Alumina or the oxide of Alumi?iium, is a form of pure clay and is known as argilla. According to Hering, the symptoms which Hart- laub obtained are not pure, because he simply washed his preparation of clay, while Hahnemann subjected his to a red heat. ALUMINA. 617 You notice by the table on the board that I have placed Bryonia as the complement of Alumina. This is particularly true of the gastric symptoms. These drugs follow each other well in gastro-enteric affec- tions. Bryonia, also, acts as an antidote to Alumina, as does also Chamomilla. I have placed several of the concordant remedies with a few words in parenthesis to indicate the points of resemblance. Thus Pulsatilla is marked by chlorosis and ozsena, showing that in these two affections particularly, Pulsatilla is concordant with Alumina. Then you notice that Plumbum is similar to it in colic, smdiVux and Sulphur in spinal affections, etc. Alumina acts best in aged persons of spare habits, who are rather wrinkled and dried-up looking, or in girls at puberty, especially if they are chlorotic, and also in delicate or scrofulous children, particularly children who have been artificially fed — that is, nourished by the many varieties of baby foods with which the market is glutted. Such children are weak and wrinkled; nutrition is decidedly defective. The bowels are inactive. This constipation is characteristic. There is a great deal of difficulty in voiding the stool even though the faeces be soft, showing you at once that the inactivity of the bowels is the main influence at work in its causation. Here, it is like Bryonia. Except- ing that the latter has more hardness and dryness of the faecal matter. The child suffers from ozaena or chronic nasal catarrh, with a great deal of dryness of the nose. This you know by the dry sniffling sound which the child makes in breathing through its nose. The child, too, when teething, may suffer from strabismus. This comes from weak- ness of the internal rectus muscle of the affected eye. This symptom is sometimes curable by medicine, and when it is so, this method is preferable to any surgical procedure. Sometimes, it follows worms. Then Ci?ia is the remedy; when it comes from brain irritation, Bella- donna; and Cyclajnen when from menstrual or gastric irregularities. The Alumi?ia patient is very low-spirited and inclined to weep, like Pulsatilla, and this low-spiritedness is worse on awakening, here re- sembling Lachesis, Pulsatilla, Sepia, etc. At other times, you find the patient troubled with an apprehensive state of mind, a fear that he will go crazy, and this is an exact counter part of Calcarea ostrearum, Iodine, etc. This shows you the irritable state of brain fibre. Another peculiarity that may be present, particularly in hysteria, is suicidal tendency when the patient sees blood, or a knife, or something of that kind. 6l8 A CLINICAL MATERIA MKDICA. Men in whom Alumina is useful are hypochondriacal. There is a great deal of lassitude and indifference to labor or work. An hour seems to them half a day. They are exceedingly peevish and fretful; and here you find Alumina rivalling Nux vomica and also Bryonia. Now, on the right side of the board, you will notice several headings under which I propose to consider Alumina. First, what changes are made in the blood by Alumina? I cannot tell you how it alters the blood, but there are diseases of the blood to which it is applicable, and it is convenient here to bring these to your notice. We find it indi- cated in anaemia, and also in chlorosis, especially in 3^oung girls at puberty, when the menses are pale and scanty, and there is an abnormal craving for certain indigestible articles, such as slate pencils, chalk, whitewash, etc. The leucorrhcea to which they are subject is usually transparent, and quite ropy and tenacious, or else is composed of yel- lowish mucus, which is profuse, sometimes running down the limbs to the feet. This exhausts them very much, because it is rich in albumen. With these symptoms, you will almost always find the mental states that I have given you. Now in nervous affections. Alumina has been used in nervous af- fections of a very grave character. Boenninghausen used the metal Aluminium for the following symptoms in that dreaded disease, loco- motor ataxia: frequent dizziness; objects turn in a circle; ptosis, diplopia or strabismus; inability to walk in the dark or with the eyes closed without staggering; feels as if walking on cushions. There is formication, or sensation as from creeping of ants in the back and legs. The nates go to sleep when sitting. The heels become numb when walking. A feeling in the face as though it was covered with cob- webs, or as though the white of an egg had dried on it. Pain in the back, as though a hot iron were thrust into the spine. These are the symptoms indicating Alumina, and these are the symptoms which led Boenninghausen to Aluminium, and enabled him to cure four cases of the disease. Next, the mucous membranes. Alumifia is a unique drug here. It acts in a limited but very well-described class of cases. It causes un- mistakable dryness of the mucous surfaces. If you keep that fact in mind you can explain all the symptoms which it causes. You have at once the key to its dyspepsia, nasal catarrh, sore throat and constipa- tion. There is dryness of the mucous membranes. After a while, there is formation of mucus, which is thick, yellow, and very difficult ALUMINA. 