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Dec 30, 2011

Clinical Experience By Henry N. Guernsey,M.D.

The following article on clinical cases was originally published in “The Hahnemannian Monthly” Volume 6,   August 1870.

Repertorization part is prepared to understand the case by modern tools.

Clinical Experience

By Henry N. Guernsey,M.D.

Case 1.  Mrs. A., of Delware, called on me a few weeks since, complaining of what she termed dyspepsia. Upon asking her to relate her symptoms in the order of their severity as it seemed to her, she replied, that a feeling of emptiness or goneness in her stomach discomforted her more than anything else, but she thought it of no account, as she vomited all her food soon after taking it, and she would naturally feel emptiness and goneness from want of food. I desired her to state merely facts, and I would draw my own conclusions. She replied: “It is a fact that I vomit nearly all my food; I have a painful sensation of emptiness in my stomach all the time; my sleep is broken and does not refresh me, my bowels are very costive, the stools being knotty and very difficult, and they have scarcely been moved for two years without an injection, and I do not think they would be moved now at all without an injection; my urine is cloudy and offensive, and a hard crust settles, that it is difficult to scrape from the vessel; I am very weak and miserable, have spent over two hundred dollars during the past two years for medicine, and despair of becoming any better; but I was compelled by my husband to consult you.”

I always prescribe sepia when a train of symptoms like the above in italics occur in a single case. In this case I gave the patient a few pellets of Sepia 55 m, dry on her tongue, and three packages containing twelve powders each of sac.lac.; one to be taken every night; and enjoined upon her that she should on no account resort to any more injections or other measures for the relief of her bowels, or of other symptoms, and to report to me in forty days. She thought she would not live to see me again if she were to leave off taking injections.

A few days ago she reported that she had not vomited since seeing me, her vowels had become regular very soon, and that she had no need of injections; indeed, she said, she got well so fast her husband was frightened. He was coming to the city that day on business, and he wished her to come and ask particularly what had been the matter, as she had been so sick so long, and now had gotten so well so soon. He did not understand it.

Sepia 55m, a single dose, always produces similar results in similar cases, if plenty of time is allowed the single dose to act. I do not give my experience hastily, nor base it on a single case. I only delineate my path where it has been well trodden; that others may follow it is safety.

Repertorization :  Radar 9

RECTUM - CONSTIPATION - difficult stool
STOOL - KNOTTY, nodular, lumpy
URINE - ODOR - offensive
SLEEP - WAKING – frequent

Case 2. Two months since a married lady consulted me in regard of her health. She was weak and unhappy, particularly in the morning, when she would feel on awakening, friendless, forsaken and very unhappy. The same symptoms would occur if she chanced to waken during the night. Had a poor appetite, bowels very costive, with a feeling of constriction of the anus, so much so that for months she had not attempted to defecate without the aid of an injection; urine scanty and dark-colored. She had any other symptoms, but the above were the most important. She attributed these sufferings to domestic troubles. The above italicized symptoms always turn my thoughts to lachesis; particularly the mental symptoms. I gave her a single dose of Lachesis 4 M, in my office, and charged her to take no more injections, nor in any way to interfere with the treatment. In about two weeks the unhappiness had greatly improved; the vowels had become regular; and in about six weeks from the first and only dose of Lachesis 4 M, she reported herself quite well in all respects.

Repertorization:  Radar 9

MIND - SADNESS - morning
STOMACH - APPETITE – diminished
URINE - COLOR – dark

Case 3. June 12th, was called to see a little boy 18 months old. Found him restless; must be carried all the time to keep him quiet; very sleepless day and night, would sleep only in short naps. He had a disagreeable filthy smell about him all the time, thought great effort was made to keep him clean by frequent bathing and changing of dress. Could not keep milk on his stomach but a short time; it would be rejected sour and in curds. Weak beef-tea or water could be retained. His stools were of a pale, brown fluid, smelling like rotten eggs. He was getting very weak. The italicized symptoms reminded me of Psorinum more than of any other remedy. I gave Psorinum 42M, a single dose only, in the morning. He slept well the following night, the next day the bowels were better, and the bad smell about his body was lessened. On the next day still improving; bowels well; no more bad smell from his body; resumed his milk diet and has been well since. But a single dose of Psorinum, as above, was given and no other remedy.


GENERALS - FOOD and DRINKS - milk - agg.
STOOL - ODOR - eggs, like rotten

 Case 4. May 19th, visited a little boy about 9 years old, and found him in the following condition; urine nearly suppressed, but passed in small quantities once in twenty-four hours. Stools dark-brown, fluid, and passed involuntarily; delirious much of the time; lies on his back with his knees drawn up; complains much of the back of his head; pulse 120 and hard; breath very fetid; bores his nose very much; nostrils raw and bloody, even into the corners of the mouth; picks his skin in places, making it raw and bloody when he bores into it with much force, and he seems vexed that he cannot bore it deeper, on account of the pain seems to give him; he seems very intent in his efforts to bore and pick the raw surfaces. The italicized symptoms directed attention at once to Arum triphyllum, which was given in water, in the 20 M dilution, every two, four or six hours, as it might seem necessary. Next day he was better and the medicine was discontinued. After two days it was found necessary to repeat a few doses as before. He continued to improve, in all respects, finally under this treatment, till the 31st of May, when there were no indications left for Arum, but as there were passed considerable quantities of red sand with the urine, one dose of Lycopodium 6M was given. On the 14th of June, one dose of Lycopodium 100 M was given, and today (June 25th) he is perfectly well and romping about in the country.


NOSE - BORING in nose with fingers
MOUTH - ODOR - putrid
GENERALS - PULSE – frequent

Case 5. March 25th, visited a little girl about ten years old and found her in the following condition: Perfectly delirious day and night; cannot be roused to consciousness even for a short time; urine and feces are passed involuntarily, in bed; had, while she could express herself, much pain in the occiput, and down in the spine; is very restless, particularly every night after midnight, but there is a marked degree of restlessness constantly, and much distress; the breath is cold, and the skin is cold and clammy; the lips, teeth and tongue, – so much of it as could be seen – were dry, black and covered with sordes. She took a little water from a spoon frequently, or would occasionally suck a wet rag. It seemed like a hopeless case, but our conclusion, drawn from the italicized symptoms, was that Arsenicum Album 8M would do good if anything could. It was accordingly given in water, every one, two, three or four hours, as it seemed best to the nurse, in accordance with instructions given her. In the morning I found the child somewhat better. The medicine was thereupon discontinued, to be administered as before, if she got decidedly worse. She became worse before next day and repeating the medicine brought no relief. Arsenicum 15 m was now given, as at first, and prompt relief followed and continued several days and purple spots, with pus in their tips, came out on back and hips. She became worse again, in spite of the medicine, when Arsenicum 40 M was had recourse to, and completed the cure. She is now (June 25th), fit and perfectly well. In every improvement, medicine was withheld, and repeated when it seemed necessary.


MIND - RESTLESSNESS - night - midnight – after
HEAD - PAIN - Occiput
STOMACH - THIRST - small quantities, for - often; and
BLADDER - URINATION - involuntary
BACK - PAIN - Spine

Dec 26, 2011

A Case of Chronic Gastritis

© Dr.R.S.Mann 2011

Presented By
Dr. R S Mann

Mr S.. kumar, 35 yr male, From Nainital, has following complaints since 10 years.

Burning in stomach, whole abdomen, with eructations which starts every time after eating. Lot much thirst and frequently drinks water, with dry lips. Constipation with insufficient stool. Heaviness of abdomen with tight feeling.

Dose not want to involve anywhere, not want to work, not want to talk and aversion to noise.

No taste in mouth. Aversion to fatty food, sweets. Desire salt. Weakness, want to lie down always. Feel coldness in back.

Frowning constantly while explaining his complaints. Very thin person.

Likes winter, remain healthy comparatively in winters but worse in summers from beginning of March to October. Complaints aggravate at change of weather.

Personal history of recurrent jaundice from many years. Jaundice at beginning of summers in march, every year from few years.

Drug History: Taking antacids of many types daily since many years. Lot much burnings if he miss even a single dose.

