Arsenicum Album

V Phosphorus.

Aconite, Sulphur. Phosphorus, Rhus, Lachesis.

Ipecac, China, Veratr. alb., Colchicum, Ferrum. Baptisia, Muriatic acid, Phosphoric acid, Nitric acid. Antimonium crud., Antimonium tart., Nux v., Pulsa- tilla. Secale, Camphor, Carbo v. Apis.

Ailanthus. v Anthracinum.

>Sesquioxide of iron.

>China.

> Ipecac.

> Ferrum.

> Graphites.

> Camphor. >Veratr. alb.

Irritability.

Inflammations: stomach, uterus, etc. Fevers: continued, typhoid, intermittent. Skin: exanthemata, indurations, gangrene, carbuncle, Arsenicum. <j cancer, ulcer.

Nerves: neuralgia, convulsions, stupor, exhaustion,

fainting. Catarrhs: eyes, nose, throat, lungs, etc. Dropsy: anasarca, hydrothorax.

To-day we take up for study the last of the acid remedies. I refer to Arsenious acid or Arsenicum album. It has quite a number of con- cordant remedies, and quite a list of antidotes. Its complementary remedies are Phosphorus and Allium saliva.

55° A CLINICAL MATERIA MEDICA.

Arsenicum has long been known as a speedy means of destroying life, hence it has been frequently used for suicidal and homicidal pur- poses. It has the property of uniting with animal tissues, probably with the albuminous portions, hardening them and causing them to resist the usual process of decay. This fact is taken advantage of by taxidermists in stuffing birds and animals. Cases of accidental poison- ing with Arsenic are quite common, and this is all the more so because of the use of Arsenic in the arts.

In the form of Scheele's green, or arsenite of copper, it enters into the composition of certain paints. It is used frequently in the manufacture of certain green wall-papers, and also in artificial flowers. It is also introduced into pastes to be used in sealing packages, which are to protect goods from insects. All these uses of Arsenic render poisoning, especially chronic poison- ing, by it not at all uncommon.

In certain districts Arse?iicum is indulged in as an article of diet. The women take it for the purpose of beautifying the complexion, and the men indulge in it because it enables them to work hard with little or no fatigue. The drug acts on muscular tissue so as to increase its power of endurance. We may make use of this fact when some dis- ease has resulted, from climbing mountains or a long journey, as a pro- voking or modifying cause.

The "Arsenic" vice is very objection- able, and certainly very injurious. After awhile these persons will suffer from Arsenic poisoning; especially if they move away from the region where they are living. The symptoms of slow arsenical poison- ing are these : the eyelids are oedematous and the patient suffers from slight conjunctivitis; the eyes are always red and injected, and smart and burn. Associated with these symptoms is dim sight.

Whether this comes from the inflammation externally, or from any in- ternal ocular trouble, I am unable to say. The mucous membrane of the mouth, nose and throat is unnaturally red and dry. The sufferer complains of almost constant thirst. Digestion is most certainly de- ranged.

The patient will tell you that he is dyspeptic. The skin as- sumes rather a dry, dirty look; it is only exceptionally clear and trans- parent. The patient suffers frequently from nettle-rash. Long wheals appear, and these itch and burn intolerably.

Still later, eczema makes its appearance. The patient also suffers from stubborn neuralgia in different parts of the body. These are the most common; and the most certain symptoms indicating arsenical poisoning. In addition to these there will be some acute symptoms.

For instance, there will be

ARSENICUM ALBUM. 55 1

times when he has attacks of vomiting, with deathly nausea. He will vomit everything he drinks. At other times he has symptoms indi- cating cholera morbus, e.g., vomiting and purging, and coldness of the surface of the body.

You may frequently be called upon to antidote arsenical poisoning. If it is an acute case you should excite vomiting and administer the sesquioxide of iron as an antidote. Dialyzed iron has also been rec- ommended. It has the advantage of being more stable than the ses- quioxide. For the nausea occuring during chronic poisoning, Ipecac acts very nicely. In the acute attacks simulating those of cholera morbus, Veratrum album relieves.

Cinchona also suits many of the symptoms; particularly the debility, dropsy and neuralgia.

Graphites is one of the best remedies to cure the skin symptoms of chronic arsenical poisoning.

Now we will consider the symptoms of Arsenicum in their totality. Quite a universal symptom of the drug, and that, too, whether the re- sult of poisoning or of proving, is what I have already mentioned as an irritability of fibre. This is prominent in the worst cases in which Arsenicum may be used. Death may be almost certain, and yet there is this irritability of fibre showing the universal characteristic of the drug.

Even when the patient lies unconscious, his stupor is broken by anxious moans and restlessness. Consistently with this quality of the drug, we find Arsenic indicated in patients who are anxious and restless, frequently changing their position, full of fear of death; hence they do not wish to be left alone for fear they will die. Delirium is violent, more violent than in any other of the acids except Nitric acid. It is worse at night, particularly after midnight.

The patient has visions of ghosts and other fanciful figures, with trembling of the whole body. You cannot here fail to recognize the similarity to de- lirium tremens or mania- a-potu. Arse?iicum here is of great use, particularly in old offenders who are seriously diseased by the use of alcohol, and who, from some cause or other, cannot get their usual drink.

The pains which the Arsenicu?n patient experiences, whether neu- ralgic or otherwise, make him desperate and angry, and at times almost furious. When falling asleep, he jerks and starts. During sleep his dreams are frightful and fantastic. Before going any further, I want to introduce a caution in regard to Arsenic. Arsenic is not a remedy

552 A CUNICAI, MATERIA MKDICA.

usually called for in the beginning of diseases. The tendency of the symptoms is deathward. If you give the drug too soon, in a disease which in itself tends deathward, you may precipitate the result which you are anxious to avoid. I have myself several times made the mis- take despite great caution.

Do not give Arse?iicum early in typhoid fever unless the symptoms call for it unmistakably. Here it is espe- cially dangerous to give it too soon. Often Rhus tox. precedes its use. I will say the same thing in regard to tuberculosis.

In the last stages of this disease this restless tossing about is not an Arse?iic symptom, and Arsenicum will not relieve it. That is only a precursor of death. You must be certain that the mental state is undisputably that of Arsenic, or you will do harm instead of good to your patient. There is one exception to this word of caution, and that is in inflammations of the gastro-enteric system.

I may say that Arsenicum may here be given quite early in the case without doing any harm, on the contrary with much benefit.

Now for the inflammations and fevers of Arsenicum. Arsenicum alters the blood. It is useful, as we shall learn, in low types of dis- ease, when the blood-changes are serious. The inflammations of this remedy are characterized by their intensity, and by their tendency to the destruction of the tissue which is inflamed.

In these local inflam- mations of Arsenic you will find burning lancinating pains the charac- teristic sensations. This is described by the patient as though hot coals were burning the part. It is often accompanied by throbbing. Now this burning when Arsenicum is the remedy indicates destruction of tissue, hence it calls for this remedy in gangrene, in sloughing, in carbuncles; and in that dreadful disease cancer.

And it does not call for Arsenic when this burning is a mere sensation. Patients occasion- ally complain of burning pains, here and there, which arise from nervous causes only. Arsenicum does no good then. I have often seen physicians give Arse?iic when women complained of burning pain in the ovaries.

