BY AD. LIPPE, M. D., PHILADELPHIA, PA

In a “Materia Medica” published by Dr. C. J. Hempel and containing the lectures delivered by him at the Homoeopathic Medical College of Pennsylvania, while occupying the Chair of Materia Medica in that Institution, Dr. Hempel says (lecture on Lachesis, p. 1142) that because toxicologists teach that the poison of serpents is digested by the gastric fluids, it has become questionable with almost all thinking Homoeopathists, especially in Germany,“ whether the almost interminable array of symptoms which Dr. Hering alleges to have been produced by Lachesis poison, is not the work of fancy rather than observation. In spite of every effort to the contrary, the conviction has gradually forced itself upon my (Prof. Hempel's) mind that the pretended pathogenesis of Lachesis which has emanated from Dr. Hering is a great delusion, and that, with the exception of the poisonous effects with which this publication is abundantly mingled, the balance of the symptoms is unreliable.”

“It has been accepted as an axiom that medicine, and poisons can only affect the nerves through the blood, and that the medicines and poisons pass through the veins into the blood.” It has also been proved of late that “the gastric juices do not destroy all animal poisons, and a reference to the experiments by Claude Bernard will establish that fact.”

All these and other objections to the admissibility of Dr. Hering's Lachesis provings would be in place, and might be considered had not the experiment decided the correctness of the provings. The only truly logical plan to show that an alleged proving is a delusion or a fancy, is to state some cases in which the medicine chosen according to the alleged proving and properly administered had failed to produce the expected effect; but if, as is the case with Lachesis, a long array of published cases fully confirm the correctness of the provings by the curative results when applied in diseases according to the homoeopathic law, no reasoning a priori can destroy the conclusion which the successful experiment forces upon us. But if Professor Hempel sees other difficulties arising from the fact that our provings have been conducted with alcoholic attenuations and that the poisonous qualities were so destroyed, he is again in error. Dr. Hering did not potentize the poison of Lachesis in alcohol, but on the 28th of July, 1828, he triturated the freshly obtained poison with Sugar of milk up to the third trituration, and from this trituration all further potencies were made. To correct the erroneous belief that Lachesis is not of much, if of any, therapeutic value, I will first review the provings of this very valuable remedy and then examine the homoeopathic literature and see what numerous observers have published on Lachesis.

In the tenth, volume of the Archiv., part II, page 1, we find the first remarks on Lachesis by Dr. C. Hering, written in 1828. He there relates how he obtained the poison of the Trigonocephalus Lachesis, on the 28th day of July, 1828, how he made the triturations and his first provings.* [The identical serpent from which Dr. Hering obtained the poison is still in the Museum of the Academy of Natural Sciences in Philadelphia.] On page 24 of the same number of the Archiv. is a subsequent letter from Dr. Hering, dated Paramaribo, June 18th, 1830, in which he makes additional remarks on Lachesis. The first publication of the arranged symptoms of the fragmentary provings of Lach. appeared in 1833, in Vol. XIII of the Archiv., “fur die homoeopathische Heilkunst,” by Dr. Hering. In these symptoms arranged out of the meagre and fragmentary provings we find already the elements of the great medicine. Symptom 5. “Pressing through the whole head with catarrh and a stiff neck.” This combination is not again to be found in the Materia Medica, and often has Lachesis proved itself to be the curative remedy when in the beginning of a catarrh, this headache and stiff neck predominated. Symptom 9. “Erysipelatous inflammation of the left cheek, under the eye; at first, itching at night, the prover awakened frightened from a slight noise; in the morning the spot became red, increasing and much worse after sleeping after dinner; the next morning it was very much swollen and itched so intensely that it could scarcely be endured. The lower eyelid also swollen, red and itching. Pulsating (hammering) headache before and after the erysipelas.” This symptom, corresponding with erysipelas of the left side of the face, shows as characteristic for Lach. and we will later allude to it; again the aggravation after sleep, especially sleeping after dinner; also the left side. Symptom 14. “Intensely offensive smell of the feces which were otherwise normal.” Here again we find already the characteristically offensive smelling feces of Lachesis, if they are even otherwise normal. In the second part of the Archiv., for 1833, we find under the practical communications by Dr G. W. Gross the following remark: “The observation which Dr. Haubold made some time ago that Lachesis was a useful remedy in ulcers on the lower extremities, I can now corroborate. A number of ulcers on the lower extremities; of dirty appearance, and which had improved under the action of some doses of Silicea but which would not heal, closed and fully healed in a very short time from a few doses of Lach.”

