Vinca Minor

Vinca minor is one variety of the periwinkle. It contains a bitter and astringent principle, making it of service asa " tonic," to use old- school language, and also as a styptic to control haemorrhage. These properties it retains in the potencies. For instance, it may be used for profuse menstruation or passive menorrhagia when the blood flows in one continuous stream, associated of course with great debility.

I find that Dr. Richard Hughes, in his Ma?iual of Pharmacodyna?nics , speaks of three cases of post-climacteric haemorrhage, all of which were improved by Vinca minor. In one a permanent cure resulted; in the other two there was a return of the haemorrhage, and in one of these the trouble was due to carcinoma.

Vinca minor, like its relative, Oleander, produces an offensive smell- ing eruption on the scalp and face and behind the ears, in which vermin breed. It develops a crust which allows the discharge to re- main beneath, and decomposition furnishes pabulum for the vermin ;- the hair falls out and is replaced by gray hair.

Viyica minor is also useful in plica polonica, a condition in which the hair is matted together.

In these skin symptoms you may compare Vinca minor with several remedies; first with Viola tricolor. This is useful in crusta lactea, when the exudation is very copious. Like Vinca, it mats the hair to- gether, but there is this peculiarity which always enables you to dis- tinguish between the two, namely, Viola has urine with a peculiar pungent odor, which has been aptly compared to that of cat's urine. You may think of it when persistent eczema is accompanied by

1 68 A CUNICAI, MATERIA MEDICA.

disturbance in the urinary organs, either too copious urination, or sud- den cessation of the urinary secretion.

Another remedy is Arctium lappa, which is useful for moist offensive eruption, forming grayish- white crusts, especially when the adjacent glands are swollen; the axillary glands may even suppurate. There is polyuria with pain in the bladder after voiding the urine.

Still another remedy for crusta lactea or tinea favosa is Nux juglans. It has soreness on and behind the ears, like Graphites; the scalp is red and itches violently. Scabs appear on the arms and in the axillae (also Arseiiicum iod.).

Staphisagria is a good remedy for an oozing foetid eruption, worse on the occiput; the hair falls out. Scratching seems to cause the itch- ing to change place. It is particularly indicated in sickly children with pale face and dark rings around the eyes. They are easily angered and reject proffered gifts, just as under Chamomilla. It is especially indicated after the abuse of mercury.

Ustilago has caused, but it has not yet been reported to have cured, a filthy eruption of the scalp, in which part of the hair came out, leaving the remainder matted. A watery serum oozed continually from the eruption.

AlvSTONIA SCHOLARIS.

Alstonia, so far as proved, causes debility, low fever, often with diarrhoea, and, when pushed, rigors, sweat, etc., purging, cramps and vertigo. Clinically, it has been used in chills and fever, in diarrhoea of malarial origin, here vieing with China, and for chronic intermit- tent fevers suppressed by quinine.

It contains Ditaine, which, like Curare, paralyzes peripheral motor- nerve filaments. This is not, as in Chininum, preceded by reflex ex- citement. Ditaine evidently paralyzes vaso-motor nerves. It seems to resemble China in diarrhoea, chills, etc., but has not the irritability of the latter.

LECTURE XV.

GELSEMIUM SEMPER VIRENS.

Gelsemium sempervirEns is a 3^ellow-flowering plant indigenous to the South. It is an evergreen, and puts forth its fragrant flowers among the earliest in the spring. It is highly poisonous; especially active in this respect is the bark of the roots. During our late civil war this plant was largely used in the South as a substitute for Opium as a narcotic.

It is a member of the Loganiacese, all of which are more or less poisonous. From this order we obtain also Nux vomica, Ignatia and Spigelia.

Its alkaloid, Gelsemi?ie, is a mydriatic like Atropine and Duboisine. Applied locally or used internally in large doses, it dilates the pupil. Given internally in small doses, however, it contracts the pupil.

To acquire a thorough knowledge of Gelsemium will not tax you much. Its sphere of action is well defined. In poisoning cases we find that the prominent and universal symptom is paralysis of the motor nerves. Keep this fact before you and the symptoms of this remedy will be readily understood, especially if you apply the paretic action to both voluntary and involuntary muscles.

The mind is at first clear; or there may be a slightly stupefied condition as in the case of al- coholic intoxication, a sluggishness in thought and in emotion. Later in the toxic effects of the drug you will note that the sphincters be- come relaxed; the anus remains open, permitting the escape of faeces. Urine escapes freely and involuntarily. Still later, respiration becomes labored, as though the muscles had not the power to lift the chest.

Finally, the heart-muscle gives out, and the patient dies. Looking, then, at these symptoms as presenting in a nutshell the action of this drug, we find that it is a depressant. It acts upon the cerebro-spinal system, particularly upon the anterior columns of the cord. We also see that, by producing this sluggishness of thought, this stupid state of the mind, it must have an action on the vascular system.

It is through the vaso-motor nerves that it produces passive congestion, and this congestion may be either venous or arterial. Passive congestion is generally of venous origin; but under Gelse??iium the passive

170 A CUNICAI, MATERIA MEDICA.

hyperemia refers to both arteries and veins. In addition to this nervous action of the drug, it has something of an affinity for the mu- cous surfaces, giving rise to catarrhal inflammations. It is not diffi- cult with this outline of the drug to fill in the characteristics.

We find that, in obedience to its paralytic action, it causes diplopia. This double vision, when Gelsemium is the remedy, comes from pare- sis of the muscles of the eye.

Ptosis, or paralysis of the upper lid, calls for Gelsemium when it is associated with thick speech and suffused redness of the face. The eyeballs feel sore, the soreness being worse on moving the eyes. In this last symptom it is similar to Bryonia.

In ptosis we may compare Gelsemium with Causticum, Rhus toxi- codendron, Sepia, Kalmia, and Alumina. Rhus tox. is useful in ptosis, or, in fact, in paralysis of any of the ocular muscles, when the disease occurs in rheumatic patients as a result of getting wet.

Sepia is indicated in ptosis when it is associated with menstrual ir- regularities.

Kalmia is also useful in ptosis of rheumatic origin, when attended with a sensation of stiffness in the lids.

Causticum, in the ptosis of rheumatic subjects.

Alumina is indicated in ptosis associated with rectal inertia and con- sequent constipation.

Returning now to Gelsemium, we find that there is difficulty in swallowing, dysphagia, as it is called. This symptom is due to defect in the muscles of deglutition.

Gelsemium also acts upon the larynx, causing aphonia, or want of voice; the patient may be able to whisper, but he can scarcely utter any sounds on account of the paretic state of the laryngeal muscles. This symptom is frequently observed in hysterical women especially after emotions of a depressing character. Paralysis after emotion is noted under other drugs; for example, under Natrum mur., which has, " the arm almost loses its power after a fit of anger;" Stannum, para- lysis mostly left-sided with perspiration of the affected part; Staphi- sagria, paralysis of one side from anger.

The heart is affected by Gelsemium; on going to sleep the patient is suddenly aroused by a feeling that the heart will stop beating. He feels that the heart would cease to beat if he did not move about. Here the heart-muscle is in a weakened state, and there is a sort of instinct on the part of the person to move about to stimulate it to act.

GEESEMIUM SEMPERVIRENS. 171

Digitalis has a symptom which is just the reverse of this, namely, the patient fears that the heart will cease beating if he makes any motion.

Grindelia robusta has great weakness of the heart and lungs. When the patient drops off to sleep he wakes up suddenly with a sensation as if respiration had ceased.

In post-diphtheritic paralysis, Gelsemium is our most valuable rem- edy. In one very severe case of this disease under my care, Gelsemium effected a perfect cure. The child did not have sufficient strength to hold herself up. The spine in the upper cervical region was bent backward.

One side of the body was paralyzed. In attempting to walk, the child would shuffle along as though she had no control over the muscles. If she attempted to turn around, she would fall. The speech was thick and heavy, as though the tongue were too large for the mouth.

There was marked strabismus. But sensation was nearly perfect. I ordered the patient to be stripped twice a day, laid on the bed, and thoroughly rubbed. I gave her Gelsemium internally, and under the use of this remedy she made a perfect recovery.

I doubt whether Gelsemium will cure paralysis of organic origin, where there are tissue alterations in the brain, the spinal cord, or the peripheral nerves themselves.

Gelsemium is useful in some cases of headache. I said a few mo- ments ago that it causes a passive congestion, and by that I mean, not a violent, sudden afflux of blood to a part, but a dilated condition of the bloodvessels, such as may be found under Ferrum phos. The headache begins in the nape of the neck, passes up over the head, and settles down over the eyes. It is usually worse in the morning, and is accompanied by stiff neck, or it begins at 2 or 3 a. m. and reaches its acme in the afternoon.

The patient cannot think effectively or fix his attention. He becomes listless and stupid; he has dizziness with blurred sight and heaviness of the head. These symptoms are alle- viated by the discharge of watery-looking urine.

Oleum animale has cured megrim with polyuria, the urine being per- fectly clear. Compare also Ig?iatia, Sa?iguinaria} Kalmia, Melilotus, Aconite and Silicea.

The face is a suffused red color. The eyes grow heavy and bloodshot. There is great difficulty in lifting the upper lids; often, too, the speech is thick, as though the tongue were unwieldy. Altogether, the face has the appearance of one under the influence of liquor. Thought is

172 A CUNICAL MATERIA MEDICA.

slow, so that the patient answers questions either slowly or imperfectly. This condition is accompanied by a pulse which is full and round, and seems to flow under the fingers like a current of water. It resembles the Aconite pulse, but lacks the tone of the latter. It is not hard and unyielding like the pulse of Aco?tite. Not infrequently the headache is preceded by blindness, as under Psori?ium.

