Iodine

Spongia.

So much for Bromine; now for Iodine; and first let me speak of the symptoms arising from its abuse. Iodine is an absorbent; it has the property of causing absorption, particularly of glandular structures- Its absorbent properties extend to other tissues, involving, finally, even nervous structures. We find, for instance, in persons who are poisoned with Iodine, great emaciation. With the female, the mam- mary glands become atrophied and the ovaries, too, no doubt.

With the males, the testicles surfer in the same manner and there is the in- evitable progressive loss of sexual power. The skin becomes dark yellow and tawny, dry from deficient action, the sclerotica become yellow, yellow spots appear on the face and also on the body. There is excessive appetite, he is anxious and faint if he does not get his food. He is relieved while eating and yet he emaciates despite the amount of food he eats.

Sooner or later the nervous system becomes involved and he is afflicted with tremor. He becomes nervous and ex- citable; every little annoyance, which would be unnoticed in his normal condition, causes trembling. He has a longing for the open air, as if the cold fresh air gave him more health. This gives a fair idea of the condition to which the patient is reduced by the over use of Iodine.

One of the best antidotes to £his state is Hepar. Some cases require Sulphur. The individual symptoms decide.

Now compare Iodine with Bromine in chest affections. Iodine is indi- cated in pneumonia, more so, perhaps, than Bromine. It is especially useful when the disease localizes itself, that is, when the plastic exuda- tion* commences. There is a decided cough with great dyspnoea, difficulty in breathing, as though the chest would not expand (and here the trouble is situated in the chest itself) , and blood-streaked sputum.

You will find some portions of the lungs beginning to solidify. You may also give it later in the disease, after the stage of hepatization, in the stage of resolution, when instead of absorption

*Under Mercurius and Iodine, exudates are plastic; Bryonia, serous and plastic; Hepar, purulent.

HALOGENS. 509

and expectoration of the exudate, slow suppuration appears with hectic fever and emaciation; the patient feels better in the cool open air than he does in the warm room.

Phthisis pulmonalis sometimes calls for Iodine. You here find it indicated in young persons who grow too rapidly, who are subject to frequent congestion of the chest, who are rather emaciated, and who suffer from dry cough, which seems to be excited by tickling all over the chest. The patient cannot bear the warm room. Expectoration is tough and blood-streaked. There is a well-marked feeling of weak- ness in the chest, particularly on going up stairs, The patient has a very good appetite, and is relieved by eating.

The nearest remedy to Iodine here is Phosphorus, which is also well adapted to phthisis in the rapidly-growing young.

Iodi?ie is also indicated in enlargement of the heart, whether or not accompanied by disease of the valvular structures. There is palpitation of the heart, particularly after any manual labor. It is suited espe- cially to dark-complexioned persons, with dark hair, etc. The heart feels as if it were being squeezed by a firm hand.

At other times there is excessive weakness in the chest, with ' ' goneness ' ' or exhausted feeling. The patient can scarcely talk or breathe, so weak does he feel. This shows that Iodine acts on the connective tissue. In valvular affections there is a feeling of vibrat'ion over the heart, just such a sensation as you get when stroking a purring cat.

Spigelia has that same purring, vibrating feeling over the region of the heart.

Now let me give 5^ou the difference between Iodi?ie and Bromine in scrofulous affections. Iodine causes induration of the glands more marked than does Bromine. They are hard, large and usually painless. There is a characteristic of Iodine which is universal, and that charac- teristic is torpidity and sluggishness.

The very indolence of the dis- ease is suggestive of Iodine. It also produces atrophy of the glands. The mammae waste away and the testicles dwindle. We find it indi- cated in scrofulosis of children, when they emaciate rapidly, despite a ravenous appetite.

They are hungry all the time. They cry for their dinner, they feel better while eating, and yet they do not gain any flesh. They are always better in the open air and worse from any con- finement in the warm room. The mesenteric glands are enlarged, and you have what is known as tabes mesenterica.

This indicates Iodine, particularly when you have these other symptoms present together with excessive mental irritability.

5IO A CLINIC AL MATERIA MEDIC A.