Repertorization:- Radar

GENERALS - SEASONS - summer; in - agg.
GENERALS - WEATHER - change of weather - cold to warm agg.
GENERALS - FOOD and DRINKS - sweets - aversion
GENERALS - FOOD and DRINKS - salt - desire
GENERALS - LIE DOWN - desire to

MOUTH - TASTE - wanting, loss of taste

STOMACH - ERUCTATIONS - eating - after
STOMACH - THIRST - large quantities, for
STOMACH - THIRST - large quantities, for - often; and
STOMACH - PAIN - burning - eating - after

ABDOMEN - PAIN - burning

RECTUM - CONSTIPATION – insufficient



MIND - FROWN, disposed to

Combined Rubric:-

MIND - NOISE - aversion to
MIND - SENSITIVE - noise, to

 Medicines: Total 24 rubrics are taken into account. Out of 24 score is -- Nat Mur 24/56, Sulph 21/47, Ars Alb 21/40, Nux V 20/40, Phos 19/46, Lyco 19/40, Sep 19/38, Bryonia 19/38.

Natrum Mur. covering every symptom of the patient.


19 October, 2011

Natrum Mur 200  CH  3 doses prescribed 6 hourly, with Sac Lac for a week.

Patient does not returned after a week.

26 December, 2011

Patient came for weakness after viral fever.

All his gastric complaints cured magically, after 4th day of prescription on 19th October 2011, patient start to relive, day by day all the complaints gone. No eructations, no burning afterward, no weakness. Now he works smoothly all the day without tiring.

Dec 25, 2011

Epilepsy of Long Standing By Dr. H. Gouixon

This Case Orginally published in "Allg. Hom. Ztg,, vol. Lxix.
Vol. xxm, No. xci.—January, 1865" and same year published in "THE BRITISH JOURNAL OF HOMEOPATHY VOL 23"


August E—, of T—, aet. 28, at present of stout appearance and well-formed; when one looks at the shape of his skull he gives the idea of a good-natured man of limited intellect. When he was ten years old he had, one day in school, without appreciable cause, a violent epileptic attack. He lost consciousness completely, and nearly twenty-four hours elapsed ere he recovered from the paroxysm. At that time he was of quite a different character of body from what he is now. In fact, his acquaintances described him as a wretched, withered-looking little fellow. He was put apprentice to a tailor for some years, and afterward became servant to a landed proprietor. Suddenly, about fourteen years after the first single attack, he had again a violent outbreak of epilepsy. Curiously enough the fits now came on periodically, one occurring every Saturday, or at latest Sunday. The fits seldom kept off for a fortnight. On the 15th April, 1864, he sought my advice. He had a curious appearance. His face covered with small and large, old and fresh scars, like that of a warrior, all reminiscences of fits of epilepsy he had had, these fits taking him so suddenly that he fell to the ground as if struck down. On this account he had been obliged to give up his place as servant long since. His tongue presents not only several scars from wounds inflicted by biting, but the anterior third is, in fact, only connected with the remainder of the tongue at one side, whilst the middle of this third is still further removed from the rest of the tongue by a complete fissure. The patient asserts that he has an attack now once a week. Previous to the fit he experiences peculiar jerks in the body, and hears distinct voices, saying in rapid succession,  "Ja, ja, ja, ja," or else he has roaring noises in the head. The premonitory symptom, known as "aura epileptica," is absent. Although, in general, as is often the case, the fit is followed by great prostration and sleep; still, occasionally, he is cheerful, and quite himself immediately after the fit. The fits are not connected with any particular time of the day. Sometimes they come on in bed in the morning, sometimes while he is at work, fetching water, &c. The complexion intimates fullness of blood and congestion. The conjunctiva are very red. Speech is difficult for him (perhaps partly owing to the split tongue); he betrays a certain amount of laziness, and a constant smile gives him the appearance of a great amount of good humour or commencing moria. He confesses that in former years he used to masturbate excessively, and this circumstance I regard as of much more importance in an anamnestic point of view, since other possible causes, such as hereditary tendency, wounds, mental affection, excesses of other kinds, &c., are wanting.

In consideration of the present physical and psychical state, of the existing plethora, the attacks of giddiness depending thereon, the illusions of hearing, which amount to actual hallucinations, the difficulty of speaking and thinking, I considered Causticum to be the most appropriate remedy. I moistened sugar of milk with three drops of the 3rd dilution and divided it into eight powders, one to be taken every night at bed-time.

A fortnight afterwards the patient reported, with visible joy, that a fit had occurred, but that it was much milder than usual. I did not attach much importance to this. After the continued use of this remedy (waiting always a week without medicine) the attacks became not only always milder, so that the fourth and fifth (since commencing the medicine) consisted only of a transient "jerk" and at length they went off completely. Whereas, formerly, an attack occurred every eight days, the patient has now been a quarter of a year without one, a result certainly deserving of notice.

That there cannot be here a question of a cure by nature is very evident. There may be many self-deceptions among the records of homoeopathic cases, many pneumonias, many acute catarrhs of the stomach, cured in an equally short time without Aconite and Pulsatilla, but all the more striking are cases like the above, of which it would be absurd to allege, after the epileptic fits had occurred regularly every week for six years, that left to themselves they should rapidly decline in intensity from the 15th April, 1864, and after about five weeks quite disappear. It is not requisite to be an adherent of the post hoc ergo propter hoc, still where the facts are so, then the favorable issue of the disease must be solely ascribed to the remedy employed. In similar cases Causticum has already been useful. Perhaps in course of time we may be able to determine with precision, the whole series of epilepsies for which Causticum may be universally acknowledged and employed as the specific.

CLINICAL OBSERVATIONS -Some kinds of Paralysis, Chorea, and Epilepsy: By Dr. Th. Rueckert Case 5

This Article was published in "THE BRITISH JOURNAL OF HOMEOPATHY VOL 23".

Some kinds of Paralysis, Chorea, and Epilepsy

By Dr. Th. Rueckert
 Case V —Although the following case is not so instructive as a published case ought to be, still I cannot resist relating it, as it shows how a simple remedy is often at hand when least expected. 
On the 8th December, 1861, Mrs. Wiindrig, of R—, brought her boy, aet. 13, from the country to me. Since his sixth year, after a fright he had got, he had suffered from epileptic fits, which occurred regularly every afternoon at 5 o'clock; in winter, however, about Christmas time, they came as often as three or four times a day, but in summer they became rarer. The mother's powers of observation were so feeble that I could not elicit from her any peculiarities of the fits, except that they often lasted a long time before the boy regained consciousness. He was small for his age, backward, and his look showed a want of development in the intellect. All his corporeal functions were in order. 
In the absence of decided indications for a remedy, and in hopes of getting some after wards by following my instructions, I gave Sulph. 30, three doses, one to be given every third night. 
My trouble however was in vain, for I never again saw the mother, only the boy himself reported on the 23rd December that he had had a fit every day; on the 7th January, 1862, that he had no longer a fit every day; on the 29th January, the 16th February, the 2nd March, the 17th March, and the 26th May that he had no fits, and could attend school without interruption. 
At length in August, 1863, the mother sent other patients to me with a message that her boy had continued quite well, was grown strong, and had gone into service with a farmer. That was cito etjucunde!

Dec 24, 2011

CLINICAL OBSERVATIONS -Some kinds of Paralysis, Chorea, and Epilepsy: By Dr. Th. Rueckert Case 4

This Article was published in "THE BRITISH JOURNAL OF HOMEOPATHY VOL 23".

Some kinds of Paralysis, Chorea, and Epilepsy
By Dr. Th. Rueckert

Case IV —F— basket-maker in R -, aet. 30, dark complexion, short, had formerly always good health, except that he often suffered from heartburn; in his youth he had practiced onanism for some years. In 1849 he was affected with condylomatous gonorrhoea, and treated with copaiva and mercury, after which his stomach remained weak, and he often complained of stomach-ache. 

Two years ago be became affected with epileptic fits, generally at 4 a.m., also several times during the day. He was treated by several homoeopathic practitioners without effect. He then had recourse to a non-medical friend acquainted with homoeopathy, who gave me the following account:—

" F. got from me Calc. 30, once a week, and after waiting eight weeks, a few doses of Sulph. 30. After Calc. the fits ceased for three months, and after Sulph. they again reappeared more frequently. After six weeks Calc. was again given, which was followed by other three months of exemption."