Here, then, you have symptoms which suggest Gelsemium in a va- riety of diseases. How useful it ought to be in the congestive stage of spotted fever! In addition to the symptoms already mentioned, there is another which is characteristic of spotted fever, namely, depression; the system seems to be laboring under the effect of some poison which it cannot overcome. So you have every indication here for the use of Gelsemium in that dreaded disease.

But when the case advances to active inflammation, or when there is effusion, Gelsemium gives place to other remedies.

In addition to the headache above described, there is another form which is associated with a feeling as though there were a band around the head, or across the forehead.

Let us now consider the fever of Gelse?nium. It causes a fever which is remitting or intermitting in its type. You will find it a valuable remedy in the remitting types of fever in children. During the febrile exacerbation they are very nervous and restless, tossing about continually.

(You must not give Aconite in these cases, unless the mental symptoms of that remedy are present.) The face has the suffused redness I mentioned above, and there is drowsiness. When aroused from this drowsy state the child is peevish, irritable, nervous, even somewhat excitable, but there is never the violent tossing about of Aconite. In extreme cases the drowsiness may give place to con- vulsive motion. The muscles of the face twitch; the child becomes rigid, as though it were about to have a convulsion.

There is usually not very much thirst, but there is great prostration, so that the child seems too weak to move. Every part of the body seems to be so sore that he cries out if you move him. These symptoms will remit and, possibly, the next morning, slight perspiration will show itself. The next afternoon the symptoms return as before.

In intermittent types of fever you may select Gelsemium in the be- ginning. The chill runs up the back or starts from the feet and ex- tends upward. It is sometimes associated with copious urination and with bruised aching all over the body. The patient wants to be held

GEESEMIUM SEMPERVIRENS. 173

so that he will not shake so much. Then comes the fever with the symptoms that I have already mentioned. Sometimes irritability is exhibited. He can neither bear noise nor light. The sweat is slight or partial, but it relieves all the pains. The tongue is coated white or yellow. Speech is thick. The bowels are constipated and the stools are yellow. It is especially indicated in intermittent fever of non- malarial origin.

In adults we find Gelsemium the remedy in bilious fever, particularly bilious remittent fever. The reason that it is useful in bilious fever is that it causes a passive congestion of the liver. The blood flows slug- gishly through the liver. This is not the portal stasis found under Nux vomica, but it is a lazy now of blood. Thus the liver becomes overcharged with blood, the bile cannot be properly secreted, and there is a bilious type of fever.

In typhoid fever Gelsemium is indicated, particularly in the initial stages; when, during the first week, the patient feels sore and bruised all over, as if he had been pounded. He dreads to move. He has headache. More than that, he has loss of muscular power. He is drowsy, and has this same suffused red face. In these cases Gel- semium will so modify the course of the fever that the patient will pass through it with comparatively mild symptoms.

We may find Gelsemium indicated in catarrhs excited by warm, moist, relaxing weather, with excoriating discharge from the nose, making the nostrils and wings of the nose raw and sore. There are frequent paroxysms of sneezing, especially in the morning, and sore throat, the tonsils being red and somewhat tumefied, with difficulty in swallowing. I would remind you, in passing, that this difficulty in swallowing is not what it is under Belladonna. Under the latter remedy the difficulty comes from the extent of the swelling, and also from spasmodic contraction of the fauces, owing to the hyperesthesia of the nerves.

No sooner does water touch the throat than it is ex- pelled through the nose. With Gelsemium the d3<sphagia is the result of the paretic state of the muscles, or the patient was muscularly weak when he caught cold. With this cold you will find dry, teasing, tick- ling cough, with very little expectoration. There is a sensation of dryness in the mouth, although it is not dry, which reminds us of Nux moschata and Nat? tint mur.

The right nostril is red and sore; there is a feeling as if hot water were passing over the mucous membrane of the nostrils; relief comes when near the fire. You find general pros- tration, and often, too, neuralgia of the face.

174 A CLINICAL MATERIA MKDICA.

Quillaya (or soap bark) cures colds contracted in warm relaxing weather. Like Gelsemium there are muscular languor, desire for rest and quiet, general bruised feeling, even of the eye-balls, etc. The for- mer, however, has more of a stuffed sensation in the nose; the latter a fluent, excoriating coryza with neuralgia of the face and head.

Now in prosopalgia Gelsemium may be of use when the disease affects one side, and is intermitting in its type. The seventh pair of nerves is involved, and the patient makes all sorts of grimaces.

Gelsemium has some slight action on the skin. It produces redness and an itching which is violent enough to prevent the patient from falling asleep. A fine eruption, consisting of small pimples, and some- what resembling that of measles, may appear. Gelsemium may, there- fore, be used in measles in the beginning, when fever is a prominent symptom, and we have the watery discharge from the nose, excoriat- ing the alse nasi and the upper lip.

There is apt to be associated with this a hard, barking, croupy cough and hoarseness.

Aconite, other things being equal, is the best remedy we have for the beginning of measles. If you have a case that you presume is going to be measles, with fever, restlessness, photophobia, coryza, sneezing, and hard, croupy cough, you are justified in giving Aconite.

If there be any fever Pulsatilla is not the remedy.

When the skin is moist with the fever, Belladonna is more likely to be the remedy.

When the characteristic drowsiness and suffused face is present, you may give Gelse?niu?n in the beginning of any eruptive disease, even if there be convulsions present.

Next I want to speak of the action of Gelsemium on the genital organs. On the male organs it produces a condition very nearly ap- proaching impotence. There are frequent involuntary emissions at night, with relaxation of the organs, no lascivious dreams, and often cold sweat on the scrotum. It is indicated especially in those cases which arise from masturbation.

I would have you note here another remedy, namely, Dioscorea. This is excellent for what we may term atonic seminal emissions. The organs are so relaxed that two or three dreams, with emissions of semen, occur in a single night. The day following the emissions the patient feels weak, particularly about the knees In these cases I know of no remedy like Dioscorea. I usually give it first in the 12th potency, and afterward in the 30th.

GELSEMIUM SEMPERVIRENS. 175

Caladium seguinum is indicated for the bad effects of sexual ex- cesses, when wet-dreams occur without any lasciviousness or any sexual excitement whatsoever.

Ag?ius castus is the remedy for spermatorrhoea in old sinners. The parts are cold and relaxed; the sexual appetite is gone and the patient is melancholic.

Other remedies which may be compared with Gelsemiurn in its ac- tion on the male organs are Digitalis, Phosphorus , Nux vomica, Cal- carea ostr. , Lycopodhim and Camphor.

Sepia, Selenium, and Conium produce a similar seminal weakness, with erethism and easy emissions.

In gonorrhoea, Gelsemium is indicated in the beginning when there is marked urethral soreness. There are also burnings at the meatus and along the course of the urethra. The discharge as yet is slight, not having become purulent. The disease may have been suppressed, and, as a result, may be complicated with epididymitis. In gonor- rhceal rheumatism it may be a useful remedy.

In diseases of the female organs, Gelsemium is an invaluable rem- edy. First of all, we find it useful in rigid os uteri. You must not confound this condition with the more common spasm of the os, which calls for Belladonna. Often we find in labor, after it has lasted several hours, that there has been tardy dilatation of the os.

The ex- amining finger finds the os unyielding, hard and thick. The patient is hysterical and full of nervous excitement. The pains leave the uterus and fly all over the body or shoot upward and backward. At other times the pains go from before backward and the uterus seems to push upward.

Or there is a sensation of a wave rising from the uterus to the throat, ending in choking. This condition calls for Gelsemium.

Another condition, exactly opposite to this, also calls for Gelsemium, namely, complete atony of the uterus. The neck of the uterus is as soft as putty. It is perfectly flabby. The body of the uterus does not contract at all. The bag of waters bulges freely from the os, but there is no attempt whatever at expulsion. In such cases, give a few doses of Gelsemium.

In the premonitory stages of puerperal convulsions Gelsemium is an admirable remedy. Albuminuria may be present. The convulsions are preceded by drowsiness, and twitching of different parts of the body. The os is either rigid, as I first mentioned, or else everything

176 A CUNICAI, MATERIA MKDICA.

is perfectly inactive; the pulse is full and large, but soft. Sharp, dis- tressing, cutting pains in the abdomen go from before backward and then upward, and with every pain the face flushes.

Gelsemium may also be used in the non-pregnant state. The uterus is markedly anteflexed and feels as if squeezed by a band. The uterine symptoms are associated with a frontal headache and dim vision. The head feels enormously enlarged, with a wild confused feeling in it. These symptoms alternate with sharp labor-like pain in the uterus extending to the hips and back, and even down the thighs. Gelsemium is often useful in neuralgic and congestive dysmenorrhcea when bearing down coexists.

Caulophyllum is similar to Gelsemium in dysmenorrhcea and follows it well.

Actea racemosa and Sepia have headaches reflex from uterine irrita- tion.

Gelsemiurn is useful for the effects of emotions, particularly after fright or fear. A suddenly appearing diarrhoea, coming on from ex- citement, as for instance ' ' stage-fright ' ' or the anticipation of some trying ordeal, calls for Gelsemium. The stools are copious, yellow and papescent. The tongue is coated white or yellowish.

Other remedies coming into play in cases of diarrhoea arising from^ emotional influences are Opiu?ny Veratrum album, Argentum nitricum and Pulsatilla.

Opium in cases coming on as a result of fright, especially when the image of the thing which caused the fright constantly appears before the mind.

Veratrum album in diarrhoea after fright, associated with cold sweat on the forehead.