We find Iodine causing a rather singular diarrhoea. In such cases the spleen is enlarged, quite hard, and very sensitive to the touch. The liver, too, must be affected, because the stools are whitish; some- times they are wheylike. This last symptom you will often find con- nected with obscure disease of the pancreas. Iodine has such an affinity for glandular structures, that it, no doubt, attacks the pancreas as well as other glands.

We also find Iodine affecting the ovaries. It is indicated in ovarian dropsy. In such cases as this, the single fact that Iodine has helped in ovarian dropsy must not lead you to give Iodine in every case of that trouble. Other remedies have proved themselves useful.

Apis, Colocynth, and other drugs, have cured cases, and they have sometimes failed. If the whole picture of the patient calls for Iodine, it is your duty to give that drug, but not unless such is the case. It must be given for weeks or months before it will bring about absorption of the tumor.

We also find Iodine indicated in cancer of the uterus, particularly with profuse haemorrhages. The leucorrhoea is characteristic, being yellowish and very corrosive. This, in conjunction with the other Iodine symptoms, sallow, tawny skin, ravenous appetite, etc., makes Iodine the remedy which will relieve many cases and cure some.

In this connection we have other remedies to remember, and notably among these, Hydrastis, which has cured epithelioma, and may be a remedy for uterine cancer. I have, however, had no personal success with it. It has been used both externally and internally, when indi- cated by symptoms which have already been given you in another lecture; especially has it marked goneness at the epigastrium, and pal- pitation after every motion.

There is a substance, or remedy, known as Lapis albus. It is one of Grauvogl's remedies. He, at one time, went to a certain spring, the waters of which, it was claimed, would cure tuberculosis, scrofulosis, and even cancer. On examining the spring, he noticed that the water had gradually worn a crevice in the rocks.

He took away a piece of this rock over which the water was falling, and made triturations of it. With this he cured several cases of goitre, and also several cases of scirrhus. This rock has been analyzed, but the analyses differ so that I hardly know which one to recommend.

Iodine is sometimes indicated in rheumatic joint affections, with effu- sion and emaciation. Hydrarthrosis yields, according to Jahr, Jousset

HAIX>GKNS. 511

and others, to Iodine. In acute cases, compare Apis; in the chronic, Sulphur.

Both Iodine and Bromine are of some use in ulcers. Iodine, for in- stance, is useful in ulcers rather of a scrofulous form, with spongy edges, and discharges of a bloody, ichorous, or even purulent character.

Now, Bromine is somewhat similar. It is useful in ulcers which have a carrion-like odor, with threatening gangrene. The surround- ing skin has a greenish-yellow hue. That is the form of ulcer to which Bromine is especially adapted.

Now, a few words about Chlorine. I do not know much about it as a medicine. It may be given in a crude form by allowing the gas to be absorbed by ice-cold water, and thus it may be prepared for the cases to be enumerated. Chlorine, and in fact all its combinations, seem to have a special affinity for mucous membranes.

Hence we find it indicated in catarrhs. Chlorine produces a watery discharge from the nose, with a thin, excoriating coryza, making the nose sore, both in- side and about the alse. On examining the mouth, you find it, too, affected with a low grade of inflammation. Chlorine here produces small, putrid-smelling ulcers, yellowish- white, which are aphthous in character.

Chlorine is indicated in scorbutic states of the blood, as are all the chlorides. We find under Natrum ??iur. and Kali chloricum the same kind of stomacace, with excessive foetor of the breath.

We find Chlorine also acting on the nervous system, probably through the blood. It is indicated in typhoid conditions; the patient has a fear of becoming crazy, or that he will lose his senses. He is very forgetful; he cannot remember names, etc. There is a constant fear of some impending disease.

There is also, under Chlorine, a peculiar painful sensation in the vertex, passing down the left side of the body. This is a precursor of typhoid fever. It is worse after eat- ing. In such cases Chlorine will often modify the fever.

Chlorine is also indicated in impotence, but when this impotence has been produced by inhalations of the fumes of Chlorine, Lycopodium is the proper antidote.

Chlorine is a very good antidote to Sulphuretted hydrogen.

512 a clinical materia medica.

Spongia.

{ Aeon., Bell., Hep., Iod., Brom. Spongia. J Anacardium.

I Caust., Selen., Phos. ^ Badiaga.

