In the numbers for January, February and March, of Vol. iv. of the Review, were given some observations on the treatment of this fever, with the object, if possible, to develop a better method than the habitual or empirical employment of certain remedies, supposed to stand in specific relation to it, irrespective of the resemblance of the characteristic symptoms of the case under treatment to those of the supposed specific drug, which the law of cure requires. A protest was then entered against this practice of habit, which so signally disregards the demands of the law, the truth and importance of which is freely admitted by those, even, who thus in their practical duties disregard its claims. Instead of this practice, one founded on a strict individualization of the case, after which only can a specific remedy be found, was urged, and then the subject was farther considered, especially in the variety so rapidly fatal, characterized in all its elements by extreme torpor, destroying life by a speedy paralysis of all its forces, and generally so little amenable to remedies. New remedies for this variety were suggested; and then the consideration of the variety more particularly characterized by violent inflammatory action, especially of the brain, was entered on. This was continued so far as the examination of Aconite and Bryonia, with a view to develop their exact relation to this variety, when the discussion was suspended by other duties, though the intention to examine other remedies, in relation to this and other varieties of this disease, was not abandoned. It is now proposed to resume the subject, and as far as possible, to endeavor to give signs by which these relationships may be recognized. In entering on the subject anew, we shall, in the first place, according to our purpose already declared, examine, so far as related to our subject, the elements of that drug, more often misused, and from which, notwithstanding many failures, more is still expected, than from the use of any other. Of course we refer to
Belladonna .-In the numbers of the Review above mentioned, while protesting against the indiscriminate use of this drug, we have endeavored to call attention to a class of cases in which it can seldom if ever be found otherwise than hurtful, and to show that this must ever be true from the nature of the case, the class being characterized by torpor, or depressed action of the vital forces, while the effect of this drug, on these forces, is to produce the exact opposite, viz.: an exaltation of their action. Consequently the relation of the remedy to this class is never homoeopathic, but always antipathic, and hence the result of its use must be, by the law of drug relationship, in its secondary, or reactive effects, to intensify the morbid state which was to have been moderated and controlled by its use. But in that, variety characterized by excessive action of these forces, especially as affecting the brain, the case is different. In this variety the drug under consideration is often of the greatest value, it maybe even indispensable. For some of the symptoms of a representative case of this class the reader is referred to page 387 in vol. iv. of this Review, and he is requested to compare these with the following symptoms of Belladonna, and also these last with those of cases which he may be called to treat practically, and, where similarity of these groups do not obtain, to avoid carefully the use of this drug, if he is desirous of making a homoeopathic prescription and cure. The following is a translation of the symptoms which are likely to meet their counterpart in cases of the fever under consideration. That many of them are strikingly like those often met in practice is obvious. That they sustain the assertion of the active, demonstrative character of the action of this drug, as found in the records of its effects on the healthy, which we have here and elsewhere insisted on as characteristic, cannot admit of a doubt.
Convulsions - with outcries and loss of consciousness — with delirium - with distortion of the eyes - especially affecting the flexor muscles - with jerkings, especially of the hands and feet, loss of the sense of touch, and loose rattling of mucus in the bronchi. Rigidity with bending of the body and head backwards, or to the left side. Attacks of rigidity or immobility of all, or of a single limb, sometimes with loss of sensation, distended superficial veins, red and turgid face, full, quick pulse and copious sweating.
Skin. - Scarlet spots and scarlet redness, especially on the face, throat, chest, abdomen and hands, with acute swelling of the parts; sometimes with rapid small pulse, tightness of the chest, violent cough, delirium, increased activity of the memory, rubbing of the nose, and distended pupils. Erysipelatous inflammations, also with swelling, or even with gangrene of the parts. Redness, inflammation and swelling of the entire skin of the body.
Glands . - Swelling of the glands, painful or suppurating. Sleep. - Coma. Stupefying coma, like lethargy, with deep sleep and moaning respiration, lying motionless, occasionally opening the eyes with wild look, or jerking of the tendons; pale, cold face, cold hands, and hard small pulse, wakes with a start and fright especially on going to sleep, sometimes with sweat on the forehead and epigastrium, and fear as if something under the bed made a noise. Restlessness and tossing.
During Sleep. - Outcries. Sighings. Jerkings, which wake the child up, also on falling asleep. Singing and loud talking. Suffocating snoring during inspiration. In the evening when falling asleep, he feels as if swimming in the bed. On closing the eyes to sleep, immediately there are frightful visions and jerkings. Anxious and frightful dreams. Dreams of falling.
Disposition. - Unwillingness to speak. Indifference. Apathy on which nothing makes an impression. Answers only with anger and outcries. Increased susceptibility of all the senses; all impressions on these are too strong. Howling and outcries for the merest trifles, increased by being spoken to.
Intelligence. - Insensibility, with convulsions, especially of the arms. Loss of consciousness. Stupidity. Insensibility, as if in a dream, also in the evening in bed. He neither sees nor hears. He recognizes no one, even his relations, especially by the sense of hearing. He does not know whether he sleeps or wakes. Illusions of the senses, and imagination. Delirium, especially at night, with a staring look. Murmuring delirium. Vertigo with trembling of the hands; with dullness of the senses; with nausea.
Head.-Heaviness of the head. In the forehead, especially over the eyes, with pain in them when touched, and difficulty of opening them especially in the morning, on waking. Pressing heaviness in the occiput, or towards the temples, with diminished hearing. Heaviness in the head like drunkenness, with vertigo . Outward pressure in the head, with sensation of bursting, especially in the forehead, as it all would come out forwards. Tearing in the head, especially in the forehead over the eyes, in the vertex (Scheitel). Shootings to the temples outwards, or in the temples. Pressing shootings in the temples, or to all sides of the brain. Cutting shooting, as if with knives, especially evenings, in the whole head, or only in the occiput. Shootings from one temple to the other. Throbbing in the whole head, after pressing cutting. Pressing throbbing in the occiput. Strong pulsation of the arteries of the head, especially of the forehead and temples, or with sensation in the bones of the forehead as it they were raised up; or in the morning after walking, with pulsations in the whole body. Heat in the head. Painful sensibility of the hairy scalp to the slightest touch, even of the hair. Convulsive shaking and bending backwards of the head.
Eyes. - Red. injected conjunctiva, also with shootings and tears. Spasms of the eyelids. Eyes opened wide. Eyes prominent. Immovable. Sparkling, brilliant, distorted, or in convulsive motion. Glassy. Red. Great sensibility to light, with spasmodic turning of the eyes from the light.
Face . - Burning heat and redness, especially of the cheeks, as if after drinking wine, with congestion of blood to the head, or with violent headache and ice cold extremities. Red, scarlet spots on the face, also with strong pulse. Convulsions of the lips. Distortion of the mouth. Lips dark red and dry.
Mouth . - Great dryness of the mouth, extending to the throat; the larynx as if constricted, hindering swallowing, also with or without thirst. Bloody froth at the mouth, with grinding of the teeth and shaking of the head. Mouths of the salivary ducts excoriated, as if corroded. Sticky slime in the mouth for the most part with sensation of dryness. Foul smell from the month, as if from disordered stomach. Tongue cracked, red, hot and dry. Papillae bright red, inflamed and swollen. Trembling of the tongue. Heaviness of the tongue. Paralytic weakness of the organs of the voice. Difficult and stammering speech, also like that of drunkenness, with full consciousness and dilated pupils. Nasal speech. Loss of speech.