Argentum nitricum when diarrhoea follows great excitement, espe- cially when the imagination has been played upon. Diarrhoea from anticipation.

Pulsatilla in diarrhoea from fright, when the stools are greenish, yellow and slimy, or very changeable and worse at night; trembling; weeping.

Gelsemium may even avert impending abortion from depressing emotions, with the peculiar pains mentioned above in connection with labor. In this condition you should compare Aconite and Opium.

Conium, Physostigma and Tabacum intensify the action of Gelsemium.

Gelsemium is antidoted by stimulants, and by Belladonna, Digitalis, China and Cojfea.

LECTURE XVI.

NUX VOMICA.

Nux vomica, another member of the Loganiacese, is a drug that was known as early as 1540, A. D., in which year, one Valerius Cordus wrote a remarkably accurate description of it. The fruit of the tree is about the size of an orange and contains a bitter, gelatinous pulp. This pulp, it is said, is eaten by some of the birds of India, although it is well known to contain Strychnine.

The Nux itself is the seed de- prived of the pulp and shell. This seed is disk-shaped, and about one inch in diameter and one-quarter of an inch thick. Its surface is satiny by reason of a thick covering of adpressed radiating hairs.

You will recall that I have already mentioned that Ignatia and Nux vomica both contain as active principles two alkaloids known as Strychnia and Brucia. The Brucia occurs in much smaller quantities than the other, and is present more in the bark of the tree than in the nut itself. Its properties are somewhat similar to those of Strychnia. Both alkaloids are combined with an acid known as Igasuric acid, which is identical with the malic acid found in apples and pears.

Strychnia, the principal alkaloid of Ignatia and Nux vomica, has a well-described symptomatology, being a poison not uncommonly used for suicidal and homicidal purposes, and also for the extermination of the lower animals, cats, rats, etc. Strychnia causes restlessness, trembling of the limbs, stiffness of the neck and jaws, constriction of the throat and tetanic convulsions with opisthotonos. These tetanic convulsions differ from those of true tetanus only in the fact that the muscles relax between the paroxysms.

The temperature of the body is not so high as in true tetanus, and trismus comes late in Strychnia poisoning. These Strychnia convulsions are re-excited by impressions made on the senses, particularly by the slightest touch, while rubbing relieves; the patient is conscious throughout the attack. In very large or in oft-repeated doses, Strychnia causes paralysis of afferent nerves. Finally, collapse ensues as the result of exhaustion of the motor centres.

I give you these symptoms of Strychnia for two purposes. One is that you may be familiar with them in order to recognize them in case one of your patients is unfortunate enough to be poisoned with

178 A CUNICAL MATERIA MEDICA.

the drug. The other is that you may the better understand the action of Nux vomica, for Strychnia being its principal ingredient, you will find running all through its symptomatology this over-impressibility; by this I mean that everything impresses the patient excessively. Ex- ternal impressions, such as sounds, odors and noises, excite him, and this symptom, I say, is characteristic of the drug.

The smallest fatal dose of Nux vomica is said to be three grains; that of Strychnia, one-half a grain.

Strychnia resembles Picrotoxine, Veratria, Cicuta virosa, Thebaine, Hydrocya?iic acid, Bellado?ina, Stramonium, Aconite, Physostigma, Passiflora, Curare, Camphor, and Phytolacca; but especially are its effects like traumatic tetanus.

Picrotoxine , according to Bartholow, is synergistic with Strychnia; but respiration is accelerated, not so much from spasm of the respira- tory muscles as from spasm of the glottis; and there is less suscepti- bility to slight touch. Gubler asserts that Picrotoxi?ie produces more choreic symptoms.

Veratria causes incoordination by producing relaxation of some fibres with contraction of others; that is, following prolonged contrac- tion of muscles comes a state of partial relaxation with fibrillary con- tractions. Herein it somewhat resembles Strychnia; but it differs widely in purging and vomiting, and in general paralysis occurring, not from exhaustion, but from direct devitalizing of the muscles.

Thebaine causes tetanus, but may be distinguished by its hypnotic symptoms. It is said to be the most poisonous of the active principles of Opium.

Physostigma, which contains the alkaloid Eserine, can be confused with Strychnia only in a limited range of symptoms. It increases the irritability of the sensory nerves and also causes tetanic spasms of in- voluntary muscles. But in the main, it differs widely from Strych?iia, causing spinal paralysis and diminished reflex action. Hence, when such symptoms as constriction of the throat, cramps in the stomach and bowels, tenesmus recti, stiff spine and legs, tight feeling in and about the eyeballs, etc., suggest a similarity to Strychnia, such con- sentaneous evidences of spinal paralysis as the following will serve for differentiation: trembling; so feeble he can hardly walk; finds difficulty in making the muscles obey the will (like Gelse??tium and Co?iium)\ unsteady when walking with the eyes closed.

In Strychnia, death re- sults from asphyxia caused by tetanic spasm of the respiratory

NUX VOMICA. 179

muscles; in Physostigma, from paralysis. The pupils, too, differ; the former causes dilatation during the convulsions, with contraction dur- ing the interim; the latter causes contraction with defective accommo- dation and twitching of the eyelids.

If, now, the remote effects of Strychnia are to be considered — such effects as follow severe but not fatal poisoning, or such symptoms as are frequently produced by potencies — we may still discriminate by the characteristic irritability, which is more marked in Strychnia; every- thing makes too strong an impression; odors cause fainting; there are muscular tremors with excitement; desire for coitus, but during the act the penis becomes flaccid.

Curare, although it contains Strychnia, acts quite differently from the latter on account of the presence of the alkaloid Ctirarine. This substance destroys the irritability of the end-organs of the motor nerves, leaving the muscles themselves intact. Reflex action is diminished or destroyed, and respiration is paralyzed. Sensation is not materially altered.

Owing to paralysis of the vagus, the heart's action is accelerated, bat blood-pressure is not increased. In fact, from paralysis of vaso-motor termini, the bloodvessels dilate, lessen- ing resistance to the blood currents. Increased peristalsis is not due to spasm, but to paralysis of the inhibitory splanchnic fibres.

We have no very trustworthy provings of Curare. Baruch has used it for so-called " liver-spots;" and Dr. Paul Pitet records several interesting cures of muscular weakness, embarrassed respiration from deficient power, immobility with fixed gaze on awakening, and eczema of infants, worse on the face and behind the ears, especially in scrofulous children ( World" s Homceopathic Convention, vol. i).

It has also been used by Baruch, I think, for catalepsy, with spasms of the lower jaw, and for paralytic weakness in the hands and fingers of pianists.

Phytolacca differs essentially from Strychnia in its acrid-narcotic properties, as well as in its tardy gastro-intestinal irritation and col- lapse. Still the convulsive symptoms are somewhat similar; the limbs are stiff, the hands firmly shut, the feet extended and the toes flexed; the jaws are clenched and the lips everted showing the teeth; opistho- tonos is present; the chin is drawn down to the sternum; there is alter- nate relaxation and spasm of the facial muscles.

Passiflora incarnata has cured cases of tetanus in hot countries, where, unhappily, they are but too common. Dr. Archibald Ba}me,

l8o A CLINICAL MATERIA MEDICA.

of Barbadoes, W. I., reports two cures with the tincture and the ix {Hahnemannian Monthly , May, 1881).

Angustura is placed among aromatic bitters and is called a tonic. But it is more than this. It causes drawing, tension, and stiffness of the muscles and joints, with a bruised, sore feeling, as after a blow. This tension is marked enough in the temporal and masseter muscles to suggest trismus.

The drug also affects the bones. There are points of resemblance between Angustura and another of the Rutaceae, the Ruta graveolens. Injury to periosteum frequently suggests the latter; and it is very probable that injury with incipient muscular con- tractions may need the former.

Dr. Hering, who was fully aware of the confusion of Angustura with Strychnia, nevertheless reported a cure of tetanus with the former, and printed the symptoms thereof in his Guiding Symptoms. Dr. Hubbard reports a cure made with Angustura {Medical Investiga- tor, April, 1870).

That Angustura vera acts on the bones has been fully confirmed. iE^gidi used it when the long bones were affected (see Raue' s Pathology} . Dr. C. G. Raue writes me that the preparation with which he cured podarthrocace was unquestionably the vera. It was Jenichen's, and this manufacturer carefully distinguished between Angustura vera and Angustura falsa, or Nucis vomica cortex seu Brucea antidysenterica.

Dr. Aug. Korndoerfer, Sr.,used Jenichen's 200th for necrosis of the lower jaw. One side of the jaw had been successfully excised; but the disease made its appearance on the other side; the cure was com- plete.

Among the general characteristics of Angustura we may refer to irritation from a slight offence (with caries). Craving for coffee (clinical, but confirmed by Dunham, Boenninghausen, and iEgidi). Tenesmus recti, with soft stool; urging to urinate, with copious flow (see Dr. Edmundson's case, Hahnemannian Mo?ithly, October, 1876). I cannot, then, quite agree with Dr. Hughes, who asserts that A?igtcstura has no recognized therapeutic place.

Aconite in one of its manifestations, causes a general tension of nerves and vessels, characterized by the wTell-known anxiety, heat, etc. (see Hughes's Pharmacodynamics) . It also induces trismus, stiff- ness of the limbs, and even opisthotonos. We see now why Reynol could use it successfully in trismus of horses (Trousseau's Therapeutics, vol. ii); and, further, why it is recommended in the beginning of trau- matic tetanus.

NUX VOMICA. I8l

It does not, however, like Strychnia, cause increased reflex excita- bility. There is present rather a diminution or perversion of sensi- bility, expressed by tingling numbness.