619 of detachment. Let me show you a few illustrations of this. In the eyes, for instance, it will be indicated in blepharitis particularly, with great dryness of the conjunctiva. The lids feels stiff and they crack, so dry are they. The nearest analogue here is Graphites, which has the same symptoms, only it has more bleeding than has Alumina. Alumina is useful in asthenopia from irritated conjunctiva; also in granular lids and chronic blepharitis. For dry eyes, Allen recommends, also, Berberis, Natrum carb. , and Natrum sulph. Eyes dry on reading, Crocus, Arge?ttum nitricum, Cina, Natrum mur. Drooping eyelids, Nux moschata, Sepia, Rhus, Gelsemium. Alumiyia also has loss of power over the internal rectus. Here it is like Agaricus, Jaborandi, Conium, Ruta, and Natrum mur. The latter, according to Woodyat, is the best. In nasal catarrh you will find Alumina indicated in children with great dryness of the nose, formation of scabs and remotely, thick, tenacious yellow phlegm or mucus, which is difficult of removal. The cough indicating Alu??iina is dry and spasmodic. It is worse in the morning when the patient coughs until he detaches a small amount of tightly adherent mucus, which relieves for a while. You find it indicated in disease of the throat, in a relaxed condition of the mucous membrane, just that condition you meet with in clergy- men's sore-throat. The throat is very dry on waking with husky, weak voice. It is dark red, the uvula elongated. The patient is better from hot drinks. Hoarseness appears worse in the morning, with a feeling as of a splinter in the throat when swallowing. This last symptom you find also under Hepar, Argentum nitricum, Nitric acid, etc. The mucous membrane of the stomach is dry, and, therefore, there is defective secretion of gastric juice. Here you have the same dys- pepsia as is curable with Bryo?iia. The distinctive symptoms for Alumina are these: there is a feeling of constriction along the oesophagus when swallowing food. The patient is always worse from eating potatoes; that is a good indication for Alumina. There is aversion to meat and a craving for indigestible substances. The liver is sensitive to touch, and there are stitching pains in that organ, as under Bryonia. You find the constipation with urging to stool already described, even though the stool be not dry and hard. Piles itch and burn, and are moist. 620 A CLINICAL MATERIA MBDICA. Next, we consider the action of Alumina on glands. Here I have only one symptom for you, and that is the use of the drug in treating buboes. You may give it in gonorrhceal bubo when there exists with it a yellowish gonorrhceal discharge, with burning and itching along the urethra, particularly at the meatus. Lastly, the skin. Alumi?ia acts here just as it does on the mucous membranes, producing dryness and harshness of the skin; as a conse- quence, we find it indicated in rough, dry eruptions, which crack and may bleed, although not often, and which itch and burn intolerably, and are worse in the warmth of the bed. You will recall here that Argentum nitricum, Nux vomica, and Sul- phur are similar to Alumina in spinal affections. Mercurius is the most similar remedy. Alumina has been used as an antidote to the colic caused by Plum- bum. LECTURE LX. PLUMBUM AND STANNUM. Organs. It has a tendency to cause paralysis and spasmodic symptoms, rheu- matism, affections of the mucous membranes, and diseases of the skin and organs generally. You will recall the fact that there is an inimi- cal relation between Phosphorus and Causticum. These remedies do not follow each other well, although indicated in the same class of diseases. This is to be remembered particularly by those who use the higher and medium potencies. The main power of Causticum is the first one on the list, the para- lytic weakness which the drug exhibits. This paralytic tendency is a genuine potash weakness. Causticum is especially suited to patients who are timid, nervous and anxious, and full of fearful fancies, par- ticularly in the evening at twilight, when shadows grow longer and fancy more rife. The child, for instance, is afraid to go to bed in the dark. This applies not to the unfortunate child who entertains these fears by reason of faulty education, but to the child who is afraid as the result of nervous disease. As an adult, the patient is apprehensive that something is about to happen, or he feels conscience stricken, as if he had committed some crime. When closing his eyes, he sees 73° A CLINICAL MATERIA MEDICA. frightful images. This is no new symptom to you, as you will recall it as belonging to several remedies. The patient, especially if a woman, is apt to be tearful and melancholy. The face is a correct picture of the mental condition, and is expressive of this low-spirited state. The face is apt to be sallow and sickly looking. The patient is