In 1837 Dr. Hering published, at Allentown, the effects of the serpent-poison to which publication Dr. Hempel alludes, and which he endeavors to brand as a work of fancy rather than of observation. This monograph was the most elaborate publication of the day, and the more complete and best arranged description of the effects of a new medicine as it gives. First: many symptoms which have been observed by proving the Lachesis-poison on healthy persons. Second: A few symptoms which were observed on the sick. Third: many symptoms which were removed by Lachesis (curative effects). Fourth. A few symptoms of Crotalus. Fifth: all other effects of this and other serpent poisons caused by the bite of snakes, which were then known; nor were the known effects on animals excepted.* [Since this publication of the effects of the serpent-poison by Dr. Hering in 1837, no additional provings of Lachesis have been published, nor have any provings been made as far as I have been able to ascertain All the Lachesis symptoms published in the Materia Medica are taken from the monograph published in 1837; all assertions to the contrary are false and erroneous.]

This monograph was the guide to the homoeopathic physician and according to the symptoms there collected, recorded and arranged, he applied it to the cure of diseases. How far the record has been found correct can only be shown by the results of “experiment,” and while I refrain from combating Dr. Hempel's erroneous opinion by stating my individual experience (I shall do that in a later article disconnected with the present object in view), which might seem like giving but another opinion, I will now call before the bar of medical investigation some witnesses who have deposed their record in the homoeopathic literature.

In the Archiv., 14,1, 7, Dr. Gross relates a case of mental disease cured by Lachesis: A young man who, having studied too much, had become mentally diseased. Extraordinary talkativeness (contrary to his usual habits), continually making speeches in the choicest language, but passing from one thing to the other, and talking about the most heterogeneous things. Towards those around him he was full of distrust and haughtiness. Lach. ²⁰ cured him soon. Compare in the provings, symptoms 3074.

In the sixth edition of Dr. Hering's Hausarzt, 1849, page 41, we find already some characteristic symptoms indicating the administration of Lachesis in delirium tremens, giving them as established by several successful cures of the disease by Lachesis prescribed by Dr. Hering. He there says, the “Lachesis will be indicated if the attacks come principally in the afternoon or after sleeping, when the patients talk much and when they often change the subject, or when they remove their neck-cloth or shirt-band from the neck and even tear it away.” Compare symptoms 3073, 3074, 928, 929, 930, 931, 932, 933, 934, 935, 936, 2820, 2821.

In the Allgem. Hom. Zeitung. 36, 233, we find Dr. Black to say,“ that Lachesis is indicated by one-sided tensive headache drawing from the neck over the head to the eyes, with vomiting, stiffness of the neck and tenderness of the scalp.” In the British Journal, 5, 434, we find that Lachesis cured a case of headache of four months standing; the characteristic symptoms were the one-sidedness, the giddiness with paleness of the face, general sensation of stiffness and pain in the left side of the abdomen.*[As the patient was a lady, the pains were most likely in the left ovary for which Lachesis is pre-eminently specific.]

In the Allgem. Hom. Zeitung, 51, 6, we find a case of chronic headache which had continued for years, cured by Lach. The pain coming every two to four days, always in the right side of the head, pulsating, pressing and extending to the neck which became stiff, worse during menstruation.

In the same number of the same journal, Pope relates another case where the headache had lasted six weeks, at first, pain in the vertex which then extended over the right side of the head, and over the face with pricking as from needles in the limbs of the same side, worse in the afternoon; it was promptly cured by Lachesis.

In the Archiv. 30, 3,120, Dr. Schellhammer relates a case of fistula lachrymalis cured in two weeks with one dose of Lachesis, and which was accompanied by a long standing eruption on the face, which he had treated unsuccessfully for one year with other homoeopathic remedies.

In the Allgem. Rom. Zeitung 41, 227, Dr. Hering relates a case where, after Otorrhoea, the right ear remained dry and obstructed, with almost entire deafness, and which was cured by one dose of Lachesis⁵⁰⁰ in one week. Compare symptoms 556 and 558.

