Bromine

Chlorine.

Sepia, Natr. m. { Silic, Phos. I Badiaga.

[ Merc, iod., Nitr. ac. Calc. phos.

Carbo animalis and Carbo veg. do not follow each other well. They are so far inimical that one may not be given with benefit after the other. They are too nearly alike. Carbo animalis contains some phosphate of lime. Carbo animalis is complementary to Calcarea phos- phor ica, especially in affections of the glands.

Carbo animalis is suited to old persons and to those who are greatly debilitated by disease, especially when there is a predominance of what is known as venous plethora. You find such patients particularly in- clined to blueness of the skin. The hands and feet readily become blue, with distended veins showing through the skin. They become ill from very slight causes.

The cheeks often get bluish. Both remedies are indicated in decomposition of tissue of the body, as in gangrene and ulcerations of the surface or of internal parts, with putrid discharges. Both, too, are indicated in weakness of the digest- ive organs, both are indicated for the bad effects of loss of animal fluids, particularly during lactation.

Now, as a general distinction between the two drugs, you may re- member this: although both drugs act on the glands, the predomi- nance is in favor of the Carbo animalis for glandular affections. For instance, we find it indicated in induration of glands, of the axillary glands and of the glands in the groin, particularly in syphilitic or gonorrhoeal patients. These buboes are hard like stone; Carbo animalis is especially useful when these have been opened too soon, and when

49° A CLINICAL MATERIA MEDICA.

there is a gaping wound which has partly healed, leaving the sur- rounding tissues of an almost stony hardness.

Badiaga rivals Carbo animalis in just these cases, particularly in in- durated buboes that have been maltreated.

Again, we find Carbo animalis indicated in cancer more frequently than Carbo veg.; particularly is it useful in cancer of the breast or of the uterus. In mammary cancer you have the glands indurated in little nodes; or small circumscribed portions which are as hard as stone. L<ater the skin around the induration becomes bluish and mottled, thus showing you the characteristic effect of Carbo animalis in produc- ing venous stasis. The axillary glands on the affected side become indurated and there are burning, drawing pains through the mammae.

In the case of cancer of the uterus there are induration of the cervix, metrorrhagia, and burning pains extending down the thighs, and thin, offensive vaginal discharge.

In affections of the digestive organs, Carbo a?iimalis differs from Carbo veg. in this: we find that under Carbo animalis there is goneness and empty feeling in the pit of the stomach, not relieved by eating, and in this respect it is very similar to Sepia.

We find these symptoms indicating Carbo a?iimalis in preference to Carbo veg. in the weakness of nursing women ; we notice that every particle of food taken distresses the stomach, just as we found under Carbo veg. , but with Carbo animalis there is coldness about the stomach, which is relieved by pressing firmly with the hand or by friction over the abdomen, thus showing you the weak debilitated condition in which the patient is, who requires this remedy. Carbo veg. has drag- ging heaviness about the stomach to distinguish it. Both remedies have piles with this weak digestion, but there is oozing of a thin, inodorous fluid from the rectum in Carbo a?iimalis which does not exist as markedly under Carbo veg.

Both drugs meet again in affections of the chest. We find them both indicated in the late stages of pneumonia, bronchitis, or of phthisis pulmonalis, when there is destruction of the lung tissue and decom- position of the fluid which is expectorated. It is just here that you are most liable to make a mistake in selecting one drug for the other. Carbo animalis has this symptom to distinguish it, suffocating hoarse cough producing shaking of the brain as though the brain were loose in the head.

And a cold feeling in the chest. Expectoration is green, purulent and horribly offensive, and conies generally from the

CARBO ANIMALIS. 49 1

right lung, in which you probably will find by examination, a cavity. As soon as the patient closes his eyes he feels as if he were smothering.

Other remedies having cold sensation in the chest are: Bromine, Paris quad, and Camphor.

The Carbo veg. cough is spasmodic, with deep, rough voice or else with aphonia. There is decided burning in the chest and expectora- tion is profuse, particularly in the bronchitis of old people. It is yellow and very foetid, more so than in Carbo animalis. The patient has dyspnoea, worse on turning over in bed and on dropping off to sleep. There is a great deal of rattling in the chest.

Carbo animalis is more useful than Carbo veg. in constitutional syphilis, and for this reason: while both may be indicated in consti- tutional or tertiary syphilis, after the abuse of mercury, particularly when the glands are affected, and there is great emaciation, Carbo a?iimalis is indicated more by these symptoms: it has coppery- red blotches on the skin, particularly on the face. That you know to be the characteristic hue of syphilitic eruptions. In this respect it re- sembles Mercurius bin., Nitric acid and Badiaga more than it does Carbo veg.