Spo?zgia is not a chemical substance. It is derived from the animal kingdom, but, because its symptoms are closely allied to those of the halogens, it is convenient to study the drug here. Spongia contains Iodine, also some Bromine and some calcareous matter, and probably other ingredients of minor importance. It differs from Iodine.

In the first place, it is adapted to light-complexioned persons, and it has not the same property of producing plastic or fibrous exudates that Iodine has. It acts, however, on structures very similar to those in- fluenced by the halogens, especially the glandular system and mucous surfaces. We find it of service in tuberculosis, and we shall find it in- valuable in the treatment of heart disease.

First, let us study its action on the glands. It is indicated just as are the halogens in indurations and enlargement of the glands. Thus we find it indicated in goitre. The swelling is hard and large, one or both sides are swollen, sometimes even with the chin, and particularly is this associated with suffocating spells at night.

This suffocation does not come alone from the size of the goitre, because some very small goitres give rise to this symptom in a very great degree. I would also call your attention to the fact that goitres will vary in size at different times. They will be larger at one time than another. It is said that they increase and decrease with the moon.

It has, there- fore, been suggested that you give Spongia, or whatever drug you select, with the waning moon. In this way you hurry its decline.

Spongia acts on the testicles just as powerfully as the halogens, pro- ducing hardness and swelling of these glands. It is particularly useful in cases of maltreated orchitis or inflammation of the testicle after checked gonorrhoea. There is a peculiar sort of squeezing pain in the testicle and cord, worse on any motion of the body or clothing.

In cases of orchitis, our first remedy is not Spongia. Pulsatilla stands at the head of the list, and next to it we may rank Hamamelis, or witch-hazel. The latter drug should be used both locally and in- ternally. It relieves the intense soreness and enables the patient to

SPONGIA. 513

attend to his duties. Still another remedy is Mercurius solubilis , par- ticularly when what little gonorrhceal discharge is present is yellowish- green.

Another remedy in the very beginning is Gelsemium.

When, however, you have this peculiar screwing-like, squeezing pain in the cord and testicles, with hardness there, Spo?igia comes in as one of our best drugs.

We find Spongia indicated in acute larjmgitis. This is an alarming disease. It is indicated after Aconite, when there are harsh, barking cough and suffocative spells during sleep, arousing the patient. The larynx is extremely sensitive to the touch. Do not give Lachesis in these cases, for the sensitiveness is not due to hyperesthesia of the cutaneous nerves, but it is the result of the inflamed condition of the laryngeal cartilages. Simply turning the head will bring on a suffo- cative spell.

Now there is another remedy that I would have you remember in this connection, and that is Sambucus. This is useful when these spasms of the larynx occur frequently during the course of acute laryngitis.

The same symptoms that suggest Spongia in laryngitis also indicate it in laryngeal phthisis.

I will not speak of the application of Spongia to croup, because I gave that to you in the early part of this lecture when speaking of Bromine and Iodine.

We come next to the lungs. We find Spongia indicated in true tuberculosis of the lungs. It is especially called for in the beginning of the stage of solidification of the lung tissue. You find the apices of one or both lungs dull on percussion.

The cough is of a hard, ringing, metallic character. It is excited by deep breathing or by talking, by any little excitement, or by dry, cold winds, seldom by damp weather. It is relieved for awhile by eating or drinking. Ana- cardium also has this same symptom, eating relieves the cough.

There is a great deal of congestion of the chest, especially when the patient is moving about, walking in the street for instance. This is accom- panied by sudden weakness as if the patient would fall. In such cases Spongia has cured when given early.

Spongia is followed well by Hepar when the same kind of cough continues, but with rather more rattling from the production of mucus, whether blood-streaked or not. The symptoms are worse towards

514 A CLINICAL MATERIA MKDICA.

morning, while with. Spongia they are worse before midnight. You find, too, that the Spongia patient is subject to frequent flashes of heat in these phthisical cases, and these return whenever he thinks about them. He also experiences a chill which usually commences across the back. He shakes even when near a warm stove. The heat which follows is all over the body except the thighs, which remain numb and chilly.

Spongia is useful in organic affections of the heart. The patient cannot lie flat on the back with the head low without bringing on a spell of suffocation. He is frequently aroused from sleep as if smoth- ering. He sits up in bed with an anxious look, flushed face, and rapid, hard breathing.

