Stannum

Ferrum. Manganum. Niccolum. Kobaltum.

MINERAL KINGDOM. 457

coming in the morning or afternoon, insignificant as it may appear under other circumstances, serves as a differentiation between these two drugs. Now in making this statement I do not mean that be- cause Sulphur produces a morning diarrhoea, that it must always be the remedy when that symptom is presented; but I do mean that when you are compelled to decide between two remedies having opposite directions in action, this relation becomes of great importance. As you approach the remedies or chemicals at the neutral point of the magnet, you find these effects less marked, until, finally, they are un- noticeable.

There is another fact which we may learn from this arrangement of drugs. You notice that here we have oxygen and sulphur. They are chemical elements, which are placed near together in chemistry, and are similar not only as chemicals but also as medicines. Next on the list we have nitrogen, which is used in medicine in the form of Nitric acid.

Below this we have a list of remedies which constitute a group in chemistry known as the halogens; they consist of Fluorine, Fluojic add, Iodine, Bromine, and Spongia. The latter drug is placed here not as a chemical substance, but as a drug which owes its medic- inal properties to the iodine and bromine which it contains. It is of practical value to remember these drugs in this connection, because they are not only chemically similar, but they are also similar as medicines. Moreover, this grouping of remedies enables you to keep in mind a group of remedies from which you may choose one to suit your case.

I have introduced cyanogen here because it holds import- ant chemical and medicinal relations to the halogens. Below we have the carbon group, Carbo veg., Carbo animalis, Anthrakokali , the dia- mond, and Graphites. I have also placed in this group Petroleum and Cosmoline or petroleum jelly, two oily substances, rich in carbon, and having many resemblances to the pure carbons.

In a future lecture I shall give you the characteristics which belong to all the carbons, so that you can say here is a patient who needs some preparation of carbon, which shall it be? This you de- termine in the same way as you selected one of the halogens. Next we have a group composed of Phosphorus and its acid and Arsenicum. Below, we have Tellurium, Antimonium crudum and Antimoniu7n tariaricum, which is similar enough to the sulphide to be placed along side of it.

This group of drugs possesses many similarities. Phos- phorus and Arsenic are continually placed in contrast in the physician's mind, and it is often difficult for him to decide which he shall give.

45§ A CUNICAI, MATERIA MEDICA.

The Antimony preparations are similar in form and isomorphous with Sulphur and Selenium. There is another fact which we may borrow from chemistry, and that is that substances of similar crystal- line structure have similar medicinal effects. These substances often replace each other in chemistry. I give you these facts so that you may have a rational conception of drugs, not as mere individuals, but as consistent with nature and with themselves.

Here below we have the noble metals, gold and silver. Then we may go up on this side tracing the drugs through the same relation we did on the other. Every one knows how closely related, chemically and medicinally, are Barium and Strontium. This relation is very much like that of simi- larity in origin.

They are not apt to follow one another well. Here are Sulphur and Sulphiiric acid; suppose you are going to decide be- tween them and suppose it to be a perplexing case. You say ' ' I will give Sulphur, and if he is not better to-morrow I will give Sulphuric acid.''' That is bad practice. It would be much better to say that I will give Sulphur to-day and Calcarea to-morrow.

Why ? They are similar drugs, but entirely foreign in their family relations and origin. Why do I dwell on these two relations ? Because I want you to dis- tinguish between that which is the same and that which is similar.

Ignatia and Nux vomica are too much as though they were the same thing. Ignatia and Zinc are concordant remedies which are similar but which are not identical. You note that I have placed hydrogen above all the potash salts. You notice that here is placed antozone.

Ozone is negative oxygen, and antozone is positive oxygen. Ozone exists in the sea-air and how many times do you send your patients to the sea-shore for relief. We may derive a hygienic fact from this statement; if I have a patient who is something of a Sulphur patient, I would think that sea-air would do him good because sea-air is rich in ozone, and ozone in a general way suits his condition. On the other hand, if he belongs more to the " salt" class of drugs I would not send him to the sea-shore.