In debility, we find Carbo veg. always superior to Carbo animalis. There are very few characteristic S3^mptoms indicating the latter as a remedy in the last stages of typhoid fever, pneumonia and scarlatina. The only difficulty you will have in deciding between the two drugs will be in the debility attendant upon lactation.

In affections of the ears we find Carbo veg. and Carbo animalis again meeting. Thus, we find both drugs causing otorrhoea. The discharge is thin, ichorous, bloody and excoriating in both remedies. With Carbo animalis there is also associated a swelling of the perios- teum behind the ears over the mastoid process.

Here it is similar to Nitric acid, Aurum and Capsicum. With Carbo veg. we find this otorrhoea particularly as a sequel to exanthematous diseases, as measles and scarlatina. There is no swelling of the periosteum back of the ear. Both remedies are indicated in deafness.

Carbo animalis has this peculiar symptom: they cannot tell whence sound comes. Carbo veg. is indicated in deafness when the ears are too dry from the absence of the cerumen or wax, or when there is discharge of offensive ceru- men.

In eye affections we find Carbo animalis indicated when the patient is far-sighted; while walking along the street objects seem to him to

A CLINICAL MATERIA MEDICA.

be far off . The eyes seem as if they were loose in their sockets. This feeling is due to relaxation in the connective tissue similar to that found in the brain. Old people have dimness of sight on attempting to read, but this is relieved by rubbing the eyes.

Carbo veg. is indicated when the patient is near-sighted; objects have to be placed near to the eye to be seen. This symptom is worse after exerting the eyes or after using them steadily for any length of time.

I will first call your attention to Bromine. Bromine produces a rather peculiar effect on the sensorium, causing a sort of vertigo, which is worse from running water. Anything moving rapidly pro- duces this vertigo. It is associated with a peculiar anxious state of mind.

Now this anxiety belongs to all of the halogens. It hardly originates in the mind, probably coming from some defect in the body, itself. It is a common symptom in heart and lung affections, and it is probably thence that the symptom springs. This anxiety is expressed in this way: the patient expects to see objects jumping about or he feels as if on turning his head he must see something or some one.

This is an effect of Bromi?ie, and those of you who are familiar with Bromide of Potassium will recognize whence it gets its anxiety. The vertigo is relieved by nose-bleed, showing at once that it is congestive in character. Another symptom indicative of congestion under Bro- mine is this: after dinner there is sensation deep in the brain as though a fit of apoplexy were impending. The patient feels as if he would lose his senses.

The Iodine mental condition is more marked than that of Bromine. It is a decided erethism, during which the patient is very excitable and restless, moving about from place to place, now sitting here, now sit- ting there; he fears that every little occurrence will end seriously. In his anxiety he shuns every one, even his doctor. He has a great dread of people.

At times he becomes quite excited and delirious, with vertigo, red face and anxiety. In children with tabes mesenterica here is a characteristic irritability, screaming when looked at.

HALOGENS. 503

Next, the lymphatic system. Like all the other members of this group, Bromine attacks the glands and causes enlargement and indu- ration of the glands. Hence it is called for in scrofulosis. It is par- ticularly suited to scrofulous patients, children usualh7, when the parotid gland or glands are indurated, when there is a tendency to suppuration, with excoriating discharge, persistent hardness of the gland around the opening, and undue amount of warmth or heat in the gland.

I have merely mentioned the parotid gland for purpose of illustration. Bromine also affects the mammary gland, for cancer of which it has been a very useful remedy. You may perhaps remember that I told you the other day that it was similar to Carbo animalis. Like Carbo animalis, it has induration of the glands in the axilla with burning pains.

But ' Bromhie also has cutting pains. The breast is hard and on palpation, a dull subdued sort of throbbing may be felt in it. Sometimes the drawing or cutting is so marked that it feels as if a string were pulling from the gland into the axilla, a symptom more often calling for Croton tiglium or Paris quad.

The testicles are acted upon by Bromine. We find them swollen, hard and perfectly smooth and unduly hot. The pain is worse from jarring. You will find that glandular affections yield to Bromine, especially in persons of light complexion, with fair skin and light blue eyes.

I mention this symptom here to make use of it in a few moments as a symptom of comparative value. I do not mean to say that every scrofulous child with blue eyes must have Bromine, but I do mean that this symptom is of use to enable us to distinguish Bromine from the other halogens.

The tonsils, too, are affected in Bromine. Thus we find them deep red and swollen and covered with a network of dilated bloodvessels. They are worse when swallowing, and are accompanied usually with swelling of the glands externally. There is a feeling of rawness in the throat with this tonsillitis.