Rosenberg 17 and 22 says Lachesis has cured redness of the nose in drunkards; also Mercurio-syphilitic cases. In drunkards it cured the internal soreness of the nose when the internal nose was full of scabs, and when in Mercurio-syphilitic cases much pus mixed, with blood, was discharged from the nose. Compare symptoms 594, 622, 623.

A great many cases of various diseases of the throat which have been cured by Lach. are related in Vehsemeyer's Jahrbuch 1,1,13,14.Allg. Hom. Zeitung 57,10; in Dr. Hering's Hausarzt, sixth edition, 201; in All. Hom. Zeitung 50, 87; 41, 24; 45,108; in Hirschel's Zeitschrift 2, 23; 4, 128; 4, 129. The characteristic symptoms in these are: “Great desire to swallow, swallowing very difficult and painful on account of a sensation as if a lump or plug was lodged in the throat. Painful constriction of the throat. When swallowing, great fear of suffocation and choking. The drink which has been swallowed escapes through the nose. It is more difficult to swallow solids than fluids.” Compare symptoms 982, 983, 984, 985, 994.

In Archiv. 15,1, 55, Dr. Hering relates a case of chronicgastricism by Lachesis. The principal symptoms were a very variable appetite, aggravation of discomfort after eating and then the stomach becoming filled with wind, which the patient was compelled to throw off; giddiness, languor and the breathing oppressed. When lying down, in the evening, the least covering touching the month or nose so impeded his breathing that he feared suffocation.

In the Allg. Hom. Zeitung 34,19, and British Journal, 1847, two cases are related of the inflammation of the cecum (typhlitis) in which Lachesis cured, after other medicines had been unavailing. A very characteristic symptom in both cases was that the patient could only lie on the back with the legs drawn up.

In the Allg. Hom. Zeitung 22, 45, Dr. Gross relates a case of diarrhea cured by Lachesis. The characteristic symptoms were, painless brown and very offensive evacuations, tongue dry and red, twitching of the hands.

In Archiv. 15,1,48, Dr. Hering relates a case of syphilitic ulcers in the throat cured by Lachesis. The ulcers looked yellow and greenish. violent pain when swallowing solid food, the drink escaping through the nose. A continuous titillation in the ulcers caused her to cough, difficult expectoration, cough, hawking; if the hawking comes after a meal she has to vomit what she has eaten. The external throat is painful to the touch, the pain in the throat extending to the ears. Attacks of pain in the bones at night driving her out of bed. Attacks of violent headache, beginning when she rises in the morning, worse when she elevates her head. The patient had been treated for syphilis for ten years by eleven physicians. Four doses of Lachesis cured her.

In the Allg. Hom. Zeitung 41, 24, we find it related that some old cases of Mercurio-syphilitic buboes, which had suppurated a long time, were cured by Lachesis.

In the Archiv. 18, 2, 6, Dr. B. relates a case of Hysteria cured by Lachesis“; he found the indication for this remedy in the symptom that the dryness of the mouth and throat were accompanied by a continued sensation in the velum palati, as if desquamation was about to take place.

In the Corresp. Blatt 2, a case is related in which Lachesis

cured blue milk, which came involuntarily from the mammae of a mother who had nursed for five months.

In Hirschel's Neue Zeitschrift, is a case related by Dr. Oehme. He cured a tumor in the left mamma, the pain was cutting and pricking; worse before and after menstruation, and extended to the arm. The tumor, as well as the menstrual disorders, were promptly cured by Lachesis.

In Hirschel's Neue Zeitschrift 3, 68, we find a case of puerperal peritonitis cured by Lachesis. The characteristic symptoms for Lachesis were: the color of the face livid, bluish. Abdomen swollen. Urinary and fecal evacuations suppressed. Lochial discharge thin and fetid. Unconsciousness with violent chills daily.

In Dr. Hering's Hausarzt, sixth edition, page 176, the characteristic symptoms of the cough which is cured by Lachesis are given as the result of observation of the curative effects of this medicine in many cases; they are, cough caused by pressure on the throat, the patient is unable to have his throat covered; cough at night, during sleep, or from tickling in the throat-pit, or as soon as falling asleep; while coughing, the chest feels raw through to between the shoulders, with stitches in the sides and bloody expectoration; or cough as if some fluid had come into the wrong passage, or violent cough from ulcers in the throat with straining to vomit, hawking of much mucus from the throat with much saliva in the mouth, difficult expectoration; the cough is especially severe after eating, after sleeping, when rising from a recumbent position; the cough is accompanied by pain in the throat, ears, head and eyes.

