Arum Triphyllum

The so-called " Jack in the pulpit " is the first drug in the order for our consideration. This remedy has an interesting history. Some twenty-five years ago there appeared an epidemic of scarlet fever, in the course of which nearly every case that was not promptly cured in the beginning died. The percentage of losses under homoeopathic as well as under other systems of treatment was truly frightful.

The reason for this was that we had no remedy which covered the symp- toms of the epidemic. In a poor family, living in a small street, there

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were five children sick with this epidemic form of scarlatina. The physician who was called to attend them had lost so many cases under the usual remedies that he thought it useless to have recourse to these. He thought it better to try something new. Arum trip hy Hum had only been experimented with to a certain degree, but still it had been known to produce certain symptoms which led him to the selec- tion of the drug, which he administered in a low potency.

All the cases recovered. It was afterward prescribed in other cases during the same epidemic, with marked success. From that time to this, Arum triphyllum has been looked upon as a valuable drug in the treat- ment of diphtheria, malignant forms of scarlet fever, and also other fevers having a typhoid form.

In scarlatina, we may use Arum triphyllum when there is an ex- coriating discharge from the nose and mouth, making the nose and upper lip raw and sore. The tongue swells; its papillae are large and red, giving it a rough feeling comparable to a cat's tongue. The throat is very sore, and the tonsils are much swollen. There is often a dry cough which hurts the child so much that he cringes under it and involuntarily puts the hands to the throat as if to modify the pain.

The discharge from the mouth, also, makes the lips and surrounding parts of the face sore, cracked and bleeding, even the saliva itself be- ing very acrid; scabs form; the child will not open his mouth. He is excitable and irritable in mind as well as in body. Thus, you see that Arum triphyllum is an exceedingly irritating drug. The child is restless, tosses about, is cross and sleepless at night.

The eruption may come out very well and there may be double desquamation. At other times the rash is dark and imperfectly developed; the child picks and bores its fingers into its nose, or nervously picks at one spot till it bleeds. In mild cases, the urine may be very profuse; in severe cases the urine is greatly diminished and the appearance of profuse urina- tion is a sign that the remedy is acting well. In very bad cases, how- ever, those in which the malignancy shows itself in both the internal and external symptoms, you will find a perfect picture of uraemia.

The child tosses about the bed unconscious, and has this involuntary picking at one spot or boring the finger into the nose; the urine is completely suppressed. The brain is very much irritated, as shown by the restless tossing about and the boring of the head into the pil- low. In such a case, Arum triphyllum may save the patient, although, at the best, the case is an exceedingly doubtful one.

2IO A CUNICAI, MATERIA MKDICA.

I have never seen inflammation of the brain yield to Arum tri- phyllum, unless some of these symptoms were present; either irritation about the throat, mouth, or nose, or else this peculiar picking or bor- ing at the nose or at one spot till it bleeds. I think that as a rule it is indicated when the cerebral inflammation comes from the suppression of some violently acting poison, such as we find present in scarlatina or diphtheria. Nor would I think of giving Arum in uraemia if it arose in the course of ordinary Bright's disease. I do not think it can be the remedy unless the symptoms already referred to are present.

Arum triphyllum has a marked effect upon the larynx. It pro- duces a hoarseness which is characterized by a lack of control over the vocal cords. If the speaker attempts to raise his voice it suddenly goes up with a squeak. With this symptom you may use Arum in clergyman's sore throat, whether this affection be the result of over- straining the voice or of cold.

Possibly the remedy most similar to it in this hoarseness and un- certainty of voice is Graphites, which is excellent for singers who can- not control their vocal cords, and who develop hoarseness and cracked voice as soon as they begin to sing.

In Carbo veg. the voice is deep, failing when the endeavor is made to raise it.

Another remedy for this condition is Selenium. The patient gets hoarse as soon as he begins to sing.

Other remedies for the effects of increase of the voice are Arnica, Rhus tox., Causticum, Phosphorus and Natrum muriaticum.

Now let us study for a few moments the analogues of Arum tri- phyllum. First of all we shall consider Nitric acid.

This was formerly the only remedy we had for scarlatina maligna. It has the excoriating discharge from the nose. No remedy has it more marked, not even Arum. The discharge from the nose makes the nostrils and lips sore.