He has now had again several attacks, the last a fortnight ago, when he observed at first a whirling feeling in the head. On this account he wanted to go out into the open air, but he fell down in convulsions. During the fit there is foam at his mouth, and the thumbs are turned inwards. After the fit great weariness and sleep. If when the fit is on there is acid vomiting, the fit soon terminates. The last attack differed from the former ones in this, that when complete unconsciousness came on, the patient sang, whistled, and laughed, but suddenly was unable to speak; with great anxiety. The patient moreover asserts that after every meal he has stomachache and heartburn; is very weak after coitus, with cold hands and feet. In the morning he was often short of breath, he had to press his sides with his hands, and take deep inspirations. From a strong smell of tar, with which he has much to do, he feels uneasiness and nausea. 

Prescription. The 11th September, 1862, he got, in consideration of the sycosis for which he had already taken many remedies in vain, Thuja 30 in 3 tablespoonfuls of water, twice a day.

24th September.—He has had no more fits, but an eruption of pimples has several times appeared on the glans, and a secretion of purulent matter, or red moist places, behind the glans, and occasionally traces of condylomata, particularly after coitus, which, however, soon disappeared.

In January, 1863, he had for several days a peculiar symptom, as if fire came out of his right eye, and then as if something black was thrown past the eye, whereby he felt as if he should lose consciousness. Heartburn, stomach-ache, and great weariness of the limbs were permanent symptoms at that time. 

Now, August 1863, he has been a whole year without a fit, and feels quite well.

Postscript in July, 1864.—On the 30th November, 1863, his wife wrote to me that he went from home on the 28th, and deranged his stomach with very rich and highly seasoned food, and on his way back was exposed to much tobacco smoke, which, as he was no smoker, he could never bear; that he came home with the right eye somewhat inflamed; that on the 29th he had eaten fat pork for dinner, that then he had attended a meeting where there were many people, much smoking, and many gas-lights, which were highly disagreeable to him; that after this he returned home heated about 6 p.m., went to bed about 7, soon fell asleep, snored loudly, and about 9 had a convulsive attack, of which he knew nothing on awaking, and went about his usual work the following morning. I therefore sent Silic. 100 in solution, to be taken for 3 days. Since then he has remained quite well, and doubtless he would not have had the last attack had he not taken too many liberties. He is now under my care for a chancre, but is otherwise well.

CLINICAL OBSERVATIONS -Some kinds of Paralysis, Chorea, and Epilepsy: By Dr. Th. Rueckert Case 3

This case was published in "THE BRITISH JOURNAL OF HOMEOPATHY VOL 23".

Some kinds of Paralysis, Chorea, and Epilepsy
By Dr. Th. Rueckert

Case III —Miss P— aet. 25, strong, full-blooded, short, healthy-looking, has, as she says, always enjoyed good health up to three years ago, when, after a distressing dream, as she alleges, she had an attack of rigor, followed by fits of alternate laughing and weeping. These attacks have since been periodical; only latterly the weeping has given place entirely to laughing. They are worst just before menstruation, which is regular every four weeks, but sometimes more, sometimes less copious. It is generally preceded by more or less severe cutting in the abdomen. In winter when she is occupied with weaving, the attacks come on more frequently; in summer when she is engaged in field work they are seldom. Her legs are heavy as lead, and when sitting, she often observes a jerking in them. Before the attack comes, they become cold up to the knee, as if she had them in cold water. Then comes a creeping through all the limbs, and the involuntary laughter commences. At the same time she has flushes of heat and headache, the character of which is shooting and throbbing, in a small spot on the top of the head. The digestion was in good order.

Prescription on the 3rd of March, 1863, Sulph. 30, three doses to be taken every other night.

10th March.—After the second dose she had a fit, but it was slighter than usual, but accompanied by redness of face, and the above-described headache. She complains of great weariness in the limbs. Prescribed Sacch. lact. 

27th April.—No further attack; she feels quite well, the limbs quite light.

18th February, 1864.—Her health not in the least deranged, in spite of having had to sit so long in the room during the winter.

CLINICAL OBSERVATIONS -Some kinds of Paralysis, Chorea, and Epilepsy: By Dr. Th. Rueckert Case 2

 This Article was published in "THE BRITISH JOURNAL OF HOMEOPATHY VOL 23".

Some kinds of Paralysis, Chorea, and Epilepsy
By Dr. Th. Rueckert

Case II.—A tailor, aet. 40, tall, of strongly marked phlegmatic temperament, hitherto always healthy, had about Christmas suffered from erysipelas of the head, which was improperly treated, and left behind it the following horrible symptoms, from which he had been suffering for six weeks, all the time treated with the greatest care by an allopath; but all in vain, so that the patient dismissed his doctor.

The morbid picture we observed on the 25th February, 1863, was the following:—I went to see the patient, who lived at some distance, and found him in a small, narrow room, in which he could scarcely turn, lying naked in a miserable bed, emaciated to the last degree; the countenance expressive of pain and despair; the head, arms, and legs in constant movement; the hands constantly wringing, and he constantly groaning and crying, " Oh my God ! what will become of me" He then, with a loud distinct voice, repeated the Lord's prayer, some verses of hymns, and the introductory prayer to the communion. In this state he passed day and night, he had no sleep, indeed his uneasiness grew worse at night, he wanted to get out, in fact he leaped out of bed several times, and required people to watch him. When I spoke to him he recognized me, and reached out to me; he answered all questions properly, and begged me to relieve him of his painful anxiety. When I took hold of his hand to feel his pulse and observe the play of the tendons, he drew it hastily away from me, because his anxiety increased when he was held. He had little appetite, and had to be fed, because he could not hold the spoon, and carry it to his mouth. His bowels were rather costive, urine normal. 

Prescription. Cupr. 6 in solution, for twenty-four hours. I did not see the patient again for several months, but received reports from the parish officer, under whose care I had left him.

1st March.—He has been better and worse, at night he has always most restlessness, but the movements of the limbs are not so violent, there is less anxiety, more appetite, bowels more regular. Cupr. as above.

3rd March.—On the 1st, at 3 p.m., he was bad again, he would not allow the bed clothes on him, wished to jump out of bed, complained of internal heat, and had much thirst. His bowels were opened by a simple clyster. He continued the Cupr. 

11th March.—No material improvement, the patient complains chiefly of internal heat, his bowels are confined, and he says he feels as if the limbs were twisted. He has often burning in the soles of the feet. He has little sleep and after sleeping is more restless, but not so much so as formerly, he speaks quite rationally. In consequence of the peculiar sensation in the belly, the constipation and the burning of the soles, I now (as nothing more was to be expected from Cupr.) gave him Nux Vom. 6 and 30, a dose to be given every other evening.

16th March.—The day before the medicine arrived he was quite quiet, had appetite, sleep, and only one hour of restlessness at night. After the first dose of Nux he had more excitement, two hours of nocturnal restlessness, and mental disturbance, but the following day he was better; the bowels are still costive.

On the 18th March, I sent Argent nitr. 12, 1 dose to be taken in solution.

27th March.—The patient slept for some hours at night, had appetite for his food, regular bowels, the anxiety has gone off, he often sits up in bed and reads, and only now and then he has twitchings in the muscles. He complains of great weakness, but starts at every little noise. I sent him now 3 doses of Ignatia 12, one daily.

9th April.—The improvement advances, digestion good, he lies quietly with his clothes on, can also go to the water closet, does not sleep by day, but at night for hours at a time, still complains of great weakness and tearing in the legs. To complete the cure I sent one dose of Sulph. 30, to be mixed with three spoonfuls of water, half a spoonful twice daily.

Up to the 19th July, when I was able to visit him, I heard that he kept well, and then I found him sitting up in his room at the spinning wheel, looking stout and pleased. He had nothing more to complain of, except some bodily weakness, and I found edema of the legs, for which I prescribed Lycop. 30, after which the edema rapidly went off, and the patient could again earn his living as a day laborer.

July, 1864.—The patient remains quite well.

CLINICAL OBSERVATIONS -Some kinds of Paralysis, Chorea, and Epilepsy: By Dr. Th. Rueckert Case 1

 This case was published in "THE BRITISH JOURNAL OF HOMEOPATHY VOL 23".