In the Allg. Hom. Zeitung 13, 230, Lobethal tell us that he has cured several cases of bronchitis with Lachesis, when he found in chronic bronchitis a great sensitiveness of the larynx, hoarseness, and when the patient complained that he felt a thick lump in the throat as from accumulated mucus.

In Archiv. 15, 2,139, a case is related in which Lachesis²⁰ cured a periodical asthma. The patient awakens after midnight, the chest feeling constricted; also, in the morning, when rising suddenly, the breathing slow, heavy, wheezing; he must bend forward when rising or sitting.

In the Hygea 59, 7, Dr. Wurm calls attention to Lachesis in hepatization of the lungs.

In Archiv. 15, 1, 56, we find a case in which Lachesis cured a patient who had, six months previously, been treated for pneumonia by blood letting. The prominent symptoms were: a short superficial hacking cough which was very distressing and often caused retching, as if vomiting would follow, very little expectoration of thin tough mucus or of rough small lumps. He coughs only through the day, more after walking in the open air, after talking and after sleeping, is worse during damp weather and after eating fish. The cough seemed to be caused by a tickling in the pit of the stomach, and he complains of much pain there when coughing. Short breathing especially when working with his arms.

Dr. Hering in his Housarzt 300, Kreussler in bis Therapeutics 124, and Dr. Stapf's Archiv. 16, 1, 90, say, that, in panaritium, Lachesis will not only relieve the pain but will assist when suppuration has already begun and will hasten it, especially when the skin has a dark red or bluish color.

In Vehsemeyer's Jahrbuch 1, 1, page 15, Dr. Fielitz relates a cases in which Lachesis²⁰ cured. An abscess in the bend of the knee had been healed, but had left the muscles contracted so that the leg could not be straightened. In a fortnight the patient was cured, could straighten his leg again and walk again.

In the Allg. Hom. Zeitung 18, 329, we find Dr. Gross relating cases in which Lachesis cured inflammatory swellings in the neck after scarlet fever; they suppurated and healed; also oedomatus swellings after scarlet fever.

In Dr. Hirschel's Zeitung 1, 115, Dr. Lobethal says, that when after scarlet fever, the accumulation of water extended to the thorax and pericardium, Lachesis has cured, particularly when the urine look black.

In the Allg. Hom. Zeitung 18, 131, Dr. Gross relates a cure of erysipelas by Lack²⁰ A lady, 40 years of age, who had not menstruated for one year, sprained her foot; after much exercise the ankle became greatly swollen, the erysipelatous swelling extended to the knee; when she walked she experienced a sticking pain in the ankle; the upper part of the foot was covered with dark red lentil shaped pimples. After a few days the erysipelatous swelling disappeared, the pimples dried up, and the menstruation returned.

In the Allg. Hom. Zeitung 19, 177, Knorre relates two cases of erysipelas of the lower extremities cured by Lach. Also a case of vertigo after suppressed erysipelas, and a case of flat open ulcers on the left lower limb with erysipelas, cured by Lachesis.

In the Archiv. 17, 2, 52, Dr. Gross relates a cure with Lachesis; the patient had confluent smooth round white pustules of the size of a mustard seed in the palms of her hands, they contained a white fluid and itched intolerably; they healed under the effects of Lach. in seventy-two hours.

In the Archiv. 15,1, 53, we find a case of itch cured by Lachesis. The prominent symptoms were, itching over the whole body, at first burning and then there appeared on the hands and feet itching pustules, with violent itching, burning and beating; a spreading red swelling appeared under the pustules with large blisters, first filling with water and later with pus; the inflammation extending to the elbows and knees, some of the large blisters became of a bluish black color, with pulsating burning pain, the pain extending to the head, teeth, chest and back; boring pain in the vertex. When the itching lessened, the patient complained of dyspnea. Cured in one week.

In Hygea 9, 6, Dr. Grieselich relates a case of cure, by Lachesis, of ulcers on the lower extremities, the color of the skin around the ulcers was bluish; the discharge from the ulcers ichorous.

