Podophyllum peltatum

Volume I — Special Symptomatology

(Mandrake, May-Apple.)

Botanical Description. —Height about one foot, stem round, sheathed at base, dividing into two round petioles, between which is the flower. Leaves broadly cordate, in five to seven lobes, each lobe about six inches long, from the insertion of the petiole; two lobed and dentate at apex; barren stems, with one centrally peltate leaf. Flower pedunculate, drooping, white, about two inches in diameter. Fruit ovate, oblong, large, yellowish, with a peculiar flavor, likened by "Wood to the strawberry.

It is an indigenous, perennial herb, with a long, jointed, dark brown rhizoma, or root, about half the size of the finger, spreading extensively in rich grounds, and giving off fibres at the joints; internally it is yellowish. The fruit is fleshy, one-celled, one or two inches in length, of a lemon color, with brownish spots when ripe, and covered with a large, persistent stigma. The mucilaginous pulp is edible, and esteemed as a luxury by many persons; it encloses twelve seeds, in pulpy arils.

[Tli e variety named Podophyllum montanum, by Rafinesque, grows in the South.]

Mandrake grows throughout the United States, in low, shady situations, flowering in May and June, maturing its fruit in September and October.

The root is the officinal portion ; the proper time for collecting it is in the latter part of October, or early part of November, soon after the ripening of the fruit.

The fruit possesses slightly laxative and diuretic properties, the rind and seeds being the medicinal portions.

The leaves are deemed poisonous, probably possessing the same properties as the root.

Podophyllin is the resin obtained from mandrake, and is very extensively used instead of the crude root. Dr. King, the eclectic, claims to have discovered and introduced this preparation to the notice of the medical profession. It is a yellowish or yellow-brown powder, insoluble in water, oil of turpentine, dilute Nitric acid, and diluted alkalies. It is said to be composed of two resins, both of which are purgative, one is soluble in alcohol only, the other in alcohol and ether. It has no alkaline or acid reaction, but forms a saponaceous compound with the alkalies. It has a bitter, nauseous and acrid taste. From four to eight grains act as an emetocathartic, with griping, nausea, prostration and watery stools. From two

to four grains as a drastic-cathartic, with nausea and griping; even one half a grain often acts as an active cathartic.

Officinal Preparations. — Tincture of the root, with strong alcohol; dilutions. Podophyllin and its triturations. (The rind of the fruit, the seeds, and the leaves, are all medicinal, the pulp of the fruit edible.)

Analogues. — Arnica, JEsculus, Bryonia, Collinsonia, Chelidonhim, Hel leborus niger, Iris versicolor, Lilium, Mercurius Sol., Nitric acid, Pulsatilla, Sulphur, Veratrum album.

Mind and Sensorium. Stupor, with vomiting, purging and collapse.

• Depression of spirits; he imagines he is going to die or be

very ill.

• Hypochondriac mood, from disorder of the liver. {Hale.)

Head.

• Morning headache, with heat in the vertex.

Pressing pain in the temples in the forenoon, with drawing in

the eyes, as if strabismus would follow. Dull, heavy pain in the forehead, with soreness over the seat

of the pain.

• Giddiness and dizziness, with the sensation of fullness over

the eyes.

Morning headache, with flushed face. Pain on the top of the head, when rising in the morning. Stunning headache through the temples, relieved by pressure. ° Headache alternating with diarrhoea.

Vertigo while standing in the open air; with inclination to fall forward.

° Polling of the head during difficult dentition in children

{Bell, Williamson.) ° Perspiration of the head during sleep, with coldness of th"

face (while teething). 0 Irritation of the brain — reflex — from disorder of the bowels 0 Bilious headache, worse in the morning.

Eyes.

Smarting in the lids; drawing sensation in the eyes.

Pain in the eyeballs and in the temples, with heat and throbbing of the temporal arteries.

The eyes appear inflamed in the morning.

Mouth and Teeth.

° Grinding of the teeth at night, in children; also with rolling of the head in teething children.

Copious salivation, but without the destructive action of mercury.

• Offensive odor from the mouth, at night, perceptible to the

patient. 0 Stomatitis materna. (?)

0 Chronic inflammation of the tongue; cracked, swollen and bleeding. {Hale.)

• Foul, putrid taste in the mouth.

0 Tongue full and broad, with a 'pasty coat in the center. {Scudder.)

° A red tongue, not bright red ; rough, with uniformly erect

papillae. (Ib.) ° A dull, bluish color of the tongue. (Ib.)

Throat.

• Sore throat, commencing on the right side and going to the

left (Lye, Lach., left, going to right). ( Williamson.) Sore throat, left side, worse in the morning, especially painful

when swallowing liquids. Soreness of the throat, extending to the ears.

• Rattling of mucus in the throat, (-lb.)

• Goitre. ( Williamson and Eclectics.)

Gastric Symptoms. Voracious appetite and great thirst, with strong digestion, (p.)

• Loss of appetite, or satiety from a small quantity of food, followed by nausea and vomiting, (s.)

• Regurgitation of food, which is sour, with acid eructations;

belching of hot flatus; acidity of the stomach, and unpleasant, sickly sensation in the stomach, (s.)

Vomiting of food an hour after meal, with craving appetite immediately afterward.

Vomiting of food, with putrid taste and odor.

"Gastric affections, attended by depression of spirits; heartburn; vomiting of hot, frothy mucus, etc.

[The nausea commences three or four hours after a large dose; is persistent and depressing, continuing for 24 or 36 hours, often with vomiting of bile, and ingesta, and with purging and severe colic. (Hale.)]

Vomiting of dark green, bilious matter, mixed with blood, the blood dark and coagulated.

The stomach contracts so hard and rapidly in the efforts to vomit, that the wrenching pain causes them to utter sharp screams.

• Dyspepsia, in its most aggravated forms. ( Williamson.)

• Gastritis, acute and chronic. {Hale.)

• Nausea and vomiting, with fullness in the head; the vomiting is persistent.

• Heart-burn, and water-brash, with heat in the stomach. Throbbing in the epigastrium, followed by diarrhoea.

• Vomiting of thick bile and blood for eighteen hours; iu

acute gastritis.

• Vomiting and diarrhoea of bilious matters. Sensation of hollowness in the pit of the stomach. Stitches in the epigastrium, from coughing.

Liver.

• Fullness, with pain and soreness in the right hypochondrium. Stitches in the right hypochondrium; worse while eating.

° Chronic hepatitis, with costiveness, tenderness, and pains in

the region of the liver. Twisting pain in the right hypochondrium, with sensation of

heat in the part. Sensation of weight and dragging in the left hypochondrium. ° Congestion and enlargement of the liver; acute and chronic

hepatitis.

° Congestion and torpor of the portal system.

° Gall-stones, with the characteristic symptoms; will expel them, if given in large doses, alone, or after large quantities of olive oil. (Hale.)

[Podophyllin, primarily, causes increased functional activity of the liver, with large flow of bile; secondarily, the liver becomes torpid, and jaundice and retention of bile occurs. (Hale.)]

Abdomen.

• Intense cramp-like colic, with retraction of the abdominal

muscles, at ten p. m. and five a. m. Pain in the bowels, at daylight in the morning; relieved by

external warmth; by bending forward while lying on the

6ide, but aggravated by lying on the back. Pain and rumbling in the transverse colon, at three o'clock

a. m., followed by diarrhoea.

The pain in the bowels is first attended by coldness, which is

followed by heat and warm perspiration. Heat in the bowels, with inclination for stool. Faintness, with sensation of emptiness in the bowels, after

stool.

• Sharp pain above the right groin, preventing motion (in the

last month of pregnancy). 0 Dull, unpleasant pain or weight in the hypogastric region.

(in many diseases. Scudder.) Distension of the abdomen, even enormous swelling (in case

of fatal poisoning). 0 Myalgia of the abdominal muscles; after abuse of purgatives.

{Hale.)

° Lead-colic, with retracted abdomen, etc. ( Williamson.) 0 Conditions simulating 'puerperal peritonitis* when it has

been preceded by diarrhoea, or abuse of purgatives (not

useful in true peritonitis). {Hale.) 0 Tympanitic distension of the abdomen in typhoid, and in

children, with diarrhoea. {Hale.)

Intestinal Symptoms.

• Primary. — Abundant, soft, fcecal evacuations, with colic

and nausea (from laxative doses), i. e., one quarter gr. Podophyllin.

Stool earlier in the morning than usual, but natural (from small doses).

• Frequent stool during the day, but of natural consistence. Six soft yellow stools a day, with some griping.

• Profuse diarrhoea, preceded by colic, worse in the morning..

• Diarrhoea early in the morning, followed by very frequent,

papescent, yellow stools, for forty-eight hours. Evacuation of green stools in the morning. Diarrhoea immediately after eating or drinking (also Croton

tig).

• Haemorrhoids — inflamed, sore, swollen and painful.

• Painful diarrhoea, with screaming and grindiny of the

teeth, in children (during dentition). ( Williamson.)' White, slimy stools, with severe colic and nausea.

Hot, watery, frequent, profuse evacuations, attended with prostration and cramps, as in cholera.

• Muco -gelatinous stools, like white of egg, after which the

colic ceases, and does not return. {Hale.)

• Food passes the bowels in an undigested state. ( Williamson.) 0 Evacuations which consist of dark yellow mucus, which

smells like carrion. (Jeanes).

• Frequent stools, yellow, green, watery, brown mucus, all of

which may be streaked with blood, with strong urging — and heat and pain in the anus.

• Diarrhcm, with prolapsus ani at every stool.

After stool/ flashes of heat running up the back, cutting in the bowels, severe and painful tenesmus; great weakness and faintness and pain in the lumbar region.

During stool/ urging in the bowels; heat and pain in the anus; sensation as if the genital organs would fall out; (in women) bearing down, as if from inactivity of the rectum; nausea; gagging; tormina, and pain in lumbar region.

Before stool/ intense nausea; colic; rumbling in left side. ° Diarrhoea — bilious, cholera-morbus, dysentery/ pain in the

back, and sometimes vomiting ; acute enteritis/ colitis,

rectitis, etc.

Secondary — Constipation for two days after the purging.

• Constipation, with headache and flatulence. Faeces hard, dry, and voided with difficulty.

• Constipation, alternating with diarrhoea.

• Hard stool, coated with tough, yellow mucus. (Hale.)

° The first part of the stool large and hard, followed by fluid

and wind. (Scudder.) 0 Chronic diarrhoea — worse in the morning. Frequent chalk-like stools/ very offensive, with gagging and

excessive thirst (in children — see Calc.c.) ( Williamson.)

• Clay-colored, offensive stools, with jaundice. (Hale.)

• Descent of the rectum, from a little exertion, immediately

followed by stool, or a discharge of thick, transparent mucus, sometimes of a yellow color ; and mixed with blood. ( Williamson, Hale.)

• Prolapsus ani, most frequently in the morning. (Jeanes.)

• The anus feels very sore, sensitive and swollen. Chronic, painful, hemorrhoidal tumors, all around the

anus, some of them bleeding. {Hale, and many others.)

• Internal haemorrhoids, with prolapsus recti. (lb. )

[For the primary symptoms, the best curative results are obtained with the attenuation above the 3d ; for secondary symptoms the dilutions below the 3d.— Hale.]

Urinary Organs.

• Profuse secretion of urine (p.)

• Involuntary discharge of urine, during sleep. ( Williamson).

• Frequent nocturnal urination, during pregnancy. (Tb.) Pain in the region of the kidneys, followed by flow of urine

depositing calculi sediment.

• Suppression and retention of urine.

• Diminished secretion of urine. Scanty urine, with frequent voidings.

Generative Organs. Male. — Stitching pain above the pubis, and in the course of

the spermatic cords. ° Diseases of the prostate gland, associated with rectum

troubles. (Hale.) ° Gonorrhoea; gleet; syphilis (?) (Eclectic authorities^) Female. — * Leucorrhoea ; discharge of thick, transparent

mucus.

*Leucorrhoea, attended with constipation and bearing down in the genital organs.

• Suppression of the menses in young females, with bearing

down in the hypogastric and sacral region, with pain

from motion, relieved by lying down. 0 After pains, with strong bearing down and flatulency. 0 Prolapsus uteri, with much aching pain in the region of left

ovary, heat running down to the left thigh, in pregnancy,

must lie on the stomach. ( Williamson^) 0 Prolapsus uteri or vagina, especially after confinement. 0 Prolapsus recti, with violent bearing down pains; intolerable

pain in her back, with profuse excoriating leucorrhoea

and great ardor urinse. ( Williamson.)

° Chronic prolapsus, with great costiveness. {Ib.)

