4. The debility remaining behind after the acute attack is over demands medicinal, as well as hygienic and dietetic, help. The great "tonic" for it I find to be phosphorus.* The nervous system is its main seat; and there has not been such a drain of fluid as should call for china, nor is there evidence of the destruction of red corpuscles which needs arsenicum. A further indication for the remedy is that which is mentioned in the article from which I have already quoted:-"The morbid changes found after death, and due to influenza itself, are of a character due to all forms of acute infective disease-namely, parenchymatous degeneration of the liver, kidneys, and spleen, of the muscular substance of the heart, and of the minute blood-vessels." A minor degree of such degeneration may fairly be conceived as present in the often extreme debility of convalescents from the disease. Phosphorus is the chief poison whose post-mortem appearances belong to this category: the law of similars therefore guides us to it as the chief medicine to aid in repairing the destruction which has been wrought.

In so speaking, I have confined myself to my own personal experience, which has been fairly extensive. I find, however, similar remedies in use at the hands of those who have written on the subject both at home and abroad. Dr. Grundal, of Stockholm, prefers rhus as the constitutional remedy, deeming it as specific as mercury in syphilis. He gives the 2x dilution.†

* I am bound to notice, however, the commendation bestowed by Dr. Cartier on avena sativa here (L'Art Médical, Oct., 1896). Dr. Proctor finds iberis valuable when the debility most affects the heart (H. W., Nov., 1900). Hahn. Monthly, Aug., 1894, P. 543.

LECTURE XXI.

GENERAL DISEASES.

Erysipelas-Phagedana-Malignant Pustule-Glanders-Pyæmia -Septicemia-Actino-mycosis-The Arthritic Affections.

Hitherto I have followed, with but slight variation, the order of our official nosology. But I am unable to do so with the remainder of the eighty titles it now ranks under the heading of "General Diseases." Most of them are so local in situation, or so limited to particular occasions or stages of life, that I think I shall consult your convenience as well as my own by considering them in other relations than the present. To-day I shall take first the blood-infections-erysipelas; phagedæna; malignant pustule; pyæmia and septicæmia; actino-mycosis; and glanders, with farcy and grease.

Erysipelas used to be reckoned, in our nomenclature, as including phlegmonous inflammation of the integument as well as superficial, and also diffuse cellulitis. The former inclusion.is, I think, pathologically justifiable, and has been maintained; the latter is wisely dropped. We shall speak, then, of simple and

of phlegmonous erysipelas.

1. The treatment of simple erysipelas is one of the most defined and most successful things we have in homoeopathy. It resolves itself into the discriminate use of three medicinesbelladonna, apis, and rhus.

The pathogenetic power of belladonna to inflame the skin is unquestionable; you may see it illustrated in numerous symptoms of the "face" and "skin" categories of my arrangement of the drug in Part iii. of the "Hahnemann Materia Medica." Of its curative power I cannot speak better than in the words of one who must have had abundant opportunity of comparing its effects with the treatment of erysipelas by other measures: I mean the distinguished surgeon, Mr. Liston. After detailing some cases of the disease, cured mainly with fractional doses of the extract of belladonna, he said to his students,* "Of course we cannot pretend to say positively in what way this effect is produced, but it seems almost to act by magic. You know that this medicine is recommended by homoeopathists in this affection, because it produces on the skin a fiery eruption or * See Lancet, April 13, 1836.

efflorescence, accompanied by inflammatory fever. similibus curantur, say they. . The medicines in the above cases were certainly given in much smaller doses than have hitherto ever been prescribed; the beneficial effects, as you witnessed, were unquestionable. I have, however, seen similar good effects from the belladonna prepared according to the Homœopathic Pharmacopoeia, in a case of very severe erysipelas of the head and face, under the care of my friend Dr. Quin. The inflammatory symptoms and local signs disappeared with very great rapidity." All homoeopathists are unanimous in praising belladonna where the dermatitis is intense; nor should the presence of a few vesicles or of some amount of swelling be supposed to render other medicines preferable, as long as the colour of the affected part is bright red and the general fever high. But should edema become the prominent feature of the local inflammation, or should phlyctenæ form in abundance and the skin be purplish, it is generally allowed that apis or rhus must become its substitute respectively. Of the efficacy of apis you may read some good examples from Dr. Yeldham's pen in the twelfth volume of the British Journal of Homœopathy.

2. In phlegmonous erysipelas our first reliance must be on aconite. Here, too, we can quote old-school authority in support of our practice. "Administered at the commencement," says Dr. Ringer, "it often at once cuts short the attack; and even when the disease continues in spite of it, it will reduce the swelling and hardness, lessen the redness, and prevent the inflammation from spreading." Should the cutaneous inflammation be considerable, belladonna, or perhaps ferrum phosphoricum," may be alternated with it. If, in spite of these remedies, the cellulitis threatens suppuration, it is—as Bähr says -useless to try to check the process by mercurius; it is better to promote it with hepar sulphuris, holding silicca in reserve to limit it if excessive. I need not say that surgical measures must be employed as far as may be necessary. Should gangrene occur, lachesis is the specific remedy; but arsenicum may be required for the typhoid condition which will ensue.