Throat. - As if raw and excoriated, especially when swallowing, touched with the tongue, or chewing. Burning in the tongue and fauces, especially when swallowing food or drink. Shootings and pain as if swollen, only when swallowing, turning the neck or feeling of the throat. Inflammation, swelling and redness of the throat and fauces, palate, uvula and tonsils. Swallowing painful, difficult, or entirely prevented, even of fluids, which often return through the nose. Impossibility of swallowing, with aversion to all liquids, even to madness. Dryness of the throat and mouth prevents swallowing.
The above are literal translations of symptoms of Belladonna, as found in the first volume of Jahr's Codex. The translation has been made from this, rather than from the Materia Medica Pura, or other volumes of provings, because of its character, being a compilation from the various proving in existence when it was prepared, as presenting a wider range of symptoms than is found in other works. For this reason this has been selected, though the writer was fully aware of the rather frequent witch-work this compiler is in the habit of making with symptoms of original provers, by reducing two or more of them to one, or dividing one into two or more, or of omitting parts of symptoms, altogether, to bring the whole into a state and dimensions better suited to his notions of what symptoms ought to be. For the purposes of the present paper, notwithstanding this unpardonable defect of the work, the wider range of the Codex presented advantages which have been availed of to gather in one view the symptoms which are scattered through other works, and by which the drug is related to the disease under consideration. There may be other symptoms under other rubrics in the pathogenesis of the .drug, which may find their counterpart in cases of the fever, but the object was to present those which are oftenest repeated in cases affecting severely the brain and throat, through one or other of which attacks are oftener fatal than through destructive processes in other parts of the body. And first let us examine those indicative of brain affection, and see if their character sustains the judgment expressed, that the action of this drug on the brain is characterized by excess of action as opposed to torpor.
In the first rubric, convulsions, every fact sustains this view, if we except the paralysis of sensation and mucous rattle, which are not incompatible with it, being both often met in the last stage of what has been unquestioned inflammatory condition of the brain, though both symptoms are also met in cases of torpor or paralysis of this organ.
In the second the relation may be to the first stage of the inflammatory state or the torpid, the symptom being of that general character which may be found in a great variety of affections, and hence as indicative of specific character of either drug or disease is not of the first importance.
In the third there is certainly less of specific likeness to the peculiar eruption of the fever than might have been expected from the almost universal use of the drug, based largely on the scarlet quality of the eruptions it has produced. There is none whatever to the eruption of the fever, as oftenest met at the present day, in its severest manifestations, except in the one item of color. There are here three forms of scarlet eruption, all of them attended by swelling, which the eruption of the fever is not; one of them by gangrene, which the scarlet rash is not likely to be, though a peculiar affection of the throat, to be noticed by-and-bye, may be thought by some to negative this. The first is certainly attended by many phenomena often met in the fever which characterize it as well as the drug, and which it is likely have much to do with the curative relation of the drug to the disease, notwithstanding the swelling, which the fever rarely shows, except of the glands and the cellular tissue about the throat. After a careful attention to the skin affections of Belladonna, these three are all by which it can be said to be related to the fever by the law of similars, it can hardly be supposed that these alone were the reasons for elevating this drug to the dignity of a supposed general specific for scarlatina. There must have been other and stronger resemblances. in other elements of drug and diseased action.
Of the sleep there is nothing very peculiar. The coma is not so characterized as to declare it more like that of scarlatina than of anyone of the numerous affections of which it may be found a symptom. So of waking. These symptoms are met in scarlet fever as well as in other affections, and are indicative of active rather than torpid state of the vital forces of the brain, though coma belongs to both. The same observation it will be noticed is equally applicable to the symptoms during sleep, and to those of the fever, and disposition, if, in relation to this last, it be remarked, that apathy may belong to the early stage of either torpor or inflammation.
The developments of the effects of the drug in the modifications it produces of intellect, are of the highest interest and are without exception similar to those which often result from inflammation, though insensibility and loss of consciousness may be met in states of torpor.
Of the symptoms of the head, all belong to the inflammatory condition, while only vertigo and heaviness are common to this and torpor; while those of the eyes, ears and face are all strictly inflammatory in their character, those of the mouth are mixed. All may be attendant on some stage of inflammation, while some of them are often met in states of torpor. The symptoms of the throat, it will be observed, are all subjective, except the redness and swelling, and all such as characterize common phlegmonous inflammation of the parts, of an acute character. The absence of those symptoms which characterize the class of cases so often fatal through destruction of the tissues about the throat, internal or external, is note-worthy. There is nothing of the foul smell, and tenacious, offensive, and often, excoriating secretions which are constant concomitants of the internal sloughing of the throat, or of the hard and immense swelling of the exterior cellular tissue which so soon sloughs and discharges externally, if its progress be not checked.; after which, how generally fatal these attacks are, we all know too well. The pathogenesis of Belladonna will be searched, in vain for good and sufficient reasons for its use in these sad cases. There are no such reasons, and yet it has been given again and again, and though it has often failed of giving the least aid to a cure, it has still been the one great resort, as though, the case being scarlet fever, it must somehow benefit. Such prescription must have resulted from some such reason (or unreason) as this, for in the pathogenesis of the drug, the only true foundation for specific prescribing, it has no support. Its administration in such cases, where it must almost always be out of place, is not merely attended by a loss of time, where the loss can be so ill afforded, and where there is always so little to lose, but the drug, by its antipathic relation, must often inflict great and positive mischief on the poor patient, which he has little power to resist. We have protested against this course of prescribing, and again, with this protest, we declare that it cannot, be too carefully avoided. In any case where the practitioner is tempted to give this drug, let him look carefully to its pathogenesis, and if in this he finds the resemblance to the characteristics of his case which the law of cure requires, the result will not disappoint him. But if this resemblance be wanting let him avoid its use as he would a certain evil. If he can do no better than this, by all means let him leave his patient to his God and the powers of recuperation. He has given, for, in these circumstances, this is his highest duty, humiliating as the declaration may be.
