the condition of irritation is yet present, as revealed in the sudden startings and twitching of the muscles of the face and facial expressions; they complain of nothing; the perceptive power is often suppressed; feces passed unconsciously; retention of urine, and the bladder might burst unless relieved mechanically; lips and tongue dry, the latter often like wood furrowed and either clean or thickly coated, frequently brownish black, sometimes also lips and teeth; incoherent muttering; speaking sometimes impossible; intestinal secretions are colliquative; stools watery and bloody; often enormous meteorism. In the lungs coarse râles, purring and whistling sounds; nutrition sinks rapidly. The first sign of improvement in these cases will be a short refreshing sleep, or from the state of sopor they may die easily; when recovery takes place it may leave them weak-minded. Carbo veg. Decomposition of the organic substance; torpor is everywhere manifest in equal degree, and finally sinks into paralysis; this depresses the vitality. Circulation of the blood not accelerated; pulse extremely weak, sometimes scarcely felt; blood moves slowly through the vessels; clogs in the capillaries, and causes a cyanotic condition; temperature often below normal; body covered with cold, clammy sweat; sensorial activity lost; patients lie upon the back, closed eyes and open mouth, scarcely conscious of anything; can be aroused only with difficulty for a few moments; conscious of no wants; tongue moist, of a pale bluish color; colliquative discharges from the bowels flow off involuntarily; respiration difficult; little or no cough; mucous râles, sometimes quite loud; sputum bloody; hypostasis of the lungs; if recovery takes place it will be slow and insidious; death may occur at any time from usual causes. Veratrum alb. Circulation sluggish; pulse slow, weak, and soft; blood moves slowly through the capillaries, where it becomes clogged and cyanosis arises; the serous constituents of the blood, which are tending toward decomposition, ooze mechanically through the relaxed vascular walls of the skin, producing cold sweats of the mucous membrane, and thereby profuse vomiting and diarrhea; temperature sinks below normal; the turgor disappears, so that the skin becomes relaxed and wrinkled, eyes lose their brilliancy and become sunken, nose pointed, lip relaxed; consciousness but little affected; delirium slight or absent. Case to illustrate. Cocculus. At the opening of the disease faintness, loss of memory, want of appetite; they feel so weak they cannot leave the bed; apathetic condition, which finally passes into actual sopor; if awakened, they complain of vertigo; sensation of a heavy load pressing upon the head; weakness and paralyzed feeling in the limbs and eyelids, which can scarcely be kept open, or there may be twitching and drawing sensations; they think correctly, but slowly, and soon relapse into sopor; facial expression shows absence of mental activity; this is not constant, as they have moments of awakening; pulse weak, and sometimes sinks below the usual number, or above; temperature about normal; skin pale and relaxed; tongue clean or moderately coated; constipated; respiratory mucous membrane normal; decomposition of blood not present. For particularly violent or dangerous symptoms, secondary conditions, or sequelæ, the following remedies may be employed: Aconite is used by some physicians in the first stage of the fever to control it, but it usually fails, as it does not correspond to the entire change taking place. The same may be said of Bell., although this is sometimes useful in ameliorating the violent pressure of blood to the head and delirium at the beginning of the disease. Puls. also may be used to remove some special symptom, but it will have little or no effect upon the morbid process at large. Important Points in a Symptomatic Mode. A remedy may be chosen which will satisfy most of the symptoms and hence give a favorable change to the disease, but we must not rely thereon, but must find a remedy that corresponds both in symptoms and morbid process generally; secondly, a symptomatic mode of treatment should be used only when some morbid symptom ascends to a disproportionate degree of violence, sopor being one of these conditions which most frequently calls for this form of treatment, and Opium and Hyos. are the best and would be given. Opium. It produces an increased activity of the imagination, while, on the other hand, it blunts and depresses the common sensations and the consciousness; the sensorium is, as it were, closed