0 Excessive vomiting in pregnancy and conditions arising from

a congested condition of the pelvic viscera. ° Prolapsus uteri, with hypertrophy, ulceration and prolapsus. Pain in the region of the ovaries, especially the right. ° After-pains, with strong bearing down. ° Haemorrhoids and prolapsus recti, after confinement. ° Ability to lie comfortably, in the early months of pregnancy,

only on the stomach. {Jeanes.) 0 Swelling of the labia, during pregnancy. ° Induration of the os uteri.

° Uterine diseases caused by or complicated with, or aggravated by, diseases of the rectum. {Hale.} Larynx.

° Cough, accompanying remittent fever. ( Williamson^) ° Dry cough; loose, hacking cough. {Ib.) 0 Whooping cough, with costiveness and loss of appetite. {Ib.) ° Cough from disease of the liver. {Hale.)

Chest.

Pains in the chest, increased by taking a deep inspiration. Snapping in the right lung, like breaking a thread, on taking

a deep inspiration. Inclination to breathe deeply; sighing and shortness of breath. Sense of suffocation when first lying down at night. Sensation as if the heart was ascending into the throat. Palpitation of the heart, with a clucking sensation rising up to

the throat.

° Stinging pain in the region of the heart.

0 Palpitation of the heart, from physical exertion or mental

emotion, in persons subject to rumbling in the ascending

colon.

[No proof of the Podophyllum ever having cured any organic disease of the heart. The symptoms are probably sympathetic from gastric and hepatic irritation. — Hale.]

Back.

Pain in the small of the back when walking or standing. Pain in the lumbar region, with the sensation of coldness, worse at night, from motion.

Pain between the shoulders, with soreness, worse at night and

from motion. Pains are of a myalgic character.

° A sharply defined ache in the sacro-ischiatic formica, with tenderness on pressure. (Scudder.)

Upper Extremities. Mjalgic pains in the left forearm and finger. Weakness of the wrist, with soreness to the touch. ° Pain in the course of the ulnar nerve of both arms.

Lower Extremities. Pain and weakness in the left hip, increased by going up stairs. Pains in the thighs, legs and knees, worse from standing. c Slight paralytic weakness of the left side. Creaking in the knee joints, from motion. Stiffness on beginning to move. ° Severe pain and swelling of the ankle joints. Aching of the limbs, worse at night Coldness of the feet. Perspiration of the feet in the evening.

Fever.

Chilliness when lying down or in the evening. Chill in the morning, with pressing pain in both hypochondria.

Backache before the chill

The shaking and sensation of coldness continues for some time

after the heat commences. ° Bilious fever, either remittent or intermittent.

Sleep.

0 Eestless sleep of children, with whining at night. A feeling of fatigue on waking in the morning.

Skin.

° Sallowness of the skin in children.

° Moisture of the skin, with preternatural warmth.

Generalities.

' Fullness of the superficial veins, indicating impairment of the innervation of the sympathetic system of nerves. (Scudder.)

Volume II — Special Therapeutics

Of all our indigenous remedies the Mandrake has, perhaps, the greatest popularity, even with allopathic physicians. With the people, and the other so-called systems, namely, the eclectics and botanies, its use can be traced back to the early history of this country.

A variety termed Podophyllum montanum by Rafinesque grows in the South.

Mandrake grows throughout the United States in low, shady situations, flowering in May and June, maturing its fruit in September and October.

The root is the officinal portion. The proper time for collecting it is in the latter part of October, or early part of November, soon after the ripening of the fruit.

The fruit possesses slightly laxative and diuretic properties, the rind and the seeds being the medicinal portions.

The leaves are deemed poisonous, probably possessing the same properties as the root.

Podophyllin is the resin obtained from Mandrake, and is very extensively used instead of the crude root. Dr. King, the eclectic, claims to have discovered and introduced this preparation to the notice of the medical profession. It is a yellowish or yellowbrown powder, soluble in water, Oil of Turpentine, diluted Nitric acid, and diluted alkalies. It is said to be composed of two resins, both of which are purgative; one is soluble in Alcohol only, the other in Alcohol and Ether. It has no alkaline or acid reaction, but forms a saponaceous compound with the alkalies. It has a bitter, nauseous, and acrid taste. From four to eight grains act as an emeto-cathartic, with griping, nausea, prostration, and watery

stools. From two to four grains as a drastic cathartic, with nausea and griping; even one-half a grain often acts as an active cathartic.

Medical History. — According to Rafinesque, the Cherokee Indians made great use of this plant. It was probably in use among all the Indian tribes and by them introduced to the early white settlers. The aborigines used the root to expel worms. “The Cherokees,” says Rafinesque, “ use it as a vermifuge ; also drop the fresh juice of the root into the ear as a cure for deafness. The Osage Indians consider it as a cure for poisons, by driving them through the bowels. All the tribes are fond of the fruit.” The history of the medical use of this plant is mainly confined to the early botanic and later eclectic physicians. A few allopath ists, like Barton, Tully, Zollicotfer, and others, used it considerably, but it never has been a favorite drug with that school. In the hands of incautious or ignorant physicians, the Podophyllum and its active principle have been productive of an immense amount of injury to the people of the West. I have treated many painful, severe, and incurable diseases of the stomach and intestines, uterus, and urinary organs, which could be dated distinctly to overdosing with this potent drug. Next to Mercury, it is capable of inflicting more injury to the human organism, when abused, than almost any other drug in common use; yet eclectics denounce Mercury in all its forms, while pouring this poison down their patients.

The original proving was made by Dr. Williamson, of Philadelphia, and published in the “Transactions of the American Institute of Homoeopathy,” vol. i. I shall make that the basis of this article, and add thereto the pathogenetic and clinical symptoms which have been collected since that publication.

It has been used more extensively, perhaps, than any of the new remedies, and is already looked upon by our school as a valuable polychrest. Eclectic physicians, and of late many of the allopathic school, have come to look upon the Mandrake as a kind of panacea for nearly all acute diseases, and useful in almost all chronic affections. With its enthusiastic admirers it ranks with Calomel. Medical adjectives have been exhausted in describing its powers and virtues. It is said to be cathartic, emetic, alterative, anthelmintic, hydragogue, sialagogue, deobstruent, febrifuge, anti-periodic, diuretic, etc. It is a fact that like Mercury it penetrates every nook and cranny of the organism, and there is scarce an organ or tissue of the body but feels its malign influence when it is introduced into the system in toxical doses. It has been used in nearly every disease in the nomenclature, and it is said to have proved curative in those of the most opposite character. I shall try to show in my clinical remarks the real sphere of action of this medicine, and shall not only give my own opinions, but those of the best observers of all schools of medicine.

Nervous System. — Podophyllum does not act specifically upon the nerves as does Aconite or Nux vomica. In this respect it ranks with Bryonia, Aloes, and other medicines of the same class. The pains induced by the Mandrake are probably myalgic in their character. In idiopathic neuralgia, or, indeed, neuralgia in any form, it is of doubtful utility.

Muscular System. — We have not sufficient proof, nor do we find anything in the pathogenesis which would lead us to suppose that Podophyllum acted directly upon the muscular fibre, as does Bryonia, Cimicifuga, or Helonias. To fully understand the action of Mandrake and other similarly acting and depressing drugs, one should read that instructive book, “Inman on Myalgia.” I would suggest that Podophyllum causes pains, cramps, and other sensations and affections of muscular tissue by (a) its irritating action upon mucous membranes and ( b ) by a depressing action upon the vital power. According to Inman, all drastic purgatives may cause myalgia, and even cramps and wasting of muscle. Viewing the action of this medicine as I do, I cannot consider it indicated in rheumatism affecting muscles or tendons. If it has been found beneficial in that disease, it has been from some indirect action and not from any specific effect. I have known it to cause severe myalgic pains and soreness, and have found it curative in similar conditions, but never in true rheumatism. The Podophyllin has the power to cause other pains besides those referred to the bowels, stomach, and other portions of the digestive tract. I have known it to cause pain in various parts of the system, but I believe them to be generally myalgic. Dr. Coe, whose testimony is sometimes valuable, says :

Podophyllin is sometimes very tardy in its operation, not acting under eighteen or twenty hours, and frequently it will operate more freely during the second twenty-four hours than during the first. In cases of chronic disorders of the liver, at others in the spleen, and other viscera, considerable pain will frequently be experienced in the diseased organs during the operation of the medicine. Sometimes the pain will be in the liver, and at others in the spleen, again in the kidneys (medical aggravation), also in the back of the neck and head, in the pleura, intercostal muscles, etc. (myalgia) ; but these symptoms will subside with the operation of the medicine.

He thinks those are favorable indications, showing that the remedy is at work arousing the dormant energies of the system. It is not necessary, however, to cause these pains.

Mucous Tissues. — In its action on mucous membrane it ranks with Mercurius, Iris versicolor, Veratrum album, and other drastic cathartics. It is powerfully irritant to this tissue, especially those of the digestive tract. It is not directly specific in its action upon the mucous membrane of the respiratory and urinary passages. It will, however, irritate and inflame any mucous surface when brought in contact with it, sometimes acting as a powerful escharotic. Of its power to cause inflammation of any and all portions of the mucous membrane, from the mouth to the anus, there can be no doubt. Such effects have been too often observed in practice, by all physicians who have had an opportunity to notice its action when administered in material doses. It even causes ulceration of this tissue, and may be said to act, as Dr. Freligh asserts of Mercury, “ as a solvent of the living solids,” but not to the extent of the former poison. Podophyllum is homoeopathic to enteritis, gastritis, etc., and even to bronchitis and urethritis under certain circumstances, which will be noticed under appropriate headings.

Serous Tissues. — It is said to affect, by its “ alterative action,” the serous membranes of the body, and prove curative in pleuritis, peritonitis, synovitis, and even meningitis ; but its action in this direction is not, in my opinion, specific or direct, as is the case with Bryonia.

Glandular System. — It is here that Podophyllum is a close analogue of Mercury, Iodine, Iris versicolor, etc. When taken up into the circulation it is eliminated by the glands, and is thus rendered capable of causing irritation, inflammation, and even

suppuration of almost any glandular organ or structure; but it cannot be termed a u glandular remedy ” in the same sense that we estimate Iodine, Baryta, and Phytolacca. The glands principally affected by Podophyllum are the liver, salivary and gastric glands, and perhaps the ovaries. The mammary, lymphatic, thyroid, and mesenteric do not appear to be under its direct influence.

Fever. — By referring to the “ Symptomatology” vol. i, you will see that a large number of febrile symptoms are arranged under that head, but the compilers of the original pathogenesis did not designate the purely pathogenetic, or separate them from the curative.

Dr. Williamson observes that Podophyllum is indicated in quotidian, tertian, and quartan agues, and for “periodical diseases” generally. The practitioner, however, must not expect too much of this remedy in intermittents. It cannot be ranked with Nux vomica, China, Quinia, Cornus cedron, or any of the “ anti-periodic” group of medicines which act curatively by virtue of that power, but rather with Mercurius, Leptandra, Iris versicolor, etc., which act as curative agents in intermittent fevers by another power, namely, of correcting the condition of particular organs, as the liver, and thus removing the obstacles to a recovery. In my practice, which was at one time extensive in a district cursed with ague, 1 had ample opportunity to observe the action of Podophyllum in this disease. I never found it of benefit unless the hepatic, intestinal, and gastric symptoms corresponded with those of the drug ; when given for the symptoms of the fever alone, enumerated above, it was not curative. In fact it would remove all the other symptoms, and the paroxysms of fever would still occur in a modified form. But if alternated with Ipecac., China, Quinia, Cornus, or Nux vomica (in quotidian), Arsenicum, Cedron, or Nat. mur. (in tertian), the cure would be prompt and permanent. Those who are opposed to alternation of remedies can use the Podophyllum first and the remedy afterwards. As the testimony of eclectic physicians may be interesting on this point, I will quote:

In bilious fevers, either remittent or intermittent, it not unfrequently arrests

the disease, at the first prescription, if given in the proper manner, or it so far modifies the attack that the case becomes mild and manageable. — King.

Morrow makes the same statement, but says it is only indicated when there is evident hepatic torpor or congestion :

During the early stages of most febrile diseases, particularly intermittent and bilious remittent fevers, Podophyllin is an agent of superior efficacy. A single dose often arrests the severest attacks of fever. — Jones and Scudder.

In the treatment of fever and ague, we almost invariably precede the employment of the other remedies by the free exhibition of Podophyllin. By so doing, in this climate, we cut the disease short at once, and oftentimes have no occasion for further medication. We have known many cases of intermittent fever yield to a single dose of the Podophyllin, and we have no doubt but the credit of the cure is frequently due to this agent where it is attributed to other means. — Dr. Coe.