Some kinds of Paralysis, Chorea, and Epilepsy
By Dr. Th. Rueckert

Case 1 —S. M— a girl, aet. 22, came on the 2nd July, 1863, to ask my advice. She was bent forward, and walked with short and trailing steps. She is of feeble constitution, earthy, pale countenance, and complains of the following symptoms-

Since her 14th year she had suffered from frequent attacks of water-brash and vomiting of food. She generally vomited most of what she ate, but she could, soon after doing so, eat again. For the last six or seven weeks the vomiting has ceased, but in place of it she now complains of her back and legs. She has no particular pain in the back or sacrum, nor is any vertebra painful; she has only a paralytic weakness from the back into the legs. When she goes out to walk, she can get on for a little while, but then her strength fails her, the legs refuse to do their duty, and she must stop to rest. In this way she had with great difficulty crawled about three miles to see me. I made her walk about the room, which she did bent quite forward, she could not step out properly, it seemed as if her legs were quite stiff. She complains of no particular pains, nor is there any emaciation. It is always dim before her eyes; she cannot read more than a line. There is nothing abnormal visible in the eyes. For some time back she has every week had urinary tenesmus, the water comes away in drops. She has never been regularly menstruated, it only came on scantily; for a year she had none. She has often leucorrhoea of a bland description. Her digestion is better, the bowels regular. 

Prescription. 1 dose of Thuja, 30. 

20th July.—The urinary complaints were better the first week, the second they quite disappeared; the leucorrhoea is less. In back, sacrum, and legs, no alteration; the same stiffness when walking. 

4th August.—The catamenia have returned and kept on for three days; no urinary symptoms. In the back and sacrum there was occasional burning, less latterly. She has less difficulty in moving about the house, not much improvement in walking about the street. The skin of hands and arms is much chapped, the neck and arms are desquamating, and feel very rough. No prescription.

She presented herself again on the 9th November. She now complained of nothing except a slight want of sensibility of the skin of the legs, she walked with ease about the room, and she had been dancing all night.

Dec 20, 2011


This Article originally publsihed in THE AMERICAN HOMOEOPATHIC REVIEW., Vol. III. NEW YORK, NOVEMBER, 1862. No. 6.


After some weeks of varied indisposition and much mental anxiety, Dr. R., aged 35 years, was taken ill on the 22d day of October, 1861. He felt great general prostration; a great heat all over; a strong desire to sleep, with sleeplessness; pain in all his limbs; a want of appetite and aversion to light. He took for these symptoms one dose of Bell.200
The following morning, the 23d, he was visited by Dr. Hering and myself, and the following symptoms were ascertained by our examination: he had not slept the night previous, his mind was too active, but they were always the same ideas which disturbed him; a continued hacking cough, from a tickling in the bronchial tubes, aggravated and excited by motion or talking; he raised at times tough green mucus; the cough causing violent stitches in the head; the head pained all over and felt numb. The tongue was coated white, the edges showing the impression of the teeth; pulse small, empty and frequent, vacillating between 94 and 106; no appetite; very little thirst; utter prostration of strength; very low spirited and taciturn; no passage from the bowels for forty-eight hours; urinating but seldom, and the discharge very scanty. There could be no doubt that a very serious disease was developing itself, and that we had to expect a case of typhoid fever. As the Doctor had taken Belladonna on the previous evening without any result as yet, we concluded to wait until evening before prescribing so that we might be certain that Belladonna was not developing any curative or other symptoms. We met at five, p.m., and found all the symptoms we had observed in the morning aggravated, the tongue was whiter, the edges softer, the cough more frequent, the pulse not as full, the prostration greater. The patient received four pellets of Calcarea carb.200 (Lehrman), and another dose of Calcarea carb. was left with the direction to be given in a solution of water, should there be no improvement in six hours. The next morning it was found that no further medicine except the one dose administered at five, p.m., had been given as the patient had slept soon after taking it. The cough had become less frequent and the head much relieved; the pulse was softer and fuller; the skin moist; an increased expectoration of green phlegm had much relieved him from the incessant tickling cough; the tongue was less coated and clearing off from the edges. He continued to improve from day to day; five days after taking the one dose of Calcarea carb. he was able to sit up, his appetite returned and he has been quite well since.
Calcarea carb. cured this case because it was the only remedy that had similar symptoms among the provings.— The utter sleeplessness from over-activity of the mind, the same ideas always disturbing the patient correspond only with Calcarea carb.; while the tickling, hacking cough aggravated by talking and motion corresponds with Calc. carb., Chin., Phos., Silicea, etc. In this case no aggravation appeared after the exhibition of the medicine, but that invariably beneficial sleep, indicating that the true curative remedy had taken effect, and that an improvement was to be anticipated. The improvement was gradual and steady leaving Dr. R. without the sequel of disease and medicine, and in the possession of full health.
Mrs. L. aged 45 years, had been suffering from diarrhoea for ten days during the hot days of August. The diarrhoea commenced in the following manner, was painless but was relieved only for a short time by Sulph.200, a few days later a watery discharge became more frequent in the evening and caused a great deal of burning for which Phos. was given with but little relief. On the tenth day the following symptoms were present: watery diarrhoea, grey, oftener during the day, worse after eating, the discharge passing with a gush; before the discharge, cutting pains in the upper part of the abdomen, the desire to stool very sudden and after the stool burning and soreness in the anus and rectum which were worse in the evening and during the forepart of the night; after the stool great weakness, sensation of sinking in the lower part of the abdomen and frequent perspiration. One dose of Nat. carb.200 was given in the morning. About ten minutes after taking the medicine a discharge came on very suddenly with not much straining, consisting of green lumps and white mucus; the next discharge was brown and in a few days the normal condition returned.
Nat. carb. has not all the symptoms related very strongly pointed out under the provings, but no other remedy has all the symptoms of the case. The time of the day is not strongly pointed out in the provings, but Nat. carb. has aggravation of diarrhoea after eating. See Hahnemann's Chronic Diseases: symptoms 485 and 486, the violent gushing stool is found,'Ibid 494, and reads  “violent sudden desire to go to stool, followed by a liquid discharge, which passes and gushes with violence from the patient." The burning and soreness in the rectum is Ibid: 413 and 414. The remedy which has next to Natrum carb. the greatest similarity with the symptoms of the disease is Croton tiglium; but Croton tigliutn has more diarrhoea after drinking, and also motion always increases the desire to evacuate; the gushing discharges and the burning after stool in the anus and rectum are characteristic of both remedies.