I would send him where antozone exists, as in fogs. We will now proceed to study the drugs derived from the min- eral kingdom. The remainder of the hour I will devote to the consid- eration of Selenium. To-morrow we will study the king of remedies, Sulphur.

MINERAL KINGDOM. 459

Selenium.

f Arum tri. < Cinch.

Selenium. \ Caust., Carbo v., Phos., Spong. ^J^' ! Sulphur. <Fg*s

Selenium is isomorphous with Sulphur and resembles it both chemi- cally and medicinally. We find it producing very little effect on the blood and lymphatic vessels, but it acts on the nervous system. We often find it the remedy in nervous diseases. It seems to produce a weakness or general debility involving all parts of the body.

This debility is expressed by easy fatigue from any exertion or labor. If the patient sits up a little too late at night, or exerts his mind a little too much, he is exhausted the whole of the next day and is thereb}^ unfitted for either mental or physical work. Particularly is he weak- ened from hot weather. It is evident that the hot weather weakens him.

This is further shown by the fact that he becomes stronger as the sun sinks and the temperature with it. He is sluggish on account of this debility. He wants to sleep from sheer exhaustion, and yet he is always worse after sleep. He cannot bear any nervous exhaustion, consequently he is made worse by seminal emissions, whether volun- tary or involuntary.

As a result of the seminal loss, the next day he is irritable, suffers from mental confusion, headache, almost paralytic weakness of the spine, involuntary escape of prostatic fluid, dribbling of semen during sleep, and after stool and urination. Now you will notice at once the resemblance of the drug to Sulphur. Both have bad effects of mental exhaustion and loss of sleep, and both have in- voluntary emissions and prostatorrhoea. The distinction lies in the fact that Selenium has more of the relaxation.

Here you find two substances suitable in similar conditions, and yet the shade of differ- ence is sufficient to enable you to know which one is the more useful for your case. Both have impotence. With Sulphur there is more coldness and shrivelling of the genital organs. With Selenium there is more of this total giving up or relaxation, so that semen dribbles away involuntarily.

We may be called upon to use Selenium for the sequelae of typhoid fever. When the patient begins to walk about, there is such great debility of the spine that he fears that he will be paralyzed. Again,

460 A CLINICAL MATERIA MEDICA.

you see the great similarity between Sulphur and Selenium. Sulphur is invaluable in the exhaustion consequent upon protracted diseases. This again we have in Selenium. In Selenium, such characteristic Sulphur symptoms as flushes of heat on the least motion are lacking. Sulphur has more of that gone weak feeling in the forenoon, which is not marked under Selenium.

We find Selenium also indicated in headache of nervous origin. The pain is of a stinging character, and is usually situated over the left eye, and it is worse from the heat of the sun. Notice again how hot weather influences the Selenium patient. The headaches return quite periodically every afternoon, and are increased by any strong odor, as the odor of tube-roses, musk, etc.

This headache is evidently nervous because it is associated with profound melancholy and profuse flow of clear limpid urine. You often find this last symptom in hys- terical patients. Other remedies, however, have it in more marked degree, as, for instance, Gelsemium, Ignatia, Lac defloratum, Moschus, etc.

Again, another indication of the nervous origin of this headache is seen in the fact that the patient is worse from drinking tea and from certain acids, notably lemonade. Even tamarind-water aggravates. Here again we have resemblances to the Sulphur, in the periodical re- turn of the headache. With Sulphur, however, it does not return every afternoon, but every week; nor has this remedy the aggrava- tion from tea, although it has from coffee.

You will find both remedies indicated in the headache of drunkards and of those who have been guilty of debauchery. The Sulphur head- ache is worse from all forms of alcoholic drinks. The Sele?iium head- ache is sometimes improved by brandy, as are also the gastric symp- toms. You will find that the patient has a longing for brandy.

Now this is not the drunkard's craving. It is the result of a peculiar weak- ness in the stomach, a feeling as if the patient wanted something to stimulate him, and brandy is desired, as it has a temporary palliating effect. The same symptom you find under Staphisagria and Hepar sulphur, both of which have that great relaxation and dragging or want of tone in the walls of the stomach and consequent insufficiency in the secretion of gastric juice.

