDOMEN: Ve ratr. BY OPEN AIR: Ars. Lye. Phosph, IN — — : Bry. Coccul. Ipecac. N. vom. (Rhus.) Spig. BY GETTING ANGRY : (Cham.) FROM ASCENDING : Arg. N. vom. BY BARING ONE SELF : N. v?m. BY DRAWING ALONG BREATH . Dulc. Hep. s. BREATHING: Bellad. Coloc Dulc. Graphit. Hepar sulph. Natr. liiar. Sulph. 52 COUGH. BY BENDING IN THE CHEST: Phos. acid. AFTER CHAGRIN: Aco. Bry* IN COLD AIR: Aco. Bry. Carbo Teg. Hepar sulph. Pliosphor. Spong. BY TAILING COLD: Bry©. Cupr. Dros. Ipec. Op. N. toiii. Rhus. FROM TAKING COLD : Carbo veg. Dulc. Hep. s. Petr. Phosphor. BY CONTRACTION OF ABDO- MEN: Dros. BY GETTING COOL : Am. Rhus. AFTER CRYING: Arn. AFTER DRINKING: Aeon. Ar- senic. Bry. Coccul. Ferr. Hep. sulph. Lye. N. Torn. Op. (Phosph.) FROM DRINKING COFFEE: Capsic. Cham. Coccul. Ign. N. vom. FROM DRYNESS : Puis. BY FEELING OF DRYNESS: Merc. AFTER EATING: Bell. Bryon. Chin. (Dig.) Ferr. N. vom. Opium. (Puis.) Ruta. Staph. Zinc. WHEN EATING : Carbo vegetabil. Coccul. (Puis.) Sep. BY EMOTIONS : Aeon. Arn. Bry. Cham. Xujcv om. Op. Rhus. Staph. AFTER ERUCTATION: Staph. BY EXPIRATION : Cann. N. vom. AS FROM FEATHER-DUST : Bellad. Cale. Cina. Ign. BY HEAT OF BODY: (Aco.) BY GETTING HEATED : Aco. Bry. Ipec. N. vom. Thnj. AS FROM A HAIR ON THE TONGUE : Sil. HYPOCHONDRIA, irritation in: Thuj. — inspiration : Cina, Croc. Ipec. Puis. deep: Bry. Cina. Ipec. IRRITATION, generally: Aconit. Alum. Arg. Arn. Ars. Asaf. Bar. Bellad. Bryon. Calc. Cann. Carbo an. Carbo veget. Canst Cham. China. Cina. Coccul. Coloc. Con. Croc. Dig. Euphorb. Ferr. Graphit. Hepar s. Hyosc. Ignat. Iod. Ipec. Lye. X. vom. Nitric ac. Petr. Phosph. Pulsat. Rhodod. Sabin. Sep. Sil. Sing. Stann. Staph. Sul- phur. Thuj. Zinc. Yeratr. BY AN IRRITATION IN THE LARYNX: Aco. Alum. Arn. Ar- sen. Bar. Bry. Canth. Caps. Carbo an. Carbo veget. Cham. Cina. Coccul. Coff. Dros. Hep. s. Ign. Iod. Ipec. Merc. Mur. ac. >'. vom. Pulsat. Sabad. Sabin. Sep. Sil. Spongia. Staph. Sulph. FROM IRRITATION IN THE REGION OF THE;YOID;BODY : (Iodine.) Spong. FROM IRRITATION IN THE STOMACH: Bell. Bry. Merc. BY LAUGHING: Arg. Chin. Stann. BY LOSS OF BREATH: Aur. Coccul. Dros. Euphr. Hep. sulph. Ign. Ipec. Nux vom. Spig. AFTER LYING DOWN: >\ vom. Puis. Rhus. Ruta. Sabad. Staph. WHEN LYING DOWN : Ambr. Ars. Bellad. Cham. Coccul. Con. Dros. Ferr. Hyosc. Ignat. Ipec. Merc. Phosph. Puis. Rhus. Sabad. in bed: Cham. Ferr. Ntue vom. Puis. Rhus. on the back : H. vom. on left side : Aeon. Bryon. Ipec. Phosph. Puis. on right side: Aco. Carbo an. Ipec. FROM MENTAL LABOR: Ignat. X. vom. BY MOTION : Arn. Ars. Bryon. Ferr. y. vom. BY MUCUS : Cham. Cina. Puis. BY MUCUS ON CHEST : Caustic. Stann. BY MUCUS IN TRACHEA: N. vom. FROM NAUSEA : (Bry.) N. vom. COUGH. 53 WHILE NURSING : Chin. Fere. DURING PREGNANCY: Ipecac. Puis. BY PRESSURE : Iod. BY READING : N. vom. BY READING ALOUD : Nitric acid. Phosph. IN REST: Caps. Dros. Euphorb. Ferr. Hyosc. N. vom. Phosph. Puis. Rhus. Samb. BEFORE RISING : N. vom. IN THE ROOM:Arg. Bry. Croc. Puis. Spig. IN SCREAMING: Arn. BY SHOCKS : N. vom. WHEN SITTING: Hell. Phosph. IN SLEEP: Arn. BeU. Calcarea. Cham. Lach. Nitr. ac. Sep. WHEN SMOKING: Aeon. Bryon. Coloc. Ferr. Hell. Ign. Nux vom. Petr. Spong. Staph. WHEN STEPPING INTO WA- TER: Spig. BY STITCHES : Aconit. Bryon. N. vom. WHEN STOOPING: Ai£. Canst. Hep. s. Spig. BY SUFFOCATIVE FITS: Cham- om. Ipec. Puis. AS FROM VAPOR OF SULPH. Carbo veg. Chin. Ign. Lye. Puis. FROM SWALLOWING: Op. FROM TALKING: Bar. Cham. China. Hep. s. Ign. Ipec. Merc. Phosphor. Stann. Rhus. WHEN TEETHING: Chamom. Cina. Hyosc. Ipec. Rhus. THROAT, as if swollen: Ars. — scraping in : Ambr. Croc. --roughness in: Bry. Nux vom. Plumb. Rhus. Sabad. — irritation: Coff. — scraping in : Puis. Sab. — mucus in : Caustic. Chamom. Coc- cul. Euphr. — stitches in : Cham. Stann. — dryness in : Bry. Dros. Puis. Rhus. Stann. — constriction in : Coccul. Ign. — rising in: Cham. THROAT-PIT, tickling in: Bella. Cann. Cham. Coccul. Ign. Phos. ac. Puis. — pain generally : N. vom. STOMACH, tickling in pit of: Bar. Bell. Bry. Hep. s. Natr. mur. Phosph. ac. BY TICKLING IN THROAT : Dig. N. vom. BY TITILLATION IN THROAT : Ambra. Bryon. Calc. Caustic. Chin. Euphorb. Hepar sulph. Iod. Zinc. HIP, twitching in : Ars. ON WAKING : Ign. Nux vom. Puis. Rhus. WHEN WALKING: Alumina. Ars. Carbo veget. Ferr. Natrum mur. AFTER WALKING IN THE OPEN AIR : Ferr. Ipec. WHEN GETTING WARM IN BED : Cham. N. vom. Puis. BY WEAKNESS: Stann. WORSE BY COUGH: Ign. BY YAWNING: Arn. N. vom. Accompanying Ailments. ABDOMEN, pain in: Dros. Lye. N. vom. Phosph. Ph. ac. Sil. Ve- ratr. — cutting in: Veratr. — stitches in: Ars. Sep. Veratr. —shocks in : Natr. mur. — bruised in: Arsen. N. vom. Puis. — contraction: Dros. — pain in muscles of : Hyosc. — stitches in sides of : Arn. ABDOMINAL RING, stitches in: Veratr. ANXIETY: Aeon. Cina. Coffea. Rhus. ASTHMA: Am. Carb. v. Canst Coccul. Dig. Euphorb. Ferr. Ipec. 54 COUGH. Natr. mur. Phosphor. Rhodod. films. Sep. Veratr. BACK, stitches in : Aco. Chin. Merc. Puis. Sep. B I ADDER, pain in : Caps. BREATHING, breath, hot : Ant. cr. —snorting: Chin. ■■"etid: Caps. — want of: Ferr. Ipec. -incarceration of : Aeon. Arn. Bar. Bryon. Calc. Cina. Cupr. Ipec. Merc. Nat. mur. Sil. Spig. CATARRH: Bell. CERVICAL GLANDS, pain in: Natr. nmriat. CHCKING: Carbo veget. Droser. ito. sulph. Ipec. N vom. Puis. Sep. Sulph. CHEEKS, drawing in : Carb. veg. CHILLINESS: Calcar. Carbo veg. Con. Phosph. Sulph. COLIC : Ambr. Arsen. Canth. Coloc. Con. Droser. (Eerr.) Ipec. Lycop. N. vom. Phosph. Sep. Stann. Ve- ratr. CONCUSSING THE BODY: Ant. cr. Ipec. Puis. Rhus. CONSCIOUSNESS, loss of: Cina. CONSUMPTION: China. Ferr. N. vom. Puis. CRYING : Arnic. Bellad. Cina. Hep. s. MEST, oppression in : Rhus. Veratr. burning in: Ant. crud. Carb. veg. Caust. Cina. Ferr. Phos. Ph. ac. Spong. pressure in: Carb. "veg. Chin. Iod. Ph. ac. Sil. as if shaken : Rhus. ulcerative pain : Staph, —as if hollow: Sep. Zinc. itching: Ambr. coldness in : Zinc. cramp in : Cina. scraping in : Ruta. Staph. roughness: (Arn.) Carb. veg. Kali carb. Lye. Sep. — rattling: Bell Caust. Cham. COUGH, — pains generally : Ambr. Ars. Bel- lad. Carb. veg. Caustic. Cham. Cina. Coif. Dig. Dros. Kali carb. Lye. Merc. Mur. ac. N. vom. Nat. mur. Nitr. ac. Phosph. Ph. ac. Puis. Sep. Spong. Sulph. Veratr. — relieved by pressure: Phosph. — cutting: Natr. mur. Sulph. — excoriated, as if: Carbo. veg. Lye. Phosph. Sep. Spong. — heaviness: Zinc. — tension in : Phosph. Rhus. — stitches in: Aco. Arn. Ars. Bell. Bry. Cann. Chin. Coff. Con. Dros. Merc. Nux vom. Natr. mur. Pulsat. Rhus. Sabad. Sep. Zinc. — fullness: Sabin. — qualmishness: Rhus. — as if sore : Alum. (Arn.) Bar. Carb. veg. Caust. Cina. Hepar sulph. Ipec. Lye. Mur. ac. Nux vom. Nitr. acid. Phosph. Sep. Silic. Spig. Spong. Stann. Sulph. — pain as if bruised : Arn. —as if flying to pieces : Arsen. Bry. Caps. Merc. Zinc. — drawing: Caps. — contraction: Dros. EAR-ACHE : Caps. (N. vom.) EPYGASTRIUM, pain in: Ambra. Dros. N. vom. — stitches in: Sep. ERECTIONS: Cann. Canth. ERETHISM, vascular : Arn. Chin. ERUCTATIONS: Ambr. Veratr. EYES, obscured: Coff. — sparks before : Kali. — tears in: Cina. Puis. Sabad. FACE, blue: Ipec. Op. Veratr. — pale : Cina. —hot : Bell. Ipec. Sulph. — sweat in : Ipec. — distorted: Spoils:. FAUCES, burning in: Caust. Ph. acid. COUGH. 55 — sore feeling in : Canst. FALLING DOWN: Ipec. FOREHEAD, cold sweat on : Veratr. HANDS, swelling of : Aeon. — coldness of : Sulph. HEAD, pressure in : Alnm. Bry. Con. Nitr. ac. Pkosph. Buta. — as if shaken: Rhus.. — heat in: Ars. Ipec. Snlph. — tearing in: Alnm. Calc. Sep. — pain generally: Aco. Bell. Bry. Chin. Con. Lye. Sabad. — stitches in: Alum. Arn. Bry. Calc. Carb. veg. Con. Buta. Sabad. — shocks in : Arsen. Ipecac. Lye. Natr. mur. Bhus. — as if bruised: Sulph. — as if flying to pieces : Bryon. Caps. Merc. NwxYom. Natr. mur. Phosph Ph. acid. Sep. Sulph. — contractive pain in : Petr. HEAT : Arn. Bell. Nux vom. Sabad. HOABSENESS: Aco. Ambr. Asa foet. Chin. Gina. Droser. Samb. Spong. Stann. Terat. ILL-HUMOB: (Bell.) (Spong.) LABYNX, ulcerative pain in : Car- bo veg. — crawling: Sabin. — irritation in: Coccul. — pain generally : Spong. — stitches : Kali c. Phosph. — as if sore : Arg. Bry. Carbo veg. Hep. sulph. Ign. Kali c. Natr. mur. Sep. LABYNX, as if torn : Staph. LIMBS, pain in: Caps. MOUTH, dry: Coccul. NAPE OF NECK, pain in: BeU. NAUSEA: Bryo. Caps. Drosera. Ipec. Merc. N. vom. Puis. Buta. NOSEBLEED: Aco. Bros. Merc. Puis. PAIN IN ABM : Dig. Puis. PALPITATION OF HEABT : Ar- nic Calc. PAIN AS FBOM HERNIA : Petr. — as from fatigue : Puis. — generally : Ambra. Droser. X. vom. — tension : Hell. — stitches: Aco. Ars. Bryon. Phosph. Sabad. Sulph. — as if bruised: Bry. — contraction in : Dros. — hip : Ars. Bellad. Caustic. Rhus. PRESSURE IN HYPOCHON- DRIA : Coccul. Spong. Valer. PENIS, pain in the : (Ign.) PTYALISM: Veratr. RECTUM, stitches in: Nitric ac. RESTLESSNESS : Aconit. Coff. Samb. RIBS AS IF BRUISED : Arn. . SALIVA, bloody : Dros. SCREAMING: Op. Samb. SHORTNESS OF BBEATH: Bry. SHOULDEB, stitches in : Puis. — blade, stitches in : Mercur. Sep. SIDE, stitches in: Aco. Bry. Puis. Zinc. SLEEPLESSNESS : Hyosc. Lycop. N. vom. Puis. Bhus. Sabad. SNEEZING: BeU. Bryo. Hepar sulph. SMALL OF BACK, pain in: Merc. — stitches in : Aco. Arn. Nitric acid. SPERMATIC CORD, stitches in: Veratr. START, tendency to : Aco. STERNUM, pain of : Bell. Chin. Sep. Sil. STOMACH, pressure in: Lye. — pain in: Bry. Hell. Ipecac. Lye. Phosph. Puis. Rhus. Buta. Sabad. Sep. — pressure in pit of: Phosph. — simple pain : Sepice. Stannum. Thuj. — pain generally : Ambr. Bryo. Ipec — stitches: Ars. Bry. Phosph. Sulph. — qualmishness: Ign. — sore pain : Bry. j — as if bruised : Stann. -contraction : Ars. 56 LARYNX AND TRACHEA. SUFFOCATIVE FITS : Aco. Bryon. Cham. Cupr. Hep. s. Ipec. Op. Spig. Spong. SWEAT : Ars. Dig. Hep. sulph. Ipec. Ehus. Sabad. Spong. TASTE IN MOUTH, as of blood: Bell. Ehus. — bad: Caps. TEETH, gritting of: Bell. TOOTH-ACHE : Lye. TEEMBLING OF WHOLE BODY : Phosph. TESTICLES, pain in: Zinc. THEOAT, bitter taste in: Ehus. — burning in: Mur. ac. Phosph. — pressure in : Caps. — inflammation: Aco. Cham. Ipec. Nnx vom. Puis. — ulcerative pain : Caps. — as if swollen : Caps. Puis. — itching: Ambr. — titillation: Bry. Kali c. — scraping: Ambr. Bell. Bry. Croc. Hep. s. — roughness : Carbo an. Caust. Hep. s. Kali c. Phosphor. Bhocl. Sep. Spong. — pain generally: Caps. Hepar s. Natr. mur. Phosph. Sil. Sulph. — stitches in: Bryo. Nitric acid. Phosph. — dryness: Puis. Ehus. — sore pain : Ambra. Phosphor. Sep. THEOAT-PIT, pain in: N. vom. THBOBBING IN AETEEIES : Calc. THYEOID GLAND, itching in: Ambra. — CAETILAGE, titillation in: Puis. TOSSING ABOUT: Aeon. Arn. TEACHEA, itching in: Ambr. N. vom. — tickling in : Cham. Sabin. — pain generally : Camph. Chin. Ign. N. vom. Spong. — shocks: Bry. Cina. — as if sore : Ant. crud. Bryon. Cann. Caust. Chin. Nux vom. Natr. mur. Plumb. Stann. — as if torn : Staph. ULCEES, pain in: Con. UMBILICUS, pain in : Ambr. UEINATE, urging to : Ipec. UEINATION, involuntary: Antim. crud. Bry. Puis. Spong. Staph. Yeratr. UEINE, retention of: Ipec. YEETIGO : Aco. Coff. VOMITING, in general: Arnica. (Bell.) Bry. Calc. Capsic. Carbo veg- Con. Cuprum. Dros. Hep. s. Iod. Ipec. Kali c. Nux vom. Phosph. ac. (Puis.) Sabad. Sep. — bitter: Cham. Sep. —of food: Bryo. pig.) Dros. Ferr. Natr. mur. (Ehus.) — of mucus: Dros. Hyosc. '. . — sweet : Calc. — of water: Dros. WATEBBBASH: Amb. Ars. Bry. Spig. Staph. WEAKNESS : Chin. Ferr. Veratr. YAWNING: Op. XX. LARYNX AND TRACHEA. Sensations. 1. Larynx. AIE, rising of : Lye. APHONIA : Bell. Carb. veg. Caust. Hep. sulph. Merc. Natr. mur. Phos. Plat. BURNING : Canth. Chamoiu. Spong. CHOKING : Cupr. Dros. CONSTEICTION : Camphor. Cham. LARYNX AND TRACHEA. 57 occul. Coff. Ipec. Mosch. N. vom. Plumb. Puis. Spong. Yeratr. CONTRACTION: Spong. CONTUSIYE PAIN : Ruta. COUGH, desire to : Aeon. Arnica. Bry. Canth. CajDs. Cham. Cilia. Coccul. Coff. Droser. Ign. Ipec. X. vom. Puis. Sabad. Sabin. Spong. Staph. CRAMP Y FEELING: Cham. Nux vom. CRAWLING: Sabin. CROUP, gangrenous : Chin. — membranous: Aco. Cham. Dros. Lack. Samb. Spong. DRYNESS: Alum. Carb. an. Con. Hyosc. Nux vom. Natr. mur. Petr. Phosph. Spong. Sulphur. Zinc. FOOD GETS INTO THE LAR- YNX: Aco. Cann. Rhus. Yeratr. HAWKING UP MUCUS : Alumina. Ambr. Ant. crud. Arg. Aur. Bry on. Calc. Camph. Cann. Canth. Carb. an. Canst. Cham. Chin. Cina. Coc- cul. Croc. Dig. Dulc. Hyosc. Iod. Kali c. Loch. Lye. N. vom. Natr. mur. Phosph. Plumb. Rhod. Rhus. Sabad. Sabin. Samb. Selen. Spig. Stann. Staph. Sulph. Yaler. HEAT : Ant. crud. Canth. Iod. HOARSENESS: Aeon. Alumina. Ambr. Am. Ars. Asa f. Bell. Bry- on. Calc. Camph. Canth. Caps. Carb. an. Carb. veg. Caust. Cham. Chin. Cic. Coff. Con. Croc. Cupr. Dig. Dros. Ferr. Graph. Hep. Ign. Iod. Kali c. Loch. Lycop. Merc. Mur. ac. Nux vom. Natr. mur. Nitr. ac. Op. Petr. Phosph. Ph. ac. Plat. Plumb. Puis. Rhus. Sabad. Samb. Sec. corn. Selen. Sep. Sil. Spig. Spong. Stann. Staph. Stramon. Sulph. Thnj. Veratr. Zinc. INFLAMMATION: Aeon. Dros. Ipec. N. vom. Puis. Spong. ITCHING: Ambra. Con. Nux vom. MUCUS, accumulation of: Alum. Arg. Ars. Calc. Carb. an. Caust. Cham. Chin. Cina. Coccul. Coff. Dig. Hyosc. Iod. Kali c. Lye. Nux vom. Natr. mur. Phosph. Samb. Sep. Stann. PHTHISIS OF LARYNX: Ambra. Carb. veg. Caust. Cupr. Dros. Ign. Iod. Lach. Merc. Nux vom. Pulsat. Spong. Stann. Sulph. AS OF A PLUG: Bar. Kali c. PRESSURE: Bar. BeUad. Capsic. Carb. veg. Cic. Graph. AS IF RAW: Arg. Puis. ROUGHNESS: Alum. Ambr. Ars. Bell. Canth. Caps. Carb. veg. Caust. Chin. Coff. Kali c. Mur. ac. N. vom. Natr. mur. Phosph. Phos. ac Plumb. Puis. Rhod. Rhus. Sabad. Sil. Spong. Stann. Sulph. Zinc. AS IF SCRAPED : N. vom. Pulsat. Sabad. Yeratr. SCRAPING: Alumin. Carbo veg. Ign. Kali c. Natr. mur. Nitr. acid. Rhus. Sabad. Spong. Staph. SENSITIVENESS: Bell. laches. Phosph. Sulph. Hepar. sulph. Iod. Phosph. Sep. Spong. Zinc. SIMPLE PAIN: Aeon. Canthar. Hep. s. Iod. Lach. N. vom. Spong. AS OF A SOFT BODY: Dros. SORE FEELING: Arg. Bry. Carb. veg. Caust. China. Graph. Ign. Iod. Kali c. Natr. mm.-. Puis. Sep. SPASM: Mosch. Yeratr. STITCHES: Capsic. China. Dros. Hyosc. Iod. Kali c. Nitr. ac. Phosph. Spig. Zinc. AS IF STOPPED UP : Spong. LIKE YAPOR OF SULPH. : Mosch. SWELLING: Iod. Sil. AS IF SWOLLEN: Cans. Iod. TEARING: Ign. TENSION: Spong. TICKLING : Calcar. Carb. veg. Con. Hep. s. Ipec. Merc. Sabin. Zinc. 58 EXTERNAL NECK AND NAPE OF THE NECK. TINGLING: Con. Dros. Graphit. Iod. Kali c. Natr. mur. Sep. Zinc. VOICE, raised : Stann. — impure : Baryta. Carbo vcg. Caust. Graphit. Merc. Natr. mur. Sulph. 2. Trachea. BUKNING : Euphorb. Phosphor. Rhus. Sulph. Zinc. COLDNESS: Camph. Sulph. AS IF CONSTRICTED: Ars.Ignat. Ipec. Mosch. N. vom. Puis. Rhus. AS IF CONTRACTED: Coccul, Lach. Staph. COUGH, desire to: Aeon. Arg. Arn. Asa feet. Bryon. Cann. Cham. China. Cina. Cocc. Croc. Ferr. Hy- osc. Ignatia. Ipec. Nux vom. Puis. Sabina. Spig. Staph. Veratr. CROUP: Hep. Phosph.. DRYNESS: Alum. Carbo veget. Caust. Cina. Phosph. Puis. Rhod. Sep. Sulph. Zinc. FEELING OF : Camph. Causticum. Phosph. Puis. Stann. HEAT: Iod. INFLAMMATION: Aeon. Capsic. Con. Drosera. Iod. Ipecac. Spong. ITCHING: Ambr. N. vom. Puis. MUCUS, accumulated: Alumina. Arg. Aur. Bar. Bell. Calc. Camph. Cann. Capsicum. Caust. Coccul. Cuprum. Hepar s. Hyosc. Ignatia. Iod. Lye. N. Yom. Natrum mur. Nitric ac. Op. Phosphor. Plumb. Puis. Samb. Stann. Sulph. Zinc. (See larynx.) NUMB FEELING: Aco. SIMPLE PAIN: Camph. Capsic. Carbo an. Chin. Ign. K. vom. Phosph. Puis. Sporty. PHTHISIS OF TRACHEA: Aco. Arg. Arn. Calc. Caust. Chamom. Cuprum. Dros. Ferr. Hep. Lye. Jf. vom. Nitric ac. Phosph. Puis. Rhus. Spong. Stann. Sulph. Veratr. PRESSURE: Bar. Graph. Phosph. Thuj. ROUGHNESS: Alum. Carbo veg. Caust. Dig. Graph. Iod. Kali c. Mur. ac. N. vom. Natrum mur. Ni- tric ac. Phosphor. Plumb. Puis. Rhodod. PJius. Stann. Sulph. Zinc. (See larynx.) AS OF A FOREIGN BODY : Cann. Cic. Hyosc. SCRAPING: Alum. Antim. crud. Canth. Carbo veget. Caustic. Graph. Hep. s. Kali c. Lye. Mur. ac. Nitr. ac. Pulsatilla. Stann. Sulph. AS IF SCRAPED : N. vom. Puis. Rhus. Veratr. SENSITIVENESS: Phosph. SHOCKS : Bry. Cina. AS IF GONE TO SLEEP : Aco. AS IF SORE: Ant. crud. Bryon. Cann. Caust. Cham. China. Iod. N. vom. Natrum muriat. Phosph. Plumbum. Rhus. Sil. Stann. STITCHES : Ant. crud. Arg. Bar. BeU. Caps. Ipec. Thuj. AS IF STOPPED UP : Rhus. AS OF VAPORS OF SULPH.: Puis TICKLING: Aconit. Arn. Capsic. Cina. Ferr. Ipec. N. vom. Puis. Rhus. Sabin. Yeratr. TINGLING : Arm Calc. Carbo veg. Dros. Euphorb. Iodine. Kali c. Lye. Petr. Phosphor. Platina. Sep- ia?. Sil. Stann. Thuj. AS IF TORN: Staph. XXI. EXTERNAL NECK AND NAPE OF THE NECK. Sensations. 1. Neck. BLOTCHES : Sec. corn. BOILS : Arn. Caust, Sep. BURNING : Ferr. Ign. AS IF BRUISED : Arn. Cic. s. Sabin. COLD FEELING : Phosph. Hep EXTERNAL NECK AND NAPE OF THE NECK. 59 CRAMP: Cic. CUTTING : Graph. Ruta. Sam*,. DRAWING: Aco. Ant. cruel Am. Asa f. Bell~Bvy. Camphor. Cantha- ris. Chin. Cic. Coccul. Croc. Dulc. Graph. Kali. Nux vom. Natr. mur. Nitr. ac. Ph. ac. Puis. Rhod. Sabin. Spig. Spong. Staph. Yeratr. ERUPTION: Ant. crud. Ars. Aur. Bry. Canth. Dig. Hep. sulph. Merc. Ph. ac. Puis. Spig. Spong. Staph. Thuj. Yeratr. AS IF THE FLESH WERE DE- TACHED : N. vom. GLANDS, boring in: Bell. Pulsat. Sabad. — pressure in : Aur. Bell. Chin. Cina. Coccul. Ign. Mercur. Rhus. Stram. — simple pain in: Alum. Ambra. Arn. Bry. Calcar. Carbo veget. Caust. China. Cic. Con. Graph. Hell Ignat. Kali c. Lye. Merc. N. vom. Natr. mur. Nitr, ae. Phos. Ph. ac. Pulsatilla. Rhus. Selen. Sep. Sil. Spig. Spong. Stann. Staph. Thuj. — suppuration : Bell. Hyosc. Sil. — sensitiveness : Arnic. Aurum. Spong. — inflammation: Bar. Bell. Canth. Kali c. Nitric ac. Plumb. Yeratr. — swelling : Alum. Ambra. Arg. Arn. Asa f. Aur. Bar. Bell. Bry. Calc. Camph. Canth. Carbo veg. Cham. China. Cic. Coccul. Con. Dulcam. Ferr. Graph. Hepar s. Ign. Iod. Lye. Merc. Mur. ac. Natr. mur. Nitr. ac. Petr. Phosph. Ph. ae. Plumb. Puis. Rhus. Sabad. Sep>. Sil. Spigel. Spong. Stann. Staph. Sulphur. Thuj. Yeratr. Zinc. — —feeling of: Spong. Staph. — hard swelling: Coccul Plumb. Rhus. Spig. Staph. • — itching: Con. Ant. crud. — tickling : Kali c. —pinching: Bry. Yeratr. — creeping: Con. — as if air passed through : Spongia. — as if excoriated : Con. —as if pressed together : Ign. GOITRE : Amur. Spong. — as if swollen : Spong. — large: Calc. Carbo an. Caust. Iod. Kali c. Lycop. Natr. mur. — pressing: Spong. — hard: Iod. Spong. — movements in : Spong. — pressing out: Spong. — as if alive : Spong. — painful: Iod. Plat. — stitching : Iodine. Spongia. Sulph. — larger : Iod. — constriction in : Iod. HEAD DRAWN TO ONE SIDE: Chin. Cupr. Hyosc. HEAT: Calc. Caust. Cham. Ign. Sep. Sulph. ITCHING: Alum. Bry. Carbo veg. Ign. Natrum mur. Nitric ac. Op. Puis. Rhus. Stann. Thuj. LAMENESS : Dig. Lye. Sulph. PAIN : laming : Cocc. — rheumatic : Aco. Iod. Rhod. Staph. — as of sore : Bry. Cic. Yeratr. — in lower vertebras : Con. —simple : Bell. Bry. Calc. Caps. Caust. Ferr. Graphit. Kali c. Lack. Nux vom. Phosph. Ph. ac. Sabin. Sil. Zinc. AS IF PRESSED OUT: Spong. PRESSING: Sil. PRESSURE: Aco. Ant. crud. Arg. Arn. Aur. Bell Calc. Cann. Carbo veg. Caust. Ign. Kali c. Lach. Lye. Nitr. ac. Ph. ac Sabin. Spong. Staph. Yeratrum. Zinc. RESTLESSNESS: Thuj. SCRAPING: Ars. SLEEP, gone to: Carbo an. SPASM : Ant. crud. Spong. SPOTS, yellow: Iod. — red: Bell Carbo veg. Coccul. N. vom. Sep. Stann. 60 EXTERNAL NECK AND NAPE OF THE NECK. STIFFNESS: Alum. Ang. Argent. Ars. Beil. Bryon. Calcar. Campk. Carbo an. Causticum. China. Cic. Coccul. Croc. Cupr. Dig. Ferr. Graph. Hell. Lye. Merc. Natr. mux. Nitric ac. Petr. Phospk. Pkospk. ac. Rhus. Sil. Spong. Stapkys. Tkuj. Yeratr. Zinc. STITCHES : Aco. Ant. crud. Aur. Bell. Bry. Cantlt. Ckin. Cina. Coc- cul. Cupr. Dig. Graphite*. Hep. s. Kali c. Pkos. Samb. Spig. Spong. Staphys. Thuj. Yeratr. Zinc. SWEAT: Cann. Cham. Coff. Ipec. N. vom. Blius. SWELLING, of bones : Calc. SWELLING: Alum. Ars. Bell. Calc. Caustic. Cic. Iod. Lye. Merc. Nitr. ac. Phos. Bhus. Sil. Zinc. — external: Alum. Am. Ars. Bar. Caustic. Croc. Hyosc. Iod. Lye. Puis. Ekocl. — kard : Caust. Lye. N. Yom. TEAEING: Am. Aur. Carbo veg, Ckam. Cupr. Iod. Kail c. Lyc. Merc. Pkos. Plumb. Sabin. Selen. Spong. Staph. Sulpkur. Zinc. TENSION : Arg. Am. Bar. Bell. Bry. Calc. Campk. Cr:?(stic. Cic. Dig. Grapk. Iod. Plumb. Puis. BhoO. Rhus. Spigelia. Spjong. Stapk. Sulpk. Zinc. THROBBING O F CAROTIDS : Opium. Spong. — of arteries: Bell. Hepar s. Op. Spong. AS IF TIED TOO FAST: Am. TINGLING: Spong. TWITCHINGS: Cantkar Spong ia. Zinc. — convulsive : Pkospk. ULCERS : Ars. Hyosc. Lycop. Sec. com. ULCERATIYE PAIN: Grapk. Puis. YEINS. swelkngof: Op. Tkuj. WEAKNESS : Arnica. Coccul. Staph. Yeratr. AS FROM A WRONG POSITION: Dulc. Tkuj. Zinc. . 2. Najje of the Neck. BEATING: Con. BLOTCHES: Hep. BOILS : Arn. Sil. BORING: Bar. BURNING: Arn. Bar. Calcarea. "Carbo veget. Ignatia. Mercur. Bh. ac. COLDNESS, feeling of: Sulph. CONTRACTION: Puis. CRACKING: Spong. CRAMP : Ant, crud. CRAMPY FEELING: Tkuj. Sil. CRAMPY STIFFNESS : Zinc. CRAWLING: Dulc. CUTTING: Dig. DRAWING: Alum. Ambra. Ant. crud. Asa foet. Bell. Campkor. Cann. Caps. Ckin. Color. Con. Dig. Hyosc. Kali c. Lycop. Merc. Mosch. Xux vom. Pk. ac. Plumb. Pulsa- tilla. Rhodod. Rkus. Ruta. Sep. Staph. Sulpk. Tkuj. Zinc. ERUPTION: Bar. Bellad. Bryon. Canst, Ckam. Hep. Lycop. Sep. Sil. Staph. GLANDS: see Neck. GRASPING: Lyc. HEAT : Ign. Lack. Pkospk. HERPES^: Hyosc. ITCHING: Garb. veg. Nitr. acid. Rkodod. Rkus. Sep. Sil. Staph. LAMING PAIN: Cina. Nux vom. Spig. Stapk. Yeratr. AS OF A LOAD : N. vom. Bh us. AS IF THE FLESH WERE LOOSE: Aco. NAPE OF NECK, stiff: Acouit. Arg. Ars. Bar. Bell. Bry. Calc. Campk. Cantk. Caps. Carb. an. Caust. Ckin. Coloc. Dig. Dros. Dulc. Grapk. Hell. Hyosc. Ig-u. Kali c. Lack. Lyc. Merc. N. voiu. Natr. mur. Nitr. ac. Petr. Phos. Pk. ac Plat. Puis. Rhod. Rhus. Sec. com. CHEST. 61 Sep. Sil. Spigel. Spong. Stann. Staph. Sulph. Thuj. Veratr. Zinc. P AIN , cramp y : A rn . — rheiunatic : Aeon. Asa f. Grapkit. Iod. Merc. >"ux voiu. Puis. Rhod. Rhus. Staph. Veratr. — simple: Aeon. Bry. Cann. Chin. Dulc. Graph. Hyosc. Ipec. Kali. Merc. Nux^vom. Natr. mur. Petros. Phosphor. Rhoclod. Sabad. Sep. Spigel. Stann. — as if tired : Rhus. — ulcerative : Puis. PRESSURE: Anibr. Asa f. Bar. Bell. Bry. Carb. veg. Coccul. Coloc. Dig. Euphorb. Graph. Laches. Lycop. Merc. Mosch. Natr. mur. Phosj^h. Ph. ac. Rheum. Rhus. Samb. Spong. Staph. Thuj. PULLING IN MUSCLES: Coloc. PUSTULES: Staph. RASH: Canst. SARCOMA: Bar. Gale. SENSITIVENESS: N. vom. AS IF GONE TO SLEEP: Rhus. Spig. SPOTS, yellow: Iod. — red : Carb. veg. Sep. Stann. STEATOMA: Bar. Puis. STITCHES: Aeon. Alum. Arn. Bar. Bellad. Calc. Camph. Cann. Chin. Coccul. Graph. Ign. Merc. Phosph. ac. Puis. Rhus. Sepiae. Stann. Staphys. Sulph. AS IF" STRAINED: Dulc. Nux vom. Puis. Zinc. SWEAT : Chin. N. vom. Sulph. AS IF SWOLLEN: Sep. TEARING: Asa f. Camph. Canth. Carb. veg. Graph. Ign. Kali c. Nux vom. Natr. Phosph. Plumb. Sil. Spig. Sulph. TENSION: Alumin. Arnic. Aur. Bar. Bryon. Calcar. Camph. Canth. Carb. an. Caust. Con. Dig. Euphorb. Graph. Hyosc. Iod. Ipec. Kali c^ Mosch. Nitr. acid. Plat. Plumb. Pulsat. Rhus. Sep. Sil. Staph. Sulph. Thuj. Zinc. TETANUS: Op. TWITCHING: Asa f. Caps. Chest. Natur. mur. Ph. ac. Sulph. MUSCLES, twitching of: Arg. ULCERS: Sil. UNSTEADINESS: Aeon. WEIGHT : X. vom. Petr. Phos. Rh:is. Sabin. Samb. XXII. CHEST. Sensations. 1. Interim! Chest. ANXIETY : Aeon. Arn. Asa f. Bry. Camph. Cann. Caps. Chin. Coccul. Ignat. Lach. Mosch. N. vom. Pul- sat. Rhus. Samb. See. e. Spig. Spong. Staph. Valer. Veratr. AS IF A BAND AROUND : Sabad. Sabin. BLOOD, of erethism: Alum. Carb. veg. N. vom. Plumb. Rhod. Sep. Spong. Thuj. AS IF THE BLOOD DID NOT CIRCULATE: Sabad. AS IF BOUNDING: Croc BORING: Aconit. Alum. Asa f. Cina. Kalic. Mur. ac. Ph. ac. Rhus. Spig. Staph. Thuj. BURNING: Aeon. Alum. Ambr. Ant. crud. Arg. Arn. Ars. Asa f. Bar. Bell. Bry. (ale. Canth. Carbo veget. Caust. Chamom. Chin. Cic. Cina. Coeeul. Coff. Con. Dros. Ferr. Graph. Hyosc. Ign. Iod. Lach. 62 CHEST. Lyc. Merc. Mosch. Mur. acid Nux voni. Pliosph. Ph. ac. Plat. Euta. Sabad. Sabin. Sec. corn. Sep. Spong. Starm. Sulph. Zinc. CATAEKH: Am. Cann. Ign. Nux worn. CHILLINESS: Brj. Natr. AS IF CONCUSSED: Rhus. COOLING, pleasant: Euta, CONSTBICTION : Aconit. Alumi- na. Arn. Ars. Asa f. Bell. Cann. Caps. Carb. an. Cham. Coccul. Coloc. Cupr. Digit. Droser. Ferr. Hell. Iffnat. Mosch. Nux vom. Natr. mur. Op. Phosph. Ph. ac. Puis. Plat. Rhodod. Rhus. Euta. Spig. Stann. Stram. Sulph. Veratr. CEAMPY PAIN : Puis. Veratr. CEAMPY FEELING: Aco. BeU. Bry. Canth. Carbo. an. Cham. Cina. Dulc. Hyosc. KaU c. Mur. ac. Nux vom. Plat. Ehod. Stann. Thuj. Yeratr. CUTTING: Alum. Arg. Arn. Aur. BeU. Calc. Caust. Chin. Con. Dig. Dulc. Kali c. Lyc. Merc. Mur. ac. Ph. ac. Plat. Pulsat. Euta. Sabin. Samb. Spig el la. Spong. Stann. Sulph. Yeratr. Zinc. DIGGING: Arnica, Cann. Cina. Dulc. Ferr. Petr. Stann. AS IF DILATED : Bry. Stann. DBA WING INWABD : Cham. DEOPSY: Aeon. Ambra. Arn. Ars. Bry. Caps. Chin. Ferr. Hell. Ipec. Kali carb. Op. Bhus. Sabad. Spiff. Yeratr. — of chest: Ars. Carbo veg;. Coloc Con. Dig. Dulc. KaU c. Lyc. Mur. ac. Stann. DRYNESS, feeling of: Alumina. Canth. Ferr. Phosph. Stram. AS IF EMPTY: Coccul. Stann, AS IF FALLING: N. vom. FEEMENTING: Phosph. FULLNESS: Aeon. Antim. crud. Arn. Bar. Canth. Caps. Con. Ferr. Ign. Lyc. Mosch. Nitr. ac. Phosph. Puis. Ehus. Euta. Sabad. Sabina. Sepiae. Sulph. Veratr. GNAWING : Arg. Euta. GEIPING : Yeratr. GUEGLING: Cina. KaU c. Natr. mur. Euta. HAMMEEING: Phosph. HEAT : Arn. Ars. Aur. Bellad. Bry. Calc. Caust. Chin. Cic. M. vom. Nitric ac. Opium. Puis. Ehus. Euta. Spongia. Stann. Sulph. HEAYLNESS: Aeon. Alum. Bar. Bry. Calc. Iod. Phosph. Plat. Ehod. Sabad. Samb. Sepice. Stapjh. Sulph. Zinc. INFLAMMATION : Aconit. Arn. Bry. Cann. Hyosc. N. vom. Puis. Rhus. Euta. Sec. corn. Spong. ITCHING: Carbo veg. KaU carb. Phosph. Ph. ac. JEBKS : Cann. Croc. Con. Lyc. Ya- ler. — as if Uving : Croc. as if loose : Bry. as if the lungs adhered: Euph. Thuj. LUNGS, as if less dilatable: Asa f . Bry. Cina. — suppurating: Plumb. Puis. — inflaniniation of: Aco. BeU. Bry. Lyc. Phosph. Puis. Rhus. Sepia?. Sulphur. Tart, einet. — phthisis of: Bry on. Calcar. Carbo veg". China. Con. Dulc. Ferr. Graph. Iod. KaU c. Lyc. Natrum mur. Phosph. Pulsat. Ruta. Samb. Sep. Spig. Stann. NAUSEA : Aeon. Arg. Asa feet. Bry. Croc. Nux vom. Rhus. Staph. PAIN, as if excoriated: Alum. Ars. Bar. Bry. Calc. Carb. veg. Const. Cic. Cina. Graph. Ipec. KaU c. Lyc. Merc. Mur. ac. Natrum niur. Nitric acid. Phosph. Phosph. ac. Ehus. Sabina. Sep. Sil, Spongia. Stann. Staph. Sulph. Yaler. Zinc. CHEST. 63 — as if bruised : Aco. Alum. Ambr. Arn. Bar. Canrpli. Caust. Chamom. Chin. Con. Ferr. Kali c. Merc. Phosph. Rhod. Spig. Spong. Stan- nuni. Thuj. Zinc — as if flying to pieces: Bry. Cina. — drawing: Asa f. Cann. Capsic. Car- bo veg. Cham. Chin. Coccul. Con. Digit. Dulc. Kali c. Nux vom. Ni- tric ac. Op. Plat. Puis. Ruta. Sep. Sil. Spig. Spong. Stann. — simple: Alum. Arn. Ars. Bar. Gale. Caps. Carbo anim. Carbo veg. Caustic. Cham. Chin. Cina. Coioc. Conium. Croc. Dulc. Ferr. Graph- ites. Iod. Lye. Mosch. Mur. acid. Nitric ac. Phosph. Putsat. Rhod. Ruta. Selen. Sep. Sil. Spig. Spong. Stann. Sulphur. Yeratr. Zinc. PINCHING: Alum. Bellad. Carbo veg. Cina. Dulc. Ign. Kali c. Phos. ac. Samb. Spig. Spong. Thuj. PRESSING: Alum. Ambra. Bry. Graph. Ign. Nitr. ac, Phosph. Sulph. Yeratr. — asunder: Euphorb. PRESSURE FROM WITHOUT: Cann. Chin. Coccul. Ign. N. vom. within: Arg. Asa f. Bell. Bryon. Cina. Dulc. Yaler. Zinc. — as from a load: Arg. X. vom. Rheum. Sabad. Samb. Spig. AS IN THE LOWER PART CF THE CHEST: Alum. Am. Asa feet. Chin. Cic. Croc. Hyosc. Plum- bum. Ruta. Sabad. Zinc. PULSATING: Alum. Bryon. Dig. Dulc. AS IF RAW: Ambr. Arn. Arsen. Bryon. Chin. Coccul. Dig. Hell. N. vom. Natr. mur. Rhus. Zinc. RESTLESSNESS : Bell. Chin. Staph. Thuj. RUSH OF BLOOD: Aeon Arn. Bry. Carbo veget. Coccul. Cupr. Ferr. Hyosc. >~ux vom. Natrum mur. Puis. Rhod. Sep. Spong. Thuj. SHOCKS : Aconit. Calc. Cann. Croc. Dulc. Mur. acid. Plat. Ruta. SHUDDERING : Aeon. SPASM: Aconit. Arg. Asa feet. Bry. Calc. Cham. Cina. Coccul. Cofi. Cupr. Dig. Ferr. Ipec. Kali c. Lye. Mosch. Nitr. ac. Petr. Phos. Pols. Sec. corn. Sep. Sulph. Thuj. Zinc. STITCHES, in left side: Aconit. Alum. Ant. crud. Arg. Arn. Asaf. Bell. Bry. Calc. Camphor. Cann. Canth. Caps. Carb. veg. Caust. Chin. Cic. Cina. Coccul. Con. Croc. Dig. Dub-. Euphorh. Graph. Hell. Ign. Ipec. Kali c. Lye. Merc. Mosch. Mur. ac. Natr. m wr. Phosph. Ph. ac. Plat. Plumb. Puis. Rhus. Ruta. Sabad. Sabin. Samb. Sep. Spigel. Spong. Stann. Staphys. Sulph. Thuj. Yaler. Yeratr. Zinc. —in right side: Aeon. Alum. Ambr. Ant. crud. Arg. Am. Asa J'. Bell. Bry. Canth. Carb. an. Carb. veg. Caustic. China. Cina. Coccul. Co- loc. Con. Croc. Dig. Dulc. Graph. Hyosc. Ign. Iod. Kali carb. 3Iere. Natr. mur. Nitr. ac. Op. Phosph. Ph. ac. Plumb. PJtiis. Ruta, Sabad. Sep. Sil. Spig. SiDong. Stann. Staph. Sulph. Thuj. Yeratr. Zinc. — in middle of chest : Aco. Alum. Ant. crud. Bry. Cham. Chin. Iod. Phosph. Plumb. —in diaphragm : Spig. —in sternum : Aeon. Arg. Arn. Aur. Bell. Bry. Calc. Canth. Capsic. Caustic. China. Con. Dulc. Ferr. Graph. Hep. Lye. Natr. mur. Nitr. ac. Pliosplt. Ph. ac. Plumb. Sabin. Spig. Sulph. — from the chest through the back : Aeon. Ambr. Bryon. Canth. Carb. Carb. veg. Chin. Coccul. Ferr. Ly- cop. Plumb. Sabin. Sil. Spig. Sulph. — from within: Argent. Asa f. Bry. Canth. Carb. veg. Chin. Muriat. ac. 64 CHEST. Nitric ac. Sabad. Spig". Spong. Vdler. AS IF STOPPED UP: Bry. TEABING: Arg. Canthar. Carbo veg. Caust. Con. Dulc. Graph. Kali c. Merc. Natr. mur. Op. Petr. PhOsph. Puis. Bhus. Spig. Stram. Zinc. TENSION: Arg. Ars. Bell. Bry. Cann. Caustic. Cham. Cic. Coccul. Con. Dig. Dulc. Euphorb. Graph. Ign. Lye. Mur. acid. N. vom. Natr. mm*. Phosphor. Pulsat. Eheum. Rhod. Rhus. Euta. Sabin. Sep. Spig*. Stann. Stajjh. Sulph. Zinc. THKOBBING: Aeon. Asa f. Bar. Bell. Bry. Cann. Caps. Chamom. Coff. Digit. Graph. Ign. N. vom. Phosph. Sil. Sulph. Thuj. Veratr. Zinc. TICKLING : Bar. Cham. Chin. Kali carb. Phosph. Stann. Veratr. AS IF TOO TIGHT : Hell. Pulsat. Spig. TIGHTNESS, feeling of: Puis. TINGLING: Aeon. Arsen. Coloc. Phosph. ac. Sep. Spig. Spong. Stann. Thuj. TEEMBLING: Kali carb. Phosph. Euta. Sabin. TWITCHING: Cina. Coloc. Croc. Dulc*. Kali c. Lye. Natr. mur. Sep. Spig. Yaler. ULCEBATIYE PAIN: Bry. Puis. Staph. WAEMTH: Bry. Coff. HeU. Nhx vom. Yeratr. — unpleasant : Alum. Euphorb Natr. mur. — f eeling of : Merc. WEAKNESS: Iod. Kali c. Plat. Rhus. Stann. Sulph. — feeling of: Carbo veg. Chin. Plat. Stann. Staph. AS IF WEAEY : Arn. Carb. veg. Spong. WEENCHING : Samb. 2. External Chest. BLUE SKIN NEAK CLAYICLE^. Thuj. BOILS : Arn. Chin. BUENING : Ambr. Arsen. Asa f . Bar. Bell. Canth. Caps. Croc. Digit. Droser. Euphorb. Ferr. Mur. ac. N. vom. Phosph. Ph. ac. Plat. Eheum. Ehus. Selen. Sulph. Zinc. BONE-PAIN: Chin. CHILLINESS: Spig. CONTEACTION: Arn. Dap h. Bry. Dig. N. vom. Op. Plat. Ehod. Bhus. Spig. CONTUSIYE PAIN : Ant. cr. Arn. CEACKLING: Eheum. CEAMPY FEELING: Aeon. Arg. Calc. Cham. Cina. Dig. Dulc. Nitr. ac. Plat. Sep. Yeratr. CEEEPING: Arn. Dros. CEEEPING CHILL : N. vom. DBA WING : Aeon. Asa f . Carb. veg. Cupr. Dig. Dulc. Lycop. Mur. ac. Y. vom. Puis. Bhus. Spig. Stann. Zinc. GNAWING: Arg. Calcar. Euta. Spong. HEAT: Cham. Cic. Dig. Puis. HEEPES: Ars. Lye. Petrol. Staph/ INSENSIBILITY: Bhus. ITCHING: Alum. Ant. crud. Bar. Calcar. Canth. Capsic. Carb. v. Caust. Chin. Coccul. Con. Kali c. Lye. Natr. mur. Op. Phosph. Pills. Sep. Spong. Staph. Yeratr. — of the sides of chest : Alum. Arn. Canth. Cic. Nitr. acid. Spong. JEBKING: China. Platin. Pulsat. Stann. Stram. LAMING PAIN: N. vom. PAIN, as if contused: Con. Dulc, Merc. Mur. ac. Natr. mm-. — as if sprained: Arn. Coccul. — as if sore : Bar. Bryon. Sep. Staph. Yeratr. — as if bruised: Arn. Chin. Ign. Merc. N. vom.Xatr. mur. Nitr. ac. CHEST. 65 Phosph. Ph. ac. Rheum. Spig. Staph. Sulph. — simple: Ant. cr. Bry. Cann. Capj- sic. Chin. Cupr. Dulc. Natr. mux. Phosph. Ph. acid. Puis. Rhodod. Rhus. Sabin. Sep. Silic. Staphys. Sulph. Yeratr. PECKING: Ruta. PIMPLES: Ant. crud. Aur. Bell, Bry. Cantli. Coccuh Con. Hep. Ph. ac. Plumb. Rhus. Staph. PINCHING: Nux vom. Phosphor. Rhod. Samb. PRESSURE: Alum. Ambra. Arg. Arn. Asa f. Aur. Bry. Camph. Canthar. Chin. Cina. Coccul. Cupr. Dulc. Dros. Hyosc. N. vom. Plumb. Rheum. Ruta. Sabin. Spig. Stann. Staphys. Sulphur. Yaler. Yeratr. Zinc. — from without: Rhus. PRICKLING: Plat. PULLING: Phosph. RASH: Ant. crud. Staph. Yaler. Yeratr. REDNESS: Aur. BeU. RHEUMATIC PAIN: Ambr. Bry. Spig. RIBS RAISED: Spig. SENSITIVENESS: Cann. Canthar. N. vom. Sulph. SHUDDERING: Chin. Cina. Nux vom. Plat. Ruta. Spig. Staph. AS IE TOO SHORT : N. vom. GONE TO SLEEP : Merc. SPASMS : Cic, Puis. Strain. Yeratr. SPOTS, brown: Carta) veg. — yellow : Ars. Phosph. — red : Bell. Carbo veg. Coccul. Lye. Sabad. STITCHES: Arn. Asa feet. Aur. Bell. Bry. Calc. Camph. Cann. Cantl\. Caust. Chin. Coccul. Con. Croc. Dros. Dulcam. Euphorb. Hep. Mar. ac. Nux vom. Nitr. ac. Phosph. Ph. ac. Plumb. Puis. Rheum. Rhus. Ruta. Sabad. Sabin. Sil. Spig. Spong. Stann. Staph. Sulph. Teuc. Yeratr. Zinc. SWEAT : Arg. Arn. BeU. CalcCanth. ('hin. Coccul. Euphr. Hep. Ipec. Lye. Merc. Phos. Ph. ac. Ilumb. Rhus. Sabad. Sec. corn. Selen. Sep. SWELLING: Bryon. Calc. Can. Dulc. Iod. Rhus. Sep. Sil. Sulph. TEARING: Ambr. Bry. Camph. Dulc. Iod. Kali c. Lye. Merc. N. vom. Rhod. Sabin. Spig. — near the clavicle : Lye. Stann. TENSION : Asaf. Cham. China. Dig. Dros. Dulcan. Euphorb. Ferr. Iod. Merc. Mur. ac. N: vom. Natnun mur. Phosph. Puis. Rhodod. Rhus. Sabina. Spig. Slann. Thuj. TUBERCLES : Cann. Caust. TWITCHING : Merc. Spig. ULCERS : Ars. Hep. Sulph. ULCERATIVE PAIN : Bry. Puis. WARMTH : N. vom. Rhus. WRENCHING: Puis. 3. Axillce. (Arm pit.) BURNING: Carbo veg. CRAWLING: Con. Mezer. DAMPNESS : Carbo an. Sulph. DRAWING: Bell. Sil. AS IE EXCORIATED: Con. INDURATION: Iod. INFLAMMATION : Nitric ac. Petr. Phosph. Sulph. ITCHING: Carbo an. Carbo veg. Caust. Con. Dig. Kali. Phos. Sep. PAIN GENERALLY : Bellad. Car- bo veg. Con. Nitric ac. Sil. SENSITIVENESS: Nitr. ac. STITCHES: Arn. Con. Sulph. SUPPURATION : Calc. Coloc. Hep. Petr. Sil. Sulph. SWEAT: Dulc. Kali. Natr. mur. Phosph. Rhod. Sep. Sulph. SWELLING: Bellad. Calc. Phosph. Iod. Hep. Lye. Natnun mur. Ni- tric ac. Petr. Phosph. Sep. Sulph. 66 CHEST. Breasts. 4. Mammary glands. BLOTCHES : Bell. Calc. Carb. Carbo an. Chamom. Con. Dulc. Graph. Lye. Phos. Euta. Sil. Sulph. CANCEE : Arnica. Ars. Calcar. Car- bo an. Carbo veg. Caust. Kali, Lye. Nitric ac. Phosph. Bhus. Sep. Sil. Sulph. CONTUSION: Am. CBAWLING: Con. DEAWING: Cham. EEYSIPELAS: Aco. Bell. Bry. Phosph. Sil. AS IF EXCOBIATED : Con. HAEDNESS : Ambr. Bryonia. Cham. Con. Phosphor. Plumb. Sil. Sulph. HEAT : Bell. Bry. Cann. INDUEATION, see Tubercles. INFLAMMATION : Aconit. Arn. Bry. Carbo veget. Cham. Con. Phosph. Pulsat. Sil. Sulph. ITCHING: Canst. Con. Kali. N. vom. Plumb. Ehus. MILK, bitter and'yellow : Eheum. — blueish: Lack. — too fat : Puis. — setting in : Puis. — fever: Aeon. Arn. Bryo. Cham. Coff. Ign.'N. vom. Op. Puis. Rhus. — excessive flow of : Aconit. Chin. — vanishing of: Agn. Bryon. Calc. Cham. Puis. Rhus. Sec. corn. Zinc. — increase of : Bryon. N. vom. Puis. — stoppage of : Bell. —flow of: Bell Calc. Puis. PAIN, simple : Cann. Chamom. Coloc. Con. Mercur. Silic. Yeratr. PEESSUEE: Bell. Ph. ac. Pulsat. Sabin. SHUDDEBING: Coccul. N. vom. TOO SMALL: Cham. STITCHES : Alum. Bar. Bellad. Con. Nux vom. Natr. mar. Plumb. Sep. Veratr. Zinc. SWELLING : Bell. Bry. Cham. Con. Dulc. Merc. Phosph. Plumb. Puis. Euta. Sabina. Sil. Sulph. TEAEING : Bar. Cham. TENSION: Puis. ULCEBS: Hep. Merc. Phos. Sil. Sulph. ULCEEATIYE PAIN: Merc. WITHEBING: Chamom. Con. Iod. 5. Nipples. BUBNING: Cic. Graph. Sulph. CEEEPING: Sabin. DISCHABGE OF BLOOD AND HUMOE: Lye. Plumb. HAEDNESS: Merc. INDUEATION : Bry. INFLAMMATION: Aco. Bryon. Cham. Phosph. Puis. Sil. Sulph. . ITCHING: Con. Pulsatilla. Ehus. Sabad. PAIN, simple: Graphit. Nux vom. Eheum. Sulph. EHAGADES : Am. Graphit. Sulph. SENSITIVENESS : N. vom. SHOCKS : Bry. SOEENESS: Am. Calc. carbon. Cham. Graph. Lye. Puis. Sulph. SOEEPAIN: Calc. Zinc. STITCHES: Camph. Cann. Coccul. Ign. Lye. Mur. ac. Eheum. Sabin. Sulph. SWELLING: Merc. ULCEEATION: Cham. 6. Heart and region of the heart. ANXIETY : Aeon. Alum. Ambr. Ars. Aur. Calc. Cann. Canth. Chamom. Cina. Coccul. Croc. Cupr. Ferr. Graph. Hell. Lye. N. vom. Nitric ac. Op. Phosph. Plumbum. Pulsat. Rhus. Sec. corn. Sep. Sil. Stram. Sulph. Veratr. BEATS OF THE HEAET, inter- mittent: Bry. Chin. Digital. Kali. Natr. mur. Sulph. — slow. Arn. — quick : Arn. Asa f . Sabin. — unequal : Asa f . Sabin. — imperceptible : Ehus. Verat. CHEST. 