There was no evidence whatever of active inflamma- tion ; the burning was purely an ovaralgia. Arsenicum could do no good here. If, however, there is ovaritis with the pain, Arse?iic be- comes an invaluable remedy. All these cases in which Arsenic is called for are relieved by hot applications, and greatly aggravated by cold.

The most important sites for the Arsenicum inflammations are the stomach and bowels primarily, and next to these the heart. The in- flammation in the stomach and bowels may vary from slight irritation

ARSENICUM ALBUM. 553

to the most destructive gastritis and enteritis. The mouth is dry, the tongue white as if whitewashed, or, in some cases with irritable stomach, the tongue is red with raised papillae. Thirst is intense, but the patient drinks but little at a time because water molests the stomach. An ordinary amount of food causes a feeling of fulness or repletion.

In this symptom it is similar to Lycopodium. The least food or drink is vomited as soon as taken. But we may have another group of symptoms : weak, sinking sensation at the pit of the stomach, relieved by eating, but so soon as he begins to eat, he has urging to stool with diarrhoea. Here the drug is similar to Cinchona and Ferrum.

There is very distressing heartburn. Sometimes burning in the stomach like coals of fire is associated with the diarrhoea. The stools are undigested, slimy and bloody, and are attended with violent tenes- mus and burning in the rectum. If this goes on, the stools become brownish or blackish, and horribly offensive, showing that it is indi- cated in most serious cases of enteritis and dysentery.

The exciting causes for these various sets of symptoms are sudden chilling of the stomach with ice- water or ice-cream, alcoholic drinks in excess, certain poisons, as the ptomaine of sausage meat that has spoiled, rancid fat, spoiled butter or fat that has undergone decomposition, and lobster salads at certain seasons of the year.

Arsenicum also excites intestinal disease which is almost identical with cholera Asiatica. Even the organic growths of cholera are found in the discharges from the Arsenic proving. Do not conclude from this that Arsenic must be the remedy for cholera Asiatica. It is only the remedy when we have the following symptoms : intense vomiting and purging, the stools being not so much like rice-water as they are brownish-yellow, profuse, and offensive.

The vomited matters are green, yellow and bilious. There is burning thirst, with the intense agony which belongs to Arse?iicum. The surface of the body is as cold as ice, but internally, the patient feels as if on fire.

Arsenicum is also useful in cholera infantum, and in atrophy of in- fants. It is indicated by many of the symptoms that have already been enumerated. The symptoms of the bowels are, undigested stool, diarrhoea which is provoked just as soon as the child begins to eat or drink, aggravation after midnight (particularly the restlessness and the diarrhoea), and rapid emaciation. The child's skin is apt to be harsh and dry, and often yellowish and tawny. The little patient is

554 A CLINICAL MATERIA MBDICA.

restless, evidently being in constant distress. Here, too, we often have to give Arsenic quite early in the case, because here the symp- toms have been going on before your arrival. It stands in close rela- tion with Nux vomica and Sulphur m. atrophy of infants. For instance, early in the case of marasmus, you may give Arsenicum, providing diarrhoea is present, in a case which would call for Nux vomica or Sul- phur were constipation present.

The same dried-up mummy which you find in the Sulphur case, with the peculiar gastric symptoms of Arse?iic, would call for Arsenic. In far-advanced cases, the resem- blance is not to these remedies, but to Cinchona , or China, and to Argentum nitricum.

Now let us study some of the related remedies of Arsenicum in gastro-intestinal troubles.

Arge?itum nitricum has slimy, greenish stools, with excessive flatu- lence, worse at night. Although both remedies have restlessness, it is not the same in each case. Arsenicum has a restless desire to change place, now sitting, now standing. The restlessness of Nitrate of Silver is purely nervous. The patient has difficulty in breathing, with long sighs.

Much more frequently will you be called upon to differentiate between Arse?iicu?n and Carbo veg. Carbo veg. is somewhat similar to Arsenicum in abdominal affections arising from chilling the stomach, as with ice-water. It has, perhaps, less of the distinctive restless tossing about, but at the same time it may have a nervous, irritable, anxious state, without tossing about. Carbo veg. is also a similar remedy to Arsenicum when rancid fat has excited gastro-enteric symptoms.

Secale cornutum is very similar to Arsenicum in many of its symp- toms. The two drugs are complementary. They agree well one with the other. In the abdominal symptoms both drugs meet in cholera Asiatica.

Arsenicum may be distinguished from Secale by these few symptoms: the movements in Secale are copious and come in spurts; Secale has not the same restlessness that belongs to Arsenicum. Now, when there are any spasmodic symptoms present, as is often the case, you will find, under Secale, fingers spread asunder, with tingling in the hands and feet, intolerance of heat.

Veratrum album is somewhat similar to Arsenicum, in cholera morbus. The latter has not so copious a stool as the former, and cold sweat on the forhead is more marked in Veratrum.

ARSENICUM ALBUM. 555

Do not forget that Cadmium sidphiiricum is similar to Arsenicum in black vomit, whether that symptom occur in yellow fever or in any other disease.

We find Arsenicum often indicated in intermitting types of fever. We all know how often Arse?iic succeeds Cinchona in the treatment of chills and fever. It has cured many cases, especially after the failure of Quinine, or after the abuse of that drug; or when the fever has been contracted in salt marshes along the seashore. The chill is not well defined; in fact, it is rather irregular, but the heat is unmis- takable.

It is intense, with burning thirst, especially for hot drinks; cold drinks make the patient feel chilly. Sweat does not always re- lieve. Sometimes it appears very tardily. The apyrexia is marked by severe symptoms, dropsy showing itself as the result of enlarged spleen or liver.

The patient is scarcely able to sit up. He is often annoyed by neuralgia, which is typical in its recurrence. The pain usually affects one side of the face and seems to be almost maddening, driving the patient from place to place. At the height of the attack there are nausea and vomiting and buzzing in the ears.

Arsenicum may be also used in intermittent, semilateral headache of malarial origin, especially after the abuse of quinine.

There are several drugs similar to Arse?iicum in these malarial neu- ralgias. Cedron has neuralgia, returning at precisely the same hour each day.

Chininum sulphuricum is also suited to periodical attacks of neu- ralgia, relieved by hard pressure.

Valerian is to be thought of in hysterical patients.

Cactus grandiflorus has neuralgic and other forms of pain, which are sure to appear when the patient misses an accustomed meal.

Kalmia and Kreosote are useful in neuralgia, especially when there are burning pains.

Magnesia phos. is called for in neuralgia which occurs regularly each night, and is relieved by heat and pressure.

Mezereum has neuralgia in the cheek-bone or over the left eye. The pains leave numbness. They are worse from warmth. It is espe- cially useful when there have been herpetic eruptions after the abuse of mercury. It is one of the remedies we use for the neuralgia of zona.

Robinia has: jaw-bone feels as if disarticulated. With this there is intensely sour taste and waterbrash or sour vomiting.

556 A CLINICAL MATERIA MKDICA.

Other remedies to be borne in mind are Cinchona, Spigelia, Platinum, Stannum and Ckelidonium.

In typhoid fever Arsenicum is indicated late in the disease, when the blood changes have so far progressed that you have a picture of com- plete exhaustion. The patient thinks himself still able to move about until he finds out how weak he is. He has fainting attacks, which are very alarming; he faints dead away, with cold sweat on the body. The delirium is worse after twelve p. m., and is attended with great restlessness.