against the external world; the visions are fantastic, but in a certain measure coherent, yet they may follow ideas to their most distant consequences, because they only in so far deviate from normal as the regular perception of the external world fails to the object; secondarily, sinking of the vital activity in the vascular system, absence of ideas, dullness of imagination, and over-sensitiveness of the general sensation. Patient makes movements toward regular movements, although he lies stupid; delirium is moderate; pleasant expression of the face; pulse accelerated; temperature and thirst. increased; moderate determination of blood to the head. Hyoscyamus. Primary action depresses nerve life and intellectual activity; useful when there is torpor of the entire organism; stupid, staring expression; whether delirium or no, there is a confused medley of different images; the perceptive powers, even in the mild intervals, are so depressed that they cannot communicate impressions received. Hemorrhages occur very often in this disease. If they occur early, they are beneficial. Arsenicum or Carbo veg. will be required if they become dangerous. For imbibition, suggillation, or hypostasis, Arnica will be required. Perforation of the Intestines. Diagnosis of, by the peritoneal pains, etc.; were cured after receiving Bryonia. In women, at commencing convalescence, there may be burning and urging in urinating, and tenesmus vesicæ. For this Puls. or Canth. will be required. Parotitis will be controlled by Merc. sol. Pneumonia infiltration is considered one of the most dangerous concomitants of typhoid fever, but in this case no change should be made in the remedy without some urgent reason; especially is this the case in patients taking Phos. or Arsenicum. Diarrhoea. Arsenic is usually the remedy. If an extreme sinking of strength continues to progress, although the typhus condition is extinguished, Carbo veg. or China will be called for. During convalescence food is required and not medicine. (From Wurmb und Caspar's Klinische, trans. by A. McNeil, pp. 29, 74, 117, 162, vol.'III., 1876.) Typhoid. History of an epidemic. (L. H. Willard, Feb., 1876.) With usual symptoms Bry. Ars. did no Aconite contra-indicated in. (H. V. Miller, Indications for remedies in. (Dr. Brews- - Gelsemium. Great prostration in typhoid; also great prostration in spermatorrhoea; - tremor, anxiety, and muscular relaxation; neuralgia of 5th pair; cerebro-spinal meningitis; promotes sweat; active congestions from taking cold, with occipital headache, pains in back and limbs, fever. (H. M., July, 1876.) Gelsemium will abort 60 per cent. of typhoid fevers. If it fails in 24 hours, use Baptisia, which will add 20 per cent. to above, Quick, excited circulation, chilliness, malaise, soreness all over body, sometimes localized pains or flying pains; secretions partially suppressed; Gelsemium. If then fever arises next day, scanty sweat, give Baptisia; or, again, give it if sweat appears profusely, with only partial abatement. (J. T. Greenleaf, H. M., July, 1876.) Hemorrhages from bowels in typhoid, with restlessness and thirst, blood copious and pale, Ars.; if no thirst, blood in cakes, Alum; Cactus, when no assignable cause (Lippe); Terebinth., urine contains blood, after scarlatina (Dunham); Gelsemium, hemorrhage and diarrhoea during pregnancy, patient had just heard of the sudden death of her father (Lippe). (H. N. Guernsey, H. M., Jan., 1876.) Patient cyanotic, extremities cold, was almost dead. Carbo veg. 30 cured. (Dr Fischer, A. H. Z. 92, p. 93.) Eyes deeply sunken, closed, and stuck together with mucus; face pale, sunken, features lengthened, almost hippocratic; cheeks circumscribedly red; mucous mem brane of nose dry; dry, cracked, blackcrusted lips; teeth covered with sooty black mucus; tongue dry and black; cadaverous smell from mouth; but little thirst; drinks roll down the œsophagus audibly; belly sunken; stools involuntary, with a terrible odor; urine passed mostly involuntarily, looks like thick beer, has a foul smell; skin covered with sticky sweat; pulse small, without force, very quick; complete loss of consciousness; deafness; muttering; picking at the bedclothes, sliding down in bed. Arsen. 