67 — stronger: Ars. Aur. Calcar. Chin. Dig. Dulcani. Hyosc. Phosph. Sa- bina. Spinel. Yeratr. —full: Aeon. BURNING: Carb. veg. Op. PuLs. CONTUSIYE PAIN: Natr., mur. CRAWLING: Canth. DRAWING: Canth. EXCITEMENT, vascular: Carbo veg. Nux vom. Sulph. HEART, trembling of: Aur. Bell. Calc. Camph. Cina. Rhus. Sep. Sing. — throbbing in the region of the : Ars. Bar. Calc. Hell. Lycop. Phos- phor. Sep. Sil. Sulphur. Zinc. HUMMING: Spig. INFLAMMATION: Aeon. Arsen. Bry. Cann. Coccul. Spig. Puis. Rheum. JERKING : Am. N. vom. Plumb. OPPRESSION: Bell. Cham. Nux vom. Spig. PALPITATION, generally: Aeon. Alum. Amb. Am. Ars. Aur. Bar. Bell. Bry on. Calcar. Camph. Cann. Canth. Carbo an. Carbo veg. Caust. Cham. China. Coccul. Coloc. Con. CToc.Cupr.Dig.Grazjh. Hell. Ign. Iod. Ipec. Kali. Lye Merc. Mur. ac. Natrnm mur. Nitric ac. Xux vom. Petr. Phosph. Phos. acid. Plumb. Puis. Rhus. Sabad. Sab hi. Secale corn. Sep. Sil. Spig. Spong. Staph. Sulph. Thuj. Yaler. Yeratr. Zinc. — Avith anguish: Aeon. Alum. Ars. Aur. Calc. Cann. Caust. Cham. Chiu. Coccul. Coloc. Dig. Graph. Kali. Lye. Mbsch. Natr. mur. Xux vom. Phosphor. Plat. Plumb. Puis. Sec. corn. Sep. Sil. Sulphur. Spi- gel. Thuj. Yeratr. — without anxiety : Carbo anim. Ipec. Sulph. Thuj. Zinc. — perceptible: Plumbum. Rhus. Sa- bin. Yeratr. — audible : Camph. Dig. Spig. — spasmodic : Sec. corn. — visible : Con. Dulc. Graphites. Iod. Rhus. Secale corn. Spig. Sulph. Thuj. PxlIN, simple: Cann. Cantharis. Cham. Puis. Ruta. Thuj. PRESSURE: Aco. Am. Ars. Asa f. Bell. Cann. Canth. Cham. Con. Graph. Kali. Lye. Natr. mur. Nux vom. Pulsat. Rhus. Spig. QUALMISHNESS: Cham. N. vom. RUSH OF BLOOD: Aeon. Asa f. Carbo veg. Cham. FeiT. Lye. Nux vom. Nitric ac. Phosph. Puis. Sep. Sulph. STITCHES: Am. Aur. Calcar. Canth. Capsic. Carbo veget. Caust. Cham. China. Croc. Ign. Mur. ac. Nux vom. Nitric ac. Petr. Plumb. Rhus. Sep. Spig. Sulph. Yaler. Zinc. TEARING: Canth. Lye. WARMTH: Cann. Yeratr. — feeling of : Rhod. WEAK FEELING : Rhus. WEIGHT : Croc. Puis. According to Situation and Circumstances. 1. Aggravated. IN THE OPEN AIR : Ambr. Bryon. Caust. China. Coccul. Coffea. Con. Euphorb. Graph. Ignat. Lye. Merc. Natr. mur. Nux vom. Rhus. Sabad. Sep. Spig. Stann. Staph. WHEN ASCENDING: Bell. Graph. N. vom. Sep. Thuj. Zinc. the stairs : N. vom. Rhus. Ruta. Spong. Staph. WHEN BREATHING: Aeon. Ant. crud. Arg. Arn. Ars. Asa f. Aur. Bryo. Calc Cann. Caps. Cnamom. China. Cina. Coccul. Dulc. Dros. Graphit. Hep. Hyosc. Lycop. Mer- cur. Natr. mur. Nitr. ac. Puis. Sep. Spig. Stann. 68 CHEST WHEN DRAWING A LONG BREATH : Calc. Merc. Natr. mur. AFTER A COLD: Acoii. Bryon. Carbo veg. Chain. N. vom. Rhus. IN THE COLD: Rhus. Sabad, IN COLD AIR: Aconit. Bryonia. Carbo veg. Coccul. Rhus. Sabad. Spong*. BY CONTACT: Aeon. Arg. Am. Bar. Bry. Calc. Canth. Caps. Carbo veg. Cham. Chin. Coccul. Cupr. Dros. Dulc. Graph. Merc. Nux vom. Phos23h. Ph. ac. Plumb. Rhod. Rhus. Ruta. Sabin. Spig. Staph. Sulphur. Yeratr. AFTER CONTUSIONS : Arn. Puis. Rhus. Ruta. WHEN COUGHING: Aco. Alum. Ambr. Ant. crud. Arn. Ars. Bar. Bryon. Calc. Cannab. Caps. Carbo veget. Caustic. Cham. Chin. Cina. Coff. Con. Dig. Dros. Ferr. Iod. Kali. Lye. Merc. Mur. ac. Natr. mur. Nitric ac. N. vom. Phosph. Phosph. ac. Puis. Rhus. Ruta. Sabad. Sa- bina. Sep. Sil. Spigel. Spongia. Stann. Staph. Veratr. AFTER COUGHING: Cina. Ferr. IN DAMP WEATHER: Carb.veg- etab. DURING DIGESTION: Lye. WHEN DRINKING: Chin. AFTER DRINKING: Arn. China, Coccul. Con. Cupr. Nux vom. Yeratr. BY DRINKING COLD : Thuj. AFTER DRINKING BEER: Sep. wine : Ant. crud. Nux vom. WHEN EATING: Arnic. China. Coccul. Ign. Phosph. AFTER EATING: Aconit. Ambra, Ant. crud. Arn. Asa f. Bry. Canth. Caps. Carbo an. Caust. Chamom. Chin. Coccul. Con. Ferr. Hyosc. Ign. Lye. Merc. Nux vom. Phos. Puis. Rhus. Ruta. Sep. Thuj. Valer. Veratr. Zinc. BY EATING WARM FOOD: Eu- phorbium. BY GETTING WARM IN BED: Chamom. Puis. Rhus. BY EMOTIONS : Phosph. BY BODILY EXERTIONS : N. vom. Ehus. Spong. AFTER EXPECTORATING : Zinc WHEN FALLING ASLEEP : Sul. BEFORE THE FEVER: Chin. DURING THE FEVER : Aeon. Bryon. Chin. Ipec. — the chill: Bry. Ipec. N. vom. Puis. Rhus. — the heat : Aeon. Caps. China. Ipec. Nux vom. Puis. AFTER A FRIGHT: Aeon. Cha- mom. Ign. Op. BETWEEN THE INSPIRATION: Ign. Merc. Spig. WHEN LIFTING: Bar. Kali. Lye. AFTER LYING DOWN: HeU. Ig- nat. Nux vom. Puis. Rhus. Sabad. Stram. WHEN LYING DOWN: Ant. crud. As a f. Calc. Canth. Carbo veg. Cham. Ferr. Natr. mur. Nitr. ac. Puis. Rhus. Selen. Sulph. BY MENTAL LABOR: Ign. N. vom. Sep. BEFORE THE MENSES: Cupr. Puis. Spong. DURING THE MENSES : Bell. Caustic. Cham. Graph. Phosphor. Puis. DURING MOTION: Aeon. Alum. Arg. Am. Bell. Bry. Calc. Camph. Cann. Capjsic. Carbo veg. Cham. Chin. Coccul. Con. Dig. Euphorb. Ferr. Graphit. Hep. Ign. Iod. Lye. Mercur. Natrum mur. Nitric ac. Nux vom. Op. Phosph. Ph.ac. Puis. Rhodod. Ruta. Sabina. Samb. Sep. Spigel. Spongia. Stann. Staph. Sulph. Veratr. Zine. WHEN MOVING THE ARMS : Dig. Plumb. Puis. CHEST. 69 BY MUSIC : Nux vom. Staph. DURING NOSE BLEED: Carbo veg. WITH NAUSEA : BeU. BY PRESSING ON THE ABDO- MEN: Asaf. BY EXTEKNALPKESSURE: An- tim. crud. Bry. Chin. Cina. N. vom. Ruta. Spongia. Staphys. Va- ler. WHEN RAISING ONE'S-SELF: Aco. Arg. Bry. (ami. Cic. Dig. Ign. Stann. Staph. WHEN RISING FROM BED : Ant. crud. Plat. Stann. Staph. from a seat : Sil. AFTER RISING: Nux vom. Puis. Rhus. Spig. WHEN READING : Chin. loud : Coccul. DURING REST: Arg. Arn. BeU. Caps. Cham. Chin. Ferr. Natr. mur. Phos. ac. Puis. Rhus. Ruta. Samb. Stann. IN THE ROOM: Bry. Croc. Puis. Rhodod. Spig. BY RUNNING : Bry. Cina. Nux vom. Sil. BY SINGING: Stann. WHEN SITTING: Arg. Ars. Asa foet. Bell. Calc. Caps. Carbo anim. Carb. veg. Chin. Cina. Coloc. Bros. Dulc. Euphorb. Ferr. Merc. Mur. ac. Phos. Puis. Rhus. Ruta. Sabad. Silic. Spigel. Spong. Stann. Staph. Sulph. Tlmj. Valer. crooked: Argent. China. Rhod. Rhus. Spig. Spong. erect : Aeon. Natr. mur. AFTER SLEEPING : Aconit. ^inbr. Brijon. Calcar. Chin. Coccul. Euphr. Ignat. Nux vom.Op. Rheum. Sabad. BY SMOKING: Cic. Ign. Spong. Staph. WHEN SNEEZING: Aeon. Bryon. Cina. Merc. Sil. WHEN STANDING : Carb. an. Con. Euphorb. Natr. mur. Stann. Sulph. Zinc. BY MAKING A WRONG STEP: Bry. Puis. Spig. BY STIMULANTS: Stann. BEFORE STOOL: Spig. DURING STOOL: Spig. AFTER STOOL: Sil. WHEN STOPPING THE BREATH : Dros. Merc. Spig. WHEN EXPIRING AIR: Ambr. Ant. cr. Arg. Ars. Aur. Bry. Carb. veg. Cham. Chin. Cic. Cina. Ign. Iod. Mur. ac. Phosph. ac. Ruta. Sabad. SejD. Spigel. Stann. Staph. Zinc. WHEN INSPIRING AIR: Aco. Ars. Arn. Aur. Bar. Bry. Calc. Camph. Cann. Canth. Caps. Carb. v. Caust. Cham. Chin. Cic. Cina. Coc- cul. Coloc. Con. Dulc. Euphras. Hell. Hyosc. Iod. Kali. Lye. Merc. Mur. ac. Natr. mur. Nitr. ac. Op. Phos. Ph. ac. Plat. Plumb. Pulsat. Rhus. Ruta. Sabad. Sabin. Sep. Sil. Spigel. Spong'. Stann. Sulph. Yaler. Veratr. Zinc. WHEN DRAWING A LONG BREATH : Aeon. Arg. Arn. Bryon. Canth. Caps. Cina. Bros. Ign. Puis. Rhus. Sabin. Spig. WHEN STOOPING: Aeon. Alum. Arg. Arn. Asa f. Bry. Cann. Caps. Carb. veg. Chin. Coccul. Coloc. Big. Dros. Hell. Ign. Merc. Nitr. ac. N. vom. Phos. Ph. ac. Puis. Rhodod. Rhus. Silic. Spigel. Spong. Stann. Staph. Valer. Zinc. WHEN STRAINING: Rhus. WHEN TALKING: Bry. Cann. Canth. Chin. Coccul. Ignat. Puis. Rhus. Strain. WHEN TALKING LOUD : Carb. v. Kali. Mur. acid. Natr. mur. Stann. BY TIGHT CLOTHES : N. vom. Spong. 70 BACK. BY TURNING TO THE RIGHT SIDE: Spig. WHEN TURNING IN BED : Aeon. Caiin. Caps. Carb. veg. Niix vom. Staph. BEFORE VOMITING: Cttpr. WHEN WAKING: Ant. cr. Arn. Dig. Euplir. Ign. Puis. Rhus. Sa- bad. WHEN WALKING: Aconit. Am. Bryon. Camph. Caps. Chin. Cic. Coccuh Ferr. Ign. Nux vom. Ruta. Spigel. Sporg. Staph. Valer. Ve- ratr. AFTER W T ALKING: Pulsat. Rhus. Valer. WHEN WALKING IN THE OPEN AIR: Bry. Chin. Coif. N. vom. Rhus. Spig. Spong. Staph. AFTER WALKING IN THE OPEN AIR : Ferr. N. vom. Rhus. Sabad. WHEN WALKING FAST: Chin. Spig. WHEN WRITING: Asa f. Chin. Coccul. Valer. 2. Believed. IN THE OPEN AIR: Bry. Natr. rnur. Puis. BY WARM AIR: Carb. veg-. BY BENDING BACK : Aeon. Cann. N. vom. Puis. BY BREATHING : Asa f . Cina. BY EXPIRATIONS : Cina. Merc. BY INSPIRATIONS : Cina, Merc, BY DRAWING A LONG BREATH : Dig. Stann. DURING CONTACT: Mur. ac. AFTER DRINKING : Bry. Ferr. AFTER EATING: Bry. Rhus. Sa- bad. AFTER ERUCTATIONS: Ambr.. Canthar. Kali N. vom. Petr. Sep.. Zinc. AFTER EMISSION OF FLATU- LENCE : Spig. Strain. Veratr. BY FRICTION: Calc. WHEN LYING DOWN: Alum. Bry. Canth. Iod. Nux vom. Sabad. Zinc. on one side : Alum. on the back : Arn. Bry. Ign. Puis. Sabad. on the painful side : Ambr. Arn. Bry. Cham. Ign. Nux vom. Puis. on the painless side : Ign. N. vom. BY MOTION : Arg. Arn. Cham. Cina. Dros. Euphorb. Mur. ac. Ph. ac. Plumb. Puis. Rhus. Sabad. Sep. BY PRESSURE EXTERNALLY: Asa f. Bry. Chin. Cina. Dros. Ign. Puis. Veratr. DURING REST: Arn. Bry. Chin. N. vom. Sabin. Staph. BY RISING: Canth. Carb. anim. Dulc. N. vom. Puis. Rhus. IN THE ROOM: Bry. Cham. Nux vom. BY SITTING UP: Alum. Asa f. China. Dig. Puis. Spig. WHEN SITTING : Alum. Bry. Caps. N. vom. WHEN STANDING: Chin. Cicut. Ruta. BY STOOPING: Chin. Ign. Valer. AFTER SWEAT: Canthar. Cham. N. vom. Puis. WHEN WALKING: Chin. Cicut. Dros. Ferr. Mosch. Plumb. Puis. Rhus. Ruta. Staph. Sensations. 1. Scapulce. (Shoulder Blade.) BOILS : Amm. mur. Led. XXIII. BACK. BURNING: Aeon. Bar. Carb. veg. Chel. Iod. Lye. Sep. Sil. Sulph. Veratr. BACK. 71 CHILLINESS : Alum. Rhus. CONTRACTION: Chin. Lach. Lye. Rhus. Viol. trie. CRAMPY FEELING: Baryt. Bel- lad. Kali. Merc. Rhus. CRAWLING: Laur. CUTTING: Calcar. carbon. Rhus. Sulph. ac. DISLOCATION PAIN : Chin. Coloc. Mur. ac. Petr. Plumb. Rhod. ERUPTION: Bell. Bryon. Caust. Lijc Merc. Phosph. Ph. acid. Squilla. GNAWING : Alum. Merc. Phos. ac. HEAT : Mur. ac. Puis. HEAVINESS: Menyanth. ITCHING: Amm. mur. Arn. Bell. Daph. Laur. Mercur. Oleand. Spig. Stront. PAIN, as if sore : Coloc. Plat. bruised: Anac. Bar. China. Hell. Kali. Merc. Natr. mur. N. vom. Sulph. Thuj. PRESSURE: Anac. Arn. BeUad. Bry. Calc. Caust. Chin. Laur. Mur. ac. Seneg. Sil. Sulphur. Stann. Zinc. RIGIDITY: Ang. JBellad. Caustic. Led. AS IF GONE TO SLEEP : Anac. STITCHES: Alumin. Amm. mur. Anac. Asa f. Aur. Bry. Bell. Bov. Camph. Cann. Canthar. Caps. Caust. Chin. Cina. Cocc. Colch. Dulc. Ferr. Hep. Kali. Lach. Laur. Mur. acid. Natr. Natr. mur. Nitr. Nitric ac. N. vom. Plumb. Puis. Ran. bulb. Sabad. Samb. Sassap. Sepise. Spig. Spong. Stannum. Thuj. Zinc. TEARING AND Dl.AWING : Alum. Anac. Asa f. Aur. Calc. carb. Carbo veg. Caust. Chamom. Dulc. Lach. Lye. Mur. magn. Phos. Plumb. Rhod. Rhus. Sep. Stann. TENSION: Alum. Bar. Carbo an. Coloc. Colch. Kali. Kreosot. Natr. Rhus. Sep. Sil. Sulph. THROBBING: Baryt. Kali. Merc. Phosph. TUBERCLES : Amm. mur. TINGLING: Anac. Dulc. Sabad. Sil. TWITCHING: Calc. carb. Phosph. Rhus. Squilla. 2. Back. AS IF ALIVE: Plumb. BORING : Aconit. Agar. Coccul. Spig. Thuj. BURNING: Aeon. Agar. Arnica. Ars. Bar. Carbo an. Carbo veg. Chel. Lye. Merc. Mur. ac. Nitric ac. Nux vom. Phosphor. Plat. Sep. Sil. Sulph. Veratr. CHILL: Bellad. Calc. carb. Dulc. Lach. Lye. Nux vom. Phosph. Rhus. Sep. Sil. Stann. Sulph. COLD FEELING: Carbo veget Con. Mur. ac. CRAMPY FEELING: Carbo vege- tab. Euphr. Merc. Nitr. Puis. CRAWLING: Aeon. Bell. Graphit. Laur. Natr. Sec. corn. CURVATURE OF THE SPINE: Bell. Calc. carb. Lycop. Merc. Puis. Rhus. Sil. Staphys. Sulph. CUTTING: Calc. carb. Sep. Sil. DIGGING: Aeon. Sep. DISLOCATION-PAIN: Agar. Ar- nic. Calcar. Cocc. Mur. ac. Rhus. Sulph. ERUPTION : Bar. Bell. Calc. carb. Carbo veg. Caust. Cocc. Led. Merc. Natr. mur. Pulsat. Sel. Sep. Squil- la. Sulph. HEAT : Con. Merc. Natrum mur. Phosph. ac. Puis. Sulph. HEAVINESS: Ambra. Carbo veg. Phosph. Sep. Sulph. ITCHING: Alumina. Amm. mur. Baryt. Calc. carb. Causticum. Daphne. Laur. Kali. Lycop. Merc. 72 BACK. Natr. Nitric ac. Phos. Sassap. Sil. Sulph. Thuj. JERKS : Calc. carb. Staph. LAMENESS: Agar. Cocc. Natr. mur. Phosph. MUSCLES, twitching of : Carbo veg. OPISTHOTONOS : Ang. Bell. Can- thar. Cham. Cicut. Lgn. Nux vom. Op. Bhus. Stann. Stram. PAIN, sore : Kali. Plat. Staph. — as if bruised : Agar. Alumina. Amm. mur. Am. Ars. China. Dros. Lach. Merc. Natr. mur. N. vom. Rhus. Buta. Stann. Stram. Yeratr. — simple : Agar. Alum. Arsen. Asa f . Aur. Bov. Calc. carb. Cann. Carbo animalis. Hyosc. Kreos. Lye. Hep. Lach. Natr. mur. Nitric ac. N. vom. Op. Petr. Sep. Sil. Sulph. Veratr. PRESSURE: Aconit. Agar. Arn. Bell. Cale. carb. Carbo veget. Caust. Cocc. Dulc. Graphit. Kali. Lye. Mur. ac. Natrum mur. Nux vom. Pulsat. Bhus. Sep. Stannum. Staph. Veratr. Zinc. AS IF GONE TO SLEEP : Mer- cur. Phosph. RIGIDITY: Ang. Petr. SHUDDERING : Ang. Bell. Canth. Chel. Cocc. Daph. Colchic. Graph. Lach. Led. Natr. mur. Nux vom. Puis. Bhus. Sabad. Staph. Sulph. Thuj. SPASM: Agar. Bell. Iod. Lye. SPOTS : Sep. Carbo veg. STIFFNESS : Agar. Alum. Carb veg. Caust. Kali. Led. Nux vom. Petr. Pulsatilla. Sep. Sulph. STITCHES : Aeon. Ant. cruel. Ar- gent. Arn. Asa f. Bry. Calc. carb. Cann. Caps. Caust. Chin Colch. Con. Cycl. Dros. Dulc. Hep. Kali. Lachesis. Lycop. Muriatic acid. Natr. Oleand. Platina. Plumb. Puis. Rhus. Rhod. Sabin. Spig. Sil. Stann. Thuj. Valer. Verb. SWEAT : Chin. Ipec. Lye. Nux vom. Phosph. Pulsat. Sepise. Stram. Sulph. SWELLING: Baryt. Bell. Puis. Staph. TEARING AND DRAWING: Aco- nit. Ars. Bell. Bry. Calc. carb. Canth. Caps. Carbo veg. Caustic. Cina. Cham. Cocc. Ferr. Hep. Kali. Lach. Led. Lye. Mang. Mez. Natr. Natr. mur. N. vom. Op. Phosph. Puis. Bhus. Sep. Sil. Stann. Stram. Sulph. TENSION: Amm. mur. BeU. Con. Hep. Mosch. Natr. Natrum mur. Sulph. Zinc. TETANUS: Ang. Cicut. Nux vom. Op. Petr. Plumb. THROBBING: Baryt Lye. Phos. Puis. TREMBLING: Cofif. Merc. TUBERCLES : Ant. crud. Caust. WARMTH, feeling of: Carbo veg. Coff. Laur. WEAKNESS : Agar. Arn. Carb. vesr. Lach. Lye. Nitric ac. N. vom. Pe- trol. Phos. Plat. Sulph. Sec. corn. 3. Small of the back: BORING: Aeon. BURNING : Aeon. Mur. ac. Nux vom. Phosphor. Rhus. Sepise. Thuj. CHILLINESS : Lach. Lycop. Puis. Sabin. COLDNESS : Carbo veg. Spong. — feeling of : Hell. CONTUSIVE PAIN : Arn. Ruta. CRACKING: Sulph. Zinc. CRAWLING: Alum. Menyanthes. Sassap. CRAMPY FEELING : Bryon. Caust. Chin. Nux vom. CUTTING: Aur. Bellad. Canthar. Natr. Natr. mur. Puis. Zinc. ERUPTION: Calc. carb. Natrum. Sep. Thuj. GNAWING: Amm. Canth. Phos. Sulph. STOOL AND ANUS. 73 GRIPING : Cham. Graph. Merc. ITCHING : Carbo veget. Caust. Kali. Merc. Natr. rnur. JERKS : Asar. Bry. Chin. Rhus. LAMENESS: Cove. Dub: Lach. Natr. mur. Nux vom. Selen. Sil. NUMB FEELING: Carbo veg. Plat. Spong. AS IF FLASHING THROUGH : Xatnira mur. PAIN, as if dislocated : Agaric. Am. Rhus. Sulph. sore : Caust. Natr. Sulph. ac. bruised : Aco. Alum. Amm. mur. Arg. Am. Aur. Bryon. Caust. Cham. Cina. Graph. Ign. Lach. Magn. mur. Nux mosch. Nnx vom. Platina. Rhus. Ruta. Stront. Sulph. Tlmj. Veratr. — simple: Aconit. Agar. Amm. mur. Am. Baryt. Bov. Bry. Calc. carb. Carbo an. China. Kali. Ign. Ipec. Led. Lycop. X. vom. Puis. Petr. Rhod. Rhus. Ruta. Sabadilla. Sepiae. Stront. Sulph. Zinc. PRESSURE: Aeon. Bryon. Carbo veg. Caust. Graph. Kali. Lach. Lye. Men. Mosch. Nitric acid. Puis. Rhus. Sep. Spjong. Staphys. Sulph. Veratr. PULSATIONS: Caust. Natr. mur. SPASMODIC PAIN: BeUad. Cocc. Sil. Sulph. STIFFNESS : Aeon. Ambra. Amm. mur. Baryt.BeU. Bry. Carbo veget. Caustic. Kali. Lach. Lycop. Pulsat. Rhus. Sil Sulph. STITCHES: Aeon. Ambra. Anac. Arg. Arn. Bell. Bry. Canthar. Carbo veg. Carbo an. Caust. Chin. Cocc. Con. Graph. Ign. Iod. Lach. Lye. Magn. carb. Merc. Natr. Natr. mur. Nux vom. Phos. ac. Puis. Rhus. Sab. Sep. Sil. Stront, Tart. Thuj. TEARING AND DRAWING : Alum. Ars. Baryt. Bry. Calc. carb. Canth. Carbo veg. Caustic. Cham. Chin. Cocc. Hep. Kali. Kreos. Lach. Lye. Natrum mur. Nux vom. Phosph. ac. Rhus. Sab. Sep. Sil. Sponga. Stann. Stram. Stront. TENSION: Aeon. Barit. Carbo veg. Caustic. Nitric ac. Nux vom. Sil. Thuj. THROBBING: Graphit. Ign. Nux vom. Natr. mur. Sep. TWITCHING: Calc. carb. Caustic. Chin. Con. Puis. Staph WEAKNESS : Ars. Cocc. Lach. Merc. Natrum mur. Nux vom. Phosph. Sep. XXIV. STOOL AND ANUS. Constipation. 1. Cii trader of Stool. ACRID: Ars. Bry. Cham. Lach. Merc. Puis. Veratr. ASH-COLORED: Asar. Dig. BILIOUS: Arsen. CJiamom. Chin. I)ulc. Ipec. Merc. Puis. Sulph. Veratr. BLACK: Ars. Calc. c. Camph. Chin. Cupr. Hep. Merc. Op. Squill. Stram. Veratr. BLOODY: Ant. crud. Arn. Ars. Asar. Bry. Canth. Carb. veg. Chin. Cupr. Dale. Ipec. Lye. Merc. Nitr. ac. N. mosch. X. vom. Phosph. Puis. Rhus. Sep. Sil. Sulph. acid. Tart. Veratr. BLOOD, lined with: Alum. Ambr. Con. Bry. Ipec. Merc. Nux vom. Puis. Rhus. Thuj. BROWN : Arnic. Bryon. Chin. Mer- 74 STOOL AND ANUS. cur. Rheuni. See. Squill. Sulph. Yeratr BRIGHT-COLORED : Anac. Carbo veg. Canst. BURNING: Ars. Lack. Merc. CADAVEROUS SMELL: Bism. Ca?*b. veg. Stram. CLAYEY : Calc. Carb. CONSTIPATED : Aeon. Amm. mur. Am. Aur. Bar. Bell. Bry. Calc. carb. Cann. Cantlu Carbo veg Caustic. Cham. Chin. Cina. Coccul. Coloc. Con. Crot. Daph. Eerr. Graph. Hep. Kali bich. Lach. Laur. Lye. Mere. Mo sch. Natr. mur. Nux vom. Op. Plat. Plum. Puis. Rkodod. Bhus. Sabad. Seneg. Sep. Sil. Spong. Staph. Stram. Sulph. Thuj. Yeratr. Zinc. DIARRHCEIC: Aeon. Amm. mur. Ant. crud. Ant. carb. Ars. Asa foet. Aur. Bell. Bisrn. Bry. Calc. carb. Calad. Caps. Carb. veg. Carb. an. Chamom. Chin. Coloc. Cicut. Cocc. CorTea. Cupr. Dulc. Ferr. Graph. Hep. Hell. Hyosc. Ign. Ipec. Lach. Lye. Magn. carb. Merc. Natr. Natr. mur.Xitr. acid.'N. mosch.3T.ro???. Op. Petr. Phosph. Phosph. ac. Puis. Ran. seel. Rheum. Bhodod. Rhus. Sabad. Sec. Sepiae. Spigel. Spong. Squill. Stann. Staph. Stram. Sulph. Tartar. Yaler.Veratr. Zinc. DIARRHCEA, from cold: Bell. Bry. Cham. Dulc. Merc. Nux vom. Puis. Bhus. Sulph. — after drinking beer : Ferrum. Rhus. — after eating : Arsen. China. Coloc. Lach. — after getting heated : Bry on. Coff. Nux vom. — after a fright : Aco. Op. Terat. — after a fit of joy : Coff. Op. — with vomiting: Antim. tart. Ars. Asar. Cupr. Ipec. Xnxvom. Phos. Rheum. Yeratr. — after eating fruit : Ars, Chin. Puis. — after eating milk : Bry. Lye. Sulph, — after a cold drink : Ars. Bry. Carb. veg. Puis. — after drinking: Arsen. Caps. N. vom. — of children: Cham, Ipecac. Merc. Rheum. Sulph. — chronic : Arsen. Calc. Canth. Chin. Graph. Ipec. Nitr. ac. Phosph. Rhus. Sulph. — nocturnal: Ars. Bry. Cham. Chin. Dulc. Kali. Merc. Phosphor. Puis. Rhus. Sulph. Yeratr. — dysenteric : Ars. Caps. Carb. veg. Coloc. Chamom. Colehic. Merc. A". vom. Op. Pulsat, Rhus. Sulph. Ve- ratr. — frothy: Calcar. carb. China. Rhus. Sulph. — painless: Arsen. Carbo veg. Cha- mom. Chin. Eerr. Hyosc. Lye. Merc. Op. Phosph. Sec. Sulph. Stram. — watery : Ant. cruel. Ant. tart. Ars. Calc. Carb. Caps. Cham. China. Cupr, Ferr. Helleb. Hyosc. Ipec. Natr. mux. Xux vom. Petr. Phosph. Ph. ac. Puis. Rhus. Sec. cor. Sulph. Tart. Yeratr. — spirting : Ars. Merc. N. vom. DIFFICULT: Amm. mur. Anac. Ant. Arn. Aur. Bar. Bry. Canth. Carb. v. Chin. Cocc. Graph. Hep. Ign K.ali. Lye. Mag-n. mur. Natr. mur. Nux mosch. Nux vom. Oleand. Petrol. Phosph. Plat. Pul- sat. Rhodod. Ruta. Sassap. Sll'tc. Stajjh. Sutyh. Thuj. FERMENTED: Ipec. FETID: Ars. Bry. Calc. Carbo veg. Chin. Lach. Merc. Nitr. acid. Puis. Sil. Sulph. WITH FLOCKS : Ipec. Yeratr. HAYING A FOUL SMELL : Ars. Bry. Carb. v. Cham. Chin. Nitr. ac. N. vom. Sec. cor. Sulph. STOOL AND ANUS. 75- FREQUENT, too: Anac. Arn. Ars. Bellad. Cale. curb. Caps. Cham. Chin. Cocc. Coff. Coloc. Dulc. Ferr. Graph. Ignat. Natr. mur. Nitr. ac. N. vom. Phosph. Ph. ac. Petr. Puis. Ran. seel. Rhus. Silic. Thuj. Valer. GRAYISH: Asar. Digit. Mercur. Phosph. ac. Rheum. GREENISH: Arsen. Aur. Bellad. Chain. Cupr. Dulc. Ipec. Merc. Phosph. Phos. ac. Puis. Stann. Sulph. Veratr. HARD : Agar. Amm. Amm. mur. Ant. crud. Asa feet. Aur. Bar. Bell. Bry. Calc. carb. Cann. Carb. veg". Caustic. Cham. Cina. Coccul. Con. Daph. Graph. Hyosc. Guaj. Hep. Ign. Kali. Laur. Led. Lycop. Magn. mur. Merc. Natr. mur. N. vom. Op. Petr. Phosph. Phosph. acid. Plumb. Puis. Rheum. Rho- dod. Rhus. Ruta. Sabad. Sec. corn. Selen. Sep. Sil. Spong. Stann. Sta%>h. Sulph. Sulph. acid. Thuj. Veratr. Verb. HARD AND LOOSE ALTER- NATELY: Ant. crud. Ars. Iod. N. vom. INSUFFICIENT: Anac. Alum. Arn. Ars. Calc. Chin. Daph. Hep. Kali. Lack. Lye. Mur. magn. Natr. N. vom. Sep. Sil. Sulph. INVOLUNTARY: Aeon. Am. Bell. Calc. Chin. Hyosc.JjSLch. Nat. mur. N. vom. Op. Phosph. ac. Rhus. Sec. corn. Sulph. Veratr. — at urinating : Mur. ac. — during sleep : Arn. Puis. Rhus. LEAD-COLORED: Plumb. LOOSE: Ant. crud. Canth. Chin. Ign. Merc. N. mosch. Rheum. Sep. Sulph. LUMPY: Agar. Bar. Bell. Graphit. Lach. Magn. mur. Nux vom. Op. Plumb. Sil. Sulph. Sulph. ac. Thuj. PAPESCENT : Agar. Antim. crud. Arn. Asa i. Bell. Chin. Daph. Dros. Euphorb. Lach. Mezer. Nitr. Phosph. ac. Puis. Rheum. RJiod. Selen. Sil. Sulph. Tart. PITCH, like: Hep. Lach. Merc. Sassap. PURULENT: Arn. Canthar. Iod. Ldch, Merc. Sulph. SHEEP-DUNG, like : Brom. Magn. mur. Plumb. SLIMY : Agar. Amm. m. Ant. cr. Arn. Ars. Asar. Be',1. Bor. Canth. Caps. Chain. Carb. veg. Coloc. Chin. Colch. Dulc. Graph. Hell. Hyosc. Kali. Ipec. Merc. Mur. magn. Natr. mur. N. vom. Phosph* Ph. ac. Puis. Rhus. Ruta. Sec. Spig. Stann. Staph. Sulph. Tart. Veratr. SMARTING : Merc. Puis. SMELLING SOUR: Calc. carb. Chamom. Dulc. Hep. SOFT: Aeon. Amm. mur. Antim. crud. Bryon. Calc. Carb. an. Carb. veg. Chin. Cocc. Coff. Con. Dros. Dulc. Graph. Guaj. Kali. Mur. ac. Natr. mur. Nitr. Nitr. ac. Phosph. Ph. ac. Puis. Rhodod. Sep. Sulph. Veratr. Viol. trie. Zinc. STIRRED EGGS, like: Chamom. Chin. Merc. N. mosch. Pulsat. Rlius. SuIxjIi. Viol. trie. TENACIOUS: Ars. Caust. Hell. Kali. Laches. Mercur. Plumb. Zinc. UNDIGESTED : Antim. crud. Arn. Arsen. Bryon. Cham. Chin. Ferr. Lach. Merc. Nitr. ac. Oleand. Phosph. Ph. ac. Sulph. Veratr. WITH TAENIA: Calc. Carb. veg. Filix m. Graph. Magn. mur. Merc- N. vom. Petrol. Sabad. Sab. Stann. Sulph. Valer. WITH ASCARLDES : Aconit. Asar. Calcar. Cham. Chin. Cina. Ferr. Ignat. Merc. N. vom. Squill. Spong. Sulph. Teucr. 76 STOOL AND ANUS. WITH LUMBRICI : Aconit. Anac. Bell. Calc. curb. Cham. Cicut. Cina. Graph. Lycop. Merc. Natr. mur. Nux vom. Ruta. Sabad. Sec. corn. Spigel. Sulph. Val. WHITISH: Aeon. Ars. Caustic. Cham. Chin. Colch. Digital. loci. Merc. Nux vom. Plumb. Phosph. Pulsat. Rhus. Sec. Spong. Sulph. Veratr. YELLOWISH: Ars. Asa feet. Calc. carb. Chamom. China. Coloc. Cocc. Dulcam. Merc. Petr. Phosph. Puis. Rhus. Veratrum. 2. Accompanying Ailments. a. BEFORE STOOL. BACK-ACHE: Yeratr. COLIC: Agar. Amm. mur. Ant. tart. Ars. Asar. Bry. Canth. Chin. Croc. Big. Kali. Ignat. Laur. Merc. Nitr. Nux vom. Petr. Puis. Rheum. Rhus. Stann. Staph. Sulph. Verat. CHILLINESS: Mercur. Nux vom. Yeratr. DREAD OF MEN: Ambr. FLATULENCE, distress from: Agar. Amm. mur. Arn. Calc. phosph. Dulc. Ferr. Phosph. Ph. ac. Puis. Spig. Stront. HEAT: Merc. Phosph. NAUSEA : Aeon. Rhus. Veratr. PAINS IN THE ANUS: Carbo anim. Colchic. Kali. Lach. Oleand. Phosph. Plat. RECTUM, pain in: Nux vomica. Puis. Rhus. SMALL OF BACK, pain in : Dulc. Sulph. PROSTATIC JUICE, discharge of: Selen. Sulph. Ph. ac. RUSH OF BLOOD TO THE HEAD: Opium. SCREAMING OF CHILDREN: Cham. Rheum. Rhus. SWEAT : Aeon. Bell. URGING TO STOOL : Cocc. Con. Lach. Mere. Rhus. Sil. Staphys. Thuj. YOMITING : Ant. tart. Yeratr. b. DURING STOOL. BACK-ACHE: Puis. CHILLINESS: Yeratr. COLIC: Agar. Amm. mur. Anac. Ant. cruel. Arn. Ars. Asa feet. Bry. Calad. Canth. Carbo an. Cham. Cupr. Dulc. Drosera. Fen> Graph. Hep. Ignat. Ipec. Kali. Merc. Natr. mur. Nitric ac. Nux vom. Phosphor. Plumb. Puis. Rheum. Rhus. Sep. Spig. Sulph. Sulph. ac. Yeratr. DROWSINESS : Nux mosch. FAINTING: Petr. Sassap. Spig. FLATULENCE, discharge of : Calc. carb. Calc. phosph. Cocc. Sab. Staph. — distress from: Amm.muriat. Arn. Hyosc. Nux vomica. Sab. Spong. HEAT : Rhus. Sulph. LABOR-LIKE PAIN: Op. NAUSEA: Ant. tart. Ars. Asar. Cupr. Hell. Merc. Nitric acid. Prun. Sulph. Veratr. PALPITATION OF HEART : Ant. tart. Nitric acid. PROSTATIC JUICE, discharge of: Ign. Phosph. ac. Sil. RECTUM, pain in: Asar. Calcar. Merc. Magn. mur. N. vom. Puis. Sab. Sulph. Yeratr. — falling of : Ars. Asar. Calcar. Daph. Ignatia. Merc. Nux vom. Puis. Ruta. Sepiae. Sulph. RUMBLING IN BOWELS: Ar- senic. Calc. carb. Lycop. Olean- der. Phosph. Phosph. acid. Sulph. acid. RUSH OF BLOOD TO THE HEAD: Rhus. SHUDDERING: Bell. Nitric acid. Rheum. Veratr. SWEAT: Bell. Mercur. Stramon. Veratr. STOOL AND ANUS. 77 TENESMUS: Aeon. Ars. Colch. Laur. Merc. Nux vom. Op. Rhus. Selen. Sulph. Yeratr. THIRST: Ars. Cham. Chin. VARICES, protrusion of: August. Kali. Merc. Nux vom. VERTIGO: Cham. Yeratr. VOMITING: Arg. Ant, tart. Ars. Cupr. Kali bichr. Ipec. Rheum. Sulph. Veratr. WEAKNESS, feeling of: Veratr. C. AFTER STOOL. ANIXETY: Caust. AS IF BRUISED: Calc. CHILLINESS : Canth. Mezer. Puis. CHILL: Daph. Mez. Plat. COLIC : Agar. Amm. mur. Anac. Carbo veget. Con. Dros. Dulc. Iod. Kali bichr. Lye. Nux Yom. Natr. mur. Op. Phos. Pulsat. Rheum. Stann. Sulph. Veratr. CONGESTION OF THE HEAD: Lach. DROWSINESS : Nux mosch. ERUCTATIONS: Baryt. Merc. FLATULENCE, discharge of : Agar. Calc. Carbo veget. Hep. Lye. Nux vom. Phosph. Puis. Suljjhur. Thuj. HEAD-ACHE : Ambr. Sab. Sil. LANGUOR: Arn. Ars. Bry. Calc. carb. Chin. Colic. Cuprum. Daph. Ferr. Hyosc. Ipec. Lach. Lye. Phosph. Puis. Sec. corn. Veratr. MUCUS, discharge of: Asarum. Merc. Phosph. Stann. NAUSEA: Aeon. Caust. Veratr. SMALL OF BACK, pain in : Puis. PALPITATION OF THE HEART : Caustic. Con. RECTUM, pressure in : HeUebor. Ignat. — pain in : Cham. Nux vom. — constriction of : Nux vom. — prolapsus of: Merc. SWEAT: Aeon. Caust. TENESMUS: Capsic. Ipec. Merc. Nitr. Phosph. Rheum. Rhus. Sulph. Staph. THIRST: Caps. VERTIGO : Carbo an. Zinc. VOMITING: Veratr. 3. Anus, with rectum and perineum. a. ANUS AND RECTUM. BLEEDING BETWEEN STOOL : Alum. Ant. cruel. Caps. Carbo veg. Merc. Phosph. Puis. Sabin. Sep. Stram. Sulph. BORING IN THE RECTUM: Va- ler. BURNING IN THE ANUS : Am- nion, mur. Ant. tart. Ars. Baryt. Bov. Bry. Caps. Carbo anim. Carbo veget. China. Cocc. Coloc. Graph. Iod. Ipec. Kali. Laur. Merc. Mur. ac. Natr. Natr. mur. Nitric ac. N. vom. Oleand. Phosph. Puis. Sepice. Stront. Sulph. Thuj. Verat. — in the rectum : Alumina. Aur. Ars. Calc. Carbo an. China. Con. Eu- phorb. Lye. Mur. ac. Magn. mur. Natr. mur. Nitric ac. Petr. Phosph. Pals. Sep. Stront. Sulph. Veratr. CONTRACTION: Camph. Conium. Natr. mur. Nux vom. Op. — in annus : Alum. Ang. Carbo an. Cocc. Graph. Ign. Nitric ac. Nux vom. Plumb. Sec. Sep. Sulph. — in rectum : Amm. Bell. Calc. Chin. Coloc. Ferr. Ign. Nux vom. Phosph. Sep. Thuj. CREEPING : Calc. Colchic. Croc. Kali. Natr. Nux vom. Plat. Rhus. Sabad. Sep. Zinc. CUTTING IN ANUS : Arsen. Chin. Caust. Kali Laur. Lye. Natr. Nux vom. Phosph. Staphys. Sulph. — in rectum: Cauth. Caust. Chin. Lye. Mang. Nux vom. Phosph. Sep- Sulph. DRAWING IN: Plumb. EXCORIATION: Cham. Graph. 78 STOOL AND ANNUS. — in anus : Alum. Amm. Arsen. Graph. Hep. Merc. Nux vom. Phosph. Puis. Sassap. Veratr. — in rectum : Camph. Natrum mur. Phosph. Ph. ac. Puis. FIGAYARTS: Nitric acid. Sabina. Thuj. FISTULA KECTI : Calc. Caust. Petr. Sil. Sulph. GNAWING : Ang. Merc. Phosph. HEAT: Canth. Con. HERPES : Natr. mur. ITCHING IN ANUS : Aeon. Alum. Ambr. Ant. crud. Barijt. Bell. Bry. Calc. Carbo veg. Caust. China. Cina. Croc. Euph. Ign. Kali. Lye. Merc. Nitric ac. Nux vom. Op. Phospjhor. Platin. Rhus. Sabad. Sassap. Sep. Sil. Stann. Stapjh. Sulph. Teuc. Thuj. Zinc. — in rectum : Aco. Ambr. Asar. Bell. Cic. Cin. Chin. Euphorb. Ferr. Ign. Nitric ac. Nux vom. Ruta. Sabad. Sep. Sil. Spigel. Stann. Sulph. Teuc. Valer. MUCUS, discharge of, between stool : Antim. Caps. China. Colchic. Hell. Graph. Merc. Phosph. Puis. Rhus. Sep. Spig. Sulph. Tart. PAIN, simple : Aconit. Canthar. Car- bo an. Caust. Lye. Merc. Natr. mur. Nux vom. Phosph. Seneg. — in rectum : Aeon. Ambr. Camphor. Merc. Magn. mur. Sep. PINCHING: Merc. Natrum mur. Sabad. PRESSURE IN ANUS: Aeon. Baryt. Calc. Cyclam. Laur. Nitric ac. Nux vom. Petr. Phosphor. Puis. Seneg. Staph. — in rectum: Arn. Bell. China. Kali. Lye. NHric ac. Nux vom. Ojnum. Phosph. Sen. Stann. RECTUM, prolapsus of: Antim. crud. Ars. Asar. Bry. Colch. Dulc. Ign. Lach. >Ierc. Natrum muriat. Nux vom. Ruta. Sep. Sulpjh. REMAINING OPEN, always : Phos. SORENESS : Ars. Carbo an. Cau- stic. Hep. Graph. Merc. Nitric ac. Phosph. Sep. Sulph. — pain as of: Amm. Ars. Caust. Graph. Hep. Ign. Mur acid. Natr. mur. Nux vom. Phosph. Puis. Sep. Spongia. Sulphur. Yeratr. SPASM, (in anus): Colch. Lach. Kali bichr. — in rectum: Gale. Caust. Chin. Colch. Lach. Lye. SPHINCTER ANI, lameness of: Bell. Cole. Hyosc. STITCHES IN ANUS : Aeon, Ars. Bry. Canth. Carbo an. Carbo veg. Chin. Con. Croc. Graph. Ign. Ipec. Kali. Lye. Natrum. Natr. mur. N. vom. Phos. Phosph. ac. Plat. Ran. bulb. Sab. Sep. Sil. Sulph. — in rectum : Alum. Ant. tart. Bell. Bov. Carbo an. Caustic. Chin. Graph. Ign. Lye. Magn. mur. Natr. mur. Nux vom. Phospjh. Puis. Ru- ta. Sep. Sil. Sulph. Valer. SWELLING : Camph. Graph. Hep. Ign. Nux vom. TEARING IN THE ANUS : Colchic. Daph. Kali. Nux vom. Phos. ac. Sep. Thuj. — in rectum : Carbo veg. China. Lye. Kali. Nux vom. Phosph. ac. Ruta. Sabad. TENESMUS: Aeon, Am. Arsen. Bellad. Bov. Calc. Canthar. Caps. Colch. Daph. Euphorbiiun. Hep. Ipec. Kali. Laur. 3Ierc. Natr. Ni- tric ac. Nux vom. Phosph. Plat. Rheum. Rhus. Ruta. Sep. Stapjh. Sulphur. Yeratr. Zinc. THROBBING: Grat. Lach. Natr. mur. TORPOR: Alum. Carb. veg. Chin. Ign. Kali. Lycop. Natr. mur. Nux vom. Op. Ruta. Sep. Staph. Thuj. Yeratr. ULCERS : Caust. Sassap. URINE AND URINARY ORGANS. 79 URGING TO STOOL : Alum. Anac. Am. Ars. Asa f. Bar. Bellad. Calc. Camph. Cantli. Carb. v. Caustic. Coccul. Colch. Coloc. Con. Ferr. Graphit. Hepar. Hyose. Ign. Kali. Lack. Lye. Merc. Magn. mur. Xa- trum. Xatr. inur. Xitr. ac. X. moscli. X. von. Petr. Phos. Puis. Rheum. Rhodod. Rhus. Ruta. Sabad. Sep. Sil. Stann. Staph. Sulphur. Veratr. Verb. — with emission of flatulence: Carb. an. Lach. — with falling of rectum : Ruta. Merc. — at night : Merc. Puis. Sulph — with erections : Thuj. — painful: Ars. Caust. Sulph. — ineffectual : Aeon. Anac. Am. Asa f. BeR. Calc. Carb. Caps. Carb. veg. Caust. Coccul. Colch. Con. Graph. Hell. Ign. Lach. Lye. Kali bich. Merc. Magn. mur. Xatr. Natr. mur. Xitr. ac. Xux vom. Phosph. Plumb. Pulsat. Rheum. Rhus. Ruta. Sa- bad. Sassap. Sep. Sil. Spig. Stann. Staph. Stram. Sulph. Thuj. Yeratr. VARICES : Ambra. Ammon. mur. Anac. Antim. crud. Ant. tart. Ars. Bar. Bell. Brom. Calc. Caps. Carb. an. Carb. veg. Caust. Coloc. Ferr. Graph. Hell. Ignat. Kali. Lach. Lye. Magn. Merc. Mur. as. Natr. mur. Xitr. ac. Xux vom. Phosph. Ph. ac. Plumb. Puis. Rhus. Sabin. Sep. Sil. Stram. Sulph. Sulph. ac. Thuj. — protruding: Calc. Caustic. Ferr. Graph. Merc. Puis. Sep. Sulph. Thuj. — with colic: Carb. veg. Nux vom. Sulph. — blue : Carb. veg. Mur. ac. — blind: Ars. Cham. Ign. Nux vom. Puis. Sulph. Veratr. — bleeding: Aconit. Amm. Antim. crud. BelL Calc. Caps. Carb. veg. Chin. Cupr. Ferr. Ipec. Ign. Merc. Xux vom. Phosph. Puis. Sab. Sep. Stram. Sulph. 1 — burning: Ant. crud. Arsen. Calc. carb. Caps. Carb. an. Graph. Nitr. ac. Sulph. ac. — inflamed : Aeon. Arsen. Xux vom. Sulph. — swollen : Alnm. Calcar. carb. Carb. veg. Graph. Nux vom. Puis. — ulcerated: Nux vom. Puis. Sulph. — itching: Aeon. Graph. Phosph. Sulph. Sulph. ac. — humid: Sulph. — excoriated: Cham. — stinging: Ars. Baryt. Caust. Puis. — suppressed flow of : Carb. veg. N. vom. Sulph. — as if sore : Merc. Mur. ac. Phosph. Puis. Stann. b. PERINEUM. BURXIXG : Ant. crud. Rhodod. COXTRACTIOX: Sep. Sulph. CUTTIXG: Lye. N. vom. HERPES: Petr. IXFLAMMATIOX : Plumb. ITCHIXG: Agn. Ars. Carb. veg. X. vom. Petr. Seneg. Tarax. PAIX, simple : Caust. Lye. Phos. SOREXESS: Carb. v. Merc. Rhod. STITCHES: Alum. MercXat. Sep. TEARIXG: Daph. XXV. URINE AND URINARY ORGANS. ZTMTJSrJEJ. 1. Quality Thereof. ACRID : Ant. tart. Am. Borax. Cal- car. Cann. Canth. Caust. Clem. Creos. Graph. Hep. Iod.Kali. Merc Xatr. mur. Rhus. Sassap. Seneg. Thuj. Verat. 80 URINE AND URINARY ORGANS. AMMONIACAL : Asa f. Carbo veg. Creos. Iod. Mosch. Nitr. acid. Petr. Phosh. BILIOUS: Valer. BLOODY: Aeon. Ambr. Ant. tart. Am. Ars. Calc. carb. Cann. Canth. Capsic. Carbo veg. Chin. Coloc. Con. Hep. Ipec. Lye. Merc. Mezer. Nitr. acid. Nux vom. Op. Phosph. Ph. ac. Puis. Sec. corn. Sep. Squil- la. Sulph. Zinc. BROWN: Aeon. Ambr. Am. Ars. Asa f. Bell. Bry. Calc. Canst. ColcJt. Dig. Merc. Nitr. ac. Petr. Phosph. Rhodod. Puis. Sep. Sulph. Tart. Yaler. BURNING: Aeon. Arsen\ Camph. Cann. Canthar. Caps. Creos. Digit. Hep. Merc. Phosph. Staph. Yeratr. BLACKISH: Colch. CAT'S URINE, smelling like : Viol. tart. — like garlic : Phosph. — sour. Ambr. Calcar. Graph. Merc. Natr. — pungent : Asaff . Bor. Merc. — like 'sulphur : Phosph. — foul: Carbo veg. Dulc. Merc. Nitr. ac. Phosph. ac. Puis. Rhod. Sulph. Viol. trie. — like violets : N. mosch. Tereb. CLEAR: Amm. muriat. Euphr. Hy- osc. Laches. Nitr. Squill. Stramm. COLD : Agar. Nitric acid. COLORLESS (see pale) : Puis. COPIOUS: Aeon. Alum. Ambra. Amm. mur. Arg. Arn. Ars. Aur. Barijt. Bell. Bism. Bryo. Canth. Carbo veg 1 . Carbo an. Chin. Cicut. Clem. Coloc. Creos. Cycl. Daph. Digital. Euph. Guaj. Hyosc. Ign. Iod. Laur. Led. Lycopod. M. arct. Merc. Mur. ac. Natrum. Nitric. Oleand. Petr. Phosph. Phosph. ac. Pulsat. Rhus. Sab. Sassap. Selen. Senega. Spig. Squilla. Staph. Sulph. Tar. Thuj. Yaler. Verat. Verb. Vi- ola trie. Vit. LIKE CURD : Ambr. Cina. DARK: Aco. Ant. tart. Arn. Asa f. Bell. Bry. Carbo veg. Chin. Colch. Dig. Hell. Hep. Iod. Ipec. Lach. Lycop. M. arct. Merc. Nit?ic acid. Op. Phosph. Rhus. Selen. Sep. Staph. Sulphur. Tart. Veratr. DIMINISHED: Aco. Agar. Ambr. Ammon. mur. Ant. tart. Arn. Ars. Aur. Bell. Bry. Calcarea carb. Cann. Canth. Carbo veg. Caust. Cham. Chin. Coccul. Coff. Colch. Con.Cupr. Daph. Dig-. Dulc. Graph. Grat. Hell. Hep. Hyosc. Iod. Ipecac. Kali. Laur. Led. Lye. Merc. Mur. acid. Nitric ac. Nux mosch. Nux vomica. Op. Petr. Phosph. Phosphoric ac. Plumbum. Puis. Ruta. Sabad. Sas- sap. Sec. corn. Selen. Seneg. Squil- la. Stannum. Staph. Strain. Stront. Sulph. Veratr. Zinc. FIBRES, full of: Cann. FIERY: Aeon. Bry. Cann. Colch. Plumb. LIKE FLOUR: Calc. Graph. Mep. Natrum mur. FROTHY: Lach. Laur. Lycopod. Seneg. GREENISH: Ars. Camph. Iodine. Kali. Rhod. Ruta. Veratr. HOT: Aeon. Ars. Bry. Canthar. Cham.^Colchic. Dulcam. Hep. Lach. Nitric ac. INODOROUS : Ambr. Dros. LIGHT-YELLOW: Ambra. China. Sec. corn. LITTLE AT A TIME: Aconit. Agar. Bell. Cann. Canth. Caust. Colchic. Dig. Euphorb. Hell. Hyosc. Iod. Kali. Laur. Led. Merc. Nitric ac. Nux vom. Op. Petr. Phosph. Puis. Rhus. Ruta. Sil. Staph. Sulph. Tart. Yeratr. LOAM-COLORED : Anac. Canthar. Ign. Sabad. Sassap. Sep. Sulphur. Zinc. URINE AND URINARY ORGANS. 81 MILKY: Aur. Carbo veg. Dulc. Iod. Phosph. ac. OPALESCENT: Iodine. Phosphor. Puis. PALE : Agar. Alum. Am. Aur. Bell. Bism. Canth. Chel. Chin. Cocc. Colchic. Color. Con. Creos. Dig. Hep. Ignat. Iod. Lach. Laur. Mur. acid. Nitr. X. jugl. Nux vom. 01. an. Par. Phosph. Phos. ac. Pulsat. Rhod. Rhus. Sassap. Secede corn. Staph. Stram. Strontia. Sulph. Sulph. ac. Zinc. PURULENT: Cann. Ca?ith. Clem. Lye. Xux vom. Sabin. Sep. RED: Aco. Ant. crud. Antim. tart. Am. Bell. Bry. Calc. Camph. Cann. Canth. Carb. veg. Chin. Golch. Coloc. Con. Dig. Hep. Lpec. Kali bichr. Merc. Xux vom. Op. Phos. Plumbum. Puis. Sassap. Sep. Sil. Squilla. Staph. Sulph. SEDIMENTOUS : Aconit. Alum. Ambr. Ant. crud. Am. Arsen. Aur. Baryt.Bry. Calc. car b. Camph. Cann. Canth. Carbo an. Carbo veg. Caust. Cham. Clin. Chinin. Cicut. Col- chic. Coloc. Con. Creos. Dulcam. Graph. Hep. Hyoscyam. Iod. Ipec. Kali. Lach. Laur. Lol. tern. Lye. Mang. Mercur. llezer. Natr. mur. Nitr. Nitric ac. Nuxmosch. Oleand. 01. an. Opium. Petr. Phosph. Phosph. ac. Puis. Rhus. Ruta. Sas- sap. Selen. Seneg. Sepiae. Sil. Spong. Squilla. Sulph. Sulph. v\ Tar. Tlaij. Yaler. Zinc. SEDIMENT, blueish: Prun. - — bloody : Aconit. Calcar. carb. Cann. Canth. Caps. Coloc. Dulc. Lye. Merc. Phosphor. Phosph. ac. Pills. Sep. Sulph. Sulph. ac. Zinc. — brown : Ambr. Lach. Yaler. — thick : Camph. Laur. Mercur. Se- cale corn. Spong. Sulphur. Yaler. — dark : Iod. —purulent : Canthar. Clem. Con. Lye. Puis. Sep. — fibrous : Cann. Canth. Cham. Mei*c Mezer. Sassap. Seneg. Tart. Zinc. — flocculent : Cannab. Cham. Merc. Nitr. Nitric ac. Seneg. Tart. — gelatinous: Puis. — yellow: Ammon. mur. Bry. Cham. Chin. Cupr. Lye. Phos. Sil. Sponge Sulph. Sulph. ac. Zinc. — of yellow sand: Sil. — gray : Ant. tart. Con. Spong. — gravelly : Ambra. Ant. cruel. Calc. carb. Canth. Chin. Lach. Lye. Natr. mur. Nitric acid. Nux niosch. Nux vom. Op. Phosph. Puis. Ruta. Sas- sap. Sept. Sil. Thuj. Yaler. Zinc. — clayey — Amm. m. Anac. Kali. Sas- sap. Sep. Sulpjh. Sulph. ac. Zinc. — floury: Ant. tart. Calc. Graph. Merc. Hyos. Natr. mur. Phosph. ac. Tart. — reddish: Aeon. Ambr. Amm. mur. Ant. crud. Am. Ballad. Canth. Chin. Coloc. Con. Creos. Dulc. Graph. Iod. Ipec. Kali. Lach. Lye. Mang. Mez. Natr. mur. Nitr. a<\ Op. Petr. Phosph. Puis. Sec. corn. Selen. Sep. Sil. Squill. Thuj. Yaler. - — like blood : Amm. — like red sand : Natr. mur. Nitr. ac. Sil. — slimy: Ant. crud. Ars. Aur. Bry. Calc. carb. Carb. veg. Caust. Chin. Cina. Coloc. Con. Dulc. Hep. Ipec. Merc. Natr. Natr. mur. Nitr. acid. N. vom. Phosph. Phosph. ac. Puis. Rheum. Sassap. Seneg. Sulphur. Yaler. — turbid: Alum. Con. Rhus. Zinc. — violet : Puis. — whitish : Amm. Baryt. Bell. Calcar. Canth. Caps. Colch. Coloc. Con. Dulc. Graph. Hep. Ignat. Nitr. ac. Oleand. Petr. Phosph. Phosph. ac. Prun. Puis. Rhodod. Rhus. Sep. Spig. Spong. Sulph. Yaler. Zinc. URINE AND URINARY ORGANS. — whitish-turbid : Con. Rhus. — cloudy: Alum. Ambr. Bryon. Canst. Kali. Laur. Merc. Nitr. Petr. Phosph. ac. Plat. Seneg. Thuj. Valer. — brick-dust : Aeon. Arn. Chin. Ipec. Puis. TENACIOUS : Canth. Cupr. Creos. Dulc. Phosph. ac. THICK: Camph. Con. Dulc. Iod. Nux vom. Plumb. Sabad. Seneg. Sulph. ac. TURBID: Ambr. Anac. Ant: tart. Ars. Aur. Bell. Cann. Canth. Car- bo an. China. Chlorof. Cina. Clem. Colch. Coloc. Con. Cycl. Dig. Dulc. Hep. Ignat. Iod. Kali. Lach. Lye. Merc. Mosch. Mur. ac. Nitr. acid. Phosph. Plumb. Pulsat. Rhus. Sabad.: Sassap. Sep. Sulph. Sulph. ac. Valer. Veratr. Zinc. — becoming : Ambr. Ang. Arn. Aur. Bry. Caust. Cham. Cina. Con. Dig. Graph. Hep. Iod. Laur. Mercur. Mezer. Nitr. Petr. Phosph. ac. Rhus. Sassap. Seneg. Sepise. Sulph. Thuj. Valer. WHITISH: Ang. Arn. Aur. Cann. Garb. veg.