This is attended by great prostration. The throat is extremely sore and is covered with membrane of a diphther- itic character, either dark and offensive, or else yellowish-white. The mouth (whether the disease be diphtheria or scarlatina) is studded with ulcers, which appear principally on the inside of the cheeks, on the lips and on the borders of the tongue. This ulceration is accom- panied by salivation, the saliva usually being watery and very acrid.

The pulse frequently intermits every third or fifth beat, a very bad symptom. Nitric acid is also preferable to any of the other remedies

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in diphtheria with these excoriating discharges when the disease ad- vances and affects the stomach (whether or not the membrane in these cases spreads to the stomach, I cannot say); when, with great prostra- tion and membrane in the throat and nose, there is distress and uneasi- ness referred to the stomach, with total rejection of all food.

Muriatic acid is another remedy in these malignant cases of scar- latina and diphtheria. Under this remedy there is the most intense prostration. The patient seems to have scarcely life enough to move. He is worse at about ten or eleven o'clock in the morning.

The mouth is studded with deep ulcers having a dark or black base. They tend to perforate the parts on which they are situated. Muriatic acid frequently has the intermittent pulse of Nitric acid, but accom- panying this symptom there are involuntary stool and urine.

In addition to Nitric acid and Muriatic acid in cases having this dangerous group of symptoms you should think of Alcohol. Grauvogl, you may remember, found that diphtheritic membrane was dissolved and its growths destroyed by several substances, one of them being Alcohol. So this agent has become a remedy for diphtheria. Alcohol in the form of brandy and water tends not only to destroy the growth, but also aids in counteracting the terrible prostration.

Lycopodium is similar to Arum trip hy Hum in scarlatina and in diph- theria. It has a similar nasal discharge, usually associated, however, with dull, throbbing headache at the root of the nose or over the eyes. The nose is so stuffed up that the child cannot breathe at night. The patient bores and picks at the nose just as under Arum triphyllum.

But in the Lycopodium case the diphtheritic deposit travels from the right to the left side. The patient is always worse from sleep even after a short nap. He suddenly awakens from sleep, crying out as if frightened; nothing can be done to pacify him. He is irritable and peevish.

In more advanced cases calling for Lycopodium, you will find the child unconscious and in a deep sleep. The lower jaw drops, the urine is scanty or even suppressed, and what does pass stains the bedding or clothing red and deposits a red sand. The breathing is rapid, rattling, with waving of the alse nasi and snoring. The mu- cous membrane of the throat is ulcerated and oedematous.

Hvery symptom points to impending paralysis of the brain.

Ammonium causticum was first suggested by Dr. J. P. Dake as a remedy in diphtheria appearing in the nasal cavities, with a burning, excoriating discharge from the nose, and great prostration. The

212 A CLINICAL MATERIA MKDICA.

symptoms above mentioned led Dr. Dake to use the remedy in an epidemic which appeared in Nashville, Tennessee.

I^astly, let me mention Ailanthus. This drug is a member of the order of Simarubacecz. It is analogous to Quassia, Cedron, Brucia, etc., all of which are of bitter taste and have anti-malarial properties. Its history is as follows: Dr.

P. P. Wells, of Brooklyn, had two cases of poisoning in children. From his statement of the symptoms, it would certainly seem that he had to treat malignant cases of scarlatina; but there being no such epidemic about at that time, he looked for other causes, and found that the little patients had been chewing the blos- soms of the Ailanthus.

This told him at once that the Ailanthus would probably become a remedy in scarlatina. He made provings of the drug, and found that they fully confirmed what he had already learned from these poisoning cases. Since then this remedy has been successfully used many times. A year ago I attended a boy with scarlatina.

The child lay in a stupor with his mouth wide open. The throat was swollen, the nose stuffed up, and the slight rash that had appeared on the body was dark and mixed with bluish spots. I gave Lycopodium, without any benefit whatever. The child grew worse instead of better.

I then thought of Ailanthus, and gave it in the sixth potency, with the result that the child was completely cured. I believe the patient would have died had it not been for the Ailan- thus.

Ailanthus resembles Arum triphyllum in the acridity of the dis- charges. There are excoriating discharges from the mouth and nose, making the lips sore. We find a similar swelling of the throat, both inside and outside. So far as these superficial symptoms are con- cerned, the remedies are identical.

But there is a great difference to be recognized in the other symptoms. The A ilanthus patient becomes drowsy and lies in a stupor, hence this drug is indicated when there is torpidity rather than the restless tossing about of Arum triphyllum.