Seleniwn comes to us well-recommended, in a peculiar form of con- stipation, though it failed me in the one case in which I used it. The constipation for which it is indicated is one purely due to atony of the

MINERAL KINGDOM. 46 1

intestinal tract. Peristaltic action is almost nil, so that faeces become impacted. The faeces are hard and dry from absorption of their mois- ture, and require removal by artificial means, yet Selenium is said to tone up the rectum and prevent the recurrence of this symptom. The same symptom is found under Alumina, Opium, Plumbum and Bryonia, but these are probably not indicated so often during convalescence.

Another peculiarity of Selenium which qualifies its symptoms is the character of the sleep. The patient sleeps in cat-naps. He awakens often in the night, or is easily aroused by any slight disturbance. He awakens at precisely the same hour every morning before his usual rising time, when all his prevailing complaints are worse.

Here again it resembles Sulphur. These "cat-naps" are characteristic of Sul- phur. The true Sulphur sleeplessness is this : The patient is aroused from sleep and is then wide awake. He has not this periodical hour of awakening each morning, which calls for Sele?iium.

Another resemblance between the two drugs you will find in affec- tions of the skin. Selenium is useful in skin diseases, particularly when there is itching in the folds of the skin as between the fingers, and about the joints, particularly the ankle joint. The itching may also occur in small spots and is associated with tingling, here again showing involvement of the nervous system. The hair falls off, not that of the head, the eyebrows and whiskers, but of other parts of the body.

You will find on the scalp an eczematous eruption which oozes a serous fluid after scratching. Here, again, it bears a striking re- semblance to Sulphur, but is distinguished from that remedy if the patient is old enough to describe his case, by this tingling in spots.

We sometimes find, although not often, that Sele?iiu?n, like Sulphur, is indicated in chronic affections of the liver. Especially is it called for in enlargement of the liver with loss of appetite, particularly in the morning; there is white coating on the tongue, thus separating it at once from Sulphur. Then, too, with loss of appetite, Sulphur has increase of thirst, which is lacking in Selenium. There are sharp stitching pains in the hepatic region, worse on any motion and worse on pressure and sensitiveness of the liver.

Now if there is a peculiar fine rash over the hepatic region, Selenium is the only remedy you can think of to suit your case.

Selenium has a very marked action on the larynx and lungs. Sev- eral animals were poisoned with Selenium. It produced inflammation of the lining membrane of the larynx and congestion of the lungs with

462 A CLINICAL MATERIA MEDICA.

exudation into the pulmonary substance. Post-mortem examination showed the mucous membrane to be congested, with dark purplish spots here and there through it. Oozing of blood and frothy serum followed the incision of the knife. I have used Selenium successfully in the hoarseness of singers, particularly when the hoarseness appears as soon as they begin to sing.

It may also be used when hoarseness appears after long use of the voice. There is frequent necessity to clear the throat by reason of the accumulation of clear starchy mucus. These symptoms point suspiciously towards incipient tubercular laryn- gitis. Here Selenium is grouped with Arum triphyllum, Spongia, Causticum, Carbo veg. and Phosphorus.

Arum triphyllum has entirely different effects, but it bears a strong symptomatic resemblance to the throat symptoms of Sele?iium. It is also useful for the hoarseness of singers and orators, but especially in- dicated when the voice suddenly gives out during use. For example, the patient is talking in a sort of monotone when the voice suddenly breaks and goes up to a higher key.

The antidotes to Selenium are Pulsatilla and Ignatia. China and wine are inimical to it. The debility caused by Selenium, so says Hahnemann, is very much increased by the use of Cinchona. Now the emaciation caused by Selenium is very similar to that of Cinchona. We have debility and emaciation from loss of animal fluids, a condition also found under Cinchona; yet the two drugs are inimical.

LECTURE XLV.

SULPHUR.

( Causticum. Stannum. \ Phosphorus, Sulphur. Sepia, Pulsatilla, etc.

\

V