> Cina. Con. Iod. Merc. Phosph. Ph. ac. Bhus. Sassap. Sulph. WHITISH-YELLOW: Amm. Phos. WHITISH-GREEN: Camph. WHITISH-TURBID : Cann. China. Con. YELLOW: Ant. crud. Arn. Ars. Bell. Bry. Canth. Cham. Chin. Daph. Hyosc. Iodine. Ipec. Lach. Led. Magn. m. Nitr. Petr. Rheum. Samb. Sassap. Veratr. Zinc. 2. Urine After Stool. BURNING URINE : Cann. Canthrj\ Caps. N. mosch. Puis. Staph. Veratr. DIABETES : Aeon. Argent. Bell. Cann. Cupr. Clem. Dig. Hyosc. Led. Nitr. ac. Pulsat. Rhus. Squill. Stram. Tar. Yeratr. — with emaciation : Merc. — with head-ache : Veratr. — with back-ache : Phosph. ac. — with sweat: Aeon. Bell. MICTURITION, nocturnal: Agaric. Ambr. Amm. mur. Anac. Arn. Ars. Bry. Bov. Calc. Canth. Con. Graph. Iod. Kali. Lach. Lye. Natr. Natr. in. Nitr. ac. Puis. Rhus. Ruta. Sep. Sil. Stront. Sulph. Thuj. Zinc. — too frequent: Aeon. Anac. Ant. crud. Arg". Arn. Ars. Aur. Bar. Bell. Bry. Calc. carb. Calc. j^hosph. Camph. Can. Caps. Caust. Chel. Chin. Coff. Con. Creos. Cyclam. Daph. Euphorb. Graph. Hell. Hyosc. Ign. Iod. Kali. Laches. Led. Lye. M. austr. Merc. Mur. ac. Natr. Natr. mur. Nitr. N. vom. Oleand. Petr. Phosph. Phosph. ac. Plumb. Rhus. Sassap. Selen. Sil. Spig. Spong. Squill. Staph. Sulph. Tar. Thuj. Valer. Veratr. Verb. — difficult : Aeon. Agar. Bellad. Camph. Cann. Canth. Cic. Dig. Euphorb. Hyosc. Hep. Nux mosch. Op. Phosph. Plumb. "Sec. corn. Thuj. — too seldom: Aeon. Agar. Amnion. mur. Apis. Arn. Arsen. Aur. Bell. Bry. Camph. Canthar. Carb. veg. Chin. Cic. Colch. Cupr. Dig. Graph. Hep. Hyosc. Iod. Laur. Led. M. austr. Mane. Merc. Nitr. ac. V. vom. Op. Phos. Plumb. Puis. Ruta. Sec. corn. Squill. Staph. Stram. Sulph. ac. Verat. — drop by drop: Agar. Arn. Bell. Camph. Cann. Canth. Caps. Caust. Chin. Clem. Colchic. Con. Dig. Dros. Dulc. Euphorb. Graph. M. austr. Merc. N. mosch. Nux vom. Petr. Phosph. ac. Puis. Rhus. Ruta. Sil. Staph. Stram. Sulph. Thuj. URINE AND URINARY ORGANS. 83 — interrupted : Agar. Carb. an. Caust. Clem. Con. Dulc. Led. M. austr. Op. Phosph. acid. Puis. Sulph. Thuj. Zinc. — involuntary: Aeon. Ant. tart. Am. Ars. Bell. Bry. Calc. Canthar. Carb. veg. Caust. Chin. Cic. Cilia. Creos. Dig. Dulc. Ferr. Hep. Hyosc. Iod. Lach. Laur. Led. Lye. M. austr. Merc. Natr. mur. Nitr. ac. Nux vom. Petr. Phosph. ac. Puis. Rhus. Ruta. Sep. Sil. Spig. Squill. Stram. Sulph. Veratr. when coughing: Bry. Caust. Natr. mur. Veratr. — at night, in bed : Aeon. Ars. Bell. Bry. Carb. v. Caust. Cham. Cilia. Con. M. austr. Natr. Op. Puis. Rhus. Ruta. Sep. Sil. Stram. Sulph. in the first sleep : Sep. — in the day-time : Ferr. ISCHURIA: Aconit. Agar. Arn. Aur. Bellad. Camph. Cann. Canthar. Chin. Cic. Coloc. Con. Dig. Eu- phorb. Graphit. Hep. Hyosc. Laur. Lycop. Nitric ac. Nux vom. Op. Plumbum. Pulsat. Ruta. Sabina. Strain. Sulph. Veratr. Zinc. STREAM, double : Canth. — thin : Camph. Canth. China, Led. Mercur. Puis. Spongia. Staph. — scattering: Cann. Canth. — slow: Camph. Merc. Plat. — strong: Agn. Cic. Vit. TENESMUS OF BLADDER: Aco- nit. Arn. Camphor. Cann. Canth. Caps. Colch. Merc. Nux vom. Puis. Sab In. Sassap. Squilla. Sil. Viol. trie. URGING TO URINATE: Aeon. Agar. Alum. Ambra. Ammon. mur. Ant. tart. Arg. Arn. Am. Bar. Bell. Bor. Bovist. Bry. Calc. carb. Cann. Canth. Caspic. Carbo an. Caust. Chamom. Cicut. Cocc. Colchic. Coloe. Con. Copaiv. Creos. Dig. Dulc. Euphorbium. Graph. Guaj. Hell. Hyosc. Ignat. Iod. Ipec. Kali. bichr. Lach. Lycop. M. austr. Mur. magn. Men. Merc. Mur. ac. Natr. Nitric, ac. N. jugl. N. vom. Petr. Phosph. Phos. ac. Plumb. Puis. Rhod. Rhus. Ruta. SabaOilla. Sabina. Sambuc. Sassap. Selen. Sep. Sil. Spig. Squill. Stann. Staph. Sulphur. Tar. Tart. Thuj. Veratr. Zinc. — with scanty discharge : Aeon. Anac. Ant. cruel. Antim. tart. Bell. Bry. Calc. carb. Cann. Canth. Caps. Carb. veg. Caust. Cocc. Colch. Cuprum. Con. Digit. Dros. Euphorb. Hell. Hyosc. Iod. Led. M. austr. Men. Merc. Natr. Nitric ac. Nux mosch. Nux vom. Petr. Phosph. Phosph. acid. Plumb. Puis. Ruta. Sabad. Samb. Sassap. Staph. Sulph. Ve- ratr. — with copious discharge : Agar. Alum. Ant. tart. Arg. Ars. Bellad. Bism. Carbo an. Cin. Calc. Cycl. Creos. Lach. Mur. ac. Natr. mur. Rhus. Spig. Squilla. Stann. Sulph. Tar. Verb. Viol. trie. — irresistible : Baryt. Bell. Bry. Calc. Chin. Ign. Merc. Nitr. ac. Phosjjh. Phosph. acid. Pulsat. Rhus. Ruta. Squilla. — ineffectual: Aco. Arnica. Camph. Canth. Caps. Caust. Cham. Chin. Dig. Hell. Hyosc. Merc. Mur. acid. Nux vom. Petr. Ph. ac. Plumb. Pulsat. Sabina. Sassap. Sec. corn. Sep. Squill. Sulph. 3. Accompanying Ail- ments. a. Before urination. BURNING IN THE URETHRA: Arn. Cann. Natr. Nux vom. Puis. Zinc. 84 URINE AND URINARY ORGANS. CUTTING IN THE URETHRA: Can th. — in the abdomen : Puis. DRAWING IN RENAL BWION: Clem. — in penis : Cic. GENERALLY: Am. Bor. Bryon. Bellad. Canth. Chin. Cic. Coloc. Creos. Digit. Dnlc. Hep. ftux vom. Phosph. ac. Plumb. Puis. Rhod. Rhus. Sulphur. Tar. PAIN IN THE BLADDER: Nux vom. SORE PAIN IN URETHRA: Cop. Nux vom. Phosph. STINGING IN THE BLADDER: Canth. TEARING IN THE GLANS : Chin. b. During urination. BURNING IN BLADDER: Aconit. Camph. Lach. Staj)h. — in urethra : Ambra. Ars. Bar. Calc. Cann. Canth. Caust. Cham. Clem, Chin. Colch. Dulc. Ferr. Hep. Ipec. Kali bichr. Merc. Nitric ac. Nux vom. PJiosph. ac. Puis. Sabad. Sas- sap. Sep. Staph. Sulphur. Thuj. Yeratr. GENERALLY: Aeon. Anac. Apis. Ars. Bell Bor. Bry. Calcar. Camph. Cann. Canthar. Caps. Carbo veg. Canst. Chin. Clem. Colch. Con. Cupr. Dig. Dulcam. Graph. Hell. Hep. Ipec. Kali. Lye. Mur. magn. Merc. Mezer. Mur. ac. Natr. mur. Nitric ac. Nux vom. Petr. Phosph. Phosph. ac. Puis. Rhod. Rhus. Sassap. Sec. corn. Seneg. Sep. Spigel. Staph. Stram. Sulph. Thuj. Yeratr. Zinc. GNAWING IN URETHRA : Caust. HEAT IN URETHRA : Caust. ITCHING IN URETHRA: Alum. Ambra. Arn. Canth. Daph. Lye. Natr. mur. Nux vom. Thuj. LANCINATIONS IN URETHRA: Ant. crud. Calc. Canth. Con. Dig. Graph. Merc. Phos. ac. Puis. Zinc — in bladder: Canth. Lye. Thuj. —in renal region : Canth. Merc. OS COCCYX, pain in: Graph. PRESSURE IN BLADDER : Aeon. Con. Nitric ac. Spig. Staphys. Yeratr. Zinc. — in the urethra : Canth. Puis. — in renal region : Bell. Lye. PROSTATIC JUICE, discharge of: Natr. Phosph. ac. STITCHES IN BLADDER: Canth. Lye. Sulph. —in urethra: Bry. Can. Canth. Chin. Clem. Con. Cupr. Daph. Graph. Ign. Lach. Merc. Natr. mur. Sulph. Thuj. — in kidneys : Aco. Bell. Canth. Hep. Phosph. ac. — in bowels : Nitric ac. STOOL INVOLUNTARY: Muriat. ac. Squill. c. After urination. BURNING IN URETHRA: Con. Graphit. Lye. Merc. Nitric acid. Rhod. Sulph. CUTTING IN URETHRA: Canth. Con. Staph. Sulph. DRIBBLING OF URINE: Bryon. Calc. carb. Lach. Petr. Selen. Thuj. DRIBBLING OF BLOOD: Daph. Zinc. GENERALLY: Anac. Antim. tart Am. Asa f. Aur. Bell. Calad. Calc. Cann. Canth. Capsic. Chin. Clem. Coloc. Con. Creos. Dig. Hep. Kali. Lach. Lye. M. arct. Mercur. Mur. ac. Natr. Natr. mur. Nitr. ac. Nux vom. Par. Phos. Plat. Puis. Rhod. Rata. Selen. Seneg. Sep. Stann. Staph. Sulph. Thuj. Yeratr. Zinc. ITCHING IN URETHRA: Canth. Lye. Sassap. MUCUS, discharge T . vom. Phos. Plumb. Puis. Rhus. Thuj. Yit, — at night: Canth. Merc. Natr. mur.. Nitric ac. Plumb. Puis. Staph. Sulph. ac. Zinc. — in the day-time: Cann. Hyosc^ Lach. Puis. SEXUAL ORGANS AND FUNCTIONS. 91 — day and night : Canth. — too short : Calad. Calc. Con. Selen. — deficient: Agn. Calad. Camphor. Con. Graph. Hell. Loch. Lye. Magn. carb. Nux mosch. Puis. Teucr. Vit. — too feeble : Baryt. Caladium. Lach- esis. Lye. Mercur-. Selen. Sulph. — too strong: Canthar. Creos. Lach. Natr. mur. Nux vom. Op. Phos. Puis. Sabin. Zinc. —too painful: Cann. Canth. Graph. Ign. Kali. Mere. Nitric ac. Nux vom. Plumb. Sabad. Sulph. Thuj. — without sexual lust : Ambra. Calad'. Cann. Caps. Graphit. Lach. Magn. Natrum muriat. Phosph. ac. Sabad. Sabin. Sil. Spig. SEMEN BLOODY: Caust. Canth. Led. Merc. — thin: Selen. — inodorous: Selen. — watery: Led. Sulph. — flow of: Agar. Alum. Anac. Arg. Arn. Ars. Aur. Baryt. Bell. Bism. Bov. Brom. Calad. Calc. Canth. Carbo an. Carbo veg. Caustic. China. Cicut. Con. Ferr. Graphites. Guaj. Kali. Lach. Led. Lye. Magn. Merc. Natr. Natr. mur. Nitric ac. Nux mosch. Nux vom. Op. Petr. Phosph. Phosph. ac. Puis. Kan. bulb. Ehus.Euta. Sangv. Selen. Sep*. Silicea. Stann. Staph. Sulphur. Thuj. Verb. Tit. Zinc. in the day-time : Canthar. Car- bo an. Caust. Graph. Lach. not taking place during inter- course: Calad. Graph. Kali. Lach. Lye. with relaxed penis : Bellad. Con. Graph. Mosch. N. vom. M. arct. Plumb. Selen. at stool : Phosph. ac. — weakening : Baryt. Carbo an. xjliin. Kali. Lach. Lye. Nux vom. Phosph. Phosph. ac. — too soon: Bor. Calad. Calcar. Lye. Phosph. Sel. Zinc. — too often : Bar. Calc. carbon. CantJi. Carbo veg. Chin. Ci: Con. Kaii. Lye Nitric ac. Petr. Phosph. Phosph. ac. Sep. Sil. Sulph. — during the siesta : Alumina. Caust. Clem. Mercur. Staph. Sulph. — without force: Canthar. Con. Phosph. Selen. — deficient : Calad. Calc. Camphor. Kali. Lach Lye. Natr. mur. — followed by languor: Baryt. Calc. carb. by anxiety : Carbo an. by head-ache : Calcar. Lach. Sil. irresistible desire : Ehus. heaviness in the limbs next day : Puis. amorous fancies : Alumina. Ars. Aur. Baryt. Bism. Calc. Chin. Grat. Led. Natr. Nux vom. Ole- and. Op. Phosphor. Plumb. Sa- bad. Samb. Sassap. Sil. Staph. Viol. trie. SEMEN, followed by dryness of the skin : Baryt. contractive feeling in urethra: Thuj. voluptuous dreams : Calcar. ph. Kali carb. — early in the morning: Lach. N. vom. Plumb. Puis. — after midnight : Samb. — several nights in succession : Aur. Caust. Carb. an. Con. — after onanism : Calc. Carbo veg. Chin. Natr. mur. Ph. ae. Sep. Staph. — without dreams : Anac. Ant. crud. Bism. Calc. Cic. Guaj. Phosph. Puis. Ran. sc. Buta. Stann. Verb. Zinc. fancies: Phos2m. thrill : Anac. Natr. Carb. Sulph. ac. Plat. — painful: Calc. Cann. Canth. Clem. Mosch. Natr. carb. Sassap. Thuj. 92 SEXUAL ORGANS AND FUNCTIONS. — with cutting in urethra : Bor. — with cutting in urethra afterwards : Natr. niur. — too late: Agar. Calc. Lack. Lye. Petr. SEXUAL INTEBCOUBSE, aver- sion to : Agar. Cann. Caust. Clemat. Kali. Lye. Phosph. Ehod. — desire for: Calcar. Canth. Chin. Lach. Moscli. Phos. Puis. Stann. Yeratr. — falls asleep during: Bar. Lye. — followed by mental languor : Calc. Sep. by pain in urethra : Canth. by dullness of head : Bo v. Chin. Lye. by ill-humor : Petr. by back-ache: N. vom. — with relaxed penis: Con. Lye. N. vom. — followed by weakness : Agar. Calc. Kali. Lycop. Nitr. ac. Selen. by sweat : Agar. by bruised feeling : Sil. by tremor of the legs: Calc. carb. SEXUAL LUST : Calc. carb. Canth. Carb. veg*. Chin. Graph. Hyosc. Lach. Mosch. ■ Natr. mur. N. vom. Phosph. Plat. Puis. Sep. Stann. Stram. Veratr. Zinc. SEXUAL DESIEE TOO STEONG: Agar. Alum. Ant. cruel. Aur. Baryt. Bov. Calc. Cann. Canth. Carb. veg. China. Coff. Con. Dig. Dulc. Ferr. Graph. Hijosc. Ign. Iod. Kali. Lach. Lycop. Mane. M. arct. M. aust. Men. Merc. Mosch. Natr. mur. N. vom. Op. Petr. Phos. Plat. Plumb. Puis. Ehus. Euta. Sabin. Sep. Sil. Staph. Stram. Sulph.Jera.tr. Zinc. SEXUAL DESIEE, like priapism: Canth. Graph. Natr. mur. N vom. Phosph. Plat. Puis. Staph. — like satyriasis: Canth. Merc. N. vom. Phosph. Sulph. Verat. — deficient : Amm. mur. Bellad. Bor. Calc. carb. Camph. Con. Graph. Hep. Kali. Lach. Lye. Magn. c. . Nitr. ac. Phosphor, ac. Ehod. Stann. Sulph. — too feeble : Alum. Ambr. Bar. Bell. Bor. Calacl. Calc. Carbo an. Caust. Clem. Ferr. Graph. Hep. Kal. Lact. Lye. Magn. c. Mur. ac. Natr. mur. Nitr. ac. Op. Petr. Phosph. ac. Ehod. Selen. Sep. Spong. Stann. Sulph. Teucr. — with impotence : Agar. Graph. Se- len. SEXUAL POWEE, too feeble : Agar. Bar. Calad. Calc. Canth. Chin. Con. Ignat. Mang. N. mosch. Selen. Sep. Sulph. Yit. deficient : Agar. Agn. Ant. crud. Baryt. Calad. Calc. Camph. Cann. Carb. v. Caust. Chin. Chlor. Con. Cupr. m. Ferr. Graph. Hep. Ign. Iod. Laches. Lye. Mosch. Mur. acid. Natr. mur. Nitr. acid. N. mosch. N. vom. Phosph. Plumb. Ehus. Selen. Sep. Sil.Sulph.Thu^. Vit. Zinc. A. SEXUAL ORGANS. JFFMA.LF SEJCTJJlL OJEtaJtNS JlNJD FUNCTIONS. Petr. Sa bin. Sil. Staph. Sulph. Thuj. DAMPNESS : Aur. Sulph. EEUPTIONS: Calc. Caust. Dulc. Graph. Merc. Nux vom. Petr. Ehus. Sep. Staph. Sulph. Veratr. 1. External Organs. APHTHAE: Carb. veg. BUBNING: Cale. Canth. Carbo veg\ Caust. Kali. Lye. M. austr. N. vom SEXUAL ORGANS AND FUNCTIONS. 93 GENERALLY: Aeon. Agar. Alum. Ambr. Aram.. Ant. crud. Am. Asa f. Aur. Bar. Bell. Bry. Calc. Canth. Carbo veg. Cham. Chin. Coff. Con. Creos. Dulc. Ferr. Graph. Hyosc. Kali. Lye. Meph. Merc. Natr. Natr. mur. Nitr. ac. Nux vom. Petr. Phosph. Platin. Pulsat. Bhns. Sec. corn. Sep. Silic. Staph. Sulph. Thuj. Yeratr. GNAWING : Kali. Lye. Nux vom. HAIR, falling out : Natr. mur. Nitr. ac. HEAT: Aur. Canth Carbo veg. M. austr. Merc. Nux vom. ITCHING : Agar. Alum. Ambr. Calc. Carbo veget. Creos. Con. Dulc. Kali bichr. Kali carb. Lye. Merc. Natr. mur. Nux vom. Sep. Staphys. Sil. Sulph. NETTLE-RASH : Ant. tart. PAINFULLNESS : Kali bichr. Merc. Staph. PIMPLES : Graph. Kali. Merc. PUSTULES : Bry. Merc. REDNESS: Carbo veg. SWELLING: Ambra. Amm. Aur. Canth. Carbo veg. Meph. Mercur. Nitric ac. Nux vom. Sec. corn. Sep. Thuj. SORENESS: Ambr. Amm. Carbo Yeget. Caust. Daph. Graph. Hep. Kalic bichr. Lye. Merc. Petr. Rhus. Sep. Sil. Sulph. Thuj. SORE PAIN: Ambr. Brom. Cham. Creos. Ferr. m. Rhus. Thuj. STITCHES: Aur. Con. Croc. Gra- phit. M. austr. Merc. Phosph. Sep. Staph. Thuj. TUBERCLES: Calc. Merc. Phos. ULCER: Graph. Merc. Nitric ac. Sec. corn. Sex). Thuj. VARICES: Calc. carb. Carbo veg. Lye. VESICLES: Graph. Staph. 2 Vagina. BURNING : Aur. Cham. Hyosc. Lye. Sulph. Thuj. CONTRACTION: Mosch. Rhus. Sep. Thuj. DRYNESS: Bell. Lye. GENERALLY : Alum. Ambra. Aur. Ars. Bell. Calc. Canth. Capsic. Car- bo veg. Caust. China. Coff. Con. Creos. Dulc. Ferr. Ferr. m. Graph. Hep. Iodine. Kali. Lye. Mur. magn. Mercur. Xatr. Natr. mur. Nitric ac. X. vom. Petr. Phosph. Plat. Puis. B 7 :us. Sabina. Secale corn. Sep. Sil. Stann. Staph. Sulph. Sulph. acid. Thuj. HEAT : Aur. Creos. Merc. INDURATIONS: Bell. Sep. INFLAMMATION: Merc. Nitric acid. — with swelling : Merc. ITCHING: Con. Creos. Sulph. — with voluptuous feeling : Creos. LABOR-LIKE PRESSING: Croc. Moschus. Sil. PAIN DURING INTERCOURSE: Ferr. PROLAPSUS: Creos. Ferr. Merc. Nux vom. Sep. Stann. SORENESS: Hyosc. Kali bichr. — with burning : Hyosc. — painful: Ferr. m. Rhus. SPASMODIC PAIN : Nux vomica. Staph. STITCHES : Ars. Berb. Con. Mur. ac. Nitric ac. Puis. Rhus. SWELLING: Kali bichr. Merc. 3. Uterus. CANCER: Ars. Bell. Calc. Carb. an. Clematis. Creos. Graph. Iod. Kreo- sota. Lach. Phosph. Rhus. Sabin. Sec. corn. Sil. Sulph. Thuj. CONTRACTION : Sep. Thuj. CORROSIVE ULCERATION OF OS TINC^E: Ars. Bell. Merc. Ni- tric ac. Sep. Thuj. 94 SEXUAL OKGANS AND FUNCTIONS. CUTTING IN THE OS UTEKI: Puis. DESCENSION : Sec. corn. DISTENSION: Lye. Phosphor ac. Sep. DRAWING: Puis. Rhus. GENERALLY : Aeon. Antim. crud. Arn. Asa i. Aur. Bell. Bov. Bryon. Calc. Carbo an. Carbo veg. Caust. Chain. China. Cocc. Coff. Con. Cre- os. Croc. Ferr. Geum urb. Graph. Hyoscyam. Ign. Iod. Ipecac. Kali. Lack. Magn. carb. Magn. mur. Mosch. Natr. Natr. mur. Nux mosch. Nux vom. Op. Phosph. ac. Plat. Puis. Rhus. Sabadilla. Sabina. Sec. corn. Sep. Stann. Stram. Sulphur. Tlmj. Zinc. HEMORRHAGE: Aeon. Arg. nit. Aloe. Am. Bell. Bry. Calc. Canth. Carbo an. Carbo veg. Cham. Chin. Coffea. Creos. Croc. Ferr. Hyosc. Iod. Ipec. Lye. Mag. m. M. austr. Merc. Mill. Natr. carb. Nitric ac. Nux mosch. Nux vom. Phosph. Plat. Psor. Puis at. Rhus. Sabin. Sec. corn. Sep. Sil. Squill. Stram. Sulph. INDURATION: Aur. Bell. Carb. an. Chin. Clem. Cocc. Con. Iod. Magn. mur. Rhus. Sep. Staph. INFLAMMATION: Aeon. Bellad. Bry. Canth. Cham. Chin. Coff. Con. Dulc. Ign. Lach. Merc. Nux vom. Plat. Puis. Sabin. Sec. com. LABOR-LIKE PAIN: Cham. Mur. ac. Op. Sec. corn. Sep. POLYPI: Calc. Staph. Tlmj. PROLAPSUS : Aur. Bell. Calc. Cre- os. Merc. N. vom. Sep. Stann. PUTREFACTION : Carbo an. Sec. corn. SENSITIVENESS OF NECK OF UTERUS: Chin. SORE, pain as if: Mur. ac. Rhus. SPASMS : Bell. Bryon. Caustic. Chamom. Cic. Cocc. Con. Geum urb. Hyosc. Ignatia. Magn. Magn. mur. Natr. mur. Nux vom. Plat Fulsat. Sep. Stann. SPASMODIC PAIN: Cocc. Ignat. Nux vom. Thuj. STITCHES: Muriat. acid. Phosph. Plat. SWELLING: Bell. Merc. N. vom. Sec. Sep. 4. Ovaries. DROPSY: Apis. Ars. Canthar. Dul- cam. Iod. Mercur. Sepise. Staph.(?) GENERALLY: Aeon. Agar. Ambr. Ant. crud. Apis. Ars. Asa f. Aur. Bell. Canth. Carbo an. Carbo veg. Chin. Coloc. Con. Graph. Hyosc. Ign. Iod. Kali. Lach. Lye. Merc. Mezer. Nux vom. Flat. Plumb. Ran. bulb. Sabin. Sassap. Sec. corn. Sep. Staph. Sulphur. Thuj. Yit. Zinc. INDURATION: Apis. Aur. BeUad. Carbo an. Iod. Lach. INFLAMMATION : Aconit. Ambra. Ant. carb. Apis. Ars. Bell. Bry. Canth. China, Coloc. Con. Dulc. Ign. Lach. Mercu, . Flat. Puis. Sa- bin. Staph. SENSITIVENESS: Apis. Plat. SWELLING: Apis. Graph. Iod.(?) Lach. 5. General Symptoms. FIGWARTS : Nitric ac. Thuj. PAIN AS IF BRUISED : Bar. m. PRESSING TOWARDS THE PARTS : Bell. Bov. Chin. Cha- mom. Con. Croc. Graph. Ipec. Kali. Mere. Moseh. Natr. Flat. Pul- sat. Sep. Sulph. Thuj. RUSH OF BLOOD: Bell. China. Croc. Ign. Nux vom. Phosph. Plat. Sec. corn. Sulph. SORENESS BETWEEN THE THIGHS : Arsen. Caust. Creos. Graph. Hep. Lye. Nitric acid. Phosph. Rhod. Sep. Sulph. WEIGHT, feeling of ■ Nux vom. ■ SEXUAL ORGANS AND FUNCTIONS. 95 SEXUAL FUNCTIONS ANP INSTINCT. BLOOD, loss of, between the pe- riods : Ambr. Am. Bell. Bov. Calc. Cham. Chin. Coc. Coff. Croc. Hyosc. Kali. Ipecac. Merc. Magn. mur. Nux vom. Petr. Phosphor. Prim. Rhus. Sabin. Sec. corn. Sep. Sil. Sulph. Stram. — of pregnant females : Cham. Cocc. Kali. Phosph. Sabina. Sec. corn. — of nursing females : Sil. INTERCOURSE, aversion to : Cann. Canst. Chlor. Cub. Kali. Lye. Natr. mur. Petr. Phosph. — desire for: Calc. Creos. Kali. Sa- bin. Sulph. ac. — with pains : Creos. Ferr. mur. Kali. — with too ready conception: Bor. Canth. Merc. Natr. — with nausea: Sil. — without thrill : Ferr. m. MISCARRIAGE: Aco. Apis. Am. Asar. Bell. Bry. Calc. Calend. Canth. Caps. Carbo an. Carbo veg. Cham. China. Cocc. Croc Cycl. Ferrum. Hyosc. Ipec. Iod. Kali. Lach. Lycop. Merc. Nitric ac. Nux mosch. Nux vom. Op. Phosph. Plat. Plumbum. 'Puis. Rhus. Ruta. Sabin. Sec. corn. Sep. Sil. Sulph. Zinc. — disposed to: Asar. Calcarea. Carb. veg. Cocc. Creos. Ferr. Kali carb. Lye. Nux mosch. Plumb. Puis. Ru- ta. Sabin. Sabad. Sep. Sil. Sulph. — of chlorotic females : Carbo veg. Chin. Ferr. Sep. Sulph. — with congestion of blood to the womb : Bell. N. vom. Plat. Sep. — with 'spasms: Cham. Hyosc. Ipec. Nux vom. — with leucorrhcea : Calc. Ferr. Sep. Sulph. — at the outset of pregnancy : Sabin. Confinement, Ailments Incident to. AFTER-PAINS TOO VIOLENT, LONG: Am. Bryon. Bell. Calc. carb. Cham. Coff. Cupr. Ferr. Ign. Kali. Nux vom. Puis. Rhus. Ruta. Sabina. Sep. Sulph. INJURY OF PARTS DURING DELIVERY: Am. PAINS SPURIOUS: Bell. Cham. Cocc. Coff. Cupr. Hyosc. Ign. Ipec. Kali. Nux mosch. Nux vom. Op. Puis. Sec. corn. Sep. Stann. with urging on the rectum : Nux vom. violent : Aeon. Coff. with contraction of the womb : Bell. — too feeble: Am. Bell. Camphor. Carb. veg. Cham. Chin. Cocc. Coff. Graph. Ign. Kali. Lye. Magn. mur. Mosch. Natr. Natr. mur. N. mosch. Nux vom. Op. Puis. Rhus. Ruta. Sec. corn. Sep. Sulph. Sulph. ac. after a fright : Op. of feeble persons : Sec. corn. with spasmodic pains : Puis. — too strong: Aeon. Arn. Aur. Bell. Cham. Cocc. Coff. Con. Hyosc. N. vom. Sec. corn. Sep. PLACENTA ADHERING : Bell. Puis. Sec. corn. SEXUAL INSTINCT EXCITED : Bell. Calc.' Canth. Chin. Coff. Con. Creos. Ferr. Graph. Hyosc. Kali. Mane. Mosch. Nux vom. Plat. Phosph. Puis. Stram. Sulph. Sulph. ac. Thuj. Yeratr. Zinc. — unto nymphomania : Bell. Canthar. Hyosc. Merc. Natr. mur. Phosph. Plat. Puis. Raj>h. sat. Stram. Yeratr. SPASMS : Bell. Cham. Cic. Cocc. Hyosc. Ignat. Ipecac Mosch. Plat. Stram. Veratr. 96 SEXUAL ORGANS AND FUNCTIONS. UTERINE HEMORRHAGE : Bell. Chaniom. Chin. Croc. Eerr. Ipec. Plat. Sabin. Sec. com. Menses. MENSES, pale, watery: Alum. Arn. Bell. Berb. Bov. Calc. Carb. an. Carbo veg. Cocc. Con. Creos. Dig. Ferr. Graph. Hell. Hyosc. Ipec. Kali. Led. Lye. Magn. Mane. M. austr. Merc. Natr. m, Nitr. ac. N. mosch. Phosph. Plat. Puis. Bhus. Sabin. Sec. corn. Sep. Sulph. Tart. — brown : Bry. Calc. Carb. veg. Con. Rhus. — thick: Arn. Croc. Cupr. Magn. c. N. mosch. N. vom. Plat. Puis. Sulph. — dark, black : Amm. Ant. crud. Arn. Asar. Bell. Bism. Bry. Canth. Carb. an. Carb. veg. Cham. Chin. Creos. Croc. Ferr. Ign. Lack. Magn. Nitr. Nitr. ac. Nux vom. 01. an. Plat. Puis. Sec. corn. Selen. Sep. Sulph. — thin: Eerr. Graph. Sabin. Sec. corn. — flesh colored : Sabin. Stront. — too soon: Alum. Ambr. Amm. Arn. Asa f. Asar. Bell. Bor. Bov. Bry. Calc. Canth. Carb. an. Carb. veg. Cham. Clm. Cin. Cocc. Colch. Coloc. Con. Creos. Croc. Dulcam. Ferr. Fluor, ac. Gent. Graph. Grat. Hell. Hep. Ign. Iod. Ipec. Kali. Laur. Led. Lye. Magn. M. austr. Mang. Mosch. Mux. ac. Natr. mur. Nitr. ac. Nux mosch. Nux vom. Petr. Phosph. Phosph. ac. Plat. Puis. Bhod. Bhus. Sabin. Sec. corn. Sep. Silic. Spong. Stann. Staph. Sulph. Sulph. ac. Veratr. Zinc. — light-colored : Am. Bell. Bry. Calc. Canth. Carb. veg. Dros. Dale. Hyosc. Led. M. austr. Phosph. Bhus. Sabin. Sec. corn. Stront. — too short : Amm. Bar. Con. Dulc. Graph. Lack. Magn. mur. M. arct. Mang. Mercur. Phosph. Plat. Puis. Ruta. Sulph. — too long: Aeon. Ars. Asar. Bar. Bryon. Canth. Carb. an. Caust. Chin. Coff. Croc. Cupr. Dulc. Ferr. Ign. Lye. M. austr. Natr. mur. Nux vom. Phosph. Plat. Puis. Sabin. Sec. corn. S.il. Sulph. Sulph, acid. — at night : Bov. Magn. carb. Sabm. — by fits and starts: Cham. Puis. Sabin. — acrid: Amm. carb. Ars. Canth. Carb. v. Graph. Kali. Nitr. Phosph. Puis. Sassap. Silic. Sulph. Sulph. ac. — frothy: Arn. Ferr. Ipec. — slimy: Cocc. Puis. — too scanty : Aco. Alum. Amm. Arn. Asa. Baryt. Bor. Bry. Calc. Carb. veg. Caust. Cicut. Coccul. Con. Creos. Crot. Cupr. Dig. Dulc. Ferr. (xraphit. Ign. Iod. Kali. Kali hydr. Lach. Lye. M. arct. Magn. Merc. Natr. mur. 01. an. Phosph. Puis. Ruta. Sabad. Sassap. Sep. Sil. Staph. Sulph. Veratr. Vit. Zinc. — too late: Aeon. Amm. Ast. Aur. Bell. Bry. Caust. Chamom. Chel. Cic. Cocc. Con. Croc. Cupr. Dulc Ferr. Graph. Hyosc. Hyp. Iod. Kali. Lach. Lye. Magn. Merc. Natr. carb. Natr. mur. Nic. Nitr. ac. Nux mosch. Petr. Phosph. Puis. Rhus. Sabad. Sabin. Sassap. Sep. Silic. Stront. Sulph. Vitr. Zinc. — too copious: Aco. Agar. Ambr. Amm. mur. Ant. cr. Arg. nitr. Ars. Bar. carb. Bell. Bor. Bry. Calc. Canth. Carb. v. Chain. Chel. Chin;. Cina. Coff. Creos. Croc. Cycl. Dulc. Ferr. Hyosc. Ign. Iod. Ipec. Laur. Led. Lye. M. austr. Merc. Mosch. Mur. ac. Natr. mur. Nitr. ac. N. mosch. Nux vom. Phell. SEXUAL ORGANS AND FUNCTIONS. 97 Phosph. Flatin. Plumb. Rhus. Ruta. Sabin. Samb. Sec. corn. Sep. Sil. Spong. Stram. Sulph. Sulph. ac. Verat. Vine. Zinc. — too copious at nignt : Amm. carb. — lumpy: Amm. carb. Am. Bell. Canth. Cham. Chin. Croc. Ferr. Fluor, ac. Hyosc. Ipec. N. vom. Plat. Puis. Rhus. Sabina. Stram. Stront. — irregular: Cocc. Iod. N.vom. Puis. Ruta. — suppressed: Aeon. Agn. Alum. Amm. Ars. Baryt. Bell. Bry. Calc. Caust. Cham. Chin. Cocc. Coloe. Con. Croc. Cupr. Dulc. Ferr. Graph. Hyosc. Ign. Iod. Kali carb. Lye. M. arct. Magn. mur. Mercur. Natr. mur. N. mosch. Paeon. Petr. Phosph. Puis. Rhod. Rhus. Ruta. Sabad. Sang. Sassap. Sep. Silic. Staphys. Stram. Sulph. Valer. Verat. Vit. Zinc. — of young girls, delaying: Bry. Calc. Caust. Cocc. Con. Dulc. Graph. Kali. Lach. Lye. Magn. Natr. mur. Petr. Puis. Sabin. Sep. Stramon. Sulph. — fetid: Bell. Bry. Carb. an. Cham. Chin. Croc. Ign. Kali. Merc. Phos. Rheum. Sabin. Sil. Sec. corn. — repeating: Alum. Bry. Ferr. M arct. Natr. mur. N. vom. Phosph. Ph. ac. Puis. Rhus. Sep. Veratr. Zinc. Menses and the Accompa- nying Ailments. 1: Previous to the menses. ABDOMEN, distended : Ammon. mur. Creos. Lye. — distention: Creos. Lye. ANXIETY: Ammon. Cocc. Con. Merc. Natr. mur. Stann. BACK-ACHE: Ann. Bar. Brom. Calc. Caust. Hyosc. Magnes. carb. Mosch. Nitr. N. mosch. Nux vom. Spong. BREAST, spasm of: Cocc. Cupr. BREASTS SWOLLEN: Bry. Calc. — painful: Calc. Con. BURNING IN PUDENDUM: Calc. CANINE HUNGER: Magn. carb. CARDIALGIA: Lach. Nux mosch. Puis. Sep. CATARRH : Graph. Puis. CHILL: Lye. Puis. Veratr. COLDNESS OF THE TRUNKS: Mang. COLIC: Amm. BeU. Calc. Cham. Puis. Sep. — labor-like: Hyosc. — with fainting : Sep. —with vomiting : Puis. — with pressing : Magn. carb. COLIC : Alum. Amm. mur. Cham. Croc. Ferr. Hyosc. Nux vom. OL an. Plat. Puis. COUGH: Graph. Sulph. Puis. DELIRIUM: Lye. Hyosc. DIARRHOEA : Bov. Sil. Veratr. DREAMS: Calc. Caust. Con. DROWSINESS: Puis. EXCITED NERVES : Creos. Lye. ERUPTION IN NAPE OF NECK: Carbo veg. EXPECTORATION, bloody: Phos. FACE HOT : Alum. Lye. — pale: Puis. — blue: Veratr. — bloated: Chin. IN GENERAL : Alum. Amm. Asar. Bar. Bry. Calc. Carbo veg. Caustic. Cham. Chin. Coccul. Coff. Con. Creos. Cuprum. Ferr. Glon. Graph. Iod. Kali. Lach. Lye. Mane. Mang. Merc. Mur. ac. Natr. mur. N. mosch. Nux vom. 01. an. Phosphor. Phos. ac. Plat. Puis. Rhus. Sep, Sulph. Sulph. ac. Veratr. GUMS SWOLLEN : Baryt. Mercur. Phosph. HARD HEARING: Creos. 98 SEXUAL ORG-A.NS AND FUNCTIONS. HEAD-ACHE: Carbo veg. Cupr. Ferr. Iod. Lach. Natr. mur. Sulph. Veratr. HEABTBUBN: Sulph. HEAT: Calc. INCLINATION TO VOMIT: Ve- ratr. ITCHING HEEPES : Carbo veg. — of the parts : Graph. Sulph. LABOE-LIKE PAIN: Ehus. Plat. LANGUOR: Alum. Nux mosch. LAUGHTEE: Hyosc. LEGS WEAEY AND HEAVY : Bar. Lye. LEUCOEBHCEA: Alum. Calcar. Ferr. Sulph. LIMBS AS IF BEUISED : Nitric acid. LIVEE, stitches in : Con. — pains in the : Nux mosch. LOSS OF APPETITE: Bell. LOSS OF CONSCIOUSNESS: China. Sep. MELANCHOLY: Caust. Lye. Natr. mur. NAUSEA: Veratr. NOSEBLEED: Sulph. Veratr. PAINS IN THE BEEASTS : Con. PALPITATION OF HEAET: Al- umina. Cupr. Iod. Sep. Spong. PEEVISH : Cham. Natr. mur. PEESSING TOWAED THE PAETS : Magn. carb. Plat. PUPILS DILATED : Lye. EUSH: Dulc. EESTLESSNESS : Creos. Kali carb. EUSH OF BLOOD: Alum. Cupr. Mane. Merc. — to the head : Merc. SENSITIVENESS: Sep. SHUDDEEING: Sep. SLEEP, EESTLESS : Alum. SOEENESS OF PAETS: Kali carbon. Sil. SPASMS, abdominal: Cham. Cupr. SPASMS: Cham, Cocc. Coff. Cupr. Hyosc. Merc. — hysteric: Hyosc. — in abdomen : Carbo veget. Cham. 2. At the appearance of the menses. COLIC : Graph. Staph. DIAEEHCEA: Veratr. FLATULENCE: Staph. IN GENEEAL : Aco. Bryon. Caust. Cham. Graph. Hyosc. Ign. Iodine. Merc. Natr. mur. Plat. Puis. Sep. Sil. HEAD-ACHE: Hyosc. NAUSEA: Hyosc. PAINS IN LIMBS : Sep. SPASMS : Aeon. Cham. Coff. Plat. SWEAT: Hyosc. UEGING TO UEINATE : Sassap. VOMITING : Carbo veget. Phosph. Puis. 3. During the menses. ABDOMEN DISTENDED : Alum- ina. Natr. Zinc. — coldness in : Kali carb. — pinching in : Alum. — pressure in : Cocc. Con. Nux vom. Sec. corn. — cutting in : Sulph. ANXIETY: Bell. Natr. mur. Zinc. BACK-ACHE: Amm. carb. Caust. Lye. BLOODY EXPECTOEATION : Phos. BUENING IN ANUS: Amm. mur. BUENING IN THE HANDS AND FEET: Carbo veg. Calc. COLIC: Alum. Amm. Bar. Bell. Calc. Carbo an. Carbo veg. Cham. Cocc. Con. Graph. Kali. Ign. Lach. Lye. Magn. carb. Natr. Nitr. Nux vom. Phos. Plat. Sec. corn. Sil. Stront. Sulph. Zinc. CONSTIPATION: Natr. mur. Sil. CONVULSIONS: Chin. Cham. DELIEIUM: Hyosc. DISCHAEGE OF BLOOD AT STOOL : Amm. mur. EAES, humming in : Petr. Verat. SEXUAL ORGANS AND FUNCTIONS. 99 ERUCTATION: Bry. Graph. Kali carb. EYES, agglutinated : Calc. carb. —black before the : Puis. EEUPTION: Kali. Sil. FACE, pale : Amm. Graph. Lye. Puis. — blue : Veratr. — color of, changing : Zinc. — jaundiced : Caust. FAINTING: Ign. Lye. Natr. mur. Nux vom. FEVER (chill and heat) : Natr. mur. Phosph. CHILL : Graph. Nux vom. Puis. — and shaking : Natr. carb. FLATULENCE : Cocc. Kali carb. IN GENERAL: Aeon. Alum. Amm. carb. Amm. mur. Bell. Bov. Calc. Canth. Carbo an. Caust. Cham. Chin. Cocc. Coffea. Con. Creos. Cupr. Graph. Hyosc. Ign. Kali. Laches. Lye. Magn. m. Mur. ac. Natr. Natr. mur. Nux vom. Phosph. Plat. Pulsat. Sabin. Sep. Sil. Stan- num. Suljih. Veratr. Zinc. GUMS SWOLLEN : Merc. Nitr. ac. HEAD : congestion of : Calcarea. Caust. Chin. Con. Glon. Iod. Merc. Phosph. — ache: Alum. Bry. Calcar. Carbo veg. Graph. Hyoscyam. Kali carb. Laur. Lye. Magn. carb. Natr. mur. Nux vom. Phosph. Puis. Plat. Sepise. Sulph. Veratr. — heat in : Calc. Cham. HEAT : Magn. mur. N. vom. Sep. LANGUOR: Alum. Bov. Carbo an. Graph. Ign. Iod. Kali. Magn. carb. Magn. mur. Nux vom. Petr. Puis. Phosphor. Sec. corn. Zinc. LEGS, languor in the : Sulph. — drawing in the : Spong. LEUCORRHCEA: Coccul. LIMBS AS IF BRUISED : Phosph. BODY AS IF BRUISED: Ambr. Conium. Petr. SMALL OF BACK AS IF BRUISED: Caust. LIMBS, cold: Cham. — pain in: Bry. Con. Graph. Magn. mur. Nux vom. Sep. Veratr. LOINS, pain in: Berb. Sec. com. LOSS OF CONSCIOUSNESS: Cham. LOSS OF APPETITE: CuprMagn. carb. LOWER LIMBS GO TO SLEEP: Puis. LOWER LIMBS, pain in the: Cha- mom. Nitr. Veratr. — blueness of the : Ambr. MELANCHOLY : Mane. Natr. mur. Sep. MENTAL DERANGEMENT : Hy- osc. Veratr. NAUSEA . Amm. Calc. Graph. Lye. Magn. carb. N. vom. Phosph. Puis. Veratr. — with water-brash : Puis. NIGHT-SWEAT : Bell. Graph. NOSE-BLEED: Sep. OPPRESSION: Bell. Ign. Nitr. ac. PAIN, labor-like : Cham. Graph. Hy- osc. Lach. Sabin. PALPITATION OF HEART : Crot. Ign. Iod. Phosph. Sep. PARTS, burning in the : Rhus. Sil. — itching in the : Hep. Lycop. Sulph. Zinc. — pains in the : Canth. Sep. PRESSING DOWNWARD : Amm. carb. PRESSURE IN PIT OF STOM- ACH: Caps. Sulph. — in small of back : Puis. — in vertex: Calc. caust. DIARRHCEA : Amm. mur. Bov. RESTLESSNESS: Plat. Sep. RUSH OF BLOOD TO THE HEAD : Calc. Chin. SLEEP, restless : Alum. Calcar. Kali car]). SLEEPLESSNESS: Amm. Sep. 100 SEXUAL ORGANS AND FUNCTIONS. SMALL OF BACK, pains in : Anim. Anim. mur. Bell. Berb. Calc. Carbo vegetabil. Cham. Cocc. Creos. Croc. Graph. Ign. Iod. Kali. Lack. Lye. Natr. >~ux vom. Phosph. Puis. Se- cale corn. Snlph. SXEEZIXG: Magn. carb. SOREXESS BETWEEX THE THIGHS : Graph. Kali carb. Sas- sap. — of the parts: Graph. Kali carbon. Sil. SPASMS : Aeon. Cham. Cocc. Coff. Cupr. Hyosc. Ign. Lach. Xitric ac. Puis. — in abdomen: Cham. Cocc. Graph. Mane. Xux vom. Puis. -Sulph. — with pressure down : Sep. — in the chest : Phosph. Puis. STITCHES IX THE PARTS : Sul- phur, acid. STOMACH, pressure in : A mm. Bry. Puis. Sassap. SWEAT : Graph. Hyosc. Magn. mm-. SWOLLEN CHEEKS: Graph. S WOLLEX FEET : Calcar. Graph. Lye op. THIGHS, pain in the : Con. Magn. mur. Sassap. THIBST: Xitr. Veratr. TOOTH-ACHE : Amm. Cale. Cham. Carbo vessel. Kali. Laur. Phosph. Sep. TBEMBLIXG : Hyosc. Sil. TRISMUS: Hyosc. URGES' G TO STOOL, ineffectual: Calc. Puis. URIXATIOX, involuntary: Calcar. carb. URIXATE, urging to: Puis. Sabin. YEBTIGO: Calc. Caustic. Iodine. Phosph. Puis. Veratr. YOMITIXG: Amnion, mur. Carbo veg. Lye. Phosph. TVHIXIXG MOOD : Plat. Zinc. YAWNING: Bell. Carbo animal. Phosph. 4. After the menses. AXXIETY: Phosph. BACK, coldness in : Kali. CABDIALGIA: Kali carb. CHILL: Graph. Puis. I COLIC : Graph. Lye. Xux vom. DIARRHCEA: Graph. ' ERYSIPELAS : Stram. EXHAUSTIOX: Alum. FAIXTXESS : Alum. Phos. Plat. IX GEXEBAL: Alum. Berb. Bor. Bryon. Calc. Carbo an. Con. Creos. Cupr. Graph. Kali. Lye. Merc. Natr. mur. Xux vom. Phosph. Phosph. acid. Plat. Puis. Sep. Sil. Stramon. Yeratr. Zinc. HEAD, heavy: Xatr. mur. LEUCOERHCEA: Alum. Bov. Canth. Creos. Merc. Phosph. acid. — bloody: Sil. — yellowish: Phosph. acid. PALPITATIOX: Iod. PARTS, pain in the: Creos. Xatr. mur. PRESSIXG TO THE PARTS: Creos. RELAXED: Alum. SMALL OF BACK, pain in : Magn. carb. Puis. SPASMS, abdominal : Creos. STERILITY: Amm. Calc. Cann. Caust. Cic. Con. Croc. Ferr. Graph. Merc. Xatr. mur. Phosjjh. Plat. Plumb. Puis. Ruta. Sabin. Sep ice. Sulph. Sulph. ac. STOOL, bloody: Graph. TOOTH-ACHE : Calc. Magn. YOMITIXG: Puis. Whites. LEUCORRHCEA: Alum. Ambra. Amm. Amm. mur. Anac. Ant. crudum. Ars. Bell. Bor. Bov. Bry. Calc. Carbo an. Carbo v?g. Caust. Cham. Chin. Coccul. Con. Creos. Drosera. Ferr. Graph. Guaj. Hep. Iod. Kali. Lye. Magn. Magn. mux. SEXUAL ORGANS AND FUNCTIONS. 101 Merc. Mezer. Natr. Natrum mur. Nitric ac. Nux vom. Petr. Pliosph. Pulsat. Ean. bulb. Euta. Sabina. Sassap. Sep. Sil. Squill. Staunum. Sulph. Sulph. ac. Thuj. Vit. Zinc. 1. According to its Quality. LEUCORRHCEA, old: Iod. — smarting: Cham. Ferr. Lach. Phosph. Merc. — blistering: Pliosph. — pale-yellow : Merc. corr. — bloody : Canth. Carbo veget. Chin. Cocc. Creos. Nitric ac. Sep. Sulph. ac. — blood-red: Chin. Lye. — brown: Amm. mur. Carb. an. Nitric ac. — burning: Calc. Carbo an. Con. Creos. Puis. Sulph. ac. — thick : Ars. Bov. Caust. Kali bichr. Natr. mur. Puis. Sabina. Zinc. — thick-slimy: Bov. Con. — thin: Carbo veg. 01. an. Puis. Sulph. — transparent : Sep. Stann. Sulph. ac. — purulent: Calc. Chin. Coccul. Creos. Ign. Merc Nitric ac. Sabin. Sep. —albuminous: Ammon. muriat. Bor. Bov. Mez. Petr. Plat. — staining the linen : Creos. — flesh-colored : Cocc. Nitr. ac. — yellow : Aeon. Alum. Arsen. Bov. Carbo an. Cham. Creos. Kali carb. Kali bichr. Lycop. Natr. Nux vom. Sabin. Sep. Stann. Sulph. — staining yellow : Carb. an. —yellow-green: Bov. — greenish : Bov. Carbo veget. Lach. Merc. Sep. — green-reddish : Sep. —ichorous: Sabin. — itching: Alum. Ars. Calc. Creos. Kali. Merc. Natr. m. Sabin. Sep. — milky. Amm. Calc. Carbo veg. Creos. Ferr. Lye. Phos. Puis. Sil. Sabin. — milk-colored : Carbo veg. — reddish : Calcar. China. Cocc. Nitric ac. Pliosph. — in fits and starts: Calc. Cham. Lye. — acrid: Alum. Amm. Arsen. Bov. Calc. Carb. veg. Cham. Con. Creos. Ferr. Ign. Iod. Kali. Kali. hydr. Lye. Merc. Mezer. Natr. mur. Phosph. Puis. Ran. bulb. Ruta. Sep. Sil. Sulph. — slimy : Alum. Amm. m. Bor. Bov. Calcar. Coccul. Creos. Daph. Ferr. Graph. Guaj. Lach. Magii. Merc. Mezer. Natr. Natr. mur. iNitr. acid. N. vom. 01. an. Plumb. Puis. Sabin. Sassap. Stann. Sulph. Thuj. Zinc. — painless : Creos. N. vom. Puis. — excoriating : Alum. Natr. mur. — starch like : Sabin. — fetid : Chin. Creos. Natr. Nitr. ac. N. vom. Sabin. Sep. — watery: Amm. Ant. tart. Carb. veg. Cham. Creos. Graph. Merc. Mezer. Mur. ac. Puis. Sep. Sil. — white, slimy : Graph. — tenacious: Aeon. Bar. Bov. Mezer. Phosph. Sabin. Stann. 2. Accompanying Ailments. ABDOMEN, distended: Amm. m. Sep. — pains in: Bell. Caustic. Con. Creos. Ign. Lye. Magn. mur. Puis. Sil. Sulph. labor-like: Dros. AT URINATING : Sil. AFTER URINATING: Carb. veg. DISCHARGED IN THE MORN- ING : Natr. mur. FACE, pale : Ars. Puis. Sep. IN GENERAL : Alum. Ambr. Amm. mur. Ars. Bell. Bov. Calc. Carb. an. Caust. Chain. Cocc. Con. Cop. Creos. Ferr. Graph. Ign. Kali Lye. Magn. Magn. mur. Merc. Natr. mur. Pliosph. ac. Prun. Puis. Sabin. Sec. corn. Sep. Sil. Sulph. Sulph. ac. Zinc. 102 UPPER EXTREMITIES. PRESSING DOWN : Natr. mur. SMALL OF BACK, pains in : Bar. Caust. Graphit. Kali. Magn. mur. SPASMS, abdominal: Magn. mur. STITCHES IN UTERUS : Sep. WEAKNESS : Alum. Creos. Sep. XXVII. EXTREMITIES. TJPJPER, Arm-Pit. BOEING : Arg. Phosph. BURNING : Carbo veg. Cocc. Men. Phosph. Plumb. Puis. Bhus. Sep. CREAKING: Croc. Daph. Merc. CRAWLING: Cocc. DISLOCATION-PAIN : Magn. Phos. ERUPTION: Alum. Ant. crudum. Kali. Sulph. IN GENERAL : Aeon. Alum. Ambr. Amm. mur. Asa feet. Bell. B17. Carbo veg. Caust. Chin. Colch. Creos. Digit. Euphorb. Ferr. Kali. Lach. Laur. Led. Lycop. Magn. Magn. mur. Merc. Mezer. Natr. Nux vom. Phosph. Puis. Bhod. Rhus. Sep. Sil. Squill. Stann. Stront. Sulph. Thuj. Viola, tricol. Zinc. HEAVINESS: Aeon. Am. Phosph. Puis. ITCHING: Caustic. Magn. Ignat. Natr. Op. LAMENESS : Lach. Puis. Sil. MUSCLES, twitching of: Croc. Spig. Spong. PAIN AS IF BRUISED: Aco. Alum. Coccul. Ferr. Ign. Lye. Magn. Plumb. Spig. Sulph. Zinc. PAIN, simple: Bry. Daph. Graphit. Kali. Magn. — laming: Ambr. Chin. Euphor- bium. Mur. ac. Nux vom. PRESSURE: Am. Bell. Bryon. Caust. Colch. Creos. Digital. Laur. Lycop. Natr. Ole&ad. Phosph. ac. Ran. bulb. Rhus. Sep. Staph. Sulph. Zinc. RAISED: Merc. GONE TO SLEEP: Ferr. SPOTS, brown: Ant. crud. STITCHES: Aeon. Alum. Asa f. Bell. Bry. Calc. Caust. Cicc. Cocc. Ferr. Graph. Guaj. Lgn. Kali. Lach. Laur. Lye. Nitric acid. Phos. Plumb. Pulsat. Rhus. Sil. Staph. Stann. Sulph. Thuj. Zinc. Veratr. SWELLING: Aeon. — feeling of : Bell. TEARING: Aeon. Ambr. Argent. Bell. Bov. Bry. Caust. Canth. Carb. veg. Chin. Graph. Iod. Kali. Laur. Led. Lye. Natrum mur. Nux vom. Phos. Rhus. Stront. Zinc. TENSION: Dig. Euphorb. Hyosc. Kali. Petr. Teucr. Zinc. THROBBING: Daph. Magn. mur. Rhod. Sulph. Tar. Arms. Upper arms.