In impending tetanus we certainly have efficient preventives of the full-fledged disease. Aconite, with fever, anxiety, tension of muscles, tingling and numbness; Veratrum viride, Hypericum, with excrucia- ting pain in the wound; Belladonna, Cicuta, Silicea, and possibly Angustura, if the wound is suppurating or has suddenly ceased to dis- charge pus.

Hydrocyanic acid was first recommended in tetanus by Begin; and Dr. Hughes, in his paper on that acid, read at the World's Conven- tion in 1876, cited poisoning cases which prove its homceopathicity to epilepsy and to tetanus. The relation of this acid to the latter disease is more fully brought out in Dr. Hughes's Pharmacodynamics , where we read: "Hydrocyanic acid causes tetanus; there is not, as with Strychnia, evidence of increased reflex excitability; but, as with Acojiite and Cicuta, persistent tonic spasm; this it produces by direct action upon the spinal cord."

It seems especially useful when the tetanic symptoms show them- selves mostly in the muscles of face, jaws, and back; there are tris- mus, risus sardonicus and embarrassed respiration, with lividity and frothing at the mouth. Dr. Charles A. Barnard reports two cases of traumatic tetanus relieved with this acid.

In each instance only the spasms of face, jaws, and chest were ameliorated, other remedies be- ing needed for the remaining symptoms (see New England Medical Gazette, October, 1882). This affinity of Hydrocyanic acid for the upper part of the body does not contra-indicate the medicine in opisthotonos and general tetanic rigidity, for under its baneful in- fluence both trunk and extremities are thrown into spasm. In one case, spasms commenced in the toes and spread over the body.

But the acid undoubtedly affects the medulla oblongata most powerfully, and consequently lungs, heart, and larynx suffer through thepneumo- gastric nerve. It bears but little resemblance to Strychnia, but is simi- lar to Cicuta, Lachesis, and Nicotine.

Lachesis has relieved when, with trismus and spasm of the larynx, there is blueness from asphyxia and the patient sleeps into the paroxysm.

Cicuta virosa contains a volatile alkaloid termed Cicutine, which is chemically identical with Coniine. According to Boehm, this plant

1 82 A CLINICAL MATERIA MKDICA.

causes vomiting, diarrhoea, and tetanoid convulsions, and in man also syncope and strabismus. Cicutoxine is another alkaloid derived from Cicuta. It is the most powerful of the Cicuta derivatives, causing in frogs, alternate tonic and clonic spasms. The respiration is hurried, the inspiratory so far exceeding the expiratory act that the animal be- comes distended with air.

In mammals, the first effect is profuse salivation, quivering of the muscles, and then spasms. The breathing grows very rapid, and then suddenly convulsions develop. Respira- tion, as with Strychnia, is suspended by contraction of the respiratory muscles. If irritated, spasms return; after the paroxysms subside, the animal lies completely exhausted.

Now these views of the action of Cicuta embody characteristics which have for years guided the homoeopathist in the choice of this powerful remedy; sudden rigidity; then jerking and violent distortion, followed by utter prostration; tonic spasm renewed by touch; great op- pression of breathing; lock-jaw; face dark red; froth at the mouth; opisthotonos; loss of co?isciousness .

The seizure in the Cicuta case is more epileptiform than in Strychnia and there is generally loss of consciousness. Reflex excitability is less marked in the former. The exhaustion of Cicuta is equalled only by Chininum arsenicosum.

Tabacum and its alkaloid Nicotine, which is also closely related to Coniine, cause drawing back of the head, with rigidity of the muscles of the neck and back; contraction of the eyelids and the masseter muscles; hissing respiration from spasm of the laryngeal and bronchial muscles; alternate tonic and clonic spasms, followed by general relax- ation and trembling; retraction of the abdominal muscles; contractions of parts supplied with involuntary muscle-fibres, as the intestines, ureters, etc. ; these contractions are accompanied by intense pain, nausea, cold sweat and speedy collapse, with asphyxia.

Tobacco, then, acts upon the spine, especially upon the medulla oblongata, and also upon the abdominal ganglia. Its tetanic symp- toms with asphyxia resemble those of Hydrocyanic acid rather than those of Strychnia. A characteristic difference between Tobacco and Nux vomica is well brought out in their respective applications to renal colic. In Nux there is pain down the right ureter into the genitals and leg, nausea and vomiting; in Tabacum, pains down the ureter, with deathly sickness and cold sweat.

Veratriun album causes trismus with spasm of the glottis and

NUX VOMICA. 183

constriction of the chest, amounting almost to suffocation; the hands and feet are drawn inward, and the pupils are contracted. It may be distinguished from Strychnia by the fact that under Veratrum album the convulsions are secondary to exhausting diseases and are never primary, as under Strychnia.

Stramonium, like Strychnia, causes tetanic convulsions, which are worse from touch or from light. The chief distinction is that with St?ramonium mania is almost always present, while under Strychnia the mind is clear to the last hours of life.

Camphor is similar to Strychnia in tetanic spasms. It has showing of the teeth from drawing up of the corners of the mouth, but when Camphor is indicated in tetanic spasms, we find the ever-present deathly coldness.

In studying Nux vomica, you should remember these prefatory re- marks.

Next let me say that Nux vomica is complementary to Sulphur. By that I mean that after Nux vomica has done as much as its symptoms will allow it to do, very frequently the remaining symptoms find in Sulphur the remedy that will complete the cure.

Now, let me give you the Nux vomica temperament. It does not necessarily follow that you must not use Nux if the constitution is not what I am going to describe; but it does follow that it acts better in the constitution about to be mentioned. Nux vomica is best adapted to rather thin, spare patients. It does not seem to act so well on the fleshy.

Especially is it indicated if the patient is rather irascible and is quick and active in his motions. He has a nervous temperament. He is extremely susceptible to external impressions and hence cannot tolerate noise, odors or light. The face is rather sallow or yellowish.

There is a sort of false plethora that gives the patient at times red cheeks on the yellow background. Generally, too, you will find that he suffers from any strain on the mind, particularly if this overtaxing of the mental powers is intensified or rendered more injurious by sedentary habits. Thus you will find the drug of great value for those who deprive themselves of sleep and exercise in pursuance of their studies. You will find it frequently indicated in ministers who take very little exercise and who have become dyspeptic.

They have headache and are tired in the morning when they awake. The Nux patient frequently lies awake at night; the mind is so wrought up that he cannot sleep. Thoughts run through the mind in confusion. He

184 A CLINICAL MATERIA MKDICA.

does not fall asleep until long after midnight, and then awakes in the early morning, perhaps at four or five o'clock. Falling asleep again, he awakes once more, feeling as if he had been on a spree, and his sleep had done him no good. He has a bitter taste in the mouth; the tongue is coated; he complains of dull headache, and, in fact, of every symptom that points to wearing out of the system from overwork. This, then, is the kind of patient in which you will find Nux vomica most effective.

Nux may avert an oncoming cerebral softening especially when sedentary habits and severe mental strain have preceded it, as well as in cases where intemperance antedates the disease. The patient com- plains of headache when he exerts his mind. His memory is fickle, he is dizzy and his walk grows unsteady. The remedy may be fol- lowed by Phosphorus, Picric acid or Sulphur.

The Nux patient, you will find, has a great deal of trouble with the digestive organs. He suffers from headache, situated either in the occiput or over one eye, usually the left. When the pain settles over the eye, it usually begins in the morning, and increases until night, and is accompanied generally by a sour taste in the mouth (less fre- quently by a bitter taste), by accumulation of flatus, and by annoy- ing retching. This may be associated with vomiting of food and of sour matter, but the prominent feature of the vomiting is the violent retching, often more or less ineffectual, showing the irritated condition of the stomach.

He has the characteristic peculiarity of waking in the early morning and then falling asleep, only to awake again feeling worse than at first. The bowels are constipated; and this constipation consists, characteristically, in ineffectual urging to stool. Thus you see that it is not due to atony of the rectum, but to irregular, fitful ac- tion. He suffers, also, from gastralgia, which is usually made worse by eating.

It is sometimes worse, however, when the stomach is empty- The pain starts in the epigastrium, and radiates in various directions, into the back, etc. The paroxysms are very apt to recur periodically every morning, and are often associated with vomiting of sour matter and ineffectual urging to stool. The pains themselves are of a griping, clawing character, as though a hand were scraping the inside of the stomach; they are often relieved by hot drinks. Now, you will notice that the symptoms I have mentioned for Nux vomica, if mentioned in pathological language, would have to be put under the term gastric irri- tability.

The nerves are in such a state of hypersesthesia that the

NUX VOMICA. 185

ingestion of food causes spasmodic action of the stomach and ejection of its contents. This, you will notice, is pathologically similar to the condition of the rectum.

In this extreme gastric irritability, we find Nux vomica a remedy without which we cannot well get along. You are treating a patient who has been prostrated by disease; as soon as he swallows food, up it comes. Nux is here one of the remedies to be thought of, particularly in children who are very excitable, and in men when they have in- dulged in excessive eating or in debauchery.

In other cases, where there is much burning in the stomach with the violent ejection of food, Bismuth is the remedy. The Subnitrate of Bismuth is the remedy for pure gastralgia, that which is not associ- ated with any catarrh, or with any of the symptoms of indigestion. The epigastric pains may be burning, griping, or lancinating, extend- ing into the adjacent spine Pressure, heaviness and burning in the stomach, convulsive gagging. The patient vomits at intervals when the stomach becomes full, and then the amount of vomited matter is enormous.