either taciturn and distrustful, or is inclined to fits of anger, with scolding. This is, as you know, by no means dissimilar to Phos- phorus, and yet you must not make the mistake of giving one, when the other is indicated. Memory' fails. Any attempt at mental labor is followed by untoward symptoms, such as stitches in the temples when reading or writing, feeling of tension in the head and scalp, particularly in the forehead and about the temples. This is worse in the evening, and also on awakening from sleep. Here again it is very similar to Phosphorus, which also has that feeling of tension. The patient also has a rather odd sensation, and one that is not frequently met with, and that is a feeling as though there were an empt)^ space between the brain and the cranial bones. This is relieved by warmth. As odd as this symptom may seem to you, it is not too uncommon for you to make note of. Our materia medica is not over rich in this direction, and so we ought to utilize every such symptom that we can get. The vertigo of Causticum is that which belongs to an excited brain and spine, such as we find in the incipiency of paralysis, and even of locomotor ataxia. There is a tendency to fall either forward or side- ways. There is with this vertigo a constant feeling of anxiety and weakness of the head. It is worse on rising and on trying to fix the mind, indicating a weakened cerebral circulation. The sight is be- dimmed as though the patient were looking through a fog. Now, concomitant with these brain symptoms you have the following symp- toms, one or two of which ought to be present in order to make the picture complete. The skin in these cases is apt to be dry and hot, and there is almost always constipation, which constipation is quite characteristic. It is attended with a great deal of urging, probably from defective expulsive effort in the rectal muscular fibres, with red- ness of the face and fulness of the bloodvessels. This symptom is very common in weak persons and in children when they are nervously debilitated. Very characteristic of the drug is paralysis of single parts or of single nerves. Thus you may have to use it in paralysis oKthe facial CAUSTICUM. 731 nerve, particularly when it is the result of exposure to dry or cold winds. It may also be called for in ptosis, when the result of the same cause. Causticum is still further called for in paralysis of the tongue, when deglutition and speech are more or less destroyed, paralysis of the lips, and in glosso-pharyngeal paralysis. In this last-named disease, you cannot expect much improvement from any remedy. The larynx and the bladder may be attacked. These are illustrations of the local pal- sies which come within the range of Causticum. These paralyses ma3* be caused either by deep-seated nervous disease, or, very characteris- tically, by exposure to cold, particularly to the intense cold of winter, when the patient is of the rheumatic diathesis. Aconite, like Causticum , is useful in paralyses which are traceable to exposure to cold, especially to dry cold winds. Aconite suits well in the beginning, and Causticum more when the paralysis has become chronic and refuses to yield to the Aconite. Rhus tox. and Dulcamara compare favorably with Causticum for paralysis of rheumatic origin, provoked by exposure to a damp and cold atmosphere, particularly when there have been changes from tol- erably warm to cold and wet days. Dulcamara is suited to the begin- ning of such cases, and not when the trouble becomes chronic. Rhus tox. is suited to chronic cases. Nux vomica and Colchicum are also to be thought of in paralysis from exposure. Stammering has been cured by Causticum when caused by imperfect control of the tongue. In paralysis of the tongue, it may require to be followed by Stramonium, Dulcamai'a, Muriatic acid or Baryta car- bonica. You may also find Causticum indicated in paralysis which arises from apoplexy; it is not called for, for the immediate results of the stroke, not for the congestion, nor for the exudation, but for the remote symptoms, when, after absorption of the effused blood has taken place, there still remains paralysis of the opposite, side of the body. Causticum may be applied in diseases of children. It is suited to children of a scrofulous habit in whom, though emaciated generally and particularly about the feet, the abdomen is large and tumefied. The3T are slow in learning to talk. There is a tendency to scrofulous inflammation of the eyes, scabs form about the tarsi; the conjunctivae become injected, and the cornea inflamed. There is a constant feeling 732 A CUNICAL MATERIA MEDICA. as of sand beneath the eyelids. An eruption appears about the scalp, especially behind the ears, making this portion of the skin raw and excoriated. The discharge is slight in quantity and sticky in character. Often there is otorrhcea, purulent in its character. The child stumbles when it attempts to walk. The cause of this symptom will be found in disease of the brain or spine. These cases do not recover rapidly. There is defective nutrition in the whole nervous system. You must instruct your patients that hygienic measures