You will find a loud blowing sound over one or the other valve. Spongia is particularly indicated after Aconite. Here there is the same arousing from sleep with great distress, the face is red and there is probably great congestion of the chest. Aco?iite suits only the hy- peremia that precedes endocarditis.

Spongia comes in when exudation has commenced and the mischief has been already done. While it does not remove the deposit, it prevents the disease from advancing. In treating heart cases do not begin too soon with Lachesis, Hydro- cyanic acid or Arsenicum. Begin rather with Aconite, Spongia, Spigelia, Bryonia of Phosphorus.

Ajrse?iic and such remedies come in later. If you give them too soon you weaken the patient. Unless you have a complete picture for the remedy, do not give in the first stages one usually indicated in the last stages of a disease.

LECTURE XLIX.

THE ACIDS.

Fluoric acid. Phosphoric acid. •

Muriatic " ' Hydrocyanic "

Nitric " ' Picric "

Sulphuric " ' Lactic

Oxalic " Malic

Citric " Silicic

Arsenious acid. .

There are many of the acids, many more in fact than have been placed on the board. There are not many of them, however, with which we are thoroughly acquainted, and there are but few facts that need be stated with reference to others. The very idea of acid, you will at once understand, implies more or less of an electro-negative character. They all combine very readily with the electro-positive substances, as potassium and sodium.

You must rid yourself of the impression that the term ' ' acid ' ' necessarily implies that these sub- stances are sour, for all acids are not sour nor do all acids redden litmus paper. It was formerly supposed that all acids contained oxy- gen, and that oxygen was one of their necessary ingredients. This has been disproved, for certain acids — as hydrofluoric and muriatic acids — contain no oxygen. These acids are derived from the mineral and vegetable kingdoms.

Of those derived from the former, we use in medicine Fluoric and Muriatic acids, which are obtained from the halogens; Nitric acid, a combination of nitrogen and oxygen; Sulphuric acid, Phosphoric acid, Silicea or Silicic acid, which exists as sand in nature and is by no means sour. So, too, the substance which we term Arsenicum is an acid — Arsenious acid.

From organic chemistry Hydrocyanic acid, sometimes called Prussic acid. That, we shall find, exists in a great variety of plants. Then here is Oxalic acid, with which you are already somewhat familiar. Many of you who have tasted the ' ' sorrel grass ' ' know how sour the leaves are. It is Oxalic acid which gives them their acidity. It exists also in the rhubarb. Rhubarb, either the medicinal or the edible

516 A CLINICAL MATERIA MEDICA.

variety, may or may not be poisonous. When raised on new ground it is very apt to contain an undue amount of Oxalic acid, and thus may make some persons very sick. Malic and Citric acid are derived from the vegetable kingdom. Malic acid is found more particularly in ap- ples and pears and also in raspberries. Citric acid is found chiefly in oranges and lemons. Acetic acid is an organic acid, and is the principal ingredient of vinegar. Lactic acid is derived from sour milk.

In the first place we may say a few words about the acids in general and tell what characterizes them as a class. It has been determined by careful experimentation with the acids as a class that they decrease the acid secretions of the body and increase the alkaline. If, for in- stance, a quantity of acid, such as Citric acid, is taken into the stomach, it will diminish the secretion of the gastric juice. On the other hand, it will increase the secretion of the saliva.

The practical value of this hint is hygienic rather than therapeutic, and yet in that degree it is of great use. For instance, we know how intolerable, at times, thirst is in fevers. Now this thirst may be due, at least in part, to lack of secretion from the salivary glands. The mouth is parched and dry; the tongue cleaves to the roof of the mouth.

In such cases as this, acidulated drinks, by acting reflexly, increase the flow of saliva, and will give your patient great relief. For instance, you may give lemonade, providing, of course, it is not antagonistic to your indicated remedy. There are some medicines which Citric acid will antidote and some which will disagree with it. Again, if you are giving Bella- donna, you would not think of using vinegar, as vinegar retards the action of that drug.

But when giving Belladonna you may use lemonade, as that aids the action of the remedy. Antimonium crudum will not tolerate acids, but you may use tamarind water. Now if you find the mouth or throat sore in fever, the ' ' edge ' ' must be taken off the acid by the admixture of some mucilaginous substance to the drink. You might use gum Arabic, but that interferes with digestion somewhat.