Water is vomited as soon as it reaches the stomach. But unlike Nux, the pains are usually relieved by cold drinks, and, though the patient is greatly prostrated, the surface of the body is warm.

In still other cases, we find Arsenicum the remedy, when, in addition to the burning pains, we have the intolerable restlessness and anxiety, thirst, etc. It produces a perfect picture of subacute gastritis. A remedy more valuable than any yet mentioned is Kreosote. Kreosote is excellent for this irritable weakness of the stomach. Food cannot be digested. But its distinctive character lies in the fact that, though the stomach retains the food several hours, it finally ejects it undi- gested.

Another form of stomach trouble to which Nux is applicable is a dyspepsia in which there is marked aggravation an hour or so after eating. About twenty-four hours before the attack comes on, the patient complains of great hunger. He craves meats, gravies, and fat foods, and is averse to coffee. He has violent thirst, but water dis- tresses the stomach and causes distension; after even a light meal; he is obliged to loosen his clothing. He is troubled with sour and bitter eructations, and hiccough.

In gastric symptoms following debauchery, when Nux fails, Carbo veg. is a good remedy, although Sulphur may be required.

1 86 A CLINICAL MATERIA MEDICA.

Pulsatilla is preferable to Nux vomica when the symptoms have re- sulted from a mixed diet, such as meats, pastry, nuts, ice cream, etc., especially if the temperament agrees.

In constipation, Nux is similar to several other remedies. Lyco- podium has constipation with ineffectual urging to stool, but under this remedy the ineffectual urging is caused by constriction of the rectum and anus.

Carbo veg. has an urging to stool similar to that of Nux, but it is relieved by the passage of flatus, showing at once the cause of the urging.

Under Opium, Bryonia, and Alumina the constipation is unattended by urging to stool. Opium has constipation from inactivity of the bowels; the stool consists of hard, round, black balls.

The Bryonia constipation results from dryness of the alimentary tract. The stools are large, dry, and hard.

Marked inactivity of the rectum characterizes Alumina. The evacuation of even a soft stool requires great effort.

Nux vo7nica has a marked action on the liver. It is particularly in- dicated in liver affections in those who have indulged to excess in alcoholic liquors and highly-seasoned food, or who have abused them- selves with drastic purgatives. Nux is one of the best remedies we have to counteract the effects of allopathic dosing. In taking charge of a case that has been under old-school treatment you will frequently find it necessary to administer Nux before you can get a clear picture of the symptoms.

In these cases you will often find the liver swollen, hard and sensitive to the pressure of the clothing. Colic is frequently present, and may come from an accumulation of flatus, which presses either upward toward the chest, producing inconvenience in breathing, or downward toward the rectum and bladder, developing both urging to stool and desire to urinate. Or it may be a hemorrhoidal colic. By this I mean abdominal pains which follow the sudden stoppage of hemorrhoidal flow.

The patient has perhaps been subject for years to piles, with bleeding at stool. If from some cause, this flow is suddenly checked and headache or colic results, Nux will help him. If the liver is enlarged, you should give Nux in repeated doses, and you will often be gratified to find the liver resume its natural propor- tions. If it does not, then you must fall back on Sulphur, Sepia or Mag?iesia mur.

Nux may also be indicated in the enlarged liver of drunkards.

NUX VOMICA. 187

Here you may compare it with Sulphur, Lachesis, Fluoric acid, Arseni- cum and Ammonium mur.

Nux vomica is also useful in jaundice provoked by violent anger, by abuse of quinine, or by too high living. The patient has attacks of faintness, after which he feels very weak.

Chamomilla may be employed in jaundice resulting from a fit of anger, as also may Bryonia, Natrum sulph. and Aconite.

Bryonia is especially useful in jaundice when the case has been spoiled by the abuse of calomel or blue mass.

In jaundice from the effects of quinine you should compare Hepar, Mercurius, Pulsatilla and Arsenicum.

Carduus ?narianus is indicated in jaundice with dull headache, bitter taste in the mouth, and white-coated tongue, especially in the middle, with the tips and edges red. There is nausea with vomiting of an acid green fluid. The stools are bilious, and the urine golden- yellow. There is an uncomfortable fulness in the region of the liver.

In haemorrhoids, Nux may be useful when there is itching, keeping the patient awake at night, and frequently so severe as to compel him to sit in a tub of cold water for relief. There is frequent inef- fectual urging to stool, and the piles are apt to bleed. But unless Nux is thoroughly indicated in such cases, it should not be prescribed, for while it may cure the piles, it is likely to excite some other trouble more unbearable than the one it has relieved.

The analogues of Nux in haemorrhoids are several. SEsculus hip- pocastanum is a wonderful remedy in abdominal plethora. You will find it indicated when there is throbbing deep in the abdomen, par- ticularly in the hypogastric region. The haemorrhoids, which may or may not bleed, are accompanied by a feeling of dryness in the rectum, as though little sticks or splinters were pricking the folds of the mu- cous membrane.

This is the keynote for sEsculus. sEsculus also has weak feeling at the sacro-iliac symphysis, as though the back were about to give out at this point.

The next remedy to be mentioned in this connection is Aloe. This drug has abdominal plethora and flatulence, like Nux and Sulphur, and haemorrhoids like Nux, Sulphur and Aisculus. But it differs from these remedies in that it acts almost entirely on the rectum, produc- ing catarrh of its mucous lining. The stools are accompanied by an ex- pulsion of copious flatus. The haemorrhoids protrude like a bunch of grapes and are greatly relieved by cold water. There is also a sort

1 88 A CLINICAL MATERIA MKDICA.

of uncertainty about the rectum, shown in a feeling as if the bowels were about to move. Aloe also cures a headache which, like that of Nux vomica, is situated over the eyes. It is attended by a sensation as though a weight were pressing the eyelids down. Relief comes from partially closing the eyes.

Collinsonia is indicated in haemorrhoids when there is a sensation of sticks in the rectum. Constipation is usual. The bowel symptoms are worse in the evening and at night. Collinsonia is also useful in prolapsus uteri complicated with haemorrhoids.

It is just as fre- quently indicated in this condition as is Podophyllum in prolapsus uteri with diarrhoea and prolapsus recti. Collinsonia has a symptom found also under Opium, namely, dry balls of faecal matter are passed from the rectum; but they differ from those of Opium in that they are of a light color.

Hamamelis is called for in haemorrhoids when there is considerable haemorrhage with marked soreness of the affected parts. The back feels as if it would break.

Nux vomica may be used in diarrhoea coming on after a debauch. The patient is usually worse in the morning. The stools are papescent or watery, and are scanty and accompanied by urging, thus keeping up the character of the remedy. The patient retches in the morning, vomiting perhaps a little froth or sour fluid. He craves liquor, of course, but his stomach is so irritable that he vomits the stimulant as soon as it is taken. Such persons seem to be particularly intolerant of milk.

We may give Nux in dysentery when there is frequent ineffectual urging to stool, ceasing as soon as the bowels move. The stools are bloody, slimy, watery and scanty. The patient is worse in the morn- ing. Nux is indicated by these symptoms whether the disease is the result of cold, or whether it comes from the suppression of an excre- tion, such as the perspiration.

Mercurius is distinguished from Nux in dysentery by the fact that in the former the urging to stool does not cease with the evacuation, no matter how free the latter may be.

Another concordant remedy in dysentery is Aloe. This drug is useful in dysentery when there is griping pain in the hypogastrium before stool, resembling Nux vomica very closely here. The stool consists of blood and mucus, coming out in jelly-like masses. The griping may or may not cease after stool. In addition, an extraordi- nary amount of mucus must be expelled.

NUX VOMICA. 189

Nux is a valuable remedy in hernia, whether inguinal or umbilical. It is indicated when, on rising in the morning, the patient complains of a feeling of weakness in the abdomen, particularly in the region of the inguinal canal. It affects especially the left side.

Lycopodium may be used for right-sided inguinal hernia.

Cocculus Indicus comes into play in umbilical hernia after Nux vom- ica has failed.

Let us now study the action of Nux on the eyes. We find it indi- cated in many eye diseases. You may give Nux in ordinary con- junctivitis, particularly when it is worse in the morning. This period of aggravation is so well marked that it becomes characteristic of the drug.

There is agglutination of the lids and photophobia in the morn- ing. For instance the child buries its head in the pillow in the morn- ing and forenoon, while in the afternoon it uses its eyes freely. These symptoms may also indicate the drug in scrofulous ophthalmia and in blepharospasmus.

In inflamed eyes Euphrasia should be compared. It has the morn- ing agglutination but the photophobia is especially noticeable in arti- ficial light. The tears are profuse and acrid, causing the lids to smart, while with Nux the lid-edges itch and burn without discharge.

In spasms of the eyelids Agariais is generally the best remedy, but you should consult also Belladonna, Natrum mur., Euphrasia, Pulsa- tilla, etc.

Nux may also be indicated when the deeper structures of the eye are involved. For instance, it may be given in that dread disease, atrophy of the retina, whether it comes from choroido-retinitis or not.

We find it indicated, too, in another condition of the retina, namely, retinal hyperesthesia. It is indicated by intolerance of light, worse in the morning ; the least attempt to use the eyes is followed by in- tense pains and spasmodic motion of the ocular muscles; with this there may be excoriating lachrymation and frequent pains in the top of the head.

In amblyopia or impairment of vision due to the effects of tobacco and intoxicating liquors or of debauchery, no remedy will do more toward restoring the power of the weakened optic nerve. Even when atrophy has commenced, Nux will palliate if it does not entirely cure.

Another condition in which you find Nux indicated is in ccchymoses of the sclerotic coat, when a certain amount of blood is effused beneath the conjunctiva. These often follow debauchery or sitting up late at night to study, in persons subject to dyspepsia.