must be observed in conjunction with medicinal, and that you can promise a cure if they will but be patient with you. Other remedies which may be thought of here are, first, Sulphuric acid, which is a good remedy for this weakness or giving way of the ankles; another is Sulphur, and still another, Silicea. Still further, as illustrating the paralytic effect of Causticum, we find it causing aphonia or failure of the voice. This may or may not be catarrhal. It is associated with great weakness of the laryngeal mus- cles, which seem to refuse their office. This is often the case in phthisis and in laryngeal troubles, whether of a tubercular nature or not. The paralytic tendency is further illustrated in the cough. The patient is unable to expectorate. Just as under Sepia, Drosera, Kali carb., Arnica and a few other remedies, the patient succeeds in raising the sputum so far, when it slips back into the pharynx. The remedy also has this as characteristic: the patient cannot cough deep enough for relief. In addition to these paretic symptoms in catarrhs, you may also add the following: rawness and burning down the throat and trachea, feeling as if these parts were denuded, and hoarseness with aggravation in the morning. At this time, also (consistent with the action of the potash salts generally), there is accumulation of mucus in the fauces and larynx. The sputum often tastes greasy and soapy. Drinking cold water relieves the cough. Accompanying the cough, we find pain over the hips, which is very characteristic, and, too, the cough is often associated with involuntary spurting of urine. This last symptom is very characteristic of Causticum. It is also found under Natrum mur., Apis, Phosphorus, Pulsatilla and Scilla, which is excellent in spurting of urine in old people. In the laryngeal symptoms, it is necessary to make a distinction be- tween Causticum and Phosphorus. One point of difference is that Phosphorus often has evening aggravation of the hoarseness; Causti- cum has aggravation in the morning. Both have this nervous causticum. 733 weakness. One sj'inptom I have often found indicating Phosphorus, and that is, extreme sensitiveness of the box of the larynx. The pa- tient dreads to cough, because it aggravates the laryngeal soreness. He dreads to talk for the same reason. Relief from cold drinks is found only under Causticum. More similar to Causticum yet, is Carbo veg. Here you can make no serious mistake, because both drugs follow each other well. If you do make the mistake of giving one of these when the other is indicated, you will not injure your patient any more than from the delay caused by your imperfect selection. Both remedies have this rawness and soreness down the throat ; both have hoarseness, Carbo veg. having aggravation in the evening and Causticum in the morning. The former is indicated after exposure to damp evening air; the latter, after dry, cold, severe winter weather. Eupatorium perfoliatum is very similar to Causticum in that it causes hoarseness worse in the morning. Both remedies are indicated in in- fluenza with aching all over the body, but Eupatorium has more sore- ness than burning and rawness in the chest. In the hoarseness of singers or those who exert their voices a great deal, Causticum resembles Rhus tox., Graphites, Arum tri. and Selenium. In some cases, when Causticum fails in chronic hoarseness worse in the morning or evening, Sulphur is an all-sufficient remedy. Still another kind of cough for which you may give Causticum is one which improves up to a certain point and then remains stationar)', getting neither better nor worse. Causticum is a good remedy for buzzing and roaring in the ears, or tinnitus aurium, when sounds reecho unpleasantly in the ears. A voice which is of an ordinary tone, sounds loud and reechoes in the ear with unpleasant confusion. When Causticum is the remedy, these symptoms may be concomitant with catarrh of the throat involving the Eustachian tube. They may also be symptoms of Meniere's disease, of which affection I once cured a case with Causticum. There are two drugs which you may compare here, namely. Salicy- lic acid and Salicylate of Soda, which have caused and cured Meniere's disease. You may also compare Carbon bisulphide and the well-known Cin- chona. When sounds reecho in the ear, think also of Calcarea ostr. and Phosphorus. 734 A CLINICAL MATERIA MEDICA. We find Causticum indicated in involuntary urination or enuresis, particularly in children. It is especially called for when the accident occurs, during the first sleep. The trouble is aggravated in the winter and ceases or becomes more moderate in summer. The urine is espe- cially liable to escape involuntarily during the day in winter, as the result of any excitement. Compare in enuresis, Plantago major and Kreosote (involuntary dis- charge of profuse, pale urine); Calcarea ostr. (fat children); Sepia, (little girls, worse in first sleep); Belladonna (nervous children); Fer- rumphos. (during the day). For nursing women we may use Causticujn when over-exertion or loss of sleep threatens their supply of milk. This makes them very low-spirited, and they are