This, too, as you know, is common enough in scrofulous children. Many have a strong temptation to ex- cise the tonsils, but this is not good practice, for you can often cure this trouble by internal medication. In some cases, this enlargement of the tonsils may be looked upon as a forerunner of tuberculosis.

We find Bromine indicated in enlargement of another gland, namely the thyroid gland, and curing what has been termed bronchocele or goitre.

We next have to speak of Bromine in its action on mucous

504 A CLINICAL MATERIA MKDICA.

membranes. Beginning with the nose, we find that it is useful in coryza or in nasal catarrh, when the discharge is profuse, watery and excori- ating. The nostrils, alternately, seem to be stopped up. There is peculiar headache associated with this coryza, a heavy pressure in the forehead which seems to be pushing the brain down and out at the root of the nose.

The nose is very sore inside and also around the alae. This is a smarting soreness, just such as you would expect the fumes of Bromine to cause. Later, ulcers form in the nose, with the escape of crusts or scabs, which are blown out and which are always blood}7. Every attempt to blow the nose is followed by a discharge of crusts and blood.

This you know is common enough with scrofulous children.

Coming now to the throat and lungs, we find Bromine indicated in spasm of the glottis, sometimes called laryngismus stridulus. This is a very difficult disease to cure. It is often central in its origin. It commences by sudden closure of the glottis.

The child turns blue in the face, and its body becomes convulsed. One spell ceases only to be followed by another. In the second stage, general convulsions appear, followed by emaciation. The trouble may be reflex from dentition, or from indigestion, or from enlargement of the thymus gland.

If it can be found to be the result of enlargement of the thymus gland, then^ Iodine is clearly indicated. When it has been caused by retarded dentition, I think that Calcarea phosphorica promises better than any- thing else. Dr. Dunham records a case that had been given up by an allopathic physician, but, knowing the symptoms of Chlorine, which, above all other remedies, will produce this spasm of the glottis, he generated some Chlorine, and allowed the child to inhale the fumes, with almost instantaneous relief and final cure.

All the halogens are useful in this condition, but Chlorine is here the best of them all. Their symptoms differ but little so far as the local symptoms are concerned. We may also think of Sambucus, Antimonium tartaricum, Belladonna, Lachesis, Arsenicum and, in some cases, Phosphorus.

Lachesis is particularly indicated when the patient awakens from sleep with it.

Ignatia, whenever a cross word or correcting the child brings on the spasm.

Another remedy is Cuprum, especially when the spasms are general and the child clenches its thumbs.

Ipecacuanha may be of some use in some cases, but I have no con- fidence in it.

HALOGENS. 505

Nor have I in Sambucus, because, under Sambucus, I think the trouble is more in the chest, whereas, with Cuprum, the halogens, Cal- carea phos., Lachesis and Belladonna, the trouble is in the larynx itself.

This spasm of the glottis often comes in the course of croup, in which disease Bromine may be the remedy when inspiration seems to be exceedingly difficult; the child is suddenly aroused from sleep as if choking. These symptoms are relieved by a drink of water, which seems to quiet the spasmodic condition. In membranous croup Bromine is indicated by the following symptoms in addition to the spasm already referred to: the child has at first a deep, rough voice, which, in the evening, amounts almost to aphonia.

It cries with a hoarse, husky voice. The membrane seems to come up from the larynx into the throat. Every inspiration provokes cough, especially every deep in- spiration. Breathing is hoarse, rasping and whistling, as though the child were breathing through a sponge or through some loose metallic substance which is vibrating.

This is caused by the vibration of membrane as it is deposited more or less uniformly over the interior of the larynx. Later, there is rattling in the larynx. When the child coughs it seems as if the larynx were full of the loose rnucus.

Antimonium tartaricum is very similar to Bromine in croup. It has rattling and wheezing, extending down the trachea as well as in the larynx.

Now, I wish to say a few words about other remedies in connection with croup, especially concerning Aconite, Hepar, Spongia and Kaolin. Kaolin is a kind of porcelain-clay, a combination of lime and silica, and has proved very useful in membranous croup. The relation which these remedies hold is this: Aconite is useful in the beginning of croup, whether spasmodic, catarrhal or membranous. It is indicated by the child suddenly arousing from sleep as if it were smothering.

There is great restlessness. The skin is hot. There must be some anxiety present. Breathing is dry.

There is no sound of mucus. Soon the child seems better and falls asleep, only to be aroused again. Arnica is especial^ indicated in these cases if the symptoms have followed exposure to drjr, cold winds. Do not stop your remedy too soon.

If you do, while the child will be better in the morning, the symptoms may return with renewed violence the next night, and, before you know it, the mucous membrane of the larynx and trachea will take on fibrinous exudation and 3^ou lose your patient.