There is another condition in which Belladonna has often been given without the benefit following which was expected, and which a hasty examination of its pathogenesis might declare was reasonably anticipated. We refer to the stupid, comatose state which is sometimes developed even early in the history of the case, at other times only later. Belladonna seldom relieves this, though we have both coma and stupidity in its pathogenesis. And so clear and positive is the expression, that the seeming is still after frequent disappointments, that it must relieve, at least this next case, notwithstanding the previous failures. The explanation of these disappointments is not difficult. It is found in the fact, already sufficiently insisted on, in this and the paper on Typhoid Fever, that Belladonna is not homoeopathic to a condition of torpor. And the coma and stupid dullness which belong to scarlatina, to which we here refer, are of this condition. Its action, if it act at all in cases of this description, must he antipathic, and therefore not curative. If given in larger doses, there may possibly follow a palliation which can only be of brief continuance. Opium or Stramonium will more likely be in place in cases of this kind, the preference being for Opium in those where these symptoms are simple and strongly expressed, and for Stramonium where there is mixed, so to say, somewhat of activity with the torpor:
In the series of remedies from which we may be called to select in the treatment of a case of scarlet fever, characterized by the phenomena of acute inflammatory action within the head, if viewed as standing in the order of the degree of violence which marks this variety of their action on the brain and its membranes, the first place will undoubtedly be given to Belladonna. This appears conclusively if we compare the elements of its pathogenesis given above with those of the other members of the series. By this standard, (and it is in the order of the violence of their action we propose to consider them) the third place is as certainly to be given to Hyoscyamus. The value of this drug in the treatment of inflammatory affections of the brain, resulting from the action of general causes, has been fully recognized. Where the symptoms of a case are similar to those produced by the drug on the healthy, it is no bar to its use that the disease is the result of a specific poison. It would have been but natural to anticipate its efficacy in this class of affections from the success which has followed its use in the non-specific inflammations. That which would have been anticipated of its value in these cases, has been often fully confirmed by practical results. It hence becomes of. the highest importance here, as with Stram., to fix the exact place of the drug in the series of those from which we are to choose in our prescription, and to establish as clearly as possible the signs which decide for its selection. Before proceeding to this, the general remark may be permitted, that the sphere of Hyoscyamus in the treatment of scarlet fever is a limited, though not an unimportant one. It is rare that it is more than a temporary resort for the relief of some sudden attack of the brain, which, if not controlled, threatens destructive consequences. In such cases it may be of the highest value, though never a curative for the entire disease. Its sphere seems to be limited to cases with acute inflammatory affection of the brain, or to that state between erethism and torpor, which places it in relation to
Bell. and Stram., as in typhoid fever, below Stram. This will appear plain on a careful comparison of the symptoms of the three related drugs, which are liable to be repeated in those of the fever. The symptoms of Hyoscyamus related to scarlet fever are fewer in number, and those which are most prominent are accompanied by fewer concomitants, showing that it strikes less deeply into the vital forces than either of its allies, and that the disturbances of the vital balance which it produces, are fewer in number a well more superficial than those of either Bell. or Stram. If we begin the series of its symptoms as in the preceding, we shall find its
Convulsions sustaining this view. Spasmodic bending of the limbs, while the curved body is thrown upward in the air. Spasmodic tetanic stiffness of the whole body. Jerking of the limbs. Subsultus. Convulsive motions of the limbs with frothing at the mouth; great throwing about of the body; with a renewal on the slightest attempt to swallow liquids; with thumbs drawn inward on the palms.
General prostration of strength, with trembling of the whole body and coldness of the extremities. Burning of the skin when laying the hand on any part of the body. Inflammation of the skin of the whole body with cinnabar redness.
expression of countenance, suffocating snoring during inspiration [The distinction between this symptom and that so characteristic of Opium is not difficult; with Opium, the respiration is slow, deep, loud, and snoring, but there is no suffocation.] Whimpering, with throwing lip of the arms, tossing about of the head, throwing about and jerking of the feet, (Stram. more of the hands) and opening and spreading, and then closing of the fingers.
Sleeplessness from nervous excitability, with convulsions and shuddering as if from fright. Sleepless the whole night. Sleepless with anxiety. The child passes the whole night in tossings and cries, wakes with screams. Wakes and starts up in a fright. The sleep is interrupted by grinding the teeth. Frightful dreams.
Restlessness the greatest, he moves constantly from place to place. Terrible anxiety. Shudderings alternating with trembling and convulsions. Uses violence, and strikes his attendants. Insensibility to nipping and pinching. Entire loss of perception and understanding. Complete stupidity and loss of consciousness. He neither sees nor hears. Does not recognize his relations. Sits in bed like a statue, immovable, and bereft of his senses. Delirium even when awake, as if he had seen a man who was not present. Absurd talking and muttering. Grasps at the nearest object and cries that he shall fall. Lies naked in bed, talking. Violent moving of the hands with constant burning heat, outcries and difficult breathing. Remembers occurrences long past. Great weakness of memory. Inability to think. Dullness and sinking into continued sleep. Confusion of the head as if absent-minded. Vertigo with clouded sight. Violent vertigo. Vertigo as if from drunkenness.
Continued violent pains in the head, with preternatural heat, alternating with pain in the nape of the neck. Dull pains in the base of the brain; in the forehead, especially in the membranes of the brain. Heaviness of the head with severe pain.
Eyes, sparkling and red, distorted and open, prominent and convulsed; sunken, sparkling and staring; staring and distorted; gazes on those present with a staring look. Strabismus. Inability to open the eye-lids. Pupils much dilated or contracted. Objects appear enlarged and brighter colored.
Tongue red, dry and parched, while it is clean or brown coated. Burning dryness of the tongue and lips which look like burnt leather. Sensation of fullness of the tongue, as if burnt, much increased by speaking and inspiration. In ability to speak distinctly. Loss of speech with loss of the senses.
Great dryness of the throat (also shootings) and almost constantly with thirst. The throat is so dry and constricted that a single swallow (of tea) will suffocate him. Pressure of the throat, as if swollen, when, and when not, swallowing. Points to the throat with the finger as if something stuck there. The throat as if constricted, preventing swallowing. Inability to swallow. He spits out the liquids which have been put in his mouth. It requires only a cursory comparison of the above symptoms with the two series which have preceded it, to discover the differences which control the selection of either of these drugs in cases when one of them is called for by the law of similars. The convulsions of Hyoscyamus are quite peculiar. In one of its forms, affecting chiefly the flexor muscles of the limbs and trunk. In another the tonic character of the spasms is quite marked, more so than in either of the others. Jerkings in the symptoms of Hyos. are replaced by trembling shaking in those of Stram. The jactitation is peculiar to the convulsions of Hyos. or at least this feature is more prominently expressed here, than with either of the others. The trembling is here accompanied by general prostration, while it is not so in the case of the others. Burning of the skin is peculiar and different from the skin affections of either of the others. It will be well to note carefully the symptoms of sleep, and to compare them with the effects of Opium, as well as with those of Bell. and Stram. The similarity of the symptoms of Hyos. and Opium in this rubric are quite marked, and it is often in this rubric that the symptoms are found which decide the choice of the remedy. 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. If, in this class of cases, time be lost in proving, by actual trial, the worthlessness of Bell., the case will probably pass on to a hopeless state, the condition having been either aggravated by the action of an inappropriate drug, or allowed to progress uninterruptedly towards a fatal termination, during the whole time in which the action of a rightly selected drug could have been curative. It is in just this class of cases that the utmost care should he used in the first prescription, for the enemy is likely to allow little chance of good from any subsequent one if this proves to be wrong. The symptoms developed during sleep, are also worthy of careful attention. The symptoms of the intellect, head and eyes, though like to those at times developed in an inflammatory attack within the head, are many of them of a less distinctive or demonstrative character than are those of its two related remedies, and this is one of the chief differences by which its true character and place in practice are indicated. Where the symptoms are more demonstrative in their character they have also more numerous concomitants.
