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sponsibility; buoyance. Mentally elated and gay. Under Chlorinethe patient has a fear of becoming crazy, or that he will lose his senses; he is very forgetful; he cannot remember names. Like Iodine, there is constant fear of some impending disease.
Next the lymphatic system.-Like all other members of this group, Bromine attacks the glands and causes enlargement and induration. It is particularly suited to scrofulous children. The glands have a tendency to suppurate, with excoriating discharges and persistent hardness of the gland around the opening, and undue amount of warmth or heat in the gland. For cancer of the mammary gland it has been a very useful remedy. The breast is hard, and on palpation a dull, subdued throbbing may be felt in it. Sometimes the drawing or cutting is so marked that it feels as if a string were pulling from the gland into the axilla. The testicles are acted upon by Bromine. They are swollen, hard and perfectly smooth. The pain is worse from jarring. The glands are unduly warm. It has been found that glandalar affections yield to Bromine better, especially in persons of light complexion, with fair skin and light blue eyes.
The tonsils, too, are affected in Bromine. They are red, swollen, and covered with a network of dilated blood vessels. They are worse when swallowing, and are accompanied usually with swelling of the glands externally. There is a feeling of rawness in the throat with this tonsillitis. It is indicated in enlargement of the thyroid gland and is one of the best remedies for the cure of goitre.
Iodine causes induration of the glands more marked than does Bromine. They are hard, large and usually painless. There is a characteristic of Iodine which is universal, and that characteristic is torpidity and sluggishness. The very indolence of the disease is suggestive of Iodine. It also produces atrophy of the glands. The mammæ waste away and the testicles dwindle. It is indicated in scrofulosis of children, when they emaciate rapidly, despite a ravenous appetite. They are hungry all the time. They cry for their dinner. They feel better while eating, and yet they do not gain any flesh. They are always better in the open air and worse from any confinement in a warm room. The mesenteric glands are enlarged and you have tabes mesenterica. This indicates Iodine, particularly when you have other symptoms present, together with excessive mental irritability.
You will find Iodine affecting the ovaries. It is indicated in ovarian dropsy, also in cancer of the uterus, particularly with profuse hemorrhages. The leucorrhea is characteristic, being yellowish, and very corrosive. This, in conjunction with the other Iodine symptoms, sallow, tawny skin, ravenous appetite, etc., makes Iodine the remedy which will cure many cases.
Iodine is said to act best in goitre when given after full moon, or when the moon is waning.
Iodine is indicated in pneumonia, more so, perhaps, than Bromine. It is especially useful when the disease localizes itself, that is, when the plastic exudation commences. There is a decided cough, with great dyspnea, difficulty in breathing, as though the chest would not expand, and blood-streaked sputum. You will find some portions of the lungs beginning to solidify. You may also give it later in the disease, after the stage of hepatization, in the stage of resolution, when instead of absorption and expectoration of the exudate, slow suppuration reappears, with hectic fever and emaciation; the patient feels better in the cool air.
Phthisis pulmonalis sometimes calls for Iodine. You here find it indicated in young persons who grow too rapidly, who are subject to frequent congestion of the chest, who are rather emaciated, and who suffer from dry cough, which seems to be excited by tickling all over the chest. The patient cannot bear the warm room. Expectoration is tough and blood-streaked. There is a well-marked feeling of weakness in the chest, particularly on going upstairs. The patient has a very good appetite, and is relieved by eating.
In the throat and lungs we find Bromine indicated in spasm of the glottis, laryngismus stridulus. The child turns blue in the face, and its body becomes convulsed. One attack ceases only to be followed by another. In the second stage, general convulsions appear, followed by emaciation. The trouble may be reflex from dentition, from indigestion, or from enlargement of the thymus gland. If it can be found to be from enlargement of the thymus gland, evidently then Iodine would be indicated. All the halogens are useful in this condition, but Chlorine is here the best of them all. Their symptoms differ but little so far as the local symptoms are concerned. This spasm of the glottis often comes in the course of croup, in which disease Bromine may be the remedy when inspiration seems to be exceedingly difficult. The child is suddenly aroused from sleep, as if choking. These symptoms are relieved by a drink of water.
In membranous croup Bromine is indicated by the following symptoms in addition to the spasm already referred to: The child has at first a deep, rough voice, which, in the evening, amounts almost to aphonia. The child cries with a hoarse, husky voice. The membrane seems to come up from the larynx into the throat. Every inspiration seems to provoke cough, especially every deep inspiration. Breath- ing is hoarse, rasping and whistling, as though the child were breathing through a sponge, or some loose metallic substance which is vibrating. This is caused by the vibration of membrane as it is deposited more or less uniformly over the interior of the larynx. Later, there is rattling in the larynx. When the child coughs it seems as if the larynx were full of loose mucus.
Iodine differs from Bromine in that it is indicated when the membrane has formed; inspiration is difficult from occlusion of the lumen of the larynx by the membranous formation; inspiration is wave-like, or in jerks. The cough is moist but harsh, the voice almost extinct from hoarseness. The child grasps its throat to relieve the pressure, throws its head far back so as to straighten the route from the mouth to the lungs and favor the passage of air. Particularly worse in the morning. Iodine is best adapted to dark complexioned children with dark hair and eyes, and cases that come from damp weather.