apt to have this sallow, sickly complexion which is characteristic of Causticum. Causticum may be used in spasmodic diseases, even in convulsions. Thus it may be used in epilepsy, particularly in la petit mat. When walking in the open air, the patient falls, but soon recovers. During the unconscious stage, the patient passes urine. Causticum may even be used when the attacks are of a convulsive nature, especially when they recur at the new moon. Now you are not to consider that the moon has anything to do with these epileptic attacks. It is only the laws which govern the relation of the planets, which regulate the tides and have to do with the periodicity of nature generally that also apply to the moon and to the disturbances within the human body; so it is that some symptoms are worse at new moon, others at full moon; some at the rise and others at the fall of the tide. It does not, therefore, follow, be- cause the patient is worse every time at new moon, that the moon causes the aggravation. Causticum is, moreover, indicated in epilepsy when it is connected with menstrual irregularities, and also when it occurs at the age of puberty. In these symptoms Causticum is closely allied to Calcarea ostrearum. Causticum is indicated in chorea when the right side of the body is affected more than the left. The muscles of the face, tongue, arm and leg are all involved in the disorderly movements. When the patient attempts to speak, words seems to be jerked out of the mouth. The patient is anxious and restless in bed at night. He must sit up and change his position. He involuntarily throws the head about, and finally he falls asleep exhausted. During sleep the legs and arms are constantly " on the go." Lastly, we may be called upon to use Causticum in rheumatism, causticum. 735 especially when the joints are stiff and the tendons shortened, drawing the limbs out of shape. It is frequently indicated in what has been termed rheumatoid arthritis. Rheumatic pains attack particularly the articulation of the jaw. They are worse from cold and are relieved by warmth. Causticum is also useful in rheumatism of the right deltoid, here be- ing comparable with Phosphoric acid, Sanguinaria and Ferritin. Now, you will have to distinguish Causticum here from several other remedies. Rhus tox. also has rheumatism from exposure to cold. Some of the distinctions between it and Causticum I have already given you. There is yet another good one. Rhus tox. has restlessness and relief from motion all the time. In Causticum the restlessness only occurs at night. Further Rhus is worse in damp weather, Causti- cum in dry weather. Guaiacum is to be preferred to Causticum, and follows that remedy well when, in either gout or rheumatism, there are contractions of the tendons, drawing the limbs out of shape, aggravated by any attempt at motion, particularly if there are well-developed gouty nodosities in the joints. Colocynth is to be remembered for articular rheumatism when the joints remain stiff and unwieldy. The pains in the affected parts are of a boring character. Causticum also acts on the skin, one of its most characteristic symp- toms being warts. It is useful in the cure of these hypertrophies of the papillae when they occur on the hands or face. I remember once giving Causticum to a child who had two warts on the under e3^elid. At the end of the third week after taking the remedy, there was a string of warts over the inner canthus of the other eye. I believed that these resulted from the Causticum. Of course, I stopped the medicine. At the end of several weeks more, all the warts had disap- peared, and the child has had none since. This shows you that Caus- ticum really produces and cures warts. Causticum may be called for in colic after the failure of Colocynth. The pains are of a griping, cutting character, and are relieved by bending double. Particularly do you find pains of this character suggesting the drug in menstrual colic. Previous to the menses, these colicky pains appear, and are associated with tearing pains in the back and limbs. The menses cease almost entirely at night, or continue for days after the normal time. All the sufferings cease entirely at night. LECTURE LXXIII. KALI CARBONICUM. Phos. , Carbo veg., Arsen. Ant. tart. Hypophosphite of lime, Psorinum. Caust., Senna. Natr. m. V I^Lachesis. Kali carb. < Carbo veg. To-day I will study with you Carbonate of potash, known in our nomenclature as Kali carb. This is complemental to Carbo veg. and similar to it in many forms of disease, particularly in lung inflamma- tions. Sometimes when one fails' the other completes the cure; hence the origin of the complemental relation. We have quite a number of analogues to Kali carb., some of which have been placed on the board. We will have occasion to refer to some of these as we go on. There is also somewhat of a complemental relation between Kali carb. and Phosphorus. Kali carb. exerts an influence over the manufacture of the blood, quantitatively as well as qualitatively. This is shown in the anaemia which the remedy causes. And is illustrated by the following symp- toms: frequent chilliness; every time