The above embodies the general estimate of the eclectic school as regards the value of this medicine in agues. No writer pretends that it has any actual anti-periodic power. It has been noticed in many of our provings that certain febrile and even 'painful symptoms were decidedly aggravated, or had a tendency to recur at certain hours in the day, or alternate days. This peculiarity renders a drug an “ anti-periodic.” In the proving of Podophyllum we find that certain febrile and other symptoms tend to occur in the morning, but this I consider rather an indication of its remittent action. Future experiments will decide.

In bilious fever this medicine is an excellent homoeopathic remedy. No other drug so often corresponds with the symptoms, particularly when there is much intestinal irritation. It is admirably indicated in the various forms of remittent fever, which in the West are considered “ bilious” in character. The febrile symptoms are quite strongly marked, and may afford some data for the selection of this drug, but we should be guided principally by the general symptoms. As above stated, eclectic physicians, and of late many allopathic, are enthusiastic believers in the power of Podophyllum, when given at the outset of nearly all fevers, in cathartic doses, of arresting or “ breaking up ” such attacks. But I need not acquaint the homoeopathic physician that such practice is sometimes fraught with the most deplorable consequences. When the patient is strong and robust, the vitality of the organism may rally from its depressing action or medicinal aggravation

of the malady ; but if such reaction does not take place, the fever, which may have been mild in its character, is changed to a serious and intractable one. The intestinal irritation which the Podophyllin sets up will go on and withstand all the rude means of the eclectic to arrest it. In this way 1 have known simple remittents changed into enteric or typhoid fever. In irritative fever and infantile remittent no remedy will give better satisfaction, not even Mercurius. But it should be used with caution in all fevers accompanied or caused by intestinal or gastric irritation. In these cases it is primarily homoeopathic, and should be used in the fourth and sixth dec. dil.; but should symptoms denote inactivity of the liver and glandular system of the intestines, and constipation with jaundice exist, then the second or third dec. trit. may be used safely.

In typhoid and typhus fevers (enteric) the Podophyllum is often indicated. It is quite as homoeopathic to the irritation, inflammation, and even ulceration of Peyer’s glands as Mercurius and Arsenicum ; but it is not so well indicated by the general symptoms, namely, the condition of the blood, etc., as Baptisia, Phosphoric and Muriatic acids, or even Leptandra, or Iris. Dr. Hill (“ Epitome”) says Podophyllin is the best remedy for the diarrhoea of typhoids. But homceopathists can accept no such wholesale assertion. If the diarrhoea, in a case of typhoid, corresponds to the Podophyllum diarrhoea, then, and only then, is it a specific remedy. The best writers in the eclectic school are aware of the danger of giving large doses of Podophyllin in typhoid and other low fevers, and all are particular to warn the physician not to use it when there is much prostration or intestinal irritation existing. Notwithstanding this the physicians of that and the old school are generally so ignorant of disease, and so reckless of consequences, as to give this powerful drug in typhoid fever. The consequences are that few patients under that treatment have vitality to resist the toxical effects of the drug and the disease. If Podophyllin is prescribed in true enteric (or typhoid fever) it should be only the middle and higher potencies — the tenth and upwards. The Podophyllum may be used lower — in the third or sixth. These general remarks I deem sufficient to point out the applicability of the remedy in the various forms of fever. They

will serve to guide the practitioner in the selection of the drug by the special symptoms. Even the exanthematous fevers form no exception.

The action of Podophyllum on the skin has never been fully investigated. Although eclectics claim to cure some chronic eruptive diseases with it, I doubt if it has any specific action on that tissue. The provings do not show any irritation of the skin, nor have I ever observed any skin symptoms arise from its internal use. The topical application will cause redness, vesication, and pustulation, but I do not consider this effect as specific.

The g astro-intestinal and hepatic symptoms and pathological conditions caused by Podophyllum are of more importance to us than any other. Its effects on all these tissues is the foundation and origin of nearly all the symptoms belonging to the drug.

Beginning with the buccal cavity we find the following symptom :

Copious salivation ; * offensive odor from the mouth ; * offensiveness of the breath at night, perceptible to the patient; taste of fried liver in his mouth at night; sourness of the mouth and tongue on waking in the morning; white fur on the tongue with foul taste ; putrid taste in the mouth.

Dr. Williamson contributes the curative symptoms marked with a star. The effect of the Podophyllum upon the mouth is quite specific and noteworthy. All writers agree that it will cause symptoms like salivation. I have known it to cause severe ptyalism in numerous cases when abused by eclectic physicians. Even in the 3d trit. this effect is quite noticeable in persons who are subject to stomatitis or have been mercurialized. Dr. Coe says :

It has been said that Podophyllin is capable of producing ptyalism, but we have never seen any evidence of the fact in persons who had never taken Mercury. The only symptoms of salivation we have ever observed have been in those cases where Mercury has been taken at some previous time. Podophyllin is powerfully resolvent, and by its peculiar excitation of the glandular system will sometimes dislodge deposits of latent mercurial atoms, and so bring about a season of mercurialization. Lobelia, Irisin, and Phytolaccin will frequently do the same.

This is a species of special pleading often resorted to by eclectic practitioners, but it is untenable. If these drugs will cause pytalism when Mercury is in the glands, it will cause the same symptoms

when Mercury is not present. The only difference will be that the presence of Mercury renders the glands more susceptible to the action of these agents. Podophyllin is homoeopathic to ptyalism, even mercurial ; to stomatitis, and many inflammatory affections of the gums and buccal mucous membrane. It has been found curative in “ nursing sore mouth,” “ canker in the mouth.” I have cured with the dilutions, used as a wash, a case of chronic inflammation of the tongue, which was red, dry, cracked, and often bleeding, and somewhat swollen. It seemed idiopathic, as no gastric derangement was noticeable.

The throat symptoms imply a greater degree of inflammation, namely :

Sore throat, commencing on the right side and then going to the left ; soreness of the left side of the throat, especially painful when swallowing liquids, and worse in the morning ; dryness of the throat; soreness of the throat extending to the ears; * rattling of mucus in the throat; * goitre-, * sore throat, commencing on the right side and going to the left.

The three curative symptoms are contributed by Dr. Williamson. The first is due to the irritant action of the Mandrake upon the tonsils and mucous follicles of the throat. This medicine has made undoubted cures of goitre in the hands of homoeopathic as well as eclectic physicians. The testimony on this point seems conclusive, but I cannot say that I have ever seen much benefit from its use in my hands, at least no such decided effects as follow the use of Iodine, Bromine, and their salts, even in minute doses. Nor have I found it of much value in tonsillitis, in which it is inferior to Phytolacca or Baryta carbonica.

The effects of Podophyllum on the stomach and bowels are now quite well understood.

By referring to the symptomatology of this remedy, you will see that I have attempted to arrange the symptoms into primary and secondary. They begin with a lax state of the bowels; then follows soft mushy diarrhoea, then watery and slimy, and finally mucous and bloody, with tenesmus. After these primary conditions we get the secondary, namely, constipation, piles, prolapsus recti, etc.

With the primary symptoms we get a great many concomitant

or reflex symptoms, -which can only be learned by a careful study of the pathogenesis.

One instance will suffice, namely, the reflex brain-symptoms, which occur during the primary intestinal irritation. In adults we find headache, vertigo, and confusion of mind. In children, owing to the sensitive condition of the brain, we get actual cerebral irritation, manifested by rolling of the head and grinding of the teeth , with moaning. The head is not primarily affected, but cases of actual cerebral irritation have been cured by Podophyllin in the middle and higher attenuations.

I quote Dr. S. Ringer’s observations on this drug. (See Ringer’s “ Therapeutics.”)

The action of Podophyllum on the gastro-intestinal and hepatic system has been thoroughly investigated by Dr. Anstie, who has studied the action of Podophyllin on dogs and cats, and has found that in from two to ten hours after the injection of an alcoholic solution into the peritoneal cavity, and after the effects of the Alcohol had ceased, Podophyllin excited vomiting and almost incessant diarrhoea.

Dr. Anstie does not usually describe the character of the stools ; but in one experiment he states that they consisted of glairy mucus, and in two other experiments the stools were highly colored with what looked like bile. In many of the experiments the stools contained blood. The animals suffered great pain, and soon became exhausted.

At the post-mortem examination the oesophagus was healthy, but the stomach somewhat congested — induced, as Dr. Anstie suggests, by the violent efforts of vomiting. The small intestines, especially at the lower part of the duodenum, were intensely congested, and in some instances the lower part of the duodenum was extensively ulcerated. The large intestines were but slightly inflamed. Although the injections were poured into the abdominal cavity, the peritoneum itself was not at all inflamed, not even around the unabsorbed granules of Podophyllin. The contents of the intestines were liquid. In all the instances in which the effect of the medicine on the heart and respiration is mentioned, respiration ceased before the heart stopped.

From these experiments it was evident that Podophyllin has an especial affinity for the small intestines, and chiefly for the duodenum.

The results of these experiments, and the fact that Podophyllin produced no apparent change in the liver, led Dr. Anstie to conclude that it is not a cholagogue. The Edinburgh committee carefully investigated the action of Podophyllin on healthy dogs. The reporter, Dr. Hughes Bennett, states that doses of Podophyllin, varying from two to eight grains, diminished the solid constituents of the bile, whether they produced purgation or not, and that doses which produced purgation lessened both the fluid and solid constituents of the bile.

But assuming that Podophyllin is incapable of increasing the secretion of bile in health, it by no means follows that in this respect it is inoperative in disease.

It is quite conceivable that Podophyllin and other remedies may remove certain morbid conditions of the liver which arrested the secretion of bile, and so act indirectly but efficaciously as cholagogues ; and surely it is far better to promote the secretion of the bile by restoring the liver to health, than to give a drug (if such exist) to compel a diseased liver to secrete. In the one case we remove the hindrance to the secretion of the bile ; in the other, if it is possible, we compel the secretion in spite of this obstacle. *

The experience of those who have largely used this drug is strongly in favor of its possessing cholagogue properties ; and the author’s experience leads him to a like conclusion.

For instance, its effects are very marked on the motions of children, with the following symptoms : During the early months of life, and especially after a previous attack of diarrhoea, obstinate constipation may occur, with very hard motions, crumbling when broken, and of a clay color, often mottled with green. Sometimes the passage of the hard stools through the sphincter of the rectum occasions great pain, causing the child to scream at each evacuation. At the same time there may be much flatulent distension of the belly, which excites frequent colic ; this, in its turn, making the child cry, often without cessation. The morbid condition of the motions is frequently observed in children of one or two months old, who are fed instead of suckled. The author knows nothing so effectual in bringing back the proper consistence and yellow color to the motions as Podophyllin. A grain of the resin should be dissolved in a drachm of Alcohol, and of this solution one or two drops are given to the child on a lump of sugar, twice or three times in the day. The quantity administered must be regulated by the obstinacy of the bowels, which should be kept open once or twice a day. Under this treatment the motions often become natural, the flatulent distension of the belly gives way, and the child quickly improves. The restoration of the color to the motions is probably owing to the increased secretion of bile by the action of the Podophyllin.

That disagreeable cankery taste, unconnected with excess in alcoholic drinks, generally occurring only in the morning, but sometimes continuing in a less degree all day, gives way usually to Podophyllin ; and if it fail Mercury generally answers. It is true that this symptom, when due to constipation, is removable by many purgatives, but Podophyllin and Mercury answer best.

Small doses of Podophyllin are highly useful in some forms of chronic diarrhoea. Thus, a diarrhoea with highly colored motions, with cutting pains, is generally relieved by small doses of Podophyllin, the bowels becoming regular, and the pain speedily subsiding. This medicine is especially indicated if this form of diarrhoea occurs in the early morning, compelling the patient to leave his bed several times, but improving after breakfast or by the middle of the day ; or sometimes diarrhoea does not occur after breakfast, but returns early next morning. Indeed, Podophyllin will generally cure this morning diarrhoea, even if the motions are pale and watery. By means of Podophyllin the author has cured chronic diarrhoea of watery, pale, frothy motions, with severe cutting pain, even when the diarrhoea has lasted for many years. Two or three minims of a solution containing a grain of Podophyllin, in two drachms of rectified spirit, should be given three or four times a day.

Podophyllin is very useful in some forms of sick headache. The nature and the order of the symptoms differ greatly in different cases of sick headache. Some, for instance, are accompanied by constipation, others by diarrhoea, and in each of these kinds the stools may be either too light or too dark in color. There are, besides, many other varieties of sick headache. Where the headache is preceded, accompanied, or followed by a dark-colored, bilious diarrhoea, Podophyllin generally does good. Two or three minim doses of the solution just mentioned, given three times a day, will restrain the diarrhoea, lighten the color of the motions, and, if the medicine is persevered with, either prevent the attacks or considerably prolong the intervals. When the diarrhoea is of a light color, and the motions evidently contain too little bile, it is considerably benefited by a hundredth part of a grain of Bichloride of mercury, given three times a day. Again, when the headache is accompanied by constipation and the motions are of a dark bilious character, a free Podophyllin purge every day, or alternate day, is very useful. Even in those nervous headaches occurring either just before, at, or directly after the menstrual period, if associated with constipation and dark-colored stools, purgative doses of Podophyllin often give relief.