He is sleepless at three a. m. on account of the great heat. The mouth and tongue are covered with sordes, and with a dark brownish coating. Sometimes the tongue is very red. Around the dorsum and tip of the tongue you wTill find the papillae red and raised, as under Belladonna, but the concomitant symptoms enable you to differentiate it from that remedy at once.

The mouth is full of blisters and aphthous ulcers which bleed readily. In other cases, the tongue is bluish with ulcerated edges. Sometimes, in severe cases, water cannot be swallowed because of partial paralysis of the oesopha- gus. You do not often find much tympany in the Arse?iic case.

The bowels are very much disturbed. Diarrhoea is almost always present, and seems to be provoked by every attempt to eat or drink. Some- times, stool and urine are involuntary. The stool is yellowish and watery in character, horribly offensive and worse after midnight.

At other times the stools contain blood, slime and pus. In some cases the urine is retained from atony of the muscular fibers of the bladder. The fever is intense, being almost sufficient to consume the patient. Sometimes, you have the hemorrhagic diathesis to deal with, and there is oozing of blood from various parts of the body, from the eyes, nose, etc.

This is a dangerous symptom.

Colchicum is a remedy which we are very apt to neglect in typhoid fever. It seems to stand in typhoid conditions between Arsenic and Cinchona, having the excessive weakness of the former remedy and the marked tympany of the latter. The chief symptoms of Colchicum are abdominal. They are, this great tympany, involuntary, forcible, watery stools, accompanied with nausea and frequent vomiting of bile.

The body is hot and the limbs are cold, just as in Phosphorus. The nose is dry and blackish. The teeth and tongue are both brown. The mind is somewhat cloudy.

He answers questions correctly, but otherwise says nothing. He seems not to know the danger he is in.

The relations of Arsenic to other remedies in typhoid fever have

ARSENICUM ALBUM. 557

been described to you elsewhere. I need not, therefore, repeat them here.

Arsenicum may also be useful in continuous fever, which, in its early stages, so closely resembles that of Aconite that you may not be able to distinguish between the two drugs. There are hot skin, full bounding pulse, restlessness and anxiety. Thus far, it is exactly like Aconite. But it does not end here.

It goes on to a continuous type of fever without any intermissions, and with only slight remis- sions. The heat increases, the patient grows more restless and weaker, the tongue becomes brown and typhoid symptoms develop.

Now, the distinction between Arsenic and Sulphur is easily made. Sulphur is also useful in continuous fever. Arsenic is indicated when the great restlessness and burning show you that the case has gone beyond simple continuous fever.

Now, the action of Arsenicum on the mucous membranes. We find it an excellent remedy in winter colds. The nose discharges a thin, watery fluid, which excoriates the upper lip, and yet the nasal pass- ages feel stuff ed-up all the time. This is accompanied by dull throb- bing frontal headache.

Repeated attacks of this kind of catarrh or coryza result in the discharge of thick, yellowish, muco-purulent matter. Ulcers and scabs form in the nose. Sneezing is a prominent symptom. Now this sneezing in the Arsenic case is no joke.

It does not give the relief which one usually gets from a good sneeze. It is a sneeze which starts from irritation in one spot in the nose as from tickling with a feather. After the sneeze, this irritation is just as annoying as it was before. As the cold creeps downwards, you find the case complicated with catarrhal asthma.

Dyspnoea appears. The patient cannot lie down, particularly after midnight. He is greatly relieved by cough with expectoration of mucus.

Arse nictiin jodatum closely resembles the "album" in coryza, hay- fever and influenza. It has the same thin, acrid discharge, and chill- iness, but owing to the Iodine it contains there is a marked affinity for lymphatic glands.

You will at once recognize the similarity between the symptoms of Arsenic and those of hay-fever. Other remedies which you may re- member for this condition are: Aila?ithus, Silicea (which has itching or irritation in the posterior nares or at the orifices of the Eustachian tubes), Lobelia inflata, and a remedy introduced by the late Dr. Jeanes, Rosa Damascena.

558 A CLINICAL MATERIA MBDICA.

This Rosa Damascena is useful in the beginning of rose-cold when the Eustachian tube is involved and there is some little hardness of hearing and tinnitus aurium.

Sinapis nigra is indicated when the mucous membrane of the nose is dry and hot. There is no discharge. The symptoms are worse in the afternoon and evening. Either nostril may be affected alone or alter- nately with the other.

Wyethia is specific when with the usual symptoms of hay- fever there is itching of the soft palate.

Arsenic is one of our prime remedies in asthma, whether acute or chronic, with aggravation after midnight and from lying down. The patient is beside himself with anguish. The case may be complicated with emphjrsema, expiration being very much prolonged as in that disease. It follows Ipecac well.

In emphysema you should compare Lac/zesis, Sulphur, Ipecac, Anti- monium tartaricum, Naphthalin, Carbo veg, and above all the Arse- nite of Antimony.

In diphtheria, Arsenicum comes into use as a most valuable drug. Arsenic crude kills the microscopic growths which produce the dis- ease. In its potentized state it cures when there is foetid breath, ady- namic fever and a great deal of somnolence, which is broken by starts, crying out and by jerking of the limbs. The membrane looks dark and is gangrenous.

The pulse is rapid and weak. I would advise you to substitute Arsenicum iodatum, if, in addition to the usual Arsenicum symptoms, there is marked enlargement of the lymphatic glands.

I have stated that Arsenic acts on the heart. It gives us a list of cardiac symptoms which are, in brief, these: the heart-beat is too strong, it is visible to the person standing by and is audible to the patient himself. It is worse at night and is particularly aggravated when the patient is lying on his back. There maybe palpitation with great irregularity of the heart's action.

Or the pulse may be acceler- ated and weak. In cardiac inflammations, endocarditis or pericarditis, we find Arse?iic indicated after the suppression of measles or scarlatina. You then find present the characteristic restlessness and agony of the drug, tingling in the fingers, especially those of the left hand. (Edema is more or less general, beginning with puffiness of the eyes and swelling of the feet and ending with general anasarca.

There is great dyspnoea. Now there are two varieties of dyspnoea which belong

ARSENICUM ALBUM. 559

to heart disease, one which depends upon the defective carrying of the blood through the lungs and the system generally, and the other which is due to accumulation of water in the chest, hydrothorax and hydropericardium. There are spells of suffocation, worse at night, particularly after midnight and on lying down. The skin is cool and clammy, while internally, the patient is burning hot. Now if this condition calling for Arsenic goes on uncured, Bright' s disease of the kidneys develops.

The urine is highly albuminous and contains waxy and fatty casts. Dropsy appears. Little blisters form in the cedematous limbs on the legs, and these burst, and serum oozes forth. The skin itself is rather tense and has a pale waxen hue.

Exhausting diarrhoea usually accompanies these symptoms. There is very apt to be also a burning thirst with intolerance of water.

I wish you now to recall the comparison that I have already given you between Arsejiicum and Apocy?iam, and Acetic acid, which stands midway between Arse?iicum and Apis. I would also have you recall the similarity between Arsenicum and Mercurius sidphuricus in hydro- thorax.

In kidney affections you may compare Arsenicum with Apis, Helle- borus, Phosphorus, Aurum, Terebinthina and Digitalis.

Now the Digitalis symptoms are these: there is venous hypersemia of the kidneys. You are to study it, therefore, in renal affections when there are present dropsy, feeble or slow pulse, scanty dark turbid urine, which will, of course, be albuminous. It is exactly like Arsenic, without the restlessness and irritability of that remedy.