Irish moss, Iceland moss and slippery-elm are too medic- inal. They all act powerfully on the lungs, and you might induce medicinal symptoms if you employ them. Flaxseed has some medic- inal effect, but not sufficient to make its use inappropriate. Another substance which may be used is gelatin, that is, if you know that it is pure.

Some of it is made from the refuse of the tanner; some from fish-bones, and this is quite palatable; but best of all is that made from calves' feet. This last may be used in water to relieve the sharpness of the acid.

THE ACIDS. 517

We find that vegetable acids may be useful in dyspepsia, simply for their hygienic value. You may give them, for instance, in sour stomach. You then administer the acid before eating. Allow the patient to drink lemonade before meals and you will often find that the usual heartburn and sour risings after eating are thus diminished.

Pepsin, which is often used as an adjuvant in the treatment of dyspepsia, is perfectly allowable, as it does not interfere with the action of any medicine and is not itself a medicine. It is often aided in its action by some kind of acid, particularly in the digestion of nitroge- nous articles of food.

Vinegar has been used as an antidote for intoxication.

There is a property of Lactic acid which is well worth noticing. This is a very corrosive acid. It will eat into every tissue of the body. In fact, it will dissolve the enamel of the teeth, so that great care must be used in its administration. When prescribed in material doses, it is usually administered through a tube, wmich prevents it from touch- ing the teeth. Dr. Hering wras in the habit of recommending that the teeth be wrashed occasionally with cream that had become sour by keeping twenty-four hours.

Muriatic and Lactic acids favor digestion. Some persons are greatly relieved by drinking sour milk.

Sulphuric acid must be avoided in any form whatever, because it tends to make the food insoluble \>y combining with its albuminous constituents. Sulphuric acid is not used in dietetics, except by children in the cheap candy called "sour-balls," which are acidulated almost exclusively with this acid.

Hydrocyanic acid certainly aids digestion. There are some persons who have been cured of dyspepsia by eating peach-kernels, which con- tain this acid.

There is a distinction between the mineral acids on one side and the organic acids on the other. The mineral acids, as a class, all produce an irritability of fibre together with weakness and prostration. I am now speaking of their medicinal effects. You will find them to pro- duce an irritable weakness — with the weak and irritable pulse — whereas the vegetable acids produce weakness without irritability.

The acids, too, as a class, check haemorrhages. This is a quality that belongs to nearly all of them. We all know that Acetic acid is useful in this sphere. When I have a patient who is subject to haemorrhage, I am in the habit of instructing the nurse, in case haemorrhage sets in

518 A CLINICAL MATERIA MBDICA.

before I can be called, to dip a cloth in vinegar and place it over the pubes. In many cases, this will be successful. We all know, too, that Citric acid will produce and cure haemorrhage. A child, after eating too freely of lemons, had haemorrhages from every orifice of the body, even from the conjunctiva.

We shall see that Phosphoric, Sul- phuric and Arsenious acids all produce and all check haemorrhages. It is said that they all do this by reason of their astringency. But how can this be so when they act favorably even in the two-hundredth potency ?

Another quality of the acids is their tendency to produce pseudo- membranes. Thus we find some of them indicated in diphtheria; Muriatic, Phosphoric, Stdphuric and Nitric acids, for instance. Here, again, caution is necessary. As these acids, particularly the vege- table acids, may cause croupous deposits, do not permit a child con- valescing from croup to partake of acid fruits. When the child is susceptible, any one of these acids may tend to produce this disease again.

We find that all the acids cause a peculiar debility. This is not a simple functional weakness, such as might result from a rather ex- hausting diarrhoea, such as you find under Cinchona, or such a func- tional weakness of the nerves as will be curable by Zinc, but it is a debility which arises from defective nutrition, particularly from blood disease. Thus we find them called for in very low types of disease, disease in which blood poisoning is a prominent feature, in typhoid states and in scarlatina, particularly when of a low type, in conditions of exhaustion from abuse of various organs of the body. Thus drunkards, who have long been indulging in liquors to excess, may be relieved by Sulphuric, Phosphoric and Arsenious acids.