I know that it is now generally held, and on conclusive evidence, that in sick headaches, or, as they are often termed, nervous headaches, migraine, hemicrania, the origin of mischief is situated in some part of the central nervous system, and it is asked, therefore : Of what use is it to give medicine to act on the stomach, liver, or intestines ?

It is further urged, that when sickness, diarrhoea, or constipation accompany or follow the headache, they are the result and not the cause of the attack. Granted that the central nervous system is the seat of the complaint, yet it is excited in various ways in various people, one cause producing an attack in one person, but failing to excite one in others. Thus a single or several articles of diet will with some surely bring on an attack. In some persons the fit is preceded by diarrhoea, bilious or pale ; in others, by constipation ; again, in others, it is clearly traceable to uterine derangement. It is true that even in any of these cases certain circumstances, common to all, will precipitate an attack — as fatigue, overexcitement, or nervous exhaustion. Yet these patients, in many of their attacks, experience, almost unfailingly, warning by symptoms due sometimes to the stomach, or the bowels, or the womb. It appears, therefore, to me that the treatment of this disease must be of three kinds. One treatment should be directed to the removal of the affection of the nervous system ; another, by the prevention of the exciting cause ; and lastly, a third treatment to the subdual of an attack, as, for instance, by means of applications to the seat of pain, and also, as I believe, by means of medicines which act on the stomach, liver, intestines, or womb.

Experience certainly leads me to hold firmly that the foregoing directions, with respect to treatment, are correct ; that where the attacks are preceded by hepatic or intestinal disturbances, Podophyllin or Mercury are very useful agents ; nay, I am inclined to believe that they are serviceable even when the symptoms only accompany the pain, and are probably the result, and not the cause, of the attack. Although it may be urged that it is folly to treat the effects in order to remove the cause, still, as we have seen in the section treating of counter-irritants, that local applications to the seat of pain appear to control the central nervous

disease, there is no reason why the remedies which affect the terminations of the other affected nerve, namely, the vagus, should not also be able to modify the central affection.

Some American physicians go so far as to say that this drug fulfils all the indications of Mercury. In America it is called vegetable Mercury.

The injection of Podophyllin under the skin has been recommended. It is readily soluble in equal parts of Liquor potassae and water ; and if the drug is pure this solution is not precipitated by the addition of water. The injection of this solution to the extent of one-tenth to one-third of a grain quickly purges — sooner, it is said, than when given by the stomach — and causes no pain.

Podophyllin is a rather uncertain purgative. The pure drug causes very little griping. In too large doses it is very apt to produce slimy and bloody stools, particularly in children.

Dr. Anstie’s estimate of the curative powers of Podophyllin does not differ greatly from those of an eminent English homceopathist, Dr. John Moore, of Liverpool, whose observations I shall quote. I think Dr. Moore is a little too sanguine as to the permanent good results from material doses of the drug, but as he is undoubtedly judicious and cautious in its administration, no bad results may attend its use in his hands. In the practice of less careful and observant physicians its free use in all cases might be followed by secondary symptoms of an unpleasant character.

Dr. Moore has doubtless hit the chief pathological keynote of the hepatic action of this powerful drug. He says :

Lactic acid is an effectual antidote to its effects. Fifteen grains have been given, and immediately afterwards a draught of sour milk, and the effect of it has been nil. Sugar antidotes it somewhat ; salt increases its action ; Acetic acid does not affect it.

In gout it is useful after acute symptoms have subsided ; or in cases where the attack is preceded by premonitory symptoms it is indicated at once. It will ward off an impending attack of gout. It had good effects in jaundice when it had returned again and again, after China and Mercurius. The following inferences are drawn from the facts related :

First. That it is a very active and penetrating medicine, resembling Calomel in its specific action on the liver and glandular system, but beyond that the similarity ceases.

Second. That its direct sphere of action is on the entire portal system, and indirectly all other systems connected with that, either by nervous or vascular ties.

Third. That while the liver and gall-bladder are directly acted upon by this medicine specifically, and led by it to discharge their contents, great relief is given to the lungs and the brain when oppression of these vital organs is connected with inactive and irregular action of the liver.

Fourth. That torpidity of liver, rather than vascular, is the chief sphere of it ; in other words, a non-secretory state, or a state of non-expulsion of the secretion of bile, is the indication for it, and this state is indicated by sallow complexion, furred tongue, and constipation.

Fifth. That the curative dose in such cases must be brought near to the physiological, viz., the 10th, 5th, or 4th of a grain, given once, or at the utmost twice, a day, and immediately arrested if diarrhoea appears.

Sixth. That the middle dilutions ought to be prescribed for the other diseases in which it is indicated, — diarrhoea, dysentery, prolapsus ani or uteri, etc.

Seventh. That the diseases in which it has been found most serviceable by the writer are gout, erysipelas, spasmodic and bronchial asthma, and chronic bronchitis, and in all these diseases only as an intercurrent. (The writer has not had any personal experience of its benefit in syphilis and goitre, and cannot, therefore, affirm or deny its power in these diseases.)

Eighth. That it is not specially indicated in hepatitis, nor in any of the early stages of acute diseases, save in the diarrhoea and dysentery, for which it is homoeopathic.

Ninth. That it ought never to be given where a simple aperient is required, as in cases of indigested food, lodgment in the paecum, and colon, etc. Its use should be restricted to liver constipation.

Lastly. While a specific has been defined by Dr. Drysdale, as a remedy in which the whole physiological is absorbed into its therapeutical action, there are some exceptions, and this I believe to be one of those where the boundary line between the physiological and therapeutic action is not easily defined, and where we are most certain of the therapeutic effects when we touch the physiological sphere.

The symptoms recorded as belonging to the liver are not as well defined as they should be. It is difficult to decide whether all the pains are myalgic or really in the organs referred to in the headings. Some of the symptoms are undoubtedly myalgic. The curative symptoms of fulness, etc., have been so often verified by Dr. Williamson and others of our school, that we may safely say that it indicates hepatitis or congestion of the liver. The “ chronic hepatitis with costiveness ” is also a valuable observation. It is not necessary, however, that constipation should be present ; it is as useful when that disease is attended with diarrhoea, or the two states alternately. From many years’ experience with, and observation of, the use of Podophyllin in diseases of the liver, I feel qualified to venture the following observation relative to its pathogenetic and curative action upon that organ. I believe the Podophyllum and its active principle to be a direct stimulant of the liver. I am aware that some of the most astute investigators of

the allopathic school deny that Mercury has any direct or specific action on that organ. They would probably allege the same of the Mandrake, but there are certain reasons, which I shall give farther on, why I consider the arguments against Mercury not valid in the case of Podophyllum. The primary action of Podophyllum in large doses is generally to cause vomiting and diarrhoea of undoubted bilious matters. I have examined the evacuations caused by Podophyllin, in cases of jaundice, which before its administration were completely free from bile, and found that the green color was actually due to that secretion. The examination was made with the most approved chemical tests. The patient felt the action of the drug upon the liver before it nauseated or caused any intestinal irritation. (The dose was one-fourth of a grain of the pure resinoid, triturated with ten of Sugar of milk.) In still smaller doses, third trituration, it will cause bile to appear in the previously clay-colored stools. I consider this medicine, therefore, primarily homoeopathic to acute irritation, congestion, and inflammation of the liver, bilious diarrhoea, and hepatic pains. A further proving is needed to give special indications. The powerfully irritating effect which this drug has upon the secretory functions of the liver enables it to cause such excessive action as may pass over into passive congestion, chronic inflammation, suspension of function from exhaustion, suspension of biliary secretion, and even retention of that fluid. Podophyllum has been abused in the hands of eclectics as badly as Mercury in the allopathic school. I have known it to cause chronic hepatic diseases, as jaundice, enlargement, and even some organic affections. There is scarcely an acute or chronic disease of this important viscus, in which this medicine may not, in some of its stages, be found useful. A careful study of our proving, together with the observations of physicians of both schools, will give us much information as to its sphere of action.

The dose in hepatic diseases is a matter of great importance. I believe an adherence to the following rules will give the physician greater success with the medicine than he could obtain without them: (1.) For the primary (acute) conditions, similar to those caused by large doses of Podophyllum, give the highest and middle attenuations. (The third or eighteenth of Podophyllum, and

sixth or thirtieth of Podophyllm.) (2.) For symptoms and conditions (chronic) simulating the secondary effects, give the lower attenuations, and in rare cases even the one-tenth of the resinoid. (3.) In a few cases, as in retention of the bile from obstruction of the gall-duct, or in cases of gallstones, we must have the direct mechanical effects of Podophyllum. In such cases crude doses are required. This is best illustrated by the following case of expulsion of gallstones, reported by me to the “ North American Journal of Homoeopathy,” vol. xii, p. 258 :

In vol. vii, p. 304, of this journal, my industrious colleague, Dr. Marcy, made mention of “ an empirical remedy for gallstones,” and says : “ For the violent spasmodic pains which accompany their passage to the intestines, we have found the following treatment, derived from an empirical source, eminently efficacious : As soon as the pains have declared themselves, we give the patient six ounces of tepid Olive oil, and then prescribe Nux vomica and Aconite in alternation every half hour. We also apply hot-water fomentations, and occasionally a warm bath, when the paroxysm is not speedily ameliorated.” The case which I will now report is a very interesting one. The patient was a young lady, residing in Chicago, who had been subject for several years to attacks of supposed gastralgia, which would pass off in a few days, under the use of anodynes, leaving her slightly jaundiced* This attack had been much more severe, and she had been under the care of two professors in the allopathic college in this city for six weeks when I was called. They pronounced the disease “ neuralgia of the stomach.” The character of the pain had not changed, only to grow more severe since its onset. She had been drugged with Blue mass, Calomel, Opium, Dover’s powder, and Chloroform, and received only temporary benefit from their use. I found her emaciated, jaundiced (her skin of the hue of bronze), tongue coated white; no appetite; headache most of the time ; pulse quick and hard, but small ; urine very scanty, a yellowish-brown color, and was found to contain bile when the usual tests were applied. The pains in the epigastrium extended to the right side, region of the gall-bladder, and were remitting, i. e., there were paroxysms of great intensity, but some pain all the time ; excessive nausea, when the pain became severe ; constipation and diarrhoea alternated, and in either condition the evacuations were now, and had been, destitute of bile for several weeks. At my first visit I was undecided as to the pathological condition at the bottom of the difficulty, but gave Aconite and Nux vomica. The next I decided that the malady originated from the presence of gallstones in the gall-duct, obstructing completely the passage of bile into the intestines, and giving rise to the intense pain. No relief had been obtained from the remedies, and she had been obliged to resort to Chloroform all night. I now resolved to try Dr. Marcy’s treatment. Six ounces of tepid Olive oil were ordered, but she could only be induced to swallow three. This was at 3 p.m. At 9 p.m. the other three ounces were administered. Nux and Aconite were continued as before.

Third day. No improvement. She took Chloroform about half the time, to get relief from the intense spasmodic pain ; urine more scanty and of a deeper

color ; slimy, white diarrhoea, not a trace of bile in the discharges ; vomiting of mucus ; no bile had been vomited for several weeks. I ordered a hot bath. In the attempt to take it, a very severe chill set in, with fainting. This was followed by some fever. In the evening she became stupid, and would not answer questions, and I feared she would go into coma. Dr. Coe gives the following treatment for gallstones : He gives at bedtime a powder composed of Podophyllin, grs. ij. ; Euphorbin, grs. j. ; Caulophyllin, grs. ij'. The next morning, “ as soon as the nausea attending the operation of the powder has subsided, administer eight ounces of pure Olive oil.” “ We have known,” he asserts, “ as many as two hundred of these concretions, varying in size from that of a small pea. to that of a hazelnut, to be passed after the administration of a single dose of Podophyllin and the oil.” My patient was rapidly sinking, and I knew that if the obstruction was not soon removed, the blood would become irretrievably poisoned with bile. I did not deem it necessary to follow Coe’s practice. Podophyllin is the real agent which dislodges the concretions from the duct. This it does, I believe, by increasing the expulsive power or peristaltic action, so to speak, of the gallbladder and its duct. The Olive oil may aid in relaxing and dilating the duct, and it carries the concretions through the bowels after they have been expelled. I accordingly gave one grain of Podophyllin in the evening ; she was allowed Chloroform during the night. In the morning she swallowed three ounces of Olive oil at 6 o’clock, At 9 o’clock she vomited bile ; at noon she had a free evacuation from the bowels, of a bilious appearance. At 3 p.m. another bilious stool, and with it a discharge of several gallstones. They fell into the vessel with a metallic sound, as the nurse informed me. All pain ceased about the time she vomited, and did not return. The concretions were round, about the size of a cherry, rough externally, yellowish, and when broken in two showed a radiating appearance from a common centre. No account was kept of the number passed, as the nurse was somewhat negligent and failed to collect them. In a few days, under the use of Aconite and Nux vomica, the jaundice had nearly disappeared ; her appetite returned, and in two weeks she was able to ride into the country, and has since enjoyed good health.