Sulphur. - Before presenting the elements of the pathogenesis of this drug, we wish to make a few general observations on its use, especially in the treatment of acute diseases. There is a notion prevailing with many practitioners that this remedy, though of great value, is more especially appropriate to the treatment of chronic than acute affections. That if in place at all, !n dealing with the latter, it is only after the first stage of the attack has passed, or there have been deposits in cavities, in parenchyma, or upon surfaces, which are to be removed; or the acute attack has roused to activity some old cachexy or chronic miasm, giving to the case much of the character of that class of affections for which Sulphur is supposed to have special appropriateness. This, though an error, is not without excuse. It has in part, at least, grown out of the division of diseases by the great Master into the two classes of psoric and apsoric, and giving to Sulphur the place of first importance in the treatment of cases of the first division. To the efficacy of the drug in this class of affections the experience of intelligent Homoeopathicians of all countries bears ample testimony. The error of those who have failed to recognize its importance in the treatment of the second class, is in this restricted view of its relations to one class, and to an altogether too limited view of the prevalence and importance of the miasms which are the producing essence of those affections which all term chronic. (Psoric.) There is not attack of acute or a psoric disease, where these miasms may not be brought into action from their previous latent state and in which then they are not a cause of increased embarrassment to the practitioner, and danger to the patient. It is just the causes of the apsoric class which are likely to excite the activity of the psoric poison. How often is this the case in measles, typhoid fever, pneumonia, influenza, etc., and when this occurs, in these or other affections, who shall draw the line where the case ceases to be acute and becomes chronic? We make this statement of the general liability of diseases, commonly called acute, to become complicated in their progress by the roused activity of psoric miasm, thus broad, in the full view and belief of the almost universal prevalence of this poison in each individual of our race. Where is there one, who can be said to be entirely free from it? And wherever it exists, there it may and does become active whenever subjected to the action of causes which in their nature tend to rouse it from its latent to an active existence. Of such causes, all experience proves, that those which originate common acute diseases are the most important. Therefore, even on the view of the relationship of this drug which would limit it to the treatment of affections commonly received as chronic, or psoric, it may be called for in the treatment of any one member of the other class by reason of this complication of the chronic element, so likely to occur, and so important when met. [See paper on the “Use of High Potencies in the Treatment of the Sick,” by Carroll Dunham, M.D., p. 297 et seq. Vol. II of this review, where this subject has been more fully discussed.
But this is not all the truth. There is in the relationship of Sulphur to diseased conditions, as their curative, no law which separates it from the law which declares and constitutes this relationship for all other drugs. There is no exceptional element by which it is removed from the domain of the common law, which requires similarity of the characteristics of the drug and the disease for the constitution of this relationship. Neither is there anything in the division of diseases into the two classes named which removes either of them from the authority of this common law“ in the discovery and establishment of their curative relations. This division evolves no new relations and imposes no new conditions. It is the similarity of the required elements and this alone which declares that this or any other drug will cure a given case. If this similarity be ascertained, it does not matter whether the case may have been classified as acute or chronic or whether the drug has its place with the psoric or apsoric; the one will be cured by the other in all cases and conditions where cure is yet possible.
If these views are correct, it follows that Sulphur may be in place in the treatment of any, the most acute, diseases, inflammatory or otherwise; that it is sure to be the best remedy in any or all these, whenever its characteristics are more like the characteristics of the disease, than are those of any other drug. And this is just what enlightened experience and observation has proved to be the fact. Under the guidance of this law of similars it has been selected for the cure of the most violent and dangerous inflammations, and they have yielded to its power. Indeed, broad as is its clinical application by this law, it may be doubted whether in any class of diseases it has greater value, or will oftener be followed by success, when rightly selected, than in that of the most important inflammations, in which, hitherto, it has been unwarrantably neglected. This certainly has not happened from a failure after a careful study of its pathogenesis, to find a resemblance to the phenomena of acute inflammation of important organs. How beautifully and how often has the use of this drug in Peritonitis, Pneumonia, Pleuritis, Meningitis, etc., been followed by the prompt and complete disappearance of these grave affections, showing conclusively, not that its psoric relationships are less general or important than has been supposed, but that like all other drugs, it has other relations, scarcely less important, growing out of the general law of similars, by which it stands allied to a large class of important affections, which may or may not be complicated with the psoric poison, but which have their origin from causes entirely independent of this. An example illustrative of this is often met in the progress of cases of scarlet fever, especially in those which are characterized by prominent brain affection. The following symptoms from its pathogenesis are the grounds of this relationship:
Miliary rash (Friesel) on the whole body, sticking itching, or itching followed by exfoliation of the skin. [A tolerable picture of the cutaneous phenomena of scarlet fever, as now oftenest met, from the beginning to the end.] A fiery red or scarlet (Scharlachartiger) eruption over the whole body. After a slight rubbing, the skin is for a long time very painful, as if it were raw. Swelling, suppurations and indurations of the glands. [Not necessarily belonging to this fever with the affection of the brain we are considering, though in the progress of these cases the glands of the throat often become involved.]
Difficulty of falling asleep, with frequent waking, at night. In the evening, in bed, he cannot fall asleep for an hour. Cannot sleep before twelve o'clock, and then there is frequent waking and tossing about in the bed. On account of great restlessness, he cannot sleep after midnight. Wakes each time with fright, as if from a terrifying dream, and after waking is filled with anxious phantasies, from which he cannot free himself. Restless tossing here and there without waking. Severe pains in the head which hinder sleep, and allow of rest in no position. Frequent waking on account of beating of the arteries in the head. Waking, especially in the evening, on falling asleep, with frightened start. Calls out as if unconscious (in sleep). Delirium, in a restless sleep, filled with dreams, before midnight, like anxious delirium. Eyes half open in sleep. Indistinct muttering in sleep. Snoring. Lies with the arms over the head. Frightful and anxious dreams, in which he gets out of bed, unconscious, followed by violent headache. Immediately on closing the eyes, visions of strange and frightful apish faces, which he can not keep away. The child is angry and passionate. Excited temper, easily excited. Seizes on things with great haste.
Headache with nausea, also with heat and rushing sound (sausen) in the head. Heaviness of the head, which makes every motion unpleasant; in the vertex; like a weight pressing from above downwards upon the brain, as if a band were drawn around the head. Pressure, mostly on the vertex, as if the eyes would be forced out, or as if the brain were pressed from above. Tension in the forehead. Drawings in the forehead and temples and in the occiput, so sensitive while chewing that he must stop eating. Jerking pains in the head, especially over the right eye. Shootings in the temples; in the vertex. Throbbing in the head morning and evening; in the temples; hammering throbbing, during earnest speaking, or very painful. Single blows through the head. Congestion of blood to the head, and often with flushing heat. Heat in the head, mornings and evenings, with cold feet; great and dry, with glowing redness of the face, mornings, on waking. Humming in the head, especially in the vertex. Ringing rushing towards, and out of, the ears. Striking of the brain upon the skull when moving the head, with pressing pain. With every nod of the head pain as if the brain were struck.
Redness of the eyes the whole day, with great itching in them in the evening. The pupils are greatly contracted. Intolerance of light especially of sun-light. The symptoms connected with sleep have been given somewhat fully, from a conviction that it is often in connection with these that the indications for the use of Sulphur in this fever are found. It is no objection to this view that these symptoms are often met in other and less grave affections. It does not follow from this admitted fact that they may not be also indices of curative relationship in graver affections, when similarity to them obtains in the phenomena of the disease. It will be noted also that there are few moral or intellectual symptoms in those translated above. It is true also that in the class of cases for which Sulphur will be found of the greatest importance, this class of symptoms have few representatives, or are, in some cases, almost in abeyance. The head symptoms are important and quite suggestive of acute inflammation. It is true in many cases of the brain affection we are here considering, the subjective symptoms are more or less completely masked by the paralyzed perceptions of the patient, and that we are deprived to that extent of their aid in our study for the selection of a curative, but where this paralysis is found in connection with other phenomena of cerebral inflammation, these symptoms may be assumed to be more or less present, for the purposes of the prescription, and acted on as if really detected.
A little girl of five years was attacked with the ordinary symptoms of scarlet fever, in the latter part of Nov., 1844. 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 military 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, hard, and somewhat roughened. The throat was moderately swollen, internally and externally, impeding 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 now became more quiet, then fell asleep, had a good night, and in the morning appeared convalescent. She recovered from this time without accident.