*) BLUE SKIN: Cupr. Lach. Secale corn. Veratr. BORING : Canth. Plumb. Rhus. BURNING: Agaric. Aur. Borax. Carbo veg. Dulc. Kali. Lach. Nux vom. Phosph. Bhus. Sep. Zinc. BONE-PAINS: Bar. BeU. Lycop. Merc. Nitric ac. Thuj. COLDNESS: BeU. Camph. Cham. Hyosc. Kali bichr. Bhus. Veratr. *) U. means Upper, L. Lower arms. UPPER EXTREMITIES. 103 — feeling of : Graph. Rhus. Sec. corn. CONTRACTION : Bism. Calc. CONTUSIVE PAIN: Cycl. Hell. CONVULSIONS: Bell. Chamom. Cocc. Cupr. Hyosc. Ipecac. Op. Rhus. Squill. Secale corn. Stram. Veratr. CRAMPY : Calc. Cin. Dulc. Men. Oleand. Phosph. Valer. CREEPING: Bell. Cocc. Sec. com. Sep. ERUPTION : Ant. crudum. Cane Carbo veg. Dulc. Kali. Phos. ac. Sep. ERYSIPELAS : Bell. Rhus. FAINTNESS: Alumin. Anac. Am. Asar. Calcar. Cupr. Cycl. Guaj. Ign. Kali. Led. Natr. mur. N. vom. Plat. Plumb. Rhod. Sep. Stann. Yaler. IN GENERAL : Amm. mur. Antim. cruel. Asa feet. Aur. Bell. Bryon. Cantlc. Carbo an. Carbo veg. Chel. Clem. Coccul. Con. Cupr. Dig. Ferr. Hep. Ign. Iod. Kali. Lach. Lycop. M. arct. Mang. Hezer. Mur. acid. Natr. mur. Nitr. Oleand. Petr. Plumb. Phos. Puis. Rhodod. Rhus. Selen. Sep. Sil. Stann. Staphys. Sulph. Sulphur, ac. Valer. HEAT : Bryon. Natr. mur. Nitr. acid. FEELING OF HEAT : Bry. Graph. Nitric ac. Staph. HERPES : Kali carb. Natr. mur. Sulph. — U. and L. : Bov. Con. Dulc. Graph. Natr. muriat. Phosph. Sil. ITCHING: Daph. Dulc. Euphorb. Lach. Laur. M. austr. Nux vom. Oleand. Ran. sc. Ruta. Stront. Thuj. JERKS : Anacard. Oleand. Ruta. Stann. LAMENESS: Agar. Bism. Caust. Chel. Cocc. Kali. Lach. Nux vom. Phos. ac. Staph. B£I SCLES, twitching of : Coccul. Men. Yaler. NUMBNESS : Ainbr. Aur. Bell. Cham. Coccul. Iod. Plat. Puis. Veratr. PAIN, simple : Agar. Baryt. Bell. Bry. Calc. Cupr. Graph. Puis. Zinc. — laming: BeU. Chamom. Dig. Natr. mur. Rhod. Sil. Zinc. — as if dislocated: Alum. Bry. Eu- phorb. Rhod. —as if bruised : Bellad. Coccul. Cycl. Daph. Ferr. Hep. M. austr. Magn. mur. Natrnm mur. Nitric ac. Plat. Plumbum. Puis. Sep. Sulph. Thuj. Veratr. PARALYSIS : Agar. Bell. Caustic. Chel. Lach. Oleand. Rhus. PRESSURE : Ammon. mur. Anac. Arg. Asa feet. Aur. Bell. Calcar. Camph. Cycl. Daph. Euphorb. Led. Nux vom. Petr. Puis. Rhod. Sabin. Stann. Staphys. Sulph. Yit. GONE TO SLEEP: Ambr. Baryt. Cham. Coccul. Croc. Graph. Ignat. Kali. Lach. Lycop. Magn. mur. Nux vom. Petr. Rhus. Sec. corn. Sep. Sil. SPASMS : Bell. Cuprum. Ipjec. Sec. corn. SPOTS, red: Plat. Rhus. Sulph. STIFFNESS : Amm. mur. Caust. !Nux vom. Oleand. Sassap. Rhus. STITCHES : Aeon. Alum. Antim. crud. Arn. Asa f . Bell. Bry. Canth. Cocc. Con. Dulc. Ferr. Guaj. Kali. Laur. Mang. N. mosch. Phosph. Phosph. acid. Puis. Rhod. Rhus. Sabina. Squill. Stann. Stajoh. Sulph. Tar. Thuj. SWEAT: Asar. Ipec. SWELLING : Antim. crud. BeU. Bry. Hell. Rhus. SWELLING OF BONES : Rhus. Sil. Sulph. 104 UPPER EXTREMITIES. TEARING : Agar. Amm. mur. Anac. Arn. Aur. Bell. Bryon. Canth. Carbo an. Caustic. Chel. China. Cin. Con. Digit. Dros. Ferr. Guaj. Kali. Led. Lye. Mur. ac. Magnes. mur. Nitr. Nux vom. Phosph. Plumb. Puis. Bhus. Sabina. Sassap. Sil. Stann. Staphys. Sulph. Zinc. TENSION : Ant. crud. Asa fast. Bry. Dig. Laur. Bhus. TEEMBLING: Ars. Bry. Capsic. Causl. Cicut. Hyosc. M. arct. Op. Petr. Phosph. Puis. Rhus. Sabad. Sil. Spig. Sulph. Yeratrum. TUBEBCLES : Ant. cruel. Arsenic. Calc. Cocc. Nitric ac. Staph. TUMOBS: Ant. crud. Ars. Caust. Natr. mur. Nitric ac. ULCEES : Lach. Ehus. Shoulder-Joint. BEATING : Magn. Merc. Thuj. BUBNING : Brom. Graph. CONTUSIYE PAIN: Dros. CEEAKING: Ant. tart. Bar. Cic. Croc. Ferr. Merc. Thuj. DISLOCATED, as if: Magn. DEAWING: Asa f. Carbo veget. Cham. Magn. mur. Staph. FEELING OF WEAKNESS : Dros. — of heaviness: Puis. IN GENEEAL: Arn. Asa f. Bry. Calc. Carbo veg. Caust. Croc. Dros. Ferr. Ign. Kali. Lach. Lye. Led. Merc. Natrum mur. Nux vom. Pulsat. Rhus. Staph. Sulph. Ve- ratrum. Vit. Zinc. HEAT, feeling of: Brom. INFLAMMATION: Aeon. Bry. Led. Puis. Ehus. JEBKING: Puis. JEEKS : Colch. Sil. LAMENESS : Lye. Puis. Stann. PAIN AS IF DISLOCATED : Alu- min. Ambr. Arn. Caps. Croc. Ign. Natr. mur. Petr. Puis. Ehod. Rhus. Sabina. Sep. Spigel. Thuj — as if bruised : Ferr. Ign. Kali. Nux vom. — simple : Aco. Calc. Croc. Ign. Natr. mur. Phosph. — laming : Euphorb. Nux vom. Puis. Staph. PEESSUEE: Bism. Bryon. Calcar. Dros. Kali. Laur. Led. Staph. Vit. STIFFNESS: Caust. Euphorbium. Staph. STITCHES : Asa fast. Bry. Calcar. Coccul. Crot. Ferr. Graphit. Hell. Ignat. Iod. Laur. Led. Mercur. Puis. Staph. Stront. Sulph. ac. Thuj. SWELLING: Aeon. Bry. Hep. TEAEING : Ambr. Argent, Bism. Bry. Carbo veg. Caust. Ferr. Graph. Ign. Led. Merc. Phos. Puis. Bhus. Sabin. Sulph. Yit. TENSION: Asa f. Bov. Bry. Eu- phorb. Laur. Lye. Zinc. Arm-Pit. BUENING: Carbo veg. Caust, CUTTING: Kali. ERUPTION : Lye. Merc. Natrum mur. Nitric ac. Petr. Sep. GLANDULAR SWELLINGS : Bel- lad. Calc. Hep. Iod. Mercur. Natr. mur. Nitric ac. Sulph. Ehus. Staph. SOEENESS : Carbo veg. SORE, as if: Teucr. STITCHES : Arn. Canth. Graph. Men. Staph. Zinc. SWEAT: Hep. Kali. Lach. Merc. Nitric ac. Phosph. Rhus. Sep. TEARING : Colch. Kali. Natr. mur. Lower Arm, BLUE SKIN: Samb. BORING : Asa f. Natr. Phosph. ac. Ran. sc. BURNING: Agar. Amm. mur. Asa feet. Carb. veget. Euphorb. Graph. Merc. Mur. ac. Oleander. Rhus. Sulph. Zinc. UPPER EXTREMITIES. 105 BONE-PAIN : Kali biclir. Natr. mur. Spong. CHILL : Ign. Puis. Khus. COLDNESS: Bry. Nux vom. Rhus. CONTUSIVE PAIN : Dros. CRAMP Y : Anac. Cin. Conium. Ole- and. Plat. Rhodod. Ruta. Valer. CREEPING: Am. Bell. Cocc. Con. Merc. Op. See. corn.. DEADNESS : Nux vom. ERUPTION : Amnion, mur. Calad. Canst. Lach. Lye. Merc. Nitr. ac. Phosph. ac. Sil. Staphys. Sulph. Thuj. Zinc. FAINTNESS : Nux vom. Rhus. IN GENERAL: Aeon. Agar. Alum. Amm. mur. Anac. Arg. Arn. Asa f. Bell. Baryt. Bism. Bryon. Calad. Calc. Camph. Canth. Carbo an. Caust. Chamom. China. Cic. Cin. Colchic. Con. Creos. Croc. Cupr. Dulc. Ferr. Graph. Guaj. Hep. Hy- osc. Ign. Kali curb. Laur. Lye. M. arct. Mang. Merc. Mezer. Mosch. Mur. ac. Natr. Nitr. Nitric ac. Nux vom. Oleand. Phosph. Phosph. ac. Plumb. Puis. Ran. sc. Rhod. Rhus. Ruta. Sabin. Sassap. Selen. Sep. Sil. Spig. Squill. Stann. Staph. Sulph. Tar. Teucr. Thuj. Valer. Vit. Zinc HEAT: Bry. HEAVINESS: Anac. Aur. Croc. M. austr. Phos. ac. Sulph. HERPES: Con. Magn. Merc. Nux vom. INSENSIBILITY: Stront. ITCHING ■ Agar. Amm. mur. Carb. an. Caust. Dulc. Hyosc. Laur. Merc. Puis. Ran. Rhus. Spig. Sulph. JERKS : Dulc. LAMENESS : Bellad. Calc. Caust. Dulcam. Lach. Lycop. Sil. Sulph. PAIN AS IF BRUISED : Con. Croc. Mur. ac. Rhus. Ruta. Zinc. — as if dislocated : Coccul. Led. ~-&% if sore : Arn. Cic. Rhus. — simple: Croc. Baryt. Bellad. Calc. Graph. Phosph. — laming: Baryt. Bism. Cycl. Dulc. Mosch. Natr. mur. Nux vom. Ruta. Sfl. Staph. Stront. Zinc. PRESSURE: Anac. Asa f. Baryt. Bismuth. Camph. Cocc. M. arct. Mang. Oleander. Plat. Prun. Ruta. Sabin. Spigel. Staphys. Verb. RASH : Merc. Selen. SHOCKS: Oleand. SPOTS, blueish: Sulph. ac. Thuj. —red: Vit. STITCHES: Aconit. Anac. Ant. crud. Arn. Asa f. Bell. Bov. Bryon. Calc. Carbo an. Caustic. Cicut. Cycl. Dig. [Hyosc. Lycop. Magn. Merc. Mosch. Oleand. Phosphor. Phosph. ac. Ran. bulb. Sabin. Sas- sap. Spig. Staph. Stram. Tar. Thuj. SWELLING: Bry. Calc. Caust. Lye. Nux vom. Rhus. TEARING: Aeon. Alum. Ammon. mur. Anac. Arg. Asa f. Aur. Baryt. Bell. Bism. Bry. Canth. Carbo veg. Caust. Cina. Colch. Cupr. Cycl. Daph. Dig. Graph. Grat. Guaj. Kali. Lach. Lycop. Mur. ac. Magn. mur. Natr. mur. Nitric ac. Phosph. Puis. Ran. bulb. Rhod. Rhus. Sas- sap. Sil. Stannum. Staph. Stront. Sulph. Teucr. Thuj. Valer. Zinc. TENSION : Anac. Arn. Caustic. Co- loc. Dig. Kali. Led. Puis. Stront. Sulph. Zinc. THROBBING: Sabad. TREMBLING : Caustic. Nitric ac. Rhus. TUBERCLES: Coccul. — miliary: Agar. WARTS: Calc. Sil. WEAKNESS : Dulcam. Nux vom. Rhus. Elbow and Joint. BONE-PAIN, nocturnal: Lye. BORING: Caust. Thuj. 106 UPPER EXTREMITIES. BURNING : Asa feet. Carbo animal. Carbo veg. Calc. phosph. Mercur. Mill. Nitr. Phosph. Plat. Rhus. Sulph. BRUISING PAIN: Canst. Dulcam. Puis. Ruta. Sulph. Yeratr. CONTRACTION : Canst. Laur. Sec. corn. CONTUSIVE PAIN: Caustic. Dros. Ruta. TEARING : Alum. Ambr. Aur. Bov. Canth. China. Colchic. Daph. Iod. Kali carb. Kali bichr. Laur. Lye. Merc. Mur. ac. Nitr. Nux mosch. Pulsat. Bhus. Ruta. Sassap. Sil. Stront. Sulph. Zinc. CREAKING: Ant. cruel. Conium. Merc. M. arct. Sulph. DISLOCATION PAIN : Arn. Mang. Rhus. ERUPTION: Dulc. Hyosc. Merc. Sabin. Staph. Sulph. PAINT FEELING: Led f GNAWING: Dulc. ITCHING: Agar. Alum. Caustic. Laur. Merc. Natr. Phosphor. Rhus. Sulph. — in the bend of the elbow: Canth. Laur. Spig. JERKING: Bellacl. Caustic. Croc. Natr. mur. Nitric ac. Rhus. Yeratr. LAMENESS : Bell. Graph. PAIN, simple : Cupr. Dig. Laur. Phosph. Puis. Sulph. ac. — laming : Bell. Cham. Coccul. Daph. Sabin. Staph. Stront. PARALYSIS: Dulc. Petr. PRESSURE: Alum. Argent. Hep. Led. Zinc. STEATOMA: Hep. STIFFNESS: Kali carb. M. arct. M. austr. Stann. Thuj. STITCHES : Asa f. Bellad. Bryon. Coccul. Coloe. Hell. Kali. Laur. Merc. Mur. ac. Nux mosch. Phosph. Rhod. Sabin, Spig. Spong. Thuj. SWELLING: Bryon. Hep. LacJu Yeratr. Yit. TENSION: Daph. Dros. Mur. ac. Puis. Rhus. Stann. Sulph. THROBBING : Rhus. Thuj. TUBERCLES : Caust. Mur. ac. WEAKNESS : Staph. Sulph. Bend of the Elbow. IN GENERAL : Amm. mur. Anac. Arn. Bell. Canth. Caust. Clem. Con. Cupr. Dros. Graph. Iod. Kali. Laur. Lye. Men. Petr. Phosph. Puis. Sep. Spig. Sulphur. Thuj. Yaler. Zinc. Tip of the Elbow. IN GENERAL: Agar. Alum. Bry. Carbo an. Causticum. Graph. Hep. Merc. Mur. ac. Oleand. Phosphor. ac. Rhus. Sabina. Spong. Stann. Wrist-Joints. BORING: Hell. Rhod. COLD FEELING: Rhus. CREAKING : Con. Merc. Selen. DISLOCATION-PAIN: Arn. Bov. Bry. Calc. c. Caust. Graph. Ign. Lye. Nux vom. Rhodod. Bhus. Buta. Sabin. Stannum. Staph. Sulph. ERUPTION: Merc. Calc. phosph. Rhus. Sulph. EXCORIATION: Sulph. GANGLIA: Magn. m. Sil. IN GENERAL: Aeon. Amm. Anac, Arn. Ars. Asa f. Bism. Bov. Bry. Calc. c. Calc. phosph. Carbo veg. Caustic. Chel. Colch. Creos. Cycl. Dig. Euphrasia. Graph. Hep. Hyosc. Iod. Kali. Led. Lye. Mang. Merc. Mezer. Nitr. Phosphor. Puis. Rhod. Rhus. Ruta. Sabin. Sassap. Selen. Sep. Sil. Staphys. Stront. Sulphur. Teucr. Thuj. Yerb. Zinc. ITCHING: Amm. mur. WANT OF MOBILITY : Sep. UPPER EXTREMITIES. 107 NODES, gouty: Calc. C. Lye. NUMBNESS: Bov. Croc. SPOTS : Kali. Petr. STIFFNESS: Bellad. Caust. Chel. Lach. Led. Lye. Puis. Rhod. Ruta. Sabina. Sep. Sulphur. Thuj. STITCHES: Alum. Am. Bryon. Calc. c. Caust. Con. Graphit. Hell. Kali. Laur. Merc. Natr. mur. Nux vom. Rat. Sep. Sil. Squill. Sulph. SWELLING: Bry. Calc. TEARING: Baryt. Bov. Calc. c. Carbo veg. Chel. Grat. Kali. Lach. Mezer. 01. an. Phosph. Plumb. Puis. Rhod. Sabina. Sulph. Teucr. TENSION: Amm. carb. Spongia. Zinc. TREMBLING: Aeon. TWITCHING: Bar. Rhus. Sulph. Valer. PAIN : Aeon. Ammon. Asa feet. Hyosc, Merc. Nitr. Sulph. — laming: Aconit. Asar. Bism. Eu- phorb. Kali. Led. Nux vom. — as if sprained : Am. Calc. c. Puis. Rhod. — as if bruised: Calc. phosphor. Caust. Nitric ac. Puis. Buta. PRESSURE: ~Le&. Nitr. ac. Stann. Zinc. WEAKNESS : Merc. Phosph. Hands. BEATING: Sabad. BLISTERS : Amm. mur. Arg. nitr. Bell. Canth. Clem. Hep. Kali. Lach. Natr. mur. Rhus. Sep. Squill. Sulph. BLUENESS: Aco. Camph. Cupr. Lac 1 .. Nux vom. Rhus. Samb. Ye- ratrum. BOILS: Calc. carb. Hep. Lycop. Merc. BURNING: Aeon. Anac. Aurum. Bryon. Calc. Chin. Hell. Kali. Lach. Laur. Nux mosch. Nux vom. Op. Phosph. Sec. com. Sep. Squill. Stann. Staphys. Sulph. Zinc. BRITTLE, skin: tiraph. Natr. mur. CHILBLAINS: Agar. Nitr. ac. Petr. Phosph. Puis. Stann. Sulph. CHILLINESS: Ambr. Anac. Merc. Nux vom. Petr. COLDNESS: Aeon. Agar. Ambr. Am. Aur. Bar. Bell. Calc. c. Camph. Cann. Caustic. Cham. Chin. Crot. Cuprum. Cycl. Daph. Dig. Dros. Ferr. Hell. lori. Ipecac. Kali. M. arct. Mang. Nitric ac. Nux vom. Phosph. Puis. Ranunc. bull). Rhus. Samb. Sep. Spigelia. Sulph. Thuj. Yeratr. Yit. — feeling of : Rhus. Sec. corn. CONTRACTION: Cann. Cin. Merc. Nux vom. Prun. Sec. corn. CRAMP Y FEELING: Aeon. Ambr. Anac. Asa f. Aur. Calc. carb. Cann. Eupltr. Graph. Lycop. Mang. Men. Mercur. Mosch. Nitr. Xu.r vom. Plat. Sil. Spig. Spong. Strain. CREEPING: Am. Ars. Bar. Bell Caust. Croc. Lach. Laur. Nux vom. Phosph. Plat. Rhodod. Ruta. Sec. corn. Spig. Sulphur. Veratr. — as if gone to sleep : Bry. DEADNESS: Calc. Con. Laches. Nux vom. Phosph. Rhus. Sec. corn. Sil. Zinc. DESQUAMATION OF HANDS: Amm. Barr. Ferr. Merc. Phoxplt. ac. Sep. Sulph. DISLOCATION-PAIN: Bar. Rhus. DRY PALMS OF HANDS: Bism. DRYNESS: Lye. Natrum. Sabad Sulph. EMACIATION: Graph. Gratiola. Selen. ERUPTION: Alum. Antim. crud. Ars. Canth. Carbo veget. Cic. Hep. Lye. Merc. Mur. ac. Nitric ac Rhus. Secale corn. Selen. Spig. Staph. Sulphur. Sulph. ac. Zinc. ERYSIPELAS : Ran. bulb. Rhus. IDS UPP^K EXTREMITIES. IN GENERAL : Aeon. Agar. Ambr. Amm. Anac. Arg. Am. Ars. Asa f. Aur. Bar. Bell. Bism. Bry. Calc. Carbo veg. Caustic. Cliamom. Chin. Coccul. Creos. Cupr. Dig. Dulc. Ferr. Graph. Hep. Ipec. Kali. Lack. Laur. Led. Lye. M. aret. Mang. Men. Mere. Mur. ac. Natrum. Natr. mur. Nux vom. Op. Petr. Phosph. Pliosph. ac. Plumb. Puis. Kan. bulb. Rhod. Rhus. Ruta. Samb. Sec. corn. Selen. Sep. Sil. Spig. Stann. Staph. Sulph. Veratr. Verb. Zinc. HEAVINESS: Bov. Caust. Nitric. Phosph. HEAT : Aeon. Bry. Carb. veg. Coc- cul. Graph. Hell. Hepar. Led. Lye. Nitric ac. N. vom. Phosph. Sep. Stann. Staph. Zinc. HEEPES: Ambr. Bov. Calcarea. Clem. Dulc. Merc. Natr. mur. Sas- sap. Sep. Sulph. Zinc. INSENSIBILITY : Bell. Lye. Natr. mur. Rhus. Sec. cornut. Stann. Stront. Zinc. ITCH: Merc. Sep. Selen. Sulph. ITCHING : Aur. Bov. Cann. Caustic. Cina. Coccul. Hep. Kali. Nitric ae. Phosph. ac. Plat. Plumb. Rhus. Sulph. Veratr. JERKS: Valer. NODES, arthritic: Calc. carbon. Calc. phosph. Led. Lye. Rhod. Rhus. Sep. Sulph. NUMBNESS : Asa feet. Coccul. Car- bo veg. Lach. Lye. Puis. Rhus. Ruta. PAIN : Agar. Daph. Nux vom. Plumb. — laming: Bell. Bism. Caustic. Cijcl. Dig. Nux vom. Sil. Vit. PARALYSIS: Ambr. Crot. Cupr. Lach. Natr. mur. Nux vom. Phos- phor. Plumb. Rhus. Sil. Zinc. PARCHED SKIN: Lycop. Phosph. acid. PRESSURE: Asa f. Calc. phosph. Carbo veg. Cycl. Hep. Kali. Men. Nitric ac. Staph. Zinc. REDNESS: Dulc. Fluor, ac. Nux vom. Sabad. Sangn. Staph. RHAGADES: Cycl. Graphit. Petr. Sulph. ROUGH: Alum. Kali. Nitric ac. Phosph. ac. GONE TO SLEEP : Ambra. Baryt. Carbo an. Croc. Fluor, acid. Graph. Kali. Lach. Lycop. M. austr. Natr. mur. N. vom. Phosph. Puis. Sec. corn. Sil. Veratr. SORE, pain as if: Calc. c. Nitric ac. Rhus. BRUISED, pain as if: Carbo veg. Dros. Ruta. SPASM: Bell. Caust. Sec, corn. SPASMODIC FEELING: Anac. Bell. Caust. Plat, — pain : Anac. Caustic. Lycop.' Spig. SPOTS: Ant, tart. Nitr. ac. Sep. — red: Merc. Sep. STIFFNESS: Ars. Bellad. Caust, Cham. Coloc. Croc. Mervur. Rhus. Zinc. STITCHES : Aconit. Ang. Am. Asa f. Bellad. Calc. phosphor. Carbo an. Caust. Caps. Chel. Cina. Hell. Graph. Lach. Led. Lye. Mosch. Magn. mur. Par. Plumb. Squill. Stann. SWEAT : Ant. tart. Calcar. c. Cann. Cliamom. Coccul. Con. Laur. Natr. mur. Nitric acid. Nux vom. Phosph. Sulph. Veratr. —cold: Caps. Sep. — in palm of hands: Aeon. Bar. Calc. c. Con. Dulc. Fluor, ac. Ignat. Laur. Merc, Nux vom. Rheum. SWELLING: Aconit. Ars. Bell. Bry. Calcar. Caust, China. Coccul. Dig. Ferr. Hep. La eh. Lye. Merc Nux vom. Phosph. Rhus. Ruta. Sec. corn. Stann. Sulph. — nocturnal : Dros. UPPER EXTREMITIES. 109 TEARING AND DRAWING : Agaric. Amm. Am. Ars. Aur. Bel- lad. Calc. Canth. Carbo veget. Canst. Chamom. Chel. China. Colch. Cuprum. Digit. Graph. Grat. Iod. Kali. Lack. Laur. Led. Lye. Mang. Mur. acid. Natr. rnur. Nitr. Petr. Phell. Phos. Plumb. Rheum. Rhod. RJlus. Sabin. Selen. Sep. Spig. Stann. Sulph. Teucr. Verb. Zinc. TENSION: BeU. Canth. Caustic. Chin. Hyp. Zinc. TREMBLING: Agar. Anac. Ant. tart. Ars. Bell. Bism. Bryon. Calc. c. Caustic. Chin. Cic. Coccul. Coffea. Crotal. Eerr. magn. Hyos- cyam. Iod. Kali. Lach. Led. Nitr. ac. Oleand. Op. Phosph. Plat. Plumb. Rhus. Sil. Spong. Stan- num. Stram. Sulph. Zinc. TUBERCLES: Ars. Calc. Coccul. Lye. Natrum mur. Nitric ac. Rhus. TWITCHING : Anac. Bar. m. Asa f. Bell. Cina. Cupr. Graph. Ignat. Lach. Laur. Meph. Natr. Op. Plat. Ran. bulb. Sep. Stann. Sulph. ac. Vit. ULCERS: Ars. Lye. Sil. Sulph. URTICARIA: Hep. VARICOSE VEINS : Alumin. Am. Calc. Chel.'Chin. Laur. Men. Nux vom. Op. Phosph. Puis. Rheum. Rhod. Stront. Sulphur. Thuj. CRACKED VEINS: Alum. Calc. Creos. Graph. Lach. Magn. «c. Merc. Natrum mur. Nitric ac. Petr. Sil. Sulph. Zinc. VESICLES: Daph. WARTS: Calc. c. Caust. Dulcam. Rhus. Sep. Thuj. WEAKNESS: Calc. Carb. veg. Caust. Chin. Cupr. Hell. Nitr. Nux vom. Phosphor. Sil. Tab. Zinc. YELLOWNESS ■ Canth. Ign. Merc. Spig. Fingers. BLOTCHES : Lach. Lye. Staph. BURNING: Asa f. Asar. Calcar. Caust. Con. Dig. Kali. Lach. Natr. Nitric ac. Nux vomica. Oleand. Plat. Sil. Sulph. Sulphur, ac. Ve- ratr. BONE-PAIN: Fluor, ac. CHAPPING: Fluor, ac. Natrum mur. Petr. Sil. CHAPPING OF SKIN : Petr. CHILBLAINS : Agar. Croc. Nitr. ac. Nux vom. Petr. Puis. Rhus. Sulph. COLDNESS : Antim. tart. Calad. Cham. Chel. Digit. Hell. Lye. Mur. ac. Merc. Rhod. Sulph. Tar. Thuj. CONTRACTION: Ambra. Anacard. Antim. tart. Arg. Bism. Calc. Caus- tic. Cina. Colchic. Coloc. Graph. Lye. Merc. Nux vom. Plat. Rhus. Ruta. Sec. corn. Sep. Sil. CONTRACTION OF TENDONS : Caust. CRAMPY FEELING : Anacard. Am. Ars. Asa f. Calc. Cin. Coccul. Cycl. Euphr. Graphit. Ignat. Lye. Mur. ac. Mosch. Nux vom. Oleand. Phosph. Plat. Rhus. Stann. Staph. Sulphur. Veratr. CREAKING: Bar. Caps. Nitr. CREEPING : Aeon. Anibr. Amm. mur. Ars. Calc. Caust. Cina. Croc. Graphit. Kali, M. arct. Magn. Natr. mur. Opium. Plat. Ran. bulb. Rhod. Rhus. Sec. corn. Sep. Sil. Sulph. Thuj. Veratr. Verb. — in the tips of the fingers : Aco. Amnion, mur. Croc. M. austr. Sec. corn. Sep. Thuj. — as of ants: Sec. corn. — as if gone to sleep : Mur. ac. DEADNESS : Agar. Calc. Caust. Cic. Con. Hep. Lycop. Merc. Nitric ac. Phosph. ac. Puis. Rhus. Sec. corn. Sulphur. Thuj. Veratr. 110 UPPER EXTREMITIES. — gangrenous: Sec. corn. — of tips of fingers : Ant. tart. Chel. DESQUAMATION OF THE SKIN : Amm. mur. — on the tips of the fingers : Sabadilla. DISLOCATION-PAIN : Bell. Cham. Ign. Natr. mur. Phosphor. Spig. Sulph. DRYNESS OF TIPS OF FIN- GERS : Ant. tart. ERUPTION: Antim. crud. Baryt. Canthar. Caust. Clem. Cycl. Daph. Grapli.Lach. Lyc.Mur. ac. Phos.ac. Plumb. Puis. Rhus. Spigel. Squill. Yeratr. Zinc. — between the fingers : Graph. Sulph. acid. ERYSIPELAS : Lye. Rhod. — of the tips of fingers: Thuj. EXHAUSTION : Sil. Rhus. HEAT: Sabad. Thuj. IN GENERAL : Aeon. Alum. Ambr. Amm. mur. Anac. Antim. tart. Arn. Ars. Asa f. Baryt. Bell. Bism. Bor. Bry. Calcar. Canth. Carbo vegetab. Caust. Cham. Chel. Cic. Cina. Coc- cul. Colch. Creos. Croc. Cyclam. Dros. Ferr. Graph. Hell. Hep. Ign. Kali. Lach. Lye. M. arct. M. austr. Magn. Mercur. Mosch. Natr. Natr. mur. Nux vom. Oleand. Phosph. Puis. Ran. Rhodod. Rhus. Ruta. Sabad. Sec. corn. Sep. Sil. Spigel. Stann. Staphys. Stront. Sulphur. Teucr. Thuj. Yaler. Yeratr. Yerb. Vlt. Zinc. HERPES : Ambr. Merc. Nitric ae. Ran. bulb. INFLAMMATION : Aco. Con. Hep. Kali. Lye. Merc. Puis. Ran. Sil. INSENSIBILITY: Digit. Ferr. N. vom. Phosph. Blius. Sec. corn. — of tips of fingers : Ant. tart. Cham. Ferr. M. austr. Staph. ITCHING: Agar. Alum. Aur. Calc. Camph. Caust. Chel. Con. Cycl. Lach. Lye. Nux vomica. Oleander. Phosph. Plumb.'Puls. Ehod. Sulph. ac. Zinc. Yeratr. ITCHING, between the fingers : Aur. Lach. Plumb. Rnod. — at the tips of fingers : Ambra. Ant. crud. Sulph. ac. Spig. LAMENESS: Carbo veg. — of the thumb: Kali. NODES, arthritic: Graph. Lye. NUMBNESS: Ang. Calc. Caust. Con. Cina. Euphr. Ferr. Graph. Kali. Lach. Lycopod. Phosph. Plat. Rhus. Sec. com. Sil. Staph. Sulph. PAIN : Caust. Led. Sassap. Yeratr. — as if bruised : Amm. carbon. Cina. Natr. mur. Nitric ac. — laming: Bellad. Cycl. Digit. Kali. Mosch. Sabin. Sil. PARALYSIS: Calc. Bryon. Kali. Lach. Phosph. PRESSURE: Asa f. Bell. Con. Cycl. Dig. Hell. Hyosc. Ban. Rhod. Ruta. Sassap. Staphys. Tar. Teucr. Yit. Zinc. REDNESS : Agar. Nux vomica. RIGIDITY: Ars. Merc. GOING TO SLEEP : Aeon. Ambra. Amm. mur. Aur. Bar. Calc. Carbo an. Cham. Cina. Croc. Dig. Graph. Lod. Kali. Lach. Lye. Merc. Magn. mur. Natr. mur. Nux vom. Par. Petr. Phosph. Plumb. Puis. Rhus. Sassap. Sec. corn. Sep. Sil. Staph. Sulphur. Thuj. Yeratr. SORE BETWEEN THE FIN- GERS: Graphites. SPASM: Bellad. Chamom. Hyper. Ign. Nux vom. Rhus. Yeratr. SPASMODIC FEELING: Anac. Bell. Caust. Digit. Nux vom. Plat. Rhod. SPOTS, yeUow : Con. Petr. Sabadilla. — dark : Ant. tart. — red: Plumb. Zinc. STITCHES: Ambr. Amnion, mm-. Anac. Arn. Bryon. Carbo an. Car- bo veg. Caust. Colch. Croc. Dapli. UPPER EXTREMITIES. Ill Dig. Graph. Kali. Lack. Lye. Merc. Mur. ac. Natrum mur. Nux vom. Oleand. Petr. Phosph. Ban. sc. Bhod. Bhus. Sabad. Sassap. Stann. Staph. Sulph. ac. Teucr. Thuj. Verb. Zinc. SWELLING : Amm. caru. Arsenic. Biy. Calc. Hep. Iod. Lach. Lye. Magn. Merc. [Nitr. Nux vom. Phosph. Ean. seel. Bhus. Sil. Sulph. Thuj. — feeling as of a : Bell. 'TEARING: Agar. Ambr. Ammon. mur. Arsen. Aur. Bell. Bism. Canth. Carbo veg. Caust Chel. Colch. Daph. Hell. Ign. Iod. Kali. Lach. Laur. Lye. Magn. Merc. Mur. ac. Natrum mur. Nitr. 01. an. Par. Phos. ac. Plumb. Ban. bulb. Bhod. Sabin. Sil. Spig. Stann. Staph. Sulph. Teucr. Zinc. TENSION : Canth. Iod. Phosph. Plumb. Puis. Veratr. THROBBING: Carbo veget Crot. Sil. Sabad. Teucr. THUMB GOES TO SLEEP : Kali. Plumb. — clenched : Bell. Cham. Hyosc. Ign. Bhus. TBEMBLING: Ambr. Bry. Bhus. Stront. TWITCHING : Alum. Amm. mur. Anac. Bry. Caust. Cham. Cic. Cin. Crotal. Cupr. Dig. Ign. Lycop. M. austr. Merc. Ol. an. PhosjJh. Plumb. Bheum. Rhod. Rhus. Sabad. Stann. Sulph. Sulph. ac. ULCEBS: Alum. Ars. Caust. Lye. Natrum mur. Ban. bulb. Sil. Sulph. UBTICABIA: Hep. WABTS: Caust. Lach. Lycopod. Petr. Sep. Sulph. WEAKNESS: Carbo veget. Hell. Nitr. Bhus. Sil. YELLOW/turning: Chel. Finger-Joints. BOBING: Hell. CBAMP-PAIN : Euphr. Magan. Plat. Sulph. CBEAKING: Baryt. Caps. Meph. Nitr. DISLOCATION-PAIN: Natrum mur. Phosph. Sulph. DBY, as if: Puis. IN GENEBAL: Ambr. Amm. Aur. Bell. Calc. Caps. Carbo veg. Caust. Cham. Chin. Colch. Con. Creos. Drosera. Graph. Hell. Hep. Ignat. Kali. Led. Lye. Mang. Merc. Natr. mur. Nitr. Nitric ac. Nux vomica. Oleand. Phosph. Plat. Puis. Bhod. Bhus. Buta. Sep. Sil. Spig. Spong- Staph. Sulph. Sulph. ac. NODES, gouty: Calcar. Clem. Hep. Lye. Bhod. Staph. PAIN: Kali. Sil. Sulph — laming: Bell. Calc. PBESSUBE: Led. Merc. Zinc. BEDNESS: Lye. Spong. STIFFNESS : Aur. Ars. Carbo an. Caust. Graph. Hep. Lycopod. Bhus. Sep. Sulph. STITCHES : Am. Bar. Bry. Carbo veg. Con. Hell. Ign. Men. Nitric ac. Bhus. Sabin. Sepise. Sulph. ac. SWELLING: Euphr. Hep. Lycop. Nitric ac. TEABING: Agar. Ammon. Anac. Aur. Bell. Bryon. Carbo veg. Caust. Chel. Colch. Hell. Kali. Led. Lye. Phosph. acid. Plat. Puis. Bheum. Bhodod. Bhus. Buta. Sabin. Samb. Spig. Staph. Sulph. Teucr. Zinc. TENSION : Iod. Nitric ac. Puis. Sep. ULCEBS: Sep. Tips of Fingers. IN GENEBAL : Ambr. Amnion, mur. Ant. tart. Asa f. Bor. Calc. Chel. Croc. Hep. Lach. M. austr. Phos. Pulsat. Bhus. Sec. corn. Sep. Sil. Spig. Staph. Sulphur. Teucr. Thuj. Yeratr. 112 LOWER EXTREMITIES. Finger-Nails. ALTERED COLOR: Ars. Mur. ac. BLUE: Chel. Chin. Chlor. Crotal. Dig. Nux vom. Petr. DISTORTION: Graph. Sep. Sulph. EXFOLIATION: Graphit. Mercur. Sulpli. IN GENERAL: Alum. Ant. crud. Arsen. Bar. Bism. Bor. Bov. Calc. Caust. Chel. Colch. Con. Crotal. Digit. Graph. Hep. Kali. Iodine. Lach. M. austr. Merc. Natr. mur. Nitr. Nitric ac. Nux vom. Phosph. Pulsat. Ran. bulb. Sabad. Sep. Sil. Sulph. Sulph. ac. Thnj. GNAWING: Alum. GROWTH, slow: Ant. crud. HANG-NAILS: Natr. mur. Rhus. Stann. Sulph. NAILS, brittle: Graphit. Mercur. Thuj. — growing in : Sil. Sulph. PRESSURE : Calc. Caust. TEARING UNDER THE NAILS : Sil. — all round : Ambr. Lye. THICKENING: Graph. Sabad. ULCERATED: Alum. Arsen. Bar. Calcar. Conium. Hep. Kali. Laehes. Lycopod. Mercur. M. austr. Natr. mur. Petr. Phosph. Sepiae. Silie. Sulph. Thuj. ULCERATIVE PAIN : BeUad. Con. Graph. Hep. Kali. Merc. Plat. Puis. Sil. Sulph. Sulph. acid. Thuj. YELLOWNESS: Ambr. Con. Merc. Nux vom. LO~WE!Il JS^TRJEJ^XTT^JS. Extremities. (t. signifies thigh, 1. leg.) IN GENERAL : Anac. Arn. Bellad. Bry. Calc. c. Calc. phosph. Carbo veg. Caustic. China. Colchic. Crot. Dig. Graphit. Guaj. Ignat. Iod. Kali bichr. Kali carb. Lach. Led. Lycop. Merc. Mezer. Mosch. Mur. ac. Natr. Natr. mur. N. vom. Oleand. 01. an. Phosph. acid. Plat. Plumb. Puis. Rhodod. Rhus. Ruta. Sabin. Sep. Sil. Spigel. Spong. Staph. Sulph. Thuj. Yaler. Viol. tr. Thighs. BLOTCHES: Calc. c. Lach. Merc. Staph. BOILS : Hep. Sep. Sil. BORING : Arn. Rhus. Staph. BURNING: Asa f. Carbo animal. Carbo veget.T>spph. Euphorb. Kali. Nux vom. Phos. Plumb. Rhus. Sil. Sulph. Zinc. CARIES : Asa f. Aur. Calc. c. Hep. Merc. Nitric ac: Phos. Sep. Sil. Sulph. COLDNESS (t. and 1.) : Ars. Bell. Calad. Calc. c. Camph. Carbo veg. Daph. Led. Lye. Nitric acid. Nux vom. Op. Puis. Sec. corn. Sep. Sulph. Yeratr. — f eeling of : Helleb. M. austr. Oleand. — feeling of (t. and 1.) : Camph. Carb. veg. Chin. Merc. Natr. Sec.- corn. CONTUSIVE PAIN (t. and 1.) : Arn. Euphorb. Led. Nux mosch. Rhod. But a. CONVULSIONS (t, and 1.) : Cham. Caustic. Cuprum. Hyosc. Ign. Ipec. Men. Op. Plumbum. Rhus. Sec. corn. Strain. CRAMPS : Asar. Chin. Colch. — (t. and 1.) : Bell. Bism. Cina. Ctipr. Lach. Nux vom. Rhus. Sec. corn. Stram. LOWER EXTREMITIES. 113 CRAMPY FEELING: Angust. Am. Calc. c. Cycl. Digit. Graphit. Hyosc. Lycopod. Men. Petr. Phos- phor. Rhus. Sep. Yaler. Yeratr. CREEPING: Arsenic. Bell. Guaj. Mane. Rhus. Sec. corn. CUTTING (t. and 1.) : Alum. BeU. Bry. Graph. Lycop. Natr. Sil. Sulph. ac. DISLOCATION-PAIN ( t. and 1.) : Carbo veg. Caust. Led. Natr. mur. Rhus. EMACIATION: Arg. nitr. Arsen. Calc. c. China, Iod. Lack. Mere Nux vom. Selen. ERUPTION: Clem. Euphorb. Gra- phit. Kali. Lye. Merc. Natr. mur. Rhus. Sil. Sulph. EXTERNAL SIDE: Anac. Asa f. Bellad. Caustic. Coccul. Euphorb. Merc. Mezer. N. vom. Phosph. ac. Rhus. Stann. Sulph. Zinc. POSTERIOR SIDE : Alum. Antim. crud. Calc. c. Canth. Carbo veget. Caust. Con. Euphob. Graph. Ign. Kali. Led. Lye. Men. Merc. Mezer. Phosph. Phosph. ac hus. Selen. Sep. Stann. Staph. Sulph. Yeratr. Zinc. INTERNAL SIDE : Ant. crud. Asa f. Calc. c. Carbo veg. Caust. Grayh. Hep. lod.Kali. M. austr. Merc. Mur. acid. Nitric ac. Oleand. Petroleum. Rhod. Sabin. Selen. Stann. Staph. Sulph. Tar. Thuj. ANTERIOR SIDE : Anac. Aug. Ar- gent. Asa foet. Bar. Cann. Chin. Digit. Euphorb. Kali. Lye. Men. Mur. ac. Natrum mur. Nux vom. Olean. Phos. ac. Sabin. Sil. Spong. Stann. Thuj. Yaler. FAINT FEELING : Am. Ars. Bry. Chin. Crot. Dig. Guaj. Hell. Kali. Laur. Oleand. Phosph. ac. Plat. Rhodod. Ruta. Spig. Yeratr. — (t. and 1.) : Agar. Alum. Ambra. Amm . Amm. mur. Arsen. Asar. Bell. Bryon. Calfc. c Cann. Caust China. Con. Croc. Graph. Hell. Ign. Ipec. Lach. Laur. Led. Lye. Nitr, ac. Nux mosch. Nux vom. Phosph. Ph. ac. Plat. Plumb. Puis. Rhodod. Rhus. Ruta. Sec. corn. Sep. Stront. Sulph. Zinc. FORMICATION: Ast. Bellad. Nux vom. Sec. corn. IN GENERAL : Agar. Ambr. Anac. Ant. tart. Arn. Asa f. Asar. Bell. Bry. Calc. c. Caps. Carbo an. Car- bo veg. Caust. Chel. Chin. Cocc. Colchic. Creos. Crotal. Cycl. Eu- phorb. Graph. Guaj. Hell. Hep. Ign. Kali. Lach. Led. M. austr. Merc. Mezer. Mosch. Mur. ac, Natr. mur. Nitric ac. Nux vom. Oleand,. Phos. ac. Plat. Puis. Ran. bulb. Rhodod. Rhus. Sabin. Selen. Sep. Sil. Spigel. Spong. Stann. Staph. Sulph. Thuj. Zinc. HEAT : Aconit. Bryon. Caustic. Sulph. HEAYINESS : Alum. Ambr. Bry. Calc. c. Cann. Carbo veget. Graph. Hell. Ign. Iod. Kali. Lach. Lact. M. arct. Natrum mur. Nux vom. Puis. Rhus. Ruta. Sep. Spig. Stann. Sulphur. Sulph. ac. HERPES : Graph. Lye. Merc. Staph. Sulph. Zinc. INSENSIBILITY (t. and L) : Ambr. Ars. Asar. Carbo veg. Lach. Lye. Oleand. Op. Rhus. Sec. corn. ITCHING: Agar. Ant. crud. Ars. Calc. c. Carbo veg. Cic. Dig. Eu- phorb. Graph. Lach. Led. M. arct. Merc. Natrum mur. Nitric ac. N. jugl. Nux vom. Oleand. Rhod. Sec. corn. Sil. Spig. Staphys. Sulphur. Thuj. Yeratr. Zinc. JERKS (t. and 1.) : Antim. tart, Cal- car. c. Cic. Creos. Euphr. Merc. Phosph. Stram. Sulph. Sulph. ac. LAMENESS : Causticum. Coccul. Oleand. 114 LOWER EXTREMITIES. — (t. and L): Bell. Bry. Caust. Coc- cul. Dig. Iod. Lack. Mane. Natr. mur. N, Yom. Rhus. Buta. Sec. corn. Sep. Sil. Sulph. Zinc. MUSCLES BELAXED (t. and I.) : Ambr. Calc. c. Garbo veg. Eerr. Iod. Merc. Nux vom. Phosph. ac. NODES, gouty: Ant. cruel, Calc. c. Calc. ph. Lycop. Bhus. Staph. Sulph. NUMBNESS : Carbo veget. Ferr. Graph. Spong. — (t. and I.): Ang. Asa f. Calc. c. Carbo veg. Coccul. Iod. Kali. Lach. Merc. N. vom. Plat. Bhus. Sulph. Yeratr. PAIN (t. and 1.) : Arn. Anacard. Aur. Calcar. c. Carbo veg. Cupr. Daph. Graph. Lycop. Mur. ac. Nitric ac. Phosphor. Bhus. Sil. Stann. Sulph. — laming : Carbo Teg. Caust. Cina. Coccul. Ign. Natr. rnur. Nux vom. Bhus. Sep. — as if sore (t. and 1.) : Anac. Am. Calcar. c. China. Graph. Kali. Led. Lycop. Nux vom. Bhocl. Staph. Sulph. — as if bruised: Bry. Bell. Calc. c. Caust. Coccul. Cuprum. Graph. Guaj. Hep. Led. Men. Natr. N. yom. Phosph. ac. Plat. Puis. Ruta. Sepias. Spig. Sulph. Tar. Yaler. Veratrum. (t. and 1.) : Bry. Bell. Canthar. Carbo veg. Croc. Graph. Laur. Natr. Nux mosch. Sep. Sil. Stann. PBESSUBE: Agar. Caps. Digital. Guaj. Led. Men. Mosch. Mur. ac. Nitric, ac. Oleand. Ph. ac. Sabin. Sassap. Sil. Stann. Verb. PULSATIONS : Asa feet. Coccul. Plat. SHUDDEBING: Cann. Chin. Ign. Phosph. Puis. GONE TO SLEEP : Ambra. Canth. Cham. Coccul. Croc. M. arct. Mosch. Nux vom. Oleander. Puis. Bhus. Sec. corn. Veratr. SO BE NESS BETWEEN THE THIGHS: Graph. Kali. Mercur. Bhod. Selen. Sulph, SPOTS, red: Graph. Merc. STAGGEBING : Asar. Coccul. Hell. Ign. Iod. Nnx yom. Oleander. Op. Rhus. Sec. corn. Stram. Yeratr. STIFFNESS: Ars. Graphit. Ignat. Natr. mur. Oleand. Bhod. — (t. and 1.) : Alum. Ang. Bell. Calc. c. Caust. Cic. Ferr. Ign. Kali. Led. Merc. Natr. mur. Phosph. Rhus. Sep. Sulph. STITCHING : Aco. Arn. Asa foet. Bell. Bry. Calc. c. Caustic. Coccul. Con. Euphr. Graph. Guaj. Hyosc. Laur. Mangan. Men. Nux vomica. Oleand. Phos. Rhus. Sabad. Sas- sap. Sep. Spig. Spong. Stann. Staph. Sulph. Tar. Thuj. Yiol. tr. Zinc. STRETCHY FEELING: Bellad. Daph. Phosph. ac. SWEAT : Carbo an, Merc. N. vom. Bhus. Thuj. — (t. and 1.) : Asa f. Hep. Phos. Sep. Yeratr. SWELLING (t and 1.) : Arsen. Bry. Calc. c. Carb. veg. Chin. Colch. Dulcam. Hell. Lye. Merc. Phosph. Sec. corn. Sep. Sil. Sulph. SWELLING OF BONES (t and 1.) : Asaf. Aur. Calc. c. Calc. ph. Dulc. Iod. Lye. Merc. Phosph. Phosph. ac. Bhus. Sil. Staph. Sulph. TEARING AND DRAWING : Aga- ric. Alum. Amm. mur. Anac. Asa f. Aur. Bellad. Bry. Calc. c. Canth. Carbo an. Caiut. Chamom. China, Coccul. Colchic. Daph. Bndc. Eu- phorb. Graph. Guaj. Kali. Lycop. Merc. Mezer. Natr. mar. Xitr. ac. Nux yom. Phos. ac. Plat. Plumb. Puis. Rhus. Sepiae. Sil. Stann. Sulph. Yaler. Zinc. LOWER EXTREMITIES. 115 TEN SION : Am. Calc. c. Carbo veg. Creos. Guaj. Lye. Merc. Men. Ni- tric ac. Petr. Rhod. Rhus. Sabin. — t. and 1. : Alum. Carbo anim. Caust. Cham. Dulcam. Iod. Kali. Lye. Natr. mar. Pulsat. Sep. Sulph. Zinc. THROBBING (t. and 1.): Antim. tart. Asaf. Bell. Brom. Bry. Dig. Kali. M. austr. Natrnni mur. Phos- phor. Rhus. Buta. Sulph. TREMBLING (t. and 1.) : Ammon. mur. Arn. Calc. c. Carbo veg. Caust. Cic. Con. Digit. Graph. Lach. Mercur. Natr. Nux mosch. Nux vom. Plat. Plumb. Puis. Rhus. Sil. TWITCHING: Agn. Arn. Asa f. Caust. China. Graph. Laches. Lye. Mang. Nux vom. Phos. Puis. Rheum. Rhus. Sep. Sil. Staph. Sulph. Yaler. Yeratr. ULCERS : Calc. Sil. Thuj. — t. and 1. : Calc. Carbo veget. Graph. Lye. Merc. Natrum. Nitric ac. Petr. Rhus. Silic. Sulph. UNEASINESS (t. and 1.): Ars. Cann. Carbo veg. Caustic. Chin. Con. Graph. Kali. Lach. Merc. Nux vom. Phosphor. Plat. Ruta. Sep. Sulph. VARICOSE VEINS (t. and 1.): Ambra, Arn. Ars. Calc. c. Carbo veg. Ferr. Graph. Lye. M. austr. Puis. Sulph. Zinc. Legs. BOILS : Hep. Merc. Magn. carb. Xux vom. Sil. Sulph. BORING: Anacard. Aur. Mercur. Staph. BURNING: Agar. Arsen. Asa f. Carbo veg. Caust. Crot. Kali. Lye. Nux vom. Phosph. ac. Rhus. Sep. Tar. Teucr. Zinc. COLD FEELING: Ambra. Mosch. Puis. Yaler. CONTRACTION: Ars. Canth. Cocc. Lye. Nux vom. CRAMP (in calves) : Alum. Ambra. Ang. Ars. Calc. carb. Camph. Carb. veg. Chamom. Cin. Coloc. ' Cupr. Dulc. Ferr. Graph. Hep. Hyosc. Ign. Laches. Led. Lye. M. austr. Men. Natr. Natr. mur. Nitric ac. N. jugl. N. vom. Petr. Rhodod. Rhus. Samb. Sec. corn. Sep. Sil. Stram. Sulphur. Yeratr. Zinc. CREEPING: Bell. Cic. Ipec. Nux vom. Rhus. Sec. corn. CUTTING: Calc. c. Phos. ac. Thuj. (compt. t.) DIGGING: Spig. EMACIATION : Phos. ac. Samb. ERYSIPELAS : Arn. Rhus. Sulph. FAINTNESS: Natr. mur. Oleand. Plat. Stann. FLESH LOOSE, as if: Nux vom. Rhus. IN GENERAL : Aco. Ambr. Amm. mur. Anac. Ant. cruel. Antim. tart. Ars. Asa f. Bell. Bry on. Calc. c. Carbo veg. Canth. Caust. Cham. Chel. Conium. Creos. Cup>r. Cycl. Dig. Euphorb. Ferr. Graph. Hyosc. Ign. Ipec. Kali. Lach. Led. Lye M. austr. Men. Mercur. Mezer. Natr. N. vom. Oleand. Phosph. Phosph. ac. Plumb. Puis. Rhod. Rhus. Sabin. Sec. corn. Sep. Sil. Spigel. Spongia. Staph. Sulph. Tar. Yaler. Veratr. Vit. HEAT : Aeon. Bell. Bry. Guaj. Hyosc. HEAVINESS: Ars. BeU. Camph. Ferr. Ign. Ipec. Laur. Lye. Rhus. Veratr. (comp. t.) HERPES : Lye. Plumb. Staph. Sulph. Zinc. ITCHING: Agar. Asa f. Aurum. Calc. c. Chel. Dulcam. Daph. Kali. Lach. Laur. Lye. Natr. Op. Sabin. Sil. Staph. Sulph. LAMENESS : Agar. Ars. Carb. veg. NODES, gouty: Antim. crud. Rhus. Sulph. Staph. 116 LOWER EXTREMITIES. NUMBNESS: Alum. Graph. Kali. Sil. (comp. t.) PAIN AS IF SOEE: See t. — as if bruised: Alumina. Asar. Calc. c. Caust. Croc. Digital. Ferr. Phosph. Plumb. Sepiee. (comp. t.) PEESSUKE : Agar. Arn. Ars. Asaf. Bell. Camph. Cupr. Cylc. Ign. Led. Mang. Nux mosch. Nux vom. Phos. ac. Bhus. Kuta. Sep. Stann. Tar. Valer. Zinc. PULSATIONS: Asa fcetida. Plat. Stann. RIGIDITY, feeling of (t. and 1.) : Cham. Coccul. SHUDDERING: Kali. GONE TO SLEEP : Asa f. Cicuta. Ign. Laur. Nux vom. Plumb. Samb. SPOTS, blue: Arn. Lach. — yellow: Stann. — red: Aeon. Calc. c. Conium. Merc. Sulph. ac. STIFFNESS: Ferr. Ipee. Petr. (comp. t.) STITCHING: Amm. mur. Anac. Ant. cruel. Arn. Asa f. Bell. Bry. Calc. c. Carbo an. Caustic. Chin- Graph. Hell Ign. Kali. M. arct. Men. Mur. ac. Natr. mur. Nux vom. Plumb. Phosphor. Plat. Bhus. Ruta. Spig. Staph. Sulph. Yaler. SWEAT : Euphorb. Hyosc. Mercur. (comp. t.) SWELLING: Aconit. Asa f. Ferr. Led. Puis. TEARING AND DRAWING : Agar. Alum. Ambr. Ant. tart. Arn. Ars. Bell. Bryon. Calc. c. Carbo an. Carbo veg. Caust. Cham. Colch. Croc. Dulcam. Euphorb. Ferr. Graph. Ignat. Kail, Laeh. Lye. M. austr. Mezer. Magn. mur. Natrum. Nux vom. Phosph. Puis. Rhod. Rhus. Sassap. Sep. Silicea. Spong. Staph. Sulph. "Valer. Zinc. TENSION: Asa f. Bry. Calc. c. Chamom. Cocc. Graph. Ign. Kali. N. vom. Puis. Rhus. Spig. Valer. (comp. t.) TICKLING: Laur. TREMBLING : See t. TWITCHING: Anac. Arsen. Asar. Bellad. Cina. Cupr. Graph. Hyosc. Lycop. M. austr. Men. Op. Petr. Plumb. ULCERS: Ars. Calc. c. Graphit. Lach. Lye. Buta. StajJh. ULCERATIVE PAIN: Puis. UNEASINESS: See t. Heels. IN GENERAL : Amnion, mur. Ant. cruel. Arg. Am. Calc. c. Caust. Coloc. Cycl. Graphit. Ign. Kali. Leel. Lycop. M. arct. Merc. Natr. Nitric ac. Petr. Pulsat. Bhoeloel, Rhus. Sabin. Sec. corn. Selen. Sep. Sil. Spongia. Stann. Stront. Sulph. Yaler. Yiola. trie. Feet. BENT INWARDS : Sol. n. BOILS : Calc, c. Merc. BURNING: Am. Ars. Calc. c. Coc- cul. Crotal. Graph. Hep. Lye. Merc. Natr. Xatruni mur. Phos. ac. Puis. Rhus. Sec. corn. Sep. Sil. Stann. Tar. CHILBLAINS: Ant. cruel. Cham. Nitr. ac. Nux vom. Petr. Phosph. Puis. Rhus. Sulph. COLD, liable to take: Con. Sil. COLDNESS: Ambra. Amm. mur. Ant, crud. Ant. tart. Arn. Bell. Calad. Calc. c. Ceiustic. Chel. Chin. Coff. Con. Daph. Digit. Graph. Ign. Ipec. Kali. Lach. Lye. Men. Mur. ac. Natr. Nux vom. Oleand. Petr. Phosph. Puis. Rhodod. Rhus. Sabin. Samb. Sepiae. Sil. Squilla. Stann. Sulph. Yeratr. CORNS: Ant. erud. Arn. Calc. c. Caust. Ign. Lye. Nux vom. Puis. Ran. sc. Rhus. Sep. Sil. Sulph. LOWER EXTREMITIES. 117 CKAMPY FEELING : Calc. c. Cal- ad. Canst. Graph. Hep. Laches. Lye. Natr. mm. Petr. Sil. Sulph. — in the soles : Calc. c. Chelid. Ferr. Euphorb. Natr. c. Selen. Sil. Sulph. CHEEPING: Arn. BeU. Caustic. Dulc. Graph. Ign. Natr. Nux vom. Phosph. Rhodod. Rhus. Sec. corn. Sep. Stann. DEADNESS: Ant. cmd. Arsenic. Calc. c. N. vom. Rhus. Sec. corn. Sil. DESQUAMATION: Dulc. DRY SOLES OF FEET : Bism. EXHAUSTION, feeling of: Bellad. Bov. Cham. Croc. Ferr. Lye. Phos. Plat. Rhus. Zinc. ERUPTION: Graph. 