Irt the words of Dr. Marcy, I assert “ that this affords an example where the consistent homoeopathist is justified in employing a chemical and purgative agent to rid the system of foreign substances which nature is struggling to throw off. It is not disease which we are to remove, not a therapeutic agent which we are to administer.” I recognize three methods of restoring health, viz., the chemical, the mechanical, and the homoeopathic. By the first we can remove an irritating cause of disease, as by the use of Nitric acid in Oxalic acid urine ; by the second we can expel a biliary calculus with Podophyllin and Olive oil ; and by the last — the only law of cure — we remove, with Aconite and Nux, the hepatic inflammation consequent upon the passage of the stones. I maintain that my treatment was as rational and scientific as that of the surgeon who removes the spiculae of bone or the musket-ball, and then uses his specific remedies, with his surgical appliances.

It is amazing to witness the vast confidence which the eclectic physicians have in Podophyllin in nearly every disease of the liver. They use it almost indiscriminately in the most opposite states and conditions, and functional organic affections of that organ. I have not space to quote their observations and praises, but would refer the reader to their works on practice and Materia Medica. In congestion of the portal circle this medicine appears to have an immense curative power, in which it is only equalled by Mercury, Chelidonium, and Leptandra. In diseases of the spleen the Podophyllum has been found useful. It may be tried in acute inflammation or chronic enlargement.

In jaundice from a catarrhal affection of the gall-ducts, it does not equal Chelidonium or Carduus. In jaundice from failure of the hepatic cells to perform their functions, it is more suitable, but may have to be aided by Myrica, Leptandra, or Mercurius.

The primary diarrhoea caused by Podophyllum I have already described. Dr. Bell, in his monograph, has admirably given the characteristic indications.

There are only two forms of diarrhoea in which this medicine is secondarily indicated. I allude to that form which is accompanied by complete jaundice, and in which the evacuations are clav-colored and very offensive; and the diarrhoea which alternates with constipation, in some chronic hepatic disorders. In these varieties it will be found necessary to use the lower dilutions and triturations, while in the former affections the middle and the highest potencies will act curatively. Dr. Jeanes has cured many cases of relaxed bowels, when the stools were too frequent but natural, with the highest attenuations of this remedy.

Acute and chronic colitis is a disease which calls for the Podophyllum. The symptoms of the drug and disease bear a remarkable resemblance, as a comparison will show. Dysentery is one of the diseases in which this medicine has been found most useful. An abuse of this drug, and even its moderate and careful use, in some cases is sure to bring symptoms of acute dysentery. It is useful in chronic or acute dysentery, and in many cases will be found more beneficial in all the stages than any other agent.

One feature of the Podophyllum dysentery is the almost invariable presence of prolapsus ani, or a tendency thereto. I once attended two children, aged respectively three and six years, who had been dosed with Podophyllin by an eclectic. Dysentery was present in both patients, and also prolapsus recti. The mucous membrane of the rectum was red, inflamed, and exquisitely sensitive. Drs. Jeanes and Williamson noticed similar pathogenetic

effects. I cured the children with Nux and Nitric acid. Many cases of prolapsus recti have been cured with Podophyllin, even when of six years’ standing, and accompanied all that time with diarrhoea. Dr. Gatchell gives the indications for this remedy in dysentery, “ commencing with a watery diarrhoea, terminates in a muco-sanguineous dysentery, accompanied with sickness at the stomach. If the diarrhoea which preceded the dysentery especially manifested itself early in the morning, the case will be more appropriate.” He advises six drops of the tincture in six ounces of water, a teaspoonful at a dose, which is to be repeated after each stool, until improvement commences. This prescription will cure many cases of dysentery. This remedy is chiefly indicated in the so-called bilious dysentery, in which the stools look like pea-soup, and consist of a yellowish, greenish, or bloody mucus, having a disagreeable odor, and accompanied with violent pains in the region of the colon, rectum, and anus. It causes and aggravates hemorrhoids and severe tenesmus, with prolapsus ani, especially in children; sometimes nausea and vomiting go with the above symptoms. The active principle, or Podophyllin, at the third trituration is often more effectual and prompt in its action than the tincture. Altogether it is one of the best remedies we possess for the cure of dysentery, enteritis, and many other inflammatory diseases of the intestinal tract.

Cholera morbus is sometimes treated very successfully by the use of Podophyllum. It causes, in large doses, similar watery, flocculent discharges, very profuse and exhausting, accompanied with cramps in the abdominal and flexor muscles of the extremities. In this respect it is the analogue of Elaterium, Jatropha, Euphorbia cor., Arsenic, and Veratrum. Asiatic cholera, in some of its phases, ought to find a specific remedy in this medicine. So abundant are the alvine evacuations of serum caused by Mandrake, that eclectics use it as a hydragogue cathartic in cases of dropsy. In cholera infantum it was found by Drs. Jeanes and Williamson to be eminently useful. I have used it in a good many cases of this disorder, as well as in diarrhoea from teething, and nearly every intestinal disease to which children are subject, and have found it as useful as Mercury, Chamomilla, or Pulsatilla. In the bowel complaints of children, the practical physician is cognizant

of the colic with spasmodic retraction of the abdominal muscles, the spasmodic tenesmus, and tending to prolapsus ani ; all strong indications for this medicine.

Hoemorrhoidal affections are admirably under the control of Podophyllum. The specific affinity which this drug has for the liver, portal system, and rectum, as shown in the pathogenesis, enables it to cause haemorrhoids from portal congestion, chronic hepatic affections, and primary irritation, congestion, and even inflammation of the veins and mucous membrane of the rectum. It will be found useful in external piles, for those which bleed and those which do not. The sensations it causes in the rectum, anus, and hemorrhoidal tumors are similar to the effects of Aloes, of which it is a congener.

Dr. Itichard Hughes says :

My experience with this drug is limited to its action on the alimentary canal and its associated viscera. There is one form of that very vague affection known as “ biliousness,” in which it is very useful. This is characterized by sickness and giddiness, bitter taste and rising, tendency to bilious vomiting and purging, and dark urine. Podophyllin, from the first to the third trituration, has generally, in my hands, rapidly removed these symptoms. On the other hand, when biliousness means dull pain in the right hypochondrium, pale and costive motions, loss of appetite, and depression of spirits, it will resist Podophyllum, and yield pretty quickly to the third decimal trituration of Mercurius solubilis. I cannot, therefore, agree to the generalization which styles Podophyllum “ the vegetable Mercury.”

What is the precise nature of the physiological action of Podophyllum upon the biliary apparatus seems to be very doubtful. It is certain, however, that it exerts a specific action of an irritant nature upon the mucous membrane, especially upon that of the small intestine and the rectum. Our provings are confirmed in this particular by the experiments of Dr. Anstie on animals, recorded in the “ Medical Times and Gazette,” for 1862. I have found it act well in a case of chronic duodenitis. In inflammatory irritation of the jejunum and ileum, it is invaluable, for I know of no other potent drug which affects, specifically, this part of the alimentary canal. The influence of Arsenic and Kali bichromicum becomes weaker as the duodenum is passed, to he renewed in the case of the latter at the colon ; with the former hardly till we reach the rectum. Mercurius corrosivus affects the large intestine only. Podophyllum might be cautiously tried in the enteric lesion of typhoid fever, with which it has at least a local affinity. The same reason which makes it so valuable in affections of the small intestine, renders it unsuitable in ordinary dysentery, which has its seat in the colon. In cases, however, where a dysenteric diarrhoea appears to depend upon inflammatory irritation of the rectum, Podophyllum will give rapid relief. Such a malady is not uncommon in children, and is accompanied with painful prolapse

of the rectum at each stool. Here I give Podophyllin at the third trituration ; but in the simple prolapsus ani from debility, of infancy and childhood, I have almost invariably seen beautiful results from the tincture of Podophyllum in the twelfth dilution. In the same form, following Dr. Jeanes (see Hale, p. 346), I have given it with perfect success in cases where, in children, the stools are too large and frequent, but natural in color and consistence.

In acute or chronic mucous or follicular enteritis, it is specifically and primarily indicated. No drug, not even Mercury, so surely causes these conditions. Whether the disease be present in children or adults, the Podophyllum will be found promptly curative.

Diarrhoea, in nearly all its varied manifestations, finds a similimum in the pathogenesis of this potent drug.

Dr. S. M. Schell, of Chesterville, Pennsylvania, communicates the following experience with this remedy and Leptandra in diarrhoea.

Case I. — A boy, three years of age ; chronic diarrhoea of three months’ standing (treated allopathically), without any good results. The evening and night previous to being called to see the child, he had fifteen passages, of a very disagreeable odor, and of the color and consistence of tar. Gave four drops Tincture leptandra, in two-thirds; glassful of water, dessertspoonful every hour for four hours. The next stool natural. Cured in twelve hours, and well since — now one year.

Case II. — Mr. - , had chills, and had taken great quantities of allopathic

medicines. When I saw him he was much debilitated, sallow complexion, bad nightsweats. Gave a few powders, first of Carbo veg., with some effect, and on examination again gave Leptandra 1st in powder, and the cure was rapid.

Diarrhoeas occurring in the early morning only, cured with Podophyllum 3d, no failures. In one case, a boy, the stools were tarlike, but occurring in the morning. Gave Leptandra, with no effect. Then gave Podophyllum 3d ; cure rapid.

Drs. Hering, Jeanes, Ringer, and many others lay much stress on the tendency to morning aggravation of the intestinal and, indeed, all the symptoms of Podophyllum.

I have not yet been convinced that this remedy specifically and distinctly affects the uterus, any more than does Aloes, Nux vom., or Collinsonia. I believe it affects that organ, as well as the vagina, by its action on the circulation in the pelvis.

Besides the symptoms marked as curative and pathogenetic, Drs. Williamson and Jeanes have cured the following : “ Prolapsus uteri — many cases ; numb, aching pain in the region of the left ovary, with heat running down the left thigh, in the third

month of pregnancy ; ability to lie comfortably only on the stomach in the earlier months of pregnancy ; swelling of the labia during pregnancy ; after-pains, attended with flatulency. Other homoeopathic practitioners have found the Podophyllum useful in many of the diseases of women, especially when involving the uterus and ovaries. It is still an unsolved question, in what way the medicine affects the uterus ; in some cases it would seem to do so by its action on the bowels and rectum, as is the case with Aloes. It is well known that any drug which powerfully irritates the lower bowel will cause congestion and even inflammation of the womb, by extension of effect through contiguous tissues ; thus Aloes may cause the above, as well as uterine cramps, menorrhagia, prolapsus, etc. It is thought by some that Podophyllum has a similar action, but it would seem from our proving, as well as numerous clinical cases reported, that the medicine must have some direct action on the uterus and ovaries.

Prolapsus Uteri et Vagina. — Case I. — A lady who had lately given birth to a stillborn child, of large size, with a serious loss of blood, and had undoubtedly the symptoms of a severe prolapsus of the womb. Arnica was given a few days, followed by China and Carbo veg. ; these greatly increased the strength of the patient, after which I gave Mercurius 3d, four powders, and Podophyllin 3d, four powders, on alternate days. In four or five days she was completely cured.

Case II. — A lady had been confined about four weeks previously, but had been suffering ever since with violent bearing-down pains in the region of the womb ; intolerable pain in the back ; great degree of weakness ; aphthae, and several scrofulous swellings about the neck. On examination, I found a moderate degree of prolapsus, swelling and induration of the os uteri, a profuse, excoriating leucorrhoea, and great ardor urince. I gave, in this case, Mercurius sol. and Podophyllin, in alternation, daily, which relieved in ten days the prolapsus, and reduced the os uteri to its normal size. The aphthae yielded at the same time to a great extent, Belladonna relieving this symptom. Sulphur, Sepia, and Mercurius iodatus removed the leucorrhoea and swelling of the glands in three weeks’ time. The 2d attenuation was used.

Case III. — Prolapsus uteri, brought on by a violent strain, seven years ago. She was emaciated from violent suffering, loss of appetite, cold, and debilitating nightsweats, violent burning in hypochondriac region, extreme low spirits. Mercurius vivus 3d removed the nightsweats permanently ; Podophyllin 3d removed the other symptoms, with the prolapsus, and she remains cured — more than one year.