It will be noticed there was a marked peculiarity in this case. The patients eyes were wide open, even staring, and yet she seemed to see nothing. She seemed wide awake and yet to hear nothing. She paid no attention to anything said to quiet or comfort her. No one of her senses seemed to recognize objects or relations around her. She did not know she was on the bed all the time she was so anxious to go to it. The whole state was so like that of sleep-waking, or somnambulism, that the resemblance could not fail of being recognized. The relation of Sulphur to this state is disclosed by the followed symptoms: “The night walker gets out of his bed, as if unconscious, saying, 'my head, my head, I am insane;' and seizing upon the forehead. Rises from the bed as if somnambulic, thinks there is a fire, dresses herself, speaks out at the window in alarm, when she hears nothing, but is much debilitated and as if bruised for three days.” The state of waking unconsciousness is here clearly disclosed, and though the expressions or hallucinations are not the same as those manifested by the patient, the general state of the two, it will be seen at once, as to essential particulars, was the same. The truth of this view is confirmed by the prompt recovery of the patient after taking the drug. Other similar cases have been relieved with the same promptness and completeness by the use of Sulphur.
This case, in connection with the above symptoms, gives opportunity for the remark that it is not the literal similarity of the pathogenetic record and the expressions of patients which the law of cure contemplates or requires, but a likeness of the essential nature of the symptoms as disclosed to the perception of the provers and patients, and the observations of others who may be capable of judging the objective phenomena presented.
Stramonium. In many of its pathogenetic elements this drug stands in relation to Belladonna, much as China does to Arsenicum. The similarity of their symptoms, though great: often finds the difference which negatives identity in the degree of their intensity, Stramonium, in this comparison, representing the minor quantity. Each of these remedies of course, presents numerous other elements distinctly characteristic of each, concerning which no question will arise as to the selection of either, when their counterparts are met in examinations of the sick; while, in relation to those which are similar, the practitioner will often find himself thrown upon this quantitative difference, as his chief guide in, exact prescribing. In the group of these similar elements where we meet the greatest resemblance, and where we are oftenest compelled to rely on this difference of degree of intensity, we find many of the symptoms by which these drugs are relate to scarlet fever. This will fully appear when we come to present the symptoms of Stramonium. Before proceeding to this, we wish to call especial attention to this remedy in its relation to this fever. Its importance here has not always been fully appreciated. It is not too much to say that as the disease is met at this day, and in this locality, it is as often called for by the law of similars as Belladonna, perhaps oftener. And further, as to these two relatives, it is not enough for good practice, to follow the one with the other, if that first given fails to produce the desired result. This will too often end in fatal consequences, for one of two reasons. If the one be appropriate the other is not, for though similar they are not identical. Nor, indeed, are they similar, but often quite different, in those elements which decide the choice of a remedy according to the law of cure. If, then, by mistake or neglect, that is given which is not similar in these elements, and therefore not appropriate to the case, it is not a mere negative proceeding, leaving the case after the action of the drug, (which cannot be curative for lack of the requisite similarity,) where it was when this wrong selection was made.
The action of drugs on the living organism is a positive action, never a mere negative one. If not in the curative direction, and it can never be if the similarity of its characteristic effects to the characteristic phenomena of the disease be wanting, it must be in some other, and that of necessity more or less an opposite one, and therefore hurtful. The extent of this pernicious action will be conditioned by the susceptibility of the patient, and the quantity and repetition of the doses of the drug. The first clement of this condition will vary much in different diseases and in different examples of the same diseases. This difference is determined by, and is the result of, that newly created susceptibility to drug action which ever arises with the first results of the action of the morbid cause. It is this susceptibility which has necessitated the reduction of doses of drugs adapted to the removal of these results, till that which the most enlightened experience has discovered to be productive of the maximum of good, is found to be so small that the faith of many is still unable to receive the truth. If the action of the drug selected happens to be in the opposite direction of that which is curative (i. e. antipathic), as is not unfrequently the case in the selection of Belladonna in scarlet fever, where this increased susceptibility is great, the morbid action cannot fail of being intensified, and the result will be, as it has often been, fatal.
It can hardly be necessary to say that the second condition - the magnitude and repetition of doses of inappropriate drugs - is mischievous in the direct ratio of these elements. And yet it is first in the memory of all who have had much experience in treating grave affections like the fever under consideration, especially of those who have been much sought as counseling advisers in such cases, that too often there has been sad evidence of the hope, that it might be possible, if large enough quantities of even a wrongly selected drug could be given, and often enough repeated, this would at last, in some unknown way, work out the results which can only follow the use of that which is strictly similar. And that not unfrequently, this use of that which is similar, being resorted to in doubt of its true character, as in ignorance of the importance of this fact, has been followed by consequences scarcely less sad. .
The other reason of fatal consequences, from the error we have discussed, is the loss of time given to the development of the disappointment which must result from the use of wrong remedies. In diseases of slower progress in destructive processes, this loss may sometimes be repaired, or even be of no very great detriment, but the case is quite different where the advance, from initiation of morbid action to complete destruction of life, is so rapid as is often witnessed in this fever. Here, if there is to be any success of treatment, it must come from first efforts, for there is often no time allowed in which to remedy the mischiefs of a first mistake. Even if there be no added intensity to the diseased activities from the effects of wrong remedies, or, which is nearly as bad, from the wrong use of those which are right, the rapid exhaustion of the vital forces by the morbid poison is so great, that the whole sum of them are soon brought below that point below which curative responses to the action of any remedy are impossible. There cannot therefore be too great caution in deciding between the claims of two remedies where the similarities are so great as in the case of Bell. and Stram., in cases where a mistake may be followed by so sad results, and which there can be so little opportunity to repair.
Violent convulsions of the limbs; convulsions in bed, of the severest kind, so violent that he must be restrained; frightful convulsions at the sight or bright, shining things, as light, a mirror, or the surface of water; convulsions with delirium, especially excited by being touched; convulsions first of the left arm, then of the right leg, then very quick of the head; violent, of the muscles of the lower jaw, lips, of the left arm and right leg; shock-like jerkings, of the left leg especially, which is drawn up towards the body; spasmodic jerkings of the limbs; slow contractions and extensions of the limbs in paroxysms.
[Paralytic trembling of the arms and hands, especially of the right, with which he constantly reaches into the air, and attempts to grasp some imaginary object; at the same time the power to direct the hand to the desired point, at will, was sensibly Impaired.]
Restlessness, [with itching of the skin; great restlessness with moaning; throwing up the arms and legs, but most with the arms, with opening and shutting of the hands and many motions of the fingers; tossing about in the bed; in spells of restlessness he would drink, when it was offered him but he did not ask for it.]-Williamson.
Red miliary rash on the chest and back, paler in the morning, in the evening more abundant and deeper red, made more apparent by warmth, followed by exfoliation of the skin. Many small, shining, star shaped petechiae on the face, neck and chest.
[Face and breast of a coppery red color, somewhat mottled, similar to the color of a North American Indian, the sclerotic coat of the eye of a pink color. Eruption visible on the left knee, not on the right. An old cicatrix on the forehead was very red. The alae nasi and space round the mouth and a spot on each temple were white. Restlessness with itching of the skin (case of poisoning by W. Williamson, M.D.) Face covered with patches of an irregular shape, not elevated above the rest of the skin, of a fiery red color (“Case of Poisoning,” by Carroll Dunham, M.D.) Face became of a deeper scarlet than is ever seen in scarlet fever, and the neck and throat, as well as the face, were covered with a multitude of small spots of a brilliant red color, many of which were star shaped (Dr. Meigs). The skin of the body except the bead was reddened dry and hot. Frank's Magazine.] — American Homoeopathic Review, Vol. IV, p. 556, et seq.