'Petr. Sulph. ERYSIPELAS : Nux vom. Dulc. FETOS: Plumb. Sil. IN GENERAL: Aeon. Anac. Arn. Ars. Asa f. Aur. Baryfc. Bell Bry. Calc. c. Camph. Caiv o ve _;. Caust. Cham. Conium. Creos. Cuprum. Ferr. Graph. Hep. Ign. Kali. Led. Lye. Merc. Natr. Natr. mur. Nux vom. Petr. Phosph, Plumb. Puis. Rhod. Rhus. Ruta. Samb. Secale corn. Sep). Sil.St&mi.Stront. Sulph. Verat. Zinc. GOUT: Am. Bryon. Graph. Lach. Led. Lye. Nux vom. Oleand. Rhus. Ruta. Sabin. Yeratr. HEAT: Aeon. Arn. Bryon. Calc. c. Carbo anim. Led. Nux vom. Puis. Phosph. Sep. Sulph. —of the soles : Anac. Nux vomica. Sangn. ITCHING: Agar. Asa £. BeL. Calc.c. Coccul. Lach. Lycop. Puis. Selen. Stann. LAMENESS: Oleander. Phosphor. Plumb. NUMBNESS: Bryon. Carbo veget. Con. Op. Phosph. ac. PAIN AS IF BRUISED: Bry. Laur. Magn. c. — as if sprained: Arn. Carbo veg. PRESSURE: Asa f . Bellad. Bryon. Graph. Led. Nux vom. Plat. Stann. Sulph. ac. PULSATIONS : Ran. bulb. RIGID FEELING: Asa feet. GONE TO SLEEP : Alum. Ammon. mur. Ant. tart. Bar. Cocc. Euphorb. Graph. Kali. Lach. Laur. Lycop. Kux vom. Oleand, Plumb. Rhod. Sep. Sil. STIFFNESS : Arnbr. Ars. Led. SPASM: Bar. BeU. Nux vom. Rhus. Secale corn. STITCHES: Alum. Arn. Asa foet. Bellad. Bryon. Calc. c. Carbo veg. Chin. Graph. Ign. Kali. Meph. Mur. ac. Natr. Natrum mur. Nitr. acid. Phosph. Ran. sc. Sep. Sil. Sulph. SWEAT: Bar. Calc. c. Cann. Carbo veg. Cupr. Graph, Ipec. Kali. Led. Lycop. Magn. mur. Merc. Nitr. ac. N. jugl. Ph. ac. Pulsat. Sep. Sil. Squill. Sulph. — of the soles of feet: Arn. Chin. Plumb. SWELLING: Amm. c. Arn. Ars. Asa f. Bell. Bry. Calc. carb. Caps. Caust. Cham. China. Cocc. Crotal. Digit. Ferr. Graph. Kali. Lach. Led. Lye. Merc. Natr. Natr. mur. Petr. Phosph. Puis. Rhod. Rhus. Sec. corn. Sep. Sil. Stann, Staph. Sulph. TEARING AND DRAWING: Al- um. Ant. crud. Am. Bellad. Bism. Bov. Carbo veg. Caustic. Chin. Colch. Ferr. Graphit. Hep. Lacli. Lycop. Merc. Natr. Natr. mur. Ni- tric acid. Phosph. ac Rhodod. Si 1 . Spig. Stann, Strum. Sulph. TENSION: Bry. Led. Rhus. Sulph. TICKLING : Laur. Rhod. Sil. TREMBLING: Arn. Ars. Coffea. Stram. Yeratr. Zinc. 118 LOWER EXTREMITIES. TWITCHING: Am. Chin. Cupr. Graphit. Ign. Ipec. Laur. Phosph. Sep. Yeratr. ULCEES: Ars. Ipec. Lack. Merc. Euta. Sec. com. Sulpli. ULCERATIVE PAIN: Bry. Graph. UNEASINESS: Am. Bar. Carbo veg. Rhus. Tarsal Joints. BEATING : Arg. Euta. BEND, liable to : Carbo an. Na- trum. Natrum mur. Nitric ac. Nux vom. Rhus. BORING: Spig. BURNING: Calc. Euphorb. Sul- phur. CREAKING : Camph. Kali bichr. Petr. IN GENERAL : Ambr. Am. Arsen. Bry. Calc. c. Carbo animal. Canst. Creos. Cycl. Dros. Graph. Hepj. Ign. Kali. Led. Lycop. Mang. Merc. Mezer. Natr. mur. Nitric ac. Petr. Phos. Puis. Rhus. Ruta. Sep. Sil. Spig. Staph. Stront. Sulph. Zinc. ITCHING : Daph. Kali. Oleancl. Selen. LAMENESS: Natr. mur. Oleancl. PAIN AS IF SPRAINED: Am. Bry. Carbo veg. Canst. Dros. Led. Men. Natr. Nux vom. Prun. Rhus. Sulph. Valer. — as if bruised : Calcarea. Hep. Valer. — as from weariness : Croc. Nux vom. PRESSURE : Camph. Daph. Led. Natr. Spig. PULLING : Caust. Spig. SPASM: Ars. Jot/. STIFFNESS : Capsic. Caust Chel. Ignat. Kali. Led. Lye. Petr. Rhus. Ruta. Sep. Sulph. STITCHES : Am. Ars. Asa f. Bov. Bry. Caustic. Kali. Oleand. Rhus. Spig. Sulph. SWELLING: Arsen. Asa f. Bry on. Calc c. Led. Lye. Merc. Rhod. Rhus. Sulph. TEARING AND DRAWING: Agar. Arn. Arsen. Colch. Euphorb. Kali. Merc. Puis. Ran. bulb. Rhod. Rhus. Spong. Zinc. TENSION: Bry. Lye. Sep. Zinc. WEAK FEELING: Calc. c. Carbo an. Merc. Dorsum of Feet. IN GENERAL : Asa f. Bry. Cam- phor. Caust. Hep. Lycop. Mercur. Mur. ac. Natr. Par. Puis. Rhus. Spig. Sulphur. Tar. Thuj. Zinc. Soles of Feet. IN GENERAL: Ambr. Anac. Arn. Ars. Bell. Bry. Calcar. c. Carbo veg. Caust. Creos. Cuprum. Graph. Lye. Mercur. Mur. ac. Natr. Petr. Phosp h. Phosph. ac. PheR. Plumb. Pulsat. Rhus. Sil. Stront, Sulph. Tar. Hip and Joint. BORING: Arn. Cin. Merc. BURNING: Bell. Carbo veg. HelL Rhus. Ruta. Sep. Valer. CREAKING : Anac. Camph. CRAMPY FEELING : Bellad. Plat. Sulph. CUTTING: Alum. Cacl. c, IN GENERAL : Aeon. Amm. Ant, crud. Ant. tart. Arn. Bellad. Bry. Calc. e. Carbo veget. Caust. Coc- cul. Coloc. Creos. Ferr. Hell. Ign. Ipec. Kali. Led. Lye. M. austr. Mercur. Natr. mur. Nitric ac. N. vom. Phosph. Phosph. ac. Pulsat. Rhus. Ruta. Sep. Silicea. Stront. Sulph. Teucr. Veratr. HIP-DISEASE : Biy. Calear. e. Caust. Coloc. Hepar. Mere. Nitric ac. Phosph. ac. Rhus. Ruta. Sil. Sulph. (See Limping, spont.^) IS CHI AS : Aeonit. Bell. Bry on. Caust. Chamom. Coloc. Led. Merc. Nux vom. Puis. Rhus. Euta. Sa- bin. Sep. Sulph. LOWER EXTREMITIES. 119 ITCHING : Caustic. Led. Natrum. Sep. LAMENESS: Cham. Lye. Veratr. LIMPING, spontaneous : Aconit. Bell. Calc. c. Caust. Coloc. Lye. Merc. Rhus. Kuta. Staph. Sulph. Zinc. (See Hip-disease.) NUMBNESS: Lach. Staph. PAIN, simple : Aco. Bell. Cham. Led. Nux vom. Rhod. Rhus. Ruta. — laming: Bell. Cina. Coccul. Lach. Natr. mur. — as if sprained : Amm. m. Am. Bry. Caust. Cham. Euphorb. Ipec. Na- trum mur. Nux vom. Rhus. — as if sore : Cic. — as if bruised: Alum. Am. Bry. Caust. Croc. Ferr. Lach. Natr. Natr. mur. Phos. ac. Ruta. Sep. Zinc. PRESSURE : Am. Asar. Caustic. Coccul. Euphorb. Led. Nux vom. Ruta. Sabadilla. Sep. Stann. PULLING: Natr. mur. STIFFNESS : Bell. Caust. Chamom. Ign. Led. Sep. Staph. STITCHES : Alum. Bellad. Bry on. Calc. c. Caust. Coccul. Ferr. Graph. Ign. Led. Natr. mur. Nux vom. Rhus. Sil. Zinc. SWELLING: Bry. Sep. TEARING AND DRAWING: Alum. Ant. crud. Bry. Carbo veg. Caust. Con. Dulc. Euphorb. Kali. Lye. Merc. Natr. Natr. mur. Rhod. Rhus. Sep. Zinc. TENSION : BeU. Lye. Natr. mur. Xltr. ac. Puis. Rhus. TWITCHING: Calc. carb. Coccul. Mezer. N. vom. Sep. Sil. Sulph. WEARINESS, feeling of: Thuj. Knee and Joint. ANEURYSM IN BEND OF KNEE: Carbo veg. BORING: Caust. Canth. BURNING : Asa feet. Tabac. Carbo veg. Lye. Mur. ac. Phosph. Sulph. COLDNESS : Aeon. Arsen. Chin. Daph. Puis. Sep. Sulph. — feeling of : Dig. Veratr. CONTRACTION : Carbo an. Lycop. Merc. Rhus. Sil. Sulph. CONTRACTIVE FEELING IN HAM-STRINGS : Con. Nitric ac. RJtus. Ruta. Sulph. Veratr. CREAKING : Camph. Caust. Coc- cul. Led. Nitric ac. Nux vom. Petr. Rhus. Selen. Sulph. CRAMPY : BeUad. Bryon. Caust. Oleand. CREEPING: Rhus. CUTTING : Graphit, Tax. Thuj. Veratr. ERUPTION: Hep. Kali. Lye. Nux vom. Phosph. ac. Thuj. FUNGUS OF THE KNEE: Ant. crud. Ars. Bell. Bry. Calc. c. Iod. Kali hvdr. Led. Lycop. Merc. Phosph. Puis. Rhodod. Rhus. Sep. Sil. Sulph. IN GENERAL : Aco. Anibr. Amm. Amm. mur. Anac. Ant. crud. Arg. Arn. Axs.Asaf. Asar. Bry. Calc. c Calc. phosph. Caps. Carbo vegc Caustic. Chin. Colch. Con. Ferr. Cycl. Graph. Hep. Iod. Kali. Lachesis. Led. Lye. Mane. M. austr. Merc. Natr. Natrum mur. Nitric ac. Nux mosch. Nux vom. Petr. Phos. Plumb. Puis. Rheum. Rhod. Rhus. Ruta. Sabad. Sep. Sil. Spigel. Stann. Staph. Sulph. Tar. Valer. Veratr. Vit. Zinc. GIVING WAY, liable to: Arnica. Bell. Camph. Caust. Chin. N. vom. Rhod. Rhus. Ruta. Sulphur. HEAT, feeling of: Aur. m. Calc. c. Ign. HEAVINESS: Chin. Rhus. Verat. HERPES : Calc. c. Natr. Natr. mur. Petr. Sulph. — in the bend of the knee : Calc. c. Graph. Natr. Natrum mur. Psor. Sulph. 120 LOWER EXTREMITIES. ITCHING: Asa feet. Caust. Kali. Lye. Mur. ac. Nitric ac. — in bend of the knee : Natr. Nux vom. Sassap. JERKS : M. austr. Spig. Sulph. ac. PAIN AS IF DISLOCATED : Agar. Arn. Caust. Ipec. Men. Nitric ac. Phos. Rhus. Spig. Staph. — as if sore : Carbo an. Caustic. Nux vom. Sulph. — as if bruised: Amm. carbon. Ars. Aurum. Caniph. Graph. Hep. Jatr. Led. Nux vom. Rhus. Buta. Stann. Veratr. Zinc. PRESSURE: Alum. Asa f . Bellad. Calc. c. Chel. Cycl. Led. Magn. mur. M. austr. Rheum. Stann. Sulph. Thuj. PRICKLING : Aur. m. PULLING : Caust. Natr. mur. SHOCK IN THE BEND OF THE KNEE: Yeratr. GONE TO SLEEP : Carbo veg. SPASM: Ruta. Sulph. SPOTS, red: Lye. Petr. Rhus. SPRAIN, liable to : Nux vom. Rhus. STIFFNESS : Ambr. -Ammon. mur. Ars. Bell. Bry. Calc. Caps. Caust. Coloc. Graph. Hell. Ignat. Kali. Lach. Led. Lye. Natr. mur. Nux vom. Petr. Phosph. Pulsat. Rhus. Sassap. Sep. Stann. Sulph. STITCHES : Alumina. Ant. crud. Arn. Asa f. Bell. Bry. Calc. Carbo an. Caust. Chel. Cocc. Con. Graph. Hell. Kali. Lach. Laur. Led. Natr. mur. Nitric ac. Petr. Phos. Puis. Rhus. Sassap. Sep. Sil. Stann. Staphysag-. Tab. Thuj. Yaler. Veratr. SWEAT : Calc. Led. SWELLING: Ars. Bryon. Calc. c. Calc. phosph. Chin. Coccul. Ferr. Graph. Hep. Kali hydr. Iod. Lach. Led. Lye. Mur. ac. Nitric ac. Nux vom. Phos. Puis. Rhod. Rhus. Sep. Sil. Sulph. TEARING AND DRAWING: Aconit. Agar. Alum. Anac. Am. Bell. Benz. ac. Bryon. Calc. carb. Calc. phosph. Canth. Carbo an. Caust. Cham. China. Clem. Colch. Crot. Euphorb. Iod. Kali. Kali bichr. Lach. Laur. Led. Lycop. M. austr. Merc. Mur. ac. Natrum. Nitr. Phos. Puis. Rhod. Rhus. Sep. Sil. Spig. Stront. Sulphur. Zinc. TENSION: Am. Bryon. Caustic. Graph. Kali. Laches. Led. Nitric ac. Nux vom. Phosph. Puis. Rhus. Sep. Sulph. THROBBING: Calc. c. Ruta. TUBERCLES : Calc. c. Chin. Led- Lye. Nux vom. TWITCHING: Bell. Caps. Caust. Chin. Laur. Plumb. Sulphur. Yeratr. UNSTEADINESS: Aconit. Arnica. Carbo veg. Nux vom. Rhus. WANT OF MOBILITY: Graph. WEAK FEELING: Aconit. Arnica. Asar. Bryou. Caust. Chin. Con. Cupr. Ferr. Ign. Laeh. Led. Lye. Merc. Natrum mur. Nitric ac. Plat.- Puis. Stann. Staph. Sulph. Yeratr. WEARINESS : Asar. Cocc. Couiuin. Nux mosch. Pulsat. Ruta. Nails. IN GENERAL: Alum. Ars. Caust. Graph. Hep. Hell. Mereur. Natr. Natrum mur. Nux vom. Phosph. ac. Sabad. Sep. Sil. Sulph. Tibia. IN GENERAL: Agar. Anac. Arn. Ars. Asa f. Bell. Calc. Caustic. Coloc. Con. Creos. Dulc. Graph. Kali. Lach. Lycopod. Mang. Mere. Mezer. Mur. ac. Phos. Puis. Rhod. Rhus. Sabin. Sep. Sil. Spong. Tar. Zinc. LOWER EXTREMITIES. 121 Calves. IN GENERAL : Alum. Ambr. Ant. crud. Ars. Asa f. Bry. Calc. Caps. Caustic. Cham. Coloc. Croc. Cupr. Ferr. Graph. Hyosc. Ign. Led. Lye. M. austr. Mang. Merc. Natr. Natr. mur. Nitr. ac. Nux vom. Petr. Puis. Rhus. Sabina. Sec. corn. Sep. Sil. Spig. Stann. Staph. Sulphur. Tar. Valer. Veratr. Toes. BORING: Merc. Ran. sc. BURNING: Am. Dulc. Nitric ac. Nux vom. Staph. — in the toe-balls : Bry. CHILBLAINS, blisters : Ars. Nitric ac. Petr. CHILBLAINS: Agar. Amm. Ant- crud. Caust. Nitr. ac. Nux yoiu. Petr. Phosph. Puis. Rhus. Sulph. COLDNESS : Calad. Sulph. CONTRACTION: Cham. Ferrum. Hyosc. Nitr. Nux vom. Lye. Merc. Plat. CRAMPY : Amm. Am. carb. Bar. c. Calc. Caust. Ferr. Hyosc. Ign. Lye. Mosch. Nux vom. Plat. Sulph. CREEPING: Alum. Asa f. Caust. Hep. Lach. Plat. Plumbum. Rhod. Sec. corn. DEADNESS : Cycl. Sec. corn. IN GENERAL: Agar. Amm. Aru. Aur. Calcar. Carbo an. Carbo veg. Caust. Colch. Graph. Kali. Magn. carb. Merc. Mezer. Natrum mur. Nitric ac. Petr. Phosph. Phos. ac. Plat. Ran. seel. Sabin. Sec. com. Sil. Sulph. ITCHING: Ambr. Cycl. Daph. Hep. Nux vom. Paeon. Pulsat. Stront. Staph. JERKS : Anac. Arn. NUMBNESS: Arn. Crot. Phosph. — of toe-balls: Puis. PAIN AS IF BRUISED : Aur. Sulph. PRESSURE: Asa f. Cycl. Graph. Nux vom. PRICKLING: Aeon. Ant. tart. REDNESS: Carbo veg. GONE TO SLEEP: Cham. Nux vom. Rhus. SORENESS: Graph. Natr. Ban. bulb. Sil. SPASMS : Bar. m. Cham. Nux vom. 01. an. STIFFNESS: Sec.com. Sil. Sulph. STITCHES : Am. Asa feet. Calcar. Carbo veget. Caustic. Cocc. Graph. Lycopod. Natr. mur. Oleand. Puis. Ran. bulb. Ban. sc. Sil. Veratr. Zinc. SWEAT : Arn. Sil SWELLING : Arn. Carbo veg-. Graph. Merc. Nitric acid. Phosph. Sabin. Sulph. — of toe-balls: Daph. Led. TEARING AND DRAWING : Agar. Amm. mur. Arn. Ars. Asar. Camph. Caust. Chin. Cicuta. Cycl. Hej). Kali. Lach. Led. Lye. Par. Phos. Puis. Bhus. Sil. Sulph. Stront. Yit. Zinc. Valer. TICKLING: Ambr. TWITCHING: Asa f. Chin. Cupr. Merc. Ran. sc. ULCERS : Ars. Caustic. Graph. Petr. Sep. Toe-Joints. IN GENERAL: Arn. Aur. Bism. Calc. Caust. Cham. China. Conium. Cycl. Graph. Hep. Kali. Led. Lye. Merc. Phos. Puis. Rhod. Bhus. Buta. Sabin. Sep. Sil. Staph. Sulph. Teucr. Valer. Zinc. 122 XXVIII. SKIN AND EXTERNAL SYMPTOMS. ABSCESSES, acute: ^trs.Bell. Hep. Lack. Merc. Phosph. Pulsat. Sil. Sulph. — chronic: Calc. c. Calc. ph. Con. Hep. Lack. Iod. Lycop. Merc. Ni- tric ac. Phosph. Sil. Staph. Sulph. Thuj. BED-SORES: Agar. Am. Baryt. Calc. c. Carbo veg. Caustic. Chin. Cic. Creos. Ferr. Graphit. Hepar. Ign. Lach. Lycop. Mercur. Nitric ac. Petr. Puis. Rhus. Buta. Sep. Silic. Sulph. Sulph. ac. BITING IN THE SKIN: Ant.crud. Bar. Canth. Cham. Dig. Graphit. Kali. Led. Lye. Nux vom. Oleand. Plat. Pulsat. Ban. sc. Bhus. Buta. Spong. Staph. Veratr. Vit. BLOATING: Ant. crud. Ars. BeU. Bryon. Calc. c. Caps. Cupr. Dulc. Ferr. Graph. Kali. Lycop. Merc. Mosch. Oleand. Op. Pulsat. Bhus. Spig. Staph. Sulph. BLOODY-TUMORS : Bryon. Merc. Sec. corn. — blisters : Ars. Canth. Secale corn. Sulph. BLOTCHES: Apis. Creos. Dulc. Natr. mur. Bhus. Sulph. BOILS: Ant. crud. Am. Bellad. Calc. c. Carbo anim. Euphorh. Hep. Lach. *Led. Lye. Merc. Mur. ac. Nilr. ac. Phosph. Phosph. ac. Sec. corn. Sep. Sil. Staph. Sulph. Sulph. ac. Thuj. BLOTCHES: Agar. Ant crudum. Ars. Bell. Bry. Calc. c. Carbo anim. Caust. Con. Daph. Dale. Graphit. Hep. Iod. Lach. Led. Lye. Magn. Mang. Mezer. Natrum mur. Oleand. Petr. Phosphor. Puis. Bhus. Buta. Sec. corn. Sep. Sil. Staph. Sulph. Thuj. Verat. BURNING OF SKIN: Aconit.Arn. Ars. Asa f. Aur. Aur. mur. Bell. Bryon. Calc. Camph. Caps. Carbo veg. Caust. Cic. Coccul. Creos. Cupr. Dig. Euphorb. Ferr. Hep. Ign. Kali. Lach. Lye. Merc. Nitr. ac. Nux vom. Op. Phosph. Puis. Bhus. Secale corn. Sep. Sil. Spig. Staph. Sulph. Sulph. ac. Veratr. Viola, tr. COLOR OF THE SKIN, blue: • Arsen. Bell. Cina. Con. Cupr. Dig. Hydr. ac. Lach. Merc. Op. Phosph. ac. Sec. corn. Veratr. pale : Bellad. Calc Chin. Coccul. Ferr. Graph. Kali. Lycop. Nitric ac. Nux vom. Plat. Pulsat. Sep. Spigel. Sulph. yellow: Ambr. Ars. Bell. Bryon. Canth. Carbo vegetab. Chain. China. Con. Ferr. Ign. Lye. Merc. N. vom. Op. Plumb. Puis. Rhus. Sep. Spig. Sulph. Veratr. red: Aconit. Arn. Bell. Bry. Canth. Dulc. Graph. Lye. Merc. N, vom. Op. Phos. ac. Rhus. Buta. Secale corn. Stram. Vit. — sallow: Calc. Ferr. Iod. Laches. Merc. Natr. c. Phos. Sec. corn. Sep. COMEDONES: Calcar. c. Natr. Natrum mur. Nitric ac. Selen. Sulph. CONTUSIVE PAIN: Am. Rhus. Sulph. ac. CRACKING OF THE SKIN: Alumin. Arn. Calc. c. Cham. Creos. Hep. Kali. Lach. Lye. Natr. Natr. mur. Nitric ac. Petrol. Pals. Rhus. Sep. Sil. Sulphur. Zinc. CRUSTA LACTEA: Calc. Carbo veg. Dulc. Graph. Lye. Merc. Rhus. Sassap. Staph. DAMP SKIN: Alum. Ars. Calc Carbo veget. Cic. Clem. Dulc. Graph. Lye. Merc. Nitric ac. Petr. Rhus. Sepise. Sil. Sulph. SKIN AND EXTERNAL SYMPTOMS. 123 DESQUAMATION: Aeon. Amm. Amin. mur. Arsen. Aur. Bell. Bov. Caustic. Clem. Dulc. Graph. Hell. Iod. Mercur. Mezer. Oleand. Plws. Phos. ac. Puis. Rhus. Secale corn. Sep. Sil. Staph. Veratr. Eruption. IN GENERAL : Aeon. Amm. carb. Ant. crud. Arn. Ars. Aurum. Bar. Bov. Bnj. Calc. carl). Canth. Carb. an. Carbo veget. Caust. Cic. Clem. Con. Cuprum. Cycl. Dulc. Ferr. Graphit. Hell. Hep. Ipec. Kali. Lach. Lijc. Magn. c. Magn. m. Merc. Natr. Natr. mur. Nitric ac. Nux vom. Oleander. Petr. Phosph. ac. Puis. Rhod. Rhus. Sassap. Selen. Sepice. Sil. Spigelia. Staph. Stront. Sulphur. Sulph. ac. Thuj. Viola, tr. Zinc. ERUPTION, peeling off: Ammon. Bell. Clem. Hell. Led. Merc. Mezer. Phosph. Sepiae. Sil. Staph. — smarting: Bry. Calc. Calc. caust. Caust. Euphorb. Lach. Led. Mezer. Natr. mur. Puis. Sil. Spong. Sulph. — vesicular: Ant. crud. Ars. Bry. Canth. Carbo an. Caustic. Clem. Dulc. Graphit. Hell. Hep. Kali. Lach. Natr. Natr. mur. Nitr. ac. Phosph. Ran. bulb. Rhus. Secale corn. Sep. Sulph. gangrenous : Arsen. Carbo veg. Camph. Sec. corn. — purulent : Ant. tart. Ars. Asa feet. Calc. Clem. Dulc. Hep. Kali bichr. Lye. Merc. Natr. Natr. mur. Nitric ac. Puis. Rhus. Sec. corn. Sep. Sil. Staph. Sulph. Zinc. — humid: Alum. Ars. Bovista. Carbo an. Carbo veg. Caust. Clem. Dulc. Graph. Hep. Kali. Lach. Lye. Nitr. ac. Petr. Rhus. Selen. Sep. Sil. Staph. Sulph. Sulph. ac. — flat : Ars. Asa f. Bell. Lach. Lye. Natr. Nitric ac. Phosph. ac. Selen. Sep. Sil. — corrosive : Ars. Baryt. Borax. Calc. Cham. Con. Graphit. Hep. Kali. Lach. Mercur. Natr. Nitric ac. Pe- trol. Rhus. Sep. Sil. Staph. — yellowish: Creos. Euphorb. Merc. Nitr. ac. — miliary: Agar. Ars. Carbo veget. Graph. Hep. Led. Natr. mur. Nux vom. Zinc. — itching : Aco. Ant. crud. Ant. tart. Ars. Bry. Canth. Caustic. Cham. Clem. Graphit. Ignat. Kali. Lach. Mercur. Mezer. Nitric ac. Oleand. Ran. bulb. Rhus. Sep. Sil. Staph. Sulph. Veratr. — coppery : Arsen. Carbo an. Creos. Lach. Merc. Rhus. Veratr. — nettle-rash : Aco. Apis. Ars. Bell. Bry. Calc. c. Caustic. Cepa. Cop. Dulc. Hep. Ipec. Lye. Natr. mur. Puis. Rhus. Secale corn. Petr. Sep. Sulph. Veratr. — scurfy: Alum. Ant. crudum. Bell. Calc. c. Carbo anim. Carbo veg. Cic. Con. Dulcam. Graph. Hep. Lye. Mercur. Puis. Rhus. Sassap. Sepice. Sil. Sulph. — scaly : Amm. mur. Ars. Aur. Bell. Bry. Calc. c. Clem. Dulc. Graph. Led. Lycopod. Mercur. Oleand. Phosphor. Phosph. ac. Puis. Rhus. Sep. Sulph. — dry : Bar. Calc. c. Carbo veg. Cupr. Dulc. Graph. Led. Lycop. Magn. c. Mercur. Phosph. Sep. Sil. Staph. Veratr. — rickly: Bor. Calc. c. Cham. Graph. Hep. Merc. Natrum. Nitr. ac. Petr. Rhus. Sil. HERPES, generally: Alumin. Ambr. Arsen. Bov. Bry on. Calc. c. Carbo veget. Caustic. Chel. Clem. Chlor. Conium. Creos. Dulc. Fluor, ac. Graphit. Hep. Kali. Lach. Led. Lye. Merc. Natr. Natr. mur. Nitric acid. 124 SKIN AND EXTERNAL SYMPTOMS. Oleander. Petr. Rhus. Pkosph. Sep. Silic. Spig. Staph. Sulph. — suppurating: Dulc. Lycop. Merc. Rims. Sep. Sil. Sulph. — humid : Bov. Calcar. c. Clem. Con. Graphit. Hep. Lach. Lye. Natr. Nitric ac. Rhus. Sep). Sil. Sulph. — spreading: Ars. Calc. Graph. Lye. Merc. Nitr. Petr. Rhus. Sil. Sulph. — furfuraceous : Ars. Calear. Dulc. Graphit. Sep. Sil. Sulphur. — crusty: Bar. Bov. Calc. c. Clem. Con. Dulc. Graphit. Lach. Lye Merc. Rhus. Sep. Sulph. — pustulous: Creos. Mercur. Sulph. — ring-shaped: Natr. Natrum mur. Sep. — scaly: Ars. Clein. Dulcam. Merc. Phosph. Rhus. Sulph. — syphilitic: Aur. Merc. Nitric ac. Thuj. — grape-shaped: Calc. c. — dry: Ars. Bov. Calc. carl). Dulc. Graph. Led. Lye. Merc. Rhus. Sepiae. Sil. Sulphur. Veratr. MEASLES: Aeon. Ars. Bell. Bry. Coif. Dulcam. Iod. Ipec. Mercur. Phosph. Puis. Rhus. Sulph. MILIARIA, white : Ars. Bry on. Ipec. Nuxvom. Sulph. Valer. — of lying-in women: Bry. Ipec. PIMPLES: Ant. cruel. Ars. Bry. Calc. c. Canth. Caustic. Chamom. Con. Dulc. Graph. Kali. Merc. Natr. Natrum mur. Nitric ac. Phosph. Puis. Rhus. Sep. Sil. Spong. Staph. Sulphur. Sulph. ac. Thuj. Zinc. PURPLE-RASH: Aco. Bell. Coff. Sulph. PUSTULES : Ant. crud. Ant. tart. Arn. Ars. Bell. Bryon. Caust. Cic. Clem. Dulcam. Hyosc. Merc. Nitr. ac. Petr. Pulsat. Rhus. Sil. Staphys, Sulph. RASH : Aeon. Ant. crud. Ant. tart. Arn. Ars. Bell. Bry. Canth. Carbo veg. Causticum. Cham. Coffea. Graph. Ipec. Lach. Merc. Phos- phor, ac. Puis. Rhus. Selen. Staph. Sulphur. Veratr. RUBEOLA : Aeon. Bell. Bry. Coff. Merc. Puis. Rhus. SCARLET-RASH: Aconit. Bell. Bry. Coff. Dulc. Ipecac. Merc. Phosph. Sulph. — suppressed: Apis. Bry. Phos. Sul- j)hur. SMALL-POX: Ant. crud. Antim. Tart. Arn. Ars. Bell. Canthar. Mercur. Puis. Rhus. Sil. Sulph. — spurious : Bell. Merc. Pulsat. Rhus. — black: Ars. Rhus. Sec. corn. Sep. Sil. SPOTS, blue: Arn. Ars. Bry. Con. Crot. Lach. Nitric ac. Nux mosch. Nux vom. Op. Phosph. Rhus. Sec. corn. Sulpjhur.ac. — bloody (Petechia) : Arnica. Ars. Bell. Bry. Calc. Conium. Crot. Ferr. Hyosc. Laches. Led. Nitric ac. Nux vomica. Phosph. Puis. Rhus. Ruta. Sec. corn. Sep. Sil. Sulphur. Sulph. ac. — brown red: Cann. Nitr. ac. — raised : Merc. — yellow : Arn. Ars. Conium. Ferr. Iod. Lach. Lycop. Petr. Phosjjh. Sep. Sulph. greenish : Arn. Con. Crot. Ruta. Sep. — liver-colored : Ant. crud. Arn. Calc. Carbo veg. Con. Dulc. Ferr. Lye. Merc. Natrum. Nitric ac. Nuxvom. Phosph. Sep. Sulph. — mottled: Crot. Thuj. — dark-red: Natr. mur. Thuj. — red : Amm. Arn. Bell. Bry. Calc. Carbo veg. Coccul. Cycl. Dulc. Graph. Kali. Lach. Lye. Magn. Merc. Nitr. ac. Phos. Rhus. Sabad. SKIN AND EXTERNAL SYMPTOMS. 125 Sep. Sil. Sulphur. Sulph. ac. — scarlet-red : Amm. Bell. — black: Crot. Lack. Sec. corn. — violet : Yeratr. — white: Alum. Ars. Phospn. Sep. Sil. Sulph. YARICELLA : j±nt. crua. Ant. tart. Bryon. Carbo veg. Ipec. Led. Merc. Pulsat. Rims. Sep. Sil ZONA: Ars. Graph. Mercur. Rhus. Sil. Sulph. Excrescences. CHILBLAINS: Agar. Ant crud. Am. Carbo an. Chain. Lycop. Nitr. Petr. Phosph. Puis. Rhus. Sulph. Sulph. ac Thuj. — blistered: Cepa. Nitric ac. Rhus. — blue-red: Am. Puis. — inflamed: Cham. Xitric ac. Puis. Sulph. — itching: Nitric acid. Nux vom. Sulph- FUNGUS H^MATODES: Arsen. Calc. Carbo an. Carbo veg. Lach. Lycop. Merc. Nitric acid. Phosph. Sil. Sulph. Thuj. FUNGUS MEDULLARIS: Carbo an. Phosph. Sil. FUNGUS ARTICULARIS : Autim. crud. Ars. Creos. Iod. Lach. Rhus. Sil. Staph. Sulph. GANGLIA : Amm. c. Calc. c. Phos. Sil. Zinc. MOLES: Calc. Carbo veg. Merc. Phosph. Sep. Sil. Sulph. Sulph. ac. Thuj. NOMA : Aur. mur. Creos. Fluor, ac. Iod. Sec. corn. POLYPI: Aur. Calc. Con. Hep. Lye. Merc. Nitric ac. Phosph. Puis. Sil. Staph. Sulphur. Teucr. Thuj. STEATOMA: Antim. crud. Baryt. Calc. c. Graph. Hep. Nitric ac. Sabin. Sil. Sulph. SYCOSIC WARTS : Calcar. Lycop. Nitric ac. Phosph. ac. Sabina. Thuj. — hornv : Ant. crud. WARTS : Ars. Bar. Bell. Bor. Calc. Caust. Cepa. Dulc. Hep. Kali bichr. Lach. Lye. Natr. Nitr. ac. Petr. Phos. ac. Rhus Ruta. Sangn. Sep. Sil. Staph. Sulph. Thuj. — bleeding : Natr. c. Nitric ac. Sulph. ac. Thuj. — burning: Arsen. Petr. Rhus. Thuj. — suppurating: Caust. Hep. Sil. — inflamed: Calc. Natr. c. Nitr. acid. Rhus. Sil. — flat: Calc. c. Dulc. — pedunculated: Dulc. Lye. Sabin. Thuj. — horny : Ant. crud,. Natr. carb. Sulph. Thuj. — small: Calc. Rhus. Sulph. — painful : Calc. c. Nitric acid. Sulph. Thuj. — split: Lye. Nitric ac. Phosph. ac. Thuj. ERYSIPELAS: Aeon. Arn. Arsen. Bell. Bry. Calc. c. Camyh. Canth. Carbo an. Graph. Hey. Iod. Lach. Merc. Nitric ac. Phos. Puis. Rhus. Sabad. Sep. Sulyh. — vesicular : ^r.s\|Bell. Canth. Graph. Lach. Phosphor. Puis. Rhus. Sey. Sulph. —flying: Bell. Puis. Rhus. — smooth: Aeon. Amm. Bell. Merc. — with swelling: Amm. Apis. Ars. Bar. Bell. Bryon. Calc. Graph. Hep. Lycop. Merc. Nitric acid. Phosph. Rhus. Sulph. FORMICATION : Arn. Bar. Carbo veg. Bell. Kali. Laur. Lycop. Mm-. ac. Natrum. Nux-YOm. 01eand.P7h. Thuj. VEINS, swelling of : Arn. Bell. Chin. Croc. Ferr. Graph. Hyosc. Phos. Pulsat. Sulph. Thuj. WOUNDS : Arn. Carbo veget. Hep. Lach. Merc. Phosphor. Puis. Rhus. Staph. Sulphur. Sulph. ae. Zinc. — bleeding: Arn. Laches. Phosph: Sulph. Sulph. ac. — cut: Arn. Staph. Sulph. ae. — contused: Arn. Con. Hepar. Rhus. Rut a. Sulph. ac. — punctured: Carbo veget. Cic. Con. Hep. Xitric ae. by insects: Aconit. Apis. Arn. Bell. Calad. Lach. Merc. Seneg. — burns: Aco. Arn. Ars. Canthar. Carbo veg. Caustic. Creos. Sulph. ac. Urtic. ur. XXII SLEEP, DREAMS. CLAIRVOYANT STATE: Aconit. Op. Phosph. Sil. Sulph. DROWSINESS, in the evening : Ant, tart. Ars. Asa f. Bar. Bell. Bov. Calc. c. China. Cin. Con. Croc. Crotal. Ign. Kali. Lach. Laur. Natr. mur. N. vom, Phosph. Ph. ac. Puis. Rhus. Selen. Sil. Valer. -in the morning : Ant. crudivm. Arn. Asa f. Calc. c. Caust. Con. Graph. Kali. Merc. Natr. Natr. mur. Aux vom. Phosphor. Phosph. ae. Puis. SLEEP, DREAMS. 129 Rhus. Sep. Sil. Spig. Stram. Sulph. — in the afternoon : Agar. Canthar. Caust. Chin. Coff. Croc. Graphit. Guaj. Ignat. Kali. Lach. Laur. Lycop. Mur. ac. Natr. Natr. mur. N. vom. 01. an. Phosph. Pulsat. Rhus. Sep. Sil. Staph. Sulph. Thuj. Veratr. Viol. tr. Zinc. — in the day-time : Agar. Arabr. Amm. carb. Anac. Ant. crud. Ant. tart. Ars. Asa f. Aur. Bell. Bry. Calc. c. Canthar. Carbo veg-. Caust. Cham. China. Coccul. Con. Croc. Dulc. Ferr. Gent. Graph. Hell. Ign. Kali. Lact. Laur. Led. Lye. Mercur. Mosch. Natr. Natr. mur. Nitr. ac. N. mosclt. N. vom. Op. Phosph. Phosphor, ac. Pulsat. Ran. bulb. Rheum. Rhus. Sabad. Selen. Sep. Sil. Stram. Sulph. Tart. Veratrum. Viola tr. — in the forenoon: Agar. Ant. crud. Ant. tart. Cannabis. Carbo veget. Fluor, ac. Graphit. Kali. Laches. Mosch. Natrum. Sabad. Sassap. Sepise. Sulph. — excessive' Ant. tart. Coff. Croc. N mosch. Op. Phosph. ac. FALLING ASLEEP TOO LATE : Alum. Anac. Ant. tart. Ars. Bellad. Bry. Calad. Calc. c. Carbo an Car- bo veg. Caust. Chin. Creos. Graphit. Guaj. Ignat. Lach. Led. Lye. Merc. Natrum carb. Natr. mur. N. vom. Petr. Phosphor. Puis. Rhus. Selen. 5ep.Sil. Spig. Stann. Sulph. Positions in Sleep. ARMS AB OVE THE HEAD: Calc. c. N. vom. Plat. Puis. Ve- ON THE STOMACH: Bell. Coc- cul. Ign. Stram. LEGS STRETCHED : BeUad. Cham. Puis. — drawn up : Carbo veg. Cham. Plat. Puis. only one : Stann. HAND UNDER THE OCCIPUT: Ign. — under the head : Antim. tart. Ars. N. vom. Pulsat. Spigel. Viol. od. BOTH HANDS UNDER THE OC- CIPUT: Ambr. KNEES SPREAD : Cham. M. arct. Plat. Viol. od. HEAD DRAWN BACK : Bell. Cina. Hell. Hyosc. Ign. — inclined forward : Cic. Puis. Staph. Viol. od. — stooping: Arn. Spong. — toward the back : Ambr. Ant. tart. Ars. Bry. Calc. c. China. Cic. Ferr. Ign. Lye. Nux vom. Phosph. Puis. Rhus. Stram. Sulph. — on one side: Par. Merc. Natr. Nux vom. Phosph. Spigel. Sulph. — to left side: Lye. Natr. carb. Phosph. — to right side : Merc. Phosph. SITTING: Aeon. Ars. Lye. Puis. Sulph. SLEEP, with nightmare : Calcar. Caust. Puis. Sulph. —with starting up : Ars. Bell. Cham. Cina. Coff. Graphit. Ign. Ipecac. Kali. Lycop. Op. Samb. Sulph. — with screaming : Antim. tart. Bell. Cham. Rheum. Zinc. — with eyes half open : Cin. Ipec. Op. — stupid: Ant. tart. Bell. Calad. Calc. c. Camphor. Cic. Con. Croc. Graph. Ign. Led. N. mosch. Nux vom. Op. Phosph. Puis. Sec. com. Spig. Valer. — with throwing off the cover: Cham. Con. Puis. — sound : Ant. crud. Antim. tart. Ars. Bell. Camph. Cic. Croc. Ign. Led. Mosch. N. mosch. Op. Phosphor. ac. Puis. Sec. corn. Selen. Stram. Veratr. — with grasping at flocks : Ant. tart. Ars. Hyosc. 130 SLEEP, DREAMS. -early : Anac. Ant. tart. Asa f . Calc. Caust. Con. Croc. Graph. Ignat. Kali. Laur. Lye. Merc. Natr. N. vom. Phosphor. Phosph. ac.Puls. Sep. Sil. Sulph. Veratr. -settling down in bed : Mnriat. acid, -tossing about : Arsen. Bell. Cham. Cin. Hep. Laches. Kheum. Rhus, -too long: Am. Bellad. Calc. Carbo veget. Coccul. Hyosc. Kali. Ign. Merc. N. vom. Phos. Phosph. ac. Plat. Sep. Verat. -too light: Anac. Ars. Bry. Carbo veg. Chin. Ferr. Ignat. Merc. N. vom. 01. an. Selen. Sil. -with open'mouth : Cin. Merc. Rhus, -with somnambulism : Bryon. Phos. Sulph. , -with talking: Alum. Arnica. Bell. Carbo an. Cham. Magn. c. Nux vom. Puis. Ehus. Sil. Sulph. -slumber-like: Graph. -with snoring : Cainph. Cham. Chin. Dulc. Fluor, ac. Graph. Hep. Op. Sil. Sulph. Stram. -loud talking : N.vom. -with moaning : Alum. Cham. Ign. Merc. Op. -with involuntary stool : Arnic. -unrefreshing : Aeon. Alum. Ambr. Ant. tart. Bellad. Bry. Calc. Cann. Carbo veg. Caust. Chel. Chin. Cic. Con. Croc. Ferr. Graph. Hep. Ign. Kali. Lach. Lye. Magn. mur. Merc. Natr. Natr. mur. Nitric ac. N.vom. Op. Petr. Phosph. Phosph. acid. Puis. Rhus. Secale corn. Selen. Sil. Spigel. Staphys. Sulph. Viola trie, -restless: Agn. Alum. Antim. tart. Ars. Asa f . Aur Bar. Bell. Bor. Bry. Calc. Cane. Cann. Caustic. Cina. Cham. China. Coccul. Coff. Coloc. Creos. Daph. Dig. Dulcam. Ferr. Graph. Hep. Ign. Kali. Lach. Lijc. Mang. Merc. Mosch. Mur. ac. Natr. Nitric ac. Nux vom. Petr. Phosph. Puis. Rat. Rheum. Rhod. Rhus. Sa- bad. Sec. corn. Sep. Sil. Sulphur. Tereb. Thuj. Veratr. "Viola tr. — interrupted: Ars. Cina. Cocc. Ign. Kali. Merc. Pulsat. Rhus. Sulph. SLEEPLESSNESS : Aeon. Ambra. Anac. Ars. Bar. Bell. Bry. Calc. c. Cainph. Cann. Caust. Cham. Chin. Cin. Coff. Con. Creos. Dapjh. Dig. Dulc. Ferr. Fluor, ac. Graph. Hep. Hydr. ac. Hxjosc. Ign. Kali. Lach. Led. Lycop. Merc. Mosch. Natr. Nux vom. Op. Oleand. Phosphor. Puis. Rhod. Rhus. Sangn. Selen. Sep. Sil. Squill. Sulph. Sulph. ac. Thuj. Valer. Yerat. Vine. — before midnight : Ars. Bellad. Bry. Calc. c. Carbo anim. Carbo veget. Chin. Con. Cycl. Graphit. Ign. Kali. Laches. Lye. Merc. Natr. Ni- tric acid. Phosphor. Pulsat. Rhus. Selen. Sep. Sil. Spig. Staph. Sulph. Valer. — after midnight : Ars. Asa feet. Aur. Capsic. Coffea. Hep. Hyosc. Kali. Lach. Lye. Merc. Natrum. Nitric ac. Nux vom. Plat. Pulsat. Bhodod. Rhus.Samb. Sep. SiZ.Sulph. ac.Thuj. SOPOR: Agn. Ant. crud. Ant. tart. Arn. Bar. Bell. Brom. Camph. Cic. Con. Croc. Graphit. Hell. Ign. Kali. Lact.Laur. Merc. Mosch. N. mosch. Op. Phosph. ac. Plumb. Puis. Sec. corn. Teratr. Vit. WAKING, too early: Ars. Asa feet. Bryon. Calc. c. Coff. Croc. Dulc. Hep. Ign. Kali. Lye. Magn. Mur. ac. Nati*. carbon. N. vom. Phosph. ac. Ran. bulb. Rhod. Sep. Sil. — frequent: Ambra. Ant. crud. Arn. Ars. Bell. Bism. Calc.c. Cann. Car- bo anim. Caust. Cham. Chin. Cic. Coff. Dig. Fluor, ac. Graph. Hep. Kali. Lye. Mang. Merc. Nitric ac. Xux vom. Phell. Phosph. Pulsat. Rhus. Ruta. Samb. Selen. Sep. Sil. Staph. Sulphur. Sulph. ac. Tereb. Teucrium. Zinc. SLEEP, DREAMS. 131 — difficult: Antim. tart. Con, Nitric ac. Op. Rhus. — too late : Am. Calc. Caustic. China. Con. Graph. Kali. Lach. Laur. Merc. Xatr. carb. Nux vom. Olean. Pkosph. Phosph. ac. ;Pulsat. Sep. Sil. Sulph. YAWNING: Ant. tart. Ars. Bellad. Bry. Calc. c. Caust. Chamom. Cin. Coccul. Creos. Croc. Ferr. Hell. Ign. Kali. Laur. Lye. Mur. ac. Natr. Xatr. mur. N. vom. Op. Plios. Puis. Rhus. Sep. Sil. Stann. Staph. Sulph. Yeratr. — with stretching : Ars. Calc. c. Caust. Cham. Ign. Ipec. Xux vom. Puis. Rhus. Spongia. Staph. Valer. — spasmodic: Ign. Plat. Rhus. Dreams. IN GENERAL: Aeon. Alum. Am- bra. Ant. tart. Arn. Bellad. Bry. Calc. Caps. Carbo veget. Cham. Chin. Cic. Con. Croc. Graph. Hell. Hep. Tgnat. Kali. Lach. Laur. Lye. M. arct. Magn. Mang. Merc. Na- trum. Xatr. mur. Nitric ac. N. vom. Op. Par. Phosphor. Phos. ac. Puis. Ran. sc. Rhus. Sabad. Sec. corn. Sep. Sil. Stann. Staph. Stram. Sulph. Thuj. Valer. Vit. ANXIOUS : Aeon. Ambr. Anac. Arn. I Ars. Aur. Bar. Bellad. Calc. c. Cann. Carbo veg. Caust. Chamom. Chin. Con. Creos. Fluor, acid. Graphit. Hep. Iod. Ign. Kali. Lye. Mann. carb. Merc. Xatr. Natrum mur. N. vom. Op. Phosph. Psor. Puis. Rhus. Sassap. Sep. Stram. Sulphur. Teucr. Thuj. Yeratr. DREAMS, of thieves: Aur. Magn. m. Merc. Yeratr. — of falling: Bell. Digit. Ignat. Merc. Phosph. ac. Thuj. into water : Ferr. Magn. c. — of fire : Alum. Anac. Antim. tart. Calc. carb. Hep. Plagn. Magn. mur. Phos. Rhus. Spig. — of war: Hyosc. Magn. carb. Thuj. — of animals : Arn. Hyosc. Xux vom. — of wild animals: Xux vom. — of death: Coccul. Kali carb. Nux vom. Plat. — of dead bodies: Anac. Ars. Aur. Brom. Calc. c. Graphit. Iod. Kali. Magn. carb. Phos. ac. Sulph. ac. Thuj. — of poisoning: Natr. mur. — of imprisonment : Clem. — of dead persons : Natr. carb. Sulph. acid. — of water : Amm. mur. Arsen. Ferr. Graphit. Ign. Magn. carb. Merc. Natr. Nitr. Sil. — of quarreling: Arn. Calcar. Cham. Magn. carb. N. vom. Phosph. Puis. Selen. Stann. — vexing: Ambra. Ars. Asar. Caust. Cham. Con. Hep. Ign. Natr. Nux vom. Phell. Phosph. Rhus. Staph. Sulph. — pleasant : Agar. Alum. Ant. crud. Calc. c. Carbo veget. Coccul. Coff. Croc. Graphit. Ignat. Kali. Lach. Mercur. Natr. Natr. mur. Xux vom. Op. Phosph. Puis. Sep. Sil. Staph. Sulph. Viol. tr. — of flowers: Natr. c. — of fine country : 01. an. — of gold: Cycl. Magn. c. — of journeys: Crot. Lach. Magn. carb. Op. — of dancing: Magn. carb. — continued : Calc. carb. Ign. Xatr. c. Puis. — nauseous: Amm. carb. Natr. mur. Zinc. — that can be remembered: Bellad. Natr. mur. Phosph. —frightful : Calcar. c. China. Graph. Kali. Lye. Nux vom. Op. Phosph. Puis. — lascivious : Antim. crud. Calc. c. Canth. Chel. Con. Graphit. Ignat. 132 GENERAL SYMPTOMS. Kali. Lack. Lye. Merc. Natr. Natr. mur. Nux vom. Oleand. Op. Plat. Plumbum. Puis. Sep. Staph. Thuj. Tine. Viol. tr. -indifferent: Chin. Ign. Nux vom. Puis. Stront. Sulph. -half -awake : Op. -vivid : Anae. Arn. Ars.TSell. Calc. c Canthar. Cham. Cic. Coffea. Con. Fluor, ac. Ignat. Lach. Lye. Magn. carb. Mang. Merc. Natr. Natrum mur. Petr. Phosphor. Pulsat, Rhus. Euta. Sil. Squill. Sulph. -merry : Caust. Laur. Op. -fanciful : Calc. c. Kali. Lach. Natr. Nitric ac. — wandering : Calc c. Kali. Lye. Natr- Natr. mur. Nux vom. Sulph. — sad: Ign. Laur. Natr. c. Op. Phos. Zinc. — that cannot be remembered : Aur. Bellad. Cic. Hell. Ign. Iod. Lach. Lye. Merc. Natr. Natr. mur. 01. an. Plat. Ehus. Samb. Selen. Spig. Sulph. Tar. Yeratr. — confused: Bar. Calc. c. Chin. Cic. Crot, Hell. Led. M. austr. Natr. Petr. Phos. Puis. Spig. Stann. — wakeful: Aeon. Am, Bell. Cham. Lach. Merc. Nux vom. Op. Phos. ac. Stram. XXI GENERAL SYMPTOMS. (AH the pains which belong exclusively or mor particularly to a certain part should be looked for under chat head.) AGGBAYATION, in the afternoon: Agar. Alum. Ant. crud, Asaf. Bell. Bism. Calc, Canth. Carbo veget. Caustic. Cic. Coccul. Coloc. Con, Creos. Ferr. Hell. Ign. Lach, Laur. Lye. Mosch. Nitr. Nitric ac. Nux vom. Op. Phosph. Puis. Euta. Selen. Seneg. Sil. Spig. Staph. Teucr. Thuj. Yeratr. Zinc. — in the open air: Agar. Ambr. Arn. Bar. Calc Camph. Carb. an. Cham. Chin. Coeeul. Coff. Ferr. Guaj. Ign. Lach. Lye. M. austr. Mur. ac. Natr. Nitric ac. N mosch. I. vom. Op. Phosph. ac. Rhus. Selen. Sil. Spig. &taph. Stram. Sulph. ac. Thuj. Yiol. tr. — when alone : Ars. Kali. Lye. Stram. — before breakfast : Amm. mur. Bar. Calc Cann. Caustic. Croc Ferr. Ign. Iod. Kali. Laches. Lye. Nux vom. Plat, Plumb. Ehus. Sabad. Spig el. Staph. Yaler. Yerb. — by changing one's position : Caps. Carbo veg. Ferr. Lach. Lyeopod. Phosph. Puis. Ehus. when chewing : Alum. Amm. Amm. mur. Bell. Bry. Calc. Ch ina. Euphr. Hep. Ignat. Mang. Men. Natr mur. Nitric ac. Oleand. Phospjh. Phosph. ac. Puis. Rhus. Sabin. Sep. Staph. Sulph. ac. Thuj. Zinc. -in the cold: Aco. Amm. Arn. Arg. Ars. Aur. Bar. Bellad. Camph. Carbo veg. Caust. Cic. Con. Dulc. Graph. Hell. Hep. Hyoscyam. Ign. Kali. Magn. Magn. muriat. Mosch. Nux vom. Petr. Phos. Bhod. Rhus. Sabad. Sep. Sil. Spong. Squill. Stront. Sulphur, ac. Yeratr. •in company: Bar. Hell. Lye. Natr. Phosph. Plumbum. Sep. Stann. -by contact: Aeon. Ang. Arn. Ars. Bell. Bov. Bnj. Cann. Carbo veg. Cham. Chel. Cin. Coccul. Colch. Cupr. Ferram. Graph. Hell. Hep. Hyosc Led. Lye. Magn. mur. Merc. Mezer. Nitric ae. Nux vom. Oleand. GENERAL SYMPTOMS. 133 Phosph. acid. Pulsat. Ran. bulb. Ehoclod. Rhus. Sabin. Sec. corn. Sep). Sil. Spig. Staph. Strain. Sulph. Tart. emet. Yeratr. -gentle contact: Bell. China. Jfux vom. -by crying: Arn. Bell. Cham. Cupr. Lach. Puis. Yeratr. -by a draught of air: Bell ad. Cole. Cham. Chin. Hep. Ign. Kali. Led. Xatr. Nux vom. Puis. Rhus. Selen. Sep. Silic. Sulph. -drinking coffee : Canth. Caustic. Cham. Coccul. Ign. Lye. Merc. Nux vom. Pnlsat. Rhus. Sid ph. — cold liquids: Ant. crud. Ars. Caustic. Con. Graph. Ign. Lye. " Mang. Merc. Xux mosch. Nux vom. Rhod. Rhus. Sulph. Yeratr. -after drinking: Ars. Bry. Cham. China. Coccul. Coloc. Con. Croc. Dros. Ferr. Hep. Ign. Merc. Mezer. Xatr. Xatr. mur. Nux vom. Puis. Rhus. Ruta. Squill/Sep. Sil Sulph. Tart. emet. Yeratr. -while drinking : Anac. Arsen. Bell. Bry. Canth. Colch. Hyosc. Ign. Iod. Lach. Mercur. Phosph. Rhus. Sep. Sulph. Strain. -drinking beer: Ferr. Lye. N. vom. Puis. Bhus. Stram. Sulph. Yerat. -drinking tea : Ferr. Selen. warm liquids : Ambr. Anac. Bell. Bryon. Carbo veg. Cham. Hell. Kali. Mezer. Phosphor. Pulsat. Spig. Sulph. ac. cold water : Arsen. Bell. Canth. Croc. Ign. Lye. Natrum. N. vom. Phos. ac. Rhod. Bhus. Sulph. Sulph. ac. Yeratrum. wine : Ant. crud. Ars. Cede. Coff. Lach. Lye. Xatr. Xatr. mur. Xux vom. Op. Ban. bulb. Selen. Sil. Zinc vinegar: Ant. crud, Ars. Ferr. Lach. Nux vom. Sulph. -before eating: Ambr. Calc. Chel. Croc. Ferr. Graph. Ign. Iod. Kali. Lach. Laur. Natr. Phosph. Plumb. Puis. Rhus. Sabad. Sulph. while eating : Amm. Ars. Bar. Bry. Calc. Carbo an. Carbo veg. Cham. Coccul. Graph. Hep. Kali. Lach. Lycop. M. arct. Xatr. Natr. mur. Nitric ac. Phosph. Puis. Rhod. Sep. Thuj. Yeratr. — after eating: Amnion, mur. Anac. Ars. Asaf. Bryon. Calc. Carb. veg. Caust. Cham. China. Con. Graph. Hyosc. Iod. Kali. Lycopod. Merc. Mur. ac. Xatr. Natrum mur. Ni- tric acid. Xux vom. Posph. Pulsat. Rhus. Sep. Sil. Sulph. Sulph. ac. Yeratrum. Zinc. — by eating bread: Bry. China. Kali. Xatrum mur. Xux vom. Puis. Rhus. Sep. Staphysag. Sulph. Zinc. eggs: Ferr. fat : Ars. Carbo veget. Cycl. Ferr. Hell. Magn. mm-. Nitric ac. X. vom. Pulsat. Sep. Sulph. Tar. Thuj. fish : Kali. Plumb. smoked meat : Calc. Sil. vegetables : Ars. Bryon. Hell. Lijc. Xatr. Puis. Yerat. honey: Natr. peas and beans: Bry. Calc. Lye. Xatr. mur. Petr. Puis. meat: Carb. an. Ferr. Puis. Staph. Sulph. oysters : Lye. pastry : Carbo veg. Puis. roots : Calc. Lye. Puis. onions: Xatr. Thuj. potatoes : Yeratr. farinaceous food : Sulph. milk: Ambr. Arsen. Bryon. Calc. Cham. China. Con. Ign. Kali. Lye. Natr. Xatr. mur. Nitr. ac. X. vom. Samb. Sep. Spong. Sulph. fruit : Arsen. Bry. Carbo veg. Chin. Magn. mur. Puis. Rhod. Selen. Yeratr. 