We find them indicated, too, in diabetes mellitus. The principal acids for this condition are Phosphoric and Lactic acids.

We find, too, that many of the acids are useful in scurvy, particularly when it has arisen from a diet of salty food with deprivation of vege- tables. So much for our general review of the acids. We will now begin to speak of the acids in order, and, first of all. of Fluoric acid.

THE ACIDS. 519

Mezer. I Stilling.

Wk begin this morning with the study of Mercury and its combi- nations. Mercury has long been known and used as a medicine in the old school of practice. Its abuse, when given in excess or inappropri- ately, has rendered it a very unpopular remedy among the laity. There are many physicians in the so-called old-school practice who have endeavored to obtain for Mercury a substitute which would answer the same purpose without deleterious results.

They have been more or less successful, but they have never really obtained any- thing equivalent to that remedy in its genuine usefulness. Of late days, there are not so many allopathic physicians who give the great doses of Mercury that used to be so common. This caution in its ad- ministration is no evidence of improvement of the medical world, scientifically speaking,- but only that they have been driven to this course by their unfortunate results and by popular clamor. There are many physicians who are afraid to let their patients know that they are taking mercurials.

The eclectics have substituted such plants as Podophyllum and Leptandra for Mercury, especially in liver affections.

We, of the homoeopathic school, are not afraid to use mercurials, because we do so according to a fixed law, guided by their effects on the human system; therefore, we are not in any danger of the bad

THE PREPARATIONS OF MERCURY. 585

results which follow overdosing or misapplication of the drug. You notice that I have placed on the board a number of mercurial prepa- rations. All of these have some medicinal properties, but we have not the time, nor will it be proper, to dwell on them all. Our main object is to treat of the principal actions of Mercury in general, and then to teach you the principal characteristics which will enable you to prefer one of these preparations rather than others.

From the gen- eral character of the patient, you know that he needs some mercurial preparation, and you want to know wmich one. We have here two preparations, Mercurius vivus and solubilis, that I have placed on the same line. I do not know enough to separate them symptomatica!^'. The provings have been separately placed in Allen's Encylopcpdia, but I have not been able to see any essential differences between them.

These preparations are the quicksilver, or metallic Mercury, and the Soluble Mercury of Hahnemann. Mercurius solubilis is not a pure mercurial preparation. It contains some Ammonia and some Nitric acid. There are only traces of AHtric acid, however, and yet these traces must modify its symptomatology somewhat, but to what degree I do not know.

The provings of the "solubilis'" are excellent. They are complete, much more so than those of the " vivus." These latter are collected more from poisoning cases and from clinical cases than from actual provings. If, then, the s}miptoms are clearly placed in the Encyclopedia under Soluble Mercury, I would advise you to use that preparation. Below the Mercurius vivus and solubilis on the board we have two preparations of Mercury with Chlorijie.

Next comes Mercurius aceticus, of which we have but few symptoms. Next we have the two Iodides of Mercury, wThich are very important. The Biniodide is red, the Protoiodide, yellow. Then wTe have the Cyanide of Mercury.

Next we have Cinnabaris, which is the Sulphide of Mercury. Beneath this we have the Sulphate of Mercury, and then the Mercurius prtzcipitatus ruber. Of the latter three we have but few symptoms. Cinnabaris, the two iodides, the corrosivus, the solubilis and the vivus are the most frequently used.

You see here on your right a list of antidotes to Mercury. That is in itself evidence of the numerous ill-effects which may result from its abuse. The}' are not all of equal importance. As I mentioned the other day, Hepar is the most important antidote for Mercury, and also for many of the other metals. It is useful for the mental symptoms that may follow a course of Mercury, the anxiety, distress, and even

586 A CLINICAL MATERIA MEDICA.

the suicidal mood; also for the bone pains, sore mouth, ulcers and the gastric symptoms.

Nitric acid is particularly to be remembered when the lower tissues are attacked, as the periosteum, the bones and the fibrous tissues. The patient has bone-pains worse at night, aching in the shins in damp weather, ulcers in the throat; particularly if secondary syphilis is com- plicated by mercurial poisoning.

Cinchona is said to antidote the chronic ptyalism produced by Mer- cury.

Dulcamara has been successfully used for the salivation of Mercury, particularly when it is aggravated with every damp change in the weather.