Lieut. S., aged 24 years, was stationed before Richmond and participated in the battle of the Seven Pines; he was there much exposed to the wet weather, over-fatigued, and having no proper food and very bad water to drink was attacked with violent diarrhoea, for which he took with some benefit Bryonia, China, and Ars. Having only salt meats to eat, and later, when stationed at Harrison's Landing, the water being more impure, he became worse again and came to Philadelphia to be under my care. > On the 16th of August I found the following symptoms:
Stools discharged in a gush, preceeded by some pain in the abdomen; stools consisting of yellow water; motion, eating or drinking caused him at once to go to stool; perfect rest alone gave him relief; after stool a burning in the anus; much emaciation and debility. I gave him one dose of Croton tig.30 (Jenichen). He felt better the next day and under the influence of the one dose of Croton tig. and a proper diet, mutton, rice, okra, tomatoes, Claret and water, he continued to improve. A soreness in the abdomen which prevented him from buckling any thing around his waist, was removed, ten days later, by one dose of Sulph.200 He has resumed his active duties in the field.
In this case no other remedy but Croton tig. could be given; the aggravation of the diarrhoea from eating and drinking as well as from motion have not been observed under any other medicine, while the gushing stools consisting of yellow water are also under Croton tig.
Major M., aged 42 years, who had been stationed at Fortress Monroe and later at Norfolk, came under my care on the 10th of July, 1S62. He had complained of diarrhoea for which Opium had been administered in large doses. When I saw him he had the following symptoms:
Several attacks during the day; frequent desire to go to stool, and when he gave up to this feeling, he passed only discolored and sometimes large lumps of mucus; the continual desire to evacuate became a violent tenesmus; the rectum feeling as if violently contracted; this tenesmus also effected the bladder. Great debility and emaciation followed these attacks, depriving him of sleep, had no appetite and not much thirst.
July 10th. One dose of Nux vom.30 relieved him so far that he passed some faeces, the strangury remaining; on
July 11th. I gave one dose of Caps.30 The strangury ceased, the attacks came -on only once in forty-eight hours, always in the afternoon, he at first passed a large quantity of black and very foetid faeces, and then a quantity of mucus which was followed by frequent violent attacks of fruitless straining, with a sensation as if the rectum was violently constricted.
July 16th. I ordered him Lach.200 (Lehrmann), six pellets dissolved in half a tumbler full of water, one table-spoonful to be taken every four hours for one day. The attacks returned every other afternoon during a fortnight, but each time with less violence and finally ceased without further medicine. The major remains well and is again in the field.
In the year 1855, a married lady, the mother of three children, aged 35 years, came under my care with the following symptoms:
She had periodical attacks beginning with pain in the region of the right kidney, which incommoded her mostly when she moved about or rode in a carriage, the pain was at first a dull indescribable sensation, a heaviness, and finally in the course of ten or more days it became more severe until at length a very severe colic commenced, the pain drawing from the right kidney through the ureter into the bladder, when much blood was discharged with the urine; after this discharge had lasted two or three days she was relieved for a period of three to six weeks. The medicines I administered, at intervals and according to the changes of the collateral symptoms had been, Canth., Puls., Cannabis, Berb., Calc. c, Thuja, Sassap., Lycopod.. Zinc. Zinc. had a better and a longer effect then any of the other medicines, the amelioration only lasting a short time; on the whole the disease became gradually worse. While laboring under the attack, which now lasted much longer than formerly, she tossed about, screaming and vomiting. After passing some blood, there was a sediment like brick-dust to be seen in the urine. I now gave Ocimum canum., according to the few, but characteristic symptoms published by Dr. Mure, I began with the sixth potency which caused at once a violent aggravation, later I gave the thirtieth potency, and since this, 1857, the patient has gradually recovered, her health remaining excellent.
Mrs. O, aged 35 years, mother of four children, the youngest four years of age, had been suffering for more than three years before coming uuder my care, in May, 1862. Mrs. C. is emaciated and of nervous temperament . For more than three years she had not menstruated; she had frequent attacks of violent colic almost always at night, between two and four o'clock, a.m., those attacks came on at irregular intervals from three to ten days and were followed at times by vomiting of food or mucus, and, if this vomiting did not take place, by a severe headache the next morning. The day after such an attack she would feel very weak in body and mind, notable to fix her attention on any subject, and loosing herself in the street because she could not know where she was; when she thus spoke she could not find the right words. The pulse was small and feeble. Mrs. C. had had all sorts of treatment, she had found some palliatives at times, but the disease always returned more violent when the palliatives ceased to relieve.
She took, on the 25th day of May, one dose of Kali carb.30 (Lehrmann). The first night after taking the medicine she had a very severe attack lasting one hour, but she did not suffer so much during the day, the following night she had another attack, less violent then the first night and another still lighter attack came on the following night; all at the same hour, three o'clock, a.m. The repetition of attacks in this manner had never taken place before. The patient improved afterwards, had for some weeks c6nsiderable pain in the small of the back, menstruation returned and she has remained well since.
In the month of April, 1860, the following case came under my care. Mrs. M., married six months and in the fifth month of pregnancy, has been sick for three'days with headache, pain in the limbs and fever. I visited her on the third day; she had taken no medicine, complained of great weakness, severe pains in her head, in all her limbs, but mostly in her back; much worse when moving, no sleep, bitter taste, much nausea, tongue yellow and becoming very dry, moderate thirst, face red, skin hot and dry, pulse 120 beats a minute, full and hard constipation, discharge of urine scanty and dark. Several members of the family had died during the last few years of typhus fever under allopathic treatment. I gave the patient several doses of Bry.200 and found her easier the next day, I omitted the medicine. The following day, the fifth day of the disease, she was much worse, she had vomited frequently during the night, mostly bilious matter; the headache had been much worse, she was now unconscious, delirious, talked incessantly, she passed urine involuntarily, picked the bed clothes, tongue dry and black, face very dark red, eyes wide open, glassy, pupils dilated, when she drank a loud gurgling noise in her throat to the stomach. I gave her Cuprum met.200 (Jenichen) six pellets dissolved in half a tumbler full of water, every two hours one tablespoonful to be given till an improvement was apparent. After the second dose she fell asleep, slept uninterruptedly for ten hours, perspired profusely, and awoke feeling well but very weak. She took no more medicine and was able to take her meals with the family on the twelfth day of her sickness. The pregnancy progressed and at the proper time she was delivered of a healthy child.

Dec 18, 2011

Rheumatism By P.P. Wells, MD PART II

 This Article on RHEUMATISM was published by P.P.Wells in The American Homeopathic Review, Vol 3, New York, Nov, 1862. No 5,6,7. Here it is again published in two parts.PART I can be read here.


Arsenicum—Drawing tearings, especially in the limbs, with inability to lie on the affected side, and which are relieved by motion of the affected part. Pains which are felt during sleep. It is especially appropriate in protracted cases, with nocturnal aggravation of the pains, great emaciation, and profuse sweatings from exhausted vital force.

Calc. carb., is almost specific for cases contracted by working in the water, or a long continuance in it.

Causticum affects the fibrous tissues in the neighborhood of joints, as ligaments and tendons, and also the periosteum, i.e., the white rather than red fibrous tissues, and produces little or no discoloration, and if there be swelling it is pale. It causes shooting pains, especially in the joints, after taking cold. Tearings in the joints and bones, relieved by warmth and in bed. Shortening of tendons and rigidity and flexion of joints. Great sensibility to cold, open air, and currents of wind, which aggravate the pain. The patient is averse to lying uncovered. Its period of aggravation is evening. It is often appropriate in both acute and chronic cases with and without fever.

Chamomilla, is oftener applicable to acute and inflammatory cases with fever, than to chronic, apyretic cases. The pains are drawing in character, worse at night, and in bed; relieved by external warmth. The patient is disposed to constant movement of the affected part, which is numb, and partially paralytic. Tearings in the limbs, especially in the evening, and only relieved by constantly turning in bed. Drawing jerks in the bones and tendons. Pains in the periosteum, with paralytic weakness. Sensation of paralysis in parts, after the cessation of the pains. Rigid sensation and as if bruised in the joints, with cracking when moving. Its period of exacerbation is evening and before midnight. It will be perceived by the above, that the notable points in this drug are, it attacks chiefly the parts about the joints and periosteum (see Caustic.), paralytic sensation and partial paralysis of affected parts, pains aggravated evening and before midnight, and in bed; relief by external warmth and by moving the part affected. There can be no mistake in its use, if these points are remembered, and also that the disposition it excites is angry, petulant and depressed. (See Nux vom.)

Chin, is valuable in many cases resulting from the abuse of Mercury, especially in weak and emaciated subjects, with inclination to excessive perspiration. (See Ars.) It affects the tissues around the joints, periosteum, lumbar muscles, and those of the face, chiefly. The parts about the joints are swollen, and excessively sensitive to touch. The pains are worse at night, and while lying and sitting are tensive, drawing, as if bruised, and are accompanied by a sensation of weakness in the affected part, which is also restless and disposed to constant movement, which relieves. Great excitability of the whole nervous system, especially the nerves of sense (see Nux v.), all impressions on these are too strong.

Hepar sulph. is also related to cases of Mercurial rheumatism, especially in scrofulous subjects. There are tearings and shootings in the limbs and joints, with aggravation at night, especially during a nocturnal chill. Excessive nervous excitability, so that all impressions on body or mind cause internal trembling.

Ignatia. Pains in the joints as if sprained or dislocated. In the periosteum and long bones, pressing bruised pain especially at night and in bed; and the pains which appear while lying on the side, disappear when lying on the back. Relief by change of position. Great sensibility to currents of air. Alternations of disposition, showing opposite states, at short intervals. The general condition apathetic and depressed. Period of exacerbation, afternoon, evening and after midnight.