134 C&SNERAL SYMPTOMS. — turnips: Puis. salt food : Carbo veg. Lye. — sour food : Ant. crud. Ars. Ferr. Natr. Nux vom. Sep. Sulph. sweet : Cliarn. Ignat. Natr. Merc. -by eructations: Cann. Chamom. Coccul. Kali. Laches. Phosph. Plumb. Rhus. Sabin. Sep. -in the evening : Arribr. Amm. Ant. crud. Arn. Ars. Asa f. Bell. Bry. Calacl. Calcar. Caps. Carbo veg. Caust. Coff. Colch. Croc. Dulcam. Euphr. Ferr. Hell. Hyosc. Ignat. Iod. Lach. Lycop. M. austr. Magn. Men. Merc. Mtr. ac. Vetr. Phosph. Plat. Puis. Ean. sc. Rhod. Ehus. Selen. Sep. Sil. Sulphur. Sulph. ac. Tart. emet. Thuj. Zinc. -during expirations: Bry. Caustic. Colchic. Dig. Ign. Iod. Oleancl. Puis. Sep. Spigel. Veratr. Viol. od. -in the fall : Chin. Colchicum. Ehus. Veratr. ■in a feather-bed: Aur. Coloc Lycopod. Mang. Merc. Pulsat. Rhus. Sulph. -in the forenoon : Alum. Ambra. Ant. crud. Argent. Bar. Calc. Cann. Carb. vegetab. Caust. Coc- cul. Con. Euphorb. Ferr. Gh~aph. Guaj. Hep. Ign. Kali. Laur. Lye. Magn. mm. Mang. Nux mosch. Nux vom. Phosph. Phosph. ac. Puis. Rhus. Sabacl. Selen. Sepiae. Sil. Spig. Staph. Sulphur. Sulph. ac. Viol. tr. -when hungry: Aur. Graphit. Iod. Kali. inspiration: Aconit. Anac. Arn. Bry. Calc. Chamon. Croc. Guaj. Hyosc. Ipec. Lye. Merc. Mosch. Oleand. Rhus. Sabad. Sabina. Selen. Squill. Spong. Sulph. -by laughing : Ars. Bell. Bor. Carbo veg. Chin. Con. Nux vom. Phosph. Stann. — in bright light : Ant. crudum. Bell.. Calc. Cham. China. Coffea. Con. Croc. Euphr. Graph. Hep. Ign. Lye. Magn. mm. Merc. Natr. Nux vom. Phosphor. Phosph. ac. Pul- sat. Rhus. Sep. Sil. Spig. Strain. Sulph. -when looking in the bright light : Bry. Bell. Calc. Kali. Merc. Phosph. Zinc. down : Calc. Spig. up : Calc. Graphit. Puis. Selen. Sil. Thuj. sidewise : Bell. lying down : Ambra. Amm. mur. Ars. Asaf. Aur. Aur. mur. Bry. Canth. Caps. Chamom. Coloc. Conium. Croc. Dros. Dulc.Ferr. I^n. Kali. Lye. Magn. mur. Men. Mur. ac. Natr. Op. Phos. ac. Plat. Puis. Rhod. Rhus. Samb. Selen. Sepise. Stann. Stront. Sulph. Tar. Tart. emet. Teucr. in bed : Alum. Ambr. Ant. crud. Ars. Aur. Bellad. Bor. Calc. Carbo veg. Cham. Chin. Cina, Coff. Coloc. Dros. Ferr. Graph. Ign. Iod. Kali. Led. Lycop. Magn. Mang. Merc. Mur. ac. Nitric ac. Nux vom. Phosph. Plat. Puis. Rhod. Rhus. Samb. Sec. corn. Selen. Sep. Sil. Spig. Sulphur. Tart. emet. Veratr. Viol. od. on the back : Ars. Canth. Caust. Cham. Chin. Cuprum. Ign. Iod. Kali. Lach. Mercur. N. vom. Phos. Puis. Rhus. Sep. Sulph. Thuj. on the side : Aeon. Anac. Arn. Bry. Calad. Calc. Carbo an. Con. Ferr. Ign. Kali. Lye. Merc. N. vom. Puis. Seneg. Stann. Sulph. Viol. tr. on the painful side : Aeon. Arn. Ars. Bar. Calad. Caustic. Chin. Graph. Hep. Iod. Kali Lye. GENERAL SYMPTOMS. 135 Magn, Nitr. ac. N. mosch. N. vom. Phosphor. Phosph. ac. Bate. Selen. Sil. Spong. Thuj. - — on the painless side: Anibr. Arn. Bry. Calcar. Caustic. Cham. Coloc. Ignat. Kali. M. anstr. Puis. Rhus. Stann. -after lying down in the evening : Ambr. Amm. Ars. Aur. Caustic. Cham. Coff. Dros. Dulc. Ferr. Hyosc. Ign. Kali. Lye. Magn. Magn. mur. Nitric ac. Plat. Plumb. Puis. Rhus. Samb. Seneg. Sepice. Stront. Sulph. Tar. emet. Veratr. Viol. od. -at new-moon : Calc. Caustic. Cupr. Lye. Sep. Sil. -at full-moon: Calc. Graph. Natr. Sil. Sulph. -in the morning: Aeon. Ambr. Amm. mur. Ant. crud. Aur. Calad. Calc. Carb. an. Garb. veg. Chel. Cic. Coccul. Coffea. Con. Croc. Dulcam, Euphr. Graph. Hep. Hyosc. Ign. Iod. Kali. Lye. M. austr. Natr. Natr. mur. Nitr. Nitric ac. N. vom. Op. Petr. Phosph. Phosph. ac. Rheum. Rhodod. Rhus. Selen. Sep. Squill. Staph. Sulphur. Tar. Tart, emet. Veratr. -during motion: Anac. Arn. Asar. Bell. Bry. Camphor. Carb. veg. Chel. Coccul. Colchic. Croc. Graph. Hell. Hep. Iod. Led. M. austr. Mercur. Natr. Natr. mur. Nitric ac.N. vom. Petr. Phosphor. Rhod. Rhus. Sab ad. Sec. corn. Selen. Squill. Spig. Spongia. Staph. Sulph. ac. -at the beginning of motion: taps. Caust. Con. Ferrum. Lye. Phosph. Puis. Rhus. Samb. at night: Aeon. Ambr. Ang. Ant. crud. Am. Arsen. Aur. Bell. Bry. Calc. Camph. Canth. Caps. Carbo an. Caust. Cham. Chin. Coff. Colch. Con. Croc. Cupr. Dulcam. Ferr. Graph. Hell. Hep. Ign. Iod. Kali. Lach. Lycop. Magn. Magn. mur. Mang. Merc. Mezer. Natr. mur. Ni- tric ac. Nux vom. Op. Phosphor. Plumb. Samb. Secale corn. Selen. Sil. Staplujs. Stront. Sulph. Tar. emet. Thuj. —when nursing : Aeon. Bell. Bryon. Calcar. Cham. China. Con. Dulc. Kali. Merc. Phos. ac. Pulsat. Rhus. Sep. Sil. Staph. Sulph. — by suppressed perspiration: Bell. Bryon. Calc. Cham. Chin. Dulc. Kali. Lye. Merc. Nux vom. Oleand. Phosphor. Phosph. ac. Rhus. Sec. corn. Sep. SO. Sulph. — by external pressure : Agar. Ang. Ant. crud. Bar. Bry. Cann. Carbo veg. Cina. Cupr. Hepar. Ign. Iod. Lach. Lye. Mosch. Natrum mur. Oleand. Plat. Ruta. Sabin. Selen. Sep. Sil. Spong. Staph. Stramon. Sulph. Verb. — raising the trunk : Aeon. Arn. Ars. Bell. Bry. Cham. China, C ic. Con. Ferr. Ignat. Mur. ac. N. vom. Op. Phosph. Puis. Rhus. Squill. Spong. Sulph. Sulph. ac. — by reading : Asa f . Bar. Bell. Calc. Chin. Coff. Con. Croc. Graph. Ign. Kali. Lye. Natr. Natr. mur. Nux vom. Phos. Sil. Sulph. Sulph. ac. Vit. —during rest : Arsen. Asa f cet. Aur. Calc. Caps. Chin. Coloc. Con. Dul- cam. Euphorb. Ferr. Ignat. Kali. Lach. Lye. Mosch. Natrum. Nitr. Oleand. Op. Phosphor, ac. Plat. Puis. Rhod. Rhus. Sabad. Samb. Selen. Sep. Stannum. Stront. Tar. Thuj. Valer. Veratrum. Viol. tr. —when rising from a seat : Bell. Bry. Calcar. Caps. Carbo veget. Cham. Coccul. Con. Ferr. Graph. Ign. Laches. Laur. Lye. Natr. mur. Nux vom. Phos. Pulsat. Rhus. Selen. Spig. Tart. emet. Thuj. 136 GENERAL SYMPTOMS. -in the room: Aeon. Alumina. Anac. Ant. crud. Asa itet. Asar. Calc. Carbo veget. Cic. Con. Croc. Graph. Hell. Iod. Lijc. Magn. Mezer. Natrum miir. Phosph. Plumb. Puis. Ran. sc. Lhodod. Sabina. Selen. Spong. Stann. Ve- ratr. Vit. -by running : Arn. Ars. Bell. Bry. Caust. Ign. Led. Natr. mur. N. vom. Oleand. Sil. Sulph. -by sexual intercourse : Calad. Kali. Selen. -after sexual intercourse : Agar. Calad. Calc. Chin. Kali. Natr. Petr. Phos. ac. Selen. Sep. Staph, -when sitting: Agar. Ambr. Ant. crud. Asa f. Aur. Bar. Calc. Capjs. Chin. Cina. Coff. Con. Cuprum. Cycl. Dulc. Euphorb. Graph. Ignat. Iod. Lach. Lye. M. arct. Magn. mur. Muriat. ac. Natr. Ni- tric ac. Oleand. Phosph. ac. Pla- tina. Puis. Rhod. Rhus. Sabad. Seneg. Sep. Spong. Sulph. ac. Tar. Thuj. Veratrum. Verb. Viol. tr. -smoking tobacco : Ant. crud. Calc. China. Euphr. Ignat. Lach. Nux vom. Puis. Rhus. Ruta, Selen. Spong. Staph. -in the spring: Ambr. Bellad. Calc. Carbo veg. Lye. Natr. mur. Puis. Rhus. Sulph. Veratrum. -when standing: Alum. Aur. Cal- car. Cann. Caustic. Coloc. Con. Cycl. Euphr. Ferrum. Graph. Ign. Laur. Lye. Magn. mur. Mosch. Natr. Oleander. Op. Phosph. ac. Puis. Rhod. Rhus. Samb. Sep. Staphys. Sulph. Tar. Valer. Ye- ratr. -when stooping: Aco. Aniui. Arn. Bar. Bry. Calc. Caps. Cham. Coc- cul. Croc. Graph. Hep. Ipec. Kali. Mang. Mercur. Nitr. Oleander. Petr. Plumb. Rhod. Seneg. Sep. Sil. Spigel. Stront. Teucr. Thuj. Valer. — in the summer : Antim. crud. Bell. Bry. Carbo veget. Lach. Lye. Natr. Natr. mur. Puis. Selen. Veratr. — in the sun : Antim. crud. Camphor. Euphr. Graphit. Ipecac. Lach. Natr. Pulsat. Selen. — after suppressed catarrh: Bry. Calc. Carbo veg. Chin. Con. Dulc. Graph. Ipec. Lye. Merc. Natr. mur. Nitric ac. Nux vom. Phosph. Puis. Rhod. Sep. Sil. Sulph. Sulph. ac. — when swallowing : Aeon. Ars. Bar. Bell. Bry. Camph. Chin. Coccul. Coffea. Croc. Hep. Hyosc. Kali. Magn. Merc. Nitric acid. Nux vom. Petr. Phos. Puis. Rhus. Sassap. Sep. Spig. Staph. Thuj. Veratrum. —after swallowing: Ambr. Bry. Cham. Hep. Lgn. Iod. Nitric ac. N. vom. Phos. Pulsat. Rhus. Zinc. — between the acts of swallowing: Ambra. Arn. Graphit. Lgn. Lach. Laur. Merc. Nux vom. Phosph. ac. Sabin. Spong. Stann. Staph. — when sweating: Aeon. Arsen. Bry. Caust. Cham. Cocc. Dig. Ferr. Lgn. Ipec. Lycop. Merc. Natr. Nux vom. Op. Phosph. Pulsat. Rhus. Selen. Sep. Stram. Sulph. Tart. em. Thuj. Veratr. — when talking: Ambr. Arnica. Bell. Calc. Cann. Cham. Chin. Coccul. Dig. Dulc. Graph. Ign. Lod. Lye. Mang. Merc. Natrum. Natr. mur. Phosph. Phosph. ac. Rhus. Selen. Sep. Sulph. — during a thunder-storm : Lach. Na- trum. Phosph. Rhod. Sil. — after uncovering one's self: Ant, crud. Ars. Aur. Bell. Cham. China. Cic. Clem. Colchic. Graph. Hep. Hyosc. Ign. Lach. Natr. Natr. mur. Nux mosch. Nux vom. Puis. Rhod. Rhus. Samb. Sil. Stram. Stront. GENERAL SYMPTOMS. 137 — from vomiting-. Ars. Asar. Bryon. Cupr. Ipec. Nux vom. Plumb. Puis. Sep. Sil. Sulphur. Veratr. —on waking: Ambra. Amm. mur. Arn. Ars. Bryon. Calad. Calc. Car- bo veg. Caust. Chin. Coccul. Digit. (xraphit. Hepar. Ign. Kali Magn. mur. Merc. Natr. Natr. mur. Nitric acid. Nux vom. Phosphor. Pulsat. Rhus. Sabin. Samb. Sepice. Staple. Stront. Sulph. — walking fast: Arn. Ars. Bell. Bry. Caust. Cupr. Led. Lye. Nux vom. Oleander. Rhus. Silic. Spig. Squill Sulph. — when walking out into the cold air : Ars. Caust. Mosch. Nux vom. Ban. bulb. Sabad. — in warmth : Ambr. Ant. crud/Bell. Calad. Carb. veg. Cham. Coc. Bros. Graph. Ign. Iod. Ipec. Lach. Led. Lye. Merc. Natr. mur. Nux mosch. Op. Phosph. ac. Pulsat. Rhus. Sec. coru. Selen. Senega. Sep. Staph. Tart. emet. Thuj. — by watching : Ambra. Coccul. Here. N. vom. Puis. Selen. Sep. — after getting wet: Ars. Bell. Bry. Calc. Colch. Dulcam. Ipec. Lye. N. mosch. Pulsat. Rhus. Sec. corn. Sep.Sulpli. — by a change of weather : Ammon. Bry. Calc. Dule. Graphit. Mang. Nux mosch. Phosph. Puis. Bhod. Rhus. Sep. Sil. Sulph. — damp weather: Ammon. Aur. Calc. Carbo veg. Chin. Dule. Ferr. Lach. Laur. Lye. Merc. Muriat. ac. Nitric ac. >'ux mosch. Puis. Rhod. Rhus. Rata. Seneg. Spig. Staphys. Sulph. Veratr. — in stormy weather : Arsenic. Cham. Lach. Lye. Mur. ac. Natr. N. mosch. Nux vom. Phos. Puis. Rhod. Rhus. Spig. Sulph. — in dry weather: Asar. Bellad. Bry. Carbo veg. Caustic. Cham. Hep. Ipec. Mur. ac. Nitric ac. Nux vom. Phosph. Sabad. Sil. Spong. — by wet : Amm. Ant. crud. Bellad. Calc. Cauth. Carbo veg. Clem. Dule. Lye. Merc. Nitric ac. Nux vom. Phosph. Puis. Rhus. Sep. Sil. Spig. Staph. Stront. Sulph. — in winter : Aeon. Ars. Aur. Bar. Bell. Bry. Caust. Cham. Coccul. Con. Dulcam. Hell. Hep. Ign. Kali. Lye. Merc. Nux mosch. Nux vom. Puis. Rhod. Rhus. Sep- Sulphur. Veratr. — when writing : Anac. Asa f. Calc. Carbo veget. Coccul. Graph. Ign. Kali. Lye. Natr. Natr. mur. Nux vom. Phosph. Ruta. Sil. Spong. Zinc. Amelioration of the Pains. IN THE OPEN AIR: Alum. Anac. Asa f. Aur. Bar. Cann. Carbo veg Con. Croc. Graph. Hell. Ign. Iod Kali. Lycoj). Magn. Mezer. Natr Phosph. Plat. Puis. Sabin. Selen, Sepise. Spong. Stront. Sulph. Ve- ratr. Vit. BY BORING INTO THE EAR OR NOSE: Lach. Natr. Phosph. Thuj. BEFORE BREAKFAST : Caust. Cham. Chin. Con. Kali. Lye. Natr* mur. N. mosch. Phosph. Phosph. ac. Sabin. Selen. Sil. Sulph. ac. Zinc. BY DEEP BREATHING: Ign. Lach. Oleand. Spig. WHEN CHEWING : Bryon. Chin. Spig. IN THE COLD: Ambra. Ant tart. Asar. Cin. Croc. Dros. Graph. Iod. Kali. Led. Lye. Merc. Natr. Natr. mur. Plat. Puis. Rhus. Sec. rami. Sep. Sulph. Thuj. Veratr. BY CONTACT: Anac. Asa f . Calc. carb. Cycl. Drosera. Lycop. Mang. 138 GENERAL SYMPTOMS. Mm-, acid. Natr. Phosph. Sulph. Thuj. IN THE DAEK : Bar. Bell Calc. carb. China. Con. Croc. Euphr. Graph. Ignat. Kali. Lye. Mercur. Natr. Phosph. Phosph. ac. Puis. Sepise. Sil. Sulph. AFTEB DEINKING: Bry. Graph. Phosph. Ehus. Sil. AFTEB EATING: Calc. c. Cann. Chel. Ferr. Graph. Ign. Iod. Kali. Each. Merc. Natrum. Phos. Squill. Stront. Veratr. WHEN EATING: Ambr. Anacard. China. Croc. Ferr. Graphit. Ign. Iod. Lach. Merc. Nux vom. Puis. Spig. Staph. Tar. Zinc. BY EEUCTATIONS : Ant. tart. Bar. Carbo veg. Coccul. Graphit. Ign. Kali. Lach. Lye. Natr. Nux vom. Sil. Sulph. BY FOOD AND DEINK, bread : Caust. Natr. — vinegar: Puis. — meat: Veratr. — coffee: Ars. Cham. —cold food : Bell. Bry. Cham. Ferr. Kali. Laches. M. austr. Merc. Phosph. Phosphor, ac. Puis. — warm food: Ars. Con. Graph. Ign. Lye. Mur. ac. N. mosch. Nux vom. Rhus. Sulph. Veratrum. — cold water : Bry. Caustic. Phosph. Puis. Sep. — warm water : Nux vom. Ehus. — wine : Con. Lach. Op. BY IMPOSING ONE'S HAND: BeU. Croc. Natr. BY MENTAL LABOE: Croc. Fen-. Natr. BY BODILY LABOE: Ign. Natr. Ehus. Sep. BY LEANING AGAINST : Carbo veg. Ferr. Kali. Staph. IN THE LIGHT: Calc. c. Carbo an. Carbo veg. Con. Plat. Stront. WHEN LYING DOWN : Alum. Ambra. Arn. Bell. Bry. Calc. c. Canth. Caust. Coccul. Colch. Croc. Dig. Graph. Hep. Iod. Merc. Natr. Natr. mur. N. vom. Oleand. Phos. ac. Sassap. Squill. Sec. corn. Stan- num. Straph. Stram. -in bed: Bell. Bry. Canth. Caust. Cic. Cin. Con. Dig. Ferr. Lach. Lye. Natrum mur. Nitric ac. Nux vom. Phosphor. Ehus. Sabad. Squill. Selen. Sil. Staph. Stram. Yeratr. on the back : Aeon. Bry. Calc. c. Carbo an. Con. Creos. Ferr. Ign. Kali. Lye. Natr. mur. Nux vom. Plat. Sepiae. Stann. Sulph. on the side : Arn. Ars. Bry. Cham. Cupr. Iod. Lach. Natr. N. vom. Phosjjh. Rhus. Sep. on the affected side : Bry. Cham. Ign. Kali. Puis. Ehus. on the painless side : Aeon. Ars. Bar. Bell. Graph. Hep. Iod. Nux vom. Phos. Euta. Sil. Sulph. Thuj. - — with the head high : Ant. tart. Ars. Cann. China. Hep. Nux vom. Puis. Spig. bent double: Coloc. Pulsat. Rheum. IN THE EVENING, after lying down: Bar. Bell. Bry. Calc. c. Carbo veg. Cic. Cin. Croc. Graph. Hell. Hep. Iod. Natr. mur. Nux vomica. Oleand. Eheum. Ehodod. Secalecorn. Squill. Staph. BY MOTION: Ambr. Asa f. Aur. Caps. Chamom. Con. Cycl. Dulc. Ferr. Fluor, ac. Lach. Lye. Merc. Mosch. Nitr. Op. Phosjihor. ac. Puis. Ehodod. Rhus. Sabad. Sanib. Sepioe. Sulph. Tar. Yaler. Verb. BY CONTINUED MOTION: Con. Ferr. Kali. Lye. Puis. Sil. Yaler. Veratr. BY EXTEENAL PEESSUEE: Amm. mur. Anac. Ars. Aur. Bry. GENERAL SYMPTOMS. 139 Canth. Chel. Con. Dulcam. Graph. Ign. Kali. Magn. mur. Men. Mur. ac. Natr. Nux vom. Phosphor, ac. Plumb. Rhus. Sulphur. Sulph. ac. Yeratr. Ylt. BY RAISING ONE'S SELF: Ant. tart. Arsen. Cede. c. Cham. China. Dig. Ign. Kali. Lye. Oleand. Puis. Samb. Sep. Sil. Sulph. WHEN READING: Natr. IN REST: Agar. Anac. Ant. tart. Asar. Am. Bell Bry. Calad. Carbo an. Carbo veg. Caustic. Chel. Coff. Colch. Croc. Ferr. Graph. Hell. Iod. Ipec. Led. Mang. Merc. Natr. mur. Nux mosch. N. yoni. Phosph. Plat. Rheum. Rhod. Selen. Spigel. Squill. Staph. Sulph. ac. WHEN RIDING IN A CAR- RIAGE : Graph. Nitric ac. IN THE MORNING AFTER RIS- ING : Ambr. Ant. tart. Ars. Bell. Calad. Carbo anim. Cycl. Euphorb. Ferr. Graph. Ign. Iod. Kali. Led. Lye. Mang. Mercur. Merzer. Natr. Nux vom. Phosph. Pnlsat. Rhus. Selen. Sep. Sulphur. Yeratr. Yiola od. IN THE ROOM: Agar. Amm. mur. Ars. Bell. Calc. carb. Camph. Cann. Carbo an. Carbo veg. Cham. Chin. Coccul. Con. Creos. Ferr. Guaj. Ign. Lach. M. austr. Natr. Nitr. ac. N. inoseh. Rax vom. Oleand. Petr. Rheum. Ruta, Selen. Sil. Spig. Stram. Sulph. ac. Teucr. Yaler. BY SCRATCHING: Asa foet. Bry. Calc. c. Caust. Cic. Cychl^n. Led. Mur. ac. Natr. Oleand. Phosphor. Ruta. Sulph. Sulph. ac. Thuj. BY SLEEP : Ars. Ipec. N>^ vom. Phosph. Puis. WHEN SITTING: Bryon. Calad. Camph. Cann. Chamom. Cic. Coffea. Colch. Croc. Hell. Hyosc. Iod. Merc. Mezer. N. mosch. Nux vom. Phosph. Rheum. Rhus. Squill. Secale com. Staph. WHEN STANDING: Antim. tart. Asar. Bell. Calad. Calcar. c. Coccul. Colchic. Croc. Hell. Hep. Iod. Ip< j r. Led. Mercur. Mur. ac. N. vom. Phos. Ruta. Squill. Selen. Spig. Yit. IN SOCIETY: Arsen. Kali. Lye. Stram. IN SWALLOWING : Ambr. Graph. Ign. Lach. Led. Merc. Nux vom. Pulsat. Squill. Spongia. Staph. IN SWEATING: Calad. Cham. Clem. Graph. Hep. Lye. Nitr. ac. Nux vom. Oleand. Rhus. Selen. Stram. Thuj. Yeratr. BYUNCOYERING ONE'S SELF: Calc. c. Chamom. Ferr. Ignat. Iod. Lye. Phosph. Puis. Secale corn. Spig. Yeratr. OX WAKING: Ars. Calad. Hell. Nux vom. Phosph. Pulsat. Sep. Thuj. WHEN WALKING FAST: Ignat. Natr. mur. Sep. BY THE WARM STOYE: Ars. Aur. Caust. Con. Hep. Ign. Kali. Magn. N. vom. Rhod. Rhus. Stront. Sulph. BY WASHING: Amm. mur. Ars. Asar. Caust. Chel. Pulsat. Rhod. Spig. the face: Asar. Mezer. Saba- dilla. BY WEEPING: Anac. Ign. Lye. IN DAMP WEATHER : Aeon. Asar. Caust. Sep. Ipec. N. vom. Sil. Spong. IN DRY WEATHER : Ant. crudum. Calc. carb. Chin. Dulcam. Fen-. Lach. Lye. Merc. Natr. X. mosch. Prdsat. Rhus. Sulph. Yeratr. BY WIPING WITH THE HAND : Asa foet. Calc. c. Clna. Cycl. Ign. Natr. Phosph. Plumb. Puis. Thuj. 140 GENERAL SYMPTOMS. IN WABMTH: Aeon. Amni. Arn. Ars. Aur. Bar. Bell. Camph. Carbo veget. Caust. China. Cic. Coccul. Dulc. Ferrum. Graph. Hell. Hep. Hyoscyam. Ign. Kali. Lach„ M. austr. Magn. Merc. Mosch. Natr. N. mosch. Nux vomica. Petr. Phos. Ehod. Rhus. Sabad. Sarnb. Squill. Sil. Staphys. Stront. Sulph. ac. Verat. Zinc. ANAEMIA: Arn. Ars. Bell. Bry. Calc.c. Carbo veg. Chamom. Chin. Con. Ferr. Ign. loci. Kali. Lach. Lye. Merc. Natr. Natr. mur. Nitric. ac. N. vom. Phosph. ac. Puis. Ehus. Sep. Sil. Squill. Staph. Sulphur. Sulph. ac. Veratr. ANEUEYSMS: Carbo veg. Ferr. Graph. Kali. Lach. Lye. Puis. Sulph. APPAEENT DEATH : Arn.Bellad. Carbo veg. Cham. Chin. Lach. Nux vom. Op. Tart. emet. APOPLEXY: Aeon. Arn. Baryt. Bell. Calc. Camph. Caust. Chin. Coccul. Coif. Dig. Ferr. Hyosc. Ipec. Lach. Lycop. Merc. N. vom. Puis. Rhus. Sil. Stram. Tart, emet, Veratr. ATEOPHY: Ars. Baryt. Bellad. Calc. c. China. Cina. Iod. Ipec. Lach. Merc. Nux vom. Ehus. Sil. Sulph. BONES, affections of, in general: Arn. Ars. Asa foet. Aur. Bell. Calc. carb. Calc. phosph. Carbo veget. China. Con. Dulc. Graphit. Hep. Iod. Kalibichr. Lach. Lycop. Merc. Mezer. Nitric ac. Phosph. Pulsat. Ehus. Ruta. Sabin. Sec. corn. Sil. Spong. Staphysag. Sulph. Sulph. ac. Thuj. — swelling: Asa f. Aur. Calc. Dulc. Guaj. Hep. Lye. Merc. Nitric acid. Phosphor. Puis. R 1 :us. Euta. Sil. Staph. Sulphur. — fractures: Am. Asa f.^Calc. Lycop. Rhus. Ruta. Sil. Symphyt. Sulph. — inflammation : Asa foet. Aur. Bell. Calc. Chin. Hep. Lycop. Merc. Ni- tric ac. Phosph. Sil. Sulph. — pains: Ars. Asa f. Aur. Bar. Calcar. China. Cic. Daph. Fluor, ac. Lach. Lye. Merc. Nitric ac. Phos. Phos- phor, ac. Plumb. Euta. Sil. Staph. Sulph. — curvature: Asa foet. Bellad. Calc. Calc. phosph. Hep. Iod. Lye. Merc. Phosph. Plumb. Ehus. Sil. Sulph. — caries : Arsen. Asa foet. Aur. Calc. Fluor, ac. Hep. Lye. Merc. Nitric ac. Phosph. Phosph. ac. Euta. Sep. Sil. Spong. Sulph. BLUE DISEASE : Aco. Arn. Ars. Aur. Bellad. Camph. Carbo veget. Chin. Con. Cuprum. Digit. Ferr. Ipecac. Lach. Merc. Nux vom. Op. Phosph. Pulsat. Ehus. Sec corn. Yeratr. BOUNDING, as of something : Croc. BUENS : Ant, crud. Arn. Ars. Carb. veg. Caust. Creos. Laches. Secale corn. Stram. CHAGBIN, consequences of: Aco. Ars. Bry. Cham. Chin. Coff. Coloc. N. vom. Phosph. Ph. ac. Plat. Staph. — suppressed: Ign. Phosph. ac. — with wrath: Coloc. Staph. N. vom. CHAMOMILE, excessive use of: Aeon. Coff. Ign. Puis. Nux vom. CHILDEEN, diseases of: Aeon. Bar. Bell. Bryon. Calcar. Cham. Cin, Coff. Drosera. Hep. Hell. Ign. Iod. Ipec. Merc. Nux mosch. Nux vom. Puis. Rheum. Silic. Spongia. Sulph. CHINA, aliments from abuse of: Arn. Ars. Bell. Calc. c. Canthar. Carbo veg. Ferr. Ipec. Lach. Lye. Merc. Natr. mur, H. vom. Sep. Puis. Sulphur. Yeratr. GENERAL SYMPTOMS. 141 CHOLERA: Ant. tart. Ars. Asar. Camph. Carbo veget. Cupr. Dulc. Hydr. ac. J air. Ipecac. Lach. Nux vom. Phosph. Ph. ac. Sec. com. Yeratr. CHOLERINE : Bry. Puis. Rhus. CHOLERIC TEMPERAMENT : Aeon. Anac. Bry. Caust. Cham. Cin. Cupr. Hyosc. Kali. Lach. Natrum. Nitric ac. Nux vom. Op. Phosphor. CHLOROSIS: Bell. Calc. carb. Camph. Chin. Coccul. Conium. Crot. Ferr. Graphit. Hell. Ign. Kali. Lach. Lye. Natr. mur. Nitric ac. Nux vom. Plat. Plumb. Puis. Sep. Staph. Sulph. Valer. COLD, taking: Aeon. Ant. crud. Ars. Bell. Bry. Calc. Caust. Cham. Coff. Dulcam. Hep. Ijjec. Merc. N. vom. Phosph. Puis. Rhus. Sil. Sulph. — liable to take: Aconit. Bell. Bry. Calc. Carbo veg. Caust. Cham. China. Dros. Dulc. Hep. Lye. Merc. Natrum. Nitric ac. Nux vom. Puis. Rhus. Sep. Sil. Sulph. COMPLAINTS, periodical: Arnic. Ars. Bell. Bry. Carbo veget. Chin. Ign. Ipec. Natrum mur. N. vom. Puis. Rhus. Spig. Sulph. CONCUSSION: Am. Belli. Bry. Cic. Con. Nux vomica. Rhus. Veratr. AILMENTS INCIDENT TO CON- FINEMENT: Aconit. Agn. Ar- nica. Bell. Bry. Calc. Cham. China. Coff. Hep. Hyosc. Ignat. Lye. Merc. N. vom. Op. Phosph. ac. Plat. Puis. Rhus. Sec. corn. Sil. Sulph. Yeratr. CONGESTIONS OF BLOOD : Aeon. Amm. Am. Asa f. Aur. Bell. Bry. Calc. c. Carbo vegetab. Chin. Croc. Cupr. Dig. Ferr. Graph. Hyosc. Kali. Lycop. Merc. Natr. mur. Nitric ac. IS. vom. Op. Phosph. Puis. Rhus. Seneg. Sep. Sil. Stram. Sulph. Sulph. ac. Veratrum. Viola tr. CONTUSIONS: Aeon. Arg. Am. Cic. Con. Led. Oleand. Petr. Puis. Rhodod. Rlius. Ruta. Sulph. Sulph. ac. CRAWLING: Bell. Calcar. Sep. Sulph. DEBILITY, nervous: Am. Baryt. Bell. Calc. Carbo veget. Cham. Chin. Coff. Cuprum. Graph. Hyosc. Ign. Iod. Ipec. Lach. Lye. M. arct. Mercur. Natr. Natr. mur. Nitric ac. Nux mosch. N. vom. Phos. Phosph. ac. Plat. Pulsat. Rhus. Sec. com. Selen. Sil. Stann. Stram. Valer. Veratr. DRUNKARDS, ailments of: Aeon. Ars. Bell. Calc. Carbo veget. Hy- osc. Ign. Lach. Natrum. Natr. mur. Nux vom. Op. Puis. Rhus. Sil. Stram. S-ulph. DRYNESS OF INNER PARTS: Aeon. Ambr. Ars. Asa f. Bellad. Bry. Calad. Calc. Carbo veg. Cham. Cic. Con. Croc. Dulc. Graph. Hy- osc. Ign. Lye. Magn. mur. Mang. Merc. Natrum. Natr. mur. Nitric acid. Nux mosch. Nux vom. Par. Phosph. Puis. Rhus. Samb. Sec. corn. Seneg. Sepiae. Sil. Spong. Stram. Sulph. Veratr. Zinc. EMACIATION: Ambra. Anacard. Ars. Bar. Bry. Calc. carb. Canthar. Carbo veg. Chamom. Chin. Chlor. Cina. Coccul. Cupr. Dulc. Ferr. Graphit. Hep. Lgn. Iod. Ipec. Laches. Lye. Merc. Natr. Natr. mur. Nitric ac. N. vom. Phosph. Phos. ac. Plumb. Puis. Sec. corn. Selen. Sil. Stann. Staplnjs. Sulph. Yeratr. EXCESSES, consequences of: Ana- card. Ars. Bar. Calc. carb. Carbo veg. Chin. Conium. Kali. Lach. Mercur. Natr. Natr. mur. N. vom. 142 GENERAL SYMPTOMS. Phosph. Phosph. ac. Puis. Kims. Sec. corn. Sep. Sil. Staph. Sulph. Tlmj. Veratr. FAINTING: Aeon. Am. Arsenic. Bell. Bryon. Gale. Camphor. Cann. Carbo veget. Chamom. China. Coc- cul. Coff. Creos. Dig. Ferr. Hep. Hyosc. Ign. Ipec. Lach. Laur. Mosch. N. mosch. JV. vom. Op. Petr. Phosph. Phosph. ac. Pulsat. Ban. sc. Ehus. Sangn. Secale corn. Sep. Sil. Spig. Stramon. Tart. emet. Veratr. Viola od. FAT, tendency to get : Antim. crud. Ars. Calcar. Caps.'' Croc. Cupr. FeiT.JGraphit.'Lach.Lyc.jMerc.-Op. Pulsat. Spong. Sulph. Veratr. FE AE, consequences of : Aeon. Bell. Hyosc. Ign. Lach. Op. Puis. Verat. FEMALES, diseases of : Aeon. Agar. Alum. Ambra. Arnica. Bell. Bor. Calcar. Caps. Caustic. Cham. Chin. Cic. Coccul. Con. Croc. Ferrum. Graph. Hyoscyam. Ign. Ipec. Kali. Lach. Magn. mur. Merc. Mosch. Nux mosch. Nux vom. Plat. Puis. Ehus. Safoin. Sec. corn. Selen. Sep. Spongia. Stann. Sulph. Valer. Veratr. Fever, General Charac- ter of. FEVEE, bilious: Aeon. Ant. crud. Ant. tart. Ars. Bry. Bellad. Cham. Coccul. Coloc. Creos. Ign. Ipec. Merc. Natrum mur. N. vom. Puis. Sulph. Verat. — catarrhal: Aeon. Ars. Bry. Bellad. Caust. Chamom. Con. Dulc. Ipec. Lach. Magn. mur. Merc. N. vom. Puis. Ehus. Sulph. — gastric: Ant. crud. Antim. tart. Ars. Aur. Bell. Bry. Cham. Coccul. Coloc. Hepar. Ignat. Ipec. Mercur. Magn. c. N. vom. Phosph. ac. Puis. Khus. Sulph. Veratr. — yellow: Aeon. Ars. Bell. Bry. Crot Ipec. Mercur. Nux vom. Puis. Rhus. Sulph. — puerperal: Aeon. Bell. Bry. Cham. Nux vom. Puis. Rhus. —milk : Aeon. Bell. Calc. Coff. Puis. — nervous: Aeon. Arn. Arsen. Bell. Bry. Camph. Chamom. Hyosc. Ign. Lye. Mercur. Mur. acid. N. vom. Op. Phosphor, ac. Rhus. Stram. Veratr. — rheumatic: Aeon. Arn. Ars. Bell. Bry. Caustic. Cham. Colch. Dul- cam. Ipecac. Mercur. N. vom. Puis. Rhus. Sil. Sulph. — wound : Aeon. Am. Bry. — dentition: Aeon. Bell. Calc. Cha- mom. Merc. Nux vom. Sulph. — hectic: Arsen. Calc. China. Coc" cul. Cupr. Dig. Ign. Iod. Ipec. Kali. Laches. Lye. Nux vom. Phosph. Phosph. ac. Puis. Sil. Staph. Sulph. — typhus, abdominal: Aconit. Ars. Bell. Bry. Merc. Nux vom. Phosph. ac. Rhus. — typhus, cerebral: Aeon. Arn. Ars. Bell. Bry. Carbo veget. Chin. Crot. Hyosc. Lach. Mercur. Mur. ac. N. vom. Op. Phosph. Phosph. ac. Pulsat. Rhus. Sulph. Veratr. — typhus, putrid: Ars. Asa f. Bry. Carbo veget. Chin. Ferr. Graph. Hep. Ipec. Lach. Merc. Mur. ac. Nux vom. Op. Phos. ac. Rhus. FLUIDS, ill effects of loss of: Calc. Carbo veg. Chin. Cin. Con. Lach. Lye. Natr. Natr. mur. Nitric ac. Nux vom. Phosph. ac. Sulph. Sulph. ac. Thuj. Veratr. FEEEZING, consequences of : Aco. Ars. Bry. Carbo veg. Laches. Ni- tric ac. Sulph. ac. Fever, According to Par- ticular Symptoms. BUENTNG : Arsen. Bry. Ehus. Ve- ratr. GENERAL SYMPTOMS. 143 CHILLINESS IN GENERAL: Ambra. Ant. tart. Arn. Ars. Bryon. Calc. Canth. Cham. China. Cin. Colch. Cupr. Ferr. Graph. Hep. Ign. Ipec. Lach. Lye. Merc. Mezer. Xatr. mur. Nux vom. Phosph. Phosph. ac. Puis. Rhus. Sabad. Sassap. Sep. Sil. Spig. Sulph. Thuj. Yeratr. —external: Arn. Chin. Ly cop. Merc. Nux vom. Phos. Rhus. Veratr. — semi-lateral : Ant. tart. Bry. Caust. Ignat. Lye. Nux vom. Puis. Rhus. Spig. — internal: Anac. Ars. Bellad. Bry. Calc. Chamom. China. Hell. Ignat. Ipec. Lach. Laur. Lycop. N. yoin. Phosph. Pulsat. Squill. Sep. Thuj. Veratr. — with shaking : Aeon. Bryon. Caps. Cham. Chin. Ign. Ipec. Nux vom. Rhus. Veratr. HEAT IN GENERAL : Aco. Amm. mur. Anac. Antim tart. Arn. Ars. Bell. Bry. Calc. Canth. Carb. veg. Caust. Cham. Chin. Cin. Coffea. Con. Cijcl. Ferr. Graph. Hell. Hep. Ign. Ipec. Kali. Lach. Magn. mur. Mem Mosch. Mur. ac. Nitr. ac. Nux vom. Op. Phosph. Phosph. ac. Puis. Rhus. Sabad. Sil. Squill. Stannum. Staph. Strain. Sulphur. Sulph. ac. Veratr. — external : Aeon. Ars. Bell. Bry. Calc. Camphor. Carbo veg. Cham. Cic. Coccul. Coff. Coloc. Digit. Dulc. Euphorb. Hell. Hyosc. Ign. Kali. Lach. Lye. Mang. Merc. Mur. ac. Nux vom. Op. Phosph. Puis. Rhus. Sep. Sil. Squill. Strain. Sulph. Zinc. — flashes of: Arn, Calc. caro. Chin. Graph. Iod. Kali. Lycop. Natrum. Nux vom. Phosph. Plat. Puis. Rhus. Ruta. Sep. Stann. Sulph. Thuj. — semi-lateral: Arn. Bell. Bry. Croc. Ignatia Lye. Nux vom. Phosph. Puis. Rhus. Sulph. — internal : Aeon. Arn. Ars. Bell. Bry. Calc. Canth. Carbo veg. Caust. Cham. Cic. China, Coloc. Con. Graphit. Hell, Ipec. Lye. Magn. mur. Nitric ac. Nux vom. Phosph. Phosphor, ac. Puis. Rhus. Sabad. Samb. Sec. corn. Spig. Spong. Stann. Veratr. Zinc. LOSS OF CONSCIOUSNESS: Bell. Bry. Carbo veg. Hell. Hyosc. Lach. Op. Phos. ac. Rhus. Stram. LOSS OF THIRST: Ant. tart. Ars. Canth. Carbo veg. Caust. Chin. Hell. Ipec. Merc. Puis. PULSE, intermittent: Aeon. Ars. Bry. Dig. Kali. Lach. Natr. mur. Op. Phosph. ac. Sec. corn. Stram. Sulph. — filiform : Colch. Lach. Veratr. — large : Aeon. Bell. Bry. Cupr. Dig, Ferr. Hyosc. Ign. Merc. Nitr. Nux vom. Phosph. Spig. Stram. Veratr. — hard: Aeon. Arn. Bar. Bell. Bry. Canth. Chin. Digit. Ferr. Hyosc. Ign. Merc. Nux vom. Phosph. ac. Sabin. Samb. Sil. Strain. Veratr. — small: Aeon. Ant. tart. Ars. Bar. Bell. Calc. carb. Camph. Carbo veg. China. Cina. Cocc. Cupr. Iod. Ipec. Kali. Lach. Laur. Merc. Natr. mur. Op, Phosph. acid. Plat. Puis. Sec. corn. Sil. Stram. Sulphur. Sulph. ac. Veratr. — slow : Ambr. Ant. crud. Ant. tart. Ars. Bell. Camph. Canthar. Cic. Con. Dig. Hell. Ign. Kali. Laur. Mosch. Op. Puis. Rhodod. Sec. corn. Sep. Stram. Veratr. — slower than the beats of the heart : Cann. Dig. Hell. Sec. corn. Veratr. — quick: Aco. Ant. tart. Arn. Ars. Asa f. Bell. Bism. Bry. Carbo veg. Coloc. Croc. Dig. Hyosc. Ignat. iU GENERAL SYMPTOMS. Iod. Lach. M. austr. Merc. Nitric acid. Nux vom. Phosph. Phosph. ac. Pulsat. Rhus. Sanib. Sil. Spong. Stann. Strain. Sulphur. Yeratr. Zinc. — imperceptible: Aconit. Ars. Car- bo veg. Coccul. Cupr. Ferr. Ipec. Lach. Merc. Op. Sec. com. Sil. Stann. Yeratr. — irregular: Agar. Antim. crud. Ars. Caps. Chin. Digital. Hyosc. Kali. Lach. Natr. mar. Op. Phosph. ac. Plumb. Sec. corn. Strain. Sulphur. Yeratr. — soft: Ant. tart. Ars. Baryt. Bel- lad. Carbo veg. China. Coccul. Cuprum. Iodine. Kali. Laur. Merc. Op. Phosphor. Plat. Sec. corn. Yeratr. — tremulous: Arsen. Calc. Cic. Kali. Phosph. Rhus. Sangn. Spig. SHIVERING : Aeon. Ars. Asa feet. Aurum. Bell. Calad. Canth. Caps. Cham. China. Coccul. Croc. CycL Ferr. Graph. Hep. Ign. Kali. Mercur. Mezer. Natr. Nitr. Nux vom. Puis. Rheum. Rhus. Sabad. Sec. corn. Sep. Staph. Yaler. Ye- ratr. STRETCHING : Ars. Ipec. N. vom. Rhus. SWEAT, in general: Aco. Ambr. Amm. mur. Ant. tart. Ars. Bar. Bell. Br ij. Calc. Canth. Caps. Carbo an. Carbo veget Caust. Cham. CI dor. Chin. Coff. Con. Dig. Dros. Ferr. Graph. Guaj. Hep. Hyosc. Ignat. Kali. Lye. M. austr. Magn. mur. Merc. Natrum. Natr. mur. Nitric ac. Nux vom. Pho&ph. Phosphor, ac. Puis. Rheum. Rhod. Rhus. Sabad. Sainb. Selen. Sepiae. Sil. Staph. Stram. Suljjh. Tar. Thui. Yeratr. IRRITABILITY, bodily. Aeon. Arn. Asar. Aur. Bell. Bry. Canthar. Cham. Chin. Coffea. Cupr. Ferr. Hyosc. Ign. Lach. M. arct. Merc. Natr. Nux vom. Phosph. Pulsat. Rhus. Selen. Sil. Spong. Staphys. Yeratr. — want of: Anac. Ars. Bism. Calc. Caniph. Carb. veget. Cic. Con. Croc. Dulc. Ferr. Graph. Hyosc. Ign. Iod. Ipec. Kali. Lach. Laur. Lycop. Magn. Merc. Nitric ac. Nux mosch. Oleand. Op. Phos. ac. Rhod. Sec. corn. Sep. Staph. Stram. Sulph. JAUNDICE : Aeon, Ambr. Ant. crud. Ars. Aur. Aurum mur. L Bellad. Bry. Canth. Carbo veget. Cham. Chin. Con. Croc. Dig. Ferr. Hep. Ignat. Lach. Lycop. Merc. Nitric ac. Nux vom. Op. Pulsat. Rhus. Sulph. Sep. Yeratr. .JEALOUSY, ailments from : Hyos- eyam. Ignat. Lach. N. vom. Phos. ac. Puis. Staph. JOY, consequences of excessive Aeon. Coffea. Op. LANGUOR : Antim. crud. Calc c Carbo veget. Coccul. Ignat. Iodine. Kali. Lach. Lye. Mercur. Mosch. Natr. Natr. mur. Op. Phosphor. Phosph. ac. Plat. Pulsat. Selen. Seneg. Sulph. Teucr. Thuj. Yaler. LAZINESS: Alum. Arsen. Baryt. Bell. Bryon. China. Coccul. Guaj. Iod, Kali Lach. Merc. Mur. ac. Natr. Xatrum mur. X. vom. Ole- ander. Phos. ac. Pids. Sec. corn. Se- len. Sep. Zinc. LIMPING: Bell. Calc. Caust. Coloc. Merc. Pulsat. Rhodod. Rhus. Sep. Sulphur. LOCHIA, morbidly altered : Bellad. Calcar. Con. Nux vom. Plat. Puis. Sec. corn. MARASMUS OF OLD PEOPLE : Ant. tart. Bar. Calc. c. Con. Olean. Op. Phosph. Phosph. ac. Rhus. Se- cale cor 7i. MELANCHOLY TEMPERA- MENTS: Ars. Aur. Bellad. Calc. GENERAL SYMPTOMS. 145 China. Graph, Ignat. Lach. Lycop. Merc. Natr. Nux vom. Phosph. ac. Puis. Sep. Sil. Veratr. MOTION, dread of: Ant. tart. Ars. Bar. Bell. Calad. Caps. Chin. Dnlc. Hell. Ign. Lach. Lye. Merc. Natr. Natr. mur. Nux vom. Sulph. Thuj. MUCOUS MEMBEANES, diseases of the : Alum. Apis. Arsenic. Bell. Bry. Calc. Caps. Caustic. Cham. China. Chlor. Dulc. Euphr. Fluor. ac. Hep. Ign. Lye. Merc. Mur. ac. Natr. mur. Nitric acid. Nux vom. Phosph. Pulsat. Khus. Sangn. Sep. Sil. Stann. Sulph. Sulph. ac. MUSCULAE TWITCHINGS : Am- bra. Asaf.BeW. Clem. Coloc. Croc. Cuprum. Graph. Loci. Kali. Lach. Mezer. Natr. Natr. mur. Plat. Rhus. Secale corn. Sil. Spong. Sulphur. Sulph. ac. Viola tr. Zinc. GLAND ULAE AFFECTIONS: Ammon. mur. Apis. Arsenic. Aur. Baryt. Bell. Calc. carb. Carbo an. Carbo veget. Cham. Coccul. Con. Dulc. Graph. Hep. Iod. Kali. Lye. Merc. Natr. Natr. mur. Nitric ac. Nux vom. Phosph. Phos. ac. Plumb. Ran. bulb. Rhus. Sep. Sil. Spong. Staph. Sulph. Sulph. ac. Thuj. GOUT: Aeon. Ant. crud. Arg. Am. Ars. Asa f. Aur. Baryt. Bell. Bry. Calc. carb. Calc. phosphor. Caps. Carbo an. Carbo veg. Caust. Cham. Chin. Colch. Dig. Dulcam. Ferr. Graph. Hep. Ignat. Iod. Kali, car- bon. Kali bichr. Led. Lye. M. austr. Merc. Mezer. Natr. Natrum mur. Nux vom. Phosphor. Puis. Rhodod. Rhus. Sabina. Sassap. Sep. Sil. Spong. Staphys. Sulph. Thuj. Ve- ratr. Vit. Zinc. GRASPING AT FLOCKS : Arsen. Bell. Hell. Hyosc. Iod. Muriat. ac. Op. Phosph. ac. Ehus. Stram. HEATED, consequences of getting : Aeon. Bell. Bry. Calc. Carbo. veg. Kali. Lye. Nux vom. Puis. Sil. , HEAVINESS OF THE BODY: Chin. Lach. Kali. Natr. Natr. mur. Phosph. Sep. Stann. HUNGER ill effects of: Ant. crud. Ars. Bry. Calc. carb. Chin. Ipec. Puis. Sulph. HYDEOPHOBIA: Lobelia. Arsen. Bell. Canthar. Hyosc. Lach. Phos. Stram. HYPOCHONDEIA: Asa foet. Aur. Bellad. Calc. Canth. Caust. Cham. Cina. Coccul. Con. Ferr. Graphit. Ignatia. Iodine. Lach. Lye. Magn. mur. Merc. Mill. Mosch. Natrum, Natrum mur. Nux mosch. N. vom. Phosph. ac. Plat. Puis. Sabin. Sep. Staph. Sulph. Valer. Veratr. HYSTEEIA : Agn. Asa f. Aurum. Bell. Calcar. Caustic. Coccul. Con* Ignatia. Lach. Nux mosch. Phosph. Plat. Puis. Sep. Sil. Sulph. Valer. Viola od. INDUEATIONS: Arn. Ars. Aur. Bell. Calc. ■ Camphor. Carbo an. Cham. Chin. Clem. Con. Dulc. Ferr. Graphit. Hep. Iodine. Lach. Lye. Magn. mur, Phosph. Plumb. Puis. Sep. Sil. Sulph. Thuj. INFLAMMATIONS : Aeon. Antim. crud. Ant. tart. Arn. Arsenic. Bell. Bry. Calc. Cannab. Canth. Carbo veget. Cham. Con. Creos. Cupr. Dig. Dros. Dulc. Euphorb. Euphr. Hepar. Hyosc. Iod. Ipecac. Kali. Lach. Lye. Magn. carb. Merc. Mur. ac. Nitr. Nitr. ac. Nux vom. Phos. Plumb. Puis. Pihus.Ruta. Sec. corn. Sep. Spong. Squill. Sulph. Sulph. ac. Veratr. NEEVOUS EXCITEMENT : Ambr. Bell. Calc. c. Cham. Chin. Coffea. Ferr. Iod. Laur. Merc. Nux vom. Phosph. Phosph. ac. Puis. Rhus. Sep. Sulph. Valer. Veratr. 146 GENERAL SYMPTOMS. NETJBALGIA : Aeon. Arnic. Arsen. Bellad. Bry. Calc. Capsic. Cham. Coccul. Coff. Colonic. Hep. Ig'nat. Kali. Merc. Mezer. JSfatr. Nux voin. Puis. Rhus. Spig 1 . Staph. Sulph. Thuj. Valer. Veratr. NODES, gouty: Antim crud. Arnica. Br yon. Calc. carbon. Calc. Phosph. Caust. Graph. Hepar. Led. Lycop. Mercur. Nux vom. Pulsat. Rhodod. Ehus. Staph. Sulph. ONANISM, consequences of: Calc. Carbo veg. Carbo animal. China. Coccul. Con. Kali. Lach. Lycop. Merc. Natr. JSfatr. mur. Nux youi. Oleand. Phos. Phosph.. ac. Pulsat. Ehus. Sil. Staph. Sulph. Thuj. PAINS, wandering : Am. Bell. Chin. Mang. N. mosch. Puis. Bhod. Ehus. Sabin. Sep. Sulphur. PAEALYSIS : Anac. Arn. Asar. Bar. Bell. Bry. Calc. Caps. Carbo veg. Caust. China. Cic. Cocc. Con. Croc. Crot. Dig. Dulc.Fevr. Eluor. acid. Hyosc. Ign. Kali. Lach. Laur. Dye. Magn. mur. Merc. Natr. Natr. mur. Nitric ac. Nux vom. Oleand. Op. Phosph. Plumb. Puis. Rhus. Sec. corn. Sil. Stann. Strain. Sulph. Veratr. Zinc. PHDEGMATIC TEMPERA- MENTS: Bell. Caps. Chin. Iod. Lach. Merc. Natr. Natr. mur. Nitric ac. Puis. Sulph. PLETHOEA : Aeon. Arn. Aur. Bell. Bry. Calc. Chin. Dig. Ferr. Graph. Hyosc. Kali. Lycop. Natr. mur. Nitric ac. Nux vom. Phosph. Puis. Ehus. Strain. Sulph. POISONING WITH ALUM: Puis. Yeratr. — with arsenic : Carbo veget. China, Eerr. Hep. Ipec. Lach. Lye. Nux vom. Sulph. Yeratr. — with lead: Alum. Bell. Nux vom. Op. Plat. — with colchicum : Coccul. Nux vom. Puis. — with iron : Ars. Hep. Ipecac. Puis. — with adipic poison : Arsenic. Phos. acid. — with fish-poison: Bell. Campjhor. — with honey : Camph. — with iodine : Arsen. Bellad. China. Phosph. Sulph. — with toad-poison: Ars. (?) — with copper: Bell. Hepar. Ipec. N. vom. — with opium : Bell. Coff. Nux vom. — with phosphorus : Coff. Nux vom. Sulph. — with mushroom : Carbo veget. Coff. Puis. — with mercury: Arn. Aur. Bell. Carbo veg. Cham. Chin. Dulc. Hep. Iodine. Kali bichr. Lach. Lye. Nitr. ac. Mezer. Phos. ac. Sil. Staph. Sulph. Thuj. — with sal. ammoniac: Coff. N. vom. — with sarsaparilla : Bell. Merc. Sulph. — with acids : Aeon. Bry. Op. Puis. — with sulphur : Arsen. Mercur. Puis. Sil. — with stramonium : Coff. Hyoscyam. Nux vom. — with poison- vine : Bell. Bry. Merc. Sulph. — with alcohol : Coff. Nux vom. : — with sausage-poison: Arsen. Bell. Bry. — with tin : Carbo veget. Hep. Puis. PEE GN ANC Y, ailments incident to : Aco. Bell. Bry. Calc. Chamom. Con. Hyosc. Lach. Lye. N. vom. Phos. Plat. Puis. Sep. Suljih.Te- ratr. EAPHANIA: Arsen. Bell. China. Hyosc. Iod. Op. Ehus. Secale corn. Sol.nlgr. Strain. EHEUMATISM: Aco. Arn. Ars. Bell. Bry. Carb. veg. Caustic. Cham. China. Colch. Hep. Ignat. Kali GENERAL SYMPTOMS. 147 bichr. Lach. Lye. Merc. Nitric ac. Nux voin. Pulsat. Rhodod. Rhus. Sassap. Sep. Spigel. Sulph. Thuj. Yeratr. BIDING IN A CARRIAGE, ail- ments from : Ars. Carbo veg. Coc- cul. Colch. Ferr. Ign. Natr. Petr. Psor. Sil. Sulph. EICKETS: Asa f. Bell. Calc. c. Calc. phosph. Lye. Merc. Phosph. Pulsat. Ehus. Silk. Sulph. SALT, ill effects of eating too much : Carbo veg. Merc. Nux vom. S A N G U I N TEMPERAMENT : Aeon. Am. Bry. Bell. Cham. Hyoscyam. Ign. Nux vom. Rhus. Sulph. Sulph. ac. Veratrum. Zinc. SCURVY: Amm. mur. Ars. Aur. Bor. Calc. Carbo an. Carbo veg. Creos. Hep. Iod. Mereur. Mur. ac. Natrum mur. Nitric ac. Nux vom. Silic. Staph. Sulph. Sulph. ac. SEA-SICKNESS: Ars. Coccul. Creos. Ipecac. Petr. Rhus. Sulph. Veratr. SEDENTARY HABITS, ill effects of: Aco. Carbo veg. Calc. Ignat. Natr. Natrum mur. N. vom. Puis. Sulph. SEMILATERAL AILMENTS, left side : Aeon. Alum. Amm. mur. Apis. Arn. Asa f. Asar. Bry. Calc. Cann. Chin. Cic. Colch. Coloc. Croc. Cupr. Daph. Dulc. Ign. Iod. Lach. Lye. Mereur. Natr. Nitric ac. Nux mosch. Nux vom. Petr. Phos. Bhocl. Seleu. Sep. Spig. Sulphur. Sulphur, ac. Tar. Tart. emet. Thuj. Veratr. Viola od. — right side : Agar. Alum. Bar. Bell. Bism. Brom. Bry. Canth. Carho an. Caust. Cina. Con. Crot. Dig. Dros. Hepar. Ignat. Kali. Led. M. arct. Mosch. Oleand. Phosph. ac. Plumb. Rhus. Ruta. Sabacl. Sabina. Sangn. Sil. Spongia. Staph. Stront. Sulph. ac. Tart. emet. Thuj. Vit. — cross-wise: Agar. Mangan. Sil. SENSATION AS IF BLOWN UP- ON BY WIND : Nux vom. Ole- ander. Rhus. Stram. — as if congealing: Bellad. Cic. Cin. Bros. Hyosc. Led. Puis. Sec. corn. Stram. — as if growing larger : Asa feet. Bell. Ignat. Laur. Phosph. Puis. Rhus. — as of a hair: Lycop. Natr. mur. Sulph. — as of growing smaller : Calc. Croc. — as of something alive: Croc. Ign. Lach. Mereur. Sec. corn. Sulph. Thuj. SPANISH FLIES, ill effects of: Camph. SPASMS, generally : Aeon. Ang. Arn. Ars. Asa f. Bell. Bry. Calc. carb. -Camph. Caust. Cham. Cic. Cina. Coccul. Coff. Con. Croc. Cupr. Hell. Hyosc. Ign. Ipec. Lach. Laur. Lycop. Merc. Mosch. Nux mosch. Nux vom. Op. Plat. Plumb. Puis. Rhus. Ruta. Sec. corn. Stann. Stram. Sulph. Tart. emet. Veratr. Zinc. — in the evening: Caust. Cina. Laur. Nux vom. Puis. Stann. Stram. — with anxiety : Ars. Bell. Calc. Cham. Cin. Cupr. Hyosc. Ign. Lach. Puis. Veratr. — with dyspnoea : Ang. Bell. Camph. Cupr. Ign. Ipec. Nux vom. Op. Puis. — with staring eyes : Bell. Hyoscyam. Nux vom. Op. Sec. corn. Stram. — with contortion of the eyes : Aeon. Bell. Coccul. Cuprum. Hyosc. Ign. Lach. —with upwards : Bell. Ignat. Lach. — with downwards : Cic. Lach. — with sidewise : Bell. Caust. Hyosc. Lach. — glazed eyes : Coccul. — half open eyes : Caust. Cina. Ipec. — with eyes protruded : Hyosc. 