The Ailanthus rash comes out imperfectly; it is dark red or bluish, and is mixed with petechise.

Some little time ago, several members of the class asked me to speak of the remedies useful in diphtheria, and while I am on the sub- ject of Aru?n and its analogues in this affection, I shall take the op- portunity to comply with that request.

Baptisia tinctoria has long enjoyed a great reputation in typhoid fever. It has lately been used in diphtheria, and in scarlatina also

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when the child is very much prostrated and lies in a half-stupid state, almost like one intoxicated. The face is dark-red, and has a besotted look, and the discharges from the mouth and nose are horribly offen- sive, so much so, indeed, that one might suppose that gangrene of the affected parts had taken place.

Rhus tox. we find indicated in rather severe cases, when the mem- brane is dark in color and bloody saliva runs out of the mouth during sleep. These symptoms are associated with inflammation of the glands about the neck, of a dark erysipelatous hue.

Phytolacca decandra we find useful when, in the beginning of the disease, there are creepy chills and backache. The patient is weak, and feels faint when he sits up in bed. On looking into the throat you find it dark-red, almost purple. There is great burning in the throat, with aggravation from hot drinks.

Amygdala amara is indicated when there are sharp, lancinating pains in the swollen tonsils. The palate and fauces have a dark-red hue, and the patient is very much prostrated.

Naja tripudians is to be administered when there is impending par- alysis of the heart. The patient is blue. He awakens from sleep gasping. The pulse is intermittent and thready. Dr. Preston, of Norristown, has been very successful with Naja when the symptoms I have mentioned were present.

Apis mellifica is indicated in diphtheria, when, from the very be- ginning, the child is greatly prostrated. He is feverish and drowsy at 3 p. m. The pulse ranges from 130 to 140, and is very weak. At first the throat has a varnished appearance as though the tonsils and fauces were coated with a glossy red varnish.

The membrane forms on either tonsil, oftener on the right than on the left, and it is thick like wash-leather. The tongue is often swollen. If the child is old enough to talk to you, he will complain of a sensation of fulness in the throat, necessitating swallowing but making the act very difficult. The uvula, in fact the whole throat, is cedematous and swollen.

The rima glottidis is swollen, red, and cedematous, making breathing diffi- cult. In some of these cases the breath is very foetid, while in others it is not so in the least. In some cases a red rash appears over the body, greatly resembling that of scarlatina. The child is often thirst- less in spite of the presence of fever.

Arsenicum album is called for in rather severe cases of diphtheria, when the throat is very much swollen both internally and externally,

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and the membrane has a dark hue and is very foetid. There is a thin, excoriating discharge from the nose. The throat is ©edematous, just as it is under Apis. The patient is restless, especially after midnight, and is greatly prostrated. The urine is scanty; the bowels are consti- pated, or else there is an offensive, watery diarrhoea.

Natrum arsenicosum is the remedy when the throat is of a dark purplish hue, with great swelling and prostration, but without much pain.

Kali permanganatum is useful when the membrane is horribly offensive. The throat is oedematous, and there is a thin discharge from the nose; the chief characteristic of the drug is this extreme foetor.

Lachesis is called for when the membrane forms first on the left ton- sil and spreads thence to the right. It is to be distinguished from other drugs which act in a similar manner by the fact that the symp- toms are worse from empty swallowing, and are often relieved by eat- ing or swallowing solid food. There is a constant feeling as of a lump on the left side; this descends with each act of deglutition, but returns again. Sometimes, on waking from sleep, there is a feeling as if there were needles in the throat, which create suffocation.

When the tonsils are very much swollen, fluids are apt to return through the nose. The fauces are of a dark purplish color, and there is great prostration. The heart is weak in its action. There is ag- gravation after sleep, and the throat is sensitive to the slightest touch.

Belladonna is not a prominent remedy in diphtheria. When you do give it in this disease, make sure that it is the remedy or you will lose valuable time. It may, however, be the remedy in the early stages when the violence of the attack calls for it, if there is congestion of the head before the membrane has formed.

Other frequently indicated remedies are Kali bichromicam , Iodine, Bromine, Mercurius biniodatus, Mercurins cyanalus, etc. Some of these I have already given you, and the others you will get in future lectures.