Again, we find Arsenicum indicated in that dreadful disease, angina pectoris. The patient is obliged to sit upright; he cannot move a muscle of his body without great suffering. He holds his breath, so painful is it for him to breathe. The pain seems to radiate from the heart all over the chest and down the left arm. In extreme cases there is cold sweat on the forehead, the pulse becomes scarcely per- ceptible, and, with all this, there is apt to be burning around the heart.

I would now like to refer to the action of Arsenic on the skin. You have already seen that it tends to produce induration or harden- ing of the skin. This renders it a valuable remedy in eczema, in fact, in every variety of skin disease in which there is thickening of that structure, with copious scaling. Arsenicum is also useful in eczema proper, when vesicles appear which turn into pustules and form scabs.

560 A CUNICAI, MATERIA MED1CA.

Arsenicum is specifically indicated for bran-colored scales on the head, coming down over the forehead. It may also be called for when there is a thick scabby eruption on the scalp, oozing pus, and very offensive.

Arse?iicum compares with Sepia, Rhus tox., and Graphites. L,ike Sepia there is a dry scaly desquamation, but in Sepia this " peeling " follows vesicles which were not surrounded by very red skin, or it follows a fine rash, worse about the joints, or a circular eruption like herpes circinatus.

Rhus tox. has vesicles on a red erysipelatous surface, chiefly about the genitals and on hairy parts.

Graphites looks very much like Arsenicum, but has oozing of a glutinous fluid.

Clematis is similar to Arsenicum, but has more rawness, aggravation from washing and moist, alternating with dry scabs.

Hydrocotyle has eczema with skin thick and scaly, but less burning than in Arsenic.

Under Kreosote the scales pile up into large masses; eruptions on the extensor surfaces of the limbs. Restlessness. Natrum mmiaticum on the other hand produces scaly eruptions on flexor surfaces and the bends of joints; dandruff alternating with catarrh and loss of smell.

In the exanthematous diseases we find Arsenicum indicated first of all in urticaria. Here it is a valuable drug when the wheals are at- tended with burning, itching, and restlessness. Particularly may it be indicated for the bad effects of repercussion of hives. Even croup may be cured by Arsenic if it follows the retrocession of nettle-rash.

In scarlatina Arse?iic is to be used in some of the worst cases when the rash does not come out properly. The child is thrown into con- vulsions, and lies pale and in a sort of stupor, with restlessness and moaning. Suddenly it seems to arouse, and immediately goes into convulsions, and then relapses into stupor again. Arsenicum is also useful when, during the course of scarlatina, the parotid glands swell and suppurate, after the failure of Rhus.

Arsenicum is useful in gangrene, particularly in the dry gangrene of old people, with great soreness and burning in the affected part, with relief from warm or hot applications. This modality furnishes you with a sufficient distinction between Arsenic and another great gangrene remedy, Secale, which is useful in dry gangrene, with relief from cold applications. Lachesis is one of the best remedies for gan- grene after injuries, as when the edges of a lacerated wound turn black.

ARSENICUM ALBUM. 56 1

Cinchojia suits in gangrene with haemorrhage or after great loss of blood.

We may use Arsenicum in carbuncles or in boils with pepper-box openings and dipping deeply into the cellular tissues. It is indicated by the character of the pains, which you know run all through the Arsenicum symptoms, cutting, lancinating, burning pains, with aggra- vation after midnight, and irritability of mind and body.

Arsenicum sometimes fails in carbuncles. Then we have to resort to Anthracinum, chiefly in the thirtieth potency. It has precisely the same symptoms as Arsenicum, but to a more intense degree.

Phytolacca is a remedy to be thought of in this affection when there are lancinating, jerking pains. It is said to promote suppuration.

Carbo veg. and Lachesis are remedies that we neglect in this disease. If we use Carbo veg. it is well also to use a charcoal poultice over the carbuncle.

Arsenicum may be used in cancer. I am not going to propose that this drug will cure cancer. Epithelioma has been cured by Conium, Hydrastis, Arsenic, Clematis and a few other remedies. But in cases of genuine open cancer I have not seen any cases cured; but even if these cases cannot be cured, it is still possible to give them some relief.

The pains of cancer you know to be torture. They are of a sharp lancinating character; a red hot knife thrust into the part could not be worse. Arsenic sometimes relieves these cases when indicated.

In some cases Arsenicum iod. relieves when Arsenicum album fails. In others Belladonna brings relief.

The ulcers for which Arsenicum may be given are not usually very deep. They are rather superficial. The pains are of the character already described, burning and lancinating. The discharge is apt to be excoriating, dark and sanious and they are apt to bleed very readily.

Lastly, we will consider Arsenicum as a remedy in nervous affec- tions. It is indicated in hemicrania when the pains are worse over one e3^e, and are of a severe lancinating character. They often alternate with colic or affections of the liver. They are worse from any motion, and are temporarily relieved by cold applications.

It may also be used in epilepsy. The patient falls down uncon- scious, and then writhes in convulsions. Before the attack he has spells of vertigo and intense aching in the occiput. The convulsions are followed by stupor, which, however, is not complete, but is broken by the ever present restlessness.

LECTURE LIV.

PHOSPHORUS.

Nux vom., Coffea, Ambra. Rhus tox., Muriatic acid, Iyachesis. Carbo veg., Arsenicum, Nitric ac, Kali carb. China, Veratr. alb. . Sulphur, Calcarea ostr., Silicea, Lycopod., Calcarea

phosphorus, i phos

Cepa, Bryonia. Zinc.

Terebinthina. Osmium.

>Nux vomica, Terebinthina. <Causticum.

This hour I wish to say a few words about Phosphorus. It has two complements, Arsenicum and Allium cepa. I have placed Nux vomica and Terebinthina as the antidotes. The use of Terebinthina comes to us from the old school. It seems to antidote Phosphorus by chemical action in rendering it inert. It also has antidotal effects when used in potency. Nux vomica is good when Phosphorus, as a remedy, has produced over-effects, or when it has been incorrectly given.

In the study of Phosphorus we have to remember, first of all, as most important and as a quality that permeates every part of the Phos- phorus proving, its action on the nervous system. Its symptoms in no instance point to increase of power or vitality, or to any genuine stimulation of function, but rather to that condition which we found under Arsenic, irritable weakness. The patient is exceedingly sus- ceptible to external impressions. He can bear neither light, sounds nor odors; he is very sensitive to touch.

Electric changes such as occur in sudden changes of the weather, but particularly in a thunder- storm, make him anxious and fearful, and aggravate all existing symptoms. His mind, too, is excitable and impressionable. He is easily angered and becomes vehement. This is not a simple peevish- ness.

He actually gets beside himself with anger, and, just like the

PHOSPHORUS. 563

Nux and the Chamomilla patient, he suffers physically in consequence. At other times he is anxious and restless, especially in the dark or about twilight. He has all sorts of fanciful or imaginary notions. He sees faces grinning at him from every corner of the room.

His thoughts may be so stimulated that they fairly rush through his mind; but this effect is only transient, and followed either by inability to think and remember, or by aggravation of all his symptoms on mental exertion. He cannot stand mental tax. Here again ft impinges on Nux vomica. As further evidence of the irritable weakness of Phos- phorus, we have the delirium of that remedy.

Now this delirium may be associated with typhoid fever, with jaundice, or with sexual erethism. It may be quite violent. It is characterized by a condition of ecstacy. The patient has a notion that his body is all in fragments, and he wonders how he is going to get the pieces together.

