Kalium Arsenicosum

I Bryonia.

[_ Lycopodium.

I shall be brief in my remarks on Chelidonium, as we have not the time to treat exhaustively of the drug. It is a unique remedy, possessing points of similarity with its congeners, Sanguinaria and Opium, and also with Nux vomica, Mercurius, Phosphorus and Kali carb. The plant yields an acrid, yellow, bitter juice, which, when applied locally, pro- duces inflammation and even vesication. The principal value of Che- lidonium lies in its action on the liver, lungs and kidneys.

The patient is low-spirited, inclined to weep, but knows no reason therefor ; rest- less, must move from place to place, with mental anguish ; headache, with coldness extending from the neck into the occiput ; the head is so heav}^ he can scarcely raise it from the pillow ; pressure in the occi- put toward the left ear.

Chelidonium may be indicated in many affections of the liver, from a simple congestion to a positive inflammation. It produces pains in the right hypochondrium all the way from a simple soreness to the most aggravating variety of sharp stitches, which shoot from the liver down into the stomach, or down into the back from the posterior aspect of the liver. There is marked pain under the angle of the right shoulder-blade. That is the key-note for the drug in hepatic disease.

282 A CLINICAL MATERIA MKDICA.

In addition to this you have the usual hepatic symptoms, swelling of the liver, chills, fever, jaundice, yellow-coated tongue, bitter taste in the mouth, tongue taking the imprint of the teeth, as you find under Mercury, and desire or craving for milk, which exceptionally agrees. There is usually also a craving for acids and for sour things, as pickles and vinegar. The stools are characteristically profuse, bright yellow and diarrhoeic, or they may be clayey. These are the symptoms of Chelidonium, and they are very definite.

Let me tell you how to apply them. You may use the drug in simple biliousness ; in hepatic con- gestion or inflammation, and also in pneumonia with bilious symptoms, in what has been termed bilious pneumonia. The symptoms indicat- ing it in the latter affection I will give you presently.

This pain under the angle of the right scapula of Chelidonium brings to mind pains of a similar character found in other remedies. Cheno- podium has dull pain lower than the angle of the right scapula and nearer the spinal column.

Ranunculus bulbosus has pain along the whole inner edge of the left scapula, at times extending below its inferior angle and through the left chest.

Lobelia syphilitica has pain under, not below, the inner border of the left scapula, worse after weeping.

Angustura has sharp cutting pain from just beneath the right scapula to the breast near the nipple.

Bryonia is very similar to Chelidonium in hepatic affections. Both remedies have sharp stitching pains,. both have pain under the right shoulder blade, both have bitter taste in the mouth and yellow-coated tongue, and both have swelling of the liver. But Bryonia differs in its stool, which is either hard, dry and brown or, if loose, it is papescent and profuse and associated with a colic very much like that of Colo- cynth. Sometimes the stools have an odor of old cheese.

Lycopodium, which bears some resemblance to Chelidonium, is easily differentiated, especially in the rumbling of flatus in the left hypochon- drium, in the sour rather than the bitter taste, in the sour vomiting, in the fulsomeness after partaking of small quantities of food, and in the character of the pains, which are dull and aching under Lycopodium, and sharp and lancinating under Chelidonuim.

You ma}^ use Chelidonium in neuralgia of the face. The pains go from the right cheek bone into the teeth or into the eye, or the pain may be located in the supra-orbital nerves. This neuralgia will not

SANGUINARIA AND CHELIDONIUM. 283

yield to Chelidonium , however, unless 3^011 have some of the hepatic symptoms of the drug present. It is a neuralgia dependent on disor- der of the liver, and not an idiopathic prosopalgia.

Chelidonium is useful, as I have already intimated, in bilious pneu- monia. It is also indicated in the capillary bronchitis of children when these hepatic symptoms are present, especially when it follows measles or whooping cough. The face in these cases is apt to be deep red. There is great oppression of the chest, as shown by the efforts to breathe and a fan-like motion of the alse nasi (a Lycopodium symptom, by the way), one hot and one cold foot (another Lycopodium symptom), and stitching pain under the right scapula.

The cough is usually loose and rattling. The expectoration is not easily raised.

Mercurius is sometimes indicated in bilious pneumonia. It differs from Chelidonium in the character of the stool more than in anything else. The Mercury stool is slimy and is attended with great tenesmus before, during and after the stool, while in Chelidonium it is quite free. The Mercurius expectoration is apt to be blood-streaked, and there are sharp pains shooting through the lower portion of the right lung to the back, a symptom which, however, may also be in Cheli- donium.

Antimonium tartaricum has yellow skin, urine and vomit, in bilious pneumonia ; stinging under right false ribs, frothy yellow tenacious sputum, rattling in chest with suffocation, fan-like motion of alse nasi, great oppression, strong heart beat.

Kali carb. is a remedy often forgotten in pneumonia. It is not in- dicated in the beginning, but later, when there is copious exudation into the lungs, with great rattling of mucus during the cough. The symptoms are worse toward two or three o'clock in the morning. The expectoration contains little globules of pus. There may even be cyanotic symptoms with pufhness of the upper eyelids.

LECTURE XXVIII.

CUCURBITACEiE.

i . Colocynthis cucumis.

4. Cucurbita (Squash).

Flatulency.

Bowels and fever.

Let us now enumerate these medicines. Fifth on the list is the Momordica balsamina ; of this we have but one characteristic symptom, and that is accumulation of flatus in the splenic flexure of the colon, precisely like Lycopodium. It is a very convenient thing to know this. For instance, if, during the course of a more or less chronic disease, this one symptom becomes very annoying, and you do not want to destroy the action of the drug you are giving, you simply interpolate a dose of Momordica, which removes the symptom and enables you to go on with the treatment as before.

CUCURBITACE^. 285

color, coming out with a gush, with cutting pains in the abdomen. Thus, you see, it is comparable with Croton tiglium, Podophyllum, Veratrum album, and remedies of that type.

It is readily distinguished from Croton tiglium, which is adapted to a profuse, yellow, watery stool, which is provoked every time the pa- tient eats and drinks.

Podophyllum has, as you all know, the morning aggravation to dis- tinguish it.

The remaining medicines belonging to the Cucurbitacetz are the Citrullus, or water-melon ; the Cucurbita, or squash, the seeds of which, as well as those of the pumpkin, have been used for taenia ; the Colocynth, and the Bryonia alba; the last two being drugs of great importance, we shall proceed to their consideration in extenso.

COLOCYNTHIS CUCUMIS.

Neuralgia.