the patient goes out of doors, he becomes chilly if the air is in the least cool, not having the normal resistance to temperature; quite consistent with this anaemia, there is throbbing in the bloodvessels all through the body. This is not plethora, but only an appearance of plethora. It is associated with local congestions which are really anaemic in origin; the blood being normal volumetrically, but is not as rich in red corpuscles as it should be. The congestion to the head is associated with humming in the ears. The patient surfers from vertigo when he turns his head rapidly, or from riding in a carriage, or from anything that diminishes, the supply of blood to the brain. He suffers from weakness of sight, especially following excessive sexual indulgence. Again, we find Kali carb., by reason of this anaemia, indicated after KAU CARBONICUM. 737 severe or protracted diseases. It thus becomes useful for the weak- ness following labor or abortion when we have the following symptoms: there is a very troublesome backache, a weak, lame feeling in the small of the back, which makes walking very difficult to the patient; the patient suffers from cough and frequent sweating at night. You find persistent discharge of blood from the uterus. The urine is loaded with urates. This latter symptom, this excess of urates, shows great waste of tissue, and is evidence of the exhaustion which Kali carb. causes and cures. You will recall that I mentioned Kali carb. as a drug which causes great exhaustion in the muscular system, and it is frequently in this kind of exhaustion that the urates are excessive in the urine. Kali carb. acts not only on the voluntary muscles, but on the heart also. The heart becomes weakened when it is indicated, and you thus have a pulse which is irregular or intermittent, or, being rapid, is very weak. Now, this character of the pulse in Kali carb. will qualify every disease in which you may use the drug. It is a characteristic of the drug which lies at the very root of its symptoms; therefore, you will seldom find Kali carb, indicated when there is a full round pulse. This condition of the urine, in which it is loaded with urates as evi- dence of exhaustion from disease, is also found under other remedies. Perhaps the best remedy in the materia medica for this symptom, other things being equal, is Causticum. Remember that this assertion is to be qualified. A symptom of this character has not the same value as a symptom of the mind would have. It is characteristic in its place, and yet, if symptoms more characteristic of the case indicate another drug, then you should not think of using Causticum. Sup- pose you have a patient whose other symptoms are those of Kali carb. , for example, a woman after confinement with backache, sweat, and other symptoms of importance, then you may give Kali carb. with confidence. But if you have a patient with no prominent symptoms, and with this excessive deposit of urates in the urine, Causticum will help you out. Still another remedy for this symptom is Senna, which is one of the best remedies in the materia medica for simple exhaustion with exces- sive nitrogenous waste. The particular combination of symptoms that we have under Kali carb., the sweat, the backache and the weakness, are found in no other remedy. It acts as well with the high as the low potencies. 738 A CLINICAL MATERIA MEDICA. You may also remember the Hypophosphite of Lime, which comes near to the Kali carb. in the excessive sweating, weakness and pallor of the skin. You may also remember, as akin to Kali carb., Psorinum, which, as you have already learned, is eminently useful in convalescence from disease when there is great weakness, profuse sweat and, in addition, a mental state of abject hopelessness. The patient despairs of perfect recovery. Next, let us look at the action of Kali carb. on the nervous system. Viewed mentally, the patient is excessively peevish and nervous, and is very easily startled. You often find this in women. They are startled by imaginary hallucinations; they imagine that some one is in the room or some figure comes before the mind and tantalizes them. Especially is this anxiety manifested on any noise, as the mere shut- ting of a door or window, particularly if the noise be unexpected. They are not only startled as many healthy persons would be under similar circumstances, but they are so frightened, that they are driven into a fit of trembling. You will sometimes find the intellect seriously impaired when Kali carb. is indicated. The patient does not seem to care for anything. This indifference is associated with great bodily exhaustion. When questioned, the patient, usually a female, does not seem to know exactly what to say or what she wants. The con- dition borders somewhat on that of Phosphoric acid, but still the apathy of the two remedies is not exactly the same. Kali carb. has not a sen- sorial apathy, but it has exhaustion too great to frame the answers to your questions. You will frequently find these symptoms of the mind calling for Kali carb. in puerperal mania and in puerperal fever. Again, we find that spasms may occur as a symptom of the nervous system under Kali carb. The patient does not lose consciousness dur- ing the convulsions, hence the remedy is not indicated in true epilepsy; but it may be indicated in puerperal eclampsia, the spasms seeming to pass off with eructations of wind. The spine suffers severely in the Kali carb. patient. In addition to the backache, already mentioned as the result of anaemia or of abor- tion, we have spinal irritation, which, by the way, is just as vague a symptom as is any other of a general character, as headache. You must always know what causes this spinal irritation. Does it come from loss of fluids, from brain troubles, from emotional causes, or what ? In the Kali carb. patient you will find it frequently occurring KALI CARBOXICUM. 