He imag- ines that he is a great person surrounded by grand accoutrements, the mania of grandeur it is sometimes termed. At other times the mania takes the form of sexual excitement. He uncovers his person without any shame and seeks to gratify his sexual appetite, no matter who may be the victim. These delirious attacks pass into a state of coma, or into stupid condition of mind or state of apathy, during which he answers questions not at all or very reluctantly.

Phosphorus is here very similar to Hyoscyamus, and often follows that remedy to erotic mania. It also bears points of resemblance to Stravionium, Bapfisia, Rhus fox. and Muriatic acid.

The same quality of the drug is shown in the symptoms throughout the body. Headache, for instance, is attended with increased sensi- tiveness to odors; the sense of smell is very acute, so that the patient faints away from the smell of flowers. There may be pulsating, throb- bing headache, worse from music. The hearing for the sound of the human voice is imparled; associated with this is roaring in the ears, as from rush of blood.

Sounds reverberate unpleasantly in the ears. There is also sexual excitement with frequent erections, lascivious thoughts entirely beyond the control of the patient, and frequent seminal emissions during sleep.

Symptoms of the spinal irritation are very characteristic of Phosphortts. These are associated with palpitation of the heart, worse from any emotion, whether it be grief, anger or pleasure. The spine, as in all these cases of spinal irritation, is exceedingly sensitive to touch. With all this there is a weakness of the spine. The back feels weak, as if it

564 A CT.INICAIv MATERIA MEDICA.

would soon give out. There is weakness of the limbs, with trembling, on beginning to walk. The patient stumbles a great deal, catching his toes in every little projection of the floor or pavement. He totters, and there seems to be imperfect coordination.

He is sleepless from excessive heat. When asleep, his dreams are of a horribly exciting character. These are illustrations of the erethism of Phosphorus and also of diminished resistence to external stimulants. Such persons may degenerate into various diseased conditions.

The loss of animal fluids, as blood, semen, or milk, or too frequent child-bearing, or too rapid growth in the young, is sufficient to precipitate nervous diseases such as paralysis, chorea and spinal disease, or tuberculosis.

You will find Phosphorus indicated in locomotor ataxia, when there is a great deal of burning along the spine. There is also great ting- ling and formication along the spine and in the affected extremities. In the beginning the patients have extreme sexual excitement. That is a sort of sine qua non, either that they are excessively excitable, or else have been so.

You seldom find Phosphorus indicated in impotence, unless it has resulted or has been preceded by over-excitation of the sexual organs. This is a valuable hint. I find it especially indicated in young men who are trying to restrain their natural passion, and yet there is locally this erethism. This Phosphorus helps most wonderfully to control?

If, by reason of celibacy or of over-indulgence in sexual pleasures, the sexual organs lose their power and the patient becomes impotent, Phos- phorus is the remedy when this has been preceded by over-excitation. It is different from Conium, in which the patient may have been natu- rally excitable, but has gone on to this weakness.

Phosphorus is indicated in locomotor ataxia also, when it can be traced to excessive loss of animal fluids, as semen.'

Softening of the brain is another form of atrophy of the nervous tissue in which Phosphorus has won many laurels. The patient has a dull pain in the head, a wearied, tired feeling all the time, and slight difficulty in walking. It is particularly indicated after the use of Nux vomica. The question is sometimes asked, and quite properly, too, how can you put Nux vomica down as the antidote of Phosphorus, and then speak of it as a remedy that can precede or follow it?

First, the antidote may follow the drug and may be needed, not to antidote it, but because symptoms which come up have an opposite polarity, and, consequently, require an opposite remedy; and, secondly, a remedy may be antidotal in some of its symptoms and concordant in others.

PHOSPHORUS. 565

Phosphorus may be used very successfully in chorea when it occurs in children who are growing too fast. The patient is very weak and walks as if paralyzed.

Continuing the nervous symptoms of Phosphorus still further, we find it indicated in low types of nervous fever and in typhoid types of fever. I am induced to use this expression, typhoid types of fever, in order to show that you can consider Phosphorus, not only in typhoid or typhus fever, but in any form of fever which assumes a typhoid form when these symptoms appear. It is indicated when there is great cerebro-spinal exhaustion. It is particularly the brain and spine which seem to have suffered from typhoid poison.

The face is apt to be of an ashy or waxen hue or appearance. The tongue is covered with a viscid, thready sort of slime, which is expectorated with great difficulty. It seems to collect on the teeth and around the gums and on the tongue. It is tenacious and the patient is weak; and these two incompatibles make it difficult for him to cleanse the mouth.

The body is hot. — and by the body I mean the trunk, — the head being rather cool and the limbs decidedly cold. There is congestion of both chest and abdomen. The breath is hot, and there is almost always either bronchial catarrh or pneumonia. I refer now more particularly to the pneumonic infiltration which belongs to typhoid fever, in which case Phosphorus is often indicated.

The patient has burning thirst, which is relieved by drinking cold water. The thirst is worse from three to six o'clock in the afternoon. The patient is better from cold water until the water becomes warm in the stomach, when it is violently ejected. Phosphorus does not often do any good in vomiting, except in the chronic vomiting of dyspeptics, unless this condition is present.

This is quite different from Arsenic. It is also very different from Bismuth, this last-named remedy has vomiting immediately after taking food, with burning, cardialgic pains.

It is different from Kreosote, which has vomiting of undigested food hours after eating.

Let us return to Phosphorus in typhoid types of fever. The bowels are always affected. You will find that the liver is sore to the touch and usually enlarged. This is also true of the spleen. The patient has diar- rhoea as soon as he eats. Here it is identical with Arsenic. Now, the stools in the Phosphorus case are flaky, dark, and often bloody, and there is extreme weakness after stool, that being a decided cerebro-spinal

566 A CLINICAL MATERIA MEDICA.

symptom. You find it in the cerebro-spinal remedies, in Conium, in Nux vomica, and especially in Phosphorus. When there is constipa- tion you may have what has been called characteristically " dog stool," i. e., long, slender stool, which is evacuated with considerable effort. During this fever, which I say is mostly congestive and affects the chest and abdomen, the patient continually throws off the bed-clothes.

He puts the arms out of bed to cool off. There is profuse sweat which does not relieve. Now I would like to caution you here that Mercury is not indicated in typhoid fever unless there be clearly defined icteroid symptoms, consequently you will not often have occasion to give it in this fever, and never should you give it for this symptom, "profuse sweat without relief, ' ' unless it is so well defined by the icteroid and bowel symptoms that you are certain that you have the properly indi- cated remedy.

Other remedies than Mercury have this symptom, notably Phosphorus, and also Rhus tox. and Chamomilla , the latter par- ticularly in children. Phosphorus is indicated even in extreme cases of typhoid fever when there is threatening paralysis of the lungs. The patient lies in a sort of coma, with hot breath and rattling breathing. It seems as if there was a large quantity of phlegm rattling in the lungs.

The limbs are cold and are covered with a cold sweat. The pulse is scarcely perceptible.

I would here remind you of Carbo veg. as also being suitable in col- lapse. It follows Phosphorus very well. It is distinguished, theoretic- ally at least, from the latter remedy by this: Phosphorus acts more upon the cerebro-spinal nervous system and Carbo veg. more upon the sympathetic nerves, particularly on the solar plexus.