506 A CLINICAL MATERIA MEDICA.

You will need to change to Spongia when you have these symptoms present: breathing during inspiration is hard. and harsh, as though the child was breathing through a sponge. The cough has a decidedly hard, barking, ringing sound. As yet the sputum is scanty. Spongia follows Aconite, especially after exposure to dry, cold winds, and in light-complexioned children with blue eyes. The symptoms are usually worse before midnight. Suppose this fails you, then you may have recourse to Hepar sulpharis calcarea.

Hepar usually is worse after midnight and towards morning. The cough has the same harsh, croupy sound, but there is a great deal of moisture with it. This is the indication for Hepar. It, too, is worse from exposure to dry, cold winds. Sometimes all these drugs fail, and we have to resort to the halogens, especially to Bromine and Iodine.

I have already given you the symptoms of Bromine; let me tell you how to distinguish it from Iodine. Iodine is particularly indicated after the failure of Hepar, when the membrane has formed; inspiration is exceedingly difficult, both from spasms of the throat and occlusion of the lumen of the larynx by the membranous formation. Inspiration is wave-like or in jerks. The cough is moist but harsh, just as you found under Hepar.

The voice is almost extinct from the hoarseness. The child grasps its throat to relieve the pressure, throws its head far back so as to straighten the route from the mouth to the lungs and favor the passage of air. It is particularly worse in the morning. Iodine is especially adapted to dark-complexioned children with dark hair and eyes.

This in itself is a great distinction between Iodine and Bromine. That is why I spoke of the use of Bromine in light-com- plexioned children, because this fact has been proven to be a good dis- tinction between these two drugs, and hence, as a comparative symp- tom, is one of great value to you. Iodine is particularly adapted to cases that come from damp weather. Long- continued damp cold weather will produce just such a cough as Iodi?ie will cure.

Do not change the remedy in these cases too often. Do not change your remedy on account of alarming symptoms that spring up, unless you are certain that they indicate a cha?ige.

Kaolin has been used successfully for membranous croup even when the membrane dips down deep into the trachea. There is extreme soreness of the chest. The patient does not want anything to touch him. He will not permit you to use steam or hot cloths, because the chest is so sore.

HALOGKNS. 507

Returning to the study of Bromine, we find it useful in affections of the lungs. It is indicated in asthma, when the patient feels as if he could not get air enough into his lungs, consequently he breathes very deeply. The explanation of this lies not only in the lungs, but also in the constriction of the glottis. Although the patient expands his chest well, air does not go in on account of the narrowness of the opening in the larynx. It is especially indicated in asthma coming on, at or near the seashore.

We also find Bromine useful in pneumonia, particularly when it affects the lower lobe of the right lung, hence lobar pneumonia. We often find nose-bleed as a concomitant symptom when Bromine is indi- cated in these cases. The patient also has the symptom just mentioned under asthma, "seems as if he could not get enough air into the chest; " while there seems to be plenty of mucus, the patient does not appear to be able to expectorate it.

We also find Bromine indicated in tuberculosis of the lungs, par- ticularly when the tubercular deposit is more manifest in the right lung. The patient suffers frequently from congestion of the head and chest, which is relieved by nose-bleed. Notice how often that symp- tom occurs under Bro?ni?ie. There is also pain in the mammary region going up into the axilla. The eyes seem to be affected along with the chest symptoms giving rise to a chronic conjunctivitis.

Bromine produces a very characteristic picture of uncomplicated hypertrophy of the heart, by which I mean, muscular enlargement without valvular lesion. The patient finds it difficult to exert him- self on account of the oppression about the heart. He has palpitation when he begins to move and when he gets up from a sitting to a stand- ing posture. The pulse is full, hard and rather slow, which is just the character that belongs to an over-active enlarged heart.

It has cured many cases of this hypertrophy of the heart. I think it was Dr. Thayer, of Boston, who cured many cases of this trouble with Bromine. It may also be used in cardiac asthma, especially when the asthmatic paroxysms are better at sea than on land.*

You here find Bromine similar to Aconite, but it lacks the anxiety of that remedy. Both remedies are suited to uncomplicated cardiac

* Professor Farrington refers above to the asthma of Bromine as coming on at or near the seashore, and here he speaks of cardiac asthma better on sea than on land. Both may be right, for being at sea differs from being at the seashore* where you may have land breezes. — S. 1^.

508 A CUNICAL MATERIA MEDICA.

hypertrophy, but Aconite has fear and anxiety. The patient fears that he will drop dead in the street.

It is also similar to Aconite and Rhus tox., both of which remedies have uncomplicated hypertrophy of the heart from over-exertion.