The skin of the whole body covered with a smooth, red eruption, which was dry and burning hot, so like the characteristic eruption of scarlet fever, that no difference could be perceived. It was in broad patches, with small interspaces, accompanied by much itching. [ Case of poisoning observed by myself.]
Quiet sleep, especially after the convulsions; constant, deep sleep, also with snoring and occasional drawing up of the legs, or with very deep inspirations, drawn with great effort. Coma, with rattling respiration, bloody froth at the mouth, and dark -brown face. Restless sleep at night. Wakes. with screaming and howling. In sleep, lies on the back, with open, staring eyes.
Great heat of the skin, towards noon, with redness of the face, vertigo, and lachrymation; with small, quick pulse, and cinnabar redness of the face; with talking in sleep. Pulse small, quick, rapid and irregular, or finally, hardly perceptible; strong and full; hard and full. Perspiration with great thirst; cold over the whole body.
Great angry irritability; strikes those around him, with tearful outcries; great desire to bite, and to tear everything, even his own limbs with his teeth; rapid alternations of laughing, crying and singing.
Stupidity; sees nothing, does not know his own relatives, grasps about with the hand, and stamps with the foot; he recognizes nothing about him, takes his book to go to school, but thoughtlessly takes the wrong door, hears speaking in his stupefying slumber but understands nothing; surrounding objects appear very small to him, whilst he himself seems, large and noble; he believes he sees many persons, and, grasps at them; frightful illusions, with shrinking or expression of terror in his countenance; thinks he sees spirits; imagines a dog is about to attack him; screams because of dogs, cats and rabbits which approach him from all sides; many terrifying phantasms which appear more to one side than directly in front of him; loquacious delirium; mild delirium; timid or terrified delirium; muttering; screaming; till he is hoarse and loses his voice; terrified raving; very loquacious raving; springs out of the bed at night and, screams that the disease will burst out at his head; starts up in great anguish and with violence, screams that she, shall fall, clings to her mother despairingly, then whistles, points to flying gnats which she endeavors to seize; laughs, and whimpers; loss of recollection, with internal restlessness.
Dullness of the head; difficulty of thinking; sensation of weakness and unpleasant lightness in the head; [quite characteristic] deafening (betaubung) of the head with clouded sight beclouding of all the senses; insensibility to external impressions; loss of the sense of feeling; after beclouding of all the senses, an eruption of a red rash on the back, with perspiration; vertigo, with redness of the face; vertigo with constant drawing backwards of the head and great drowsiness. Heaviness of the head. Pains in the head of the severest kind; with pains in the eyes; dizzy headache with fainting and thirst; squeezing headache; throbbing headache, also especially in the vertex, with attacks of fainting, or in the night coupled with diarrhea; congestion of blood to the head; heat in the head with sparkling eyes; convulsions of the head, (and of the arms,) also with hiccough, especially in the morning; spasmodic drawing of the head, also with snoring and grinding of the teeth, and convulsed eyes, or with screams and throwing the arms over the head; frequent raising of the head from the bed.
Swelling of the eyes, also distortion of the eyeballs and dilated pupils; lachrymation of only the left or right eye, or of both with cloudy sight, great sensibility· to light which causes tears to flow; eyes are closed, only opened when spoken to; sparkling eyes; staring eyes, also with aspect as if drowsy; eyes dull and cloudy; paralysis of the upper eyelid; pupils dilated; also from the outset, or with cloudy sight; pupils dilated and immovable; pupils contracted, even in the dark they are hardly at all dilated; entire loss of sight and hearing, or sees and hears very badly.
Redness of the face, also purple colored, with staring of the eyes; with very red cheeks and lips; trembling of the lips as well as of the hands and feet; dryness of the lips as well as of the tongue.
The mouth as if raw over the whole inner surface; great dryness or the mouth, which does not allow the swallowing of a bit of bread, it tastes also like straw; the dryness extends to the throat, and compels frequent drinking and moistening of the mouth; tongue very dry; dry and rough, as is also the palate; hot and dry as also the throat; swelling of the tongue so that it hangs from the mouth; paralysis of the tongue with trembling while protruding it; organs of speech as if paralyzed; stutters without being able to utter a single word; constant mutterings.
As in the case of the symptoms of Belladonna, many of these of Stramonium, so far as they disclose affection of the brain, are indicative of inflammation or of its results. Mixed with these are others of a different nature, and this mixed character of the symptoms of Stramonium, is one of the first and important facts, which arrests the attention of the student of its action on the living economy. There is in this, with the inflammatory phenomena, another class which indicates that the drug has seized on the nerve fibre itself, modifying its functions in a very remarkable manner. There is a peculiar excitability and mobility of the nerve system disclosed, by the character of the convulsions, trembling, restlessness, etc., which is worthy of careful study, the like of which is found in no other drug. It is to a great extent in these extra inflammatory symptoms that the distinguishing differences between this drug and Bell. are to be learned. We have said they are peculiar, we know no better word by which to characterize them. They are evidently not inflammatory, they are very distinct from torpor, they are not paralytic, though they partake more of this character, and tend more to this state than do the corresponding symptoms of Bell. They seem to consist essentially in an erethism of the nerve fibre itself, which rapidly exhausts its functional susceptibility, and soon ends in its entire suspension, if the dose be large, or its action be not soon interrupted by the use of appropriate means. The symptoms of the skin, sleep and fever are such as are commonly met in scarlet fever; those of the skin, especially, are a more complete picture of the eruptive feature of the disease than is found in the pathogenesis of any other drug; while those of the disposition, intelligence, head, etc., disclose distinctly an inflammatory state of the brain analogous to important elements in the pathology of the fever we have so often to combat. The inflammatory symptoms of the head affections, are less marked and demonstrative than the corresponding symptoms of Bell. Though similar in kind they are less in degree. This, with the mixed symptoms of erethism already mentioned, will be quite sufficient guides to a right selection of Stram. in the treatment of this formidable malady. The importance of being able to decide at once and with certainty on that one of these which is especially appropriate to a given case, can hardly be over-estimated. The difficulty lies in the similarity of the general affections they produce. This is removed by a knowledge of the specific symptoms which accompany these, and which differ very greatly. To exhibit as plainly as possible this similarity and this difference, and thus to secure our practice as far as possible, from the frequent error of giving the one where the other is required by the law of similars, has been judged of sufficient importance to warrant a repetition of the symptoms of these drugs in parallel opposed columns. It is believed a study of them in this relation will fully justify the view taken of the nature of the symptoms of each, and make the discrimination of their differences comparatively easy, and that there are sufficient considerations to warrant the appropriation of the space on our pages which the repetition of symptoms will require. In making this comparative study, let it be remembered here as ever, that while it is the similarity of the symptoms of the drug to those of the disease which constitutes the one as curative of the other, it is just the opposite of this, as between the choice of two similar drugs for the cure of a given case. It depends wholly on the greater similarity of those elements in which they differ, to the symptoms of the disease, to decide which is the true curative.