Kali hydriodicum, or the Iodide of Potassium, is a well-known antidote for Mercury, and has come into practice of late years, and is given by both schools of medicine very extensively, whether the case be syphi- litic or not. Like Nitric acid, it is particularly indicated when syphilis and Mercury combine to make the patient sick, especially when the lower order of tissues are involved, as the bones, the periosteum and the glands; when there is the well-known syphilitic ozaena, a thin watery discharge from the nose, making the upper lip sore and raw.

You will find it the best drug we have for the repeated catarrhs which may follow the abuse of Mercury. Every little exposure to a damp atmosphere, or even to cool air, causes coryza. This, remember, is a case of mercurial poisoning which the Iodide of Potassium is to antidote. The eyes are hot, and watery, and swollen.

There are neuralgic pains in one or both cheeks, the nose feels stuffed up and is swollen, and discharges at the same time a profuse watery scalding coryza, and there is more or less sore throat. These symptoms recur at every fresh exposure. There is scarcely any drug which will cure these quicker than will Iodide of Potassium.

There is another salt of potash that has an antidotal relation to Mercury, and that is Kali chloricum. This is an efficient antidote when the poison has developed a sort of scorbutus, and the gums are spongy, soft, and bleed easily; there are ulcers of an aphthous character in the mouth and throat, and foetor of the breath.

Aurum has next mention. This we find particularly called for in the mental depression and suicidal mania which may develop after a course of Mercury, and also for the caries of the bones, particularly of the bones of the palate, nose, etc.

THE PREPARATIONS OF MERCURY. 587

Asafoetida also comes in as a drug to be thought of in the bone affections developed b}' Mercury. Here you have, as a characteristic distinguishing it from the others, extreme sensitiveness around the dis- eased portion of bone. For instance, in the case of an ulcer communi- cating with a carious tibia, the parts are so sensitive that the patient can scarcely bear the dressing that you apply. You will find that the tissues are firmly adherent to the bone for some little distance around the inflamed portion.

Then, too, you find Asafoetida sometimes indi- cated for iritis following mercurialization. Here, to distinguish it from other remedies, you have the same characteristic, extreme soreness of the bones around the eye.

Staphisagria is an antidote for Mercury, and in rather bad cases, too, when the system is very much depreciated by the mercurial poison. We find the patient wasting away and sallow, dark rings around the eyes, well-marked mercurial mouth and throat, with spongy gums, tongue flabby, ulcers on the tongue and in the throat and well-marked bone pains.

Lachesis is an occasional antidote for some of the symptoms, when the mercurial poison has been engrafted upon the constitution and the special characteristics of that remedy are present.

Iodine comes in as an antidote, especially wrhen the glands are affected.

Mezereum is excellent when the mercurial poisoning has invaded the nervous system and neuralgia has developed. This neuralgia may ap- pear in the face, in the eyes or in any part of the body.

Lastly, we have Stillingia, which is called for in broken down consti- tution with periosteal inflammation and nodes on the bones.

Mercury, it is well known, enters into loose combination with the tissues of the body. It has been found in every tissue and may be excreted by almost every channel. It has been found in the perspira- tion, urine, bile, faeces and saliva. It has even been found in the child in utero and, again, in the nursing infant, when the drug has been taken by the mother.

I said that the combination of Mercury with the tissues is a loose one, by which I mean it is early disrupted. If a person is poisoned with Mercury, it will be readily displaced by one of the above remedies. It is only the chronic cases that need give you concern, and the cure of which you may despair of. When mercuri- alization is combined with other poisons, as with syphilis and scrofula, then you will have greater difficulty.

588 A CLINICAL MATERIA MEDICA.

The symptoms of poisoning by Mercury are these: after exposure to the poison, the breath takes on a sickening sort of odor hard to describe but easy to remember. There is also a metallic taste in the mouth. These are very early symptoms and assert themselves long before the well-known characteristics of the drug appear. The patient feels languid and is frequently sick at his stomach.

He vomits his food without any apparent cause. His face becomes rather pale, with dark rings around the eyes; the lips are rather livid and purplish. He complains of heat, particularly in the forehead and down the root of the nose. He cannot bear the warmth of the bed.