Thus far I have spoken of erysipelas as it ordinarily occurs; but I have now to mention some special varieties, complications and sequela which belong to it.

When erysipelas of the head invades the brain, the belladonna we shall probably be giving for the cutaneous eruption will ordinarily answer every purpose. If, however, rhus should

* See J. B. H. S., v., 195. Another alternative would be the tarentula cubensis, the bite of which spider causes a phlegmonous inflammation, and which has been used with good effect in carbuncle.

be the remedy for the condition of the surface, stramonium may better suit the delirium; as in a case recorded in the Revue Homœopathique Belge for December, 1876. If the cerebral symptoms are those of oppression, especially when the hyperæmia of the skin has diminished, cuprum—as recommended by Jahr-should be preferred. For erysipelatous angina, with its threatenings of oedema glottidis, apis is an excellent medicine. There is a wandering erysipelas in which the dermatitis springs from place to place discontinuously. Bähr and Jahr agree in praising graphites here; the latter adds arsenicum where there is much prostration of strength. Bähr speaks of "erysipelatous attacks without fever," and says that lycopodium and hepar sulphuris take the place of belladonna and rhus when they occur. He praises the same remedies for the oedema which is sometimes left behind by the disease, when this is often painful; giving graphites, sulphur, and aurum when it is not so. Recurrent erysipelas is generally amenable to rhus.

As regards local applications designed to check the progress of the dermatitis, I can say nothing about the nitrate of silver and sulphate of iron in use in ordinary practice; but I may mention that Dr. Garth Wilkinson speaks of obtaining excellent results from the application of the tincture of veratrum viride, and that Dr. Bayes testifies to the same success with a strong lotion of this drug.

Phagedæna is said to embrace two varieties-" sloughing phagedæna" and "hospital gangrene." It may be defined as a morbid change, probably of constitutional origin, occurring in an ulcer or a wound whereby destructive processes are set up threatening the death of the part and often of the patient. It was most familiar of old in its nosocomial form; now it chiefly comes before us as an incident of soft chaucre. In the latter case anti-syphilitics are sometimes required, and we must leave the question of its treatment till we come to venereal disease. But when sloughing sets in upon a non-venereal ulcer, or when the so-called "traumatic gangrene" supervenes upon an injury, let me recommend you to rely for medication upon lachesis. The references given in my Pharmacodynamics will shew you that in the treatment of the latter trouble it has proved an invaluable ally."

Malignant Pustule, when communicated by direct inoculation, doubtless demands the early excision or cauterization of the

* Four cases of "gangrene," various in origin, are reported by Dr. Lambreghts fils in the Journal Belge d'Homœopathie for July-August, 1897. In all lachesis 6 was markedly curative.

affected part. The success attendant upon this measure is too great and constant to justify its neglect. But if the virus has been otherwise introduced into the system, or if the patient is seen too late for local measures to be of any avail, the symptoms are so like those of the traumatic gangrene and other blood-poisonings from infected spots in which lachesis has proved the specific remedy, that its administration would be strongly indicated. Indeed, Dr. Carroll Dunham has already used it with the utmost success in an American outburst of the disease, as he thus relates*:

"In the year 1853 there prevailed quite extensively in Brooklyn an epidemic of what was called malignant pustule.' A furuncular formation appeared, generally upon the lower lip, attended with severe pain, and frequently surrounded by an erysipelatous areola. The most marked constitutional symptom was a very rapid and excessive loss of strength, the patient being reduced from vigour to absolute prostration within the space of twenty-four to thirty-six hours. Allopathic physicians at first resorted to the local application of nitrate of silver to the pustule. In those cases, thus treated, which came under my personal observation, death followed cauterization within twenty-four hours.

"In eight cases treated by myself, lachesis was the only remedy used. It relieved the pain within a few hours after the first dose was given, and the patients all recovered very speedily."

Glanders, "equinia," when occurring in its acute form in the human subject, is so constantly fatal, that to cure it would be a triumph indeed. I do not know that such success has ever been claimed for homœopathy. Bähr and Jahr do not mention the disease, and Jousset speaks of its remedies theoretically only. He recommends aconite and arsenicum. My own study of the disease, as described in books (for I have no practical knowledge of it), would lead me to suggest kali bichromicum, mercurius and crotalus as its most promising remedies. The first-named is exquisitely homoeopathic to the respiratoryespecially the nasal-affections of the disease, and hardly less so to its cutaneous phenomena, as may be seen on reading the "skin" section of Dr. Drysdale's arrangement of the drug in the Materia Medica, Physiological and Applied. Mr. Moore speaks of having effected unequivocal cures of glanders in the horse mainly by its use. Mercurius would be preferable when the purulent tendency was more pronounced, and the lymphatic glands were primarily affected-forming the "farcy-buds" of

† American Hom. Review, iv., 110.