190 A CIvINICAL MATERIA MKDICA.

If these ecchymoses are of traumatic origin, you should study Ledum, Arnica and Hamamelis.

Now for Nux vomica in catarrhs. Nux is suited to the initial stages of the ordinary coryza, particularly when it has been caused by dry, cold weather, or by sitting in cold places, especially by sitting on cold steps. The trouble is associated with sneezing, and a stuffed-up sen- sation in the nose at night and in the open air, with fluent coryza in a warm room and during the da3^. The eyes water, and there is a scrap- ing rawness in the throat.

These symptoms are associated with ach- ing all over and chilliness, worse from moving, even when covered up warmly in bed.

The rawness of Nux differs from that of Mercurius. It is not a sore, raw feeling as if the skin were off, so much as it is a rough, scraping sensation. Mercurius is useful in coryza, with rawness and soreness of the nose and throat, with aggravation in damp weather.

Pulsatilla is the remedy for a " ripe" cold, in which the discharge is green and bland. If Pulsatilla is prescribed in the beginning, it usually spoils the case.

If, despite the use of Nux, the cold travels downward and involves the chest, I have found Phosphorus to follow well.

There is an epistaxis curable by Nux vomica. It occurs in persons, of a hsemorrhoidal disposition, and is preceded by headache or red cheeks. It usually comes on at night during sleep, although it may occur at any time.

Nux may also be used in Eustachian catarrh, when there is itching and tingling along the Eustachian tube, inducing a frequent desire to swallow.

You will sometimes find symptoms of the mouth suggesting Nux as a remed}r. Ulcers form on the lips, accompanied by burning and sticking pains. Ulcers also appear on the gums. The stomacace of Nux vomica is of gastric origin.

Cough is not a prominent symptom of Nux vomica. You may em- ploy it in coughs of nervous origin: for instance, in coughs which are provoked by mental work. It may also be used in coughs of gastric origin. The patient suffers from cough after eating and in the morn- ing. There is usually severe headache and soreness in the stomach and bowels.

In diseases of the chest we do not find Nux indicated very fre- quently. It is sometimes useful in asthma, not often in the purely

NUX VOMICA. 191

nervous type, but commonly in that arising from gastric disturbance. It is associated with a feeling of fulness and oppression in the stom- ach, particularly manifested after a hearty meal, during which the patient must loosen all the clothing about the hypochondria in order to obtain relief. The abdomen is distended with flatus. The asth- matic symptoms are worse after a meal, after 12 o'clock at night, in the morning, and are always increased by cold air or any exertion, par- ticularly ascending a height.

Belching relieves.

There is a drug analogous to Nux vomica which is often overlooked by members of our school, and that is Zingiber. Zingiber or ginger, unless given too frequently, has a tonic effect on the stomach. It is not a safe article of food for children, or for those who have any kid- ney affection, as it rather favors the development of morbus Brightii. As a medicine, Zingiber may be used in asthma of gastric origin.

The attacks come on in the night toward morning. The patient has to sit up to breathe, but despite the severity of the paroxysms, there seems to be no anxiety.

Carbo veg. and Lycopodium are similar to Nux in asthma from ab- dominal irritation with marked flatulence.

In haeinopt3^sis or blood-spitting, Nux vomica is indicated when the trouble results from debauchery. The attack usually appears after a drunken spree or after some violent emotion, such as anger, but it may also result from suppressed haemorrhoidal flow.

Nux vomica is a useful remedy in diseases of the genito- urinary organs. It is indicated in renal colic, when one kidney, usually the right, is the seat of the disease. The pains extend into the genital organs and down the leg, and they are usually associated with intense backache. We must here differentiate Nux from Lycopodium, Can- tharis, Belladonna and Berberis.

Lycopodium, like Nux, usually chooses the right side, but the pains extend along the course of the ureter and end in the bladder; they do not descend the leg. The backache is relieved by urination. It may be given after Nux.

One of the best remedies during the parox3rsms of renal colic is Cantharis , which relieves the patient by lessening the amount of local irritation and thus permitting nature to get rid of the stone with less suffering to the patient.

Belladonna is another remedy for renal calculi. The pains are of a sharp, shooting character and differ from those of Nux in the fact that

192 A CLINICAL MATERIA MEDICA.

they come suddenly and radiate in various directions from the central point of irritation. The patient grows feverish and excitable. Bella- donna relaxes the spasmodic constriction caused by the stone and al- lows it to pass more readily.

Berberis is an excellent remedy for renal calculi. The pains are of a shooting character. The patient cannot make the slightest motion, and must sit bent over toward the painful side to obtain relief. If, in addition, he complains of sharp, darting pains following the direction of the ureter and extending into the legs, there is no remedy like Ber- beris. You find in the urine a reddish deposit, consisting of mucus, epithelium, and amorphous urates.

Berberis sometimes has biliary calculi associated with the renal dis- ease. Belladonna is also useful in cholelithiasis, but the remedy to cure the condition permanently is Cinchona. This has been highly recommended by Dr. Thayer, of Boston. Unless some symptom or symptoms call specifically for another drug, put your patient on a course of Cinchona and have him continue it for a number of months.

In the passage of gall-stones, when remedies fail to relieve, I find that ether, externally and internally, is very good, acting better here than chloroform.

We find Nux indicated in hematuria, when it is traceable to the same cause as the haemoptysis described above, namely, to debauchery.

Nux vomica is indicated also in affections of the bladder, particu- larly in strangury accompanied by painful urging to urinate, with the passage of only a few drops at a time, causing burning and scalding and other uncomfortable sensations. With this urging to urinate there is also urging to stool.

In gonorrhoea Nux is useful after the abuse of cubebs or copaiva, when the discharge is thin. Sometimes I have noticed that after gon- orrhoea has been cured so far as the discharge is concerned, the patient still complains of irritation far back in the urethra, probably in the prostate, causing an uncomfortable feeling which the patient refers to the root of the penis. Nux often relieves this condition.

Nux is useful in sexual excesses, especially for the bad effects of early masturbation. It is one of a group of remedies used in these cases ever since the days of Hahnemann. This group consists of Nux vomica, Sulphur, Calcarea carb. and Lycopodium. Nux is to be given when the patient has headache, frequent involuntary emissions at night, especially towards morning; he complains of backache and

NUX VOMICA. 193

difficulty in walking. Do not repeat your medicine too often, and when improvement ceases under Nux, Sulphur will almost always be the next remedy indicated.

Calcarea carb. usually follows Nux and Sulphur, particularly when night sweats follow every emission; or, after marriage, every coitus is followed by weakness of mind and body.

Lycopodiu?n is indicated still later, when the case has gone on to complete impotency. The erections are either absent or imperfect. The genitals are cold and somewhat shrivelled.

Staphisagria is called for in the bad effects of masturbation, particu- larly if there is great emaciation, with dark rings about the eyes, sal- low face, and well-marked peevishness and shyness.

There is still another remedy which I would mention in this connec- tion, and this is Cobalt. This is an excellent remedy for backache in the lumbar region, following seminal emissions, whether voluntary or involuntary; the backache is particularly worse while sitting.

Nux is indicated in a variety of diseases of the female sexual organs. We find that it has caused and therefore can cure prolapsus uteri. It is to be used when the disease is of recent origin, and has resulted from a sudden wrenching of the body. These symptoms are often associated with constipation accompanied by ineffectual urging to stool. If Nux does not entirely cure, the best remedy to follow it is Sepia.

The menses, under Nux vomica, are almost always profuse, are gen- erally dark in color and are accompanied by retching and cramps in the abdomen. The patient has frequent fainting spells about the time of the menses, especially when in a warm room.

During pregnancy, Nux is a useful remedy for the morning sick- ness. The patient rises in the morning feeling haggard and sick at the stomach. The more retching predominates over vomiting, the more can we expect of Nux vomica. Jaundice, even, may be present. The skin is sallow, the bowels are constipated, and the appetite is lost. Still later, the patient complains of great pressure upward, as though she could not breathe.

During labor, Nux is the remedy when the constipation calls for it. The labor pains may be very spasmodic and severe; the woman has a constant inclination to stool and urine. This symptom, when Nux is the remedy, is not due to mechanical causes, such as the pressure of the child's head, but it is purely of reflex origin. Frequently, you

194 A CUNICAI, MATERIA MKDICA.

will find fainting during the pains, or the pains begin in the back and descend thence to the buttocks and thighs. We may also give Nux when the labor pains nearly or entirely cease, exactly as in Pulsatilla. The temperament of the patient will enable you to decide between the two.

Nux is often useful to prevent the return of metrorrhagia, preced- ing the climaxis or during labor. There are the urging to stool, faint- ness, etc., already mentioned.

Now let us take up the action of Nux vomica on the spine. It pro- duces, as we have seen when speaking of Strychnia, irritation of the motor centres and efferent nerves. The backache cured by Nux is that located in the lumbar region. It is usually worse at night when lying in bed, and the patient cannot turn over without sitting up. It is thus useful in lumbago. The longer he lies in bed in the morning the more does his back ache.

Picric acid should be mentioned here. This substance is known chemically as trinitrophenol, and is a violent poison. It is to be thought of when, after every severe mental effort, the patient suffers from intense headache of a throbbing character, felt more particularly at the base of the brain. There is often an accompanying congestion of the spine, with an increase of sexual excitement, so that erections, become violent enough to be termed priapism.

Nux vomica is indicated in torticollis, arising from cold or due to spinal disease.

Belladonna is the best remedy for stiff neck of rheumatic origin or from cold. The stiffness is apt to be on the left side.