As soon as he gets warm in bed, his aches and pains begin. Then his mouth begins to feel sore. The mucous membrane becomes puffed, swollen and redder than natural. The salivary glands begin to secrete more rapidly and the mouth is filled with saliva, which is, however, normal in its com- position.

In a more advanced case, the saliva becomes vitiated. It is no longer the pure secretion, for the glands are overworked. The breath becomes more and more offensive, the gums swell and are tender to touch and the teeth become loose. A dark red line some- times appears on the gums below the teeth.

Later, the gums grow spongy and yellowish-white and ulcerate and discharge an offensive matter. The tongue swells and readily takes the imprint of the teeth. The glands then become involved and you find more or less tumefac- tion of the parotid and cervical glands. If you were to look into the mouth at this stage, you would find the opening of Steno's duct red and inflamed and, in some cases, even ulcerated.

Other glands, too, are affected. We find the pancreas attacked by Mercury. The liver also comes in for a share of the poison. You are probably aware that the liver is markedly affected by Mercury, and that allopathic physicians have been accustomed to give blue mass or calomel in almost every at- tack of "liver-complaint." Quite recently, several eminent physicians in the old school have declared that Mercury does not increase the flow of bile and hence is not useful for torpid liver; but, however that may be, it is certain that Mercury does affect the liver in one way or another.

It has caused catarrh of the duodenum, and this catarrh has extended along the bile-duct into the liver. This is a form of trouble which frequently causes jaundice, and a form, too, for which Mercury is useful. It has also produced and cured hepatitis, particularly when one or more abscesses have formed in the liver. Individual suscepti- bility and age vary these symptoms considerably.

You will find that

THE PREPARATIONS OF MERCURY. 589

it is more difficult to salivate children than adults.- Some persons are salivated by very small quantities, while it is difficult to affect others. The scrofulous are very seriously affected by Mercury, as you all know.

The more remote symptoms of mercurial poisoning are these: you will find that the blood becomes impoverished. The albumin and fibrin forming of that fluid are affected. They are diminished, and you find in their place a certain fatty substance; the composition of which I do not exactly know. Consequently, as a prominent symptom, the body wastes and emaciates.

The patient suffers from fever which is rather hectic in its character. The periosteum becomes affected and you then have a characteristic group of mercurial pains, bone pains worse in changes of the weather, worse in the warmth of the bed, and chilliness with or after stool. The skin becomes of a brownish hue ; ulcers form, particularly on the legs; they are stubborn and will not heal. The patient is troubled with sleeplessness and ebullitions of blood at night; he is hot and cannot sleep; he is thrown quickly into a perspiration, which perspiration gives him no relief.

The entire nervous system suffers also, and you have here two series of symptoms. At first, the patient becomes anxious and restless and cannot remain quiet; he changes his position: he moves about from place to place; he seems to have a great deal of anxiety about the heart, precordial anguish, as it is termed, particularly at night. Then, in another series of symptoms, there are jerkings of the limbs, making the patient appear as though he were attacked by St. Vitus' s dance.

Or, you may notice what is still more common, trembling of the hands, this tremor being altogether beyond the control of the patient and gradu- ally spreading over the entire body, giving you a semblance of para- lysis agitans or shaking palsy. Finally, the patient becomes para- lyzed, cannot move his limbs, his mind becomes lost, and he presents a perfect picture of imbecility. He does all sorts of queer things. He sits in the corner with an idiotic smile on his face, playing with straws; he is forgetful, he cannot remember even the most ordinary events.

He becomes disgustingly filthy and eats his own excrement. In fact, he is a perfect idiot. Be careful how you give Mercury; it is a treacherous medicine. It seems often indicated.

You give it and relieve; but your patient is worse again in a few weeks and then you give it again with relief. By and by, it fails you. Now, if I want to make a permanent cure, for instance, in a scrofulous child, I will very

A CIvINICAI, MATERIA MEDICA.

seldom give him Mercury; should I do so, it will be at least only as an intercurrent remedy.

I have placed on the board in tabular form, a list of the mercurial salts together with the parts of the body on which they act. Wher- ever you notice the cross, you know that the preparation acts on the part of the body placed on that line under the heading of Mercurius vivus. This table is only a convenient form. There is nothing prac- tical or scientific in it.