Nitric acid. <

Erosion of the mucous membranes, worse where they join the skin.

Offensive discharges.

Ulcers, irregular, exhibiting exuberant granula- tions ; worse from touch, from which they will bleed.

Abuse of mercury.

Typhoid.— Debility.

Catarrh.

Fibrous and osseous tissues.

Nitric acid as a chemical substance need scarcely be explained to you, as you know its properties so well. I therefore pass on to con- sider its use as a medicine. You know its effects on the tissues, stain- ing the skin a dark and yellowish-brown. It is a highly corrosive acid, eating into the flesh. Hence it has been used for the removal of warts, tumors, ulcers and exuberant granulations.

It acts very powerfully on the mucous membranes, and has a par- ticular affinity for the outlets of mucous surfaces where skin and mucous membrane join. Hence you will find its symptoms chiefly about the mouth, lips, nostrils, meatus urinarius and anus ; in fact, wherever skin and mucous membrane come together, there has Nitric acid a prominent action.

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As an illustration, we find it useful in stomacace or ulceration of the mouth. True to the character of the drug, this stomacace will present its most violent symptoms about the lips. There will be blisters and vesicles on and around the lips in connection with the sore mouth. Ptyalism will be present, particularly in cases that have been abused by mercury. So, too, you will find that the diarrhoea is associated with soreness and rawness of the anus.* Even fissures may be present, as I have already said.

The characteristic discharges produced by Nitric acid are offensive, thin and excoriating, and, if purulent, are of a dirty yellowish-green color and not at all laudable.

The ulcers calling for Nitric acid are offensive and characteristically irregular in outline, tending to spread at the peripher)^, but more deeply than those arising from the action of Mercurius, which produces a superficial flat ulcer. These ulcers of Nitric acid are very apt to be filled with profuse exuberant granulations, which bleed readily from the slightest touch. Even the dressing that you apply makes the ulcer bleed. The pains are of a sticking character, as if splinters were stick- ing into the affected parts.

They are often associated with burning pains. The ulcers are worse from the application of cold water. Nitric acid is particularly indicated in syphilitic ulcers after abuse of mercury, and also in those of a scrofulous character after Calcarea has failed.

Another evidence of the offensiveness of the exhalations and secre- tions in Nitric acid is found in the urine, which has a strong odor, very much like that of the horse. It probably contains an excess of hippuric acid. This symptom is most highly developed in Benzoic acid. So characteristic is it in that drug that you will seldom if ever find it absent in the great variety of diseases curable by Be?izoic acid.

The leucorrhcea is acrid, foetid, thin, brown, watery or stringy.

The stools, too, show the putridity of Nitric acid. They are very offensive, and are green in color, and in children contain lumps of casein. They are also slimy from excess of mucus and are associated with much straining; the tenesmus here closely allies it to Mercurms . At other times, particularly in scrofulous children, the stools are pale from deficiency of bile, and pasty and sour as well as offensive.

Nitric acid affects the mucous membranes, producing catarrhs. We find it indicated in coryza, particularly when it is associated with some malignant disease, as scarlatina or diphtheria. Yellow foetid eczema

*Sore excoriated anus: MERC, SULPH., Cham., Arsenic, Puis., Graph., China.

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with ulcers; the Eustachian tubes obstructed. In nasal diphtheria, Nitric acid is one of the chief remedies. The discharge from the nose is watery and very offensive, excoriating every part which it touches; frequent epistaxis. If you examine the nose, you will find that there is a well-developed white deposit therein.

Another symptom, which is a very characteristic symptom, accompanying these conditions, is inter- mittent pulse. If the membrane has descended into the throat, you will have foetid odor from the throat, too. The child will complain of a feel- ing as though there was a splinter there. This is a general characteristic of Nitric acid, a sensation as of a fish-bone, splinter or piece of glass stick- ing into the affected part .

It runs all through the symptomatology of the remedy. You find it in the ulcers, and you find it in the rectum as- sociated with the fistulse and piles, and you find it here in the throat.

Nitric acid is here very similar to its complement, Arum triphyllum, which, like the former, causes excoriating discharge from the nose, making the lips sore; the corners of the mouth crack so that the child cannot open its mouth on account of the soreness.

Another remedy is Muriatic acid, which has thin excoriating dis- charge from the nose, intermittent pulse and loss of appetite.