In the Allg. Hom. Zeitung 8, 9, 7, Dr. Gross relates five cases of cures of ulcers on the lower extremities with Lach. The bottom of the ulcers uneven and of a dirty color, the discharge thin and the odor very offensive. In one of the cases the edges were high and hard.

Dr. Wolf says, in his Homoeopathischen Erfahrungen 1, 37, among the instances of hydrops after scarlet fever which are not controlled by Apis, are those in which the urine is of a black color; these cases are promptly relieved by Lachesis.

In the Allg. Rom. Zeitung 57, 73, Dr. Tietze relates two cases of epilepsy cured by Lachesis; another cure of the same disease by Lachesis is related in Corresponden Blatt 4, 46, by Dr. Pulte.

In the Archiv. 15, 2, 120, Dr. Hering relates a case in which he cured a child of spasms, with frequently recurring loss of sight and consciousness, by Lachesis.

In the British Journal of Homoeopathy, January, 1850, two instances are related in which Lach. cured hydrophobia.

In V. T. S. 7, 309, Bojanus mentions cases of typhus fever which he cured with Lachesis. He gives as indicative symptoms: the tongue dry, black, cracked, bleeding, and trembling when put out of the mouth.

In the Journal de la Med. Hom., Leon Simon says, that Lach. has cured wounds when they had become gangrenous, and relates the case of a wound on the head becoming gangrenous and being cured speedily by Lachesis.

In the letters on the homoeopathic treatment of animals, Magdeburg, 1837, we find under the treatment of horses, page 42, that one of the most important remedies in caries, especially of the feet, is Lachesis. On page 46, that Lachesis has often cured ulcers on the feet. On page 74, that Lachesis frequently cured when the mucus came out of the nose and mouth in strings.

In the same work, third letter, 1843, under the treatment of sheep, we find, on page 9, that erysipelas vesiculare was cured by Lachesis when it appeared as an epidemic; it was characteristic when it appeared on the head without any swelling. On page 12, we find that Lachesis cured the small pox in sheep, when a large quantity of saliva ran from the mouth. On page 24, we find that stomacace was cured by Lachesis, when, in malignant cases, the vesicles in the month became blue and the saliva fell out of the month in long strings, impeding the act of drinking. On page 32, we find that swollen bones were cured by Lachesis, especially when the swelling was very painful to the touch. On page 33, we find that Lachesis cured caries of the feet. On page 51, we find that Lachesis is the principal remedy in inflammatory fever if the mucus which collects in the mouth, and nose becomes cold and runs out in strings. On page 165, Lachesis is recommended when the animal half closes one eyelid while eating.*[The same author writes also on the treatment of oxen, but they have refused to testify to the curative effects of Lachesis; only the higher animals, the sheep and horse, hare given favorable evidence.]

After relating some of the evidences given by various physicians and observers, from among high and low potency men, in various countries and at various times, and also recorded in different medical journals and works, we can not agree with Dr. Hempel when he further says:

“The conclusion I arrive at is this: that the therapeutic character of serpent poisons is still hypothetical, and will have to be investigated and scientifically determined by further experiment,”

As far as the necessity for further experiments becomes desirable we agree with Dr. Hempel, and he might have, or may still carry out his good intentions by reproving Lachesis. The provings of Thuja by Hahnemann, the reprovings of it by the Vienna provers with unmerciful massive doses, producing much useless suffering and no new symptoms, and the very latest provings of Thuja by Dr. Wolf, with high potencies, proving not only the correctness of Hahnemann's and the Vienna provings, but also enriching the Materia Medica with very valuable new symptoms, may guide the anxious investigator who would no doubt arrive at the conclusion that the former proving of the serpent poison is no delusion.

When the evidences above quoted come to be considered, and if we further reflect that this is only a part of the evidence on record, leaving out, as it does, most of the living and present witnesses and all later records, the reviewer of Dr. C. Hempel, as an author and teacher, must arrive at this conclusion:

“That the therapeutic character, i, e., the curative virtues of serpent poison, especially of Lachesis, is well established and that it requires only the application of the homoeopathic law of cure, according to the provings in our possession, to establish not only the correctness of this conclusion, but also the conclusion that Dr. C. Hempel's assertions as above stated are erroneous and are contradicted by much experience and observation; in short that the experiment and the evidences of facts are against and contradict his 'conclusion.'