Next I wish to speak to you of a property of Phosphorus which does not depend upon the action of the drug on the nervous system, and that is the power of the drug to produce fatty degeneration. Phosphorus seems to affect the blood, how is not exactly known. It decomposes the blood, rendering it more fluid, rendering it difficult to coagulate. At the same time it produces hyperemia of one part or another.

Thus you will find tendency to congestion of the head or of any of the viscera of the body. This hyperemia is not an active arterial congestion, but rather a stasis of blood. The affected part be- comes engorged with blood, and as this is of an impoverished quality, it does not nourish properly and we have setting-in fatty degeneration of the part. This may be in the brain or spine (of this I have already spoken), it may be in the heart or lungs, but it is especially apt to

PHOSPHORUS. 567

occur in the liver and kidneys. The muscles even may undergo fatty degeneration.

On the liver, Phosphorus acts very prominently. The symptoms here are directly connected with fatty degeneration. When Phospho- rus is taken for a long time you will find at first this hyperemia of the liver. That organ is consequently enlarged with the attendant symp- toms, well-marked soreness and jaundice.

The stools are apt to be grayish-white, showing the absence of the secretion of bile. The ab- domen becomes decidedly tympanitic. By and by, the jaundice in- creases to an alarming extent, the pulse becomes weak and thread- like. These symptoms are traceable to two causes: first, the inevit- able alterations in the blood which Phosphorus produces; and secondly, the poisoning of the blood by the retention within it of the elements which go to make bile.

These have a depressing effect on the heart, making the pulse slow or else weak and thread-like. If you examine the liver at this stage, you find that it is beginning to atrophy, this atrophy depending upon destruction of the hepatic cells proper and increase of the stroma of the liver. The connective-tissue framework of the liver has undergone inflammatory increase. The pressure which this exerts on the hepatic cells causes their destruction.

Thus we have what has been termed cirrhosis of the liver. Then comes ascites, and you find varicose veins coursing all over the abdomen. The blood becomes so poisoned that the patient goes into the delirium which I have already described. The urine may be highly albumi- nous in these cases.

The icteroid symptoms increase and, finally, death ensues.

Phosphorus is useful in acute yellow atrophy of the liver, a condi- tion which it also produces.

Again, it may be useful in fatty degeneration of the liver as a sequel of heart disease. It may also be indicated in waxy liver dependent upon long-lasting bone disease, as caries of the vertebra or of the hip- joint.

Phosphorus is also indicated in hepatitis when suppuration ensues with hectic fever, night sweats, enlargement in the right hypochon- drium, and marked soreness over the liver.

The jaundice of Phosphorus is not functional in origin, but is indi- cative of organic disease; it is associated with anaemia, with brain dis- ease, with pregnancy or with malignant diseases of the liver.

Phosphorus has a marked action on the alimentary tract. The

568 A CLINICAL MATERIA MEDICA.

tongue is coated white, and this, as under Bryonia, is more along the middle of the organ. With bilious affections, the tongue is coated yellow; in typhoid affections, it is brownish or blackish and very dry. Here it is very much like Rhus. The throat and adjacent parts may be inflamed, particularly the uvula.

White, transparent mucus col- lects in the throat. The patient is very hungry, particularly at night. This S5^mptom may almost amount to bulimy, which is also an indica- tion for Phosphorus in chills and fever. He wakes up hungry and lies awake until he gets something to eat.

There is longing for cold things, ice-cream, ice-water, etc. Cold food seems to relieve until it gets warm in the stomach, when there appears the characteristic vomiting of the remedy. Phosphorus may cure vomiting in chronic dyspepsia when there seems to be simple exhaustion of the stomach. Perhaps the inner surface of the viscus is coated with mucus, thus preventing the action of the gastric juice on the food.

We also find Phosphorus useful in spasmodic stricture of the oesoph- agus, especially at its cardiac end. Food seems to go down a certain distance and then it is violently ejected.

Coming to the stomach itself, we find Phosphorus indicated in that very dangerous disease, perforating ulcer of the stomach. We find it there indicated by the pain, by the vomiting of food as soon as swal- lowed, and by the vomited matters containing a dark, grumous, semi- solid substance looking like coffee-grounds.

We also find Phosphorus indicated by these same symptoms in cancer of the stomach, particularly when it is about to pass into the stage of ulceration.

Phosphorus is one of the few remedies that act on the pancreas. It is especially useful if there be fatty degeneration of that organ. The symptoms indicating it here are the gastric symptoms just enumerated, and oily stool. Sometimes the stool looks like frog spawn, or, to speak more accurately, like cooked sago. Phosphorus may also be remembered in diabetes mellitus and Bright' s disease when these have been preceded or are accompanied by disease of the pancreas.

The intestinal tract is attacked by Phosphorus almost as violently as it is by Arsenicum. It produces constipation, the character of which I have already explained to you. It also produces diarrhoea. The stools may be profuse and watery, and worse in the morning. Here it runs against Sulphur and Podophyllum. It also produces green mucous stools, worse in the morning. The stools are apt to contain undigested

PHOSPHORUS. 569

food and are very debilitating to the patient. We find Phosphorus in- dicated in cholerine, or diarrhoea occurring in time of cholera epidemics. Paralysis of the bowels is also produced and cured by Phosphorus, particularly when the lower portions of the bowels, the colon and rectum, are affected. The anus seems to stand wide open and exudes moisture.

In diseases of the urinary organs Phosphorus is a first-class remedy. It is to be thought of in the diseases classed under the general term, Bright' s disease. It is useful in fatty or in amyloid degeneration of the kidneys, especialty if associated with a similar pathological condi- tion of the liver and of the right or venous heart, with the consequent symptoms of venous stagnation and venous r^persemia in different organs, with oedema of the lungs and all the symptoms of pulmonary engorgement which indicate pneumonia. The urine contains epithelial, fatty or waxy casts.

Phosphorus may cure haemorrhages from any part of the body, par- ticularly from the lungs and stomach when associated with Bright' s disease.

Phosphorus is a decided irritant to the sexual organs in either sex, producing nymphomania in the female and satyriasis or uncontrollable sexual desire in the male.

It does not affect the female organs very prominently. The menstrual discharges seem to be altered. They are often too profuse and long- lasting, the menstrual blood being too pale. There is always a weep- ing, sad mood at that time. However, we find Phosphorus indicated more when the menses are checked; amenorrhcea when vicarious blood-spitting, epistaxis or hsematuria ensues.

In diseases of the mammary gland, Phosphorus is especially useful when abscesses have formed. The inflamed gland has an erysipelatous appearance. Red streaks radiate from the opening in the abscess. The pus discharged is not laudable, but is of a thin, watery, ichorous character. Here it is complementary to Silzcea, and very similar to Belladonna.

Next we take up the action of Phosphorus on the respiratory passages. In nasal catarrh we do not find it often indicated except it be chronic catarrh or ozsena. Then it is indicated by the color of the discharge, which is green mucus and blood-streaked. Green mucus not blood- streaked does not often require Phosphorus.

Nasal polypus, when it bleeds much, calls for Phosphorus. It may

570 A CLINICAL MATERIA MEDICA.

also be used in polypi of the ears or uterus. Other remedies to be thought of here are Teucrium, Calcarea, Calcarea phos., Thuja and Sa?iguinaria.

On the larynx it acts more prominently than any other remedy we have. The symptoms indicating it here are hoarseness, which is usually worse in the evening, at which time it may amount to aphonia, and extreme sensitiveness of the larynx. The patient is worse from talking or coughing. It hurts the larynx for him to cough or talk, so sensitive is it to the vibrations thus produced.