148 GENERAL symptoms. — with eyes closed : Bell. Cham. Coc- cul. Croc. Hvosc. Merc. Natr. mur. Op. — after repelled eruptions : Cede. Caust. Lack. Xux voru. Sulph. — with bloated bowels: Calc. Cham. Cin. Merc. — with violent movements : Calc. Cin. Cupr. Hell. Hyosc. Op. Strain. — from contact: Bell. Coccul. Stram. — with loss of sense : Bell. Camph. Cic. Cina. Cupr. Hyosc. Ign. Ipec. Lack. Xux vom. Op. Sil. Stann. Stram. — with nausea : Ipec. Xux vom. Puis. Tart. emet. Teratr. — with clenched thumb : Bell. Hyosc. Ign. Lach. Merc. — with delirium: Bell. Crot. Hyosc. Op. — with diarrhoea : Chin. Hyosc. — with thirst: Cham. Xux vom. — with eclampsia : Bell. Caust. Cham. Cic. Cin. Ignat. Hyosc. Laur. Xux mosch. Xux vom. Op. Phosim. Sec. corn. — epileptic : Agar. Ars. Bell. Calc. c. Camph. Caustic. Cham. Cic. Cina. Coccul. Cupr. Glon. Hepar. Hyosc, Ign. Lach. Merc. Xitr. ac. N. vom. Op. Plumb. Pills. Rhus. Sec. corn. Sil. Stann. Strain. Sulph. Yerat. — with vomiting: Cupr. Ipecac. Xux vom. Puis. Sec. corn. — with danger, of suffocation : Cupr. Ign. Xux vom. Op. — with yawning : Ign. Yeratr. — after emotions : Ballad. Coif. Hyos- cyam. Ign. Xux vom. — with pale face : Ipec. Xatrurn. Sil. Stann. — with blue face: Camphor. Cupr. Cin. Op. Yeratr. — yellow face : Cic. Xux vom. — red face : Bell. Ign. Stram. — with cold sweat in the face : Cocc. — with distorted features : Belladona. Cham. Coccul. Ipecac. Stram. Ye- ratr. — with involuntary emission of urine : Caust. Coccul. Hyosc. — with palpitation of the heart: Lach. Sec. corn. Spig. — with heat : Bell. Cham. Xux vom. — with seansation of hunger : Hyosc. — hysteric : Aur. Belladona. Caustic. Cham. Coccul. Coff. Cupr. Ignatia. Ipec. Mosch. Xux vom. Plat. Puis. Stram. Yeratr. —internal : Calc. carb. Caust. Cocc. Coloc. Graph. Ipecac. Magn mur. Stann. — with delirium : Bell. Cin. — with coldness of the body: Cin. Hyosc. Puis. Yeratr. — with coldness of the limbs : Caust. Hyosc. Op. Yeratr. — cataleptic: Agar. Bell. Cham. Cic. Hyosc. Ipec. Stram. Yeratr. — with locked jaw : Bell. Hyoscyam. lach. Xux vom. Opium. Plat. Ye- ratr. — of children: Bellad. Calcar. Cham. Cina. Coffea. Ipec. Xux vom. Op. Staph. — clonic: Agr. Ambr. Arnica. Arsen. Bar. Bellad. Calc. Camph. Canthar. Caust. Cham. Cic. Cina. Coccul. Con. Cupr. Hell. Hyosc. Ign. Ipec. Laches. Kali. Magn. Merc. X. vom. Op. Phosph.ii hus. Sec. com. Sepiae. Stann. Stram. Sulph. Teratr. — with movements of the head: Belt Cham. Cic. Hell. Lach. Op. Stram. — opisthotonic : Ign. — preceded by head-ache : Bell. Hy- oscyam. Lach. Xux vom. — succeeded by head-ache: Bellad. Cina. j — with contraction of the limbs : Hy- oscyam. I — with laughter: Bellad. Calc. CausL Ign. Lach. GENERAL SYMPTOMS. U9 — with creeping as of a mouse : Bell. Sulph. — with colic: Caustic. Cham. Cin. Cupr. Merc. Sulph. SWEAT, anxious: Am. Ars. Calc. Cham. Ferr. Ign. Merc. Natr. Nux vom. Phos. Puis. Bhus. Sep. Spong. Stramon. Sulph. Veratr. — bloody : Lach. Lye. Nux vom. — musty smell : N. vom. Puis. Rhus. — exhausting: Ambra. Arsen. Bryon. Calc. Carbo an. Chin. Digit. Ferr. Hep. Iod. Lye. Mercur. Natr. mur. Nitric acid. Nux vom. Phosphor. Saml). Sep. Stann. Sulph. Veratr. — fatty: Bryon. China. Merc. Selen. — staining the linen: Ars. Graphit. Merc. Selen. — yellow : Graph. Lach. Merc. — semilateral: Cham-. Chin. Nux vom. Puis. — smelling like juniper: Sep. — cold: Aeon. Amm. mur. Ant. tart. Am. Ars. Bryon. Calcar. Camph. Cannab. Carbo veg. China. Cin. Coccul. Cupr. Dulc. Hell. Hep. Ign. Ipec. Lach. Lye. M. arct. Mercur. Nux vom. Puis. Bheum. Bhus. Sa- bad. Sec. corn. Sep. Staph. Sulph. Veratr. — smelling like old cheese : Plumbum. — viscous : Aeon. Ant. tart. Ars. Bry. Cham. Daph. Ferr. Hep. Iod. Lye. Merc. Phosph. Phosph. ac. Plumb. Sec. corn. Veratr. — red : Arn. Calc. Dulc. Lycop. Nux vom. — sour smelling: Arn. Asar. Bellad. Cham. Ferr. Hep. Ignat. Iod. Ipec. Kali. Lye. Merc. Nitric ac. Bhus. Sep. Sil. Sulph. Veratr. — stinging: Cham. Con. — fetid : Ammon. mur. Baryt. Canth. Con. Dulc. Ferr. Fluor, ac. Graph. Hep. Kali. Led. Lye. Merc. Nitric. ac. Nux vom. Phosph. Puis. Bhus. Selen. Sep. Staph. Veratr. — having an urinous smell : Canthar. Nitric ac. — smelling like onion : Bo v. Lycop. — in the morning: Op. Nux vom. Plat. — with open mouth : Mosch. Op. — with distorted mouth : Bellad. Nux vom. Op. Stram. — followed by weariness : Bell. — at night : Bell. Calc. carbon. Calc. caust. Cham. Cin. Ign. Merc. Op. Sulph. — during new-moon: Calc. Caustic. Cupr. Sil. — falling down unconscious : Bell. Cupr. — after onanism: Calc. China. Coc- cul. Lach. Lye. N. vom. Op. Staph. Sulph. Veratr. — with dilated pupils: Bellad. Calc. Cic. Cin. — during the menses : Coccul. Cupr, Ignat. Nux vom. Plat. Puis. — with rattling breathing: Ipec. Lach. Nux vom. — in the back : Bell. Ign. Ipec. Op. Bhus. — falling backwards: Bell. — with froth at the mouth : Chamom. Cupr. Hyosc. Ign. Lach. Nux vom. — with froth at the mouth, bloody: Lach. Op. Pyrocarb. — during sleep : Bellad. Calcar. caust. Cin. Sil. — followed by drowsiness : Bell. Dros. Ign. Lach. Op. — after a fright : Bellad. Coffea. Ignat. Lach. Op. Nux vom. Veratr. — with a scream : Cina. Crot. Hyosc. Lach. Nux vom. Op. Sulph. — followed by weakness : Bell. Calc. Cic. Sec. corn. Veratr. — with sticky sweat on the head: Camph. —tetanic: Aconit. Ars. Bell. Camph. Cic. Cupr. Ign. Ipec. Lanr. Op. 150 GENERAL SYMPTOMS. Plat. Elms. Secale com. Strain. Veratr. — Saint Yitus' dance, chorea: Bell. Canst. Coccul. Croc. Cupr. Hyosc. Ign. Lack. Laur. Nux vom. Stram. Zinc. — after an injury : Arn. Pulsat. Rhus. Sulph. — alternately red and pale : Ign. — with crying: Bell. Caust. Cuprum. Ign. Lach. Puis, —of lying-in females : Bell. Chamom. CofT. Hyosc. Ign. Puis. — caused by worms: Calc. Cin. Hy- osc. Merc. N. vom. Sulph. — dentition: Bell. Calc. Coff. Cham. Ign. Merc. Sulph. — with gritting of the teeth: Cin. Coff. Hyosc. — with trembling : Cupr. Lach. — with twitching: Bell. Calc. Caust. Cham. Cina, Cuprum. Hyosc. Ign. Ipecac. Lach. Merc. Op. Plumb. Rhus. Sec. corn. Stram. Sulphur. YeratrUm. SPIRITS OF CAMPHOR, ill effects of: Coff. Op. STRAINING BY LIFTING, ill ef- fects of : Arn. Bryon. Calc. Coccul. Con. Graph. Lye. Natr. Nitric ac. Nux vom. Phosph. Phos. ac. Rhus. Ruta. Sil. Sulph. Sulph. ac. SWEAT, ill effects of suppression of sweat : Aeon. Bell. Bry. Cham. Chin. Dulcam. Lach. Nux vom. Pulsat. Sil. Sulph. TEA, ill effects of: China. Ferrum. Lach. THIRST : Aeon. Ars. Bellad. Bryon. Canth. Cham. Ipecac. Merc. Nux vom. Puis. Rhus. Sulph. Veratr. TOBACCO, ill effects of: Cham. Coccul. Nux vom. UNEASINESS, bodily: Aconitum. Anac. Ars. Asar. Bellad. Bry. Calc. Cann. Carbo veg. Cham. Chin. Cof- fea. Croc. Cupr. Ferr. Graph. Hy- oscyain. Ign. Iod. Kali. Lycop. M. austr. Merc. Mur. ac. Natr. N. vom. Op. Phos. Plat. Rhus. Samb. Sep. Sil. Staph. Stram. Sulph. Veratr. YASCULAR ERETHISM: Aconit. Arribra. Arn. Aurum. Bellad. Bov. Bry. Calc. c. Carbo veget. Caustic. China. Con. Creos. Ferr. Hep. Iod. Kali. Lyeop. Natrum mur. N. vom. Op. Petr. Phosph. Rhus. Sassap. Sepiae. Sil. Stann. Sulph. WALK, difficulty of learning to walk : Calcar. Mercur. Sil. Sulph. WEAKNESS, general: Agar. A mm. Anac. Arn. Ars. Bell. Brom. Cale. Carb. an. Carbo veg. China. Cocc. Conium. Ferr. Fluor, ac. Graphit. Ipecac. Kali. Lach. Lycop. Magn. mur. Merc. Natr. Natr. mur. Nitric ac. NuxYoni. Oleand. Op. Phosph. Phosph. ac. Plat. Puis. Rhus. Sec. corn. Sepiae. Sil. Staph. Sulphur. Veratr. WEANING, ailments from : Bellad. Bry. Calc. Puis. WEARINESS: Arn. Ars. Bell. Calc. Cann. Caust. Chin. Coccul. Coffea. Con. Croc. Ferr. Graph. Hep. Ign. Ipec. Kali. Lycop. Merc. Natr. Nux vom. Oleand. Phosph. Plat. Puis. Rhod. Rhus. Spong. Sulph. Tart. em. Thuj. Veratr. — consequences of : Arn. Bry. Coff. Rhus. Puis. WHITE, red parts turning: Arsen. Bor. Calc. Ferr. Hell. Mercur. Ni- tric ac. Nux vom. Phos. Secale corn. Staph. Sulph. Sulph. ac. WOUNDS : Arn. Calendul. Hyper. BURNS: Arnica. Urtica. PAIN FROM BURNS : Ars. Caust. INDEX. INDEX TO REPERTORY, OR LIST OF SYMPTOMS. A Abdomen, morbid symptoms in... 37 Abscesses 127 Acne rosacea 17 Acid stomach 35 After pains, abnormal 95 Aggravation of pains 132-137 Amaurosis 9 Amelioration of pains 137 Anaemia 140 Aneurysm 140 Anger, effects of 3 Anus, excoriated 77 Anus and rectum, affections of 77 Anxiety and fright, effects of 3 Aphonia, loss of voice 56 Aphthae 24 Apoplexy 140 Apparent death 140 Appetite, loss of 29 Arms and armpits 102 Asthma 45 Atrophy.. 140 Aversion to various kinds of food and drink 29 Axillae, symptoms in 65 B Back, morbid feelings in re- gion of 70-71 Bad effects of food or drink . 30 Ball, hysteric 25 Bedsores 122 Black pores on nose 16 Blackness of vision, sudden 9 Bladder, affections of 85 Bladder, catarrh of the 85 Bladder, inflammation of. . . 85 Blotches 122 Blue disease 140 Blurred sight 9 Bones, affections of 140 Brain, concussion of . . . 5 Brain, inflammation of 5 Breath and breathing, abnor- mal 45 Burns 140 c Calves of the legs, symptoms of 121 Cancer of the breast 66 Cancer of the lips 21 Cancer of the nose 16 Cancer of the stomach. ..... . 35 Cancer of the tongue 27 Cantharis, ill effects of 147 Cardialgia 38 Caries 140 Cataract 9 Catarrh 42 Catarrh, accompanying ail- ments of 44 Catarrhal fever 42 Chagrin, consequences of 140 Chapping of lips 21 Chamomilla, ill effects of. . . 140 Chest, morbid symptoms of. 61 Chilblains 121 China, ill effects of 140 Cholera, Asiatic 141 Cholerine 141 Colic, various kinds of 38 Color, illusions of 9 Comedones 122 Confinement, ailments dur- ing and after 95 Consciousness, loss of 1-2 Constipation 74 Contusions 141 Cornea, spots on 11 Coryza 42 Cough, various kinds of.. . . . 51-59 Cough, causes of 51-52 Cough, accompanying ail- ments of 53-56 Cracking of skin 122 Cracking of tongue 27 Cramp of the stomach 35 Croup, disposed to 25 151 152 INDEX TO REPERTORY. Croup, various forms of 57-58 Croup, gangrenous 25 Crusta lacta 19 D Deafness 15 Debility, nervous 141 Delirium 2 Desire for certain kinds of food and drink 29 Diabetes insipidus 82 Diarrhoea 74 Dilation of pupils 12 Dreams 131 Dropsy of the abdomen 39 Dry coryza of infants 141 Dysentery 42 E Earache 14 Ears, inflammation of 15 Ears, pains in 15 Ecchymosis in eyes 11 Emotions, causing disease. . 3 Epistaxis 16 Eructations 31 Erections 90 Eruptions on various parts. 8-21-19 Erysipelas 125 Erysipelas of mammae 66 Erysipelas of scrotum 89 Eyelids, paralysis of 13 Eyelids, spasm of 13 Eyelids, inflammation of. . . . 13 Eyes, affections of the 9 Eyes, inflammation of the. . 11 Eyes, swollen 12 Eyes, ulcerated 13 Exhaustion from mental la- bor 2 Expectoration, various kinds 50-51 Extremities, symptoms of. .. 102 Extremities, lower, symp- toms of 112 Extremities, upper, symp- toms of 102 F Face, eruption in 19-21 Eace, swelling of 48 Fat, tendency to get 142 Fear, consequences of 142 Feet, symptoms of 116 Feet, dorsum, symptoms of. . 118 Feet, soles, symptoms of. . .. 118 Females, diseases of 92 Fever, bilious 142 Fever, catarrhal, 42-142 Fever, dentition. ... 142 Fever, gastric 142 Fever, hectic 142 Fever, milk 142 Fever, puerperal 142 Fever, rheumatic 142 Fever, wound 142 Fever, yellow 142 Fever, particular symptoms of 142 Figwarts at anus 78 Figwarts on private parts. .. 94 Fingers, symptoms of 109 Finger joints, symptoms of.. Ill Finger nails, symptoms of. . 112 Finger tips, symptoms of. . . Ill Fitful 1 Fistula lachrymalis 14 Fistula dentalis 23 Freckles 18-125 Forebodings 2 Freezing, consequences of.. . 142 Fright 3 Fungi, articular, heematodes, medullaris 119 Fungus, hsematodes of eye. . 11 G Ganglia 125 Gangrene 87-125 Glans, affections of the 87-88 Glands, affections of 59-60-145 Glaucoma 9 Goitre 59 Gonorrhoea 87 Gout 145 Gravel 86 Grief, ill effects of 3 H Hemorrhage from ears 15 Hemorrhage from eyes 11 Hemorrhage from nose 16 Hemorrhage, uterine 94 Hands, symptoms of 107 Hang-nails 112 Hard hearing 15 Head, peculiar sensations in external 8 Head, trembling of < 9 Headache 6 Headache, various forms of. 6 Hearing, defects of 15 Hearing, illusions of 16 Heart, inflammation of 67 Heart, affections of, aggra- vated by 67 Heartburn 32 Heels, symptoms of 115 Hemeralopia 9 Hemicrania 6 Herpes • -••< 123 Herpes in face 19 Hip joint US Hoarseness 67 Hunger, abnormal 30 Hunger, ill effects of 145 Hydrocephalus 6 Hydrophobia 145 Hypochondria 145 INDEX TO REPERTORY. 153 Hypochondriac region, mor- bid sensations in the 37 Hysteria 4-145 Hysteric ball 25 I Illusions of color 9 Illusions of hearing 16 111 usions, optical 10 Illusions of size, shape, dis- tance 10 Illusions of things not pres'nt 10 Indurations 145 Inflammations 145 Inflammation of bladder. ... 85 Inflammation of the bowels. 39 Inflammation of the ears 15 Inflammation of the eyes. . . 11 Inflammation of eyelids 13 Inflammation of the heart. . 67 Inflammation of the larynx. 51 Inflammation of mammae... 66 Inflammation of mouth 25 Inflammation of nose 16 Inflammation of ovaries 94 Inflammation of palate 35 Inflammation of pharynx ... 26 Inflammation of the tongue. 28 Inflammation of trachea 57 Inflammation of urethra 86 Insanity 2 Intoxication 1 Ischuria 83 Itch 126 Itching of scalp 8 J Jaundice 18-144 Jaws, affections of the 22 Jealousy 3 Jealousy, ailments from 144 Joy, consequences of 144 K Kidneys, affections of 86 Knee-joints, symptoms of. .. 119 L Lachrymation 11 Larynx, inflammation of. . . 57 Larynx,morbid sensations in 56 Larynx, phthisis of 57 Lips, affections of the 21 Lips, cancer of the 21 Lips, eruptions on 21 Lips, rhagades of 22 Lips, swelling of 22 Lochia, derangement of 144 Long-sighted 12 Loss of blood between peri- ods 95 Loss of consciousness... — 2 Loss of voice, see aphonia. . . 56 Lumbago, see small of back. 12 M Mammae, cancer of 66 Mammae, erysipelas of 66 Mammae, inflammation of. .. 66 Mammae, swelling of 66 Mammary glands, affections of 66 Measles 123 Memory, defects of 3 Meningitis 5 Menses, character of 96-97 Mental derangements 3 Micturition, nocturnal 82 Micturition, abnormal . . 83 Micturition, at night in bed 83 Miliaria 124 Milk, defects of 66 Mindderangementand weak- ness of 1 Miscarriage 91 Moles 125 Moles in uterus, see polypi. . 94 Mouth, affections of the 24 Mouth, inflammation of 25 Mucus, dropping of, from pos- terior nares 72 N Nape of the neck, stiff. 60 Neck, stiff 60 Nervousness ... 145 Neuralgia 146 Nipples, affections of .... 66 Nipples, sore 66 Nodes, gouty 146 Npma 125 Nose, affections of 16 Nose, dry 42-48 Nose, inflamed 16 Nose, polypus of the 17 Nose, stoppage of 43 Nose, swelling of the 17 Nose, ulceration of 17 o Obscuration, see blackness. . 11 Onanism, consequences of. .. 146 Opisthotonos 72 Optical illusions 10 Ovaries, affections of 94 Ovarian dropsy 94 p Pains, spurious labor 95 Pains, wandering 146 Palate, affections of 25 Palpitation 57 Paralysis 146 Paralysis of eyelids 13 Pellicle on the eyes 12 Penis, affections of 81 Perineum, affections of, see anus 79 Pharynx, affections of 25 154 INDEX TO REPERTORY. Pharynx, inflammation of.. 26 Photophobia 10 Phthisis laryngea, (see Phthi- sis of larynxj 57 Pimples in face 20 Pityriasis 126 Placenta, adhesion of 95 Plethora 146 Poisoning with various sub- stances 146 Polypi of the nose 17 Pores, black 126 Pregnancy, ailments inci- dent to 146 Prepuce, affections of. 88 Prosopalgia 20 Prostate gland, affections of 90 Pudendum, affections of ex- ternal 92-93 Pupils, contracted ... 12 Pupils, dilated 12 Ptyalism (see salivation) 27 Purple rash 124 Pus, various kinds of 126 Pustules 124 Q Qualmishness 33 R Rage 4 liaphania 146 Rash 124 Regurgitation, (see Rising).. 32 Reports in ears 16 Rhagades of lips, (see Chap- ping) 21 Rhachitis 147 Rheumatism 146 Rickets 147 Risings 32 Rubeola 124 Rush of blood . 6 S Saliva, morbid 26 Salt, ill effects of 147 Scaly head 9 Scales on scalp 9 Scapulae, morbid feelings in region of 10 Scarlet-rash 124 Scrotum, affections of 89 Scurfs on head 9 Scurfs in nose 17 Scurvy 147 Seasickness 147 Sedentary habits, ill-effects of 147 Sediment in urine 81 Semen, morbid character of the 91 Sexual desire, unnatural 92 Sexual instinct of females, excited • 95 Sexual intercourse of females aversion to 95 Sexual weakness 92 Shortsighted 10 Shoulder joints, symptoms of 104 Skin, character of the 122~ Skin, symptoms of 122 Sleep, character and accom- panying conditions of 128-129 Sleeplessness 130 Small of back, morbid sensa- tions in 72 Smallpox 124 Sneezing 43 Somnambulism 4 Sopor 130 Sore nipples 66 Sore throat, see also Angina faucium , 25 Spasms 147 Spasm of the eyelids. ....... 13 Spasms, uterine 94 Speech, impeded 28 Spermatic cord, affections of 89 Spine, curvature of 71 Spots , 124 Spots on cornea 11-12 Squinting 12 Stammering 28 Stiff neck 60 Stomach, acid 35 Stomach, cancer of 35 Stomach, cramp of the 35 Stomach, schirrus of 35 Stomach and pit of stomach morbid sensations 35-36 Stone in bladder 85 Stool, ailments accompany- ing...., 76 Stool, character of 73-75 Stoppage of nose 43 Stuttering 28 Styes 14 Suffocative fits 47 Suicide, disposition to 4 Sweat 149-150 S weat, ill effects of suppress'd 150 Swellings 127 Swelling of eyes 12 Swelling of eyelids 13 Swelling of face 18 Swelling of lips 22 Swelling of mammas 66 Swelling of the nose IT Swelling of the ovaries 194 Swelling of tongue 28 Sycosicwarts 125 T Tarsal joints, symptoms of. . 118 Taste, morbid SO Tea, ill effects of 150 Teeth and gums, affections of the 23 INDEX TO REPERTORY. 155 Teething 23 Temper, defects of 1 Tenesmus of anus 77 Testicles, affections of 88 Thighs, symptoms of 119 Thirst, abnormal 30 Tibia, symptoms of 120 Tobacco, ill effects of 150 Toes, nails and joints 120-121 Tongue, affections of 27 Tongue, cancer of the 27 Tongue, cracked 27 Tongue, inflammation of 28 Tongue, swelling of 28 Trachea, inflammation of. . . 56 Trachea, morbid sensations in 57 Trembling of the head 9 Typhus, abdominal 142 Typhus, cerebral 142 Typhus, putrid 142 u Ulceration of eyes 13 Ulceration of the nose 17 Ulcers 41 Urethra, affections of 85 Urethra, discharges from — 86 Urinary organs, affections of 79 Urinate, urging to 82 Urine, morbid sensations ac- companying the emission of 83 Urine, quality of 79-82 Uterus, diseases of 93 Uterus, falling of 94 Uterus, hemorrhage from. . . 94 Uterus, inflammation of. 94 Uterus, putrefaction of 94 Uterus, spasms of 94 v Yagina, affections of 93 Vagina, inflammation of 93 Vanishing of sight, see black- ness 11 Varicella 125 Varices 128 Varices at anus 79 Vertigo 4 Vertigo, accompanying ail- ments of 5 Vision, sudden blackness of. 10 Vomiting 34 Vomit, inclination to 33 w Wandering of the mind 3 Waking, see sleeplessness. . . 130 Warts 125 Weakness, general 150 Weak back 72 Weak digestion 35 Weakness, sexual 92 Weaning 150 Wounds 128-150 Wrath 3 Wrist-joints, symptoms of. .. 106 z Zona 125 GENERAL INDEX. Abdomen, pain in the 293 bdominal deformity after labor 660 Abdomen pendulous 660 Abdomen, diseases of 225 Abortion (see miscarriage)... 642 Abscess of the liver 326 Abscess Psous-Psoitis 498 Abscess neucleatus 494 A bilious constitution 24 Acclimation 104 Accessory or palliative treat- ment 82 Aching pains in the back (Lumbago) 466 Accidents of various kinds... 702 " rules for restoration after drowning 703 Accidents, to excite breathing after 703 Acidity, sour stomach during pregnancy 637 Acidity, sour stomach, etc., of infants 677 Aconite as an external appli- cation 88 A constitution in which the skin is liable to become dis- eased 25 Acute contagious diseases 502 Acute articular rheumatism. 575 Acna Rosacea — Gutta rosacea 489 Adenitis (see inflammation of the glands) 475 Administration of Homoeo- pathic medicines 75 A dry wiry constitution 24 A feeble constitution 24 After effects of small pox 523 After effects of scarlet fever.. 515 After effects of typhus fever. 558 After effects of cholera 573 After pains 650 Age and the conditions qual- ifying it 27 Age, different periods of. 27-28 Ague, see intermittent Fever 525 Air as a modifier of disease... 100 Air and exercise during preg- nancy 633 A lax lymphatic constitution 25 Alcoholism 136-138 Aliments allowed during treatment Aliments prohibited during treatment Alum whey Amenorrhea (scanty menses) An apoplectic constitution... Ansemia of the brain Analogous remedies, table of A nervous constitution Angina (sore throat) Angina pectoris Animation suspended (see ap- parent death) Antharax Antidotes, table of An thony's,St.fire (erysipelas) Aphthous sore throat Aphthous sore thorat, allo- pathic treatment Aphthous sore throat, homoe- opathic treatment Aphthae Apoplectic constitution Appetite, the, and its indica- tions Apoplexy as a symptom of disease Apoplexy Apoplexy allopathic treatm't Apoplexy homcepathic treat- ment Apoplexy home treatment. Apparent death Apparent death from hunger Apparent death from a fall... Apparent death from suffo- cation Apparent death from light- ning Apparent death from drown- ing Apples, roast Apple water Arnica, external application of Arsenicum, external applica- tion of in bed sores Art of feeling the pulse Arteries and veins, diseases of the Arteries, diseases of the 103 104 727 606 24 115 81 24 204 451 702 495 729 479 204 206 207 202 24 46 49 117 118 119 121 702 702 702 702 703 703 726 726 90 32 453 453 892 GENERAL. INDEX. 893- Arteries and veins, wounds ofthe Arthritic rheumatism Arrowroot gruel Asiatic cholera Asthma Asthma, allopathic treatm't for Asthma, homoeopathic treat- ment for ,.... Asthma, home treatment for Asthma, hay (hay fever) Asthmatic affections as a complication of smallpox... Asthma of infants Asphyxia (see apparen t death) Atmospheric and other influ- ences of disease Atrophy of infants Aura epileptica Author's preface, first edit'n Author's preface, second edi- tion Baby, essentials for aby pudding Back, aching pain in the (Lumbago) Back, crick in the Bandages for ulcers and sores Bandages, elastic, to be used after labor Barber's itch Barley coffee Bath, regulations for Bath, hot fresh water Bath, cold, salt and fresh wa- ter Bath for infants, tempera- ture for Bathing, precautions to be observed in Bathing, cold, when benefi- cial Beating of the heart (see pal- pitation) Bed wetting, the, of young children Bedsores Beef tea Belching eructations Bilious constitution Bilious complaints Bilious or sick headaches Bilious fever Bilious fever, allopathic treat- ment for Bilious fever, homoeopathic treatment for Bilious colic Biliary calculi Blackish, dry, furred and tremulous tongue 710 577 725 568 423 424 426 427 426 523 689 702 30 691 140 7 722 722 466 466 714 661 488 726 90 90 91 93 92 91 445 352 559 724 250 24 225 250 273 274 274 296 330 48 Bladder, inflammation ofthe Bladder, chronic inflamma- tion of the Bladder, spasm ofthe Bladder, paralysis of the Bladder, stone or gravel in the Bladder, spasm of the, after labor Bleeding ofthe nose Bleeding of the lungs Bleeding from the womb Bleeding from wounds Bleeding piles Bleeding from the stomach... Blindness Blindness, treatment for Blood, the condition of the,as an important sign of the na- ture of the disease Blood, spontaneous dischar- ges of Bloodshot eye Blood, vomiting of Blood, vomiting of, allopathic treatment for Blood, vomiting of, homoeo- pathic treatment for Blood, spitting of Blood, discharges of, from the nose Bloody urine Bloody flux, (see Dysentery).. Blotches milk, milk scab Boils Boils and glandular swellings in connection with small- pox Bones ofthe nose, ulceration of the Bones, broken Bones, diseases of the Bottle nose Bowels, diseases ofthe Bowels, inflammation of the Bowels of infants, flatulent distention of Bowel complaints of infants. Bowels, looseness of the af- ter measles Bowels, looseness of the after smallpox Bowels constipation ofthe.... Bowels, constipation alterna- ting with looseness Bowels, confinement of the during pregnancy Brain, nerves, sensations, and senses and their indications Brain, diseases of the Brain, congestion of blood to the Brain, passive congestion of 348 348 354 356 346 651 196 386 651 710 300 251 176 177 37 38 179 251 253 254 386 196 350 284 679 494 523 190 716 458 489 261 280 678 682 508 523 310 314 638 56 106 110 113 $94 GENERAL INDEX. Brain, lack of blood to the.... 115 Brain, inflammation of the.. - 126 Brain fever 126 Brain fever, allopathic treat- ment for 127 Brain fever, homoeopathic treatment for 129 Brain, dropsy of the 131 Brain, water on the 131 Brain, water on the, treat- ment for 132 Brain and nervous systems sympathetic affections of. . 228 Brain the, in dyspepsia 246 Brain, concussion of the 706 Breathing and its indications in disease 41 Breath the, in health 41 Breathing, difficult, and its meaning 42 Breath offensive. 43 Breathing, difficult, treatm't of 194 Breathing, to excite or assist in after accident 703 Breathing, frequent, slow, quick, tardy, deep, or long small or short, difficult, moaning or sighing, oppres- sed, panting, suffocative, warm, cold, unequal, noisy, fetid or offensive, etc., and what is meant by these terms. 41-42 Breasts, inflammation of the624-661 Breasts, ulceration of the 624 Breasts, preparation of the, before confinement. 645 Breasts, swelling of the, of infants 690 Breasts, cancer of the. , 628 Bread and milk ... 722 Bright's disease of the kid- neys 339 Bright's disease of the kid- neys, allopathic treatment 342 Bronchitis, Inflammation of the bronchial tubes 390 Bronchitis, inflammatory 392 Bronchitis, inflammatory, al- lopathic treatment. 894 Bronchitis, inflammatory, ho- moeopathic treatment 396 Bronchitis, capillary. . . 396 Bronchitis of children 398 Bronchitis, home treatment. 398 Bronchitis, chronic 399 Bronchitis, chronic, allo- pathic treatment 401 Bronchitis, chronic, homoeo- pathic treatment 403 Bronchial catarrh 399 Broth for infants , 721 Broth, chicken 725 Bruises or contused wounds. 713 Buzzing in the ears 188 Bunions 501 Burns and scalds 717 Calculi, renal 346 alculi, biliary, (gall-stones) 330 Camp fever, (see typhus) 536 Calendula off, as an external application 88 Cancer of the liver 332 Cancer of the breast 628 Cancer of the uterus (womb). 627 Canker of the mouth 201 Canker of the mouth, allopa- thic treatment 203 Canker of the mouth, homoe- opathic treatment 204 Canker of the mouth, home treatment 204 Cantharis or cantharides as an external application 88 Capillary bronchitis 396 Carbo vegetabilis as an exter- nal application 90 Carbuncle 495 Carcinoma hepatis, cancer of the liver 332 Carcinoma uteri 627 Carcinoma manimse 628 Cardialgia 255 Caries of the bone 461 Catalepsy 147 Catarrhal ophthalmia 168 Catarrhal inflammation of the eyelids 168 Catarrh of the head 190 Catarrhal constitution 25 Catarrhal dysentery ■ 283 Catarrh or common cold. . . . 364 Catarrhal fever 364 Catarrhal fever, allopathic treatment 364 Catarrhal fever, homoeopathic treatment 367 Catarrh, bronchial 399 Catarrh, Epidemic — Influ- enza. 404 Catarrh, epidemic — Influenza allopathic threatment 405 Catarrh, epidemic— Influenza homoeopathic treatment... 406 Catarrh of the sexual mucous lining, Leucorrhcea 615 Catarrh of the bladder, (see chronic inflammation) 34S Causes of disease 30 Causticum or lime water for burns 89 Cerebral system, diseases of the 106 GENERAL INDEX. 895 Cephalalgia, Headache 156 Cerebro spinal meningitis, Spotted fever 106 ■Cerebrospinal meningitis, al- lopathic treatment 108 Cerebro-spinal meningitis ho- moeopathic treatment 109 Chapter I How to investi- gate the condition of the patient and determine the nature of disease 23 Chapter II Investigation of the disease 30 Chapter III Investigation of the disease contin- ued 67 Chapter IVDiet and manner of living 73 Chapter V Administration and repetition of homoeopa- thic remedies 75 Chapter YI Cerebro Spinal meningitis 106 Chapter VII The brain and nerves 156 Chapter VIII Diseases of the eye 168 Chapter IX Diseases of the ear 182 Chapter X Diseases of the nose 190 Chapter XI Diseases of the mouth and throat 201 Chapter XII Diseases of the stomach 225 Chapter XIII Diseases of the intestines 261 Chapter XIV Diseases of the liver 322 Chapter XV Diseases of the spleen 333 Chapter XVI Diseases of the kidneys 336 Chapter XVII Diseases of the bladder 348 Chapter XVIII Diseases of the male sexual organs 357 Chapter XIX Diseases of the larynx and trachea. . . 364 Chapter XX Diseases of the lungs 384 Chapter XXI Diseases of the Pleura 429 Chapter XXII Diseases of the organs of circulation . . . 438 Chapter XXIII Diseases of the arteries and veins • 453 Chapter XXIV Diseases of the bones, muscles and joints 458 Chapter XXV Diseases of the glands 475 Chapter XXVI Diseases of the skin , .-. 478 Chapter XXVII Acute con- tagious diseases 502 Chapter XXVIII Epidemic and endemic infectious diseases 525 Chapter XXIX Constitu- tional diseases without defi- nite infection 575 Chapter XXX Diseases of the female sexual organs. 599 Chapter XXXI Pregnan- cy 630 Chapter XXXII Diseases following confinement 652 Chapter XXXIII Infants treatment after birth 663 Chapter XXXIV Diseases of infancy 673 Chapter XXXV Accidents of various kinds 702 Chapter XXXVI Food for infants and invalids 720 Chapter XXXVII The Reper- tory 736 Change of life 622 Change of life, symptoms of the 623 Chafing of infants 688 Charcoal 90 Characteristics, individual.. . 29 Chest, sounds from the 70 Chest, concussion of 707 Chest, contusion of 707 Childhood, periods of. 28 Children, derangements of the stomach of 245 Children, fits of little. 146 Children, still-born 663 Children, young, food for.... 722 Children's pie 722 Children, sleeplessness of 670 Children and infants, treat- ment of 663-673 Children, bowel complaints of 682 Children derangements of during teething 695 Children, convulsions of 699 Child, care of during labor. . 649 Child-bed fever 656 Child, when may it be put to the breast 665 Chicken-pox « 524 Chicken broth 725 Chilblains 500 Chill and fever as symptoms 61-63 Chill and fever 525 Chlorosis (green sickness) 604 Cholelithiasis (see gall stone) 330 Choice of habitation 96 Choleric temperament 26 Cholera morbus 269 Cholera morbus, allopathic treatment ,.... 270 896 GENERAL INDEX. Cholera morbus, homoeopa- thic treatment 271 Cholera, asiatic 568 Cholera, malignant 568 Cholera, epidemic 568 Cholera, causes of 569 Cholera, after effects of 573 Cholera infantum 684 Chorea , 154 Chorea, allopathic treatment 154 Chorea, homoeopathic treat- ment 155 Chronic articular rheuma- tism 576 Chronic rheumatism of joints 580 Cinchona tincture, applica- tion externally 90 Cirrhosis, see chronic inflam- mation of the liver 327 Cleanliness, value of in pre- vention of disease 100 Climate, modification of. .... 96 Clothing and habits 75 Clothing during pregnancy... 634 Clothing, see apparel '. . . 95 Coffee, barley 726 Coffee, oatmeal 726 Cold in the head 190 Cold in the head, allopathic treatment for 191 Cold in the head, homoeopa- thic treatment for 192 Cold in the head, home treat- ment for 195 Cold, constitutional tendency to take 194 Cold in the head, of infants. . 674 Colic 293 Colic, various forms of 294 Colic, from worms 299 Colic, crying and wakefulness of infants 675 Common cold 364 Common cold allopathic treat- ment 364 Common cold, homoeopathic treatment 367 Complicated forms of scarlet fever — 514 Complication and after-effects of smallpox 523 Complexion the, its indica- tion 69 Concussion of the brain 706 Concussion of the chest 707 Condensed signs of pregn'ncy 630 Conditions which qualify the age .' 27 Confinement or labor 647 Confinement, duration of 652 Confinement, diseases follow- ing 652 Confluent smallpox 521 Congestion of blood to the brain HO Congestion of blood to the lungs 384 Congestion of the liver 322 Constitution and its varieties 24 Constitution, feeble 24 Constitution, bilious 24 Constitution, apoplectic 24 Constitution, a nervous 24 Constitution, dry, wiry 24 Constitution, lax, lymphatic. 25 Constitution in which the skin is liable to become dis- eased 24 Constitution, rheumatic 25 Constitution, Consumptive.. 25 Constitutional diseases 502 Constitutional diseases with- out definite infection 575 Constipation 310 Constipation, allopathic treat- ment 310 Constipation, homoeopathic treatment 312 Constipation alternating with looseness ' 314 Constipation of aged persons 315 Constipation after purging.. 315 Constipation during pregn'n- cy 638 Constipation of infants 681 Consumption 586 Consumption, preventive treatment for 593 Contagious diseases 502 Contagious diseases, sanitary rules of the N. Y. Board of Health 506 Contents, table of 15-22 Convalescence after typhus.. 557 Convulsions of infants 699 Convulsions and spasms as symptoms 53 Copper nose 489 Corns 501 Coryza 190 Coryza, snuffles of infants. . . 674 Costiveness, its indications. . 44 Costiveness, see constipation. 310 Cotton wool as an external application 89 Coughs, their indications... 67 Cough, treatment of 372 Cough, nervous 372 Coupdesoleil, (see sunstroke) 718 Coughs, after measles 508 Coughs, in connection with smallpox 523 Cough, whooping 407 Cow's milk for infants 721 Cowpox (see vaccination.).. 701 Coxalgia (see hip disease). . .. 468 GENERAL INDEX. 897 Coxalgia, allopathic treat- ment, Coxalgia, homoeopathic treat- ment Cranberries for children Critical sweat Crick in the back Cross-eyes Croup, laryngitis Croup, laryngitis, allopathic treatment Croup, laryngitis, homoeopa- thic treatment Croup, false Croup, true Crusta lactea Crying and wakefulness of new born infants. . , Cup pudding, tapioca Cup pudding, invalids' Cutaneous diseases (see disea- ses of the skin) Cuts (see wounds) Cystitis, inflammation of the bladder Cystospasmus, spasm of the bladder Dandruff. eafness Deafness, allopathic treat- ment Deafness, homoeopathic treat- ment Death, apparent, from hun- ger Death, apparent, from a fall. Death, apparent from suffo- cation Death, apparent, from light- ning , Death, apparent, from drown- ing Death, apparent, from being frozen Death, apparent, from nox- ious vapors Death, verification of Decline, first period of Dedication Deforming rheumatism Delay of the menses ... Delirium, its indications.... Delirium tremens Delirium tremens, allopathic treatment Delirium tremens, homoeo- pathic treatment Delivery, perspiration after. Delivery, weakness after Delivery, treatment after — Dentition, teething Depression of spirits 57 469 470 722 69 466 180 377 377 383 379 379 679 675 725 725 478 709 348 354 486 183 184 186 702 702 702 703 703 704 705 705 28 3 577 606 49 136 137 138 654 660 650 695 246 Derangements attendant .upon the first appearance of the menses 602 Derangement of the stomach 242 Diarrhoea 261 Diarrhoea, allopathic treat- ment 262 Diarrhoea, homoeopathic treatment 265 Diarrhoea, its indications 44 Diarrhoea, chronic. : 263 Diarrhoea of children, allo- pathic treatment 264 Diarrhoea alternating with constipation 314 Diarrhoea of lying-in women 659 Diarrhoea of infants, descrip- tion and homoeopathic treatment 682 Diagnosis 23 Diet and manner of living. . 73-99 Diet, rules for, synopsis . 103 Diet during nursing 667 Diet, supplementary of in fants ♦... 668 Difficult breathing 42. Digestive functions and their indications 44 Digestion, deranged 225 Dilation of the veins 454 Dilation of the veins, allopa- thic treatment 456- Dilation of the veins, homoe- opathic treatment. 457 Diphtheria 213 Diphtheria, allopathic treat- ment 215 Diphtheria, homoeopathic treatment 218 Discharges of blood, sponta- neous 38 Discharge from the ear 183 Discharge of blood from the lungs 386 Diseases to which the patient is especially liable 29 Disease, the part or organ usually affected 30 Disease, investigation of 30 Disease, consideration of the cause of . . . . 30 Disease, general character of 31 Disease, the causes of 30 Diseases of the brain, spinal cord, and nervous system. . 106 Diseases of the head 156 Diseases of the eye 168 Diseases of the ear 182 Diseases of the nose 190 Diseases of the mouth and throat 201 Diseases of the stomach 225 Diseases of the intestines. . . 