Convulsions with outcries and loss of consciousness; with delirium; with distortion of the eyes, and contraction especially of the flexor muscles; with jerkings, especially of the hands and feet, loss of touch, and loose rattling of mucus in the bronchi. Rigidity, with bending of the body and head backwards or to the left side; rigidity or immobility of all, or of only a single limb, sometimes with loss of sensation, distended superficial veins, red and turgid face, full, quick pulse and copious sweating.
Skin. Scarlet spots and scarlet redness especially on the face, throat, chest abdomen and hands, with acute swelling of the parts; sometimes with rapid, small pulse, tightness of the chest, violent cough, delirium, increased activity of memory, rubbing of the nose and distended pupils. Erysipelatous inflammations, also with swelling, or even with gangrene of the parts. Redness, inflammation and swelling of the entire skin of the body.
Sleep Coma. Stupefying coma, like lethargy, with deep sleep and snoring respiration, lying motionless, occasionally opening the eyes with wild look, or jerking of the tendons, pale, cold face, cold hands, and hard, small pulse. Wakes with a start and fright, especially on going to sleep, sometimes with sweat on the forehead and epigastrium, and fear as if something under the bed made a noise. Restless and tossing.
Fever. Dry, burning heat; internal or external heat or both at the same time. During the heat, delirium and redness of the face. Pulse strong and rapid; or small and quick. Perspiration, cold on the forehead; bursting out suddenly; in bed, of the whole body, from the slightest covering, also only on the parts covered, evening and morning; stains the linen dark color; during the sleep, also in the day time.
Disposition. Unwillingness to speak. Indifference. Apathy, on which nothing makes an impression. Answers only with anger and outcries. Increased susceptibility of all the senses; all impressions on these are too strong. Howling and outcries for the merest trifles, increased by being spoken to.
Intelligence. Intelligence, with convulsions, especially of the arms. Loss of consciousness. Stupidity. Insensibility, as if in a dream, also in the evening in bed. He neither sees nor hears. He recognizes no one, even his relatives, especially by the sense of hearing. He does not know whether he sleeps or wakes. Illusions of the senses and imaginations. Delirium, especially at night; with a staring look; murmuring delirium. Vertigo, with trembling of the hands; with dullness of the senses; with nausea.
Head. Heaviness of the head; in the forehead, especially over the eyes, with pain in them when touched, and difficulty of opening, especially in the morning on waking; pressing heaviness in the occiput, or towards the temples, with diminished hearing; heaviness like drunkenness, with vertigo. Outward pressure in the head, with sensation of bursting, especially in the forehead, as if all would come out forwards. Tearing in the head, especially in the forehead over the eyes; on the vertex, worse on motion and while pressing on the head, with sensation of thinness of the skull. Shootings to the temples outwards, or in the temples. Pressing shootings in the temples, or to all sides of the brain. Cutting shootings, as it with knives, especially in the evenings, in the whole head or only in the occiput. Shootings from one temple to the other. Throbbing in the whole head, after pressing cutting. Pressing throbbing in the occiput. Strong pulsation of the arteries of the head, especially of the forehead and temples, or with sensation in the bones of the forehead as it they were raised up, or in the morning after waking, with pulsation in the whole body. Heat in the head. Painful sensibility of the hairy scalp to the slightest touch, even of the hair. Convulsive shaking and bending backwards of the head.
Eyes. Red, injected conjunctiva, also with shootings and tears. Spasms of the eyelids. Eyes open wide. Eyes prominent. Immovable, sparkling, brilliant. Distorted or in convulsive motion. Glassy. Red. Great sensibility to light, with spasmodic turning of the eyes from the light. Pupils contracted, or much dilated and immovable.
Face. Burning heat and redness, especially of the cheeks, as if after drinking wine, with congestion of blood to the head, or with violent headache and ice cold extremities. Red, scarlet spots on the face, also with strong pulse. Convulsions of the lips. Distortion of the mouth. Lips dark red and dry.
Mouth. Great dryness of the mouth, extending to the throat and nose, the larynx as if constricted, hindering swallowing, also with or without thirst. Bloody froth at the mouth, with grinding of the teeth and shaking of the head. Mouths of the salivary ducts excoriated, as if it corroded. Sticky slime in the mouth, for the most part with sensation of dryness. Foul smell from the mouth, as it from disordered stomach. Tongue cracked, red, hot and dry. Papillae bright red, inflamed and swollen. Trembling of the tongue. Heaviness of the tongue. Paralytic weakness of the organs of the voice. Difficult and stammering speech, also like that of drunkenness with full consciousness and dilated pupils. Nasal speech. Loss of speech.
Throat. As if raw and excoriated especially when swallowing, touched with the tongue, or chewing. Burning in the throat and fauces, especially when swallowing food or drink. Shootings and pain as if swollen, only when swallowing, turning the neck or feeling of the throat. Inflammation, swelling and redness of the throat and fauces, palate, uvula and tonsils. — Swallowing painful, difficult or entirely prevented, even of fluids, which return through the nose. Impossibility of swallowing, with aversion to swallowing liquids, even to madness.
Violent convulsions of the limbs, - in bed, of the severest kind, so violent that he must be restrained; frightful convulsions at the sight of bright shining things, as light, a mirror, or the surface of water; with delirium, especially excited by being touched; first of the left arm, then of the right leg, then very quick of the head; violent, of the muscles of the lower jaw, lips, of the left arm and right leg; shock-like jerkings, especially of the left leg, which is drawn up towards the body; spasmodic jerkings of the limbs, slow flexion and extension of the limbs, in paroxysms.
Paralytic trembling of the arms and hands, especially of the right, with which he constantly reaches into the air, and attempts to grasp some imaginary object, at the same time the power to direct the hand to the desired point was sensibly impaired.
Restlessness [with itching of the skin; with moaning; throwing of the arms and legs, but most of the arms, with opening and shutting of the hands, and many motions of the fingers; tossing about in bed in spells of restlessness; he would drink, when it was offered him, but he did not ask for it.] Williamson.
Skin. Red, miliary rash, on the chest and back, paler in the morning, in the evening more abundant and deeper red, made more apparent by warmth, followed by exfoliation of the skin. Many small star shaped petechiae on the face, neck and chest.
[Face and breast of a coppery red color, somewhat mottled, the sclerotic coat of the eye of a pink color. Eruption visible on the left knee, not on the right. An old cicatrix on the forehead was very red. The alae nasi and space round the mouth and a spot on each temple were white. Face became of a deeper scarlet than is ever seen in scarlet fever, and the neck and throat as well as the face were covered with a multitude of small spots of a brilliant red color, many of which were star shaped. The skin of the body except the head was reddened, hot, and dry. The skin of the whole body covered with a smooth red eruption, which was dry and burning hot, in broad patches, with small interspaces and much itching.]
Sleep. Quiet sleep, especially after the convulsions; constant, deep sleep, also with snoring and unusual drawing up of the legs or with very deep inspirations, drawn with deep effort. - Coma, with rattling respiration, bloody froth at the mouth, and dark brown face. Restless sleep at night. Wakes with snoring and howling. In sleep, lies on the back, with open staring eyes.
Fever. Great heat of the skin towards noon, with redness of the face, vertigo, and lachrymation; with small quick pulse and cinnabar redness of the face; with talking in sleep Pulse small, quick, rapid and irregular, or finally, hardly perceptible; strong and full; hard and full. Perspiration with great thirst; cold, over the whole body.