Causticum has stiffness of the sterno-cleido-mastoid muscle of the right side, with drawing. The torticollis may be due to paralytic weakness, as in affections involving the spinal accessory nerve. Here Agaricus and Lachnanthes are also to be compared.

In spinal irritation you must use Nux when the backache just de- scribed is present in association with the following symptoms. Sud- den loss of power in the legs in the morning; the hands and feet go to sleep easily; stiffness and tension in the hollow of the knees; the clothing about the waist feels too tight; sensation as of a band about the waist; desire to lie down; numbness and formication along the spine and in* the extremities. These symptoms also indicate Nux in myelitis, and in the early stages of locomotor ataxia, especially when the trouble has occurred from exposure to cold or from sexual ex- cesses.

NUX VOMICA. 195

Phosphorus is in many respects very similar to Nux. Both cause an increase in impressionability; both cause spinal anaemia. But Phos- phorus tends toward complete paralysis, Nux generally toward partial paralysis dependent upon exhaustion. Both have proved useful in spinal softening.

Physostigma has a symptomatology almost typical of spinal irrita- tion. Under this drug every nerve of spinal origin is irritated. Press- ure of the finger between the vertebrae causes the patient to wince. Physostigma causes rigidity of the muscles from meningeal irritation. It finally develops trismus and tetanus.

Ambra grisea, like Nux vomica, is suited to thin, " dried up," nerv- ous subjects. It has marked numbness of the skin. Various parts of the body go to sleep readily. There are also stiffness in the small of the back after sitting and tension in the lumbar muscles, worse on awaking.

Even the scrotum and penis feel numb. Patients who complain of these symptoms are apt to be excessively nervous and weak. In company they are easily embarrassed and speak and act hastily. They are driven by nervousness to an impetuous desire to talk, but quickly give out (like Cocculus, Veratrum album, Calcarea ostrearum, Alumina, Sulphur, and Kali carb.).

Conversation and ex- ercise quickly cause fatigue.

Asarum Europoeum is suited to still another style of nervousness. It is especially adapted to irritable females, who are so exceedingly sen- sitive that even the thought of any one scratching silk or making some similar noise causes an aggravation of their symptoms.

Castoreum is indicated when females are nervous and do not react after sickness. Hence, it may be used after typhoid, especially when the patients are subject to headaches which leave the head very sensi- tive to touch. These are attended by tingling, creeping sensations which are relieved by sleep.

Nux is useful in rheumatism when it involves the larger joints and muscles. It is especially indicated in rheumatism of the trunk. The swelling in the joints is usually rather pale. The symptoms are almost always worse towards morning.

Nux has been recommended for the acne of drunkards and also for acne from eating too much cheese. Constipation from eating cheese requires Colocynth.

Sulphur should be preferred when, with other symptoms, the face is red in blotches, and Ledum when there are red blotches and

196 A CUNICAI, MATERIA MKDICA.

pimples in which sticking is induced by every least touch. Kreosote and Lachesis are also to be compared with Nux in this condition.

Next we shall look at Nux vomica in typhoid fevers. In the selec- tion of Nux in such cases, you are guided by the gastric and bilious symptoms, bitter taste in the mouth, especially in the morning, nau- sea, vomiting of bile, and characteristic constipation of the drug. The weakness which necessarily belongs to the typhoid state is expressed under Nux by a strong inclination to lie down. The nights are passed in nervous, excited sleep; slight noises cause him to start.

He moans and whimpers in his slumber and his dreams are full of bustle and hurry. He may even be delirious.

Nux vomica is useful in intermittent types of fever, when the chill is preceded or accompanied by blueness of the finger-nails; gaping and yawning are well marked. There is always aching in the limbs and in the back; this is followed by fever, and that by sweat. During the apyrexia we have prominent gastric and bilious symptoms.

A peculiarity of Nux well worthy of mention is that it seems to in- tensify the action of Sepia. The same relation exists between Sepia and Lilium tigrinum, and between Sulphur and Mercury. Nux vom- ica is inimical to Zincum.

The Nux patient is always better after an uninterrupted sleep. Led: by this symptom, Dr. P. P. Wells cured his friend, Dr. Dunham, of diphtheria with Nux, a characteristic symptom of the case being marked relief from a nap. When the sleep is disturbed, the Nux patient is always worse. Early in the evening he is irresistibly drowsy.

Nux acts best when given in the evening. According to Hahne- mann, sensitive persons should not take it fasting in the morning or on first awaking, because its most powerful symptoms are then called out. Neither should it be taken just before or after a meal, or when the mind is on a strain.

LECTURE XVII.

IGNATIA AMARA.

Ignatia Amara, or, more properly speaking, Strychnos ignatia, is a large climbing shrub growing in the Phillipine Islands and in Cochin-China. The fruit is spherical or ovoid, and about four inches in diameter. Its shell is smooth and brittle, and encloses some twenty or thirty seeds. Its name is attributed to the Jesuits, who called it St.

Ignatius' s bean, in honor of its virtues. Though chemically and botanically similar to Nux vomica, Ignatia differs materially from that remedy in symptomatology, and this, too, despite strong family re- semblances.

Ignatia is preeminently a spinal remedy, as is also Nux vomica. Like the latter, it seems to intensify the impressionability of all the senses, perhaps even more than Nux does. Under Nux, however, this over-excitability is exhibited by anger, vehemence and irasci- bility; in Ignatia, by melancholy with tendency to weeping. Now, while there is this melancholy tearful mood, yet the patient smothers her grief.

The Ignatia patient nurses her sorrows, keeping them from others, while the Nux vomica patient is vehement and angry; he strikes any one who may oppose him; he is so overbearing that one can scarcely live with him. You must separate this melancholy mood of Ignatia from that of Pulsatilla.

The Pulsatilla woman is tearful, sad, and melancholy like Ignatia, but there is not that introspective mood which develops in the Ignatia patient. She makes her grief known to every one who comes near her. She seeks sympathy. She is timid and yielding in her disposi- tion.

We find Ignatia indicated in nervous women who are burdened with grief, particularly when they dwell upon their troubles in secret. Such cases find relief in Ig?iatia, especially when of recent origin.

For the chronic or long-lasting effects of grief, we have Phosphoric acid and Natrum muriaticum. Often when the former remedy is indi- cated, the patient complains of night sweats, not from organic dis- ease, but from sheer exhaustion. She has little or no appetite, and

198 A CLINICAL MATERIA MEDICA.

complains of a sensation as of heavy pressure on the top of the head, as though a great load lay there. Emaciation, .ennui, and night sweats are characteristic symptoms. In some cases the symptoms are such as to make Phosphorus preferable to Phosphoric acid.

Natrum mur. is very similar to Ignatia in its mental state but shows more of irascibility with its melancholy. Consolation aggravates and elicits an angry rebuff. There is headache in the vertex, emaciation and tremulous palpitation from every strange noise. When Ignatia fails to remove the symptoms entirely Natrum muriaticum frequently comes in to complete the cure.

Ignatia we find, then, to be useful for the ill-effects of grief, and also, by reason of this great sensitiveness to external impressions which it produces, greater even than that of Nux vomica, we find it indicated in hysteria, especially when the patient alternately laughs and cries, or, in other words, exhibits a changeable mood. The face flushes at every emotion. Sometimes the laughing becomes spasmodic and ends in screams and even spasms of the chest with blueness of the face.

We have also globus hystericus or feeling as if a ball were rising in the throat. This is often relieved by belching, while drink- ing water causes an aggravation of the convulsive action in the throat. The patient may fall into a half unconscious state, with clenched thumbs and blue face, as we find under Cuprum. Finally a sigh and a long-drawn breath announces the return to consciousness.

Now let us consider some of the concordant remedies of Ignatia in these hysterical states.

Platina is indicated in hysterical women with violent mania or lofty, supercilious mood.

Hyoscyamus is called for when the mental condition of the patient exhibits marked jealousy. She is full of suspicions. She fears that she will be poisoned, and may on that account refuse all food and medicine.

Asafcetida, like Ignatia, has the globus hystericus; flatus accumu- lates in the abdomen and, pressing up against the lungs, produces op- pression of breathing. It is especially useful in hysterical convulsions after suppression of discharges.

Moschus is particularly suited when the patient faints readily. She sits down to her meals and faints dead away from taking even a small amount of food into the stomach. She also has violent spasms of the chest, in which it would almost seem that she must die. She turns

IGNATIA AMARA. I 99

blue in the face and foams at the mouth. She may be of a scolding disposition, and even this causes fainting.

Valerian is useful in these hysterical women, when the slightest ex- ertion causes violent headache. They often complain of a sensation as if a string were hanging down into the throat. In the latter part of the evening, they exhibit a tendency to flushes of heat. The slightest pain causes fainting.

They complain of a warm sensation rising from the stomach into the throat with the globus hystericus. You will often have to use Valerian for pains in the limbs, which simulate those of rheumatism. They are worse while the patient sits and better when she walks about.

Cocculus has a mood somewhat like that of Ignatia, Sensitive, anxious, with frightened look; loss of memory, mental confusion, vertigo; spasms of the uterus; great weakness and nausea even to fainting. A sort of semi-paralytic condition pervades the whole body: choking constriction in the upper part of the fauces with diffi- cult breathing; hysterical palsy. These symptoms in Cocculus are usually the result of night watching or loss of sleep.

Nux moschata is indicated in hysteria, associated with frequent emo- tional changes and enormous bloating of the abdomen after a light meal. The patient complains of an overpowering drowsiness and of excessive dryness of the mouth, even when that cavity exhibits the normal degree of moisture. There is also a marked tendency to faint.