For the benefit of the physicians who have been taught by Dr. C. Hempel and who have, confiding in his teaching, considered Lachesis a useless medicine, but who are willing to appeal to the test of experiment, I will add a few characteristic of that polychrest — Lachesis

Tearing, pricking and pulsating pains. Contraction of the muscles. The left side is principally affected — (paralysis). Excessively warm or excessively cold weather causes great debility. The attacks return periodically (every spring). Exacerbation in the evening. All the symptoms are worse after sleep especially after a siesta, or from taking acids, from alcoholic drinks, from the abuse of China and Mercury.

Loquaciousness; discouragement; mistrust; nervous irritability.

Itching. Erysipelas. Color bluish red or yellow. Ulcers with great sensitiveness to the touch, uneven bottoms, ichorous offensive discharge, or burning when touched, especially on the lower extremities (around the ulcers many small pimples or ulcers on a bluish red skin,

Sleeplessness, especially before midnight. When falling asleep he is awakened by a tickling cough. When awaking from sleep he feels much worse.

Intermittent fever. The attacks came on every spring, or after suppression of the fever the previous fall with Quinine, and in the afternoon; are accompanied by violent pains in the small of the back and limbs, oppression of the chest, violent headache with a red face and cold feet; during the hot stage, continual talking — face yellow or ashy. Typhus fever, especially when the tongue is very red or black or in fissures principally on the tip, or when the tongue trembles while it is put out, or if, while endeavoring to put it out, the tip remains under the lower teeth or lip and can not be put out Small quick pulse. (Yellow fever.)

Pulsating, beating headache with heat in the head, especially on the vertex or on the right side or over the eyes, preceding a cold in the head with stiffness of the neck.

The eyes water with a headache from a cold. Itching and burning of the eyes. Yellow color of the white the eyes.

Dryness, with want of wax and hardness of hearing.

Redness of the point of the nose. Bleeding of the nose (blood dark), and blowing of blood from the nose especially in the morning. Discharge of pus and matter from the nose. Coryza, with discharge of thin water and red nostrils,

Paleness, yellowness or lead-like color of the face. Erysipelatous inflammation of the cheeks,

Crumbling off of the decayed teeth.

Sensation of a plug in the throat, or as if a lump of mucus had collected in the throat with continued painful desire to swallow. The fluid which is swallowed escapes through the nose. Ulcers in the throat, on the inflamed tonsils. Empty swallowing aggravates the pain in the throat more than swallowing of food, or fluids are swallowed with less pain then solids. The inflammation and ulceration of the throat begins on the right side and extends later to the left side (Lycopodium has the opposite). The external throat is very sensitive to the touch.

Dry, red, black, cracked, especially on the tip.

Desire for wine. Great thirst.

Pain when touching the pit of the stomach. Heat in the abdomen. Inflammation and abscess of the liver. Great discomfort from having the cloths tight around the waist.

Constipation. Stools excessively offensive. Constriction in the rectum or sensation of a plug in the anus. The desire to evacuate continues after the pappy, offensive stool. Stitch in the anus when coughing or sneezing. Hemorrhoidal tumors protruding after stool and constriction of the sphincter.

Urine foaming.

Great excitement of the sexual desire.

Induration of the prepuce. Mercurio-syphilitic ulcers.

Menstruation suppressed or too scanty. Menstrual colic beginning in the region of the left ovary. Swelling, induration, pain and other anomalies of the left ovary.*[Lachesis has the same specific effect on the left ovary that Apis has on the right ovary.]

Burning in the chest. Palpitation of the heart with anxiety. Rheumatism of the heart.

Oppression worse after eating. Shortness of breath and suffocative attacks are caused by touching the larynx or aggravated when moving the arms. Periodical attacks of asthma.

Cough caused by pressure on the larynx or by any covering of the throat, by a tickling in the lowest point of the throat, when falling asleep, from ulcers in the throat; cough with rawness of the chest, difficult expectoration and pains in the throat, head and eyes.

Sensitiveness to the least touch, and, when touched, difficulty of breathing or else and attack of coughing Hoarseness with a sensation of rawness and dryness in the larynx.

Pain in the small of the back with constipation, intermittent fever, palpitation of the heart or dyspnea. Stiff neck.

Heat in the palms of the hands at night.

Flat ulcers on the lower extremities. Cold feet.

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