Disposition. Great anger and irritability; strikes around him, with fearful outcries; great desire to bite and tear everything, even his own limbs, with his teeth; rapid alternations of laughing, crying and singing.
Intelligence. Stupidity; sees nothing, does not know his relations, grasps about with his hand and stamps with the foot; he recognizes nothing about him; hears speaking in his stupefying slumber but understands nothing; surrounding objects appear very small to him, while he himself seems large and noble; he believes he sees many persons and grasps at them; frightful illusions, with shrinking or expression of terror in his countenance; thinks he sees spirits; imagines a dog is about to attack him; screams because of dogs, cats and rabbits which approach him from all sides. Many terrifying phantoms, which appear more to one side than directly in front of him; loquacious delirium; wild delirium; timid or terrified delirium; muttering; screaming till he is hoarse and loses his voice; terrified ravings; springs out of bed at night, and screams that his disease will burst out at his head; starts up in great anguish, and with violence screams that she shall fall, clings to her mother despairingly, then whistles points to flying gnats; which she endeavors to seize; laughs loud and whimpers; loss of recollection with internal restlessness
Head. Dullness of the head; difficulty of thinking, sensation of weakness and unpleasant lightness in the head. Deafening of the head with clouded light; beclouding of all the senses; insensibility to external impressions; loss of the sense of feeling; after beclouding of all the senses, an eruption of red rash on the back, with perspiration. Vertigo with redness of the face; vertigo with constant drawing backwards of the head and great drowsiness. Heaviness of the head. Pains in the head of the Severest kind; with pains in the eyes; dizzy headache with fainting and thirst; squeezing headache; throbbing headache, also especially in the vertex, with attacks of fainting, or in the right temple and with diarrhea. Congestion of blood to the head; heat in the head with sparkling of the eyes. Convulsions of the head (and of the arms), also with hiccough, especially in the morning. Spasmodic drawing of the head, also with snoring and grinding of the teeth, and convulsed eyes, or with screams and throwing of the arms over the head. Frequent raising of the head from the bed.
Eyes. Swelling of the eyes, also distortion of the eyeballs and dilated pupils. Lachrymation of only the left or right eye, or of both with cloudy sight. Great sensibility to light which causes tears to flow. The eyes are closed only opened when spoken to. Sparkling eyes. Staring eyes, also with aspect as it drowsy. Eyes dull and cloudy. Paralysis of the upper eyelids. Pupils dilated, also from the outset or with cloudy light. Pupils dilated and immovable. Pupils contracted, even in the dark they are hardly at all dilated. Entire loss of eight and hearing or sees and hears very badly.
Face. Redness of the face, also purple colored, with staring of the eyes; with very red cheeks and lips. Trembling of the lips as well as of the hands and feet. Dryness of the lips as well as of the tongue.
Mouth. The mouth as it raw over the whole inner surface. Great dryness of the mouth, which does not allow the swallowing of a bit of bread, it tastes like straw. The dryness extends to the throat, and compels frequent drinking and moistening of the mouth. Tongue very dry. It is dry and rough as is also the throat. Swelling of the tongue so that it hangs from the mouth. Paralysis of the tongue with trembling while protruding it. The organs of speech as it paralyzed, he stutters without being able to utter a single word. Constant muttering.
We have already called attention to this remedy in speaking of the treatment of the torpid variety of the disease before us. In recurring to it here, our object is to point out more particularly the indications for its use. It is worthy of remark, that though in general, 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. The swellings to which the two are related are also quite unlike. Bell. belongs to those of the glands, with the phenomena of acute or of the acutest inflammation; while that of Lachesis is of the cellular tissue, threatening suppuration or gangrene, the whole tone of the general phenomena being of a lower grade than that which is so characteristic of its relative. This is notably true of those about the throat. It is of the utmost importance to distinguish these differences in practice, and to select the remedy appropriate to the given case in the first instance, for if we fail to do so then, it is more than likely we shall have little opportunity to amend this mistake. If the process of destruction now set up, of which we are so plainly warned by these accidents, be not met and conquered at the outset by the administration of the appropriate remedy, the case will soon pass beyond the reach of help from any, however judicious may be the selection, later in the history of the case. Of the variety of the fever characterized by these swellings
We shall speak more particularly hereafter. It is only alluded to here for the purpose of illustrating the contrast between the action of these drugs, which we wish to present in a manner to elucidate, as far as possible, the place of each in the treatment of this formidable disease. It will be seen at once, we think on only a cursory glance at their pathogenesis, that they here belong to opposite conditions, and can never be substitutes for, nor alternates of, each other. The nearest to this which can occur is, that Lachesis may rightly follow Bell. if from the use of this we have failed of curative action, where it seemed appropriate, and the case has progressed, notwithstanding its use, to that lower plain of action which we have pointed out as indicative of the condition which calls for the use of Lachesis.
In the treatment of that variety of the fever characterized by acute inflammatory action in the brain, it must be apparent from what has been said, that Lachesis is not likely to find an extended use. It will not be difficult, however, to place its proper sphere in that class of cases where the symptoms indicate a low grade of inflammatory action, and where fatal issue is not so much to be feared from inflammation and its consequences, as from exhaustion of the vital forces from the direct action of the morbid poison upon them. In its relation to the inflammatory cerebral variety its place seems to be below that of Stram., Hyos., Sulph., and Rhus. The moral symptoms are scarcely at all like those of acute cerebral inflammation, and the intellectual, but slightly so. Inability to think acutely and continuously. Great weakness of the memory, listening is very difficult, the words spoken seem immediately to be wiped away. Entirely without memory, he neither hears nor understands what others say, though he can still think correctly. These are all. The symptoms of the head are something more positive. The pains of the head are deep within, and are aggravated by external pressure. Or they are dull in the forehead, or whole head, with nausea, in the afternoon. Heaviness of the head in the occiput, forehead, or deep in the centre of the head, with vertigo, mornings, on waking. Pressing pain in the head, with nausea or with drowsiness; or under the whole skull, as if from taking cold, or with nausea alternating with heat, and much increased by stooping. It is great in the morning with strong congestion to the head. Constriction of the head over the ears, with pressure to these, under both temples. The tensive pains in the head are relieved by external pressure, and are sometimes accompanied by whizzings and rushings (sausen) and sensation of heat in the head. Shootings in the vertex (scheitel), also from the eyes to the vertex, or in the temples, or in the whole head, as if from knives, with, stiffness of the neck. Throbbing pain, with beating from every motion, causing nausea, and efforts to vomit, with painful boring in the vertex. Great congestion of the head. Heat of the head.
These are symptoms which may be met in cases of cerebral inflammation, and these will most certainly find their curative in Lachesis. It sometimes happens however, in these cases, that the head symptoms are not very definitely expressed, or are masked by the general condition of the patient, as of insensibility, or by the violence of other symptoms, as convulsions. This is not an uncommon experience in the cerebral inflammations of scarlet fever. The remedy is then to be found from a study of other and more general symptoms, less obscured by these accidents; being controlled in all cases by the resemblance of characteristic symptoms, and never by the fact that this or that remedy has cured other cases, which we believed to have been like that under treatment. It will be seen, most likely, on a careful study of the case of the variety of the fever under consideration, that where Lachesis is in place, the inflammatory state is one approaching, by its low grade, to a condition of torpor, if it does not really present positive symptoms of this state.
|The American Homoeopathic Review Vol. 04 No. 07, 1864, pages 289-298, pages 348-359, pages 398-410, pages 443-446
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