739 with the uterine symptoms. Thus, you will have pressure in the small of the back as though there were a heavy weight pushing down there. There are also bearing down in the uterine region during the menses, burning along the spine, especially along the right side of the spine. This is not a real congestion. It is merely a subjective sensa- tion caused by irritation of the posterior spinal nerves. The backache is worse while the patient is walking. She feels so exhausted that she must drop into a chair or support herself in some way. Some- times you find, in the morning, a pulsation in the small of the back, quite akin to the pulsations occurring in other parts of the body. Here the drug is quite analogous to Sepia and the well-known Cimici- fuga. This pulsating and drawing backache is particularly relieved when the patient lies down. This suggests a comparison between Kali carb. and Natrum mur. You will recognize at once the resem- blance in the spinal symptoms, the spinal irritation, the backache and the relief from lying down. Natrum ??itir. has, particularly, relief by lying flat on the back with firm pressure. Further than this, you will find these two drugs playing into each other's hands in the treatment of amenorrhcea. Hahnemann says that Kali carb. will bring on the menstrual flow when Natrum mur., though indicated, fails. I once cured a singular backache with Kali carb. A very nervous patient came under my treatment for dyspepsia. She said to me: ' ' There is something very strange about my case. Every time I eat a meal I suffer for half an hour or more with most intense pain in the back." This was certainly an odd symptom. I did not know where in the materia medica to find it. I hunted, and found under Kali carb. this symptom: pain in the spine while eating. I gave her Kali carb., which cured her completely. On the mucous membranes, Kali carb. acts, causing quite a series of catarrhal symptoms. We may give it in coryza with hoarseness or loss of voice. The patient catches cold at every little exposure to the fresh air. This is a very strong symptom of Kali carb. The Kali carb. patient has a tendency to obesity, and is rather weak in muscular de- velopment. With the catarrhal symptoms of this remedy there often occurs a sensation in the throat as though there were a lump there which must be swallowed. The neck is stiff and the uvula elongated. There are stinging pains in the throat when swallowing just as marked as under Apis. Sometimes we have a more chronic form of catarrh in the nose ; the 74-0 A CUNICAI, MATKRIA MKDICA. nasal passages are obstructed, and the patient can only breathe with the mouth open. This obstruction is relieved in the open air, but returns so soon as the patient enters a warm room. There is either a discharge of foetid green mucus or, in the morning, the nose is swollen and red, and there is a bloody discharge. There is a sticking sensa- tion in the pharynx, as from a fish-bone lodged there, whenever the patient becomes cold. This is a good symptom for Kali card. You will find it in Allen' s Encyclopedia in large type. Now, in addition to these symptoms, there is almost always accumu- lation of mucus in the pharynx. The patient "hawks and hems" in the morning. This hawking is found under every alkali, but this one peculiarity, sensation as of a fish-bone in the throat as soon as he " catches cold," with the hawki?ig, is found under no other remedy. Hepar, Nitric acid, Alumen, Carbo veg., and Argentum nitricum all have this sensation as of a splinter or fish-bone in the throat. In coughs, we sometimes find Kali card, of use. The cough is of a paroxysmal character, and is accompanied by gagging and by vomit- ing of sour phlegm and of food. This suggests the use of Kali carb. in whooping cough, in which disease it has been very successful. Boen- ninghausen has given us a characteristic symptom for Kali carb., namely, a little sac filled with water between the upper lids and eye- brows. You will often meet with that symptom. I would warn you not to confound it with a similar condition which is in no particular patho- logical at all, and that is a certain looseness of the tissues in this locality occurring in persons advanced in years. Now for the action of Kali carb. on the lungs. We find it indicated in bronchitis, pneumonia and phthisis pulmonalis. I will give you the symptoms calling for it in these