Ledum. This remedy is allied to both gout and rheumatism, and to acute and chronic cases, with and without swelling. It affects the joints, muscles, tendons, and periosteum. In the joints it produces jerking and shooting tearings; throbbing which hinders motion; paralytic pains, in all the joints, at night in bed, while moving the body; painful nodules in the joints. In the limbs, pains as if bruised; flying rheumatic tearings, from motion; tearing in the back and knees; pressing, and tearing pressing pains in the limbs, worse evenings and in the warmth of the bed; drawings in all the long bones, during motion. The warmth of the bed and the bed covering are insupportable. This intolerance of covering is quite characteristic of Ledum. Pains aggravated by motion. Period of aggravation evening and before midnight.

Lycopodium. In rheumatism of the finger-joints, and especially in chronic cases. In the practice of the writer it has been used with the best results in a case of rheumatic gout affecting these joints, of fifteen years standing. The joints were much distorted and filled with the characteristic chalk deposites. A perfect cure of the case, with absorption of the calcareous deposites, was effected by Lyc 200 followed by Graph.200, in about six months. The case was characterized by a profuse, icy cold perspiration of the affected hands and fingers, to the extent that several drops a minute would fall from the fingers' ends if these were permitted to hang downwards, and this in the hottest day of July. This remedy may also be of use in affections of the larger joints (mostly in chronic cases), if the general symptoms of the case are like the characteristics of this drug.

Mereurius sol. This drug is especially related to cases of syphilitic origin or complication, affecting the joints, bones, or periosteum. The swelling of the joints is likely to be large, pale, or slightly red, and puffy in appearance, or oedematous. The pains are tearing, drawing, shooting, pressing; in the bones as if broken; in the joints as if sprained; worse evenings and night, and insupportable in the heat of the bed; accompanied by profuse perspiration (often sour or offensive smelling), which gives no relief to the pains.

Nux mos. In cases chiefly of the muscles, the result of chill, or of protracted exposure to cold and dampness. The pains are of a drawing character, worse during repose; relieved by warmth, and aggravated by cold open air.

Nux vom, (see ante). This remedy is especially appropriate to attacks of the large muscles of the loins, and the large joints.

Rhododendron. In cases caused by storms, and a raw chilly atmosphere. The pains are worse during repose (see Rhus tox. and Dulc), and nights in the warmth of the bed (see Merc, Puls., Rhus. tox., and Sulphur). The pains are tearing, drawing and shooting, worse on change of weather. The pains are frequently without redness or swelling. Aftor abuse of Merc, in single joints, with redness and.swelling, aggravation of the pains at night and towards morning, which causes tension and stiffness of the joints. There is great sensibility to cold windy weather.

Rhus tox. (see ante), is one of the principal remedies for that class of rheumatic cases which has the pains relieved by .motion, and worse during repose, numbness of the affected part after motion. It is appropriate to attacks of whatever tissue, if the characteristic symptoms of the case are like those of the drug.

Ruta graveolens. Pains as from a blow, fall, or as if crushed; aggravated by touch, bending the body or the affected joints. The pains in the limbs and loins are relieved by continued motion. Ruta affects chiefly the bones and joints. There is with. the pains of the affected joints a sense of want of power, or partial paralysis. The wrist and first joint of the thumb are not unfrequently the seat of these pains, the patient being unable to grasp or hold objects with the affected hand. The pains of Ruta are aggravated by cold damp weather, and by repose. The disposition is sad, depressed, anxious, or angry.

Sabina, has drawing pains in the long bones of the upper and lower extremities, extending to the joints, where they are most severe, worse in a room and better in the open air. Paralytic pains in the joints after exertion. Tearing shooting in all the joints, with sensation as if swollen, with shooting drawings through the long bones. Cracking of the joints. This remedy has been repeatedly curative of rheumatism of the metatarso-phalangeal joint of the great toe characterized by great swelling, bright shining red, intense sensibility to touch and motion, worse at night. Fever high.

Sepia. In chronic cases, or in the obstinate remains of acute, which have resisted other remedies (see Sulphur). It has tension in different limbs, as if the tendons were too short; drawings in all the limbs, especially in the knees and fingers; drawing tearings, from below upwards, in the arms and legs, only in repose, with great weakness. Tearings in the knees and elbows. Sensation in the joints as if they would be easily sprained or dislocated. Cessation of the pains during powerful movement and walking in the open air. They appear most frequently and severely while sitting in repose and forenoons and evenings. Aggravations evenings and nights. Local warmth relieves the pains (see Ars. and Cham.). The pains are often accompanied by shuddering. Great sensibility to cold air, especially to the North wind.

Sepia was successful in removing the remainder of an acute attack located in the right knee, after Sulph., which at first gave great relief, had failed to effect a complete cure. The knee was semi-flexed, stiff', swollen, red, painful, worse at night, with a great sense of weakness in the joint. The pain and sensitiveness to touch were chiefly in the external lateral ligament. Sepia*", one dose, removed the whole pain, stiffness, swelling, and weakness as well as an extreme sensibility to cold air, and to every change of weather, which had been of some standing. There seems to have been a complete extinction of the rheumatic constitution in this case by the one dose, though it had been active at times for years. There has been no return of pains, or sensibility to change of weather.

Sulphur is appropriate to both acute and chronic cases, though seldom to the early stages of acute; to the results of taking cold, especially from cold dampness, or from working in water; (see Calc. carb.) to cases with or without swelling. Pains with loss of power and numbness in the part affected; shootings in the joints, with stiffness, or at night; pains like a sprain; tension as if from shortening of the tendons, or especially in the tendons of the feet after a short walk; drawings and tearings in the knee and shin-bone, evenings; cracking of the joints, especially of the knee and elbow. Warmth relieves and cold aggravates the pains (see Ars., Cham., Sep., etc.). The pains appear and are aggravated at night. Great disposition to take cold. Great sensibility to wind and open air. Pains on a change of weather. Dread of washing.

Thuja. If the latest observations on this drug should be sustained by practical experience, it will be found scarcely less than a specific in rheumatism, from gonorrhoeal poisoning. Respect for recent writers who have associated this drug with this poison as its great antidote, will secure to Thuja a careful attention in all cases of this kind. The symptoms which ally it to rheumatism are in the neck, tearing, which prevents turning the head; burning cutting, extending between the shoulder blades. In the back, pressing sensation of heaviness extending to the ankles, hindering walking; as if bruised, with great weakness; the whole back is painful, with stiffness of the neck; like a painful saddle over the nape of the neck, shoulders and spine. In the loins a boring tearing pain, extending to the left hip, causing limping. In the shoulders, tearing in the right, preventing lying on it and turning the head; tearing in both, or alternating from one to the other; severe stitch in the left; pain which prevents raising the arm over the head. In the arm, continued pain in the left, from the shoulder to the wrist and fingers, preventing grasping with the hand; in the middle of both, pain as if bruised. In the hands, drawings and tearings; pains in the fingers of the left, preventing grasping; in the thumb and finger joints, stiff, shooting, drawing, jerking and tearing pains, then swelling, when the pains gradually decline. In the hips, pain in the right, worse while sitting; drawings in the right, extending to the sole of foot; pain from the hip to the spine; sudden pain in the left, while stooping, so he can hardly step, with the sensation as if the leg were too long; the whole leg to the foot pains as if crushed. In the shin, shooting in the left, with swelling and redness of a spot, from which the pain extends to the ankle, and does not endure the least touch. In the knees, shooting in both so they cannot be bent, tension in the left; tearings; like excoriation, shooting, tightening, worse on sitting and rising from the seat, and at, night preventing sleep. In the ankle, shooting and tearing with swelling, and also of the sole, worse in the morning. Aggravations for the most part afternoon, evening and night. Warmth relieves and cold increases the pains.

Veratrum. One of the characteristics of this drug is that the violence of its pains produce delirium. In cases of rheumatism where delirium attends its exacerbations, Veratrum can hardly fail to be of service. It produces pains in the limbs like bruise and pressure. Its pains are intolerant of the heat of the bed, but are relieved by rising and walking about. They are renewed by damp cold weather. Renewal of the pains on rising which cease on lying down again. Stiffness of the limbs, especially forenoon and while standing.

A remedy of the first importance in the treatment of rheumatism is Lachesis. It is appropriate in both acute and chronic cases, and should always be in mind when treating cases from mercurial or syphilitic poisoning. The pains are increased evening and night; by touch and motion, and after sleeping, either day or night. It is more appropriate to the cases of spare or emaciated subjects (see Ars.), and also to cases with free perspiration, without attendant relief of the pains. (See Merc. sol.)