6th cured. (Dr. Fielitz, A. H. Z. 17, p. 241, quoted by Karl Hencke, A. H. Z. 93, p. 157.) or Enteric Fever. (Boughton Kyngdon, Brit. Jour., April, 1876.) EXANTHEMATA. Scarlet Fever. In the introduction to Belladonna (Reine Arzneimittellehre, b. 1, s. 15,) Hahnemann has clearly stated what he understood by the term Scharlachfieber (scarlet fever), for which he claimed to have found not only a specific curative, but a prophylactic as well. He says this is the "true erysipelatous, smooth (glatte) scarlet fever, as described by Sydenham, Plencitz, and others," and remonstrates against the objections to the claim of his prophylactic, that it did not protect against attacks of Rothe Friesel (miliary rash), which appeared in Belgium in 1801, and which he says is quite a different affair, and requires to be treated with very different remedies. This is not the disease which Sydenham described and Hahnemann cured and prevented. That which is now generally met in practice, and which passes under this name, is quite différent in its nature, elements, and curative relationships, from the smooth scarlatina of Sydenham. This difference has been increasing from year to year, till now it is one of the rare occurrences that one meets a case of what Hahnemann calls "true scarlet fever." The disease has been assuming more and more each year the character of Purpurfriesel" (miliary rash), which he says scarlet fever is not, and the remedies required by the one do not cure the other. The whole idea of finding a specific for the whole family of scarlet fever is a sheer absurdity, and the practice, so general, of treating almost all cases, at least in the outset, regardless of their individualities, with one drug, is wholly unworthy of a school of medicine which claims to be a school of individualization, and that its practice is one of specifics, based on this, in each individual case. A child of seven years, in school, in perfect health, was seized with pain in the head so sudden and violent that she gave a sharp outcry, soon vomited violently, which only increased the intenseness of the pain in the head; she was immediately. removed to her home, and in a few moments became drowsy; this soon passed into a deep sleep, and this deepened into a coma, from which there was no rousing, and then came convulsions, paralysis, loud, difficult respiration, with hissingblowing. The skin suddenly became hot, with red patches here and there, and in these were slightly raised red points, so that these patches had a marked roughness to the feel; the intermediate spaces had an opaque, dull aspect, giving to the whole a mottled or marbled appearance. As the case progressed the red spots became dark, approaching to purple, and then livid; the extremities became cold; and the restlessness, which had been extreme, was only quieted by the profound coma and death, which followed in sixteen hours after the first attack. This case is a tolerably fair picture of its class. Cases like this, subject to modifications of some of their symptoms, are met in all epidemics. One of these, not infrequent, is: the eruption in its early appearance is dark-colored, and soon becomes livid, slowly regaining its color when this is expelled by pressure. This is quite signifi cant in any stage of the disease, and, if occurring early, with rapid and feeble pulse, threatens the worst results. Now what similarity have the recorded symptoms of Belladonna to this whole picture? None. Or if in some of the symptoms there be an apparent resemblance, this is certainly only apparent, and not in the least real. For example, the pain in the head. This, with Belladonna, if it be violent to the degree witnessed in this little patient, is accompanied by excess of activity in the arterial circulation, especially in that of the head; the pulse is not only quick and sharp in its beat, but is hard under the finger; the accompanying nervous phenomena are those significant of actiivty-the exact opposite of those in this case, where all were indicative of torpor. The drowsiness and coma of Bellad. are accompanied by, if not the result of, active cerebral congestion, and the same is true of the convulsions it produces. The opposite is true of cases like that given above the congestions are passive, the result of a sluggish and not of an active circulation. Paralysis from the action of Belladonna is the result of pressure on the brain, either from the accumulation of a continuously increasing congestion of this organ or of its membranes, or of accumulated serum in its ventricles and between its membranes, in the effusion of which a previous congestion has terminated. Paralysis in this class of cases of scarlet fever is only one of the manifestations of that loss of brain-power in general, the sum of which is at once expressed by the term paralysis of the brain." The loss of power in distant parts is the result of loss of power in the brain itself. Its functions are paralyzed, each