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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.

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