It also causes catarrhal and membranous croup, but it is not usually indicated here in the beginning. But it acts as a sort of prophylactic to prevent the return of the disease. It is useful also in advanced cases of croup when the cerebro-spinal system is giving out, just as we found in typhoid states. Thus there are aphonia, rapid sinking of strength, cold, clammy sweat, rattling breathing, sunken, pale face and dropping of the lower jaw.

The pulse in such cases is weak, thready and intermittent. In this group of symptoms Phosphorus is very similar to Lycopodium.

You find Phosphorus indicated in tracheitis and bronchitis, especially in tall, slender persons of rather tuberculous habit or tendency, rather inclined to stoop and to be hollow- chested. The cough is particularly worse on going from the warm room into the cold air, or in changes from warm to cold. It has dry, tickling cough caused by irritation in the larynx and beneath the sternum. In extreme cases it is associated with tremor of the whole body, so nervously weak is the patient.

It is frequently accompanied by almost intolerable pain in the larynx from laryngeal catarrh, by splitting pain in the head just as you found under Bryonia, and by burning rawness down the larynx and trachea. There is tightness across the upper third of the lungs. Now, a word of caution respecting this tightness. It is not a feeling as from a band around the chest, but as though the lungs themselves were con- stricted.

The relation between the fauces, larynx and trachea, as a starting point for cough, has been aptty mapped out by Dr. Dunham and care- fully distributed among three remedies. For instance, Belladonna acts upon the fauces. It causes dry, tickling, teasing cough. The throat is bright red and the tonsils enlarged.

Going further down, you find tickling in the suprasternal fossa. Every change in the breathing causes cough. This condition calls for Rumex.

PHOSPHORUS. 571

When the irritation extends down still further, into the bronchi, then Phosphorus becomes the remedy.

We find Phosphorus indicated in a great variety of coughs. Thus it is useful in stomach or hepatic cough coming on after the patient eats, and starting from tickling at the pit of the stomach. It is also indicated in cough made worse by the entrance of a stranger into the room ; this being purely a reflex nervous symptom. It is also called for in cough provoked by strong odors. In fact, perfumes or anything that will disturb the balance of the nervous system will bring on cough under Phosphorus.

Phosphorus is indicated in bronchitis or bronchial catarrh, whether the disease involves the bronchial tubes high up or whether it extends down into the bronchioles. The symptoms are as follows: cough, with tearing pain under the sternum, as if something were being torn loose; suffocative pressure in the upper part of the chest, with constriction of the larynx. You will also find the lungs to be engorged with blood, mucous rales through the chest, panting and labored respiration and even emphysema.

The sputa are of various kind. Thus we may have bloody and mucous sputum. Very characteristic is sputum, consisting of yellowish mucus, with streaks of blood running through it. It may be rust-colored, as in pneumonia, or it may be purulent and have a sweetish or salty taste.

In pneumonia, Phosphorus is indicated when the bronchial symp- toms are prominent. Then it is almost certain to be the remedy. It does not cause hepatization of the lungs, so that it would not be indi- cated when the lung or lungs are in a complete state of hepatization. But it may be indicated for typhoid symptoms in the course of pneu- monia (these symptoms I have already given to you), especially in the latter part of the period of deposit and in the early part of absorption, that is, just when hepatization is coming on and just when it is going off.

There is great dryness of the air-passages, with burning, excoriat- ing, raw feeling in the upper part of the chest.

In tuberculosis you find Phosphorus indicated particularly in youths, and by this expression I mean both young men and women who have grown too rapidly, who have delicate skin, long silky eyelashes, and who are of easy, graceful manners. The mental development is excel- lent, yet they have not the physique to support this keenness of mind. Particularly is it indicated if they have a hereditary tendency to con- sumption, or have had bone diseases in early childhood. The early

572 A CLJNICAE MATERIA MEDIC A.

symptoms, you will notice, are these: the patient catches cold easily; he suffers from rush of blood to the chest; he has the above-mentioned constriction across the chest with every little cold; pains through the apex of the left lung; cannot lie on the left side; aphonia; dry cough; hectic flush of the cheeks, particularly towards evening; oppression of the chest at night, forcing him to sit up: empty feeling at the pit of the stomach, particularly in the forenoon at ten or eleven o'clock; he awakens hungry at night, feeling that he must eat, and that he would faint if he did not.

Finally, the hectic fever grows more prominent. There is rapid formation of vomicse or cavities in the lungs. These are the indications for Phosphorus in pneumonia, and I must supple- ment them with a warning. Unless you give the drug cautiously, you precipitate what you would prevent.

Be certain that it is the remedy, and do not give it too often, or you will hasten the process you are anxious to avoid. I would not advise you to give Phosphorus in well- marked tuberculous patients. If tubercles have been deposited in the lungs, you should hesitate before giving it, unless the " picture" call- ing for it is so strong that you cannot possibly make a mistake.

I may say that the same is true also of Sulphur. Sulphur is adapted to the onset of the disease. Then, a dose or two allowed to act will frequently head these symptoms off. But after tubercles have been deposited, you must be careful how you use the drug.

I would next say a few words about the action of Phosphorus on the heart. It is particularly indicated in affections of this organ when the right side of the heart is involved more than the left. Its symptoms point more to the bad results that follow disease of the right heart than disease of the left; in a word, venous stagnation. It is suited to all forms of palpitation; palpitation from emotion, as from the sudden entrance into the room of an unexpected visitor, welcome or unwelcome; from motion; and also from rush of blood to the chest.

Particularly does this latter occur in the rapidly-growing young.

Phosphorus must also be remembered in endocarditis, in which disease it is often forgotten. Particularly is it indicated when endo- carditis or myocarditis occurs during the course of acute inflammatory rheumatism or during pneumonia.

Phosphorus is also useful for fatty degeneration of the heart. You distinguish it from Arsenicum by the involvement of the right heart, by venous stagnation and pufifiness of the face, particularly under the eyelids. Arsenicum has more symptoms of the left heart, more

phosphorus. 573

oppression of the chest in breathing, more orthopncea, and more ana- sarca or general dropsy.

Phosphorus acts upon the bones. We find this illustrated in the necrosis of the lower jaw, formerly so common among matchmakers. The fumes of the Phosphorus cause necrosis of the lower and some- times of the upper jaw. You may ask, is this not a local effect pro- duced by inhalation of the fumes ?

If it is a local effect, why does it affect by preference the lower jaw? Why not the upper? But, when persons have been poisoned by eating Phosphorus , if necrosis re- sults, it is the lower jaw that is affected, thus showing you that the drug has a special affinity for this bone. It is to be remembered in caries or necrosis of the lower jaw.

This you sometimes meet with from teething or from an inflamed or suppurating gland. Phosphorus affects other bones as well as the lower jaw, however. We find it not infrequently indicated in caries of the vertebra in scrofulous children. The concomitant symptoms have to decide the remedy for you.

For instance, the child is of the characteristic Phosphorus build. There is diarrhoea, worse in the morning, much like that of Sulphur, the stool containing undigested food. There is tendency to involvement of the lungs. For instance, the patient catches cold easily, with marked tendency to bronchitis.