But the great province of this remedy is that class of cases threatening the heart or its appendages, or where these are actually invaded. In this class, so dangerous, and sooner or later, s0 fatal, if not met at the outset promptly by appropriate remedies, Lachesis is second in importance to no other medicine. The frequency and serious character of these attacks, will perhaps warrant a few remarks devoted to them in this connection, in which we hope to show the relation of this and some other remedies to rheumatism of the heart and its appendages, and to point out the proper place of each in the treatment, so far as we may he able in the brief space at our command for this purpose.

The first remark we have to make is, that in the treatment of every case of acute rheumatism, attacks of the heart should be suspected and watched for constantly, no visit being passed without positive knowledge of the state of the heart derived from actual careful examination of its condition. It is not enough that\he patient complains of no pain, or is silent as to unusual sensations in the cardiac region, for many cases make destructive progress without these, and without exhibiting the symptoms presently to be named, and which usually characterize such attacks. Nothing but a careful examination of the sounds of the heart's action can be perfectly relied on as evidence of its safety or danger in cases of acute rheumatism. No matter what the other symptoms, while these reveal only the dull, soft and smooth sounds, with the regularity of rhythm, and no more nor less than the active impulse of health, we need entertain no fear. It is all right. But any departure from these is a warning, and woe to both physician and patient if it bo not heeded and met by proper means. Is there a greater impulse to the beat than accords with the general signs of fever, it is significant of threatened trouble, and this is much enhanced, if at the same time the action of the heart is more rapid than would have been anticipated from the grade of violence of the fever, and still more if this action is tumultuous, or irregular in its rhythm. If with or without these signs there is heard with the usual sound of the beat, one as if from the friction of two rough surfaces—a rubbing—or with each beat, a blowing like that from the action of a small hand bellows, we have no occasion longer for suspicion, for trouble is already upon us. 
The careful examination of the state of the heart is the more earnestly insisted on, because without this the evil may reach a development necessarily destructive before it is in the least perceptible in the general symptoms of the case.

A sad instance of the oversight we here would guard against, came under the observation of the writer some years ago, in the case of a lad 19 years old who had been ill about three months, the latter part of which time he had complained of no pain, but laid constantly in one position, on his right side, much bent forward, and well over on the face; he was desponding, said he could not get up nor move, though his physician insisted he could, and that " there was nothing the matter with him." On compelling him to get up and Stand on his feet, the poor lad fainted, and the doctor was only puzzled. He was not instructed. It was now the writer was requested to see him, and to say what was "the matter."

A single glance at the outlook and position of the patient instantly excited a suspicion which was fully confirmed by placing the ear over the region of the heart. Its action was so rapid and irregular as not to admit of counting, and more tumultuous than had been previously met by the writer.— The first question, whether he had had rheumatism was answered, that he had three months before, but that his pains suddenly left him six or eight weeks ago, since which he had had no return of them, and had been as I saw him, making no complaints, but insisting constantly, in reply to his physician, who told him there was nothing the matter with him 'and that he should get up and dress himself, that he could not. He was for a long time told this daily, and it was only after the attempt and result above stated, that his physician desisted, but was not satisfied. When told his patient had rheumatism of the heart, he became angry, rude and violent in his denials of the fact, which dissection, two weeks afterwards, established.

In cases of rheumatism attacking young subjects, it should be remembered that the danger of this metastasis is in the inverse ratio of the age. It is rare that children who have suffered from this disease wholly escape deposits on the valves or membranous tissues about the heart. After thirty years the danger of this is comparatively less, though cases do occur much later in life than this. The danger is much greater in thin, nervous, and feeble patients, and in those who have been poorly nourished. Such patients should he watched with double care, and if possible, the evil arrested at the outset. It frequently happens that in such subjects, there is a strong tendency of the disease to return to the heart, after having been once or twice removed to its original point of attack. They call for the utmost vigilance; the heart once invaded acquires peculiar susceptibility to subsequent attacks.

In all cases of acute rheumatism, where the pains of the affected parts suddenly disappear, without corresponding amendment in the general conditions and symptoms, the state of the heart should at once be suspected and examined. If the modifications of its healthy sounds above named are found, there is certainly a transference of the diseased activity to this organ or some of its appendages. There will most likely be with these some of the following symptoms, though the absence of any, or all of them, should not be taken as certain evidence of the integrity of the heart. They differ also much in their intensity in different cases, from extreme severity, to so light a degree as to attract little or no attention. Their lighter manifestation, or even the absence of any of them, however, is not to be taken as a measure of the danger of the patient, as the case just given shows.

The pain in the region of the heart is often intense, shooting, stabbing, boring, burning, pressing, or like a bruise.— Anxiety, restlessness, oppressed respiration, which is short, hurried, often irregular, and always with the short, abrupt expiration compelled by the intolerance of the pressure of the inflated lungs; short, dry, abrupt, loud, and, for the most part, single cough. This cough is peculiar, and once heard is not easily forgotten. It belongs to affections of the heart in general, and is seldom wanting in cases of the kind under consideration. Pressure, like a weight, on the middle or the lower part of the sternum is often present, very troublesome, and embarrassing to the respiration and sleep, sleeplessness at night, or if the patient sleeps, ho is often suddenly waked by a sense of suffocation, or fright, which soon partially passes away after waking—anxious and frightful dreams from which the patient wakes fatigued, and to which fatigue there is no rest. Pale and anxious countenance, indeed there is a peculiar physiognomy to these cases, which, however indescribable, when once seen, is not difficult to recognize. Great prostration of strength and utter intolerance of exertion. Profuse perspiration is a frequent concomitant, but it gives no relief to the patient. He lies, for the most part, on the right side, with the trunk bent forwards, or he is semi-recumbent, inclining to the right side. The manner of the patient is anxious and agitated. His speech is difficult, abrupt, short, and almost always painful. He is for the most part taciturn, desponding, and sometimes exceedingly petulant. His sufferings are likely to be much aggravated at night.
The above symptoms and remarks are given especially for those who are still inexperienced in the observation and treatment of these cases, and to such (the remark is not necessary to the mature practitioner), we say further, spare no pains in your first prescription. Be sure that it is strictly accurate before you proceed, whatever time it may require, and whatever may be the state of the patient, or the agitation and anxiety of his friends. We say be sure, because doing nothing for a short time, in such cases, is far better than doing wrong, which is often an irreparable mischief. It begets complications or excites inveteracies which sometimes are difficult or impossible to overcome. Avoid the loose practice of giving two or more medicines at the same time, for here it will prove not only useless, but most likely mischievous. The frequency of the repetition of the doses must depend on the severity of the attack and the rapidity with which it seems to be running its course. The more violent and rapid require doses at shorter intervals. In prescribing we must have reference as well to the general symptoms as to those more immediately about the heart, and of these last we have the two classes of subjective and objective, both important, in their control of the choice of the remedy.

Aconite may be in place at the very outset of the attack, as it is in the beginning of most inflammations with fibrinous deposit, if there be full, hard, quick pulse, great heat of the skin, thirst and anxiety, with restlessness and loud complainings under the sufferings; sharp shootings in the region of the heart, etc. It is seldom of service later in the attack, and in this it only obeys the law which limits its usefulness in this class of inflammations to the stage of deposit, which is often quite brief. It may be well to caution the class of practitioners for whom these remarks are especially designed not to lose too much time in fruitless waiting for relief from Aconite which it cannot bring, but rather, if it has seemed appropriate in the beginning, and has brought partial relief to the pain, anxiety, difficult respiration and cough, and the amendment has ceased to progress favorably, to proceed at once to the selection of a remedy more appropriate to the case. It is to be remembered that however valuable this remedy may be in the beginning, for a first curative impression, it seldom is sufficient for the complete cure of these cases, and never in constitutions invaded by psoric taint. We use this expression in the general sense which signifies the presence of a miasm which when developed becomes a chronic disease, with no tendency in itself to a limited existence, or to a spontaneous cure, but the course of which, when unimpeded by appropriate remedies, is towards dissolution. We prefer this general expression to "scrofula " and the many other indefinite terms which have been employed to designate the class of cases 'referred to. These remarks are, to a considerable extent, applicable to

Bryonia as a remedy for rheumatism of the heart. It is often valuable in the first stage, as a relief to present suffering, but rarely suffices for a cure, and never of severe cases. It is especially appropriate in this stage, when the fever is acute, with great thirst for cold drinks, pulse hard and quick, the shootings in the heart greatly aggravated by the least motion, and the respiration much embarrassed by a sense of pressing weight in the middle of the sternum. It is more applicable to cases, where the membranes and muscular tissue are chiefly attacked.