perhaps in a different degree, and the loss in different functions appearing successively, partially, and progressively, till in the final sum are swallowed up the whole of the forces of life. Hydrocyanic acid attacks the living forces at their centre, and suddenly extinguishes their sum. In this respect there is a marked similarity between the action of the two poisons. There is a further resemblance. The acid destroys life by paralyzing the nervous centres. It is true, So far as we know of the effects of the drug, that with this the process is sudden, and with the whole, simultaneous, while with the morbid poison the process is more gradual, and is accomplished by successive steps. In this the two poisons are dissimilar in their action. Tobacco also, in massive doses, attacks and destroys life in a manner very similar to that of Hydrocyanic acid. The remarks as to the partial proving of the acid are equally applicable to Tobacco. It is here named for the same reasons given for the suggestion of the acid. Crotalus horridus is deserving of special attention. This poison, also, goes direct to the central forces of life in its initial attack, and proceeds to gradually paralyze and extinguish the living functions, till all are lost, in a manner so like the action of the scarlet fever poison that even the most unskilled observer cannot fail to perceive the resemblance. But, unlike what is now known of the remedies already named, this shows a wonderful resemblance, in the details of its action, to the details of the symptoms of the disease. In these cases remembrance should always be had of that most interesting and reliable cognate of the Crotalus-Lachesis. The whole picture of cases, in their progress to a fatal termination, after the bites of these serpents, is so strikingly like the fatal progress of this variety of scarlet fever, after the attack of the morbid cause, that the resemblance cannot but inspire, in those who have proved the verity that the law of cure is no other than the law of similars, a confident hope that in this class of poisons, and especially in the two members of the class above named, may be found the means of successfully overcoming these rapid cases of scarlet fever, heretofore so generally fatal. But if this or any other class of remedies are to be employed successfully, they must be given early, and with no previous paltering with useless Aconite or Belladonna. Bryonia is often of great value in cases where the eruption has suddenly disappeared, and this disappearance has been followed by symptoms threatening great danger to the patient. In treating the coma of scarlet fever, so often significant of grave cerebral condition, and often developed even early in the case, the experience of years has taught that little is to be expected of good from either Bell. or Stram., while prompt relief will follow the use of Opium or Hyos., if these be selected with careful reference to their differences and to the similarity of these to the symptoms of the case. Girl of five years was attacked with the ordinary symptoms of scarlet fever. The initiation of the attack was with chills, vomiting, violent headache, prostration, peevishness, flushed face, injected eyes, etc. Then in a few hours came the eruption in the miliary form, patchy, and evanescent. At times it was bright and full, then it faded and partially disappeared. The mind soon became wandering, and then delirious, the character of the delirium being active rather than muttering. The heat of the skin was great, while the skin was at the same time dry, bard, and somewhat roughened. The throat was moderate swollen, internally and externally, impe in somewhat both speech and deglutition. The patient was treated chiefly with Bell., till the evening of the fourth day, growing rather worse than better, at which time, in addition to her previous symptoms, she was apparently wide awake, but positively asleep so far as perception or recognition of her surrounding relations were concerned. She no longer knew her attendants or heeded whatever was said to her. She was in great agitation and anxiety, with loud outcries, not screams, calling out that she wished "to go to bed," though she was upon the bed at the time. Immediately on being laid on her pillow she would spring up and call out that she wanted "to go to bed; " and this was repeated as often as she was replaced, with the assurance that she was already on the bed. She seemed to have no apprehension of what was said. to her. The eyes were injected and staring. The aspect dull and heavy, though very anxious, and apparently