Dr. D. G. Klein writes me:

I have cured a few cases of chronic prolapsus with the Podophyllum peltatum. I will cite the most important case :

Symptoms. — Great costiveness, stool once in three days, with great difficulty ; frequent micturition, had to get up three or four times every night ; great weakness and soreness of the back, especially after washing, etc.

Prescribed Podophyllum peltatum, a tincture prepared by myself from green root, not very strong, three drops a day in six tablespoonfuls of water, taken inthree doses. In three weeks’ time the case was entirely cured, bowels regular, no difficulty with the urine, and the back strong and without pain.

Induration of the Os Uteri. — Dr. Gatchell mentions, incidentally, that Dr. Brown, of Cincinnati, cured with a trituration of Podophyllin an induration of the os, which had resisted the efforts of the distinguished Professor Morrow until he abandoned the case in despair.

According to some physicians Podophyllin is useful in swelling and inflammation of the ovaries. Its general specific action on the glandular system would lead us to suspect it of the power of causing disease of those organs. I once found it beneficial in a case of chronic ovaritis, with symptoms like those in the proving. It is also useful in many of the disorders of pregnant females, especially when caused by a congested condition of the pelvic viscera ; the morning sickness, or excessive vomiting of pregnant women, will often be relieved by this medicine. Eclectic physicians praise it highly in simple, recent amenorrhoea, but they use it as the allopathist uses Aloes, not homoeopathically. In congestive amenorrhoea, however, it is homoeopathic to the condition, and in minute doses wrill act curatively.

Dr. J. T. Talmage, of Brooklyn, New York, communicates the following experience with this medicine :

Podophyllum peltatum, and its active principle, Podophyllin, I have found curative of almost every morbid condition for which Mercurius sol., Mercurius dulcis, and Mercurius vivus have proven the homoeopathic specifics. I have to that extent made them substitutes for the latter remedies. They are more radical and rapid in their cure than the minerals. I have especially found Podophyllin valuable in haemorrhoids, both internal and external, for acute and chronic constipation, and all the morbid sequelae attendant upon that condition, both during pregnancy and its absence.

Mrs. M., forty-five years of age, sanguine temperament, full habit, not through the “ change of life,” being sensitive to all atmospheric changes, with no tubercles in substance of lungs, with a large vomica, the remnant of an abscess many years since, has suffered for fourteen years from the consecutive stages of uterine disease, congestive inflammation, ulceration and induration of os uteri ; also from retroversion, dysmenorrhoea, menorrhagia, and chronic constipation ; only palliated, with few exceptional instances, by her allopathic adviser, Dr. Delafield, of New York, or his homoeopathic successor.

By a proper homoeopathic treatment she was cured of all her ills, except induration and constipation. The former was much relieved, but having been so long chronic had become organic, and is incurable. Her constipation, in addition to the usual discomforts, had the characteristic of waking her almost every night, not always at the same hour, with a severe abdominal colic in the umbilical region, which lasted from one to two hours. The only relief she could obtain was prophy lactic, a laxative, the day prior. Homoeopathic remedies had no effect either in high or low dilutions. Finally I prescribed Podophyllin, the first homoeopathic trituration, a small powder every four hours. The constipation of years yielded, and an evacuation came the second day. Subsequently, powders of the same were given A.M and p.m. They made a permanent cure in ten days, both of colic and constipation.

Mrs. It. F., a lady in affluent circumstances, during the last two years passed through the hands of six physicians, three of whom were allopathic, and the other half homoeopathic. They all treated her for dyspepsia, debility, and constipation. Obtaining no perceptible benefit from treatment, she finally put herself under my care. Judging from symptoms that her sufferings were the sequence of uterine disease, I proposed an examination with the speculum. It was acceded to, and I found extensive hypertrophy, ulceration, and prolapsus (the os uteri readily admitting the first two fingers of the right hand to the second joint, and presented itself very near the vulva).

In a few months I cured the hypertrophy, both of the os and fundus uteri, and the ulceration, and thereby much relieved the prolapsus.

The patient, within six months after the commencement of my treatment, became enceinte , and is now nearly eight months gone. With the cure of her uterine trouble she improved every way, in returning regularity of organic function, muscular and adipose development, increased strength, and freedom from hypochondria, one of her dependent complaints. .

Chronic constipation, dysentery, and haemorrhoids remained, and gave her frequent attacks of tenesmus uteri, tenesmus vesicae, and tenesmus recti, abdominal colic, and severe sick and nervous headache. After a protracted trial of all the remedies, with but little effect, I at last, upon the patient becoming completely discouraged, prescribed, as an experiment, Podophyllin 1st trituration, every four hours. In two days she had a natural evacuation, and relief of all her troubles. Since then, two months, she has been daily regular, with one or two exceptions, when she stopped the medicine, thinking it no longer necessary. She now, and has most of the time, taken one powder a day.

The following symptoms would seem to indicate that it affected the heart in a specific manner:

Inclination to breathe deeply; sighing; shortness of breath; sensation in the chest as if the heart was ascending to the throat ; sensation of suffocation when first lying down at night ; palpitation of the heart, from exertion or mental emotion ; * palpitation of the heart, with a clucking sensation rising up to the throat, which obstructs respiration ; sticking pain in the region of the heart ; palpitation of the heart from physical exertion, in persons subject to rumbling in the ascending colon; heavy sleep, and a feeling of fatigue on waking in the morning, followed by drowsiness in the forenoon.

The first curative symptom above was a case reported by Dr. Ward. It is to be regretted that a physical examination of the heart was not made, that we might know the condition of that organ. Such omission is to be deprecated in all clinical reports. The last heart-symptom is not marked with an asterisk in the original pathogenesis. Dr. Hempel, however, placed it in the “ Symptomen Codex,” probably upon good authority ; in fact, the remark in parenthesis in the original (Jeanes’s “Numerous Cases”) would seem to imply that he had cured that symptom in numerous cases, although it might imply only that it had been indicated as a pathogenetic symptom. The condition of the heart which gave rise to those symptoms needs elucidation; taking the collateral symptoms into account, we should say it was a sympathetic derangement of that organ, from disease of the liver, occurring in a debilitated subject. I do not think the Podophyllin is capable of curing (although it may palliate) any seated or organic disease of the heart. As a palliative, however, and as an aid to Digitalis, it is very efficacious in those congestions of the liver with venous stasis and great torpidity. An appreciable dose of the lx trit. will promptly remove the congestion, starting the flow of bile, and relieve the overtaxed heart.

I will conclude my lecture by giving you the estimate of the value of Podophyllum from two representative men, one belonging to the eclectic, the other to our own school of practice.

I hope you will see therein some hopeful indications of the coming medical millennium, when physicians shall meet on the common ground of scientific truth — a time when bigotry and prejudice shall have been banished from professional life.

I will first quote the practical and investigating Dr. Scudder, editor of the “ Eclectic Medical Journal,” who has for several years adopted the homoeopathic practice in part, and who is a close observer of the action of medicines, and believes in the value of “ characteristic symptoms.”

Within the year 1874 he has written several articles on the use of Podophyllin. He decries its abuse also, and condemns its routine use for the one indication, namely, constipation.

He says he has found several characteristic conditions and symptoms which always indicate the medicine, and, given either indication, it will cure the whole ensemble of symptoms with which the patient is afflicted. This is the same doctrine taught by our believers in “ keynote indications.”

The most prominent indication for Podophyllin, he says, is “fulness of the superficial veins ” This condition, he thinks, indicates an impairment of innervation of the sympathetic system of nerves. When this condition is present, he gives appreciable doses — from one-tenth to one one-hundredth of a grain every few hours. This is correct, for the condition is similar to the secondary effects of the drug. He says the Podophyllin should not be given in the opposite state, cold skin, imperceptible veins, pinched expression, etc. Why ? Because he (Scudder) does not yet believe in attenuated doses. The fact is, that his contraindication is one of my keynotes — a condition similar to the severe primary effects of the drug, and for that condition the 6th or 12th dilution or trituration is perfectly indicated. We find that condition in cholera infantum, dysentery, dyspepsia, enteritis, and many other diseases characterized by prostration.

Dr. Scudder will find, if he tries the higher attenuations, that they will often act with surprising efficacy, when indicated by the primary toxic effects of Podophyllin.

He gives other characteristic indications for its use, some of which I had observed in my own practice before I read his papers.

I quote his words, italicizing his indications. In his case, where he mixes Podophyllin and Hydrastia, I should alternate them, only for the reason that a tenet of our school teaches that it is best not to use double medicines.

I will add, however, that it has not been logically proven, as a scientific fact, that double medicines are inefficacious. One of the most successful of German homoeopathists, Dr. Leutze, habitually prescribed double medicines, and I know that many physicians in our school in this country do the same thing. There may yet be discovered some law which will permit the union of two remedies, and guide us in the administration of such medicines; but as yet I am not sufficiently convinced of the value of such a method, except in a few peculiar instances.

But to return to Dr. Scudder. He says :

A certain class of diseases of organs supplied from the sympathetic will be

marked by a dull, unpleasant pain, or weight, in the hypogastric region. The sensation is singular, and the feeling will sometimes cause the patient to bend forward to relieve himself. When the sensation is analyzed, it is referred to parts within the abdomen, and probably to the lower convolutions of the ileum. It is found in fevers and inflammations, but especially in dyspepsia, imperfect blood-making, disease of the spleen, irregularities of the bowels, — both diarrhoea and constipation, — diseases of the urinary apparatus, and the reproductive organs. In whatever disease found, especially if well marked and characteristic, Podophyllin will prove curative.

Among the queer indications for the remedy may be named a sharply defined ache in the sacro-ischiatic foramina, with tenderness on pressure, of which I may give a case. W., aged forty-three, has suffered from liver complaint, or something else, for years, for which he has taken liver (?) medicines in large doses, Podophyllin among them (and the Podophyllin pills always made him worse). For some months he has had pains in the course of the ischiatic nerves, for which he has taken various remedies without relief. Prescribed Podophyllin, gr. onetwentieth, with Phosphate of hydrastia, one-fourth ; one pill daily. Was relieved of pain within one week, and rapidly regained his health. Quite as singular a case of what seemed and had been diagnosed chronic cystitis was cured with the same prescription, the remedy being prescribed for the hypogastric and ischiatic pains.

Let a patient complain of pain in the course of the ulnar nerve, and I would always think of Podophyllin as a remedy. Why? For no other reason than it cures such cases.

A rather common symptom, and a very good one to prescribe by, is a peculiar stool, the first part large and hard, followed by fluid and wind. Use Podophyllin triturated, or in small doses with the Hydrastia.

A tongue full and broad, with a pasty coat in the centre, is a good indication for small doses of Podophyllin, or even large ones. If I was induced to use the old-fashioned emeto-cathartic of Podophyllum, or -in, this would be the case.

A red tongue (not bright red), with uniformly erect papillce, rough, will be an indication for Podophyllin (in small doses) in some cases.

I am not sure but a dull-bluish color of tongue is a good indication for the remedy, and would be glad if some of our readers will observe it carefully. Podophyllin in small doses is a stimulant to the sympathetic nervous system, and influences all vegetative processes, but especially those of digestion and bloodmaking. Some of our readers should rather keep this in view as the leading idea, and give it when such stimulation is necessary. This is well enough, but I like to prescribe for special symptoms. It gives the best result.

These special indications are valuable, and I advise you to make a note of them.

I have among my patients a lady who, once or twice a year, has attacks of severe pain and swelling of both ankle-joints. For many years she suffered weeks, and often months, under the treatment of various physicians of both schools, before she recovered. Finally, some physician gave her one-tenth grain doses of Podo-

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phyllin thrice a day for a few days, followed by one-grain doses of Quinine, four times a day, for a few days. This treatment acted specifically and cured promptly. She has tried the Podophyllin alone and the Quinine alone, but neither cured ; only when used together is an attack promptly arrested. We have often observed the same thing to occur in other diseases with other remedies. It would seem that it is a natural law that some remedies should precede or follow others. Hahnemann implies as much in many of his comments on the medicines in his “ Materia Medica Pura.”

Dr. W. S. Searle, of New York, in a paper entitled, u A glance at the Effects of Podophyllin,” observes :

Upon the sensorium no marked primary action is discernible. As secondary effects, however, we find depression of spirits with fatalistic ideas, and vertigo with a tendency to fall forward. Secondarily, also, it produces other decided disturbances in the head. The prover complains of dull, heavy, pressing pains, which are confined to the forehead, temples, and vertex, and are relieved by external pressure. These pains generally occur in the morning on waking, and grow less during the forenoon. (The diarrhoea has also this morning aggravation.) As accompaniments of the pain, we observe drawing sensations in the eyes, and at times soreness at the seat of distress. It is noticeable that the headache may alternate with the diarrhoea, which the drug also produces.