Arsenicum is a remedy for a later stage of these cases, where there is great prostration of strength, cold, damp surface, or cold and sticky perspiration; great restlessness; rapid emaciation; great oppression of the respiration; burning pains in the region of the heart; pulse small, rapid and feeble; worse when lying on the back; and also at night, and especially after midnight.

Pulsatilla, if with the well-known disposition characteristic of this medicine, and the common symptoms of this metastasis, there be shootings in the region of the heart, or heavy pressure and burning; palpitation much increased by slight mental emotions, or by speaking, with anxiety, intolerance of the pressure of the clothes, which the patient constantly endeavors to remove, and also with darkening of the vision, and aggravation by lying on the left side. This remedy may be of service in the late stage of the attack, and aid the absorption of the deposited fibrin. The patient is worse evening and night, before midnight.

Lachesis. This is one of the most important remedies in rheumatism of the heart, and in cases of deposited fibrin into the cavity and upon the surface of the pericardium, or upon the surface of the valves, it is one of our chief reliances for its removal. In the last named variety, valvular deposit, it divides the field with Spongia and perhaps Iodine. In rheumatism of the pericardium or endocardium it has no rival, and for it there is at present no known substitute. It has been the pleasant experience of the writer, many times repeated, to watch the daily subsidence of the physical signs of the presence of this most important affection, till the last trace of the fearful friction sound disappeared,- and with this, the gradual return of the patient's accustomed health. The subjective symptoms which indicate Lachesis in this affection are weight in the chest with anxiety; spasmodic pain (cramp like) in the heart, which causes palpitation; the heart feels as if constricted; a sensation as if the heart intermitted a single heat, which produces a slight cough, which seems to re-establish the circulation. Shortness of breath after every motion, especially of the hands, with great weariness. Inability to lie down on account of a suffocating sense of fullness in the chest, with the necessity if removing all pressure from the neck and chest, and gasping for breath, and when relieved of this, the patient lies on the left side with the head raised high. The anxiety, paleness of face, restlessness, perspiration, often excessive, are symptoms which nearly ally this remedy to Ars. They should be regarded as allies, not substitutes for each other. Both are exceedingly valuable, each being in its place, but a careful examination of the symptoms will show that their place is not identical. If called on to state the physical condition to which each is most appropriate, in these affections of the heart, it might be said Ars. is more related to cases with deposit of water in the cavity of the pericardium, and Lach. of fibrin upon the surfaces of the affected organ, of its valves, or of its investing membrane.

Spongia has been mentioned as related to cases with fibrinous deposit upon the valves. If the success which has followed its use by the writer shall continue to attend its prescription in such cases, it will prove a remedy of the highest value. Repeatedly he has had opportunity to observe the speedy, gradual disappearance of the valvular murmur) after giving this remedy, and corresponding relief of the subjective symptoms of the case, quite as satisfactory and remarkable as are often the results of the same remedy in croup. It seems to stand in much the same relation to rheumatic affections of the valves as Lach. does to that of the external and internal membranes of the heart. It was first suggested to the writer as a remedy in diseases of the heart by that eminent Master of the Materia Medica, Dr. A. F. Haynel, of Baltimore. This mention brought to his recollection the effects of Spong. upon a colored servant of the writer, who had suffered many years from an organic affection of the heart—of which she died a year or two after. She stealthily seized and speedily ate and swallowed a piece of sponge, just roasted, which lay in her way, while my back was momentarily turned towards her. The effect was sudden and alarming. It produced a terrible beating of the heart, a suffocation which threatened to be fatal, the lips became livid, respiration violently gasping, great pain in the heart, terror and fear of approaching death. After ten or fifteen minutes these symptoms began gradually to subside, and the dose, though rather large, was followed by a very remarkable relief of her old heart symptoms, which lasted several weeks. The terror of the experiment was sufficient to cure her of all inclination to steal medicines in large doses.

It was not till some ten years after this rather unexpected and startling experiment that a night call, in great excitement and alarm, brought the writer, at about two o'clock, a.m., to the bedside of a patient whose rheumatism had left the lumbar muscles and seized the 'heart, and this was the second similar metastasis in this case. The patient was awakened between one and two, a.m., by a sense of suffocation, accompanied by violent, loud cough, great alarm, agitation, anxiety, and difficult respiration. The action of the heart was violent and rapid, and each beat was accompanied by a loud blowing, as of a bellows. This symptom might have been and probably was the result of the deposit by the previous attack. There could hardly have been time in this recent one for an accumulation of fibrin equal to its production. The whole appearance of the case brought up the recollection of the experiment of my servant. The phenomena of the two cases were quite similar, indeed strikingly so. I immediately gave two pellets of the 200th of Spongia tost., Jenichen's preparation. The relief to the distressing symptoms of the patient was prompt, remarkable, and permanent. The bellows sound, which was loud, gradually disappeared, and in a day or two ceased to be heard. This was the result of my first trial of Spongia in heart disease. I have since, from successes, come to have great confidence in it, where the valves are chiefly the seat of attack, and where the patient is suddenly awaked at night, and shows a train of symptoms like those given above.

Spigelia. This remedy is adapted to cases where the irritibility of the heart is excessive, the beating violent or undulatory, or not synchronous with the beat of the pulse, the pains shooting and sharp, respiration short and oppressed, with great anxiety. The cases to which it is best adapted are those where the neuralgic element predominates, or, if inflammatory, where the deposit is small or before the stage of deposit is reached. In cases marked by distinct rubbing or bellows sounds, it may relieve pains and oppressed respiration, anxiety and restlessness, and the violence of the heart's action, but probably will exercise little influence over the absorption of inflammatory products.

Phosphorus. It is possible this remedy deserves more attention in the treatment of these cases than it has received. In the only case where it has been used by the writer, the result was striking and remarkable. It is given here because it illustrates a principle of the first importance in homoeopathic practice. There was nothing in the symptoms immediately referable to the heart, which was strikingly suggestive of Phos. rather than any other remedy. But the general symptoms were strongly characteristic of the drug, a3 were also the circumstances by which the symptoms were aggravated and relieved. Among the symptoms which found their resemblance in the pathogenesis of Phos. were pressure as if a great weight were lying on the middle of the sternum. Great pressure in the upper part of the chest; cough excited by drinking. Excoriation of the chest when coughing; cough wakes him constantly at night, and excites great pain in the breast. It was impossible to lie on the back.
This patient was now in his third attack of cardiac rheumatism. The first was some three years before this and the second five months. Since the first he had always had short breath and cough, inability to exert himself, palpitation of the heart, and depression of spirits from the belief that he had an incurable disease of the heart, which drove him to reckless courses of life. He became irregular and careless in his habits, drank very freely of intoxicating drinks, being willing by these or almost any means to end his wretched existence. In this third attack he had loud friction and bellows sounds. He was extremely petulant. The least trifle drove him to the greatest anger. He scolded violently if in the least opposed, or at any suggestion not perfectly agreeable. On getting Phos., Lehrman's, he was soon relieved of his most troublesome symptoms, and under the use of the remedy, six globules in half a tumbler of water, a teaspoonful every six hours, his convalescence was complete in about two weeks. He also lost the evidences of the old deposits upon the valves and on the pericardium, and when last seen by the writer, some months after, he was in apparent health, and in constant attendance upon business. The absorption of these deposits, it is believed, must be attributed to the effect of the drug, an effect certainly as unexpected as agreeable. The object of giving this case to the reader, is, to call his attention to the drug, if he should have similar symptoms to treat, or cases with other characteristics of Phos. believing it to be worthy of more attention than it has received in the treatment of the class of cases under consideration. At the same time we cannot but protest against giving this or any other drug, because a patient has cardiac rheumatism, without first making a careful comparison of the symptoms of the case with those of the drug, and then it is only to be given because of the resemblance required by homoeopathic law of cure.