261 898 GENERAL INDEX. Diseases of the liver and spleen 322 Diseases of the kidneys 336 Diseases of the bladder 348 Diseases of the male sexual organs 357 Diseases of the respiratory organs . , ... 364 Diseases of the larynx and trachea 364 Diseases of the lungs.. 384 Diseases of the pleura 429 Diseases of the organs of cir- culation 438 Diseases of the heart 438 Diseases of the arteries and veins 453 Diseases of single systems . . . 458 Diseases of the bones, mus- cles and joints 458 Diseases of the glands 475 Diseases of the skin 478 Diseases of the arteries 453 Diseases of the veins 453 Diseases, epidemic and en- demic infectious 525 Diseases, acute contagious... 502 Diseases, constitutional, without definite infection. 575 Diseases of the female sexual organs 599 Diseases following confine- ment 652 Dislocations, partial 707 Division and repetition of doses 80 Doses and their division 80 Dose for an adult 79 Dose for infants and chil- dren , 79 Doses for internal remedies. 78 Dose of globules (pills) 78 Dose of tinctures 79 Dose of triturations 79 Dose, to insure a proper 82 Dose, for eradicative treat- ment 102 Drainage, to prevent 'disease 96 Dropsy of the brain ..... 131 Dropsy of the brain, congen- ital 132 Dropsy of the brain, allopa- th ic'treatment 132 Dropsy of the brain, homoeo- pathic treatment 132 Dropsy of the chest 433 Dropsical swellings after scar- let fever 515 Dropsy 719 Dry, wiry constitution 24 Drowning, apparent death from.... 703 Duration of confinement 652 Duration of suckling — wean- ing 669 Dysentery, catarrhal. 283 Dysentery, epidemic 284 Dysentery, allopathic treat- ment 288 Dysentery, homoeopathic treatment 291 Dysmenorrhea (painful menstruation) Dyspepsia 225 Dyspepsia, allopathic treat- ment 235 Dyspepsia, homoeopathic treatment 237 Ear, diseases of the 182 ar, inflammation of the. .. 182 Ear, discharge from 183 Ear, neuralgia of 185 Ear, humming or buzzing in 188 Earache 182 Earache, rheumatic or ner- vous 187 Eclampsia, spasms of infants 146 Eczema 492 Eggs, allowed in sickness. . . 100 Eggs, soft boiled 724 Eggs and milk 724 Egg toast, how to make 723 Electricity in paralysis of the eye : 177 Electricity in colic 299 Elm bark mucilage 727 Emaciation of infants 691 Emansio mensium 604 Empty pulse 34 Employment of the mind during pregnancy 634 English " pap " 721 Enlargement of the heart. .. 450 Enteritis— Inflammation of the bowels 280 Enteritis, allopathic treat- ment 281 Enteritis, homoeopathic treatment 283 Enteralgia 293 Enteric fever 536 Enteric fever, homoeopathic division and treatment of. 545 Enteritis as a complication of measles 504 Enuresis nocturni 352 Epidemic and endemic infec- tious diseases 525 Epidemic catarrh 404 Epidemic cholera 56S Epileptic vertigo 141 Epilepsy 139 Epilepsy, allopathic treat- ment 142 GENERAL INDEX. 899 Epilepsy, homoeopathic treat- ment 145 Epilepsy, onanism as a cause 141 Epistaxis ' 196 Eradicative and preventive treatment 93-101 Eructations — Belching 250 Essentials for a baby 722 Evacuations, their indica- tions 44 Excess of blood to the brain 110 Excess of blood to the brain allopathic treatment 113 Excess of blood to the brain homoeopathic treatment. .. 114 Excessive secretion of milk. 653 Excessive perspiration af- ter delivery 654 Excoriation of the nipples. . 661 Excoriation of infants 688 Exercise, the value of in pre- vention of disease. 100 Exercise of infants 671 Expectoration, and its indi- cations 72 External remedies and appli- cations 87 External application of a poultice 87 External application of a fomentation 87 External application of Ar- nica 87 External application of cal- endula 88 External application of rhus. 88 External application, for in- cised wounds 710 External application, for lac- erated wounds 712 External application, for contused wounds or bruises 713 External application, for punctured wounds 714 External application, for gunshot wounds, splinters, etc 714 External application, for dis- locations 707 External application, for sprains 707 External application, for burns or scalds 717 External ^application, for stings of insects 718 Erysipelas 479 Ervsipelas, allopathic treat- ment 482 Erysipelas, homoeopathic treatment 483 Erysipelas, home treatment. 484 Erysipelas, of infants 481 Erysipelas, symptomatic 481 Erysipelas, wandering 481 Erysipelas, deviations from the common course of '480 Erysipelas, fever... 480 Erysipelas, susceptibility to, in the face 484 Erythema— Simple redness of the skin 478 Eye, the, affords a multitude of symptoms and indica- . tions in disease 64-65 Eye, diseases of the 168 Eye, inflammation of the. . .. 168 Eye, weeping or watery 178 Eye, bloodshot 179 Eye, crossed 180 Eyes, inflammation of the, of infants 673 Eace, ache 162 ace, ague 162 Facial herpes 490 Fainting, its indications 49 Fall, apparent death from a. 702 Falling down of the bowel.. 315 Falling of the womb 619 Falling sickness — Epilepsy.. 139 False pains before labor 647 Fat, excessive 71 Fattv degeneration of the heart 448 Favus— Scald head 496 Feeble pulse 34 Feeble constitution. 24 Felon or whitlow 500 Females, affections peculiar to 599 Female sexual organs, dis- eases of the , 599 Ferunculus — Boils 494 Ferunculus, malignant. ..... 495 Fetid or offensive breath. . .. 43 Fetid discharges after labor, 659 Fever, general remarks on. . 271 Fever, general treatment and diet during 272 Fever, gastric or bilious 273 Fever, gastric or bilious, al- lopathic treatment 274 Fever, gastric or bilious, ho- moeopathic treatment 277 Fever, catarrhal 364 Fever, scarlet 508 Fever, scarlet, symptoms and course of 509 Fever, scarlet, uraemia in. . . 512 Fever and ague 523 Fever, intermittent 525 Fever, intermittent, allopa- thic treatment 527 Fever, intermittent, homoeo- pathic treatment 531 Fever, inflammatory 535 900 GENERAL INDEX. Fever, typhoid 536 Fever, enteric 536 Fever, typhus 536 Fever, yellow 562 Fever, hay 426 Fever, erysipelas 480 Fever, milk 655 Fever, child-bed or puerperal 656 Fever, sun 718 Fever, brain 126 Fever, spotted, see Meningi- tis 106 Fever, remittent 274 Fevers, the urine foretells the changes at next crisis 39 First signs of approaching labor 646 Fistula lachrymalis 178 Fits of little children 146 Flatulency, its indications.. 45 Flatulence of infants 674 Flatulent distention of the stomach and bowels of in- fants 678 Flaxseed tea 726 Flesh, loss of or unhealthy increase of. 71 Flour as an external applica- tion for burns and scalds. . 90 Flooding after labor 651 Flux — Dysenteria 285 Flux — Dysenteria, allopathic treatment 288 Flux — Dysenteria,homoeopa- thic treatment. .. , 291 Fly, Spanish, as an outward application 88 Fomentations, application of 87 Food, see aliments «... 95 Food of infants 720 Food for invalids : 723 Food for young children 722 Foot, inflammation of the joints of the 474 Fractures of bones 716 Freezing, apparent death from : 704 Frequent pulse ' 34 Frozen limbs 501 Full pulse 34 p alactorrhoea 653 VJall-stone 330 Galling— Excoriation of in- fants 688 Gastric or bilious fever 273 Gastric or bilious fever, allo- pathic treatment 274 Gastric or bilious fever, hom- oeopathic treatment 277 Gastric derangements during pregnancy 635 General habits and method of living 29 General remarks on fever.... 271 General treatment and diet during fever 272 Glandular swelling and boils in connection with small- pox 523 Glands, congloate, diseases of the 475 Gonitis. 471 Gout Granular ophthalmia 172 Gravel 346 Green sickness — Chlorosis. .. 604 Grief, see mental emotions. . Groaning as a symptom 72 Groin, rupture of the, of in- fants Gruel, how to make 723 Gruel , arrow-root . . , 725 Gruel, water. 725 Gruel, rice 725 Gruel, sago 725 Gunshot wounds 714 Gutta rosacea 489 Habits of living 95 abits and clothing 75 Habits of regularity 100 Habits during pregnancy 634 Habitation, choice of 96 Haematemesis 251 Haemorrhoids 300 Haemorrhoids, allopathic treatment. 300 Haemorrhoids, homoeopathic treatment 303 Haemorrhoids, home treat- ment 303 Haemoptysis, see Spitting of blood 386 Hard pulse 34 Hardness of hearing 183 Hay fever 426 Hay Asthma 426 Head, diseases of the 156 Head, cold in the 190 Head, cold in the, allopathic treatment 191 Head, cold in the, homoeopa- thic treatment 192 Head, swelling of the, of in- fants 664 Head, congestion of blood to the HO Head, cold in the, of infants. 674 Head, dropsy of the, see drop- sy of the brain 131 Headache 156 Headache, allopathic treat- ment 157 GENERAL INDEX. 901 Headache, homoeopathic treatment Headache, neuralgic Headache, bilious or sick 158 Heat and cold — chill and fev- er as symptoms Heat, exposure to (sunstroke) Hearing, the, as a symptom in disease Hearing, hardness of Heart, diseases of the Heart, inflammation of the. . Heart, palpitation of the Heart, fatty degeneration of the Heart, hypertrophy of the. . Heart, enlargement of the. .. Heartburn Helminthiasis — Worms Hematuria Hematuria, allopathic treat- ment Hematuria, homoeopathic treatment. ... Hemicrania or megrim Hemorrhage from the lungs Hemorrhage from the stom- ach Hemorrhage from the nose. . Hemorrhage from the womb see flooding Hemorrhage from wounds, means of stopping Hemorrhage from extracting a tooth Hereditary disease Hernia, see rupture. . . - Herpes — Tetter Herpes— Tetter, of the face. . Herpes, zoster. Zona Herpes iris and circinnatus.. Hiccup as a symptom of dis- ease Hiccup, general article on. .. Hiccup, treatment for Hiccup of infants Hip-joint, inflammat'n of the Hives — Urticaria Hoarseness as a symptom. .. Homoeopathic medicines, their administration, repe- tition, doses, preservation, etc Home, choice of (see habita- tion) Honeycomb tetter Hordeolum — Stye Hot fresh water bath Humming or buzzing in the ears Hunger, apparent death from Hydrocephalus — W a t e r on the brain i59 157 ■250 61 718 183 438 438 445 448 450 450 637 304 350 351 351 156 386 251 197 651 708 711 27 665 490 490 91 491 55 427 428 674 468 484 70 iO 96 496 180 90 188 702 131 Hydrocephalus, al lopathic treatment 132 Hydrocephalus, homoeopa- thic treatment 132 Hygiene of pregnancy 633 Hyperaemia of the brain 110 Hyperaemia of the brain, al- lopathic treatment 113 Hyperaemia of the brain, ho- moeopathic treatment 114 Hypertrophy of the heart. . . 450 Hypochondriacal affections. 246 Hysterics 148 Hysterics, allopathic treat- ment 152 Hysterics, homoeopathic treatment 149 Hysterics, home measures.. 152 Incised wounds 710 n continence of urine 352 Indications of the pulse 32-34 Indications of the urine . . 38 Indications of the breathing 41 Indications of the digestive functions 44 Indications of the evacuations 44 Indications of wind in the stomach 45 Indications of nausea and vomiting 45 Indications of thirst 47 Indications of the tongue. . . 48 Indications of motion and rest 51 Indications of the sensations 56 Indications of tearfulness and laughter 71 Indications of coughs 67 Indigestion .225-226 29 663 664 665 665 665 665 666 720 670 674 674 677 677 481 Individual characteristics... Infants, treatment of Infants, swelling of the head of Infants, rupture of Infants, rupture of navel of. Infants, rupture of groin Infants, when may they be put to the breast Infants, observations on the suckling of Infants, food for 669- Infants, sleeplessness of Infants, hiccup of Infants, snuffles of Infants, vomiting of milk of Infants, sour stomach of Infants, erysipelas of Infants, flatulence of Infants, flatulent distention of the stomach and bowels Infants, aphtha?— Thrush of. Infants, nursing sore mouth 678 680 680 902 GENERAL INDEX. Infants, constipation of 681 Infants, diarrhoea of . . 682 InfantSjSummer complaint of 684 In fants, chafing— -E xcori a- tions of 688 Infants, asthma of 689 Infants, swelling of the breasts of 690 Infants, atrophy — E macia- tionof 691 Infants, teething of 695 Infants, spasms of 699 Infants, broth 721 Infants, inflammation of the eyes of 673 Infancy, diseases of 673 Inflammation of the brain. . 126 Inflammation of the brain allopathic treatment for. .. 127 Inflammation of the brain, homoeopathic treatment. . 129 Inflammation of the eyes 168 Inflammation of the eyes, allopathic treatment. . 170 Inflammation of the eyes, ho- moeopathic treatment 174 Inflammation of the Iris. . . 169 Inflammation of the ear 182 Inflammation of the nose - , 196 Inflammation of the mouth. 201 Inflammation of the tonsils. 207 Inflammation of the bowels. 280 Inflammation of the bowels, allopathic treatment 281 Inflammation of the bowels homoeopathic treatment. . . 283 Inflammation of the perito- neum • 316 Inflammation of the perito- neum, allopathic treatm't. 318 Inflammation of the perito- neum, homoeopathic treat- ment 319 Inflammation of the liver. .. 322 Inflammation of the liver, al- lopathic treatment 323 Inflammation of the liver, homoeopathic treatment. . . . 324 Inflammation of the spleen.. 333 Inflammation of the kidneys 336 Inflammation of the kidneys allopathic treatment 337 Inflammation of the kidneys homoeopathic treatment.. . 338 Inflammation of the bladder 348 Inflammation of the testes. . 357 Inflammation of the larynx. 369 Inflammation of the bron- chial tubes 390 Inflammation of the lungs. 413 Inflammation of the pleura. . 429 Inflammation of the womb seeLeucorrhcea 615 Inflammation of the veins. .. 455 Inflammation of the bones and periosteum 458 * Inflammation of the joints. . 467 Inflammation of the hip joint 468 Inflammation of the knee joint 471 Inflammation of the joints of the foot 474 Inflammation of the breasts.624-661 Inflammatory bronchitis 392 Inflammatory jaundice 330 1 nflammatory fever 535 Influenza 404 Influenza, allopathic treat- ment 405 Influenza, homoeopathic treatment 406 Injections, rules for 82 Injuries, see wounds 709 Insects, stings of 718 Intermittent pulse 34 Intermittent fever 525 Internal remedies and doses 78 Intestines, diseases of 261 Introduction, Dr. Bean's.. 10-14 Invalids, food for 720 Invalids' cup pudding 725 Invalids, apple pie 725 Investigate of disease (diag- nosis) . . 30 Investigation of urine, the proper time for 39 Investigation of the patient. 23 Invermination — Worms 304 Itch, barbers' 488 Itch — Scabies 497 Itching of the genitals dur- ing pregnancy 641 Jaundice 327 aundice, allopathic treat- ment 328 Jaundice homoeopathic treat- ment 329 Jaw, locked 133 Joints, diseases of the 458 Joints, inflammation of the. 467 Joints, rheumatism of the.. . 575 Kidnej-s, diseases of the .. 336 idneys, inflammation of the 336 Kidneys, inflammat'n of the allopathic treatment 337 Kidneys, homoeopathic treat- ment 338 Kidneys, Bright's disease of 339 Knee joint, inflammation of. 471 Knne joint, inflammation of allopathic treatment 472 Knee joint, inflammation of homoeopathic treatment. . . 473 Labor, first signs of 646 abor, preparation of the bed for 646 Labor, or parturition 647 Labor, care of child during. 649 Labor, the attentions to the woman after 650 Labor, general management diet, etc 650 Labor, flooding after. 651 Labor, retention of the urine after 651 Labor, incontinence of urine after 652 Labor, preparation of the breasts before 645 Labor, false pains before 647 Labor, after pains of 650 Labor, duration of confine- ment 652 Labor, excessive perspiration after 655 Labor, milk fever after 655 Labor, child-bed fever after. 656 Labor, irregular discharges of the lochia after 658 Labor, diarrhoea after 659 Labor, weakness after 660 Lacerated wounds 712 Lachrymal sack, obstruction or fistula of the 178 Large pulse 34 Laryngitis— croup 377 Laryngitis, allopathic treat- ment 377 Laryngitis, homoeopathic treatment 383 Larynx and trachea, diseases of the 364 Larynx, inflammation of the 369 Laughter and tearfulness and what they indicate 71 Leuchorrhcea — Whites 615 Lemonade . . 726 Life, the change of in females 622 Lightning, apparent death from 703 Limbs, retarded strength of, in infants 672 Limbs, frozen 501 Lime water, external applica- tion of 89 Liver, diseases of the 322 Liver complaint 322 Liver, inflammation of the. . 322 Liver, abscess of the 326 Liver, chronic inflammation of the 327 Liver, cancer of the. 332 Living, habits of 95 Living, manner of life 29 Lochia! discharge and irreg- ularities of 658 GENERAL INDEX. 903 Lochial discharge, excessive 659 Lochial discharge, suppres- sed 659 Lochial discharge, offensive. 659 Lock-jaw 133 Lock-jaw, allopathic treat- ment 134 Lock-jaw homoeopathic treat- ment 136 Lock-jaw, of infants 135 Loss of consciousness, its in- dications in disease 49 Loss of or unhealthy increase of flesh 71 Looseness of the bowels dur- ing Small Pox 523 Lumbago, crick in the back. 466 Lungs, diseases of the 384 Lungs, congestion of the 384 Lungs, congestion of the, al- lopathic treatment 384 Lungs, congestion of the, ho- moeopathic treatment 385 Lungs, bleeding from the. .. 386 Lungs, inflammation of the. 413 Lungs, inflammation of the of children 420 Lymphatic tumors 475 Male sexual organs, diseases of the 357 Malignant cholera 568 Mammae (breasts) inflamma- tion of the 661 Mania a potu — Delirium Tre- mens 136 Marasmus, of infants 691 Marrow, inflammation of the 460 Mastitis (inflammation of the breasts) , . 624 Maturity, first period of 28 Maternity (see Pregnancy). . 630 Means to be employed against cholera 575 Measles— Morbili 502 Measles — Morbili, allopathic treatment 505 Measles — Morbili, homoeopa- thic treatment 507 Measles, after effects of 508 Measles, enteritis as a compli- cation of 504 Medicines, when to be taken 82 Medicines, homoeopathic rules for preserving; 82 Medicines, systematic table of rules for giving ... 84 Megrim — Headache 156 Melancholic temperament.. 26 Meningitis, cerebro-spinalis. 106 Meningitis, cerebrale 126 Meningitis, chronic 128 Menorrhagia 611 904 GENERAL INDEX. Menorrhagia, mechanical means for suppressing... 615 Menopause— Change of life. . 622 Menstruation 599 Menses, derangements upon the appearance of the 602 Menses, suppressed, delayed or scanty . . 606 M enses, profuse 611 Method of living, general habits 29 Milk, secretion of the 652 Milk, scanty secretion of the 653 Milk, suppression of the 653 Milk, excessive secretion of the 653 Milk fever 655 Milk, vomiting of, by infants 677 Milk scab, milk crust... 679 Milk, cow's for infants 721 Milk toast 724 Milk, thickened 724 Milk and eggs 724 Mind, employment of the during pregnancy 634 Miscarriage 642 Miscarriage, to prevent a ten- dency to 643 Modified smallpox 522 Monthly flux or periodical discharges of females 599 Morbus divinas 139 Morbus herculeus — Epilepsy 139 Morbus Brightii 339 Morbili — Measles 502 Morbili, allopathic treatm'nt 505 Morbili, homoeopathic treat- ment 507 Morning sickness during pregnancy 635 Motion or rest as symptoms 51 Mouth, diseases of the 201 Mouth, canker of the 201 Mouth, inflammation of the. 201 Mouth, wounds of the ... 711 Mucilage of elm bark 727 Mumps 220 Mumps following other dis- eases 221 Mumps, treatment 222 Muscles, diseases of the 458 Mush, brown, for supper 722 Mustard whey 727 Mutton tea 725 Myelitis, see inflammation of the marrow 460 "\Tasitis-Inflammation of the IN nose 196 Nausea and vomiting, their indications 45 Nausea, general article on. . . 249 Naval rupture of infants 665 Near-sighted 180 Necrosis (death of bone) 461 Nephritis — Inflammation of the kidneys 336 Nerves, brain, sensations and senses and their indications 49 Nervous or rheumatic ear- ache 187 Neuralgic headache 157 Neuralgic headache, allopa- thic treatment 157 Neuralgic headache, homoeo- pathic treatment 159 Neuralgia 162 Neuralgia, allopathic treat- ment 163 Neuralgia, homoeopathic treatment 165 Neuralgia of the ear 185 Nipples, sore 661 Nose, diseases of the 190 Nose, polypi of the 196 Nose, inflammation of the.. 196 Nose, bleeding from the 196 Nose, bleeding from the, allo- pathic treatment 197 Nose, bleeding from the, ho- moeopathic treatment . 198 Nose, bleeding from the, home treatment 200 Nose, bottle 489 N ose, copper 489 Nurse, the choice of a 667 Nursing, diet during 667 Nursing sore mouth of in- fants 680 Oatmeal coffee 726 bservations on pregnancy. 632 Observations on the suckling of infants 666 Obstipation, see Constipation 310 Odontalgia — Toothache 222 Offensive or fetid breath 43 Onanism, as a cause of epi- lepsy 141 Ophthalmia 168 Ophthalmia, purulent...*. 169 Ophthalmia, granular ...... 172 Ophthalmia, chronic 172 Ophthalmia, of infants 173-673 Ophthalmia, scrofulous 173 Organs of respiration, disea- ses of 364 Orange whey ... 727 Orchitis 357 Ostitis— Inflammation of the bones 458 Otitis— Infl'mat'n of the ear 1S2 Otorrhcea— Discharge from the ear 1S3 Overheating 71S Oyster soup for invalids 724 GENERAL INDEX. 905 Pain in the teeth 222 ains of various kinds as symptoms 56-60 Pains, false, before labor 647 Pain in the chest or painful respiration and what it in dicates 42 Pain in the bowels 293 Pain, absence or sudden sup- pression of 57 Pain, intermittent and what it indicates 58 Pain, inflammatory or ner- vous 59 Pain in the nerves of the face 162 Painful an d difficult menstru- ation 611 Printers' colic 294 Palsy or paralysis . 122 Patient, condition of the, method of investigating.... 23 Palliative treatment 82 Palpitation of the heart 445 Parturition, treatment before 645 Part first, diagnosis and prog- nosis 23 Part second, Diseases of the brain and nerves 106 Part third, Diseases of the head * 156 Part fourth, the gate 201 Part fifth, the digestive func- tions 225 Part sixth, Diseases of the liver and spleen 322 Part seventh, Diseases of the kidneys and bladder 336 Part eighth, Diseases of the male sexual organs 357 Part ninth, Diseases of the respiratory organs 364 Part tenth, Diseases of the organs of circulation 438 Part eleventh, Diseases of single systems 458 Part twelfth, Constitutional diseases.. 502 Part thirteenth, Diseases pe- culiar to women 599 Part fourteenth, Treatment of infants 663 Part fifteenth, Surgery 702 Part sixteenth, Repertory 736 Panada, how to make 723 Paralysis as a symptom 55 Paralysis 122 Paralysis, allopathic treat- ment 122 Paralysis, homoeopathic treatment 125 Paralysis, home treatment... 125 Paralysis of the face 124 Paralysis of the insane 125 Paralysis, infantile 124 Paralysis of the bladder 356 Parotitis 220 Parotitis, treatment for 222 "Pap," English 721 Patient general investigation of 23 Passive congestion of the brain 113 Pendulous abdomen 660 Pepsin, formula for making. 476 Periods of life 27-28 Period of approaching ma- turity 28 Period of decline 28 Peritonitis 316 Peritonitis, allopathic treat- ment , 318 Peritonitis, homoeopathic treatment 319 Periostitis 460 Perspiration after delivery... 654 Perspiration after delivery, excessive 655 Pertussis — Whooping cough. 407 Phlegmatic temperament 27 Phlebitis — Inflammation of the veins 453 Phrenitis 126 Ph thisis— Consumption 586 Pie, children's 722 Pie, invalids' apple 725 Piles 300 Piles, allopathic treatment... 300 Piles, homoeopathic treat- ment 303 Pityriasis 486 Plethoric constitution 23 Pleura, diseases of the 429 Pleura, inflammation of the 429 Pleuritis 429 Pleurisy 429 Pleurisy, allopathic treatm't 431 Pleurisy, homoeopathic treat- ment 436 Pleurisy of infants 435 Pneumonia 413 Pneumonia, allopathic treat- ment 417 Pneumonia, homoeopath ic treatment 421 Pneumonia, of young c h i 1- dren 420 Poisons, their antidotes— see table of remedies 728 Polypi of the nose 196 Position of the patient as a symptom 53 Potencies (strength) of medi- cine 80 Pott's disease 458 Poultice, application of 87 906 GENERAL INDEX. Pox, small 516 Pox, chicken 524 Precautions to insure proper doses 82 Preface to First Edition 5 Preface to Second Edition 4 Pregnancy 630 Pregnancy, condensed signs of 630 Pregnancy, observations on.. 632 Pregnancy, hygiene of 633 Pregnancy, employment of the mind during 634 Pregnancy, gastric derange- ment during 635 Pregnancy, nausea and vom- iting of 635 Pregnancy, clothingand hab- its during 634 Pregnancy, constipation dur- ing 638 Pregnancy, toothache dur- ing 639 Pregnancy, urinary difficul- ties during... 641 Preservative measures against cholera 575 Preventive and eradicative treatment 93 Profuse menstruation 611 Prognosis 23 Prolapsus uteri 619 Prolapsus ani 315 Proof spirits of wine as an application for burns 89 Pruritis-Itching of the geni- tals 641 Prunes, stewed 726 Psoriasis 487 Psous psoitis 498 Pudding for babies 722 Pudding, tapioca cup 725 Pudding, invalid's cup 725 Puerperal fever 656 Purulent ophthalmia 169 Pustula nigra 495 Pyrosis 637 Auick pulse 34 v^uick breathing 42 Quinsy 207 Quinsy, allopathic treatm'nt 210 Quinsy, homoeopathic treat- ment 211 "D ash, nettle 484 Xiash, scarlet 508 Raw cotton as an * external application 89 Red, dry and glassy tongue. 48 Redness, swelling, heat, and tingling of the skin (erysi- pelas) 479 Regularity of habits 100 Regulations, general, for diet and regimen 73 Regulations and remarks re- specting internal remedies and their application. . 78 Regulations respecting the bath 90 Regurgitation of milk, acid- ity, etc., of infants 677 Relaxation of the bowels dur- ing Pregnancy 261 Relaxation of the bowels of lying-in women 659 Remedies and doses, remarks etc., respecting them 78 Remedies, table of analogous 81 Remedies, table of, with La- tin and English names, an- tidotes, etc 728 Remedies and applications, external, remarks etc., re- specting 87 Remittent or bilious fever. . . 273 Renal calculi 346 Rennet whey 727 Repertory 736 Repetition and selection of medicines 76 Respiratory organs, diseases of 364 Rest, its indications 51 Restlessness as a symptom. . 52 Retarded strength of the limbs 672 Rheumatic or catarrhal con- stitution 25 Rheumatic or nervous ear- ache. 187 Rheumatism, articular 575 Rheumatism of the joints 575 Rheumatism, chronic. . . 576 Rheumatism, deforming 577 Rheumatism, arthritic 577 Rheumatism, chronic of the joints 580 Rheumatism of the sciatic nerve 584 Rheumatism of the back — Lumbago 466 Rhus tox. as an external ap- plication 88 Rickets 462 Rickets, home and mechani- cal measures for 463 Rickets, allopathic treatm't. 463 Rickets, homoeopathic treat- ment 464 Rice gruel 725 Rice water 727 Ringing and buzzing in the ears 188 Ringworm 491 GENERAL INDEX. 907 Roast apples for invalids. .. . 726 Rose— Erysipelas 479 Rules for preserving homoeo- pathic medicines 82 Rules for diet, under treatm't 103 Rules for injections 82 Rules for restoring persons after accidents 703 Rupture in infants 665 Rupture, navel, of infants. .. 665 Rupture, groin, of infants. . . 665 Saliva, its indications 72 alt water bath, cold. 91 SaltRheum 492 Sago gruel 725 Sanguine constitution 23 Sanguine temperament 26 Scabies— Itch , 497 Scab, milk — milk crust 679 Scald head 496 Scalds and burns 717 Scarlet fever— Scarlatina . 508 Scarlet fever, complicated forms of ... 514 Scarlet fever, after effects of 515 Scarlet fever, symptoms and course of 509 Scarlet fever, uraemia in 512 Scarlet fever, Belladonna as a preventive 513 Scarlet rash 508 Scarlatina 508 Scanty secretion of milk 653 Scanty or suppressed men- strual flow 606 Sciatic rheumatism 584 Scorbutis 224 Scrofulous ophthalmia 173 Scrofula, Scrofulosis 595 Scurvy 224 Secretion of the milk 652 Secretion of the milk, sup- pressed after delivery 653 Secretion of the milk,"exces- si ve after delivery 653 Selection, repetition and ad- ministration of the medi- cines 76 Selection of a nurse 667 Sensations of discomfort. ... 61 Sensations of anxiety, their indications 1 63 Sensations and senses 49 Sexes, the, and their distinc- tions 27 Sexual organs, male, disea- ses of the 357 Sexual organs, female, disea- ses of the 599 Shingles 491 Short-sightedness 176 Sick headache 250 Sickness at the stomach , nau- sea and vomiting, indica- tions afforded by 45 Sickness in the morning, dur- ing pregnancy 635 Sickness, green, predisposing causes and treatment of. . . 604 Sight, the 65 Sight, short 176 Signs of pregnancy 630 Skin, diseases of the 478 Skin, simple redness of the, 1 erythema 478 Skin, inflammation of the, with swelling, heat, red- ness and tingling, (erysipe- las) 479 Sleep, its character as a symp- tom 53 Sleep, sleeplessness of infants 670 Slow pulse 34 Slow breathing 42 Sluggish pulse 34 Small pulse 34 Smallpox — Variola 516 Smallpox, allopathic treat- ment 518 Smallpox, homoeopathic treatment 520 Smallpox, confluent 521 Smallpox, modified 522 Smallpox, complications and after-effects of 523 Smallpox, boils during 523 Smallpox, cough during 523 Smallpox, asthma during. . . 523 'Smallpox, looseness of the bowels during 523 Smallpox, mode of living during. 523 Smell, the sense of 66 Sneezing, yawning. groaning etc., their indications 71 Singultus 427 Snuffles, cold in the head, of infants 674 Soap plaster as an appli- cation for burns 89 Soft pulse :. 34 Soft toast, how to make 723 Sore throat— Angina • 204 Sore throat, allopathic treat- ment 206 Sore throat, homoeopathic treatment 207 Sore th roat, ulcerated 207 Sore nipples 661 Sore mouth, nursing of in- fants. 680 Sores or ulcers 475 Sounds from chest and indi- cations 70 Sour stomach, see Heartburn. 637 908 GENERAL INDEX. Sour stomach of infants 677 Spanish fly as an outward application 88 Spasm of the stomach 255 Spasm of the stomach, allo- pathic treatment 256 Spasm of the stomach, hom- oeopathic treatment 257 Spasm of the bladder 354 Spasm of the bladder, after labor 651 Spasms and convulsions as symptoms 53 Spasms of infants , 699 Speech and voice, and their indications 70 Speech, loss of as a symptom 71 Spermatorrhoea 358 Spine, disease of the 460 Spirits, depression of the 246 Spitting of blood 386 Spitting of blood, allopathic treatment 387 Spitting of blood, homoeopa- thic treatment 388 Spleen, inflammation of the 333 Spotted fever 106 Spotted fever allopathic treat- ment 108 Spotted fever, homoeopathic treatment 109 Sprains 707 Stammering as a symptom.. 70 St. Anthony's fire, erysipelas 479 Stenocardia 451 Stenocardia, allopathic treat- ment 452 Stenocardia, home treatment 453 Stillborn children 663 Stings of Insects 718 Stomatitis 201 Stomach, diseases of the 225 Stomach, derangements of the, not habitual 242 Stomach, derangements of the, of children 245 Stomach, hemorrhage from 251 Stomach, spasm of the 255 Stomach, spasm of the, allo- pathic treatment 256 Stomach, spasm of the homoe- opathic treatment 257 Stomach of infants, flatulent distention of 678 Stomach, sickness at the, nausea -. 249 Stone in the bladder 346 Stone, inflammation of the kidneys connected with. ... 336 Stone cutters' asthma 690 Stoppage of the bowels — Con- stipation 310 Strains or sprains in general 707 Strabismus , 180 Strength, retarded of the limbs 672 Strong pulse 34 St. Vitus' dance — Chorea 154 St. Vitus' dance, allopathic treatment 154 St. Vitus' dance, homoeopa- thic treatment 155 Suckling, duration of; wean- ing... 669 Suckling of the infant, gene- ral observations 666 Suffocation, apparent death from 702 Summer complaint of infants 684 Sunstroke, sun fever 718 Supper, brown mush fur 722 Suppression of perspiration after delivery 655 Suppression or delay of the menses 606 Suppression or scanty secre- tion of milk 653 Surgery 702 Suspension of doses 80 Suspended animation 663 Sweat, its indication 68 Sweat, critical 69 Swelling of the limbs during pregnancy 640 Swelling of the head of inf ts 664 Swelling of the breasts of in- fants 690 Swollen cracked and furrowed or swohen and indented, swollen and red tongue 48 Swooning— Fainting 49-50 Stye 180 Sycosis mentagra 488 Symptoms exhibited by irri- gation of the lining or mu- cous membrane of the sto- mach 231 Symptoms exhibited by irri- tation of the nerves of the stomach 233 Symptoms of the change of life 622 Symptomatic erysipelas 481 Sympathetic affection of the 'brain and nervous system. 246 Svnochia 535 Synoehial or inflammatory fever 535 Synovitis, see inflammation of the joints 467 Synopsis of the rules for diet 'under treatment 103 Systematic table of rules for 'the administration of doses 84 Table of analogous remedies s l able of contents 15 GENERAL INDEX. - Table of remedies with their English and Latin Dames ..lid their antidotes 728 Tape worm 806 Tape worm, allopathic treat- ment 309 Tape worm, home treatment .*>(»!» Tapioca cup pudding 726 Tardiness in breathing, its indications 24 Tarsus 474 Taste, the, its indications... 66 Tearfulness and laughter. .. 71 Tea, beef, for invalids 724 Tea, mutton, for invalids ... 725 Tea, flaxseed, for invalids... 726 Teeth, pain in the 222 Teething of infants 695 Temperament, sanguine 26 Temperament, choleric 26 Temperament, melancholic. 26 Temperament, phlegmatic 27 Temperaments and their var- ieties 26 Temperature of bath for in- fants 93 Tenderloin, broiled, for in- valids 724 Testes, inflammation of the. 357 Testes, inflammation of the, treatment for 358 Tetanus— Lock-jaw 133 Tetanusallopathic treatment 134 Tetanus, homoeopathic treat- ment 136 Tetter, scaly 487 Tetter— Herpes 490 Tetter, honeycomb 496 The antecedents of a patient's family 27 The sexes and their distinc- tions 27 Theage and conditions which qualify it 27 The part or organ usually diseased 30 The pulse; its varieties and indications :'»2 The art of feeling the pulse.. ;52 The condition of the blood... ;;7 The urine; its varieties and indications 38-39 The healthy appearance of urine . . . The proper time for investi- gating the urine. ... :V.) The breath in health II The digestive functions 44-225 The evacuations, and indica- tions. ... 44 The appetite and its indica- tions 16 The tongue, its Indications.. is The sensations and tbeir in- dications The organs of sense, their In- dications The complex 'n, its Indication The voice and speech, its in- dications The saliva, its indications. .. The expectoration, its indica- tions The habits of living The change of life Thickened milk Thirst, its indications Throat, aphthous sore Throat, to clear the, after a<-- cident Thrush— Aphtha- Thrush — Aphthae of infants. Time etc., for investigating the urine as a clue to the nature of the disease . . Toast, soft, how to make . . . Toast, o 622 724 17 680 39 72:; 724 724 726 2<»7 210 210 18 48 711 117 12H 910 GENERAL INDEX. Typhus fever Typhus characterized by stu- por Typhus, abdominal Typhus, convalescence and debility after Typhus, after effects of Ulcers, lymphatic tumors diseases of the cinglo- bate glands Ulcerated sore throat Unequal pulse Uremia in scarlet fever Urine and its varieties Urine, healthy appearance of Urine, bloody Urine, proper time for inves- Urine, its variations, the in- dications Urine, retention after labor.. Urine, inability to hold after labor Urine, the foretells — the change at crisis Urinary difficulties during pregnancy Urtica Diocia,or Urtica Urens externally applied Urticaria Uterus, cancer of the Yaccination . , arieties of temperaments. Varicose veins Varicose veins, during preg- nancy Varices Variola— Smallpox Varioloid Veins, diseases of the Veins, inflammation of the. . Veins, varicose Veins, dilation of Verification of death Vinegar whey Voice and speech, and their indications ... Voice, loss of, as a symptom. Vomiting, its indications in disease Vomiting of blood Vomiting during pregnancy Vomiting of milk by infants Wakefulness of infants.... andering erysipelas Warmth, to . restore after ac- cident Water, pure as a necessity for health Water on the brain Water on the brain, allo- pathic treatment 536 557 549 557 558 475 207 34 512 38 38 350 39 39 651 652 39 641 89 484 627 701 26 454 640 454 516 522 453 453 454 454 705 727 70 70 45 251 635 677 675 481 703 100 131 132 1 Water on the brain, homoeo- pathic treatment J32 Watery, or weeping eye i78 Water brash during preg'ncy 637 Water, gruel for invalids 725 Water, apple for invalids 726 Water, toast for invalids 726 Water, rice for invalids 727 Weakness after delivery 660 Weaning of infants 669 Weeping eye 178 Wetting the bed, see Enuresis nocturni 352 When medicines should be taken 82 Whey, alum 727 Whey, mustard 727 Whey, vinegar 727 Whey, rennet 727 Whey, orange 727 White swelling 471 Whites, leuchorrhcea 615 Whitlow, or felon 500 Whooping cough 407 Whooping cough, allopathic treatment 410 Whooping cough, homoeopa- thic treatment 411 Wind in stomach and bowels, as a symptom 45 Windpipe, diseases of the. . . 364 Womb, falling of the 619 Womb, cancer of the . 627 Womb, inflammation of the see Leuchorrhcea 615 Women, diseases peculiar to. 599 Worm colic 299 Worms — Helminthiasis 304 Worms, allopathic treatment for 305 Worms, homoeopathic treat- ment for 306 Worms, tape 308 Worms, pin, (thread worms) 305 Worms, long round 306 Wounds 709 Wounds, incised 710 Wounds, manner of dressing 710 Wounds of arteries and veins 710 Wounds of the mouth 711 Wounds, lacerated 712 Wounds, contused bruises... 713 W r ounds, gun shot 714 Wounds, punctured 714 Yawning, as a symptom 72 ellow fever 559 Yellow fever, its symptoms. 562 Yel low fever, allop athic treatment 564 Yellow fever, homceopatic treatment 566 Young children, food for 722 £ 906 fill ■iwh