separate states as we go on. The most characteristic symptom of all, and one which runs through the symptomatology of the drug, is stitching pains which are prominently located in the walls of the chest. They are made worse by any motion, but unlike Bryo?iia} they come at all times independently of this ag- gravation. They occur characteristically in the lower third of the right lung, going through the chest to the back. They may occur all over the chest, but that above mentioned is their most frequent site. Then, too, they are erratic and wander all over the body. Here it reminds you of Kali bichromicum, Pulsatilla and Sulphur. Kali carb. is indicated in infantile pneumonia or capillary bronchitis when the following symptoms are present: intense dyspnoea; although KALI CARBONICUM. 74I there is a great deal of mucus in the chest, it is raised with difficulty. The child is so oppressed that it can neither sleep nor drink. Breath- ing is wheezing and whistling in character, and the child has a choking cough. You should here compare Kali carb. carefully with Antimo- nium tartaricum and thus determine which suits the case best. One cannot be the remedy when the other is indicated. In phthisis, Kali carb. is indicated when the constitution favors it. The patient has a bloated alkaline look to the face. There are also present these well-defined stitching pains through the chest and over the body, with the puffiness of the upper eyelids. Cough is difficult. The patient cannot get up the sputum. He raises it partly, when it slips backwards into the pharynx. Now, if you examine this expec- toration, you will find that it is often bloody, and that there are little globules of pus scattered through it. There is an aggravation of all the symptoms from three to five o'clock in the morning. This hour of aggravation belongs to all the potash salts. There is also a very stubborn sensation, namely, chilliness at noon. Kali carb. is indicated in cardiac inflammations, in endo- and peri- carditis when these sharp stitching pains are characteristic. Do not give it too soon in the case. It is not an early remedy in cardiac dis- ease. It is indicated rather late when there is a deposit on the cardiac valves. In such a case as this Spigelia is apt to precede the exhibition of Kali carb. The latter follows when the sharp pains persist and there is the characteristic 3 A. m. aggravation. We find these same stitching pains under Kali carb. in lumbago, a very stubborn form of rheumatism. The same symptom applies in cases of impending miscarriage and during labor; sharp stitching pains in the lumbar region shooting down from the buttocks into the thighs. The same kind of pain suggests this remedy in nephritis from cold, or from a blow over the region of the kidneys. Lastly, in connection with the stitching pains, I want to refer you to its application in puerperal fever of the metritic form, that is, when metritis is a prominent condition. There are sharp, stabbing, cutting pains in the abdomen, the abdomen is bloated and distended, and the urine is dark and scanty, the pulse is rapid but feeble, and you have present the state of mind described in the early part of the lecture. One more symptom and we are done with the drug, and that is its use in dyspepsia. You will find it called for in indigestion, particu- larly in old persons, in those who have lost a great deal of vital fluids, 742 A CLINICAL MATERIA MEDICA. when there is an empty, weak feeling in the stomach before eating and bloatedness after eating, especially after soup or coffee. There are sour eructations, heart-burn, and uneasy, nervous feeling when hungry. You see then that Kali carb. is a remedy indicated in a great variety of diseases. It is a drug much neglected in practice, for the same reason that many other remedies are — because the hurried and careless physician falls into routinism. INDEX OF REMEDIES. ABIES CANADENSIS prolapsus uteri, 146 ABIES NIGRA dyspepsia, 305, 350, 370 mental symptoms, 305 ABROTANUM see Artemesia Abrotanurfi ABSINTHIUM, 243 epilepsy, 420 delirium tremens, 243 typhoid fever, 243 ACALYPHA INDICA haemoptysis, 369 haemorrhages, 369 ACETIC ACID dropsy, 104 ACIDS remarks on the, 515 ACONITIC ACID, 315, 336 ACONITINE, 315 ACONITUM FEROX, 314 ACONITUM NAPELLUS, 314 abortion, 325 amenorrhoea, 674 cerebral congestion, 320 cholera infantum, 324 colic. 287, 324 conjunctivitis, 321, 397 continued fever, 316 coryza, 294, 326 croup, 323, 505, 684 diarrhoea, 324 dysmenorrhoea, 325 dysentery, 324 episcleritis, 321 eyes, 321, 397 fever, 291, 316, 318 gastric catarrh, 324 gastric fever, 291 gastritis, 324 glaucoma. 321 haemoptysis, 324 haemorrhages, 243 headache, 200 heart, 225, 322, 507, 514 hernia, 325. hypertrophy of the heart, 323, 508 inflammations, 36, 99, 316 labor, 325 measles, 174, 326, 361 meningitis, 294, 320, 407 mental symptoms, 316, 321, 409 milk fever, 325 nephritis, 325 nervous system, 315 ACONITUM NAPELLUS vContinued) neuralgia, 321, 322 paralysis, 315, 322, 731 pleurisy, 293, 323. pleurodynia, 331 pneumonia, 295, 323 poisoning, 315 pregnancy, 325 puerperal fever, 321, 325 pulse, 317 scarlatina, 325 serous membranes, 293