Returning to Bromine, it has been found useful in affections of the lungs. It is indicated in asthma, when the patient feels as if he could not get air enough into his lungs. Although the patient expands his chest well, air does not go in on account of the narrowness of the opening in the larynx. It is especially indicated in asthma, coming on at, or near the sea-shore. It is also useful in pneumonia, particularly when it affects the lower lobe of the right lung, hence, lobar pneumonia.
We often find nose-bleed as a concomitant symptom, when Bromine is indicated in these cases. The patient also has the symptom just mentioned under asthma-seems as if he could not get air into the chest. While there seems to be plenty of mucus, the patient does not appear to be able to expectorate it. It is also indicated in tuberculosis of the lungs, especially of the right lung. The patient suffers from congestion of the head and chest, which is relieved by nose-bleed. There is also pain in the mammary region-going up into the axilla. The eyes seem to be affected along with the chest symptoms, giving rise to a chronic conjunctivitis.
Bromine produces a very characteristic picture of uncomplicated hypertrophy of the heart; the patient finds it difficult to exert himself on account of the oppression about the heart. He has palpitation when he begins to move and when he gets up from a sitting to a standing position. The pulse is full, hard and slow. It is also indicated in cardiac asthma.
On the mucous membranes Bromine is useful in coryza, when the discharge is profuse, watery and excoriating. The nostrils, alternately, seem to be stopped up. There is a peculiar headache associated with the coryza, a heavy pressure in the forehead, which seems to be pushing the brain down and out at the root of the nose.
Both Iodine and Bromine are of some use in ulcers. Iodine in ulcers rather o fa scrofulous form, with spongy edges, and discharges of a bloody, ichorous, or even purulent character. Bromine is somewhat similar. It is useful in ulcers which have a carrion-like odor, with threatening gangrene. The surrounding skin has a greenishyellow hue.
There is not much known about Chlorine as a medicine. It produces a watery discharge from the nose, with thin, excoriating coryza, also putrid smelling ulcers in the mouth, with a dry tongue. Chlorine is indicated in scorbutic states of the blood, and typhoid conditions where the patient has a fear of becoming crazy, or that he will lose his senses. He is very forgetful. There is a constant fear of some impending disease. There is also under Chlorine a peculiar, painful sensation in the vertex, this sensation passing down the left side of the body. This is a precursor of typhoid fever. It is worse after eating
In addition to its action upon the larynx and bronchial tubes, it has been found that Fluorine acts especially upon the lower tissues and is indicated in deep, destructive processes, bed sores, ulcerations, varicose veins and ulcers, complaints of old people, or the prematurely aged, with indifference toward their friends and mentally elated and gay.
DISEASES OF THE LYMPHATICS.
By W. H. Ļoomis. The lymphatic system consists of numerous small, thin-walled vessels with many valves, commencing in the tissues as lymph-capillaries and emptying into larger vessels that carry the contained lymph to the subclavian veins. In certain places along the lymphatics, as in the axilla and groin, are found groups of little glands called lymphatic glands. These consist of a cortical portion and a medullary portion, which is made of lymphoid tissue, in the center of which are a number of cells rapidly undergoing karyokinesis.
All the lymphatics, including the lacteals of the intestines, with the exception of the right half of the body from the diaphragm upward, empty into the thoracic duct; this vessel, about the diameter of a goose quill, empties into the left sub-clavian vein. The lymphatics of the right side of the body from the diaphragm upward, empty
through a smaller vessel into the right subclavian vein. The anastomosis between the lymphatic vessels is so free that no trouble arises from injuries or their division, except when the main trunks of the limb or duct meet in the axilla or groin, and when the thoracic duct itself is injured, as in the neck or left side.
The thoracic duct opens into the junction of the left internal jugular and subclavian veins by a delta, hence it is the exception for all these outlets to be included in a ligature; if a chyle fistula forms it tends spontaneously to close. If the thoracic duct were opened and ruptured, along with fracture of the spine, the patient would die in a few days and chyle would be found in the right pleural cavity. If the thoracic duct has been injured by a bullet, by a stab in the root of the neck, by operation such as ligature of the subclavian artery or removal of the glands, chyle escapes, but on account of the number of outlets, and the communications with the vena azygos and the right thoracic duct, the rent may be expected to heal, meanwhile the external wound should be plugged with gauze.
Axillary lymphatics are most commonly injured in the extensive removal of the axillary glands for mammary cancer; the result of the lymphatic obstruction is chronic edema of the limb or elephantiasis. In the groin the same result has followed the excision of the lymphatic glands. The limbs become much enlarged by solid ædema, which can scarcely be pitted by pressure, the skin becomes rugose, and vesicles may form and leak lymph, causing eczema.
Lymphangitis, or inflammation of the lymphatic vessels, the most common of the diseases of the lymphatics, is either acute, sub-acute or chronic, and generally associated with more or less inflammation of the lymphatic glands.
Causes.— The most common primary cause is the absorption of infective products, especially streptococci from a wound, often very trivial, such as a simple scratch, abrasion, sting, or puncture; or the organism may enter by an abrasion of the skin, as a chafe of the heel, excessive friction or sunburn..
Pathology.- The walls of the lymphatics become infiltrated with cells, swollen and softened while the endothelium is shed, and the lymph contained in the vessels may undergo coagulation. The inflammation spreads to the surrounding tissues, but seldom higher in the course of lymphatics than the first set of glands, which also become swollen and infiltrated and arrest the further progress of the septic products. Lymphangitis may terminate in resolution, or in suppuration in and around the glands or in the lymphatics themselves. When