In the eyes some hyperaemia of the conjunctiva is visible, with drawing, smarting, aching, and heavy sensations. These symptoms occur equally, whether the prover has ingested the drug or only been exposed to its dust.

The tongue exhibits a moist, white coating, and salivation is copious. The breath is offensive even to the prover himself, and a foul putrid taste disgusts him. The pharynx is at first full of mucus, but afterwards becomes dry. Then deglutition becomes painful, especially when swallowing liquids, and soreness, appearing first upon the right side, extends to the left, and upwards through the Eustachian tubes.

The appetite is diminished and soon satisfied, while a, strong desire for acids is developed. What little food is taken is not well digested, for burning, acid eructations soon appear, and after a short time nausea sets in, rapidly increasing to vomitings. Some of the food seems to undergo putrefactive fermentation, for the ejecta have, at times, a putrid taste and odor. The vomiting is very protracted and often very severe, being accompanied by agonizing epigastric pain. Even after the stomach has been thoroughly emptied, the inverted peristaltic action continues, and extends also to the duodenum, so that bile, mingled perhaps with blood, is ejected.

Sometimes colic now puts in an appearance, but not seldom the disturbances in the abdomen are unaccompanied by pain. When colic does occur it is aggravated by lying upon the back, and relieved by bending forward. The intestines become distended with gas, and a profuse diarrhoea sets in.

Before the stool there is often a sensation of heat in the abdomen, while after it comes a feeling of great emptiness. Both colic and diarrhoea are worse in the morning. In the region of the liver, fulness, soreness, and stitching pains are developed, and similar feelings are complained of in the splenic territory.

In the morning aggravation of the bowel symptoms Podophyllum resembles Aloes and Sulphur, but may easily be differentiated from these. The stool of Aloes is a windy spurt of watery or slimy, yellow fecal matter, the desire for which can hardly for an instant be controlled from a seeming if not real weakness of the internal sphincter. Sulphur demands equal haste from tenesmus. It has a brown stool, not especially flatulent, and neither so scanty as that of Aloes, nor so profuse as that of Podophyllum. Podophyllum gets its victim up early, but not in so great haste as the others (probably because the internal sphincter alone is affected), and has a very profuse, yellow, or greenish stool — so profuse, indeed, that one wonders whence so much can come. It often contains undigested food, and is very offensive to the smell, having sometimes the odor of carrion.

Not seldom it is preceded by prolapse of the rectum. Accompanying it are excessive prostration, simulating even the collapse of cholera ; constant, heavy, dragging pain in the back, which increases during and after stool ; flashes of heat running up the back, and sometimes severe tenesmus. At a later stage mucous and muco-gelatinous stools occur, which may be streaked with blood. The whole alimentary canal becomes so irritable that the ingestion of food or drink at once renews the desire for stool.

As secondary and reverse effects, the stool becomes dry and hard, is voided with difficulty, and is covered with yellow mucus. This condition alternates with returns of the diarrhoea.

Similarly to the bowels the kidneys are affected. First comes enuresis with, at times, involuntary nocturnal discharge, and then follows diminished secretion. A sediment occurs, but its nature has not been determined.

Little is known of its effects upon the male organs. An eclectic druggist, however, states that those engaged in preparing the resinoid suffer from a pustular eruption upon the scrotum. Topically applied it produces similar effects upon other portions of the skin.

Upon the female organs its influence varies with the time of its administration. Given at or near the time of menstruation, it hastens and increases the flow of blood as well as of vaginal mucus. But, if sufficient interval occurs between the dose and menstrual nisus for the primary effect of the drug to disappear, the secondary and reverse symptoms obtain, viz., amenorrhoea and dryness of the vagina. It is noticeable that it produces prolapse of the vagina as well as of the anus.

Upon the respiratory organs its influence is slight and purely reflex. This is also true of the few symptoms which are developed in the extremities.

It is susceptible of physiological interpretation. It attacks the involuntary muscles, particularly those of the bloodvessels which supply the alimentary canal, with its adjacent and contributing organs. In this way it affects the kidneys, uterus, and the heart itself. Of the involuntary sphincters, moreover, it causes a paresis.

Beginning with the mouth and salivary glands, the result of such a paresis of the bloodvessels would cause stasis, passive congestion. The capillaries are relaxed and overdistended ; their lattice-like tissue opens, and out pour floods of serum and protoplasmic masses ; epithelial activity is stimulated, and an imperfect, half-elaborated, and abundant secretion is the result. The same conditions produce like effects in the mucous membrane and glands of the stomach, and hence a similarly inefficient gastric juice is deluged upon the food. This, together with the directly irritant effect of the drug upon the surface of the stomach, induces nausea and vomiting. The same results are seen in the intestinal canal. It pours forth a superabundant secretion. The decomposition of the undigested food, and perhaps also the irritated mucous membrane itself, furnish the gas which distends the intestine and pains its irritated nerves ; and hence the colic and the flood of fecal discharge.

Upon the liver, spleen, kidneys, and uterus its effect is the same in kind, and therefore each discharges profusely its half-elaborated production.

Upon the muscular fibres of the heart the action of the drug is particularly powerful. The beat becomes feeble, the pulse weak — then scarcely perceptible ; the surface of the body is bathed in a cold and clammy sweat ; and thus death by collapse steals on.

The involuntary sphincters are enfeebled, so that the rectum and vagina prolapse, and the sphincter vesicse fails to perform its whole duty.

All the glands above mentioned have their parenchyma distended, and hence come the sensations of weight, dragging, fulness, soreness, etc., in them all.

Nothing but secondary symptoms remain for which to account. The heavy, dull, frontal headache with which the prover awakes from a stupid sleep is easily explicable. The secretory organs, which have lately been so active, have now reacted against the influence of the drug; their capillaries have contracted and secretion has fallen below the normal standard. Such a condition produces just these kind of head symptoms. In confirmation, we may refer to the fact that after the diarrhoea has ceased and constipation begun, occasional returns of the former occur, and with the recurrence of the loose stools the headache disappears.

We have only a few outlines of the secondary picture; but these, together with the primary picture and our clinical records, complete the drawing. Here also Podophyllum is often valuable.

Beginning with the head, and coming to the mouth and throat, we find a dry, yellowish tongue ; a foul, bitter taste, and thirst, with very little appetite. The pharynx is dry and deglutition painful. The stomach is irritable and the gastric juice small in quantity. Owing to the diminished secretion of bile (or perhaps rather to its retention and re-absorption) there is more or less jaundice, and the stools become pale, dry, and hard. The urine is scanty, charged with sediment, and colored yellow by the biliary acids. There is also, in women, amenorrhoea, with its train of consequences.

Crowning all, and growing out of the irritable condition of the heart itself, together with the stimulus reflected upon it from other excited organs, comes general fever.

To this congeries of symptoms Podophyllum is secondarily homoeopathic.

What does this practically mean ? I confess I do not know. Hale would tell you it means that, to be curative in these conditions, it must be administered in small doses. But some facts are decidedly against Hale’s law of dose. For instance, Dunham, in his lecture on Graphites, says he has been equally successful in the treatment of the diarrhoea and constipation which are cognate to this drug, with the two hundredth attenuation. (The antipsorics have no primary and secondary symptoms. — Hale.)

Multitudes of similar facts can be adduced from our clinical records, and we must therefore remit the whole matter to those who feel competent to deal with this vexed question of the dose.

To what diseases is it applicable ?

First, and most accurately, to bilious fever. With this as a type we shall not go far wrong in its administration. It has been praised for its curative power in typhoid forms of fever ; in the genuine zymotic fevers it may be given as an intercurrent in persons of a bilious temperament.

In intermittent fever it may, at times, be useful in a similar way, but it is better adapted to the remittent type, which is generally bilious au fond.

In the treatment of gallstones its use is, of course, purely toxical.

Is there any warrant in the pathogenesis for supposing that it is more than a mere function-remedy ? If my physiological reading of it be correct, I think there is. In such conditions of vascular stasis as have been described, the white blood-corpuscles and other more minute particles of protoplasm pass through the meshes or stomata of the capillaries, and wander by their inherent power of locomotion into the various neighboring tissues. Here they grow and multiply, and by their transformations bring about the series of phenomena which we call inflammation. Hence, we may prophesy that it will be useful in gastritis, hepatitis, enteritis, dysentery, and perhaps even in nephritis and metritis. However, should it ever be appropriate in such forms of disease, we should expect to find in the history of each case an incipient stage when the symptoms corresponded to those existing in the proving.

I have thus endeavored to characterize Podophyllum, and if it has afforded you as much information as the study of the drug has me, I am fully repaid for my trouble .

Lactic acid is an effectual antidote to the effects of it. Fifteen grains have been given, and immediately afterwards a draught of sour milk, and the effect of it has been nil. Sugar antidotes it somewhat ; common salt increases its action ; Acetic acid does not affect it. In gout it is useful after acute symptoms have subsided, or in cases where the attack is preceded by premonitory symptoms it is indicated at once. It will ward off an impending 'attack of gout. It had good effects in jaundice when it had returned again and again after China and Mercurius. The following inferences are drawn from the facts related :

First. That it is a very active and penetrating medicine, resembling Calomel in its specific action on the liver and glandular system, but beyond that the similarity ceases.

Second. That its direct sphere of action is the whole portal system, and indirectly all other systems connected with that either by nervous or vascular ties.

Third. That while the liver and gall-bladder are directly acted upon by this

medicine specifically, and led by it to discharge their contents, great relief is given to the lungs and the brain when oppression of these vital organs is connected with inactive and irregular action of the liver.

Fourth. That torpidity of liver, rather than vascular congestion, is the chief sphere of it ; in other words, a non-secretory state, or a state of non-expulsion of the secretion of bile, is the indication for it, and this state is indicated by sallow complexion, furred tongue, and constipation.

Fifth. That the curative dose in such cases must be brought near to the physiological, viz., the 10th, 5th, or 4th of a grain, given once, or, at the utmost, twice a day, and immediately arrested if diarrhoea appears.

Sixth. That the middle dilutions ought to be prescribed for the other diseases in which it is indicated, — diarrhoea, dysentery, prolapsus ani or uteri, etc.

Seventh. That the diseases in which it has been found most serviceable by the writer are gout, erysipelas, spasmodic and bronchial asthma, and chronic bronchitis, and in all these diseases only as an intercurrent. (The writer has not had any personal experience of its benefit in syphilis and goitre, and cannot, therefore, affirm or deny its power in these diseases.)

Eighth. That it is not specially indicated in hepatitis, nor in any of the early stages of acute disease, save in the diarrhoea and dysentery for which it is homoeopathic.

Ninth. That it ought never to be given where a simple aperient is required, as in cases of undigested food, lodgments in the caecum and colon, etc. Its use should be restricted to liver constipation.

Lastly. While a specific has been defined by Dr. Drysdale as a remedy in which the whole physiological is absorbed into its therapeutical action, there are some exceptions, and this I believe to be one of those where the boundary line between the physiological and therapeutic action is not easily defined, and where we are most certain of the therapeutic efforts when we touch the physiological sphere.

I quote the valuable differentiation of the analogues of Podophyllum, by Dr. Farrington :

PODOPHYLLUM.

MERCURIUS YIYUS.

MIND.

Low-spirited ; fears he is going to die ; i Fears loss of reason, fears he will behypoehondriacal. 1 come insane ; anxious.

HEAD.

Throbbing temples, eyes ache, head hot, morning.

Rolling head ; grinding teeth ; whining at night; head sweaty in sleep; flesh cold. Dentition difficult.

Splitting frontal fulness, head hot; evening, night.

Fontanels open; restless sleep, moaning, groaning ; sweat all over, clammy, cold, sour. Dentition difficult.

EV

Ophthalmia scrofulosa, even perforation of the cornea ; worse in the morning .*

MOUTH,

Breath smells foul.

Tongue white, dry.

Saliva copious.

Throat sore ; worse right side ; swallowing liquids ; in the morning.

STOMACH,

Nausea, gagging ; vomit of blood, bitter ; or, painful retching.

Flatus in the right abdomen ; palpitation, sleepy mornings. X

Liver feels hot, sore; twisting pains; better from rubbing that region ; costive ; stools hard, dry, difficult.

Colic (as from lead), with retraction of the abdominal walls.

Stool chalklike, offensive, with gagging ; clay-colored ; black ; watery, profuse > painless, gushing, exhausting; mealy sediment ; bloody, green, yellow mucus, smelling like carrion ; worse towards morning, in the morning.

After stool, exhaustion ; cutting pains ; weak, even after natural stool.

Prolapsus recti from any exertion ; with diarrhoea.

URINE, (

Urine scanty, frequent at night (pregnancy).

Dragging pains in the ovarian regions.

MERCURIUS YIYUS.

ES.

Ophthalmia scrofulosa, pustules on the cornea ; lids crusty ; worse evening and night.