Still further, we may be called upon to use Phosphorus in caries of the vertebra when the inflammation has extended inwards and involved the spinal cord itself. This you notice to be ex- pressed first by burning in certain portions of the spine. The patient cannot tolerate any heat near the back. A hot sponge on the back causes him to wince.

There will be a feeling as of a band around the body. The difficulty in walking increases until finally the child can- not walk at all. There is often partial loss of control over the sphincters.

Phosphorus also affects the joints, the hip and knee-joints in par- ticular. Hence, it may be indicated in morbus coxarius or in white swelling, both common, as you know, in scrofulous children. Here, too, you have to separate it from the other antipsorics by the general symptoms. I would say, for your guidance, that Phosphorus belongs with Silicea and seems to complement it. It is useful when Silicea has been partially successful in these joint-diseases.

Fistulae in the glands and about the joints are apt to form with Phos- phorus. These fistulous ulcers have high edges from exuberant granulations, the purulent discharge being rather thin and ichorous.

574 A CLINICAL MATERIA MEDICA.

Around the ulcer Phosphorus has, probably more than Silicea, an erysipelatous blush, often radiating as in Belladonna. There will frequently be burning, stinging pains, well-marked hectic fever with night sweat, diarrhoea, and anxiety towards evening.

These same symptoms apply to inflammation of the mammary glands when there are fistulous ulcers, as in Silicea, but distinguished from that remedy by the erysipelatous blush.

Burning and stinging pains also suggest Apis, but Apis does not cause deep-seated suppuration, such as that in the parenchyma of an organ.

Next, I wish to say a word about the action of Phosphorus on the eyes. While it may not be the best remedy for affections of the ex- ternal parts of the eye, it certainly does lead the list for diseases in- volving the deeper structures of that organ, as the retina, choroid and vitreous humor. It is particularly in nervous affections of the eye that we find Phosphorus indicated, and by " nervous" I mean belong- ing to the nerves of the eye. Thus it is suited to hyperemia of the choroid and retina, which may even result in retinitis or choroiditis, and when it does so result, it is apt to be a serious trouble.

Vision is greatly lessened. The patient sees all sorts of abnormal colors, black spots in the air and gray veils over things; it seems as if he were con- stantly looking through a mist or fog. Objects look red. Letters ap- pear red when reading.

That symptom, I believe, is under no other remedy but Phosphorus. Other remedies have red vision, but under Phosphorus alone is it that in reading the letters look red.

This remedy is also indicated in retinitis accompanying kidney affections, retinitis albuminuria.

It may also be indicated in retinitis with suppression of menses or some other uterine or ovarian disorder. When you have an eye affec- tion to deal with do not forget that the eyes are not the whole body. Remember that lesion in the eye may have as a starting point, disease in some other part of the body. Therefore, in making your prescrip- tion, do not forget to look for the constitutional symptoms that may be present.

We also find Phosphorus indicated in either amblyopia or asthenopia, particularly when associated with Bright' s disease or resulting from loss of fluids. When the patient attempts to read the letters blur and run together, and the eyes smart and burn. It is useful in amblyopia occurring after typhoid fever, sexual excesses or loss of fluids. It is

phosphorus. 575

also suited to blindness after lightning-stroke. In these cases the patient almost always sees a green halo around the candle-light.

I would like to say that Phosphorus will retard the growth of cata- ract. Other remedies that may suggest themselves in this condition are Silicea, Baryta carb., Conium, Seca/e, Natrum mur., Calcarea ostr. and Magnesium carb.

In addition to producing oversensitiveness to sound, as already mentioned, Phosphorus has the opposite effect, deafness or hardness of hearing, particular^ for the sound of the human voice. We have exactly the opposite symptom under Ignatia. This deafness may be purely nervous, as after typhoid fever. It may also indicate the drug in congested states when the hardness of hearing is associated with buzzing and roaring in the ears.

Phosphorus acts on the blood, destroying its coagulability. Thus it is that small wounds bleed much. I think that these are the words of the symptom as Hahnemann gave it to us. The way that he found that to be characteristic of Phosphorus was this: one prover noticed that when he pricked his finger it was difficult to stop the bleeding.

Hahnemann put this down as a possible symptom of Phosphorus. Later, a patient came to him, and described the totality of her symp- toms. She had this bleeding. He gave her Phosphorus which cured her.

Since then this drug has been used many times for this hsemor- rhagic diathesis. Lachesis has a similar symptom, but has not been so thoroughly confirmed as has Phosphorus.

Phosphorus is also indicated in haematemesis. This may be vicari- ous as from a suppressed menstrual flow, or it may result from simple congestion of the stomach, or even from organic disease of the stomach, particularly open cancer or round ulcer of the stomach. The vomited matters contain dark grumous substances, looking like coffee-grounds.

Phosphorus may also be used in haemoptysis, when indicated by the symptoms already given.

LECTURE LV.

THE PREPARATIONS OF ANTIMONY.

f Depresses the heart and circulation. I Increases sweat. Antimony. <j Mucous membranes: — catarrhs.

I Nausea, vomiting, purging, fainting, collapse. [ Skin: — rash; pustules.

Wk take up for study to-day two of the preparations of antimony, Antimonium crudum and Antimonium iartaricum. The term A7itimo- nium crudum does not imply that it is the metallic antimony but that it is the ore, the form in which it is most frequently found in nature. Antimonium tartaricum is a compound salt the tartrate of antimony and potash. There are other Antimony preparations used in medicine, but we shall only consider the above-named as they are the most im- portant.

Antimony exerts a depressing influence on the heart and circulation. Respiration too is disturbed by it, and in the majority of cases, perspi- ration is increased. The next important seat of action of antimony is the mucous membranes, particularly that of the alimentary canal. It causes nausea, vomiting and purging, with faintness and relaxation.

The vomited matters you will find at first to consist of mucus and food. I^ater they contain bile, and finally blood. It is not because antimony has a special effect on the liver that we have this bilious vomiting, but because it causes a regurgitation of bile. Cramps occur in the limbs.

These are accompanied by purging and thus you have a perfect picture of collapse such as you find in cholera or cholera morbus. Now, the emetic properties of antimony are not local. Ex- periments have been made by which the stomach has been extirpated, a bladder placed in its stead, and antimony injected into the blood. Retching will ensue, and yet there is no stomach.

It therefore acts through the pneumogastric nerves.

Antimony will cause convulsions. This convulsive action is trace- able to disturbance in the circulation at the base of the brain.

THE PREPARATIONS OF ANTIMONY. 577

The lungs become engorged with blood by any preparation of anti- mony. It is said that hepatization of a portion of the organ may fol- low poisoning by it, especially by its tartrate. This has been doubted of late. It has been claimed that this so-called hepatization was in reality atalectasis.

You also find antimony causing emphysema, particularly of the borders of the lungs.

Animals fed on antimonic acid will have fatty degeneration of the liver, heart, etc.

The skin is attacked by the antimonies. The irritation they here produce is rather slow and tardy, but the result is very characteristic. There will be, at first, slight redness; this is followed by development of papules, and these papules become pustules. Pustular eruptions are very characteristic of antimony, particularly of the tartrate. These pustules resemble the eruption of small-pox, so much so that Antimonium tartaricum has been used as a remedy in that disease, and with success.

Antimony is particularly useful when pustules appear about the genital organs, whether they be syphilitic or not.

While the preponderance is in favor of Antimonium iartaricum for pustulation, Antimonium crudum carries off the palm for horny ex- crescences and callosities on the feet and hands.

We will now consider