apprehensive. At six o'clock in the evening she got a dose of Sulphur. She soon became more quiet, then fell asleep, had a good night, and in the morning appeared convalescent. She recovered from this time without accident. Lachesis has so many resemblances to Belladonna as to be rightly regarded as one of its nearest relatives; in scarlet fever they are oftenest in relation to conditions the exact opposites of each other, the symptoms indicative of Bell. being sharp and demonstrative, while those of Lachesis declare threatening gangrene or destructive decomposition of both fluids and solids. Instead of active, strong pulse, hot, dry skin, glowing redness of the face and injected eyes, throbbing pains in the head, etc., we have a cool surface, perhaps covered with cold perspiration; torpid, peripheral circulation; passive hemorrhages of dark fluid blood; sloughing ulceration of surfaces where the specific effects of the poison are more especially localized; acrid or foul secretions, etc. In cases with the dense diphtheritic deposit, Lachesis should always be borne in mind, and given without hesitation in cases where there is in the symptoms no clear indication for some other remedy. In case of sloughings in the throat, or when these are threatened, Lachesis is one of the chief reliances. The Bichromate of potash should be remembered in this variety of throat affection where there is a copious secretion of tenacious stringy mucus, and also in cases where ulcers are formed under exudated substances on the fauces and tonsils. Inflammation and swelling of the glands of the neck, throat, and the salivary apparatus are common in this fever, and often troublesome to both patient and physician. The importance of this complication is determined by the number of the glands involved, the extent of the swelling, and the character of the fever present. Where this is of a marked adynamic character, this condition of the gland is often indicative of danger, to which it contrib utes in no small degree. If the swellings are small, and limited to one or two of the glands, they will be found no great obstacle to a recovery. But where the swellings are large, or these have passed into illconditioned suppuration, they add considAt the erably to the gravity of the case. beginning of the swelling, if it be painful to touch, with vigor of febrile reaction, Belladonna will be found the best remedy. If the pain and sensibility to touch be less, with less febrile reaction, give Mercury. If the swellings threaten suppuration, or if this have already begun, Hepar sulph. is the best remedy. If there be sensibility to touch, with little febrile reaction, and the case threatens to pass into torpor, Rhus tox. is called for; Sulphur in cases where Mercury has seemed indicated, but has not proved equal to arresting the swellings, which have progressed notwithstanding its use. If the case be of the adynamic variety, or be passing into this state, Ailanthus should be remembered. (P. P. Wells, N. A. J., Feb., 1876.) Great muscular weakIn a strong man. ness; memory greatly lessened; so confused that often he could not use the right words to express himself; pulse fast and weak; urine acid and turbid; patient could not raise himself without help. Cuprum cured quickly. (Rademacher, quoted by Dr. Sorge, A. H. Z. 92, p. 116.) Apis and Belladonna in. (O. M. and S. In Louisville, Ky. Eighty cases with one -Ailanthus. (S. Lilienthal, M. I., vol. III., p. 287, '76.) -- Cold water treatment has resulted in and Diphtheria. Malignant cases Anginosa. Throat completely closed; Afterward ulcerated throat right. Merc. jod. 30 cured. (W. James Blakeley, M. I. vol. IV., p. 167, 1876.) When it is of the diphtheritic form, Salicylic acid will change the character of the putrid breath and promote a healthy action; when the patches are in mouth and soft-palate, throat very sore, can hardly swallow any fluids or solids, five to eight grains of Sul. iron in half a glass of water, a teaspoonful, one to three hours, with Kali b., has caused speedy improvement. (V. L. Moore, M. I., vol. IV., p. 539, 1876.) Eruption coming out badly, skin looking marbled, vomiting, diarrhoea and epistaxis occurring. Ipecac brought out the eruption and the consequent disappearance of the other symptoms. (Dr. Richter, A. H. Z. 92, p. 147.) Diagnosis and treatment. (H. W., vol Dr. Edward Martin recommends medicated Apis mel. in. (Thos. Nichol, H. W., vol. Post-Scarlatinal Dropsy. Boy, æt eight. Apis 12 four times a day for fou, Cannabis 30, one days. Improvement. dose. Cure, (W. R. Gorton, A. O., 1876 p. 455.) |