THROAT.

Breath smells fetid.f

Tongue yellow, moist, flabby.

Saliva copious, fetid.

Throat sore ; worse left side ; swallowing saliva and liquids ; evening air.

ABDOMEN.

Nausea; vomit bile, bitter or sweetish (as from worms).

Flatus not so marked as in Podophyl. ; fulness in stomach and. hypochondria.

Liver so sensitive he cannot lie on the right side or bear the least touch ; costive, with ineffectual straining.

Colic as from worms ; sweet taste ; hard, tender, distended abdomen.

Stool tenacious, crumbling, small in shape; grayish-white; black, pitchlike; not gushing, but burning; watery, corrosive ; bloody mucus, slimy, with much tenesmus; odorless or simply sour ; worse usually evening and night.

After stool, cutting and great tenesmus ; sweat ; trembling ; burning in anus.

Prolapsus recti inflamed, black ; when straining.

Urine scanty, with constant, violent urging.

Shooting from ovaries to hips ; suppuration.

• In compounding Mandrake pills, the dust causes inflamed eyes, perforating ulcer, itching eruption, worse about the genitals. The morning aggravation is marked, Merc, is worse from the glare and heat of the fire.

f This fetor comes from ulcerative processes ; the foulness in Podophyl. is indescribable.

| A group many times confirmed by Dr. Jeanes.

Prolapsus uteri, with backache at sacrum ; after confinement ; from washing ; with prolapsus ani ; with amenorrhoea ; stool frequent, though natural.

Pregnancy. Can lie comfortably only on the abdomen (early months) ; frequent urination ; prolapsus uteri after.

Cough in remittent fever ; loose during dentition ; whooping-cough, with constipation and loss of appetite.

Palpitation from any exertion, with flatulence; heart as if it came into the throat.

MERCURIUS VIVUS.

Prolapsus uteri et vaginae, with soreness of the genitals, externally and internally ;* much urging in the rectum ; stools crumble, or slimy, bloody.

Pregnancy. Stomach very sensitive to touch or pressure ; scorbutic symptoms, sore gums, etc. ; lochia, with sore genitals.*

Cough, with burning and rawness, moist, but phlegm does not loosen ; so convulsive cannot speak ; whooping-cough in two paroxysms.

Palpitation on awaking, thumping, agitation; trembling or feeling as if life were ebbing away.

FEVER.

Pulse slow ; scarcely perceptible ; pulseless, collapse, chill 7 a.m. ; forgets the words.

Heat, with delirium and loquacity ; afterwards forgetful of what has passed.

Sweat, warm on the legs ; feet cold ; head-sweat, with coldness of the skin ; sleep during sweat.

Flashes up the back and abdominal pains during stool.

Pulse usually full, strong; pulseless, with hot body. Chill A.M.,f but more

evening.

Heat, with ebullitions, constriction of the chest ; anxiety.

Sweat cold, clammy on the legs ; cold sweat on the forehead ; skin burns ; sweat never relieves.

Chilliness between or after stool.

GENERALITIES.

"Worse from walking on uneven ground ; misstep.

Worse in the morning.

Worse from acid fruit with milk.%

Worse from any form of motion.

Worse evening and night.

Worse from sweets, from sugar.

• This soreness is very characteristic, and indicates Mercury in scarlet fever, etc.

f The morning chill is after rising from bed ; but the evening attack is most important. This collect of symptoms is invaluable in bilious fevers.

J Podophyllum has received the name of Vegetable mercury. It helps promptly in dyspepsia caused by Calomel.

Anxiety, fears he is going to die.

Dentition. Rolls the head, grinds the teeth ; child whines at night, restless sleep, half-open eyes; head sweats, legs cold, face cold ; vomiting frothy mucus, green ; or food ; or only gagging ; stools profuse, gushing, green, watery, or white ; offensive ; from midnight, but worse in the morning.

SULPHUR.

Anxiety ; despairs of salvation.

Dentition. Child lies in a stupor, eyes half open, or sleeps in cat-naps, jerks the limbs ; fontanels open, pale face, cold sweat on face, cold extremities ; vomiting sour-smelling; stools watery, green, involuntary, white, sour, or offensive; irresistible, sudden urging in the morning.

STOMACH, ABDOMEN.

Eructations hot, sour ; smell like rotten eggs.

Worse from acid fruits with milk. Tongue white or brown.

Flatus in the right abdomen ; palpitation ; sleepy forenoon.

Bowels move after being washed.

Colic, with cramplike knots or retraction of the abdominal walls.

Eructations sour ; taste like rotten eggs.

Worse in every form from milk.

Tongue white, red tip.

Flatus mostly in the region of the sigmoid flexure.

Aversion to washing; generally worse therefrom.

A similar cramping as if the intestines were in knots ; pains go to chest, to groins.

The stools are very similar : changeable, watery, green, mucous, white, undigested, with colic, cramps in the thighs ; vomiting, purging, with prolapsus ani (more marked in Podophyl.). They meet, hence, in cholera infantum, cholera, summer diarrhoeas. Sulph. has, with Podophyl., the profuse, gushing, painless stools, but has more marked the excoriation and redness of the anus. It pictures, according to Hering, the whole course of Asiatic cholera ; hence becomes a prophylactic. Podophyl. may apply in painless cholera morbus, and in cholera when cramps, profuse discharges, prostration, etc., are present. In cholera infantum Sulph. shows its supremacy as a nutritive remedy.

Drowsiness, or restless sleep, rolling the head ; flesh is soft, flabby ; sallowness.

Stupor, suppressed urine (hydrocephaloid impending) ; flesh wrinkled, yellow, dry; child looks like an old man.

FEVER.

Remittent or intermittent type ; forgetful during the chill; loquacious delirium in the heat, violent headache.

More a continuous remittent type ; between chill and heat delirium sets in ; prostration, increasing with the congestion and heat ; headache.

SULPHUR.

Tongue coated uniformly white, yellow, or brown ; jaundice.

After the hot stage forgets all that has passed.

Tongue dry, if coated, more yellowbrown centre; jaundice.

Fever if continuous, causes slowness in responding .*

PODOPHYLLUM.

More depression of spirits. Morning headache ; hot vertex.

NUX VOMICA.

HEAD.

I More irritability, anger.

Morning headache ; heat in the forehead.

EYES.

Ophthalmia worse in the morning ; perforation of the cornea.

Ophthalmia worse evening and morning ; ecchymosis of sclerotica.

Complexion sallow, dingy.

FACE.

] Complexion yellow, with a red flush.

MOUTH, THROAT.

Breath foul (night).

Throat sore ; worse from swallowing liquids.

Breath offensive, morning.

Throat sore as if raw, scraped ; worse after eating, from solids.

STOMACH,

Tongue white or yellow coated.

Dyspepsia from abuse of calomel.

Vomit hot, sour, bilious, bloody.

Flatus in the ascending colon; palpitation ; drowsy forenoons.

Region of the liver sore ; relief from rubbing the right side ; stools black or clay-colored ; jaundice ; stool difficult.

Stool difficult from inactive bowels ; prolapsus ani even with loose stool.

Stool watery, gushing, profuse, green ; with sudden urging, often painless ; offensive ; worse in hot weather.

ABDOMEN.

Tongue red, sore, and coated yellow at the base.

Dyspepsia from abuse of drastic medicines.

Vomit sour or bitter, of dark blood.

Flatus in the hypochondria, pressing upwards or down on to the bladder and rectum.

Region of the liver worse from pressure ; must loosen the clothing ; stools black, large, ineffectual urging ; jaundice.

Stool difficult from spasmodic action ; hence ineffectual urging ; prolapsus ani.

Stool thin, brown, dark water, small, frequent, offensive; ineffectual urging, worse in cold changes.

URINE, GENITALS.

Urine scanty, frequent ; or frequent uri- Painful, ineffectual urging to urinate ; nation during pregnancy. even in pregnancy frequent urging.

Prolapsus uteri after washing, after parturition, has frequently yielded to either.

• The latter is an observation of Dr. C. Wesselhceft.

Prolapsus, with falling of the rectum; stools are naturally formed, but too frequent and weakening; sacral pains; aching in ovarian region.

After-pains, with much bearing down, flatulency.

In pregnancy (early months), must lie on the abdomen ; (later) pains above the right groin.

Whooping-cough, with costiveness, loss of appetite; cough in intermittent fever ; cough during dentition.

Palpitation of the heart from physical exertion ; flatulence ; drowsy forenoons.

NUX VOMICA.

Prolapsus, with urging to stool ; stools large ; backache worse turning in bed ; tightness in the hypochondria ; cough dry, teasing.

After-pains too long-lasting; pressure on the rectum.

In pregnancy (especially later months) difficulty of breathing from upward pressure.

:, CHEST.

Whooping-cough, with costiveness, nosebleed ; “ stomach ” cough ; cough of students.

Palpitation of the heart, the heart feels tired ; palpitation lying ; wind from the stomach.

SLEEP.

Whining in sleep (teething children) ; languid on awakening in the morning.

Awakens 3 A.M., ideas crowd upon him ; if he falls asleep, he reawakens much fatigued.*

FEVER.

Chill 7 A.M. ; forgets words he wishes to use.

Heat, with delirium and excessive loquacity, thirst, headache ; forgetful afterwards.

Sweat warm on the head, with cold face (dentition) ; sleep in sweat.

Chill p.m. ; goes to sleep between chill and heat.

Heat, with overexcited senses, worse from external impressions.

Sweat clammy, sour, or offensive ; onesided sweat.

GENERALITIES.

Debility (especially with bowel disturbances).

Complaints of teething children.

Abuse of Calomel ; eating acid fruit with milk ; poisoning with lead.

Debility, with oversensitive nerves.

Complaints of “ high-livers.”

Abuse of purgatives; indulging in liquors ; poisoning with lead, copper.

• Nux vomica has a whimpering and moaning in sleep ; waking from troubled, busy dreams, frightened, as if some one were in the room. (Typhus, mania-apotu.)

MIND, HEAD.

Forgetful during the chill.

Low-spirited ; imagines he will die or be very sick ; liver affected.

Dull headache, with pain behind the eyes (liver affected).

Difficult thought ; forgets easily. Troubled, weeps, must move from place to place ; liver affected.

Neuralgic pains from occiput to left ear ; occiput heavy (liver affected).

Eyes inflamed in the morning ; scrofulous ophthalmia.

Complexion sallow, as in jaundice.

Not yet given in neuralgia of the face.

MOUTH,

Tongue white, furred, or yellow.

Throat sore ; worse right side ; in the morning ; swallowing liquids.

STOMACH,

Taste foul ; breath foul.

Dyspeptic symptoms from abuse of Mercury ; liver torpid, with soreness, fulness in the right hypochondrium, better from rubbing ; costive, clay-colored stools ; sallow complexion, putrid breath, furred tongue ; dull headache ; aching behind the eyes ; loathing or regurgitation of food; worse after eating.

Diarrhoea from acid fruit and milk; during dentition; discharges yellow, green, slimy.

Loose cough, rattling on the chest during dentition. Whooping-cough, with constipation and loss of appetite. Cough associated with remit-

Lachrymation, with fistula, with neuralgia ; when looking fixedly.

Sallow or sunken, gray ; blue around the eyes.

Right supraorbital neuralgia ; eyes water.

THROAT.

Tongue narrow, pointed, or thickly furred.

Constricted feeling above the larynx; sensation as after swallowing too large a morsel.

ABDOMEN.

Taste bitter.

Dyspeptic symptoms, with liver complications, indicated by pain under angle of right shoulderblade ; congestion of the liver, with sharp stitching pains, throbbing ; costive clayey stools ; jaundice; pain from occiput to left ear; longing for milk, coffee, they agree; better (pains) after eating.

Diarrhoea better from milk ; during pneumonia ; capillary bronchitis ; discharges bright yellow.

Rattling cough, with capillary bronchitis ; bright-yellow diarrhoea. Whoopingcough, with forcible expectoration of lumps of mucus. Pneumonia with one

tent fever, lessening during the remissions.

Palpitation of the heart from physical exertion ; as if the heart were ascending into the throat ; rumbling in the right abdomen ; morning drowsiness.

CHELIDONIUM.

cold ear and foot, one warm ; great oppression ; fanlike motion of the ake-nasi ; pain under the right scapula.

Palpitation so violent as to shake the bed ; stitches in the heart ; great anxiety ; often associated with congestion of the liver and portal system.

Lumbar backache after washing, with 'prolapsus uteri ; diarrhoea.

Pinching, spasmodic pains on the inner edge of the right scapula.

Whining, moaning in sleep ; rolling the head (teething).

Sleepy in the forenoon, with flatus in the ascending colon.

SLEEP.

Sleepy, yet cannot sleep.*

Heavy sleep all day in patient’s suffering from portal congestion.