Belladonna is indicated in hysterical states, when the patient is boisterous and wild, with red face, etc.

The Valerianate of Zinc I have used for a common symptom of hys- terical persons and of nervous patients generally, and that is, what has been termed the fidgets. They cannot sit still, or the}' must keep the legs in constant motion. I have used it, and I do not remember to have failed to cure in a single instance. This uneasiness of the feet is not an uncommon symptom in old cases of uterine disease; I usually give the remedy in the second or third potency.

The headache of Ignatia is usually situated in one spot in the head, just as though a nail were being driven into the skull at that point. Any little mental work, or in fact any work that is irksome or more severe than usual, any strong odor, whether pleasant or otherwise, any emotion which would be borne without trouble by one whose nerv- ous system was in a natural state, may bring on this headache. The attack often ends with vomiting. These headaches are often periodical,

200 A CLINICAL MATERIA MEDICA.

returning every two days. They often terminate with a copious flow of pale, limpid urine. Several other remedies have headache, relieved by copious urination. They are: Aconite, Gelsemium, Kalmia, Meli- lotus, Sanguinaria , Silicea and Veratrum album.

Sometimes the Ignatia headache is of a throbbing character, worse in the eyes, and about the eyebrows and the root of the nose; it is relieved for a time by a change of position. Again, Ignatia may be indicated in headache, when the head feels heavy, as if from congestion, and yet the pain is better from leaning forward; sometimes aggravation occurs from stooping, thus giving us what Hahnemann calls an alternate effect. The Ignatia headaches are aggravated by talking or listening intently, and by coffee.

The power of Ignatia to produce increased excitability renders it useful in spasms, not only of hysterical origin, but also in those occur- ring in delicate women who are not hysterical, and in children. The spasms are excited by emotions, such as fright or fear. For example, the child has a convulsion after being punished. Afterward, when the child goes to sleep, there is whimpering in the sleep.

Under ordinary circumstances the child will get over the trouble without any treatment; but if it happens to be extremely delicate, or if the trouble occurs during the period of dentition, or there is some reason for fear- ing convulsions or hydrocephalus, Ig?iatia may prevent a great deal of trouble. During the convulsions in which Ignatia is the remedy, you will usually find the face deathly pale, although at times it is flushed. There is twitching of individual muscles, particularly those about the eyelids or the mouth, and the child stiffens out.

As was said before, Ignatia is especially indicated when the convulsions have appeared after grief, fright, or some violent emotion.

Nervous women in labor may require Ignatia for spasms. These spasms, however, are to be distinguished from those calling for Bella- donna, Stra?nonium, etc., by the absence of fever or severe conges- tion, and from Hyoscyamus by the absence of unconsciousness or mania.

In these convulsions produced by emotions, unless you have clearly in your mind the distinctions between several remedies, you may not make so prompt a cure as you should. Opium, like Ig?ialia, is a rem- edy for the immediate effects of emotions. It does little or no good for the protracted effects. It, too, is worse after punishment, fright or fear. The body stiffens out, and the mouth and the muscles of the

IGNATIA AMARA. 201

face twitch. Thus far it is exactly like Ignatia. The distinction lies in this particular: under Opium the face is dark red and bloated, and the spasms are more frequently associated with loud screams than under Ignatia.

Glonoin produces sudden violent congestions of the head, as does Opium. Like Opium and Ignatia, it may be used for the sudden effects of violent emotions. In the convulsions the fingers are spread asunder and extended, a symptom which you also find under Secale.

Veratrum album also is suitable for convulsions after sudden violent emotions, but the face is cold and blue, with cold sweat on the fore- head.

Hyoscyamus has sudden starting and twitching of the muscles, more so than Ignatia; one arm will twitch and then the other. The motions are all angular. There is a great deal of frothing at the mouth. The patient seems to be wild.

Belladonna is probably more frequently indicated than any other remedy for convulsions following violent emotions, anger, etc., with bright red face, wild straining eyes, hot head, and spasms of the glottis.

Opium is probably the best remedy when, from fright of the wet- nurse, the child has retention of urine.

Cuprum is indicated in convulsions where the fingers are clenched. There is marked blueness of the face and mouth. Any attempt to swallow fluids causes gurgling in the throat.

Chamomilla is useful in convulsions of children after any emotion. It is easily distinguished from Ignatia by the petulant angry disposi- tion of the child. One cheek is red and the other pale, and there is hot sweat about the face and head.

There is a sore throat curable by Ignatia. The patient complains of a sensation as though there were a plug in the throat, worse when not swallowing. Examining the tonsils, you find them studded with small superficial ulcers having a yellowish-white color. There is a constricted feeling about the throat, with a great deal of nervousness and insomnia.

The cough of Ignatia arises from constriction of the larynx, or from a sensation as of a feather there. The more the patient coughs, the worse does the tickling become.

Ignatia may be used in chills and fever when there is thirst during the chill, and when the warmth of the stove or other artificial heat

202 A CUNICAI, MATERIA MEDICA.

relieves the chill. This is not a common symptom. It is very different from Nux vomica, which usually finds no relief from covering up or from the heat of the stove. Capsicum has relief from applying the hot water bottle. Lachesis has longing for the heat of the fire, yet the chill is not shortened thereby. Arsenicum has chill relieved by warmth. Other remedies are Rhus fox., Menyanthes, Nux moschata and Sabadilla.

The action of Ignatia on the genital organs must also be mentioned, as we find it indicated in dysmenorrhcea, associated with what is termed menstrual colic; that is, when there is a great deal of bearing down in the hypogastric region. The patient exhibits hysterical symp- toms. The pains are labor-like in character, and are seemingly re- lieved by pressure, by lying down, and by change of position. The menses are dark, frequent and copious.

The nearest remedy here is Cocculus Indicus. This has uter- ine spasms and dark menstrual flow, but the backache always en- ables you to differentiate this drug from others. It has a weak, lame feeling in the small of the back, as though the patient were about to be paralyzed. The limbs tremble when she begins to walk. In addition to this, she often complains of a feeling of emptiness or hol- lowness in various cavities of the body, especially in the chest and- abdomen.

Pulsatilla is at times indicated for this menstrual colic, particularly when the menses are dark in color and delayed. The flow is usually fitful. The patient is apt to be chilly, and the more severe the pains are, the more chilly does the patient become.

Chamomilla is a third drug similar to Ig?iatia in uterine spasms. It is indicated by the mental symptoms. The patient is so cross that she can scarcely answer any one civilly.

I would like you to remember also Magnesia mur., which is indi- cated in uterine spasms accompanying induration of the uterus, whether of a scirrhous nature or not.

Actea racemosa is called for in uterine spasms when the pains fly across the hypogastrium from side to side.

In disorders of digestion Ignatia is useful when the patient com- plains of bitter or sour-tasting mucus in the mouth and copious saliva- tion. There is fanciful aversion to certain foods. He asks for a cer- tain food, but after tasting, refuses it. Food may be regurgitated. Gastralgia is present. He has hiccough, aggravated by eating and

IGNATIA AMARA. 203

smoking, and, especially in children, by emotions. There is an empty, gone feeling at the epigastrium, with qualmishness. In some cases there is empty retching, relieved by eating. The patient vomits at night the food taken in the evening. The bowels are disordered.

Hyoscyamus is one of our best remedies for hiccough occurring after operations on the abdomen.

Stramonium and Veratrum album for hiccough after hot drinks, and Arsenicum and Pulsatilla after cold drinks.

Teucrium marum verum is useful in jerking hiccough after nursing.

Cajuputum suits hiccough coming on the slightest provocation {Sulphuric acid). There is spasmodic stricture of the oesophagus, the tongue feels swollen. Flatulence is present.

Ammonium muriaticum is characterized by hiccough with stitches in the chest, and empty, gnawing sensation in the stomach after a full meal.

Igjiatia is useful in prolapsus ani, which may or may not be accom- panied by haemorrhoids. You have as a characteristic symptom sharp stabbing pains shooting up into the rectum. This prolapsus ani may annoy the patient, even if there is soft stool. There is distressing constriction at the anus, aggravated after stool, and better while sit- ting. Itching and creeping at the anus as from ascarides, in which condition Ignatia is sometimes an excellent remedy.

Indigo is said to be a good remedy for ascarides, especially in mel- ancholy children. Honey given night and morning will act as a pal- liative. Teucrium should also be thought of in this connection.

Ignatia produces a variety of symptoms referable to the eye, making it a useful remedy in several diseases of that organ. Like Agarzcus, it has nictitation of the eye-lids, with spasmodic action of the facial muscles. There are neuralgic pains about the eyes. These are ex- ceedingly severe, and are often associated with the globus hystericus. Ignatia may also be useful in phlyctenular ophthalmia, when there is intense photophobia and a feeling of sand in the eyes.

The toothache of Ignatia is worse between than during acts of eat- ing. Now this is in perfect harmony with the throat symptoms of the drug; that is, there is a feeling as of a lump in the throat which is not felt during but between the acts of deglutition. The "lump" may feel sore while swallowing, but it is felt more markedly between acts of deglutition. This symptom has led to the selection of Ignatia in aphthous sore-throat (the tonsils being swollen and studded with white flat patches), and even in diphtheria.

204 A CIvINICAIv MATERIA MEDICA.

Zincum holds a very peculiar relation to Ignatia and to Nux vomica. It follows Ignatia well, while it is inimical to Nux vomica.

Natrum muriaticum follows Ignatia well, especially in mental ail- ments.

LECTURE XVIII.

SPIGELIA ANTHELMINTICA, CURARE AND THE JUGLANDACE^E.