Another effect of Nitric acid, and one, too, in which it has no su- perior, is its use to remove the bad effects of mercury. The particular symptoms which call for it in this condition are these: irritability, restlessness and mental anxiety. This irritability amounts to cursing and swearing. There are also periosteal pains; ophthalmia; inflamma- tion or ulceration of the cornea, with tendency of the ulcers to perfor- ate; hardness of hearing from catarrh of the middle ear and Eustachian tube; ptyalism; ulcers in the throat; caries of bones, particularly of the mastoid process of the temporal bone; dysentery, etc.

It is adapted to secondary more than to primary syphilis, and more especially adapted to secondary syphilis after the abuse of mercury. Chancres have even returned and are phagedenic. There is great soreness in the bones at night, particularly in the bones of the head and along the shins, and this is worse from every change in the weather. On a damp day he will have a boring pain in the bones.

Ulcers appear in the throat or on the surface of the body, and these are characteristically irregular in outline. Warts develop, and these are almost always more or less pediculated. There are yellowish- brown spots or copper-colored spots all over the body. There is great debility, with sweat and exhaustion.

536 A CLINICAL MATERIA MEDICA.

When mercury has been abused, Hepar is probably the best antidote we have. When mercurialization is conjoined with syphilis, Nitric acid is the preferable remedy.

Nitric acid may be needed in the treatment of phthisis. There are sudden rush of blood to the chest, and decided hectic fever, which indi- cates ulceration of the lungs from breaking down of tubercles. The chest is extremely sore to the touch. The patient suffers from frequent haemorrhages from the lungs, the blood being bright red and profuse.

There is great dyspnoea, so that the patient cannot talk without getting out of breath. There are also morning hoarseness, exhausting phthisi- cal diarrhoea, worse in the morning, and sharp stitches through the right chest to the scapula. The pulse is intermittent. The least at- tempt at exertion causes palpitation of the heart and dyspnoea.

The sweat comes particularly at night and towards morning, and exhausts the patient very much. The skin is apt to be cold towards morning. He is chilly on getting into bed. Heat comes in flashes, or it is only in the hands and feet.

The cough is of a tickling character, and seems to annoy him all night. You hear on examination, loud rales all through the chest, and the expectoration is offensive, bloody and decidedly purulent, and of a dirty green color, not being yellowish- green and laudable, as you find under Lycopodium and Pulsatilla. Some- times the cough is loose and rattling in character. The patient is usually of thin build, with dark hair and eyes.

Nitric acid is very often indicated in phthisis after Calcarea ostre- arum or Kali carb. Calcarea is especially suited to leucophlegmatic patients. The face is pale and sallow. There is soreness of the chest, which is very much aggravated by touch or pressure.

The cough is loose and rattling. Diarrhoea, if present, is worse in the evening. Hoarseness, through persistent, is painless. When, however, the Cal- carea condition has run into the acid debility.

Nitric acid is one of the very best remedies to follow. It does not often cure, but it relieves and prolongs life for years.

Still another application that we may make of Nitric acid is in typhoid fever, particularly in the ulcerative stage, when Peyer's patches have begun to break down. You will find the patient greatly exhausted. The characteristic indications for Nitric acid are these: stools are green, slimy and offensive, and sometimes purulent from the pus coming from these ulcers, and there is profuse bright red haemor- rhage from the bowels, with fainting on the slightest motion. The

HYDROCYANIC ACID. 537

tongue is either white and studded with vesicles or little sore spots, or it is brownish and dry. We may have well-marked pneumonic compli- cations. There seems to be threatening paralysis of the lungs, which you know is by no means an uncommon thing in typhoid fever. This incipient paralysis of the lungs is expressed by loud rattling of mucus in the chest. The pulse, in such cases, you will find to intermit at every third beat.

Now, do not forget Moschus, Phosphorus, Antimonium tart. , Arseni- cum and Cuprum and other remedies that I have mentioned in this connection.

In haemorrhage from the bowels during typhoid, you may also re- member Alumen, which is useful when there are large clots passed.

Arsenicum is called for in this haemorrhage when the flow consists of dark watery blood, and is associated with anxiety and restlessness.

We find Hamamelis indicated when there is a dark venous flow, without anxiety. Sometimes the blood is dark and pitch-like.

Still another remedy is Leptandra, which is useful in typhoid fever with symptoms of a bilious character, when the stools consist of black blood, looking like pitch.